Fire Based EMS

Craig Alan Evans

Craig Alan Evans

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What do you think is a better system, all EMS or Fire Based EMS? I work in a fire based EMS system and just wanted to see what everyone thought.
 
EMS based. In some of my experience, the paramedic cert is regarded as just a merit badge to get onto a department with little interest in the medicine.
 
my ridealong was with fire based ems.

they had 1000/1 ems calls over fire. they were all required to be paramedics, except the engineers/operators.

they had a contract with an ambulance company for transports.
 
The only positive in my area of having fire play an EMS roll is that the fire department is a city based unit. Meaning for each city there is at least one station meaning faster response times. The ambulance company in my area is well an area based company. In a 24 hour period we will have a total of 20 ALS ambulances covering a 5,000 square mile area.

If my company was able to staff enough units per day to staff on a city basis then the fire department would not be needed on the majority of calls (still need manpower for full arrests, big patients, Cut and Rescue operations).

Often we will arrive on scene before the fire department and cancel them because they are not needed. Does the patient suffer because of this? No.

As stated earlier in my post the fire department responds in my area to "stop the clock".
 
That's interesting Desert. Where I work it's fire based EMS and the call volume is about 67% EMS. The paramedics rotate from the engines, squads, and trucks to the medic units and they all take EMS very seriously. We respond with one 4 person engine and a 2 person paramedic crew on a general ALS call and everyone has a job and contributes. I think the patient receives excellent care with all 6 people functioning as a cohesive team.
 
rwik123 said:
EMS based. In some of my experience, the paramedic cert is regarded as just a merit badge to get onto a department with little interest in the medicine.
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There I some of this in the system I work in, but we weed most of those people out with our ALS internship. They may not be into medicine, but unless they are good medics they don't cut the mustard.
 
To further elaborate in my neck of the woods, the fire department respond in engines or ladder trucks. There is at least one medic among the firefighters. The ambulance is provided by a third party company (Non-fire ambulance) that staffs ALS ambulances.

The firefighters do not rotate among anything. The only time they ride in the ambulance is for critical patients. Since fire responds to all medical aids they run 90% EMS calls (that they don't transport) and 10% fires, car accidents, and other fire related issues.

Normally the engine will have 1-4 people on board and the ambulance will have 2-4 on board. At least one medic on the engine and at least one medic on the ambulance.

The majority of EMS calls do not require 6 people. The majority of EMS calls require a taxi. The only times I have found 6 people to be useful (by useful I mean everyone is doing something and no one is standing around) are car accidents, when we have to hike a patient out, when the patient is extremely heavy, full arrests, and MCIs (I may be forgetting some reasons). Those aren't the majority of EMS calls however, rather the minority.
 
Craig Alan Evans said:
What do you think is a better system, all EMS or Fire Based EMS? I work in a fire based EMS system and just wanted to see what everyone thought.
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The only fire based EMS systems I've seen that work are those that have always done EMS. An example would be the ALS FD I work for, which when it was founded did both (a merger of a volly fire and volly EMS agency).

What I mean by that is they didn't just pick it up for budgetary or call volume reasons (or response time reasons).

It is tough to up and add EMS transport response and be truly good at it (just as it would be tough to up and add fire response and be truly good at it). If you've never worked transport, you'll probably be bad at transport to start.

You can really substitute any job functions and fields for my above comments.
 
Craig Alan Evans said:
The paramedics rotate from the engines, squads, and trucks to the medic units and they all take EMS very seriously. We respond with one 4 person engine and a 2 person paramedic crew on a general ALS call
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Sounds pretty similar to Los Angeles County Fire. Every EMS call automatically gets an engine and a paramedic squad (pickup truck style chase vehicle) dispatched along with a BLS ambulance from one of the private companies they contract with. Which ambulance company gets the call depends on the geographical location in the county as its broken down into exclusive operating areas for 911 response ambulances. Out of the 80 some odd ambulance companies in the county only 6 have any primary 911 response contracts. No clue if the county firefighters rotate from the squad to the engine or truck or whatever though.
 
Craig, it's very easy to look at Fire-Based EMS systems through the NOVA prism and think it's the ideal solution (although I would argue Alex FD/EMS is a better way of doing things). However, the majority of FD based EMS I've seen since I left that area is atrocious. The "care" provided by the FDs in a couple of the bigger cities would be laughable if it weren't so bad for the patient. The majority of firefighters simply don't care enough about EMS to do it correctly. My FTOs often spend a significant amount of time undoing bad habits new medics were taught by the FD during their internships. There are certainly bright spots, but overall I can't say I'm a supporter of FD based EMS.
 
Yeah Kyle from my experience in Hancock Co MS just after Katrina that's exactly what I found out there. My thought is though that it just doesn't have to be that way and that the system works, but you are right, it doesn't work unless the FD has complete but in on EMS and that seems to be rare.
 
Craig Alan Evans said:
I am getting the feeling it's not like that around most of the country.
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I like what you said in your above post. I think you might find that there are many EMS folks with a chip on their shoulder when it comes to fire/EMS.
 
Maybe if we started referring to it as an EMS based fire system that would help. Based on call volumes that is truly what it is, but I'm thinking the chip is coming from EMS professionals that are not dealing with fire systems that have truly embraced EMS.
 
i just think responding fire apparatus to a medical call is the dumbest thing ive ever seen. Why not break that crew up and put two ambulances on the road? and responding to every call is dangerous and an unnecessary risk. I know they are going code 3 regardless of the nature, so lets send a multi-ton vehicle across town to respond to something they cant do anything for.

I think that EMS should be the main emergency response unit. I like how Pittsburgh and New Orleans runs all rescue calls in the cities and my town is moving that way

Ive posted about this topic in the past, and fire and EMS do not share a common mission, structure or focus. EMS has more in common with police then with fire.
 
Craig Alan Evans said:
Maybe if we started referring to it as an EMS based fire system that would help. Based on call volumes that is truly what it is, but I'm thinking the chip is coming from EMS professionals that are not dealing with fire systems that have truly embraced EMS.
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The problem with trying to call most areas an EMS based fire system is that EMS is not their main focus. At the station I was an explorer at we only did EMS training twice.... and I was there for 5 years.

If a fire breaks out the fire department sends many engines out (at least 4). That leaves no fire engines available for EMS calls until a coverage unit gets into the area. Often we hear over the fire dispatch radio "Engine 4 is out of service for medical aids. You can show us second in." But if they get a fire or car accident they are the first ones responding. That is a Fire based EMS response.
 
Bullets said:
i just think responding fire apparatus to a medical call is the dumbest thing ive ever seen. Why not break that crew up and put two ambulances on the road? and responding to every call is dangerous and an unnecessary risk. I know they are going code 3 regardless of the nature, so lets send a multi-ton vehicle across town to respond to something they cant do anything for.

I think that EMS should be the main emergency response unit. I like how Pittsburgh and New Orleans runs all rescue calls in the cities and my town is moving that way

Ive posted about this topic in the past, and fire and EMS do not share a common mission, structure or focus. EMS has more in common with police then with fire.
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Public Safety is the responsibility of fire, EMS, and police. Where I'm from fire and EMS mesh together like peaches and cream. They share way more mission objectives than either one with law enforcement. The multi-ton fire vehicles have nearly all the same EMS equipment as the responding ambulances. They are staffed with paramedics that rotate from engine, truck, rescue, and transport unit. Their skills are not dulled because of it. They are enhanced. We always have a minimum of one paramedic on the suppression apparatus, but based on who happens to be working that day we may have 2,3, or even 4 paramedics on an engine. Just last week A shift ran an asthmatic arrest in a 7 year old. The Rescue Engine was first on the scene with three very experienced paramedics. The driver of the engine also rotates to the transport unit as a paramedic officer when needed. Not far behind was the transport unit staffed with two paramedics. The officer of the transport unit also fills in as the driver of the Rescue when needed. It's truly a highly functioning cross trained group of professionals. 5 out of 6 of the responders on scene were experienced paramedics who all worked together as a cohesive team. They were on the scene for less than 5 min and at the nearest pediatric specialty hospital in less than 12 min total with a successful resuscitation and any intervention you can imagine for a case like that performed. The crew from the engine went with the transport unit to the hospital. While the ambulance crew was writing their report and restocking their equipment the Engine was responding with a different ambulance to another EMS call and doing it all over again. That's not a waste of money or a dumb thing. It's poetry in motion and top notch service to the public. I'm not sure that kid would have survived in other parts of the country.
 
Bullets said:
i just think responding fire apparatus to a medical call is the dumbest thing ive ever seen. Why not break that crew up and put two ambulances on the road? and responding to every call is dangerous and an unnecessary risk. I know they are going code 3 regardless of the nature, so lets send a multi-ton vehicle across town to respond to something they cant do anything for.

I think that EMS should be the main emergency response unit. I like how Pittsburgh and New Orleans runs all rescue calls in the cities and my town is moving that way

Ive posted about this topic in the past, and fire and EMS do not share a common mission, structure or focus. EMS has more in common with police then with fire.
Click to expand...

of all the calls i went on my ridealongs with the fd, only was run code 3, and then it was canceled after 2 mins.
 
I've always been concerned about the "dilution of skills" with six paramedics on scene. How many intubations in the field does each paramedic get per year? How many RSIs? How many other invasive procedures does each paramedic do each year? How do you maintain competency?

If your fire service absolutely, positively has to get its fingers in EMS, A tiered system, similar to Seattle fire, is probably best. If you really have to run suppression apparatus to ambulance calls, then put EMTs on fire engines that are able to triage appropriately to BLS transport or request an ALS unit if needed.

I don't see how any paramedic can maintain competency when they "rotate from the engine to the squad to the ambulance." To me, that just sounds like a mishmash of skills. Mediocrity at its best. You might be able to do a lot of things, but none of them really well.

Of course, this is just my opinion. :/
 
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