# Why is EMS mixed with FD?



## thatSPIKYflip (Aug 9, 2009)

This is a simple question.  Many towns mix their EMS with their FD.  Why can't they just keep the two separate?  Isn't it how the "public safety triad" works? PD deals with enforcing the law; EMS deals with medical emergencies; FD deals with fires.

On a side note: Are there any law enforcement agencies that employ EMS personnel?


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## WuLabsWuTecH (Aug 9, 2009)

Yes there are so called public safety agencies that do FF, EMS and PD.

A lot of TEMS crews are PD staffed.

And they do it because it saves money in some instances.  Only have to pay for one firehouse and can staff both your crews there.  Other places its union mandated.  Most places EMS is a lot heavier than FD so it gives the FFs something to do so we're not just paying them to sit around.  We have so many fire station sin our city that some only run once every two days or so but the guys in the medic average 6 calls a day.


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## ResTech (Aug 9, 2009)

Yes, Maryland State Police MedEvac is staffed by Paramedics who are also State Troopers who also do patrol work as well. I believe California has some Sheriffs departments that provide MedEvac with Paramedics as well. 

I agree, Fire and EMS should be separate.


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## HotelCo (Aug 9, 2009)

thatSPIKYflip said:


> This is a simple question.  Many towns mix their EMS with their FD.  Why can't they just keep the two separate?  Isn't it how the "public safety triad" works? PD deals with enforcing the law; EMS deals with medical emergencies; FD deals with fires.
> 
> On a side note: Are there any law enforcement agencies that employ EMS personnel?



They have Public Safety Officers (or as I like to call them FireMediCop) that are trained as FFs, Paramedics and Police officers. Some PDs also have tactical medics.


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## Pudge40 (Aug 9, 2009)

I think in some places it is a one word answer: POLITICS.


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## Dominion (Aug 9, 2009)

To the OP.  CAn of worms, you have just opened it.  

I agree with seperation.  I won't deny that there are tempting benefits to be had working as a fire medic out of a station vs. an EMS service that works out of the truck (like all of the services here for the most part). Although some crews do hang out in the station while not on a run.

The benefits you tend to hear in some systems are better pay, better budgets and subsequently equipment, retirement, benefits, quarters, etc.  Not like that everywhere but I do hear those benefits often.  (As to the not like that everywhere, here for example fire medics get quarters, work the truck/engine on a 50% split, pay is less than the local EMS specific services though.)

Our PD/Swat employs the local county service medics in 'detail shifts'.  There is a pool of medics who are trained for the duty and will run with various 'PD' agencies serving warrants, traffic stops for drug trafficking, etc.


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## DrankTheKoolaid (Aug 9, 2009)

*re*

Really is a matter of local economy and if the area had a FD in place first.  In area's where there was an existing FD as the areas grew the FD maintained providing in some fashion or another ems services, mostly to fluff call numbers to justify the FD existance, wages and cost to the local area's general fund as over the years with the increased fire awareness the number of actual fire calls a FD responding to is a drop in the bucket in comparison of EMS calls in the same areas.  In area's that did not start with a FD they are mostly seperate as monetarily it's not justified to pay fire system wages to run ALS EMS services.


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## 46Young (Aug 9, 2009)

The volume of suppression calls has decreased substantially in recent years. However, there still needs to be adequate staffing for suppression units - for response times, expedition of fireground tasks, and RIT duties should a FF call a mayday. Remember, a typical EMS incident is for one or two pts. A structure fire can involve many victims at once.

So, this can result in fire companies having significant downtime, even with driils, other training, public service/public ed, and station duties. 

A municipality may decide to assume EMS responsibilities for several reasons - to utilize otherwise idle personnel, to boost call volume for staffing issues, to collect revenue from EMS billing, to provide adequate coverage to the area not being provided by the previous provider.

Many would have you believe that striving for proficiency in both EMS and suppresion is spreading onself too thin, and therefore unrealistic. It is not, based on my own personal experience and observations especially if the recruit has prior experience in either discipline before crosstraining in the other. Neither discipline is rocket science, believe me, although some may not be cut out for one or the other. Both disciplines require real life field experiences to build on classroom/practical training to be solid anyway. Dual role personnel, who are crosstrained in both EMS and suppression are versatile, and can by used in either role, which helps with staffing, to reduce OT and holdovers. Medics on apparatus can initiate timely ALS care when a medic unit has an extended ETA. The engine medic can also assist the EMS unit, and ride to the hospital if needed.

Whether it be single role or dual role, fire based providers, at least in larger depts, enjoy superior working conditions, benefits, pension, 457 deferred comp, higher pay, DROP, prestige, relative lack of burnout compared to private or hospital based third service providers (typically, as ther are exceptions). Collective bargaining, good PR, and strong political support will do that.

Our dept runs EMS like a third service, except that the personnel are crosstrained and can jump from EMS to suppression as staffing requires.

Having worked private IFT, hospital based 911/IFT, third service 911 prior to firemedic, I could never go back long term. Many from similar backgrounds here have said the same. Life is sweet on this side. I can't see doing 25+ years under the working conditions/lower pay/inferior retirement(defined contribution! I'll have to work until I'm 90!) that non fire based EMS provides.


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## Dominion (Aug 9, 2009)

Another example of how services interact with each other.  Here in Louisville until the mid 70's the EMS was run from the PD or private service.  Sometime around the mid 70's the services split into Louisville EMS and Jefferson County EMS with Louisville being the 'city' service and Jefferson County being obviously the county service.  

Again in the 90's LEMS merged with Louisville Fire Department and LFD began running medics and basics within their service, this was still considered to be the city service with JCEMS being county.

Then again in 2003 the city and county governments merged creating Louisville Metro.  This effectively made the city border continous with the county border.  (Jefferson county and Louisville are essentially the same despite having smaller neighborhood cities still)

In 2005 they took the LFD and JCEMS and merged each into what is now being run, Louisville Metro EMS (LMEMS).  LMEMS provides 911 for Greater Louisville with only two exceptions.  In the small area of Anchorage and Jeffersontown.  

Anchorage Fire and Rescue provides 911 (fire and EMS) for the small city of Anchorage.  One Engine and two trucks which can be Medic/Medic or Medic/Basic depending on the shift.  Anchorage also provides backup support for LMEMS.  Anchorage calls are priorty assigned to Anchorage trucks unless already on runs.  Anchorage Fire has been around since 1910 or something like that, EMS has been in anchorage since the 70's and was established because it's pretty much the edge of the county and about 30-45 mins away from anything depending on traffic.

In Jeffersontown the local private transfer service (Yellow Ambulance) provides 911 coverage EMS while fire support is provided by a smattering of smaller local volly and paid services.  

The entire county despite having a paid fire (LMFD) has many volly services that provide support for that community.  

Hope that helps your question some on the politics and such of one area.  Maybe someone else will care to share their cities history?


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## 46Young (Aug 9, 2009)

To answer the question regarding PD employment of EMS - Nassau County PD (Long Island NY) trains their P.O.'s to EMT-B, and employs an all ALS EMS division. Most rigs have only one provider. A P.O. will arrive onscene in their cruiser, assist with pt care, and drive the unit to the hospital. Nassau County PD EMS enjoy fire service-like benefits with a 20 or 25 and out pension 
(can't remember), high salary, strong union, great work schedule, and many perks and such.


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## kecpercussion (Aug 9, 2009)

I think that EMS should definitely be separate. FDs waste a lot of time and money worrying about EMS duties. That's just my opinion


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## ResTech (Aug 9, 2009)

> FDs waste a lot of time and money worrying about EMS duties



How is time and money spent on EMS considered a waste?


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## kecpercussion (Aug 9, 2009)

Well it is hard to argue that when a fire or EMS company goes out on a call it is expensive and when they both go out it costs twice as much. And on most minor EMS calls the FD does not need to go, it is pretty easily handled by an EMS company. 

Now a larger scale EMS call is a different story don't get me wrong, but i don't think FDs need to respond to everything.


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## SanDiegoEmt7 (Aug 9, 2009)

kecpercussion said:


> I think that EMS should definitely be separate. FDs waste a lot of time and money worrying about EMS duties. That's just my opinion


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## MrBrown (Aug 9, 2009)

The very first Paramedics were firefighters; Eugene Nagel says he used the Miami fire department because had nobody else he could train and deploy out in the streets and out of what I argue was more convienence he used the fire department because they were already there.


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## Dominion (Aug 9, 2009)

kecpercussion said:


> Well it is hard to argue that when a fire or EMS company goes out on a call it is expensive and when they both go out it costs twice as much. And on most minor EMS calls the FD does not need to go, it is pretty easily handled by an EMS company.
> 
> Now a larger scale EMS call is a different story don't get me wrong, but i don't think FDs need to respond to everything.



Fire used to respond to everything.  Now fire no longer responds on medicals unless requested specifically by the crew for assistance.  Fire responds on most traumas, there is some secret formula but I don't know it.  It's a flow chart dealy on what the FD does and doesn't respond on.  Volly stations are different, they respond on almost anything if it's in their district.  Paid departments not so much.


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## 46Young (Aug 9, 2009)

kecpercussion said:


> Well it is hard to argue that when a fire or EMS company goes out on a call it is expensive and when they both go out it costs twice as much. And on most minor EMS calls the FD does not need to go, it is pretty easily handled by an EMS company.
> 
> Now a larger scale EMS call is a different story don't get me wrong, but i don't think FDs need to respond to everything.



Other than gas and mileage, it costs the no more to send suppression personnel on an EMS aid. They're already on duty primarily for suppression duties. As I've mentioned previously, FF's typically have more downtime than EMS, and using them in an EMS capacity is getting the most bang for your buck. Besides, if the pt turns out to be low acuity, the suppression piece can go in service and still remain onscene and lend a helping hand. 

Having extra providers to assist pt care can dramatically reduce onscene time, to the pt's benefit. Remember, a firemedic can deliver timely ALS care when EMS units have extended ETA's. The EMS crew's job is made easier with extra hands, and that promotes longevity due to reduced injury potential and less burnout potential. 

We don't typically send more than an EMS unit on low priority call types.

I don't understand the comment about "worrying about EMS duties".


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## 46Young (Aug 9, 2009)

Being a firemedic is very fufilling IMO, as we're truly full service providers. We can provide ALS and provide safety via suppression duties. Having 9-10 others to joke around with, beds, showers, kitchen/grill, day room, gym, attending public functions and fundraisers doesn't hurt. Good times!

Moving between EMS and suppression keeps things interesting and fresh. I like both equally as well. It keeps me motivated to improve at both disciplines. We do plenty of OOS and inservice training in both disciplines. Maintaining our CME's are a breeze as such. I could do this for 30 years with no problem. We have a blast at the station and on calls everyday. I can't see sitting on a street corner or running 20-30 calls a day for the same 30 years, though. 

We promote off of lists based on exams and educational requirements. How many EMS agencies promote for the few supervisory positions available using the "good ole boy" system? Odds are heavily in favor of the typical street EMT or medic remaining on the street for the duration of their career, save a dispatch position.


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## minneola24 (Aug 9, 2009)

If my local FD only responded to non - medical calls like fires and rescues then they would only leave the fire station like once every 1 or 2 days, so maybe here its a cost issue and since the fire stations are spread out all over the city it lowers response time to get someone medical treatment if the ambulances are far away or are busy.


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## 46Young (Aug 9, 2009)

Hey, don't get me wrong, I wish that EMS only agencies could enjoy the same benefits and conditions that fire based EMS does. If that were the case, I probably wouldn't have ever discovered the firemedic position (I worked NYC for a while and didn't know dual role positions existed until someone clued me in) and I wouldn't have had to leave NY to find a career spot that would keep my family comfortable, keep me driving to work with a smile on my face everyday, and a financially promising retirement to look forward to.

Single role EMS personnel should have better options available than those currently in existence. I don't like being slapped around, being in fear of losing my job constantly for no good reason, running a mind numbingly high call volume for 24-48 hours straight, having to work multiple jobs to survive, being one injury from the poor house. Been there, done that.


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## EMTinNEPA (Aug 10, 2009)

46Young said:


> Being a firemedic is very fufilling IMO, as we're truly full service providers.



:unsure: lolwut?

So somebody who solely does EMS work ISN'T a full-service provider?  They are shorting the patient and the public?  Also, if you don't enforce the law, are you a full service provider?


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## 46Young (Aug 10, 2009)

EMTinNEPA said:


> :unsure: lolwut?
> 
> So somebody who solely does EMS work ISN'T a full-service provider?  They are shorting the patient and the public?  Also, if you don't enforce the law, are you a full service provider?



Full service as in I can do ALS as well as rescue victims from a burning structure, burning car, below grade/high angle rescue, extrication, removal from an oxygen deficient environment, etc. etc. and so on. Full service as far as rescue and pt welfare is concerned as I'm not restricted to EMS only and can potentially save life and limb in many other ways. 

What I'm trying to say is that a firemedic can help a pt/victim in other ways than EMS only. You knew what I meant, as I'm sure others do, but you felt the need to question me anyway.


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## EMTinNEPA (Aug 10, 2009)

46Young said:


> What I'm trying to say is that a firemedic can help a pt/victim in other ways than EMS only. You knew what I meant, as I'm sure others do, but you felt the need to question me anyway.



I felt the need to question you because you are implying that those who do only EMS are somehow not fulfilling their responsibilities to the patient.  As someone who is striving to be the best provider I can be and a militant fire-EMS separatist (as you and I have discussed in detail in the past), I find that extremely insulting.


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## Ridryder911 (Aug 10, 2009)

To the original post, The reason EMS is placed into the Fire Service is because City Leaders are ignorant about EMS. Sorry, there is just so many hats one can wear and be proficient at and if they are proficient at EMS then they are lacking somewhere else. 

It was not that long ago that that the majority of EMS snubbed their noses at EMS. Until the late 80's most of the Fire Services had no desire to have EMS within their ranks. Yes, few cities absorbed the ambulance service or had rescue squads but at the same time many hospitals as well provided the service. It was not until administration foreseen the potential lack of funding and fire responses decreasing that any real sincerity was placed into having Fire Based EMS. 

It is ludicrous to have them mixed. Yes, the Fire Service has done a great job of snowballing most cities into the "what if" game. I will admit that they were able to form unions and contracts to obtain great benefits and as well as great marketing scam to continue the on going process. 

In comparison to other corporations or city services that when their need has decreased the division is down sized or abolished yet the Fire Service continues to grow. I will admit that they were definitely smart as in the PR and marketing tool as well. Each labor day we always see the public servant obtaining money for Jerry's kids or at Halloween handing out candy to the kids... You bet those things matter when deciding to increase tax revenues and city commissioner and manager votes. Unfortunately, most EMS services are too busy responding to calls to be able to perform those tasks and the crews are too tired to perform these off duty. As well, there is no accountability of what they do is really necessary or if they did a great job or not. The public assumes that the structure was a loss because of the fire... not knowing it was improperly attacked or poorly ventilated. Each major fire has a PSO officer that will inform the press and the thousands watching reminding on how heroic the members were each and every time. Seriously, they were just doing their job, yep very smart marketing tool.

I was at a conference the other day and this same discussion was made. Possible we should re-name Fire Service to EMS with fire trucks. Why not? Since the majority of responses are EMS calls with approximately only 25-35% of fire services response are fire related. Why can't EMS absorb the fire departments and manage them? I know of cities that the fire service attempted to take over a well established EMS and when the EMS offered to manage and operate the fire department at a cheaper and more efficiently the Fire Service dropped all interest in the take over. 

I do believe we will see a shift. Citizens are tired of extreme taxes. Especially seeing multiple rigs on medical calls and even on MVC with a more than 3 or 4 responding... I even ask .. why? More and more are asking; Why should we have so many if they are not responding and fire suppression numbers are down? Why should blue collared non-degree person that will be making a 6 figure income with great benefits and only have to work 120 days a year? Not a bad gig. 

EMS is medicine. Nothing more or nothing less. Not all fire services are bad in fact few are but their interest is and as it should be is fire suppression. EMS should be EMS, a third party division that can operate well that should be partially funded for overhead expense but can make it on billing and providing services. Each should be accountable upon its own. 

Work with other emergency services to provide care. It should not be a competition or just another division to provide. EMS is and needs to be independent upon it's own, accountable to itself. 

R/r 911


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## Ridryder911 (Aug 10, 2009)

46Young said:


> Full service as in I can do ALS as well as rescue victims from a burning structure, burning car, below grade/high angle rescue, extrication, removal from an oxygen deficient environment, etc. etc. and so on. Full service as far as rescue and pt welfare is concerned as I'm not restricted to EMS only and can potentially save life and limb in many other ways.
> 
> What I'm trying to say is that a firemedic can help a pt/victim in other ways than EMS only. You knew what I meant, as I'm sure others do, but you felt the need to question me anyway.



Let's be truthful. How many *real* rescues did you perform last year or better your department? I mean life saving high angle death defying rescues? In those rescues how many could be treated with first responder level care immediately then care turned over to EMS? 

Let's start comparring actual events versus potential. Be prepared you bet, but one can "what if" to death. If EMS used this philosophy then there always would be an extra crew sitting around awaiting the "big one". Again, accountability and performance. If Fire Service pay was based upon per response and performance, what do you think the salaries would be? 

R/r 911


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## 46Young (Aug 10, 2009)

I'm paid for my potential. Same as when I was EMS only previously. Some days are chill, some days you're earning your paycheck and then some. That's the nature of the business. My typical workday isn't an episode of Ladder 49, Backdraft, Emergency or Rescue Me. Just like a typical workday in NYC EMS was hardly like an episode of Third Watch. That's why I said "potential". 

Emergency services are in fact paid based on the "what if" factor. I certainly don't have a crystal ball that can predict when and where my dept's calls will occur and what those calls will entail.

As far as treating rescues at the first responder level and then turning it over to EMS, it's not necessary. I can and have jumped in the box to perform ALS immediately after performing suppression duties. We can do both, no need for outsourcing. We've got it covered.

All of that hero stuff may happen very infrequently, but we're paid to step up to the plate without hesitation when we're needed.


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## 46Young (Aug 10, 2009)

Ridryder911 said:


> To the original post, The reason EMS is placed into the Fire Service is because City Leaders are ignorant about EMS. Sorry, there is just so many hats one can wear and be proficient at and if they are proficient at EMS then they are lacking somewhere else.
> 
> It was not that long ago that that the majority of EMS snubbed their noses at EMS. Until the late 80's most of the Fire Services had no desire to have EMS within their ranks. Yes, few cities absorbed the ambulance service or had rescue squads but at the same time many hospitals as well provided the service. It was not until administration foreseen the potential lack of funding and fire responses decreasing that any real sincerity was placed into having Fire Based EMS.
> 
> ...



I've said it several times, it's really not that difficult to maintain proficiency in both EMS and suppression. Weak argument there. It's really dependent on the individual if they're motivated to keep their skills and knowledge up. 

Yes, including EMS to justify staffing, use otherwise idle personnel and receive revenue from billing is a great thing, so long as an appropriate share of $$$ goes to the EMS side. Why give that revenue away to a third party provider when the jurisdiction can use the revenue to their benefit? Win-win situation.

You say snowballing and marketing scam. I say effective campaigning, good PR and strong collective bargaining. "What if" is the nature of the business, as I've said earlier. Just like people can't buy insurance only when a car accident, house fire or devastating illness/injury occurs, we can't predict when and where an emergency will occur, and know exactly how many personnel to staff each day to cover on a day to day basis.

As far as accountability, our EMS is constantly QA/QI, is answerable to our OMD, and we are just as accountable in a court of law as any other EMS provider. Our suppression officers are required to follow manuals pertaining to any number of emergencies, not unlike EMS protocols, and can also be questioned in court for their decisions/deviation from the manual.

There are several reasons as to why we run multiple pieces on an MVA. Fairfax County has I-95, I-395, I-495, and I-66. Where 95 395 and 495 converge is affectionately referred to as the "mixing bowl". These highways have inner and outer loops. Many out of state drivers pass through. When an MVA occurs, there is frequent issue as to where the incident actually is. Oftentimes the caller gives a bad location. This area can be quite confusing to a native, let alone transient traffic. The answer is to send a medic, engine, and possibly a heavy rescue in each direction. When the incident is located, the remainder of units are places inservice. 

An engine is always dispatched for any highway incident. It blocks several lanes of traffic, offers additional hands for pt care (typically more than one pt on an MVA) and protection for a vehicle fire with the bumper line. If it's a potential pin job, a heavy rescue will be sent for extrication. That's why you'll see numerous apparatus on an MVA. In NY oftentimes only my ambulance was onscene. I've been nearly run over on several occasions.

You're right, it's not a bad gig. Why shouldn't a blue collar worker make in excess of 100k/yr? You sound resentful. Yes, I'm scheduled to work around 120 days per year. These are 24 hour days, for an average of 56 hours/wk. So base that 100k on an extra 16 hours per week. When I was clued in as to how we're hooked up in fire based EMS, I almost fell over. I was all over that, believe me.

I realized pretty early in the game that EMS only gigs weren't sustainable for a career, due to burnout, low pay, working conditions, and lousy retirement compared to fire based. I talked my wife into moving for Charleston County EMS, citing a 24/48 work schedule, state retirement, decent pay for the area. My wife and daughter hardly saw me as I'd be stuck working an extra 12-24 hours after my shift. I would come home spent and need to sleep when I actually was home. Weak potential for advancement there, with an entirely subjective promotional system, based on whether they like you or not. Now, I return home somewhat rested, and I never spend more than one day away from home, unless by choice. My salary will allow us to afford a house, provide my children for down payments for their own, the opportunity for vacations. If I decide to enter the DROP, we canuse that money, along with my pension, to buy another home down south to enjoy our retirement. third service EMS has let me down, so I've changed my reality for the better. 

What's not to like about working fire based EMS from the employee's perspective? Most houses would probably be happy to let you ride the box exclusively if you want.

We don't need to partner up or outsource our EMS. We have a whole EMS division that functions like a thirs service. It just so happens that our personnel are crosstrained and can ride on either side as staffing requires.


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## 46Young (Aug 10, 2009)

The fire service has sustained layoffs, pay freezes and pay cuts do to the economic downturn. These proportionally miniscule compared to jobs cuts in the business sector, however. It's all perspective. 

If there's this supposed shift away from fire based EMS, I haven't seen any indication of such. Fire based EMS uses idle suppression personnel to provide EMS. Crosstraining providers helps stem OT and forced OT. The jurisdiction won't want to give up the EMS revenue. If EMS happens to run in the red, I don't see how an outside provider would be willing to assume responsiblility anyway, as they would go out of business. There can always be single role fire based EMS, effectively a third service with FD benefits. A career medic or EMT would be foolish not to jump on that.

If there's a movement on the horizon to divorce EMS from suppression, you could've fooled me. Firemedics continue to be hired across the country. We faced a potential of 89 uniformed layoffs this year back in April. We've since graduated 9 firemedics and hired 20 more. FF/EMT positions are currently unavailable.

Some rural areas depend on volunteer EMS almost entirely. Hit or miss if you get ALS coverage, let alone EMS at all. Paid firemedics at local FD's would be a valuable resource.


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## 46Young (Aug 10, 2009)

Another thing, some argue that fire based EMS providers offer substandard care. If accountability is emphasised and personell receive proper ConEd/QI there's no reason why a firemedic can't provide the same proficiency in care that a single role provider does. I've witnessed plenty of poor care from single role EMS providers, so inferior care from fire based EMS if given QI/ConEd is a weak argument. 

I guess that if EMS is your sole area of expertise, it can be tough to swallow the notion that someone else could do your job well while also assuming other important responsibilities.

There's no reason why others can't go fire based, maybe just single role. EMS providers shouldn't have to work several jobs, usually in a constantly fatigued state to make a livable wage. Washington State and I think Oregon have solid third service organizations. East coast you could check out Alexandria Va, LeeCounty EMS (FL), maybe Baltimore or Philly (I don't have much knowledge of either service).


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## mycrofft (Aug 10, 2009)

*WuLAb and Pudge nailed "why"  first-out...plus "history".*

Because fire depts offered the most cost effective means to implement EMS when it started burgeoning at the beginning of the Seventies, the command structure lends itself to running the organization, and it makes money sense to use FD on something when they are not drilling, cleaning, cooking, sleeping, or actually responding to fires and other emergencies, and to provide EMS then and there rather thean waiting.

The problem is that Fire moves non-medical professionals into the professional end of the EMS operation, acting as administrators, affecting program and personnel actions hinging upon medical-professional issues versus fire/paramilitary organization issues. Some depts force firefighters to work as EMS when what they are good at and want to do is fight fire, extricate, and pet the Dalmatian (plus a dozen other very worthwhile and taxworthy public safety pursuits).


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## wyoskibum (Aug 10, 2009)

thatSPIKYflip said:


> This is a simple question.  Many towns mix their EMS with their FD.  Why can't they just keep the two separate?  Isn't it how the "public safety triad" works? PD deals with enforcing the law; EMS deals with medical emergencies; FD deals with fires.



Two words, consolidation & infrastructure

The fire service has been around a lot longer than EMS.  In a lot of communities, the Fire Dept has the infrastructure and the tax base already in place.    Why two separate departments when you can consolidate them and have one Fire/EMS Chief instead of a Fire Chief and a EMS Chief?  Why build an EMS station next door to an existing Fire Station?  Why have a fire fighter and a EMT when you can have a  Firefighter/EMT?

Now, before anybody jumps all over me, let me add this disclaimer:  I don't necessarily subscribe to such logic, but I have heard elected officials cite the above reasons.


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## boingo (Aug 10, 2009)

Yeah, and the first time there is a fatal structure fire and the first due companies are "tied up" on EMS runs the FD will cry to the city that they need more FF's, more aparatus, more $$$ etc....You don't see any big city FD's looking to merge with PD's to "save money", in fact the IAFC recently released a position statement adamantly opposed to the merger of FD's and PD's, although have no problem with EMS.  Perhaps FD's should look to stay busy patching roads or working for the water and sewer department?  

If a FD and EMS agency are to merge, EMS should absolutely be the ones running things.


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## 46Young (Aug 11, 2009)

EMTinNEPA said:


> I felt the need to question you because you are implying that those who do only EMS are somehow not fulfilling their responsibilities to the patient.  As someone who is striving to be the best provider I can be and a militant fire-EMS separatist (as you and I have discussed in detail in the past), I find that extremely insulting.



That post was not meant to belittle EMS efforts. when I decided to become a medic, part of the reason was to be able to do more for my pts. Adding suppression capabilities is a continuation of that line of thinking from my perspective. I can provide ALS, and I can help pts/victims in even more ways.

If I'm a single role provider, when I'm first onscene at a vehicle fire with trapped occupants, I can't do jack. Suspected CO posioning in an apartment with unconscious pts inside, can't do jack. Car runs down an embankment, lands in such a way that critically injured pts are trapped, can't do jack. First onscene at a house fire and a mother runs outside and advises that her child is stuck up in the bedroom. Can't do jack.


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## alphatrauma (Aug 11, 2009)

46Young said:


> I've said it several times, it's really not that difficult to maintain proficiency in both EMS and suppression. Weak argument there. _It's really dependent on the individual if they're motivated to keep their skills and knowledge up._



You my friend, along with many others (FF/Medic) like you, are the minority... in my experience. Most FF I've talked to, and precepted under, HATE EMS and only do it for the pay increase (or because they have to). They want to fight fires and ride the engine, not deal with patients... and it shows, through their apathetic attitude and pisspoor patient care. I will admit, there are those who enjoy/excel at both, but they are few and far in between.




46Young said:


> I guess that if EMS is your sole area of expertise, it can be tough to swallow the notion that someone else could do your job well while also assuming other important responsibilities.



Just _doing_ your job and doing it well, are two entirely different matters. What is really tough to swallow, is the fact that governments/municipalities would rather fund exorbitant retirements and ridiculous pay bonuses, rather than fund/fortify a standalone progressive EMS system.



46Young said:


> Most houses would probably be happy to let you ride the box exclusively if you want.



Aint that the truth. I had no qualms in telling station crews (Capts/LTs etc), during my field rotations, that I had absolutely no interest in firefighting and wanted to do EMS only... didn't go broadcasting it, but if asked I pulled no punches about my thoughts of firebased EMS. Seemed like it made them want to recruit me that much more. They appreciated my honesty and joked that I could ride the medic everyday if I wanted. 


Sure, I (or any other medic) could join a fire service for the money and perks... but at what cost? I'm sure FFs don't want someone standing next to them, at a structure fire, that doesn't want to be there. And I damn sure wouldn't want some hack riding with me on serious calls. How does one maintain proficiency and excel at something they don't want to do? Maybe I should just join a fire service and rake in the dough... I'll just sandbag anytime I have to roll in turnout gear.


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## Ridryder911 (Aug 11, 2009)

46Young said:


> That post was not meant to belittle EMS efforts. when I decided to become a medic, part of the reason was to be able to do more for my pts. Adding suppression capabilities is a continuation of that line of thinking from my perspective. I can provide ALS, and I can help pts/victims in even more ways.
> 
> If I'm a single role provider, when I'm first onscene at a vehicle fire with trapped occupants, I can't do jack. Suspected CO posioning in an apartment with unconscious pts inside, can't do jack. Car runs down an embankment, lands in such a way that critically injured pts are trapped, can't do jack. First onscene at a house fire and a mother runs outside and advises that her child is stuck up in the bedroom. Can't do jack.



As well in the role of a F/F can't do jack either. Sorry, poor analogy. You have a CO patient, you will have to gear up and go get the patient, remove the patient and then when in a safe area treat the patient. 

Guess what? I'll be there waiting for the patient to do the treatment. 

Car runs down embankment. Not in FD but never has stopped me or any of the EMS I have been in to be the first inside the vehicle when the it is secured. Don't see your point. 

Extrication and or rescue is not EMS. Totally separate issues. One does not have to be medically educated to perform any of those task. Simple first aid can temporary treat until professional help. One is not to establish an IV inside that CO house or inside an house fire. 

I understand your desire to do rescue. I was a Fire Officer for a while and entered Fire Service with a degree and cert.'s to do it the right way. I too at one time believed I should be able to deliver care when and where it was needed. I was wrong. I had fellow firefighters that was no more than first responders that taught me different. Very little treatment is going to be performed while in the rescue portion. Oxygen, simple splinting and bleeding (all within EMR) and then patient to a safe designated area where more aggressive treatment can be performed. In reality if EMS is there they can perform the ALS tx needed and you can return to the rescue or rest as one should. 

As well, how many times has one induced asthmatic or respiratory problems by having smoke or chemical smell off the bunker or equipment? How well is the manpower of many Fire Services not needed those additional two persons for the line? 

Again, there is no reason to force Fire Service to be any higher than EMR. Even EMT would be stretching it. Do to their fast responses simple treatment with simple equipment has demonstrated the best outcomes. CPR, oxygen, simple controlling of bleeding and immobilization within the first few minutes all of these can be provided by good first aid care. Followed up by good sound medical care by EMS (ALS level). 

Flooding the staff with Paramedics within the fire service does not demonstrate any advantages rather the opposite in decreasing skill levels. Having extra hands at such scenes, yes is beneficial and again there would be no change except the line firefighter could resume their primary role as the patient is cared for or transported. Thus reducing the number needed. 

R/r 911


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## downunderwunda (Aug 11, 2009)

46Young said:


> Another thing, some argue that fire based EMS providers offer substandard care. If accountability is emphasised and personell receive proper ConEd/QI there's no reason why a firemedic can't provide the same proficiency in care that a single role provider does. I've witnessed plenty of poor care from single role EMS providers, so inferior care from fire based EMS if given QI/ConEd is a weak argument.
> 
> I guess that if EMS is your sole area of expertise, it can be tough to swallow the notion that someone else could do your job well while also assuming other important responsibilities.
> 
> There's no reason why others can't go fire based, maybe just single role. EMS providers shouldn't have to work several jobs, usually in a constantly fatigued state to make a livable wage. Washington State and I think Oregon have solid third service organizations. East coast you could check out Alexandria Va, LeeCounty EMS (FL), maybe Baltimore or Philly (I don't have much knowledge of either service).




Answer me one simple question. 

How many proper Fire calls are attended annually, & how many EMS calls do you run annually?

Now, calculate how much it costs to run a fire service & the income generated from those calls.

Repeat for EMS.

REALITY CHECK - EMS SHOULD RUN FIRE.


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## atropine (Aug 11, 2009)

To the op, so you get a hero when you call 911, everything else is substandard, just kidding. In some parts of the country that's just how ems is delievered.


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## eynonqrs (Aug 11, 2009)

EMS needs to stay EMS. Fire Dept's have no business to run EMS. This is all a ploy to jack up response numbers to keep firehouses open, and get fancy toys. I know of a few "fire dept" based ambulances, either paid or volunteer that want to break away because they are tired of the non sense. I am glad that I work for and volunteer for a non fire dept based service. We have better equipment, proper training and don't have to answer to smoke eaters that have no clue how to run a proper EMS service.


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## 46Young (Aug 12, 2009)

Ridryder911 said:


> As well in the role of a F/F can't do jack either. Sorry, poor analogy. You have a CO patient, you will have to gear up and go get the patient, remove the patient and then when in a safe area treat the patient.
> 
> Guess what? I'll be there waiting for the patient to do the treatment.
> 
> ...



Yes, a single role FF can't do much for the pt after pulling them from a hazardous environment. When I said that a firemedic can help pts/victims in more ways than medics, I didn't necessarily mean using both EMS and suppression skills at the same time. I have done that on occasion, however. Like the time I pulled the bumper line for a quick knock on a car fire. The Lt ordered me to jump on the one-and-one medic to txp the pt to the hosp (I stripped out of my bunkers, due to off-gassing). What I'm trying to say is that I'm able to do other things to help that are past the medic's scope and role. I don't mean to belittle medics, I just want to be capable of more. It's loosely analagous to medics striving for an increase in scope of practice. Having the ability to do more good.

I've climbed in many a car with trapped occupants. What I meant is that you may have no access to a pt without extrication. I'm not TROT, but we do carry cutters/spreaders, sawzall, and a small amount of shoring equipment on our engines. No extrication, no stabilization of the vehicle, no access to the pt. We do drills with the Tower for stokes basket operations as well. The medic hooks in and rides with the pt in the basket.

Yes, extrication, rescue, and EMS are seperate disciplines. Being trained in each gives one the opportunity do more for a pt or victim than a single role provider. Just because it isn't straight up EMS doesn't mean that the pt isn't being helped in other important ways that may directly affect their well being.

If I was exposed to an IDLH, I'll always strip my gear before pt care. If I'm toned out during PT I don't respond in bunker pants, I'll use my coveralls. 

I'll have to agree with you on the problem of flooding the scene with medics. In addition, the paramilitary structure has Lt's in the lead role, oftentimes with the second or third medic being "skills medics" only, not having to do any critical thinking. It's better than having too few, or none at all in some cases, however.

The fire service and single role EMS agencies both have many examples of well run EMS and piss poor EMS. It's too difficult to just say one is definitively better than the other. Same thing for FD's taking suppression pieces out of service to run EMS calls. Is the service resource rich, or will response times suffer severely? Would there be medic coverage otherwise, would there be no ALS available for an extended period of time if not for an ALS engine?

We could go on ad nauseum all day with examples of depts that are run well to support our positions, as well as depts that are run horribly to discredit the other side's position. Things vary too much from place to place to be able to make blanket statements such as "All EMS should be seperate from fire", "Fire based EMS is the best", "Fire/EMS should be run by EMS not fire", "All private EMS are only profit driven and have lousy pt care", "FF's shouldn't be trained over EMR", "Third service EMS providers are burnt, and don't take their job seriously as they're just using it as a stepping stone" or "Doing both EMS and suppression well is impossible as you're spreading yourself too thin". We can all find examples supporting each blanket statement, as well as examples to the contrary.


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## nomofica (Aug 12, 2009)

HotelCo said:


> They have Public Safety Officers (or as I like to call them FireMediCop) that are trained as FFs, Paramedics and Police officers. Some PDs also have tactical medics.



My PD has TEMS. Although our FD and EMS aren't integrated, I know that one of our suburb communities' FD and EMS are (my EMR instructor was a FF/EMT-P with said community). 

My stance on the integration is big city = no go, rural/suburb community w/ lower population = probably not a bad idea.


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## 46Young (Aug 12, 2009)

nomofica said:


> My PD has TEMS. Although our FD and EMS aren't integrated, I know that one of our suburb communities' FD and EMS are (my EMR instructor was a FF/EMT-P with said community).
> 
> My stance on the integration is big city = no go, rural/suburb community w/ lower population = probably not a bad idea.



that actually sounds like a good rule of thumb.


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## 46Young (Aug 12, 2009)

One thing's for sure, fire based EMS, at least at Coastal Cali, AZ, MD/DC/NoVa and similar places have a WAY better deal for the worker. Instead of demonizing fire based EMS and crying about how we've got the juice, how about trying to actually DO something about it?

http://www.emtlife.com/showthread.php?t=14273

Or you could just sit there, and whine "FDEMS sucks, it's not fair, they're taking over, they're paid too much, wah wah wah"! I, for one, don't want to work until I'm 90 and have to decide between paying for meds, food, or electricity. I've seen way too many elderly who don't have a pot to pee in or a window to throw it out of, as the saying goes. It shouldn't be that way. I'm not going out like that. Are you?


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## 46Young (Aug 13, 2009)

downunderwunda said:


> Answer me one simple question.
> 
> How many proper Fire calls are attended annually, & how many EMS calls do you run annually?
> 
> ...



REALITY CHECK - IT'LL NEVER HAPPEN AS LONG AS EVERYONE COMPLAINS RATHER THAN ORGANIZING AND GETTING THEIR SHARE. THE FIRE SERVICE HAS THE JUICE, PLAIN AND SIMPLE. I started a thread in regards at the lounge.

It's not as simple as comparing call volume. It's analagous to buying insurance after you sustain an injury, illness, or robbery. You need to be prepared for the "what if"? When a structure fire or other significant event happens, there needs to be adequate resources to handle the incident. If they're mostly idle otherwise, that's besides the point. Now, what could we do with the idle FF's to better utilize their downtime? Oh wait...... that's right.......

Other than parking and speeding tickets, how much revenue does a PD generate? Should they be running fire or EMS? I don't follow the logic. 

The FD will already have the infrastructure in place. It doesn't take too much to add some medics and ALS equipment for their engines.


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## Seaglass (Aug 13, 2009)

46Young said:


> that actually sounds like a good rule of thumb.



I agree. 

Of the urban places I've seen, only one place with mixed fire/EMS doesn't have all kinds of issues. My cynical side says it's because they're all focused on waging war with the private companies. 

I volunteer with a rural fire/EMS service. It's just too small to have a fire/EMS rivalry going on... if you don't get along with even one person, you're really not going to be able to avoid working with them. So not getting along with half the department isn't an option. 

It seems like training's also important. Both places I mentioned require or strongly encourage everyone to train and run calls for both sides.


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## subliminal1284 (Aug 13, 2009)

Studying Kung Fu I once asked my sifu why its not a good idea to study many arts and he told me an old chinese saying..."Practices many, master of none"


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## Seaglass (Aug 13, 2009)

subliminal1284 said:


> Studying Kung Fu I once asked my sifu why its not a good idea to study many arts and he told me an old chinese saying..."Practices many, master of none"



Funny how many accomplished martial artists have studied more than one discipline.


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## subliminal1284 (Aug 13, 2009)

That was his point, you can be good in more than one, but you will never be a master of any of them.


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## atropine (Aug 13, 2009)

subliminal1284 said:


> That was his point, you can be good in more than one, but you will never be a master of any of them.



So what your saying is ems is okay, since the Dr.'s are the masters and we can still practice ems and suppression, I mean you take the patient to the er for the (Master) Dr. right?


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## subliminal1284 (Aug 13, 2009)

You didnt comprehend the meaning of the saying at all did you? 

All it means is if you are trying to perform several acts you will never be as good in anyone of those acts as if you were studying and putting all your focus in to just one.


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## Seaglass (Aug 13, 2009)

subliminal1284 said:


> All it means is if you are trying to perform several acts you will never be as good in anyone of those acts as if you were studying and putting all your focus in to just one.



Or maybe the variety will mean you'll last longer before burning out.

I'm not sure it's an ideal solution, but there are some good firemedics out there. I can see how it's hard to have other options with small budgets.


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## MRE (Aug 13, 2009)

Seaglass said:


> Or maybe the variety will mean you'll last longer before burning out.



How about having enough calls with EMS and FD combined to keep people interested and active, where separate there are too few calls to do so.


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## 46Young (Aug 13, 2009)

Most people trying to master  a specific martial art practice for what, maybe two to three days per week for two hours. Maybe they get to black belt, and maintain that while they round themselves out with another art. If MMA's didn't adapt by learning several disciplines, the Gracie clan would still be undefeated to this day. Remember the old videos of various accomplished stand up artists getting tapped easliy by the Gracies? 

A firemedic will have had completed a medic program and a FF 1 and 2 academy at a minimum. Bonus points if you've worked for several years prior to crosstraining for the dual role position. We do regular EMS ConEd on duty, as well as EMS in station drills. We even go over a protocol in detail every monent at lineup. We also have a training matrix that mandates a number of company suppression drills monthly. We are also regulary taken out of service as a company while on duty for multi unit drills. This can be a live burn, maze training, throwing ladders/flowing water, medevac drill, etc. etc. Certainly more training than 6 hours a week between running calls and drills, to address your weak analogy regarding mastering martial arts.

I'm not saying that every dept does it like this, but our setup makes it optimal for maintaining proficiency in both disciplines. we're certainly not spreading ourselves too thin, despite what many may claim. Sorry (not really).


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## 46Young (Aug 13, 2009)

Seaglass said:


> Or maybe the variety will mean you'll last longer before burning out.
> 
> I'm not sure it's an ideal solution, but there are some good firemedics out there. I can see how it's hard to have other options with small budgets.



Agreed that doing both helps protect against burnout. I can definitely do this for 30 years, barring a devastaing injury/illness. Way more advancement opportunities, too.


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## alphatrauma (Aug 13, 2009)

Question...

- How would being a Paramedic make one a better Firefighter?
- How would being a Firefighter make one a better Paramedic?

Let's set aside pensions, burnout, bonuses, politics, etc...

If Joe FF is on scene during a structure fire, what element of his Paramedic training/education will help him in suppressing the blaze?

If John EMT-P is treating a critical CHF patient, what element of his FF education/training will enhance his ability to properly assess and treat this patient in the field?

Fire and EMS are not synonymous or interchangeable. It is a marriage of convenience, and statistically speaking, it's days are numbered. You do not need to be ALS to fight fires or extricate patients, nor do you need to be versed in fire science to provide ALS interventions.


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## subliminal1284 (Aug 13, 2009)

I am actually not against fire/ems being combined, In places with low call volume it just doesnt make economic sense to have a budget for fire and ems separately.


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## firecoins (Aug 13, 2009)

we should combine sanitation with EMS.  At least we have the same pickup time of 5AM.


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## 46Young (Aug 13, 2009)

alphatrauma said:


> Question...
> 
> - How would being a Paramedic make one a better Firefighter?
> - How would being a Firefighter make one a better Paramedic?
> ...



You're right, being a paramedic doesn't make one a better firefighter.
Being a firefighter doesn't make one a better paramedic, either. 
I never said it did. What I HAVE said is that being one won't necessarily detract from the other, provided one keeps up on their skills and Con Ed.

Statistically speaking, huh? Tell that to all of the firemedics that continue to be hired despite the dismal economic situation. I have observed station closings, RIF's, pay cuts and pay freezes, but nothing near the scale that others have suffered in the business sector. I think either Rid or Vent mentioned that even some RN's have been laid off, and it's increasingly difficult for new grads to find work. The handwriting is hardly on the wall regarding the fire/EMS marriage.

You're right, you don't need a P-card to be good at suppression, nor do you need FF 1&2 to be a good medic. It has been proven that one can do both, however. I'm currently paid about 15 grand or so over a basic FF. So, it costs Fairfax 15 grand/yr to supply an engine with an ALS qualified FF rather than a basic FF, giving an extra unit available for ALS coverage, a unit with a significant amount of downtime, statistically speaking. Compare that with the cost of a chase car with a medic.

You're right, fire and EMS is a marriage of convenience. It also happens to work well if run properly. It will continue to do so due in large part to unions, good PR, political muscle, etc.


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## medic417 (Aug 13, 2009)

firecoins said:


> we should combine sanitation with EMS.  At least we have the same pickup time of 5AM.



And water department should take over fire as the both play with water.


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## firecoins (Aug 13, 2009)

medic417 said:


> And water department should take over fire as the both play with water.



and police and library should be one organization because they both go by the book.  Judges just throw books from benches.


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## medic417 (Aug 13, 2009)

firecoins said:


> and police and library should be one organization because they both go by the book.  Judges just throw books from benches.



I think with our plans we can solve the budget crisis of the nation.B)


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## atropine (Aug 13, 2009)

subliminal1284 said:


> You didnt comprehend the meaning of the saying at all did you?
> 
> All it means is if you are trying to perform several acts you will never be as good in anyone of those acts as if you were studying and putting all your focus in to just one.



Why do I have to be good or (Master) just one thing, why can't I do both, I mean for crying out loud our job is to get the patient to definitive care right? I don't think I need a degree to do that. I mean unless I am wrong, to me definitive care is a Dr., lab, cath lab, x-rays etc. I don't carry any of those on my rig.


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## alphatrauma (Aug 13, 2009)

atropine said:


> Why do I have to be good or (Master) just one thing, why can't I do both, I mean for crying out loud our job is to get the patient to definitive care right? *I don't think I need a degree to do that. *I mean unless I am wrong, to me definitive care is a Dr., lab, cath lab, x-rays etc. I don't carry any of those on my rig.



Most who lack degrees don't.


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## firecoins (Aug 13, 2009)

I know people employed separtely as both firefighters with the FDNY and work at a NYC voluntary hospital as a perdiem medic.  They do both quite well without difficulty.  

As a medic who is not a firefighter I oppose the combined FF/Medic due to the loss of medic only jobs.  I have no interest in firefighting. I want the ability to do 911 EMS without being a firefighter.


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## 46Young (Aug 13, 2009)

Thanks, I forgot all about that. There are some FDNY firefighters that work at local hospitals doing 911 medic work. One of my old partners is a FF and he also works per diem at NSUH Manhasset as an RN!


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## atropine (Aug 13, 2009)

alphatrauma said:


> Most who lack degrees don't.



I am not I don't have a degree, even in the fire service you need at the very least an AAS to promote, but unless Iam wrong nobody is carrying x-ray machines or lab stations with them.


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## 46Young (Aug 14, 2009)

atropine said:


> I am not I don't have a degree, even in the fire service you need at the very least an AAS to promote, but unless Iam wrong nobody is carrying x-ray machines or lab stations with them.



Medic cert gets us 12 points on a promotional exam!


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## alphatrauma (Aug 14, 2009)

firecoins said:


> As a medic who is not a firefighter I oppose the combined FF/Medic due to the loss of medic only jobs.  I have no interest in firefighting. *I want the ability to do 911 EMS without being a firefighter.*



.... Werd!


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## ResTech (Aug 14, 2009)

Im with ya Firecoins... I don't agree with duel-role positions either. Even though Im told if all u want to do is ride the Medic unit someone assigned to the Medic unit would be more than happy to switch with ya.... 

I still think Paramedic jobs should be separate. I have my State Firefighter I cert but just not into fire suppression. Rescue work I would love though.


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## 46Young (Aug 14, 2009)

firecoins said:


> I know people employed separtely as both firefighters with the FDNY and work at a NYC voluntary hospital as a perdiem medic.  They do both quite well without difficulty.
> 
> As a medic who is not a firefighter I oppose the combined FF/Medic due to the loss of medic only jobs.  I have no interest in firefighting. I want the ability to do 911 EMS without being a firefighter.



I do see your point. Other than Alexandria Fire and EMS (100% seperate EMS division), there aren't any other paid 911 EMS agencies in Northern Va. I'll obviously disagree with anyone that says EMS should be seperate from fire as a blanket statement, but there should be options regionally for those who want single role medic work only.


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## atropine (Aug 14, 2009)

ResTech said:


> Im with ya Firecoins... I don't agree with duel-role positions either. Even though Im told if all u want to do is ride the Medic unit someone assigned to the Medic unit would be more than happy to switch with ya....
> 
> I still think Paramedic jobs should be separate. I have my State Firefighter I cert but just not into fire suppression. Rescue work I would love though.



Why should it be separate?, what are you going to do as a medic that you can't learn to do anything thing else. We as paramedics aren't performing surgery in the back the ambulance, your taking them to a place so they can recieve definitive care.


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## JPINFV (Aug 14, 2009)

Maybe because some of us value being able to provide care beyond reciting protocols written at an 8th grade science and reading level.

Maybe because some of us value being able to provide care without contacting medical control (like, you know, Los Angeles County). 

Better question. What does being able to roll hose or throw a ladder have to do with providing medical care?


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## EMTinNEPA (Aug 14, 2009)

This is ridiculous!

The only reason fire has ANY involvement in EMS is because when EMS was created, the firefighters were already there.  EMS back then consisted of a ride to the hospital, nothing more!  When somebody realized that what was done in an emergency room wasn't physically impossible out in the world, the game started to change.  Now EMS would be well on its way to being viewed as a genuine medical profession if it weren't for the fire departments with their three month medic mills, cookbook medicine, and medics who are medics just because they wanna wide in tha firetwuck!  Do you think if a paramedic's educational level were on par with a PA or RN and medics everywhere were taught to operate autonomously instead of following protocols to the letter that people could say "oh, I can be a master of two trades instead of just a jack", or that we would even be having this conversation?  Somehow I doubt it.  Somehow I doubt I would be sitting here wondering how I'm going to score two full-time positions after medic school so that I can live with a little financial security.


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## Ridryder911 (Aug 14, 2009)

atropine said:


> Why do I have to be good or (Master) just one thing, why can't I do both, I mean for crying out loud our job is to get the patient to definitive care right? I don't think I need a degree to do that. I mean unless I am wrong, to me definitive care is a Dr., lab, cath lab, x-rays etc. I don't carry any of those on my rig.



Obvious, you have not learned to master either profession. Under what standards and definition are you using to label you as having "mastered" EMS or "Fire Service"? As one that has a degree in both areas, I can assure you I doubt that anyone could master both. Even your asinine statement displays your lack of understanding of emergency medicine and especially prehospital care. 

Define what is definitive care?  Surgery. ICU. or even dismissing a patient? What about services that actually treat and never transport and leaves patient education material alike the hospital? 

Thank goodness, the old days of being able to place a patch on anyone will soon be over! Requiring statistics to be able to read journals (without pretty pictures), having academic level of anatomy and physiology so practitioners actually may know not just the parts of the body but how the body actually works- even at a cellular level. Since the majority of our care is geared to that (unfortunately the majority are not educated enough to recognize that). 

Even EMR level will be introduced to Public Health and each level will increase. I and others are hoping that the focus will be placed upon medicine. So much, there will be no time to allow anything else as well as accountability will be raised so those that do not know it, will be removed by infrastructure or litigation(s). In other words, calling oneself a  master of multiple things will be much harder when one has to truly and fully understand the profession and be held accountable. Labeling one self a master; will have qualification both academic and clinical practice. 

R/r 911


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## atropine (Aug 14, 2009)

[

Better question. What does being able to roll hose or throw a ladder have to do with providing medical care?[/QUOTE]

It seperates the men from the boys.,


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## atropine (Aug 14, 2009)

EMTinNEPA said:


> This is ridiculous!
> 
> The only reason fire has ANY involvement in EMS is because when EMS was created, the firefighters were already there.  EMS back then consisted of a ride to the hospital, nothing more!  When somebody realized that what was done in an emergency room wasn't physically impossible out in the world, the game started to change.  Now EMS would be well on its way to being viewed as a genuine medical profession if it weren't for the fire departments with their three month medic mills, cookbook medicine, and medics who are medics just because they wanna wide in tha firetwuck!  Do you think if a paramedic's educational level were on par with a PA or RN and medics everywhere were taught to operate autonomously instead of following protocols to the letter that people could say "oh, I can be a master of two trades instead of just a jack", or that we would even be having this conversation?  Somehow I doubt it.  Somehow I doubt I would be sitting here wondering how I'm going to score two full-time positions after medic school so that I can live with a little financial security.



I think if a paramedics education was on par with a PA's or RN there would be no paramedics, because who do this job for $12.00 per hour. Two trade isn't all that bad pay scale wise, I made more than the RN supervisor last year at one of the local hospitals, and still went on two 3 week vacations.^_^


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## VentMedic (Aug 14, 2009)

atropine said:


> I made more than the RN supervisor last year at one of the local hospitals, and still went on two 3 week vacations.^_^


 
I believe we already calculated out your $100k from last year in another thread. You had to work well over 3000 hours to make that. The RN supervisor only had to work 3 - 12 shifts per week or about 1800 hours to make the same in CA. If you were to work the same number of hours as the RN, you would be in the low income group. The one thing that strikes fear into the heart of every FD employee and union is going to a 40 hour work week. The perks would be gone.   Right now that is being discussed as an option for a FD in norther CA.


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## ResTech (Aug 14, 2009)

If your gonna do this job I think the goal should always be to "master"... even if the goal is unobtainable in this field, it is the only goal to be shooting for.

There are prob a lot of great Paramedics that cities don't ever get to consider because they don't (or won't) want to be a Firefighter. Fire and EMS are TOTALLY different fields. The only thing that blends them is tradition, convenience of delivery by already having fire stations in the community, and similar vehicles. The core of EMS which is direct patient care, has nothing to do whatsoever with the fire service and I think this confuses many Firefighters and fire service administrators. 

Many firefighters see EMS as a pay grade increase or something that is forced on them of which they comply so they can live their dream of being a career Firefighter. Tell me this isn't true with a large majority?


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## JPINFV (Aug 14, 2009)

atropine said:


> I think if a paramedics education was on par with a PA's or RN there would be no paramedics, because who do this job for $12.00 per hour. Two trade isn't all that bad pay scale wise, I made more than the RN supervisor last year at one of the local hospitals, and still went on two 3 week vacations.^_^


If paramedic education was more like RNs or PAs then the pay would be higher than $12/hr.


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## Onceamedic (Aug 14, 2009)

JPINFV said:


> If paramedic education was more like RNs or PAs then the pay would be higher than $12/hr.



Holy crap! you make 12$ and hour?  Here in our neck of the woods a brand new baby medic starts at 10.50 - but I did get an 18 cent an hour raise last year....


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## 46Young (Aug 14, 2009)

JPINFV said:


> If paramedic education was more like RNs or PAs then the pay would be higher than $12/hr.



Not without unions or strong political organizations to force employer's hands in that regard. Look at the fire service in the Carolinas. Right to work states. There are FF's making $8/hr that need to work multiple 72 hour shifts to survive. There are firemedics in Sc, Mt. Pleasant for one, who are only starting around 30 grand or so. Stark contrast to FF's in CA making 100k, or FDNY FF's topping out in the 60's after 5 years. 

See the post above, I'm sure they could use some backing to improve their situation. I'm sure that their employers aren't going to care if new medics have more education, as long as there's more warm bodies to backfill the position. The medic supply isn't exactly going to dry up just because there's a mandated requirement of 2-3 years education or whatever. Medic pay will always be subject to supply and demand, unless a good union or political organization can negotiate for a better deal.


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## Onceamedic (Aug 14, 2009)

46Young said:


> Not without unions or strong political organizations to force employer's hands in that regard. ......
> 
> See the post above, I'm sure they could use some backing to improve their situation.



Attempts at unionization a couple of years ago led to supervisor harassment and other tactics that broke the attempt.  We run 48 hour shifts and I personally average 20 calls on that shift.  Standup 48s (2, may 3 hours of sleep the entire set) are not rare.  You can be on the back end of the 48 and be forced to take a long distance transfer of 4 hours one way.  It is dangerous.  It may take massive lawsuits/deaths before anything changes.  I am open for any advice or assistance any of you may care to render.


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## 46Young (Aug 14, 2009)

EMTinNEPA said:


> This is ridiculous!
> 
> The only reason fire has ANY involvement in EMS is because when EMS was created, the firefighters were already there.  EMS back then consisted of a ride to the hospital, nothing more!  When somebody realized that what was done in an emergency room wasn't physically impossible out in the world, the game started to change.  Now EMS would be well on its way to being viewed as a genuine medical profession if it weren't for the fire departments with their three month medic mills, cookbook medicine, and medics who are medics just because they wanna wide in tha firetwuck!  Do you think if a paramedic's educational level were on par with a PA or RN and medics everywhere were taught to operate autonomously instead of following protocols to the letter that people could say "oh, I can be a master of two trades instead of just a jack", or that we would even be having this conversation?  Somehow I doubt it.  Somehow I doubt I would be sitting here wondering how I'm going to score two full-time positions after medic school so that I can live with a little financial security.



I was like you once. I was trying to figure out how to survive on a medic salary, trying to schedule PT jobs, and somehow have more than a few bucks for retirement. Many medics become "stuck" because the money is just good enough to survive, if you're working 60-80 hours/wk or more. There's often no feasable way to continue your education if you need the two jobs to pay the bills, support a family, mortgage, etc. Catch 22. No time. 

I was pointed in the direction of the fire service, and should be well off in retirement. I'd be happy to join, give money for and actively participate in activities to further the profession through union and other political organizations. 

Rid says that higher educational standards and accountabilty will be a reality in the near future. I cerainly hope so. Any future providers should be "legit" and be proficient no matter what service they work for. Maybe my children will be able to work TSEMS with FD quality conditions.

You can remain bitter, and work yourself to the bone until you're 90, or you can take real steps to change your reality. 
http://www.emtlife.com/showthread.php?t=14273


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## 46Young (Aug 14, 2009)

Kaisu said:


> Attempts at unionization a couple of years ago led to supervisor harassment and other tactics that broke the attempt.  We run 48 hour shifts and I personally average 20 calls on that shift.  Standup 48s (2, may 3 hours of sleep the entire set) are not rare.  You can be on the back end of the 48 and be forced to take a long distance transfer of 4 hours one way.  It is dangerous.  It may take massive lawsuits/deaths before anything changes.  I am open for any advice or assistance any of you may care to render.



Move somewhere that has better conditions. that's what I did. seriously, our union supports certain candidates pulclicly for election/re-election, lobbies, and does various charities, such as the MDA "Fill The Boot", AHA Heart Walks, and the like. Each paycheck many of us volunteer $5 to be used for lobbying and other political gain. 

You'll need almost everyone to be onboard to thwart efforts by management to break up organization. "Strength in Solidarty". If your people are easily intimidated, it'll never happen. You'll all need to stay the course. You could attach to another local, perhaps even the IAFF as some others have done. they'll be a valuable resource. 

With political muscle, you'll be able to lobby or otherwise put forth legislation to abolish shifts in excess of 24 hours. Getting air time or other forms of advertisement to warn the public of the deadly dangers of extended shifts would be a great idea as well.


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## Onceamedic (Aug 14, 2009)

EMTinNEPA said:


> This is ridiculous!
> 
> When somebody realized that what was done in an emergency room wasn't physically impossible out in the world, the game started to change.



I think what actually created our "profession" was a famous study that demonstrated that soldiers wounded on the battle field in Vietnam had a better chance of survival than a civilian in an MVA.  This disparity was explained by trained battle field medics and fast transport to definitive care.


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## atropine (Aug 14, 2009)

VentMedic said:


> I believe we already calculated out your $100k from last year in another thread. You had to work well over 3000 hours to make that. The RN supervisor only had to work 3 - 12 shifts per week or about 1800 hours to make the same in CA. If you were to work the same number of hours as the RN, you would be in the low income group. The one thing that strikes fear into the heart of every FD employee and union is going to a 40 hour work week. The perks would be gone.   Right now that is being discussed as an option for a FD in norther CA.



What are you talking about?, have you looked at a recruitment flyer latley, Orange County Fire Authority max out thier base salary for FF/medics at about 90k a year without any over time, so does the city of Anaheim. Not bad cas for dual role, agin we are taking the pt to the hospital for definitive care, you don't need a two year degree to do that.


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## EMTinNEPA (Aug 14, 2009)

46Young said:


> The medic supply isn't exactly going to dry up just because there's a mandated requirement of 2-3 years education or whatever. Medic pay will always be subject to supply and demand, unless a good union or political organization can negotiate for a better deal.



How do you know?  Two or three years as opposed to six months would certainly separate "the boys from the men", as it was so put earlier in this thread.  Also, if the states went with a national standard and started cracking down on accredidation, a lot of unaccredited medic programs would cease to exist.  The remaining programs would still put out the same number of graduates.  Higher demand and lower supply means you gotta sweeten the deal to meet your demand.


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## 46Young (Aug 14, 2009)

EMTinNEPA said:


> How do you know?  Two or three years as opposed to six months would certainly separate "the boys from the men", as it was so put earlier in this thread.  Also, if the states went with a national standard and started cracking down on accredidation, a lot of unaccredited medic programs would cease to exist.  The remaining programs would still put out the same number of graduates.  Higher demand and lower supply means you gotta sweeten the deal to meet your demand.



Good, I hope you're right. you shouldn't need two full time jobs to stay off of welfare.


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## 46Young (Aug 14, 2009)

VentMedic said:


> I believe we already calculated out your $100k from last year in another thread. You had to work well over 3000 hours to make that. The RN supervisor only had to work 3 - 12 shifts per week or about 1800 hours to make the same in CA. If you were to work the same number of hours as the RN, you would be in the low income group. The one thing that strikes fear into the heart of every FD employee and union is going to a 40 hour work week. The perks would be gone.   Right now that is being discussed as an option for a FD in norther CA.



How would a 40 hour workweek benefit a FD financially? We work 56 hours/wk here, and due to current FLSA mandates, all 56 hours are straight time. OT is paid at a higher rate, though, than if we were paid straight for 40 hours and 1.5 time for the last 16. 

To reduce work hours to 40/wk would require a dept to hire additonal personnel, with all associated redruitment/academy costs, as well as medical, holiday, pension, sick benefits and such. 

How are the powers that be saying that a reduction in work hours is more cost effective?


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## ResTech (Aug 14, 2009)

> agin we are taking the pt to the hospital for definitive care, you don't need a two year degree to do that.



I don't know why you keep saying this. All you really need to take a patient to definitive care is a motorized vehicle with four wheels.. that would do the job of getting them there but is far from adequate. 

A degree in my opinion makes future learning and adapting more intuitive and serves to progress the profession. And not to mention a degree is a must for EMS officers. 

Let's not have providers who only know how to recognize specific S/S and fit them to a page in a protocol book.


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## EMTinNEPA (Aug 14, 2009)

Is transfer to definitive care all our profession is about?  What about situations like a cardiac arrest where definitive care is actually within the paramedic scope of practice?

We can be a taxi service or medical professionals.  The choice is ours.


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## VentMedic (Aug 14, 2009)

atropine said:


> What are you talking about?, have you looked at a recruitment flyer latley, Orange County Fire Authority *max out* thier base salary for FF/medics at about 90k a year without any over time, so does the city of Anaheim. Not bad cas for dual role, agin we are taking the pt to the hospital for definitive care, you don't need a two year degree to do that.


 
Max out?  Have you actually checked their salary chart on their website lately?  Either OC or Anaheim?  

Do these FFs only work 36 hours per week?   No.  

Thus, the RN who only puts in a 12 hours day 3/wk and still makes $90k is still ahead in time and $/hr.

When I joined the FD, a degree as a Paramedic was highly respected and sort after.  It is a shame that the FDs have recruited those like yourself who have no interest in maintaining EMS as a respected profession within the FD for it to receive the ridicule it does today.


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## VentMedic (Aug 14, 2009)

46Young said:


> How would a 40 hour workweek benefit a FD financially? We work 56 hours/wk here, and due to current FLSA mandates, all 56 hours are straight time. OT is paid at a higher rate, though, than if we were paid straight for 40 hours and 1.5 time for the last 16.
> 
> To reduce work hours to 40/wk would require a dept to hire additonal personnel, with all associated redruitment/academy costs, as well as medical, holiday, pension, sick benefits and such.
> 
> How are the powers that be saying that a reduction in work hours is more cost effective?


 
That is what your union is feeding you. If you actually work out the math, it is cost saving in the long run. There would be no 1.5x to figure out since 40 hours would be it.  No 24 hours shifts.  2 -12 and 2- 8 or 5 - 8 hour shifts. The unions know this and usually as soon as the cities start talking 40 hour/wk, they compromise quickly on whatever issues they are holding out on. 

The problem would lie in the fact that the FD would no longer be attractive to many if it became a normal job. There would be no playing house with the boys for a couple times a week and sleeping on the tax payers dollar. There would be little things scheduled throughout each shift to keep one occupied.


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## Ridryder911 (Aug 14, 2009)

VentMedic said:


> The problem would lie in the fact that the FD would no longer be attractive to many if it became a *normal job*. There would be no playing house with the boys for a couple times a week and sleeping on the tax payers dollar. There would be little *things scheduled throughout each shift to keep one occupied.*




Gulp! WORK?!!! There would be decline of attractiveness of recruitment. Re-do the salary range upon the education and actual productivity alike the rest of the city employees and see what the salary would be. Think of the millions that would be saved upon salaries, retirement and injuries. 

Require candidates to have a degree in Fire Science before application to an academy. Place them on 40 hour work week as you described with details at night alike all other citizens that have a job. Again productivity should be measured and evaluated for pay raises or even to maintain the positions. 

The Fire Service should thank insurance companies everyday. Without the ISO cities would definitely decrease their city budget. 

R/r 911


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## 46Young (Aug 14, 2009)

VentMedic said:


> That is what your union is feeding you. If you actually work out the math, it is cost saving in the long run. There would be no 1.5x to figure out since 40 hours would be it.  No 24 hours shifts.  2 -12 and 2- 8 or 5 - 8 hour shifts. The unions know this and usually as soon as the cities start talking 40 hour/wk, they compromise quickly on whatever issues they are holding out on.
> 
> The problem would lie in the fact that the FD would no longer be attractive to many if it became a normal job. There would be no playing house with the boys for a couple times a week and sleeping on the tax payers dollar. There would be little things scheduled throughout each shift to keep one occupied.



We only pay 1.5x over our prescheduled hours (over 56, per FLSA). All OT is either holdover, late calls, or prescheduled OT. I would think that more would need to be hired, maybe 20-30% more employees to cover the 16 hours lost per FF. We used to do two 10's and 2 14's. 

If we are only paying OT over our prescheduled 56 hours/wk per FLSA, how is a 40 hour workweek saving money? All of our prescheduled work hours are straight time. More employees to pay medical benefits, pension, etc. etc. I'm not getting it.


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## VentMedic (Aug 14, 2009)

46Young said:


> All of our prescheduled work hours are straight time. More employees to pay medical benefits, pension, etc. etc. I'm not getting it.


 
That's what some EMS services thought when they changed to 12 or 8 hour shifts. Workmen's comp claims decreased, less sick calls and it was easier to fill a short shift. As Rid was mentioned productivity was measured. 

I se this is a concept that is difficult for you to deal with but the rest of the working world has adapted to it very nicely including their budget. FFs just get a little frightened bcause there may be less TV time, shopping for groceries at least 3x a day, coffee run and showering with the guys for a little brotherly bonding. These are the perks that usually attract people into the FD and not really the fire fighting aspect of it. You see the FD also has some of the same johnny rescue recruitment issues as EMS. The quality of the average recruit has sank over the past couple of decades.


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## Ridryder911 (Aug 14, 2009)

46Young said:


> We only pay 1.5x over our pre scheduled hours (over 56, per FLSA). All OT is either holdover, late calls, or prescheduled OT. I would think that more would need to be hired, maybe 20-30% more employees to cover the 16 hours lost per FF. We used to do two 10's and 2 14's.
> 
> If we are only paying OT over our pre-scheduled 56 hours/wk per FLSA, how is a 40 hour workweek saving money? All of our pre-scheduled work hours are straight time. More employees to pay medical benefits, pension, etc. etc. I'm not getting it.



Here is another way to look at it. Reduce areas or even eliminate areas that could be worked upon between responses such as pre-planning, code enforcement, etc. duties usually assigned to the man of the 9-5 shifts and eliminate their positions thus saving money and increasing productivity. In between calls, one would be doing something. Televisions and recliners could be removed .. "Gasp!" and be an actual workplace. 

With all the "sleep deprivation" studies and increasing risks of known health problems associated with sleep disorders; why increase the risks and pay for it later? 

Unions can't have their cake and eat it too. If there is no money and there is a way to modernize and increase productivity, and lower tax base rate, why would any fire service be against it? If they* truly * were for what is the best for the citizens! A more productive fire service, less tired firefighters (more safe for them) and less budget.. a win, win situation! Why should firefighters have any better retirement, benefit package than any other city worker? I would argue that animal control places their lives in danger on more a regular basis as well as the trash/sanitation and road worker than the majority of firefighters. 

As well, each fire needs to be closely reviewed and scrutinized. Could better attack been done? Did the officer in charge, actually perform their job/role precisely? Did the team really do their best? Why not have independent audits perform reviews to ensure the best tactics was performed. Merit wages based upon knowledge and performance should be attached to promotions and benefits. No more "blanket" raises. Want a raise, show something more than showing up for work and working out. 

Imagine, reduced taxes, better up-keep on equipment and firefighters having to work more than 10 days a month! Reduce the salary based upon the merits of the job as education and performance level. With this action, we would see how many would want EMS to be within the Fire Service area, as EMS is about 70-85% of fire services responses. It would be very interesting. 

As more and more communities are looking at ways to reduce overhead and budgets, this could be a very manageable way of decreasing costs and increasing jobs.

R/r 911


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## MrBrown (Aug 14, 2009)

This whole discussion is quite interesting.  It was briefly on the wind here that Fire Service was being pegged to take over EMS mainly to stamp out chronic problems of fragmentation, funding, service delivery and pay parity but that seems to have gone away.

It would seem the that the Fire Service *****es every time it gets a bad rap about being hooked up with emergency medical care; well guess what, you did this to yourself!  

I am sure there are a few departments who run EMS as part of the Fire Service and do it very well but there are those big city or county level departments where every firefighter is also a paramedic.  These are the ones who deliver sub-optimal care and give fire based EMS a bad rap.  I read firefighter/paramedics in Miami were averaging about one intubation a year per officer, that has to be good for skill maintenance right there and .... that LACoFD medics were trained to interpret ECGs by reading what the computer printed out!

Remind me to get sick in Seattle if I am in need of fire based EMS


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## 46Young (Aug 14, 2009)

There's a simple answer to shorter shifts - tour swaps! Just ask the FDNY. Any union worth it's salt will not stand for limitations on tour swaps, as it doesn't cost anything.

I chose this position at this particular place due to the benefits, perks, etc. I'd be crazy not to. If things aren't as they are, my wife would have never agreed to move here. Maybe there's talk (just talk, as I haven't seen any changes yet) in CA regarding changes to salary, shifts, etc. I haven't seen anything in regards in this neck of the woods, though. No well run FD would be willing to reduce what they're giving their employees as stated previously. Most of their good talent will leave for greener pastures. Strength in Solidarity!

I'm still not grasping how it's saving money to add positions for the reduction of work hours as you'll need to give each employee medical benefits, a pension, sick days, holidays/personal days, gear, so on and so forth. 

Yes, we're sworn to help the public, but we're also looking out for our families and our own financial security. I have mouths to feed, so why would I want to give back what's already contracted to us? We're going to fight tooth and nail to keep what we've achieved thus far. We know how the game is played. And we play it well. Hey, if things take a dramatic turn for the worse for the fire service, I could always go back to school for my RN.


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## 46Young (Aug 14, 2009)

Serious question - it's high time we had an improvement in education and accountability. Additional educational requirements ought to translate to greater scope of practice, higher pay, benefits, etc. It's been suggested that a paramedic should hold a Bachelor's or even a Master's. that should be sufficient to legitimize the profession, and eliminate any pretenders.

Here's the question: How many are willing to complete a 4-6 year degree for a job as a medic given the current conditions? No one's going to give up 4 years to make maybe 30 grand or so. An increase in pay/benefits won't happen overnight. If it's something that will take 15-20 years from now to thin the supply, then I can understand that. Mandating a 4-6 year degree for medic credentials will thin the herd, but how long will that take? How many are willing to join political organizations, or unionize to achieve these goals?

I'm not trying to pee in anyone's corn flakes, I'm honestly interested what the complete game plan (educaton, political agenda, etc) is to bring the paramedic profession up to par with other healthcare careers, and what we can do to help. I have a good setup where I'm at, but that doesn't mean that I want the EMS profession to stay stagnant. When I first came into the field, I was taken aback at how much better the fire service and the police were taken care of compared to EMS. Tough to comprehend at the time.


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## Ridryder911 (Aug 14, 2009)

46Young said:


> Serious question - it's high time we had an improvement in education and accountability. Additional educational requirements ought to translate to greater scope of practice, higher pay, benefits, etc. It's been suggested that a paramedic should hold a Bachelor's or even a Master's. that should be sufficient to legitimize the profession, and eliminate any pretenders.
> 
> Here's the question: How many are willing to complete a 4-6 year degree for a job as a medic given the current conditions? No one's going to give up 4 years to make maybe 30 grand or so. An increase in pay/benefits won't happen overnight. If it's something that will take 15-20 years from now to thin the supply, then I can understand that. Mandating a 4-6 year degree for medic credentials will thin the herd, but how long will that take? How many are willing to join political organizations, or unionize to achieve these goals?
> 
> I'm not trying to pee in anyone's corn flakes, I'm honestly interested what the complete game plan (educaton, political agenda, etc) is to bring the paramedic profession up to par with other healthcare careers, and what we can do to help. I have a good setup where I'm at, but that doesn't mean that I want the EMS profession to stay stagnant. When I first came into the field, I was taken aback at how much better the fire service and the police were taken care of compared to EMS. Tough to comprehend at the time.



Although I am all for increase in pay, many do go for the professional route making little and having a heck of a lot more than an associate or masters degree. I know of school teachers making as little as $25K a year and Professors of History that barely make $40,000 that have an PhD and decades of service. When I exited nursing school I made more than those that taught me, and I was a field medic, for true professionals money usually has little to do with the intent of those serious of entering the profession. Again, a choice I hope that we can bypass but one of the benefits should be monetary gains; but not the whole emphasis. 

I still have heard anyone describe on the whys, we should be paid more? In reality one usually goes for 10 months of trade school training which in comparison is equal to a LPN/LVN (actually they go longer). The salary is slightly more for Paramedics in most areas or comparable. Why should this so called profession be making more when the emphasis is placed upon how one can obtain the goal the easiest and fastest route? Never the best or increasing the role or demands to justify the respect and of course financial rewards. 

I keep hearing retirement, pay, etc.. yet have read of what we could do to provide for the patient... (you know the reason we are supposed to be in it?) 

Most are only with 1 patient for < than an hour. Consider what level of care was provided and what performance was done, it was actually pretty good pay. 

Increase the education, increase the care and then and only then expect and demand a change! 

R/r 911


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## 46Young (Aug 14, 2009)

Ridryder911 said:


> Although I am all for increase in pay, many do go for the professional route making little and having a heck of a lot more than an associate or masters degree. I know of school teachers making as little as $25K a year and Professors of History that barely make $40,000 that have an PhD and decades of service. When I exited nursing school I made more than those that taught me, and I was a field medic, for true professionals money usually has little to do with the intent of those serious of entering the profession. Again, a choice I hope that we can bypass but one of the benefits should be monetary gains; but not the whole emphasis.
> 
> I still have heard anyone describe on the whys, we should be paid more? In reality one usually goes for 10 months of trade school training which in comparison is equal to a LPN/LVN (actually they go longer). The salary is slightly more for Paramedics in most areas or comparable. Why should this so called profession be making more when the emphasis is placed upon how one can obtain the goal the easiest and fastest route? Never the best or increasing the role or demands to justify the respect and of course financial rewards.
> 
> ...



I haven't mentioned much if at all about pt care, as you and others have spoken volumes in regards. I'm all for greater education, and a legit field internship. I'll agree that most RN's, LPN/LVN's, and other healthcare professionals do more work than that of a medic, on average. What I haven't heard much of is increasing our bottom line, retirement, etc.

As for the school teacher making 25k, or the History Professor making 40k, I feel that they're selling themselves short, considering their educational investment. Noble, yes, but it's a rough world out there, and we need to be real about what it takes nowadays to be comfortable financially, if not just surviving. I don't feel that EMS should stand for mediocre wages and lousy retirement, which is typical for the field. It's sad that many need to work several jobs, and still won't have much for their retirement.

We have families to feed and mortgages/bills to pay. That's real. A healthcare career should be selfless by nature, but I like having electricity, running water, and food in my fridge. If you want to be noble, then lend your FT expertise to your local volunteer organization. I'm sure they could use the help. If and when I decide if I want to stay in Stafford, I'll buy a house, and then lend my services to the local EMS rescue squad. I'm sure they have plenty of suppression volunteers already 

Unions and political organizations will help foster change in EMS for the better. The way I see it, we can start organizing now, and have the political muscle ready for when the educational reform is realized. At the very least, unions and such can help fend off future FD takeovers of EMS, and help EMS workers achieve some level of parity with cops and FF's. We're not working 100% of the time, and it's certainly not back breaking physical labor, but it is important work. Anyone disagree with this last paragraph?


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## atropine (Aug 15, 2009)

46 these guys just don't get it, things are not going to change anytime soon, at least where I live. You got to make that cash, I can't let my wife find out about my g/f so I need cash and 20 days off a month to live it up.


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## 46Young (Aug 15, 2009)

atropine said:


> 46 these guys just don't get it, things are not going to change anytime soon, at least where I live. You got to make that cash, I can't let my wife find out about my g/f so I need cash and 20 days off a month to live it up.



You're right, I haven't seen any real indication of a power shift from FDEMS to third service or privates, just talk. Talk is cheap. I figured that out, and made the smart move over to the fire side. Call me silly, but I thought that I should have some degree of financial prosperity and great working conditions if I intend to make this a career. I'm just sayin'. I, for one, don't have 20 or 30 years to wait around for conditions in EMS to change for the better. I'll help out, fight the good fight, but I need to eat. Best job in the world! 

I'm hoping everyone will realize that they need to employ fire service style political tactics to get theirs. It isn't going to happen otherwise. Believe that. Jealous rants about fire service hookups and firehouse life on internet forums do nothing. Change nothing.


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## Ridryder911 (Aug 15, 2009)

I get it. I also get that citizens are tired of seeing $1 million dollar trucks setting at grocery stores or seeing the local FD build a $3,000 volleyball court to work-out. 

I also get that I work in an EMS that only recieves < than a 0.1% tax revenue of the 911 system (< $70,000 yr) and is able to operate in the black and have a 1.5 year (rainy day) fund. That we too as a third party EMS have the same benefits or close to as the Fire Service. That we can acclaim that our units actually pay for themselves and as well personell are productive. Can you? 

If Fire Service responded to supression events as many times as EMS does, how many F/F would retire? How many F/F would stay if they were to respond to 5, 10, 20 fires or emergencies a day? How many would physically be able to retire if those demands were placed upon them? 

Times may have not changed yet... but just wait. When more and more people are loosing jobs, homes and it begins to hit them personally, the hero complex may not be what one will want to bank upon to save their profession. Union or not.

Our personell salaries is comparable to that of the fire service, in fact we have many that left large city due to the increase in pay and benefits. As well, they only have one function and one focus so they can really master the job as they were educated (degree) to do... EMS. 

Let's look at cities like Austin and so forth. Again, benefits and wages that are equal or surpass the fire service. 

Will it take time? Unfortunately yes. Just remember, it was not that long ago FD had the same standing in fact most cities < than 50 years ago most F/F had to have second jobs. I too do hope that it will not take us that long, and believe we are awakening as more and more cities see that EMS does not have to be a tax burden upon citizens. Again, it is all  nice until it hits home. 

Economics is really pretty easy. Employment =Tax revenue= pays city income = salaries. No jobs = no tax revenue = no city jobs or cuts. Firefighters making 6 figure income only working 10 days a month for < than 6 hours of productive work in that 24 hour shift? Hmmm... does that sound fair to an unemployed person or those that have to work an extra job to make a living? 

I call the "tick syndrome" sucking off the blood of others. 

Definitely they are not paying for those with extreme knowledge or productivity, rather most are paying for the "what ifs". And as ecomomic times gets harder and harder, the gamble of the what ifs seems more distant than the current "now" circumstance.

It may not happen everywhere or suddenly but we have already seen it start, as we have not seen but the tip of the economic spiral as well.  

I was speaking to Fire Officers at a conference two weeks ago as they were discussing academies being down sized or eleminated. Positions not being filled as those that retire and leave a spot. Divisions being down sized and being consolidated in effort to save themselves. Personally, I am glad I am not in their shoes.. as we are increasing staffing and units and growing. Reimbursement rates are at a high as documentation and validation is maintained. Patient outcome based therapy to reduce waste and costs, and increased treatment care is put in place to reduce morbidity. Our productiveness can be measured by outcomes and in dollar amounts. EMS can and will expand into other areas without touching pocket books of those that do not need our services. 

I do hope we can learn off others such as the fire service and not repeat the same mistakes. Fire Service definitely has a needed place as a public service, no arguement however; the management and how it is operated needs an overhaul. 

R/r 911


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## 46Young (Aug 15, 2009)

So, what's the game plan, the entire game plan, including organization and politics, to bring the EMS profession up to par? What should we all be be doing right now to take steps in that direction?

Also, the economy is cyclical. The economy should change for the better, hopefully in a few years or so.

We faced a RIF of 89 personnel back in April. We lost no one, just promoted 31 Lt's, graduated 9 firemedics, and hired 20 more. I find it interesting that through the economic crisis that our ALS incentive pay, $2-3/hr riding pay, or 2 bonus pay steps for being ALS weren't even considered to be put on the chopping block.


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## Ridryder911 (Aug 15, 2009)

46Young said:


> So, what's the game plan, the entire game plan, including organization and politics, to bring the EMS profession up to par? What should we all be be doing right now to take steps in that direction?
> 
> Also, the economy is cyclical. The economy should change for the better, hopefully in a few years or so.
> 
> We faced a RIF of 89 personnel back in April. We lost no one, just promoted 31 Lt's, graduated 9 firemedics, and hired 20 more. I find it interesting that through the economic crisis that our ALS incentive pay, $2-3/hr riding pay, or 2 bonus pay steps for being ALS weren't even considered to be put on the chopping block.



I am not against any system that it is working for, as long as it is actually performing medical care and not just subsidiary to maintain FTE's. I do believe your being very optimistic to delusional if you believe the economy will be better within a few years.

The way as in any other business is being involved at the grass roots level on upward as in legislation and requiring state's to change their laws in regards to rules & policies governing these. Being actively involved in State EMS Associations that will promote EMS into a profession and as you described needed benefits for all. 

It is great there are a few Fire Services that might have their act together, unfortunately I believe there is as many alike private that does not. Thus harming the EMS profession and worse harming or being detrimental in patient care. 

We have to be the patient advocate and at the same time be the EMS professional advocate, albeit private, fire or third party. 

Here is a link to what is occurring nationally with the Advocates for EMS. You will see action is being attempted. 

http://d.yimg.com/kq/groups/149397/1391470009/name/Advocates for EMS July Report.doc


R/r 911


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## triemal04 (Aug 15, 2009)

So let's take a quick look at some of the more recent things that have been posted that have been...well...slightly untrue.

2 transports a day can pay for an ALS ambulance (this may not have been in this thread but, hey, I'm to lazy to look).  Try again.  When you figure in the hourly cost of employing a paramedic (hourly rate+pension+health insurance+life insurance+workers comp+social security+unemployment insurance+paid sick time+paid vacation+anything I've left out) it's to high.  Nationally roughly a third of what an employer pays an employee is paid for with their benefits; be even higher for a service that treat's it's employees well.  Which is what everyone wants, right?  So, say 2 paramedics working for $20.00/hr (starting pay) plus $15/hour in benefits (when it's broken down to an hourly basis) for 24 hours.  $1680.  Figure the average ALS call will be cost the pt $1000 and there's a tiny bit of wiggle room (forgetting that there are people a service needs that don't run calls (supes, managers, secretary's, billing/finance, etc etc) who's pay comes from somewhere, equipment, fuel, training, etc etc) until you remember that most services don't get fully reimbursed for a call.  Oops.  Guess 2 calls will not pay for a single ALS ambulance.  Try again.


> You my friend, along with many others (FF/Medic) like you, are the minority... in my experience. Most FF I've talked to, and precepted under, HATE EMS and only do it for the pay increase (or because they have to).


Funny, my experience is the exact opposite.  In my experience the most bitter, burned out medics I've met (and the ones that gleefully talk about abusing pt's who they don't like, the ones that routinely mis-diagnose, mistreat and have protocols that would make a basic laugh) come from private companies.  So who does that make right?  Could it be that things are different all over? Shocking to suggest, I know.  Could it be that, if done right, fire-based EMS is beneficial and well run?  Could it be that, if done wrong private/third service EMS can be horrible and detrimental?  Yes to both.  And the opposite for both is true as well.  


> How many proper Fire calls are attended annually, & how many EMS calls do you run annually?
> Now, calculate how much it costs to run a fire service & the income generated from those calls.
> Repeat for EMS.


Addressed already, but wow...talk about a simpleton who needs a reality check.  Fire, police, public works, several common city services don't bring in revenue, or only a little.  Yet all are vital to having a city that is well run and well protected.  Simply not bringing in cash does not mean that there is a problem.  (hell, where I am EMS actually costs the department (and thus the city) money since we spend more on it than we collect in billing...price of ensuring that we can provide high-quality care)  For most vital services the number of units has to be based off of the potential need for something; sure, if a fire department only goes on a couple of fires a month you'd think that the number of apparatus could be cut...except now response times will increase, fire loss increases, lives lost will increase, insurance rates increase, just not a good idea.

Simply having a degree will not magically fix our problems.  I'll go out on a limb and say anyone who thinks that is a moron.  It's a first step, and a big one, but not the only one that needs to be taken.  Oregon has required degrees for paramedics for 10 years now (don't know how long Kansas has had that requirement) and the average starting pay for private/third service/hospital EMS is still only about ~15.00 with lousy benefits, if any.  While that may be better than what people get in other areas, it's still rather horrible.

Since it needs to be said:  EMS should not have to be combined with a fire department to survive, or to have good benefits for their employees.  In a perfect world it would be completely separate everywhere (without private services at all) with good pay rates and working conditions for both.  But, that would require action on the part of people who would rather sit and whine about things.  Hell, this thread is a great example.  Instead of offering ideas on how to change things, this turned into yet another example of people blaming the big bad fire department for all EMS's problems.  Perhaps more people should get off their asses and do less complaining if they truly want change...


> Now EMS would be well on its way to being viewed as a genuine medical profession if it weren't for the fire departments with their three month medic mills, cookbook medicine, and medics who are medics just because they wanna wide in tha firetwuck!


Riiiiight...because the only bad medics come from fire departments...only firefighters go to medic mills or other lousy medic schools.  Reality check sparky, there's lousy people everywhere.  In fact, the worst schools I know of are run/sponsored by a rather large private company.  Oops.  NREMT-P candidate; that must have been the fastest paramedic class every for you already to be ready to test...unless that is just a fancy feel-good way for you to say that you are still a student who has yet to start paramedic school.

If anybody actually knows of a fire-department that considered moving all it's employees to a 40-hour work week, feel free to list them.  You know, that pesky "prove it."  Though this isn't to say that in some circumstances that it wouldn't save a city money; a very small combo (paid and volunteer) dept could easily save money by moving paid staff to 40-hour weeks and augmenting staffing with volunteers.  Long as the quality of service didn't decline...meh.  This is what a lot of PG County does.  Larger departments (even mid-sized really) it wouldn't work for.  When you figure the number of line firefighters that are needed to be working 24/7, and the number of admin jobs that could (supposedly, though realistically it wouldn't work that well) be done by an otherwise regular firefighter, the numbers don't work.  In the vast, vast majority of cases many more people would have to be highered to provide the correct amount of coverage 24/7.  Even if sick leave usage decreases and productivity increased (great, but as people like to point out, except in a very few situations fire departments don't bring in revenue) those savings would be offset by having to pay for a new employee.  Not feasible except in certain situations.

And uh...hate to break the bubble, but ISO really doesn't matter a huge amount anymore.  Some insurance companies still look at the ISO rating, and it does matter a bit more for businesses than homeowners, but the day of ISO driving everything is gone.  


> Let's look at cities like Austin and so forth. Again, benefits and wages that are equal or surpass the fire service.
> Will it take time? Unfortunately yes. Just remember, it was not that long ago FD had the same standing in fact most cities < than 50 years ago most F/F had to have second jobs. I too do hope that it will not take us that long, and believe we are awakening as more and more cities see that EMS does not have to be a tax burden upon citizens. Again, it is all nice until it hits home.


And hopefully that is what will happen everywhere someday.  But, as I said here and in another thread, that means people who would rather take the easy way and complain/blame others would have to work.  We did it (and still do it) in the fire service...what the hell is wrong with people in EMS?

Edit:  Think that's everything...though I probably left a few things out.


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## Ridryder911 (Aug 15, 2009)

There's lie the problem $20 hour to start? Get real! As well as $15.00 an hour for benefits? Wow! No wonder cities are going broke fast! What benefits per say is $15.00 an hour? Workmen's comp .. what playing volleyball or lifting weights? At $35.00 for a hose jockey without a requirement of formal education or accountability. What a scam! 

As well, I don't know how much you charge and collect but in even in my rural area ALS calls are more than a grand a piece. 

Comes down to good business sense as well. My units by far (unlike the squads) routinely respond to about 10-16 calls per 24 hour shift (and that's even in a rural area) not 2. Now multiply that by about $800 -$1000 clearing per insurance or private pay. Now, in comparison how much does your fire service bring in (other than tax revenue)? 

Again, wait until unemployment hits your area and see where the cuts begin.. 

R/r 911


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## triemal04 (Aug 15, 2009)

Ridryder911 said:


> There's lie the problem $20 hour to start? Get real! As well as $15.00 an hour for benefits? Wow! No wonder cities are going broke fast! What benefits per say is $15.00 an hour? Workmen's comp .. what playing volleyball or lifting weights? At $35.00 for a hose jockey without a requirement of formal education or accountability. What a scam!
> 
> As well, I don't know how much you charge and collect but in even in my rural area ALS calls are more than a grand a piece.
> 
> ...


Well, what do you think a paramedic should be paid?  The cost of living will vary which can skew payrates, but for this area $20/hr will be around 50K a year...pretty decent though not always enough for some parts of the state.

Far as the benefits...health insurance isn't cheap (dental/vision/health I mean), neither is any type of decent pension; even a 401K with an employer money match will run up costs.  Workers comp...funny, most people here get it because of back injuries, injuries due to assaults, and regardless, it's often a required fund.  Get over it.  Funny, I was actually talking about that cost being for a single-role paramedic.  Guess you are that simple sometimes.  Nationally the cost for benefits averages roughly $8.00 hour...given that will include people who get the most minimal, and based on EMS services around here, $15/hr for benefits is reasonable.  For decent benefits anyway...though if you want to provide less go for it I guess.

The charges for an ALS call...I cover a rural area.  It does vary depending on how far out the pt is, but yeah, the base rate+mileage averages to roughly $1000 per call.  Suppose it could be more if the rates were jacked up and FireMed was removed...though that still wouldn't fix the reimbursement problem.  Not that that can't be done of course.

Oh silly...your last paragraph makes no sense.  I know most units respond to far more than 2 calls in a shift.  My contention is that EMTinNEPA said that an ALS ambulance can be paid for with 2 ALS call per day.  Not true.  Curious though, with such a progressive service as yours, what do you pay?  Do you offer any benefits?  What is the cost per employee?

Uh...duh, as I've said, my department doesn't bring in a lot of money.  There's always some from the Prevention and code enforcement (though not much) and quite a bit from EMS (though we spend more on it than we bring in to keep the standards and quality up...and our reimbursement rate sucks), but really...not much comes in.  Kind of like the police.  Guess that means we should give them the chop too, right?  Since they don't bring in revenue, get rid of them.  And public works, right?  They should probably be the first to go...


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## triemal04 (Aug 15, 2009)

Missed the edit...nuz.  You asked, so here's the answer, even though I allready said it in the original post...you must have missed it.  Oops.  Benefits=pension+health insurance+life insurance+workers comp+social security+unemployment insurance+paid sick time+paid vacation+anything I've left out.  Not all of that is a "benefit" per se since the employer is required to provide it, but all is an extra cost on top of the employees base pay.  Clear?


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## Ridryder911 (Aug 15, 2009)

triemal04 said:


> Missed the edit...nuz.  You asked, so here's the answer, even though I allready said it in the original post...you must have missed it.  Oops.  Benefits=pension+health insurance+life insurance+workers comp+social security+unemployment insurance+paid sick time+paid vacation+anything I've left out.  Not all of that is a "benefit" per se since the employer is required to provide it, but all is an extra cost on top of the employees base pay.  Clear?



I gotcha and understand. I ask do you charge for your services in patient charges, even though you are tax base service? 

Again, I do understand the benefits of fire as being one at one time, but I ask this. Do you bring money back into the service to clear the expense or will your expenses have to be paid by tax revenue?

R/r 911


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## 46Young (Aug 16, 2009)

triemal04 said:


> So let's take a quick look at some of the more recent things that have been posted that have been...well...slightly untrue.
> 
> 2 transports a day can pay for an ALS ambulance (this may not have been in this thread but, hey, I'm to lazy to look).  Try again.  When you figure in the hourly cost of employing a paramedic (hourly rate+pension+health insurance+life insurance+workers comp+social security+unemployment insurance+paid sick time+paid vacation+anything I've left out) it's to high.  Nationally roughly a third of what an employer pays an employee is paid for with their benefits; be even higher for a service that treat's it's employees well.  Which is what everyone wants, right?  So, say 2 paramedics working for $20.00/hr (starting pay) plus $15/hour in benefits (when it's broken down to an hourly basis) for 24 hours.  $1680.  Figure the average ALS call will be cost the pt $1000 and there's a tiny bit of wiggle room (forgetting that there are people a service needs that don't run calls (supes, managers, secretary's, billing/finance, etc etc) who's pay comes from somewhere, equipment, fuel, training, etc etc) until you remember that most services don't get fully reimbursed for a call.  Oops.  Guess 2 calls will not pay for a single ALS ambulance.  Try again.
> 
> ...



Great post! Dead on, I couldn't have said it better myself. I literally LOL when I read the comment on the NREMT-P candidate. 

You got what I meant when I asked how going to a 40 hour/wk work schedule will save money. There's numerous additional expenses such as pension, workers comp, life insurance, health insurance, unemployment insurance, paid sick time/vacation, life insurance, etc. considering that will have to be paid for each and every employee that needs to be hired to staff 24/7 now that 24 hour shifts would be abolished. Remember, those 56 hour/wk employees are being compensated 100% straight time due to FLSA. Sorry, I'm not buying that nonsense about FD's living in fear of a grand shift to 40 hr workweeks. Try again.

PG (Prince George's County, MD) laid off a bunch of FF's and closed a couple of houses, I think. They can do that, as they have the mutual aid agreement as a safety net. they're seriously downstaffed, with maybe only 2 or 3 FF's at each house. We bail them out quite often. 411 house and sometimes 405 house will fill their stations.

Again, raising educational standards isn't going to do jack without significant political influence, as evidenced by the Oregon and Kansas references. I wish it did. This would help me out in several ways. First, a decrease in the medic supply should drive my level of compensation ever higher. Supply and demand. Next, OT will be more copious. I can take that as comp time, roll it to sick/annual leave, go on more vacations and retire a couple of years earlier (use sick time as service credit). My scope of practice may increase, and we'll be able to do more for our pts. Finally, when I do medic per diem work for private EMS or third service, my hourly compensation will be that much higher.

The role reversal of medic and FF salaries in the Carolinas and other places can be explained easily. Lack of unions or other strong political organization. the medic pay isn't that great down there regardless, it's just that FF's accept lower standards down there. $8/hr, they need to get onboard with the IAFF. Perhaps the national collective bargaining movement will be realized, then they can correct the situation. EMS will let that happen, stand by on the sidelines as usual rather than be key players, as there are too few willing to do anything to stick up for themselves.


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## 46Young (Aug 16, 2009)

Ridryder911 said:


> I gotcha and understand. I ask do you charge for your services in patient charges, even though you are tax base service?
> 
> Again, I do understand the benefits of fire as being one at one time, but I ask this. Do you bring money back into the service to clear the expense or will your expenses have to be paid by tax revenue?
> 
> R/r 911


Triemal already said it:
Addressed already, but wow...talk about a simpleton who needs a reality check. Fire, police, public works, several common city services don't bring in revenue, or only a little. Yet all are vital to having a city that is well run and well protected. Simply not bringing in cash does not mean that there is a problem. (hell, where I am EMS actually costs the department (and thus the city) money since we spend more on it than we collect in billing...price of ensuring that we can provide high-quality care) For most vital services the number of units has to be based off of the potential need for something; sure, if a fire department only goes on a couple of fires a month you'd think that the number of apparatus could be cut...except now response times will increase, fire loss increases, lives lost will increase, insurance rates increase, just not a good idea.


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## 46Young (Aug 16, 2009)

For RidRyder, it's great that the majority of citizens in your jurisdiction are insured, keeping your service in the black. Many other areas receive meager insurance reimbursements, if they're lucky. Some areas also have a scourge of uncompensated cases. Does that mean these areas don't deserve quality care? Does that mean the local providers should settle for way less than a livelable wage?


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## Ridryder911 (Aug 16, 2009)

Actually in my area only about 39% are insured as in patients almost 75% are on Medicare. The reason of collection are only about 80% of what is billed, yet good management techniques can still operate in the black. 

Here is another problem you fail to address. According to the census over 330 people are turning the age of 60 every hour and thus increasing the "baby boomer' generation as one of the largest retirement groups in the history of the U.S. In other words fixed income and poor retirement outcomes. You actually believe that the tax base can maintain itself? 

This is also one of the reasons the sudden surge of EMS calls and it is predicted within 5-10 years, that one can double or triple their EMS responses. 

I believe that this is where you and I disagree on what is vital for the city. Relying on the fear factor of the community in regards to fire protection. Statistically, the fire service has done too good of a job in fire prevention as in codes and education. Fire suppression responses are down in comparison than before. Any other business would have to adjust and be accountable or basically be truthful.

Again, during poor economic times and high unemployment the tax base rate drops tremendously. Loss of jobs does not sustain a tax base. Simple logic still acclaims money can not go out if it does not come in. Would it not make more sense for a community to contract to a third party EMS that would provide that service for a reduced rate or even free in lieu of charging all? 

What about setting up a third party EMS that can operate within the revenues without tapping into citizens that is not in need? Why pay for personnel and equipment not needed? 

Again, my point that Fire Based EMS is a poorly managed system. They are dependent upon tax revenue, as most Fire EMS administrators have little to no healthcare management. In reality, that what is EMS or should be, nothing else. It can be done within a Fire EMS system, but I have seen few of those that actually make a profit so those monies can be placed back into the ear marked section and reduce tax revenue on the budget. Unfortunately, this is a rarity and not the norm because of the traditional methodology of Fire administration is only to operate off cities monies or grants. Again, I state poor management and poor administration due to failure to understand EMS as a healthcare industry and nothing more. 

So basically, you are describing.. no matter how bad the economy becomes or gets, tax payers should fund fire services to maintain a healthy and prosperous lifestyle of firefighters? That as a public utility, pay structures should have no regard upon the economic times as in reduction of pay or benefits even though citizens that provide the monies are suffering? In other words, to hell with them as long as we get our $$$ and benefits? Then let's hide behind the "what if" fear factor and promote the Union to ensure that we get our way. Let's hoodwink them, knowing there are other options that would not tap into their personal finances and provide the same or better care. Shameful. 

A facade promoted that disaster may strike at any time, and again no accountability to the citizens. There is a difference between from not a being a good idea to the reality of no money to fund them. Why should others make up the difference or have cuts in other needed areas because of luxury of a good union? Truthfully, if you know there is a better and cheaper way to fund an EMS that could provide the same level of care and service, would it not be lying to the public? Would it not be solely for self reasons? Can you truthfully say that you have what is in the best interest of the public or to thy self? 

R/r 911


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## triemal04 (Aug 17, 2009)

Ridryder911 said:


> I gotcha and understand. I ask do you charge for your services in patient charges, even though you are tax base service?
> 
> Again, I do understand the benefits of fire as being one at one time, but I ask this. Do you bring money back into the service to clear the expense or will your expenses have to be paid by tax revenue?
> 
> R/r 911


Before I forget, would you mind sharing what you think a paramedic should be paid and what type of benefits they should receive?  And, if you don't mind (though it's not as important) what medics at your service receive?

And yes, we do charge pt's a fee for service (base rate plus mileage) as I've already said.  And yes, that is on top of the taxes we already receive from them.  To be perfectly honest I'd rather we didn't need to charge, but, without reducing the level of service provided (in both fire and EMS) the tax rates would have to go higher...and that ain't gonna happen around here partner.

Already told you as well (seriously man, did you read anything I wrote?) EMS does cost the department money.  In part because of the standard that is maintained, and also in no small part because of our lousy reimbursement rate.  (it's not handled by the department, so you can forget using that as a reason against fire based EMS).  It definitely could be better, but there are unfortunately a lot of people that we transport that can't afford to pay, and medicare as you know does not fully reimburse EMS services which doesn't help things.  It's nice to have the tax base; means we don't need to go after people as hard when they can't pay.

It's common around here for fire departments to have taken pay cuts, given up cost of living raises, gone on extended pay freezes, not replaced personnel and more because the departments are strapped for cash.  So you can get off your high horse with the whining about "maintaining healthy and prosperous lifestyles for firefighters."  When money get's tight every city employee feels it eventually.  Of course, the nice thing about a fire-based EMS system (or third service) is that, unlike a private-for-profit, if the service goes into the red because people can't pay, costs have gone up, etc etc, the service will still run, it won't be pulled out with minimal notice...something privates seem to be rather good at.

Get over it.  Fire is a necessary service.  Same as police, EMS, public works, water, road crews, all that and more.  All need to be funded and staffed at levels that provide the right amount of care/protection/service for the city.  Will there be times (like now) when there is not enough money and service may need to be cut or rethought?  Yes.  But cutting service because of a personal issue or because someone thinks something isn't needed is beyond stupid.


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## 46Young (Aug 17, 2009)

Ridryder911 said:


> Actually in my area only about 39% are insured as in patients almost 75% are on Medicare. The reason of collection are only about 80% of what is billed, yet good management techniques can still operate in the black.
> 
> Here is another problem you fail to address. According to the census over 330 people are turning the age of 60 every hour and thus increasing the "baby boomer' generation as one of the largest retirement groups in the history of the U.S. In other words fixed income and poor retirement outcomes. You actually believe that the tax base can maintain itself?
> 
> ...



Sure, fire responses are down. What do you mean by adjust and be accountable? Downstaff and close stations? With greatly increased response times and reduced manpower as a result, our fireground ops will need to be reduced to that of only defensive operations. The vast majority of buildings here are type 5 construction, and will be well involved by the time we arrive. Conditions will be untenable, and any search ops will be called off. Interior attecks will be a thing of the past. we'll just surround and drown the structure from now on. It takes about 12 FF's to save just one during a mayday, 12 we'll no longer have. No more RIT level 2 or 3. If we were here a few minutes sooner, maybe we could've pulled out little Johnny from his bedroom, but now it's too late. Yes, this is a "what if" scenario. As I've stated earlier, we can't predict incident times and types, as we lack the ability to predict the future. We'll always have our space heaters, food on the stove, improperly discarded cigarettes, arson and such.

how would it be profitable for a third party EMS organization to contract with the community if they'll be in the red (uncompensated cases, poor medicaid reimbursement, etc). If the community isn't turning a profit from EMS, how would a third party magically do it? 

My understanding is that Fairfax uses third party billing for it's residents only, causing them nothing. Hardship waivers are also entertained if the pt has no real means of paying. Our Ambulance division essentially acts as a third service, except that personnel are crosstrained to ride both sides. It saves money on staffing. Again, if EMS here turns a profit, it's better to let the county keep it. If it isn't turning a profit, no private provider would want to take it over, lest they go bankrupt.

The union has worked hard to get us where we are at this time. We have families to feed, bills and mortgages to pay. Many of us came here instead of other areas due to the salary, benefits and working conditions. If the county starts dramatically reducing pay/benefits, there'll be a mass exodus to other jurisdictions, and will ultimately cost the county more in hiring, training, OT, so on and so forth.

In my personal case, I moved out at 22, always lived within my means. I didn't run up much credit, and neither has my wife. We've always driven older, much older cars, lived in apartments, and were living one or two paychecks away from bankruptcy at times. We could've bought expensive toys on credit, or been approved for a sizeable mortgage, and got into the flipping game. We both grew up with single parents. I've gone hungry at times, and her mother was on welfare for a brief period (she used it to eat, then got a job to get off of public assistance! Imagine that!). I've always worked several jobs to stay ahead, such as loading trucks, Snapple delivery, bouncing Latin and Hip-Hop clubs, as well as several EMS jobs at the expense of family time. We did the right thing, and didn't contribute to this recent economic downturn. 

We made the decision to move here for this job, which will take care of us and reward us with a comfortable lifestyle. So yes, I have a huge problem with giving a large part of that up for the greater good. I, as many others, took the job based on what they are promising. If these types of setups didn't exist, I probably would've went to nursing school. However, it's no longer necessary to spend another 2-4 years in school at the further expense of family time, as we're set up pretty well here. 

Call it entitlement, or whatever we want, but we've done what we're supposed to regarding finances, and we're finally getting ours. I love my job, both sides. I respect the community I serve tremendously, and strive to do my job to the best of my ability, for their benefit. I'm also willing to die on the job if that's the way it goes down. It's what we signed up for, quality EMS/public service is what the community is paying for. 

We're not the ones who kept trading up for larger houses, or getting an ARM with the intent of flipping. I wasn't the one giving out sub prime mortgages to the underpriveleged. We weren't living our lives on credit, then claiming bankruptcy when the bubble burst. We didn't partake in expensive toys, and we took only one vacation the whole time we were married prior to taking this job. we still don't own a house, but that'll change soon.

So, we traveled far away from home, leaving friends and family for what this place promised us. We've done nothing wrong. 

If that's selfish, then it's selfish. I have no problems going to sleep every night.

Once more, and this bears repeating, it's appropriate to propose the question "what if" regarding fire and EMS. We can't predict the number of calls, the type, and time of origin. We can't.

Also, if we're concerned with helping the public so much over our personal needs, putting the public first, then volunteer. We work JOBS. Our JOB pays the bills. If you want to truly put the public first, then donate every penny of your disposable income to various charities. Work a second job and give away that paycheck, too.


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## triemal04 (Aug 17, 2009)

Forgot to mention this in my last post.

Anybody who believes that fire departments should be downsized because much of the staffing is not needed on a daily basis and is there for a "what if" situation...you may want to withdraw those statements.  Or start talking about all the other things that should be changed because they're based on a "what if."  Like what paramedics can do...I don't know...much of what we can do will only rarely, if ever be done by many paramedics...probably better to reduce our scope since those things aren't needed.  Same goes for RN's, RT's, PA's, NP's, hell, basically everyone in the medical field.


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## 46Young (Aug 17, 2009)

Some here have projected a disdain towards unions. Let's look at how they've helped in NY.....

FDNY EMS has more than it's fair share of problems, but it does have the Local 2507, they've recently become uniformed, have a 25 and out pension, GHI insurance (no out of pocket health expenses!), job security if you're civil service, etc. The local won't allow crosstraining of FDNY personnel, that's for sure.

Many of the NY area 911 participating hospitals aren't union, but need to offer an attractive package to steer employees from a union shop. This is a large reason as to why NY hospitals pay so well, have great schedules with limited holdover, great benefits, medical, working conditions and such. They absolutely needed to offer this to get the best talent in the area. That bears repeating - these hospitals needed to offer top pay, benefits, etc. to attract the best employees. When FDNY took over NYC EMS, these employees still needed a reason to jump ship. 

This is a very important indirect effect of local agencies being union, and all of the increased benefits that go along with it. Other agencies need to offer more, or else their agency will be full of substandard employees. 

With NSLIJ, my former employer, this was very true. whenever another hospital would get something, we would get it too. Automatic.

This "at will" garbage needs to end. When I first began work at NSLIJ CEMS, I was made to sign a paper that read: "You reserve the right to terminate your employment at any time, and we reserve the right to do the same". I wasn't going to turn down the job by any means, but I was definitely taken aback by being required to sign that document as a condition of employment. It was at that exact moment that I began to realize that I would need protection, job security, basically someone to go to bat for me and play hardball should I be pushed around by an employer. CCEMS had me sign a similar document, go figure. That's some horse :censored:

As long as you're "at will", you stand little chance of bettering your situation, to cause any real change in your organization. That's why there are still places that pay MEDICS ten bucks an hour! How do you live on that? 

RidRyder is obviously opposed to organized labor, and a significant increase in pay/benefits for EMS workers as things stand currently. He repeatedly says that we don't deserve to be paid well, like RN's, RT's and such. Not without increased education. That needs to happen, for sure, but most can't afford to wait out any changes for 20-30 years or so. Unions and/or strong political influence will bring changes NOW. Times are as tough as ever now, especially when the Govt will be looking to take even more of your money to give to the poor and underprivileged. Grab all of the money you can. 

RidRyder likely middle or upper management, a real "company man". It's in his best interest to keep salaries as low as will be tolerated, to keep his agency in the black. Maybe a bonus or two for keeping costs down below a certain number?


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