A colleague told me about a hiring process his department recently held, targeting lateral entry, experienced paramedic/firefighters. During the interview process, they asked one candidate, “What is your weakest clinical skill?” His response: “All of them, because I'm an engine company paramedic.” He went on to explain that in this role, he rarely gets to perform any ALS skills.
Most people would agree that the addition of paramedics to fire department response has been a good thing. Countless lives have been saved when ALS interventions are available within minutes of an emergency call. Since most fire departments’ calls are medical in nature, it makes sense to expand paramedic services, in some cases, to having all firefighters also be paramedics.
But is it possible to have too much of a good thing? Is there a downside of the trend toward having all firefighters also be paramedics?
Obstacles to maintaining EMS skills
One issue that emerges with any advanced technical service is the challenge of maintaining high levels of response capability when skills are not routinely used. This can be a problem for engine company paramedics, as was voiced by the job applicant above, but it also applies to other specialties, such as technical rescue or hazmat. It’s great to have a department dive rescue or high angle team, but if members of that team are not highly experienced and confident about their skills, their response could potentially lead to more casualties beyond the initial emergency.
The logistics of keeping hundreds of paramedics current on critical skills can be daunting for any fire department. Paramedic training is time consuming and demanding of special equipment or conditions. Given those challenges, some firefighters and departments have cut corners, falsified training records or pushed the boundaries of ethics in how they approach training.
Another concern for those who are in highly skilled but low frequency response roles is that of morale. Becoming a paramedic, a hazmat officer or a high angle rescue specialist are positions that take substantial commitment and passion to be successful. Putting in all the time and energy it takes to achieve these positions and then rarely being able to actually do the job can be demoralizing. Professionals in those roles might question their commitment and even find themselves just going through the motions to maintain certifications. This could result in a dangerous outcome when those skills and abilities are finally most needed.
Creating regional teams for specialized skills
What is the answer to this dilemma? At least one fire official has been so bold as to suggest that some departments have too many paramedics, and that employing more paramedics does not necessarily translate into better lifesaving outcomes overall.
Many jurisdictions recognize that while they will need specialty team response on occasion, they do not have the resources to support such teams individually. Therefore, they cooperate with other departments or organizations to either form regional teams or develop mutual aid agreements for specialty skills, such as technical rescue.
Such cooperative or regional teams can provide advantages. Members from different departments are likely to have various experiences and points of view, bringing a wider, more diverse approach to complex problems. The economy of scale is a major factor also, allowing organizations to pool resources to purchase equipment and vehicles. Training resources can also be shared, diminishing the burden on any one department.
However, there are drawbacks and challenges to such cooperative approaches as well. If prevailing cultures of neighboring departments are ones of competition and suspicion rather than respect and collaboration, forming and maintaining such regional teams can be difficult. There is also a logistical challenge in getting people together from organizations that might have different schedules, staffing standards and internal priorities.
The success of such teams depends on strong leadership, but that leadership must be collaborative rather than autocratic. All individual members must feel a sense of investment and personal commitment to the success of the team. Regional teams must rise above interpersonal differences and departmental rivalries to be successful.
Above all, maintain morale
Forming regional teams is more practical for the occasional highly technical incident rather than for things like routine medical response. Many factors can contribute to a decline of paramedic skills and morale, including repeated response to incidents that do not require ALS training or equipment. I have talked to paramedics at a number of departments who entered the field with high hopes and motivation, only to feel completely burned out after years of running endless, mostly trivial calls.
The bottom line is this: If you train people in advanced technical skills, you must ensure that those people have the opportunity to use those skills in a meaningful way on a regular basis. If not, proficiency will decline, training will become less rigorous and morale will plummet. And those skills may not be there when you most need them.