Fire Based EMS

[medicsb]

'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.

So, let archaic terminology define you? Especially if the term was adopted in the days before modern EMS, when they just put a patient on a stretcher and only drove them to the hospital? It's even more insulting in that context.

 

[Christopher]

So, let archaic terminology define you? Especially if the term was adopted in the days before modern EMS, when they just put a patient on a stretcher and only drove them to the hospital? It's even more insulting in that context.

Shouldn't leave out that they cleaned used bandages in boiling water 'round these parts as well. Is it seriously that insulting to be called a "rescue squad"?

The only time I can remember somebody using it derisively was an interventional cardiologist bemused by our posterior STEMI notification (he took notice when we pointed out the correct IRA for him from the ECG; "just how many hours of training do you boys on the rescue squad get now?").

Perhaps I'm just less sensitive to the subject, for example, every soda is a "coke" here; no great offense there.

...or perhaps I realize it is a monumental P.I.T.A. to change the name of a 501(c)(3); not to mention a business expense not worth making.

 

[medicsb]

I know, it is a little nit-picky on my part. Though, there is an inherent disconnect when one claims that an organization takes EMS so seriously yet they couldn't even be identified as an EMS organization by name. I mean, if EMS is so important, I would think it would be worth the time and trouble to change the name to reflect that.

I don't mean to pick on you or your service, specifically. But, this is just something I think is problematic across the board with FDs.

 

[ExpatMedic0]

I worked near Portland Oregon for 5 years. You wanna know how our system worked, something like this.

Patient calls 911,
Fire department gets there first with an entire engine. The engine is staffed with 1 Paramedic and the rest are EMT's. All the FD's EMT's stand in a circle with their arms crossed or hands in their pockets. Sometimes the LT will hold a clip board to look important. Turns out Grandma is having some breathing trouble today. In the middle of the circle is the patient and FD Paramedic as he/she "assess" the patient.

1-2 minutes of time goes by and AMR arrives. AMR has to break through the circle of firemen observing the call, speak to the FD Paramedic who has been on scene maybe 1 or 2 minutes and has not even had time to complete an assessment let alone make a treatment. AMR takes over care, the FD is released from the call and heads back to the station.

At the end of the day the FD gets a run report which documents there services and this all gets recorded. At the end of the year the FD can show they go on 10 calls a day... but really %99 of the time they do nothing or are not needed. The entire engine crew did nothing except 1 drove the fire truck and 1 initiated patient care for a minute or two. The staffing for personal and equipment in a system like this is absolutely absurd. This is the way it works in the majority of Oregon and much of Washington.

 

[Christopher]

I know, it is a little nit-picky on my part. Though, there is an inherent disconnect when one claims that an organization takes EMS so seriously yet they couldn't even be identified as an EMS organization by name. I mean, if EMS is so important, I would think it would be worth the time and trouble to change the name to reflect that.

I don't mean to pick on you or your service, specifically. But, this is just something I think is problematic across the board with FDs.

Perhaps if the prima donna paragods* at our service made a big enough stink about it we'd change our name to reflect our culture as Rescue / Fire rather than Fire / Rescue.

But then the OCD crowd would argue F comes before R in the alphabet, and it really doesn't roll off the tongue. The super-OCD crowd would also recognize that when our departments merged it was stations 5 and 22, which provided fire and EMS respectively. Reversing the order would not jive with station numbers and we'd go crazy with lifetime honorary members getting angry.

At some point somebody would raise their hand and ask why we're not Fire / EMS or EMS / Fire / Rescue...but then we'd end up like my Industrial Fire Brigade's patch: "GE/GEH/GNF Wilmington, NC Emergency Response Organization", and that also doesn't roll off the tongue by any stretch of the imagination.

* I am one of them--in fact my partner and I were rated the biggest ones in NC by OEMS--and I really don't see what we gain by changing our name just to let people know we are super cereal about EMS. I think our actions speak for themselves.

 

[EpiEMS]

If FD-based EMS services that don't do transport switched to having fly-cars with one or two personnel (EMT, Medic, EMT/EMT or Medic/EMT) responding prior to transporting EMS response, it'd be a heck of a cost savings. One region in Washington State has done so: http://www.king5.com/news/local/New...om-non-emergency-medical-calls-143465176.html

 

[EpiEMS]

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.

The report from KPMG and Pomax (a major management consultancy and a public safety consultancy) on the proposed Toronto FD and Toronto EMS merger came down pretty conclusively and said:

"•Consolidation appears to be most effective when it is implemented in jurisdictions with a mature fire service and an emerging paramedic service or no paramedic service.
•There is little evidence to suggest that a consolidated fire and paramedic service is financially, operationally, or organizationally advantageous in the circumstance where the two organizations are competent."

I think this is something that is pretty obvious when we look at most FD/EMS systems in major cities (like the FDNY and NYC EMS merger that resulted in such deterioration of quality).

 

[Carlos Danger]

I worked near Portland Oregon for 5 years. You wanna know how our system worked, something like this.

Patient calls 911,
Fire department gets there first with an entire engine. The engine is staffed with 1 Paramedic and the rest are EMT's. All the FD's EMT's stand in a circle with their arms crossed or hands in their pockets. Sometimes the LT will hold a clip board to look important. Turns out Grandma is having some breathing trouble today. In the middle of the circle is the patient and FD Paramedic as he/she "assess" the patient.

1-2 minutes of time goes by and AMR arrives. AMR has to break through the circle of firemen observing the call, speak to the FD Paramedic who has been on scene maybe 1 or 2 minutes and has not even had time to complete an assessment let alone make a treatment. AMR takes over care, the FD is released from the call and heads back to the station.

At the end of the day the FD gets a run report which documents there services and this all gets recorded. At the end of the year the FD can show they go on 10 calls a day... but really %99 of the time they do nothing or are not needed. The entire engine crew did nothing except 1 drove the fire truck and 1 initiated patient care for a minute or two. The staffing for personal and equipment in a system like this is absolutely absurd. This is the way it works in the majority of Oregon and much of Washington.

And this pretty well summarizes the overall problem with FD first response.

It seems that any way you slice the pie, it would be far more economical for those (FD) personnel to be responding on an ambulance and handling the call themselves.

Or just staying in quarters.....

 

[Tigger]

Both places I work have fire dispatched with us. We are in control of scenes at both locations too.

One department sends a pickup with two guys and BLS equipment out with us. This is generally helpful, makes getting the patient to the ambulance (this is a pretty rural area) much easier. I also have someone writing for me, taking, vitals, and possibly getting a history from family/bystanders. This leaves my medic and I free to focus on assessment and immediate interventions. The FFs for the most part are very helpful and are quick to ask what they can do to help. If they can't be useful, they leave. This FD staffs five FFs a shift, so there are still three FFs on the engine for fire coverage/second calls.

The other place sends and engine out with is. Due to staffing issues the engine rarely has more than 2 FFs on it. 2 is a good number of extra hands, but it seems wasteful to drive the engine everywhere. We also get the shift captain in his pickup, he could not show up to most calls and it would be fine. I'm not sure why the officer has to run every call district wide, seems like the opposite of a promotion.

The FDs argument for sending the engine is that if they drop another call while returning they need to be able to respond right away with the engine. If they could staff a crew of three one could stay behind with the engine and meet them on scene.

Many calls we could probably take by ourselves. A crew of three on the ambulance would be ideal, but it's going to be tough to break that paradigm.

 

[ExpatMedic0]

And this pretty well summarizes the overall problem with FD first response.

It seems that any way you slice the pie, it would be far more economical for those (FD) personnel to be responding on an ambulance and handling the call themselves.

Or just staying in quarters.....

The fully staffed engine tier response systems are so ridiculous. I can't believe the idiots in charge allow that to continue. That whole system in Oregon and Washington left a bad taste in my mouth. Also the FD's fought tooth and nail when the Oregon Paramedic degree requirement was made. Most of the firemen I spoke with did not want to do EMS, they wanted to be firemen. With that said, I know not every system is like this. I am not saying it is impossible for an FD to do transport ALS EMS.

There are pro's. The fire service has a very strong arm to flex with things like the IAFF and also there local municipality/civil service integration. If used in our favor this power could help EMS tremendously! FD pay and benefits are normally much better than private EMS services. The happiness of employee's is also much greater with the FD. In addition to that, the fire service often has higher physical fitness and uniform standards, reflecting a higher degree of professionalism. In addition the minimum physical fitness standards ensure a healthier physically fit employees that are also physically capable of more in any emergency situation. The FD also has room for promotion. Not to mention they are one of the very few places a pension still exists instead of a worthless 401k.

Furthermore, I like many aspects of the fire service. My uncle, my grandfather, and my great grandfather where all firemen. My friends in the fire service often invite me over to the station to have a meal with them or join in on EMS training sometimes. The comradery the fire service has is far superior to that of EMS and reminds me of a more civilized version of what I experienced while in the Army, which I miss at times.
Another example. Although Medic 1 is a highly controversial system in Seattle, there Paramedic training is over 3000 hours (over 3 times the national average) They also boast some of the nations best ALS pre-hospital statistics.

And there are Con's
As I said earlier there are many cons to a fire system. I have listed many of them before. One big one is that the fire service does exploit EMS to justify its existence, however as someone else mentioned the word "exploit" could certainly be turned around to "embrace", that is up to the local department at hand. From what I have seen a minority of departments "embrace" EMS and the majority seem to "exploit" EMS like the example I gave above. That is just the way it is.

Hypothetically it could work, and I would support the following fire based system
If the fire service made it a single role transport department (like FDNY and SFFD for example, but also the following) requiring transport paramedics to be firemen is completely out of the question. If they want to volunteer transfer to suppression, fine, that is a whole other career. If the fire service indeed "embraced" EMS and did not treat it like the red headed step child of the fire department. This would mean single role EMS employee's are treated with the same respect, benefits, and comparable pay as the fire suppression staff.

If they also helped EMS at a national level increase education standards, mandate college degree's while eliminating vocational tech training, increase public awareness, and promote the advancement of paramedicine. They would also need to recognize EMS as its own entity, which is a form of health care, not just a branch of fire/rescue. They would need to work closely with other areas of health care.
Furthermore they would need a plan for the other aspects of EMS, not just 911, which they seem to overlook quite often. This includes Critical Care Transport by ground and HEMS. In addition to that, the concept of community paramedicine is growing rapidly, they would need to improvise, adapt, and tackle all of these challenges just as well as a 3rd party municipal EMS agency could. Lastly, to get my blessing, they would help make the Paramedic more autonomous and help contribute to a true national standard which also mandated higher education, to get the U.S. on par(or above) with the common wealth countries. To accomplish all this many of the officers would need to enter EMS policy making and EMS research with minimum of advanced master degree's such as an MPH. They would need to be a true advocate for EMS and patients, and not only Fire/Rescue.

If they could do all this for us, I would get on my knee's and embrace them in all their glory. However, if anyone did this for us, I would do the same... I don't care if its the sanitation workers, or the parcel delivery service....

Personally, at a local level, I think our best bet of accomplishing the majority of what I stated above is a government 3rd party municipal EMS agency, like the UK and Australia have. Something EMS can call its own, utilize civil service status, pay/benefits, and municipal promotion structures.

 

[Amberlamps916]

I worked near Portland Oregon for 5 years. You wanna know how our system worked, something like this.

Patient calls 911,
Fire department gets there first with an entire engine. The engine is staffed with 1 Paramedic and the rest are EMT's. All the FD's EMT's stand in a circle with their arms crossed or hands in their pockets. Sometimes the LT will hold a clip board to look important. Turns out Grandma is having some breathing trouble today. In the middle of the circle is the patient and FD Paramedic as he/she "assess" the patient.

1-2 minutes of time goes by and AMR arrives. AMR has to break through the circle of firemen observing the call, speak to the FD Paramedic who has been on scene maybe 1 or 2 minutes and has not even had time to complete an assessment let alone make a treatment. AMR takes over care, the FD is released from the call and heads back to the station.

At the end of the day the FD gets a run report which documents there services and this all gets recorded. At the end of the year the FD can show they go on 10 calls a day... but really %99 of the time they do nothing or are not needed. The entire engine crew did nothing except 1 drove the fire truck and 1 initiated patient care for a minute or two. The staffing for personal and equipment in a system like this is absolutely absurd. This is the way it works in the majority of Oregon and much of Washington.

You just described a typical day at work for me in Socal. The only difference being us on scene first about 85-90% of the time and having fire usually send 1 guy in to see if they're needed. Seriously, there are times when their station is about 1-2 miles from the call and by the time they arrive, we'll have the patient loaded in the ambulance. The sand-bagging that occurs here is ridiculous.

In the rare times that they are first on scene, they don't bring their equipment in most of the time. They just stand around and perform some half-&@$ assessment, which is usually just patient demographics, by the time we get there.

 

[ExpatMedic0]

You just described a typical day at work for me in Socal. The only difference being us on scene first about 85-90% of the time and having fire usually send 1 guy in to see if they're needed. Seriously, there are times when their station is about 1-2 miles from the call and by the time they arrive, we'll have the patient loaded in the ambulance. The sand-bagging that occurs here is ridiculous.

In the rare times that they are first on scene, they don't bring their equipment in most of the time. They just stand around and perform some half-&@$ assessment, which is usually just patient demographics, by the time we get there.

Yep, it sucks. Imagine what would happen to the fire departments budget and job security if this was eliminated, like it should be. Most of the west coast works like this.... its an absolute joke and disgrace.

It is a huge misuse of resources, a disservice to the community and local budget, and very clear and present reality that someone in higher places is accommodating special interest.

 

[snarff]

Where I work and live its all fire based EMS. The only private ambulance service are medical transport and do some EMS when the system is dumped which is very rare.

Its not too bad here we have 3 departments in the valley all do ALS. They give preference to medics when hiring and those that are not medics are required to start a program with 3 years of hire (department pays). This being the case the vast majority are medics with some older grandfathered ones that are just EMT.

Typically every engine, ladder has at lest one medic on board. The engines or ladders do first response in their first due if the first due medic is out. So if you are on the second due ambulance the crew there is people you know and work with all the time so its kinda nice. The other plus is you are not on an ambulance everyday. While I like being on an ambulance it is nice to have a day here and there ridding ladder or engine.

 

[emtdansby]

I've always felt fire and EMS needed to be two separate services. Firefighters want to fight fire, paramedics want to use medicine. When you require either to do the other job, they are not passionate about it. I have seen patient care fall to the wayside because the fire/medic just didn't care. He only got his paramedic to get on with the department and has no interest in EMS.