A Proposal on Integrating Emergency Medical Services (EMS) and Fire Services


Statement of Problem 3

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Purpose of the Study 4

Research Hypothesis 5

Significance of the Study 5


Working environment for EMS professionals 5

Physiological and Psychological Risks of Providing Emergency Services 6

Fire and EMS Personnel 7


Research Design 9

Data Analysis 10





Chapter One: Introduction

The fire service began operations in 1735 and was introduced by Ben Franklin’s Union Fire Company. Together with the emergency medical service, they both act as first responders in a community. The two departments act towards responding to wide-ranging events like disasters and other emergencies. In the United States, there is approximately 900,000 EMS personnel according to Haynes and Stein (2014), and more than one million firefighters within 3.8 million square miles (Michael & Stein, 2013). Tracy and Matthew (2014) explain that the role of fire services and EMS professionals’ role have expanded to include response to radiological, biological, and chemical attacks and threats, as well as, radical violent extremists. 

The inclusion of the expanded all hazards response in the country was as a result of the mass transit attacks in London, the crash of flight 93 in the Stone Creek Township cornfield, the Pentagon, in September 11, 2001, against New York, and also the hybrid targeted violence (Tracy & Matthew, 2014). Irrespective of the expansion of role, the responsibility of fire and EMS personnel all over the country fails to incorporate their intelligence. Michael and Stein (2013) argue that there is a need to train the fire and EMS personnel in consuming and exercising intelligence. There is a need to identify ways to incorporate the fire service and EMS services.

Problem Statement

The Emergency Medical Services (EMS) is the system responsible for the provision of transport and pre-hospital medical treatment for individuals who require definitive medical care. Other systems that provide transport and treatment include air ambulance agencies, hospitals, fire departments, and private ambulance companies. The type of system is variable based on the available resources, needs, and service area. In addition, the level of care provided by these systems is wide-ranging where some give patients basic support and other advanced care. EMS is the first on the scene to provide medical intervention provided by the government in the country and is responsible for responding to large-scale disasters including fire.

The upcoming work will revolve around the integration of fire services into the EMS and the impact it would have.  However, EMS is an independent organization and the Federal agencies require evaluating the profession including funding and coordination. The fire department, for example, has received federal funding and coordination. Such coordination from the federal agencies is likely to result to solve the upsurge capacity of EMS, as well as, the limited funding it receives.  EMS remains a substantial player in Homeland Security and the unmet needs call for more support to the organization. Consistently, this research paper will argue that EMS will be more effective through the integration of fire services to EMS to strengthen the agencies and the response to disasters. 

Statement of Problem

           Previous studies on the integration of fire and EMS populations have concentrated on the psychological effects of exposure to critical incidents, personally disturbing incidents, psychological distress, job satisfaction, occupational stress, and burnout. Fire and EMS providers constantly face critical incidents like motor vehicle crashes, cardiac arrests, gunshot wounds, and pediatric trauma/death. In addition, fire/EMS providers face environmental challenges including lack of social appreciation and negative personal impacts like psychological trauma. They are also faced with psychological distress due to exposure to critical incidents comparable to what is experienced by victims. This essay will explore some of the traumatic incidences experienced and ways to cope with the trauma after exposure. The research will explore if combining the fire services and EMS will increase the effectiveness of the service.

Purpose of the Study

             The purpose of the study will be to investigate the impact of changing or combining the federal agency of EMS with fire services. The study will explore the level of traumatic stress symptomatology in fire/EMS professionals. The study will also identify some of the coping strategies these populations require to adapt to mitigate effectively the traumatic stress symptomatology that is majorly experienced by fire/EMS professionals. The coping strategies are critical for the society they serve, as well as, for their benefit. Although previous studies have evaluated coping methods for fire/EMS professionals, the research will explore coping methods that effectively mitigate the traumatic stress symptomatology following exposure to a critical incidence. The objective of this study is that it will contribute to the current research on the effective application of coping strategies to fire/EMS provider’s psychological well-being that will enrich and support the physical and psychological health of the professionals. 

Research Hypothesis

  1. Currently, there lacks a relationship between the subjective stress level and traumatic stress symptomatology level of fire/EMS providers following critical incidents.
  2. There is no identified relationship between the traumatic stress symptomatology and demographic data of fire/EMS professionals.
  3. There is no existing relationship between the traumatic stress symptomatology of fire/EMS professionals and the coping strategy they choose irrespective of controls against the exposure of fire/EMS professionals to incidents.

Significance of the Study

             The study will be beneficial as it will help in the identification of coping strategies that are beneficial to ire/EMS professionals who are constantly exposed to incidents that greatly affects them. Some of the benefits anticipated for the upcoming study include: enhancing occupational satisfaction, decreasing the potential for burnout, and improvement of psychological health of fire/EMS providers. This will be beneficial to the entire society, the fire/EMS providers, as well as their families. 

Chapter Two: Literature Review

The section will explore previous scholarly works conducted on the topic. 

Working Environment for EMS Professionals

According to William (2009), the EMS operates for approximately 56 hours in a week, which in approximation is equal to 2,800 hours in a year. The study also identified that work shifts of the professionals are hectic where, for example, they can work for 10- to 24-hours and majorly (53.8%) operate in a 24 hours schedule. The traditional shifts of the time were operating for 24 hours, taking a rest of 48 hours and resuming for 24 hours shift. Schooley and Horan (2007) explain that on average, the EMS professionals respond to approximately 10 calls within a 12-hour shift.  

                EMS and fire professionals operate in an environment that exposes children, as well as, adults who are coping with traumatic and life-threatening conditions.  Schooley and Horan (2007) explain that EMS/fire professionals are exposed to conditions like mass casualty incidents, completed suicides and homicides, body handling, repugnant victim scenes, injuries and death of children and infants, exposure to chemical and bio-hazardous materials, and partner’s personal safety. The fire/ EMS professionals exposed to these incidents have to cope with exposed trauma. 

                Pozzi (1998) conducted a study in Albuquerque Fire Department, among 331 fire/EMS professionals it identified that 289 (90%) of the fire/EMS providers had past experiences of personal assault during their day-to-day work experiences.  Similarly, Grange and Corbett (2002) conducted a study among 4,102 EMS calls to examine the response of EMS professionals during a 31-day period. According to the study, the respondents were exposed to violent behaviors in approximately 8.5% of their call. In addition, fire services and EMS are exposed to risky chores that may risk their health. 

Physiological and Psychological Risks of Providing Emergency Services

Previously, researches were focused principally on the effect of disasters in victims. However, the researchers have changed their angle and are now inclined towards the examination of the impact of trauma on the rescuers during disasters. The four primary psychological symptoms identified by these studies include posttraumatic stress disorder (PTSD), “Vicarious Traumatization” (VT), secondary traumatic stress (STS), and burnout. Quinn-Davidson and Varner (2012) explain that burnout among rescuers is a result of limited employee input into the organizational processes, lack of appreciation for services rendered, and excessive workplace expectations.  Another term that can explain the impact of burnout is cumulative stress.

Fire and EMS Personnel

The aspect of fire and EMS professionals have been highly debatable, particularly their role as first responders and the intelligence they gather while still acting as first responders. Quinn-Davidson and Varner (2012) argue that fire and EMS professionals are present in towns and the community doing their day-to-day activities and identify any suspicious behaviors or activities. During their everyday activities, the fire and EMS professionals face challenges in the community they operate. Schooley and Horan (2007) explain that the fire and EMS professionals have varying perception of the community they serve. 

Mims (2011) explains that there are varying perceptions among the fire and EMS professionals where some agencies argue they should be integrated while others argue against it. The National EMS Preparedness Summit in 2006 resulted in disagreements following the release of “EMS Back to the Future – An Agenda for Federal Leadership” by Homeland Security Policy Institute (HSPI). According to the report, transiting the EMS service from the transportation department to the Department of Homeland Security would form a similar agency like the United States Fire Administration (USFA). However, this move has been debatable where some agencies like the International Association of Fire Chiefs (IAFC) opposed this move where they stated that EMS was better in the fire service.  Failure to reach a consensus, the opponents felt the move would diminish the role of USFA.

Schooley and Horan (2007) argue that excluding EMS from the fire department would be in line with EMS’ interest, which is a multitude of non-fire based providers. However, unlike the proponents, the proponents argue that the fire departments approach to EM is that they do not tolerate it but they embrace and accept it. Based on this argument, the fire department should not be the leading agency in this discipline.  With or without the EMS, the structure of fire services is different from one volunteer to another. Generally, the USFA should develop credentialed fire departments instead of their level of EMS service delivery by tying the eligibility for federal EMS assistance dollars.

The HSPI report has also been opposed by other fire-related constituency groups including the International Fire Instructor Association (IFSTA), National Volunteer Fire Chiefs (NVFC), National Fire Protection Association (NFPA), and International Association of Firefighters (IAFF). However, McCallion (2011) argues that all the opposing constituencies are led by the need to secure the service of the fire department but fail to secure the interest of the EMS department. Mims (2011) argues that in the past, EMS has been parented by the fire department without equal regard to its imperative role in the community. Based on this, the placement of EMS under USFA at the federal level will result in the EMS having an obligation to assist the fire services with their need rather than protesting and following their individual needs. 

EMS Network

According to McCallion (2011), the EMS strategy is a form of a fragment as the majority of committees lack statutory authority or the strategy to guide the department. The formation of the strategy is based on an understanding of what and who is involved, which includes players and stakeholders. The strategy considers the recognition of limitation, support for the strategy, and their interests. This can be attained through the use of bases of power-direction of interest diagram where the players rather than the stakeholders are placed at the core of what is required in building interest based strategy. The EMS should be centered in the chart as their interest is to serve the stakeholders following an interest-based power direction. Following Bryson (2004) theory, the players are at the center, but in our case study, the EMS stakeholders should be considered as the most influential groups that will drive the department to the required direction. 

Chapter Three: Methodology

The study will explore the impact of combining the EMS and fire services. It will investigate some of the challenges and barriers facing these strategies, which include traumatic stress symptoms in fire/EMS professionals. This chapter will include an overview of the populations to be studied, the tools to use in the upcoming study, the procedures to follow for the study, and a general overview of the research process and design used in analyzing data. 

The study aims at conducting the study in Durham County situated in the State of North Carolina. In particular, the study will investigate the Durham County Fire/EMS system, which comprises of one city fire/EMS department, one county EMS agency, and five county fire/EMS agencies. The EMS system in Durham County serves a district of 290 square miles and approximately eleven paramedic ambulances serve them – six outside the city and five operating within the city. The county also has first responder/EMT service at a near proximate fire station. In approximate, the system contains 500 career and volunteer firefighters, and 100 career and volunteer paramedics/Emergency Medical Technicians (EMTs).  The research will collect data from Durham County EMS system.

Research Design

The study will investigate the challenges and barriers facing these strategies, which include traumatic stress symptoms in fire/EMS professionals. It will also include some of the challenges facing fire/EMS professionals in the form of work-related stress. This will help in identifying some of the coping strategies that fire/EMS professionals can apply in solving stress symptomology and increase the effectiveness of the strategy. In addition, the researcher aims at identifying some other barriers or debates towards the integration of fire/EMS professionals.

The research method of choice is the qualitative research method. The reason for choosing a qualitative research design rather than quantitative research design is because the data collected cannot be quantified. Due to this, the researcher will follow a qualitative research design rather than a qualitative research design. Accordingly, Maxwell (2012) argues that qualitative research design provides an in-depth understanding of understanding some aspects and the way to manage those situations. 

The research method of choice will be a systematic analysis. The reason for choosing this method is that in comparison to the literature review, it is more effective. According to Mallett et al. (2012), a traditional literature review introduces the topic, summarizes the major issues, and gives illustrative examples. However, a systematic review records how a researcher selected the primary studies including the process of analyzing the studies to arrive at conclusions. Mallett et al., (2012) argues that the special aspect of the systematic review is that they are transparent about how they arrive at conclusion. In addition, a systematic review avoids misinterpretations of the knowledge based on that; it evaluates every piece including its relevance and quality. 

Data Analysis

The research will explore three research hypotheses. The three hypotheses tried to evaluate the lack of a connection between stress and fire/EMS professionals. The research will formulate research questions. For the upcoming study, the research questions to be explored include: 

  1. What is the significance of combining fire and EMS?
  2. What are the structures of EMS?
  3. What are the barriers of integrating fire and EMS services
  4. What forms an EMS network?

To minimize the aspect of bias, the researcher will develop and follow a reproducible methodology by ensuring the process is transparent. The aspect of inclusion and exclusion, in this case, is that the study will include articles that explore fire and EMS services. The articles for the study will be searched from multiple databases and will exclude any Wikipedia and other non-scholarly articles. The study will include the aspect of validity and reliability of study findings through the use of critical appraisal tools. The data will then be analyzed across the studies. 

Chapter Four: Results and Findings

The results of the systematic review will be included in chapter four

Chapter Five: Discussion

The study will discuss the results and the findings of the study and base or pin them to the results of the study. This will critically analyze the research problem and help in generating conclusive decisions from the study. These decisions will help in the formulation of recommendations for the study. 

Chapter Six: Conclusion and Recommendations

Based on the discussion, the researcher will formulate recommendations for the study. This section will be followed by a conclusion section where the researcher will provide a summary of all sections in two or three paragraphs. This section will provide a conclusive statement where in this case, is integrating the fires service to the EMS will be effective and advantageous for services, the government, and society to be served.


Grange, J. T. & Corbett, S. W. (2002). Violence against Emergency Medical Services personnel. Prehospital Emergency Care, 6(2), 186-190.

Haynes, H. J., & Stein, G. P. (2014). US fire department profile 2013. Quincy, MA: National Fire Protection Association.

Mallett, R., Hagen-Zanker, J., Slater, R., & Duvendack, M. (2012). The benefits and challenges of using systematic reviews in international development research. Journal Of Development Effectiveness4(3), 445-455. doi: 10.1080/19439342.2012.711342

Maxwell, J. A. (2012). Qualitative research design: An interactive approach (Vol. 41). Sage publications.

McCallion, T. (2011). NASEMSO survey provides snapshot of EMS industry. Journal of Emergency Medical Services, 37, 34-35.

Michael, K., & Stein, G. (2013). “U.S. Fire Department Profile through 2013 Fact Sheet.”. National Fire Protection Association. Retrieved from http://www.nfpa.org/research/reports-and-statistics/the-fireservice/administration/us-fire-department-profile.

Mims, L. (2011). Improving Emergency Medical Services (EMS) in the United States through improved and centralized federal coordination. NAVAL POSTGRADUATE SCHOOL MONTEREY CA.

Pozzi, C. (1998). Exposure of prehospital providers to violence and abuse. Journal of Emergency Nursing, 24, 320-323.

Quinn-Davidson, L. N., & Varner, J. M. (2012). Impediments to prescribed fire across agency, landscape and manager: an example from northern California. International Journal of Wildland Fire, 21(3), 210-218.

Schooley, B. L., & Horan, T. A. (2007). Towards end-to-end government performance management: Case study of inter-organizational information integration in emergency medical services (EMS). Government Information Quarterly, 24(4), 755-784.

Tracy, F., & Matthew, S. (2014). “Hybrid Targeted Violence: Challenging Conventional “Active Shooter” Response Strategies.”. Homeland Security Affairs 10. Retrieved from https://www.hsaj.org/articles/253.

Williams, D. M. (2009) 200 JEMS salary and workplace survey. Journal of Emergency Medical Services, 31, 38-49.

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