In planning for large-scale terrorist incidents, U.S. decision-makers at all levels of government – local, state, and federal – must consider, among other things, how to triage and transport the maximum number of casualties at the incident scene with the probably limited assets available. Many first-responder agencies already keep emergency medical services (EMS) personnel on duty 24 hours a day.

Nonetheless, there seem to be never enough EMS units or emergency-medical technicians (EMTs) on duty to handle the number of calls that occur on a typical day. Complicating this already difficult situation is that there has been a growing, but probably unintentional, tendency to rely on mutual-aid contracts with neighboring communities to meet the daily shortfall of EMS units and EMT personnel. Even with additional units being stood up, though, overall preparedness still seems to fall short in far too many jurisdictions throughout the country.

Partly for that reason, many foresighted communities have resorted to integrating their fire departments and EMS units in various ways to provide a more seamless response to major incidents that cause a large number of casualties. This combining of scarce talent with already well-trained personnel enables the community’s fire departments to use their engine and truck companies to assist EMS units by providing additional staffing that may include EMT-trained personnel and, frequently, drivers as well.

Florida and California Have the Bright Idea

One idea that has demonstrably helped many communities is to use firefighters as paramedics in certain situations. During several major natural disasters that have happened in Florida and California in recent years this concept was used to good effect and helped significantly in reducing the number of deaths and injuries resulting from those disasters. During Hurricane Andrew, for example, a number of fire stations became mini-MASH units, for all practical purposes, for the communities affected.

The concept of combining paramedic care with the quick-response capabilities of the fire services continues to prove its effectiveness each day. Not only is on-site medical care initiated more quickly by paramedic-staffed engine and truck crews but the continuum of care is complete from the initial assessment of injuries to the delivery of victims to the emergency department of a hospital or other medical facility.

When they are fully equipped and fully staffed for such contingencies, paramedic-capable engine and truck companies are a more cost-effective way to deal with a large number of casualties than adding more ambulances to increase and improve overall EMS capabilities. To begin with, instead of purchasing and staffing more ambulances, many communities can use existing (and already paid for) vehicles more efficiently by adding a paramedic to serve on the fire department’s engine and/or truck companies; this option could be implemented for only about one tenth of the cost that would be incurred by outfitting an additional EMS unit.

Costs and Benefits, Pros and Cons

A growing number of cities throughout the United States have been strongly advocating the paramedic-engine concept for several years, and a number of other cities have implemented similar programs when faced with an increasing number of EMS calls and, in some communities at least, a decreasing number of fires.

Another factor to consider is that many paramedic-staffed engine and truck companies already are dispatched to incident scenes for the sole purpose of decreasing the response time required to transport sick or injured victims to hospitals or other medical facilities. The vehicles used must, of course, be outfitted with various medical systems, devices, and equipment such as cardiac monitor/defibrillator systems, oxygen tanks, intravenous fluids, medicines and medications of various types, and even child-delivery kits.

Another idea that has helped augment, improve, and expand EMS response capabilities is the requirement in many communities that all firefighters be EMT-B trained. This is probably one of the most important changes, in fact, that have occurred in the EMS field in recent years. The benefits that flow from having a higher EMT level of training available within the fire service itself also have made the preparation and planning for mass-casualty incidents more flexible to some extent. With more and better trained personnel available to call on, it is much easier for a community’s administrators and decision makers to expand EMS on-site capabilities during large-scale disasters and catastrophes.

To summarize: The use of fire departments and fire-service personnel to augment overall EMS capabilities in times of crisis has been an ongoing trend for several years. But the question remains: Is that enough? There still are too many communities throughout the country that have not embraced the idea of using these highly skilled and well trained personnel to the fullest extent possible. (It is recognized, of course, that training firefighters who are interested primarily in fighting fires to also be able to serve as EMTs and/or paramedics presents a difficult cultural challenge, but that is a different type of problem, and not insurmountable.)

In the final analysis, it seems clear that, when all of the factors pro and con are taken into consideration, today’s fire-service personnel could, should, and must be multifunctional in their capabilities. When large-scale mass-casualty incidents do occur – the usual qualification stated is “not if, but when” – the only way that many and perhaps most U.S. communities will be able to cope with them is to ensure that as many first-responder personnel as possible are trained in more than one discipline to meet the multifaceted challenges they will be facing.

Glen Rudner
Glen Rudner

Glen Rudner retired in 2022 as a manager of environmental operations for the Norfolk Southern (NS) Railway with environmental compliance and operations responsibilities in Tennessee, Alabama, Mississippi, and Louisiana. Previously, he was the hazardous materials compliance officer for NS’s Alabama Division (covering Alabama, Mississippi, Louisiana, and southwestern Tennessee). Prior to NS, he served as one of the general managers at the Security and Emergency Response Training Center in Pueblo, Colorado. He worked as a private consultant and retired as a hazardous materials response officer for the Virginia Department of Emergency Management. He has nearly 42 years of experience in public safety. He spent 12 years as a career firefighter/hazardous materials specialist for the City of Alexandria Fire Department, as well as a former volunteer firefighter, emergency medical technician, and officer. As a subcontractor, he served as a consultant and assisted in developing training programs for local, state, and federal agencies. He serves as secretary for the National Fire Protection Association Technical Committee on Hazardous Materials Response. He is a member of the International Association of Fire Chiefs Hazardous Materials Committee, a member of the American Society of Testing and Materials, and a former co-chairman of the Ethanol Emergency Response Coalition. He served as a member of the FEMA NAC RESPONSE Subcommittee.

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