Another Florida EMS goes Fire

[EMTinNEPA]

If you come in with the Paramedic cert, they get a higher pay.

No, we do not have our EMS/FD set up like NY or SF.

A paramedic is only worth $6k - $8k a year?

 

[boingo]

I'm not convinced that having a paramedic on every fire truck makes for better EMS delivery. The vast majority of calls don't require ALS level care in the first 4 minutes. If a fire department is going to deliver high quality ALS level care, I believe the Seattle model is best. Fire first responders, with ALS providers in ambulances, not ladder trucks. Just because you can put an ALS provider on scene in 4 minutes doesn't mean the quality of care is going to be better. Over saturation with paramedics is what makes places like L.A such an abortion of pre-hospital medicine.

 

[Shishkabob]

I'm neutral on Fire EMS. Fact is, some places can do it great, while some places (cough DC cough) can suck horribly at it.


Just because someone is a fire-medic doesn't mean they are a bad medic. There are places, SUCH AS FLORIDA, where if you want to be a 911 medic, you pretty much have to be a FF as well. Pretty close to the same thing here in DFW. Some cities in DFW don't force you to ride the box, you can actually choose to, which is all the better.

 

[Melclin]

I don't think that the issue is the individual medic. I'm sure there are plenty of good fire medics, its more the debate over the system as a whole, as I understand it.

 

[Shishkabob]

And as I state in every single thread that has to do with generalizations;


DON'T generalize every single person/group throughout the country. (Says the person who commented on DC)


Not all cops are bad. Not all fire medics suck. Not all medics follow the law. Not all Basics are clueless. Not all candy is good.

 

[VentMedic]

I'm not convinced that having a paramedic on every fire truck makes for better EMS delivery. The vast majority of calls don't require ALS level care in the first 4 minutes. If a fire department is going to deliver high quality ALS level care, I believe the Seattle model is best. Fire first responders, with ALS providers in ambulances, not ladder trucks. Just because you can put an ALS provider on scene in 4 minutes doesn't mean the quality of care is going to be better. Over saturation with paramedics is what makes places like L.A such an abortion of pre-hospital medicine.

No, we do not transport patients on engines or ladder trucks.
This is where some don't understand a Fire Based EMS system. Many do have ambulances and transport their own patients.

The system in L.A. is not the best model but that also has to do with their entire state system.

 

[VentMedic]

A paramedic is only worth $6k - $8k a year?

That is on top of a very decent FF income plus benefits including retirement.

 

[boingo]

No, we do not transport patients on engines or ladder trucks.
This is where some don't understand a Fire Based EMS system. Many do have ambulances and transport their own patients.

The system in L.A. is not the best model but that also has to do with their entire state system.

LOL! I know they don't transport on those appartus, I just think its overkill to staff supression pieces with paramedics in order to have a paramedic on every call in 4 minutes.

 

[VentMedic]

Would you rather have something like EMTinNEPA described with a mish mash of responders who are EMTs with limited skills and equipment?

I don't always agree with running as many pieces of equipment to one scene as some systems do but there are far worst EMS systems out there that don't believe in providing Paramedics or even a paid employee for some consistency.

 

[HotelCo]

Here we go again...

 

[Tincanfireman]

This subject is near and dear to me, since I have family living in the Golfview district of Polk County and my late MIL was transported many times by Polk County Fire/Rescue before she passed. Vent and Sasha are correct; they do it right in Florida; but what works in one locale may be inappropriate for another. You have to understand, Polk County is enormous, both geographically and population. They are 7th in population for the entire state (source), but that includes areas as diverse as Lakeland and some of the biggest cattle farms and orange groves in the state. It is 15 miles from the Golfview station to my FIL's front door, so backup is going to be awhile. If crosstraining provides a higher level of safety for responding crews and the populace in general and if it has been proven to work as well as it does in FL, then why not employ it?

 

[boingo]

Would you rather have something like EMTinNEPA described with a mish mash of responders who are EMTs with limited skills and equipment?

I don't always agree with running as many pieces of equipment to one scene as some systems do but there are far worst EMS systems out there that don't believe in providing Paramedics or even a paid employee for some consistency.

Sure, there is worse things than too many paramedics, however that doesn't make the "medic on every truck" system much better. I won't argue that a fire department can't provide quality EMS, its just that the vast majority don't. Seattle is an example of a fire based system, that to me works as it should. There are no ALS engines, no ALS ladder trucks, only fire EMT first responders with high quality paramedics that treat a lot of high acuity patients, and have a strict QA/QI program in place, and EMS isn't a "punishment" assignment but one that requires constant advancement and con-ed.

 

[boingo]

This subject is near and dear to me, since I have family living in the Golfview district of Polk County and my late MIL was transported many times by Polk County Fire/Rescue before she passed. Vent and Sasha are correct; they do it right in Florida; but what works in one locale may be inappropriate for another. You have to understand, Polk County is enormous, both geographically and population. They are 7th in population for the entire state (source), but that includes areas as diverse as Lakeland and some of the biggest cattle farms and orange groves in the state. It is 15 miles from the Golfview station to my FIL's front door, so backup is going to be awhile. If crosstraining provides a higher level of safety for responding crews and the populace in general and if it has been proven to work as well as it does in FL, then why not employ it?

Proven how? There was a retrospective study done 10 or so years ago in the Orlando area that showed a 20% misplaced endotracheal intubation rate, is that how its "done right"? Too many medics with too few patient care interactions produce piss poor results, intubation is one of the hot topics at the moment. Look at the numbers coming out of systems with a high number of paramedics per population, and then compare it to a system with a low number of medics per population. More does not equal better. Can more equal better? Perhaps, but it would take a very involved medical director and a committed group of medical professionals to provide the needed clinical experience to maintain a high level of proficiency, haven't seen it yet.

 

[VentMedic]

Here we go again...

Do you want to explain that? How much experience with various systems do you have to offer a comment?

 

[HotelCo]

Do you want to explain that? How much experience with various systems do you have to offer a comment?

The whole "fire-based EMS" discussion is brought up over and over, and the arguments are the same. Sure, once in a while we have a new argument brought up either for or against it, but overall...

And to answer your question, not much.

 

[VentMedic]

only fire EMT first responders with high quality paramedics that treat a lot of high acuity patients, and have a strict QA/QI program in place, and EMS isn't a "punishment" assignment but one that requires constant advancement and con-ed.

Where do you get the idea it is a punishment? Do you think I don't know what is involved to be a good Paramedic rather than one that just weres the patch to play with the L/S? I joined the FD because I wanted to be a Paramedic and I had to have a degree back in the day to beat out my competitors for a spot as a Paramedic.

Florida has a large elderly population and the high call volume even in rural areas which is probably another reason volunteer ambulances would not be popular.

Not all FF/Paramedics will actually be working as a Paramedic. Some may never work as a Paramedic. We also have many residents in CA and FL who are Paramedics but will never work as one for a FD or otherwise. Right now with the low education standards, it doesn't take a lot of effort for some to get the cert to see what it is all about especially since there are enough medic mills around with no prerequisites required except a 120 hour EMT patch. If they don't get on with the FD, they may continue to flip burgers at Burger King.

 

[VentMedic]

The whole "fire-based EMS" discussion is brought up over and over, and the arguments are the same. Sure, once in a while we have a new argument brought up either for or against it, but overall...

And to answer your question, not much.

Ignoring issues will not make them go away.

Ignoring issues will also limit your knowledge of how things are done in EMS throughout the U.S. and other countries. It never hurts to see how something is done elsewhere and someday you may have a position to where you can incorporate some new ideas.

 

[boingo]

Where do you get the idea it is a punishment? Do you think I don't know what is involved to be a good Paramedic rather than one that just weres the patch to play with the L/S? I joined the FD because I wanted to be a Paramedic and I had to have a degree back in the day to beat out my competitors for a spot as a Paramedic.

Florida has a large elderly population and the high call volume even in rural areas which is probably another reason volunteer ambulances would not be popular.

Not all FF/Paramedics will actually be working as a Paramedic. Some may never work as a Paramedic. We also have many residents in CA and FL who are Paramedics but will never work as one for a FD or otherwise. Right now with the low education standards, it doesn't take a lot of effort for some to get the cert to see what it is all about especially since there are enough medic mills around with no prerequisites required except a 120 hour EMT patch. If they don't get on with the FD, they may continue to flip burgers at Burger King.

In some systems, riding the "box" is punishment when you want to ride suppresion. I'm not saying that is the case everywhere, it may not be the case at all at the department you started with. My issue is with over saturation of providers, regardless the education level unless there is the clinical opportunities required to maintain a high level of competence. I think you would agree that a Florida medic mill (or any states medic mill) paramedic assigned to an engine company stuffing plastic down someones throat is a bad idea. A better idea would be proficient BLS level first response with highly qualified, highly experienced ALS back up, with rigid medical oversite, regardless of the affiliation of said ALS provider. A medic with a pulse on every truck to stop the ALS "clock" is not better medicine. I'd rather have competent advanced care in 10 minutes than half assed "advanced" care in 4. That is the only point I'd like to make. The organization providing care is irrelevant.

 

[ResTech]

Generally speaking I am against Fire-based EMS... I've seen it too many times... Firefighter's who want nothing to do with EMS... in fact I've known some that absolutely hate it... become ALS solely because they are forced to do it as part of their job. They have no desire to provide great care or keep up on the latest trends within the field and be cutting edge. All they want to do is ride the shiny fire truck and fight fire. And the ones I know went through a very condensed EMT-Intermediate course just to get the patch so they can fill a spot on a Medic unit in the city.

Fire & EMS are totally seperate functions and fields. The same people who were so against EMS being considered Public Safety due to the distinct medical element of EMS are now advocating Fire based EMS... how is that??? If EMS is a medical profession and not Public Safety then it doesn't belong within a Fire Department, right?

Both fire and EMS should have people who can dedicate themselves to their field and do it well. If you don't want to provide EMS then you shouldn't be forced to. And if you are a great Paramedic who doesn't want to fight fire, then you shouldn't have to nor be held back from a job.

I wanna work in Baltimore City and would meet the fire qualification but I hate fire suppression... would you want me backing you up on a line on a row house fire??? nope. Same as I wouldn't want you providing care for me or being my partner when I know your heart isn't in it or have very little clue what ur doing.

 

[VentMedic]

The same people who were so against EMS being considered Public Safety due to the distinct medical element of EMS are now advocating Fire based EMS... how is that???

I am not against Public Safety. A FD is part of Public Safety and that is another role they must provide.

Not all FDs are the same and Baltimore may be a very bad example for both firefighting and EMS. There are many FDs that do have a balance. I too would not want a FF watching my back at a fire scene who didn't give a crap about being a FF. But, there are many more who are very good at both professions. Unfortunately, EMS in many areas, whether it is Fire or not, depends more on skills with a recipe to follow rather than knowledge and guidelines in place with the protocols.