We’re More Like Police Than Fire

fireemscopWhen EMS professionals complain, the justification often includes an appraisal of how our family in the ‘big red trucks’ do (or sometimes, don’t do) things instead of comparing ourselves to our brothers and sisters that make up that ‘thin blue line’. The choice of comparison is most likely swayed by the fact that somewhere around half of us working in EMS do so while wearing a fire-based uniform during our time on the ambulance. In addition, the vast majority of us spend more of the time that we are off the rig inside a fire station than in a police station. However, when we look critically at the tasks we perform, it becomes quite apparent that we may actually relate more closely to law enforcement activities than we do fire suppression operations. Obviously, we do not enforce any laws. In fact, it is easy to argue that we spend our time trying to break the laws of nature; however, I am talking about something more fundamental here.

A firefighter responding by himself to a scene is of little value. His normal operation is always as a part of a team. The introduction of only a second firefighter on the scene of a structure fire also has a minimal value. Even though they are trained to enter structures as a pair, these first two going in depend on another two staying outside. In reality, a dozen or more firefighters can be required in order to be effective in controlling even a small structure fire. Additionally, all of these firefighters require support from specialized apparatus including fire trucks with ladders, fire engines prepared to pump large quantities of water, and rescue vehicles containing other heavy equipment. As their operations begin on scene, their first goal is protecting the public from that scene. The next goal is to suppress the active conflagration in an otherwise inanimate building in order to minimize a calculated loss. There is never any intention to restore the premises, but simply to minimize what is sacrificed. And in certain circumstances, the best course of action may be to simply protect other structures while allowing that one to be completely consumed. Their work rarely relies on the awkward, or even self-serving, social interactions with the public to obtain situational awareness. Firefighters intellectually study the smoke and building basing judgments on previous plans for exactly this situation in a building that they have likely already studied and know by plan. They also operate within a legal jurisdiction that permits them complete legal control of a property in order to definitively negotiate an acceptable outcome that weighs certain losses until control can be safely transitioned back to the actual owner in the end.

The primary tools of the police officer, on the other hand, mainly include the items attached to their utility belt or what can be carried in their hands or head. They often operate individually, or in very small ad-hoc groups of their peers. While they are keen observers at the scene, their size-up of the situation relies heavily on interviews with the public. This highly subjective investigation is the first step in resolving a complaint that intends to make the situation as whole again as possible. Statements are confirmed or denied based on physical evidence that can be discovered by the officer. The resolution, like the problem that makes it necessary, is seldom known beforehand which makes prior planning nearly impossible. At times, a definitive resolution cannot even be accomplished on scene. In those cases, individuals must be transported to magistrates who will make the final judgments that ultimately determine the outcome. Law enforcement officers play an important role of gathering information on situations that range from the mundane to the extreme. A continuum of dynamics that can change quickly from one to another as they continue to interact with the personalities involved.

In much the same way as a law enforcement officer, the paramedic controls the situation through their presence and professional demeanor as much as by any task they perform. The situation, always involving both medical as well as psychological aspects, can improve or destabilize based on the confidence that participants place in that individual leader. The situations they encounter are of an endless variety and the severity of the situation is equally dynamic while often not being as obvious to everyone else involved. The actions of both the officers and medics are tightly constrained by specific protocols due to the fact that they deal directly with people and are constantly subject to internal, and even public, review. They both prefer to develop and work through the consent of those involved rather than compulsion. While the nature of calls for service can vary widely, medics train constantly for the worse cases such as STEMI, stroke, cardiac or respiratory arrest. It is in these incidents, where moments matter, that their skill and training distinguish them. Fortunately, these life-critical situations requiring an immediate response are seldom what they encounter. Too often though, they allow the infrequency of demands on these skills to lull them into a level of complacency and a desire for normalcy. Like our law enforcement counterparts, we must always prepare our minds for the worst case scenario involving our patient.

Along those same lines, we must consider how we are deployed. The fact that there are typically far fewer EMS resources than any other emergency services branch, and that they can be necessary on scene without delay; it is more logical to consider their deployment to be dynamic in a similar way to police resources. The need for large numbers of personnel and heavy equipment on the fire side make fixed stations more logical in order to ensure adequate response times to stationary real property assets. However, people (our patients), are dynamic. They move about and either cluster or disperse in recognized patterns that can easily be modeled. Consequently, our similarity to law enforcement operations in dealing with people requires us to think in many ways like these officers and admit that our jobs differ more from firefighters than we might like to think.

5 Comments

  • Jan Sickels says:

    An interesting comparison that I hadn’t thought about before, and even in the small community we serve, I can see how this is true. We are fortunate to work well with our local law enforcement, who also respond to most of our calls, and with the FD, who responds to MVAs automatically and other calls as requested. Thank you for the enlightening article.

  • S. Benson says:

    Having worked in NYC prior to the merger with FDNY, I agree with much of this.
    The paradigms that guide EMS are much closer to PD than Fire. Now, this is not a good/bad or right/wrong thing: it’s a matter of the right tool for the job

  • Anne C says:

    I would have to agree. It is about the skill set and functional aspects of the job.

  • Jo Essenburg says:

    Interesting thoughts! Having worked in the EMS field and now hospital based, I got to see both ‘sides’ of healthcare. Things are changing, and changing fast. I believe the FD 24 hours shifts will start transitioning to 12, 10, and/or 8 hours shifts. To help alleviate the costs, you going to see a huge paradigm shift on how EMS operates. Wouldn’t be surprised to see ALS units staffed with a sole Paramedic. Plenty of BLS units to handle the vast majority that can respond with ALS if needed. BLS units won’t transport to ER often, instead to Urgent Care Center or followup with a Nurse Practitioner. EMS will operate more like cops, in that they operate in smaller and sometimes by themselves.

  • Peter O'Meara says:

    Jo is right. Even though the original article makes a good case for the similarities with Police compared to fire fighters, Paramedics are health professionals. It is the health paradigm and health sciences education/research that will drive the evolution of paramedicine as a serious and respected profession. It also needs to be considered that in many others countries the role of fire departments in EMS is either non-existent or restricted to first responder roles.

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