# Why don't some like the fire mix?



## JWalters (Sep 27, 2014)

I have noticed a few people on here say that they feel that fire and EMS should not be mixed, in terms of being a ff and an EMT/P. I'm curious as to why. Or if you think they are a great mix, I'd like to know why you feel that way as well.

I was thinking of joining our FD and doing the state FF 1/2 training but my primary focus, over the next couple year, is getting through a medic program.


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## ghost02 (Sep 27, 2014)

I don't go to home depot for computers.


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## JWalters (Sep 27, 2014)

ghost02 said:


> I don't go to home depot for computers.



Well, me either. 

Ok, to be more specific...I've seen people flat out say that they think having both an EMT cert as well as a FF cert is a bad idea. Where I live, all of our municipal ambulances are run out of FD's. I'm just curious as to what is so "bad" about it, especially if you live in an area where the EMS/FD often is run under one direction. I see it as a way to make a greater contribution to my community....or maybe I am just delusional.  That is entirely possible.


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## sjukrabilalfur (Sep 27, 2014)

Just a small-sample anecdote.

When I was a student and doing clinicals with [unnamed urban midwestern fire/rescue service], the FF/Medics all vastly preferred being on the pumper to being assigned to the ambulance. They seemed like cool guys, and they weren't derelicts on the ambulance, but they treated it as a chore, or just something they just sort of had to do to get to their next pumper shift and it showed in how they handled their calls. I don't know if that's indicative of how all FF/Medics approach the ambulance side, but if it is, I'd rather the services be separated.


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## avdrummerboy (Sep 27, 2014)

^^^^^ THAT ^^^^^

Most guys that I know that go fire do it because they want to be the hero firefighter guy fighting fires and cutting things apart, most see running med aid calls as just a chore, something that has to be done because they are told to do it. My belief, at least where I'm at, fire dept. should be FF/ First responder trained, and respond only to fire/ rescue calls, not every call that goes out!


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## JWalters (Sep 27, 2014)

Interesting. Yeah, I can see why people would feel that way if these were their experiences.


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## MrJones (Sep 27, 2014)

The individual-level issues are summarized nicely above. At the organizational level, too many fire departments use the EMS side to justify their budgets, yet the EMS side usually endures second-hand citizen status. At some point the IAFC will have to accept the obvious and direct that dual services be referred to as EMS-based fire services.


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## chaz90 (Sep 27, 2014)

I believe in becoming truly proficient at one skill rather than passable at two. I think some can become competent in both, but the majority are only really interested in doing one and are thus a liability while functioning in the other role despite what their PR machine says. I don't want a paramedic forced to be a firefighter coming in to my burning house, and I don't want a firefighter forced to be a paramedic treating my critically ill grandmother.

My caveat to that is I don't always disagree to FF training to a BLS level and first responding on certain calls. All ALS care (true paramedic level) though should be provided by a dedicated single role provider.


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## Rialaigh (Sep 27, 2014)

I find that most people that express "dislike" for the ff/ems mix may have a valid reason or two to have that dislike but generally have a dozen reasons that just don't make sense.

From the vast majority of budget, management, and training standpoints it makes a lot of sense to combine the two entirely. From a call numbers stand point it makes sense to combine the two. From almost all tangible measurements it makes sense to run the two as one service.

Unless EMS can quickly and effectively transition into prehospital community medicine and show value in that I think fire based EMS will become more prevalent very rapidly. Even if EMS transitions into community paramedicine effectively I am not so sure that the 911 portion wouldn't be better managed as a combined EMS/Fire service and that paramedics working prehospital community paramedicine would function better working directly with hospitals as opposed to their EMS services.


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## JPINFV (Sep 27, 2014)

I don't want a plumber practicing medicine.


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## Handsome Robb (Sep 28, 2014)

Some might not think it's a valid reason but we're one of if not the only nations that combines EMS and Fire and have one of the worst EMS systems of "first world" countries.

Don't get me wrong, some FDs do EMS very well but it is not the norm.


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## TransportJockey (Sep 28, 2014)

Handsome Robb said:


> Some might not think it's a valid reason but we're one of if not the only nations that combines EMS and Fire and have one of the worst EMS systems of "first world" countries.
> 
> Don't get me wrong, some FDs do EMS very well but it is not the norm.


We also have the lowest standards of entry into the field of any of the developed countries. There's a reason us ems is looked down on


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## MrJones (Sep 28, 2014)

Rialaigh said:


> I find that most people that express "dislike" for the ff/ems mix may have a valid reason or two to have that dislike but generally have a dozen reasons that just don't make sense.
> 
> From the vast majority of budget, management, and training standpoints it makes a lot of sense to combine the two entirely. From a call numbers stand point it makes sense to combine the two. From almost all tangible measurements it makes sense to run the two as one service.
> 
> Unless EMS can quickly and effectively transition into prehospital community medicine and show value in that I think fire based EMS will become more prevalent very rapidly. Even if EMS transitions into community paramedicine effectively I am not so sure that the 911 portion wouldn't be better managed as a combined EMS/Fire service and that paramedics working prehospital community paramedicine would function better working directly with hospitals as opposed to their EMS services.


And I find that most people that express "like" for the FF/EMS mix are either FFs for whom becoming an EMT or Medic was the cost of admission to join their local fire department or fire department leaders who are riding the back of EMS to keep their departments solvent.

Makes sense from a budget, management and training standpoint? Show me a study not sponsored by the IAFF, IAFC or any other entity with a vested interest in the fire side that demonstrates that to be the case. From a call numbers stand point? Only if you are using EMS calls, which now typically account for upwards of 80% of a Fire/EMS system's calls, to justify the budget for the fire side of the system. Almost all tangible measurements? What other measurements are there that might make your case?

Ultimately, the only measurement that truly matters is the level of care provided by a system and that is a direct measure of the competence (which is the sum of the education, training and experience) of the EMTs and Paramedics providing that care. Prove to me - empirically, not anecdotally - that the typical fire system provides a higher level of care than a typical third service and you might convince me. Otherwise, your simply regurgitating IAFF/IAFC propaganda.

/soapbox


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## Rialaigh (Sep 28, 2014)

MrJones said:


> And I find that most people that express "like" for the FF/EMS mix are either FFs for whom becoming an EMT or Medic was the cost of admission to join their local fire department or fire department leaders who are riding the back of EMS to keep their departments solvent.
> 
> Makes sense from a budget, management and training standpoint? Show me a study not sponsored by the IAFF, IAFC or any other entity with a vested interest in the fire side that demonstrates that to be the case. From a call numbers stand point? Only if you are using EMS calls, which now typically account for upwards of 80% of a Fire/EMS system's calls, to justify the budget for the fire side of the system. Almost all tangible measurements? What other measurements are there that might make your case?
> 
> ...



This is flat out not even close to the only measurement that matters. The goal is ultimately a higher level of care but the costs associated with that are very important. Making a blanket statement like "better care at any cost" is just not an appropriate or responsible way to look at healthcare of any level. 

I do not at the moment have the time to respond in full but I will be more then happy to discuss this later tonight when I have the time to put together a well thought out post.


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## MrJones (Sep 28, 2014)

Rialaigh said:


> This is flat out not even close to the only measurement that matters. The goal is ultimately a higher level of care but the costs associated with that are very important. Making a blanket statement like "better care at any cost" is just not an appropriate or responsible way to look at healthcare of any level.
> 
> I do not at the moment have the time to respond in full but I will be more then happy to discuss this later tonight when I have the time to put together a well thought out post.


Feel free to put together a well thought out post, but I've made my point and I stand by it.


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## SandpitMedic (Sep 28, 2014)

An intelligent debate is about to be had.


(Back to the peanut gallery)


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## Rin (Sep 29, 2014)

FD's are still fairly homogenous.  Many are still good ol' boys clubs.  Friends with the mayor/chief/etc?    Welcome to the head of the hiring line.  Female?  Good luck with that dual role.  There will always be 50 guys bigger and stronger than you who are better suited to pulling people out of structure fires. 

This is especially problematic in multicultural areas.  When all your FF brothers are like you, but the patients you respond to are poor people/females/minorities having a bad day, it only nurtures the little prejudices lurking in your mind.  

This can impact the conclusions reached from assessment of those patients, and the treatment of those patients, especially by lazy or reluctant providers eager to get back to fooling around at the station.

Female patients can also be reluctant to share embarrassing medical details with men, especially if the men are young, especially if they show up with half a dozen male crew members (as happens in places that have a pumper also respond).

FireEMS is ultimately a concept that's only good on paper.  You can't ignore the human factor in a business that's all about people.


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## 46Young (Sep 29, 2014)

sjukrabilalfur said:


> Just a small-sample anecdote.
> 
> When I was a student and doing clinicals with [unnamed urban midwestern fire/rescue service], the FF/Medics all vastly preferred being on the pumper to being assigned to the ambulance. They seemed like cool guys, and they weren't derelicts on the ambulance, but they treated it as a chore, or just something they just sort of had to do to get to their next pumper shift and it showed in how they handled their calls. I don't know if that's indicative of how all FF/Medics approach the ambulance side, but if it is, I'd rather the services be separated.



I did my first five years a tiered single role EMS system. Back then, I was 100% about EMS, and had no doubt that I wanted to be on the street for 20-30 years doing ALS 911 txp. Then, the job started getting to me - having to post on street corners, no sleep or downtime, mandatory forced OT, constantly interrupted meals (sitting down for dinner three times and still not eating - that type of thing), and people calling for every little thing (missed lunch to run a call for a kid with head lice once), and most importantly, for not enough money. There's also the boredom/frustration factor that there's no realistic career ladder, so street EMS txp is really the only thing most of us could do for their entire career.

So, I went to fire based EMS. At that time, being a medic was what I still liked doing the most, but fire had interested me for some time. The real reason for the jump was because I needed to do something different than just ambulance txp day in and day out, with better benefits and pay. So, it becomes frustrating when you want to do more than just transport, but keep getting moved back to the ambulance repeatedly. After some time, you just get tired of wasting your time running non-acute calls, missing drills, meals, PT, and sleep. The engine is back in service in 20 minutes, but if you're transporting, you know that it's going to be an hour to an hour and a half until you can get back to the station, if you can avoid a second call on the road. I think that it's the lack of relative downtime that breeds resentment towards ambulance work. There are many other medics like me that started single role and then went fire. They all say that they would never go back to single role. They also all say that at one time they liked being medics, but that it was beat out of them by having to ride the ambulance most of the time, typically running people all day and night with minor issues that don't really need an emergency room. There's also the QA/QI thing - medics on the ambulance have much, much more to worry about than someone who rides backwards on the engine.

More or less, I feel the same way as these other dual role medics. I get a good ALS call once in a blue, and I truly enjoy those type of calls, but I have no use for the 90%+ mundane calls that keep us out of the station all day. As a result, I prefer to be off of the ambulance as much as possible, to do other things and once again look forward to coming to work. The good calls are too infrequent to make it worth it to do a tour on an ambulance - we're an all-ALS txp system, so we run everything. It's a lousy feeling to be taking a beating on the ambulance day in and day out when everyone else in the station gets to go back in service, enjoy downtime, and get things done throughout the day. I've seen some hardcore medics grow to resent the ambulance for these reasons.

Also, let's not forget that even in single role EMS, there are plenty of people that resent ambulance txp. EMS is a stepping stone job for a lot of people, because it pays well enough to pay for room and board while they work towards a better career. Average single role EMS burnout is 7-10 years for a reason. This resentment and burnout is hardly just a fire service thing. It's just that in the fire service, there's other paths to choose to get out of txp. Resentment develops when the employee is denied the opportunity to pursue those paths.


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## BEN52 (Sep 29, 2014)

I would like to add a couple of points here based upon my experience working in a variety of systems; full time fire based EMS, private contract EMS, and muncipal third service as well as an ER paramedic in a facility greeting EMS providers from all types of systems.

First and foremost there are bad providers in all systems, nobody is immune. Secondly it seems to me that third service systems are judged based upon there shining stars such as Wake County and Austin / Travis County whereas fire based systems are judged upon the systems generating negative press.

For many suburban communities fire based ems makes sense because it allows for properly staffed fire and ems response. If they where to be seperate im not sure the money would be there. The paid fire service has established funding mechanisms in place. EMS as a whole does not.

As a provider who likes both disciplines but would pick EMS if I could only pick one I chose fire based EMS because it offers a stable and well compensated career with legitimate upward mobility. There are not many EMS only gigs that will pay me a nice salary with a sound pension and good benefits. I work 8-9 days a month and make north of 70k a year with a 25 year pension. As a family man that is important. As a provider I work out of a comftorable station with clean and ample living quarters, laundry facilities, a fully equiped kitchen, and an ample weight room. This may not seem like much but none of my EMS only jobs had this. I spend my downtime in comfort as opposed to a street corner. I am given safe and modern equipment. My agency has a pretty decent in house EMS training program in conjunction with our medical control hospital. I am also offered the opportunity to attend just about any outside training course free of charge and on the clock.


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## vcuemt (Sep 29, 2014)

BEN52 said:


> I would like to add a couple of points here based upon my experience working in a variety of systems; full time fire based EMS, private contract EMS, and muncipal third service as well as an ER paramedic in a facility greeting EMS providers from all types of systems.
> 
> First and foremost there are bad providers in all systems, nobody is immune. Secondly it seems to me that third service systems are judged based upon there shining stars such as Wake County and Austin / Travis County whereas fire based systems are judged upon the systems generating negative press.
> 
> ...


I think you're illustrating the points of those who are anti-fire-based-EMS.


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## 46Young (Sep 29, 2014)

BEN52 said:


> I would like to add a couple of points here based upon my experience working in a variety of systems; full time fire based EMS, private contract EMS, and muncipal third service as well as an ER paramedic in a facility greeting EMS providers from all types of systems.
> 
> First and foremost there are bad providers in all systems, nobody is immune. Secondly it seems to me that third service systems are judged based upon there shining stars such as Wake County and Austin / Travis County whereas fire based systems are judged upon the systems generating negative press.
> 
> ...




+1, my sentiments exactly

I wouldn't be surprised if we worked at the same place. You've described my department pretty well.


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## Carlos Danger (Sep 29, 2014)

BEN52 said:


> As a provider who likes both disciplines but would pick EMS if I could only pick one I chose fire based EMS because it offers a stable and well compensated career with legitimate upward mobility. There are not many EMS only gigs that will pay me a nice salary with a sound pension and good benefits. I work 8-9 days a month and make north of 70k a year with a 25 year pension. As a family man that is important. As a provider I work out of a comftorable station with clean and ample living quarters, laundry facilities, a fully equiped kitchen, and an ample weight room. This may not seem like much but none of my EMS only jobs had this. I spend my downtime in comfort as opposed to a street corner. I am given safe and modern equipment. My agency has a pretty decent in house EMS training program in conjunction with our medical control hospital. I am also offered the opportunity to attend just about any outside training course free of charge and on the clock.



Sounds like a great job. If I could get politicians to extort enough money from the taxpayers to pay me $70k a year plus benefits & retirement in exchange for 2 days per week worth of work - much of which I spent watching TV or sleeping - I'd like my job whole lot, too.

But liking my job doesn't make an economic or patient-oriented argument for it. I'd need to do much better than brag about how good I have it if I wanted to convince others that the model itself was superior.

I'm not personally against fire-based EMS; I am for the most efficient and effective delivery model. I don't see how increasingly complex medicine fits into a firefighter-based system, and I don't see how responding to a chest pain call with 8 personnel and a half-million dollar piece of fire apparatus that is incapable of transporting a patient is efficient, but I am open to being convinced.


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## Angel (Sep 29, 2014)

Rin said:


> FD's are still fairly homogenous.  Many are still good ol' boys clubs.  Friends with the mayor/chief/etc?    Welcome to the head of the hiring line.  Female?  Good luck with that dual role.  There will always be 50 guys bigger and stronger than you who are better suited to pulling people out of structure fires.
> 
> This is especially problematic in multicultural areas.  When all your FF brothers are like you, but the patients you respond to are poor people/females/minorities having a bad day, it only nurtures the little prejudices lurking in your mind.
> 
> ...



THIS.

@46Young , I also agree with you as I did some Fire based EMS for internship and being on the medic getting beat to crap day in and day out does wear on you. but at the same time, once seniority is built up, those guys dont have to rotate to the medic if they dont want to. posting does suck, for 10-12 hour shifts though, i guess its doable.

on the other hand, if EMS was more how fire was (I think (atleast) where @LACoGurneyjockey) works, itd be better. Station based EMS, unrelated to fire. Would that change your mind then?

If as a Medic, I could have station based EMS, the same or similar benefits, pay, retirement I would never consider moving to the fire side. Since none of that exists (yet) I am pursuing fire so when im in my 30's and 40's I can have better job satisfaction. 

so I agree with Rin as to why NOT have fire based EMS, and agree with 46Young as to why TO have fire based EMS. I think egos (and unions) are too strong to ever make it the perfect/ideal situation for both. Where Medics arent forced to do suppression and vice versa.


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## sjukrabilalfur (Sep 29, 2014)

46Young said:


> I did my first five years a tiered single role EMS system. Back then, I was 100% about EMS, and had no doubt that I wanted to be on the street for 20-30 years doing ALS 911 txp. Then, the job started getting to me - having to post on street corners, no sleep or downtime, mandatory forced OT, constantly interrupted meals (sitting down for dinner three times and still not eating - that type of thing), and people calling for every little thing (missed lunch to run a call for a kid with head lice once), and most importantly, for not enough money. There's also the boredom/frustration factor that there's no realistic career ladder, so street EMS txp is really the only thing most of us could do for their entire career.
> 
> So, I went to fire based EMS. At that time, being a medic was what I still liked doing the most, but fire had interested me for some time. The real reason for the jump was because I needed to do something different than just ambulance txp day in and day out, with better benefits and pay. So, it becomes frustrating when you want to do more than just transport, but keep getting moved back to the ambulance repeatedly. After some time, you just get tired of wasting your time running non-acute calls, missing drills, meals, PT, and sleep. The engine is back in service in 20 minutes, but if you're transporting, you know that it's going to be an hour to an hour and a half until you can get back to the station, if you can avoid a second call on the road. I think that it's the lack of relative downtime that breeds resentment towards ambulance work. There are many other medics like me that started single role and then went fire. They all say that they would never go back to single role. They also all say that at one time they liked being medics, but that it was beat out of them by having to ride the ambulance most of the time, typically running people all day and night with minor issues that don't really need an emergency room. There's also the QA/QI thing - medics on the ambulance have much, much more to worry about than someone who rides backwards on the engine.
> 
> ...



I appreciate what you have to say about that. I'm still fresh and my experiences with other services is really limited. That's also why I wanted to make sure to point out that everyone I rode with was still highly proficient. I can see how ambulance days may raise the concern about being another small brick in the burnout wall for someone working in the fire services and I'll make sure I keep all of that in mind.


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## JWalters (Sep 29, 2014)

Rin, your post was pretty much why I was thinking FOR the mix of two. If I had to choose one In would never choose fire, but I have entertained the notion on a number of occasions as a secondary thing because of the reasons described. We have an all male department right now, except for one EMT who does no fire work. We had a female ff several years back but she moved away. So I look at it not as an ego thing but I think that I would be a good, relatable responder to women, children, etc. in a fire or rescue response situation.

On a side note, I really didn't realize this was such a hot topic. I appreciate all the good insight, though.


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## 46Young (Sep 29, 2014)

Remi said:


> Sounds like a great job. If I could get politicians to extort enough money from the taxpayers to pay me $70k a year plus benefits & retirement in exchange for 2 days per week worth of work - much of which I spent watching TV or sleeping - I'd like my job whole lot, too.
> 
> But liking my job doesn't make an economic or patient-oriented argument for it. I'd need to do much better than brag about how good I have it if I wanted to convince others that the model itself was superior.
> 
> I'm not personally against fire-based EMS; I am for the most efficient and effective delivery model. I don't see how increasingly complex medicine fits into a firefighter-based system, and I don't see how responding to a chest pain call with 8 personnel and a half-million dollar piece of fire apparatus that is incapable of transporting a patient is efficient, but I am open to being convinced.



If I was more concerned with just having good protocols/guidelines/equipment but with mediocre pay I would focus my efforts on places like Wake Co. and Charleston County. Just be prepared to be stuck in a lower middle class pay scale, which also means that your retirement will be modest, which means that you can't take it and move somewhere cheaper, because you're already living there. Where work is concerned, I'm looking at pay/benefits first, and then I'm going to focus on the best departments that offer that.


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## 46Young (Sep 29, 2014)

Angel said:


> THIS.
> 
> @46Young , I also agree with you as I did some Fire based EMS for internship and being on the medic getting beat to crap day in and day out does wear on you. but at the same time, once seniority is built up, those guys dont have to rotate to the medic if they dont want to. posting does suck, for 10-12 hour shifts though, i guess its doable.
> 
> ...



I spent 6 months in a station based third service municipal EMS department before I went to fire. Yes, we had stations, beds, a kitchen, living room etc. but we were hardly ever there to use the facilities. I tried to bring my lunch and dinner to work, but we would be stuck out on the road for hours, with my food spoiling in the microwave or drying out in the oven. We worked a 24/48 w/o kellys, with very frequent 12 and 24 hr. holdovers. There was the same lack of a career ladder that is problematic in EMS in general. At my current employer, I've had one promotion already, and I'm studying for the next promo. exam that's being held this winter. If I had stayed in single role EMS, there's a 95% chance that I would still be on an ambulance, with no raises other than step increases. 

The problem with non fire based EMS is that most places put out barely enough ambulances to cover normal call volume, and hire barely enough people to staff them. This results in busy tours and frequent holdover OT. A lot of places just burn through their people and replace them with new ones. No place is going to put out extra ambulances and hire more people just so that the units can be less busy. Their solution is to enter into automatic aid/mutual aid agreements as a fix, or far worse - System Status Management/PUM.

Besides the lack of a career ladder and poor pay, what ruined single role EMS for me was the high call volume. I'm not saying that we should just screw off all day and run two calls. What I am saying is that on a 24 hour shift, it should be understood that some on-the-clock sleep should occur. IMO this should amount to a minimum of four hours sometime between 2200 and 0600, preferably more. If it's a busy urban system, then the shifts should be 8's and 12's, with perhaps a day/evening 16 at the most. With these shorter shifts, dedicated off-the-air OOS meal breaks need to be implemented, just like employees in other industries. No more eating breakfast at 2 in the afternoon and dinner at 1 in the morning, and no more grabbing fast food because that's what's available on the road, and having to eat it on the road like damn animals. In my fire based experience, employees have options to get off of the box, and do something else entirely. Just off the top of my head, there's EMS training for the field and the academy, fire training, various suppression apparatus, Hazmat, Tech Rescue, Peer Fitness, and many promotional opportunities in and out of the field.


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## 46Young (Sep 29, 2014)

Remi said:


> Sounds like a great job. If I could get politicians to extort enough money from the taxpayers to pay me $70k a year plus benefits & retirement in exchange for 2 days per week worth of work - much of which I spent watching TV or sleeping - I'd like my job whole lot, too.
> 
> But liking my job doesn't make an economic or patient-oriented argument for it. I'd need to do much better than brag about how good I have it if I wanted to convince others that the model itself was superior.
> 
> I'm not personally against fire-based EMS; I am for the most efficient and effective delivery model. I don't see how increasingly complex medicine fits into a firefighter-based system, and I don't see how responding to a chest pain call with 8 personnel and a half-million dollar piece of fire apparatus that is incapable of transporting a patient is efficient, but I am open to being convinced.



Don't forget that dual role providers are subject to FLSA, where time and a half only starts at 212 hours over a four week period, or 53 hours a week. The 48 hour guy has to do five more hours of straight time before getting OT pay. My system has a 56 hour workweek, similar to a 24/48. A $70k/yr salary equates to around $23/hr as a base, less if you have night diff. added. In NYC I was making $30/hr as a medic on a 40 hour workweek, non FLSA. Getting me for $70k/yr where my hourly is only $23/hr and OT starts on the 54th hour is a real bargain IMO. It's even more beneficial to the employer because for every five 56 hour employees hired, they would have to hire seven forty hour employees to have the same coverage. That saves benefits/retirement etc.for two employees on every five. 

Really, any single role medic that works a 56 hour week for less than $50k/yr to start is getting ripped off, and should look to trade up for a better department ASAP. %50k/yr is around $16/hr for an FLSA employee. I shudder to think what the hourly rip=off rate is for a medic starting at around $35k as is common in the Carolinas (I think this includes Wake Co.).


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## Tigger (Sep 29, 2014)

There is nothing inherently wrong with fire based EMS, and properly designed fire-based systems can certainly provide excellent care. As with all agencies, it comes down to the culture and the people. If the fire department does not embrace EMS like it does fire or other disciplines, the care delivered will be substandard as its people have no reason to do otherwise. This is not soley an issue with fire based EMS. There are plenty of third service EMS agencies that also lack the culture needed to provide excellent care.

That said, I have a huge issue with fire departments using EMS to sustain their staffing without putting effort into it despite it being the majority of the department's call volume. I get the putting out a fire takes a lot people and training. But that cannot come at the expense of the EMS service.


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## 46Young (Sep 29, 2014)

sjukrabilalfur said:


> I appreciate what you have to say about that. I'm still fresh and my experiences with other services is really limited. That's also why I wanted to make sure to point out that everyone I rode with was still highly proficient. I can see how ambulance days may raise the concern about being another small brick in the burnout wall for someone working in the fire services and I'll make sure I keep all of that in mind.



Thanks.

That describes me as well - I strive to be professional and proficient on-scene - any disdain towards the job does not show on a call. On the EMS side, I pretty much look at it as something mundane that pays real well, the very occasional good call notwithstanding. My enthusiasm has shifted significantly to fire at this point. I still very much enjoy medical discussions and learning new things, it's just that I hardly ever get the chance to put any new knowledge or skills into action. Basically, I have a deep interest in medicine, but not in the non-acute mundane hand-holding that EMS really is. 11 years into the game feel that I am allowed to hold that opinion.


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## 46Young (Sep 29, 2014)

Tigger said:


> There is nothing inherently wrong with fire based EMS, and properly designed fire-based systems can certainly provide excellent care. As with all agencies, it comes down to the culture and the people. If the fire department does not embrace EMS like it does fire or other disciplines, the care delivered will be substandard as its people have no reason to do otherwise. This is not soley an issue with fire based EMS. There are plenty of third service EMS agencies that also lack the culture needed to provide excellent care.
> 
> That said, I have a huge issue with fire departments using EMS to sustain their staffing without putting effort into it despite it being the majority of the department's call volume. I get the putting out a fire takes a lot people and training. But that cannot come at the expense of the EMS service.



+1000


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## 46Young (Sep 29, 2014)

JWalters said:


> Rin, your post was pretty much why I was thinking FOR the mix of two. If I had to choose one In would never choose fire, but I have entertained the notion on a number of occasions as a secondary thing because of the reasons described. We have an all male department right now, except for one EMT who does no fire work. We had a female ff several years back but she moved away. So I look at it not as an ego thing but I think that I would be a good, relatable responder to women, children, etc. in a fire or rescue response situation.
> 
> On a side note, I really didn't realize this was such a hot topic. I appreciate all the good insight, though.



It is a hot topic. Many formerly single role coverage areas are being replaced by fire departments, for better or worse. By replaced I mean that many single role EMS employees are losing their jobs or are being forced to relocate to stay with the company. I would be against fire based EMS if my job was in jeopardy. I chose to go where the money and power is. In addition to the reasons I stated earlier for leaving NY and eventually going fire based, there was always the threat that the city would end their partnership with the hospitals for EMS coverage (I was a hospital based NYC medic). A whole hospital chain, St. Vincent's CMC went down like dominoes, and FDNY EMS now has those ambulance tours. Municipal single role EMS, in many areas, is going to be unstable and unreliable as a long term career choice due to the threat of fire takeover and hospital closings due to the scourge of uncompensated cases if you're in hospital based EMS. The fire department will never go away, but EMS continues to be absorbed by fire. It's really like survival of the fittest out there.

Many larger departments have quotas to fill, so female hiring usually isn't a problem. The only problem is when the females choose not to do dedicated strength training, and just focus on cardio and maybe some light weights or calisthenics. Being able to run a 5:30 minute mile is fine for self rescue, but not for performing fire ground tasks or rescuing victims or other firefighters. It's a simple fix. I could take most females and get them to a level where they're physically superior to at last a third of the men with proper training.


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## BEN52 (Sep 29, 2014)

Remi said:


> Sounds like a great job. If I could get politicians to extort enough money from the taxpayers to pay me $70k a year plus benefits & retirement in exchange for 2 days per week worth of work - much of which I spent watching TV or sleeping - I'd like my job whole lot, too.
> 
> But liking my job doesn't make an economic or patient-oriented argument for it. I'd need to do much better than brag about how good I have it if I wanted to convince others that the model itself was superior.
> 
> I'm not personally against fire-based EMS; I am for the most efficient and effective delivery model. I don't see how increasingly complex medicine fits into a firefighter-based system, and I don't see how responding to a chest pain call with 8 personnel and a half-million dollar piece of fire apparatus that is incapable of transporting a patient is efficient, but I am open to being convinced.


 
Your reply is full of assumptions, innuendos, and flat out ignorance.

First and foremost, I don't see any "extortion" taking place to pay my salary. My salary is dictated by a union contract that is renegotiated every 2 years. That contract is negotiated between the union and the elected officials of the city. The public continues to elect our numerous multi term officials who agree to our public record contract. The fact that they continue to re-elect these folks speaks to the lack of cicitzen contempt for my salary. The contract stipulated salary is funded by tax dollars in the form of tax levies, sales tax, property taxes, and impact of service assessments. Our levies pass at nearly 90% every time including during the peak of the recession. Clearly our voting populace is ok with this "extortion" as you put it. Our business community is vibrant, varied, and thriving. Our commercial real estate has a less than 3% vacancy rate which is excellent for a city of our size. We continue to add businesses both large and small. Clearly the business community feels that our taxes are reasonable and provide a return.

Secondly, I don't work "only 2 days a week" as you put it. I work 50 hours a week. Do I sleep at night? Absolutely. Do I sleep through the night uninterupted? Almsot never. While I may be sleeping at work I am still at work. I am unavaliable for anything but work. I can't attend social functions and I am away from my family therefore I refuse to not be compensated for this time. On top of that, 24 hour shifts sleeping or not save the citizen money. To switch to 12 or 8 hour shifts would require more FTE's than 24 hour shifts. Do I have down time on my shift? Most days yes. That being said, my days are not spent doing nothing. We have some type of on shift training every day. On even days we drill on fire and on odd days we drill on EMS. We are allotted 90 minutes for PT every shift unless calls for service dictate otherwise. Some may view this as a luxury and leisure item. I view this as a neccesity. Ensuring my health, wellness, and physical capabilities is a benefit to myself, my crew, and most improtantly the citizens. The citizens have the right to have a physically fit and mentally sound employee responding to their calls for service. PT is protecting the investment made in me by the taxpayer. Outisde of PT and drill we maintain a robust public education program that addresses both fire and medical issues. We routinely conduct school visits for fire prevention as well as fall and disease management / prevention visits for the elederly. Beyond this we spend a decent amount of time cleaning and maintaing our fleet and quarters. Again the citizens have invested in us so we find it appropriate to care for that investment.

As far as your comment regarding our 8 man response to EMS calls goes, that is patently false. We do not routinely send 8 guys to a medical call. Our standard response was historically 2 in the ambulance and 2 on the engine. However due to budgetary constraints we at the officer's discretion send two on the squad and one on a chase car. Say what you want, but I like the help both medically and for safety's sake both in lifting and scene safety. An extra pair of hands, an extra strong back, an extra pair of eyes securing the scene.

You also commented on our ability to keep pace with the advances in prehospital care. That is a bold assumption that has no merit. We work under a very involved medical director who affords us significant clinical freedom. We operate a more than adequate in house training program in conjunction with our medical director. This is legitimate training not pencil whiped con ed. We also participate in clinical trials with a local university hospital. Part of are annual training includes a visit to the OR and / or cadaver lab for invasive procedure competencies. Many of the anti fire based EMS folks tout education. More than half of our department has significant post high school education with many having degrees. Myself, I have a 4 year biology degree. I am more than confident I can keep pace.

The problem is most of the anti fire based EMS folks do two thing; they pain with a very broad brush and they sell themselves short. Don't assume all fire based agencies are created equal as they are not. The pay, benefits, retirement, and career progression in single role jobs is poor because so many single role providers have reduced themselves to believing that it is ok and the fire guys are "extorting". They always talk about advancing clinical standards which is very improtant but they should also not settle and advance their career standards as well.


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## vcuemt (Sep 29, 2014)

BEN52 said:


> Your reply is full of assumptions, innuendos, and flat out ignorance.
> 
> First and foremost, I don't see any "extortion" taking place to pay my salary. My salary is dictated by a union contract that is renegotiated every 2 years. That contract is negotiated between the union and the elected officials of the city. The public continues to elect our numerous multi term officials who agree to our public record contract. The fact that they continue to re-elect these folks speaks to the lack of cicitzen contempt for my salary. The contract stipulated salary is funded by tax dollars in the form of tax levies, sales tax, property taxes, and impact of service assessments. Our levies pass at nearly 90% every time including during the peak of the recession. Clearly our voting populace is ok with this "extortion" as you put it. Our business community is vibrant, varied, and thriving. Our commercial real estate has a less than 3% vacancy rate which is excellent for a city of our size. We continue to add businesses both large and small. Clearly the business community feels that our taxes are reasonable and provide a return.
> 
> ...


Press releases should be filed with the press officer, please.


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## gotbeerz001 (Sep 29, 2014)

vcuemt said:


> Press releases should be filed with the press officer, please.


BEN52 makes a solid, well-thought out case. Why would you try to take away from that?


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## vcuemt (Sep 29, 2014)

gotshirtz001 said:


> BEN52 makes a solid, well-thought out case. Why would you try to take away from that?


because I disagree with what he's saying...

but I can't be arsed to spend twenty minutes going through why because what's the point?


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## gotbeerz001 (Sep 29, 2014)

Then post your own thoughts on the matter. To simply try to weasel out of a discussion which is (clearly) one-sided amongst the group is a cheap move.


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## gotbeerz001 (Sep 29, 2014)

vcuemt said:


> because I disagree with what he's saying...
> 
> but I can't be arsed to spend twenty minutes going through why because what's the point?



If you "can't be bothered", then simply sit back and read the commentary train silently. Your input added nothing.


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## gotbeerz001 (Sep 29, 2014)

I agree with BEN (obviously).

If you choose to feel sorely about those who have (arguably) better jobs than you do, call up your retired co-workers who agreed to do away with pension-based retirement systems in lieu of the 401k that you have now. 

The fact is that, by design, fire based EMS can be superior simply because of established infrastructure and overall lower costs of doing business for that specific line item. Are we paid well? Sure. Do we arguably do much more than the standard single-function? Yes. 

Those who say that EMS is 80% of what we do are comparing apples and oranges. Depending on the response area, call volume will likely be 65-85% EMS, but if you consider hours worked per member, the numbers start to reflect more accurately what we do. 

Example: 3 person engine crew and 2 person medic respond to a medical. Engine is committed for 20 minutes and medic unit committed for 1 hour. That total 3 working hours for that call. 

House fire call requires 3 engines (9 personnel), 1 truck (4 personnel), 1 medic (2 personnel) and a Chief. If the engine companies are committed for 3 hours each, the truck for 1 hour, the medic for 1 hour and the Chief for 2 hours, the total commitment for the call is 35 hours to run one call... And a simple residential at that. If it were a multi-alarm commercial or significant vegetation fire, the hours will grow exponentially. 

We are required to respond appropriately to all calls at any time. To deny us that reality is to preach and maintain ignorance. 

As for EMS, the quality of care is determined by the individual. I have worked with every kind of medic partner, both private and municipal. There are ****ty medics on both sides of the fence. 

Are there plenty of single function medics who are better than I am at that one discipline? Absolutely. You ****ing better be... That's your ONE JOB. 

That being said, am I proficient in my skills and able to serve my community adequately, especially in a busy urban area with short transport times? Absolutely.

Bottom line is this: if you don't like the job you have, apply for mine and be a great fire medic. My guess is that if your chosen mode rebellion is to complain, you'll complain wherever you are.


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## MrJones (Sep 29, 2014)




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## 46Young (Sep 29, 2014)

vcuemt said:


> Press releases should be filed with the press officer, please.



Ad hominem much?


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## MrJones (Sep 29, 2014)

46Young said:


> Ad hominem much?


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## 46Young (Sep 29, 2014)

gotshirtz001 said:


> I agree with BEN (obviously).
> 
> If you choose to feel sorely about those who have (arguably) better jobs than you do, call up your retired co-workers who agreed to do away with pension-based retirement systems in lieu of the 401k that you have now.
> 
> ...



I've said that before during a similar debate. Yes, EMS is 70% to 80% of calls, but there are only two people on an ambulance. Every MVA gets an engine to block, and there are four people on it. Every alarm bell gets an engine and a truck. Every inside gas leak gets two engines, a specialty unit (Heavy Rescue or Truck), and an ambulance. Our box alarm is four engines, two trucks, rescue squad, BC, EMS supervisor, and an ambulance. A RIT level one (deployed when confirmed fire) sends more engines and such. Hazmat incidents get two Hazmat specialty units in addition to the standard gas leak response. Etc. etc. 

EMS is 75% or so of dispatched calls, but the fire calls are typically more resource intensive. As such, that 75% figure is inaccurate - it doesn't tell the whole picture. Our ALS engines and Heavy Rescue Squads are useful when the first due medic is out on another call.


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## 46Young (Sep 29, 2014)

MrJones said:


>



Sure I do - an ad hominem seeks to discredit the source, rather than debate the talking points. In this case, the press release comment was intended to discredit or marginalize the post by saying that it resembles a press release by the IAFF rather than original thought. Then, being marginalized, there is no need to respond to the points made in that post. An abusive ad hominem is when you call the poster names or attack their character/


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## 46Young (Sep 29, 2014)

You "anti's" really need to try out this ALS first response thing. It's great to not have to move a patient, to have many hands to move equipment and such, more people for safety and scene management, and another medic to help out with ALS when you're exhausted at 0-dark 30. I can run an entire chest pain protocol and leave the scene 10-12 minutes after marking onscene- 12 lead within 5, ASA, NTG, two lines, and capno.

In NYC it was usually just my partner and I dispatched alone for most calls, moving overweight people down numerous flights of stairs on a stair chair, humping our equipment from flight to flight. 30 mins. on-scene for a real ALS, even if we get onscene and request a BLS unit for pt care assistance. No wonder there are so many broken down paramedics and EMT's in EMS.


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## vcuemt (Sep 29, 2014)

gotshirtz001 said:


> If you "can't be bothered", then simply sit back and read the commentary train silently. Your input added nothing.


Welcome to the Internet.



46Young said:


> Sure I do - an ad hominem seeks to discredit the source, rather than debate the talking points. In this case, the press release comment was intended to discredit or marginalize the post by saying that it resembles a press release by the IAFF rather than original thought. Then, being marginalized, there is no need to respond to the points made in that post. An abusive ad hominem is when you call the poster names or attack their character/


You certainly misused it. It's ok though. After all, you're just a dumb fire fighter.

(See what I did there?)


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## Carlos Danger (Sep 29, 2014)

BEN52 said:


> Your reply is full of assumptions, innuendos, and flat out ignorance.



You really shouldn't take the things said on these forums so personally. Clearly I was speaking in general terms and not about you or your department, since I have no way of even knowing where you work. 

I don't begrudge you for having a good job that you enjoy. And as I wrote earlier, I'm not even necessarily against the idea of a fire-based EMS system. I'm against inefficiency when it comes to taxpayer dollars, and poor focus when it comes to the prehospital expert who needs to know more and more all the time. And unfortunately I see a lot of room for that in fire-based EMS.



BEN52 said:


> First and foremost, I don't see any "extortion" taking place to pay my salary. My salary is dictated by a union contract that is renegotiated every 2 years. That contract is negotiated between the union and the elected officials of the city.



That's great. The problem though, is 1) most people pay exactly zero attention to local politics and do not vote in local elections and referenda, and more importantly, 2) just because a majority of voters support politicians who support fire-based EMS doesn't even begin to prove that it's the best way. Maybe everyone in your community really is well-informed and truly supportive. Great. Still doesn't mean there's not a better way. Remember Cash for Clunkers? Ever hear of the "Bridge to Nowhere"? I could list hundreds of other programs that were approved by taxpayers and even popular among many at the time, but in retrospect, can be viewed as nothing more than a massive waste.

And if you don't think taxation is a form of extortion.....try choosing not to pay your taxes because you strongly disagree with how your hard earned money is being used, and see what happens. Then look up the definition of "extortion". Then explain the difference to me.




BEN52 said:


> Secondly, I don't work "only 2 days a week" as you put it.


Oh no? Then what did you mean in your first post when you wrote: 



BEN52 said:


> *I work 8-9 days a month* and make north of 70k a year with a 25 year pension.


​Is 8-9 days a month substantially different than 2 days a week?




BEN52 said:


> The problem is most of the anti fire based EMS folks do two thing; they pain with a very broad brush and they sell themselves short. Don't assume all fire based agencies are created equal as they are not. *The pay, benefits, retirement, and career progression in single role jobs is poor because so many single role providers have reduced themselves to believing that it is ok and the fire guys are "extorting".* They always talk about advancing clinical standards which is very improtant but they should also not settle and advance their career standards as well.



Whenever this discussion comes up, you guys brag about how much better your salary, benefits, and working conditions are than what most single-role paramedics enjoy - just look at you and 46young's first replies to this thread - and you try to frame the overall debate as one of "we are just treated like we should be treated, and you guys are letting yourselves get shafted". 

Look, I'm glad you guys tend to have it good, but guess what: *your compensation isn't what this debate is about.* This debate is about the best way to deliver prehospital care, not the best way to get high salaries for paramedics.

Again, I am not strictly against fire-based EMS. But as a taxpayer, I find it hard to believe that it's an efficient model. And as a clinician, I find it hard to believe that the combined firefighter/paramedic role attracts or breeds the kind of dedicated and clinically-focused expert that we need to keep improving prehospital care.


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## 46Young (Sep 29, 2014)

vcuemt said:


> Welcome to the Internet.
> 
> 
> You certainly misused it. It's ok though. After all, you're just a dumb fire fighter.
> ...



I must have been mistaken. It appeared that instead of debating the post, you looked to downplay it by relating it to IAFF propaganda. I must have also mistaken the fact that in the next post you stated that you refuse to debate the points. My bad.


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## MrJones (Sep 29, 2014)

46Young said:


> Sure I do - an ad hominem seeks to discredit the source, rather than debate the talking points. In this case, the press release comment was intended to discredit or marginalize the post by saying that it resembles a press release by the IAFF rather than original thought. Then, being marginalized, there is no need to respond to the points made in that post. An abusive ad hominem is when you call the poster names or attack their character/



Inigo was right; that word does not mean what you think it does. An ad hominem fallacy occurs when the user overtly attacks somebody or subtly casts doubt on their character or personal attributes as a way to discredit their argument.

What you're referring to is a Genetic Fallacy, in which an idea is either accepted or rejected because of its source, rather than its merit.

You're welcome.


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## Tigger (Sep 29, 2014)

gotshirtz001 said:


> I agree with BEN (obviously).
> 
> If you choose to feel sorely about those who have (arguably) better jobs than you do, call up your retired co-workers who agreed to do away with pension-based retirement systems in lieu of the 401k that you have now.
> 
> ...


I'll pick my battles here and just comment about the bolded the statement, which I believe to be wholly inaccurate. Quality of care is absolutely determined by the system. If the system refuses to hold its providers to a reasonable standard, that is a failed system, plain and simple. And there are many fire departments that do not hold its providers to a standard under the guise of "its only one role that they play." If you're going to provide EMS, you need to do it right. Part of doing it right is designing the right system for the covered area and then having a culture that supports its implementation and continued efficacy. Leaving the individual provider to determine the quality of care is how poor expectations and subsequent crap systems develop. 

And again, this is not a problem inherent to the fire service. Some EMS agencies will allow their providers this leeway to cut costs and others because they just don't care. Still does not make it acceptable.


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## 46Young (Sep 29, 2014)

Remi said:


> You really shouldn't take the things said on these forums so personally. Clearly I was speaking in general terms and not about you or your department, since I have no way of even knowing where you work.
> 
> I don't begrudge you for having a good job that you enjoy. And as I wrote earlier, I'm not even necessarily against the idea of a fire-based EMS system. I'm against inefficiency when it comes to taxpayer dollars, and poor focus when it comes to the prehospital expert who needs to know more and more all the time. And unfortunately I see a lot of room for that in fire-based EMS.
> 
> ...




We bring up superior salary and working conditions because it's the truth. Everyone should enjoy the same benefits, and not settle for the single role status quo. I'm sure that single role EMS with a fleet large enough to handle significant call volume without wearing out it's medics and EMT's would be ideal, and with more appropriate pay and benefits, but that's pretty much a unicorn, save for King Co. and maybe ATC-EMS. A single role provider should be better at their job, and having state of the art guidelines and equipment make for a great system for the patients, but this is still a job - this is how we eat. Any system that pays scrub wages to it's employees is exploitative of it's employees. Paying a medic $12/hr ($39k/yr in a 24/48 system) is nearly a crime IMO. If you think that's appropriate, then don't lament about why EMS is not a degree profession - no one with any


MrJones said:


> Inigo was right; that word does not mean what you think it does. An ad hominem fallacy occurs when the user overtly attacks somebody or subtly casts doubt on their character or personal attributes as a way to discredit their argument.
> 
> What you're referring to is a Genetic Fallacy, in which an idea is either accepted or rejected because of its source, rather than its merit.
> 
> You're welcome.



No need to split hairs, call it what you want, the end result is the same - attempted marginalization of the post, then willfully avoiding further discussion on the topic.


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## MrJones (Sep 29, 2014)

46Young said:


> ...No need to split hairs, call it what you want, the end result is the same - attempted marginalization of the post, then willfully avoiding further discussion on the topic.


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## 46Young (Sep 29, 2014)

Remi said:


> You really shouldn't take the things said on these forums so personally. Clearly I was speaking in general terms and not about you or your department, since I have no way of even knowing where you work.
> 
> I don't begrudge you for having a good job that you enjoy. And as I wrote earlier, I'm not even necessarily against the idea of a fire-based EMS system. I'm against inefficiency when it comes to taxpayer dollars, and poor focus when it comes to the prehospital expert who needs to know more and more all the time. And unfortunately I see a lot of room for that in fire-based EMS.
> 
> ...



The debate is about why some people don't like fire based EMS. That includes salary/benefits, staffing/deployment, working conditions, as well as guidelines, training, and equipment. I'm not bragging about salary, benefits, and career ladders; it's simply the truth. I think that EMS workers deserve more than a dead end job with subsistence pay. That's why I left single role EMS. I'm 100% for the best situation for the employees - this is supposed to be a career. This is how we eat. The training, equipment, guidelines/protocols, and working conditions vary greatly from department to department, as well as from fire based to hospital based to muni third service to the privates. Every system has it's stellar systems, and every system has it's losers.

All I'm saying is that on the average, fire based EMS takes much better care of it's employees than in single role EMS. I'm sure that single role medics should be more proficient than fire based medics, although I don't find it particularly difficult to handle ALS and fire. They don't put you through medic school and fire school simultaneously. Usually either they get hired as medics, or get put through medic school a few years after being hired as a firefighter. It's not as difficult to manage suppression and EMS as some would have us believe. Really, think about it - medic school is anywhere from six months to two years; mine was 13 months long at NY Methodist in Brooklyn. Fire school certifying in FF I/II takes about 23 weeks give or take. That's about the time and effort it takes to earn an ADN at best, let alone a Bachelors degree. Yes, they're two different skill sets, but don't tell that to my FDNY firefighter friends that work part time as nurses, PA's, hospital based medics, as plumbers, electricians, carpenters, personal trainers, etc. There are a few guys that I work with that own landscaping companies, and others that do roofing, siding, and handyman work. I don't know how they could ever do that well - it's two unrelated skill sets. To use the logic that to do fire and EMS is to spread yourself too thin is to say that no one should ever focus on more than one source of linear income.

Yes, our pay and benefits should be the norm. It is practically criminal, IMO, to pay a medic $12/hr, but I've just described the hourly rate for someone that works a 24/48 and makes $38k/yr, which is a typical pay rate in the Carolinas. The equipment, training, and protocols vary greatly in single role EMS, before even considering fire based systems. We've had many single role medics escape to Northern Virginia from places like Ohio and the Southeast, as well as California and AZ. If anyone thinks that $12/hr for medics, and $8/hr for EMT's is normal, and that firemedics are overpaid, should not lament the lack of a degree as a barrier for entry into EMS. No one with any common sense will waste 3-4 years in college for a $12/hr job with no promotional track. 

I work a variant of the 24/48, so I work 10-11 days/month. Yes, technically I work 2.5 days a week or so, but it's a 56 hour workweek. That is 140% more hours than the normal 40 hour employee. I'm not going to work every day, but I am gone from home a lot, and I consider myself lucky if I get manage the first off day without having to sleep at some point in the day to recover from the previous night's work. As far as our pay, it's 53 hours straight pay every week, and for our 25 year retirement, we work the equivalent of 33+ 40 hour workweek-years. So, we're putting in 33 years on the clock for our "lucrative" 25 year retirement. Again, the employer saves on benefits/retirement on two employees for every seven hired, compared to 40 hour people. This also goes for single role people on a 56 hour workweek, so when looking at these figures, the $12/hr is practically welfare wages. I made $30/hr as a medic in NYC, so making $70k/yr in a dual role FLSA system is not unreasonable, since it's about $23/hr of mostly straight time, while being responsible for two skill sets. The real crime is not having EMS and fire work a 24/72 like it should be. Sorry that my input always comes back to salary and working conditions, but all of the other stuff doesn't matter if I'm not going to last ten years in an underpaid position while getting beaten down day in and day out.

One consideration: what do we think the average employee tenure is between hospital based, third service muni, private contract third service, and fire based EMS? Just from personal observation, I see fire as having the most longevity, private EMS as the worst, with hospital and third service being a mixed bag but still less than fire. I've worked in all four systems. The turnover is huge in each one. When I worked in SC, they had a one day orientation and put us right into the field as the second provider, which saves them money in training, which is necessary because so many people were joining and quitting on a regular basis. Why is this important? I would prefer an ambulance crew that is career-minded and experienced (typically fire based, and hit-or miss with muni third service) rather than a two year guy being driven by a two month probie, which is likely when working for an abusive muni third service system or the majority of privates. I know that I'm not off base on this, since it's well known that EMS is a transient, more or less "stepping stone" job for many. This issue comes up whenever the discussion about why EMS doesn't have a degree requirement, which leads to EMS not being organized but rather fragmented, which leads to the fact that many people leave EMS for greener pastures well before retirement. I remember reading somewhere that the average tenure in single role EMS is only 7-10 years at best. That sounds about right. In contrast, people that join fire based EMS typically stay until retirement. They may trade up once or twice for their dream department, but it pays to stick it out.


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## 46Young (Sep 29, 2014)

MrJones said:


>



What, are you 12 years old?


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## 46Young (Sep 29, 2014)

MrJones said:


> And I find that most people that express "like" for the FF/EMS mix are either FFs for whom becoming an EMT or Medic was the cost of admission to join their local fire department or fire department leaders who are riding the back of EMS to keep their departments solvent.
> 
> Makes sense from a budget, management and training standpoint? Show me a study not sponsored by the IAFF, IAFC or any other entity with a vested interest in the fire side that demonstrates that to be the case. From a call numbers stand point? Only if you are using EMS calls, which now typically account for upwards of 80% of a Fire/EMS system's calls, to justify the budget for the fire side of the system. Almost all tangible measurements? What other measurements are there that might make your case?
> 
> ...



Define "higher level of care," then please provide a link that shows how third service EMS provides this "higher level of care." I've already addressed the "80% EMS call volume" fallacy.

There are just as many substandard third service departments as there are fire based. There are just as many high quality fire based EMS employers as there are third service singles.


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## MrJones (Sep 29, 2014)

46Young said:


> Define "higher level of care," then please provide a link that shows how third service EMS provides this "higher level of care." I've already addressed the "80% EMS call volume" fallacy....


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## Tigger (Sep 29, 2014)

Reign it in.


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## TransportJockey (Sep 29, 2014)

46Young said:


> Define "higher level of care," then please provide a link that shows how third service EMS provides this "higher level of care." I've already addressed the "80% EMS call volume" fallacy.
> 
> There are just as many substandard third service departments as there are fire based. There are just as many high quality fire based EMS employers as there are third service singles.


Oh oh pick me lol. I'm an odd municipal private hybrid  that provides a higher level of care than most places.


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## ghost02 (Sep 29, 2014)

TransportJockey said:


> Oh oh pick me lol. I'm an odd municipal private hybrid  that provides a higher level of care than most places.



Your service in general is one of the ideal EMS models imho.


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## Angel (Sep 30, 2014)

Love it or hate it. Right, wrong or indifferent fire based ems is better for those looking for a career and not just a job in MOST cases. 

I think a lot of egos are getting involved and the discussion is becoming less productive, but hearif from you fire based guys has mostly, only confirmed my desire to go fire. 
Just not sure if CA is the place to do it in. 

So for that, I thank you.


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## irishboxer384 (Sep 30, 2014)

It is sometimes much easier to change job than change policy...I like the idea of fire fighter pay/schedule etc, but have zero interest in becoming a fire fighter...if someone wants to become a fire fighter and is prepared to take on another role to be one then fair play to them. If someone is sick of **** pay in non-fire EMS and gets into FD then also fair play for getting out of a situation they weren't happy with. They are just working in the realms of the system that is already in place.

Getting annoyed with the local government and how they elect to do things is one thing, being bitter at someone for earning more pay, working less hours, and doing a job they might not have wanted to do (paramedicine), is another thing entirely.

In reality, if you knowingly go into a career field with poor pay, long working hours etc then you only have yourself to blame!! Life is short, either do something about it like change career, protest, get elected to change policy...or just stop complaining!  Instead of worrying 'what the other guy is getting paid' or what 'he is doing', change your own circumstances and stop *****ing about the pay. You chose not to be in a high paying profession. I feel ZERO pity or understanding for someone who spends 20 years in a job complaining about the pay.


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## gotbeerz001 (Sep 30, 2014)

46Young said:


> I've said that before during a similar debate. Yes, EMS is 70% to 80% of calls, but there are only two people on an ambulance. Every MVA gets an engine to block, and there are four people on it. Every alarm bell gets an engine and a truck. Every inside gas leak gets two engines, a specialty unit (Heavy Rescue or Truck), and an ambulance. Our box alarm is four engines, two trucks, rescue squad, BC, EMS supervisor, and an ambulance. A RIT level one (deployed when confirmed fire) sends more engines and such. Hazmat incidents get two Hazmat specialty units in addition to the standard gas leak response. Etc. etc.
> 
> EMS is 75% or so of dispatched calls, but the fire calls are typically more resource intensive. As such, that 75% figure is inaccurate - it doesn't tell the whole picture. Our ALS engines and Heavy Rescue Squads are useful when the first due medic is out on another call.



That is what I am saying. We are fighting the same point.


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## 46Young (Sep 30, 2014)

Angel said:


> Love it or hate it. Right, wrong or indifferent fire based ems is better for those looking for a career and not just a job in MOST cases.
> 
> I think a lot of egos are getting involved and the discussion is becoming less productive, but hearif from you fire based guys has mostly, only confirmed my desire to go fire.
> Just not sure if CA is the place to do it in.
> ...



Apply to as many places as you can. You can pick up some tips and upcoming open periods on firehouse.com.

St


Angel said:


> Love it or hate it. Right, wrong or indifferent fire based ems is better for those looking for a career and not just a job in MOST cases.
> 
> I think a lot of egos are getting involved and the discussion is becoming less productive, but hearif from you fire based guys has mostly, only confirmed my desire to go fire.
> Just not sure if CA is the place to do it in.
> ...



I would recommend that you apply to as many places as you can. I would check the firehouse.com hiring and employment discussion thread for announcements and tips. 


I wouldn't count out single role places - you could apply to King Co, some Texas places, maybe Lee Co. FL. Charleston County EMS might be worth looking into. I last worked there over six years ago, so things may have improved. For example, they finally got rid of their 24 hour shifts and now do 12's. I was so happy when Fairfax called me, because I was taking a pounding on the 24's, then getting held over constantly, and being on 12 hour mandatory stand by (be available for immediate recall) twice a month as well.

In general, I would stay out of the Carolinas - there's no money there. Medics generally make more than firefighters, but you're still starting at $12/hr or less. As an example, as a six year guy, I make as much as an Assistant Chief in the City of Charleston FD. Florida and Ohio are dismal for medic hiring. Phoenix is a good dept, but hard to get into. I suppose the same could be said for the CA and NV departments, but try anyway.

Outside of CA, Northern VA has the best firemedic pay, and there's a demand for medics, so hiring may be easier here.


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## sjukrabilalfur (Sep 30, 2014)

46Young said:


> Apply to as many places as you can. You can pick up some tips and upcoming open periods on firehouse.com.
> 
> St
> 
> ...



Missouri also has some excellent EMS-only districts, if you don't mind working in some of the outermost suburbs in St Louis or K.C.

This entire thread, man...


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## gotbeerz001 (Sep 30, 2014)

Angel said:


> Love it or hate it. Right, wrong or indifferent fire based ems is better for those looking for a career and not just a job in MOST cases.
> 
> I think a lot of egos are getting involved and the discussion is becoming less productive, but hearif from you fire based guys has mostly, only confirmed my desire to go fire.
> Just not sure if CA is the place to do it in.
> ...



Why wouldn't CA be the place to do it? You are already State licensed, I assume u are locally accredited and (if I may guess) working in the Bay Area?? As a female candidate, I can't think of a reason you wouldn't get hired if you pass the CPAT and give the application process the appropriate effort.


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## TransportJockey (Sep 30, 2014)

California and 'quality EMS' doesn't usually go well in the same sentence. Not to mention I was hearing about the staggering numbers of applicants to each fire job out there. It's more ridiculous than most places in the country.


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## gotbeerz001 (Sep 30, 2014)

Being well-versed in CA application processes, she has what it takes to do well despite the numbers.


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## JWalters (Sep 30, 2014)

Remi said:


> And as a clinician, I find it hard to believe that the combined firefighter/paramedic role attracts or breeds the kind of dedicated and clinically-focused expert that we need to keep improving prehospital care.



Yes. I don't see the combined model going away though, primarily because of economics, so why not try to improve on that instead of saying the system is junk and leaving it at that?


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## JWalters (Sep 30, 2014)

46Young said:


> Many larger departments have quotas to fill, so female hiring usually isn't a problem. The only problem is when the females choose not to do dedicated strength training, and just focus on cardio and maybe some light weights or calisthenics. Being able to run a 5:30 minute mile is fine for self rescue, but not for performing fire ground tasks or rescuing victims or other firefighters. It's a simple fix. I could take most females and get them to a level where they're physically superior to at last a third of the men with proper training.



Wow.  Most females could take themselves to that point as well, they actually don't need a man to help them with that, believe it or not. I don' think that anyone-male or female-belongs in a role of EMS or fire without true physical conditioning.


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## JWalters (Sep 30, 2014)

gotshirtz001 said:


> I agree with BEN (obviously).
> 
> . Are we paid well? Sure. Do we arguably do much more than the standard single-function? Yes.
> 
> .



But not everywhere. I could make more folding sheets at the local nursing home than I would on our fire/EMS dept. HAHAHAHA  Well, actually it is not funny at all. But it's true.


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## Tigger (Sep 30, 2014)

All of this misses of the point of thread in my eyes. As was said way back, benefits and schedules have at best an indirect effect on how prehospital care is delivered. I think it is rather disingenuous for the pro-fire based EMS crowd to bring that into the mix when someone points out that it is probably not the most efficient way to deliver excellent care. But alas, what else to expect?

There are numerous third services in my state that pay the same or better than fire districts nearby. There is a career ladder and working conditions are the same or better than fire department's. Yet then we have people that are extremely set on the idea that the only career in EMS is the fire service and that such services are anomalies. That's just not the case, not to mention that there are many non-urban fire departments with the same crappy working conditions and pay.

I'm going back to hiding in my station with new equipment while I work on a side project writing grants so I can advance. Oh wait, apparently that's not possible?


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## MrJones (Sep 30, 2014)

This thread is little more than an anecdote-based johnson measuring contest. Show me some empirical data demonstrating the superiority of one model over the other and then we can have a real discussion. Until then those of us opposed to Fire-based EMS (rather, EMS-based Fire ) will stick to our collective opinions and those on the other side of the issue will stick with theirs, and there's little chance of one camp swaying the other.


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## MonkeyArrow (Sep 30, 2014)

MrJones said:


> This thread is little more than an anecdote-based johnson measuring contest. Show me some empirical data demonstrating the superiority of one model over the other and then we can have a real discussion. Until then those of us opposed to Fire-based EMS (rather, EMS-based Fire ) will stick to our collective opinions and those on the other side of the issue will stick with theirs, and there's little chance of one camp swaying the other.



Why don't you start by bringing some of your own data to the party? Remember, if you've seen one EMS/fire system, you've seen one EMS/fire system. Therefore, I don't see how you can bring data with any shred of validity trying to compare fire based EMS to third service EMS. It will have to be a one-to-one direct system comparison, which, well,


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## MrJones (Sep 30, 2014)

MonkeyArrow said:


> Why don't you start by bringing some of your own data to the party? Remember, if you've seen one EMS/fire system, you've seen one EMS/fire system. Therefore, I don't see how you can bring data with any shred of validity trying to compare fire based EMS to third service EMS. It will have to be a one-to-one direct system comparison, which, well....



I suppose I should have been more direct. I wrote "Show me some empirical data demonstrating the superiority of one model over the other..." because a review of the literature (and, yes, I _have_ reviewed the literature. Extensively) reveals a dearth of research resulting in such empirical date. Which, in turn, is why I noted that each side will stick to their opinions (opinions - not facts) and that, absent said empirical data, it is virtually impossible to change those opinions.

Clearer now?


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## 46Young (Sep 30, 2014)

JWalters said:


> Wow.  Most females could take themselves to that point as well, they actually don't need a man to help them with that, believe it or not. I don' think that anyone-male or female-belongs in a role of EMS or fire without true physical conditioning.



You would think that females preparing to test for, and work for a fire department would prepare properly, but you should see the s*** show when we hold CPAT testing. The females typically die on the 160# dummy drag and the breach/pull.

In my academy, one female, who was a former college athlete, failed to do a ladder raise (not throwing a ladder, but simply extending a ladder that is affixed to a wall), while doing work performance, which is a sequence of fireground tasks in a circuit. Her grip just gave out, but that station is not something that should give anyone any trouble. P90x and running as your main form of physical prep isn't going to cut it. Some Wendler 5/3/1 and strongman conditioning work (sled work, loaded carries, etc.) would be much more appropriate.


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## MonkeyArrow (Sep 30, 2014)

MrJones said:


> I suppose I should have been more direct. I wrote "Show me some empirical data demonstrating the superiority of one model over the other..." because a review of the literature (and, yes, I _have_ reviewed the literature. Extensively) reveals a dearth of research resulting in such empirical date. Which, in turn, is why I noted that each side will stick to their opinions (opinions - not facts) and that, absent said empirical data, it is virtually impossible to change those opinions.
> 
> Clearer now?



Yup. We were saying the same thing while managing to confuse one another.


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## 46Young (Sep 30, 2014)

Tigger said:


> All of this misses the point of thread in my eyes. As was said way back, benefits and schedules have at best an indirect effect on how prehospital care is delivered. I think it is rather disingenuous for the pro-fire based EMS crowd to bring that into the mix when someone points out that it is probably not the most efficient way to deliver excellent care. But alas, what else to expect?
> 
> There are numerous third services in my state that pay the same or better than fire districts nearby. There is a career ladder and working conditions are the same or better than fire department's. Yet then we have people that are extremely set on the idea that the only career in EMS is the fire service and that such services are anomalies. That's just not the case, not to mention that there are many non-urban fire departments with the same crappy working conditions and pay.
> 
> I'm going back to hiding in my station with new equipment while I work on a side project writing grants so I can advance. Oh wait, apparently that's not possible?



In theory, a single role EMS service should be able to provide more expert patient care than fire based services, with shorter response times, if it can be supported by a decent budget. From what I've seen, the typical single role EMS employer gets by with as little staffing and deployment as possible, paying as little as possible, which wears out the crews which facilitates apathy, indifference, and attrition. The problem with the more unscrupulous fire departments is that they take over EMS, keep the funding, staffing and deployment the same as before the takeover, and use the engine companies to shorten response times and show call volume to avoid layoffs and increase hiring. EMS can be inadequately funded in both fire and stand-alone departments. 

I can't definitively say that fire is better for quality care, or that single role is better for quality care. For every apathetic firemedic, there is an apathetic single role provider that is using the EMS job as a stepping stone, or is stuck there because they don't have the skills to find a different well-paying career. For every stellar fire based EMS department that "does it right," there are stellar single role services that have their act together. For every parasitic fire department absorbing EMS, there is an abomination of a third service agency. Really, the only thing that I can say in favor of single role services is that the provider can focus solely on EMS. This does not mean that the average single role provider will study and train in EMS twice as hard as a firemedic, though. I know/knew plenty of single role providers and fire based providers alike that just do their monthly CEU articles, attend the minimum of CEU training, and not much else. 

Having said all that, back home in NYC I know medics that could run rings around the majority of providers in my current region. Then again, we had tough hiring standards, lots of training, and we had to do inter-facility tours once or twice a week, so we got experience from both sides. It does seem like our firemedics that were single role before getting hired here seem to be more competent than our home grown products, and every third or fourth new hire is coming on with an EMS degree in hand, so there may be some validity to the single role provider being more capable than someone who spent their entire career in the fire service. Our training and internship process has become much more stringent over the past couple of years, so that may play a role in the increased quality of medics that we've been enjoying as of late. Or perhaps the fact that we're only hiring P's rather than I's like in the past may be the reason we're seeing a more competent product emerging from ALS internship.


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## Tigger (Sep 30, 2014)

Non-transporting ALS doesn't have much evidence to support it, not to mention that response times in general have a minimal effect on patient outcomes. That's my issue with sending an ambulance and engine to every call, it's just not efficient. In an ideal world the fire department would not have to justify its existence by responding to medical calls. You need a staffed fire house to make a difference with structure fires, no two ways about it. Unfortunately many translate a decrease in fires into a bunch of FFs just sitting around doing nothing, so the FD must find calls to run to avoid such an (unfounded) image. 

But that doesn't mean that providing ALS first response actually has any meaningful and positive impact on patient care.

We get two firefighters in a pickup on medicals in the fire districts with paid coverage. They are nice to have, but on many calls I think we can agree that two people are sufficient.

My experience with third services is obviously different than yours, which is of course a product of different areas. I will not attempt to compare my experience, but it is certainly more positive.


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## Handsome Robb (Oct 1, 2014)

I'm not a fire guy but I'm going to be honest, the fire guys have presented the best put together, most professional posts in this thread whereas other have just jabbed and dodged. With that said no one on either side of the debate has presented any facts. So can we stop with the memes? It's like high school in here. 



46Young said:


> Apply to as many places as you can. You can pick up some tips and upcoming open periods on firehouse.com.
> 
> St
> 
> ...



There are a few good NV departments but the pay, outside of Las Vegas, isn't staggering by any means. Also, we do have a great "frontier" hospital-based EMS-Rescue department that runs with a FD that does only that, fight fires. Rescue is left to the hospital based service but they're not an easy place to get on with


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## Mellowdnb (Oct 1, 2014)

After working on a few private based EMS services that work along with a FD, I've observed the following:
1) Some people are afraid of loosing jobs, if the city decided to say bye bye to the privates and hand over the job to the FD. Some let that lead to frustration with the FF.

2)Some privates that transport have to let FD run the call. Some people on the privates got mad because they felt like they wanted control over the entire call.

3)Some get mad at the FF that views EMS as a chore. Don't we have single role medical providers that do that too?

Should there be FF/EMS based systems? Yes. However, I feel people should have the option of wanting to be single or dual role; FF or Medics.

Let's say a department offers 70,000 before taxes to a FF/Medic. Not a bad salary at first glance. However, it's 2 jobs in one. Medical and fire. So, one could say you get 35,000 for each gig. Comes out to a not much better salary. Benefits might be better.


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## Carlos Danger (Oct 1, 2014)

46Young said:


> I can't definitively say that fire is better for quality care, or that single role is better for quality care. For every apathetic firemedic, there is an apathetic single role provider that is using the EMS job as a stepping stone, or is stuck there because they don't have the skills to find a different well-paying career. For every stellar fire based EMS department that "does it right," there are stellar single role services that have their act together. For every parasitic fire department absorbing EMS, there is an abomination of a third service agency. Really, the only thing that I can say in favor of single role services is that the provider can focus solely on EMS. This does not mean that the average single role provider will study and train in EMS twice as hard as a firemedic, though. I know/knew plenty of single role providers and fire based providers alike that just do their monthly CEU articles, attend the minimum of CEU training, and not much else.



I don't disagree with a single word of that.

The way I see it, paramedicine is at a crossroads right now (we've actually been stuck at this intersection for a while), and things can go in one of two basic directions:

We can admit that very little we do in the prehospital arena affects outcomes, and accept that our primary purpose is really just to provide safe, compassionate transport. We can stop making so much noise about increasing educational standards. We can stop pretending that we are like doctors, just with less training. We can de-emphasize or even get rid of all the ALS interventions that don't really help, which is most of them. This doesn't mean we stop trying to get better at what we do, it just means that we accept that adding interventions and skills has more to do with what _we want_ than it does our ability to provide good care to our patients.

We can strive to become true clinicians, which means first and foremost, LOTS MORE EDUCATION as a basic requirement to entry. That means investing 4 years of our lives and (for most of us) taking on substantial debt in order to become qualified to do the job we want to do. It means taking responsibility for our own protocols and the way our actions affect outcomes. It means doing research - actually learning the methods and statistics, designing projects, identifying funding, getting IRB approval, and doing the hard, tedious work. It means learning real pharmacology, not just memorizing indications, contraindications, and doses. It means realizing that your paycheck will soon rely on your ability to prove that what you do actually helps patients. It means spending a lot of time keeping up with all the new developments and finding ways to incorporate them into your practice, rather than just waiting for the new protocol updates that come out every year or two. It means lobbying bureaucrats and politicians to change statutes and regulations to grant the legal authority to do all of this. It means a lot less talking about "improving paramedicine", and a lot more doing.
Which path should EMS take, and how does that relate to the design of delivery models?


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## gotbeerz001 (Oct 1, 2014)

I don't see the trends changing in busy urban settings. The nurses we hand off to generally do not want anything more than a good hx and IV access. Even when we can justify additional meds, the prehospital menu does not often reflect what will be used in-hospital so we, in fact, would generally cause delays to definitive care as they wait for our meds to wear off. 

In these settings, higher levels of education and scope would not change the fact that 50% of those transported do not have acute illness, 30% require assessment, access and observation only, 15-18% will actually present with conditions which warrant med administration and (maybe) 2-5% actually require immediate intervention and rapid transport. 

I understand that rural settings do not necessarily fit this model, but in a system that mirrors the numbers listed, fire-based EMS will be more than sufficient.

For those systems that require higher levels of care, they should employ PAs.


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## irishboxer384 (Oct 1, 2014)

gotshirtz001 said:


> and (maybe) 2-5% actually require immediate intervention and rapid transport.



Fire fighters are not kicking in doors and rescuing blue eyed babies from fires every hour of their shift...nor are cops in fire fights outside banks everyday...less than 10% of soldiers use their weapon in anger in conflict....does this mean we can be content putting the public's trust in personnel with a lesser knowledge of fire science, law or military tactics and strategy? No...we continue to look for improvements....

Surely it is better to be extremely proficient in one career field, than a 'jack of all trades master of none'? If 2 people complete the same level of paramedic education, and one of them has no real interest in emergency medicine... is he/she going to come away with the same level of knowledge? I don't want to be a fire fighter, and I don't blame fire fighters who don't want to be medics: so why put medics in a position where they join the FD just for the money or to guarantee 911 medical response...and why put fire fighters in a position where they are only interested in fire-related response...it could be avoided.


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## gotbeerz001 (Oct 1, 2014)

Maybe I haven't made myself clear:
I enjoy fighting fire. I enjoy being a transporting medic. I too get frustrated when I am handed a poorly assessed "flu-like" pt who turns out to be septic. 

My views are reflective of the system in which I work. The medical directors do not expand the scope of paramedics since the transport times are so short and definitive care is available in a matter of minutes. While "advanced care" is a great ideal, it is a numbers game. At the private, we have over 450 employees; 300+ of which are medics. When the system is so impacted by subacute illness that can be BLSed in, requiring such higher skills, the training required to maintain such skills and the increased wages that will surely be demanded, the math doesn't add up. 

Cutco may make a superior knife, but oftentimes the one in the Leatherman works just as well... And without being so pretentious.


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## sjukrabilalfur (Oct 1, 2014)

Remi said:


> I don't disagree with a single word of that.
> 
> The way I see it, paramedicine is at a crossroads right now (we've actually been stuck at this intersection for a while), and things can go in one of two basic directions:
> 
> ...



That second model is the norm in a lot of the world, and I see no reason why investing long term in this sort of education and standard shouldn't happen.


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## irishboxer384 (Oct 1, 2014)

gotshirtz001 said:


> Maybe I haven't made myself clear:
> I enjoy fighting fire. I enjoy being a transporting medic. I too get frustrated when I am handed a poorly assessed "flu-like" pt who turns out to be septic.
> 
> My views are reflective of the system in which I work. The medical directors do not expand the scope of paramedics since the transport times are so short and definitive care is available in a matter of minutes. While "advanced care" is a great ideal, it is a numbers game. At the private, we have over 450 employees; 300+ of which are medics. When the system is so impacted by subacute illness that can be BLSed in, requiring such higher skills, the training required to maintain such skills and the increased wages that will surely be demanded, the math doesn't add up.
> ...



I'm not disagreeing with you- it is a numbers game otherwise everyone would have a financially rewarding career and everyone would have degrees and have top of the line training courtesy of the government. The thread was about why some don't like the mix, if you equally enjoy fire and medical aspects I am happy for you as you have found the career for you...but I can see why it bothers people who want a bigger slice of the pie to apply to non-fire EMS, but that is the way the cookie has crumbled.


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## Christopher (Oct 1, 2014)

Yawn.

This is a silly thread. There are dysfunctional, piss poor systems of all shapes and sizes. There are outstanding, role model systems of all shapes and sizes as well. EMS as a public service is obviously newer than fire fighting, and it will take time for wages to catch up as the public funding balance is altered. EMS has flatter organizations and less room for career growth because we don't really have a lot of job/skill differentiation (besides the patch on our shoulder). Maturation of our field (e.g. education, role expansion, etc) will improve both wages and growth opportunities. How this is delivered most effectively will vary by community and system.

Anything else is boring flame bait.



46Young said:


> In general, I would stay out of the Carolinas - there's no money there. Medics generally make more than firefighters, but you're still starting at $12/hr or less.



Southeastern NC starts paramedics around $18-20/hr now...but that's neither here nor there.


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## gotbeerz001 (Oct 1, 2014)

The trend I see more and more is single-role medics within the municipal system. They are paid less than the first responding fire medics but receive public safety pension/benefits and the (overall) support of the Fire Union. 

Seems like a good way for non fire-oriented applicants to have the best of both worlds.


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## Bullets (Oct 2, 2014)

sjukrabilalfur said:


> Just a small-sample anecdote.
> 
> When I was a student and doing clinicals with [unnamed urban midwestern fire/rescue service], the FF/Medics all vastly preferred being on the pumper to being assigned to the ambulance. They seemed like cool guys, and they weren't derelicts on the ambulance, but they treated it as a chore, or just something they just sort of had to do to get to their next pumper shift and it showed in how they handled their calls. I don't know if that's indicative of how all FF/Medics approach the ambulance side, but if it is, I'd rather the services be separated.


I will also echo this sentiment. Most FFs i know do it because they want to fight fire, and because they want to do the cool stuff. However, i find myself trying to remind them WHY we are cutting this car apart, or going in the water, or this hole....ITS PATIENT CARE. There are a number of EMS agencies in NJ that provide rescue services, and i think it is truly the best model. EMS is a life and health protection service, fire departments are in the property protection business. These are two different mindsets that i do not feel play well together


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## Tigger (Oct 2, 2014)

gotshirtz001 said:


> The trend I see more and more is single-role medics within the municipal system. They are paid less than the first responding fire medics but receive public safety pension/benefits and the (overall) support of the Fire Union.
> 
> Seems like a good way for non fire-oriented applicants to have the best of both worlds.


Minus the whole "second class citizen" issue that many of these provides face. I have worked in a fire station as a single role EMS person and there was a definite hierarchy, and I was at the bottom. Obviously n=1, but I am certainly not the first person to have this issue.


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## DrParasite (Oct 2, 2014)

46Young said:


> At my current employer, I've had one promotion already, and I'm studying for the next promo. exam that's being held this winter. If I had stayed in single role EMS, there's a 95% chance that I would still be on an ambulance, with no raises other than step increases.


as a related topic, I was applying to work for a FD, and asked about career path.  in EMS, you have EMT, Paramedic, (maybe FTO), supervisor, and then management, and  you get a 2% raise every year.  At the FD I was looking that, they had recruit FF, Firefighter I, Firefighter II, & Master firefighter (which were all non-competitive promotions, but they all carried raises), then you had Lt, Captain, BC, DC, and Chief of Dept.  Plus all the ancillary divisions.  Which has more of a career path, and which do you think pays more? 





46Young said:


> The problem with non fire based EMS is that most places put out barely enough ambulances to cover normal call volume, and hire.   barely enough people to staff them. This results in busy tours and frequent holdover OT. A lot of places just burn through their people and replace them with new ones. No place is going to put out extra ambulances and hire more people just so that the units can be less busy. Their solution is to enter into automatic aid/mutual aid agreements as a fix, or far worse - System Status Management/PUM.


remember, an ambulance that isn't on a run isn't making money... even in the best systems, they have to justify every ambulance.  Think of it this way: if an engine company is 5 miles away from the next due, in a low call volume area, and gets no calls, what happens?  nothing, because it's there to cover that area.  if the ambulance is in the same station, it's likely to get relocated somewhere else so it will go on more runs, to "justify it's existence."  Also, for the FD, if the first due area is too busy, they put another engine in that firehouse 24 hrs a day.  in EMS, you might get a power/peak load truck, but after the call volume goes down, the truck goes away.... until you get another call.


46Young said:


> Besides the lack of a career ladder and poor pay, what ruined single role EMS for me was the high call volume. I'm not saying that we should just screw off all day and run two calls. What I am saying is that on a 24 hour shift, it should be understood that some on-the-clock sleep should occur. IMO this should amount to a minimum of four hours sometime between 2200 and 0600, preferably more. If it's a busy urban system, then the shifts should be 8's and 12's, with perhaps a day/evening 16 at the most. With these shorter shifts, dedicated off-the-air OOS meal breaks need to be implemented, just like employees in other industries. No more eating breakfast at 2 in the afternoon and dinner at 1 in the morning, and no more grabbing fast food because that's what's available on the road, and having to eat it on the road like damn animals. In my fire based experience, employees have options to get off of the box, and do something else entirely. Just off the top of my head, there's EMS training for the field and the academy, fire training, various suppression apparatus, Hazmat, Tech Rescue, Peer Fitness, and many promotional opportunities in and out of the field.


what he said.


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## gotbeerz001 (Oct 2, 2014)

Bullets said:


> I will also echo this sentiment. Most FFs i know do it because they want to fight fire, and because they want to do the cool stuff. However, i find myself trying to remind them WHY we are cutting this car apart, or going in the water, or this hole....ITS PATIENT CARE. There are a number of EMS agencies in NJ that provide rescue services, and i think it is truly the best model. EMS is a life and health protection service, fire departments are in the property protection business. These are two different mindsets that i do not feel play well together



Victim rescue trumps pt care when rescuers are in a sketchy situation, though. I'm sure you agree with that. While this doesn't necessarily apply to most basic vehicle extrications, if we are in the technical rescue environment (in a hole, in the water), only the most basic interventions will likely be applied... And even then, only if it does not slow down the operation or add additional complexity.

The sooner they are out of their specific emergent situation, excellent pt care has begun.


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## avdrummerboy (Oct 3, 2014)

The title of this thread is why don't some like the fire mix? Naturally, you are going to get mixed opinionated answers and that is what the original question begs. Yes, opinions are like a certain body part, everyone has one and by the end of the day they all stink! I think the point to be taken away here is that there is good and bad in EVERY system/ setup. For every excellent fire dept. I can find you a piss poor single role EMS company. For every excellent single role EMS company I can find you a piss poor fire dept. Mixing a whole lot of stuff into one profession doesn't necessarily make it any better, especially when it is two fairly in depth areas like fire/ rescue and paramedicine, which makes one ask do Fire fighting and EMS need to be combined? Could there be an optimum to strive for, absolutely! I'd love to see EMS in this country move more towards the systems of the rest of the world in terms of training and education requirements.

Ultimately, every system is going to be different and everyone will have a different view of it all. At the end of the day, we both run together so we must make the best of it.


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## 46Young (Oct 4, 2014)

Detroit FD is going to start using their firefighters to run medical calls - by training as first responders, the EMT's, and eventually paramedics.

http://www.freep.com/story/news/local/michigan/detroit/2014/10/03/medical-first-responders/16618529/

Apparently their response times are 12 minutes and 40 seconds. This is where I disagree with fire taking on EMS, as a band aid for poor response times. Clearly, Detroit needs a bunch more ambulances, not suppression rigs to keep the patient company until an ambulance eventually gets to them. As I've said before, many employers (of each type) put out the bare minimum amount of ambulances they need to cover normal call volume, and rely on automatic aid/mutual aid and first responder resources to "stop the clock."

At least in my system the engine is either on-scene the same time as an ambulance, or is waiting 2-3 minutes tops for an ambulance in most cases. The manpower is nice to have, and I can get off scene way quicker than I would be able to with just two people. When I worked in NYC, they typical ALS call where I 'm starting lines, pushing meds, etc. would take up to 30 mins. on-scene. Here, if I'm on-scene more than 15 minutes to do ALS, it's too long. Shorter on-scene times result in quicker in-service times. Quicker in-service times makes every unit less busy overall. I consider us fortunate here, because even our busiest units only average 7-9 calls a day, with each call lasting an hour, give or take ten minutes. That's our busiest units on a 24 hour shift. I cringe when I hear of some places running 14 calls in a 24 hour shift with that being a slow day.

Edit: I can see the benefit of a combined service making the calls run quicker, but only if the service chooses not to under-deploy because of this efficiency. Said another way, I feel that it's good to use suppression units, with it's lower net utilization hours, to shorten on-scene times, but not if that results in less ambulances on the road. I can also see a benefit on OT control if members are dual role - it's easier to fill scheduling gaps with employees that are certified to ride in several different positions. Otherwise, mandatory hold and recall occurs to fill sick leave and vacation relief.


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## 46Young (Oct 4, 2014)

Fairfax County continuously hires FF/medics, but they're opening up the process for FF/EMT's from Oct. 25th through Oct. 31st only:

http://emtlife.com/threads/fairfax-county-fire-and-rescue-hiring-emt-bs.39653/


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## Burritomedic1127 (Oct 6, 2014)

Being that I've worked for both fire and private in the state the OP was from ill add my 2 cents. In MA the general thought process is getting on a fire department is "hitting the lottery" (quotes from co workers when i was hired after the civil service BS) and private EMS is something inferior. If it means anything i left the fire department to go back to the same private company as a medic full time again rather than part time in disgust. The overall thought of EMS in the Fire Depart is that its a punishment in between the RARE fires. The ambulance would be open every shift because people did not work to work EMS even at overtime rates ($1000/day for this dept). So whoever was punished would spread that negativity over to patient care. Dont get me wrong there are some great providers with a strong knowledge but they would not want to even sniff at the ambulance due to "already paying their dues." While on a medical, a fire was toned out and nearly every single person on scene at the medical, cleared up even before the pt was fully assessed, knowing they could call in a mutual aid private EMS crew to take over the call. I wont echo alot of points that have been said in this forum, but i think these FF who look as EMS as a punishment should realize that your job (as a FF) is the only type of job that is trying to put itself out of business (Fire prevention, better building codes, etc). I would recommend starting to embrace the EMS side of things because once a town manager realizes all of this money is being spent on something that rarely happens anymore, Im sure there will be fights to be on the ambulance for the shift because your jobs depend on it.


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## titmouse (Oct 7, 2014)

Here in Miami if you want to make better money FD is the way to go (if you get in)... To say the least when I was in the fire academy and I was asked "Why do you want to be a fire fighter?" I have told the instructor the reason is to be on the rescue (ambulance), they were not impressed and the answer put me in a tough place.


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## Shishkabob (Oct 7, 2014)

gotshirtz001 said:


> Are there plenty of single function medics who are better than I am at that one discipline? Absolutely. You ******* better be... That's your ONE JOB.



So, essentially what you're saying is that someone will be better at medicine because it's their sole job, while you can't be because you have to split yourself in to two different jobs, meaning you're willing to provide less than the best to your citizens when it comes to their health and safety?


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## TransportJockey (Oct 7, 2014)

Linuss said:


> So, essentially what you're saying is that someone will be better at medicine because it's their sole job, while you can't be because you have to split yourself in to two different jobs, meaning you're willing to provide less than the best to your citizens when it comes to their health and safety?


Holy hell look who's back from the dead


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## gotbeerz001 (Oct 7, 2014)

Linuss said:


> So, essentially what you're saying is that someone will be better at medicine because it's their sole job, while you can't be because you have to split yourself in to two different jobs, meaning you're willing to provide less than the best to your citizens when it comes to their health and safety?



Not exactly. What I am saying is that I believe that the service I provide to be superior overall in regards to health and safety by not being limited to a single function. This is based on the scope of practice identified by the medical director, socioeconomic conditions and corresponding call trends of the system that I work in.

Working here, I am the best bang for the taxpayers buck. 

I am realistic enough to say that I may not be the best choice for your system without making some adjustments. 

If you would like to operate in a world of fantasy where budgets, training opportunities and experience are infinite, I guess that's what the internet is for. 

As I have said before in several different ways, you can buy a $30 pair of pliers, a $45 knife, a $15 screw driver and a $20 file if you choose. However, if you purchase a Leatherman and have ONE TOOL that can do all those jobs just as effectively 90% of the time, you have not only saved money, you have gained flexibility.

My goal is to be the most effective problem solver that I can be in my community. Medicine is one aspect of that goal and I take every aspect of that very seriously.


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## Shishkabob (Oct 7, 2014)

There's a reason why those who work in construction have Leathermans', but also have dedicated tools: The dedicated tools work better at their job, while the Leatherman is there to skimp out on simple jobs.

As for why you continue to advocate for the most cost-effective way to give your citizens sub-optimal care, I do not know.


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## Tigger (Oct 7, 2014)

gotshirtz001 said:


> \
> 
> As I have said before in several different ways, you can buy a $30 pair of pliers, a $45 knife, a $15 screw driver and a $20 file if you choose. However, if you purchase a Leatherman and have ONE TOOL that can do all those jobs just as effectively 90% of the time, you have not only saved money, you have gained flexibility.
> 
> My goal is to be the most effective problem solver that I can be in my community. Medicine is one aspect of that goal and I take every aspect of that very seriously.



And any sort of repair job done with my Leatherman has always been a much larger pain than when I used the actual correct tool for the job. Hmm wonder why that is?


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## Rialaigh (Oct 7, 2014)

I have read through this thread multiple times and appreciate many of the responses, there is a lot of good discussion going on here.



Linuss said:


> There's a reason why those who work in construction have Leathermans', but also have dedicated tools: The dedicated tools work better at their job, while the Leatherman is there to skimp out on simple jobs.
> 
> As for why you continue to advocate for the most cost-effective way to give your citizens sub-optimal care, I do not know.



My question to you (being you in general) about this is why do people continue to advocate for the least cost effective method of having more specialized dedicated tools for their job when our special single role dedicated tools in prehospital medicine have been shown for the most part to make 0 difference in patient outcomes. I find it hard to argue that the medic that is better trained on pushing cardiac drugs and EJ's and hanging prehospital drips and giving fluids...etc..etc..etc...is somehow providing better medicine and service then double role medics who may not be as proficient at many of those things and others (throw intubation, crics, etc... in there). When you look at the effectiveness of those interventions on mortality and morbidity how can you argue that even if someone is "better" at their job that they are providing "better service" to their community by making 0 effective difference in outcomes while being far less cost effective.


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## MrJones (Oct 7, 2014)

Rialaigh said:


> I have read through this thread multiple times and appreciate many of the responses, there is a lot of good discussion going on here.
> 
> 
> 
> My question to you (being you in general) about this is why do people continue to advocate for the least cost effective method of having more specialized dedicated tools for their job when our special single role dedicated tools in prehospital medicine have been shown for the most part to make 0 difference in patient outcomes. I find it hard to argue that the medic that is better trained on pushing cardiac drugs and EJ's and hanging prehospital drips and giving fluids...etc..etc..etc...is somehow providing better medicine and service then double role medics who may not be as proficient at many of those things and others (throw intubation, crics, etc... in there). When you look at the effectiveness of those interventions on mortality and morbidity how can you argue that even if someone is "better" at their job that they are providing "better service" to their community by making 0 effective difference in outcomes while being far less cost effective.


Interesting, and a possible attitude changer if, in fact, what you say has actually been proven empirically. To that end, would you care to share any of the studies you've seen in which "...single role dedicated tools in prehospital medicine have been shown for the most part to make 0 difference in patient outcomes"? Or perhaps the studies you've seen that compare "...the effectiveness of those interventions on mortality and morbidity...." between single role and dual role medics? Citations will suffice - I have access to a number of academic search engines.


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## Shishkabob (Oct 7, 2014)

Rialaigh said:


> My question to you (being you in general) about this is why do people continue to advocate for the least cost effective method of having more specialized dedicated tools for their job when our special single role dedicated tools in prehospital medicine have been shown for the most part to make 0 difference in patient outcomes. I find it hard to argue that the medic that is better trained on pushing cardiac drugs and EJ's and hanging prehospital drips and giving fluids...etc..etc..etc...is somehow providing better medicine and service then double role medics



Whilst the discussion on the effects of morbidity and mortality from EMS is a valid one, and most of what we do makes no difference (on the same hand, most of what people call for doesn't need any of what we can do anyhow), here's a question for you:

Your family member is short of breath.  You call 911.  The local EMS agency has RSI and other low-utilization, high-risk procedures that if done right can help, and if done wrong can kill.  All other things being equal, would you rather have the one who focuses solely on medicine, or the one who was forced in to it and focuses more of their time and training on something completely unrelated to medicine?


Some will scream "straw-man!" but it's the truth.  Fact is there are technicians and there are clincians: Just because two medics are equal skill at starting IVs doesn't mean they're equal at doing differentials and correctly treating (or not treating) when needed.


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## Chewy20 (Oct 7, 2014)

Linuss said:


> Whilst the discussion on the effects of morbidity and mortality from EMS is a valid one, and most of what we do makes no difference (on the same hand, most of what people call for doesn't need any of what we can do anyhow), here's a question for you:
> 
> Your family member is short of breath.  You call 911.  The local EMS agency has RSI and other low-utilization, high-risk procedures that if done right can help, and if done wrong can kill.  All other things being equal, would you rather have the one who focuses solely on medicine, or the one who was forced in to it and focuses more of their time and training on something completely unrelated to medicine?
> 
> ...


 
Do you happen to work in central texas? lol Your rationale sounds familiar to me now.


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## gotbeerz001 (Oct 8, 2014)

Linuss said:


> Some will scream "straw-man!" but it's the truth.  Fact is there are technicians and there are clincians: Just because two medics are equal skill at starting IVs doesn't mean they're equal at doing differentials and correctly treating (or not treating) when needed.



Technicians can become clinicians. Isn't that the process you went through?

The determining factor is not the patch on the shoulder but the determination of the individual. 

For every sub-par fire medic, I know a burnt out single-role. In the end, we are fighting for the same argument from opposite sides.


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## STXmedic (Oct 8, 2014)

gotshirtz001 said:


> For every sub-par fire medic, I know a burnt out single-role.


This is one of the biggest things I notice. 

It makes since that single-role medics should be superior to fire medics on a fairly consistent basis. It may be a regional thing, but this has not been my observation. I do know some great single-role medics, but I know far more who are terrible at their job with no desire to improve. And these aren't just guys waiting to get on FDs, either. 

On the flip side, many of the best paramedics I know are fire medics. Hell, one of the systems around here that's known to consistently have stellar medics is a fire-based system. Even in my very large FD, where I will readily admit a good portion of our medics are sub-par in my eyes, I would still trust many of our fire medics over much of the area's stand-alone medics.

The idea makes sense. I like it. Doctors, or mid-levels, or nurses, or whatever area of healthcare you choose do not act as plumbers as another part of their job function. Theoretically, a single-role medic should be superior in medicine to a fire medic, since that is what they specialize in. In my personal experience, however, that is not the case. At least not with any reliable consistency.


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## vcuemt (Oct 8, 2014)

STXmedic said:


> This is one of the biggest things I notice.
> 
> It makes since that single-role medics should be superior to fire medics on a fairly consistent basis. It may be a regional thing, but this has not been my observation. I do know some great single-role medics, but I know far more who are terrible at their job with no desire to improve. And these aren't just guys waiting to get on FDs, either.
> 
> ...


I think it's a hypothetical that we can't yet translate to reality. Fire is, in many cases, where the best medics will go because of pay, pension and stability reasons. However, the best firemedics I know do it for the medicine and the fire is part of the job because the job is the best a medic can get. That these medics would be equally great, if not better, if medicine was all they did makes sense, but one can't say for certain.


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