Fire-based EMS vs EMTs?

[Monkey]

... 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.

BINGO!!! It's so hard to teach CRITICAL thinking. Teaching medics is easier when you're working with a good EMT, someone with a bit of a foundation. There is a lack in most schools to go BEYOND the "Book Learnin" and into actually THINKING.

Bad EMT's make bad medics, or usually mediocre at best. ALS should always start with BLS and work up, but medics seem to want to start high and work down, which leads to unnecessary steps.

Firemedics in this area are relegated to extra hands, doing delegated work that the medic off the box dictates. It's no wonder they are annoyed to have to get all that same education to be "helpers" when all they wanted to do was fight fires.

 

[JPINFV]

Interesting point. When you say properly funded what do you mean? What would you like to see added?

Why is the fire department regularly being sent on medical calls? If the problem is a legitimate "not enough units" (no... saving a minute on scene time isn't doing anything the vast majority of times), then funding needs to be added for more units. If it's man power, than maybe urban departments need to consider going to 3 man crews. I don't see a problem with using the fire department every now and again, just as I think that EMS should be providing medical rehab services on long term fire ground operations (after all, you don't go to a plumber for artery disease, you go to a physician even if both work with pipes). Medicine is EMS's game, and we -have- to own that.

 

[JPINFV]

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.

If an engine or truck company had such a high unit hour utilization as the ambulance, what would the fire department do? Add another truck or engine, correct?

Why aren't they adding more ambulances?

 

[abckidsmom]

If an engine or truck company had such a high unit hour utilization as the ambulance, what would the fire department do? Add another truck or engine, correct?

Why aren't they adding more ambulances?

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Money, pure and simple. Tradition and money. IMO, the FD busy-ness just doesn't work in a higher volume EMS scenario. When the Chief wants to have a meeting at 7 pm with the whole station, and the medic just so happens to be in the house, the medic should be on downtime.

Instead, they're sitting in the Chief's meeting, not resting. A 24 hour medic unit with UHU higher than .4 needs to be basically resting when not on calls. Instead, they're drilling, PTing, cleaning, looking busy, etc.

 

[JJR512]

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.

Around here, most people that take a paramedic program are taking it so they can fill out a fire department application.

But the real truth of the matter is that many of them are filling out the fire department application so they can become paramedics.

Around here, if you want to function as a paramedic, your main choices are to volunteer, work for a private company, or work for a fire department.

Volunteering is a separate issue. Between private companies and FDs, around here, most people would choose the FD. The FDs are the only agencies that provide emergency services around here. The private companies are inter-facility only, and most people (in my experience) don't become paramedics so they can sit with a vent patient being moved from a community hospital to a large medical center. So most people (again: around here) that want to work as paramedics want to join fire departments. Not because they want to be firefighters, but because it's largely the only way to actually work as a paramedic.

At least in the greater Baltimore/DC metro area, I am aware of only one fire department that hires people to be paramedics only. There may be others but at least as of a few years ago, the Annapolis City FD did this. I never understood why more departments wouldn't hire someone to be EMS-only. Many firefighters don't really like EMS, as has already been noted many times in this thread, so if you get someone that actually wants to work EMS why not hire that person to do just that?

 

[JPINFV]

Problems that I foresee with mixing fire only with EMS only in a fire department.

1. Pay scales? Ok, arguably a working fire call carries more risk than an EMS call, and on that view should pay more. However, there are a magnitude more EMS calls than working fire calls, therefore EMS should get paid more.

2. Are both EMS and fire side "uniformed" or just the fire side?

3. If EMS is a separate, and for all intents independent, agency within the fire department, is it really the fire department? Should there really be a fire department logo on the side of the ambulance?

4. If so, is there any credance if a fire suppression employee considers the EMS employees to just be fire fighter imposters because of the names on the side of the vehicle and on the patch?

5. Should EMS side employees be forced due to work place culture to qualify their position when they say that they're employees of the fire department? On a personal note, when I did my masters degree at Tufts, you would never hear me say that I was a student at "Tufts Medical School" for that reason (even though the MS in Biomedical Sciences program is in the medical school). However while I could say that I'm a Tufts grad student, there isn't that second umbrella layer to go to for the EMS providers.

3/4/5 can just as easily be switched with fire suppression being a separate entity in a municipal EMS agency.

6. Since, in general, fire suppression jobs have more competition, is giving points for working for the EMS side a "back door?" Is it right?

 

[46Young]

If an engine or truck company had such a high unit hour utilization as the ambulance, what would the fire department do? Add another truck or engine, correct?

Why aren't they adding more ambulances?

It would seem that most urban and suburban areas that run single role EMS have high call volume as well. Why don't they run more ambulances? NY and Charleston were both very busy. I rarely saw the station. In my dept, we rarely have an ALS engine company staying with a pt due to lack of resources. They're onscene for five minutes or less before the arrival of the ambulance in most cases, if not running with their own medic unit. We might cover a second due call (the ambulance), but we're certainly not depleted in most cases. Still, we can run 6-10 txp's in 24 hours. Not busy enough for the bean counters to justify adding units, but we're still out of the station for 8-12 hours a day on average, more in busier areas. Each call runs 1 1/2 to 2 hours with our electronic ePCR's.

 

[abckidsmom]

It would seem that most urban and suburban areas that run single role EMS have high call volume as well. Why don't they run more ambulances? NY and Charleston were both very busy. I rarely saw the station. In my dept, we rarely have an ALS engine company staying with a pt due to lack of resources. They're onscene for five minutes or less before the arrival of the ambulance in most cases, if not running with their own medic unit. We might cover a second due call (the ambulance), but we're certainly not depleted in most cases. Still, we can run 6-10 txp's in 24 hours. Not busy enough for the bean counters to justify adding units, but we're still out of the station for 8-12 hours a day on average, more in busier areas. Each call runs 1 1/2 to 2 hours with our electronic ePCR's.

ePCRs don't make the calls last forever, providers do. After the learning curve, ePCRs should be just as fast as standard call sheets. In your area, hours and hours are burned each day at the hospital because that's the culture. Providers I know who are committed to sleeping at night tech all the calls on the nightside because it's hardly ever necessary to spend more than 30 minutes at the hospital.

Until drop times average under 45 minutes, the bean counters are never going to add medic units into the system. Why burn tax dollars chatting with ED staff?

 

[Seaglass]

In these conversations, I keep seeing conflicting themes: 1) it really doesn’t take all that much to be a medic; but 2) we’re a real profession, so dual roles don’t work. It doesn’t work both ways. I think that only the first is true at the current moment, because of how our system is designed. You don’t need all that much to follow the cookbook and call medical control, so becoming a passable firemedic isn’t a stretch. (By passable, I don't mean good or great.)

I’m not sure whether that’s a good thing. On the one hand, I think EMS really should become a true profession, which means that it becomes a lot harder to be a dual-role provider. On the other, cookbooks are wonderful things when you’re so tired that you might as well be drunk. As long as EMS allows and even expects providers to operate while extremely fatigued, I don’t support giving them more responsibility.

Not that I think there aren’t dual-role firemedics who excel in both roles, because I’ve seen some. It’s just that it’s rare enough to get a really good firefighter or a really good medic. It’s even rarer to get all of those traits in one package, and have that package be satisfied with a culture that really doesn’t value them. It’s hard to build a system around exceptions.

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.

I’ve got to take exception to the “volunteer mentality” thing, because there are places where it’s the other way around.

I’ve seen areas where the career staff will constantly whine and do the bare minimum needed to maintain their EMS certs (because they’re burnt out and/or just want to fight fire), while the volunteers (who often elect to do EMS only) are still enthusiastic about training.

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.

Yes, but what teacher will want to book that firefighter to speak? They’re trying to get kids to explore options, not discourage them.

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.

+1, though I’m not convinced that it’s a modern phenomenon. Everyone wants to be a hero, but there’s no way to know whether you have courage until you’re tested. I imagine that rookies have been finding themselves lacking since firefighting began. And I’m sure that other rookies have also been confusing recklessness with courage for just as long.

The physical weakness does appear to be more of a modern issue, though. Some people get into school that shouldn’t be there. More just get lazy once class ends. It’s frustrating.

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.

I agree. There’s just too much ego, and some providers really can’t stand the thought of showing up and doing nothing, even if that’s what will best serve the patient.

 

[Veneficus]

Yes, but what teacher will want to book that firefighter to speak? They’re trying to get kids to explore options, not discourage them.

I don't think you have to discourage anyone.

There is nothing discouraging about a modern firefighter showing up and proudly and enthusiastically explaining what it is like to be a firefighter in 2011, 2012 or whenever.

Departments usually are very good at deciding who they put out in public to speak to be the face of the organization and profession.

The problem is nobody inviting the firefighter and people going off of yesterday's stories, hearsay from people not involved in the profession, and the perception of what they think they see as untrained observers.

Firefighting is a very rewarding and respectable occupation. But it is even more so when your expectations match reality.

Whether we like it or not, agree or not, the fact remains that in the US, the fire service provides a majority of EMS and to the largest populations.

Even if many if not most FDs administrate EMS in an inappropriate manner, EMS is not going to be separated from the fire service on a large scale in our lifetime.

Educating and encouraging people who would like to work in what the fire service is and not what it used to be is a large and easily implemented step in advancing US EMS.

 

[TransportJockey]

I’ve got to take exception to the “volunteer mentality” thing, because there are places where it’s the other way around.

I’ve seen areas where the career staff will constantly whine and do the bare minimum needed to maintain their EMS certs (because they’re burnt out and/or just want to fight fire), while the volunteers (who often elect to do EMS only) are still enthusiastic about training.



Yes, but what teacher will want to book that firefighter to speak? They’re trying to get kids to explore options, not discourage them.



+1, though I’m not convinced that it’s a modern phenomenon. Everyone wants to be a hero, but there’s no way to know whether you have courage until you’re tested. I imagine that rookies have been finding themselves lacking since firefighting began. And I’m sure that other rookies have also been confusing recklessness with courage for just as long.

The physical weakness does appear to be more of a modern issue, though. Some people get into school that shouldn’t be there. More just get lazy once class ends. It’s frustrating.



I agree. There’s just too much ego, and some providers really can’t stand the thought of showing up and doing nothing, even if that’s what will best serve the patient.

Keep in mind, in my particular case I'm talking about the EMS only service volunteer mentality. The service I work for has only been paid for about 2 years, and there are only three of us there who have started since they became a professional service. We are pushing for more CE opportunities, more chances to gain education, a chance to prove that we deserve an expanded scope... But the bosses and the senior people are so vehemently against that it's ridiculous.

 

[WolfmanHarris]

Until drop times average under 45 minutes, the bean counters are never going to add medic units into the system. Why burn tax dollars chatting with ED staff?

This is what's killing us in Ontario at the moment. Offload delays at hospitals while improving can still run into 2-3 hours regularly and I have had offload as long as 10 hours (though thankfully rare). Recently we've had a really good run with little to no offload delay and the difference in the shift is night and day. I may still run 4-5 calls during the same 12 hour shift, but without the offload problems we're back to base fairly quickly and just as importantly are not spending most of the shift driving around running stand-by coverage for other stations.

Thankfully programs such as the dedicated Offload RN, balancing transports to less busy hospitals (for mid and low acuity patients) and offloading low-acuity patients to the waiting room (we can't refuse transport) have helped. Behind the scenes changes in Pt. flow at the hospital have also made big strides. The regional government I work for has also informed the receiving hospitals that they must have average offload times under 30 minutes by 2014 or they will start clawing back the money they provide annually for capital expenditures.

 

[abckidsmom]

This is what's killing us in Ontario at the moment. Offload delays at hospitals while improving can still run into 2-3 hours regularly and I have had offload as long as 10 hours (though thankfully rare). Recently we've had a really good run with little to no offload delay and the difference in the shift is night and day. I may still run 4-5 calls during the same 12 hour shift, but without the offload problems we're back to base fairly quickly and just as importantly are not spending most of the shift driving around running stand-by coverage for other stations.

Thankfully programs such as the dedicated Offload RN, balancing transports to less busy hospitals (for mid and low acuity patients) and offloading low-acuity patients to the waiting room (we can't refuse transport) have helped. Behind the scenes changes in Pt. flow at the hospital have also made big strides. The regional government I work for has also informed the receiving hospitals that they must have average offload times under 30 minutes by 2014 or they will start clawing back the money they provide annually for capital expenditures.

This is a real problem, but the delay I'm talking about is just foot-dragging, chatting instead of doing the tasks needed to clear up from the hospital.

 

[Seaglass]

I don't think you have to discourage anyone.

There is nothing discouraging about a modern firefighter showing up and proudly and enthusiastically explaining what it is like to be a firefighter in 2011, 2012 or whenever.

I agree that having people enter the field with realistic expectations could be helpful. I'm just not sure where these modern firefighters who are enthusiastic about an average day actually are. The ones I'm talking to really just want to run structure fires, and are either bored or annoyed with most of their calls. Could just be my area, of course.

(Then again, I could see myself doing it someday, if I stay in the field and don't burn out in the meantime. For now, even though I'm rather inexperienced and not even a medic yet, I've been known to informally tell kids that they should think about becoming FF/RNs... but I'm definitely an exception among people I know.)

Keep in mind, in my particular case I'm talking about the EMS only service volunteer mentality. The service I work for has only been paid for about 2 years, and there are only three of us there who have started since they became a professional service. We are pushing for more CE opportunities, more chances to gain education, a chance to prove that we deserve an expanded scope... But the bosses and the senior people are so vehemently against that it's ridiculous.

That's unfortunate. My local vollies are mostly pretty enthusiastic about education and CEs, at least for the EMS-only people. Every service is different, I guess.

 

[abckidsmom]

I agree that having people enter the field with realistic expectations could be helpful. I'm just not sure where these modern firefighters who are enthusiastic about an average day actually are. The ones I'm talking to really just want to run structure fires, and are either bored or annoyed with most of their calls. Could just be my area, of course.

(Then again, I could see myself doing it someday, if I stay in the field and don't burn out in the meantime. For now, even though I'm rather inexperienced and not even a medic yet, I've been known to informally tell kids that they should think about becoming FF/RNs... but I'm definitely an exception among people I know.)

I find that in all of emergency services, though. Cops are bored or annoyed with mediating arguments and working minor MVAs, medics are bored or annoyed with boring or annoyign patients. As if the people owe us our adrenaline rush or something.

 

[46Young]

ePCRs don't make the calls last forever, providers do. After the learning curve, ePCRs should be just as fast as standard call sheets. In your area, hours and hours are burned each day at the hospital because that's the culture. Providers I know who are committed to sleeping at night tech all the calls on the nightside because it's hardly ever necessary to spend more than 30 minutes at the hospital.

Until drop times average under 45 minutes, the bean counters are never going to add medic units into the system. Why burn tax dollars chatting with ED staff?

Ask someone you know from our dept about the ePCR version 5.1. It's very slow, it freezes constantly, bumps you out to the inbox repeatedly, won't print w/o restarting (3-5 mins per restart), and also won't sync to server w/o restarting. We're strongly encouraged to remain at the hospital to finish and print the report. The quickest ePCR's for BLS can take 35-45 mins. The standard ALS w/o interventions is 45 mins to an hour, if you give drugs and narcs it's around 75-90 mins, and can be even more for a cardiac arrest. This is no lie, the computer moves very slowly, no matter how hard you try to expedite the process. Ask someone from the dept. They'll tell you. It might be a little quicker if you do some of it enroute to the hospital, but I prefer to tend to my pt instead.

 

[DesertMedic66]

Firefighters have the calls that they would prefer to get. just like in EMS. EMS have there own favorite calls that they want to get. for some they may like medical problems, others may like trama calls, and yet others prefer the transports. Firefighters are the same way. some prefer structure fires, some prefer wildland fires, TC's etc. not all firefighters hate EMS and some dont even like fires. at my station most of the firefighters are perfectly fine and even enjoy getting Medical calls. we have fun while doing it which makes us be enthusiastic about calls. granted some firefighters will start to get burnt out when they are on 72 hours straight with maybe a 10 min nap. but at that point they dislike any call they receive whether it be Medical or fire.

 

[WolfmanHarris]

Ask someone you know from our dept about the ePCR version 5.1.

I'm not sure if we're talking about the same program by the ePCR by Siren has also killed clearance times at the hospital. Even without offload delay, complicated calls can take forever to chart due to how convoluted and slow the software is. That's without it crashing and freezing during transfer of ECG's and vitals, printing, or for no reason what so ever. Heck it even takes up to 10 minutes for the system to spit out the completed ACR when it's time to print.

I've gotten good with it since it's all I've used since I got out of school and I've been around technology my entire life, but it even takes me about 20-30 minutes to chart the average call. Some of our senior guys can take over an hour or more to complete a chart.

 

[46Young]

In these conversations, I keep seeing conflicting themes: 1) it really doesn’t take all that much to be a medic; but 2) we’re a real profession, so dual roles don’t work. It doesn’t work both ways. I think that only the first is true at the current moment, because of how our system is designed. You don’t need all that much to follow the cookbook and call medical control, so becoming a passable firemedic isn’t a stretch. (By passable, I don't mean good or great.)

I see that problem here. The more recent FFM hires are put through a 16 week internship process in addition to fire school, and are drilled hard, and can easily be failed out of a job. The dept has been putting it's interested incumbents in NVCC's medic program. The problem is, once you finish recruit school and your ALS internship, the educational accountability drops off. We have open book protocol tests every year. We have the tests for our alphabet cards that we do every two years. That's it for testing, although we do on duty con. ed. taught by BSN's and PA's. We don't have any med math exams, no general knowledge exams, nothing. You can lose your ALS cert or get fired, but it takes a lot, certainly more than the hospital that I came from. I'm told that if we hold medics too accountable, make them test often to keep their ALS status, they'll voluntarily drop their cert, and we'll get less interested applicants, who instead apply to another dept that's not so strict.

 

[46Young]

I'm not sure if we're talking about the same program by the ePCR by Siren has also killed clearance times at the hospital. Even without offload delay, complicated calls can take forever to chart due to how convoluted and slow the software is. That's without it crashing and freezing during transfer of ECG's and vitals, printing, or for no reason what so ever. Heck it even takes up to 10 minutes for the system to spit out the completed ACR when it's time to print.

I've gotten good with it since it's all I've used since I got out of school and I've been around technology my entire life, but it even takes me about 20-30 minutes to chart the average call. Some of our senior guys can take over an hour or more to complete a chart.

It's the Zoll RescueNet Tablet PCR, version 5.1. Your experience sounds similar to mine, for sure. Every time I get toned out I know I'm not seeing the station for 1 1/2 to 2 hours, no matter how fast we work.