By Ryan Harding
For small towns across the United States, when danger strikes, volunteer firefighters are often a community’s first line of defense for every conceivable emergency.1 Be it fire, automobile wreck, medical emergency, or any other reason to dial 911, volunteers across this nation will take a pause from their private life to help their neighbors in their hour of need.2
Despite this dependency, volunteer fire departments are struggling in the United States as their membership declines and their remaining membership ages.3 Further, this decline is occurring at the same time that demand for their services, especially medical services, is dramatically increasing.4 As such, this article will examine why volunteer fire departments now serve primarily as medical providers and why their membership continues to decline.
Background
There is perhaps no American institution as steeped in history and tradition as the volunteer fire service. Our Founding Fathers, for example, were volunteer firefighters, and many of the greatest conflagrations in American history were fought and extinguished by volunteer firefighters.5 Furthermore, during the early period of American history, almost all fire departments, even in large cities such as Chicago (IL) and New York (NY), were volunteer departments.6 However, as technology increased and our cities became more industrialized and populous, the need soon arose for a full-time, career fire service.7
Nevertheless, to this day, the vast majority of our nation’s firefighters are still volunteers.8 Of the 1,140,750 firefighters nationwide, 69 percent are volunteer firefighters.9 Further, of the 30,052 fire departments nationwide, 85 percent are staffed entirely or mostly by volunteer firefighters.10 Perhaps not surprisingly, volunteer fire departments protect smaller cities and rural communities while career departments protect midsize to large cities.11
Changing from Fire to Medical Service
Nevertheless, for both career and volunteer fire departments, the nature of their service is changing dramatically from a fire-based service to a medical-based service.12 As seen in Figure 1, the total number of fire department emergency responses has increased to more than 31 million from its 1980s figure of just fewer than 11 million.13 This is the case in spite of the fact that the actual number of fires and mutual-aid responses has decreased from 3,262,000 in 1980 to 2,538,000 by 2013.14 However, the number of medical calls has dramatically increased from just over five million in 1980 to more than 21 million by 2013.15 As a result, medical emergencies now account for 68 percent of emergencies that fire departments respond to and now are a fire department’s primary responsibility.16
The reasons for this shift in job responsibility are numerous. First, fires are becoming much less common. Second, over the past 50 years, fire departments have gradually been expanding their role as medical providers.17 This evolution began largely as a result of the 1966 paper entitled “Accidental Death and Disability: The Neglected Disease of Modern Society,” which highlighted the fact that accidents, especially automobile accidents, were the leading cause of death among persons under the age of 38.18 This report highlighted the dismal state of emergency first aid and recommended training firefighters in emergency medical services.19
Following this publication, governments responded to the epidemic of traumatic injury.20 At the local level, metropolitan cities such as Miami (FL), Seattle (WA), and Los Angeles (CA) began training select firefighters in advanced life saving techniques.21 At the federal level, Congress passed The Emergency Medical Services System Act of 1973, which provided grants for planning, establishing, and expanding emergency medical services throughout the nation.22 The states were then given the responsibility of implementing the law, and many chose to expand the duties of existing fire departments.23 Firefighters were then cross trained as emergency medical technicians and paramedics and began to be dispatched to medical emergencies in addition to their normal responsibilities of fires and automobile wrecks.24 This trend of fire departments providing medical care continues to this day with firefighters, as they have for the past four decades, providing the majority of medical services during emergencies that occur outside of the hospital.25
Volunteer fire departments are absolutely necessary in providing medical services, since they primarily protect rural areas and small towns while ambulance companies locate themselves and most of their units in urban environments.26 Thus, when an emergency arises in a rural area, an ambulance is often far away from the location of the emergency and takes considerably longer to reach the patient, which negatively affects survival rates.27 Moreover, many rural hospitals continue to close and consolidate, so transport times between the incident and the emergency room continue to increase.28 Volunteer fire departments, however, are strategically and evenly located across the nation’s communities and can respond within minutes of a medical emergency to provide critical life support to patients.29 Thus, for most rural communities, the volunteer firefighter is the first line of defense when traumatic injuries and life threatening medical emergencies strike.
The Decline
Despite the growing dependency on volunteer fire departments for medical care and the increase in demand for their services, the number of volunteer firefighters is decreasing. From 1987 to 2013, the number of volunteer firefighters decreased from 816,800 to 786,150, a decrease of 30,650.30 The reasons for this decline include the rise of the two-income family, the increasing medical emergencies, changing demographics in rural areas, a changing business climate, and a plethora of other factors.31
During the same period, however, requests for fire department services increased from 12,237,500 emergency calls in 1987 to 31,644,500 emergency calls annually by 2013.32 Making matters worse, especially in smaller communities, these departments are struggling to attract new members and are instead relying on older members to remain active well into their 50s, 60s, and beyond.33 Thus, with older members making up a greater and greater share of the volunteer firefighter population, the decline of the volunteer firefighter should only be exacerbated with time.
The Future
Local and state governments, as well as the federal government, should now recognize that (1) the primary function of the volunteer fire department is providing medical care and (2) the decline in the number of volunteer firefighters represents a risk to the health and safety of the American public. Although more research is needed, governments should respond to these new realities with appropriate legislation and policies.
Endnotes
1. Andrea Wells, “First Line of Defense: Insuring Volunteer Fire Departments,” Insurance Journal (June 2, 2014), www.insurancejournal.com/magazines/features/2014/06/02/330244.htm.
2. Ibid.
3. Andrew Brown and Ian Urbina, “The Disappearing Volunteer Firefighter,” New York Times, (Aug. 16, 2014), www.nytimes.com/2014/08/17/sunday-review/the-disappearing-volunteer-firefighter.html?_r=0.
4. Ibid.
5. Craig Collins, “The Heritage and Evolution of America’s Volunteer Fire Service,” A Proud Tradition: 275 Years of the American Volunteer Fire Service 11 (2012), www.nvfc.org/wp-content/uploads/2015/10/Anniversary_Publication.pdf.
6. Ibid at 10-13.
7. Ibid at 10-15.
8. National Volunteer Fire Council, Volunteer Fire Service Fact Sheet 1 (2013), http://www.masc.sc/SiteCollectionDocuments/Risk%20Management/Fire_Service_Fact_Sheet_2015.pdf.
9. Ibid.
10. Ibid.
11. Hylton J.G. Haynes and Gary P. Stein, “U.S. Fire Department Profile – 2014,” National Fire Protection Association 1, 19 (2016), file:///C:/Users/Ryan/Downloads/osfdprofile%20(14).pdf (showing that 95% of volunteer firefighters are in departments which protect fewer than 25,000 people).
12. Brown, supra note 3.
13. National Fire Protection Association, Fire Department Calls (2014), http://www.nfpa.org/news-and-research/fire-statistics-and-reports/fire-statistics/the-fire-service/fire-department-calls/fire-department-calls.
14. Ibid.
15. Ibid.
16. Ibid.
17. International Association of Fire Fighters, Emergency Medical Services: A Guidebook For Fire-Based Systems 9 (Franklin D. Pratt et al. eds., 4th ed. 2003), www.iaff.org/tech/PDF/EMSGuideBk.pdf.
18. National Academy of Sciences, “Accidental Death And Disability: The Neglected Disease Of Modern Society 8-9” (1966), www.ems.gov/pdf/1997-reproduction-accidentaldeathdissability.pdf
19. Ibid at 5-6.
20. International Association of Fire Fighters, supra note 17, at 10.
21. Ibid.
22. Ibid.
23. Ibid.
24. Ibid.
25. Franklin D. Pratt, “Prehospital 9-1-1 Emergency Medical Response: The Role of the United States Fire Service in Delivery and Coordination,” Fire Service-Based EMS Advocates 1, 5 (2007), www.iaff.org/tech/PDF/FB%20EMS%20Whitepaper%20FINAL%20July%205%202007%20.pdf
26. Hilda R. Heady, “A Delicate Balance: The Economics of Rural Health Care Delivery,” 287(1) JAMA 1, 110 (2002) (showing that it is twice as expensive to operate a rural ambulance company).
27. Thomas J. Esposito et al., “The Impact of Variation in Trauma Care Times: Urban versus Rural,” 10(3) Prehospital and Disaster Medicine 161, 162 (1994) (Table 1 shows that the mean response time for an ambulance to patient in an urban area is 6 minutes, while the mean time is 11 minutes in rural areas.).
28. Brian Depew, “Rural Hospitals Closing at rate of 1 per month,” Center for Rural Affairs (Mar. 1, 2016), http://www.cfra.org/news/160301/rural-hospitals-closing-rate-1-month.
29. Hylton J.G. Haynes and Gary P. Stein, “U.S. Fire Department Profile – 2014,” National Fire Protection Association 1, 19 (2016), file:///C:/Users/Ryan/Downloads/osfdprofile%20(14).pdf.
30. Ibid at 5.
31. U.S. Fire Administration, Retention and Recruitment for the Volunteer Emergency Services 1, 5-15 (2007), https://www.usfa.fema.gov/downloads/pdf/publications/fa-310.pdf.
32. National Fire Protection Association, supra note 13.
33. National Volunteer Fire Council, supra note 8, at 2; John O’Connell, “Fire in the belly: A trio of senior veterans are an indispensable component of the Logan-Trivoli Fire Protection District” Peoria Journal Star, Jan. 2, 2006, at C6.
Ryan Harding is a firefighter on the Logan-Trivoli Fire Protection District in Hanna City, Illinois. He is a law student at the University of Illinois College of Law and an articles editor on The Elder Law Journal.
