Emergency medical responder vs certified first responder

[gotbeerz001]

I really like your explanation, it's pretty compelling!
The question it poses to me, then, is fire first response generally necessary, and, if so, at what level is it useful? I would say, generally, in an urban area, fire based first response is helpful, but could be at the EMT level, with a 2 FF/EMT team.

I am not opposed to the idea and would guess that it would work...until it didn't. All it takes is one call that goes poorly based on undertrained (or simply understaffed) companies for the negative media to turn the tide. Frankly, when the companies are staffed and at the station, it would be a hard position to defend when people expect the highest service for their tax dollars spent. While we know that more people doesn't always equate to better service, it is often comforting for the patient who calls once every 10 years and says "I had no idea I would get SIX of you!"

Furthermore, the argument can be made that ALS equipped ambulances staffed with BLS attendants would (seemingly) make more sense as the fire medic makes initial contact and assessment and either rides in with the ambo or downgrades the call to BLS. While we know that there are serious pitfalls to that deployment model, it's easier to make the case to the public that it makes the most fiscal sense. There would be a logical push to augment engine staffing to 4-person companies with a minimum of 2 paramedics on each rig to allow the engine to remain in service with 3 personnel when one medic rides in but allows for immediate 2-in/2-out accountability when responding to a fire.


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[gotbeerz001]

Also, FFs don't generally have a problem with medicals when they are also running the full scope of calls from a piece of suppression apparatus. The fastest way to kill the service attitude in a FF is to give them the title "Firefighter" but then use them in a single-function (EMS). If the deployment model uses either fire-based medic units or QRV-type squads, they either need to be hired as single function (and hopefully those dedicated to EMS) or have the shift be a 50% commitment where those lower in seniority work it but are guaranteed at least 50% of the time they will staff a piece of suppression equipment.


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[VentMonkey]

or have the shift be a 50% commitment where those lower in seniority work it but are guaranteed at least 50% of the time they will staff a piece of suppression equipment.

With due respect, this statement solidifies part of the perpetual argument of fire-based EMS vs. single-role EMS.

Without side tracking too much from the ops initial question (if the ops still even there, lol), it shouldn't be seen as a chore, or something someone with "less seniority" should be relinquished to. It just makes it sound like more a nuisance than anything.

Perhaps I read it wrong, or too far into it though.

 

[gotbeerz001]

With due respect, this statement solidifies part of the perpetual argument of fire-based EMS vs. single-role EMS.

Without side tracking too much from the ops initial question (if the ops still even there, lol), it shouldn't be seen as a chore, or something someone with "less seniority" should be relinquished to. It just makes it sound like more a nuisance than anything.

Perhaps I read it wrong, or too far into it though.

Nope, I hear you. My point was simply that FFs can/will be interested in EMS if it is an aspect of their job, not their entire job. The variety is a large part of why we enjoy our job.

IMO, I am a fan of fire-based ALS transport, working the same schedule and deployed from the station with fire medics working 50% of the time in the suppression/first responder role and 50% on the medic. This way you generally run with the same crews and it keeps all the skills sharp.


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[VentMonkey]

Nope, I hear you. My point was simply that FFs can/will be interested in EMS if it is an aspect of their job, not their entire job. The variety is a large part of why we enjoy our job.

IMO, I am a fan of fire-based ALS transport, working the same schedule and deployed from the station with fire medics working 50% of the time in the suppression/first responder role and 50% on the medic. This way you generally run with the same crews and it keeps all the skills sharp.


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Sorry, op, your thread has officially been hijacked.

Do you feel MOST firefighters view it the same as you do?

If so, how is it that they've stigmatized the way that they have in regards to their delivery of prehospital care?

I think we can all agree that burnout knows no limits, but a large chunk of the firefighter "paramedics" that have helped (or not) create this stigma seem genuinely disinterested in, and/ or put off by EMS even if they rotate on and off the box/ squad/ truck/ engine, etc., etc., etc...

Then again, I'm a guy who comes from a county with departments that "force" many of their firefighters (til this day) into paramedic school...paid...by their department. Many of whom still take the "meh, if I fail, I'm still getting paid" approach.

 

[Handsome Robb]

IMO, I am a fan of fire-based ALS transport, working the same schedule and deployed from the station with fire medics working 50% of the time in the suppression/first responder role and 50% on the medic. This way you generally run with the same crews and it keeps all the skills sharp.


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We're a county third service and are stationed in house with a fire crew at the vast majority of our stations. Each medic unit usually has 3-4 suppression units they run calls with on a regular basis and we work the same schedule so we know each other pretty well.




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[dutemplar]

Sorry, op, your thread has officially been hijacked.
Then again, I'm a guy who comes from a county with departments that "force" many of their firefighters (til this day) into paramedic school...paid...by their department. Many of whom still take the "meh, if I fail, I'm still getting paid" approach.

Yeah, that comes down to the training and cultural mentality of the department. Are there there to punch a clock while occasionally cutting a car apart and doing the splash and bash at a fire... or are they there as a "one stop shop" emergency service. Is the bone box a valued (and not beat to death) unit, or is it chronically understaffed and ran to death.

 

[VentMonkey]

Is the bone box a valued (and not beat to death) unit, or is it chronically understaffed and ran to death.

@dutemplar, this is an excellent point. This can happen with any service, whether it's fire-based (single, or dual function), third service, or private.

Low morale can most worsen anyone's view about any job title, or career field really.

 

[DrParasite]

When I was working on the ambulance, I wouldn't trust anything a firefighter told me any assessment about the patient, unless i knew that said firefighter either currently works (as their side job) or has worked on an ambulance. I've been burned too many times by firefighters (and cops) who are EMTs, but give me incorrect information because they don't do EMS on a regular basis.

Now that I am on the firetruck, I wouldn't trust most of my coworkers with a sick patient, unless they have experience actually being on an ambulance. Being a first responder is great, but it's also really easy to do (and way more fun). 15 minutes of patient contact, and turn the patient over to the ambulance for the duration.

While there are some firefighters who are decent clinicians (and I have met several in NC who actually surprised me as to how accurate their assessments were, despite never working on an ambulance), the vast majority will only do enough con ed to keep their cert valid, and even then will sit through class texting instead of actually paying attention and asking questions.

 

[VentMonkey]

When I was working on the ambulance, I wouldn't trust anything a firefighter told me any assessment about the patient, unless i knew that said firefighter either currently works (as their side job) or has worked on an ambulance. I've been burned too many times by firefighters (and cops) who are EMTs, but give me incorrect information because they don't do EMS on a regular basis.

Now that I am on the firetruck, I wouldn't trust most of my coworkers with a sick patient, unless they have experience actually being on an ambulance. Being a first responder is great, but it's also really easy to do (and way more fun). 15 minutes of patient contact, and turn the patient over to the ambulance for the duration.

While there are some firefighters who are decent clinicians (and I have met several in NC who actually surprised me as to how accurate their assessments were, despite never working on an ambulance), the vast majority will only do enough con ed to keep their cert valid, and even then will sit through class texting instead of actually paying attention and asking questions.

Digging the honesty, @DrParasite. Do you think it's safe to say that this is a blanket statement for most fire departments, at least in your experience?

I think this is often where the line is drawn, especially in a state like mine that is so dependent in the FD providing ALS care.

Many (again, not all) take the approach you've described in your post, but the problem is,they're often either handing patient care off to an equal level provider, and/ or their fellow FFPM's who are "on the box" that day.

 

[DrParasite]

Digging the honesty, @DrParasite. Do you think it's safe to say that this is a blanket statement for most fire departments, at least in your experience?

it is absolutely a blanket statement, I am painting everyone with a broad brush, stereotyping, etc. There are absolutely exceptions, but in my experience, they are the rarity, not the norm.

I think this is often where the line is drawn, especially in a state like mine that is so dependent in the FD providing ALS care.

Is the FD providing ALS from engines, or ambulances? I have no issues with FF/PM, especially where everyone rotates between the supression units and the transport units. But if you have a paramedic who hasn't been on the ambulance in 15 years, how sharp of a provider do you think they are? BTW, I feel the same way about administrative officers in EMS agencies, who haven't treated anyone on the ambulance in years, but still have a P card.

10 or 15 years ago I once had a career fire captain tell me he was an experienced EMS provider, despite never working on an ambulance. I told him that it's easy to be with a patient for 5-15 minutes, apply oxygen, maybe even do some CPR, fill out some check boxes and a patient care report, and then turn the patient over to the ambulance. There is minimal accountability, if you do mess up, the ambulance crew typically fixes it, if your treatment is wrong, the ambulance crew will fix it, and at the end of the day if you do miss some critical thing, often the opinion is "they are firefighters, doing EMS is not their main job" so the bar isn't set at high. If you want to become an experienced EMS provider, than you need to actually spend a lot of time on the ambulance, experiencing patient care from initial contact to turnover at the hospital

 

[NysEms2117]

When I was working on the ambulance, I wouldn't trust anything a firefighter told me any assessment about the patient, unless i knew that said firefighter either currently works (as their side job) or has worked on an ambulance. I've been burned too many times by firefighters (and cops) who are EMTs, but give me incorrect information because they don't do EMS on a regular basis.

Do you think there is a way to help fix this? I understand you'll always have people that think they know it all, people that judge based on age, and all that. I'm not debating this because to be honest I think I may be part of the issue. I work on an ambulance 1 day every 10 or so days.*mainly working in law enforcement* granted Im usually going to be the low man on the totem pole(emt basic)

 

[gotbeerz001]

I also believe that it is impossible (or at least extremely difficult) to be a good medic if you have only ever been engine-based; I say this often and those who have been (or still currently) a transporting medic generally agree.


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[VentMonkey]

I also believe that it is impossible (or at least extremely difficult) to be a good medic if you have only ever been engine-based; I say this often and those who have been (or still currently) a transporting medic generally agree.


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What if your department only provides engine paramedics that transport if it's an "ALS patient", but would otherwise turf it to their contracted BLS ambulance provider?

 

[gotbeerz001]

What if your department only provides engine paramedics that transport if it's an "ALS patient", but would otherwise turf it to their contracted BLS ambulance provider?

Slippery slope... I would say the ideal is that the engine medic would need have a background as a transporting medic.


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[VentMonkey]

Slippery slope... I would say the ideal is that the engine medic would need have a background as a transporting medic.


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I would agree. This was an original plan of mine, until it was side tracked, lol.

 

[MackTheKnife]

Why all the fire hate? [emoji602]


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I AM NOT FF: I think what you're seeing is a majority opinion the EMR is useless for the most part and a lot of the opiners are FF. EMT has also been cast in a negative light on here from time to time as a qualification that perhaps should go away. Sort of like in my world where LPNs still exist but are fading out.

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[DrParasite]

What if your department only provides engine paramedics that transport if it's an "ALS patient", but would otherwise turf it to their contracted BLS ambulance provider?

So that means your ambulance people become lazy incompetent taxi drivers, because they never see sick patients, and when they do, they have the medic there to do all the work and tell them what to do. If you never do a hands on assessment, if you never use your critical thinking differential diagnosis brain, why should you be thought of as anything other than a taxi driver? No wonder the paramedics don't trust these providers, they never actually utilize anything they learned in school!

If the engine paramedic actually transports the patient to the ER with the ambulance crew, than that's a lot different than one who is just a first responder and turf medic.

 

[VentMonkey]

If the engine paramedic actually transports the patient to the ER with the ambulance crew, than that's a lot different than one who is just a first responder and turf medic.

Again, many moons ago when I was looking into these specific departments, the (my) idea was to gain ~5 years single-role paramedic time on an ambulance, then apply to these type of departments. My personal opinion is that these types of departments/ deployment models should require 3-5 years of single-role/ transport paramedic experience; perhaps even closer to the 5-10 year mark. A very green paramedic really has no business being an assessment paramedic/ engine paramedic with these capabilities. I feel the same way about HEMS programs and flight paramedic experience, but I digress.

The ones that I am referring to in terms of their deployment is basically a 3-4 man engine company with 1-2 FFPM's that respond with a BLS department. If you deem them to be a BLS patient, it's sent via the BLS ambulance (the BLS providers themselves are more than welcomed to assess, and/ or reassess these patients en route to the hospital; I used to), if not you follow up to the hospital and provide ALS care.

If another call goes out in your first-in area, your engine company still has one more FFPM to utilize for that call and can meet you at the same ED should that patient be transported there as well; if not you can meet up with them back at the station and catch a ride back with your BC, respectively.

This was one of my goals in order to make a career out of being a paramedic, but again, I know this will not happen for me any longer as I have learned that I do not possess the desire to perform as a paramedic and do fire suppression. I am "just a career paramedic", albeit extremely content, and happy with what I do.

As far becoming lazy incompetent taxi drivers, well that's entirely up to the individuals themselves. If a patient is shipped BLS, and the EMT's delivering patient care see no reason to assess the patient themselves, this is not something that should be held over the ALS providers head, assuming the paramedic did a proper assessment to begin with.

 

[DrParasite]

[QUOTE="VentMonkey, post: 622723, member: 30261]If another call goes out in your first-in area, your engine company still has one more FFPM to utilize for that call and can meet you at the same ED should that patient be transported there as well; if not you can meet up with them back at the station and catch a ride back with your BC, respectively.[/quote]I would imagine this system only works if you work in a small city with a hospital in it, as I can't see an engine leaving it's first due, or a BC going OOS our of their primary just to pick up a medic... or several medics who have been taken to the hospital.[QUOTE="VentMonkey, post: 622723, member: 30261]As far becoming lazy incompetent taxi drivers, well that's entirely up to the individuals themselves. If a patient is shipped BLS, and the EMT's delivering patient care see no reason to assess the patient themselves, this is not something that should be held over the ALS providers head, assuming the paramedic did a proper assessment to begin with.[/QUOTE]It's more of an issue with the system, than the individual providers. I can see being the EMT on that ambulance being an extremely sucky mind numbing job, because the medic deals with every sick patient, and the EMT deals with the people who just need a ride to the ER. I have heard anecdotal stories from California where people are like that, where the FD runs the show, and the EMTs on the ambulance are just biding their time until they get hired by a FD. I can also see it being VERY VERY easy to get complacent, and not identify a sick patient or know what to do, since you haven't done in it in a while.

Then again, I know paramedics that can ALS any patient, as well as paramedics that would turf a patient to the EMTs when they really shouldn't.

But I will end my contribution here, until I have something that i relevant to the original topic.