Sorry if this has been posted its hard to search on my phone for prior topics.
I hear many county medics and private agencies not agreeing with the idea that the fire depts has Als transport like in Washigton state and many areas in the northwest. We also know that king county medic one is usually the staple of Als treatment and is always at the forefront of EMS.
Rather that argue who is better I would like to focus on the political and financial aspect of why different areas get up the ALS transport system differently.
- thanks
"Forefront" is relative, and highly dependent on which arbitrary measurement you use. If you go with SCA resuscitation, KCM1 is pretty good. Not so much if you go by "pain palliated", "respiratory distress" or "ACS/AMI recognition and treatment".
Personally, I think that fire departments that transport should be ALS, possibly critical care, have amazing gear and progressive protocols. They should try and mirror systems like Wake County, and collaborate to do so (there is precedent here, with the state-level fire academies). I think that they should be split departments with EMS-only options, but I can see the arguments for dual-role medics and can't really argue with them. I also think that there should be effective and meaningful policies in place to make the ambulance a fun and desirable duty, not a punishment box. In other words, mirror San Antonio, San Angelo or El Paso, not Dallas or Detroit or NYC or Washington DC or Seattle or LAFD.
Financially, I think that the decision to support an ALS transporting fire department is responsible if the city is willing to subsidize it entirely to an adequate level and not rely on billing to fund the department. This predicates a stable local economy, a relatively affluent tax base, and fairly large but steady call volume. A private ALS/BLS service for IFT and 911 backup (need not be an ALS truck) are also probably pretty important. Non-traditional asset deployment is probably a great idea as well- not necessarily posting, but deployment of multiple ambulances to high-volume areas. Separate medical calls from fire calls, and consider adding a third firefighter to ambulances when practical- you don't need four men on a ladder or engine that will go to the same fire as the ambulance anyway.
Non-transporting ALS fire could greatly be improved by putting that money towards SUVs instead of fire engines.
Politically, I think that ALS fire is a powerful draw, but one that has potential to strangle a city or county. There is a difference in staffing- you need more paramedics for most large communities than you need firefighters, and those paramedics need to be in smaller units and utilized more often to make financial sense. This means that a department is either split (with the positives and negatives inherent) or accepts a lot of paramedics into its ranks. I think that it is up to the members of that department to see if that assimilation is a positive one or a negative "EMS sucks" one. Fire departments are way, way better at politics than private providers, since they play off of the "hero" label, the work of their private and third-service counterparts, and they have a strong, national union. Image sells, and fire departments have image out the wazoo. Their organized, generally well-funded unions also help quite a bit in local politics. However, greed is a factor.
Let's look at Clark County, Nevada. AMR and its EMSC brother provide the vast majority of 911 transport and ALS care in a high-volume, high-cashflow 911 system, and most of the IFT. Generally speaking, unless you're a very high-profile case in terms of media exposure or a level-one trauma that MedicWest or AMR didn't get to first, you're being treated and transported in a private ambulance with private supplies and a private employee. The fire departments in the Valley do excellent jobs most of the time, but generally they do not transport- they are set up as first-response. However, the unions, via their political contacts, have made it so that fire medics run everything on-scene until they release the patient to AMR (poor choice, IMO, but workable). Then, faced with budget cuts, fire departments started a long-term, very public smear campaign against AMR and MedicWest, with plenty of blatant falsehoods. One department, NLVFD, even started transporting all of their own patients in an attempt to drive AMR/MWA out of their area. This lasted for about a month, in which the department burned its year's overtime budget and was pushed to near-bankruptcy by overtime at ridiculously inflated FF salaries. MedicWest came back in to the rescue, relatively unaffected by the loss in income (realistically, they probably profited from the transfers they were able to take in lieu of nonpaying 911 calls) and things returned to normal. Fire-based EMS is a great thing as long as unions don't get greedy.
