Should Physicians Run the Fire Department?
The EMS workload in most communities has skyrocketed in the last twelve years. Even departments that have closed fire companies to staff more ambulances, like Baltimore, find after that painful reallocation that the EMS workload has surpassed the capacity of the new transport units. Philadelphia, Detroit and other resource-strapped center cities have EMS services that are overwhelmed by work.
With medical incidents accounting for 70 to 80% of the response activity, maybe the fire department needs a leader with a different skill set. I recently listened to one presentation that advocated this concept, using Metro Louisville as an example. Which was a little weird, since metro EMS is a separate agency from fire. Here are the details:
LOUISVILLE METRO EMS
When Louisville and Jefferson County, Kentucky, governments merged in January 2003; emergency-medical service continued to be provided by two separate agencies, Louisville Fire Department and Jefferson County EMS. A year later a task force recommends merged EMS; Mayor conducts national search for a physician with emergency medical experience to implement a combined, community-wide EMS system that is medically and data driven. Link to Metro EMS website: http://www.louisvilleky.gov/EMS/
Dr. Neal Richmond named Louisville Metro EMS chief executive officer in August 2004. Richmond is the former deputy medical director for the New York City Fire Department. By December 2005 EMS introduces deployment adjustments to put 65 percent more response vehicles on the street, utilize rapid-response (fly cars) and adjust shifts to enhance scheduling flexibility and minimize required overtime. The system is not perfect, an October 2006 television report talked about some incidents requiring long waits for ambulances and the fire union objection to single paramedic staffed fly cars. http://www.wlky.com/target32/10139485/detail.html
ALLOCATE RESOURCES BASED ON COMMUNITY OUTCOMES
The advocate for a physician-run fire department indicated that one result would be more resources (money, people, and focus) would be dedicated to patient care than "putting the wet stuff on the red stuff." This issue of re-allocating resources from fire suppression is as old as the National Fire Protection Association.
It was one of the first irate letters Percy Bugbee received when the NFPA Quarterly journal started in 1896. Bugbee’s first editorial called for 50% of a fire department budget and staffing be dedicated to fire prevention. The chief responded with an objection, writing that his men were in the business to fight fire, not to prevent them.
While the issue has changed, the fierce feeling remains. I joined to fight fire! Firefighters are passionate about their craft. Firefighting remains a challenging, high-risk, group activity that demands an expert level of technical performance from every person. It is not a job; it is a life-style decision.
Maybe a better service delivery model is a separate EMS agency with no fire service involvement. Wonder who will do the vehicle extrications?
Mike "FossilMedic" Ward
original post January 15, 2008. Reformatted with replacement graphics April 23, 2012
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