In My Head

I sat in the Captains seat, palms and fingers cradling my head, willing my heart rate to slow down. Once I got control of that, I figured the dizziness would stop. The patient on the stretcher droned on about wanting an IV, wanting a blanket, wanting something, I don't know, I wasn't able to hear her.

We had arrived at her residence at the same moment that my radio started the transmissions that will last in my head long after I leave the EMS division of The Providence Fire Department.


"Expedite that rescue, CPR in progress…"

"Any rescue to clear…"

"Rescue 5, are you available?…"

"Negative, on scene with a patient…"

"Rescue 3, are you available?…"

"Negative, transporting to Rhode island Hospital…"

"Ladder 3 to Fire Alarm, CPR in progress, Providence Police officer involved…"

"Roger Ladder 3, we have mutual aid responding…"

"Rescue 6, your status?…"

"Transporting to Fatima…"

"Any Rescue to clear…"


The transmissions continued. My head kept spinning. My patient kept right on complaining. When we arrived at her house, her daughter had stuck her head out of the second floor window and told us "she can't walk." As soon as I entered their apartment, the patient stood up, and said "get me out of here!" and headed for the door. Her son, who looked to be about thirty years old yelled after her, "Where's my medications!" and the window yeller looked on, then said, "she needs to go to a nursing home, she hasn't changed her clothes in a week!"


and the radio went on…


"Ladder 1 with a Cranston Rescue, respond to Crossroads for an assault in the lobby…"

"Engine 3, respond to 99 Kennedy Plaza with an East Providence rescue for an intoxicated male…"

"Engine 13, respond with a Cranston Rescue to Roger Williams Park for an intoxicated male…"


and the voices in my head started…

and the lady on the stretcher kept on complaining.

and my head kept on spinning.

and it hasn't stopped.



I've been banging my head against a wall for years. Nobody listens, nobody cares. A good cop dies while our six rescues continue to be used as taxi's for the homeless and street sweepers for the city. Just remember, if you ever need us, when seconds count, we'll be minutes away, or not available at all.

Providence Journal, 2007

When Seconds Count….

When disaster strikes, illnesses arise or accidents happen in the City of Providence help is only a 911 call away.  Or is it?  Far too often when a rescue is needed there is nobody to send.  Providence’s six Advance Life Support Rescues simply cannot handle the volume of calls generated by the people living in and visiting Providence.    Responding to an emergency in a timely fashion is critical.   Tragically, here in the Renaissance City, when seconds count, help is often minutes away.  Surrounding cities and towns fill the gaps in coverage with mutual aid agreements, but due to a lack of reciprocation that safety net is eroding.

Each of Providence’s six advanced life support rescues handle nearly five thousand emergency calls a year, far above the national average.  Cranston, East Providence, Johnston and Pawtucket routinely send their rescue crews into Providence when needed.  Providence, the biggest city in Rhode Island and second largest in New England does not have the resources to repay the favor.  Smithfield, Lincoln, Cumberland, Warwick, Central Falls; all send rescues to Providence.  Are the taxpayers of those communities paying to subsidize Providence’s irresponsibility?  What are these communities getting in return?  Not much.

A progressive fire department, properly funded has a responsibility to the public it protects.  Emergency Medical Services are the most used aspect of the fire service.  Many departments report upwards of eighty percent of their calls are emergency medical responses.   The cities and towns surrounding Providence have properly staffed their departments to handle the need:

  • Warwick,                    population  87,233*                      4 Rescues
  • Cranston,                   population  81,617*                      4 Rescues
  • East Providence,      population  49, 515*                     3 Rescues
  • Providence,                population 176,862*                    5 Rescues

*(2005 Census)

In 2006 Providence added a sixth rescue to help address the mutual aid problem.  The truck operates on a temporary basis and has no assigned personnel, using overtime to fill the seats.   While the number of mutual aid calls into Providence from surrounding communities did decrease slightly, it did nothing to improve working conditions, morale or number of calls responded to by the firefighters assigned to the rescue division.  Most days the city’s six rescues run non-stop.  Experience in the field is invaluable.  You just can’t teach a person lessons learned in the street.  All of the knowledge and experience doesn’t do much good if the person in possession of such life saving skills no longer serves on the rescue.

The stress of the job has taken its toll on the Providence Fire Department’s Rescue Division.  Qualified Rescue Officers have given up their rank, handed in their bars and left the division, leaving the positions vacant.  In their place, inexperienced firefighters have volunteered as acting officers on the rescue trucks.  While they have performed better than anybody has the right to expect, the loss of leadership is palpable.  Morale is at an all time low, firefighters who would rather be fighting fires, some with decades of firefighting experience are sent to the rescue division to act as rescue technicians.  Some crews have an acting officer with five years experience in charge of a rescue with a technician who has twenty years on the job.  The calls are non-stop, the crews deal with the situation the best they can.

Twelve people manning six rescues in a city of 180,000 is woefully inadequate by anybody’s standards.  The dozen medics on call manage to provide Emergency Medical Services to the people of Providence in an efficient, professional manner when they are available.  Their lack of availability is the issue.

Michael Morse is a Lieutenant with the Providence Fire Department, and author of Rescuing Providence




  • Local1234 says:

    Reform has to start within the city but extend to the state level. This BS about responding an ALS rescue to every nonsense call and transporting every nonsense caller can stop. It really can! All you need is someone with the balls to say “ENOUGH” and change city policy and state protocol. Send a BLS unit to a BLS call, send a private ambulance to a non-emergent call for “treat and convey” or “transport to detox”, say “NO transport” to so many of the other calls for which a taxi would more than suffice, bill the system abusers (deduct from their fed/state granted funds). Save the rescues for call that merit a rescue, save the personnel from physical/mental/spiritual injury. Bite the bullet and make sure that the division that does 80% of the work gets the proper percentage of the budget, equipment and staffing. But this will take some work from the inside as well…you MAY, just MAY have to be willing to give up the status quo and forget about the call backs, forget the rhetoric about how it’s “going to cost us jobs”, forget about EMS as a stepping stone to a job on the Hazards,the “big red bed” and the extra pay for getting your C license (but not need to be on a rescue). We’ve all heard the great lines about loosing manpower, how it’s an excuse to bring in private companies, how “we have to stay strong” and all the other great lines we always hear at every meeting. We can’t have it both ways, it can be done but it has to start with “us”. Otherwise, you’re going to have nothing to write but more and more of these.

  • Michael Morse says:

    I’m doing my part, brother, and it ain’t easy. Nobody wants to hear it.

  • Local1234 says:

    Michael, I know I am ranting to the choir over here but sometimes I just have to get it off my chest. Plus your readership needs to see it in black and white as well. Maybe they will get their heads thinking. God knows you can’t say these thing aloud in the day room with being tarred, feathered and so. As Rush put it, “Be cool or be cast out”. Meanwhile the disease itself doesn’t get treated, we just take two aspirins and hope for the best.
    Keep up the good work and don’t let them break your spirit!

  • JoeEMT799 says:

    Liability, liability, liability is usually the defense for this nonsense we call EMS but what about the responsibility to protect the public. The abuse of the system could stop but leadership and administrations fail time and time again to address the root cause of the problem. Until EMS grabs its balls and stands up for itself it will continue to fail. Local 1234 listed the logical fixes that most common sense people would agree with but the leadership of the city is not going to go against the grain of the problem and fix it. The EMS system will continue to chug along chew people up and spit them out when they have had enough. Some will stay for money others will try to hang in there but the bottom line is until someone dies it won’t change.

    Sadly the loss of a great Providence Police Officer Max Dorley, still may not be enough to get the system changed.

    We were tied up with a drunk that calls everyday while MAX laid waiting for that needed Rescue!

  • Michael Morse says:

    Thanks Joe, well stated.

  • Bullets says:

    So there is no 911 BLS in Providence? You send ALS trucks to drunks and miscellaneous pains, routine falls, minor MVAs?

    Your mutual aid puts up with this work load? Around here most squad would tell you to pound salt and find someone else

  • Local1234 says:

    Bullets, as a rule fire departments provide EMS services in this state and when you call you get an ALS response every time. This is a rule of thumb and I am sure there are exceptions but you get the idea. A neighboring department wouldn’t refuse mutual aid to the city unless there were dire circumstances. In some cases municipalities have had to call in mutual aid themselves because their Rescue(s) was in another city/town. Taxpayers just haven’t caught on that they are subsidizing other cities and towns. They’re pissed off about our pensions but they would really be livid if they knew and understood the whole story!

    • Bullets says:

      I guess things are different. two neighboring towns have mutual aid agreements, but it was not equitable. City couldn’t cover their calls and had Town ambulances in all the time, to tje point where Town residents had to wait for their trucks to return from City. Finally town said enough and pulled out, no more mutual aid to City.

      This is all BLS, ALS is part of the hospitals

  • Cs says:

    Funny how people talk of have “privates” take this and that. I’ve never heard of private fire trucks…
    My city should be the SOLE provider for Medical services/ems. Hold/Que calls, priority calls, nurse triage calls, engage in EMS prevention, add units.

    My department hasn’t added an ALS unit in more then 6 years, and no new BLS in 5 years. It takes people dying waiting and the news covering it to bring change.

    • Tired of it says:

      You’re right. Providence should ignore the 30+ ALS units in their city at any given time because they don’t wear the right patch on their sleeve or have the right card in their wallet. Instead, STEMIs, strokes, siezures, drowning CHFers, stabbings, shootings, assorted significant traumas, and police officers with no pulse should keep waiting for trucks from Warwick, Lincoln, Seekonk, and Barrington.

      That’s something else nobody will tell you- every week for the past month Providence has completely exhausted the resources of their immediate bordering towns (Cranston, EP, NP, Johnston, Pawtucket) and had to start begging from the “outer ring” cities and towns, I guess you could call them. Who’s next? Coventry? Woonsocket? Portsmouth? (Have to skip Warren and Bristol to get to that last one, since the other two aren’t union. Can’t have that.)

      Meanwhile, the Rescue Division’s own “brothers” outvote them every time someone tries to make a change for the better during a contract negotiation, because “better” for EMS doesn’t automatically translate into “better” for the Big Red Trucks. And the BRTs of course are where “the real firemen” are, holding onto that $60 a week so they can throw on an NIBP cuff and a pulse ox probe, and report that they’re “obtaining vitals” for whatever rescue happens to be crawling its way to their location Right.

      Are we supposed to believe that a 20-something kid in the privates is REALLY going to do that much worse? Ever see some of the emergency runs they pull out of the nursing homes? Train wrecks. And they do it with two people on the truck. I say given em a chance. Is a less-experienced ALS truck onscene in 5 minutes in a city with 6 hospitals SO much worse than the union brothers 20 minutes out?

      • Michael Morse says:

        Good rant, Tired of it all. Try doing it for twenty years and those rants might get even better. There is much more to the problem than letting privates in on 911 calls. I’m all for getting that ball rolling, but doubt if I’ll ever see it. As much as I’d like to argue your points, i really can’t, because you are right more than wrong.

        • Tired of it says:

          Thanks for the kind words Michael; the second I hit “post” I figured it might not even see the light of day. Reading it again, I wouldn’t blame you. It looks a lot harsher today .

          I also don’t mean to suggest that privates are a panacea or should be the saviors of Providence and the PFD. I think if I could re-emphasize any point I made, it would be that, at least in the short term, could they really do worse? The only thing worse than a bad plan is no plan, and that’s what we have now.

  • Michael Morse says:

    The most frustrating part in all of this is we all have good ideas that go nowhere. Every person in EMS that I talk, or know through this blog, all over the country and world, is aware of the chaos, and every one of us has great ideas. Maybe the problem is lack of real leadership on a national scale, I don’t know but it just keeps getting worse.

  • Sam says:

    I have read, and re-read this post and started to respond many times with suggestions, solutions and everything in between. All of it has been thought of before. No amount of hindsight can turn back time to try and have a different outcome of this call. I feel for your department and your fellow Public Safety Officer. I have been in that same situation, dug up those old memories and contemplated my own feelings after reading this. But like you said Michael, this is not just a local problem. It’s a nationwide problem.

    We faced the same thing here in my town in Texas. But we just happen to have a City Manager that overheard a mutual aid call to our city and finally came to the realization that we were under-staffed. It can easily happen to towns that grow to fast or have leaders that become politically involved with other pet projects. EMS is looked at as a non-essential service, until it is essential.

    Sometimes it takes a tragedy like this to open the minds of our local leaders to the ugly truth that we are not as adequately staffed as we should be. I can only hope and pray that this incident can do this for your city. My heart goes out to you, Bud. Keep up the good fight and I hope that something good will come out of this.

  • Brendan says:

    Thoughts and prayers with Providence PD. This is a recurrent nightmare of mine that I’ve thankfully never experienced. I work in a system with far more EMS resources than yours and we’re still stretched thin often enough to scare me. I’m most afraid of the anger I feel towards the public that calls us for the bullshit. It’s a learned behavior that we’ve not been given the right to try and educate and correct. Thank you for voicing our frustrations and I’m sorry you have to feel it so directly. Please keep up the good fight, it gives those of us with less time on the job (4 years) strength to carry on when experienced and dedicated medics keep at it. Good luck and God bless.

  • michael says:

    Thanks, Sam, it is a bit frustrating.

    “EMS is looked at as a non-essential service, until it is essential.”

    That is a great line, I hope you don’t mind if it turns up here at one time or another.

  • Sam says:

    Anytime brother, no props needed. I’m pretty sure I borrowed it from someone else too…. Be Safe!!

  • mike says:

    they say north prov, east prov and johnston wont respond to providence calls when needed if someone is an emergency situaton let me say to those 3 cites np, ep, and jonston guess u dont care about your brothers and sisters my guess will be if this stops providence will call warwick, and cranston when an emergency true people

  • EMT-C says:

    The problem is systemic, the general public needs to be re-educated. the red box with red lights ISN'T A TAXI!
    Unfortunately, nobody has stepped up, I wonder if someone on the AEB will now look at this as it is and start a PSA campaign to tell RI'ers Wake up, you are only hurtig your neighbors by abusing the system.

  • EMT-C says:

    AEB… Typo, should have been the AAB (Ambulance Advisory Board)

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