Dear United States Fire Service:

You are big, strong and the nation’s undisputed all-hazard responder. You have 30,000 departments across the nation and more than 1 million firefighters. You respond to millions of emergency medical calls each year in addition to your firefighting responsibilities. You have widespread respect from the public, a high-level fire administration in the federal government, the largest caucus in Congress, one of the most powerful labor unions in the country and envious political clout, as evidenced by your hosting the first Presidential Forum of the 2008 election earlier this year.

Despite this considerable strength, your recently released paper, Prehospital 9-1-1 Emergency Medical Response: The Role of the United States Fire Service in Delivery and Coordination, sounds awfully defensive. Even worse, in my opinion, the paper fails to meet its objective of proving that the fire service should be the coordinator and point agency for EMS in every community in the nation.

You did not need to ransack history to point out that the fire service has been involved with medical care since the Crusades. No one doubts that firefighters can provide medical aid. But your paper makes numerous unsubstantiated assertions that come off as reactive and defensive and hardly help your cause. Instead of just saying that the fire service is the nation’s EMS champion, why don’t you just become that champion? You can start by becoming truly passionate about EMS. Make EMS a fire service priority. Tell the world that EMS is mostly what you do. Make EMS the headliner of your conferences. Grow the IAFC’s EMS section from 1,200 members to 12,000. Demand that the fire-service trade journals dedicate more than a column and an occasional article to EMS.

You applaud Miami Fire Rescue for recognizing the importance of medical response and changing its name to include the word “rescue.” I suggest all fire departments stop calling themselves fire departments, and instead embrace EMS in their titles.

If you truly want to be the nation’s EMS champion, advocate for EMS at a national level and for the needs of all EMS providers. Your fire caucus and lobbying organizations have left EMS out in the cold for too long, thus resulting in a growing movement among non-fire-based EMS organizations to organize and advocate for EMS as a distinct and important part of healthcare, public health and public safety. True EMS advocates clamor for more attention and dollars for EMS on a federal level. They want to strengthen EMS’ place in the federal government through the creation of an EMS Congressional caucus and a single, high-level, federal EMS agency. If this movement worries you – join in the fight.

As the big and powerful fire service, you can lead the fight for more recognition for EMS without bullying. Embrace the fact that EMS is diverse and that no one system design has been proven universally effective. Everyone will respect your honesty. Use your clout to push the government to recognize the critical importance of EMS in every community. As you do, all ships will rise with the tide, but no one will fail to notice that yours is the largest ship.

If you are serious about the fire service taking the point position on EMS, why not change the names (and attitudes) of the US Fire Administration and the Congressional Fire Services Institute to include EMS? As the nation’s EMS champion, why not join with all of the non-fire-based EMS groups in an effort to bring attention to the flawed fee-for-transport system and help create something new? Such unity would be difficult to ignore. And while you’re at it, use your clout to help the nation figure out how to provide quality EMS care in rural areas where workforce shortages are huge, and there are no union jobs. Such efforts would make your predecessors, the Maltese Knights, proud.