Fire First Mindset
These thoughts are geared towards dual role fire and EMS departments, which I’m sure makes up a lot of us. I work for a rural county department and I also volunteer at a larger suburban department, both of which have a dual mission of providing fire and EMS protection to the citizens we serve. I recently spent some time flow testing different types of hose and nozzle combinations to gain some insight into the tools we use. While sharing some of my initial and very informal findings, a coworker informed me that I spend (waste) too much time on fire related training and that “we’re an EMS department”. I disagree with both of those ideas, and my reasons are below.
First off, just because a dept is running a higher volume of EMS calls compared to fire, doesn’t mean they’re running high acuity EMS calls. Of all the calls we run an ambulance out the door with lights and sirens blaring, how many of them are we transporting with lights and sirens? My point here is that even though EMS calls may be the bulk of daily calls for service, how many are actually for a patient experiencing a true threat to life or limb? I’d venture to say that upwards of 80-90% of the patients we see are not experiencing that threat. That doesn’t mean we shouldn’t be prepared to handle the hard calls, just that those hard calls come at a much lower rate than we might realize.
Unless you’re running strictly EMS and have no fire suppression expectations, training, or capabilities, you are not an EMS department. You are a FIRE department with a high volume of EMS calls and low duty cycle for fire calls. I fear that not acknowledging that fact is a critical mistake that sets up the wrong mind set from the very beginning. Let me break that down some, if you don’t accept that first and foremost, your greatest responsibility to your citizens will be fire prevention and suppression, then your mind set is flawed. We are the first and last line of defense when the people we chose to protect are threatened with fire. There is no one else to call but us, and we must be prepared to meet that obligation.
EMS saves a life at a time. Good firemanship saves multiple lives at a time. Someone else’s shoddy firefighting skills won’t kill you on an EMS call, but they might very well kill you on the fireground. It is true that poor EMS skills may endanger a patient and we should be on top of that game also, however, there are resources available to us for the tough medical call. We can call a medic unit or an EMS supervisor. Patients don't get worse because we load them up and administer a diesel bolus to quickly get them the emergency department. If ground transport is too long, we have medevacs we can initiate to deliver a patient to definitive care in a fraction of the time a ride on the box takes. End of the day, there are generally additional resources we can seek on a difficult medical or trauma call. Do not for one second take my words here as a cop out to not be available to provide excellent, competent patient care if it is your duty to do so.
On the flip side of this, a fire will not be as forgiving as an EMS call might be, and there are no additional resources to ask for. A rough fire call is our problem to solve. Our citizens called us and no one else is coming. Yeah I know there is mutual aid and 2nd and 3rd due engines, but we’re going to rely on the next due company to show up and do our job? There isn’t another team of firefighters waiting to come fix it if we can’t. We’re not calling a firevac helicopter to take the structure to a NIST laboratory where we can fight the fire in a controlled environment with unchanging variables.
In refining this article I had the opportunity to bounce ideas off of Dennis LeGear, and this is what he had to add;
“There is no such thing as transporting a fire to a hospital, stabilizing it, and having days to deal with it's problems. Time can not be bought at a structure fire, the clock is ticking and the cure (water=life) has to be applied properly through coordination of members on scene. At the same time their actions also must rescue those in harms way. The developing structure fire is critically ill from the get go. Only the first due agency and really the actions of the first companies have a shot at a cure that leaves life and property intact. An ER/ED team represents years of training, millions of dollars of equipment, and decades of learning and continued education to hone their trade-craft. Can we say the same thing when looking at a first alarm assignment in our agencies? After all we are tasked with the same thing, saving and preserving life.” -Dennis LeGear
In areas where we don’t see much fire it’s easy to become complacent. It’s easy to stop focusing on training for fire when it’s not an event we’re often confronted with. It’s easy to fall into the “it doesn’t happen here” attitude and I believe that saying EMS is our bread and butter is falling into that exact mindset. It can’t happen here. It won’t happen here. We never see fire. Until we do see it, until it does happen here. If you’re not training on fire and you’re experiencing positive outcomes on fire calls, you’re not being successful, you’re getting lucky. Luck doesn’t cut it on this job, and someday that luck will run out.
We owe it to ourselves, our team, our families, and our citizens to be prepared to solve their problems. This isn’t an attack on EMS in the fire service, just a rejection that EMS is more important than fire. As LT McCormack says, keep fire in your life. Don’t fall into the “it doesn’t happen here” trap. It will happen here, and we have chosen to deal with it. Knock the rust off, stay dirty!
Thank you to the mentors out there that have helped me organize these thoughts and encouraged me to put them in writing. Also, thank you to those that have justified my position and reminding me I’m not alone in my beliefs. Keith Niemann and Dennis LeGear, thank you for the ideas you shared with me that drove my thoughts on this.