# Which SHOULD come first FIRE or EMS?



## slawson (Oct 7, 2008)

Been a while since I have posted. I have been kinda out of ems for a while then got back in - worked for a jacked up private service - yada yada. But my interest level is coming back (thankfully).

I have been debating this for a while locally here and want everyones opinion.

Let me set the scene. Our fire district is diverse. We have a US highway, and dirt roads with steep cliffs and hairpin turns. Our dispatch comes through the local state police post. (We don't have a "county dispatch" per se`). I have worked there as a dispatcher before and let's just say things always don't go as they should. But the accepted protocol is to dispatch the private ambulance service to the scene of an accident BEFORE sending your local fire departments. In our district, EMS is around 15-20 minutes out. Our FD response time is on average 5(ish).

In one instance, I heard EMS clearing en route to an accident in our area BEFORE we were even notified. This means the call had to come in to dispatch, the dispatcher get the information, 911 dispatcher hang up with the caller, pick up the phone, call the ems service dispatcher, give them the information, the ems service dispatcher picks up the phone and calls the closest ems station, gives the crew the information, the crew gets out of the station into the unit and gets on their way and then keys up the radio and says they are all in route. ALL of this happens THEN we were notified to go to the call. 

My point is this. Fire departments have the ability to effect the outcome of the scene more than any other agency. As ems, we can't do anything if the car is on fire, victim trapped. If fire is not an ems agency (such as our case), the least they can do is stabilize the scene, remove any obvious hazards and prevent other accidents. 

The extra time it takes to notify the ems agency, is the amount of time you are delaying the first agency to be on scene. And in my opinion anything you can do to delay the first agency arriving on scene is a wrong decision. 

If you guys don't care, let me know what you think and give me some examples.

THANKS!!!

Sean
EMT-B
AHA CPR Instructor
Firefighter I


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## medic417 (Oct 7, 2008)

If people are hurt they need medical professionals more than they need firefighters.  I think you send the medical first and support people second.  Or if you really want to waste tax dollars automatically dispatch both at same time for all calls.


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## slawson (Oct 7, 2008)

2 Questions....

Do you think that only EMS should go to accident scenes? 

It seems that you may think that way from the comment below.


> Or if you really want to waste tax dollars automatically dispatch both at same time for all calls.



Do you think that fire should be dispatched second (if at all) even though they are closer to the scene and can have it secured (and safe) prior to EMS arrival?

Thanks for your reply!


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## JPINFV (Oct 7, 2008)

If you can't provide transport, then yes, the ambulance should be notified first unless rescue or fire suppression is needed.


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## medicdan (Oct 7, 2008)

I think the important factor here is arrival times... if it takes the ambulance, on average 15 minutes to arrive, compated to ~5 for fire, they should certainly be rolling first. Train you FFs as CFRs or EMTs, and throw some BLS equipment onto the engine and you are good (in Boston we are always happy to arrive on scene to find the patient already boarded by fire!).


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## slawson (Oct 7, 2008)

JPINFV said:


> If you can't provide transport, then yes, the ambulance should be notified first unless rescue or fire suppression is needed.



Interesting.

The way I thought about is this..

If an accident happens a couple hundred feet from a fire station, why would you not notify the FD to stabilize the scene/pt first. Given, we are only speaking of 2-3 minutes of difference between each, but to me it seems logical to get an agency on scene (regardless of role really) as soon as possible. Without anyone on scene so many hazards exist that put the pt as well as other motorists in harms way??

We all know Joe Citizen can't tell if a rescue situation or fire suppression is truly needed. Sometimes we get good info, but would we want to judge it by that?

I am NOT trying to sway anyone my way here - I just want to look at all angles.

THANKS FOR THE REPLIES!


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## slawson (Oct 7, 2008)

emt-student said:


> I think the important factor here is arrival times... if it takes the ambulance, on average 15 minutes to arrive, compated to ~5 for fire, they should certainly be rolling first. Train you FFs as CFRs or EMTs, and throw some BLS equipment onto the engine and you are good (in Boston we are always happy to arrive on scene to find the patient already boarded by fire!).



Just to clear it up - you think if fire can get there sooner - roll fire first or did I just selectively interpret that? haha

Thanks...


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## Flight-LP (Oct 7, 2008)

slawson said:


> Been a while since I have posted. I have been kinda out of ems for a while then got back in - worked for a jacked up private service - yada yada. But my interest level is coming back (thankfully).
> 
> I have been debating this for a while locally here and want everyones opinion.
> 
> ...



If the vehicle is not on fire, does not have individuals entrapped, does not have hazardous fluids on the ground, nor requires manpower for large individuals, then a fire response is not needed. You are dead wrong in your belief that fire is the almighty that saves the scene. I have worked thousands of MVA's and very few required the FD. Your dispatch is correct in sending EMS first, after all, they are the medical professionals who will directly intervene in the pts. life. Assistance is always appreciated, but immediate needs should be dispatched first. EMS for the pt., Police for scene control, wreckers to clear the scene, and then maybe the FD. Sorry, if none of the above are required, then you are at the bottom of the totem pole..................................


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## JPINFV (Oct 7, 2008)

I say transport because the vast majority of time critical (if the patient isn't time critical, then does it matter the order that response agencies get notified?) patients can not be helped prehospitally. Oxygen and c-spine isn't nearly as important in a patient with critical internal injuries as prompt transport to a trauma surgeon.


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## medic417 (Oct 7, 2008)

slawson said:


> 2 Questions....
> 
> Do you think that only EMS should go to accident scenes?
> 
> ...



Comments in Line


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## slawson (Oct 7, 2008)

Flight-LP said:


> If the vehicle is not on fire, does not have individuals entrapped, does not have hazardous fluids on the ground, nor requires manpower for large individuals, then a fire response is not needed. You are dead wrong in your belief that fire is the almighty that saves the scene. I have worked thousands of MVA's and very few required the FD. Your dispatch is correct in sending EMS first, after all, they are the medical professionals who will directly intervene in the pts. life. Assistance is always appreciated, but immediate needs should be dispatched first. EMS for the pt., Police for scene control, wreckers to clear the scene, and then maybe the FD. Sorry, if none of the above are required, then you are at the bottom of the totem pole..................................



Don't get me wrong - in NO WAY do I think that fire is an almighty scene saver - I am an EMT too - I have been there where FD is useless - just trying to get everyone's opinion.

Here thought FD does traffic control, police do reports! haha


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## slawson (Oct 7, 2008)

medic417 said:


> Comments in Line



Very good response. I am beginning to think I am wrong on this one guys!


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## KEVD18 (Oct 7, 2008)

when you're cooking a large meal with different types of food, you want them all to be done at the same time so everything arrives at the table while its still hot. so you start the things that are going to take the longest to cook first, then the nexty longest etc.

95% of the time, fd is wasted on ems runs. flight pretty much nailed it in his post.


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## FireResuce48 (Oct 7, 2008)

I like having the engines and or ladders on scenes of a wreck. It's nice to have some barrier protection and it's always nice to have some extra hands especially when you know those extra hands know what they are doing.


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## JPINFV (Oct 7, 2008)

Extra hands who knows what they're doing? Strange how the only time I've heard the term "cosmetic backboard" was from a firemedic.


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## EMTWintz (Oct 7, 2008)

I dont think this was said but in my town both fire and rescue are vollie. We have several FF who are First Responders. But def. if there is a wreck you may like having FF there to run traffic


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## TransportJockey (Oct 7, 2008)

EMS first. Police can run traffic around the scene. Unless the pt needs extrication or the car is on fire, keep FD away


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## 41 Duck (Oct 7, 2008)

We don't have a choice, here.  FD is always dispatched with us for MVAs--sadly, we can't even cancel them.  90% of the time, they're not needed and are merely in my way.


Later!

--Coop


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## firecoins (Oct 7, 2008)

I think tow trucks should come first.


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## rmellish (Oct 7, 2008)

Its all situational. At the rural county service I run with Fire is only dispatched when there is a possible hazmat, 10-50, or fire in the city. EMD also dispatches them as manpower for known or suspected cardiac arrests. Police are dispatched for "Life Alert" tags in case forcible entry needs to be made into a residence.

 In the outlying county vollie FD is dispatched as first response due to longer response times. 

Ideally the decision to dispatch fire should be made on a case by case basis. EMS should be notified first on EMS calls.


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## flhtci01 (Oct 7, 2008)

In our communtiy both EMS and fire are volunteer and separate organizations.  EMS gets dispatched first.  If it is highly likely fire is not needed they will not get paged out.  If it is an accident that might involve extrication, additional manpower, etc., they get paged immediately after EMS.


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## MJordan2121 (Oct 7, 2008)

*Firemen/EMT's*

I believe that firemen are, indeed, essential. In South Mississippi, there seems to be a fire station every few miles and we only have around 9-11 ambulances at night covering two big counties. When we have to venture out the city into the county, it can sometimes take us 10-20 minutes to get there, depending on how far out it is. The firemen can get there fairly quickly and can at least give the pt oxygen, start getting pt information, use CPR, if needed, and can start c-spine immobilization, should it be necessary. I believe that we all work as a team and I am thankful they are there on every call with us. Plus, you  never know if you will need lift assistance, backup, or whatever.


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## Noctis Lucis Caelum (Oct 7, 2008)

MJordan2121 said:


> I believe that firemen are, indeed, essential. In South Mississippi, there seems to be a fire station every few miles and we only have around 9-11 ambulances at night covering two big counties. When we have to venture out the city into the county, it can sometimes take us 10-20 minutes to get there, depending on how far out it is. The firemen can get there fairly quickly and can at least give the pt oxygen, start getting pt information, use CPR, if needed, and can start c-spine immobilization, should it be necessary. I believe that we all work as a team and I am thankful they are there on every call with us. Plus, you  never know if you will need lift assistance, backup, or whatever.



Pretty much i agree with everything you said, especially the part on additional help.  Also scene safety is a must.


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## Jon (Oct 7, 2008)

I think your bigger issue is that your area is so fragmented and territorial that this is even a question.

Where I volunteer and where I work... we have county-wide dispatch. 911 calltakers enter the call in CAD, then a dispatcher selects the appropriate unit and pages Fire AND EMS over the pager frequency and dispatches the calls. PD is dispatched by their dispatcher... and because the fire dispatcher has to activate tones, etc, we often hear our calls go out to PD a few moments before we get the call.

If every fire house has their own dispatch... whoever the PSAP is has to pass the info to them, then the fire house needs to dispatch... that takes time. if the PSAP has to make 2 phone calls... I'd call the ambulance first, probably because it is doing the most good the most times. _*BUT THIS ISN'T THE PROBLEM! THE PROBLEM IS THAT YOU SEEM TO HAVE LOTS OF "LITTLE KINGDOMS" THAT WANT TO BE THIER OWN BIG-CITY FIRE DEPARTMENT.*_


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## EMTWintz (Oct 8, 2008)

flhtci01 said:


> In our communtiy both EMS and fire are volunteer and separate organizations.  EMS gets dispatched first.  If it is highly likely fire is not needed they will not get paged out.  If it is an accident that might involve extrication, additional manpower, etc., they get paged immediately after EMS.



That is exactly how it is here. Only one step further. If there is a medical ER on the interstate, then at least one Fire truck rolls so they can route traffic. We only have 2 part time police officers and its the luck of the draw if they show up.


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## Flight-LP (Oct 8, 2008)

I keep hearing responses citing "traffic control" or "barrier". Do you really honestly believe that your fire truck was designed to be a traffic barrier. Is that what your community spent over $100,000 on? Doubtful.................

Also, how many of you are trained in traffic control? I don't mean standing out in the street with a flashlight. I am referring to true knowledge in directing the flow of traffic, appropriate hand signals, flow patterns, etc.

The answer will probably be very few. It is not your job to handle traffic, thats why God invented law enforcement! Let them do their job, you do yours if it is even needed on that scene. God help any agency that gets an unknowledgable FF run over, or worse yet, cause another wreck because they don't know what they are doing. Stick with what you know.....


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## EMTWintz (Oct 8, 2008)

Flight-LP said:


> I keep hearing responses citing "traffic control" or "barrier". Do you really honestly believe that your fire truck was designed to be a traffic barrier. Is that what your community spent over $100,000 on? Doubtful.................
> 
> Also, how many of you are trained in traffic control? I don't mean standing out in the street with a flashlight. I am referring to true knowledge in directing the flow of traffic, appropriate hand signals, flow patterns, etc.
> 
> The answer will probably be very few. It is not your job to handle traffic, thats why God invented law enforcement! Let them do their job, you do yours if it is even needed on that scene. God help any agency that gets an unknowledgable FF run over, or worse yet, cause another wreck because they don't know what they are doing. Stick with what you know.....



I can't speak for everyone else's FD but I know ours has had training in traffic control. Our FD has the flares, the air traffic cone thingys and the hand signals down pat.


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## slawson (Oct 8, 2008)

Let me just make clear though folks, I didn't ask the question because it's "my kingdom" or any other territorial issues - it was a pt issue really.

The way I saw it in relative to an accident with injuries - anything you do to delay the first agency arriving on scene was, in my opinion, a wrong decision. 

If a car is in the middle of an heavy intersection - to me it makes since to get the FD there asap to be able to secure the scene.

Having PD do traffic control is great - and probably should happen, however, here it's just not set up that way and I don't have ample opportunity to change that. Traffic is another duty tasked to the fire department.

I asked the question just to see everyone's opinion on them. And I thank you - keep them coming. It seems the solution to this is to attempt to get them dispatched using a simulcast broadcast via the radio. 

Currently dispatcher calls private ambulance service who then calls the closes ambu station. The FD is dispatched via radio & alphanumeric pager as backup.


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## 41 Duck (Oct 8, 2008)

Jon said:


> _*BUT THIS ISN'T THE PROBLEM! THE PROBLEM IS THAT YOU SEEM TO HAVE LOTS OF "LITTLE KINGDOMS" THAT WANT TO BE THIER OWN BIG-CITY FIRE DEPARTMENT.*_



Yes you CAN get an amen!



Later!

--Coop


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## Ridryder911 (Oct 8, 2008)

Personally, I like firefighters to get there first. 

First to see if the scene is safe/hazardous materials (dead firefighter bodies on the ground is a good clue) or hear the shots fired. 

Second: See if there is loose wild animals, or various decomposition 

Third: Carry my equipment and the patient. 

Hey, they have to do something!...

R/r 911


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## FFMedic1911 (Oct 8, 2008)

By reading some of the post it is clear we have some fire haters on the board.IMO and this is coming from a firemedic who takes both jobs serious,fire and ems should be dispatched at the same time.If you have an eta of 15 min for any ambulance and 5 for a fire truck why would you make someone wait to receive care.This stupid hose monkey(me) saved a 16 y/o male involved in an mvc once by keeping the airway open while waiting on ems.I think sometimes we let are little kingdoms get in the way of what we are here for in the first place.


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## BossyCow (Oct 8, 2008)

rmellish said:


> Its all situational. ......
> 
> Ideally the decision to dispatch fire should be made on a case by case basis. EMS should be notified first on EMS calls.



Best post on the topic! It has to depend on the systems involved. In our system the FD has not just people trained in traffic control but actual card carrying State DOT Flaggers. All heavy extrication equipment are carried on the fire trucks. Also, after the pt is loaded into the ambulance and on their way to the hospital in the ambulance, fire stays on the scene until the glass is up, road is clear and everything is done. 

To say that fire is worthless on a scene is a gross generalization based on anecdotal information.


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## Ridryder911 (Oct 8, 2008)

I don't hate firefighters. Just they are not EMS. Truthfully, most fire services are more strategically placed with multiple stations more than EMS services and can respond faster. Even though I was joking, in reality it is true in comparison EMS is much busier than fire.

I don't see a problem with having Fire Service on the scene as long as it is in the role as first responder only. Having only two EMS personnel on most medical calls is ridiculous. Yes, even though I was joking it only makes sense to assist in carrying and assisting on the call. 

When dispatching, why not dispatch simultaneously? We do. The tones go out on both frequencies at the same time; therefore one is not over another.


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## Code 3 (Oct 8, 2008)

Ridryder911 said:


> I don't hate firefighters. Just they are not EMS. Truthfully, most fire services are more strategically placed with multiple stations more than EMS services and can respond faster. Even though I was joking, in reality it is true in comparison EMS is much busier than fire.
> 
> I don't see a problem with having Fire Service on the scene as long as it is in the role as first responder only. Having only two EMS personnel on most medical calls is ridiculous. Yes, even though I was joking it only makes sense to assist in carrying and assisting on the call.
> 
> When dispatching, why not dispatch simultaneously? We do. The tones go out on both frequencies at the same time; therefore one is not over another.



Is the FD you run with a BLS provider? If not, would your views change if every fire department in your county was ALS? I'm just curious because in my county every FD is ALS with the exception of two cities that still use FF/EMT's.


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## Ridryder911 (Oct 8, 2008)

No, my FD is not ALS. Personally, I don't believe FD should be the ALS providers. I have worked in systems that has such, and believe if one is going to provide ALS care, one should have to ride in with them. 

R/r 911


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## Hastings (Oct 8, 2008)

I enjoy having the FD or PD on scene before I arrive for the reasons you listed in the original post. 

1. Scene safety.
2. Extrication.
3. Triage.
4. Initial vitals.
5. Availability for lift assist.



And those are all well within a first responder role. They're invaluable in that manner. It just speeds things up, and makes things more efficient. They're there to make initial contact prior to my arrival and they're willing to step aside once I get there. I have no complaints. Again, I really value the first responders.



Edit: That being said, EMS contact should never purposely be delayed.


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## slawson (Oct 8, 2008)

FFMedic1911 said:


> By reading some of the post it is clear we have some fire haters on the board.IMO and this is coming from a firemedic who takes both jobs serious,fire and ems should be dispatched at the same time.If you have an eta of 15 min for any ambulance and 5 for a fire truck why would you make someone wait to receive care.This stupid hose monkey(me) saved a 16 y/o male involved in an mvc once by keeping the airway open while waiting on ems.I think sometimes we let are little kingdoms get in the way of what we are here for in the first place.



I was kind of thinking the same thing FFMedic... my primary concern is for the pt. The earlier someone can initially make pt contact the earlier someone can provide even the slightest benefit to that pt. 

FD's here do much more than extricate / fire supression on scene. As the below posts state, clean up glass, make sure rdway is ready to reopen etc. At least here, FD offers much benefit to the overall scene and to the pt than in other cases.

It seems the solution is for simulcast dispatch. Both tones, both frequencies.

The other obstacle is getting the central dispatch to do that one small change.


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## FireResuce48 (Oct 8, 2008)

Flight-LP said:


> I keep hearing responses citing "traffic control" or "barrier". Do you really honestly believe that your fire truck was designed to be a traffic barrier. Is that what your community spent over $100,000 on? Doubtful.................
> 
> Also, how many of you are trained in traffic control? I don't mean standing out in the street with a flashlight. I am referring to true knowledge in directing the flow of traffic, appropriate hand signals, flow patterns, etc.
> 
> The answer will probably be very few. It is not your job to handle traffic, thats why God invented law enforcement! Let them do their job, you do yours if it is even needed on that scene. God help any agency that gets an unknowledgable FF run over, or worse yet, cause another wreck because they don't know what they are doing. Stick with what you know.....



Do you not position your apparatus for maximum barrier protection?
And police aren't always available. Especially if you are running out of a place that tends to see allot of crime. There just might be other stuff going on. Also the extra set of lights at night really helps light up the scene.

I also don't see why allot of people are so against fire medics or even firefighters in the basic rolls. I personally know so excellent fire medics that are running in Maryland that you could rely on for excellent patient care and could count on while on the fire ground.


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## marineman (Oct 8, 2008)

I have no problem with firefighters being on scene as long as they move aside when we get there so we can get to work. As for which should be paged first, my thought is because the ambulance has a longer travel time and will in the end to the patient the most good dispatch the ambulance first. All of ours are dual page anyway so we don't have that issue.

I'm not a medic yet but I don't really like the thought of ALS fire services if they're not transporting. If the ALS fire service gets on scene prior to the medics as we've seen in Florida especially if they're not working on an ambulance with major patient contacts their skills probably aren't that sharp. The potential negatives of ALS fire treatment by far outweigh the minor benefit.

Also at least locally we are supposed to get 2 sets of vitals before interventions to ensure an accurate baseline and prove trending. One can be a set taken by the first responders but the second must be our own. If a fire fighter comes in and starts a bunch of ALS procedures it  makes that impossible to get and could inhibit quality patient care down the road.


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## FFMedic1911 (Oct 8, 2008)

marineman said:


> I have no problem with firefighters being on scene as long as they move aside when we get there so we can get to work. As for which should be paged first, my thought is because the ambulance has a longer travel time and will in the end to the patient the most good dispatch the ambulance first. All of ours are dual page anyway so we don't have that issue.
> 
> I'm not a medic yet but I don't really like the thought of ALS fire services if they're not transporting. If the ALS fire service gets on scene prior to the medics as we've seen in Florida especially if they're not working on an ambulance with major patient contacts their skills probably aren't that sharp. The potential negatives of ALS fire treatment by far outweigh the minor benefit.
> 
> ...


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## JPINFV (Oct 8, 2008)

FireResuce48 said:


> I also don't see why allot of people are so against fire medics



Example on why having fire medics is plain idiotic:



> *Boston EMS has taught its 62 paramedics to interpret an ECG "manually";* and in a study, they performed as well as a "blinded" emergency physician and a cardiologist who reviewed their prehospital ECG readings (Feldman JA, Brinsfield K, Bernard S, et al: "Real-time paramedic compared with blinded physician identification of ST-segment elevation myocardial infarction: Results of an observational study. American Journal of Emergency Medicine. 23[4]:443-448, 2005).
> 
> *"But we have 2,500 paramedics [and 27 provider agencies] in L.A. County," Rokos said, "And obviously we can't train everyone to read ECGs." So Los Angeles County has paramedics rely on an automated computer ECG interpretation. "All they have to do is read ***Acute MI, and that's their ticket to go," he said.*


-Paramedics Activate Cath Lab for STEMI Patients in Some Areas, EMS Insider February 2007 Vol. 25 Issue 2. http://www.jems.com/news_and_articles/articles/Paramedics_Activate_Cath_Lab_STEMI_Patients.html

Guess which system has the fire medics? Would you trust a fire fighter to have your back when going into a structure fire if you knew that the only reason he was a fire fighter was to work EMS and actively avoided anything remotely fire related? 

Example 2:
Who is one of the major opponents of advancing requriments for paramedics? If you answered "the fire service," you're correct.



> The IAFC EMS Section expresses concern regarding the following points in the draft education standards:
> 
> • The IAFC EMS Section would like to see substantiation on why there is an increase in training hours and how the new hour level was determined.
> 
> • While the IAFC EMS Section supports higher education and the aim of increased professionalism in EMS, it is concerned that the general move toward college-based courses, the increase in hours and resulting financial impact will adversely affect departments’ ability (especially volunteer departments) to meet the goals of the standards.


-International Association of Fire Chiefs, Re: Formal Comments on the National EMS Education Standards, Draft 1.0, http://www.iafc.org/associations/4685/files/ems_NtlEMSeduStandardsSectionComments070731.pdf

So, essentially his points are:
1. The average fire fighter is too stupid to require more hours.
2. The average fire fighter is too stupid to complete college courses.
3. The current requirement (110 hours (NHTSA, and thus NREMT, standard per National Standard Curriculum) for EMT-B and a suggested 900 or so hours for EMT-P) is enough training and education. (if you actually think that 110 hours is enough please start a thread, I'd be happy to discuss this there).

Yes, I have a problem with systems that put having more numbers and more useless trucks (hey, I bet if you had as many ambulances as fire engines that the "benefit" of having the fire department respond would go away quickly and yes, a fire engine on a medical call is about as useful as having a tow truck at a structure fire) above providing good patient care and higher standards.


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## marineman (Oct 8, 2008)

FFMedic1911 said:


> This is news to me.If this is true i make a vote we stop this silly practice and go back to the days of being ambulance drivers.Wow i knew this als stuff was the devil.



Wow, maybe I was unclear in my wording so I'll say it again (read it slow if it helps). I believe ALS in the field is absolutely fantastic and the quicker we can initiate ALS the better it is for the patient. My problem lies between local protocols and engines carrying ALS equipment (it has nothing to do with fire medics that work on an ambulance). My protocols state that I must; no matter what, absolutely without fail get two (2) sets of vitals before initiating therapy to establish a baseline. And no matter what, one (1) of those sets of vitals must be done by me and me alone; no machines, no first responders, no firefighters even if they moonlight as paramedics or ER docs. If a first responder initiates O2 therapy I have to stop the O2 for 3-5 minutes, then take a set of vitals to establish my baseline (I can use the one the first responders took for my second). Therein lies the problem of the engines initiating ALS procedures; many are irreversible to get a true set of baseline vitals.

In the particular system that I work in this is not an issue because engines don't carry ALS equipment and our average response time is between 6 and 7 minutes. In a different system I think a change within the SOP would be rectified if some of those variables were changed however in my current system that is my stance that engines and ALS drugs are not a good combination.

And my stance on the original question remains the same that the ambulance does the most good for the patient so they should be first out.


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## reaper (Oct 8, 2008)

marineman said:


> Wow, maybe I was unclear in my wording so I'll say it again (read it slow if it helps). I believe ALS in the field is absolutely fantastic and the quicker we can initiate ALS the better it is for the patient. My problem lies between local protocols and engines carrying ALS equipment (it has nothing to do with fire medics that work on an ambulance). My protocols state that I must; no matter what, absolutely without fail get two (2) sets of vitals before initiating therapy to establish a baseline. And no matter what, one (1) of those sets of vitals must be done by me and me alone; no machines, no first responders, no firefighters even if they moonlight as paramedics or ER docs. *If a first responder initiates O2 therapy I have to stop the O2 for 3-5 minutes, then take a set of vitals to establish my baseline (I can use the one the first responders took for my second). *Therein lies the problem of the engines initiating ALS procedures; many are irreversible to get a true set of baseline vitals.
> 
> In the particular system that I work in this is not an issue because engines don't carry ALS equipment and our average response time is between 6 and 7 minutes. In a different system I think a change within the SOP would be rectified if some of those variables were changed however in my current system that is my stance that engines and ALS drugs are not a good combination.
> 
> And my stance on the original question remains the same that the ambulance does the most good for the patient so they should be first out.




You are kidding on that statement, I hope. That is the most ridiculous thing I have ever heard of. So if an asthmatic is on O2 when you arrive, you stop O2 for 3-5 minutes to determine if they really need it?


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## JPINFV (Oct 8, 2008)

Just curious, Marineman, by chance are your protocols online and if so, can you post a link?


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## triemal04 (Oct 8, 2008)

Unfortunately, what JPINFV fails to realize (again, as usual) is that both IAFC and IAFF do not dictate policy for individual fire departments, (similar analogy here and maybe food for thought for some:  http://www.emslive.com/articles/49/1/Private-v-Fire-EMS-The-Final-Word/Page1.html) and also that (another failure in understanding)all the article proves is that LA County has a lousy EMS system...duh...no arguement here.  Unfortunately for him it does not show that all fire-based EMS services have issues anymore than me posting an article about disgruntled private paramedics or private paramedics making mistakes would indicate that all of them are angry or poor providers.

(this is where I once again toss out the challenge for someone to show me a third service/private/hospital based EMS system of the size of LA City or LA County that is problem free...I'm still waiting on that one from the last time I asked)

I can do a quick search and find lots of problem fire departments where EMS is concerned...funny how often the articles are usually about the same few departments.  I can also do a search and find lots of private/other type services that have problems.  As I said though, this doesn't prove anything about either one, except that in ANY type of service, there will be good ones, and bad ones out there.  (I know, I know, sucks to admit, but there it is)


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## JPINFV (Oct 8, 2008)

Triemal, how many systems openly brag about their short comings though? Similarly, this isn't LaCo Fire or City of LA Fire issue. Those treatment policies are a standard for ALL paramedic agencies in LaCo, regardless of if they are fire departments and private companies. It's an entire region (and I'll throw in Orange County's emergency medical system as well because there are tons of stupidity there too). Furthermore, pointing out mistakes on an individual level is a non-seqitor. It doesn't matter how good or bad a provider is if they are handcuffed to such a low level that they don't actually have to draw any conclusions about their patient. The machine does it for them and the system administrators are proud about it. Granted, though, most of the emergency medical responses in La Co (and all in OC) are through the fire department. This is not an individual department that's screwed up, it's an entire region. A region dominated by EMS based fire suppression. 

As far as IAFC dictating policy, you're right, they don't dictate local policy. Of course the National Scope of Practice isn't a local policy either. Besides, your side stepping that one of the major problems with EMS is the abysmal, almost non-existent, education requirements that the IAFC was opposing. Honest question, how many fire departments require all of their paramedics to have an associates degree or higher education in paramedicine? I doubt many, if any at all, do. 

Of course why stick with So Cal. We could always bring Collier County. You know, the place making waves because the fire medics failed a pharmacology exam forcing the medical director to reduce their role to the level of EMT-Bs. If the fire fighters truly cared about patients, they would have passed the exam. After all, they had a month to study for it. Instead they are openly protesting that the medical director is no longer allowing them to put the public at risk.


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## triemal04 (Oct 8, 2008)

I don't know if I'd call that bragging or not, but regardless...I suppose since those poor standards include private ambulances as well, based on your way of thinking (as your posts show) I can be safe in believing that all privates are poor providers...since there are those that can only rely on a machine to interrpret ecg's for them.  Of course that'd be wrong, but oh well.

I didn't think you'd be able to see the point of the link; but to be blunt:  there will be good fire department run ambulances and bad, just like every other kind.  The problem you have (especially here) is that you used one example from an area that is horrible at EMS (apparently at all levels and kinds) to justify saying that ALL fire-based EMS is bad.  Would have thought you'd know better.  Edit:  it ends up being the choice of the individual departments like it will be of the individual; do we maintain high standards, or allow them to become lax?  Like with an individual:  do I allow my standards to drop because my service says I can, or do I maintain them at as high a level as possible?

Poor education requirements for fire departments?  How many privates require associates degrees?  How many services period accept a paramedic no matter where they were trained?  That's a hollow arguement there.  (and every fire department in Oregon requires an associates...weird how when that's the standard it get's followed...and weird how it's possible for that to become standard even though the big bad IAFC says don't do that)

Feel free to bring up Collier (though it was only 1 department that actually failed the pharmocology exam), it still shows that you are unable to grasp this simple premise:


> I can do a quick search and find lots of problem fire departments where EMS is concerned...funny how often the articles are usually about the same few departments. I can also do a search and find lots of private/other type services that have problems. As I said though, this doesn't prove anything about either one, except that in ANY type of service, there will be good ones, and bad ones out there. (I know, I know, sucks to admit, but there it is)


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## marineman (Oct 9, 2008)

reaper said:


> You are kidding on that statement, I hope. That is the most ridiculous thing I have ever heard of. So if an asthmatic is on O2 when you arrive, you stop O2 for 3-5 minutes to determine if they really need it?



Sadly there is no joke involved. I do not agree at all with it and you can take a guess at how often we follow that particular protocol but that is what it says and that is why ALS engines in my coverage area would not be beneficial.


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## FFMedic1911 (Oct 9, 2008)

So if the pt. is intubated you pull the tube and wait 3-5 so you can get vitals.Your protocols suck.
PS. Thanks for helping me to remember to read slow.I'am a hose jockey and as such very stupid.


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## Flight-LP (Oct 9, 2008)

FFMedic1911 said:


> So if the pt. is intubated you pull the tube and wait 3-5 so you can get vitals.Your protocols suck.
> PS. Thanks for helping me to remember to read slow.I'am a hose jockey and as such very stupid.



You either need some self esteem or a better technique for sarcasm, that was lame..........


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## FFMedic1911 (Oct 9, 2008)

Thanks flight! I'am trying.This is hard stuff.I married a nurse hoping one day I could become great.Maybe between her and your posts I will reach my goals.


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## Jeremy89 (Oct 14, 2008)

Not sure how everything works in everyone's respective EMS systems, but here we dispatch an engine and rescue at the same time.  Usually the engine gets there first, but I've seen a rescue respond, begin treatment, then 5 mins later, the Fire Dept rolls up, which seems somewhat pointless to me but I guess its protocol around here.

What _should_ happen first?  I think the current system we have in place works fine.  If fire shows up first, they can begin pt treatment and even cxl a rescue in route, so as to not waste resources.


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## mbcwgrl (Oct 15, 2008)

Well... Where I work Fire and EMS get toned at the same time... We all go "together" I work for a private service and most FD's that we run with are city. We have come to work together and have Fire's radio in our dispatch center. (Fire has ours as well, although I dont think they listen to them). If you cant change how things are dispatched and one HAS to go before the other... I say EMS. (unless there is a fire or immediate HAZMAT situation). Where I work all EMS have some (and some have alot) of training in stabalizing a scene and extricating victims. I am a firm believer of working together but when agencies refuse to, you still need to do whats best for the pt(s). Rapid medical intervention would be the best for any pt regardless if it injury or illness.


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## sabbymedic (Oct 17, 2008)

I work in Ottawa Canada and our policy is to send Fire on most if not all collisions. The reason behind this is in the event that someone is trapped or there is fluid or fire you have the proper agency on scene to deal with such an emergency.

We are all dispatched through different centres meaning that 911 gives the call to the appropriate dispatch centre. The units responding are enroute fairly quick for all agencies responding.


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## knxemt1983 (Oct 18, 2008)

slawson said:


> Just to clear it up - you think if fire can get there sooner - roll fire first or did I just selectively interpret that? haha
> 
> Thanks...



so why come here and ask our opinions if you already have your mind made up?

there is not really a debate here. we deal witht eh emergency at hand, there is not that much of a danger to the general public in the 2 minutes it takes to get both departments rolling. ever thought of a 3-way calling system so both agencies can be notified at the same time.


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## Desert Ranger (Oct 18, 2008)

Our protocols in the National Park I work in are that all incidents involving motor vehicles will have both fire and ems personnel on scene. It can take up to two hours for either to arrive depending on where the incident occurs. Just because there is no fire in the vehicle, doesn't mean the possibility doesn't exist.


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## wolfwyndd (Oct 21, 2008)

We are all (probably) going to have differing opinions on how this should be handled due to various jurisdictions working differently.  

In the jurisdiction that I live (and work) we dispatch fire and EMS at the same time for an MVA.  Response times for both fire and EMS can take up to 10 minutes, seriously, depending on how far out on the country roads the MVA happened.  Of the three fire stations we have in our township, only ONE of them has full timers and that's only M - F 8am - 5pm.  Our ONE EMS Squad is one full time crew 24/7/365 so most of the time EMS gets there first.  EMS gives a general scene size up but usually doesn't cancel fire even if there is no fire / extrication / whatever needed because our EMS uses fire for scene safety and traffic control and clean up.  Oh, and let's not forget the cutting of the battery cable.  Whether air bags have deployed or not, the vehicle still needs to be de-energized and stabilized.  Police?  Oh, they'll show up eventually, but unless they are chasing the vehicle that was involved in the accident, they're usually the LAST to show up.


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## Anomalous (Oct 21, 2008)

Hastings said:


> I enjoy having the FD or PD on scene before I arrive for the reasons you listed in the original post.
> 
> 1. Scene safety.
> 2. Extrication.
> ...



Sounds great.  How do you get them to do 2,3 and 4?  They are always willing to help lift though.


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## Hal9000 (Oct 22, 2008)

I like to have fire and PD on scene for MVAs.  I had one MVA where a crewmember almost got taken out by some maniac because there was no one for traffic control.  The dispatcher said she'd sent a SO, but he was 20 minutes out.  So I got on the radio and w/i 4 minutes we had two engines to help with traffic.  

I like help, as long as it isn't just some Joe Blow there for excitement.  Some care is better than none; highest level of care always.


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## himynameismj (Oct 22, 2008)

I can't believe this is going on for so long. Try this one.. train your dispatchers to know when he should need to call both at the same time. The winner of the race can always cancel the other if need so be.


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## Mercy4Angels (Nov 2, 2008)

EMS last - you wanna get killed or blown up ? if we get hurt then how can we help anyone else


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## medic417 (Nov 2, 2008)

Yup blue canarys and red robbins can let you know how far away to stage.


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## reaper (Nov 2, 2008)

Mercy4Angels said:


> EMS last - you wanna get killed or blown up ? if we get hurt then how can we help anyone else



Yep, cause god knows us EMS people can't identify a danger!


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## JonTullos (Nov 3, 2008)

When I worked at my county's 911 dispatch center, we almost always dispatched fire first.  Reason was because the fire department could almost always get to the patient first.  All of the firefighters in the city are required to obtain NREMT-B cert. and the county firefighters are "strongly encouraged" to obtain MFR cert.  Therefore, so the theory went, the FF's could get there, do assessments and get the patient as prepared as possible for transport.  The EMS seemed to prefer it this way as they felt it made their jobs easier when they reached the scene.  Plus, if the FD is automatically there in most cases, they have more help in lifting the patient and getting equipment from the rig.


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## Canadian_EMT (Nov 4, 2008)

Medics first always. 90% of the time fire gets cancelled and if for some reason they beat us there, we have 20 other people walking around looking for stuff to do. Don't get me wrong, when fire is needed, they are great to have, but if they are not, go back to bed


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## rr22705 (Nov 4, 2008)

Fire and Emt should be dispatched at the same time, they are not in a competition, but should be working together to save lives.


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## LucidResq (Nov 4, 2008)

rmellish said:


> Its all situational. At the rural county service I run with Fire is only dispatched when there is a possible hazmat, 10-50, or fire in the city. EMD also dispatches them as manpower for known or suspected cardiac arrests. Police are dispatched for "Life Alert" tags in case forcible entry needs to be made into a residence.
> 
> In the outlying county vollie FD is dispatched as first response due to longer response times.
> 
> Ideally the decision to dispatch fire should be made on a case by case basis. EMS should be notified first on EMS calls.





himynameismj said:


> I can't believe this is going on for so long. Try this one.. train your dispatchers to know when he should need to call both at the same time. The winner of the race can always cancel the other if need so be.



EXACTLY. 

It doesn't make sense to make such a broad generalization when there are such a wide variety of fire, EMS and rescue agency set-ups out there in such a wide variety of settings. Furthermore, each individual agency will face such a wide variety of incidents in which a wide variety of factors such as the nature of the call, available resources, hell - even the weather, are at play. 

In some systems and circumstances it's better to send one over the other. In others, it's better to only send one and reserve the other if needed. Obviously preserving life is of the highest priority for both EMS and fire, and each has their own set of trained personnel, equipment and skills intended to save lives. Isn't it in the patient's best interest to get over the immature rivalry and bickering and just recognize the value of the other side in working towards a common goal? 

There isn't much even the most skilled paramedic in the world can do for a patient who's on fire or completely inaccessible, and likewise, once the flames are out or the patient is freed, the firefighter's life-saving tools aren't so life-saving anymore. 

So my answer to the OP is neither "fire" or "EMS", it's cohesive dispatch systems with well-trained, efficient dispatchers and the building of a unified public safety community that fosters cooperation, not competition.


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## JPINFV (Nov 4, 2008)

What's amazing is the amount of people who saw the topic and completely failed to read the original poster's post. The question CAN'T be answered by saying "both at the same time" because the dispatch system at the OP's region isn't set up that way. In the end, we're talking about a minute or two difference which most likely won't affect the outcome in any meaningful way anyways. 

Similarly, for the "canary" or "ZOMG THE PaTiEnT mIgHt Be On FiRE!!1one" crowd, exactly how many calls have you been on where a viable patient was found to be actively burning when the first responding unit arrived on scene? The example given was an accident, but the theme of the tone of the post indicated all medical calls. Not all accidents require extrication tools (which, even after the patient is extricated, will still have to wait for EMS to be transported) and spontaneous human combustion is exceedingly rare. A structure fire call *is not* an EMS call.


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## Jeffrey_169 (Nov 12, 2008)

*I agree with you*

If fire is closer, and EMS is farther away, and both are needed (as suggessted by the MOI), then both should be dispatched at the same time. Before I moved here to go to school I practiced in an area for 6 years where standard protocal was to dispatch fire and EMS at the same time. 

Fire is an invaluable resource that can often make the diferance between life or death, esp. when speed is of the essence. Fire can extracate, provide more details of the scene, provide pt. assessment, packaging, hazard conttrol, etc. that can provide for a speedier transport for the pt. If EMS is still several minutes out, then fire has done you a great service. 

I don't understand why they wouldn't dispatch fire first if they are closer. That makes no sense to me. I am not judging yor service, but from what you are saying, I agree with you that fire should be dispatched either first, or at the least in rapid sucession.


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## Stephens248 (Nov 19, 2008)

In our city, this is a non issue.  FD is ALS, all paid on call are FF/EMT-B at a min.  All full time are FF/EMT-P with a min of 1 EMT-P on duty at station per each alpha rig in service.  Typically the alpha with medic will dispatch immediately.  In addition, our alphas also have the smaller extrication equipment on board.  We run our ambulatory service.  

Not saying other set up’s are inferior, obviously it’s a much smaller population than others posting here.  It’s just very interesting as a rookie to learn that every state/ county/ city, does things different.  If I never got into this profession, I would have had no idea where my EMS were coming from, I would just be glad to see flashing lights if I ever had to call for help.


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## Ryanpfd (Nov 19, 2008)

i believe EMS should always come first, I hear everyone saying they would rather be on a engine compared to a ambulance. I believe a house is replaceable. a person is not! I also believe fire apparatus should always fallow a ambulance for extra support. two EMTs cannot safely lift a 450lb patient.


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## JPINFV (Nov 19, 2008)

1. What does a house have to do with this thread?

2. Not every patient is 450 pounds. 
2.1 The hospital employees can always help move patients.


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## Mongoose (Nov 19, 2008)

Idk if I'm echoing every other post here or what...but personally I like to have a big@$$ engine angled behind me on any TC (MVA).  I'm from a huge metropolitan area. Holding c-spine by yourself, w/your rig parked in front of the TC, you can feel pretty isolated and exposed in the middle of a 9-lane boulevard w/a speed limit of 50mph. However that's about the only time I think FD is really needed, and I acknowledge that it varies from jurisdiction to jurisdiction.

In my county FD responds with EMS. We are toned out simultaneously by state patrol, and I'd say I'm first on scene about 50% of the time. I think ALS should be delegated to the ambulance. Typically county FD provides ALS out here, but one day I was 1-and-1 staffed w/a medic on a designated IFT car. That particular day we were put into the 911 system and got a call for cp. We showed up seven minutes before county FD ALS to an active AMI. When FD got there we were already headed out the door w/a saline lock, nitro, lidocain, and a completed 12-lead. If I had been on my usual BLS shift the only thing I would have been able to do is O2, POC, assist w/nitro, and monitor vitals every 5min while nervously toying with the AED.

Yeah there's always the chance that FD could show up first and be waiting on EMS ALS to arrive, so if fire insisted on responding to all EMS calls, why not keep the county medics and have them work in conjunction with our medics? If they assume patient care up to and including transport to the hospital then they can ride with us (like if they are first on by a significant margin), if not they can assist and be dismissed. The only reason I suggest that is because logistically and politically it would be nearly impossible to suddenly ground all the county medics. I'm also not saying it would be the right decision, it'd just be nice if both could work together.

Yeah...my $0.02 worth, sorry if it's not really comprehensible, I'm tired.


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## EMTinNEPA (Nov 19, 2008)

JPINFV said:


> A structure fire call *is not* an EMS call.



Working structure fires in this county get an ALS rig for rehab.  I know, it DOESN'T make much sense, does it?


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## EMTinNEPA (Nov 19, 2008)

Let me preface this post with the following statement: I am the most militant FD/EMS separatist in the history of mankind.

Now that we've got THAT out of the way...

When there's a structure fire, the FD does its job, and what do we do?  Rehab.  An MVA is an EMS call.  The patient needs EMS.  Patient won't always need the Bucket Brigade.  Just like a structure fire won't always need rehab.

Bottom line: EMS gets dispatched first because it is an EMS call.  GET OVER IT.


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## Ryanpfd (Nov 19, 2008)

JPINFV said:


> 1. What does a house have to do with this thread?
> 
> 2. Not every patient is 450 pounds.
> 2.1 The hospital employees can always help move patients.



This has alot to do with this thread. Engines are a big help to EMS personal on scene, on scene the hospital employees cannot help you. Because atleast where im from the hospital staff....is busy in the HOSPITAL and are not going to show up on scene. When Im dispatched to the scene Im not told the patients size so in the common case of having a heavy set patient i like haveing atleast three poeple to help move them for those more bulky patients. I also agree the big red engine is very comforting on at a MVA.


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## JPINFV (Nov 19, 2008)

EMTinNEPA said:


> Working structure fires in this county get an ALS rig for rehab.  I know, it DOESN'T make much sense, does it?



Never mind, missed the second post.


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## JPINFV (Nov 19, 2008)

Do people forget what they actually post? By the way, you still haven't answered what a _*HOUSE*_ has to do with this thread. 



Ryanpfd said:


> This has alot to do with this thread. Engines are a big help to EMS personal on scene, on scene the hospital employees cannot help you. Because atleast where im from the hospital staff....is busy in the HOSPITAL and are not going to show up on scene. When Im dispatched to the scene Im not told the patients size so in the common case of having a heavy set patient i like haveing atleast three poeple to help move them for those more bulky patients. I also agree the big red engine is very comforting on at a MVA.






> I believe a house is replaceable. a person is not!


If the house is on fire, it's primarily a fire department call, and thus out of the scope of this thread. Last time I checked, houses don't get sick and need the service of an ambulance. They do catch fire, but this thread isn't about building on fire.



> I also believe fire apparatus should always fallow a ambulance for extra support. two EMTs cannot safely lift a 450lb patient.



How in God's holy name is that supposed to be interpreted as helping on scene? Where the hell else besides the hospital is the fire engine going to follow the ambulance?


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## Ryanpfd (Nov 19, 2008)

JPINFV said:


> Do people forget what they actually post? By the way, you still haven't answered what a _*HOUSE*_ has to do with this thread.
> 
> 
> 
> ...



OK lets put it this way, Both should be dispatched at the same time. In my district fire apparatus is automatic to any call whether it is EMS or fire. a house doesnt get sick. But at some fire scenes EMS help may be needed. a engine will follow a ambulance to the scene and return to the station once the ambulance is on its way to the hospital. This thread is about what should come first? EMS or Fire right? well fire doubles about every thirty seconds if i remember my fire one training. By the time the first engine gets thier is normaly about five to seven minuites but that changes on your district. also it takes a few minuites to go through dispatch. I called 911 yesterday to get extra personal to my fire dept for a medical transport i was on the phone w. 911 for about three minutes. thats alot of time that fire will spread. And Im still confused where you stand anyway? I think you just LOVE to argue :wacko:


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## JPINFV (Nov 19, 2008)

This is about which should come first on an accident or medical call, not a fire call. Furthermore, this thread is about which should come first when you can't dispatch both at the exact same time. Did you even read the original post or just look at the title? At no time did the original poster even refer to a structure fire.


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