# sent to me by a physician



## Veneficus

http://www.youtube.com/watch?v=xl-rO6RGVCk

all the best in trying to overcome BS like this with the divide and conquer, you are not worthy to be in EMS lines.


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## emt_angel25

WOW. thats all i can say cause im in a complete state of shock here


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## firecoins

I got to the Star of Life 2 minutes in.  Non firebased EMS also has it.


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## HotelCo

It seems that the point that came up most often in the video is response time... Private EMS is unable to respond as quickly as Fire Departments? They have better vehicles? Last I checked (around here at least) We drive pretty much the same thing.


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## foxfire

I don't get it. What are they trying to say?:unsure:


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## HotelCo

foxfire said:


> I don't get it. What are they trying to say?:unsure:



They're trying to say that Fire based EMS is better than private EMS.


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## foxfire

Why do they think that? What is causing them to come to that comclusion? 
I don't see a difference in the two, but I am new to the field.  I am trying to understand this world of ems. Please explain.


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## daedalus

Yess, now where is this Fire based EMS you say?


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## firecoins

EMS should be a third service.


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## HotelCo

firecoins said:


> EMS should be a third service.



Detroit EMS has that working pretty well. It's by no means perfect, but at least they're trying.


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## firecoins

NY its run by the FD but it is essentially a third service. EMTs and Medics have nothing to do with firefighting at least.


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## foxfire

firecoins said:


> EMS should be a third service.



oh, they are wanting to put EMS and fire together, is that what they are saying?


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## firecoins

foxfire said:


> oh, they are wanting to put EMS and fire together, is that what they are saying?



Right. that is what Fire Based EMS is, firefighters being EMS providers as well.


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## foxfire

firecoins said:


> Right. that is what Fire Based EMS is, firefighters being EMS providers as well.



 It seems that they are against private amublance services. Why? They are doing the same EMS stuff, arn't they?


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## firecoins

foxfire said:


> It seems that they are against private amublance services. Why? They are doing the same EMS stuff, arn't they?



$$$ money $$$

There are less than hald the fire calls there used to be.  Fire prevention has been very successful.
Fewer calls means politicians may want to reduce fire dept jobs.  But they can reverse that if they do EMS.  Notice how they don't want FDs merging with Police because doing 2 jobs would make them worse at both all of a sudden.


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## foxfire

firecoins said:


> $$$ money $$$
> 
> There are less than hald the fire calls there used to be.  Fire prevention has been very successful.
> Fewer calls means politicians may want to reduce fire dept jobs.  But they can reverse that if they do EMS.  Notice how they don't want FDs merging with Police because doing 2 jobs would make them worse at both all of a sudden.



hmm, that makes sense. I can't imagine FD and PD put together. Our city has the Fire and EMS together.
 When I did my ride times, I had to race the firemen to the patient, if I wanted to be able to do anything on that call.  
 Thank you for explaining all that to me.


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## HotelCo

foxfire said:


> hmm, that makes sense. I can't imagine FD and PD put together. Our city has the Fire and EMS together.
> When I did my ride times, I had to race the firemen to the patient, if I wanted to be able to do anything on that call.
> Thank you for explaining all that to me.



PSOs (Public Saftey Officers) are more common now. They combine PD and FD into a single service.


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## MMiz

foxfire said:


> hmm, that makes sense. I can't imagine FD and PD put together. Our city has the Fire and EMS together.
> When I did my ride times, I had to race the firemen to the patient, if I wanted to be able to do anything on that call.
> Thank you for explaining all that to me.


In many Michigan communities it is common to have Public Safety Officers who are trained as Police Officers/Fire Fighters/EMT-Basic.


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## HotelCo

MMiz said:


> In many Michigan communities it is common to have Public Safety Officers who are trained as Police Officers/Fire Fighters/EMT-Basic.



Some are transitioning to have them as medics. Oak Park (if your familiar with the area) has a few medics now.


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## Sapphyre

HotelCo said:


> It seems that the point that came up most often in the video is response time... Private EMS is unable to respond as quickly as Fire Departments?



Hmmm, that's why, most of the time, I'm on scene before fire....


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## firecoins

There are often more fire dept personnel than EMS so they usually can have some forst response vehicle there quickly but not necessarily an ambulance.


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## 281mustang

What's with the stigma against fire based EMS?


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## MMiz

281mustang said:


> What's with the stigma against fire based EMS?


The argument that fire-based EMS systems are firefighters first, and then use EMS to rationalize their existence.  When I call 911 for a medical emergency I want the _best medic_, not a firefighter who practices medicine in order to get/keep a job.

The argument is that either a third (separate) EMS service or private EMS can do a better job.


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## Hockey

MMiz said:


> In many Michigan communities it is common to have Public Safety Officers who are trained as Police Officers/Fire Fighters/EMT-Basic.



mmhmm 

And you should see the fight that both sides put up when they try to do it anymore

I was in the process for Kzoo DPS but they did a freeze around a year ago now.


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## Hockey

MMiz said:


> The argument that fire-based EMS is a way for fire departments are firefighters first, and then EMS to rationalize their existence.  When I call 911 for a medical emergency I want the _best medic_, not a firefighter who practices medicine in order to get/keep a job.
> 
> The argument is that either a third (separate) EMS service or private EMS can do a better job.




Firefighters can multi-task dontcha know?  Regular private based EMS can't!

Jeez MMiz what is wrong with you!?


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## HotelCo

Hockey9019 said:


> mmhmm
> 
> And you should see the fight that both sides put up when they try to do it anymore
> 
> I was in the process for Kzoo DPS but they did a freeze around a year ago now.


Of course, because the Fire and Police Depts want to be the only ones to do wht they do. They know that if they are all crosstrained, that there can/will be cuts. I don't blame them for wanting to keep their jobs.


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## emt_angel25

281mustang said:


> What's with the stigma against fire based EMS?





There is nothing wrong with fire based EMS services. but that video makes it seem like fire based EMS is the best thing since sliced bread. and in some cases its the truth. but for those of us who dont work for a fire based service (like me) it hits a nerve to say that the rest of us dont know what we are doing and that our response times are slower. not the case for around here. we do just fine with out having fire personnel on the scene all the time. i love our firefighters they are great when we need them. but we dont need them all the time.


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## trevor1189

I have no problem with fire based ems as long as the ems side is properly funded to provide the best possible patient care. Also, if someone calls 911 for medical emergency there is no need to send a rescue engine and an ambulance just so the fire side can make some money off the call.

If I remember correctly there was a story about DC Fire that billed for a fire truck that was parked in front of the patients home while the ambulance handled the patient.


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## Sasha

MMiz said:


> The argument that fire-based EMS systems are firefighters first, and then use EMS to rationalize their existence.  When I call 911 for a medical emergency I want the _best medic_, not a firefighter who practices medicine in order to get/keep a job.
> 
> The argument is that either a third (separate) EMS service or private EMS can do a better job.



Sometimes the best medic IS also a fire fighter. Being a fire fighter is not synonymous with bad care. Being a third service EMS provider is not synonymous with good care. You have good and bad providers on both sides of the spectrums.

EMS based fire service is a necessary evil in some areas and if that's how their city or county chooses to provide their citizens with EMS services, so be it.


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## EMTinNEPA

Since when did we settle for "necessary" evils?


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## firecoins

Sasha said:


> Sometimes the best medic IS also a fire fighter. Being a fire fighter is not synonymous with bad care. Being a third service EMS provider is not synonymous with good care. You have good and bad providers on both sides of the spectrums.
> 
> EMS based fire service is a necessary evil in some areas and if that's how their city or county chooses to provide their citizens with EMS services, so be it.



Yes someone can be a firefighter, plumber, soldier, business owner or anything else and be a good paramedic. It has nothing to do with it.  

This is about EMS systems being run by people interested in running an EMS organization.  EMS should not be sold out to Fire or police so they can justify and finance their firefighting or law enforcment budgets which is what is being done. As I said, there are fewer structure fires due to fire prevention.  Firefighting budgets are being cut so EMS is being added so firefighting can be fully financed.


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## Jon

The entertaining thing is that in many of the images they are showing, there are private/3rd service EMT's there - including lots of AMR folks. Sillyness.


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## Mountain Res-Q

firecoins said:


> $$$ money $$$
> 
> There are less than hald the fire calls there used to be.  Fire prevention has been very successful.
> Fewer calls means politicians may want to reduce fire dept jobs.  But they can reverse that if they do EMS.  Notice how they don't want FDs merging with Police because doing 2 jobs would make them worse at both all of a sudden.



*Careful, I'm tired, I will rant a little here...*

I think firedcoins hit the nail on the head.  This isn't the first time I've seen this arguement.  Consider...  It is called the FIRE Department.  They/You are called FIREfighters.  Why?  Because the original purpose of Fire was to... FIGHT FIRES.  Now consider all the things your local fire departments respond to:  Vehicle Accidents, Rope Rescues, Water Rescues, Dive Calls, Public Service Assists, Haz Mats, Confined Space Rescues, and (yes) Medical Calls.  If you look a the history of the Fire Service this didn't come about in one day.  Fire was a VERY serious concern once upon a time; i.e. Chicago, etc....  Fire did a GREAT job in education, prevention, and protection... so good that the number of Actual Fires that they respond to has been greatly decreased.  From a monetary and political stadpoint the justification for maintaining so many fire departments wasn't there after a while.  So they started branching out into rescue.  Hence the title often heard "Fire/Rescue".

The problem was that most of those rescue techniques were pioneered and the domain of volunteer rescue squads, volunteer search and rescue, and other volunteers specialty teams.  So fire "pushed" out those service agencies and now (in many areas) have a hard time coexisting with them.  That is a problem that I have personally seen in California.  There has been a push for years (behind the scenes) to do away with Search and Rescue Teams in California and hand all responsibilities (except for wilderness search - becasue it ain't glamerous enoguh I guess) over to Fire.  Steps have been made toward that for years.  Rope Rescue and Swiftwater Rescue were all originally developed by old SAR farts back in the day.  They developed techniques and standards that are still the bases for all we do today in those fields.  But now Fire has to put an NFPA stamp on them and call the service their own, leaving SAR folks to either follow along or risk being viewed as irrelivant.  Example:  The internationally recognized "Father of Swiftwater Rescue" was also one of our teams 13 founding members.  He invented the craft and was still teaching it up until his death over 2 years ago.  He taught our team everything, certified them, and built this team up to one of the most renowned swiftwater rescue teams in California (if not the U.S. for awhile)... that is until Fire decided to NFPAize the craft and the state of California told us that we needed to conform to their standards; which meant hundreads of dollars a year per person and masive amount of time to stay current in a craft that was so butchered by the NFPA that while the basics remain the same, there was so much unnessisary crap (in the opinion of those original founders and pioneers in Swiftwater Rescue) by the Fire Guys that our expert team dropped from having 30-40 SRT-A's to only 8-12 SRT-1's and a couple SRT-A's.  That' just one example, I have others.

Now the problem is expanding, because in order to continually justify their Fire budgets and their "need" they needed to expand into medical.  First it starts out as being first responders, then they start pushing out private ambulance and transporting patients, then they start putting their own standards on EMS which they call "better", and then we see private ambulance going away.

Here's my problem with that:  In order to be the best at what you do, you need to focus on that.  Now, there are a lot of great Fire/Medics out there and a lot of realy bad Pure Medics, but my general observation has been this in California:  EMT-1 is now pretty much required for every firefighter in order to be hired on a regular fire/first responder department.  So every FF I know also has their EMT and 90% of them suck at EMS.  I know that the debate rages that the EMT level of training is inadequate, but the vast majority of FF's I know and have worked with don't even met those low standards; hell they shouldn't even have a first aid card.  They barely pass the class because they don't really want to do EMS, but feel that they must.  They get tutored by their Fire Buddies so that they memorize just enough to pass the lame testing that any idiot could pass.  They do not want to have any involvement in patient care and it shows in their training and their care.  Get an inacurate BP, throw on the Non-rebreather, and stand around waiting for the Ambulance?  That's the justification for maintaining their budget?  Now this is not a reflection on all you Fire/EMS folks.  I know a few Fire guys that I would entrust the care of my family with... but just a few.  I hope you Fire/EMSers here actually care about the EMS portion of your job, as evidenced by your presense on an EMS forum, but I have seen what happens when Fire is forced to accept any EMS role.  They want to fight fires and rip into cars with the Jaws, but most I know have no interest in EMS.  So all that Fire Based EMS will do, at least in my area, is force out the good Pure EMSers that have no interest in Fire, hurt the good pure Medics who chose to stay with the new FIRE/RESCUE/EMS, and limit the options of the community when it comes to EMS - a service that might do well in some areas, but (IMHO) Fire based EMS will lower the standard of care in a lot of cases (my area as an example)...

*... I'm tired, ignore my ranting.  :blush:*


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## VFFforpeople

Isn some areas, like mine we deal with water rescue,low angle, structure,weather EMS. I am not saying 3rd party EMS crews can not handle it. I am just saying/seeing Fire or PD can get more people to the sence and faster than the 3rd party EMS crew. (I am speaking my area, not saying this for all). We cut our Fire budgets and PD budgets first, before anything else. (I do find this odd). So, not all areas put Fire EMS in to save the budget. I am grateful to have AMR or in my area Mercy show up, it is great to see them and a sigh of relief. We all work well together with them. That is just my thought.


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## EMTinNEPA

<---- is still waiting to see one shred of empirical evidence that suggests that fire-based EMS is superior.  Until that day comes, the money-grubbing morons who want EMS to be just another public service/financial support for the fire department, as opposed to taking its rightful place in the healthcare industry, can go pound sand.


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## Veneficus

*said physician replies*

http://www.youtube.com/user/drexmedic

and the truth shall set you free.


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## 46Young

The original video made me vomit, and I'm a firemedic. I've worked EMS in NYC and in SC prior, and I think that the strongest providers were in the FDNY EMS system(like a third service, being seperate from suppression), and the voluntary hospitals operating in the same system. Tons of good jobs, and the ALS units are reserved for high priority call types, resulting in a quick learning curve. Response times were good, since units sit on street corners. My dept fully funds EMS, provides plenty of training, but has several problems. Fire based EMS will always have individuals who "backdoor" their way in with a brand new medic cert, with little to no experience whatsoever. Assuming that they really do enjoy EMS, they'll have an extremely tough time developing a solid pt assessment, and skills base. With most EMS runs, we have 6-9 responders crowding the scene, typically two to four being medics. The medic officer calls the shots, gathers info, and generally determines the presumptive Dx and resultant course of action. It's goofy onscene, for lack of a better term. The new medic basically becomes a "skills medic", gathering diagnostics and starting IV's only, with little input regarding Tx decisions. I'm lucky that my medic officer treats me as an equal, rather than an incompetent. I'm used to just me and my partner getting it done alone, maybe with a BLS unit to back us on an arrest, or to drive a critical pt. The majority of FF's here have a good outlook on EMS, and mean well, but aren't really needed about 75% of the time, and can delay care/removal to the bus. It's tough to gain competence as either a BLS or ALS provider in a resource rich Fire/EMS organization. It's advisable to gain experience elsewhere, then join the FRD when you feel you're comfortable as a provider. I have a side job for a local private agency that does a lot of cath lab runs, and critical care runs. When I suggest that others do the same, they look at me like I'm nuts. This isn't the best place if you're looking to be an aggressive medic, but I also love the fire side, and the salary/benefits/working conditions/career development/perks(hooked up gym in station, for one) are among the best in the nation. I do miss my days serving Corona, Elmhurst, Jackson Heights, and Astoria, truth be told. Just a dismal future there career wise, and a subpar standard of living.


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## subliminal1284

Quick response doesnt make a difference if someone lives or dies riiiiggghhhtt.......


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## EMTinNEPA

subliminal1284 said:


> Quick response doesnt make a difference if someone lives or dies riiiiggghhhtt.......



Quick response doesn't make a difference if your quick response gets you halfway to scene really fast.


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## subliminal1284

Have to disagree, if someone is bleeding profusely every minute counts and the sooner someone gets there to assist that person the better.


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## EMTinNEPA

subliminal1284 said:


> Have to disagree, if someone is bleeding profusely every minute counts and the sooner someone gets there to assist that person the better.



And you come first.  Respond at a _reasonable_ rate, because if you wreck because you're trying to get there fast, not only do you delay response time for the patient you were going to, but you're taking up another two ambulances for you and your partner.  Sure, response times make a difference, but that doesn't mean you should drive like a bat out of hell with no regard for personal safety.


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## subliminal1284

Sure I agree with being safe about getting there, but  I was referring to the difference between arriving on scene in 5 minutes or 10 minutes can be the difference of life and death.


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## EMTinNEPA

subliminal1284 said:


> Sure I agree with being safe about getting there, but  I was referring to the difference between arriving on scene in 5 minutes or 10 minutes can be the difference of life and death.



And this applies to ALL EMS.  How is this relevant to a discussion on fire vs. private?


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## 46Young

EMTinNEPA said:


> And you come first.  Respond at a _reasonable_ rate, because if you wreck because you're trying to get there fast, not only do you delay response time for the patient you were going to, but you're taking up another two ambulances for you and your partner.  Sure, response times make a difference, but that doesn't mean you should drive like a bat out of hell with no regard for personal safety.



I agree. Emergency driving isn't a video game like Grand Theft Auto. We lost a colleague at NS-LIJ CEMS several years ago, when his ambulance was split in two, with a pt onboard, while speeding excessively. I was working at CCEMS 3/08 when the ambulance railed a car on Calhoun street doing 50 in a 25 for a BS unconscious(drunk). They had to do a cut job to get the C of C student out, and she was long dead by then. We also lose some firefighters each year for hte same reason. Most, if not all of these deaths/injuries are preventable.


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## firecoins

faster is better than not faster but it not the only factor. what does this have to with fire based EMS versus other systems?  

Yes I think EMS is exactly like Grand Theft auto.


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## 46Young

firecoins said:


> faster is better than not faster but it not the only factor. what does this have to with fire based EMS versus other systems?
> 
> Yes I think EMS is exactly like Grand Theft auto.



Driving down Roosevelt Ave in Jackson Heights at 0300 does remind me of GTA, now that I think about it. The crossdressers and bar fights were quite entertaining as well.


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## firecoins

46Young said:


> Driving down Roosevelt Ave in Jackson Heights at 0300 does remind me of GTA, now that I think about it. The crossdressers and bar fights were quite entertaining as well.



EMS in Jackson Heights is exactly like Grand Theft Auto. Bed Sty is better.


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## JPINFV

46Young said:


> Driving down Roosevelt Ave in Jackson Heights at 0300 does remind me of GTA, now that I think about it. The crossdressers and bar fights were quite entertaining as well.



...but if you kill the hookers do you get your money back?


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## firecoins

JPINFV said:


> ...but if you kill the hookers do you get your money back?



you get your heroin back.


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## Maya

Wow, that is crazy.  And totally impractical.  I don't see that ever happening.  Just looking at how things are with the economy and in California right now, in particular -- it's totally ridiculous.

The San Francisco FD just had a six million dollar budget cut.  If you look at other places in the Bay Area, like Oakland, Hayward, and Fremont, they're completely inundated with calls.  There's no way they could take over for private ambulance companies.  Also, it's MUCH more expensive to buy, maintain, and run a fire engine than a regular ambulance.  In order to cover all of the extra calls, they would need more fire/emts and medics, who get paid WAY more then regular ems, and that's huge taxpayer dollars that nobody's gonna want to pay.

Don't get me wrong, I'm hoping to get into the FD eventually too.  Firefighter put their lives on the line every day and deserve every penny they get.  I just don't see this kind of thing being put into practice.


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## HotelCo

Maya said:


> Don't get me wrong, I'm hoping to get into the FD eventually too.  Firefighter put their lives on the line every day and deserve every penny they get.  I just don't see this kind of thing being put into practice.



Firefighters don't respond to enough fire calls around here to be worth the cost of fulltime firefighters. A local city has an all volunteer Fire Dept and it works great. (Keep in mind this isn't a rural township, this is a good size suburban city.)


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## CAOX3

I don't care what uniform you wear as long as you can handle your business.


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## Summit

firecoins said:


> EMS should be a third service.



yep.........


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## bstone

I'm kinda shocked no one look at the following-

if all your EMTs and medics are primarily FFs then what happens when the FFs are all out fighting a fire and an EMS call comes in. Do the FFs simply leave the burning building and go to the medical call? Do the guys holding the hoses put them down to go get in their firetrucks to go play medic elsewhere?

Seems like a bad manpower idea to put all your eggs in one basket. Right?


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## 46Young

bstone said:


> I'm kinda shocked no one look at the following-
> 
> if all your EMTs and medics are primarily FFs then what happens when the FFs are all out fighting a fire and an EMS call comes in. Do the FFs simply leave the burning building and go to the medical call? Do the guys holding the hoses put them down to go get in their firetrucks to go play medic elsewhere?
> 
> Seems like a bad manpower idea to put all your eggs in one basket. Right?



There will be crews dedicated to the ambulance for the shift. Our FF's are crosstrained as either EMT's or medics. All engines are ALS with at least one medic as part of the crew. Different houses have different ways of working it out, but typically the two medics will alternate riding the engine or the box every other day/tour. 

An engine will typically be dispatched for ALS back with the medic unit. If the closest engine is on a job, then the next closest will be sent. If there is a void in coverage, units can be relocated to other houses. We also have mutual aid agreements with all of the surrounding jurisdictions to ensure adequate coverage. 

Hardly putting all of our eggs in one basket. In fact, given the low volume of suppression call types nowadays, it makes sense to crosstrain personnel and rotate them between EMS and suppression apparatus. Cutting FF positions will cost property/lives. Provided they're properly trained, using personnel in an EMS capacity is more efficient then having two seperate entities.

New medic hires at Fairfax will go through a 16 week ALS internship involving 3 12's on an ambulance, and 4 hours/wk of lecture/scenarios prior to the start of the suppression academy. Medics out of the academy also need 18 months on the street before being allowed to ride lead on a medic unit.


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## bstone

46Young said:


> There will be crews dedicated to the ambulance for the shift. Our FF's are crosstrained as either EMT's or medics. All engines are ALS with at least one medic as part of the crew. Different houses have different ways of working it out, but typically the two medics will alternate riding the engine or the box every other day/tour.
> 
> An engine will typically be dispatched for ALS back with the medic unit. If the closest engine is on a job, then the next closest will be sent. If there is a void in coverage, units can be relocated to other houses. We also have mutual aid agreements with all of the surrounding jurisdictions to ensure adequate coverage.
> 
> Hardly putting all of our eggs in one basket. In fact, given the low volume of suppression call types nowadays, it makes sense to crosstrain personnel and rotate them between EMS and suppression apparatus. Cutting FF positions will cost property/lives. Provided they're properly trained, using personnel in an EMS capacity is more efficient then having two seperate entities.
> 
> New medic hires at Fairfax will go through a 16 week ALS internship involving 3 12's on an ambulance, and 4 hours/wk of lecture/scenarios prior to the start of the suppression academy. Medics out of the academy also need 18 months on the street before being allowed to ride lead on a medic unit.



If your medics are out fighting a fire then they aren't available to treat someone having an MI. Right? Calling the next-closest firehouse only delays care. Fire-based EMS is not a good idea.


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## Sasha

bstone said:


> Fire-based EMS is not a good idea.



In your opinion. In my opinion it works well.


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## bstone

Sasha said:


> In your opinion. In my opinion it works well.



My opinion is right. _Always_.


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## Sasha

bstone said:


> My opinion is right. _Always_.



Yeeeah, okay!


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## firecoins

bstone said:


> My opinion is right. _Always_.


the end of all threads are near.


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## bstone

Sasha said:


> Yeeeah, okay!



And anyone who disagrees with me is simply wrong. _Always_.


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## daedalus

Around these parts, you would rather a private service take you non-911 than some of the fire based agencies.


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## LucidResq

daedalus said:


> Around these parts, you would rather a private service take you non-911 than some of the fire based agencies.



And around these parts, faced with a leg amputation, I would rather hobble myself to the hospital rather than have a certain few private companies take me. 

I think it's a very broad generalization to say fire-based EMS is always bad. It definitely, definitely works well in some areas. 

Funny how you don't hear an uproar among communities that are served by fire-based EMS, they seem to be satisfied with the service they are receiving.


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## reaper

Most communities have no clue, what service they have. Nor do they know if it is good or bad.

Now, with the budget crisis's going on, a lot more people are starting to question why a BRT is responding with an ambulance. The average Joe does not know what type of response they are getting. Throw their money away on things and they start to open their eyes and questioning the way things are done.

Does Fire/EMS work decent in some areas? Sure it does. But, I will never agree that it is the way it should be done. I think it does a disservice to EMS and holds it back. It is up to every community to step up and figure out what works for them and how they want their taxes spent!


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## 46Young

bstone said:


> If your medics are out fighting a fire then they aren't available to treat someone having an MI. Right? Calling the next-closest firehouse only delays care. Fire-based EMS is not a good idea.



Try reading the entire post before you comment. The first sentence says "There will be crews dedicated to the ambulance for the shift." If anything, we actually have more resources than we need, IMO. 

I don't know how things work out by you, but there isn't a pump panel, any pre-connects or ladders on our ambulances. The crew may help the Truck driver to throw ladders while on standby at the fireground, but are not getting dressed and actively participating in fireground operations otherwise. The medic crew is strictly EMS for the entire shift. Fire-based EMS works well here.

When I worked NYC EMS, we frequently ran out of available ALS units on busy tour 1's, leaving BLS units to handle cardiac conditions, arrests, diabetics, etc. alone. When I worked Charleston County EMS in SC, response times in the more rural areas would top 15-20 mins. We had BLS engine backup onscene within a few minutes, tops. The EMT's tubed a couple of pts(EMT's no longer intubate currently) for us well PTA, also. 

You'll have to try harder to convince me that third service EMS can deliver the goods better than fire based EMS. If anything, third service EMS is understaffed, overworked, and can rely on FD help in certain areas anyway.


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## 46Young

bstone said:


> My opinion is right. _Always_.



That's something that people say when they can't provide an effective argument.


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## 46Young

reaper said:


> Most communities have no clue, what service they have. Nor do they know if it is good or bad.
> 
> Now, with the budget crisis's going on, a lot more people are starting to question why a BRT is responding with an ambulance. The average Joe does not know what type of response they are getting. Throw their money away on things and they start to open their eyes and questioning the way things are done.
> 
> Does Fire/EMS work decent in some areas? Sure it does. But, I will never agree that it is the way it should be done. I think it does a disservice to EMS and holds it back. It is up to every community to step up and figure out what works for them and how they want their taxes spent!



When we show up onscene, the pt may be suprised on the large turnout. I inform them that the county cares about it's residents and would prefer to have adequate help should it be needed. Your tax dollars at work. If anything, the county's residents have come to expect our turnout as the status quo. As such, there would be complaints if service was reduced.


----------



## 46Young

bstone said:


> And anyone who disagrees with me is simply wrong. _Always_.



What are you, 12?


----------



## 46Young

Having said everything above, I will admit that a fire-based EMS system needs to have well trained EMT/medics, and a well organized system with significant resourced dedicated to EMS. This includes a sufficient # of units, state of the art equipment, progressive protocols, and enough dedicated staff to cover vacancies. 

I've heard stories of municipalities taking over EMS purely to boost call volume, allow billing, and to siphon $$$'s to the suppression side(FDNY does this with EMS, and they're seperate operations). I haven't seen that at Fairfax, or any of the surrounding jurisdictions, to my knowledge, with the exception of DC or PG county. 

If it's run well, fire based EMS is a wise choice. If it's implemented for the wrong reasons, it can leave much to be desired. 

I do disagree with a municipal FD taking over EMS and not allowing for single role EMS under the FD banner. This unfairly shuts out career EMS personnel from continuing their career there. However, that isn't a factor in how effective the EMS system is. 

Also, to help stem the tide of medics who get their cert solely to circumvent the FD hiring process and increase their odds, an experience pre-requisite should be enforced to be considered for a firemedic position. Possibly 1-3 years ALS experience prior. Give preference to those who worked EMS only as well, for a higher probability of landing one that's serious about EMS. 

Perhaps some of you can help by posting fire based single role EMS agencies for those that want FD quality benefits without having to do suppression. I started a thread requesting info on quality EMS agencies to help others. Please post there.


----------



## JPINFV

46Young said:


> You'll have to try harder to convince me that third service EMS can deliver the goods better than fire based EMS. If anything, third service EMS is understaffed, overworked, and can rely on FD help in certain areas anyway.



So, remind me. If fire based EMS is so good, why aren't the fire departments trying to take over the police department? After all, fire suppression has just as much in common with medical care that it does with law enforcement. 


see this thread: http://www.emtcity.com/index.php?showtopic=14392


----------



## firecoins

LucidResq said:


> Funny how you don't hear an uproar among communities that are served by fire-based EMS, they seem to be satisfied with the service they are receiving.



Nor do I hear that about people receiving terrible service from volunteer corps.  I don't think public communities are aware of what they should be or could be getting.


----------



## 46Young

Btw, our ALS personnel go on duty quarterly to EMSCEP, for 8 hours of con-ed taught by PA's, RN's, and RT's. We also incorporate EMS drills with our in station suppression drills. These are part of the monthly training matrix, and is required. This makes my NREMT-P and state recerts painless. CCEMS would mandate us to attend 6 hours monthly on our day off(for straight time, not OT!) At NSLIJ, and I'm surewith many hospital based/privates, you're on your own with CME's.


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## 46Young

JPINFV said:


> So, remind me. If fire based EMS is so good, why aren't the fire departments trying to take over the police department? After all, fire suppression has just as much in common with medical care that it does with law enforcement.
> 
> 
> see this thread: http://www.emtcity.com/index.php?showtopic=14392



In my jurisdiction the current system works well. Our personnel are assigned to either EMS or suppression apparatus for the shift. In that capacity the EMS division functions the same as a third service agency. We are resource rich, so tying up an ALS engine for a few moments or so is no big deal.  

The intent of a PSO would be to wear all three hats at the same time.  The only way for a PSO program to work would be for those crosstrained to be dedicated to either LE, fire, or EMS only depending on the shift. Logistical nightmare if one could be subject to performing all three functions on the same shift.

The FF EMT/medics here have proven that one can be proficient in both of these disciplines. To complete medic school, a fire academy, AND a police academy would be spreading the individual too thin. 

Nassau County PD runs EMS for the county along with vollies. LEO's are crosstrained to EMT-B. ALS are single role. On a call, the LEO will meet up with the  county ALS unit, which typically has one crew member only, to assist pt care and drive the ambo to the hosp. The LEO is now out of service for police matters until they're driven back to their cruiser. Now add suppression duties to the list. Doesn't work. That's one example of what the union was arguing.


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## JPINFV

So it only works well when fire can divert resources from EMS to fight fires, but not if it goes the opposite way? Cool beans. At least we know where fire stands when they continue to basterdize EMS.


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## 46Young

JPINFV said:


> So it only works well when fire can divert resources from EMS to fight fires, but not if it goes the opposite way? Cool beans. At least we know where fire stands when they continue to basterdize EMS.



Once again, we have crews dedicated to EMS units. No one's cannabalizing ambulance crews for suppression duties. We upstaffed for this purpose.


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## JPINFV

The fact that you consider it "upstaffed" to be properly staffed gives it away.


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## 46Young

JPINFV said:


> The fact that you consider it "upstaffed" to be properly staffed gives it away.



Yes, we hired enough personnel to adequately fill positions for both sides. We routinely have one or two extra FF's above minimum staffing in each house for each shift who are up for detail, if a vacancy should need to be filled. They will be sent to fill either an EMS unit or suppression unit, whichever is lacking in staffing.

This ensures that no units are run down due to staffing. You give upstaffing a negative connotation. What, exactly, is wrong with the way my dept handles vacancies? As far as my dept is concerned, being upstaffed IS being properly staffed. No units will be run down. 

A prime third service example: CCEMS handles vacancies by forcing employees to stay for up to an additional 24 hours past the normal shift, which is a 24/48. This can happen as frequently as is necessary, and does, irrespective of how much OT the employee has signed up for. The forced OT isn't only on a one for one basis, it can be for any unit in the county. Personnel are also subject to being on call for a 12 hour block twice monthly on their days off, no stipend given, only OT $$'s if they're called. Forced OT has also prevented some from completing their monthly CME's. 

Is that your idea of "properly staffed" as opposed to upstaffed? 

The CCEMS scenario is common to many areas, I'm sure. This only serves to significantly lower morale, promote attrition, and provide fatigued techs coming to your aid. No wonder why EMS only is frequently seen as a stepping stone job. Third service EMS is awesome. Been there, done that. Wasted six months of my life that I'll never get back.


----------



## rmellish

That video is unreal.


----------



## 46Young

I challenge those viewing this forum to advise how third service EMS, properly run, is superior to fire based EMS, also properly run. I repeatedly hear claims of FBEMS as being substandard providers, apathetic toward the medical field, not staffing EMS units properly, siphoning $$$'s from EMS to fire, firemedics dropping their medic cert after getting on, having engines stay onscene routinely for 20 mins+ waiting for a bus to stop the clock.

These are examples of NOT being properly run. These complaints vary from dept to dept, and ought not be indicative of FBEMS as a whole.

Tell me how TSEMS is superior, both from the public's vantage point, and that of the employee. Serving the public is why many of us chose this path, I've vollied in the past as well, but this is how I provide for my family. 

I came to the realization after only four years in EMS that it's highly unlikely that you'll see this career to the end after 25 years or so(even more if your service doesn't have a pension). Many burn out at or around the 10 year mark. I had lots of fun in NY working T1's, but I owed myself and my family a better deal. Sadly, those in EMS typically use it as a stepping stone to a better career, go fire based for a better deal, or are stuck with no realistic way to better themselves. If this doesn't describe you personally, that's a good thing. Career advancement for EMS only agencies is sorely lacking when compared to fire and LE.


----------



## 46Young

Also, in the interest of fairness in comparing the ideal TSEMS vs the ideal FBEMS, the TSEMS would be on it's own, with no EMS aid from local FD's, other than lift assists or help on an MVA. This is in reference to response times, timely delivery of ALS care, and more medically trained personnel onscene.


----------



## JPINFV

46Young said:


> This ensures that no units are run down due to staffing. You give upstaffing a negative connotation. What, exactly, is wrong with the way my dept handles vacancies? As far as my dept is concerned, being upstaffed IS being properly staffed. No units will be run down.



That's not what you said. You said,


> Once again, we have crews dedicated to EMS units. No one's cannabalizing ambulance crews for suppression duties. *We upstaffed for this purpose.*



which gives the impression that providing enough personal to properly man ambulances and engines is considered "upstaffed" and not "normal" staffing.

As far as "upstaffing" is concerned, what happens when more people call out sick? Right now Boston FD is averaging something around 13 people calling out sick a day, which is more than they are currently upstaffed for. Since they don't have enough money to pay for overtime, they've resorted to closing up to 4 companies a day to meet needs. Thank God Boston FD doesn't run EMS.


----------



## JPINFV

46Young said:


> Tell me how TSEMS is superior, both from the public's vantage point, and that of the employee. Serving the public is why many of us chose this path, I've vollied in the past as well, but this is how I provide for my family.


There's a reason why not every fire fighter is trained for swift water, hazmat, technical rescue, high angle rescue, etc. There's value in specialization, especially in fields that require a lot of background knowledge like medicine. You don't need to be a physics expert to go rope climbing. To provide competent medical care, you do need chemistry, physics, anatomy, physiology, biochemistry, and breadth courses. Alternatively, is your idea of providing competent prehospital medical care involve just being able to read at an 8th grade level and being able to paint by numbers? 

From the employee standpoint, it's all about not being forced into a field that they would otherwise not enter, unless you deny that that happens.


----------



## 46Young

By upstaffed, I mean that there are sufficient personnel to cover vacancies. A proactive approach. Personnel can be held for 12 additional hours, for a cap on 36 consecutive hours, if needed. This is infrequent, and is only on a one-for-one basis. Are you advocating employee holdovers to plug scheduling holes instead of hiring the necessary personnel? Like I said, each house will be upstaffed(which means those over minimal staffing - 4/engine, 3/truck, 2 for medic, 4 for heavy rescue) by one or two people to cover vacancies.

We don't currently have the problem that Boston has. Until the current economic crisis took hold, Fairfax County FRD ran four academies per year to keep staffing up as we added firehouses and apparatus. Currently, we have nine firemedics graduating at the end of the month, with 20 more being hired for the next class, beginning their internship this August.

Enough with the upstaffing fetish. I don't know how to better explain it, nor can I find any error with my dept's reasoning with this policy.


----------



## 46Young

Our FF/EMT's and medics have been crosstrained for some time. This is nothing recent. Anyone who has been hired knows that EMT is part of the job description. There are some old timers that weren't required to take EMT, but most of our staff is trained to at least that level.

I've seen our firemedics and medic Lt's work, and they do both sides equally well, on the whole, from what I've seen. Firemedic prehires are required to have NREMT-P or VA EMT-P prior to hire. Similar requirements, I would think, if one were to apply to any EMS only agency. I don't get what you're trying to prove by the paint by numbers and 8th grade comment. I already stated that new medics do a 16 week internship with weekly classroom sessions, and aren't allowed to ride lead until 18 months post academy. This is way more than most agencies are doing, and this includes EMS only.

No one is being forced to work here. There are fire based single role medics, as well as plenty of third service agencies with pensions. North Carolina is full of them.

I have a good handle on what constitutes good prehospital care. I worked five years for North Shore LIJ CEMS doing both NYC 911 and interfacility txp. Ask someone. I've also worked at CCEMS as stated earlier. I've worked private EMS as well. I've seen enough to tell competent work from incompetent, thank you.


----------



## 46Young

I still haven't heard any convincing arguments as to why TSEMS is superior to FBEMS. TSEMS typically has rotating schedules, so you're screwed with attending school, unless you use mutuals or paid time off. Fixed schedules seem to be a selling point for hospital based/private EMS, but that only facilitates attririon when the employee completes their degree and moves on.


----------



## atropine

If you let the privates run ems, you get low wages, and low wages = sub par employees, where if you have a nice pay garde and benifits you get more qualified applicants, who provide and lets face paramedicine is not rocket science service, that is my take on it. I guess too many privates would bid for contracts and medics would be making min wage.


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## rmellish

atropine said:


> If you let the privates run ems, you get low wages, and low wages = sub par employees, where if you have a nice pay garde and benifits you get more qualified applicants, who provide and lets face paramedicine is not rocket science service, that is my take on it. I guess too many privates would bid for contracts and medics would be making min wage.



Third services aren't necessarily privates. It is possible to have an EMS service run by a municipality which is not under the auspices of the fire service. Incidentally, I think it's the best option.

 Privates aren't necessarily for profit. My service for example, is a private *not for profit* in essence a third service only partially supported by the county. For profit EMS doesn't seem like the best idea when it comes to 911 providing though, based on personal experience. 

Also, if Fire "does it better" then why do so many fire based EMS providers hire "civilian" techs and medics? If they do that they're pretty much a third service...


----------



## 46Young

atropine said:


> If you let the privates run ems, you get low wages, and low wages = sub par employees, where if you have a nice pay garde and benifits you get more qualified applicants, who provide and lets face paramedicine is not rocket science service, that is my take on it. I guess too many privates would bid for contracts and medics would be making min wage.



Pulse and a patch, it's all about keeping warm bodies on the rig. Turnover isn't a problem, as there are five more waiting to take your place.


----------



## 46Young

rmellish said:


> Third services aren't necessarily privates. It is possible to have an EMS service run by a municipality which is not under the auspices of the fire service. Incidentally, I think it's the best option.
> 
> Privates aren't necessarily for profit. My service for example, is a private *not for profit* in essence a third service only partially supported by the county. For profit EMS doesn't seem like the best idea when it comes to 911 providing though, based on personal experience.
> 
> Also, if Fire "does it better" then why do so many fire based EMS providers hire "civilian" techs and medics? If they do that they're pretty much a third service...



The best option? Perhaps you haven't seen Charleston County EMS or FDNY EMS(under FDNY, but operates essentially as a third service). 

Hiring civilian techs or not, the service is still fire based. The FD is hiring and providing the goods. They'll typically have suppression personnel, typically trained to at least med first responder, to run medical aid.

Care to provide reasons as to WHY a PROPERLY run TSEMS trumps a PROPERLY run FBEMS, other than "personal experience"? Things vary from region to region, I'm referring to the TSEMS vs FBEMS concepts in their purest form.


----------



## 46Young

No one has given any good reasons for the superiority of TSEMS, other than a few examples exclusive to the particular dept being referenced. Almost every dept has something that could be improved, fire and EMS alike. That's why I stated earlier to compare properly run models for each type.


----------



## JPINFV

Do you have any evidence that fire based saves money or is superior? I find it next to impossible to believe that sending a fire engine to every medical call is cost efficient.


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## rmellish

Let's approach this from another angle. How can EMS advance as a profession if it's always seen as the :censored::censored::censored::censored::censored::censored::censored: stepchild of the fire service?


----------



## 46Young

rmellish said:


> Let's approach this from another angle. How can EMS advance as a profession if it's always seen as the :censored::censored::censored::censored::censored::censored::censored: stepchild of the fire service?



How about you attempt to answer my question as above on post # 90 instead of speaking in cliche? I'm still waiting for a convincing argument as how to why TSEMS is superior to FBEMS. 

EMS is far from :censored::censored::censored::censored::censored::censored::censored:ized where I work. Try again.


----------



## 46Young

JPINFV said:


> Do you have any evidence that fire based saves money or is superior? I find it next to impossible to believe that sending a fire engine to every medical call is cost efficient.



I asked you first. Don't try to flip it on me without providing  effective arguments for your position. 

Better to have more help than is needed, than to summon help after the fact. It's probably not cost effective to send ALS on every call either, as many third service agencies do, either.


----------



## firecoins

46Young said:


> No one has given any good reasons for the superiority of TSEMS, other than a few examples exclusive to the particular dept being referenced. Almost every dept has something that could be improved, fire and EMS alike. That's why I stated earlier to compare properly run models for each type.



Why should Fire be its own service? We can EMS run fire better than fire can. Police can run fire better than fire can. Sanitation can run fire.  

Why not merge all local government departments and have 1 department do everything?


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## JPINFV

46Young said:


> I asked you first. Don't try to flip it on me without providing  effective arguments for your position.
> 
> Better to have more help than is needed, than to summon help after the fact. It's probably not cost effective to send ALS on every call either, as many third service agencies do, either.



Kinda of hard to sit here and justify things to someone who will brush off every justification, and then change his opinion to be self serving. After all, you just backtracked from 





46Young said:


> . Cutting FF positions will cost property/lives. Provided they're properly trained, using personnel in an EMS capacity is more efficient then having two seperate entities.



 to "Oh, it'snot all that cost effective after all."

As far as sending paramedics to every call, next time you go to the emergency room, as for the ER tech to examine you to see if you need a specialist. After all, you would hate to spend extra money for a physician.


----------



## VentMedic

JPINFV said:


> Do you have any evidence that fire based saves money or is superior? I find it next to impossible to believe that sending a fire engine to every medical call is cost efficient.


 

It is not efficient and Florida realizes we have some serious issues with that. However, with the way the ALS engines are placed through the community, we don't have to rely on a volunteer ambulance company that has minimally trained first responders who must call for intercepts after playing on scene with whatever "tools" their state has allowed them to carry. 

So I see no problem with the engine being used as a first response vehicle that is ALS capable until the FD ambulance arrives from another station. I do see a problem if the engine is running from the same station and the call is for a sprained ankle. I also see a problem with an engine, FD ambulance and private ambulance running to that same call. These are the issues currently being addressed in Pinellas County, FL by the FDs and Sunstar.

South Florida has been trying to clean up its response somewhat and have prioritized their call dispatching in some counties.


----------



## JeffDHMC

Round here people simply just don't know any better. Same reason people get fleeced by mechanics, they just don't know any better. I could talk your ear off with stories that support just the opposite.



LucidResq said:


> And around these parts, faced with a leg amputation, I would rather hobble myself to the hospital rather than have a certain few private companies take me.
> 
> I think it's a very broad generalization to say fire-based EMS is always bad. It definitely, definitely works well in some areas.
> 
> Funny how you don't hear an uproar among communities that are served by fire-based EMS, they seem to be satisfied with the service they are receiving.



Is fire based EMS always bad? I'll guess not, it just does not work all that well a lot of the time. BUT, it is the fault of EMS that we must suffer these attacks, say what you will about FD EMS, they market themselves much better. If we would have jumped right instead of left years ago and forgone the perceived need to stay alive by billing for service we would be much better off now.


----------



## rmellish

VentMedic said:


> So I see no problem with the engine being used as a first response vehicle that is ALS capable until the FD ambulance arrives from another station. I do see a problem if the engine is running from the same station and the call is for a sprained ankle. I also see a problem with an engine, FD ambulance and private ambulance running to that same call. These are the issues currently being addressed in Pinellas County, FL by the FDs and Sunstar.
> 
> South Florida has been trying to clean up its response somewhat and have prioritized their call dispatching in some counties.



I do have a problem with a $500k engine or worse a ladder being used as a first response vehicle to EMS runs. These EMS runs are recorded the same as fire runs, and this "run volume" is used to justify the purchase of new engines and ladders. It would seem far more cost efficient to send a SUV, Rescue, or even a fly car on ALS first response. That way the community won't be paying for new engines and ladders as often.


----------



## VentMedic

rmellish said:


> I do have a problem with a $500k engine or worse a ladder being used as a first response vehicle to EMS runs. These EMS runs are recorded the same as fire runs, and this "run volume" is used to justify the purchase of new engines and ladders. It would seem far more cost efficient to send a SUV, Rescue, or even a fly car on ALS first response. That way the community won't be paying for new engines and ladders as often.


 
So you suggest the FD buy at least 60 additional vehicles if it has 60 stations for just the EMS calls besides their ambulances? 

At least even with an ALS engine, they are getting more than BLS trained providers. Again, many FDs have streamlined to where these engines only run if they are needed for response time and are the closest unit. Although, many FDs now have enough ambulances where an engine is not always dispatched. 

You can not look at how CA, especially Southern CA,  does things because other FDs do things a lot more efficiently. Seattle is also a very good example of this. So don't bash all FDs at be wrong.


----------



## rmellish

VentMedic said:


> So you suggest the FD buy at least 60 additional vehicles if it has 60 stations for just the EMS calls besides their ambulances?
> 
> At least even with an ALS engine, they are getting more than BLS trained providers. Again, many FDs have streamlined to where these engines only run if they are needed for response time and are the closest unit. Although, many FDs now have enough ambulances where an engine is not always dispatched.
> 
> You can not look at how CA, especially Southern CA,  does things because other FDs do things a lot more efficiently. Seattle is also a very good example of this. So don't bash all FDs at be wrong.



You're right, my statement applies more to certain municipalities in my region. I'm not against FD ALS first response by any means, however *in some cases* it could be delivered in a more efficient manner.


----------



## VentMedic

rmellish said:


> You're right, my statement applies more to certain municipalities in my region. I'm not against FD ALS first response by any means, however *in some cases* it could be delivered in a more efficient manner.


 
I agree.

That is why I will use Pinellas(FL) and Collier (FL) counties as well as LA in some of my examples.

Edit:
Almost forgot Washington, D.C. and their contribution to making FDs look like idiots when it comes to EMS.


----------



## JPINFV

VentMedic said:


> At least even with an ALS engine, they are getting more than BLS trained providers. Again, many FDs have streamlined to where these engines only run if they are needed for response time and are the closest unit. Although, many FDs now have enough ambulances where an engine is not always dispatched.



I would argue that combining an engine company with a first response SUV (since, either way, that unit would be out of service during a medical call. Engineer stays with the engine and, if a fire call occurs during a medical run, the SUV and engine can meet at the fire) would save money by decreasing the cost in maintenance, gas millage, and ultimately extending the life of the engine. Yes, there would be a large upfront cost, but it's a long term investment that makes more sense then replacing an engine where over half of the millage occurred responding to a medical call.


----------



## VentMedic

JPINFV said:


> I would argue that combining an engine company with a first response SUV (since, either way, that unit would be out of service during a medical call. Engineer stays with the engine and, if a fire call occurs during a medical run, the SUV and engine can meet at the fire) would save money by decreasing the cost in maintenance, gas millage, and ultimately extending the life of the engine. Yes, there would be a large upfront cost, but it's a long term investment that makes more sense then replacing an engine where over half of the millage occurred responding to a medical call.


 
So you also now want ANOTHER vehicle responding?

An ALS engine, an ALS SUV, an ALS FD ambulance and maybe even a private ALS ambulance going to the scene?   Where is the cost saving to the FD buying another SUV for each station?  What is with all the intercepts?   ALS is on scene and not EMT-Bs.    At better run responses, the ALS engine is optional and not a requirement.  Essentially, there will be a FD ambulance and maybe a private ambulance which may be called to transport.


----------



## JPINFV

No. The SUV responds in place of the engine.The only time BOTH the SUV and engine would respond to an incident is if a call comes in while the SUV is out on a medical call and the actual engine is needed. This would also reduce the need to send an engine to go grocery shopping. 

I also don't see the point in having 2 ambulances respond as a first response.


----------



## VentMedic

JPINFV said:


> No. The SUV responds in place of the engine.The only time BOTH the SUV and engine would respond to an incident is if a call comes in while the SUV is out on a medical call and the actual engine is needed. This would also reduce the need to send an engine to go grocery shopping.
> 
> I also don't see the point in having 2 ambulances respond as a first response.


 
Only one ambulance may be the first response. However, if the ALS engine is closer then that is toned out for the first response vehicle. It does not run if the FD ALS ambulance is closer. 

Our FDs are very large and what you are suggesting would still involve buying over 60 additional vehicles as well as staffing for those 60+ vehicles. 

Many patients may not need a bunch of Paramedics in the back to care for them. Usually one Paramedic will suffice from the private service if that is how the response is set. The FD ambulance will return to service to still be a first response vehicle. Some do not have private ambulances running and it is just the FD ambulance.


----------



## atropine

why don't they ALL, just do it like LAco.FD, the right way. I mean 30+ years and nobody has any heartburn yet. Plus your able to down grade a call to bls and keep the als squad still in service.


----------



## JPINFV

...because Southern California EMS is the model system for what not to do.


----------



## daedalus

atropine said:


> why don't they ALL, just do it like LAco.FD, the right way. I mean 30+ years and nobody has any heartburn yet. Plus your able to down grade a call to bls and keep the als squad still in service.



LAcoFD is a JOKE everywhere else in the country. They may go around thinking they are badasses, but hardly justified. Just look at LA county paramedic protocols compared even too Ventura county, or to Washington State.


----------



## atropine

daedalus said:


> LAcoFD is a JOKE everywhere else in the country. They may go around thinking they are badasses, but hardly justified. Just look at LA county paramedic protocols compared even too Ventura county, or to Washington State.



well thats my point, if it's that bad as everyone who matters says it is, why has it not changed in the last 30+ years?, I'll tell you why, because thier protocols are practical, plus we all operate under some MD's license anyways so were really not all the great as we think we are.


----------



## reaper

How long have you been a medic?


----------



## JPINFV

reaper said:


> How long have you been a medic?



Alternatively, did you stay at a Holiday Inn Express last night?


----------



## EMTinNEPA

atropine said:


> why don't they ALL, just do it like LAco.FD, the right way.



I feel a terrible disturbance in the force... as if millions of brain cells just cried out in terror... and were suddenly silenced.


----------



## CAOX3

This threads a riot.  Havent we been arguing this exact point for like twenty years?


----------



## Ridryder911

atropine said:


> why don't they ALL, just do it like LAco.FD, the right way. I mean 30+ years and nobody has any heartburn yet. Plus your able to down grade a call to bls and keep the als squad still in service.



Brought to you by the makers of "just read what the machine interperts the ECG" ... and other antiquated ideas. LACFD could had and should had, but did not. 

R/r 911


----------



## MendoEMT

OKAY..... (I work as an EMT, but also have fire experience and experience as a dispatcher) having read over the entire discussion, here is what I can deduce:

1.)  EMS is relatively new in comparison with FD and LE services and as such is still very much "in the works" and a really streamlined way of providing a nationally standardized EMS response is far from complete.  

2.)  Due to the great lengths that the FD has gone to in regards to fire prevention, the number and severity of fires that are being responded to are greatly diminished and as such, fire needs a way to not only justify it's existence (and size) but also a way to generate additional revenue.  EMS seems to be a great way for this, especially when hard facts are laid out:  in the majority of regions nation-wide, medical calls comprise nearly 80% of an average FD's total runs.

3.)  As some have mentioned previously in this forum, third service EMS is unfortunately very often used as a stepping stone for aspiring EMTs and medics to move on to bigger and better (paying) jobs in fire.  Often, many in the biz move on to fire not so much because they don't like the EMS side of it, but because TSEMS doesn't pay nearly as well as a fire job and you really can't beat FD benefits.  

4.)  EMTs and Paramedics working for both TSEMS and FBEMS have the same level of training and have to pass the same national registry exam, so in both arenas the personnel responding are equally skilled and both systems find it possible to meet their mandated response times, so the whole argument about a faster response is moot (to those who doubt, talk to FFs in areas where the FD acts as first responder to a TSEMS company and ask them how often they are able to initiate ALS care before an ambulance shows up [not often] and then ask if that impacts the difficulty in keeping up their medic cert.  Besides, as we all know, seconds don't really count but for _maybe_ 1% of the calls, probably less.  See what I'm driving at?)

These points are why FBEMS is gaining in popularity....  BUT DO THESE THINGS MAKE EITHER FBEMS OR TSEMS SUPERIOR OVER THE OTHER?  

The answer:  hardly.

In some regions FBEMS works great, in others, TSEMS seems to be best, but from the perspective of someone who has seen both in action, a third solution that I have yet to see suggested appears to be better than either.  While there are pros and cons with both systems, what we really need is for EMS to move away from privatized companies and to be run by county/regional/city/state governmental systems and be run more like a fire dept, not dependent on how much money can be gleaned from medicare or restricted by a FD that views EMS as secondary to fire.  AHHHHH!!!!! I KNOW!!! Scary, huh?

The problem is that TSEMS are run by private companies who are, to be honest, out to make a buck.  I know, I know, hardly a new idea and not fair to all those "virtuous and honest" private EMS companies out there.  But in the process of increasing profit margins, the employees and sometimes even the patients suffer for it.  So why not make EMS a FD-like entity, something funded by our tax dollars (and what medicare begrudgingly pays out)?  

It's true that sending an engine out to every sprained ankle is a waste of money, just as it is true that it is better to have all the necessary resources on hand rather than having to call for them later, so why not have both fire and EMS run by the same region, although separately, and use the dispatching protocols that are already in place in many areas implemented so that EMS can be dispatched and have fire dispatched as well when appropriate or expedient?  

Just a thought.


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## VentMedic

MendoEMT said:


> 1.) EMS is relatively new in comparison with FD and LE services and as such is still very much "in the works" and a really streamlined way of providing a nationally standardized EMS response is far from complete.


 
However, EMS should not be compared with the FD and LE when talking about medicine and that is regardless of which service is doing it. EMS is actually older than many medical professions who have their acts together. At 40+ years it is time to stop using the "in the works" excuse. Also, if a FD has just started doing EMS, it is new to them regardless of how long the FD has existed. There are however, FDs that have been doing EMS for 40+ years and do it right. Unfortunately LA has stayed somewhere around 1970 and has not advanced much past the "train some FFs to get there real quick".

Other than that, good post.


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## GR1N53N

MendoEMT said:


> ...
> These points are why FBEMS is gaining in popularity....  BUT DO THESE THINGS MAKE EITHER FBEMS OR TSEMS SUPERIOR OVER THE OTHER?
> 
> The answer:  hardly.
> 
> In some regions FBEMS works great, in others, TSEMS seems to be best, but from the perspective of someone who has seen both in action, a third solution that I have yet to see suggested appears to be better than either.  While there are pros and cons with both systems, what we really need is for EMS to move away from privatized companies and to be run by county/regional/city/state governmental systems and be run more like a fire dept, not dependent on how much money can be gleaned from medicare or restricted by a FD that views EMS as secondary to fire.  AHHHHH!!!!! I KNOW!!! Scary, huh?
> ...




It sounds like you may have spent some time in Ontario.  Up here our municipalities/counties run the EMS service as a separate entity from fire.  BUT, unlike not having fire as backup except on MVCs, as someone suggested would happen if this were the case, they have a tiered response system.  Fire are recognized as first responders and are trained as such, sometimes with BTLS or some such trauma cert. - that way those fire boys who want to focus on fighting fires don't have to remember too much medical business, just enough to make them useful for their EMS support role.  Fire is codispatched with EMS to any unresponsive call (and often arrive first, as there are more fire stations) and when EMS arrives, they take over, with fire as support.  While some of the EMS crews aren't fond of fire being 'in the way' at some of their calls, this does seem to be an effective way of keeping EMS services dedicated to EMS, without losing the extra manpower of a handy, first-response trained, fire service.

Of course, the US medical system in general is rather different from ours here, with obviously a much greater focus on private providers (from EMS to the hospitals), so it's not really a surprise that gov't-run EMS is not big down there.  And from the sounds of it, both FDNY-style EMS and private services (and even that whole fire-trained-as-EMS thing seems to work for some, though it still boggles the mind a little, having never seen it in action) have their benefits/costs, and EMTs/medics can be good/bad no matter what service they're in...


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## firecoins

VentMedic said:


> However, EMS should not be compared with the FD and LE when talking about medicine and that is regardless of which service is doing it. EMS is actually older than many medical professions who have their acts together. At 40+ years it is time to stop using the "in the works" excuse. Also, if a FD has just started doing EMS, it is new to them regardless of how long the FD has existed. There are however, FDs that have been doing EMS for 40+ years and do it right. Unfortunately LA has stayed somewhere around 1970 and has not advanced much past the "train some FFs to get there real quick".
> 
> Other than that, good post.



P.A.s, respiratory therapists or what have you have other b.s to put up with but not the municipality being the main employers.


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## VentMedic

firecoins said:


> P.A.s, respiratory therapists or what have you have other b.s to put up with but not the municipality being the main employers.


 
Many hospitals are part of a government system such as the VA, public trusts, county and city. They must still put up with the budget and tax issues when it comes to staffing. SF recently had several layoffs from their healthcare facilities since the city budget is messed up. Other hospitals rely on a trauma tax and compete for money with other agencies. 

It all depends on what your area has become accustomed to. Florida is primarily Fire. There are very few private ambulances that provide 911 EMS in the state. And, it is all ALS.

Some areas will argue their volunteer BLS ambulance is sufficient. However, it is often the EMT volunteers that play a role in saying BLS is good enough and the public may trust what the home town vollies are saying.   Our FDs also have excellent PR to keep people informed that they are there and for what purposes.  The door to door smoke detector checks that many FDs have been doing recently is a great public safety campaign as well as getting some photo ops with the senior citizens.


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## firecoins

I don't see respiratory therapy becoming part of the FD anytime soon. Yes resipratory therapy is done at various government installations but it isn't restricted to that.

Private EMS IFT aren't either but you can have 1 employer for major metroplitan areas where many medical facilities that hire RTs or PAs exist.


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## VentMedic

firecoins said:


> I don't see respiratory therapy becoming part of the FD anytime soon. Yes resipratory therapy is done at various government installations but it isn't restricted to that.
> 
> Private EMS IFT aren't either but you can have 1 employer for major metroplitan areas where many medical facilities that hire RTs or PAs exist.


 
Why are you wanting to put RRTs in FDs?

RRTs are on Specialty and some HEMS.  

But, I don't see what your point is here.


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## rmellish

MendoEMT said:


> The problem is that TSEMS are run by private companies who are, to be honest, out to make a buck.  I know, I know, hardly a new idea and not fair to all those "virtuous and honest" private EMS companies out there.  But in the process of increasing profit margins, the employees and sometimes even the patients suffer for it.  So why not make EMS a FD-like entity, something funded by our tax dollars (and what medicare begrudgingly pays out)?



Third service doesn't necessarily equal private. The best solution, I think we're agreeing here, is making EMS it's own entity, seperate from the FDs, many of whom use EMS as yet another way to get tax dollars.


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## VentMedic

rmellish said:


> Third service doesn't necessarily equal private. The best solution, I think we're agreeing here, is making EMS it's own entity, seperate from the FDs, many of whom use EMS as yet another way to get tax dollars.


 
Yes some do but in all fairness, areas like South Florida birthed the modern Paramedic in the FDs because the fire stations were closest to the people. The ambulances were few and stationed at hospitals, which were also few, or at a funeral home. The FFs could get there quicker and that is still true in many areas today. Getting help to the people the quickest was the idea the doctors, such as Dr. Nagel, had in mind and not this BS between the different providers/services we have today. The design was also to raise the standard in the community to have "ALS" or Paramedic providers go to scene before the minimally trained care of the ambulance attendants. But some still fight that concept for advancement which was the vision of the founders of the modern Paramedic. 

At that same time, the U.S. did have a great model for a hospital based Paramedic EMS service know as Freedom House. However, it was never accepted probably due to issues other than medicine and rarely gets even a small note in EMS history.

quote from article I recently posted.
http://www.silive.com/healthfit/advance/index.ssf?/base/living/1246872608231790.xml&coll=1


> Dr. Sheldon Jacobson, or "Shelly" as most of us knew him, is considered the "Father of paramedics." In 1974, he took a small group of young men working as ambulance drivers and attendants and transformed them into professionals who became the foundation upon which much of New York City's pre-hospital emergency medicine was built.


It was later that NYC got into teaching "ambulance attendants" to be Paramedics. Again, this was the concept to put better trained providers on the street and to get away from just the "BLS" that was available. Still today, that concept is argued against but not by those who may need EMS care but by some EMS providers. So heaven forbid if the FDs see a need and want to carry on with the design of providing ALS care to the people in their community.


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## 46Young

I believe mendo's post and vent's reply to be accurate. I was waiting for someone to acknowledge that either FB or TS EMS could work equally well if ran properly. For the public's benefit, timely delivery of ALS care, by competent providers is desired, with adequate txp units available. This can be accomplished by TS fly cars, or FD medics on suppression apparatus. As long as the end result is the same, who is showing up is unimportant. 

NYC EMS, with FDNY units, hosp units, or private units, strive to keep response times short by having many units posted on street corners throughout the city, for a quicker response than if you were coming from a station. FDNY engine crews are CFR-D only, and aren't really necessary on most of the calls they are dispatched to. 

CCEMS, a municipal third service agency in SC, runs every unit ALS out of stations dispersed throughout the county. Charleston City, N Charleston, James Island(very competent), Awendaw, St. John's, and St. Andrews FD's give BLS backup for extended response times. No ALS with the exception of Mt. Pleasant FD, who seek to have txp units of their own in the furure.

Fairfax County FRD operates as I've stated previously, with a small contingent of vollie ALS/BLS buses. 

These are personal experiences of which I draw my opinions from. 

As an employee, your goals will be either to do EMS as a stepping stone, go EMS only as a career, or go fire(EMS). Many do go FBEMS for superior working conditions, pension, bennies, $$$'s, solid medical coverage, DROP, etc. The paramilitary structure is beneficial in some areas, but not so much for pt care.

TSEMS municipal could potentially be just as satisfying for the employee as FB, but EMS doesn't have the political clout or collective bargaining strength of the FD's. Medics are becoming a dime a dozen if not so already(Ohio and FL come to mind) courtesy of medic mills. As such, the employer is under no obligation to improve your $$$/bennies, as there are plenty of warm bodies to fill your spot when you get fed up and leave. 

There's also nothing wrong with a muni TSEMS using the local FD for ALS back for timely ALS care. That could work just as well as EMS in Fairfax. 

FBEMS with crosstrained personnel will typically have the advantage with staffing, as personnel are versatile, to reduce forced OT and putting units OOS. TSEMS tends to burn out their employees with high call volume, holdovers, and micromanaging. The employer will seek to get the job done with as few units as possible, with little regard for the employee.

If one wants to do EMS as a career, as a lifer, I highly recommend going municipal TSEMS, or FB single role EMS(Alexandria Fire and EMS for example). On the whole, since employers have gone largely from defined benefit(pension) to defined contribution, it's been proven over and over again that people do a poor job of managing their retirement.

Most municipal employers, to my knowledge, have state/city retirement, with an optional deferred comp(457) with no employer contribution. A 401k/403b will eventually run out. a pension, especially with yearly COLA adjustments, will not. You don't want to grow old, have to take out a reverse mortgage on your house, and rotate meds due to financial difficulty.


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## firecoins

VentMedic said:


> Why are you wanting to put RRTs in FDs?


I am not. 





> But, I don't see what your point is here.


I forgot what point I was making. I was responding to something you said but I can't remeber at this point.


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## 46Young

If anyone knows of decent EMS only agencies, be it TS or FB, post it at my quality EMS agencies thread. Maybe it will help some. North Carolina has quite a few, but I don't know of the quality. I've heard Acadian is good, also.


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## reaper

46Young said:


> I believe mendo's post and vent's reply to be accurate. I was waiting for someone to acknowledge that either FB or TS EMS could work equally well if ran properly. For the public's benefit, timely delivery of ALS care, by competent providers is desired, with adequate txp units available. This can be accomplished by TS fly cars, or FD medics on suppression apparatus. As long as the end result is the same, who is showing up is unimportant.
> 
> NYC EMS, with FDNY units, hosp units, or private units, strive to keep response times short by having many units posted on street corners throughout the city, for a quicker response than if you were coming from a station. FDNY engine crews are CFR-D only, and aren't really necessary on most of the calls they are dispatched to.
> 
> CCEMS, a municipal third service agency in SC, runs every unit ALS out of stations dispersed throughout the county. Charleston City, N Charleston, James Island(very competent), Awendaw, St. John's, and St. Andrews FD's give BLS backup for extended response times. No ALS with the exception of Mt. Pleasant FD, who seek to have txp units of their own in the furure.
> 
> Fairfax County FRD operates as I've stated previously, with a small contingent of vollie ALS/BLS buses.
> 
> These are personal experiences of which I draw my opinions from.
> 
> As an employee, your goals will be either to do EMS as a stepping stone, go EMS only as a career, or go fire(EMS). Many do go FBEMS for superior working conditions, pension, bennies, $$$'s, solid medical coverage, DROP, etc. The paramilitary structure is beneficial in some areas, but not so much for pt care.
> 
> TSEMS municipal could potentially be just as satisfying for the employee as FB, but EMS doesn't have the political clout or collective bargaining strength of the FD's. Medics are becoming a dime a dozen if not so already(Ohio and FL come to mind) courtesy of medic mills. As such, the employer is under no obligation to improve your $$$/bennies, as there are plenty of warm bodies to fill your spot when you get fed up and leave.
> 
> There's also nothing wrong with a muni TSEMS using the local FD for ALS back for timely ALS care. That could work just as well as EMS in Fairfax.
> 
> FBEMS with crosstrained personnel will typically have the advantage with staffing, as personnel are versatile, to reduce forced OT and putting units OOS. TSEMS tends to burn out their employees with high call volume, holdovers, and micromanaging. The employer will seek to get the job done with as few units as possible, with little regard for the employee.
> 
> If one wants to do EMS as a career, as a lifer, I highly recommend going municipal TSEMS, or FB single role EMS(Alexandria Fire and EMS for example). On the whole, since employers have gone largely from defined benefit(pension) to defined contribution, it's been proven over and over again that people do a poor job of managing their retirement.
> 
> Most municipal employers, to my knowledge, have state/city retirement, with an optional deferred comp(457) with no employer contribution. A 401k/403b will eventually run out. a pension, especially with yearly COLA adjustments, will not. You don't want to grow old, have to take out a reverse mortgage on your house, and rotate meds due to financial difficulty.



This is one of the better posts I have seen on the issue. Kudos to you.


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## 46Young

reaper said:


> This is one of the better posts I have seen on the issue. Kudos to you.



Thanks. Being a part of fire based EMS, I can't help jumping in when some start taking shots at FD's. I actually don't have a problem with TSEMS, it's just no longer for me. 

Repeatedly during this thread I was asking for proof that the third service concept was better than fire based. The correct answer is that they can both be equally effective. TS or FB agencies both have the potential to deliver superb service, but there are many examples of failures from both sides. The only real advantage seems to be from the employee's perspective with FD benefits. 

I've heard that Seatlle does TSEMS well. It would be great if others could follow their lead. 

There are fire based single role medics(Alexandria Va), which would be the best of both worlds, from the worker's perspective.


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## reaper

I agree. While I am not a fan of FD EMS, I will say that there are some that work fine. But, there are a majority that fail big time. When You discuss TSEMS, I look only at City or county run services, That is third service. I know quit a few that make it work and have the pay and benefits to match FD's. But, there are also a lot of third service EMS that fail big time!

CCEMS is an example of failure. A good service watches out for the employee and their safety. I work for the largest one in that state and have no problems with it.

Metro-Dade fire/rescue is well known for it's superb service. They have been this way for many years and have it down to a science.

Private services are mostly jokes. There are a few around the country, that have made it work. Acadian is one that does fairly well.

While I am against Fire based EMS, I also know that there are some that do it right. In a perfect world all EMS would be a third service city or county based. I have nothing against a fire/medic, I just think they would be better off with one discipline.


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## 46Young

I can see how there is concern that learning both paramedicine and suppression will hinder one's ability to do either one well. I wrote earlier that there should be an experience prerequisite of 1-3 years or so of medic experience prior to a firemedic appointment. Having experience as a medic will allow one to spend a larger percentage of their efforts studying suppression. 

At Fairfax, we get to go to cont. ed. on duty for quaterly 8 hour sessions. There are EMS drills incorporated into the monthly mandatory training matrix. Medics are not permitted to ride lead until 18 months post academy. New hires do a 16 week ALS ambulance internship with weekly classroom sessions prior to suppression school. 

Experience pre-reqs and dedicated EMS training as above helps with the "spreading oneself too thin" thing. Worth mentioning is that firemedics here are well compensated for the additional requirement of maintaining proficiency in both disciplines.

A question for those knowledgeable about existing PSO programs: are those crosstrained for any combo of EMS/fire/LE compensated for the additional responsibilities? For example, is a FF paid at a higher grade for LE training? Or EMS to LE?


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## EMTinNEPA

46Young said:


> I've heard that Seatlle does TSEMS well. It would be great if others could follow their lead.



Actually, Seattle is one of the few who do Fire-Based EMS properly.  But then again, Seattle is one of the national leaders in EMS, period.  If you look at the video in this thread where the physician responds, Seattle boasts a 45% survival rate for out-of-hospital cardiac arrests that present in v-fib.


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## 46Young

EMTinNEPA said:


> Actually, Seattle is one of the few who do Fire-Based EMS properly.  But then again, Seattle is one of the national leaders in EMS, period.  If you look at the video in this thread where the physician responds, Seattle boasts a 45% survival rate for out-of-hospital cardiac arrests that present in v-fib.



Question about Seattle, just curious: What are their criteria for working/not working an arrest? Do they induce post arrest hypothermia? Do they work asystole as an initial rhythm? In traumas?


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## Ridryder911

EMTinNEPA said:


> Actually, Seattle is one of the few who do Fire-Based EMS properly.  But then again, Seattle is one of the national leaders in EMS, period.  If you look at the video in this thread where the physician responds, Seattle boasts a 45% survival rate for out-of-hospital cardiac arrests that present in v-fib.



I will not debate Seattle has been percieved a leader and yes they have done studies. It those studies and statements that need to be reviewed carefully. 

R/r 911


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## 46Young

Ridryder911 said:


> I will not debate Seattle has been percieved a leader and yes they have done studies. It those studies and statements that need to be reviewed carefully.
> 
> R/r 911



That's what I was getting at. If you have certain exclusion criteria, you can make the numbers do whatever you want.


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## VentMedic

EMTinNEPA said:


> Actually, Seattle is one of the few who do Fire-Based EMS properly. But then again, Seattle is one of the national leaders in EMS, period. If you look at the video in this thread where the physician responds, *Seattle boasts a 45% survival rate for out-of-hospital cardiac arrests that present in v-fib*.


 
There's a key work missing here:  "witnessed".


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## EMTinNEPA

VentMedic said:


> There's a key work missing here:  "witnessed".



Ok, true.  I forgot that.  Thanks for pointing that out.


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## JPINFV

Do the Utstein!


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## CAOX3

VentMedic said:


> There's a key work missing here:  "witnessed".



In that case

We have a 100% survival rates for witnessed  v-fib arrests with bystander CPR, underneath a telephone pole with an AED station, in front of an ambulance with a transport time of 45 seconds to a staffed interventional cath lab on middle age males with a hx of heart disease. 

See we are the bomb too 

Playing with the criteria to achieve the desired effect, there is a new idea.  The fact of the matter is short response times and bystander CPR saves lives and it is the only thing that has been proven to signifigantly increase survival rates.

-posted from my phone


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## JPINFV

^
Well, that is the elephant in the room for a lot of EMS statistics. Namely, if you look at 100 systems self reporting numbers (any number), you will have 100 different criteria. You see the same thing with response times. Does the response start at 911 dispatch, ambulance dispatch, crew dispatch, or enroute? Does it end when the ambulance reaches the scene or at patient contact time? 

You have a bigger issue with cardiac arrest patients since there's the gap between the patient showing obvious signs of death and the proverberal point of no return. If an unwitnessed arrest is found 10 minutes after collapse, it is already too late but the crew will end up working the patient and throwing up another point is the "loss" column even though the crew never had a chance. At least with the Utstein criteria (witnessed v-fib arrests), you now have a standardized criteria that accounts for the "never had a chance" population.


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## CAOX3

Agreed.  

Until we have a universal criteria encompassing everything from response times to discharge and all points in between we will never truley know what is effective.


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## VentMedic

Some more articles of interest:

*Six Minutes to Live or Die*
http://www.usatoday.com/news/nation/ems-main.htm



> Now, Boston saves 40% of cardiac arrest victims, second among the nation's biggest cities after Seattle's 45%


 


> The city {Seattle} has trained ordinary citizens — from taxi drivers to restaurant employees — in CPR, making them members of what is known as Medic Two. Seattle firefighters work as instructors for the program and teach about 18,000 people a year. Since 1971, the city has trained 650,000 people. As a result, Seattle now has one of the highest "bystander CPR" rates in the nation — 44%. That means that nearly half of all cardiac arrest victims get CPR from a co-worker, a loved one or a stranger in the minutes between collapse and when emergency medical crews arrive.


 
*Survival by the Numbers*
http://www.usatoday.com/news/health/2005-03-01-ems-numbers_x.htm


> USA TODAY studied 12 cities that measure their cardiac-arrest survival rates by the international gold standard called the Utstein template. This tool is the best indicator of EMS life-and-death performance because the victim's outcome is determined in the field, not in the hospital.
> 
> The template considers only the most savable of cardiac-arrest victims: those who collapse in front of a witness and need a shock from a defibrillator. It counts as survivors only those who leave the hospital with good brain function.


*Cities Deceptive About EMS Response Times*
http://cms.firehouse.com/content/article/article.jsp?sectionId=46&id=16007


> "Los Angeles is one of many cities that routinely lie to themselves about their true response times to medical emergencies," the article says. "The result is needless deaths."


 
*Cooking the Books? Measuring Cardiac Arrest Survival Rates*

http://www.emsresponder.com/print/F...easuring-Cardiac-Arrest-Survival-Rates/3$2308


> With the Utstein template, only those victims who have a good chance to be saved are counted. Further, the Utstein template counts only those survivors who leave the hospital without serious brain damage.


 
*Cardiac Arrest Resuscitation Evaluation in Los Angeles: CARE-LA*

*http://www.annemergmed.com/article/S0196-0644(04)01740-8/abstract*



> *Of 2,021 consecutive cardiac arrest patients on whom resuscitation was attempted, 1,700 (84%) met entry criteria as a primary cardiac event. Overall, neurologically intact survival was 1.4% (99% confidence interval [CI] 0.8% to 2.4%) Three patients were lost to follow-up. Survival from bystander-witnessed ventricular fibrillation was 6.1% (99% CI 3.3% to 11.0%). Absolute survival differences from witnessed ventricular fibrillation was higher but not statistically different than that from Chicago (−3%; 99% CI −8% to 2%) and New York City (−2%; 99% CI −6% to 3%). The rate of bystander cardiopulmonary resuscitation (CPR) for our population was 28%, for which the overall survival rate was 2.1%. The survival rate for patients with witnessed arrests and bystander CPR was 3.2%. Among patients with no bystander CPR, the survival rate was 1.0%.*


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## GR1N53N

> Survival from bystander-witnessed ventricular fibrillation was 6.1% (99% CI 3.3% to 11.0%).



Excuse my ignorance, but how do you categorize bystander-witnessed v-fib?  Or rather, how does a bystander know it's v-fib, as opposed to another rhythm?

I'd read their methods, but apparently my workplace doesn't subscribe to that particular journal (I work in an institutional cell bio lab, so that's not really much of a surprise).


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## JPINFV

GR1N53N said:


> Excuse my ignorance, but how do you categorize bystander-witnessed v-fib?  Or rather, how does a bystander know it's v-fib, as opposed to another rhythm?
> 
> I'd read their methods, but apparently my workplace doesn't subscribe to that particular journal (I work in an institutional cell bio lab, so that's not really much of a surprise).



They're talking about presenting rhythm. So if paramedics arrive at a witnessed arrest and the patient is in v-fib, it is a witnessed v-fib arrest.

The article itself is a bit of a mess, though. I especially enjoyed California's new EMS level, EMT-Defibrillator. Strange, though, because when I started working in 2005, the levels in California were EMT-I (1), EMT-II (2), and EMT-Paramedic.


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