# What is your Policy regarding an Ambulance being sent to Fire scenes?



## Fish (Sep 29, 2011)

The Agency I work for sends a Medic unit to every fire, we provide rehab for the cities Fire Departments within our County and anyone who may or may not have been injured. 9/10 if we do end up having patient it is a Fire Figher who fell out, and boy are they glad we were there to help them out. We would then call in another ambulance for transport and treat the patient until they arrive, they would transport and we would stay commited to Fire Scene.

Read story below.

http://www.emsworld.com/article/article.jsp?id=18417&siteSection=1

After reading this story I will say this, Denver is a lot busier than us and I have never been to a fire scene where someone was actually trapped in the house, many times there are reports of someone being trapped but those reports have always been false.

That being said, we go to every Fire Scene and do work.  No we are Not Fire Fighters, we are County Based Single Role Medics. What is your Policy?


----------



## abckidsmom (Sep 29, 2011)

In our system, we have dual-role medic units supplemented by volunteer EMS-only units.  The dual-role medic unit is needed for the fire staffing on the initial response.  In this situation, the medic crew would have tended to the patients and the fire operations would have been defensive only in our system.  A medic unit is dispatched on every structure fire to fill the role of medic, but they can be coming from up to 25 minutes away given the rural environment.

This incident in Denver is really unfortunate.  I remember from my time in EMS dispatch for a third service, single-role agency that we all shuddered when a working fire came in, cause we knew we were going to lose a unit for quite a while, but they were there to take care of what needed caring for, especially to be ready for any problems fire encountered.  We back each other up.

Sounds like in addition to this poor dispatching that they had, this particular incident came in when they were at a low ebb anyway.  These things tend to happen sometimes.  I hate when a big incident comes in when we are NUA.  Our system was NUA when we had our earthquake last month.  It was a nightmare for several hours, catching up.


----------



## Shishkabob (Sep 29, 2011)

We're in a paid EMS, volly fire county.  If we hear a fire go out, a crew might decide to mosey on out to look and standby, but a unit isn't sent unless there are confirmed injuries.


Once it becomes a 3 alarm fire, an ambulance gets dedicated to the fire scene until cleared.




The thing I don't like about that story is this:  Even if there were an ambulance on scene, the fact that there were 3 patients means it still would have taken just as long to transport all of them.  The first transporting unit on scene establishes command.  This is an obvious MCI, and as such, you can't just grab one and go, you need other trucks to come and grab them first.


----------



## Anjel (Sep 29, 2011)

We send a unit or two for fire standby. 

Especially in our main city. It looks good that we are there, and in case they do need us, we are there to help immediately.


----------



## exodus (Sep 29, 2011)

Linuss said:


> We're in a paid EMS, volly fire county.  If we hear a fire go out, a crew might decide to mosey on out to look and standby, but a unit isn't sent unless there are confirmed injuries.
> 
> 
> Once it becomes a 3 alarm fire, an ambulance gets dedicated to the fire scene until cleared.
> ...



The box wouldn't of had to stay? The supervisor( Who's a medic) could stay while the other 2 were transported, and then only one would have had to wait.


----------



## epipusher (Sep 29, 2011)

When it is a confirmed working fire, or if initial call comes out as possible entrapment.


----------



## LucidResq (Sep 29, 2011)

Automatically send one rig to every reported structure fire. Fire will often send them available once they get on scene. We are near Denver, large city, with firefighter medics and private ALS EMS. 

This is unfortunate. Denver has a very odd system in my opinion and from what I know. Their PD, EMS and Fire are all very independent. I think sometimes that bites them in the butt.


----------



## VCEMT (Sep 29, 2011)

When requested.


----------



## Fish (Sep 29, 2011)

We also have an Ambulance standby at staging for SWAT missions, to support the SWAT Medics participating in the Mission.


----------



## fortsmithman (Sep 30, 2011)

Only when the FD requests us.


----------



## AmeriMedic21 (Sep 30, 2011)

We get dispatched every time for structure fires. And as needed for grass fires.


----------



## cpsauthority (Sep 30, 2011)

AmeriMedic21 said:


> We get dispatched every time for structure fires. And as needed for grass fires.



Same here . . .


----------



## Handsome Robb (Sep 30, 2011)

If the FD determines it is truly a working structure fire an ALS unit is dispatched priority 1. 

Too many calls are false alarms to take a unit out of service right off the bat. Our response times are fast enough that by the time fire does extricate a victim we will be on scene.


----------



## DesertMedic66 (Sep 30, 2011)

With our main city fire department we will go stand bye on structure fires automatically. As for other areas (county fire) they have to call and request an ambulance.


----------



## MasterIntubator (Sep 30, 2011)

We get 2 transporting units for structure fires ( 1 medic/ 1 BLS minimum ) - prefer 2 medic units.

The first one generally always goes operational, second becomes primary transport medical/command aide.  

A separate rehab unit is called for rehab.


----------



## LondonMedic (Sep 30, 2011)

Fish said:


> http://www.emsworld.com/article/article.jsp?id=18417&siteSection=1


What's the big deal? There's equipment, a para and some techs on scene. 9 minutes, 17 minutes, it's really unlikely that there's going to be any _real_ difference to outcomes here.

And I know American buildings tend to be different to European, giving you different fire conditions, but do you really have casualties who need a paramedic at every structure fire?


----------



## EMSDude54343 (Sep 30, 2011)

In our system we have two types of transports, Fire based with one ff/med and one ff/emt that cover all unincorporated areas of our county. And single cert trucks with med/med or med/emt which cover the major city in the county for medical only, as the city handles their own fire related calls. 
Within the major city, we send the closest transport regardless of whether they are single or dual certified, they go as a stand by unit in case there are any injuries to ff's or civilians, and if they end up having  a pt then we send another unit so there is always a unit on scene. If there are reports of multiple pts we will send more transports as necessary to assure enough for standby and for pt transport/care. If we do send a dual certified unit to a city fire call, they may end up being used by the city as ff's to assist in extinguishment, and if that happens we send the next closest transport to standby.
If a fire occurs outside the major city within the county jurisdiction, we send two 'fire based rescues' which are the dual certified trucks. They serve multiple roles, the first in unit will set up RIT for entry crews, or tend to any pts on scene. The second in unit will either take over RIT or assist in other FF duties... Again if there are reports of multiple pts we will assign additional units as necessary regardless of certification level, will be based on distance to call.
When I say major city… its 40 sq miles, population of about 55,000, biggest city in the county. The county itself is larger than the state of Rhode Island with a population of 350,000. The county and the city are the only two fire depts within the county. Both depts are ALS depts with every engine and rescue/transport being ALS equipped with at least one medic per truck so there is always someone on scene to provide pt care.


----------



## Fish (Sep 30, 2011)

LondonMedic said:


> What's the big deal? There's equipment, a para and some techs on scene. 9 minutes, 17 minutes, it's really unlikely that there's going to be any _real_ difference to outcomes here.
> 
> And I know American buildings tend to be different to European, giving you different fire conditions, but do you really have casualties who need a paramedic at every structure fire?



No, we don't. I can't speak for every service in the US. But our Ambulances are mainly there for the FF in rehab. Rarely is there a civilian casualty at a Fire, but if there is. Well, there we are.


----------



## dstevens58 (Sep 30, 2011)

Not sure of our exact policy, but in the year that I've been with this rural department we were only dispatched to a confirmed fire (mutual aid with pumper and tanker) and ambulance was requested and dispatched because it was a chemical plant.


----------



## Epi-do (Sep 30, 2011)

I am a civilian medic for the fire department.  We dispatch a medic unit on every box alarm to be there for the FFs.  We respond non-emergent unless the fire comes out as an entrapment.  If there are any injuries that require transport, additional units are dispatched to the scene.


----------



## LondonMedic (Sep 30, 2011)

Fish said:


> No, we don't. I can't speak for every service in the US. But our Ambulances are mainly there for the FF in rehab. Rarely is there a civilian casualty at a Fire, but if there is. Well, there we are.


What does rehab cover? I thought it was just heatstroke and dehydration?


----------



## Fish (Sep 30, 2011)

LondonMedic said:


> What does rehab cover? I thought it was just heatstroke and dehydration?



Rehab is requirement. The Fire Fighters are to rotate in and out of our rehab at a Fire Scene to be assesed. We hydrate them, take Full set of vitals and compare them with our parameters, if they have any complaints then those are addressed. The most common cause of death to a Fire Fighter is Cardiac related, and we will be there should that happen. That being said, we do not have BLS units in our County, so pickins are slim! You want an Ambulance, its gonna have Medics.


----------



## frdude1000 (Sep 30, 2011)

An ambulance is sent to all fires on the initial dispatch.  If they have firefighters and SCBAs, they can do fire work.  If they do not, they just standby and do rehab.


----------



## Fish (Oct 1, 2011)

Here is an update:

http://www.emsworld.com/article/article.jsp?id=18431&siteSection=1


----------



## 46Young (Oct 2, 2011)

IMO, an amblance, a paramedic ambulance needs to be dispatched to every fire call. If you hold off on seding an ambulance, if someone gets burned, suffers smoke inhalation, or if the occupant has already suffered one of these injuries prior to fire resources arriving onscene, you're already behind the 8-ball. These are two very time sensitive pt care situations. If it's just a room and contents, food on the stove, a light ballast that smoked up the hall or something, that situation will be resolved rather quickly, and the ambulance can be placed in service rather quickly.

Also, half of all firefighter fatalities are due to cardiac related issues. Even if it is just a minor fire, and not a structure fire, a firefighter can still drop out due to heat exhaustion/stroke, dehydration, etc. Again, you're behind the 8-ball if you have to call for an ambulance after the S/Sx have already begun.

Unless, it's a fire/ALS system, then you'll have medics there that can start care in the meantime, and progress to ALS if the bus has an extended response time.


----------



## NomadicMedic (Oct 2, 2011)

We send a medic unit (dual medics) to every structure fire. Fire provides the ambulance, so we're good to go if needed. Also, we respond cold unless there is a report of occupants in the structure or if an interior fire attack is underway. 


Sent from my iPhone.


----------



## Jon (Oct 3, 2011)

Around my neck of the woods, anything that gets a still box or box alarm gets a BLS ambulance as well... Some places will keep the ambulance available and have an EMS Officer response only if no injuries are reported.

Once the fire hits 2nd/3rd alarm, additional EMS resources are usually due, both to assist with medical sector and coordinate rehab sector.


----------



## jjesusfreak01 (Oct 8, 2011)

Fire comes to half of our medical calls here and stays until cancelled, so it's the least we can do to go to their fire scenes until cancelled. 

We get cancelled only if there is no fire onscene (false call) or it was controlled PTA with no injuries. If it is any type of working fire, we stay until its put out with no injuries confirmed.


----------



## Fish (Oct 8, 2011)

jjesusfreak01 said:


> Fire comes to half of our medical calls here and stays until cancelled, so it's the least we can do to go to their fire scenes until cancelled.
> 
> We get cancelled only if there is no fire onscene (false call) or it was controlled PTA with no injuries. If it is any type of working fire, we stay until its put out with no injuries confirmed.



Who do u work for?


----------



## tssemt2010 (Oct 8, 2011)

our agency sends out ambulances for standby once a 2nd alarm is called


----------



## DrParasite (Oct 8, 2011)

We send a BLS ambulance to every working structure fire.  Well, that's if Fire's dispatch center notifies us that they have a fire.  Usually a supervisor will go too.  

However, many times we don't have any ambulances available.  In those cases, the Supervisor will typically respond solo, and the ambulance will be sent once one becomes available.


----------



## jjesusfreak01 (Oct 9, 2011)

Fish said:


> Who do u work for?



Wake County.


----------



## Tigger (Oct 11, 2011)

The 911 contract that my company holds includes an ambulance being sent to every working structure fire. Generally it's a BLS truck so the dedicated ALS truck can remain in service for the rest of town, and there is no way the powers that be would ever take an ALS transfer truck OOS for a fire standby when much money could be made doing ALS transfers...


----------



## MassEMT-B (Oct 11, 2011)

Usally just a BLS truck is sent for stand bys. We acutally just had a 3 alarm fire happen a few weeks ago. We had to bring some supplies to the crews there and they had 1 ALS and 2 BLS doing stand by at the fire.


----------



## systemet (Oct 12, 2011)

LondonMedic said:


> What's the big deal? There's equipment, a para and some techs on scene. 9 minutes, 17 minutes, it's really unlikely that there's going to be any _real_ difference to outcomes here.
> 
> And I know American buildings tend to be different to European, giving you different fire conditions, but do you really have casualties who need a paramedic at every structure fire?



I think the reason that so many systems in North America are sending EMS resources to fires is that many dispatch centers are run by FD's.  I'm sure the NFPA has regulations for EMS responses.

My old system used to send us to pretty much everything.  We spent a lot of time parked outside apartment complexes while they went in and removed pots of burned soup from the stove.  It was total overkill.  I remember spending 8 hours one day, as a paramedic ambulance in a busy system, watching a fire crew steam frozen hose off a parking lot ("just in case someone gets hurt").  I could have fulfilled this role just as easily from the station 3 minutes away, but then they wouldn't have a dedicated resource, and would have to roll their dice with the system status at any given moment.  It was interesting listening to the radio and hearing trucks get dispatched across the city to cardiac arrests, while we were watching what should be a fairly routine procedure.  

Rehab at a working fire usually consists of sitting in a bus (a literal "bus" -- not NYC ambulance slang!)  with a bunch of FF, running a set of vitals each time they rotate out / go through an oxygen tank.  On an ideal day, with a cooperative Fire DC, you identify people who are fatigued / dehydrated / dyspneic, and give them a longer rest period, food, rehydration, and determine whether they need ER transport, and you send the rest back into the fire once they've had a quick rest break.  On a bad day, it's a free-for-all with people walking into the truck grabbing a gatorade, sitting outside having a smoke, and then going back in without any real control.  It depends on how well EMS and FD work together, and the given staff in charge.  Broadly speaking, a lot of the firefighters don't want to admit to being tired / injured, for fear of appearing weak.  A lot of them enjoy the rarity of a working fire, and don't want to be pulled out. 

I'm sure there's something published about this, but I'm not feeling energetic enough to go looking for it.  My personal opinion is that sending ambulance's to anything where it's (i) not confirmed on fire, and (ii) there's no confirmed patients, is pretty pointless if the response time is short.  I think there is a valuable safety role in having a rehab sector at a working fire, but it's effectiveness depends on the organisational culture of the FD and EMS.

[Just want to add, this is my personal experience, primarily drawn from working in an urban environment with a large department that didn't have a good working relationship, and a lot of historical animosity.  Other's experiences may vary greatly.]


----------

