A Strained 9-1-1 System and Threats to Public Health

The emergency medical services (EMS) system in the United States (U.S.) is fragmented, with various private and public entities responsible for dispatching calls, acting as first responders, and providing transport for medical emergencies [1]. Fire departments represent the majority (89 %) of first responders to arrive on the scene of an accident or emergency in large metropolitan areas [1]. Indeed, in 2013, fire departments nationwide responded to 31,644,500 calls to the 9-1-1 emergency response system [2]. The majority of the calls (68 %) were for medical assistance, while only 4 % of calls were fire-related. In comparison, in 2003, 61 % of calls were for medical assistance and 7 % of calls were fire-related [3]. This distribution of fire service responses reflects broader national trends, which include a decreasing incidence of fires and fire-related injuries [4], along with an increased public reliance on calling 9-1-1 as a point-of-entry into the health care system [1, 5, 6]. The fire service is therefore engaged in activities far beyond fire prevention and control, performing social and medical functions that are key to supporting the public’s health. Across the U.S., there are 27,140 registered fire departments, which employ 1,065,600 firefighte