Why EMS Belongs in the Fire Service

In the March/April 1979 issue of EMS Magazine, Eugene Nagel, MD, featured an essay by K.E. McCullough on the role of the fire service within EMS. In the essay, Chief McCullough argued why the fire department should provide EMS, as well as claiming that an EMS background would soon be imperative for top fire department administrators.

Eugene Nagel: In the last issue, the Paramedic column looked back at EMS over the years. Key phrases from past articles were lifted so we might see how true were the words written several years ago. Continuing in the same spirit, I asked a friend in the Miami Fire Department to offer some thoughts on EMS from his perspective "in the trenches." K.E. "Ken" McCullough was a lieutenant when I first met him in 1963. During his 26-year career he served as a firefighter, driver-engineer, paramedic officer, aerial officer, assistant director of training, chief of rescue division and fire marshal. He is now deputy chief of administration. We worked together on the early telemetry packages, first paramedic course and testing the MAST garment, and he learned to intubate on me after I was properly anesthetized with local anesthetic. I think there is food for thought in his words. As you will see, he gives considerable flak to his fellow chiefs, characteristic for "tell-it-like-it-is" McCullough.

K.E. McCullough, Deputy Chief of Administration, Miami Fire Department: If one were to examine the missions of the fire service, it would be seen that most fire departments' primary responsibilities are the preservation of life and property through prevention, control and quick suppression of fires, and the provision of emergency medical care and transportation for the critically sick and injured.

In my opinion, the fire service is the logical organization to provide EMS care. The personnel are trained to function under emergency conditions. Good communication systems already exist. The existing structure is ideal for supervision and command, and the fire service is career-oriented with most employees working 25 to 30 years.

The Proposition 13 concept--one of fiscal belt-tightening currently sweeping the country [Ed's Note: Prop. 13 was a 1978 antitax measure passed by Calif. voters. It helped spark a wave of similar measures throughout the U.S.]--demands that our firefighters provide the full spectrum of service--fire prevention, fire inspections, fire suppression and emergency medical services--in order to show some degree of cost-effectiveness. When fire departments provide all of these services, firefighters should move freely in and out of the Emergency Medical Services Division, Fire Inspection Division, as well as combat fire, broadening each of the firefighter's understanding of the department's overall mission, gaining an understanding of the interaction among departments, as well as with outside organizations. It is our responsibility to manage our organizations effectively and efficiently by providing the most service delivery of emergency medical services. It is also the responsibility of fire departments to develop good managers. Soon an EMS background will be imperative for top fire department administrators.

"Tunnel vision" is probably the most communicable disease in the fire service today, having reached epidemic proportions in the '60s. Today, this disease is a threat to older and less progressive fire chiefs. A recent Wall Street Journal article described it as occurring to people to devote their entire time and effort to one particular kind of problem, developing skills and knowledge which make them experts in that particular area. Without exposure to other concerns these experts develop tunnel vision. It's a common ailment, even among otherwise competent leaders. Necessarily, most managers or supervisors get their start in one specialty or another. The tendency--at the bottom of the ladder--is for people to know more and more about less and less. Unfortunately, the more knowledgeable some individuals become in their own work, the more all-important it becomes to them, and the less sensitive they become to the viewpoints of people specializing in other areas.