Fire and EMS readiness: What it means and why it matters

Twenty years ago, if you asked firefighters why they chose their profession they would have most likely responded with: "to fight fire."

Nowadays, most departments' fire calls account for less than 10 percent while emergency medical service responses make up over 70 percent. Those numbers dictate that the role of the fire service must change.

And as Chief Gary Ludwig has witnessed in his 30-plus year career, that change can sometimes come slowly, but eventually becomes engrained in the fire service's culture.

"In the 1920s, the fire service tried to switch from using horses to motorized apparatus. The firefighters fought that back then and didn't want to switch. They even did studies to show the horses were faster than motorized apparatus," Chief Ludwig said. "But change eventually comes, and if you were to ask somebody today if we should go back to the horses, they would tell you that you're crazy."

Like the motorized fire apparatus, EMS will eventually be seen as a normal component of what the fire service provides.

"You're always going to have pockets of the country that are slow to embrace EMS, but that's not reflective of the fire service as a whole," Chief Ludwig said.

In his presentation at International Association of Fire Chief's Fire-Rescue Med conference in May, Chief Ludwig, along with Ed Racht, MD and chief medical officer with American Medical Response and Mike Ragone, director of EMS System Design at American Medical Response, will discuss the critical role the fire department plays in the fast-changing health care system.

Ludwig's seminar, "Fire and EMS Readiness and Resiliency: Focusing on What Really Matters," will be held May 22; the early registration discount is available until April 21.

Chief Ludwig, with the Champaign (Ill.) Fire Department, has 31 years of fire and rescue experience. He started his career in St. Louis, where he retired as chief paramedic from the St. Louis Fire Department. He is chairman for the EMS Section of the IAFC, has lectured at more than 225 fire and EMS conferences in 42 states and serves on the FireRescue1 and Fire Chief editorial advisory board.

The fire service, he says, is becoming an integral player in delivering health care.

Fire-EMS readiness
Departments evolving into a fire-based EMS system must take on an all-hazards approach.

That means when the bell hits, firefighters must be ready for everything — and that includes EMS.

"I'm a strong proponent of training. We have to be ready and prepared for whatever happens," Chief Ludwig said. "If you look at any call you've ever been on, anywhere from 25 to 30 percent of what you show up on, anticipate or prepare for is going to be different than what you expected."

As a result, crews must be adaptable enough to deal with whatever happens.

"We have to continually train. It's amazing when you do show up on a call and you just go into automatic mode because your training kicks in and gets you through it."

Training and having the proper equipment in place is important, but ensuring crews get there safely continues to be the number one best practice to be fully prepared and ready.

Why fire-EMS performance measures matter
What's not changed since the days of horse-drawn fire rigs is that no matter if your department runs a fire-based EMS system or not, all first responders are in the people business.

One hundred percent of fire, rescue and EMS calls is taking care of people and that means personnel have to be committed to providing a certain level of customer service.

"Customer satisfaction is important because we're obviously here to take care of people," Chief Ludwig said. "We might have done everything correct medically, but did we take care of them properly" And that means treating patients with respect, dignity and like a person."

One department Chief Ludwig collaborated with surveyed patients who had experienced chest pain and asked if their fire-EMS department took care of their pain.

More than 50 percent said that by the time they got to the hospital they still had chest pain and discomfort.

Based on the survey, the department revised its protocols. They got more liberal with their use of IVs and surveyed their patients again. The response was overwhelming that pain and discomfort had been addressed before arriving at the hospital.

"That was a key measurement for that department to make sure they were taking care of their customers," Chief Ludwig said. "We have a tendency of measuring how many IVs we started, how many were successful, how many patients we have, but we never choose to measure the satisfaction of the customer.

"And that's why we're there at the end of the day — to take care of the people. It's a key measurement that we should be paying attention to in fire and EMS."

Another performance measure Chief Ludwig pays attention to is response times. Some will say that response times don't matter, but he argues against that point.

"Response times definitely do matter. That's why people are calling us — they want us there. Response time is always a performance measure that we want to pay attention to. It might not matter medically in some cases, but it matters to the person who calls. When they call, they want someone to show up to take care of their needs."

As an example, response times make a difference in cardiac arrest patients.

"If we can get someone there in four minutes, then we can start resuscitation procedures and even include mechanical CPR devices and drug therapies," Chief Ludwig said. "And because of that, what used to be a 1 to 2 percent survival rate is now in some communities greater than 15 to 20 percent in cardiac arrest patients."

And because fire and EMS make a difference in patient care and outcome, departments need to starting thinking non-linear versus linear.

Hitting roadblocks
One quality about being resilient is that departments must remember to remain adaptable, flexible and move out of old deployment models to create ones based on patients and their needs.

"We need to get out of this 50-year-old model of taking everyone to the emergency room no matter how small their complaint is," Chief Ludwig said.

At the end of the session, he hopes attendees will not only be armed with best practices in readiness and resilience but also take the facts discussed back to their departments and municipal leadership.

However, Chief Ludwig has seen how difficult it can be for attendees to implement those ideas within their own departments.

The majority of attendees, he said, walk away enthused, motivated and looking to change things at their department. But when they get back into the real world, they face roadblocks to implementing those ideas.

"If you follow the path of the idea to its fruition, there are many steps along the way that are designed to block it from being implemented," he said. "And eventually you just give up because it's too hard and something else comes up.

"But that's also why Fire-Rescue Med is a great place for support. You have chief officers who are running fire-based EMS systems so you have an opportunity to network, learn from them on what they're doing and maybe they've hit some of those roadblocks that you've hit and they can give you some tips on how to get through those."

And barriers to change is clearly one thing in the fire service that hasn't changed in 20 years.

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