Stand alone EMS vs combo departments for career development

Veneficus

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I agree with Dr. P there should be more ambulances that fire trucks.

But I also think it is not a problem of numbers, it is a problem of culture.

In the US fire service, and in the US culture in general, there is an idea that technology can replace human skill.

This manifests in many way in fire and EMS.

Any firefighter who has actually fought fire can tell you it takes multiple things happening at once. Suppression, rescue, ventilation, rehabilitation, logistics, etc.

So you buy a million dollar fire truck and put 3 guys on it. You can't do these things. So you are the most expensive basement saver dept in the world. You get paid to watch buildings burn in the name of "safety."

Even NFPA gives into this evidenced by their "minimum manning" and "two in two out" standards. (rather lack of standards)

So every FD in the country is buying multiple pieces of useless apparatus, the latest foam, the biggest pump, etc. But they don't have the one thing you need to actually fight a fire. (firefighters)

You see the same in EMS. lack of education, no problem, a new device, a new protocol. Lack of resources, increased wait. Rather than fix the problem you get a promise and an apology. (Empty words.)

Again we must realize, the fire service is a function of society. Medical care is not in all societies.

As much as EMS persons wish they were a safety force, they are not, they are part of healthcare service. (I concede sometimes this role is done by a public safety force, but it is not intrisically public safety)

You know why we can name the services that are "outstanding EMS agencies?" because their local population values that service enough to pay for it. They find the money.

It is a complex problem. As much as I would like to see 4 or 6 ambulaces for every firetruck, the people who ultimately pay do not want to see that.

It is an interesting dichotomy when I see healthcare workers complain about socialized medicine. Because socialized medicine is a function of society. Just like Police and Fire.

It is the exact same as purposfully shooting yourself and then blaming the gun manufacturer.

We talk about prevention, educations, etc. In thread upon thread for years upon years. BUt nothing will change until:

1. EMS realizes it is a healthcare provider, not a safsety service.

2. It must redefine it's role in order to provide value

3. It must accept an increase in education that society values and demands.

4. It must advocate for an increase in healthcare spending or a more substantial part of the current spending be directed towards it.


Until that happens, generations long after us will be having these very discussions.

If you want equal pay as fire and LE, you must demonstrate equal value. US EMS simply has not. They fight against the very measures that everyone else has used and think it will work.

Forget all the IAFF, volunteers, private ambulance service political nonsense.

Strip it down to the cold hard truth.

EMS in the US is not a profession. It is a vocation. It is that way for only one reason. Providers themselves do not demand it is a profession.

If you want to be a doctor, you must meet the minimum standards set by other doctors. The same with lawyers, and priests.

How many EMS providers get an advanced education and demand it of their peers?

How many of you who want to be a profession or want more money hold advanced credentials and sit around at work and talk about how you wouldn't trust somebody with less?

How many of you do not lead by example?

Something to think about.
 
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46Young

Level 25 EMS Wizard
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No, you have an EMS department that can fight fires. Big difference.
I said it before, and I will say it again: if you give EMS enough staffing, funding, and apparatus to handle the call volume, and always have a 5 minute response, you wouldn't have to have any other services doing EMS during routine operations. Let EMS be it's own agency, tell the FD and PD to GTFO of EMS's business, and make the EMS Chief/Director/Head of Agency and equal to the Police and Fire Chief. There is absolutely no need to always be under the FD or PD, other than they are the big boys in town, and that's the way we have always done it.

It's pure semantics - in most combo fire/EMS departments, there are more EMS runs than fire runs, although the average fire call uses more people and apparatus the average EMS call, so an 80%/20% or a 70%/30% split will be slightly more weighted towards fire. Still more EMS than fire, though. That's anywhere you go, but we still call fire departments "fire departments."

So, most combo departments are really EMS departments that fight fire in a call volume/utilization sense, but not in regards to total head count. There will always be more firefighter positions than EMS positions. Like Vene said, police and fire are necessities, and EMS is a luxury. If this were untrue, then every hospital would be a level one trauma center/stroke center/STEMI center/hyperbaric, etc. etc. It's kind of the same thing. Hospitals and EMS are both healthcare, and can be either municipal, not for profit, or for profit.

Regardless, in a combo dept you still have dual role employees in a combined/shared command structure, which again is the subject of the original post. EMS just doesn't have enough going on to have much diversity in job functions to have many promotional opportunities, and to follow Vene's logic, functions such as Hazmat, TROT, vehicle extrication etc. are emergency services, which naturally falls under the domain of public safety, which is why fire and police typically monopolize these services. That's just how the system works.

So long as the tax base will not support proper staffing and deployment of a stand alone EMS system, the bean counters are always going to look to services with a relatively low net utilization (most commonly fire, sometimes LE) to augment the EMS response, which allows them to get away with putting less txp units on the street. Not right, but that's how it typically goes.
 
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