Fire Als transport vs other..

[911bru]

Sorry if this has been posted its hard to search on my phone for prior topics.
I hear many county medics and private agencies not agreeing with the idea that the fire depts has Als transport like in Washigton state and many areas in the northwest. We also know that king county medic one is usually the staple of Als treatment and is always at the forefront of EMS.
Rather that argue who is better I would like to focus on the political and financial aspect of why different areas get up the ALS transport system differently.

- thanks

 

[leoemt]

King County Medic One and Seattle Fire Medic One are good at what they do. However, they hate to transport anyone who isn't "circling the drain". King County does not allow private ALS. That means as a Basic, I get turfed a lot of patients that really should go ALS.

On the one hand the experience is great. I have successfully managed some pretty critical patients - not that I have to for long as were about 5 minutes from a hospital at any given point in the city.

However, there are things that I can't do and that is frustrating to say the least. Nothing worse than being in back with a patient knowing they need more help than you can give.

Ultimately, whether ALS or BLS, the goal is to get the patient to definitive care which is someone with MD after their name. We are pretty successful in this.

My personal opinion is fire should not be involved in EMS. They can do rescue and fight fires but EMS should be performed by either private or public ambulance services. I won't elaborate on this as I currently work in this system and I have pretty strong opinions which usually turn into pissing matches on this forum.

If you have anything specific you want to know concerning King County feel free to PM me.

 

[RocketMedic]

Sorry if this has been posted its hard to search on my phone for prior topics.
I hear many county medics and private agencies not agreeing with the idea that the fire depts has Als transport like in Washigton state and many areas in the northwest. We also know that king county medic one is usually the staple of Als treatment and is always at the forefront of EMS.
Rather that argue who is better I would like to focus on the political and financial aspect of why different areas get up the ALS transport system differently.

- thanks

"Forefront" is relative, and highly dependent on which arbitrary measurement you use. If you go with SCA resuscitation, KCM1 is pretty good. Not so much if you go by "pain palliated", "respiratory distress" or "ACS/AMI recognition and treatment".

Personally, I think that fire departments that transport should be ALS, possibly critical care, have amazing gear and progressive protocols. They should try and mirror systems like Wake County, and collaborate to do so (there is precedent here, with the state-level fire academies). I think that they should be split departments with EMS-only options, but I can see the arguments for dual-role medics and can't really argue with them. I also think that there should be effective and meaningful policies in place to make the ambulance a fun and desirable duty, not a punishment box. In other words, mirror San Antonio, San Angelo or El Paso, not Dallas or Detroit or NYC or Washington DC or Seattle or LAFD.

Financially, I think that the decision to support an ALS transporting fire department is responsible if the city is willing to subsidize it entirely to an adequate level and not rely on billing to fund the department. This predicates a stable local economy, a relatively affluent tax base, and fairly large but steady call volume. A private ALS/BLS service for IFT and 911 backup (need not be an ALS truck) are also probably pretty important. Non-traditional asset deployment is probably a great idea as well- not necessarily posting, but deployment of multiple ambulances to high-volume areas. Separate medical calls from fire calls, and consider adding a third firefighter to ambulances when practical- you don't need four men on a ladder or engine that will go to the same fire as the ambulance anyway.

Non-transporting ALS fire could greatly be improved by putting that money towards SUVs instead of fire engines.

Politically, I think that ALS fire is a powerful draw, but one that has potential to strangle a city or county. There is a difference in staffing- you need more paramedics for most large communities than you need firefighters, and those paramedics need to be in smaller units and utilized more often to make financial sense. This means that a department is either split (with the positives and negatives inherent) or accepts a lot of paramedics into its ranks. I think that it is up to the members of that department to see if that assimilation is a positive one or a negative "EMS sucks" one. Fire departments are way, way better at politics than private providers, since they play off of the "hero" label, the work of their private and third-service counterparts, and they have a strong, national union. Image sells, and fire departments have image out the wazoo. Their organized, generally well-funded unions also help quite a bit in local politics. However, greed is a factor.

Let's look at Clark County, Nevada. AMR and its EMSC brother provide the vast majority of 911 transport and ALS care in a high-volume, high-cashflow 911 system, and most of the IFT. Generally speaking, unless you're a very high-profile case in terms of media exposure or a level-one trauma that MedicWest or AMR didn't get to first, you're being treated and transported in a private ambulance with private supplies and a private employee. The fire departments in the Valley do excellent jobs most of the time, but generally they do not transport- they are set up as first-response. However, the unions, via their political contacts, have made it so that fire medics run everything on-scene until they release the patient to AMR (poor choice, IMO, but workable). Then, faced with budget cuts, fire departments started a long-term, very public smear campaign against AMR and MedicWest, with plenty of blatant falsehoods. One department, NLVFD, even started transporting all of their own patients in an attempt to drive AMR/MWA out of their area. This lasted for about a month, in which the department burned its year's overtime budget and was pushed to near-bankruptcy by overtime at ridiculously inflated FF salaries. MedicWest came back in to the rescue, relatively unaffected by the loss in income (realistically, they probably profited from the transfers they were able to take in lieu of nonpaying 911 calls) and things returned to normal. Fire-based EMS is a great thing as long as unions don't get greedy.

 

[Veneficus]

The economics and politcs are intwined.

Who is paying, how much, and who is getting it.

All of the various systems are theorhetically capable of providing equal and high level care. Some choose to, some don't. The reasons vary, but usually revolve around the enthusiasm and values of the individual organizations.

That is why it is so subjective on who is best.

As many agencies have discovered, when you call youself the best, you basically make yourself a target for everyone elses ire.

 

[ExpatMedic0]

Medic 1 should not even be included when speaking of a nationwide fire service ALS transport. To my knowledge no one else has anything like there program. They are an exception.
most fire based EMS seems to be IMO a way to generate revenue for the fire service. Much like why an engine responds on every EMS call in many systems. It is a joke. Sometimes I feel as if bystanders would be just as useful if I actually needed any assistance. Its a way to justify there existence and keep numbers looking good. When was the last time you herd the fire service advocating for increased educational standards for EMS, advancing our career, or progressing us as a legitimate health care provider and not just manual labor/emergency response?

 

[ExpatMedic0]

Don't get me wrong, I know the fire department pays better than private ambulance and offers better benefits. Private ambulance is often just as evil or even worse than the fire department. In fact there are a lot of incompetent uneducated bafoons running many private EMS agencies. At least the fire department has physical standards, and deeper pockets, Ill give them that.

There are good folks at the fire department but its not a healthcare agency.

If the fire department would advocate for us and get more involved with progressing us as a health care provider/profession, increasing education standards, and lobbying for us (ALS transport), I would succumb to there almighty power and unions.

Currently your best bet (in the USA anyway) is 3rd party municipal agencies, hands down.

 

[911bru]

I personally believe that all 911 calls should be responded only by government agencies. 911 is a government system also it's tax based again we don't have private police officer show up when you call 911 or private fire departments to your residence so I don't see why we should have private Ambulances seeing that their entire goal is to make a profit. the government can ask the run at a deficit and still maintain its operations.
After doing an internship in the Seattle area and also knowing a few king County medical one paramedics and Tacoma fire medics I really like and appreciate how they are structured and the efficiency in which they work.
I believe that police,fire and Ems should be government run.
You as an employee know that you have a great career of you make it on as a fire medic, as very few go from fire medic to private ambulance companies.
Better pay, benefits, union , shifts and also respect. It's the total package in my opinion.

 

[911bru]

Don't get me wrong, I know the fire department pays better than private ambulance and offers better benefits. Private ambulance is often just as evil or even worse than the fire department. In fact there are a lot of incompetent uneducated bafoons running many private EMS agencies. At least the fire department has physical standards, and deeper pockets, Ill give them that.

There are good folks at the fire department but its not a healthcare agency.

If the fire department would advocate for us and get more involved with progressing us as a health care provider/profession, increasing education standards, and lobbying for us (ALS transport), I would succumb to there almighty power and unions.

Currently your best bet (in the USA anyway) is 3rd party municipal agencies, hands down.

My first experience was from the Seattle area and after seeing how they run things, and the quality of medics that they demand I'm all for places following the way the set it up.

 

[ExpatMedic0]

I personally believe that all 911 calls should be responded only by government agencies.

I agree %100 but the fire department is not a health care agency, nor is the police department. Boston EMS, Honolulu EMS, Austin Travis County EMS, those are a handful of 3rd party local government EMS providers that come to mind.

I am from Portland so I know a taste of what your talking about near Seattle. I am not going to talk about politics revolving around medic 1.... All I will say is %99 of fire based EMS in the USA is not like that. Its not... not even close!

Look at the rest of the modern world, countries like Australia and the UK.... we could learn a thing or two from them.

 

[911bru]

I respect everyone's opinion and I am on here to listen and learn... I'm a newbie ...

 

[ExpatMedic0]

Ill give it a rest and let some others chime in. Just understand medic 1 is a unique (and often controversial) thing. There Paramedic program is over 3000+ hours long and all prior Paramedics have to "redo" Paramedic school. Much of it is taught by M.D.'s There is no other program or system I am aware of the in the United States at that scale that is similar to medic 1.
Also the BLS providers in that system might have a thing or two to say regarding it... but once again I am not getting into the politics.

Now compare that with a fire department mentioned here before in Texas, which requires 600 hours for Paramedic certification which does not even qualify for NREMT, taught by other vocationally trained firemen

 

[911bru]

I heard of some private ambulance companies making you be at there local station while on call for around $2.00 per hours then you get paid per each call... This like this sound creepy and I don't see fire departments doing this type of stuff .

I hear of 3rd party government ems programs and I think they are far better of an idea that truly private ambulances.
Usually these government ambulances are county etc... And they are call "free enterprise businesses " when it comes to the legal accounting part from the government. They want and try to make profit but provide some structure the area wants and still let's the area not a lot rely on tax payers..

 

[Shishkabob]

or private fire departments to your residence

Might wanna look again, buddy. Quite a few places are serviced by private-for-profit fire agencies.

so I don't see why we should have private Ambulances seeing that their entire goal is to make a profit.

So you're against hospitals too, right? Profit guides competition, which leads to innovation.

Nothing wrong with wanting profit, the issue is letting it get in the way of good care. In the strictest of ideas, FDs pushing for more funding are pushing for more 'profit' to hire more people and get bigger benefits. No different from AMR or Rural/Metro.

the government can ask the run at a deficit and still maintain its operations.

You can only run at a deficit for so long before you start feeling the crunch...


I personally don't want someone in charge of my life, with potentially deadly procedures such as RSI, and the medications Paramedics carry, if the person doesn't WANT to be a Paramedic for the medicine, instead of being a medic because that's what their fire agency requires. There's a plethora of info on this forum as to why Fire-based EMS should not exist in many peoples eyes, and I'm one of the most outspoken opponents of fire-based EMS.

 

[leoemt]

I personally believe that all 911 calls should be responded only by government agencies. 911 is a government system also it's tax based again we don't have private police officer show up when you call 911 or private fire departments to your residence so I don't see why we should have private Ambulances seeing that their entire goal is to make a profit. the government can ask the run at a deficit and still maintain its operations.
After doing an internship in the Seattle area and also knowing a few king County medical one paramedics and Tacoma fire medics I really like and appreciate how they are structured and the efficiency in which they work.
I believe that police,fire and Ems should be government run.
You as an employee know that you have a great career of you make it on as a fire medic, as very few go from fire medic to private ambulance companies.
Better pay, benefits, union , shifts and also respect. It's the total package in my opinion.

Um, sorry you are wrong. With the exception of Seattle, very few dispatch centers in WA are government agencies. Most, while overseen by the sheriff, are private companies under contract.

There is no valid argument as to why EMS should be performed by a government agency. Both government and private rely on funds to operate. Many government agencies are charging their patients for transport. Everett, Edmonds, Lynnwood, are just a few.

The health care system is a privatized system. The only hospital in Seattle that is "public" is Harborview. First Hill, Cherry Hill and Ballard are all owned by Swedish. Then you have Northwest and University of WA Medical Center which are owned by the University as is Harborview. Virginia Mason and Group Health and Childrens are all private. Up north, Edmonds (Swedish), Colby (providence) and St. Joseph (Bellingham - Peace Health)

There are private fire departments in the US. Rural Metro does a lot of fire, especially in the SouthWest. Boeing has their own fire department as well and while they are mainly for Boeing property they will respond mutual aid for the city.

Some towns have disbanded their police force and switched to private security. Sheriff or State will respond for major instances but security performs the general patrol and minor calls. None in WA have done this though. However, Seattle uses security for its alarm response.

Point is effective services can be performed by private. In Seattle, all BLS transports go by AMR. While I have the utmost respect for Seattle Fire, I think better care is performed by AMR than by fire. They fight fires and perform rescues, I do EMS. Use your strengths.

 

[EpiEMS]

Look at the rest of the modern world, countries like Australia and the UK.... we could learn a thing or two from them.

Agreed. And I'm pretty moderate, I don't even mind fire helping with rescue, but EMS ought to be separate from the fire service. It's all about sticking to the core competency of your profession/field/job. I don't see any economies of scope with FD-based EMS. Indeed, I'd bet you that costs are higher: it's way more costly to dispatch a suppression vehicle plus an ambulance rather than, say, just an ambulance and a fly car/QRV/squad. Just consider the capital costs alone. Plus, if FD doesn't do any EMS, you can downsize the FD...and they can just do BLS response to priority calls...

*runs and hides*

 

[CFal]

I think that in some cases Fire based EMS makes more sense and in others a 3rd service EMS system makes more sense, all depends on where you are. I agree with a previous poster that said 911 should be government agencies, be it 3rd service or Fire based.

 

[NomadicMedic]

If the fire service wants to have ambulances, let them do it. Just hire single role paramedics. Don't make the people who are passionate about EMS be hose jockeys.

 

[Shishkabob]

I think that in some cases Fire based EMS makes more sense

Expand further.

 

[CFal]

Expand further.

In more rural areas combining coverage provides for a quicker response. In many parts of the country there are large swaths of land with fewer people per square mile. EMS calls have a larger volume, but take fewer people to respond than a fire, like how in EMS we spend most of our time training on calls that are low volume but more complex. You would have a lot of fire fighters sitting around doing nothing and EMS workers over burdened. In more urban areas you have the critical mass to support independent services.

 

[Handsome Robb]

I want someone to give me a better reason other than "it should be" as to why 911 EMS should be a government agency.

If a FD wants to do EMS, fine. Like n7 said, hire single roll providers, make them separate divisions and treat them as equals, not the red-headed step children.

There's no reason a private agency can't provide equal or superior 911 services to a region.

I'd say the system I work in along with the system of a few other unnamed members are great examples of this.

FWIW I work for a private agency under a Public Utility Model.