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Fighting fire from an ambulance: A difficult but rewarding job

Firefighter/paramedics assigned to the ambulance face unique challenges but also gain unparalleled experience


For some firefighter/paramedics, the burden of being assigned to an ambulance is too great, but for others, it provides immense experience and on-the-job training.

Photo/Ben Thompson

Being assigned to the ambulance as a firefighter/paramedic is tough.

Our job is entirely different from members assigned to a suppression apparatus. We have the same training, the same turnout gear and, officially, we share the same chain of command. But out on the streets, the needs of our patients carry the highest priority. No one is there to look over our shoulder to tell us what to do. And when we get it wrong, the responsibility is ours alone to bear.

Another key difference: the commitment to long hours spent transporting patients to the hospital. After we load the patient into the back of the ambulance, our firefighter counterparts get to hop back on the engine and head back to the station. But for us, the call continues, sometimes stretching on for hours as we await a bed in an overflowing emergency room.

For some firefighter/paramedics, the burden of being assigned to an ambulance is too great. This is especially true for those at urban fire departments with a high call volume, like mine.

One by one I’ve watched friends leave for smaller departments that do not transport. Many have even accepted a lot less pay just to get away from the ambulance.

I would be a liar if I claimed to have never had moments when I considered following them. But those moments have never gone past that initial thought because the truth is, I love what I do. And because it is so tough, it has afforded me opportunities I would have never gotten if I had given it up to go somewhere else to ride backward on a fire engine.

Getting battle-tested in the fast lane

No form of training can replace experience. During my first year assigned to one of my department’s busiest ambulances, I gained more experience in high-pressure situations than some do during their first 10 years on the job.

Running out of a station on the west side of Birmingham, Alabama, it was common for us to have a cardiac arrest, gunshot wound and a house fire in a single shift.

In the beginning, it was almost too much for me. The lack of confidence in my abilities, combined with the number of tragic events that I couldn’t stop, started to weigh me down. Everyone else around me seemed so confident, and they never failed to back it up. But I wasn’t sure if I could ever get to their level.

But then one day, we responded to a 5-year-old who had been hit by a car. When we arrived, I saw every paramedic’s nightmare – a mother cradling a limp child in her arms, heading toward the ambulance.

Without thinking, I ran to meet her. The mother didn’t protest when I took her injured child from her arms. I can still see the boy’s brown eyes looking up through patches of road rash.

But what stands out most to me about that moment was this: I was not afraid. I knew what to do, and I felt like I could do it better than anyone else.

Thankfully, the little boy ended up being OK after we got him to the hospital. And I have tried to never let go of that feeling I experienced when I took him into my arms.

Hands-on learning with the truck company

My ambulance ran out of the same station as one of our department’s most coveted truck crews. No one ran more fire calls than they did, so firefighters all over our city were vying for an opening.

Even though I occasionally rotated onto the truck to get in some time on the suppression side, no one wanted my spot on the ambulance. So even as a rookie, I didn’t have to worry about someone with more seniority coming along and bumping me from my spot. This gave me the chance to work alongside some very experienced firefighters, gleaning as much knowledge as I could along the way.

During that time, we had a battalion chief who liked to run through fire scenarios on the dry erase board after lunch. In red marker he’d draw crude depictions of one-story houses or garden-style apartments with fire showing from a window. Then, after listing out different combinations of variables that needed to be considered – limited water, difficult access, common attics, etc. – he would put someone in “command” and ask him to run the fire scene.

No matter what scenario he drew on the board that day, it seemed we would run the exact call soon after. This allowed me the chance to see those great firefighters put everything we had discussed into practice. It was like having a classroom lesson and then stepping directly into the lab – but a lab on steroids!

Attitude is everything

It hasn’t all been great. I have had my patience tested by frequent callers. I have been sleep-deprived and felt unappreciated.

Like I said, this job is tough.

But the fire service tests us all. It could be through an assignment to a busy ambulance or it might happen to you while responding to an impending disaster. It is how we respond to these challenges that will define our careers.

For those of us lucky enough to work for the fire department, our response is the only thing we can control.

Next: Watch Chief Goldfeder tackle how we can sell the fire service (with EMS!) to prospective members.

Ben Thompson is a battalion chief in Birmingham, Alabama. In 2016, Thompson developed his department’s first mobile integrated health (MIH) program and shared his experiences from building the program at TEDxBirmingham. Thompson was the recipient of the 2016 Emergency Medical Service Provider of the Year Award and the 2018 Joe E. Acker Award for Innovation in Emergency Medical Services, both in Jefferson County, Alabama. He has a bachelor’s degree from Athens State University in Alabama and is a licensed paramedic. Connect with Thompson through his website