Note to Readers: This article is a companion to the July 2014 PM magazine cover story “No Cause for Alarm – Sustainability in Fire Service Depends on Change.”  

Over the course of the past 40 years, the fire service has undergone a significant evolution. The name, in fact, may not be reflective of what the majority of the fire agencies are called upon to do each day.

Forty years ago, the fire service was doing just that, responding only to fires and rescue calls, while emergency medical services (EMS) were handled by either the local mortuary or the local hospital. Hazardous materials were, if on fire, extinguished and when spilled, washed down the drain. Urban search and rescue, tactical medics, hazmat, CBRNE (chemical, biological, radiological, nuclear, and explosives) defense teams, and paramedics were not even on the radar screen, yet are prevalent today in fire agencies.

Building and fire codes have made communities safer, and standards have made such equipment as fire apparatus, breathing equipment, ladders, and portable equipment better and easier to use. Firefighters in most local governments are better trained and educated than their predecessors. They have expanded their scope of work to include advanced life support, hazmat response, urban search and rescue, and homeland security. As a result, the fire service has become an expensive service provider in communities today, often accounting for increased general fund expenditures. I know in my own organization, we account for 22.9 percent of the city’s general fund expenditure, which is a significant commitment on behalf of the city.

Looking to the Future

But the fire service is at another crossroads in its history, and that is: What is it to become in the future? The fire service today responds to millions of calls a year and most are for EMS. Therein lies the threat and the opportunity for the fire service in the immediate future. The current system has been built on a system of defined staffing and deployment that works well for structural fire response, but may not be the most effective nor efficient model for the majority of calls that are being responded to today.

As building and fire codes are updated, sprinklers are used more, and community risk reduction becomes a common tool in use at the local level, the number of fires will continue to go down, as will the risk for other human-caused catastrophic events. The emergence of the Affordable Care Act may lead to the fire service finding itself in a “perfect storm;” a storm that fire service organizations simply will not be able to navigate.

Why a perfect storm? The organizational culture in most fire service agencies is resistant to change, and this poses a threat in the near future as the role in EMS service delivery may be changing quite rapidly. There is sometimes a lack of understanding or unwillingness by people in the profession to accept the impact that fewer fires and the changing roles in EMS will have on integrated mobile health care in the future. For those departments that are fully engaged in and reliant on EMS to justify the current level of resources, this could be a game changer.

The pressure to privatize local EMS response historically provided by the fire service will increase dramatically at the local level, as policies are written to implement the Affordable Care Act. An objective to reduce or maintain healthcare costs will result in shifting as much care to out-of-hospital care and treatment. This will ultimately reduce the number of patients who are going to the local hospital emergency department and will have an impact on the overall number of calls the fire service responds to if localities are not providing the service.

There are a number of fire agencies already researching and implementing innovative concepts to expand their services and scope of practice in several states. Tualatin Valley Fire & Rescue in Oregon uses a single medic to assess low acuity calls and conduct follow up on the patient. Community paramedicine has been implemented in Minnesota due to an expanded scope of practice, and in Mesa, Arizona, a transitional response vehicle, which couples a paramedic and a nurse practitioner, is doing treat-and-release of medical issues that historically would have been transported to a local emergency department.

Such innovations are often not an easy task as there are those in the fire service profession who are fighting the changes and are totally focused on fire response as the saving grace for the fire service in the future. While this may be an effective strategy in larger metropolitan areas, for the majority of the fire service, this posture could be extremely problematic 10 years from now. In the next decade, fire agencies may find themselves in one of the final three stages of what author Jim Collins cites in his book How the Mighty Fail. Those stages are denial, salvation, and irrelevance.

In recent history we have been witness to this occurring over and over again in the private sector. Remember these companies: Pan Am, Bethlehem Steel, Polaroid, Woolworth’s, Swiss Air, WorldCom/MCI, Tyco, Montgomery Ward, and TWA. Where are they now, and what led to their demise?

As the economy has become constrained, and the public sector has failed to re-engineer its practices, we are seeing this type of institutional demise occur in the public sector as well.

Ask yourself these questions:

1. If your community’s public safety department quit providing EMS service in the next year, how many private vendors would likely bid to replace it?
2. Would it cost the local government more or less to outsource the service than what it costs to provide it today?
3. If the locality bid out all services, could a community compete?
4. Can your organization adapt to this rapidly changing environment in time to maintain and expand the services that it is now providing to the community?

The answer for most public-based agencies would be the same: probably not.  So the operative question is: How can the fire service be sustained in the future? I think the answer is adaptability and innovation. Many organizations today use one model to provide service. We place three or four firefighters on an engine or ladder company, work them on a schedule of 24 hours, and respond them to everything.

Yet with minimal analytics, we often find that calls for service, our population, and ultimately, our overall community risk can fluctuate on an hourly and daily basis. Yet we use one static deployment model; that is, to provide service. As we look to adapt and innovate for the future, the fire service must look at such things as shift schedules, use of peak unit staffing, and expanding services to areas that would be viewed as nontraditional. If the fire service fails to do so, then an uncertain and difficult future lies ahead.

Opportunity for Innovation

In the next decade, the fire service has a great opportunity to innovate and re-engineer historic fire service models and practices. To do so, fire agencies must adapt their services and delivery of those services to meet what customers want and need, and must wholeheartedly embrace such changes as opportunities if they hope to sustain the profession into the future.

The question is, is the fire service up to the challenge?