Fire-based EMS vs EMTs?

[46Young]

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?

1. The pay scale is should be subject to supply and demand. If a fire position has 800 to 1 odds, and the medic spot is 5 to1, the medic should make more. It was like that in Charleston County SC. Medics made 45k after 6 months, and topped at 68k. FF's made around 22k to start, not sure of the top out. Charleston City was around 33k to start. The only difference is if the medic turnover continues no matter what the pay, then you might as well pay less for them to begin with.

2. Both should be uniformed. FDNY EMS fought for quite some time to get uniformed status and stronger collective bargaining rights.

3. If they're truly independent, they ought to have their own identity. This has been a sore point with FDNY EMS ever since they were absorbed by FDNY in 1996. This becomes a gray area when fire suppression runs medical aids for more than just manpower.

4. The FDNY culture is to hold the attitude that EMS are fire wannabees, and don't deserve to wear their patch. EMS would rather have their own uniforms and identity. They were quite happy before the merger. Most EMS only employers that are within the FD have distinctly different uniforms, and prominently display "EMS" somewhere on their unuiform to distinguish themselves from the FF's.

5. Just say you're working for the FD as a paramedic.

6. If you're talking about FDNY's EMS backdoor policy, then no. That was created for certain protected classes to have a way to jump the list. If you're a FDNY EMS employee, you take the test, and all you need to do is pass, and then you place above everyone on the open competitive list. That's why it's not right.

 

[Chimpie]

Let's keep the conversation about PCR software to its own thread please.

 

[Seaglass]

As if the people owe us our adrenaline rush or something.

That's exactly the kind of entitled attitude I see, and it bothers me.

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.

That's fine. Often enough, though, liking the ambulance makes you less of a firefighter in the eyes of your peers. I think that's a problem.

 

[Veneficus]

1. The pay scale is should be subject to supply and demand. If a fire position has 800 to 1 odds, and the medic spot is 5 to1, the medic should make more. It was like that in Charleston County SC. Medics made 45k after 6 months, and topped at 68k. FF's made around 22k to start, not sure of the top out. Charleston City was around 33k to start. The only difference is if the medic turnover continues no matter what the pay, then you might as well pay less for them to begin with.

I would like to point ot that it has been established even in nonemergency fields that when working conditions are overly bad, an increase in pay does not correlate to an increase in retention.

 

[46Young]

That's fine. Often enough, though, liking the ambulance makes you less of a firefighter in the eyes of your peers. I think that's a problem.

JJR512 was trying to say that in his region (my county's nearby), the recruits are taught to value and respect EMS as much as the fire side. The culture nowadays is that fire and EMS are both part of emergency services in general. In my county, from orientation day, to the first day of the academy and beyond, the importance of EMS is stressed. If we don't care for EMS, then we should look elsewhere for employment.

In many regions, you have to be fire based to work in paid 911 EMS. Those who are mainly interested in EMS typically have no problem telling you that. Where we get the resentment is that we get around 20k/yr over the basic FF, and an easy promotion two years out of the academy, for another (almost) 6 grand. I'll tell anyone that they can go out and get their P-card if they want. I did it FT on my own dime while supporting my wife and infant child at home. Don't tell me any sob stories. Here's your cheese. I explain our increased compensation like this: The paramedic job description is it's own career in many places. The medic needs to do a lot of training and receive a lot of education on the front end. Continuing ed will be done, but it's not that difficult to maintain after the initial cert. A few alphabet cards, 24 hours/year or so of CME's, and occasional review of evidence based medicine. The FF starts off with minimal training, and will slowly add on skills sets (TROT, Hazmat, truck ops, etc) as they move along in their career. These will result in promotions eventually, although there is more competition than there is for the EMS promotion. Our promotion is much easier to get because so few want it. There's much less to learn to progress in the EMS career ladder than ther is for the fire side. Most of the work was done in the front end.

This is also why it's possible to be dual role. Most of your EMS training is done before you start. Whether you're a FF only, or a FF/EMT(medic), you're learning the fire side at the same pace. You're doing the same drills, studying the same manuals, and promoting on the same timeline as each other. For EMSs, you only need to stay sharp running calls, and maintaining your cert as above.

 

[46Young]

I would like to point ot that it has been established even in nonemergency fields that when working conditions are overly bad, an increase in pay does not correlate to an increase in retention.

That was kind of what I was trying to say with the last sentence. It just came out weird.

 

[JPINFV]

The paramedic job description is it's own career in many places. The medic needs to do a lot of training and receive a lot of education on the front end. Continuing ed will be done, but it's not that difficult to maintain after the initial cert.

...

There's much less to learn to progress in the EMS career ladder than ther is for the fire side. Most of the work was done in the front end.

Emphasis added.

I think that's one of the problems. The initial education is front loaded, but I, personally, feel that if paramedics want the recognition that they yearn from the medical community, then they need to start owning their own care. To me, it isn't enough to just do the 72 hours of CME (NREMT requirement) and for paramedics to just wash their hands of CMEs. I think paramedics need to be up to date on the science, and take an active roll in pushing the edges of EMS treatment, including making sure that current treatments are evidence based. Paramedics should be thinking, asking, and when appropriate, pushing to implement treatments that can be moved from the hospital to prehospital.

For example, if you aren't doing 12 leads, it shouldn't be enough to say,"Well, the medical director doesn't allow it." You, knowing that it IS the standard of care, should be pushing to implement it. Same with, say, CPAP. Paramedic professionals need to be proactive with protocol changes, not reactive. This mindset, though, takes more time than just 72 hours of CME every 2 years and then wash their hands.


Edit: This, however, breaks from the task-tactics-strategy (fire fighter-officer-chief) division of responsibility in the fire service with the paramedic being responsible for all 3 when providing medical care.

 

[Veneficus]

Emphasis added.

I think that's one of the problems. The initial education is front loaded, but I, personally, feel that if paramedics want the recognition that they yearn from the medical community, then they need to start owning their own care. To me, it isn't enough to just do the 72 hours of CME (NREMT requirement) and for paramedics to just wash their hands of CMEs. I think paramedics need to be up to date on the science, and take an active roll in pushing the edges of EMS treatment, including making sure that current treatments are evidence based. Paramedics should be thinking, asking, and when appropriate, pushing to implement treatments that can be moved from the hospital to prehospital.

For example, if you aren't doing 12 leads, it shouldn't be enough to say,"Well, the medical director doesn't allow it." You, knowing that it IS the standard of care, should be pushing to implement it. Same with, say, CPAP. Paramedic professionals need to be proactive with protocol changes, not reactive. This mindset, though, takes more time than just 72 hours of CME every 2 years and then wash their hands.


Edit: This, however, breaks from the task-tactics-strategy (fire fighter-officer-chief) division of responsibility in the fire service with the paramedic being responsible for all 3 when providing medical care.

This creates huge problems when EMS is pushing for unproven treatments like in Naples, FL.

It also doesn't help when they try to remove themselves from medical oversight like in Louisiana.

 

[JPINFV]

This creates huge problems when EMS is pushing for unproven treatments like in Naples, FL.

It also doesn't help when they try to remove themselves from medical oversight like in Louisiana.

There's a difference between going rogue and working within the medical community. If a paramedic sees something and think, "Why aren't we doing this?" they should take the initiative to research and present it to the medical director for consideration. To me, there's a big difference between working with the medical director and just following what the medical director says blindly.

 

[Veneficus]

There's a difference between going rogue and working within the medical community. If a paramedic sees something and think, "Why aren't we doing this?" they should take the initiative to research and present it to the medical director for consideration. To me, there's a big difference between working with the medical director and just following what the medical director says blindly.

I certainly agree, but in modern US EMS, the medical director is more easily replaced than the medics. The solution is simple. FACEP needs to lobby that in the future only an Emergency Medicine physician with an EMS fellowship should be eligible to become a medical director. (by a certain date) That would make it considerably more difficult to replace a medical director. Sort of a viagra for their impotence.

I know that basically cuts out a lot of people, like me, but for the greater benefit I think it is a reasonable price to pay.

Most medical directors are basically filling the role for free. I think part of the solution is that EMS agencies will have to realistically pay for medical direction. Which most are absolutely loath to do.

I also see the need for a specific ratio of doctors to paramedics. Anyone in the fire service or military can tell you a certain ratio of leadership to rank and file is needed. 1 medical director to 100 or 200 or even 500+ EMS providers is basically no oversight at all.

If I could make it so, I would have a medical director and a multidiscipline physician advisory board in every system. With an asst. medical director (physician of some sort) for every 25 ALS providers. Other ALS providers would no longer be responsible for overseeing their own level. Though I would suggest ALS providers to oversee BLS providers to reduce the number of physicians needed to a reasonable number.

Most likely this would require regionalization of many smaller agencies into a larger one, but I also advocate that is for the better as well.

 

[Shishkabob]

I know that basically cuts out a lot of people, like me, but for the greater benefit I think it is a reasonable price to pay.

Greater benefit for whom? The ER physician?


Honestly, an ER physician who drastically limits his medics with archaic orders is worse than a more liberal medical director with limited emergency medicine experience but reads the studies and promotes good patient care.


Aggressive ER physician > aggressive non-ER physician > limited, old-view, useless ER physician.

 

[Veneficus]

Greater benefit for whom? The ER physician?


Honestly, an ER physician who drastically limits his medics with archaic orders is worse than a more liberal medical director with limited emergency medicine experience but reads the studies and promotes good patient care.

That is why the EMS fellowship needs to be part of the requirement.

No physician is going to give up the pay raise of being an attending/consultant physician for 2 to 3 years more resident level pay learning about EMS if they don't have at least a reasonable interest in the betterment of EMS.

 

[DesertMedic66]

That's fine. Often enough, though, liking the ambulance makes you less of a firefighter in the eyes of your peers. I think that's a problem.

it all really depends on how integrated the fire department is into the EMS world. in areas where you mostly get fires then it could be a problem. but in areas where EMS calls are most of the calls then everyone is ok with them and even start to like them. in my area roughly 80%-90% are EMS so most firefighters (not all) have grown to like EMS calls.

in my area the fire department usually arrives on scene before the ambulance. a couple of times we have had to wait 45 minutes to an hour for the ambulance to arrive. so one hour with the Fire based EMS is alot better then one hour without any medical attention. again this is just for my area.

 

[jgmedic]

it all really depends on how integrated the fire department is into the EMS world. in areas where you mostly get fires then it could be a problem. but in areas where EMS calls are most of the calls then everyone is ok with them and even start to like them. in my area roughly 80%-90% are EMS so most firefighters (not all) have grown to like EMS calls.

in my area the fire department usually arrives on scene before the ambulance. a couple of times we have had to wait 45 minutes to an hour for the ambulance to arrive. so one hour with the Fire based EMS is alot better then one hour without any medical attention. again this is just for my area.

you volly with CDF, yes? where are you that takes 45 min? Desert Center, Thermal, Blythe, Poppet Flats if your resident ambos are out? maybe Anza if Temecula and Hemet are depleted. Also, where in Cal Fire are those guys all ok with running medical aids, I'll give you that there are crews and maybe even a few stations where EMS is the priority, but most!? I don't think so.

 

[DesertMedic66]

you volly with CDF, yes? where are you that takes 45 min? Desert Center, Thermal, Blythe, Poppet Flats if your resident ambos are out? maybe Anza if Temecula and Hemet are depleted. Also, where in Cal Fire are those guys all ok with running medical aids, I'll give you that there are crews and maybe even a few stations where EMS is the priority, but most!? I don't think so.

I was an explorer for 5 years now getting into volly. beaumont. on one of the occasions it was the first rain of the season and there were alot of TC's. beaumont doesnt have very good roads so they get flooded easliy. we had a hemet ambulance take back roads around the flooding to get to us. and i never said that EMS is the priority. i just said that EMS accounts for 80 to 90 percent of our call volume. and once again it all depends on the person.

 

[threesevenkilo]

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

The town I used to dispatch for was a small hill town and about 70% of the FD were EMT-B or P. They had a policy that only the EMT's were allowed to respond to medical general recalls but the other 30% had still had to be first responder certified.

On the other hand, the city I work in is a nightmare. We had a guy fall about 12 feet from staging onto his head. He was complaining of back pain and you could see abrasions on the back of his head. Two off duty firefighters (who work in the city) come over and take the guy from a supine position and have him roll himself onto his stomach for a "position of comfort."

Take each agency on it's own merit is the best thing that can be said over and over.

 

[JJR512]

I've been away for a few days due to illness and have just checked up to see how this is going, and I apologize if I didn't read every single new post absolutely thoroughly. Someone was talking quite a few posts back about going to an elementary school to talk about what being a firefighter is truly like.

I am not a firefighter; I actually started Firefighter I training two nights ago. But I've thought about what I might do at some point in the future if I ever had the opportunity to go to an elementary school, like for a career day when kids bring their parents in and they talk to the class about what they do. So again, keep in mind that I'm not a firefighter now but this is sort of a hypothetical plan of what I would do after I become one.

Obviously, I would take in the turnout gear and show the kids how quickly I can put it on, including SCBA. That's expected, that's what they want to see, so they get that first. But after that, I talk a bit about how modern fire departments are really more about rescue and EMS than actual firefighting. I show them an EMS bag and all the stuff in it, I might put the pulse ox on one of the kids. Maybe I'd even bring in a monitor and let some kids see their own heartbeat. As an EMT-B I can't use a monitor but they don't know that, and I am expected to know how to set up a three-lead so I wouldn't be doing anything with it I'm not supposed to. I would tell them that this is something that Paramedics use and what they use it for, etc.

So I don't know; I haven't planned it out in great detail, I know I'd have a limited amount of time. But I've thought about this since long before this thread came up, and I know that if I was in that position, although I'd be going there ostensibly as a firefighter, I'd probably talk more about EMS and rescue than firefighting.

 

[emt seeking first job]

What about instances where a patient has to be worked in an unstable environment ?

Fire also involves rescue and extraction.

Having a medic trained to enter a buring building and treat the patient inside can not be a bad things.

 

[Veneficus]

What about instances where a patient has to be worked in an unstable environment ?

Fire also involves rescue and extraction.

Having a medic trained to enter a buring building and treat the patient inside can not be a bad things.

You cannot succesfully treat a patient in a burning building. I've tried.

There are very few rescue specific occurances where the treatments available to EMS actually help.

 

[Shishkabob]

What about instances where a patient has to be worked in an unstable environment ?

Fire also involves rescue and extraction.

Having a medic trained to enter a buring building and treat the patient inside can not be a bad things.

Who says EMS can't do rescue/extrication? I know those that do.


If you're in a rural place like mine where you rely on only volunteer fire departments for rescue/extrication, and they are only at the EMT level (if that), your butt is still in those locations taking care of the patient if need be.