# Volunteer Fire Departments & EMS



## slawson (Nov 6, 2007)

HEY EVERYONE...

It has been a while since I have posted here mainly due to family additions, relocating, new job (6 month old son)...

My question pertains to Volunteer Fire Departments only as I am a member of one and am attempting to get more information about creating an EMS program. If your department does this please let me know how it's setup. Do you have to have a medical director? Is it run through the local ambulance service? We basically are about a 25 active roster department that is a "Fire" oriented department. They really do not wish to do search and rescue and everytime ems has been mentioned it has opened up a swarm of bees for days later. I think it is mostly due to not being educated on how EMS works and how it would work within our agency. That is what I am attempting to figure out.

We would not be transporting. Since EMS is anywhere from 20-40 minutes in some locations, we would be first responders. Myself and one other person are currently the only 2 EMT-B's in this department, and since the other emt has stated he wants no part of this(scared of liability??-why become an emt), it leaves me as the only emt. Finally this brings up the issue of can we respond. What I mean by that is if we advise dispatch that we now respond to ems calls, and occasionaly no one is available to respond when our department is dispatched, would we be liable for patient care since ems transport would already be in route? Several departments in the area face that same situation which is "only respond when we can". Be it right - I don't know. But I would like some insight on this.

Let me know what the national level of par is - if such a level exists and how your VOLUNTEER fire department has your EMS program set up.

THANKS FOR ALL YOUR HELP. 
Sean
EMT-B


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## reaper (Nov 6, 2007)

Sean,

 You are better off to respond as first responders only. You can provide first response medical care until ems arrives. All of your dept. can be trained to first responder level.

You would have to check out your states regulations on the issue. Most states do not require a medical director for first responders. You can forget about being trained as a EMT. You need to have a MD to provide care as a EMT. There really is not much difference in the care you can provide between the two. Plus, it will save you the "can of worms" you will open up here, about volunteer EMS systems.

Again, you need to contact your state EMS dept. and find out what their regulations are on the whole thing. I applaud you for wanting to help out. But, most career EMS professionals don't like volley ems being around. So look at the first responder level. it will save you allot of headaches.


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## slawson (Nov 6, 2007)

*Thanks....*

Do not want to open up the worms! Sorry.... I know how that goes....

Thats good to know that MFR's are usually not required to have a medical director. Although I have been an EMT for nearly a year now, I have very little EMS experience unfortunately. 

So how does it usually work? Anyone who reponds I assume would have to take the MFR's course and go through National Registry the same way EMT's do here in the state? What are the general protocols for MFR's on scene? Do they just stabilize and obtain vitals/sample hx for the ems crew to do a load and go? And finally, if that is the case, would it provide a community value with ems times ranging from 10-60 minutes? (Yes, 60+ minutes sometimes)

I apologize for all the questions, but when I talk about this in front of the board (if it ever gets to that) then I want to be able to explain it in and out.

Thanks again!


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## Guardian (Nov 6, 2007)

Set up an investigative committee within your department.  Make sure your chief or assistant chief is on that committee.  Then, discuss the issue with the local ems provider and your state office of EMS.  You all are going to need more emts but other than that, I don't see a reason why you couldn't act as first responders.  Good luck!


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## So. IL Medic (Nov 9, 2007)

I also volunteer for my town's fire dept (work for the county ALS ambulance service). Our FD has a BLS truck that responds to our area calling for ALS intercepts when needed. 

Our setup is straitforward - we talked to the system EMS coordinator for acceptance into the system for their requirements at BLS. Bought the truck, equipment, and had a core group that passed their EMT-B. All accepted by the system as basics. Got the truck inspected and passed. Went into service as a BLS provider. Then got gungho and had two officers take the instructor course, got a site code, and do our own CEU classes.

Bear in mind, we do BLS calls and transport our pts. That absolutely requires we be part of the system under the PMD. But then, our state requires First Responders to be in the system under PMD control as well.

So it depends on what your dept wants. If EMS response that transports is long, go the whole way and do a BLS rig. If EMS response is 5-6 mins, first responders might make more sense to your budget.


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## slawson (Nov 10, 2007)

*Update...*

I really appreciate all the info guys/gals. Although we could fit this into the budget a full fledged BLS transport truck would not be logistically feasible. I have found out as far as I can obtain that medical first responders are not required to be under a MD. But what suprised me is that some departments here respond as CPR certified only. Meaning they go for lifting assistance and if someone has coded prior to ems arrival they will start CPR. Strange sounding but I am just figuring the way all this works.

I am talking more with the local depts and seeing how it would all work and just figuring some things out. If any of you have any more info on what you do let me know. BLS transport would be great but we don't have the manpower to guarnantee a response.

That brings up another question.... If we are dispatched to an EMS call as medical first responders and are not available for reasons of manpower for example, are we liable for patient care although EMS is in route? What are your thoughts and opinions on this?

We have been told that since you say you respond and don't - it's the same thing as saying you respond to fires and don't. The only difference is ems is still in route. Would we be liable if the closest ems crew would be 30 minutes out and a pt coded or something drastic occured?

Let me know what you think..

THANKS SO MUCH!

-Sean


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## So. IL Medic (Nov 12, 2007)

slawson said:


> That brings up another question.... If we are dispatched to an EMS call as medical first responders and are not available for reasons of manpower for example, are we liable for patient care although EMS is in route? What are your thoughts and opinions on this?



My first reaction is no. You're dept would be a nontransport, supportive response in the realm of mutual aid. The primary responsibility would be the full time, transporting EMS agency.


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## slawson (Nov 12, 2007)

this is what I thought as well... 

I think I am going to give our state ems board a ring.

Keep all the info coming..

-Sean


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## firecoins (Nov 12, 2007)

I would imagine this would be like most FD first response which is CFR/MFR only when they are available.


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## BossyCow (Nov 13, 2007)

slawson said:


> I have found out as far as I can obtain that medical first responders are not required to be under a MD.
> 
> 
> 
> -Sean



Really?  Any level of certification is through our state DOH and operates under the licence of the MPD for the region who signs the application for certification that is sent in.  First Responders are currently out of fashion though, its the same length of course as EMT-B but for less return.


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## firecoins (Nov 13, 2007)

BossyCow said:


> Really?  Any level of certification is through our state DOH and operates under the licence of the MPD for the region who signs the application for certification that is sent in.  First Responders are currently out of fashion though, its the same length of course as EMT-B but for less return.



here they are called CFRs and get half the training an EMT-B gets. FDNY firefighters and many cops are required to get the CFR training.


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## slawson (Dec 21, 2007)

*Update!!!*

Hey guys & gals.....

After many discussions with fellow members - it seems what I am trying to accomplish has been tried in the past with people who are much more qualified than I to talk about the subject..

To make a long story short, after 60 years of our volunteer fire department being a primaraly fire run response, I was attempted to get a very, VERY basic ems program. When private ambulance services are on average in our district 25 minutes out, and some responses excede 50 minutes, I thought it vital that a first response program be implemented. I have spoke with several members who have been there for years. To be quite honest, I can't find anyone on the entire department who would be interested in responding to ems calls. Nearly every single person who I speak to including line officers continually mention the one "L" word - liability. 

The only thing I have proposed (unofficially at that), is that we all become AED/CPR certified. No transport, no drugs, no major interventions. Minimal Liability....

I fear that mostly its due to lack of education. Although this area is considered "sue happy" in general, I feel that we should strive for better things, to serve and protect our community. The general attitude is why should we do more when we don't have to. I usually respond - because it's our duty, because we are blessed enough to have all the equipment to do it, because we have the personell, and most importantly, our citizens truley need this.

Let me also say that our department is set up in a way that a board of appointed people ultimately makes the major decisions for our department. And let me add that we have a budget of about 130,000 + per year. We have 3 engines, 1 75ft ladder, a rescue truck (used for general response) and a few other vehicles. We are a volunteer department with an ISO of 4.

I simply am at a loss when it comes to the attitude of we only do fire because we are a fire department and fire departments respond to fires. Most fire personel I know are always wanting to help and are the eternal learner... Mostly, I think lack of education on the ems system, and people set in thier ways. 

Is this an attitude that someone else has experienced? If so, how did you overcome it? If anyone has any suggestions, please let me know. I would really like to get something started. As you can tell from my rambling, the attitudes have frustrated me. I am open to suggestions.

THANKS AGAIN!


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## thowle (Dec 21, 2007)

Thats a good question, and I'm sure it has already been well answered but I'll get on my giant little (yeah?) soap-box and put my two-cents worth in.

At our fire department we are mostly "fire" oriented as well, and do not wish to persue any search and rescue, or extrication quests/tasks.  We are located in a fairly rural area, where EMS w/ transport is about 15-20 minutes away, code 3.

Our fire department has an established "medical response" additive, or addition that is known by the dispatchers as a "first responder" crew, which seems to be exactly what you are wanting/mentioning.

We operate directly under the county (our local) ambulance provider's medical direction, and protocols.  The city (department) has a contract, or agreement to provide medical mutual aid within our extended** jurisdiction for medical response calls where we are seen needed as a first responding crew for the primary frontline EMS crew.

Of course, we don't get paged or called on ALL calls, but most of them -- espeically if it is emergency traffic.  We are requested (mutual aid, not automatic) by the EMS personnel directly prior to them leaving their base, UNLESS it is a motor vehicle accident within our district -- then it is an automatic dispatch.

We are not taking the place of our local EMS, therefore we are NOT responsible for patient care if we DO NOT respond, however the liability falls on the individual's EMT license, Fire Department, and the providing ambulance service if something is done incorrectly (not following protocols) while responding under the established medical response, and providing patient care.

Medical response, in an ideal situation should NOT be activated or called upon WITHOUT EMS already being enroute, or having already been notified -- after all, you are providing your services to the patient on behalf of the EMS in advance, just allowing that "buffer" time from the "911 call" until EMS arrives.

Hope this helps.


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## certguy (Dec 21, 2007)

*Vollies and EMS*

Hi Sean , 
   In this day and age , it seems like a pretty stone - age attitude you're running into . In most depts. the majority of responses are EMS runs . I was a call firefighter in an area of 12 square miles  , 2,800 people , and 2 additional auto aid areas . We provided BLS service to these areas with 1 amb. One of the auto aid areas had a small vollie dept. that many times , couldn't respond due to lack of manpower . When they couldn't go , it was just our amb. I've got a couple ideas for you . #1 How are you funded ? EMS runs translate into increased responses , which may possibly open additional funding to you . #2 Point out the possibility that this training would help your firefighters as well as the community . If the pt. was a family member , can they wait that long for help ? #3 What if one of your own goes down on a call ? Been there , done that . I got hurt trying to recue a pt. who wasn't there . I was glad our guys knew what they were doing . Yours deserve the same . A way you could attract more EMT's could be to have an out of district firefighter program . My dept. did and as an out of district FF , I was required to be an EMT and had a minimum manning requirement that I had to do at least 24 hours per month . If they do bring up a funding issue , it can be brought before the voters as a supportive tax . Let them decide . 

                        I hope this helps , 

                                Craig


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## BossyCow (Dec 21, 2007)

I sympathize with you but have spent enough time on the admin side to understand the danger of starting a program under today's rules and regulations.  The liability is huge.  If an organization is comfortable doing what they do, with the money they have, it's going to be very difficult to ask them to move solidly outside of their comfort zone to a very scary environment.  

The best way to approach this is to educate them on the benefits to the community.  You can also campaign to get citizens to run for the governing board that are interested in starting an EMS program.  But first, get your ducks in a row.  Have copies of SOG's and Policies and Procedures from other districts.  Have the rules and regulations of your local State DOH or whoever runs EMS licensure.  Have the quotes from the liability insurance groups.  Comparisons with other comparable districts from your area. 

It can be done, but the investment of your time and the recruitment of others willing to come on board and share the work will be as tremendous as the feeling of accomplishment you will get if you can actually make it happen.


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## slawson (Dec 26, 2007)

*AGAIN! Thanks...*

Thanks to both of you!

In reference to financial.. It's not a problem. They are a tax district that is well funded. We have all the resourses in the world to make this happen and make it a flagship model for other departments to follow, however with the (perfectly described) stone age attidtude, it's a simple no. Lack of education is what it boils down to.  In reference to the "what if it was your family member?" the response was "well if it were someone we knew we could roll a truck or something"... which bother me for obvious reasons. And finally in response to the on scene rehab / personell care they either want an ambulance from the private service to respond on all major fires or the emts that are on the department (myself and one other) assist on scene until transporting agency could arrive.

And might I add - I am starting small - CPR/AED. No medical director needed, no big fancy transport truck. We already have a new rescue truck for response. All we need is a a few others to be CPR/AED certified and insurance ( I would assume). But the stone age attitude of "we are a fire deaprtment and don't respond to anything on fire" is the norm there.

They even wanted us to stop responding to accidents with injury/entrapment a while back to the the same thing - "liability". We have never been sued due to negligence just a bunch of good hearted but extremely conservative guys....

Any other thoughts/suggestions/complaints? You all are really helping in such a HUGE WAY! THANKS!!


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## Anomalous (Dec 26, 2007)

slawson said:


> ....We have never been sued due to negligence just a bunch of good hearted but extremely conservative guys....




The best defense against negligence is good patient care.


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## sucked-in (Jan 30, 2008)

I am a member of a volunteer fire department in Montana, but only as an EMS person. I work under the fire chief, but do operate (somewhat) under the local ambulance medical director. The fire department will receive a page from the dispatch center for any medical calls in our jurisdiction, and whether or not an EMT is able to respond just depends. No liability is incurred unless we actually do patient care. Most people understand that if no responders are available, than thats just how it is. The fire department has also paid for any personnel already on board to take the EMT course. I've also seen ads in the newspaper from a neighboring town asking for volunteer EMTs for the fire dpt. . . just a thought - many people are willing to help if they know there's a need.


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