How to build fire-based EMS for volunteers

By Jared Kimball

For years we've heard this mantra: "Fire departments fight fires and emergency medical services take care of people. We are firefighters first and foremost." While true, this approach can be detrimental to the volunteer fire services.

Some departments run rescue squads for the initial response and possible transport; other departments combine fire, EMS and rescue services under one department.

The data shows that EMS is a growing need within most communities fire departments serve. This increased need has led to predictable strains on the system.

The result has been that transporting EMS agencies are increasingly delayed due to ballooning call volumes, non-emergent transfers, improper use of coverage and others reasons.

That’s why it is paramount that volunteer fire department leaders consider running medical calls to decrease the time between when 911 is activated for a medical response and service is delivered.

Supporting an EMS division within your department may not be something you want to consider, but can prove beneficial. Recruiting and retaining members of various backgrounds can give your department greater depth in response, increase the value of training and allow for better community services.

Know the needs

When considering starting an EMS division within your department, first understand your community’s need. Start by asking these three questions.

• Does the department need to provide medical care for a long duration on scene?
• Does your department need to handle high-acuity patients who require a greater depth of care?
• Is your department more likely to do initial assessment and then prepare for transport?

Surveying these needs requires research into the dispatched medical emergencies in the past few months or years. If your department does not provide hospital transportation, contact the area’s EMS agency operations manager to discuss the need that the service feels is appropriate.

With a greater understanding of the community’s needs, the next step is to find a medical director for the department. The fire department medical director’s role will vary based on that person’s scope of involvement.

You may have a family practice physician who is a friend of a leader in the department and says that they will sign off on whatever is needed. Another option is a local emergency department physician who may take on the role and offer further training because he will be receiving the very patients you are treating on scene.

Regardless of who it is, the medical director should be involved with the development of medical protocols, a manual that has policy and procedures for various types of calls.

The medical director’s signature once the protocols are developed and completed is important, because each member of the department will be working under the director’s medical license.

Make sound protocols

Another way of using the medical director is to have them recommend the different skill level required for each protocol. For example, a protocol written for an Emergency Medical Responder will dictate minimal interventions, while the same protocol written for a paramedic can allow for a large amount of intervention.

Protocols are also a legal document that your responders will need to know. These are the governing guidelines to what a responder can and can’t do during patient treatment.

The department’s lead EMS members need to be involved with the protocol development. Whether it is a person that recently joined or an older member who has two decades within the ranks, the highest-trained member must be tasked with starting the protocol-development process.

To make life easier, contact a neighboring department and ask to review their protocols. Or, if your medical director serves several departments, they may already have protocols that they regularly review and update.

The science of EMS changes frequently, as newer studies are published and guidelines are changed. It is key to stay up with these current practices to provide optimum patient care.

Educating your members will require the same dedication as your other training courses.

If most of your members are obtaining the EMR level, this is the first level of training that’s recognized by the standards that are taught with the National Registry of Emergency Medical Technicians. Learn if your state requires responders to test for the national certification.

Get training

The EMR course is a 40-hour course that can be done over time and provides things like basic medical terminology, rescue concepts and lifesaving interventions. EMRs are not required to do any clinical time during their training, which keeps the course short.

The next level up is the Emergency Medical Technician. EMT training varies from state to state, but NREMT suggest that the training is around 150 didactic hours and 24 to 36 clinical hours to be held on an ambulance. This will allow the student to experience the types of calls EMTs handle.

Once the EMT student passes the course, the next step is to challenge the National Registry — a rite of passage. The testing is standardized and allows for the same test that’s proctored in Vermont to mirror what’s being done in Louisiana.

Students who successfully complete both didactic and skills testing earn NREMT certification. Most states require a state license to practice. Contact your local EMS bureau for guidance on how to acquire this information.

The highest level of training is a National Registered Paramedic. An EMT certification is a prerequisite to starting the NRP course.

Most paramedic program are between 1,200 and 1,800 hours. Various clinical dates will need to be filled and completed. The training for paramedics are normally housed within an EMS agency or at a local college.

Once you’ve decided on the level of response needed in your coverage area, your protocol development and training implementation can begin. Review your department's insurance plan to have a better understanding of the level or treatment the department is covered and held liable for.

Adding an EMS division within your department will allow for additional EMS personnel to volunteer their time and skills to assist in their communities. Some members may not be active within the department because they don’t want to be a firefighters — an EMS division will give them a different way to serve.

Who knows, there may be a new EMS-based mantra we’ll be reciting in the coming years.

About the author
Jared Kimball is a firefighter, EMS captain, paramedic and president of the board of directors with the Coteau Volunteer Fire Department in Houma, La. He has been involved with the volunteer fire service since 2003 and has worked as a ground/flight paramedic for a private agency in his community.