The overwhelming number of fire departments provide some level of emergency medical services (EMS) and have been doing so for quite some time. The increase in job responsibilities has changed many aspects of emergency service delivery including the core mission of fire suppression.

There is no doubt that EMS has increased the status of fire departments, improved education levels, and ultimately saved countless lives in the process. It is hard to imagine what the service would look like if EMS was not such a huge part of it. But, like any significant portion of any service, the changes have created and continue to create challenges with respect to service delivery in all aspects of the fire department.

WORKFORCE STRAIN

One aspect of the added responsibilities that doesn’t get enough attention is the added strain on the workforce. We all know that most firefighters cannot say no when asked to help. Yet, one must start to wonder what the impact is on the continual increase in EMS responses and the need to maintain current as the profession changes. Additional runs, added training, new equipment, and maintenance responsibilities greatly change the work day and increase demands. Regardless of your views on this, there are points where the job growth exceeds the capabilities of the individuals. At some point, there needs to be the realization that without adequate resources, there cannot be proper delivery of service, and quality in some areas will suffer.

The issue of work overload is a tricky one. It is probably as much about the political realities in your organization and community as it is about any concrete reason. Certainly, there are places where the workforce can take on additional responsibilities, but there are others that have reached a saturation point. It may be difficult to quantify this. You will need to evaluate the entire package of services provided, the quality desired, and the ancillary activities needed to maintain the goals. You will also need to look at your personnel. Regardless of your views on “burnout,” more and more studies are indicating that there are workload factors that affect the mental and physical health of firefighters. Pay attention to the details so that the most important part of service delivery is not on overload.

Fatigue can also be a factor to consider. Employees who are not adequately rested or properly rehabbed are not going to make the best possible decisions. In the moments that matter, you should want medics to make good choices and minimize mistakes. This is especially important for the low-frequency/high-risk events (thank you, Gordon Graham). We should all know that people who are overly tired will not make good decisions as a rule. While there are occasions where circumstances do not allow for ideal rest periods, those who experience regular and routine times of excessive fatigue must consider options to change this situation.

EMS VEHICLES

Apparatus have evolved as departments look for the best model from which to deliver quality EMS. There is the base vehicle, the ambulance, and an assortment of rescue vehicles along with paramedi