hmmmm, where to start.... how about in most combined fire/EMS systems, EMS takes up 80% of the call volume, yet gets 20% of the budget?
Or if you have a civilian medic in the FD, the civilian medic who might need a year or two of education to get certified as a medic, will make nowhere near what the zero to hero FD makes on the engine, when the FF went through a maybe 6 month academy before being put on the engine?
many years ago I worked part time as a part time EMT for a FD that had an ambulance. every month, one full time member of the FD (who were all EMTs and one or two were few paramedics) was taken off the engine and assigned to the ambulance, and paired up with a part timer. They were paid twice as much as every part timer, had great benefits, didn't take a paycut when they were on the ambulance, and were absolutely miserable. When they took vacation time, they always did it during their EMS month. They wanted to be firefighters. And when the opportunity presented itself for them to outsource the ambulance, they jumped on it.
Lets talk about staffing..... in general terms, most urban EMS systems are understaffed. All things being equal, most 100% career FDs are pretty well staffed. They rarely have all their units on calls, and while sometimes they do run, most do get some down time during a shift. For rough numbers, any given area should have as many BLS units as engines, and ALS units as ladders. With those numbers, you wouldn't need to send all the suppression units on EMS calls, which consists of 80% of their call volume.
Let talk about budgets.... Fire departments are, historically, a black hole for money. millions of taxpayer dollars are spent, and they will never turn a profit. EMS, however is expected to make money. they bill for everything. so the budget of EMS get cut when they don't generate enough revenue. we won't put another ambulance on, if it won't be profitable. and a fire engine is seen as an insurance policy; it's there in case it's needed. an ambulance is only worth having if it's goin on a call and making money.
There are some great firefighter/paramedics. more often than not, they started as paramedics, worked as ambulance paramedics for several years, before getting hired by the fire department. some even continue to work part time as ambulance paramedics. most firefighter paramedics that I know are firefighters who got their paramedic for reasons other than to be good healthcare providers on the ambulance. they are firefighters who do just enough con ed to maintain their medic cert; and they want to be on the suppression units saving lives, not being on the ambulance.
if you force someone to be something they really don't want to do, if you treat them poorly compared to their suppression counterparts, if you don't give them the resources or direction to do the job right, and if you have accepted substandard and half-assed providers for so long, does it really surprise you that you get low results?
