# Private 9-1-1/ALS Opportunity



## EMT Rookie (Dec 21, 2018)

A couple weeks ago I’m reading up on some threads about the history of ALS operations in Orange County and LA County and why private medics and companies have been completely shut out....and then I just came across a press release today from the town of Placentia in Orange County who is asking for companies to bid on 911 ALS in their town - they’re covered by OCFA AND I learned on top of that that they actually told OCFA a few months ago that they didn’t want to re-up their contract or something like that....check out the info I came across on the city website.  Www.placentia.org/fireems Www.placentia.org/fireemsrfp


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## Uclabruin103 (Dec 22, 2018)

Looks like an effort to get a better contract from OCFA. Only real other option would be to contact to a private company for fire services.  I fear for people if one of the privates OC ambulances get 911 services. The one I used to work at was a joke, every shift would have expired meds found in my box . That's just one example .


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## aquabear (Dec 22, 2018)

The separation of Fire and EMS services is interesting in this RFP, but I highly doubt the OC firefighters’ unions would let a private service do ALS, just look at the fear mongering they did when ALS IFT units were rolled out.

To complicate things, if a private ALS provider came in, the way I read the RFP, the ALS provider is still stuck with Emergency doing transports, and I don’t think a competing private ALS service would want to pay for ALS fly cars/squads, only to collect the ALS/BLS assessment fees and miss out on transport revenue. I would imagine if Emergency did bid on providing ALS, OCFA would make their lives a living nightmare in the rest of their service area out of simple pettiness.

I would sill LOL if OCFA lost the bid to another department though.


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## VentMonkey (Dec 22, 2018)

I agree with the above replies. This won’t change much. 

I love and miss a lot of things about my old stomping grounds- this is certainly not one of them. The fire gargantuans will proceed as usual.

After skimming through the RFP link, the only applicable non-fire private would be LYNCH(?).

And as someone else already pointed out, they weren’t exactly welcomed with open arms by the knuckle-draggers.

I wonder if @deadhead has any insight regarding this Emergency! Ambulance EOA.

Haha, to bend over backwards for “Father Fire”. No thanks.


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## ITBITB13 (Dec 27, 2018)

I’m excited to see how this turns out.
 I wonder if other cities will start going in the same direction after they see how much money is saved with private ALS response.


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## ITBITB13 (Dec 27, 2018)

Uclabruin103 said:


> Only real other option would be to contact to a private company for fire services. .



Correct me if I’m wrong, but Falck has private fire resources in other countries and whatnot right?
I’m not too familiar with private fire departments in the US. Can somebody enlighten me?


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## VentMonkey (Dec 27, 2018)

ITBITB13 said:


> I’m excited to see how this turns out.
> I wonder if other cities will start going in the same direction after they see how much money is saved with private ALS.


Did you read the RFP? It doesn’t appear exclude OCFA from proposal.

Given their hands in the SoCal fire-driven “EMS” politics, do you really think much will change? Why would it?

I’m not trying to burst any bubbles, but realistically speaking it’s highly unlikely a private is going to swoop in and show the public down south how much more sense it makes.

Again, they’ve done an excellent job at pulling the wool over their publics eye for decades..._decades_.

Remember that time CARE wanted to staff ALS cars in OC? What happened to that idea?


ITBITB13 said:


> I’m not too familiar with private fire departments in the US. Can somebody enlighten me?


I don’t know that it’s all too common anymore, but I’d reckon it’s similar to private EMS with regards to contracts and the like. Southwest (R/M) Ambulance used to (still does it?) do it in AZ.

CalFire contracts their fire services with certain counties in CA. However,I’m gonna let @CALEMT elaborate if he so desires.


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## Peak (Dec 27, 2018)

ITBITB13 said:


> Correct me if I’m wrong, but Falck has private fire resources in other countries and whatnot right?
> I’m not too familiar with private fire departments in the US. Can somebody enlighten me?



There are a number of private fire departments in wildland. There are some that will do structure protection for individuals rich enough to pay for it. Mostly they are small private contractors who get deployed to federal incidents; a lot of tender operators, a few type 6 crews, a smattering of other engine types, and a few helicopters. The vast majority of the support services (catering, potable water, showers, toilets...) are all contracted out.

There are a few private departments that are ran by industrial or other companies, but I don't know of any that are for profit for outside companies; think chemical plants, oil refineries, and so on.


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## Ensihoitaja (Dec 27, 2018)

Rural/Metro used to run some- they actually got their start doing fire protection for Scottsdale, AZ. That contract ended a while ago. They had a few other fire operations, but I'm not sure what happened to them after the AMR buyout, though.


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## DrParasite (Dec 28, 2018)

ITBITB13 said:


> Correct me if I’m wrong, but Falck has private fire resources in other countries and whatnot right?
> I’m not too familiar with private fire departments in the US. Can somebody enlighten me?


R/M is probably the biggest "private fire contractor," however they were booted from scottsdale in 2003.  They do have provide some services in unincorporated areas of the US, however it's not much, but I guess it's better than nothing.

there are actually quite a few "private" FDs, but they are usually airport fire departments or wildland companies, or industrial fire brigades (and yes, R/M does provide some services, as does some police departments such as PAPD's ARFF in NYC).   There are very few private municipal fire departments, unless you count the volunteer corporations that contract with a city or town to provide services.  I knew a couple guys who work (or worked for them), and the young guys are all just killing time until they (or rather if they can) get hired by a municipal department; the older guys are counting the days until they can retired.

The fire service is VERY difficult to run privately, because in 99.99% of the US, the fire service is a black hole for money, and making a profit while maintaining good services is nearly impossible, especially for a reasonable price.  EMS is a little better, because you can bill for services, but it's still tough to make a profit while maintaining top notch service.  

Pick 2 of 3 options: cheap, good or fast; you can't do all three, which is why private for profit systems fail so often in the public safety world.


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## EMT Rookie (Dec 30, 2018)

VentMonkey said:


> Did you read the RFP? It doesn’t appear exclude OCFA from proposal.
> 
> Given their hands in the SoCal fire-driven “EMS” politics, do you really think much will change? Why would it?
> 
> ...



I think this is an awesome opportunity.  I don’t see anything in the rfp’s That prevents OCFA from submitting a proposal - I think it’s great that they’re being made to compete with everyone else.  But that’s assuming they even bother to participate in the process.  There is no way OCFA can compete with the private companies on cost alone - they will be 10x’s the cost of our company.  Plus, they can’t compete on quality of care either.  The fire component, who knows?  The city can start its own little fire brigade with help from Brea and Fullerton FD.


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## EMT Rookie (Dec 30, 2018)

ITBITB13 said:


> I’m excited to see how this turns out.
> I wonder if other cities will start going in the same direction after they see how much money is saved with private ALS response.


I agree!  The more I think about this the more I can see how much money cities can save every year by letting us do our jobs and handle ALS/BLS and let their fire guys put out fires.


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## VentMonkey (Dec 31, 2018)

EMT Rookie said:


> I think this is an awesome opportunity.  I don’t see anything in the rfp’s That prevents OCFA from submitting a proposal - I think it’s great that they’re being made to compete with everyone else.  But that’s assuming they even bother to participate in the process.  There is no way OCFA can compete with the private companies on cost alone - they will be 10x’s the cost of our company.  Plus, they can’t compete on quality of care either.  The fire component, who knows?  The city can start its own little fire brigade with help from Brea and Fullerton FD.


It’s cool you’re hopeful and all, but I just don’t know that you fully understand the logistical challenges that a private company faces in attempts to provide ALS care in any parts of SoCal that they’ve yet to already established a footprint in.

Maybe it would be cost-efficient for the City of Placentia, but at what cost to the company? Where will all of these single role paramedics magically appear from?

Most paramedics aren’t invested in becoming the best paramedic that they can be. That’s just a fact. I work alongside many who are the same, as well as some who truly do care. Point being, the individual determines the quality of care, not the type of paramedic.

Traditionally, yes, fire-bases EMS has their hands in way too many honey jars. If I had to guess it’s a well-intended proposal that will either A) fall by the wayside, B) resume business as usual, or C) both.

It’s SoCal EMS—specifically LA/ OC EMS. You either leave, or you find a pocket that suits your liking. Also, I don’t know of any agency on this side of The Pond that call the FD a fire brigade, except perhaps the folks to the north of us.


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## ITBITB13 (Dec 31, 2018)

VentMonkey said:


> It’s cool you’re hopeful and all, but I just don’t know that you fully understand the logistical challenges that a private company faces in attempts to provide ALS care in any parts of SoCal that they’ve yet to already established a footprint in.
> 
> Maybe it would be cost-efficient for the City of Placentia, but at what cost to the company? Where will all of these single role paramedics magically appear from?
> 
> ...



Well I’m not sure about the OC, but it wasn’t too long ago when single role paramedics existed in LA County. Then fire departments came along, and well you know how that turned out. 
I’m sure the chances of it happening are slim. But money talks. There’s a chance that during the bidding process, Placentia will realize the cost difference, and wonder what the heck they were doing all along. And this could spread to other cities like a virus. 
As far as medics magically appearing goes, I myself would jump all over the opportunity to be a single role paramedic in the OC or LA. And I’m sure I’m not the only one here who would love to do so. 
Not all medics want to be fireman and vice versa. 

While they’re at it, so cal FDs might as well take over Edison, and CalTrans, and the DWP. 
But like I said, unfortunately the chances of this happening are probably slimmer than I would like to admit. 

And let’s say it DOES happen, and EMS in Placentia goes private. Whatever company gets it will definitely be opening a can of worms with all SoCal fire departments, especially if they already have BLS transport contracts in other EOAs. 

Another issue would be one that’s already a big one within private SoCal ems. Pay.

But with all that being said, there’s still a possibility to get the gears turning towards making SoCal EMS Private, and a “happy”  world where medics like myself can work as a medic, and medic only. 

Before all you fire guys start gaining up on me, please know I have nothing against Fire, Fire departments, or anything fire related.


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## CCCSD (Dec 31, 2018)

It’s NOT “Fire guys”, it’s Medics and EMTs who have actually BTDT and have knowledge you don’t seem to appreciate. I don’t know how much you truly understand about EMS/FD/Contracts and such, but I’m betting slim to none.


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## ITBITB13 (Dec 31, 2018)

CCCSD said:


> It’s NOT “Fire guys”, it’s Medics and EMTs who have actually BTDT and have knowledge you don’t seem to appreciate. I don’t know how much you truly understand about EMS/FD/Contracts and such, but I’m betting slim to none.



My appreciation for private EMS has nothing to do with my appreciation for the fire service. I apologize if I came off to you in that way.


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## VentMonkey (Dec 31, 2018)

ITBITB13 said:


> As far as medics magically appearing goes, I myself would jump all over the opportunity to be a single role paramedic in the OC or LA. And I’m sure I’m not the only one here who would love to do so.


Because of its location (a legitimate question, not a dig)? Why not move, or work 2 hours to the north, east, or west?

I work in a system that is what you’re describing as “happy”, but we’re still constantly looking to hire more paramedics to meet demands. It’s also very well established in its county, yet logistical challenges never cease to exist.

Add a heavy ALS fire-based presence in the neighboring cities. I’m just saying it’s a pipedream that’s been such by many for years...to include myself at one time.

To clarify what I meant~ they still need to agree to staff “X” amount of ALS cars, with county-approved ALS equipment with in whatever stipulative contract is ultimately draw up, staffing patterns, etc. All at the mercy of the city’s requests.

Also, privatized (for-profit) EMS should not exist in the “EMS” setting. In the IFT setting? Absolutely. But, I don’t want to open up _another_ stale can of worms.

ETA~ Perhaps look in to taking, or auditing an EMS management course. Maybe you’ll walk away with a fresh perspective and some insight as to how these things work on the backside.


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## CCCSD (Dec 31, 2018)

ITBITB13 said:


> My appreciation for private EMS has nothing to do with my appreciation for the fire service. I apologize if I came off to you in that way.



I’m not Fire, I have no dog in this hunt. I’m merely pointing out some lapses in information which vent monkey addressed above.

I work in an area that has a plethora of Fire Medics who don’t transport, and the ONLY reason they exist is to provide the FDs with a reason to staff so many engines per department. If they were funded per Fire response, they would be 1/4 career and 3/4 volley or PCF.

No skin off my nose when a typical scene has 5-6 medics ****ing around...it’s what the public wants. I’ve found that if I need things to move faster for the patient, I just remind them they are being recorded on my body worn camera. Magic.


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## Uclabruin103 (Jan 10, 2019)

ITBITB13 said:


> Correct me if I’m wrong, but Falck has private fire resources in other countries and whatnot right?
> I’m not too familiar with private fire departments in the US. Can somebody enlighten me?



They would be more than capable of putting in a bid.  I know of a one private company that put in a bid for a Southern Californian city.  However, surrounding agencies could refuse to offer automatic aid to the company.  And I believe there's some sort of law, making it difficult for an essential service to turn over to private.


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## ITBITB13 (Jan 19, 2019)

Uclabruin103 said:


> A  However, surrounding agencies could refuse to offer automatic aid to the company.



I could totally see this happening, out of spite towards whatever private company.


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## Mike Hughes (Jan 19, 2019)

ITBITB13 said:


> Correct me if I’m wrong, but Falck has private fire resources in other countries and whatnot right?
> I’m not too familiar with private fire departments in the US. Can somebody enlighten me?


In the UK Falck have an ambulance wing and do a lot on behalf of the NHS but they do not provide fire services


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## PotatoMedic (Jan 19, 2019)

Falck is the largest private ambulance service.  They also do a lot of fire fighting in Europe and in South America I believe.  They also do a lot of industrial safety training.  Their parent company also owns Lego!


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## Medic496 (Feb 8, 2019)

This is not a new idea.  If I remember correctly, this is how ALS was started in Santa Ana.  Many ALS programs ran out of hospitals at first.   I believe the old Santa Ana program was a hospital based ALS program and later the City adopted it and ran their ALS ambulances.   I believe it was in the 1990's that the SAFD folded the ALS program into the department.   Where is SAFD now?  The model they moved to broke them.   Back to medic squads and a BLS ambulance.  Four personnel on scene is enough.  If the patient is on fire, a fire engine will be sent.


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## ITBITB13 (Feb 8, 2019)

Medic496 said:


> If the patient is on fire, a fire engine will be sent.



Anyone know what gas mileage is on a ladder truck, or quint?


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## Peak (Feb 8, 2019)

ITBITB13 said:


> Anyone know what gas mileage is on a ladder truck, or quint?



Its hard to calculate because of all the time spent on scene idling, 4 MPG is a very good day. Fuel economy is only a small fraction of why custom cab fire apparatus are so expensive to run.


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## EMT Rookie (Feb 10, 2019)

Peak said:


> Its hard to calculate because of all the time spent on scene idling, 4 MPG is a very good day. Fuel economy is only a small fraction of why custom cab fire apparatus are so expensive to run.


Thus further perpetuating the insane logic of sending a 40,000 pound million dollar rig with a million dollar crew riding on it to tend to Uncle Roscoe’s chest pains.


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## DrParasite (Feb 10, 2019)

EMT Rookie said:


> Thus further perpetuating the insane logic of sending a 40,000 pound million dollar rig with a million dollar crew riding on it to tend to Uncle Roscoe’s chest pains.


Because other than fuel, you're paying them the same amount whether they are at the station playing cards or going to help uncle Roscoe who has chest pain.

Plus, if you want to short change the local EMS system with available EMS resources, you can just send the FD to stop the clock, so when someone complains that the ambulance took too long, you can say "but you had a trained fire truck with EMS personnel on scene in 4 minutes."

I happen to like the idea of sending the FD in a QRV instead of the BRT.... but looking from the fire side, there are some advantages to everyone being on one truck.


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## EMT Rookie (Feb 10, 2019)

DrParasite said:


> Because other than fuel, you're paying them the same amount whether they are at the station playing cards or going to help uncle Roscoe who has chest pain.
> 
> Plus, if you want to short change the local EMS system with available EMS resources, you can just send the FD to stop the clock, so when someone complains that the ambulance took too long, you can say "but you had a trained fire truck with EMS personnel on scene in 4 minutes."
> 
> I happen to like the idea of sending the FD in a QRV instead of the BRT.... but looking from the fire side, there are some advantages to everyone being on one truck.


There’s a much simpler solution: allow the EMS professionals to respond to EMS calls and allow the fire professionals to respond to fires. A medic, EMT and your run of the mill ambulance is all you need - it’s all that’s ever been needed.


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## Peak (Feb 10, 2019)

EMT Rookie said:


> Thus further perpetuating the insane logic of sending a 40,000 pound million dollar rig with a million dollar crew riding on it to tend to Uncle Roscoe’s chest pains.





DrParasite said:


> Because other than fuel, you're paying them the same amount whether they are at the station playing cards or going to help uncle Roscoe who has chest pain.
> 
> Plus, if you want to short change the local EMS system with available EMS resources, you can just send the FD to stop the clock, so when someone complains that the ambulance took too long, you can say "but you had a trained fire truck with EMS personnel on scene in 4 minutes."
> 
> I happen to like the idea of sending the FD in a QRV instead of the BRT.... but looking from the fire side, there are some advantages to everyone being on one truck.




That's a whole soapbox I could preach from all day, but the thing that gets me going the most is that it isn't even functional.

Ladder trucks are heavy, slow, and have a large turning radius; putting a pump on it makes it even heavier. In my opinion quints are rarely needed, its usually either a way for a district to not pay for a engine and ladder crew or a way for crews to justify having a stick that can still mostly function as an engine.

Look at the majority of departments and you will find that they really don't need custom cab engines, and that commercial would serve the same purpose and save about half the cost. Rarely do groups really need the couple of feet in length saved by a custom, and if we used cab overs like in Europe it wouldn't even matter. Yet so many departments fight to keep that 400K chrome chariot/engine. Can't let progress get in the way of tradition.

I think in some environments that having EMS trained fire personnel make sense (predominetly low volume/low density/rural areas), but in large urban areas it just doesn't. Why should fire run a QRV instead of the 3rd service? I also think that when you start to look at areas where it makes sense for fire to have an EMS role, it usually makes for sense for them to cross staff an ambulance anyway.


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## DrParasite (Feb 10, 2019)

I could respond, but the post would be 4 pages long, and most of it would involve me agreeing you with on most things (although once you pull up on the ladder to a structure with heavy fire showing, and the engine is tied up on another assignment, you will be happy you have the pump and hose), but also been around the block enough to know what happens in so many places, that it's one of the reasons why i don't work full time in EMS anymore.


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## EMT Rookie (Feb 10, 2019)

Peak said:


> That's a whole soapbox I could preach from all day, but the thing that gets me going the most is that it isn't even functional.
> 
> Ladder trucks are heavy, slow, and have a large turning radius; putting a pump on it makes it even heavier. In my opinion quints are rarely needed, its usually either a way for a district to not pay for a engine and ladder crew or a way for crews to justify having a stick that can still mostly function as an engine.
> 
> ...


Fire will always have an EMS role - that of an EMT assisting medics as needed and the ocassional patient extrication or technical rescue.  Let the medics be medics - and they don’t have to work for public fire departments to do their jobs either.


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## Peak (Feb 10, 2019)

DrParasite said:


> ...although once you pull up on the ladder to a structure with heavy fire showing, and the engine is tied up on another assignment, you will be happy you have the pump and hose...



In some ways I wasn't a very good firefighter. I never really cared that much about putting out the fire, I just wanted to make entry and search; maybe I was really meant to be a truckie. Dragging a hose slows down your search so much and all I really cared about was rescue.


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## Peak (Feb 10, 2019)

EMT Rookie said:


> Fire will always have an EMS role - that of an EMT assisting medics as needed and the ocassional patient extrication or technical rescue.  Let the medics be medics - and they don’t have to work for public fire departments to do their jobs either.



Meh, I don't think that most fire departments need nearly the EMS presence they have. The department that serves the area around my hospital is BLS only, and I can't think of a time when it detrimented care. I certainly do think that there is a place for some EMS in fire, and in some areas this very much includes medics, but I also think that a lot of departments at this point have gone too EMS heavy. 

I was a fire medic at a small department, and for us it made a lot of sense. Our group of fire medics were also very interested in giving good quality medical care, something I think many firefighters are not invested in. I also think that the current presence of EMS care in fire is holding back a lot of development of 3rd services in most of the US.


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## VentMonkey (Feb 11, 2019)

@EMT Rookie seriously? You need to get out of LA/ OC/ SoCal “EMS”.


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## ITBITB13 (Feb 11, 2019)

Peak said:


> Its hard to calculate because of all the time spent on scene idling, 4 MPG is a very good day. Fuel economy is only a small fraction of why custom cab fire apparatus are so expensive to run.





DrParasite said:


> I could respond, but the post would be 4 pages long, and most of it would involve me agreeing you with on most things (although once you pull up on the ladder to a structure with heavy fire showing, and the engine is tied up on another assignment, you will be happy you have the pump and hose), but also been around the block enough to know what happens in so many places, that it's one of the reasons why i don't work full time in EMS anymore.



I’m pretty sure I’m not the only one interested in seeing your 4 page opinion.


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## VentMonkey (Feb 11, 2019)

ITBITB13 said:


> I’m pretty sure I’m not the only one interested in seeing your 4 page opinion.


I’m not. Just leave SoCal as well...


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## DrParasite (Feb 11, 2019)

ITBITB13 said:


> I’m pretty sure I’m not the only one interested in seeing your 4 page opinion.


In a nutshell, there is 0 reason for the for the FD to be on 90% of EMS calls.  Fire should do fire, EMS should do EMS.  For rough numbers, In a career system, tiered is generally the way to go, so you should have as many BLS ambulances as engines, and staffed ALS ambulances as ladders/rescues, with competent EMD screening, sending the appropriate level ambulance to the appropriate call.  If you have a fire based EMS system, and you have more engines than ambulances yet the majority of your calls are EMS, than you're not allocating your resources appropriately based on the call volume. 

Fire can be helpful to EMS on certain calls (cardiac arrests, rescues), when additional manpower or special equipment is needed, but if you have a properly staffed EMS system, you rarely need a first responder to stop the clock.  ALS engines are stupid, a waste of money, and there is no evidence that they are actually beneficial.  If you must have a first responder, downgrade them to BLS, make sure they are good at BLS, and have enough ALS ambulances that ALS can be started a few minutes after the engine arrives.

This also means having EMS as an independent 3rd service government entity, so they get all the government retirement benefits, and the government is responsible for it's operation, and funds it's operations like any other government department, not a private entity who is contracted to provide a service and all too often isn't given the funding to do the job well, and still make a profit.

SoCal is apparently a very special area to work in.... if you are with the FD, you get paid well and know everything, if your on the ambulance, you are a taxi service.  not really something that appeals to me, but they have a glutton of providers who are just hoping and praying they get that golden ticket and get hired by the FD.  But if you really want to do EMS, it's best to get out of SoCal.

That wasn't too horrible, was it @VentMonkey?


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## ITBITB13 (Feb 11, 2019)

VentMonkey said:


> I’m not. Just leave SoCal as well...



Sure, consider me gone. Or how about you leave, I stay?



DrParasite said:


> In a nutshell, there is 0 reason for the for the FD to be on 90% of EMS calls.  Fire should do fire, EMS should do EMS.  For rough numbers, In a career system, tiered is generally the way to go, so you should have as many BLS ambulances as engines, and staffed ALS ambulances as ladders/rescues, with competent EMD screening, sending the appropriate level ambulance to the appropriate call.  If you have a fire based EMS system, and you have more engines than ambulances yet the majority of your calls are EMS, than you're not allocating your resources appropriately based on the call volume.
> 
> Fire can be helpful to EMS on certain calls (cardiac arrests, rescues), when additional manpower or special equipment is needed, but if you have a properly staffed EMS system, you rarely need a first responder to stop the clock.  ALS engines are stupid, a waste of money, and there is no evidence that they are actually beneficial.  If you must have a first responder, downgrade them to BLS, make sure they are good at BLS, and have enough ALS ambulances that ALS can be started a few minutes after the engine arrives.
> 
> ...



Not bad at all. I’m sure everyone knows this to be truth. But whether people choose to accept it or not, is another topic of discussion.


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## VentMonkey (Feb 11, 2019)

ITBITB13 said:


> Sure, consider me gone. Or how about you leave, I stay?


I did. Lighten up Francis, it was a suggestion not a dig.


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## ITBITB13 (Feb 11, 2019)

VentMonkey said:


> I did. Lighten up Francis, it was a suggestion not a dig.


No hard feelings here, I’m not one to get all angry on an Internet forum. There’s already too much hate already between ems.


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