There are many configurations of the delivery of EMS across the USA. Uniformity and standardization may sound simpler, but after five decades serving multiple communities as an EMS provider, it is clear to me that there are many “right” ways to provide quality service. As a smart person once said, “If you have seen one EMS System… you have seen one EMS System!” 

Specifics of working with firefighters at the scene depend on the EMS System configuration and the level of medical training of the firefighters, SOPs, and how often you work and train together. 

Many of the public have watched EMS providers and Systems portrayed in popular TV shows such as: Chicago Fire, 9-1-1, and Rescue Me, which all take place in large cities where the Fire Departments often have a dual-role, cross-trained firefighter-EMTs and Paramedics, who staff fire department ambulances. What is on TV often creates public expectations as some viewers do not realize their community EMS System may have a different configuration.  

What Does the Data Reveal? 

An analysis of the types of EMS, who provides the service, and fire service involvement can be found by reviewing the 2020 NASEMSO’s National EMS Assessment, the 2020 NFPA US Department Profile, and the National Fire incident Reporting System data. Some highlights of these extensive documents include:    

According to NFPA’s 2020 US Department Profile: 

• There was a total of 1,041,200 firefighters in the USA, consisting of 35% career and 65% volunteer. 

• There were 29,452 fire departments in the USA. 

• 37% of the fire departments provide no emergency medical services, 46% provide basic life service (BLS), and 17% provide advanced life support (ALS). 

According to 2020 NFIRS data: 

• Fire Departments responded to 26,959,000 calls/runs. 

• Of the Fire Department calls/runs that year, 64% were categorized as “EMS and rescue services.” 

• Only 4% of the Fire Department calls/runs involved a fire. 

According to the 2020 NASEMSO report types of services include: 

• 11,450 services provide 911 response (scene) with transport. It was estimated there are over 54,284 ambulances in the USA for this purpose. 

• 6,778 services provide 911 response (scene) without transport. 

• 1,988 services provide ground specialty care services (e.g., interfacility, critical care, other transport). 

• 747 services provide air medical services.  

According to the 2020 NASEMSO report, the number of responders by level of training included: 

• 113,973: EMR 

• 583,608: EMT 

• 39,294: AEMT 

• 17,634: Levels Between EMT and Paramedic (Excluding AEMT) 

• 268,420: Paramedic 

Same Call: Different Communities with Different System Design 

The call might be the same: “responding to a two-car MVC with injuries at a busy intersection,” but the level of involvement with firefighters at the scene can differ based on the EMS System design. Here are a few examples: 

• Fire based system where the initial response is a FD first response vehicle (which could be the nearest Engine Company with dual-role, cross-trained EMTs (or EMRs) backed up by the Fire Department rescue/ambulance with dual-role, cross-trained firefighter Paramedics. This has the advantage of singular command, single agency training and SOPs and often the personnel work together as a team. 

• Fire based system where the initial response is a FD first response vehicle (which could be the nearest Engine Company with dual-role, cross-trained EMTs (or EMRs) backed up by the Fire Department rescue with dual-role, cross-trained firefighter Paramedics and the transportation is provided by a contracted commercial ambulance service. Depending on the contract services the ambulance crew may be EMTs or EMT and a Paramedic. In cases where the patient care requires basic life support and does not require advanced life support, the transport may be done by the ambulance service crew alone. In cases where patient care involves advanced life support the Fire Department Paramedic works with the ambulance crew and rides along during transport to the hospital. This works best when the agencies allow the ambulance crews and the firefighters to train together as a team. 

• EMS system where the initial response is a FD first response vehicle Engine Company with dual-role, cross-trained EMTs (or EMRs) backed up by the ambulance service with an EMT and a Paramedic. The Ambulance Service may also dispatch a supervisor for additional assistance at the scene. This involves multiple agencies with a well-practiced unified command structure. It is important that there be clear SOPs, so everyone knows their role and each other’s capabilities. Training together is helpful so personnel can work together as a team. The FD may also be involved by providing a rescue squad with tools and training to disentangle and extricate patients from their vehicle as needed. This too works best when all involved have trained together and know each other’s capabilities.  

• Finally, there are still those communities where the Fire Departments are not involved in emergency medical services. This FD may be called to the scene to provide an Engine Company for fire suppression and/or washdown of the scene. Although they are not likely to be called to respond to a medical call but should still be kept in the training loop as emergency responders in the community.   

All Firefighters at the Scene 

Regardless of the EMS System configuration and the specific role that the fire service plays at our “2-car MVC with injuries at a busy intersection” there are several things every emergency responder needs to do: 

• Always Have Situational Awareness. It can save your life and those around you!  

• Remember Safety is an Essential Behavior, not just a motto. Be sure to watch each other’s 6, and dress the part for your role (e.g., PPE, safety vest). 

• Communications are Important. Keep it simple, clear, and confirm NOT ASSUME it is understood.  

• Incident Command. This should be followed and practiced on every call, not just the “big one.”  

• Listen, listen, listen, and learn. Those who arrived prior to you have nuggets of info to share with you if you listen. Remember so many have been told “if you see something, say something.”  

• Respect All Responders. Appreciate in public and critique in private. 

• Follow your Agency SOP on Talking to the Media. Let the PIO take that job rather than your words being taken out of context. 

• The call is not over until it is properly and accurately documented. 

• We can learn from every call to be better at our craft the next time!