But, I'm a pilot.

[gotbeerz001]

#conflicted


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[NomadicMedic]

It's even more difficult when carpenter pilots make 3 times as much as the pilots who don't build houses.

 

[gotbeerz001]

For those who have a problem with carpenter pilots, what do you think the appropriate level of interaction should be?? I hear gripes that fire medics are lazy and chronically undertreat patients but also are not appreciated when they try to maintain or dictate care beyond field transfer. So where is the "sweet spot" for a fire medic trying to get along? I wonder if maybe some transporting medics find that they have conflicting thoughts on the matter which set them up to always talk **** about the FFPM just trying to do their job...

Please be specific and explain which interventions are expected for your standard calls (ALOC, CP, SOB etc...) and which interventions should be left for the transporting medic to dictate.


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[VentMonkey]

For those who have a problem with carpenter pilots, what do you think the appropriate level of interaction should be?? I hear gripes that fire medics are lazy and chronically undertreat patients but also are not appreciated when they try to maintain or dictate care beyond field transfer. So where is the "sweet spot" for a fire medic trying to get along? I wonder if maybe some transporting medics find that they have conflicting thoughts on the matter which set them up to always talk **** about the FFPM just trying to do their job

My personal take is that the type of paramedic that most, not all, FFPM's portray is dictated by the approach their department, and in turn, culture with it takes with the EMS delivery of their department.

Many (not all) times it seems as though it's approached similar to the way they would "take down" a fire, complete with a command approach. I guess what I am trying to say is that all to often I have seen them have a "one-size fits all" style of running calls.

I think we can all agree, this is often not the case with medicine in general, and like it or not, we're still very much being held accountable as medical professionals.

Now, what the fire department does bring waaay better than most transport paramedics (again, in my experience), is a professional public service approach.

 

[WolfmanHarris]

The sweet spot would be no fire-medic at all. There is no need to have an ALS provider available for the care needed in the seconds to short minutes they'll actually spend with the patient. The only patients and interventions that are that time sensitive require BLS care. If arrival of a transport unit is so delayed that this isn't the case than that system is drastically under-resourced as for a large segment of our sickest patient, while what we do may alleviate symptoms, definitive care is only found in the hospital.

We're currently dealing with the Ontario branch of the IAFF pushing a platform of "Fire-Medics" (something we do not have anywhere in this province). They want any FF's who are currently or were once Paramedics to be able to practice as such while working as a FF. They're arguing that it's both cost neutral, which no union worth the dues they're paid would actually allow for long and that it's for the benefit of patients, despite that total lack of evidence of need. Certainly they've been arguing response time, but refusing to do an apples to apples comparison on times. Since EMS in Ontario measures from call received to arrive scene and fire reports travel time only.

I'm not saying a service cannot provide excellent pre-hospital care and provide top notch fire suppression and rescue, but when EMS is viewed as a merit badge course, and something you do to get on the engine or to keep call volumes up, etc etc. than that's not the case.

 

[gotbeerz001]

The sweet spot would be no fire-medic at all. There is no need to have an ALS provider available for the care needed in the seconds to short minutes they'll actually spend with the patient. The only patients and interventions that are that time sensitive require BLS care. If arrival of a transport unit is so delayed that this isn't the case than that system is drastically under-resourced as for a large segment of our sickest patient, while what we do may alleviate symptoms, definitive care is only found in the hospital.

We're currently dealing with the Ontario branch of the IAFF pushing a platform of "Fire-Medics" (something we do not have anywhere in this province). They want any FF's who are currently or were once Paramedics to be able to practice as such while working as a FF. They're arguing that it's both cost neutral, which no union worth the dues they're paid would actually allow for long and that it's for the benefit of patients, despite that total lack of evidence of need. Certainly they've been arguing response time, but refusing to do an apples to apples comparison on times. Since EMS in Ontario measures from call received to arrive scene and fire reports travel time only.

I'm not saying a service cannot provide excellent pre-hospital care and provide top notch fire suppression and rescue, but when EMS is viewed as a merit badge course, and something you do to get on the engine or to keep call volumes up, etc etc. than that's not the case.

So you're telling me that the unstable pt in a treatable dysrhythmia or a severely hypoglycemic pt should remain in their state for and additional 5-10 minutes because of "politics"?


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[WolfmanHarris]

So you're telling me that the unstable pt in a treatable dysrhythmia or a severely hypoglycemic pt should remain in their state for and additional 5-10 minutes because of "politics"?


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No I'm saying they shouldn't have a system so poorly resourced that a properly staffed Ambulance takes 15 minutes in an urban or suburban area for to reach a high acuity call. I work in a very well resourced area, our response times are at records lows and FD does not beat us to calls in an estimated 75% of calls (data is still pending) and when they arrive before us it is by less than a minutes. (We are station based, but dynamically deployed to balance coverage)

It's not politics, it's EBM. Generally I find FD's are hostile to it though because it doesn't support their claims that seconds count in ALS. There is not medical need for what they're proposing in my province yet they have no interest in that discussion. Or the legitimate concerns about patient safety associated with limited pt contacts and degradation of skills and the providing medical care during a 24 hour shift.

 

[Summit]

You are going to be flying a beautiful plane. You've got an excellent work schedule, and you're gonna make some awesome money.

Good analogy except for this part does not apply to new pilots

 

[gotbeerz001]

While I don't disagree with you, your experiences and mine vary quite a bit. We currently (transport) cannot keep a full staff and at any point have up to 30 open spots being covered with OT and forced mandation.

Your system sounds ideal but does not match the reality that I see in both my systems. Fact is, for better or for worse, the fire medic is a necessary part of our matrix. Maybe it is because I work both sides and take my role seriously, but I find that things work best when you have both sides working together to provide care.


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[CALEMT]

but I find that things work best when you have both sides working together to provide care.

It is in fact a team event as I like to preach.

 

[WolfmanHarris]

While I don't disagree with you, your experiences and mine vary quite a bit. We currently (transport) cannot keep a full staff and at any point have up to 30 open spots being covered with OT and forced mandation.

Your system sounds ideal but does not match the reality that I see in both my systems. Fact is, for better or for worse, the fire medic is a necessary part of the matrix. Maybe it is because I work both sides and take my role seriously, but I find that things work best when you have both sides working together to provide care.


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Not questioning your commitment or competence, or saying that your system doesn't provide good care. You asked for the "sweet spot" I think the sweet spot is no Fire-Medic, because no more than a First Responder trained FF is needed for the occasional manpower augment on very high acuity or trauma calls.

 

[EpiEMS]

The sweet spot? A good co-pilot (carpenter trained or not!) who knows when to ask the pilot's opinion and is able to provide temporizing measures until the pilot is available, if needed...

But maybe I'm going a little far on this metaphor.

 

[StCEMT]

While I may not like the huge push to be both firefighters and medics, I don't completely disagree with their existence as a whole. Where I disagree is like some ad I saw a long time ago regarding a cardiac arrest with 6 medics on the call and questioning what level of care people would want for their family (P vs B). However, there have been a few times where having a fire guy ride along as an extra medic has been helpful. Now where I work, I am the only medic on the truck. It is nice knowing I can have one of them jump in the back and help if I ever need it. Do I usually need it? No. But for that one call? Yea, I'll take it.

 

[EpiEMS]

While I may not like the huge push to be both firefighters and medics, I don't completely disagree with their existence as a whole. Where I disagree is like some ad I saw a long time ago regarding a cardiac arrest with 6 medics on the call and questioning what level of care people would want for their family (P vs B).

I've been looking for this ad! It's a laughable one from both a system design and a clinical perspective...

 

[SpecialK]

I quite like the fire brigade in a mild sort of way; I've visited a couple fire stations in various other countries (for example England and Australia) and sort of casually asked if they have any involvement in medical work, specifically interested in their first-responding to cardiac arrests. The answer has sort of been a perplexed look, then a firm "NO" usually followed quickly by "and we want to keep it that way". In England, the union had even sought a court order to legally prevent them responding to cardiac arrests.

All fire stations here do first response to cardiac arrest and the careers guys are on-scene in a couple of minutes but it takes the volunteer brigades a couple minutes until they turn out (because they need a driver, officer and two firefighters who have to drive into station) but they don't mind doing cardiac arrests either. Some more rural or remote brigades have become "first responders" who will respond to known life-threatening emergencies if an ambulance is not immediately available however there was severe pushback from the UFBA (and it's volunteer members) about doing any sort of medical work outside of what had not been very deliberately agreed to. The firefighters made it very clear; they wanted no part of it in general because they wanted to be firefighters.

It takes so much of my effort just to focus on maintaining an appropriate level of clinical knowledge to keep up with the ever-increasing expectations and responsibilities of pre-hospital care. For example; the new CPGs have moved from ceftriaxone in septic shock to co-amoxiclav followed by gentamiacin for certain presentations, and the option of retaining ceftriaxone if the patient has a life-threatening allergy to penicillin (the language is to "call for" it but I don't know who as it is physically being removed from the kits as far as I know). So, now, not only must ambulance personnel be very good at recognising sepsis (which can be very difficult) but also taking on an even greater role in determining the source (or most likely source) of infection as it will directly determine the antimicrobial therapy given. There are a greater number of sections where treatment may be initiated and the patient left at home, or referred elsewhere, and this is in addition to the hundred billion other little things

I don't have enough hours in the day to be the "best" at everything now required of ambulance personnel so how on earth you can combine the two is beyond me ....

The one thing I will say I like about the fire service is they have a much better funding mechanism by the way of insurance levies and not being tied to the Government for money; makes it much easier I bet. Ambulance has to fight tooth, death and nail to the Ministry of Health for every cent whereas the fire service is seemingly rich with insurance levy money.

 

[EpiEMS]

I don't have enough hours in the day to be the "best" at everything now required of ambulance personnel so how on earth you can combine the two is beyond me ....

Quoting for truth. This is part of the inherent problem that many folks like to point out about fire-based EMS.

 

[Seirende]

I've been looking for this ad! It's a laughable one from both a system design and a clinical perspective...

http://emtlife.com/threads/fear-mongering.42509/

Here you go. Just search for "hose monkey" on this forum and it's the first result.

 

[EpiEMS]

@DEmedic
This is the greatest picture ever.

Who knew that you needed a paramedic to perform chest compression...?

 

[NysEms2117]

@DEmedic
This is the greatest picture ever.

Who knew that you needed a paramedic to perform chest compression...?

Just saying every one of those dudes is jacked beyond belief lol

 

[EpiEMS]

Just saying every one of those dudes is jacked beyond belief lol

"I want my tax dollars spent to keep firefighters super muscle-y," said no taxpayer ever!