Why do Fire Engines Arrive Before Ambulances?

The fire service has changed drastically over the short time it has existed. With the advent of Emergency Medical Services (EMS) roughly 50 years ago, the fire service had to figure out a way to provide that service as many towns and jurisdictions turned to them to EMS coverage to their fire districts.

“Why do fire engines arrive before the ambulance?” It is a question the fire service hears a lot. The answer is quite simple:

In terms of logistics in providing the best care possible to sick or injured individuals, early response and arrival of medically trained fire personnel are essential. The considerations that drive the decision and result in fire engines arriving before ambulances are cost, training, limited resources, and strategic placement of those limited resources.

Since the advent of Emergency Medical Services (EMS), the fire service has worked hand in hand with EMS agencies to deliver patient care, both as primary providers and as early first responders, provide strategic and logistical support, and generally aid in the overall mission success of delivering emergency care to people in need.

A Quick History of Emergency Medical Services

The only concept similar to emergency medicine that predates the 1970s is battlefield care for the wounded. But even this was not truly emergency medicine. Treatment was not provided on the scene in most cases.

Why do Fire Engines Arrive Before Ambulances?

Wounded soldiers would be scooped up and taken to forward stationed hospitals and treatment areas where the patient care would take place. Orderlies simply looked for live soldiers among the ruins of battle and brought them in the condition they found them to the field hospitals. This has happened as far back as history is recorded, sometimes days after a battle has taken place.

In the United States, ambulances have been around since the Civil War era, but on an extremely limited basis. Until the 1970s, ambulances generally loaded a patient up and delivered them to the closest hospital. In rare circumstances, there may be limited basic supplies on board, and in many cases, a patient simply was loaded without anyone else in the back with them.

During this time, several big cities were experimenting with organized ambulance care, in most cases based out of hospitals with local doctors riding along to treat patients in the field. It was not until the Vietnam era that emergency treatment in the field took off.

In 1966 the National Highway Safety Act created the Department of Transportation which was tasked with, among many other things, developing a national model and standards for getting emergency medical care to the general public in the field.

In 1973 the Emergency Medical Services Act established operational areas of the EMS system and gave birth to the system we have today. Fast forward almost 50 years and the result of research and data collection has brought EMS to where it is today, a multifaceted system that utilizes other agencies, such as fire departments, to achieve successful patient outcomes.

Why Fire Departments?

The fire service has long been the “catch-all” for any function or emergency where there are no real specializations. A given day may see a fire department run medical calls, inspect new construction, deliver fire education programs, and control traffic, but not fight or extinguish any fires.

Why do Fire Engines Arrive Before Ambulances?

And medical emergencies have become a bulk of the emergency calls that fire departments experience. Fire departments expect to perform when there is an emergency. Mass casualty events, natural disasters, specialized rescues, building fires-it does not matter. The general public expects the fire department to be efficient and reliable in times of need.

How did this happen? Mostly by their own doing. For generations, firefighters were not only willing to step in and help but vocal in their abilities and pride. This has pushed the fire service to a model today where the fire service faces challenges head-on and continues to willingly take on new responsibilities.

This happens for a variety of reasons, but politics aside, it has a lot to do with municipalities and local governments spending a lot of money to staff and equip fire departments and community members, and taxpayers that want to see a return on their taxes and donations.

So, back to why fire engines arrive before ambulances. Three main reasons: strategic locations, available resources, and medical necessity.

Strategic Locations

As technology and resources became available to towns and rural areas, fire departments were founded and started in just about every small town. Larger cities had numerous fire departments, each taking care of their blocks or districts. Departments quickly moved beyond hose carts and bucket brigades as communities and departments constantly worked to improve their fire coverage.

The one thing in common throughout all of these departments, regardless of rural or urban, volunteer or paid/career, was the desire of firefighters to better their communities and offer whatever they could do to improve the communities and protect the residents within those districts. This creation and organization of fire departments have led to a vast system of departments within the fire service.

From major metropolitan areas to rural communities of a few hundred people, the fire service has reached beyond all demographics to establish this vast network of departments and emergency responders. The result is an amazingly large amount of strategically placed fire departments and first responders throughout the country.

Statistically, there are far fewer EMS stations than fire stations, and many stations double as both. The same can be said for ambulances versus fire apparatus. For example, a local county has 16 fire departments and 6 EMS stations, and about 80 fire apparatus to 14 ambulances.

Some of the EMS responses can take more than 20 or 30 minutes to respond, and it gets far worse in rural areas. In rural America, it can still take over an hour or longer to get an ambulance. Fire departments fill these response gaps.

The strategic location of these fire departments allows firefighters to respond and get to the medical emergency a lot faster providing potentially life-saving care for the patient until the EMS personnel arrive on the ambulance.

The ability of fire departments to arrive before EMS and initiate patient care has resulted in states enacting certain minimums and requirements for departments within their states. While the desire of individuals to respond and help are at the root of the fire service responding to medical calls, certain training minimums and certifications ensure quality patient care.

How do ambulances know where to go? Check out our article HERE!

What Resources do Fire Engines Have for Medical Emergencies?

The historical fire service response to medical calls is like the old question about the chicken and the egg. What came first? Did fire departments acquire resources so they could respond to medical emergencies, or did the medical emergencies they were asked to respond to initiate their need to get resources to keep up?

Why do Fire Engines Arrive Before Ambulances?

Either way, the results are fire departments that are equipped with the resources to provide at least basic care to individuals experiencing medical emergencies. These resources come in many forms, the most important of which is manpower.

In many instances, the most important resource on a fire engine responding to medical emergencies are the firefighters themselves. Most receive at a minimum basic medical training and can effectively deliver emergency care that might otherwise take considerably more time to initiate, in some cases an hour or more.

Beyond the staffing on the fire engines, many fire engines are equipped with medical equipment to aid in the delivery of medical care. It is more and more common to staff fire engines with firefighters trained to the paramedic or other Advance Life Saving (ALS) level.

This allows them to administer drugs and other breathing and cardiac interventions while waiting for the ambulance to arrive.

Other resources include the specialized equipment and training necessary to extricate, disentangle, rescue, access, or otherwise retrieve patients. When responders are dispatched to medical emergencies, they never know exactly what they are getting into. A modern fire engine has the basic equipment to function independently, and if they are not able to solve the problem, they can quickly secure the resources to do so.

Medical Necessity

One thing learned early on in EMS is the fact that many emergencies require lots of help. Most ambulances are staffed with 2 care providers. Many emergency medical calls require more than 2 providers to resolve safely and effectively.

Patients can be stuck in tight or hard to access spaces, weigh hundreds of pounds, require lifting or moving, or generally require move manpower than an ambulance crew can provide. More providers, the fire engine, is necessary to bring the medical emergency to resolution.

Beyond physical help maneuvering and accessing patients, many medical emergencies themselves require multiple care providers. Patients in cardiac arrest requiring Cardiopulmonary Resuscitation (CPR) can easily require 3-4 providers. Other patients may be experiencing multi-system traumas or medical conditions that require additional care providers.

When the emergency medical response is needed, it is easy to see why fire engines are sent to the scene with the ambulance, often arriving first and initiating the care of the patient. Fire engines arrive before ambulances so that, when lives hang in the balance, the best resources are there, in a timely fashion, to offer the best outcome to the emergency.

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