Our job requires so much, why do people think we do so little?
Originally published on LinkedIn
Imagine this scenario:
You get bad news about your health. You need a highly technical life-saving surgery, and you don’t have a lot of time before it is too late. You go to the hospital, and the staff prepares you for surgery. While you are lying on the gurney waiting, you feel nervous. Your life is at risk. Finally, you are told the doctor will come to examine you before going to the operating room. As you wait, you become curious about your doctor’s qualifications. Did they go to an ivy league university? Did they graduate at the top of their class? Have they kept up on advances in medical science? Are they experienced and technically proficient at the surgery they are about to perform on you?
As you wonder about your doctor, a person walks in wearing a polo shirt with the name of a plumbing company on it. They tell you they will be performing your surgery. Of course, you ask, “are you a doctor or a plumber?”. “Both,” they say, “I’m a plumber/doctor. I perform various cardiothoracic surgeries on my patients and perform a variety of plumbing-related home repairs”.
How would you feel? Would the unique and multifaceted nature of your physician/plumber’s career make you confident in the outcome of your surgery? Or would you be skeptical that someone can be an expert in multiple disciplines?
This is the dilemma facing the fire service today. In fact (and this is not a popular sentiment), we probably shouldn’t be calling ourselves “the fire service.” We do so much more than firefighting. In many places around the United States, including the suburban Chicago area, fire departments are staffed by firefighter/paramedics. There are several reasons for this but the two most important are:
Due to improvements in codes and other risk reduction efforts, the prevalence of fires has decreased precipitously over the last several decades while calls for other services have skyrocketed.
The efficiency demanded by economic concerns has resulted in a paradigm in which more and more has been added to suburban fire departments’ missions. Major cities often have separate firefighters and paramedics and the workload to justify the distinct roles. Volunteer fire departments and professional public or private EMS providers often protect rural environments. It is in the suburban environment that economic and political realities have most often forced the two jobs together.
Firefighting is hard enough all by itself
Before we discuss the implications of blending multiple disciplines, let’s think about firefighting itself. Firefighting requires a litany of skills for various applications. The knowledge and skills required of urban firefighters facing a high-rise fire are far different from those needed by suburban firefighters who face primarily residential fires in one or two-story homes. And both of these skill sets are vastly different than those required by firefighters fighting wildland fires in remote areas. The reality of firefighting is, just like in the medical field, specialization is beneficial if you can afford it, but a broad skillset is essential in most cases.
Consider the average suburb. In the town where I work, there are thousands of one and two-story homes, dozens of apartment buildings, various commercial properties, schools, churches, restaurants, venues, and high hazard facilities such as industrial manufacturers and a large-scale chemical plant. To be prepared to mount a meaningful response to a fire at all of these properties, a person could spend their entire career training and honing their skills without getting bored. However, the decreasing prevalence of fires has given the public the impression that the risk is low. The fact is that while the raw number of fires has decreased significantly, the risk of dying in a fire has remained stable. So, it really matters how you measure risk.
The addition of EMS
About 50 years ago, suburban Chicagoland departments started adding emergency medical services (EMS) to their missions. As with every other part of the medical field in the last 50 years, EMS has become increasingly more complex. Pre-hospital care requires a high degree of competency. The “ambulance drivers” in TV shows are not a realistic depiction of what is demanded of modern paramedics. Suburban paramedics are daily required to know and utilize a vast array of medical information and protocols and perform a litany of time-sensitive interventions. Also, for many people, the EMS system is the provider of last resort. Those without transportation, insurance, or other resources call 911 for non-emergent medical issues often because they have no other choice. Additionally, the lack of mental health resources in the United States results in ambulances responding to calls that could and should be better handled by mental health professionals. The average suburban paramedic is part emergency room doctor, part social worker, part counselor—all of this in addition to being a firefighter.
Continued mission creep
The addition of other disciplines such as hazardous materials response and technical rescue (high angle, trench, confined space, etc.) requires firefighter/paramedics to respond to calls of a highly technical nature.
And all of the aforementioned duties are JUST what happens when firefighter/paramedics respond to 911 calls. In addition to these tasks, suburban fire departments provide community risk reduction programs by enforcing codes, inspecting buildings, and delivering public education initiatives.
Our litigious society mandates excellent record keeping. This requires more data entry work than you might think. After a 911 call in which paramedics might spend 15-30 minutes with a patient, they spend at least as long documenting the interaction for the patient’s medical record. Every activity at a fire department is documented; every call, every training drill, every inspection. Most people don’t envision their local firefighters seated at computers for hours every day, but this is often the case, and it is exacerbated by the fact that fire departments don’t focus on computer skills when recruiting, so oftentimes people with limited computer skills find themselves doing work they never imagined.
What can we do?
Can we shrink our mission? It doesn’t seem likely. The last several decades have seen more and more responsibility added to the workload of suburban fire departments, not less. There is no reason to suspect the trend will not continue. There are two things we can do; we can understand our jobs better, and we can become better communicators. We can tell our elected leaders about everything that is required of us and be better advocates for the resources to do our jobs well. We can advocate for better solutions to problems without worrying about “putting ourselves out of business.”
I’ve heard it said that the solution to all of life’s problems can be found at the firehouse table. This is funny, but it’s not true. While lively dialogues about our limitations and frustrations with each other can be therapeutic, we are often “preaching to the choir” at the firehouse table. Our efforts would be better spent explaining our issues to those who don’t already understand.
For just one example, everyone around the firehouse table understands that when one of our residents is facing a mental health crisis, there must be a better, more targeted way to help than sending 6-8 police officers and firefighter/paramedics in large, loud vehicles to try to convince them to go to the emergency room for their non-medical issue. We know this isn’t the optimal solution. It is not even really a good solution; it’s just the only solution available due to circumstances we don’t control. The ability to explain issues like this to people with the authority to change things is not taught at the fire academy.
What ideas do you have to make us better at understanding and communicating the issues facing the fire service?
