It is clear that the recently formed group Fire Service Based EMS Advocates (FSBEMSA) has ruffled the feathers of some EMS providers and leadership of some EMS national organizations who are not fire based.
FSBEMSA consists of five national fire service organizations -- the International Association of Fire Chiefs (IAFC), International Association of Fire Fighters (IAFF), Congressional Fire Services Institute (CFSI), National Fire Protection Association (NFPA) and National Volunteer Fire Council (NVFC) -- and its goal is to demonstrate the value of fire-based EMS. The disparaging remarks of those who got their feathers ruffled can be read on Internet correspondence. You can hear their disdain whispered in the back halls of conferences and even in the conference halls themselves. In some cases, it is not even whispered. Some are downright vocal with their opinions about fire service-based EMS and the recent formation of FSBEMSA.
What is confusing is -- why?
FSBEMSA does not attack other EMS system designs such as third-service and private ambulances companies, hospital-based ambulances or others. In a White Paper and video that FSBEMSA has released, the group champions the attributes and value of fire-based EMS systems. Can we really expect a non-fire-based national EMS organization to be a promoter of fire service-based EMS? But before the ink was dry on the White Paper, some individuals and some within some national EMS organizations were crying foul. Obviously, they felt threatened and were displeased that such a document and video would be released to decision-makers and politicians.
The advocacy by FSBEMSA is not an indictment on other EMS models, but is a response to the need to show the value of fire-based EMS after recent attacks. Within the past five to seven years, it has become fashionable to bash fire-based EMS and firefighter/paramedics. This has been in official ways and unofficial ways.
As an example, a medical doctor who sits on the Judiciary Oversight Commission for EMS in Washington, DC, wrote in an e-mail to other commission members last year, "The truth is fire-based EMS is expensive, inefficient care." His biased comments cannot be supported with any studies or scientific evidence. Other instances that have cropped up, including an academic paper issued by George Washington University last year that was circulated within the Beltway in Washington implying that third-service, private and hospital-based EMS programs are the proper way to design an EMS system.
Another case in point is the fact that in recent years, there has been a strong push by EMS organizations outside the fire service to get their hands on federal fire service grant funds. Interestingly, before the year 2000, the entire distribution of federal funding to the fire service amounted to only about $48 million, while police organizations were receiving typically over $1 billion a year. Since then, the fire service has seen funding of about $5 billion. Now that federal dollars are flowing to the fire service, non-fire-based EMS organizations want a piece of that pie. These non-fire-based EMS organizations were successful through legislation to mandate that 2% of the FIRE Act grant money go to non-fire-based EMS organizations. The fire service is not opposed to non-fire EMS systems obtaining federal money, but they should get it somewhere else -- after all, the fire service has never tried to go after federal money being doled out to the police.
It is not uncommon for non-fire-based EMS organizations to do their own education and public relation work. The American Ambulance Association (AAA), which predominantly represents private ambulance companies, does a "Stars of Life" campaign on Capitol Hill each year during EMS Week with U.S. representatives and senators. The event brings outstanding EMTs and paramedics to Washington each year for an awards banquet and an opportunity to speak with lawmakers. There is nothing wrong with this and it is a national EMS organization that is finding an opportunity to market itself to decision-makers who authorize federal funding of Medicare and Medicaid. I do not hear any rumblings about the AAA's efforts, so why be upset that the fire service is doing the same thing by promoting its value of providing EMS?
The bottom line is that nobody is going to espouse the value of the fire service delivering EMS other than the fire service. As the nation's largest provider of emergency medical services, the fire service delivers tremendous benefits toward pre-hospital care. Roughly 46% of all transporting agencies in the U.S. are fire departments. In countless communities where the fire service doesn't offer transport, engine and truck companies with skilled firefighters respond as first-response companies, sometimes riding to the hospital on non-fire department ambulances.
FSBEMSA will continue to flourish, as other national fire service organizations have already expressed interest in joining. Further, FSBEMSA will continue to educate local, state and federal decision-makers of the worth of fire-based EMS while being respectful of non-fire-based EMS systems and those national EMS agencies that are not fire based.
GARY LUDWIG, MS, EMT-P, a Firehouse® contributing editor, is a deputy fire chief with the Memphis, TN, Fire Department. He has 30 years of fire-rescue service experience. Ludwig is chairman of the EMS Section for the International Association of Fire Chiefs (IAFC), has a master's degree in business and management, and is a licensed paramedic. He is a frequent speaker at EMS and fire conferences nationally and internationally, and can be reached through his website at www.garyludwig.com.
