# What a bunch of crap!!



## karaya (Dec 7, 2009)

Firefighters will no longer respond to calls whereby the patient is experiencing flu like symptoms. Here's the story:

http://www.jems.com/news_and_articl...il_concerned_over_no_response_flu_policy.html


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## boingo (Dec 7, 2009)

Last I checked CO poisoning sx's can closely resemble flu-like sx's....tis the season...Venting roofs w/o scba, overhaul w/o scba, responding to calls in flip flops and shorts are o.k. though.


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## Lifeguards For Life (Dec 7, 2009)

karaya said:


> Firefighters will no longer respond to calls whereby the patient is experiencing flu like symptoms. Here's the story:
> 
> http://www.jems.com/news_and_articl...il_concerned_over_no_response_flu_policy.html



that's not gonna last..... i hope


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## zmedic (Dec 7, 2009)

If you read the article you'll notice it's just FD that's not going, EMS still is. I only need FD for arrests, extracation, and if we have to carry a 400lb patient. Two of those things EMD should be able to sort out. The last I can call once on scene. 

Oh, and if my patient is on fire. Why else would they send 5 guys in turnout gear who are driving a $500,000 truck that gets 5 miles/gallon. (Don't get me started)

You know, we're probably going to get to a place where we just can't send EMS to every call. I know there is litigation issues, but we need to be able to say "you are telling me that you've had toe pain for 6 months and nothing really changed tonight and you know how to get a cab, no we're not sending an ambulance." 

Sure ideally we'd be able to go to every call, and in normal situations it's possible. But systems need to be able to say "there is a epidemic, we are getting 5,000 calls a day for flu, and we aren't going to be able to respond to heart attacks and strokes if every ambulance is on a flu call." Basically it turns into a triage situation.


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## JPINFV (Dec 7, 2009)

Meh. If the fire department is just going to sit around with their thumbs up their butts anyways while the medical professionals do their job, I don't see the concern. The only difference is that the fire department has to stop padding their response figures by not responding to patients that aren't on fire.


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## nicolel3440 (Dec 7, 2009)

What about the volly departments that have no emt training any how.  What is the point of them responding to a flu call and puting themselves in danger of getting sick and then not being able to help someone when they are really needed.


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## JPINFV (Dec 7, 2009)

If it's a department with no EMS training/education, why are they responding to pure medical calls anyways on a first response basis?


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## nicolel3440 (Dec 7, 2009)

There not and i should have thought of that before i posted but i still dont see the point in putting any fire fighter out there for a flu call. But that is just my point of veiw


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## BLSBoy (Dec 7, 2009)

I only need an Engine or Ladder Co. for ALS level calls, life assist or when their tools and knowledge are needed. 
This is not total crap, this is the start of using resources when needed.
While I disagree how some say it, there is little to no use for Fire on many scenes.


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## JPINFV (Dec 7, 2009)

Why would you need an engine or ladder company for paramedic level calls? Are your paramedic level calls routinely on fire?


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## BLSBoy (Dec 7, 2009)

They get there before we do, and by following AHA guidelines, early access to CPR/AED, its nice to have an extra set of hands or 4.


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## JPINFV (Dec 7, 2009)

Wow. Paramedics in NJ only respond to cardiac arrest calls?


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## BLSBoy (Dec 7, 2009)

*sighs*
Have you any clue as to how NJ MICU's are dispatched?
Have you any clue as to the areas I work in?

Often times the FD is needed for forceable entry, they get there before we do and start O2, gathering meds and calming/moving family members,  and if an arrest, starting CPR and AED before we arrive. 

Not to mention if its an area where the MICU is far out from, they assist with pt care, lifting, moving, etc. 

Minimum on an ALS level call is 2 EMTs, 2 MICPs, 3 bags, a monitor and a cot. 

Having extra hands on scene is VERY helpful to move, lift, carry, start care, scribe, etc. 
I get it though, you don't like firemen. You have already made it clear. We get it.


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## JPINFV (Dec 7, 2009)

No, I don't know how MICUs respond, but when your only major example is CPR and AED, I have to guess that that's the main call that they are being dispatched to.


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## BLSBoy (Dec 7, 2009)

JPINFV said:


> No, I don't know how MICUs respond, but when your only major example is CPR and AED, I have to guess that that's the main call that they are being dispatched to.



Life threatening calls only. 
Chest pain
AMS
SOB
Cardiac arrest
Major trauma
Diabetic emergencies
Seizures
as requested per EMS, FD or PD.


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## 46Young (Dec 7, 2009)

BLSBoy said:


> *sighs*
> Have you any clue as to how NJ MICU's are dispatched?
> Have you any clue as to the areas I work in?
> 
> ...



Many hands make light work. Also quick work, for the pt's benefit. When I worked EMS in NYC it was often only my partner and myself. Thank goodness my partners could lift. Now, we have 5-6 onscene for many calls. If it's BS and we don't need the manpower, we'll put suppression in service. Otherwise, things get done in a more efficient manner, and I'm doing only a small fraction of the lifting I was doing previously, which greatly reduces my chance of injury. Win-win for all involved. Also, I know for a fact that my FF brothers and sisters can lift.


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## 46Young (Dec 8, 2009)

"Firefighters, however, are near the bottom of the priority list for H1N1 vaccinations and Pitta stressed that somebody will respond to the medical call, it just may not be as many people as would normally respond."

There you have it. Single role EMS have access to the vaccine, the FF's do not. If you give access to the vaccine to all, then all should be obligated to provide pt care. This is not the case, and requiring the FF's to respond unprotected when others are may accelerate the spread of the disease throughout the community.

Where I work, before we had an available vaccine, only the txp crew would engage in pt care, unless extra help was absolutelty necessary, then the minimum amount needed would jump in. This limits the potential exposures, thus limiting the potential for the virus to spread locally. A prudent policy. We only vaccinated our ALS personnel here due to availability issues. If we have a suspected AFRI, only ALS personnel will engage in pt contact.


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## Dominion (Dec 8, 2009)

This is how I prefer it.  Our FD's respond on the following by default:

MVA
Full Arrest
Known Bariatrics
Fires with EMS response

We can request FD only for lift assistance or if we need a driver (in which they will send us one guy in a FD Fly car)

Don't get me wrong, the Fire guys are a GREAT bunch of people, all of them are truly awesome.  However I'd rather they not respond on any of my medical calls, the only exception is engines that have basics and jump kits when we have no trucks available in county or one truck on their way back.  In those cases we sometimes will get a fire response on med calls.


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## RyanMidd (Dec 8, 2009)

Police and EMS still respond.

What's the big deal? If forced entry is required, you kick near the doorknob or break an insignificant window. Problem solved.

These are people with flu-like symptoms, not people who require a third-storey evacuation.


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## 46Young (Dec 8, 2009)

JPINFV said:


> No, I don't know how MICUs respond, but when your only major example is CPR and AED, I have to guess that that's the main call that they are being dispatched to.



Come now, we know that what's dispatched and what's discovered onscene can be quite different. Pts other than cardiac arrests can benefit from timely ALS care, as well, considering that a txp unit may be greatly extended.


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## JPINFV (Dec 8, 2009)

If paramedic ambulance response times aren't up to snuff, then that's an indication for more paramedic ambulances, not putting paramedics on fire engines. Similarly, while I do understand that not all calls are coded dispatched appropriately for a variety of reasons (not enough information, information not provided, caller misinterpeting what's going on, so on and so forth), designing an emergency medical system around cardiac arrests is just stupid. 

Engine responses instead of more ambulances is like saying that fire departments could do with a slower response time to structure fires if we throw some hoses and a hydrant wrench on an ambulance or police car. After all, what's the worry as long as someone's putting water on a fire?


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## 46Young (Dec 8, 2009)

JPINFV said:


> If paramedic ambulance response times aren't up to snuff, then that's an indication for more paramedic ambulances, not putting paramedics on fire engines. Similarly, while I do understand that not all calls are coded dispatched appropriately for a variety of reasons (not enough information, information not provided, caller misinterpeting what's going on, so on and so forth), designing an emergency medical system around cardiac arrests is just stupid.
> 
> Engine responses instead of more ambulances is like saying that fire departments could do with a slower response time to structure fires if we throw some hoses and a hydrant wrench on an ambulance or police car. After all, what's the worry as long as someone's putting water on a fire?



Actually, since we're all crosstrained to both suppression and EMS, we can and do help on a structure fire. 

Two EMS units get dispatched initially to a fire, one for pts and one for rehab. If there are no pts initially, one person will load up the cot, and the other will help the engine driver hook up, or help the truck driver throw ladders. Seconds count in these situations. 

If, on the rare occasion that only one suppression unit is onscene, and there's need for a search or a VES, the medic crew can get dressed and function as the outside crew (initial RIT) for a few minutes to satisfy the "two in/two out" requirement until help arrives.

Having everyone crosstrained definitely has it's advantages.


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## JPINFV (Dec 8, 2009)

So you would have no problem if the fire department had trouble meeting response times for structure fires, that they would add ambulances with hoses on it instead of new engines? This isn't about cross training (which is, in the end, it's own issue. You don't see psychiatrists doing heart surgery). It's about offering the proper resources instead of a band aid.


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## 46Young (Dec 8, 2009)

JPINFV said:


> So you would have no problem if the fire department had trouble meeting response times for structure fires, that they would add ambulances with hoses on it instead of new engines? This isn't about cross training (which is, in the end, it's own issue. You don't see psychiatrists doing heart surgery). It's about offering the proper resources instead of a band aid.



There's currently no way to fit a water tank, pump panel or hoses on ambulances. Nor are they needed. 70% or so of call volume is EMS. As such, EMS units ought to be dedicated to EMS only roles, where suppression units can assist given relative downtime. On the flipside, our engines can respond to ALS calls without risking a lack of suppression coverage. Good depts plan effectively for these situations.

It's already been established that dual role personnel can function well on both sides. Crosstraining isn't an issue at all for good depts that train their members properly. Crosstraining psychiatrists to do heart surgery is an unfair analogy, as the time and resources necessary to train dual role fire/EMS is but a small fraction of what would be needed for your failed analogy. Many on the forum agree that an assosciate's would be adequate for a 911 field medic. Add a suppression academy of approx 20 weeks or so. You're only at three years. For sake of argument, add two years for a fire science degree, which is redundant, in part, for someone who has completed a professional academy. So maybe you're at five years of prep, tops. How many years of pre med, med school, residency and fellowship do you need for your specialty? What about that of a psychiatrist? How much total between the two?


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## JPINFV (Dec 8, 2009)

46Young said:


> How many years of pre med, med school, residency and fellowship do you need for your specialty? What about that of a psychiatrist? How much total between the two?



Psychiatry is a medical specialty and as such psychiatrists go through the same medical school as other physicians. Psychologists, on the other hand, are not physicians. The total amount of post graduate training (residency) for emergency physicians (since you said "my specialty" and EM is what I'm currently working towards) is 3-4 years depending on the program. Psychiatry is a 4 year residency. So you're looking around 7 years to do more. Probably 6 since the off service rotations are going to be the same in many cases.  

Now, sure, you're engines can respond, but what exactly are you going to do if you have a time sensitive emergency requiring, say, surgery? Your engine is now useless because it can't provide the ultimate hospital treatment for the patient, transport. Any EMS system that is substituting fire engines for ambulances are doing their citizens a grave disservice.


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## Seaglass (Dec 8, 2009)

JPINFV said:


> Psychologists, on the other hand, are not physicians.



Yep--they're PhDs. Or PsyDs, who receive less scientific and more counseling training, but still carry doctorates. Both generally take about 5-7 years to get the degree, with PsyDs taking about a year or so less than PhDs and not passing the licensing exams as often. In a lot of states, you also need a year or two under supervision before being independently licensed. So it's 6-9 years from entering the graduate program to practice. 

The line's been getting rather blurry, though. Psychologists now have prescription privileges in some areas, and you run across the occasional psychiatrist (usually an older one... psychiatry programs have cut a lot of counseling training, and keep cutting more) who does mainly talk therapy. The current model, pushed mostly by insurance companies, is that psychiatrists do med management and psychologists do everything else, even for the same patient. Who knows how long that'll last, though. 

To make things interesting, you also run into occasional neurologists who wind up in more of a psychiatric role. A lot of neurological disorders are comorbid with or cause psych problems, so it's a logical progression, but it's sometimes pretty hard to figure out where a particular doctor started. 

It can also be confusing, but PhDs in anything but clinical or counseling psychology (social psych, industrial/organizational, etc.) are also called psychologists. They're researchers, not practitioners, though, at least in the clinical/medical sense. You do find physiological psych/neuroscience types in research medicine pretty often, though.


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## Pudge40 (Dec 9, 2009)

nicolel3440 said:


> What about the volly departments that have no emt training any how.  What is the point of them responding to a flu call and puting themselves in danger of getting sick and then not being able to help someone when they are really needed.



Umm I run with a volly company I am an EMT. PA has a Quick Response Program for fire companies. This means that if dispatched for a QRS or Medical Assist your truck will NOT leave with out at least one EMT. Don't use blanket statements please.


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## Lifeguards For Life (Dec 9, 2009)

46Young said:


> There's currently no way to fit a water tank, pump panel or hoses on ambulances. Nor are they needed. 70% or so of call volume is EMS. As such, EMS units ought to be dedicated to EMS only roles, where suppression units can assist given relative downtime. On the flipside, our engines can respond to ALS calls without risking a lack of suppression coverage. Good depts plan effectively for these situations.
> 
> It's already been established that dual role personnel can function well on both sides. Crosstraining isn't an issue at all for good depts that train their members properly. Crosstraining psychiatrists to do heart surgery is an unfair analogy, as the time and resources necessary to train dual role fire/EMS is but a small fraction of what would be needed for your failed analogy. Many on the forum agree that an assosciate's would be adequate for a 911 field medic. Add a suppression academy of approx 20 weeks or so. You're only at three years. For sake of argument, add two years for a fire science degree, which is redundant, in part, for someone who has completed a professional academy. So maybe you're at five years of prep, tops. How many years of pre med, med school, residency and fellowship do you need for your specialty? What about that of a psychiatrist? How much total between the two?



our rescues for the county have 200 gallons of water and hose in them


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## Tincanfireman (Dec 9, 2009)

RyanMidd said:


> If forced entry is required, you kick near the doorknob or break an insignificant window. Problem solved.
> 
> These are people with flu-like symptoms, not people who require a third-storey evacuation.


 
In many urban environs, those doorknobs and insignificant windows are also equipped with bars and multiple high-security locks.  Just my .02...


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## Scout (Dec 9, 2009)

Pudge40 said:


> Don't use blanket statements please.



http://www.monkeyboobies.com/gallery/d/799-1/FacePalm.jpg

Conditional as in those who do not have...


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## WolfmanHarris (Dec 9, 2009)

Funniest co-response I've seen lately was a syncope w/palpitations that had FD tiered (as they are in that town on CP's, SOB's, VSA's and the like; for better or worse).

Arrived and met by an FF in front of the building and ask for report. He says "Ummm... there's a Paramedic on scene already you'll have to ask him." Turns out one of our guys who was involved in the H1N1 vaccinations in that community centre was brought over by a bystander. FD still seemed surprised when I cleared them before I'd even made pt. contact, as if their standing watching was necessary.

I love having FF's on scene for arrests and messy calls, but some of the tiered response arrangements we have are ridiculous. Especially when EMS response times in my region are not only dropping, but manage to beat fire most of the time. And getting better as we co-locate more Paramedic stations attached to Fire Halls in new construction areas.


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## Jeffrey_169 (Jan 12, 2010)

I am a little Leary about posting on this issue due the unpopularity of some of my personal views, but hey I'll bite. 

We know as clinicians we are going to be exposed to potentially infectious diseases; it goes with territory.  Don your PPE and go about it. Wash your hands good, and often. 

We do in fact have a duty, as the public is trusting us to be there for them. It is a sad day when someone in America dials 9-1-1 and we refuse to respond. A sad day.


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