Fire-based EMS vs EMTs?

[Putrid Existence]

So, browsing around these forums, and just the internet in general, there seems to be quarrel between fire-based EMS and regular EMTs. If the fire fighters have EMS covered, then what's the point of having EMTs in the first place? Not trying to start any arguments, I'm just genuinely curious and have a lot of questions about the whole EMS lifestyle/landscape.

 

[abckidsmom]

I recommend you get out of CA and see how EMS can be run. The redundancy in the systems I've seen and heard about there makes my unit-hour-utilization meter shatter and fall to the floor in a thousand pieces.

 

[Putrid Existence]

I recommend you get out of CA and see how EMS can be run. The redundancy in the systems I've seen and heard about there makes my unit-hour-utilization meter shatter and fall to the floor in a thousand pieces.

Can you give an example or two please?

 

[usalsfyre]

If the fire fighters have EMS covered, then what's the point of having EMTs in the first place?

Perhaps you should ask the average firefighter what their opinon of EMS is, and their goal for their EMS career.

Then ask yourself, do I REALLY want to be treated with multiple interventions that may be harmful to my longterm morbidity/mortality by this guy?

 

[MrBrown]

Fire based EMS is worse than the borg man, seriously .... if you want to sick whatever you do, do not do it in Houston or Los Angeles.

 

[Bieber]

So, browsing around these forums, and just the internet in general, there seems to be quarrel between fire-based EMS and regular EMTs. If the fire fighters have EMS covered, then what's the point of having EMTs in the first place? Not trying to start any arguments, I'm just genuinely curious and have a lot of questions about the whole EMS lifestyle/landscape.

The point is to have a fully dedicated service whose only purpose is to provide the very best possible EMS service possible. EMS ought to be advancing, progressive, focused on the medicine, and constantly seeking higher educational standards. Fire-based EMS, on the other hand, more often than not seems focused on generating revenue for the fire side of things and on lowering educational standards for EMS across the board.

Fire-based EMS makes no more sense to me than hospital-based construction companies; they're two wholly distinct jobs and if you think they're so interchangeable then you might ask why there are such things as fire-based EMS but no hospital-based fire departments.

I get it, the fire departments are working themselves out of a job and they're latching onto EMS in an attempt to survive. And I feel for them, that sucks. At the same time, for my profession to be degraded by fire departments who care only about fire service and not about bettering EMS or its educational standards, you can certainly see where some of the animosity comes from.

And until the IAFF takes the stance that fire departments are the best providers of EMS because they advocate raising educational standards and advancing EMS and NOT because "fire departments are strategically placed to provide the quickest response", my answer to fire-based EMS will always be "no, thank you".

 

[Aidey]

Fire based EMS is worse than the borg man, seriously .... if you want to sick whatever you do, do not do it in Houston or Los Angeles.

Or DC.

Or most of Florida.

To the OP, the short of it is that most FFs became FFs because they wanted to be FFs. A FDs primary goal is still fighting fires. EMS, despite being 70-80% of most areas call volume is a lower priority. Many FFs were forced to be paramedics and EMTs to keep their jobs.

Non FF EMS employees became EMTs and paramedics becuase they wanted to be EMTs and Paramedics. They tend to care more about the medicine. There are good and bad people in both settings, but EMS is not the priority in the vast majority of FDs.

 

[WTEngel]

It isnt as simple as all the generalizations being made. I have worked on both sides of the fence. I was lucky enough to have a medical director at the fire department I worked at who genuinely cared about EMS and education, and the FD administration and line personnel supported him. It was a requirement to be a paramedic (as it is in most of North Texas) to even be considered for emloyment.

Let's not generalize. I have known plenty of non fire based EMS personnel who have had attitudes that put some career firefighters to shame. I have also known career firefighters who were resistant to EMS and were going to be that way until they retired.

The bottom line is take each agency for what it is. Some EMS agencies are better than others in regards to education and professionalism (Austin comes to mind) and some fire department based EMS systems are top notch (quite a few North Texas cities come to mind.) find what you want and where you fit in and go for it!

 

[Chimpie]

The bottom line is take each agency for what it is.

This is exactly right.

I have resisted the urge to post on here because I know of only a handful of agencies and departments. Here locally, EMS is part of the fire department and I (as a patient) couldn't ask for more professional personnel or for them to have better equipment.

Now, where I grew up, EMS is a private service and they leave MUCH to be desired.

But I can't say that EMS should be a part of the fire service throughout based on the above. It wouldn't be right.

 

[usalsfyre]

It isnt as simple as all the generalizations being made. I have worked on both sides of the fence. I was lucky enough to have a medical director at the fire department I worked at who genuinely cared about EMS and education, and the FD administration and line personnel supported him. It was a requirement to be a paramedic (as it is in most of North Texas) to even be considered for emloyment.

Let's not generalize. I have known plenty of non fire based EMS personnel who have had attitudes that put some career firefighters to shame. I have also known career firefighters who were resistant to EMS and were going to be that way until they retired.

The bottom line is take each agency for what it is. Some EMS agencies are better than others in regards to education and professionalism (Austin comes to mind) and some fire department based EMS systems are top notch (quite a few North Texas cities come to mind.) find what you want and where you fit in and go for it!

Unfortunately generalizations is pretty well all we can deal in in this area. And GENERALLY, fire based EMS is not going to be as medically oriented as third-service EMS. With privates it's a toss up.

The very first EMS agency I drew an actual paycheck from was one of the finest I've ever had the pleasure to be involved with. It was also fire-based. The second and third one were both clinically years behind the time and massively resistant to change. They were fire and hospital based respectively.

The problem I have with fire-based EMS is not the exceptional systems, it's that the mediocre to bad ones seem to be greater in number as well as more entrenched in a culture that is usually behind the times and downright belittling to EMS than many privates/third services I've seen. Partly because they are afforded the luxury of government protection. These are the services that use the "**** box" as punishment for either a. being new or b. pissing the wrong person off. Bottom line if it's easier to fire the medical director than a line employee it's probably a recipe for clinical problems.

 

[Veneficus]

something to consider

As objectively as I can, I would like to state that:

The fire service sees EMS as an add on skill.

EMS providers struggle to obtain professional status.

Let us consider the definition:

pro·fes·sion noun \prə-ˈfe-shən\

1: a calling requiring specialized knowledge and often long and intensive academic preparation.

That doesn't sound like an add on skill to me.

There are a handful of people comparitively who engage in multiple professions. Especially very intensive ones like Law and Medicine. None who are great at both.

You can see where people who do engage in multiple professions will not be able to devote a majority of time to both. Making them less capable in one even if they obtain the minimum. As well, eventually the values or demands of multiple professions will come into conflict.

When they do, the individual will have to make a choice, which relegates one of them to being secondary. Not something unidiscipline professions find overly acceptable.

Some people claim to be good at both fire and EMS. I will agree to good, or acceptable, but certainly not great. I have done both fire and EMS, and I can attest that nobody fights fire like dedicated engine and ladder companies. Nobody rescues people better than dedicated rescue companies, nobody does hazmat better than dedicated hazmat companies, and nobody does EMS better than dedicated EMS providers. (even if they are part of the fire department) All of these positions required skills which are perishable. They all require continuing education and improvement. If you are spending all of your time maintaining all of these skills (which is physically impossible), you probably don't have much life outside of work, which is really not healthy or sustainable.

If you notice, many of the very admirable fire departments around the world, have dedicated specialized providers of various fire related disciplines. Just like doctors specialize in medicine because it is too broad of a topic for anyone person to be the master of all.

In all fairness, a fire department has the potential do EMS as well as anyone else. But there are all kinds of caviats that are often unmet. Dedicated providers, equal administrative power, dedicated to the mission of providing EMS as a service rather than something to generate revenue or preserve jobs, proper training, retraining, and continuing development. Proper bugetary spending, proper prehire selection of individuals commited to the mission, and constantly improving EMS service based on the needs of the public over the wants of the department.

But in a vast majority of fire departments these requirements are not met and have no intention of being.

It is also true that private and 3rd service EMS providers often fall short in these demands as well, but for different reasons. (to the same end though)

Another major problem with the fire service getting into EMS is that the fire service is paramilitary in structure. Higher ranking officers give orders in the form of tasks to lower ranking members. This chain of command structure often relieves personal responsibility and accountability for decisions down the chain as long as they perform the prescribed skill. It actually works extremely well for firefighting, where "freelancing" is a vulgarity, life and mission threatening, and to be avoided at all costs.

The nature of prehospital medical care actually requires a great deal of independant decision making and action. Anyone who makes a decision is responsible for it. Calling for help in the form of orders from medical control is most efficently used as an exception rather than the rule.

These two different ways of functioning usually attract different types of people. Which is ripe for conflict. Both parties often want the other to be more like them.

As such, the fire service, mostly in the US, uses their political power to make EMS from initial training to accountability of its staff as "fire like" as possible. Which is basically a repetative task which neither requires nor allows deviation or decision making.

Medically minded EMS providers (which are a minority in the US) understand and embrace that medicine is not always repetative and sometimes requires considerable deviation and always decision making.

Complicating matters is the fact that as the world evolves, the needs of the people who are paying for service evolve, and most providers of all flags are trying to perfect yesterdays' practices which are no longer relavent in today's world. Which creates even more conflict.

There is no easy way to reconcile the differences.

 

[JJR512]

Fire-based EMS vs EMTs?

The very thread title is out of whack.

The thread title makes it seem like fire-based EMS providers aren't EMTs. The fact is, the fire-based personnel who are providing EMS are EMTs or better. Oh, sure, maybe in some areas the fire people are First Responders but they usually aren't the primary EMS caregivers.

If you want a thread title that doesn't show any initial bias, how about "Fire-based EMS vs. privatized EMS".

The IAFF and fire department chiefs can take whatever stance they want. Ultimately, it comes down to the individual provider, and I have seen many high-quality EMTs and Paramedics that come from a fire department background. They do their continuing education, they go to conferences and seminars and workshops, they are advancing themselves to continuously be high-quality EMS providers.

 

[Veneficus]

If you want a thread title that doesn't show any initial bias, how about "Fire-based EMS vs. privatized EMS".

But that is just as biased as it eliminates 3rd service municiple, public safety officer agencies that are police fire and EMS, industrial EMS providers, entertainment EMS providers, event EMS providers, wilderness EMS providers, as well as police/ems agencies. (and I am sure I forgot a few somewhere)

Perhaps the biggest problem in the delivery of US EMS is that there is no one definition of even what it is.

 

[JJR512]

As objectively as I can, I would like to state that:

The fire service sees EMS as an add on skill.

EMS providers struggle to obtain professional status.

Let us consider the definition:

pro·fes·sion noun \prə-ˈfe-shən\

1: a calling requiring specialized knowledge and often long and intensive academic preparation.

That doesn't sound like an add on skill to me.

I'm sure you would love the Howard County (Maryland) Department of Fire and Rescue Services. They don't see EMS as an add-on skill. At HCFR, EMS (at the EMT-B level) is something that every firefighter is taught as part of the academy training. It isn't an add-on, it's a core component just as much as where to aim the hose or how to crib a crashed car.

 

[lampnyter]

The very thread title is out of whack.

The thread title makes it seem like fire-based EMS providers aren't EMTs. The fact is, the fire-based personnel who are providing EMS are EMTs or better. Oh, sure, maybe in some areas the fire people are First Responders but they usually aren't the primary EMS caregivers.

If you want a thread title that doesn't show any initial bias, how about "Fire-based EMS vs. privatized EMS".

The IAFF and fire department chiefs can take whatever stance they want. Ultimately, it comes down to the individual provider, and I have seen many high-quality EMTs and Paramedics that come from a fire department background. They do their continuing education, they go to conferences and seminars and workshops, they are advancing themselves to continuously be high-quality EMS providers.

Yes but an EMT is different than an EMT with experience. Just because they have EMT doesnt mean they know what they are doing on the field.

 

[JJR512]

But that is just as biased as it eliminates 3rd service municiple, public safety officer agencies that are police fire and EMS, industrial EMS providers, entertainment EMS providers, event EMS providers, wilderness EMS providers, as well as police/ems agencies. (and I am sure I forgot a few somewhere)

Perhaps the biggest problem in the delivery of US EMS is that there is no one definition of even what it is.

I am not familiar with "3rd service municipal, public safety officer agencies that are police fire and EMS", so please excuse me for not including them. As for industrial EMS, entertainment EMS, and everything else you mentioned, I don't think they particularly belong in the discussion because it seems that the OP's intent was to compare first-line emergency response to the public. Industrial EMS doesn't do that, they provide emergency response within the company. Same for entertainment. Wilderness EMS is a separate subject.

 

[usalsfyre]

I'm sure you would love the Howard County (Maryland) Department of Fire and Rescue Services. They don't see EMS as an add-on skill. At HCFR, EMS (at the EMT-B level) is something that every firefighter is taught as part of the academy training. It isn't an add-on, it's a core component just as much as where to aim the hose or how to crib a crashed car.

Nice thought, but when EMT-Basic is covered in 3-4 weeks (usually 80% or more of call volume) vs. 16 weeks or more for the fire-based part of the curriculum (20% or less of call volume) do you see where the impression there's a disparity MIGHT come into play? Yes, it's treated as an add on skill, not the core component of the academy.

 

[JJR512]

Yes but an EMT is different than an EMT with experience. Just because they have EMT doesnt mean they know what they are doing on the field.

Yeah and just because they're also a firefighter doesn't mean they don't have experience and it doesn't mean they don't know what they're doing in the field.

As for what I was ACTUALLY talking about in what you quoted, the level of experience is irrelevant to the thread title. The thread title implies a comparison of fire-based EMS to non-fire-based EMS. To compare something you need to have one variable as the basis for comparison. The variable here is whether the EMS is fire-based or not.

If you want to make experience the basis for comparison then you'd need to start a new thread called, "Experienced EMTs vs. Inexperienced EMTs".

 

[Veneficus]

I'm sure you would love the Howard County (Maryland) Department of Fire and Rescue Services. They don't see EMS as an add-on skill. At HCFR, EMS (at the EMT-B level) is something that every firefighter is taught as part of the academy training. It isn't an add-on, it's a core component just as much as where to aim the hose or how to crib a crashed car.

But EMT is a technical skill set, no different from fire suppresion, extrication, various technical rescue specialties etc. When you have to start deciding on treatments based not only on signs and symptoms, but a host of disciplines like anatomy, physiology, pathology, pharmacology, etc, you lose the comfort of simple protocol and the ability is truly measured. If you are learning those disciplines at the depth to make independant decisions, you certainly don't have time for anything else.

As an example suitable for EMS, if you have a patient in septic shock, you might have to chose which therapy, the order, as well as the possibility of withholding treatment based on presentation or comorbidity. Take my word, that is an art, and it cannot performed well by people who are responsible for 10 other things.

I stand by my statement, any department where the individual providers are expected to perform multiple skill sets rather than a dedicated role, they are simply a jack of all trades and master of none.

When any of those departments can fight fire like a dedicated engine company, ventilate and search like a ladder company, etc in a cities like NYC Chicago, Cleveland, LA, or Miami, then there is something to talk about. Until then, it is simply "acceptable" or "the best you can."

 

[JJR512]

Nice thought, but when EMT-Basic is covered in 3-4 weeks (usually 80% or more of call volume) vs. 16 weeks or more for the fire-based part of the curriculum (20% or less of call volume) do you see where the impression there's a disparity MIGHT come into play? Yes, it's treated as an add on skill, not the core component of the academy.

You want to talk about disparities then fine, talk about disparities. I wasn't talking about disparities, I was responding directly to a comment that referred to EMS training as add-on training for the fire service. This may be true in many cases, but as I've just shown, it's not true for Howard County, MD.

It may not be the subject that gets the most time during the academy training but it does get time, an equal time for all, during the academy training. That fact right there proves that at least for this county, it isn't add-on, it's core training. "Add-on" training means, by definition, that after everyone is done the fire training, some people go on to a special class for the EMS component.