What if We Treated the Firefighters Like Doctors? by Stephen A. Vaughn MD PhD


The “fire problem” in the United States is out of control. Costs of firefighting have skyrocketed. A once volunteer operation, fire departments are now heavily staffed with full-time career firefighters, who are generously paid and reap massive benefits and are protected by unions. American firefighters have taken home trillions of dollars in salary – yet fires still occur daily in every town in the United States. The fire companies are organized in a variable pattern, each state, city and township adding its own structure to firefighting operations. There are not standard Best Firefighting Practices being used, and there is no national certification of American Firefighters. No ongoing method is being used to assure that firefighters are keeping up with the complex and ever-developing world of Fire Science and Firefighting Technology. Yet, fire department remain mired in the pre-technology past, with little interreliance on modern methods of information science in the firefighting world.

In any fire department in any major city, few firepersons are actually fighting fires at any given time. Most are standing around doing make-work projects that are dropped when an alarm comes in. No attempt has been made to categorize the efficiency of firefighting on a national level.

There is little ground-level documentation of the type, nature, scope and purposes of individual firefighter’s daily activities. Firefighting is at the crossroads – the nation can no longer afford chaos in its firefighting efforts.

  • A national, cabinet-level Department of Fire Safety and Prevention should be immediately organized.
  • Nationally-standardized Fire Fighting Methods should be codified and mandated in every local Department.
  • Non-firefighting duties should be outsourced to intermediate-level personnel. Shining brass, feeding the dalmatian and sweeping the station should be performed by lower-cost personnel.
  • A standard method of reporting of FIre Fighting Actions should be developed. Each firefighter should document the nature, kind and size of the fire being fought; the flammable materials ignited; the severity and danger of their individual duties; and finally, a self-assessment on personal failures and how they will fight the next fire better.
  • Property owners and residential dwellers shall critique the Firefighters’ individual performances based on their satisfaction for services.
  • Quality-review personnel should be required to evaluate the individual actions of every firefighter, and tier them into a pay-for-performance scenario, based on their fire outcomes. (e.g. successful suppression with a utilizable structure; loss of structure, loss of life, etc.) This independent QR can be crosschecked with the individual ,firefighters’ accounts for discrepancy and dishonesty in self-report.
  • All citizens should be required to underwrite fire insurance, or post a bond equivalent to a fire insurance policy, notwithstanding if they own any flammable property. This will standardize the costs of firefighting.
  • One’s previous history of fires on one’s own property should not be taken into account in a discriminatory fashion in setting fire insurance policy.
  • Firefighters shall bear personal liability exposure for the cost of fires which they have not fought according to Best Firefighting Practices. Individual performance insurance must be undertaken for firefighters to guarantee their due diligence in the performance of their duties.
  • Biannual National Firefighter Certification shall be required, with continuing educational performance on such topics as Water-Based Fire Protection Systems, the National Fuel Gas Code, Fire Protection Infrastructure for Land Development in Wildland, Rural, and Suburban Areas, National Standard Screw Threads for Fire Hose Couplings and Fittings and Fire Control for Radioactive Metal Fires.
  • All persons to be removed from a burning structure shall, if possible, be requested to complete a “Consent-to-Rescue” form, if conscious. MInors are not required to sign consent to rescue.
  • In order to maintain confidentiality, the identity of all persons rescued from a burning residence shall be kept strictly confidential, unless they have filled out a “Consent to Release Fire Information” form. This includes infants and minors rescued from burning structures. Persons claiming parental authority will be required to show a Governmental photo ID, and a birth certificate or documentation of adoption or similar authority
  • Firefighters are required to successfully capture dropped, flung or hurled infants and children, and are subject to criminal penalties for failing to catch them properly..

“Creative Destruction of Firefighting” can rapidly be accomplished by authoritative input and control over firefighter services by brainstorming by the Silicon Valley technologies on refulgent proaction in novel tesseractive principles of business topology. In the future, we expect that human-based firefighting will be replaced by robot firefighters controlled by the latest iPhone technology by the residents of the engaged structure, rendering the need for firefighters obsolete..
What are some other atrocities we can think of for our poor firefighters?

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  6 comments for “What if We Treated the Firefighters Like Doctors? by Stephen A. Vaughn MD PhD

  1. Michael Gorback
    July 2, 2014 at 4:30 pm

    Let’s not forget to trash them anonymously at firegrades.com.

    “The person who took my call about the fire could have been a little more friendly. All he would talk about was where the fire was and whether anyone was trapped inside. When they showed up they sprayed water all over, even on things that weren’t on fire. Not recommended!”

  2. Pat
    June 27, 2014 at 10:06 am

    This is hilarious, well done!

  3. Ben Van Raalte
    June 27, 2014 at 9:32 am

    Right now firefighters get to retire at average age of 55 at full salary. Sooner if disabled. Since the average firefighter works 48 weeks, get holiday, sick, and vacation time off, he averages 1700 hours a year. After 30 years that is 50,000 hours.
    By the completion of medical school the average physician has 20-25,000 hours. After residency that is another 9000-35,000 hours ( pre hour reform). Meaning surgeons would retire after they completed residency or at least draw a pension equal to 100% of their highest salary, and the average physician would have 5-10 years in practice before retirement and getting a pension equal to the highest years salary.
    Yes, firefighters can die, 4000 total died in the last 37 years about 100 a year. Physicians also acquire hepatitis, other diseases and have the highest suicide rate.
    So lets also make the firefighters first spend 15 years training to be a firefighter, the first 8 they pay to go to firefighter school. The next 4 they are paid minimum wage. After that they will be assigned a district and will have to work all the hours necessary to fight fires in that district. They will also have to pay back the cost of firefighter school. Retirement will need to be moved to age 65.

    • June 28, 2014 at 8:40 am

      It’s fortunate that the bureaucrats haven’t found the way to the firehouse – although I’ve heard that firefighters are starting to become infested with bureaucratic hookworms and other awful hangers-on.
      We will be a society of doctors who aren’t allowed to doctor, standing amongst a landscape of burnt-out rubble.

  4. June 27, 2014 at 7:44 am

    Let’s not forget the firefighter’s daily duty to document the fire conditions of each home they protect in their EFR (electronic firefighter record). Pre-fire screening, documentation of conditions and procedures during a fire, and post-fire analyses all must be fully recorded and available for RAC audit by national fire insurance agencies. If any of the documentation is incomplete or insufficient evidence has been provided regarding the necessity of the fire services, the fire insurance agency has the right to deny coverage for the work completed by fire fighters (regardless of the homeowner reasoning for their emergency call).

    The fire fighters must use an EFR that complies with meaningful use standards (such as equipment order entry, interoperability with other EFRs, and easy access to fire records by home owners) and will need to self-pay for the upgrades required to meet EFR requirements ongoing, including ICDf-10 which has 60,000+ codes for fire classification, including critical codes such as “fire initiated by friction from cat” or “fall from turret, causing spontaneous combustion of nearby grass fire, spreading to nearby structures – left side.”

    Any miscoding is grounds for non-payment for services, further auditing, and penalties and fees. The EFR has the additional benefit of auto-populating irrelevant data into the daily firefighter notes (including things like firetruck odometer readings, hose pressures from 2 years ago, and firehouse toilet cleaning schedules) and being fully accessible to firetruck-chasing lawyers who eagerly await homeowner service complaints so they may requisition fire documentation to prove that the firepersons performed substandardly based on the EFR. For example, lack of documentation that the firetrucks left the station to provide immediate assistance to a 4 alarm fire is, of course, evidence that they never left – and meets the requirements for professional negligence.

    To protect themselves from potential malpractice lawsuits, firefighters must secure their own professional liability insurance, which (depending on the firefighter’s expertise and specialty), may cost in excess of $300K per year.


    So who wants to be a fireman? Raise your hands!

    • June 28, 2014 at 8:54 am

      Also, since the elderly and indigent should not pay for individual fire insurance, the firefighters will have to bill their salary differently to a residential structure owned by someone on FireCare or FireCaid. They must have a UFD – unique firefighter number – for their billing. Their office can handle the paperwork.
      I like the idea of electronic records, because all that paper could become a fire hazard!

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