# NYPD vs FDNY



## jona2125 (Sep 3, 2011)

Anyone see this. Seemed like a big cluster situation. The two divisions obviously didn't want to work together. Thoughts/opinions?

http://statter911.com/2011/09/03/a-...tion-of-brooklyn-motorcyclist-from-under-car/


----------



## bstone (Sep 3, 2011)

What is the NYPD doing in the business of rescue? Isn't this solidly delegated to fire?


----------



## Shishkabob (Sep 3, 2011)

I'm more worried about the darn old bat who gets nothing more than a ticket for running over a motorcyclist due to her stupidity and old-bat-ness.


----------



## jona2125 (Sep 3, 2011)

Yea it's a shame all together. There's no point in dwelling on the things that should have happened. It's better to admit what went wrong, and work on improving it in the future. I really think the rush to get the spreader in was a poor decision. It wasn't very stable when the started lifting and the bags were almost in place. Too much rushing from two different response teams. They were too busy fighting over control and that made the scene unsafe. You have to work together, or else, well exactly what happened here. It's just unfortunate


----------



## jona2125 (Sep 3, 2011)

bstone said:


> What is the NYPD doing in the business of rescue? Isn't this solidly delegated to fire?



Well the NYPD have a special ESU (Emergency Service Unit) that responds to these things but because FDNY is more delegated to these incidents naturally it's a huge turf war. You can see what happens in the video how they go back and forth trying to put equipment in place and lift the car. Should have had a designated crew, even better have half and half and let them work together not as individual crews for the same task. It just causes disruption and poor results


----------



## DesertMedic66 (Sep 3, 2011)

Or just have the police worry about their normal job and fire worry about theirs. Imagine how NYPD would feel if FDNY had a "special unit" that would do their jobs. IMO it's a really stupid idea.


----------



## Shishkabob (Sep 3, 2011)

firefite said:


> Or just have the police worry about their normal job and fire worry about theirs. Imagine how NYPD would feel if FDNY had a "special unit" that would do their jobs. IMO it's a really stupid idea.



About as stupid as fire doing extrication in the first place....


----------



## bstone (Sep 3, 2011)

FDNY should form a special "security response unit" squad, which will be a rapid response to any crime situation. They will have complete authority in the situation.

^That would be insane. Let FDNY do what they do best and let NYPD do what they do best. I saw a video on the OPs linked site where they had detectives talking about rescue situations. That's insane.


----------



## Bullets (Sep 3, 2011)

firefite said:


> Or just have the police worry about their normal job and fire worry about theirs. Imagine how NYPD would feel if FDNY had a "special unit" that would do their jobs. IMO it's a really stupid idea.



PD's job is public safety. EMS and PD has FAR more in common then EMS and Fire do. 

Fire is a property protection agency, Police and EMS are public safety agencies


----------



## JPINFV (Sep 3, 2011)

Bullets said:


> PD's job is public safety. EMS and PD has FAR more in common then EMS and Fire do.
> 
> Fire is a property protection agency, Police and EMS are public safety agencies



EMS is health care and, potentially, public health, not public safety.


----------



## DesertMedic66 (Sep 3, 2011)

Linuss said:


> About as stupid as fire doing extrication in the first place....



Who should be doing extrication?


----------



## DesertMedic66 (Sep 3, 2011)

Bullets said:


> PD's job is public safety. EMS and PD has FAR more in common then EMS and Fire do.
> 
> Fire is a property protection agency, Police and EMS are public safety agencies



EMS and PD have nothing to do with each other. EMS isn't preventing crimes or stopping crimes or investigating crimes, etc. PD isn't responding to medical calls (in my area) or doing anything EMS does. 

The only thing in common is well both wear uniforms (some EMS don't) and both have lights and sirens.


----------



## Shishkabob (Sep 3, 2011)

firefite said:


> who should be doing extrication?


EMS should.


----------



## DesertMedic66 (Sep 3, 2011)

Linuss said:


> EMS should.



Uhhhh why?


----------



## bstone (Sep 3, 2011)

100% against EMS doing extraction. FD does that very well. They train for it long and hard.


----------



## Shishkabob (Sep 3, 2011)

firefite said:


> Uhhhh why?



Because extrication is a patient centered ordeal, therefor you should have someone that, you know, has the responsibility of the patient, in charge of it.


I'm not talking swift water rescue, I'm not talking high angle... I'm talking basic extrication.  No reason EMS shouldn't, and in fact in a few areas EMS IS the one in charge of basic extrication for that very reason.




bstone said:


> They train for it long and hard.



I'm sure ESU trains long and hard for extrication to... so why are you against them doing it?  Why would EMS be unable to train for it?




ONLY reason fire got involved in rescue / extrication is the same exact reason they have been getting involved in EMS:  To justify their jobs.


----------



## bstone (Sep 3, 2011)

> I'm sure ESU trains long and hard for extrication to... so why are you against them doing it? Why would EMS be unable to train for it?



Clearly they didn't train long and hard. They dropped a car on a guy. FD was taking a long time to properly do it. ERU futzed it up.


----------



## DesertMedic66 (Sep 3, 2011)

bstone said:


> 100% against EMS doing extraction. FD does that very well. They train for it long and hard.



Same opinion. We don't have any room on the ambulances for any kind of equipment, let alone stairchairs, we don't have any of the protective gear that we would need to keep us safe. Most ambulances only have 2 crew members, so you would need at least 2 ambulances to do extrication. We don't have the training that would be needed.

The list of reasons why EMS shouldn't do extrication keeps going.


----------



## Shishkabob (Sep 3, 2011)

bstone said:


> Clearly they didn't train long and hard. They dropped a car on a guy. FD was taking a long time to properly do it. ERU futzed it up.



Because mistakes never happen on extrication scenes.


On one hand, yes, we do see the video.  On the other hand, we do not know the condition of the patient that prompted them to think a quicker way would have been better.


Would you fault crews for doing a rapid extrication of a patient in a time critical situation who became paralyzed after the move?


----------



## bstone (Sep 3, 2011)

Linuss, this "ERU" is a group that has unknown training, unknown certification and unknown skill. The FD, however, has well known training, well known certification and well known skill.

If I needed someone to pull me from under a car I would want the FD to do it.


----------



## DesertMedic66 (Sep 3, 2011)

Linuss said:


> Because mistakes never happen on extrication scenes.
> 
> 
> On one hand, yes, we do see the video.  On the other hand, we do not know the condition of the patient that prompted them to think a quicker way would have been better.
> ...



They said the patient died on impact


----------



## adamjh3 (Sep 3, 2011)

I think I remember seeing on an episode of "Help: Following Paramedics" PD doing extrication, but I'll let someone else chime in on that, since my experience with any sort of extrication other than maybe going down a flight of stairs is nil.


----------



## Shishkabob (Sep 3, 2011)

firefite said:


> The list of reasons why EMS shouldn't do extrication keeps going.



And your list is a complete and utter falacy.



> Same opinion. We don't have any room on the ambulances for any kind of equipment,



Bull.  Your current ambulances might not, but you don't speak for other agencies.  I know an agency here in DFW where EMS has basic hydralic tools on ALL their ambulances, and they have the average sized ambulance.




> we don't have any of the protective gear that we would need to keep us safe.


  Than put the equipment on to keep us safe.



> Most ambulances only have 2 crew members, so you would need at least 2 ambulances to do extrication.



Again, I know an agency here that has 2 crew members and yet they do extrication.

I work in a rural system... I've had MVCs happen where my "extrication team" consisted of a single firefighter volunteer showing up in an engine.



> We don't have the training that would be needed.



Than do the training.


----------



## usalsfyre (Sep 3, 2011)

firefite said:


> EMS and PD have nothing to do with each other. EMS isn't preventing crimes or stopping crimes or investigating crimes, etc. PD isn't responding to medical calls (in my area) or doing anything EMS does.
> 
> The only thing in common is well both wear uniforms (some EMS don't) and both have lights and sirens.



If we're going to insist on placing EMS in a "public safety" category...

EMS (in most places) is individuals using their judgement and operating with relative autonomy on the best way to resolve a situation, a supervisor is only called for higher level situations and the deployment scheme tends to be mobile and flexible...which is an awful lot like how the PD operates. 

The FD tends to travel in small packs, generally a supervisor is present at all times, there's next to no autonomy below a certain level(if you ride the bucket, you were hired from the neck down) and the deployment scheme is station based and very fixed. 

Fire-base EMS started in a few places because no one else was doing it. It was soon co-opted by other elements within the fire service solely to expand their power-base and preserve jobs, witness the string of poorly done mergers (as recently as two years ago). If the majority of FDs really gave a crap about EMS they would devote career paths, money and staffing to it.


----------



## Shishkabob (Sep 3, 2011)

firefite said:


> They said the patient died on impact




All the stories I've read were the patient was alive after the initial accident, alive on arrival of crews, alive after the vehicle fell back on top of him, alive on arrival to the hospital, and dead later at the hospital.


----------



## DesertMedic66 (Sep 3, 2011)

Linuss said:


> And your list is a complete and utter falacy.
> 
> 
> 
> ...



And to do all of that is going to cost alot of money. Along with medics and EMTs saying "you want us to do extrication, well then I better be getting a nice pay raise". 
"you want me to train to do extrication? Well then that better be paid training" etc. 

And yes for my area we have type 2 ambulances with no extra room for anything so we would have to get new ambulances. 

Now I would love to hear someones argument to the state saying "we need more money so we can get all the equipment we need to do extrication, even though Fire already does extrication, already have the safety gear, already have the equipment needed, and already have the training needed."


----------



## Shishkabob (Sep 3, 2011)

Just more excuses, really.  There's not a single reason why EMS cannot / should not do basic extrication.



Fire is essentially a big wasteful sink anyhow.  Why not divert the funds from them to EMS?  We do more work anyhow, and they do the little side-gigs that are hardly ever done but use to justify their budgets...


----------



## bstone (Sep 3, 2011)

If you want me to do extraction or any other sort of non-medical rescue then you can send me to the Fire Academy and train me in all the things they get trained for. I think that's called being a "Firefighter Paramedic" or "Firefighter EMT". You can also pay me to do that.


----------



## usalsfyre (Sep 3, 2011)

bstone said:


> Linuss, this "ERU" is a group that has unknown training, unknown certification and unknown skill. The FD, however, has well known training, well known certification and well known skill.



You haven't witnessed some of the things I've seen on FD run extrications obviously...

ESU is actually a well known entity. It's an interesting concept, and not as flawed as some would like to believe. ESU trucks are going to be on the road and likely in the area. The (well documented) issue in NYC is lack of well defined responsibility and significant service overlap leading to turf wars. While I tend to agree with actually go farther than Linuss and think that all rescue is a patient focused activity and needs to be medicine centered, the reality is I don't care who does rescue as ling as is defined beforehand and they're well trained.

Heck there's a city here that has separate fire, PD, EMS and rescue.


----------



## Shishkabob (Sep 3, 2011)

And I'll reiterate:

There is no reason why EMS cannot be taught extrication in school, ambulances equipped with basic hydraulic tools, and safety gear put on.


Some agencies do it already, so if you're saying it can't be done, you're wrong.


----------



## Shishkabob (Sep 3, 2011)

usalsfyre said:


> While I tend to agree with actually go farther than Linuss and think that all rescue is a patient focused activity and needs to be medicine centered, the reality is I don't care who does rescue as ling as is defined beforehand and they're well trained.



As long as I have veto power, as it IS my patient, I don't care who does the actual cutting.



The patient is ultimately my responsibility, therefor if it has to do with their health, it will go through me.  Luckily in my area, the VFDs ask us how we'd like to extricate the patient.


----------



## usalsfyre (Sep 3, 2011)

firefite said:


> "you want us to do extrication, well then I better be getting a nice pay raise"


Interestingly enough, the entire world is not tied into the IAFF/AFL-CIO philosophy of "you gotta pay me more money to do anything extra".


----------



## JPINFV (Sep 3, 2011)

bstone said:


> Linuss, this "ERU" is a group that has unknown training, unknown certification and unknown skill. The FD, however, has well known training, well known certification and well known skill.
> 
> If I needed someone to pull me from under a car I would want the FD to do it.



Do you, personally, know what the certification, training, and skill level of FDNY, or are you assuming that because they are fire fighters they obviously have it?


----------



## bstone (Sep 3, 2011)

> Do you, personally, know what the certification, training, and skill level of FDNY, or are you assuming that because they are fire fighters they obviously have it?



Got quite a few friends in FDNY. They are all FF2s. A few are FF3s. I'll call one of them and ask what other training they have with regards to extraction, ropes, etc.


----------



## DesertMedic66 (Sep 3, 2011)

Linuss said:


> Just more excuses, really.  There's not a single reason why EMS cannot / should not do basic extrication.
> 
> 
> 
> Fire is essentially a big wasteful sink anyhow.  Why not divert the funds from them to EMS?  * We do more work anyhow * , and they do the little side-gigs that are hardly ever done but use to justify their budgets...



How do we do more work then fire does? Please enlighten me. Last time I checked we respond to medical emergencies (medical and trauma) and that's pretty much about it. Where as fire responds to Fires of all types, HAZMAT, MVC, flooding (sand bag operations), and medical emergencies (in alot of areas). That's all I think of at the moment. 

So it seems to me as if fire does more work. (I'm not bashing on Fire or EMS)


----------



## usalsfyre (Sep 3, 2011)

bstone said:


> Got quite a few friends in FDNY. They are all FF2s. A few are FF3s. I'll call one of them and ask what other training they have with regards to extraction, ropes, etc.



Which is flawed reasoning in and of itself, because NFPA standards only acknowledge FF I and FF II (NFPA 1001). Further, fire academy extrication training is VERY basic in many cases. NFPA has separate standards for vehicle rescue technician.


----------



## JPINFV (Sep 3, 2011)

bstone said:


> Got quite a few friends in FDNY. They are all FF2s. A few are FF3s. I'll call one of them and ask what other training they have with regards to extraction, ropes, etc.



Ah, so you made a comment about the standards of one agency vs the standards of another saying that one is well known simply because you know a few in it, vs the other which is unknown simply because you don't know anyone in the agency? 

So basically, the certification, training, and skill levels of both agencies aren't well known enough to make an actual comparison.


----------



## bstone (Sep 3, 2011)

> fire academy extrication training is VERY basic in many cases. NFPA has separate standards for vehicle rescue technician.



Like I said, I will call to ask what their training is. It's a valid question and I am seeking the answer.


----------



## usalsfyre (Sep 3, 2011)

firefite said:


> How do we do more work then fire does? Please enlighten me. Last time I checked we respond to medical emergencies (medical and trauma) and that's pretty much about it. Where as fire responds to Fires of all types, HAZMAT, MVC, flooding (sand bag operations), and medical emergencies (in alot of areas). That's all I think of at the moment.
> 
> So it seems to me as if fire does more work. (I'm not bashing on Fire or EMS)



Most cities fire workload is about 20% of EMS workload. How many fires realistically are there? How many HazMats?


----------



## Shishkabob (Sep 3, 2011)

firefite said:


> How do we do more work then fire does? Please enlighten me. Last time I checked we respond to medical emergencies (medical and trauma) and that's pretty much about it. Where as fire responds to Fires of all types, HAZMAT, MVC, flooding (sand bag operations), and medical emergencies (in alot of areas). That's all I think of at the moment.
> 
> So it seems to me as if fire does more work. (I'm not bashing on Fire or EMS)



You're confusing "types of things done" for "calls done".  Yes, they can "do" HAZMAT, but honestly, how many times does your average sized agency do that?

And honestly, each and every item you posted there, EMS will go to as well.  HAZMAT spill?  EMS is there.  MVC?  EMS is there.  Fire?  EMS is there.   Yet, I don't have fire show up on a huge portion of my medical calls.




Sorry, it's a well documented statistic that EMS is a bigger portion of 911 calls than fire-related calls.. by a huge margin.


----------



## DesertMedic66 (Sep 3, 2011)

usalsfyre said:


> Most cities fire workload is about 20% of EMS workload. How many fires realistically are there? How many HazMats?



Everyone knows there isn't too many fires (aside from the summertime) or HAZMATs. Just pointing out that Fire does more then EMS. (all my opinions are based on my area where fire responds to every medical call). If fire drops medical then yes EMS would probably be more busy and do more. But for right now fire does more work.


----------



## bstone (Sep 3, 2011)

Here's a link to FDNY's training academy:
http://www.nyc.gov/html/fdny/html/units/fire_academy/fa_index.shtml

The website is really lousy and some of the links didn't work, as well as being really sparse on the info.


----------



## DesertMedic66 (Sep 3, 2011)

Linuss said:


> And honestly, each and every item you posted there, EMS will go to as well.  HAZMAT spill?  EMS is there.  MVC?  EMS is there.  Fire?  EMS is there.   Yet, I don't have fire show up on a huge portion of my medical calls.



MVC EMS is not always there. Fires? You mean EMS actually respond to fires in your area? The ambulance is not called to a fire unless a firefighter/bystandard goes down and wants to be transported to the hospital (for my area). Fire will do medical stuff on scene, if the patient needs or wants to go to the hospital then the ambulance is called to transport.


----------



## usalsfyre (Sep 3, 2011)

firefite said:


> MVC EMS is not always there. Fires? You mean EMS actually respond to fires in your area? The ambulance is not called to a fire unless a firefighter/bystandard goes down and wants to be transported to the hospital (for my area). Fire will do medical stuff on scene, if the patient needs or wants to go to the hospital then the ambulance is called to transport.



That's the problem, this is all region dependent. In my service area we get fire if it's a pin in or we need an LZ. That's it, so most MVCs have only EMS and PD. We respond to all structure fires and multiple department wildfires. So our workload is quite a bit heavier than the paid FD here.


----------



## Aidey (Sep 3, 2011)

bstone said:


> Clearly they didn't train long and hard. They dropped a car on a guy.* FD was taking a long time* to properly do it. ERU futzed it up.



This is one of the things I seen pointed out numerous times in the comments on this incident. Even going with the assumption that the FD had determined it was a non-viable patient air bag operations always seem to take forever. I don't think I have yet to see them used efficiently. 



Linuss said:


> And I'll reiterate:
> 
> There is no reason why EMS cannot be taught extrication in school, ambulances equipped with basic hydraulic tools, and safety gear put on.
> 
> ...




I'm with Linuss on this one. There is no reason that extrication and firefighting have to go together. Or any of the other various specialized types of rescue training. I've found who does what varies significantly by region and demand.


----------



## DesertMedic66 (Sep 3, 2011)

usalsfyre said:


> That's the problem, this is all region dependent. In my service area we get fire if it's a pin in or we need an LZ. That's it, so most MVCs have only EMS and PD. We respond to all structure fires and multiple department wildfires. So our workload is quite a bit heavier than the paid FD here.



Fire doesn't respond to medical calls in your area? If your system is ran like that then yes it seems as if EMS does have a heavier workload. 

As for my area fire responds to anything that EMS responds to along with alot more. So fire has a much heavier workload then EMS here.


----------



## usalsfyre (Sep 3, 2011)

firefite said:


> Fire doesn't respond to medical calls in your area? If your system is ran like that then yes it seems as if EMS does have a heavier workload.
> 
> As for my area fire responds to anything that EMS responds to along with alot more. So fire has a much heavier workload then EMS here.



Only echo level calls, as a BLS first response. 

Why run fire to low level calls? Seems like a massive waste of resources.


----------



## jona2125 (Sep 3, 2011)

bstone said:


> Linuss, this "ERU" is a group that has unknown training, unknown certification and unknown skill. The FD, however, has well known training, well known certification and well known skill.
> 
> If I needed someone to pull me from under a car I would want the FD to do it.



I agree. Fire has proper available equipment for this. The ESU tries to keep up with that but it has not been the greatest success. I really hate seeing a mash up of out of place departments. Fire and EMS = Decent. Police and EMS = Bad juju. The huge point that should be clear from this video is that EVERYONE has a specific JOB to do. They should focus. Police should worry about scene safety, fire should worry about getting access to the patient, and EMS should worry about patient care. That's how it really should have been handled.


----------



## bstone (Sep 3, 2011)

The one thing we haven't brought up (I don't think) is ICS. Who was the Incident Commander? Why wasn't that chain of command followed?


----------



## usalsfyre (Sep 3, 2011)

jona2125 said:


> Fire and EMS = Decent. Police and EMS = Bad juju


This message brought to you by the IAFF...

Care to elaborate on this totally unsubstantiated statement?


----------



## Shishkabob (Sep 3, 2011)

jona2125 said:


> The huge point that should be clear from this video is that EVERYONE has a specific JOB to do. They should focus. Police should worry about scene safety, fire should worry about getting access to the patient, and EMS should worry about patient care. That's how it really should have been handled.



Except the ESUs job IS extrication / rescue and not traffic control, so that throws that argument right out.




Anyways, everyone is missing the main thing about this thread:

Some old bat sucked at driving that lead to a situation that cost someone their life, and all she gets is a slap on the wrist.   That should irk everyone.  Evil old ladies.  It's a darn conspiracy.


----------



## DesertMedic66 (Sep 4, 2011)

usalsfyre said:


> Only echo level calls, as a BLS first response.
> 
> Why run fire to low level calls? Seems like a massive waste of resources.



It stops the clock and that's all the public cares about. Same reason we run code 3 to every 911 call. Public wants us there fast. If we don't get there fast enough then we can lose our contract.


----------



## Aidey (Sep 4, 2011)

firefite said:


> It stops the clock and that's all the public cares about. Same reason we run code 3 to every 911 call. Public wants us there fast. If we don't get there fast enough then we can lose our contract.



Eventually we're going to have to say the hell with what the public cares about and do what is right and scientifically proven to work. 

Look at the mess we're in with antibiotic resistant bacteria because the uneducated public demanded antibiotics for everything and Doctors played along. Occasionally the public has to be told they're wrong and they need to suck it up and deal with it. We're educated*, the public is not.

*In theory.


----------



## Bullets (Sep 4, 2011)

FDNY call stats

EMS runs in 2010-1.4 MILLION
Fire runs in 2010-26, 119

Is there any doubt what gets more use, who works harder and longer? 

In NJ, Extrication is an EMS gig in most places. My town has on squad that handles it, they have a truck with all their Cutting tools, every squad member has turnout gear, and fire only goes to MVCs for minor fluids and fire suppression.

Engine on an EMS call----Justifying a fire district, justifying taxes, justifying jobs. Downsize down size downsize, convert firehouses to EMS houses. Replace engines with Ambulances. Make Paramedic a promotion to FF, not the other way around.


----------



## jona2125 (Sep 4, 2011)

usalsfyre said:


> This message brought to you by the IAFF...
> 
> Care to elaborate on this totally unsubstantiated statement?



I'm just saying each division should stay within their own division. Fire doing EMS is for money saving but I'm not going either way with that statement. EMS doing Fire doesn't make any sense. Police doing either of those duties is just as confusing. There is a difference between police being a first response and them being a dedicated team. This whole subject is a can of worms and I knew that. But I'm not here to start a argument on what is and what should be. I like how most of everything is setup. The main point was for this video and how when there are these special populations of multi task oriented companies, that they should at least work together better. This is just as much a turf war with NYFD vs NYPD ESU as Fire Departments with EMS vs separate EMS & Fire is. That's all I'm saying. I'm not going to justify which is better at all or the reverse. Just creating conversation on how you can take what you learn and apply it later. Especially regarding what happened in the video. 

My goal is to be  FireMediCop. When I get there, I won't be going farther than first response skills if I'm on duty as a Cop and have a gunshot victim, same with a fire. If I work fire im not going to go out restraining people, and if I'm a medic I'm not worried about anything but my patient. That's how it should be dealt with. But that's my opinion and the world's full of 'em. I'll leave it at that.


----------



## DesertMedic66 (Sep 4, 2011)

Aidey said:


> Eventually we're going to have to say the hell with what the public cares about and do what is right and scientifically proven to work. .



I honestly don't see that happening with a private EMS company. If we don't give the public what they want then they won't want us. Meaning we lose our contract meaning we lose our jobs. Then the town will give another ambulance service the contract. We are here to basically serve the public. If they don't get what they want then we are gone.


----------



## Anthony7994 (Sep 4, 2011)

firefite said:


> And to do all of that is going to cost alot of money. Along with medics and EMTs saying "you want us to do extrication, well then I better be getting a nice pay raise".



Volunteer firefighters don't seem to complain, and I wouldn't either knowing I could help a patient even further than I could before. I'm for it.


----------



## MrBrown (Sep 4, 2011)

Sherman27 said:


> Volunteer firefighters don't seem to complain, and I wouldn't either knowing I could help a patient even further than I could before. I'm for it.



Because firefighting for volunteers is a hobby, just like volunteer Ambulance Officers ... it's something they do in their spare time.


----------



## JPINFV (Sep 4, 2011)

Aidey said:


> Eventually we're going to have to say the hell with what the public cares about and do what is right and scientifically proven to work.
> 
> Look at the mess we're in with antibiotic resistant bacteria because the uneducated public demanded antibiotics for everything and Doctors played along. Occasionally the public has to be told they're wrong and they need to suck it up and deal with it. We're educated*, the public is not.
> 
> *In theory.




1. Any response time after 4 minutes is purely customer service. 

2. Customer service is important. In the end cities and health care facilities, via tax dollars and insurance dollars, are consuming the services produced by their contract provider. Make them unhappy and they find someone else to provide the service. 

3. Comparing this to antibiotics doesn't really work. Reasonable response times does not cause IVs to stop working. Similarly, response times does not necessarily mean transport, leading to backup further down stream. 

4. Community paramedicine (probably one of my most favorite sessions at EMS World Expo). Communities and hospitals will support it because of the efficiency it brings downstream and the service aspect brought to the citizens.


----------



## SHFD (Sep 4, 2011)

Linuss said:


> And I'll reiterate:
> 
> There is no reason why EMS cannot be taught extrication in school, ambulances equipped with basic hydraulic tools, and safety gear put on.
> 
> ...



Settle down there, hero. I don't know how it works in other states, but around here EMS as a separate entity is becoming more obsolete, as many FD's are beginning to do all their own EMS. It makes the most sense. To say that FD's are not at all patient centered is ignorant, FD's have evolved over the years and although some old Jakes like to resist it, it's becoming increasingly EMS focused. I'm a volly FF, and a Private agency EMT so I get both sides of it. FF's don't go to the Academy just to wet their willy on the red stuff, we learn extensive rescue techniques and, and that goes back to the Firehouse where FD's train train train to perfect them. On top of that, there aren't a lot of FD's that will take someone who isn't a basic, or in some cases a medic.

You know those big red trucks with all the woo woo's? These days they carry a whole lot more than hoses and nozzles. Some go so far as to equip ALS engines, but just about any FD has apparatus designated for rescue scenes. They come equipped with all manner of equipment one would need, and a full crew to boot. 

Does it really make sense that FD's should actually just devolve and try to stuff all that equipment on to an ambulance? Not to mention the man power issue. Sure, you can recall an instance where 2 people can extricate someone but anyone with a brain will admit that it is far from ideal, because scenes become more complicated than that. Calling an additional ambulance for resources for one pt instead of an engine company is ridiculous. 

The biggest roadblock to this concept is funds. I don't care what XYZ agency does, mine runs BLS in vans. We don't have enough room in them as is, no we are not carrying cutters and spreaders on our trucks, not even in the box trucks. Who is going to pay for this training either? Is my company going to put me through the academy to learn how to use these tools? Some agencies are stingy about reimbursing employees for coned, much less superfluous rescue training that the FD already has, and has been doing for years.

EMS has enough trouble getting over the ambulance driver image, I think it needs to stick to what it's ultimate purpose is: Safely treat and transport your patient to the hospital. More technical, and complicated tasks should stay in the realm of FD's. I won't deny that some FD's have to justify their budgets these days, and that's because there aren't as many fires as there used to be. But just as EMS has evolved from being taxi drivers, to advanced care, FD's roles have evolved. If anyone doesn't fit into this picture, it's police.


----------



## Shishkabob (Sep 4, 2011)

SHFD said:


> Settle down there, hero. I don't know how it works in other states, but around here EMS as a separate entity is becoming more obsolete, as many FD's are beginning to do all their own EMS. It makes the most sense.


  No, it doesn't, and I have already stated why.

Desolve the big fire departments, they aren't needed.  Give the funds to EMS instead, who does a MUCH higher percentage of the calls. 

Sorry, it's not really logical to have 4 people and an engine sitting around waiting for a fire when there's only a handful of working ones ALL year.




> To say that FD's are not at all patient centered is ignorant, FD's have evolved over the years and although some old Jakes like to resist it, it's becoming increasingly EMS focused.



Only, and I put emphasis on only, to defend their budget.  

I know there are firefighters who like doing EMS... but without a doubt the vast majority just want to 'put blue on red'.  



And I dare you to tell me DCFD or DFD are "good" at running patient care.





> On top of that, there aren't a lot of FD's that will take someone who isn't a basic, or in some cases a medic.


  Ta-da... it's the department requiring it, not the person WANTING to do it just to do it. 

Sorry, I don't want the person who hates EMS in charge of my care with 60+ different medications that can kill me.





> Does it really make sense that FD's should actually just devolve and try to stuff all that equipment on to an ambulance?



Rescue equipment?  Yes, yes it does.

Hell, what makes the MOST sense is having EMS run fire, and not the other way around. It's 80/20 EMS to fire calls in every place that puts out statistics.  Why should the less use entity be in charge of the other?




> Not to mention the man power issue. Sure, you can recall an instance where 2 people can extricate someone but anyone with a brain will admit that it is far from ideal, because scenes become more complicated than that. Calling an additional ambulance for resources for one pt instead of an engine company is ridiculous.



It's ridiculous to call for an additional ambulance, but not to call for an engine that costs about twice as much, gets a lot less mileage, and has at least twice as many people on board?

That makes sense to you?




> The biggest roadblock to this concept is funds. I don't care what XYZ agency does, mine runs BLS in vans. We don't have enough room in them as is, no we are not carrying cutters and spreaders on our trucks, not even in the box trucks. Who is going to pay for this training either? Is my company going to put me through the academy to learn how to use these tools? Some agencies are stingy about reimbursing employees for coned, much less superfluous rescue training that the FD already has, and has been doing for years.



And this was already answered by me:  The agency that does 80% of the calls (EMS) should get the majority of the funds. 






> EMS has enough trouble getting over the ambulance driver image, I think it needs to stick to what it's ultimate purpose is: Safely treat and transport your patient to the hospital.


  The very fact that you think our sole job is to transport shows you're either quite new, quite old, or anti-EMS.




> More technical, and complicated tasks should stay in the realm of FD's.



Why?  Because they have been?  The only reason why "fire does it" it because fire has "always done it".  Again, I point you to the EMS agencies that do things from simple extrication to hard technical rescue... They've proven EMS can do it.




> I won't deny that some FD's have to justify their budgets these days, and that's because there aren't as many fires as there used to be.


  Ta-da!  Extrication is a patient centered ordeal.  Why have the least medically trained and educated personnel in charge of it?


Should a cop be in charge of running a fire ground and putting out a fire?


----------



## usalsfyre (Sep 4, 2011)

Some of this is going to echo Linuss, but....



SHFD said:


> Settle down there, hero. I don't know how it works in other states, but around here EMS as a separate entity is becoming more obsolete, as many FD's are beginning to do all their own EMS. It makes the most sense.


Explain how it makes sense in any way other than a "I need to justify my rather large budget and staffing requirements" way.



SHFD said:


> To say that FD's are not at all patient centered is ignorant, FD's have evolved over the years and although some old Jakes like to resist it, it's becoming increasingly EMS focused.


You need to see more than just a couple of FDs before you make this statement. I'd wager the majority aren't anything close to patient focused. Not to mention stand-alone EMS already WAS patient focused....



SHFD said:


> I'm a volly FF, and a Private agency EMT so I get both sides of it. FF's don't go to the Academy just to wet their willy on the red stuff, we learn extensive rescue techniques and, and that goes back to the Firehouse where FD's train train train to perfect them.


Speaking as a guy who's been a Vehicle Rescue, High Angle and Swift Water Tech, most fire academies training in rescue is laughable. It's the equivalent of the 600 hour medic course. In addition there's a fair number of FDs who spend far more time holding down a recliner than training. 



SHFD said:


> On top of that, there aren't a lot of FD's that will take someone who isn't a basic, or in some cases a medic.


See Linuss' comments. 



SHFD said:


> You know those big red trucks with all the woo woo's? These days they carry a whole lot more than hoses and nozzles. Some go so far as to equip ALS engines, but just about any FD has apparatus designated for rescue scenes. They come equipped with all manner of equipment one would need, and a full crew to boot.


Since none of us in stand-alone EMS could have possibly had a fire-service background right? Not to mention a "full crew" in many places outside of New England means...two people. 



SHFD said:


> Does it really make sense that FD's should actually just devolve and try to stuff all that equipment on to an ambulance? Not to mention the man power issue. Sure, you can recall an instance where 2 people can extricate someone but anyone with a brain will admit that it is far from ideal, because scenes become more complicated than that. Calling an additional ambulance for resources for one pt instead of an engine company is ridiculous.


Calling an engine company is a fairly ridiculous concept in and of itself. ESU probably has a better concept with small vehicles to respond to this kind of stuff. Pittsburgh EMS manages to run extrication by themselves. 



SHFD said:


> The biggest roadblock to this concept is funds. I don't care what XYZ agency does, mine runs BLS in vans. We don't have enough room in them as is, no we are not carrying cutters and spreaders on our trucks, not even in the box trucks. Who is going to pay for this training either? Is my company going to put me through the academy to learn how to use these tools? Some agencies are stingy about reimbursing employees for coned, much less superfluous rescue training that the FD already has, and has been doing for years.


Funding and reimbursement is a huge issue here. It doesn't pay, so many EMS services aren't going to do it. That said, don't assume all FDs are doing this, or for that matter are doing it well. Like I said, there's a city in this area that has a paid FD and PD, private EMS and a volunteer rescue agency. The FD has no tools, or training in how to use them outside of the day in fire academy of "this is an A post".  



SHFD said:


> EMS has enough trouble getting over the ambulance driver image, I think it needs to stick to what it's ultimate purpose is: Safely treat and transport your patient to the hospital.


Yet you think the FDs should be doing it. 




SHFD said:


> More technical, and complicated tasks should stay in the realm of FD's.


Because they've shown themselves capable of handling the technical complex task that is firefighting by continuing to kill 100 people every year the same way again and again. 



SHFD said:


> I won't deny that some FD's have to justify their budgets these days, and that's because there aren't as many fires as there used to be. But just as EMS has evolved from being taxi drivers, to advanced care, FD's roles have evolved.


Evolved kicking and screaming because if they don't they'll be cut down to appropriate sizes and have to use appropriate tactics in the current climate of very limited life safety risk and disposable buildings. 



SHFD said:


> If anyone doesn't fit into this picture, it's police.


Beyond, "just because the FD does it" has anyone come up with a convincing reason the PD has no business in EMS or rescue? 

I'm not totally anti Fire-based EMS. I'm anti crappy EMS. At one point in my life I was involved with a hellaciously good EMS service that happened to be in with an FD. I'd put many of the medics at that place up against any medic anywhere. The equipment, education, QA, ect was top notch. My understanding is there are som FDs in the DFW metroplex that are the same. Let them continue to run EMS. That said, that's not the norm I've seen, rather it's very much the exception. 

The FD has been very, very good at finding new roles to worm into to make themselves as entangled in the needs of modern society as possible. In this way however, they've been their own worst enemy, as they often can't perform all of these roles well, especially in smaller departments that can't afford to the have a crew specialized in HazMat, a crew specialized in tech rescue, ect. Instead you get the "jack of all trades master of none" on duty that day that may, or may not have the knowledge to mitigate the situation. They are often able to muddle through it, but the failures are also spectacular when they try to BS their way through something and fail.


----------



## shfd739 (Sep 4, 2011)

SHFD said:


> Settle down there, hero. I don't know how it works in other states, but around here EMS as a separate entity is becoming more obsolete, as many FD's are beginning to do all their own EMS. It makes the most sense.



I'm not sure how this makes the most sense. Most of the FDs I know of that do EMS do it just to say they can and it winds up being a budget hole. One dept. I know of just started doing transports and for what they spent in capital to get started they will never recoup. 



Sent from my electronic overbearing life controller


----------



## SHFD (Sep 4, 2011)

> Linuss said:
> 
> 
> > No, it doesn't, and I have already stated why.
> ...


----------



## fortsmithman (Sep 4, 2011)

Here in Canada in the province of Alberta the provincial government took over EMS operations as a provincial third service.  It took control from municipal, county third services and fire departments.  As well next to Alberta in British Columbia EMS is also under provincial control.  As well in countries other than the USA EMS is a government run third service.


----------



## usalsfyre (Sep 4, 2011)

SHFD said:


> Rather than refute every single point, I'll just refocus to what I think is the crux of the matter.
> 
> Unfortunately there a lot of people who agree with this fallacy, and because of it there are firehouses all over the country being shut down, losing apparatus and manpower. It may seem logical that a FD could use less money if they do less fire's, but in practice it's dead wrong. It's dangerous to think this way because a fireground/hazmat incident will present the exact same danger every single time. The frequency of fires is irrelevant, because it will require the same amount of resources to get it under control every time. When you try to gerrymander a FD's budget around it's call volume, people get hurt, and the first ones to get hurt are FF's.
> 
> Fires do not care how many engines and ladders you have, or how many alarms you have to strike to get the job done. Whether or not a FD has dozens of 3+ alarm fires a year, or only a handful, it's still just as dangerous every single time.


Except....it's not. Despite the shouting from the rooftops of the fire service lobby, life safety risk has gone down significantly over the years. Look at the death rate from fires in say 1970 vs the death rate from fires today. It's significantly less. Changes in education, construction and suburbanization, ect have led to this. Yet fire departments insist on using tactics that are similar to when horses were pulling steam pumpers. Interior firefighting in modern construction is more often than not a dangerous waste. 100 years of tradition unimpeded by progress truly applies here. If interior firefighting isn't the focus of your department and only used when there is a verified life-safety risk, and rescue, not extingushment is you focus in those situations, your manpower needs drop considerably. 



SHFD said:


> FD's adapt because they understand they cannot handle a budget cut and get the job done safely. You try to look it from the perspective that your sheer call volume makes you more important, but you understand very well the ratio of ALS to BLS calls is very disproportionate. Regardless of how many people actually require prehospital interventions, you have to be able to meet the demand of 911 calls with the right resources for when you actually do respond to a high priority call. It doesn't matter how often you use narcan, it's essential to treating an opiate overdose, therefore you must be equipped with it. Of course the difference between funding apparatus, personnel, and pensions is much greater than some seldom used drugs in your medbox, but it's essentially the same concept.


Actually one of the purposes of EBM is finding out what treatments are cost effective for the benefit gained and what's not.



SHFD said:


> I don't know how many people here work privates, but I do and I think they are a bunch of bologna.


Some are, some aren't. My service is far better equiped and educated than an FD and a municipal right up the road, and we're an "evil" private. But then the fire service lobby always says "scabs are bad". 



SHFD said:


> I think all EMS should be municipal, and because fire is already municipal I think with the growing trend of Fire becoming EMS oriented, it makes sense to completely integrate the two.


So your best argument is "because the FD is there already"?  



SHFD said:


> As a private EMT working in a tiered response system, I also deal with a lot of FF's that I can tell don't want to be there and sometimes they just take up space. But on the other hand, the departments I volly for handle our own transports, and although there is a mix of interest between members who prefer EMS or Fire, we practice the same amount of professionalism to both because it's our job.


Common in volly situations. Not so common in many full-time FDs. 



SHFD said:


> There are many fulltime FD's that do their own transports, and they have excellent medics/basics because they adapt to their roles.


And many don't. Just like many privates don't. Somme FDs are every bit as dollar oriented when it comes to EMS as the privates you hate so much. I've seen it. 



SHFD said:


> When more FD's begin to take on transports, FF's will adapt accordingly and EMS skills improve as a necessity. Some salty old timers will simply have to pass the torch to younger guys like myself who are more keen to the task of modernizing FD's in the process, but it will happen in time.


Or they won't. I worked for an FD that had been doing EMS transport for 20 years. The attitude towards EMS was among the worst I've ever seen. 



SHFD said:


> No one likes EMT's anyways, might as well let the job be performed by a profession that is already respected.


Wow, way to make an argument, insult your opponents. Besides, look at the media lately to see how much respect FDs are getting. 

I know FDs taking over EMS looks ideal when you listen to the fire service lobby. But look for info elsewhere. The FD taking over EMS in places where it's working well is as BS privates taking it from the FD when it's working well. Probably even more so as FD-based EMS RARELY saves money. Look at Kansas City, DC(not that it was really working there) and NY for evidence of that.


----------



## Anthony7994 (Sep 4, 2011)

SHFD said:


> > No one likes EMT's anyways, might as well let the job be performed by a profession that is already respected.
> 
> 
> 
> I'm not trying to jump in the midst of this argument, but this statement is simply ridiculous. It's things like this that make people hate FFs in the first place...thinking they're the best thing in the history of emergency services and that everyone else should bow to them. Way to go, pal.


----------



## Tigger (Sep 4, 2011)

Linuss said:


> No, it doesn't, and I have already stated why.
> 
> Desolve the big fire departments, they aren't needed.  Give the funds to EMS instead, who does a MUCH higher percentage of the calls.
> 
> Sorry, it's not really logical to have 4 people and an engine sitting around waiting for a fire when there's only a handful of working ones ALL year.



Maybe in your area, but not in the areas that I live. There are still many, many "legacy structures" with old construction in the northeast that require manpower above all else when they catch fire. There may be fewer fires than there were in the 1970s, but they have not gotten any appreciatively easier to put out. 



> Only, and I put emphasis on only, to defend their budget.
> 
> I know there are firefighters who like doing EMS... but without a doubt the vast majority just want to 'put blue on red'.



Right, because it's impossible to have an interest and ability in more than one thing. 

So if EMS starts taking over rescue operations, every EMS provider will suddenly love extrication too? Not everyone loves every aspect of their job, and that's going to happen in every field.



> And I dare you to tell me DCFD or DFD are "good" at running patient care.



Hooray for making blanket judgements about departments that no one here probably has any firsthand knowledge of!



> Ta-da... it's the department requiring it, not the person WANTING to do it just to do it.
> 
> Sorry, I don't want the person who hates EMS in charge of my care with 60+ different medications that can kill me.



Again, not everyone who does not work for a single service EMS provider hates EMS. There are plenty of firefighters that enjoy EMS as much as they enjoy firefighting. Many firefighters do in fact realize that much of their job involves medicine. Firefighters that complain about the EMS aspect of the job in a Fire/EMS department are working at the wrong department. 



> Hell, what makes the MOST sense is having EMS run fire, and not the other way around. It's 80/20 EMS to fire calls in every place that puts out statistics.  Why should the less use entity be in charge of the other?



Sure, why not. But in many areas you can't simply take Fire's budget and give it straight to EMS. There may be less fires these days, but they still take (close to) the same number of people to put them out. Ensure that the firefighters are also fire inspectors to minimize "idle" time and provide a valuable community service.



> It's ridiculous to call for an additional ambulance, but not to call for an engine that costs about twice as much, gets a lot less mileage, and has at least twice as many people on board?
> 
> That makes sense to you?



Makes plenty of sense to me. I want those twice as many people on board coming to my extrication. Not only is more trained help arriving, but more equipment is too. I agree that basic hydraulic equipment can be fit on many medium duty ambulances, but what happens when you need more than a combi tool? Things like struts, rams, cribbing, and airbags, are those all going to fit on the ambulance too? Sure you could have a dedicated EMS rescue truck (as some agencies do), but are the providers staffing that truck getting the patient contacts they need to stay sharp? Won't that truck also cost at least twice at an ambulance does? And to provide the same capability in terms of response zone coverage as a fire department, won't you need to buy and equip several of them?

Look at a place like Pittsburgh, they have two rescue trucks staffed with 2 each. Hardly enough manpower if you ask me. Sure, more ambulances could be dispatched for additional manpower, but now you are taking away units off the street whose primary function is patient care and transport. Doesn't exactly sound like a win for the EMS system to me. And while Pittsburgh EMS does do extrication, fire still goes to MVAs for fire protection, fluids, and actual extrication operations being that the truck companies carry extrication equipment. Fire's rigs are also much larger (especially truck companies) and are used as blockers on highway incidents, something that an ambulance is not nearly as well suited for. From what I understand Fire still does quite a bit of work since PBEMS rescue units have only two members aboard.

Then there's the manpower issue. A rescue/ambulance rolls up to an MVA. If the patient is injured, isn't that crew in all likelihood tied up with patient care? Now a second ambulance is dispatched. Now a 2 person "extrication team" is on scene. Are two people going to be enough remove the roof and lift the dash? Maybe, but it's tough to argue that you would prefer two people doing the extrication instead of four. Also, will these new ambulances be provided with any sort of fire protection system? I have no interest in working near a wrecked vehicle with leaking fluids and power tools without a charge hoseline in place if I can help it, not sure about you. 



> And this was already answered by me:  The agency that does 80% of the calls (EMS) should get the majority of the funds.



Or we could stop competing with Fire with funding (the reverse would have to happen too). Maybe EMS needs to have its own source of funding like many other aspects of government (like schools).



> Why?  Because they have been?  The only reason why "fire does it" it because fire has "always done it".  Again, I point you to the EMS agencies that do things from simple extrication to hard technical rescue... They've proven EMS can do it.



Not to mention that fire in many areas has more manpower and equipment than EMS or anything.



> Ta-da!  Extrication is a patient centered ordeal.  Why have the least medically trained and educated personnel in charge of it?



It is no doubt a patient centered process, but I fail to see how being a paramedic changes the process. Please explain how you knowledge of medicine will effect the extrication process, I am honestly curious. I'm trying to think of a scenario beyond some sort of crushing injury where the crushing object is removed and the patient becomes unstable as a result.  

Hopefully anyone involved in extrication know enough not to hurt the patient with the process, I don't think anyone needs to be a medic to realize that.



> Should a cop be in charge of running a fire ground and putting out a fire?



Not sure of relevance?


----------



## Shishkabob (Sep 4, 2011)

Tigger said:


> So if EMS starts taking over rescue operations, every EMS provider will suddenly love extrication too? Not everyone loves every aspect of their job, and that's going to happen in every field.



Except, as has been stated multiple times by multiple people in this thread, extrication is most certainly a patient focused thing, so why SHOULDN'T the people who are doing patient care do it?




> Hooray for making blanket judgements about departments that no one here probably has any firsthand knowledge of!



Sorry, I most certainly DO have first hand experience with DFD, what they can do, and how they are on calls.

If I'm involved in an MVC in Dallas, I'm crawling to Parkland or Baylor.  I'd get the same level of care from DFD as I would doing things to myself without any equipment.




> Look at a place like Pittsburgh, they have two rescue trucks staffed with 2 each. Hardly enough manpower if you ask me.



And each and every one of their street medics is trained in extrication.  They should already have an ambulance on scene when the rescue is sent, so there's, at minimum, 4 people.  Plus, I have yet to see a decent sized agency that doesn't send a supervisor to scenes that require special skills such as that.




> Not to mention that fire in many areas has more manpower and equipment than EMS or anything.


  Again, because they keep taking over more aspects to justify their budget, then ask for an increase in budget to take on those tasks.  It's a cycle.




Tigger said:


> Not sure of relevance?



Relevance is, not a single part of putting out a fire has to do with law enforcement.

However, EVERY part of extricating a patient has to do with healthcare delivery from EMS.


----------



## DrParasite (Sep 4, 2011)

your right, EMS cannot be taught how to do rescue.





its a completely absurd concept




in fact, it's just stupid to think that EMS can do rescue, they don't have the training.




that's just crazy thinking.





btw, 2 out of those 4 are 100% paid agencies, one is combination, and one is an all ALS EMS system.

The ONLY reason FD goes on EMS calls is because the EMS system is understaffed.  even on an MVA, if EMS had more units, spread out with fire stations, EMS would be FD to the scene EVERY time.  but the majority of EMS systems bandaid an understaffed EMS system instead of properly funding and staffing it.  It's like that in NYC (see EMS arriving late to the party, while FD engine, FD truck, multiple PD, ESU little, ESU big are already at the party before EMS arrives), and almost every other urban area.

FDNY and NYPD have been doing rescue for close to 80 years.  NYPD got really busy with rescue in the 60s to 70s when most of NYC was burning down.  Both have training, both can do rescue, and they both work well individually (FD with engine, truck, and rescue company, PD with RMP, ESU, and rescue truck), but FD and PD do not work well together.  Numerous incidents have been documented where it happens.  both have their chain of command, and they don't listen to the others bosses.


----------



## Tigger (Sep 4, 2011)

Linuss said:


> Except, as has been stated multiple times by multiple people in this thread, extrication is most certainly a patient focused thing, so why SHOULDN'T the people who are doing patient care do it?



I was hoping you would not choose to ignore my question about how being a paramedic changes the way that a vehicle should be cut apart. This is not an attack by any means, I am honestly curious.



> Sorry, I most certainly DO have first hand experience with DFD, what they can do, and how they are on calls.
> 
> If I'm involved in an MVC in Dallas, I'm crawling to Parkland or Baylor.  I'd get the same level of care from DFD as I would doing things to myself without any equipment.



Sorry for some reason I didn't think of Dallas even though you are in Fort Worth oops. Still doesn't change much about DC though...



> And each and every one of their street medics is trained in extrication.  They should already have an ambulance on scene when the rescue is sent, so there's, at minimum, 4 people.  Plus, I have yet to see a decent sized agency that doesn't send a supervisor to scenes that require special skills such as that.



Right, and I mentioned that. But what if the patient is actually injured? Doesn't the first on scene ambulance take over the patient care role? Now you're back to 2-3 people doing the extrication and your supervisor is no longer acting as a supervisor. I don't think pulling transporting ambulances off the street for manpower is the best solution either. Who is providing fire protection and fluid control (all necessary to some degree at an MVA scene, like it or not).



> Again, because they keep taking over more aspects to justify their budget, then ask for an increase in budget to take on those tasks.  It's a cycle.



Will we ever stop looking at funding as an "us vs. them" conundrum? 
Also I am not seeing many FDs in my area getting an increase in their budget even when they do take over EMS. Maybe they can keep their original budget, but mostly EMS is taken on as a way to stop the FD from bleeding money. I agree that is a poor reason for taking on EMS before you ask, just stating how things happen in some places.


----------



## Tigger (Sep 4, 2011)

DrParasite said:


> your right, EMS cannot be taught how to do rescue.
> 
> its a completely absurd concept
> 
> ...


UMDNJ and Pittsburgh both staff with 2 members as well. 

I am in no way arguing that EMS cannot preform rescue operations. It just has to be done the right way, with the proper amount of staffing. 2 guys on a rescue truck covering an entire city while relying on ambulances for more personnel just does not seem to be the best way to deliver rescue services if you ask me.


----------



## DrParasite (Sep 4, 2011)

Tigger said:


> UMDNJ and Pittsburgh both staff with 2 members as well.
> 
> I am in no way arguing that EMS cannot preform rescue operations. It just has to be done the right way, with the proper amount of staffing. 2 guys on a rescue truck covering an entire city while relying on ambulances for more personnel just does not seem to be the best way to deliver rescue services if you ask me.


My friend, I agree 100%.  

They are only staffed with 2 because they aren't staffed appropriately, while a fire-rescue is staffed with 4-6 guys.   simple solution: give them more money and allow them to increase the staffing level to 4 people.  

But again, EMS is constantly staffed to the minimum possible.  that results in 2 on the ambulance (instead of 3) and 2 on the rescue (instead of 4).


----------



## boingo (Sep 4, 2011)

firefite said:


> Or just have the police worry about their normal job and fire worry about theirs. Imagine how NYPD would feel if FDNY had a "special unit" that would do their jobs. IMO it's a really stupid idea.



Imagine if FDNY started doing EMS and NYC*EMS were there too...oh, wait...


----------



## DrParasite (Sep 4, 2011)

Tigger said:


> 2 guys on a rescue truck covering an entire city while relying on ambulances for more personnel just does not seem to be the best way to deliver rescue services if you ask me.


and 2 guys in a patrol car is not the best way to deliver rescue services.  but if you put them in a rescue truck, train them properly in how to do the job, give them the equipment to do the job right, and now where are you?

or even better, an engine, truck, and rescue is not the best way to deliver EMS.  but if you give them an ambulance, EMS training, and the equipment to do the job properly, than in theory what do you have?

bottom line, most EMS systems AREN'T set up to provide rescue services to an area, and those that do are typically set up with the minimum staffing levels allowable.  HOWEVER, like the above two examples, with the proper equipment, the proper staffing, and the proper training, there is absolutely ZERO reason why they can't.


----------



## bstone (Sep 4, 2011)

Is this so-called "Emergency Response Unit" going to be training EMTs and providing for emergency medical care as well? There is not a lot of info on them.

I asked a friend who is an officer with the NYPD. He tells me that the ERU has "priority" or "authority" when they are on scene. I am not surprised he said this since he is part of the NYPD, but it just seems weird to have detectives participating in extraction, rescue, etc.


----------



## usalsfyre (Sep 4, 2011)

Y'all are living in a fantasy world if you think the majority of departments in the US have a heavy rescue staffed with four members available at all times.


----------



## DrParasite (Sep 4, 2011)

bstone said:


> Is this so-called "Emergency Response Unit" going to be training EMTs and providing for emergency medical care as well? There is not a lot of info on them.


unless I am mistaken, every ESU cop (not ERU) is an EMT or paramedic.  whether or not they actually ride on an ambulance is a different story.  But they all either are or used to be EMTs of some level.


bstone said:


> I asked a friend who is an officer with the NYPD. He tells me that the ERU has "priority" or "authority" when they are on scene. I am not surprised he said this since he is part of the NYPD, but it just seems weird to have detectives participating in extraction, rescue, etc.


ESU officers are detective-specialists, not detective-investigators.  they aren't actual detectives in the investigative way you are thinking, but still hold the rank of detective for pay and title purposes.  It also puts them above every patrol officer and below every supervisory officer (even though I have heard they only take orders from ESU Sgts and ESU supervisory personnel).

also, they are considered (at least by NYPD) to be the best of the best, and as such, are often called upon to take the lead in operations due to their extensive training.  Doesn't surprise me at all that they call the shots at scenes that are within their scope.

and usalsfyre, almost every 100% career FD that I am aware of has at least 4  firefighters on their rescue company.


----------



## Anjel (Sep 4, 2011)

firefite said:


> MVC EMS is not always there. Fires? You mean EMS actually respond to fires in your area? The ambulance is not called to a fire unless a firefighter/bystandard goes down and wants to be transported to the hospital (for my area). Fire will do medical stuff on scene, if the patient needs or wants to go to the hospital then the ambulance is called to transport.




We respond to fires as standby in case someone gets hurt. 




ALSO....

When I went through basic it was a requirement to be certified in Rescue and Extrication. So I had to take a class that the fire fighters do. 

How to use all the hydraulics and tools. Also had to look at it from the medical perspective and be in the car with the patient while being extricated. 

I could extricate if I needed to. And so should all other EMS workers.


----------



## DesertMedic66 (Sep 4, 2011)

Another one of my major concerns is that most (not all) ambulances have 2 crew members. So that leaves 1 for patient care and 1 for extrication? If something goes wrong with the patient and you need 2 crew members helping the patient well there goes all your man power for extrication. If something goes wrong during extrication well then your either gonna have to leave the patient or hope your partner grows some extra arms and can handle it all.


----------



## usalsfyre (Sep 4, 2011)

So it would be unheard of to send two ambulances to a pin-in?

Think outside the box a little.


----------



## DesertMedic66 (Sep 4, 2011)

usalsfyre said:


> So it would be unheard of to send two ambulances to a pin-in?
> 
> Think outside the box a little.



Take 2 transporting ambulances out of service to help with 1 extrication instead of using a fire engine that doesn't transport. I can see the extended time on scene do to the ambulance having to clean up all their extrication equipment along with medical equipment. Talk about stretching out resources. 

There is a difference between thinking outside the box and making a smart decision while thinking outside the box.


----------



## usalsfyre (Sep 4, 2011)

firefite said:


> Take 2 transporting ambulances out of service to help with 1 extrication? Talk about stretching out resources.
> 
> There is a difference between thinking outside the box and making a smart decision while thinking outside the box.



As opposed to an engine? What happens of theres a fire in that district while they're working the extrication?

Staff it adequately, and it's not a problem. 

What I see is a whole bunch of people arguing for the delivery model they're comfortable with, without examining other options. The FD might be the best way to provide rescue. But it might not be either.


----------



## Shishkabob (Sep 4, 2011)

How many extrications have you worked?



Let's just assume it's a single car MVC with a single patient:

Most ambulances are medic/basic.  Show me a medic who hasn't worked a train wreck critical patient by themselves, and I'll show you a medic with minimal field experience (or in a multi-medic response agency).  If a patient needs more than 1 provider due to being critical / "something going wrong", you better have a second ambulance there anyhow, as honestly, in a situation such as that, an EMT isn't going to cut it. 

If you get the patient out and start transporting, you still only have the Paramedic in the back with the patient as the EMT will be driving... so that really didn't help much, did it?

If the situation warrants a provider in a car, you're really only ever going to fit one provider in there, and as far as my experience goes, it's always been the medic for extended extrication.  (Though I have my partner crawl through the car on non-critical... air bags scare me!)



I have, and will, take a second ambulance out of service to back me up (or me back up another crew), if it is believed that the second Paramedic will be a benefit.  




Just being honest here.


----------



## MrBrown (Sep 4, 2011)

The Fire Service are absolutely genius at turning people's car into bits and getting them out, while we do have Ambulance Rescue (SERT) they are more tactical/Police Armed Offenders/high angle medical support to the Fire Service sort of thing.

If some bloke needs his to be cut of his car here, the Fire Service are very aware they need to wait until Ambulance has the patient properly stabilised (as best as possible) and enough pain relief administered as appropriate, Brown tells you those goggles and crash gloves come in handy!

Of interest in New South Wales in Australia; their primary sources of extrication are Police Rescue and rurally ASNSW Rescue.  It would appear that NSW Fire Brigades are not overly involved.


----------



## Shishkabob (Sep 4, 2011)

Tigger said:


> I was hoping you would not choose to ignore my question about how being a paramedic changes the way that a vehicle should be cut apart. This is not an attack by any means, I am honestly curious.



The Paramedics assessment can and should dictate what sort of methods are required for the patient.  Unstable patients don't have the luxury of time that stable patients do, where you have more time to troubleshoot issues that arise.



I spent a lengthy amount of time on scene last shift thinking of the best way to move a patient from his couch to our stretcher, 3 feet away, causing the least amount of pain.  That was AFTER I had already started an IV and gave fentanyl.


----------



## MrBrown (Sep 4, 2011)

Linuss said:


> The Paramedics assessment can and should dictate what sort of methods are required for the patient.  Unstable patients don't have the luxury of time that stable patients do, where you have more time to troubleshoot issues that arise.l.



True that, do you not get inside cars?

If some bloke pinned by his nunngered legs under the dashboard is that crook we put on a helmet, crash gloves and goggles and go in through the backseat or passenger seat or have the Fireys pry a door open with a crowbar and do what we need to in order to stabilise the patient as best we can while the Fireys get him out.

Kiwi (and Australian) ambo's are no strangers to wrecked cars' backseats, upside down cars, crawling under a bus etc


----------



## usalsfyre (Sep 4, 2011)

I'm not making the argument that the FD has no place in extrication, just that its role shouldn't be assumed because they're the Fire Department. The area I'm from (NOVA) has adequate FD resources, a ton of extrication and technical rescue geniuses, adequate staffing on the squads ect to make extrication work.

Where I'm at now? We have questionable training, spotty coverage and lowest-bidder equipment by our county volly FDs, and a paid FD in town that may respond if they have no other incidents to attend to and if the pin is confirmed with one, sometimes two people. Meaning we have to get on scene and confirm the pin, wait for the vollys to scratch the call, then call the paid department. It would make a hell of a lot of sense for us to staff a vehicle like this: 
	

	
	
		
		

		
			




with a supervisor and another person. This type of truck could carry a set of hydraulic tools, basic access gear ect. The hold-up? Funding....


----------



## Shishkabob (Sep 4, 2011)

MrBrown said:


> True that, do you not get inside cars?



I've been known to and have no problem doing it if I think it will benefit the patient.

But if it's a car with undeployed airbags, I have no qualms asking the firefighters if they want to get in instead, while I "supervise"  



Infact, I have a scar on my left arm from my last extrication... back in May. 



(I NEVER get the good MVCs.  One of the other trucks in my county gets a rollover every other shift, if not EVERY shift... all my MVCs are either very minor or self-extricated... gah)


----------



## MrBrown (Sep 4, 2011)

Linuss said:


> (I NEVER get the good MVCs.  One of the other trucks in my county gets a rollover every other shift, if not EVERY shift... all my MVCs are either very minor or self-extricated... gah)



Sounds like you blokes have such fun in the wild wild west.  The last decent road traffic accident for Brown was like two years ago, some young guy pinned under the dashboard by his nunngered femurs.  

*Brown rolls up in a beat up pickup truck, Dixie Chicks music blaring, spits on the ground, adjusts large cowboy hat and hip pouch full of suxamethonium

Can Brown come play frontier ambo now? 

And before you say anything Natalie Maines is hawt


----------



## Shishkabob (Sep 4, 2011)

MrBrown said:


> Sounds like you blokes have such fun in the wild wild west.  The last decent road traffic accident for Brown was like two years ago, some young guy pinned under the dashboard by his nunngered femurs.



We're in a rural county with high speeds (70mph) and no road barriers separating the lanes... it happens often.




My first true fatality as a 911 medic was NYE in an MCI MVC when I was first truck on, with 8 patients and 1 fatality.  The most critical of the patients self extricated (which was amazing), while it took about 30 minutes to get the 7 patients out of the other vehicle.


Took over an hour to get the body of the fatality out... that's how mangled it was.


----------



## MrBrown (Sep 4, 2011)

We have a lot of rural roads here, two lane, no barriers, winding, blind corners etc so for the the rural Paramedics really nasty road traffic accidents are not uncommon.  Sad thing is the rural blokes are the thinnest-spread and the Fire Service are all volunteers so might be a while before you get cut out but hats off to those rural volunteers they give 200% 

HEMS and PRIME Ambulance Doctors are frequent sights at our RTAs

Out in the sticks you get big heavy combination vehicles (tractor-trailers) and tractors and farm equipment involved too, people stuck under 4WD vehicles down the back of the farm, legs and other appendages lopped off by tractor PTOs and whatnot.

Brown remembers some bloke who got stuck in his little Japanese car under a rolled eighteen wheeler, poor bloke was super deluxe style crook.


----------



## Shishkabob (Sep 4, 2011)

MrBrown said:


> Brown remembers some bloke who got stuck in his little Japanese car under a rolled eighteen wheeler, poor bloke was super deluxe style crook.



[youtube]http://www.youtube.com/watch?v=LuNjOfan0zA[/youtube]


----------



## Martyn (Sep 4, 2011)

firefite said:


> Fire doesn't respond to medical calls in your area? If your system is ran like that then yes it seems as if EMS does have a heavier workload.
> 
> As for my area fire responds to anything that EMS responds to along with alot more. So fire has a much heavier workload then EMS here.


 

I think our figures speak for themselves: http://polkfire.polkfl.com/Information/StatisticalInformation/tabid/90/Default.aspx


Lets face it, Polk County (just about the biggest county in Florida) is a fire/ems system. Judging by the figures below if they didn't go to EMS calls and interfere then seems to me they would just be sitting on their butts all the time. Can of worms now open!!!


----------



## Martyn (Sep 4, 2011)

Quote from Polk County EMS website:



> The Division responds to approximately 75,000 events yearly serving a population of over 580,000. Each ambulance carries the latest state of the art emergency medical equipment, and through the EMS Medical Director cutting edge prehospital medical treatment and transportation are provided for all citizens and visitors.


 
As I see it it is all about fire wanting a bit of the action to justify their huge budgets


----------



## Tigger (Sep 4, 2011)

usalsfyre said:


> So it would be unheard of to send two ambulances to a pin-in?
> 
> Think outside the box a little.



I could take three ambulances out of service or one ambulance and an engine company with tools out of service and get same number of people on scene. Which drains the system more?

And if I send three ambulances, I still have no fire protection, no fluid control, and nothing beyond basic hydraulic cutting equipment (which to be fair is often what is found on an engine company in some areas, though the guys around here have struts and cribbing for stabilization).


----------



## Aidey (Sep 4, 2011)

For the record, I rarely see our major FDs here have a hose pulled for fire protection or any kind of fluid control. Heck, I can count on one hand the number of times I've seen someone cut a battery...or even remove the keys from the ignition.


----------



## Tigger (Sep 4, 2011)

Linuss said:


> The Paramedics assessment can and should dictate what sort of methods are required for the patient.  Unstable patients don't have the luxury of time that stable patients do, where you have more time to troubleshoot issues that arise.



This makes sense. But is it necessary for you to actually cut up the car? Surely if you told the responding fire crew that you had a critical patient they would get the picture and do what they can to provide a rapid extrication? The person on the tool doesn't need to be a medic, they need to be good at cutting cars into pieces carefully. I agree though, the highest level medical provider should be calling the shots at an extrication.


----------



## Tigger (Sep 4, 2011)

usalsfyre said:


> Where I'm at now? We have questionable training, spotty coverage and lowest-bidder equipment by our county volly FDs, and a paid FD in town that may respond if they have no other incidents to attend to and if the pin is confirmed with one, sometimes two people. Meaning we have to get on scene and confirm the pin, wait for the vollys to scratch the call, then call the paid department. It would make a hell of a lot of sense for us to staff a vehicle like this with a supervisor and another person. This type of truck could carry a set of hydraulic tools, basic access gear ect. The hold-up? Funding....



In your situation that makes tons of sense considering that you are the only full time emergency service around besides a sheriffs department or something. I'm sure they too are stretched very thin, and have no interest in rescue services. But for areas that have 24/7 FD coverage with good staffing and equipment, wouldn't it make sense to save more ambulances for EMS calls?


----------



## Cup of Joe (Sep 4, 2011)

In my opinion: EMS should be all about the patient.  Police should secure the scene and continually assess and maintain scene safety.  Fire should be responsible for extrication of the patient.  

On a scene of a bad, one car MVA that requires extrication, police should place their cars and flares to protect the scene from coming traffic, and the officers themselves should make sure traffic keeps moving around the scene, as well as keeping an eye out on the scene for anything that could make the scene unsafe.  EMS should be focused on the patient.  Fire should stabilize the vehicle and start cutting.  Lets say something in the video happened, where PD decided to lift a car without it being stabilized, EMS should say "That's not safe for our patient"  and Fire should say, "That's not the best way to get the patient out."


----------



## usalsfyre (Sep 4, 2011)

Tigger said:


> In your situation that makes tons of sense considering that you are the only full time emergency service around besides a sheriffs department or something. I'm sure they too are stretched very thin, and have no interest in rescue services. But for areas that have 24/7 FD coverage with good staffing and equipment, wouldn't it make sense to save more ambulances for EMS calls?



Yep, if the FD is performing the job well then why not. My point all along has been you can't apply the "FD should do it" model everywhere, and that extrication at its core is a patient focused medical activity and just because someone has rank doesn't mean they should be making the decisions.


----------



## usalsfyre (Sep 4, 2011)

Cup of Joe said:


> In my opinion: EMS should be all about the patient.  Fire should be responsible for extrication of the patient.


These are not separate activities. They are intertwined.


----------



## Cup of Joe (Sep 4, 2011)

usalsfyre said:


> These are not separate activities. They are intertwined.



Couldn't agree more.  And in the idea of having them focus on a particular job on scene doesn't mean they all aren't working together or towards different goals.


----------



## DesertMedic66 (Sep 4, 2011)

Linuss said:


> How many extrications have you worked?
> 
> 
> 
> ...



I don't keep track of how many calls I run. 

We have fire respond to every call so we don't need to take a second ambulance out of service. We will just have 1 or 2 firefighters ride with us if we think the patient is going to go south on us. 

If there is only one patient then we only get one ambulance even if it's a full arrest because we also have fire on scene. I've even had medic transport 4 stable patients at once. 

We have roughly 8 medic units for 2,400 square miles so we have to have a good reason and be able to justify having a second unit dispatched and put out of service. So at least in my area EMS doing extrication is not going to happen for a long long time. 

Now we could probably handle medical calls if fire didn't respond but it's still good to have them there for many reasons (IMO). I don't see anything changing with how we operate.


----------



## usalsfyre (Sep 4, 2011)

So what your saying is fire is massively overstaffed and EMS is massively understaffed...


----------



## DesertMedic66 (Sep 4, 2011)

usalsfyre said:


> So what your saying is fire is massively overstaffed and EMS is massively understaffed...



Understaffed yes but not by choice. If we need more ambulances we have about a 30-45 min wait time. 

And someone (forgot who) said something I agree with. Police should be scene safety, EMS should be patient care, fire should be extrication. Each can focus on their job but they need to communicate. If fire is on scene first they are incharge of both patient care and extrication. Once EMS arrives we take over all patient care. Communication seems to be the major issue


----------



## frdude1000 (Sep 4, 2011)

Our department is combined fire/ems.  Our fire apparatus responds as first responders and as manpower on ems calls.  Most of our engines are ALS and we use them to upgrade BLS units to ALS and to upstaff medic units on ALS-2 responses (unconscious, code, etc.).  

We call MVA's PIC's in my area (personal injury collision).  For a smaller road collision, you get 1 BLS ambulance and 1 fire apparatus.  For a highway collision, you get 1 engine, 1 bls unit, and 1 rescue squad.  For a PIC with reported entrapment, roll over, etc, you get the engine, a tower, an ambulance and a squad.  To be a firefighter in my county, you must be an EMT also.


----------



## MrBrown (Sep 5, 2011)

Brown will never understand the justification for sending a ladder or aerial appliance, which is a gargantioun monstrosity weighing thousands of pounds and used for extricating people from high places, to a road traffic accident, which is usually something occuring at ground level.


----------



## boingo (Sep 5, 2011)

usalsfyre said:


> So what your saying is fire is massively overstaffed and EMS is massively understaffed...



That is EXACTLY what he is saying.


----------



## silver (Sep 5, 2011)

MrBrown said:


> Brown will never understand the justification for sending a ladder or aerial appliance, which is a gargantioun monstrosity weighing thousands of pounds and used for extricating people from high places, to a road traffic accident, which is usually something occuring at ground level.



Technically FDNY only has 5 rescue companies (they also have squad companies that run in rescue pumpers).

NYPD ESU has 10 heavy rescue trucks.


----------



## akflightmedic (Sep 5, 2011)

I agree, there was NOT enough quality footage of the brunette FDNY EMT to determine her accurate level of hotness, but initial impression was satisfactory.


----------



## JOHNFORCENYC (Sep 5, 2011)

Fdny & nypd should work hand in hand & not against each other. The prime reason of appearing to a call is to rescue both critical & non critical patients.  In my case, since i work in nyc, they are my priority.  

It is sad to say that fdny & nypd dont get along. I hope in the near future that both realize, its not about whos better than who, but the obligation of helping a patient is a priority!


----------



## firecoins (Sep 5, 2011)

Both they NYPD ESU units and FDNY units should have extrication capabilities.
I have little interest in how it may be done in your local but this is necessary in NYC. Both units particpate in many rescues and are well trained. Just wish they could work together better.


----------



## DrParasite (Sep 5, 2011)

silver said:


> Technically FDNY only has 5 rescue companies (they also have squad companies that run in rescue pumpers).


technically you are right.  however, every truck company has a full set of rescue tools, cribbing, and airbags.  There are also 7 Rescue Engine Companies (called Squads in NYC).  that are equipped and trained to operate as engine, truck or rescue companies, depending on what the situation calls for and how they are dispatched.


silver said:


> NYPD ESU has 10 heavy rescue trucks.


they have 10 big heavy rescues (3 in Brooklyn, 1 in Staten Island, and 2 in every other borough), but they also have 40 REPs (ESU patrol trucks), which carry scba gear, medical kits and rescue equipment including heavy hydraulics.

so as you can tell it's isn't as simple as 5 FD vs 10 PD.

I still think there is a huge duplication of services, and a recipe for problems esp when both agencies rush the scene, to see who can rescue the person first or make the first cut in the car.  and the video shows what can happen.


----------



## Tigger (Sep 5, 2011)

MrBrown said:


> Brown will never understand the justification for sending a ladder or aerial appliance, which is a gargantioun monstrosity weighing thousands of pounds and used for extricating people from high places, to a road traffic accident, which is usually something occuring at ground level.



Lots of compartment space on North American aerials, perfect for filling with shiny things that lift and cut things. That and they make excellent blocking apparatus for highway MVAs, though it sure does suck to lose an 850k ladder to semi truck. Better than losing a person though right?


----------



## NYBLS (Sep 6, 2011)

No one has yet to the multiple individuals saying that a charged line is needed on an extrication. Anyone have a plan for that?


----------



## clibb (Sep 6, 2011)

Linuss said:


> How many extrications have you worked?
> 
> 
> 
> ...



Linus,

What do you do with a Trauma patient that an EMT cannot do? Pain meds? I would really love to know. We run EMT/Medic ambulances here and fire do respond to our calls. We have a very good relationship with fire and sure we'll take a firefighter with us if we need it, but a second medic? Barely. 
I don't know the protocols you have with AMR. Here as a Basic, I can start an IV, give 250 ml of fluid. I can intubate patients with a Kingtube after the medic has missed 2 times. 
I would rather have a firefighter cut out a person out of a vehicle because they have been TRAINED doing that. 

I COMPLETELY agree with you when it comes to dissolving all Fire Departments. People need to concentrate more on EMS and not fire. Most calls that Fire Departments respond to are medical calls, well maybe not in NYC. 
My insurance guy told me that it costs them MORE if a Fire Department puts out the fire at my house than it does to just let it burn down and rebuild it. 
Firefighters are people who haven't realized that 95% of their job is medical calls


----------



## MusicMedic (Sep 6, 2011)

i dunno about you guys, but a Van Ambulances really dont have alot of space.. 
i can barley stuff a bariatric patient in the back.. on top of the Medic and his drug box and Me.. it can get quite stuffy.. on top of that add heavy extracation gear? yeah im not gonna have room to move my feet.. 

even in the Mods (box ambulances) it can get stuffy when you have more than two people working on a patient... i really dont know where the extracation gear is gonna go? Maybe strapped on top of the rig?


----------



## MusicMedic (Sep 6, 2011)

Another point or two or three I want to make: 

say for example a 300 lb male gets trapped in a car and needs to be extricated.. i sure as hell wouldn't want to break my back with just me and my partner extricate them.. I would want a few more bodies at least. which leads me to another point: I call for back up and another ambulance responds: out comes two 105 lbs 5'3 EMT's (male or female).. im not that big either but I would want more help than that.. 

which also leads me to a another point: Extrication gear can be heavy and requires strength to manipulate properly. FF's go through rigorous Physical Ability Testing to get hired and even more rigorous PT in the academy.. 

if EMS/Private Ambulance companies wanted to do Extrication, it would require the EMT's/Medics on board to also be held to a certain physical standard which then would certainly eliminate people from EMS..


----------



## FrostbiteMedic (Sep 6, 2011)

firefite said:


> Who should be doing extrication?



Neither Fire, nor police, nor ems. 3rd service rescue, like is common here in Tennessee. Let Fire do fire, let EMS do EMS, let LE do LE. I believe Rescue should do rescue. To me, combining these services is like saying Fire-based EMS is the greatest thing since sliced bread (no offense to the Fire EMTS and Medics on this board). Separate job=Separate agencies
*holds up umbrella for the crap storm that is about to rain down on him*


----------



## MrBrown (Sep 6, 2011)

The Fire Service should handle extrication; thats their job, its what they have done for donkeys years and they are very good at it.

New South Wales in AU has Ambulance Rescue in some areas which provides extrication at road traffic accidents otherwise (like generally anywhere else in the world) its done by NSW Fire Brigades.

Locally speaking Ambulance Rescue (SERT) provides support to the Police Armed Offenders Sqaud, CBRN and medical support for USAR/high angle/cliff/cave rescue.

If somebody here needs to be cut out of a car, the Fire Service is very aware they need to work with/wait for Ambulance to take care of the patient.

Most road traffic accidents you can get an ambo in the back, through the windscreen, under the bus etc to get some initial assessment and stabilisation, collar, bleeding control/torniquet as appropriate, intravenous fluids or pain relief.


----------



## Shishkabob (Sep 6, 2011)

Re-watched the video.


Look at 4:55 when the car is dropped.  It's clearly evidence that chocks were in place, under the car when it fell.  It's also clearly evident that the car did not drop all the way back down to it's original position, but at a higher position due to the chocks being in place.


----------



## Shishkabob (Sep 6, 2011)

clibb said:


> What do you do with a Trauma patient that an EMT cannot do? Pain meds? I would really love to know.   I don't know the protocols you have with AMR. Here as a Basic, I can start an IV, give 250 ml of fluid. I can intubate patients with a Kingtube after the medic has missed 2 times.



I don't work for AMR anymore, but they sure as hell did not allow EMTs to do IVs, Kings, or ETI.  My current agency allows EMTs to do Kings, and honestly if I need an airway while a patient is still trapped, chances are it will be a King.



You mean besides the ability to do a much better / thorough assessment?
Analgesia and sedation
More than your "250ml of fluid", if warranted.  (Not to mention different kinds)
Intraosseous access
EJ
RSI / DAI
Spinal clearance



I can go on if you wish?




> I would rather have a firefighter cut out a person out of a vehicle because they have been TRAINED doing that.


  Yet another fallacy that I wish you would quit perpetuating.  

EMS can, and in many places is, trained in it as well.  Why not have them do it?








MusicMedic said:


> if EMS/Private Ambulance companies wanted to do Extrication, it would require the EMT's/Medics on board to also be held to a certain physical standard which then would certainly eliminate people from EMS..



How is that a bad thing?


----------



## MassEMT-B (Sep 6, 2011)

MusicMedic said:


> if EMS/Private Ambulance companies wanted to do Extrication, it would require the EMT's/Medics on board to also be held to a certain physical standard which then would certainly eliminate people from EMS..



I have seen fat fire fighter. Where I use to volunteer almost all the firefighters were overweight and they had no problem doing extrications. Also being in shape for EMS isn't a bad thing. I don't want a partner that isn't strong enough and is going drop the person we are stair chairing most likely hurting me and the pt. I really don't care who does extrication as long as they know how to do it safely and efficiently.


----------



## CAOX3 (Sep 6, 2011)

Im pretty sure I could be trained to do just about anything including extrication.

The real question is what would be the benefit of having me do it opposed to the fire department.


----------



## Shishkabob (Sep 6, 2011)

PS-- Anyone else see the hyper-rotation of the neck?  He is prone with his chest to the ground, as evidence by his legs and left hand positions.  His head is quite obviously rotated unnaturally to the left, almost to a 180.



Ouch.


----------



## MusicMedic (Sep 6, 2011)

Linuss said:


> PS-- Anyone else see the hyper-rotation of the neck?  He is prone with his chest to the ground, as evidence by his legs and left hand positions.  His head is quite obviously rotated unnaturally to the left, almost to a 180.
> 
> 
> 
> Ouch.


 i just noticed that.. yeah double ouch.. Mucho Spinal Damage there.. even if he survived he probably would have some degree of paralysis..

and from the looks of it the front of the car ran over his head before coming to a complete stop? the second tire almost ran over him agian? 

this whole situation is Fubar


----------



## clibb (Sep 6, 2011)

Linuss said:


> I don't work for AMR anymore, but they sure as hell did not allow EMTs to do IVs, Kings, or ETI.  My current agency allows EMTs to do Kings, and honestly if I need an airway while a patient is still trapped, chances are it will be a King.
> 
> 
> 
> ...



A much better and thorough assessment, Really? Like put the patient on the monitor? What else?
I can spinally clear someone to my protocols. You're the prime example of what happens to an EMS provider when they go straight to Paramedic School.


----------



## usalsfyre (Sep 6, 2011)

clibb said:


> A much better and thorough assessment, Really? Like put the patient on the monitor? What else?
> I can spinally clear someone to my protocols. You're the prime example of what happens to an EMS provider when they go straight to Paramedic School.



You mean he becomes a competent and knowledgeable clinician?

The big problem with most EMTs (and for that matter, a large number of paramedics) assessments is "you don't know what you don't know".


----------



## Shishkabob (Sep 6, 2011)

clibb said:


> A much better and thorough assessment, Really? Like put the patient on the monitor? What else?



So, a first responder will be as good as a doctor in assessing and treating trauma, correct?  I mean, what's the doctor gonna do, an x-ray?  What else?

I'll be the first to say that no provider should pull the "I was only educated to this level", as yes, a first responder, EMT, etc etc, can and SHOULD continue their education.  Your assessment isn't soley based off your skills and your initial education.

But let's be honest here; the average paramedic has a deeper understanding of anatomy, physiology, and assessment than the average EMT.  That's the very reason WHY they have different levels, and further schooling to do the levels.  It's not an attack on EMTs.   (Go through my last 3 years of posts and see my view on "Paragods" and EMTs)


(JPIN isn't average, he's a freak)






> I can spinally clear someone to my protocols. You're the prime example of what happens to an EMS provider when they go straight to Paramedic School.



Guess I need to add more since you're fixated on the skill aspect;

Chest decompression
Needle cric
Surgical cric


----------



## samiam (Sep 7, 2011)

Our police officers are triple cross trained EMT-B, Police, Fire Their main job is police work however they are usually first on scene and will stabilize and ASSIST as needed.


----------



## Handsome Robb (Sep 7, 2011)

clibb said:


> A much better and thorough assessment, Really? Like put the patient on the monitor? What else?
> I can spinally clear someone to my protocols. You're the prime example of what happens to an EMS provider when they go straight to Paramedic School.



Stop before you say something more ridiculous, please.

Trauma isn't just "put the white stuff on the red stuff and drive fast"


----------



## MrBrown (Sep 7, 2011)

clibb said:


> A much better and thorough assessment, Really? Like put the patient on the monitor? What else?
> I can spinally clear someone to my protocols. You're the prime example of what happens to an EMS provider when they go straight to Paramedic School.



This statement is the perfect example of sticking your foot in your mouth.

Patient assessment is not determined by what fancy toys you have at your disposal but yes, they sure do help.


----------



## MonkeySquasher (Sep 9, 2011)

I agree!  Anything that has to do with a patient's care is totally tied to patient extrication and rescue.  Let's follow this concept!

So, an accident that needs patients extricated is DEF tied to patient care.  This will require hydraulics which need a generator.  We'll need a pump and water tank for the charged handline as required by NFPA, as well as proper extrication PPE, and possibly struts/jacks/rams/airbags/cribbing.  This may also require set of irons, and cutter for the batteries.  Also, a saw or two couldn't hurt, with extra blades and batteries/fuel.  Also, tarps.  If the vehicle is engulfed when we arrive, we would need airpacks to extinguish it, as required by both NFPA and OSHA.  I would want to extinguish it myself to ensure I don't cause steam burns to my patient.  If it's dark out, we'll need a light tower.... or four.

BUT WAIT!  Little Timmy just fell down the well and is injured!  Well now we'll need properly trained people, and at a minimum a few hundred feet of life-safety rope, a tripod, harnesses, rack, and other proper tech-rescue equipment and training.  If this well is far from a roadway or down a ravine, we could also use a stokes basket and more rope and manpower, all rescue- and medical-related, of course.

But now, a tank is leaking some fertilizer and people are sick!  Clearly only rescue-trained Paramedics can save they day, and we need to get to our patients.  I now require Level A suits to go with my SCBAs, along with proper decontamination equipment and that watertank/pump/hose combination again.  I'll retrieve and decon these people myself to ENSURE proper patient care.

What's that, a person swept away from a ditch during a storm?  Well good thing we have our RIB and lifejacks (floaties?) along with cold-water-immersion suits, because when they patient gets onboard I'll need to monitor them for hypothermia, initiate rewarming, and possibly even perform CPR or intubation immediately.

And then I got to thinking, what if there's a workplace shooting and people are wounded inside?  There's been multiple instances of workplace or school violence where deaths occur because rapid care wasn't given to victims.  And I need to save them, so my rescue team will need ballistic helmets and protective vests, possibly shields.  But now to protect ourselves and our patients, we'll all need to be armed.  No sense going about this half-arsed.

....On second thought, maybe a tank, so we can just DRIVE ON IN THERE TO EXTRACT THEM OURSELVES.   h34r:


tl;dr - I get it, EMS is still the redheaded step-child that is trying to make a name for itself.  Fire is the bratty older brother who always gets the cool stuff and gets what it wants.  The fact remains, we are three pillars of public service that cannot stand alone without the other two.  We should each stick to what we do best.  There's no denying, our common goal is proper service to our patient.  My job is patient care, and if I feel there's an issue with my patient or extrication, I'll speak to the person doing it.  Otherwise, I don't care who cuts the damn car, as long as my patient gets out.  I am VERY EMS-oriented, and stress proper patient care at all times.  But turning over anything related to patient treatment to us?  It's a bit much.


----------



## 46Young (Sep 25, 2011)

Linuss said:


> Just more excuses, really.  There's not a single reason why EMS cannot / should not do basic extrication.
> 
> 
> 
> Fire is essentially a big wasteful sink anyhow.  Why not divert the funds from them to EMS?  We do more work anyhow, and they do the little side-gigs that are hardly ever done but use to justify their budgets...



My understanding about the fire service, from the inside, is that we're a catch-all. Our job description, in a nutshell, is that we solve chaos. That's it. 

We're not the power company, but we respond to wires down. We're not the gas company, but we respond to both inside and outside gas leaks. My department spent several days in the Huntington area of Fairfax County, which saw significant flooding, assisting the victims, helping them pump water out of their basements and first floors, getting them out of their homes, etc. Our USAR teams go to other jurisdictions and countries to help with natural disasters. We aren't the Coast Guard, but we do Swift Water Rescue. We're not locksmiths, but we're called to open up locked cars, and even people's homes. We do "Public Service" calls, which encompass everything from lifting Grandma off of the floor and putting her back in bed to clearing tree limbs off of the sidewalk.

This all hazards, catch-all, solving chaos mandate explains why the fire service got into EMS in the first place. In some areas, especially rural areas, EMS simply didn't exist until the local fire authority assumed that responsibility. I believe that my department is one of them, combined fire and EMS since the beginning. 1932 at the latest, it would appear:

http://www.fairfaxcounty.gov/fr/deptinfo/history.htm#pre

"1932 - Volunteer Station 1 (McLean) purchased the first Ambulance - a 1926 LaSalle."

If your department or agency was founded later than 1932, then fire based EMS was in existence before your orgainization was.

I suppose other departments noticed that these departments had been doing EMS, and decided that it's appropriate that they do the same. Some assumed EMS for the right reasons. Others, obviously, had more exploitative motives.

This all hazards mandate has led the fire service to assume whatever duties they can secure without opposition. This explains the Hazmat operations, TROT (Techincal Rescue), EMS, Fire Marshalls, Extrication, etc.

Yes, it's job security, and you can't really fault forward thinking individuals for seeking to secure their positions and careers. Besides, having these functions on your resume makes you quite marketable for another career after retirement.


----------



## 46Young (Sep 25, 2011)

usalsfyre said:


> Most cities fire workload is about 20% of EMS workload. How many fires realistically are there? How many HazMats?



80/20 or 70/30 would be an accurate precentage in favor of EMS if you were talking about call volume only. The real numbers are somewhat different. Let me explain:

Certain suppression unit responses involve much more than only one unit. For example, an inside gas leak uses two engines, a truck company, a medic unit, and a BC (4/1 ratio). An alarm bell always gets two engines and a truck. An MVA gets an engine and a medic unit unless it's a suspected pin job, then you get one or two squads (one for each dierction if on the highway), so it's 3/2, or 4/2. A box alarm gets four engines, two trucks, a heavy rescue, two BC's, an EMS supervisor, and a medic unit (two if the first gets a pt), so it's a 9/2 or 9/3 ratio. Add some more suppression pieces if you need a fire boat or multiple tankers to run a water shuttle operation. Don't forget rehab units and Light & Air units as well for second alarms, not to mention the extra engines, trucks, etc. that come with second alarms and greater. The medical aid calls where you get an engine with the medic unit can be argued in either direction depending on who you talk to. 

A more accurate number would be net utilization for each unit, quantified by the number of calls each one responds to, tallied for fire, tallied for EMS, then compared for a more accurate ratio.

Alternatively, you could count net utilization hours by unit, but then that's an apples to oranges comparison when talking about run volume.


----------



## 46Young (Sep 25, 2011)

Linuss said:


> You're confusing "types of things done" for "calls done".  Yes, they can "do" HAZMAT, but honestly, how many times does your average sized agency do that?
> 
> And honestly, each and every item you posted there, EMS will go to as well.  HAZMAT spill?  EMS is there.  MVC?  EMS is there.  Fire?  EMS is there.   Yet, I don't have fire show up on a huge portion of my medical calls.
> 
> ...



See the above post, in reference to net utilization per unit.


----------



## 46Young (Sep 25, 2011)

usalsfyre said:


> That's the problem, this is all region dependent. In my service area we get fire if it's a pin in or we need an LZ. That's it, so most MVCs have only EMS and PD. We respond to all structure fires and multiple department wildfires. So our workload is quite a bit heavier than the paid FD here.



You don't have any suppression units taking up a few lanes to protect the scene? That's a problem.


----------



## 46Young (Sep 25, 2011)

Aidey said:


> This is one of the things I seen pointed out numerous times in the comments on this incident. Even going with the assumption that the FD had determined it was a non-viable patient air bag operations always seem to take forever. I don't think I have yet to see them used efficiently.
> 
> 
> 
> ...



Consider that a paramedic will make the best attempt to access and treat the patient during the extrication process. Consider that the extrication crew would like to avoid losing control of the vehicle and crushing that paramedic, the pt, and possible members of the squad working on the car. Extrication is not a three minute rush job. It can take up to an hour or more. This is why we have crush syndrom protocols that use NS, dextrose, bicarb, and possibly albuterol (at least here).

The cribbing and other shoring methods absolutely need to be placed properly before you can raise the vehicle with the bladders or whatever you're using. Up an inch, more shoring. Up an inch, more shoring. Rinse, wash, repeat.

From what I've seenand heard, the FDNY crews were moving with a purpose, and not like they're in a Chinese fire drill, which is what ESU looked like. It appears to me that the ESU person used spreaders to lift the vehicle (WTF?) and then lost control of it, causing the issue.

I worked in NYC EMS for five years, and I've seen many of these "who's phallus is bigger" contests between FDNY and NYPD ESU. Many of the ESU people have not ever done a cut job in their entire career. The FDNY Heavy Rescue crews live and breathe this stuff.

But you're right, there's no reason that extrication and firefighting have to go together. There's also no reason why they cannot coexist. IMO, the same is true for EMS and fire. IMO, for bost cases, (fire/extrication, fire/EMS) the situation is dependent on region and demand. One size does not fit all in the world of Emergency Services.


----------



## fortsmithman (Sep 25, 2011)

clibb said:


> A much better and thorough assessment, Really? Like put the patient on the monitor? What else?
> I can spinally clear someone to my protocols. You're the prime example of what happens to an EMS provider when they go straight to Paramedic School.



Correct me if I'm wrong, but wasn't Linuss a working EMT before he went to medic school.  So he wouldn't be one who went straight to medic school.


----------



## 46Young (Sep 25, 2011)

Linuss said:


> Except the ESUs job IS extrication / rescue and not traffic control, so that throws that argument right out.
> 
> 
> 
> ...



NYPD ESU have Tac Medics (one did ride alongs on my bus while they went through medic school), they perform SWAT type functions as well. I've done many standbys for barricaded EDP's, and have seen ESU do their thing. Extrication is just another of their functions.


----------



## 46Young (Sep 25, 2011)

Sherman27 said:


> Volunteer firefighters don't seem to complain, and I wouldn't either knowing I could help a patient even further than I could before. I'm for it.



Apples and oranges, career and volunteer. besides, with volunteer, those individuals only certify in what they want to be certified in. Many don't want anything to do with an ambulance. Othere only want to be on an ambulance. Others yet will only respond to certain calls, and not others. When you're career, you don't have near that amount of discretion.

Also, if you lie own whenever your employer expands you job description without some incentive, then they will continue to do so until you're inundated with more tasks than you can handle. I belive that one jurisdiction had their FF's cutting grass or something during their downtime.


----------



## Bullets (Sep 26, 2011)

46Young said:


> You don't have any suppression units taking up a few lanes to protect the scene? That's a problem.



why do i need to bring an engine to a MVC just block MORE lanes of traffic on a highway? traffic control is PDs job. more apparatus, more people=more chance for injury. 



			
				46Young said:
			
		

> "1932 - Volunteer Station 1 (McLean) purchased the first Ambulance - a 1926 LaSalle."
> 
> If your department or agency was founded later than 1932, then fire based EMS was in existence before your organization was.



Unless you live in NJ, then private independent volunteer EMS organizations existed as early as 1927 and realistically existed prior to that


----------



## adamjh3 (Sep 26, 2011)

Bullets said:


> why do i need to bring an engine to a MVC just block MORE lanes of traffic on a highway? traffic control is PDs job. more apparatus, more people=more chance for injury.



If that BRT is placed correctly it has more of a chance of _deflecting_ the vehicle of an inattentive motorist. Car not going through scene = less chance of injury. Besides, an MVC with entrapment is already likely taking up a couple lanes of traffic, better to put a barrier there than a cop with a vest and flashlight.


----------



## dixie_flatline (Sep 26, 2011)

MonkeySquasher said:


> I agree!  Anything that has to do with a patient's care is totally tied to patient extrication and rescue.  Let's follow this concept!
> 
> So, an accident that needs patients extricated is DEF tied to patient care.  This will require hydraulics which need a generator.  We'll need a pump and water tank for the charged handline as required by NFPA, as well as proper extrication PPE, and possibly struts/jacks/rams/airbags/cribbing.  This may also require set of irons, and cutter for the batteries.  Also, a saw or two couldn't hurt, with extra blades and batteries/fuel.  Also, tarps.  If the vehicle is engulfed when we arrive, we would need airpacks to extinguish it, as required by both NFPA and OSHA.  I would want to extinguish it myself to ensure I don't cause steam burns to my patient.  If it's dark out, we'll need a light tower.... or four.
> 
> ...



This is in the running for my favorite comment of the year.  How can anyone expect EMS to do extrication (unless you just give all of the heavy rescue pieces to the EMS squads)?  With the Glidescope and CPAP and Autopulse and whatever new toy comes out next year, we can barely fit all of the _medical_ crap on the ambulance.  There certainly isn't room for cribbing, air bags, saws, and the million other things that you need for an entrapment rescue.  Even so, then you get too much overlap because a lot of the equipment on the rescue pieces can also be used in a myriad of fire-type calls, so the fire department would still need rescue-type apparatus, and then the municipality would be paying twice for similar units (not that government ever operates rationally).



Bullets said:


> why do i need to bring an engine to a MVC just block MORE lanes of traffic on a highway? traffic control is PDs job. more apparatus, more people=more chance for injury.



As for you - sorry, but no.  Even though the cops in our area actually have a great relationship with the Fire Department, they still operate under their own ABC's mentality - Ambulances Before Cops. Namely, they will park in front of the ambo if at all possible, and use cones and flares to try and divert traffic. They try, but cannot always guarantee a closed-off, safe operating area. It's not like we can technically even give orders that the cops have to follow - and we certainly can't pull up and wait 10 minutes for all of the cruisers to get there and finish pushing traffic away from the scene before we start our operations.

Using a heavy piece to provide a shadow to work in is the only way I've seen to rapidly establish a relatively safe work environment.  An 18-wheeler going at speed would probably still ruin everyone's night, but the squad or engine give you the best coverage/protection.


----------



## DrParasite (Sep 26, 2011)

46Young said:


> This all hazards mandate has led the fire service to assume whatever duties they can secure without opposition. This explains the Hazmat operations, TROT (Techincal Rescue), EMS, Fire Marshalls, Extrication, etc.


other Rescue units from your state:
http://www.carsrescue.org/ which has eight advanced life ambulances (medic units), three advanced life support quick response cars (zone cars), two heavy rescue trucks (squads), a water rescue truck with two boats, a technical rescue truck, a collapse rescue trailer, a command car, a mass causality incident truck and a special events bicycle response team with support trailer

http://www.rescue14.com/ 6 ALS certified ambulances 1 BLS certified ambulance1 heavy rescue/squad truck (ALS certified - non-transport) 1 support/utility vehicle (ALS certified - non-transport) 2 medically equipped response cart

I'm sure there are more but I'm too lazy to find ever non-fire based Rescue Squad in your state.  The only reason I bring this up is because many EMS agencies do rescue too, or have expanded their operations to fill a need.  and many do it without the tax funding that is provided to fire departments (and yes, I think CARS even operates as a Truck Company at working fires, despite being an EMS organization).  So that all hazards idea isn't limited to just the fire service.


46Young said:


> The cribbing and other shoring methods absolutely need to be placed properly before you can raise the vehicle with the bladders or whatever you're using. Up an inch, more shoring. Up an inch, more shoring. Rinse, wash, repeat.


agree 100%, wish more people followed this way of thinking in their operations.





46Young said:


> From what I've seenand heard, the FDNY crews were moving with a purpose, and not like they're in a Chinese fire drill, which is what ESU looked like. It appears to me that the ESU person used spreaders to lift the vehicle (WTF?) and then lost control of it, causing the issue.


lifting the vehicle using the spreaders isn't the problem.  i wouldn't do it, but I was told that it is an approved way to lifte the car, especially in an life saving situation.  

the biggest problem with this operation was when they lifted an inch, they didn't crib an inch.  so when the tool failed, instead of having the car come down and inch on the cribbing, it came down hard on the victim's head.  


46Young said:


> I worked in NYC EMS for five years, and I've seen many of these "who's phallus is bigger" contests between FDNY and NYPD ESU. Many of the ESU people have not ever done a cut job in their entire career. The FDNY Heavy Rescue crews live and breathe this stuff.


I find that very hard to believe that any ESU cop has never done a cut job in their career.  I have seen and heard multiple ESU units respond cross borough for a pin job (and sometimes cross borough lines), they can jump calls anytime they want, and often race to calls.  plus with the call volume of NYC, I find it very hard to believe that they have never in their entire crew done a cut, unless they were a pair of newbie ESU officers.

One other thing to remember, every Truck company in FDNY has a cutter, spreader, ram, and set of airbags.  In this case, it was the truck company that was extricating, not the Heavy Rescue.  Not only that, but on more and more extrication jobs, the BC is returning the Rescue and Squad, since the truck company has the patient extricated before they even get on scene.


----------



## Bullets (Sep 26, 2011)

dixie_flatline said:


> This is in the running for my favorite comment of the year.  How can anyone expect EMS to do extrication (unless you just give all of the heavy rescue pieces to the EMS squads)?  With the Glidescope and CPAP and Autopulse and whatever new toy comes out next year, we can barely fit all of the _medical_ crap on the ambulance.  There certainly isn't room for cribbing, air bags, saws, and the million other things that you need for an entrapment rescue.  Even so, then you get too much overlap because a lot of the equipment on the rescue pieces can also be used in a myriad of fire-type calls, so the fire department would still need rescue-type apparatus, and then the municipality would be paying twice for similar units (not that government ever operates rationally).



I expect EMS to do extrication by doing EXACTLY what you propose, giving all the equipment to the EMS Agency. I know engines carry basic extrication equipment, but any Fire Co ive seen that does heavy work has a separate vehicle that contains all the equipment needed for Tech rescue, confined space, collapse, rope, ect. So if your going to have a separate vehicle, why cant EMS have that vehicle? You wouldnt have two vehicles, you would have one, and it would be EMS's





adamjh3 said:


> If that BRT is placed correctly it has more of a chance of _deflecting_ the vehicle of an inattentive motorist. Car not going through scene = less chance of injury. Besides, an MVC with entrapment is already likely taking up a couple lanes of traffic, better to put a barrier there than a cop with a vest and flashlight.





dixie_flatline said:


> As for you - sorry, but no.  Even though the cops in our area actually have a great relationship with the Fire Department, they still operate under their own ABC's mentality - Ambulances Before Cops. Namely, they will park in front of the ambo if at all possible, and use cones and flares to try and divert traffic. They try, but cannot always guarantee a closed-off, safe operating area. It's not like we can technically even give orders that the cops have to follow - and we certainly can't pull up and wait 10 minutes for all of the cruisers to get there and finish pushing traffic away from the scene before we start our operations.
> 
> Using a heavy piece to provide a shadow to work in is the only way I've seen to rapidly establish a relatively safe work environment.  An 18-wheeler going at speed would probably still ruin everyone's night, but the squad or engine give you the best coverage/protection.




We rarely have fire on MVC's in either of the jurisdictions i work in. They are used for entrapment and they just pull a line for possible fire suppression. otherwise they just sit there and i will explain why.

This applies for two towns about 40miles apart that i work for, its the same situation in both town. At any time there are 2-3 ambulances staffed in each town. one of these crews is a rescue crew. IF a call requires rescue equipment, that crew rolls the Heavy and another rolls an ambulance. At the same time, the volly FF are paged, respond from home, get a engine and then respond to the scene. By the time FF get to the MVC, EMS is in the car, cutting and extricating. So unless im cutting, we dont bring fire because its a hazard to have volleys bluelight it from their home then run code 1 all the way to the call. 

EMS has and will continue to be the sole operator of heavy/tech rescues in both areas in which i work. i like it because it streamlines operation, we dont have pissing contests with fire

Also, LEOs dont like FF because they generally cause problems and interfere


----------



## dixie_flatline (Sep 26, 2011)

Bullets said:


> We rarely have fire on MVC's in either of the jurisdictions i work in. They are used for entrapment and they just pull a line for possible fire suppression. otherwise they just sit there and i will explain why.
> 
> This applies for two towns about 40miles apart that i work for, its the same situation in both town. At any time there are 2-3 ambulances staffed in each town. one of these crews is a rescue crew. IF a call requires rescue equipment, that crew rolls the Heavy and another rolls an ambulance. At the same time, the volly FF are paged, respond from home, get a engine and then respond to the scene. By the time FF get to the MVC, EMS is in the car, cutting and extricating. So unless im cutting, we dont bring fire because its a hazard to have volleys bluelight it from their home then run code 1 all the way to the call.
> 
> ...



I guess we are kind of talking past each other. Our experience is with two vastly different systems - I work in a combined career/vollie department, in which Fire handles Suppression and EMS both.  I don't have enough experience with how your type of system actually works to carry on an intelligent debate with so many variables changed.  

I'll acknowledge that in your area, with the constraints of volunteers responding (no such thing as blue lighters in MD, no POV responses period) and such, you may very well be correct in your assessment. If the fire department in unstaffed during the day and cannot guarantee any kind of timely response (equal or better than the EMS units), then they probably _shouldn't_ have the keys for the primary extrication pieces. I stand by my department in this area though, as having that fire apparatus blocking traffic has undoubtedly saved my bacon before.


----------



## Bullets (Sep 26, 2011)

dixie_flatline said:


> I guess we are kind of talking past each other. Our experience is with two vastly different systems - I work in a combined career/vollie department, in which Fire handles Suppression and EMS both.  I don't have enough experience with how your type of system actually works to carry on an intelligent debate with so many variables changed.
> 
> I'll acknowledge that in your area, with the constraints of volunteers responding (no such thing as blue lighters in MD, no POV responses period) and such, you may very well be correct in your assessment. If the fire department in unstaffed during the day and cannot guarantee any kind of timely response (equal or better than the EMS units), then they probably _shouldn't_ have the keys for the primary extrication pieces. I stand by my department in this area though, as having that fire apparatus blocking traffic has undoubtedly saved my bacon before.




I guess i wasnt clear. In my system, when fire does respond to stuff on major highways, they usually block lanes that do not need to be closed, obstruct scenes and get in arguments with LEO and EMS over command and scene control. Many times when EMS is operating in the shoulder or a high way, fire will arrive and block the right lane or two. This results in FD and PD arguing, PD telling fire to get off the scene or move the apparatus, FD saying they are involved in the scene somehow and refusing to move. Ive seen engines towed off the highway and Fire chiefs handcuffed and booked by PD. 

Thats why EMS or PD tries to determine if FD is needed quickly and if not, cx them as fast as possible. FD is generally found to be a nuisance


----------



## LondonMedic (Sep 26, 2011)

What the :censored::censored::censored::censored: is wrong with you people?


----------



## dixie_flatline (Sep 26, 2011)

LondonMedic said:


> What the :censored::censored::censored::censored: is wrong with you people?



Uh.... what?

The list is long and distinguished, but you'll have to be a little more specific.


----------



## 46Young (Sep 26, 2011)

Bullets said:


> I guess i wasnt clear. In my system, when fire does respond to stuff on major highways, they usually block lanes that do not need to be closed, obstruct scenes and get in arguments with LEO and EMS over command and scene control. Many times when EMS is operating in the shoulder or a high way, fire will arrive and block the right lane or two. This results in FD and PD arguing, PD telling fire to get off the scene or move the apparatus, FD saying they are involved in the scene somehow and refusing to move. Ive seen engines towed off the highway and Fire chiefs handcuffed and booked by PD.
> 
> Thats why EMS or PD tries to determine if FD is needed quickly and if not, cx them as fast as possible. FD is generally found to be a nuisance



There's a reason why you need a suppression unit to block the scene - there are numerous instances of near misses, responders actually getting hit, and even LODD's from lack of protection. If you give frustrated drivers even the smallest amount of space, they'll try and squeeze through the scene. I've almost been hit myself. People feel they are self important, and only care about getting past the scene, in any way possible, to get where they're going without regard to anyone else.  We have pictures from a few of our engines that have been struck from behind, sometimes at highway speed!

You're placing a lot of trust in other drivers if you're willing to leave yourself exposed like that when working an MVA. Besides there being drunks on the road, you also have a scourge of distracted driving - drivers eating, playing with the radio, dialing through their ipod, texting, nodding off at the wheel, fixating and trying to follow their GPS, etc. We didn't get any engine coverage in NYC unless it was a cut job, and I almost got run over more than a few times.

The FD resources are absolutely correct in taking extra lanes. We're taught to take any lanes involved in the incident, plus one extra lane. There have been too many documented collisions and near misses to not have this policy. You can blame all the poor drivers out there for this line of thinking. The engine will be positioned at an angle in such a way that if it gets hit (which it does, on occasion, good thing it's there!), it will roll away from the scene, not into it.

What's going to do a better job of protecting you, a police cruiser, or a 40+ ft. engine?

If lack of resources precludes your area from having this type of coverage, then this is moot. Otherwise, this is standard practice for many other places.

I work the I495/95/395 "mixing bowl" in Northern Virginia. You wouldn't believe the amount of stupidity and carnage I've seen here. So many loops and turns, the directions change without changing direction (example, 495 outer loop south becomes 495 north after going through the bowl), the GPS has people cutting across four or five lanes, etc.


----------



## 46Young (Sep 26, 2011)

Bullets said:


> why do i need to bring an engine to a MVC just block MORE lanes of traffic on a highway? traffic control is PDs job. more apparatus, more people=more chance for injury.
> 
> 
> 
> Unless you live in NJ, then private independent volunteer EMS organizations existed as early as 1927 and realistically existed prior to that



What I meant is that there are many EMS organizations that came into existence in the 40's, 50's, 60's, and 70's. It's difficult to say that one type of system should replace all others when the one you work came into existence much later than other, differently structured systems.

My point is that no one delivery model can claim that they have "rights" to EMS, and can say that other types of systems should not be in place.


----------



## 46Young (Sep 26, 2011)

dixie_flatline said:


> This is in the running for my favorite comment of the year.  How can anyone expect EMS to do extrication (unless you just give all of the heavy rescue pieces to the EMS squads)?  With the Glidescope and CPAP and Autopulse and whatever new toy comes out next year, we can barely fit all of the _medical_ crap on the ambulance.  There certainly isn't room for cribbing, air bags, saws, and the million other things that you need for an entrapment rescue.  Even so, then you get too much overlap because a lot of the equipment on the rescue pieces can also be used in a myriad of fire-type calls, so the fire department would still need rescue-type apparatus, and then the municipality would be paying twice for similar units (not that government ever operates rationally).
> 
> 
> 
> ...



That remindes me, the engine is supposed to park behind the scene, and the ambulance is supposed to park in front of the scene. A police cruiser, or even two, simply cannot effectively protect a highway scene, or a busy intersection for that matter, especially if they're in front of the scene instead of behind it, where the suppression unit would be.


----------



## imadriver (Sep 26, 2011)

Not that my opinion is important in anyway, But I figure I'd chime in just because I'm in the middle on this.

In our area, we work extremely well with our Fire and Law. We have both "County" and "City" Fire and Law. Fire is mixed, some stations Voly, some Paid.

Depending on the call, everyone may respond. Law for just about any situation that may become dangerous. Fire one "major" calls, which really is our higher priority Breathers, and Chest Pains. Everyone responds to things like Cardiac Arrests, MVA's, and anything else we request them for. Such as Man Power, Crowd Control, and so on.

Law handles combative patients (Aside from ones that are medical issues, such as Hypoglycemics), large crowds, traffic control, and bystander that may be or become dangerous. And even can assist us with basic medical stuff. Some are great about holding pressure on wounds, even doing compressions and so on.

Fire handles (or is in charge of) the more "Physical things" such as Extrication, pulling people out of holes, moving cars from the road, fuel spills from MVA's., and so on They also a great assistance to Patient care, (some are EMT's or Medics) Fire Fighters help us a lot on Cardiac Arrests and other major calls depending on their scope of practice, back boarding, oxygen applications, and other stuff. 

EMS is absolutely in charge of anything Medical, even in the presence of a fire Medic, once we are on scene.

Some Pros and Cons:

Fire sometimes do some pretty crazy things with Medical Patients. Mostly just because they aren't around them that often or it's just their training. Such as Every Breather we get is always on a NRB (hopefully) at 12LPM, even if they really don't need it.

I like Fire doing extrication, and they do it well (Which there are only a couple FD's here that can do complex extrication). The reason being is that we (EMS) can Focus all of our attention on Patient Care.

Fire is a little overstaffed, and EMS a little understaffed. And Average day for an EMS crew is about 7-13 calls in a 12-hour shift. Each FD average is about 2-5. But on the same token, there are about +5 FD's in our area for a day shift, and about +9 FD's on any night shift (Due to the lack of EMS Units).

Law is great. They help us directly if they can. If Not, they always find something useful to do.

Aside from a few bad apples, everyone once they get on scene asks "Where are we at? Let me start my job. And After that, What can I help you with?" 

The Biggest thing I think, is that EVERYONE communicates with each other. No stone is left unturned by at least two people. If anyone is just standing around because they are out of things they can do, they help someone else with their tasks at hand until everything is taken care of.


In my personal opinion, Law has their place and job, Fire has their place and job, EMS has there place and job. And We all have our Primary functions, but when it boils down to it, everyone is multipurpose. 

Law, Fire, and EMS, all have one thing in common. We are all public servants. Sometimes we have to step out of our norm to do the most good. If that means I'm running emergency just to teach a new mother how to give her baby Tylenol, then let it be so. At least I helped.

Lastly, Everyone Has The Same Goals: Make sure we are safe. Make sure our partners are safe. Make sure the public is safe. Make sure we do everything that we can. And Go Home Alive.


----------



## Bullets (Sep 26, 2011)

46Young said:


> LOOOOOONG



I guess i see what you mean, and i am all to familar with how people respond to traffic diversion, i make my living dealing with traffic, EMS is just my supplemental job. However, i work on the New Jersey Turnpike, Garden State Parkway, I287/440, US 1/9, SH 35, 18, so i work on plenty of limited access highways and multilane state highways and we just dont have FD rsources on 99% of the emergent activity i deal with, be it EMS or PD and we i think we have had a handful of close calls. NJSP does a great job protecting EMS, and the local LEOs have enough units to cover us

Saturday night i had the opportunity to work with UMDNJ Rescue 1, and they were an excellent rescue squad and a perfect example of how EMS can operate extrication effectively. also, here is a whole bunch of EMS operated rescue vehicles

http://njfirepictures.smugmug.com/F...47760_nNHyC/4/130318449_nzzVH#614945789_P9BQD


----------

