# DC Firefighters whine about name change.



## Aidey

> And while publicly firefighters grumble about the cost of new shirts,  hats, and jackets, which they pay out of pocket for, privately -  they're more upset about a brand that says "FEMS,” which some might  construe as less than flattering.
> 
> 
> "I won't wear it!" said one sergeant who didn't want to be named.
> 
> 
> He does have the option of wearing his dress uniform shirt instead.
> 
> 
> "A  patch is a logo, a patch is an image, a patch represents the team that  you play for and if that changes to something you don't like or respect,  that's a big deal," adds Farren.



http://www.myfoxdc.com/dpp/news/dc/some-firefighters-unhappy-with-dc-fire-and-ems-rebranding-032911

Would it be wrong to tell the DC firefighters to STFU?


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## Veneficus

I think the obvious solution is to remove EMS from the DCFD. 

Not just on the patch.


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## Minnick27

Man, they are whining like a bunch of girls!


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## BLSBoy

Aidey said:


> Would it be wrong to tell the DC firefighters to STFU?



Yes. They have not had a raise in 5 years, and now the admin is gonna blow 100s of thousands of dollars on patches, stickers, decals and the man hours to replace them. Further, "FEMS" is a horrible acronym, and it goes on to kill decades upon decades of tradition. While I am one who is ALL for progress, this is insanity. 
Finally, do you work for DCFD? Who are you to judge them and what they want? If anyone needs to "STFU", it would be you.


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## Aidey

Veneficus said:


> I think the obvious solution is to remove EMS from the DCFD.
> 
> Not just on the patch.



No kidding. I do not want people providing medical care that are that delusional about their own self importance. Not that that isn't a problem elsewhere, DC just makes an art form out of it.


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## dixie_flatline

This is entirely political (obviously).  It stems from the Rosenbaum murder back in 2006.  Prominent writer/editor from the New York Times was robbed in NW DC.  An ambo took 20+ minutes to arrive in a nice area of town, and he was deemed drunk by the responding crew and transported low priority to a distant hospital (20+ more minutes).  Waited over an hour to be seen, until he started vomiting and the hospital staff finally realized his brains had been beaten in with a steel pipe.  In lieu of filing a huge suit, the family agreed to a task force charged with auditing/evaluating the district's EMS structure top-to-bottom.  

This re-branding seems like little more than a token gesture to show that they really do take EMS seriously in the Fire Department now.  And yeah, FEMS might not be as "cool" as DCFD on the back of your manly tshirt, but the real gripe is the one echoed by BLSBoy - my neighbor is a DC firefighter and they haven't had a raise in years.  Now they're watching the department (who didn't ask the union for any input) unilaterally decide to spend the money to re-brand every uniform, vehicle, and piece of equipment in the district.


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## PotatoMedic

Veneficus said:


> I think the obvious solution is to remove EMS from the DCFD.
> 
> Not just on the patch.



I think the obvious solution is to dissolve DC"fire" and start from scratch.  That place is a total cluster.


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## 46Young

Numer one, yes, they haven't had a raise in years, and they're also fighting against being moved from a four platoon schedule to a three platoon schedule, which will save the city money, but also extend their work hours from 42 to 56. DC is way to busy to have a 24/48 variant. Like others said, if money's really that tight, then now's not the time to worry about logos and patches. 

Number two, I was watching the story on Fox5 last night, and it was reported that the employees would have to purchase clothing out of their own pockets if this change is put into effect. 

"DC Emergency Services" or something similar would have been a better choice. The average layperson won't know what "FEMS" stands for, so it's a poor choice of an acronym. It sounds like a name for a female softball team or bowling league.

My county says "Fire and Rescue." Alexandria says "Fire and EMS." Nothing wrong with either one. FEMS is an acronym no one has ever heard of, and defeats the purpose of a citizen being able to identify who you are and what your function is. Does FEMS mean federal something or other? Why are the feds in my hallway? Is there a raid going on?


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## Farmer2DO

BLSBoy said:


> Yes. They have not had a raise in 5 years, and now the admin is gonna blow 100s of thousands of dollars on patches, stickers, decals and the man hours to replace them. Further, "FEMS" is a horrible acronym, and it goes on to kill decades upon decades of tradition. While I am one who is ALL for progress, this is insanity.
> Finally, do you work for DCFD? Who are you to judge them and what they want? If anyone needs to "STFU", it would be you.



Really?  That's how we address people on this forum?  You don't need to agree with everything everyone else says.  If you did, it would be a boring place.  You can, however, treat other people and their opinions with a bit of respect, even if they don't agree with yours.

I personally agree with Aidey.  While this may not be the most opportune time to be spending money to change all of this over, big f***ing deal!  They once again prove that EMS is the red headed step child.  

And, hundreds of thousands of dollars?  Where did that come from, because I didn't see that anywhere in the article.

As for the pay raise in 5 years and paying for their own uniform shirts, cry me a river.  Let's compare that to paramedics who run more calls, have more knowledge of medicine (and don't be fooled; DCFD took on EMS to justify their existence with call volume), are treated like second class citizens in many areas, and generally don't get anywhere near the benefits packages that FFs do.  They have civil service jobs that are untion protected with retirement packages, and all of that is better than most people get that work their butts off in EMS.  Has anyone noticed that we're in a recession?  Private industry is laying people off, and the people that get to keep their jobs are not getting raises, or are getting pay cuts.  So what makes the FFs think they are entitled to MORE taxpayer money?  Union mentality at its best.  

There is an option to wear a dress uniform shirt instead, so yes, they don't have to buy their own shirts if they don't want to.  

"I won't wear it!"  I can just picture this seargent, laying on the floor, fists bunched, flailing his arms back and forth in a full blown temper tantrum to make a 3 year old proud.  Grow up.

As for the union members not getting any input?  Who cares?  Again, in the private sector, people realize that management gets to make these decisions without having to kiss the rear ends of the employees.  Ever think that management may have different goals than the employees?  Like not getting sued because of the incompetence of your agency causing the death of someone with enough money and influence to do something about it?  

Did anyone ask the EMS employees what they thought about finally being included?  Maybe they think it's a good thing.  Oh yeah, Fire doesn't care what EMS thinks.

So yeah, DC Firefighters.....STFU.


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## Farmer2DO

46Young said:


> Numer one, yes, they haven't had a raise in years, and they're also fighting against being moved from a four platoon schedule to a three platoon schedule, which will save the city money, but also extend their work hours from 42 to 56. DC is way to busy to have a 24/48 variant. Like others said, if money's really that tight, then now's not the time to worry about logos and patches.
> 
> Number two, I was watching the story on Fox5 last night, and it was reported that the employees would have to purchase clothing out of their own pockets if this change is put into effect.
> 
> "DC Emergency Services" or something similar would have been a better choice. The average layperson won't know what "FEMS" stands for, so it's a poor choice of an acronym. It sounds like a name for a female softball team or bowling league.
> 
> My county says "Fire and Rescue." Alexandria says "Fire and EMS." Nothing wrong with either one. FEMS is an acronym no one has ever heard of, and defeats the purpose of a citizen being able to identify who you are and what your function is. Does FEMS mean federal something or other? Why are the feds in my hallway? Is there a raid going on?



As was pointed out earlier, if your spouse is in cardiac arrest, or your house is on fire, I don't really think you're going to care about what the decals say.

Not going to know what agency is there?  You mean the big red truck with guys in turnout gear jumping off and pumping water won't be a clue?  How about the big box, where they load people into the back and take them to the hospital?  I don't know about you, but that doesn't sound like the feds to me.

While I think going from a 42 hour work week to a 56 hour work week is a huge change, people need to remember that governments are on the verge of financial collapse.  Spending needs to be brough in line with revenue.  Period.  There is going to be some uncomfortable belt tightening.  Oh well.  would they prefer that 1/4 of the workforce have their jobs eliminated?


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## BLSBoy

Every Ambulance, Engine, Truck, Rescue Squad, Reserve apparatus, Chiefs car, supervisor vehicle, repair truck, etc, etc, etc now has to be taken in from the road, changeover needs to occur OR a company needs to be placed out of service so a freaking sticker can be placed on. Now factor in fuel costs, wear and tear on the vehicle, buying the stickers/decals, the cost in manpower which SHOULD be doing something else more productive. Easily tallies in the 100k mark. 
And cry me a friggin river about, "private EMS this, that, and everything else." Private EMS is a SCAB, and should be relegated to interfacility transports ONLY! I was a hospital based paramedic in South Jersey , running my tail off, working bad hours because management could make me do it. I worked nights where in 12hrs, we had 30+ dispatches for service, and was there until 1030am completing my charts. I CHOSE to move, become a Fire Based Paramedic (but not a FireMedic for this dept), take a 50% pay cut, and become union protected. 

Best of luck to DCFD.


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## usalsfyre

DC EMS sucks. It sucked when it was a third service, it sucks even worse under the FD. The place goes through medical directors like a Hugh Heffner goes through blondes. It is THE shining example of a fire and EMS merger gone wrong. From the FD side, the only thing EMS is good for is to justify budgets. EVERY DC firefighter I have ever spoken with speaks of EMS in derogatory terms. The only FD I've seen that is more anti-EMS is FDNY.

They may not have had an across the board raise in give years, but I can almost garuntee they're still getting step increases. As to being too busy to be on a three platoon system, how many runs would be eliminated by an adaquately staffed EMS division that didn't require first responder engines in every stinking call?

So, if you can't tell, I'm pretty damn unsympathetic to the "plight" of DCFD. They made their own bed, now they can lay in that bad boy.


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## usalsfyre

BLSBoy said:


> And cry me a friggin river about, "private EMS this, that, and everything else." Private EMS is a SCAB, and should be relegated to interfacility transports ONLY!


I had some respect for you until this. You sir, are the one who needs to shut up. The generalization of FD based EMS as good and private as bad is astounding. Did Marx help you form this opinion? I left a cushy fire-based job voluntarily because the medicine sucked and I was tired of listening to my coworkers bull scat. So I guess I'm a scab? Typical IAFF crap. 



BLSBoy said:


> I was a hospital based paramedic in South Jersey , running my tail off, working bad hours because management could make me do it. I worked nights where in 12hrs, we had 30+ dispatches for service, and was there until 1030am completing my charts. I CHOSE to move, become a Fire Based Paramedic (but not a FireMedic for this dept), take a 50% pay cut, and become union protected.
> 
> Best of luck to DCFD.


Good for you, hopefully your taxpayers are more understanding than most. My feeling is a whole crapload of public employees are about to learn what the real world's like. Good luck with having the benefits you were promised at hire come retirement.


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## BLSBoy

Ha! I am not IAFF at all. 
Our medicine does not "suck". Take a look at the CIRC study that was just concluded, we were one of the few depts chosen to participate in this international study. Our protocols are among some of the best in the state, are highly progressive, so please, do not tell me our medicine "sucks" until you know where I work, and my protocols. If you like, I can send you the newest version, I just got them in my email today. 
I worked private EMS, hospital based EMS, Fire based EMS as a Firefighter/EMT, and now, Fire based EMS as a paramedic only. Out of all of those, the PUBLIC based ones, aka Fire Based, were the ones where we were not working with shoddy equipment, not asked to engage in shady billing practices, we were not told "the customer comes first", when it was plain to all to see the almighty dollar comes first. 

I have seen both sides to the coin, and I have worked them both. I can not stand it when privates come in, low ball a bid, take over from the public provider (fire or EMS only), then whine about how high it is to provide care after they placed people out of a job. 

And do NOT place blame for the current economic crisis on us. How about we start cutting Medicade, welfare and foreign aid before we start cutting FD, PD, and EMS. I work for 11.50/hr so I have a well funded pension that will care for my needs when I retire.


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## Shishkabob

If momey/budget was such a big deal, as mamy FFs claim, then the logical solution is to disband the fire department into volunteer only, or a combo paid/volly, then put the momey saved in to a standalone EMS system, adequately funded and staffed.


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## usalsfyre

Funny, my current hospital based job has and has had massively better equipment than my last FD job, or any FD based transport in this area. What I'm saying is you can't generalize public=good, private=bad. Our medicine is light years ahead of my last FD job, but my first FD job was in the cutting edge. 

When did the "customer" (i.e. patient) coming first become a bad thing? 

The only place I have ever been asked to change a report so it was "easier to bill" had "Fire" in it's name. That's between two FDs and three private providers (one air, two ground).

I'm not blaming public employees for the budget crunch. I do actually hope you pension and other benefits are there come retirement time for you. A whole slew of people don't share my view though, and I would be fully prepared for that.

What REALLY pissed me off though was the description of me as a "scab" when there's not mire than 5 out of 100+ paramedics at my last FD I would trust to take care of my family. Those guys are the "scabs and scrubs" not a dedicated private service medic.


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## JPINFV

BLSBoy said:


> Every Ambulance, Engine, Truck, Rescue Squad, Reserve apparatus, Chiefs car, supervisor vehicle, repair truck, etc, etc, etc now has to be taken in from the road, changeover needs to occur OR a company needs to be placed out of service so a freaking sticker can be placed on. Now factor in fuel costs, wear and tear on the vehicle, buying the stickers/decals, the cost in manpower which SHOULD be doing something else more productive. Easily tallies in the 100k mark.


Yet we continue to send fire engines needlessly to medical calls hauling around tons of material that are absolutely not needed for a medical call. A simple squad car would be more efficient than putting all of that mileage on an engine or truck. Oh, but we're concerned about a one time trip down to the maintenance facility. That one trip doesn't hold a candle to all of the needless wear and tear put on the vehicles for medical aid calls. Of course this is also something that could be handled when the vehicle is in the shop for routine maintenance anyways.  



> And cry me a friggin river about, "private EMS this, that, and everything else." Private EMS is a SCAB, and should be relegated to interfacility transports ONLY!


I hope you, say, don't go to a private hospital, well, ever. Also, if private EMS is a scab, I can think of more interesting diseases to describe outfits like DC FEMS compared to 3rd government agencies. 



> I was a hospital based paramedic in South Jersey , running my tail off, working bad hours because management could make me do it. I worked nights where in 12hrs, we had 30+ dispatches for service, and was there until 1030am completing my charts. I CHOSE to move, become a Fire Based Paramedic (but not a FireMedic for this dept), take a 50% pay cut, and become union protected.



Because fire department ran EMS systems don't suffer from being overloaded with calls? 



> Best of luck to *DC FEMS*.


Fixed that for you.


On another note, shouldn't it be DC EMSF? Or, better yet. EMS and Irrigation. After all, how many fire departments call EMS "rescue" instead of its proper name? Irrigation seems to be the appropriate medical word for fire suppression. After all, what is fire suppression if not irrigating objects on fire?


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## 46Young

Farmer2DO said:


> As was pointed out earlier, if your spouse is in cardiac arrest, or your house is on fire, I don't really think you're going to care about what the decals say.
> 
> Not going to know what agency is there?  You mean the big red truck with guys in turnout gear jumping off and pumping water won't be a clue?  How about the big box, where they load people into the back and take them to the hospital?  I don't know about you, but that doesn't sound like the feds to me.
> 
> While I think going from a 42 hour work week to a 56 hour work week is a huge change, people need to remember that governments are on the verge of financial collapse.  Spending needs to be brough in line with revenue.  Period.  There is going to be some uncomfortable belt tightening.  Oh well.  would they prefer that 1/4 of the workforce have their jobs eliminated?




If the "BRT" is outside, and we're a couple of floors up inside the projects or an apartment complex, they can't see the truck or the bus unless they have x-ray vision. I speak from experience. I worked EMS in NYC for North Shore-LIJ, and also for Jamaica Hosp. The NS uniform was a dark blue shirt, just like the NYPD (we got our uniform from the same place that the NYPD does, and our shirts had a NYPD tag on the inside, so they really were the same shirts), the pants were the same color, and had a lighter blue stripe going down the side. We had an EMT or medic patch on one shoulder, and a small circular hospital patch on the other, nothing on the back. We looked like state troopers. The Jamaica uniforms were similar, but no stripe.

LEO's would get flower pots, bricks, and such dropped down at them from upper floors. The same happened to us. When walking through the halls, we'd get the occasional shoulder thrown into us as we're passing by. They know that if a cop fights back, they have to deal with Al Sharpton, right or wrong. Never mind walking into an apartment, and then a dispute begins. Not everyone read the small print on our uniforms. 

DC has no business going to a three platoon schedule, being as busy as they are. I worked down in SC for a busy EMS system, that were 24/48, no kelly's, and it was miserable. We were all worn out. DCFD's union has squashed the last few attempts, thank goodness. If they lay off 25% of their work force and ago to a 56 hour week, what kind of candidates do think they're going to get in the future? There are many well paying depts in the surrounding area, with better working conditions.

As far as unions. for all their faults, there's definitely something to be said for not having to just accept whatever admin wants to do. I've seen what it's like with no union down in the deep south. It's their way or the highway. No thanks. Ours is a good balance, I think. We're in a right to work state, we have no collective bargaining, but our political activity keeps things fair. If you want to rant about unions, there are several threads on this forum where your rants would be more appropriate. There are also numerous threads about fire based EMS, the read headed step child thing, call volume, etc. What you're saying has been repeated here ad nauseum. We don't need yet another fire bashing or union bashing thread.

One more thing, I agree that the DC FF's need to better embrace EMS, but I can understand how many don't want to do EMS there. I don't know of any depts in the area that have seperate fire and EMS. Philly is the closest, then there's NC. Their mindset is that they have to do EMS if they want to be FF's. There's no other way to be a FF, so they're going to take the job. It's like an EMT or medic that really wants to do EMS, but also has only dual role fire and EMS depts. They become FF's do that they can do municipal EMS. Several on this forum have said that they would work for a FD, even do the fire academy and training, if only they don't have to ride on suppression apparatus afterward. FF's more often than not have the same attitude, if you reverse the circumstances. I'm seeing the culture change with the newer hires, but these attitudes still exist. It's more so the older members that have the anti-EMS attitude. The newer, younger members have more often than not were raised seeing fire and EMS as a combined service, so they see the FF's job description including EMS as being normal, and one in the same.


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## JPINFV

BLSBoy said:


> Ha! I am not IAFF at all.
> Our medicine does not "suck". Take a look at the CIRC study that was just concluded, we were one of the few depts chosen to participate in this international study. Our protocols are among some of the best in the state, are highly progressive, so please, do not tell me our medicine "sucks" until you know where I work, and my protocols. If you like, I can send you the newest version, I just got them in my email today.


Yet you're generalizing all private based EMS outfits. 









> I worked private EMS, hospital based EMS, Fire based EMS as a Firefighter/EMT, and now, Fire based EMS as a paramedic only. Out of all of those, the PUBLIC based ones, aka Fire Based, were the ones where we were not working with shoddy equipment, not asked to engage in shady billing practices, we were not told "the customer comes first", when it was plain to all to see the almighty dollar comes first.



...and that's applicable for every place?

Oh, and "public" is not synonymous with "fire based." 



> I have seen both sides to the coin, and I have worked them both. I can not stand it when privates come in, low ball a bid, take over from the public provider (fire or EMS only), then whine about how high it is to provide care after they placed people out of a job.


So the public employees are entitled to those jobs for eternity? What about the private service employees that the public services put out of work? 



> And do NOT place blame for the current economic crisis on us. How about we start cutting Medicade, welfare and foreign aid before we start cutting FD, PD, and EMS. I work for 11.50/hr so I have a well funded pension that will care for my needs when I retire.


The Federal Government shouldn't be funding local services anyways. Division of government! How does it work? The constitution! How does it work?


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## Shishkabob

Theres a difference between someone being trusted with 60 different drugs who wants nothing to do with them, and someone being trusted with a charged hose who wants nothing to do with it.


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## JPINFV

Linuss said:


> Theres a difference between someone being trusted with 60 different drugs who wants nothing to do with them, and someone being trusted with a charged hose who wants nothing to do with it.



Actually, I'd argue that there's very little difference. If I was a fire fighter, I would not want the person who had my back to have zero interest in fire fighting. Similarly, if I'm a patient, I don't want the person administering drugs to me to have zero interest in EMS. Unfortunately, the people who have zero interest in EMS far outnumber the people who have zero interest in fire suppression at EMS based fire suppression services.


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## 46Young

BLSBoy said:


> Every Ambulance, Engine, Truck, Rescue Squad, Reserve apparatus, Chiefs car, supervisor vehicle, repair truck, etc, etc, etc now has to be taken in from the road, changeover needs to occur OR a company needs to be placed out of service so a freaking sticker can be placed on. Now factor in fuel costs, wear and tear on the vehicle, buying the stickers/decals, the cost in manpower which SHOULD be doing something else more productive. Easily tallies in the 100k mark.
> And cry me a friggin river about, "private EMS this, that, and everything else." Private EMS is a SCAB, and should be relegated to interfacility transports ONLY! I was a hospital based paramedic in South Jersey , running my tail off, working bad hours because management could make me do it. I worked nights where in 12hrs, we had 30+ dispatches for service, and was there until 1030am completing my charts. I CHOSE to move, become a Fire Based Paramedic (but not a FireMedic for this dept), take a 50% pay cut, and become union protected.
> 
> Best of luck to DCFD.



I agree that 911 EMS should be 100% municipal. You also don't see SSM in a fire based system, although you can see it with a third service PUM, such as RAA (Richmond).


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## 46Young

usalsfyre said:


> Funny, my current hospital based job has and has had massively better equipment than my last FD job, or any FD based transport in this area. What I'm saying is you can't generalize public=good, private=bad. Our medicine is light years ahead of my last FD job, but my first FD job was in the cutting edge.
> 
> When did the "customer" (i.e. patient) coming first become a bad thing?
> 
> The only place I have ever been asked to change a report so it was "easier to bill" had "Fire" in it's name. That's between two FDs and three private providers (one air, two ground).
> 
> I'm not blaming public employees for the budget crunch. I do actually hope you pension and other benefits are there come retirement time for you. A whole slew of people don't share my view though, and I would be fully prepared for that.
> 
> What REALLY pissed me off though was the description of me as a "scab" when there's not mire than 5 out of 100+ paramedics at my last FD I would trust to take care of my family. Those guys are the "scabs and scrubs" not a dedicated private service medic.



"Scab" is a little much. I have seen what happens when you have EMS provided by a for profit system (or a not for profit system, but it's still run like a business), though. I feel it's a conflict of interest when profit is involved.


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## 46Young

Linuss said:


> Theres a difference between someone being trusted with 60 different drugs who wants nothing to do with them, and someone being trusted with a charged hose who wants nothing to do with it.



Not really, someone can get killed either way.


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## usalsfyre

46Young said:


> "Scab" is a little much. I have seen what happens when you have EMS provided by a for profit system (or a not for profit system, but it's still run like a business), though. I feel it's a conflict of interest when profit is involved.



This is an organizational culture issue. Like I said, the last FD I worked at mentioned the "4 million we contribute towards the City budget" every time we had any kind of meeting with admin types. They also asked me on multiple occasions to come in and "change some wording so this will be easier to bill". Overtime was scrutinized, we ran short regularlly because "we haven't budgeted for the overtime". Vacation was revoked if someone else hot injured and put you over the max number that were allowed off.

Current job (not-for-profit hospital) ask only that I document accurately and completely and does not scour over OT.


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## Veneficus

wow,

This is all a really exciting conversation. That we all have had many times.

But are some radical thoughts.

Government employees should not be "entitled" to any higher pay than non government employees. You can argue social systems all you like, but the payroll and benefits of government workers far outstrip the private sector. 

So you cannot argue for reduction in government spending and disproportionate raises and benefits for government workers.

If you can do better than the government job, you should go there, but don't hold your breath. The government is not responsible for provding a better life and working conditions for you than you could get otherwise.

From what I have learned about DCFD, the responsible choice would be to go to BLS only and field more ambulances.

I was a firefighter, I realize the shortcomings of the fire service. It is why  left. But when arguing about call volume, it is a double edged sword. It takes manpower to fight fire. It takes lots of equipment initially, not in an hour from various mutual aid. Fire suppression is an essential service and it costs a lot.

Various political bodies over the years have decided to reduce funding for it in order to pay for more visible things that win votes. In many places this has left the fire service totally ineffective and simply a waste of what money is spent on it because it cannot effectively fulfill its mission.

Public will is just as responsible for the largely ineffective merging of fire/ems in many places. 

If you want good fire service and good EMS, you have to pay for it. Like insurance, hopefully you never need it. But you will be considerably dissapointed if you find yourself underinsured and do require it.  

If people want effective fire and super EMS, *if they don't want to pay for it*, they should STFU.

Changing decals and stationary is not as major of an expense as portrayed. Most private corperations in all aspects of industry pay for that out of already budgeted spending. It is also very finite spending. If it costs even a million dollars one time, that money would not sustain a pay raise for even one cycle in such a large department. It couldn't pay for the training, payroll, and benefits of 1 firefighter for 1 year. (which i might add is far more in cost than what a welfare recipient gets in a year) So if you are truly looking to save money, it is better to cut things more expensive right?


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## BLSBoy

JPINFV said:


> The Federal Government shouldn't be funding local services anyways. Division of government! How does it work? The constitution! How does it work?



No arguement here. FireACT, SAFER, etc, all that money should be kept at the local level. 
The STATES are required to provide a Medicade program. Out of a $70 billion dollar budget (roughly) in the state of Florida, (roughly) $20 billion will be going to Medicade. How could that money be spent better? Hmmmmmmmmmm.........


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## DesertMedic66

JPINFV said:


> Yet we continue to send fire engines needlessly to medical calls hauling around tons of material that are absolutely not needed for a medical call. A simple squad car would be more efficient than putting all of that mileage on an engine or truck.
> ?



not trying to start anything but as for my city this would not work. we have 3 firefighters on duty at all times. we have 2 engines and a squad unit. if we dedicated just using only the squad unit to go to medical calls then you would have to pay for at least 2 more firefighters on duty at all times as well as a new station for them to sleep at since ours only sleeps 4, and the firefighters here work 72 hours and sometimes get forced to do 96 hour shifts so they really need a place to sleep. so from what i see having an engine respond is alot cheaper then having a squad unit dedicated to running EMS calls.

and actually replacing all the decals would cost money. as for the engines here they would have to be repainted because its not just a decal. but you would have to most likely pay an engineer overtime to drive the engine to the shop. along with gas, mileage, and time. when we take a engine into the shop we take all the equipment out.


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## usalsfyre

firefite said:


> not trying to start anything but as for my city this would not work. we have 3 firefighters on duty at all times. we have 2 engines and a squad unit. if we dedicated just using only the squad unit to go to medical calls then you would have to pay for at least 2 more firefighters on duty at all times as well as a new station for them to sleep at since ours only sleeps 4, and the firefighters here work 72 hours and sometimes get forced to do 96 hour shifts so they really need a place to sleep. so from what i see having an engine respond is alot cheaper then having a squad unit dedicated to running EMS calls.
> 
> and actually replacing all the decals would cost money. as for the engines here they would have to be repainted because its not just a decal. but you would have to most likely pay an engineer overtime to drive the engine to the shop. along with gas, mileage, and time. when we take a engine into the shop we take all the equipment out.



Or the engine crew could single pull the squad and engine. Three is not enough to do interior attack anyway, so the "splitting the crew up" argument doesn't wash. And a decal could easily be placed over the existing painted insignia. FD's are going to start thinking outside the box, or staff will be cut.


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## DesertMedic66

usalsfyre said:


> Or the engine crew could single pull the squad and engine. And a decal could easily be placed over the existing painted insignia. FD's are going to start thinking outside the box, or staff will be cut.



what do you mean by single pull? and the decal wouldnt work in this area. our firefighters are content on keeping a clean engine and a decal on the would would be taken off really fast. the only decal we have on the engine is a MDA support decal. why have a nice paintjob with a clear coat just to slap on a cheap decal?


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## usalsfyre

Single pull means you run the apparatus as needed. Meaning squad for medicals, engine for fires and alarms, ect. The other truck, and prbly one person on medicals, is left behind to bring the other truck as needed.

As for the decal over the paint job? Cost savings. And if the decal cones off so they can "keep a clean engine"? Write up the whole shift for destroying property the first time it happens. The second time? People start examining their career options. Do I like it? Not really. But cost effecincy is going to be big in the near future. The post 9/11 honeymoon is over.


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## Veneficus

firefite said:


> what do you mean by single pull? and the decal wouldnt work in this area. our firefighters are content on keeping a clean engine and a decal on the would would be taken off really fast. the only decal we have on the engine is a MDA support decal. why have a nice paintjob with a clear coat just to slap on a cheap decal?



If you have time to clean off a decal, you don't see enough fire to buy a fire truck anyway.


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## DesertMedic66

usalsfyre said:


> Single pull means you run the apparatus as needed. Meaning squad for medicals, engine for fires and alarms, ect. The other truck, and prbly one person on medicals, is left behind to bring the other truck as needed.
> 
> As for the decal over the paint job? Cost savings. And if the decal cones off so they can "keep a clean engine"? Write up the whole shift for destroying property the first time it happens. The second time? People start examining their career options. Do I like it? Not really. But cost effecincy is going to be big in the near future. The post 9/11 honeymoon is over.



if your out on a medical call and a fire gets reported you would have to drive possibly across town to get the engine and then drive to the reported fire. and we never have 1 person working. the buddy system. and having 2 people on the engine isnt going to help. if only 2 firefighters on on scene of a fire and they need to make entry into the building its not possible. the engineer has to stay by the engine to control the pump. that would leave one firefighter to make entry. A rule is "2 in and 2 out". and then you would be leaving one person at the medical call. again the buddy system comes into play. i would not want to be the only person on a call.


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## DesertMedic66

Veneficus said:


> If you have time to clean off a decal, you don't see enough fire to buy a fire truck anyway.



my old station has gone 24 hours and 52 mins without a call. and then there are days when we would get pounded. we make time to attempt to wash the engine. we will have soap all over the engine and then get a call and have to quickly wash the soap off. the decals we have are on the inside of the windows so they stay clean. with the abuse some of the engines see the decal will not stay on. when we get back from a fire we wash all the equipment and the engine. we get alot of calls for fires during the summer because im in SoCal. but we still have time to wash and we definatly need an engine.


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## usalsfyre

firefite said:


> if your out on a medical call and a fire gets reported you would have to drive possibly across town to get the engine and then drive to the reported fire. and we never have 1 person working. the buddy system. and having 2 people on the engine isnt going to help. if only 2 firefighters on on scene of a fire and they need to make entry into the building its not possible. the engineer has to stay by the engine to control the pump. that would leave one firefighter to make entry. A rule is "2 in and 2 out". and then you would be leaving one person at the medical call. again the buddy system comes into play. i would not want to be the only person on a call.



How do you follow "two-in-two-out" (meaning two inside the IDLH atmosphere and two outside it ready to immediately render assistance, NOT "two go in, two go out")with a three person crew? Because with three person staffing you dang well better be a "squirt water through the window" FD unless you've got a life safety issue. And a car in the driveway isn't proof, especially if your dragging a line in and putting the fire out instead of making a rapid search.

So what happens now if the entire engine crew is across town on a medical? Do you abandon the patient to run the fire? You still have to drive across town right? How do you follow the "buddy system" with three firefighters? How do you set up incident command when your only outside person is assigned to another task?


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## DesertMedic66

usalsfyre said:


> How do you follow "two-in-two-out" (meaning two inside the IDLH atmosphere and two outside it ready to immediately render assistance, NOT "two go in, two go out")with a three person crew? Because with three person staffing you dang well better be a "squirt water through the window" FD unless you've got a life safety issue. And a car in the driveway isn't proof, especially if your dragging a line in and putting the fire out instead of making a rapid search.
> 
> So what happens now if the entire engine crew is across town on a medical? Do you abandon the patient to run the fire? You still have to drive across town right? How do you follow the "buddy system" with three firefighters? How do you set up incident command when your only outside person is assigned to another task?



by 2 in and 2 out i meant "2 go in and 2 come out". wel will have 2 firefighters gaining entry into the building as the 3rd firefighter who is the engineer stays outside and handles the pump and also takes over incident commander of the scene. as soon as the second engine arrives on scene they are the RIC team "rapid intervention crew". as soon as a reported fire gets reported we automatically send out 3 engines. if we are on a medical call we will wait for the ambulance to arrive then ask if they need assistance. if they do then we stay. if they dont then we gear up as we are driving to the fire.


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## Aidey

Right now the Rosenbaum family has DC FEMS in between a rock and a hard spot (as they should). DC has two options, change or get their pants sued off of them. We all know that the city would lose that lawsuit big time. I am actually impressed at the choice the family made to try and enact change rather than just collect multiple millions.

Although, at this point if the city doesn't get their butt in gear I wouldn't blame the family if they sued, and then used the money to start a private ambulance company to make up for the abysmal care provided by FEMS. I can think of at least two other high profile screw ups that have happened since Rosenbaum that resulted in a patient's death.*

I have a modicum of sympathy that the FFs have to pay for uniform items themselves. However, they probably could have avoided getting in this situation had they got their act together long ago. And the very small amount of sympathy I have is pretty much eliminated by the FFs acting like petulant children over the whole thing. 


*Young child with pneumonia and guy having an MI diagnosed as 'indigestion'.


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## usalsfyre

firefite said:


> by 2 in and 2 out i meant "2 go in and 2 come out". wel will have 2 firefighters gaining entry into the building as the 3rd firefighter who is the engineer stays outside and handles the pump and also takes over incident commander of the scene. as soon as the second engine arrives on scene they are the RIC team "rapid intervention crew". as soon as a reported fire gets reported we automatically send out 3 engines. if we are on a medical call we will wait for the ambulance to arrive then ask if they need assistance. if they do then we stay. if they dont then we gear up as we are driving to the fire.



Firefite, I'm way off topic here, but I'll say this. You need to think long and hard about continuing with this department if this is the way you operate. Fire service standards, like many others, are written in blood. 2 in 2 out is an absolute requirement. If the roof should fall in while your inside prior to anyone being there to help you, your dependents will most likely not receive the PSOB as you were involved in what was essentially an illegal operation. The "incident commander" being on the pump panel is laughable, how is he going to watch fire conditions? If you get ejected while dressing out enroutre, again no PSOB and you died before you could ever get to the scene.

I work part time for a department that has three in shift. It sucks waiting for mutual aid. But I refuse to do anything overly dangerous for property. It can be replaced. I can't. Several years ago our county had two guys die in a house that was empty, and most of the contents was burned up long before they died. Why were the there? "Because that's what fireman do!" That's just not a good enough excuse to tell my kids anymore.


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## medic417

usalsfyre said:


> Firefite, I'm way off topic here, but I'll say this. You need to think long and hard about continuing with this department if this is the way you operate. Fire service standards, like many others, are written in blood. 2 in 2 out is an absolute requirement. If the roof should fall in while your inside prior to anyone being there to help you, your dependents will most likely not receive the PSOB as you were involved in what was essentially an illegal operation. The "incident commander" being on the pump panel is laughable, how is he going to watch fire conditions? If you get ejected while dressing out enroutre, again no PSOB and you died before you could ever get to the scene.
> 
> I work part time for a department that has three in shift. It sucks waiting for mutual aid. But I refuse to do anything overly dangerous for property. It can be replaced. I can't. Several years ago our county had two guys die in a house that was empty, and most of the contents was burned up long before they died. Why were the there? "Because that's what fireman do!" That's just not a good enough excuse to tell my kids anymore.



I thought the rules had changed that for 2 in you had to have 4 out.  Theory being needed 2 people to drag each ff that went down out of the fire.  Maybe that was just a smart suggestion that never got implemented because to many consider it cheaper to replace a ff than to protect them.


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## jgmedic

firefite said:


> not trying to start anything but as for my city this would not work. we have 3 firefighters on duty at all times. we have 2 engines and a squad unit. if we dedicated just using only the squad unit to go to medical calls then you would have to pay for at least 2 more firefighters on duty at all times as well as a new station for them to sleep at since ours only sleeps 4, and the firefighters here work 72 hours and sometimes get forced to do 96 hour shifts so they really need a place to sleep. so from what i see having an engine respond is alot cheaper then having a squad unit dedicated to running EMS calls.
> 
> and actually replacing all the decals would cost money. as for the engines here they would have to be repainted because its not just a decal. but you would have to most likely pay an engineer overtime to drive the engine to the shop. along with gas, mileage, and time. when we take a engine into the shop we take all the equipment out.



How often is 266 fully staffed? Is the squad all volly staffed like S72 is? CDF is a whole different ballgame from most municipal FD's. I'll agree their schedule is ridiculous if you're at a busy house, but as a whole, the Pass isn't all that crazy. Plus the squad thing works at some CDF stations. So it could work, how bout if they pulled E266, put 2 medics on the squad and made 66 BLS?


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## DesertMedic66

usalsfyre said:


> Firefite, I'm way off topic here, but I'll say this. You need to think long and hard about continuing with this department if this is the way you operate. Fire service standards, like many others, are written in blood. 2 in 2 out is an absolute requirement. If the roof should fall in while your inside prior to anyone being there to help you, your dependents will most likely not receive the PSOB as you were involved in what was essentially an illegal operation. The "incident commander" being on the pump panel is laughable, how is he going to watch fire conditions? If you get ejected while dressing out enroutre, again no PSOB and you died before you could ever get to the scene.
> 
> I work part time for a department that has three in shift. It sucks waiting for mutual aid. But I refuse to do anything overly dangerous for property. It can be replaced. I can't. Several years ago our county had two guys die in a house that was empty, and most of the contents was burned up long before they died. Why were the there? "Because that's what fireman do!" That's just not a good enough excuse to tell my kids anymore.



by the time that the first crew is able to enter the building a second engine will arrive and have set up as a RIC. our stations are pretty close together and we run 3 engines out of one of the stations. as for the getting geared up as we are driving to the scene you can do that as long as your seatbelt on. i have done that multiple times. the IC is the engineer until a higher up arrives in their response trucks. then the higher ranking firefighter will take over IC. thanks for your opinion usal. but i have worked with in this area for 5 years and i have seen how it operates and how they get stuff done. we do stuff safely and follow all the fire codes for our area.


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## 46Young

firefite said:


> by the time that the first crew is able to enter the building a second engine will arrive and have set up as a RIC. our stations are pretty close together and we run 3 engines out of one of the stations. as for the getting geared up as we are driving to the scene you can do that as long as your seatbelt on. i have done that multiple times. the IC is the engineer until a higher up arrives in their response trucks. then the higher ranking firefighter will take over IC. thanks for your opinion usal. but i have worked with in this area for 5 years and i have seen how it operates and how they get stuff done. we do stuff safely and follow all the fire codes for our area.



How is the engineer supposed to pump and also run command? If the second engine is functioning as RIT (RIC), who's getting a secondary water supply, or pulling a back up line? We haven't even discussed having a truck company ladder the windows in case that interior crew gets cut off. Also, "Two In Two Out" means no one goes in alone, and there needs to be at least two outside for rescue if a mayday is called. You actually need around 12-13 FF's just to rescue one. This only scratches the surface as to why there needs to be so many FF's on a structure fire, for those that suggest cutting staffing and deployment. 

Here, for a house fire, the first due engine has command, decides to go interior or defensive, then passes command to the second engine. Thge second engine establishes a water supply if the first due didn't bring their own. The third due has the back up line, and the fourth due is RIT. The first truck has ladders and venting, the second truck has utilities and roof cuts if needed, and the first heavy rescue has search unless they are extended, then the first truck has search. There's also two EMS units, an EMS supervisor, and BC. An effective attack may not be possible without these resources. And that's only the first alarm. Also realize that having only two on a truck or three on an engine is also understaffing. I'll post the truck staffing video from my county again:

http://www.youtube.com/watch?v=a_K-K6o5cGc

I know this is way off topic, but inadequate staffing and deployment, and the suggestion to cut back on that due to call volume alone (EMS runs more so cut fire staffing since they run less), gets me going. Like it was said earlier, either you staff and deploy suppression ops adequately, or don't bother at all, since they're ineffective otherwise.


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## usalsfyre

firefite said:


> by the time that the first crew is able to enter the building a second engine will arrive and have set up as a RIC. our stations are pretty close together and we run 3 engines out of one of the stations. as for the getting geared up as we are driving to the scene you can do that as long as your seatbelt on. i have done that multiple times. the IC is the engineer until a higher up arrives in their response trucks. then the higher ranking firefighter will take over IC. thanks for your opinion usal. but i have worked with in this area for 5 years and i have seen how it operates and how they get stuff done. we do stuff safely and follow all the fire codes for our area.



I was surprised by what I thought you were saying, because my understanding of the department I think you work for is they're very safety oriented. Glad to see that impression wasn't wrong. 

I've been to several LODD funerals, hopefully my quota is met for life. Amazing Grace on bagpipes unlocks a profound sadness within me. As such, I'm kinda preachy when it comes to fireground safety. 

Keep your head down and collar up.


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## 46Young

46Young said:


> How is the engineer supposed to pump and also run command? If the second engine is functioning as RIT (RIC), who's getting a secondary water supply, or pulling a back up line? We haven't even discussed having a truck company ladder the windows in case that interior crew gets cut off. Also, "Two In Two Out" means no one goes in alone, and there needs to be at least two outside for rescue if a mayday is called. You actually need around 12-13 FF's just to rescue one. This only scratches the surface as to why there needs to be so many FF's on a structure fire, for those that suggest cutting staffing and deployment.
> 
> Here, for a house fire, the first due engine has command, decides to go interior or defensive, then passes command to the second engine. Thge second engine establishes a water supply if the first due didn't bring their own. The third due has the back up line, and the fourth due is RIT. The first truck has ladders and venting, the second truck has utilities and roof cuts if needed, and the first heavy rescue has search unless they are extended, then the first truck has search. There's also two EMS units, an EMS supervisor, and BC. An effective attack may not be possible without these resources. And that's only the first alarm. Also realize that having only two on a truck or three on an engine is also understaffing. I'll post the truck staffing video from my county again:
> 
> http://www.youtube.com/watch?v=a_K-K6o5cGc
> 
> I know this is way off topic, but inadequate staffing and deployment, and the suggestion to cut back on that due to call volume alone (EMS runs more so cut fire staffing since they run less), gets me going. Like it was said earlier, either you staff and deploy suppression ops adequately, or don't bother at all, since they're ineffective otherwise.



Edit: This isn't directed at you, firefite, but rather to illustrate why staffing is important for fires.


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## usalsfyre

46Young, there's a whole lot of departments that need to admit defeat and be "spray from outside" departments. However the culture of the fire service seems to prevent this.


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## 46Young

usalsfyre said:


> 46Young, there's a whole lot of departments that need to admit defeat and be "spray from outside" departments. However the culture of the fire service seems to prevent this.



No kidding. Especially with the type 5 stick homes. If you're inside more than 15-20 give or take from when the fire started (plus delay in reporting), and don't have a knock, then it's time to think about getting out and setting up the artificial rain makers. There's no warning like spongy floors or anything. The roof just dumps right on top of you, or the floor just drops right out.

Down in Charleston, they've been resistant to the safety culture. Our retired member, Jimmy Ghi, met a lot of resistance, and eventually resigned after conditions were made untenable for him.


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## usalsfyre

Yeah, gussett plates were scary enough, but the laminated glue crap being used now is enough to give me nightmares. Not to mention larger homes with more open space floor plans are being constructed this way. 

You know the fire in the truck staffing video? A friend of mine was one of the last guys out the window onto Truck 403's stick. This was one of those "eye openers" for me.

Charleston I'm sure, like many smaller southern departments, wants to remain in the "good old boy" system. Unfortunately more guys will die because of a few dinosaurs discomfort over change.


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## DesertMedic66

Normally first crew will catch the hydrant. If not then one firefighter from the second engine crew will attach to it. We don't have a heavy rescue unit or any ladder trucks. We normally won't call for ambulances since we are also EMS. As soon as the call for a reported fire comes in we send 3 engines. After the fire is confirmend we send a breathing support 1 or 2 more engines and a DC to take over IC from the first arriving engine. After everyone arrives on scene we have roughly 14 or more. But as soon as the first engine arrives on scene we start firefighting operations.


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## CAOX3

Yeah I agree the names ridiculous, and whats the point of changing the name, is that in some way going to fix the problem?


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## ffemt8978

This thread has gone walkabout and needs to get back on topic.


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## DesertMedic66

Another thing that is on topic, at least some of the firefighters gear says the city and then fire. So if DCFD is on the back of their turnout gear that's more money right there plus the time to have the name fixed.


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## admemt1982

firefite said:


> by 2 in and 2 out i meant "2 go in and 2 come out". wel will have 2 firefighters gaining entry into the building as the 3rd firefighter who is the engineer stays outside and handles the pump and also takes over incident commander of the scene. as soon as the second engine arrives on scene they are the RIC team "rapid intervention crew". as soon as a reported fire gets reported we automatically send out 3 engines. if we are on a medical call we will wait for the ambulance to arrive then ask if they need assistance. if they do then we stay. if they dont then we gear up as we are driving to the fire.



2 in 2 out does NOT mean that. and if you have any doubts im sure your local osha office will set you straight in a very expensive way. 2 in 2 out means for every 2 people you have in the building you have 2 people outside or a dedicated RIT team in order to rescue those inside if needed. this is straight out the book.


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## ffemt8978

Last chance to get it back on topic...


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## admemt1982

ffemt8978 said:


> Last chance to get it back on topic...



id shoot a spit ball at you but we seem to be missing this smileyh34r:h34r:h34r:


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## admemt1982

i feel like dc needs to pick something better to jump up and down about than the the letters on the back of their t-shirts that they dont HAVE to buy. or heres an idea ( GASP ) just wear their company t-shirts


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## 46Young

What about Fire, Emergency Call, and EMS Services?(FECES)

I saw this on another forum and almost spit out my drink.

What if you take a slight pause between the F and the EMS? It would be quite derogatory.


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## 18G

I agree the FEMS acronym is not the best but I am loving that EMS is right there! 

I'm so sick of FD EMS providers whining and complaining all the time when they are tasked with taking care of people. There is nothing I dislike more than Fire-based EMS. 

Fire and EMS are like plumbers and chefs.... how are the two related again? They are not related. Dragging around fire hose, shooting water, and doing fire inspections, has absolutely nothing to do with providing healthcare. 

EMS needs to separate from DC Fire.


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## usalsfyre

46Young said:


> What about Fire, Emergency Call, and EMS Services?(FECES)


Probably incredibly appropriate from what I've seen and heard of DC EMS.



46Young said:


> What if you take a slight pause between the F and the EMS? It would be quite derogatory.


No more derogatory than the problEMS poster that made it's way around the fire service a couple of years ago.


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## usafmedic45

> I do not want people providing medical care that are that delusional about their own self importance.


Never get seriously ill or injured outside of a hospital in the United States then....or in one as a matter of fact.


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## 46Young

18G said:


> I agree the FEMS acronym is not the best but I am loving that EMS is right there!
> 
> I'm so sick of FD EMS providers whining and complaining all the time when they are tasked with taking care of people. There is nothing I dislike more than Fire-based EMS.
> 
> Fire and EMS are like plumbers and chefs.... how are the two related again? They are not related. Dragging around fire hose, shooting water, and doing fire inspections, has absolutely nothing to do with providing healthcare.
> 
> EMS needs to separate from DC Fire.



Generalize much?

You don't need to have two aspects of your job description to have significant overlap to do either one well. There are EMS depts that run heavy rescues. NYPD ESU does the same. Nassau County PD (NY) uses LEO's trained to EMT-B as crew members on their ambulances. Water rescue and TROT has little overlap with structural firefighting. Our Fire Marshalls are put through the county's police academy, given additional education on the LE side, and are detectives when they are finished. Little overlap to structural firefighting with the exception of building construction there as well. 

As far as didactic content necessary to do both fire and EMS, I'd argue that a BSN, RRT, or a PA are responsible for more than that. How about a doctor? If it's supposedly so difficult to command the knowledge for both EMS and firefighting, how could it be possible that anyone could get through medical school? It would be too much. How many people in EMS work towards other degrees such as Business Admin, Emergency Management, Pub Admin, etc. Wouldn't that be spreading yourself too thin since EMS, which you're working FT, and also studying for these degrees are like plumbers and chefs? Regarding training, you're running both suppression and EMS calls every day, depending on where you're riding. There are several monthly drills for each side. There are in-service EMS CEU's quaterly. For suppresion there are numerous OOS on duty multi-company drills that are mandated throughout the year, three Operational Academy Rotations OOS each year, and other multi company in service drills as well.

It's not as difficult to do both fire and EMS, or police and EMS, as you would like to believe.


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## 46Young

usalsfyre said:


> Probably incredibly appropriate from what I've seen and heard of DC EMS.
> 
> 
> No more derogatory than the problEMS poster that made it's way around the fire service a couple of years ago.



I was waiting for someone to get that!


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## 18G

46Young said:


> Generalize much?
> 
> You don't need to have two aspects of your job description to have significant overlap to do either one well. There are EMS depts that run heavy rescues. NYPD ESU does the same. Nassau County PD (NY) uses LEO's trained to EMT-B as crew members on their ambulances. Water rescue and TROT has little overlap with structural firefighting. Our Fire Marshalls are put through the county's police academy, given additional education on the LE side, and are detectives when they are finished. Little overlap to structural firefighting with the exception of building construction there as well.
> 
> As far as didactic content necessary to do both fire and EMS, I'd argue that a BSN, RRT, or a PA are responsible for more than that. How about a doctor? If it's supposedly so difficult to command the knowledge for both EMS and firefighting, how could it be possible that anyone could get through medical school? It would be too much. How many people in EMS work towards other degrees such as Business Admin, Emergency Management, Pub Admin, etc. Wouldn't that be spreading yourself too thin since EMS, which you're working FT, and also studying for these degrees are like plumbers and chefs? Regarding training, you're running both suppression and EMS calls every day, depending on where you're riding. There are several monthly drills for each side. There are in-service EMS CEU's quaterly. For suppresion there are numerous OOS on duty multi-company drills that are mandated throughout the year, three Operational Academy Rotations OOS each year, and other multi company in service drills as well.
> 
> It's not as difficult to do both fire and EMS, or police and EMS, as you would like to believe.



You mistook my post. I am not saying that an individual can't do both equally well. The problem is the majority do not WANT to do both equally well nor should they be expected to as a part of their job. Should RN's also be responsible for handling janitor calls in the hospital? By your philosophy why not? An RN and janitor aren't related the same as EMS and Fire not being related  

It's no secret that the majority of Firefighters have no interest in providing medical care, especially not on an ALS level. They want to fight fire and that is it. They view EMS as a secondary job function and it is something that they try to get out of doing at any cost. 

How many career FF's do you hear really wanting to run the Medic???? They all whine when they have to!


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## Veneficus

46 and 18

I think you both have valid points. I think the truth is somewhere in the middle. 

I have worked for an FD where EMS was considered "part of the mission," however the definition of EMS in that mission was to provide some cookbook treatments on the way to the hospital. If the pt. arrived with a heartbeat or looking better than you found them, the mission was accomplished.

By that definition, fire based EMS was doing an outstanding job. 

I also worked at places where assignment to the EMS transport vehicle was either for the new guys or as punishment. There were a handful of more experienced guys who really enjoyed the EMS side and were superior care providers by any definition. But they were few and their EMS involvement considered "quirkey." But they were tolerated because they had proven themselves equally proficent at suppression and other FD activities. They are still exceptional people.

As the generations in the fire service shift, there is more focus on EMS that I see happening. Unfortunatley, as before, very few are actually good at both. Though obviously they all meet the minimum requirements.

The problem that I see moving forward with fire based EMS is that the FDs don't seem to want to expand out of simple transport operations. These are not financially sustainable first off. There will always be more calls than units available even if you stopped buying fire trucks and went to ambulances only. (Clearly not realistic.) The fire service did embrace prevention and other public services in a full way, but the knowledge base required in order to do health prevention or alternative transport destinations is coniderable. It would take the hiring of extraordinary people en masse. Which is not the hiring policies of most FDs. Giving major points on hiring exams to military, residents, ect, largely excludes highly educated people. After all even if you gradated top in the class for public administration at Harvard, you couldn't take a test in Philly, with any reasonable chance of getting hired over the guy who grew up there, spent a tour in the armed forces, but may be around the average of a 40 ASVAB score. Now you are taking people who weren't fit to be military medics when I enlisted, and are putting them through EMS school to work on the civ. side. 

Most of the current fire leadership in the country either has no formal education or a degree that was set up to give them credit for their longevity. Do you really think a person with a Chemical engineering PhD is going to take order from some guy with 240 fire school and a hazmat tech cert for ~50K a year?

See the problem?

As for the comparison to medical school. That will never be comparable. Med students are not expected to know all there is to know to be great at medicine. They are expected to know enough medicine to function as a doctor. Later they choose to specialize because the knowledge bank is so big no one person can know it all, much less be good at all of it. Nobody hires a doctor expecting them to. Very different from what is expected of firefighters today.

It would work if departments were able to hire a bunch of specialists, but most simply cannot afford it.

Additionally, people get throgh medical school by being absolutely submerged in medicine. The same simply cannot be said for the FD when they are partially submerged in suppression while being sprayed with a hazmat hose and having EMS water balloons lobbed at them.

Look at the dichotomy. 

Fire suppression, aggressive action where independant action is often dangerous.
EMS, entirely independant action that requires a balance of aggression and discretion.
Hazmat, initially conservative and standoffish, followed by a consult from experts and then tightly controlled action.  
Tech rescue, large amounts of highly specialized knowledge again requiring both independant judgement as well as ability to function as part of a unit.

Regretfully, most humans cannot be asked to master such diverse requirements and then perform them often enough to be proficent at them. There simply isn't enough time in the day. A few drills and inservice will do nothing to change that.

What's more, the pace of medicine is advancing so rapidly, that what was great medicine may be witchcraft in a few short months. EMS providers in the US are already 20-30 years behind. As the need for medical knowledge increases for EMS providers to function in prevention and other efforts that will be the basis of future medicine, I think it is not realistic to ask firefighters to be proficent at so much while trying to make things as simple as possible so they can in order to cope with the diversity.

whether people care to admit it or not, or are just terrified of the change, what makes EMS valuable has changed and will continue to evolve from its original concept.  It really was possible and easy to be a great firefighter and paramedic in 1990. But we are some years removed from that antiquity. 

It is similar to claiming that it is possible to be great at faster than light communications and travel by saying it was possible to be a good automobile driver and talk on a cell phone at one time.


----------



## Shishkabob

46Young said:


> Like it was said earlier, either you staff and deploy suppression ops adequately, or don't bother at all, since they're ineffective otherwise.



Same thing can be said for EMS, and honestly someones health is more important than their beloved wall clock.  Play defensive until you get more crews there to back you up.   

No reason why in most jurisdictions you can't maintain a small FF force and just call in the vollies for the bigger stuff.


----------



## 46Young

Linuss said:


> Same thing can be said for EMS, and honestly someones health is more important than their beloved wall clock.  Play defensive until you get more crews there to back you up.
> 
> No reason why in most jurisdictions you can't maintain a small FF force and just call in the vollies for the bigger stuff.



That doesn't work. The people with money and influence aren't going to be happy with nothing but a surround and drown operation in their neighborhoods. being able to mount an offensive attack can mean the difference between containing a fire to just a room and contents, or just one unit, and the entire row or apartment complex:

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

This was one of ours. It flashed, as we can see, and the crew would have never made it inside, nor would the windows have been laddered with just a "small firefighting force." The fire was contained to the end unit.

Besides the increased insurance cost due to lower ISO ratings, as soon as the dept starts burning down most of it's structure fires, not to mention if there are any deaths attributed to inadequate staffing and deployment, there will be a strong movement to upstaffing suppression resources. The reason we have paid departments is because the volunteer presence is inadequate. If you pull vollies from several other jurisdictions, then who's going to run jobs in their districts?

EMS definitely needs better staffing and deployment (and not by SSM or a PUM), but not at the expense of suppression resources.


----------



## 46Young

@ Vene, I'm picking up what you're putting down. If we were responsible for what a foreign medic was, it would be difficult to do anything else well. EMs was much more simple back in the 90's. Seeing our former practices as witchcraft is a good way to look at it. 

I could see a FD hiring dual role, but then having their people choose a side for career development. If you want to promote, then you're doing one or the other. If you join a FD to fight fire and don't embrace EMS, the odds are that you're not going to promote very high if at all, since you'll have a lot of competition. As far as EMS, it will be easier to promote, so medics who mostly want to do EMS, who tolerate the fire side, will be attracted to that type of opportunity. If you join the dept just for fire and got the P-card for that reason alone, chances are you'll be stuck at that rank for much of your career if you want the suppression career ladder.


----------



## JPINFV

46Young said:


> EMS definitely needs better staffing and deployment (and not by SSM or a PUM), but not at the expense of suppression resources.



The problem is that the opposite is also true. The answer to having not enough ambulances is not adding an additional engine as a paramedic assessment unit. EMS shouldn't suffer for the needs of fire suppression. However, given the choice between fully staffing fire suppression or EMS, most fire departments are going to fully staff fire suppression, despite the majority of their calls being EMS in nature.



> If you pull vollies from several other jurisdictions, then who's going to run jobs in their districts?



If you pull suppression resources for EMS calls, who's going to run the fire calls? If you pull EMS resources for fire calls, who's going to run EMS calls? That is the contradiction for putting paramedics on fire engines.


----------



## JPINFV

46Young said:


> As far as EMS, it will be easier to promote, so medics who mostly want to do EMS, who tolerate the fire side, will be attracted to that type of opportunity.




However, and I've never received an answer for this, how many fire departments are going to hire fire medics who have no interest in suppression past being able to run the big red ambulance? How many fire fighters would feel safe going into a fire where their partner has zero interest in suppression and puts no effort past the minimum? It's evident that plenty of fire departments accept the opposite (interest in EMS only as a means to get onto the fire department), but I doubt that many will hire fire fighters who's sole interest is EMS.


----------



## 46Young

JPINFV said:


> The problem is that the opposite is also true. The answer to having not enough ambulances is not adding an additional engine as a paramedic assessment unit. EMS shouldn't suffer for the needs of fire suppression. However, given the choice between fully staffing fire suppression or EMS, most fire departments are going to fully staff fire suppression, despite the majority of their calls being EMS in nature.
> 
> 
> 
> If you pull suppression resources for EMS calls, who's going to run the fire calls? If you pull EMS resources for fire calls, who's going to run EMS calls? That is the contradiction for putting paramedics on fire engines.



I'm going to say that the EMS staffing and deployment generally gets the short end of the stick regardless of what system is in place. We had not enough ambulances in NYC. It was just as bad pre FDNY merger. There were not enough ambulances in Charleston County SC. There are not enough ambulances in any dept that uses SSM. There are not enough embulances in most of the private 911 providers, where profit is the primary goal. Besides creating/saving position and such, fire based first response uses otherwise idle suppression units for EMS runs. Since relatively few of our patients are truly time sensitive, a delay in txp of a few minutes while waiting for the ambulance isn't going to make or break things. 

Good departments plan for surges in call volume with proper deployment, mutual aid agreements, station fills, putting frivolous calls on hold, paring back responses, etc.


----------



## 46Young

JPINFV said:


> However, and I've never received an answer for this, how many fire departments are going to hire fire medics who have no interest in suppression past being able to run the big red ambulance? How many fire fighters would feel safe going into a fire where their partner has zero interest in suppression and puts no effort past the minimum? It's evident that plenty of fire departments accept the opposite (interest in EMS only as a means to get onto the fire department), but I doubt that many will hire fire fighters who's sole interest is EMS.



FF's whose sole interest is in EMS won't generally apply, since they have an aversion to running into burning buildings and other dangerous situations, a fear of hights, claustrophobia, and probably significant physical discomfort. With FF's that don't like EMS, they're going to apply anyway, and there's no way to tell what their true intentions are. They're not going to come out and say it during the oral boards. They're going to "play the game" in the academy by doing and saying what the basic training staff wants, and keeping their mouth shut otherwise. The same goes for their rookie year. 

Consider also that the department may restrict their medics from riding in truck companies, heavy rescues, doing Hazmat or TROT, etc. After a while, they get tired of doing EMS only for the most part, and discover that they have to drop their ALS cert in order to be able to do other things within the dept. Compare this to single role EMS where they just quit, on the average of seven years, as there are no other avenues to explore in their dept. In the fire service, you get a mix of those who never wanted to do EMS in the first place, and others who liked EMS at first, but had that enthusiasm taken away from them by being denied other opportunities within the department. They burn out on EMS just like most everyone else who does EMS only as a career. You need that break from EMS transport to make it sustainable for a career. If I'm wrong, then why are there relatively few "lifers" in EMS? And how many of them are there by choice, and how many are there because they have no other viable income choices?


----------



## JPINFV

46Young said:


> Consider also that the department may restrict their medics from riding in truck companies, heavy rescues, doing Hazmat or TROT, etc. After a while, they get tired of doing EMS only for the most part, and discover that they have to drop their ALS cert in order to be able to do other things within the dept.


However, how many departments is it a requirement (explicit or de facto based on competition) to be a paramedic? Why is it that departments don't expect everyone to be expert on truck work, hazmat, white water, etc, but expect everyone to be an expert in EMS? Does the fact that it's expected from everyone instead of an icing on the cake type assignment change the internal dynamic? Are there perks for those other positions besides doing something different? 



> Compare this to single role EMS where they just quit, on the average of seven years, as there are no other avenues to explore in their dept. In the fire service, you get a mix of those who never wanted to do EMS in the first place, and others who liked EMS at first, but had that enthusiasm taken away from them by being denied other opportunities within the department. They burn out on EMS just like most everyone else who does EMS only as a career. You need that break from EMS transport to make it sustainable for a career. If I'm wrong, then why are there relatively few "lifers" in EMS? And how many of them are there by choice, and how many are there because they have no other viable income choices?



I think that's one way to look at it. I think another issue is that the type of people EMS needs is the type of people that are driven away from the current culture. Too many systems expect cook book medics, so why would someone who doesn't want to read a cookbook with the option to do something else go into EMS? How many people never enter the field or leave because of the "mother may I" stupidity and low standards are driven from EMS into medicine, nursing, and respiratory therapy because those fields offer more freedom and because they can. I'll be honest, if I thought EMS offered a modicum of freedom outside of a few systems (which don't exist in Southern California, be it private, fire, or otherwise), I might have had a tough choice between medical school and paramedic school. It's the lack of freedom and independence more than the work conditions or pay than anything else that kept me from seriously considering becoming a paramedic. Unfortunately, the type of people that are attracted to the cookbook positions are not compatible with the people attracted to the higher powered systems. Which is, of course, another significant problem.


----------



## 46Young

JPINFV said:


> However, how many departments is it a requirement (explicit or de facto based on competition) to be a paramedic? Why is it that departments don't expect everyone to be expert on truck work, hazmat, white water, etc, but expect everyone to be an expert in EMS? Does the fact that it's expected from everyone instead of an icing on the cake type assignment change the internal dynamic? Are there perks for those other positions besides doing something different?
> 
> 
> 
> I think that's one way to look at it. I think another issue is that the type of people EMS needs is the type of people that are driven away from the current culture. Too many systems expect cook book medics, so why would someone who doesn't want to read a cookbook with the option to do something else go into EMS? How many people never enter the field or leave because of the "mother may I" stupidity and low standards are driven from EMS into medicine, nursing, and respiratory therapy because those fields offer more freedom and because they can. I'll be honest, if I thought EMS offered a modicum of freedom outside of a few systems (which don't exist in Southern California, be it private, fire, or otherwise), I might have had a tough choice between medical school and paramedic school. It's the lack of freedom and independence more than the work conditions or pay than anything else that kept me from seriously considering becoming a paramedic. Unfortunately, the type of people that are attracted to the cookbook positions are not compatible with the people attracted to the higher powered systems. Which is, of course, another significant problem.



I agree with both parts. I know that there are regions or whole states as the case may be where the P-card is required for hire. It's not required in my general area, although some choose to go that route since the basic FF hiring has slowed significantly in most cases, or competition due to EEO quotas. What I've seen a lot of lately with our most recent recruit schools is either medics that have grown tired of the BS and lack of career advancement in single role 911, and others who don't have the opportunity around here to do non fire based 911. Some love fire, and others do it as a necessary evil, just like FF/medics that dislike EMS, which will probably always be a problem to some extent. As far as I'm concerned, you can dislike EMS, so long as you do a good job regardless. When your apathy transfers to pt care, then we have problems. EMS is being pushed hard as an important part of our mission, from the initial interview, through testing, the academy, and now in the field. I'm not naive in that I think it's like this in many other places, unfortunately.


----------



## Veneficus

46Young said:


> @ Vene, I'm picking up what you're putting down. If we were responsible for what a foreign medic was, it would be difficult to do anything else well. EMs was much more simple back in the 90's. Seeing our former practices as witchcraft is a good way to look at it.



I would just like to point out that many foreign EMS services didn't evolve out of altruism towards the medics or the desire to be respected.

It came from money. Countires cannot sustain trillions in deficit. Part of cost control in the future of US medicine is going to be prevention and treatments that reduce the need for multiple parties at multiple levels. 

I don't think US EMS is going to embrace this because I said it was a good idea or anything of the like. I think they are going to have to when the current pay system, (I have to use small words this is not a English QWERTY keyboard and the keys are in weird places) is forced to stop paying $300-$1000+ for a modified taxi ride when a large percentage of the patients require neither an ambulance nor an emergency dept. (or even a doctor for that matter) With 26% of the US GDP paying for healthcare of the elderly and indigent, something will have to give. Passing this cost onto the individual will simply price the service out of the market.

I doubt there are more fiscally conservative people than me, but simply making cuts while applying/maintaining layers is not going to work.

Just think of the job losses for fire and EMS when the current reimbursement is inevitably and significantly reduced or eliminated.

I think I will start a thread on the economics of this sometime this weekend. But I just wanted to mention this briefly as I wait for a train.      



46Young said:


> I could see a FD hiring dual role, but then having their people choose a side for career development. If you want to promote, then you're doing one or the other. If you join a FD to fight fire and don't embrace EMS, the odds are that you're not going to promote very high if at all, since you'll have a lot of competition..



I think that would work for larger departments, but what about the ones with 3-10 guys on duty at any given time? That is a majority of the US fire service.

It would also have to be stipulated there could be no crossover, which is a problem now. You advance up through EMS then keep your rank and switch to fire, the dept loses the huge investment they have in you for your EMS trianing, loses one of its highest trained and skilled providers, then gets a minimally qualified fire suppression guy. 

If you told somebody that if they went in the EMS track and decided to switch they could do so only at an entry level position, when they were open, it would solve a lot if not all of the fire people "using" EMS.


----------



## mikeward

*Some perspective from a DC street*

*Calling them FEMS will not improve out-of-hospital emergency medical care*



> March 29, 2011
> 
> Councilmember Phil Mendelson
> Committee on Public Safety and the Judiciary
> 
> Chairman Mendelson:
> 
> I appreciate your dedication to focus the fire department on its EMS mission.
> 
> I have to share a frustration with the effort to ban "DCFD" and the eagle/badge emblem.
> 
> The majority of employees that staff the ambulance in 2011 are dual role firefighter/emt and firefighter/medics.
> 
> This is a significant change from the single-role ems employees staffing transport units before the 2007 EMS Task Force.


Read the rest here: Clicky


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## mikeward

*The District of Columbia IS different*

Unless you work in the city, you will never appreciate the profound dysfunctional uniqueness of a jurisdiction that functions as both a city and a state ... but is controlled by the US Congress.

If you are interested, check out these two items by FossilMedic on Firegeezer (dot) com:

*Singing Pigs, Resistant Cultures and DC EMS* – January 1, 2010

*Two DC EMS Snapshots* – January 4, 2010

My perspective is that the delivery of out-of-hospital emergency medical care HAS improved.

In addition to 5 years of no raises, the fire chief announced this week the possible elimination of up to 400 uniformed positions - an entire platoon.

A concern is that the city will go from a four platoon to three platoon system, increasing the average work week from 42 to 56 - without an increase of pay.


For FY 2012 the city has already eliminated:

Two Assistant Fire Chief positions, four Deputy Fire Chief positions and six Battalion Chief positions. The savings from the eliminated positions is approximately $2.4 million. 

An additional 65 vacant positions were eliminated in the Agency Management program, Fire Prevention and Education, Operations Support, and Field Operation programs for a savings of approximately $2.7 million.


Finally, the "rebranding" reflects an internal battle within the department that may have little to do with deliver of emergency medicine in the street.

If you were a fan of "The Wire" series on HBO, the complexity of this issue may feel familiar


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## Veneficus

mikeward said:


> A decision maker within the fire and ems department said the change was made *to make ambulance duty "more palatible"* to the dual role firefighter/medics and firefighter/emts that staff the units.



In a combination department, the people who find EMS unpalatible should be the first 400 to lose their jobs.

In any industry in any state or city, nobody is an indentured servant. If they do not like the evolving mission of the department, whether they are a chief or a probie, they should be shown the door.

As for the pay and benefits, I don't see a lot of sympathy going around for the pay and benefits of government workers at the moment. In the past few years many private secotr workers have had to make significant concessions. Why should government employees be any different?

Again, if the 56 hour work week and a new mission is too much. There is always the private sector.

Personally I have no sympathy for laborers who try to dictate terms of employment to superiors by means of legalized extortion and thuggery.

Let them eat cake.


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## 46Young

It would be funny if they knocked on the door during a call, and announced "F-EMS!" They wouldn't technically be wrong.


----------



## Veneficus

46Young said:


> It would be funny if they knocked on the door during a call, and announced "F-EMS!" They wouldn't technically be wrong.



might be worth calling 911, just to hear that.


----------



## DrParasite

mikeward said:


> Every big city fire department is involved in EMS first response, most also operate the ambulance service.


Absolutely wrong.  Newark NJ is a pretty big FD, and a pretty big city, and they have absolutely nothing to do with EMS.  and many of those big fire departments do not run EMS, at least not as equals to their FD "brothers."





mikeward said:


> None of those with ambulances have felt the need to change the identity of the fire department.
> 
> Not FDNY (New York City), LAFD (Los Angeles City), Chicago, Philadelphia, Miami-Dade, St. Louis, Memphis, Seattle, San Francisco, Dallas or Houston.


and in NYC, Chicago, Philladelphia, St. Louis, EMS is treated like the :censored::censored::censored::censored::censored::censored::censored: stepchild; used for run numbers, but paid less than their suppression counterparts, and benefits aren't anywhere near as good. 





mikeward said:


> I get the symbolism, and that it was one of the EMS Task Force recommendations.
> 
> I also remember the excitement and efforts of the members of the fire and ems department to get the gold eagle/badge logo on the rigs and on the uniforms as soon as they could. Many of the uniform patches, t-shirts and decals were direct employee purchases.
> 
> Part of the emergency service lifestyle is that many employees buy additional shirts, t-shirts, "job-shirts" and jackets that proudly proclaim their affiliation with a storied and proud emergency service agency.  Outlawing the wearing of DCFD branded clothing creates a personal financial impact on the employee.
> 
> It is fiscally imprudent to require a massive change of decals, uniform patches and uniform shirts - it will NOT change employee attitudes or symbolize to the public a change in focus or dedication of the firefighters, ems providers and civilians who make up the fire and ems department.
> 
> A recurrent tradition is that a new fire chief "marks" his territory by changing the color of the fire trucks or the uniform patch.
> 
> I am confident that Chief Ellerbe does not need to make the same type of marking to assure fire department focus on EMS.


absolutely agree 100%

I personally thing FEMS is kinda stupid.  a better name would be DCFD/EMS, which would go on EVERY piece.  every shirt, every patch, every logo, every fire truck would have EMS in big bold letters.  No more DCFD, every FF tshirt, turnout coat, and helmet would have EMS right next to FD, and be stenciled DC Fire/EMS .  no exceptions.

or make it DCEMS/FD, since most department go on more EMS calls than fire ones.  So they are really an EMS department that fights fires during their downtime.


----------



## HotelCo

Personally, I could care less what they call themselves. DCFD is fine by me.


----------



## MrBrown

46Young said:


> As far as didactic content necessary to do both fire and EMS, I'd argue that a BSN, RRT, or a PA are responsible for more than that. How about a doctor? If it's supposedly so difficult to command the knowledge for both EMS and firefighting, how could it be possible that anyone could get through medical school?



Because the amount of knowledge required to be a Paramedic in the US is paltry and bare bones compared to the rest of the world.

A thousand hours (or less) of "skills orientated training" by PowerPoint slide, "everybody goes to the hospital" and "contact medical control" does not compare.

This does not ensure a "commanded" of that knowledge.



46Young said:


> It's not as difficult to do both fire and EMS, or police and EMS, as you would like to believe.



Then why does no other nation outside the US have "fire based EMS", why does the London Fire Brigade, Metropolitan Fire and Emergency Services (Melbourne, Australia) and the New Zealand Professional Firefighters Union openly state they want no part of the EMS game because it is not in the interest of the profession?

Why is it we require a three year Degree for our Paramedics as well as a Post Graduate qualification in Speciality Practice for Intensive Care Paramedic and do other nations require equivalent education if its so easy to be a Paramedic, or a Paramedic and a Firefighter?


----------



## 46Young

MrBrown said:


> Because the amount of knowledge required to be a Paramedic in the US is paltry and bare bones compared to the rest of the world.
> 
> A thousand hours (or less) of "skills orientated training" by PowerPoint slide, "everybody goes to the hospital" and "contact medical control" does not compare.
> 
> This does not ensure a "commanded" of that knowledge.
> 
> 
> 
> Then why does no other nation outside the US have "fire based EMS", why does the London Fire Brigade, Metropolitan Fire and Emergency Services (Melbourne, Australia) and the New Zealand Professional Firefighters Union openly state they want no part of the EMS game because it is not in the interest of the profession?
> 
> Why is it we require a three year Degree for our Paramedics as well as a Post Graduate qualification in Speciality Practice for Intensive Care Paramedic and do other nations require equivalent education if its so easy to be a Paramedic, or a Paramedic and a Firefighter?



When I say that it's not difficult to do both firefighting and EMS, that refers to the U.S. system.

I'd like to know what the stats from other developed countries, with 3-4+ years of education show in regards to pt outcomes. Is pt morbidity/mortality significantly worse in the states then it is elsewhere? As far as treat and release, or diection to a facility other than an ED, you can consult OLMD, save 2-3 years of education, and get the same result. RN's work for 911 (Richmond VA) and do phone triage and suggest alternatives to EMS txp over the phone. That's with an assasciate's. Basically, I'm trying to understand how much a four year paramedic degree, possibly with post graduate study as the case may be, affects pt outcomes over what we have in the states. With maybe 5-10% of our patients being time sensitive, and transportation decision for STEMI's and CVA's taking up much of that, I'm betting there's not much difference at all. If you want to get into billing skill hours vs mileage, then I can see the benefit of all that education. If you want to talk about community outreach/service, that's another discussion. There's an upper limit as to what we can do in the field. how much definitive care are we realistically working towards as field paramedics?


----------



## MrBrown

46Young said:


> I'd like to know what the stats from other developed countries, with 3-4+ years of education show in regards to pt outcomes. Is pt morbidity/mortality significantly worse in the states then it is elsewhere? As far as treat and release, or diection to a facility other than an ED, you can consult OLMD, save 2-3 years of education, and get the same result. RN's work for 911 (Richmond VA) and do phone triage and suggest alternatives to EMS txp over the phone. That's with an assasciate's. Basically, I'm trying to understand how much a four year paramedic degree, possibly with post graduate study as the case may be, affects pt outcomes over what we have in the states. With maybe 5-10% of our patients being time sensitive, and transportation decision for STEMI's and CVA's taking up much of that, I'm betting there's not much difference at all. If you want to get into billing skill hours vs mileage, then I can see the benefit of all that education. If you want to talk about community outreach/service, that's another discussion. There's an upper limit as to what we can do in the field. how much definitive care are we realistically working towards as field paramedics?



Look at all the studies saying Paramedics intubating people make outcomes worse; we have a near 100% success rate with intubation, have RSI and so far all our failed intubations have been managed without cricothyrotomy.

We have prehospital thrombolysis and antibiotics, unlimited drug dosages (in line with prudent professional praxis), can leave people at home and no have no "medical control".  

We are well paid (compared to the US) and Paramedic is a respected and well developed career field not some skip and hop job that pays $9 an hour to sit at a gas station and get a wrecked back because Jack Stout is a **** head

Why do we have these things? Because we are well educated career Professionals with qualifications equal to that of any other allied health profession who demand respect and are trusted by our Clinical Management Group and others.

How many US Paramedics still give everybody high flow oxygen, everybody gets an IV, if you get an IV you get fluid, here is 2mg of morphine for your shattered leg, if you stand up your heart will stop beating, oh look AMLS told me to treat septic shock with permissive hypotension .....


----------



## Sandog

> We are well paid (compared to the US) and Paramedic is a respected and well developed career field not some skip and hop job that pays $9 an hour to sit at a gas station and get a wrecked back because Jack Stout is a **** head



Perhaps that is because NZ population is about half that of NYC. Put things into perspective, the US population is in excess of 300 million all the while much of our tax dollars are spent maintaining international peace. If you think the latter is not true, read a history book.  The money train is not running by our EMS station.

 I often see that you make jabs at US EMS, well good for you, aren't you special... And for Pete's sake, why do you always speak in the third person. You obviously have a chip on your shoulder when it comes to the US and I get that, I have no problem with that, but must you constantly remind us of it? Keep in mind, many people in all countries are doing the best they can to survive this economically turbulent time with the money at hand. 

I think it is great that you are prospering in EMS and I am sure many of us are envious, but things are what they are here in the US, we have little control on changing things as it currently stands, so how about cutting us some slack...


----------



## mikeward

MrBrown said:


> Then why does no other nation outside the US have "fire based EMS", why does the London Fire Brigade, Metropolitan Fire and Emergency Services (Melbourne, Australia) and the New Zealand Professional Firefighters Union openly state they want no part of the EMS game because it is not in the interest of the profession?
> 
> Why is it we require a three year Degree for our Paramedics as well as a Post Graduate qualification in Speciality Practice for Intensive Care Paramedic and do other nations require equivalent education if its so easy to be a Paramedic, or a Paramedic and a Firefighter?



Hello Mr. Brown:

1)  While the labor leadership of London, Melbourne and New Zealand have opposed assuming additional duties as emergency medicine caregivers, the same economic and workload pressures exist as they do in the United States ... decreasing fire workload + increasing cost of fire brigade staffing.

I have provided information to two non-US metro cities considering fire brigade based ems response, including transport. This is due to increasing response times of transport units from the ambulance agency and political issues.  Cannot reveal the clients.

2)  I have evaluated the three year paramedic degree used in your part of the world when considering applicants to our graduate program. Not quite apples-to-apples when considering learning outcomes and the areas covered.

The 2013 Scope of Practice model brings US paramedic education closer to your degree program.

Mike Ward


----------



## usalsfyre

Mr Ward, 

I respect your opinion and once upon a time I was a student in a program you were the interim head of, but, can you realistically state that the cost/benefit analysis shows fire-based EMS response to be the best option? To me no matter what uniform the employees are wearing the FTEs still exist if they are wanting response times (which is a poor way of measuring medical care, but the standard none-the-less) within 8:59. Granted some cost would be saved via reduction of administrative cost, but most metro FD's (at least that I've seen and been involved with) tend to be severely top heavy and I see EMS adding to, not taking away from that if run properly. 

I understand the union's desire to protect the employee, but at some point concession will have to be made. Ideally any cuts will be made via attrition, but I for see the days of dual paramedic FD based ambulances and multiple medics on FD apparatus coming to an end, not increasing.


----------



## mikeward

DrParasite said:


> Absolutely wrong.  Newark NJ is a pretty big FD, and a pretty big city, and they have absolutely nothing to do with EMS.



Hello Doctor ....

"Absolutely wrong" is a pretty broad brush.  Newark Fire is an outlier.

Newark is home to the only hospital-based heavy rescue company:
http://www.uh-ems.org/rescue.html

New Jersey has interesting history with ems regulations, preserving first-aid level ambulances and restricting paramedics to hospital-based systems.


----------



## mikeward

usalsfyre said:


> .. but I for see the days of dual paramedic FD based ambulances and multiple medics on FD apparatus coming to an end, not increasing.



So do I. 

Putting 3 to 7 paramedics at an incident does not improve patient outcome and is frightfully expensive to maintain. A battalion of underexperienced ALS caregivers.

Getting an AED to a sudden cardiac arrest and continuous closed chest compressions have the biggest impact on cardiac arrest patient outcomes.

By the way, maintaining an 8:59 minute ambulance response 90% of the time is equally ineffective and expensive when we look at patient outcomes.

Thanks for the response.

Mike


----------



## MrBrown

mikeward said:


> Hello Mr. Brown:
> 
> 1)  While the labor leadership of London, Melbourne and New Zealand have opposed assuming additional duties as emergency medicine caregivers, the same economic and workload pressures exist as they do in the United States ... decreasing fire workload + increasing cost of fire brigade staffing.



Not really, the Fire Service has seen that its job is being the Fire Service and sticking to it,  The Fire Service (at least here in NZ) is a well funded and stable organisation that is not prey to the immense political pressure that its US counterparts seem to be.

They have also recognised they are not career medical professionals and to intrude upon the Ambulance Service would be stepping on toes, and in their own words, not in the interest of the Fire Service, Ambulance or the public.



mikeward said:


> I have provided information to two non-US metro cities considering fire brigade based ems response, including transport. This is due to increasing response times of transport units from the ambulance agency and political issues.  Cannot reveal the clients.



The London Fire Brigade (at least anecdotally) considered Fire first response or something along those lines to high priority medical emergencies to "save response time" but the UK is not where Brown would look for an example of effective prehospital call triage, the silly ORCON clock and all. 

You will not find non US Fire agencies jumping on the Ambulance bandwagon because outside the US it seems that Ambulance is a stable entity which is well funded and not prey for the Fire Service to engulf in an effort to justify their own existence.



mikeward said:


> 2)  I have evaluated the three year paramedic degree used in your part of the world when considering applicants to our graduate program. Not quite apples-to-apples when considering learning outcomes and the areas covered.
> 
> The 2013 Scope of Practice model brings US paramedic education closer to your degree program.



A little bit maybe.  The Fire Unions are on record as questioning the need for increased hours of education and they successfully lobbied the CoAEMSP to drop the requirement to be affiliated with a University.

Good job Fire Service.

Now, which degree did you evaluate. AUT or WP? You do realise that as our entry level qualification a Graduate is placed through an extensive on road consolidation period (ontop of the 1,200 hours of practicum they had on the degree) with an appropriate scope of practice?

Our ALS qualification is the Post Graduate Certificate in Speciality Care (Advanced Paramedic Practice) and generally takes from outset, five to six years to reach Intensive Care Paramedic level.


----------



## DrParasite

mikeward said:


> Hello Doctor ....
> 
> "Absolutely wrong" is a pretty broad brush.  Newark Fire is an outlier.
> 
> Newark is home to the only hospital-based heavy rescue company:
> http://www.uh-ems.org/rescue.html
> 
> New Jersey has interesting history with ems regulations, preserving first-aid level ambulances and restricting paramedics to hospital-based systems.


Correct.  And if you look at the run numbers found here, http://www.firehouse.com/magazine/run-surveys/2009-national-run-survey-total-calls you will find they run more fire calls (just fire, not EMS) than some of the bigger names (San Antonio Fire Department #9 overall and Clark County Nv #15 overall).  So the statement that EVERY big city FD runs a first response program is "absolutely wrong."

And Newark has a Fire Department Rescue,  (Newark Fire-Rescue) and Police based Rescue (Newark PD Emergency Services Unit), in additional to University Hospital's EMS Rescue.  And Fire Departments still don't do any type of EMS first response.

your comments about the history about NJ and EMS are pretty accurate, but completely off topic.


----------



## DrParasite

MrBrown said:


> You will not find non US Fire agencies jumping on the Ambulance bandwagon because outside the US it seems that Ambulance is a stable entity which is well funded and not prey for the Fire Service to engulf in an effort to justify their own existence.


wow, this happens to be the most accurate observation I ever read from Mr Brown.


----------



## boingo

MrBrown said:


> Because the amount of knowledge required to be a Paramedic in the US is paltry and bare bones compared to the rest of the world.
> 
> *A thousand hours (or less) of "skills orientated training" by PowerPoint slide, "everybody goes to the hospital" and "contact medical control" does not compare.
> 
> This does not ensure a "commanded" of that knowledge.*
> 
> Really?  3 years here equal an associates degree, not too far off from degree programs in the states.
> 
> 
> *Then why does no other nation outside the US have "fire based EMS", why does the London Fire Brigade, Metropolitan Fire and Emergency Services (Melbourne, Australia) and the New Zealand Professional Firefighters Union openly state they want no part of the EMS game because it is not in the interest of the profession?*
> 
> You ever hear of Denmark?


----------



## mikeward

MrBrown said:


> The London Fire Brigade (at least anecdotally) considered Fire first response or something along those lines to high priority medical emergencies to "save response time" but the UK is not where Brown would look for an example of effective prehospital call triage, the silly ORCON clock and all.
> 
> You will not find non US Fire agencies jumping on the Ambulance bandwagon because outside the US it seems that Ambulance is a stable entity which is well funded and not prey for the Fire Service to engulf in an effort to justify their own existence.



There are issues with the NHS Trust and responsiveness of some ambulance services. A 2000 court of appeals ruling KENT vs. GRIFFITHS:



> A series of cases in the 1990s had held that none of the other emergency services was duty bound to go to the aid of persons in peril,  albeit that in 1968 it had been decided that a sick person who managed to present at an open hospital accident and emergency unit thereby effectively created a doctor–patient relationship, and so was entitled to reasonably careful treatment.  Then, in 2000, the Court of Appeal, in the case of  Kent v  . Griffiths, held that an unreasonably delayed response by an ambulance service to an emergency call could be actionable negligence.
> 
> Kevin Williams. LITIGATION AGAINST ENGLISH NHS AMBULANCE SERVICES AND THE RULE IN KENT v. GRIFFITHS   Med Law Rev (2007) 15 (2): 153-175. doi: 10.1093/medlaw/fwm001 First published online: May 21, 2007



From a 2003 Daily Mail article by Beezy Marsh


> *Emergency failures highlighted*
> 
> More than half the country's ambulance services are missing targets for answering the most urgent calls, it was revealed yesterday.
> 
> The Government's NHS Plan said 75 per cent of 'immediately life-threatening' cases should be reached within eight minutes and set a deadline of 2001 for trusts to comply.
> 
> But official figures for 2001-2 show 18 of the 32 NHS ambulance trusts in England missed the target, although performances did show an improvement.
> 
> The slowest response times were in London, where ambulance crews face major problems on traffic-clogged roads. Just 57 per cent of the most urgent calls, classified as Category A, were responded to within eight minutes.
> 
> Among rural services - where the problem is travelling long distances along country lanes - West Country Ambulance NHS Trust was the worst performer, achieving just 58 per cent.
> 
> East Anglian Ambulance NHS Trust managed nearly 64 per cent, and Hampshire Ambulance NHS Trust nearly 70 per cent. For other emergency calls, classified as Category B and C, 16 trusts met the aim of responding to over 95 per cent within 14 minutes in urban areas or 19 minutes in rural areas.
> 
> Demands on the ambulance service-rose over the period, with emergency calls up from 4.4million to 4.7million.
> 
> The Health Department admitted last night that it has extended its deadline, giving trusts until the end of this year. Officials said performance was improving, with figures for March showing 28 trusts meeting the eight-minute target.
> 
> Read more: http://www.dailymail.co.uk/health/article-122826/Emergency-failures-highlighted.html#ixzz1InMiHImc



It resulted in this 2005 policy document on *Transforming NHS Ambulance Services*

link goes to a 72 page .pdf document

The change in NHS Ambulance Trust response time in April 2008 is described in this London Ambulance Service link.

 How about this:



> *Welsh ambulance service winter response concern*
> 
> Welsh Conservatives have spoken out after the ambulance service missed the 65% target for eight-minute emergency response times in November (2010)
> 
> http://www.bbc.co.uk/news/uk-wales-12122289





> *Wales has the UK's slowest ambulance response times to emergency calls, figures obtained by BBC News suggest.*
> 
> The average response time in Wales last year (2009) was eight minutes and 47 seconds, against a benchmark of eight minutes.
> 
> Wales also had the highest proportion of calls which took longer than both eight minutes and 15 minutes to receive a response.
> 
> The Welsh Ambulance Service Trust said improvements had been made but more work was needed.
> 
> http://www.bbc.co.uk/news/10274201



My sources are indicating some politicians are willing to compel the fire brigade to assume additional duties. 

Some politicians are calling for the dismantling of the NHS Ambulance Trust - "Plaid has renewed a pledge to dissolve the Welsh Ambulance Trust and transfer its responsibilities to local health boards (LHBs) - despite saying it would not “fragment” the health service in Wales."  2011 March 29 from *Health Services Journal*.   

Like the US, there are significant labor and compensation issues.

Mike


----------



## systemet

46Young said:


> I'd like to know what the stats from other developed countries, with 3-4+ years of education show in regards to pt outcomes. Is pt morbidity/mortality significantly worse in the states then it is elsewhere?



I doubt that you are going to find good numbers on that.  Very little in EMS has been subject to rigorous outcome-based research.  

Even if you were to see a difference in mortality between the US, and, let's say, the fine land of Lichenstein, it would be difficult to know how much of this difference is due to preventative medicine, demographic factors, or in-hospital care.  It's extremely difficult to control for these things.

On the surface at least, the US has a higher infant mortality and lower life expectancy than many other industrialised nations.  But it also has a lot of poverty, poorer access to medical care (many uninsured versus almost all other industrialised nations having universal healthcare), lots more penetrating trauma, a much greater overall rate of violent death, and probably a greater amount of illegal immigration than many others.  It's hard to reasonably suggest that this difference is due to EMS care.  This isn't to bash on the US -- I'm not American, you guys choose to run your country however you want.   They're just factors that would be confounders if you tried to do this sort of research.



> Basically, I'm trying to understand how much a four year paramedic degree, possibly with post graduate study as the case may be, affects pt outcomes over what we have in the states.



I don't think this research has been done.  At least if you're talking about hard outcomes like death, disability, etc.

As Mr Brown pointed out, there are some instances where surrogate outcomes are better in other countries, e.g. intubation success rate -- although I wonder if the numbers reported have actually been published in a peer reviewed journal?  But, of course, a greater rate of putting a tube in the trachea might have nothing to do with actual patient survival.  

It is possible that further education and training beyond the average in the US has little impact on mortality and morbidity.  It may not be cost effective, either.  I think at this point, we can only guess.

But I would suggest that professionalising EMS is in the interests of everyone working in it currently.  Certainly moving toward a BScN entry to practice for the RNs has done nothing to harm their care, professionalism, income, career advancement or mobility.  When you compare what a paramedic is able to do, in terms of monkey skills, to other health care providers, and the responsibility that comes with these skills, we're woefully undereducated.



> If you want to talk about community outreach/service, that's another discussion. There's an upper limit as to what we can do in the field. how much definitive care are we realistically working towards as field paramedics?



I agree that there's probably an upper limit, but it's a limit that seems to move slowly upwards as time goes on.  In my short time I've seen interventions like RSI become much more prevalent (actually, universal), and widespread use of thombolysis, new agents for sedation/intubation (e.g. ketamine), administration of drugs by non-paramedic providers, etc.  It seems like each year we're asking paramedics (and EMTs) to do more and more complicated medicine, with the support of only a very brief training program.  We risk becoming technicians, if we don't push for more education.

We have a tendency to see the benefit of EMS in terms of cardiac arrest outcomes, response times, trauma scene times and transport times, etc.  In terms of that 5% of critical calls that you mention.  But perhaps over the next decade or two, the area where EMS is going to expand is into diverting people away from the hospital, referring them to other agencies (home care, family physician, etc.), and treating and releasing on scene (I realise that you mention community outreach and education in your post).  This is going to require a keen sense of professionalism and greater education.


----------



## MrBrown

mikeward said:


> There are issues with the NHS Trust and responsiveness of some ambulance services. A 2000 court of appeals ruling KENT vs. GRIFFITHS:
> 
> 
> 
> From a 2003 Daily Mail article by Beezy Marsh
> 
> 
> It resulted in this 2005 policy document on *Transforming NHS Ambulance Services*
> 
> link goes to a 72 page .pdf document
> 
> The change in NHS Ambulance Trust response time in April 2008 is described in this London Ambulance Service link.
> 
> How about this:
> 
> 
> 
> 
> 
> My sources are indicating some politicians are willing to compel the fire brigade to assume additional duties.
> 
> Some politicians are calling for the dismantling of the NHS Ambulance Trust - "Plaid has renewed a pledge to dissolve the Welsh Ambulance Trust and transfer its responsibilities to local health boards (LHBs) - despite saying it would not “fragment” the health service in Wales."  2011 March 29 from *Health Services Journal*.
> 
> Like the US, there are significant labor and compensation issues.
> 
> Mike



Brown did not bother to actually read 99% of this 

Why? Because if the target is faulty when why cry when you do not meet it? 

ORCON is a joke

Tom Reynolds, Mark Glencourse. Dr Malcolm Wollard and others complain about it because its a stupid system and no wonder its never met.  Millions and millions and millions of pounds has been spent in pursuit of this eight minute target and it has even resulted in a down skilling of ambulance staff (ECSW/ECA role introduction) 

Therefore its moot point mate, if Brown shoots himself in the food and complains about it hurting, well more fool Brown for shooting himself in the foot!


----------



## usalsfyre

Systemet is right, outcome based studies on education are likely never going to exist. I would argue that considering the results of OPALS (the closest thing we have) calling for them is, in a word, stupid.

Where education helps is the knowledge and trust to be able to direct people away from the ED to appropriate resources. Which saves money. If your saving the system money, you can request higher reimbursement (think higher pay). Right now EMS has a very low value, as all we do is cost a significant amount to transport to the most expensive area of medicine outside the OR.


----------



## mikeward

MrBrown said:


> Brown did not bother to actually read 99% of this



Then there is no point having a discussion with you.

It is not important if YOU agree with the NHS measurements, as it is clear that your ability to influence health policy stops at the door of your ambulance. 

My point was to show the progression of the issues that would lead to (a) the dismantling of the ambulance trust model in the UK and (b) the foundation of an increased role of the fire brigade in EMS first response and (gasp!) transport.

The decision makers will dismantle a system that does not meet their requirements, even if it a clinically excellent, Brown-approved, ambulance service.

Mike
counting down the federal shutdown in the shadow of the Capital


----------



## Veneficus

mikeward said:


> Then there is no point having a discussion with you.



Funny that, I say the same thing about profire based EMS advocates who are so used to spouting their party line that reason escapes them. 



mikeward said:


> It is not important if YOU agree with the NHS measurements, as it is clear that your ability to influence health policy stops at the door of your ambulance..



Brown is doing better than me, I have no ability to influence health policy. I can tell people what is best for their health, from individuals to the masses, but I have absolutely no ability to get them to comply with it.  



mikeward said:


> My point was to show the progression of the issues that would lead to (a) the dismantling of the ambulance trust model in the UK and (b) the foundation of an increased role of the fire brigade in EMS first response and (gasp!) transport.



Dismantling of the ambulance trust model? Somehow I doubt it. In America it is easy to set absolutely pointless targets and get people to fall for it hook line and sinker. But in a system where there are still physicians that have influence, the medical benefits, especially given the European culture's respect for physicians, will likely always be able to add reason to the political argument.

As for B ), the US has more than demonstrated the economic waste of a minimally trained responder transporting every patient to the ED. Given the need to reduce climbing costs in NHS, as well as keeping the spending of the fire brigades low, I do not see politicians actually advocating for a system that the US clearly demonstrates is not sustainable economically, nor able to meet its own self determined targets of importance.  

Even if a politician gets on TV and plays to the desires of the simple masses, as is constantly shown, it is behind closed doors where the real play happens.



mikeward said:


> The decision makers will dismantle a system that does not meet their requirements, even if it a clinically excellent, Brown-approved, ambulance service.



Again, there are simply too many variables in play. Their requirements and public perception are probably very different. As well, so long as physicians are actively interested and involved in the policy making, clinical relevence will always be a significant part. 

We all know what happens when an ambulance arrives in 8:59, 90% of the time in life threatening emergencies. The patient is either dead, irreversibly dying, or could wait a few more minutes anyway.  

We also are all very aware that as the demand for service rises, the ability to field enough units in a transport system whose primary benchmark is response time, is not realistic or cost effective.

We are also very aware of the costs involved once everyone with the most minimal complaints hits the door of the ED.

Also in NHS, there are certain rules that make minimally trained and incapable providers dumping on EDs completely impractical. Particularly the time limits on patient disposition.


----------



## medicsb

BLSBoy said:


> Every Ambulance, Engine, Truck, Rescue Squad, Reserve apparatus, Chiefs car, supervisor vehicle, repair truck, etc, etc, etc now has to be taken in from the road, changeover needs to occur OR a company needs to be placed out of service so a freaking sticker can be placed on. Now factor in fuel costs, wear and tear on the vehicle, buying the stickers/decals, the cost in manpower which SHOULD be doing something else more productive. Easily tallies in the 100k mark.
> And cry me a friggin river about, "private EMS this, that, and everything else." Private EMS is a SCAB, and should be relegated to interfacility transports ONLY! I was a hospital based paramedic in South Jersey , running my tail off, working bad hours because management could make me do it. I worked nights where in 12hrs, we had 30+ dispatches for service, and was there until 1030am completing my charts. I CHOSE to move, become a Fire Based Paramedic (but not a FireMedic for this dept), take a 50% pay cut, and become union protected.
> 
> Best of luck to DCFD.



Hmmm, I think I know where you worked and which medic unit you are talking about though I could be wrong.  I worked in South Jersey and we had one truck that ran like said (though 30 would be an exaggeration).  If you responded to 20 in a shift (which might be more characteristic of a day shift), you treated 4-6 on average and split that with your partner.  Sure, on some days you treated more.  In my experience, it was uncommon that night shift stayed later than 8 for charting, but pretty common for those on day shift, sure.  Also, the equipment there was pretty good.  It got beat-up, but that happens when the medic units run 3000-9000 calls in per year.  I don't recall there being shady billing practices.  After-all they don't bill for refusals (even diabetics that get treated) or for pronouncements (even if you worked them first).  I'm sure we would agree on many things being wrong with NJ EMS and many problems with the hospital system in particular that I'm pretty sure you are talking about (the one over the bridge from Philly). 

Anyhow, as far as union protection... The past year has shown that many workers are getting the axe despite "union protection".  Though I believe in unions, the MICUs in NJ have not cut staffing anywhere.  At most, I remember a few had hiring freezes for a period of time.  The fire services and municipal EMS services in many places were cut or nearly cut.

Anyhow, I don't really blame you for choosing to move and get a union job at a place that is slower and that has more progressive protocols.  But, your blanket statements about fire-based EMS being superior rings hollow when one considers all the different systems and the ones that have been shown to be successful.  Also, if you just wanted to be a public worker protected by a union, why not just jump the bridge to Philadelphia and join PFD?  

As far as DCFD vs. DCFEMS.   I think a department should generally represent what it does in its name.  The majority of large city fire departments primarily do EMS yet they do not include it in their name (I don't think "rescue" counts).  They should change their names in my opinion.  I'm glad DCFD did.  They did the right thing.  If they don't want to acknowledge that EMS is their primary job, then they should get out of the EMS business.


----------



## DrParasite

medicsb said:


> Hmmm, I think I know where you worked and which medic unit you are talking about though I could be wrong.  I worked in South Jersey and we had one truck that ran like said (though 30 would be an exaggeration).


think AC not Virtua.


medicsb said:


> Anyhow, as far as union protection... The past year has shown that many workers are getting the axe despite "union protection".  Though I believe in unions, the MICUs in NJ have not cut staffing anywhere.  At most, I remember a few had hiring freezes for a period of time.  The fire services and municipal EMS services in many places were cut or nearly cut.


that's Fire service and municipal EMS are tax funded, and expensive, while everything else in EMS is outsourced.  The call volume hasn't gone down, so it's pretty hard to lay people off in EMS, especially when you have a rising call volume.  The need is still there, and if you lay off full timers, all that will happens is overtime costs skyrocket.    



medicsb said:


> Also, if you just wanted to be a public worker protected by a union, why not just jump the bridge to Philadelphia and join PFD?


hahahahah! I'd rather jump off the bridge than work for PFD as a paramedic.  PFD is arguably the of the worst EMS systems in the nation, grossly understaffed and overworked.  Why do you think the PD transports so many shooting victims instead of waiting for the ambulance?  EMS in NJ has it's issues, but it is leaps and bounds ahead of Philly EMS.


medicsb said:


> As far as DCFD vs. DCFEMS.   I think a department should generally represent what it does in its name.  The majority of large city fire departments primarily do EMS yet they do not include it in their name (I don't think "rescue" counts).  They should change their names in my opinion.  I'm glad DCFD did.  They did the right thing.  If they don't want to acknowledge that EMS is their primary job, then they should get out of the EMS business.


ehhhh, in the grand scheme of things, I think there are bigger battles to fight, but I think that most large city fire departments are actually EMS departments that fight fires, instead of Fire departments that do EMS, and their names should reflect accordingly....

of course, they could always separate the EMS department, fund it properly from taxes, and reduce the wear and tear on all the fire department vehicles, and you can send an ambulance to a medical emergency instead of a non-transporting fire vehicle.  but that's neither here nor there.


----------



## BLSBoy

medicsb said:


> Hmmm, I think I know where you worked and which medic unit you are talking about though I could be wrong.  I worked in South Jersey and we had one truck that ran like said (though 30 would be an exaggeration).  If you responded to 20 in a shift (which might be more characteristic of a day shift), you treated 4-6 on average and split that with your partner.  Sure, on some days you treated more.  In my experience, it was uncommon that night shift stayed later than 8 for charting, but pretty common for those on day shift, sure.  Also, the equipment there was pretty good.  It got beat-up, but that happens when the medic units run 3000-9000 calls in per year.  I don't recall there being shady billing practices.  After-all they don't bill for refusals (even diabetics that get treated) or for pronouncements (even if you worked them first).  I'm sure we would agree on many things being wrong with NJ EMS and many problems with the hospital system in particular that I'm pretty sure you are talking about (the one over the bridge from Philly).
> 
> Anyhow, as far as union protection... The past year has shown that many workers are getting the axe despite "union protection".  Though I believe in unions, the MICUs in NJ have not cut staffing anywhere.  At most, I remember a few had hiring freezes for a period of time.  The fire services and municipal EMS services in many places were cut or nearly cut.
> 
> Anyhow, I don't really blame you for choosing to move and get a union job at a place that is slower and that has more progressive protocols.  But, your blanket statements about fire-based EMS being superior rings hollow when one considers all the different systems and the ones that have been shown to be successful.  Also, if you just wanted to be a public worker protected by a union, why not just jump the bridge to Philadelphia and join PFD?
> 
> As far as DCFD vs. DCFEMS.   I think a department should generally represent what it does in its name.  The majority of large city fire departments primarily do EMS yet they do not include it in their name (I don't think "rescue" counts).  They should change their names in my opinion.  I'm glad DCFD did.  They did the right thing.  If they don't want to acknowledge that EMS is their primary job, then they should get out of the EMS business.



Medic 6 in AC, one random weekend, we got SPANKED. All weekend long. 20 was the minimum, 30 was the busiest. I left quarters at 1030, just catching up on charts. 
Some nights were slow, others busier. All depends on how good your BLS is, and how restless the natives decide to get. 

I don't say that fire based EMS is better, per se. I am lucky enough to be in a pretty progressive area, but the quality of the care all depends on the quality of the provider. PFD and DCFD are prime examples of how to do it wrong. They are also areas where you treat few human beings, and more animals. I challenge any dept, 3rd service, or a tack on to FD or PD to provide better care when you have hundreds of animals calling for all sorts of ailments that are non life threatening during peak service hours. It is nearly impossible to properly staff, fund, stock, and service that many units and still not tax the hell out of the citizens. 

I enjoy having a representative with me when there is even so much as a threat of disciplinary action against me, who knows the laws, regulations, and contracts inside and out, so I won't be railroaded. Yes, this protects slugs, and it angers me to no end, but it HAS protected my hide against a very vindictive officer who does not like certain people. I also enjoy a bed at night and when I need a power nap, decent workout equipment so I can keep myself in shape, so I lessen my chances of injuring myself on duty, and stay healthy for my entire career. 

I really would LOVE to engage in a NJ EMS debate with everyone who has a stake in it, but they usually turn into a paid vs volly, who is to blame fest, and people get spanked by admins, threads get locked, and feelings get hurt. If we can all try to behave, I think we can try again.


----------



## medicsb

BLSBoy said:


> Medic 6 in AC, one random weekend, we got SPANKED. All weekend long. 20 was the minimum, 30 was the busiest. I left quarters at 1030, just catching up on charts.
> Some nights were slow, others busier. All depends on how good your BLS is, and how restless the natives decide to get.



My apologies for assuming you had worked where I worked.  I can't comment on AC.  Medic 43 in Camden runs almost non stop, but they generally see about 25-30% of the patients they're dispatched, which is probably why most medics didn't complain all that much about it.  Actually, most medics seemed to enjoy working there.  



> I don't say that fire based EMS is better, per se. I am lucky enough to be in a pretty progressive area, but the quality of the care all depends on the quality of the provider. PFD and DCFD are prime examples of how to do it wrong. They are also areas where you treat few human beings, and more animals. I challenge any dept, 3rd service, or a tack on to FD or PD to provide better care when you have hundreds of animals calling for all sorts of ailments that are non life threatening during peak service hours. It is nearly impossible to properly staff, fund, stock, and service that many units and still not tax the hell out of the citizens.



Maybe you were speaking for your area, but you were strongly implying that fire-based EMS is somehow superior.  I basically threw PFD out there as a rebuttal.  Anyhow, referring to private services as scabs was over-the-top, especially considering that it is part of the IAFF an IAFC agenda to take over EMS anywhere it can by undermining present EM services of all kinds in order to take over. (I know you said you are not IAFF; I was using them as an example.) I don't doubt that there are private services scabbing FDs or other EM services, but there are plenty of FDs hellbent on scabbing EMS.  To call private services "scab" creates a "pot calling the kettle black" scenario.       




> I really would LOVE to engage in a NJ EMS debate with everyone who has a stake in it, but they usually turn into a paid vs volly, who is to blame fest, and people get spanked by admins, threads get locked, and feelings get hurt. If we can all try to behave, I think we can try again.



I think you and I would agree on most things overall, though I do not think it is as bad many people think (particularly outsiders).  And conversely, I don't think it is as good as some "insiders" seem to think (e.g. some EMTs and medics who have never worked outside NJ).  But, ultimately, I probably (literally) don't have the time to participate in such a debate.  I hardly have time to reply to anything here.


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## BLSBoy

Timing couldn't be better. An actually fairly nonbiased article. 
http://www.firefighternation.com/forum/topics/forprofit-ems-finds-opposition


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## ilemtbwantn2bTXEMT-P

I have lived in Chicago most of my life and been to DC and New York. The Chicago Fire Department has said time again its always Tradition unimpeded by progress. I have also worked in Private EMS alongisde Chicago Firefighters who would be just as ticked as the DC Guys are. The Fire Service and EMS are similar yes but you can be a Fire Department and have EMS Service without changing your name. If the budget cuts aren't enough in lowering pay and causing layoffs meaning less manpower heck some cities are closing firehouses ot save money. How is changing thier name saving any money or helping any budgeting crisis be solved. They've been known as DCFD for years just the same as Chicago has been CFD and New York FDNY. Both of those cities have EMS heck Chicago is going fully ALS across the board now Engones, Squads, and Trucks inlcuded not just all the Ambulances and theyre still the CFD. Progress doesn't mean throw out tradition. Tradition is something everyone in the Fire Service takes a lot of pride in, so yeah DCFD has all the right to be pissed and if they gotta chnage their name why shouldn't the cops be changing their's too. The bottom line is Big City Firemen love tradition and when you threaten that you also are thretaening alot of what the fireman stands for. And for those of you who say the Union sare bad and dumb consider this the IAFF IAFC and FOP the public safety unions do more for the citizens than most of the city governments do from St. Baldricks to Fill the Boot for Jerry's Kids and their the voices of the responders when the goevernment doesn't give a hoot about anyone or anything but themselves and their agendas, which lately seem a alot important than the welfare and safety of the public.


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## Veneficus

ilemtbwantn2bTXEMT-P said:


> I have lived in Chicago most of my life and been to DC and New York. The Chicago Fire Department has said time again its always Tradition unimpeded by progress. I have also worked in Private EMS alongisde Chicago Firefighters who would be just as ticked as the DC Guys are. The Fire Service and EMS are similar yes but you can be a Fire Department and have EMS Service without changing your name. If the budget cuts aren't enough in lowering pay and causing layoffs meaning less manpower heck some cities are closing firehouses ot save money. How is changing thier name saving any money or helping any budgeting crisis be solved. They've been known as DCFD for years just the same as Chicago has been CFD and New York FDNY. Both of those cities have EMS heck Chicago is going fully ALS across the board now Engones, Squads, and Trucks inlcuded not just all the Ambulances and theyre still the CFD. Progress doesn't mean throw out tradition. Tradition is something everyone in the Fire Service takes a lot of pride in, so yeah DCFD has all the right to be pissed and if they gotta chnage their name why shouldn't the cops be changing their's too. The bottom line is Big City Firemen love tradition and when you threaten that you also are thretaening alot of what the fireman stands for.



Firefighters are public servants, nobody gives a crap about what they think of traditions. 

Being a firefighter is not a right despite what some think. 

I think the issue at hand is that the EMS provided in DC has failed several times in very high profile public ways. The attempt at integrating EMS into the fire mission there is not going well and a name change is part of the strategy to start a stronger push into motivating the rank and file into acceptance.

The purpose of a public servant is to serve the mission the public pays for, not define their own.


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## ilemtbwantn2bTXEMT-P

No no yeah I agree with you in that they need to serve to public. However my point was more that FDNY and CFD get  it done perfectly fine heck sometimes they pull off extraodrinary things like CFD with the blizzard, and still get it done whether its Fire or EMS. If it doesn't work well with EMS being part of Fire in DC then don't have it be have a spereate agency for EMS and leave Fire as Fire. Their intertwined and yes we're all public servants but at the same time is it right for us as responders to become some pawn in a spending battle, when we're all mostly there just becuase we wanna help people. Traditions are a huge part of all that though, from the Pipes and Drums at a LODD Funeral to the Maltese Cross to just the words Fire Department and Firefighter even our helmets hold tradition. Like it or not Tradition is what the Fire Service is really known by, the Tradition of being there to help when your house is on fire or your in a car wreck. From the Steam Engines to The Pierces and E-Ones and Ambulances of today that Tradition is one that will never go away.


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## usalsfyre

Tradition is not always a good thing. Hundreds of years of tradition unimpeded by progress is a good part of the reason the fire service continues to kill 100+ people a year.


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## ilemtbwantn2bTXEMT-P

usalsfyre said:


> Tradition is not always a good thing. Hundreds of years of tradition unimpeded by progress is a good part of the reason the fire service continues to kill 100+ people a year.



True its not always good but it is a part of this line of work never the less


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## BLSBoy

usalsfyre said:


> Tradition is not always a good thing. Hundreds of years of tradition unimpeded by progress is a good part of the reason the fire service continues to kill 100+ people a year.



Or its 70 year old volunteers having MIs from being awoken by tones, 18 year old volunteers who drive like morons in their POV and crash. While our LODD yearly totals stay the same, we have also expanded what is known as an LODD. Poor example.


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## Veneficus

BLSBoy said:


> Or its 70 year old volunteers having MIs from being awoken by tones, 18 year old volunteers who drive like morons in their POV and crash. While our LODD yearly totals stay the same, we have also expanded what is known as an LODD. Poor example.



To my knowledge,

MI and vehicle accidents have been the leading causes of firefighter death since my career started in 89.

Unless something has changed dramatically that I haven't heard about, while not directly related to fireground or rescue operations, I think that it speaks volumes about the situational awareness and a culture that does not place a premium on the aweness of the hazards or the safety of all aspects of the job. 

In that respect, it is no different from the initial EMS only training of scene safety.


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## BLSBoy

When you have poor, rural areas where there is apathy/no time available from younger members of the community, and thats all they can afford, then there is no choice for the community. 
I think it is nothing short of a disgrace that we need to rely on those that should be retired and enjoying time with family to respond to emergencies. Until we can get yearly NFPA physicals for every member, every year, we will continue to have an abnormally large number of LODDs.


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## Aidey

ilemtbwantn2bTXEMT-P said:


> Progress doesn't mean throw out tradition. Tradition is something everyone in the Fire Service takes a lot of pride in, so yeah DCFD has all the right to be pissed and if they gotta chnage their name why shouldn't the cops be changing their's too. The bottom line is Big City Firemen love tradition and when you threaten that you also are thretaening alot of what the fireman stands for.


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## medicsb

ilemtbwantn2bTXEMT-P said:


> I have lived in Chicago most of my life and been to DC and New York. The Chicago Fire Department has said time again its always Tradition unimpeded by progress. I have also worked in Private EMS alongisde Chicago Firefighters who would be just as ticked as the DC Guys are. The Fire Service and EMS are similar yes but you can be a Fire Department and have EMS Service without changing your name. If the budget cuts aren't enough in lowering pay and causing layoffs meaning less manpower heck some cities are closing firehouses ot save money. How is changing thier name saving any money or helping any budgeting crisis be solved. They've been known as DCFD for years just the same as Chicago has been CFD and New York FDNY. Both of those cities have EMS heck Chicago is going fully ALS across the board now Engones, Squads, and Trucks inlcuded not just all the Ambulances and theyre still the CFD. Progress doesn't mean throw out tradition. Tradition is something everyone in the Fire Service takes a lot of pride in, so yeah DCFD has all the right to be pissed and if they gotta chnage their name why shouldn't the cops be changing their's too. The bottom line is Big City Firemen love tradition and when you threaten that you also are thretaening alot of what the fireman stands for. And for those of you who say the Union sare bad and dumb consider this the IAFF IAFC and FOP the public safety unions do more for the citizens than most of the city governments do from St. Baldricks to Fill the Boot for Jerry's Kids and their the voices of the responders when the goevernment doesn't give a hoot about anyone or anything but themselves and their agendas, which lately seem a alot important than the welfare and safety of the public.



I don't have any sympathy when it comes to what they're called.  If the majority of their work is EMS, then, like I have said, their name should reflect that along with the command structure.  I doubt CFD or FDNY will change their name anytime soon, but I think that they should (not that it really matters to them what I think).  Also, if CFD (OR DCFEMS or any other all-ALS FD) wants to save money, they'll start with axing the ALS component of their engines and ladders.  There is NO EVIDENCE to show that ALS engines in addition to ALS ambulances has ANY impact on morbidity and mortality.  ALS engine increase wear and tear on the apparatus, increase cost through wages, increase cost through equipment purchase and maintenance, increase cost through increased requirements for con. ed., increased cost for increased medical oversight, and so on.  All the cost without anything to show for it. What has been shown to be beneficial?  Training fire fighters to do CPR and use an AED - that's it.  

Probably the greatest tradition of FD is "brotherhood".  No name change can take that away.  The ONLY thing I can think of that should delay a name change is the economy, as it will cost A LOT of money to change all the uniforms and to resticker all of the apparatus.  Other than that, there is no reason not to change the name.


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## Jon

And with the name change comes a new motto. "DC FEMS: hey! At least we aren't Detroit!"


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## HotelCo

Jon said:


> And with the name change comes a new motto. "DC FEMS: hey! At least we aren't Detroit!"



?


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## DrParasite

HotelCo said:


> ?


a cheap shot about regardless of how bad DC EMS is, Detroit EMS is still run much poorly


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