# Cleveland to merge fire and EMS



## 46Young (Nov 8, 2011)

http://www.firehouse.com/news/top-headlines/cleveland-integrate-fire-department-ems

There are people on my department that have either worked in Cleveland EMS or know people that do (we get a lot of Ohio refugees in NOVA). From what I've been told, EMS is pretty poor there, so I don't think the merger will make it much worse. 

It's not clear if they're going dual role, and if so, what is going to happen to the existing EMS personnel.

Anyone have any additional info on this?


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## 46Young (Nov 9, 2011)

http://blog.cleveland.com/metro/2011/11/cleveland_moves_to_merge_fire.html

Sounds like the same rhetoric - faster response times, saves money, etc. Perhaps it's true, I don't know.

Edit: I hear that they want to force EMS to take the CPAT so that they can be forced into fire school, that EMS admin will be placed under a suppression BC, and will be phased out with attrition. ALS first response on the fire side.


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## usalsfyre (Nov 9, 2011)

So, they took the typical way of doing it....


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## atropine (Nov 9, 2011)

While agree with the cpat thing, Iam too sure about the forcing people into the suppression side of things, but then again these are the sign of the times and if you don't like it go somewhere else I guess. The only reason I do agree with the cpat is because I believe everyone should have to be in a healthly state to prevent any injury to ourselves.


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## 46Young (Nov 9, 2011)

usalsfyre said:


> So, they took the typical way of doing it....



Unless we go to a four year degree for medics, which would choke off the supply to the FD's, it looks like this is the ongoing trend. The only FD's that give EMS it's due attention and funding are those that have always been combined. What I mean is that not all FD's that have always been combined do EMS well, but the only ones that do are ones that have always been combined (from what I've seen). It appears that FD takeovers generally don't end well for the EMS side.


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## 46Young (Nov 9, 2011)

atropine said:


> While agree with the cpat thing, Iam too sure about the forcing people into the suppression side of things, but then again these are the sign of the times and if you don't like it go somewhere else I guess. The only reason I do agree with the cpat is because I believe everyone should have to be in a healthly state to prevent any injury to ourselves.



I agree 110% on some sort of PAT, that must be completed every year, along with passing a physical exam including a pulmonary function test, blood work, mobility testing, vision and hearing, etc.

The problem with the CPAT is that EMS is not pulling lines, raising ladders, pulling ceilings, crawling through tunnels, or forcing entry. These are the things that the CPAT tests.


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## JPINFV (Nov 9, 2011)

46Young said:


> Edit: I hear that they want to force EMS to take the CPAT so that they can be forced into fire school,



So, fire fighters, would you feel comfortable making an interior attack knowing that your backup is only there because they were forced to do so in order to keep their job, and would drop fire suppression faster than a Kardashian marriage if they could?


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## medicsb (Nov 9, 2011)

ALS first response = waste of money and time.  Not a single shred of evidence anywhere that even remotely associates it with any improvement of patient outcome.  And, all in all, it probably makes for really crappy medics.


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## 46Young (Nov 9, 2011)

JPINFV said:


> So, fire fighters, would you feel comfortable making an interior attack knowing that your backup is only there because they were forced to do so in order to keep their job, and would drop fire suppression faster than a Kardashian marriage if they could?



We have people on the job right now that don't want to go interior. Either the're EMS minded, or they're just there for the pay, schedule and benefits, and want to do the least amount possible to keep their job. These individuals tend to work their way onto ambulances all of the time, or just go to slow houses. The thing is, way more people will join a dual role FD mainly for suppression, and accept EMS as part of the job, than the amount of people that want to do EMS only but will accept that they have to run into burning, collapsing buildings. The threat of losing life or limb will turn off most that would join a FD to do EMS while having no suppression interest. 

There are also people in single role EMS that don't want to be there, either. They're easy to spot - they're minutemen at shift change, they try to walk whoever they can even if they shouldn't, they'll find reasons or use creative documentation on a regular basis to withhold meds or other interventions, they never pick up a call in their first due if it goes to someone else (and they're reaonably close), and they take as long as possible with their reports (They'll just give us another call if we go available).

I'm also told that existing dual role FD's will not consider hiring single role EMS to help with staffing since that opens the door for the privates to take over the EMS txp. It's too bad. I know a good number of medics where I work that enjoy EMS, but not 100% of the time. When they're kept off the engine for an extended period of time, they begin to resent EMS. That flip-flop makes for a long, enjoyable career. There's a reason why the average single role EMS tenure is only 7-10 years. I'm at 9+ years right now. Had I stayed in NY, I'd be in a different medical field by now, or working feverishly to that end. I wouldn't do single role EMS for 25-30 years. There's no career ladder, it becomes both stressful and mundane, has lots of needless drama from dispatchers and admin, and sitting in the box every day and then lifting heavy objects and people will break down your body sooner or later.

I'd have liked dual role EMS/police if it were available. Plenty of career advancement and different areas to move into courtesy of the police side.


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## 46Young (Nov 9, 2011)

medicsb said:


> ALS first response = waste of money and time.  Not a single shred of evidence anywhere that even remotely associates it with any improvement of patient outcome.  And, all in all, it probably makes for really crappy medics.



I feel that it's a matter of degree. I've worked in an urban environment (NYC) where there were plenty of EMS resources without needing suppression personnel. due to population density, we had units stacked on each other, sometimes only blocks away, and the tax base to support it all. 

In the suburbs, it's a toss up. My current environment is more or less suburban. We could handle most of our calls without manpower or another medic, but there are times that we do need another medic and/or another basic or two.

In rural areas, the backup is necessary, and sometimes vital. I used to work in Charleston county, SC. You can go from urban (Charleston/N. Charleston) to suburban (James Island, Mt. Pleasant, IOP) to rural (Edisto/Kiawah/John's Island/Awendaw/Mclellanville), where EMS txp has 20-45 min response times. First response can initiate care, and also call for HEMS early if appropriate. They've come in real handy on many occasions due to sparse deployment.


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## Fish (Nov 9, 2011)

JPINFV said:


> So, fire fighters, would you feel comfortable making an interior attack knowing that your backup is only there because they were forced to do so in order to keep their job, and would drop fire suppression faster than a Kardashian marriage if they could?



I think people missed the real Gem in your post. "faster than a Kardashian marriage" buwahahaha! Funny stuff


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## Fish (Nov 9, 2011)

medicsb said:


> ALS first response = waste of money and time.  Not a single shred of evidence anywhere that even remotely associates it with any improvement of patient outcome.  And, all in all, it probably makes for really crappy medics.



Agreed, show me the evidence it works. You can't, because it doesn' exist. Now show me how much waisteful spending it causes, and this you can because it is fact!





Also, it was already a city run ALS service. I guess they are thinking grouping admin and such will save money orrrrrr? Who wants to take bets that somehow the budget towards the EMS department actually decreases after this merger.


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## 46Young (Nov 10, 2011)

Fish said:


> Agreed, show me the evidence it works. You can't, because it doesn' exist. Now show me how much waisteful spending it causes, and this you can because it is fact!
> 
> 
> 
> ...



I would have never of thought it possible before I sold out to the fire side, but I like the extra hands to carry my equipment, move my patients, drop a line, get vitals, admin. the meds I choose while I gather a Hx. It makes my job a lot easier, it spares my musculoskeletal system, and makes for a long career due to that and being able to work in other areas than just EMS txp. I used to pride myself on handling the logisitcs of most calls with just me and my partner, but I like it better this way. If I'm going to run a bunch of calls, at least I don't have to hump much equipment or break my back lifting heavy hitters as much. It's also nice to have an extra person available to turn your rig around if needed.

Sure, it may be cost neutral or cost more, but I'd never go back to single role unless I was desperate. I have all the tools and equipment I need to do my job effectively, such as CPAP, in line nebs, jet insufflation, EZ-IO w/ bariatric needle, King LTS w/ sump tube, the Rad 57 CO monitor, vacuum splints, ETCO2 capnography and nasal capnoline, IN Versed, Narcan and Fent, and fairly liberal protocols/guidelines w/ st. order pain management. With my previous single role jobs we worked too hard, the pay and retirement was undesireable, and the career ladder was not there. Total dead end job.

Having said that, I don't agree with takeovers, just that already existing dual role systems that have been around for decades deserve to be there, just like these Cleveland EMS employees also deserve to be there and not be forced out by having to pass a CPAT and possibly be forced to successfully complete the fire academy as a condition of future employment. I'll never agree with any agenda that puts people needlessly out of work, no matter what type of service we're tallkng about.

Honestly, I could care less how much a sytem costs to run, so long as it's sustainable, performs it's function as designed, and provides me with adequate working conditions, benefits, salary, retirement, and a career ladder.


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## Fish (Nov 10, 2011)

46Young said:


> I would have never of thought it possible before I sold out to the fire side, but I like the extra hands to carry my equipment, move my patients, drop a line, get vitals, admin. the meds I choose while I gather a Hx. It makes my job a lot easier, it spares my musculoskeletal system, and makes for a long career due to that and being able to work in other areas than just EMS txp. I used to pride myself on handling the logisitcs of most calls with just me and my partner, but I like it better this way. If I'm going to run a bunch of calls, at least I don't have to hump much equipment or break my back lifting heavy hitters as much. It's also nice to have an extra person available to turn your rig around if needed.
> 
> Sure, it may be cost neutral or cost more, but I'd never go back to single role unless I was desperate. I have all the tools and equipment I need to do my job effectively, such as CPAP, in line nebs, jet insufflation, EZ-IO w/ bariatric needle, King LTS w/ sump tube, the Rad 57 CO monitor, vacuum splints, ETCO2 capnography and nasal capnoline, IN Versed, Narcan and Fent, and fairly liberal protocols/guidelines w/ st. order pain management. With my previous single role jobs we worked too hard, the pay and retirement was undesireable, and the career ladder was not there. Total dead end job.
> 
> Having said that, I don't agree with takeovers, just that already existing dual role systems that have been around for decades deserve to be there, just like these Cleveland EMS employees also deserve to be there and not be forced out by having to pass a CPAT and possibly be forced to successfully complete the fire academy as a condition of future employment. I'll never agree with any agenda that puts people needlessly out of work, no matter what type of service we're tallkng about.



I am not saying having extra hands is not needed, because I think it is. I was saying ALS first response is not cost effective because it has no scientific value or backing. BLS first response does however, and those same BLS first responders can lift equipment and help you treat and assess just as well as the ALS first response. After all, only one Medic can talk to the patient at a time.

Multiple research studies by universities have shown when BLS FR is compared to ALS FR, ALS has no sigificant improved survive rate and that it is not an efficient EMS model.

I am an advocated of FD BLS first response, I think if you give them the tools to handle any true emergency until ALS arrives than the system works. Let do the following:

o2 Admin
CPR
AED
Epi 1:1,000 IM
Albuterol
Oral Glucose
Check BGL
ASA
Nitro
First Aid

These have been shown through research to be the drugs and procedures that can save a life when given early on, within 8mins of onset of 911 call.

Infact, most studies show that the most efficient model is to have BLS within 5-8mins and ALS between 8-12mins.

Denver Health, Wake County, and one other busy Metro service all did studies on this.

Also, and I cannot remember the name of it for the life of me. But an FD did a study like this and the end result was the Medical Director recommending that they delete ALS first response due to it having no value and being inefficient.

I do believe that Medical Director was later fired after much pressure for the FD union *rolls eyes*


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## Fish (Nov 10, 2011)

A google search found this

http://onlinelibrary.wiley.com/doi/10.1197/j.aem.2005.02.013/abstract

Paramedic response in less than 8mins shows no improved survival rate, but give the tools I mentioned above to a BLS first responder and have them respond in 4mins or less and we see a survival rate increase compared to having no one respond for 8mins.

And I mistated above, it was not wake County, it was Mecklenburg.


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## Tigger (Nov 10, 2011)

Fish said:


> I am not saying having extra hands is not needed, because I think it is. I was saying ALS first response is not cost effective because it has no scientific value or backing. BLS first response does however, and those same BLS first responders can lift equipment and help you treat and assess just as well as the ALS first response. After all, only one Medic can talk to the patient at a time.
> 
> Multiple research studies by universities have shown when BLS FR is compared to ALS FR, ALS has no sigificant improved survive rate and that it is not an efficient EMS model.
> 
> ...



As you note, BLS first response when done right is what is most effective in a true emergency. The only thing I would add to the above list of interventions is perhaps a King-type airway considering the difficulties that many have using only a BVM. That an including albuterol nebulizers along with rescue inhalers (maybe you meant that...).

The city of Boston only generally staffs six paramedic ambulances at peak times, yet in the last study I saw Boston was the "second best" city to have a heart attack in. There are a lot of Boston EMS BLS trucks on the streets with competent crews that good at managing real emergencies, and the medics are great since they see the "sickest of the sick." It doesn't seem like to many other cities still place so much emphasis on BLS anymore, which is why I find the heart attack study interesting.


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## Tigger (Nov 10, 2011)

Fish said:


> Agreed, show me the evidence it works. You can't, because it doesn' exist. Now show me how much waisteful spending it causes, and this you can because it is fact!



While I don't disagree that there is a lack of evidence showing the effectiveness of ALS first response, I also question how we measure effectiveness in EMS. Cardiac arrest survival rates may not be changed by ALS first response, but that doesn't mean it isn't making a difference for the patients. All else equal, I'd rather a fire medic giving me an antiemtic for extreme nausea then wait for the ambulance alone. I've taken many people on my BLS truck that could have benefited from ALS level care, but I couldn't get ALS because they were in danger of dying anytime soon, a situation that doesn't happen with ALS first response.

Obviously EMS isn't all about saving lives, it's about doing good for your patient. It just seems very difficult to measure how do good for the patients when they have a serious, but not life threatening complaint.


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## akflightmedic (Nov 10, 2011)

Tigger said:


> The city of Boston only generally staffs six paramedic ambulances at peak times, yet in the last study I saw Boston was the "second best" city to have a heart attack in. There are a lot of Boston EMS BLS trucks on the streets with competent crews that good at managing real emergencies, and the medics are great since they see the "sickest of the sick." It doesn't seem like to many other cities still place so much emphasis on BLS anymore, which is why I find the heart attack study interesting.



One could also argue that in the city of Boston, the position of Paramedic is a promotion. There are dozens of EMTs working who actually are paramedics just waiting for the advancement when a slot opens.

To expand on that further, if they are on a BLS truck I will make the assumption they have no ALS equipment because by job title alone this is prohibited...HOWEVER what they DO have is Paramedic knowledge.

Did the KNOWLEDGE of a paramedic working in an EMT role increase the proper use of ALS units in a timely fashion thereby skewing above results? Did the KNOWLEDGE of the paramedic working as an EMT keep ALS units free from those iffy calls where just an EMT may have called ALS for confirmation so that the ALS unit which remained free was able to respond quicker to true ALS emergencies, thereby again skewing times?

I think one could argue and prove that BLS supplies coupled with ALS knowledge/education could save more lives overall.


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## Fish (Nov 10, 2011)

Tigger said:


> As you note, BLS first response when done right is what is most effective in a true emergency. The only thing I would add to the above list of interventions is perhaps a King-type airway considering the difficulties that many have using only a BVM. That an including albuterol nebulizers along with rescue inhalers (maybe you meant that...).
> 
> The city of Boston only generally staffs six paramedic ambulances at peak times, yet in the last study I saw Boston was the "second best" city to have a heart attack in. There are a lot of Boston EMS BLS trucks on the streets with competent crews that good at managing real emergencies, and the medics are great since they see the "sickest of the sick." It doesn't seem like to many other cities still place so much emphasis on BLS anymore, which is why I find the heart attack study interesting.



Yes, Nebulizers is what I was referring to with the Albuterol


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## Fish (Nov 10, 2011)

Tigger said:


> While I don't disagree that there is a lack of evidence showing the effectiveness of ALS first response, I also question how we measure effectiveness in EMS. Cardiac arrest survival rates may not be changed by ALS first response, but that doesn't mean it isn't making a difference for the patients. All else equal, I'd rather a fire medic giving me an antiemtic for extreme nausea then wait for the ambulance alone. I've taken many people on my BLS truck that could have benefited from ALS level care, but I couldn't get ALS because they were in danger of dying anytime soon, a situation that doesn't happen with ALS first response.
> 
> Obviously EMS isn't all about saving lives, it's about doing good for your patient. It just seems very difficult to measure how do good for the patients when they have a serious, but not life threatening complaint.



That is not what the evidence suggest, it still is suggesting that Fire BLS First response arrives within 4mins. And an Ambulnace arrives within 8-12. No one is advocating not sending first responders to a call at all. 

The cities that the studies were done all have a Medic on the Ambulance, so it is stating that a Medic arrives at every call. The medic just does not need to be there in under 4mins if an EMT is going to be there in under 4mins.


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## Tigger (Nov 10, 2011)

Fish said:


> That is not what the evidence suggest, it still is suggesting that Fire BLS First response arrives within 4mins. And an Ambulnace arrives within 8-12. No one is advocating not sending first responders to a call at all.
> 
> The cities that the studies were done all have a Medic on the Ambulance, so it is stating that a Medic arrives at every call. The medic just does not need to be there in under 4mins if an EMT is going to be there in under 4mins.



Agreed, my above post was poorly worded. My point is that for a patient that is truly sick, but not with a life threatening complaint, BLS does almost nothing. That interim time between first responder and arrival and ambulance arrival is significant at times, and I imagine that we would all consider timely relief of pain and suffering as a large part of EMS. ALS first response is useful here, but I don't think it can be quantified well statistically. I guess the wider question is whether or not everything done by EMS needs to be quantifiably useful, or are there other measures of success?


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## sweetpete (Nov 10, 2011)

I lived in C-town my whole life (prior to moving to Houston 3 years ago). Believe me when I say.....CFD taking over CEMS is the BEST thing to ever happen to CEMS!! 

They've always been the "step child" of Cleveland Safety even though they run their BALLS off!!! Maybe now they'll get some much deserved respect while cutting out some administration.

Just my humble opinion. Take care.


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## medicsb (Nov 10, 2011)

sweetpete said:


> I lived in C-town my whole life (prior to moving to Houston 3 years ago). Believe me when I say.....CFD taking over CEMS is the BEST thing to ever happen to CEMS!!
> 
> They've always been the "step child" of Cleveland Safety even though they run their BALLS off!!! Maybe now they'll get some much deserved respect while cutting out some administration.
> 
> Just my humble opinion. Take care.



Well, allowing ones self to be adopted (and co-opted) pretty much ensures that you will remain a step child.


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## sweetpete (Nov 11, 2011)

Like I said, it was never gonna change. Perhaps now it will. At least they'll be working under the same umbrella as far as finances and leadership goes.

We'll have to wait and see. I think it's the best thing for them.


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## medicsb (Nov 11, 2011)

sweetpete said:


> Like I said, it was never gonna change. Perhaps now it will. At least they'll be working under the same umbrella as far as finances and leadership goes.
> 
> We'll have to wait and see. I think it's the best thing for them.



Maybe.  Considering how other mergers have gone, I'm not holding my breath.  This whole situation is why EMS will remain a step child.  Medics don't want to fight for themselves and will take the "easy" way out.   A shame, really.  (Of course this is not in any way exclusive to Cleveland.)


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## 46Young (Nov 11, 2011)

Fish said:


> I am not saying having extra hands is not needed, because I think it is. I was saying ALS first response is not cost effective because it has no scientific value or backing. BLS first response does however, and those same BLS first responders can lift equipment and help you treat and assess just as well as the ALS first response. After all, only one Medic can talk to the patient at a time.
> 
> Multiple research studies by universities have shown when BLS FR is compared to ALS FR, ALS has no sigificant improved survive rate and that it is not an efficient EMS model.
> 
> ...



I'll have to agree that ALS first response doesn't have any effect on pt outcomes. I'll actually go a bit further and say that if a department is dual role, their medics are seeing less pts overall, particularly acute pts, assuming a 50/50 rotation, so that their learning curve and overall proficiency is curbed greatly.

I'll add the King LTS to your BLS list. Our BLS can drop a King. 

Now, that learning curve and overall proficiency thing is not exclusive to FD EMS. I left NYC, which IMO has an excellent tiered system, for Charleston, SC, before I ended up where I am now. They are a 100% one and one EMS system (single role). I went from seeing several truly sick pts a night to seeing severa a month if I was lucky. Otherwise, it was V.O.M.I.T. calls for the most part - Vitals, O2, Monitor, IV, Txp. I feel that it takes many more years to get good at what you do in that type of system. Back home, I did three years as an EMT. We handled all kinds of stuff on our own, backed up medics when they were delayed, and we also knew when to really call. As a medic, we no longer ran non acute call types, only diff breathers, cardiacs, stat ep, unconscious, inbleed, arrests, and confirmed multi-traumas. If I was to have started my EMS career here, or in SC, I'd be working under medics, and learn basically nothing for those three years. As a medic, in those two years, I'd have the equivalent experience of maybe 2-3 months on the job in NYC.

My question is, do you advocate a tiered system or all-ALS for: urban, suburban, rural? Since you advocate BLS FD first response (we had that in Charleston from surrounding FD's), we'll assume a timely BLS response.


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## 46Young (Nov 11, 2011)

Tigger said:


> I guess the wider question is whether or not everything done by EMS needs to be quantifiably useful, or are there other measures of success?



Sure, how about employee retention and job satisfaction? The people making the system work are also important. We're more than just warm bodies to fill a spot. With an average burnout of 7-10 years, and less in some places, we're losing providers with valuable experience, and the burnout also encourages providers to withhold certain interventions, and encourage pt initiated refusals due to laziness. We're also losing providers due to orthopedic injuries. I'd rather have someone show up at my door with 15 years on the job, that still enjoys what they do, with a six year person with the same potitive outlook, than a three year burnout and a two month rookie, both disgruntled because they're making only ten bucks an hour with no retirement. I'd also like more stringent hiring standards (Polygraph, psych, etc.) and a yearly physical that includes a timed course with strenuous work related tasks, similar to the FD's CPAT. If your workforce is healthier, they'll perform better, be able to withstand fatigue and other stressors better, and cost the employer much less in disability and sick leave abuse.


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## 46Young (Nov 11, 2011)

medicsb said:


> Well, allowing ones self to be adopted (and co-opted) pretty much ensures that you will remain a step child.



Well, although it's wrong to require the existing EMS employees to crosstrain (or potentially crosstrain), future hires will be equal to their fire counterparts. By being dual role, everyone's the same, and the can enjoy what I'm assuming is superior pay, benefits, and working conditions.

Again, I'm not advocating the move, I actually disagree with it, as it's forcing EMS to do fire, or be displaced. Just that post merger, it's no longer an adversarial relationship, as everything is integrated. People on the fire side will be on the box, and some will be medics. EMS will be riding on suppression apparatus. There will no longer be sides. Everyone will have the same benefits and working conditions.


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## 46Young (Nov 11, 2011)

medicsb said:


> Maybe.  Considering how other mergers have gone, I'm not holding my breath.  This whole situation is why EMS will remain a step child.  Medics don't want to fight for themselves and will take the "easy" way out.   A shame, really.  (Of course this is not in any way exclusive to Cleveland.)



The field is too transient to allow for any real organization. When I started my EMS career, and even when I became a medic, I had no thoughts of selling out to the fire side. The thing is, as time went on, I wanted more out of my career than the choices of riding an ambulance, being in dispatch, and Lotto-like odds of making it into management or an off the road position such as fleet management or QA/QI PCR review. I also saw sitting in a box for 30 years, beating up my body lifting repeatedly in awkward positions, and having my sleep disturbed on many nights as not being sustainable for the long term. I suspect many others that shunned the EMS only job type came to the same conclusions. 

Now, typical day on the job: Four-five transports totalling six-seven hours out of the station, equipment check and drills in the morning, Pizza for lunch brought in by local soccer moms (thanks for a show and tell last week), two hours of PT (sometimes broken, but usually never twice), dinner cooked for me for only $5, afternoon nap for an hour or 45 minutes, dish games after dinner to see who washes them, and overnight no hitters 3 out of every four nights after midnight.

On my department alone, we have a handful of Cleveland EMS refugees, four others from my old hospital in NYC, four former FDNY EMS employees, and a guy from North Las Vegas, I think the place that was fighting off the N. Las Vegas FD attempt at taking over transports.

Remember, for every one of us that sells out to fire, or just starts out that way, there are many more in EMS that move on to other careers, go to college, or drop to per diem to work FT in a more sustainable career. Really, in a system where an EMT or medic will do gypsy moves from department to department chasing an additional $1/hr, this tells me that these employers are jobs that no one sees as desireable for the long term, otherwise they would stay and build tenure. Places that are sustainable exist mainly in Texas and WA, from what I read on this forum. EVerywhere else is pretty much screwed. NC has good systems, but the pay sucks.


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## Fish (Nov 11, 2011)

Tigger said:


> Agreed, my above post was poorly worded. My point is that for a patient that is truly sick, but not with a life threatening complaint, BLS does almost nothing. That interim time between first responder and arrival and ambulance arrival is significant at times, and I imagine that we would all consider timely relief of pain and suffering as a large part of EMS. ALS first response is useful here, but I don't think it can be quantified well statistically. I guess the wider question is whether or not everything done by EMS needs to be quantifiably useful, or are there other measures of success?



Yeah but that sounds like a system problem, here our average ambulance response time is something like 6 1/2 mins. So no long responses here and it is a dual Medic system.


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## Fish (Nov 11, 2011)

46Young said:


> My question is, do you advocate a tiered system or all-ALS for: urban, suburban, rural? Since you advocate BLS FD first response (we had that in Charleston from surrounding FD's), we'll assume a timely BLS response.



I think tiered systems are good as long as there is a good dispatch system in place. I am talking advanced EMD protocols, or Medics and nursing answernig 911 calls like some systems do. That way we can ensure(or atleast limit) occurences of sending non-emergent BLS responses to patients houses who are actually having an MI.

As far as Rural, where responses can be at 30mins as a Norm. I agree ALS first response can be a big help here.

Even with a Tiered system I still advocate a BLS first response in 4mins or less, that way if a BLS transport unit is coming and the BLS FR can tell this is no BLS issue and dispatch made a mistake they can upgrade.


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## medicsb (Nov 11, 2011)

I tend to think that the reason the field is transient is because, by and large, no one wants to stick around and make it what they would like to be.  Medics and EMTs generally don't want to organize (most don't even care to be a part of NAEMT), they want to hop on someone elses coat-tails and ride to comfort.  Fire and police didn't get where they are by waiting for others to do it for them or by waiting to be taken over.  They banded together and fought for it over a long period of time.  The nursing profession has gotten to where it is because they organized, advocated, and fought for themselves.  They've been so successful that they're now trying to independently practice medicine (with far far far far less training, no less) through the new DNP degree. 

Actually, something many within EMS don't realize is that Emergency Medicine is actually younger than paramedicine.  The first paramedic training programs began in the late 60s.  The first EM residencies didn't begin until the early 70s (1st was in Cincinnatti in 1970, 2nd was in Philly in '71).  The first board examination for EM wasn't 'til 1980 and EM didn't get primary board status 'til 1989.  EM would still be practiced by moonlighting opthamologists, family med, interns, med students, etc. had the early EM physicians not organized, which they did quickly and vigorously.  (ACEP form in '68.  UAEM in 1970. STEM & EMRA in another couple years and so on.)  EM had little respect in the beginning.  Most physician had no concept of what was EM.  Anesthesiologists fought against EM docs over paralytics.  Neurologists didn't want EM docs ordering CT scan without consultation.  EM fought for what they now have.  And within medicine, they exponentially more respect than they did 30 years ago.  When you look at EMS as a profession, it really hasn't gone too far.  Not that I would expect it to move as quickly as EM, but we are behind other modern EMS systems, which are even younger than us.

Anyhow, all this isn't really directed at you. (And I don't necessarily blame people moving to the fire side, though it bums me out to no end.)  This is everywhere. And I'm just as guilty, too.  I fit an example you made - I've "moved on" to medicine.  Though, I plan to stay involved with EMS (goals being medical director and research).  

Anyhow, I don't have many solutions to offer.  I wish I did.  But, I do know that organization is crucial for advancing EMS.  Until that happens, it WILL be a step child and respect will be hard to come by.

Sorry if this was a little disjointed, tangential, or rambling; I just came off a week of exams.



46Young said:


> The field is too transient to allow for any real organization. When I started my EMS career, and even when I became a medic, I had no thoughts of selling out to the fire side. The thing is, as time went on, I wanted more out of my career than the choices of riding an ambulance, being in dispatch, and Lotto-like odds of making it into management or an off the road position such as fleet management or QA/QI PCR review. I also saw sitting in a box for 30 years, beating up my body lifting repeatedly in awkward positions, and having my sleep disturbed on many nights as not being sustainable for the long term. I suspect many others that shunned the EMS only job type came to the same conclusions.
> 
> Now, typical day on the job: Four-five transports totalling six-seven hours out of the station, equipment check and drills in the morning, Pizza for lunch brought in by local soccer moms (thanks for a show and tell last week), two hours of PT (sometimes broken, but usually never twice), dinner cooked for me for only $5, afternoon nap for an hour or 45 minutes, dish games after dinner to see who washes them, and overnight no hitters 3 out of every four nights after midnight.
> 
> ...


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## sweetpete (Nov 12, 2011)

I can't help but completely agree with Young46. I'm much happier as a medic working on a FD than I would be working as a dedicated medic on an ambulance. 

I see how the kids on the box are either burned out, over worked, depressed, out of shape etc...... I can't help but feel bad for them, so I try to make their job as easy as possible when we are caring for the same patient on a scene. 

I'll offer to do whatever they want me to without "taking over" the scene.

At the end of the day, I thank GOD I'm on a fire department and not a box. I think the guys/gals at CEMS will feel the same if they choose to get their 240 card.


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## Fish (Nov 12, 2011)

sweetpete said:


> I can't help but completely agree with Young46. I'm much happier as a medic working on a FD than I would be working as a dedicated medic on an ambulance.
> 
> I see how the kids on the box are either burned out, over worked, depressed, out of shape etc...... I can't help but feel bad for them, so I try to make their job as easy as possible when we are caring for the same patient on a scene.
> 
> ...



Being with an FD is nice because you get time off of the engine, then all you do is get pissy that your on the ambulance that day and not the Engine, and then the patient is all why is my Houston Fire Fighter so mean, and your all cause I wanna be on the Trurck and run a fith of the calls as the Ambulance and get paid the same


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## DrParasite (Nov 12, 2011)

46Young said:


> The field is too transient to allow for any real organization. When I started my EMS career, and even when I became a medic, I had no thoughts of selling out to the fire side. The thing is, as time went on, I wanted more out of my career than the choices of riding an ambulance, being in dispatch, and Lotto-like odds of making it into management or an off the road position such as fleet management or QA/QI PCR review. I also saw sitting in a box for 30 years, beating up my body lifting repeatedly in awkward positions, and having my sleep disturbed on many nights as not being sustainable for the long term. I suspect many others that shunned the EMS only job type came to the same conclusions.


Were you in FDNY EMS, or NYC EMS?  If you were in FDNY EMS, you will know that despite merging EMS into the FD, they are still doing all the stuff you said.

I am all for incorporating EMS into the FD, increasing the payrates to put EMS on par with FD, and rotating people from the engine/truck to the ambulance (everyone but the officers).  But that isn't what happens in almost all these mergers.


46Young said:


> Now, typical day on the job: Four-five transports totalling six-seven hours out of the station, equipment check and drills in the morning, Pizza for lunch brought in by local soccer moms (thanks for a show and tell last week), two hours of PT (sometimes broken, but usually never twice), dinner cooked for me for only $5, afternoon nap for an hour or 45 minutes, dish games after dinner to see who washes them, and overnight no hitters 3 out of every four nights after midnight.


That's awesome, I'm jealous.  But you also aren't in an urban environment anymore.  you aren't running 20 calls a day, because the call volume doesn't have you going on 20 calls a day.  That allows you to have a station, bunks, etc because you don't need to be posted to minimize response times (system status management doesn't work anyway but some city managers still believe in it).


46Young said:


> On my department alone, we have a handful of Cleveland EMS refugees, four others from my old hospital in NYC, four former FDNY EMS employees, and a guy from North Las Vegas, I think the place that was fighting off the N. Las Vegas FD attempt at taking over transports.


again, it's not just fire vs non fire.  it's urban ems environment vs suburban ems.  


46Young said:


> Remember, for every one of us that sells out to fire, or just starts out that way, there are many more in EMS that move on to other careers, go to college, or drop to per diem to work FT in a more sustainable career.


I wouldn't call it selling out, rather doing what is best for your long term career.  No one faults you for that.


46Young said:


> Really, in a system where an EMT or medic will do gypsy moves from department to department chasing an additional $1/hr, this tells me that these employers are jobs that no one sees as desireable for the long term, otherwise they would stay and build tenure. Places that are sustainable exist mainly in Texas and WA, from what I read on this forum. EVerywhere else is pretty much screwed. NC has good systems, but the pay sucks.


The problem is, and has been for a while is, the fire service isn't the answer.  

Lets build EMS stations, lets put enough ambulances on the road to handle the call volume, so you are only running 6 calls in a 12 hour shift, or 10 in a 24 hour shift.  allow ambulances to take an hour or two for PT, give them time to eat as a crew, pay EMTs and Paramedics enough to only work 1 job, an develop a  career path, and a retirement system.  Everything the fire department has, but keep it in the EMS department.  under the EMS department.  Establish an EMS chief, EMS DC, and EMS Section chiefs, as well as station chiefs.  it can be done, but most places won't because they will cost too much money, and EMS is chronically under funded and no one wants to give them enough money to do the job well.

I have said it before, and I will say it again: My dream is for EMS to be staffed like the FD, with enough units only 24/7 to handle the peak cal volumes.  so if the busiest time has 30 separate EMS assignments going on, than they have 30 EMS units on 24/7, as well as stations for the crews to be assigned to when not on an assignment.  

But that's only a dream, because it would be too expensive to run EMS properly, and it's easier to band aid it with FD first response and run crews into the ground than actually give EMS agencies the funding to do the job properly.


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## sweetpete (Nov 12, 2011)

Fish....I can't argue there!!!  LOL

But, a patient should never feel like a burden because a firefighter would rather be on the engine/truck that day. That's just unprofessional.

I truly feel that everybody should get rotated off the ambulance in a regular, steady fashion. It just seems fair.


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## 46Young (Nov 13, 2011)

medicsb said:


> I tend to think that the reason the field is transient is because, by and large, no one wants to stick around and make it what they would like to be.  Medics and EMTs generally don't want to organize (most don't even care to be a part of NAEMT), they want to hop on someone elses coat-tails and ride to comfort.  Fire and police didn't get where they are by waiting for others to do it for them or by waiting to be taken over.  They banded together and fought for it over a long period of time.  The nursing profession has gotten to where it is because they organized, advocated, and fought for themselves.  They've been so successful that they're now trying to independently practice medicine (with far far far far less training, no less) through the new DNP degree.
> 
> Actually, something many within EMS don't realize is that Emergency Medicine is actually younger than paramedicine.  The first paramedic training programs began in the late 60s.  The first EM residencies didn't begin until the early 70s (1st was in Cincinnatti in 1970, 2nd was in Philly in '71).  The first board examination for EM wasn't 'til 1980 and EM didn't get primary board status 'til 1989.  EM would still be practiced by moonlighting opthamologists, family med, interns, med students, etc. had the early EM physicians not organized, which they did quickly and vigorously.  (ACEP form in '68.  UAEM in 1970. STEM & EMRA in another couple years and so on.)  EM had little respect in the beginning.  Most physician had no concept of what was EM.  Anesthesiologists fought against EM docs over paralytics.  Neurologists didn't want EM docs ordering CT scan without consultation.  EM fought for what they now have.  And within medicine, they exponentially more respect than they did 30 years ago.  When you look at EMS as a profession, it really hasn't gone too far.  Not that I would expect it to move as quickly as EM, but we are behind other modern EMS systems, which are even younger than us.
> 
> ...



Of course no one wants to stick around - the barrier to entry is low, so they have little skin in the game, unlike physicians, who probably aren't going to change professions after that gargantuan educational investment. An EMT or medic works in the field for a while, sees that things aren't going to improve any time soon, and either pursue higher education as another option (like you) or go somewhere that they can do EMS as a sustainable career and finally be gainfully employed. I suppose it's cheating in a sense, tapping out and affiliating with a FD. But, with a wife and childrn to support, I'm going to choose the sure thing over an uncertain future. I don't want to stick to my guns, and turn around at 45 years old and discover that we're no better off than 10-15 years ago. I'm not big on hope and change.

The whole thing's a catch-22. Not too many people are going to pursue higher education without a payoff, and many are not going to stay in the field long term due to the pay and lack of career advancement. You need people both educated and committed to do EMS as a career, until retirement, for organization to happen. Employers could mandate degrees as a condition of hire (all forms of EMS delivery are to blame), but hardly anyone does. No degrees = lower pay, so it works out for them.


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## 46Young (Nov 13, 2011)

Fish said:


> Being with an FD is nice because you get time off of the engine, then all you do is get pissy that your on the ambulance that day and not the Engine, and then the patient is all why is my Houston Fire Fighter so mean, and your all cause I wanna be on the Trurck and run a fith of the calls as the Ambulance and get paid the same



We're told even before hire that we'll be moving back and forth between the engine and the medic unit. What happens a lot is that the engine driver or engine officer will also be a medic, so the medic gets bumped off the engine when it's their turn, and rides the box instead. 

Many of the newer hires come from EMS only systems, and enjoy EMS. But consider that the average burnout in EMS is 7-10 years. This is in non fire based systems. This means that people who originally intended to do EMS as a career are generally quitting the field in that timeframe, and they wanted to do EMS 100% of the time. When the medic gets bumped from the engine for weeks or months, or indefinitely as the case may be (dual hatter engine officer assigned to the station), they begin to feel the effects of the call volume, frivolous calls, and having to be awake for 1-2 hours each call on the overnights, the same as single role medics who also grow tired of being out of the station all day and night. They also miss the fire side, and want to be able to do that part of their job as well. 

It's that ability to go from suppression to EMS, back and forth, that keeps things fresh and makes for a long career. I know that when I was on an engine for a couple of months straight, I missed the transports (at least the acute ones). On the engine, we would just assess, do a few interventions, and then watch them leave (unless they were CTD). I also like not having to check with three other people before getting clearance to go anywhere, to PT, whatever. With just you and your partner, you can go anywhere you want, whenever you want, and you also have ultimate control over pt care.


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## 46Young (Nov 13, 2011)

DrParasite said:


> Were you in FDNY EMS, or NYC EMS?  If you were in FDNY EMS, you will know that despite merging EMS into the FD, they are still doing all the stuff you said.
> 
> I am all for incorporating EMS into the FD, increasing the payrates to put EMS on par with FD, and rotating people from the engine/truck to the ambulance (everyone but the officers).  But that isn't what happens in almost all these mergers.
> That's awesome, I'm jealous.  But you also aren't in an urban environment anymore.  you aren't running 20 calls a day, because the call volume doesn't have you going on 20 calls a day.  That allows you to have a station, bunks, etc because you don't need to be posted to minimize response times (system status management doesn't work anyway but some city managers still believe in it).
> ...



I was in NYC EMS through NS-LIJ and Jamaica Hospital. I was referring to the benefits of dual role departments, which afford the previously single role medics a real, attainable career ladder for the first time.

As far as urban to suburban, Charleston County EMS has that and rural as well. They had twelve hour and 24 hour units, based on net utilization hours. We had bunks, a kitchen, day room, etc, but we hardly ever saw them. I knew that running contant call volume wasn't sustainable for the long term, so that was one more reason on top of many others to go fire based. No one wants to do that for 30 years or so.

Everything that you said about staffing, deployment, various chiefs, pay, exists here. For example, I received a promotion last year to EMS Technicinan last year. In some places, you'll never get any kind of promotion whatsoever. We have EMS Lt's, EMS Capt I's (both ride on the box), EMS Capt II (EMS road supervisor), EMS BC and EMS DC. A good number of current and past BC's, DC's, and even a couple of AC's are ALS or were for much of their careers. Our call volume is hardly excessive. The busiest units average 10 calls in 24 hours. We have four more transport units than we have engines, 41 to 37 respectively.

My formerly single role ALS academy buddies, and also the seven others from the NYC 911 system working here have all said that they would never go back to a single role system. 

The urban exparience was fun for the five years I did it, and that experience has served me well in other systems, but it's a young person's game. Eventually, you're going to look for something better if you're not stuck there (spouse unwilling to move, OT necesary to pay bills, home with a mortgage, etc.).


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## Fish (Nov 13, 2011)

46Young said:


> We're told even before hire that we'll be moving back and forth between the engine and the medic unit. What happens a lot is that the engine driver or engine officer will also be a medic, so the medic gets bumped off the engine when it's their turn, and rides the box instead.
> 
> Many of the newer hires come from EMS only systems, and enjoy EMS. But consider that the average burnout in EMS is 7-10 years. This is in non fire based systems. This means that people who originally intended to do EMS as a career are generally quitting the field in that timeframe, and they wanted to do EMS 100% of the time. When the medic gets bumped from the engine for weeks or months, or indefinitely as the case may be (dual hatter engine officer assigned to the station), they begin to feel the effects of the call volume, frivolous calls, and having to be awake for 1-2 hours each call on the overnights, the same as single role medics who also grow tired of being out of the station all day and night. They also miss the fire side, and want to be able to do that part of their job as well.
> 
> It's that ability to go from suppression to EMS, back and forth, that keeps things fresh and makes for a long career. I know that when I was on an engine for a couple of months straight, I missed the transports (at least the acute ones). On the engine, we would just assess, do a few interventions, and then watch them leave (unless they were CTD). I also like not having to check with three other people before getting clearance to go anywhere, to PT, whatever. With just you and your partner, you can go anywhere you want, whenever you want, and you also have ultimate control over pt care.



I understand this from an employee stand point, but from a clinical and tax payer stand point. It holds no water.


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## 46Young (Nov 13, 2011)

Fish said:


> I understand this from an employee stand point, but from a clinical and tax payer stand point. It holds no water.



No benefit clinically, you've got me there. My county's answer is to put at least two medics on every ALS call, rather than have anyone flying alone. As far as dual role and proficiency, I'll say that a paramedic's education is front loaded, unlike fire, where you spend your entire rookie year studying and drilling. Medics come ready made as far as education is concerned. Let's face it, EMS is only a narrow slice of the medical profession. It really isn't that difficult to become proficient in EMS transport. In fire, to promote, we now need degrees, as well as various classes, such as Officer I,II,III, and Instructor I,II,III. We're taking Pump Operator classes, as well as whatever seminars we can get selected for. Our relevant degrees are in areas such as Fire Science, EMS AAS, and Emergency Management.

The good thing is, we can (we're required to, in fact) drill both EMS and suppression topics on a regular basis. It's not too difficult to maintain proficiency in both disciplines, provided you're in a regular flip flop rotation.

As far as costs, the pro combination argument is that having dual role personnel saves on OT/holdover costs, since personnel are more interchangeable. It's less difficult to fill vacancies. Overall, you'll need less employees in a combined system than you would if both were seperate. In addition, there's much less turnover in a fire based system, so there's less of a hiring cost. The ALS first response allows the department to operate with less ambulances. It would be ideal, of course, to have the EMS fleet upstaffed instead, but it's unrealistic to expect this when most (probably all) single role EMS departments seek to operate with the least amount of units possible. SSM is an extreme example of this (as ineffective as it is). 

We can argue that the fire based employees are paid much more than they would be in a non-fire service, but isn't the main complaint in EMS the poor pay? I say that the fire based people have that liveable wage that everyone else (save a few systems in TX and WA) long for. Of course, if you replace a $70,000/yr FF/medic and a $50,000/yr FF/EMT with a $16/hr medic and an $11/hr EMT (if you're lucky) there will be cost savings, but you get what you pay for. 

Our medics get $70k/yr after internship, but they can do both jobs. You cut the average career medic's yearly compensation (40k/yr) in half, you have $20k. Since our FF's come out making $50k (figure around 15k of that for EMT, half of an average $30/yr), these salaries aren't really out of line, IMO. Not out of line considering that we work an average 56 hour workweek, 53 of which are straight time per FLSA. For every five employees the county hires, they're saving the costs of two 40 hour employees. So, that $70k medic would only be maybe a $50k medic or less, and that $50k FF would only be a $35k FF. Not so generous when you look at it that way.

This is why I say that while systems in places such as NC are good, the pay still sucks. They're working 56 hour schedules as well (IIRC), so if a medic is only making $30-something a year to start, their hourly is quite poor. I found this out in Charleston SC. I was hired at around $38k/yr on a 24/48. My hourly was $11-$11.50, not more than that. If you're working a 56 hour schedule (48 hour even) and your base is less than 60k give or take, you're getting jacked.


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## Fish (Nov 13, 2011)

46Young said:


> No benefit clinically, you've got me there. My county's answer is to put at least two medics on every ALS call, rather than have anyone flying alone. As far as dual role and proficiency, I'll say that a paramedic's education is front loaded, unlike fire, where you spend your entire rookie year studying and drilling. Medics come ready made as far as education is concerned. Let's face it, EMS is only a narrow slice of the medical profession. It really isn't that difficult to become proficient in EMS transport. In fire, to promote, we now need degrees, as well as various classes, such as Officer I,II,III, and Instructor I,II,III. We're taking Pump Operator classes, as well as whatever seminars we can get selected for. Our relevant degrees are in areas such as Fire Science, EMS AAS, and Emergency Management.
> 
> The good thing is, we can (we're required to, in fact) drill both EMS and suppression topics on a regular basis. It's not too difficult to maintain proficiency in both disciplines, provided you're in a regular flip flop rotation.
> 
> ...



In the private sector there is poor pay, they don't have big liberal unions fighting to suck every ounce of funds out of a city like the fire department does. In the third service sector pay and benefits is good though. And we have to be honest with ourselves, an AS degree in Fire science is a joke, the only thing I am missing from completing my AS degree in Fire science is the actually academy. The courses felt like 4th grade level, and what is taught in the Fire academies(I only know this because I led PT at one) is just as easy. There is nothing difficult about the requirements to become a FF. That is why you get an *** load of applicants per each hire, because everyone wants to get a lot of pay, and awesome retirement and not really do to much. Am I anti-Fire Fighters? No, not by an stretch. I am just anti-Fire department expansion into EMS and anti- extremely high salaries for FFs when EMS and PD make so much less. And the job of a FF in no way compares to PD as far as danger is concerned. Everyday on the Job, every traffic stop, every house they enter is dangerous. For a FF, their jobs get dangerous 1-3 times a year when they go on a fire. And everyone forgets about EMS? EMS is now more dangerous than FD. We had more line of Duty Deaths than the FD did last year, wheres the love?


How come you don't think SSM is effective?


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## 46Young (Nov 13, 2011)

Fish said:


> In the private sector there is poor pay, they don't have big liberal unions fighting to suck every ounce of funds out of a city like the fire department does. In the third service sector pay and benefits is good though. And we have to be honest with ourselves, an AS degree in Fire science is a joke, the only thing I am missing from completing my AS degree in Fire science is the actually academy. The courses felt like 4th grade level, and what is taught in the Fire academies(I only know this because I led PT at one) is just as easy. There is nothing difficult about the requirements to become a FF. That is why you get an *** load of applicants per each hire, because everyone wants to get a lot of pay, and awesome retirement and not really do to much. Am I anti-Fire Fighters? No, not by an stretch. I am just anti-Fire department expansion into EMS and anti- extremely high salaries for FFs when EMS and PD make so much less. And the job of a FF in no way compares to PD as far as danger is concerned. Everyday on the Job, every traffic stop, every house they enter is dangerous. For a FF, their jobs get dangerous 1-3 times a year when they go on a fire. And everyone forgets about EMS? EMS is now more dangerous than FD. We had more line of Duty Deaths than the FD did last year, wheres the love?
> 
> 
> How come you don't think SSM is effective?



I've got 87 FF LODD's in 2010 vs 35 EMS LODD's in 2010:

http://www.usfa.fema.gov/fireservice/fatalities/statistics/casualties.shtm

http://nemsms.org/notices10.htm

Were you referring to deaths per every 1000 members?


As far as SSM,

http://www.emsworld.com/article/103...wers-response-times-and-enhances-patient-care

And yes, fire science is a Mickey Mouse degree; that's why we train and study well beyond what's offered in that degree and the fire academy. It's only the bare bones basics.

Also, our frequency of fires are less than they have been, but they are no less dangerous when they do occur, and we're also expected to resond in a timely fashion regardless. It's probably the only fire that citizen will ever have. We are also subject to various cancers. This is why we're protected under the Heart and Lung Bill, with seven presumptive cancers. The average firefighter dies ten years earlier than the average life expectancy.

I worked urban EMS for five years. I wrestled with the EDP's, I've jumped out of the way on highway incidents, and I've been in theback during two ambulance MVA's. You'll only suffer an exposure or needle stick if you let it happen. I find fire suppression more dangerous. We have type V construction that fails much more quickly with a larger fire load and void spaces, and synthetic materials/plastics that make a room flash in mere minutes vs 20-30 minutes in legacy models. The potential for injuries is much greater as well, although I'll give the repetitive use injury edge to EMS. About half of firefighter fatalities are due to cardiac events. What is it in EMS? (Not breaking chops, I'm really wondering).

Ever consider that the low barrier to entry for many fire departments is for purposes of quota hiring? Merit based hiring is all but dead in most large departments. For example, we have the CPAT, a watered down ability test that is little more than a joke. FDNY used to require two year's worth of college, but that's been taken away to include more people. Chicago's entrance exam is pass/fail. I wonder why?

The barrier for entry in EMS is still lower than that, though. So is the pay.

I feel that all emergency services should be on par with the fire service, not that the fire service compensation should be knocked down to a step above welfare wages like EMS in some places.


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## JPINFV (Nov 13, 2011)

46Young said:


> We are also subject to various cancers. This is why we're protected under the Heart and Lung Bill, with seven presumptive cancers. The average firefighter dies ten years earlier than the average life expectancy.



...and how often are fire fighters seen on the videos on Statter911 who are in the smoke (especially when doing roof work or working a car fire) without proper respiratory protection? I honestly wonder what the rate of cancer is in fire fighters who consistently and properly use their SCBA when fighting a fire. Eating smoke may be sexy, but if the cost is cancer, than I'd rather not be sexy. ...and yes, the same critique goes for EMS providers who fail to utilize proper BSI. 



> About half of firefighter fatalities are due to cardiac events. What is it in EMS? (Not breaking chops, I'm really wondering).



I wonder what the mortality and disability rate would be on both sides if you take away factors that don't involve the business. There's a difference between dying in the line of duty and dying at work. Dying from an MI at the station should not be considered a LODD, regardless of the service.


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## Fish (Nov 13, 2011)

46Young said:


> I've got 87 FF LODD's in 2010 vs 35 EMS LODD's in 2010:
> 
> http://www.usfa.fema.gov/fireservice/fatalities/statistics/casualties.shtm
> 
> ...



Private services are a "You got a cert? Well come aboard!!!!!!!!!!" Not at third services, we are talkin 3-4 days of testing.

I was going off of this one for the year 2010, sorry:

FD
http://www.tdi.texas.gov/reports/fire/documents/fmloddannul10.pdf

EMS
http://www.dshs.state.tx.us/emstraumasystems/emshon.shtm


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## Fish (Nov 13, 2011)

46Young said:


> As far as SSM,
> 
> [Also, our frequency of fires are less than they have been, but they are no less dangerous when they do occur, and we're also expected to resond in a timely fashion regardless. It's probably the only fire that citizen will ever have. We are also subject to various cancers. This is why we're protected under the Heart and Lung Bill, with seven presumptive cancers. The average firefighter dies ten years earlier than the average life expectancy.
> 
> ...



I agree, EMS should be brought to the pay/benefits level FD has and that FD should not be decreased. I just don't agree when FD cries for more and more.


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## Fish (Nov 13, 2011)

JPINFV said:


> Dying from an MI at the station should not be considered a LODD, regardless of the service.



I agree, a life time of poor health habits, or poor family history should not equate for a LODD. Just because you happened to have had the MI while you were at a Fire Scene or medical scene instead of walkin up the steps at home.


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## Fish (Nov 13, 2011)

You will still never get me to agree that a Fire Fighter or a Medic should be making more than  Police Officer, Corrections Officer, or Member of our military.


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## Everett (Nov 13, 2011)

Most places seem to be going this route for various reasons.

I agree with the principal of consolidating municipal fire and ems, however not the cross training.

I believe it is important for both police and fire to be trained in some type of first responder aspect, or atleast CPR and first aid. However, I whole heartedly do not agree with the fact that a firefighter must become a paramedic or vice versa. 

There are some that should only do one, and there are those who can/should do both. Leave it as an option.


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## 46Young (Nov 13, 2011)

JPINFV said:


> ...and how often are fire fighters seen on the videos on Statter911 who are in the smoke (especially when doing roof work or working a car fire) without proper respiratory protection? I honestly wonder what the rate of cancer is in fire fighters who consistently and properly use their SCBA when fighting a fire. Eating smoke may be sexy, but if the cost is cancer, than I'd rather not be sexy. ...and yes, the same critique goes for EMS providers who fail to utilize proper BSI.
> 
> 
> 
> I wonder what the mortality and disability rate would be on both sides if you take away factors that don't involve the business. There's a difference between dying in the line of duty and dying at work. Dying from an MI at the station should not be considered a LODD, regardless of the service.



Very nice. We just had one of our FF's die in his sleep not even a month ago:

http://www.fairfaxfirefighters.org/index.cfm?section=1
http://www.fairfaxfirefighters.org/memorial.cfm?action=detail&id=1

There have been many documented cases of FF's dropping dead on a call, on the way back from a call, later at the station, and in their sleep following a significant incident. We've had several mambers in our department treated for (c0nfirmed) MI's on the job, and one cardiac arrest save after he dropped while running around the station. Waking abruptly to tones and the ensuing adrenaline slam isn't healthy, although this isn't exclusive to the fire service. What is unique is the fact that we get dressed in heavy gear, carry heavy tools, and have to remain fully encapsulated, on air, and have to endure that for an extended period of time. The inability to disperse heat, the adrenaline dump, and the dehydration will reveal underlying cardiac issues. We even have new technology with softer tones that gradually increase in volume to mitigate the abrupt awakening somewhat. 

As far as eating smoke, good departments have SOP's in place that clearly state when the FF is mandated to don the proper PE. With all of the plastics and synthetic materials found in modern homes, most of us know that a few breaths of thick smoke will take us out. I'm willing to wager that these "smoke eaters" are not career FF's from medium to large sized departments.


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## 46Young (Nov 13, 2011)

Fish said:


> Private services are a "You got a cert? Well come aboard!!!!!!!!!!" Not at third services, we are talkin 3-4 days of testing.
> 
> I was going off of this one for the year 2010, sorry:
> 
> ...



I understand.

As far as the hiring process, at Charleston County EMS all I had to do is fly down for an interview, obtain a background check from the NYPD, a driving abstract, and pass an entrance exam at a CBT center. For the FD, I had to drive down for the entrance exam, drive again for a CPAT practice session, another day for the CPAT, the next trip was three days - one day for the medical/physical, one day for the psych eval, and two days for two polygraphs. Many of us had to do two polys. In Charleston, we had a one day county orientation, then I was on the street. At Fairfax, I had a 23 week fire academy and a 16 week ALS internship/testing.


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## JPINFV (Nov 13, 2011)

So unless you want to define "LODD" as "fire fighter dies," what's a reasonable demarcation between "LODD" and "non-LODD"? ...and to be fair, watch me go off the next time someone suggests that wearing seat belts in the back of the ambulance isn't conductive to care. 

As far as mandated, are you telling me you've never seen people bend the rules, even mandated rules?


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## 46Young (Nov 13, 2011)

Fish said:


> I agree, EMS should be brought to the pay/benefits level FD has and that FD should not be decreased. I just don't agree when FD cries for more and more.



You don't ask, you don't get. The worst they can say is "no." If we didn't ask for more, we'd have about the same deal as..... EMS, who has no voice outside of some local unions such as FDNY EMS Local 2507, or 1199 for some of the NYC 911 participating hospitals. Not saying that we deserve more, but this job is how we pay our bills. If we can get more, we're going to go for it. If the requests are too unreasonable, we'll simply be denied. We also operate in a right-to-work state, so our influence is purely political, as in no collective bargaining.


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## 46Young (Nov 13, 2011)

Fish said:


> I agree, a life time of poor health habits, or poor family history should not equate for a LODD. Just because you happened to have had the MI while you were at a Fire Scene or medical scene instead of walkin up the steps at home.



I addressed this a couple of posts ago. This is why we have our Occupational Health Center, where we have very comprehensive yearly physicals including pulmonary function testing, blood work, urinalysis, stress tests, vision and hearing, and further testing if anything comes up. We also have a yearly Work Performance Evaluation, which is annual timed obstacle course while on air and full gear. We do the most possible in hiring and yearly evaluations to determine fitness for duty. We also have a mandatory on duty physical training policy.

The thing is, you can't say if it's poor lifestyle choices or job stressors that cause a death, so it's presumptive. It's nice to have the benefit of the doubt, instead of "sorry about your luck." This was fought for vigorously so that the FF's survivors would be taken care of.


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## 46Young (Nov 13, 2011)

Fish said:


> You will still never get me to agree that a Fire Fighter or a Medic should be making more than  Police Officer, Corrections Officer, or Member of our military.



You'll get no argument from me about the military. The Corrections Officers definitely get the short end of the stick. Here in my county, FF's and cops get roughly the same starting salary, although the FF's work more hours. Remember what I said earlier, we get paid well, but we're also working more hoursn than a cop or C.O. 

A starting FF here gets a little under $50k/yr before differentials and FLSA (if on shift work). That's around $17/hr, since nearly all of our hours are straight time. A 40 hour employee making $17/hr would only be making around 36k/yr. The extra hours are built in OT (actually, it's straight time). My hourly right now is only around $23/hr (I've been in a few years, and also got a promotion), plus $5k/yr in ALS cert pay, some night diff, and between $2 and $3/hr riding pay for being the ALS provider on the engine nd medic, respectively. The cert pay is worth $1.72/hr, the night diff about  $0.70/hr, and the riding pay about $2.50/hr. So, my base hourly rate is about $28/hr. If I was a 40 hour employee, my yearly income would be around $58k. Remember, a paramedic in my area will make around 40k/yr, s half of that is 20k. Take that from my yearly 50 hour rate, and that leaves 38k as a Technician, one rank above FF before the built in OT. That's not as grandiose a salary as it would seem at first glance. The LEO's hourly rate is in the 20's. 

When working 25 years to qualify for normal service retirement, we actually work an average of 33.75 forty hour workweek-years. That's 8.75 years of built in OT at a straight time rate over our career to get our base pay.


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## 46Young (Nov 13, 2011)

JPINFV said:


> So unless you want to define "LODD" as "fire fighter dies," what's a reasonable demarcation between "LODD" and "non-LODD"? ...and to be fair, watch me go off the next time someone suggests that wearing seat belts in the back of the ambulance isn't conductive to care.
> 
> As far as mandated, are you telling me you've never seen people bend the rules, even mandated rules?



People bend the rules, but our department SOP's clearly state that the department is not responsible for illness, injury, or death from improper PPE use, or non-compliance with seatbelt policy (wear them at all times). You fail to use your PPE, wear it wrong, or decide to finish getting dressed going down the road instead of at the station so that you can belt up right away, you're on your own.

LODD vs non LODD is pretty much death from an acute event while on the clock, and for a certain time period after the shift, I think it's 24 hours, for sudden death.


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## 46Young (Nov 13, 2011)

Everett said:


> Most places seem to be going this route for various reasons.
> 
> I agree with the principal of consolidating municipal fire and ems, however not the cross training.
> 
> ...



Around 300 or so out of 1600 of our force are paramedics, and we have no mandation to be ALS, only that if you're hired as a FF/medic, you must keep the cert until you can promote out of the position. Everyone must be EMT's though.


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## Fish (Nov 13, 2011)

46Young said:


> I understand.
> 
> As far as the hiring process, at Charleston County EMS all I had to do is fly down for an interview, obtain a background check from the NYPD, a driving abstract, and pass an entrance exam at a CBT center. For the FD, I had to drive down for the entrance exam, drive again for a CPAT practice session, another day for the CPAT, the next trip was three days - one day for the medical/physical, one day for the psych eval, and two days for two polygraphs. Many of us had to do two polys. In Charleston, we had a one day county orientation, then I was on the street. At Fairfax, I had a 23 week fire academy and a 16 week ALS internship/testing.



1 DAY? Boo! Charelston just won EMS service of the year too, I would have expected more.

Hey will you PM me and tell me about Charelston a little more in detail? I almost applied there instead of where I am now and always wondered the "what could have been"

Where I am at now, Orientation isssssss I wanna say 1 and  /1/2 months - 2 months??????? FTO Time is a minimum of 40 shifts.

We have a pre testing screening process, a 3 day testing process, backgrounds, pysichals(spelt that wrong) Interviews.


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## Fish (Nov 13, 2011)

46Young said:


> You don't ask, you don't get. The worst they can say is "no." If we didn't ask for more, we'd have about the same deal as..... EMS, who has no voice outside of some local unions such as FDNY EMS Local 2507, or 1199 for some of the NYC 911 participating hospitals. Not saying that we deserve more, but this job is how we pay our bills. If we can get more, we're going to go for it. If the requests are too unreasonable, we'll simply be denied. We also operate in a right-to-work state, so our influence is purely political, as in no collective bargaining.



I have asked, begged, pleaded, bribed, threatend, protested, decleared war, and still I get no love....... Ok only one of those are true.


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## JPINFV (Nov 13, 2011)

I also want to make something clear, because I think based on your earlier post that it was taken the wrong way. I wasn't trying to be a **** with how I was discussing the definition of LODDs. It's an emotional issue, but when discussing policies and statistics, an issue where emotion needs to be removed.


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## Fish (Nov 13, 2011)

JPINFV said:


> I also want to make something clear, because I think based on your earlier post that it was taken the wrong way. I wasn't trying to be a **** with how I was discussing the definition of LODDs. It's an emotional issue, but when discussing policies and statistics, an issue where emotion needs to be removed.



Word


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## 46Young (Nov 15, 2011)

Fish said:


> 1 DAY? Boo! Charelston just won EMS service of the year too, I would have expected more.
> 
> Hey will you PM me and tell me about Charelston a little more in detail? I almost applied there instead of where I am now and always wondered the "what could have been"
> 
> ...



http://www.emtlife.com/showthread.php?t=13483&highlight=charleston+county+ems&page=3

Post # 28.

If you have more questions, PM me.


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## 46Young (Nov 15, 2011)

JPINFV said:


> I also want to make something clear, because I think based on your earlier post that it was taken the wrong way. I wasn't trying to be a **** with how I was discussing the definition of LODDs. It's an emotional issue, but when discussing policies and statistics, an issue where emotion needs to be removed.



It's cool.

Our NFPA standards came from those before us unwittingly damaging or killing themselves. Even with proper PPE, we're still getting exposures. Who's to say whether we get cancer from OTJ exposures or from something off duty? No one can tell either way, but it's possible that it was from the job. It can't be proven that it was not from the job with any certainty. Same thing for stoking out or having a massive MI OTJ. That's why it's called presumptive legislation. It was shown that the firefighter popoulation had a higher incidence of these diseases than the general population, such as the seven presumptive cancers, the cardiac issues, etc. That's where the presumptive legislation came from. This is also why we're mandated to abstain from using tobacco products as a condition of employment, undergo a yearly physical and screening, the Work Performance Evaluation, etc.

My uncle died from lung CA. He was a Union carpenter, who worked with asbestos before it was deemed dangerous. He also smoked. The cancer was legally presumed to be from the asbestos, since it could not be definitively prove that it was not.


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## usalsfyre (Nov 15, 2011)

The only thing I'll add to the LODD issue is that if you knock out the fairly large percentage of volunteers who 1)are over the age of 65 and have cardiac events 2)die in POV accidents "responding" to a scene and 3)die in homemade apparatus rollovers the numbers do look significantly different.


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