# FD EMS vs Private



## JDallas (Dec 17, 2012)

Throughout this website, I've detected varying levels of contempt between Fire-Based and private EMS. I'm curious what the reasoning behind that is?

I understand that some people want to be in strictly one area- Fire or EMS- but many other people (such as myself) are interested in both?

What makes American Medical Response better than San Bernardino County Fire at patient care/transport? (simply using a local example here, same idea applies pretty much anywhere)


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## Ewok Jerky (Dec 18, 2012)

I have no problem with Fire/Rescue/EMS personnel.  I DO have a problem with people who have no interest in EMS who get their medic only to get on with a FIRE dept.

The majority of a fireman's job is running medic calls, especially if they are on the box.  These type of firemen tend to be lazy at best, incompetent and dangerous at worst.

Believe me, the privates have lazy burnt out medics too, but probly not as many as your average fire dept.

for example (in a CA system with ALS engine and private transport company):

1-we how up to a father holding his limp, very pale 10 Y/O son in his arms.  One fire guy is sitting on the tail board, one is standing with a clipboard, and the lead medic has 0 info for us when we arrive, no Hx, no vitals.

2-we show up for an obvious BLS ground level fall with ankle pain. nothing ALS about it, and when I say ankle pain I mean pain, not Fx.  After we load the Pt up the medic from the engine tells me to put her on a cannula "just because, you know".


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## JDallas (Dec 19, 2012)

I guess I'm just unique in the fact that I live in an area where our firefighters aren't *required* to do medical calls, so I've never experienced this first hand.


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## ams17 (Dec 20, 2012)

I'm confused as to why in some places, you must be medic to become ff...or ff to become medic. I think that stands in the way of countless people trying to further or even start a career. 





beano said:


> I have no problem with Fire/Rescue/EMS personnel.  I DO have a problem with people who have no interest in EMS who get their medic only to get on with a FIRE dept.
> 
> The majority of a fireman's job is running medic calls, especially if they are on the box.  These type of firemen tend to be lazy at best, incompetent and dangerous at worst.
> 
> ...


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## Christopher (Dec 20, 2012)

JDallas said:


> Throughout this website, I've detected varying levels of contempt between Fire-Based and private EMS. I'm curious what the reasoning behind that is?
> 
> I understand that some people want to be in strictly one area- Fire or EMS- but many other people (such as myself) are interested in both?
> 
> What makes American Medical Response better than San Bernardino County Fire at patient care/transport? (simply using a local example here, same idea applies pretty much anywhere)



I work for a fire department as a paramedic and we operate a unit in the same area as County units. There was pushback when we went Paramedic level initially, but now they realize we're serious about it and we're no longer "in competition".

I work for a private 3rd service EMS, but we exclusively handle transport in that County, so we don't compete with fire departments, nor do they provide paramedics.

Our area has great working relationships with all of the departments and in both areas we meet regularly to discuss QA/QI concerns.

It seems instead that some States allow for dysfunctional EMS systems and thus encourage and exaggerate the problems between "Fire-based EMS" and "EMS".

(news flash, it is just EMS)


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## ThatPrivate (Dec 21, 2012)

I often wondered the same thing. I know that generally paramedics that are trained as a firefighter get paid more then single role. I can't speak about the laziness because I'm new to EMS and haven't experienced it yet. Another thing I notice is the benefits are a little better with firefighter based EMS followed by county/municipal run EMS and lastly private companies. Each system isn't perfect and it depends on the area your in. Hope this helps.


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## Christopher (Dec 21, 2012)

ThatPrivate said:


> ...and lastly private companies.



My day job is at a huge, multinational corporation. Corporations are given little incentive to ensure you receive wonderful benefits. They're given every reason to decrease cost. Practically by definition working for a private company is going to entail worse benefits than other forms of employment.


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## MagicTyler (Dec 22, 2012)

IMO privates should go away, and fire or PD should have an EMS division, or EMS should be its own county/city entity. Fire/ALS should not exist, deticated ALS ambulance under a fire department is ok though. Its too much to be a good firefighter and a good medic, they are two totaly different jobs.


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## Tigger (Dec 22, 2012)

MagicTyler said:


> IMO privates should go away, and fire or PD should have an EMS division, or EMS should be its own county/city entity. Fire/ALS should not exist, deticated ALS ambulance under a fire department is ok though. I*ts too much to be a good firefighter and a good medic, they are two totaly different jobs.*



Really? Sure they are different, but the education required for both of them doesn't even approach that of a bachelors degree. If you demand that competency be shown for both roles and compensate appropriately, what would the issue be?


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## mycrofft (Dec 22, 2012)

*Dear OP*







*"You didn't want to ask that question".*
("I didn't want to ask that question").

*"You don't really want the answer to that question anyway"*
 ("I don't really want the answer to that question anyway").

*"Move along"....*


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## DeepFreeze (Dec 22, 2012)

*6, 1/2 dozen the other...*

I think you really need to narrow your question down because it is so broad. It all depends on your area/state/socio-economical influences. I am a career firefighter in a upper-middleclass community and we work very well with Private EMS as one unit. I've been a private emt in another lower income area where Fire doesn't want to get out of the engine to do medicals.

I will say that everyone should be giving full pt care and treat everyone respectfully and compassionately. Lazy Firefighters or Firefighters that can't see that EMS is now part of the daily job are behind the times.

I think where the contempt can sometimes come is the "we vs them" feeling, that needs to go away. Benefits, pay differences, unions, they all play a role in that and again it depends on your area. EMS can get jealous that Fire is getting paid more, Fire can get mad that EMS is taking up too much time from "fire duty", etc. etc.


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## ThatPrivate (Dec 22, 2012)

There's also hospital based EMS. Sometimes they are pretty good but then again it depends on the hospital and how well they work with law enforcement and fire.


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## 46Young (Dec 22, 2012)

MagicTyler said:


> IMO privates should go away, and fire or PD should have an EMS division, or EMS should be its own county/city entity. Fire/ALS should not exist, deticated ALS ambulance under a fire department is ok though. Its too much to be a good firefighter and a good medic, they are two totaly different jobs.



An academy that trains up to the FF2 level runs 24 weeks give or take. A medic program  runs a year give or take. Each side has an Associates degree, but the average time to educate and train an American FF/medic is less than a year and a half. Good municipal departments will have plenty of fire training, and also offer EMS CEU's either on-duty, or hold a sessions every month or two on OT.

 If slow call volume or the FF/medic not seeing enough calls on one side or the other is your argument, then anyone working in a rural single role system must be a poor provider. Even in busy systems or semi-busy systems, the type of calls may be very routine and not challenging at all. Fires are few and far between in many places, as are cut jobs, tech rescue, Hazmats, etc. Many EMS only systems run emt/medic on every bus, and run every type of call, so they see only a few sick patients and a whole lot of non-emergent nonsense. I run about fifty to sixty EMS calls a month, the majority being on a txp unit, and I can count the number of true diff breathers, cardiacs, arrests, and multi-traumas I see on one hand. I might give meds once a shift or less.

Also, by your logic, if 18 months or so of education and training (plus maybe an ALS internship after hire) is too much to be a good firefighter and a good medic, then earning a four year degree should be practically impossible. I won't even get into Attorneys, CPA's, teachers, NP's, PT's, MD's, etc.


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## Veneficus (Dec 22, 2012)

MagicTyler said:


> IMO privates should go away, and fire or PD should have an EMS division, or EMS should be its own county/city entity. Fire/ALS should not exist, deticated ALS ambulance under a fire department is ok though. Its too much to be a good firefighter and a good medic, they are two totaly different jobs.



First off. There are just as many bad FD EMS services as there are bad privates. 

Furthermore, the bad FD services actually affect a far greater number of patients.

Now that we got that out of the way...

I think EMS should be its own entity. Not because the fire service can't be good at it. There are FDs that provide great EMS service. At least they provide what could have been consdered great in the year 1980.

The only things that really stop FD from being great ALS transport services are money and how much the organization values the mission of EMS.

Having said that, the reason I think it needs to be seperate is because the ALS transport method of EMS is not sustainable. There simply will never be enough units as call volumes increase. Dropping everyone off at the ED that calls an ambulance is an economic nightmare.

As such, the future of EMS will be both more of a publichealth/prevention role and properly dispose of callers to the correct healthcare or social entity. (navigating healthcare for the pt.) 

Not because I said so. Prevention was the major aspect of success in both the FD and LE. Prevention is cheaper than emergency by a lot. It reduces call volumes so you can respond to emergencies with a reasonable amount of equipment and people.

We have advanced medical knowledge to the point where "acute" emergencies barely exist. A majority is exacerbation of chronic health problems.

The current US ALS education and service model is not designed for this. It will have to evolve. That will require paramedics to be educated on who needs to be admitted, treat and release, etc. 

Which means, sooner or later, most likely later, there will be so much required to be a good medic that either A. these providers will suck at firefighting/rescue/hazmat/etc. etc. because they spendso much time on the healthcare aspects of EMS. (Much of the fire service is a skill, like all skills when you don't use them you lose them) B. Paramedical education will attract people who either don't want to be firefighters or don't have the physical requirements curently accepted. (Because they spent more time at school than in the gym, there are only so many hours in a day and I can tell you the gym was not even on my radar in medical school.)

As for not being able to be good at both. I think it is evident that people who fight a lot of fire (mostly urban municipal) are good at it. People who see fire once in a while are not as good at it. But the day is coming when there simply won't be enough hours in the day to practice fire service skills that are hardly ever used and provide healthcare.(both emergent and non)

The reason most FDs that currently do EMS are not good at it isn't because they can't be, it is because they don't want to be.


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## xrsm002 (Dec 22, 2012)

beano said:


> I have no problem with Fire/Rescue/EMS personnel.  I DO have a problem with people who have no interest in EMS who get their medic only to get on with a FIRE dept.
> 
> The majority of a fireman's job is running medic calls, especially if they are on the box.  These type of firemen tend to be lazy at best, incompetent and dangerous at worst.
> 
> ...



@beanp my hometown and the city to the west of it actually require all ff to be EMT certified actually I think it's a state requirement for TX, both FDs also require you to get your medic within two years of being hired or they fire you. Or you good have your medic and they will put you through the fire academy.the only reason I'm not working for them is they make you do both the box and engine time and I have no interest in being a firefighter, but I respect them and know several of them. But I wish they would let medics who aren't FF work just on the ambulance.


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## Veneficus (Dec 22, 2012)

xrsm002 said:


> @beanp my hometown and the city to the west of it actually require all ff to be EMT certified actually I think it's a state requirement for TX, both FDs also require you to get your medic within two years of being hired or they fire you. Or you good have your medic and they will put you through the fire academy.the only reason I'm not working for them is they make you do both the box and engine time and I have no interest in being a firefighter, but I respect them and know several of them. But I wish they would let medics who aren't FF work just on the ambulance.



That is because the purpose of FDs performing EMS is to save *firefighter* jobs, not to provide jobs for nonfirefighters.


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## Fish (Dec 22, 2012)

46Young said:


> An academy that trains up to the FF2 level runs 24 weeks give or take. A medic program  runs a year give or take. Each side has an Associates degree, but the average time to educate and train an American FF/medic is less than a year and a half. Good municipal departments will have plenty of fire training, and also offer EMS CEU's either on-duty, or hold a sessions every month or two on OT.
> 
> If slow call volume or the FF/medic not seeing enough calls on one side or the other is your argument, then anyone working in a rural single role system must be a poor provider. Even in busy systems or semi-busy systems, the type of calls may be very routine and not challenging at all. Fires are few and far between in many places, as are cut jobs, tech rescue, Hazmats, etc. Many EMS only systems run emt/medic on every bus, and run every type of call, so they see only a few sick patients and a whole lot of non-emergent nonsense. I run about fifty to sixty EMS calls a month, the majority being on a txp unit, and I can count the number of true diff breathers, cardiacs, arrests, and multi-traumas I see on one hand. I might give meds once a shift or less.
> 
> Also, by your logic, if 18 months or so of education and training (plus maybe an ALS internship after hire) is too much to be a good firefighter and a good medic, then earning a four year degree should be practically impossible. I won't even get into Attorneys, CPA's, teachers, NP's, PT's, MD's, etc.



You never answered my PM


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## drjekyl75 (Dec 23, 2012)

MagicTyler said:


> IMO privates should go away, and fire or PD should have an EMS division, or EMS should be its own county/city entity. Fire/ALS should not exist, deticated ALS ambulance under a fire department is ok though. Its too much to be a good firefighter and a good medic, they are two totaly different jobs.



The county I live in, the sheriff's dept. serves as the ALS. They use local private companies as the transports. I think the guys from the sheriff's dept do a good job but like everywhere some are better than others. We run into guys who prefer to play cop first and are crappy medics and lazy. We also see very short life spans for the guys on the road, they tend to burn out quick and switch divisions to get out of running medicals. This is why I'd like to see more of the private companies run ALS in addition to the sheriff's dept.


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## Achilles (Dec 23, 2012)

drjekyl75 said:


> The county I live in, the sheriff's dept. serves as the ALS. They use local private companies as the transports. I think the guys from the sheriff's dept do a good job but like everywhere some are better than others. We run into guys who prefer to play cop first and are crappy medics and lazy. We also see very short life spans for the guys on the road, they tend to burn out quick and switch divisions to get out of running medicals. This is why I'd like to see more of the private companies run ALS in addition to the sheriff's dept.



And what county would this be?


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## Anjel (Dec 23, 2012)

Achilles said:


> And what county would this be?



Genesee county. They still have ALS, but they have sherif medics that will ride in if it is a BLS unit that responds.


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## drjekyl75 (Dec 23, 2012)

Anjel said:


> Genesee county. They still have ALS, but they have sherif medics that will ride in if it is a BLS unit that responds.



For awhile there were issues because if you are treated by the Sheriff's dept. you aren't billed for the ALS because they are funded through taxes. If a private company showed up and they happened to be ALS you were billed for service. so it came down to if the sheriff showed up they could jump on anyone's truck ALS or BLS and run the call if they chose. Another issue was then the sheriff guys would take the "good" calls and dump stuff they didn't want onto the private companies.


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## Hunter (Dec 23, 2012)

Veneficus said:


> That is because the purpose of FDs performing EMS is to save *firefighter* jobs, not to provide jobs for nonfirefighters.



This! 

That's the only reason fire had taken over EMS is to pay their bills that they can't cover with just fire runs.


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## Christopher (Dec 23, 2012)

Hunter said:


> This!
> 
> That's the only reason fire had taken over EMS is to pay their bills that they can't cover with just fire runs.



At my fire department this just isn't the case. We receive ~70% of our budget through fire fees and ~20% through EMS billing; the remainder through contracts with the county and various towns.

We took on ALS transport to serve a community need.

That being said, if we didn't combine the two funding sources we wouldn't have 4 career staff 24x7x365 (19 total; chief, asst chief, captain, 4 shifts of 4 folks).


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## Veneficus (Dec 23, 2012)

Christopher said:


> At my fire department this just isn't the case. We receive ~70% of our budget through fire fees and ~20% through EMS billing; the remainder through contracts with the county and various towns.
> 
> We took on ALS transport to serve a community need.
> 
> That being said, if we didn't combine the two funding sources we wouldn't have 4 career staff 24x7x365 (19 total; chief, asst chief, captain, 4 shifts of 4 folks).



Unfortunately your department is the exception, not the rule. 

FDs I have been with in the past used the run numbers generated by EMS calls as the basis for their budget proposals. However, nowhere near the budget increases went towards anything remotely EMS related, but there was always nice big shiney new fire equipment. A lot that wasn't ever used or needed.

However, our staffing levels (aka my job) and keeping the lights on depended on these budgets. It wasn't until after I left the fire service that they began actually billing for EMS.

I am sure most fire departments don't actually "rely" on the money generated from EMS to keep the lights on. It probably doesn't come close to paying even 1 full time salary, which with benefits and pay 15 years ago was near $1million a year at our regional departments. 

But I would be very surprised to learn that these "medical responses" whether it is CFR or ALS transport don't still play a large role in the budgeting.

As I often say, if you want the answers to most things, just follow the money.


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## Christopher (Dec 23, 2012)

Veneficus said:


> Unfortunately your department is the exception, not the rule.
> 
> FDs I have been with in the past used the run numbers generated by EMS calls as the basis for their budget proposals. However, nowhere near the budget increases went towards anything remotely EMS related, but there was always nice big shiney new fire equipment. A lot that wasn't ever used or needed.
> 
> ...



Considering the expense of providing EMS...I dunno. 1300 transports a year (2200-2300 EMS calls, 800-900 fire calls) is only able to cover 20% of our expenses! Granted, we put the shiny new stuff on EMS at least as much if not more than on the fire side.

There are plenty of examples of FD based EMS that does it right. Blaming fire depts is an indirect means of attacking the real problem:

Paying for EMS coverage is completely messed up.

Fire departments don't get into it for the money, perhaps for the call volume, but it doesn't represent anything close to a sustainable funding source. Taxes or fire fees are the bulk of a fire department's revenue.

The more likely cause is people pointing out call volumes going down on fire while EMS goes up, yet fire depts get larger budgets. The squeaky wheel gets the grease. It makes business sense to take on the Loss Leader so you can keep the doors open. Can't blame a business for making that sorta move.


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## Veneficus (Dec 23, 2012)

Christopher said:


> Considering the expense of providing EMS...I dunno. 1300 transports a year (2200-2300 EMS calls, 800-900 fire calls) is only able to cover 20% of our expenses! Granted, we put the shiny new stuff on EMS at least as much if not more than on the fire side.
> 
> There are plenty of examples of FD based EMS that does it right. Blaming fire depts is an indirect means of attacking the real problem:
> 
> ...



I don't blame them for doing it. Like I said, when my job depended on it, I carried the banner for it. 

I respectfully disagree there are "a lot" of departments doing it right. Infact I can name all the ones that cover more than a million people that do. 

Tax dollars to be able to handle call volume is a relatively stable funding source. From fire levies to laws dictating budget percentages, the FD is very adept at keeping its share of the pie.

Again, not a fault, a requirement. It is hard to fault people for trying to keep their job.

However, the US fire service is not keen to embrace regional coverage nor willing to accept the amount of job and salary loss to do it. 

Again, keeping your own job. If you are the chief of a department of 19, in a regionalized system, you might be lucky to still have a job. You certainly won't be the chief, and you would be even luckier to be an officer. 

My last LT has more knowledge and experience than 90% of "non-big city" fire chiefs. Any single captain or B chiefs could probably run 3/4ths of the state without much effort.

It is sometimes referred to as the "my little kingdom" approach to fire departments.

Be careful about buying into fire service altruism. It is easy to get caught up in the propaganda and very difficult to see the forest from the trees.


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## Christopher (Dec 23, 2012)

Veneficus said:


> I don't blame them for doing it. Like I said, when my job depended on it, I carried the banner for it.
> 
> I respectfully disagree there are "a lot" of departments doing it right. Infact I can name all the ones that cover more than a million people that do.
> 
> ...



I work for a 3rd service private as well as an FD, plus a day job at a Fortune 10 company...I'm easily the most cynical person around when it comes to corps/gov'ts 

I see 3rd service private doing it right and doing it wrong. I see FD's doing it right and doing it wrong. I see municipal services doing it right and doing it wrong.

Basically, it isn't who delivers the care but instead how they deliver the care. And you hit on probably the biggest factor: how the folks in charge want it delivered.

(As for the fd altruism, it isn't our dept which is altruistic but rather the people because at the end of the day the budget will be met)


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## DeepFreeze (Dec 23, 2012)

I feel that this kind of thread makes everything go like this:

http://qkme.me/3sbdjl


Not saying your thread is troll bait at all...but you can see how much momentum this thread gains. 

Let's all agree to disagree :deadhorse:


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## Tigger (Dec 23, 2012)

DeepFreeze said:


> I feel that this kind of thread makes everything go like this:
> 
> http://qkme.me/3sbdjl



Fact.


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## Veneficus (Dec 23, 2012)

I thought this one was much more civil than most.


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## ffemt8978 (Dec 23, 2012)

Veneficus said:


> I thought this one was much more civil than most.



It is, which is why it hasn't been locked yet.


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## DrParasite (Dec 25, 2012)

*Painting with a very broad brush*

I love FD EMS.  pension, good benefits, stationed at a fire house, have a bunk room, lockers, kitchen, and a supervisor is usually a person who will help you out.

I hate FD EMS.  firefighters don't want to be on the ambulance, they are just doing their shift until they can get back on the engine.  that leads to poor patient care and poor attitudes.  Not only that, but just because you have an EMT cert doesn't mean you know what EMS is.... how much con ed above the minimum have you completed?  Do you know the difference between sick and not sick?  And on the EMS systems that fall under the FD (FDNY, DC, Detroit, Philly, etc), where the EMS is part of the FD in name, but understaffed, underpaid, redheaded stepchild is often used for run numbers, but the funding still goes to the suppression side, and despite EMS having between 2x and 4x as many runs as the suppression side, there are usually more suppression units than ems units.  And all too often, the EMS crews are looking to transfer to the fire side, to make more money, go on less runs, and be treated much better.

I hate private EMS.  pay sucks, management treats their staff as easily replaceable, and you get run into the ground because they won't pay for additional trucks (because a truck not going on a run isn't making any money for the company, and that gets into the bottom line).  contracts change hands yearly, so you can work for the same private in the same area for 10 years, and if a new company wins the contract, you start at the bottom of the pay and seniority area if you want to stay in that area.... else you get laid off.   Trucks are falling apart, missing critical equipment, and all too often you find worthless slugs in uniforms, because there are no requirements to get the job except to have a pulse.  "we don't care if you kill patients, as long as your paperwork meets the billing requirements and you don't crash the ambulance" is very common.

Private EMS.... cheaper for the taxpayer, they bill the people who use the service more than the government.... I guess that's the only good thing....

to each his or her own.  I still think the FD should put out fires, and the EMS agency should deal with the sick and injured on their own.  and the EMS chief should be equal to the fire chief, and the EMS supervisors should stand up for their people like the fire supervisors do.


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## nick92 (Dec 27, 2012)

the cruel world :/


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