The Cumberland Gap Volunteer Fire Department (CGVFD) provides fire and rescue services to the historic town of Cumberland Gap, Tennessee, and the surrounding area. CGVFD is staffed, operated, and managed entirely by osteopathic medical students at Lincoln Memorial University-DeBusk College of Osteopathic Medicine (LMU-DCOM) in Harrogate, Tennessee. Call volume 2012: 34 total, 18 false. 2013: 27 total, 19 false. 2014: 30 total, 20 false.

Trained and ready for action, the CGVFD medical student firefighters were called to duty during finals week on Wednesday, Dec. 9, 2015. Tones drop, “Cumberland Gap Volunteer Fire Department, have a report of a house fire, fully involved, unknown if anyone is inside, time now 23:41.” Every member heard the call and, despite being tired from the constant studying and testing over the past few days, responded without hesitation. Fire Chief Brandon Wilkinson (osteopathic medical student [OMS] year II) first responded to the fire station and then onto the fire in Engine 81, with firefighter Wayne Cox (OMSIII) shortly after in Tanker 82. “Both apparatus en route, all firefighters respond straight to scene,” Wilkinson advised on the radio. With smoke visible a mile away, Wilkinson arrived on scene to Ken Todd (OMSIII), Chris Moore (OMSIII), Patrick Herling (OMSII), and Andrew Smith (OMSI) dressed in turnouts. They were standing outside a large two-story home with fire rolling through its kitchen and living room and out the exterior wall and making a run for the rest of the house. “We have to get in there quick, or else the whole thing is gonna go,” Todd said as he grabbed a self-contained breathing apparatus off the truck and started walking toward the house.

With the engine parked and in pump gear, everyone moved as they had trained many times before. Lines stretched out, hoses charged, and water flowing, the firefighters organized in teams of two and formulated an action plan quickly as the initial attack got underway. Using pike poles to pull down the ceiling and expose the fire, they were able to get in front and effectively stop the fire from running through the ceiling and burning down the whole house. Once the fire was extinguished, a secondary search was performed along with overhaul to determine, without question, that the fire was now completely extinguished.

Standing in the middle of the driveway in smoke-stained turnouts, looking up in the now cool, calm night sky, Todd asked Wilkinson, “What do you have in the morning?”

“Biochem examination. You?”

“OPP [Osteopathic Principles and Practices] Practical.”

Both laughed. Time now 03:45.

Dedication to Service

Medical students are known for their ambition, involvement in extracurricular activities, and eagerness to contribute to society. For many, a desire to fulfill medical school application requirements for club and organizational involvement turns to a means of fulfilling their desire to contribute and grow as individuals prior to matriculation. Through hours of high school volunteer service and club organizations to 5K runs and fund-raising dance marathons for pediatric cancer at their undergraduate education, medical students are aware long before they receive their acceptance letters that they are committing to a life of going above and beyond the call of duty. This real world service experience allows them to develop problem-solving skills, working as a team and developing relationships with key players to accomplish the goals they have set out to achieve in their various associations. Resolving obstacles and providing solutions for health in communities creates skills that further individual growth and maturity.^1,2 These activities begin to define them, just as much as their grade point average and MCAT scores, and allow them to start answering the infamous question, why do you want to be a doctor?³ The summation of their experience and academic performance is what grants them entrance into their medical institutions that match their goals and the type and scope of medical practitioners that medical institutions aim to produce.

LMU-DCOM in rural east Tennessee offers medical students an exemplary opportunity to serve the poverty-stricken communities at the heart of Appalachia. The university was founded to serve the region of rural Appalachia with primary care and emergency medical practitioners that the area desperately needs. As a native to eastern Tennessee, the president and foremost financial contributor to the school, Pete DeBusk, is both a figurehead on campus as well as a service member who has no qualms about riding the tractor to assist with new campus construction projects. As such, his generosity and commitment to service have exemplified the type of service and commitment to community that the institution seeks from its future medical doctors in attendance.

The historic town of Cumberland Gap has greatly benefited from its proximity to Lincoln Memorial University and DCOM, in particular. The small town was historically one of the three gaps in the mountains that allowed for safe and easy passage to the West for pioneers. Though you would expect it to be a busy tourist attraction, it still remains a small town of 483 residents. One of the greatest needs in the town is the need for emergency services. With many older residences, poor health and safety codes, fires, and flooding, emergency response needs remain constant.

LMU-DCOM students pride themselves on their community involvement, seeking new programs and finding needs within the rural community. With a population at 24 percent below poverty level and 14.8 percent without health insurance, Claiborne County, Tennessee, is a community in need of public health service.⁴ Relocating from all over the world, LMU-DCOM students use their previous experiences in health care volunteering to provide a foundation for numerous startup programs. LMU-DCOM students’ involvement in the rural community varies from health education in elementary schools to cardiopulmonary resuscitation instruction in high schools to emergency service departments.⁵ In particular, the local emergency service departments, specifically volunteer fire departments, suffer from recruiting and retention difficulties based on the physical and training demands without financial compensation. Often, volunteers become fatigued and discouraged.

Service Beyond Medicine

Due to local retention difficulties, CGVFD was threatening to close its doors. Medical students living in the community reached out and recruited students with previous emergency service experience. Located only three miles away from LMU-DCOM, CGVFD is situated in the town of Cumberland Gap. The CGVFD is responsible for the town of Cumberland Gap (population of 483), the town of Tiprell (population of approximately 500), and Lincoln Memorial University dormitories (population of 228). Instead of being staffed by local volunteers, CGVFD is entirely staffed by LMU-DCOM students. Since medical students have two years of didactic training at LMU-DCOM and travel to rotation sites outside of the region for the last two years of school, CGVFD relies heavily upon constant training and community outreach. Upon agreeing to volunteer, student firefighters undergo a required 16-hour basic fire course followed by a 64-hour basic firefighting course provided by the state of Tennessee. Together, these 80 hours of instruction provide the minimum training necessary to work as a firefighter in Tennessee. However, constant in-house and local training is required to maintain a skill level well above the minimum standards.

CGVFD has become a robust and dependable presence in the town, providing emergency and fire response. CGVFD is solely composed of 12 medical students who are constantly on call to respond to 911 emergencies. Working in conjunction with local fire, police, and emergency medical services (EMS) in surrounding counties, CGVFD also participates in mutual aid training and response with local departments. In addition to writing for state grant funding and hosting community pancake breakfasts and yard sales to raise funds to maintain and purchase necessary equipment, the medical students also install fire alarms that have been donated by Claiborne County for Cumberland Gap and Tiprell residents to improve the health and safety of its residents.

As multiple news stories, anecdotal tales, and research reveal, there is a national trend in the decline of volunteer firefighters. The decline results from a simultaneous decrease in the number of active recruits and increase in the average age of volunteers, suggesting that the issue lies in recruitment and retention.⁶ Another concern results from the type of communities under the protection of volunteer fire departments—they are generally rural and impoverished ones. A survey in south central Pennsylvania revealed that 25 percent of volunteer firefighters earned more than $50,000 annually in an area where the median income for 2009–2012 was $51,173.27.⁶ The communities protected by volunteer fire departments are likely impoverished, and those offering the protection earn less than their neighbors. Table 1 shows how CGVFD has recruited and retained a consistent number of volunteer firefighters, resulting in a steady-state equilibrium of trained staff for the department and the local community. Additionally, a majority of these volunteer firefighters were not trained upon arriving to LMU-DCOM, meaning that they successfully completed mandatory training while completing medical studies.

Table 1: Recruitment, Retention, and Staffing of CGVFD Over Five Academic Classes

*”Lost” due to fail out/dropout or other departure from LMU-DCOM and CGVFD

Table 2: Residency Placement for Inaugural class of graduate LMUD-COM and CGVFD Firefighters, as of 2016

For a few short years, medical students become residents of these communities that host their educational institution. While medical studies are more demanding than a full-time job, students should not feel immune from civic duties for the community in which they now live. “To see our students invested in making their community a more safe and secure place is a dean’s dream,” LMU-DCOM Dean Brian Kessler said. “These students have embraced LMU-DCOM’s mission of service to humanity, and they live it each day. The commitment the students have made to the Cumberland Gap Volunteer Fire Department is a special one, and it has not gone unnoticed.” For these medical students, serving their community started before answering the Hippocratic Oath as physicians and will continue long after.

References

1. Ferrari ND 3rd, Cather GA. Community service, learning and the medical student. Educ Health (Abingdon). 2002;15:222-227.
2. Loh AZ, Tan JS, Lee JJ, et al. Voluntary community service in medical school: a qualitative study on obstacles faced by student leaders and potential solutions. Glob Health Action. 2015;8:27562.
3. Mowery YM. A primer on medical education in the United States through the lens of a current resident physician. J Thoracic Dis. 2015;7:E473-E481.
4. S. Department of Commerce. United States Census Bureau QuickFacts, Claiborne County, Tennessee. United States Census Bureau website. Available at www.census.gov/quickfacts/table/PST045215/47025. Accessed Sept. 2, 2016.
5. Querubin J. Cardiopulmonary resuscitation (CPR) instruction by osteopathic medical students to laypersons, middle school, and high school students in a rural and underserved community: a preliminary report. Poster presentation at: Association for Prevention Teaching and Research; 2016.
6. Miller A. Human Resource Strain and Organizational Survival: Investigating the Survival State of the Rural Volunteer Emergency Services in the South Central Mountains Region of Pennsylvania [master’s thesis]. Huntingdon, Pennsylvania: Juniata College; 2015.

Dr. Wilkinson is fire chief and Dr. Herling is a member of the CGVFD. Both are students in the College of Osteopathic Medicine at Lincoln Memorial University, DeBusk.