The Case for EMS as a Third Service

This is the page where the Fire Department model of providing EMS services gets rebuked.

I’m waving the flag for Rich, though I would be just as happy to do it on my own. Before working for EMS Local 2507 for 12 years, I was a Correspondent for Firehouse Magazine for 12 years and the Editorial Director of Firehouse Communications for three years (some of that Correspondent time overlapped with my EMS 2507 job). I have written over a hundred articles on firefighting, and produced many videos for American Heat. I covered the tragic Hackensack fire as well as the devastating Stouffer’s Inn fire in Westchester. I have great admiration for our fire suppression forces. That at least allows me to qualify to enter this discussion.

What happened here in NYC  — in the “merger” of FDNY and NYC*EMS — is what’s called a “transparent consolidation.” That is, the essential functions of the two services weren’t combined. EMS was just put under the management authority of FDNY. Medics did not get on fire trucks, and Firefighters did not get on ambulances. The CFR-D first response program diverts some FDNY resources to EMS calls, but it essentially is just an added function for FDNY, not a modification of its core mission.

One of many. An article written in June for the New York Times by reporter N. R. Kleinfield describes the baptism of fire of a FDNY probie, who gets a rescue on a fire call, which of course is a crowning achievement for any Firefighter, and justly so. (Does the New York Times ever do an article on an EMT or Paramedic’s first save. Uh, no.)

The Kleinfield article explains, first off, that Firefighter Sullivan had not had a fire for 96 days when he finally got the run that would kick off his career as a smoke eater. Before and presumably after that run, Kleinfield describes Sullivan’s work as follows: “The vast majority of what a New York firefighter does, though, has nothing to do with fire. Last spring, firefighters in Queens had to retrieve a police officer who got stuck in a tree trying to save a cat. Firefighter Sullivan had not had tree calls, but his tours were a litany of balky elevators, car accidents, chirping carbon monoxide detectors, frozen pipes, blown sprinkler heads, gas leaks, smoking manholes, scaffolding emergencies, the cascade of false alarms that fate tossed his way.”

The New York Times has a poetic way of putting things. Maybe “that fate tossed his way” is not the best way to describe this. It may be more accurate to say that, with an oversupply of men and equipment, FDNY has experienced a lot of mission creep. It handles most every kind of public safety emergency that is not a crime, including EMS. So it’s not really about “fate.” As McAllan said, it’s spelled B-U-D-G-E-T, and what it takes to defend it.

FDNY has been a victim of its own success. Crusaders like former Bronx DA Mario Merola worked with the FDNY Red Caps and the insurance companies and put arson-for-profit out of business. Fire proof construction codes and the decline in smoking did the rest.

In the 90’s, an erudite, gifted researcher, Dr. Martin McNamara, outlined the differences between Fire and EMS, and what it takes to provide each service. He examined both kinds of work in minute detail. His studies, which are below, were distributed by Rich McAllan to anyone who would listen, including City Council Members, State legislators, government officials, and of course the EMS rank and file. I can’t improve on what McNamara says in his careful and well-reasoned analysis which concludes that using the Fire Service is a wasteful way to provide EMS services.

McNamara has a long career in emergency medicine, beginning in the ED in 1998. He has a number of awards under his belt, including the EMS Distinguished Service Medal for contributions to emergency medical services and 20 years of service to EMS, the (Canadian) Premier’s Award for contributions to the field of health care, and the Dr. Ted Evans Award for excellence in research.

Rather than go over the arguments (you should read McNamara yourself), I’ll just let one Canadian Paramedic, Ben Davidson, put the whole “fire service takeover of EMS” thing in a nutshell. He wrote  on Facebook: “can’t we all just agree,,,, we won’t propose cost effective high performance fire delivery models where always mobile fast attack mini pumpers jump fire calls and always roaming 24/7 dynamic deployment fire vehicles bring the other 6 within 10 minutes,,,,, and they stop trying to take over our paramedic services…..”

Click on the images to read the complete reports.

Dr. Martin McNamaraMcNamara

The McNamara Report on Fire and EMS01

The McNamara Report on Fire and EMS Services

First Response by Martin McNamara01

McNamara’s first study of first responder models.

 

 

 

 

 

The Bennett Report: This report was written by a researcher working in the office of then City Council President Andrew Stein. It outlines what went wrong in the early stages of the EMS-FDNY merger. It was killed, probably by FDNY, and never saw the light of day. McAllan of course provided a lot of the material it was based  on…so here it is.

The Bennett Report on the FDNY-EMS Merger (Unreleased)01

Unreleased report on problems in the first year of the FDNY-EMS merger.

In 2002 McAllan Calls for EMS to be a Third  Emergency Service1

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