Chapter 23: Fire and Emergency Medical Care
1
Pre-Lecture
I. You Are the Fire Fighter
Time: 5 Minutes
Small Group Activity/Discussion
Use this activity to motivate students to learn the knowledge and skills needed to understand the role of the fire service in
emergency medical care.
Purpose
To allow students an opportunity to explore the significance and concerns associated with emergency medical care.
Instructor Directions
1. Direct students to read the “You Are the Fire Fighter” scenario found in the beginning of Chapter 2.
2. You may assign students to a partner or a group. Direct them to review the discussion questions at the end of the
scenario and prepare a response to each question. Facilitate a class dialogue centered on the discussion questions.
3. You may also assign this as an individual activity and ask students to turn in their comments on a separate piece of
paper.
Lecture
I. Introduction
Time: 5 Minutes
Slides: 1-5
Lecture/Discussion
A. This chapter will help you understand the role played by the fire department in providing emergency
medical services (EMS).
B. This role varies from one department to another.
C. By learning the components of the EMS system, you will have a better understanding of the relationship
between fire departments and EMS, including:
1. The importance of EMS as part of the fire department mission of saving lives and protecting property
2. The difference between basic life support (BLS) and advanced life support (ALS) levels of emergency
medical care
3. The different types of EMS training and certification
4. The importance of EMS training for fire fighters
5. The different types of EMS systems provided by fire departments
6. The variety of interactions between EMS providers and other members of the health care team
D. The material presented in this chapter is not designed to make you an EMS provider.
1. To achieve that goal, you will need to take an approved course leading to certification or registration as
a First Responder, an Emergency Medical Technician-Basic (EMT-Basic), an Emergency Medical
Technician-Intermediate (EMT-Intermediate), or an Emergency Medical Technician-Paramedic (EMTParamedic).
Chapter 23: Fire and Emergency Medical Care
2.
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This material introduces you to the different levels of care that EMS systems provide, the types of
training available in EMS, the types of EMS systems found in fire departments, and the other health
care providers who are also part of the EMS system.
II. The Importance of EMS to the Fire Service and the Community
Time: 10 Minutes
Slides: 6-8
Lecture/Discussion
A. The mission of the fire service is to save lives and protect property.
B. When many people think of their fire department, they think of fire suppression first.
1. However, in some fire departments, more than 80% of the emergency calls are requests for emergency
medical services.
2. Many fire departments have added “EMS” or “rescue” to their names to reflect this change.
C. Most fire departments provide some level of emergency medical services, although the degree of
involvement varies.
1. Some departments provide only extrication and medical assistance for vehicle collisions.
2. Others are the first responders for emergency medical calls, or provide basic or advanced life support
until another agency arrives to transport the patient.
3. Still other fire departments provide both medical first response and patient transportation services.
D. Delivering emergency medical service fits directly into the fire department mission of protecting lives and
property.
E. The same fire stations, emergency vehicles, and fire fighters that are available to respond quickly to fires
can also be used to deliver assistance to people who need urgent medical care.
1. Relatively small investments in EMS training and equipment can greatly increase the fire department’s
ability to deliver life-saving services to the public.
F. In most communities, much of the funding for the fire department’s operations comes from tax dollars paid
by the citizens of that community.
1. Their continued support is vital for the department’s fire suppression and EMS activities. EMS
functions deliver both an essential service to the citizens and positive public relations for the
department.
2. The community responds positively, and its support enables your department to maintain its
effectiveness in all areas of operation.
G. When you respond to an emergency, you should realize that the citizen who called 9-1-1 probably had little
or no training in identifying a medical emergency or knowing what to do to help a person in distress.
1. Sometimes, what the caller perceives as an emergency is actually a minor incident.
2. At other times, the call may not be made until the patient’s condition is literally life-threatening.
H. A competent and caring EMS provider will always remain supportive of the patient and the caller, even
when the call was unnecessary or delayed.
III. Levels of Service
Time: 5 Minutes
Slides: 9-13
Lecture/Discussion
Chapter 23: Fire and Emergency Medical Care
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A. Emergency medical services are provided at the basic life support (BLS) level and at the advanced life
support (ALS) level.
B. Basic life support is the level of medical care that can be provided by persons trained to perform a limited
set of emergency medical skills.
1. Basic life supports skills include:
a. Scene control
b. Evaluating conditions for responder safety
c. Patient assessment
d. Basic airway management techniques
e. Cardiopulmonary resuscitation (CPR)
f. Administering oxygen
g. Splinting
h. Controlling external bleeding and bandaging
i. Treating for shock
j. Lifting and moving patients
k. Transporting patients to an appropriate medical facility
2. BLS providers can perform cardiac defibrillation to return an irregular heartbeat to a normal rhythm by
using an automated external defibrillator (AED).
3. But basic life support services do not include the administration of medications beyond assisting the
patient with his or her prescribed medications, or the administration of intravenous fluids.
4. People qualified to perform BLS skills are trained as medical first responders or as EMT-Basics.
C. People who provide advanced life support (ALS) services have extensive training in advanced lifesaving
procedures.
1. Advanced life support systems require a greater investment in equipment and personnel training than
BLS systems.
2. Advanced life support skills include:
a. Advanced airway management techniques
b. Endotracheal intubation to keep the airway open and help the patient breath
c. Administering intravenous fluids to treat shock
d. Administering medications for various conditions
e. Monitoring and interpreting heart rhythms
f. Electrically pacing the heart by using medical intervention
g. Defibrillating the heart
h. Removing trapped air from the chest
3. Advanced life support services include airway techniques such as endotracheal intubation and
administration of intravenous fluids or medications.
4. Advanced life support personnel operate as the extension of a physician and use standing orders,
protocols, and/or radio direction from the physician to assure uniform and correct treatment.
5. People who provide advanced life support are trained as EMT-Paramedics, although there are also
EMT-Intermediate levels of training that include limited advanced life support skills.
IV. Training
Time: 15 Minutes
Slides: 14-23
Lecture/Discussion
A. Most fire fighters will need to learn some emergency medical care techniques.
Chapter 23: Fire and Emergency Medical Care
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2.
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Many departments require that all personnel be trained in EMS as well as in fire suppression.
The required training level will depend on the design of the local emergency medical service delivery
system and on the functions performed by the fire department.
B. EMS providers may be trained to provide basic or advanced life support.
C. EMS courses in the United States follow a national standard curriculum, established by the U.S.
Department of Transportation that assures uniformity of knowledge and skills.
1. Basic life support courses are offered at the first responder level and at the EMT-Basic level.
2. The first responder course is designed for people such as police officers, teachers, and day care
providers who encounter medical emergencies as part of their jobs.
a. The first responder is expected to assess and provide basic care for the patient until EMT-Basics or
EMT-Paramedics arrive to provide further care and transportation to a medical facility.
b. The first responder course typically exceeds 40 hours in length and is designed to train a person to
stabilize a patient at the scene by providing immediate, lifesaving care such as controlling
bleeding, establishing an airway, initiating CPR, and using an AED.
c. A first responder course covers many of the same topics as the EMT-Basic course but without as
much detail.
d. A first responder course will not prepare a person to work on an ambulance.
e. It is designed for people who will treat patients at emergency scenes either under the direction of
an EMT or prior to the arrival of EMT-Basics or EMT-Paramedics.
f. First responders can be certified in some states or nationally registered through the National
Registry of Emergency Medical Technicians.
3. The Emergency Medical Technician-Basic (EMT-Basic) course involves more than 110 hours of
training.
a. The EMT-Basic course teaches:
i.
Scene size-up
ii.
Securing the scene and scene safety
iii.
Patient assessment
iv.
Simple airway techniques
v.
CPR
vi.
Splinting
vii.
Bandaging
viii.
Administering oxygen
ix.
Lifting and moving ill and injured patients
x.
Controlling external bleeding
xi.
Treating for shock
xii.
Ambulance operations
xiii.
Performing cardiac defibrillation using an automated external defibrillator (AED)
b. The course consists of lectures, skills practice, and observation time in an emergency department
and on an ambulance.
c. EMT-Basic certification is the minimal level of training necessary to provide care to a patient in
an ambulance.
d. After completing EMT-Basic training, a student may become a state-certified EMT-Basic, a
nationally registered EMT-Basic, or both, depending on the state in which he or she was trained.
4. The Emergency Medical Technician-Paramedic (EMT-Paramedic) program is designed to teach
advanced life support skills and techniques.
a. Most EMT-Paramedic courses require at least one year to complete and build on the EMT-Basic
course.
b. Covered areas include:
i.
Using electrocardiograms to evaluate the patient
ii.
Administering medications
iii.
Inserting endotracheal tubes into the airway
iv.
Electrically pacing the heart
v.
Defibrillating the heart
c. The EMT-Paramedic course also covers the causes and treatments of diseases.
Chapter 23: Fire and Emergency Medical Care
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d.
The course includes both clinical time in the hospital and time working on an advanced life
support unit.
e. A student who completes the EMT-Paramedic program is eligible to become a state-certified
EMT-Paramedic, a nationally registered EMT-Paramedic, or both, depending on the state in which
he or she was trained.
5. Most states have established standards for an intermediate level of care.
a. The Emergency Medical Technician-Intermediate (EMT-Intermediate) can perform a limited
number of advanced life support skills.
b. The skills that an EMT-Intermediate can perform vary from one state to another.
c. Like EMT-Basics and EMT-Paramedics, EMT-Intermediates can be state-certified, nationally
registered, or both, depending on the state in which he or she was trained.
d. Both EMT-Paramedics and EMT-Intermediates work under the direction of physician medical
directors.
D. EMS training may be offered through a fire-training academy, a community college, a vocational training
center, or a hospital.
1. In some areas, fire fighters receive this training before beginning work with the department; in other
jurisdictions, the training is provided by the fire department to employees.
E. To keep up with changes in the EMS field and to refresh current skills and knowledge, EMS providers must
attend continuing medical education (CME) classes (also commonly referred to as continuing education
units or CEUs).
1. These classes are important to ensure that EMS providers are performing at a satisfactory level and are
aware of changes in medical protocols or procedures.
2. They also provide an opportunity for EMS crews to review some of their more interesting calls, which
can be an invaluable learning experience.
3. Because state and national requirements for recertification include on-going education, these sessions
can count toward recertification.
4. CME is also an important part of a fire department’s efforts to improve the quality of its services.
V. EMS Delivery Systems
Time: 10 Minutes
Slides: 24-27
Lecture/Discussion
A. Emergency medical services can be delivered in several ways.
1. Various organizations, including fire departments, separate EMS departments, law enforcement
agencies, hospitals, volunteer organizations, and for-profit companies can operate EMS delivery
systems.
2. Some EMS systems operate with a combination of these organizations performing different roles.
3. Local and state government officials usually decide which agency will handle EMS, and it is important
to realize that one type of system is not inherently better or worse than another.
4. The quality depends on the training and dedication of the EMS providers and the quality assurance
measures that are implemented within the system, not on the system used.
B. There are several advantages to having EMS systems located in the fire department.
1. The entry requirements for fire fighters help assure quality employees.
2. Most fire departments are required to regularly monitor the health and fitness of their employees and
have mechanisms in place for continuing education.
3. Fire departments also have the infrastructure in place to support EMS operations, including radio
systems, dispatch services, and fire stations located strategically throughout the community.
Chapter 23: Fire and Emergency Medical Care
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4.
C.
D.
E.
F.
G.
The fire department is familiar with the community and its people, which can be invaluable when
responding and treating patients.
There are two primary types of EMS delivery systems within fire departments: combination systems and
fire department EMS systems.
In a combination system, the fire department provides only medical first response, while EMS transport is
provided by a separate agency.
1. The EMS first response services may be part of an engine or truck company’s responsibility, or
provided by a special EMS unit. First response may be provided at the basic or advanced life support
levels.
2. Although this system limits the number of fire department personnel dedicated to EMS and does not
require them to transport patients, it also has disadvantages.
a. A fire company may be out of service for a long time if it must wait for a transport unit from
another agency to arrive.
b. Patient care can be adversely affected if there are not enough EMS transport units available.
3. A combination system requires that fire department personnel and transport agency personnel have a
good working relationship and effective communications.
4. The responsibility for patient care must be transferred from the fire department to the agency that
operates the ambulance.
a. One way to ensure this is through joint training efforts.
In fire department EMS systems, the fire department provides both medical first response and EMS
transport.
1. Both medical and transport services may be provided at either basic life support or advanced life
support levels.
2. As in a combination system, engine companies, truck companies, or special EMS units may be used
for medical first response.
3. Because all of the personnel work for the same agency, training is easily accomplished and efforts are
coordinated under a united control.
Some fire departments that supply EMS service cross-train personnel in both fire suppression and
emergency medical services.
1. Cross-training enables the department to rotate personnel between fire suppression duty and EMS duty.
Other departments train the personnel in either fire suppression or EMS, resulting in a separate staff of
EMS providers within the department.
VI. Interactions
Time: 10 Minutes
Slides: 28-31
Lecture/Discussion
A. If you become an EMS provider, you will come into contact with many people in your community.
1. EMS providers must strive to be equal service providers.
2. You must do your best to provide prompt, efficient, competent care for all members of your
community, regardless of their age, socioeconomic background, or nature of injury.
3. Your attitude will affect the way patients, their family members, and bystanders respond to you.
4. Your attitude may even affect the way people judge the care you deliver.
B. Each EMS system has a physician medical director who authorizes the providers in the service to deliver
medical care in the field.
1. The appropriate care for each injury, condition, or illness that EMS providers will encounter is
determined by the medical director and is described in a set of written standing orders, or protocols.
Chapter 23: Fire and Emergency Medical Care
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2.
3.
4.
Medical control is either off-line (indirect) or online (direct), as authorized by the medical director.
Standing orders are a type of indirect medical control.
The standing orders direct the EMS providers to take specific action when they encounter different
situations.
5. Each EMS provider must know and follow the protocols developed by the system’s medical director.
6. The medical director is the ongoing working liaison for the medical community, hospitals, and the
EMS providers.
7. If treatment problems arise or different procedures should be considered, the medical director must be
consulted for a decision and directions.
8. The medical director also determines and approves the continuing education and training courses that
are required to ensure that proper training standards are met.
C. When EMS providers transport a patient to a hospital for additional care, they must transfer the care of the
patient to hospital personnel.
1. A good working relationship between EMS providers and other members of the health care team helps
ensure good patient care.
2. An understanding of the hospital procedures and policies will also help EMS providers who may be
required to assist hospital personnel during the transfer.
VII. Summary
Time: 5 Minutes
Slide: 32
Lecture/Discussion
A. As a new fire fighter, you will have an important role in providing emergency medical services to the
citizens of your community
B. Emergency medical services are provided at the basic life support (BLS) level and at the advanced life
support (ALS) level.
C. Most fire fighters will need to learn some emergency medical care techniques.
D. Emergency medical services can be delivered in several ways. You must do your best to provide prompt,
efficient, competent care for all members of your community, regardless of their age, socioeconomic
background, or nature of injury.
Post-Lecture
I. Wrap-Up Activities
Time: 40 Minutes
Small Group Activity/Individual Activity/Discussion
A. Fire Fighter in Action
This activity is designed to assist the student in gaining a further understanding of the fire department’s role in emergency
medical care. The activity incorporates both critical thinking and the application of fire fighter knowledge.
Chapter 23: Fire and Emergency Medical Care
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Purpose
This activity allows students an opportunity to analyze a firefighting scenario and develop responses to critical thinking
questions.
Instructor Directions
1. Direct students to read the “Fire Fighter in Action” scenario located in the Wrap-Up section at the end of Chapter 23.
2. Direct students to read and individually answer the quiz questions at the end of the scenario. Allow approximately 10
minutes for this part of the activity. Facilitate a class review and dialogue of the answers, allowing students to correct
responses as needed. Use the answers noted below to assist in building this review. Allow approximately 10 minutes for
this part of the activity.
3. You may also assign these as individual activities and ask students to turn in their comments on a separate piece of
paper.
Answers to Multiple Choice Questions
1. Answer B: The fire fighters who are trained at the EMT-basic level can provide basic life support treatment (BLS).
2. Answer B: An EMT-basic can only perform BLS functions. These functions often support the more advanced treatment
provided by a paramedic. Starting an IV and administering drugs are ALS functions.
3. Answer A: The engine company is a BLS unit and should begin providing BLS treatment to the seriously injured patient
until an ALS unit arrives. When the medic unit arrives, the paramedics will assume responsibility for treating and
transporting the patient.
4. Answer B: After the paramedics arrive and take over treatment of the driver, the condition of the passengers should be
evaluated. This can be performed by BLS providers.
B. Technology Resources
This activity requires students to have access to the Internet. This may be accomplished through personal access, employer
access, or through a local educational institution. Some community colleges, universities, or adult education centers may
have classrooms with Internet capability that will allow for this activity to be completed in class. Check out local access
points and encourage students to complete this activity as part of their ongoing reinforcement of firefighting knowledge and
skills.
Purpose
To provide students an opportunity to reinforce chapter material through use of online Internet activities.
Instructor Directions
1. Use the Internet and go to www.FireFighter.jbpub.com. Follow the directions on the web site to access the exercises for
Chapter 23.
2. Review the chapter activities and take note of desired or correct student responses.
3. As time allows, conduct an in-class review of the Internet activities and provide feedback to students as needed.
4. Be sure to check the web site before assigning these activities, as specific chapter-related activities may change from
time to time.
II.
Lesson Review
Time: 15 Minutes
Discussion
Note: Facilitate the review of this lesson’s major topics using the review questions as direct questions or overhead transparencies.
Answers are found throughout this lesson plan.
Chapter 23: Fire and Emergency Medical Care
A.
B.
C.
D.
E.
F.
G.
H.
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How does the delivery of emergency medical services (EMS) fit into the mission of the fire department?
Why can the delivery of EMS be considered a customer service issue?
How does basic life support differ from advanced life support?
What skills can be performed by ALS but not by BLS?
What are the two levels of EMS training for basic life support providers? For advanced life support
providers?
Why can EMS work well within a fire department?
How does a combination EMS system differ from a fire department EMS system?
What three groups interact with you as a fire department EMS provider?
III. Assignments
Time: 5 Minutes
Lecture
A. Advise students to review materials for a quiz (determine date/time)
B. Direct students to read the next chapter in Fundamentals of Fire Fighter Skills as listed in your syllabus (or reading
assignment sheet) to prepare for the next class session.