I was waiting for someone to get that!
DC Firefighters whine about name change.
- Thread starter Aidey
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I was waiting for someone to get that!
18G
Paramedic
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You mistook my post. I am not saying that an individual can't do both equally well. The problem is the majority do not WANT to do both equally well nor should they be expected to as a part of their job. Should RN's also be responsible for handling janitor calls in the hospital? By your philosophy why not? An RN and janitor aren't related the same as EMS and Fire not being related
It's no secret that the majority of Firefighters have no interest in providing medical care, especially not on an ALS level. They want to fight fire and that is it. They view EMS as a secondary job function and it is something that they try to get out of doing at any cost.
How many career FF's do you hear really wanting to run the Medic???? They all whine when they have to!
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46 and 18
I think you both have valid points. I think the truth is somewhere in the middle.
I have worked for an FD where EMS was considered "part of the mission," however the definition of EMS in that mission was to provide some cookbook treatments on the way to the hospital. If the pt. arrived with a heartbeat or looking better than you found them, the mission was accomplished.
By that definition, fire based EMS was doing an outstanding job.
I also worked at places where assignment to the EMS transport vehicle was either for the new guys or as punishment. There were a handful of more experienced guys who really enjoyed the EMS side and were superior care providers by any definition. But they were few and their EMS involvement considered "quirkey." But they were tolerated because they had proven themselves equally proficent at suppression and other FD activities. They are still exceptional people.
As the generations in the fire service shift, there is more focus on EMS that I see happening. Unfortunatley, as before, very few are actually good at both. Though obviously they all meet the minimum requirements.
The problem that I see moving forward with fire based EMS is that the FDs don't seem to want to expand out of simple transport operations. These are not financially sustainable first off. There will always be more calls than units available even if you stopped buying fire trucks and went to ambulances only. (Clearly not realistic.) The fire service did embrace prevention and other public services in a full way, but the knowledge base required in order to do health prevention or alternative transport destinations is coniderable. It would take the hiring of extraordinary people en masse. Which is not the hiring policies of most FDs. Giving major points on hiring exams to military, residents, ect, largely excludes highly educated people. After all even if you gradated top in the class for public administration at Harvard, you couldn't take a test in Philly, with any reasonable chance of getting hired over the guy who grew up there, spent a tour in the armed forces, but may be around the average of a 40 ASVAB score. Now you are taking people who weren't fit to be military medics when I enlisted, and are putting them through EMS school to work on the civ. side.
Most of the current fire leadership in the country either has no formal education or a degree that was set up to give them credit for their longevity. Do you really think a person with a Chemical engineering PhD is going to take order from some guy with 240 fire school and a hazmat tech cert for ~50K a year?
See the problem?
As for the comparison to medical school. That will never be comparable. Med students are not expected to know all there is to know to be great at medicine. They are expected to know enough medicine to function as a doctor. Later they choose to specialize because the knowledge bank is so big no one person can know it all, much less be good at all of it. Nobody hires a doctor expecting them to. Very different from what is expected of firefighters today.
It would work if departments were able to hire a bunch of specialists, but most simply cannot afford it.
Additionally, people get throgh medical school by being absolutely submerged in medicine. The same simply cannot be said for the FD when they are partially submerged in suppression while being sprayed with a hazmat hose and having EMS water balloons lobbed at them.
Look at the dichotomy.
Fire suppression, aggressive action where independant action is often dangerous.
EMS, entirely independant action that requires a balance of aggression and discretion.
Hazmat, initially conservative and standoffish, followed by a consult from experts and then tightly controlled action.
Tech rescue, large amounts of highly specialized knowledge again requiring both independant judgement as well as ability to function as part of a unit.
Regretfully, most humans cannot be asked to master such diverse requirements and then perform them often enough to be proficent at them. There simply isn't enough time in the day. A few drills and inservice will do nothing to change that.
What's more, the pace of medicine is advancing so rapidly, that what was great medicine may be witchcraft in a few short months. EMS providers in the US are already 20-30 years behind. As the need for medical knowledge increases for EMS providers to function in prevention and other efforts that will be the basis of future medicine, I think it is not realistic to ask firefighters to be proficent at so much while trying to make things as simple as possible so they can in order to cope with the diversity.
whether people care to admit it or not, or are just terrified of the change, what makes EMS valuable has changed and will continue to evolve from its original concept. It really was possible and easy to be a great firefighter and paramedic in 1990. But we are some years removed from that antiquity.
It is similar to claiming that it is possible to be great at faster than light communications and travel by saying it was possible to be a good automobile driver and talk on a cell phone at one time.
I think you both have valid points. I think the truth is somewhere in the middle.
I have worked for an FD where EMS was considered "part of the mission," however the definition of EMS in that mission was to provide some cookbook treatments on the way to the hospital. If the pt. arrived with a heartbeat or looking better than you found them, the mission was accomplished.
By that definition, fire based EMS was doing an outstanding job.
I also worked at places where assignment to the EMS transport vehicle was either for the new guys or as punishment. There were a handful of more experienced guys who really enjoyed the EMS side and were superior care providers by any definition. But they were few and their EMS involvement considered "quirkey." But they were tolerated because they had proven themselves equally proficent at suppression and other FD activities. They are still exceptional people.
As the generations in the fire service shift, there is more focus on EMS that I see happening. Unfortunatley, as before, very few are actually good at both. Though obviously they all meet the minimum requirements.
The problem that I see moving forward with fire based EMS is that the FDs don't seem to want to expand out of simple transport operations. These are not financially sustainable first off. There will always be more calls than units available even if you stopped buying fire trucks and went to ambulances only. (Clearly not realistic.) The fire service did embrace prevention and other public services in a full way, but the knowledge base required in order to do health prevention or alternative transport destinations is coniderable. It would take the hiring of extraordinary people en masse. Which is not the hiring policies of most FDs. Giving major points on hiring exams to military, residents, ect, largely excludes highly educated people. After all even if you gradated top in the class for public administration at Harvard, you couldn't take a test in Philly, with any reasonable chance of getting hired over the guy who grew up there, spent a tour in the armed forces, but may be around the average of a 40 ASVAB score. Now you are taking people who weren't fit to be military medics when I enlisted, and are putting them through EMS school to work on the civ. side.
Most of the current fire leadership in the country either has no formal education or a degree that was set up to give them credit for their longevity. Do you really think a person with a Chemical engineering PhD is going to take order from some guy with 240 fire school and a hazmat tech cert for ~50K a year?
See the problem?
As for the comparison to medical school. That will never be comparable. Med students are not expected to know all there is to know to be great at medicine. They are expected to know enough medicine to function as a doctor. Later they choose to specialize because the knowledge bank is so big no one person can know it all, much less be good at all of it. Nobody hires a doctor expecting them to. Very different from what is expected of firefighters today.
It would work if departments were able to hire a bunch of specialists, but most simply cannot afford it.
Additionally, people get throgh medical school by being absolutely submerged in medicine. The same simply cannot be said for the FD when they are partially submerged in suppression while being sprayed with a hazmat hose and having EMS water balloons lobbed at them.
Look at the dichotomy.
Fire suppression, aggressive action where independant action is often dangerous.
EMS, entirely independant action that requires a balance of aggression and discretion.
Hazmat, initially conservative and standoffish, followed by a consult from experts and then tightly controlled action.
Tech rescue, large amounts of highly specialized knowledge again requiring both independant judgement as well as ability to function as part of a unit.
Regretfully, most humans cannot be asked to master such diverse requirements and then perform them often enough to be proficent at them. There simply isn't enough time in the day. A few drills and inservice will do nothing to change that.
What's more, the pace of medicine is advancing so rapidly, that what was great medicine may be witchcraft in a few short months. EMS providers in the US are already 20-30 years behind. As the need for medical knowledge increases for EMS providers to function in prevention and other efforts that will be the basis of future medicine, I think it is not realistic to ask firefighters to be proficent at so much while trying to make things as simple as possible so they can in order to cope with the diversity.
whether people care to admit it or not, or are just terrified of the change, what makes EMS valuable has changed and will continue to evolve from its original concept. It really was possible and easy to be a great firefighter and paramedic in 1990. But we are some years removed from that antiquity.
It is similar to claiming that it is possible to be great at faster than light communications and travel by saying it was possible to be a good automobile driver and talk on a cell phone at one time.
Shishkabob
Forum Chief
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Same thing can be said for EMS, and honestly someones health is more important than their beloved wall clock. Play defensive until you get more crews there to back you up.
No reason why in most jurisdictions you can't maintain a small FF force and just call in the vollies for the bigger stuff.
That doesn't work. The people with money and influence aren't going to be happy with nothing but a surround and drown operation in their neighborhoods. being able to mount an offensive attack can mean the difference between containing a fire to just a room and contents, or just one unit, and the entire row or apartment complex:
http://www.youtube.com/watch?v=30SCtOHUGhc
This was one of ours. It flashed, as we can see, and the crew would have never made it inside, nor would the windows have been laddered with just a "small firefighting force." The fire was contained to the end unit.
Besides the increased insurance cost due to lower ISO ratings, as soon as the dept starts burning down most of it's structure fires, not to mention if there are any deaths attributed to inadequate staffing and deployment, there will be a strong movement to upstaffing suppression resources. The reason we have paid departments is because the volunteer presence is inadequate. If you pull vollies from several other jurisdictions, then who's going to run jobs in their districts?
EMS definitely needs better staffing and deployment (and not by SSM or a PUM), but not at the expense of suppression resources.
@ Vene, I'm picking up what you're putting down. If we were responsible for what a foreign medic was, it would be difficult to do anything else well. EMs was much more simple back in the 90's. Seeing our former practices as witchcraft is a good way to look at it.
I could see a FD hiring dual role, but then having their people choose a side for career development. If you want to promote, then you're doing one or the other. If you join a FD to fight fire and don't embrace EMS, the odds are that you're not going to promote very high if at all, since you'll have a lot of competition. As far as EMS, it will be easier to promote, so medics who mostly want to do EMS, who tolerate the fire side, will be attracted to that type of opportunity. If you join the dept just for fire and got the P-card for that reason alone, chances are you'll be stuck at that rank for much of your career if you want the suppression career ladder.
I could see a FD hiring dual role, but then having their people choose a side for career development. If you want to promote, then you're doing one or the other. If you join a FD to fight fire and don't embrace EMS, the odds are that you're not going to promote very high if at all, since you'll have a lot of competition. As far as EMS, it will be easier to promote, so medics who mostly want to do EMS, who tolerate the fire side, will be attracted to that type of opportunity. If you join the dept just for fire and got the P-card for that reason alone, chances are you'll be stuck at that rank for much of your career if you want the suppression career ladder.
JPINFV
Gadfly
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The problem is that the opposite is also true. The answer to having not enough ambulances is not adding an additional engine as a paramedic assessment unit. EMS shouldn't suffer for the needs of fire suppression. However, given the choice between fully staffing fire suppression or EMS, most fire departments are going to fully staff fire suppression, despite the majority of their calls being EMS in nature.
If you pull suppression resources for EMS calls, who's going to run the fire calls? If you pull EMS resources for fire calls, who's going to run EMS calls? That is the contradiction for putting paramedics on fire engines.
JPINFV
Gadfly
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However, and I've never received an answer for this, how many fire departments are going to hire fire medics who have no interest in suppression past being able to run the big red ambulance? How many fire fighters would feel safe going into a fire where their partner has zero interest in suppression and puts no effort past the minimum? It's evident that plenty of fire departments accept the opposite (interest in EMS only as a means to get onto the fire department), but I doubt that many will hire fire fighters who's sole interest is EMS.
I'm going to say that the EMS staffing and deployment generally gets the short end of the stick regardless of what system is in place. We had not enough ambulances in NYC. It was just as bad pre FDNY merger. There were not enough ambulances in Charleston County SC. There are not enough ambulances in any dept that uses SSM. There are not enough embulances in most of the private 911 providers, where profit is the primary goal. Besides creating/saving position and such, fire based first response uses otherwise idle suppression units for EMS runs. Since relatively few of our patients are truly time sensitive, a delay in txp of a few minutes while waiting for the ambulance isn't going to make or break things.
Good departments plan for surges in call volume with proper deployment, mutual aid agreements, station fills, putting frivolous calls on hold, paring back responses, etc.
FF's whose sole interest is in EMS won't generally apply, since they have an aversion to running into burning buildings and other dangerous situations, a fear of hights, claustrophobia, and probably significant physical discomfort. With FF's that don't like EMS, they're going to apply anyway, and there's no way to tell what their true intentions are. They're not going to come out and say it during the oral boards. They're going to "play the game" in the academy by doing and saying what the basic training staff wants, and keeping their mouth shut otherwise. The same goes for their rookie year.
Consider also that the department may restrict their medics from riding in truck companies, heavy rescues, doing Hazmat or TROT, etc. After a while, they get tired of doing EMS only for the most part, and discover that they have to drop their ALS cert in order to be able to do other things within the dept. Compare this to single role EMS where they just quit, on the average of seven years, as there are no other avenues to explore in their dept. In the fire service, you get a mix of those who never wanted to do EMS in the first place, and others who liked EMS at first, but had that enthusiasm taken away from them by being denied other opportunities within the department. They burn out on EMS just like most everyone else who does EMS only as a career. You need that break from EMS transport to make it sustainable for a career. If I'm wrong, then why are there relatively few "lifers" in EMS? And how many of them are there by choice, and how many are there because they have no other viable income choices?
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JPINFV
Gadfly
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However, how many departments is it a requirement (explicit or de facto based on competition) to be a paramedic? Why is it that departments don't expect everyone to be expert on truck work, hazmat, white water, etc, but expect everyone to be an expert in EMS? Does the fact that it's expected from everyone instead of an icing on the cake type assignment change the internal dynamic? Are there perks for those other positions besides doing something different?
I think that's one way to look at it. I think another issue is that the type of people EMS needs is the type of people that are driven away from the current culture. Too many systems expect cook book medics, so why would someone who doesn't want to read a cookbook with the option to do something else go into EMS? How many people never enter the field or leave because of the "mother may I" stupidity and low standards are driven from EMS into medicine, nursing, and respiratory therapy because those fields offer more freedom and because they can. I'll be honest, if I thought EMS offered a modicum of freedom outside of a few systems (which don't exist in Southern California, be it private, fire, or otherwise), I might have had a tough choice between medical school and paramedic school. It's the lack of freedom and independence more than the work conditions or pay than anything else that kept me from seriously considering becoming a paramedic. Unfortunately, the type of people that are attracted to the cookbook positions are not compatible with the people attracted to the higher powered systems. Which is, of course, another significant problem.
I agree with both parts. I know that there are regions or whole states as the case may be where the P-card is required for hire. It's not required in my general area, although some choose to go that route since the basic FF hiring has slowed significantly in most cases, or competition due to EEO quotas. What I've seen a lot of lately with our most recent recruit schools is either medics that have grown tired of the BS and lack of career advancement in single role 911, and others who don't have the opportunity around here to do non fire based 911. Some love fire, and others do it as a necessary evil, just like FF/medics that dislike EMS, which will probably always be a problem to some extent. As far as I'm concerned, you can dislike EMS, so long as you do a good job regardless. When your apathy transfers to pt care, then we have problems. EMS is being pushed hard as an important part of our mission, from the initial interview, through testing, the academy, and now in the field. I'm not naive in that I think it's like this in many other places, unfortunately.
I would just like to point out that many foreign EMS services didn't evolve out of altruism towards the medics or the desire to be respected.
It came from money. Countires cannot sustain trillions in deficit. Part of cost control in the future of US medicine is going to be prevention and treatments that reduce the need for multiple parties at multiple levels.
I don't think US EMS is going to embrace this because I said it was a good idea or anything of the like. I think they are going to have to when the current pay system, (I have to use small words this is not a English QWERTY keyboard and the keys are in weird places) is forced to stop paying $300-$1000+ for a modified taxi ride when a large percentage of the patients require neither an ambulance nor an emergency dept. (or even a doctor for that matter) With 26% of the US GDP paying for healthcare of the elderly and indigent, something will have to give. Passing this cost onto the individual will simply price the service out of the market.
I doubt there are more fiscally conservative people than me, but simply making cuts while applying/maintaining layers is not going to work.
Just think of the job losses for fire and EMS when the current reimbursement is inevitably and significantly reduced or eliminated.
I think I will start a thread on the economics of this sometime this weekend. But I just wanted to mention this briefly as I wait for a train.
I think that would work for larger departments, but what about the ones with 3-10 guys on duty at any given time? That is a majority of the US fire service.
It would also have to be stipulated there could be no crossover, which is a problem now. You advance up through EMS then keep your rank and switch to fire, the dept loses the huge investment they have in you for your EMS trianing, loses one of its highest trained and skilled providers, then gets a minimally qualified fire suppression guy.
If you told somebody that if they went in the EMS track and decided to switch they could do so only at an entry level position, when they were open, it would solve a lot if not all of the fire people "using" EMS.
Some perspective from a DC street
Calling them FEMS will not improve out-of-hospital emergency medical care
Calling them FEMS will not improve out-of-hospital emergency medical care
Read the rest here: Clicky
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The District of Columbia IS different
Unless you work in the city, you will never appreciate the profound dysfunctional uniqueness of a jurisdiction that functions as both a city and a state ... but is controlled by the US Congress.
If you are interested, check out these two items by FossilMedic on Firegeezer (dot) com:
Singing Pigs, Resistant Cultures and DC EMS – January 1, 2010
Two DC EMS Snapshots – January 4, 2010
My perspective is that the delivery of out-of-hospital emergency medical care HAS improved.
In addition to 5 years of no raises, the fire chief announced this week the possible elimination of up to 400 uniformed positions - an entire platoon.
A concern is that the city will go from a four platoon to three platoon system, increasing the average work week from 42 to 56 - without an increase of pay.
For FY 2012 the city has already eliminated:
Two Assistant Fire Chief positions, four Deputy Fire Chief positions and six Battalion Chief positions. The savings from the eliminated positions is approximately $2.4 million.
An additional 65 vacant positions were eliminated in the Agency Management program, Fire Prevention and Education, Operations Support, and Field Operation programs for a savings of approximately $2.7 million.
Finally, the "rebranding" reflects an internal battle within the department that may have little to do with deliver of emergency medicine in the street.
If you were a fan of "The Wire" series on HBO, the complexity of this issue may feel familiar
Unless you work in the city, you will never appreciate the profound dysfunctional uniqueness of a jurisdiction that functions as both a city and a state ... but is controlled by the US Congress.
If you are interested, check out these two items by FossilMedic on Firegeezer (dot) com:
Singing Pigs, Resistant Cultures and DC EMS – January 1, 2010
Two DC EMS Snapshots – January 4, 2010
My perspective is that the delivery of out-of-hospital emergency medical care HAS improved.
In addition to 5 years of no raises, the fire chief announced this week the possible elimination of up to 400 uniformed positions - an entire platoon.
A concern is that the city will go from a four platoon to three platoon system, increasing the average work week from 42 to 56 - without an increase of pay.
For FY 2012 the city has already eliminated:
Two Assistant Fire Chief positions, four Deputy Fire Chief positions and six Battalion Chief positions. The savings from the eliminated positions is approximately $2.4 million.
An additional 65 vacant positions were eliminated in the Agency Management program, Fire Prevention and Education, Operations Support, and Field Operation programs for a savings of approximately $2.7 million.
Finally, the "rebranding" reflects an internal battle within the department that may have little to do with deliver of emergency medicine in the street.
If you were a fan of "The Wire" series on HBO, the complexity of this issue may feel familiar
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In a combination department, the people who find EMS unpalatible should be the first 400 to lose their jobs.
In any industry in any state or city, nobody is an indentured servant. If they do not like the evolving mission of the department, whether they are a chief or a probie, they should be shown the door.
As for the pay and benefits, I don't see a lot of sympathy going around for the pay and benefits of government workers at the moment. In the past few years many private secotr workers have had to make significant concessions. Why should government employees be any different?
Again, if the 56 hour work week and a new mission is too much. There is always the private sector.
Personally I have no sympathy for laborers who try to dictate terms of employment to superiors by means of legalized extortion and thuggery.
Let them eat cake.
DrParasite
The fire extinguisher is not just for show
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Absolutely wrong. Newark NJ is a pretty big FD, and a pretty big city, and they have absolutely nothing to do with EMS. and many of those big fire departments do not run EMS, at least not as equals to their FD "brothers."
and in NYC, Chicago, Philladelphia, St. Louis, EMS is treated like the :censored::censored::censored::censored::censored::censored::censored: stepchild; used for run numbers, but paid less than their suppression counterparts, and benefits aren't anywhere near as good.
absolutely agree 100%
I personally thing FEMS is kinda stupid. a better name would be DCFD/EMS, which would go on EVERY piece. every shirt, every patch, every logo, every fire truck would have EMS in big bold letters. No more DCFD, every FF tshirt, turnout coat, and helmet would have EMS right next to FD, and be stenciled DC Fire/EMS . no exceptions.
or make it DCEMS/FD, since most department go on more EMS calls than fire ones. So they are really an EMS department that fights fires during their downtime.
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HotelCo
Forum Deputy Chief
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Personally, I could care less what they call themselves. DCFD is fine by me.