Dual-Role Provider Frequently Asked Questions & Infographic

In 2014, the Alexandria Fire Department began transitioning from a single-role staffing model to a dual-role or “all-hazards” model. The primary purposes of this transition are to provide a higher level of service to our community by ensuring that at least one member of every fire or ambulance crew will be certified to provide Advanced Life Support (ALS) care, and that all fire engines and trucks will have a crew of four instead of three.

Page updated on Oct 27, 2015 at 10:33 AM

Updates:

What types of personnel provide fire and emergency medical response in Alexandria?

The Alexandria Fire Department includes three types of first responders:

  • Firefighter-EMTs have at least 240 hours of training to fight fires, and at least 240 hours of additional training as Emergency Medical Technicians. EMTs can provide Basic Life Support (BLS) care, which includes performing CPR, controlling bleeding, administering automatic defibrillation, and providing oxygen support.
  • Firefighter-Medics have at least 240 hours of training to fight fires, and at least 781 hours of training as Paramedics. Medics can provide Advanced Life Support (ALS) care, which includes starting IVs, administering medications, and performing advanced emergency medical procedures.
  • Paramedics (“Medics”) have at least 781 hours of training to provide ALS care, but do not have training to fight fires.

Firefighter-EMTs and Firefighter-Medics are known as “dual-role providers” because they are trained and certified to provide both fire and emergency medical response. Medics are known as “single-role providers” because their focus is emergency medical response only.

Along with Firefighters, both EMTs and Medics are critical first responders, and all are truly heroes in our community. All meet the same high standards of professionalism and public service, and all have an important place in any emergency medical response system. Still, Medic certification is substantially more time-intensive and expensive to obtain and maintain, and many emergencies do not require ALS care. That’s why it’s not necessary for every provider to be a Medic, and why it’s important for EMTs and Medics to be distributed throughout the system in an efficient and cost-effective manner.

The Department also includes chiefs, quality managers, and administrative staff. The Alexandria Fire Department works closely with surrounding public safety agencies, particularly Arlington, Fairfax County, and the Metropolitan Washington Airports Authority. Crews and vehicles from any of these agencies may respond to a fire or emergency medical call in Alexandria, depending on which unit is closest.

What types of calls for services does the Alexandria Fire Department receive?

In 2013 (the last full year before the new system began), 28% of calls for service were fire-related (e.g. fire alarm, smell of gas, actual fire), 32% of calls were for medical emergencies appearing to require ALS care (e.g. trouble breathing, major injury), and 40% of calls were for medical emergencies appearing to require only BLS care.

What has changed about the way fire and emergency medical service are provided in Alexandria?

In 2014, the Alexandria Fire Department began transitioning from a single-role model to a dual-role model.

  • In the old single-role model, ambulances were staffed with two Medics, and fire engines and trucks were staffed with three or four Firefighter-EMTs.
  • In the new dual-role model, staffing is being shifted so that each fire engine will carry one Firefighter-Medic and three Firefighter-EMTs, and each ambulance will carry one Firefighter-Medic and one Firefighter-EMT. This is also called an “all-hazards” model, because the crew of any unit can begin handling any type of emergency.

What were the drawbacks of the old single-role model?

Under the old single-role model, all personnel could provide BLS care for a medical emergency, but: 1) only fire unit crews could fight a fire, and 2) only ambulance crews could provide ALS care. If a fire unit arrived first to an emergency requiring ALS care, the patient would have to wait longer for an ambulance. If an ambulance arrived first to a fire, the Medic crew could not approach the fire.

About half the time (55%) you call 911 for a medical emergency, an ambulance will happen to be closest to you and will arrive first. But the other half of the time (45%), a fire unit will arrive first. ALS care is needed for about half of medical emergencies, and BLS is sufficient for the other half. This means that about half the time ALS care is needed, it was not available on the first arriving unit under the old system.

Under the old system, every ambulance carried two Medics. Although some emergencies may require two ALS providers, most do not. This meant that one ALS provider was on the scene of an emergency when he or she could have provided service somewhere else. When a patient was transported to a hospital, the ambulance would be driven by an ALS provider who could not provide either ALS or BLS care while driving. When the ambulance got to the hospital, the ALS provider would have to wait for the patient to be received and for the paperwork to be done before returning to service. In other words, by having two ALS providers on each ambulance, one was providing ALS care in the system far less often than the other, while other patients were waiting for ALS care elsewhere.

The new system ensures that all fire engines and ambulances carry both Firefighter-EMTs and Firefighter-Medics, so the first arriving unit will be able to provide both fire response and ALS care. By having ambulances driven by BLS providers instead of ALS (with an ALS provider in the back with a patient like always), ALS providers can spend more time providing patient care throughout the system.

What are the benefits of the new dual-role system for the public?

  • Nearly 100% of the time, you’ll get both Firefighters and at least one ALS provider on the first unit to arrive to your emergency. This means no matter what kind of help you need, you’ll get it first nearly all the time.
  • All 10 of our stations will house ALS ambulances. Currently, four of the 10 do not.
  • Under the old system, many fire units only carried a crew of three, and we did not have enough positions to staff a dedicated heavy rescue unit. Under the new system, we can ensure that every fire engine and truck has a full crew of four, and we’ll have enough staffing for a dedicated heavy rescue unit for special operations such as technical rescue, vehicle extrication, and hazardous materials support. This means safer working conditions for our first responders and better support for you. And since we’re reallocating existing personnel, we won’t have to add any new positions. This will save nearly $3 million per year versus adding a fourth firefighter to each fire unit by hiring new personnel.  The current staffing model includes a full crew for the fire engine at Station 210 on Eisenhower Avenue.

What are the benefits of the dual-role system for staff?

  • Under the new system, every provider will have the opportunity for a promotion. By cross-training, Firefighter-EMTs can choose promotion to Firefighter-Medic, and Medics can choose promotion to Firefighter-Medics. These promotions come with automatic pay increases of 10% to 20%. In addition, cross-trained staff can pursue competitive promotions to supervisory positions.
  • All personnel will be covered by the highest level of disability and retirement benefits. State law presumes that certain heart and lung diseases are a result of firefighting work, but does not provide this presumption for single-role medics. A cross-trained Firefighter-Medic will be covered by the presumption and therefore receive higher benefits in the case of illness. Cross-trained staff will receive additional pension benefits, as well.
  • Cross-training encourages staff to expand their public safety scope and further develop their professional skills. For those who wish to cross-train, this can provide exciting new opportunities.

How does the dual-role system compare to surrounding jurisdictions?

Alexandria is the only locality in our area that still uses the old, single-role model. However, since surrounding departments respond to calls in Alexandria every day when their units are closer, dual-role providers have actually been working successfully in Alexandria for years.

Will a Firefighter-EMT who recently cross-trained to become a Firefighter-Medic perform to the same standards as a Medic who has focused only on emergency medical service for years?

This question poses a false dilemma. Under the old system, 45% of the time you called 911 with a medical emergency, the first arriving unit did not carry a Medic at all. Therefore, the comparison should be between “no Medic” and “any Medic,” not between “old Medic” and “new Medic.”

That said, all personnel are required to follow the same national, state, and local protocols applicable to their certifications and the emergencies to which they’re responding, regardless of how long they’ve worked for the Fire Department or what their job titles are. For example, a Firefighter-Medic who recently cross-trained and a single-role Medic who chose not to cross-train are both required to follow the same approach to starting an IV. These protocols are continuously monitored by the Fire Department’s medical director (a doctor), and follow the same professional standards used throughout the country. The Fire Department also has a full-time position devoted to providing quality control of patient care. This is recognized as a best practice in emergency medical service and isn’t changing under the new system.

Will I receive the same standard of care from a Firefighter-Medic and a Firefighter-EMT as I would have from two Medics?

Again, this question poses a false dilemma. Under the old system, 45% of the time you called 911 with a medical emergency, the first arriving unit did not carry a Medic at all. Therefore, the comparison should be between no Medic and one Medic, not between one Medic and two Medics.

To the extent there’s an advantage to having two ALS providers at a scene instead of one (which there may or may not be depending on the type of emergency and number of patients), it’s important to understand that you will still receive two ALS providers when your call appears to require ALS care. The only change in this regard is that the providers will arrive on separate vehicles instead of together. The fact that two vehicles may arrive instead of one is not new; since a fire unit is the first to arrive to a medical call 45% of the time, under the old system an ambulance would often be the second unit to arrive.

Every provider is in constant radio communication with dispatchers and can consult with a more experienced provider, a provider with a higher level of certification, or a supervisor, whenever necessary.

Is the new system just a proposal?

No. The new system began in 2014, and 38 Firefighter-EMTs and Medics are already in the process of cross-training or have completed their new certifications. As time goes on, more and more providers will cross-train and the benefits of the new system will expand to the entire city. The first fire engine with a fully cross-trained crew on all three shifts entered service in 2015, at Station 207 on Duke Street.

What will happen to personnel who choose not to cross-train? Will they be forced out?

No Firefighter or Medic will be required to obtain the other certification; they may continue in their current roles for as long as they wish. As they retire or choose other employment over time (due to the natural attrition in any organization), they will be replaced with cross-trained staff.

What is changing about shift schedules?

Under the old system, Firefighter-EMTs worked in three 24-hour shifts on the following schedule for an average of 56 hours per week, or an average of 10 days per month:

  • Work 24 hours - Off 24 hours
  • Work 24 hours - Off 24 hours
  • Work 24 hours - Off 4 Days

Medics worked in four 24-hour shifts on the following schedule for an average of 42 hours per week, or an average of 8 days per month:

  • Work 24 hours - Off 48 hours
  • Work 24 hours - Off 4 Days

Under the new system, all personnel will work in three 24-hour shifts on an average 56-hour weekly schedule. This is essential to providing the scheduling flexibility to redistribute personnel across fire units and ambulances.  All members of the Department have a strict limit on the number of consecutive hours they can work, and all are permitted to rest between required activities during their shifts.

Will a streamlined schedule make it harder to recruit qualified applicants?

No. Much of the pushback from single-role Medics over the new system results from their understandable desire to remain on the old Medic schedule. The old schedule also helped attract attention from applicants considering jobs among area jurisdictions, because Alexandria’s schedule was more generous than others. However, Alexandria has continued to receive more than enough qualified applicants even after discontinuing the old schedule for new hires. For example, the Department received more than 1,600 applications for 12 positions filled in August 2015.

Will Medics be compensated for working more hours if they cross-train?

Yes. Medics who cross-train to become Firefighter-Medics will receive a 10% pay raise for obtaining the additional certification and a 10% pay raise for working more hours per work, for a total of 20% higher pay. (Firefighter-EMTs who cross train as Firefighter-Medics will also receive the 10% pay increase for cross-training.)

Is the new schedule consistent with federal labor laws?

Yes. The Fair Labor Standards Act (FLSA), a federal law that governs employment wages and hours, requires Firefighters to receive overtime pay (time and a half) for more than 53 hours per work cycle, and requires other staff to receive overtime pay for more than 40 hours per week. Both the old schedules and the new schedule provide overtime opportunities for all personnel, because this is less expensive for taxpayers than adding additional positions.  The primary purposes of cross-training are to place an ALS provider on every first-arriving unit, and to achieve four-person staffing all on fire units, not to save money on overtime.

Does the new system provide equal opportunities for men and women?

Yes. All personnel hired since 2010 (whether male or female, and whether Firefighter/EMT, Medic, or Firefighter/Medic) have passed the same Candidate Physical Assessment Test (CPAT), and those hired before 2010 are not required to take the CPAT to cross-train. There are no differences in hiring or promotional standards between men and women.

Prior to the transition, 14% of Firefighter/EMTs and 30% Medics were women (vs. national averages of 4% for Firefighters and 29% for EMTs and Medics). As of August 2015, 35% of the Firefighter/EMTs and 8% of the Medics who have already chosen to cross-train are women. In other words, the Department has had no problem recruiting women for either Firefighter or Medic roles; in fact, we exceed the national averages for both. Likewise, many women are choosing to cross-train for additional certifications.

While any given man or woman might prefer riding on a fire unit or riding on an ambulance, neither assignment is objectively better than the other. All personnel are assigned job duties based on the community’s public safety needs, and these duties are always subject to change.

Additional Questions and Answers Added October 2015:

For patients requiring ALS care, can Firefighter/EMTs perform time-critical lifesaving interventions?

Yes, Firefighter/EMTs can perform time-critical, lifesaving, BLS interventions up to their level of training and certification. ALS providers (Firefighter/Medics) have the training and ability to perform more advanced lifesaving interventions.

Since most patients require a transport to the hospital, what is the value of having an ALS provider on a fire engine that can't do patient transport?

Under the old system, when a patient required transport in an ambulance, two ALS providers were taken out of service until the patient reached the hospital and the necessary paperwork was completed to transfer the patient.  Under the new system, one of those ALS providers will still be in circulation and will often be the first to arrive at a call for service until the ambulance arrives.

Will single-role Medics be removed from ambulance riding positions and placed in other jobs?

No.  Single-role Medics will continue to ride on ambulances as the Fire Department transitions to the new model.  No positions have been or will be eliminated as a result of the new system, and no Medic will lose his or her job if he or she chooses not to cross-train.  The Fire Chief has converted eight riding assignments for Firefighter/Medics and single-role Firefighters while adding a Firefighter/Medic to an engine company.   This conversion of eight riding positions has had no impact on the single-role Medics in the Department, due to vacant single-role Medic positions.  Again, no Medics were forced to cross-train or lose their jobs due to this change.  

The Fire Department has always stated that we would look at and consider options that would further enhance our system and to provide opportunities for those that can’t cross train or choose not to. 

In 2014, an EMS Supervisor was moved from Station 203 to Station 210.  Since there are no other ALS providers at Station 203, would it have been better to leave the supervisor there?

This move was approved at the request of the EMS Supervisors in order to move a Supervisor closer to high call volume in the west end of the City, and in order to provide for a Supervisor at Station 210 until Engine 210 is staffed. EMS Supervisors do not automatically respond on all ALS calls.  When the new system is fully implemented, all fire engines and ambulances will be able to respond to all calls as needed.

When will all 10 stations have ALS providers?

As staff chooses to cross-train or turns over due to normal hiring and attrition, more fire engines will be staffed with a Firefighter/Medic.  All 10 stations will have ALS capacity once the new system is fully implemented.

Will the net pay increase for Medics who choose to cross train be less than 10%?

No.  Numerous calculations have been done for those personnel who have already cross-trained or are considering cross-training, and all have shown at least a 10% net pay increase when including transition pay.

Will the total number of ALS providers in the system significantly increase, thereby reducing each provider's exposure to ALS patients and resulting in decreased skill proficiency and worse patient outcomes?

No.  The total number of ALS providers needed under the new system remains about the same as before; they will just ride on different vehicles.

Did the latest Firefighter recruit class include any women?

For the group of 12 Firefighters hired in August 2015, two women were offered positions. One declined in order to take another job, and one is on military duty and may join a later class. A new recruit class will start later in the fall, in which six of up to eight recruits will be women.  Approximately 17% of the Department's Firefighters are women, compared with national average of less than 4%.

Is a “tiered” EMS system—which deploys Firefighter/EMTs on first arriving units and supplements them with a small cadre of experienced Medics—both more efficient and more effective than one that deploys Firefighter/Medics on fire engines?

There are different approaches communities use to deliver EMS.  The new system has been determined to be best for Alexandria and for the regional response system as a whole. This system also addresses staffing on the fire apparatus which respond to all hazards. This is an enhancement to overall service to the community.



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