FIRE SERVICE

Fire fighters spend much of their time at fire stations, which usually have features in common with a residential facility like a dormitory. When an alarm sounds, fire fighters respond rapidly, regardless of the weather or hour. Fire fighting involves the risk of death or injury from sudden cave-ins of floors, toppling walls, traffic accidents when responding to calls, and exposure to flames and smoke. Fire fighters also may come in contact with poisonous, flammable, or explosive gases and chemicals, as well as radioactive or other hazardous materials that may have immediate or long-term effects on their health. For these reasons, they must wear protective gear that can be very heavy and hot.

Work hours of fire fighters are longer and vary more widely than hours of most other workers. Many work more than 50 hours a week, and sometimes they may work even longer. In some agencies, fire fighters are on duty for 24 hours, then off for 48 hours, and receive an extra day off at intervals. In others, they work a day shift of 10 hours for 3 or 4 days, a night shift of 14 hours for 3 or 4 nights, have 3 or 4 days off, and then repeat the cycle. In addition, fire fighters often work extra hours at fires and other emergencies and are regularly assigned to work on holidays. Fire lieutenants and fire captains often work the same hours as the fire fighters they supervise. Duty hours include time when fire fighters study, train, and perform fire prevention duties.

Applicants for municipal fire fighting jobs generally must pass a written exam; tests of strength, physical stamina, coordination, and agility; and a medical examination that includes drug screening. Workers may be monitored on a random basis for drug use after accepting employment. Examinations are generally open to persons who are at least 18 years of age and have a high school education or the equivalent. Those who receive the highest scores in all phases of testing have the best chances for appointment. The completion of community college courses in fire science may improve an applicant’s chances for appointment. In recent years, an increasing proportion of entrants to this occupation have had some postsecondary education.

As a rule, entry-level workers in large fire departments are trained for several weeks at the department’s training center or academy. Through classroom instruction and practical training, the recruits study fire fighting techniques, fire prevention, hazardous materials control, local building codes, and emergency medical procedures, including first aid and cardiopulmonary resuscitation.

They also learn how to use axes, chain saws, fire extinguishers, ladders, and other fire fighting and rescue equipment. After successfully completing this training, the recruits are assigned to a fire company, where they undergo a period of probation.

Among the personal qualities fire fighters need are mental alertness, self-discipline, courage, mechanical aptitude, endurance, strength, and a sense of public service. Initiative and good judgment also are extremely important, because fire fighters make quick decisions in emergencies. Members of a crew live and work closely together under conditions of stress and danger for extended periods, so they must be dependable and able to get along well with others. Leadership qualities are necessary for officers, who must establish and maintain discipline and efficiency, as well as direct the activities of fire fighters in their companies.

EMS FIELD

People’s lives often depend on the quick reaction and competent care of emergency medical technicians (EMTs) and paramedics—EMTs with additional advanced training to perform more difficult prehospital medical procedures. Incidents as varied as automobile accidents, heart attacks, drownings, childbirth, and gunshot wounds all require immediate medical attention. EMTs and paramedics provide this vital attention as they care for and transport the sick or injured to a medical facility.

In an emergency, EMTs and paramedics typically are dispatched to the scene by a 911 operator, and often work with police and fire department personnel. (Police and detectives and firefighting occupations are discussed elsewhere in the Handbook.) Once they arrive, they determine the nature and extent of the patient’s condition while trying to ascertain whether the patient has preexisting medical problems. Following strict rules and guidelines, they give appropriate emergency care and, when necessary, transport the patient. Some paramedics are trained to treat patients with minor injuries on the scene of an accident or at their home without transporting them to a medical facility. Emergency treatment for more complicated problems is carried out under the direction of medical doctors by radio preceding or during transport.

EMTs and paramedics may use special equipment, such as backboards, to immobilize patients before placing them on stretchers and securing them in the ambulance for transport to a medical facility. Usually, one EMT or paramedic drives while the other monitors the patient’s vital signs and gives additional care as needed. Some EMTs work as part of the flight crew of helicopters that transport critically ill or injured patients to hospital trauma centers.

At the medical facility, EMTs and paramedics help transfer patients to the emergency department, report their observations and actions to emergency room staff, and may provide additional emergency treatment. After each run, EMTs and paramedics replace used supplies and check equipment. If a transported patient had a contagious disease, EMTs and paramedics decontaminate the interior of the ambulance and report cases to the proper authorities.

Beyond these general duties, the specific responsibilities of EMTs and paramedics depend on their level of qualification and training. To determine this, the National Registry of Emergency Medical Technicians (NREMT) registers emergency medical service (EMS) providers at four levels: First Responder, EMT-Basic, EMT-Intermediate, and EMT-Paramedic. Some States, however, do their own certification and use numeric ratings from 1 to 4 to distinguish levels of proficiency.

The lowest-level workers—First Responders—are trained to provide basic emergency medical care because they tend to be the first persons to arrive at the scene of an incident. Many firefighters, police officers, and other emergency workers have this level of training. The EMT-Basic, also known as EMT-1, represents the first component of the emergency medical technician system. An EMT-1 is trained to care for patients at the scene of an accident and while transporting patients by ambulance to the hospital under medical direction. The EMT-1 has the emergency skills to assess a patient’s condition and manage respiratory, cardiac, and trauma emergencies.

The EMT-Intermediate (EMT-2 and EMT-3) has more advanced training that allows the administration of intravenous fluids, the use of manual defibrillators to give lifesaving shocks to a stopped heart, and the application of advanced airway techniques and equipment to assist patients experiencing respiratory emergencies. EMT-Paramedics (EMT-4) provide the most extensive prehospital care. In addition to carrying out the procedures already described, paramedics may administer drugs orally and intravenously, interpret electrocardiograms (EKGs), perform endotracheal intubations, and use monitors and other complex equipment.

EMTs and paramedics work both indoors and outdoors, in all types of weather. They are required to do considerable kneeling, bending, and heavy lifting. These workers risk noise-induced hearing loss from sirens and back injuries from lifting patients. In addition, EMTs and paramedics may be exposed to diseases such as hepatitis-B and AIDS, as well as violence from drug overdose victims or mentally unstable patients. The work is not only physically strenuous, but can be stressful, sometimes involving life-or-death situations and suffering patients.
 

Initiative and good judgment also are extremely important, because fire fighters make quick decisions in emergencies. Members of a crew live and work closely together under conditions of stress and danger for extended periods, so they must be dependable and able to get along well with others.