Are San Diego City Paramedics Making Too Much?

[DrParasite]

For the life of me, I still don't understand the practicality of sending engines on medical calls. [rhetoric]Granted, I haven't been in EMS long... maybe someone could enlighten me?[/rhetoric]

oh that's easy. it stops the clock, which is from the moment the person calls 911 until "help" arrives. it ignores that fact that the "help" doesn't want to be there, the "help" while on paper is qualified doesn't practice enough to be proficient in the skills, and ignores the fact that very often the patient needs transport to a hospital ER, not a non-transport vehicle to hold the patient's hand and say "don't worry, the ambulance is on the way."

Also, it justifies the FD positions, and it gives the FD more run numbers. Plus, it's a better position for a politician to say "we aren't going to close your local firehouse that goes on 2 runs every 24 hours" but we aren't going to give the local EMS system the resources it needs to make it to your house when you call 911 within 8 minutes.

Plus, most people don't care about the local EMS system, don't care about the funding or staffing levels of the local EMS system, and actively insist that EMS agencies run with less and less funds, until the time it takes the ambulance to long to get to them when THEY have a medical emergency, than it's the fault of EMS that it took so long.

pretty easy to explain if you ask me

 

[marshmallow22]

If you don't like what agencies are offering for pay then look elsewhere. Even if that means going out of state... especially CA!. Besides AMR Ventura County and Santa Barbara, there is no money to be made as a private medic in So. Cal. There will be NO FD's hiring any time soon, and if so they will be most likely picking up laterals from other departments in which guys are leaving due to city budget issues. Get out of CA, be a real medic with real protocols, and get paid for it. A number of states offer good pay with city benefits and pension for being a 3rd service medic or a single function medic with a fire dept. Texas, NM, Florida, Illinois, Idaho, Wash. just to name a few. As for AMR Ventura County and Santa Barbara, it's still AMR. It's only a matter of time before Ventura and Santa Barbara county FD's push for more medic engines and/or squads and in turn AMR can reduce their # of units. Before you know it, those counties will be another LA county AMR. AMR hates their employees working 24 hr shifts and only cares about their bottom line (shareholders). Once again, expand your horizons and get the heck out of CA!

My 2 cents.

 

[ShotMedic]

FDs are hiring just not the way they used to. They used give anyone with a Pcard a job. Now its just competitive. So you have to be a marketable person and build your resume and better yourself in the fireside as well as the medical side. To think that all firefighters are over being medics is a huge generalization! Some of the best medics is So Cal are firefighters. To have a engine on-scene first is awesome in my opinion. IF the call is BS then they can Cancel you leaving you available for someone who really needs your help. if its a CPR or the patient goes south then you have more then enough willing helpers who would like to jump in on anything you ask. Now a days most firefighters in So Cal started off running IFTs on a BLS ride then worked as a private medic. Then got to the moneyy spot on the big shiny red engine. Is there a ton of crappy engine medics out there who are over it? ofcourse. Is there a bunch of crappy single role medics who are over weight and can barely get up a flight of stairs? ofcourse. But is there awesome engine medics with great EMS knowledge? i think so. and same on the flipside.
my $.02$

 

[DesertMedic66]

FDs are hiring just not the way they used to. They used give anyone with a Pcard a job. Now its just competitive. So you have to be a marketable person and build your resume and better yourself in the fireside as well as the medical side. To think that all firefighters are over being medics is a huge generalization! Some of the best medics is So Cal are firefighters. To have a engine on-scene first is awesome in my opinion. IF the call is BS then they can Cancel you leaving you available for someone who really needs your help. if its a CPR or the patient goes south then you have more then enough willing helpers who would like to jump in on anything you ask. Now a days most firefighters in So Cal started off running IFTs on a BLS ride then worked as a private medic. Then got to the moneyy spot on the big shiny red engine. Is there a ton of crappy engine medics out there who are over it? ofcourse. Is there a bunch of crappy single role medics who are over weight and can barely get up a flight of stairs? ofcourse. But is there awesome engine medics with great EMS knowledge? i think so. and same on the flipside.
my $.02$

I agree with this statement 100%.

 

[usalsfyre]

How do you define an "awesome" medic? I'm not saying awesome engine medics don't exist, but I can probably count the ones I've run into on two (maybe one) hand.

 

[LucidResq]

They way things are, honestly, all of the good medics I've met have fallen into one of three categories:

Those on private services who are typically burnt-out and frustrated with their situation (they often are involved in contracts in which the FD has total control).

Third-service or hospital-based medics who are generally in control at scenes, paid well and happy with their positions.

Fire medics who have an equal or greater interest in medicine in comparison to the fire stuff, who are mostly in the FD for the variety, job stability and unequaled compensation.

I know quite a few people who are primarily interested in EMS but recognize working for a FD is almost always the best way to support a family. Can you blame them for turning to the "dark side"?

 

[jgmedic]

They way things are, honestly, all of the good medics I've met have fallen into one of three categories:

Those on private services who are typically burnt-out and frustrated with their situation (they often are involved in contracts in which the FD has total control).

Third-service or hospital-based medics who are generally in control at scenes, paid well and happy with their positions.

Fire medics who have an equal or greater interest in medicine in comparison to the fire stuff, who are mostly in the FD for the variety, job stability and unequaled compensation.

I know quite a few people who are primarily interested in EMS but recognize working for a FD is almost always the best way to support a family. Can you blame them for turning to the "dark side"?

This. I love my job as a medic, I deeply care about better EMS education and about being an educated provider. I love my family and supporting them well even more. So you better damn well believe I'm working towards the one place in SoCal I can have decent benefits and pay for myself and them, FD.

 

[usalsfyre]

Can you blame them for turning to the "dark side"?

Not really, but don't bad mouth me either for trying to change the horribly warped system that is most FD-based EMS, or for that matter probably 50% or more FDs in the US period.

 

[sweetpete]

oh that's easy. it stops the clock, which is from the moment the person calls 911 until "help" arrives. it ignores that fact that the "help" doesn't want to be there, the "help" while on paper is qualified doesn't practice enough to be proficient in the skills, and ignores the fact that very often the patient needs transport to a hospital ER, not a non-transport vehicle to hold the patient's hand and say "don't worry, the ambulance is on the way."

Also, it justifies the FD positions, and it gives the FD more run numbers. Plus, it's a better position for a politician to say "we aren't going to close your local firehouse that goes on 2 runs every 24 hours" but we aren't going to give the local EMS system the resources it needs to make it to your house when you call 911 within 8 minutes.

Couldn't DISAGREE more. Where I serve, our FD is 100% pro-EMS. We run ALS engines and first respond to the "serious" calls in order to back the play of our EMS brothers/sisters. We usually arrive first because we have more engines in the city than the county has ambulances.

Not to mention, our firefighters are typically in 110% better physical shape than 3/4 of the ambulance medics that arrive. In addition to "holding a patient's hand" (which, by the way, isn't always a bad thing) we start/interpret EKGs, start a line, provide first line cardiac drugs,package and load the patient, etc... The only service we don't provide that the medic unit does is the actual transport. Even then, we'll ride in on ANY call the in-charge medic asks us to. Often times, we'll even offer if the patient seems "iffy".

When EMS and Fire play nicely, it's like a ballet. But when you have people who don't respect the other side equally, it becomes a mosh pit. Sorry if you don't agree. But that's a fact. To even say that a FD is trying to "pad" there numbers by adding EMS to the mix is just ignorant. Ask the patient or the parent of the patient who called 911 and they'll tell you....."the sound of a Q2 on a fire truck rounding the corner is like an angel singing". They don't care who shows up first, as long as someone CAPABLE is there to help, which I can say with NO hesitation, our firefighters are more than capable.

 

[JPINFV]

Couldn't DISAGREE more. Where I serve, our FD is 100% pro-EMS. We run ALS engines and first respond to the "serious" calls in order to back the play of our EMS brothers/sisters. We usually arrive first because we have more engines in the city than the county has ambulances.

Are there enough low use procedures (e.g. intubations) to support both FD and EMS paramedics?

So no one complains when an EMS run comes in?

No one is forced to become a paramedic, either officially or in order to be competitive for hiring (de facto required)?

Is there an actual need for paramedic first response? After all, not everyone in the hospital is a physician.

Not to mention, our firefighters are typically in 110% better physical shape than 3/4 of the ambulance medics that arrive. In addition to "holding a patient's hand" (which, by the way, isn't always a bad thing) we start/interpret EKGs, start a line, provide first line cardiac drugs,package and load the patient, etc... The only service we don't provide that the medic unit does is the actual transport. Even then, we'll ride in on ANY call the in-charge medic asks us to. Often times, we'll even offer if the patient seems "iffy".

What does physical shape have to do with providing paramedic first response? I'm willing to bet that most firefighters are in 110% better physical shape than most ED physicians. Do you want the firefighters replacing ED physicians now?

How much time is normally saved? How many of those procedures actually help (e.g. the only thing shown to help in a cardiac arrest is compressions and defibrillation are the only things shown to improve survival to discharge)? Starting a line and then not giving anything doesn't help.

When EMS and Fire play nicely, it's like a ballet. But when you have people who don't respect the other side equally, it becomes a mosh pit. Sorry if you don't agree. But that's a fact. To even say that a FD is trying to "pad" there numbers by adding EMS to the mix is just ignorant. Ask the patient or the parent of the patient who called 911 and they'll tell you....."the sound of a Q2 on a fire truck rounding the corner is like an angel singing". They don't care who shows up first, as long as someone CAPABLE is there to help, which I can say with NO hesitation, our firefighters are more than capable.

I think there's a difference between questioning the appropriateness of fire department paramedic first response and dis/respecting field staff. This is a debate for forums and city council meetings, not on a medical scene. Similarly, the "angel singing" comment is just as applicable with an EMT first response as a paramedic first response.

 

[sweetpete]

Are there enough low use procedures (e.g. intubations) to support both FD and EMS paramedics?

Absolutely. We average 5 or 6 cardiac arrests each month. Even 1 a month would justify an ALS truck, not to mention the other ALS calls we go on. Plus, our training time is equal to the county's since we're under the same medical control.

So no one complains when an EMS run comes in?

Sometimes (typically, there's more complaining at dinner or after midnight) But, not when we get on scene. It's all customer service/patient care at that point.

No one is forced to become a paramedic, either officially or in order to be competitive for hiring (de facto required)?

No. EMT-Basic and your fire cert. is all that's required. But the medic cert pays more. All medic school is voluntary and reimbursed upon successful completion. So it makes it fair to the employee and the city.

Is there an actual need for paramedic first response? After all, not everyone in the hospital is a physician.

Sure, sometimes. Nonetheless, every truck has at least one medic at any given time. Usually more than one. It's what the our public expects, at this point.


What does physical shape have to do with providing paramedic first response?
Alot when it comes to climbing stairs, bringing patients down (especially "bigger" patients), doing compressions.....physical stamina and strength are just as important as knowledge in this field. That's just my opinion though.

Do you want the firefighters replacing ED physicians now?
That's ridiculous. I don't see the correlation and I never implied that in my post. ED docs are awesome.

How much time is normally saved? How many of those procedures actually help (e.g. the only thing shown to help in a cardiac arrest is compressions and defibrillation are the only things shown to improve survival to discharge)? Starting a line and then not giving anything doesn't help.

We average between 3-5 mins between our arrival and the next incoming medic unit. So, in EMS terms.....that's a lifetime. You can do alot to help a patient in that window. Also, we carry about 90% of the same drugs that the medic unit carries, minus RSI. So, yes, we can typically get a HUGE jump on a serious life-threat prior to ambulance arrival.

I think there's a difference between questioning the appropriateness of fire department paramedic first response and dis/respecting field staff. This is a debate for forums and city council meetings, not on a medical scene. Similarly, the "angel singing" comment is just as applicable with an EMT first response as a paramedic first response.

I would tend to agree with this point. As a parent, I want that ambulance asap. My point is that I'll take an ALS engine/truck in addition. However, knowing what I know now and having been an EMT-B for awhile before becoming an EMT-I, and especially now that I'm "rounding third" with with my medic school, I would want an ALS ambulance/truck EVERYTIME over a basic, in a true life-threatening emergency.. No offense to any EMT-Basics. That's my viewpoint.

And btw, my info is strictly based on the needs of the community that I serve. Every city/metro is different, so I know it's not a "cookie cutter" delivery system.
Thanks,

 

[DrParasite]

great statement that supports my point:

We usually arrive first because we have more engines in the city than the county has ambulances...
When EMS and Fire play nicely, it's like a ballet. But when you have people who don't respect the other side equally, it becomes a mosh pit. Sorry if you don't agree. But that's a fact. To even say that a FD is trying to "pad" there numbers by adding EMS to the mix is just ignorant....
Ask the patient or the parent of the patient who called 911 and they'll tell you....."the sound of a Q2 on a fire truck rounding the corner is like an angel singing". They don't care who shows up first, as long as someone CAPABLE is there to help, which I can say with NO hesitation, our firefighters are more than capable.

So you admit that Houston has more fire trucks than ambulances, and I'm guessing that Houston is like almost every urban city in the US where EMS calls outnumber fire calls by a margin of at least 2:1.

So Houston fire is arriving first because the City won't staff the EMS system with enough ambulances to do the job properly, without the bandaid assistance of the HFD first response engines.

In fact, I'm betting you could eliminate quite a few of those engine company responses if they had more ambulances, so you wouldn't need the engine to even do a first response run.

and many studies have shows that in the majority of the calls, 2 minutes don't make a difference in mortality of patients (no I don't have the cite with me, but it has floated around here).

I'm sure your citizens feel very relieved when they hear the Q, because it tells them someone is there. but that relief is due to ignorance on behalf of the public.... they would be much better if they had an ambulance show up who could transport them to the hospital, instead of a non-transporting fire engine. after all, studies have shown in the urban environment that ALS doesn't affect mortality on a statistical level.

Don't get me wrong, having extra hands on an MVA, cardiac arrest, even just to help carry an obese patient is definitely appreciated.

But I'd rather get a quick ride to the hospital in a BLS ambulance who can get me to the ER, than have 4 firefighters standing around me when I am having an MI or get shot or hit by a car or I'm having a stroke saying "don't worry the ambulance is on the way" and then waiting and hoping they don't get diverted or flagged down or have a flat tire etc.

but that's just me, I'm a bigger fan of evidenced based medicine instead of the emotional belief that a non-transporting ALS first responder will actually do anything that has a benefit on patient outcomes.

 

[usalsfyre]

but that's just me, I'm a bigger fan of evidenced based medicine instead of the emotional belief that a non-transporting ALS first responder will actually do anything that has a benefit on patient outcomes.

Somebody please check the tempature in Hades because I agree completely with DrParasite on this statement.

 

[ShotMedic]

How many ambulance responses actually end in a transport? I think we just need, transport fireengines or put a tow hitch on the existing engines? Whose down?

 

[jgmedic]

Part of the problem is that FD's are far better at PR than EMS. They, for the most part, present themselves as far more professional than most EMS services.

 

[usalsfyre]

Part of the problem is that FD's are far better at PR than EMS. They, for the most part, present themselves as far more professional than most EMS services.

I haven't found they present themselves more professionally, but rather have learned to play on emotion and impress with pomp, circumstance and tradition.

FDs have been seriously playing up the "hero" thing for ten years now. What's regrettable is it's actually set us back in certain areas. Safety, for instance. To many fireman have started to believe their own PR.

 

[jgmedic]

I haven't found they present themselves more professionally, but rather have learned to play on emotion and impress with pomp, circumstance and tradition.

FDs have been seriously playing up the "hero" thing for ten years now. What's regrettable is it's actually set us back in certain areas. Safety, for instance. To many fireman have started to believe their own PR.

I agree to a point, but I believe that is good PR(for them), if people believe what they are seeing, who are they more likely to support?

 

[usalsfyre]

I agree to a point, but I believe that is good PR(for them), if people believe what they are seeing, who are they more likely to support?

Yeah, it's good to believe what you sell...'till a building falls on your head.

A department around here had a double LODD because two guys were somewhere they never should have been. They're held up as "heros" even though they were inside a structure with no savable contents, because of the hype. Houston FD kills at least one firefighter a year in a vacant building, yet they're "heroes" and HFD sees no reason to revise their tactics.

Why does it piss me off so bad? Because I'm tired of hearing about preventable deaths (FD and EMS) and wondering if it was a friend of mine....

 

[jgmedic]

Yeah, it's good to believe what you sell...'till a building falls on your head.

A department around here had a double LODD because two guys were somewhere they never should have been. They're held up as "heros" even though they were inside a structure with no savable contents, because of the hype. Houston FD kills at least one firefighter a year in a vacant building, yet they're "heroes" and HFD sees no reason to revise their tactics.

Why does it piss me off so bad? Because I'm tired of hearing about preventable deaths (FD and EMS) and wondering if it was a friend of mine....

LAFD, same story. I'm not saying I agree with it, I'm saying it's a huge factor in the disparity between not only pay, but public opinion in the public vs. private/3rd EMS debate.

 

[usalsfyre]

LAFD, same story. I'm not saying I agree with it, I'm saying it's a huge factor in the disparity between not only pay, but public opinion in the public vs. private/3rd EMS debate.

That I certainly agree with. And the I also agree that a big problem image wise is I get lumped in with the dialysis derby employee in shorts, flip-flops, an untucked and unbuttoned uniform shirt and enough metal in his face that it looks like he fell into a tackle box (not anti-tattoo or piercing, but keep it tasteful). Why? Because we both have "ambulance" written on the vehicle we show up in.