Cleveland to merge fire and EMS

[Tigger]

That is not what the evidence suggest, it still is suggesting that Fire BLS First response arrives within 4mins. And an Ambulnace arrives within 8-12. No one is advocating not sending first responders to a call at all.

The cities that the studies were done all have a Medic on the Ambulance, so it is stating that a Medic arrives at every call. The medic just does not need to be there in under 4mins if an EMT is going to be there in under 4mins.

Agreed, my above post was poorly worded. My point is that for a patient that is truly sick, but not with a life threatening complaint, BLS does almost nothing. That interim time between first responder and arrival and ambulance arrival is significant at times, and I imagine that we would all consider timely relief of pain and suffering as a large part of EMS. ALS first response is useful here, but I don't think it can be quantified well statistically. I guess the wider question is whether or not everything done by EMS needs to be quantifiably useful, or are there other measures of success?

 

[sweetpete]

I lived in C-town my whole life (prior to moving to Houston 3 years ago). Believe me when I say.....CFD taking over CEMS is the BEST thing to ever happen to CEMS!!

They've always been the "step child" of Cleveland Safety even though they run their BALLS off!!! Maybe now they'll get some much deserved respect while cutting out some administration.

Just my humble opinion. Take care.

 

[medicsb]

I lived in C-town my whole life (prior to moving to Houston 3 years ago). Believe me when I say.....CFD taking over CEMS is the BEST thing to ever happen to CEMS!!

They've always been the "step child" of Cleveland Safety even though they run their BALLS off!!! Maybe now they'll get some much deserved respect while cutting out some administration.

Just my humble opinion. Take care.

Well, allowing ones self to be adopted (and co-opted) pretty much ensures that you will remain a step child.

 

[sweetpete]

Like I said, it was never gonna change. Perhaps now it will. At least they'll be working under the same umbrella as far as finances and leadership goes.

We'll have to wait and see. I think it's the best thing for them.

 

[medicsb]

Like I said, it was never gonna change. Perhaps now it will. At least they'll be working under the same umbrella as far as finances and leadership goes.

We'll have to wait and see. I think it's the best thing for them.

Maybe. Considering how other mergers have gone, I'm not holding my breath. This whole situation is why EMS will remain a step child. Medics don't want to fight for themselves and will take the "easy" way out. A shame, really. (Of course this is not in any way exclusive to Cleveland.)

 

[46Young]

I am not saying having extra hands is not needed, because I think it is. I was saying ALS first response is not cost effective because it has no scientific value or backing. BLS first response does however, and those same BLS first responders can lift equipment and help you treat and assess just as well as the ALS first response. After all, only one Medic can talk to the patient at a time.

Multiple research studies by universities have shown when BLS FR is compared to ALS FR, ALS has no sigificant improved survive rate and that it is not an efficient EMS model.

I am an advocated of FD BLS first response, I think if you give them the tools to handle any true emergency until ALS arrives than the system works. Let do the following:

o2 Admin
CPR
AED
Epi 1:1,000 IM
Albuterol
Oral Glucose
Check BGL
ASA
Nitro
First Aid

These have been shown through research to be the drugs and procedures that can save a life when given early on, within 8mins of onset of 911 call.

Infact, most studies show that the most efficient model is to have BLS within 5-8mins and ALS between 8-12mins.

Denver Health, Wake County, and one other busy Metro service all did studies on this.

Also, and I cannot remember the name of it for the life of me. But an FD did a study like this and the end result was the Medical Director recommending that they delete ALS first response due to it having no value and being inefficient.

I do believe that Medical Director was later fired after much pressure for the FD union *rolls eyes*

I'll have to agree that ALS first response doesn't have any effect on pt outcomes. I'll actually go a bit further and say that if a department is dual role, their medics are seeing less pts overall, particularly acute pts, assuming a 50/50 rotation, so that their learning curve and overall proficiency is curbed greatly.

I'll add the King LTS to your BLS list. Our BLS can drop a King.

Now, that learning curve and overall proficiency thing is not exclusive to FD EMS. I left NYC, which IMO has an excellent tiered system, for Charleston, SC, before I ended up where I am now. They are a 100% one and one EMS system (single role). I went from seeing several truly sick pts a night to seeing severa a month if I was lucky. Otherwise, it was V.O.M.I.T. calls for the most part - Vitals, O2, Monitor, IV, Txp. I feel that it takes many more years to get good at what you do in that type of system. Back home, I did three years as an EMT. We handled all kinds of stuff on our own, backed up medics when they were delayed, and we also knew when to really call. As a medic, we no longer ran non acute call types, only diff breathers, cardiacs, stat ep, unconscious, inbleed, arrests, and confirmed multi-traumas. If I was to have started my EMS career here, or in SC, I'd be working under medics, and learn basically nothing for those three years. As a medic, in those two years, I'd have the equivalent experience of maybe 2-3 months on the job in NYC.

My question is, do you advocate a tiered system or all-ALS for: urban, suburban, rural? Since you advocate BLS FD first response (we had that in Charleston from surrounding FD's), we'll assume a timely BLS response.

 

[46Young]

I guess the wider question is whether or not everything done by EMS needs to be quantifiably useful, or are there other measures of success?

Sure, how about employee retention and job satisfaction? The people making the system work are also important. We're more than just warm bodies to fill a spot. With an average burnout of 7-10 years, and less in some places, we're losing providers with valuable experience, and the burnout also encourages providers to withhold certain interventions, and encourage pt initiated refusals due to laziness. We're also losing providers due to orthopedic injuries. I'd rather have someone show up at my door with 15 years on the job, that still enjoys what they do, with a six year person with the same potitive outlook, than a three year burnout and a two month rookie, both disgruntled because they're making only ten bucks an hour with no retirement. I'd also like more stringent hiring standards (Polygraph, psych, etc.) and a yearly physical that includes a timed course with strenuous work related tasks, similar to the FD's CPAT. If your workforce is healthier, they'll perform better, be able to withstand fatigue and other stressors better, and cost the employer much less in disability and sick leave abuse.

 

[46Young]

Well, allowing ones self to be adopted (and co-opted) pretty much ensures that you will remain a step child.

Well, although it's wrong to require the existing EMS employees to crosstrain (or potentially crosstrain), future hires will be equal to their fire counterparts. By being dual role, everyone's the same, and the can enjoy what I'm assuming is superior pay, benefits, and working conditions.

Again, I'm not advocating the move, I actually disagree with it, as it's forcing EMS to do fire, or be displaced. Just that post merger, it's no longer an adversarial relationship, as everything is integrated. People on the fire side will be on the box, and some will be medics. EMS will be riding on suppression apparatus. There will no longer be sides. Everyone will have the same benefits and working conditions.

 

[46Young]

Maybe. Considering how other mergers have gone, I'm not holding my breath. This whole situation is why EMS will remain a step child. Medics don't want to fight for themselves and will take the "easy" way out. A shame, really. (Of course this is not in any way exclusive to Cleveland.)

The field is too transient to allow for any real organization. When I started my EMS career, and even when I became a medic, I had no thoughts of selling out to the fire side. The thing is, as time went on, I wanted more out of my career than the choices of riding an ambulance, being in dispatch, and Lotto-like odds of making it into management or an off the road position such as fleet management or QA/QI PCR review. I also saw sitting in a box for 30 years, beating up my body lifting repeatedly in awkward positions, and having my sleep disturbed on many nights as not being sustainable for the long term. I suspect many others that shunned the EMS only job type came to the same conclusions.

Now, typical day on the job: Four-five transports totalling six-seven hours out of the station, equipment check and drills in the morning, Pizza for lunch brought in by local soccer moms (thanks for a show and tell last week), two hours of PT (sometimes broken, but usually never twice), dinner cooked for me for only $5, afternoon nap for an hour or 45 minutes, dish games after dinner to see who washes them, and overnight no hitters 3 out of every four nights after midnight.

On my department alone, we have a handful of Cleveland EMS refugees, four others from my old hospital in NYC, four former FDNY EMS employees, and a guy from North Las Vegas, I think the place that was fighting off the N. Las Vegas FD attempt at taking over transports.

Remember, for every one of us that sells out to fire, or just starts out that way, there are many more in EMS that move on to other careers, go to college, or drop to per diem to work FT in a more sustainable career. Really, in a system where an EMT or medic will do gypsy moves from department to department chasing an additional $1/hr, this tells me that these employers are jobs that no one sees as desireable for the long term, otherwise they would stay and build tenure. Places that are sustainable exist mainly in Texas and WA, from what I read on this forum. EVerywhere else is pretty much screwed. NC has good systems, but the pay sucks.

 

[Fish]

Agreed, my above post was poorly worded. My point is that for a patient that is truly sick, but not with a life threatening complaint, BLS does almost nothing. That interim time between first responder and arrival and ambulance arrival is significant at times, and I imagine that we would all consider timely relief of pain and suffering as a large part of EMS. ALS first response is useful here, but I don't think it can be quantified well statistically. I guess the wider question is whether or not everything done by EMS needs to be quantifiably useful, or are there other measures of success?

Yeah but that sounds like a system problem, here our average ambulance response time is something like 6 1/2 mins. So no long responses here and it is a dual Medic system.

 

[Fish]

My question is, do you advocate a tiered system or all-ALS for: urban, suburban, rural? Since you advocate BLS FD first response (we had that in Charleston from surrounding FD's), we'll assume a timely BLS response.

I think tiered systems are good as long as there is a good dispatch system in place. I am talking advanced EMD protocols, or Medics and nursing answernig 911 calls like some systems do. That way we can ensure(or atleast limit) occurences of sending non-emergent BLS responses to patients houses who are actually having an MI.

As far as Rural, where responses can be at 30mins as a Norm. I agree ALS first response can be a big help here.

Even with a Tiered system I still advocate a BLS first response in 4mins or less, that way if a BLS transport unit is coming and the BLS FR can tell this is no BLS issue and dispatch made a mistake they can upgrade.

 

[medicsb]

I tend to think that the reason the field is transient is because, by and large, no one wants to stick around and make it what they would like to be. Medics and EMTs generally don't want to organize (most don't even care to be a part of NAEMT), they want to hop on someone elses coat-tails and ride to comfort. Fire and police didn't get where they are by waiting for others to do it for them or by waiting to be taken over. They banded together and fought for it over a long period of time. The nursing profession has gotten to where it is because they organized, advocated, and fought for themselves. They've been so successful that they're now trying to independently practice medicine (with far far far far less training, no less) through the new DNP degree.

Actually, something many within EMS don't realize is that Emergency Medicine is actually younger than paramedicine. The first paramedic training programs began in the late 60s. The first EM residencies didn't begin until the early 70s (1st was in Cincinnatti in 1970, 2nd was in Philly in '71). The first board examination for EM wasn't 'til 1980 and EM didn't get primary board status 'til 1989. EM would still be practiced by moonlighting opthamologists, family med, interns, med students, etc. had the early EM physicians not organized, which they did quickly and vigorously. (ACEP form in '68. UAEM in 1970. STEM & EMRA in another couple years and so on.) EM had little respect in the beginning. Most physician had no concept of what was EM. Anesthesiologists fought against EM docs over paralytics. Neurologists didn't want EM docs ordering CT scan without consultation. EM fought for what they now have. And within medicine, they exponentially more respect than they did 30 years ago. When you look at EMS as a profession, it really hasn't gone too far. Not that I would expect it to move as quickly as EM, but we are behind other modern EMS systems, which are even younger than us.

Anyhow, all this isn't really directed at you. (And I don't necessarily blame people moving to the fire side, though it bums me out to no end.) This is everywhere. And I'm just as guilty, too. I fit an example you made - I've "moved on" to medicine. Though, I plan to stay involved with EMS (goals being medical director and research).

Anyhow, I don't have many solutions to offer. I wish I did. But, I do know that organization is crucial for advancing EMS. Until that happens, it WILL be a step child and respect will be hard to come by.

Sorry if this was a little disjointed, tangential, or rambling; I just came off a week of exams.

The field is too transient to allow for any real organization. When I started my EMS career, and even when I became a medic, I had no thoughts of selling out to the fire side. The thing is, as time went on, I wanted more out of my career than the choices of riding an ambulance, being in dispatch, and Lotto-like odds of making it into management or an off the road position such as fleet management or QA/QI PCR review. I also saw sitting in a box for 30 years, beating up my body lifting repeatedly in awkward positions, and having my sleep disturbed on many nights as not being sustainable for the long term. I suspect many others that shunned the EMS only job type came to the same conclusions.

Now, typical day on the job: Four-five transports totalling six-seven hours out of the station, equipment check and drills in the morning, Pizza for lunch brought in by local soccer moms (thanks for a show and tell last week), two hours of PT (sometimes broken, but usually never twice), dinner cooked for me for only $5, afternoon nap for an hour or 45 minutes, dish games after dinner to see who washes them, and overnight no hitters 3 out of every four nights after midnight.

On my department alone, we have a handful of Cleveland EMS refugees, four others from my old hospital in NYC, four former FDNY EMS employees, and a guy from North Las Vegas, I think the place that was fighting off the N. Las Vegas FD attempt at taking over transports.

Remember, for every one of us that sells out to fire, or just starts out that way, there are many more in EMS that move on to other careers, go to college, or drop to per diem to work FT in a more sustainable career. Really, in a system where an EMT or medic will do gypsy moves from department to department chasing an additional $1/hr, this tells me that these employers are jobs that no one sees as desireable for the long term, otherwise they would stay and build tenure. Places that are sustainable exist mainly in Texas and WA, from what I read on this forum. EVerywhere else is pretty much screwed. NC has good systems, but the pay sucks.

 

[sweetpete]

I can't help but completely agree with Young46. I'm much happier as a medic working on a FD than I would be working as a dedicated medic on an ambulance.

I see how the kids on the box are either burned out, over worked, depressed, out of shape etc...... I can't help but feel bad for them, so I try to make their job as easy as possible when we are caring for the same patient on a scene.

I'll offer to do whatever they want me to without "taking over" the scene.

At the end of the day, I thank GOD I'm on a fire department and not a box. I think the guys/gals at CEMS will feel the same if they choose to get their 240 card.

 

[Fish]

I can't help but completely agree with Young46. I'm much happier as a medic working on a FD than I would be working as a dedicated medic on an ambulance.

I see how the kids on the box are either burned out, over worked, depressed, out of shape etc...... I can't help but feel bad for them, so I try to make their job as easy as possible when we are caring for the same patient on a scene.

I'll offer to do whatever they want me to without "taking over" the scene.

At the end of the day, I thank GOD I'm on a fire department and not a box. I think the guys/gals at CEMS will feel the same if they choose to get their 240 card.

Being with an FD is nice because you get time off of the engine, then all you do is get pissy that your on the ambulance that day and not the Engine, and then the patient is all why is my Houston Fire Fighter so mean, and your all cause I wanna be on the Trurck and run a fith of the calls as the Ambulance and get paid the same

 

[DrParasite]

The field is too transient to allow for any real organization. When I started my EMS career, and even when I became a medic, I had no thoughts of selling out to the fire side. The thing is, as time went on, I wanted more out of my career than the choices of riding an ambulance, being in dispatch, and Lotto-like odds of making it into management or an off the road position such as fleet management or QA/QI PCR review. I also saw sitting in a box for 30 years, beating up my body lifting repeatedly in awkward positions, and having my sleep disturbed on many nights as not being sustainable for the long term. I suspect many others that shunned the EMS only job type came to the same conclusions.

Were you in FDNY EMS, or NYC EMS? If you were in FDNY EMS, you will know that despite merging EMS into the FD, they are still doing all the stuff you said.

I am all for incorporating EMS into the FD, increasing the payrates to put EMS on par with FD, and rotating people from the engine/truck to the ambulance (everyone but the officers). But that isn't what happens in almost all these mergers.

Now, typical day on the job: Four-five transports totalling six-seven hours out of the station, equipment check and drills in the morning, Pizza for lunch brought in by local soccer moms (thanks for a show and tell last week), two hours of PT (sometimes broken, but usually never twice), dinner cooked for me for only $5, afternoon nap for an hour or 45 minutes, dish games after dinner to see who washes them, and overnight no hitters 3 out of every four nights after midnight.

That's awesome, I'm jealous. But you also aren't in an urban environment anymore. you aren't running 20 calls a day, because the call volume doesn't have you going on 20 calls a day. That allows you to have a station, bunks, etc because you don't need to be posted to minimize response times (system status management doesn't work anyway but some city managers still believe in it).

On my department alone, we have a handful of Cleveland EMS refugees, four others from my old hospital in NYC, four former FDNY EMS employees, and a guy from North Las Vegas, I think the place that was fighting off the N. Las Vegas FD attempt at taking over transports.

again, it's not just fire vs non fire. it's urban ems environment vs suburban ems.

Remember, for every one of us that sells out to fire, or just starts out that way, there are many more in EMS that move on to other careers, go to college, or drop to per diem to work FT in a more sustainable career.

I wouldn't call it selling out, rather doing what is best for your long term career. No one faults you for that.

Really, in a system where an EMT or medic will do gypsy moves from department to department chasing an additional $1/hr, this tells me that these employers are jobs that no one sees as desireable for the long term, otherwise they would stay and build tenure. Places that are sustainable exist mainly in Texas and WA, from what I read on this forum. EVerywhere else is pretty much screwed. NC has good systems, but the pay sucks.

The problem is, and has been for a while is, the fire service isn't the answer.

Lets build EMS stations, lets put enough ambulances on the road to handle the call volume, so you are only running 6 calls in a 12 hour shift, or 10 in a 24 hour shift. allow ambulances to take an hour or two for PT, give them time to eat as a crew, pay EMTs and Paramedics enough to only work 1 job, an develop a career path, and a retirement system. Everything the fire department has, but keep it in the EMS department. under the EMS department. Establish an EMS chief, EMS DC, and EMS Section chiefs, as well as station chiefs. it can be done, but most places won't because they will cost too much money, and EMS is chronically under funded and no one wants to give them enough money to do the job well.

I have said it before, and I will say it again: My dream is for EMS to be staffed like the FD, with enough units only 24/7 to handle the peak cal volumes. so if the busiest time has 30 separate EMS assignments going on, than they have 30 EMS units on 24/7, as well as stations for the crews to be assigned to when not on an assignment.

But that's only a dream, because it would be too expensive to run EMS properly, and it's easier to band aid it with FD first response and run crews into the ground than actually give EMS agencies the funding to do the job properly.

 

[sweetpete]

Fish....I can't argue there!!! LOL

But, a patient should never feel like a burden because a firefighter would rather be on the engine/truck that day. That's just unprofessional.

I truly feel that everybody should get rotated off the ambulance in a regular, steady fashion. It just seems fair.

 

[46Young]

I tend to think that the reason the field is transient is because, by and large, no one wants to stick around and make it what they would like to be. Medics and EMTs generally don't want to organize (most don't even care to be a part of NAEMT), they want to hop on someone elses coat-tails and ride to comfort. Fire and police didn't get where they are by waiting for others to do it for them or by waiting to be taken over. They banded together and fought for it over a long period of time. The nursing profession has gotten to where it is because they organized, advocated, and fought for themselves. They've been so successful that they're now trying to independently practice medicine (with far far far far less training, no less) through the new DNP degree.

Actually, something many within EMS don't realize is that Emergency Medicine is actually younger than paramedicine. The first paramedic training programs began in the late 60s. The first EM residencies didn't begin until the early 70s (1st was in Cincinnatti in 1970, 2nd was in Philly in '71). The first board examination for EM wasn't 'til 1980 and EM didn't get primary board status 'til 1989. EM would still be practiced by moonlighting opthamologists, family med, interns, med students, etc. had the early EM physicians not organized, which they did quickly and vigorously. (ACEP form in '68. UAEM in 1970. STEM & EMRA in another couple years and so on.) EM had little respect in the beginning. Most physician had no concept of what was EM. Anesthesiologists fought against EM docs over paralytics. Neurologists didn't want EM docs ordering CT scan without consultation. EM fought for what they now have. And within medicine, they exponentially more respect than they did 30 years ago. When you look at EMS as a profession, it really hasn't gone too far. Not that I would expect it to move as quickly as EM, but we are behind other modern EMS systems, which are even younger than us.

Anyhow, all this isn't really directed at you. (And I don't necessarily blame people moving to the fire side, though it bums me out to no end.) This is everywhere. And I'm just as guilty, too. I fit an example you made - I've "moved on" to medicine. Though, I plan to stay involved with EMS (goals being medical director and research).

Anyhow, I don't have many solutions to offer. I wish I did. But, I do know that organization is crucial for advancing EMS. Until that happens, it WILL be a step child and respect will be hard to come by.

Sorry if this was a little disjointed, tangential, or rambling; I just came off a week of exams.

Of course no one wants to stick around - the barrier to entry is low, so they have little skin in the game, unlike physicians, who probably aren't going to change professions after that gargantuan educational investment. An EMT or medic works in the field for a while, sees that things aren't going to improve any time soon, and either pursue higher education as another option (like you) or go somewhere that they can do EMS as a sustainable career and finally be gainfully employed. I suppose it's cheating in a sense, tapping out and affiliating with a FD. But, with a wife and childrn to support, I'm going to choose the sure thing over an uncertain future. I don't want to stick to my guns, and turn around at 45 years old and discover that we're no better off than 10-15 years ago. I'm not big on hope and change.

The whole thing's a catch-22. Not too many people are going to pursue higher education without a payoff, and many are not going to stay in the field long term due to the pay and lack of career advancement. You need people both educated and committed to do EMS as a career, until retirement, for organization to happen. Employers could mandate degrees as a condition of hire (all forms of EMS delivery are to blame), but hardly anyone does. No degrees = lower pay, so it works out for them.

 

[46Young]

Being with an FD is nice because you get time off of the engine, then all you do is get pissy that your on the ambulance that day and not the Engine, and then the patient is all why is my Houston Fire Fighter so mean, and your all cause I wanna be on the Trurck and run a fith of the calls as the Ambulance and get paid the same

We're told even before hire that we'll be moving back and forth between the engine and the medic unit. What happens a lot is that the engine driver or engine officer will also be a medic, so the medic gets bumped off the engine when it's their turn, and rides the box instead.

Many of the newer hires come from EMS only systems, and enjoy EMS. But consider that the average burnout in EMS is 7-10 years. This is in non fire based systems. This means that people who originally intended to do EMS as a career are generally quitting the field in that timeframe, and they wanted to do EMS 100% of the time. When the medic gets bumped from the engine for weeks or months, or indefinitely as the case may be (dual hatter engine officer assigned to the station), they begin to feel the effects of the call volume, frivolous calls, and having to be awake for 1-2 hours each call on the overnights, the same as single role medics who also grow tired of being out of the station all day and night. They also miss the fire side, and want to be able to do that part of their job as well.

It's that ability to go from suppression to EMS, back and forth, that keeps things fresh and makes for a long career. I know that when I was on an engine for a couple of months straight, I missed the transports (at least the acute ones). On the engine, we would just assess, do a few interventions, and then watch them leave (unless they were CTD). I also like not having to check with three other people before getting clearance to go anywhere, to PT, whatever. With just you and your partner, you can go anywhere you want, whenever you want, and you also have ultimate control over pt care.

 

[46Young]

Were you in FDNY EMS, or NYC EMS? If you were in FDNY EMS, you will know that despite merging EMS into the FD, they are still doing all the stuff you said.

I am all for incorporating EMS into the FD, increasing the payrates to put EMS on par with FD, and rotating people from the engine/truck to the ambulance (everyone but the officers). But that isn't what happens in almost all these mergers.
That's awesome, I'm jealous. But you also aren't in an urban environment anymore. you aren't running 20 calls a day, because the call volume doesn't have you going on 20 calls a day. That allows you to have a station, bunks, etc because you don't need to be posted to minimize response times (system status management doesn't work anyway but some city managers still believe in it).
again, it's not just fire vs non fire. it's urban ems environment vs suburban ems.
I wouldn't call it selling out, rather doing what is best for your long term career. No one faults you for that.

The problem is, and has been for a while is, the fire service isn't the answer.

Lets build EMS stations, lets put enough ambulances on the road to handle the call volume, so you are only running 6 calls in a 12 hour shift, or 10 in a 24 hour shift. allow ambulances to take an hour or two for PT, give them time to eat as a crew, pay EMTs and Paramedics enough to only work 1 job, an develop a career path, and a retirement system. Everything the fire department has, but keep it in the EMS department. under the EMS department. Establish an EMS chief, EMS DC, and EMS Section chiefs, as well as station chiefs. it can be done, but most places won't because they will cost too much money, and EMS is chronically under funded and no one wants to give them enough money to do the job well.

I have said it before, and I will say it again: My dream is for EMS to be staffed like the FD, with enough units only 24/7 to handle the peak cal volumes. so if the busiest time has 30 separate EMS assignments going on, than they have 30 EMS units on 24/7, as well as stations for the crews to be assigned to when not on an assignment.

But that's only a dream, because it would be too expensive to run EMS properly, and it's easier to band aid it with FD first response and run crews into the ground than actually give EMS agencies the funding to do the job properly.

I was in NYC EMS through NS-LIJ and Jamaica Hospital. I was referring to the benefits of dual role departments, which afford the previously single role medics a real, attainable career ladder for the first time.

As far as urban to suburban, Charleston County EMS has that and rural as well. They had twelve hour and 24 hour units, based on net utilization hours. We had bunks, a kitchen, day room, etc, but we hardly ever saw them. I knew that running contant call volume wasn't sustainable for the long term, so that was one more reason on top of many others to go fire based. No one wants to do that for 30 years or so.

Everything that you said about staffing, deployment, various chiefs, pay, exists here. For example, I received a promotion last year to EMS Technicinan last year. In some places, you'll never get any kind of promotion whatsoever. We have EMS Lt's, EMS Capt I's (both ride on the box), EMS Capt II (EMS road supervisor), EMS BC and EMS DC. A good number of current and past BC's, DC's, and even a couple of AC's are ALS or were for much of their careers. Our call volume is hardly excessive. The busiest units average 10 calls in 24 hours. We have four more transport units than we have engines, 41 to 37 respectively.

My formerly single role ALS academy buddies, and also the seven others from the NYC 911 system working here have all said that they would never go back to a single role system.

The urban exparience was fun for the five years I did it, and that experience has served me well in other systems, but it's a young person's game. Eventually, you're going to look for something better if you're not stuck there (spouse unwilling to move, OT necesary to pay bills, home with a mortgage, etc.).

 

[Fish]

We're told even before hire that we'll be moving back and forth between the engine and the medic unit. What happens a lot is that the engine driver or engine officer will also be a medic, so the medic gets bumped off the engine when it's their turn, and rides the box instead.

Many of the newer hires come from EMS only systems, and enjoy EMS. But consider that the average burnout in EMS is 7-10 years. This is in non fire based systems. This means that people who originally intended to do EMS as a career are generally quitting the field in that timeframe, and they wanted to do EMS 100% of the time. When the medic gets bumped from the engine for weeks or months, or indefinitely as the case may be (dual hatter engine officer assigned to the station), they begin to feel the effects of the call volume, frivolous calls, and having to be awake for 1-2 hours each call on the overnights, the same as single role medics who also grow tired of being out of the station all day and night. They also miss the fire side, and want to be able to do that part of their job as well.

It's that ability to go from suppression to EMS, back and forth, that keeps things fresh and makes for a long career. I know that when I was on an engine for a couple of months straight, I missed the transports (at least the acute ones). On the engine, we would just assess, do a few interventions, and then watch them leave (unless they were CTD). I also like not having to check with three other people before getting clearance to go anywhere, to PT, whatever. With just you and your partner, you can go anywhere you want, whenever you want, and you also have ultimate control over pt care.

I understand this from an employee stand point, but from a clinical and tax payer stand point. It holds no water.