# Boston Globe: Should the FD respond to medicals?



## medicdan (Jan 23, 2009)

> The massive 42-foot ladder truck, with its 110-foot rear-mounted ladder and 500-gallon water tank, was designed for fighting raging fires and plucking people from burning buildings. But on its recent fatal run, Ladder 26 was on a more pedestrian duty: a medical call for a man having difficulty breathing.
> 
> In recent years, such calls have become commonplace for fire departments across the Commonwealth. And firefighters, who receive far fewer calls for fires than they did a generation ago, have welcomed the work. With a declining number of fires to fight nationwide, the medical runs have helped to keep fire departments busy and boost sagging call numbers. Last year, medical calls accounted for 37 percent of the 70,176 runs made by Boston firefighters.



http://www.boston.com/news/local/ma..._dept_defends_using_trucks_for_medical_calls/

There was an LODD in Boston two weeks ago after a brake failure on a Boston Fire Ladder as it was clearing from a medical call. Recently, there has been increased scrutiny of BFD over their apparatus maintenance, staffing levels, and now Fire response to medical calls. 

I know this is a long, deep seated debate, but I want to bring up two new questions.

What role does a ladder have responding to a medical as opposed to an Engine responding? 

Boston boasts some very good revival statistics for SCA pre-hospital, and part of that strength is because they have a system response time of under 4 minutes. (~4 min FD, ~6min BLS, ~8min ALS). Clearly these good stats can be partially attributed to FD's response. What IS the role of a FD in urban EMS? What about in these economic times?


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## JPINFV (Jan 23, 2009)

emt-student said:


> What role does a ladder have responding to a medical as opposed to an Engine responding?



Coming from a Southern California/EMS based fire suppression system, it seems like the ladder truck responds if the engine is already on another call.


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## medicdan (Jan 23, 2009)

> Each firehouse alternates the vehicles it sends on medical calls, MacDonald said. One month, the fire engine will answer medical calls. The next month, the ladder truck will respond. The goal, he explained, is making sure firefighters assigned to each truck use the EMT training they have received.



Quoted from above article.


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## imurphy (Jan 23, 2009)

Well there are three reasons why FD are dispatched to medical assist as far as I see

1. To keep their EMT skills in use

2. If they were only sent to fire / Rescue there would be SO much sitting around doing nothing. 

3. If the city noticed so much sitting around doing nothing, budgets could be cut. Harsh, but unfortunate fact.


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## karaya (Jan 23, 2009)

You forgot the unions!!  The IAFF has pushed a great deal of resources for the past decade into getting fire to take over EMS.  Of course their logic is simple; more calls mean more money.

Many of the departments around me have tried several times for tax increase based on the fact they are running more calls.   But what they didn't tell the taxpayers is that nearly 70% of their calls are now EMS in which they respond a truck along with the county EMS provider.   What a waste of tax dollars and unnecessary wear and tear on $500,000 pumpers and million dollar ladder trucks.  Most of the time they spend just getting the stretcher for the medics.


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## Tincanfireman (Jan 23, 2009)

This is an age-old debate in the fire world, and most of the time it comes down to money. EMS Division wants more people, $$$, equipment, and funding due to a rapidly increasing call volume caused by an aging population, increased violent crime rate, overwhelmed transportation infrastructure, and other factors. The City Manager has a dwindling pot of resources, but a paid fire suppression division with a declining fire response volume due to improved codes, increased use of sprinklers, better construction standards, and so on. City Manager elects to utilize the FD as a means to get trained personnel to the taxpayers in less time, thus assuring his re-election by showing how fiscally responsible he is and how he has lowered response times (neglecting to mention that transport times have actually increased because the ambulances are running on rubber bands and JB Weld). Ladder trucks are utilized because they are rarely needed for their intended and designed purpose (i.e. rescuing people from 10th story windows and/or depositing hundreds of thousands of gallons of water on burning structures). In addition, the ladder companies are traditionally oriented towards rescue and have a greater crew experience level on shoring, extrication, etc. Besides that, ladder trucks usually have a tremendous amount of space for hydraulic rescue equipment, cribbing, shoring, backboards, and the like. City fathers don't like to see a $500,000 investment constantly sitting in the firehouse, either. They usually prefer to see the equipment on the streets, US flag flying in the breeze as it responds to another emergency. It demonstrates to the constituency that We Care About Our Citizens and We Are Doing Everything We Can In These Tough Times. The problem in Boston was that the truck wasn't maintained properly (7 *months* past the last manufacturer recommended 90 day brake inspection) and that maintenance requests and write ups on the brakes had been deferred due to funding. Now, on my "fire hat" days I thoroughly enjoy helping out my EMS brethren and sisters at an incident. By the same token, on my EMS duty days I am always glad to see the engine or ladder pull up and offer their assistance. Please don't think for a minute that I'm taking sides in this; I'm simply trying to explain why fire trucks show up at medical emergencies. As for what I have written above, keep in mind this is one facet of about a million different ways of comingling fire and EMS responses. I'm never gonna say I'm an expert on any of this stuff, it's just one perspective from the cheap seats, from a joint fire officer and EMS provider's viewpoint.


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## firecoins (Jan 23, 2009)

In NYC an engine responds in the same fashion as Boston. Most of the time it is a waste.  There are enough cases where we need the hands carrying patients down several flights of stairs in non-elevator buildings.  That tends to  happen in NYC and Boston as well I assume.


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## A36 (Jan 23, 2009)

How about fly-cars? Of course, then the issue is who staffs them. That and who's paying for them.


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## firecoins (Jan 23, 2009)

A36 said:


> How about fly-cars? Of course, then the issue is who staffs them. That and who's paying for them.



we are talking about firefighters? Right?  No firefighters should not be responding in fly cars to medical emergencies.


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## Sasha (Jan 23, 2009)

firecoins said:


> we are talking about firefighters? Right?  No firefighters should not be responding in fly cars to medical emergencies.



If they're Medics and EMTs, then why not?


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## firecoins (Jan 24, 2009)

Sasha said:


> If they're Medics and EMTs, then why not?



there is almost no point to an EMT flycar.  There is no point to the engines responding and they have emts on them.  They are good for lifting and moving if needed.  

The FDNY fire side is not allowed to operate at an ALS level even if they are trained as a medic.  I don't know what the Boston FD is like.


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## medicdan (Jan 24, 2009)

Boston FD only responds to "serious" EMS calls-- cardiac arrest, diff breathing, major MVAs, etc, or sometimes if an EMS unit is far away, FD will be dispatched. 

I dont accept the reasoning that its okay to put 1/2 a million dollar apparatus on the streets so the FFs can "Maintain their EMT skills", whats the chance they are going to have real patient care?


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## A36 (Jan 24, 2009)

firecoins said:


> there is almost no point to an EMT flycar.  There is no point to the engines responding and they have emts on them.  They are good for lifting and moving if needed.
> 
> The FDNY fire side is not allowed to operate at an ALS level even if they are trained as a medic.  I don't know what the Boston FD is like.



AFAIK Boston FD operates on a BLS level. I have no problem having FD doing first response on medicals. If it's gonna take the transporting ambulance 10 minutes to get on scene and the FD can be there in 1, the FD can stabilize the pt, get PMH, meds, demos, and help the ambulance crew get the pt transported faster. My argument for the fly cars is why send an engine when you can send something that isn't gonna block the entire street, which happens quite a bit in Boston.


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## Shishkabob (Jan 24, 2009)

Here in Fort Worth, the private 911 responds to all calls from Priority 3 (nothing) to Priority 1 (life threats)

Fort Worth FD responds to Priority 1's and 2's as they are generally closer then the nearest ambulance.  When the ambulance arrives, they send FD on their way back to bed unless they need lift help or it's serious.


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## mikeN (Jan 25, 2009)

I've seen Boston Ems trucks beat Boston fire to calls. Bfd does not transport but typically fire be on scene first to initiate care.


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## AusMed (Jan 27, 2009)

This is an issue that is currently being debated on the ground in my home state.
There is currently a fair bit of tension between Fire and EMS due to what has been happening over the last 12 months, and this being brought up isn't helping things.
I can definately see the benefits to it for life threatening cases, as long as they are appropriately trained, have appropriate equipment and have *continual *training.


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## FF894 (Jan 27, 2009)

Fire departments nationwide responded to 1.64 million fire calls in 2006, compared with 2.98 million in 1980, a 44 percent decline, according to the Quincy-based National Fire Protection Association. But at the same time, the association said, they went on more medical calls: from 5 million in 1980 to 15 million in 2006, a 200 percent increase.

Quote above is from article.  My question is if fire calls saw a 44% decline and EMS calls saw a 200% increase in the same time period, why do they still have more fire trucks than ambulances.  Wouldn't it make sense to reduce fire trucks and increase ambulances so the ambulances can be there first?  Seems pretty straight forward.


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## FF894 (Jan 27, 2009)

Fly cars for firefighters make no sense.  They need the apparatus for the potential next call.  If they leave the medical and there is a fire, it makes no sense to have to go back to the station to switch vehicles.  The apparatus can do both call profiles, a fly car can only do one.


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## JPINFV (Jan 27, 2009)

Since there's normally 3-4 fire fighters on an apparatus, wouldn't it make sense to send 2 fire fighters in a fly car and leave the 3rd and 4th back at station with the apparatus? If there is a fire call (and to be honest, that really is a big "if" now a days), then the entire crew can redevous at the fire.


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## triemal04 (Jan 27, 2009)

JPINFV said:


> Since there's normally 3-4 fire fighters on an apparatus, wouldn't it make sense to send 2 fire fighters in a fly car and leave the 3rd and 4th back at station with the apparatus? If there is a fire call (and to be honest, that really is a big "if" now a days), then the entire crew can redevous at the fire.


Nix on that.  Only way it would work is if the company was staffed with 5-6 people, and that's pretty damn rare these days.  If your idea were implemented, it wouldn't work; what happens when the flycar is at a medical and can't leave and the engine is needed?  Yes, eventually they can rendevous with each other, but the lag time between having an effective company, and one that would not be used (2 people is about worthless) would be problematic.  Of course, the same problem would come up if the entire company was at a medical...hence why an engine/truck should not be sent to every medical call.


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## mikeN (Jan 27, 2009)

Keep in mind, Boston Fire does not do PT transports.  
As for the fly cars, cross the river into cambridge and cambridge fire has 2 "fly cars" staffed by medics.  These are basically vans staffed by 2 medics with forcible entry equipment.  Cambridge as 2 rescue trucks but they mostly rely on ProEMS for most transports since they already have a high call volume for as it is.


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## A36 (Jan 28, 2009)

Transport was never my issue, but I can understand needing the apparatus if there's another call that requires it. We can scratch the fly cars then.

Boston EMS used to run cars staffed with an EMT and a police officer (this is a LONG time ago) to go to scenes and determine the appropriate level of response. After BPD took their officers out, the lone EMTs were getting assaulted and that ended that program. Don't think that's going to work either.


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## mikeN (Jan 28, 2009)

Boston Ems having police ride along makes sense given some areas. Boston Ems gets self defense lessons in the academy and after graduation you get a bullet proof vest and handcuffs.


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## firecoins (Jan 28, 2009)

FF894 said:


> Quote above is from article.  My question is if fire calls saw a 44% decline and EMS calls saw a 200% increase in the same time period, why do they still have more fire trucks than ambulances.  Wouldn't it make sense to reduce fire trucks and increase ambulances so the ambulances can be there first?  Seems pretty straight forward.


Things like 9/11.  When an firefighter dies,  we see the funeral, aparade etc  You might get a quick blurb about an EMS workers if anything.


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