# Why the does fire have control on a medical incident???



## RanchoEMT (Apr 25, 2011)

FIRE vs. EMS

HEMS LONDON 'Medic ONE'
http://www.youtube.com/watch?v=G0EENc_zNR0

***Please Note:  I will refer to only ALS ambulances as “EMS” for this Post.

I was just sitting here watching “HEMS London” and it dawned on me after watching the European EMS system do as they do…. How much further ahead they are than the American system.  (At least in my mind, maybe you all have differing opinions…)  One major difference in systems I noted was the lack of Fire Dept. Personal running the Medical Calls…  And I started to question FIRE’s role in EMS, “Aside from early access during rescue operations, why does fire have control over EMS related incidences, normally?”

Shouldn’t the EMS Ambulances who are Specific to MEDICAL incidences have Control on scene of a Medical Patient??? Shouldn’t the Fire department personnel who are Specific to Fire, Hazmat, Rescue/Salvage, etc. Operations have Control over Fire, Hazmat, Rescue/Salvage, etc.??? Like-wise for Law Enforcement?

Wouldn’t it be more logistically sound to keep the Fire Dept. Available for other Non-Medical calls that they and ONLY THEY could be running???

*** I am aware that every EMS system is different, but in California Fire has control over medical incidences and dependent upon their assessment they will either ride along in a support function or throw the patient to the EMS Ambulance Crew, WHO WILL STILL BE TAKING THE PATIENT TO THE HOSPITAL WITH A PARAMEDIC PROVIDING THE SAME CARE REGARDLESS IF FIRE MADE IT TO THE CALL AT ALL. ***

If one was to think long and hard about what FIRE is actually doing at a scene, it can be figured that it’s really no more than what an ambulance crew could be doing. (Aside from Rescue/Complicated Access operations.)

*A short Theory*: The Fire department has in a way shot themselves in the foot, what with improving advancements in fire safety, restrictions/regulations, etc.   that actually do make a difference and do prevent a lot of fire’s from happening.  But this is in essence a bad business move, defeating the fire department’s purpose and marginalizing the need for a fulltime fire department that is specific to ONLY running fire calls.

“Any service that exists to work towards marginalizing its own relevance will require, for its own buoyancy, an escape function or secondary capacity which must work at restoring its original level of necessity.  Assuming of course the same road is not further taken to necessitate the need for a third function. …But leave it to the Fire Dept.”

EMS has since become “Fire’s Escape Function”, keeping the fire department running calls and appearing both busy and needed.

“Either send a Probie out in civi’s to go out and set fires or get the department trained as paramedics.”   -A Fire Chief at some point in time…

I feel a specific Fire vs. EMS tension that I believe is founded on the idea that if fire is able to marginalize the need for EMS Ambulances, by making them appear incompetent, lazy, unkempt, and generally seconded the Fire department will be able to retain EMS for as long as the government and citizens agree with these gestures.  Holding onto that which is not rightfully theirs. It is possible that American EMS is a system that is set up for fighters and there healthy longevity as ‘heroes’.

It seems to me that currently, at least the CA system, is ran with priority to Police, Fire and then EMS…

Priority as it seems should be reworked to: Law Enforcement, EMS, then Fire….

There are a lot of Great Minds and Hard-Thinkers that come together on this website and I would love for you to share your insights and make known my misspellings. :^D 
	-Thank you, Pre-empt.




--Some Things To ​Think About--
-Do you guys think if EMS(non-fire) wages were at par or above Fire/Police, we would have more control over local EMS systems?

-Do you think if to be a firefighter implied driving around in a goofy euro style fire box, with a goofy bright yellow bicycle helmet and functioning as a Second-IN medical service, you would still see 10,000 people put in an app for one available position at a dept.?

“You shouldn’t have a private company respond when a tax paying citizen calls 911.”

You wouldn’t have a private company providing fire safety and law enforcement, then why would you have a private company provide medical services.  Shouldn’t the same government which provides law enforcement, fire/rescue provide Medical Services in the capacity of a government ambulance that takes you to the hospital and can administer beyond advanced life support in the field/on scene, like the HEMS in London with a Mobile Doctor?


----------



## Veneficus (Apr 25, 2011)

Welcome to my world.

But here is the brief brief summary.

Healthcare is not a government function in the US. Fire and Police are.

In order to maintain low tax rates, service must be reduced to as cheap as possible. 

In some areas that means outsourcing to private companies.

If you want superior service, it has to be paid for. There is not the political will for it simply.


----------



## Sandog (Apr 26, 2011)

> In order to maintain low tax rates, service must be reduced to as cheap as possible.



That ship has sailed, there are no low tax rates in Ca, yet the state is broke and I use that word with its duality. The state is broke, the system is broke, and how can you hope to attract quality personnel when the wages won't cover a simple living? I am not some kid with a 100 hours of schooling but I did get into EMS with blinders on and was sorely disappointed when I was introduced to the reality of things. 

I have met many people in EMS that are of the highest moral caliber and they do what they do for the love of the job. I find the wages that EMS folks make to be appalling,  100 hours or 1000 hours of training I care not. These people have to jump through hoops and obstacles just to carry a patch; these men and women provide care for our sick at their most vulnerable time. Should I even mention the liability they carry with that patch? Despite all this there are people willing to carry that gurney. What EMS people need to do is rally together and form a union. Yes I said it... so there


----------



## firetender (Apr 26, 2011)

*A CL's Pre-Emptive Strike*

Typically, this is not a subject that attracts balance. 

Oh, threads start innocently enough but soon they become opposing sides fiercely tossing razor sharp pendulums back and forth to each other. Lots of blood all over the place!

So let's see if we can all CONTRIBUTE without CORRUPTING the initial intention of the OP; _*"And I started to question FIRE’s role in EMS."*_

The OP offered some theories and personal observations and asked a bunch of questions. Maybe the OP could be helped to better understand why and how it works, or how and why it doesn't, without getting into the realm of high-drama, finger-pointing or immovable positions.

It's worth looking at, maybe first by directing him to some past threads that were somewhat comprehensive in their coverage of the subject (before they got closed, anyhow )


----------



## johnrsemt (Apr 26, 2011)

I always tried to ignore the fire crews or officers when they tried to be in charge on a medical run.   Most of the time the officers were great and just did paperwork or talked to the family. 
   Did have one officer who always questioned why I did what I did,  usually after the run.   I always suggested he go to Paramedic school,  usually shut him up.  Especially when his crew would laugh.


----------



## Veneficus (Apr 26, 2011)

Sandog said:


> What EMS people need to do is rally together and form a union. Yes I said it... so there



Earlier in life I would probably have typed 2 pages on the complexities of this and the long term consequences.

But now I am of the mind to just say "go for it, and let me know how it works out in about 10 years."

Medicine is a business, and if you increase the cost of labor, ultimately the people paying the price are the people paying for the medicine because nobody along the chain is going to eat the increased labor cost.

In the US that is medicare, medicade, (both tax funded) insurance premiums, and of course aggresive billing practices regarding private payers.

Those cost increases you will be bearing, and will exceed by a considerable margin, the increase in your pay.


----------



## DrParasite (Apr 27, 2011)

RanchoEMT said:


> Wouldn’t it be more logistically sound to keep the Fire Dept. Available for other Non-Medical calls that they and ONLY THEY could be running???


in a properly staffed and funded EMS system, the only role FD would role would be as a lift assist.

however in order to do this, you would need to have enough ambulances to cover the call volume, and have an ambulance on scene in under 7 minutes EVERY time (or greater than 90% of the time, 5 minutes would be even better).  you would also need a command staff (on duty deputy chief/EMS manager and 2 on duty batt Chiefs/EMS supervisor, depending on coverage area size), as well as special operations and enough spare vehicles in usable condition for routine maintenance, plus all the necessary support people.  Not only that, but having the ability to be accepted as a monetary black hole (like the FD and PD, who get lots of tax money and never ever show a profit) and be funded 100% by taxes would allow it to happen.

I think Wake County EMS is one of the only departments that I am aware that comes close to this level.  

Most let the FD run the show because they have the available command staff, tax base, and extra units who are able to make it to scenes when the ambulance is gonna take too long.  Sadly, most EMS don't have the resources available that the FD is able to get.


----------



## DesertMedic66 (Apr 27, 2011)

Major reason for fire to respond in this area is due to response time. Why wait possibly 10+ mins for an ambulance to get on scene when an ALS fire crew might be able to get there in under 3. 

I did a ride out in Rancho. We were short 6 ambulances. We got a serious call for a motorcycle vs tree. Our response time was 26 mins 12 seconds. Fire was on scene in under 5. I would not wanna have a femur fracture and not have any pain meds for 26 mins when I could have them in under 5 mins. 

All the fire crews I have ran with are really good. If they arrive first they start doing everything. Then when we show up they brief us and let us take over as they just write down info. If we arrive first they help us with all of our gear and write down the info. 

I am 100% for having fire crews run EMS calls as long as they operate like I said before. It allows for faster response times, faster time from being dispatched to arriving at the hospital, and often better patient care (Case in point a call today: 72 year old man was in an irregular heart rhythm. The EMS medic wanted to shock him into a normal rhythm. Fire medic suggested doing a vegal reflex, something like that, to get the normal rhythm back. It worked and saved us from having to shock or administer meds to a fully alert patient instead he just had to hold his breath.)


----------



## BEorP (Apr 27, 2011)

firefite said:


> Major reason for fire to respond in this area is due to response time. Why wait possibly 10+ mins for an ambulance to get on scene when an ALS fire crew might be able to get there in under 3.
> 
> I did a ride out in Rancho. We were short 6 ambulances. We got a serious call for a motorcycle vs tree. Our response time was 26 mins 12 seconds. Fire was on scene in under 5. I would not wanna have a femur fracture and not have any pain meds for 26 mins when I could have them in under 5 mins.



It is pretty clear to me that the bigger question in the example you give is why the solution isn't actually more ambulances, not having fire do medical calls.


----------



## Jon (Apr 27, 2011)

I think DrP is dead on.



firefite said:


> Major reason for fire to respond in this area is due to response time. Why wait possibly 10+ mins for an ambulance to get on scene when an ALS fire crew might be able to get there in under 3.
> 
> I did a ride out in Rancho. We were short 6 ambulances. We got a serious call for a motorcycle vs tree. Our response time was 26 mins 12 seconds. Fire was on scene in under 5. I would not wanna have a femur fracture and not have any pain meds for 26 mins when I could have them in under 5 mins.
> 
> ...


In the first case, sounds like the fire-medics would be better used on an ALS transport unit, rather than in their current dual-role position. 26 minute response times, when fire can be onscene in 5, shows me that the system isn't preforming the way it should.

As for the latter one... same can be accomplished by putting 2 medics on every ambulance. And it means you don't have to spend the fuel to drive the pretty red truck to the scene, and pay the 4 guys on the pretty red truck, too.



BEorP said:


> It is pretty clear to me that the bigger question in the example you give is why the solution isn't actually more ambulances, not having fire do medical calls.


Quoted For Truth


----------



## sir.shocksalot (Apr 27, 2011)

firefite said:


> and often better patient care (Case in point a call today: 72 year old man was in an irregular heart rhythm. The EMS medic wanted to shock him into a normal rhythm. Fire medic suggested doing a vegal reflex, something like that, to get the normal rhythm back. It worked and saved us from having to shock or administer meds to a fully alert patient instead he just had to hold his breath.)


What is the difference between a Fire medic and an EMS medic? Do they have a special certification titled "Firemedic"? If so, how do obtain one of these godly certifications for myself?

Can we drop the whole firefighters are better medics/single role medics are better medics crap? There are dumb dumbs and geniuses in every service from private, to 3rd service, to fire based. Saying inflammatory remarks that one provides better care than the other serves no purpose to the discussion, especially without any scientific evidence of such.

To the OP, my main complaint about fire based EMS is that it's a colossal waste of tax payer money. If my Grandma has an asthma attack and forgot her inhaler I don't want a fire truck and an ambulance with a total of 6 people in bunker gear at my house to give her a neb. Thankfully my Grandma lives in Australia and won't have to deal with that crap. Adequate dispatch triage will eliminate unneeded fire response to calls that don't need extra hands (arrests, MVA, etc need extra hands), even then I can run an arrest with just an extra cop to do CPR. It's just a waste of tax payer money for a fire truck to show up to a intoxicated individual. Also why do I have to pay for a paramedic in every fire house? There is no proven benefit to early ALS (or any ALS for that matter) so why does he make $75K+ a year to provide no scientific benefit. Early CPR is the only benefit an extremely short response time can prove, even then the difference is only made if they make it in about 2 mins and that benefit is eliminated by adequate rates of bystander CPR.

TL;DR version: Fire trucks are expensive to run and completely not needed for 80% of ambulance responses.


----------



## DesertMedic66 (Apr 27, 2011)

sir.shocksalot said:


> What is the difference between a Fire medic and an EMS medic? Do they have a special certification titled "Firemedic"? If so, how do obtain one of these godly certifications for myself?
> 
> Can we drop the whole firefighters are better medics/single role medics are better medics crap? There are dumb dumbs and geniuses in every service from private, to 3rd service, to fire based. Saying inflammatory remarks that one provides better care than the other serves no purpose to the discussion, especially without any scientific evidence of such.
> 
> ...



No difference. And I never said one is better then the other. Sometimes having another "set of eyes" on scene is good and can lead to better patient care. I am basing all this from what I have worked with and what is better for the patient. Is it better to have a patient waiting on scene for 20+ mins with no aid or having fire get there in 5 mins? What is better for the patient is odviously clear.


----------



## DesertMedic66 (Apr 27, 2011)

Jon said:


> I think DrP is dead on.
> 
> 
> In the first case, sounds like the fire-medics would be better used on an ALS transport unit, rather than in their current dual-role position. 26 minute response times, when fire can be onscene in 5, shows me that the system isn't preforming the way it should.
> ...



It was the day before thanksgiving so alot of people used their time off. Fire does not transport in this area. And lastly "it better money wise to have an EMT and medic partner. As opposed to dual medics" - straight from my employers. There is no flawless system. This is one of the flaws.


----------



## MrBrown (Apr 27, 2011)

firefite said:


> No difference. And I never said one is better then the other. Sometimes having another "set of eyes" on scene is good and can lead to better patient care. I am basing all this from what I have worked with and what is better for the patient. Is it better to have a patient waiting on scene for 20+ mins with no aid or having fire get there in 5 mins? What is better for the patient is odviously clear.



That argument is invalid.  Just because the Fire Service can show up faster does not make them better.  The Fire Service is probably, in your patch anyway, better funded, equipped and deployed.

This is the mainstay of the IAFF's argument for Fire based EMS, it was the entire reason that Eugene Nagel MD chose the Miami Fire Department for prehospital defibrillation in the late 1960s.

It remains an invalid argument.  Elsewhere in the world, Ambulance is just as well deployed as the Fire Service and we get along fine without the Fire Service.

Now let us assume we have a non Fire based Paramedic and a Fire based Paramedic, both are equally educated.  Who is going to be wore, some bloke who sits on a Fire truck and sees maybe a few patients and is a "non transporting first responder ALS engine medic" vs somebody who works on the ambulance and sees a lot of patients for a longer time period because they transport them?


----------



## DesertMedic66 (Apr 27, 2011)

MrBrown said:


> That argument is invalid.  Just because the Fire Service can show up faster does not make them better.  The Fire Service is probably, in your patch anyway, better funded, equipped and deployed.
> 
> This is the mainstay of the IAFF's argument for Fire based EMS, it was the entire reason that Eugene Nagel MD chose the Miami Fire Department for prehospital defibrillation in the late 1960s.
> 
> ...



Once again I never said "fire medics are better then EMS medics". The reason that it's better for patient care is faster response times. Faster response times normally allow for faster interventions. If getting on scene faster for the patient is not better for patient care then heck why are we driving when we could just walk?


----------



## Veneficus (Apr 27, 2011)

firefite said:


> Once again I never said "fire medics are better then EMS medics". The reason that it's better for patient care is faster response times. Faster response times normally allow for faster interventions. If getting on scene faster for the patient is not better for patient care then heck why are we driving when we could just walk?



That is a pathetic argument.

All except a handful of EMS interventions in specific circumstances make no difference medically. The purpose and value of US EMS is to deliver the patient to the hospital.(It's all they get paid for actually) A non-transporting unit does not achieve that goal.

Easily 90% and often argued 95% of EMS calls are non emergent. So just because you show up faster with some hocus pokus sideshow isn't really "better for the patient."

Even less are time sensitive emergencies. The 8:59 90% was derived from the response times of the fire service at the time it was suggested. Think about the outcome when you show up 8 minutes after a cardiac arrest. Then open up your EMT text and recall when brain death starts to occur. 8 minutes, not een 9 minutes, is beyond the upper estimates by 1/3.

When you show up at the ED in any country I have been involved in healthcare in, if your problem is not medically emergent, you get sent to the waiting room. (In some hospitals in the US that can be more than 10 hours and I have seen up to 16.) Once you are seen, you have to wait yet again.

When you call yor GP in the US, you are told if _you_ think it is an emergency to call 911 or go to the ED. Otherwise you get an appointment that can be days out. (The average across the country according to the last NEJM article I saw on it was 41 days)

Except as a public relations stunt, the cost of a bunch of ALS engines and ladders economically exceeds any benefit they offer. In the real world cost is just as much a part of the system as care. Some patients will slip through the cracks. It is unavoidable.

As Brown suggested, it is deployment that makes the perceived difference. It is also area specific. Do you know in larger cities EMS calls are actually held with no response at all based on dispatch information?

What is better for the patient is to quit wasting money on the fire service and spend that money in healthcare. Particularly public health and prevention.

As for why you are not walking, that is just too stupid to address.


----------



## DesertMedic66 (Apr 27, 2011)

Veneficus said:


> That is a pathetic argument.
> 
> All except a handful of EMS interventions in specific circumstances make no difference medically. The purpose and value of US EMS is to deliver the patient to the hospital.(It's all they get paid for actually) A non-transporting unit does not achieve that goal.
> 
> ...



I know that most of the calls are non life threatening. But if I fracture my femur I am going to want pain meds as soon as possible. I wouldn't want to wait for the meds. 

Your saying that response times don't matter because 90% is not life threatening. So then if we walk it won't make a difference. We can save on gas, insurance, registration, and car accidents. Yes I know it sounds stupid but that's how I interpreted what your saying. 

For my area if we cut fire then we will have the public complain alot more about response times (they already do that now). Whatever makes the public happy is usually what will happen. And over here there has been no talk on cutting fire from EMS because they are a vital resource for us. 

And 41 days to get a doctors appointment? I'm glad I live in a small town. I call and my appointment will usually be the next day.


----------



## usalsfyre (Apr 27, 2011)

Somehow, EMS was able to almost completely separate itself from the rest of medicine early in its existence. This was combined with FD's flocking towards EMS starting in the 1980s to bolster run numbers, which had been falling precariously from all time highs in the 70's, and justify their staffing levels (which had been based in the higher run volumes)to politicians eager to make cuts in one of the more expensive items on a budget ledger. The argument was "the guys are already here". 

The result was and has been that EMS never had to stand up to the cost-benefit analysis that the rest of medicine has always experienced, until now. Furthermore, by flying the "public safety hero's" flag, some in EMS have sought to latch onto the  "Tough on Crime" and "War on Terror" type arguments, with the vague notion that if you didn't support massive increases in public safety spending, you were somehow "against" society at large. This went to all new ridiculous levels post 9/11/2001. Meanwhile, public health and injury prevention, which EMS had a chance to be a huge part of (who else in health care regularly interacts with the public at large in their homes? Even home health has an established relationship prior to ever seeing the patient) was shunned as "non-emergent", "a waste of time" "nurse work" or "bull$hit system abusers". Very simply, the people who needed our help the most were shunned as uninteresting to the adrenaline-junky culture of EMS. This is reflected in everything from our educational standards to our payment structure.   

However, the seed sown is beginning to have to be reaped. Public safety is now having to live through its own cost-benefit examinations, and the results are not pretty, especially in the days of  disposable buildings, excellent fire prevention strategies, mandatory sprinkler laws and evidence-based medicine. The separation from the rest of medicine means EMS never updated their practices to reflect what is modern. The refusal of to push into public health means very, very little cost benefit can be shown to the system. 

Very simply, EMS must change or die. We will end up being taxi drivers if nothing further is done. It's no longer about "pay us more if you want us to do more", it's about "do more or don't have a job". Unfortunately most in EMS seem massively resistant to change, from the leaders at the top due to organizational inertia/current profit margins to the new guy hoping to have the same "sweet" career as the guys before him ("couple of years on the $hitbox and then I never have to ride it again"). The way we are headed forward is delusional. 

At one point Veneficus posted about nursing taking over EMS. I was one of the "rabidly against" camp. However, the more and more I look into it and talk to the average EMS provider (not folks on here) the more I realize this is probably the best option if EMS is going to live.


----------



## RanchoEMT (Apr 27, 2011)

*firefite*

firefite I think you’re missing the big picture, the theoretical “what could be” Picture that were visualizing, and I'm not saying that because your taking a different stance on the issue, but your arguments aren't making sense...

Let’s look at AMR Rancho where you did your ride along. 
You have Fire Engines with 3-4 firefighters on them in this city. And you have an ambulance with a medic and an EMT.

There are three possibilities for patient care here. 
1.	An ambulance comes and takes the patient to the hospital providing the same care on scene and on the way that ANY medic would.
2.	Fire gets on scene and provides care until an ambulance gets on scene and takes the patient to the hospital, assuming patient care all the way to the hospital.
3.	Fire gets on scene and an ambulance doesn’t come and they sit there forever providing care.

First was an ambulance response, second was both an ambulance and a fire engine, third is where the problem lies.  The second example has its problems to with 3-4 FF to many on scene, but example three is just stupid. The only good reason to have an engine role out is response times… Which I believe is your argument.  
SURE! Currently fire can provide a quick response with medics, but that is CURRENTLY do to their city specific stationing and coverage.  But why not work towards a system where an ambulance is available to respond from every city in that 3-5min. window instead of a fire engine?? We’re looking at a theoretical system in which’ let’s say in every “fire House” there is an ambulance crew. (some places already do this.) Why send an engine when you could send the ambulance???  The ambulance HAS TO COME ANYWAYS TO TAKE THE PATIENT… And if an engine responds from the same location that an ambulance does why oh why send an engine???

***Point being, Fire sticks their heads into medical matters that are none of their business. We’re not out to trample on FF’s, hell let’s take those same FF out of their bunker gear and into some blue polos and have them run some ambulance only runs. Let’s keep people who know what there doing employed.

Let’s look at a Fire dept. you may have ran with during your ride along… 

Montclair fire dept.
http://www.ci.montclair.ca.us/depts/fire/current_year_to_date_calls_for_service_statistics.asp

There were over 600 Medical Calls which all of them REQUIRED an Ambulance on scene to take the patient.  This is compared to 17 Fire Calls that year that REQUIRED the engine. 

Once again the point is: why would an engine with FF need to respond unless requested for additional help and/or access???  Why can’t an ambulance (WAY CHEAPER) provide the same patient care that ANY medic unit would?

Doesn’t it seem that 600:17 medical calls would necessitate the need for some serious re-workings to the current system with some more emphasis put towards providing better medical care and less on the million(s) spent on the Big Red Truck and its crew????  600 medical calls, you would think the high call volume would also necessitate the need for better salaries for the medical specific guys but what’s been set in motion must come to an abrupt and well fought stop if that’s to ever happen. i.e. pay 17:600 wage differences between FF and transporting Medics.

Side Note: HELL Why Not Put an AMBULANCE in every fire house?!  Like LA City.


----------



## Veneficus (Apr 27, 2011)

Cut for brevity.



RanchoEMT said:


> Doesn’t it seem that 600:17 medical calls would necessitate the need for some serious re-workings to the current system with some more emphasis put towards providing better medical care and less on the million(s) spent on the Big Red Truck and its crew????  600 medical calls, you would think the high call volume would also necessitate the need for better salaries for the medical specific guys but what’s been set in motion must come to an abrupt and well fought stop if that’s to ever happen. i.e. pay 17:600 wage differences between FF and transporting Medics.
> 
> Side Note: HELL Why Not Put an AMBULANCE in every fire house?!  Like LA City.



If you want to play an interesting numbers game, if you need to staff 4 firefighter positions at a cost $50K each, which is modest when you include the benefits, that is $200,000 a year per shift to respond to medical calls.

You could get a doctor for each shift for that amount and the ability to cut down on transport would be included.


----------



## DesertMedic66 (Apr 27, 2011)

RanchoEMT said:


> firefite I think you’re missing the big picture, the theoretical “what could be” Picture that were visualizing, and I'm not saying that because your taking a different stance on the issue, but your arguments aren't making sense...
> 
> Let’s look at AMR Rancho where you did your ride along.
> You have Fire Engines with 3-4 firefighters on them in this city. And you have an ambulance with a medic and an EMT.
> ...



If you want to look at individual fire departments then how about Big Bear. They have a total of 6 ambulances with normally at least 2 of those being staffed. When they get a medic call they roll out one ambulance and their fire engine. They only hire fire medics there. So you will have 2 medics in the ambulance and then 2-4 medics on the engine. 

The reason that fire has a good response time is because they don't have to transport. They can be on a medical call for under 5 mins before they go back in service. Ambulances transport which normally means they are out of service for a longer time unless the patient AMAs. 

So does it make sence to have an ambulance crew waiting at the hospital to drop off a patient while having another 911 call on hold? Or would it make sence to have that same ambulance crew waiting at the hospital while a perfectly capable ALS engine crew respond to that 911 call?

In my honest opinion I don't see fire separating from EMS operations anytime in my area and I am perfectly fine with that. When I had to call 911 for my mom I wanted help as soon as possible. I would have been soo mad if a fully capable ALS fire engine didn't respond because "fire should have nothing to do with EMS" and that caused me to wait longer for help. 

I know I'm not thinking about it from a money stand point. That's because I hate dealing with money. Yes it would be cheaper to do alot of things but cheaper doesn't mean a system will work better.

Yes having an ambulance crew with 3-5 min response times to every place would be nice. But it's extremely hard when an ambulance gets taken out of service for a long time to have that response time. You would have to have a really overstaffed company for that to happen. 

Where I work at right now we have a 30-45 min response time to some areas that we cover. And that response time is with every unit just being posted and no units on a call elsewhere.


----------



## usalsfyre (Apr 27, 2011)

firefite said:


> When I had to call 911 for my mom I wanted help as soon as possible. I would have been soo mad if a fully capable ALS fire engine didn't respond because "fire should have nothing to do with EMS" and that caused me to wait longer for help.


Yet it probably made no difference in outcome. May I ask, what did the FD do for your mom? Arguments based on emotion are part of the problem with EMS.



firefite said:


> I know I'm not thinking about it from a money stand point. That's because I hate dealing with money.


Here's where you and 90% of other line level providers fail. I know that thinking of people's pain and suffering in terms of dollars and cents is uncomfortable. But someone is doing it I assure you. Until EMS as a whole begins to see, in monetary terms, why the current system is flawed and why change is needed EMS will continue down the path to failure.


----------



## DesertMedic66 (Apr 27, 2011)

usalsfyre said:


> Yet it probably made no difference in outcome. May I ask, what did the FD do for your mom? Arguments based on emotion are part of the problem with EMS.
> 
> 
> Here's where you and 90% of other line level providers fail. I know that thinking of people's pain and suffering in terms of dollars and cents is uncomfortable. But someone is doing it I assure you. Until EMS as a whole begins to see, in monetary terms, why the current system is flawed and why change is needed EMS will continue down the path to failure.



She had a PE due to birth control meds. Caused her to have a panic attack and start posturing from the lack of oxygen. Fire arrived on scene and started a line, 12 lead, O2 because her stats were low, administered a drug (I don't know what it was), and calmed her down. When the ambulance showed up and was on scene for less then 2 mins before transport to hospital. Life flight from that hospital to another one with a working MRI and caught the blood clot on it's way back into the heart.


----------



## sir.shocksalot (Apr 27, 2011)

firefite said:


> She had a PE due to birth control meds. Caused her to have a panic attack and start posturing from the lack of oxygen. Fire arrived on scene and started a line, 12 lead, O2 because her stats were low, administered a drug (I don't know what it was), and calmed her down. When the ambulance showed up and was on scene for less then 2 mins before transport to hospital. Life flight from that hospital to another one with a working MRI and caught the blood clot on it's way back into the heart.



As Usalfyre pointed out, none of what was done by the FD would make any difference in outcome. Hyperventilation is usually self limiting, eventually you will pass out and resume a normal respiratory pattern.
I think you are missing what people are saying. Response times haven't proven to change anything, even with flights. So whether a fire truck gets there in 5 mins or an ambulance in 10, the outcome of the pt won't be changed. 
Also getting an ALS engine there for pain meds is completely irrelevant when most protocols won't allow for adequate pain control. Heck, just the other day the local fire department transported a dislocated shoulder that was having spasms with only 100mcg of Fentanyl on board because "thats the protocol", when I asked why they didn't give Valium for spasms they said "it's against protocol". So the argument for early pain meds is moot when most services have completely inadequate pain control protocols.

Also, 6 Paramedics on scene? Holy skill dilution Batman. I wonder when was the last time one of those guys got a tube?


----------



## Shishkabob (Apr 27, 2011)

Not to mention, very few EMS agencies can do anything for PEs, let alone first responding fire departments... and that's even if you can discern a PE from some other condition going on before it's too late.


----------



## DesertMedic66 (Apr 27, 2011)

Linuss said:


> Not to mention, very few EMS agencies can do anything for PEs, let alone first responding fire departments... and that's even if you can discern a PE from some other condition going on before it's too late.



They didn't know at the time that it was a PE. The medic told my mother that's what he thought it was but couldn't confirm it. Having fire on scene allowed for a much faster transport time. You said "before it's too late" that is referring to time. So having a quick transport time did save on time to the hospital.


----------



## usalsfyre (Apr 27, 2011)

firefite said:


> Having fire on scene allowed for a much faster transport time.


Explain


----------



## DesertMedic66 (Apr 27, 2011)

sir.shocksalot said:


> As Usalfyre pointed out, none of what was done by the FD would make any difference in outcome. Hyperventilation is usually self limiting, eventually you will pass out and resume a normal respiratory pattern.
> I think you are missing what people are saying. Response times haven't proven to change anything, even with flights. So whether a fire truck gets there in 5 mins or an ambulance in 10, the outcome of the pt won't be changed.
> Also getting an ALS engine there for pain meds is completely irrelevant when most protocols won't allow for adequate pain control. Heck, just the other day the local fire department transported a dislocated shoulder that was having spasms with only 100mcg of Fentanyl on board because "thats the protocol", when I asked why they didn't give Valium for spasms they said "it's against protocol". So the argument for early pain meds is moot when most services have completely inadequate pain control protocols.
> 
> Also, 6 Paramedics on scene? Holy skill dilution Batman. I wonder when was the last time one of those guys got a tube?



If response times haven't been proved to change a pt's outcome then why are there studies that say the faster CPR is started on an arrest the better chance that person has of surviving?


----------



## usalsfyre (Apr 27, 2011)

firefite said:


> If response times haven't been proved to change a pt's outcome then why are there studies that say the faster CPR is started on an arrest the better chance that person has of surviving?



Unless you can get to the patient within 4-6 minutes of witnessed arrest, they don't matter...


----------



## DesertMedic66 (Apr 27, 2011)

usalsfyre said:


> Explain



Gladly. Ambulance was off loading another patient to the ER when I called. The fire department got here in under 5 mins. An ambulance from the next city responded in about 10-15mins. Fire had everything done her by the time the ambulance showed up. Once the ambulance got here they loaded her up in less then a min. The fire medic rode in the ambulance giving his report to the EMS medic on the way to the hospital. 

If fire didn't respond then it would have been longer time to transport because the ambulance crew would arrive and have to do all the interventions fire did and then transport.


----------



## DesertMedic66 (Apr 27, 2011)

usalsfyre said:


> Unless you can get to the patient within 4-6 minutes of witnessed arrest, they don't matter...



But once again that is dealing with time. So on some calls time does in fact make a difference on the possible outcome of a patient.


----------



## usalsfyre (Apr 27, 2011)

So the medics can't perform interventions enroute?


----------



## usalsfyre (Apr 27, 2011)

firefite said:


> But once again that is dealing with time. So on some calls time does in fact make a difference on the possible outcome of a patient.



Around 1% if I'm not mistaken. Comes back to cost/benefit. Plus a CPR card and AED make as much (or more) difference as ALS care.


----------



## DesertMedic66 (Apr 27, 2011)

usalsfyre said:


> So the medics can't perform interventions enroute?



They can. Normally they like to do everything on scene. I have never seen an ambulance crew be first on scene and not do some kind of assessment (that takes times) before they load the patient up. I have never seen a primary assessment done in the back of the rig. For me it has always been in on scene.


----------



## usalsfyre (Apr 27, 2011)

I'm going to do my own assessment matter who I'm taking care from. How else do you know if the assessment has changed or is wrong if you don't?


----------



## DesertMedic66 (Apr 27, 2011)

usalsfyre said:


> Around 1% if I'm not mistaken. Comes back to cost/benefit. Plus a CPR card and AED make as much (or more) difference as ALS care.



There aren't too many AEDs for the publics use here. So the quickest access to AED is by the unit that gets on scene first. I'm not one to count money (I know that's a problem for some people).


----------



## usalsfyre (Apr 27, 2011)

firefite said:


> There aren't too many AEDs for the publics use here. So the quickest access to AED is by the unit that gets on scene first. I'm not one to count money (I know that's a problem for some people).



Whether you like counting money or not, it's the reality in the US, and the main reason FDs are in EMS in the first place.


----------



## DesertMedic66 (Apr 27, 2011)

usalsfyre said:


> I'm going to do my own assessment matter who I'm taking care from. How else do you know if the assessment has changed or is wrong if you don't?



I agree with that. But it allowed for the ambulance to do their own assessment on the road rather then on scene thus saving time.


----------



## Shishkabob (Apr 27, 2011)

firefite said:


> They can. Normally they like to do everything on scene. I have never seen an ambulance crew be first on scene and not do some kind of assessment (that takes times) before they load the patient up. I have never seen a primary assessment done in the back of the rig. For me it has always been in on scene.



Ok, here's the flaw in your rational:


You're stating that fire saved time because they did the assessment so the "ambulance didn't have to"

If fire didn't go, the ambulance crew would have done the assessment.

If the ambulance could get on scene in the same time limit as the engine, they could theoretically take just as much time doing the assessment as the engine.





> They can. Normally they like to do everything on scene. I have never seen an ambulance crew be first on scene and not do some kind of assessment (that takes times) before they load the patient up. I have never seen a primary assessment done in the back of the rig. For me it has always been in on scene.



And that's bad how?  Too many people think of EMS just as a transport.  If I can diagnose and treat on scene and not transport, I view that as a win.

I will do my own assessment, and I will stay on scene as long as I deem I have to, to do my job well.  Depending on the nature of the call, I can go in, grab the patient and run, go in, stabilize the patient and run, or take my time.  None of the above is wrong.


No delay.


----------



## DesertMedic66 (Apr 27, 2011)

usalsfyre said:


> Whether you like counting money or not, it's the reality in the US, and the main reason FDs are in EMS in the first place.



Yeah I know that as well. But I'm not in the back of the rig thinking "hmmm he doesn't really need this right now so im gonna let the hospital do it so I can save money". I don't think about the costs of stuff when I am doing something nor am I going to let it sway my judgment.


----------



## DesertMedic66 (Apr 27, 2011)

Linuss said:


> Ok, here's the flaw in your rational:
> 
> 
> You're stating that fire saved time because they did the assessment so the "ambulance didn't have to"
> ...



But the fact is that the ambulance crew couldn't have made it on scene in the same time as fire.


----------



## Shishkabob (Apr 27, 2011)

usalsfyre said:


> and the main reason FDs are in EMS in the first place.



Albeit under extremely false and convoluted pretenses.


----------



## Shishkabob (Apr 27, 2011)

firefite said:


> But the fact is that the ambulance crew couldn't have made it on scene in the same time as fire.



Because fire gets the funding instead of EMS to put a proper number of ambulances on the streets.


----------



## usalsfyre (Apr 27, 2011)

firefite said:


> Yeah I know that as well. But I'm not in the back of the rig thinking "hmmm he doesn't really need this right now so im gonna let the hospital do it so I can save money". I don't think about the costs of stuff when I am doing something nor am I going to let it sway my judgment.



I agree, it doesn't really sway mine either. But when you start talking system design, it's vital your willing to understand there is such a thing as "acceptable loss".


----------



## DesertMedic66 (Apr 27, 2011)

usalsfyre said:


> I agree, it doesn't really sway mine either. But when you start talking system design, it's vital your willing to understand there is such a thing as "acceptable loss".



That's the reason I am not going higher up into the system. Im staying on a field personal level as either an EMT, Medic, Fire/EMT, or Fire/Medic.


----------



## usalsfyre (Apr 27, 2011)

firefite said:


> That's the reason I am not going higher up into the system. Im staying on a field personal level as either an EMT, Medic, Fire/EMT, or Fire/Medic.



A word of advice, it's easy to say this at 19 years old and just starting out, but at some point in your career I can almost assure you that you will want some control of your destiny.


----------



## DrParasite (Apr 27, 2011)

firefite said:


> Gladly. Ambulance was off loading another patient to the ER when I called. The fire department got here in under 5 mins. An ambulance from the next city responded in about 10-15mins. Fire had everything done her by the time the ambulance showed up. Once the ambulance got here they loaded her up in less then a min. The fire medic rode in the ambulance giving his report to the EMS medic on the way to the hospital.
> 
> If fire didn't respond then it would have been longer time to transport because the ambulance crew would arrive and have to do all the interventions fire did and then transport.


your logic is faulty, because it is limited by the current system.

What your system didn't need was a fire medic first responder, what they needed was another transporting ambulance.  maybe your town needs two trucks 24/7, I don't know, but it seems like a better answer would be having a second ambulance instead of a 4 person fire medic engine.

not only that, but in your example, the Engine either has to follow the ambulance to the hospital to pick up their medic, or has to operate down a FF until the medic makes it back from the hospital.  this is also assuming the ambulance doesn't get dispatched for another job (or possibly a mutual aid job) before they drop off the fire medic.  so when you get the fire, your engine company doesn't even have a full crew to work with.

Plus, the patient has a PE... what can the fire engine do?  the person needs an ER, and an ambulance to take them there, not a fire engine to babysit until the ambulance can get there.



Linuss said:


> Because fire gets the funding instead of EMS to put a proper number of ambulances on the streets.


that's the exact same thing I have been stating for years.....


----------



## DesertMedic66 (Apr 27, 2011)

DrParasite said:


> your logic is faulty, because it is limited by the current system.
> 
> What your system didn't need was a fire medic first responder, what they needed was another transporting ambulance.  maybe your town needs two trucks 24/7, I don't know, but it seems like a better answer would be having a second ambulance instead of a 4 person fire medic engine.
> 
> ...



Ambulance is a private company. They don't have the means to have another unit on the road. A VST drives the fire medic to where ever he needs to go. I'm no medic but im going to take a huge jump for an EMT and say extremely low O2 stats should be treated as soon as possible. That was done by the engine crew.


----------



## usalsfyre (Apr 27, 2011)

firefite said:


> Ambulance is a private company. They don't have the means to have another unit on the road. A VST drives the fire medic to where ever he needs to go. I'm no medic but im going to take a huge jump for an EMT and say extremely low O2 stats should be treated as soon as possible. That was done by the engine crew.



Poor system design is not an excuse for expensive ALS first response.


----------



## DesertMedic66 (Apr 27, 2011)

usalsfyre said:


> Poor system design is not an excuse for expensive ALS first response.



So since it's a poor system then there should be no ALS first response?


----------



## usalsfyre (Apr 27, 2011)

firefite said:


> So since it's a poor system then there should be no ALS first response?


Take the money differential between four fire/medics and four fire/basics a shift. Increase the subsidy of the EMS service by that amount. See if they can add another truck.


----------



## DesertMedic66 (Apr 27, 2011)

usalsfyre said:


> Take the money differential between four fire/medics and four fire/basics a shift. Increase the subsidy of the EMS service by that amount. See if they can add another truck.



Here we run 1-3 EMTs and 1 medic. And the problem with that is that fire is funded thru taxes. EMS is private and paid for by the people we transport. If we cut down on fire EMS still won't see any money from taxes because Cali is in so much debt.


----------



## Shishkabob (Apr 27, 2011)

firefite said:


> I'm no medic but im going to take a huge jump for an EMT and say extremely low O2 stats should be treated as soon as possible. That was done by the engine crew.



Just FYI, if it WAS a PE causing low o2 sats... supplemental O2 has little effect on it.


----------



## blogspoter507 (Apr 27, 2011)

*Fire Vs EMS*

I personally have never had any problem with Firemen on scenes. Even during MVA and patient extraction our Firemen have always been helpful....

With that said I think its important to explain that my EMS service and Fire department are separate services.

Although I haven't personally experienced problems with Fire Departments I know its a common complaint in the EMS world. I don't believe that Fire and EMS should be together because when you force a Paramedic to be a Firemen or vise versa then the patient is the one that ends up paying the price. 

In the world of public service you must want to do the job. It requires both motivation and compaction to provide the best patient care.


----------



## DesertMedic66 (Apr 27, 2011)

Linuss said:


> Just FYI, if it WAS a PE causing low o2 sats... supplemental O2 has little effect on it.



I'm not sure if the PE was causing the low O2 sats but I know the sats were going up extremely slowly without O2. I wanna say they were 86% when fire first arrived and a couple mins later they were 89%. They placed a NRB and it went up to 99%-100%.


----------



## RanchoEMT (Apr 28, 2011)

*Your Logic is questioning at times....*



firefite said:


> If you want to look at individual fire departments then how about Big Bear. They have a total of 6 ambulances with normally at least 2 of those being staffed. When they get a medic call they roll out one ambulance and their fire engine. They only hire fire medics there. So you will have 2 medics in the ambulance and then 2-4 medics on the engine.
> The reason that fire has a good response time is because they don't have to transport. They can be on a medical call for under 5 mins before they go back in service. Ambulances transport which normally means they are out of service for a longer time unless the patient AMAs.



Let’s set the golden rule down… On a medical call, you will need every time, an ambulance to TRANSPORT the patient to the hospital, every time. 

You say Big Bear has 6 ambulances and 2 of them are being used at any given time.  By the numbers, 4 of them are collecting dust, while the engine crew with 2-4 medics on board goes out with the 2 In-service AMBULANCES and does….. an assist with the ambulance.  (Not Needed)

These 2-4 Medics are doing what on that engine that they couldn’t being doing on an ambulance???

You must realize that this is like the example I provided in my previous post. The Fire Engine that is for Fire Fighting Operations staffed with capable ‘Medical Medics’ is redundant.  These 2-4 medics are rolling out in an engine while leaving 4 capable AMBULANCES back at the fire house….

“Well You Need A Fire Engine Available Always/Anyways for Fires” argument….
All of this because the Fire Engine(staffed with Medics) needs to be available not for *600 or so Medical transports but for the *17 or so fires that pop up year to year…… ready with medics……. On a Non-transporting vehicle….. with medics…….

*Figures aren’t available for the exact Medical vs. Fire calls ratio for Big Bear, so I will still use the Montclair Fire Dept. figures as a baseline, as the outnumbering medical calls are typical with every fire dept.

Please Note: This is almost implying that preparing for a fire is more important that preparing and adequately staffing for Medical calls, which are significantly more probable and occurring with 30:1 odds….  Almost Emphasizing: A Salvage Property before Life philosophy. 



firefite said:


> *The reason that fire has a good response time is because they don't have to transport.*



Did the ambulances that came from the same fire house as the engine not get there at the same time and transport?! Please enlighten me…. Why did the engine roll out again??? If there is an ambulance staffed with a competent Medic that is able to run the call with or without the Fire Engine, Once again why oh why is a Fire Engine responding to a Medical Call???



firefite said:


> They can be on a medical call for under 5 mins before they go back in service.


The Fire Engine can. The ambulance that transported cannot. So now you have an engine rolling around the city with 2-4 medics (Please Note: 1 medic needed per ambulance to provide ALS care, with 4 ambulances with transport capabilities sitting in the fire house somewhere in the dark).  The engine is going to get a call, and these 2-4 medics are going to respond without the capability to transport the patient, almost as if to say after waiting for upwards of 20 minutes, Completely munsoned on scene looking around waiting for a transport to arrive, “Wish we had an ambulance right now.” Not to mention they are out of service for other calls that pop up while they wait!



firefite said:


> So does it make sence to have an ambulance crew waiting at the hospital to drop off a patient while having another 911 call on hold? Or would it make sence to have that same ambulance crew waiting at the hospital while a perfectly capable ALS engine crew respond to that 911 call?


Are you talking about the Fire Engine that we left alone back in Big Bear that is going to get to the call and have to wait for an ambulance??? That’s weird you would think they would need an AMBULANCE UP THERE ASAP…. Like 2-4 of them….. But where would we find such resources???...... hmm…



firefite said:


> Yes having an ambulance crew with 3-5 min response times to every place would be nice. But it's extremely hard when an ambulance gets taken out of service for a long time to have that response time. You would have to have a really overstaffed company for that to happen.


Any company that has 2-4 medics driving around on a non transporting Fire Engine in my mind is overstaffed or dumb staffed. One medic per ALS call is adequate, everyone else is just an assist. Those ambulances you talk of that sit there doing nothing can serve more purpose than that fire engine that roles around providing professional first assessments. Its cheap in its holistic capabilities.  You bring up your family member that benefitted so much from the Fire Engine coming to your house. Let me ask you, and be honest. Next time, if there was an AMR ambulance available and Fire Engine available up in big bear with the same en-route time as either, which would you prefer to show up at your door? The Fire Engine or a transporting ambulance with load and go capabilities, the same drug box, a gurney, and a generic Medic?


----------



## DesertMedic66 (Apr 28, 2011)

RanchoEMT said:


> Let’s set the golden rule down… On a medical call, you will need every time, an ambulance to TRANSPORT the patient to the hospital, every time.
> 
> You say Big Bear has 6 ambulances and 2 of them are being used at any given time.  By the numbers, 4 of them are collecting dust, while the engine crew with 2-4 medics on board goes out with the 2 In-service AMBULANCES and does….. an assist with the ambulance.  (Not Needed)
> 
> These 2-4 Medics are doing what on that engine that they couldn’t being doing on an ambulance???



they cant have all the firefighters on ambulances because if they do get a fire or a TC well then they would have to drive back to the station to get the engine for the extrication tools.

its extremely hard to carry a LSB in snow and ice with 2 people let alone do it safely. 



> you must realize that this is like the example I provided in my previous post. The Fire Engine that is for Fire Fighting Operations staffed with capable ‘Medical Medics’ is redundant.  These 2-4 medics are rolling out in an engine while leaving 4 capable AMBULANCES back at the fire house….



4 capable ambulances that can NOT be staffed. you have to have at least 1 ambulance staffed and 1 engine staffed. once again if you would like to staff all the ambulances but not the fire engine then thats good. but wait!!! what if there is a TC with entrapment????? you dont have a staffed engine with the extrication tools. looks like that patient is out of luck until another citys fire engine arrives. 



> “Well You Need A Fire Engine Available Always/Anyways for Fires” argument….
> All of this because the Fire Engine(staffed with Medics) needs to be available not for *600 or so Medical transports but for the *17 or so fires that pop up year to year…… ready with medics……. On a Non-transporting vehicle….. with medics…….
> 
> *Figures aren’t available for the exact Medical vs. Fire calls ratio for Big Bear, so I will still use the Montclair Fire Dept. figures as a baseline, as the outnumbering medical calls are typical with every fire dept.
> ...



umm how is having a fully staffed fire engine making it "A Salvage Property before Life philosophy"? fire responds to alot more then just fires.





> Did the ambulances that came from the same fire house as the engine not get there at the same time and transport?! Please enlighten me…. Why did the engine roll out again??? If there is an ambulance staffed with a competent Medic that is able to run the call with or without the Fire Engine, Once again why oh why is a Fire Engine responding to a Medical Call???



the engine rolled out for support. do you not want any support on calls? you have a 300lb patient up on the 4th floor, are you not wanting support with that call? you get a TC with entrapment and fire doesnt respond, are you superman? are you going to be able to roll the dash or cut the roof off? ummm no. if you get a full arrest are you going to want 1 person doing compressions and airway at the same time because you only sent out one ambulance? or are you going to want 1 person doing compressions and another person doing airway??




> The Fire Engine can. The ambulance that transported cannot. So now you have an engine rolling around the city with 2-4 medics (Please Note: 1 medic needed per ambulance to provide ALS care, with 4 ambulances with transport capabilities sitting in the fire house somewhere in the dark).  The engine is going to get a call, and these 2-4 medics are going to respond without the capability to transport the patient, almost as if to say after waiting for upwards of 20 minutes, Completely munsoned on scene looking around waiting for a transport to arrive, “Wish we had an ambulance right now.” Not to mention they are out of service for other calls that pop up while they wait!



so what your saying is either cut the engine out or have more firefighters on duty?? yeah i see major problems with both of those "plans" of actions




> Are you talking about the Fire Engine that we left alone back in Big Bear that is going to get to the call and have to wait for an ambulance??? That’s weird you would think they would need an AMBULANCE UP THERE ASAP…. Like 2-4 of them….. But where would we find such resources???...... hmm…



so once again cut fire or add more firefighters? hmmmmmmm. ambulances do such a great job at getting people out of cars or putting out fires. and adding more firefighters. california is in debt and you wanna add MORE firefighters when they are already being laid off?!?!?! i hear a 5150 hold being called out........




> Any company that has 2-4 medics driving around on a non transporting Fire Engine in my mind is overstaffed or dumb staffed. One medic per ALS call is adequate, everyone else is just an assist. Those ambulances you talk of that sit there doing nothing can serve more purpose than that fire engine that roles around providing professional first assessments. Its cheap in its holistic capabilities.  You bring up your family member that benefitted so much from the Fire Engine coming to your house. Let me ask you, and be honest. Next time, if there was an AMR ambulance available and Fire Engine available up in big bear with the same en-route time as either, which would you prefer to show up at your door? The Fire Engine or a transporting ambulance with load and go capabilities, the same drug box, a gurney, and a generic Medic?



the call for my family member was not up in big bear and big bear fire did not respond. and obviously i would want the ambulance. BUT that was not the case. fire was 5 mins out and AMR was 10-15 mins out. let me ask you a question now. if your family member lets say went into full arrest would you want fire to respond who is 5 mins away followed by AMR or would you want AMR to respond who is 10-15 mins away with no help until then? they both carry the same equipment the only differences is that AMR can transport and fire cant. hmmmmmm if only we knew which one has the likelyhood of a better out come


----------



## RanchoEMT (Apr 29, 2011)

firefite, It appears everyone else has given up and I'm not going to argue with you anymore either. Your mind is already made up and I feel you misinterpret almost everything that is said to you.  I wish no more time lost in your company... To you sir, have a good day and an excellent fire career.


----------



## 46Young (Apr 29, 2011)

Two things:

First, if fire and EMS staffing and deployment are lacking that much, you need to go to a single pull system. Members leave their gear on the middle of the floor. If an EMS run comes in, two people throw their gear on the bus and go. If a second EMS run comes in, two more members do the same. That leaves two others to take the engine out. If a fire comes in, they could at least do a search or VES for victims, or set up an exterior attack. After clearing from the hospital, the members can show up in the ambulance, with their gear, and join in. That's the best you can do with six members. 

Second, fire isn't only responding to 17 calls out 891. what about the hazardous conditions calls, public service calls, good intent calls, and false alarms? That's 268 out of 891, or 30% of run volume. Fire calls are presumably actual structure fires, car fires, brush fires, etc. Hazardous conditions would be gas leaks, CO calls, and the like. Good intent would be wellness checks, replacing smoke detectors, etc. Public service would be picking a citizen up off the floor and back into bed or their wheelchair, if no injury or medical etiology is suspected, or other issues, such as a flooded basement where they need you to get down there and shut off the water. False alarms are not actually false alarms until proven to be so, either by the suppresion unit onscene, or by cancellation via phone by the homeowner/manager. 

That 70%/30% split can also be misleading. The 70/30 breakdown only represents the number of calls on each side, not the amount of resources used for each call. An EMS response may be just an ambulance or an ambulance and engine. Fire calls can involve many more resources than just one or two apparatus. A more realistic measure would be to take each individual unit, and break down the percentage of EMS and non EMS responses. Truck companies, heavy rescues, tankers, Hazmat units, light and air, rehab units, etc must all be taken into account.


----------



## DesertMedic66 (Apr 29, 2011)

RanchoEMT said:


> firefite, It appears everyone else has given up and I'm not going to argue with you anymore either. Your mind is already made up and I feel you misinterpret almost everything that is said to you.  I wish no more time lost in your company... To you sir, have a good day and an excellent fire career.



Thanks. And you too but I am not in a fire career as of right now. Purely EMS.


----------



## Bosco578 (Apr 29, 2011)

To answer the original question, because EMS allows it to happen,and to an extent EMS management allow it.


----------



## Veneficus (Apr 29, 2011)

46Young said:


> Two things:
> 
> First, if fire and EMS staffing and deployment are lacking that much, you need to go to a single pull system. Members leave their gear on the middle of the floor. If an EMS run comes in, two people throw their gear on the bus and go. If a second EMS run comes in, two more members do the same. That leaves two others to take the engine out. If a fire comes in, they could at least do a search or VES for victims, or set up an exterior attack. After clearing from the hospital, the members can show up in the ambulance, with their gear, and join in. That's the best you can do with six members.
> 
> ...



I am not disagreeing with you, but I would like to point out that some departments (many I have seen) will pad call volume by counting multiple aspects of a single call as multiple calls.

An example would be: Original response to a structure fire, recall of off duty persons, call for mutal aid, units responding after clearing other calls, and the call for post incident investigation get counted as 5 fire calls instead of 1.

I think that is a blatent self serving practice that undermines the respect of the fire service in the organizations that practice it.


----------



## 46Young (Apr 29, 2011)

To answer the original question, the fire depts that absorbed EMS (there are quite a few that have done both suppression and EMS for many years) do it to both protect/increase safe staffing levels and also to save money. 

If suppression apparatus are idle a fair amount of the day, the rationale is that they could be used to augment EMS delivery during their downtime, instead of being otherwise unproductive. Most single role EMS departments don't adequately staff end deploy EMS transport units to begin with (SSM for example), and the fire service is no different. By using ALS engines, which are already in place and available, the municipality can get by with less transport units, right or wrong. It's a matter of adding ALS equipment and the additional salary bump and training for the engine medic, as opposed to buying and equipping an ambulance, and also the costs of two more employees, to include hiring, training, equipment, benefits, paid time off, injury or sick leave, retirement, etc.

In the case of a dual role department that does transport,  money is also saved by crosstraining their people. Details are easier to fill, and OT is reduced. By not hiring as many people to staff the ambulances, since the ALS engines are taking their place to extent, money is saved on personnel as above.

Perhaps outsourcing to a private EMS provider would cost less money, but they can't cut corners to protect profits. They need dedicated 911 units, more than what already existed since they're doing it without ALS engines, that can't be redirected to IFT's. They can't count on IFT's to handle 911 overflow and get away with lower deployment of 911 units; it's too risky, as these units may be tied up with transports. If X amount of units are needed for proper coverage, then X amounts of units need to be deployed by the company for the price they're quoting. No gimmicks like SSM, or blurring the lines between IFT rigs and 911 rigs. Their training, hiring standards and equipment need to be the same as the municipal system they replaced. Otherwise, they're not providing the same coverage as the former dual role system was; they're providing an inferior product on the cheap. Also, if they no longer turn a profit, they'll either walk away, or they'll need a more generous subsidy from the municipality, which defeats the purpose of outsourcing in the first place. To suggest a reduction in force of suppression staffing and deployment to pay for more EMS in that situation shows one's ignorance of the fire side and what they do.


----------



## 46Young (Apr 29, 2011)

Veneficus said:


> I am not disagreeing with you, but I would like to point out that some departments (many I have seen) will pad call volume by counting multiple aspects of a single call as multiple calls.
> 
> An example would be: Original response to a structure fire, recall of off duty persons, call for mutal aid, units responding after clearing other calls, and the call for post incident investigation get counted as 5 fire calls instead of 1.
> 
> I think that is a blatent self serving practice that undermines the respect of the fire service in the organizations that practice it.



I haven't seen it, but I'm sure it goes on. The closest thing I've seen is with FDNY and FDNY EMS. We would cancel the FDNY CFR engine, but they would mark onscene first and then go available, to be able to add the call to their numbers. If duplicates to a certain call go out, fire or EMS, each call will be recorded. For example, we could get multiple calls for an MVA, each with a slightly different location, with a different unit dispatched. It could be "GCP/LIE" "LIE/Little Neck" or "LIE/CIP." That's three EMS calls, with three different incident numbers, for the same call. Even if units are cancelled by others that know the area and recognize it as a duplicate job, they still get added to the city's stats. Right or wrong, that does show an increased call volume, which helps their case when confronted with the bean counters. In today's environment of severe budget cuts and layoffs, I can't fault a department for padding their stats for self preservation. It's like pulling teeth to get any form of increased staffing for EMS or fire, but it's all too easy to have that taken away. The messed up part is that to regain these staffing levels afterward, concessions will need to be made in the form of salary and benefits.


----------



## Veneficus (Apr 29, 2011)

46Young said:


> I haven't seen it, but I'm sure it goes on. The closest thing I've seen is with FDNY and FDNY EMS. We would cancel the FDNY CFR engine, but they would mark onscene first and then go available, to be able to add the call to their numbers. If duplicates to a certain call go out, fire or EMS, each call will be recorded. For example, we could get multiple calls for an MVA, each with a slightly different location, with a different unit dispatched. It could be "GCP/LIE" "LIE/Little Neck" or "LIE/CIP." That's three EMS calls, with three different incident numbers, for the same call. Even if units are cancelled by others that know the area and recognize it as a duplicate job, they still get added to the city's stats. Right or wrong, that does show an increased call volume, which helps their case when confronted with the bean counters. In today's environment of severe budget cuts and layoffs, I can't fault a department for padding their stats for self preservation. It's like pulling teeth to get any form of increased staffing for EMS or fire, but it's all too easy to have that taken away. The messed up part is that to regain these staffing levels afterward, concessions will need to be made in the form of salary and benefits.



I don't think the politicians and bean counters fall for it though. 

That's the trouble.

Then when you have no credibility and need something desperately, your pleas fall on ears who don't believe you.

Even worse is when they pull the card that they already gave you something you asked for but didn't need so you aren't getting your most recent request.


----------



## jmc519 (Apr 29, 2011)

I'll add my $.02, though I'm heavily debating doing so at this point.

I'm on a paid-on-call fire department, that has no medical whatsoever. The EMS agency in our area is a separate entity. For certain calls (MVA with injury, or a PIA), we're automatically dispatched to the scene. Otherwise, EMS has to call for us (as with lift assists).

Our purpose on those PIA calls is to ensure the safety of the EMS crew and the patient. We disable the car (either cut or remove battery cables, depending upon damage to the car). We extricate if necessary. 

At our point of arrival to a scene, yes, we establish command. But, we don't do this in lieu of the EMS personnel who are there (and they have better response time than us, we have to report to the station, then go to scene, they're staffed). We do what we're trained for, and that is making sure that the vehicle and scene is secure, that traffic is handled (which should be PD), etc.

Furthermore, the medics and EMTs on our local EMS agency know they can work hand in hand with us for the benefit of the patient. They tell us what they need to have happen, and we get it done, while they control the medical aspect. 

Sure, sometimes someone steps on someone else's toes, but we get it worked out so it doesn't happen again in the future. And yeah, there are things we don't agree on, both personally and professionally, but when it comes down to it, we make what we have work.

My experiences here sound drastically different than what I've read on this thread. And maybe my opinions will change when I start work as an EMT-B with our local EMS agency (which should be in the next week or two). I don't know. Things always look different from the other side of the fence.

Just thought I'd share.


----------



## emt seeking first job (Apr 29, 2011)

Veneficus said:


> Earlier in life I would probably have typed 2 pages on the complexities of this and the long term consequences.
> 
> But now I am of the mind to just say "go for it, and let me know how it works out in about 10 years."
> 
> ...





I envision a system where EMS and Health Care will be a public service. Just like k-12 Public Education, Police and Fire. 

If someone wants to enhance the basic level of service, then just like one get get private security, education they can pay and get it.

It can easily be paid for by legalizing and taxing gambling and all drugs.

http://www.leap.cc/cms/index.php

It can also help if the people formerly investigating the baove go after tax avoidance, both of the off the books construction guy, and the upper level buisness owner.

No more tax avoidance. At least limit it.

No more cruise ships registered in Liberia. Thats insane. Is the friggin Liberian Navy going to rescue a cruise ship in distress ? NO !! The US Navy will. Therefore the ships should pay US Taxes and charge the passengers more.

By virtue of being in the USA, everyone gets free care to stabilize them. Then an assessment is made if they should be here. If not fly them back to their country of orgin. If that country wont take them, no more foreign aid.

Fly them back. IT HAPPENS ALREADY !!!!!!!!!!!

Just place them on a plane and fly the plane to where they are from.

http://www.nytimes.com/2008/08/03/us/03deport.html

It is just framed differently. 

EMS is a new phemomena. 

Health care could be free to all. The people who perform it could even get paid more than private health care if they organize, just like private secuirty and private teachers get paid less than public ones....


----------

