Fire Trucks at medical scene

Dutch-EMT

Dutch-EMT

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When i look at series like paramedics, I see even by a "chestpain" call a fire truck at the scene. Here (in the Netherlands) a fire truck only responds to medical calls when there is a resuscitation goïng on.
In the cities with professional fire fighters the crew drives out at each of these calls. In the low-residental areas were there are only voluntairy fire fighters the fire department and police only get's a call when there are no ambulances within 10 minutes of the call. They respond with CPR and AED (nothing more).
Every other medical call (no matter what urgent) is responded by the ambulance only.

How does this work in U.S.A.? Is there always an fire truck responding, no matter what call of medical aid? Or is there a difference between voluntairy and professional fire departments?
And who pais the bill of the Fire Dept. sending this truck? Or is this organized by the authorities?
 
Depends on where you are in the USA. In my area no fire response unless we request them to help lift a patient or if needed to cut a patient out of a car. In other areas the fire depts respond to all EMS calls so they can claim they had a lot of calls when in fact they were not needed 99% of the time they responded. This allows them to ask for more money. That is the reason the fire service in the USA keeps trying to take over EMS so they can get more funds. When you factor in how many runs are EMS and how many are fire it should be EMS taking over fire, but instead fire takes over EMS and in many cases it gets neglected while the fire department buys new trucks that they don't need.

OK so short answer depends on where you are in the USA.
 
What you have to remember is that a lot of EMS in the US is provided by the Fire Department. It is the policy (so I was told in 1993) of the IAFF/IAFC to actively seek out and take over EMS wherever possible.

The Fire Service here is totally seperate from Ambulance but they do show up to cut people out of cars or other funny spots on occasion.
 
The FFs are more community based in my area, so they can often get onscene more quickly than EMS, although EMS has very short response times. All FFs are either FRs or EMTs, so they can patch up and do basic treatment before EMS arrives. I think it's a good relationship here. On full emergency calls (no matter what they turn out to be) they are there to lend a hand, and will disappear just as quickly if they aren't needed. I get somewhat jealous when I see the FFs running around in shorts when I'm stuck in black ems pants all day.
 
For every diabetic, we have 1 truck with a charged line ready, just in case the guy need sugar.
 
MrBrown said:
What you have to remember is that a lot of EMS in the US is provided by the Fire Department.
Click to expand...

33%...




In Fort Worth, the calls that have more of a chance of being life/limp threatening get a fire response along with the ambulance. On calls that are just a sick person, it's just an ambulance.

Most often, the moment the ambulance arrives, the Paramedic sends the engine back home, as most FD engines in Ft Worth only have EMTs.


Go to Dallas, and most get dual engine/fire response because not only are all FFs also medics, but it's fire-based EMS.
 
I work Private EMS. In the main city I respond in, the full time FD rolls for everything. They are a non transporting ALS units with 2 paramedics (we call em Echo units around here).
If it is an EMS only call I would say they are helpful 40% of the time, getting IV's, drawing up Rx, getting quality Hx from family, etc...

If I had to chose to have FD respond to all or none, I would chose all, as long as they are ALS.

The best situation would be having FD only roll on high priority runs.

Also work POC Fire that transports ALS, and have to say it is a much smoother operation.
 
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in my area, EMS is provided 100% by the Fire department. the paramedics are on the fire engines and ambulances only have EMT's (with some exceptions). we will normally have 2-4 paramedics on every call, and it will be downgraded as needed. it is a system that works if utilized correctly, it is a broken system if not.
 
I did my schooling in Savannah and I didn't even see FD on a rollover in one of the most boring non-eventful places in the Savannah area. Infact when EMS needed a hand in chest compressions we always had a cop doing the pumping. When I did my clinical in Atlanta I was shocked at how Fire responded to almost everything. And most FFs I saw were EMT or Paramedic qualified which I enjoyed. Nothing like having a few extra hands to lug big Bertha around.

But if I had to have my choice between PD and FD on scene, I'd much rather have PD on scene. They'll do the grunt work and when people get testy they can break the taser out.
 
Our fire department does both fire and ems, we rotate duties regularly, we have four als ambulances(transporting) and 5 als engines, they are staffed with paramedics, our engines are sent on potentia "serious medical" calls ie chest pain stroke dib etc, for the extra hands for a 12 lead iv start etc, they carry the same medical equipment as the ambulances except the stretcher. they will also respond if the rescue for that station is on another call with the idea that we have an average response time with a full als crew in less than 4 minutes while the ambulance coming across the city may take a few minutes.
 
Big differences i'm reading here.
Not to offend the fire fighters, but when I'm looking at working with sick or wounded patiënts vs fighting fires, cutting cars and do other technical work, i see two different specialities.
That's why in Europe the EMS and FireDepts are two different professions.
There are in Germany fire departments running EMS stations, but the paramedic and EMT (rettungssanitäter and rettungsassistent) on the vehicles aren't trained to work on a fire engine.

Wouldn't it be better when looking at quality and specialism of the job of paramedic that those things would be seperated?
When i'm looking at patiëntpravicy, I should prefer tow paramedics in my livingroom instead of 6 firefighters from an engine.
 
WE often joke about being medics that sometimes ride fire trucks, we do probably 70% to 30% ems to fire. it works well for us but ems is the majority of our job.The engines dont respond to all the calls and are turned around when the extra hands arent required.
 
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Dutch-EMT said:
Big differences i'm reading here.
Not to offend the fire fighters, but when I'm looking at working with sick or wounded patiënts vs fighting fires, cutting cars and do other technical work, i see two different specialities.
That's why in Europe the EMS and FireDepts are two different professions.
There are in Germany fire departments running EMS stations, but the paramedic and EMT (rettungssanitäter and rettungsassistent) on the vehicles aren't trained to work on a fire engine.

Wouldn't it be better when looking at quality and specialism of the job of paramedic that those things would be seperated?
When i'm looking at patiëntpravicy, I should prefer tow paramedics in my livingroom instead of 6 firefighters from an engine.
Click to expand...

We have a winner. Yes you are absolutely correct. It makes no sense having two completely different professions combined. I mean it would make as much sense as combining doctors with dog catchers.
 
Dutch, i can say that as both a Firefighter and paramedic that I have specialized in both. neither detracts from the other. and at least here in California, you dont have to make the choice between 2 paramedics or 6 firefighters because we cross train and many departments are only hiring Firefighter/paramedics you will have 6 firefighter/paramedics in your living room. if it is a BS call then 4 of the FF/PM get back one the big red truck and 2 of the FF/PM take the call.

i am not advocating one system over another, there are plenty of great systems out there as already stated, what i can say is that this system here works for us. we can have paramedics on scene in less than 5 minutes, under normal circumstances.
 
Which brings up the topic of more than two medics on a scene...
 
In my area, we have private EMS complimented by QRS in certain areas where an ambulance cannot be in 10 minutes or less. My station does not provide QRS because we have 2 ambulance services within 10 minutes, with one of the ambulances stationed within the general vicinity.

FD will be called for extreme lift assists and Rescue operations. We do carry an AED on the Rescue, just in case. Also, not that it matters in our situation, but over 3/4 of my volunteer dept are either EMT or Medic certified.
 
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Because in the majority of the US, EMS is both underfunded and understaffed, and the US Fire Department as a whole is used to band aid said understaffed EMS systems.

In systems all over the US, a fire truck is sent because EMS doesn't have enough resources to handle the call volume. This happens in 100% volunteer EMS systems, as well as 100% career systems, and everything in between. Taking the extreme of EMS in NYC or Philadelphia, to the middle of now where US, where 30 emergencies a year is a busy year, and very often the FD is used to supplement the local EMS system, or when the EMS unit is coming from the next town over or several towns away.

A good EMS system has enough resources to handle ALL the calls, on it's own, with a less than 6 minute response to ALL calls, from the chest pain/MI, to the stubbed toe.

Unfortunately, the majority of systems can't do this, usually because they don't have enough ambulance, or they staff just enough ambulances to handle all the calls based on statistical data, and never having additional units available to handle routine surges in call volumes.

So the FD is used as a first responder, to "stop the clock" on emergencies, so even if it takes the ambulance (which the patient needs) 20 minutes to get there, due to no units available, or EMS unit coming from the other end of town, or doing a turnaround at the ER, the AHJ can say "well, we had a unit on scene in under 6 minutes, even if it is a non-transporting unit with guys who can't get the sick person to definitive patient care."

FD should go on rescue assignments, MCIs, or if you need additional lifting power, but this should be the rarities, not the routine EMS calls because your system if frequently out of EMS resources. Again, good systems would operate this way. Unfortunately, most of the systems in the US don't.
 
I don't know. I think even if fire responds simply to "stop the clock" it can totally be worth it. If EMS has 6 minute response times, and fire 4, that two minutes could make a huge difference two someone who was in arrest for a few minutes before 911 was called.

If EMS arrives first, great. If fire arrives first, then you did truly just shave a few minutes off of your EMS response time, because the MI patient will have FFs assisting with their nitro and giving O2, the MVA victim will have someone stabilizing cspine and stopping hemmorrhage, and the kid who just broke her leg on the playground will have firefighters there to assure her that she will be ok. Even if its just a few minutes, its totally worth it.
 
why in a nice suburban city with good tax paying residents, should we pay firefighters to just sit at the station, when there is only 20 real house fires a year and 5,000 medical calls.

medical calls generate revenue, fire not so much.

we may not want to combine the jobs, but it is for the benefit of the citizens safety and cash. Plus most of the young guys (like myself) enjoy both sides of they job.
 
Ah, I love this road.

...because in my experience, the fire department is neither an efficient, progressive, or effective source of delivering prehospital medical care.
 
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