Richard Marinucci

As you might expect, I am biased toward fire-based emergency medical services (EMS).

I suppose you should expect this, as I have spent my career in organizations providing EMS. This does not mean that I don’t appreciate the private sector or that there are places where this service is doing a good job for the community. But, I do get more defensive when some people try to make the case that fire-based EMS doesn’t make a difference and that statistically there is no direct benefit. Try telling that to some of the people who have been resuscitated-or their family members!

More Than Numbers

While not exactly scientific, I think there are reasons the statistics don’t show a significant difference when you look at just the numbers. Fire departments go on an increasing number of EMS calls. As anyone who has responded can tell you, the vast majority of these calls are not what might be classified as true life-and-death emergencies. They could be difficulty breathing, broken bones, general malaise, or other medical situations that do not threaten the patient’s life. They do need care and transport but generally not special services. Medics or emergency medical technicians can take vitals, apply splints, administer oxygen, and provide other services. There usually is no sense of urgency during these types of calls. As such, they get handled competently by whoever shows up, and the outcome is predictable: The patient ends up at a definitive care center and receives the treatment he needs. Only a small percentage of calls require immediate action from highly trained and competent personnel. So, if you look at this statistically, you could say that only a few calls really benefit from the special talents of paramedics. When you consider the raw numbers, you may conclude that it doesn’t matter.

To prepare for these types of discussions, fire service professionals need to understand the benefits of fire-based EMS and be prepared to explain logically and succinctly their perspectives. The first question often asked is why the fire department is involved in EMS. Some people will try to paint the picture that fire departments do it because they are trying to justify their existence because the number of fires is down. I suggest you look at this issue closely. In most communities, fire departments respond to an increasing number of medical calls that drive up the percentage based on the total. This does not necessarily mean that the number of fire calls is fewer but that they are not increasing at the same pace as the EMS calls.

In my experiences, fire calls were steady or maybe even slightly increased from year to year while EMS calls grew at a much faster pace. Some people want to translate that so it appears that the fire calls are becoming less significant. I will admit that the number of serious fires-the kind that are likely to make the news-may be decreasing, but that does not always mean that there are fewer. Fire prevention, better response times, better built-in fire protection like alarms and sprinklers, and better trained firefighters are all contributing factors to this. But if one of these events occurs, you still need resources. Check out National Fire Protection 1710, Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments, if you need help determining what to send on a response. Don’t equate a smaller percentage to a need for fewer resources.

Where Statistics Fit

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