Seems like a simple question, but I was flabbergasted by the number of responses in the vein of "they were the first FD that hired me" when I was working for fire-based services.
Fire-based EMS vs EMTs?
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Seems like a simple question, but I was flabbergasted by the number of responses in the vein of "they were the first FD that hired me" when I was working for fire-based services.
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Haha. Well, I guess it all goes back to the attitude of the individuals. And one can only do so much to help change another's attitude.
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TransportJockey
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I work for a municipal EMS agency and a lot of the people that work there think the same thing. I butt heads with almost every single person I work with that we need to keep educating ourselves and they still have the volunteer mentality of doing the minimum needed.
firetender
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It's About Focus
This has always been a tough one. My personal experience was that EMS for Fire was largely an afterthought. As I watched EMS develop in Fire Depts., back in the 1970's, I saw a pattern that had little to do with patient care and lots to do with access to resources (spelled; $).
In those systems, where being trained as EMT became mandatory but usage of the skills not, I'm sorry (for a lot of people!) but there just didn't seem to be a consistent quality of care, primarily exhibited by a marked lack of INTEREST in developing more advanced skills.
Within many FDs, EMS became a VEHICLE for advancement, not an ASPIRATION on its own. When you are required to do your time in EMS, who's gonna suffer?
To a certain extent, the same could be said of private firms whose primary focus is on profit. EMS then becomes a vehicle to lock in the TRANSPORT business. Vehicles and equipment are supported in a bare-bones matter and the welfare of its practitioners placed on the back-burner, if not flopped off the stove altogether.
My point is wherever the emergency care of the sick and injured becomes secondary to other concerns, you will lose consistency in the level of care. Wherever EMS individuals are mandated to do many things peripheral to expanding their abilities and education in EMS, patient care suffers.
Rather than complain about what is, we should focus on what needs to be: the development of an EMS specialty that is recognized nationwide, (perhaps) standardized), requires continuing education and asks of its practitioners that they be immersed in emergency care. Period.
There should be only one guiding force: improved pre-hospital patient care and appropriate referral.
Yes, it does boil down to the attitude of the individual, but that does not take us off the hook for perpetuating systems that support lackadaisical attitudes amongst those who provide this vital service.
But you know, 40 years down the line the people STILL don't get that we are a vital service, equal, if not more demanding on the life forces of its practitioners as Fire or Police.
Whose fault is that?
This has always been a tough one. My personal experience was that EMS for Fire was largely an afterthought. As I watched EMS develop in Fire Depts., back in the 1970's, I saw a pattern that had little to do with patient care and lots to do with access to resources (spelled; $).
In those systems, where being trained as EMT became mandatory but usage of the skills not, I'm sorry (for a lot of people!) but there just didn't seem to be a consistent quality of care, primarily exhibited by a marked lack of INTEREST in developing more advanced skills.
Within many FDs, EMS became a VEHICLE for advancement, not an ASPIRATION on its own. When you are required to do your time in EMS, who's gonna suffer?
To a certain extent, the same could be said of private firms whose primary focus is on profit. EMS then becomes a vehicle to lock in the TRANSPORT business. Vehicles and equipment are supported in a bare-bones matter and the welfare of its practitioners placed on the back-burner, if not flopped off the stove altogether.
My point is wherever the emergency care of the sick and injured becomes secondary to other concerns, you will lose consistency in the level of care. Wherever EMS individuals are mandated to do many things peripheral to expanding their abilities and education in EMS, patient care suffers.
Rather than complain about what is, we should focus on what needs to be: the development of an EMS specialty that is recognized nationwide, (perhaps) standardized), requires continuing education and asks of its practitioners that they be immersed in emergency care. Period.
There should be only one guiding force: improved pre-hospital patient care and appropriate referral.
Yes, it does boil down to the attitude of the individual, but that does not take us off the hook for perpetuating systems that support lackadaisical attitudes amongst those who provide this vital service.
But you know, 40 years down the line the people STILL don't get that we are a vital service, equal, if not more demanding on the life forces of its practitioners as Fire or Police.
Whose fault is that?
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BLSBoy
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I am proud to be both a Firefighter and Paramedic. I thoroughly enjoy both aspects of my job, and learning more only benefits the citizens that I am sworn to serve.
There are plenty of firefighter EMT's/medics that genuinely enjoy EMS. At least at first. They also enjoy the other areas of the fire service. They may like engine work, Hazmat, TROT, truck work, riding the heavy rescue, etc. A few things happen:
First, medics will spend a lot of time on the ambulance. They're supposed to split their time 50/50 between suppression and EMS txp, but you may have a dual hatter officer or driver that bumps them from their engine tour. The opportunities to ride specialty units such as a Hazmat rescue, TROT rescue, or a truck company are severely limited. The ambulance crew can be out of the station for 1 1/2 to 2 hours per call. You run 10 calls, and that's most of your day. You're missing meals, PT, drills and other training, study, and sleep time. The suppression crews may be back in the station 20 mins after the tone by comparison. So, the medic is generally prohibited from enjoying much versatility in the dept, they're out of the station for most of their day, and they're bumped from their engine tour in certain stations. It gets old after a while.
So, quite a few medics eventually drop their ALS cert, so they can go in to different areas of the dept, have more downtime to PT, drill, cook dinner, and sleep some (it is a 24 hour shift, so the opportunity to sleep is to be expected).
Before you say that they shouldn't be medics/EMT's in the first place if they don't want to do it for a career, realize that quite a few in the EMS only field quite after several years due to burnout. If the firemedic is doing EMS txp 90% of the time or more, they'll burn out the same as a career medic often does, and for the same reasons. The fact that they're in a FD is irrelevant in that regard. The negative aspects of the job are the same, except for benefits and a better career ladder. There's nothing wrong with a firemedic wanting to get off of the ambulance half of the time give or take. I feel that it gives you a break from the call volume and monotony, gives you a change of pace, and helps to keep one's interest in EMS for much longer than would be the case otherwise.
Also, if you're doing suppression in NY, LA, Miami, Chicago, etc, of course you're going to excel at it. On the same token, you can be a medic or EMT in NYC, and also excel. To say that being dual role in depts that are slower than these inner city environments is unfair. I feel that the NYC medic will see much more than one that works in a suburban or rural area. It doesn't mean that the rural medic sucks. The FFM may be just adequate but not excellent in firefighting, but so will anyone else in an environment that sees comparitively little fire. To say that the FFM isn't as good at firefighting as a FDNY FF is like comparing apples to oranges.
First, medics will spend a lot of time on the ambulance. They're supposed to split their time 50/50 between suppression and EMS txp, but you may have a dual hatter officer or driver that bumps them from their engine tour. The opportunities to ride specialty units such as a Hazmat rescue, TROT rescue, or a truck company are severely limited. The ambulance crew can be out of the station for 1 1/2 to 2 hours per call. You run 10 calls, and that's most of your day. You're missing meals, PT, drills and other training, study, and sleep time. The suppression crews may be back in the station 20 mins after the tone by comparison. So, the medic is generally prohibited from enjoying much versatility in the dept, they're out of the station for most of their day, and they're bumped from their engine tour in certain stations. It gets old after a while.
So, quite a few medics eventually drop their ALS cert, so they can go in to different areas of the dept, have more downtime to PT, drill, cook dinner, and sleep some (it is a 24 hour shift, so the opportunity to sleep is to be expected).
Before you say that they shouldn't be medics/EMT's in the first place if they don't want to do it for a career, realize that quite a few in the EMS only field quite after several years due to burnout. If the firemedic is doing EMS txp 90% of the time or more, they'll burn out the same as a career medic often does, and for the same reasons. The fact that they're in a FD is irrelevant in that regard. The negative aspects of the job are the same, except for benefits and a better career ladder. There's nothing wrong with a firemedic wanting to get off of the ambulance half of the time give or take. I feel that it gives you a break from the call volume and monotony, gives you a change of pace, and helps to keep one's interest in EMS for much longer than would be the case otherwise.
Also, if you're doing suppression in NY, LA, Miami, Chicago, etc, of course you're going to excel at it. On the same token, you can be a medic or EMT in NYC, and also excel. To say that being dual role in depts that are slower than these inner city environments is unfair. I feel that the NYC medic will see much more than one that works in a suburban or rural area. It doesn't mean that the rural medic sucks. The FFM may be just adequate but not excellent in firefighting, but so will anyone else in an environment that sees comparitively little fire. To say that the FFM isn't as good at firefighting as a FDNY FF is like comparing apples to oranges.
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Are you saying that because their shirt says "Fire Department" patient care suffers?
firetender
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No, I said;
"wherever the emergency care of the sick and injured becomes secondary to other concerns, you will lose consistency in the level of care."
The operative word is "Wherever"
I'll leave the rest to your personal interpretation. Perhaps mentioning that the attitude of the Delivery Service -- in whatever form -- will largely shape the attitudes of its practitioners would be useful.
That was my point.
That multiple role people who see a little of everything are not as proficient as those that see a lot of one thing.
It seems popular among some members of the fire service as of late to really believe they are super at everything they ever had a few hours of initial training at.
Like I said before, that is a very dangerous attitude to hold or perpetuate.
Monkey
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Back when I got my start, if you wanted to be a firefighter, you went to academy and you were on your way.
Now you MUST be a Paramedic to be a firefighter... so many of the students that come through medic schools aren't doing it for the love of EMS, they're doing it because they HAVE to, to be able to drag hose. So they're forced to be medics, don't want to be, and spend about a year of their time getting licensed for something they don't want to do but have to, to have be a firefighter.
So does that hinder pt. care? maybe, cuz they'd rather be doing anything else than repsonding to grandmas sore toe at 3am.
Now, this is strictly coming from the viewpoint of Southern California, other places may be different, obviously. I'd say many of FireMedics here did it under protest to get on with the FD.
Now you MUST be a Paramedic to be a firefighter... so many of the students that come through medic schools aren't doing it for the love of EMS, they're doing it because they HAVE to, to be able to drag hose. So they're forced to be medics, don't want to be, and spend about a year of their time getting licensed for something they don't want to do but have to, to have be a firefighter.
So does that hinder pt. care? maybe, cuz they'd rather be doing anything else than repsonding to grandmas sore toe at 3am.
Now, this is strictly coming from the viewpoint of Southern California, other places may be different, obviously. I'd say many of FireMedics here did it under protest to get on with the FD.
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I'm trying to interpret what your point is. Are you saying that it is up to the agencies involved? (which I agree with also)
And I think that's a concern I throw out at the educators and recruiters of today. Fire departments are not just fire departments any more. They are taking on the role of EMS, whether it's transporting or just stabilizing. They (the student/future firefighter) needs to understand this and feel comfortable with their career choice.
Monkey
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So do you think that the medics schools should weed out those that are more interested in the fire aspect than being medics?
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No, I think those interested in responding to fires need to understand that many departments also respond to EMS calls. If they don't want to respond to EMS calls they need to find a department that does not and never will in order for them to be happy and enjoy their career.
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You make some really interesting points. Maybe this is how fire and EMS should evolve.
Monkey
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I wholeheartedly agree with you. The thing I see is, so many of these young guys are drawn to the southern california "life" and flock here. There are so many transplants from other areas as well as the saturation of the ones graduating school here, yet the attitude still prevails. It's no mystery what is required, but I'd say 2 in 5 don't want to be medics, just fire. I think a lot of it is an immature prestige thing.
It got worse after 2001 when it was suddeny heroic to be a firefighter again. For many years it was one of those government "labor jobs" that was worthy of a budget cut at every opportunity as we spent time desperately trying to demonstrate our value.
I think that many new people today don't really want to be firefighters. They want to be what they fantasize firefighters are. They want the prestige, but not the work it takes. They want to always be safe but still be considered the ones who laugh in the face of danger.
In a little over 7 years teaching medic classes, I can name every one of the few students who wasn't taking paramedic class to fill out a fire application. Out of hundreds of students I can count how many actually got a full time fire job either in the area or moving away.
Going to paramedic school to be a firefighter is no different than becomming a biology major to become a doctor. It just gets you the credentials you need in the shortest amount of time. Then armed with these papers, you enter the real rat race. With the same odds of hitting the lottery, pretending like you may find some secret trick to give you an advantage over others where none exists.
There is a lot of money to be made taking advantage of these peoples' fantasy. No school that makes money off of student population is going to do anything to weed out or otherwise dissuade people from playing the game.
If there is going to be real change in the type of person entering the fire service, it is going to take the "new school" firefighters going to elementary schools and telling kids there what being a firefighter really is. Because once they get to highschool, the dream is already set.
I see that a lot nowadays. They want the prestige, the hero image, the schedule and benefits, but then refuse to go inside, or make their air bleed out prematurely so that their vibralert is going off before they even make the fire room. There's also quite a few on the job that have no prayer of carrying out a civilian, let alone another FF in a RIT scenario, due to physical weakness.
medicRob
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The same is true of a lot of individuals who pursue EMS. They have this idea in their head that we are everything they have seen on TV assuming that our days are spent doing crichs, intubating, inserting chest tubes, and shocking asystole to bring a patient back. They usually keep on with this train of thought until they reach their first clinical where they realize that the reason we are going to the Trauma I center today is not for a trauma at all, but rather to take a patient to their dialysis appointment in the same hospital. They see our profession as skill based from the beginning with no true realization of what it is we do or the intricacies [I use that term very loosely] involved.
In some ways, I feel that this miseducation over what it is an EMT actually does on a day to day basis is one of the reasons the majority of individuals in EMS over treat patients with the assumption that every one needs high flow 02 and 2 14g IV's regardless. Add this thought process to protocols that were already outdated by 5 years or more on the date of their implementation due to the ever-changing nature of evidence-based treatment modalities coupled with the lack of formal education requirements in the fields of: Biology, Pharmacology, Chemistry, and Mathematics to name a few that are present in so many of these "Parathinktheyare" courses sponsored by the Houston FD (Brown, 2010) offering no regard whatsoever for educating individuals to be anything more than cookbook followers at best with no true understanding of the underlying pathologies associated with various disease processes(be they medical or traumatic in nature), and you end up with medics who blindly follow protocols with no regard for treating patient condition or deviating from the cookbook to treat a patient, even when the best treatment is to sometimes do nothing and transport.
That type of plan may only work for the more well funded depts. We've already made our heavy rescues into ALS FR units. The medic can either be on the engine or the rescue, so long as there's one ALS FR vehicle in each station. Our trucks and TL's will be getting ALS equipment as well. This makes sense for our dept, since they recently combined the EMS and fire career ladders. Past the basic FF, we have four techs - EMS, TROT, Apparatus, and Hazmat. Then you can make Master Tech or LT. In the past, you could split at the Lt rank and go strictly EMS. You rejoin suppression at the BC rank and above. Now, all officers are fire certified, and ALS if they have it. So, if I'm going to be riding the seat of a suppression unit one day, I need truck time, and squad time if I want to go TROT or Hazmat. In a lesser funded dept, having specialty pieces unavailable due to EMS calls can leave significant coverage gaps. The wear and tear, especially on a TL, can be costly. We're fortunate to have more than adequate staffing and deployment, with a solid mutual aid agreement, so we can get away with this arrangement w/o any issues.
firetender
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To be honest with you, Chimpie, I don't think the agencies will institute change in much the same way that neither hospitals nor schools turned Nursing from advanced ***-wiping to a profession. Their first loyalty is to themselves; they are the results of change, not the change itself.
It's up to enough of us who truly understand the value of the profession to promote OURSELVES, unify and then set standards for those who follow in our footsteps. WE are the ones who must say EMS is EMS and not Fire, Police, or any other hybridized service.
We have to be strong enough to mold the profession into something that is NOT an add-on. I see movement happening through EMS 2.0 and other unifying agents. Consciousness IS growing and we're getting closer, but it's going to take a whole lot more of us to do the work, and the first step is to re-define what we do based on the services we actually provide.
I did mention the attitude of the delivery service attracting medics who are okay with being less-than focused on the M of EMS. But ultimately, it will have to be the medics themselves that just don't want to work at anything that asks less than full-involvement. Medics themselves need to stand up and say, "Sorry, that's NOT how I want to do the work!"
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