Fostering True Brotherhood Among First Responders: A Call for Equity

First Responders, Brothers in Arms…Sort of…Kind of…ok, not really.

In June of 2000, the Indiana General Assembly passed the legislation needed to fund a 1-million-dollar construction project for line-of-duty deaths for the “Law Enforcement and Fire Fighter Memorial”. A memorial funded by the taxpayers, memorializing mostly tax-funded positions and the organizations that don’t even contribute to that said tax fund. A memorial completely void of Paramedics and EMTs who have died in the line of duty who WEREN’T from fire-based organizations.

Brotherhood in Emergency Services: A Myth Unveiled

Ladies and gentlemen, we are going to discuss a theme in this blog today, the theme of brotherhood. You see memes and shirts and Facebook posts every day about the “undying” loyalty that we brothers, across the first responder disciplines, have with one another. I am here to tell you that as an EMS provider, this is nothing more than getting a card for the holidays instead of an invite to the gatherings.

We are not brothers. Brothers stand up for one another and have each other’s backs. This is not the case when it comes to the alarming disparities between Fire, EMS, and Police. Disparities that are largely created not by our politicians, but by the lobbying groups representing the individual factions, i.e. representatives of Law Enforcement and Fire.

Legislative Disparities: Neglecting EMS

Over the past 10 years of advocacy work in the state of Indiana, I can no longer count on both hands how many times I have had to advocate against a piece of proposed legislation from our “brothers” in red and blue because they have submitted a piece of legislation for EMS but completely neglected to include much of the industries paramedics and EMTs. The death benefit for line-of-duty deaths, the memorial mentioned above, a Mobile Integrated Healthcare fund that only municipal agencies can take advantage of….. the list is quite extensive. If we are brothers, then why are EMS workers largely left out of influential legislation unless you have “Fire” next to your EMS credential?

Funding Disparities: A Stark Reality

If you pull the Indiana-approved budget for 2024-2025, you can easily identify some incredible funding disparity. Despite the countless testimonies to legislatures on the negative impact of a crumbling EMS infrastructure on long-term clinical outcomes and on our community’s healthcare ecosystems, EMS is only mentioned in the budget three times, and that’s only if you include the MIH/CP grant that caters to fire department based EMS, I guess community taxpayers who contributed to the fund don’t get to take advantage of it just because they chose a non-municipal service.

Monetary Allocation: A Disheartening Calculation

One of these said funds, the “Emergency Medical Services Fund” (Fund Source 47880-385) is for a whopping $3920.00 dollars annually. I think that comes out to be about .00004167 cents per EMS provider…. Awesome! Thank you, sir, may I have another? IDHS just recently went on a road show bragging about their massive spending for FIRE-based academies across the entire State… Cool. Here I thought the staffing crisis and continued cadence of losing available ambulances on the road and its corresponding impact on the trauma system was a real issue, didn’t know we needed more firefighters. Don’t get me started on the funding for law enforcement and corrections.

Imbalanced Priorities: Disregard for EMS

The Indiana Public Safety Fund is 7.9% of Indiana’s total budget (51.6 billion dollars), which is over $4 billion for Public Safety. Indiana Code specifies EMS is to be and can be funded from this budget line item. Including most of the competitive grant-based funding for EMS, not just public safety allocations, total funding for EMS (which isn’t equal access across all agency types) is approximately .02% of the total public safety funding. Law enforcement is the biggest winner of the budget games, followed closely by fire……EMS isn’t even in the race.

The Cost of Unbalanced Support: Taxpayers and Emergency Costs

How are taxpayers rewarded for all of this unbalanced funding and support given to police and fire? Well, if you reviewed the Certified Public Expenditure cost data from the Medicaid cost offset program that only municipal agencies can take advantage of, you will get a very clear picture of one major “benefit”, EXPENSE. Data from 2011-2017 shows that the average cost per ambulance trip run out of a fire department is over $2,800.00, with the low being around $1300.00 and the high being over $3800.00. In 14 years of running ambulance services, including rural 911 programs, it has never cost me more than $1200.00 to complete a run and my average was closer to $600.00…. In true brotherhood fashion, the defense for the exorbitant expense from our brothers is a “what about-ism” that degrades other EMS agency types that aren’t Fired by saying they are lower quality, yet don’t ask them for quality clinical data measures to prove it…. they won’t have them.

The Misalignment of Funding and Fire-Based Calls

The truth, fire departments need to fund their fire-based service lines in an era where fire-based calls continue to drop significantly. The US Fire Administration showed a decrease in fire-based calls by another 6% from 2019-2020 and according to the NFPA, there has been a 45% decrease in fire-related calls from 1980-2021. Hell, the NFPA shows that the average Fire Department goes on more than double “False Alarm” calls at 8% than they do actual fire calls, sitting at 3.9% … Yet fire-specific funding is increasing, and the State is building a system to create more firefighters and the only thing increasing for our Fire and Police brothers are increased responses to medical, mental health or addictions related calls, for which they are receiving isolated funding for while EMS stands outside in the rain. Before you use increased medical calls within the Fire Department as justification for the increased funding, remember that 37% of departments, according to NFPA, don’t respond to medical calls at all.

Discrepancies in Priorities: Evaluating Costs and Impacts

Oh yeah, all of this additional Fire funding is pressed against the two pressing Key Performance Indicators. The number of deaths associated as a result of fires the cost of those fires’ destruction of property and the corresponding impact on the economy. Deaths according to NFPA in 2021 were 3800, the damage costs were 15.9 billion. Sounds like a lot, but I must remind you that overdose deaths by themselves were over 106,000 people in 2021 and the cost to the system is approximately 696 billion dollars, so tell me again why the funding doesn’t match the need proportionately if the goal is to save lives and save property? This is just one modality too!

The Unheard Voices: Neglect of EMS Sacrifices
There have been nearly 20 line-of-duty deaths of EMS-only providers over the past 15 years…..their names, lives, and work don’t matter as much as our brothers in red and blue do. That’s the only truth our State and “brothers” have made apparent, but you won't find that truth in rhetoric. There is plenty of “Brotherly Rhetoric” or false support from legislators and our so-called “Brothers”, but the facts based in action are loud and clear, if you are a paramedic or an EMT only, you are second class. Your sacrifices don’t deserve to be immortalized, despite your non-fire-based organization and you paying into these taxed-based funds for programming such as death benefits and after a lot of advocacy you can finally get them as a non-fire-based EMT or Paramedic!!!! But you only get it if you pay extra money for it…. while our brothers in red and blue don’t have to do that, despite their agencies not contributing to the fund that pays for it. Congratulations on realizing that if you have dedicated your life to your patients while sacrificing your physical health, mental health, family life, and financial security and don’t have FIRE next to your name… You mean less to your so-called “brothers”.

I don’t know about you, but I feel more like an outcasted stepbrother than a real one.

If you are a Fire Fighter, Law enforcement, or Corrections Officer and you take offense to this….suck it up. Do the right thing. All First Responders matter and we should all advocate for ALL of them, not just for specific cohorts, the star of life isn’t an Asterix!

Nathaniel Metz, President and CEO, Phoenix Paramedic Solutions