Today’s firefighters in Virginia and across the nation are expected to do far more than extinguish blazes — they are also a critical part of the emergency medical response system.
In fact, contrary to what the job they’re named for implies, the majority of calls to which firefighters respond are to provide emergency medical services.
It is up to each locality across the state to develop training plans. In June, a comprehensive report on Montgomery County’s fire and rescue services detailed that its volunteers do not have a countywide policy requiring minimum training standards.
“This puts not only the firefighter at risk, but also their colleagues,” the report states.
Still, volunteers are eligible to respond to calls and possibly enter an Immediately Dangerous to Life or Health environment with little to no training.
The problem
Medical aid calls accounted for 66% of total U.S. fire department calls in 2024, a 20% increase from when the organization first began recording calls in 1980. That’s according to the National Fire Protection Association fire experience survey.
About this story
Fire departments across our region are the first line of defense during emergencies for many communities, but they continue to grapple with declining volunteerism, inadequate resources and funding, and the changing nature of their work.
Cardinal News is amplifying potential solutions to these problems in a monthslong project; check out our project page here to follow along.
People experiencing a sudden heart attack, stroke, drug overdose or injury due to a vehicle accident may first receive life-saving care from a person coming out of a fire truck, since fire stations are often more strategically placed based on emergency calls.
Across the country, rising populations have resulted in rising dependency on emergency medical services. In Montgomery County, for example, a steady increase in new housing construction between 2013 and 2023 could bring more than 11,000 new residents and up to 1,000 additional fire and rescue calls each year, according to the county’s assessment report.
Changes to response coordination and population density have fundamentally changed job expectations for firefighters — changes that are reflected in the type of training firefighters and first responders received at an event in Blacksburg.
The symposium
“That is why we get invited to these places, because they realize that these might be firefighters responding first,” said Dusty Lynn, a registered nurse and paramedic who, along with other healthcare professionals, taught a neonatal resuscitation class at the inaugural Virginia First Responders Symposium in June.
The nine-day event was held at the Virginia Tech Inn & Skelton Conference Center, bringing nearly 500 from across the commonwealth together for specialized training opportunities. The symposium focused on nine different education tracks such as EMS, fire and hazmat, technical rescue and mental health, with multiple off-site venues used for training as well, such as tractor and school bus extraction.
“We’re promoting getting out of those silos and everybody working together,” said Kevin Dillard, chairman for the Virginia First Responder Symposium committee. “We think we can make the whole system here in Virginia much stronger that way.”
For the last 50 years, this gathering was called Rescue College, organized under the Virginia Association of Volunteer Rescue Squads. Training was still the main focus but only included EMS and volunteer rescue personnel. “And then last year, the organization decided to honor the legacy of the last 90 years and go in a new direction to better serve all first responders, including fire, rescue, law enforcement, telecommunicators, mental health professionals, public safety chaplains,” said Dillard.
Learning that can be passed on
EMS served as the largest educational track at the symposium, offering 29 different courses, including 11 courses specifically for pediatric EMS. This provides an opportunity for a growing number of interested firefighters and other first responders to expose themselves to new disciplines and tools they lack in their departments.
“To make a long story short, most pediatric bags are Neanderthal. They do not have as advanced stuff to be able to do this,” said Augie Rosas, a paramedic from Loudoun County.
That means, he said, that his department lacks the positive pressure ventilation (PPV) device he used during Lynn’s class to accurately measure the pressure going into the lungs of a newborn. Too little pressure may not fully inflate the lungs, while too much can deliver excessive air volume, increasing the risk of serious lung injuries, including a collapsed lung.
Rosas said the majority of resuscitations he and other EMTs perform are on adults, leaving little room for preparation and consideration of new equipment. But he is taking what he learned in Blacksburg back to Loudoun County to share with his peers and make recommendations to his superiors to include the PPV devices in the first-responder medical kit.
“I present all over the United States, and I would say, especially in rural areas, that is definitely still an issue,” said Lynn about firefighters increasingly responding to medical-related calls. Extensive training opportunities, Lynn says, provide them with the proper training and empower them with confidence to respond the best they can to a manifold of situations.
Outside perspective
Firefighters have felt the tide shift for many years. In 2015, authors of an article in the National Library of Medicine titled “A Strained 9-1-1 System and Threats to Public Health,” asked 123 firefighters from 12 different departments across the U.S. about job demands, organizational climate, and occupational safety and risk. Those who participated said that 70% to 90% of their departments’ 911 calls were for EMS runs rather than for fires.
The article details how rising EMS call volumes reflected a broader shift toward using 911 as an entry point to healthcare. It concluded firefighters need training not only to provide medical care, but also to connect residents with appropriate health and social services — a challenge that continues today.
“When people think about volunteer firefighters, they think they just run fire calls, or they just run auto accidents, but that’s so far from the truth,” says Dillard, “they’re going out there to either get on the scene before the ambulance does and provide care or arrive about the same time and assist with care. That’s why we circle back to the symposium.”
Limitations
While exposure to more training helps, it doesn’t reduce the growing number of calls firefighters face. Between fire- and medical-related calls, more than 3.2 million in 2024 went toward false alarms, more than 1.5 million department calls were for providing mutual aid to initially responding fire departments and more than 400,000 were to respond to incidents involving hazardous materials, according to the NFPA.
“Usually when you don’t know who to call, you call a fire department. And it’s a lot of that,” said Greg Burton, a member of the Covington Volunteer Rescue Squad and vehicle extrication course coordinator for the Virginia Association of First Responders, a course taught at the symposium. “A little boy the other day got his finger stuck in the fender of a tractor. He wasn’t hurt, he just couldn’t get his finger out of the hole. So, who do you call? Who is responsible for getting his finger out of the hole? So they called the fire department.”
As one participant highlighted in the 2015 article, many of the calls they respond to are low-acuity medical incidents that strain resources, pulling crews away from more serious emergencies and exposing responders to unnecessary risks.
“You know, years ago, they [firefighters] might go out on a house fire, and then go days, or even weeks without another call. And now the demand is so big, they’re going out multiple times a day in many cases,” said Dillard.
And while the Virginia Tech symposium provided training opportunities for agencies to keep up with the changing nature of their work, events like these may not always be accessible to everyone.
Paid fire departments can more easily send firefighters to training events, Dillard said. They can pay career members overtime to cover the short-staffed station while other members are away at training.
Volunteer departments, however, have to make sure they have the bandwidth to send firefighters out of town for a nine-day event and still respond to calls at home.
The registration fee could also be a barrier for smaller departments with lower budgets.
It costs $100 per person to attend the event, though Dillard said that’s a good price for nine days of training and lunch every day. Grant funding paid for the first 400 people to register this year, which helped smaller departments participate, he said.
Adapting to the situation
As EMS calls continue to outpace all other types of emergency responses, firefighters and other first responders are increasingly turning to specialized training to prepare for a role that is becoming as much about medical care as fire suppression.
“If I arrive on scene to a car crash, I welcome the sight of that big truck,” said Lynn, “It’s a blocker, because when you look at how many people stop on the side of the road, and the emergency response that gets killed, because they’re not paying attention, you have a little bit of a barrier there when you have a big fire truck.”
Between 2023 and 2024, medical-related calls for fire departments actually dropped by more than 178,000, but still account for more calls than every other category combined. The Virginia First Responder Symposium reflects how first responders are pooling their resources to adapt their training to the realities of today’s emergency calls.
“This just being our first year, normally we’ll get 250-300 people signed up,” said Dillard, “the need is there, and the willingness to train together is there, and this is going to be the floor, it’s only going to grow from this point.”
