# Emergency medical responder vs certified first responder



## Nyfirefighter10925 (Oct 11, 2016)

Can anyone tell me wat the differs from emergency medical responder vs  certified first responder


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## TransportJockey (Oct 11, 2016)

The name and credentialing body

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## EpiEMS (Oct 11, 2016)

Nyfirefighter10925 said:


> Can anyone tell me wat the differs from emergency medical responder vs  certified first responder


National standards and the NREMT use the nomenclature "Emergency Medical Responder." New York State, in its infinite wisdom, uses the term "Certified First Responder." The scope of practice is essentially the same, as is the educational standard, as of May 2013.


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## VentMonkey (Oct 11, 2016)

You know what they both have in common? Neither are universally seen as the _basic_ emergency medical technician.

What's the point of this cert? Really, I don't understand it, as it isn't recognized in my state.

Why not just get you basic and be a good FF/EMT? 

I'm genuinely curious, and in no way trying to incite an argument.


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## EpiEMS (Oct 11, 2016)

VentMonkey said:


> You know what they both have in common? Neither are universally seen as the _basic_ emergency medical technician.
> 
> What's the point of this cert? Really, I don't understand it, as it isn't recognized in my state.
> 
> ...



No EMR recognition? Interesting. What do they require for, say, cops? I think California has their Title 22 first aid training, which is below EMR, but above standard first aid...

The EMR is a useful tool for pre-transport apparatus arrival (I think a rural MVC is the best example) plus, it helps fire departments justify big budgets (40 hour class x 4 FFs + $800k truck = a massive multiple of runs that you can justifiably send them on).

Please ignore the strike-through that randomly appeared below.

Historical context for EMR is important. As we know it today, the EMR "initiate immediate lifesaving care to critical patients who access the emergency medical system. This individual possesses the basic knowledge and skills necessary to provide lifesaving interventions while awaiting additional EMS response and to assist higher level personnel at the scene and during transport." They use "minimal" equipment at the scene. We're talking truly fundamental interventions - CPR/AED, hemorrhage control, not moving the possible cervical spine injury (I know, I know, not much science on that last one). Historically, the First Responder was more of an outgrowth (downwards) from the EMT scope, as seen in the Crash Injury Management course from 1973. That eventually turned to what was the First Responder course from 1979, which is closer to what we know today.


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## VentMonkey (Oct 11, 2016)

EpiEMS said:


> plus, it helps fire departments justify big budgets (40 hour class x 4 FFs + $800k truck = a massive multiple of runs that you can justifiably send them on).


This^.


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## EpiEMS (Oct 11, 2016)

VentMonkey said:


> This^.


That's always gonna be the justification, in my book. It's cheaper than a true basic level response. EMR should not be the standard for BLS first response, unless you're depending on people who do it as a collateral duty (i.e. PD).


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## gotbeerz001 (Oct 11, 2016)

Why all the fire hate? 


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## VentMonkey (Oct 11, 2016)

EpiEMS said:


> That's always gonna be the justification, in my book. It's cheaper than a true basic level response. EMR should not be the standard for BLS first response, unless you're depending on people who do it as a collateral duty (i.e. PD).


Sadly, from a strictly fiscal standpoint this makes sense.

Admittedly, I am not too familiar with what actually separates an EMR from an EMT, and in California, yes, many carry the "first responder" title, though some more than others, take it seriously.

It's kind of unfortunate, as I think we can all agree that simple and proper bleeding control, and CPR go a *very *long way in our environment.

I also feel that if theses folks were put through an EMT course vs. EMR course, even if only a few more things covered, and/ or it still being a vocational title, perhaps they would feel a tad more obligated to perform these tasks with not only a sense of pride, but also be a bit more assertive; though, I am sure there are some kick *** EMR's out there.


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## VentMonkey (Oct 11, 2016)

gotshirtz001 said:


> Why all the fire hate?
> 
> 
> Sent from my iPhone using Tapatalk


All jokes aside, I don't hate fire, but I think more often than not most firefighters like, well, fighting fires...rightfully so might I add.

I know a handful of good FF's and FFPM's that can do both fairly well, I just think in an environment where they're being utilized at the EMR level, it makes more sense to have said department pay for a full EMT course.

If anything, this shows love for my fellow "first responsders".


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## EpiEMS (Oct 11, 2016)

gotshirtz001 said:


> Why all the fire hate?



Haha, it's not hate! Just pointing out the fact that firefighters, on the mean, do more sick calls than fire fighting, so they need to think about how they train, staff, and respond. An $800,000 engine with four EMR firefighters getting paid $50,000 a year (minimum...if you add in pension and other benefits, it's more like double that) to respond to your average EMS call provides about nothing in marginal benefit to the patient.





From a fiscal perspective, if you were to cut that 4 EMRs in an $800,000 truck to 2 EMRs in a $50,000 SUV, fire-based first response becomes much, much more fiscally tenable.



VentMonkey said:


> Sadly, from a strictly fiscal standpoint this makes sense.
> 
> Admittedly, I am not too familiar with what actually separates an EMR from an EMT, and in California, yes, many carry the "first responder" title, though some more than others, take it seriously.
> 
> ...



California has issues, for sure 

I like the idea of sending your professional responders to an EMT course, but given current models of staffing, etc., it may not make sense, especially because they don't transport. (It's not like Medicaid, say, generally reimburses BLS non-transporting agencies, as far as I know)


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## NysEms2117 (Oct 11, 2016)

EpiEMS said:


> Haha, it's not hate! Just pointing out the fact that firefighters, on the mean, do more sick calls than fire fighting, so they need to think about how they train, staff, and respond. An $800,000 engine with four EMR firefighters getting paid $50,000 a year (minimum...if you add in pension and other benefits, it's more like double that) to respond to your average EMS call provides about nothing in marginal benefit to the patient.
> 
> 
> 
> ...


This is so beyond true. I can't even imagine the amount of false calls in a big college town for burnt popcorn ect.


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## EpiEMS (Oct 11, 2016)

NysEms2117 said:


> This is so beyond true. I can't even imagine the amount of false calls in a big college town for burnt popcorn ect.


Yeah, and odds are, your average fire call is actually medical in nature!
http://www.nfpa.org/news-and-resear...e/fire-department-calls/fire-department-calls


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## gotbeerz001 (Oct 11, 2016)

The point which I often make is that many people make the mistake of saying that medicals are most of what firefighters DO rather than stating accurately that they simply make up 60-80% of the call volume. The problem is that all calls are not created equal. 

For instance, a medical aid may take 20 minutes turn-time x 3 person engine company; that is one hour of personnel time for that call. 

A first alarm residential fire may get 3 engines, 2 trucks a chief and a medic unit with an average commitment of 2 hours (some at scene more time, some less). If you have 3-person engines, 4-person trucks, that's a total of 40 personnel hours... The equivalent of 40 basic medical aids. 

Now while fire calls have been consistently declining over the years, the number of non-medical calls continue to increase as well. Gas leaks, rescues etc also require a significant amount of time and multiple company commitment. 

All this to say, fire medics need to be proficient in their EMS duties; to speak to the contrary is idiotic. However, to say that medicals are 80% of what we do is simply false. 


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## VentMonkey (Oct 11, 2016)

gotshirtz001 said:


> All this to say, fire medics need to be proficient in their EMS duties; to speak to the contrary is idiotic. However, to say that medicals are 80% of what we do is simply false.
> 
> 
> Sent from my iPhone using Tapatalk


And this, IMO, speaks volumes for the type of FFPM I am sure you are.

Unfortunately, all too often this is not the case. I have worked in an all ALS system, and I had no major issues. Now I don't, and I still don't have any major issues.


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## gotbeerz001 (Oct 11, 2016)

Just for insight, my primary job is an Engineer/Paramedic for a smaller agency (5 stations) averaging 3 calls per 24 hr shift at slower stations and up to 14 calls at the busiest stations. We have multiple highways, significant wildland threat and serve approximately 70,000 people. We place a high value on customer service. Local hospital is less than 15 minutes away with specialty centers upwards of 40 mins by ground. 

My side gig is a transporting medic in a dense urban setting. Fire crews we work with easily run upwards of 20+ calls per 24 hr shift with the average being 12 or so. 7-8 transports in a 12-hr shift is my norm. We are rarely more than 10 minutes from a hospital, most of which provide some sort of specialty. 

My approach to medicine comes from existing in both these worlds. I get frustrated by lazy fire medics as much as I do burnt-out transporting medics. I feel that I treat patients appropriate to their condition. When in fire mode, I feel our role is to treat life-threatening illness/injury appropriately but allow the transporting medic the ability to treat/transport/triage the patient as they see fit. This means that I do not start an IV at scene unless I plan to put something in it. I will perform all necessary actions at scene but do not delay transport any more than necessary. When transporting, I generally want to get off-scene as soon as possible once I have ruled out injury/illness requiring a specialty center.  While I get frustrated by fire medics who do not treat appropriately (this is rare), I do not hold anything against those who provided appropriate (though minimal) care. 

The biggest issue we need to address is the prioritizing of calls; this is where I believe we need to focus if we want to get our resource allocation correct. The problem is that dispatching is based off the subjective info provided by a frantic public (or downplayed symptoms for some); this is why we get Delta responses for sore knees w abn breathing but get Alpha responses for sick people who have actually been septic for 3 days. 

All that to say, everyone has their role. Unfortunately, transporting medics get a narrow view of what fire does because they only see us when there is a medical. Furthermore, the standard held to each other should be "safe and appropriate" care; a 20-year single-function transporting medic will always have more clinical insight than a 5-year fire medic who is required to maintain proficiency in medical, fire, rescue, fitness, vehicle operation, pumping etc etc etc... Let's just value what each brings to the table. 


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## gotbeerz001 (Oct 11, 2016)

VentMonkey said:


> And this, IMO, speaks volumes for the type of FFPM I am sure you are.
> 
> Unfortunately, all too often this is not the case. I have worked in an all ALS system, and I had no major issues. Now I don't, and I still don't have any major issues.


Haha. Too kind! 


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## VentMonkey (Oct 11, 2016)

gotshirtz001 said:


> My approach to medicine comes from existing in both these worlds. I get frustrated by lazy fire medics as much as I do burnt-out transporting medics. I feel that I treat patients appropriate to their condition. When in fire mode, I feel our role is to treat life-threatening illness/injury appropriately but allow the transporting medic the ability to treat/transport/triage the patient as they see fit. This means that I do not start an IV at scene unless I plan to put something in it. I will perform all necessary actions at scene but do not delay transport any more than necessary. When transporting, I generally want to get off-scene as soon as possible once I have ruled out injury/illness requiring a specialty center.  While I get frustrated by fire medics who do not treat appropriately (this is rare), I do not hold anything against those who provided appropriate (though minimal) care.


Just to add to this, in my experience, the quality of fire-based paramedicine that I have seen is usually dependent on high the department itself prioritizes their EMS section.

Some stellar EMS systems are delivered by fire departments fire departments, nationally.
The ones that, to this day, take this bulk of their revenus seriously though, it's those departments that unfortunately spoil the whole bunch.

In California, the fact of the matter is we have to learn to accept that fire-based EMS isn't going anywhere anytime soon, so we can either embrace it, or leave.

As a side note: just below being a flight paramedic, on my "paramedic to-do list" would be working as a FFPM for a non-transporting fire department...by the beach.


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## VentMonkey (Oct 11, 2016)

VentMonkey said:


> Just to add to this, in my experience, the quality of fire-based paramedicine that I have seen is usually dependent on *how *high the department itself prioritizes their EMS section.
> 
> Some stellar EMS systems are delivered by fire departments, nationally.
> 
> ...


Forgive me, had to go back and edit my words. Banana hands strike again!.


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## EpiEMS (Oct 11, 2016)

gotshirtz001 said:


> The point which I often make is that many people make the mistake of saying that medicals are most of what firefighters DO rather than stating accurately that they simply make up 60-80% of the call volume. The problem is that all calls are not created



I really like your explanation, it's pretty compelling!
The question it poses to me, then, is fire first response generally necessary, and, if so, at what level is it useful? I would say, generally, in an urban area, fire based first response is helpful, but could be at the EMT level, with a 2 FF/EMT team.


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## gotbeerz001 (Oct 11, 2016)

EpiEMS said:


> I really like your explanation, it's pretty compelling!
> The question it poses to me, then, is fire first response generally necessary, and, if so, at what level is it useful? I would say, generally, in an urban area, fire based first response is helpful, but could be at the EMT level, with a 2 FF/EMT team.


I am not opposed to the idea and would guess that it would work...until it didn't. All it takes is one call that goes poorly based on undertrained (or simply understaffed) companies for the negative media to turn the tide. Frankly, when the companies are staffed and at the station, it would be a hard position to defend when people expect the highest service for their tax dollars spent. While we know that more people doesn't always equate to better service, it is often comforting for the patient who calls once every 10 years and says "I had no idea I would get SIX of you!"

Furthermore, the argument can be made that ALS equipped ambulances staffed with BLS attendants would (seemingly) make more sense as the fire medic makes initial contact and assessment and either rides in with the ambo or downgrades the call to BLS. While we know that there are serious pitfalls to that deployment model, it's easier to make the case to the public that it makes the most fiscal sense. There would be a logical push to augment engine staffing to 4-person companies with a minimum of 2 paramedics on each rig to allow the engine to remain in service with 3 personnel when one medic rides in but allows for immediate 2-in/2-out accountability when responding to a fire. 


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## gotbeerz001 (Oct 11, 2016)

Also, FFs don't generally have a problem with medicals when they are also running the full scope of calls from a piece of suppression apparatus. The fastest way to kill the service attitude in a FF is to give them the title "Firefighter" but then use them in a single-function (EMS). If the deployment model uses either fire-based medic units or QRV-type squads, they either need to be hired as single function (and hopefully those dedicated to EMS) or have the shift be a 50% commitment where those lower in seniority work it but are guaranteed at least 50% of the time they will staff a piece of suppression equipment. 


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## VentMonkey (Oct 11, 2016)

gotshirtz001 said:


> or have the shift be a 50% commitment where those lower in seniority work it but are guaranteed at least 50% of the time they will staff a piece of suppression equipment.


With due respect, this statement solidifies part of the perpetual argument of fire-based EMS vs. single-role EMS.

Without side tracking too much from the ops initial question (if the ops still even there, lol), it shouldn't be seen as a chore, or something someone with "less seniority" should be relinquished to. It just makes it sound like more a nuisance than anything.

Perhaps I read it wrong, or too far into it though.


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## gotbeerz001 (Oct 11, 2016)

VentMonkey said:


> With due respect, this statement solidifies part of the perpetual argument of fire-based EMS vs. single-role EMS.
> 
> Without side tracking too much from the ops initial question (if the ops still even there, lol), it shouldn't be seen as a chore, or something someone with "less seniority" should be relinquished to. It just makes it sound like more a nuisance than anything.
> 
> Perhaps I read it wrong, or too far into it though.


Nope, I hear you. My point was simply that FFs can/will be interested in EMS if it is an aspect of their job, not their entire job. The variety is a large part of why we enjoy our job. 

IMO, I am a fan of fire-based ALS transport, working the same schedule and deployed from the station with fire medics working 50% of the time in the suppression/first responder role and 50% on the medic. This way you generally run with the same crews and it keeps all the skills sharp. 


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## VentMonkey (Oct 11, 2016)

gotshirtz001 said:


> Nope, I hear you. My point was simply that FFs can/will be interested in EMS if it is an aspect of their job, not their entire job. The variety is a large part of why we enjoy our job.
> 
> IMO, I am a fan of fire-based ALS transport, working the same schedule and deployed from the station with fire medics working 50% of the time in the suppression/first responder role and 50% on the medic. This way you generally run with the same crews and it keeps all the skills sharp.
> 
> ...


Sorry, op, your thread has officially been hijacked.

Do you feel _MOST _firefighters view it the same as you do? 

If so, how is it that they've stigmatized the way that they have in regards to their delivery of prehospital care?

I think we can all agree that burnout knows no limits, but a large chunk of the firefighter "paramedics" that have helped (or not) create this stigma seem genuinely disinterested in, and/ or put off by EMS even if they rotate on and off the box/ squad/ truck/ engine, etc., etc., etc...

Then again, I'm a guy who comes from a county with departments that "force" many of their firefighters (til this day) into paramedic school...paid...by their department. Many of whom still take the "meh, if I fail, I'm still getting paid" approach.


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## Handsome Robb (Oct 13, 2016)

gotshirtz001 said:


> IMO, I am a fan of fire-based ALS transport, working the same schedule and deployed from the station with fire medics working 50% of the time in the suppression/first responder role and 50% on the medic. This way you generally run with the same crews and it keeps all the skills sharp.
> 
> 
> Sent from my iPhone using Tapatalk



We're a county third service and are stationed in house with a fire crew at the vast majority of our stations. Each medic unit usually has 3-4 suppression units they run calls with on a regular basis and we work the same schedule so we know each other pretty well. 




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## dutemplar (Oct 13, 2016)

VentMonkey said:


> Sorry, op, your thread has officially been hijacked.
> Then again, I'm a guy who comes from a county with departments that "force" many of their firefighters (til this day) into paramedic school...paid...by their department. Many of whom still take the "meh, if I fail, I'm still getting paid" approach.



Yeah, that comes down to the training and cultural mentality of the department.  Are there there to punch a clock while occasionally cutting a car apart and doing the splash and bash at a fire... or are they there as a "one stop shop" emergency service.  Is the bone box a valued (and not beat to death) unit, or is it chronically understaffed and ran to death.


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## VentMonkey (Oct 13, 2016)

dutemplar said:


> Is the bone box a valued (and not beat to death) unit, or is it chronically understaffed and ran to death.


@dutemplar, this is an excellent point. This can happen with any service, whether it's fire-based (single, or dual function), third service, or private.

Low morale can most worsen anyone's view about any job title, or career field really.


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## DrParasite (Oct 14, 2016)

When I was working on the ambulance, I wouldn't trust anything a firefighter told me any assessment about the patient, unless i knew that said firefighter either currently works (as their side job) or has worked on an ambulance.  I've been burned too many times by firefighters (and cops) who are EMTs, but give me incorrect information because they don't do EMS on a regular basis.

Now that I am on the firetruck, I wouldn't trust most of my coworkers with a sick patient, unless they have experience actually being on an ambulance.  Being a first responder is great, but it's also really easy to do (and way more fun).  15 minutes of patient contact, and turn the patient over to the ambulance for the duration.

While there are some firefighters who are decent clinicians (and I have met several in NC who actually surprised me as to how accurate their assessments were, despite never working on an ambulance), the vast majority will only do enough con ed to keep their cert valid, and even then will sit through class texting instead of actually paying attention and asking questions.


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## VentMonkey (Oct 14, 2016)

DrParasite said:


> When I was working on the ambulance, I wouldn't trust anything a firefighter told me any assessment about the patient, unless i knew that said firefighter either currently works (as their side job) or has worked on an ambulance.  I've been burned too many times by firefighters (and cops) who are EMTs, but give me incorrect information because they don't do EMS on a regular basis.
> 
> Now that I am on the firetruck, I wouldn't trust most of my coworkers with a sick patient, unless they have experience actually being on an ambulance.  Being a first responder is great, but it's also really easy to do (and way more fun).  15 minutes of patient contact, and turn the patient over to the ambulance for the duration.
> 
> While there are some firefighters who are decent clinicians (and I have met several in NC who actually surprised me as to how accurate their assessments were, despite never working on an ambulance), the vast majority will only do enough con ed to keep their cert valid, and even then will sit through class texting instead of actually paying attention and asking questions.


Digging the honesty, @DrParasite. Do you think it's safe to say that this is a blanket statement for most fire departments, at least in your experience?

I think this is often where the line is drawn, especially in a state like mine that is so dependent in the FD providing ALS care.

Many (again, not all) take the approach you've described in your post, but the problem is,they're often either handing patient care off to an equal level provider, and/ or their fellow FFPM's who are "on the box" that day.


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## DrParasite (Oct 14, 2016)

VentMonkey said:


> Digging the honesty, @DrParasite. Do you think it's safe to say that this is a blanket statement for most fire departments, at least in your experience?


it is absolutely a blanket statement, I am painting everyone with a broad brush, stereotyping, etc.  There are absolutely exceptions, but in my experience, they are the rarity, not the norm.


VentMonkey said:


> I think this is often where the line is drawn, especially in a state like mine that is so dependent in the FD providing ALS care.


Is the FD providing ALS from engines, or ambulances?  I have no issues with FF/PM, especially where everyone rotates between the supression units and the transport units.  But if you have a paramedic who hasn't been on the ambulance in 15 years, how sharp of a provider do you think they are?  BTW, I feel the same way about administrative officers in EMS agencies, who haven't treated anyone on the ambulance in years, but still have a P card.

10 or 15 years ago I once had a career fire captain tell me he was an experienced EMS provider, despite never working on an ambulance.  I told him that it's easy to be with a patient for 5-15 minutes, apply oxygen, maybe even do some CPR, fill out some check boxes and  a patient care report, and then turn the patient over to the ambulance.  There is minimal accountability, if you do mess up, the ambulance crew typically fixes it, if your treatment is wrong, the ambulance crew will fix it, and at the end of the day if you do miss some critical thing, often the opinion is "they are firefighters, doing EMS is not their main job" so the bar isn't set at high.  If you want to become an experienced EMS provider, than you need to actually spend a lot of time on the ambulance, experiencing patient care from initial contact to turnover at the hospital


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## NysEms2117 (Oct 14, 2016)

DrParasite said:


> When I was working on the ambulance, I wouldn't trust anything a firefighter told me any assessment about the patient, unless i knew that said firefighter either currently works (as their side job) or has worked on an ambulance. I've been burned too many times by firefighters (and cops) who are EMTs, but give me incorrect information because they don't do EMS on a regular basis.


Do you think there is a way to help fix this? I understand you'll always have people that think they know it all, people that judge based on age, and all that. I'm not debating this because to be honest I think I may be part of the issue. I work on an ambulance 1 day every 10 or so days.*mainly working in law enforcement* granted Im usually going to be the low man on the totem pole(emt basic)


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## gotbeerz001 (Oct 15, 2016)

I also believe that it is impossible (or at least extremely difficult) to be a good medic if you have only ever been engine-based; I say this often and those who have been (or still currently) a transporting medic generally agree. 


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## VentMonkey (Oct 15, 2016)

gotshirtz001 said:


> I also believe that it is impossible (or at least extremely difficult) to be a good medic if you have only ever been engine-based; I say this often and those who have been (or still currently) a transporting medic generally agree.
> 
> 
> Sent from my iPhone using Tapatalk


What if your department only provides engine paramedics that transport if it's an "ALS patient", but would otherwise turf it to their contracted BLS ambulance provider?


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## gotbeerz001 (Oct 15, 2016)

VentMonkey said:


> What if your department only provides engine paramedics that transport if it's an "ALS patient", but would otherwise turf it to their contracted BLS ambulance provider?


Slippery slope... I would say the ideal is that the engine medic would need have a background as a transporting medic. 


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## VentMonkey (Oct 15, 2016)

gotshirtz001 said:


> Slippery slope... I would say the ideal is that the engine medic would need have a background as a transporting medic.
> 
> 
> Sent from my iPhone using Tapatalk


I would agree. This was an original plan of mine, until it was side tracked, lol.


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## MackTheKnife (Oct 17, 2016)

gotshirtz001 said:


> Why all the fire hate?
> 
> 
> Sent from my iPhone using Tapatalk


I AM NOT FF: I think what you're seeing is a majority opinion the EMR is useless for the most part and a lot of the opiners are FF.  EMT has also been cast in a negative light on here from time to time as a qualification that perhaps should go away. Sort of like in my world where LPNs still exist but are fading out.

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## DrParasite (Oct 18, 2016)

VentMonkey said:


> What if your department only provides engine paramedics that transport if it's an "ALS patient", but would otherwise turf it to their contracted BLS ambulance provider?


So that means your ambulance people become lazy incompetent taxi drivers, because they never see sick patients, and when they do, they have the medic there to do all the work and tell them what to do.  If you never do a hands on assessment, if you never use your critical thinking differential diagnosis brain, why should you be thought of as anything other than a taxi driver?  No wonder the paramedics don't trust these providers, they never actually utilize anything they learned in school!

If the engine paramedic actually transports the patient to the ER with the ambulance crew, than that's a lot different than one who is just a first responder and turf medic.


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## VentMonkey (Oct 18, 2016)

DrParasite said:


> If the engine paramedic actually transports the patient to the ER with the ambulance crew, than that's a lot different than one who is just a first responder and turf medic.


Again, many moons ago when I was looking into these specific departments, the (my) idea was to gain ~5 years single-role paramedic time on an ambulance, then apply to these type of departments. My personal opinion is that these types of departments/ deployment models should require 3-5 years of single-role/ transport paramedic experience; perhaps even closer to the 5-10 year mark. A very green paramedic really has no business being an assessment paramedic/ engine paramedic with these capabilities. I feel the same way about HEMS programs and flight paramedic experience, but I digress.

The ones that I am referring to in terms of their deployment is basically a 3-4 man engine company with 1-2 FFPM's that respond with a BLS department. If you deem them to be a BLS patient, it's sent via the BLS ambulance (the BLS providers themselves are more than welcomed to assess, and/ or reassess these patients en route to the hospital; I used to), if not you follow up to the hospital and provide ALS care.

If another call goes out in your first-in area, your engine company still has one more FFPM to utilize for that call and can meet you at the same ED should that patient be transported there as well; if not you can meet up with them back at the station and catch a ride back with your BC, respectively.

This was one of my goals in order to make a career out of being a paramedic, but again, I know this will not happen for me any longer as I have learned that I do not possess the desire to perform as a paramedic _and _do fire suppression. I am "_just a career paramedic_", albeit extremely content, and happy with what I do.

As far becoming lazy incompetent taxi drivers, well that's entirely up to the individuals themselves. If a patient is shipped BLS, and the EMT's delivering patient care see no reason to assess the patient themselves, this is not something that should be held over the ALS providers head, assuming the paramedic did a proper assessment to begin with.


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## DrParasite (Oct 18, 2016)

[QUOTE="VentMonkey, post: 622723, member: 30261]If another call goes out in your first-in area, your engine company still has one more FFPM to utilize for that call and can meet you at the same ED should that patient be transported there as well; if not you can meet up with them back at the station and catch a ride back with your BC, respectively.[/quote]I would imagine this system only works if you work in a small city with a hospital in it, as I can't see an engine leaving it's first due, or a BC going OOS our of their primary just to pick up a medic... or several medics who have been taken to the hospital.[QUOTE="VentMonkey, post: 622723, member: 30261]As far becoming lazy incompetent taxi drivers, well that's entirely up to the individuals themselves. If a patient is shipped BLS, and the EMT's delivering patient care see no reason to assess the patient themselves, this is not something that should be held over the ALS providers head, assuming the paramedic did a proper assessment to begin with.[/QUOTE]It's more of an issue with the system, than the individual providers.  I can see being the EMT on that ambulance being an extremely sucky mind numbing job, because the medic deals with every sick patient, and the EMT deals with the people who just need a ride to the ER.  I have heard anecdotal stories from California where people are like that, where the FD runs the show, and the EMTs on the ambulance are just biding their time until they get hired by a FD.  I can also see it being VERY VERY easy to get complacent, and not identify a sick patient or know what to do, since you haven't done in it in a while.

Then again, I know paramedics that can ALS any patient, as well as paramedics that would turf a patient to the EMTs when they really shouldn't.

But I will end my contribution here, until I have something that i relevant to the original topic.


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## VentMonkey (Oct 18, 2016)

Fair enough @DrParasite , but FWIW I think this still has some application even to the original topic...for which I have yet to even see the OP reply to.

Yeah, the departments I had looked at that provide this type of service were 4-5 station departments roughly. You make some good points, and assuming you're a FF (you are, correct?), your input on this thread further serves as relevant not only to the OP's original post, but to the general direction this thread has taken. I am not a FF, FF/ EMT, or FF/ PM, so logistically I have nothing to back my ideas up, this is just what I had running through my head. 

And yes, the stories you hear from California have some truth to them, but like anywhere, it boils down to individual perception. Many do become disgruntled, and complacent, but hey that can happen in any line of work. I did it for roughly 5 years in the county most everyone here moans and groans about, and do you know what I took away from it? What kind of paramedic I DID NOT want to be, and how I DID NOT want to deliver patient care. I also observed those that did a solid job on the way to the ED as their second set of hands, and those that did not (I had my fair share of "discussions" with those that I felt were subpar). So, to me when I hear people that come from where I am pissing and moaning, I get it...to an extent. It is on that individual, as it was on me, to realize they can do something themselves about it, or continue to be complacent, and disgruntled in their delivery of care, but either way placing the blame on the system itself, or it's particular deployment model has little to do with their own accountability for their level of care, or lack there of, as a technician/ clinician.

If you're truly interested in medicine in a prehospital setting, it will persevere through most any form of burn out, or complacency. And in order to tie this back to the original topic, I understand budgets may not allow it, but even at the basic EMT level, you're focus is on the importance of proper BLS delivery and it's place in the prehospital setting. I don't know that the same can be said for EMR, or an EMR course, but by all means, correct me if I am wrong.


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