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
Not too many years past, fighting a fire consisted of putting a kerchief across your face and squirting water on a fire. A patient with a medical problem would be thrown in the back of an ambulance and rushed to the ER. How things have changed.
Today’s firefighter is a highly trained professional. They have expertise in a multitude of fires; chemical, structure, electrical, etc. They have sophisticated and complicated equipment. Pumps, chemicals, air packs and other protective gear. They need constant training to keep their skills up. They fight fires in a coordinated manner with a Chief directing the attack of the fire with lieutenants under him. In addition to fighting fires, firefighters are charged with search and rescue. They may have special training in mountaineering and other skills. 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. No longer is the measure of a good aid unit speed. 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. They routinely do cardiograms, administer medication, start iv’s, intubate patients, treat collapsed lungs and I can go on. We have all seen examples of these highly trained teams working in critical, life-threatening situations.
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. The equipment consists of personal protection gear, trucks, pumps, etc. They attack a fire and are required to meet strict physical standards. With better building codes, smoke detectors, etc. 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. You have fire commissioners and a fire chief. How hard is it to understand the word fire? 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. We were the first in the country to do early defibrillation, we were among the first in the country to have a paramedic on every run and give our paramedics their own response vehicle, give clot-buster medications for heart attacks in an out of hospital setting and the list goes on. Our historic response time, despite being a volunteer unit, 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 different missions; two different budgets; two different personality groups. I want Fire commissioners focusing with laser-like intensity on Fire and rescue. I want the Hospital commissioners to bring the same focus to EMS. 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, and rarely last as they are dependent on exceptional individuals rather than sound structure. It would be a huge mistake to believe passing the buck will solve the problems facing EMS. I do not envy your position and I recognize you are the unfortunate heirs of the current problems. 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.
