Fire v Private EMS
The Law does not care.
Now, neither do I.
by David Givot
Since about 1987 my position on the age-old debate about Fire vs. Private or Third-Service EMS has unambiguously and unapologetically favored the latter. To say otherwise would be nothing short of gargantuan hypocrisy.
Over the years I have welcomed, if not provoked, boisterous debate on the subject with anyone willing to engage. Using words like greedy and egotistical, obtuse and devious, I condemned the devolution of ALS into the fire service at the expense of providers whose sole focus is the delivery of quality medical care and the patients they could have served. I have warned of the dangers inherent in placing such responsibility in the hands of firefighters who are distracted by non-medical diversions, or worse, drafted against their will into a paramedic program.
I have been steadfast in my convictions for twenty-some years. Until now.
Since I began studying the Law and speaking to EMS providers about how to protect themselves, the majority of my audiences have been fire department based. As a guest lecturer at UCLA/DFH Paramedic School, the students I teach mostly represent area fire departments. I have had countless one-on-one discussions with fire department paramedics, and paramedic candidates, in recent months and I have discovered something that I should have seen long ago…
A few months ago I spoke at the Kentucky State EMS Conference. Between sessions, I was discussing the local EMS delivery system with a veteran – non-fire department – paramedic and I posed the question: Fire or Private, which is the superior delivery system? Of course it was a rhetorical question, I was already sure of the answer. Nevertheless, he surprised me with an answer that was both simple and obvious. His answer was this: “It doesn’t matter.”
It doesn’t matter? Of course it matters. Doesn’t it? What?
“It doesn’t matter,” he said because any EMS system can only be truly measured one provider at a time. In the end, the delivery system is nothing more than a means of transportation. It is the commitment and dedication of the individual provider that matters. If a provider does not want to be there, it does not matter what the patch on his or her arm says, the patient suffers either way.
Friggin’ light bulb!
Since that conversation I have addressed hundreds more EMS providers, discussing the perils and pitfalls of the job as it relates to legal entanglements. Likewise I have had countless interactions with fire department paramedics; opportunities to talk about Law, EMS, and the changes that have taken place over the years and what is coming next.
In each one of those interactions I considered my conversation in Kentucky as a sort of template to interpret some bigger picture meaning behind what they would say; to get some reading as to what kind of provider they are and their words did not disappoint. That guy in Kentucky was 100% right on the money.
Fire, Private, Third-Service…
Same dog, different fleas.
EMS is not the expression of the sum of its parts. EMS is the individual parts; each provider is EMS and, like the Law, EMS does not care how you get to the scene, EMS only cares about what you do when you get there.
A fire department paramedic who only went through training because of the pay increase is just as dangerous as the private paramedic who hates his job and his employer for paying so little. The dedicated, committed private paramedic who joins the fire department for a more secure future should be no less engaged than the dedicated, committed private paramedic who does not. The age old and ongoing battle between fire and private (or third service) EMS is the wrong battle.
If there must be a battle over quality patient care, and there must be, it should be between those who are committed and dedicated to the best possible patient care and those who are not. That is the only fight about which the law truly cares; that is the only fight about which providers should care. That is now the only fight about which I care.
The greatest challenge now is convincing providers and provider agencies to look closely at themselves and make the honest determination of where they fit; to recognize that reputations are built and shattered; families are preserved or decimated; lives are saved and lost, one provider at a time.
Like the Law, in EMS there is no half-way: The act was legal or it was not, the care was proper or it was not and for each there is a consequence. The provider with poor skills will ultimately be held to account, as will the partner who knew about it and said nothing. While there may seem to be some gray area in both, rest assured that at the end of the day, the gray is gone.
As a paramedic, my study and understanding of the law has cast an ultra-bright light on just how much the two have in common. It is an understanding of the law that brings clarity to what it means to be an EMS provider, because the law – like medicine – looks only at the facts and likelihoods before committing to a course of action or creating a result.
EMS and the Law are very much alike. Both seem to expand and contract; adapt and evolve as the needs and expectations change; as we learn more about what works and what does not. Each like the other may be defined by the progress of generations or identified by the foibles of those whose interests in quality are diverted by other distractions.
Ultimately, both share a common goal: to make better the world it serves. Ultimately, each is only as strong as those who deliver it.
Which provider are you?