# Getting EMT-B cert for Firefighting?



## FuManChu

Hi all.
I am new to this forum, and I am new to the whole EMT thing as well. 
I am a junior in high school, and have about a year left before I graduate.
Im not planning on going to college to get a degree, but I am thinking about pursuing a career in Emergency medicine and Firefighting. 
I just have a few questions. How long are the courses usually for becoming an EMT-B. Also, I am not the greatest at math, would that hurt me at EMT training?
My idea after high school is, get EMT-B certified, work on a BLS ambulance for a little bit, then apply for a Firefighting position. 
What do you think? I know some departments require more than that, but with some of the research I did, I might be ok. But if you have any suggestions im all ears.
Basically Im just asking for some guidance and tips for becoming an EMT-B to Firefighter. 
Thanks a lot everyone.
-Anthony


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## Shishkabob

EMT-B training, done through a community college, is a semester in length, typically 2 nights a week.

There is very little math involved in EMT-B programs.  If you decide to up your certification to the Paramedic level, there IS more math.



Without knowing where you live, we can't comment on your plan.  Some FDs will hire you without EMT, some will hire you with it, and some will not hire you unless you're a paramedic.


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## FuManChu

Linuss said:


> Without knowing where you live, we can't comment on your plan.  Some FDs will hire you without EMT, some will hire you with it, and some will not hire you unless you're a paramedic.



I am living in California.


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## Shishkabob

Good luck with that.


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## TransportJockey

EMTs in CA are a penny a dozen. Hope you have something good to offer to an FD


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## FuManChu

jtpaintball70 said:


> Hope you have something good to offer to an FD



Do you think courses in Fire Science would help a lot?

Would I have time fore these courses while working as an EMT?


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## TransportJockey

Pappaly said:


> Do you think courses in Fire Science would help a lot?
> 
> Would I have time fore these courses while working as an EMT?



It might, but I know some FD candidates in ABQ NM that were getting turned down even with an AAS in Fire Science or a bachelors because they were EMTs.

And working as an EMT might give you time for school if you don't have to work 6 days a week to make a decent wage


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## Rsion4191

Well , seeing as you're in California . I know of a program here in Southern California that was a month long , five days a week 4PM-10PM . It's up to you whether you'd like to go to school THAT MUCH & whether it would fit into your schedule . If you'd like to look it up , check out CIEMT.com . Another thing , not much math is used in BLS . Biggest math I've really used is weighing a dialysis patient & subtracting the gurney weight . As for Fire , good luck with just an EMT-B Cert . I'm only a year older than you & even then , I still need A LOT more than just a cert to go into fire .


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## FuManChu

Rsion4191 said:


> Well , seeing as you're in California . I know of a program here in Southern California that was a month long , five days a week 4PM-10PM . It's up to you whether you'd like to go to school THAT MUCH & whether it would fit into your schedule . If you'd like to look it up , check out CIEMT.com . Another thing , not much math is used in BLS . Biggest math I've really used is weighing a dialysis patient & subtracting the gurney weight . As for Fire , good luck with just an EMT-B Cert . I'm only a year older than you & even then , I still need A LOT more than just a cert to go into fire .



Thanks for that info. what other things should I have to get into fire? Fire science courses? go to the fire academy?


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## Whittier

Pappaly said:


> Thanks for that info. what other things should I have to get into fire? Fire science courses? go to the fire academy?



Basically, get everything you possibly can to raise yourself above all the others... and there are A LOT of others. Even then... heh... not easy. If it's what you want though, don't let that discourage you.

Take a look here for some good information:

http://www.fireprep.com/how_to_best_prepare_yourself_t.html


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## AnthonyTheEmt

Hey man, just wanted to say welcome to the site. My name is Anthony too (not all of us can be so blessed). Anyways, im in california and also going for fire. Most places in CA require a minimum of a pre-service academy, and at the very minimum, EMT, and CPAT. My suggestion is get your EMT, get some experience, get your AS degree in Fire Science, and if you are feeling up to it, go for your medic. Also, where in California are you? There are some good programs up in the bay area of Nor Cal.


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## TransportJockey

He's asking on a medical forum about Fire Dept advice...


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## CAOX3

jtpaint



Pappaly said:


> Hi all.
> I am new to this forum, and I am new to the whole EMT thing as well.
> I am a junior in high school, and have about a year left before I graduate.
> Im not planning on going to college to get a degree, but *I am thinking about pursuing a career in Emergency medicine and Firefighting*.
> I just have a few questions. How long are the courses usually for becoming an EMT-B. Also, I am not the greatest at math, would that hurt me at EMT training?
> My idea after high school is, get EMT-B certified, work on a BLS ambulance for a little bit, then apply for a Firefighting position.
> What do you think? I know some departments require more than that, but with some of the research I did, I might be ok. But if you have any suggestions im all ears.
> Basically Im just asking for some guidance and tips for becoming an EMT-B to Firefighter.
> Thanks a lot everyone.
> -Anthony



Really, I was under the assumption that fire departments still played a role in EMS in this country.


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## TransportJockey

True, but Brown is a lucky one in that he's from a country where hosemonkeys don't play a part in EMS. For the most part I have been up front and honest about opinions on his best bets at joining an FD


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## Shishkabob

They do, but honestly the best place to get info on how to get in to the fire service isn't on a forum where the majority of posters AREN'T FFs.  It' dbe smarter and faster to go to a fire service oriented site where you will have more FFs, or at the very least, more people with experience in getting hired in the fire service.


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## joeshmoe

I have to admit I always find EMS vs firefighter tension amusing. I dont really have a dog in this fight, but its still fun to watch.


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## FuManChu

Whittier said:


> Basically, get everything you possibly can to raise yourself above all the others... and there are A LOT of others. Even then... heh... not easy. If it's what you want though, don't let that discourage you.
> 
> Take a look here for some good information:
> 
> http://www.fireprep.com/how_to_best_prepare_yourself_t.html



haha, believe it or not, I already have that link bookmarked on my browser. I checked it out earlier today. 
other than getting EMT-B certified, I think I will take some fire technology/science classes, and maybe go to a fire academy.


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## CAOX3

jtpaintball70 said:


> True, but Brown is a lucky one in that he's from a country where hosemonkeys don't play a part in EMS. For the most part I have been up front and honest about opinions on his best bets at joining an FD



That is your opinion. 

I know plenty of degreed "hose monkey" paramedics, that are an asset to the EMS profession and havent seen the inside of a fire truck in twenty- years.

I dont hold any grudges as to where they decide to seek employment.

Why should they agree to lousy pay, lousy benefits and no retirement because the majority of stand alone EMS systems dont feel the need to pay and care for their employees?

My opinion is I dont care what color the truck is you show up in as long as your competent to handle your business.


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## MrBrown

Brown did not intended to ruffle feathers but stands by his unpalatable comments.

If you think I am harsh, those who are Firefigher/Paramedics and roll up to a call with two fire trucks and barell through the door in all thier getup when six guys end up standing around doing nothing with ther hands in thier pockets while one takes a blood pressure and the other attempts to turn oxygen on should come down here.



> get EMT-B certified, work on a BLS ambulance for a little bit, then apply for a Firefighting position.



I've been to jobs where you can tell who I am with just doesn't care or worked with people who have the "this job will look good on my resume and that's all the effort I am going to give" attitude. It is sooo obvious by the way the Officer speaks, how they act, what they say and the *****ing they do.

Please do not use prehospital medicine as a stepping stone to the Fire Service.



> Im not planning on going to college to get a degree, but I am thinking about pursuing a career in Emergency medicine and Firefighting.



You'd fit right in down at the 10 week patch factory school for Houston Fire Department Scaramedics.

I don't mean to break this kid's hopes and dreams and sound like a tard but the fact that EMS can be [ab]used in this manner just drives me crazy!


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## LucidResq

Get in excellent shape. Then get in better shape.

Don't do anything you wouldn't want to have to admit to in a lie detector test. No drugs whatsoever, no underage drinking, no stealing for sure. Don't do anything illegal (even if you won't get caught by the cops... lie detector tests will catch you) or morally questionable. Keep your credit report clean and pretty. Yes, they can and will look at your credit. 

Volunteer at a fire dept. to gain experience. 

Go to college. Don't just take fire science classes. Get a degree. Get your paramedic.

Learn Spanish. Learn a trade that has nothing to do with firefighting or EMS... if you can get your CDL... great... working as an arborist, heavy equipment operator... stuff like that... for some reason Fire Depts eat that stuff up. 

You won't get hired until you're at least 21. It will probably take several years after that.

Apply for jobs even when you don't think you'll get them. Learning to apply and test for fire jobs is a skill in itself. Many departments administer written exams early in their hiring process. These cover basic writing, reading, math, vocabulary, problem solving, etc. Make sure you're up to speed. If you don't get a high enough score, you will be cut out of the race very early on. Yes, you do need math. Not so much for actually working as a firefighter, but for getting hired. 

Find mentors. Make as many connections as possible. 

Join the military.

The sooner you realize that there are usually thousands of qualified (nevermind the unqualifed ones) applicants for a fire position, and that the departments truly have the pick of the litter, the sooner you will realize why you have to work very hard for several years to even be considered.


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## Shishkabob

MrBrown said:


> You'd fit right in down at the 10 week patch factory school for Houston Fire Department Scaramedics.



Holy cow, what is with your infatuation with TEEX this past week?


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## armywifeemt

I am utterly shocked that not a single person here mentioned the Explorers program. 

I know it isn't a regional thing because all the departments back home in Ohio had one, and a fair number of the ones up here have them too. 

You've gotten some great advice... get in good physical condition, work on skills that while not directly related to the EMS/Fire Service will come in handy (someone mentioned a CDL, working with heavy equipment, learning spanish.. all great ideas, all with applications to emergency response) and keep your nose clean. Those things are very important...

What might help you get a job sooner rather than later is getting involved in an explorers program. A lot of fire departments have one.. it is a program that allows teenagers to begin riding along and experiencing firsthand what emergency responders do. You receive training, often times are able to apply that training toward certification once you turn 18, and there is no better way to find out whether or not this is actually something you want to do. 

After that, I wouldn't start with city fire departments. Look in large towns.. some places have departments that are a combination of volunteer service and paid personnel (that is the type of department I volunteer at) and if you are looking to make this a career, that is a great way to do it. Start as a volunteer, prove your commitment and dedication, and when job opportunities open up you will have a much better chance of being hired than someone straight off the street.

Also, some departments have a "live-in" program. They allow a group of people (selected through an application process much like applying for a job) to live in the fire department free of rent and utilities, in exchange for a certain number of shifts a week (usually fairly reasonable) and let me tell you the experience is valuable.


By the way.. to those naysayers out there who think firefighters should keep away from medical.. I started out as a firefighter... and I put every much as much effort, passion, and dedication into honing my skills as an EMT as I ever have in the fire service. 


Yes... some people just should not touch medical... there are quite a number of medical people out there who aren't firefighters that I think are just too stupid for this profession... But some people really can be good at both, love doing both, and put their all into every aspect of emergency response.


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## dave3189

MrBrown should stick to discussing issues in New Zealand!  First off, here in the states working for a pvt Amb company is a stepping stone to future jobs, including FDs.  I don't know anyone who is planning on being a career EMT with an Amb Co. making $11.75/hr?!  Even the companies themselves will admit this to you.  So his point to Anthony regarding his intentions is off base and invalid.  Secondly, I don't work or live in Houston but I'll bet my license that their FD is not training medics in 10 weeks!!! Also, news flash!!! Here on the west coast, FDs are pretty much the only EMS game in town.  EMS makes up about 80% of our calls.  That being said, why would you not include pre-hospital medicine as a stepping stone to the Fire service?  People should do some basic research before posting opinions that show their ignorance.


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## CAOX3

MrBrown said:


> I don't mean to break this kid's hopes and dreams and sound like a tard but the fact that EMS can be [ab]used in this manner just drives me crazy!



Break his dreams?  If he attains his goals he will be a firefighter paramedic in two years,  retired at fifty with a pension around sixty grand and full benefits.

Or he could go your route and work at a private company until he is sixty eight, hope his 401k doesnt tank and wonder where the money to pay for his medications is going to coming from.

At least he will be able to say he didnt use EMS as a stepping stone. 

Please, you do whats best for you and your family.  I would never judge a person for a decision they made securing their future.  

Fire pays better until that changes expect more of the same and frankly I cant blame them


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## MrBrown

CAOX3 said:


> Break his dreams?  If he attains his goals he will be a firefighter paramedic in two years,  retired at fifty with a pension around sixty grand and full benefits...
> 
> Fire pays better until that changes expect more of the same and frankly I cant blame them



Touche my friend. 

*Brown bites his tongue

Ow my tongue!


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## FuManChu

Hey everyone. I didn't mean to start a disagreement or anything among members and I apologize. I just asked this question, because in a lot of the research I have done so far, a lot Fire Dept's require some EMT training, so I figured there would be some useful knowledge here. I did already ask some questions on a fire forum as well, but I thought it wouldn't hurt to get some info from here.
Anyways, thanks for all the info! Sorry again for creating a small disagreement between a few of you. 
Thanks
-Anthony


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## Level1pedstech

You don't need to apologise to anyone on this site. I will let you in on a little secret, a large number of these monkeys will never make it into the ER onto an ambulance and for sure not a fire truck because despite their rap they just don't have what it takes,period. If you dig around you will find who knows their stuff and who are just tools with nothing better to do than take sniper shots at new guys that need a little advice. I don't give a rats butt what their level of education there is no excuse for such behavior. I have never seen such rude and downright :censored::censored::censored::censored:ty attitudes as some on this site have but there are also some great people with great advice that will ALWAYS try and help you out (a couple posted on this thread, hint) so keep coming back and asking questions.

 You may want to take a look at firehouse.com and firecareers.com,both are big fire and EMS sites and will be great resources for you in the future. Firecareers has a paid side for job notifications but the forums are all free and there are many full timers and command staff that will gladly answer a new guys questions. Its been a little slow over there but there is tons of information to be found. You will get strong solid advice from those who have been where you are.

 Best advice get your EMT, a degree,fire academy and then your medic (if you have an interest in medicine),get into the best shape possible,learn how to take a fire service interview (crucial to your success) and test,test,test. The average age for new recruits is about 32 with many of our returning heroes getting first crack at the jobs but you have plenty of time. That's the basic formula,pretty simple.


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## Shishkabob

Disagree.  Skip fire academy.  Get your EMT, get your medic, then have your future employer pay for your fire academy... many are willing to do that.  


And don't be against the prospects of moving, because FF jobs in Cali might not be the easiest thing to get in to.


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## NomadicMedic

there are a couple of things that will put you at the head of the pack.

1) Excellent physical condition.
2) Unquestionable ethics.
3) Paramedic Cert.

Most departments, throughout the interview process, will look for and find the guys that have a moral compass that points straight north, are down with keeping themselves in excellent shape and have the tenacity and wherewithal to put themselves through medic school. Those are candidates that fire departments want.

Of course, if you do have Firefighter I, that's a huge help. However, most larger departments will put you through their own academy.

you may want to look at: http://www.aspiringfirefighters.com/index.html and order the "Aspiring Fire Fighter's 2 Year Plan". Good advice on how to build yourself into the best candidate you can be.

Good luck.


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## EMSLaw

LucidResq said:


> Join the military.



This.  While it's possible to become a FF via the civil service process without being a veteran, it is a lot harder.

In my state, if you are a veteran, you go directly to the top of the hiring list.  In many other states, you get points on the exam.  If you happen to be a veteran, you want to apply in a state like mine.  If you happen to not be, you want to apply in some state where they only give 5 points. ;p

You should only join the military if you want to serve in that way.  But, the collateral consequence of that service is that you may well find it much easier to get your dream job when you're done.  (And, again depending on your state, may get creditable service towards your pension for your military time, plus an enhanced pension for veterans, etc.).

Something to consider.


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## LucidResq

dave3189 said:


> Secondly, I don't work or live in Houston but I'll bet my license that their FD is not training medics in 10 weeks!!!



*Certification,* please. You don't have a license (I apologize if I was mistaken and you were referring to your driver's license as opposed to your EMT ). Yes - there is a big difference between licensure and certification. People should do some basic research on their own credentials before posting opinions that show their ignorance. 



dave3189 said:


> Also, news flash!!! Here on the west coast, FDs are pretty much the only EMS game in town.  EMS makes up about 80% of our calls.  That being said, why would you not include pre-hospital medicine as a stepping stone to the Fire service?  People should do some basic research before posting opinions that show their ignorance.



Your logic is a little skewed and you're not getting what the people you're arguing with are arguing for. The fact that currently the majority of calls a FD responds to are medical does NOT make it right, or the best way to do things. You'll find that most people on this forum think that having EMS as it's own entity is ideal - preferably operated by the government, a hospital, or some other non-profit health care organization. 

I don't blame people who see that working as a paramedic in the fire service is much better than working for a private company. There are even studies showing that fire medics have significantly higher levels of job satisfaction, pay, benefits, etc than those in private services. That is why I gave advice to the OP. If I had the choice to work as a paramedic for a fire department or for one of the privates right now, I would choose the fire department with very, very, very few exceptions (ironically those exceptional services are not even private, they're hospital-based). Yes it needs to change but I do not expect people to take $12 an hour and crap benefits to work as good, well-educated, career paramedics in the meanwhile as some kind of futile protest. 

I do take issue with the fact that the system as a whole encourages people who have no interest in EMS to participate in EMS. Firefighters who hate being EMTs but get the certification anyways just to get a job are pretty damn common, and it hurts a critical public health system as a result. It's like telling people "Well before you can become a cop, you have to be a nurse." So you end up with a bunch of people who dislike taking care of sick people and have no interest or motivation to excel at nursing working as nurses because they're so committed to being cops. And the freaking law enforcement community, which is inherently paramilitary and has nothing to do with health care, running a HEALTH CARE system. 

People have referred to EMS as existing in a "black box" that is not subject to the scientific scrutiny that other medical fields were born out of. Hmmm... wonder why? Research is critical to medicine. It is not as critical to LE and Fire. If EMS were taken under the wing of medicine rather than organizations that were formed to deal with burning buildings... it would start seeing the benefits of evidence-based practice, higher educational standards, etc that are routine in other medical fields. I don't think your average firefighter, other than the few that are officers or have investigation, management, etc duties, needs a college degree or anything more than a HS diploma and plenty of on-the-job training. The policies and cultures of the fire service reflect this, and that's fine as long as they're just doing fire suppression & prevention and some technical rescue. I do think that your average EMS personnel needs a degree and a significant amount of formal education, as well as on-the-job training.


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## TransportJockey

dave3189 said:


> MrBrown should stick to discussing issues in New Zealand!  First off, here in the states working for a pvt Amb company is a stepping stone to future jobs, including FDs.  I don't know anyone who is planning on being a career EMT with an Amb Co. making $11.75/hr?!  Even the companies themselves will admit this to you.  So his point to Anthony regarding his intentions is off base and invalid.  Secondly, I don't work or live in Houston but I'll bet my license that their FD is not training medics in 10 weeks!!! Also, news flash!!! Here on the west coast, FDs are pretty much the only EMS game in town.  EMS makes up about 80% of our calls.  That being said, why would you not include pre-hospital medicine as a stepping stone to the Fire service?  People should do some basic research before posting opinions that show their ignorance.


read
http://www.teex.com/teex.cfm?pageid...=ESTI&Course=EMS135&templateid=14&navdiv=ESTI


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## Level1pedstech

Linuss said:


> Disagree.  Skip fire academy.  Get your EMT, get your medic, then have your future employer pay for your fire academy... many are willing to do that.
> 
> 
> And don't be against the prospects of moving, because FF jobs in Cali might not be the easiest thing to get in to.



 Many departments in CA require a basic academy which includes FF1. Not all but many. Most academies have night and weekend classes which go well with other school and work schedules. Most if not all of the larger departments will run you through a recruit academy even if you have a firefighter 1 academy under your belt. The departments with the better reserve programs will want an academy recognized by the state. For a young guy some reserve time would be of great benefit when he starts interviewing.


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## Level1pedstech

I wanted to add that when it comes time to interview having an academy in your resume could be the difference when it comes time to extend conditional offers. Departments like to see that you have the skill,knowledge and level of physical ability that is gained when you complete an academy. Why should a department invest thousands on some poor boob with a medic cert that washes out halfway through the recruit academy. Gone are the days when having a medic cert and a pulse was your ticket onto the floor of most departments. With many departments facing huge budget deficits and the real possibility of closing stations an applicant especially a younger guy needs to have all the tools he can put in his box to remain competitive in a very tough job market.


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## Shishkabob

And why waste thousands of dollars and a year on someone who drops out of medic school or fails the NREMT?  ^_^


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## Level1pedstech

Im not sure on where your going with wasting a year. Can you clarify?


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## Shishkabob

If someone has FF1 but doesn't have medic and the FD sends them to medic school.


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## Level1pedstech

I strongly suggest going for the medic cert if of course one truly has an interest in being a FF/PM. There are plenty of departments out west that still hire FF/EMT's and many want an academy. I have never been in favor of getting your medic to get on the floor and like I said these days its not the ticket it once was. I think we agree on what should be done but we disagree on the order in which to go about becoming as competitive as possible in the state of CA. Degree,academy and medic,reserve or volunteer time,getting into and staying in peak physical condition,learn how to take a fire service interview and test,test.test. Sound a little better?


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## dave3189

People need to keep in mind the drastic differences between jurisdictions and states regarding the EMS structure.  As I stated earlier in this post, on the west coast, EMS (other than transport) is handled universally by F.D. using a tiered system of BLS and ALS, and occasionally ILS care levels.  Depending on where you live, it is ludicrous to blindly give advice to someone telling them not to muck up the Fire service by getting their EMT cert.  I'm aware of the belief system that many have of wanting EMS and Fire to be separate.  That being said, having lived in So Cal and Western WA (both with Fire Based EMS) I have no question it is the best way to run EMS.  It is Cleary the most inexpensive and provides continuity and lack of duplication of resources.  I have a friend who is a FF (won't mention where) who is responsible for suppression/rescue only.  You know what he does for the most part on a typical 24?  Sleeps, watches TV and plays Xbox... yeah, yeah they drill a bit too.  My point is, why have a crew sitting in a station sitting around waiting for Fires and rescues while 80% of the calls coming in are EMS related?  For those who say that FFs provide sub-par medical service, I'd tell you it’s a stereotype.  Maybe 25 years ago, when the trends started changing there were some "Truck Monkeys" who weren't happy with having do the EMS thing.  Those days are over.  Today's FFS (at least out west) embrace EMS as just as much of their job as suppression.


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## Shishkabob

So instead of cutting back funding for a rarely used function and putting that money into a dedicated EMS group, you'd rather force people to do something they don't want to?  Mmmkkay. 



You living in only Fire based EMS areas makes you think fire based is the best. That's kind of skewed. 

I live in DFW, one of the most populous metropolises in the world, and we have all 3 types of EMS in this area. Obviously I'd have more exposure than you at the different systems and how they work, correct?


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## Shishkabob

That last sentence came off ratter condrotational. I appologize.


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## dave3189

Who said FFs don't like EMS? That's an assumption on your part!? Guess what, Cops don't like doing traffic control or taking BS reports... Should we create another agency that sits around waiting for those calls? 
Again it comes down to efficiency. Makes no sense to have FFs sitting around all day waiting for a fire call when 8 out of 10 are EMS related. If u were
the mayor of a city in charge of budget considerations, I'm sure you'd feel differently?


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## LucidResq

dave3189 said:


> I have a friend who is a FF (won't mention where) who is responsible for suppression/rescue only.  You know what he does for the most part on a typical 24?  Sleeps, watches TV and plays Xbox... yeah, yeah they drill a bit too.  My point is, why have a crew sitting in a station sitting around waiting for Fires and rescues while 80% of the calls coming in are EMS related?



Exactly why we should cut back on funding for Fire and devote more resources and funding for a third service EMS. 

EMS was at one point the red-headed stepchild of public safety. Then, as the need for a fire department has decreased, fire departments were happy to snatch EMS up as a reason to keep them around. Fire-based EMS shouldn't exist just an excuse to keep people employed as firefighters and for cities to dump more money in to purchasing fire engines and stations. 

Some real world examples to back these opinions...

In 1997 the San Francisco Fire Department, which had been providing BLS only, merged with the ALS ambulance service operated by the local Public Health dept. By 2003, there were enough problems to warrant an examination by a Civil Grand Jury. They came to the conclusion....



> "EMS is treated like a poor stepchild in SFFD. Few in number, the firefighter/paramedic providers of EMS are surrounded and led by firefighters and firefighter officers who have a limited appreciation of EMS work."



In 2005 the city health department released a report examining "critical deficiencies" in the EMS operations of San Francisco. Auditors found that treatment protocol errors/emissions were found in 70% of cases, clinical performance standards were met just 44% of the time for patients transported to the ED and only 10% of charts were completed properly. 

No such major problems prior to the merger.


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## LucidResq

OH- Here's another great example of the fire service's commitment to providing quality EMS. 



> Every day across Louisiana, firefighters are busy battling blazes and, in some cases, saving lives.
> 
> Soon, firefighters may take on a new role if lawmakers in Baton Rouge approve a new proposed bill.
> 
> “It would be firefighters practicing medicine without oversight … no oversight by the gubernatorial-approved EMS commission,” said Dr. Jullette M. Saussy.
> 
> Saussy heads up all emergency medical services in Orleans Parish. She said proposed House Bill 1030, written by state Rep. Karen St. Germain from the Baton Rouge area, makes all firefighters exempt from any medical or emergency oversight when they're at a scene.



And what does the Louisana fire service have to say about this? 



> The Louisiana State Firemen’s Association said Saussy is using scare tactics. Nick Felton, who represents the association in New Orleans, said that what the doctor is saying is “boogie man stuff, not fact.”
> 
> Felton went on to say that “the intent of the legislation is that we don't need the EMS board in on our discipline. A lot of the firefighters think they treat us like criminals, like we’re always wrong."
> 
> Felton said the bill has the utmost of every major Firemen’s Association in the state.


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## jwilliams161

Well the emt-b program I'm starting this summer is 10 weeks at a community college


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## dave3189

As far as your examples are concerned... examples are like opinions, everyone has them.  I can show you just as many examples of Fire based EMS systems that have had great success.  The bottom line is (even with better fire codes) we will always need FFs in our communities.  As I said before, why have them sitting around doing nothing waiting for a fire/rescue call when they are as capable as anyone else of providing EMS.  Is the dual education requirement too much for ya?  Is 3-4 months of EMT school and the fire academy just too much info for the old hard drive to store?  Again, there are examples of failures in systems of both types in certain situations... that's inevitable.  My point is that it is far more efficient, inexpensive and less beaurocratic to have them combined.  Ever watched an emergency unfold in NYC?  Love those guys/gals to death, but what a cluster____!  At an emergency in the water, you'll have FDNY, FDNY EMS, NYPD ESU (which is a rescue as well as L.E. unit) NY Port Authority & on and on... I'm assuming you all have taken NIMS courses.  Think about the Incident Command principals and what is more efficient?  As for the Louisiana thing, I'm not sure what that even means?  Any legitimate EMS organization works under the direction of a Medical Program Director.


----------



## Shishkabob

dave3189 said:


> Who said FFs don't like EMS?



*Sigh*  Sure, there are FFs who like EMS.  Hell, I never put a quantitative figure on my statement.  

But if you are going to try and tell me that some/many/most/all FFs didn't become EMTs/Medics JUST for the job, and that they have little to no interest in medicine, you sir are VERY mistaken.

You're a self proclaimed expert on the matter.  Go to your local stations and ask how many of them WANTED to do EMS, and how many of them just got the certs because they had to for the job.




> That's an assumption on your part!?


  Not an assumption.  I know fire/medics who hate doing EMS, and I know ones that love them.  But for you to tell me what I do and do not know is laughable.




> Guess what, Cops don't like doing traffic control or taking BS reports... Should we create another agency that sits around waiting for those calls?


  Last I checked we didn't require LEOs to hold certification in directing traffic.



> Again it comes down to efficiency. Makes no sense to have FFs sitting around all day waiting for a fire call when 8 out of 10 are EMS related. If u were
> the mayor of a city in charge of budget considerations, I'm sure you'd feel differently?



Agreed! 

Again, if most calls don't require fire-based skills, WHY pay for fire?  You're talking about economical efficiency but you're arguing against your self.


If a specialized department is hardly used, why not withdraw funding from that and put it where it WILL be used, instead of making the department bigger and require MORE funding to be less specialized?





And just for further emphasis:




> Guess what, Cops don't like doing traffic control or taking BS reports... Should we create another agency that sits around waiting for those calls?


  Last I checked we didn't require LEOs to hold certification in directing traffic.


----------



## dave3189

It is an assumption on your part.  Have you ever taken a statistics class?  Are you aware of statistical inference, sample size, empirical evidence based conclusions?  “Your” particular experiences as far as what you’ve heard and spoken to about what people like or don’t like doesn’t mean much as far as the bigger picture.  So, again it is an assumption on your part!  

As far as Fire is concerned, I’m not sure why you are so confused?  It’s rarely used, but a critical resource when there is a fire!  We are always going to have fires and therefore need FFs.  When there is a large fire, you need ample resources to deal with it.  Look at the military… when we are not at war, do we just close up shop and get rid of people?  Of course not, they need to be on stand by for when they are needed.  My point to that end is, since we need to have FFs available to respond why not use them in a dual role as EMS providers?  

I work at an F.D. The guys/gals I work with embrace the job and all that comes with it.  My Dept provides an in house EMT-I course for airway, IV and 12 lead.  People are chomping at the bit to take the class!  As far as your question about how many FFs took EMT cause they had to, is invalid and irrational.  Out here, its part of the job, end of story.  That question is like asking a Dr. what their intent was in going to Med School or a soldier’s intent for going to basic training.


----------



## Shishkabob

> I work at an F.D.



I'd be lying if I said I was surprised.





You're arguing with your own ideals and you don't even see it.


----------



## dudemanguy

Dave makes a good argument about fire based EMS being more cost effective.

Is there any evidence that fire based EMS has a significant effect on patient care? Lower survival rates or worse patient outcomes? More lawsuits and charges of negligence? Do hospital emergency departments see a difference between the two?


----------



## TransportJockey

dudemanguy said:


> Dave makes a good argument about fire based EMS being more cost effective.
> 
> Do hospital emergency departments see a difference between the two?



I know the hospital system I used to work in (3 hospitals) would tend to groan when FD based would be bringing someone in. We hated dealing with the FDs. We had trouble with things being done and their entire attitude sucked.


----------



## dave3189

How am I Possibly arguing against my ideals? For a
remedial follow follow up for our slower learners, here goes!? I believe in Fire based EMS.  I work for an EMS based FD where we do both.  I agree with this system because of the fact that we need FFs on duty in the event of fires or rescues, ie: vehicle extrication.  That being said, I think it's utterly
silly and a waste of resources for FFs to sit around all day waiting for fires and that is why I agree with these same individuals also providing primary EMS. It is a more simple command system and is ultately less expensive because
of less logistic, beauracratic and duplication of resource issues.


----------



## CAOX3

I would say in the perfect world firefighters would handle fire issues, police officers would handle police issues and EMS personell would handle EMS issues. 

We dont live in a perfect world and in this economy I dont see any drastic changes being made to how EMS is delivered.  As long as its being delivered competently thats all we can hope for.

I know EMS/firefighters and EMS only providers some suck and some are fantastic it isnt dependent on what uniform their wearing.


----------



## AnthonyTheEmt

MrBrown said:


> I think it's the an absolute disgrace to the face of prehospital medicine.
> 
> Should you wish to be a Firefighter, go to Fire school.
> 
> Do you think your patients and coworkers want to be treated by or work with an Ambulance Officer who is a true professional with a desire to work in prehospital medicine or some wanker who wants a quick patch to make himself look flash and get on da big red truck?
> 
> Go away.



Hey man, how bout you lay off and stop being such a ****. Who are you to judge?


----------



## dudemanguy

CAOX3 said:


> I know EMS/firefighters and EMS only providers some suck and some are fantastic it isnt dependent on what uniform their wearing.



I think that sums it up. 

I'm an EMT who has zero interest in or knowledge of firefighting. In my area EMS is handled by a private ambulance company. There is a volunteer FD in one of the small towns that has a BLS rig. I'm not sure how useful it is, but the firefighters do seem to be thrilled when they get a call and get there before ALS and get to do something lol


----------



## medichopeful

jtpaintball70 said:


> read
> http://www.teex.com/teex.cfm?pageid...=ESTI&Course=EMS135&templateid=14&navdiv=ESTI



Holy crap h34r:h34r:h34r:


----------



## Melclin

jtpaintball70 said:


> He's asking on a medical forum about Fire Dept advice...



Yup. Unfortunately, that is something that would seem normal over your way. Asking about being a fireman on an Ambulance forum makes about much sense as asking about law enforcement on a fireman forum. *Not having a go at you OP. It's not at all your fault that you walked into this argument.* Just understand that American EMS has many problems and the issue of poor education and its association with FD is at the centre of it. Brown and I come from countries where paramedics are educated to a level commensurate with the kind of medical care they are providing. I'm talking uni graduate school, not six months of 'community college'. So you can see why it pisses us off that people spend 15 seconds in the back room of an FD and think they are "in emergency medicine". 



AnthonyTheEmt said:


> Hey man, how bout you lay off and stop being such a ****. Who are you to judge?



Someone who comes from a country where paramedics are medical professionals on par with ICU/crit care nurses, not first aiders. 

Would it piss you off if you had spent 8 years becoming a medical professional and some idiot chimes in with, "Yeah go to bone head college and get your cert, IV's are easy. I can tubed a mellon once and I barely passed the NREMT's test for kids who can't read good, so I assume I'm good at medicine and junk"?


----------



## joeshmoe

Melclin said:


> I'm talking uni graduate school, not six months of 'community college'. So you can see why it pisses us off that people spend 15 seconds in the back room of an FD and think they are "in emergency medicine".
> 
> Would it piss you off if you had spent 8 years becoming a medical professional and some idiot chimes in with, "Yeah go to bone head college and get your cert, IV's are easy. I can tubed a mellon once and I barely passed the NREMT's test for kids who can't read good, so I assume I'm good at medicine and junk"?



Exaggerate much? I guess now it should take 8 years of education to work on an ambulance? I wonder how many of our forum members got their first ambulance job after 8 years of medical education....im gonna take an educated guess and put the number at ZERO. 

With the number of people in this country spread out over such vast distances, and the number of 911 calls responded to every year, good luck making sure everyone who drives an ambulance meets that educational criteria, or even half that. How much is an ambulance ride gonna cost with that? 

I'm happy for Australians if you have such a magnificant EMS system in your country, which has a population thats what, like 8% of Americas? Really, what works in Australia isnt necessarily going to be workable here.

Have you ever even BEEN to America, much less worked in EMS here, done any EMS training here, or taken an NREMT exam?

I see so much hyperbole and exaggeration in some of the comments here, its time to put on the waders.


----------



## TransportJockey

joeshmoe said:


> Exaggerate much? I guess now it should take 8 years of education to work on an ambulance? I wonder how many of our forum members got their first ambulance job after 8 years of medical education....im gonna take an educated guess and put the number at ZERO.
> 
> With the number of people in this country spread out over such vast distances, and the number of 911 calls responded to every year, good luck making sure everyone who drives an ambulance meets that educational criteria, or even half that. How much is an ambulance ride gonna cost with that?
> 
> I'm happy for Australians if you have such a magnificant EMS system in your country, which has a population thats what, like 8% of Americas? Really, what works in Australia isnt necessarily going to be workable here.
> 
> Have you ever even BEEN to America, much less worked in EMS here, done any EMS training here, or taken an NREMT exam?
> 
> I see so much hyperbole and exaggeration in some of the comments here, its time to put on the waders.



Actually, Australia is pretty damned big and their population in some area is just as spread out or more than anywhere in the US. And why should they have to work the inferior system. Their entry level is what we should be striving for. Not a 120 hour 'advanced first aid' level like is staffed in a lot of places


----------



## MrBrown

joeshmoe said:


> Exaggerate much? I guess now it should take 8 years of education to work on an ambulance? I wonder how many of our forum members got their first ambulance job after 8 years of medical education....im gonna take an educated guess and put the number at ZERO.



No, it should not take eight years that's a bit silly.  You can be a Doctor (MD) here in six.  

But it shouldn't only take ten weeks down at the local patch factory or six months at a College.  That is not adequate time to learn the art of advanced prehospital medicine.



joeshmoe said:


> With the number of people in this country spread out over such vast distances, and the number of 911 calls responded to every year, good luck making sure everyone who drives an ambulance meets that educational criteria, or even half that. How much is an ambulance ride gonna cost with that?



With all due respect, your first two points are not relevant.  Look to very rural Victoria in Australia and the rural parts of Canada to see how they get around the problem of isolation.

The number of calls is not relevant either, you should have sufficent resources to respond to them.  Lowering education standard is not an excusable way of increasing numbers of Ambulance Officers.



joeshmoe said:


> I'm happy for Australians if you have such a magnificant EMS system in your country, which has a population thats what, like 8% of Americas? Really, what works in Australia isnt necessarily going to be workable here.



About 10% I'd say; and again with due respect, that is not relevant.  All your states require four years of medical school for doctors, at least two years for nurses, a Bachelors for all other allied health professions right?  The NFPA standards are national standards for the Fire Service are they not?  



joeshmoe said:


> Have you ever even BEEN to America, much less worked in EMS here, done any EMS training here, or taken an NREMT exam?



Yes, yes, yes and yes.  

I am not an ALS level Officer, and yet I can score in excess of 90% on every NREMT style Paramedic (ALS) exam I take; what does that tell you?

This is going to turn into a pissing match again, so I'm gonna sit down and be quiet.


----------



## Shishkabob

dave3189, you know why your argument is invalid?  Because if you truly wanted efficiency, and save money on the budget, you'd be pushing for LE based EMS and making fire volunteer.  It'd save money more then your idea.

Why not make all LEOs EMT and Medic certified?  They have to be on the road anyhow, and they will always beat fire to the scene.


----------



## dave3189

Linuss, that's a silly argument and anyone who is reading this knows it.  I'm not going to entertain your slippery slope fallacy argument of efficiency with respect to merged services!  What's your next silly suggestion, merge Fire, EMS, LE, all utility companies, NGOs, Coast Guard, Life Guards, etc?  Bottom line, you are making assertions about the effectiveness of Fire based EMS with absolutely no facts or empirical evidence to support your contention.  I don't know which type of EMS provides better overall patient care on a nationwide scale... nobody does?  My opinion is based on the fact that Fire based EMS cuts down on beaurocratic and Incident Command red tape and again, since we need FFs (regardless of improved fire standards) why not have them working in a dual capacity.  I have had a great experience with Fire based EMS.  Unlike you however, I understand that my own experiences are a small microcosm of the big picture and don’t necessarily represent the "big picture".  Again, you might want to do some studying on statistics and research methods.  In the end though, I respect your opinions and appreciate all of our efforts to better our profession.  Happy Easter!


----------



## Shishkabob

> Bottom line, you are making assertions about the effectiveness of Fire based EMS



I never ONCE commented on the effectiveness of Fire based EMS.



> My opinion is based on the fact that Fire based EMS cuts down on beaurocratic and Incident Command red tape



And again, if that is your view, that having 2 functions in one job cuts down on the red tape, why not combine EMS and LE and make fire volunteer since it isn't used as often?  Again, 2 functions, 1 job.


You can't argue against that logic since it _is_ your logic.


----------



## joeshmoe

Combine LE and EMS? hahaha. Thats a good one.

So you object to firefighters doing EMS, because their heart isnt really in it or whatever, but you think the typical cop has a burning desire to be a paramedic?


----------



## dave3189

Your contention is that most FFs don't like EMS.  I think common sense would dictate that someone who doesn't like their job is not as effective as someone who is passionate about their job.  Again, you have no stats or empirical evidence to support that most FFs don't like EMS. 

Your merging of services argument is a slippery slope.  Why don't you just suggest that the US Government have one nationwide agency to deal with everything from crime, fire, ems, hazmat, pandemic outbreaks, natural disasters, terrorism, ECT?  I would encourage you to brush up on your NIMS courses, or if you have not had them maybe take them.  Specifically, Nims 100 (Introduction to Incident Command).  Pay special attention to the discipline of span of control.  It will give you some insight into the matter.


----------



## TransportJockey

dave3189 said:


> Your contention is that most FFs don't like EMS.  I think common sense would dictate that someone who doesn't like their job is not as effective as someone who is passionate about their job.  Again, you have no stats or empirical evidence to support that most FFs don't like EMS.
> 
> Your merging of services argument is a slippery slope.  Why don't you just suggest that the US Government have one nationwide agency to deal with everything from crime, fire, ems, hazmat, pandemic outbreaks, natural disasters, terrorism, ECT?  I would encourage you to brush up on your NIMS courses, or if you have not had them maybe take them.  Specifically, Nims 100 (Introduction to Incident Command).  Pay special attention to the discipline of span of control.  It will give you some insight into the matter.



Keep in mind not everyone is reqiured to do NIMS. Hell, until I moved to CO and started looking for a job, I hadn't even heard of the damn things.


----------



## Shishkabob

joeshmoe said:


> Combine LE and EMS? hahaha. Thats a good one.
> 
> So you object to firefighters doing EMS, because their heart isnt really in it or whatever, but you think the typical cop has a burning desire to be a paramedic?



I don't know how I can explain this any differently for you to understand:


Dave says fire should do EMS because otherwise fire would be sitting around all day doing nothing.  He says them doing 2 roles makes sense financially because when not doing fire, they can do EMS. Again:  1 job doing 2 things to save money is his idea.


If he's for that, than why would he be against LE doing EMS?  I mean, again, it's LE doing EMS when not busy doing something else.  Than, when LE has EMS, we can make fire purely volunteer.


There, money saved.  Made 3 services in to 1.5 .  Fire only needed when there is a fire, and LE can do EMS when called.  You cannot argue against that plan, then argue for fire based EMS to 'save money' or circumvent the 'red tape'.





dave3189 said:


> Your contention is that most FFs don't like EMS.



Where did I say most?  Heck, I remember stating in a reply to your first accusation that I never once made a single inference to any quantitative figure.  Translation:  I never gave a number.  So quit stating I did, quit infering I did, and quit making that seem like my argument.


----------



## Veneficus

The ever present EMS vs. fire argument...

If I could once more add some perspective having argued both sides. 

Many fire services I know of or have been personally involved with see EMS as an add on duty. Like various techinical rescues. Basically a "paramedic" is a card that allows you to follow a larger set of treatments than a CPR card. 

This is all neatly filed under the term "public safety." 

What I have seen (many many places over the years) is that Fire based EMS attempts to simplify the science of medicine into a stepwise progression. Then further limits the art of the practice by limiting as much decision making as possible. (in other words, simplifying.)

Having said that I know of at least 2 and have served on 1 3rd service EMS agency that did the same. So it is not restricted to the fire service. 

Likewise, I know of a handful of fire departments that focus on EMS. So clearly it is possible to have the fire service provide some level of it. 

But here is the rub.

There have been more advances in medicine over the last 10 years than in the entire prior history of man. It takes a lot of time and effort to keep up with that. In fact, people spend their entire professional lives trying.

The fire service with all of its many responsibilities largely neglects medicine. They do not treat patients, they have treatments that epidemiologically should help the most patients. Outlying individuals have become "acceptable losses." But nobody likes to talk about that.

Many fire departments do not devote the required resources to EMS. Look at a vast majority of places. The amount of fire apparatus they have compared to fire call volume is completely disproportionate. With far more fire units than is called for. If you truly wanted to argue cost savings, you would eliminate many fire positions and stations. 

At the same time there is considerable EMS runs with a handful of ambulances. 

The fire service attempts all kinds of crap to reduce EMS runs without commiting the resources required to serve the public health needs which lead to the activation of EMS.

You hear often that 911 is for emergencies. Don't call for EMS if you don't have an emergency. Strangely enough, a FD wouldn't tell you not to call if you smelled smoke but didn't see fire. They then turn around and tell you not to call if you have a medical problem unless you are dying. I find that behavior to demonstrate a lack of commitment to EMS. 

Of course everyone thinks their FD is different, that they do it right. sadly they are mistaken. Often they don't even know what issues they have, and even if they do, make minimal efforts to correct it. 

If you think your FD does things properly, I challenge you to put it to the test. Fly me out to your place. See if you can prove me wrong. I know a thing or two about medicine, EMS, and firefighting. I have yet to find a FD that will put their money where their mouth is. Talk is cheap. 

At the same time, you have professionals, both in the US and abroad, who are rightly insulted by being labeled "the same" as the FD paramedics. They should be. They devote considerable time and energy, accept personal responsibility for their decisions and actions, and in the effort to do the most for their patients, spend all their time focusing on the ever evolving world of medical knowledge. 

Dual role providers simply cannot measure up. It would be like comparing a family practice doc who is also a lawyer to a neurosurgeon or a trial lawyer. Simply by having to devote time to other things, lessens the time spent in the specific field and creates a less able professional. 

Inevitably somebody will say they know a great firefighter, paramedic, who is also a lawyer, or some other "professional" and does all of them well. But do they?

Can they fight fire with the proficency of an inner city firefighter who sees multiple working fires a day?

Can they provide medical care comparable to a professional who sees 40+ patients a day?

Can they then perform their third function as well as a person spending all their time doing it?

Obviously the answer is no. Whether it is the lack of fire, lack of technical rescue, lack of patient contact, or whatever, decision making and skill atrophy occur. Every minute you spend practicing firefighting, is a minute away from medicine or vice versa.

If you lose 1/4 of your patients, from just being the minimum or "good enough" of a paramedic, how many more lives are lost than in the last structure fire you had to fight? How often are those fires? In 10 years you could lose hundreds more people from second rate medical care than second rate fire suppression. It is even worse if you do neither well. 

Just some things to consider.


----------



## dave3189

I'm not sure where you are referring to as far as Fire neglecting EMS and lacking the most current training and protocols?  In Seattle and Western Washington in general, our EMS (Fire Based) is absolutely top notch!  You can take any type of service and find places where the quality of care sucks, including hospitals, LE, Fire, EMS,  and on and on.  This can specifically include Fire Based EMS, Privates, hospital based and so on.  The point is, there is nothing inherent to Fire based EMS that reflects a propensity toward a lack of care.  

As for Linuss, again read up on span of control, unity of command, incident command.  It's one of those things, you get it or you don't!

"


----------



## Veneficus

dave3189 said:


> I'm not sure where you are referring to as far as Fire neglecting EMS and lacking the most current training and protocols?  In Seattle and Western Washington in general, our EMS (Fire Based) is absolutely top notch!  You can take any type of service and find places where the quality of care sucks, including hospitals, LE, Fire, EMS,  and on and on.  This can specifically include Fire Based EMS, Privates, hospital based and so on.  The point is, there is nothing inherent to Fire based EMS that reflects a propensity toward a lack of care.
> 
> As for Linuss, again read up on span of control, unity of command, incident command.  It's one of those things, you get it or you don't!
> 
> "



But when you compare the population of Seattle and Western washington with the populations of Houston, Phoenix, DC, NYC, Philly, and a large part of all the miniture midwest departments every block, the amount of capable fire service is significantly dwarfed by the incapable. 

It would be like saying all basketball players were as good as a handful of all stars.

All the fire service like to Hold Seattle out as the example, but how many make any effort to emulate them? How many 6 month paramedic programs do you have out there?


----------



## Shishkabob

dave3189 said:


> As for Linuss, again read up on span of control, unity of command, incident command.  It's one of those things, you get it or you don't!
> 
> "




So, are you for or against LE based EMS?  Why or why not?


----------



## dave3189

So, are you for or against DOT based EMS? Why or why not?

p.s. It fits your requirements?  They are out on the road 24/7 and would beat FD to the scene.


----------



## TransportJockey

dave3189 said:


> So, are you for or against DOT based EMS? Why or why not?
> 
> p.s. It fits your requirements?  They are out on the road 24/7 and would beat FD to the scene.



WA has DOT on the road 24/7? Wow, beats NM. 

Besides that, DOT would make sense... after all EMS is born from DOT


----------



## LucidResq

Although I don't think EMS merging with LE is a good idea, I don't think that's what Linuss is arguing for. It does, to me, make about as much sense as having EMS combined with the fire department, if not more sense. 

The fact is, a fire department that does not provide EMS, has very limited utilization today with the advent of fire codes and fire prevention. LE is used much more often. So if we're talking about saving money, I agree, cut fire down to a very small paid staff, or on-call, and merge EMS with LE. Maximum efficiency right there. 

I've worked extensively with the fire department in my area. They do have relatively high standards, and I would say that I would be comfortable having one of their medics taking care of me or a family member. I don't think anyone here is arguing that all fire-medics are piss poor providers. However, I think it's hysterical that they have their enormous engines and ladders and squirts responding to almost every medical call, simply because they only have a few ambulances but a paramedic on every rig so the engines are often the closest. Then you have to wait for either their ambulance to show up to transport or a private ambulance. Efficiency at it's finest, right? Wonder how much gas that wastes. 

By the way, can you please explain why on Earth you keep belligerently arguing that we know nothing about statistics or ICS? I have no idea what this has to do with the conversation as you have not mentioned any numbers, nor related ICS in a meaningful way to what you're arguing. 

And yes, I have taken college statistics and all of the ICS classes.


----------



## Shishkabob

> Although I don't think EMS merging with LE is a good idea, I don't think that's what Linuss is arguing for. It does, to me, make about as much sense as having EMS combined with the fire department, if not more sense.
> 
> So if we're talking about saving money, I agree, cut fire down to a very small paid staff, or on-call, and merge EMS with LE. Maximum efficiency right there.




Ding ding ding.  Been trying all day for him to realize that, but instead keep getting posts about slippery slopes and DOT.


I thought I had dysphasia...


----------



## Melclin

joeshmoe said:


> Exaggerate much? I guess now it should take 8 years of education to work on an ambulance? I wonder how many of our forum members got their first ambulance job after 8 years of medical education....im gonna take an educated guess and put the number at ZERO.
> 
> *I should have been clearer. I meant 8 years in the same sense that it takes a doctor ~13 years to become an attending/consultant physcian including both experience + formal education. It actually does take ~8 years to become a fully qualified paramedic (ALS) here:
> -3 years of university,
> -1 year internship,
> -no less than 2 years experience our basic level (although often more, and to be granted entry to the ALS graduate course, you need to have inpressed your peers enough to be nominated for it),
> -1 year in grad school, followed by an ALS internship. So you could say that 8 years is conservative.
> 
> Given that they autonomously manage treatment modalities that are very much physician only and that even most physicians have oversight for, it is not at all unreasonable. *
> 
> or taken an NREMT exam?
> 
> *Yes. After 1.5 years of my undergrad degree, I could easily pass the practice exams. Most of the time because the questions are written at such a low level, one can figure it out even if you don't know the answer. After a little over two years of our degree, I rarely get any questions wrong. Its absurd that I should be able to this without any formal ALS specific education and unfortunately this is not a reflection on me, but on the inadequacy of the test. If someone had trouble with that test, I wouldn't let them near me with a thermometer let alone 100 of sux. *



10 Char


----------



## dave3189

Out here in WA, we don't have a medic on every rig so we are not running engines and trucks on aid/medic calls.  We have designated Aid units and Medic units that respond accordingly.  The problem with your suggestion about making Fire mostly Vollie is that guess why some people work in that capacity currently?  You guessed it...! They’re trying to get exp to get hired full time.  Take that carrot away and many of those vol FFs go away as well.  As far as my reference to stats is concerned, I have not made any assertions about who likes EMS and who doesn’t, etc.  I was merely pointing out to Linuss that one's own experiences don't mean much in the bigger picture.  I have responded to the LE/EMS question, albeit sarcastically hence my point about merging EMS with DOT.  By the way, according to Linuss' logic it makes about the same sense.  They are out on the road, responding to emergencies, and they don't drive those big gas guzzling engines & trucks you guys hate so much!


----------



## atropine

Dearest OP, if you want to be be selective on where you want to land that dream gig here in Cali, you need to be a paramedic, and have a FF1 acdemy and nothing less.


----------



## atropine

Linuss said:


> If someone has FF1 but doesn't have medic and the FD sends them to medic school.



most departments if not all departments in southern Cali are not sending anyone to medic school anymore due to the economy.


----------



## triemal04

Veneficus said:


> The ever present EMS vs. fire argument...
> 
> If I could once more add some perspective having argued both sides.
> 
> Many fire services I know of or have been personally involved with see EMS as an add on duty. Like various techinical rescues. Basically a "paramedic" is a card that allows you to follow a larger set of treatments than a CPR card.
> 
> This is all neatly filed under the term "public safety."
> 
> What I have seen (many many places over the years) is that Fire based EMS attempts to simplify the science of medicine into a stepwise progression. Then further limits the art of the practice by limiting as much decision making as possible. (in other words, simplifying.)
> Kind of like requiring all paramedics to consult with a MD prior to their treatments (heeeeello New Jersey), requiring MD contact to give anything more than O2 and aspirin, removing meds that are only "rarely" used, having very simplistic protocols and on and on...of course, it's non-fire-based EMS that does this...
> 
> Having said that I know of at least 2 and have served on 1 3rd service EMS agency that did the same. So it is not restricted to the fire service.  Glad you at least can recognize that, but I'm gonna continue so bear with me...
> 
> Likewise, I know of a handful of fire departments that focus on EMS. So clearly it is possible to have the fire service provide some level of it.
> 
> But here is the rub.
> 
> There have been more advances in medicine over the last 10 years than in the entire prior history of man. It takes a lot of time and effort to keep up with that. In fact, people spend their entire professional lives trying.
> 
> The fire service with all of its many responsibilities largely neglects medicine. They do not treat patients, they have treatments that epidemiologically should help the most patients. Outlying individuals have become "acceptable losses." But nobody likes to talk about that.
> But then, private EMS (and all other types) does this as well.  In fact, I'd say that it's more of a systemic problem with private EMS; I know multiple people who can't remember when they last had any in-house EMS training or were given the resources to get that training and education on their own.  This isn't a problem that only faces the fire service.
> 
> Many fire departments do not devote the required resources to EMS. Look at a vast majority of places. The amount of fire apparatus they have compared to fire call volume is completely disproportionate. With far more fire units than is called for. If you truly wanted to argue cost savings, you would eliminate many fire positions and stations.
> It's not a disproportionate amount either; what people need to remember is that it's not the total number of fires that is used to justify the number of units, but how many units are needed for those fires; if it takes say, 2 engines and a truck for a fire, then those need to be staffed for that area to be adequately protected.  The fire service, EMS, police, and even medical facilities, aren't staffed in a "reactive" way; the number of people working/the equipment available should be, and hopefully is, proportionate to what can reasonable go wrong.  Saying cut the numbers because the volume is down would be like saying get rid of crich's because they are used so rarely.  Or get rid of a CT scanner that is used only a couple times a week but is the only one available for a large area.  I will admit though, that there is waste in many departments, and some units should be cut.
> 
> At the same time there is considerable EMS runs with a handful of ambulances.
> Unfortunately that is sometimes true, but again, not always, and it's not limited to the fire service.  I could point out the non-fire EMS agencies that are removing ambulances from an already overworked system, cutting pay and benefits which decreases the quality of their new employees, but that would be cheating.
> 
> The fire service attempts all kinds of crap to reduce EMS runs without commiting the resources required to serve the public health needs which lead to the activation of EMS.
> Can you explain that a bit more?
> 
> You hear often that 911 is for emergencies. Don't call for EMS if you don't have an emergency. Strangely enough, a FD wouldn't tell you not to call if you smelled smoke but didn't see fire. They then turn around and tell you not to call if you have a medical problem unless you are dying. I find that behavior to demonstrate a lack of commitment to EMS.
> Why?  EMS abuse, and ER abuse is a very common thing.  Granted, more needs to be explained, but telling someone not to call because they need a refill on their prescription is a valid reason.  Educating people about what needs and ambulance and/or an ER visit is an appropriate thing to do.
> 
> Of course everyone thinks their FD is different, that they do it right. sadly they are mistaken. Often they don't even know what issues they have, and even if they do, make minimal efforts to correct it.
> 
> If you think your FD does things properly, I challenge you to put it to the test. Fly me out to your place. See if you can prove me wrong. I know a thing or two about medicine, EMS, and firefighting. I have yet to find a FD that will put their money where their mouth is. Talk is cheap.
> So...you're willing to do that for ANY EMS service, right?  Because anybody willing to look rationally at this is aware that problems plague all types of EMS.
> 
> At the same time, you have professionals, both in the US and abroad, who are rightly insulted by being labeled "the same" as the FD paramedics. They should be. They devote considerable time and energy, accept personal responsibility for their decisions and actions, and in the effort to do the most for their patients, spend all their time focusing on the ever evolving world of medical knowledge.
> As do I.  As do many fire-based paramedics I know.  I get very upset when I get lumped in with some non-fire based EMS providers (I won't say what type because it doesn't matter in this case); the level and amount of care provided by some non-fire based services that I've seen is appalling, and when someone compares me to "that paramedic from XXXX" it's...well...aggravating, because I know what kind of care that service gives.
> 
> Dual role providers simply cannot measure up. It would be like comparing a family practice doc who is also a lawyer to a neurosurgeon or a trial lawyer. Simply by having to devote time to other things, lessens the time spent in the specific field and creates a less able professional.
> 
> Inevitably somebody will say they know a great firefighter, paramedic, who is also a lawyer, or some other "professional" and does all of them well. But do they?
> 
> Can they fight fire with the proficency of an inner city firefighter who sees multiple working fires a day?
> 
> Can they provide medical care comparable to a professional who sees 40+ patients a day?
> I hope to god that there isn't a paramedic dealing with 40+ pt's a day...though with some privates out there it's getting to be within the realm of possibility...
> 
> Can they then perform their third function as well as a person spending all their time doing it?
> 
> Obviously the answer is no. Whether it is the lack of fire, lack of technical rescue, lack of patient contact, or whatever, decision making and skill atrophy occur. Every minute you spend practicing firefighting, is a minute away from medicine or vice versa.
> 
> If you lose 1/4 of your patients, from just being the minimum or "good enough" of a paramedic, how many more lives are lost than in the last structure fire you had to fight? How often are those fires? In 10 years you could lose hundreds more people from second rate medical care than second rate fire suppression. It is even worse if you do neither well.
> 
> Just some things to consider.


Replies in red.  I'm not going to argue with that last couple of paragraphs because...well...you're right.  Having to know and be an expert in multiple different fields is not appropriate, and while it can and is done (sorry, but it is) it shouldn't be.  Hopefully at some point the educational level (of both providers *and the pubic*) will advance enough so that it isn't necessary to do so.  But right now, with the way then entire system is, what's being done  by the fire service can and does work.  Just as what's being done by non-fire EMS doesn't work.  And of course the reverse is also true.

Unfortunately, what you've said is right.  Not everywhere, but in enough places that it's a problem.  And even more unfortunate is that it's right no matter what type of service you bring up; fire-based, private, third service, hospital-based and so on.  Just think...if people would stop getting so worked up about this issue, realize that the problems extend well beyond any one type of provider and work on fixing the actual root causes instead of the symptoms, then something might actually be done!  But no...instead what happens is the same old bickering.


----------



## Veneficus

_Kind of like requiring all paramedics to consult with a MD prior to their treatments (heeeeello New Jersey), requiring MD contact to give anything more than O2 and aspirin, removing meds that are only "rarely" used, having very simplistic protocols and on and on...of course, it's non-fire-based EMS that does this..._

Yes, New Jersey, is a special case. (for more than just EMS)

It has been my observation that while there are non fire based agencies that do this, as I mentioned I worked for one at one time, and it is not unique, because of the volume of fire based services compared to non fire services, and the outdated leadership and concepts, it becomes the fire service that is the major perpetuator.

_But then, private EMS (and all other types) does this as well. In fact, I'd say that it's more of a systemic problem with private EMS; I know multiple people who can't remember when they last had any in-house EMS training or were given the resources to get that training and education on their own. This isn't a problem that only faces the fire service._

I think this would be a more fair statement if you remove non emergent transport from EMS. After all, there is nothing emergent about it, it is basically a healthcare safety net in the form of a trucking company. Many private agencies that do not do emergent response really have no need of continuous emergency training. However, if you do look at the primary private and 3rd service responders around the nation, you find it is a minority that do not provide adequate training.

_It's not a disproportionate amount either; what people need to remember is that it's not the total number of fires that is used to justify the number of units, but how many units are needed for those fires; if it takes say, 2 engines and a truck for a fire, then those need to be staffed for that area to be adequately protected. The fire service, EMS, police, and even medical facilities, aren't staffed in a "reactive" way; the number of people working/the equipment available should be, and hopefully is, proportionate to what can reasonable go wrong. Saying cut the numbers because the volume is down would be like saying get rid of crich's because they are used so rarely. Or get rid of a CT scanner that is used only a couple times a week but is the only one available for a large area. I will admit though, that there is waste in many departments, and some units should be cut._

I respectfully disagree with this. The equipment is entirely disproportional to the need. How many 120’ ladders do you need? How many can you even use at one time? How many FDs have a bunch of engine companies with 2 or 3 guys on each? What can you do with that? What is the point of having a fire house on every block with a 5 minute response of 3-4 guys according to NFPA ½ should be outside anyway. So you have to wait the same amount of time to actually attack a fire or effect a rescue because of resources arriving from remote locations. But that is a discussion for a fire board. The trouble is they don’t want to hear the 200 year old operating model doesn’t work anymore. 

_The fire service attempts all kinds of crap to reduce EMS runs without commiting the resources required to serve the public health needs which lead to the activation of EMS.
Can you explain that a bit more?_

I am sure you have seen it, or at least heard of it. Nurse on call, dispatch refusals, a private company contracted to transport what the FD doesn’t deem “emergent enough.”

_Why? EMS abuse, and ER abuse is a very common thing. Granted, more needs to be explained, but telling someone not to call because they need a refill on their prescription is a valid reason. Educating people about what needs and ambulance and/or an ER visit is an appropriate thing to do._

It is not abuse, it has become a safety net. There is no other resource to call. When you need help dial 911. I’ll illustrate a personal example and a few others. But it can apply to many more situations.

My wife once got a UTI, a fairly common event for females. So being a healthcare provider, instead of going to the ED, I called the family doc. (and we have some good insurance) after quite a bit of arguing, they tell me they can get her an appointment in 35 days. Now think about that. Difficulty urinating from a bacteria infection for 35 days. So when you cannot urinate and become hyperkalemic (among other things) or become septic then it is worthy of an ED? You would let the problem go that long? For us, of course off to the ED we went.

According to a NEJM article the national average to see a PCP is 48 days. If you can’t wait a month and ½ the ED becomes the default. People need an ambulance to get to a doctor. Given a choice, I'm willing to bet if they had another viable option they would use it.

The example of  prescription refill is utter BS. I am sorry but it demonstrates a complete lack of understanding. If granny can’t afford to get her CHF medication refilled on her fixed income and is homebound with no family care, calling 911 and getting a ride to the ED does solve the problem for everyone. In a much more cost effective and humane way then waiting until she is in crisis. 

A poor person getting a ride to the ED to be educated on what OTC meds to give an infant with a fever because they honestly don’t know, is not a waste of resources, compared to letting a fever go uncontrolled in an infant. (much different in older kids and adults) 

These mundane “abuses” actually save lives and large amounts of money. It costs considerably less to tie up a transporting ambulance and crowd an ED than a few days in an ICU.

The very nature of what needs an ER visit has changed. 

_So...you're willing to do that for ANY EMS service, right? Because anybody willing to look rationally at this is aware that problems plague all types of EMS._

Absolutely and unequivocally.

_As do I. As do many fire-based paramedics I know. I get very upset when I get lumped in with some non-fire based EMS providers (I won't say what type because it doesn't matter in this case); the level and amount of care provided by some non-fire based services that I've seen is appalling, and when someone compares me to "that paramedic from XXXX" it's...well...aggravating, because I know what kind of care that service gives._

Lumped in with professional EMS providers or the dialysis derby, granny tranny trucking company? I wouldn’t be too upset to be grouped into the same category with a Lee county or Wake County EMS provider. Just as I am sure they would want to be grouped in With a King County provider. But how about being grouped in with DC? They are the fire service EMS in our nation's Capital. For all the world to see and compare to. 

_but in enough places that it's a problem._

More than 2/3 the population of the United States makes the Pacific Northwest fire services the exception, not the rule. I don’t know, but I am willing to bet between Los Angeles, Houston, DC, and NYC (nevermind Philly, Chicago, and the other major FDs) there is more population than in the entire state of Washington, which does have a commendable fire service EMS system.

I am more than willing to solve the problems. But when the advocates of fire based EMS think they are doing a fine job, it makes it really hard to get anywhere. I focus what seems unfairly on the FD services because they are the major provider. When you fix a major problem, many smaller ones seem to take care of themselves.

Why is it the only Fire service that tries to reduce the number of paramedics is in Washington State? Again I ask, why are other FDs not even attempting to emulate the successful model at all?


----------



## triemal04

Veneficus said:


> Yes, New Jersey, is a special case. (for more than just EMS)
> 
> It has been my observation that while there are non fire based agencies that do this, as I mentioned I worked for one at one time, and it is not unique, because of the volume of fire based services compared to non fire services, and the outdated leadership and concepts, it becomes the fire service that is the major perpetuator.
> To be clear, I was only referring to transporting depts; generally speaking a non-transporting unit is only needed in certain circumstances, and then only at an EMT level, if that.  If you want to discuss the fallacy of having 4 paramedics on an engine then you're preaching to the choir.  When you only focus on transporting agencies (of any kind) it does become clearer that, while the fire service does have it's flaws, and, admittedly, does not always act in the best medical interest, all types do the same thing.  Consider the private service (and I do mean one that takes emergency calls) that will do whatever it can to increase their profits, even if that is detrimental to the pt's and providers.
> 
> I think this would be a more fair statement if you remove non emergent transport from EMS. After all, there is nothing emergent about it, it is basically a healthcare safety net in the form of a trucking company. Many private agencies that do not do emergent response really have no need of continuous emergency training. However, if you do look at the primary private and 3rd service responders around the nation, you find it is a minority that do not provide adequate training.
> I didn't meant a NETS agency; for this and all my statements I specifically meant services that take 911 calls or handle other "emergent" situations.  For much of private EMS, it is only about the bottom line; if profits can be increased by cutting something, then they will.  If higher education and the ability to better treat people cost to much...then it's gone.  I have seen and heard of worse training from private EMS than I have from transporting fire depts.  But, I will admit that I know the other side exists too.
> 
> I respectfully disagree with this. The equipment is entirely disproportional to the need. How many 120’ ladders do you need? How many can you even use at one time? How many FDs have a bunch of engine companies with 2 or 3 guys on each? What can you do with that? What is the point of having a fire house on every block with a 5 minute response of 3-4 guys according to NFPA ½ should be outside anyway. So you have to wait the same amount of time to actually attack a fire or effect a rescue because of resources arriving from remote locations. But that is a discussion for a fire board. The trouble is they don’t want to hear the 200 year old operating model doesn’t work anymore.
> Actually, in the context it's been brought up, it is a discussion for here.  As I said, plans aren't made for the specific numbers of certain events, but on the likelihood of something happening, and on what resources are needed for that likely event.  If that wasn't the case then...what's the point of carrying crichs?  Jet ventilators?  Pitocin?  Mag?  Beta-blockers?  Antibiotics?  Why not just wait until you reach the hospital?  How about that rarely used CT scanner?  After all, those things are rarely used, so why bother with them?  Hell, some of what we, and you as a doctor, learn about we will only need to apply in certain circumstances.  Should we not bother learning about it?  Of course not.  It's the same concept though.
> 
> I am sure you have seen it, or at least heard of it. Nurse on call, dispatch refusals, a private company contracted to transport what the FD doesn’t deem “emergent enough.”
> Well guess that means they aren't in it for the money then.  But...most of those things could have their place.  Nurse on call...if it's used appropriately so that someone can be referred to an appropriate resource if they don't need an ER visit; dispatch refusals...ok, that's probably a bad idea.  Dispatch triage on the other hand is a better idea; using a separate service for non-emergent transfers...seems to work for King County and Boston, it allows the paramedics to focus on calls that require their knowledge and abilities and not on calls than can be handled by EMT's.
> 
> It is not abuse, it has become a safety net. There is no other resource to call. When you need help dial 911. I’ll illustrate a personal example and a few others. But it can apply to many more situations.
> Sorry, at a certain point it is abuse.  For someone who is out of options no, but for the person calling again and again and again for the same issue that does not require assistance...
> 
> My wife once got a UTI, a fairly common event for females. So being a healthcare provider, instead of going to the ED, I called the family doc. (and we have some good insurance) after quite a bit of arguing, they tell me they can get her an appointment in 35 days. Now think about that. Difficulty urinating from a bacteria infection for 35 days. So when you cannot urinate and become hyperkalemic (among other things) or become septic then it is worthy of an ED? You would let the problem go that long? For us, of course off to the ED we went.
> What about a clinic?  Urgent Care?  Were those things an option?  Not in your particular situation, but it's not uncommon for the pt to have been told by their MD (or the receptionist in a lot of cases) to go to the ER because they can't be seen that day, then have myself or another paramedic talk with their PCP and find that they can have an appointment that day.
> 
> According to a NEJM article the national average to see a PCP is 48 days. If you can’t wait a month and ½ the ED becomes the default. People need an ambulance to get to a doctor. Given a choice, I'm willing to bet if they had another viable option they would use it.
> Or they weren't sure what to do as you mentioned above, so they called 911.  This is the time when PUBLIC education should come into play.  Outline their options for getting to where they need to go.
> 
> The example of  prescription refill is utter BS. I am sorry but it demonstrates a complete lack of understanding. If granny can’t afford to get her CHF medication refilled on her fixed income and is homebound with no family care, calling 911 and getting a ride to the ED does solve the problem for everyone. In a much more cost effective and humane way then waiting until she is in crisis.
> So she can afford a bill from an ambulance?  So the service can afford to eat the majority of the bill that medicare won't pay?  Look, I know healthcare is screwed up and that the ER is the only help some people have; I have no issue taking them if that's the case and in any situation I could care less if the bill get's paid.  But, doing something that costs someone around $1000 for a trip that isn't needed is ludicrous and not right.  That though, is a completely separate argument from this.  And I really did mean people who want their prescription refilled and just want a ride to the ER because there happens to be a pharmacy there.
> 
> A poor person getting a ride to the ED to be educated on what OTC meds to give an infant with a fever because they honestly don’t know, is not a waste of resources, compared to letting a fever go uncontrolled in an infant. (much different in older kids and adults)
> And that poor person will pay for the ambulance how?  And the ER bill?  How will they pay that?  I'm more a fan of finding them the right resources for the situation.  Again though, this is getting to be a different topic.  I'm all for continuing, just sayin'...
> 
> These mundane “abuses” actually save lives and large amounts of money. It costs considerably less to tie up a transporting ambulance and crowd an ED than a few days in an ICU.
> And it costs money on all sides.  See the preceding paragraph though.
> 
> The very nature of what needs an ER visit has changed.
> I agree completely.
> 
> Absolutely and unequivocally.
> Thank you for that.
> 
> Lumped in with professional EMS providers or the dialysis derby, granny tranny trucking company? I wouldn’t be too upset to be grouped into the same category with a Lee county or Wake County EMS provider. Just as I am sure they would want to be grouped in With a King County provider. But how about being grouped in with DC? They are the fire service EMS in our nation's Capital. For all the world to see and compare to.
> Again, I am only talking about 911-type services, not a NETS.  And if someone compared me to Lee, Wake or King County (the service not the system, though either would be fine ) I would be ecstatic.  But that's not the case for me.  Just as the fire-service has it's lousy systems, so do privates.  And hospitals, third service, etc etc.



Apparently the post is to long...stay tuned.


----------



## triemal04

Part 2.



Veneficus said:


> More than 2/3 the population of the United States makes the Pacific Northwest fire services the exception, not the rule. I don’t know, but I am willing to bet between Los Angeles, Houston, DC, and NYC (nevermind Philly, Chicago, and the other major FDs) there is more population than in the entire state of Washington, which does have a commendable fire service EMS system.
> 
> I am more than willing to solve the problems. But when the advocates of fire based EMS think they are doing a fine job, it makes it really hard to get anywhere. I focus what seems unfairly on the FD services because they are the major provider. When you fix a major problem, many smaller ones seem to take care of themselves.
> And when the advocates of private EMS refuse to accept the problems they face and the horrendous practices and standards they have, it makes it really hard to get anywhere.  See, I can do it too, and it's still true.
> 
> Why is it the only Fire service that tries to reduce the number of paramedics is in Washington State? Again I ask, why are other FDs not even attempting to emulate the successful model at all?


For the last paragraph, because, as I said, you aren't wrong in your assessment.  Fire-based EMS can be a problem, and is a problem in many places.  But then so are all other types.  People forget that and trot out the fire service as this all powerful boogeyman that is holding EMS back, but at the same time turn a blind eye to the abuses that are going on around them and are perpetuated by non-fire systems.  Can we (we as in all providers) do better?  Absolutely.  Should we?  Same answer.  But all the finger-pointing in the world won't do anything; people need to be able to look objectively at EMS and come up with a solution, but this doesn't happen.  Just look at this thread, or any of the other dozen times it's come up.  

Look honestly at everything you've said.  It can be applied across the board.  Does this mean that it's ok for the fire service to do it too?  Hell no, it absolves nobody.  Does this mean that it's ok in general?  Never.  Does this mean that all fire departments are guilty of it?  No more than it means that all non-fire based departments are guilty of the things I've seen them do.

Is fire-based EMS holding back EMS?  To be perfectly honest, to a certain extent it is.  Nowhere near as bad as some people would like to think, but yeah, it is.  But then, so is private EMS.  Where are the diatribes and hatred about them?


----------



## armywifeemt

I happen to believe that what holds EMS back is mass stupidity. We just need to have an IQ test with a cutoff score for anyone working in the medical profession. Period.


----------



## Veneficus

triemal04 said:


> Is fire-based EMS holding back EMS?  To be perfectly honest, to a certain extent it is.  Nowhere near as bad as some people would like to think, but yeah, it is.  But then, so is private EMS.  Where are the diatribes and hatred about them?



I wouldn't call it hatred, I don't hate the FD, I just don't like the spouting how they are so great at EMS but they cannot live up to their propaganda. IF you are going to say you are the best, you better be able to back it up no matter what industry you are in.

From my personal perspective. Changing a unionized FD is near impossible. Changing the culture of the fire service is near impossible. 

Getting rid of a private service that doesn't measure up is easy. Just don't renew the contract or at contract negotiations demand certain things.

Not all privates increase the bottom line by slashing. Some actually expand their service realms as well as offer a higher level of care. But I agree a majority do slash service, equipment, etc. Like I said though, fixing a private is really easy.

As well, fixing a poor third service is just as easy, just threaten to merge them with the FD. They will change.


----------



## atropine

armywifeemt said:


> I happen to believe that what holds EMS back is mass stupidity. We just need to have an IQ test with a cutoff score for anyone working in the medical profession. Period.



I can't see that this will work, who decides what is a medical profession?, because in southern Cali most consider ems a stepping ston job and nothing more.


----------



## MrBrown

Brown does not dislike the Fire Service but passioniately detests any involvement they have with providing prehospital medicine.

Sorry Houston Fire Department but 12 weeks is not enough time to train a nobody to become confident in and capable of providing advanced life support.

It's quite provable the IAFF and IAFC EMS Section are anti-education and very misleading in thier promotion of Fire Based EMS.

Brown wonders if Brown should be referring to Brown in the third person h34r:


----------



## dave3189

*Funny*

Last week, Mr. Brown stated that Houston FD was turning out Medics in 10 weeks.  This week he is now stating 12 weeks.  I assert he is wrong in both instances.  Not sure if it is intentional or just ignorance but either way it is a silly assertion!  Mr. Brown can you provide any proof or documentation that HFD trains ALS in 10 or 12 weeks?  Of course you can't, so stop spreading ridiculous propaganda!


----------



## TransportJockey

dave3189 said:


> Last week, Mr. Brown stated that Houston FD was turning out Medics in 10 weeks.  This week he is now stating 12 weeks.  I assert he is wrong in both instances.  Not sure if it is intentional or just ignorance but either way it is a silly assertion!  Mr. Brown can you provide any proof or documentation that HFD trains ALS in 10 or 12 weeks?  Of course you can't, so stop spreading ridiculous propaganda!



You know that link I posted a few pages back? That's HFDs medic mill


----------



## MrBrown

dave3189 said:


> ...stop spreading ridiculous propaganda!



No, no mate that's the job of the IAFC EMS Section and the IAFF.

http://www.teex.org/teex.cfm?pageid=training&area=TEEX&templateid=14&Division=ESTI&Course=EMS135

Note each class is less than 12 weeks.

There was a press release around somewhere stating that the first class they ran was graduating a few years ago and how most of the students where Houston Firefighters.

It's no seceret that Dallas Fire Rescue sends thier guys to a twenty-four week patch mill at UTSW/Parkland and that most Paramedic programs in the US are around six to nine months.  Some are a two semesters, some are three (or two regular and a summer).

It should also be no suprise that the IAFC EMS Section does not support increased education nor having to send all Paramedic students to college.


----------



## dave3189

HFD does their own medic program according to their site?  Regardless, this Teex program is not 10 weeks or 12 weeks.  The initial 240 hours (didactic/lecture) is what they are referring to with the initial 15 weeks or 12 weeks.  Then, there are additional clinical and field internships that are completed over the next several months.  I'm not a big fan of the EMS fast track mills.  That being said, it is deceptive to call this program a 10 or 12 week medic program.  As we are all aware, the clinical and field time requirements of any EMS training are part of the total amount of hours for the program.


----------



## MrBrown

It may be slightly untrue but you add in two hundred "hours" of exposure to a clinical environment when the student has very little *real*knowledge to begin with coz they got baked for ten weeks out in the Texas heat and your product is gonna flop.

California is slightly better in that they require external validation by CoAEMSP for thier Paramedic programs but accreditation has been gotten at by the Fire Service; the requirement to have every program afilliated with a College or University was dropped after *****ing from the IAFC EMS Section.

In Cincinati the Fire Department first picks volunteers to become Paramedics, but may "assign" them to Paramedic duty if numbers so dictate.

Civillian Paramedics were too expensive for the Los Angeles City Fire Department so in the late 1990s they gave thier jobs to Firefighters who they were already paying so it worked out cheaper.

Los Angeles also has two pages of standing orders which is the exact quantity they had over thirty years ago.

The Fire Service is not the be-all-and-end-all of problems, but they sure as hell don't help but nor does AMR or the DOT or the fact I can get 90% on the practice NREMT Paramedic tests and I am *not* an ALS Officer and have had no formal ALS level education.

Sure, most anyone can cram, squeak through a standardized test written at the 8th grade level, and sew on a patch. The Houston Fire Department proves that every day.


----------



## dave3189

Again, I'm not a fan of these quick fast track programs.  I agree with you that 2 semesters (6 months) is too fast to train a medic.  That being said, it is not true that Houston is spitting out ALS in 10, 12 or even 15 weeks.


----------



## medic417

dave3189 said:


> HFD does their own medic program according to their site?  Regardless, this Teex program is not 10 weeks or 12 weeks.  The initial 240 hours (didactic/lecture) is what they are referring to with the initial 15 weeks or 12 weeks.  Then, there are additional clinical and field internships that are completed over the next several months.  I'm not a big fan of the EMS fast track mills.  That being said, it is deceptive to call this program a 10 or 12 week medic program.  As we are all aware, the clinical and field time requirements of any EMS training are part of the total amount of hours for the program.



Houston contracts with TEEX  for their in house program who unless they recently changed does offer a 10 and a 12 week course plus clinical time.   It is not deceptive to call it that short because many programs that are 6-9 months still have clinicals following completion.  Same idea.  The key point is there is no true education required to be a Paramedic in the USA.


----------



## dave3189

Your argument is silly!  Do you know of anyone who has attended medical school?  One of my best friends is going through as we speak.  News flash...! I guess medical school has been reduced to just 2 years!  If you know anything about the subject, the first 2 years are academic and years 3 and 4 are clinical.  Should we apply the same principal and assume the last 2 years are not part of the program?  Link me to any legitimate ALS training program website and show me where the required clinical/field time is not included in the program structure and included hours?


----------



## dave3189

*Brown is wrong again!*

The city of L.A. (LAFD) has had Fire based medics for decades.  Hell, L.A. was one of the pioneering jurisdictions in EMS/Para-Medicine back in the early 70s along with Seattle.  Brown, do you fact check anything you say or do you subscribe to the "fling it against the wall and see what sticks" theory of debate?

"There is no room for the whacker train in EMS"


----------



## TransportJockey

dave3189 said:


> The city of L.A. (LAFD) has had Fire based medics for decades.  Hell, L.A. was one of the pioneering jurisdictions in EMS/Para-Medicine back in the early 70s along with Seattle.  Brown, do you fact check anything you say or do you subscribe to the "fling it against the wall and see what sticks" theory of debate?
> 
> "There is no room for the whacker train in EMS"



From this: http://lafdtraining.org/ems-s/wp-content/uploads/2009/08/ems-history.pdf




> From 1973 through 1992, virtually all LAFD rescue ambulances and paramedic positions
> were staffed with single-function civilian EMT-I’s and paramedics.



He said Civilian medics. Now the LAFD decided they could do it better and save money by terminating the single role providers.


----------



## jgmedic

jtpaintball70 said:


> From this: http://lafdtraining.org/ems-s/wp-content/uploads/2009/08/ems-history.pdf
> 
> 
> 
> 
> He said Civilian medics. Now the LAFD decided they could do it better and save money by terminating the single role providers.



Still a few of the old blue helmets around, though few and far between. I believe LACoFD has always had dual-role ff/pm on the squads.


----------



## dave3189

I'm not sure quite how to read the distinction between Civilian and non-civilian?  In King County (Medic One) the FDs have full time designated Medics that are assigned to the Medic Units.  Some (maybe even most) came from the Fire ranks but some did not.  That being said, I wouldn't consider these guys & gals to be civilian.


----------



## dave3189

Interesting article, thanks for providing it.  There are a couple glaring inconsistencies in it however.  For one, it states that the EMT-I level is the minimum nationally accepted level for ambulance care.  What planet are they from?  Second, it states that they have BLS units staffed with EMT-I personnel.  Ummm, wouldn't that make these units ILS level???


----------



## Veneficus

dave3189 said:


> I'm not sure quite how to read the distinction between Civilian and non-civilian?  In King County (Medic One) the FDs have full time designated Medics that are assigned to the Medic Units.  Some (maybe even most) came from the Fire ranks but some did not.  That being said, I wouldn't consider these guys & gals to be civilian.



I think the distiction has to do with the terms of their employment. Some fire departments employ paramedics in a way similar to a contractor and not a member of the municiple fire service. Not to beat a dead horse but DC was doing that prior to starting their currently incomplete merger. It is also done in parts of IL, with several private agencies "hirng out" ALS memebers.

The long and short of it is, they do not get the same pay and benefits as the Fire fighters but they are not required to have fire training and obviously do not take part in non medical activities such as rescue or suppression.

In places I have seen this in action, the medic is basically a second class employee in all respects. Both in pay and benefits, managerial support, and almost total lack of respect by the municiple firefighters.  

As opposed to a firefighter/paramedic who is assigned to a ALS transporting unit full time in the same way a person can be assigned to an engine company, truck company, etc.

If you are going to have a dual role agency, the firefighter/paramedic model with dedicated assignment seems to be a better implementation model.


----------



## TransportJockey

dave3189 said:


> Interesting article, thanks for providing it.  There are a couple glaring inconsistencies in it however.  For one, it states that the EMT-I level is the minimum nationally accepted level for ambulance care.  What planet are they from?  Second, it states that they have BLS units staffed with EMT-I personnel.  Ummm, wouldn't that make these units ILS level???



In CA EMT-1 is equal to EMT-B everywhere else. They didn't mean EMT-I as in Intermediate, just as a roman numeral 1


----------



## armywifeemt

jtpaintball70 said:


> In CA EMT-1 is equal to EMT-B everywhere else. They didn't mean EMT-I as in Intermediate, just as a roman numeral 1





Yeah. Same story in Alaska. We have EMT-I, EMT-II, and EMT-III with advanced levels for each of them that with a medical directors sign off allows them to expand their scope of practice by a few more skills. Essentially I is equivalent to basic, II is equivalent to intermediate, and III is somewhere between intermediate and paramedic. Paramedics aren't very common up here.


----------



## triemal04

Veneficus said:


> I wouldn't call it hatred, I don't hate the FD, I just don't like the spouting how they are so great at EMS but they cannot live up to their propaganda. IF you are going to say you are the best, you better be able to back it up no matter what industry you are in.
> I won't argue with that.  The service model that is used by most fire departments is better than most other types though; don't know about the best.  Unfortunately, the delivery of that service can be lacking.
> 
> From my personal perspective. Changing a unionized FD is near impossible. Changing the culture of the fire service is near impossible.
> It's not impossible, but it does take time.  Potentially a long time in some dept's.  It in no way excuses what happens, I don't mean that, but this is something that people forget when complaining about the treatment of EMS by fire depts.  Sudden changes often create varying amount of dissent, anger and confusion, more so when the system changing it has a long and tradition filled history; there will be growing pains.  This doesn't only affect the fire service either.  San Francisco is a good example of this; they went from providing very little EMS responses to suddenly providing the full range in a short amount of time, and incorporated a large number of people into the dept who didn't want to be there, and didn't have any understanding of the difference in working for a fire dept and a non-fire EMS agency.  Of course that will create problems!  Of course it won't be fixed overnight, and not in 10 years either!  Can it be fixed though?  Yes, if BOTH sides are willing to change, but if one or both aren't willing to make concessions, then no, you get what you have today.  But then, look at dept's that have always provided EMS and you may find a different story.  Unfortunately, you may not.  Of course, you can look at services that only exist to provide EMS and are horrible at it too.
> 
> Getting rid of a private service that doesn't measure up is easy. Just don't renew the contract or at contract negotiations demand certain things.
> It's not that easy; generally bids for that type of thing have to be taken, and the lowest costing one is often the private, or another one.  Add in the complete lack of public understanding of EMS, and it's even more problematic.  Lot's of time the deciding factor is who can put on ambulance on-scene the fastest and for the least money; response times matter for that kind of thing.  It's not right, but it does play a huge part in determining who covers an ASA.  Same for the demands; people have to know what to demand, and have to have the knowledge to be able to really check to see if their demands are met.  Say you want an ambulance staffed with 2 ALS providers...you might get a medic and an EMT-I which is technically allowable.
> 
> Not all privates increase the bottom line by slashing. Some actually expand their service realms as well as offer a higher level of care. But I agree a majority do slash service, equipment, etc. Like I said though, fixing a private is really easy.
> Some do, but many, many don't.  And not just privates either.
> 
> As well, fixing a poor third service is just as easy, just threaten to merge them with the FD. They will change.
> Meant as a joke or not, that's funny!


Replies in red.  When looked at objectively, fire-based EMS is a model that CAN work and work well.  It just has to be done correctly, like anything in medicine, or life.  When done wrong, it's bad, when done right, it's good.


----------



## Veneficus

triemal04 said:


> Replies in red.  When looked at objectively, fire-based EMS is a model that CAN work and work well.  It just has to be done correctly, like anything in medicine, or life.  When done wrong, it's bad, when done right, it's good.



Without a doubt. But like I said, more often than not, it is wrong. 2 out of 3 departments I served with did EMS very wrong. The evidence is even worse than my anecdote. What's worse is they have no desire to change. The real icing on the cake is when they really believe they are doing nothing wrong.


_I won't argue with that. The service model that is used by most fire departments is better than most other types though; don't know about the best. Unfortunately, the delivery of that service can be lacking._

I think that is speculation. I gave examples of third service that is done right. Particular Private services (no names here) have also done outstanding work.

I also think that the future of EMS in order remain economically viable will have to transition to a more public health type role. But whether my prediction is right or wrong, (though it is really starting to look accurate) I just don’t see the fire service embracing it. Even if they do I think it will be difficult to implement. Just as accepting EMS has been. You simply cannot be the best if you are constantly 30 years behind the times. It is also a waste of money to pay for outdated service.

_It's not impossible, but it does take time. Potentially a long time in some dept's. It in no way excuses what happens, I don't mean that, but this is something that people forget when complaining about the treatment of EMS by fire depts. Sudden changes often create varying amount of dissent, anger and confusion, more so when the system changing it has a long and tradition filled history; there will be growing pains. This doesn't only affect the fire service either. San Francisco is a good example of this; they went from providing very little EMS responses to suddenly providing the full range in a short amount of time, and incorporated a large number of people into the dept who didn't want to be there, and didn't have any understanding of the difference in working for a fire dept and a non-fire EMS agency. Of course that will create problems! Of course it won't be fixed overnight, and not in 10 years either! _

So we should pay for an accept an agency that provides what they want, not what is needed or valued by the people paying? I cannot accept that.

The problem that arises is medicine changes much faster than the FD does. As I stated above the very mission of EMS is likely and seems to be changing. If a major group of FDs are already behind the curve, where will they be in 10 years? Meeting another outdated need with a service model no longer applicable? 

_It's not that easy; generally bids for that type of thing have to be taken, and the lowest costing one is often the private, or another one. Add in the complete lack of public understanding of EMS, and it's even more problematic. Lot's of time the deciding factor is who can put on ambulance on-scene the fastest and for the least money; response times matter for that kind of thing. It's not right, but it does play a huge part in determining who covers an ASA. Same for the demands; people have to know what to demand, and have to have the knowledge to be able to really check to see if their demands are met. Say you want an ambulance staffed with 2 ALS providers...you might get a medic and an EMT-I which is technically allowable._

That is exactly why municipalities need to hire experts in the know to help negotiate the terms. The public doesn’t want to become EMS system experts. They want capable help when they call at as little cost as possible. But value also justifies cost. So if you have to spend a little more to get a lot more, people are generally accepting. Look at buying a car. If I told you the tricked out model was a couple thousand more than the stripped down version, just on raw features to price ratio most would see it is a better deal.

But hiring some of these consulting firms that actually nothing more than advocates for a specific type of service regardless of local need (I am too kind to name names here) doesn’t constitute the expert help a municipality needs.  

As well, fixing a poor third service is just as easy, just threaten to merge them with the FD. They will change.
_Meant as a joke or not, that's funny!_

Funny or not, it is the truth. When their livelihood is on the line, they will step up or move out. If they can't produce I will be leading the charge for the FD takeover. My priority is the quality of the medicine/service. My antagonist is the substandard no matter who the provider is. I am also not concerned with jobs, if you cannot provide a quality and valuable service, you find a new job.


----------



## dave3189

Without a doubt. But like I said, more often than not, it is wrong.

Veneficus,  You claim other people are using speculation... what about your comment above?  That is also speculation.  We live in a big nation.  Your particualr experiences with Fire Based EMS is not even close to being emperical evidence to support your contention.  This is especially true considering the vastly different ways that different parts of the country structure EMS


----------



## triemal04

Overall I don't see it as being an unwillingness to change, but more of an issue of change coming slowly.  Which can be a problem with medicine.  But that doesn't mean that things are the same everywhere as they were 5, 10 or 20 years ago.  Different departments have embraced EMS and have changed how they deliver it.  People focus on the large dept's that make the papers, but tend to ignore the smaller ones that don't and provide the bulk of fire-based EMS.  Hell, if EMS could actually speak with one voice and give a good, accurate, factual reason for changing things, and then follow through with it, then change would be the only option.  

There are multiple examples of each type of service providing both high and low quality care; what I meant was the way a system can be set up in a fire dept vs somewhere else.  Working for a municipality the pay/benefits are often better than elsewhere (though this often is true for third services), there is a steady source of money to support the service and it's needs, the infrastructure of the dept doesn't have to be duplicated, and because of this, the quality of applicants can be higher, and the length of time they stay in that position/dept can be longer.  Not having to be only concerned with profits but quality.  Being more answerable to the public.  I will admit that a third service can provide many of these same benefits though and is also a great model.

It's not that you need to accept the problems or that they are right; just that people need to understand why some of the problems have occurred.  Again, the fire service isn't the big bogeyman people think it is, and isn't alone in causing problems with EMS. 

I agree; whoever determines who gets a contract should be well informed.  But all to often aren't.  And while the public doesn't need to be an expert on EMS, they absolutely MUST be well enough informed to understand what is happening.  If Joe Blow doesn't know or care who runs the ambulance, then what he gets may very well be a lousy service.  But if Joe Blow knows enough about EMS to care who does it, he may start complaining to elected officials and causing a stink.  Public education is absolutely vital to the future of EMS.  If you want to pay more to get more, then it needs to be justified, and the public must be able to understand why it happens.  If all the public knows is that Service X can get an "ALS" unit there in 7 minutes, and Service Y will take 8 (but provide a better service), they'll probably choose Service X.  

That depends.  Some do step up and increase the level of service they provide.  Others don't, either because they can't, or it isn't needed.  Others can provide proof that the current system works and doesn't need to be changed.  I agree though, if you provide a service that is surpassed by someone else, then you shouldn't be doing it anymore.

See...once again this has stayed on the topic of "fire depts are bad and shouldn't be in EMS" when the topic ought to be "EMS is in a bad way and needs to change."


----------



## Veneficus

dave3189 said:


> Without a doubt. But like I said, more often than not, it is wrong.
> 
> Veneficus,  You claim other people are using speculation... what about your comment above?  That is also speculation.  We live in a big nation.  Your particualr experiences with Fire Based EMS is not even close to being emperical evidence to support your contention.  This is especially true considering the vastly different ways that different parts of the country structure EMS



you should read a few pages up where I point out the populations covered by ineffective fire service EMS.


----------



## dave3189

Not sure how you designate what is effective EMS and what is not? afterall, it isn't black and white. That being said, you still stated a generalization about Fire Based EMS that is unsupported and unfounded. I can point out some private services here on the west coast that many consider substandard EMS.  I don't apply those opinions to the whole country and make assertions about private EMS as a whole.


----------



## Veneficus

triemal04 said:


> See...once again this has stayed on the topic of "fire depts are bad and shouldn't be in EMS" when the topic ought to be "EMS is in a bad way and needs to change."



I think you misunderstand my contention. 

It is not simply fire departments are bad. You are correct, it is an EMS problem. But it doesn't change the fact that most EMS is fire based in the US. Therefore, most is all but synonomous with the fire service. If there is any hope of change, it must come from the majority. 

When many smaller departments are mentioned, I don't think the argument can hold. There are entire states full of fire departments that run EMS, even if they were the greatest in the world, their combines volumes cannot compare patient contact with the volumes of a NYC, LA, or DC. EMS is patient driven, giving population considerable significance in the equation. If suddenly there was change in standards in large departments, smaller ones would have to follow suit or they would not be providing standard of care. 

If a small department runs 20 calls a day, one of the larger ones could exceed that in 1/2 hour. Even including the volunteer departments, I just can't see the numbers adding up to the major cities.

Applying the Seattle system I also cannot possibly see the equation of a bunch of low volume departments having the provider skill of high volume ones. 

I am not trying to be mean, but does anyone suggest skill atrophy is not a factor and patient contact is not absolutely required to be proficient?

I just don't think the time frames you suggest are required to bring the fire service as a whole up to speed demonstrates anykind of value or meets the demands of providing medical care. Depending on healthcare spending reform, it may not even be viable. 

If the goal of EMS is simply transport to hospital, the expenses involved with ALS may not even be worth it. 

If the problems of EMS are to be solved, it must be embraced as medical care. Not simply a taxi for people deemed "worthy" of an emergency response.  Both the police and fire services have embraced prevention. In the coming years, medical prevention will be even more important. Fire and even crime does not take up 1/6 of the GDP. 

The measurement of quality medical care cannot be made up by the fire service, it must be measured by the same standards as the rest of medicine.

Do you see major fire departments embracing that? Do you see money for smaller ones to embrace that? 

I can think of several solutions to the problems faced, that most certainly could include the fire service. But as long as a whole the fire service resists, they will be the major obstacle which must be targeted, and they will make their service obsolete.

I agree there are departments embracing and trying to change the status quo. But until they break from the ranks of the organizations resisting the change, they will never have any momentum to push for it.

I am not nor have I suggested that private service would be the answer, nor have I suggested the answer must be third service or hospital based. 

I have identified the problem and it is the fire service's culture of resistance to change and meeting the demands of today. 

I really think the national advocates of fire service sees EMS as an add on patch or skill like hazmat or tech rescue. That mentality or culture or whatever you want to attribute it to is not conducive to medicine.

I beleive it was Columbus, Ohio that recently first put forth the idea of downgrading from ALS to only BLS only for economic savings. That proposal should be a wakeup call for every fire department in the country. But instead of demonstrating the value of ALS, they just tried the usual scare tactics, while it may seem like a viable short term solution. It seriously damages the good will given to the fire service and could really haunt it later on.

I'd be more than happyy to try and help the fire service, but like a patient, you can't help those who don't want it.


----------



## Veneficus

dave3189 said:


> Not sure how you designate what is effective EMS and what is not? afterall, it isn't black and white..



It is very black and white. The purpose of medicine is to maintain producers in society. If you spend more than you save, you might as well do nothing. Medicine is not some ideological altruistic money losing endevor. 

If you are turning people away, cannot keep up with volume of requests for help and appropriately and cost effectively manage these requests, then your agency is a weak link in the health care system. That makes it ineffective.

There is some old school thinking that EMS is life saving measures during an acute emergency and transport to "definitive care." But is definitive care the hospital ED? Clearly not in all cases. Have the major EMS agencies (which are all fire based) made measurable advances in better disposition of patients?

If you claim to embrace EBM, look at all the studies on the effectiveness of morbidity and mortality of prehospital ALS. With the exception of Washington State, the numbers are quite grim. So by even the "old measure of EMS" it is a failure. The only measure which is globablly successful among fire based EMS is response time. Which a growing body of evidence shows as inconsequential. 

So if a practice is continued inspite of evidence it doesn't positively affect outcome, the practice is ineffective. 

It is not the only weak link. But it must be part of the solution.






dave3189 said:


> That being said, you still stated a generalization about Fire Based EMS that is unsupported and unfounded. I can point out some private services here on the west coast that many consider substandard EMS.  I don't apply those opinions to the whole country and make assertions about private EMS as a whole.



But my generalizations are based on the population centers of the United States. 

I never argued that private EMS wasn't largely substandard. Infact by the same measures it is. Nor did I state any other model was superior. But if the fire service advocates are going to state they are better, then they will have to demonstrate that. All I have seen out of anywhere but washington state is piss and wind. 

Again my contention is that US EMS is ineffective by the measurements of medical care. If EMS of anytype thinks it can come up with its own standards of measuring its medical care it becomes nothing more than a selfserving, glorified, over priced taxi.

If you think my observations of fire based EMS are unfair, you could call up some union brothers, or go to some conventions and push for them to get with the program Washington champions. By all the measures listed it is a superior system.


----------



## EMTzimp

I took my EMT class in Mission Viejo, CA.  Link 2 Life Emergency Training.

Website.... Link2Life.org

Class was 14 days in a row 10-12 hours a day. 

No math involved at all.

Good Luck!


----------



## MrBrown

It's not so much an issue of quick patch mills it's more an issue of the Fire Service being pro-EMS when it suits them because it increases thier budgets and keeps the mayor off thier back about the ring of chairs around the telly but seem to be anti-EMS when it comes to providing the service.

The IAFC EMS Section and the IAFF actively sought to keep down the amount of education required in the National EMS Education Agenda and to remove the need for Paramedic programs to be accredited through a College or University.  They also use out dated evidence which is no longer valid to support thier agenda and use very deceptive marketing to promote Fire based EMS.

To the Fire Service it very much seems that there is nothing wrong with the horrendously inadequate education that passes muster in the US.

So, how do we know I am not talking out my arse, why lets go to the horses mouth! *neigh

FROM THE IAFF AND THE IAFC THEMSELVES .... (with sources so you can CHECK I am not, unlike the first statement, making up lies)




> It is no surprise that study after study has shown that fire department-based prehospital emergency medical care systems are superior to other provider types.
> 
> Source



And yet, I am unable to find any evidence of this nor do they site any reference for such studies.



> _IAFF (Emergency Medical Services: A guidebook for fire-based EMS Systems)_
> 
> The “Golden Hour” describes the precious time period from time of injury through location and transportation to definitive care of a
> critically injured trauma patient to minimize death and permanent disability
> 
> Source



UBER FAIL, the IAFF is selling a nicely packed idea which has no evidence to support it and has been flamed by the medical community as being about as relevant as ham soup to promote its product




> _IAFF (Emergency Medical Services: A guidebook for fire-based EMS Systems)_
> 
> Fire fighters not only respond more rapidly than their single-role EMS counterparts, but are also more effective in terms of patient outcomes (Braun 1990).
> 
> Source



I notice the IAFF convienently left out the full APA source for that study; after extensive Googling it appears this study published TWENTY YEARS AGO looked at single third service EMS survival from cardiac arrest vs. Firefighters with AEDs in a first response cabability.

MEGA UBER FAIL; what a bunch of retards, of course ANYBODY showing up with an AED is going to improve survival rates. Without considering the context or timing of this research, the IAFF uses it to promote itself as being superior, FAIL!



> _IAFC EMS Section_
> 
> One of the biggest concerns fire service-based paramedic programs were concerned with was the apparent mandatory need to be affiliated with or sponsored by a college or university and that previous standards didn’t allow fire departments or fire/EMS academies to be considered in this process.
> 
> http://www.iafc.org/displayindustryarticle.cfm?articlenbr=40545



Why is the IAFC against have to have Paramedic programs affiliated with a college? Why do they want to continue the back room training of ambo's by ambo's?



> _IAFC EMS Section_
> 
> ...[The IAFC EMS Section] question... whether the increase in knowledge gained through the draft [National EMS Education Standards] will have a real effect on the actual field practice
> 
> Source



OMG how retarded do you have to be to get onto the IAFC EMS Section? Are they SERIOUS????? 



> _IAFC EMS Section_
> 
> The IAFC EMS Section would like to see substantiation on why there is an increase in training hours
> 
> Source



Maybe because the United States has the lowest standards in the developed world which still count "hours of training" and were written in 1994, 1985/1999 and 1998 (EMT-Basic, Intermediate/85, Intermediate/99 and Paramedic respectively)?

But as said in #2, the IAFC obviously cannot understand the difference between KNOWLEDGE and SKILL because they are retards and a couple hundered hours of skills based training seems to be adequate for them.




> _IAFC EMS Section_
> 
> The IAFC EMS Section...is concerned that the general move toward college-based courses, the increase in hours and resulting financial impact will adversely affect departments’ ability...to meet the goals of the standards
> 
> Will the increase in education standards further impact the pool of people who can complete the requirements?
> 
> Source



Then by all means, lets WATER DOWN THE STANDARD so a bunch of firefighters can meet it and it won't cost the fire daprtment too much lord knows we can't have that, that's a wonderful idea, never mind the fact that it might further deprofessionalise EMS and negatively effect patient care; but the IAFC doesn't seem to think that is important; see #2

If you can't meet the standard, maybe you should not be in the game? But of course the fire department can't have that now can they?




> _IAFC EMS Section_
> 
> With respect to CoAEMSP certification for paramedics under “Educational Infrastructure,” the education standards should also include certification via fire service academies accredited at the state level. Many states have “Technical/Vocational” schools that are not colleges/universities but provide a great deal of the EMS education. Many fire academies have excellent education and highly qualified training staff but would not qualify if the requirement was held to a college or university setting.
> 
> Source



Again, how retarded and arse-backward do the IAFC EMS Section have to be? They are supporting the old tech school medic courses which elsewhere in the world have not existed for at least a decade. As for the staff, oh yes LETS CONTINUE TO WATER STANDARDS DOWN so a bunch of minimally educated fire service or tech mill paramedic instructors don't have to get a REAL EDUCATION and know WTF they are on about.

I guess it's acceptable to keep teaching smokeys about "Sidney Sinus", that CPAP "pushes lung water" and so on and so forth because that is what they learnt. 

Never mind that in the UK, Australia and New Zealand all college Paramedic instructors have a Masters Degree or above.

Contrast the clinical competence and knowledge of one of our Intensive Care Paramedics who has a Post Graduate qualification, has to submit evidence of at least 40 hours of CCE per year and undertake re-validation in each skill every two years to one of the "Firefighter/Paramedics" who might intubate one patient a year because they ride on a non transporting "ALS Engine".

If Fire/EMS works so well why have both the New Zealand Fire Service Commission and the Professional Firefighters Union fought so hard to stay away from doing any medical calls stating it is not in the best interest of either profession?

I am so disheartened and outraged.


----------



## Veneficus

MrBrown said:


> It's not so much an issue of quick patch mills it's more an issue of the Fire Service being pro-EMS when it suits them because it increases thier budgets and keeps the mayor off thier back about the ring of chairs around the telly but seem to be anti-EMS when it comes to providing the service.
> 
> The IAFC EMS Section and the IAFF actively sought to keep down the amount of education required in the National EMS Education Agenda and to remove the need for Paramedic programs to be accredited through a College or University.  They also use out dated evidence which is no longer valid to support thier agenda and use very deceptive marketing to promote Fire based EMS.
> 
> To the Fire Service it very much seems that there is nothing wrong with the horrendously inadequate education that passes muster in the US.
> 
> So, how do we know I am not talking out my arse, why lets go to the horses mouth! *neigh
> 
> FROM THE IAFF AND THE IAFC THEMSELVES .... (with sources so you can CHECK I am not, unlike the first statement, making up lies)
> 
> 
> 
> 
> And yet, I am unable to find any evidence of this nor do they site any reference for such studies.
> 
> 
> 
> UBER FAIL, the IAFF is selling a nicely packed idea which has no evidence to support it and has been flamed by the medical community as being about as relevant as ham soup to promote its product
> 
> 
> 
> 
> I notice the IAFF convienently left out the full APA source for that study; after extensive Googling it appears this study published TWENTY YEARS AGO looked at single third service EMS survival from cardiac arrest vs. Firefighters with AEDs in a first response cabability.
> 
> MEGA UBER FAIL; what a bunch of retards, of course ANYBODY showing up with an AED is going to improve survival rates. Without considering the context or timing of this research, the IAFF uses it to promote itself as being superior, FAIL!
> 
> 
> 
> Why is the IAFC against have to have Paramedic programs affiliated with a college? Why do they want to continue the back room training of ambo's by ambo's?
> 
> 
> 
> OMG how retarded do you have to be to get onto the IAFC EMS Section? Are they SERIOUS?????
> 
> 
> 
> Maybe because the United States has the lowest standards in the developed world which still count "hours of training" and were written in 1994, 1985/1999 and 1998 (EMT-Basic, Intermediate/85, Intermediate/99 and Paramedic respectively)?
> 
> But as said in #2, the IAFC obviously cannot understand the difference between KNOWLEDGE and SKILL because they are retards and a couple hundered hours of skills based training seems to be adequate for them.
> 
> 
> 
> 
> Then by all means, lets WATER DOWN THE STANDARD so a bunch of firefighters can meet it and it won't cost the fire daprtment too much lord knows we can't have that, that's a wonderful idea, never mind the fact that it might further deprofessionalise EMS and negatively effect patient care; but the IAFC doesn't seem to think that is important; see #2
> 
> If you can't meet the standard, maybe you should not be in the game? But of course the fire department can't have that now can they?
> 
> 
> 
> 
> Again, how retarded and arse-backward do the IAFC EMS Section have to be? They are supporting the old tech school medic courses which elsewhere in the world have not existed for at least a decade. As for the staff, oh yes LETS CONTINUE TO WATER STANDARDS DOWN so a bunch of minimally educated fire service or tech mill paramedic instructors don't have to get a REAL EDUCATION and know WTF they are on about.
> 
> I guess it's acceptable to keep teaching smokeys about "Sidney Sinus", that CPAP "pushes lung water" and so on and so forth because that is what they learnt.
> 
> Never mind that in the UK, Australia and New Zealand all college Paramedic instructors have a Masters Degree or above.
> 
> Contrast the clinical competence and knowledge of one of our Intensive Care Paramedics who has a Post Graduate qualification, has to submit evidence of at least 40 hours of CCE per year and undertake re-validation in each skill every two years to one of the "Firefighter/Paramedics" who might intubate one patient a year because they ride on a non transporting "ALS Engine".
> 
> If Fire/EMS works so well why have both the New Zealand Fire Service Commission and the Professional Firefighters Union fought so hard to stay away from doing any medical calls stating it is not in the best interest of either profession?
> 
> I am so disheartened and outraged.



I would just like to add the National Fire Academy is not accredited either. 

Other than that, I would like to adopt Brown.


----------



## MrBrown

Veneficus said:


> ...Other than that, I would like to adopt Brown.



Momma will be so proud


----------



## Radioactive

Maybe this thread will come back around.  I can see the merit in all of the arguments here.  There are good points being made about the ongoing issues, but the constant conflict puts some of us in the middle.  

In my area, there are 2 semi-large private ambulance companies and the FD.  I call them private ambulance companies because they own and operate ambulances, but what they really are is non-emergent transport companies.  For actual emergency care, there only seems to be 2 options, Local ED or FD.  

I might come off as a bit of a wacker here, but I'm not getting in to the game to practice *non*-emergency medicine.  I already did that for a decade.  I'm tired of hospitals, so that leaves me with FD.  I find this unfortunate, but not horrible, mostly because I will need to be a firefighter before I can become a actual emergency medical provider.  I agree that I think my skills as a firefighter will suffer due to my lesser interest in that subject (although I am interested in the fire industry.)  I do plan on becoming a Paramedic, and my goal is to actually provide emergency care as opposed to collecting urine samples in an ED.

For those of us not blessed with the circumstance to be involved in a purely EMS service, how can we better function in the role of a FD Paramedic?


----------



## Veneficus

Radioactive said:


> I might come off as a bit of a wacker here, but I'm not getting in to the game to practice *non*-emergency medicine.  I already did that for a decade.  I'm tired of hospitals, so that leaves me with FD.?



I think you may be sorely dissapointed if you think "emergency medicine" is exciting. Even in the busiest trauma centers and biggest emergency departments. It is hours and hours of caring for non emergent patients punctuated by the occasional emergency. Some days you have a run and get a few good ones. But even if one comes in, you may not be assigned to be a provider for them. 

EMS is exactly the same. Easily more than 90% of the patients you see will be people who think they have an "emergency" but would be better served by other areas of healthcare or social services.

as I mentioned earlier, EMS is trending towards less "emergent" and more preventative or primary care both formally and in patient value. 




Radioactive said:


> For those of us not blessed with the circumstance to be involved in a purely EMS service, how can we better function in the role of a FD Paramedic?



Move. just kidding 

The best thing to do is first to get done what you need. You can become a firefighter in around 240 hours. Unless you work for a dept. that sees a lot of fire regularly, you disinterest will not make you any less capable than the skill atrophy of your peers. It helps to get to at least operation level hazmat and I very much enjoy technical rescue work because you are always rescuing a patient.

If you are working in a department that doesn't see or accept EMS as the primary mission, everytime you break from the routine or look deeper you will be met with resentment. You will be reminded it is not a hospital, you just treat signs and symptoms, or that you outright suck. If you persevere through this 5 or so years you will generally find acceptance and just labeled as "quirky." After a very long time (a decade or more) you will probably be recognized as a the department EMS Guru and you will be celebrated. (unless you become the EMS officer or some other form of QA, then no matter what you do you "will not get it")

If the department does value its EMS duties, you will probably enjoy it very much and find many like minded and highly capable people.

It has been my experience that many capable providers find EMS (especially rigid fire based systems) too limiting and choose to move on or are strongly encouraged to. There is much written on the brain drain in EMS. I was told several times firefighting (largely by firefighters) it is not a job for the very smart or the ambitious. There are many former firefighters in medicine, especially in leadership positions I have noticed. 

If you want, PM and I can be more specfic.


----------



## Radioactive

Veneficus said:


> I think you may be sorely dissapointed if you think "emergency medicine" is exciting. Even in the busiest trauma centers and biggest emergency departments. It is hours and hours of caring for non emergent patients punctuated by the occasional emergency. Some days you have a run and get a few good ones. But even if one comes in, you may not be assigned to be a provider for them.



I actually have worked primarily in the ED as a radiographer, and did so for quite a while.  I am familiar with the day-to-day there and I am under no delusion that EMS will be super-fast and exciting.  Its not the pace or the excitement, but the content, that interests me.  



Veneficus said:


> If the department does value its EMS duties, you will probably enjoy it very much and find many like minded and highly capable people.
> 
> It has been my experience that many capable providers find EMS (especially rigid fire based systems) too limiting and choose to move on or are strongly encouraged to. There is much written on the brain drain in EMS. I was told several times firefighting (largely by firefighters) it is not a job for the very smart or the ambitious. There are many former firefighters in medicine, especially in leadership positions I have noticed.


All I can do is hope that I find like-minded folks.  The drain is something that I am fairly worried about.  I think of myself as fairly smart, but not terribly ambitious.  All I ever wanted for my life is a career that I could be proud of and know that I am making a difference.  But honestly, I'm still getting way ahead of myself.  I haven't even finished mt EMT-B yet.


----------



## triemal04

Veneficus said:


> <snip>It is not simply fire departments are bad. You are correct, it is an EMS problem. But it doesn't change the fact that most EMS is fire based in the US. Therefore, most is all but synonomous with the fire service. If there is any hope of change, it must come from the majority.
> I don't know that it is.  If you consider non-transporting units, then yes you're right.  But in reality, those are the places that have (should have I suppose) the least impact on the future/current state of EMS.  This comes down to, again, a lack of public education, and a lack of a cohesive EMS voice.  If the public understood EMS, less credibility would be applied to the fire dept that has 4 medics on a unit but only provides 2 minutes of pt care.  And with a cohesive EMS voice, that info could be gotten to the public.
> 
> When many smaller departments are mentioned, I don't think the argument can hold. There are entire states full of fire departments that run EMS, even if they were the greatest in the world, their combines volumes cannot compare patient contact with the volumes of a NYC, LA, or DC. EMS is patient driven, giving population considerable significance in the equation. *If suddenly there was change in standards in large departments, smaller ones would have to follow suit or they would not be providing standard of care.*
> If all you focus on are numbers of pt's treated, I'd bet that more pt's are treated/transported by non-fire EMS than by fire depts, so that would mean that non-fire EMS should have the most impact and responsibility for the current state of affairs.  Yes, those areas do make it into the news which doesn't help the image of EMS, but beyond that, what impact do they really have?  If the bolded were true, then everyone would be modeling their system of those places you mentioned.  Thankfully, this isn't the case.  False argument, sorry.  While it doesn't help public perception, the practices followed aren't trickling down; change is still coming from the bottom up more than anything.
> 
> <snip>
> 
> Applying the Seattle system I also cannot possibly see the equation of a bunch of low volume departments having the provider skill of high volume ones.
> Depends.  I agree, without experience performing your job you will never reach the same level you would if you did it daily.  But that doesn't change the fact that, lower call-volume or not, fire dept's are providing similar types and levels of service as the King Co Medic 1 system (not quite that high though).  Numbers don't account for everything; you ought to know that.
> 
> I am not trying to be mean, but does anyone suggest skill atrophy is not a factor and patient contact is not absolutely required to be proficient?
> Oh god no.  It's a very real thing.  Hence why having 4 medics on a non-transporting unit is asinine.  This is one of the area's that some (not all) fire dept's fail at; more is not always better.
> 
> I just don't think the time frames you suggest are required to bring the fire service as a whole up to speed demonstrates any kind of value or meets the demands of providing medical care. Depending on healthcare spending reform, it may not even be viable.
> I wish it wasn't so, but, it is a real thing.  And it doesn't affect only fire depts; if you've been around long enough, can you remember back to when ER doc's started to intubate on a regular basis?  I've heard about the huge backlash from anesthesiologists, and that is STILL an ongoing problem in some areas, though not as bad.  My point being, there will almost always be a lag time in ALL services and businesses when change occurs, especially if it's a dramatic one.  Nobody change effectively change overnight, and, if you'll notice, as I said before, it's often the more tradition-bound dept's that have the hardest time changing, but they also don't have a lot of effect on the overall state of EMS.
> 
> <snip>
> 
> If the problems of EMS are to be solved, it must be embraced as medical care. Not simply a taxi for people deemed "worthy" of an emergency response.  Both the police and fire services have embraced prevention. In the coming years, medical prevention will be even more important. Fire and even crime does not take up 1/6 of the GDP.
> I concur.  Hopefully this is the direction EMS moves in.  And, hopefully as that happens, and the education increases, you will start to see a decrease in the number of transporting fire depts.
> 
> The measurement of quality medical care cannot be made up by the fire service, it must be measured by the same standards as the rest of medicine.
> It isn't just the fire service; don't start believing the bogeyman theory.  All EMS is judged differently than the rest of medicine.  And all of EMS is at fault for that happening.
> 
> Do you see major fire departments embracing that? Do you see money for smaller ones to embrace that?
> Possible.  Like with good/bad care, that would come down to a case by case issue; some might be able to do it, and some won't.
> 
> I can think of several solutions to the problems faced, that most certainly could include the fire service. But as long as a whole the fire service resists, they will be the major obstacle which must be targeted, and they will make their service obsolete.
> As a whole the fire service isn't resisting; that's what you aren't understanding.  Some areas don't do EMS well and resist change, but then, so do other service models.  Some national org's write position papers, but those org's don't enforce policy for the depts in this country.  While they can affect national policy, they don't affect what each dept does, and really...where is the response from the rest of EMS?  If the policy changes are so wrong, it should be easy to refute.  But that doesn't seem to be happening.  Blame fire, sure, but blame the rest of us as well.  As things change it won't just be fire depts that have trouble adapting.
> 
> <snip>
> 
> I have identified the problem and it is the fire service's culture of resistance to change and meeting the demands of today.
> It's not just the fire dept's resistance to change though, you don't seem to be seeing that.  While part of the problem, the fire service is not the root cause or the deciding factor.
> 
> I really think the national advocates of fire service sees EMS as an add on patch or skill like hazmat or tech rescue. That mentality or culture or whatever you want to attribute it to is not conducive to medicine.
> It's not, but as I said, they don't set policy.  And where are the people to speak up and point out that what they say is wrong?
> 
> <snip>
> 
> I'd be more than happyy to try and help the fire service, but like a patient, you can't help those who don't want it.


Don't mistake what some places do for what all do or want.  Don't think that what the IAFC and IAFF national offices say is what is happening, or what depts want.  Don't think that other service models wouldn't be adversely affected by change and may not be as strong proponents as some would think.

You say the fire service as a whole provides substandard care?  Can you prove that?  Can you prove that some other service as a whole provides good care?  And if you can, then why isn't it being shared publically?  Prove what is good and what is required of EMS, make it so crystal clear that nobody can come up with a reason to not do it, and then you'll start to see change.  But...who's doing that again?  Who's educating the public?  Who's speaking for EMS?  Oh yeah...nobody.

If you want to see change, you need to show why it must happen.


----------



## triemal04

I see poor brown subscribes to the bogeyman theory; the fire service is evil!  Everything that is wrong with EMS is their fault!  If they didn't exist EMS would be perfect!  They are the only ones holding EMS back!  :censored::censored::censored::censored:e.  That belief of course disregards almost all facts, the current state and the history of American EMS.  

I also can't help that brown will complain about the fire dept using dated evidence, and yet does the same thing with several of his links.  The stink of hypocrisy is rising again...  Oh well.  Let's look at those things again.

"It is no surprise that study after study has shown that fire department-based prehospital emergency medical care systems are superior to other provider types."  No self-respecting devil's advocate or anyone with a brain could help but wonder, where is the study that shows the fire service is inferior when it comes to EMS?  Not anecdotal evidence, or evidence gleaned from 1 or 2 depts, but as a whole?

"The “Golden Hour” describes the precious time period from time of injury through location and transportation to definitive care of a critically injured trauma patient to minimize death and permanent disability"  That actually is what the concept of the golden hour is.  It has nothing to do with time per se, and I don't believe that's how it was referrenced by the IAFF.

"Fire fighters not only respond more rapidly than their single-role EMS counterparts, but are also more effective in terms of patient outcomes (Braun 1990)."  So...where is your actual proof to refute this and show that it's not true.  Do you have anything, or is this just ranting and raving?  If you want to argue that something is wrong, you had best be able to show why it is, not just complain and rave.  

"One of the biggest concerns fire service-based paramedic programs were concerned with was the apparent mandatory need to be affiliated with or sponsored by a college or university and that previous standards didn’t allow fire departments or fire/EMS academies to be considered in this process."  Ok, that's pretty dumb.  Nevermind.

"...[The IAFC EMS Section] question... whether the increase in knowledge gained through the draft [National EMS Education Standards] will have a real effect on the actual field practice"  Will it?  That is actually still an unknown at this time and a valid question.  The change in paramedic level education is pretty small all things considered.  How much impact will this actually have?  As steps forward go, it's a small one.  Future steps may change things more, but this doesn't do a lot.  

"With respect to CoAEMSP certification for paramedics under “Educational Infrastructure,” the education standards should also include certification via fire service academies accredited at the state level. Many states have “Technical/Vocational” schools that are not colleges/universities but provide a great deal of the EMS education. Many fire academies have excellent education and highly qualified training staff but would not qualify if the requirement was held to a college or university setting."  It's actually a valid question.  If a school meets all the requirements of CoAEMSP except for being associated with a college and provides all the education required by the new standards, should they be denied?  For what reason?  Of course, followers of the bogeyman theory will of course assume that all schools where firefighters are taught have Bubba as the head of the program.  Sad.  People who have a real understanding of the challenges facing EMS here will already know that there are a huge number of crappy so-called schools that aren't associated with any fire dept.  It's not exactly a problem that affects only one group.

Which leads me to a burning question I have.  Not to get personal mrbrown, but why is it that, when discussing American EMS, you are only able to reference or discuss things that other people have brought up?  You can't seem to have an original thought on this issue, but parrot what you hear on...an internet forum.  An anonymous one at that.  What's the reason?  Inquiring minds want to know.  You've said you do know about EMS here, and yet, all you can talk about is what someone else talks about first.

**I don't agree with just about everything that's quoted in this post, but there are some...inconsistencies in how brown interprets them.  If you actually know what you are talking about, it's much easier to have an informed discussion, versus freaking out with only a bit of the needed info.**


----------



## MrBrown

triemal04 said:


> I see poor brown subscribes to the bogeyman theory; the fire service is evil!  Everything that is wrong with EMS is their fault!  If they didn't exist EMS would be perfect!  They are the only ones holding EMS back!  :censored::censored::censored::censored:e.  That belief of course disregards almost all facts, the current state and the history of American EMS.



As I have said elsehwere, the Fire Service is not the root cause of the problem but they but one of the factors.  They may infact be one of the larger ones given the strength of the Fire Union's promotional power.

How does it disregard any facts about the history of EMS in the USA?

In the late 1960s Dr Eugene Nagel wanted to get out-of-hospital defibrillation for cardiac arrest in Miami.  When he is interviewd in "Making a Difference: The History of Modern EMS" he states it was out of convienence more than anything to use the Fire Department because they were in the streets, had radios and a network of vehicles and a disclipine; all he had to do was teach them some medical skills.

Cobb and Cohen in Seattle/King County turned to the Seattle Fire Department to create Medic One in 1969.

It was in 1970 that Los Angeles County wanted to get a Paramedic system running but the locals complained bitterly about any sort of taxation to fund it because they were already overtaxed at the local level.  The Los Angeles County Fire Department figured they had a lot of spare capacity because they only spend a couple of percent of thier time fighting fires and doing prevention work and could run EMS.

Then if we look at Los Angeles City they had single-role civillian Paramedics up until 1992.  



triemal04 said:


> I also can't help that brown will complain about the fire dept using dated evidence, and yet does the same thing with several of his links.  The stink of hypocrisy is rising again...  Oh well.  Let's look at those things again.



You're missing the point.  One or two of the documents might be a few years old (and I agree they are) however one must consider that these documents come from the IAFC EMS Section and the IAFF websites so should represent that which is current.

The other point is that the evidence (studies) the IAFC EMS Section use are very old (one is from 1990) and they are no longer clinically relevant evidence because a lot has changed since 1990 which makes the particular study in question void.

In 1990 EMT-Ambulance (EMT-Basic) could not use an AED nor where they widely avaliable (PAD/BLS with AED) and the study looked at arrival times and ROSC in cardiac arrest for those treated by civillian EMS vs Fire based EMS.

We all know anybody with an AED who rolls up be it the Fire Service, Jack Armstrong the All American Boy or the cops is probably going to have a positive impact upon rate of ROSC.  I think its common knowledge cardiac arrest survival rates don't go on ROSC they go on neurologically intact people who walk out of hospital post community arrest; the Fire Service however chose not to use that proper marker of effectiveness for whatever reason; probably so they could get higher numbers and make themselves look better.

You will notice the Fire Service are very deceptive and refer to that study as proving that they offer superior patient care; they do not state in what context i.e. ROSC from cardiac arrest given fire-service AED first responder programs in 1990.  Therefore, it is very misleading.



triemal04 said:


> "It is no surprise that study after study has shown that fire department-based prehospital emergency medical care systems are superior to other provider types."  No self-respecting devil's advocate or anyone with a brain could help but wonder, where is the study that shows the fire service is inferior when it comes to EMS?  Not anecdotal evidence, or evidence gleaned from 1 or 2 depts, but as a whole?



The USA Today published a rather large article a few years back which showed cardiac arrest survival rates for 50 large American cities that presented data.  With the exception of Seattle, the lowest numbers were Fire Department based EMS cities.

The recent intubation studies that come out of Miami show horrendously low succes rates, and they are, a Fire based EMS system.

I see what you are saying, but, turn that around and say the same thing to the IAFF, where is thier evidence? 



triemal04 said:


> "The “Golden Hour” describes the precious time period from time of injury through location and transportation to definitive care of a critically injured trauma patient to minimize death and permanent disability"  That actually is what the concept of the golden hour is.  It has nothing to do with time per se, and I don't believe that's how it was referrenced by the IAFF.



No of course not, thats why they use the word "time" in there and why it is called, the "golden hour"!

The point is the golden hour has been proven to have no basis in evidence (Bryan Bledsoe did a good presentation on it a few years back plus there have been several studies that say it has no real relevance) and be a myth without any solid foundation.

It is just another example of deceptive marketing by the IAFF to promote Fire Based EMS; oh we can get there quicker and stop the golden hour clock. 



triemal04 said:


> "Fire fighters not only respond more rapidly than their single-role EMS counterparts, but are also more effective in terms of patient outcomes (Braun 1990)."  So...where is your actual proof to refute this and show that it's not true.  Do you have anything, or is this just ranting and raving?  If you want to argue that something is wrong, you had best be able to show why it is, not just complain and rave.



It was horrendously difficult to find this paper, there are some obscure references to it around the internet but I cannot find the actual article itself.  

Notice the IAFF again left out the full APA reference for that study? I am not saying it was deliberate but sure is highly convienent.




triemal04 said:


> "...[The IAFC EMS Section] question... whether the increase in knowledge gained through the draft [National EMS Education Standards] will have a real effect on the actual field practice"  Will it?  That is actually still an unknown at this time and a valid question.  The change in paramedic level education is pretty small all things considered.  How much impact will this actually have?  As steps forward go, it's a small one.  Future steps may change things more, but this doesn't do a lot.



The problem is that the Standards affect all levels of practice and many fire departments use Basic and Intermediate EMTs on thier staff.  So it's a bit niave to say it only affects Paramedic level care.

I can sort of see where you are coming from in that at the end of the day the system only has two outputs (transport or get a refusal) and that an increase in knowledge will not change that (specifically as a result of the changes in that document).

It is however very disturbing that the Fire Unions are questioning the need for an increase in knowledge given that the US standards are some of, if not the, lowest in the developed world.




triemal04 said:


> "With respect to CoAEMSP certification for paramedics under “Educational Infrastructure,” the education standards should also include certification via fire service academies accredited at the state level. Many states have “Technical/Vocational” schools that are not colleges/universities but provide a great deal of the EMS education. Many fire academies have excellent education and highly qualified training staff but would not qualify if the requirement was held to a college or university setting."  It's actually a valid question.  If a school meets all the requirements of CoAEMSP except for being associated with a college and provides all the education required by the new standards, should they be denied?  For what reason?  Of course, followers of the bogeyman theory will of course assume that all schools where firefighters are taught have Bubba as the head of the program.  Sad.  People who have a real understanding of the challenges facing EMS here will already know that there are a huge number of crappy so-called schools that aren't associated with any fire dept.  It's not exactly a problem that affects only one group.



It's true and I fully agree not every crappy medic patch factory for warm pulses is associated with the Fire Service; I have never said that.

We all know the Instructor certifications are again woefully inadeuqate in the US and that many are simply teaching what they were taught because they have no greater understanding of the material than when they were taught it.

To affiliate programs with a College or University system would demand higher level qualifications for Instructors and weed out those who are simply regurgitating from thier own knowledge or the PowerPoint slides.

Paramedicine faculty here in New Zealand, in Australia, the UK and Europe have Masters Degrees or higher and Paramedic education is part of the University system.

If the vocational education system works so well then why have other developed nations removed it and insisted every Paramedic go to University?

What original idea or concept would you like me to come up with?  I don't forsee anything I could think up that has not been thought up before by somebody else because they recognise the same problems as I do.


----------



## Veneficus

http://www.youtube.com/watch?v=xl-rO6RGVCk

http://www.youtube.com/watch?v=kEpcMyM8_0c&feature=related

http://www.youtube.com/watch?v=ad80GcWSJC0&feature=related

To use language from the video, they have a standing army, deployed in every community. 

I seriously think you underestimate the political capabilities of such an organization. Particularly when used to protect their won interests. 

http://www.iaff.org/About/About.htm

http://www.iaff.org/politics/Firepac/what.html

I challenge anyone to find any labor union that has any interest but its own continuation at heart.

If your fire service or members reject the IAFF or IAFC positions, perhaps you should stop being a member and publically distancing your department and persons from their positions. (I won't hold my breath)


----------



## triemal04

MrBrown said:


> The USA Today published a rather large article a few years back which showed cardiac arrest survival rates for 50 large American cities that presented data.  With the exception of Seattle, the lowest numbers were Fire Department based EMS cities.


Are you freakin' serious!?  Tell me that was a joke and you are smarter than that.  (you are talking about this, right:  http://www.usatoday.com/news/nation/ems-day1-seattle.htm  If not then my apolgies, and you can ignore what I'm about to say)  That was essentially a poll of the 50 largest cities on how their cardiac arrest survival rates where based on the Utstein Criteria for pt's in vfib/vtach.  Only 26 responded, and only 14 were able to give the info they wanted, and 12 more were able to give a bit more info, but it's unclear if those 12 were counting all codes or just those in vfib/vtach, and if they were counting any ROSC pt who made it to the hospital as a save.  It's also unclear where the paper came up with the survival rate percentage; they estimated the number of people in vfib/vtach based on averages, and it's unknown if the respondents gave them a number of "saves" or a percentage.  Add in that the services at the top were fire depts as well and....sad.  Dear god...why would you even think to bring that up?  Not to mention that basing how good a system is based on cardiac arrest rates is probably the worst way to go about doing it.



> The recent intubation studies that come out of Miami show horrendously low succes rates, and they are, a Fire based EMS system.


http://www.ncbi.nlm.nih.gov/pubmed/15855946?dopt=AbstractPlus  Is that what you're talking about?  It's from Orlando, but all I could think of.  And it includes multiple types of services, not just fire-based.  Try again.  (if that's not what you were talking about then my apologies, and if you wouldn't mind posting a link to it that'd be appreciated)  While you are at it, can you show something that shows that all fire-based EMS is bad?  Because neither of those two items do that.  The same type of thing can be found for every type of service out there, but it doesn't prove that one type is inherently less good than another.  I mean, if you want to judge an entire service model on 1 or 2 areas, then be my guest, just realize how ridiculous that is, and do it for EVERYONE.  



> I see what you are saying, but, turn that around and say the same thing to the IAFF, where is thier evidence?


Not a clue.  Where is your evidence that they are wrong?  I mean, you wouldn't believe something unless there was some evidence behind it, right? 



> No of course not, thats why they use the word "time" in there and why it is called, the "golden hour"!


Yeah...my bad.  I wrote that in a hurry.  What I meant was that it has nothing to do with it being an hour, just that the theory of there being a time limit between when the injury happens and when definative care is needed is still accurate; what has been debunked is the part about it being an hour long.  Should be called the "golden time" as it can range from a couple minutes to a couple days.



> It was horrendously difficult to find this paper, there are some obscure references to it around the internet but I cannot find the actual article itself.
> 
> Notice the IAFF again left out the full APA reference for that study? I am not saying it was deliberate but sure is highly convienent.


Again I'll ask:  where is your proof that this isn't accurate?  You are making a lot of claims but showing very little in the way of real evidence.  You are all for evidence based medicine and decison making, right?  Perhaps you need to follow through in this situation.



> The problem is that the Standards affect all levels of practice and many fire departments use Basic and Intermediate EMTs on thier staff.  So it's a bit niave to say it only affects Paramedic level care.


It really doesn't.  You need to actually go look at what the changes will be before you try and discuss this.  This is less a change in education levels than it is a standardization process.  There is some increase to be sure, but across the board it's very small.  And many non-fire EMS services use non-paramedics too; what's your point?  Paramedics will be having the greatest impact on what happens to pt's, so a large part of the focus should be on what their education level is.  Not to mention that much of the changes do affect paramedics...



> It is however very disturbing that the Fire Unions are questioning the need for an increase in knowledge given that the US standards are some of, if not the, lowest in the developed world.


Again, do you really think that the minimal changes made will affect pt care?  Go look at what will change.  It is a valid question, right or wrong.



> To affiliate programs with a College or University system would demand higher level qualifications for Instructors and weed out those who are simply regurgitating from thier own knowledge or the PowerPoint slides.


Thanks, you are just helping to prove that you don't know much about EMS here.  Simply being associated with a college (which is all that is required; doesn't have to be part of a college) does not gaurentee that the quality of the instructors will go up.  There are very few places that require the instructors of college-based EMS programs to hold Master's or above; some don't even require a BA.  And, guess what, CoAEMSP does not judge schools on the quality of thier programs; just on if they meet certain requirements.  So, I'll ask the question again:  if a school meets all the requirements and holds to the new standards, why should they be denied?



> If the vocational education system works so well then why have other developed nations removed it and insisted every Paramedic go to University?


Who said it worked well?  It's a valid question is all.  Simply being associated with a college does not gaurentee the quality of instruction, just like not being associated with one doesn't.  If all requirements are met with that one exception, why should they be denied?  What really needs to happen is for somone to come up with a way to objectively judge the quality of instruction given along with everything else.  That would have the most, and best impact.



> What original idea or concept would you like me to come up with?  I don't forsee anything I could think up that has not been thought up before by somebody else because they recognise the same problems as I do.


Basically, anything to show that you actually know what you are talking about when it comes the certain aspects of American EMS, and aren't simple regurgitating what you read here.  So far, you fail utterly at that.


----------



## Veneficus

triemal04 said:


> Not a clue.  Where is your evidence that they are wrong?  I mean, you wouldn't believe something unless there was some evidence behind it, right?.




Are you suggesting that the IAFF and IAFC and by extension all the advocates of fire based EMS should be able to spout their utter lies and total BS as fact because nobody can prove them wrong even though they cannot prove it themselves?

As far as I am aware in science, you cannot prove a negative. So that is a very boased argument that it cannot be proven wrong. 

Let's talk about reporting numbers for a minute.

Why aren't FDs using the Utstein template? Why are they not responding to requests for their numbers?

Are they going to adopt the new AHA reporting system? are they going to Publish their numbers?

I have to ask myself, one of the agencies that employs me reports their numbers all over the news. (of course it is a hospital)Have you ever noticed the Seattle area never fails to report their numbers? Why do you think that is?

Because their numbers are great. They are something to brag about, not hide. 

If the Fire service was truly interested in advancing medical care, why wouldn't they mandate a publically available standardized reporting system? 

Could it be they know they really suck and don't want anyone to find out?


In my home state a mandatory reporting system was established. (most of the state is Fire based EMS, in fact we could count on one hand the 911 agencies that aren't. They accepted the system on the caviat it would not be made public and was only for internal record keeping. They went as far as to sue to keep it private when medical officials going over the records wanted to divulge the numbers in order to force departments to change. (I am told by a doctor who saw them the numbers were abysmal)

Look at the recent legislation put forth in the state of LA. Why would a fire service suggest they should not be held accountable to the state agency overseeing EMS? Perhaps the regulatory agency was being too hard on them? No organization in any industry that is of quality fears an oversight body. Most can't wait to host them so they can brag about the results.

Bottom line:

The fire service bodies brag how great they are. Challenge people to the impossible scientific task of proving them wrong. Use very poor studies to demonstrate they are correct. Fight to not use or report recognized medical reporting standards.  

Why would you do any of that unless you suck and need to hide it?


----------



## MrBrown

Why is Fire based EMS used nowhere else in the world except the US if it works so well?

Why have both the New Zealand Fire Service and the New Zealand Professional Firefighters Union vigorously fought so hard to not to medical runs, stating it is not in the interest of either profession?

Look at Firefighter/Paramedics in Washington DC, how many lawsuits and new items have they had recently about substandard patient care.... hmm

What about the recent spate of "dead people" who werent really dead; most of them were from Fire based EMS systems; Arizona, Arkansas, Maryland ....

The scientific evidence just does not exist to prove either of us right.  

Is the Fire Service 100% to blame for piss poor EMS? No, are they the worst ... probably.


----------



## atropine

One reason fire-based ems exist in the US is because we rock, second who the hell wants to be a private medic any ways making $14.00 an hour, I know what I know and what I know is that I make more than some RN's and PA's, and until somebody who has a higher pay grade than my chief decides that the system is broken who Iam to say say lets fix it.


----------



## Hal9000

atropine said:


> One reason fire-based ems exist in the US is because we rock, second who the hell wants to be a private medic any ways making $14.00 an hour, I know what I know and what I know is that I make more than some RN's and PA's, and until somebody who has a higher pay grade than my chief decides that the system is broken who Iam to say say lets fix it.



Indeed:

http://www.dailynews.com/ci_12175241



> --56 firefighters earned at least $100,000 in overtime on top of their annual salaries last year, up from three in 1999 and 10 in 2005.
> 
> --The average Los Angeles firefighter earned about $36,500 in overtime in 2008, compared with $29,000 in 1999. Their average salary and overtime compensation totaled $117,000.
> 
> --The department's top earner racked up a total of $570,276 in overtime in the last three years, including $206,685 in 2006. His three-year overtime total was nearly double his base salary for that period.
> 
> --Recruits earn overtime for after-hours remedial training "if they feel the need for more time to grasp the skills," a department spokeswoman said.
> 
> ...
> 
> The highest overtime earner in 2008 was Donn D. Thompson, a firefighter-paramedic III. He earned $173,335 in overtime in addition to his nearly $100,000 base salary while working at Fire Station 19 on Sunset Boulevard in Brentwood.
> 
> The year before, Thompson earned $190,256 in overtime and in 2006 the figure was $206,685.
> 
> The second-highest overtime earner in 2008 was firefighter-paramedic Alan Naeole. He took in $164,785 in overtime at Air Operations, based at Van Nuys Airport, in addition to his $100,000 base pay.


----------



## Veneficus

Hal9000 said:


> Indeed:
> 
> http://www.dailynews.com/ci_12175241



sounds like somebody of a higher paygrade should replace the chief as the OT earnings suggest they could hire 1 or more people at near the same cost as paying overtime.

_One reason fire-based ems exist in the US is because we rock, second who the hell wants to be a private medic any ways making $14.00 an hour, I know what I know and what I know is that I make more than some RN's and PA's, and until somebody who has a higher pay grade than my chief decides that the system is broken who Iam to say say lets fix it. _

Let me try to be as kind as possible. 

You cannot identify potential problems in the system you work in and rely on people to tell you what is best without making any attempt to mprove your care by analyzing data?

You base the effectiveness of your medical treatment on your earnings?

I've heard of evidence based medicine, but income based medicine? I think the term used to identify people in medicine who base effectiveness on what they earn and not if the treatment works "quaks" or "snake oil salesmen."

The union must be real proud of you.

Probably best if you don't make any decisions.


----------



## atropine

Veneficus said:


> sounds like somebody of a higher paygrade should replace the chief as the OT earnings suggest they could hire 1 or more people at near the same cost as paying overtime.
> 
> _One reason fire-based ems exist in the US is because we rock, second who the hell wants to be a private medic any ways making $14.00 an hour, I know what I know and what I know is that I make more than some RN's and PA's, and until somebody who has a higher pay grade than my chief decides that the system is broken who Iam to say say lets fix it. _
> 
> Let me try to be as kind as possible.
> 
> You cannot identify potential problems in the system you work in and rely on people to tell you what is best without making any attempt to mprove your care by analyzing data?
> You base the effectiveness of your medical treatment on your earnings?
> 
> I've heard of evidence based medicine, but income based medicine? I think the term used to identify people in medicine who base effectiveness on what they earn and not if the treatment works "quaks" or "snake oil salesmen."
> 
> The union must be real proud of you.
> 
> Probably best if you don't make any decisions.



Hey pal, don't be a hater, again if things are so bad the why arent the citizens crying about drastic change?, it is what it is, the reality is that you can do all that much in the field and no medical director is going to risk all that liability. Plus all the education debate is a joke who the hell is going go to school for four years as some suggest should be the min for paramedic and turn around to pick up a gig that only pays $14.00 an hour, not me or anyfone eles I know, those who cry and complain either can't cut it in the fire service, because they too fat and lazy or just need to complain about something. Guys right are testing every chance they can because they want cold hard cash that is the reality of it.


----------



## TransportJockey

atropine said:


> Hey pal, don't be a hater, again if things are so bad the why arent the citizens crying about drastic change?, it is what it is, the reality is that you can do all that much in the field and no medical director is going to risk all that liability. Plus all the education debate is a joke who the hell is going go to school for four years as some suggest should be the min for paramedic and turn around to pick up a gig that only pays $14.00 an hour, not me or anyfone eles I know, those who cry and complain either can't cut it in the fire service, because they too fat and lazy or just need to complain about something. Guys right are testing every chance they can because they want cold hard cash that is the reality of it.



Some of us have no desire to be forced into the hosemonkey role. And some like me couldn't pass a FD physical due to past injuries (I have had 2 FD physicals and due to a large quantity of metal in my lower left leg that limits range of motion, I couldn't pass)


----------



## dave3189

Why is Fire based EMS used nowhere else in the world except the US if it works so well?

The United states does most things better than any other countries???!  I wouldn't be using that arguement to make your point!


----------



## Veneficus

atropine said:


> Hey pal, don't be a hater, again if things are so bad the why arent the citizens crying about drastic change?.



Propaganda?
apathy?
ignorance?
Who can say? But most american's don't even know how their government works, much less what they can do to effect change.



atropine said:


> it is what it is, the reality is that you can do all that much in the field and no medical director is going to risk all that liability.



I find itto be true, a medical director won't risk the liability because a GED and vocational cert just isn't enough to trust people to make informed medical decisons. For example Naples, Florida, among others.



atropine said:


> Plus all the education debate is a joke who the hell is going go to school for four years as some suggest should be the min for paramedic and turn around to pick up a gig that only pays $14.00 an hour, not me or anyfone eles I know,.



Unionized employees in many industries have felt the same way. Look at what a US steel worker makes today, or how great the jobs are over at GM. It may have escaped your notice, but in the modern era, it is near impossble to make a middle class living performing skilled labor in the US. 

From the political side, one party is pro union, one is anti union, which means the benefits you enjoy today may be first on the chopping block if the current administration were to be replaced. Additionally doesn't CA have a major budget deficit? Eventually there will be painful cuts or a major tax raise, or both. The IAFF will ot be the first union to bankrupt its industry. 

In the WSJ the other day I read that unemployment for people without a bachelor's degree was at 20.9% With a 4 year degree 7.something% I don't know about you or the people you know that wouldn't get a degree for $14.00an hour, but from the employment standpoint, it sure looks like a good idea to have one. Currently there are many people with a degree accepting jobs well beneath them, for less money. When the junior guys get laid off, what are they going to do? Try to compete for jobs with people who have degrees? 



atropine said:


> those who cry and complain either can't cut it in the fire service, because they too fat and lazy or just need to complain about something.



Don't know where you got that idea from, but it is very simpleminded. There are many people, who paygrade is well above "chief" who try to effect change in order to make sure people like you will have a job in the coming days when your value in society is called into question. I also am quite proud to be one of those guys who did make it in the fire service and moved on to bigger things. It may have escaped your notice, but only the people with a degree get to sit around the table when discussions on what the future holds takes place. I wouldn't want to be the one with no input on how valuable I am when those decisions are being made. 



atropine said:


> Guys right are testing every chance they can because they want cold hard cash that is the reality of it.



As they always have, and always will. But those positions are very rare, and in jeopardy. Look around the world at the lifestyle an uneducated laboring class can expect. This isn't 1930, we live in a global economy. If it is happening elsewhere, it is only a matter of time before it happens here. 

Keep in mind also basic economics. When Supply is high (guys lining up left and right) an demand is low (uneducated labor) it is only a matter of time before the union cannot save your job because somebody is willing to do it for $14.00/hour. From the national level on down, "business as usual" is not going to be for many more years. Especially since "irresponsible" Govt. spending s not looked kindly upon currently. What are you planning to do when a group of teabaggers decide you are govt. waste they don't want to pay for? many in the middle and working class might be wondering why they are paying taxes for those firemen to make outrageous sums of money.

Perhaps it might have occured to you many of your leaders will be retired when trying to save your industry with the same playbook used in the late 1800s doesn't work. It would really suck to be a few years from retirement, or higher in age without an education when you find yourself out of work. If you think $14.00/ hour sucks now, wait till your 55 and you're competing for a job with some highschool kid at McDs because all the guys not employed at the FD working a low class private ambulance go out and get a degree in the next few years.

Thinking your job is beyond reproach and not being aware of the factors affecting you because "somebody with a higher pay grade is taking care of it," is not only short sighted, it is historically shown to not be effective. 

I just gave you knowledge more valuable than your chief or your union reps, for nothing. A kind jesture for a guy that just needs something to complain about.


----------



## MrBrown

atropine said:


> ...Plus all the education debate is a joke who the hell is going go to school for four years as some suggest should be the min for paramedic and turn around to pick up a gig that only pays $14.00 an hour, ...



Could be why you make about $50k here as a Paramedic (entry level) and $60 or $70k as an Intensive Care Paramedic.


----------



## dave3189

Some of us have no desire to be forced into the hosemonkey role. And some like me couldn't pass a FD physical due to past injuries (I have had 2 FD physicals and due to a large quantity of metal in my lower left leg that limits range of motion, I couldn't pass) __________________

Funny you say you have no desire to be a hosemonkey, but yet you admit you took two FD physicals and failed them.  Were you taking the physicals just for kicks?  BTW, one might argue if you are physically unable to be a FF, you may not be physically able to be in EMS?


----------



## TransportJockey

dave3189 said:


> Some of us have no desire to be forced into the hosemonkey role. And some like me couldn't pass a FD physical due to past injuries (I have had 2 FD physicals and due to a large quantity of metal in my lower left leg that limits range of motion, I couldn't pass) __________________
> 
> Funny you say you have no desire to be a hosemonkey, but yet you admit you took two FD physicals and failed them.  Were you taking the physicals just for kicks?  BTW, one might argue if you are physically unable to be a FF, you may not be physically able to be in EMS?



I took two physicals because at the time they were the only places hiring EMTs. Wound up working private service and enjoyed it much more than I ever did on internship at FD

And The only reason I failed was due to range of motion. I have no problems running or doing anything else that they required. It's the same reason I was turned down for active service at USCG, USAF, and USA physicals


----------



## Hal9000

Veneficus said:


> Additionally doesn't CA have a major budget deficit? Eventually there will be painful cuts or a major tax raise, or both. The IAFF will ot be the first union to bankrupt its industry.



Ask and ye shall receive:

Clicky the linky 



> *The Stanford report estimates that California's shortfall for government pensions and health care benefits is about $535 billion* (Anderson, Contra Costa Times, 4/5).
> 
> Researchers tallied CalPERS' unfunded liabilities at $239.7 billion and CalSTRS' liabilities at $156.7 billion.
> 
> *Pension Liabilities Could Lead To Health Cuts, Other Changes*
> 
> The Stanford report suggests that California would need to put $360 billion into its pension and health benefit systems immediately to have an 80% chance of meeting 80% of the obligations within 16 years (Contra Costa Times, 4/5).
> 
> "The consequences are clear: increasingly large portions of state funding for programs Californians hold dear such as schools, parks and health care will be diverted to pay for this debt."



But wait, there's more



> "Something has got to give," says Joe Nation, the director of a Stanford University graduate program that is reporting today that the cumulative shortfall from California's three giant pension funds alone is somewhere around $500 billion.
> 
> Not only is that considerably more than the state is currently projecting, but it's almost six times the state's entire general fund budget. In other words, it would take California six years -- with no spending on education, public safety, health care or anything else -- to fill the gap.
> 
> *But as NPR and others noted, that $1 trillion figure is unrealistically low.*
> Experts like Joshua Rauh, an associate professor of finance at the Kellogg School of Management at Northwestern University, say pension funds are using exaggerated assumptions about investment returns.
> 
> *"Our calculation is that it's more like $3 trillion underfunded," Rauh told NPR.*
> 
> The Stanford report, for instance, concludes that the California pension funds have been using an inappropriately high "discount rate" to calculate future liabilities, and uses 4 percent instead. (The report also reflects the three California funds' $110 billion -- or 24 percent -- loss in portfolio value between mid-2008 and mid-2009. But if the portfolios have continued to more or less mirror the performance of the Dow, they have likely gained back much of that loss by now.)


----------



## dave3189

It's funny reading all the different opinions on this topic, as it reminds me of listening to politicians and how they always take the side of their party.  We all think the system we work in is the best.  I haven't read any posts from someone saying I work in Fire Based and it sucks, or vice versa with privates?  I'm not bashing anyone, hell... I'm guilty of it myself.  It's just funny how we all spend so much time trying to make our points and convince others to agree with our contention when in the end we are all loyal to the systems we work in.


----------



## Hal9000

dave3189 said:


> It's funny reading all the different opinions on this topic, as it reminds me of listening to politicians and how they always take the side of their party.  We all think the system we work in is the best.  I haven't read any posts from someone saying I work in Fire Based and it sucks, or vice versa with privates?  I'm not bashing anyone, hell... I'm guilty of it myself.  It's just funny how we all spend so much time trying to make our points and convince others to agree with our contention when in the end we are all loyal to the systems we work in.



Eh, I think that Veneficus was fire... (?)


----------



## LucidResq

I'm going to have to throw this out there....

Taiwan's EMS system is even more fire-based than in the US. 100% fire-based, actually. They've had mixed results. An advantage of their system is the education level of their providers - they all have a degree. This is a result of the fact that all public safety workers in Taiwan - police & fire - must have a degree (associate's level, at least, I believe). A major problem that they have is a lack of EXPERIENCED medics. EMS positions in the fire service are an "entry-level" track to fire officer positions, so almost every person who does EMS for a few years promotes up to be an officer a position that does no EMS. So you have constant, extremely high turnover.


----------



## Hal9000

LucidResq said:


> I'm going to have to throw this out there....
> 
> Taiwan's EMS system is even more fire-based than in the US. 100% fire-based, actually. They've had mixed results. An advantage of their system is the education level of their providers - they all have a degree. This is a result of the fact that all public safety workers in Taiwan - police & fire - must have a degree (associate's level, at least, I believe). A major problem that they have is a lack of EXPERIENCED medics. EMS positions in the fire service are an "entry-level" track to fire officer positions, so almost every person who does EMS for a few years promotes up to be an officer a position that does no EMS. So you have constant, extremely high turnover.



I'm ignorant, but are there many fire-based organizations which have much of a progression ladder for EMS, or one that makes financial sense to follow?  Good example you provided.


----------



## Veneficus

dave3189 said:


> It's funny reading all the different opinions on this topic, as it reminds me of listening to politicians and how they always take the side of their party.  We all think the system we work in is the best.  I haven't read any posts from someone saying I work in Fire Based and it sucks, or vice versa with privates?  I'm not bashing anyone, hell... I'm guilty of it myself.  It's just funny how we all spend so much time trying to make our points and convince others to agree with our contention when in the end we are all loyal to the systems we work in.



I was working at a FD when I discovered something was wrong. I then went to another FD where it was even worse. During my third FD employment (whch actually valued EMS), I became of the mind that despite carrying the party line for years, something needed to change.

I have since encountered other former firefighters (most of whom are now physicians, and a handful serving in medical only capacities both in hospital and teaching organizations) that noticed the same thing. 

I have even worked private and 3rd service EMS. I am not supporting one system over another. I am striving for the best system, who provides it is inconsequential. But in order to get there it will take certain things. Which will need to be done in a certain order. 

In my experience and research, the fire service is the largest opponent of change. Which is not only for the better, but without it puts both fire and EMS at the risk of becomming obsolete. (happy to discuss specifics anytime)

I support any agency wishing to advance the cause. The trouble is the fire service seems to be led by a bunch of people who don't want to admit change must happen. They spout propaganda and like history has always done, eventually the truth will come out. 

Some of the fire services most distinguished leaders are driving it to a cliff with EMS. I hope the rank and file will not go over like lemmings, but it is in their hands, not mine. I can only point out the cliff and how to change course.

If you deny there are problems, whether fire based, private, public, 3rd service, whatever; it is like denying the Americans are invading Iraq as our tanks roll through the streets. (you remember that Iraqi information minister under Sadaam doing that!)

There are countless examples in literature as well.

I suspect I get through to some and not others. But I will continue to try.


----------



## MrBrown

Veneficus makes a good point; I do not have a preference as to one system over the other either.  Medic One can continue to be intergrated with the Fire Departments of King and Whatcom Counties for as long as ever because they do a good job of it.  Likewise, if Austin Travis County EMS in Texas continues to be a good third service agency, let them be a third service agency forever and a day.

The Fire Service seems to be the biggest pusher of low standards and resisting change because they simply have the largest finger in the pie. 

Oregon requires at least a two year Degree to become a Paramedic, how many Fire based EMS systems are out there in Oregon?

I have experience in two of our services here (we only have 4 nationwide) and the difference between the two is amazing simply because one embraces change and forward thinking.


----------



## Radioactive

dave3189 said:


> Why is Fire based EMS used nowhere else in the world except the US if it works so well?
> 
> The United states does most things better than any other countries???!  I wouldn't be using that arguement to make your point!




I just want to point out that this response is spectacular.  I very well may be using it as my sig.


----------



## MrBrown

dave3189 said:


> Why is Fire based EMS used nowhere else in the world except the US if it works so well?
> 
> The United states does most things better than any other countries???!  I wouldn't be using that arguement to make your point!



I can't figure out if you're being serious or making a joke.

If you actually mean that then you're a moron.


----------



## Radioactive

It was certianly a joke.  The grammar by itself is laughable.  Sometimes I forget that sarcasm doesn't translate well in text.  Maybe I shoulda used the proper [sarcasm on/off] denotation.


----------



## triemal04

Veneficus said:


> Are you suggesting that *the IAFF and IAFC and by extension all the advocates of fire based EMS* should be able to spout their utter lies and total BS as fact because nobody can prove them wrong even though they cannot prove it themselves?
> Absolutely not.  I'm not absolving anyone of their responsibilities to prove what they say.  Just that, if you are going to say that someone is wrong, you should be able to show why they are wrong.  And the bolded portion...that's pathetic.  I'm sorry, but you should be smarter than that.  Neither of those 2 unions set's policy for individual dept's, neither enforces anything for the fire service, and neither "set's a course" so to speak, for the fire service.
> 
> As far as I am aware in science, you cannot prove a negative. So that is a very boased argument that it cannot be proven wrong.
> That is the worst kind of copout there is!  Crap, think about what you just said.  "I'm right, you're wrong, but I can't prove it, but that doesn't change anything."  Damn!  You can do better than that.  I mean...do you want ME to list out the areas where the fire-service model fails at EMS?  It's very easy to do, and I'd be happy to do it since you don't seem able to.
> 
> Let's talk about reporting numbers for a minute.
> 
> Why aren't FDs using the Utstein template? Why are they not responding to requests for their numbers?
> 
> Are they going to adopt the new AHA reporting system? are they going to Publish their numbers?
> Uh...is anyone else?  (the answer to that is no, the vast majority of all types of services are NOT collecting that info using that criteria, and many aren't collecting it at all.  Some are though.).  What's good for the goose is good for the gander; if you are going to attempt to use this to prove that an entire model fails, then you had best use it for EVERYONE.  And...look at the USA Today numbers again.  You should be aware that several private, hospital-based and third service agencies were also not able to report their numbers, or were unwilling.  Since you seem to be so focused on numbers, then try this on:  third-service and hospital based make up the smallest number of transporting agencies, so, going by the numbers, that would indicate that a larger percentage of them are failing to collect appropriate data.  Guess that means they are causing issue's with EMS more than fire in this case.
> 
> I have to ask myself, one of the agencies that employs me reports their numbers all over the news. (of course it is a hospital)Have you ever noticed the Seattle area never fails to report their numbers? Why do you think that is?
> 
> Because their numbers are great. They are something to brag about, not hide.
> Have you ever noticed that almost every service doesn't report their numbers?  Come on...so far each one of your responses has been a hollow argument.  You can do much better than that.
> 
> If the Fire service was truly interested in advancing medical care, why wouldn't they mandate a publically available standardized reporting system?
> Very good question actually.  But...if non-fire services are doing so great, then where is the push by them, and more importantly, where is the SUPPORT BY THEM for such a thing?
> 
> Could it be they know they really suck and don't want anyone to find out?
> Could be.  More likely it's the fact that there is no one governing body for fire dept's nationwide, just as there isn't for any service type.  Sorry, once again, that's a failed and hollow argument.
> 
> In my home state a mandatory reporting system was established. (most of the state is Fire based EMS, in fact we could count on one hand the 911 agencies that aren't. They accepted the system on the caviat it would not be made public and was only for internal record keeping. They went as far as to sue to keep it private when medical officials going over the records wanted to divulge the numbers in order to force departments to change. (I am told by a doctor who saw them the numbers were abysmal)
> That's pretty bad, I won't lie, and really, unforgivable.  But this represents more than that one dept...how?
> 
> Look at the recent legislation put forth in the state of LA. Why would a fire service suggest they should not be held accountable to the state agency overseeing EMS? Perhaps the regulatory agency was being too hard on them? No organization in any industry that is of quality fears an oversight body. Most can't wait to host them so they can brag about the results.
> 
> Bottom line:
> 
> The fire service bodies brag how great they are. Challenge people to the impossible scientific task of proving them wrong. Use very poor studies to demonstrate they are correct. Fight to not use or report recognized medical reporting standards.
> Impossible?  Are you kidding me?  Once again, would you like me to give you actual examples of how the fire-service model doesn't work and where it is failing EMS?  It's not that hard to do.
> 
> Why would you do any of that unless you suck and need to hide it?


This is getting ridiculous.  Very little you have said is accurate, or provable beyond an anecdotal level, or applicable to an entire system.  If you want change, you need to show why change is needed!  It's a simple concept.  And it's doable in this case.

My whole point in getting into this thread was to point out that to many people subscribe to the "bogeyman theory" when it comes to the fire-service.  It would seem you do too.  You keep saying that you don't like one service over another, and yet, only point out perceived flaws in one, while refusing to accept that these flaws are not systemic, and that there is no one body that sets policy for the fire service.  (the best you've done is point out what the IAFC and IAFF have said since they can affect policy at that national level, and yes, some of what they do is very problematic.)  You want to talk about problems with EMS...let's look at other services.  Who is it that runs NCTI, a notorious patch-factory with multiple locations?  Who is it that pays people horrible wages with little to no benefits/retirement?  Who is that does very little in the way of background checks?  Who is it that seems to always make the news for a medic assaulting/sexually abusing a pt?  Who is that refuses to spend money lobbying for medicare reform for ambulance reimbursement?  Who is it that has little to no career advancement?  Who is it that only wants people to be employed for 5 or so years?  Do you want me to keep going?

I'll freely admit that the fire-service model has some problems and bears some of the responsibility for the shape EMS is in (once again, do you want ME to point out the ways that's happened?), but as the only offender, or even the majority offender...please, use you head and look objectively at the entire system.


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## triemal04

MrBrown said:


> Why is Fire based EMS used nowhere else in the world except the US if it works so well?
> 
> Why have both the New Zealand Fire Service and the New Zealand Professional Firefighters Union vigorously fought so hard to not to medical runs, stating it is not in the interest of either profession?
> 
> Look at Firefighter/Paramedics in Washington DC, how many lawsuits and new items have they had recently about substandard patient care.... hmm
> 
> What about the recent spate of "dead people" who werent really dead; most of them were from Fire based EMS systems; Arizona, Arkansas, Maryland ....
> 
> The scientific evidence just does not exist to prove either of us right.
> 
> Is the Fire Service 100% to blame for piss poor EMS? No, are they the worst ... probably.


Dear MrBrown;

Thank you for your interest in American EMS.  It's heartening to know that people from other countries are aware of the poor shape it's in and are concerned with what the future holds.

Unfortunately, you continue to make it very clear with every post that you do not full understand the current situation, how this situation was reached, the problems faced, root causes of those problems, or what the problems with certain service-models are.

Until you are able to clearly understand and articulate these things, or even refute the responses to your previous attempts, it would probably be better for you to remove yourself from this conversation and avoid any embarrassment.

Thank you,

A Concerned Citizen.


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## triemal04

dave3189 said:


> It's funny reading all the different opinions on this topic, as it reminds me of listening to politicians and how they always take the side of their party.  We all think the system we work in is the best. * I haven't read any posts from someone saying I work in Fire Based and it sucks*, or vice versa with privates?  I'm not bashing anyone, hell... I'm guilty of it myself.  It's just funny how we all spend so much time trying to make our points and convince others to agree with our contention when in the end we are all loyal to the systems we work in.


Um...me?  I haven't said that it sucks, but I'll be the first to admit that there are problems with the way it's run that affect almost every dept in the nation, and the first to admit that the fire-service does bear it's share of responsibility for the current state of EMS.

Edit:


MrBrown said:


> Oregon requires at least a two year Degree to become a Paramedic, how many Fire based EMS systems are out there in Oregon?


Hmmm...another failure at understanding and knowing what the situation is.  The majority of transporting agencies in Oregon are fire-based.  With few exceptions, the career dept's that provide a first responce capability provide a paramedic level service (needed or not).  Failed again, eh brown?


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## Veneficus

*e pluribus unum*

_Absolutely not. I'm not absolving anyone of their responsibilities to prove what they say. Just that, if you are going to say that someone is wrong, you should be able to show why they are wrong_

I provided the links, The doctor who responded by video I thought covered it quite well. He used published data to refute exactly what they claimed. I don’t think anyone could demonstrate to you anything that would change your defense of the propaganda.

_. And the bolded portion...that's pathetic. I'm sorry, but you should be smarter than that. Neither of those 2 unions set's policy for individual dept's, neither enforces anything for the fire service, and neither "set's a course" so to speak, for the fire service._

I am not sure why you think the bolded statement is pathetic. Both Mr. Brown and I have linked to and spelled out quite well the positions of the ignorant labor union leadership. I even supplied a link to how much their political action committees have spent over the years lobbying their position. If you think the IAFF and IAFC doesn’t influence the decision makers of respective departments who may be members, you may need to travel some more outside the backwater of the Pacific Northwest.

_ That is the worst kind of copout there is! Crap, think about what you just said. "I'm right, you're wrong, but I can't prove it, but that doesn't change anything." Damn! You can do better than that. I mean...do you want ME to list out the areas where the fire-service model fails at EMS? It's very easy to do, and I'd be happy to do it since you don't seem able to._

I really don’t see how trying to scientifically prove a negative concept is a cop out? But of course you are free to list why you think the fire service model fails at EMS. But would it be anything more than your anecdotes? Please don’t post something about response times or some other nonsense measurement though. It hurts both my eyes and my head

_Uh...is anyone else? (the answer to that is no, the vast majority of all types of services are NOT collecting that info using that criteria, and many aren't collecting it at all. Some are though.)_

I didn’t say nobody else wasn’t to blame for not using or reporting standard data. But I also didn’t see a video by advocates of private, third service, or hospital based EMS trying to put out propaganda on why their system is superior.

_. What's good for the goose is good for the gander; if you are going to attempt to use this to prove that an entire model fails, then you had best use it for EVERYONE. And...look at the USA Today numbers again. You should be aware that several private, hospital-based and third service agencies were also not able to report their numbers, or were unwilling._

You should read my statement again where I said that agencies who can be proud of their numbers do show them off. It was not exclusive. 

_Since you seem to be so focused on numbers, then try this on: third-service and hospital based make up the smallest number of transporting agencies, so, going by the numbers, that would indicate that a larger percentage of them are failing to collect appropriate data._

Do I understand you correctly? You say that third service and hospital based services make up the smallest number of agencies (which I don’t doubt) but that the fire service model which makes up a majority of US agencies doesn’t cause most of the problems? I am not sure I understand your logic.

_ Guess that means they are causing issue's with EMS more than fire in this case._

Colorful. A minority group of agencies causing more problems than the majority when engaged in the same behavior?

_Have you ever noticed that almost every service doesn't report their numbers? Come on...so far each one of your responses has been a hollow argument. You can do much better than that._

I have noticed that most do not report their numbers. I stand by what I said, those who don’t must have something to hide. 

_Very good question actually. But...if non-fire services are doing so great, then where is the push by them, and more importantly, where is the SUPPORT BY THEM for such a thing?_

By your own argument, these non fire services are a minority, who cannot or do not spend the money that the fire service could. I am quite sure if those advocating for the fire service spent more time pushing for standards and less time trying to compare EMS effectiveness with fire suppression response times, the minority would be compelled to follow the majority standards.

_Could be. More likely it's the fact that there is no one governing body for fire dept's nationwide, just as there isn't for any service type. Sorry, once again, that's a failed and hollow argument._

I don’t think you understand what I am getting at or are in denial. A political action group is not a governing body. I did not suggest they were. However, such organized lobbying affects policy at all levels, not just federal. Perhaps you should try to more thoroughly understand how labor unions and professional associations wield their power. In fact since Poland is in the news, perhaps it should be pointed out that it was a labor union action that brought down the socialist government in the 80’s. For a body that isn’t governing body (which would be a guild) that is some significant power and influence. In political circles I think it is termed “mob rule.”

_That's pretty bad, I won't lie, and really, unforgivable. But this represents more than that one dept...how?_

Your question is: How does the data submitted by every EMS agency in the state represent more than one department?


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## Veneficus

*but wait there's more...*

_My whole point in getting into this thread was to point out that to many people subscribe to the "bogeyman theory" when it comes to the fire-service. It would seem you do too. You keep saying that you don't like one service over another, and yet, only point out perceived flaws in one._

I am afraid a bunch of ignorant vocational laborers do not instill enough fear in me to subscribe to a “bogeyman theory.” I have stated in this thread and others that I think fixing the problems manifested in the fire service is the toughest challenge and will have the greatest impact. Are you suggesting that systemic EMS problems can be solved by singling out the minority agencies and forcing the majority fire service EMS agencies (often a municipal) to comply with the standards of private industry? could we then demand the same burden of proof to successfully sue a private corperation as a municiple governemt?

_Who is it that runs NCTI, a notorious patch-factory with multiple locations?_

Were it not for a political coalition of volunteer services and the IAFF non accredited “patch factories” would not exist. Have you forgotten who lobbied to maintain vocational classification of EMS as well as holding down educational requirements? In fact, the fabled National Fire Academy is not accredited education. How embarrassing. The industry leaders can’t go to college.

_Who is it that pays people horrible wages with little to no benefits/retirement?_ 

EMS providers outside the fire service are paid commensurate with their education and therefore value to society. It is only Unionized fire service laborers who can hold a government hostage and demand pay in excess of their value in the provision of service (EMS or otherwise). Tell me, what is the average pay in any other industry for a laborer with a GED or high school diploma and approximately 1000 hours of vocational training? Certainly not anywhere close to that of a fireman. 

_Who is that does very little in the way of background checks?_

What has this got to do with anything? All a background check proves is a person hasn’t been caught doing anything in the past. It is not predictive of behavior, ability, or integrity. Not to mention it also prohibits redemption. In the city of Cleveland, Ohio, a serial rapist passed all checks, was hired, and employed by the fire department for 10 years before he was prosecuted and convicted. Many of his victims testified in court that they didn’t come forward because they feared the word of such an upstanding member of the community would be believed over their accusations. This anecdote aside, how many people in the fire service have you witnessed behave in a manner that would not be acceptable of the general public because “they are special?” How often are they terminated for such behaviors?

_ Who is it that seems to always make the news for a medic assaulting/sexually abusing a pt?_

I might ask who is it that abuses patients and doesn’t make the news? Even when the abuse does make the news regularly like in DC, the discipline is rather minor.

_Who is that refuses to spend money lobbying for medicare reform for ambulance reimbursement?_

Good question. Certainly not private transport services.

_Who is it that has little to no career advancement?_

A factory laborer, a mechanic, a plumber, a mason, a carpenter, private EMS, a teamster, and every other vocational laborer who cannot exploit their government employer.

_Who is it that only wants people to be employed for 5 or so years?_

That is a fine question too. But I am not sure it is entirely accurate. Many non Fire EMS agencies go to considerable lengths to attract and retain quality employees. But I stipulate that many of the more desirable employees move on to true professional status in other related fields. Similar to how somebody can put themselves through school to become an architect as a carpenter. Perhaps you are arrogant enough to believe that a firefighter is somehow more special than any other type of vocational laborer? Because of what? The danger of the work? Not as dangerous as fishing or mining.

_ Do you want me to keep going?_

Please, by all means. I’d love to hear how a firefighter is such a superior human being compared to all the other mere mortals of the laboring class.

_ I'll freely admit that the fire-service model has some problems and bears some of the responsibility for the shape EMS is in (once again, do you want ME to point out the ways that's happened?), but as the only offender, or even the majority offender...please, use you head and look objectively at the entire system._

Use yours. Fix the minority offenders and everything will magically be fixed over at the FD? How do you plan to fix the systemic problems with EMS when a politically active mob spreads “bogeyman” propaganda about response times, the cost of educating their medical providers, the sky is falling, the end of the world is coming and we are going to save you from it if you have what we deem “a real emergency” agencies? Magic, prayer, or closing your eyes clicking your heels together 3 times and saying "there's nothing like the fire service"?

_Um...me? I haven't said that it sucks, but I'll be the first to admit that there are problems with the way it's run that affect almost every dept in the nation, and the first to admit that the fire-service does bear it's share of responsibility for the current state of EMS._

I say it sucks, is that what makes me believe in the “bogeyman?” Of course I gave up trying to defend the party line some years ago. But I will try to now figure out how there are problems with the way it is run in every department in the nation if there is no national governing body. Especially if they are the same or similar problems.


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## triemal04

:censored::censored::censored::censored: it.  There's more than enough flaws within your last 2 posts that I could continue pointing them out, but what's the point?  You believe what you want, and despite the fallacy of it, that won't change.  I suppose you're right and everybody should go on thinking that the fire service is the ultimate evil as far as EMS is concerned, that they are all that is holding EMS back, that if they were gone EMS would be a wonderful, problem free system, that every individual deptartment walks in lockstep with the IAFF and IAFC and mindlessly follows what they say, that each department is exactly the same, that nothing and no one else is creating problems for EMS or bears any responsibility and so forth.

Cheers.


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## Hal9000

triemal04 said:


> that each department is exactly the same, that nothing and no one else is creating problems for EMS or bears any responsibility and so forth.
> 
> Cheers.



I didn't read anything similar to that in what he posted...


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## atropine

Hey hal9000, trying to explain it further is a waiste those who can't complain, simple as that their is no change happening anytime in the current ems system, especially where I live and work, and yes I am worth every penny that the city pays me, if not more and even though we still have brown outs Iam still going to make more than any RN or PA I know. I am all for education hell I even have to have a four year degree to promote, I just don't think giving taxi rides to the er promotes formal degrees.


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## Veneficus

*Do I understand this correctly?*



atropine said:


> if not more and even though we still have brown outs Iam still going to make more than any RN or PA I know.



Do you think somebody might figure out that might be a waste of money? 



atropine said:


> I am all for education hell I even have to have a four year degree to promote, I just don't think giving taxi rides to the er promotes formal degrees.



So your job is so menial that you don't think it requires education but you should be paid more than a degreed worker?



atropine said:


> and yes I am worth every penny that the city pays me,.



Did your mommy tell you that?

Maybe you should come back and argue after you get promoted.


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## FuManChu

Hey Everyone I'm back! 

Been a while since I was back on the forum, a few things have changed. I graduated High School with a 3.5 GPA. 
Been attending Solano College for 3 semesters now, on my fourth one finishing up all my general education. Been on the Dean's list for the past 3 semesters. After this semester is done I will have all my general education completed and I will be focusing on my Fire Science courses which include the Fire Academy next spring. After that I will have my degree in Fire Science as well as having completed a Firefighter 1 Academy. 

This summer I am going to attend an EMT-B course, and see how I fare with it. If I do well and enjoy it, I will put effort into getting into a semester long anatomy and physiology course to help me build a foundation before trying to get into a Paramedic program. 

My views have changed since I have first posted in the forum. I am not looking at EMT and possibly paramedic as just a stepping stone for getting hired as a firefighter, but I see it more as valuable knowledge I will have to work hard for to attain, and work hard to stay proficient at to better serve a community I may be working for. 

I just wanna say thanks for all the advice all around from everyone. 
And again I didn't mean to start any arguments or disagreements, and I am sorry if asking about EMT for Firefighting seemed unsettling to some. 

I have a few more questions.

What are some good paramedic programs in the SF Bay Area, and are there good prep courses? or is taking Anatomy and Physiology the best I can do to help prepare for that.

Again Thanks a lot everyone for contributing in some way. 
Sorry it took so long for me to reply (almost 3 years ). 

-Anthony


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## Sandog

Solano College? I use to live in Fairfield many years ago. If you want to go fire, a good entry point is attend a Wildland fire academy and then shoot for Cal Fire. You should have EMT for Cal Fire. Also USFS is a good place to start, assuming you attend a wildland academy. You will most likely start out as a seasonal FF so in your off-time, attend school and apply to a fire academy and get your FF1. 
As for the math, you should take a simple college math class so you can do the hydraulics stuff in FF, but that is just simple math. I made a excel hydraulics calculator, let me know if you want it, and I will post it. 

It is tough getting into fire here in Ca, but it is possible.

Oh, and yes, an A&P class is definitely recommended. Just the one semester one will do for now.
Last, but not least, What ever you do, do not get a DUI or you can foget about it.


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## FuManChu

Also, 
I am still worried about math! 
I know for EMT-B it won't be anything to worry about, but if I plan on going through a Paramedic Program, I know it may be a problem. 

For General Education at my college I needed to take a college level math course, so I took Statistics and passed with a B, had an A throughout the whole semester but didn't do well on the final so got a B. 
I still feel I am terrible at math, and would hate taking another math course, but would I need to for a paramedic program? Or would I be able to just brush up on some math on my own time and be ok? Or what kind of math would one recommend for a paramedic program?


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## FuManChu

Sandog said:


> Solano College? I use to live in Fairfield many years ago. If you want to go fire, a good entry point is attend a Wildland fire academy and then shoot for Cal Fire. You should have EMT for Cal Fire. Also USFS is a good place to start, assuming you attend a wildland academy. You will most likely start out as a seasonal FF so in your off-time, attend school and apply to a fire academy and get your FF1.
> As for the math, you should take a simple college math class so you can do the hydraulics stuff in FF, but that is just simple math. I made a excel hydraulics calculator, let me know if you want it, and I will post it.
> 
> It is tough getting into fire here in Ca, but it is possible.




Thanks Sandog! 
I read that the Solano College Fire Academy now includes The Wildland Fire Academy in it now, so I won't have to take a separate academy or separate courses. 
However I won't be starting the academy for about a year, I need to take some pre-reqs for it. 

My girlfriends grandfather has been in the USFS for some 20+ years or so and told me he could help me getting on a hotshot crew after the fire academy if I wanted. That may be an option, after the Academy if I don't do the Paramedic program first after that.


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## kthealy

Since CA has some of the highest paying departments, they are only going to hire the highest level candidates. Some departments have tests that people can only take if they have a B.A/B.S. degree. I got my 4 year degree from Santa Clara University, and now starting fire classes a community college after getting my EMT cert. Have fun


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## FuManChu

kthealy said:


> Since CA has some of the highest paying departments, they are only going to hire the highest level candidates. Some departments have tests that people can only take if they have a B.A/B.S. degree. I got my 4 year degree from Santa Clara University, and now starting fire classes a community college after getting my EMT cert. Have fun



Thanks Kthealy.

Do you mind me asking what you got your Bachelors in?


----------

