# Report: FIRE doing EMS should come to an end.



## SandpitMedic (Jul 23, 2015)

This report presents actual data and is public now- and it's saying the things we've all known for years.

Essentially- why are 4 dudes making 6 figures showing up in a $500,000 truck to treat someone who stubbed their toe  or essentially may require an ambulance? That's anecdotal; just an example. It's actually much deeper and gets really, really gritty about the Fire Service not being unnecessary and cost-inefficient in running EMS calls.

I particularly like this little line:
"The result is a clear impression of firefighters as self-serving rather than community serving."

Ouch!

It's common sense logic. And the post 9/11 unwaivering and firey love of the American Hero is seemingly burning out.
It kind of takes an anti-fire tone, which I don't necessarily agree with, yet it does raise issues suggesting change on a public scale, change that we have long been discussing with our partners in the cab.

http://www.mercurynews.com/ci_18283358


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## SandpitMedic (Jul 23, 2015)

To add: This will also stem the issue of everyone and their mothers becoming paramedics. Change is coming, and is necessary for the future of prehospital healthcare. We're finally heading in the right direction, no disrespect to the firemen. 
Paramedics= ALS/CCT/BLS medical; Fire=fire/rescue/BLS


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## squirrel15 (Jul 23, 2015)

Well the article is 4 years old, anything else come of it? And the cost of an engine is irrelevant, they make it seem as though you have to pay $500,000 for an engine anytime it moves. And those 3-4 dudes making 6 figures, they will be making that no matter what. So why not pay them to respond to the medical calls instead of paying them to sit around eating sleeping and working out? Also having the extra hands on scene for our increasing obesity problem here in America is beneficial and if you end up having more than one patient, you aren't sitting around waiting for those lift assists and extra hands.


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## SandpitMedic (Jul 23, 2015)

Those are great counter points. Valid as well, however, they are trying to cut costs... I don't think they'll still make that much money.

Honestly, I don't know what ever came of it. I was just happy to see this circulating today, even if it is 4 years old. It brings attention to the issue.

People need to start having this debate. Not us, in particular. On a public scale.


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## RedAirplane (Jul 23, 2015)

If there is a fire, and there is a medical call, firefighters should (probably) go to the fire.

If running medical calls is straining the system, and you may have to hire more people or buy more $500K engines, then let's talk.

Otherwise... you're closer, medically trained, and not doing anything. So why not come on over? 
(BTW I think the same should apply to cops, and ultimately, citizen responders, but that's a different issue)


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## squirrel15 (Jul 23, 2015)

Also, what about fire departments that run the ambulances? What would that be considered?


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## SandpitMedic (Jul 23, 2015)

That's fine. A model like SFFD/FDNY that have medical/suppression branches type of thing.
The budget is coming up again, and that could be a reason the old article is floating around again.


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## squirrel15 (Jul 23, 2015)

So would those medics when on an engine work under a bls scope of practice? I guess I just don't see how it would save money by not having them respond to medical calls


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## SandpitMedic (Jul 23, 2015)

No... the point is... stop putting paramedics on fire trucks all together. Stop forcing all the firemen to go to medic school.

Everyone now will be grandfathered in of course, they will never get away with getting rid of folks for being over qualified. No matter how hard they pushed, but implementing new rules. Then you'd save a ton by cutting the salary 5, 10, 20 percent (I dunno, I'm not an economist) on new hires, and in turn reduce the pensions, etc... You'd also save by not having to buy ALL of your apparatus ALS equipment, you could also spend less on purchasing 2-3-4 more ambulances versus a single pumper or ladder truck. All of these things are pretty much mentioned in the article.


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## SandpitMedic (Jul 23, 2015)

Chase cars, community care ambulances (medic, cct, NP, etc), and single role providers are the wave of the future. the fire model is antiquated. 90% of the time their response is a waste of time on the medical calls we run. I don't see how you can really justify not agreeing if you've ever worked in the field. (Sure there are a lot of obese pts, still not adequate justification for all calls). Clearly, MVAs, suspected Codes, or other situations where manpower would benefit would still result in dispatching the BRE.


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## SandpitMedic (Jul 23, 2015)

I'm interested in hearing the opinions of some of our forum geniuses... remi, transportjockey, DE, rocket, STX, AK, etc.

(It won't allow me to do the @tags for some reason. )


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## ThadeusJ (Jul 23, 2015)

Funny, I believe Toronto just started discussions on exploring this option. 

http://www.thestar.com/news/gta/201...sal-pits-firefighters-against-paramedics.html


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## squirrel15 (Jul 23, 2015)

So if you work for a FD ambulance, you can never work on an engine for the same FD just because you're a medic? And what department do you know of buying a truck or engine to respond to medical calls? I'd like to know how the budget is affected by fire responding other than in fuel... You wanted a discussion, sorry you don't agree with my point of view. Saying just because and engines initial costs are expensive is not a valid argument to me... Especially when you're suggesting add a chase with another paid employee...


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## ThadeusJ (Jul 23, 2015)

Hey...Johnny and Roy were doing it looooongbefore we knew about it. And if its on TV, it must be right.


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## chaz90 (Jul 23, 2015)

squirrel15 said:


> So if you work for a FD ambulance, you can never work on an engine for the same FD just because you're a medic? And what department do you know of buying a truck or engine to respond to medical calls? I'd like to know how the budget is affected by fire responding other than in fuel... You wanted a discussion, sorry you don't agree with my point of view. Saying just because and engines initial costs are expensive is not a valid argument to me... Especially when you're suggesting add a chase with another paid employee...


To me, it's a comparison like "why can't I pick up shifts as a city trash collector since I work for the city as a medic anyway?" 

The two are entirely different jobs. Just because they were combined in the past due to availability of firefighters doesn't mean the mix holds up in today's world. Both modern firefighting and prehospital ALS (with greater than urban transport times) are specialized fields that can have poor outcomes if employee training or education is minimized to focus on something else.

I don't mean to come off as anti-firefighter. I also care about the motivations of firefighters and ensuring they have the same passion and dedication to train in their chosen field as their EMS counterparts do. In my experience, most people are truly interested in one field or the other. The thought processes and mindsets between the two are totally different, and I think they attract different kinds of people. I don't want a "passable" firefighter who is focused on EMS leading a RIT team to rescue a downed FF or coordinating a high angle rescue, nor do I want a "minimum standards" paramedic who isn't interested in keeping up with medicine attempting to treat my grandmother in respiratory failure with an hour before they reach definitive care. 

My exceptions? I have no problem with training FF to the BLS/EMT level, nor do I have a problem with separate role EMS/Suppression branches of a fire department. Honestly, I can also be convinced of the merits of a dual role AEMT/FF in urban settings, because I think the argument can be made that in certain systems full ALS paramedic scope is of little utility if transport times are typically less than 5 minutes.


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## SandpitMedic (Jul 23, 2015)

He just said exactly what I was going to say, plus some.

That's the discussion... You don't have to apologize because I disagree with you, Squirrel.

Fire and EMS are two different things.
Also, I bet they would save a metric ton not having to pay for fuel, maintaining and repairing, and purchasing apparatus designed for fire suppression in routine EMS response.


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## squirrel15 (Jul 23, 2015)

I don't see why the fire department would have an EMS branch then. I think its something we are used to seeing at this point, but with the proposal you're making the EMS system should be completely seperate from fire, whether it be city, county, or privately run. If it is privately run, maybe there could be some saved money because of contracts and fees covered by the private company. If run by the city or county, I see it being more expensive. You would have a need for more ambulances, would need to employ more personnel, and would be stocking all of those ambulances like you would an ALS engine.

@SandpitMedic reread my last post, I didn't mean to come off as an *** like I did


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## SandpitMedic (Jul 23, 2015)

It doesn't _have_ to be provided by the fire department... and yes, that is the proposal... separate the suppression firefighters and ALS medical responders. That is the point. I have no idea where you're from, where you work, or how long you've been in this business. I am finding it difficult to understand why you cannot pry the idea out of your mind that the fire dept must somehow be involved in providing ALS medical care. I know that's how it has been done--- that doesn't mean it works or is the most efficient.

MOST firemen who work on ALS fire departments (Where the department has made it mandatory for folks to be medics) don't even want to be medics, they want to be firefighters. It shows in their patient contact, yet they HAVE to be paramedics to be firemen. Get it? This proposal will eliminate that also. Perhaps not entirely, and certainly not everywhere.



squirrel15 said:


> And what department do you know of buying a truck or engine to respond to medical calls?



Um, a whole lot of them.



> I'd like to know how the budget is affected by fire responding other than in fuel.....


Okay, for example: staffing one engine is the equivalent of staffing two ambulances (in terms of personnel). Even if you took away two engines, and added three ambulances, you're still saving hundreds of thousands of dollars _just_ on payroll alone by now having six responders where you used to have eight, AND you can cover more area with the additional unit. It's math... less people = less payroll/bennies/pensions/etc. That's not even counting the money saved on all that other stuff that we've mentioned...

Are you following?


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## squirrel15 (Jul 23, 2015)

I'm reading this as you do not want fire to respond at all. I don't believe they need to be ALS and but they should remain trained at a BLS level and respond to medical calls.


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## WolfmanHarris (Jul 23, 2015)

ThadeusJ said:


> Funny, I believe Toronto just started discussions on exploring this option.
> 
> http://www.thestar.com/news/gta/201...sal-pits-firefighters-against-paramedics.html


Not quite. The Ontario Professional Firefighters Association, their union has. It has been rejected as unsafe by the Ontario Base Hospital Group, the body of medical direction for Paramedic services in Ontario, the Ontario Association of Paramedic Chiefs has come out against, the Ontario Association of Fire Chiefs has been strangely silent, and obviously the Paramedic Associations and Unions (not the same thing here) have come out against. Politics being politics, anything can happen, but I find it extremely unlikely that this will go anywhere.

Here FF's are trained to FR or EMR (40-80 hrs) vs 2 years for PCP and a further year for ACP, it's not just a matter of them going to these calls; they're neither required medically nor do they have the adequate training to be of use. Where I work we are rapidly moving away from tiering FD to all but the most serious calls and clearing them if the Pt. isn't a cardiac arrest in lieu of using our own units for back-up. As my Chief puts it, the best back-up for Paramedics, are Paramedics. Thankfully I'm part of a very well resourced, forward thinking service.


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## Tigger (Jul 23, 2015)

To me the root issue came about when someone realized that EMS could possibly make a municipality revenue. Suddenly fire departments could justify their budgets because now they bring in revenue. Except for the part where they do not. Reimbursements are at an all time low as are collections in most places. Running a 911 EMS system is not going to be profitable almost anywhere outside of wealthy suburbs.

And that's fine.

We should not expect emergency services to be profitable, that is not their intent. The unhappy fire-EMS marriage will end when this collectively realized by those that fund us. To do this we need to be cost effective and provide more services than we do now so we are worth that funding.


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## SandpitMedic (Jul 24, 2015)

I agree with most of what you said, except this:


Tigger said:


> We should not expect emergency services to be profitable, that is not their intent.



This is free market capitalism. The same reason hospital corporations make billions, and healthcare corporations make billions, and insurance companies make billions, and AKflightmedic makes billions (just kidding), and every other service that morally _shouldn't be for profit_ (unrelated example: prisons) is the reason why EMS has turned into a for-profit industry. There is money to be made, and someone is going to make it.

I see nothing wrong with charging for a service - unless we as a society say that in a true emergency we will foot the bill for each other via taxes (like the FD/PD) then why shouldn't EMS bill. (I'm not talking about Medicaid- that is a broken and antiquated system as well which has its place, but needs an overhaul). I think making EMS a tax subsidized industry would help it; that is one of the fire based EMS ideas that works. However, if it isn't a true emergency, which is about 75% give-or-take (and that's being generous) of all calls, the person receiving the service should foot the bill 100%. Whether that's private pay or covered by insurance is irrelevant, but it should be at a personal cost to the "customer." Just like if I pay for a taxi or for my phone bill. Everything else in our society works that way. Why should ambulance rides be any different?

Edit to add: I do not agree with charging insane amounts for "record profits"  and all that jazz - it should be at a price that is reasonable and covers the costs of services. Not a price gouging system like we currently have.

So whether or not fire goes back to providing fire/rescue/BLS only, and a third party or agency provides for all ALS and BLS transports, well... Someone has to pay for it, regardless. And the current "paying for it" system is not sustainable.


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## Tigger (Jul 24, 2015)

SandpitMedic said:


> I agree with most of what you said, except this:
> 
> 
> This is free market capitalism. The same reason hospital corporations make billions, and healthcare corporations make billions, and insurance companies make billions, and AKflightmedic makes billions (just kidding), and every other service that morally _shouldn't be for profit_ (unrelated example: prisons) is the reason why EMS has turned into a for-profit industry. There is money to be made, and someone is going to make it.
> ...


There are other means of funding besides billing the patient, as you have noted. The residents (and visitors if you do it right) should be funding the EMS system, but doing so through reimbursements is just not a realistic goal. We are hoping to pass a sales tax in my area, which I think is an awesome solution.


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## SandpitMedic (Jul 24, 2015)

Yeah... Taxing could be a good way... Of course. We are certainly taxed out the wazoo as it is. It shouldn't be free for the abusers. Yes, a tax for covering actual emergencies. But not for the habitual 911 callers and riders.


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## MonkeyArrow (Jul 24, 2015)

SandpitMedic said:


> Yeah... Taxing could be a good way... Of course. We are certainly taxed out the wazoo as it is. It shouldn't be free for the abusers. Yes, a tax for covering actual emergencies. But not for the habitual 911 callers and riders.


The majority of people who erroneously call 911 do not have means of payment anyways. What are you going to do to a homeless guy? Sue him, collect what money. In my experience, people who have insurance and therefore you are likely to get reimbursement from are not your typical 911 abuser.


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## Carlos Danger (Jul 24, 2015)

The SoCal model of every EMS response requiring a 5-man crew on a $600,000 ALS engine _plus_ a separate transport ambulance is, on its face, ridiculously wasteful and inefficient. You can probably purchase, maintain, and staff at least two - perhaps three - ALS ambulances for every ALS engine. And you'd need fewer engines, too, if they were only responding to fires and MVC's instead of to every EMS call. It only makes sense when you finally see it for what it really is - a means of maintaining manpower and budgetary allotments, and nothing more. Public safety expenditures well above the national average are a big part of the reason why so many municipalities in CA are in such horrible financial shape. It is unsustainable.

I'm personally a fan of EMS being operated as either a county or city based third service. I think it just makes sense. But I also have to concede that there are lots of examples of FD's doing a really good job of running EMS, and some really good private services, too.

The bottom line is that the vast majority of EMS calls can be safely and effectively run by a single ambulance with a two-person crew, and anything more is simply wasteful.


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## Tigger (Jul 24, 2015)

SandpitMedic said:


> Yeah... Taxing could be a good way... Of course. We are certainly taxed out the wazoo as it is. It shouldn't be free for the abusers. Yes, a tax for covering actual emergencies. But not for the habitual 911 callers and riders.


Compared to the rest of the developed world that considers access to healthcare to be a right....we pay much less. 

There are many reasons why the US is far behind the rest of the developed world when it comes to EMS. The lack of funding is no doubt one of them.


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## SandpitMedic (Jul 25, 2015)

Tigger said:


> Compared to the rest of the developed world...


Have you ever been outside of the US? (Excluding Canada) Serious question, not to be a smart ***.
You can read all of these wonderful things about how every other socialist system is so great, and you can read how all of these socialist systems are crumbling and the providers/patients are worse off then we are. You can read whatever you want, and there's plenty of versions out there to fit your idea of how it is. However, until you have experience in other "developed" countries then it really doesn't matter. Theoretically, yeah that's very moral and ethical...everyone should be entitled to free healthcare. But the reality is that nothing is free - someone is paying for it. And the system ain't so great.  :/ Go work in or intern in one of those systems and report back your personal experiences.
Am I saying the US has the best system? Absolutely not... I'm just saying neither do the "everyone gets free healthcare" nations either.

@MonkeyArrow, true... there is a homeless population to take into account. However, there are far more abusers in the gap between homeless and rich people who pay their bills (or at least try to pay their bills). Is _every bill_ going to get paid? Of course not. But that doesn't mean the way we are doing it is right... because clearly it is not. I'm with Remi, as I stated. It's grossly inefficient financially and practically.


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## Tigger (Jul 25, 2015)

SandpitMedic said:


> Have you ever been outside of the US? (Excluding Canada) Serious question, not to be a smart ***.
> You can read all of these wonderful things about how every other socialist system is so great, and you can read how all of these socialist systems are crumbling and the providers/patients are worse off then we are. You can read whatever you want, and there's plenty of versions out there to fit your idea of how it is. However, until you have experience in other "developed" countries then it really doesn't matter. Theoretically, yeah that's very moral and ethical...everyone should be entitled to free healthcare. But the reality is that nothing is free - someone is paying for it. And the system ain't so great.  :/ Go work in or intern in one of those systems and report back your personal experiences.
> Am I saying the US has the best system? Absolutely not... I'm just saying neither do the "everyone gets free healthcare" nations either.


Well let's get a few things straight first. I am not suggesting it's free. To have these systems requires more tax revenue, pure and simple. No one is entitled to free healthcare, but people should be able to access it. This county has a healthcare access problem, which is why the EDs are overcrowded and the ambulances often filled with system abusers. EMS and the ED are guaranteed access points, but they are far from cost effective. One way to fix this is to expand and change the way this country provides primary care, but that will likely increase taxes. 

And to answer your questions, yes. I lived in New Zealand for six months in 2012. I accessed their healthcare system as a patient with preexisting conditions (lumbar fractures) without any issues and found the care I received to be on par with what I had been receiving in the states, and easier to get. I was working a sports medicine job prior to leaving so I think I have adequate means to compare the two. I didn't intern there (tough to do as a someone on a student visa), but I did do some rides with St. John in Auckland and spoke at length with a few EMS providers there. I also have elderly extended family who live there, so we spent a fair bit of time talking about how healthcare differs from the two countries. In 2013 I wrote my undergrad thesis on healthcare access challenges for Maori, noting that despite very pressing problems, New Zealand actually has effective measures in place to overhaul population healthcare practices, unlike this country. They spend money on developing primary and preventative care networks, and it shows with their outcomes. 

I've travelled through a fair bit of Europe as well, but I am not going to say I've done much more than amateur research on their prehospital care.


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## SandpitMedic (Jul 26, 2015)

Good assessment on our issue in the U.S. Sorry I misinterpreted your statement (access vs. free)

That's a broad brush though, and has little to do with _who_ is providing EMS at the field level (FD vs other). Sorry for the thread derail, but yes you are correct that it is a general healthcare issue. I don't really want to dive into that in this thread.

Also, I'm glad you've got some worldly experience. That comes in handy. I've got some buddies that used to be with St. John... Sounds cool. I hadn't realized how strict their protocols were... Also for another thread


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## DrParasite (Jul 26, 2015)

the issue with that line of thinking in, and always has been, there are typically more staffed and inservice fire engines than ambulances in any given area, despite the fact that said area has more medical calls than fire calls.  So the closer unit (typically the fire truck) gets there first, stops the clock, initiates handholding, and might even initiate some patient care (CPR, defib, bleeding control, etc).  

If any given area wanted to actually get Fire Depts to stop doing EMS runs, they would need to have as many in service ambulance as their are in service engines, and we all know that has been a pipe dream of mine for the past 15 years, and will probably never happen.


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## Tigger (Jul 26, 2015)

SandpitMedic said:


> That's a broad brush though, and has little to do with _who_ is providing EMS at the field level (FD vs other). Sorry for the thread derail, but yes you are correct that it is a general healthcare issue. I don't really want to dive into that in this thread.



Meh, I see it as related. The IAFF has not exactly been supportive of allowing EMS to progress. They've protested increased educational standards and are now being obstinate about EMS being moved to Health and Human Services. Not to mention that the vast majority of FDs providing EMS did it to save FF jobs and there isn't exactly a rush by EMS/Fire agencies to start providing additional pre-hospital healthcare services, which is what EMS needs to become if it wants to remain relevant. There are exceptions of course.


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## 46Young (Jul 28, 2015)

SandpitMedic said:


> No... the point is... stop putting paramedics on fire trucks all together. Stop forcing all the firemen to go to medic school.
> 
> Everyone now will be grandfathered in of course, they will never get away with getting rid of folks for being over qualified. No matter how hard they pushed, but implementing new rules. Then you'd save a ton by cutting the salary 5, 10, 20 percent (I dunno, I'm not an economist) on new hires, and in turn reduce the pensions, etc... You'd also save by not having to buy ALL of your apparatus ALS equipment, you could also spend less on purchasing 2-3-4 more ambulances versus a single pumper or ladder truck. All of these things are pretty much mentioned in the article.





SandpitMedic said:


> Okay, for example: staffing one engine is the equivalent of staffing two ambulances (in terms of personnel). Even if you took away two engines, and added three ambulances, you're still saving hundreds of thousands of dollars _just_ on payroll alone by now having six responders where you used to have eight, AND you can cover more area with the additional unit. It's math... less people = less payroll/bennies/pensions/etc. That's not even counting the money saved on all that other stuff that we've mentioned...
> 
> Are you following?





Remi said:


> The SoCal model of every EMS response requiring a 5-man crew on a $600,000 ALS engine _plus_ a separate transport ambulance is, on its face, ridiculously wasteful and inefficient. You can probably purchase, maintain, and staff at least two - perhaps three - ALS ambulances for every ALS engine. And you'd need fewer engines, too, if they were only responding to fires and MVC's instead of to every EMS call. It only makes sense when you finally see it for what it really is - a means of maintaining manpower and budgetary allotments, and nothing more. Public safety expenditures well above the national average are a big part of the reason why so many municipalities in CA are in such horrible financial shape. It is unsustainable.
> 
> I'm personally a fan of EMS being operated as either a county or city based third service. I think it just makes sense. But I also have to concede that there are lots of examples of FD's doing a really good job of running EMS, and some really good private services, too.
> 
> The bottom line is that the vast majority of EMS calls can be safely and effectively run by a single ambulance with a two-person crew, and anything more is simply wasteful.



It is very true that you can get a lot better EMS coverage with a few ambulances than one engine with 4-5 people. However, it is not a matter of meeting EMS demand by adding more engines instead of ambulances. It is instead a mater of using already existing fire apparatus to augment the EMS response, or more typically make up for a lack of deployment on the EMS side. Fire apparatus are staffed and deployed the way they are because there needs to be a timely response to suppression incidents. Regardless of suppression call volume, there still needs to be adequate coverage of a district, especially with type 5 construction, and heavy fire load (synthetics, plastics and such that are found in abundance in modern homes). Along with that, it is not a matter of how many calls are EMS, and how many calls are suppression. Most departments have 70% to 80% calls dispatched as EMS. What most people fail to realize is that a fair number of suppression calls require more than one fire apparatus (box alarms, inside gas leak, pin job, fire alarm, Hazmat, CO alarm, things like that). EMS typically gets an ambulance with two people on it at a minimum. A more fair way to compare suppression vs. EMS call volume would be to count the total number of ambulances that received a call over a year vs. the total number of suppression units that received a call over a year (excluding medical aid of course). That would tell a very different picture than the old "80% of calls are EMS, so take away engines and put more ambulances on the street."

Don't get me wrong, I feel that most places don't put out enough ambulances to handle call surges, much less give the average unit some downtime (#SSM/PUMsucks). The truth is, most employers are going to put out just enough ambulances to handle normal call volume. This goes for fire departments as well as privates, hospitals, and third service municipal alike. They all do it. Given this to be true in many places, it makes sense to have fire do first response to help out, since they are typically more idle than EMS, because they are staffed/deployed to cover an area irrespective of call volume or lack thereof. Look at the NIST studies to see why fire suppression requires a timely response, along with safe staffing levels if you don't believe me. 

Having suppression first response may not necessarily affect pt. outcomes, but the manpower does help out the txp crew immensely. How many broken down EMT's and medics do you know that are in pain every day, or had to leave the field? You now have several extra hands to carry equipment and assist in pt. care. I can say from experience that when I was in NYC, 20 min. on-scene for BLS and 30 mins. for ALS was typical for us. In my current system, I can get off scene in 10-15 min. for BLS, and 15-20 for ALS, or 10-15 for ALS if I take the engine medic with me and do most of the stuff in trainsit. There is a time savings to be had with suppression first response. Preferably, it would be BLS suppression with dual medic txp. Otherwise, one txp medic nd one suppression medic, so that you have two medics to care for a critical pt.

As far as revenue, if EMS was not profitable. how would a private company be able to go into contract with the local govt? They would lose money, or the govt would have to pay them enough to make it profitable. Better to leave it to the municipality, rather than have the private operate with managing costs as the highest priority.


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## Tigger (Jul 28, 2015)

Though I do not think that fire departments really have much business providing EMS, I agree with your point about suppression. Removing fire apparatus staffing or funding and replacing that with ambulances is not the solution. Staffing requirements for fire suppression have not changed much and probably need to remain. But if that's the argument that's going to be used, they should not also be providing EMS response to all medical calls like is done in so many places. I cannot count how many times I've had the engine crew take off in the middle of an EMS run because they have a fire call, which looks awful. But, that is in fact what they are there for.

Here in Colorado Springs AMR provides a medic/basic ambulance and the engine companies (and most trucks [sigh]) all have a medic as well, with the goal of having two medics on scene for every call in case of a critical patient. Now maybe this is a local problem, but the concept sucks. You have a paramedic who rarely spends more than five minutes with most patients and often drags his or her feet before providing treatment until the ambulance medic arrives in charge of the responding ambulance, who is shockingly halfway decent at medicine. You can imagine how this plays out. 

If you want to be a paramedic (or any EMS provider), you need to be able to run a call from start to finish, and the current system does not allow for that. If the FD were not our overlords, it would be different. We do not need an engine company for most calls, and it would be nice to have extra hands that didn't repeatedly question the transporting paramedic's actions because they have no idea what they are doing.


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## 46Young (Jul 28, 2015)

We have 4 on the engine, and four on the majority of our ladder trucks, with the left bucket being a medic. If the suppression piece needs to go on another call, the suppression medic can stay on-scene for txp. The engine or truck will clear from an EMS run with a non-acute pt. to run another ALS in the first due if the txp crew doesn't need them, same for fire calls.

Not that difficult to work things out with the txp crew


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## 46Young (Jul 28, 2015)

FWIW, regarding the disdain of fire crews towards having to do EMS txp, from what I've seen and heard, the issue isn't so much of hating to pt. care per se. The bad attitude towards txp is more because of the nature of many of the calls, how they're typically non-acute, typically situations where an ambulance was not needed. This viewpoint is not exclusive to fire. These types of calls routinely burn out career EMT's and medics as well. The EMS people are pretty much stuck with having to run these nothing calls all of the time, whereas the fire people desire an escape from these time draining, unnecessary calls by getting off the ambulance onto a suppression piece.

When my department changed from a tiered ALS/BLS system with fire ALS first response to an all-ALS system (every txp unit EMT/Medic), I lost my love for txp. Just like many others, I have grown tired of responding and not getting to eat breakfast, lunch, or dinner at a normal time, from PT or a drill, or getting up three times a night to run toe pain, drunks, drug seekers, BS neck and back pain from an MVC, flu/stomach virus calls from 20-somethings, things like that. These txps take 45-90 minutes out of your day, and for nothing. You made zero difference in their outcome, and they could have easily driven themselves, got a cab, or had a friend drive them to urgent care. 

Realize that I got my start in NYC 911, three as a basic, two as a medic, and another 7 in my current system as a medic. When I started out I envisioned myself as a career medic, but the all-ALS system has killed my enthusiasm for txp. Life is much better as an engine medic. Every firehouse in my system has an ALS engine and a medic unit, and four stations have an extra medic unit. We chase the medic on the majority of our calls (we have the same EMD system being used by dispatchers with no EMS experience). If the medic needs me to txp, it is because the pt. is in some sort of real distress, so I get to do pt. care, and the txp. medic gets stuck with cleanup (I do what I can until the engine shows up) and the report, and I get to go in-service. A 90 min. call is only a 30 min. call for me. In my particular situation, I see no benefit whatsoever to be the txp medic instead of the suppression medic. My txp days are laden with several mandatory reports for each txp, and I'm ultimately held responsible for everything that goes on with the calls. That means that I need to babysit personnel that I do not know, like OT and exchange people. Bags don't make it in, or if people botch up interventions, it falls back to me. I'm happy that I get to move back and forth from the txp unit on a regular basis. The OT vacancies in the station typically move to the ambulance, as the stations take care of their people by moving them fro the ambo to the suppression piece if the vacancy is there. This means that if you're on the bus, you can look forward to holdover/recall, or at the least being stuck an hour or two past shift change waiting for OT personnel to show up for relief.

That is why I, and the majority of fire based EMS people try to avoid working txp.


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## avdrummerboy (Aug 3, 2015)

In other words, you're burnt out, all but the most critical of calls make you suicidal. You are proving an oft repeated point really, that a lot of people get into fire to do anything other than EMS. One of the main points of us incorrectly labeled 'anti-FD' folks is that fire SHOULD focus on fire/ rescue, the fun stuff that you get into the fire service to do, and EMS should handle the med aids and transports. Where I work, we cancel fire on basically everything short of a full arrest or a 1000 pounder, and guess what? It works great, there are no issues and the FD is kept in service for what they are there for, fires and rescues. This idea that the FD needs to respond to every single medical aid call is ridiculous and it's time that that point be realized and addressed.


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## 46Young (Aug 3, 2015)

Not entirely accurate - a common complaint from people that get into EMS for EMS, not just fire, is that EMS is 90% hand holding and 10% action. Single role EMS people tire of running minor calls, just like fire fire based providers prefer to avoid if possible.

In my case, I did 5 yrs in the NYC 911 system. As a basic, I got sick of bs calls. I became a medic. Medics don't get dispatched to BLS. Maybe half of my patients required ALS beyond an ECG and IV. It kepte interested in 911 txp. Now, I'm in an all-ALS system, so basically I'm BLS again with an occasional, very occasional good ALS call. There's no fulfillment in that.

Fire people escape from that by going into different job functions. Single role EMS get into dispatch, promote (rare), educate/promote into another area of healthcare, or just quit. 13 years in the field, with well over 13 yrs worth of txp time (based on a 40 hr workweek), I'm over doing non-acute BLS or VOMIT (vitals/O2/Monitor/IV/Txp) as the vast majority of calls. Give me my old ALS job types with no dispatched BLS, running out of a station that has beds, shower, gym, kitchen, a 24/72 schedule, with NY money, with FD retirement and benefits, I would be okay doing txp for the long term. That does not exist.

I've had enough of getting up 2-3 times a night for BLS, or eating meals 2-3 hrs. after the fact. That would be fine if they were good ALS, but the typical headache for five days, N&V after eating bad Taco Bell, I have neck and back pain after an MBA with nothing more than paint transfer, not so much.


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## avdrummerboy (Aug 3, 2015)

The burnout of non tiered people and those of us who suffer in an all ALS system, where too many ALS personnel end up on insane calls like hangnails, all complicating the scene, comes from a outdated and preposterous system of protocols and abilities (not skills.) We need to be able to refuse to take the nonsense calls as well as be able to transport to alternative care centers- urgent care, mental health centers, etc.- not just hospital ED's. 

And again, you yourself are living proof that an ALS fire apparatus is not needed on every single call, you only went out of the worst of the worst where the extra ALS helping hands would be needed. 99% of calls need nothing other than an ambulance (private or otherwise) and most off of that barely qualifies for BLS transport. The fire department should respond to just that, fire and rescue.


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## adamNYC (Aug 5, 2015)

When I hit a car on my bicycle fire once showed up and gave me an icepack, then left when EMS arrived.


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## DrParasite (Aug 26, 2015)

46Young said:


> It is instead a mater of using already existing fire apparatus to augment the EMS response, or more typically make up for a lack of deployment on the EMS side.


so if you deployed more EMS resources, or a more appropriate amount of EMS resources, you wouldn't need so many existing fire apparatus.


46Young said:


> Most departments have 70% to 80% calls dispatched as EMS. What most people fail to realize is that a fair number of suppression calls require more than one fire apparatus (box alarms, inside gas leak, pin job, fire alarm, Hazmat, CO alarm, things like that). EMS typically gets an ambulance with two people on it at a minimum.


I call BS on this entire statement.  A Box alarm gets 4 engines, 2 ladders, 1 rescue, & 1 chief on dispatch, but most calls are downgraded to maybe 1 engine and 1 ladder once the first unit gets on scene and confirms it's BS.  Most inside gas leaks get a box response, but can be handed with 1 engine and 1 ladder once the gas company gets on scene.  Pin jobs require 1 engine and 1 rescue.  CO alarms require maybe an engine.  major hazmats are like structure fires: very manpower intensive, require a lot of resources, and are relatively rare compared to the overall run volume.  

I would wager than many calls "could" be handled by one apparatus; however it's more efficient to have two or three units working together to achieve a common goal.

EMS has two people on an ambulance, compared to 3 to 5 on the fire apparatus. And it's rare to get more than one ambulance on a scene for one patient.


46Young said:


> A more fair way to compare suppression vs. EMS call volume would be to count the total number of ambulances that received a call over a year vs. the total number of suppression units that received a call over a year (excluding medical aid of course). That would tell a very different picture than the old "80% of calls are EMS, so take away engines and put more ambulances on the street."


not sure what you mean.... if you compare the UHU of a fire unit and an EMS unit, i'm pretty sure the EMS unit's would be higher.





46Young said:


> Don't get me wrong, I feel that most places don't put out enough ambulances to handle call surges, much less give the average unit some downtime (#SSM/PUMsucks). The truth is, most employers are going to put out just enough ambulances to handle normal call volume.


I would argue that most don't put out enough, and use the FD to pick up the slack.


46Young said:


> FWIW, regarding the disdain of fire crews towards having to do EMS txp, from what I've seen and heard, the issue isn't so much of hating to pt. care per se. The bad attitude towards txp is more because of the nature of many of the calls, how they're typically non-acute, typically situations where an ambulance was not needed. This viewpoint is not exclusive to fire. These types of calls routinely burn out career EMT's and medics as well. The EMS people are pretty much stuck with having to run these nothing calls all of the time, whereas the fire people desire an escape from these time draining, unnecessary calls by getting off the ambulance onto a suppression piece.


agreed



46Young said:


> Realize that I got my start in NYC 911, three as a basic, two as a medic, and another 7 in my current system as a medic. When I started out I envisioned myself as a career medic, but the all-ALS system has killed my enthusiasm for txp. Life is much better as an engine medic. Every firehouse in my system has an ALS engine and a medic unit, and four stations have an extra medic unit. We chase the medic on the majority of our calls (we have the same EMD system being used by dispatchers with no EMS experience). If the medic needs me to txp, it is because the pt. is in some sort of real distress, so I get to do pt. care, and the txp. medic gets stuck with cleanup (I do what I can until the engine shows up) and the report, and I get to go in-service. A 90 min. call is only a 30 min. call for me.


truer words were never spoke.  I spend the first 15 years of my career on an ambulance.  Since I relocated, and accepted a new position, I'm almost entirely on the engine for an EMS call (or Rescue if that is dispatched).    We also have an ALS ambulance in our firehouse, so they are usually there within 5 minutes of our arrival.  We also only go on life threatening calls.  It's so much better than being an the ambulance.  and it's more fun.


46Young said:


> That is why I, and the majority of fire based EMS people try to avoid working txp.


I've said this before, and I will say it again.... if a FF says they are an experienced EMS professional, and they have never worked on an ambulance, I don't trust them.  They haven't done EMS; first responding and then turning the patient over to the ambulance crew for transport is much different than handling patient care from initial contact until you arrive at the ER.


46Young said:


> Fire people escape from that by going into different job functions. Single role EMS get into dispatch, promote (rare), educate/promote into another area of healthcare, or just quit. 13 years in the field, with well over 13 yrs worth of txp time (based on a 40 hr workweek), I'm over doing non-acute BLS or VOMIT (vitals/O2/Monitor/IV/Txp) as the vast majority of calls. Give me my old ALS job types with no dispatched BLS, running out of a station that has beds, shower, gym, kitchen, a 24/72 schedule, with NY money, with FD retirement and benefits, I would be okay doing txp for the long term. That does not exist.


I'd be happy for a BLS job where I got the same amenities you describe, but still have enough downtime to sleep in a bed, work out, shower, and learn new things about my job.  Bonus points if I can be housed in an EMS station, instead of being a guest in the house of another agency.


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## SandpitMedic (Aug 31, 2015)

#truth


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## Bullets (Sep 3, 2015)

I Am of the opinion that EMS should provide pre-hopsital medical care and fire departments should put out fires.

Staffing an engine with 4 EMTs to first respond to a medical call when i could put that same manpower out with 2 transport units seems far more logical when 90% of our calls are medical. I also am strongly against the FD involvement in rescue operations. Both my EMS jobs provide rescue services as do many other jurisdictions because rescues are patient care activities. I do not need an engine with 4 guys and a rescue with 4 guys. I can run a pin job with a 2 person ambulance and a 2 person rescue, which is how we run at all my jobs, its how most EMS rescues run, a 2 man crew. I dont need them on MVAs ever. Our fire departments are suppression only agencies and this is how it should stay.

Maybe we should have EMS-based fire!


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## Martyn (Sep 6, 2015)

SandpitMedic said:


> No... the point is... stop putting paramedics on fire trucks all together. Stop forcing all the firemen to go to medic school.
> 
> Everyone now will be grandfathered in of course, they will never get away with getting rid of folks for being over qualified. No matter how hard they pushed, but implementing new rules. Then you'd save a ton by cutting the salary 5, 10, 20 percent (I dunno, I'm not an economist) on new hires, and in turn reduce the pensions, etc... You'd also save by not having to buy ALL of your apparatus ALS equipment, you could also spend less on purchasing 2-3-4 more ambulances versus a single pumper or ladder truck. All of these things are pretty much mentioned in the article.



And stop all the medics having to go to fire school. I joined EMS as an EMT NOT a firefighter.


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## Martyn (Sep 6, 2015)

“If this was about patient care,” van Pelt says, firefighters “would be advocating to the politicians to increase EMS money, increase hospital money.”

Well, derrh....er, yeah


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## Crash Course (Sep 7, 2015)

Interesting Article regarding Firefighter/Paramedic matters in Ontario that was published in the Huffington Post:


> By: Michael Kruse
> Paramedic, Science Advocate
> 
> *The Dispute Between Fire Fighters and Paramedics Threatens Patient Safety*
> ...



Read the rest here: http://www.huffingtonpost.ca/michael-kruse/fire-medics-will-fail-in-_b_7891754.html


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## SandpitMedic (Sep 9, 2015)

Interesting article reflecting the FD in EMS in _The Washington Post_. That is, however, a subtopic in this article, which mainly focuses on the lack of need for such large departments with excessive payrolls and budgets. The comments are hilarious, the firefighters are up in arms that someone (a university law & economics professor) put some statistics together and is seemingly anti-paid FF and anti IAFF. I think he makes a lot of sense, but I don't agree with every point. Valid questions are raised.

While I agree that FD budgets and salaries are too high, and that there should be less fire engines and more ambulances, I do not agree that all FDs should be volunteer.

I post the article and its flaming rebuttal - seriously... This guy has got these firemen all _fired up!_ (pun intended)

Article:
https://www.washingtonpost.com/opin...c647a395_story.html?postshare=901441781301698

Rebuttal: (one of many as you can imagine)
http://www.statter911.com/2015/09/0...ton-post-should-be-ashamed-for-publishing-it/


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## 46Young (Sep 9, 2015)

SandpitMedic said:


> Interesting article reflecting the FD in EMS in _The Washington Post_. That is, however, a subtopic in this article, which mainly focuses on the lack of need for such large departments with excessive payrolls and budgets. The comments are hilarious, the firefighters are up in arms that someone (a university law & economics professor) put some statistics together and is seemingly anti-paid FF and anti IAFF. I think he makes a lot of sense, but I don't agree with every point. Valid questions are raised.
> 
> While I agree that FD budgets and salaries are too high, and that there should be less fire engines and more ambulances, I do not agree that all FDs should be volunteer.
> 
> ...



Seriously, that's the best that you can do, there are less fires, so replace reduce staffing and deployment, and somehow reverse the trend of dwindling volunteer participation and replace the career members? I almost spit my drink all over my computer when the author used the rationale that the Revolutionary War soldiers were volunteers, so firefighters should be the same. Using that logic, we should replace EMS, police, nurses, and perhaps even incoroprate volunteers into our Armed Services to replace paid soldiers. At least he admits that firefighter salaries can more than double with OT. So, with that admission, we can take his LA average salary of $142,000, and realize that the pay before any OT would be $70k/yr or less, not really out of place in a region with a high cost of living such as LA. Realize as well regarding OT budgets that if the OT burden becomes too great, they will hire more employees. There is always a balancing act where it costs less to pay out OT rather than hire more people, since it cost $$$ to hire, train, gear, pay benefits, and retirement to more employees. To a point, paying existing employees 1.5x is the cheaper option.

Also, it's not "the firefighters are up in arms that someone (a university law & economics professor) put some statistics together," it's Dave Statter, a civilian reporter that runs a fire blog, not a member of service. 

I've explained numerous times on this forum that the fact that fires are less frequent is not a justification to reduce staffing and deployment of suppression resources. Fires still occur, and many residential building s do not have sprinklers. Fires burn much hotter, and much more rapidly than before, due to the proliferation of type V construction (lightweight wood construction) which has a high fire load, and a large degree of synthetic materials in most homes, which also burns hotter, faster, and gives of more toxic byproducts than natural materials that were found in older homes. If anything, there needs to be a more rapid response time than there has been in the past, and there needs to be an adequate number of firefighters on each apparatus to quickly accomplish vital fireground tasks upon arrival. 

Don't take my word for it, look instead at these two links. The first is a NIST video from UL that compares a legacy room to a modern room, and the difference in time to flashover. The second video is from the NIST studies that we did in Crystal City in Arlington VA. I participated in this study. The purpose of the study was to show how different staffing and deployment scenarios affected the timeliness of various fireground tasks.

http://www.firefighternation.com/videos/legacy-and-modern-fire-behavior

http://www.nist.gov/fire/staffstudies.cfm

The author also chose to focus on figures regarding confirmed structure fires, and conveniently overlooked all of the other supression-related calls. I don't see how terrorism training would significantly increase staffing levels. He's reaching really far with that one. Just like fire has it's "food on the stove," smells and bells, minor outside fires and such, EMS gets it's share of false alarm medical alarms, pt. refusals, no pt. found, things like that, and also what I would call a scourge of unnecessary transports, which would be patients that are able to transport themselves to urgent care of their PCP, for conditions that will not have a change in outcome from using (abusing) EMS resources to txp to the ED. 

This was also a regurgitation of a similar article from 2002. I can say from personal observation, at least in the Northern VA/MD/DC area, that there has been a decrease in volunteer staffing/participation, and an increase of career staffing for area departments. More and more stations that were formerly 100% volunteer now have daytime paid crews, and combo stations progressed to 24/7/365 paid crews. For example:

http://www.wboc.com/story/9693807/gainesville-volunteer-fire-department-dissolved

Fred's old article:

http://www.econlib.org/library/Columns/Mcchesneyfire.html

_*I challenge you to review Dave Statter's response, and show how/where he is inaccurate.*_ I agree with Dave when he says that the article was "Truly one of the dumbest articles ever written about firefighting & the Washington Post should be ashamed for publishing it." I was astonished at how overwhelmingly ignorant that piece was. To someone that doesn't know any better, the article would seem interesting, but when you look at the actual facts his logic fails in grand fashion.


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## 46Young (Sep 9, 2015)

Barry Roberts Greer does a fine job of dismantling Ted McChesney here:

http://campusreports.com/?p=2103

Where in Barry's rebuttals is he inaccurate?


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## SandpitMedic (Sep 9, 2015)

All _fired_ up... See....

How *dare* we question the failing economical and antiquated model of the fire service and the dwindling need for the hoards of union firefighter across these here United States of America! An Engine AND a ladder on every stubbed toe!  With spare units in every station in case of a national disaster! Terr'ism and backdrafts can come out of nowhere!

_(Those are my sarcasm faces)._

Listen, you can get mad all you want... The part where I said firefighters are up in arms was not directed at the rebuttal blog, but rather the thousands of combined comments by fire service members on the various media outlets where the article and other rebuttals are published online. I.e Social media, blogs, and _The Washington Post's _own website.

This going to be a fiery and explosive debate without regards to the actual fundamentals and basis for the query.
Jobs and salaries are being called into question as well as why fire trucks are rolling on knee pain calls... So I fully expect the defensive posture.

The bottom line is that we all agree that something needs to change. And nowhere in my commentary did I say I think he was 100% right. I was merely presenting an article, and a rebuttal, to highlight the growing concerns over the way the fire service currently operates and its need for its own overhaul. The public is taking notice and politicians are taking notice. Save for another post 9/11 hero syndrome, this isn't going away.

I am in the middle of the road on the issue. I don't think they ought to lose their jobs, but I do think we need more ambulances and less fire service vehicles when it is absolutely clear that around 90% of all calls are EMS related. If you ignore that little factoid then your words are hallow. I'm not "anti-fire" at all, but the current model is unsustainable. These are the questions/thoughts we have been asking/thinking as a public service community for a long time, and now the issue has captured the attention of people who have new ideas and make decisions. That's the best I can do.


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## 46Young (Sep 9, 2015)

SandpitMedic said:


> All _fired_ up... See....
> 
> How *dare* we question the failing economical and antiquated model of the fire service and the dwindling need for the hoards of union firefighter across these here United States of America! An Engine AND a ladder on every stubbed toe!  With spare units in every station in case of a national disaster! Terr'ism and backdrafts can come out of nowhere!
> 
> ...



No one's getting mad, nor is this "fiery and explosive." Dave Statter, Barry Greer and myself have presented facts to refute McChesney's article in totality. I do agree that we need more ambulances - I've said this on numerous occasions. However, it shouldn't come at the expense of de-staffing fire suppression personnel. "The 70%-90% calls are EMS so scale back fire" position has already been debunked.

Again, where in Statter's or Greer's rebuttals were they inaccurate? Let's discuss the facts, not personal opinion.


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## 46Young (Sep 9, 2015)

Bullets said:


> I Am of the opinion that EMS should provide pre-hopsital medical care and fire departments should put out fires.
> 
> Staffing an engine with 4 EMTs to first respond to a medical call when i could put that same manpower out with 2 transport units seems far more logical when 90% of our calls are medical. I also am strongly against the FD involvement in rescue operations. Both my EMS jobs provide rescue services as do many other jurisdictions because rescues are patient care activities. I do not need an engine with 4 guys and a rescue with 4 guys. I can run a pin job with a 2 person ambulance and a 2 person rescue, which is how we run at all my jobs, its how most EMS rescues run, a 2 man crew. I dont need them on MVAs ever. Our fire departments are suppression only agencies and this is how it should stay.
> 
> Maybe we should have EMS-based fire!



Pin job - best practices, engine blocks the scene, and staffs a hoseline to protect the patient and Heavy Rescue crew. The other engine bucket person can go into the car for pt. care, if the txp crew wasn't issued PPE. The txp crew is better off not getting dressed anyway, at least not in hot weather - it can be distracting to pt care to be soaked in sweat, overheated, and in heavy turnouts. The Heavy Rescue - the driver sets up lights if needed, and humps equipment to the car. The rt bucket grabs the tools and generator if needed -we use Holmatro. The left bucket brings cribbing and begins stabilization. Two bucket people should be used - one cuts, and the other one spreads. For stabilization - we use Res-Q-Jacks typically - you need one person on each side with the officer controlling the lift on each side with commands. Airbags - two bucket people cribbing, the driver operating the airbag, the officer giving lift commands. Less than 4 people and you're getting away from best practices. A side out should only take a few minutes, a routine dash lift or roll, 5 minutes for a routine operation.

As far as MVA's, anyone who doesn't want a suppression unit to block is endangering everyone at the scene. First responders and victims can get hit by traffic trying to squeeze by, or by distracted drivers that plow into the scene at full speed. Research how many cops, EMS, and fire get hit and sometimes killed by other cars while working the scene.


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## SandpitMedic (Sep 9, 2015)

Stats can be manipulated to fit any argument. I don't need to debate everyone's articles to know there is a problem. I am basing my opinion on my own experience in 3 different urban US EMS systems. I don't care what Statter or Greer or McChesney say... they all have statistics and opinions. I've read what they said, they all paint nice pictures that support their agenda. As I said, the fire service feels threatened, and the defensive posture is expected.

My intent is not to come to a conclusion with you that solves the issue right here on EMTlife.
Again, I'm just pointing out that the issue is becoming public domain, and the people who are going to make the decisions (read: not you, not I) are taking notice. That is the only fact I care about. I will be well into grad school way before any real changes take place. Right now, it's all just beating chests.

Also... everyone has an opinion.


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## 46Young (Sep 9, 2015)

SandpitMedic said:


> Stats can be manipulated to fit any argument. I don't need to debate everyone's articles to know there is a problem. I am basing my opinion on my own experience in 3 different urban US EMS systems. I don't care what Statter or Greer or McChesney say... they all have statistics and opinions. I've read what they said, they all paint nice pictures that support their agenda. As I said, the fire service feels threatened, and the defensive posture is expected.
> 
> My intent is not to come to a conclusion with you that solves the issue right here on EMTlife.
> Again, I'm just pointing out that the issue is becoming public domain, and the people who are going to make the decisions (read: not you, not I) are taking notice. That is the only fact I care about. I will be well into grad school way before any real changes take place. Right now, it's all just beating chests.
> ...



If their positions are simply a matter of agenda and manipulating statistics, it should be rather simple to disprove them, and lend credibility to McChesney's position. Strengthening McChesney's position would give power to the position of reducing the FD budget (reducing personnel) to upstaff EMS. I simply asked for valid rebuttals against the response to McChesney's article, and you haven't been able to do that thus far.

Again, I have said time and time again that there needs to be more ambulances. Most EMS agencies, whether they're privates, hospital based, or muni Third Service, typically try to get by with the least amount of ambulances possible. SSM/PUM, and the reliance of automatic/mutual aid or calling up private ambulances for call surge on a continual basis is  a strong example of that. Every so often someone comes along and says to decrease fire staffing/funding to fund EMS positions. I find that ignorant, as in lacking knowledge of the subject, not in a derogatory way. The point of my earlier responses is that it goes way deeper than a simple call volume ratio of 70%-80% in favor of EMS, and employee salaries. I'm asking to be shown how the numerous other considerations (the responses to the article) should be marginalized or not considered whatsoever, which would make the 70%-80% call volume thing a strong enough reason alone to do what you advocate. But it's not.

Does the fire service put substantial energy and resources into protecting and advancing our careers and benefits? Yes, we do. This is why it's so quick and easy to source valid rebuttals with data and sometimes studies to support our position. These studies and data are useful when it comes to writing grants, or protecting our budget allowance with the Board of Supervisors. For example, from the NIST study I posted earlier, we were able to add a fourth person to 8 of our ladder trucks, and we've had another grant approve to hire for the remaining six units. We have those 14 positions reserved for an ALS provider. It may not affect pt. outcomes most of the time, but it sounded good to the politicians. We were also able to add an extra fire station recently with an engine, medic unit, and a tanker. ISO trials helped us out there. Every time we get an engine, we also get an ambulance. We would be going backwards, and getting our pay reduced if we based staffing and deployment solely on the number of calls dispatched EMS, and the number of calls dispatched non-EMS. It's not that simple.


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## 46Young (Sep 9, 2015)

Post #481:

http://www.emtlife.com/threads/aust...ying-them-as-basics.31397/page-24#post-588864

I compared ATCEMS (single role EMS, regarded as one of the best in the nation), vs. my department. We have less than half of the square miles, about the same population, 5 more ambulances, all of which are ALS and 24/7/365, vs their system, which has 37 ambulances, not all of which are full time. Their EMS call volume is double ours. Their fire department has 45 stations, so maybe 45 engines at the most, probably less. We have four more ambulances than we do fire engines (38 engines, 42 ambulances). Basically, we provide more than double the ambulance coverage than one of the most highly regarded single role EMS systems in the nation. Yes, it's not cheap, but if it were, you would have a situation in Austin, with rampant turnover, frequent forced OT, documented depression and ETOH issues, and very sadly, two suicide (RIP Brothers). Our IAFF Local has lobbied to keep and increase job positions, which is easier to do when you demonstrate your worth to the public, instead of letting things like reduced fires and having the bulk of dispatches being ALS gut your staffing levels. We successfully fought off a reduction in force of over 100 positions the same year that I finished the fire academy. Now, we have safe staffing levels for our ladder trucks, ambulance deployment more than double that of ATCEMS, which keeps our call volume down to 4.45/unit/24 hrs, and we've been able to hire enough new medics to quiet down the mandatory hold/recall OT that was beginning to become a problem, although not as bad as ATCEMS.

I left EMS and joined fire, partly because it's a significantly more secure career, with much better working conditions. Firefighting wasn't my first choice of a career. I had done six years in EMS before going fire. I saw/experienced what kind of deal the typical single role EMS provider can expect, and I wanted out in a bad way. Other medics in my recruit school that were also EMS refugees all said that they would never go back. If nothing else, if I had to do EMS only in this department, it's very cushy compared to what I've seen on the non-fire EMS side. That was my plan if I found out that suppression wasn't my cup of tea.

Also, the Austin FD runs 70% medical calls, not 80% or 90% like some people say:

http://www.austintexas.gov/department/fire/about


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## SandpitMedic (Sep 10, 2015)

I know you have a well articulated argument, and you really want to debate this issue. I am not the guy. Debate is great, but no one is changing their minds on this issue - no firefighter is ever going to say, "You know, I make too much..." or "You know, they're right. I really don't need to be here today. I'll volunteer for a brownout."  That said, I have no desire to beat chests and see who can scream the loudest, use the biggest words, and/or frighten the populace the most that they may burn to death if we take a single engine out of service. I don't care to debate that with you further. Times are changing - this is happening, and the IAFF and its members are going to have to swallow the pill the hard way, or have it forced down their throats. You may disagree, but this is happening. Overall, nationwide, the IAFF and fire service has had held the reigns of its own destiny for too long, and has gotten out of control.

I have my own opinions based on my own experience; you have yours. Taking statistics from a single department or two or three does not exemplify anything of substance. It is merely statistical bias and sample bias, and really is not a measure of the systemic issues nationwide. Sure, you think FD is doing it right - you're a firefighter... I am not shocked.  I see things from a different lens than you do. _Do I hold a bias against the fire service? No_, I whole heartedly do not have a bias against the fire service. However, as a_ taxpayer_ I believe the fire service is chewing through an insane amount of public funds that does not match or commensurate with the actual tangible requirements for fire and emergency protection. I also see a different perspective, coming from dual-response services where, indeed, engines and ladders are rolling out to chronic abdominal pain et.al. patients which is just plain wasteful.

As a taxpayer and a man on the inside I see a need for overhaul. Your vigorous defense and the IAFF's vigorous defense is not surprising, as I have beaten to death that point. I think a lot of things need revision... The fire service just happens to be one of those items.


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## Bullets (Sep 11, 2015)

46Young said:


> Pin job - best practices, engine blocks the scene, and staffs a hoseline to protect the patient and Heavy Rescue crew. The other engine bucket person can go into the car for pt. care, if the txp crew wasn't issued PPE. The txp crew is better off not getting dressed anyway, at least not in hot weather - it can be distracting to pt care to be soaked in sweat, overheated, and in heavy turnouts..


Transport crew should make contact with the patient and maintain that for the entirety of the call. We issue our EMS turnouts. Our Engine arrives, block and pulls the handline for suppression, maybe throws some speedy dry for fluids. 2 man rescue arrives, driver does the 360 and starts throwing stabilization with the assistance of the other transport EMT. We use Rescue 42s, so he'll throw 2 if the vehicle isnt upright. We dont lift with our struts. 2 man will start the PTO and select his choice of 5 preconnected tools. Once the driver has his stabilization secure, removal will begin. Wtih the ambulance or 2 and the rescue, that gives us 4-6 people more than enough to do 90% of what we encounter

And we also have electric combi tools on the ambulances, so our first due can perform a door pop and cancel the whole response withing 90 seconds of arrival. Cuts down on the amount of code 3 driving, makes everyone safer.

Institutionally, we feel that we are cutting this car, jumping in the water, rappelling down to get a patient who needs medical attention. Why would we send someone trained to put out fire to provide medicine? Do you let your mechanic work on your teeth? If the person was on fire then we would call someone trained to fight fire. My experiance has been that the fire departments solution is to throw as much manpower at a problem and hope it works out. I would rather have 2-3 highly trained rescuers than 6-8 average trained ones.


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## SandpitMedic (Sep 11, 2015)

And there is more than one way to eat a Reese's....

Or... something like that.

Good post @Bullets


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## 46Young (Sep 16, 2015)

In reading the most recent thread about ATCEMS, and how their working conditions are undesirable, it made me realize that their conditions are common throughout EMS. I'm referring to things like frequent mandatory holdover and recall (forced OT), high call volume, too high to do much drilling, self-study, or rest at night, 24 hr. shift in a busy system, adversarial supervision, uneven discipline from one employee to the next, no job security/protection, pay lower than fire or police, and very high turnover with employees burning out, developing alcoholism and depression (see the ATCEMS article on suicides). Having progressive guidelines are great, but not if you're using your KSA's only very infrequently, which is increasingly becoming the case as employers move to a fleet of all ALS (MB staffing).

ATCEMS isn't a ghetto, low funded department, it's top 10 in the nation IMO. If working for a fire department was off the table for me, ATC would be on my short list of places that I would apply to, and follow up aggressively with. The fact is, the fire service has much more influence to prevent many of the undesirable pay/benefits/working conditions that plague EMS. It stinks, but it's also true. EMS should enjoy the same influence as a FD or PD, but somehow EMS got passed by in the race for funding and employee organization (unions and such). I'm sure that there are plenty of FD's that would be happy to leave someone on the ambulance all of the time if that's what they want. After 6 years in EMS, I realized that I'll make out better in the long term by aligning with fire, who offers a much better employment package than nearly all of EMS. It wasn't my original intention, but I want a decent standard of living when I retire.

Ideally, EMS could pull of what nurses did, which is to increase the barrier of entry to a degree, sell the notion that this education benefits the patient, and then command a higher salary with better benefits and job security. Unfortunately I don't see how this will occur. Not too many people want to go to college for 2-4 years to make $12-$15/hr, and bet on that changing in time to plan for a secure retirement. Hence the short average tenure in EMS, where people typically move on to a different public safety profession, a different medical profession, or something else entirely.


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## Martyn (Sep 26, 2015)

46Young said:


> Pin job - best practices, engine blocks the scene, and staffs a hoseline to protect the patient and Heavy Rescue crew. The other engine bucket person can go into the car for pt. care, if the txp crew wasn't issued PPE. The txp crew is better off not getting dressed anyway, at least not in hot weather - it can be distracting to pt care to be soaked in sweat, overheated, and in heavy turnouts. The Heavy Rescue - the driver sets up lights if needed, and humps equipment to the car. The rt bucket grabs the tools and generator if needed -we use Holmatro. The left bucket brings cribbing and begins stabilization. Two bucket people should be used - one cuts, and the other one spreads. For stabilization - we use Res-Q-Jacks typically - you need one person on each side with the officer controlling the lift on each side with commands. Airbags - two bucket people cribbing, the driver operating the airbag, the officer giving lift commands. Less than 4 people and you're getting away from best practices. A side out should only take a few minutes, a routine dash lift or roll, 5 minutes for a routine operation.
> 
> As far as MVA's, anyone who doesn't want a suppression unit to block is endangering everyone at the scene. First responders and victims can get hit by traffic trying to squeeze by, or by distracted drivers that plow into the scene at full speed. Research how many cops, EMS, and fire get hit and sometimes killed by other cars while working the scene.



Totally agree with above having attended more than a few MVA's, however...

(Purely hypothetical of course...)...'911, whats your emergency', 'My husband is having a heart attack'....Dispatch then sends engine 220 (a ladder truck), a few minutes after that they then send Medic 72. Meanwhile on scene Mrs X is waiting. The fire truck is 15 minutes away (rural-ish). The ambulance is only 7 minutes away but because they got toned out AFTER the fire truck it takes them 20 minutes to get there after initial 911 call. Meanwhile, on scene Mr X is becoming a smurf, Mrs X doesn't know CPR and is panicking too much to listen to 911 operator. Engine 220 gets on scene and medic starts his magic. 10 minutes after he starts his magic the ambulance arrives...its not looking good. Just across town Mrs Y's son is having an epileptic seizure. She calls 911 and pumper 211 is toned out. A few minutes later medic 74 is dispatched. 20 minutes later Mr J calls 911....'My house is on fire'. Oops, no fire trucks nearby (they are all on medical calls, remember?) so dispatch sends medic 34...don't worry, all the ambulances carry a fire extinguisher!!! And we can always call for backup from the next county. Or we could call the fire off the medical calls, but the fire is just across from engine 220's station and it will take them 25 minutes to get there. Just another busy night, hey ho, we can't save them all.

Having ridden with county ambulances it ALWAYS amazed us how fire beat us on scene 9 times out of 10 and we were only 2-3 miles away from incident, fire was at least 6-7 miles away...turbo charged fire trucks? Or fire getting toned out before EMS just to justify sending a ladder truck for a pimple?

By the way, if ambulances were only sent on medical calls Mrs X's husband might have made it, Mrs Y's son wasn't too bad anyways and Mr J's house might not now be a pile of ashes.

See below


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## Martyn (Sep 26, 2015)

Just as an aside, I got called 911 non emergency response for a GLF, outside the residence was (if I remember correctly) a ladder truck, a pumper, the battalion chiefs vehicle a county ambulance and us (I was working with Americare at the time), I think there was one or two sheriff deputies there as well. When we got on scene my partner and I were like WTF???

Somewhere I have pictures to prove it...now, what hard drive are they on???


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## johnrsemt (Sep 27, 2015)

If ambulances were only sent on EMS runs;  for the most part everyone would be ok;  but when EMS gets to the scene and you find out that the patient that was called in having minor problems breathing is now a smurf, and weighs 400lbs.  So you can treat the breathing problem (or the cardiac arrest) while you wait the extra time for the fire crew (or 2nd EMS from the next town or other side of your town to show up to help move the patient.
My old fire department Dispatch would decide who needs extra help (per caller info, and history of the address {400lb pt, breathing difficulty, etc}) and send an engine or Ladder with an Transporting ambulance.   Minor runs, got just EMS.  Fire runs got no EMS, unless someone was trapped or it was marked working.
Bad thing is they taught kids in the schools if your house is on fire, pick up the phone, dial 911 and leave phone off the hook while you evacuate and dispatch would tone out a box alarm for it.   Two times in about a month's period we had people do that 'cause husband was in cardiac arrest and caller didn't have time to talk on the phone.   So they would get 3 engines and 2 ladders, and a chief,  and usually 4-6 medics but no ambulances.   

Not a perfect system but it works pretty well


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## SandpitMedic (Sep 28, 2015)

How about if a caller gives limited info such as "cardiac arrest" only and hangs up they just send an ambulance and any manpower unit... 3 engines, 2 ladders, and a chief?! No transporting unit?!

... That's not a system that works pretty well... That's full potato.

I'd be happier with a transporting unit, an extra crew or engine, and a cop because no one really knows what they're truly getting.
I have no need for ladders, and no scene needs more than 5-6 providers... Let alone 21... Jeeze.  (I come from urban systems, so the cops usually get dispatched on any unknowns that sound fishy and most cardiac arrests for crowd control and safety if they are available.)


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## DPM (Sep 28, 2015)

I agree with these previous posts. The argument "well what if it's YOUR grandmother and she's in cardiac arrest?!" doesn't hold much water for me. What if the tables were turned, and we had a system where an Ambulance could arrive on scene within 8 mins and an Engine / other BLS fire could arrive in 12 if it was high acuity etc? Why is non transporting fire the more important responder? 

My ideal system has many more ALS and BLS ambulances, and probably far fewer fire engines.

I know I'll get heat for this, but do we still need the same response times that we did in the 80's? At a quick look the number of fires has gone down by nearly 50%, and the fire protection and holding standards have increased also. It is my opinion that many fire departments are using their EMS responses to justify their pre 1980 staffing levels. I think that  it is these levels, and the cost associated with them, that is preventing county EMS agencies from staffing an appropriate level of ALS and BLS transport units.


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## MicahW (Sep 28, 2015)

I disagree with not having FD respond to any medicals.  Although I have had some bad experiences with crews that are lazy and do not want to do anything that does not interest them, fire can be of great help.  Where I work, we run 2 man rigs.  Our ALS rigs consist of one ALS provider and one BLS provider.  They can be great for doing compressions as well as lifting and moving.  I have responded to many calls where fire is already providing crucial treatment upon our arrival and often have histories, meds, etc. ready for us.  That being said, I have arrived to calls where fire has already been there for 5 minutes, and they are just sitting there with their medical bag on the ground, unopened, waiting for us.  It really depends on the engine or truck responding.  I do agree that EMS should be its own department, but that does not mean that we cannot receive help from fire.


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## DPM (Sep 28, 2015)

You're missing my point. You're advocating early treatment, as am I. I'm also not saying that we don't need fire / help ever. I don't think it's unreasonable to say that in around 70% of cases having 3+ from an engine and 2 from the box is over kill. 

If we staff appropriate levels of ALS ambulances then we could make the 8min time ourselves. Then in the relatively rare occasions where we need all hands to the pump we can dispatch fire as well. ROUTINELY dispatching them is where I think the issue lies.


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## MicahW (Sep 28, 2015)

I see your point but I rarely get a call that comes in as "abdominal pain (no need for fire) but the patient is 350 pounds and at the top of a spiral staircase, so we'll dispatch fire to help you out with moving the patient".  I would rather have fire there just in case I need help, and possibly not need them, than to not have them.  I get that it may take up money, but for the large part, it doesn't affect us--it's their budget, not ours.


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## DPM (Sep 28, 2015)

It does affect our budget though. County EMS pays ever ALS department for every medic that they have on the books. Plus, as a tax payer, you're on the hook for replacing that $10 million pumper because it's now worn out in 6 years and not 10 or 15. 

Having them "just in case" isn't good enough.


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## MicahW (Sep 28, 2015)

I see what you mean but I work at a private company so it definitely doesn't affect me, and even my volunteer company largely pays for itself through billing.  I do think that it might be a better idea though to send maybe 2 or 3 guys in the chief's car: it's faster and cheaper and if they do end up getting called to a fire, they can just meat their rig there.


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## Tigger (Sep 28, 2015)

MicahW said:


> I see your point but I rarely get a call that comes in as "abdominal pain (no need for fire) but the patient is 350 pounds and at the top of a spiral staircase, so we'll dispatch fire to help you out with moving the patient".  I would rather have fire there just in case I need help, and possibly not need them, than to not have them.  I get that it may take up money, but for the large part, it doesn't affect us--it's their budget, not ours.


There are two time I want fire to come. One is on time sensitive calls like an arrest, anaphylaxis, and things of that nature that they could beat us to or extra hands will certainly be needed for. Those calls are fairly identifiable via EMD and they can be dispatched immediately. The other is for complicated "patient extrication" and I can call for them to come and we will wait till they arrive without any detriment to the patient.

So why do they need to be there on every call?


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## DPM (Sep 29, 2015)

The article did an excellent job of articulating the point of view that I've held for quite some time, and so far no one has been able to come up with a better counter argument than "sometimes it's nice to have lots of people on scene when you need them".


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## SandpitMedic (Sep 29, 2015)

MicahW said:


> I get that it may take up money, but for the large part, *it doesn't affect us--it's their budget, not ours.*




I usually respect everyone's opinion, but you lost me here. You clearly have absolutely no idea what you're talking about given your last statement. Financially, someone is paying for it. It's all "our" budget... Have you never heard of taxes?

As for the rest, your entire argument is based on emotion and absent logic. The stance of, "I'd rather dispatch everyone to everything just in case" is bogus.

It also has nothing to do with interpersonal relationships between fire and EMS on scene. "I don't like fire crews" is also a bogus reason you're trying to assign to us because we oppose the idea of fire being dispatched too much. 

If you actually read what we wrote we actually give real life experiences and scenario based alternatives, all of which still include fire or more hands in a timely manner during true emergencies.


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## SandpitMedic (Sep 29, 2015)

DPM said:


> The article did an excellent job of articulating the point of view that I've held for quite some time, and so far no one has been able to come up with a better counter argument than "sometimes it's nice to have lots of people on scene when you need them".



This


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## Noncreative (Oct 1, 2015)

Yeah, I like the idea of Fire restructuring towards EMR/BLS, but I've got no issue with them running ALS, whoever can get there fastest works for me.  I do get the cost aspect of it, if fire would send an ambulance instead of a truck they'd be way more effective.  But, as Micah said, it's their budget, and I doubt the maintenance saved on the trucks would impact my taxes at all.  Honestly I'd rather they send a Type 2 with three Fire, than a truck, because they could transport right off the back with a ride-along already there.


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## NTXFF (Oct 9, 2015)

I'm sure I'm about to be a not so popular guy here.  As someone who operates within a fire based system I'm trying to figure out where you work where you've got a battalion, engine, and truck showing up on a medical call.  Cardiac arrest: engine and medic.  Fall: engine and medic. Chest pain: engine and medic.  MVA not on the highway: engine and medic. Our protocols far exceed and system in our area for aggressiveness and the guys here take riding the medic very seriously.  We've got a high save rate and have never even had a complaint filed against our system.  Reading all this fire bashing is pretty ridiculous and with those attitudes I'd hate to be fire in your area and have to work with y'all. As far as the six figure salary I'm not sure where they are even talking about.  Captains are a six figure position but very few departments offer that to a FF/PM. I can understand some frustration but realistically we all have the same job and personally I support either independent EMS or fire based.


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## Tigger (Oct 9, 2015)

What attitude would that be? There is no good reason for anything besides and ambulance to be sent to the majority of medical calls, regardless of the model. I suppose it is "nice" to have five or six people on scene but often it is more of a hinderance than a help and it's not a good of resources. If fire would send two people I'd be a bit more on board with that, but that doesn't happen in many places.

Let's be honest here. Fire departments that do not have ambulances only started responding to every medical call because it helps justify their existence. I don't think that's right and I don't think FDs should be forced to cut staffing because their are fewer fires (a very shortsighted argument). But when other, shortsighted people did choose to make FDs answer for their budget, this was the solution. That doesn't make it a good idea though.


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## jwoods (Oct 9, 2015)

Well, coming from a Fire based organization who provides ALS transport. I can see some validity to an ALS engine being first up on a medical call. It's a double edged sword though. One, we can decide if transports even needed. Alieving our abused ALS transport units or Rescues we call them, freeing them up. However, bandaging an *** boil at 3 am when a structure fire kicks off can be a little frustrating as well. But Tigger your right, it's all about the money, and both fire and ems were never intended to generate revenue nor should they be.


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## Tigger (Oct 9, 2015)

ALS first response has very little evidence to support its efficacy. Send ambulances to medical calls.


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## triemal04 (Oct 9, 2015)

jwoods said:


> Well, coming from a Fire based organization who provides ALS transport. I can see some validity to an ALS engine being first up on a medical call.


Like what?  And not anecdotal examples if you can, but real reasons why having a paramedic on an engine would be beneficial.


> It's a double edged sword though. One, we can decide if transports even needed. Alieving our abused ALS transport units or Rescues we call them, freeing them up.


Does you specific department actually do this, and if so how often?  How long is an engine arriving before an ambulance?  I only ask because this gets tossed around occasionally without anything to back it up.


> However, bandaging an *** boil at 3 am when a structure fire kicks off can be a little frustrating as well. But Tigger your right, it's all about the money, and both fire and ems were never intended to generate revenue nor should they be.


So you're ok going to EMS calls until something more fun is going down?  I'm sure that wasn't what you mean, but that's certainly how it can easily be taken.   It also brings up the question of, if that's the case, and not only do the people on the engine want to be elsewhere, but in fact *should* be elsewhere, wouldn't the public be better served by not using that unit in a way it was not meant for?


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## jwoods (Oct 9, 2015)

First, in my situation down here all medical calls are run by the fire department, We run a priority dispatch system. The majority of our Fire houses are staffed with a ALS suppression apparatus and an ALS Transport Rescue (ambulance)If a less critical priority medical call is dispatched, the engine rolls. If a high priority call is dispatched, the Rescue rolls. If the rescue is out, the ALS suppression is first up.
And I didn't say I enjoy medical calls until something more fun comes along, This system is far from perfect and does need tweeking.


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## triemal04 (Oct 10, 2015)

jwoods said:


> First, in my situation down here all medical calls are run by the fire department, We run a priority dispatch system. The majority of our Fire houses are staffed with a ALS suppression apparatus and an ALS Transport Rescue (ambulance)If a less critical priority medical call is dispatched, the engine rolls. If a high priority call is dispatched, the Rescue rolls. If the rescue is out, the ALS suppression is first up.
> And I didn't say I enjoy medical calls until something more fun comes along, This system is far from perfect and does need tweeking.


Oh good, I'm glad that wasn't what you meant.  I'm sure you can see how an unscrupulous person would take what you said to mean that though...

If you don't mind, would you mind answering the questions I asked?  Specifically, why having a paramedic on an engine is appropriate; and not anecdotal examples if you can, but real reasons why having a paramedic on an engine would be beneficial.  And, how often is your department actually cancelling the paramedic unit, plus how long are they arriving before the ambulance?  As well as, if the people on the engine want to be elsewhere, and in fact *should* be elsewhere, wouldn't the public be better served by not using that unit in a way it was not meant for?


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## Martyn (Oct 13, 2015)

MicahW said:


> I see what you mean but I work at a private company so it definitely doesn't affect me, and even my volunteer company largely pays for itself through billing.  I do think that it might be a better idea though to send maybe 2 or 3 guys in the chief's car: it's faster and cheaper and if they do end up getting called to a fire, they can just *meat* their rig there.


 
    Barbecue?
(Sorry, couldn't resist it)


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## medicsb (Oct 13, 2015)

Tigger said:


> ALS first response has very little evidence to support its efficacy. Send ambulances to medical calls.


Actually, there is NO EVIDENCE.  I've yet to find even an abstract to support the practice (and I've looked). Simply, there is NOTHING efficient about sending fire apparatus with paramedics.  There's no efficiency involved with sending an ALS SUV when there are already ALS ambulances (e.g. Memphis FD).  Despite what all the Gary Ludwigs of the US might say, it's nothing more than wishful thinking.


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## DPM (Oct 13, 2015)

medicsb said:


> ...There's no efficiency involved with sending an ALS SUV when there are already ALS ambulances (e.g. Memphis FD).  Despite what all the Gary Ludwigs of the US might say, it's nothing more than wishful thinking.



The only time that I can see this working is when an ALS supervisor responds with the Ambulance on high acuity calls. I think London Ambulance safely showed that the single SUV responder is a bad idea.


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## Tigger (Oct 13, 2015)

medicsb said:


> Actually, there is NO EVIDENCE.  I've yet to find even an abstract to support the practice (and I've looked). Simply, there is NOTHING efficient about sending fire apparatus with paramedics.  There's no efficiency involved with sending an ALS SUV when there are already ALS ambulances (e.g. Memphis FD).  Despite what all the Gary Ludwigs of the US might say, it's nothing more than wishful thinking.


Indeed you are correct, I was going after political correctness points. 

I guess you could argue that some tiered systems use non transporting fire as their ALS but even that is not all that common outside of California. And those models miss the point of a tiered system in not having a billion paramedics.


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## 46Young (Oct 13, 2015)

DPM said:


> I agree with these previous posts. The argument "well what if it's YOUR grandmother and she's in cardiac arrest?!" doesn't hold much water for me. What if the tables were turned, and we had a system where an Ambulance could arrive on scene within 8 mins and an Engine / other BLS fire could arrive in 12 if it was high acuity etc? Why is non transporting fire the more important responder?
> 
> _*My ideal system has many more ALS and BLS ambulances, and probably far fewer fire engines.*_
> 
> I know I'll get heat for this, but do we still need the same response times that we did in the 80's? At a quick look the number of fires has gone down by nearly 50%, and the fire protection and holding standards have increased also. It is my opinion that many fire departments are using their EMS responses to justify their pre 1980 staffing levels. I think that  it is these levels, and the cost associated with them, that is preventing county EMS agencies from staffing an appropriate level of ALS and BLS transport units.





46Young said:


> Seriously, that's the best that you can do, there are less fires, so replace reduce staffing and deployment, and somehow reverse the trend of dwindling volunteer participation and replace the career members? I almost spit my drink all over my computer when the author used the rationale that the Revolutionary War soldiers were volunteers, so firefighters should be the same. Using that logic, we should replace EMS, police, nurses, and perhaps even incoroprate volunteers into our Armed Services to replace paid soldiers. At least he admits that firefighter salaries can more than double with OT. So, with that admission, we can take his LA average salary of $142,000, and realize that the pay before any OT would be $70k/yr or less, not really out of place in a region with a high cost of living such as LA. Realize as well regarding OT budgets that if the OT burden becomes too great, they will hire more employees. There is always a balancing act where it costs less to pay out OT rather than hire more people, since it cost $$$ to hire, train, gear, pay benefits, and retirement to more employees. To a point, paying existing employees 1.5x is the cheaper option.
> 
> Also, it's not "the firefighters are up in arms that someone (a university law & economics professor) put some statistics together," it's Dave Statter, a civilian reporter that runs a fire blog, not a member of service.
> 
> ...



I'm all for more ambulances, but decimating fire staffing and deployment is not the answer (see above).


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## Tigger (Oct 13, 2015)

46Young said:


> I'm all for more ambulances, but decimating fire staffing and deployment is not the answer (see above).


Most here are not suggesting that, and I have emphasized that numerous times. Still does not mean that fire engines should be responding to every medical call, nor should they have paramedics onboard.


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## DPM (Oct 15, 2015)

A City FD in my area staffs ALS Rescue Squads, which are type 3 ambulances. I recently responded with this agency and found an Engine and a Rescue Squad (read: Ambulance) already on scene. I think this is the worst example of this practice, but a perfect example of the duplication of effort that we face. 

An ambulance, equipped as such, with all the capabilities to transport sick and injured patients, but not doing that. I can't get my head around this.


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## DPM (Oct 16, 2015)

I should add: I work for the county's EMS provider, so once I was on scene we had an engine and two ambulances, but one of the ambulances was never going to transport.


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