ExpatMedic0
MS, NRP
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Agree %100. I use to work in a tier system like this, its a joke and we all know it.
Fire Als transport vs other..
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Agree %100. I use to work in a tier system like this, its a joke and we all know it.
Chief Complaint
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You can't have a 15 minute response time because fire moves quickly, especially in new construction. The difference between 5 and 15 minutes could be a fully involved house fire instead of a torched kitchen. People's tax dollars pay for fire protection, they deserve the best. It's not just about life safety, it's also a matter of property conservation, and preventing fire from spreading to other dwellings/business'.
15 minutes could mean an entire apartment building on fire, when it could have been contained to a single unit. 15 minutes to a guy trapped underneath a dumpster would seem like a lifetime. How about 15 minutes to the guy who fell down a manhole?
It's absolutely unacceptable to have a lengthy response time if you aren't in a rural area.
While the debate between fire and EMS is spirited I would like to point something out?
Fire is a threat to all of society. Since currently US EMS does not partake in public health actions the conditions treated are largely individual.
Until such a time that communities and by exptension the government decides that healthcare is a right of its citizens, then the Fire vs. EMS discussion is actually moot.
Fire gets more to protect society.
EMS, while undoubtably busier and more personal, gets less because society doesn't value them as much.
Considering the current average level of care in the US for EMS, I don't expect funding to change anytime soon.
For every 1 progressive service, there are easily 100 fly by night, 1970s protocol monkey systems.
The service US EMS is actually paid for is transport. If you show up with a mobile ICU treat and release the patient, your agency may send a bill, but medicare and the insurance companies that follow their lead aren't going to pay you because you did not do what you are being paid for...
Transport.
It's the way it is. No matter how much EMS providers think they are worth, no matter how much sunshine society blows up you, they will not put their money where their mouth is.
Fire is a threat to all of society. Since currently US EMS does not partake in public health actions the conditions treated are largely individual.
Until such a time that communities and by exptension the government decides that healthcare is a right of its citizens, then the Fire vs. EMS discussion is actually moot.
Fire gets more to protect society.
EMS, while undoubtably busier and more personal, gets less because society doesn't value them as much.
Considering the current average level of care in the US for EMS, I don't expect funding to change anytime soon.
For every 1 progressive service, there are easily 100 fly by night, 1970s protocol monkey systems.
The service US EMS is actually paid for is transport. If you show up with a mobile ICU treat and release the patient, your agency may send a bill, but medicare and the insurance companies that follow their lead aren't going to pay you because you did not do what you are being paid for...
Transport.
It's the way it is. No matter how much EMS providers think they are worth, no matter how much sunshine society blows up you, they will not put their money where their mouth is.
With the prevalence of type 5 construction, it's all the more important to get on-scene quicker, if there's any chance of containing the fire to just a room and contents, or to be able to do a search before going defensive. If the fire starts at minute zero, the call comes in two minutes later, the first due company gets the tones and pulls out at minute 5, they're already five minutes in the hole. Numerous studies have shown that the type 5 construction, with it's high fuel load and void spaces, along with all the synthetic materials in the living areas, gives you maybe ten minutes, fifteen tops to get a knock on the fire, otherwise it's just surround and drown.
Here's a call that I was on:
http://www.youtube.com/watch?v=30SCtOHUGhc
First due units were on-scene in about three minutes, about 5 mins after the initial call. My understanding is that approx. 3-4 mins passed from the start of the fire to the 911 call. So, the 1st floor flashover occurred about 10-12 minutes from the start of the fire. The truck company was able to do a search of both floors right before the flash. If, as Linuss suggests, we gut the FD budget, and allow response times to lengthen significantly (since there aren't that many fires), those first due companies would be arriving at the time of flashover, maybe afterwards. If anyone is trapped upstairs, they would be toast. The exposures, the rest of the row, would also be in jeopardy at that point.
People aren't going to tolerate lengthy fire dept responses. I believe it was Vene that said people expect to have sufficient fire and police coverage, that it's the responsibility of the local government, but that most EMS is not a consideration of most people.
See my last post, above.
Mutual aid is for protection from a surge in call volume, not as a Band-Aid for a lack of staffing and deployment. We see this a lot with two particular counties that use us all the time, but never provide any units when we're busy. We basically subsidize their fire and EMS because they won't put enough of their own units on the street. Mutual aid is not the answer to a consistent lack of coverage.
Gutting fire is not the answer. See my previous post, with the video.
My department pours a ton of money into EMS. Top of the line equipment, new apparatus before they hit 100k miles, and four of our busiest stations converted their 2nd ambulance from BLS to ALS, to help with call volume. That gives us 41 ALS units vs 37 engines, not a bad ratio, IMO. That's how it should be, but that still leaves a fire to EMS staffing ration well above 2:1. We have enough units in-service to cover our own surges, and still lend out mutual aid.
What you need is a public referendum - let the taxpayers decide if they want tax increase to fund EMS. They agreed. That's what we did in 2009, to save positions, and allow hiring of more medics.
Really, how many places in the country have well staffed EMS? Not many, probably hardly any. There are a huge amount of predominantly volunteer fire across the country. Even without the burden of funding a career department, EMS still gets understaffed, with only the minimum needed to get by. For EMS, just barely having enough units to get by seems to be the norm. How many EMS employers run with three on the bus? How many grant true OOS meal breaks? The only one that I've seen do this is Nassau County's EMS. How many places use SSM? How many places bid out to a cheap private provider? How many of those private providers play games juggling 911 units and IFT units to boost profitability? Using fire to Band-Aid this reality is clever, and it's also clever for fire depts. to exploit this fact to protect their own positions.
I don't have an easy answer to get around this situation.
I don't have an easy answer to get around this situation.
JPINFV
Gadfly
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So the standards are 2 things that EMS either sucks at (largely because it's out of their hands) or brings very little to the table for are the two standard cases?
I think EMS needs to find new standard cases to prove that they have value.
JPINFV
Gadfly
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...and there we have it. FD first response is about making sure that fire departments get funding and not for the patient. It's nice to know where the tax dollars are going.
JPINFV
Gadfly
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Ahh, but if you gut their response to EMS calls, then it's much less likely that the first due is going to be stuck at an EMS call or at the trauma center two towns down picking up their paramedic. Hence the need for less fire coverage because the units aren't stuck doing non-fire calls.
It is a damned if you do and damned if you don't scanario.
If you do not show call volume funding will be decreased to the point where fire response is ineffective. So when there is a "real" fire orother emergency, the department is blamed they squandered money and didn't produce.
If you increase call volume, you run the risk of losing your first due companies. I am sure 46 would agree, the engine, truck, and rescue all require rapid and simultaneous action to be effective. In an effective staffing model, the first and second engines as well as the first due truck or rescue can arrive near simultaneously. So much so that I have worked at a department that actually had to write an SOP on who has the right of way when they all meet at an intersection responding to the same call from different locations.
Personally I agree that it is both cheaper and more effective to use the larger regional station approach to fire response than multiple smaller stations, because units arriving piece-meal will not effectively perform all of these simultaneously required and synergistic operations.
But that is not going to cut your equipment need nor personell. It will save on capital expenditures and utilities over multiple stations.
But most places do not have the money required in order to make such a switch.
Don't forget that effective FDs have a real effect on all property owners everymonth, whether they need suppression activities or not. Firecode and enforcement protects against operation losses for business. Landlords of all types benefit from reduced fire insurance rates. Look at the recent thousand dollar + increases for detroit residents with an ineffective FD.
That is real money coming out of the pay every month. On top of the taxes already paid. What effect would it have on you if say renter's insurance went up a couple of hundred dollars per month?
While I don't believe the FD can reliably provide quality EMS, and a majority of the US population has EMS coverage provided by fire departments that do not embrace it, and consequenly do a poor job, the fact remains, if your neighbor has an MI and dies or his kid breaks an arm and suffers until the hospital, that sucks.
But when your neighbors house catches on fire and you lose yours as well, that sucks more.
Your medical condition affects you. The world got along fine without you or me before and will do so again when we are not here. Fire effects everybody.
It would be similar to you having a hospital, lose funding every year and then when somebody got really sick and blamed you for not saving them with the latest and greatest medicine and technology.
That is what the FD faces.
Couple that with the above stated facts that as time goes on, the FD requires faster response times and resources to do its job.
Most EMS is simply not time critical.
While it sucks if Ghetto Joe (urban cousin of Freddy Farmbeats) has to wait 2 hours for an ambulance for his sore throat and a dispatcher is pushing EMS crews to get it done, Joe does not require ALS ambulance, he requires transport, and he can wait days.
Overall, I agree with this. As much as I may not like the idea of "fire-based" EMS, I do not advocate funding in proportion to call volume. As has been mentioned actual fires are heavy on resources, much more so than the average EMS call or even cardiac arrest (which definitely requires more than 2 providers to be run well). EMS will always have a smaller budget as the equipment is less expensive and the required manpower is lower.
Be that as it may, there are locales where fire suppression could be down-sized to a certain extent. Most FF unions seem to want to maintain staffing for a call volume that hasn't existed in decades. In Philadelphia, the mayor has disbanded some engines and ladders and now has "brown outs", of course the IAFF hates this, but the truth is that they are not in the "war years" and there is no way they can justify the staffing they currently have. I think the mayor has generally made good decisions by downgrading some suppression and adding BLS ambulances.
I do think FDs have a role to play in EMS - MVCs, rescues (I don't really care one way or the other who pops a door or cuts a roof off a car), rapid (BLS only) response to critical calls (cardiac arrest being the big one). If them responding to some calls keeps them from being closed, I'm ok with that because I do want FFs to be able to respond in a timely fashion to a fire at my place.
FDs should proactively trim the fat before the cities do it for them. No need for every fire-fighter to be an EMT. I think MFR is a fine entry level medical training, but I would support EMT being a promotion so that every engine and ladder has 1 or 2 EMTs. No medics on engines or ladders - an expensive and unproven use of ALS. No need for medics on every ambulance (of course this doesn't just apply to FDs).
But, anyways, if any FD is going to make EMS a priority, they should change their name to reflect that. I reject "rescue" as a term. I like what DC did with DC Fire & EMS. FDNY should be FEMSNY or Emergency Services of NY (ESNY). Sure, all the FFs would be butt-hurt because it would break tradition and their identity, but I don't care for that sort of tradition and their current identity is only a half truth.
My two pennies.
Yes, it is important to ensure job security - if you're out of a job, then none of this will matter to you. The better EMS FD's value EMS to a high degree, and allocate sufficient resources in that direction. Keeping one's job, pay, and benefits stable is probably number one on anyone's priority list, but job security is always going to be number one. I don't see this as being an unreasonable priority.
If a fire call comes in, the fire crew can be placed in-service in the midst of a call with a non-acute pt. Really, maybe 10% of pts or less require time sensitive care that requires more than two providers on-scene. Most fire medical assists only last from 5-15 minutes on-scene anyway. If theunit has proper minimal staffing, the company can retain their medic, and give up a basic FF to drive, and let the txp crew both be in the back, unless there really needs to be an extra medic in back. We do this all the time, so we can stll be in-service and ALS capable with a crew of three. If the hospital is far away, the bus can bring them back, or the EMS supervisor can pick up the medic/basic.
The brownouts and such can work to a certain extent in densely populated urban areas. It doesn't work so well in regions that have a mix of urban, suburban, and rural. The busier companies are out of the station a lot, and the slower companies are too far apart to allow the next station over to be closed.
ALS engines only make sense in rural areas perhaps, but not in more populated areas that run dual medic buses.
JPINFV
Gadfly
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So it's OK for the FD to rape the EMS budget, but not OK for EMS departments to go, "Why are we paying the FD to do our job? If we cut out what we're paying the fire department to do EMS and send it to us, we can provide more efficient prehosptial care." The cognitive dissonance seen by the fire department is amazing.
JPINFV
Gadfly
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...except for all the places where the FD medic is the only medic on scene and the only FD vehicle is a fire engine. Again, that fire engine is going to do a great job responding to that fire when it's 2 cities over retrieving it's medic from the trauma center.
Fire departments: "We created an abomination of an EMS system to secure our jobs, but we need more funding now because the system is so messed up that it's reducing our response capabilities."
I don't think it is so much cognitive dissonance as it is how the fire service views prehospital care.
They see it as a collateral skill set, similar to hazmat, tech rescue, aircraft rescue/firefighting, and any other number of technical "skills" that can be learned as part of the greater all hazards vocation.
In their mind they are providing the best in prehospital care. (though I personally vehemently disagree with their definition of it and their performance)
So it is not perceieved as "raping the EMS budget" so much as it is using the EMS budget and revenue source as a means to fund the "all hazard" mission.
What I think makes it very flawed is that common human disease is mostly chronic, not acute, so a majority of patients don't fit into their "life or death" skill based intervention philosophy. Thus rendering their care over-valued and under-effective.
But like I said, they don't see it that way. Look at their selling point of delivering life saving medications in an emergency. They use cardiac arrest as the example, with a successful code being delivering textbook ACLS.
"The surgery was successful but the patient died" approach.
Apparently, in most cases, the politicians will choose to keep up FD staffing and use that staffing to Band-Aid poor EMS staffing, rather than slash the FD budget to put more buses on the road. If it were any different, we wouldn't be having this conversation. Like Vene said, people generally care more about fire and police coverage than they do about EMS. At least most of the departments in my area give their EMS division it's fair share of resources, such as Alexandria, Arlington, Fairfax County, Fairfax City, Loudon (when the volunteers don't block them from putting medic units in their houses, grrr...), Prince William, and Montgomery Cos. to name a few.
What I would like to see around here is more houses running two ambulances, rather than opening another fire station with an ambulance and an engine. That makes a whole lot more sense than cutting suppression services.
That is when you would see more than one ambulance...
He is saying that ALS engines and ALS ambulances both are not needed on a call for a single patient....... More than 1 patient, and the patient load is to much for the Ambulance? Call in another