At a recent meeting with a fire department, a fire chief proudly announced to me, "We do EMS." The fire chief left the room and the meeting progressed with his command staff.

As the meeting proceeded, it was sadly apparent that this department "did EMS," but at what level? I did not say anything - I just listened! Finally, about two hours into the meeting, a deputy chief said, "We need to tell him the truth." The room went silent as though some death announcement was coming. Finally, the truth came out when another deputy chief, was almost embarrassed to say, "We do EMS, but what we do is terrible."

The deputy chief went on to admit that even though the department went on EMS calls, that was the extent of it. No EMS training occurred. There was no quality improvement program to look at how EMS was delivered and where it could improve. Supervision of EMS consisted of one captain in an SUV on each shift refilling drug orders and trading out broken EMS equipment - nothing else.

Hearing how this fire department operated its EMS system led me to conclude that there are four categories by which fire departments go about delivering EMS: They do not tolerate the EMS mission; they tolerate the EMS mission; they accept the EMS mission; or they embrace the EMS mission.

Fire departments that do not tolerate the EMS mission are those that want nothing to do with EMS. Most of these fire departments do not run EMS calls and EMS is not even thought of in the department's mission. EMT or paramedic qualifications are not even considered when the hiring process occurs. If one of these departments was treating a critical patient, it would abandon that person if a house fire came in. Most such fire departments do not run first-responder calls. Unfortunately, I know of at least one major metropolitan fire department that falls into this category. The people of that city truly receive a degraded level of service.

The next category concerns fire departments that tolerate the EMS mission. These fire departments perform EMS as a part of their mission, but grudgingly. These fire departments respond on EMS calls, but usually do not have advanced life support (ALS) companies or paramedics. The tone from the top of the organization is, "Well, we perform EMS, but if I had my way, we wouldn't." This trickles down through the rest of the fire department. One time, I walked into the office of a fire chief and saw a sign taped up behind his desk that he obviously created on his personal computer. The sign read, "problEMS." The sign clearly implied that "E-M-S" were the last three letters in the word "problems."