# EMS Medical Director pulls 18 more ALS certs (Paramedic privileges) from FFs



## VentMedic (Sep 15, 2009)

This is a continuation of the Collier FD (FL) Paramedics drama that puts them into the hall of shame.  

Previous recent thread:

*Collier EMS director pulls certification of 25 paramedics *

http://www.emtlife.com/showthread.php?t=14529&page=4

*Tober pulls advanced life support certification of 18 more firefighters *

http://www.naplesnews.com/news/2009/sep/03/tober-pulls-advanced-life-support-certification-18/



> NAPLES — Eighteen more firefighters are having their advanced life support certifications pulled by Collier County Emergency Medical Services.
> The move comes at a time when some fire districts may soon propose to county officials that they have their own EMS licenses.
> 
> Five more North Naples firefighters and 13 firefighters from the East Naples district are no longer permitted to do advanced life support because they failed to do ride-alongs on ambulances as required, said Dan Bowman, deputy chief of EMS. Last week, 25 North Naples firefighters were decertified.


 

*Paramedics Medication Administration Record*
http://media.naplesnews.com/media/static/Paramedics_medication_administration_report.pdf


*Paramedics Procedures Performed*
http://media.naplesnews.com/media/static/Paramedics_procedures_performed_report.pdf


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## daedalus (Sep 15, 2009)

Dr. Tober is a brave man, and I admire him for holding paramedics to the standards established by the EMS system, unlike what happens around here.

Bravo.


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## VentMedic (Sep 15, 2009)

daedalus said:


> Dr. Tober is a brave man, and I admire him for holding paramedics to the standards established by the EMS system, unlike what happens around here.
> 
> Bravo.


 
If he had a twin who was an EMS Medical Director, I'd send him to L.A. ...once FL is conquered and on the right path of EMS professionalism.


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## daedalus (Sep 15, 2009)

I think it is sad that the Fire departments have actually convinced the public that evil Dr. Tober is taking away the hero firefighter's ability to provide emergency medical care in case they have an emergency. The way I understand it they are still EMTs and can provide BLS until the ALS ambulance gets on scene. That is perfectly acceptable care in my opinion.


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## VentMedic (Sep 15, 2009)

I can not believe the FD didn't just put their arses on an ambulance rotation schedule if they wanted ALS status...Period.    The FDs were the ones that wanted to do ALS EMS as the county already has Collier EMS.


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## MrBrown (Sep 15, 2009)

I applaud this MD for taking a stand against the fire unions


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## firecoins (Sep 15, 2009)

VentMedic said:


> I can not believe the FD didn't just put their arses on an ambulance rotation schedule if they wanted ALS status...Period.    The FDs were the ones that wanted to do ALS EMS as the county already has Collier EMS.



if they just followed the rules, they would have their ALS certs.


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## Hal9000 (Sep 15, 2009)

In the state of Montana, the fastest growing "EMT reviews" are coming from self-policing to give professionalism a chance to grow.  Since we all operate under a professional license here, with a state board and state rules, protocols, and regulations, it's nice to know these things are happening. 

Our medical directors just recently have been required by the state to attend official training.  One organization that I work for has gotten a new medical director who is very much like Dr. Tober.  He has rooted out much of the unprofessionalism and even helped end the "small problem" of some EMTs having fraudulent licenses.

With any luck, more medical directors will behave like Dr. Tober.


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## downunderwunda (Sep 17, 2009)

There should be more of it.

Fire has no business in EMS.

Keep them seperate

EMS has enough losers without bringing fire into it.


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## berkeman (Sep 17, 2009)

downunderwunda said:


> There should be more of it.
> 
> Fire has no business in EMS.
> 
> ...



I disagree on your generalization, and I don't think this thread is about your generalization.  In my area, the FF/EMT-Ps get lots of action, as the first responders to dispatch.  I've worked shoulder-to-shoulder with them as an EMT-B, and they know their stuff.  They are the paramedics on-scene until the mixed AMR ambu gets there for transport.  They (and I) take our roles and training responsibilities very seriously.


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## VentMedic (Sep 17, 2009)

berkeman said:


> I disagree on your generalization, and I don't think this thread is about your generalization. In my area, the FF/EMT-Ps get lots of action, as the first responders to dispatch. I've worked shoulder-to-shoulder with them as an EMT-B, and they know their stuff. They are the paramedics on-scene until the mixed AMR ambu gets there for transport. They (and I) take our roles and training responsibilities very seriously.


 
I believe downunderwunda is from the country "down under" which does not have the problems this country has with the FDs, private ambulances and education issues. His country may have other issues in EMS as it is rare to find a perfect system but I doubt if they are to the same magnitude as those in the U.S. 

Just obtaining the minimum necessary to get the FD job or having all FFs go through a program offering only minimum hours to make every FF a Paramedic is what has been the downfall of several FDs' reputation as EMS providers. It is the wrong approach. Many FDs have and some still do provide good EMS but many have failed to maintain the standards the public they serve deserve.

If you are still seeing your Paramedics with the eyes of an EMT-B, I will ask you to re-evaluate your position once you become a Paramedic and hopefully through a solid education program and not just the minimum 1070 hours that California requires.


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## TransportJockey (Sep 17, 2009)

VentMedic said:


> I believe downunderwunda is from the country "down under" which does not have the problems this country has with the FDs, private ambulances and education issues. His country may have other issues in EMS as it is rare to find a perfect system but I doubt if they are to the same magnitude as those in the U.S.
> 
> Just obtaining the minimum necessary to get the FD job or having all FFs go through a program offering only minimum hours to make every FF a Paramedic is what has been the downfall of several FDs' reputation as EMS providers. It is the wrong approach. Many FDs have and some still do provide good EMS but many have failed to maintain the standards the public they serve deserve.
> 
> If you are still seeing your Paramedics with the eyes of an EMT-B, I will ask you to re-evaluate your position once you become a Paramedic and hopefully through a solid education program and not just the minimum 1070 hours that California requires.



Or better yet, leave CA and go somewhere where there is actually progressive EMS


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## downunderwunda (Sep 17, 2009)

VentMedic said:


> I believe downunderwunda is from the country "down under" which does not have the problems this country has with the FDs, private ambulances and education issues. His country may have other issues in EMS as it is rare to find a perfect system but I doubt if they are to the same magnitude as those in the U.S.
> 
> Just obtaining the minimum necessary to get the FD job or having all FFs go through a program offering only minimum hours to make every FF a Paramedic is what has been the downfall of several FDs' reputation as EMS providers. It is the wrong approach. Many FDs have and some still do provide good EMS but many have failed to maintain the standards the public they serve deserve.
> 
> If you are still seeing your Paramedics with the eyes of an EMT-B, I will ask you to re-evaluate your position once you become a Paramedic and hopefully through a solid education program and not just the minimum 1070 hours that California requires.



Very true Vent. We are not aligned with Fire. We dont want to be aligned with Fire. 

For good reason.

The core business of a Fire Department is, oddly enough, to fight fires. So let them fight fires. If they do not have enough work to fight fires, take the funding & give it to EMS as a seperate service, able to justify its position & funding.

I fail to see any correlation between Firefighting & EMS. 

It doesnt work. Seperate them, Make each show why they deserve the money independent of the other, then see who is doing the work. 

Just a thought, instead of EMS being an offshoot of the fire dept, the fire dept should be a sub branch of EMS!!!!!


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## rescue99 (Sep 17, 2009)

downunderwunda said:


> Very true Vent. We are not aligned with Fire. We dont want to be aligned with Fire.
> 
> For good reason.
> 
> ...




Well put. Not that I totally agree..but well said. You have a valid argument.


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## 281mustang (Sep 17, 2009)

firecoins said:


> if they just followed the rules, they would have their ALS certs.


 Exactly, they brought it on themselves.


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## rescue99 (Sep 17, 2009)

281mustang said:


> Exactly, they brought it on themselves.



Such a violation of public trust IMO. Sadly, this is happening all over our  country and something I've fought in my state for almost 10 years. So far it has resulted in little change but, I think we're getting closer. When a state agency, which controls the renewal of licensure, education and CE's makes the statement; "We have a relationship with _____ambulance",  it is an all up hill battle. 

Fighting fraud is a lot harder than people realize. Politics tends to play hard ball with the backing and support dollars of well, the EMS system itself. Students, workers, educators...none of them are stepping up to the plate. Incompetence and fraud are rampant, especially when it comes to CE's. FD's are actually better than many of the private ambulance companies from what I can tell. Both have issues.


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## VentMedic (Sep 17, 2009)

rescue99 said:


> Fighting fraud is a lot harder than people realize.


 
Unfortunately(?) this can not even be called fraud because the FD and the FFs were pretty blatant in expressing they did not want to rotate on an ambulance even for the very few times required or follow their Medical Director's orders.   Somewhere in their minimum hours of Paramedic training someone forgot to tell them they work under the Medical Director's license.


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## rescue99 (Sep 17, 2009)

VentMedic said:


> Unfortunately(?) this can not even be called fraud because the FD and the FFs were pretty blatant in expressing they did not want to rotate on an ambulance even for the very few times required or follow their Medical Director's orders.   Somewhere in their minimum hours of Paramedic training someone forgot to tell them they work under the Medical Director's license.




There was intent to violate policy, period. If the policy is a licensure issue then yes, fraud could be the result. All depends on whose rules were broken and what the repercussions are and of course, how far someone takes these violations. It's a tad more complicated than these folks didn't do a shift in the back of a rig. They violated the very conditions in which they are able to work as medics which could put any certification/licensure to practice in jeopardy.


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## rescuepoppy (Sep 18, 2009)

I don't know if this is the case here but if the chief is taking the side of the fire fighters on the lack of continuing ed or documentation of EMS skills. Then is it also possible that someone needs to look into how continuing ed of fire fighting skills are being handled. Not saying that things are not being handled correctly just concerned about the possibility of a "good old boys" system being in place here.


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## VentMedic (Sep 18, 2009)

This area already had those issues recently and a couple of FDs in Collier were also guilty of sloppy record keeping and failure to check certifications.   There were a couple that let their EMT certs lapse and at least one Paramedic that falsified his cert because they only give a year to obtain it if you do not have it at hire.  They also have had issues with some driving emergency vehicles that had not met their training stanards.  So, yes, they do need some oversight.    

Dr. Tober has already tried to get attention from the state certification board on a few issues but so far they have not intervened.   For the Paramedic (or pretend Paramedic), the FD (Marco Island) made a statement that even though he didn't have a Paramedic cert he could still do all the procedures he did as an intern.  It didn't seem to matter that he was wearing a Paramedic patch and the FD listed him as a certified Paramedic.  However, he did lose his job but more for falsifying documents rather than performining medical procedures without a license.


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## 46Young (Sep 18, 2009)

downunderwunda said:


> Very true Vent. We are not aligned with Fire. We dont want to be aligned with Fire.
> 
> For good reason.
> 
> ...



It's not that simple. The FD is like an insurance policy for the public. Strip staffing and close houses, they won't be there in nearly enough time, and with enough numbers to get the job done.

http://www.firefighterclosecalls.com/staffing.php

FD's across the country have taken over EMS for various reasons, both good and bad. Good things would be to ensure adaquate coverage of EMS after experiencing failure via private or third service EMS. By crosstraining providers you'll keep FF staffing up, have enough EMS providers, and curtail OT on both sides due to versatility of field personnel. You're also utilizing FF's productively during their downtime as effective, properly trained EMS providers. Getting the most for your money. 

Bad things happen, however, when FD's assume EMS responsibilities and then put it on the back burner, redirecting funds back to the fire side at the expense of EMS. Having what amounts to "paper medics" only, as is part of the subject of this thread, is obviously wrong.

If a FD can run EMS properly and as effective (or more effective) as a third service provider, it's a good thing. Both available FF and EMS positions will be staffed, and EMS revenue will be realized by the FD. It's win-win only if run properly with proper respect given to the EMS side.

Firefighting and EMS may not have much in common, but I have witnessed the fire/EMS marriage work well around here. It can and does work, despite the lack of similarities of both sides. The main benefits are better staffing for both sides (dual role with a dedicated txp fleet), better coverage/response times for both sides, and EMS revenue going to the dept (if previously going to hosp/private EMS). It may be poorly run in other areas, but that's not everywhere. Sure, FF's could be used for garbage collection or some other form of manual labor on their downtime as some have suggested, but that would have no positive effect on staffing ratios, coverage, or response times, would they? It's the best use of resources for the municipality. This holds true more so for rural/suburban areas than urban areas, I'll admit.

The fire service in general is significantly more established and politically connected than EMS for a paradigm shift resulting in EMS running fire. 

I imagine that the system in your country works well there, I'm not suggesting that fire and EMS merge out your way. Over here, it has worked in some places, and has been an utter fiasco in others. It's really a case by case basis. As such, it's difficult to make blanket statements about the system in general. There are plenty of examples of successes and failures from both sides, plenty to support either side of the argument.


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## VentMedic (Sep 18, 2009)

46Young said:


> It's not that simple. The FD is like an insurance policy for the public. Strip staffing and close houses, they won't be there in nearly enough time, and with enough numbers to get the job done.


 
Strip them of their club house environment and the FD department might be viewed  differently.   No more emptying a station for groceries or a cup of coffee.  No more trolling the shoreline to impressive the teenage girls.  No more 24 hours shifts.  No more fancy kitchens and grills at tax payer expense.   No more elaborate shrubery.  No more new SUVs for all the ranking officers.    

Allow for a 40 hour work week and those hours to be justified with actual duties that benefit the people they serve.  

Cities can no longer afford to have several hundred FFs sitting around doing very little waiting for the next 9/11. 

We ran a lot leaner several years ago and managed to do EMS also.   The unions and FFs who have about an much interest in fire fighting as they do being a Paramedic, which is very little,  have managed to wreak havoc on some FDs.


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## 46Young (Sep 18, 2009)

VentMedic said:


> Strip them of their club house environment and the FD department might be viewed  differently.   No more emptying a station for groceries or a cup of coffee.  No more trolling the shoreline to impressive the teenage girls.  No more 24 hours shifts.  No more fancy kitchens and grills at tax payer expense.   No more elaborate shrubery.  No more new SUVs for all the ranking officers.
> 
> Allow for a 40 hour work week and those hours to be justified with actual duties that benefit the people they serve.
> 
> ...



We don't go hang out at the town center for social hour. We're prohibited from leaving the station when not on calls with the exception of PT, to procure food (one rig goes the 1/2 mile to the grocery store, not far at all), attendance at a public function (often at the public's request, block party, church function, charity, pub. ed) or to fufill a legit admin. need. Our grill and kitchen are quite old. No elaborate shrubbery either. Oh yeah, the house/apparatus are vollie owned and maintained (mostly career staffed), as are quite a few others in the county. 

Our typical day starts with a rig check prior to the start of work at 0700. We have morning lineup for about 1/2 hour give or take. Our tour includes three work days. The first involves detailed first day checks on all apparatus. Nothing for the second day, and the third is reserved for washing the floors and apparatus. Next is housework. Then, we'll PT. Next is lunch, followed by completing both suppression drills and EMS drills as required by our monthly mandatory training matrix. We'll often hold a 20 minute box street drill in the midmorning. We'll then send out a unit to pick up groceries for dinner. We typically bring our own breakfast and lunch. The late afternoon and early evening are for probie training/driver training specifically. Otherwise, it's your own time. We do the best to keep this schedule with respect to call volume. We can also be sent to fill another station due to training, or attend a multi unit drill oureslves.

We spend the majority of our day maintaining the station/apparatus, PT to do our job well/stay off of inj. leave, and training to do our jobs more effectively. "Actual duties that benefit the people they serve".

As we are subject to FLSA, all 56 of our weekly hours are straight time only. Reducing staff to 40 hours a week would significantly increase the operating budget as many additional recruits would need to be hired, costing the local govt needless $$$'s in hiring, training, medical insurance, disability, equipment, holidays, vacation, sick time, pension, etc. More higher salary officer positions will need to be created as well. There will also be that many more staffing issues as well, and more OT to be paid out as a result. The night shift won't be able to participate in multi unit drills or EMS training at the EMSCEP facility, which are both typically held in the daytime. No overnight walkthroughs for district familiarization, either. There's no real logistical/financial benefit to reducing work hours from 56 to 40/wk. Quite the opposite, really.

You're right, cities can no longer afford to have several hundred FFs sitting around doing very little waiting for the next 9/11. FF's have been given EMS duties to make better use of their downtime. I thought that I said that already.

I've already admitted that there are a good number of FD's that handle EMS poorly, whose personnel are generally apathetic towards it. There are also a good number that do it exceedingly well. Plenty of examples available on both sides.

Running staffing as lean as possible is only asking for trouble at some point. Mutual aid won't always be there.


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## VentMedic (Sep 18, 2009)

46Young said:


> As we are subject to FLSA, all 56 of our weekly hours are straight time only. Reducing staff to 40 hours a week would significantly increase the operating budget as many additional recruits would need to be hired, costing the local govt needless $$$'s in hiring, training, medical insurance, disability, equipment, holidays, vacation, sick time, pension, etc.


 
We've already had this conversation before.  One key point you keep missing is "productive man hours".    EMS agencies that have switched from 24 to 8 or 12 hour shifts were able reallocate manpower to productive zones.  Thus, they reduced costs.   Do you think everyone in the working world is wrong and only the FDs are right?


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## 46Young (Sep 19, 2009)

VentMedic said:


> We've already had this conversation before.  One key point you keep missing is "productive man hours".    EMS agencies that have switched from 24 to 8 or 12 hour shifts were able reallocate manpower to productive zones.  Thus, they reduced costs.   Do you think everyone in the working world is wrong and only the FDs are right?



I don't see how reducing weekly work hours from 56 hours (24's) to 40 hours/wk (8's, 12's) can reduce costs. That is, unless the employee's yearly salary was reduced due to a shorter workweek or effectively reducing staffing by redistributing existing personnel into the new schedule, resulting in reduced manpower. By "productive zones" are you referring to versions of system status management? This has been discussed on another thread. Running the absolute bare minimum staffing under the guise of productivity is a disasater waiting to happen. A unusually busy day, or a major incident or two will easily overextend resources. The burnout and general job dissatisfaction that ensues is obvious.

IMO, a more effective plan would be to scale back a few 24 hour houses, appropriate for off peak call volume, and add "enhancement units" during peak hours with personnel from the downstaffed houses. OT personnel could even be used to upstaff these units, as it's well known that paying OT is cheaper than hiring new personnel with all of the associated costs as per my last post. These daytime units could be 1000-2200, or 0800-2000. The 12's could be WWWOOWWOOO.

The problem with reallocating personnel in the fire service is that those that work nights won't be able to attend multi unit training or EMS inservice CME's either. Fairfax County contiues to grow. Perhaps rather than adding firehouses and apparatus, a few medic fly cars and 8 -12 hour ALS txp units should be added to meet rising call volume. Keep ALS suppression apparatus inservice more often. 

The thing that many don't realize about working fires is that response times for the first due apparatus is only part of the picture. A box alarm here gets 4 engines, two trucks or towers, one heavy rescue, one ALS unit, one EMS capt, and one BC. The first unit can't do much by themselves. It's equally important for all of the other units to arrive as well, as each has a specific assigned function. More than a few on this site have suggested that suppression personnel be downstaffed due to low call volume. Even if the first in apparatus has a statistically adequate response time, what about the other units that have been spread thin due to downstaffing? Extended response times for the water supply/command engine, the second truck for ventilation, the rescue for search/VES, the RIT engine, the third engine for the backup line, etc. Overall significant delay in tactics and operations. 

As far as the argument for suppression apparatus being "tied up" on an EMS call, a fire call could come in while working an MVA, extrication, alarm bell, hazmat or even another working fire! Departments think about this, and they plan for it. At least competent places do. Weak argument. Having firefighters trained as EMTs and Paramedics is definitely getting more bang for the buck. Fire based EMS also generates revenue for the community, and if it is kept in the FD, it pays for salaries, equipment and such for both sides.

As far as fire responding to EMS runs, I would prefer to see four or more highly trained personnel who are serious about their jobs (that's how it is here, other areas not so much) arrive to provide care rather than two private EMS workers. But that's just me. Most communities wouldn't have any EMS whatsoever if FD's didn't do it. Volunteer staffing can be unreliable. Would a private ambulance company really want to station a rig in a small town for EMS transports if they only generate several calls per week? 

I don't want a private company doing my EMS. They have been vastly inferior in my experiences. Lack of oversight, they aren't subject to the same open record laws that we are, as a tax based agency. We don't pull rigs off of the road to run scheduled, guaranteed pay IFT txp's. We provide a career level pay/benefits package so that people will perform this job as a profession, rather than a stepping stone, providing stability and accountability in the service. We provide equal levels of service to the entire county, based on response times and not profit, as ALL people in this county deserve an equal level of protection.

The fire service regards EMS as another specialty, such as technical rescue, water rescue, hazmat, USAR. These are all additional certs above the basic FF, and each receives it's proper allocation of training/con ed to maintain proficiency (here, I can't speak of other places). All are different skill sets, require knowledge and professionalism, and must be performed by someone.


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## VentMedic (Sep 19, 2009)

46Young said:


> The problem with reallocating personnel in the fire service is that those that work nights won't be able to attend multi unit training or EMS inservice CME's either.


 
BooHoo, they would be scheduled for mandatory training and would be responsible for getting their CMEs just like everyone else in the professional world.



46Young said:


> The thing that many don't realize about working fires is that response times for the first due apparatus is only part of the picture. A box alarm here gets 4 engines, two trucks or towers, one heavy rescue, one ALS unit, one EMS capt, and one BC. The first unit can't do much by themselves.


 
Nobody said anything about reducing a FD except for the waste and holding them accountable for work hours. 



46Young said:


> As far as fire responding to EMS runs, I would prefer to see four or more highly trained personnel who are serious about their jobs (that's how it is here, other areas not so much) arrive to provide care rather than two private EMS workers. But that's just me.


 
I would prefer to see 4 qualified people that want to do EMS and not because the FD made them get a cert or they got it just for the extra money. There is a failure of some to care enough to keep their skills or for the FDs to even care as long as their FFs have the cert and either give the patient a real fast taxi ride or call an ambulance that can. 



46Young said:


> Most communities wouldn't have any EMS whatsoever if FD's didn't do it.


Read some of the articles on the EMS news wires lately. Communites are finding alternatives to the FD quickly when some FDs have stated they no longer want to do EMS. 



46Young said:


> I don't want a private company doing my EMS. They have been vastly inferior in my experiences.


That's a very broad and insulting statement. Very few on this forum have been anti-Fire. You do realize there are more options than just Fire and Private which would also benefit the Paramedics. 



46Young said:


> *The fire service regards EMS as another specialty*, such as technical rescue, water rescue, hazmat, USAR. *These are all additional certs above the basic FF*, and each receives it's proper allocation of training/con ed to maintain proficiency (here, I can't speak of other places). All are different skill sets, require knowledge and professionalism, and must be performed by someone.


 
And this is exactly why the Paramedic profession has stopped growing in the FDs. It is just another cert with not much more weight than a CPR card to some. A professional Paramedic should have more than a "cert" to represent their profession. It should no longer be "just a cert". We have a lot of specialty "certs" in each of the other *health care professions* but none of them take the place of the one profession we are licensed in. *The difference is the word health care professions that have specialty certs pertaining to medicine. Firefighting and Medicine are two different fields so "medicine" is not a "specialty cert" for fire fighting. *

Back when and still, the FDs that do EMS well realize the two are separate enough to allow growth within the field of EMS by supporting their continued education and I am not just talking about getting a few CMEs. When you consider getting the few CMEs required by your state or the NR is "continuing your education", you truly have little understanding of what it takes to be a healthcare professional.

It seems your FD still thinks in terms of a "cert" and in essence is in argreement with that hideous article I posting occasionally about "a Paramedic doesn't need all that much" to get a few skills done.

And seriously you have been listening to too much union propoganda to make any rational judgements on your own. That is the one thing that I really dispise about unions is that they fill people's heads with ideas that are not rational and then depend on the crowd (or herd) mentality (hysteria) to solidify their control over them. Thus, very few union members rarely have a thought that isn't directly from the union hand book or fear inducing meetings. 

Your posts are usually filled with the same fear inciting statements that fire unions depend on to keep the public paying and their members loyal. I don't need to insult you personally but you need to think like a professional Paramedic occasionally rather than just running with a herd of FF union members. Granted your pension is your priority but you can still be a FF. Just don't drag the Paramedic down by saying it is another "cert" to the FF.  That adds no value to the Paramedic as a profession and is just insulting.


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## atropine (Sep 19, 2009)

Your posts are usually filled with the same fear inciting statements that fire unions depend on to keep the public paying and their members loyal. I don't need to insult you personally but you need to think like a professional Paramedic occasionally rather than just running with a herd of FF union members. Granted your pension is your priority but you can still be a FF. Just don't drag the Paramedic down by saying it is another "cert" to the FF.  That adds no value to the Paramedic as a profession and is just insulting.[/QUOTE]

That's just it being a paramedic alone is not a profession, it's a stepping stone job. Should it be that way?, who knows. If thing are all that bad, then why have the Fire Dpartments been running ems for the past 30 plus years at least where Iam from, and why are there still MD's that take positions a medical director for specific departments. LA County has a county medical director, and most FD's have their own medical director. Is it really an incentive to be a doc on a Fd's payroll or is it just that things are not as bad as one would like to think. I enjoy the ems side as well as the fire side, and to tell you theruth I wouldn't mind single roled postions, but I will not work for $13.00 an hour to play paramedic. Until things get so bad a drastic changes are made Iam going to enjoy my pension and salary.


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## rescue99 (Sep 19, 2009)

My own community had several of its FF scam out on a boat load of their clinical hours during a Paramedic course my tax dollars helped to pay for back in 1999-2000. I personally know of dozens and dozens more who scammed out on both didactic _and _clinicals, unrelated to the FD. We're not talking just a few hours. We're talking entire rides/clinical portions and major parts of courses simply skipped! IC's and students alike aren't afraid to open discuss their fraud. Why? Because there are no repercussions!

There is no accountability! Community leaders and the State of Michigan pass the blame onto the EMS schools/colleges that provided the courses and dismiss fraud saying; students and firefighters are not responsible for the failure of the school. EMT's and Medics are brazen enough to brag about the fraud they commit, because they can. After reading the porblems going on in the East and South, Michigan clearly  isn't the only state doing this. :sad:


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## vquintessence (Sep 19, 2009)

atropine said:
			
		

> *That's just it being a paramedic alone is not a profession, it's a stepping stone job.* Should it be that way?, who knows.



Not a profession?  Does it not require an education as well as the constant con ed, re-certifications, clinical exposure, etc?  Unfortunately, the US allows non-college accredited institutions to provide the initial education.  Luckily, for the public and the progression of EMS, the tide may be slowly changing.

Interestingly enough... doesn't the fire service have it's hands involved in a tug-of-war with this issue?  Obviously there are other self-interest groups keeping the educational standards down, but the fire unions are certainly amongst the juggernauts of opposition.

The stepping stone comment is exactly what vent/others have said in this thread and others.  Your perception of a Paramedic as a stepping stone is the *NORM* of how the fire service percieves the role of a paramedic.  Becoming a paramedic has less to do with providing health care, but instead has become a perversion on becoming a necessity to:
landing a job,
getting a promotion, 
or simply getting a pay raise.



			
				atropine said:
			
		

> I enjoy the ems side as well as the fire side, and to tell you theruth I wouldn't mind single roled postions, but I will not work for $13.00 an hour to play paramedic. Until things get so bad a drastic changes are made Iam going to enjoy my pension and salary.





			
				46young said:
			
		

> As far as fire responding to EMS runs, I would prefer to see four or more highly trained personnel who are serious about their jobs (that's how it is here, other areas not so much) arrive to provide care rather than two private EMS workers



You and 46young seem to share a commonality in the disdain for private EMS, though 46young has more contempt.  I just can't really understand how a service, which is dedicated SOLELY to the provision of EMS and IFT... can be labelled as inept and unprofessional SIMPLY because it's a private entity.

The great irony I find with your masked contempt for private EMS is illustrated with your above statement of getting to "play paramedic".


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## VentMedic (Sep 19, 2009)

atropine said:


> That's just it being a paramedic alone is not a profession, it's a stepping stone job. Should it be that way?, who knows. If thing are all that bad, then why have the Fire Dpartments been running ems for the past 30 plus years at least where Iam from, and why are there still MD's that take positions a medical director for specific departments. LA County has a county medical director, and most FD's have their own medical director. Is it really an incentive to be a doc on a Fd's payroll or is it just that things are not as bad as one would like to think. I enjoy the ems side as well as the fire side, and to tell you theruth I wouldn't mind single roled postions, but I will not work for $13.00 an hour to play paramedic. Until things get so bad a drastic changes are made Iam going to enjoy my pension and salary.


 
I believe the reputation of EMS provided in Southern California speaks for itself which is why I find 46young's statement about private ALS ambulances ridiculous.

Many of the Paramedics in CA do think as atropine does which is part of the reason why EMS is in the shape it is in that state.   There are very few FF/Paramedics in the state that would ever consider themselves as medical professionals.  That is also why they are easy targets for studies on botched EMS procedures such as intubation and RSI.  If somebody thought a Paramedic couldn't do a skill or procedure, they just did the study in Southern California to prove their point.   

Unfortunately some FL FDs have over expanded or merged too quickly and are now losing their reputations for being good providers of EMS.   I really hope that FL's FD do not go down the same path as LA and can gain or remain as respectable providers of EMS. 

atropine, your attitude is not that of a medical professional.  Hopefully you will just stay on an engine as an EMT or First Responder and do not try to do EMS or become a Paramedic.  You appear not to be in public service for the people your department serves.


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## 46Young (Sep 20, 2009)

VentMedic said:


> BooHoo, they would be scheduled for mandatory training and would be responsible for getting their CMEs just like everyone else in the professional world.
> 
> 
> 
> ...



I like being able to fufill all of my required training, both for EMS and suppression on duty, thank you. It doesn't mean that I don't do additional studying or attend CME's on my own time, though. When I worked in NYC, I had to do challenge refreshers as I was too busy working several jobs to attend any CME's. In Charleston, we were held over so frequently for 12-24 hours at a time, that I often spent a sorely needed day off attending a mandatory CME session. 

I base my opinion towards private EMS on both personal experiences and first hand accounts from co-workers. This applies to 911 privates as well as combo 911/private providers, not IFT only. If I've offended someone, chances are that I've never heard of their agency, and have not based my opinion on it. If you do work for a private, you know the truth about how it's run. I would think that the majority of posters here care about improving themselves as a provider, as evidenced by participation in the forum. But what about your co-workers? I generally hold muni TSEMS in higher regard, and hosp. based EMS even higher still. It's the straight up privates, profit driven by management, and heavily weighted with transient employees that leaves me with a poor opinion.

I do disagree with FD's taking over EMS, IF it was being run well previously. Single role providers need to have other options. 

I'll change my tune about a paramedic cert just being another specialty if and when educational standards increase. 911 medic work just isn't that difficult or challenging. Maybe it's just that I've worked for several years in the NYC 911 ALS system, which has a high initial learning curve. I haven't found it difficult to maintain or increase proficiency after assuming a suppression role. Extrication, Hazmat and water rescue all use different skills sets and equipment than basic firefighting. EMS holds less in common with fire suppression than these specialties, but guess what? Fire/EMS works. At least when run properly. It's like atropine said, I'd be content working single role EMS, it's just that the salary, etc. etc. just aren't there. The single role realm can't offer what I'm asking for.

I have the union to thank for the salary/benefits, retirement, etc that my family and I currently enjoy. Of course I'll buy into the union line. I'll defend what we have to the best of my ability. It would be foolish to do otherwise.

Also, for the record, I would like for education and scope increase, and I would be happy to help where I can. I would honestly enjoy working a challenging medic position on the side, whatever that may be. I do have love for the game, it's just that I don't find it challenging at the moment. At least not 911 paramedicine. Not when the LCD is three-six month wonder medics.


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## 46Young (Sep 20, 2009)

I don't see FD's rearranging schedules into "productive zones" in the name of efficiency (it would serve to burn out the employee, as happens often with EMS. The extreme example being system status management). The union won't bring that to the table as a bargaining chip, at least not here. If the union did allow that, they certainly wouldn't agree to a yearly salary cut in line with a reduced workweek, the hourly compensation would need to increase to keep the yearly quoted salary the same. This would either cost the local gov't needless $$$'s in hiring, training, etc. as posted previously, or result in unsafe staffing levels/available units during episodes of high call volume.

If the union did agree to a shorter workweek with productive zones, they would certainly not agree to any restrictions to shift swaps. FF's would simply trade tours to go back to 24's.


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## 46Young (Sep 20, 2009)

rescue99 said:


> My own community had several of its FF scam out on a boat load of their clinical hours during a Paramedic course my tax dollars helped to pay for back in 1999-2000. I personally know of dozens and dozens more who scammed out on both didactic _and _clinicals, unrelated to the FD. We're not talking just a few hours. We're talking entire rides/clinical portions and major parts of courses simply skipped! IC's and students alike aren't afraid to open discuss their fraud. Why? Because there are no repercussions!
> 
> There is no accountability! Community leaders and the State of Michigan pass the blame onto the EMS schools/colleges that provided the courses and dismiss fraud saying; students and firefighters are not responsible for the failure of the school. EMT's and Medics are brazen enough to brag about the fraud they commit, because they can. After reading the porblems going on in the East and South, Michigan clearly  isn't the only state doing this. :sad:



When I worked in NYC I've occasionally had medics brag about shortcuts they've taken during clinicals. One program out of Brooklyn didn't do any checkups at all. Some would brag that they would go into the ER, bounce around, get two different nurses to sign for the 8 hour clinical, and also get a signatue from the peds ER as well. 24 hours for the price of 8. I've heard of one MD at the CCU sign for three clinicals at once since he reasoned that the student won't get any benefit after rounds. WTF? Some students would do ride alongs with the NYC 911 participating hospital where they already work as an EMT, and have their buddies sign off on tubes, IV's, med admin, and "phantom ride alongs". To my knowledge none of these sacks of :censored:had any aspirations for the fire service. 

LaGuardia CC and Stonybrook University were the only two reputable medic programs in the greater NY area, IMO. As far as other places, if you're a straight shooter and get the most from your time and experience (other places will give you all the tools, but it's up to you), you'll turn out okay. If not ...... I don't even want to think about it.


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## 46Young (Sep 20, 2009)

vquintessence said:


> Not a profession?  Does it not require an education as well as the constant con ed, re-certifications, clinical exposure, etc?  Unfortunately, the US allows non-college accredited institutions to provide the initial education.  Luckily, for the public and the progression of EMS, the tide may be slowly changing.
> 
> Interestingly enough... doesn't the fire service have it's hands involved in a tug-of-war with this issue?  Obviously there are other self-interest groups keeping the educational standards down, but the fire unions are certainly amongst the juggernauts of opposition.
> 
> ...



No, not a proffesion per se. Career advancement, salary, working conditions, protection from vindictive management, reitrement, job security, longevity, and such just arent ther for the vast majority of providers. Not all, but the vast majority. I didn't have the intention of using my medic cert as a stepping stone initially, but I've had experience in several systems, and have heard about many more throughout my travels. It's been a real eye opener to see how things are for the profession on a national scale. To have any longevity, job satisfaction, financial security, career advancement, and low potential for burnout I've come to the conclusion that the fire service was the way to go. I don't agree with the fire service generally holding EMS educational standards down to allow a greater applicant pool, but it's not going to cause me to bite the hand that feeds me. 

When educational standards increase (nationally mandated), and this actually translates to the medic field catching up reasonably with RN's, RT's, etc in compensation, prestige, stability, power, so on and so forth, I'll then change my opinion. 

Back when I was doing a ride along for EMT school, a medic told me "Going into EMS, and in particular getting your medic is the quickest way to make good money without going to college. You could do it with a GED. You can make almost as much money as an RN (NYC hosp. based medic, NYHQ 2002). So true. With these medic mills and students scamming on hours, it's hard to really give the profession any due respect without a massive educational overhaul. Uphill battle, as many groups, including FD's, stand to gain little to nothing from having a shorter supply of medic applicants, that are asking for much more in comopensation and such to reflect their educational investment.

The EMS field isn't typically sustainable as a long term career choice, as evidenced by the high number of transient employees, who either go on to bigger and better things (stepping stone, whether it's to an FD or changing professions with a new degree earned while tolerating an EMS position), or simply burn out. Really, we all know more than a few people that are "stuck" in EMS as a career. They may have intended to go back to school, but they may have needed to work many extra hours to survive, and may not have had time to chip away at a degre, even a few credits at a time . Now, it's 10-20 years later, and nothing's changed. It's all they know.


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## 46Young (Sep 20, 2009)

Heck, here in VA many places will regard an EMT-P and an EMT-I as one and the same for all intents and purposes. I still don't get that.


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## 46Young (Sep 21, 2009)

Another angle regarding dual role firemedics and proficiency - how many EMS workers are out there who are also going to school FT with all of the extra study time involved, and still do well with their single role medic spot? Perhaps they're pursuing an accounting degree, law, emergency management, or something with little overlap with EMS. They aren't getting to drill EMS while working, while firemedics can drill both suppression and EMS, and also attend CME's on duty, to make it easier. Aren't they spreading themselves too thin like someone who maintains EMS and suppression proficiency simultaneously? Again, suppresion and EMS may not have much overlap regarding skills sets, but the concept does work if managed well and is an efficient and clever way to utilize FF downtime.


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## VentMedic (Sep 21, 2009)

46Young said:


> Another angle regarding dual role firemedics and proficiency - how many EMS workers are out there who are also going to school FT with all of the extra study time involved, and still do well with their single role medic spot? Perhaps they're pursuing an accounting degree, law, emergency management, or something with little overlap with EMS. They aren't getting to drill EMS while working, while firemedics can drill both suppression and EMS, and also attend CME's on duty, to make it easier. Aren't they spreading themselves too thin like someone who maintains EMS and suppression proficiency simultaneously? Again, suppresion and EMS may not have much overlap regarding skills sets, but the concept does work if managed well and is an efficient and clever way to utilize FF downtime.


 
So what you are saying is the FD employees have way too much time on their hands and too few calls to get actual patient experience.  Busy EMS Paramedics can do a large call volume during a 12 hour shift and have 3 - 4 day off to take classes and have time to study after or before work.  It is really not that difficult of a concept to grasp.  Professionals from every type of business do this. 

   If you were to take classes related to the medical profession, you would understand it is much more than "drilling" a few skills.  Rather it also involves crtical thinking.  Have you looked at the links I sent you by PM or even those involving a CCT transport in the other thread?  That knowledge should not be much more than what a good ALS Paramedic should understand as it applies to patient care.   CMEs? That all depends on who is teaching them.  I find I get more out of CMEs if they are given by professionals who are experienced in that area of patient care and not one who is just parroting from "drilling".


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## rescue99 (Sep 21, 2009)

46Young said:


> When I worked in NYC I've occasionally had medics brag about shortcuts they've taken during clinicals. One program out of Brooklyn didn't do any checkups at all. Some would brag that they would go into the ER, bounce around, get two different nurses to sign for the 8 hour clinical, and also get a signatue from the peds ER as well. 24 hours for the price of 8. I've heard of one MD at the CCU sign for three clinicals at once since he reasoned that the student won't get any benefit after rounds. WTF? Some students would do ride alongs with the NYC 911 participating hospital where they already work as an EMT, and have their buddies sign off on tubes, IV's, med admin, and "phantom ride alongs". To my knowledge none of these sacks of :censored:had any aspirations for the fire service.
> 
> LaGuardia CC and Stonybrook University were the only two reputable medic programs in the greater NY area, IMO. As far as other places, if you're a straight shooter and get the most from your time and experience (other places will give you all the tools, but it's up to you), you'll turn out okay. If not ...... I don't even want to think about it.



Yeah, and we're concerned about A/P? As well we should be of course. But first, there has to be meaningful, quality oversight!! Colleges or no college. Accredited or not. With poor ethics, no oversight and nothing to fear, there is no incentive to improve current standards. As long as we accept the way things are, nothing will change! 

While it doesn't speak for all institutions nor all people, I cannot sound off enough on the fact that there isn't anyone watching the store :wacko: We're going to continue to see the 5 minute CE's and half completed programs until the system gets smart and begins at the top where the worst of our problems do lie. Leadership has failed on multiple levels and sadly, students take advantage of the situation with the same disregard for human life.


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## 46Young (Sep 21, 2009)

VentMedic said:


> So what you are saying is the FD employees have way too much time on their hands and too few calls to get actual patient experience.  Busy EMS Paramedics can do a large call volume during a 12 hour shift and have 3 - 4 day off to take classes and have time to study after or before work.  It is really not that difficult of a concept to grasp.  Professionals from every type of business do this.
> 
> If you were to take classes related to the medical profession, you would understand it is much more than "drilling" a few skills.  Rather it also involves crtical thinking.  Have you looked at the links I sent you by PM or even those involving a CCT transport in the other thread?  That knowledge should not be much more than what a good ALS Paramedic should understand as it applies to patient care.   CMEs? That all depends on who is teaching them.  I find I get more out of CMEs if they are given by professionals who are experienced in that area of patient care and not one who is just parroting from "drilling".




The suppression side can be slow, depending what house you're at. The EMS side is definitely busier. I make sure that I get an even split of ambulance time and suppression time, so I'm not hiding out on an engine only treating pts on the bus and then wishing them well as we go back inservice. We're fortunate that the county provides time for us to get CME's on duty. when I worked 8's and 12's for a busy system in NY, I found that there wasn't sufficient time to attend enough CME's to recert that way. I was working side jobs and OT, and I was also out of the house quite often, and wasn't spending enough time with my family as it was. It's a tough sell to tell my wife that I'm disappearing for an hour drive each way during rush hour for 1.5 hour CME every week or two when that's the only evening that I'm around. It's even a tougher sell to forego family time to attend an all day lecture. It's easier and more importantly, family friendly to complete a challenge refresher. That's why online programs hold appeal to some. It's the only way they can do it.

I directed that post towards those that argue about dual role firemedics spreading themselves too thin, that it's not possible. I'm saying that some complete degrees largely unrelated to EMS while working for busy systems. I'm also saying that it's easier for a firemedic to do both than it is for someone going to school while working as a medic since we get drills while on duty.

I've taken A&P, pharmacology and elem calculus in the past. Our quaterly 8 hour CME lectures are given by two staff PA's and an RT. I'm also attending an 8 hour CME on burn pts in mid Oct. given by an M.D. on my own time. I don't do the least to get by. I'm also planning to take some more courses towards an RN degree. I've figured out that I can go to day work and do my clinicals. Excelsior is garbage.

Thanks again for those links. I've been going through them and researching all sticking points. It's proving to be a good learning experiences, and certainly exposes my weaknesses. Perhaps you could post the links for others to do the same. Discuss certain questions on that thread that pose problems.


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