A report by the watchdog panel found that 70 percent of fire department calls are medical emergencies, and just 4 percent are fire-related. But even so, firefighters respond as if they are heading to a fire, sending a crew of three or more on a truck or engine costing an average of $500,000 — five times the cost of an ambulance.

Typically only one of the three arriving firefighters has medical training, the report said. That creates a "mismatch between service needed and service provided," with fire departments deploying "personnel who are overtrained to meet the need" — that is, paramedics also trained as firefighters.

Hang on a moment while I try to remember where I put my shocked face. Read the whole article, since it may take me a moment to find it…

Ah, there it is!

Seriously, the only thing shocking about this news article is that it took the media so long to realize what most of us (outside fire departments anyway) have known for years: this isn't about providing medical care, it's about justifying staffing levels and shiny new fire engines.

I'm sure this will cue a nasty fight in comments, including the requisite number of "Ambulance Driver hates fire department EMS" opinions.

Which isn't true, by the way.

I've spent my career working in private EMS, and I do a fair amount of teaching and consulting for fire departments that provide EMS first response and/or transport, yet my personal belief is that municipal third-service EMS is the superior system model. It's not the best fit for everywhere, but in those places with sufficient call volume to support a full-time paid EMS system, I think the best way to provide it is through an EMS system that is separate from police and fire.

I guess my biggest beef is that the attitude I see fostered in so many fire department EMS systems is that EMS is not their core mission, but rather a means to an end.

And as long as 80% of their call volume is EMS, yet 80% of their funding, promotional pathways, and training are devoted to fire suppression, that opinion is not going to change.

Chime in with your comments, but keep them civil or you'll eat Ban Hammer. If the most constructive statement you have to offer is calling someone a hose monkey or a stretcher fetcher, or yet another tired iteration of "private EMS cares more about money than people" or "firefighters are a bunch of testoterone addicts who suck at medical care," find another forum, please.

Chris Kaiser does a nice, even-handed job of summing up my major beefs with fire department EMS here.

Happy Medic's eminently reasonable take on the issue.

My EMS1.com series about fire department EMS, with some excellent comments from both sides:

Marriage Counseling Part I: The Dysfunctional Fire/EMS Relationship

Marriage Counseling Part II: The Dysfunctional Fire/EMS Relationship

Marriage Counseling Part III: Detente in the Dysfunctional Fire/EMS Relationship

If only Dr. Jim Augustine had followed Heinlein’s advice before he signed on as medical director for DC Fire/EMS.

Dr. Augustine, who has an excellent reputation in EMS circles, has become the latest in a series of medical directors who failed to fix the problems with DC Fire/EMS. The article states that Dr. Augustine resigned due to health concerns. I tend to agree with TOTWTYTR that likely Dr. Augustine was sickened by the climate in DC.

The organizational climate within DC Fire/EMS, that is.*

It’s long been known that the EMS system in our nation’s capitol is littered with the professional corpses of many a medical director who tried, and failed, to teach that pig to carry a tune.

It’s the EMS equivalent of the Oakland Raider’s coaching job; a thankless career dead-end, without the power to affect any meaningful change. It’s almost like the administration takes pride in being the smelly armpit of EMS care in this country. Yet, they seem intent on every employee there being a  medic/firefighter/rescue technician, and ignoring the fact that they fail miserably at providing even basic EMS care.

Don’t get sick in the District of Columbia, folks. The EMS system there doesn’t run any better than any of the other circuses in town.








* If you’re a medic working DC Fire/EMS, and trying to provide quality care, you have my respect and my sympathies. You deserve better administration than you’re getting.

Enjoy.