# Fire Based EMS



## Craig Alan Evans (Jun 26, 2013)

What do you think is a better system, all EMS or Fire Based EMS? I work in a fire based EMS system and just wanted to see what everyone thought.


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## rwik123 (Jun 26, 2013)

EMS based. In some of my experience, the paramedic cert is regarded as just a merit badge to get onto a department with little interest in the medicine.


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## troymclure (Jun 26, 2013)

my ridealong was with fire based ems. 

they had 1000/1 ems calls over fire. they were all required to be paramedics, except the engineers/operators. 

they had a contract with an ambulance company for transports.


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## DesertMedic66 (Jun 26, 2013)

The only positive in my area of having fire play an EMS roll is that the fire department is a city based unit. Meaning for each city there is at least one station meaning faster response times. The ambulance company in my area is well an area based company. In a 24 hour period we will have a total of 20 ALS ambulances covering a 5,000 square mile area. 

If my company was able to staff enough units per day to staff on a city basis then the fire department would not be needed on the majority of calls (still need manpower for full arrests, big patients, Cut and Rescue operations). 

Often we will arrive on scene before the fire department and cancel them because they are not needed. Does the patient suffer because of this? No. 

As stated earlier in my post the fire department responds in my area to "stop the clock".


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## Craig Alan Evans (Jun 26, 2013)

That's interesting Desert. Where I work it's fire based EMS and the call volume is about 67% EMS. The paramedics rotate from the engines, squads, and trucks to the medic units and they all take EMS very seriously. We respond with one 4 person engine and a 2 person paramedic crew on a general ALS call and everyone has a job and contributes. I think the patient receives excellent care with all 6 people functioning as a cohesive team.


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## Craig Alan Evans (Jun 26, 2013)

I am getting the feeling it's not like that around most of the country.


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## Craig Alan Evans (Jun 26, 2013)

rwik123 said:


> EMS based. In some of my experience, the paramedic cert is regarded as just a merit badge to get onto a department with little interest in the medicine.



There I some of this in the system I work in, but we weed most of those people out with our ALS internship. They may not be into medicine, but unless they are good medics they don't cut the mustard.


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## DesertMedic66 (Jun 26, 2013)

To further elaborate in my neck of the woods, the fire department respond in engines or ladder trucks. There is at least one medic among the firefighters. The ambulance is provided by a third party company (Non-fire ambulance) that staffs ALS ambulances.

The firefighters do not rotate among anything. The only time they ride in the ambulance is for critical patients. Since fire responds to all medical aids they run 90% EMS calls (that they don't transport) and 10% fires, car accidents, and other fire related issues.

Normally the engine will have 1-4 people on board and the ambulance will have 2-4 on board. At least one medic on the engine and at least one medic on the ambulance.

The majority of EMS calls do not require 6 people. The majority of EMS calls require a taxi. The only times I have found 6 people to be useful (by useful I mean everyone is doing something and no one is standing around) are car accidents, when we have to hike a patient out, when the patient is extremely heavy, full arrests, and MCIs (I may be forgetting some reasons). Those aren't the majority of EMS calls however, rather the minority.


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## Christopher (Jun 26, 2013)

Craig Alan Evans said:


> What do you think is a better system, all EMS or Fire Based EMS? I work in a fire based EMS system and just wanted to see what everyone thought.



The only fire based EMS systems I've seen that work are those that have always done EMS. An example would be the ALS FD I work for, which when it was founded did both (a merger of a volly fire and volly EMS agency).

What I mean by that is they didn't just pick it up for budgetary or call volume reasons (or response time reasons).

It is tough to up and _add_ EMS transport response and be truly good at it (just as it would be tough to up and _add_ fire response and be truly good at it). If you've never worked transport, you'll probably be bad at transport to start.

You can really substitute any job functions and fields for my above comments.


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## Craig Alan Evans (Jun 26, 2013)

I agree Chris and the department I work for has always done EMS since its inception.


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## Jim37F (Jun 26, 2013)

Craig Alan Evans said:


> The paramedics rotate from the engines, squads, and trucks to the medic units and they all take EMS very seriously. We respond with one 4 person engine and a 2 person paramedic crew on a general ALS call



Sounds pretty similar to Los Angeles County Fire. Every EMS call automatically gets an engine and a paramedic squad (pickup truck style chase vehicle) dispatched along with a BLS ambulance from one of the private companies they contract with. Which ambulance company gets the call depends on the geographical location in the county as its broken down into exclusive operating areas for 911 response ambulances. Out of the 80 some odd ambulance companies in the county only 6 have any primary 911 response contracts. No clue if the county firefighters rotate from the squad to the engine or truck or whatever though.


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## usalsfyre (Jun 26, 2013)

Craig, it's very easy to look at Fire-Based EMS systems through the NOVA prism and think it's the ideal solution (although I would argue Alex FD/EMS is a better way of doing things). However, the majority of FD based EMS I've seen since I left that area is atrocious. The "care" provided by the FDs in a couple of the bigger cities would be laughable if it weren't so bad for the patient. The majority of firefighters simply don't care enough about EMS to do it correctly. My FTOs often spend a significant amount of time undoing bad habits new medics were taught by the FD during their internships. There are certainly bright spots, but overall I can't say I'm a supporter of FD based EMS.


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## Craig Alan Evans (Jun 26, 2013)

Yeah Kyle from my experience in Hancock Co MS just after Katrina that's exactly what I found out there. My thought is though that it just doesn't have to be that way and that the system works, but you are right, it doesn't work unless the FD has complete but in on EMS and that seems to be rare.


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## Sandog (Jun 26, 2013)

Craig Alan Evans said:


> I am getting the feeling it's not like that around most of the country.



I like what you said in your above post. I think you might find that there are many EMS folks with a chip on their shoulder when it comes to fire/EMS.


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## Craig Alan Evans (Jun 26, 2013)

Maybe if we started referring to it as an EMS based fire system that would help. Based on call volumes that is truly what it is, but I'm thinking the chip is coming from EMS professionals that are not dealing with fire systems that have truly embraced EMS.


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## Bullets (Jun 26, 2013)

i just think responding fire apparatus to a medical call is the dumbest thing ive ever seen. Why not break that crew up and put two ambulances on the road? and responding to every call is dangerous and an unnecessary risk. I know they are going code 3 regardless of the nature, so lets send a multi-ton vehicle across town to respond to something they cant do anything for. 

I think that EMS should be the main emergency response unit. I like how Pittsburgh and New Orleans runs all rescue calls in the cities and my town is moving that way

Ive posted about this topic in the past, and fire and EMS do not share a common mission, structure or focus. EMS has more in common with police then with fire.


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## DesertMedic66 (Jun 26, 2013)

Craig Alan Evans said:


> Maybe if we started referring to it as an EMS based fire system that would help. Based on call volumes that is truly what it is, but I'm thinking the chip is coming from EMS professionals that are not dealing with fire systems that have truly embraced EMS.



The problem with trying to call most areas an EMS based fire system is that EMS is not their main focus. At the station I was an explorer at we only did EMS training twice.... and I was there for 5 years. 

If a fire breaks out the fire department sends many engines out (at least 4). That leaves no fire engines available for EMS calls until a coverage unit gets into the area. Often we hear over the fire dispatch radio "Engine 4 is out of service for medical aids. You can show us second in." But if they get a fire or car accident they are the first ones responding. That is a Fire based EMS response.


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## Craig Alan Evans (Jun 26, 2013)

Bullets said:


> i just think responding fire apparatus to a medical call is the dumbest thing ive ever seen. Why not break that crew up and put two ambulances on the road? and responding to every call is dangerous and an unnecessary risk. I know they are going code 3 regardless of the nature, so lets send a multi-ton vehicle across town to respond to something they cant do anything for.
> 
> I think that EMS should be the main emergency response unit. I like how Pittsburgh and New Orleans runs all rescue calls in the cities and my town is moving that way
> 
> Ive posted about this topic in the past, and fire and EMS do not share a common mission, structure or focus. EMS has more in common with police then with fire.



Public Safety is the responsibility of fire, EMS, and police. Where I'm from fire and EMS mesh together like peaches and cream. They share way more mission objectives than either one with law enforcement. The multi-ton fire vehicles have nearly all the same EMS equipment as the responding ambulances. They are staffed with paramedics that rotate from engine, truck, rescue, and transport unit. Their skills are not dulled because of it. They are enhanced. We always have a minimum of one paramedic on the suppression apparatus, but based on who happens to be working that day we may have 2,3, or even 4 paramedics on an engine. Just last week A shift ran an asthmatic arrest in a 7 year old. The Rescue Engine was first on the scene with three very experienced paramedics. The driver of the engine also rotates to the transport unit as a paramedic officer when needed. Not far behind was the transport unit staffed with two paramedics. The officer of the transport unit also fills in as the driver of the Rescue when needed. It's truly a highly functioning cross trained group of professionals. 5 out of 6 of the responders on scene were experienced paramedics who all worked together as a cohesive team. They were on the scene for less than 5 min and at the nearest pediatric specialty hospital in less than 12 min total with a successful resuscitation and any intervention you can imagine for a case like that performed.  The crew from the engine went with the transport unit to the hospital. While the ambulance crew was  writing their report and restocking their equipment the Engine was responding with a different ambulance to another EMS call and doing it all over again. That's not a waste of money or a dumb thing. It's poetry in motion and top notch service to the public. I'm not sure that kid would have survived in other parts of the country.


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## troymclure (Jun 26, 2013)

Bullets said:


> i just think responding fire apparatus to a medical call is the dumbest thing ive ever seen. Why not break that crew up and put two ambulances on the road? and responding to every call is dangerous and an unnecessary risk. I know they are going code 3 regardless of the nature, so lets send a multi-ton vehicle across town to respond to something they cant do anything for.
> 
> I think that EMS should be the main emergency response unit. I like how Pittsburgh and New Orleans runs all rescue calls in the cities and my town is moving that way
> 
> Ive posted about this topic in the past, and fire and EMS do not share a common mission, structure or focus. EMS has more in common with police then with fire.



of all the calls i went on my ridealongs with the fd, only was run code 3, and then it was canceled after 2 mins.


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## NomadicMedic (Jun 26, 2013)

I've always been concerned about the "dilution of skills" with six paramedics on scene. How many intubations in the field does each paramedic get per year? How many RSIs? How many other invasive procedures does each paramedic do each year? How do you maintain competency?

If your fire service absolutely, positively has to get its fingers in EMS, A tiered system, similar to Seattle fire, is probably best. If you really have to run suppression apparatus to ambulance calls, then put EMTs on fire engines that are able to triage appropriately to BLS transport or request an ALS unit if needed.

I don't see how any paramedic can maintain competency when they "rotate from the engine to the squad to the ambulance." To me, that just sounds like a mishmash of skills. Mediocrity at its best. You might be able to do a lot of things, but none of them really well.

Of course, this is just my opinion. :/


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## IAems (Jun 26, 2013)

Admittedly, this is just a personal opinion, but as long as the majority of the country continues to operate on fire-based systems while the rest of the civilized world moves to increase the scope and training of EMS providers acting in a more healthcare-oriented vs. public safety role, the US will continue to fall behind with regard to EMS.  Furthermore, I was always confused as to why, when I call 9-1-1 for a _medical_ problem, I get a _firefighter_.  I have an immense amount of respect for firefighters; I believe that anyone serving on one of those trucks is a hero, but at what point does it become excessive and even a little ridiculous to ask them to serve in two separate and totally unrelated jobs, one which the only true similarity is the method of response (e.g. Code-3).  I think we need to work to expand the training, scope, and system of emergency _medicine _ and separate EMS from Fire completely.


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## chaz90 (Jun 26, 2013)

Craig Alan Evans said:


> Public Safety is the responsibility of fire, EMS, and police. Where I'm from fire and EMS mesh together like peaches and cream. They share way more mission objectives than either one with law enforcement. The multi-ton fire vehicles have nearly all the same EMS equipment as the responding ambulances. They are staffed with paramedics that rotate from engine, truck, rescue, and transport unit. Their skills are not dulled because of it. They are enhanced. We always have a minimum of one paramedic on the suppression apparatus, but based on who happens to be working that day we may have 2,3, or even 4 paramedics on an engine. Just last week A shift ran an asthmatic arrest in a 7 year old. The Rescue Engine was first on the scene with three very experienced paramedics. The driver of the engine also rotates to the transport unit as a paramedic officer when needed. Not far behind was the transport unit staffed with two paramedics. The officer of the transport unit also fills in as the driver of the Rescue when needed. It's truly a highly functioning cross trained group of professionals. 5 out of 6 of the responders on scene were experienced paramedics who all worked together as a cohesive team. They were on the scene for less than 5 min and at the nearest pediatric specialty hospital in less than 12 min total with a successful resuscitation and any intervention you can imagine for a case like that performed.  The crew from the engine went with the transport unit to the hospital. While the ambulance crew was  writing their report and restocking their equipment the Engine was responding with a different ambulance to another EMS call and doing it all over again. That's not a waste of money or a dumb thing. It's poetry in motion and top notch service to the public. I'm not sure that kid would have survived in other parts of the country.



Firstly, a sincere congratulations on a call that sounds like it was run well with a great outcome. That's great that your service functions well with this kind of system in place. 

Personally though, I've seen similar models backfire completely and become a breeding ground for discontent and lackadaisical medicine. Any backlash you get here isn't directed at your system in particular, but more towards the overall concept of ALS oversaturation. Fact is, having more paramedics has not been proven to improve outcomes in the slightest. There are only so many ALS skills that ever need to be done at once. With just a couple hands to assist, even the most complicated patient can be appropriately managed without 6 paramedics running around the scene.

Skill dilution happens with this many medics on a scene, even if you don't see it that way. At any given time, only one person can run a scene, only one person can pass a tube, and only one person is truly making the patient care decisions. I won't say too much on this, but I'm completely with Bullet regarding his thoughts about running fire apparatus on medical calls. These are highly specialized vehicles, and even with a few bags of medical supplies tossed in remain wholly unnecessary on the vast majority of EMS calls. I really am glad this model works out where you are, but it's a complete disaster in most of the country.


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## Arovetli (Jun 26, 2013)

EMS and police closely overlap in the "community caretaker" role, perhaps moreso than the traditional fire service role.


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## abckidsmom (Jun 26, 2013)

chaz90 said:


> Skill dilution happens with this many medics on a scene, even if you don't see it that way. At any given time, only one person can run a scene, only one person can pass a tube, and only one person is truly making the patient care decisions. I won't say too much on this, but I'm completely with Bullet regarding his thoughts about running fire apparatus on medical calls. These are highly specialized vehicles, and even with a few bags of medical supplies tossed in remain wholly unnecessary on the vast majority of EMS calls. I really am glad this model works out where you are, but it's a complete disaster in most of the country.



First I will say that I don't work in Craig's system, although I do have a lot of experience working with several providers from his department. Then I will say that I do work in a rural fire based EMS system. 

Now, about the skill dilution:

I believe that in a system like Craig's, the intense oversight and pressure to perform highly keeps everyone performing with the precision that is needed. From my outside look at the system, the laissez faire freedom of the medic in the ambulance doesn't exist. There is no cowboy time- everyone is always in the presence of 1-2 experienced medics on scenes, which leads to more compliance with what can be seen as the standard of excellence. 

Compared with my rural fire-based EMS system in which the only time I see another medic is in a meeting or at the hospital, I'm totally on my own with limited feedback and no help. 

You tell me whether you want skill dilution or wild Wild West.  

I think somewhere in the middle is a budget-possible medium. Our system literally can't afford another medic, whereas theirs is swimming in them. 

Locality funded EMS is always going to have some drawbacks in that arena. 

I do know for sure, that in a similar situation as that asthmatic arrest Craig tells about, the patient would have died. Even though I consider myself to be a decent medic, there's no way I could get the work of 5 experienced medics done in time to catch that little girl before death ran off with her. 

This is a function of system design, funding and leadership structure, but it also illustrates that in a system with extremely limited resources, having a medic on the engine only costs 10-15% more and can result in dramatically improved outcomes in critical cases.


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## Dwindlin (Jun 26, 2013)

I worked in both Fire based and EMS only systems.  I worked with just as many :censored::censored::censored::censored:ty providers in EMS only as I did in the Fire services.  The only real difference was that the fire based guys were more fun to be around.


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## Cleric (Jun 27, 2013)

I _really, really_ hate Fire/EMS mixing. Very few other modernized nations do things that way. It's really just designed to cut corners and hire the least amount of people possible, to the detriment of the people. Paramedic training in America is a joke compared to most other first-world countries, specifically to allow more Firefighters to become "Paramedics." What ends up happening, is that you have people who are truly passionate about Fire Science, that only take Medic classes as fluff to get hired and give terrible medical care. Conversely, you get people like me, who are truly passionate about EMS, but *have* to take fire science classes and become "FF/EMTs" or "FF/Paramedics," and may not take fire fighting as seriously as someone who is actually interested. 

In my opinion, Fire should stay Fire, and EMS should stay EMS. Not to say they can't be close. I'm all for Medic Rigs and EMT Cars being stationed at Fire Stations, with the EMS staff living beside Fire staff, but I'd rather have 2 really fantastic Medics who love their jobs than 6 who see EMS as "the stuff we do between fires." In fact, I'd wouldn't even mind smaller cities with firefighters who are also EMTs in the engines to assist on critical ALS calls, and for BLS calls, with private ambulances doing transport. As it is now, the EMT-B qualification seems to be designed for firefighters and private ambulance drivers. I often feel like the only person who wants solely to be an EMT to work towards being a paramedic.


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## Craig Alan Evans (Jun 27, 2013)

DEmedic said:


> I've always been concerned about the "dilution of skills" with six paramedics on scene. How many intubations in the field does each paramedic get per year? How many RSIs? How many other invasive procedures does each paramedic do each year? How do you maintain competency?
> 
> If your fire service absolutely, positively has to get its fingers in EMS, A tiered system, similar to Seattle fire, is probably best. If you really have to run suppression apparatus to ambulance calls, then put EMTs on fire engines that are able to triage appropriately to BLS transport or request an ALS unit if needed.
> 
> ...



I can tell you that we do struggle with this, but we are a small department and are able to overcome this pretty well I think. We send every medic to the OR annually to perform intubations, the EMS lieutenants monitor the issue on a daily basis and do their best to assure skill rotation. Any noted deficits are made up through EMS drills. We have a physician led CME program that is continually improving the clinical judgement skills and overall education of all the EMS providers. In short, we take EMS very seriously and it shows. With that being said I can tell you there are providers that are naturally good at one aspect of the job than others. Some are better firefighters, some are better EMS providers, some are better at technical rescue. We all have are specialties. We all have our comfort zones, and our niches where we shine, but we are small enough that we know each other very well so during a critical incident we all know who to look to for any given need. We continually learn from each other and we do our best to excel in every area. It's not a perfect system by any means, but over the years I can think of several situations where having the cross trained personnel has been a direct benefit to a situation and very few situations where it has been a problem.


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## Sandog (Jun 27, 2013)

In my area, the fire staff is sent as adjunct to the EMS rig. Our EMS is handled by Rural Metro and AMR. The fire personnel usually ascertain if the scene is safe before the EMS enter the scene, and provide assistance to the EMS as needed. Overkill? Maybe, but I see very few reports of EMS injuries while on duty. It is a symbiotic relationship and should not be viewed as turf invasion.


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## Wheel (Jun 27, 2013)

Craig Alan Evans said:


> I can tell you that we do struggle with this, but we are a small department and are able to overcome this pretty well I think. We send every medic to the OR annually to perform intubations, the EMS lieutenants monitor the issue on a daily basis and do their best to assure skill rotation. Any noted deficits are made up through EMS drills. We have a physician led CME program that is continually improving the clinical judgement skills and overall education of all the EMS providers. In short, we take EMS very seriously and it shows. With that being said I can tell you there are providers that are naturally good at one aspect of the job than others. Some are better firefighters, some are better EMS providers, some are better at technical rescue. We all have are specialties. We all have our comfort zones, and our niches where we shine, but we are small enough that we know each other very well so during a critical incident we all know who to look to for any given need. We continually learn from each other and we do our best to excel in every area. It's not a perfect system by any means, but over the years I can think of several situations where having the cross trained personnel has been a direct benefit to a situation and very few situations where it has been a problem.



The sad thing is that you're in the minority in this. Your service is one of only a handful that I've ever heard of rotating through the OR for tubes, including ems only organizations. I think ats great, and you should keep it up, but don't mistake your motivation for quality ems as something that's true of all agencies, fire based or otherwise really.


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## Wes (Jun 27, 2013)

My experience with fire-based EMS is that it's usually the smaller suburban departments that have embraced EMS excellence.  The large city fire departments are too heavily unionized and set in their ways to truly embrace excellent patient care.


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## Craig Alan Evans (Jun 27, 2013)

Wheel said:


> The sad thing is that you're in the minority in this. Your service is one of only a handful that I've ever heard of rotating through the OR for tubes, including ems only organizations. I think ats great, and you should keep it up, but don't mistake your motivation for quality ems as something that's true of all agencies, fire based or otherwise really.



So I am learning.


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## Craig Alan Evans (Jun 27, 2013)

Wes said:


> My experience with fire-based EMS is that it's usually the smaller suburban departments that have embraced EMS excellence.  The large city fire departments are too heavily unionized and set in their ways to truly embrace excellent patient care.



I am seeing this as well. We are a small department with two stations and about 70 employees, of which about 40 are paramedics. We are located in the suburbs of Washington DC in Northern Virginia. I feel we are one of the most progressive and innovative EMS systems in the state of Virginia. We make a point of always being on the cutting edge of EMS. It's one of the reasons I started working there.  I can't say enough good things about the administration and the people I work with. If you find a job you love you don't have to work a day in your life. My point is that fire based EMS can work to the betterment of both the service to the public and the budget of the municipality, but there has to be a commitment from the top down to make it happen. I think we have and continue to be the example in this area. I didn't realize when I asked this simple question that I would receive so much negative feedback on fire based EMS, or that where I worked was such an exception. It's all I've ever known so I am clearly biased, but I see and understand everyone's points against it. I'm just not seeing those points play out in my area which is a good thing.


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## abckidsmom (Jun 27, 2013)

Craig Alan Evans said:


> So I am learning.



As EMS-based fire depts go, yours is exceptional.


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## ExpatMedic0 (Jun 27, 2013)

I have absolutely no idea why anyone would consider a fire/EMS system a good thing for EMS or for health care. I think the topic has been beat to death on this forum but I will entertain the idea a little. The fire service is great, in fact to great... They are so good at there job they have put themselves out of business. Fire prevention and technology has made them almost useless in the majority of areas concerning fire suppression. As a result they exploit EMS to justify there existence, gain revenue, and protect there jobs. Many paid suburban fire departments would be screwed if they where eliminated %100 from EMS response (as they should be). Do you think most paid american fire departments could maintain current staffing if EMS was eliminated from there job duties? Fire suppression and Rescue is a fraction of what they are called out to in many areas.

- Many fire department exploit EMS to increase revenue.
-Many fire departments exploit EMS to help justify there existences (sending an entire useless engine crew on every single medical call in tier response systems)
- Many fire departments advocate for vocational and paramilitary style training of personal NOT higher education and advancing EMS as a profession
- Many fire departments fail to advocate for EMS as its own profession and as a healthcare entity. When was the last time the IAFF advocated for increased education and training of EMS personal, such as degree's? 
- Many firemen don't care or want to do EMS but have no choice. Many get Paramedic certificates not because they want to be Paramedics, but to help them get a job on the department or get a promotion. Is that who you want working your on your wife or your mother?
-Honestly the list could go on and on

I say all this based on my 10 years of experience in multiple systems working along side dual role fire based providers.


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## Craig Alan Evans (Jun 27, 2013)

ExpatMedic0 said:


> I have absolutely no idea why anyone would consider a fire/EMS system a good thing for EMS or for health care. I think the topic has been beat to death on this forum but I will entertain the idea a little. The fire service is great, in fact to great... They are so good at there job they have put themselves out of business. Fire prevention and technology has made them almost useless in the majority of areas concerning fire suppression. As a result they exploit EMS to justify there existence, gain revenue, and protect there jobs. Many paid suburban fire departments would be screwed if they where eliminated %100 from EMS response (as they should be). Do you think most paid american fire departments could maintain current staffing if EMS was eliminated from there job duties? Fire suppression and Rescue is a fraction of what they are called out to in many areas.
> 
> - Many fire department exploit EMS to increase revenue. single medical call in tier response systems)
> - Many fire departments advocate for vocational and paramilitary style training of personal NOT higher education and advancing EMS as a profession
> ...



For every negative comment about fire departments I can point to a department that is the exact opposite. I highly trained ALS engine is anything but useless and I can tell story after story of lives saved by just such a crew. Go every negative comment about firemen becoming medics for all the wrong reasons I can point to 10 guys and girls that are an example of who you would want to come take care of your family. There are two sides to every coin. I understand your point of view and I have seen the same. I would just be careful about blanket statements. The IAFF is not your local fire department. They never claim to be. The IAFF does sponsor and EMS conference. The Dominick F. Barbera EMS Conference explores all aspects of fire based emergency medical services. From the tenets of emergency response system design and operations, to medical direction and privatization, and from quality assessment and data collection to billing for transport, this Conference covers the most relevant topics affecting fire service-based EMS systems. Not all fire departments are created equal, and not all fire departments view EMS the same.  Every time you use the word exploit I would exchange it with the word embrace. Where I am from the best paramedics work for the fire department. There is no third service EMS except for non-emergency for profit companies that usually hire the medics that the fire department lets go because they don't pass our ALS internship. It's been great seeing how things operate in different parts of the country and world. I love this forum. We argue and bicker but in reality if you are on this site then you are an exceptional provider because you pass the first and most important test...you care.


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## 46Young (Jun 27, 2013)

If suppression units are largely idle, it only makes sense to do EMS, and not have to put out extra ambulances. The suppression units need to already be in place to achieve staffing and deployment objectives. It's not as simple as determining deployment based in call volume alone. Geographical distances need to be addressed as well. Cross-training personnel also saves on OT costs.

It's unreasonable to argue against ALS first response by saying that the fire department should put out more ambulances instead. Most non-fire systems put out the bare minimum of units needed to cover the usual call volume, let alone any call surges or significant incidents. This is why we have mutual aid. This is why we have systems that use SSM. This is why high call volume in EMS causes burnout - not enough ambulances in single role services. 

Also, dual role systems offer many different job functions than just EMS transport. Most single role EMS employees are stuck doing EMS transport for their whole career. We have the opportunity to do TROT, Hazmat, Fire Inspections, Peer Fitness Training, EMS training, Fire Academy Instructor, Safety Officer, and many more positions. There's many promotional opportunities to be had, unlike in EMS. Fire based EMS is better for one's career, and better for one's longevity in EMS. The average time to burnout for a single role EMS worker is 7-10 years. Within that time period, there's typically a lot of movement from employer to employer. Most people in the fire service stay put until retirement.


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## ExpatMedic0 (Jun 27, 2013)

Would either of you firemen care to elaborate on how the fire service is currently helping EMS progress? Or the last time the fire service advocated for increased higher education standards for providers? How do you suppose the fire service will deal with the future of EMS in regards to mandatory college degrees in EMS with states like Oregon, or Critical Care Transport, HEMS, and concepts like Community Paramedicine?


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## 46Young (Jun 27, 2013)

ExpatMedic0 said:


> Would either of you firemen care to elaborate on how the fire service is currently helping EMS progress? Or the time the fire service advocated for increased higher education standards for providers? How do you suppose the fire service will deal with the future of EMS in regards to mandatory college degrees in EMS with states like Oregon, or Critical Care Transport, HEMS, and concepts like Community Paramedicine?



I don't know, why don't you ask the plethora of EMS third service, hospital based, and private EMS systems that have a GED as a minimum stanard for hiring, and value field experience over education. These employers far outnumber the number of fire deparments, and single role Ems positions far outnumber those in the fire service. What have they done for EMS lately? If anything, these single role EMS providers stand to benefit from ample supply due to low barrier of entry, and low pay. 

Most places I've seen, to apply, just ask for a GED, no felonies, 21y/o, valid cert, good driving hx, and perhaps experence. 

If anything, the average firemedic in a mid-size to larfe dept is more likely to have a degree than a medic in a single role system. Fire departments value degrees for promotion, so more of us have degrees for that purpose. Single role EMS - "promotion?" What's that?


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## Arovetli (Jun 27, 2013)

ExpatMedic0 said:


> Would either of you firemen care to elaborate on how the fire service is currently helping EMS progress? Or the last time the fire service advocated for increased higher education standards for providers? How do you suppose the fire service will deal with the future of EMS in regards to mandatory college degrees in EMS with states like Oregon, or Critical Care Transport, HEMS, and concepts like Community Paramedicine?



I have a feeling this was a goal of AEMT, to keep a certificate level "Advanced" provider so fire can still paint that A word on the side. of their engine.

By and large I don't think fire is holding EMS back as much as insurance companies or politicians who use the emergency systems for dumping grounds have held it back. Fire probably helps a good bit with PR, maybe not actual patient outcomes, but definitely with manpower.

The reality of the whole issue isn't fire vs. ambulance, its the reality that in a community there are a zillion people who just don't give a damn about being responsible citizens, another zillion who just need to go to the damn doctor, and five people who will have heart attacks, strokes, and get into terrible accidents. Making it all work is a necessary disaster.


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## abckidsmom (Jun 27, 2013)

Arovetli said:


> I have a feeling this was a goal of AEMT, to keep a certificate level "Advanced" provider so fire can still paint that A word on the side. of their engine.
> .



I disagree. I think it's there to appease the people who want to do the flashy part of doing EMS, but don't want to commit to being a paramedic.


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## Arovetli (Jun 27, 2013)

abckidsmom said:


> I disagree. I think it's there to appease the people who want to do the flashy part of doing EMS, but don't want to commit to being a paramedic.



Well then I think we do agree. 

If the paramedic level is to advance and become more of a healthcare profession, it has to detach from fire who really just need OJT or trade school certificates and can say they provide advanced level care. Nothing wrong with that btw, seems mutually beneficial.


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## abckidsmom (Jun 27, 2013)

Arovetli said:


> Well then I think we do agree.
> 
> If the paramedic level is to advance and become more of a healthcare profession, it has to detach from fire who really just need OJT or trade school certificates and can say they provide advanced level care. Nothing wrong with that btw, seems mutually beneficial.



I was mostly talking about the kind of volunteers who balk at minimum standards and say "but I have a job- this is a hobby!" And then drag the whole profession down with them. 

But it's been a long day.


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## Akulahawk (Jun 27, 2013)

Fire Departments _can_ provide good EMS care. Unfortunately they often see EMS as something that helps justify their existence because they now respond to few fires, or as something they can augment their budgets with. I've met quite a few Firefighters that did EMT or Paramedic just so they could be a Firefighter, and wouldn't consider EMS otherwise. 

IMHO, _transport_ EMS should be divorced from Fire Departments. Of course, Paramedic shouldn't be a terminal job. There should be some significant ability to change jobs within that career. If Fire is to provide some EMS services, I think they should be, at most, AEMT so that the transport provider (who is Paramedic) has trained hands available to do certain tasks but is clearly the leader for that incident. 

EMS (as a separate service) should also have the opportunity to get more non-traditional EMS skills. EMS should be "allowed" to perform technical rescues and the like... but Fire won't typically like that simply because they'll see it as mission creep into many of their current roles.


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## 46Young (Jun 27, 2013)

Arovetli said:


> I have a feeling this was a goal of AEMT, to keep a certificate level "Advanced" provider so fire can still paint that A word on the side. of their engine.



The goal of AEMT was to deliver some form of ALS to rural, underserved areas that have a poor tax base. It's really difficult to get volunteers to go through a whole paramedic program, just to volunteer with that cert. It's too much of a time investment for most people to agree to, without a significant financial reward. 

I live in Virginia. This state is keeping the EMT-I and the EMT-E even though the NR is moving away from those certs. Otherwise, most of the regions outside of the "Golden Crescent" (NOVA, down I-95, Richmond, Williamsburg, out to VA Beach) wouldn't have anything more than BLS coverage whatsoever. Keeping the EMT-I/EMT-E is being done as a matter of necessity. It's not a fire thing by any means.


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## Wes (Jun 27, 2013)

Dana, respectfully, there are some volunteer paramedic providers who take this seriously.


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## Arovetli (Jun 27, 2013)

46Young said:


> The goal of AEMT was to deliver some form of ALS to rural, underserved areas that have a poor tax base. It's really difficult to get volunteers to go through a whole paramedic program, just to volunteer with that cert. It's too much of a time investment for most people to agree to, without a significant financial reward.
> 
> I live in Virginia. This state is keeping the EMT-I and the EMT-E even though the NR is moving away from those certs. Otherwise, most of the regions outside of the "Golden Crescent" (NOVA, down I-95, Richmond, Williamsburg, out to VA Beach) wouldn't have anything more than BLS coverage whatsoever. Keeping the EMT-I/EMT-E is being done as a matter of necessity. It's not a fire thing by any means.



Yes.

The concept is an advanced level certificate to extend ALS to certain segments while allowing (hopefully) paramedic to continue upward.

It has applications to many systems in need of prehospital care.


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## 46Young (Jun 27, 2013)

Arovetli said:


> Well then I think we do agree.
> 
> If the paramedic level is to advance and become more of a healthcare profession, it has to detach from fire who really just need OJT or trade school certificates and can say they provide advanced level care. Nothing wrong with that btw, seems mutually beneficial.



Fire isn't the main culprit in allowing a trade cert for employment. You can include every private company outside of Oregon, the vast majority of hospital based employers, and nearly all third service employers as well. These organizations easily outnumber the fire service in sheer number, as well as the number of employed paramedics. Let's assign the blame more appropriately, please. 

I would have to try really hard to find a non-fire based EMS organization that requires a degree to be hired as a medic, or one that gives an incentive or hiring preference to a degreed medic. For every one you can show me, I can show dozens that only require the bare minimum standards. They're really easy to find.


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## Arovetli (Jun 27, 2013)

46Young said:


> Fire isn't the main culprit in allowing a trade cert for employment. You can include every private company outside of Oregon, the vast majority of hospital based employers, and nearly all third service employers as well. These organizations easily outnumber the fire service in sheer number, as well as the number of employed paramedics. Let's assign the blame more appropriately, please.
> 
> I would have to try really hard to find a non-fire based EMS organization that requires a degree to be hired as a medic, or one that gives an incentive or hiring preference to a degreed medic. For every one you can show me, I can show dozens that only require the bare minimum standards. They're really easy to find.



Im pretty sure I didn't assign blame to anyone. If you read what I wrote, I said 'a' goal. I only used the example of fire.......because that is what the thread is titled.

There has to be some disentanglement for even the possibility of paramedics to advance.
From fire.
From routine ambulance work.
From babymomma & co.
From foolish politics.
The list goes on.


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## abckidsmom (Jun 27, 2013)

Wes said:


> Dana, respectfully, there are some volunteer paramedic providers who take this seriously.



For sure, which is why I was only referring to the bad ones. 

I was one of them, and now I work hard to develop the volunteer base in my system, teaching and mentoring, coaching and cheering. Dragging them along. Which is why I've heard all of the arguments, and had the reward of seeing a few totally succeed.


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## Wes (Jun 27, 2013)

We should compare notes sometime.  I've been very active in developing volunteer programs at several services.


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## sir.shocksalot (Jun 28, 2013)

The longer I do this job the less evil the FD seems. I think we can all agree that we'd like to see EMS evolve into something more analogous to the UK, Australia, and NZ. They have the advantage of national standards, self-governance, and are generally very centralized in that all the systems operate pretty much the same. In the US the chief culprit is that we have a billion different ways EMS is run and almost as many different ways EMS is trained. Even NREMT doesn't adequately represent any sort of average of provider skill, knowledge or scope of practice across the the US. EMS is an amorphous blob of a profession.

This blobishness really gets highlighted when we start talking fire-based vs third service vs hospital-based vs private for profit vs ad nauseam. To say fire departments shouldn't do EMS holds no more ground over saying privates shouldn't do EMS. I have seen horrific examples of all these systems. I've seen great examples of all these systems. It sounds like the OP has a fire-based service that does really well for them and really embraces EMS in its current form. Why try to fix a system that works better than many others? Now if we want to point fingers at the IAFF for holding EMS back we equally have to point our fingers at the multi-state private agencies who are also not lining up to get highly educated, and inevitably expensive, paramedics. Both want short training times for roughly the same reason. If we want EMS to grow then we need to get ourselves together and make it happen, not our employers.

We all need to stop the us vs them we have in EMS. We are very shallow and insecure as a profession in that we constantly judge each other based on the patch on our shoulder not our merits as an individual. Working at a certain place doesn't mystically make you a better or worse provider, nor the vehicle you arrive on scene with. 

My only criticism of the OPs system is the number of paramedics. I think any more than two paramedics per patient and you really start running into skill dilution. Not just with intubation but patient interview, scene management, physical exam etc. I think two paramedics is ideal, since with critical patients one paramedic can be overwhelmed and a second paramedic can be helpful to bounce ideas off of and as a check and balance to your work as one person mentioned. But kudos for how well your department has embraced EMS and also keeping your cool amongst a lot of FD criticism. Actually to everyone that has posted for being remarkably civil.


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## RocketMedic (Jun 28, 2013)

Wes said:


> Dana, respectfully, there are some volunteer paramedic providers who take this seriously.



In Far West Texas?


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## Wes (Jun 28, 2013)

I can only speak for me and the places I've worked.  For me, it's been Austin and the surrounding Hill Country along with the north Houston area. (HCESD-1/HCEC and CCEMS).


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## Craig Alan Evans (Jun 28, 2013)

sir.shocksalot said:


> The longer I do this job the less evil the FD seems. I think we can all agree that we'd like to see EMS evolve into something more analogous to the UK, Australia, and NZ. They have the advantage of national standards, self-governance, and are generally very centralized in that all the systems operate pretty much the same. In the US the chief culprit is that we have a billion different ways EMS is run and almost as many different ways EMS is trained. Even NREMT doesn't adequately represent any sort of average of provider skill, knowledge or scope of practice across the the US. EMS is an amorphous blob of a profession.
> 
> This blobishness really gets highlighted when we start talking fire-based vs third service vs hospital-based vs private for profit vs ad nauseam. To say fire departments shouldn't do EMS holds no more ground over saying privates shouldn't do EMS. I have seen horrific examples of all these systems. I've seen great examples of all these systems. It sounds like the OP has a fire-based service that does really well for them and really embraces EMS in its current form. Why try to fix a system that works better than many others? Now if we want to point fingers at the IAFF for holding EMS back we equally have to point our fingers at the multi-state private agencies who are also not lining up to get highly educated, and inevitably expensive, paramedics. Both want short training times for roughly the same reason. If we want EMS to grow then we need to get ourselves together and make it happen, not our employers.
> 
> ...



Well said! Like I've said before we all argue with each other, but we really are all here for the same reason, to better ourselves and the systems we work in by sharing and learning together.


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## Christopher (Jun 28, 2013)

Wes said:


> We should compare notes sometime.  I've been very active in developing volunteer programs at several services.



Whenever folks decry fire departments doing EMS or volunteers doing EMS, I kindly point to where I work and ask that they try and meet our standard. Few departments of any type do.

Gee I wonder why that is?! Ohhh, probably because the type of the department doesn't dictate the standards you should hold for yourself.


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## Wes (Jun 28, 2013)

As for volunteers, I've found that there are two easy ways to make sure there's a similar level of quality.

First, if you're running a combination paid/volunteer department, if possible, volunteers supplement staffing, not take away from it.  For example, at several of the services I've been involved with, volunteers helped as third crew members on the ambulance and helped with special events.

Second, if your volunteers are counting towards minimum staffing (Here in Texas, we have to have two certified providers on the ambulance.), then they go through the same FTO process and are held to the same standards, regardless of paycheck.


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## rockyfortune (Jun 28, 2013)

Not sure what is better..but where i am located the medics are out busting their butts every damn minute..its a very busy metro area and while all the firefighters are FF/EMT the paramedics hired by the city are the ones who really bust it...most FF rather be FF than FF/EMTs so they try to avoid riding the squad as much as possible.


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## Christopher (Jun 28, 2013)

Wes said:


> As for volunteers, I've found that there are two easy ways to make sure there's a similar level of quality.
> 
> First, if you're running a combination paid/volunteer department, if possible, volunteers supplement staffing, not take away from it.  For example, at several of the services I've been involved with, volunteers helped as third crew members on the ambulance and helped with special events.
> 
> Second, if your volunteers are counting towards minimum staffing (Here in Texas, we have to have two certified providers on the ambulance.), then they go through the same FTO process and are held to the same standards, regardless of paycheck.



Exactly, we use vollies for both 3rd person and for standard crew staffing. Our released volunteers are no different than career providers. Same standards, which has helped our vollies secure jobs that would otherwise be unobtainable (or get them into PA/MD programs with ease).


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## medicsb (Jun 28, 2013)

Though, I generally think that EMS should be separate from Fire and that an engines' only role is first response and doesn't require any training beyond that of an EMT, I would be ok with EMS being merged with FDs under certain circumstances.  Something that I think is REALLY important is that the name reflect what the department actually does.  Although DC FEMS has its problems at least they changed their name.

If a department wants to do EMS, their name should reflect that the overwhelming majority of their work will be (or is) EMS.  No more Philadelphia Fire Department or Fire Department of New York... How about Philadelphia Emergency Services Department (with a division of Fire and Division of EMS), and EMS and Fire Department of NY?  

Of the Fire-medics here, how many of your departments have a name that reflect EMS  being on equal footing with fire suppression?  (I'll pre-emptively argue that "Rescue" does not signify equal footing as "rescue" is pretty specific to variations of extrication and not-so-much EMS.)


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## Christopher (Jun 28, 2013)

medicsb said:


> Of the Fire-medics here, how many of your departments have a name that reflect EMS  being on equal footing with fire suppression?  (I'll pre-emptively argue that "Rescue" does not signify equal footing as "rescue" is pretty specific to variations of extrication and not-so-much EMS.)



'round these parts you are known as a "Rescue Squad" when you do EMS. Hence it has stuck with "Leland Fire/Rescue". If we could go back to the 1950's and change the vernacular, we probably would.


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## medicsb (Jun 28, 2013)

Christopher said:


> 'round these parts you are known as a "Rescue Squad" when you do EMS. Hence it has stuck with "Leland Fire/Rescue". If we could go back to the 1950's and change the vernacular, we probably would.


So, let archaic terminology define you?  Especially if the term was adopted in the days before modern EMS, when they just put a patient on a stretcher and only drove them to the hospital?  It's even more insulting in that context.


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## Christopher (Jun 28, 2013)

medicsb said:


> So, let archaic terminology define you?  Especially if the term was adopted in the days before modern EMS, when they just put a patient on a stretcher and only drove them to the hospital?  It's even more insulting in that context.



Shouldn't leave out that they cleaned used bandages in boiling water 'round these parts as well. Is it seriously that insulting to be called a "rescue squad"?

The only time I can remember somebody using it derisively was an interventional cardiologist bemused by our posterior STEMI notification (he took notice when we pointed out the correct IRA for him from the ECG; "just how many hours of training do you boys on the rescue squad get now?").

Perhaps I'm just less sensitive to the subject, for example, every soda is a "coke" here; no great offense there.

...or perhaps I realize it is a monumental P.I.T.A. to change the name of a 501(c)(3); not to mention a business expense not worth making.


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## medicsb (Jun 28, 2013)

I know, it is a little nit-picky on my part.  Though, there is an inherent disconnect when one claims that an organization takes EMS so seriously yet they couldn't even be identified as an EMS organization by name.  I mean, if EMS is so important, I would think it would be worth the time and trouble to change the name to reflect that.  

I don't mean to pick on you or your service, specifically.  But, this is just something I think is problematic across the board with FDs.


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## ExpatMedic0 (Jun 28, 2013)

I worked near Portland Oregon for 5 years. You wanna know how our system worked, something like this.

Patient calls 911,
Fire department gets there first with an entire engine. The engine is staffed with 1 Paramedic and the rest are EMT's. All the FD's EMT's stand in a circle with their arms crossed or hands in their pockets. Sometimes the LT will hold a clip board to look important. Turns out Grandma is having some breathing trouble today. In the middle of the circle is the patient and FD Paramedic as he/she "assess" the patient.

1-2 minutes of time goes by and AMR arrives. AMR has to break through the circle of firemen observing the call, speak to the FD Paramedic who has been on scene maybe 1 or 2 minutes and has not even had time to complete an assessment let alone make a treatment. AMR takes over care, the FD is released from the call and heads back to the station. 

At the end of the day the FD gets a run report which documents there services and this all gets recorded. At the end of the year the FD can show they go on 10 calls a day... but really %99 of the time they do nothing or are not needed. The entire engine crew did nothing except 1 drove the fire truck and 1 initiated patient care for a minute or two. The staffing for personal and equipment in a system like this is absolutely absurd. This is the way it works in the majority of Oregon and much of Washington.


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## Christopher (Jun 28, 2013)

medicsb said:


> I know, it is a little nit-picky on my part.  Though, there is an inherent disconnect when one claims that an organization takes EMS so seriously yet they couldn't even be identified as an EMS organization by name.  I mean, if EMS is so important, I would think it would be worth the time and trouble to change the name to reflect that.
> 
> I don't mean to pick on you or your service, specifically.  But, this is just something I think is problematic across the board with FDs.



Perhaps if the _prima donna paragods*_ at our service made a big enough stink about it we'd change our name to reflect our culture as Rescue / Fire rather than Fire / Rescue.

But then the OCD crowd would argue F comes before R in the alphabet, and it really doesn't roll off the tongue. The super-OCD crowd would also recognize that when our departments merged it was stations 5 and 22, which provided fire and EMS respectively. Reversing the order would not jive with station numbers and we'd go crazy with lifetime honorary members getting angry.

At some point somebody would raise their hand and ask why we're not Fire / EMS or EMS / Fire / Rescue...but then we'd end up like my Industrial Fire Brigade's patch: "GE/GEH/GNF Wilmington, NC Emergency Response Organization", and that also doesn't roll off the tongue by any stretch of the imagination.

* I am one of them--in fact my partner and I were rated the biggest ones in NC by OEMS--and I really don't see what we gain by changing our name just to let people know we are super cereal about EMS. I think our actions speak for themselves.


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## EpiEMS (Jun 28, 2013)

If FD-based EMS services that don't do transport switched to having fly-cars with one or two personnel (EMT, Medic, EMT/EMT or Medic/EMT) responding prior to transporting EMS response, it'd be a heck of a cost savings. One region in Washington State has done so: http://www.king5.com/news/local/New...om-non-emergency-medical-calls-143465176.html


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## EpiEMS (Jun 28, 2013)

medicsb said:


> Though, I generally think that EMS should be separate from Fire and that an engines' only role is first response and doesn't require any training beyond that of an EMT, I would be ok with EMS being merged with FDs under certain circumstances.  Something that I think is REALLY important is that the name reflect what the department actually does.  Although DC FEMS has its problems at least they changed their name.



The report from KPMG and Pomax (a major management consultancy and a public safety consultancy) on the proposed Toronto FD and Toronto EMS merger came down pretty conclusively and said: 

"•Consolidation appears to be most effective when it is implemented in jurisdictions with a mature fire service and an emerging paramedic service or no paramedic service.
•There is little evidence to suggest that a consolidated fire and paramedic service is financially, operationally, or organizationally advantageous in the circumstance where the two organizations are competent."

I think this is something that is pretty obvious when we look at most FD/EMS systems in major cities (like the FDNY and NYC EMS merger that resulted in such deterioration of quality).


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## Carlos Danger (Jun 28, 2013)

ExpatMedic0 said:


> I worked near Portland Oregon for 5 years. You wanna know how our system worked, something like this.
> 
> Patient calls 911,
> Fire department gets there first with an entire engine. The engine is staffed with 1 Paramedic and the rest are EMT's. All the FD's EMT's stand in a circle with their arms crossed or hands in their pockets. Sometimes the LT will hold a clip board to look important. Turns out Grandma is having some breathing trouble today. In the middle of the circle is the patient and FD Paramedic as he/she "assess" the patient.
> ...



And this pretty well summarizes the overall problem with FD first response.

It seems that any way you slice the pie, it would be far more economical for those (FD) personnel to be responding on an ambulance and handling the call themselves.

Or just staying in quarters.....


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## Tigger (Jun 28, 2013)

Both places I work have fire dispatched with us. We are in control of scenes at both locations too. 

One department sends a pickup with two guys and BLS equipment out with us. This is generally helpful, makes getting the patient to the ambulance (this is a pretty rural area) much easier. I also have someone writing for me, taking, vitals, and possibly getting a history from family/bystanders. This leaves my medic and I free to focus on assessment and immediate interventions. The FFs for the most part are very helpful and are quick to ask what they can do to help. If they can't be useful, they leave. This FD staffs five FFs a shift, so there are still three FFs on the engine for fire coverage/second calls.

The other place sends and engine out with is. Due to staffing issues the engine rarely has more than 2 FFs on it. 2 is a good number of extra hands, but it seems wasteful to drive the engine everywhere. We also get the shift captain in his pickup, he could not show up to most calls and it would be fine. I'm not sure why the officer has to run every call district wide, seems like the opposite of a promotion. 

The FDs argument for sending the engine is that if they drop another call while returning they need to be able to respond right away with the engine. If they could staff a crew of three one could stay behind with the engine and meet them on scene. 

Many calls we could probably take by ourselves. A crew of three on the ambulance would be ideal, but it's going to be tough to break that paradigm.


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## ExpatMedic0 (Jun 29, 2013)

Halothane said:


> And this pretty well summarizes the overall problem with FD first response.
> 
> It seems that any way you slice the pie, it would be far more economical for those (FD) personnel to be responding on an ambulance and handling the call themselves.
> 
> Or just staying in quarters.....



The fully staffed engine tier response systems are so ridiculous. I can't believe the idiots in charge allow that to continue. That whole system in Oregon and Washington left a bad taste in my mouth. Also the FD's fought tooth and nail when the Oregon Paramedic degree requirement was made. Most of the firemen I spoke with did not want to do EMS, they wanted to be firemen. With that said, I know not every system is like this. I am not saying it is impossible for an FD  to do transport ALS EMS. 

*There are pro's. *The fire service has a very strong arm to flex with things like the IAFF and also there local municipality/civil service integration.  If used in our favor this power could help EMS tremendously! FD pay and benefits are normally much better than private EMS services. The happiness of employee's is also much greater with the FD. In addition to that, the fire service often has higher physical fitness and uniform standards, reflecting a higher degree of professionalism. In addition the minimum physical fitness standards ensure a healthier physically fit employees that are also physically capable of more in any emergency situation. The FD also has room for promotion. Not to mention they are one of the very few places a pension still exists instead of a worthless 401k. 

Furthermore, I like many aspects of the fire service. My uncle, my grandfather, and my great grandfather where all firemen. My friends in the fire service often invite me over to the station to have a meal with them or join in on EMS training sometimes. The comradery the fire service has is far superior to that of EMS and reminds me of a more civilized version of what I experienced while in the Army, which I miss at times. 
Another example. Although Medic 1 is a highly controversial system in Seattle, there Paramedic training is over 3000 hours (over 3 times the national average) They also boast some of the nations best ALS pre-hospital statistics.

*And there are Con's*
As I said earlier there are many cons to a fire system. I have listed many of them before. One big one is that the fire service does exploit EMS to justify its existence, however as someone else mentioned the word "exploit" could certainly be turned around to "embrace", that is up to the local department at hand. From what I have seen a minority of departments "embrace" EMS and the majority seem to "exploit" EMS like the example I gave above. That is just the way it is.

*Hypothetically it could work, and I would support the following fire based system*
If the fire service made it a single role transport department (like FDNY and SFFD for example, but also the following) requiring transport paramedics to be firemen is completely out of the question. If they want to volunteer transfer to suppression, fine, that is a whole other career. If the fire service indeed "embraced" EMS and did not treat it like the red headed step child of the fire department. This would mean single role EMS employee's are treated with the same respect, benefits, and comparable pay as the fire suppression staff. 

If they also helped EMS at a national level increase education standards, mandate college degree's while eliminating vocational tech training, increase public awareness, and promote  the advancement of paramedicine. They would also need to recognize EMS as its own entity, which is a form of health care, not just a branch of fire/rescue. They would need to work closely with other areas of health care.
Furthermore they would need a plan for the other aspects of EMS, not just 911, which they seem to overlook quite often. This includes Critical Care Transport by ground and HEMS. In addition to that, the concept of community paramedicine is growing rapidly, they would need to improvise, adapt, and tackle all of these challenges just as well as a 3rd party municipal EMS agency could. Lastly, to get my blessing, they would help make the Paramedic more autonomous and help contribute to a true national standard which also mandated higher education, to get the U.S. on par(or above) with the common wealth countries. To accomplish all this many of the officers would need to enter EMS policy making and EMS research with minimum of advanced master degree's such as an MPH. They would need to be a true advocate for EMS and patients, and not only Fire/Rescue.

If they could do all this for us, I would get on my knee's and embrace them in all their glory. However, if anyone did this for us, I would do the same... I don't care if its the sanitation workers, or the parcel delivery service....

Personally, at a local level, I think our best bet of accomplishing the majority of what I stated above is a government 3rd party municipal EMS agency, like the UK and Australia have. Something EMS can call its own, utilize civil service status, pay/benefits, and municipal promotion structures.


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## Amberlamps916 (Jun 29, 2013)

ExpatMedic0 said:


> I worked near Portland Oregon for 5 years. You wanna know how our system worked, something like this.
> 
> Patient calls 911,
> Fire department gets there first with an entire engine. The engine is staffed with 1 Paramedic and the rest are EMT's. All the FD's EMT's stand in a circle with their arms crossed or hands in their pockets. Sometimes the LT will hold a clip board to look important. Turns out Grandma is having some breathing trouble today. In the middle of the circle is the patient and FD Paramedic as he/she "assess" the patient.
> ...



You just described a typical day at work for me in Socal. The only difference being us on scene first about 85-90% of the time and having fire usually send 1 guy in to see if they're needed. Seriously, there are times when their station is about 1-2 miles from the call and by the time they arrive, we'll have the patient loaded in the ambulance. The sand-bagging that occurs here is ridiculous.

 In the rare times that they are first on scene, they don't bring their equipment in most of the time. They just stand around and perform some half-&@$ assessment, which is usually just patient demographics, by the time we get there.


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## ExpatMedic0 (Jun 29, 2013)

Addrobo said:


> You just described a typical day at work for me in Socal. The only difference being us on scene first about 85-90% of the time and having fire usually send 1 guy in to see if they're needed. Seriously, there are times when their station is about 1-2 miles from the call and by the time they arrive, we'll have the patient loaded in the ambulance. The sand-bagging that occurs here is ridiculous.
> 
> In the rare times that they are first on scene, they don't bring their equipment in most of the time. They just stand around and perform some half-&@$ assessment, which is usually just patient demographics, by the time we get there.


Yep, it sucks. Imagine what would happen to the fire departments budget and job security if this was eliminated, like it should be. Most of the west coast works like this.... its an absolute joke and disgrace. 

It is a huge misuse of resources, a disservice to the community and local budget, and very clear and present reality that someone in higher places is accommodating special interest.


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## snarff (Jul 13, 2013)

Where I work and live its all fire based EMS. The only private ambulance service are medical transport and do some EMS when the system is dumped which is very rare.

Its not too bad here we have 3 departments in the valley all do ALS. They give preference to medics when hiring and those that are not medics are required to start a program with 3 years of hire (department pays). This being the case the vast majority are medics with some older grandfathered ones that are just EMT.

Typically every engine, ladder has at lest one medic on board. The engines or ladders do first response in their first due if the first due medic is out. So if you are on the second due ambulance the crew there is people you know and work with all the time so its kinda nice. The other plus is you are not on an ambulance everyday. While I like being on an ambulance it is nice to have a day here and there ridding ladder or engine.


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## emtdansby (Jul 13, 2013)

I've always felt fire and EMS needed to be two separate services. Firefighters want to fight fire, paramedics want to use medicine. When you require either to do the other job, they are not passionate about it. I have seen patient care fall to the wayside because the fire/medic just didn't care. He only got his paramedic to get on with the department and has no interest in EMS.


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