Stepchild 'O Mine

For a relatively short opinion piece, it generated a lot of mail. Some of the comments were insightful, others informative. Some were threatening, others just vulgar. "I got some e-mails that were basically just a lot of profanity," chuckles David Powers, the South Carolina medic who wrote the column in question. "There was one firefighter who actually threatened to punch a hole in my gas tank. He even went so far as to tell me what kind of car I drove."

Take Powers' word for it: As we enter 2006, the long-running debate over whether EMS should be the province of the fire service remains as combustible as ever. Last June, in a Guest Editorial in these pages (The Redheaded Stepchild: Does EMS Belong in the Fire Service?), Powers offered a view that it doesn't. Both his in-box and ours were subsequently scorched with cyberstacks of passionate responses, testimonials and firsthand views from both sides of the issue.

In some cases, emotion overwhelmed good judgment. But in most, even those disagreeing with Powers seemed pleased to partake in some spirited debate. "Even the firefighters who didn't agree with me seemed happy there was a dialogue," Powers says. "I guess there's been a lot of fighting and not so much dialogue, and they were happy to see that much."

Reluctant Bedfellows

There's no question that the fire service is good at what it does. We all know about the success of fire prevention and the decreasing need for fire suppression. But among many in EMS - not only those working for third services, privates and volunteers, but even among some in fire-based systems - there remains unease with the notion of assimilation. The medical mission and the fire mission are just too different, many say. In a survey conducted by this magazine last summer, just 5% of respondents thought the U.S. Fire Administration a desirable home for any new federal EMS entity.

Why such discomfort? You can probably cite several factors. Powers - who reported agreement with his separatist stance from most of his correspondents - touched on some:

• The M is for medical. EMS is essentially a healthcare undertaking, not public safety.
• EMS can be subsumed in fire-based services. In some cases, it's been given short shrift.
• Cross-trained providers can't be expected to truly master such distinctly different and difficult trades as firefighting and EMS. Each is tough enough to require full-time attention to be good at.

There are other factors as well. There are differences in the types of personalities drawn to firefighting and EMS work. These providers must approach their jobs differently: Firefighters are structured, disciplined and must function as reliable links in a chain. EMSers need to be devil's advocates, outside-the-box thinkers and largely self-directing. It can be hard to reconcile such profound inherent differences, not only in single cross-trained providers, but even within combined departments.

On a macro-level, there's the larger issue of EMS identity. Just who and what is EMS? With the fire service's interest in assuming EMS and established advantages in such areas as funding, manpower and infrastructure, will there ultimately be room left for third services? For privates? For any non-fire models?

"I think the general level of mistrust probably stems from a number of things, and one is job security," says Jack Krakeel, chief of the Fayette County (GA) Department of Fire and Emergency Services and a senior consultant with the emergency services consulting firm Fitch & Associates. "I think people are afraid that the fire service is going to be the sole, single provider of emergency medical services. And by that I mean in the context of what EMS is, not just the transport system. Clearly, emergency medical services in this country is substantially larger than just the patient-transport component. And while a large percentage of transport is provided by fire agencies today, they're also involved in many facets of EMS outside the transport sector. I think it's just a natural fear that ultimately, EMS will evolve into a solely fire-based system.