Fire Politics: Community Paramedicine: The Next Frontier

An opportunity to develop a system to serve the community

Firefighters working at Baltimore County, MD, Station 6 on “B” shift in the mid-1980s frequently witnessed histrionics and heard earthy, unprintable expletives when this writer was assigned to the medic unit. Suffice it to say that I much preferred riding the engine to an evening on the “Band-Aid box.”

Like many firefighters of that era and before, EMS duty was less then appealing.

Today, the lion’s share of out-of-hospital care is provided by fire-based EMS. Medical and rescue responses account for approximately 80% of most fire departments’ call volume. In addition, to providing basic and advanced life support response, the fire service must take the next step and embrace and expand our services into community paramedicine.


There are two reasons: self-preservation and it is the right thing do. If the Great Recession has taught us anything, it is that today’s elected officials do not view the fire service with any reverence or difference. Our budgets are routinely slashed. Firefighters and paramedics are laid off or their positions eliminated by attrition. The threat of privatization looms large in many communities.

 Community paramedicine

The impact of 9/11 has been lost on many politicians and ordinary citizens. As an industry, we must continually show value to our bosses (read: taxpayers). We must demonstrate that we are an indispensable asset to the community and merit being adequately resourced, staffed and funded.

Aggressive fire prevention efforts, stronger building codes and the expansion of sprinkler systems in both commercial and residential structures have reduced fire load. The void must be filled to justify a community’s continued investment. Traditional EMS services have been our salvation. But, as a result of changes in how medical care and services are delivered, we must re-examine how the fire service can best capitalize on this new opportunity.

The Affordable Care Act is pushing the entire healthcare industry to find efficiencies, reduce cost and ensure that patients are treated at the appropriate type of care facilities.

Anyone who has ever worked a medic unit in an urban area recognizes that many people view EMS and transport to emergency rooms as their primary medical care. This is the most expensive and least efficient option for non-life threatening cases. In rural areas, the scarcity of trained medical professionals and lengthy distances between hospitals and other medical facilities compromise and complicate health care.

Community paramedicine can and, ultimately, will be play a large role in addressing those issues. The concept is a paradigm shift in the role and deployment of paramedics and fire based EMS assets.

Traditionally, paramedics respond to an emergency call, provide treatment and determine whether or not to transport the patient to a hospital. After the response has concluded, the responding unit goes back in service and ceases to have any further contact with the patient.

In a community paramedicine environment, paramedics are immersed and integrated into the community’s overall health care delivery system.

Beyond providing emergency care, they may begin rendering routine, in-home care. In some models, the paramedics provide treatment to citizens with chronic conditions – diabetes, asthma, COPD and other ailments. They may be called upon to visit the elderly or handicapped for health screening or to ensure that they are following their medical providers’ instructions. Other duties many include follow-up visits to recently discharged patients to prevent unnecessary re-admissions.

In more developed models, community paramedicine may encompass well care, immunizations, vaccinations, substance abuse counseling and mental illnesses. To reduce overall costs, protocols may be introduced that medic units transport patients to clinics, acute care facilities or even on-call physicians to avoid an emergency room visit. In all successful models, robust community and patient education are an essential component.

Developing an effective community paramedicine model requires commitment and cooperation. Government, social services, hospitals, the physician community, local organizations, homeowner associations and others must partner to develop an integrated system that best serves the community.

If implemented properly, community paramedicine elevates the role of local fire departments. It is another value added proposition. Over the years, the fire service has embraced hazmat response, fire prevention, installing smoke detectors, in-district home and day care inspections, traditional EMS and other emergency services and community outreach and educational projects.

Community paramedicine is the next frontier. It may well provide a shield to protect against further attacks on our staffing and budgets and allow fire service leaders to lobby aggressive for more resources and actually grow their departments and operations.

There is little doubt that many of today’s firefighters may have the same attitude about this further expansion into EMS that I had so many years ago. But, survival is a very strong motivator. All firefighters and paramedics take an oath to protect life and property. Community paramedicine does just that.

KEVIN O’CONNOR serves as the Assistant to the General President of the IAFF. He supervises the Governmental Affairs and Public Policy Division. A former firefighter/EMT in Baltimore County, MD, O’Connor has held numerous leadership positions within the local, state and national fire service and union movement. He is a past chair of the Congressional Fire Services Institute National Advisory Committee and a recipient of the CFSI/Motorola Mason Lankford Fire Service Leadership Award.

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Pull quote:

We must demonstrate that we are an indispensable asset to the community and merit being adequately resourced, staffed and funded.