# Fire Trucks at medical scene



## Dutch-EMT (Aug 25, 2010)

When i look at series like paramedics, I see even by a "chestpain" call a fire truck at the scene. Here (in the Netherlands) a fire truck only responds to medical calls when there is a resuscitation  goïng on.
In the cities with professional fire fighters the crew drives out at each of these calls. In the low-residental areas were there are only voluntairy fire fighters the fire department and police only get's a call when there are no ambulances within 10 minutes of the call. They respond with CPR and AED (nothing more).
Every other medical call (no matter what urgent) is responded by the ambulance only.

How does this work in U.S.A.? Is there always an fire truck responding, no matter what call of medical aid? Or is there a difference between voluntairy and professional fire departments? 
And who pais the bill of the Fire Dept. sending this truck? Or is this organized by the authorities?


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## medic417 (Aug 25, 2010)

Depends on where you are in the USA.  In my area no fire response unless we request them to help lift a patient or if needed to cut a patient out of a car.  In other areas the fire depts respond to all EMS calls so they can claim they had a lot of calls when in fact they were not needed 99% of the time they responded.  This allows them to ask for more money.  That is the reason the fire service in the USA keeps trying to take over EMS so they can get more funds.  When you factor in how many runs are EMS and how many are fire it should be EMS taking over fire, but instead fire takes over EMS and in many cases it gets neglected while the fire department buys new trucks that they don't need.  

OK so short answer depends on where you are in the USA.


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## MrBrown (Aug 25, 2010)

What you have to remember is that a lot of EMS in the US is provided by the Fire Department.  It is the policy (so I was told in 1993) of the IAFF/IAFC to actively seek out and take over EMS wherever possible.

The Fire Service here is totally seperate from Ambulance but they do show up to cut people out of cars or other funny spots on occasion.


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## jjesusfreak01 (Aug 25, 2010)

The FFs are more community based in my area, so they can often get onscene more quickly than EMS, although EMS has very short response times. All FFs are either FRs or EMTs, so they can patch up and do basic treatment before EMS arrives. I think it's a good relationship here. On full emergency calls (no matter what they turn out to be) they are there to lend a hand, and will disappear just as quickly if they aren't needed. I get somewhat jealous when I see the FFs running around in shorts when I'm stuck in black ems pants all day.


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## firecoins (Aug 25, 2010)

For every diabetic, we have 1 truck with a charged line ready, just in case the guy need sugar.


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## Shishkabob (Aug 25, 2010)

MrBrown said:


> What you have to remember is that a lot of EMS in the US is provided by the Fire Department.



33%...




In Fort Worth, the calls that have more of a chance of being life/limp threatening get a fire response along with the ambulance.  On calls that are just a sick person, it's just an ambulance.

Most often, the moment the ambulance arrives, the Paramedic sends the engine back home, as most FD engines in Ft Worth only have EMTs.


Go to Dallas, and most get dual engine/fire response because not only are all FFs also medics, but it's fire-based EMS.


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## 82-Alpha599 (Aug 25, 2010)

I work Private EMS.  In the main city I respond in, the full time FD rolls for everything.  They are a non transporting ALS units with 2 paramedics (we call em Echo units around here).
If it is an EMS only call I would say they are helpful 40% of the time, getting IV's, drawing up Rx, getting quality Hx from family, etc...

If I had to chose to have FD respond to all or none, I would chose all, as long as they are ALS.

The best situation would be having FD only roll on high priority runs.

Also work POC Fire that transports ALS, and have to say it is a much smoother operation.


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## socalmedic (Aug 25, 2010)

in my area, EMS is provided 100% by the Fire department. the paramedics are on the fire engines and ambulances only have EMT's (with some exceptions). we will normally have 2-4 paramedics on every call, and it will be downgraded as needed. it is a system that works if utilized correctly, it is a broken system if not.


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## AtlantaEMT (Aug 25, 2010)

I did my schooling in Savannah and I didn't even see FD on a rollover in one of the most boring non-eventful places in the Savannah area.  Infact when EMS needed a hand in chest compressions we always had a cop doing the pumping.  When I did my clinical in Atlanta I was shocked at how Fire responded to almost everything.  And most FFs I saw were EMT or Paramedic qualified which I enjoyed.  Nothing like having a few extra hands to lug big Bertha around.

But if I had to have my choice between PD and FD on scene, I'd much rather have PD on scene.  They'll do the grunt work and when people get testy they can break the taser out.


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## grich242 (Aug 25, 2010)

Our fire department does both fire and ems, we rotate duties regularly, we have four als ambulances(transporting) and 5 als engines, they are staffed with paramedics, our engines are sent on potentia "serious medical" calls ie chest pain stroke dib etc, for the extra hands for a 12 lead iv start etc, they carry the same medical equipment as the ambulances except the stretcher. they will also respond if the rescue for that station is on another call with the idea that  we have an average response time with a full als crew in less than 4 minutes while the ambulance coming across the city may take a few minutes.


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## Dutch-EMT (Aug 25, 2010)

Big differences i'm reading here.
Not to offend the fire fighters, but when I'm looking at working with sick or wounded patiënts vs fighting fires, cutting cars and do other technical work, i see two different specialities. 
That's why in Europe the EMS and FireDepts are two different professions.
There are in Germany fire departments running EMS stations, but the paramedic and EMT (rettungssanitäter and rettungsassistent) on the vehicles aren't trained to work on a fire engine. 

Wouldn't it be better when looking at quality and specialism of the job of paramedic that those things would be seperated?
When i'm looking at patiëntpravicy, I should prefer tow paramedics in my livingroom instead of 6 firefighters from an engine.


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## grich242 (Aug 25, 2010)

WE often joke about being medics that sometimes ride fire trucks, we do probably 70% to 30% ems to fire. it works well for us but ems is the majority of our job.The engines dont respond to all the calls and are turned around when the extra hands arent required.


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## medic417 (Aug 25, 2010)

Dutch-EMT said:


> Big differences i'm reading here.
> Not to offend the fire fighters, but when I'm looking at working with sick or wounded patiënts vs fighting fires, cutting cars and do other technical work, i see two different specialities.
> That's why in Europe the EMS and FireDepts are two different professions.
> There are in Germany fire departments running EMS stations, but the paramedic and EMT (rettungssanitäter and rettungsassistent) on the vehicles aren't trained to work on a fire engine.
> ...



We have a winner.  Yes you are absolutely correct.  It makes no sense having two completely different professions combined.  I mean it would make as much sense as combining doctors with dog catchers.


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## socalmedic (Aug 25, 2010)

Dutch, i can say that as both a Firefighter and paramedic that I have specialized in both. neither detracts from the other. and at least here in California, you dont have to make the choice between 2 paramedics or 6 firefighters because we cross train and many departments are only hiring Firefighter/paramedics you will have 6 firefighter/paramedics in your living room. if it is a BS call then 4 of the FF/PM get back one the big red truck and 2 of the FF/PM take the call.

i am not advocating one system over another, there are plenty of great systems out there as already stated, what i can say is that this system here works for us. we can have paramedics on scene in less than 5 minutes, under normal circumstances.


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## Shishkabob (Aug 25, 2010)

Which brings up the topic of more than two medics on a scene...


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## DarkStarr (Aug 25, 2010)

In my area, we have private EMS complimented by QRS in certain areas where an ambulance cannot be in 10 minutes or less.  My station does not provide QRS because we have 2 ambulance services within 10 minutes, with one of the ambulances stationed within the general vicinity.

FD will be called for extreme lift assists and Rescue operations.  We do carry an AED on the Rescue, just in case.  Also, not that it matters in our situation, but over 3/4 of my volunteer dept are either EMT or Medic certified.


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## DrParasite (Aug 26, 2010)

Because in the majority of the US, EMS is both underfunded and understaffed, and the US Fire Department as a whole is used to band aid said understaffed EMS systems.

In systems all over the US, a fire truck is sent because EMS doesn't have enough resources to handle the call volume.  This happens in 100% volunteer EMS systems, as well as 100% career systems, and everything in between.  Taking the extreme of EMS in NYC or Philadelphia, to the middle of now where US, where 30 emergencies a year is a busy year, and very often the FD is used to supplement the local EMS system, or when the EMS unit is coming from the next town over or several towns away.

A good EMS system has enough resources to handle ALL the calls, on it's own, with a less than 6 minute response to ALL calls, from the chest pain/MI, to the stubbed toe.  

Unfortunately, the majority of systems can't do this, usually because they don't have enough ambulance, or they staff just enough ambulances to handle all the calls based on statistical data, and never having additional units available to handle routine surges in call volumes.

So the FD is used as a first responder, to "stop the clock" on emergencies, so even if it takes the ambulance (which the patient needs) 20 minutes to get there, due to no units available, or EMS unit coming from the other end of town, or doing a turnaround at the ER, the AHJ can say "well, we had a unit on scene in under 6 minutes, even if it is a non-transporting unit with guys who can't get the sick person to definitive patient care."

FD should go on rescue assignments, MCIs, or if you need additional lifting power, but this should be the rarities, not the routine EMS calls because your system if frequently out of EMS resources.  Again, good systems would operate this way.  Unfortunately, most of the systems in the US don't.


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## jjesusfreak01 (Aug 26, 2010)

I don't know. I think even if fire responds simply to "stop the clock" it can totally be worth it. If EMS has 6 minute response times, and fire 4, that two minutes could make a huge difference two someone who was in arrest for a few minutes before 911 was called.

If EMS arrives first, great. If fire arrives first, then you did truly just shave a few minutes off of your EMS response time, because the MI patient will have FFs assisting with their nitro and giving O2, the MVA victim will have someone stabilizing cspine and stopping hemmorrhage, and the kid who just broke her leg on the playground will have firefighters there to assure her that she will be ok. Even if its just a few minutes, its totally worth it.


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## 82-Alpha599 (Aug 27, 2010)

why in a nice suburban city with good tax paying residents, should we pay firefighters to just sit at the station, when there is only 20 real house fires a year and 5,000 medical calls.

medical calls generate revenue, fire not so much.

we may not want to combine the jobs, but it is for the benefit of the citizens safety and cash.  Plus most of the young guys (like myself) enjoy both sides of they job.


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## JPINFV (Aug 27, 2010)

Ah, I love this road.

...because in my experience, the fire department is neither an efficient, progressive, or effective source of delivering prehospital medical care.


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## terrible one (Aug 27, 2010)

socalmedic said:


> Dutch, i can say that as both a Firefighter and paramedic that I have specialized in both.



care to elaborate how quality is improved by having 6 FF/PM on scene? Since when does more equal better care? It works here in CA, how? Have you seen our protocols? Do you know the orignal reason for cross training FF to PM? Money! It was cheaper to have FF work as PM than to have single function roles, although I'm sure you have been told it improves patient care/quality/etc.


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## BLSBoy (Aug 27, 2010)

I'll just leave this here. 
We are a combined Paid/Volunteer Fire/EMS system, providing ALS Rescues, Engines and Ladders, as well as a few BLS apparatus, with private BLS providers as well. 
We have aggressive protocols and excellent medical direction to the 1000+ members of the Dept, serving in over 35 stations. 

http://www.tampabay.com/news/health/article1117401.ece


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## MrBrown (Aug 27, 2010)

Linuss said:


> Which brings up the topic of more than two medics on a scene...



You are lucky to have ONE Intensive Care Paramedic on scene here, if you have TWO you are REALLY, REALLY sick ...


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## LucidResq (Aug 27, 2010)

There is at least one medic on every fire apparatus out here... usually more.... and the dept is actively trying to make all of their firefighters paramedics. 

They respond on all EMS calls, but do not have any transport capabilities. 

We utilize a private EMS company for that... they are staffed with 1 medic, 1 EMT. 

I have seen as many as 3 fire medics ride in with a patient to the hospital on a critical call before... that means 4 medics in the back of that rig (unless they booted the 4th one up front).


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## jjesusfreak01 (Aug 27, 2010)

BLSBoy said:


> I'll just leave this here.
> We are a combined Paid/Volunteer Fire/EMS system, providing ALS Rescues, Engines and Ladders, as well as a few BLS apparatus, with private BLS providers as well.
> We have aggressive protocols and excellent medical direction to the 1000+ members of the Dept, serving in over 35 stations.
> 
> http://www.tampabay.com/news/health/article1117401.ece



Aww, showing off...i'm in Wake County NC...


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## BLSBoy (Aug 27, 2010)

jjesusfreak01 said:


> Aww, showing off...i'm in Wake County NC...



Haha, we modeled parts of ours from WCEMS.


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## 46Young (Aug 28, 2010)

medic417 said:


> We have a winner.  Yes you are absolutely correct.  It makes no sense having two completely different professions combined.  I mean it would make as much sense as combining doctors with dog catchers.



Dual role providers may or may not improve pt outcomes, but it hasn't been shown to adversely affect those outcomes. It makes sense from the financial standpoint in many cases. Mergers are typically done mainly to save money and positions, but haven't been shown to worsen pt outcomes.

Why should the dual role position be seperated for single minded people? I've had no problem learning fire suppression after having been a medic for a few years. Many others I work with have had no problem with it, either. EMS isn't as difficult to do well at as many would like to say, even with the additional duties of fire suppression. Now, if you were to put someone through fire school and medic school at the same time, that could present a problem. But if the individual learns one job and then the other down the road, it works out well.

You can be a medic in 6 months or less. You can graduate a fire academy in 4-6 months with FF 1 and 2. You also have the EMS AAS on one side, and a Fire Science degree on the other if you want to equal things out with college. That's still way less education and training than someone with a Master's degree, let alone that of a physician. Why is it so difficult to do both EMS and fire? At least where I work, we do plenty of on duty EMS continuing ed, the same with fire, as well as comany drills and multi unit drills for both sides. Again, this is all on duty. It's really not that hard to maintain proficiency. there's also enough EMS call volume to keep your skills sharp. Fire is going to be relatively slow wherever you go, unless you work in a busy, populated area. 

The fire service has largely taken the attitude towards EMS as a specialty, such as Technical Rescue or Hazmat. While I don't necessarily agree with this, it is how the fire service sees EMS. That model happens to work, however. You take a trained firefighter and send them to medic school. Now, you have a cometent FF who needs to maybe devote 80% of their effort to improving in EMS and 20% to fire to achieve balance. Or, in my case, work as a medic in a busy system first, then do the fire academy and concentrate 80% on fire and 20% on EMS.

For those that don't want to do both, there are plenty of thrd service EMS agencies to work for, and as many hospital based services as well. I moved out of state for my career. Single role EMS in NYC didn't provide what I wanted. I'm not sympathetic towards anyone that needs to relocate for desireable job, either.


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## 46Young (Aug 28, 2010)

terrible one said:


> care to elaborate how quality is improved by having 6 FF/PM on scene? Since when does more equal better care? It works here in CA, how? Have you seen our protocols? Do you know the orignal reason for cross training FF to PM? Money! It was cheaper to have FF work as PM than to have single function roles, although I'm sure you have been told it improves patient care/quality/etc.



If it doesn't adversely affect pt outcomes, then combining EMS and fire is in the best interests of the local government, if it saves money in doing so. Whether it improves pt care is irrelevant in the practical sense so long as it doesn't worsen outcomes, provided the local gov't is able to either cut their budget, or increase service with the same budget. Really, you're getting at least the same level of delivery at a lower cost. Any increase in service or improvement in pt outcomes is just gravy. I'd rather see more buses on the road rather than ALS first response, but the local politicians don't seem to agree in most cases. If they won't put more buses on the road, then I'm okay with increased ALS first response and a more secure and lucrative career for the medics in the FD if they're going to run all day and night on the ambulance.


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## MrBrown (Aug 28, 2010)

I have often wondeed if we measured the clinical knowledge and skill of a group of international Paramedics where each would rank and how we could fairly and accurately do such a thing.

My observation is that US Paramedics do not have to think, they have a cookbook to follow which ends in the patient going to the hospital, if things get out of depth you can always default to ringing up a Doctor on the ambo-phone and so long as you can slip in a drip, recognise a few rhythms and screw one end of the prefilled syringe into the other you can go an entire career without anybody realising.

Does that mean some are not capable of advanced clinical reasoning, no not at all.


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## 46Young (Aug 28, 2010)

On the one hand you have the single role EMS professionals who are understandably upset by FD takeovers of EMS, typically displacing them from their jobs, or forcing them to do fire. On the other hand, you have dual role personnel who enjoy both sides of the job, and have no problem doing both. You also have others that were forced to do EMS, or needed the P-cert to get the job, but it is what it is.

Neither side is looking to willingly sacrifice itself in favor of the other. Although fire based EMS has been growing, I don't see single role EMS disappearing. So, for all the single role EMS and dual role fire/EMS alike, what compromise do you suggest? We can bicker on and on incessantly, but how do we compromise and work things out?


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## 46Young (Aug 28, 2010)

MrBrown said:


> I have often wondeed if we measured the clinical knowledge and skill of a group of international Paramedics where each would rank and how we could fairly and accurately do such a thing.
> 
> My observation is that US Paramedics do not have to think, they have a cookbook to follow which ends in the patient going to the hospital, if things get out of depth you can always default to ringing up a Doctor on the ambo-phone and so long as you can slip in a drip, recognise a few rhythms and screw one end of the prefilled syringe into the other you can go an entire career without anybody realising.
> 
> Does that mean some are not capable of advanced clinical reasoning, no not at all.



More like we're handcuffed. I'd like to increase my clinical knowledge as it pertains to EMS, but there's nothing available in the U.S. past the EMS AAS. The whole cookbook thing is mainly the medical director being aware of our laughably brief medical education, which varies from a 12 week patch factory to a two year degree at the most, and likes to keep things simple to protect their license.


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## JPINFV (Aug 28, 2010)

46Young said:


> More like we're handcuffed. I'd like to increase my clinical knowledge as it pertains to EMS, but there's nothing available in the U.S. past the EMS AAS. The whole cookbook thing is mainly the medical director being aware of our laughably brief medical education, which varies from a 12 week patch factory to a two year degree at the most, and likes to keep things simple to protect their license.



Too bad that the US Fire Administration sees absolutely no reason to change from the 12 week patch factory technician to a prehospital medical professional with a degree. Notice where the concept of a college education comes into play with this. It isn't at the paramedic level... Hell, the fire service doesn't even see a need to have the educators have a real education. 







So, the whole cookbook thing is thanks to the fire fighters fighting to keep from requiring a real education.


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## Shishkabob (Aug 28, 2010)

If you're going to use the argument of money and efficiency to support mergers, then you also have to support fire being a part of EMS and not the other way. 

Its ridiculous to think that a portion that gets 80% of the calls is seen as the lower and less important of the two. 



If places truly wanted to save money, fire would be volunteer, period.


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## BLSBoy (Aug 28, 2010)

Linuss said:


> If places truly wanted to save money, fire would be volunteer, period.



Then you would see what little you save through tax reductions go bye bye in either A) insurance "adjustments", or B) go up in smoke when the structure catches fire, and you're now dropped insurance is worthless. 

It IS a very delicate balancing act, and yes, many areas ARE doing it wrong. 

Making all career EMS and all volunteer FD is no better then making every FF become a Medic. 
This requires the ****s to get put away, the brass removed from collars, jurisdictions brought down, and common sense brought into play.


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## 46Young (Aug 28, 2010)

JPINFV said:


> Too bad that the US Fire Administration sees absolutely no reason to change from the 12 week patch factory technician to a prehospital medical professional with a degree. Notice where the concept of a college education comes into play with this. It isn't at the paramedic level... Hell, the fire service doesn't even see a need to have the educators have a real education.
> 
> 
> 
> ...



I'm sure that the number if third service EMS depts, hospital based EMS depts, and private EMS agencies outnumber the number of EMS inclusive FD's, both in number of depts and number of employees. What have these employers done to support EMS requiring a "real education?" Nothing! It's a pulse and a patch in most places. No one asks where you went to school, only if your certs are valid, your background is clean, your driving record is acceptable, relevant work history, and maybe passing an entrance exam. They're just as guilty in suppressing the educational standards of EMS as the fire service is being accused of.

At least the fire service either requires or gives weight to education for career advancement. At least the fire service has career advancement. Where I work they send FF's to a degree paramedic program. We also provide Insructor I and Officer I courses, as well as Ins. 2 and 3, Off. 2 and 3. Educational points count towards the total score for our promotional exams. A technician w/o education can only score 90%. An LT 85%. Capt I 80%. Capt II 75%. This is for tests where .10% can seperate several candidates. What EMS employers do this? What EMS employers have any sort of real career/promotional ladder?

Edit: At least that chart shows some sort of professional development model. What is the typical EMS agency's model? EMT > medic > rare supervisor if you're in the right click, maybe a lateral move to dispatcher, skills instructor, or class instructor > burn out in 7-10 years and leave.


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## sir.shocksalot (Aug 28, 2010)

Maybe someone can explain to me how a fire based EMS service saves money? Private services often provide EMS services at no cost to the city, which strikes me as cheaper than a fire based EMS service. Also a municipal service would be far cheaper than a fire based service, single role paramedics are typically cheaper than career firefighers, let alone FF/medics, and street corner posting 12 hour shifts (while not ideal) would save needing more than one station. Even purchasing new stations for EMS are probably of comparable price to expanding current fire stations to accommodate an extra crew and vehicle.
The main argument I hear is that cross training saves money, but I just can't see how. An engine needs to be staffed with 3-4 FFs and ambulance needs at least 1 medic and one FF to drive; so how is that cheaper than using a municipal service to staff 1 medic and 1 emt in an ambulance and keeping 3-4 FFs on an engine?

In my experience typically the problem with Firefighters in EMS is not the Firefighter him/herself, but the great big beast of a union they belong to. The IAFF has consistently taken a stance of taking over EMS wherever it goes by fudging numbers and lying to citizens by saying Fire based EMS saves money and lowers response times (which it might, but no better than an equally funded 3rd or private service could do.) I have found good and bad firemedics, however EMS will always be secondary in the fire service, and the IAFF will never advocate for advancement of the EMS profession, since it hurts professional firefighters; so long as that is the case I will never advocate for fire based EMS.


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## MrBrown (Aug 28, 2010)

The problem with an "Associate" degree is that it's not even a real Degree in whatever you have one in, lets say Paramedicine.

I have seen a lot of two year Paramedic degrees where you have to take a lot of other subjects like computers, English, history or whatever which mean your two year Paramedic degree really only has about a full year of Paramedic education in it.

Our Bachelors and Advanced Degrees for Paramedic and Intensive Care Paramedic are exactly that - they are a Paramedic Degree.  You don't have to take any computer classes or learn about history, every class is a specalist one.  You actually study Paramedicine for three years not a bit here and a bit there and oh look some underwater basket weaving over there.

Our old Intensive Care Paramedic Diploma was two full years of Paramedic education and that was introduced in 1995.


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## 46Young (Aug 28, 2010)

Linuss said:


> If you're going to use the argument of money and efficiency to support mergers, then you also have to support fire being a part of EMS and not the other way.
> 
> Its ridiculous to think that a portion that gets 80% of the calls is seen as the lower and less important of the two.
> 
> ...



The way EMS is run with nepotism, lack of career advancement, pulse and a patch quality employee standards, using the absolute least amount of resources to barely do the job and wear out their crews, no thank you to EMS running the show.

BTW, call volume in no way lessens the importance of having adequate staffing and deployment on the suppression side. Call volume is irrelevant. How much of that call volume is medicaid abuse and/or the medically ignorant calling for things that are easily serviced by a trip to the urgent care, a PCP, or a ride to the ED via POV?


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## sir.shocksalot (Aug 28, 2010)

46Young said:


> I'm sure that the number if third service EMS depts, hospital based EMS depts, and private EMS agencies outnumber the number of EMS inclusive FD's, both in number of depts and number of employees. What have these employers done to support EMS requiring a "real education?" Nothing! It's a pulse and a patch in most places. No one asks where you went to school, only if your certs are valid, your background is clean, your driving record is acceptable, relevant work history, and maybe passing an entrance exam. They're just as guilty in suppressing the educational standards of EMS as the fire service is being accused of.
> 
> At least the fire service either requires or gives weight to education for career advancement. At least the fire service has career advancement. Where I work they send FF's to a degree paramedic program. We also provide Insructor I and Officer I courses, as well as Ins. 2 and 3, Off. 2 and 3. Educational points count towards the total score for our promotional exams. A technician w/o education can only score 90%. An LT 85%. Capt I 80%. Capt II 75%. This is for tests where .10% can seperate several candidates. What EMS employers do this? What EMS employers have any sort of real career/promotional ladder?
> 
> Edit: At least that chart shows some sort of professional development model. What is the typical EMS agency's model? EMT > medic > rare supervisor if you're in the right click, maybe a lateral move to dispatcher, skills instructor, or class instructor > burn out in 7-10 years and leave.


The career advancement you just highlighted is within the fire service, not the EMS service. EMS doesn't have much of a career advancement because there is no prehospital provider beyond the level of paramedic. In Australia, England, and New Zealand however a paramedic and go on and become an Intensive Care Paramedic, a Community Care Paramedic, Paramedic Practicioner etc.
Also there are plenty of EMS agencies who look for more than a pulse and a patch. One can argue there are just as many fire agencies who could care less where you went to medic school as long as you hold the cert.
The point most of us "anti-fire" guys is not that firefighters are dumber than single role paramedics, just that your union and fire brass will do everything to prevent EMS from becoming a huge burden on a fire department, or evolving into its own agency that has no place in a fire department. (therefore costing firefighters their jobs.)


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## 46Young (Aug 28, 2010)

sir.shocksalot said:


> Maybe someone can explain to me how a fire based EMS service saves money? Private services often provide EMS services at no cost to the city, which strikes me as cheaper than a fire based EMS service. Also a municipal service would be far cheaper than a fire based service, single role paramedics are typically cheaper than career firefighers, let alone FF/medics, and street corner posting 12 hour shifts (while not ideal) would save needing more than one station. Even purchasing new stations for EMS are probably of comparable price to expanding current fire stations to accommodate an extra crew and vehicle.
> The main argument I hear is that cross training saves money, but I just can't see how. An engine needs to be staffed with 3-4 FFs and ambulance needs at least 1 medic and one FF to drive; so how is that cheaper than using a municipal service to staff 1 medic and 1 emt in an ambulance and keeping 3-4 FFs on an engine?
> 
> In my experience typically the problem with Firefighters in EMS is not the Firefighter him/herself, but the great big beast of a union they belong to. The IAFF has consistently taken a stance of taking over EMS wherever it goes by fudging numbers and lying to citizens by saying Fire based EMS saves money and lowers response times (which it might, but no better than an equally funded 3rd or private service could do.) I have found good and bad firemedics, however EMS will always be secondary in the fire service, and the IAFF will never advocate for advancement of the EMS profession, since it hurts professional firefighters; so long as that is the case I will never advocate for fire based EMS.



On the fire side, staffing and deployment objectives need to be met, irrespective of call volume. This leaves units with a low net utilization in many areas. Crosstraining FF's as EMt's and medics saves money in a few ways. Dual role FF's save money on staffing and OT since they're versatile and can plug holes in the schedule on either side. Less personnel need to be hired if employees can do both jobs. Each job is another pension, equipment, training and hiring costs, paif time off, insurance, etc. It's cheaper to train one FF to the paramedic level and then put a monitor, drug bag, O2, airway kit, BLS bag, portable suction, a backboard and immobilization equipment on an engine than it is to buy a new ambulance, hire two medics (or medic/EMT) with all those additional costs I just mentioned, and all the equipment that goes with that. Employee retention with dual role FF/EMT's is much higher than that of single role EMS, saving on hiring costs. As far as OT, up to a point it's cheaper to allow OT to cover scheduling holes rather than hire. Dual role personnel offer an advantage to that end. they can ride the ambulance or an engine, truck, whatever.

I don't see how adding on to an apparatus bay is more expensive than building a new EMS station.

If the privates are providing EMS at no cost to the city, that means they're turning a profit. A profit that the city might as well keep. The privates are known to be profit driven by nature. How many stories do you hear of the privates using 911 buses to do IFT's? NYC hospitals and privates participating in pt streering? How do they treat their employees? Overworked and underpaid. That's who I want showing up to help me, two sleep deprived, burnt out, underpaid and disgruntled techs. Or maybe a pair that are waiting on a fire job and could care less about their current one? How many privates pack up and leave when the contract is no longer profitable, leaving the local gov't scrambling to reassemble an EMS delivery system?

Like I said before, I'd rather have more ambulances on the road, but the local politicians and bean counters won't allow this. As such, ALS first response fills the gaps when they're likely to be otherwise idle. It's cheaper than adding more buses and less hiring is needed to boot, when compared to having a seperate third service EMS.


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## Shishkabob (Aug 28, 2010)

46Young said:


> The way EMS is run with nepotism, lack of career advancement, pulse and a patch quality employee standards, using the absolute least amount of resources to barely do the job and wear out their crews, no thank you to EMS running the show.
> 
> ?



Ever think that's because fire gets a bigger chunk of the money? And that's because they fudge the numbers? 


Heck, id trust my life with ATcEMS over austin fire any day. 


ATcEMS, Rockwall county and Hood county....thee places that are proof positive that EMS can do more of the technical rescue stuff and excel at it.


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## 46Young (Aug 28, 2010)

sir.shocksalot said:


> The career advancement you just highlighted is within the fire service, not the EMS service. EMS doesn't have much of a career advancement because there is no prehospital provider beyond the level of paramedic. In Australia, England, and New Zealand however a paramedic and go on and become an Intensive Care Paramedic, a Community Care Paramedic, Paramedic Practicioner etc.
> Also there are plenty of EMS agencies who look for more than a pulse and a patch. One can argue there are just as many fire agencies who could care less where you went to medic school as long as you hold the cert.
> The point most of us "anti-fire" guys is not that firefighters are dumber than single role paramedics, just that your union and fire brass will do everything to prevent EMS from becoming a huge burden on a fire department, or evolving into its own agency that has no place in a fire department. (therefore costing firefighters their jobs.)



I'm a firefighter/medic, so that career ladder is within the EMS service, just not a single role one. We have EMS techs, EMS LT's, EMS Capt I's EMS Capt II's, EMS BC, EMS DC. We also have dual hatter positions for all of those positions as well. We also have several all hazard DC's and an AC who climbed the ranks via the EMS ladder. The two sides, EMS and suppression are intertwined, not in a power struggle.

As I said before, the vast majority of hosp based, third service, and private EMS have done next to nothing to promote EMS educational advancement. It's hardly just a fire thing. 

Like I told JP, at least the fire service gives it's medics a career advancement ladder. We can promote to EMS tech, TROT tech, Apparatus Tech, or Hazmat Tech after only two years of service. With each position, we can and still do EMS txp. After five years we can become EMS LT's or All-Hazards LT's. Seven years to make Capt I, two more for Capt II, and so on. If I was still at my old hospital I'd be jerkin' the gherkin as a field medic forever. The supervisor positions are few and far between. One person that was hired at around the same time as me back at my old hospital was just made field supervisor. We were hired in early 2003. That's seven years and change, and that was only one position. Just one. I'll have my first promotion in a couple of months, only two years out of the academy. Me and about 15-20 others. If I was hired here in 2003 instead, I'd likely be a LT or Capt I in those same 7 + years.EMS LT/Capt if I wanted.


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## 46Young (Aug 28, 2010)

Linuss said:


> Ever think that's because fire gets a bigger chunk of the money? And that's because they fudge the numbers?
> 
> 
> Heck, id trust my life with ATcEMS over austin fire any day.
> ...



I'm sure that your local case study is true, but fire based ALS first response still hasn't shown to cause an adverse affect on pt outcomes.

We spread our money evenly over fire and EMS here. The two sides are intertwined, not at odds and having a power struggle. A few of our top brass came up the ranks as medics.


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## sir.shocksalot (Aug 28, 2010)

46Young said:


> I'm sure that your local case study is true, but fire based ALS first response still hasn't shown to cause an adverse affect on pt outcomes.
> 
> We spread our money evenly over fire and EMS here. The two sides are intertwined, not at odds and having a power struggle. A few of our top brass came up the ranks as medics.


I don't believe there has been any study done regarding BLS vs ALS first response. And there certainly hasn't been any study done on fire based ALS vs other ALS response.

Also the policies of your department are not idicative of fire based EMS as a whole. Neither are the policies of the fire based EMS that I work with. Your department may provide great pt care, I know for a fact that the one I work with is atrocious. Does that mean every fire department in colorado is terrible? No, not at all. But saying that all privates or hospital based EMS is bad is not very fair. There are plenty of non-fire services that have a good EMS career advancement, from EMT to Medic to FI to CCT medic, etc. I have even heard of places that will help employees go to nursing school or PA school. Also the IAFF isn't leaping at the idea of community paramedics, or CCT medics, or really medics that do anything other than respond to emergencies. 

Fire fighters have a huge lobby group who will work hard to keep firefighters on top, EMS has no such group, and EMS is so divided that we can't really organize ourselves to advance the careers of single role paramedics. So any Paramedic who wants to advance their career in MEDICINE, they move on to nursing, or PA, or MD and so EMS continues to stagnate as our best and brightest move on to bigger and greater things.


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## firetender (Aug 28, 2010)

*It's not about rivalry*

Police protect and serve.

Fire fights fire.

EMS needs to be re-structured from the ground up to reflect what it actually provides; _*Emergent Medical Intervention*_. Emergency intervention is only a small part of the reality of what EMS has become;a strictly medical concern within the context of a greater societal service. 
This would clearly be a specialty which would take its place as one of three vital protection agencies with an identity (and accountability) completely its own. 

We haven't quite figured that out yet because we got hung up on the Emergency thing; we think that's what we actually do! Fire Departments have capitalized on non-Fire's inability to accurately describe the service we provide. Aren't emergencies what FD's are all about? Logic says that's what Fire does now, so why not let them handle more?

Because that's not what needs to be handled.

The populace we serve is not limited to those in need of emergency intervention; it has now expanded to include those with nowhere else to turn. In fact, they have become the majority of our cases. True emergencies seem to sneak in to our work load. 

The end result is that EVERYBODY wants to handle the GOOD STUFF and NOBODY wants to handle what's really out there.

EMS must assert that these are the people and ailments we really serve. We must educate ourselves to serve them better, elevating the profession as we go. We must re-design our systems of response and back up to provide a few "tiers" of support to draw from. 

Once we re-define (and expand) what we do, you can bet that Fire Departments will back off on trying to take over EMS. Why? Because their "mission" has nothing to do with placing people where they belong, and that, in a nutshell, is the work that needs to be done.

I'm not saying non-Fire services are better. I'm actually saying ALL OF US need to wake up, get rid of the childlike impression this is all about emergencies and develop something that works!


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## Dutch-EMT (Aug 28, 2010)

I think in many other countries outside US there is enough proof that FF and EMS can be split in two different professions. Well, i'll take the Dutch system for example again :wacko:...

Only towns and cities with a higher residence than 70000 have a professional fire department. That means that between 7.30AM and 6.00PM there is professional staff at the station while the voluntaire firefighters go to their daily job. Between 6.00PM and 7.30AM the voluntairy fire fighters get the fire calls.
Cities over 12000 residents have 24hour professional firefighters.

The EMS system (ambulance services) are 100% professionals. The driver of the ambulance (graduated EMT-B ) and ambulance-nurse staff the ambulance.
In our region (150000 residents, see picture) there are 7 ALS ambulances driving 24hours a day.
	

	
	
		
		

		
			




They do emergency calls and interclinical rides. There are 2 BLS ambulances driving interclinical and discharge rides only between 8.00AM and 5.00PM.
There are no professional fire fighters in the region. The biggest town residents 65000 people. 
Ofcourse our EMS system is a lot different than the paramedic based system (see this link: http://emtlife.com/showthread.php?t=15481).
The costs of the ambulance calls are payd by the health-ensurance.
In the Netherlands everybody it is obligatory to have a basic health-insurance (costs are about $100 to $125 for this year for 1 person).

Well... it works here! Ofcourse our system isn't always perfect...


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## medic417 (Aug 28, 2010)

BLSBoy said:


> Then you would see what little you save through tax reductions go bye bye in either A) insurance "adjustments", or B) go up in smoke when the structure catches fire, and you're now dropped insurance is worthless.



Actually very wrong.   Some of the best insurance rates are in communities with volunteer fire.  Yes some communities with volunteers are at the highest insurance rate.  And you find communities with paid fire all up and down that rate ladder as well.


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## Seaglass (Aug 28, 2010)

I've gotten pretty familiar with a handful of places now, and they all had issues. I think the best way to set up EMS depends on the area, though.

One was a medium-sized city that had a fire department with way too many medics. Pointless engine responses and medics who'd forgotten most of their skills were really common, as each engine seemed to have a medic or two who always handled every call. They also had a thriving, terrible third service. In this case, I'd support losing the third service entirely, and having only one or two medics per engine or fire ambulance. 

Another was middle of nowhere department, with mostly volunteer and a handful of paid employees. About half were FF/EMTs, with only a few FF/ALS of any sort, and the others were either EMS or fire only. It worked pretty well, as nobody had to perform a job they didn't actually care about. Engines did respond to medical calls when they were closer than the nearest ambulance--and in that area, "closer" could make a difference of half an hour or more"--but the only FFs who engaged in patient care were the ones who were trained for it. Given the area, it made sense and worked well. But it had other issues... namely that convincing crusty old rednecks to keep skills current in either field can be really hard. 

Another was a big city fire service which did great fire, and horrifying EMS. Riding the ambulance was required, and the FFs really resented it. They tended to express that pretty openly, even to patients. I'd support making EMS a third service  there any day.


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## DrParasite (Aug 29, 2010)

Seaglass said:


> They also had a thriving, terrible third service.


out of curiosity, why were they terrible?  was it due to being overworked and under paid, or was their clinical skill lacking due to lack of dealing with sick patients?  





Seaglass said:


> Engines did respond to medical calls when they were closer than the nearest ambulance--and in that area, "closer" could make a difference of half an hour or more"--but the only FFs who engaged in patient care were the ones who were trained for it.


again, bandaiding an under staffed EMS system with firefighters.  how about putting an EMS unit at those fire stations, so when you have a time sensitive call (cardiac arrest, MI, CVA, major trauma, etc) you have a unit that can transport to definitive care (ie, an MD and/or surgeon) instead of just performing the circle of wait until EMS actually arrives?

This is the problem with the US EMS system, we have let the fire service in, and now that they "do ems" more funding gets sent their way (in the form of equipment, salaries, and units in service), and they get sent to "stop the clock" so they get their first and more EMS units don't need to be paid for or implemented to cover the area.

just for numbers, the ratio of fire calls to EMS calls is something like 4 EMS calls to every 1 fire call.  yet, most fire departments have something like a 2:1 or 4:1 ratio of fire apparatus to EMS apparatus covering the same area.  not everywhere, just most places. So EMS does much more calls than fire (subtracting the EMS runs that the FD goes on), yet they have fewer units to do the job.  

And people wonder why EMS can't be considered an equal in the public safety field


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## socalmedic (Aug 29, 2010)

DrParasite said:


> ...This is the problem with the US EMS system, we have let the fire service in, and now that they "do ems"...



lets not forget that LA county FIRE DEPARTMENT, Orange county FIRE DEPARTMENT, Seattle FIRE DEPARTMENT, and Miami FIRE DEPARTMENT where the original players in paramedicine. you didn't let the fire department into anything, we got there first.


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## JPINFV (Aug 29, 2010)

It's just too bad that LACo and (if you mean OC, CA) OCFA haven't moved very far past the days of Jonny and Roy. Heck, they're still calling in and asking the base hospital for orders on everything worse than a stubbed toe.


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## socalmedic (Aug 29, 2010)

JP- I couldnt agree with you more, however with soo many thousands of paramedics in LA county I can see why the med director wants to keep it restricted. there is no way to control that number of paramedics with such a vast experiance level (my long time mentor at LAFD just retired after 36 ish years as a medic, PTI class 3). orange county has no excuse they have maby 500-700 medics. for the record LAFD now has 60% of field employees trained to the paramedic level that is roughly 3500. ICEMA does have some good protocols, as well as reach and mercy air. look on the bright side, LA just got approved for IO. another thing to think about in LA and OC a TRANSPORTING ambulance in O/S in less than 8min 90% of the calls with an average transport time to the hospital of less than 10 min what all do you have time to do in the back. 

for those of you not familiar with the LAcoFD system, the closest fire engine, the closest paramedic squad (pick-up truck with 2 paramedics), and the closest ambulance (dual EMT-B) gets dispatched. If the squad beats the engine they can cancel.


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## JPINFV (Aug 29, 2010)

Encouragement of field termination of cardiac arrests and selective spinal immobilization (including expanding selective spinal immobilization to the EMT level) from the paramedics (since both of those are already options). Require the paramedics to obtain enough proficiency that anything that isn't worse than a stubbed toe gets base hospital contact (and, for the unfamiliar, a Southern California base hospital contact is essentially dictating the PCR over the radio to a MICN. 9 times out of 10 it's a complete waste of time). I would love to see crics done (last time I checked, it was in LA LEMSA's protocol, but not OC LEMSA's protocol) just because it's one of the handful of procedures that, when indicated, a 10 minute transport time is a long time.


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## MrBrown (Aug 29, 2010)

If I have crushing chest pain or severe shortness of breath I am putting my foot on the gas and hoping I make it to Oregon man, seriously.


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## terrible one (Aug 29, 2010)

socalmedic said:


> for the record LAFD now has 60% of field employees trained to the paramedic level that is roughly 3500.



Dude where are you getting your numbers?!?!?
LAFD has just over *3500 TOTAL *uniformed personnel and only *747ACTIVE* paramedics

http://lafdtraining.org/ems-s/wp-content/uploads/2009/08/ems-history.pdf

There is NO WAY that OCFA has 500-700 paramedics either since OCFA is about 1/3 the size of LAFD. (too lazy to look up those numbers)


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## 46Young (Aug 29, 2010)

DrParasite said:


> just for numbers, the ratio of fire calls to EMS calls is something like 4 EMS calls to every 1 fire call.  yet, most fire departments have something like a 2:1 or 4:1 ratio of fire apparatus to EMS apparatus covering the same area.  not everywhere, just most places. So EMS does much more calls than fire (subtracting the EMS runs that the FD goes on), yet they have fewer units to do the job.
> 
> And people wonder why EMS can't be considered an equal in the public safety field



People get hung up on the whole call volume/staffing thing with EMS vs fire. Suppression staffing and deployment objectives need to be met. True fire/rescue calls may be few and far between, but when they do happen, time is truly of the essence.

http://blog.iaff.org/post/2010/04/28/Fire-Fighter-Staffing-and-Deployment-Study-Released.aspx

http://www.youtube.com/watch?v=a_K-K6o5cGc

There may be only a few fires, a gas leak, CO, etc in an area each year. But if there is a delayed response, more than a few lives can be lost among other things. To say that fire suppression staffing and deployment should be pared back due to call volume shows ignorance of what fire suppression does and why an adequate, timely response is crucial regardless of call volume.

Now, I'd personally prefer to have more ambulances on the road, QRV's and such, rather than suppression pieces. This could be through an adequately third service EMS, or through the EMS division of the local FD, doesn't matter. The problem is that many local governments want to get by with as little EMS txp staffing and deployment as possible, regardless of the provider. That gives rise to ALS/BLS engines stopping the clock, etc. I see it all over the place. ALexandria Fire and EMS has only five ambulances at the present. Richmond Ambulance Authority does SSM to use as few buses and employees as possible. Charleston County EMS runs the bare minimum and uses FD EMS aid from MT Pleasant FD(ALS), Awendaw, James Island, St. John's, St. Andrews, Charleston City, North Charleston FD's, etc. FDNY EMS gets FDNY engines on many ALS jobs as an automatic dispatch as well.


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## 46Young (Aug 29, 2010)

socalmedic said:


> JP- I couldnt agree with you more, however with soo many thousands of paramedics in LA county I can see why the med director wants to keep it restricted. there is no way to control that number of paramedics with such a vast experiance level (my long time mentor at LAFD just retired after 36 ish years as a medic, PTI class 3). orange county has no excuse they have maby 500-700 medics. for the record LAFD now has 60% of field employees trained to the paramedic level that is roughly 3500. ICEMA does have some good protocols, as well as reach and mercy air. look on the bright side, LA just got approved for IO. another thing to think about in LA and OC a TRANSPORTING ambulance in O/S in less than 8min 90% of the calls with an average transport time to the hospital of less than 10 min what all do you have time to do in the back.
> 
> for those of you not familiar with the LAcoFD system, the closest fire engine, the closest paramedic squad (pick-up truck with 2 paramedics), and the closest ambulance (dual EMT-B) gets dispatched. If the squad beats the engine they can cancel.



FDNY EMS has a similar problem. There's the FD, two privates, and a bunch of different hospitals providing 911 EMS txp in the city. As such, it's mother may I via a call to the doc-in-the-box for anything that requires deviation from the cookbook in the slightest. There are too many different providers, and each employer has different hiring and QA/QI standards.


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## Shishkabob (Aug 29, 2010)

socalmedic said:


> JP- I couldnt agree with you more, however with soo many thousands of paramedics in LA county I can see why the med director wants to keep it restricted. there is no way to control that number of paramedics with such a vast experiance level



Sure there is.  Way more selective hiring, and a better FTO program.


If other cities can do it, why is LA the exception?


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## JPINFV (Aug 29, 2010)

terrible one said:


> There is NO WAY that OCFA has 500-700 paramedics either since OCFA is about 1/3 the size of LAFD. (too lazy to look up those numbers)



I believe he was talking about all of OC, not just OCFA. However, if you're a paramedic in OC, you're a fire fighter. No way around that one as even the flight medic has a different title.


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## Seaglass (Aug 29, 2010)

DrParasite said:


> out of curiosity, why were they terrible?  was it due to being overworked and under paid, or was their clinical skill lacking due to lack of dealing with sick patients?



Let me count the ways... 

A great deal of attention to the bottom line at the expense of everything else, like decent equipment, employee education, salary, benefits, and sometimes even initiating care before getting an insurance card. Abusive supervisors, an extremely rigid pecking order, and a culture that fostered a complete lack of respect for patients didn't help. Their response times also somehow managed to be slower than fire even though they were often responding from a closer staging location. 



> again, bandaiding an under staffed EMS system with firefighters.  how about putting an EMS unit at those fire stations, so when you have a time sensitive call (cardiac arrest, MI, CVA, major trauma, etc) you have a unit that can transport to definitive care (ie, an MD and/or surgeon) instead of just performing the circle of wait until EMS actually arrives?



Actually, the ambulances did run out of fire stations. The usual setup was one BLS engine, one ALS ambulance, and one ALS chase car. They went alone to medical calls most of the time. But if the ambulance was out on a call already, it could be a long time before the next station's could get there. So you'd send the engine, along with the chase car if warranted, while dispatching the closest ambulance. It wasn't all that common. Call volumes were low to begin with. 

By total number of apparatus, or units in service, we had more EMS vehicles than fire suppression. A few stations also housed PD, but I don't know what the numbers looked like there. Some of them were trained as EMTs as well, but it was extremely rare that they acted as such. Law enforcement calls were way more common than fire, so it wouldn't make sense to tie those resources up unless both EMS and fire were already busy, which pretty much never happened.


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## socalmedic (Aug 29, 2010)

terrible one, my numbers come from Captain Wells, paramedic captain @EMS training division (now retired as of may). paramedic/engineres, paramedic/captains are not counted in their active medic count. what i said was 60% of personells are Trained to the paramedic level, not working as a paramedic, however they are allowed to perform ALS interventions as long as they are a paramedic. If i got my numbers wrong it is either 60% of 3500 or 60% is 3500, idk, your a big boy figure it out. the numbers are used more as an image of how many paramedics there are in this one system.


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## DrParasite (Aug 29, 2010)

46Young said:


> People get hung up on the whole call volume/staffing thing with EMS vs fire. Suppression staffing and deployment objectives need to be met. True fire/rescue calls may be few and far between, but when they do happen, time is truly of the essence.


agreed 100%.  and true EMERGENCY medical calls are much more frequent, and ALL need an emergency room, not a fire truck


46Young said:


> http://blog.iaff.org/post/2010/04/28/Fire-Fighter-Staffing-and-Deployment-Study-Released.aspx
> 
> http://www.youtube.com/watch?v=a_K-K6o5cGc


two links to union materials aren't good sources, esp when the last one is about a 4th FF on a truck company.  they are biased (not that they aren't right, just biased).



46Young said:


> There may be only a few fires, a gas leak, CO, etc in an area each year. But if there is a delayed response, more than a few lives can be lost among other things.


delayed responses in any field can result in loss of lives.





46Young said:


> To say that fire suppression staffing and deployment should be pared back due to call volume shows ignorance of what fire suppression does and why an adequate, timely response is crucial regardless of call volume.


this is the same fear mongering that unions use to say that every firehouse that closes will result in the loss of lives.  It's not true.  It DOES increase the chance, but that's the gambit the people in power make.  It can be said that a certain hypothetical department has too much fire protection, and maybe they are right?  no one ever says that.

The ideal situation is a firehouse with an engine, truck and rescue on every street corner, with 6 guys on each unit.  that's ideal, but also not realistic.  So the powers that be determine how many and where the suppression units should be located.  again, above my paygrade.


46Young said:


> Now, I'd personally prefer to have more ambulances on the road, QRV's and such, rather than suppression pieces. This could be through an adequately third service EMS, or through the EMS division of the local FD, doesn't matter.


me too. 





46Young said:


> The problem is that many local governments want to get by with as little EMS txp staffing and deployment as possible, regardless of the provider.


and therein lies the problem.  





46Young said:


> That gives rise to ALS/BLS engines stopping the clock, etc. I see it all over the place. ALexandria Fire and EMS has only five ambulances at the present. Richmond Ambulance Authority does SSM to use as few buses and employees as possible. Charleston County EMS runs the bare minimum and uses FD EMS aid from MT Pleasant FD(ALS), Awendaw, James Island, St. John's, St. Andrews, Charleston City, North Charleston FD's, etc. FDNY EMS gets FDNY engines on many ALS jobs as an automatic dispatch as well.


That's what I'm talking about.  look at the majority of FD's, how many of their total runs are EMS based?  I think for FDNY, they had something like 1.2 million runs last year, of which 800,000 were EMS related (I can't find the actual numbers off the top of my head).  Imagine how often those fire suppression units are unavailable for fire jobs due to being on EMS jobs in their first due?  and I know it is the same way all over.

as I said before (and you said also), municipalities want to get by with as little EMS as possible.  THIS IS WRONG.  This mentality needs to change.  EMS should be staffed properly, to handle the call volume, as well as the peaks and surges.  But they won't, and instead use the fire department to bandaid an understaffed EMS system, which costs more lives than fire related deaths, because a fire truck can't (well, shouldn't, some resort to) do what the patient needs, and that is transport to definitive care, which is a hospital ER.

thank you, you just supported the point I was trying to make.


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## nomofica (Aug 29, 2010)

Here in Edmonton, Alberta, Canada, FD is always dispatched along with EMS on chest pain, respiration problems, falls or any other sort of call where there is a foreseeable need for some brute strength and many hands. That being said, all firefighters in Alberta are required to possess a valid Emergency Medical Responder (EMT-Basic) certification by the Alberta College of Paramedics and thus all firefighters are medical responders. Pretty sure this same concept of EMS and fire response is all across the board for Canada, though I cannot be certain as I'm extremely unfamiliar with the workings of the eastern provinces.


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## DNR 1 (Aug 30, 2010)

Nicely put sir!


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## Dutch-EMT (Aug 30, 2010)

But when talking about money...
It is a lot cheaper to have an ambulance with an ambulancecrew than have a large fire engine with a couple firefighters...
I mean: an ambulance, completely equiped costs about €150.000,= MAX!
An fire engine costs €1.000.000,= minimum!
When EMS is in the FD. Why they don't buy an extra ambulance and sell one of the Engines? When most of the calls are EMS, it looks more logical in my oppinion. You save on a engine and on staff, and there is an extra ambulance on the roads...


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## terrible one (Aug 30, 2010)

socalmedic said:


> If i got my numbers wrong it is either 60% of 3500 or 60% is 3500, idk, your a big boy figure it out.




Not sure exactly what this means, but I did figure them out in my link. As for your 60% of 3500 personell are paramedics I even question that since there are only 747 paramedic positions in LAFD and once you promote to an engineer/captain you are not required to keep your P-card. Maybe your talking about 60% of 3500 are former and current paramedics I'm not sure but I highly doubt that over half of their personell has an active medic license especially when you don't even need an EMT card to get hired.


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## dave3189 (Sep 9, 2010)

*Can't believe we are talking about this again?!*

The point about privates doing it at no cost to the city is a moot point!  Guess why that is, hmmmm because they are charging for the transports which is exactly what most F.D. BLS and ALS units do.  That being said, there is still no cost to the taxpayers as a whole because the patients are paying the bills.  As for the tax payer money savings issue goes, here we go again!  For you EMS only people, I suggest you visit a Fire house and go on some ride alongs so you can see how rare fires are in the U.S.  Most F.D.s run about 80% EMS calls.  That being said, if they dont do EMS are they supposed to sit around all day and do nothing.  Then someone is going to respond to this post that they should have less FFs and more EMS people working at the F.D.  Not true, again complete ignorance as to Fire Operations.  To use an analogy, we have had a lot of military people sitting around the world doing nothing throughout the years simply because when they are needed, we need a certain staffing compliment.  It's the same with Fire Fighting.  When there is a fire, we need FFs.  The beauty is, that when not fighting fires, we can work EMS.  It aint that tough to be cross trained in these two disciplines people.  It always has to come down to the turf wars!  Bottom line, spew all the stats and stories... at the end of the day you are kidding yourself if you are actually going to make the arguement that cross trained Fire/EMS isnt more effecient and a cost saver.


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## JPINFV (Sep 9, 2010)

However, why EMS? Have the fire department take over part of the parks department. Unlike EMS calls, when a fire or extrication call comes in, the fire department can easily leave the grass half cut, however they can't leave the EMS call. Similarly, when there is a fire call and all of the paramedics are working the fire, who is left to respond for EMS calls? Opps, sorry. All of the engines were at a fire, so it took 30 minutes longer for mutual aid to arrive. Hope that extra heart muscle that died during your MI was worth the non-savings of the fire department running EMS. 

Additionally, I'll argue that to provide competent prehosptial medical care is harder than most people want to admit. Thankfully, most EMS providers are happy with the responsibilities of being a para-technician following cookbook protocols and procedures instead of being actual prehospital professionals. I personally refuse to be a para-technician, which is why I'm on the road I'm currently on. 

Also, when 80% of your calls are EMS, you're an EMS department that fights fires, not a fire department that does EMS.


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## 46Young (Sep 9, 2010)

dave3189 said:


> The point about privates doing it at no cost to the city is a moot point!  Guess why that is, hmmmm because they are charging for the transports which is exactly what most F.D. BLS and ALS units do.  That being said, there is still no cost to the taxpayers as a whole because the patients are paying the bills.  As for the tax payer money savings issue goes, here we go again!  For you EMS only people, I suggest you visit a Fire house and go on some ride alongs so you can see how rare fires are in the U.S.  Most F.D.s run about 80% EMS calls.  That being said, if they dont do EMS are they supposed to sit around all day and do nothing.  Then someone is going to respond to this post that they should have less FFs and more EMS people working at the F.D.  Not true, again complete ignorance as to Fire Operations.  To use an analogy, we have had a lot of military people sitting around the world doing nothing throughout the years simply because when they are needed, we need a certain staffing compliment.  It's the same with Fire Fighting.  When there is a fire, we need FFs.  The beauty is, that when not fighting fires, we can work EMS.  It aint that tough to be cross trained in these two disciplines people.  It always has to come down to the turf wars!  Bottom line, spew all the stats and stories... at the end of the day you are kidding yourself if you are actually going to make the arguement that cross trained Fire/EMS isnt more effecient and a cost saver.



That sounds about right.

As for the whole crosstraining debate, I suppose that the single minded people feel belittled to an extent when they see people doing their job along with another. Granted, there are quite a few that get the P-card just for an easy in with a FD, and did the bare minimum to pass, but that's not the argument. The argument is whether or not one can do fire and EMS and be good at both. I haven't heard one good argument as to why you can't, just vague offerings such as "you're spreading yourself too thin," or "they're different skills sets." Irrelevant. Some folks are just going to have to swallow that it's not that difficult to be proficient in both fire and EMS as a combined career in this country. It's not to slight single minded medics, it's important work and not everybody can get through the EMT-P program, but I found the program to be less than challenging. 

Think about it. An EMT-P program typically lasts from 6 months to 2 years. A typical fire academy that trains FF1 and FF2 lasts from four months to six months. That's two and a half years of education/training. that's about the same amount of time it takes to get an RN degree, let alone a BSN. In addition to that, medics either come to the FD with P-card in hand, or are detailed out of ops to focus solely on the medic program. If you have experience as a medic prior to being hired by a FD, then all the better! Also, many large FD's regularly schedule companies for OOS training, This can be company ops, multi unit drills, whatever. This is in addition to doing a few daily drills at the station each day while in service. Maybe pump ops, ropes, throwing ladders, building preplans and walkthroughs, various powerpoints on the numerous operating manuals such as high rise, garden apts, strip shopping centers, gas leaks/meters, etc. This is all on duty, remember? Add EMS drills and scheduled ConED, either on an off day or preferably on duty and OOS. EMS runs more calls, so we're keeping our skills sharp through repetition, right?


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## MrBrown (Sep 9, 2010)

If I need an Intensive Care Paramedic (ALS) at one am for some guy upside down in a ditch or on his floor struggling to breathe who needs intubating then I have total faith in the Officer who comes towards me.

Why? because he is not a Para-technician with a big thick cookbook and piss poor education.  Our Intensive Care Paramedics (well, all our Ambulance Officers) are amongst the most highly educated and experienced in the Western world and many already have, and will be required to obtain, a Bachelors (Paramedic) or Advanced (ICP) degrees in Paramedicine.

They have the knowledge and experience to be autonomous practitioners of advanced prehopsital medicine and not follow a recipe book which is devised for the lowest common denominator (read: biggest clinical risk) to follow.


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## 46Young (Sep 9, 2010)

JPINFV said:


> However, why EMS? Have the fire department take over part of the parks department. Unlike EMS calls, when a fire or extrication call comes in, the fire department can easily leave the grass half cut, however they can't leave the EMS call. Similarly, when there is a fire call and all of the paramedics are working the fire, who is left to respond for EMS calls? Opps, sorry. All of the engines were at a fire, so it took 30 minutes longer for mutual aid to arrive. Hope that extra heart muscle that died during your MI was worth the non-savings of the fire department running EMS.
> 
> Additionally, I'll argue that to provide competent prehosptial medical care is harder than most people want to admit. Thankfully, most EMS providers are happy with the responsibilities of being a para-technician following cookbook protocols and procedures instead of being actual prehospital professionals. I personally refuse to be a para-technician, which is why I'm on the road I'm currently on.
> 
> Also, when 80% of your calls are EMS, you're an EMS department that fights fires, not a fire department that does EMS.



In areas with mutual aid, unless you're in Detroit, it's highly unlikely that there are no engines available during simultaneous box alarms. Good depts plan for this. Relocations are effective, and we go to condition two or three if call volume surges. We push back all the low priority calls, and also scale back suppression responses, A report of fire may get two engines and a truck instead of 4 engines, two trucks, a rescue, a medic unit, BC and EMS supervisor. If it's legit, then they'll fill the box. As it stands, our fire and EMS deployment is adequate to withstand call surges. EMS Capt's can also respond to EMS runs instead of engines if they're tied up.

A suppression unit could just as easily be tied up at an alarm bell, cut job, or a gas leak when a box alarm comes through, as they could on an EMS run. And haven't studies shown that ALS first response has neither been proven nor disproven to affect pt outcomes? Unless it's something time sensitive or labor intensive, the medic crew could always release the suppression unit if feasible to run a fire. Can't do that on a suppression call, but it can be done in EMS if it's not going to harm the pt. I did just fine back in NY with just me and my partner, I'm sure the medic crews here will be okay as well in most cases. How many cases are really time sensitive, needing more than a crew of two? Maybe like 5%?

As far as the low educational standards in EMS, go complain to every employer that hires those without degrees, which include every type of delivery model, not just fire.


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## dave3189 (Sep 9, 2010)

The Parks Dept. analogy is silly, I won't even dignify it with a response.  As far as your issue with running out of resources, again silly and moot!  You could run out of resources regardless of them being fire, EMS or cross trained as both.  As far as the cookbook issue, sounds like a CA problem?  All I hear is how CA Medic protocols are cookbook.  I got news for ya, it aint a Fire problem it's a CA problem.  In WA state, we aren't cookbook and we have some of the most progressive and best (Fire Based) Medic resources in the world.  Brown, you're spewing the same tired nonsense you've been saying for months!  I hate to tell you, but nobody knows or really cares about the N.Z EMS system!  With such a supposedly great program, don't they have any network sites over there?


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## 46Young (Sep 9, 2010)

MrBrown said:


> If I need an Intensive Care Paramedic (ALS) at one am for some guy upside down in a ditch or on his floor struggling to breathe who needs intubating then I have total faith in the Officer who comes towards me.
> 
> Why? because he is not a Para-technician with a big thick cookbook and piss poor education.  Our Intensive Care Paramedics (well, all our Ambulance Officers) are amongst the most highly educated and experienced in the Western world and many already have, and will be required to obtain, a Bachelors (Paramedic) or Advanced (ICP) degrees in Paramedicine.
> 
> They have the knowledge and experience to be autonomous practitioners of advanced prehopsital medicine and not follow a recipe book which is devised for the lowest common denominator (read: biggest clinical risk) to follow.



Like I told JP, blame each and every employer that chooses to hire without an EMS degree for the lack of educational standards. Outside of Oregon, the percentage of employers requiring degrees to be hired are likely in the single digits. The best we have clinically in the U.S. is the EMS AAS, which is basically a mill with A&P, pharm, ENG, and PSY thrown in, for the most part.


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## JPINFV (Sep 9, 2010)

46Young said:


> "you're spreading yourself too thin," or "they're different skills sets."


It's ironic, though, because those are the exact arguments the fire department uses against combining fire with law enforcement. I'd argue that hoses, pumps, and ladders have as much to do with handcuffs and side arms as they do with IV catheters and cardiac monitors. 




> EMS runs more calls, so we're keeping our skills sharp through repetition, right?


Provided not every apparatus is an ALS response unit with everyone on each apparatus is a paramedic. Unfortunately, 2006 was the last time Orange County LEMSA posted an annual report (and, no, I'm not going to add up the calls from the 4 quarterly reports in 2007). Call volumes for paramedic units (paramedic units are limited to the fire departments, which makes it an easy comparison), ranged from 1265 to 0 calls in 2006 (note: I was originally going to just report a few low digit numbers along side the lowest decent sized call volume, which I was hoping to be at least in the hundreds, in case it was a special situation, however there were too many units in the single digits to just ignore the single/null digit units. Additional note, I'm not counting the out-of-county units that did mutual aid calls, so I ignored the LA County Fire count). Exactly how sharp are the skills of the medics on the units running 0 calls or a handful (under 10) calls in a year? Yes, they most likely rotate, but doesn't the fact that they are rotating from units that run, on average, 3.5 calls a day to a unit that runs zero calls in a year drastically dilutes the individual provider's call volume that much more?


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## 46Young (Sep 9, 2010)

dave3189 said:


> The Parks Dept. analogy is silly, I won't even dignify it with a response.  As far as your issue with running out of resources, again silly and moot!  You could run out of resources regardless of them being fire, EMS or cross trained as both.  As far as the cookbook issue, sounds like a CA problem?  All I hear is how CA Medic protocols are cookbook.  I got news for ya, it aint a Fire problem it's a CA problem.  In WA state, we aren't cookbook and we have some of the most progressive and best (Fire Based) Medic resources in the world.  Brown, you're spewing the same tired nonsense you've been saying for months!  I hate to tell you, but nobody knows or really cares about the N.Z EMS system!  With such a supposedly great program, don't they have any network sites over there?



NYC, the largest EMS system in the country, has been all about the cookbook since way before the fire merger, and it's the same now. The syetem has hospital based, a couple of privates, and of course FDNY EMS, which are 100% single role EMS for txp. My old medic gig down in Charleston was single role county third service, and they were cookbook as well.

I agree, that Parks Dept analogy was weak. I'm waiting for someone to mention FF/garbage men, or the PSO's. That always gets dragged up.


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## dave3189 (Sep 9, 2010)

And of course this debate wouldn't be complete without the tired, ignorant, silly and overused Fire/Law Enforcement contention!?  For those of you out there that can't see that the relationship with Fire/Rescue and EMS is obviously symbiotic in contrast to Law Enforcement... well, I'm not sure your reasoning abilities are as sharp as your EMS abilities hopefully are???


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## JPINFV (Sep 9, 2010)

46Young said:


> And haven't studies shown that ALS first response has neither been proven nor disproven to affect pt outcomes? Unless it's something time sensitive or labor intensive, the medic crew could always release the suppression unit if feasible to run a fire. Can't do that on a suppression call, but it can be done in EMS if it's not going to harm the pt.



1. I'd argue that patient outcomes matter besides life and death. Yes, an EMT crew can load and go the reactive airway disease patient with likely no long term harm, however I'm willing to bet that the patient would absolutely love to have an albuterol treatment now instead of 10-15 minutes from now. They might not die from lack of a treatment, even if they feel like they're about to suffocate. Similarly, narcotic pain control doesn't save lives, however I'd argue that it's barbaric to deny a patient pain control because all of the paramedics were doing their other job. 

1.2 Heck, there are studies that show that BLS doesn't save lives over POV transport. Let's get rid of ambulances to begin with. Is there any study that shows that anything besides an attendant trained to CPR/AED saves lives? So EMS doesn't save lives. Homeboys delivering their shot-up homies themselves to the ED saves lives. 

2. You're assuming that there are paramedics on the ambulance when plenty of systems just have paramedics on engines. Are you going to release the fire engine to go fight a fire with just 2 fire fighters on it? 



> As far as the low educational standards in EMS, go complain to every employer that hires those without degrees, which include every type of delivery model, not just fire.


I have yet to see the privates release a "Private Ambulance, The Right Response" chest beating video. You (the fire service) wants to claim that you're the "right response" fine, live up to it. However the US Fire Administration doesn't even believe that instructors need to have an education. Do I need to post their little chart again?


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## 46Young (Sep 9, 2010)

JPINFV said:


> It's ironic, though, because those are the exact arguments the fire department uses against combining fire with law enforcement. I'd argue that hoses, pumps, and ladders have as much to do with handcuffs and side arms as they do with IV catheters and cardiac monitors.
> 
> 
> 
> Provided not every apparatus is an ALS response unit with everyone on each apparatus is a paramedic. Unfortunately, 2006 was the last time Orange County LEMSA posted an annual report (and, no, I'm not going to add up the calls from the 4 quarterly reports in 2007). Call volumes for paramedic units (paramedic units are limited to the fire departments, which makes it an easy comparison), ranged from 1265 to 0 calls in 2006 (note: I was originally going to just report a few low digit numbers along side the lowest decent sized call volume, which I was hoping to be at least in the hundreds, in case it was a special situation, however there were too many units in the single digits to just ignore the single/null digit units. Additional note, I'm not counting the out-of-county units that did mutual aid calls, so I ignored the LA County Fire count). Exactly how sharp are the skills of the medics on the units running 0 calls or a handful (under 10) calls in a year? Yes, they most likely rotate, but doesn't the fact that they are rotating from units that run, on average, 3.5 calls a day to a unit that runs zero calls in a year drastically dilutes the individual provider's call volume that much more?



Our Fire Marshalls all go to our county's full fire academy and then additional training in detective work. No one's had a problem with that, as far as I know. Soe are medics as well, ans continue to do OT in the field in either role and have had no issues. 

The convenient thing for us is that most PD's don't want to merge with fire and vice versa. The deployment for EMS and fire are more similar than either one with PD, so fire/EMS makes sense to that end. 

I don't know much about L.A. but when I worked in Charleston, medic 10 and medic 6 were so slow (rural ends of the county)that they may get one call, or maybe none whatsoever in a 24 hour period. Considering how few of our pts require anything past V.O.M.I.T. how many good calls are they seeing? I'm sure this is the case in other areas as well in rural regions.


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## dave3189 (Sep 9, 2010)

Wow, JP... I'm an educated Man... but I'm afraid I can't make heads nor tails of that last rant!?  Huh?


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## JPINFV (Sep 9, 2010)

dave3189 said:


> The Parks Dept. analogy is silly, I won't even dignify it with a response.


Really? Why should fire fighters respond to EMS calls any more than requests from the Parks Department? A shovel has more to do with fire fighting than an IV and cardiac monitor. 



> As far as your issue with running out of resources, again silly and moot!  You could run out of resources regardless of them being fire, EMS or cross trained as both.






> As far as the cookbook issue, sounds like a CA problem?  All I hear is how CA Medic protocols are cookbook.  I got news for ya, it aint a Fire problem it's a CA problem.  In WA state, we aren't cookbook and we have some of the most progressive and best (Fire Based) Medic resources in the world.


California has a strong regional system with regional (county) protocols. I originally worked in an area where the only paramedics were with the fire department except for the few "air ambulance attendant" (they weren't issued county accreditation to work as "paramedics") flight paramedics. Tell me again how the cookbook protocols are anyone but the fire department's fault? Similarly, I like how you have to specify that it's the best "fire based" system. 



> Brown, you're spewing the same tired nonsense you've been saying for months!  I hate to tell you, but nobody knows or really cares about the N.Z EMS system!  With such a supposedly great program, don't they have any network sites over there?



Strange, I thought that this was an EMS site, not an United States EMS site.


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## JPINFV (Sep 9, 2010)

dave3189 said:


> And of course this debate wouldn't be complete without the tired, ignorant, silly and overused Fire/Law Enforcement contention!?  For those of you out there that can't see that the relationship with Fire/Rescue and EMS is obviously symbiotic in contrast to Law Enforcement... well, I'm not sure your reasoning abilities are as sharp as your EMS abilities hopefully are???




How, exactly, is it symbiotic? What relationship does fighting fires have with the provision of prehospital medical care again short of, "Hey, we're sitting around anyways."


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## JPINFV (Sep 9, 2010)

46Young said:


> The convenient thing for us is that most PD's don't want to merge with fire and vice versa. The deployment for EMS and fire are more similar than either one with PD, so fire/EMS makes sense to that end.


Last I checked, KC/MAST didn't want to merge either, but that didn't stop the fire service/IAFF.


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## 46Young (Sep 9, 2010)

JPINFV said:


> 1. I'd argue that patient outcomes matter besides life and death. Yes, an EMT crew can load and go the reactive airway disease patient with likely no long term harm, however I'm willing to bet that the patient would absolutely love to have an albuterol treatment now instead of 10-15 minutes from now. They might not die from lack of a treatment, even if they feel like they're about to suffocate. Similarly, narcotic pain control doesn't save lives, however I'd argue that it's barbaric to deny a patient pain control because all of the paramedics were doing their other job.
> 
> 1.2 Heck, there are studies that show that BLS doesn't save lives over POV transport. Let's get rid of ambulances to begin with. Is there any study that shows that anything besides an attendant trained to CPR/AED saves lives? So EMS doesn't save lives. Homeboys delivering their shot-up homies themselves to the ED saves lives.
> 
> ...



Reactive airway, APE, STEMI, and the like would be cases where the engine stays on scene. If the dept only has engine medics, then they need to allow for the engine medic riding to the hospital, and plan accordingly regarding staffing/deployment.

I'm not sure that many representing delivey systems outside the fire service care if instructors are educated or not, either. It's proven each and every time an employee is hired with less than an EMS degree. 

That right response line is quite effective. Since we've had no real opposition to it, we'll keep using that angle. It seems to be working. Good for job security.

I kile the homeboy delivery system. Really, all we're needed for are true cardiac/respiratory issues, and for those that truly can't move under their own power. Most others would be better off going by POV, ambulette, or by actually walking if the hospital is a few blocks away. The time lost in calling 911, driving to the scene, getting to the pt, doing the assessment, and packaging them is way more than if they got in a cab or had someone just drive them.


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## 46Young (Sep 9, 2010)

JPINFV said:


> Last I checked, KC/MAST didn't want to merge either, but that didn't stop the fire service/IAFF.



Well, one wanted to. I was talking about both parties having a mutual interest in staying seperate.


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## JPINFV (Sep 9, 2010)

dave3189 said:


> Wow, JP... I'm an educated Man... but I'm afraid I can't make heads nor tails of that last rant!?  Huh?



This might help.

http://www.fireserviceems.com/videos.php

2 part video from a medic turned physician debunking IAFF, et. al. claims. 

http://www.youtube.com/watch?v=kEpcMyM8_0c

http://www.youtube.com/watch?v=ad80GcWSJC0

On a side note, I sent a request a few years ago for IAFF et. al. source for their claims. They never responded.


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## dave3189 (Sep 9, 2010)

OK JP, although obvious to all viewing, here we go with the Parks Dept. issue.  Ya see Fire and EMS are part of Emergency Services... and the Parks Dept isn't... see? Get it now?  The problem with using an analogy to make a point is that it actually needs to be analogous   My point about CA, is that I hear that its cookbook all the time.  Since we don't have that problem here in WA, I'm assuming it’s a CA problem.  And finally, and strangely, you ask why I throw in "Fire Based" in my argument.  Well, again... here it goes so try to keep up... we have been debating fire based EMS vs. non-fire based?  Weird that I would make a point about that???


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## 46Young (Sep 9, 2010)

JPINFV said:


> How, exactly, is it symbiotic? What relationship does fighting fires have with the provision of prehospital medical care again short of, "Hey, we're sitting around anyways."



An increase of net utilization of otherwise idle crews, which allows cost savings in hiring/payroll. Similar deployment structure as well. It comes down to $$$, of course. It ultimately does in most cases.


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## socalmedic (Sep 9, 2010)

PSO (public safety officer= FF/PO/PM) has been tried and has failed. I currently only know of one city left in the state of CA that has PSO (it is in the bay area, i will have to look it up in the morning), and they don't even work as both, they specialize in FF/PM or PO. 

JP you have sparked my interest, could you provide a link for that info. i am curious as to what units those are that arent running any calls, I can think of a few off the top of my head that are 1-2 per day but none that run slower than that. you also have to remember that they are staged based on response time not unit call volume, if they where transporting medic units they would still be stationed there and run just as many calls.


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## JPINFV (Sep 9, 2010)

46Young said:


> Reactive airway, APE, STEMI, and the like would be cases where the engine stays on scene. If the dept only has engine medics, then they need to allow for the engine medic riding to the hospital, and plan accordingly regarding staffing/deployment.



Of course to do so also throws the entire, "We save lives while saving you money" argument out of the window. Isn't cost effectiveness the huge argument for EMS based fire suppression? You're no longer taking fire fighters who are just sitting around doing nothing and having them respond, you're hiring more providers and having everyone sit around on average just a little bit less (normally due to an over response.), however with still more proverbial mouths to feed. 



> I'm not sure that many representing delivey systems outside the fire service care if instructors are educated or not, either. It's proven each and every time an employee is hired with less than an EMS degree.


However how many services besides the fire service have come out publicly and said, "We don't need any education outside of management." 




> I kile the homeboy delivery system. Really, all we're needed for are true cardiac/respiratory issues, and for those that truly can't move under their own power. Most others would be better off going by POV, ambulette, or by actually walking if the hospital is a few blocks away. The time lost in calling 911, driving to the scene, getting to the pt, doing the assessment, and packaging them is way more than if they got in a cab or had someone just drive them.



I'll largely agree that plenty of people who call 911 should transport themselves. However how many people who should be calling 911 are we going to allow to be persuaded to not call to cut down on abuse?


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## LucidResq (Sep 9, 2010)

dave3189 said:


> For those of you out there that can't see that the relationship with Fire/Rescue and EMS is obviously symbiotic in contrast to Law Enforcement... well, I'm not sure your reasoning abilities are as sharp as your EMS abilities hopefully are???



Just to throw in something here... I'd like to point out that I see PD calls evolving in to medical calls much more than I see Fire calls becoming medical. 

I can't tell you how many times I've seen a PD call for an assault, welfare check, domestic, etc etc end up being sent over for an EMS response or an ambulance transport for a mental health hold. I have yet to see any of the various structure fires, alarms, lockout assists, water problems, etc require an EMS response beyond the standard stand-by on fire scenes... 

MVAs are in a different realm because they always get at least a PD response.... at least around here Fire only goes if there's a reason like injuries, damage to structure, leaking fluids, trapped parties, etc... even in that case police almost always beats Fire to the scene. 

So the "Symbiotic Relationship" between Fire and EMS is not any more obvious than that between LE and EMS, in my opinion. Yes, you can point out the rare technical rescue where it's helpful to have the front line rescuers also trained to a higher level of medical care as well, but those calls are rare (and even rarer are the calls that having a paramedic, for example, involved in the initial rescue efforts is even useful) and there's no reason strictly EMS providers can't participate in such rescues with additional training.


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## dave3189 (Sep 9, 2010)

Wow, a couple youtube videos!  Now I've been put in my place!  You mean you were able to scour the internet and find something to support your contention?  Gee, If only I could find something to support Fire Based EMS? 
I mean for God Sakes, if you want to start playing the cheese ball game, 60 Minutes said back in 1974 that with Seattle Fire's Medic One program, that Seattle was the best place in the nation to have a heart attack.


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## dave3189 (Sep 9, 2010)

Gee JP, I wasn't aware that FFs do nothing other than supression?  Vehicle extrication, confined space rescue, high angle rescue, low angle rescue, Haz Mat?


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## JPINFV (Sep 9, 2010)

socalmedic said:


> PSO (public safety officer= FF/PO/PM) has been tried and has failed. I currently only know of one city left in the state of CA that has PSO (it is in the bay area, i will have to look it up in the morning), and they don't even work as both, they specialize in FF/PM or PO.
> 
> JP you have sparked my interest, could you provide a link for that info. i am curious as to what units those are that arent running any calls, I can think of a few off the top of my head that are 1-2 per day but none that run slower than that. you also have to remember that they are staged based on response time not unit call volume, if they where transporting medic units they would still be stationed there and run just as many calls.



Sorry about that... I meant to include it in the bottom of that post. 

http://www.ochealthinfo.com/docs/medical/ems/2006_annual_system_activity_report.pdf

PDF page 8-11 (report page 7-10 due to table of contents not being a "page")

I'm sure that some of the units are temporary units to replace apparatuses that went out of service, however I felt that there's just too many to argue that for every single digit response unit.


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## JPINFV (Sep 9, 2010)

dave3189 said:


> Wow, a couple youtube videos!  Now I've been put in my place!  You mean you were able to scour the internet and find something to support your contention?  Gee, If only I could find something to support Fire Based EMS?
> I mean for God Sakes, if you want to start playing the cheese ball game, 60 Minutes said back in 1974 that with Seattle Fire's Medic One program, that Seattle was the best place in the nation to have a heart attack.



If you can't see the difference between a piece in 1974 and a contemporary piece, then I don't see any reason to continue discussing anything with you. You wanted to know where that argument was coming from and I provided said source (unless, of course, the various fire organizations end up throwing their icons on everything) as well as a rebuttal. Do you have anything to argue counter to the rebuttal besides the fact that it's on Youtube?


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## MrBrown (Sep 9, 2010)

46Young said:


> NYC, the largest EMS system in the country, has been all about the cookbook since way before the fire merger, and it's the same now. The syetem has hospital based, a couple of privates, and of course FDNY EMS, which are 100% single role EMS for txp. My old medic gig down in Charleston was single role county third service, and they were cookbook as well.



Also blame the majority of employees who don't see value or the importance of advanced education.


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## socalmedic (Sep 9, 2010)

JP- good report. I hove some info on the low numbers though.

first those are not the number of responses those are the numbers of ALS Transports (no not transports where a paramedic rides in, a transport where an "ALS skill" is utilized beyond assessment, IV and ECG 3 or 12 lead). further more many of those are units that are not usualy staffed as MEDIC. they may have been used as a medic because of staffing shortage or because there where other engines out of county on wildfires ect. below i have listed some of the "outliers" and the lease utilized actual ALS units

Anaheim 4-3, 4-4, 1-1 i have no idea what these units are as they use medic engines and contract with CARE ambulance for transport.

fountain valley truck 31 this is primarily a BLS unit however it is stationed with an ALS engine and the FF/PM can rotate making both units ALS

Garden Grove engine 2R is a reserve engine, the primary engine for that station was most likely in the shop. E3, E6, E7 primarly BLS however are stationed with ALS ambulances which allow FF/PM to rotate making both units ALS.

LAcoFD- only squad 191 is ALS Transporting, and they only reported calls ran in orange county. (to all of you out of the area, a few citys in Orange county have contracted for fire serviced from LA county fire causing these medics to respond to both LA and Orange county, they hold accreditation in both countys and follow their respective protocol)

Orange City some engines are ALS some are BLS however there is an Ambulance at the majority of the stations so they usualy make the call in since they are the transporting unit they get the count.

OCFA- heres the big list, unless it says MEDIC it is BLS the lowest numbers for ALS engines where 189 for E9 and 157 for E57. these are both in semi secluded affluent areas where the majority of the residents will transport themselves.

so with 157 being the actual lowest number for actual ALS units, i agree that one ALS skill every other call isnt enough to keep skills sharp, but lets be honest its Orange County what can they do anyway. it is a good report and i can see how the unit numbering can get confusing.


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## JPINFV (Sep 9, 2010)

A few quick comments.

I wonder if Anaheim 4-3, 4-4, and 1-1 are their Downtown Disney units since they aren't engines. 

LACo. I actually didn't realize that LACo ran primary units in OC. I just figured that they were mostly mutual aid calls and ignored LACo statistics completely (I'll admit to being biased, but at least I try to be fair when it comes to things like this). Which, of course, also confused me as to why they were included since mutual aid calls are done via home county protocols and procedures, including base contact. 

My one comment on OCFA is that the report only discusses paramedic, not EMT, transports, so the multiple zeros at best, then, were EMT units that temporarily went online as paramedic units and were never utilized. While some slack is a good thing, too much excess resources is not. I was going to comment about Medic 27, but I just looked them up on OCFA's website and they opened in 2007, which would make sense if the unit was licensed, but not operational at the end of 2006. Their 2009 volume, per OCFA's website, was 397 for everything (no breakdown between fire, extrication, EMS, etc or "medic van" [which destroys the cost argument alone, but that's a separate rant about running ambulances and not using them for transport] vs engine).


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## socalmedic (Sep 9, 2010)

hahaha, yea the whole medic van concept is lost on me. they have full stocked ambulance staffed with 2 FF/PM but dont transport... they are now buying type 3 mods to use as medic vans. at least LAcoFD uses pickup trucks. you have to remember for the cost utilization that many of these citys will low call volume are either because they want to feel exclusive and can afford to pay for the fire engine for only their neighborhood, or it is a PCF/volunteer engine which cost relatively nothing to have (for instance station 3, sunset beach)


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## Shishkabob (Sep 9, 2010)

dave3189 said:


> Gee JP, I wasn't aware that FFs do nothing other than supression?  Vehicle extrication, confined space rescue, high angle rescue, low angle rescue, Haz Mat?



Dave--- 
http://atcemsce.org/home/index.php?...n-the-austin-travis-county-ems-team&Itemid=27


You don't need fire to do ANY type of rescue.  Period.  



LucidResq said:


> Yes, you can point out the rare technical rescue where it's helpful to have the front line rescuers also trained to a higher level of medical care as well, but those calls are rare (and even rarer are the calls that having a paramedic, for example, involved in the initial rescue efforts is even useful) and there's no reason strictly EMS providers can't participate in such rescues with additional training.



And that, my friends, is exactly what ATcEMS does, and they do it damn well from anyone you may ask, and they are a 3rd service that will NEVER be combined with fire.  Each department knows it's role down there.  Fire as first response, EMS as, well... medicine.  




Dear dave:








That is all.


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## JPINFV (Sep 9, 2010)

socalmedic said:


> hahaha, yea the whole medic van concept is lost on me. they have full stocked ambulance staffed with 2 FF/PM but dont transport... they are now buying type 3 mods to use as medic vans.



Seriously? What the hell? I always found it queer (damn it, I'm reclaiming this word for it's original meaning. I like this word for it's original meaning, it just fits too well sometimes) that, at least when I worked in OC, cities like Santa Ana were running the huge medium duty ambulances while cities like Newport Beach were running regular type 3s. At least both SA and NB both transported themselves instead of having a private company come in and handle transport.


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## dave3189 (Sep 9, 2010)

Wow Linuss, that was quite a witty burn! So let me guess? hmmmm... since you're arguing against Fire Based/EMS does that mean you're not a FF?  I'm quite the astute observer aren't I?  You gotta be kidding me? 

JP, the point with youtube was to simply point out that (especially these days) it isn't difficult to find many viewpoints to support your argument.  We could go back and fourth all day sharing sources, much the way it is done with debate on the economy and politics.  

What I find funny is how you guys are such haters when it comes to Fire.  While I am an advocate of fire based EMS (and I'll admit it partly has to do with the fact that i work in it) I don't think that the non fire based EMS folks are any less skilled are qualified.  I just like the system better.  Although there is no empirical evidence to show F/B EMS are any less skilled are efficient than their counterparts, I continue to see the hater-ism on here.  Really does beg the question if there are some sour grapes cause someone couldn't get hired as a FF?????


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## dave3189 (Sep 9, 2010)

Hey JP, off the heated debate for a while, what is the idea behind the Medics in SO Cal not transporting?  I have a buddy that works for Care AMB out there and he was telling me that he transports ALS with a Medic in a Care Rig.  So different than here, our Medics tx themselves.  It just seems easier to be in an ALS rig with all your meds, etc.  thoughts?


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## 46Young (Sep 9, 2010)

Linuss said:


> Dave---
> http://atcemsce.org/home/index.php?...n-the-austin-travis-county-ems-team&Itemid=27
> 
> 
> ...



I'm trying to understand exactly to what extent that ATcEMS operates at tech rescue and Hazmat incidents. From the link you provided, it says that they provide medical care in the various rescue situations. That's not the same as being able to set up lowering systems, shoring for trenches and building collapses, for example. Besides, you need a truck to be able to position a stokes basket for a high angle rescue, anyway.

Same for Hazmat. It says that they integrate into hazmat incidents with the AFD Hazmat team. Being able to go on air, set up a decon station and carry a four gas meter is only scratching the surface on a Hazmat.

I don't know about other depts, but in ours our rescues are either hazmat or TROT (tech rescue) equipped. They're rolling toolboxes. ATcEMS has these, and they train their people to use all that, without fire involvement? If not, then you do in fact need fire for rescues.


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## JPINFV (Sep 9, 2010)

dave3189 said:


> JP, the point with youtube was to simply point out that (especially these days) it isn't difficult to find many viewpoints to support your argument.  We could go back and fourth all day sharing sources, much the way it is done with debate on the economy and politics.


I'd agree if Dr. Ex-Medic (I'm not sure if he posts here, but he posts on a handful of other forums) didn't cite everything he used to counter while the FD video didn't cite anything if I recall correctly. 



> Really does beg the question if there are some sour grapes cause someone couldn't get hired as a FF?????


Only if I can ask the question if paramedics are self-loath because they couldn't get into medical school.


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## 46Young (Sep 9, 2010)

JPINFV said:


> Of course to do so also throws the entire, "We save lives while saving you money" argument out of the window. Isn't cost effectiveness the huge argument for EMS based fire suppression? You're no longer taking fire fighters who are just sitting around doing nothing and having them respond, you're hiring more providers and having everyone sit around on average just a little bit less (normally due to an over response.), however with still more proverbial mouths to feed.
> 
> 
> However how many services besides the fire service have come out publicly and said, "We don't need any education outside of management."
> ...



We know that the vast majority of EMS systems use the bare minimum amount of ambulances to cover call volume. SSM is the most extreme example of this. What I'm saying is that good depts staff and deploy adequately. Sure, a private can come in and say that they can do it for less, but how drastically are they cutting corners to fufill that obligation? Less units? Poorer equipment? Fewer employees? Employees with much lower average experience due to high turnover caused by substandard compensation, benefits and working conditions?

As far as hiring more and having them sit around a little less, it isn't the case. In my dept, we have X amount of positions for each function. EMS txp gets a certain number, as does suppression staffing, Hazmat, TROT, fire investigations, the academy, admin, etc. For EMS, the medic in an EMS job slot may also do suppression work, but then the engine medic also does transport. It evens out. What's important is that there are two spots, staffed by two people. They may flip flop, but it's still two spots. Where the cost savings come in is with hiring and schedule gaps. If each side was seperate, more OT would be generated since there are less people that are qualified for each spot. Also, with ALS first response, less txp units are needed. That's using relatively idle suppression personnel instead of hiring more txp personnel. Upstaffing EMS txp would be ideal, but it's not the most cost effective route.

No one else has publicly downplayed the importance of education, but no one is advocating for it, either.

The problem with systems that have a "no need for EMS" disposition where the crew can deny txp due to no medical necessity is that it only takes one major lawsuit to derail the program.


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## 46Young (Sep 9, 2010)

LucidResq said:


> Just to throw in something here... I'd like to point out that I see PD calls evolving in to medical calls much more than I see Fire calls becoming medical.
> 
> I can't tell you how many times I've seen a PD call for an assault, welfare check, domestic, etc etc end up being sent over for an EMS response or an ambulance transport for a mental health hold. I have yet to see any of the various structure fires, alarms, lockout assists, water problems, etc require an EMS response beyond the standard stand-by on fire scenes...
> 
> ...



That's actually a good point. We're often called for a suspected drunk, an EDP, an assault victim, MVA pts, the decedent, prisoners that feign Cx pain, dyspnea and such in an attempt to delay a court appearance.


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## 46Young (Sep 9, 2010)

MrBrown said:


> Also blame the majority of employees who don't see value or the importance of advanced education.



The reason for that, for the most part, is that most employers don't require a degree, so many don't bother taking the extra time to get one, since time is money. Literally, the extra time is lost revenue.


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## 46Young (Sep 9, 2010)

dave3189 said:


> Wow Linuss, that was quite a witty burn! So let me guess? hmmmm... since you're arguing against Fire Based/EMS does that mean you're not a FF?  I'm quite the astute observer aren't I?  You gotta be kidding me?
> 
> JP, the point with youtube was to simply point out that (especially these days) it isn't difficult to find many viewpoints to support your argument.  We could go back and fourth all day sharing sources, much the way it is done with debate on the economy and politics.
> 
> What I find funny is how you guys are such haters when it comes to Fire.  While I am an advocate of fire based EMS (and I'll admit it partly has to do with the fact that i work in it) I don't think that the non fire based EMS folks are any less skilled are qualified.  I just like the system better.  Although there is no empirical evidence to show F/B EMS are any less skilled are efficient than their counterparts, I continue to see the hater-ism on here.  Really does beg the question if there are some sour grapes cause someone couldn't get hired as a FF?????



It's more so that we're taken care of better. Even if I had little interest in fire, I probably would have gotten into fire based EMS just for that reason. Same exact job, for much more in pay, retirement, etc. if I trade out with others that want to ride an engine most of the time. Also, I can promote off of the street much quicker in a fire based system. Two promotions and only five years on the job, and I can become an EMS LT and teach at the academy FT. In EMS only, the odds are that I would be riding the box until I retire or go out on disability.


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## 46Young (Sep 9, 2010)

JPINFV said:


> Only if I can ask the question if paramedics are self-loath because they couldn't get into medical school.



The bitterness may be because they're stuck, and can't really go into anything else without going into debt.


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## dave3189 (Sep 9, 2010)

Treating a patient as a duel role EMS/Law Enf. Officer has inherent problems that anyone who has been on this job for a while has seen.  Telling a suspected O/D patient "I'm not the police, you need to tell me what you took so I can treat you"... How is that going to work when you're a cop?  Trying to treat the patient/suspect that you as the cop just tased or used force on?  Again, good luck with that.  And then there would always be the argument that the EMT/Police Officer didn't try to resuscitate the suspect/Patient that shot at or shot an officer?  Bottom line, this concept of L.E./EMS duel role is ripe with problems, perceptions, and conflicts.


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## dave3189 (Sep 9, 2010)

Not sure what comparing a Medic to an M.D. has anything to do with what environment or system an EMT or Medic works in?  ;|


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## JPINFV (Sep 9, 2010)

dave3189 said:


> Hey JP, off the heated debate for a while, what is the idea behind the Medics in SO Cal not transporting?  I have a buddy that works for Care AMB out there and he was telling me that he transports ALS with a Medic in a Care Rig.  So different than here, our Medics tx themselves.  It just seems easier to be in an ALS rig with all your meds, etc.  thoughts?



I've always been of the opinion that if you want to run EMS, run the entire thing. As such, the vast majority of EMS in the Greater LA Area (since the medics on the engine, private company provides 2 EMTs and an ambulance is common in both LA and OC areas) has always made absolutely zero sense to me.


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## JPINFV (Sep 9, 2010)

46Young said:


> The bitterness may be because they're stuck, and can't really go into anything else without going into debt.



What's wrong with debt if you're getting a degree that isn't along the lines of ethnic studies? If the only people who went to graduate professional schools (law school, medical school, pharmacy school, etc) were people who could pay out of pocket, there would be a lot less physicians, lawyers, pharmacists, etc.


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## JPINFV (Sep 9, 2010)

dave3189 said:


> Not sure what comparing a Medic to an M.D. has anything to do with what environment or system an EMT or Medic works in?  ;|



About as much as implying that the only reason people are against EMS based fire suppression is because they can't become fire fighters.


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## Shishkabob (Sep 9, 2010)

dave3189 said:


> Wow Linuss, that was quite a witty burn! So let me guess? hmmmm... since you're arguing against Fire Based/EMS does that mean you're not a FF?  I'm quite the astute observer aren't I?  You gotta be kidding me?



Hmm.. who said I wasn't an FF?  Do you have any evidence of such that I'm not involved with a fire department in any way?  Hell, who said I was totally against ever being an FF?


I was just pointing out your clear and obvious bias in the fact that makes every argument you type laughable at being called an "argument".


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## LucidResq (Sep 9, 2010)

dave3189 said:


> What I find funny is how you guys are such haters when it comes to Fire.  While I am an advocate of fire based EMS (and I'll admit it partly has to do with the fact that i work in it) I don't think that the non fire based EMS folks are any less skilled are qualified.  I just like the system better.  Although there is no empirical evidence to show F/B EMS are any less skilled are efficient than their counterparts, I continue to see the hater-ism on here.  Really does beg the question if there are some sour grapes cause someone couldn't get hired as a FF?????



At least in my case you're making a huge assumption here. I in no way shape or form hate the Fire Service, or the firefighter EMTs/medics. In most cases, they don't do a bad job either. I just think the system could be much _better_ if EMS was a third service facilitated by the municipality or a hospital system. 

My future husband is a volly firefighter/EMT who will soon be going to Medic school and will be a career Fire Medic one day. He's one of the handful of people these days that actually is more interested in the EMS stuff than the "cool" firefighting and rescue stuff. Do I support him? Abso-****ing-lutely because I want him to actually make a livable wage. I've actually thought of going that route myself. I don't hold anything against those who make that decision because I don't think anyone should be expected to put up with outrageously low wages and poor treatment if they don't have to, to "protest" a system that could be better. It's not like it would make a difference anyways. 

Some of the best medics I've ever met are fire medics. I think you need to stop taking it personally and realize that this is a debate about the system not the people. I'm not even saying that fire-based EMS systems suck, because most are good, but in medicine (and EMS is medicine) you don't settle for good, you aim for excellence. You clearly are of the opinion that EMS is best facilitated through the fire service, but you'll find on here that many people disagree and think it could be better done as it's own entity based more in public health and medicine.


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## LucidResq (Sep 9, 2010)

In simpler terms... 

I ain't hatin' on you playa, or yo' boyz. I be hatin on the game.


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## jgmedic (Sep 9, 2010)

socalmedic said:


> JP- good report. I hove some info on the low numbers though.
> 
> first those are not the number of responses those are the numbers of ALS Transports (no not transports where a paramedic rides in, a transport where an "ALS skill" is utilized beyond assessment, IV and ECG 3 or 12 lead). further more many of those are units that are not usualy staffed as MEDIC. they may have been used as a medic because of staffing shortage or because there where other engines out of county on wildfires ect. below i have listed some of the "outliers" and the lease utilized actual ALS units
> 
> ...



When did Grove get ALS ambos? They also use Care for transport, Also, IIRC, a OC unit is not truly a medic unit unless it has two medics, anything else is considered a PAU and while some depts will send one, like FVY, every ALS call is supposed to have 2 medics riding in the hospital.


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## LucidResq (Sep 9, 2010)

46Young said:


> I'm trying to understand exactly to what extent that ATcEMS operates at tech rescue and Hazmat incidents. From the link you provided, it says that they provide medical care in the various rescue situations. That's not the same as being able to set up lowering systems, shoring for trenches and building collapses, for example. Besides, you need a truck to be able to position a stokes basket for a high angle rescue, anyway.
> 
> Same for Hazmat. It says that they integrate into hazmat incidents with the AFD Hazmat team. Being able to go on air, set up a decon station and carry a four gas meter is only scratching the surface on a Hazmat.
> 
> I don't know about other depts, but in ours our rescues are either hazmat or TROT (tech rescue) equipped. They're rolling toolboxes. ATcEMS has these, and they train their people to use all that, without fire involvement? If not, then you do in fact need fire for rescues.



I'm definitely not arguing for the fire service to hand over all rescue/extrication stuff to EMS and handle fire suppression only. It doesn't have to be all or nothing. Just look at TEMS. 

For the vast majority of SWAT calls, the ambulance staged down the street is just fine (fairly similar to rescue calls, in which medical attention may be needed, but the rescuers can take the patient to EMS without hampering pt care). Then LE agencies started looking at that small percentage of SWAT calls in which having a paramedic able to go in along side them would be beneficial. 

Did they start sending their cops to paramedic school? No. Did EMS systems start taking over all SWAT operations? No. 

They trained a few of the paramedics in the EMS system some essential SWAT things, provided the equipment they needed to go in, and now they have a few medics able to go in with the SWAT team, who do the bulk of the operations and all of the coordination.


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## jgmedic (Sep 9, 2010)

LucidResq said:


> I'm definitely not arguing for the fire service to hand over all rescue/extrication stuff to EMS and handle fire suppression only. It doesn't have to be all or nothing. Just look at TEMS.
> 
> For the vast majority of SWAT calls, the ambulance staged down the street is just fine (fairly similar to rescue calls, in which medical attention may be needed, but the rescuers can take the patient to EMS without hampering pt care). Then LE agencies started looking at that small percentage of SWAT calls in which having a paramedic able to go in along side them would be beneficial.
> 
> ...



Actually, some PD's, LACoSD, CHP, and a few others do have full time medics to staff SWAT, SAR, flight and the like. I'm not disagreeing with you at all actually though, in reference to the other poster about ATCOEMS, I believe they have rescue ambulances that can handle all but the most tech rescues, god I want to work there so bad. Anyways, why not have EMS handling basic rescue situations, less resource utilization per call should save the municipalities some cash, right?


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## socalmedic (Sep 9, 2010)

jgmedic said:


> When did Grove get ALS ambos? They also use Care for transport, Also, IIRC, a OC unit is not truly a medic unit unless it has two medics, anything else is considered a PAU and while some depts will send one, like FVY, every ALS call is supposed to have 2 medics riding in the hospital.



in 2006 i believe they still transported, this report and stats are from 2006. yes you must have 2 paramedics on transporting units or it is just a PAU however this is also just numbers on how many ALS call ins where made, PAU is allowed to call in and do ALS Tx. maby someone from care is reading this, i think GG now contracts with OCFA for a medic van to Transport.


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## jgmedic (Sep 9, 2010)

socalmedic said:


> in 2006 i believe they still transported, this report and stats are from 2006. yes you must have 2 paramedics on transporting units or it is just a PAU however this is also just numbers on how many ALS call ins where made, PAU is allowed to call in and do ALS Tx. maby someone from care is reading this, i think GG now contracts with OCFA for a medic van to Transport.



I worked for Care in 06-08, a lot in Grove, they had medic squads that responded with the "BLS" engines, but the Care grove ambos had been there for years.


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## 46Young (Sep 9, 2010)

JPINFV said:


> What's wrong with debt if you're getting a degree that isn't along the lines of ethnic studies? If the only people who went to graduate professional schools (law school, medical school, pharmacy school, etc) were people who could pay out of pocket, there would be a lot less physicians, lawyers, pharmacists, etc.



I'm talking about making rent, not getting a college loan.


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## 46Young (Sep 9, 2010)

LucidResq said:


> I'm definitely not arguing for the fire service to hand over all rescue/extrication stuff to EMS and handle fire suppression only. It doesn't have to be all or nothing. Just look at TEMS.
> 
> For the vast majority of SWAT calls, the ambulance staged down the street is just fine (fairly similar to rescue calls, in which medical attention may be needed, but the rescuers can take the patient to EMS without hampering pt care). Then LE agencies started looking at that small percentage of SWAT calls in which having a paramedic able to go in along side them would be beneficial.
> 
> ...



Maybe I read his post wrong, but it looked like he was saying that EMS agency didn't need fire whatsoever to do rescue, and then provided a link. The info contained in the link only referred to EMS supporting these rescue operations, not being able to do anything and everything involved. I think it's great that they train to be an integral part of these operations, but it sounded like he was saying that they could handle any tech rescue or hazmat on their own.


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## Shishkabob (Sep 9, 2010)

Just FYI I never mentioned HazMat... that was dave.



However, around these parts, 3rd service county based EMS does a big part of the extrication simply because you won't always get a volly fire dept on scene to help.


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## 46Young (Sep 9, 2010)

Linuss said:


> Just FYI I never mentioned HazMat... that was dave.
> 
> 
> 
> However, around these parts, 3rd service county based EMS does a big part of the extrication simply because you won't always get a volly fire dept on scene to help.



I've heard of that. FF's go to rescue school to learn that stuff, so there's no reason why EMT's or medics can't do the same. I know that some engines carry a limited amount of extrication equipment. What type of vehicle does ATcEMS turn out for cut jobs? What can they handle?

FYI, around my way we have heavy rescues that are either hazmat or TROT. When I hear rescue, I think cut jobs along with TROT stuff which is high angle, swift water, trench, confined space, building collapse, and also hazmat. When I read your link it mentioned supporting roles for both TROT type rescue and hazmat alike.


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## DrParasite (Sep 14, 2010)

46Young said:


> Maybe I read his post wrong, but it looked like he was saying that EMS agency didn't need fire whatsoever to do rescue, and then provided a link. The info contained in the link only referred to EMS supporting these rescue operations, not being able to do anything and everything involved. I think it's great that they train to be an integral part of these operations, but it sounded like he was saying that they could handle any tech rescue or hazmat on their own.


That could very easily be argued:

http://www.uh-ems.org/rescue.html

http://www.city.pittsburgh.pa.us/ems/html/rescue_division.html


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## BLSBoy (Sep 15, 2010)

DrParasite said:


> That could very easily be argued:
> 
> http://www.uh-ems.org/rescue.html
> 
> http://www.city.pittsburgh.pa.us/ems/html/rescue_division.html



Staffing R1 with just 2 people is not adequate.


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## esmcdowell (Sep 16, 2010)

*This is exactly the problem*

A. To say that Fire-based EMS is wrong/bad juju/whatever else you want to say is not helping the major problem in EMS. For one, I ask if any of you have ever been to say...Arcadia, NE, a town of 500 people, where the nearest Ambulance is over 30 minutes away, the helicopter, closer to an hour, but the local FD has a dozen emt-b's who can be on the engine and to your side in less than 10 if you have a major medical problem. Or Luther, MT, a farming community, where the ambulance can be over 2 hours away, phone service is spotty at best, and the helicopter is 45 minutes to not available, but Bob from the next ranch over, who is a firefighter/emt can go get the specially designed 4x4 engine with BLS equipment and can use the much more reliable radio network to reach a QRU medic/firefighter in another 4x4 that can be there in 20 minutes, and Bob can be back at your door in 15 minutes. Saying that Fire based EMS is wrong just because the larger departments have yet to work out the kinks isn't helping the problem, it *IS* the problem.

B. To all of you non-U.S EMS providers who keep talking about cookie cutter EMS and medic mills and poor education standards, I say step up to the plate, if you really are as smart as several of your degrees require you to be, then you most certainly should know that you hold as much, if not more power than all of us American EMS providers who would like to see the system changed to better help the people who dial those three numbers. Again, to talk of the U.S's nationally poor standards is horribly untrue, i know several emt's medic's and even our hated brothers _firefighters_ who wish that there were more we could do for the people that put their trust and money in our abilities.

C. To those of you saying that us dual role providers are somehow less than you single role EMS "professionals" I say b***s**t, I know Firefighter/Medics that are better medics and better overall care providers than any single role Medic I have ever met.
D. Okay, that's it for me, but i do want to end on this note, If you aren't helping the problem, you _*ARE*_ the problem...


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## JPINFV (Sep 16, 2010)

A. "Have yet to work out the kinks?" Exactly how long are you going to give them before you tell them that 2-4 paramedics on every vehicle with lights and sirens does work well?

B. Would Bob the volunteer FF/EMT be an EMT if it took 1-2 years of education to become an EMT? I bet the physicians at the emergency room they're delivering to still had to go through 4 years of undergrad, 4 years of medical school, and at least 3 years of residency. Additionally, why is it the responsibility of paramedics in other countries to effect change in a country foreign to them? 

C. Since you admittedly come from a rural area, exactly how many single role paramedics do you know? Would you be willing to compare the average paramedic from, say, Boston to an average So. Cal. paramedic-FF?


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## LonghornMedic (Sep 16, 2010)

JPINFV said:


> I've always been of the opinion that if you want to run EMS, run the entire thing. As such, the vast majority of EMS in the Greater LA Area (since the medics on the engine, private company provides 2 EMTs and an ambulance is common in both LA and OC areas) has always made absolutely zero sense to me.



L.A. County is a bizarre world when it comes to EMS. They invented modern EMS as we know it. But they have never evolved since. The heavy handed "mother may I" is ridiculous. The use of private ambulances as a taxi service for FF/Medics makes no sense at all. The one thing I do like is County's use of squads. When I worked EMS in Las Vegas, every department had to have the latest and greatest rescue ambulance and they don't even transport(except Las Vegas and Henderson FD)! Talk about a waste of tax payer money. Or sending an engine company to a Bravo level broken arm. The best was sending a truck company to Code 2 Alpha responses. Something like a non-code response for a infected toe nail and having a $500,000 piece of equipment and four FF is such a waste. Here, only EMS is dispatched unless it's a critical call and then they'll send FD.


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## LonghornMedic (Sep 16, 2010)

46Young said:


> I've heard of that. FF's go to rescue school to learn that stuff, so there's no reason why EMT's or medics can't do the same. I know that some engines carry a limited amount of extrication equipment. What type of vehicle does ATcEMS turn out for cut jobs? What can they handle?
> 
> FYI, around my way we have heavy rescues that are either hazmat or TROT. When I hear rescue, I think cut jobs along with TROT stuff which is high angle, swift water, trench, confined space, building collapse, and also hazmat. When I read your link it mentioned supporting roles for both TROT type rescue and hazmat alike.



ATCEMS runs four Technical Rescue units, mostly in the more rural areas of the county where you may get a volly response. Those Tech Rescue units carry extrication equipment, ropes and climbing gear for high angle rescue, swift water rescue gear, bunker gear, body armor, etc. In the city, Austin FD handles extrication. And they will work together on a high angle call. EMS has scene command on all medical calls and joint command on MVA's. Hazmat is going to primarily be handled by FD with assistance from EMS.


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## spike91 (Sep 29, 2010)

In Florida, it is a Fire-Rescue Department. That means they run both fire and EMS crews under one organization. ALL members are MINIMUM fire fighters and EMT-B certified.

That means every medical call that gets toned out is first responded by a fire truck while they wait for an ambulance to arrive at which point they transfer care and transport. All fire trucks that I saw in my area of Florida were minimum BLS staffed equipment wise, probably had an ALS bag with the narcs also.


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## MrBrown (Sep 30, 2010)

... and you just know the two minutes its gonna take the Ambulance to get there makes all the difference, because that Medicfighter (you know, the Firefighter who just hates being a Paramedic and fights it every day) is gonna do a lot of really necessary stuff right? Not.


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## spike91 (Sep 30, 2010)

MrBrown said:


> ... and you just know the two minutes its gonna take the Ambulance to get there makes all the difference, because that Medicfighter (you know, the Firefighter who just hates being a Paramedic and fights it every day) is gonna do a lot of really necessary stuff right? Not.



You, sir, clearly have never had the fortune of watching the Hillsborough County FireMedics at work. Kindly bite your tongue.


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## BLSBoy (Sep 30, 2010)

Uhhh, spike, you in Hillsborough County?


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## Dutch-EMT (Oct 11, 2010)

Well, reading another thread (about a broken arm is an ALS call), i think the system can be more efficient. 
Sending ambulance to an broken arm? come on!!! You think this really needs an ambulance? When responding to all kind of that sort of calls, you need a lot ambulances and first responding fire trucks.

In our system, the patient will be brought to the family doctor/ GP/ physician by his/her family, neighbors, etc. Everybody here has his own familydoctor/ GP.
We don't call an ambulance for non-emergency and non-life threatening things
which can be handled without ambulance. 

Ambulances (staffed and equipped) are cheaper than a firetruck (staffed and equipped). So, costs can't be a problem?!


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## zmedic (Oct 11, 2010)

Most GPs here in the states
1: Don't have x-ray machines
2: Don't reduce or cast fractures 

So there patients are going to the ED. A lot of these patients with broken arms happen after some sort of mechanism where they could have hurt something else (fall, MVA etc) so going in the ambulance is reasonable.  On the list of garbage that people call 911 for broken arms is pretty far down the list. Lets deal with people who call for pain that they've had for the last month, fever of 100.2, transport for med refills etc.


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## BLSBoy (Oct 11, 2010)

Not to mention the "entitlement" feeling that 99% of the "customers" we serve have. <_<


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## 46Young (Oct 11, 2010)

Dutch-EMT said:


> Well, reading another thread (about a broken arm is an ALS call), i think the system can be more efficient.
> Sending ambulance to an broken arm? come on!!! You think this really needs an ambulance? When responding to all kind of that sort of calls, you need a lot ambulances and first responding fire trucks.
> 
> In our system, the patient will be brought to the family doctor/ GP/ physician by his/her family, neighbors, etc. Everybody here has his own familydoctor/ GP.
> ...



At least a broken arm is a legitimate medical complaint. Most areas have the policy that anyone who calls 911 gets at least an evaluation. Only a few departments will refuse txp for minor issues. Most depts are litigation phobic. It's less risky to just transport anyone that requests it. Many of the uninsured use the ED as their primary care physician, and the ambulance as their taxi, since they won't be paying anything on either account. That's just the way it is here. People call for everything nowadays.


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