FD EMS vs Private

[JDallas]

Throughout this website, I've detected varying levels of contempt between Fire-Based and private EMS. I'm curious what the reasoning behind that is?

I understand that some people want to be in strictly one area- Fire or EMS- but many other people (such as myself) are interested in both?

What makes American Medical Response better than San Bernardino County Fire at patient care/transport? (simply using a local example here, same idea applies pretty much anywhere)

 

[Ewok Jerky]

I have no problem with Fire/Rescue/EMS personnel. I DO have a problem with people who have no interest in EMS who get their medic only to get on with a FIRE dept.

The majority of a fireman's job is running medic calls, especially if they are on the box. These type of firemen tend to be lazy at best, incompetent and dangerous at worst.

Believe me, the privates have lazy burnt out medics too, but probly not as many as your average fire dept.

for example (in a CA system with ALS engine and private transport company):

1-we how up to a father holding his limp, very pale 10 Y/O son in his arms. One fire guy is sitting on the tail board, one is standing with a clipboard, and the lead medic has 0 info for us when we arrive, no Hx, no vitals.

2-we show up for an obvious BLS ground level fall with ankle pain. nothing ALS about it, and when I say ankle pain I mean pain, not Fx. After we load the Pt up the medic from the engine tells me to put her on a cannula "just because, you know".

 

[JDallas]

I guess I'm just unique in the fact that I live in an area where our firefighters aren't required to do medical calls, so I've never experienced this first hand.

 

[ams17]

I'm confused as to why in some places, you must be medic to become ff...or ff to become medic. I think that stands in the way of countless people trying to further or even start a career.

I have no problem with Fire/Rescue/EMS personnel. I DO have a problem with people who have no interest in EMS who get their medic only to get on with a FIRE dept.

The majority of a fireman's job is running medic calls, especially if they are on the box. These type of firemen tend to be lazy at best, incompetent and dangerous at worst.

Believe me, the privates have lazy burnt out medics too, but probly not as many as your average fire dept.

for example (in a CA system with ALS engine and private transport company):

1-we how up to a father holding his limp, very pale 10 Y/O son in his arms. One fire guy is sitting on the tail board, one is standing with a clipboard, and the lead medic has 0 info for us when we arrive, no Hx, no vitals.

2-we show up for an obvious BLS ground level fall with ankle pain. nothing ALS about it, and when I say ankle pain I mean pain, not Fx. After we load the Pt up the medic from the engine tells me to put her on a cannula "just because, you know".

 

[Christopher]

Throughout this website, I've detected varying levels of contempt between Fire-Based and private EMS. I'm curious what the reasoning behind that is?

I understand that some people want to be in strictly one area- Fire or EMS- but many other people (such as myself) are interested in both?

What makes American Medical Response better than San Bernardino County Fire at patient care/transport? (simply using a local example here, same idea applies pretty much anywhere)

I work for a fire department as a paramedic and we operate a unit in the same area as County units. There was pushback when we went Paramedic level initially, but now they realize we're serious about it and we're no longer "in competition".

I work for a private 3rd service EMS, but we exclusively handle transport in that County, so we don't compete with fire departments, nor do they provide paramedics.

Our area has great working relationships with all of the departments and in both areas we meet regularly to discuss QA/QI concerns.

It seems instead that some States allow for dysfunctional EMS systems and thus encourage and exaggerate the problems between "Fire-based EMS" and "EMS".

(news flash, it is just EMS)

 

[ThatPrivate]

I often wondered the same thing. I know that generally paramedics that are trained as a firefighter get paid more then single role. I can't speak about the laziness because I'm new to EMS and haven't experienced it yet. Another thing I notice is the benefits are a little better with firefighter based EMS followed by county/municipal run EMS and lastly private companies. Each system isn't perfect and it depends on the area your in. Hope this helps.

 

[Christopher]

...and lastly private companies.

My day job is at a huge, multinational corporation. Corporations are given little incentive to ensure you receive wonderful benefits. They're given every reason to decrease cost. Practically by definition working for a private company is going to entail worse benefits than other forms of employment.

 

[MagicTyler]

IMO privates should go away, and fire or PD should have an EMS division, or EMS should be its own county/city entity. Fire/ALS should not exist, deticated ALS ambulance under a fire department is ok though. Its too much to be a good firefighter and a good medic, they are two totaly different jobs.

 

[Tigger]

IMO privates should go away, and fire or PD should have an EMS division, or EMS should be its own county/city entity. Fire/ALS should not exist, deticated ALS ambulance under a fire department is ok though. Its too much to be a good firefighter and a good medic, they are two totaly different jobs.

Really? Sure they are different, but the education required for both of them doesn't even approach that of a bachelors degree. If you demand that competency be shown for both roles and compensate appropriately, what would the issue be?

 

[mycrofft]

Dear OP

"You didn't want to ask that question".
("I didn't want to ask that question").

"You don't really want the answer to that question anyway"
("I don't really want the answer to that question anyway").

"Move along"....

 

[DeepFreeze]

6, 1/2 dozen the other...

I think you really need to narrow your question down because it is so broad. It all depends on your area/state/socio-economical influences. I am a career firefighter in a upper-middleclass community and we work very well with Private EMS as one unit. I've been a private emt in another lower income area where Fire doesn't want to get out of the engine to do medicals.

I will say that everyone should be giving full pt care and treat everyone respectfully and compassionately. Lazy Firefighters or Firefighters that can't see that EMS is now part of the daily job are behind the times.

I think where the contempt can sometimes come is the "we vs them" feeling, that needs to go away. Benefits, pay differences, unions, they all play a role in that and again it depends on your area. EMS can get jealous that Fire is getting paid more, Fire can get mad that EMS is taking up too much time from "fire duty", etc. etc.

 

[ThatPrivate]

There's also hospital based EMS. Sometimes they are pretty good but then again it depends on the hospital and how well they work with law enforcement and fire.

 

[46Young]

IMO privates should go away, and fire or PD should have an EMS division, or EMS should be its own county/city entity. Fire/ALS should not exist, deticated ALS ambulance under a fire department is ok though. Its too much to be a good firefighter and a good medic, they are two totaly different jobs.

An academy that trains up to the FF2 level runs 24 weeks give or take. A medic program runs a year give or take. Each side has an Associates degree, but the average time to educate and train an American FF/medic is less than a year and a half. Good municipal departments will have plenty of fire training, and also offer EMS CEU's either on-duty, or hold a sessions every month or two on OT.

If slow call volume or the FF/medic not seeing enough calls on one side or the other is your argument, then anyone working in a rural single role system must be a poor provider. Even in busy systems or semi-busy systems, the type of calls may be very routine and not challenging at all. Fires are few and far between in many places, as are cut jobs, tech rescue, Hazmats, etc. Many EMS only systems run emt/medic on every bus, and run every type of call, so they see only a few sick patients and a whole lot of non-emergent nonsense. I run about fifty to sixty EMS calls a month, the majority being on a txp unit, and I can count the number of true diff breathers, cardiacs, arrests, and multi-traumas I see on one hand. I might give meds once a shift or less.

Also, by your logic, if 18 months or so of education and training (plus maybe an ALS internship after hire) is too much to be a good firefighter and a good medic, then earning a four year degree should be practically impossible. I won't even get into Attorneys, CPA's, teachers, NP's, PT's, MD's, etc.

 

[Veneficus]

IMO privates should go away, and fire or PD should have an EMS division, or EMS should be its own county/city entity. Fire/ALS should not exist, deticated ALS ambulance under a fire department is ok though. Its too much to be a good firefighter and a good medic, they are two totaly different jobs.

First off. There are just as many bad FD EMS services as there are bad privates.

Furthermore, the bad FD services actually affect a far greater number of patients.

Now that we got that out of the way...

I think EMS should be its own entity. Not because the fire service can't be good at it. There are FDs that provide great EMS service. At least they provide what could have been consdered great in the year 1980.

The only things that really stop FD from being great ALS transport services are money and how much the organization values the mission of EMS.

Having said that, the reason I think it needs to be seperate is because the ALS transport method of EMS is not sustainable. There simply will never be enough units as call volumes increase. Dropping everyone off at the ED that calls an ambulance is an economic nightmare.

As such, the future of EMS will be both more of a publichealth/prevention role and properly dispose of callers to the correct healthcare or social entity. (navigating healthcare for the pt.)

Not because I said so. Prevention was the major aspect of success in both the FD and LE. Prevention is cheaper than emergency by a lot. It reduces call volumes so you can respond to emergencies with a reasonable amount of equipment and people.

We have advanced medical knowledge to the point where "acute" emergencies barely exist. A majority is exacerbation of chronic health problems.

The current US ALS education and service model is not designed for this. It will have to evolve. That will require paramedics to be educated on who needs to be admitted, treat and release, etc.

Which means, sooner or later, most likely later, there will be so much required to be a good medic that either A. these providers will suck at firefighting/rescue/hazmat/etc. etc. because they spendso much time on the healthcare aspects of EMS. (Much of the fire service is a skill, like all skills when you don't use them you lose them) B. Paramedical education will attract people who either don't want to be firefighters or don't have the physical requirements curently accepted. (Because they spent more time at school than in the gym, there are only so many hours in a day and I can tell you the gym was not even on my radar in medical school.)

As for not being able to be good at both. I think it is evident that people who fight a lot of fire (mostly urban municipal) are good at it. People who see fire once in a while are not as good at it. But the day is coming when there simply won't be enough hours in the day to practice fire service skills that are hardly ever used and provide healthcare.(both emergent and non)

The reason most FDs that currently do EMS are not good at it isn't because they can't be, it is because they don't want to be.

 

[xrsm002]

I have no problem with Fire/Rescue/EMS personnel. I DO have a problem with people who have no interest in EMS who get their medic only to get on with a FIRE dept.

The majority of a fireman's job is running medic calls, especially if they are on the box. These type of firemen tend to be lazy at best, incompetent and dangerous at worst.

Believe me, the privates have lazy burnt out medics too, but probly not as many as your average fire dept.

for example (in a CA system with ALS engine and private transport company):

1-we how up to a father holding his limp, very pale 10 Y/O son in his arms. One fire guy is sitting on the tail board, one is standing with a clipboard, and the lead medic has 0 info for us when we arrive, no Hx, no vitals.

2-we show up for an obvious BLS ground level fall with ankle pain. nothing ALS about it, and when I say ankle pain I mean pain, not Fx. After we load the Pt up the medic from the engine tells me to put her on a cannula "just because, you know".

@beanp my hometown and the city to the west of it actually require all ff to be EMT certified actually I think it's a state requirement for TX, both FDs also require you to get your medic within two years of being hired or they fire you. Or you good have your medic and they will put you through the fire academy.the only reason I'm not working for them is they make you do both the box and engine time and I have no interest in being a firefighter, but I respect them and know several of them. But I wish they would let medics who aren't FF work just on the ambulance.

 

[Veneficus]

@beanp my hometown and the city to the west of it actually require all ff to be EMT certified actually I think it's a state requirement for TX, both FDs also require you to get your medic within two years of being hired or they fire you. Or you good have your medic and they will put you through the fire academy.the only reason I'm not working for them is they make you do both the box and engine time and I have no interest in being a firefighter, but I respect them and know several of them. But I wish they would let medics who aren't FF work just on the ambulance.

That is because the purpose of FDs performing EMS is to save firefighter jobs, not to provide jobs for nonfirefighters.

 

[Fish]

An academy that trains up to the FF2 level runs 24 weeks give or take. A medic program runs a year give or take. Each side has an Associates degree, but the average time to educate and train an American FF/medic is less than a year and a half. Good municipal departments will have plenty of fire training, and also offer EMS CEU's either on-duty, or hold a sessions every month or two on OT.

If slow call volume or the FF/medic not seeing enough calls on one side or the other is your argument, then anyone working in a rural single role system must be a poor provider. Even in busy systems or semi-busy systems, the type of calls may be very routine and not challenging at all. Fires are few and far between in many places, as are cut jobs, tech rescue, Hazmats, etc. Many EMS only systems run emt/medic on every bus, and run every type of call, so they see only a few sick patients and a whole lot of non-emergent nonsense. I run about fifty to sixty EMS calls a month, the majority being on a txp unit, and I can count the number of true diff breathers, cardiacs, arrests, and multi-traumas I see on one hand. I might give meds once a shift or less.

Also, by your logic, if 18 months or so of education and training (plus maybe an ALS internship after hire) is too much to be a good firefighter and a good medic, then earning a four year degree should be practically impossible. I won't even get into Attorneys, CPA's, teachers, NP's, PT's, MD's, etc.

You never answered my PM

 

[drjekyl75]

IMO privates should go away, and fire or PD should have an EMS division, or EMS should be its own county/city entity. Fire/ALS should not exist, deticated ALS ambulance under a fire department is ok though. Its too much to be a good firefighter and a good medic, they are two totaly different jobs.

The county I live in, the sheriff's dept. serves as the ALS. They use local private companies as the transports. I think the guys from the sheriff's dept do a good job but like everywhere some are better than others. We run into guys who prefer to play cop first and are crappy medics and lazy. We also see very short life spans for the guys on the road, they tend to burn out quick and switch divisions to get out of running medicals. This is why I'd like to see more of the private companies run ALS in addition to the sheriff's dept.

 

[Achilles]

The county I live in, the sheriff's dept. serves as the ALS. They use local private companies as the transports. I think the guys from the sheriff's dept do a good job but like everywhere some are better than others. We run into guys who prefer to play cop first and are crappy medics and lazy. We also see very short life spans for the guys on the road, they tend to burn out quick and switch divisions to get out of running medicals. This is why I'd like to see more of the private companies run ALS in addition to the sheriff's dept.

And what county would this be?

 

[Anjel]

And what county would this be?

Genesee county. They still have ALS, but they have sherif medics that will ride in if it is a BLS unit that responds.