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Fire & Emergency Medical Service Mergers: 
The Leader's Role
By Capt. Michael Mayers
Hilton Head Island Fire & Rescue
While considering what might be good for your community, have you been contemplating a merger of fire and emergency medical services?  This is not a new idea, but the way people have been acting toward mergers lately would make you think so.  Daily it seems that I read yet another article about the merger of a Fire and EMS agency.  Some of our largest and most traditional fire organizations have incorporated EMS into their structure.  Whether or not it was a success in each of these cases is a whole other question.

EMS has been as much a part of the fire service as it has been anywhere else since its popular increase in the late '60's and early '70's.   The issue at hand, however, is the effective merger of previously separate entities, and thus, cultures, nomenclature, equipment, etc.  I have been involved with EMS since 1979 and I have seen some phenomenal changes.  My involvement has been primarily with the fire service side, in organizations ranging from first responders to ALS treatment and transport providers.  I have been a volunteer as well as a career paramedic and I have worked in big and small systems.  As a result, I have made some observations on how and why mergers should take place.
 
Let me start by disclosing that I am currently a career Fire Captain/Paramedic in what is now a career-only organization.  Our organization merged over eight years ago.  The corporate cultures in each of the three agencies merged were as diverse as they could come, and at one point or another in my career, I worked for each of them (among other agencies).  To say our merger was a success would be accurate, but I wouldn't say that it came without cost.  

Furthermore, don't assume that my bias leans toward wholesale merger of the fire and medical services.  The responsible parties need to analyze their unique community and determine what is in their best interest.

Why do mergers come about?  The most obvious answer is money.  Doing two jobs with less management and support staff is more cost efficient.  There are fewer stations required and increasing the numbers of responding units can result in significant decreases in service delivery time.  Mergers give "topped out" personnel a place to branch to, keeping the cost of replacing burned out employees down.  There are perceived savings in benefits procurement (additional bodies translate to more buying power when shopping benefits) and of course the revenue from charging for treatment and transport doesn't hurt either.

Consider that if merging is being undertaken to simply increase revenue, run out the competitors, or to increase your little fiefdom, if the community fails to benefit, then my suggestion is to leave well enough alone. A bone is just a bone until two lions decide they want it.  As soon as politicians and chiefs see someone is eyeing their little corner of the world, things can get very ugly.  Trust me when I say that no one will benefit.  And on top of that, Hell hath no fury like a medic made to ride a fire engine against his or her own will (or vice-versa).  So move forward with care.

Some introspection is called for prior to such an undertaking.  Some of these questions should be asked and answered: 

  • What is your goal in merging?  (What do you hope to achieve?)  
  • If we decide to merge, what preparations need to be made to insure success? 
  • How does the corporate psychology compare and how can we foster cooperation?  
  • What things can hurt this merger and how can we avoid them?  
Common goals and interests appear to be a factor in successful relationships.  Conversely, some contributing factors in disruptive relationships appear to be differing goals, an inability to communicate, dishonesty, selfishness, and most of all, inability to compromise.  The negative sides to the argument have been hashed out more times than you or I could ever count.  Some people years ago formed your organization and decided they only wanted to provide medical or fire service and formed their organizations around that intent.  If you hadn't noticed, things have changed.  The customer expects quality service and they want it now.  This service is often perceived as "one-stop shopping" or "streamlined service", resulting in community leaders pushing organizations toward merging.

As the leader of this merger, I recommend surrounding yourself with good people, but not "Yes" men.  If an idea you have needs reworking, you need to have people that can help you do that and often that calls for objectivity.  If your ideas are meeting with resistance, make the complainers come up with a solution or participate in solving the problem.  I have a rule that I live by; "Don't raise your voice unless you can raise your fists."  In other words, don't complain unless you're willing to do something to change the situation.

When merging organizations, leaders should: 

  • Be clear about the mission.  Your goals should reflect your mission, your objectives should support the goals and your budget should finance them.
  • Identify concerns and create opportunities to solve them.  Doing so allows your personnel to develop ownership.  Remember, this is the opportunity for some to shine, especially those who were held in check by the previous status quo and those who desire change, those who were overlooked in the old system (yours or theirs), and those who desire a fresh start.  Don't blow off trouble-makers right away, make them put up or shut up.  Get rid of the chronic complainers if they won't work toward solving problems.
  • Make sure expectations are crystal clear.  Take a look at your policies and procedures.  If you have no means/method/intent of enforcing something, chuck it or fix it.  A rule that falls in this category is just something waiting around to bite you.
  • Show no favoritism.  Enforce rules uniformly.  This is YOUR chance to do the things you didn't do right before as well.  Enforce the rules like you mean it.  Set the example yourself.
  • Train, train, train.  Preplan.  These tasks can solve a lot of problems.  By training and preplanning often, the troops: 1) are too busy to complain, 2) develop relationships and subsequently improve team cohesion, 3) develop familiarity with the previously unknown, and 4) identify their leaders, innovators, and slackers.  Previously foreign concepts, tools, techniques and nomenclature are exposed to members of the team and as a result, misconceptions and misunderstandings can be resolved.
  • Allocate equipment, personnel, training, time to meet the mission.  Failure to do so will severely hamper progress and will cause you to lose forward momentum.
  • Categorize apparatus and equipment into "problems and opportunities".  Plan ahead to replace/upgrade equipment.  Standardize as much as possible.  Plan ahead to make changes.  Get your personnel to make recommendations and implement them.
  • Be candid with the troops within reason.  Suppressing information is just itching for a fight.  If you're considering something/change, be out with it or get your ducks in a row prior to discussing it with anyone.  Suppressing information often just gives fuel to the "conspiracy theorists".  You may want to do something and can't.  Be honest and forthright about why you can't, otherwise, you're already doomed because you're not trying to achieve excellence, you're just trying to get by.
  • Insure that the parties of the merger are committed to a positive outcome and the ultimate success of the project.  If anyone (management, politicians) responsible for leading this merger are not committed to success, the plan is doomed to be rocky, if not fail outright.  
  • Develop individual team cohesion and morale at all levels.  Pick assignments to cause companies, divisions, officers, firefighters, and medics to bond.  Do team building exercises.  Have retreats.  Missions, especially difficult ones, cause teams to bond, especially if they're successful.
  • A main feature of leading requires one to remain open to other ideas, but not to the detriment of your customer. Schedule listening sessions, but realize that not all of the personnel are going to open up right away.  The most vocal immediate need just may be the griping of a few or a symptom of a bigger problem.  See if management and the troops' stories match up before writing off the complaints as whining and get some perspective from other less vocal individuals as well.  Consider the implementation of quality management teams that will work the solution to a problem out across the entire range from service professional to customer delivery.  Follow up with customers to see what changes could be made to improve service.
  • Be prepared to make some changes, then be prepared to change those changes in order to improve the end product.  If you're covering ground that's never been trod before, you have to learn from your mistakes.  The beauty is, though, is that like I've been saying, you're not alone.  Plenty of emergency service agencies merge every year.  The private sector experiences mergers all the time.  What makes you think that your situation is any different than theirs?  Call around to other organizations and groups and get their ideas.  Talk to the troops as well as the brass.  What may seem like a good idea may not hold up to implementation but there's nothing to say that the idea may not lead to further innovation.
    There are no shortcuts here and there's already going to be more emotion and rhetoric than you can stand.  Having leadership that is submarining the effort isn't going to get this party started.  There's nothing sacred and nothing absolute, unless you're just planning to fire everyone and do it your way. If you are not willing to work toward compromise or make some hard choices, success is going to come hard.  Relationships are sometimes about sacrifice.  Sacrifice is sometimes how you show you care.  If it's "all about you", it will be.  Negatively.
About the author
Captain Michael "Mick" Mayers  is a career Captain/paramedic  with Hilton Head Island Fire/Rescue in Hilton Head, South Carolina. 

Capt. Michael “Mick” Mayers has served the resort community of Hilton Head Island, South Carolina as a firefighter and paramedic since 1982.  He came there after several years of volunteering with Bridgeport (PA) Fire Company #1.  Read Mike's section