By Erich Wagner (File photo)
An internal debate over the future of the Alexandria Fire Department bubbled to the surface last month, as a group of paramedics denounced the city’s ongoing transition from utilizing paramedics to using hybrid firefighter/medics.
The change, which was proposed last year by Fire Chief Robert Dubé and began implementation this year, would see all future paramedics — those trained in advanced life support — also receive training as firefighters. The idea is to have someone capable of providing ALS on every ambulance and fire apparatus; currently, most fire engines are staffed only by those capable of basic life support.
Dubé said the new system, which he described as a “nationally recognized model” used by most surrounding jurisdictions, will ensure medics are more evenly distributed throughout the city without incurring the significant costs of hiring additional personnel. Currently there are three ladder trucks and eight fire engines — nine in December with the staffing of Station 210 — but only six ambulances stationed in the city.
“Not all stations have ALS, but under the new system, they all will,” he said. “It will also allow us to make sure all engines have a full crew of four people, which is safer. Now, some of them only have three.”
Since the transition began, 38 people have begun the cross-training process: 26 firefighter/EMTs, who already are trained in basic life support, and 12 dedicated paramedics. Station 207 is the first in the city under the new model, which debuted in July.
The local branch of the International Association of Fire Fighters, which also represents the city’s medics, endorsed the plan in a statement last month, under the conditions that no dedicated paramedic is forced to switch, switches require additional compensation and that no one is fired for refusing to enroll in cross-training.
But the move doesn’t sit well with the Alexandria Professional Medics Association. The group said the change, which requires reducing the number of ALS-capable paramedics in ambulances from two to one, actually could hurt service.
“A medic will have to decide if they can handle a situation or need more help,” said Michael Kohrt, president-elect of the group. “But if a patient has trouble breathing or is not breathing anymore, it can be very difficult for one paramedic to do everything that needs to be done — from clearing the airway or inserting an IV — so they’ll have to call for help and get another medic.
“And that means either another ambulance or a fire truck or an EMS supervisor. So there’s a potential delay in care.”
But Dubé pointed to data showing that in 45 percent of medical emergencies in the city in 2013, a fire unit arrives first at the scene.
“Both [ambulances and fire units] go to the call anyway, and they always have,” he said. “So if a fire engine gets there first, it’s better to have one ALS medic there than none.”
Although Kohrt acknowledged that occasionally fire units arrive at the scene of an emergency before an ambulance because medics are generally busier, he said in another common scenario, the engine arrives first for purely logistical reasons.
“Whenever I go with the engine, they leave the station in front of me and then I follow them,” he said. “Engines are bigger, louder and they have an easier time clearing traffic. So by virtue of me arriving behind them, they’ll arrive before I do.”
Kohrt said his group’s other major concern is a fear that dedicated medics eventually will be forced out of or encouraged to leave the department. He said the transition means the only promotion opportunity outside of step raises for medics, who are considered civilians — the EMS supervisor position — will be phased out in favor of sworn EMS captains, who must be cross-trained firefighter/medics.
“One thing that will happen if the chief’s plan moves forward is there will be no more civilian medics hired and everyone will be weeded out: transition to firefighters or leave by retiring or going someplace else,” Kohrt said. “They said they won’t force us out or to transition, but by not supporting us, by not hiring more of us or affording promotional opportunities, that’s what they’re doing.”
But Dubé countered that becoming a sworn firefighter/medic actually provides a much better career ladder for medics. Instead of only having the EMS supervisor position, one automatically gets an effective 20 percent pay increase, better benefits, and it opens up five levels of supervisory positions.
“So while they only had one promotion chance before, now they have five,” he said. “And I want to reiterate that we’re not forcing anybody to switch, and we’re actually looking at other career opportunities to provide to those who want to stay civilian medics.”
Dubé said he will convene a work group starting next month to look at a number of options for new supervisory positions for civilian medics. Kohrt said members of his group are excited to take part in those discussions and noted department leaders have been very responsive to the group’s concerns. But he said there simply is a philosophical difference in opinion about how best to provide service.
“Our problem with the model change isn’t their responsiveness to asking questions or our finding problems; it’s that we don’t think it’s a change for the better,” he said. “It’s been an award-winning EMS system for years and years and years. We shouldn’t change to be like other people — other people should be like us.”