# Study on Philadelphia Fire Department urges bold action to meet goals



## medicsb (Jan 19, 2012)

http://www.philly.com/philly/news/breaking/20120118_Report__Tensions_rile_Fire_Dept_.html

http://www.philly.com/philly/news/2..._action_to_meet_goals.html?ref=more-like-this

Full study here: http://www.picapa.org/filestream.aspx?file=Philadelphia_Fire_Study.pdf

No real surprises.  Fire fighters are losing their minds over this.


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## Mountain Res-Q (Jan 19, 2012)

> The report also described a Fire Department culture "resistant to change," and was critical of a management structure that "tends to reinforce the status quo."



Ya, whats new?



> instituting fines for nuisance calls.



Good luck...



> The apparent linchpin of the strategy would be beefing up the role and number of paramedics, many of whom now suffer from low morale and feel "exhausted and defeated."
> 
> The study says paramedics should be cross-trained as firefighters and should be available to assist "fire suppression needs."



Here we go again.  Jack of all trades, master of none.  More Medics?  Great, but you can not expect an already overworked group of Medics to train to do another job in addition to their own if you want to elevate prehospital patient care to more than just another government service akin to being a Garbageman, Street Sweeper, or Dog Catcher.  Not knocking those important jobs, but you shouldn't ask members of you medical community, whether a Doctor, Nurse, Dentist, or Medic to be anything more than GREAT Health Care Providers, not good Health Care Providers, Firefighters, Meter Maids, Street Sweepers, Garbage Men, Tax Collectors, or whatever else government wants a public servant to add on to their overwhelming responsibilities simply because they need to cut expenditures in Public Safety because they don't know how to "live within their means".  

Just the opinion of someone against Fire in EMS for anything more than first response to select types of calls...  :wacko:


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## medicsb (Jan 19, 2012)

Mountain Res-Q said:


> Here we go again.  Jack of all trades, master of none.  More Medics?  Great, but you can not expect an already overworked group of Medics to train to do another job in addition to their own if you want to elevate prehospital patient care to more than just another government service akin to being a Garbageman, Street Sweeper, or Dog Catcher.  Not knocking those important jobs, but you shouldn't ask members of you medical community, whether a Doctor, Nurse, Dentist, or Medic to be anything more than GREAT Health Care Providers, not good Health Care Providers, Firefighters, Meter Maids, Street Sweepers, Garbage Men, Tax Collectors, or whatever else government wants a public servant to add on to their overwhelming responsibilities simply because they need to cut expenditures in Public Safety because they don't know how to "live within their means".
> 
> Just the opinion of someone against Fire in EMS for anything more than first response to select types of calls...  :wacko:




Actually, the study proposes reducing the number of staff paramedics to 144 and increasing the number of paramedic lieutenants to 25, but cross-training them to work on the fire ground when needed.  Its kind of weird.   I think they also propose allowing FFs who are already certified as medics to do OT on ALS trucks, which they're currently not allowed to do.  They also propose hiring civilian EMTs, which would mean that the city could eliminate a whole lot of fire-fighters who are currently forced to work on the ambulances.  Basically, the number of medics wouldn't increase, just their deployment would change.  (But, yeah, I think cross-training is silly.)

Things the union will hate that have been recommended:
NO sleeping on the job allowed unless they switch to 24 hr shifts 
Closing a bunch of engine and ladder companies (7 ea?)
No ambulance opt-out for senior FFs
Hiring of civilian EMTs
Increasing the command structure for EMS
Performing prevention work for EMS
Cross-training medics to FFs
Making supervisors make FFs respond faster to EMS calls
Mandatory physical training

In other words, stuff that is actually pretty reasonable, but against their "tradition".  

I imagine that most recommendations will be trashed since its Philadelphia.


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## Veneficus (Jan 19, 2012)

Personally, 

I wouldn't put too much stock in these recommendations.

I have yet to see any study done by any consultant on the matter that doesn't advocate cross trained fire/ems in more than 20 years.

I really think advocating for it is the only thing they know how to do and exactly what they are selected and paid for.

Does anyone really believe a snake oil salesman will tell you that you need anything but snake oil?


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## Fish (Jan 19, 2012)

I like the "In a perfect world everyone would be a Medic" line that the FF threw in there. People DO NOT get it......

What services does the study recomend privatizinggggggggggg


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## Veneficus (Jan 19, 2012)

Fish said:


> I like the "In a perfect world everyone would be a Medic" line that the FF threw in there. People DO NOT get it......
> 
> What services does the study recomend privatizinggggggggggg



Let me just put your mind to rest...

NO first world nation outside the US uses joint fire/ems.

Most nations you wouldn't want to live in do either. 

Everyone else is wrong except the US? Give me a break...

On top of it, most of these nations save a lot of money on the fire service by not having a very big one. Rather than have dozens of stations (that costs a lot) they have a handful that respond timely and with enough mass of men and equipment to actually effect interior attacks. 

Something that is rarely seen in the modern US light weight construction.

Firefighters...

How many of you have faught one or 2 structures fires a day, didn't rest or take a shower between them and normal duties, and had the manual dexterity to do things like start tough IVs, or the presence of mind to make comlpex decisions? 

What "fireground activities" is a support medic going to provide that requires training as a firefighter?

None. 

So you will take EMS units off the street in a burdoned system for fire ops. 

How well is that going to work?

Then you are going to pay private EMTs with FD medics? Sounds like a way over-paid driver to me.

Instead of roving brown outs, how about system status management without resting quarters for fire apparatus? If it works for the squads, it must work for the engine and ladder Cos.

I'll even bet the places where structure fires and car accidents happen is a lot more predictable than who will get sick and when. (Or even call an ambulance)

Cities bring in these frauds in order to give the illusion of credibility and nonbias. On a good day, they can even con somebody else into paying for it.

Afterall, If I was paying for a nonbiased study, I don't give a crap what interests the potential stakeholders from the results want or would agree to. "Let them eat cake."

A study that told them what they were already implementing, what an amazing surprise. I think I am going to have an MI from from the shock.
(wait that is just gas...)

If people want joint fire/ems, fine, it's their tax dollars, let them spend it how they wish. 

But there really isn't a need to waste money and time to make it look "legit." Spewing some propaganda on TV and the internet would probably work just as well. (likely also to be cheaper)

Consultants from Ohio? I'll tell you what will be privatized.

There will be a private ambulance company who after tax dollars, manpower, and equipment are allocated to a call when the bold fire ALS heroes decide it is beneath them, usually because they wouldn't know a sick person anymore than a layperson, the caller can get billed for their privste BLS or even ALS trip to the hospital. That will free up many more ALS ambulances to do basically nothing. 

But hey, saving lives is hard work. We all know how many calls are life and death too, the ED is packed with life and death patients, even in the hallways. (sarcasm)   

I also love the charge people for abuse crap. 

So people will worry about a fine before they call if it is deemed "waste?"

You know who those people are? The elderly who actually attempt to pay their bills and worry about whether they are more worthy than somebody else. 

You know who will not be detered by a fine? The people who don't usually pay or can't pay anyway.

What then? Send them to prison on the taxpayer dime? I see the cost savings just adding up now.

If these "consultants" were anymore ignorant, they would have to think to breathe. 

If these "consultants" were anymore biased they'd be wearing FD logos and endorsements on their cloths like spots figures.

Lipstick on a pig.


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## Mountain Res-Q (Jan 19, 2012)

Veneficus said:


> Let me just put your mind to rest...
> 
> NO first world nation outside the US uses joint fire/ems.
> 
> ...



LOVE YA, VINIE...  Could not agree more.  

Locally it not uncommon to have 3 to 4 engines on every medical aid.  Waste!  Then the FD waves their call volume before the powers that be to justify their budget.  Had one where the ambulance was going code 2 while 4 engines went code 3 to a request from LE to check a "stubbed toe" post-domestic... for the paperwork.

Had a case 3 years ago: fully involved structure fire.  Engines from every direction.  First three in-units were diverted to medical aids.  Took 20 minutes for the first fire unit to arrive on scene: Volunteer Water Tended with a single operator.  Two fatalities.  All the medical aids were typical FD baby-sitting deals.  No investigation ever came about and no change.

Fire for us are BLS babysitters who are on scene 2 minutes before the ambulance simply because they have some 30+ stations in a county of 54,000.  it is dangerous, a waste of money, and does no service to anyone looking to make EMS a valid medical profession and not just a sub-discipline of the Fire Department.  

Again, I love my FFs, but come on... the law in CA says FFs are required to have "Public Safety First Aid", and I guarantee you that less that 0.1% of FDs have that as their base requirement.  You need to have your EMT (not be an EMT, HAVE the cert... big diff) at minimum and Fire/Medics are likely to be the norm in the next 20-30 years for CA.  

Again... JACK OF ALL TRADES... PROBABLY SUCKS AT THEM ALL...  Then again, it is nice to know that the guy working on my grandma in arrest hold the Department record for fastest hose lay...   :glare:


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## Veneficus (Jan 19, 2012)

*How do you plan to enforce fines for abuse?*

Caller: "I need an ambulance, I am having difficulty breathing with crushing substernal chest pain raidiating to my left arm and jaw."

Dispatcher: " I am sending the fire department right now...are you breathing? (  sorry, shameless stab at dispatch) do you have any other symptoms?"

Caller: " Yes, I feel like I am going to vomit and pass out, my pain is 11/10, every generation of my dead relatives died of a stroke or heart attack, please hurry."

Firemedic onscene: "this could be the real deal and a collegue of mine got burned in DC telling people they were having heart burn, the patient might be having an NSTEMI so despite the fact the EKG doesn't say "acute MI" across the top, we should make every effort to save this persons life, just in case."

Caller at hospital while FD fills out report speaking to nurse and doctor in confidence: "I don't really have chest pain, it hurts when I pee, but I didn't want to pay for a private ambulance or a fine."

Firemedic trying to pick up a lust interest at bar after shift: "So I saved a life today, he could have been having the big one."
(of course neglecting to mention that the call he turfed to private BLS was a lady with a vag bleed who was suffering from a ruptured ectopic pregnancy, and he wrote it off as non specific abd pain, not worthy of an ambulance.)


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## Fish (Jan 19, 2012)

Veneficus said:


> Let me just put your mind to rest...
> 
> NO first world nation outside the US uses joint fire/ems.
> 
> ...



Clap Clap Clap


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## Veneficus (Jan 20, 2012)

*For your entertainment*

a nice little jingle on how to get out of paying a fine for 911 abuse.

http://www.youtube.com/watch?v=FrS9JS-FtcQ

*(warning: a little bit of cussing in the last minute of the video. not work safe)*


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## DrParasite (Jan 20, 2012)

*Report blasts Philly Fire Department's EMS culture*

Does this shock anyone????

Report blasts Philly Fire Department's EMS culture

Paramedics 'quickly hit a career ceiling,' while firefighters are said to undervalue calls for medical emergencies

PHILADELPHIA — A scathing report released yesterday rebuked the Philadelphia Fire Department's culture, which it said caused paramedics to quickly hit a career ceiling and feel unappreciated and firefighters to undervalue calls for medical emergencies compared with fire calls.

According to the Pennsylvania Intergovernmental Cooperation Authority report, the toxic environment has led to a medical emergency response time well below national standards. The national standard is responding within five minutes 90 percent of the time. The PFD responds within five minutes just 44.8 percent of the time.

read the whole thing here:

http://www.ems1.com/fire-ems/articles/1222952-Report-blasts-Philly-Fire-Departments-EMS-culture/


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## Joe (Jan 20, 2012)

Wait is that 5 mins from tones drop to be geared up in the rig and pulling out or is that 5 mins from station to scene? We have 1 minute to be from station to pulling out of driveway. I have no idea what I would do with 5 minutes..make some coffee?


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## systemet (Jan 20, 2012)

Veneficus said:


> NO first world nation outside the US uses joint fire/ems.



I agree completely with the spirit of the post, but just wanted to be irritating and point out:

* Some parts of Canada
* Some parts of Denmark, I think.

I don't think FD-EMS has to be bad, and I know some departments that do it very well.  But the department has to recognise that it's core work becomes EMS.  That's going to be the bulk of it's responses, and means that at least as much work and resources need to go into that aspect of the job.  I think it also needs to be a lower volume center, to allow for time for the increased training demands.


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## Veneficus (Jan 20, 2012)

systemet said:


> I agree completely with the spirit of the post, but just wanted to be irritating and point out:
> 
> * Some parts of Canada
> * Some parts of Denmark, I think.
> ...



Some parts?

That is that the rare place, 1/2, 3/4?

could you send a link to the Denmark place, I cannot find it with google-fu


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## systemet (Jan 20, 2012)

Veneficus said:


> Some parts?
> 
> That is that the rare place, 1/2, 3/4?



For Canada, relatively few. The only major city with FDEMS is Winnipeg (630,000), tiered model with limited ALS.  There were historical attempts to merge EMS and FD in other large cities, including Edmonton and Calgary.  These were disastrous, but in fairness, very incomplete.

In AB there's a few FDs that are contracted to provide EMS to the provincial health care system (there's also a handful of private companies).  The largest of these are Fort MacMurray and Sherwood Park.  These regions are about 50,000 each.  There's some smaller "cities" (i.e. >10,000 people), but I'm not sure if they'd count.



> could you send a link to the Denmark place, I cannot find it with google-fu



This is a private company that does both EMS and FD, I think:

http://www.falck.dk/healthcare/

Here's a picture of a fire department EMS vehicle from Copenhagen:-

http://commons.wikimedia.org/wiki/File:København_Amb_C2_v.jpg

A presentation on Copenhagen's FD here:

http://www.eed-network.eu/assets/presentations/Denmark.pdf

I'm not sure how integrated they are, I've just seen them drive around Copenhagen, and was a little surprised to see an FD ambulance in Europe.


------


For what it's worth, I'm in favour of keeping EMS completely separate from fire departments, and think it should be a health care function.


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## Veneficus (Jan 20, 2012)

systemet said:


> I'm not sure how integrated they are, I've just seen them drive around Copenhagen, and was a little surprised to see an FD ambulance in Europe.



Thanks,

I will check it out.

For what it is worth when I was in Bratislava, the FD there had a rescue vehicle with paramedics on it, but it was just one, and it was primarily for patient or medical needs (monitoring) of a FD response.

The City also had it's own EMS system, which responded to everything other than what brought out the FD.

But I wouldn't call that integrated fire/ems, so much as it is a rescue resource.


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## systemet (Jan 20, 2012)

systemet said:


> In AB there's a few FDs that are contracted to provide EMS to the provincial health care system (there's also a handful of private companies).  The largest of these are Fort MacMurray and Sherwood Park.  These regions are about 50,000 each.



Just realised that I'm in error here.  The largest is Red Deer (80,000), and there's also Lethbridge (75,000).


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## Veneficus (Jan 20, 2012)

I just went over the link you sent on Denmark.

It only looks integrated at the administrative level. 

They have some extremely cool resources going on there for EMS though.

I think I will try to send them an email.


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## Veneficus (Jan 20, 2012)

I am especially impressed by the special response vehicle for drunks and prostitutes.


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## ffemt8978 (Jan 20, 2012)

Duplicate threads merged.


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## mycrofft (Jan 20, 2012)

How many nations had their EMS system designed by their National Highway and Traffic Safety Administration?

It made sense in 1968 (use FD as a framework to get EMT'S OUT THERE NOW), and not so much anymore. But please please do not let the big medical companies get a stranglehold on them. First, the rurals get cut off. Then the inner cities. Then they start shaving care back, and subsidizing EMT mills as they have nursing programs here.


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## Foxbat (Jan 30, 2012)

Veneficus said:
			
		

> NO first world nation outside the US uses joint fire/ems


Canadians do not approve of this statement. And Japanese. And Singaporeans. And French. And Spanish. And Germans. And Irish.



> On top of it, most of these nations save a lot of money on the fire service by not having a very big one. Rather than have dozens of stations (that costs a lot) they have a handful that respond timely and with enough mass of men and equipment to actually effect interior attacks.



Do you have any data on response times in European vs American cities?



> Instead of roving brown outs, how about system status management without resting quarters for fire apparatus? If it works for the squads, it must work for the engine and ladder Cos.



Because SSM works so well in EMS.



> If these "consultants" were anymore biased they'd be wearing FD logos and endorsements on their cloths like spots figures.



What evidence of their bias do you have, other than the fact that you don't like their findings?


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## Veneficus (Jan 30, 2012)

Foxbat said:


> Canadians do not approve of this statement. And Japanese. And Singaporeans. And French. And Spanish. And Germans. And Irish.
> 
> 
> 
> ...



I admit when I made that comment I was generalizing as I could recall no cross trained fire/EMS operations of the scale of America. 

In that respect I overreached

But if you read those pages, they are either limited to certain areas or have in the case of Both the French and others, a corresponding physician response.

In the organization systemet pointed out, you will notice a considerable public health and transportation group under the fire organization run by physicians. 

I bring this up becuase while I have witnessed the occasional cross trained provider in Europe, many are not. I strongly suspect due to the training requirements to become a paramedic. 

If I may a quote from the very website you provided?

*"Emergency medical services in France are provided by a mix of organisations under public health control , with the lead taken by a central control function called SAMU, which stands for 'Service d'Aide Médicale Urgente' or urgent medical aid service.* This central hub is supported by resources including first response vehicles or ambulances provided by the fire service and physician led ambulance provision from SMUR (Service Mobile d'Urgence et Reanimation - literally translated as mobile emergency and resuscitation service) which are 'mobile intensive care units' (MICU) that have one or more physicians on board.[1"

I am not a supporter of system status management. I lived it and I know it doesn't work. But I also know that on several joint fire/ems departments, some rather famous, the medics are relegated to SSM while suppression persons are not.

In the very article sighted here, recommend medics do not sleep on duty?

Give me a break.

As for Canada, well, we won't quibble eh


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