City of Miami Fire Rescue

[Melclin]

Anybody know much about this service?

What are their training requirements? How is their scope (a link to protocols would be nice if anyone has them)? How well regarded are they?

Im interested to know in regards to a intubation study there that showed some pretty dismal results.

 

[JakeEMTP]

Just the City of Miami was studied or the larger Miami-Dade Fire Rescue or both?

Both are Fire Based EMS with at least 2 FF/Paramedics on evey engine or sometimes ladder and every rescue ambulance. There are probably over 2500 FFs between the 2 departments and the majority are trained as Paramedics. Miami-Dade has helicopters for HEMS. Miami-Dade is a consolidation of the smaller fire departments. That was around 30 of them. It was Metro-Dade before the consolidation. I think the stats were better before the consolidation. Their protocols are pretty extensive and include RSI.

 

[rescue1]

Just out of curiosity, what study was this?

 

[Christopher]

Just out of curiosity, what study was this?

Probably a Wang or Cobas paper.

Cobas MA, et al. Prehospital Intubations and Mortality: A Level 1 Trauma Center Perspective. Anesthesia & Analgesia. August, 2009 (109):489-493.

Medline Search: "Wang HE" AND intubation.

 

[medicsb]

Anybody know much about this service?

What are their training requirements? How is their scope (a link to protocols would be nice if anyone has them)? How well regarded are they?

Im interested to know in regards to a intubation study there that showed some pretty dismal results.

They have something like 370+ medics for a city of 400,000. I imagine that a medic is lucky to get 1 tube in a year. They're set up to be dismal when it comes to intubation.

 

[Christopher]

They have something like 370+ medics for a city of 400,000. I imagine that a medic is lucky to get 1 tube in a year. They're set up to be dismal when it comes to intubation.

Indeed. Beyond the fact that their unrecognized esophogeal intubation rate is ~12%...which means they don't use capnography.

 

[MochaRaf]

Last time I checked, the greater Miami-Dade area (which includes City of Miami) has a 1.5+ year waiting list for medics. The official policy for most of the Fire Rescue departments in the area is usually opening recruitment every 2 years or so. A few of my friends graduated from medic school well over a year ago and are still currently on the waiting list for the fire department. I know one ended up going to north Florida as he didn't want to wait any longer. It is a very highly sought after job, so competition is extremely fierce.

I do have to admit that some of the practices down here and very backward... I don't have much experience with City of Miami, but I was completely shocked when I saw the equipment, or lack of equipment that Miami-Dade Fire Rescue uses down here. A perfect example is the spinal immobilization. From my experience with MDFR, I have only seen them use tape to secure the persons head to the backboard. I asked them why they do not use head blocks to keep the head immobilized, to which I got the simple response of "we aren't as fancy as you folks in the North". Unfortunately for the patient, the tape DID not keep her head immobilized as every turn her head flapped left or right... Not to mention the medic who applied the collar hyperextended the patients neck and the backboard was covered in blood from a previous call. Although the above described incident may be isolated, the main focus of this story was the lack of proper immobilization equipment. And I don't want anyone to take this as an attack on our fire services down here, it is just a bit of frustration as to how things work I guess.

 

[medicsb]

Indeed. Beyond the fact that their unrecognized esophogeal intubation rate is ~12%...which means they don't use capnography.

I believe they have adopted capnography and have brought the esophogeal tubes down to near zero (I think there may have been a comment on the article by one of the authors somewhere, where this was stated). Regardless, it won't help one become better at intubation beyong IDing bad tubes.

 

[Melclin]

All makes sense now

It was RE the Cobas paper and a failed tube rate of ~31%.

It was involved in a discussion about prehospital tubes and I looked at it and thought, I bet there is more to this story than meets the eye.

They have something like 370+ medics for a city of 400,000. I imagine that a medic is lucky to get 1 tube in a year.

Exactly why a tiered system where one tier can do everything and the other nothing is a flawed system. You need a lower level provider who can manage the not so sick pts, bit of pain relief, an anti emetic here and there, bit of fluid for this and that, a decent ability to assess pts beyond, "Oh HR >100, call ALS". Keeps the the few high level providers looking after sick people.