Editor’s note: J. Burk Gossom, MD, who was San Juan EMS Medical director from 1980-1999, wrote the following letter to Public Hospital District No. 1 Board of Directors on Feb. 4, 2018.
Submitted by J. Burk Gossom, MD
Today’s firefighter is a highly trained professional. In addition to fighting fires, firefighters are charged with search and rescue. The physical requirements can become daunting as they are required to don heavy equipment and throw themselves into hot and hostile environments. True heroes and all of us have seen news clips of firefighters risking their lives to save others.
Similarly with the EMS. The EMTs and Paramedics are highly skilled professionals who do not just transport patients but start treatment in the field. They need extensive knowledge of anatomy, physiology, illness, medications and treatment techniques.
The point being that no longer do we have a simple situation where one set of training can cover both fields. I compare firefighting to a paramilitary organization. This is evident in the very language. Command center, Captains, lieutenant, etc. They attack a fire and are required to meet strict physical standards. The number of major fires each year are few. The EMS team is a mash unit going on runs every day. A small team that needs to work closely together with each contributing and requiring constant training not only to keep up their skills but to keep up with the constant and rapid advances in emergency medicine. It is a very basic fact that the personalities and skill sets of firefighters and EMTs are quite different.
Consider human nature. Fire commissioners and Fire Chiefs run for these positions because of their interest in Fire. While you may get a great group of people and a great chief who can balance both fire and aid, it cannot and will not last.
These were the reasons we split the Aid from the Fire years ago, and they still apply. After the split, San Juan EMS went on to become one of the premier units in the country, with the best out of hospital cardiac arrest survival rates in the world. Our historic response time has been unparalleled. I do not want to return to a situation where the Aid unit is being managed by a board who splits its attention between two chiefs; two missions; two budgets; two personality groups. We want the highest level of excellence in both fire and aid and should not settle for less.
EMS inevitably ends up being in second place when it is part of a fire department. You can point to exceptions but they are just that, exceptions. It would be a huge mistake to believe passing the buck will solve the problems facing EMS. I recognize there are no easy or rapid solutions and it will take hard work and a number of years to rebuild. The answer to recent Aid Unit woes is to have better management and remember that the volunteers need to be treated like the precious commodity they are. This is your job and the Hospital Board was formed specifically to provide this leadership and oversight of the Emergency services on the Island. You should not abdicate your responsibility.