# Fire Als transport vs other..



## 911bru (Feb 13, 2013)

Sorry if this has been posted its hard to search on my phone for prior topics. 
   I hear many county medics and private agencies not agreeing with the idea that the fire depts has Als transport like in Washigton state and many areas in the northwest. We also know that king county medic one is usually the staple of Als treatment and is always at the forefront of EMS. 
   Rather that argue who is better I would like to focus on the political and financial aspect of why different areas get up the ALS transport system differently. 

    - thanks


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## leoemt (Feb 13, 2013)

King County Medic One and Seattle Fire Medic One are good at what they do. However, they hate to transport anyone who isn't "circling the drain". King County does not allow private ALS. That means as a Basic, I get turfed a lot of patients that really should go ALS. 

On the one hand the experience is great. I have successfully managed some pretty critical patients - not that I have to for long as were about 5 minutes from a hospital at any given point in the city. 

However, there are things that I can't do and that is frustrating to say the least. Nothing worse than being in back with a patient knowing they need more help than you can give. 

Ultimately, whether ALS or BLS, the goal is to get the patient to definitive care which is someone with MD after their name. We are pretty successful in this. 

My personal opinion is fire should not be involved in EMS. They can do rescue and fight fires but EMS should be performed by either private or public ambulance services. I won't elaborate on this as I currently work in this system and I have pretty strong opinions which usually turn into pissing matches on this forum. 

If you have anything specific you want to know concerning King County feel free to PM me.


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## RocketMedic (Feb 13, 2013)

911bru said:


> Sorry if this has been posted its hard to search on my phone for prior topics.
> I hear many county medics and private agencies not agreeing with the idea that the fire depts has Als transport like in Washigton state and many areas in the northwest. We also know that king county medic one is usually the staple of Als treatment and is always at the forefront of EMS.
> Rather that argue who is better I would like to focus on the political and financial aspect of why different areas get up the ALS transport system differently.
> 
> - thanks


"Forefront" is relative, and highly dependent on which arbitrary measurement you use. If you go with SCA resuscitation, KCM1 is pretty good. Not so much if you go by "pain palliated", "respiratory distress" or "ACS/AMI recognition and treatment". 

Personally, I think that fire departments that transport should be ALS, possibly critical care, have amazing gear and progressive protocols. They should try and mirror systems like Wake County, and collaborate to do so (there is precedent here, with the state-level fire academies). I think that they should be split departments with EMS-only options, but I can see the arguments for dual-role medics and can't really argue with them. I also think that there should be effective and meaningful policies in place to make the ambulance a fun and desirable duty, not a punishment box. In other words, mirror San Antonio, San Angelo or El Paso, not Dallas or Detroit or NYC or Washington DC or Seattle or LAFD.

Financially, I think that the decision to support an ALS transporting fire department is responsible if the city is willing to subsidize it entirely to an adequate level and not rely on billing to fund the department. This predicates a stable local economy, a relatively affluent tax base, and fairly large but steady call volume. A private ALS/BLS service for IFT and 911 backup (need not be an ALS truck) are also probably pretty important. Non-traditional asset deployment is probably a great idea as well- not necessarily posting, but deployment of multiple ambulances to high-volume areas. Separate medical calls from fire calls, and consider adding a third firefighter to ambulances when practical- you don't need four men on a ladder or engine that will go to the same fire as the ambulance anyway. 

Non-transporting ALS fire could greatly be improved by putting that money towards SUVs instead of fire engines. 

Politically, I think that ALS fire is a powerful draw, but one that has potential to strangle a city or county. There is a difference in staffing- you need more paramedics for most large communities than you need firefighters, and those paramedics need to be in smaller units and utilized more often to make financial sense. This means that a department is either split (with the positives and negatives inherent) or accepts a lot of paramedics into its ranks. I think that it is up to the members of that department to see if that assimilation is a positive one or a negative "EMS sucks" one. Fire departments are way, way better at politics than private providers, since they play off of the "hero" label, the work of their private and third-service counterparts, and they have a strong, national union. Image sells, and fire departments have image out the wazoo. Their organized, generally well-funded unions also help quite a bit in local politics. However, greed is a factor.

Let's look at Clark County, Nevada. AMR and its EMSC brother provide the vast majority of 911 transport and ALS care in a high-volume, high-cashflow 911 system, and most of the IFT. Generally speaking, unless you're a very high-profile case in terms of media exposure or a level-one trauma that MedicWest or AMR didn't get to first, you're being treated and transported in a private ambulance with private supplies and a private employee. The fire departments in the Valley do excellent jobs most of the time, but generally they do not transport- they are set up as first-response. However, the unions, via their political contacts, have made it so that fire medics run everything on-scene until they release the patient to AMR (poor choice, IMO, but workable). Then, faced with budget cuts, fire departments started a long-term, very public smear campaign against AMR and MedicWest, with plenty of blatant falsehoods. One department, NLVFD, even started transporting all of their own patients in an attempt to drive AMR/MWA out of their area. This lasted for about a month, in which the department burned its year's overtime budget and was pushed to near-bankruptcy by overtime at ridiculously inflated FF salaries. MedicWest came back in to the rescue, relatively unaffected by the loss in income (realistically, they probably profited from the transfers they were able to take in lieu of nonpaying 911 calls) and things returned to normal. Fire-based EMS is a great thing as long as unions don't get greedy.


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## Veneficus (Feb 13, 2013)

The economics and politcs are intwined.

Who is paying, how much, and who is getting it.

All of the various systems are theorhetically capable of providing equal and high level care. Some choose to, some don't. The reasons vary, but usually revolve around the enthusiasm and values of the individual organizations.

That is why it is so subjective on who is best.

As many agencies have discovered, when you call youself the best, you basically make yourself a target for everyone elses ire.


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## ExpatMedic0 (Feb 13, 2013)

Medic 1 should not even be included when speaking of a nationwide fire service ALS transport. To my knowledge no one else has anything like there program. They are an exception. 
most fire based EMS seems to be IMO a way to generate revenue for the fire service. Much like why an engine responds on every EMS call in many systems. It is a joke. Sometimes I feel as if bystanders would be just as useful if I actually needed any assistance. Its a way to justify there existence and keep numbers looking good. When was the last time you herd the fire service advocating for increased educational standards for EMS, advancing our career, or progressing us as a legitimate health care provider and not just manual labor/emergency response?


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## ExpatMedic0 (Feb 13, 2013)

Don't get me wrong, I know the fire department pays better than private ambulance and offers better benefits. Private ambulance is often just as evil or even worse than the fire department. In fact there are a lot of incompetent uneducated bafoons running many private EMS agencies. At least the fire department has physical standards, and deeper pockets, Ill give them that.

There are good folks at the fire department but its not a healthcare agency. 

If the fire department would advocate for us and get more involved with progressing us as a health care provider/profession, increasing education standards, and lobbying for us (ALS transport), I would succumb to there almighty power and unions. 

Currently your best bet (in the USA anyway) is 3rd party municipal agencies, hands down.


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## 911bru (Feb 13, 2013)

I personally believe that all 911 calls should be responded only by government agencies. 911 is a government system also it's tax based again we don't have private police officer show up when you call 911 or private fire departments to your residence so I don't see why we should have private Ambulances seeing that their entire goal is to make a profit. the government can ask the run at a deficit and still maintain its operations. 
   After doing an internship in the Seattle area and also knowing a few king County medical one paramedics and  Tacoma fire medics I really like and appreciate how they are structured and the efficiency in which they work. 
  I believe that police,fire and Ems should be government run. 
   You as an employee know that you have a great career of you make it on as a fire medic, as very few go from fire medic to private ambulance companies. 
  Better pay, benefits, union , shifts and also respect. It's the total package in my opinion.


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## 911bru (Feb 13, 2013)

schulz said:


> Don't get me wrong, I know the fire department pays better than private ambulance and offers better benefits. Private ambulance is often just as evil or even worse than the fire department. In fact there are a lot of incompetent uneducated bafoons running many private EMS agencies. At least the fire department has physical standards, and deeper pockets, Ill give them that.
> 
> There are good folks at the fire department but its not a healthcare agency.
> 
> ...



   My first experience was from the Seattle area and after seeing how they run things, and the quality of medics that they demand I'm all for places following the way the set it up.


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## ExpatMedic0 (Feb 13, 2013)

911bru said:


> I personally believe that all 911 calls should be responded only by government agencies.



I agree %100 but the fire department is not a health care agency, nor is the police department. Boston EMS, Honolulu EMS, Austin Travis County EMS, those are a handful of 3rd party local government EMS providers that come to mind.

I am from Portland so I know a taste of what your talking about near Seattle. I am not going to talk about politics revolving around medic 1.... All I will say is %99 of fire based EMS in the USA is not like that. Its not... not even close!

Look at the rest of the modern world, countries like Australia and the UK.... we could learn a thing or two from them.


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## 911bru (Feb 13, 2013)

I respect everyone's opinion and I am on here to listen and learn... I'm a newbie ...


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## ExpatMedic0 (Feb 13, 2013)

Ill give it a rest and let some others chime in. Just understand medic 1 is a unique (and often controversial) thing. There Paramedic program is over 3000+ hours long and all prior Paramedics have to "redo" Paramedic school. Much of it is taught by M.D.'s There is no other program or system I am aware of the in the United States at that scale that is similar to medic 1.
Also the BLS providers in that system might have a thing or two to say regarding it... but once again I am not getting into the politics. 

Now compare that with a fire department mentioned here before in Texas, which requires 600 hours for Paramedic certification which does not even qualify for NREMT, taught by other vocationally trained firemen


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## 911bru (Feb 13, 2013)

I heard of some private ambulance companies making you be at there local station while on call for around $2.00 per hours then you get paid per each call... This like this sound creepy and I don't see fire departments doing this type of stuff . 

 I hear of 3rd party government ems programs and I think they are far better  of an idea that truly private ambulances. 
  Usually these government ambulances are county etc... And they are call "free enterprise businesses " when it comes to the legal accounting part from the government. They want and try to make  profit but provide some structure the area wants and still let's the area not a lot rely on tax payers..


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## Shishkabob (Feb 13, 2013)

911bru said:


> or private fire departments to your residence


  Might wanna look again, buddy.  Quite a few places are serviced by private-for-profit fire agencies.





> so I don't see why we should have private Ambulances seeing that their entire goal is to make a profit.


  So you're against hospitals too, right?  Profit guides competition, which leads to innovation.

Nothing wrong with wanting profit, the issue is letting it get in the way of good care.  In the strictest of ideas, FDs pushing for more funding are pushing for more 'profit' to hire more people and get bigger benefits.  No different from AMR or Rural/Metro.



> the government can ask the run at a deficit and still maintain its operations.


  You can only run at a deficit for so long before you start feeling the crunch...


I personally don't want someone in charge of my life, with potentially deadly procedures such as RSI, and the medications Paramedics carry, if the person doesn't WANT to be a Paramedic for the medicine, instead of being a medic because that's what their fire agency requires.  There's a plethora of info on this forum as to why Fire-based EMS should not exist in many peoples eyes, and I'm one of the most outspoken opponents of fire-based EMS.


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## leoemt (Feb 13, 2013)

911bru said:


> I personally believe that all 911 calls should be responded only by government agencies. 911 is a government system also it's tax based again we don't have private police officer show up when you call 911 or private fire departments to your residence so I don't see why we should have private Ambulances seeing that their entire goal is to make a profit. the government can ask the run at a deficit and still maintain its operations.
> After doing an internship in the Seattle area and also knowing a few king County medical one paramedics and  Tacoma fire medics I really like and appreciate how they are structured and the efficiency in which they work.
> I believe that police,fire and Ems should be government run.
> You as an employee know that you have a great career of you make it on as a fire medic, as very few go from fire medic to private ambulance companies.
> Better pay, benefits, union , shifts and also respect. It's the total package in my opinion.




Um, sorry you are wrong. With the exception of Seattle, very few dispatch centers in WA are government agencies. Most, while overseen by the sheriff, are private companies under contract. 

There is no valid argument as to why EMS should be performed by a government agency. Both government and private rely on funds to operate. Many government agencies are charging their patients for transport. Everett, Edmonds, Lynnwood, are just a few. 

The health care system is a privatized system. The only hospital in Seattle that is "public" is Harborview. First Hill, Cherry Hill and Ballard are all owned by Swedish. Then you have Northwest and University of WA Medical Center which are owned by the University as is Harborview. Virginia Mason and Group Health and Childrens are all private. Up north, Edmonds (Swedish), Colby (providence) and St. Joseph (Bellingham - Peace Health)

There are private fire departments in the US. Rural Metro does a lot of fire, especially in the SouthWest. Boeing has their own fire department as well and while they are mainly for Boeing property they will respond mutual aid for the city. 

Some towns have disbanded their police force and switched to private security. Sheriff or State will respond for major instances but security performs the general patrol and minor calls. None in WA have done this though. However, Seattle uses security for its alarm response. 

Point is effective services can be performed by private. In Seattle, all BLS transports go by AMR. While I have the utmost respect for Seattle Fire, I think better care is performed by AMR than by fire. They fight fires and perform rescues, I do EMS. Use your strengths.


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## EpiEMS (Feb 13, 2013)

schulz said:


> Look at the rest of the modern world, countries like Australia and the UK.... we could learn a thing or two from them.



Agreed. And I'm pretty moderate, I don't even mind fire helping with rescue, but EMS ought to be separate from the fire service. It's all about sticking to the core competency of your profession/field/job. I don't see any economies of scope with FD-based EMS. Indeed, I'd bet you that costs are higher: it's way more costly to dispatch a suppression vehicle plus an ambulance rather than, say, just an ambulance and a fly car/QRV/squad. Just consider the capital costs alone. Plus, if FD doesn't do any EMS, you can downsize the FD...and they can just do BLS response to priority calls...

*runs and hides*


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## CFal (Feb 13, 2013)

I think that in some cases Fire based EMS makes more sense and in others a 3rd service EMS system makes more sense, all depends on where you are.  I agree with a previous poster that said 911 should be government agencies, be it 3rd service or Fire based.


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## NomadicMedic (Feb 13, 2013)

If the fire service wants to have ambulances, let them do it. Just hire single role paramedics. Don't make the people who are passionate about EMS be hose jockeys.


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## Shishkabob (Feb 13, 2013)

CFal said:


> I think that in some cases Fire based EMS makes more sense



Expand further.


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## CFal (Feb 13, 2013)

Linuss said:


> Expand further.



In more rural areas combining coverage provides for a quicker response.  In many parts of the country there are large swaths of land with fewer people per square mile.  EMS calls have a larger volume, but take fewer people to respond than a fire, like how in EMS we spend most of our time training on calls that are low volume but more complex.  You would have a lot of fire fighters sitting around doing nothing and EMS workers over burdened.  In more urban areas you have the critical mass to support independent services.


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## Handsome Robb (Feb 13, 2013)

I want someone to give me a better reason other than "it should be" as to why 911 EMS should be a government agency. 

If a FD wants to do EMS, fine. Like n7 said, hire single roll providers, make them separate divisions and treat them as equals, not the red-headed step children. 

There's no reason a private agency can't provide equal or superior 911 services to a region.

I'd say the system I work in along with the system of a few other unnamed members are great examples of this. 

FWIW I work for a private agency under a Public Utility Model.


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## Trashtruck (Feb 13, 2013)

Robb said:


> hire single roll providers, make them separate divisions and treat them as equals, not the red-headed step children.



LOL!
But this is the FIRE Dept!!!
Somebody please, who is a single role medic with a FD, want to tell me how they're treated?

Detroit?
FDNY?
Philadelphia?


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## CFal (Feb 13, 2013)

Robb said:


> I want someone to give me a better reason other than "it should be" as to why 911 EMS should be a government agency.
> 
> If a FD wants to do EMS, fine. Like n7 said, hire single roll providers, make them separate divisions and treat them as equals, not the red-headed step children.
> 
> ...



EMS should be a public service, I think that being a government agency in general gives the best oversight and effectiveness in EMS as is does in Fire and Police, not to say there are not examples of quality EMS using other models and that every government agencies are the best, because there are and they aren't always.  I just feel that government agencies do a better job more often than not, I think that it is more or less analogous to a US Army/Blackwater comparison.  I also think that as a government agency it gives more credibility to the profession than a private company.  On a side note I don't see any reason to think that a dual role Fire Medic cannot provide the same level of care as a single role Medic.


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## STXmedic (Feb 13, 2013)

Trashtruck said:


> LOL!
> But this is the FIRE Dept!!!
> Somebody please, who is a single role medic with a FD, want to tell me how they're treated?
> 
> ...



Our single role medics are treated just like any of the fire guys. We all get along great and have a great working relationship. I don't see the problem.


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## Shishkabob (Feb 13, 2013)

CFal said:


> In more rural areas combining coverage provides for a quicker response.  In many parts of the country there are large swaths of land with fewer people per square mile.  EMS calls have a larger volume, but take fewer people to respond than a fire, like how in EMS we spend most of our time training on calls that are low volume but more complex.  You would have a lot of fire fighters sitting around doing nothing and EMS workers over burdened.  In more urban areas you have the critical mass to support independent services.



Reason why FD beats EMS to most calls:  There are more fire stations, because they have a bigger budget.  Give EMS the same budget and then tell me who responds faster.  Infact, my agency has 1/4 the budget of our biggest FD partner, yet we run 40,000 more calls a year than they do.  Yup. Efficiency.    Cut 60mil from their budget, give us just  30mil of that, and you can only imagine the greatness that could ensue.  But nope, cutting FDs budget makes you un-patriotic and hate kittens.  

Hell, PD has pretty close to the same budget and beats FD to most calls they're co-dispatched to.  Why?  More cop cars. 


On top of that, FD spends less than 10 minutes on most calls, while EMS spend 1+ hour due to transport and the like.  Kind of easy to be running from call to call when they don't last long at all.




CFal said:


> not to say there are not examples of quality EMS using other models



Name me a single traditional fire-based EMS system that is world renowned for being progressive and aggressive in all parts of pre-hospital medicine.


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## CFal (Feb 13, 2013)

Linuss said:


> Reason why FD beats EMS to most calls:  There are more fire stations, because they have a bigger budget.  Give EMS the same budget and then tell me who responds faster.  Infact, my agency has 1/4 the budget of our biggest FD partner, yet we run 40,000 more calls a year than they do.  Yup. Efficiency.    Cut 60mil from their budget, give us just  30mil of that, and you can only imagine the greatness that could ensue.  But nope, cutting FDs budget makes you un-patriotic and hate kittens.
> 
> Hell, PD has pretty close to the same budget and beats FD to most calls they're co-dispatched to.  Why?  More cop cars.
> 
> ...



The nature of fire is that it involves more people than EMS, it takes more people to respond to a fully involved house than a cardiac arrest.  You run 40,000 more calls than them?  If it was a combined agency the workload would be more evenly distributed, rotating people into the box.


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## 46Young (Feb 13, 2013)

Linuss said:


> Reason why FD beats EMS to most calls:  There are more fire stations, because they have a bigger budget.  Give EMS the same budget and then tell me who responds faster.  Infact, my agency has 1/4 the budget of our biggest FD partner, yet we run 40,000 more calls a year than they do.  Yup. Efficiency.    Cut 60mil from their budget, give us just  30mil of that, and you can only imagine the greatness that could ensue.  But nope, cutting FDs budget makes you un-patriotic and hate kittens.
> 
> Hell, PD has pretty close to the same budget and beats FD to most calls they're co-dispatched to.  Why?  More cop cars.
> 
> ...



A properly staffed and equipped FD will have many more employees than a properly staffed and equipped EMS department in the same coverage area. Payroll is typically the largest expense, so a fire budget will naturally be larger due to that fact alone. The apparatus, equipment and PPE are more expensive as well. We have 41 ALS units, plus a few volunteer units at any given time. We have 37 engines, 14 truck companies, and eight Heavy Rescues. Add on the Hazmat unit and the Hazmat Support Unit. All in all, for the non-supervisory field units, that's 82 ambulance personnel on duty, with 228 suppression personnel. That's almost a 3:1 ratio. That's your (necessary) budget disparity right there. We cover 395 square miles with a population of 1.1 million. The on-going NIST studies are showing the necessity of safe staffing levels, four per piece, generally speaking.

I feel that my fire based department does well with progressive and aggressive EMS. We're probably as efficient and proficient as KCM1 and Wake Co. NC, but neither is anyone else. I've worked in the NYC 911 system, which is a mix of fire based single role, hospital based single role, and private single role. I know of the sytems in Nassau/Suffolk Co's in LI. I've worked in Charleston SC as a single role medic. I feel that we do much better than those systems. There's some uneccesary expenditures, but EMS is wellfunded, very well funded. 

Our pt care guidelines include Tx for various electrolyte abnormalities, versed/ketamine/Iced saline/Bicarb for agitated delerium, standing order pain management for injuries, abd pain, and ACS. We can clear C-spine in the field if appropriate. Our post arrest management includes therapeutic hypothermia, pacing, dopa, etc. We're getting the King Vision and ET Introducers for ETI, we have the QuickTrache, CPAP w/ in-line nebs, ETCO2 for ETI and sidestream NC as well. We're getting lactate meters in the near future. County policy of at least two medics present for every ALS call. There's more, but I cant think of what right now. We don't have RSI, and a few other advanced procedure yet, but that's more of a training and QA/QI issue, since we have more than 300 medics, probably closer to 400.

We have a four month field ALS internship after fire school, and regular con-ed on-duty at our training center, taught by PA's, and an NP.

There's an overabundance of resources at times, but this place is better than anywhere I've seen so far.


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## Shishkabob (Feb 13, 2013)

CFal said:


> The nature of fire is that it involves more people than EMS, it takes more people to respond to a fully involved house than a cardiac arrest.


  Sure it does.  Doesn't change my point in the least bit.



> You run 40,000 more calls than them?  If it was a combined agency the workload would be more evenly distributed, rotating people into the box.



And going back to one if my previous post, a good portion of those rotated in being forced to do something they don't want to do, being forced to be my healthcare provider when I don't want them doing it since they don't care about it.



46Young said:


> That's your (necessary) budget disparity right there. ...The on-going NIST studies are showing the necessity of safe staffing levels, four per piece, generally speaking.



Sorry if I call out fire-union sponsored studies about fires advocating more firefighters...


The studies also show that more than 2 medics on a scene are detrimental to the patient, yet FDs keep pushing more Paramedics.  Clearly they care more about property than they do about patients.


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## ffemt8978 (Feb 13, 2013)

Linuss said:


> The studies also show that more than 2 medics on a scene are detrimental to the patient, yet FDs keep pushing more Paramedics.  Clearly they care more about property than they do about patients.



Source for these studies?


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## CFal (Feb 13, 2013)

I'm not sure about that more than 2 Medics study, I would like to see that.  Does it also account for multiple patients? If a mini van full of kids collides with a truck on the highway I would like to see more than 2 Medics there.


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## DrParasite (Feb 14, 2013)

46Young said:


> A properly staffed and equipped FD will have many more employees than a properly staffed and equipped EMS department in the same coverage area.


hey 46, didn't we have this exact same discussion 
several months ago?  in fact, we went back and forth with me agreeing with your concepts, but your basic premise was all wrong?  something like what was discussed here: http://www.emtlife.com/showthread.php?t=32726

First response (whether it be ALS, BLS, FR, or MD) is not EMS.  you have patient contact for maybe 10 minutes, and then you turn them to the ambulance, who deals with everything from dealing with the initial problem and handling the transport. 

it's a waste of money, and many studies have continuously shown that.  If you want to be a paramedic, get your *** on an ambulance and do the job 100%.  it might not be as fun as being the engine medic, but that's what real ems is all about.


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## Shishkabob (Feb 14, 2013)

Quick search revealed this.  Arrests with more than 3 medics showed a decrease in survival to discharge of arrests patients with crews of more than 3 ALS providers.  You can search for the rest if you want.  So fine, I'll amend my previous statement and say more paramedics doesn't = better, and could actually mean worse.

This is not to mention the dilution of skills that happens when you split a low number of critical patients among a high number of providers, like the study my agency put out about having Advanced Practice Paramedics on an arrest, or Wake County had done about having APPs on critical patients.  Things like ET success rates and the like.



CFal said:


> If a mini van full of kids collides with a truck on the highway I would like to see more than 2 Medics there.




I've worked the MCI MVC as the only Paramedic that spent more time on scene than the time it took to load the patient and send them away.  That's all that's needed for those types of MCIs.

You're confusing one patient for multiple patients.  Apples to apples is the only way to play.


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## Wheel (Feb 14, 2013)

Robb said:


> I want someone to give me a better reason other than "it should be" as to why 911 EMS should be a government agency.
> 
> If a FD wants to do EMS, fine. Like n7 said, hire single roll providers, make them separate divisions and treat them as equals, not the red-headed step children.
> 
> ...



I don't think it should be a government entity, but for profit ems is a problem. There are some great private companies that handle ems. You work for one and so does Linus (I do too.) All three of these agencies are non-profits under the public utility model. There are still profits, but they're being invested into equipment, education, and provider pay, rather than into shareholder pockets.


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## Shishkabob (Feb 14, 2013)

Mine hasn't been private for 8 years h34r:


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## ExpatMedic0 (Feb 14, 2013)

Linuss said:


> Reason why FD beats EMS to most calls:  There are more fire stations, because they have a bigger budget.



haha reminds me of a funny story. I use to work part time doing special event stand by. Most of the other guys where from the FD picking up extra shifts for a little side money. One of them had actually retired. He use to be a Paramedic but reverted to EMT-B.

He told me when he became a Paramedic 30 years ago that they would respond in a fd pickup truck like on "emergency" and he would pass 5-10 other fire stations on the way to a call. However none of those stations had medics. He said as time went on and more stations acquired a medic the engine crew would just sit around and do nothing all day. Then private ambulance started staffing more medics and there was less demand. 

They would just sit around and doing nothing all day. The pay was really good and he was in constant fear of losing his job. He use to tell his wife"Someone is going to catch on, this cant last forever." Then one day someone came up with the brilliant idea to save all the fireman's jobs. Put a medic on every engine and have them respond to every EMS call near there station. Since the city is covered with fire stations they normally beat the ambulance which utilized "system status management" model.

All the firemen got big pay raises, kept there jobs, and could justify there existence. 

The End.


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## Wheel (Feb 14, 2013)

Linuss said:


> Mine hasn't been private for 8 years h34r:



My mistake. Public utility model? My point was that optimally a company should be investing profits back into itself instead of paying shareholders or for cool fire toys.


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## CFal (Feb 14, 2013)

Linuss said:


> You're confusing one patient for multiple patients.  Apples to apples is the only way to play.



Cardiac Arrest isn't the only emergency we deal with, you know that.  You can't cherry pick which emergencies you are going to cite studies on.  Besides, correlation =/= causation, are cardiac arrests with more than 3 medics more severe which is why more medics were sent?  Maybe maybe not, and even if so, it can easily be fixed by establishing protocol that Cardiac Arrests get no more than 3 Medics.  There are certainly times when more that 3 medics would be very helpful in EMS.


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## EpiEMS (Feb 14, 2013)

CFal said:


> Cardiac Arrest isn't the only emergency we deal with, you know that.  You can't cherry pick which emergencies you are going to cite studies on.  Besides, correlation =/= causation, are cardiac arrests with more than 3 medics more severe which is why more medics were sent?  Maybe maybe not, and even if so, it can easily be fixed by establishing protocol that Cardiac Arrests get no more than 3 Medics.  There are certainly times when more that 3 medics would be very helpful in EMS.



Per the abstract: "All adult (>or= 18 years of age) OHCA cases of presumed cardiac etiology from January 1993 through December 2005 were eligible for inclusion in the study. Cardiac arrests resulting from a drug overdose, suicide, drowning, hypoxia, exsanguination, stroke, or trauma were excluded from the study. Also excluded were cases in which no crew configuration or responding unit was available, cases in which no resuscitation effort was attempted, and cases in which no time data were available."

It's not a "severity" issue. And the results are pretty robust insofar as arrests are concerned.

Yes, arrests are not the only metric, but they're a well studied one, and along with traumatic injuries from MVCs, are probably the two "standard cases" that EMS was designed to deal with.


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## Christopher (Feb 15, 2013)

Trashtruck said:


> LOL!
> But this is the FIRE Dept!!!
> Somebody please, who is a single role medic with a FD, want to tell me how they're treated?
> 
> ...



We're treated really well where I'm at.


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## 46Young (Feb 15, 2013)

Linuss said:


> Sorry if I call out fire-union sponsored studies about fires advocating more firefighters...
> 
> 
> The studies also show that more than 2 medics on a scene are detrimental to the patient, yet FDs keep pushing more Paramedics.  Clearly they care more about property than they do about patients.



What is it about the NIST data that you feel is flawed?


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## 46Young (Feb 15, 2013)

DrParasite said:


> hey 46, didn't we have this exact same discussion
> several months ago?  in fact, we went back and forth with me agreeing with your concepts, but your basic premise was all wrong?  something like what was discussed here: http://www.emtlife.com/showthread.php?t=32726
> 
> First response (whether it be ALS, BLS, FR, or MD) is not EMS.  you have patient contact for maybe 10 minutes, and then you turn them to the ambulance, who deals with everything from dealing with the initial problem and handling the transport.
> ...



The first response thing may not improve pt outcomes unless it's in a rural, underserved area, but it certainly makes my job easier. If EMS delivery is 100% divorced from fire, the staffing and deployment is typically lacking, sorely lacking. This is why we have SSM, or systems where the ambulance runs constantly from start to finish. That's why the typical EMS employee burns out in 7-10 years, on the average.

I agree that the engine shouldn't be running on all ALS calls, or even the majority of them, but we do need to show call volume. If a suppression unit is idle for much of the time, and can be used to boost call numbers, as well as lighten the workload significantly for the txp crew, I'm all for it. I've worked in systems where it's just me and my partner for most calls. It's nice having people to help carry my equipment, load and carry the pt, etc. The other day, we went from dispatch to delivery at the ED of an obvious stoke pt in 22 mins, with a full assessment, two lines and a 12-lead completed en-route. I was able to gather Hx, while my medic partner and the engine medic worked the pt, and also did everything in the back while I called the hospital (six min txp). When I drive, I get to do all the hands-on stuff, and still not have to carry the pt. I much prefer this to having to carry all my equipment to and fro, fetch extra carrying equipment when needed, and have to carry every pt. Sometimes you're tired, and it's nice to have other medics do work while you just manage and direct the scene. It makes for a long and happy career, instead of getting beat down every day until you quit. It's nice to have your pt magically boarded and collared for you.

The units are largely idle, but still necessary to achieve deployment objectives, so it's wise to use them to boost call volume and ensure job security.

We have 41 txp units, 15 of which are double medic. Four stations have two ambulances running out of it. We have 37 ALS engines. So, that's 56 txp medics on any given day, and 37 engine medics. Our medics get plenty of time on the bus.


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## Veneficus (Feb 15, 2013)

46Young said:


> What is it about the NIST data that you feel is flawed?



The science of science...

Science is observational and experimental study. 

One of the reasons that a single study should never be used to determine practice is because of unintentional bias. 

I see EMS people do this all the time. They find a single study that favors their opinion and they run with it like it is a definitive souce.

When choosing to do a study, the methods are chosen to support the hypothesis. It is not something sinister, it is just the limitations we face.

Many things are multifactoral and our observations are the summary of different causes. It is often impossible to set up a study to account for this. Especially in biological systems. 

I use the example of soup. You literally select out part of the soup that you don't like or calls into question your corellations. 

One of the most validating aspects of science is it stands up to scrutiny. BUt really, who is trying to reproduce or scrutinize fire and EMS studies who do not have a vested interest in them?

Nobody.

Even if they did, the public safety, in particularly, fire service propaganda machine will swing into effect to not discredit the results, but to elicit emotional response to those results.

Take for example sepsis research. If I come up with a conclusion, other people refute, I don't start an ad campaign talking about saving lives, what if it were you, heroes, life and death risks, etc. 

I go back to the drawing board with this newly found information from the people who refuted my work and try to improve the process. 

At the end of all studies is a bibliography. If you truly want to evaluate a study, you must also seek out all of those studies and read them as well. You will find a lot gets lost in translation as well as selectivity. 

Research is time intensive. It also often raises more questions than it answers. 

All good research explans "why" not just simple causation/correlation.

Some people also are seduced by the ease of "studies" to prove a point. If something is quantified, it does not qualify it. But they like to believe it does. They use research as a crutch similar to religion, to explain things in an easy to understand and absolute truth way. 

Perhaps the biggest flaw in using research is the fact that it is based on observation but the principle being observed, especially in biological system, changes over time. The same can be said for public safety system. 

The major problem with these studies is they assume all providers, firefighters, etc are equal. The individual knowledge/skill/experience and team dynamics are not quantifiable or reproducable.

What it leaves you with is a study, which supporters exclaim is definitive knowledge, that really isn't worth the paper its printed on.

Bad science is not better than no science. If you think that is not true, I urge you to look at all of the science around the 1800-1900s that demonstrated things like women were not as smart as men based on cranial vault volume or any plethora of "science" published and accepted demonstrating inferiority of various races or social groups.

Even for all of this, you need somebody to accurately and truthfully present the results of good studies to people who do not understand them and convince them of their validity.

Do you take the word of a used car salesman that the used car you want to buy is perfect?

Of course not, you go and get an opinion from a mechanic. As well as a history if you are smart, and you certainly test drive a few.


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## shfd739 (Feb 15, 2013)

46Young said:


> The first response thing may not improve pt outcomes unless it's in a rural, underserved area, but it certainly makes my job easier. If EMS delivery is 100% divorced from fire, the staffing and deployment is typically lacking, sorely lacking. This is why we have SSM, or systems where the ambulance runs constantly from start to finish. That's why the typical EMS employee burns out in 7-10 years, on the average.



That last part I can agree with. 

I spent 6 years with my private company in an area where we ran from stations and generally spent time(sometimes half a day) hanging out in a station. We'd run a call and go back to a station with a regular computer to do reports on, TV, couches, etc. 

Now, same company, after 3 1/2 years in an area with only SSM/street corner posting and I'm ready to quit. It's hard on the body, constantly driving around is taxing physically and I spend way too much time in a very uncomfortable truck seat. it's hard to use a toughbook and type reports while driving around at night which means I'm constantly staying late to catch up. It sucks. 

Personally I can't keep this up and I'm trying to figure my next step. Either looking at flight jobs or switching to a 911 only agency that runs from stations. Leaning more toward flying so I can keep seeing CCT type patients.


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## Amberlamps916 (Feb 15, 2013)

I would really like to hear LA county fire's or LAFD's take on this. I haven't really seen any of their medics on this board.


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## 46Young (Feb 15, 2013)

Veneficus said:


> The science of science...
> 
> Science is observational and experimental study.
> 
> ...



I personally took part in two of these studies. I don't feel that their data is flawed from what I can see. They've been measuring the time for companies to complete certain time-critical fireground tasks with two, three, four, five, and six person crews. They found four to be the magic number. Three or fewer crew members was associated with a sharp increase in time, and the curve abruptly flattened out with 5 or more. The purpose was to justify a certain minimum staffing for each apparatus. I'm sure that some portion of the study was guided to achieve the desired result, but that can be said of many studies in all different fields.


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## 46Young (Feb 15, 2013)

shfd739 said:


> That last part I can agree with.
> 
> I spent 6 years with my private company in an area where we ran from stations and generally spent time(sometimes half a day) hanging out in a station. We'd run a call and go back to a station with a regular computer to do reports on, TV, couches, etc.
> 
> ...



I hear you. I did five years in NYC, sitting on street corners and running my but off. We were hospital based, we also had IFT shifts that were typically steady throughout the day with no breaks and usually with a late job. I had maybe 2-3 more good years in me before I would have burnt out. When I worked for Charleston County EMS, it was with a 24/48 schedule, no Kellys, and frequent holdovers for 12-24 hrs. We did frequent overnight street corner postings even though we had a station. Like you, we had to sometimes stay late to finish the ePCR reports, since we were made available upon arrival at the ED, and would frequently get the next call before we were anywhere close to finishing the current call. 

SSM and having to take calls before you finish the previous one are just band-aids for systems that under-staff and under-deploy. Sure, the supply of EMT's and medics may be abundant, but that does not make the work any less tiresome. 

I would either go with flight, or get into another medical field altogether, and do EMS on the side for kicks. I've yet to see an EMS system that's not really busy (which really means not enough units to address the call volume), unless it's rural, and then you're typically getting welfare wages.


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## Veneficus (Feb 15, 2013)

46Young said:


> I'm sure that some portion of the study was guided to achieve the desired result, but that can be said of many studies in all different fields.



That's what I said, only with more words. 

I will not get into minimum manning studies. But I will say I doubt 4 is optimal. An odd number would make sure the company officer didn't have to be hands on.


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## Christopher (Feb 15, 2013)

Veneficus said:


> That's what I said, only with more words.
> 
> I will not get into minimum manning studies. But I will say I doubt 4 is optimal. An odd number would make sure the company officer didn't have to be hands on.



Realistically 4 _is_ an odd number for an engine company. Engineer, Officer, 2-man attack crew. Second due engine, squad, or truck can build as necessary. Of course the 4 man staffing model is based on a 2-in / 2-out model...


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## shfd739 (Feb 15, 2013)

46Young said:


> I hear you. I did five years in NYC, sitting on street corners and running my but off. We were hospital based, we also had IFT shifts that were typically steady throughout the day with no breaks and usually with a late job. I had maybe 2-3 more good years in me before I would have burnt out. When I worked for Charleston County EMS, it was with a 24/48 schedule, no Kellys, and frequent holdovers for 12-24 hrs. We did frequent overnight street corner postings even though we had a station. Like you, we had to sometimes stay late to finish the ePCR reports, since we were made available upon arrival at the ED, and would frequently get the next call before we were anywhere close to finishing the current call.
> 
> SSM and having to take calls before you finish the previous one are just band-aids for systems that under-staff and under-deploy. Sure, the supply of EMT's and medics may be abundant, but that does not make the work any less tiresome.
> 
> I would either go with flight, or get into another medical field altogether, and do EMS on the side for kicks. I've yet to see an EMS system that's not really busy (which really means not enough units to address the call volume), unless it's rural, and then you're typically getting welfare wages.



Yep. Plenty of units but deployment could be better to not beat crews up so bad.  Typical shift has been 200+ miles/half tank of fuel in 12 hours just from being moved around so much.  

Flight is what I'm leaning toward and have started taking the card classes and preparing for CCP-C test. Their pay is strong with nice schedules.


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## 46Young (Feb 15, 2013)

Veneficus said:


> That's what I said, only with more words.
> 
> I will not get into minimum manning studies. But I will say I doubt 4 is optimal. An odd number would make sure the company officer didn't have to be hands on.



Five was better than four, but no so much better as to justify having five as minimal staffing. The study was done with the assumption hat the entire crew abandons the piece, so in reality we're really talking about a five person crew if the driver stays behind. RIT engines, Heavy Rescue squads, and most units on a high rise will take their drivers. 

One thing was certain, that three person companies were much slower, and going from three to four saw the greatest time savings.


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## 46Young (Feb 15, 2013)

shfd739 said:


> Yep. Plenty of units but deployment could be better to not beat crews up so bad.  Typical shift has been 200+ miles/half tank of fuel in 12 hours just from being moved around so much.
> 
> Flight is what I'm leaning toward and have started taking the card classes and preparing for CCP-C test. Their pay is strong with nice schedules.



Good luck! 

Posting and having to move every so often gets old real quick. I've spoken with a few people that either used to work at RAA in Richmond VA, or know a few that have worked there. The feeling is always the same - it's a good place for someone new to get experience, or for a casual per diem. Otherwise, it's too stressful.


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## Bullets (Feb 15, 2013)

CFal said:


> Besides, correlation =/= causation, are cardiac arrests with more than 3 medics more severe which is why more medics were sent?  Maybe maybe not, and even if so, it can easily be fixed by establishing protocol that Cardiac Arrests get no more than 3 Medics.  There are certainly times when more that 3 medics would be very helpful in EMS.



I was unaware there were levels of severity in cardiac arrest...were they only mostly dead?


Let me tell you a story

We all now EMS got its big boy pants on in the 60's, however in the great Garden State we have squads that can trace their history as far back as the 1920s. Was it a hearse kept at the funeral home? Yeah, and the guys staffing it had little more then Boy Scout level training, but you did see the local Doctor on the squads and providing the care. A few squads along the shore actually started with MDs going to patients, and the system has regressed, but that is another story. 

As EMS grew and expanded, and population levels rose from what was once the most bountiful farm lands east of the Appalachians to become the NYC suburbs following WWII, more squads formed and a base level of training was established. During this time there were Fire companies older then the towns they served, and there was limited fire codes and minimal fire prevention. These companies were so busy fighting actual fires that they did not have the time to provide any other service, so many EMS agencies, the industry being young and not taken advantage of like it is today, began the foray into rescue services, as they were being called to MVCs anyway, why not have a way to remove the injured patient from the situation. 

Johnny and Roy come around and the DOH decides this MICU thing is a thing and begins the process of developing MICU projects. Who better then to develop a group of people providing emergency care outside the emergency room then the Emergency Room (ie the Hospitals)? Again, FD is still in the war years and have no time for these medical shenanigans so they do not pursue this and let it happen. Fire codes are updated, fire prevention happens and the FDs basically begin the process of putting themselves out of business. Call volume drops while EMS calls rise, based on a number of socioeconomic factors, and FD sees this. "We are heroes, why can we be heroes there too" says the FD and they begin to make attempts to move in to the EMS business. However they gave the EMS agencies about 30 years head start to entrench themselves, so the only places in NJ where you see FD based EMS is places where there never was a volunteer EMS agency, or where the volunteers screwed up and didnt have the ability to see the future and survive.


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## STXmedic (Feb 15, 2013)

shfd739 said:


> Yep. Plenty of units but deployment could be better to not beat crews up so bad.  Typical shift has been 200+ miles/half tank of fuel in 12 hours just from being moved around so much.
> 
> Flight is what I'm leaning toward and have started taking the card classes and preparing for CCP-C test. Their pay is strong with nice schedules.



Who are you looking at? AirMedical? AirLife?

I'd like to at least do part time at one of the two, but I've still got about a year and a half before I hit my 5yr mark.


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## shfd739 (Feb 15, 2013)

Preferably REACH/Methodist Aircare. 

Air Medical wouldn't be a bad part time gig.


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## Shishkabob (Feb 15, 2013)

46Young said:


> If EMS delivery is 100% divorced from fire, the staffing and deployment is typically lacking, sorely lacking. This is why we have SSM, or systems where the ambulance runs constantly from start to finish. That's why the typical EMS employee burns out in 7-10 years, on the average.



And we go back to the point that all firefighters would rather ignore:  Give an EMS agency even just 60% of the budget of the FD and put the money where the 911 calls are (medicine, NOT fire), and most if not all the issues you guys bring up as to why working FD is better then EMS are solved.  Finite.  Done.  Gone.


But nope, keep spending the lions share of the cities budget on an agency that is designed for less than 5% of all 911 calls that are made.   Yup.  Efficiency.  Way to go IAFF.


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## 46Young (Feb 15, 2013)

Linuss said:


> And we go back to the point that all firefighters would rather ignore:  Give an EMS agency even just 60% of the budget of the FD and put the money where the 911 calls are (medicine, NOT fire), and most if not all the issues you guys bring up as to why working FD is better then EMS are solved.  Finite.  Done.  Gone.
> 
> 
> But nope, keep spending the lions share of the cities budget on an agency that is designed for less than 5% of all 911 calls that are made.   Yup.  Efficiency.  Way to go IAFF.



It's not as simple as just putting money where the calls are. To have reasonable fire coverage, there needs to be certain types of suppression units a certain distance apart, and these units need to have a certain number of FF's on them. That calls for more than a 2:1 funding ratio of fire to EMS. Sure, money for EMS needs to be increased, but it can't come from fire. For fire, the call volume doesn't necessarily dictate staffing. Units can't have 15 minute response times, and they're highly ineffective with just two people per piece.


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## Shishkabob (Feb 15, 2013)

46Young said:


> It's not as simple as just putting money where the calls are. To have reasonable fire coverage, there needs to be certain types of suppression units a certain distance apart, and these units need to have a certain number of FF's on them. That calls for more than a 2:1 funding ratio of fire to EMS. Sure, money for EMS needs to be increased, but it can't come from fire. For fire, the call volume doesn't necessarily dictate staffing. Units can't have 15 minute response times, and they're highly ineffective with just two people per piece.



It sure can, and should, come from fire, for the simple fact that since 85% of FD calls are for medicine, quit running that 85% and let the budgets fall where they may.  I'll even give you the 5% of the calls where FD actually is useful on a scene beyond carrying equipment.  So no, an 80% reduction in calls run won't mean an 80% reduction in FD budget, but it WILL be a pretty good chunk reduced that should go to EMS.


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## usalsfyre (Feb 15, 2013)

46Young, the problem with your and most of the rest of FDs in the US thought's on the subject is they assume interior attack, which is becoming increasingly idiotic as construction gets lighter and lighter.


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## Bullets (Feb 15, 2013)

46Young said:


> IUnits can't have 15 minute response times, and they're highly ineffective with just two people per piece.



Why cant they have 15min response times? Its just wood and stuff...How many fires are entrapment due to the residents being unaware? How many entrapment result because the resident went back inside the fire building? 

In suburban communities where there are multiple companies per town, that is why you call mutual aid


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## KingCountyMedic (Feb 16, 2013)

Rocketmedic40 said:


> "Forefront" is relative, and highly dependent on which arbitrary measurement you use. If you go with SCA resuscitation, KCM1 is pretty good. Not so much if you go by "pain palliated", "respiratory distress" or "ACS/AMI recognition and treatment".




Pure garbage. Do you work in King County? If so I'd love to have a talk in person on shift. Call our on duty MSO and give the details of the last "ACS/AMI" that you saw turfed by a County Medic.


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## RocketMedic (Feb 16, 2013)

KingCountyMedic said:


> Pure garbage. Do you work in King County? If so I'd love to have a talk in person on shift. Call our on duty MSO and give the details of the last "ACS/AMI" that you saw turfed by a County Medic.



I think its pretty clear that I don't work for KCM1. That being said, Im pretty sure that plenty of serious medical complaints go unattended by Kcm1. Or do you dispatch a pmed to every nausea, unknown and chest pain?


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## ExpatMedic0 (Feb 16, 2013)

Linuss said:


> It sure can, and should, come from fire, for the simple fact that since 85% of FD calls are for medicine, quit running that 85% and let the budgets fall where they may.  I'll even give you the 5% of the calls where FD actually is useful on a scene beyond carrying equipment.  So no, an 80% reduction in calls run won't mean an 80% reduction in FD budget, but it WILL be a pretty good chunk reduced that should go to EMS.



Agree %100.  I use to work in a tier system like this, its a joke and we all know it.


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## Chief Complaint (Feb 16, 2013)

Bullets said:


> Why cant they have 15min response times? Its just wood and stuff...How many fires are entrapment due to the residents being unaware? How many entrapment result because the resident went back inside the fire building?
> 
> In suburban communities where there are multiple companies per town, that is why you call mutual aid



You can't have a 15 minute response time because fire moves quickly, especially in new construction.  The difference between 5 and 15 minutes could be a fully involved house fire instead of a torched kitchen.  People's tax dollars pay for fire protection, they deserve the best.  It's not just about life safety, it's also a matter of property conservation, and preventing fire from spreading to other dwellings/business'.

15 minutes could mean an entire apartment building on fire, when it could have been contained to a single unit.  15 minutes to a guy trapped underneath a dumpster would seem like a lifetime.  How about 15 minutes to the guy who fell down a manhole?

It's absolutely unacceptable to have a lengthy response time if you aren't in a rural area.


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## Veneficus (Feb 16, 2013)

While the debate between fire and EMS is spirited I would like to point something out?

Fire is a threat to all of society. Since currently US EMS does not partake in public health actions the conditions treated are largely individual. 

Until such a time that communities and by exptension the government decides that healthcare is a right of its citizens, then the Fire vs. EMS discussion is actually moot.

Fire gets more to protect society. 

EMS, while undoubtably busier and more personal, gets less because society doesn't value them as much.

Considering the current average level of care in the US for EMS, I don't expect funding to change anytime soon. 

For every 1 progressive service, there are easily 100 fly by night, 1970s protocol monkey systems. 

The service US EMS is actually paid for is transport. If you show up with a mobile ICU treat and release the patient, your agency may send a bill, but medicare and the insurance companies that follow their lead aren't going to pay you because you did not do what you are being paid for...

Transport.

It's the way it is. No matter how much EMS providers think they are worth, no matter how much sunshine society blows up you, they will not put their money where their mouth is.


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## 46Young (Feb 16, 2013)

usalsfyre said:


> 46Young, the problem with your and most of the rest of FDs in the US thought's on the subject is they assume interior attack, which is becoming increasingly idiotic as construction gets lighter and lighter.



With the prevalence of type 5 construction, it's all the more important to get on-scene quicker, if there's any chance of containing the fire to just a room and contents, or to be able to do a search before going defensive. If the fire starts at minute zero, the call comes in two minutes later, the first due company gets the tones and pulls out at minute 5, they're already five minutes in the hole. Numerous studies have shown that the type 5 construction, with it's high fuel load and void spaces, along with all the synthetic materials in the living areas, gives you maybe ten minutes, fifteen tops to get a knock on the fire, otherwise it's just surround and drown.

Here's a call that I was on:

http://www.youtube.com/watch?v=30SCtOHUGhc

First due units were on-scene in about three minutes, about 5 mins after the initial call. My understanding is that approx. 3-4 mins passed from the start of the fire to the 911 call. So, the 1st floor flashover occurred about 10-12 minutes from the start of the fire. The truck company was able to do a search of both floors right before the flash. If, as Linuss suggests, we gut the FD budget, and allow response times to lengthen significantly (since there aren't that many fires), those first due companies would be arriving at the time of flashover, maybe afterwards. If anyone is trapped upstairs, they would be toast. The exposures, the rest of the row, would also be in jeopardy at that point. 

People aren't going to tolerate lengthy fire dept responses. I believe it was Vene that said people expect to have sufficient fire and police coverage, that it's the responsibility of the local government, but that most EMS is not a consideration of most people.


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## 46Young (Feb 16, 2013)

Bullets said:


> Why cant they have 15min response times? Its just wood and stuff...How many fires are entrapment due to the residents being unaware? How many entrapment result because the resident went back inside the fire building?
> 
> In suburban communities where there are multiple companies per town, that is why you call mutual aid



See my last post, above.

Mutual aid is for protection from a surge in call volume, not as a Band-Aid for a lack of staffing and deployment. We see this a lot with two particular counties that use us all the time, but never provide any units when we're busy. We basically subsidize their fire and EMS because they won't put enough of their own units on the street. Mutual aid is not the answer to a consistent lack of coverage.


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## 46Young (Feb 16, 2013)

Linuss said:


> And we go back to the point that all firefighters would rather ignore:  Give an EMS agency even just 60% of the budget of the FD and put the money where the 911 calls are (medicine, NOT fire), and most if not all the issues you guys bring up as to why working FD is better then EMS are solved.  Finite.  Done.  Gone.
> 
> 
> But nope, keep spending the lions share of the cities budget on an agency that is designed for less than 5% of all 911 calls that are made.   Yup.  Efficiency.  Way to go IAFF.



Gutting fire is not the answer. See my previous post, with the video. 

My department pours a ton of money into EMS. Top of the line equipment, new apparatus before they hit 100k miles, and four of our busiest stations converted their 2nd ambulance from BLS to ALS, to help with call volume. That gives us 41 ALS units vs 37 engines, not a bad ratio, IMO. That's how it should be, but that still leaves a fire to EMS staffing ration well above 2:1. We have enough units in-service to cover our own surges, and still lend out mutual aid.

What you need is a public referendum - let the taxpayers decide if they want tax increase to fund EMS. They agreed. That's what we did in 2009, to save positions, and allow hiring of more medics.


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## 46Young (Feb 16, 2013)

Really, how many places in the country have well staffed EMS? Not many, probably hardly any. There are a huge amount of predominantly volunteer fire across the country. Even without the burden of funding a career department, EMS still gets understaffed, with only the minimum needed to get by. For EMS, just barely having enough units to get by seems to be the norm. How many EMS employers run with three on the bus? How many grant true OOS meal breaks? The only one that I've seen do this is Nassau County's EMS. How many places use SSM? How many places bid out to a cheap private provider? How many of those private providers play games juggling 911 units and IFT units to boost profitability? Using fire to Band-Aid this reality is clever, and it's also clever for fire depts. to exploit this fact to protect their own positions.

I don't have an easy answer to get around this situation.


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## JPINFV (Feb 16, 2013)

EpiEMS said:


> Yes, arrests are not the only metric, but they're a well studied one, and along with traumatic injuries from MVCs, are probably the two "standard cases" that EMS was designed to deal with.



So the standards are 2 things that EMS either sucks at (largely because it's out of their hands) or brings very little to the table for are the two standard cases?

I think EMS needs to find new standard cases to prove that they have value.


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## JPINFV (Feb 16, 2013)

46Young said:


> The units are largely idle, but still necessary to achieve deployment objectives, so it's wise to use them to boost call volume and ensure job security.




...and there we have it. FD first response is about making sure that fire departments get funding and not for the patient. It's nice to know where the tax dollars are going.


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## JPINFV (Feb 16, 2013)

46Young said:


> If, as Linuss suggests, we gut the FD budget, and allow response times to lengthen significantly (since there aren't that many fires),




Ahh, but if you gut their response to EMS calls, then it's much less likely that the first due is going to be stuck at an EMS call or at the trauma center two towns down picking up their paramedic. Hence the need for less fire coverage because the units aren't stuck doing non-fire calls.


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## Veneficus (Feb 16, 2013)

JPINFV said:


> Ahh, but if you gut their response to EMS calls, then it's much less likely that the first due is going to be stuck at an EMS call or at the trauma center two towns down picking up their paramedic. Hence the need for less fire coverage because the units aren't stuck doing non-fire calls.



It is a damned if you do and damned if you don't scanario.

If you do not show call volume funding will be decreased to the point where fire response is ineffective. So when there is a "real" fire orother emergency, the department is blamed they squandered money and didn't produce.

If you increase call volume, you run the risk of losing your first due companies. I am sure 46 would agree, the engine, truck, and rescue all require rapid and simultaneous action to be effective. In an effective staffing model, the first and second engines as well as the first due truck or rescue can arrive near simultaneously. So much so that I have worked at a department that actually had to write an SOP on who has the right of way when they all meet at an intersection responding to the same call from different locations.

Personally I agree that it is both cheaper and more effective to use the larger regional station approach to fire response than multiple smaller stations, because units arriving piece-meal will not effectively perform all of these simultaneously required and synergistic operations. 

But that is not going to cut your equipment need nor personell. It will save on capital expenditures and utilities over multiple stations.

But most places do not have the money required in order to make such a switch. 

Don't forget that effective FDs have a real effect on all property owners everymonth, whether they need suppression activities or not. Firecode and enforcement protects against operation losses for business. Landlords of all types benefit from reduced fire insurance rates. Look at the recent thousand dollar + increases for detroit residents with an ineffective FD.

That is real money coming out of the pay every month. On top of the taxes already paid. What effect would it have on you if say renter's insurance went up a couple of hundred dollars per month?

While I don't believe the FD can reliably provide quality EMS, and a majority of the US population has EMS coverage provided by fire departments that do not embrace it, and consequenly do a poor job, the fact remains, if your neighbor has an MI and dies or his kid breaks an arm and suffers until the hospital, that sucks.

But when your neighbors house catches on fire and you lose yours as well, that sucks more. 

Your medical condition affects you. The world got along fine without you or me before and will do so again when we are not here. Fire effects everybody.

It would be similar to you having a hospital, lose funding every year and then when somebody got really sick and blamed you for not saving them with the latest and greatest medicine and technology.

That is what the FD faces. 

Couple that with the above stated facts that as time goes on, the FD requires faster response times and resources to do its job. 

Most EMS is simply not time critical. 

While it sucks if Ghetto Joe (urban cousin of Freddy Farmbeats) has to wait 2 hours for an ambulance for his sore throat and a dispatcher is pushing EMS crews to get it done, Joe does not require ALS ambulance, he requires transport, and he can wait days.


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## medicsb (Feb 16, 2013)

46Young said:


> Gutting fire is not the answer.



Overall, I agree with this.  As much as I may not like the idea of "fire-based" EMS, I do not advocate funding in proportion to call volume.  As has been mentioned actual fires are heavy on resources, much more so than the average EMS call or even cardiac arrest (which definitely requires more than 2 providers to be run well).  EMS will always have a smaller budget as the equipment is less expensive and the required manpower is lower.

Be that as it may, there are locales where fire suppression could be down-sized to a certain extent.  Most FF unions seem to want to maintain staffing for a call volume that hasn't existed in decades.  In Philadelphia, the mayor has disbanded some engines and ladders and now has "brown outs", of course the IAFF hates this, but the truth is that they are not in the "war years" and there is no way they can justify the staffing they currently have.  I think the mayor has generally made good decisions by downgrading some suppression and adding BLS ambulances.

I do think FDs have a role to play in EMS - MVCs, rescues (I don't really care one way or the other who pops a door or cuts a roof off a car), rapid (BLS only) response to critical calls (cardiac arrest being the big one).  If them responding to some calls keeps them from being closed, I'm ok with that because I do want FFs to be able to respond in a timely fashion to a fire at my place.  

FDs should proactively trim the fat before the cities do it for them.  No need for every fire-fighter to be an EMT.  I think MFR is a fine entry level medical training, but I would support EMT being a promotion so that every engine and ladder has 1 or 2 EMTs.   No medics on engines or ladders - an expensive and unproven use of ALS.  No need for medics on every ambulance (of course this doesn't just apply to FDs).    

But, anyways, if any FD is going to make EMS a priority, they should change their name to reflect that.  I reject "rescue" as a term.  I like what DC did with DC Fire & EMS.  FDNY should be FEMSNY or Emergency Services of NY (ESNY).  Sure, all the FFs would be butt-hurt because it would break tradition and their identity, but I don't care for that sort of tradition and their current identity is only a half truth.

My two pennies.


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## 46Young (Feb 16, 2013)

JPINFV said:


> ...and there we have it. FD first response is about making sure that fire departments get funding and not for the patient. It's nice to know where the tax dollars are going.



Yes, it is important to ensure job security - if you're out of a job, then none of this will matter to you. The better EMS FD's value EMS to a high degree, and allocate sufficient resources in that direction. Keeping one's job, pay, and benefits stable is probably number one on anyone's priority list, but job security is always going to be number one. I don't see this as being an unreasonable priority.


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## 46Young (Feb 16, 2013)

JPINFV said:


> Ahh, but if you gut their response to EMS calls, then it's much less likely that the first due is going to be stuck at an EMS call or at the trauma center two towns down picking up their paramedic. Hence the need for less fire coverage because the units aren't stuck doing non-fire calls.



If a fire call comes in, the fire crew can be placed in-service in the midst of a call with a non-acute pt. Really, maybe 10% of pts or less require time sensitive care that requires more than two providers on-scene. Most fire medical assists only last from 5-15 minutes on-scene anyway. If theunit has proper minimal staffing, the company can retain their medic, and give up a basic FF to drive, and let the txp crew both be in the back, unless there really needs to be an extra medic in back. We do this all the time, so we can stll be in-service and ALS capable with a crew of three. If the hospital is far away, the bus can bring them back, or the EMS supervisor can pick up the medic/basic.


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## 46Young (Feb 16, 2013)

medicsb said:


> Overall, I agree with this.  As much as I may not like the idea of "fire-based" EMS, I do not advocate funding in proportion to call volume.  As has been mentioned actual fires are heavy on resources, much more so than the average EMS call or even cardiac arrest (which definitely requires more than 2 providers to be run well).  EMS will always have a smaller budget as the equipment is less expensive and the required manpower is lower.
> 
> Be that as it may, there are locales where fire suppression could be down-sized to a certain extent.  Most FF unions seem to want to maintain staffing for a call volume that hasn't existed in decades.  In Philadelphia, the mayor has disbanded some engines and ladders and now has "brown outs", of course the IAFF hates this, but the truth is that they are not in the "war years" and there is no way they can justify the staffing they currently have.  I think the mayor has generally made good decisions by downgrading some suppression and adding BLS ambulances.
> 
> ...



The brownouts and such can work to a certain extent in densely populated urban areas. It doesn't work so well in regions that have a mix of urban, suburban, and rural. The busier companies are out of the station a lot, and the slower companies are too far apart to allow the next station over to be closed. 

ALS engines only make sense in rural areas perhaps, but not in more populated areas that run dual medic buses.


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## JPINFV (Feb 16, 2013)

46Young said:


> Yes, it is important to ensure job security - if you're out of a job, then none of this will matter to you. The better EMS FD's value EMS to a high degree, and allocate sufficient resources in that direction. Keeping one's job, pay, and benefits stable is probably number one on anyone's priority list, but job security is always going to be number one. I don't see this as being an unreasonable priority.




So it's OK for the FD to rape the EMS budget, but not OK for EMS departments to go, "Why are we paying the FD to do our job? If we cut out what we're paying the fire department to do EMS and send it to us, we can provide more efficient prehosptial care."  The cognitive dissonance seen by the fire department is amazing.


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## JPINFV (Feb 16, 2013)

46Young said:


> If a fire call comes in, the fire crew can be placed in-service in the midst of a call with a non-acute pt. Really, maybe 10% of pts or less require time sensitive care that requires more than two providers on-scene. Most fire medical assists only last from 5-15 minutes on-scene anyway. If theunit has proper minimal staffing, the company can retain their medic, and give up a basic FF to drive, and let the txp crew both be in the back, unless there really needs to be an extra medic in back. We do this all the time, so we can stll be in-service and ALS capable with a crew of three. If the hospital is far away, the bus can bring them back, or the EMS supervisor can pick up the medic/basic.





...except for all the places where the FD medic is the only medic on scene and the only FD vehicle is a fire engine. Again, that fire engine is going to do a great job responding to that fire when it's 2 cities over retrieving it's medic from the trauma center. 

Fire departments: "We created an abomination of an EMS system to secure our jobs, but we need more funding now because the system is so messed up that it's reducing our response capabilities."


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## Veneficus (Feb 16, 2013)

JPINFV said:


> So it's OK for the FD to rape the EMS budget, but not OK for EMS departments to go, "Why are we paying the FD to do our job? If we cut out what we're paying the fire department to do EMS and send it to us, we can provide more efficient prehosptial care."  The cognitive dissonance seen by the fire department is amazing.



I don't think it is so much cognitive dissonance as it is how the fire service views prehospital care.

They see it as a collateral skill set, similar to hazmat, tech rescue, aircraft rescue/firefighting, and any other number of technical "skills" that can be learned as part of the greater all hazards vocation.

In their mind they are providing the best in prehospital care. (though I personally vehemently disagree with their definition of it and their performance)

So it is not perceieved as "raping the EMS budget" so much as it is using the EMS budget and revenue source as a means to fund the "all hazard" mission.

What I think makes it very flawed is that common human disease is mostly chronic, not acute, so a majority of patients don't fit into their "life or death" skill based intervention philosophy. Thus rendering their care over-valued and under-effective.

But like I said, they don't see it that way. Look at their selling point of delivering life saving medications in an emergency. They use cardiac arrest as the example, with a successful code being delivering textbook ACLS.

"The surgery was successful but the patient died" approach.


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## 46Young (Feb 16, 2013)

JPINFV said:


> So it's OK for the FD to rape the EMS budget, but not OK for EMS departments to go, "Why are we paying the FD to do our job? If we cut out what we're paying the fire department to do EMS and send it to us, we can provide more efficient prehosptial care."  The cognitive dissonance seen by the fire department is amazing.



Apparently, in most cases, the politicians will choose to keep up FD staffing and use that staffing to Band-Aid poor EMS staffing, rather than slash the FD budget to put more buses on the road. If it were any different, we wouldn't be having this conversation. Like Vene said, people generally care more about fire and police coverage than they do about EMS. At least most of the departments in my area give their EMS division it's fair share of resources, such as Alexandria, Arlington, Fairfax County, Fairfax City, Loudon (when the volunteers don't block them from putting medic units in their houses, grrr...), Prince William, and Montgomery Cos. to name a few.

What I would like to see around here is more houses running two ambulances, rather than opening another fire station with an ambulance and an engine. That makes a whole lot more sense than cutting suppression services.


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## Fish (Feb 16, 2013)

CFal said:


> I'm not sure about that more than 2 Medics study, I would like to see that.  Does it also account for multiple patients? If a mini van full of kids collides with a truck on the highway I would like to see more than 2 Medics there.



That is when you would see more than one ambulance...

He is saying that ALS engines and ALS ambulances both are not needed on a call for a single patient....... More than 1 patient, and the patient load is to much for the Ambulance? Call in another


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## 46Young (Feb 16, 2013)

JPINFV said:


> ...except for all the places where the FD medic is the only medic on scene and the only FD vehicle is a fire engine. Again, that fire engine is going to do a great job responding to that fire when it's 2 cities over retrieving it's medic from the trauma center.
> 
> Fire departments: "We created an abomination of an EMS system to secure our jobs, but we need more funding now because the system is so messed up that it's reducing our response capabilities."



Those types of systems are abominations, IMO. That seems to be a West Coast thing. There must be some financial benefit to running EMS that way, instead of having their own ambulances and EMT's. I suppose having two $10/hr private EMT's is more cost effective than having to supply their own FF/EMT and FF/medic, having to maintain the ambulance fleet, etc. That's the only reason I can see the department using privates in that way rather than running EMS exclusively.


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## 46Young (Feb 16, 2013)

Veneficus said:


> I don't think it is so much cognitive dissonance as it is how the fire service views prehospital care.
> 
> They see it as a collateral skill set, similar to hazmat, tech rescue, aircraft rescue/firefighting, and any other number of technical "skills" that can be learned as part of the greater all hazards vocation.
> 
> ...



That sounds about right. I've had to defend against several snide remarks about how FF/medics get about $20,000/yr more than basic FF's with the same tenure. I explain to them that a paramedic is a stand-alone career in many other places. The same cannot generally be said of non fire/EMS Hazmat techs or TROT techs. They get quiet real quick when I point out that the TROT heroes only go to school for six weeks, the glow worms for two weeks, but medics go from six months to two years. They get trained for cut jobs OTJ, but that only takes a couple of tours.


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## abckidsmom (Feb 16, 2013)

46Young said:


> That sounds about right. I've had to defend against several snide remarks about how FF/medics get about $20,000/yr more than basic FF's with the same tenure. I explain to them that a paramedic is a stand-alone career in many other places. The same cannot generally be said of non fire/EMS Hazmat techs or TROT techs. They get quiet real quick when I point out that the TROT heroes only go to school for six weeks, the glow worms for two weeks, but medics go from six months to two years. They get trained for cut jobs OTJ, but that only takes a couple of tours.



Through a colossal paperwork error, my medic card expired for two weeks in November.  I found out real quick that being a basic on a medic unit is exquisitely easy.  I wrote no call sheets, I changed out no drug boxes, I helped my partners out and drove the ambulance.  Delightful.

And better watch out for the career dissipation light if you talk like that out loud in the station.  We don't disparage our TROT heroes.    Not much respect available for guys who are thrilled to be medics, and revel in that role.


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## Shishkabob (Feb 17, 2013)

46Young said:


> gives you maybe ten minutes, fifteen tops to get a knock on the fire, otherwise it's just surround and drown.



Then surround and drown.  No property is worth life, and Bryan Texas just lost 2 firefighters not heeding that lesson.  FD sucks at learning lessons taught in blood, as they keep doing it over and over.


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## STXmedic (Feb 17, 2013)

Linuss said:


> Then surround and drown.  No property is worth life, and Bryan Texas just lost 2 firefighters not heeding that lesson.  FD sucks at learning lessons taught in blood, as they keep doing it over and over.



Just like ambulances driving emergent all the time? I'm pretty sure there's a thread right now about that. Glass houses, sir.


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## Shishkabob (Feb 17, 2013)

PoeticInjustice said:


> Just like ambulances driving emergent all the time? I'm pretty sure there's a thread right now about that. Glass houses, sir.



Except I don't advocate running emergent to calls all the time, therefor I will throw the stone.


And my agency tries many things to prevent that from happening (not fool-proof, but alas), including going to the cities and showing that emergent response shouldn't be what EMS is measured by, but patient outcome.  We suspended emergent response for a couple of days during an ice storm a couple of years ago. Granted, limited scope, but there was no difference in patient outcome, and my agency pushed that out to the news agencies.


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## STXmedic (Feb 17, 2013)

Linuss said:


> Except I don't advocate running emergent to calls all the time, therefor I will throw the stone.
> 
> 
> And my agency tries many things to prevent that from happening (not fool-proof, but alas), including going to the cities and showing that emergent response shouldn't be what EMS is measured by, but patient outcome.  We suspended emergent response for a couple of days during an ice storm a couple of years ago. Granted, limited scope, but there was no difference in patient outcome, and my agency pushed that out to the news agencies.



And many departments don't advocate on going interior innecessarily, and practice much safer methods at structure fires. If you want to throw blanket statements, then so can I. Your system is the exception. Well, you are one of the exceptions at your system, because I'm willing to bet there are still quite a few people at MS that run emergent.


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## ExpatMedic0 (Feb 17, 2013)

abckidsmom said:


> Through a colossal paperwork error, my medic card expired for two weeks in November.  I found out real quick that being a basic on a medic unit is exquisitely easy.  I wrote no call sheets, I changed out no drug boxes, I helped my partners out and drove the ambulance.  Delightful.
> 
> And better watch out for the career dissipation light if you talk like that out loud in the station.  We don't disparage our TROT heroes.    Not much respect available for guys who are thrilled to be medics, and revel in that role.



haha ya its  fun change. I was placed on a BLS rig for a week due to a staffing issue, it was a blast. However whats even better is ALS rapid response with a basic partner. 9 times out of ten in the fly car all I did was get driven to calls, get out, evaluate, release to BLS, get back in the fly car. No transport %90 of the time from my end, very simply easy paper work


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## DrParasite (Feb 17, 2013)

46Young said:


> Really, how many places in the country have well staffed EMS? Not many, probably hardly any. There are a huge amount of predominantly volunteer fire across the country. Even without the burden of funding a career department, EMS still gets understaffed, with only the minimum needed to get by. For EMS, just barely having enough units to get by seems to be the norm. How many EMS employers run with three on the bus? How many grant true OOS meal breaks? The only one that I've seen do this is Nassau County's EMS. How many places use SSM? How many places bid out to a cheap private provider? How many of those private providers play games juggling 911 units and IFT units to boost profitability? Using fire to Band-Aid this reality is clever, and it's also clever for fire depts. to exploit this fact to protect their own positions.
> 
> I don't have an easy answer to get around this situation.


Can I quote this for truth?  quoted for accuracy?  how about for the next time we go fire vs ems staffing, and I say this exact same thing, i can just reference your post?

btw, almost every firefighter wants to do their job, go into a fire, put it out, and make everyone happy.  more often than not, it was to save property, and the homeowner is happy.   No firefighter wants to die in a fire, and the general consensus is that most will risk a lot to save a life, but few want to get hurt just to save property.  but that's another topic.


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## Veneficus (Feb 17, 2013)

DrParasite said:


> btw, almost every firefighter wants to do their job, go into a fire, put it out, and make everyone happy.  more often than not, it was to save property, and the homeowner is happy.   No firefighter wants to die in a fire, and the general consensus is that most will risk a lot to save a life, but few want to get hurt just to save property.  but that's another topic.



Can I jus ask how this is really different from EMS?

Running lights and sirens to every call despite the dangers and the fact it doesn't do anything?

Not having stations and getting fatigued posting in a truck for hours on end without basic necessities of life so the company can make a few more $ while running the risk of a serious MVC or medical error?

Of course, the easy way to solve these problems is for providers not to work at such companies. But that will never happen, EMS providers are a dime a dozen. Why pay more?


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## sweetpete (Feb 17, 2013)

PoeticInjustice said:


> And many departments don't advocate on going interior innecessarily, and practice much safer methods at structure fires. If you want to throw blanket statements, then so can I. Your system is the exception. Well, you are one of the exceptions at your system, because I'm willing to bet there are still quite a few people at MS that run emergent.



This is one of the BEST posts I've ever read on this blatantly anti-fire department website. Finally, someone who knows what they're talking about. 

I see more ambulances going emergency traffic than fire trucks on ANY given day down here in Houston. And having been in a number of those ambulances, I can practically guarantee that it's not necessarily an emergency.

Well don Poetic.

Take care,


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## Shishkabob (Feb 17, 2013)

sweetpete said:


> I see more ambulances going emergency traffic than fire trucks on ANY given day down here in Houston. And having been in a number of those ambulances, I can practically guarantee that it's not necessarily an emergency.



Every city we work with, their FD runs LS on every single call they are dispatched to, EVEN if they're going to end up staging around the corner for PD.




sweetpete said:


> This is one of the BEST posts I've ever read on this blatantly anti-fire department website.



No one here is "anti-fire".  Some of us just don't think FD should have anything to do with medicine, especially when they use it solely as a way to boost their budget.  But you're probably the same thinking when it comes to EMS doing rescue... so....


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## DrParasite (Feb 17, 2013)

sweetpete said:


> This is one of the BEST posts I've ever read on this blatantly anti-fire department website. Finally, someone who knows what they're talking about.


this is far from an anti-fire department website.  there are some individuals who are anti-fire based ems (myself included), but I support 100% the FD putting out the fires.


sweetpete said:


> I see more ambulances going emergency traffic than fire trucks on ANY given day down here in Houston. And having been in a number of those ambulances, I can practically guarantee that it's not necessarily an emergency.


probably because the ambulances are going on more calls than the fire trucks.  and I'm guessing (just wild guess) that they are going L&S to the hospital becasue they want to take a break to pee or they know they are so backed up the sooner they get to the hospital the sooner they can get back available to answer the next pending call.

oh, and veneficus, one way is the thinking of the line staff, the other way is the thinking of management, at least for EMS,  many in the FD think similarly, from upper management to line staff.


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## JPINFV (Feb 17, 2013)

sweetpete said:


> This is one of the BEST posts I've ever read on this blatantly anti-fire department website. Finally, someone who knows what they're talking about.



I imagine I support fire departments taking over EMS as you support EMS departments taking over fire suppression. 



> I see more ambulances going emergency traffic than fire trucks on ANY given day down here in Houston. And having been in a number of those ambulances, I can practically guarantee that it's not necessarily an emergency.
> 
> Well don Poetic.
> 
> Take care,


...and I've seen fire fighters out here upgrade transports to lights and sirens simply because they want to get done quicker.


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## STXmedic (Feb 17, 2013)

JPINFV said:


> ...and I've seen fire fighters out here upgrade transports to lights and sirens simply because they want to get done quicker.



And I've seen ambos here do the same thing.


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## JPINFV (Feb 17, 2013)

PoeticInjustice said:


> And I've seen ambos here do the same thing.



...and I don't doubt it for a second, but when it's a "The FD is awesome because they don't do D-bag things like go lights and sirens for no reason," it's patently untrue. Unfortunately, if a vehicle has lights and sirens, those tools will be abused.


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## STXmedic (Feb 17, 2013)

JPINFV said:


> ...and I don't doubt it for a second, but when it's a "The FD is awesome because they don't do D-bag things like go lights and sirens for no reason," it's patently untrue. Unfortunately, if a vehicle has lights and sirens, those tools will be abused.



Most certainly. It's a problem with both. There's few problems I see that are specific to just one or the other.


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## Shishkabob (Feb 17, 2013)

I'll admit it... I went L&S to the hospital yesterday to get done quicker....

That was after I gave my bradypnea patient narcan who then proceeded to exhibit trismis, clenching down on the OPA we had in, breaking all their front teeth, then exhibited anisocoria and tachypnea.  That call couldn't be over fast enough!  And before you ask... it was just 0.4mg Narcan.  I don't slam it.


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## Bullets (Feb 18, 2013)

I am not anti fire.  I am anti period doing things they aren't designed to do.  I love my engine company that works in my town,  they help us on difficult or man power intensive calls where two providers aren't enough hands.  Their charting and patient care are poor but they are helpful for compressions and on mvc. They are also the best company in the area when it comes to fighting fire. However they are 4 professionals in a volunteer department. Our fire companies run code to everything even if there are units on scene telling them to reduce.


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