By Jim Sharp, Fire Chief, West Pierce Fire & Rescue
The future of emergency medical services (EMS) has been a hot topic throughout the fire service community for some time now. Fire-based EMS programs were implemented across the country in the 1970’s, marking a major shift in the core mission of the fire service. Throughout the 80’s and 90’s, many fire departments began transporting patients with critical injuries and those requiring advanced life support (ALS). Today, people are turning to their local fire department for all forms of healthcare needs, accessing 9-1-1 for non-emergent medical care at an unprecedented rate.
An aging population, the Affordable Care Act, rapidly increasing call volume, shortages of primary care physicians, increasing costs and decreasing revenues are just a few of the challenges facing fire-based EMS programs across the country. Here in West Pierce, we are not immune. In the last five years, call volume has increased over 20% with the overwhelming majority being patients with minor or chronic medical problems. A convergence of social problems such as poverty and homelessness combined with substance abuse disorders and a whole host of mental health issues, continues to push first responders into new areas of healthcare. This has put a strain on fire-based EMS programs, not only here in West Pierce, but across the nation. It has become clear that EMS systems designed decades ago will need to undergo a major overhaul in order to meet future demands for service.
A 2013 study by the Health Resources and Services Administration projects a shortage of 20,400 primary care physicians by 2020. Who will fill this gap? Many people feel it will be the local fire department. Most modern fire departments train their firefighters as Emergency Medical Technicians and Paramedics. It would be a relatively easy step to expand their training in order to have firefighters provide in-home, non-emergent medical care. Additionally, fire stations are already strategically positioned throughout the community, making access relatively easy for most people 24-hours a day.
Many communities throughout the country are trying a variety of innovative health care programs leveraged off of existing fire department resources. Commonly referred to as Community Paramedicine or Mobile Integrated Healthcare, these programs primarily focus on fulfilling non-emergent healthcare needs within the community. Programs such as these represent a significant change in the way fire departments provide service. For decades, fire departments have focused on providing emergency medical services, with an emphasis on “emergency.” Community Paramedicine programs are focused solely on managing patients with non-emergent medical needs.
With more and more people relying on 9-1-1 to access basic medical care, fire department systems are being strained to the breaking point. As demand for non-emergent medical response continues to rise, fire departments are finding it increasingly difficult to keep resources available for critical medical emergencies and fires. With limited financial resources, fire departments have to find new and creative ways to deliver health care services.
In the 1970’s and 80’s, emergency medical calls began to outpace fire calls and fire departments found they had to re-invent themselves, in order to maintain their effectiveness in the community. Today, the fastest growing type of calls received by fire departments fall into the non-emergent medical category. Once again, fire departments will have to re-invent themselves if they expect to be successful in the future.