# Fire-based EMS vs EMTs?



## Putrid Existence (Feb 8, 2011)

So, browsing around these forums, and just the internet in general, there seems to be quarrel between fire-based EMS and regular EMTs. If the fire fighters have EMS covered, then what's the point of having EMTs in the first place? Not trying to start any arguments, I'm just genuinely curious and have a lot of questions about the whole EMS lifestyle/landscape.


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## abckidsmom (Feb 8, 2011)

I recommend you get out of CA and see how EMS can be run.  The redundancy in the systems I've seen and heard about there makes my unit-hour-utilization meter shatter and fall to the floor in a thousand pieces.


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## Putrid Existence (Feb 8, 2011)

abckidsmom said:


> I recommend you get out of CA and see how EMS can be run.  The redundancy in the systems I've seen and heard about there makes my unit-hour-utilization meter shatter and fall to the floor in a thousand pieces.



Can you give an example or two please?


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## usalsfyre (Feb 8, 2011)

Putrid Existence said:


> If the fire fighters have EMS covered, then what's the point of having EMTs in the first place?



Perhaps you should ask the average firefighter what their opinon of EMS is, and their goal for their EMS career. 

Then ask yourself, do I REALLY want to be treated with multiple interventions that may be harmful to my longterm morbidity/mortality by this guy?


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## MrBrown (Feb 8, 2011)

Fire based EMS is worse than the borg man, seriously .... if you want to sick whatever you do, do not do it in Houston or Los Angeles.


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## Bieber (Feb 8, 2011)

Putrid Existence said:


> So, browsing around these forums, and just the internet in general, there seems to be quarrel between fire-based EMS and regular EMTs. If the fire fighters have EMS covered, then what's the point of having EMTs in the first place? Not trying to start any arguments, I'm just genuinely curious and have a lot of questions about the whole EMS lifestyle/landscape.


The point is to have a fully dedicated service whose only purpose is to provide the very best possible EMS service possible.  EMS ought to be advancing, progressive, focused on the medicine, and constantly seeking higher educational standards.  Fire-based EMS, on the other hand, more often than not seems focused on generating revenue for the fire side of things and on lowering educational standards for EMS across the board.

Fire-based EMS makes no more sense to me than hospital-based construction companies; they're two wholly distinct jobs and if you think they're so interchangeable then you might ask why there are such things as fire-based EMS but no hospital-based fire departments.

I get it, the fire departments are working themselves out of a job and they're latching onto EMS in an attempt to survive.  And I feel for them, that sucks.  At the same time, for my profession to be degraded by fire departments who care only about fire service and not about bettering EMS or its educational standards, you can certainly see where some of the animosity comes from.

And until the IAFF takes the stance that fire departments are the best providers of EMS because they advocate raising educational standards and advancing EMS and NOT because "fire departments are strategically placed to provide the quickest response", my answer to fire-based EMS will always be "no, thank you".


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## Aidey (Feb 8, 2011)

MrBrown said:


> Fire based EMS is worse than the borg man, seriously .... if you want to sick whatever you do, do not do it in Houston or Los Angeles.



Or DC. 

Or most of Florida. 

To the OP, the short of it is that most FFs became FFs because they wanted to be FFs. A FDs primary goal is still fighting fires. EMS, despite being 70-80% of most areas call volume is a lower priority. Many FFs were forced to be paramedics and EMTs to keep their jobs. 

Non FF EMS employees became EMTs and paramedics becuase they wanted to be EMTs and Paramedics. They tend to care more about the medicine. There are good and bad people in both settings, but EMS is not the priority in the vast majority of FDs.


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## WTEngel (Feb 8, 2011)

It isnt as simple as all the generalizations being made. I have worked on both sides of the fence. I was lucky enough to have a medical director at the fire department I worked at who genuinely cared about EMS and education, and the FD administration and line personnel supported him. It was a requirement to be a paramedic (as it is in most of North Texas) to even be considered for emloyment.

Let's not generalize. I have known plenty of non fire based EMS personnel who have had attitudes that put some career firefighters to shame. I have also known career firefighters who were resistant to EMS and were going to be that way until they retired. 

The bottom line is take each agency for what it is. Some EMS agencies are better than others in regards to education and professionalism (Austin comes to mind) and some fire department based EMS systems are top notch (quite a few North Texas cities come to mind.) find what you want and where you fit in and go for it!


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## Chimpie (Feb 8, 2011)

WTEngel said:


> The bottom line is take each agency for what it is.



This is exactly right.

I have resisted the urge to post on here because I know of only a handful of agencies and departments.  Here locally, EMS is part of the fire department and I (as a patient) couldn't ask for more professional personnel or for them to have better equipment.  

Now, where I grew up, EMS is a private service and they leave MUCH to be desired.

But I can't say that EMS should be a part of the fire service throughout based on the above.  It wouldn't be right.


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## usalsfyre (Feb 8, 2011)

WTEngel said:


> It isnt as simple as all the generalizations being made. I have worked on both sides of the fence. I was lucky enough to have a medical director at the fire department I worked at who genuinely cared about EMS and education, and the FD administration and line personnel supported him. It was a requirement to be a paramedic (as it is in most of North Texas) to even be considered for emloyment.
> 
> Let's not generalize. I have known plenty of non fire based EMS personnel who have had attitudes that put some career firefighters to shame. I have also known career firefighters who were resistant to EMS and were going to be that way until they retired.
> 
> The bottom line is take each agency for what it is. Some EMS agencies are better than others in regards to education and professionalism (Austin comes to mind) and some fire department based EMS systems are top notch (quite a few North Texas cities come to mind.) find what you want and where you fit in and go for it!



Unfortunately generalizations is pretty well all we can deal in in this area. And GENERALLY, fire based EMS is not going to be as medically oriented as third-service EMS. With privates it's a toss up. 

The very first EMS agency I drew an actual paycheck from was one of the finest I've ever had the pleasure to be involved with. It was also fire-based. The second and third one were both clinically years behind the time and massively resistant to change. They were fire and hospital based respectively. 

The problem I have with fire-based EMS is not the exceptional systems, it's that the mediocre to bad ones seem to be greater in number as well as more entrenched in a culture that is usually behind the times and downright belittling to EMS than many privates/third services I've seen. Partly because they are afforded the luxury of government protection. These are the services that use the "**** box" as punishment for either a. being new or b. pissing the wrong person off. Bottom line if it's easier to fire the medical director than a line employee it's probably a recipe for clinical problems.


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## Veneficus (Feb 8, 2011)

*something to consider*

As objectively as I can, I would like to state that:

The fire service sees EMS as an add on skill.

EMS providers struggle to obtain professional status.

Let us consider the definition:

pro·fes·sion noun \prə-ˈfe-shən\

1: a calling requiring specialized knowledge and often long and intensive academic preparation.

That doesn't sound like an add on skill to me.

There are a handful of people comparitively who engage in multiple professions. Especially very intensive ones like Law and Medicine. None who are great at both. 

You can see where people who do engage in multiple professions will not be able to devote a majority of time to both. Making them less capable in one even if they obtain the minimum. As well, eventually the values or demands of multiple professions will come into conflict. 

When they do, the individual will have to make a choice, which relegates one of them to being secondary. Not something unidiscipline professions find overly acceptable. 

Some people claim to be good at both fire and EMS. I will agree to good, or acceptable, but certainly not great. I have done both fire and EMS, and I can attest that nobody fights fire like dedicated engine and ladder companies. Nobody rescues people better than dedicated rescue companies, nobody does hazmat better than dedicated hazmat companies, and nobody does EMS better than dedicated EMS providers. (even if they are part of the fire department) All of these positions required skills which are perishable. They all require continuing education and improvement. If you are spending all of your time maintaining all of these skills (which is physically impossible), you probably don't have much life outside of work, which is really not healthy or sustainable.

If you notice, many of the very admirable fire departments around the world, have dedicated specialized providers of various fire related disciplines. Just like doctors specialize in medicine because it is too broad of a topic for anyone person to be the master of all. 

In all fairness, a fire department has the potential do EMS as well as anyone else. But there are all kinds of caviats that are often unmet. Dedicated providers, equal administrative power, dedicated to the mission of providing EMS as a service rather than something to generate revenue or preserve jobs, proper training, retraining, and continuing development. Proper bugetary spending, proper prehire selection of individuals commited to the mission, and constantly improving EMS service based on the needs of the public over the wants of the department.

But in a vast majority of fire departments these requirements are not met and have no intention of being.

It is also true that private and 3rd service EMS providers often fall short in these demands as well, but for different reasons. (to the same end though)

Another major problem with the fire service getting into EMS is that the fire service is paramilitary in structure. Higher ranking officers give orders in the form of tasks to lower ranking members. This chain of command structure often relieves personal responsibility and accountability for decisions down the chain as long as they perform the prescribed skill. It actually works extremely well for firefighting, where "freelancing" is a vulgarity, life and mission threatening, and to be avoided at all costs. 

The nature of prehospital medical care actually requires a great deal of independant decision making and action. Anyone who makes a decision is responsible for it. Calling for help in the form of orders from medical control is most efficently used as an exception rather than the rule.

These two different ways of functioning usually attract different types of people. Which is ripe for conflict. Both parties often want the other to be more like them. 

As such, the fire service, mostly in the US, uses their political power to make EMS from initial training to accountability of its staff as "fire like" as possible. Which is basically a repetative task which neither requires nor allows deviation or decision making.

Medically minded EMS providers (which are a minority in the US) understand and embrace that medicine is not always repetative and sometimes requires considerable deviation and always decision making. 

Complicating matters is the fact that as the world evolves, the needs of the people who are paying for service evolve, and most providers of all flags are trying to perfect yesterdays' practices which are no longer relavent in today's world. Which creates even more conflict.

There is no easy way to reconcile the differences.


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## JJR512 (Feb 8, 2011)

> Fire-based EMS vs EMTs?


The very thread title is out of whack.

The thread title makes it seem like fire-based EMS providers aren't EMTs. The fact is, the fire-based personnel who are providing EMS are EMTs or better. Oh, sure, maybe in some areas the fire people are First Responders but they usually aren't the primary EMS caregivers.

If you want a thread title that doesn't show any initial bias, how about "Fire-based EMS vs. privatized EMS".

The IAFF and fire department chiefs can take whatever stance they want. Ultimately, it comes down to the individual provider, and I have seen many high-quality EMTs and Paramedics that come from a fire department background. They do their continuing education, they go to conferences and seminars and workshops, they are advancing themselves to continuously be high-quality EMS providers.


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## Veneficus (Feb 8, 2011)

JJR512 said:


> If you want a thread title that doesn't show any initial bias, how about "Fire-based EMS vs. privatized EMS".




But that is just as biased as it eliminates 3rd service municiple, public safety officer agencies that are police fire and EMS, industrial EMS providers, entertainment EMS providers, event EMS providers, wilderness EMS providers, as well as police/ems agencies. (and I am sure I forgot a few somewhere)

Perhaps the biggest problem in the delivery of US EMS is that there is no one definition of even what it is.


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## JJR512 (Feb 8, 2011)

Veneficus said:


> As objectively as I can, I would like to state that:
> 
> The fire service sees EMS as an add on skill.
> 
> ...



I'm sure you would love the Howard County (Maryland) Department of Fire and Rescue Services. They don't see EMS as an add-on skill. At HCFR, EMS (at the EMT-B level) is something that every firefighter is taught _as part of the academy training_. It isn't an add-on, it's a core component just as much as where to aim the hose or how to crib a crashed car.


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## lampnyter (Feb 8, 2011)

JJR512 said:


> The very thread title is out of whack.
> 
> The thread title makes it seem like fire-based EMS providers aren't EMTs. The fact is, the fire-based personnel who are providing EMS are EMTs or better. Oh, sure, maybe in some areas the fire people are First Responders but they usually aren't the primary EMS caregivers.
> 
> ...



Yes but an EMT is different than an EMT with experience. Just because they have EMT doesnt mean they know what they are doing on the field.


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## JJR512 (Feb 8, 2011)

Veneficus said:


> But that is just as biased as it eliminates 3rd service municiple, public safety officer agencies that are police fire and EMS, industrial EMS providers, entertainment EMS providers, event EMS providers, wilderness EMS providers, as well as police/ems agencies. (and I am sure I forgot a few somewhere)
> 
> Perhaps the biggest problem in the delivery of US EMS is that there is no one definition of even what it is.



I am not familiar with "3rd service municipal, public safety officer agencies that are police fire and EMS", so please excuse me for not including them. As for industrial EMS, entertainment EMS, and everything else you mentioned, I don't think they particularly belong in the discussion because it seems that the OP's intent was to compare first-line emergency response to the public. Industrial EMS doesn't do that, they provide emergency response within the company. Same for entertainment. Wilderness EMS is a separate subject.


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## usalsfyre (Feb 8, 2011)

JJR512 said:


> I'm sure you would love the Howard County (Maryland) Department of Fire and Rescue Services. They don't see EMS as an add-on skill. At HCFR, EMS (at the EMT-B level) is something that every firefighter is taught _as part of the academy training_. It isn't an add-on, it's a core component just as much as where to aim the hose or how to crib a crashed car.



Nice thought, but when EMT-Basic is covered in 3-4 weeks (usually 80% or more of call volume) vs. 16 weeks or more for the fire-based part of the curriculum (20% or less of call volume) do you see where the impression there's a disparity MIGHT come into play? Yes, it's treated as an add on skill, not the core component of the academy.


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## JJR512 (Feb 8, 2011)

lampnyter said:


> Yes but an EMT is different than an EMT with experience. Just because they have EMT doesnt mean they know what they are doing on the field.



Yeah and just because they're also a firefighter doesn't mean they don't have experience and it doesn't mean they don't know what they're doing in the field.

As for what I was ACTUALLY talking about in what you quoted, the level of experience is irrelevant to the thread title. The thread title implies a comparison of fire-based EMS to non-fire-based EMS. To compare something you need to have one variable as the basis for comparison. The variable here is whether the EMS is fire-based or not.

If you want to make experience the basis for comparison then you'd need to start a new thread called, "Experienced EMTs vs. Inexperienced EMTs".


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## Veneficus (Feb 8, 2011)

JJR512 said:


> I'm sure you would love the Howard County (Maryland) Department of Fire and Rescue Services. They don't see EMS as an add-on skill. At HCFR, EMS (at the EMT-B level) is something that every firefighter is taught _as part of the academy training_. It isn't an add-on, it's a core component just as much as where to aim the hose or how to crib a crashed car.



But EMT is a technical skill set, no different from fire suppresion, extrication, various technical rescue specialties etc. When you have to start deciding on treatments based not only on signs and symptoms, but a host of disciplines like anatomy, physiology, pathology, pharmacology, etc, you lose the comfort of simple protocol and the ability is truly measured. If you are learning those disciplines at the depth to make independant decisions, you certainly don't have time for anything else.

As an example suitable for EMS, if you have a patient in septic shock, you might have to chose which therapy, the order, as well as the possibility of withholding treatment based on presentation or comorbidity. Take my word, that is an art, and it cannot performed well by people who are responsible for 10 other things. 

I stand by my statement, any department where the individual providers are expected to perform multiple skill sets rather than a dedicated role, they are simply a jack of all trades and master of none.

When any of those departments can fight fire like a dedicated engine company, ventilate and search like a ladder company, etc in a cities like NYC Chicago, Cleveland, LA, or Miami, then there is something to talk about. Until then, it is simply "acceptable" or "the best you can."


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## JJR512 (Feb 8, 2011)

usalsfyre said:


> Nice thought, but when EMT-Basic is covered in 3-4 weeks (usually 80% or more of call volume) vs. 16 weeks or more for the fire-based part of the curriculum (20% or less of call volume) do you see where the impression there's a disparity MIGHT come into play? Yes, it's treated as an add on skill, not the core component of the academy.



You want to talk about disparities then fine, talk about disparities. I wasn't talking about disparities, I was responding directly to a comment that referred to EMS training as add-on training for the fire service. This may be true in many cases, but as I've just shown, it's not true for Howard County, MD.

It may not be the subject that gets the most time during the academy training but it does get time, an equal time for all, during the academy training. That fact right there proves that at least for this county, it isn't add-on, it's core training. "Add-on" training means, by definition, that after everyone is done the fire training, some people go on to a special class for the EMS component.


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## Veneficus (Feb 8, 2011)

JJR512 said:


> "Add-on" training means, by definition, that after everyone is done the fire training, some people go on to a special class for the EMS component.



I don't think that is a true or factual statement.

As was stated, unless you are spending equal and adequete time. It is an add on. Think about it.

200 hours for professional firefighter training.
120 hours for EMT.
40 hours hazmat ops.

now if it was:
200 hours fire training.
200 hours of EMT.
200 hours of hazmat.

then it is equal.


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## mc400 (Feb 8, 2011)

well I am a FF/PM for a dept that runs Engine and rescue ambulances. My goal for myself cannnot speak for everyone is to be as highly trained as possible. My future goal is either RN or PA that will move me into a future beyond my prpobable 20 year fire career. We love ems around here. It is our bread and butter. we run 40-50 working fires a year with probably 100+ rubbish and vehicle fires to go along with our 6000 other calls. A lot of Fire medics piss me off as well as the private ambo guys we work with when we run into other jurisdictions. There is a problem as a whole not just Fire or EMS. I think a good system is an ALS first response Fire Dept along with an EMS division of non-firefighters on ambos. Yet I love the fact that when on a fire and I am on the rescue it is 2 extra hands to stretch line, S/R or any other fire ground activity where as ems only parks and watches.


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## JJR512 (Feb 8, 2011)

Veneficus said:


> If you are learning those disciplines at the depth to make independant decisions, you certainly don't have time for anything else.


Why not?

The only reason why you wouldn't have time for anything else is if the one thing takes up all of your time. Nothing takes up all of anyone's time. There is time to study fire fighting before they get to the EMS part. Or they can do the EMS part first, but sooner or later, that part is going to be done with, and then there's going to be plenty of time to study fire. Unless the person dies immediately after studying the EMS part.

You can argue that nobody can be an expert in more than one thing and that's fine, but that doesn't mean the person doesn't _have the time_ to study more than one thing. And it is THAT comment that you made, that a person doesn't have time to study more than one thing in-depth, that is WRONG and is what I am directly addressing with this and the preceding paragraph.



> As an example suitable for EMS, if you have a patient in septic shock, you might have to chose which therapy, the order, as well as the possibility of withholding treatment based on presentation or comorbidity. Take my word, that is an art, and it cannot performed well by people who are responsible for 10 other things.


When a FF/EMT or a FF/Paramedic shows up on scene and is functioning as an EMT or Paramedic, he isn't responsible for 10 other things. He is only responsible for providing EMS, patient care. At least this is true in my experience. I'd hate to see a person be responsible for both fighting the fire _and_ providing EMS care at the same time. If that's the way it is in other areas, no wonder you guys are all so upset about it. That's not the way it is here, though.


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## JJR512 (Feb 8, 2011)

Veneficus said:


> I don't think that is a true or factual statement.
> 
> As was stated, unless you are spending equal and adequete time. It is an add on. Think about it.
> 
> ...



You are talking about two very different concepts, equality and whether or not something is an add-on.

If an academy class goes through 200 hours of fire training and 200 hours of hazmat training, then the entire class is graduated and sent out into the field, and six months later one-third of the students are called back to receive 200 hours of EMS training, well that's EQUAL but it's also ADD-ON.

If an academy class goes through X hours of fire training and Y hours of EMS training and Z hours of hazmat training, then all three components are CORE components, even if none of the hours are the same.

Look at it this way. If I go to McDonald's and order a #1 Combo, I get a Big Mac, french fries, and a drink. Those are the CORE components of that value meal. It doesn't matter if the weight of the french fries equals the weight of the Big Mac. It doesn't matter if it takes me the same amount of time to drink the soda as it does to eat the fries. All three of those things are the core components of the value meal. Now, if I also order an apple pie, that pie is an add-on. It isn't part of the meal. Again, it doesn't matter if the apple pie weighs the same as the Big Mac or if it takes me the same amount of time to eat it. It isn't part of the meal, so it's an add-on.


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## Veneficus (Feb 8, 2011)

JJR512 said:


> Nothing takes up all of anyone's time.



I respectfully invite you to a week of my schedule.




JJR512 said:


> And it is THAT comment that you made, that a person doesn't have time to study more than one thing in-depth, that is WRONG and is what I am directly addressing with this and the preceding paragraph.



A week of my schedule + fire school simultaneously?

How about in sequence?

How skillful of a firefighter do you think you would be? 
(I think that firefighting requires considerably more dedication than the minimum to be good at it from having done it.)




JJR512 said:


> When a FF/EMT or a FF/Paramedic shows up on scene and is functioning as an EMT or Paramedic, he isn't responsible for 10 other things. He is only responsible for providing EMS, patient care. At least this is true in my experience. I'd hate to see a person be responsible for both fighting the fire _and_ providing EMS care at the same time. If that's the way it is in other areas, no wonder you guys are all so upset about it. That's not the way it is here, though.




_"I think a good system is an ALS first response Fire Dept along with an EMS division of non-firefighters on ambos. Yet I love the fact that when on a fire and I am on the rescue it is 2 extra hands to stretch line, S/R or any other fire ground activity where as ems only parks and watches."_

I rest my case.


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## JJR512 (Feb 8, 2011)

Veneficus said:


> I respectfully invite you to a week of my schedule.


OK, and at the end of a week of your schedule, what comes after that? Another week! My isn't time lovely? It's like it goes on and on...



> A week of my schedule + fire school simultaneously?


Who said anything about "simultaneously"?



> How about in sequence?


Exactly, now you're on the right track. One might not be able to study two things at the same time, but one can certainly study one thing first, followed by another.

This is the model used by Howard County. The EMS _core_ component has a certain amount of time dedicated to it.



> How skillful of a firefighter do you think you would be?
> (I think that firefighting requires considerably more dedication than the minimum to be good at it from having done it.)


As with anything I might try, how successful I am at something depends not so much on what I may have studied before it or after it, but how much attention and dedication I give to what I'm trying _now_.

There are certainly many other variables. If I dedicated two days to becoming an EMT, naturally I would fail. If I dedicated two weeks to becoming an EMT, I might pass but I doubt I would be as good as I would if I had dedicated two months. But I spend two months in a class with an incompetent instructor vs. two weeks with an extremely competent instructor, I might be better off with the two-week class rather than the two-month class. But if I take that two-month class with the incompetent instructor and really dedicate myself to learning around the instructor's shortcomings, I'll have a lot more time to do my own research and figure things out for myself. And there are many other variables as well. It's very difficult to make blanket statements and I think too many people here are trying to make blanket statements that might be true much of the time, but certainly aren't true all of the time.



> _"I think a good system is an ALS first response Fire Dept along with an EMS division of non-firefighters on ambos. Yet I love the fact that when on a fire and I am on the rescue it is 2 extra hands to stretch line, S/R or any other fire ground activity where as ems only parks and watches."_
> 
> I rest my case.


What you quoted in italics, and you're resting of your case on it, has nothing to do with what you quoted from me immediately prior, so I'm not sure why my quote was left in there.


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## Chimpie (Feb 8, 2011)

I have to agree with JJR512 on several points. I'd quote them individually but I'm on my phone.

I believe we are talking about fire/ems combined vs. EMS being either private, hospital based, a completely separate but gov't dept, or something else.

I've never experienced hospital based EMS but it seems strange to me, the same way private emergency ems does. I'm all for capitalism, but public emergency response should not be conducted by private businesses.

Why make govt EMS a separate entity when fire assists with a majority of EMS calls anyway?

And I hate the argument that firefighters didn't apply to do EMS. Boo hoo.  Times have changed and you have to adapt.  Thanks to better codes and increased safety the number of fires have dropped dramatically.  As mentioned above, EMS calls are now the bread and butter of some if not most fire departments. If a firefighter can't get on board with that then maybe it's time to retire or find a different job.


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## JPINFV (Feb 8, 2011)

Why would fire need to assist ont he majority of EMS calls anyways if the EMS service is properly funded?

The police department often assists the fire department on calls (traffic control, etc). Should the police department and fire department merge?


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## Chimpie (Feb 8, 2011)

JPINFV said:


> Why would fire need to assist ont he majority of EMS calls anyways if the EMS service is properly funded?
> 
> The police department often assists the fire department on calls (traffic control, etc). Should the police department and fire department merge?



Interesting point.  When you say properly funded what do you mean? What would you like to see added?


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## usalsfyre (Feb 8, 2011)

Chimpie said:


> I've never experienced hospital based EMS but it seems strange to me, the same way private emergency ems does. I'm all for capitalism, but public emergency response should not be conducted by private businesses.



It did to me too, when I was on the east coast. Now fire-based EMS seem strange. 



Chimpie said:


> Why make govt EMS a separate entity when fire assists with a majority of EMS calls anyway?



Became in most places they don't. The only place this happens daily is large cities. 



Chimpie said:


> And I hate the argument that firefighters didn't apply to do EMS. Boo hoo.  Times have changed and you have to adapt.  Thanks to better codes and increased safety the number of fires have dropped dramatically.  As mentioned above, EMS calls are now the bread and butter of some if not most fire departments. If a firefighter can't get on board with that then maybe it's time to retire or find a different job.



I would argue that your in the minority in that sentiment. Ask your coworkers, how many of them TRULY want to do EMS and are not looking forward to the day when they can come into work and only worry about putting their stuff on the BRT?


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## Putrid Existence (Feb 8, 2011)

For the record, I didn't know what else to title the thread, as I'm not entirely familiar with the proper terms for each kind of person and their role within EMS. Still learning folks.


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## usalsfyre (Feb 8, 2011)

When someone can give me an argument for fire-based EMS that doesn't involve jobs, the evils of capitalism (ignoring that most FDs are reimbursed for transport), or "we're here already" then you can start to convince me. All of the above are singularly poor reasons for an entity doing EMS.


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## Veneficus (Feb 8, 2011)

Chimpie said:


> I'm all for capitalism, but public emergency response should not be conducted by private businesses.



I agree, but then who is willing to pay for it?



Chimpie said:


> Why make govt EMS a separate entity when fire assists with a majority of EMS calls anyway?



I am not saying it shold be a seperate entity. I am saying that dedicated providers under any "department" are more skillful at what they do than the "jack of all trades" many firefighters are forced to be. As a firefighter I was expected to know a vast amount of largely unrelated topics. Some of them I never performed outside of a once a year drill. I don't think or pretend I was good at them. I also had the opportunity to be a part of a dedicated company, and what skills were performed and depth of knowledge was definately 1st rate, because it is all we did. 

If a fire department wants a dedicated and propely funded and run EMS division, I can get behind that. But I don't see a whole lot of it.

I take issue with providers that really believe they are great at everything they were once trained on but rarely do because it is that kind of hubris that gets people hurt or killed. 



Chimpie said:


> As mentioned above, EMS calls are now the bread and butter of some if not most fire departments. If a firefighter can't get on board with that then maybe it's time to retire or find a different job.



Exactly. But the problem is the old guys who are usually senior officers reliving the glory days and the young guys really look up to them and try to emulate it. 

I don't doubt it is changing, but the pace is not exactly quick.


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## Chimpie (Feb 8, 2011)

usalsfyre said:


> I would argue that your in the minority in that sentiment. Ask your coworkers, how many of them TRULY want to do EMS and are not looking forward to the day when they can come into work and only worry about putting their stuff on the BRT?



And think that right there is a big point in all this. Here locally, where EMS is part of Fire, those working on the ambulance work on the ambulance.  Those that work on the BRT work on the BRT. Unless you're picking up a shift that's there's no surprises. There's no switching vehicles.


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## 22cent (Feb 8, 2011)

Thank you for that insight. I am in the trenches of an agency that is quite hostile to the EMS division, namely the ones who actually care about the job. When there is more interest in fire, the cause of ALS takes the backseat, many of them think we should only provide BLS care and go back to the good old days of straight volunteer. Its like moving backwards but I guess some people like that idea.


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## usalsfyre (Feb 8, 2011)

Chimpie said:


> And think that right there is a big point in all this. Here locally, where EMS is part of Fire, those working on the ambulance work on the ambulance.  Those that work on the BRT work on the BRT. Unless you're picking up a shift that's there's no surprises. There's no switching vehicles.



The question is, do they WANT to be on the ambulance, or are they marking time till they can "promote" to something else?


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## Chimpie (Feb 8, 2011)

usalsfyre said:


> When someone can give me an argument for fire-based EMS that doesn't involve jobs, the evils of capitalism (ignoring that most FDs are reimbursed for transport), or "we're here already" then you can start to convince me. All of the above are singularly poor reasons for an entity doing EMS.



They may be poor reasons to you but they are very valid starting points to me, the tax payer/possible patient.


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## Chimpie (Feb 8, 2011)

Putrid Existence said:


> For the record, I didn't know what else to title the thread, as I'm not entirely familiar with the proper terms for each kind of person and their role within EMS. Still learning folks.



No worries.


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## Chimpie (Feb 8, 2011)

usalsfyre said:


> The question is, do they WANT to be on the ambulance, or are they marking time till they can "promote" to something else?



They want to be there.  Again, why would you apply to a department that you know does both if you didn't wanted to work EMS?

And for those already on a department that's making the merge, adapt and enjoy or find a department that meets your needs and makes you happy.


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## Veneficus (Feb 8, 2011)

Chimpie said:


> And think that right there is a big point in all this. Here locally, where EMS is part of Fire, those working on the ambulance work on the ambulance.  Those that work on the BRT work on the BRT. Unless you're picking up a shift that's there's no surprises. There's no switching vehicles.



That is exactly how it should be.


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## usalsfyre (Feb 8, 2011)

Chimpie said:


> Again, why would you apply to a department that you know does both if you didn't wanted to work EMS?



Seems like a simple question, but I was flabbergasted by the number of responses in the vein of "they were the first FD that hired me" when I was working for fire-based services.


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## Chimpie (Feb 8, 2011)

usalsfyre said:


> Seems like a simple question, but I was flabbergasted by the number of responses in the vein of "they were the first FD that hired me" when I was working for fire-based services.



Haha. Well, I guess it all goes back to the attitude of the individuals. And one can only do so much to help change another's attitude.


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## TransportJockey (Feb 8, 2011)

22cent said:


> Thank you for that insight. I am in the trenches of an agency that is quite hostile to the EMS division, namely the ones who actually care about the job. When there is more interest in fire, the cause of ALS takes the backseat, many of them think we should only provide BLS care and go back to the good old days of straight volunteer. Its like moving backwards but I guess some people like that idea.



I work for a municipal EMS agency and a lot of the people that work there think the same thing. I butt heads with almost every single person I work with that we need to keep educating ourselves and they still have the volunteer mentality of doing the minimum needed.


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## firetender (Feb 8, 2011)

*It's About Focus*

This has always been a tough one. My personal experience was that EMS for Fire was largely an afterthought. As I watched EMS develop in Fire Depts., back in the 1970's, I saw a pattern that had little to do with patient care and lots to do with access to resources (spelled; $).

In those systems, where being trained as EMT became mandatory but usage of the skills not, I'm sorry (for a lot of people!) but there just didn't seem to be a consistent quality of care, primarily exhibited by a marked lack of INTEREST in developing more advanced skills. 

Within many FDs, EMS became a VEHICLE for advancement, not an ASPIRATION on its own. When you are _*required *_to _*do your time*_ in EMS, who's gonna suffer?

To a certain extent, the same could be said of private firms whose primary focus is on profit. EMS then becomes a vehicle to lock in the TRANSPORT business. Vehicles and equipment are supported in a bare-bones matter and the welfare of its practitioners placed on the back-burner, if not flopped off the stove altogether.

My point is wherever the emergency care of the sick and injured becomes secondary to other concerns, you will lose consistency in the level of care. Wherever EMS individuals are mandated to do many things peripheral to expanding their abilities and education in EMS, patient care suffers.

Rather than complain about what is, we should focus on what needs to be: the development of an EMS specialty that is recognized nationwide, (perhaps) standardized), requires continuing education and asks of its practitioners that they be immersed in emergency care. Period.

There should be only one guiding force: improved pre-hospital patient care and appropriate referral.

Yes, it does boil down to the attitude of the individual, but that does not take us off the hook for perpetuating systems that support lackadaisical attitudes amongst those who provide this vital service.

But you know, 40 years down the line the people STILL don't get that we are a vital service, equal, if not more demanding on the life forces of its practitioners as Fire or Police. 

Whose fault is that?


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## BLSBoy (Feb 8, 2011)

I am proud to be both a Firefighter and Paramedic. I thoroughly enjoy both aspects of my job, and learning more only benefits the citizens that I am sworn to serve.


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## 46Young (Feb 8, 2011)

There are plenty of firefighter EMT's/medics that genuinely enjoy EMS. At least at first. They also enjoy the other areas of the fire service. They may like engine work, Hazmat, TROT, truck work, riding the heavy rescue, etc. A few things happen:

First, medics will spend a lot of time on the ambulance. They're supposed to split their time 50/50 between suppression and EMS txp, but you may have a dual hatter officer or driver that bumps them from their engine tour. The opportunities to ride specialty units such as a Hazmat rescue, TROT rescue, or a truck company are severely limited. The ambulance crew can be out of the station for 1 1/2 to 2 hours per call. You run 10 calls, and that's most of your day. You're missing meals, PT, drills and other training, study, and sleep time. The suppression crews may be back in the station 20 mins after the tone by comparison. So, the medic is generally prohibited from enjoying much versatility in the dept, they're out of the station for most of their day, and they're bumped from their engine tour in certain stations. It gets old after a while.

So, quite a few medics eventually drop their ALS cert, so they can go in to different areas of the dept, have more downtime to PT, drill, cook dinner, and sleep some (it is a 24 hour shift, so the opportunity to sleep is to be expected).

Before you say that they shouldn't be medics/EMT's in the first place if they don't want to do it for a career, realize that quite a few in the EMS only field quite after several years due to burnout. If the firemedic is doing EMS txp 90% of the time or more, they'll burn out the same as a career medic often does, and for the same reasons. The fact that they're in a FD is irrelevant in that regard. The negative aspects of the job are the same, except for benefits and a better career ladder. There's nothing wrong with a firemedic wanting to get off of the ambulance half of the time give or take. I feel that it gives you a break from the call volume and monotony, gives you a change of pace, and helps to keep one's interest in EMS for much longer than would be the case otherwise.

Also, if you're doing suppression in NY, LA, Miami, Chicago, etc, of course you're going to excel at it. On the same token, you can be a medic or EMT in NYC, and also excel. To say that being dual role in depts that are slower than these inner city environments is unfair. I feel that the NYC medic will see much more than one that works in a suburban or rural area. It doesn't mean that the rural medic sucks. The FFM may be just adequate but not excellent in firefighting, but so will anyone else in an environment that sees comparitively little fire. To say that the FFM isn't as good at firefighting as a FDNY FF is like comparing apples to oranges.


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## Chimpie (Feb 8, 2011)

firetender said:


> My point is wherever the emergency care of the sick and injured becomes secondary to other concerns, you will lose consistency in the level of care. Wherever EMS individuals are mandated to do many things peripheral to expanding their abilities and education in EMS, patient care suffers.



Are you saying that because their shirt says "Fire Department" patient care suffers?


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## firetender (Feb 8, 2011)

Chimpie said:


> Are you saying that because their shirt says "Fire Department" patient care suffers?



*No*, I said; 

"wherever the emergency care of the sick and injured becomes secondary to  other concerns, you will lose consistency in the level of care."

The operative word is *"Wherever"
* 
I'll leave the rest to your personal interpretation. Perhaps mentioning that the attitude of the Delivery Service -- in whatever form -- will largely shape the attitudes of its practitioners would be useful.


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## Veneficus (Feb 8, 2011)

46Young said:


> The FFM may be just adequate but not excellent in firefighting, but so will anyone else in an environment that sees comparitively little fire. To say that the FFM isn't as good at firefighting as a FDNY FF is like comparing apples to oranges.



That was my point.

That multiple role people who see a little of everything are not as proficient as those that see a lot of one thing.

It seems popular among some members of the fire service as of late to really believe they are super at everything they ever had a few hours of initial training at.

Like I said before, that is a very dangerous attitude to hold or perpetuate.


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## Monkey (Feb 8, 2011)

Back when I got my start, if you wanted to be a firefighter, you went to academy and you were on your way.

Now you MUST be a Paramedic to be a firefighter... so many of the students that come through medic schools aren't doing it for the love of EMS, they're doing it because they HAVE to, to be able to drag hose.  So they're forced to be medics, don't want to be, and spend about a year of their time getting licensed for something they don't want to do but have to, to have be a firefighter.

So does that hinder pt. care?  maybe, cuz they'd rather be doing anything else than repsonding to grandmas sore toe at 3am.

Now, this is strictly coming from the viewpoint of Southern California, other places may be different, obviously.  I'd say many of FireMedics here did it under protest to get on with the FD.


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## Chimpie (Feb 8, 2011)

firetender said:


> *No*, I said;
> 
> "wherever the emergency care of the sick and injured becomes secondary to  other concerns, you will lose consistency in the level of care."
> 
> ...



I'm trying to interpret what your point is.  Are you saying that it is up to the agencies involved? (which I agree with also)



Monkey said:


> Back when I got my start, if you wanted to be a firefighter, you went to academy and you were on your way.
> 
> Now you MUST be a Paramedic to be a firefighter... so many of the students that come through medic schools aren't doing it for the love of EMS, they're doing it because they HAVE to, to be able to drag hose.  So they're forced to be medics, don't want to be, and spend about a year of their time getting licensed for something they don't want to do but have to, to have be a firefighter.
> 
> ...



And I think that's a concern I throw out at the educators and recruiters of today.  Fire departments are not just fire departments any more.  They are taking on the role of EMS, whether it's transporting or just stabilizing.  They (the student/future firefighter) needs to understand this and feel comfortable with their career choice.


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## Monkey (Feb 8, 2011)

Chimpie said:


> I'm trying to interpret what your point is.  Are you saying that it is up to the agencies involved? (which I agree with also)
> 
> 
> 
> And I think that's a concern I throw out at the educators and recruiters of today.  Fire departments are not just fire departments any more.  They are taking on the role of EMS, whether it's transporting or just stabilizing.  They (the student/future firefighter) needs to understand this and feel comfortable with their career choice.



So do you think that the medics schools should weed out those that are more interested in the fire aspect than being medics?


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## Chimpie (Feb 8, 2011)

Monkey said:


> So do you think that the medics schools should weed out those that are more interested in the fire aspect than being medics?



No, I think those interested in responding to fires need to understand that many departments also respond to EMS calls.  If they don't want to respond to EMS calls they need to find a department that does not and never will in order for them to be happy and enjoy their career.


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## Chimpie (Feb 8, 2011)

46Young said:


> There are plenty of firefighter EMT's/medics that genuinely enjoy EMS. At least at first. They also enjoy the other areas of the fire service. They may like engine work, Hazmat, TROT, truck work, riding the heavy rescue, etc. A few things happen:
> 
> First, medics will spend a lot of time on the ambulance. They're supposed to split their time 50/50 between suppression and EMS txp, but you may have a dual hatter officer or driver that bumps them from their engine tour. The opportunities to ride specialty units such as a Hazmat rescue, TROT rescue, or a truck company are severely limited. The ambulance crew can be out of the station for 1 1/2 to 2 hours per call. You run 10 calls, and that's most of your day. You're missing meals, PT, drills and other training, study, and sleep time. The suppression crews may be back in the station 20 mins after the tone by comparison. So, the medic is generally prohibited from enjoying much versatility in the dept, they're out of the station for most of their day, and they're bumped from their engine tour in certain stations. It gets old after a while.
> 
> ...



You make some really interesting points.  Maybe this is how fire and EMS should evolve.


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## Monkey (Feb 8, 2011)

Chimpie said:


> No, I think those interested in responding to fires need to understand that many departments also respond to EMS calls.  If they don't want to respond to EMS calls they need to find a department that does not and never will in order for them to be happy and enjoy their career.



I wholeheartedly agree with you. The thing I see is, so many of these young guys are drawn to the southern california "life" and flock here.  There are so many transplants from other areas as well as the saturation of the ones graduating school here, yet the attitude still prevails.  It's no mystery what is required, but I'd say 2 in 5 don't want to be medics, just fire.  I think a lot of it is an immature prestige thing.


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## Veneficus (Feb 8, 2011)

Monkey said:


> I wholeheartedly agree with you. The thing I see is, so many of these young guys are drawn to the southern california "life" and flock here.  There are so many transplants from other areas as well as the saturation of the ones graduating school here, yet the attitude still prevails.  It's no mystery what is required, but I'd say 2 in 5 don't want to be medics, just fire.  I think a lot of it is an immature prestige thing.



It got worse after 2001 when it was suddeny heroic to be a firefighter again. For many years it was one of those government "labor jobs" that was worthy of a budget cut at every opportunity as we spent time desperately trying to demonstrate our value.

I think that many new people today don't really want to be firefighters. They want to be what they fantasize firefighters are. They want the prestige, but not the work it takes. They want to always be safe but still be considered the ones who laugh in the face of danger. 

In a little over 7 years teaching medic classes, I can name every one of the few students who wasn't taking paramedic class to fill out a fire application. Out of hundreds of students I can count how many actually got a full time fire job either in the area or moving away.

Going to paramedic school to be a firefighter is no different than becomming a biology major to become a doctor. It just gets you the credentials you need in the shortest amount of time. Then armed with these papers, you enter the real rat race. With the same odds of hitting the lottery, pretending like you may find some secret trick to give you an advantage over others where none exists.

There is a lot of money to be made taking advantage of these peoples' fantasy. No school that makes money off of student population is going to do anything to weed out or otherwise dissuade people from playing the game. 

If there is going to be real change in the type of person entering the fire service, it is going to take the "new school" firefighters going to elementary schools and telling kids there what being a firefighter really is. Because once they get to highschool, the dream is already set.


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## 46Young (Feb 8, 2011)

Veneficus said:


> I think that many new people today don't really want to be firefighters. They want to be what they fantasize firefighters are. They want the prestige, but not the work it takes. They want to always be safe but still be considered the ones who laugh in the face of danger.



I see that a lot nowadays. They want the prestige, the hero image, the schedule and benefits, but then refuse to go inside, or make their air bleed out prematurely so that their vibralert is going off before they even make the fire room. There's also quite a few on the job that have no prayer of carrying out a civilian, let alone another FF in a RIT scenario, due to physical weakness.


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## medicRob (Feb 8, 2011)

Veneficus said:


> I think that many new people today don't really want to be firefighters. They want to be what they fantasize firefighters are. They want the prestige, but not the work it takes. They want to always be safe but still be considered the ones who laugh in the face of danger.



The same is true of a lot of individuals who pursue EMS. They have this idea in their head that we are everything they have seen on TV assuming that our days are spent doing crichs, intubating, inserting chest tubes, and shocking asystole to bring a patient back. They usually keep on with this train of thought until they reach their first clinical where they realize that the reason we are going to the Trauma I center today is not for a trauma at all, but rather to take a patient to their dialysis appointment in the same hospital. They see our profession as skill based from the beginning with no true realization of what it is we do or the intricacies [I use that term very  loosely] involved. 

In some ways, I feel that this miseducation over what it is an EMT actually does on a day to day basis is one of the reasons the majority of individuals in EMS over treat patients with the assumption that every one needs high flow 02 and 2 14g IV's regardless. Add this thought process to protocols that were already outdated by 5 years or more on the date of their implementation due to the ever-changing nature of evidence-based treatment modalities coupled with the lack of formal education requirements in the fields of: Biology, Pharmacology, Chemistry, and Mathematics to name a few that are present in so many of these "Parathinktheyare" courses sponsored by the Houston FD (Brown, 2010) offering no regard whatsoever for educating individuals to be anything more than cookbook followers at best with no true understanding of the underlying pathologies associated with various disease processes(be they medical or traumatic in nature), and you end up with medics who blindly follow protocols with no regard for treating patient condition or deviating from the cookbook to treat a patient, even when the best treatment is to sometimes do nothing and transport.


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## 46Young (Feb 8, 2011)

Chimpie said:


> You make some really interesting points.  Maybe this is how fire and EMS should evolve.



That type of plan may only work for the more well funded depts. We've already made our heavy rescues into ALS FR units. The medic can either be on the engine or the rescue, so long as there's one ALS FR vehicle in each station. Our trucks and TL's will be getting ALS equipment as well. This makes sense for our dept, since they recently combined the EMS and fire career ladders. Past the basic FF, we have four techs - EMS, TROT, Apparatus, and Hazmat. Then you can make Master Tech or LT. In the past, you could split at the Lt rank and go strictly EMS. You rejoin suppression at the BC rank and above. Now, all officers are fire certified, and ALS if they have it. So, if I'm going to be riding the seat of a suppression unit one day, I need truck time, and squad time if I want to go TROT or Hazmat. In a lesser funded dept, having specialty pieces unavailable due to EMS calls can leave significant coverage gaps. The wear and tear, especially on a TL, can be costly. We're fortunate to have more than adequate staffing and deployment, with a solid mutual aid agreement, so we can get away with this arrangement w/o any issues.


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## firetender (Feb 8, 2011)

Chimpie said:


> I'm trying to interpret what your point is.  Are you saying that it is up to the agencies involved? (which I agree with also)



To be honest with you, Chimpie, I don't think the agencies will institute change in much the same way that neither hospitals nor schools turned Nursing from advanced ***-wiping to a profession. Their first loyalty is to themselves; they are the results of change, not the change itself.

It's up to enough of us who truly understand the value of the profession to promote OURSELVES, unify and then set standards for those who follow in our footsteps. WE are the ones who must say EMS is EMS and not Fire, Police, or any other hybridized service.

We have to be strong enough to mold the profession into something that is NOT an add-on. I see movement happening through EMS 2.0 and other unifying agents. Consciousness IS growing and we're getting closer, but it's going to take a whole lot more of us to do the work, and the first step is to re-define what we do based on the services we actually provide.

I did mention the attitude of the delivery service attracting medics who are okay with being less-than focused on the M of EMS. But ultimately, it will have to be the medics themselves that just don't want to work at anything that asks less than full-involvement. Medics themselves need to stand up and say, "Sorry, that's NOT how I want to do the work!"


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## Monkey (Feb 8, 2011)

medicRob said:


> ... educating individuals to be anything more than cookbook followers at best with no true understanding of the underlying pathologies associated with various disease processes(be they medical or traumatic in nature), and you end up with medics who blindly follow protocols with no regard for treating patient condition or deviating from the cookbook to treat a patient, even when the best treatment is to sometimes do nothing and transport.



BINGO!!! It's so hard to teach CRITICAL thinking.  Teaching medics is easier when you're working with a good EMT, someone with a bit of a foundation.  There is a lack in most schools to go BEYOND the "Book Learnin" and into actually THINKING.  

Bad EMT's make bad medics, or usually mediocre at best. ALS should always start with BLS and work up, but medics seem to want to start high and work down, which leads to unnecessary steps.

Firemedics in this area are relegated to extra hands, doing delegated work that the medic off the box dictates.  It's no wonder they are annoyed to have to get all that same education to be "helpers" when all they wanted to do was fight fires.


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## JPINFV (Feb 8, 2011)

Chimpie said:


> Interesting point.  When you say properly funded what do you mean? What would you like to see added?



Why is the fire department regularly being sent on medical calls? If the problem is a legitimate "not enough units" (no... saving a minute on scene time isn't doing anything the vast majority of times), then funding needs to be added for more units. If it's man power, than maybe urban departments need to consider going to 3 man crews. I don't see a problem with using the fire department every now and again, just as I think that EMS should be providing medical rehab services on long term fire ground operations (after all, you don't go to a plumber for artery disease, you go to a physician even if both work with pipes). Medicine is EMS's game, and we -have- to own that.


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## JPINFV (Feb 8, 2011)

46Young said:


> If the firemedic is doing EMS txp 90% of the time or more, they'll burn out the same as a career medic often does, and for the same reasons. The fact that they're in a FD is irrelevant in that regard. The negative aspects of the job are the same, except for benefits and a better career ladder. There's nothing wrong with a firemedic wanting to get off of the ambulance half of the time give or take. I feel that it gives you a break from the *call volume* and monotony, gives you a change of pace, and helps to keep one's interest in EMS for much longer than would be the case otherwise.



If an engine or truck company had such a high unit hour utilization as the ambulance, what would the fire department do? Add another truck or engine, correct?

Why aren't they adding more ambulances?


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## abckidsmom (Feb 8, 2011)

JPINFV said:


> If an engine or truck company had such a high unit hour utilization as the ambulance, what would the fire department do? Add another truck or engine, correct?
> 
> Why aren't they adding more ambulances?




bing
bing
bing



Money, pure and simple.  Tradition and money.   IMO, the FD busy-ness just doesn't work in a higher volume EMS scenario.  When the Chief wants to have a meeting at 7 pm with the whole station, and the medic just so happens to be in the house, the medic should be on downtime.

Instead, they're sitting in the Chief's meeting, not resting.  A 24 hour medic unit with UHU higher than .4 needs to be basically resting when not on calls.  Instead, they're drilling, PTing, cleaning, looking busy, etc.


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## JJR512 (Feb 8, 2011)

Veneficus said:


> In a little over 7 years teaching medic classes, I can name every one of the few students who wasn't taking paramedic class to fill out a fire application. Out of hundreds of students I can count how many actually got a full time fire job either in the area or moving away.



Around here, most people that take a paramedic program are taking it so they can fill out a fire department application.

But the real truth of the matter is that many of them are filling out the fire department application so they can become paramedics.

Around here, if you want to function as a paramedic, your main choices are to volunteer, work for a private company, or work for a fire department.

Volunteering is a separate issue. Between private companies and FDs, around here, most people would choose the FD. The FDs are the only agencies that provide emergency services around here. The private companies are inter-facility only, and most people (in my experience) don't become paramedics so they can sit with a vent patient being moved from a community hospital to a large medical center. So most people (again: around here) that want to work as paramedics want to join fire departments. Not because they want to be firefighters, but because it's largely the only way to actually work as a paramedic.

At least in the greater Baltimore/DC metro area, I am aware of only one fire department that hires people to be paramedics only. There may be others but at least as of a few years ago, the Annapolis City FD did this. I never understood why more departments wouldn't hire someone to be EMS-only. Many firefighters don't really like EMS, as has already been noted many times in this thread, so if you get someone that actually wants to work EMS why not hire that person to do just that?


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## JPINFV (Feb 8, 2011)

Problems that I foresee with mixing fire only with EMS only in a fire department.

1. Pay scales? Ok, arguably a working fire call carries more risk than an EMS call, and on that view should pay more. However, there are a magnitude more EMS calls than working fire calls, therefore EMS should get paid more. 

2. Are both EMS and fire side "uniformed" or just the fire side?

3. If EMS is a separate, and for all intents independent, agency within the fire department, is it really the fire department? Should there really be a fire department logo on the side of the ambulance? 

4. If so, is there any credance if a fire suppression employee considers the EMS employees to just be fire fighter imposters because of the names on the side of the vehicle and on the patch?

5. Should EMS side employees be forced due to work place culture to qualify their position when they say that they're employees of the fire department? On a personal note, when I did my masters degree at Tufts, you would never hear me say that I was a student at "Tufts Medical School" for that reason (even though the MS in Biomedical Sciences program is in the medical school). However while I could say that I'm a Tufts grad student, there isn't that second umbrella layer to go to for the EMS providers. 

3/4/5 can just as easily be switched with fire suppression being a separate entity in a municipal EMS agency. 

6. Since, in general, fire suppression jobs have more competition, is giving points for working for the EMS side a "back door?" Is it right?


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## 46Young (Feb 9, 2011)

JPINFV said:


> If an engine or truck company had such a high unit hour utilization as the ambulance, what would the fire department do? Add another truck or engine, correct?
> 
> Why aren't they adding more ambulances?



It would seem that most urban and suburban areas that run single role EMS have high call volume as well. Why don't they run more ambulances? NY and Charleston were both very busy. I rarely saw the station. In my dept, we rarely have an ALS engine company staying with a pt due to lack of resources. They're onscene for five minutes or less before the arrival of the ambulance in most cases, if not running with their own medic unit. We might cover a second due call (the ambulance), but we're certainly not depleted in most cases. Still, we can run 6-10 txp's in 24 hours. Not busy enough for the bean counters to justify adding units, but we're still out of the station for 8-12 hours a day on average, more in busier areas. Each call runs 1 1/2 to 2 hours with our electronic ePCR's.


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## abckidsmom (Feb 9, 2011)

46Young said:


> It would seem that most urban and suburban areas that run single role EMS have high call volume as well. Why don't they run more ambulances? NY and Charleston were both very busy. I rarely saw the station. In my dept, we rarely have an ALS engine company staying with a pt due to lack of resources. They're onscene for five minutes or less before the arrival of the ambulance in most cases, if not running with their own medic unit. We might cover a second due call (the ambulance), but we're certainly not depleted in most cases. Still, we can run 6-10 txp's in 24 hours. Not busy enough for the bean counters to justify adding units, but we're still out of the station for 8-12 hours a day on average, more in busier areas. Each call runs 1 1/2 to 2 hours with our electronic ePCR's.



ePCRs don't make the calls last forever, providers do.  After the learning curve, ePCRs should be just as fast as standard call sheets.  In your area, hours and hours are burned each day at the hospital because that's the culture.  Providers I know who are committed to sleeping at night tech all the calls on the nightside because it's hardly ever necessary to spend more than 30 minutes at the hospital.

Until drop times average under 45 minutes, the bean counters are never going to add medic units into the system.  Why burn tax dollars chatting with ED staff?


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## Seaglass (Feb 9, 2011)

In these conversations, I keep seeing conflicting themes: 1) it really doesn’t take all that much to be a medic; but 2) we’re a real profession, so dual roles don’t work. It doesn’t work both ways. I think that only the first is true at the current moment, because of how our system is designed. You don’t need all that much to follow the cookbook and call medical control, so becoming a passable firemedic isn’t a stretch.  (By passable, I don't mean good or great.) 

I’m not sure whether that’s a good thing. On the one hand, I think EMS really should become a true profession, which means that it becomes a lot harder to be a dual-role provider. On the other, cookbooks are wonderful things when you’re so tired that you might as well be drunk. As long as EMS allows and even expects providers to operate while extremely fatigued, I don’t support giving them more responsibility. 

Not that I think there aren’t dual-role firemedics who excel in both roles, because I’ve seen some. It’s just that it’s rare enough to get a really good firefighter or a really good medic. It’s even rarer to get all of those traits in one package, and have that package be satisfied with a culture that really doesn’t value them. It’s hard to build a system around exceptions. 



			
				Jtpaintball70 said:
			
		

> I butt heads with almost every single person I work with that we need to keep educating ourselves and they still have the volunteer mentality of doing the minimum needed.



I’ve got to take exception to the “volunteer mentality” thing, because there are places where it’s the other way around. 

I’ve seen areas where the career staff will constantly whine and do the bare minimum needed to maintain their EMS certs (because they’re burnt out and/or just want to fight fire), while the volunteers (who often elect to do EMS only) are still enthusiastic about training. 



			
				Veneficus said:
			
		

> If there is going to be real change in the type of person entering the fire service, it is going to take the "new school" firefighters going to elementary schools and telling kids there what being a firefighter really is. Because once they get to highschool, the dream is already set.



Yes, but what teacher will want to book that firefighter to speak? They’re trying to get kids to explore options, not discourage them. 



			
				46Young said:
			
		

> I see that a lot nowadays. They want the prestige, the hero image, the schedule and benefits, but then refuse to go inside, or make their air bleed out prematurely so that their vibralert is going off before they even make the fire room. There's also quite a few on the job that have no prayer of carrying out a civilian, let alone another FF in a RIT scenario, due to physical weakness.



+1, though I’m not convinced that it’s a modern phenomenon. Everyone wants to be a hero, but there’s no way to know whether you have courage until you’re tested. I imagine that rookies have been finding themselves lacking since firefighting began. And I’m sure that other rookies have also been confusing recklessness with courage for just as long. 

The physical weakness does appear to be more of a modern issue, though. Some people get into school that shouldn’t be there. More just get lazy once class ends. It’s frustrating.  



			
				medicRob said:
			
		

> In some ways, I feel that this miseducation over what it is an EMT actually does on a day to day basis is one of the reasons the majority of individuals in EMS over treat patients with the assumption that every one needs high flow 02 and 2 14g IV's regardless.



I agree. There’s just too much ego, and some providers really can’t stand the thought of showing up and doing nothing, even if that’s what will best serve the patient.


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## Veneficus (Feb 9, 2011)

Seaglass said:


> Yes, but what teacher will want to book that firefighter to speak? They’re trying to get kids to explore options, not discourage them.


 
I don't think you have to discourage anyone. 

There is nothing discouraging about a modern firefighter showing up and proudly and enthusiastically explaining what it is like to be a firefighter in 2011, 2012 or whenever. 

Departments usually are very good at deciding who they put out in public to speak to be the face of the organization and profession.

The problem is nobody inviting the firefighter and people going off of yesterday's stories, hearsay from people not involved in the profession, and the perception of what they think they see as untrained observers.

Firefighting is a very rewarding and respectable occupation. But it is even more so when your expectations match reality.

Whether we like it or not, agree or not, the fact remains that in the US, the fire service provides a majority of EMS and to the largest populations. 

Even if many if not most FDs administrate EMS in an inappropriate manner, EMS is not going to be separated from the fire service on a large scale in our lifetime. 

Educating and encouraging people who would like to work in what the fire service is and not what it used to be is a large and easily implemented step in advancing US EMS.


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## TransportJockey (Feb 9, 2011)

Seaglass said:


> I’ve got to take exception to the “volunteer mentality” thing, because there are places where it’s the other way around.
> 
> I’ve seen areas where the career staff will constantly whine and do the bare minimum needed to maintain their EMS certs (because they’re burnt out and/or just want to fight fire), while the volunteers (who often elect to do EMS only) are still enthusiastic about training.
> 
> ...



Keep in mind, in my particular case I'm talking about the EMS only service volunteer mentality. The service I work for has only been paid for about 2 years, and there are only three of us there who have started since they became a professional service. We are pushing for more CE opportunities, more chances to gain education, a chance to prove that we deserve an expanded scope... But the bosses and the senior people are so vehemently against that it's ridiculous.


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## WolfmanHarris (Feb 9, 2011)

abckidsmom said:


> Until drop times average under 45 minutes, the bean counters are never going to add medic units into the system.  Why burn tax dollars chatting with ED staff?



This is what's killing us in Ontario at the moment. Offload delays at hospitals while improving can still run into 2-3 hours regularly and I have had offload as long as 10 hours (though thankfully rare). Recently we've had a really good run with little to no offload delay and the difference in the shift is night and day. I may still run 4-5 calls during the same 12 hour shift, but without the offload problems we're back to base fairly quickly and just as importantly are not spending most of the shift driving around running stand-by coverage for other stations.

Thankfully programs such as the dedicated Offload RN, balancing transports to less busy hospitals (for mid and low acuity patients) and offloading low-acuity patients to the waiting room (we can't refuse transport) have helped. Behind the scenes changes in Pt. flow at the hospital have also made big strides. The regional government I work for has also informed the receiving hospitals that they must have average offload times under 30 minutes by 2014 or they will start clawing back the money they provide annually for capital expenditures.


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## abckidsmom (Feb 9, 2011)

WolfmanHarris said:


> This is what's killing us in Ontario at the moment. Offload delays at hospitals while improving can still run into 2-3 hours regularly and I have had offload as long as 10 hours (though thankfully rare). Recently we've had a really good run with little to no offload delay and the difference in the shift is night and day. I may still run 4-5 calls during the same 12 hour shift, but without the offload problems we're back to base fairly quickly and just as importantly are not spending most of the shift driving around running stand-by coverage for other stations.
> 
> Thankfully programs such as the dedicated Offload RN, balancing transports to less busy hospitals (for mid and low acuity patients) and offloading low-acuity patients to the waiting room (we can't refuse transport) have helped. Behind the scenes changes in Pt. flow at the hospital have also made big strides. The regional government I work for has also informed the receiving hospitals that they must have average offload times under 30 minutes by 2014 or they will start clawing back the money they provide annually for capital expenditures.



This is a real problem, but the delay I'm talking about is just foot-dragging, chatting instead of doing the tasks needed to clear up from the hospital.


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## Seaglass (Feb 9, 2011)

Veneficus said:


> I don't think you have to discourage anyone.
> 
> There is nothing discouraging about a modern firefighter showing up and proudly and enthusiastically explaining what it is like to be a firefighter in 2011, 2012 or whenever.



I agree that having people enter the field with realistic expectations could be helpful. I'm just not sure where these modern firefighters who are enthusiastic about an average day actually are. The ones I'm talking to really just want to run structure fires, and are either bored or annoyed with most of their calls. Could just be my area, of course. 

(Then again, I could see myself doing it someday, if I stay in the field and don't burn out in the meantime. For now, even though I'm rather inexperienced and not even a medic yet, I've been known to informally tell kids that they should think about becoming FF/RNs... but I'm definitely an exception among people I know.)



jtpaintball70 said:


> Keep in mind, in my particular case I'm talking about the EMS only service volunteer mentality. The service I work for has only been paid for about 2 years, and there are only three of us there who have started since they became a professional service. We are pushing for more CE opportunities, more chances to gain education, a chance to prove that we deserve an expanded scope... But the bosses and the senior people are so vehemently against that it's ridiculous.



That's unfortunate. My local vollies are mostly pretty enthusiastic about education and CEs, at least for the EMS-only people. Every service is different, I guess.


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## abckidsmom (Feb 9, 2011)

Seaglass said:


> I agree that having people enter the field with realistic expectations could be helpful. I'm just not sure where these modern firefighters who are enthusiastic about an average day actually are. The ones I'm talking to really just want to run structure fires, and are either bored or annoyed with most of their calls. Could just be my area, of course.
> 
> (Then again, I could see myself doing it someday, if I stay in the field and don't burn out in the meantime. For now, even though I'm rather inexperienced and not even a medic yet, I've been known to informally tell kids that they should think about becoming FF/RNs... but I'm definitely an exception among people I know.)



I find that in all of emergency services, though.  Cops are bored or annoyed with mediating arguments and working minor MVAs, medics are bored or annoyed with boring or annoyign patients.  As if the people owe us our adrenaline rush or something.


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## 46Young (Feb 9, 2011)

abckidsmom said:


> ePCRs don't make the calls last forever, providers do.  After the learning curve, ePCRs should be just as fast as standard call sheets.  In your area, hours and hours are burned each day at the hospital because that's the culture.  Providers I know who are committed to sleeping at night tech all the calls on the nightside because it's hardly ever necessary to spend more than 30 minutes at the hospital.
> 
> Until drop times average under 45 minutes, the bean counters are never going to add medic units into the system.  Why burn tax dollars chatting with ED staff?



Ask someone you know from our dept about the ePCR version 5.1. It's very slow, it freezes constantly, bumps you out to the inbox repeatedly, won't print w/o restarting (3-5 mins per restart), and also won't sync to server w/o restarting. We're strongly encouraged to remain at the hospital to finish and print the report. The quickest ePCR's for BLS can take 35-45 mins. The standard ALS w/o interventions is 45 mins to an hour, if you give drugs and narcs it's around 75-90 mins, and can be even more for a cardiac arrest. This is no lie, the computer moves very slowly, no matter how hard you try to expedite the process. Ask someone from the dept. They'll tell you. It might be a little quicker if you do some of it enroute to the hospital, but I prefer to tend to my pt instead.


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## DesertMedic66 (Feb 9, 2011)

Firefighters have the calls that they would prefer to get. just like in EMS. EMS have there own favorite calls that they want to get. for some they may like medical problems, others may like trama calls, and yet others prefer the transports. Firefighters are the same way. some prefer structure fires, some prefer wildland fires, TC's etc. not all firefighters hate EMS and some dont even like fires. at my station most of the firefighters are perfectly fine and even enjoy getting Medical calls. we have fun while doing it which makes us be enthusiastic about calls. granted some firefighters will start to get burnt out when they are on 72 hours straight with maybe a 10 min nap. but at that point they dislike any call they receive whether it be Medical or fire.


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## WolfmanHarris (Feb 9, 2011)

46Young said:


> Ask someone you know from our dept about the ePCR version 5.1.



I'm not sure if we're talking about the same program by the ePCR by Siren has also killed clearance times at the hospital. Even without offload delay, complicated calls can take forever to chart due to how convoluted and slow the software is. That's without it crashing and freezing during transfer of ECG's and vitals, printing, or for no reason what so ever. Heck it even takes up to 10 minutes for the system to spit out the completed ACR when it's time to print.

I've gotten good with it since it's all I've used since I got out of school and I've been around technology my entire life, but it even takes me about 20-30 minutes to chart the average call. Some of our senior guys can take over an hour or more to complete a chart.


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## 46Young (Feb 9, 2011)

Seaglass said:


> In these conversations, I keep seeing conflicting themes: 1) it really doesn’t take all that much to be a medic; but 2) we’re a real profession, so dual roles don’t work. It doesn’t work both ways. I think that only the first is true at the current moment, because of how our system is designed. You don’t need all that much to follow the cookbook and call medical control, so becoming a passable firemedic isn’t a stretch.  (By passable, I don't mean good or great.)



I see that problem here. The more recent FFM hires are put through a 16 week internship process in addition to fire school, and are drilled hard, and can easily be failed out of a job. The dept has been putting it's interested incumbents in NVCC's medic program. The problem is, once you finish recruit school and your ALS internship, the educational accountability drops off. We have open book protocol tests every year. We have the tests for our alphabet cards that we do every two years. That's it for testing, although we do on duty con. ed. taught by BSN's and PA's. We don't have any med math exams, no general knowledge exams, nothing. You can lose your ALS cert or get fired, but it takes a lot, certainly more than the hospital that I came from. I'm told that if we hold medics too accountable, make them test often to keep their ALS status, they'll voluntarily drop their cert, and we'll get less interested applicants, who instead apply to another dept that's not so strict.


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## 46Young (Feb 9, 2011)

WolfmanHarris said:


> I'm not sure if we're talking about the same program by the ePCR by Siren has also killed clearance times at the hospital. Even without offload delay, complicated calls can take forever to chart due to how convoluted and slow the software is. That's without it crashing and freezing during transfer of ECG's and vitals, printing, or for no reason what so ever. Heck it even takes up to 10 minutes for the system to spit out the completed ACR when it's time to print.
> 
> I've gotten good with it since it's all I've used since I got out of school and I've been around technology my entire life, but it even takes me about 20-30 minutes to chart the average call. Some of our senior guys can take over an hour or more to complete a chart.



It's the Zoll RescueNet Tablet PCR, version 5.1. Your experience sounds similar to mine, for sure. Every time I get toned out I know I'm not seeing the station for 1 1/2 to 2 hours, no matter how fast we work.


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## 46Young (Feb 9, 2011)

JPINFV said:


> Problems that I foresee with mixing fire only with EMS only in a fire department.
> 
> 1. Pay scales? Ok, arguably a working fire call carries more risk than an EMS call, and on that view should pay more. However, there are a magnitude more EMS calls than working fire calls, therefore EMS should get paid more.
> 
> ...



1. The pay scale is should be subject to supply and demand. If a fire position has 800 to 1 odds, and the medic spot is 5 to1, the medic should make more. It was like that in Charleston County SC. Medics made 45k after 6 months, and topped at 68k. FF's made around 22k to start, not sure of the top out. Charleston City was around 33k to start. The only difference is if the medic turnover continues no matter what the pay, then you might as well pay less for them to begin with.

2. Both should be uniformed. FDNY EMS fought for quite some time to get uniformed status and stronger collective bargaining rights.

3. If they're truly independent, they ought to have their own identity. This has been a sore point with FDNY EMS ever since they were absorbed by FDNY in 1996. This becomes a gray area when fire suppression runs medical aids for more than just manpower.

4. The FDNY culture is to hold the attitude that EMS are fire wannabees, and don't deserve to wear their patch. EMS would rather have their own uniforms and identity. They were quite happy before the merger. Most EMS only employers that are within the FD have distinctly different uniforms, and prominently display "EMS" somewhere on their unuiform to distinguish themselves from the FF's. 

5. Just say you're working for the FD as a paramedic.

6. If you're talking about FDNY's EMS backdoor policy, then no. That was created for certain protected classes to have a way to jump the list. If you're a FDNY EMS employee, you take the test, and all you need to do is pass, and then you place above everyone on the open competitive list. That's why it's not right.


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## Chimpie (Feb 9, 2011)

Let's keep the conversation about PCR software to its own thread please.


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## Seaglass (Feb 10, 2011)

abckidsmom said:


> As if the people owe us our adrenaline rush or something.



That's exactly the kind of entitled attitude I see, and it bothers me. 



			
				firefite said:
			
		

> Firefighters have the calls that they would prefer to get. just like in EMS. EMS have there own favorite calls that they want to get. for some they may like medical problems, others may like trama calls, and yet others prefer the transports. Firefighters are the same way. some prefer structure fires, some prefer wildland fires, TC's etc. not all firefighters hate EMS and some dont even like fires. at my station most of the firefighters are perfectly fine and even enjoy getting Medical calls. we have fun while doing it which makes us be enthusiastic about calls. granted some firefighters will start to get burnt out when they are on 72 hours straight with maybe a 10 min nap. but at that point they dislike any call they receive whether it be Medical or fire.



That's fine. Often enough, though, liking the ambulance makes you less of a firefighter in the eyes of your peers. I think that's a problem.


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## Veneficus (Feb 10, 2011)

46Young said:


> 1. The pay scale is should be subject to supply and demand. If a fire position has 800 to 1 odds, and the medic spot is 5 to1, the medic should make more. It was like that in Charleston County SC. Medics made 45k after 6 months, and topped at 68k. FF's made around 22k to start, not sure of the top out. Charleston City was around 33k to start. The only difference is if the medic turnover continues no matter what the pay, then you might as well pay less for them to begin with.



I would like to point ot that it has been established even in nonemergency fields that when working conditions are overly bad, an increase in pay does not correlate to an increase in retention.


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## 46Young (Feb 10, 2011)

Seaglass said:


> That's fine. Often enough, though, liking the ambulance makes you less of a firefighter in the eyes of your peers. I think that's a problem.



JJR512 was trying to say that in his region (my county's nearby), the recruits are taught to value and respect EMS as much as the fire side. The culture nowadays is that fire and EMS are both part of emergency services in general. In my county, from orientation day, to the first day of the academy and beyond, the importance of EMS is stressed. If we don't care for EMS, then we should look elsewhere for employment.

In many regions, you have to be fire based to work in paid 911 EMS. Those who are mainly interested in EMS typically have no problem telling you that. Where we get the resentment is that we get around 20k/yr over the basic FF, and an easy promotion two years out of the academy, for another (almost) 6 grand. I'll tell anyone that they can go out and get their P-card if they want. I did it FT on my own dime while supporting my wife and  infant child at home. Don't tell me any sob stories. Here's your cheese. I explain our increased compensation like this: The paramedic job description is it's own career in many places. The medic needs to do a lot of training and receive a lot of education on the front end. Continuing ed will be done, but it's not that difficult to maintain after the initial cert. A few alphabet cards, 24 hours/year or so of CME's, and occasional review of evidence based medicine. The FF starts off with minimal training, and will slowly add on skills sets (TROT, Hazmat, truck ops, etc) as they move along in their career. These will result in promotions eventually, although there is more competition than there is for the EMS promotion. Our promotion is much easier to get because so few want it. There's much less to learn to progress in the EMS career ladder than ther is for the fire side. Most of the work was done in the front end. 

This is also why it's possible to be dual role. Most of your EMS training is done before you start. Whether you're a FF only, or a FF/EMT(medic), you're learning the fire side at the same pace. You're doing the same drills, studying the same manuals, and promoting on the same timeline as each other. For EMSs, you only need to stay sharp running calls, and maintaining your cert as above.


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## 46Young (Feb 10, 2011)

Veneficus said:


> I would like to point ot that it has been established even in nonemergency fields that when working conditions are overly bad, an increase in pay does not correlate to an increase in retention.



That was kind of what I was trying to say with the last sentence. It just came out weird.


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## JPINFV (Feb 10, 2011)

46Young said:


> The paramedic job description is it's own career in many places. The medic needs to do a lot of training and receive a lot of education on the front end. Continuing ed will be done, *but it's not that difficult to maintain after the initial cert.*
> 
> ...
> 
> *There's much less to learn to progress in the EMS career ladder than ther is for the fire side. Most of the work was done in the front end. *



Emphasis added.

I think that's one of the problems. The initial education is front loaded, but I, personally, feel that if paramedics want the recognition that they yearn from the medical community, then they need to start owning their own care. To me, it isn't enough to just do the 72 hours of CME (NREMT requirement) and for paramedics to just wash their hands of CMEs. I think paramedics need to be up to date on the science, and take an active roll in pushing the edges of EMS treatment, including making sure that current treatments are evidence based. Paramedics should be thinking, asking, and when appropriate, pushing to implement treatments that can be moved from the hospital to prehospital. 

For example, if you aren't doing 12 leads, it shouldn't be enough to say,"Well, the medical director doesn't allow it." You, knowing that it IS the standard of care, should be pushing to implement it. Same with, say, CPAP. Paramedic professionals need to be proactive with protocol changes, not reactive. This mindset, though, takes more time than just 72 hours of CME every 2 years and then wash their hands.


Edit: This, however, breaks from the task-tactics-strategy (fire fighter-officer-chief) division of responsibility in the fire service with the paramedic being responsible for all 3 when providing medical care.


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## Veneficus (Feb 10, 2011)

JPINFV said:


> Emphasis added.
> 
> I think that's one of the problems. The initial education is front loaded, but I, personally, feel that if paramedics want the recognition that they yearn from the medical community, then they need to start owning their own care. To me, it isn't enough to just do the 72 hours of CME (NREMT requirement) and for paramedics to just wash their hands of CMEs. I think paramedics need to be up to date on the science, and take an active roll in pushing the edges of EMS treatment, including making sure that current treatments are evidence based. Paramedics should be thinking, asking, and when appropriate, pushing to implement treatments that can be moved from the hospital to prehospital.
> 
> ...



This creates huge problems when EMS is pushing for unproven treatments like in Naples, FL.

It also doesn't help when they try to remove themselves from medical oversight like in Louisiana.


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## JPINFV (Feb 10, 2011)

Veneficus said:


> This creates huge problems when EMS is pushing for unproven treatments like in Naples, FL.
> 
> It also doesn't help when they try to remove themselves from medical oversight like in Louisiana.



There's a difference between going rogue and working within the medical community. If a paramedic sees something and think, "Why aren't we doing this?" they should take the initiative to research and present it to the medical director for consideration. To me, there's a big difference between working with the medical director and just following what the medical director says blindly.


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## Veneficus (Feb 10, 2011)

JPINFV said:


> There's a difference between going rogue and working within the medical community. If a paramedic sees something and think, "Why aren't we doing this?" they should take the initiative to research and present it to the medical director for consideration. To me, there's a big difference between working with the medical director and just following what the medical director says blindly.



I certainly agree, but in modern US EMS, the medical director is more easily replaced than the medics. The solution is simple. FACEP needs to lobby that in the future only an Emergency Medicine physician with an EMS fellowship should be eligible to become a medical director. (by a certain date) That would make it considerably more difficult to replace a medical director. Sort of a viagra for their impotence.

I know that basically cuts out a lot of people, like me, but for the greater benefit I think it is a reasonable price to pay.  

Most medical directors are basically filling the role for free. I think part of the solution is that EMS agencies will have to realistically pay for medical direction. Which most are absolutely loath to do. 

I also see the need for a specific ratio of doctors to paramedics. Anyone in the fire service or military can tell you a certain ratio of leadership to rank and file is needed. 1 medical director to 100 or 200 or even 500+ EMS providers is basically no oversight at all. 

If I could make it so, I would have a medical director and a multidiscipline physician advisory board in every system. With an asst. medical director (physician of some sort) for every 25 ALS providers. Other ALS providers would no longer be responsible for overseeing their own level. Though I would suggest ALS providers to oversee BLS providers to reduce the number of physicians needed to a reasonable number.

Most likely this would require regionalization of many smaller agencies into a larger one, but I also advocate that is for the better as well.


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## Shishkabob (Feb 10, 2011)

Veneficus said:


> I know that basically cuts out a lot of people, like me, but for the greater benefit I think it is a reasonable price to pay.



Greater benefit for whom?  The ER physician?


Honestly, an ER physician who drastically limits his medics with archaic orders is worse than a more liberal medical director with limited emergency medicine experience but reads the studies and promotes good patient care.


Aggressive ER physician > aggressive non-ER physician > limited, old-view, useless ER physician.


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## Veneficus (Feb 10, 2011)

Linuss said:


> Greater benefit for whom?  The ER physician?
> 
> 
> Honestly, an ER physician who drastically limits his medics with archaic orders is worse than a more liberal medical director with limited emergency medicine experience but reads the studies and promotes good patient care.



That is why the EMS fellowship needs to be part of the requirement. 

No physician is going to give up the pay raise of being an attending/consultant physician for 2 to 3 years more resident level pay learning about EMS if they don't have at least a reasonable interest in the betterment of EMS.


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## DesertMedic66 (Feb 10, 2011)

Seaglass said:


> That's fine. Often enough, though, liking the ambulance makes you less of a firefighter in the eyes of your peers. I think that's a problem.



it all really depends on how integrated the fire department is into the EMS world. in areas where you mostly get fires then it could be a problem. but in areas where EMS calls are most of the calls then everyone is ok with them and even start to like them. in my area roughly 80%-90% are EMS so most firefighters (not all) have grown to like EMS calls. 

in my area the fire department usually arrives on scene before the ambulance. a couple of times we have had to wait 45 minutes to an hour for the ambulance to arrive. so one hour with the Fire based EMS is alot better then one hour without any medical attention. again this is just for my area.


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## jgmedic (Feb 11, 2011)

firefite said:


> it all really depends on how integrated the fire department is into the EMS world. in areas where you mostly get fires then it could be a problem. but in areas where EMS calls are most of the calls then everyone is ok with them and even start to like them. in my area roughly 80%-90% are EMS so most firefighters (not all) have grown to like EMS calls.
> 
> in my area the fire department usually arrives on scene before the ambulance. a couple of times we have had to wait 45 minutes to an hour for the ambulance to arrive. so one hour with the Fire based EMS is alot better then one hour without any medical attention. again this is just for my area.



you volly with CDF, yes? where are you that takes 45 min? Desert Center, Thermal, Blythe, Poppet Flats if your resident ambos are out? maybe Anza if Temecula and Hemet are depleted. Also, where in Cal Fire are those guys all ok with running medical aids, I'll give you that there are crews and maybe even a few stations where EMS is the priority, but most!? I don't think so.


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## DesertMedic66 (Feb 11, 2011)

jgmedic said:


> you volly with CDF, yes? where are you that takes 45 min? Desert Center, Thermal, Blythe, Poppet Flats if your resident ambos are out? maybe Anza if Temecula and Hemet are depleted. Also, where in Cal Fire are those guys all ok with running medical aids, I'll give you that there are crews and maybe even a few stations where EMS is the priority, but most!? I don't think so.



I was an explorer for 5 years now getting into volly. beaumont. on one of the occasions it was the first rain of the season and there were alot of TC's. beaumont doesnt have very good roads so they get flooded easliy. we had a hemet ambulance take back roads around the flooding to get to us. and i never said that EMS is the priority. i just said that EMS accounts for 80 to 90 percent of our call volume. and once again it all depends on the person.


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## threesevenkilo (Feb 11, 2011)

Putrid Existence said:


> If the fire fighters have EMS covered, then what's the point of having EMTs in the first place?



The town I used to dispatch for was a small hill town and about 70% of the FD were EMT-B or P. They had a policy that only the EMT's were allowed to respond to medical general recalls but the other 30% had still had to be first responder certified.

On the other hand, the city I work in is a nightmare. We had a guy fall about 12 feet from staging onto his head. He was complaining of back pain and you could see abrasions on the back of his head. Two off duty firefighters (who work in the city) come over and take the guy from a supine position and have him roll himself onto his stomach for a "position of comfort."

Take each agency on it's own merit is the best thing that can be said over and over.


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## JJR512 (Feb 11, 2011)

I've been away for a few days due to illness and have just checked up to see how this is going, and I apologize if I didn't read every single new post absolutely thoroughly. Someone was talking quite a few posts back about going to an elementary school to talk about what being a firefighter is truly like.

I am not a firefighter; I actually started Firefighter I training two nights ago. But I've thought about what I might do at some point in the future if I ever had the opportunity to go to an elementary school, like for a career day when kids bring their parents in and they talk to the class about what they do. So again, keep in mind that I'm not a firefighter now but this is sort of a hypothetical plan of what I would do after I become one.

Obviously, I would take in the turnout gear and show the kids how quickly I can put it on, including SCBA. That's expected, that's what they want to see, so they get that first. But after that, I talk a bit about how modern fire departments are really more about rescue and EMS than actual firefighting. I show them an EMS bag and all the stuff in it, I might put the pulse ox on one of the kids. Maybe I'd even bring in a monitor and let some kids see their own heartbeat. As an EMT-B I can't use a monitor but they don't know that, and I am expected to know how to set up a three-lead so I wouldn't be doing anything with it I'm not supposed to. I would tell them that this is something that Paramedics use and what they use it for, etc.

So I don't know; I haven't planned it out in great detail, I know I'd have a limited amount of time. But I've thought about this since long before this thread came up, and I know that if I was in that position, although I'd be going there ostensibly as a firefighter, I'd probably talk more about EMS and rescue than firefighting.


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## emt seeking first job (Feb 11, 2011)

What about instances where a patient has to be worked in an unstable environment ?

Fire also involves rescue and extraction. 

Having a medic trained to enter a buring building and treat the patient inside can not be a bad things.


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## Veneficus (Feb 11, 2011)

emt seeking first job said:


> What about instances where a patient has to be worked in an unstable environment ?
> 
> Fire also involves rescue and extraction.
> 
> Having a medic trained to enter a buring building and treat the patient inside can not be a bad things.



You cannot succesfully treat a patient in a burning building. I've tried.

There are very few rescue specific occurances where the treatments available to EMS actually help.


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## Shishkabob (Feb 11, 2011)

emt seeking first job said:


> What about instances where a patient has to be worked in an unstable environment ?
> 
> Fire also involves rescue and extraction.
> 
> Having a medic trained to enter a buring building and treat the patient inside can not be a bad things.




Who says EMS can't do rescue/extrication?  I know those that do.  


If you're in a rural place like mine where you rely on only volunteer fire departments for rescue/extrication, and they are only at the EMT level (if that), your butt is still in those locations taking care of the patient if need be.


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## JPINFV (Feb 11, 2011)

emt seeking first job said:


> Having a medic trained to enter a buring building and treat the patient inside can not be a bad things.




Wouldn't the first thing to be done is remove the victim from a location that presents an imminent threat to life? You don't need any special EMS training to do that.


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## emt seeking first job (Feb 11, 2011)

Is there any benefit, especially if momentarily 'stuck', to performing interventions in the thick of things.

I sort of have a gut feeling that fire/EMS/and even law enforcement  are not so drastically different, and since people in one field have worked in the other, that the two disciplines could be blended or at least overlapped. 

Is someone in fire refuses to do EMS, I am sure there are dozens of people waiting in the wings willing to be cross trained and cross assigned.


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## Shishkabob (Feb 11, 2011)

emt seeking first job said:


> Is there any benefit, especially if momentarily 'stuck', to performing interventions in the thick of things.



Respiratory arrest with palpable pulses entrapped in a rolled car.


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## Veneficus (Feb 11, 2011)

Linuss said:


> Respiratory arrest with palpable pulses entrapped in a rolled car.



In theory, yes. In most cases it will make little difference past the ED.

I have intubated and decompressed people prior to extrication on several occasions, none have survived. 

I have run fluid (as well as pressors as acts of desperation) on many more.

All that has ever happened is the patient is stable enough to survive without it anyway, it complicates and prolongs the extrication, or they die.

Perhaps if you have an isolated tension pneumo(almost impossible in an MVA roll over that is all there is)it might help. 

In a handful of crush scenarios, high angle rescue, or confined space entrapments there is some benefit, but those are comparitively infrequent.


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## Shishkabob (Feb 11, 2011)

Hey, he didn't ask if there was any long term benefit, just benefit


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