# Another Florida EMS goes Fire



## VentMedic (Jun 26, 2009)

http://www.theledger.com/article/20...tle=Polk-Fire-May-Inherit-Some-EMS-Ambulances

Thursday, June 25, 2009 

*Polk County Fire May Inherit Some EMS Ambulances*



> BARTOW | Polk County Fire Services could inherit up to five of Emergency Medical Services' 32 paramedic ambulances.
> 
> If approved by Polk County commissioners, the plan would combine fire and medical services in some areas. This would allow the county to meet the needs of some of the more rural areas that have a shortage of either medical or fire service coverage.
> 
> It would improve efficiency, according to fire and emergency medical officials.


 


> One ambulance had already been taken over by fire services at the Golfview station in Lake Wales, and six paramedics and emergency medical technicians have been cross trained to respond to both medical and fire calls.
> Up to 24 more EMS paramedics and emergency medical technicians could be cross trained.


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## berkeman (Jun 26, 2009)

Wow, that was quick.  How in the world do you quickly cross-train medics and EMTs to fight fires?  Put them through the fire academy on a fast track?


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## VentMedic (Jun 26, 2009)

berkeman said:


> Wow, that was quick. How in the world do you quickly cross-train medics and EMTs to fight fires? Put them through the fire academy on a fast track?


 
We've done this some many times throughout Florida that we're getting kinda good at it.

Usually they will give the EMT(P)s 1 - 3 years to get their fire certs. Unfortunately there will be those that really not up to taking the fire academy physically. They may be SOL for a job especially since the state is largely Fire based EMS.


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## 46Young (Jun 26, 2009)

Are they putting them through suppression so they'll be subject to FLSA, or are they really going to be riding fire apparatus? I'm a huge fan of fire based EMS from the employee's side, for $$$'s, benefits, pension, DROP, working conditions and such. It's typically a much better deal than third service, private, or hospital based(save the Carolinas). I do think it's wrong to take over an EMS agency and force them to do suppression. There should be a single role option for those who don't particularly care to run into a burning building.


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## TransportJockey (Jun 26, 2009)

So whenever I go to visit my home county it's all fire based... great.


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## EMTinNEPA (Jun 27, 2009)

46Young, are those $$$'s, benefits, pension, DROP, working conditions and such also aren't worth having to join the bucket brigade and going running into burning buildings?  Or sitting back and watching firefighters who run a tenth of your call volume make twice as much as you?  Or having to bear witness to sub-par paramedics who are paramedics just because they want to ride in a shiny wed fire twuck?

The $$$'s, benefits, pension, DROP, working conditions and such could be there on the third service, private, and hospital based as well if people realized the grave injustices fire-based EMS does to them and demanded a third service.


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## EMTinNEPA (Jun 27, 2009)

*Oh, and VentMedic...*

I'm so sorry to hear that.


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## Sasha (Jun 27, 2009)

EMTinNEPA said:


> I'm so sorry to hear that.



We do fire based EMS well. It's not a tragedy.


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## EMTinNEPA (Jun 27, 2009)

Sasha said:


> We do fire based EMS well. It's not a tragedy.



What facts do you have to support the claim that you do it well?


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## Melclin (Jun 27, 2009)

I don't get this thing about fire based EMS. EMS is a completely separate field, with different skill sets, requiring different people, different equipment and go to predominantly different jobs. 

Here we have Police, Fire, and Ambulance. All are completely separate (in fact ambulance is not even technically an emergency service here). I don't get why people think its perfectly okay to have major state run (correct me if im wrong, Im assuming here) FDs and EMS is an after thought to be left to the whims of FD or private companies. *I hate the idea that EMS seems to become ancillary to firefighting. *

Where I come from the ambulance service gets way more calls, has an equivalent or bigger budget and has been professionalized more widely and for longer than FD. I'm not belittling the water fairies  but the FD is a completely different service with a completely different role. FD fights fires and do all that awesome hero stuff and Ambos are medical practitioners. *You wouldn't take a nurse and say, oh well, there's not much to your field so we'll teach you how to fight fires as well.*


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## Sasha (Jun 27, 2009)

EMTinNEPA said:


> What facts do you have to support the claim that you do it well?



What proof do you have that we don't?

Fire Based EMS is great, if done right. We are obviously doing something right as the entire state can provide ALS to all it's residents and visitors, no matter how rural and poverty stricken the area it. I had some fantastic preceptors at the FD who were wonderful medics. One thing is here, at least, the FDs make an effort to appear professional and neat, have training every single week. While you have the private services that respond with half tucked in shirts, messy hair, unrestrained long hair and get training maybe once every couple months.

I live in an FD response area and I am confident that when they respond, I'll have competent medics, not so sure when I run around in R/m's response area.


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## EMTinNEPA (Jun 27, 2009)

Sasha said:


> What proof do you have that we don't?
> 
> Fire Based EMS is great, if done right. We are obviously doing something right as the entire state can provide ALS to all it's residents and visitors, no matter how rural and poverty stricken the area it. I had some fantastic preceptors at the FD who were wonderful medics. One thing is here, at least, the FDs make an effort to appear professional and neat, have training every single week. While you have the private services that respond with half tucked in shirts, messy hair, unrestrained long hair and get training maybe once every couple months.
> 
> I live in an FD response area and I am confident that when they respond, I'll have competent medics, not so sure when I run around in R/m's response area.



ALS response in my area is 100% third service, while the Fire Departments can only provide BLS services.  There are some great EMTs running with the FD-based BLS service, but only because they work, or at one time worked, for one of the paid ALS third services.  The ones that haven't are disgustingly apparent.  Here you have FF/EMTs who will hold onto a patient's wrist for two seconds and declare that their pulse is thirty.  You have FF/EMTs who bring cardiac arrest patients down the stairs in a stairchair, and block their airway with an OPA in the process because they can't grasp the concept of gravity.  You have FF/EMTs who will wait on scene for the medics to get there.

As for looking neat, I would hardly call responding in ripped jeans and a stained FD T-shirt neat.  The paid services in my area have uniform requirements that, if not met, result in the offender being sent home.

The only two places in my county that I feel safe are the two bigger towns, because they have paid ALS third services.  If I'm in some of the more rural areas in the Northern or Southern parts of my county, I will still get the same paid ALS third services, but I do not feel safe knowing who will get there first, if they even manage to crew.

Paid services in my area can provide a paramedic on every call.  Paramedics who, I know from experience, have gone through paramedic school, then have undergone a several-month long preceptorship under direct supervision of the service's medical director, and undergo 36 credits of continuing education (education, NOT training) every year, not including the specific courses required by the service.

I see nothing that your FD can provide that my third-service and private companies cannot, except maybe paramedics who focus on being paramedics instead of being jacks of all trades.


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## VentMedic (Jun 27, 2009)

EMTinNEPA said:


> I'm so sorry to hear that.


 
Why? Much of Florida is Fire Based EMS. We do have several excellent FDs providing excellent medical care to the public. Granted we do have a couple of areas like Collier County but much of that is largely due to bad, bad management and does not represent the rest of Florida.



> ALS response in my area is 100% third service, while the Fire Departments can only provide BLS services.





> You have FF/EMTs who will wait on scene for the medics to get there.


 
Our first responders are Paramedics. We don't wait for another service to show up with a Paramedic nor do we have to drive real fast to intercept with a Paramedic ambulance.



> I see nothing that your FD can provide that my third-service and private companies cannot,


 
See above statement. It sounds like your FD needs to upgrade to ALS to improve on the service provided to the patients since your private Paramedics can not get there as quickly.

For busy FDs who do fight a lot of Fires, I am opposed to this.  I also see a problem with the EMTs from the county and private services who have no desire to fight fires putting the other fire fighters in danger at a fire scene.  It goes both ways on the jack of all trades skills.  Most of our FFs are Paramedics when they join the FD.  If they don't like the EMS part, they can usually rotate off to an engine or ladder later.  Those that like EMS will usually stay and perfect their medical skills/knowledge.  Many of the senior Paramedics with FDs had degrees in EMS because that was what it took to get hired many years ago.  I do hate to see the medic mill mentality that has taken over but again that problem also exists in private companies which have their own mills to get warm bodies working on the trucks.


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## EMTinNEPA (Jun 27, 2009)

VentMedic said:


> It sounds like your FD needs to upgrade to ALS to improve on the service provided to the patients since your private Paramedics can not get there as quickly.



Did you not read the horror stories of their EMTs?  If they let morons like that volunteer, I don't even want to imagine what kind of medics they'd hire.  What they need to do (and probably will do eventually) is pay one of the two private services to staff a paid medic at their station 24/7.  My service already does that for one volunteer service, and it's one of the primary ALS trucks for the entire county.


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## VentMedic (Jun 27, 2009)

EMTinNEPA said:


> Did you not read the horror stories of their EMTs? If they let morons like that volunteer, I don't even want to imagine what kind of medics they'd hire. What they need to do (and probably will do eventually) is pay one of the two private services to staff a paid medic at their station 24/7. My service already does that for one volunteer service, and it's one of the primary ALS trucks for the entire county.


 
Volunteer? What's that? We provide only paid services.


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## EMTinNEPA (Jun 27, 2009)

And if I may ask for clarification, Vent, do your Fire-Based Services allow paramedics to be just that: paramedics?  Or do they want all of them to be ACLS, PALS, PHTLS, AMLS, PEPP and GEMS certified paramedic fire suppression hazmat high-angle confined space swift-water vehicle rescue technicians?  If they are separate, how does paramedic salary compare to firefighter salary?


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## EMTinNEPA (Jun 27, 2009)

VentMedic said:


> Volunteer? What's that? We provide only paid services.



I know, I oppose it as well.  However, considering the number of calls the volunteer BLS services fail to crew for, half the time it's like they don't even exist at all.


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## VentMedic (Jun 27, 2009)

EMTinNEPA said:


> And if I may ask for clarification, Vent, do your Fire-Based Services allow paramedics to be just that: paramedics? Or do they want all of them to be ACLS, PALS, PHTLS, AMLS, PEPP and GEMS certified paramedic fire suppression hazmat high-angle confined space swift-water vehicle rescue technicians? If they are separate, how does paramedic salary compare to firefighter salary?


 
In my area, if they are working on the Paramedic Rescue unit or they are the lead on an ALS engine, they meet the full rerquirements as a Paramedic.

Our FDs also have many well trained specialists for the hazmat and water rescues. Even there you can not expect one to alway be a jack of all trades. If the emergency requires a dive team, a team who is very well trained for that will be dispatched. We do not believe in "yeah they took a course once and did a couple of dives" mentality. Some FFs can be trained to provide all the services in a day or two course. However, if they don't retrain and review often, what good is it? Paramedics of all services can brag about being able to intubate a child or do a cric but if they don't at least train, retrain and review often, how good will they actually be at that skill if they haven't practiced since medic school?

In some departments, it is about an average of $5 - 8k more with a Paramedic cert.  Howevr, there are other ways a FF can advance their salary.   As it stands now, the Paramedic cert is the easiest.


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## EMTinNEPA (Jun 27, 2009)

VentMedic said:


> In my area, if they are working on the Paramedic Rescue unit or they are the lead on an ALS engine, they meet the full rerquirements as a Paramedic.
> 
> Our FDs also have many well trained specialists for the hazmat and water rescues. Even there you can not expect one to alway be a jack of all trades. If the emergency requires a dive team, a team who is very well trained for that will be dispatched. We do not believe in "yeah they took a course once and did a couple of dives" mentality. Some FFs can be trained to provide all the services in a day or two course. However, if they don't retrain and review often, what good is it? Paramedics of all services can brag about being able to intubate a child or do a cric but if they don't at least train, retrain and review often, how good will they actually be at that skill if they haven't practiced since medic school?
> 
> In some departments, it is about an average of $6 - 8k more.



No, I meant can you be *JUST* a paramedic, not a firefighter?  And is it the $6k - 8k more for the firefighters or for the paramedics?


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## VentMedic (Jun 27, 2009)

EMTinNEPA said:


> No, I meant can you be *JUST* a paramedic, not a firefighter? And is it the $6k - 8k more for the firefighters or for the paramedics?


 
If you come in with the Paramedic cert, they get a higher pay.

No, we do not have our EMS/FD set up like NY or SF.


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## EMTinNEPA (Jun 27, 2009)

VentMedic said:


> If you come in with the Paramedic cert, they get a higher pay.
> 
> No, we do not have our EMS/FD set up like NY or SF.



A paramedic is only worth $6k - $8k a year?


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## boingo (Jun 27, 2009)

I'm not convinced that having a paramedic on every fire truck makes for better EMS delivery.  The vast majority of calls don't require ALS level care in the first 4 minutes.  If a fire department is going to deliver high quality ALS level care, I believe the Seattle model is best.  Fire first responders, with ALS providers in ambulances, not ladder trucks.  Just because you can put an ALS provider on scene in 4 minutes doesn't mean the quality of care is going to be better.  Over saturation with paramedics is what makes places like L.A such an abortion of pre-hospital medicine.


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## Shishkabob (Jun 27, 2009)

I'm neutral on Fire EMS.  Fact is, some places can do it great, while some places (cough DC cough) can suck horribly at it.


Just because someone is a fire-medic doesn't mean they are a bad medic.  There are places, SUCH AS FLORIDA, where if you want to be a 911 medic, you pretty much have to be a FF as well.  Pretty close to the same thing here in DFW.  Some cities in DFW don't force you to ride the box, you can actually choose to, which is all the better.


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## Melclin (Jun 27, 2009)

I don't think that the issue is the individual medic. I'm sure there are plenty of good fire medics, its more the debate over the system as a whole, as I understand it.


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## Shishkabob (Jun 27, 2009)

And as I state in every single thread that has to do with generalizations;


DON'T generalize every single person/group throughout the country. (Says the person who commented on DC)


Not all cops are bad.  Not all fire medics suck.  Not all medics follow the law.  Not all Basics are clueless.  Not all candy is good.


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## VentMedic (Jun 27, 2009)

boingo said:


> I'm not convinced that having a paramedic on every fire truck makes for better EMS delivery. The vast majority of calls don't require ALS level care in the first 4 minutes. If a fire department is going to deliver high quality ALS level care, I believe the Seattle model is best. Fire first responders, with ALS providers in ambulances, not ladder trucks. Just because you can put an ALS provider on scene in 4 minutes doesn't mean the quality of care is going to be better. Over saturation with paramedics is what makes places like L.A such an abortion of pre-hospital medicine.


 
No, we do not transport patients on engines or ladder trucks. 
This is where some don't understand a Fire Based EMS system. Many do have ambulances and transport their own patients. 

The system in L.A. is not the best model but that also has to do with their entire state system.


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## VentMedic (Jun 27, 2009)

EMTinNEPA said:


> A paramedic is only worth $6k - $8k a year?


 
That is on top of a very decent FF income plus benefits including retirement.


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## boingo (Jun 27, 2009)

VentMedic said:


> No, we do not transport patients on engines or ladder trucks.
> This is where some don't understand a Fire Based EMS system. Many do have ambulances and transport their own patients.
> 
> The system in L.A. is not the best model but that also has to do with their entire state system.



LOL!  I know they don't transport on those appartus, I just think its overkill to staff supression pieces with paramedics in order to have a paramedic on every call in 4 minutes.


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## VentMedic (Jun 27, 2009)

Would you rather have something like EMTinNEPA described with a mish mash of responders who are EMTs with limited skills and equipment?

I don't always agree with running as many pieces of equipment to one scene as some systems do but there are far worst EMS systems out there that don't believe in providing Paramedics or even a paid employee for some consistency.


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## HotelCo (Jun 27, 2009)

Here we go again...


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## Tincanfireman (Jun 27, 2009)

This subject is near and dear to me, since I have family living in the Golfview district of Polk County and my late MIL was transported many times by Polk County Fire/Rescue before she passed.  Vent and Sasha are correct; they do it right in Florida; but what works in one locale may be inappropriate for another. You have to understand, Polk County is enormous, both geographically and population. They are 7th in population for the entire state (source), but that includes areas as diverse as Lakeland and some of the biggest cattle farms and orange groves in the state.  It is 15 miles from the Golfview station to my FIL's front door, so backup is going to be awhile. If crosstraining provides a higher level of safety for responding crews and the populace in general _and if it has been proven to work as well as it does in FL_, then why not employ it?


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## boingo (Jun 27, 2009)

VentMedic said:


> Would you rather have something like EMTinNEPA described with a mish mash of responders who are EMTs with limited skills and equipment?
> 
> I don't always agree with running as many pieces of equipment to one scene as some systems do but there are far worst EMS systems out there that don't believe in providing Paramedics or even a paid employee for some consistency.



Sure, there is worse things than too many paramedics, however that doesn't make the "medic on every truck" system much better.  I won't argue that a fire department can't provide quality EMS, its just that the vast majority don't.  Seattle is an example of a fire based system, that to me works as it should.  There are no ALS engines, no ALS ladder trucks, only fire EMT first responders with high quality paramedics that treat a lot of high acuity patients, and have a strict QA/QI program in place, and EMS isn't a "punishment" assignment but one that requires constant advancement and con-ed.


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## boingo (Jun 27, 2009)

Tincanfireman said:


> This subject is near and dear to me, since I have family living in the Golfview district of Polk County and my late MIL was transported many times by Polk County Fire/Rescue before she passed.  Vent and Sasha are correct; they do it right in Florida; but what works in one locale may be inappropriate for another. You have to understand, Polk County is enormous, both geographically and population. They are 7th in population for the entire state (source), but that includes areas as diverse as Lakeland and some of the biggest cattle farms and orange groves in the state.  It is 15 miles from the Golfview station to my FIL's front door, so backup is going to be awhile. If crosstraining provides a higher level of safety for responding crews and the populace in general _and if it has been proven to work as well as it does in FL_, then why not employ it?



Proven how?  There was a retrospective study done 10 or so years ago in the Orlando area that showed a 20% misplaced endotracheal intubation rate, is that how its "done right"?  Too many medics with too few patient care interactions produce piss poor results, intubation is one of the hot topics at the moment.  Look at the numbers coming out of systems with a high number of paramedics per population, and then compare it to a system with a low number of medics per population.  More does not equal better.  Can more equal better?  Perhaps, but it would take a very involved medical director and a committed group of medical professionals to provide the needed clinical experience to maintain a high level of proficiency, haven't seen it yet.


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## VentMedic (Jun 27, 2009)

HotelCo said:


> Here we go again...


 
Do you want to explain that?  How much experience with various systems do you have to offer a comment?


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## HotelCo (Jun 27, 2009)

VentMedic said:


> Do you want to explain that?  How much experience with various systems do you have to offer a comment?



The whole "fire-based EMS" discussion is brought up over and over, and the arguments are the same. Sure, once in a while we have a new argument brought up either for or against it, but overall...

And to answer your question, not much.


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## VentMedic (Jun 27, 2009)

boingo said:


> only fire EMT first responders with high quality paramedics that treat a lot of high acuity patients, and have a strict QA/QI program in place, and EMS isn't a "punishment" assignment but one that requires constant advancement and con-ed.


 
Where do you get the idea it is a punishment? Do you think I don't know what is involved to be a good Paramedic rather than one that just weres the patch to play with the L/S? I joined the FD because I wanted to be a Paramedic and I had to have a degree back in the day to beat out my competitors for a spot as a Paramedic. 

Florida has a large elderly population and the high call volume even in rural areas which is probably another reason volunteer ambulances would not be popular. 

Not all FF/Paramedics will actually be working as a Paramedic. Some may never work as a Paramedic. We also have many residents in CA and FL who are Paramedics but will never work as one for a FD or otherwise. Right now with the low education standards, it doesn't take a lot of effort for some to get the cert to see what it is all about especially since there are enough medic mills around with no prerequisites required except a 120 hour EMT patch. If they don't get on with the FD, they may continue to flip burgers at Burger King.


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## VentMedic (Jun 27, 2009)

HotelCo said:


> The whole "fire-based EMS" discussion is brought up over and over, and the arguments are the same. Sure, once in a while we have a new argument brought up either for or against it, but overall...
> 
> And to answer your question, not much.


 
Ignoring issues will not make them go away.

Ignoring issues will also limit your knowledge of how things are done in EMS throughout the U.S. and other countries. It never hurts to see how something is done elsewhere and someday you may have a position to where you can incorporate some new ideas.


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## boingo (Jun 27, 2009)

VentMedic said:


> Where do you get the idea it is a punishment? Do you think I don't know what is involved to be a good Paramedic rather than one that just weres the patch to play with the L/S? I joined the FD because I wanted to be a Paramedic and I had to have a degree back in the day to beat out my competitors for a spot as a Paramedic.
> 
> Florida has a large elderly population and the high call volume even in rural areas which is probably another reason volunteer ambulances would not be popular.
> 
> Not all FF/Paramedics will actually be working as a Paramedic. Some may never work as a Paramedic. We also have many residents in CA and FL who are Paramedics but will never work as one for a FD or otherwise. Right now with the low education standards, it doesn't take a lot of effort for some to get the cert to see what it is all about especially since there are enough medic mills around with no prerequisites required except a 120 hour EMT patch. If they don't get on with the FD, they may continue to flip burgers at Burger King.



In some systems, riding the "box" is punishment when you want to ride suppresion.  I'm not saying that is the case everywhere, it may not be the case at all at the department you started with.  My issue is with over saturation of providers, regardless the education level unless there is the clinical opportunities required to maintain a high level of competence.  I think you would agree that a Florida medic mill (or any states medic mill) paramedic assigned to an engine company stuffing plastic down someones throat is a bad idea.  A better idea would be proficient BLS level first response with highly qualified, highly experienced ALS back up, with rigid medical oversite, regardless of the affiliation of said ALS provider.  A medic with a pulse on every truck to stop the ALS "clock" is not better medicine.  I'd rather have competent advanced care in 10 minutes than half assed "advanced" care in 4.  That is the only point I'd like to make.  The organization providing care is irrelevant.


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## ResTech (Jun 27, 2009)

Generally speaking I am against Fire-based EMS... I've seen it too many times... Firefighter's who want nothing to do with EMS... in fact I've known some that absolutely hate it... become ALS solely because they are forced to do it as part of their job. They have no desire to provide great care or keep up on the latest trends within the field and be cutting edge. All they want to do is ride the shiny fire truck and fight fire. And the ones I know went through a very condensed EMT-Intermediate course just to get the patch so they can fill a spot on a Medic unit in the city. 

Fire & EMS are totally seperate functions and fields. The same people who were so against EMS being considered Public Safety due to the distinct medical element of EMS are now advocating Fire based EMS... how is that??? If EMS is a medical profession and not Public Safety then it doesn't belong within a Fire Department, right? 

Both fire and EMS should have people who can dedicate themselves to their field and do it well. If you don't want to provide EMS then you shouldn't be forced to. And if you are a great Paramedic who doesn't want to fight fire, then you shouldn't have to nor be held back from a job.

I wanna work in Baltimore City and would meet the fire qualification but I hate fire suppression... would you want me backing you up on a line on a row house fire??? nope. Same as I wouldn't want you providing care for me or being my partner when I know your heart isn't in it or have very little clue what ur doing.


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## VentMedic (Jun 27, 2009)

ResTech said:


> The same people who were so against EMS being considered Public Safety due to the distinct medical element of EMS are now advocating Fire based EMS... how is that???


 
I am not against Public Safety.  A FD is part of Public Safety and that is another role they must provide. 

Not all FDs are the same and Baltimore may be a very bad example for both firefighting and EMS.   There are many FDs that do have a balance.  I too would not want a FF watching my back at a fire scene who didn't give a crap about being a FF.  But, there are many more who are very good at both professions.  Unfortunately, EMS in many areas, whether it is Fire or not, depends more on skills with a recipe to follow rather than knowledge and guidelines in place with the protocols.


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## ResTech (Jun 27, 2009)

I agree some are great at both and have a heart in both.... but I think a large majority would drop EMS from their job description in a heartbeat if given the chance.


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## EMTinNEPA (Jun 27, 2009)

VentMedic said:


> That is on top of a very decent FF income plus benefits including retirement.



And why not that as part of a decent paramedic income plus benefits including retirement?  Why do you have to be a firefighter as well?


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## EMTinNEPA (Jun 28, 2009)

VentMedic said:


> Would you rather have something like EMTinNEPA described with a mish mash of responders who are EMTs with limited skills and equipment?
> 
> I don't always agree with running as many pieces of equipment to one scene as some systems do but there are far worst EMS systems out there that don't believe in providing Paramedics or even a paid employee for some consistency.



Who said anything about a mish mash of responders who are EMTs?  Every single call in this county could be provided a paramedic.  The only reason they aren't is because of the county's dispatch protocols.  You act like a 911 call in my system is a death sentence and there is no paramedic or even paid EMT in sight.  I have to ask, did you hurt your back setting up such a gigantic strawman?  Yes, we have two paid ALS third services... but with a population of less than 65000 and some of that area being covered by out-of-county units, do you really need more than that?  Between the two paid services, we average maybe 25 calls in a 24 hour period.


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## Sasha (Jun 28, 2009)

EMTinNEPA said:


> And why not that as part of a decent paramedic income plus benefits including retirement?  Why do you have to be a firefighter as well?



Because FF have their crap together and Paramedics don't.


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## VentMedic (Jun 28, 2009)

EMTinNEPA said:


> And why not that as part of a decent paramedic income plus benefits including retirement? Why do you have to be a firefighter as well?


 
Nobody said you had to live in Florida. 

There are areas where you can find jobs as a Paramedic in a service with good benefits and pay. 

Like any other healthcare profession, including nursing, there may be things required that weren't in their idea of a dream job or the pay in an area is horrible. Nurses may leave FL to go to another state like CA where they can make 3 - 4x more money and take 3 - 4 times less patients.  And, they don't have to do the job of an Environmental Tech as well as patient care.

There have been quite a few on the EMS forums that suppport a volunteer system such as the one in NJ. What does being a computer programmer by day and an EMT by night have in common? 

I know education is a tired subject but until the entry level requirements of education for the EMT and the Paramedic are raised, many agencies will continue to view both as "techs" with just some additional skils to offer. If a two year degree was the standard for Paramedic, some FDs, ambulance companies and those holding the reimbursement strings in Washington, D.C. might view it a little differently.


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## EMTinNEPA (Jun 28, 2009)

Sasha said:


> Because FF have their crap together and Paramedics don't.



Could you be any more vague?


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## VentMedic (Jun 28, 2009)

EMTinNEPA said:


> Who said anything about a mish mash of responders who are EMTs?


 
You did a few pages back:



EMTinNEPA said:


> There are some great EMTs running with the FD-based BLS service, but only because they work, or at one time worked, for one of the paid ALS third services. The ones that haven't are disgustingly apparent. Here you have FF/EMTs who will hold onto a patient's wrist for two seconds and declare that their pulse is thirty. You have FF/EMTs who bring cardiac arrest patients down the stairs in a stairchair, and block their airway with an OPA in the process because they can't grasp the concept of gravity. You have FF/EMTs who will wait on scene for the medics to get there.


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## EMTinNEPA (Jun 28, 2009)

VentMedic said:


> Nobody said you had to live in Florida.
> 
> There are areas where you can find jobs as a Paramedic in a service with good benefits and pay.
> 
> ...



I will never live in Florida.  I couldn't stand to live somewhere without seasons.

What if everybody who wanted to be an architect had to be a janitor?  What if everybody who wanted to be an astronaut had to be the dude on the back of the garbage truck?  These jobs have nothing to do with one another.  The only thing EMS and Fire Suppression have in common are the lights and sirens.  It's just another ploy by the Fire Department to make money because they educated the public to the point that they're driving themselves out of existence.  And if by "environmental technician" you mean the handling of certain biological wastes, that's part of patient care.  Keeping the room and the patient clean?  Also part of patient care.  We clean our rigs after every call, DON'T we?

As I have stated on this forum several times, I am VERY anti-volunteer.  If it were up to me, every department in the United States would be a paid 24/7 third service, and the employees could have fun running into burning buildings on their time off.

And I am very pro-education.  However, it's the volunteers (like the ones that run with my local FIRE DEPARTMENTS) and FD medic mills across the country that lobby to keep the educational standards low.  I don't care if Florida and Seattle are exceptions that prove the rule.  Are two exceptions worth hundreds of cases of "same old song and dance"?


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## EMTinNEPA (Jun 28, 2009)

VentMedic said:


> You did a few pages back:



Hardly a mish-mash.  Seems like either volunteer Firefighters or FF/EMTs who don't know their anus from a hole in the ground, or a paid crew (paramedic included) that actually knows what's going on.  Most of the calls (imo should be all of the calls, but that's county's fault, not ours), there is a paid crew there to slap the volunteers, call them morons, and do the job right.  The volunteers exist only as a relic of yesteryear.  The paid services in this county could handle the call volume on their own.  And things work quite well on the paid ALS side of things.


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## VentMedic (Jun 28, 2009)

EMTinNEPA said:


> I will never live in Florida. I couldn't stand to live somewhere without seasons.
> 
> What if everybody who wanted to be an architect had to be a janitor? What if everybody who wanted to be an astronaut had to be the dude on the back of the garbage truck? These jobs have nothing to do with one another. The only thing EMS and Fire Suppression have in common are the lights and sirens. It's just another ploy by the Fire Department to make money because they educated the public to the point that they're driving themselves out of existence. And if by "environmental technician" you mean the handling of certain biological wastes, that's part of patient care. Keeping the room and the patient clean? Also part of patient care. We clean our rigs after every call, DON'T we?
> 
> ...


 
There are just as many if not more ambulance companies that have their own mills. 

I can see you don't like FFs so it is of little use to continue an argument with you. You also have not worked in very many professional systems to know all the advantages and disadvantages. And, you are not in Paramedic school yet.

Cleaning the patient care area of a truck and cleaning an entire patient room, including bathroom, which may take over an hour is a little different and takes other professionals away from their other patients. You don't have another patient in the truck when you are cleaning it so there is no comparison.



EMTinNEPA said:


> Hardly a mish-mash. Seems like either volunteer Firefighters or FF/EMTs who don't know their anus from a hole in the ground, or a paid crew (paramedic included) that actually knows what's going on. Most of the calls (imo should be all of the calls, but that's county's fault, not ours), there is a paid crew there to slap the volunteers, call them morons, and do the job right. The volunteers exist only as a relic of yesteryear. The paid services in this county could handle the call volume on their own. And things work quite well on the paid ALS side of things.


 
So whre are the paid ALS? Why are patients subject to the type of care you mentioned and for what length of time?


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## EMTinNEPA (Jun 28, 2009)

I have no problem with FFs.  If my house is burning down, I want a firefighter, who focuses all his time and all his training on BEING A FIREFIGHTER.  If I'm having a heart attack, I want a paramedic who focuses all his time and all his training on BEING A PARAMEDIC.  I want a master of the trade at hand, not a jack of all, master of none.  It's just like using the right tool for the job.  Sure, a pair of pliers may allow you to tighten the nut, but would it do the job like a perfectly-fitting wrench?

You do this all the time, address half my points, resort to NUMEROUS logical fallacies (usually strawmen, appeals to ridicule, or ad hominems), then declare that I am not worth having an argument with.

And since we've reduced the discussion to claims of bias, I have to ask, what is your problem with private third service medics?  The fact that they view healthcare as a business and treat it as such?  The fact that if they handled all the EMS, the Fire Department would have to cut significant numbers and resources?


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## EMTinNEPA (Jun 28, 2009)

VentMedic said:


> There are just as many if not more ambulance companies that have their own mills.
> 
> I can see you don't like FFs so it is of little use to continue an argument with you. You also have not worked in very many professional systems to know all the advantages and disadvantages. And, you are not in Paramedic school yet.
> 
> ...



So just because some of the bigger ambulance companies in this country have mills, that makes it ok for FDs to?

Cleaning is cleaning.  Sorry, I thought being clean was part of being a medical professional.

And how do you know what services I have worked in?  I currently work for a private/hospital based service.  In the past I have worked for private not-for-profit, pure for-profit, and fire-based services.  And I would take private ANY DAY OF THE WEEK.  I don't need to be a paramedic to recognize obvious bullcrap when I see it.

Where are the paid ALS?  Most of the time on scene before the volunteers, if the volunteers ever even get out.  On the rare occasions the vollies beat us, the patient is subject to the same level of care or sub-par care (depending on the individual on the vollie truck) for no more than 3-4 minutes, except in RARE extenuating circumstances.


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## atropine (Jun 28, 2009)

VentMedic said:


> No, we do not transport patients on engines or ladder trucks.
> This is where some don't understand a Fire Based EMS system. Many do have ambulances and transport their own patients.
> 
> The system in L.A. is not the best model but that also has to do with their entire state system.



Do you live in LA, until you do don't bash. I work in southern Cali, and this is a great system, with lots of $$$ to be made.


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## VentMedic (Jun 28, 2009)

EMTinNEPA said:


> And since we've reduced the discussion to claims of bias, I have to ask, what is your problem with private third service medics? The fact that they view healthcare as a business and treat it as such? The fact that if they handled all the EMS, the Fire Department would have to cut significant numbers and resources?


 
You are talking like you know everything about all services when you only have a little experience in the field. 

The  FDs in your area suck for medical care. I got that. That doesn't mean FDs are horrible everywhere. Some third service medics are very bad especially if they went to a 3 month wonder mill. Some are poorly run with little oversite and no adequate QA/QI in place. Some could care less about the safety of their employees. 

So, don't judge all FDs based on the limited experience you have with the bad FDs in your area. I don't judge all ambulance services based on some of the very bad ones I have seen during my 30 years in this profession. I also spent more than a decade with a county EMS service (same Florida Retirement benefits) which had both very good Paramedics and some very bad ones. 

It is the quality of the management and the attitude of the provider that makes for quality patient care.


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## VentMedic (Jun 28, 2009)

atropine said:


> Do you live in LA, until you do don't bash. I work in southern Cali, and this is a great system, *with lots of $$$ to be made*.


 
Are you one of those LA FFs that are now going to tell us all about the money you make and the hot babes you bed?

I think I have already read some of your posts on another forum as well your comment about women and no pants on this one.

Yes, you would be the one that gives professional FF/Paramedics a bad rep.


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## EMTinNEPA (Jun 28, 2009)

VentMedic said:


> You are talking like you know everything about all services when you only have a little experience in the field.
> 
> The  FDs in your area suck for medical care. I got that. That doesn't mean FDs are horrible everywhere. Some third service medics are very bad especially if they went to a 3 month wonder mill. Some are poorly run with little oversite and no adequate QA/QI in place. Some could care less about the safety of their employees.
> 
> ...



You will find no three-month wonder mill medics here... closest schools are all one year for a cert, two years for a degree, and over half of the medics have degrees.  My PRIVATE service has a rigorous QA/QI process, and a safety committee who meet (on their own private time) several times a month simply to discuss how to make our service safer.

Florida and Seattle do it right... I gave you that.  But there are too many systems like LA County, Washington DC, FDNY that focus on firefighting when the majority of their income is from EMS.  Hell, FDNY went so far as to call firefighter a "promotion" from the paramedic level.  All this does is cheapen our chosen profession.

The private services in your area suck.  I get that.  Know why they suck?  Because they all wanted to work for the fire department, but the fire department didn't have any openings.  How many of those private paramedics want to be firefighters?


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## Sasha (Jun 28, 2009)

> The private services in your area suck. I get that. Know why they suck? Because they all wanted to work for the fire department, but the fire department didn't have any openings. How many of those private paramedics want to be firefighters?



Wow, i didn't know you speak for all those privately employed EMTs/Medics in florida!


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## EMTinNEPA (Jun 28, 2009)

Sasha said:


> Wow, i didn't know you speak for all those privately employed EMTs/Medics in florida!



And I didn't know that Rural/Metro represented every single private ambulance service in the United States, but you sure made that assumption in a hurry when it supported your argument.


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## VentMedic (Jun 28, 2009)

EMTinNEPA said:


> The private services in your area suck. I get that. Know why they suck? Because they all wanted to work for the fire department, but the fire department didn't have any openings. How many of those private paramedics want to be firefighters?


 
I did not say the private services suck but yes there are many Paramedics working the BLS transport trucks until they get on with the FD.   

The FD has been the culture here for over 40 years.  If that is the primary service you grew up with, that is the norm.    Many want to be FireMedics with a FD just like Johnny and Roy.


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## EMTinNEPA (Jun 28, 2009)

VentMedic said:


> I did not say the private services suck but yes there are many Paramedics working the BLS transport trucks until they get on with the FD.
> 
> The FD has been the culture here for over 40 years.  If that is the primary service you grew up with, that is the norm.    Many want to be FireMedics with a FD just like Johnny and Roy.



So if it was the norm in their culture, that makes it right?  Do I really have to bring up numerous other embarrassing cultural norms from our species' storied past?

I idolize Johnny and Roy too.  However, whenever they go on a fire call, I fall asleep in front of the TV.


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## atropine (Jun 28, 2009)

VentMedic said:


> Are you one of those LA FFs that are now going to tell us all about the money you make and the hot babes you bed?
> 
> I think I have already read some of your posts on another forum as well your comment about women and no pants on this one.
> 
> Yes, you would be the one that gives professional FF/Paramedics a bad rep.



I liked to know how I make the profession a bad rep, but at least you got that right FF/Paramedic is a profession.


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## VentMedic (Jun 28, 2009)

EMTinNEPA said:


> So if it was the norm in their culture, that makes it right? Do I really have to bring up numerous other embarrassing cultural norms from our species' storied past?
> 
> I idolize Johnny and Roy too. However, whenever they go on a fire call, I fall asleep in front of the TV.


 
Enough FF bashing for one thread.  

I posted the thread because some have been wondering when this would finally go through in Polk County.   The next area to watch is Pinellas County and Sunstar.   Right or wrong you are not the one to determine that.   

As Bledsoe said in his article, Paramedics need to come together as professionals regardless of the system they work for if they are dealing with patient care.


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## VentMedic (Jun 28, 2009)

atropine said:


> I liked to know how I make the profession a bad rep, but at least you got that right FF/Paramedic is a profession.


 
It is a profession but that does not always mean those that do it are professional. Some are in it just for the money and the chicks. They have no interest in being either a FF or a Paramedic.


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## atropine (Jun 28, 2009)

I do ,agree with you vent on this one paramedics do need to come together, now to what extent I do not know, I can say that thing are not going to change anytime soon wat least in the area where I work( fire based ems), where the EMSA and suntars are who knows what those fates will be?


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## CAOX3 (Jun 28, 2009)

Should we care who handles EMS if its done professionaly?


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## atropine (Jun 28, 2009)

CAOX3 said:


> Should we care who handles EMS if its done professionaly?



No we should not care, but I am one of those people who think nothing will change, ems is just one of those things where companies, cities, counties will just try to fing the cheapist way to run the show, so no matter how much education you have wages and benifits are not going to change, but that's just my opion.


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## BLSBoy (Jun 28, 2009)

Hmm. Looks like there could be jobs opening up. 

My timeframe for moving back could be accelerated.....


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## boingo (Jun 28, 2009)

VentMedic said:


> Are you one of those LA FFs that are now going to tell us all about the money you make and the hot babes you bed?
> 
> I think I have already read some of your posts on another forum as well your comment about women and no pants on this one.
> 
> Yes, you would be the one that gives professional FF/Paramedics a bad rep.



At least he spelled "atropine" correctly.  :blush:


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## 46Young (Jun 28, 2009)

EMTinNEPA said:


> 46Young, are those $$$'s, benefits, pension, DROP, working conditions and such also aren't worth having to join the bucket brigade and going running into burning buildings?  Or sitting back and watching firefighters who run a tenth of your call volume make twice as much as you?  Or having to bear witness to sub-par paramedics who are paramedics just because they want to ride in a shiny wed fire twuck?
> 
> The $$$'s, benefits, pension, DROP, working conditions and such could be there on the third service, private, and hospital based as well if people realized the grave injustices fire-based EMS does to them and demanded a third service.



I've tried both hospital based EMS and third service EMS. The salary, benefits, etc. etc. will never compare to fire based EMS, especially regarding working conditions, save some depts in the pacific northwest. There are depts that have single role medics. I joined Fairfax both for the desire to do both EMS and suppression, as well as the desire to be financially comfortable. Many of us have entered the field to help others. I'm not doing this for free, however. This is what I do to support my family. I moved out at 22 y/o and worked several jobs to survive. I'm not going to work EMS as a career for peanuts. Compare general job satisfaction, burnout, and attrition between fire based and others. If there were third service agencies in existence that had comparable conditions, I would have been perfectly happy there. They don't exist. It's just how it is. As far as call volume, the medic runs 4-12 in 24 hours, the ALS engine runs 3-10 calls daily. We did 1 1/2 hrs of PT, ate an uninterrupted dinner, watched Borat in the evening, and slept most of the night. That generally doesn't happen with third service, unless you're out in God's country. I identified the superior benefits to the employee in fire based EMS, at least in Fairfax. I'm rubbing it in because you were sarcastic and bitter, with a hint of jealousy, with the one tenth call volume making twice as much comment. It would be great if EMS only could have a better deal, as there is much abuse, burnout, ridiculous call volume, and general lack of morale. I don't see that happening anytime soon, however. Do something about it instead of whining.


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## medic417 (Jun 28, 2009)

boingo said:


> At least he spelled "atropine" correctly.  :blush:


On another forum he misspelled the drug he chose for a name there.


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## 46Young (Jun 28, 2009)

EMTinNEPA said:


> I have no problem with FFs.  If my house is burning down, I want a firefighter, who focuses all his time and all his training on BEING A FIREFIGHTER.  If I'm having a heart attack, I want a paramedic who focuses all his time and all his training on BEING A PARAMEDIC.  I want a master of the trade at hand, not a jack of all, master of none.  It's just like using the right tool for the job.  Sure, a pair of pliers may allow you to tighten the nut, but would it do the job like a perfectly-fitting wrench?
> 
> You do this all the time, address half my points, resort to NUMEROUS logical fallacies (usually strawmen, appeals to ridicule, or ad hominems), then declare that I am not worth having an argument with.
> 
> And since we've reduced the discussion to claims of bias, I have to ask, what is your problem with private third service medics?  The fact that they view healthcare as a business and treat it as such?  The fact that if they handled all the EMS, the Fire Department would have to cut significant numbers and resources?


In NY, third service agencies such as Transcare(Metrocare), Jamaica/Flushing/Brookdale hosps.(I worked per diem for them), AMR, St. Johns, and the like have ongoing problems with pt steering. Insured pts go to their hosps. and uninsured pts go to city hospitals. Equipment can be subpar, and so can the quality of the provider. Private EMS is known for having crappy pay and benefits. These agencies are generally regarded as stepping stone jobs. Burning out employees is no problem when there are many more available to backfill. What's the advantage to treating healthcare as a business, from the employees end? You know any profits will be retained for the service's owner.


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## EMTinNEPA (Jun 28, 2009)

46Young said:


> I've tried both hospital based EMS and third service EMS. The salary, benefits, etc. etc. will never compare to fire based EMS, especially regarding working conditions, save some depts in the pacific northwest. There are depts that have single role medics. I joined Fairfax both for the desire to do both EMS and suppression, as well as the desire to be financially comfortable. Many of us have entered the field to help others. I'm not doing this for free, however. This is what I do to support my family. I moved out at 22 y/o and worked several jobs to survive. I'm not going to work EMS as a career for peanuts. Compare general job satisfaction, burnout, and attrition between fire based and others. If there were third service agencies in existence that had comparable conditions, I would have been perfectly happy there. They don't exist. It's just how it is. As far as call volume, the medic runs 4-12 in 24 hours, the ALS engine runs 3-10 calls daily. We did 1 1/2 hrs of PT, ate an uninterrupted dinner, watched Borat in the evening, and slept most of the night. That generally doesn't happen with third service, unless you're out in God's country. I identified the superior benefits to the employee in fire based EMS, at least in Fairfax. I'm rubbing it in because you were sarcastic and bitter, with a hint of jealousy, with the one tenth call volume making twice as much comment. It would be great if EMS only could have a better deal, as there is much abuse, burnout, ridiculous call volume, and general lack of morale. I don't see that happening anytime soon, however. Do something about it instead of whining.



The salary, benefits, etc., are not worth having to work out of a firehouse, or be asked if you are a firefighter, or be called a firefighter.  Not to me, anyway.  I'm willing to take a pay-cut and have second-rate benefits so that I don't have to fight fires, I don't have to listen to firefighters, be anywhere near firefighters, and not be called a firefighter.  The only reason Fire-Based EMS has such superior benefits is government backing.  The only reason Fire Departments have EMS is $$$ or as an archaic relic of yesteryear.  If private ambulances handled all of the 911s in New York City, how many calls a year would FDNY respond to?  How many FDNY firefighter jobs would be cut?  Am I jealous of firefighters?  Hell yes, I am.  They run a tenth of the calls I do, and spend the rest of the time watching "training videos", or "Washing the rigs" (i.e. standing outside the station and flirting with attractive passerbys).  Meanwhile, the paramedics are running their asses off all day long.  In FDNY, the FF salary is $49,480 when you factor base and fringe.  Paramedics start at $37,346.  So yes, I am jealous, especially when they pull crap like making "firefighter" a rung on the promotional ladder... ABOVE "PARAMEDIC", NO LESS!!  And what do you suggest I do about it?  With so many in EMS being perfectly fine with being lumped into the Fire Service, how is any significant movement supposed to take place?


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## BLSBoy (Jun 28, 2009)

EMTinNEPA said:


> The salary, benefits, etc., are not worth having to work out of a firehouse, or be asked if you are a firefighter, or be called a firefighter.  Not to me, anyway.  I'm willing to take a pay-cut and have second-rate benefits so that I don't have to fight fires, I don't have to listen to firefighters, be anywhere near firefighters, and not be called a firefighter.  The only reason Fire-Based EMS has such superior benefits is government backing.  The only reason Fire Departments have EMS is $$$ or as an archaic relic of yesteryear.  If private ambulances handled all of the 911s in New York City, how many calls a year would FDNY respond to?  How many FDNY firefighter jobs would be cut?  Am I jealous of firefighters?  Hell yes, I am.  They run a tenth of the calls I do, and spend the rest of the time watching "training videos", or "Washing the rigs" (i.e. standing outside the station and flirting with attractive passerbys).  Meanwhile, the paramedics are running their asses off all day long.  In FDNY, the FF salary is $49,480 when you factor base and fringe.  Paramedics start at $37,346.  So yes, I am jealous, especially when they pull crap like making "firefighter" a rung on the promotional ladder... ABOVE "PARAMEDIC", NO LESS!!  And what do you suggest I do about it?  With so many in EMS being perfectly fine with being lumped into the Fire Service, how is any significant movement supposed to take place?



Another bitter, jealous MUTT. 
FTM-PTB. 
The FDNY would not loose fireman positions. 
EMT and Medic, yes, but not Fire. 
Before you go spouting off on the finest trained, as well as one of the most gracious Fire Depts I have had the pleasure of encountering, how about you educate yourself on their innerworkings?
I work for a hospital based ALS provider, as well as a fire dept, doing BLS and fire. 
Depending on the day worked, and event on said day, generally the down time between the two are the same. Only difference is at the Fire Dept, I have 7 of my Brothers to hangout with, and a larger area to roam around in to pass the time. 
If one of my medic units put a bench out front where I could sit to pass time, I sure would. 

But hey, you live in PA. Only good thing to come from your state is PSU, the Philly sports teams, PFD, and the cheese steak.


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## EMTinNEPA (Jun 28, 2009)

BLSBoy said:


> Another bitter, jealous MUTT.



Ad hominem.



BLSBoy said:


> FTM-PTB.



Appeal to emotion.



BLSBoy said:


> The FDNY would not loose fireman positions.
> EMT and Medic, yes, but not Fire.



EMT and Medic, yes, thank God.  Then maybe they could do the job they want to do without having to listen to Bugles.

Why wouldn't they lose firefighter positions?  Without EMS, what would FDNY's call volume be?  Lower call volumes mean less active, and less active warrants fewer tax dollars.



BLSBoy said:


> Before you go spouting off on the finest trained, as well as one of the most gracious Fire Depts I have had the pleasure of encountering, how about you educate yourself on their innerworkings?



An opinion not based in logic, followed by another appeal to emotion, and an appeal to authority.



BLSBoy said:


> I work for a hospital based ALS provider, as well as a fire dept, doing BLS and fire.
> Depending on the day worked, and event on said day, generally the down time between the two are the same. Only difference is at the Fire Dept, I have 7 of my Brothers to hangout with, and a larger area to roam around in to pass the time.



Another appeal to emotion.  They aren't your brothers.  Close friends and co-workers, maybe, but not brothers.



BLSBoy said:


> But hey, you live in PA. Only good thing to come from your state is PSU, the Philly sports teams, PFD, and the cheese steak.



And another ad hominem.

So in one post, you made two ad hominem attacks, three appeals to emotion, an appeal to authority, and an opinion.  Real convincing arguments you made.  I may have to rethink my life now.


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## ffemt8978 (Jun 28, 2009)

That's enough of this one.


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