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August 14, 2011

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The use of a fire engine as a first responder is nearly universal in the urban areas of the United States. While it may seem like 5% of the calls being fires is a low number, it is not unusual. The fact is that that is still several hundred fire calls a year and a fire requires several fire apparatus, a good number of firefighters, and a quick response. The prepositioning of numerous equipped and fully staffed fire engines and trucks is the only way found to accomplish that. It also, incidentally, provides for a quick and geographically distributed response to hazmat and heavy rescue incidents.

Those trucks and people have to be there if you want effective fire service. The firefighters also all happen to be EMT's and paramedics and the fire engines have the medical equipment. There are two important factors in EMS: early intervention on scene and, with trauma, arrival at the surgical theatre within an hour. Remember that EMS is not what you see in a movie; treatment is performed on scene, including advanced care. The days of snatching someone up and throwing them in an ambulance to get to the hospital as soon as possible are mostly gone. Today, in most cases, the EMS provider arrives, performs critical interventions, provides stabilizing care, and then transports. The number of ambulances that would be required to attain these quick scene responses would almost certainly be prohibitive. While an ambulance may be out of service for an hour or more for a routine call (because of time to transport to the hospital and offload and report on the patient), the fire engine can go back in service and be ready for another call within maybe ten minutes. This means it is free to provide aide elsewhere. In other words, the typical fire engine has more "up time" than the typical ambulance. It also has to travel far fewer road miles, just going from the station to the incident and back, compared to an ambulance going from station to incident to hospital (which may be some distance) and back. It is therefore able to quickly respond in its area with a far greater availability rate than an ambulance.

There is another operational factor recommending the use of fire engines as EMS first responders: manpower for an EMS call is just as important as at a fire (though EMS requires fewer people). A critical patient cannot be treated by only two people, which is the normal staffing of an ambulance. Consider that one of those has to drive and you see that you only have one EMT/medic available for a large part of the incident. Any critical patient will require two or three people to provide adequate care throughout the incident. The crew of the fire engine can accompany the ambulance to the hospital providing that for the critical patient. Like fires, critical patients only account for a fraction of the total call volume, but they are the reason the EMS system exists.

Economically, there is a good reason the fire engines/crews are used for EMS first response. While they make comparatively fewer fire, hazmat, and rescue calls, if they were to be parked and used exclusively for those calls then they would be an idle asset for a good portion of the time. Yet, if you want effective service, they have to be there. They are trained and equipped to provide EMS service and are geographically placed for quick responses. There is a need for quick EMS first response throughout the city. Therefore it makes sense to utilize them more often for something that they can do well.

I hope this sheds some light on why a fire engine shows up when you call for a medical emergency. If it doesn't then please attribute it to my lack of persuasiveness and not a fault in the deployment model. There is a good reason it is done that way in the vast majority of American cities.

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