Before even considering the structure of the Fire/EMS system, it would be worthwhile to gain a clear understanding of the realities of the EMS system that has evolved over the past 30 years in this country. Many of the commonly accepted premises of the EMS system turn out to be based upon false assumptions or outdated models. "Getting there faster saves more lives", "the more paramedics the better the outcomes" and "all ALS systems are the best design" all turn out to be false assumptions when viewed through an evidence based analysis.
The best document to review on these issues is the White Paper produced by the University of Oklahoma Medical School which I have attached.
This is a real eye opener, written by nationally recognized emergency physicians / researchers that is a must read for anyone managing an EMS system. For example, the research shows that having all firefighters trained as paramedics is probably a bad idea in most systems and also explains why private ambulance services with dynamic staffing can produce better outcomes at lower costs. We are seeing many local governments, in light of these realities, reconsidering delivery of EMS, particularly transport, thru the fire service.
Chief Joe Pozzo, the Center for Public Safety Management, Senior Manager for Fire/EMS and I will be discussing this paper and other alternative delivery systems for fire/EMS in our upcoming ICMA University Audio Conference on February 20th. For information on attending this session go tohttp://learning.icma.org/store/seminar/seminar.php?seminar=16483