# The role of EMS in the rescue assignment



## EMTswag (Apr 4, 2012)

In one of the towns i work in, approx 30,000 people with two major highways passing through it, heavy rescue is done by two of the three volunteer fire companies and one of the two volunteer rescue squads. Per regulation in our state, any vehicle extrication utilizing heavy rescue tools require that a hand line be pulled and charged from the FD for fire suppression should the act of cutting open a car spark leaking fuel or fluids and cause a fire. 

It is a never ending battle between the two fire companies heavy rescue trucks and the squads rescue truck to do the cut in the approx 4-5 heavy rescue assignments the town sees annually. So, my question to you all is where do you see EMS' role in the rescue assignment... should it be a skill left to the fire department solely or should the cut be done by EMS rescue techs with FD backup for fire suppression? 

Personally, i'm torn between the responsibility of EMS in terms of command of the scene, which we have until the patients have been safely extricated and transported, with the fact that heavy rescue has been as staple of the fire service since its inception. On the one side EMS doing the cut means they can be more understanding of the needs of the pt and the EMT in the car with the pt, and on the other side FD is already needed on scene for fire suppression, and the nature of the fire service dictates a more in-depth knowledge of tools and the like that would give them a unique background well-suited for vehicle extrication.

What do you think?


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## DrankTheKoolaid (Apr 4, 2012)

EMS Emergency MEDICAL Services.  When working on a Ambulance leave anything not medical to those responsible for it. IE fire rescue.  What good is a medic if he hurts himself on scene doing something somebody else could have-should have been doing.  Let the hose rollers who are highly trained in rescue techniques handle it, while you as the medic tend to your patient.   
And you can begin care while patients are still entrapped in vehicles.  No need to wait for FR to extricate as long as an arm is exposed or you can get to their face if O2 is needed


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## EMTswag (Apr 4, 2012)

very good point. its not really a situation where EMTs on the ambulance are doing the cut so much as an EMS service has EMTs cross-trained as rescue techs who staff a rescue truck specifically to do rescue assignments. But I do see your point, scene safety is one of the most stressed thing in the BLS curriculum.


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## Shishkabob (Apr 4, 2012)

Rescue SHOULD be the realm of EMS, as it is a patient centered event.  The Paramedic on scene SHOULD have the utmost authority on ALL things patient care related.


Only reason FD does it is that FD has always been a grab bag of jobs to justify their existence and expenditure:  HAZMAT, Rescue, explosives, etc etc.  Not because they're "better" at it or it "fits their job", but because they jumped on it first and lobbied to have it theirs.



ATcEMS has rescue Paramedics that work alongside FFs during rescues, and that's for a reason.  They train in swift water rescue, cave rescue, extrication, etc etc.  Wise County has extrication equipment on their ambulances.   Pittsburgh EMS also does rescue.   They do it because they view it as a role that they should take part in.


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## EMTswag (Apr 4, 2012)

also a great point. in jersey up north is the only hospital-based EMS system rescue unit that i have ever heard of, UMDNJ's Rescue 1 in the city of Newark. But yes completely agree with the extrication being pt care centered and thus should be the responsibility of EMS. 

Moreover, perhaps the emphasis on hand tool use came about as a result of the fire services desire to suck up as much speciality as it could.


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## Veneficus (Apr 4, 2012)

all rescue is about a victim, which may or may not need medical care.

In the perfect world, medical care of the victim would be done by providers trained and practiced in both the medical aspects directly related to such populations as well as the technical requirements.

Whether this is fire or EMS really doesn't matter.

If you have no training or lack the proper equipment, it is best if you stay well clear to avoid being a victim yourself.


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## Shishkabob (Apr 4, 2012)

Corky said:


> What good is a medic if he hurts himself on scene doing something somebody else could have-should have been doing.



What use is a firefighter "if he hurts himself on scene doing something somebody else could have-should have been doing"?



> Let the hose rollers who are highly trained in rescue techniques handle it, while you as the medic tend to your patient.


  Only reason they are 'highly trained' is that it's expected of them at that agency.  If an EMS Paramedic were expected to do extrication as a regular part of their job, they'd be 'highly trained' too.



> And you can begin care while patients are still entrapped in vehicles.


  Rescue isn't just MVC extrication.  All I need to do is point to the rescue of a man off a 700 foot cell tower this past summer here in DFW that took 7 hours.  If those FD's didn't have a Paramedic on staff and were just all BLS, do you really think the patient could have waited 7 hours?  (Answer: No)


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## EPFD112 (Apr 4, 2012)

Linuss said:


> Rescue SHOULD be the realm of EMS, as it is a patient centered event.  The Paramedic on scene SHOULD have the utmost authority on ALL things patient care related.
> 
> 
> Only reason FD does it is that FD has always been a grab bag of jobs to justify their existence and expenditure:  HAZMAT, Rescue, explosives, etc etc.  Not because they're "better" at it or it "fits their job", but because they jumped on it first and lobbied to have it theirs.
> ...



So what? Ambulances should start stocking rescue equipment? Heck, why not just throw a pump, tank, and hand line on there too so one two man crew and pull up and handle it all. Okay, but for real...

Let the medics take care of the PT. The FD can do the cutting, or whatever. Most volunteer FF's (at least in my area) are also at least certified to a Basic level, so they have an understanding of how the cuts and movements of the vehicle are going to affect the PT. All paid depts. near me that I know of won't hire anyone that isn't certified as a paramedic. At any MVA requiring extensive extrication that I've ever been at, the FD comes up with the extrication plan, and carries it out, but the medics are kept in the loop about how we're doing it, and if they have any objections to it concerning pt. safety, then we'll adapt the plan to work around them. 

This whole argument is just pointless. We all have the same goals on scene: Do what is best for the patient. Period. Let's stop worrying about who does it, and just worrying that it gets done. We're supposed to work together as professionals to accomplish the task.


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## EMTswag (Apr 4, 2012)

not necessarily entirely pointless. depending on what area and department your rescue comes from, you could have, and most have had, situations where extrication was done with no regard for the ems treatment goals or the pts condition, and only what was easier for the fd.


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## Veneficus (Apr 4, 2012)

EMTswag said:


> not necessarily entirely pointless. depending on what area and department your rescue comes from, you could have, and most have had, situations where extrication was done with no regard for the ems treatment goals or the pts condition, and only what was easier for the fd.



The only time I have seen this is with volunteer fire departments.

You get what you pay for.

If you cannot afford a professional FD and/or EMS, or won't pay for one, you are lucky to get anything at all.

edit: the world does not owe anyone fire/ems service


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## EMTswag (Apr 4, 2012)

Agreed, but that doesn't mean it's the best option and thus shouldn't be something we just relegate to the sidelines saying "at least we have it in some form."


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## Handsome Robb (Apr 4, 2012)

Then there's a breakdown in communication and the relationship between EMS and the FD that needs to be addressed. 

There's no reason the medic can't be in charge of pt care while fire is in charge of rescue provided there are good, open lines of communication between the two groups.


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## EMTswag (Apr 4, 2012)

We may have a winner. Communication has always been a problem between our two services, especially in a third-service EMS system, and should absolutely be addressed as the root cause of most of the issues between our missions.


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## Shishkabob (Apr 4, 2012)

EPFD112 said:


> So what? Ambulances should start stocking rescue equipment? Heck, why not just throw a pump, tank, and hand line on there too so one two man crew and pull up and handle it all. Okay, but for real...



Why not?  FD already attempts to.


Oh hey look.. one local agency already does just that, with heavier equipment on a dedicated rescue driven by a supervisor.  Who woulda thunk?


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## EMTswag (Apr 4, 2012)

Well there ya go... That's a lot of extrication power for just a one man crew


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## DrankTheKoolaid (Apr 4, 2012)

Trust me Linus in the 20 years I have been in EMS i have done more rescue/extrication then I care to admit.  Everything from heavy rescue with FD to 12 hour hikes in the black of night over 2 mountain passes to get injured hunters to CPR on boats from codes on islands at our lakes.  My point being, 90% of ambulance in the 911 system are not bigcity FD rescue ambulances.  And being the case why should they be required to carry such equipment.

Sure it's great to be able to help out at scenes like we all already do.  But to put ourselves and our patients at risk when there are appropriately geared individuals to do it just makes more sense.  Am I saying we cant do it, no.


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## 18G (Apr 4, 2012)

Linuss said:


> Rescue SHOULD be the realm of EMS, as it is a patient centered event.  The Paramedic on scene SHOULD have the utmost authority on ALL things patient care related.



Exactly. Best thing I've heard in a long time.


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## 18G (Apr 4, 2012)

Corky said:


> Trust me Linus in the 20 years I have been in EMS i have done more rescue/extrication then I care to admit.  Everything from heavy rescue with FD to 12 hour hikes in the black of night over 2 mountain passes to get injured hunters to CPR on boats from codes on islands at our lakes.  My point being, 90% of ambulance in the 911 system are not bigcity FD rescue ambulances.  And being the case why should they be required to carry such equipment.
> 
> Sure it's great to be able to help out at scenes like we all already do.  But to put ourselves and our patients at risk when there are appropriately geared individuals to do it just makes more sense.  Am I saying we cant do it, no.



How is a FF going to know what interventions may be immediately necessary or what extrication techniques are best for getting the patient out time wise if they don't understand the gravity of the patient's condition?

Rescue is 100% focused around the patient with a very strong MEDICAL element as Linuss has stated.


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## DrankTheKoolaid (Apr 4, 2012)

*re*

If you notice in my original post I clearly stated patient care doesnt have to wait until extrication is completed.  Are you telling me you have never started lines or decompressed patients still in vehicles?

Rescue scenes are dynamic and everything happens at once.  Let the FF do the cutting and whatever else while you are perfomring patient care as it is safe to do so.  It really is a symbiotic relationship.

The highest medical authority is always in charge of the scene and if something that is unsafe for the patient is being performed then the rescuers will be redirected as needed.


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## mycrofft (Apr 4, 2012)

*Five is four*

Fire and EMS need to cooperate on the scene. If EMS wants to violate a mechanical safety issue (like climbing into a gas filled Volkswagen to C-spine a drunk...) FD needs to say "Stand by, what can we do to make this work better?". If FD wants to delay care beyond the useful point, EMS needs to say "Chief, we really need to get into there now". 

No reason either has to predominate, but there needs to be pre-conceived status to prevent fighting either way, or pt desertion. 

How often does this really come up in real life to where pt outcome has hinged upon EMS or FD (or law enforcement or highway department or...) ordering everyone else  around , or is it more a case of the eternal "Who trumps whom?" debate? Sometimes it gets to be like rock paper scissors (jon can po).


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## Jon (Apr 4, 2012)

I've seen rescue done all sorts of ways.

In PA, every ambulance is required to have some form of toolbox with tools, including a tool for cutting/prying for rescue. I know of IFT companies that have gotten away with an old lawnmower blade.

I've seen some agencies that expect EMS to be in the vehicle, providing care, and as the medic, I've been looked at by the Fire OIC to "direct" the rescue - do we go slow and carefully, or as rapid as possible, or somewhere in between.

I've also seen services where the Rescue company FF's are mostly experienced EMS providers, and the Fire guys end up in the car, and direct the rescue, with limited input from EMS.

I've seen other systems that are in between.


I've also seen a unified County service, where (almost) EVERYONE is at least an EMT, and many folks on the ambulance are also Fire folks. Rescue is left to the Rescue staff, with some consult by medics, and there is happiness and sunshine.


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## Veneficus (Apr 5, 2012)

18G said:


> How is a FF going to know what interventions may be immediately necessary or what extrication techniques are best for getting the patient out time wise if they don't understand the gravity of the patient's condition?
> 
> Rescue is 100% focused around the patient with a very strong MEDICAL element as Linuss has stated.



how many paramedics actually understand the gravity of the pt condition without over exaggerating it?

I am not saying EMS cannot do rescue, there are some very fine agencies that do. 

But how is it going to be paid for? Most EMS companies/departments don't make huge margins. 

How do you bill for rescue? How do you collect? From whom?

All of that equipment and training, along with retraining costs a lot. 

If some community wants to financially support it, then I am all for it. But how are you going to force providers and agencies to train and equip themselves?

We can't get EMS providers to agree on a minimum education, now we are going to start taking over fire's job?

I see a lot of EMSproviders get upset when fire absorbs local EMS, often with the cry "I don't want to go into a burning building!" 

How often do you think fire departments do that anymore? 

Sure there are some departments that do. They are usually big cities, that certainly can't pull an ambulance off the street to get 2 or 3 guys for suppression duty.

If EMS can be too complex for a fire department to have EMS providers, how is this argument not saying the same?

Are you willing to pay for the training yourself?

How about the equipment?

Constant retraining?


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## 18G (Apr 5, 2012)

Veneficus said:


> how many paramedics actually understand the gravity of the pt condition without over exaggerating it?
> 
> I am not saying EMS cannot do rescue, there are some very fine agencies that do.
> 
> ...



The whole reason there is a rescue to begin with is because a patient is involved which 99% of the time requires medical care, correct? The highest level medical provider onscene has the responsibility to access the patient and ensure they are taken care of during the rescue. 

Im not saying every ambulance company needs to buy a rescue-squad but having at least rescue awareness and the ability to function on a rescue scene is a bare minimum requirement. If an ALS provider is on the scene they have a legal and professional obligation to the patient. It's hardly acceptable for a trauma pt. to not have their airway appropriately managed because they are still inside the car. Agree? 

I wish EMS would provide rescue services more than they do. My one neighboring county does do that actually. They are "rescue companies" and provide ALS and heavy rescue services. Pittsburgh EMS is another.


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## Veneficus (Apr 5, 2012)

18G said:


> The whole reason there is a rescue to begin with is because a patient is involved which 99% of the time requires medical care, correct?



This I agree with



18G said:


> The highest level medical provider onscene has the responsibility to access the patient and ensure they are taken care of during the rescue.



This I do not always agree with.

Having been involved with rescue for some years myself, and it being my favorite part of the fire service, I think there are times when just getting the person out before medical care is the best option.

There is also the feasibility of the highest level medical provider accessing the patient. I don't want an untrained person putting themself in harms way to access a patient. That is how you wind up with 2 patients and no medical providers. 

In this particular circumstance, I think a provider with enough training to follow some type of medical direction, whether from an onsite medic or other, is the best solution when you do not have dual trained providers. (which as I stated above is ideal) 



18G said:


> Im not saying every ambulance company needs to buy a rescue-squad but having at least rescue awareness and the ability to function on a rescue scene is a bare minimum requirement.



I agee with this.



18G said:


> If an ALS provider is on the scene they have a legal and professional obligation to the patient. It's hardly acceptable for a trauma pt. to not have their airway appropriately managed because they are still inside the car. Agree?



Can a BLS provider not manage the airway with something as simple as a jaw thrust or if need a king airway?

Is it the gold standard of intubation, no, but my first field tube ever was inserted digitally in a guy trapped in his car that he ran under somebody's porch. (I was the only guy small enough to fit in the hole) The patient was still pronounced dead at the hospital, so I am guessing that ET tube didn't do much for him. 

Knowing what I know know, I am going to say that the patient needed way more advanced medicine than we (dual trained providers) were able to provide at all. In circumstances like that, it needs to be brought to the scene.   



18G said:


> I wish EMS would provide rescue services more than they do.



Me too, but I need to see a realistic plan to make it happen.

Especially in areas that have full time paid EMS and volunteer fire.


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## Bullets (Apr 5, 2012)

A volunteer EMS squad in my home town provides vehicle extrication, FDs only job is to pull a hand line and standby. The system works fine. I think FD isn't happy about it, and 2 FCs have crappy old hand operated jaws on their their engines. 

My squad houses a jetski, a 30ft dual outboard rescue boat, and a dive rescue truck and have agreements with other townships to provide water rescue for 15 miles of atlantic ocean and associated feeding streams and bays and are the primary mutual aid to the State Police and Coast Guard. Water rescue is a solely EMS activity.

All other rescue services are provided through the township OEM. They are the primary Hazmat for half the county, and keep most of the equipment used in rope, trench, EBS, confined space, ect. They use members from one FC and one EMS squad to supplement their equipment and capabilities

That said, NJ has many volunteer EMS agencies that have always managed to provide heavy rescue for decades, so it's possible to do so as a non-profit.


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## DesertMedic66 (Apr 5, 2012)

NVRob said:


> Then there's a breakdown in communication and the relationship between EMS and the FD that needs to be addressed.
> 
> There's no reason the medic can't be in charge of pt care while fire is in charge of rescue provided there are good, open lines of communication between the two groups.



Agree. I guess it's not an issue in my area seeming how every fire engine has at least 1 paramedic with the other firefighters being EMTs. 

We pretty much get on scene, take the gurney out of the ambulance and wait for fire to do their thing. Sometimes the fire medic will have the ambulance medic do patient care and sometimes the fire medic will do it. 

And I also do agree with Corky about it being Emergency Medical Service.


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## NomadicMedic (Apr 5, 2012)

I guess I'm lucky. In my system, rescue is done by the fire department with patient care being managed by the paramedic on scene. In 99% of the cases the rescue effort is led by the paramedic offering "advice" to the incident commander. 

I've been trained in vehicle rescue, I enjoy vehicle rescue. I love cutting up cars as much as the next guy... However, leaving vehicle extrication in the realm of the fire department allows another opportunity to justify their existence. And frankly, I have to carry enough gear on the truck.

As long is there's no kerfuffle over patient care, I don't particularly care who cuts the car.


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## rescue1 (Apr 10, 2012)

Ideally, the FD cuts and EMS treats and advises, in my book. Both sides should have knowledge of what the other is doing--for fire this should be something like EMT-B or at the very least MFR, and for EMS this should be rescue awareness training at the minimum--preferably more.

That way everyone has a part to play, we don't crowd our ambulances with cribbing and Hurst tools, and there are no pissing contests about "who gets to cut", like the NYPD and FDNY have.

If there was some precedent for firefighters hating rescue assignments and generally making a mess out of it, that would be one thing, but with fires on the decrease, adding technical and vehicle rescue to the FDs toolbox makes perfect sense. It's a technical skill, like firefighting, there's space on the trucks, and it allows paramedics to focus their efforts on patient care and medicine.


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## Veneficus (Apr 10, 2012)

Rescue ICU...

The field medical treatments during a rescue operation are so simple, I cannot see any reason why the people doing the cutting are not perfectly capable to be trained to provide them.

When it comes to the medical capacity of many FDs, as a former sinner myself, I am not impressed.

But the treatments available in the field, along with effectiveness that I doubt would stand up to serious scrutiny, a lot of medical knowledge is not really required to apply them.

If you had the opportunity to use blood products, could perform surgical procedures, or administer procedural sedation, I would have a different opinion. But as it stands, I am not sure a paramedic is even needed for vehicle extrication, and only rarely in other types of rescuers.

While I agree fully with 18g, that resuce is patient centered, the first and formost goal needs to be freeing the patient from whatever is entrapping them, not to provide medical care in a dangerous environment or prolong the rescue.

My opinion comes from retrospective knowledge on what I have done. Having done all kinds of things like intubate trapped people, start IVs in holes I could barely crawl into myself in the dark, etc, I really question if it ever makes a difference in all but the most rare circumstances.

Even then, the treatment provided, may not be what is needed. For example, I have never administered warmed IV fluids to a prolonged entrapment in any weather or circumstance, but that would probably be more beneficial to reduce/prevent hypothermia than administering chrystalloid to a patient in stave III or IV shock.


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## DrParasite (Oct 20, 2012)

*incredidbly bored, felt like posting pictures*

You asked the role of EMS on a rescue assignment?  maybe you should ask these career guys:


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## MrJones (Oct 20, 2012)

*I, on the other hand, didn't notice that this was an old thread*



EPFD112 said:


> ...Heck, why not just throw a pump, tank, and hand line on there too so one two man crew and pull up and handle it all....



You thought you were kidding?



> Volusia County’s new pumper/ambulances are built on 2011 Spartan MetroStar chassis with a 2011 Patriot module and Waterous CAFS. The units can carry 300 gallons of water and 30 gallons of foam. Additionally, there is a hosebed and a large transverse compartment in the cab behind the driver and officer for extra fire and extrication equipment storage.
> 
> The ambulance module features custom all-aluminum interior cabinets with Meganite countertops and rounded edge corners. The units also feature Braun’s VitalMax lighting system for shadowless light to aid in patient care, the EZ Glide sliding side-entry door for enhanced crew safety, the MasterTech IV electrical system, and the SolidBody construction.



source


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## rescue1 (Oct 20, 2012)

DrParasite said:


> You asked the role of EMS on a rescue assignment?  maybe you should ask these career guys:



Apparently Pittsburgh is thinking of transferring its rescue work over from EMS to the fire side of things.

http://www.firehouse.com/news/10812112/pittsburgh-officials-medic-contract-risking-rescues


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## Chief Complaint (Oct 20, 2012)

Doesn't seem logical to me to have EMS take control of rescue operations.  Agencies have a hard enough time training their medics to provide adequate patient care.  Giving them technical rescue, high angle rescue, swift water rescue, extrication, etc. responsibilities would be overload IMO.  

The fire department didn't take control of rescue ops because it made us look cool.  Its because nobody else really wanted to do it, or was unable to do it correctly.

The fire department has the resources to train on rescue procedures, busy EMS agencies are busy doing what they do, patient care.  Very little time for extensive training, which is what technical rescue requires.


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## Shishkabob (Oct 20, 2012)

Chief Complaint said:


> Doesn't seem logical to me to have EMS take control of rescue operations.


  Says the firefighter....




> Agencies have a hard enough time training their medics to provide adequate patient care.  Giving them technical rescue, high angle rescue, swift water rescue, extrication, etc. responsibilities would be overload IMO.


  Says the firefighter AND paramedic?

So, a Paramedic can't do rescue because it would be "overload", but having a firefighter ALSO do rescue and ALSO be a paramedic is ok?  Your bias is clearly showing...




ATcEMS trains their medics in rescue.  Wise County has extrication tools on their rigs.  Pittsburgh handles rescue.  I've never heard of a single complaint about EMS doing rescue from anyone EXCEPT FDs and their unions.


You have done/said nothing that convinces me that FD should have a monopoly over rescue.  It is simply just an exercise in trying to justify a bigger budget.


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## rescue1 (Oct 20, 2012)

I agree with CC. With the decline of fires due to better prevention, the FD also has more time to train for rescues, and more space on their apparatus for equipment. Meanwhile, medical calls are increasing, and ideally (hopefully) the educational requirements for EMS will also be increasing.

EMS should still be familiar with rescue operations though.


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## STXmedic (Oct 20, 2012)

rescue1 said:


> I agree with CC. With the decline of fires due to better prevention, the FD also has more time to train for rescues, and more space on their apparatus for equipment. Meanwhile, medical calls are increasing, and ideally (hopefully) the educational requirements for EMS will also be increasing.
> 
> EMS should still be familiar with rescue operations though.



So because there are less fires, fire departments should train less on firefighting and start selling off their equipment? :unsure:

And to the education standards and increased medical runs: Are fire departments not running medical runs? Are they not also EMTs and Paramedics that need to meet the same education requirements?

I'll echo Linuss' statement about ATcEMS. They have a rescue team, and their team is damn good. Amazingly, they are still good even though they never learned how to extinguish a structure fire...

*Coming from a fire medic


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## Chief Complaint (Oct 20, 2012)

Linuss said:


> Says the firefighter....
> 
> Says the firefighter AND paramedic?
> 
> ...



Well of course i'm biased!

I'm just saying that if it ain't broke, don't fix it.  Plus it should be, and is, a joint effort.  Fire and EMS both have their roles on the scene of a tech rescue.

Also, generally speaking, career fire departments hold their employees to a higher fitness standard than a private EMS company does.  Technical rescues can be very taxing on the body so it is of great importance to have highly trained personnel who are in peak physical shape to affect such a rescue.  

Lastly, single role EMS agencies would not be able to fund the training and equipment costs that it takes to put together a top notch tech rescue program.  From what i hear, many of them can barely keep their EMS equipment stocked due to lack of funding.  Large career fire departments have the money to send their FFs/EMTs/Paramedics to lengthy courses in order for them to become proficient in tech rescues, as well as the money to buy quality tools for such jobs.  Private companies will never be able to come up with that kind of funding.


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## rescue1 (Oct 20, 2012)

PoeticInjustice said:


> So because there are less fires, fire departments should train less on firefighting and start selling off their equipment? :unsure:
> 
> And to the education standards and increased medical runs: Are fire departments not running medical runs? Are they not also EMTs and Paramedics that need to meet the same education requirements?
> 
> ...



Obviously not. But fires account for about 5% of the run volume for most fire departments. 

Assuming a separate fire and EMS agency, to me it seems more logical to place the rescue work with the agency that runs less calls. Also, like structural firefighting, rescue is a very technical skill, and some of the tools used for rescue can also be used for firefighting.
It's not a dig against EMS only rescue teams, I just think that fire running it is more efficient.

Obvious with a single department running fire and EMS it's not an issue.


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## JPINFV (Oct 20, 2012)

Chief Complaint said:


> Lastly, single role EMS agencies would not be able to fund the training and equipment costs that it takes to put together a top notch tech rescue program.  From what i hear, many of them can barely keep their EMS equipment stocked due to lack of funding.  Large career fire departments have the money to send their FFs/EMTs/Paramedics to lengthy courses in order for them to become proficient in tech rescues, as well as the money to buy quality tools for such jobs.  Private companies will never be able to come up with that kind of funding.



Obviously the solution isn't to defund what you admit are overly funded fire departments, and increase funding to what you admit are underfunded EMS departments.


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## usalsfyre (Oct 20, 2012)

JPINFV said:


> Obviously the solution isn't to defund what you admit are overly funded fire departments, and increase funding to what you admit are underfunded EMS departments.



The IAFF will Jimmy Hoffa you for that kind of reasonable logic...


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## rescue1 (Oct 20, 2012)

JPINFV said:


> Obviously the solution isn't to defund what you admit are overly funded fire departments, and increase funding to what you admit are underfunded EMS departments.



But if all you do is pull rescue money from fire departments and give them to EMS to perform rescue, won't you still have the same issue with an underfunded EMS side, just now they also have a well funded rescue company which has moved from fire to EMS? 

I say we worry about the issues that EMS has right now, namely a lack of education and recognition, before we decide to start adding additional responsibilities.


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## JPINFV (Oct 20, 2012)

rescue1 said:


> But if all you do is pull rescue money from fire departments and give them to EMS to perform rescue, won't you still have the same issue with an underfunded EMS side, just now they also have a well funded rescue company which has moved from fire to EMS?



Isn't EMS already performing rescue operations, hence why they are looking at transferring rescue operations to the fire department? As such, why is the fire department receiving funding for rescue operations when the EMS department is the primary rescue service?


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## Chief Complaint (Oct 20, 2012)

JPINFV said:


> Obviously the solution isn't to defund what you admit are overly funded fire departments, and increase funding to what you admit are underfunded EMS departments.


I wish they had more funding, but it doesnt seem like that's going to change anytime soon.



JPINFV said:


> Isn't EMS already performing rescue operations, hence why they are looking at transferring rescue operations to the fire department? As such, why is the fire department receiving funding for rescue operations when the EMS department is the primary rescue service?



Firefighters handle rescue, not EMS, in a fire based system.  It's a joint effort, but the guys on the engine/truck/rescue handle tech rescue for the most part.


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## rescue1 (Oct 20, 2012)

JPINFV said:


> Isn't EMS already performing rescue operations, hence why they are looking at transferring rescue operations to the fire department? As such, why is the fire department receiving funding for rescue operations when the EMS department is the primary rescue service?



Where is this taking place? If you're talking about the Pittsburgh article I don't know if the FD gets rescue funding or not.

As to the OP's issue, I think funding is broken up among the volunteer agencies. And volly funding tends to vary widely depending on where you are, so I wouldn't use that as a guide.

Also, if the fire department is already going to be there (per the OP), why not put rescue tools on their engine company (or a pump on their rescue). That way you can use the money spent staffing an EMS rescue to staff more ambulances, and use the FD crew to perform rescue.


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## JPINFV (Oct 20, 2012)

Chief Complaint said:


> Firefighters handle rescue, not EMS, in a fire based system.  It's a joint effort, but the guys on the engine/truck/rescue handle tech rescue for the most part.



Except the recent conversation turned to discussing Pittsburgh, where EMS is apparently the primary team, not the fire department. See the following post:
http://www.emtlife.com/showpost.php?p=434540&postcount=32
Which you followed up with...
http://www.emtlife.com/showpost.php?p=434543&postcount=33


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## Chief Complaint (Oct 20, 2012)

Was referring to the OP.


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## Shishkabob (Oct 20, 2012)

Chief Complaint said:


> Lastly, single role EMS agencies would not be able to fund the training and equipment costs that it takes to put together a top notch tech rescue program.  From what i hear, many of them can barely keep their EMS equipment stocked due to lack of funding.  Large career fire departments have the money to send their FFs/EMTs/Paramedics to lengthy courses in order for them to become proficient in tech rescues, as well as the money to buy quality tools for such jobs.  Private companies will never be able to come up with that kind of funding.



The main FD my agency runs with has a budget nearly $70 million more than my agency, and runs 40,000 LESS calls than we do.  Yeah, THAT'S efficient.  


80% of most FDs runs are medical, so how about we split funding as such?  Give the EMS agency 80% of the FDs funding.  Imagine the awesomeness that could be done with that much more funding correctly placed where it can do the most good?


Infact, I'll settle for just 25%.


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## Chief Complaint (Oct 20, 2012)

I agree with you, private companies should be getting more money.

I just don't think that they need to take over tech rescue ops.


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## DrParasite (Oct 20, 2012)

rescue1 said:


> Apparently Pittsburgh is thinking of transferring its rescue work over from EMS to the fire side of things.
> 
> http://www.firehouse.com/news/10812112/pittsburgh-officials-medic-contract-risking-rescues


did you read the article, and see the reasoning?  EMS numbers are up, and run times are close to 17 minutes.  Now, could this be due to the all ALS system that gets inundated with BS calls that can wait, while the FD is under 8 minutes to all calls?  Or is it because PEMS don't have enough EMS units to handle the call volume (if they had twice as many EMS units, I would wager your entire yearly salary that response times would decrease substantially), while the FD has enough units to handle peak volumes and still maintain appropriate response times?

If you properly fund, train, and staff them, Public Works can handle rescue (no, I'm not suggesting it, just stating a fact).  Having staff assigned to the rescue vehicles full time, as well as the equipment and training to do the job right is what you need.





JPINFV said:


> and increase funding to what you admit are underfunded EMS departments.


increasing funding to EMS departments?  nah, why on earth would we want to a crazy thing like that?


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## rescue1 (Oct 20, 2012)

I agree with you, but the fact remains that it could cost less money to transfer rescue to fire, use the ems staffing you saved to staff more ambulances, and call it a win, all without spending more money. 
Maybe EMS is doing fine in Pittsburgh and it's just a power grab, I don't know the details. But why can't we worry about fixing the medical side of EMS before we try and take on more responsibilities?


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## usalsfyre (Oct 20, 2012)

rescue1 said:


> I agree with you, but the fact remains that it could cost less money to transfer rescue to fire, use the ems staffing you saved to staff more ambulances, and call it a win, all without spending more money.


Cause the union will go for THAT one....



rescue1 said:


> Maybe EMS is doing fine in Pittsburgh and it's just a power grab, I don't know the details. But why can't we worry about fixing the medical side of EMS before we try and take on more responsibilities?


The fire service has a lot to fix in suppression as well.


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## Ace 227 (Oct 20, 2012)

I can only offer my personal experiences with it but generally myself and my partner just stand ready until the pt is extricated and then we assist with the backboarding, etc. However, I have been on-scene when a, less than capable, rescue crew is there and I have grabbed the cutters to get the pt out. I am a BVR Tech where as some of the first due companies(volunteer) do not have any.  Whatever helps the patient.


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## DrParasite (Oct 20, 2012)

rescue1 said:


> I agree with you, but the fact remains that it could cost less money to transfer rescue to fire, use the ems staffing you saved to staff more ambulances, and call it a win, all without spending more money.
> Maybe EMS is doing fine in Pittsburgh and it's just a power grab, I don't know the details. But why can't we worry about fixing the medical side of EMS before we try and take on more responsibilities?


the fact remains, you can close down 25% of the fire houses, stop doing EMS first response (which will decrease their run volumes by 80% and free up fire resources), put all the money saved into the EMS system putting more ambulances on the road, which would decrease response times to under 10 minutes, call mutual aid for any actual fire, let EMS handle all rescue (like they have been doing for 35 years, not really taking on more responsibilities is it?) so you don't need to tie up fire resources, and call it a win, without spending any money.


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## Shishkabob (Oct 20, 2012)

rescue1 said:


> I agree with you, but the fact remains that it could cost less money to transfer rescue to fire, use the ems staffing you saved to staff more ambulances, and call it a win, all without spending more money.



Or de-fund fire because they are needed on less calls, transfer some of the funding to EMS so they can staff more ambulances, and actually save money. 


I like that one more.


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## DrParasite (Oct 20, 2012)

in case anyone was curious about the numbers:

Pittsburgh Bureau of Fire
Personnel	630 
Stations	29
Engines	28
Trucks	11

Total runs: approx 25,955, of which 12,164 were EMS & Rescue runs, and 225 were structure fires

(the above courtesy of wikipedia and PFD's website)

Pittsburgh EMS:
Personnel 156
Ambulances: 14
Rescue: 2
Stations: 13
Total runs: 56,500

(the above courtesy of the quoted article and PEMS website)

Anyone else want to use these actual numbers and facts to support their point of view?


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## Shishkabob (Oct 20, 2012)

And I'm willing to bet PFDs budget is at least three the size of PEMS...


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## DrParasite (Oct 20, 2012)

Three times????

PFD Budget: $53,004,325

PEMS Budget: $13,192,712

source: http://apps.pittsburghpa.gov/cbo/City_Council_Operating_Budget_2012_for_online.pdf

that means the FD's budget is 4x as big as the EMS budget.

btw, the public works budget is 2.5 times as large as the EMS budget, but still less than the FD's.

Can you imagine what EMS could do with a 53 MILLION dollar budget?  Imagine how many lives we could save!!!!


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## rescue1 (Oct 20, 2012)

Yikes. That is not a stellar arrangement, and the city could probably lose some engines or trucks in exchange for some ambulances.

Though, would moving the rescue capability change anything? I feel like at some point we stopped talking about rescue and are now talking about bloated FD budgets. Which is an issue, just a different one.


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## DesertMedic66 (Oct 20, 2012)

Instead of cutting down fire departments budget and then transferring it to EMS agencies (most are private agencies) and then taking rescue work out from the fire department and giving it to EMS (no where to store tools on type 2 vans), why not fully combine EMS and fire. 

Everyone seems to agree that the fire department has a pretty good union and good pay. If EMS gets combined with fire then single role medics pay should go up and you get a good union. 

The budget for EMS and fire can be combined into one. If more of the budget needs to go to EMS then no big deal because its all one budget. 

Also takes away who should do be doing extrication because its all one department now. 

Now to wait and see who will tear this post apart because "fire and EMS are completely different things and should not be combined ever". :lol:


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## Veneficus (Oct 20, 2012)

firefite said:


> Instead of cutting down fire departments budget and then transferring it to EMS agencies (most are private agencies) and then taking rescue work out from the fire department and giving it to EMS (no where to store tools on type 2 vans), why not fully combine EMS and fire.
> 
> Everyone seems to agree that the fire department has a pretty good union and good pay. If EMS gets combined with fire then single role medics pay should go up and you get a good union.
> 
> ...



That is the theory anyway. It seldom works out that way.

What actually happens is EMS gets even more of the shaft while the chief officers, who are mostly suppresion people, buy big shiney trucks that look nice in parades in case "the big one" hits.

They also spend a lot of money on trying to preserve outdated practices like an engine house every few blocks instead of a smaller number of regional stations.



firefite said:


> Now to wait and see who will tear this post apart because "fire and EMS are completely different things and should not be combined ever". :lol:



It is not that they cannot effectively be combined, it is that it is so rarely effectively combined that it is more realistic to predict it will not work out as it should in theory.


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## JPINFV (Oct 20, 2012)

firefite said:


> Now to wait and see who will tear this post apart because "fire and EMS are completely different things and should not be combined ever". :lol:




...because LA County contains so many well run models of fire based EMS. It's just too bad it's 2012 and not 1972.


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## Chief Complaint (Oct 20, 2012)

firefite said:


> Instead of cutting down fire departments budget and then transferring it to EMS agencies (most are private agencies) and then taking rescue work out from the fire department and giving it to EMS (no where to store tools on type 2 vans), why not fully combine EMS and fire.
> 
> Everyone seems to agree that the fire department has a pretty good union and good pay. If EMS gets combined with fire then single role medics pay should go up and you get a good union.
> 
> ...



Nailed it!  Great post.


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## DrParasite (Oct 20, 2012)

rescue1 said:


> I feel like at some point we stopped talking about rescue and are now talking about bloated FD budgets.


No; the statement was made that taking rescue away from EMS and giving it to FD would save money.  The budget numbers were provided in response to linuss,s comment about budgets, as well as to point out that the problem isn't that EMS can't do Rescue, but rather, the funding isn't given to EMS to do ambulance work or rescue, it's given to the FD on a 4:1 ratio.  Also, if you took some money and shifted it to EMS, many of the EMS problems would go away, and the reasons the FD should take over rescue would decrease substantially. 





firefite said:


> Instead of cutting down fire departments budget and then transferring it to EMS agencies (most are private agencies) and then taking rescue work out from the fire department and giving it to EMS (no where to store tools on type 2 vans), why not fully combine EMS and fire.


ok, first off, more EMS agencies aren't private agencies.  they might be over all nationwide, but i think if you look at the total number of agencies, you will find more non-private ones than private agencies. And second, if you look at the EMS agencies that do rescue, you will find VERY VERY few private agencies.  Rescue is expensive, especially in the begining (all the initial training, vehicles, PPE and equipment), and you need tax dollars to pay for it (and yes, EMS can and SHOULD be tax funded, but that's a discussion for another thread), most private agencies can't and won't pay for it.  Thirdly, if you are looking to store tools on the type 2 vans, you are doing it cheap, half assed, and wrong.  Look at the images I posted: all those agencies have dedicated rescue vehicles, dedicated rescue staff, and aren't running tools from the ambulance; they are using specialized vehicles designed for rescue operations.  Just like you don't carry confined space rope rescue gear in an engine, you don't carry lots of wood for trench collapse on either a ladder or engine, and a hazmat truck is a specialized vehicle designed with all your hazmat crap, if you are going to do the job 100%, you need to have a vehicle and all the necessary equipment to do it 100%, so you can be ready for anything rescue related.  Doing it halfassed and with a vehicle that is only designed to handle some types of incidents will mean you can't handle every assignment 





firefite said:


> Everyone seems to agree that the fire department has a pretty good union and good pay. If EMS gets combined with fire then single role medics pay should go up and you get a good union.


yeah, and how often does that happen?  how many mergers resulted in entry level paramedics making as much as entry level firefighters?  Can you name any big departments like this?  good in theory, almost never happens.





firefite said:


> The budget for EMS and fire can be combined into one. If more of the budget needs to go to EMS then no big deal because its all one budget.


good in theory; in reality, EMS does 80% of the total run volume, FD get 80% of the budget.  happens all over the country.





firefite said:


> Also takes away who should do be doing extrication because its all one department now.


yeah, it's the single role EMS providers who are assigned to the Heavy Rescue, have all the gear and training they need to get the job done.  Can you show me any department that would allow that?


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## rescue1 (Oct 20, 2012)

DrParasite said:


> yeah, it's the single role EMS providers who are assigned to the Heavy Rescue, have all the gear and training they need to get the job done.  Can you show me any department that would allow that?



Very few, because it makes sense to make them firefighters, allowing them to perform rescue from structure fires as well, or exist as a RIT.

My question is, when you look at the countries that we at EMTLife think do EMS correctly--Canada, New Zealand, Australia--none of them do rescue. They focus on medicine, and let the fire service focus on technical skills.

Hell, I had a partner who didn't know what a pulmonary embolism was. Why do we then want to make him also responsible for using hurst tools when he can barely do his primary job? Shouldn't we be more worried about educating our providers about medicine first?

I'm not saying that EMS can't do rescue. Like you said, Public Works can do rescue if they were trained. I'm just saying that with EMS in the infant (and occasionally crappy) stage here in America, it seems we're quick to throw new responsibilities on us just because. Also, no one has (at least over the last few pages) given a reason as to why EMS should run rescue as opposed to fire. All we've agreed on is that anyone can be trained to do it...which means it really doesn't matter who does it.

In the interest of full disclosure, I have never worked or volunteered in an area that had a paid fire department AND separate EMS. I only have experience in combined Fire/EMS departments, and paid EMS/volunteer fire areas (where I currently work). So I have no idea how that dynamic may work between different agencies.


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## DrParasite (Oct 20, 2012)

rescue1 said:


> Very few, because it makes sense to make them firefighters, allowing them to perform rescue from structure fires as well, or exist as a RIT.


which is odd, because FDNY (arguably one of the busiest FD's in the nation) uses truck companies for RIT, not rescues.  and the truck companies typically do searches at structure fires, not rescues.

Or lets think REALLY outside the box, and say since the FD doesn't have a RIT team, lets train and equip the EMS personnel as firefighters, and let them serve as the RIT team on working fires, while still being EMS personnel.  I know, the concept blows your mind.





rescue1 said:


> Hell, I had a partner who didn't know what a pulmonary embolism was. Why do we then want to make him also responsible for using hurst tools when he can barely do his primary job? Shouldn't we be more worried about educating our providers about medicine first?


well, if your partner can barely do his primary job, than maybe he should be fired and replaced with a more competent person?  I know what a PE is... I can also operate the hurst tools (although holmatro was waaaay lighter and easier to use).  and I know I'm not the only one.


rescue1 said:


> Also, no one has (at least over the last few pages) given a reason as to why EMS should run rescue as opposed to fire. All we've agreed on is that anyone can be trained to do it...which means it really doesn't matter who does it.


you know, your right.  Then again, I haven't seen anyone give a reason why fire should run rescue instead of EMS, other than the fact that they have the funding, equipment, manpower and training to do so.  So if you give EMS the funding, equipment, manpower, and training to do rescue, it takes away the reason for FD to do rescue.

The biggest reason for EMS to do rescue is because rescue is a "patient oriented" process, and who better to perform a "patient oriented" process, than the EMS providers who are the experts in patient care and what is best for the patient?  I know many firefighters who can use the tools; but can that firefighter recognize that the patient is really sick, and needs to be extricated immediately?  or if the FF being lowered on a rope rescue, can he or she perform an assessment on the patient to see what condition the patient is in?  And before you says "yes, if they are an EMT", I will counter with "well, if you can teach the firefighter to be an EMT, I can teach the EMT to be a firefighter."


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## CentralCalEMT (Oct 21, 2012)

I do not see why everyone can not play well together in the sandbox. I just ran an over the side vehicle rescue where we had 2 (BLS) fire departments, 2 law enforcement agencies as well as my ambulance on scene. We all played nicely together and were able to get the patient up. I can not imagine our last patient waiting for the rescue to be completed before being evaluated by EMS. Every EMS system is different and what works in New York City will not work in the Sierra Nevada mountains. I do not necessarily think as a rule EMS should be doing rescue work (although some agencies do an excellent job) HOWEVER, it amazes me the number of times you see pictures of critical patients in rescue situations with EMS standing in the background waiting for the patient to be extricated. There are very few times, patient care and rescue work can not happen at the same time. With proper training and PPE, EMS should be working alongside whatever agency is doing the rescue work. If people put their egos aside (and yes it is possible, since I see it every day in my area) and works together, the job gets done well.


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## rescue1 (Oct 21, 2012)

DrParasite said:


> which is odd, because FDNY (arguably one of the busiest FD's in the nation) uses truck companies for RIT, not rescues.  and the truck companies typically do searches at structure fires, not rescues.
> 
> Or lets think REALLY outside the box, and say since the FD doesn't have a RIT team, lets train and equip the EMS personnel as firefighters, and let them serve as the RIT team on working fires, while still being EMS personnel.  I know, the concept blows your mind.



FDNY still runs heavy rescues on working fires, though I don't know if they do RIT or just assist. I know they used to do RIT.

Bur are you advocating EMS based fire suppression as opposed to fire based EMS? Won't that have...you know...all the same problems that we have with combined service already? We can't argue against fire based EMS and then advocate EMS based fire.

Unrelated note, beer is delicious, but it does mean the rest of this debate is gonna have to wait till tomorrow. :beerchug:


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## Shishkabob (Oct 21, 2012)

DrParasite said:


> Three times????
> PFD Budget: $53,004,325
> PEMS Budget: $13,192,712
> that means the FD's budget is 4x as big as the EMS budget.



Funny thing is, my agency's budget is also 1/4 the budget of our biggest FD partner.  The local FD's budget is $118 million a year, while my agency is $30 million a year, and we run 40,000 more calls AND don't put a burden on the tax base.    Looking at the proposed budget, the FD gets nearly 20% of the city's budget each year. 


Yeah... "efficient".  



CentralCalEMT said:


> I do not see why everyone can not play well together in the sandbox.



It's generally not the field crews who don't get along (I say generally, because I have my own experiences as most do), but when it comes time to compete for the budget dollars that FDs and their unions tend to skew things in their way.  



rescue1 said:


> My question is, when you look at the countries that we at EMTLife think do EMS correctly--Canada, New Zealand, Australia--none of them do rescue. They focus on medicine, and let the fire service focus on technical skills.



Correction:  They tend to not do heavy rescue, but do tend to train their personnel in it, AND FD doesn't throw a hissy fit when a Paramedic gets in with the patient, like they do in some places.  On top of that, in most of those places, FD doesn't try to move beyond fire and rescue saying they could do medicine just as well as EMS does.

No, in those places, it's rather an exception, instead of a rule, to see a firefighter with any medical training beyond that of a first responder.




firefite said:


> Instead of cutting down fire departments budget and then transferring it to EMS agencies (most are private agencies)



Actually, it's split in 1/3s, with each third being private, public, and FD.  



Chief Complaint said:


> Nailed it!  Great post.



Weren't you the guy who said EMS shouldn't do rescue because EMS agencies have a hard enough time doing medicine and putting more on their plate means they'll suck?

Yes... yes you were.


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## DrParasite (Oct 21, 2012)

rescue1 said:


> FDNY still runs heavy rescues on working fires, though I don't know if they do RIT or just assist. I know they used to do RIT.


on a working fire dispatch, you get 2 engines, 2 trucks, and a BC.  on a confirmed working fire, the assignment is upgraded to 4 engines, 2 ladders, 1 rescue, 1 squad, 2 bc, and additional ladder to act as the FAST/RIT truck.  RESCUE and SQUADS often assist the RIT company, but they aren't assigned to RIT duties.  But oddly enough, FDNY also has the truck companies do rescue, in addition to the rescue company





rescue1 said:


> Bur are you advocating EMS based fire suppression as opposed to fire based EMS? Won't that have...you know...all the same problems that we have with combined service already? We can't argue against fire based EMS and then advocate EMS based fire.


I am absolutely 100% against fire based EMS.  I am also 100% against EMS based fire suppression.  

But those who do advocate for combined services always say FD can do ems, so using the same logic, I just said let EMS fight fires.  If you are in favor of one because it can work, than you can't be against the other (and both are equally absurd or equally a great idea, depending on which side you fall on).


rescue1 said:


> Unrelated note, beer is delicious, but it does mean the rest of this debate is gonna have to wait till tomorrow. :beerchug:


have one for me, the boss frowns when I start drinking while at work


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## Chief Complaint (Oct 21, 2012)

Only skimmed the last couple pages of responses, but let's be serious for a minute.  Private EMS agencies have no physical requirements for employment.  Career fire departments require that a certain standard be met.  That's why private EMS agencies don't take over rescue ops.  Fat people aren't much good at a trench rescue scene.


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## CentralCalEMT (Oct 21, 2012)

Chief Complaint said:


> Only skimmed the last couple pages of responses, but let's be serious for a minute.  Private EMS agencies have no physical requirements for employment.  Career fire departments require that a certain standard be met.  That's why private EMS agencies don't take over rescue ops.  Fat people aren't much good at a trench rescue scene.




I am sorry you have had bad experiences with private EMS personnel who do not do the job well. However......not all private EMS is full of fat and lazy slobs. Within an hour of I work, yes there are several companies that have people that are an embarrassment to EMS. However, where I work, we routinely have to hike in miles to our patients at high elevations in horrible conditions, assist with over the side rescues, and are in generally good shape. Nobody that works for us is overweight We are allowed to do PT on duty and most of us do. Like I said before, there are EMS providers who make the rest of us look bad, but I am tired of career firefighters dismissing private EMS entirely because of the actions of a few.


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## rescue1 (Oct 21, 2012)

Linuss said:


> Correction:  They tend to not do heavy rescue, but do tend to train their personnel in it, AND FD doesn't throw a hissy fit when a Paramedic gets in with the patient, like they do in some places.  On top of that, in most of those places, FD doesn't try to move beyond fire and rescue saying they could do medicine just as well as EMS does.
> 
> No, in those places, it's rather an exception, instead of a rule, to see a firefighter with any medical training beyond that of a first responder.



I believe EMS should totally be trained in rescue, and be allowed (and trained, and expected) to provide patient care during the rescue operation. 
Sorta like tactical medics, we cross train with LE to provide medical care on scene of a SWAT incident, but we don't take over law enforcement nor does LE take over EMS.

My philosophy remains that firefighters already have big trucks and tools, and plenty of time on their hands. This is even more true if they are not ALS fire departments (which I'm not the biggest fan of).
I'll also admit my idea is based mainly on cost/benefit analysis, and on the somewhat crazy idea that the money saved from fire doing rescue could be used to fund more ambulances.

That being said, it sounds like some of the firefighters near Linuss are pee pee heads if they refuse to allow EMS to access a patient during rescue. EMS should be an integral part of rescue assignment.

How does ATCEMS run rescue? I almost applied for Austin Fire Department a year ago, and their website implied that they also did rescue stuff. Does ATCEMS assist the FD, or is it the other way around?

Also, "because they're fat" is probably not a good reason to exclude EMS from rescue. This is public safety. It's like a fat person party.


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## Bullets (Oct 21, 2012)

DrParasite said:


> Or lets think REALLY outside the box, and say since the FD doesn't have a RIT team, lets train and equip the EMS personnel as firefighters, and let them serve as the RIT team on working fires, while still being EMS personnel.



See Flemington-Raritan First Aid Squad...
they are the primary RIT team for their area and assists the local FDs with fire suppression

the old truck carries all their tech rescue stuff

For those who claim that EMS cant fund a rescue division, i can point to many here in NJ, both volunteer like Wayne Memorial First Aid, Hybrid like Flemington, and paid, like UMDNJ who operate heavy rescue trucks and do so very well. My home town operates EMS rescue, but the local FDs are trying to get in on it, buying used tools and pumps because they just dont do fire work any more. I have not had positive experiences with these volunteer fire companies. I have been in a car that another town was cutting and they shook that thing like San Fran in 1989


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## DesertMedic66 (Oct 21, 2012)

I guess I view rescues differently due to the fact that all fire engines here have at least one medic on board with all the other firefighters being EMTs. Rescue work is still based on medical (with the fire medic being in charge). The ambulance (EMS) waits for the patient to get removed (to an extent. We will help backboard in the vehicle etc) and then transport. 

Fire has the man power, has the tools, has the training, has the gear, and has the medical aspect covered. We are pretty much just a taxi.


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## Tigger (Oct 21, 2012)

Bullets said:


> See Flemington-Raritan First Aid Squad...
> they are the primary RIT team for their area and assists the local FDs with fire suppression
> 
> the old truck carries all their tech rescue stuff
> ...



Doesn't UMDNJ staff their heavy rescue with only two people?


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## Veneficus (Oct 21, 2012)

rescue1 said:


> Very few, because it makes sense to make them firefighters, allowing them to perform rescue from structure fires as well, or exist as a RIT.



It is important to understand in structural firefighting, a rescue company functions more like a force multiplier.

Not only for rescue but for anything else that is needed on the fire ground.

All of the dedicated fire service rescue companies I am familiar with require time on an engine + time on a truck + time in rate to even remotely qualify for the assignment.

Just because a department has a rescue truck doesn't make them a rescue company similar to larger cities like NY, Chicago, etc.



rescue1 said:


> My question is, when you look at the countries that we at EMTLife think do EMS correctly--Canada, New Zealand, Australia--none of them do rescue. They focus on medicine, and let the fire service focus on technical skills.



Actually, many european countries train their medics in tech rescue.

Advancing into specialized rescue, like mine, mountain, collapse, etc is an upward mobility promotion.


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## rescue1 (Oct 21, 2012)

Veneficus said:


> I
> Actually, many european countries train their medics in tech rescue.
> 
> Advancing into specialized rescue, like mine, mountain, collapse, etc is an upward mobility promotion.



I'm not advocating not training EMS in rescue techniques. I'm just advocating making the fire department the AHJ for rescues. If fire and EMS are separate (which they have to be for this topic to make sense), then EMS should absolutely be included in the rescuing process.

And yes, Tigger, according to their website, UMDNJ's rescue is staffed with two EMTs. I don't know if Newark FD has a separate one or not though.


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## Bullets (Oct 21, 2012)

Tigger said:


> Doesn't UMDNJ staff their heavy rescue with only two people?



Yes, which makes the work they do all the more impressive.

However i feel that two is the ideal number on a vehicle rescue


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## MassEMT-B (Oct 21, 2012)

Chief Complaint said:


> Only skimmed the last couple pages of responses, but let's be serious for a minute.  Private EMS agencies have no physical requirements for employment.  Career fire departments require that a certain standard be met.  That's why private EMS agencies don't take over rescue ops.  Fat people aren't much good at a trench rescue scene.



There is a very easy way to fix that. If fire/ems/police split the budget as needed to run each one based on actual need and not what a union says is needed, a third service EMS could be started which has physical requirements. Which could replace the private company doing 911.


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## CFal (Oct 21, 2012)

EPFD112 said:


> \ Heck, why not just throw a pump, tank, and hand line on there too so one two man crew and pull up and handle it all. Okay, but for real...



Somebody beat you to it...







http://www.braunambulances.com/Models/Patriot.aspx


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## Tigger (Oct 22, 2012)

Bullets said:


> Yes, which makes the work they do all the more impressive.
> 
> However i feel that two is the ideal number on a vehicle rescue



Kind of tough to be a heavy rescue with two people. Door pops? That's different. It's also not heavy rescue.


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## DrParasite (Oct 22, 2012)

Tigger said:


> Kind of tough to be a heavy rescue with two people. Door pops? That's different. It's also not heavy rescue.


not at all.  in fact, if you look at 90% of the rescue jobs, all you need is two people, because more often than not, two people are actually working hard, while you have others standing around.  having 3 teams of 2 is a lot better than 6 people working at the same time with 3-4 people standing around looking pretty.

Also remember, you need an engine at every rescue scene, for both fire suppression, vehicle hazards and for initial stabilization.   So it's not like you don't need the FD to be there, they just aren't performing the rescue.

In Newark, FD sends an engine, ladder, and rescue, so you have plenty of bodies standing around to help with lifting items and moving equipment.  PD might also send a rescue unit if it's available.  But the UMDNJ Rescue Crews are usually the people on the tools performing the rescue, and are typically the most qualified rescue personnel on the scene.  Well, them an PD are tied; after all Newark PD's rescue crews are trained by the UMDNJ Rescue staff, and the two work very well together.

And while there are only 2 Rescue techs assigned to the Rescue truck at any given time, you also have field supervisors and ambulance staff who are cross trained for rescue who can gear up and assist if needed.

I believe this EMS agency has two heavy rescues, and also functions as either a truck company or RIT team at big fires http://carsrescue.org/


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## Tigger (Oct 22, 2012)

So for a complex machine entrapment or high angle rope rescue call two people would be sufficient? It's great that there are more companies responding to increase manpower, but the most important part of a rescue company is the crew on it, and two people (no matter how experienced) are not enough to make up a heavy rescue. The truck might be big and have all the tools, but it is not a self contained rescue company since it relies on other units and agencies to make the operations actually work. 

That is not to say that most rescue work is heavy rescue, or even that two people cannot do most rescue work, I agree that they can. I do not agree that they make up a heavy rescue unit however.

Maybe this is just arguing semantics, I guess being from the northeast I have a different idea of what a rescue company is. And Colorado for that matter.


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## DrParasite (Oct 22, 2012)

Tigger said:


> So for a complex machine entrapment or high angle rope rescue call two people would be sufficient? It's great that there are more companies responding to increase manpower, but the most important part of a rescue company is the crew on it, and two people (no matter how experienced) are not enough to make up a heavy rescue. The truck might be big and have all the tools, but it is not a self contained rescue company since it relies on other units and agencies to make the operations actually work.


fair enough.  please give examples of a fire department that will only sent a heavy rescue to a rescue assignment.  no engines, no ladders, maybe a rescue chief, but that's it.  please give department names and cite your sources.  

I doubt you will find any


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## rescue1 (Oct 22, 2012)

But if EMS rescue is relient on the fire department to do their job, then why is EMS doing it in the first place?


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## Tigger (Oct 22, 2012)

DrParasite said:


> fair enough.  please give examples of a fire department that will only sent a heavy rescue to a rescue assignment.  no engines, no ladders, maybe a rescue chief, but that's it.  please give department names and cite your sources.
> 
> I doubt you will find any



There aren't any, don't remember stating as such. Meanwhile, augmenting a rescue company with a truck company makes considerable sense seeing that truck companies are often tasked with being the "first due" to rescue calls. A truck company be definition is going to have the tools and manpower to assist with such tasks. Meanwhile tying up an ambulance crew to run rescue tools makes comparatively little sense given that the whole purpose of an an ambulance is to take the patient to the hospital, something that cannot be done with the crew cutting up the car. Using a supervisor defeats the purpose of having a supervisory person on scene. And dispatching an extra ambulance for manpower is a complete misuse of resources given how much more likely a medical call, something that the ambulance is you know, intended for, is to come in than an extrication call.


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## DrParasite (Oct 22, 2012)

rescue1 said:


> But if EMS rescue is relient on the fire department to do their job, then why is EMS doing it in the first place?


if EMS is reliant on the FD to do theri job, because the FD first responds to every life threatening calls, why is EMS doing it in the first place?  Every rescue operation should get an engine and a rescue.  they each have different jobs at a scene.  there is no rule that says the rescue needs to come from the FD.  in NYC for example, PD has a heavy rescue too.  As long as they are staffed and equipped to do the job, it can be done.





Tigger said:


> Meanwhile tying up an ambulance crew to run rescue tools makes comparatively little sense given that the whole purpose of an an ambulance is to take the patient to the hospital, something that cannot be done with the crew cutting up the car.


exactly, which is why you need dedicated people on the rescue truck.  In Newark's case, 2 are dedicated to the truck.  Another guy can get off the ambulance and help, but once their patient is extricated, off to the ER you go, and back to your regular 2 (which is all you need is most entrapments). 





Tigger said:


> Using a supervisor defeats the purpose of having a supervisory person on scene. And dispatching an extra ambulance for manpower is a complete misuse of resources given how much more likely a medical call, something that the ambulance is you know, intended for, is to come in than an extrication call.


As I said before, you can do it with 2.  having an extra person helps, but if you train with 2, you can work with two.  and 95% of the MVAs you only need 2 people on the rescue to handle the actual extrication.

You were the one who said "it is not a self contained rescue company since it relies on other units and agencies to make the operations actually work."  fire Departments do this all the time, because the engine or truck supports the rescue company to make the operation wokr.  Sorry tigger, those were your exact words, you can't have it both ways.


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## Shishkabob (Oct 22, 2012)

rescue1 said:


> But if EMS rescue is relient on the fire department to do their job, then why is EMS doing it in the first place?



You're right.  Take the funding away from the FD and give it to EMS where it belongs, and we won't need FD on any of our calls that don't involve flames or HazMat.


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## Tigger (Oct 22, 2012)

DrParasite said:


> if EMS is reliant on the FD to do theri job, because the FD first responds to every life threatening calls, why is EMS doing it in the first place?  Every rescue operation should get an engine and a rescue.  they each have different jobs at a scene.  there is no rule that says the rescue needs to come from the FD.  in NYC for example, PD has a heavy rescue too.  As long as they are staffed and equipped to do the job, it can be done.exactly, which is why you need dedicated people on the rescue truck.  In Newark's case, 2 are dedicated to the truck.  Another guy can get off the ambulance and help, but once their patient is extricated, off to the ER you go, and back to your regular 2 (which is all you need is most entrapments). As I said before, you can do it with 2.  having an extra person helps, but if you train with 2, you can work with two.  and 95% of the MVAs you only need 2 people on the rescue to handle the actual extrication.
> 
> You were the one who said "it is not a self contained rescue company since it relies on other units and agencies to make the operations actually work."  fire Departments do this all the time, because the engine or truck supports the rescue company to make the operation wokr.  Sorry tigger, those were your exact words, you can't have it both ways.



Fine, you win. I failed to to recognize that fact. However,* two people on a big truck does not equal a heavy rescue company.* It might work for most entrapments, but it does not work for actual heavy rescue operations. Pulling a guy here or guy there doesn't make up for it either. Then you you have four guys and one less ambulance. That totally works for multi pitch rope rescue. Oh wait...

But that's not what a rescue company is. It's experience and know how arriving on scene, with every member on board being able to manage the resources of other responding units. I don't doubt that the two person crews found in Jersey can do that. But there is only two of them, a properly staffed rescue with 4+ is tremendous force multiplier. 

Let me rephrase my argument. A two person heavy rescue unit is not a heavy rescue company, it is two guys and a big truck. Using an ambulance crews to augment it's staffing is a poor use of resources given that ambulances should be running medical calls and little else. A fire department using a ladder company to augment it's rescue is a better use of resources considering that both share similar roles.

And for what it's worth, I completely support giving EMS crews the appropriate PPE and and training needed to be actively involved in patient care during the extrication. To me it makes more sense to have someone else run the tools and whatnot so once the patient is extricated the EMS crew can depart immediately.


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## DrParasite (Oct 22, 2012)

I give up, you win.  I'm not wasting my time, because it's no longer a discussion of what can be, it's you refusing to admit that it can and does happen, in major cities  in the US.

Newark, New Orleans, Pittsburg, those are 3 big city paid departments; go and see what they do, since they all have EMS agencies that perform heavy rescue.  and I'm pretty sure they get lots of rescue assignments a year.

Maybe you should contact those departments, and not only tell them that they aren't a heavy rescue company, but that EMS can't perform rescue well.  I would love to hear their responses.

For full disclosure, I'm a trained firefighter, have worked on a career fire department that performed EMS & Rescue, have worked for a career EMS agency that performed EMS & Rescue, and am currently on a FD that handles Rescue for the town where I live.  

Either way, I have explained what the role of EMS can be on rescue assignments, in both big city USA and small town volunteer world.  If you are still refusing the see that, than that's on you, and I give up trying to open your eyes.


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