For the last week or so, a battle has been going on in the City of Tulsa, Oklahoma as the Emergency Medical Services Authority, or EMSA, has been fighting to retain control over the EMS system in the city. The Tulsa Fire Department felt that they could do a better job than the 33 years of experience and proven effectiveness that the public trust has provided. Monday, the Mayor of Tulsa Dewey Bartlett made the right choice and decided to stick with EMSA.
The Tulsa Fire Department argued that if given control over the EMS system, they could not only save the city money, but also generate more revenue by eliminating redundancies in the chain of command, redundancies that exist because the business of running an ambulance service is different from running a fire department which by definition are not redundancies at all. EMS is a complicated business and is becoming more complicated by the day. New treatments pop up all of the time, and opportunities arise for services as efficient as EMSA to participate in ground breaking studies that could change pre hospital treatment on a national scale. Ventures such as these require a leadership team that can focus 100% of their attention on the department itself.
I call this a “win” for EMS not only because I feel that EMSA is a solid, proven service but also because Tulsa did not go the route that Kansas City did by eliminating MAST last year. MAST, like EMSA, was a proven, nationally recognized service which has fallen into a state of mediocrity, longer response times, and some bizarre patient care cases since it was taken over by the Kansas City Fire Department. Â In fact, after promises of improved response times, Kansas City Fire Chief Smokey Dyer was quoted as saying that “it’s not possible” to meet the system’s mandated response times with the staff he currently has.
It is nice to see Tulsa go the route that Kansas City should have. Now is not the time or atmosphere at this juncture in pre-hospital care for a department to just “jump into it.”Â Although public perception might say that faster response times are the golden egg of EMS, those of us who actually work in the back of an ambulance understand that more times than not, effective patient care takes time, and except in some specific cases that make up 15-20% of our calls, speed and time are not the priority.
Some fire departments are very good at what they do, like Seattle, Memphis, and Phoenix. Others, like Philadelphia, Washington DC, and Detroit have shown us that they have their share of issues. More times than not though, after a certain population size, having EMS as a third service just makes more sense. Systems get to be so busy and overtaxed that trying to balance them with the time, training and management required to run a fire department is not what is best for providers, and it is not what is best for the community served. With bigger cities with a potential of more fires though, EMS belongs in the hands of a department that can focus solely at the task of hand.
While my comments might seem “Anti-Fire” please do not look at them like that. I have seen some great fire-based EMS services of a variety of sizes, and most of the services local to me do a great job running the ambulance for their towns. I admire the fire service and feel that they have a lot to teach all of us about how they handle their community relations and outreach, and their ability to have made their trade into such a well-respected profession. Saying that I am “Anti-Fire” makes about as much sense as saying the Tulsa and Kansas City Fire Departments are “Anti-EMS.”Â They have their views of how an ambulance service should be run just as I have my views of how one should be run. I do, however, consider myself to be “Pro-EMS” and will always proudly declare myself as such.
Thank you again, Mayor Bartlett for realizing the importance of having your Emergency Medical Services provided by a true third service. Hopefully, others in positions of power such as yours will follow the example you have set.