Bad Public Policy

Staffing “firefighter medics” on fire engines is NOT a best practice in EMS.

One of the stated goals of the Fire Chief’s plan is to align the City’s fire department with the EMS delivery model of surrounding jurisdictions, which currently deploy “all-ALS” systems using ALS ambulances and ALS fire engines.[i] 

A “tiered” EMS system—one that deploys a mix of BLS and ALS units—is both more efficient and more effective than an “all-ALS” system.

A “tiered” EMS system, however—one that deploys a mix of BLS and ALS units—is both more efficient and more effective than an “all-ALS” system.[ii] Nationwide, the communities with the highest survival rates for cardiac arrest (a surrogate marker for measuring the performance of an EMS system) are those that supplement BLS first responders (typically firefighters) with a small cadre of highly-trained medics.[iii],[iv]

As an example, the Seattle Fire Department, which is widely recognized as one of the best fire-based EMS systems in the country, deploys only 7 ALS ambulances to cover 84 square miles.[v] Similarly, Boston EMS, a high-performing civilian EMS system, deploys only 5 ALS ambulances to cover 48 square miles.[vi] Both systems supplement their ALS ambulances with a larger number of BLS first response units (BLS fire engines and ambulances). Neither system deploys or responds to calls with “firefighter medics” on fire engines.[vii]

Good EMS systems deliver better patient care—not simply a promise to do more things faster.

The best EMS systems (both fire-based and civilian) recognize that a good system is not defined how many resources (people, equipment, apparatus) it can deliver to a scene—or how quickly—but rather by the quality of care it provides. Simply put, “more” and “faster” do not amount to “better” when it comes to prehospital medical care. The one research study put forward by the Fire Chief in support of his plan belies this very point: it focuses solely on how quickly tasks are performed by firefighters during artificial scenarios, ignoring patient outcomes entirely.

A good EMS system is not defined how many resources (people, equipment, apparatus) it can deliver to a scene—or how quickly—but rather by the quality of care it provides.

Staffing “firefighter medics” on ambulances and fire engines is NOT necessary to staff a fire engine at Station 210 or achieve four-person staffing on all fire apparatus.

E210a

The Fire Chief has justified his plan as a means to staff a fire engine at Station 210 and achieve four-person staffing on fire apparatus.[viii] Instead of replacing civilian medics on ambulances with “firefighter medics,” however, the Chief could (and should) staff those firefighters on Fire Engine 210—which currently sits unstaffed. Moreover, four-person staffing can be achieved more cheaply—and without undermining the existing EMS system—simply by hiring more traditional firefighters (as opposed to the more expensive “firefighter medics” the Fire Chief is seeking to hire now).

Instead of replacing civilian medics on ambulances with “firefighter medics,” the Chief could (and should) staff those firefighters on Fire Engine 210—which currently sits unstaffed.

There is NO demonstrated need to make civilian medics more “versatile” by requiring that they also become firefighters.

Almost 70% of all calls for fire department service in the City are requests for EMS.[ix] This fact certainly justifies the use of firefighters to provide BLS care on the scene of EMS calls. It does not, however, justify requiring  medics—who already spend three times as long committed to calls as their firefighter colleagues (despite working fewer days each year)—to also perform firefighting functions.[x]

Civilian medics are EMS specialists with advanced training who focus exclusively on providing high-quality emergency medical care in the prehospital setting. Over the past decade, the field of EMS has become increasingly more professionalized, as evidenced by heightened educational requirements, greater clinical discretion, and a focus on evidence-based medicine. Accordingly—and especially in light of the ever-increasing demand for emergency medical services in the City—there is simply no need to add another job function (firefighting) to the important functions that civilian medics are already responsible for.

At bottom, the Fire Chief’s plan seeks to convert civilian medics into firefighters for the purpose of increasing their work hours without a commensurate increase in pay.

The Fire Chief’s plan unfairly seeks to circumvent federal work-hour regulations for civilian medics.

At bottom, the Fire Chief’s plan seeks to convert civilian medics (who are subject to federal overtime laws) into firefighters (who are exempt from overtime regulations unless they work over 53 hours in a week), for the purpose of increasing their work hours without a commensurate increase in pay.[xi] Any civilian medic who “chooses” to become a “firefighter medic”—the only option now remaining that offers job security and opportunities for career advancement—will be required to work over 700 more hours each year (a 30% increase) in exchange for less than a 10% increase in take-home pay. Adding insult to injury, this increase in pay will come in the form of  “transition pay” that will not count towards their retirement.[xii]

[i] Alexandria Fire Department. (Oct. 28, 2014). Alexandria fire department policy issues. [PowerPoint].

[ii] Eckstein, M. (July 2011). Basic and advanced life support considerations (BLS vs ALS – What does it mean for system design?). In J.M. Goodloe and S.H. Thomas (Eds.), Emergency medical services evidence-based system design white paper for EMSA.

[iii] Davis, R. (March 1, 2005). Paramedics not always the saviors of cardiac-arrest patients. USA Today.

[iv] Sanghavi, P., et al. (2015). Outcomes after out-of-hospital cardiac arrest treated by basic vs advanced life support. JAMA Internal Medicine, 175(2), 196-204.

[v] As of 2013, the Seattle Fire Department had 974 BLS firefighters and only 72 paramedics. Seattle Fire Department, 2013 Emergency Response Report. Retrieved from http://www.seattle.gov/fire/deptInfo/introduction.htm

[vi] As of 2013, Boston EMS had 244 BLS providers and only 64 paramedics. Boston EMS, 2013 Vital Statistics. Retrieved from http://www.cityofboston.gov/EMS/about/

[vii] The Boston Fire Department, which responds to EMS calls with Boston EMS, has 1611 BLS firefighters and does not provide any ALS service. Boston Fire Department, About Us. Retrieved from http://www.cityofboston.gov/fire/about/

[viii] Alexandria Fire Department. (Oct. 28, 2014). Alexandria fire department policy issues. [PowerPoint].

[ix] Data for 2014 reported to Alexandria EMS Council.

[x] Medics are committed to EMS calls from the time they are dispatched until the time they leave the hospital after transporting a patient. Firefighters are typically only committed to EMS calls from the time they are dispatched until the time that medics begin transport to the hospital.

[xi] U.S. Dept. of Labor. Wage and Hour Division. (2011). Fact sheet #8: Law enforcement and fire protection employees under the Fair Labor Standards Act (FLSA). Retrieved from http://www.dol.gov/whd/regs/compliance/whdfs8.htm

[xii] Email from the Fire Chief to fire department employees dated March 18, 2015.

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