Fire Based EMS

[Arovetli]

I disagree. I think it's there to appease the people who want to do the flashy part of doing EMS, but don't want to commit to being a paramedic.

Well then I think we do agree.

If the paramedic level is to advance and become more of a healthcare profession, it has to detach from fire who really just need OJT or trade school certificates and can say they provide advanced level care. Nothing wrong with that btw, seems mutually beneficial.

 

[abckidsmom]

Well then I think we do agree.

If the paramedic level is to advance and become more of a healthcare profession, it has to detach from fire who really just need OJT or trade school certificates and can say they provide advanced level care. Nothing wrong with that btw, seems mutually beneficial.

I was mostly talking about the kind of volunteers who balk at minimum standards and say "but I have a job- this is a hobby!" And then drag the whole profession down with them.

But it's been a long day.

 

[Akulahawk]

Fire Departments can provide good EMS care. Unfortunately they often see EMS as something that helps justify their existence because they now respond to few fires, or as something they can augment their budgets with. I've met quite a few Firefighters that did EMT or Paramedic just so they could be a Firefighter, and wouldn't consider EMS otherwise.

IMHO, transport EMS should be divorced from Fire Departments. Of course, Paramedic shouldn't be a terminal job. There should be some significant ability to change jobs within that career. If Fire is to provide some EMS services, I think they should be, at most, AEMT so that the transport provider (who is Paramedic) has trained hands available to do certain tasks but is clearly the leader for that incident.

EMS (as a separate service) should also have the opportunity to get more non-traditional EMS skills. EMS should be "allowed" to perform technical rescues and the like... but Fire won't typically like that simply because they'll see it as mission creep into many of their current roles.

 

[46Young]

I have a feeling this was a goal of AEMT, to keep a certificate level "Advanced" provider so fire can still paint that A word on the side. of their engine.

The goal of AEMT was to deliver some form of ALS to rural, underserved areas that have a poor tax base. It's really difficult to get volunteers to go through a whole paramedic program, just to volunteer with that cert. It's too much of a time investment for most people to agree to, without a significant financial reward.

I live in Virginia. This state is keeping the EMT-I and the EMT-E even though the NR is moving away from those certs. Otherwise, most of the regions outside of the "Golden Crescent" (NOVA, down I-95, Richmond, Williamsburg, out to VA Beach) wouldn't have anything more than BLS coverage whatsoever. Keeping the EMT-I/EMT-E is being done as a matter of necessity. It's not a fire thing by any means.

 

[Wes]

Dana, respectfully, there are some volunteer paramedic providers who take this seriously.

 

[Arovetli]

The goal of AEMT was to deliver some form of ALS to rural, underserved areas that have a poor tax base. It's really difficult to get volunteers to go through a whole paramedic program, just to volunteer with that cert. It's too much of a time investment for most people to agree to, without a significant financial reward.

I live in Virginia. This state is keeping the EMT-I and the EMT-E even though the NR is moving away from those certs. Otherwise, most of the regions outside of the "Golden Crescent" (NOVA, down I-95, Richmond, Williamsburg, out to VA Beach) wouldn't have anything more than BLS coverage whatsoever. Keeping the EMT-I/EMT-E is being done as a matter of necessity. It's not a fire thing by any means.

Yes.

The concept is an advanced level certificate to extend ALS to certain segments while allowing (hopefully) paramedic to continue upward.

It has applications to many systems in need of prehospital care.

 

[46Young]

Well then I think we do agree.

If the paramedic level is to advance and become more of a healthcare profession, it has to detach from fire who really just need OJT or trade school certificates and can say they provide advanced level care. Nothing wrong with that btw, seems mutually beneficial.

Fire isn't the main culprit in allowing a trade cert for employment. You can include every private company outside of Oregon, the vast majority of hospital based employers, and nearly all third service employers as well. These organizations easily outnumber the fire service in sheer number, as well as the number of employed paramedics. Let's assign the blame more appropriately, please.

I would have to try really hard to find a non-fire based EMS organization that requires a degree to be hired as a medic, or one that gives an incentive or hiring preference to a degreed medic. For every one you can show me, I can show dozens that only require the bare minimum standards. They're really easy to find.

 

[Arovetli]

Fire isn't the main culprit in allowing a trade cert for employment. You can include every private company outside of Oregon, the vast majority of hospital based employers, and nearly all third service employers as well. These organizations easily outnumber the fire service in sheer number, as well as the number of employed paramedics. Let's assign the blame more appropriately, please.

I would have to try really hard to find a non-fire based EMS organization that requires a degree to be hired as a medic, or one that gives an incentive or hiring preference to a degreed medic. For every one you can show me, I can show dozens that only require the bare minimum standards. They're really easy to find.

Im pretty sure I didn't assign blame to anyone. If you read what I wrote, I said 'a' goal. I only used the example of fire.......because that is what the thread is titled.

There has to be some disentanglement for even the possibility of paramedics to advance.
From fire.
From routine ambulance work.
From babymomma & co.
From foolish politics.
The list goes on.

 

[abckidsmom]

Dana, respectfully, there are some volunteer paramedic providers who take this seriously.

For sure, which is why I was only referring to the bad ones.

I was one of them, and now I work hard to develop the volunteer base in my system, teaching and mentoring, coaching and cheering. Dragging them along. Which is why I've heard all of the arguments, and had the reward of seeing a few totally succeed.

 

[Wes]

We should compare notes sometime. I've been very active in developing volunteer programs at several services.

 

[sir.shocksalot]

The longer I do this job the less evil the FD seems. I think we can all agree that we'd like to see EMS evolve into something more analogous to the UK, Australia, and NZ. They have the advantage of national standards, self-governance, and are generally very centralized in that all the systems operate pretty much the same. In the US the chief culprit is that we have a billion different ways EMS is run and almost as many different ways EMS is trained. Even NREMT doesn't adequately represent any sort of average of provider skill, knowledge or scope of practice across the the US. EMS is an amorphous blob of a profession.

This blobishness really gets highlighted when we start talking fire-based vs third service vs hospital-based vs private for profit vs ad nauseam. To say fire departments shouldn't do EMS holds no more ground over saying privates shouldn't do EMS. I have seen horrific examples of all these systems. I've seen great examples of all these systems. It sounds like the OP has a fire-based service that does really well for them and really embraces EMS in its current form. Why try to fix a system that works better than many others? Now if we want to point fingers at the IAFF for holding EMS back we equally have to point our fingers at the multi-state private agencies who are also not lining up to get highly educated, and inevitably expensive, paramedics. Both want short training times for roughly the same reason. If we want EMS to grow then we need to get ourselves together and make it happen, not our employers.

We all need to stop the us vs them we have in EMS. We are very shallow and insecure as a profession in that we constantly judge each other based on the patch on our shoulder not our merits as an individual. Working at a certain place doesn't mystically make you a better or worse provider, nor the vehicle you arrive on scene with.

My only criticism of the OPs system is the number of paramedics. I think any more than two paramedics per patient and you really start running into skill dilution. Not just with intubation but patient interview, scene management, physical exam etc. I think two paramedics is ideal, since with critical patients one paramedic can be overwhelmed and a second paramedic can be helpful to bounce ideas off of and as a check and balance to your work as one person mentioned. But kudos for how well your department has embraced EMS and also keeping your cool amongst a lot of FD criticism. Actually to everyone that has posted for being remarkably civil.

 

[RocketMedic]

Dana, respectfully, there are some volunteer paramedic providers who take this seriously.

In Far West Texas?

 

[Wes]

I can only speak for me and the places I've worked. For me, it's been Austin and the surrounding Hill Country along with the north Houston area. (HCESD-1/HCEC and CCEMS).

 

[Craig Alan Evans]

The longer I do this job the less evil the FD seems. I think we can all agree that we'd like to see EMS evolve into something more analogous to the UK, Australia, and NZ. They have the advantage of national standards, self-governance, and are generally very centralized in that all the systems operate pretty much the same. In the US the chief culprit is that we have a billion different ways EMS is run and almost as many different ways EMS is trained. Even NREMT doesn't adequately represent any sort of average of provider skill, knowledge or scope of practice across the the US. EMS is an amorphous blob of a profession.

This blobishness really gets highlighted when we start talking fire-based vs third service vs hospital-based vs private for profit vs ad nauseam. To say fire departments shouldn't do EMS holds no more ground over saying privates shouldn't do EMS. I have seen horrific examples of all these systems. I've seen great examples of all these systems. It sounds like the OP has a fire-based service that does really well for them and really embraces EMS in its current form. Why try to fix a system that works better than many others? Now if we want to point fingers at the IAFF for holding EMS back we equally have to point our fingers at the multi-state private agencies who are also not lining up to get highly educated, and inevitably expensive, paramedics. Both want short training times for roughly the same reason. If we want EMS to grow then we need to get ourselves together and make it happen, not our employers.

We all need to stop the us vs them we have in EMS. We are very shallow and insecure as a profession in that we constantly judge each other based on the patch on our shoulder not our merits as an individual. Working at a certain place doesn't mystically make you a better or worse provider, nor the vehicle you arrive on scene with.

My only criticism of the OPs system is the number of paramedics. I think any more than two paramedics per patient and you really start running into skill dilution. Not just with intubation but patient interview, scene management, physical exam etc. I think two paramedics is ideal, since with critical patients one paramedic can be overwhelmed and a second paramedic can be helpful to bounce ideas off of and as a check and balance to your work as one person mentioned. But kudos for how well your department has embraced EMS and also keeping your cool amongst a lot of FD criticism. Actually to everyone that has posted for being remarkably civil.

Well said! Like I've said before we all argue with each other, but we really are all here for the same reason, to better ourselves and the systems we work in by sharing and learning together.

 

[Christopher]

We should compare notes sometime. I've been very active in developing volunteer programs at several services.

Whenever folks decry fire departments doing EMS or volunteers doing EMS, I kindly point to where I work and ask that they try and meet our standard. Few departments of any type do.

Gee I wonder why that is?! Ohhh, probably because the type of the department doesn't dictate the standards you should hold for yourself.

 

[Wes]

As for volunteers, I've found that there are two easy ways to make sure there's a similar level of quality.

First, if you're running a combination paid/volunteer department, if possible, volunteers supplement staffing, not take away from it. For example, at several of the services I've been involved with, volunteers helped as third crew members on the ambulance and helped with special events.

Second, if your volunteers are counting towards minimum staffing (Here in Texas, we have to have two certified providers on the ambulance.), then they go through the same FTO process and are held to the same standards, regardless of paycheck.

 

[rockyfortune]

Not sure what is better..but where i am located the medics are out busting their butts every damn minute..its a very busy metro area and while all the firefighters are FF/EMT the paramedics hired by the city are the ones who really bust it...most FF rather be FF than FF/EMTs so they try to avoid riding the squad as much as possible.

 

[Christopher]

As for volunteers, I've found that there are two easy ways to make sure there's a similar level of quality.

First, if you're running a combination paid/volunteer department, if possible, volunteers supplement staffing, not take away from it. For example, at several of the services I've been involved with, volunteers helped as third crew members on the ambulance and helped with special events.

Second, if your volunteers are counting towards minimum staffing (Here in Texas, we have to have two certified providers on the ambulance.), then they go through the same FTO process and are held to the same standards, regardless of paycheck.

Exactly, we use vollies for both 3rd person and for standard crew staffing. Our released volunteers are no different than career providers. Same standards, which has helped our vollies secure jobs that would otherwise be unobtainable (or get them into PA/MD programs with ease).

 

[medicsb]

Though, I generally think that EMS should be separate from Fire and that an engines' only role is first response and doesn't require any training beyond that of an EMT, I would be ok with EMS being merged with FDs under certain circumstances. Something that I think is REALLY important is that the name reflect what the department actually does. Although DC FEMS has its problems at least they changed their name.

If a department wants to do EMS, their name should reflect that the overwhelming majority of their work will be (or is) EMS. No more Philadelphia Fire Department or Fire Department of New York... How about Philadelphia Emergency Services Department (with a division of Fire and Division of EMS), and EMS and Fire Department of NY?

Of the Fire-medics here, how many of your departments have a name that reflect EMS being on equal footing with fire suppression? (I'll pre-emptively argue that "Rescue" does not signify equal footing as "rescue" is pretty specific to variations of extrication and not-so-much EMS.)

 

[Christopher]

Of the Fire-medics here, how many of your departments have a name that reflect EMS being on equal footing with fire suppression? (I'll pre-emptively argue that "Rescue" does not signify equal footing as "rescue" is pretty specific to variations of extrication and not-so-much EMS.)

'round these parts you are known as a "Rescue Squad" when you do EMS. Hence it has stuck with "Leland Fire/Rescue". If we could go back to the 1950's and change the vernacular, we probably would.