There’s Your Problem Right There

In his post on calling a sow's ear a silk purse the "rebranding" of the District of Columbia Fire Department – er, excuse me, that's DC Fire/Emergency Medical Services, or DC FEMS for short – TOTWTYTR points out that while the name has changed, the culture there is just as toxic as ever:

"About 20 years ago a fire fighter in DC was fired for having a bumper sticker on his car. The bumper sticker said “DC Fire, It’s not just a job, it’s a joke”. He got his job back because he happened to be the President of the fire fighter’s union. Sadly, it appears that the joke hasn’t changed in all that time."

Read the whole thing, as it were. There's far more to his post than just the little piece I excerpted.

DC Fire/EMS has long been the smelly armpit of our country's metropolitan EMS systems. It is dysfunctional from the top down, bereft of effective leadership, and the landscape there is littered with the professional corpses of respected physician medical directors who tried, and failed, to polish that turd.

While they're rebranding, why not come up with some catchy slogans, too?

DC F/EMS: Don't let the name fool you, we're actually quite butch.

DC F/EMS: As long as we have Congress, we'll always be the second-most dysfunctional organization in town.

DC F/EMS: Hey, at least it's prettier here than in Detroit!

DC F/EMS: It's pronounced "Eff EMS."

This is not to lay the blame directly on the men and women manning those ambulances and fire apparatus, although they bear their share of it. Within any organization there exists a certain percentage of incompetents, malcontents and assholes. This is true anywhere you go.

It's just that the DC Fire/EMS administration (or union, depending on whom you talk to) seems to be remarkably tolerant of theirs, or at least, they insist on denying that have any.

And it cannot be easy to work there. Their fleet managers can't field ambulances with working air conditioners in a southern city that was friggin' built on a malarial swamp, the supply officers and purchasing agents can't outfit and equip their firefighters sufficiently, and their training (at least EMS-wise) has been a sad joke for years. And they insist on mashing together people who don't want to be together, and the command staff hopes that magic fairy dust of new policies and procedures and administrative Bandaids will make them embrace one another.

It won't.

Back in 2008 or so, DC Fire integrated civilian medics into its department to form an "integrated, all-hazards agency." These civilian medics got pay parity, rank and seniority, all without benefit of promotional exams or additonal training.

Now, if I were a firefighter with no interest in EMS, that would piss me right the hell off, just as it would piss me off if a career firefighter with a still-wet EMT-B card overruled me on a patient care decision just because he occupied a higher rung on the command ladder.

I have long said that fire and EMS are not a natural mix; we're different animals with different mindsets and different goals, and forcing us to cross-train in the other's role is a recipe for discord. Each role – fire suppression and EMS – is sufficiently important and complex that individuals should be allowed to focus on one or the other.

That is not to say that some departments haven't done the merger well, and there are plenty of medics who manage both roles well.

But there are plenty more who don't, if for no other reason than the other role wasn't what they signed up for. If you make somone undertake an endeavor unwillingly, the results of that endeavor are going to be corresspondingly shitty. Or, as I put it in an old EMS1.com column:

Imagine you have an accountant named Murray. One day, you come to him and say, "Murray, you're a darned fine accountant. I don't know how I'd manage my finances without you. But I'd like my household to run a bit more efficiently, so I need you to handle my legal matters as well. So I'm going to send you to Shysters R Us law school at night. Once you graduate, you'll still be handling my taxes. But you'll also be handling my real estate holdings, my estate planning, representing my adolescent son in his drug possession case, suing the police department in my unreasonable force case, getting me a cash settlement for my OTJ injury and my Dad's mesothelioma and asbestos exposure, and handling my divorce. So you'll need to be an expert in estate law, criminal defense, personal injury law, family law, and juvenile law…in addition to being the darned fine accountant that you already are.

By the way, this extra work is going to quadruple your workload, and you can expect to do 80 percent lawyering and 20 percent accounting. And to show you what a generous guy I am and to show you how much I respect the legal work you do…I'll pay you an extra $125 a month."

Do you think Murray might be just a little resentful, and do a less-than-stellar job as an accountant or a lawyer?

In his blog post, TOTWTYTR links to a Firehouse.com discussion forum thread on the DC F/EMS rebranding. Most of the commenters recognize it for the window dressing that it is. One comment, however, did catch my attention, presumably posted by a member of DC Fire/EMS:

"ACTUALLY…

Our first and foremost *mission* was, is and always will be the suppression of and protecting our citizens and visitors from the deadly forces of fire."

WRONG.

There's your problem right there, and I'd imagine that attitude is not a rare one at DC Fire/EMS, or for that matter, any dual-role department where fire and EMS were unwillingly merged.

Fire suppression *was* your first and foremost mission, Bub. It's not any more, and hasn't been for years.

When you work for a department that does 80% EMS calls and 20% fire calls, your primary mission is EMS.

And until that inconvenient fact is accepted widely enough that it becomes a part of your organizational culture, you will continue to be the nation's most dysfunctional EMS system.