Fire Trucks at medical scene

[terrible one]

Dutch, i can say that as both a Firefighter and paramedic that I have specialized in both.

care to elaborate how quality is improved by having 6 FF/PM on scene? Since when does more equal better care? It works here in CA, how? Have you seen our protocols? Do you know the orignal reason for cross training FF to PM? Money! It was cheaper to have FF work as PM than to have single function roles, although I'm sure you have been told it improves patient care/quality/etc.

 

[BLSBoy]

I'll just leave this here.
We are a combined Paid/Volunteer Fire/EMS system, providing ALS Rescues, Engines and Ladders, as well as a few BLS apparatus, with private BLS providers as well.
We have aggressive protocols and excellent medical direction to the 1000+ members of the Dept, serving in over 35 stations.

http://www.tampabay.com/news/health/article1117401.ece

 

[MrBrown]

Which brings up the topic of more than two medics on a scene...

You are lucky to have ONE Intensive Care Paramedic on scene here, if you have TWO you are REALLY, REALLY sick ...

 

[LucidResq]

There is at least one medic on every fire apparatus out here... usually more.... and the dept is actively trying to make all of their firefighters paramedics.

They respond on all EMS calls, but do not have any transport capabilities.

We utilize a private EMS company for that... they are staffed with 1 medic, 1 EMT.

I have seen as many as 3 fire medics ride in with a patient to the hospital on a critical call before... that means 4 medics in the back of that rig (unless they booted the 4th one up front).

 

[jjesusfreak01]

I'll just leave this here.
We are a combined Paid/Volunteer Fire/EMS system, providing ALS Rescues, Engines and Ladders, as well as a few BLS apparatus, with private BLS providers as well.
We have aggressive protocols and excellent medical direction to the 1000+ members of the Dept, serving in over 35 stations.

http://www.tampabay.com/news/health/article1117401.ece

Aww, showing off...i'm in Wake County NC...

 

[BLSBoy]

Aww, showing off...i'm in Wake County NC...

Haha, we modeled parts of ours from WCEMS.

 

[46Young]

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.

Dual role providers may or may not improve pt outcomes, but it hasn't been shown to adversely affect those outcomes. It makes sense from the financial standpoint in many cases. Mergers are typically done mainly to save money and positions, but haven't been shown to worsen pt outcomes.

Why should the dual role position be seperated for single minded people? I've had no problem learning fire suppression after having been a medic for a few years. Many others I work with have had no problem with it, either. EMS isn't as difficult to do well at as many would like to say, even with the additional duties of fire suppression. Now, if you were to put someone through fire school and medic school at the same time, that could present a problem. But if the individual learns one job and then the other down the road, it works out well.

You can be a medic in 6 months or less. You can graduate a fire academy in 4-6 months with FF 1 and 2. You also have the EMS AAS on one side, and a Fire Science degree on the other if you want to equal things out with college. That's still way less education and training than someone with a Master's degree, let alone that of a physician. Why is it so difficult to do both EMS and fire? At least where I work, we do plenty of on duty EMS continuing ed, the same with fire, as well as comany drills and multi unit drills for both sides. Again, this is all on duty. It's really not that hard to maintain proficiency. there's also enough EMS call volume to keep your skills sharp. Fire is going to be relatively slow wherever you go, unless you work in a busy, populated area.

The fire service has largely taken the attitude towards EMS as a specialty, such as Technical Rescue or Hazmat. While I don't necessarily agree with this, it is how the fire service sees EMS. That model happens to work, however. You take a trained firefighter and send them to medic school. Now, you have a cometent FF who needs to maybe devote 80% of their effort to improving in EMS and 20% to fire to achieve balance. Or, in my case, work as a medic in a busy system first, then do the fire academy and concentrate 80% on fire and 20% on EMS.

For those that don't want to do both, there are plenty of thrd service EMS agencies to work for, and as many hospital based services as well. I moved out of state for my career. Single role EMS in NYC didn't provide what I wanted. I'm not sympathetic towards anyone that needs to relocate for desireable job, either.

 

[46Young]

care to elaborate how quality is improved by having 6 FF/PM on scene? Since when does more equal better care? It works here in CA, how? Have you seen our protocols? Do you know the orignal reason for cross training FF to PM? Money! It was cheaper to have FF work as PM than to have single function roles, although I'm sure you have been told it improves patient care/quality/etc.

If it doesn't adversely affect pt outcomes, then combining EMS and fire is in the best interests of the local government, if it saves money in doing so. Whether it improves pt care is irrelevant in the practical sense so long as it doesn't worsen outcomes, provided the local gov't is able to either cut their budget, or increase service with the same budget. Really, you're getting at least the same level of delivery at a lower cost. Any increase in service or improvement in pt outcomes is just gravy. I'd rather see more buses on the road rather than ALS first response, but the local politicians don't seem to agree in most cases. If they won't put more buses on the road, then I'm okay with increased ALS first response and a more secure and lucrative career for the medics in the FD if they're going to run all day and night on the ambulance.

 

[MrBrown]

I have often wondeed if we measured the clinical knowledge and skill of a group of international Paramedics where each would rank and how we could fairly and accurately do such a thing.

My observation is that US Paramedics do not have to think, they have a cookbook to follow which ends in the patient going to the hospital, if things get out of depth you can always default to ringing up a Doctor on the ambo-phone and so long as you can slip in a drip, recognise a few rhythms and screw one end of the prefilled syringe into the other you can go an entire career without anybody realising.

Does that mean some are not capable of advanced clinical reasoning, no not at all.

 

[46Young]

On the one hand you have the single role EMS professionals who are understandably upset by FD takeovers of EMS, typically displacing them from their jobs, or forcing them to do fire. On the other hand, you have dual role personnel who enjoy both sides of the job, and have no problem doing both. You also have others that were forced to do EMS, or needed the P-cert to get the job, but it is what it is.

Neither side is looking to willingly sacrifice itself in favor of the other. Although fire based EMS has been growing, I don't see single role EMS disappearing. So, for all the single role EMS and dual role fire/EMS alike, what compromise do you suggest? We can bicker on and on incessantly, but how do we compromise and work things out?

 

[46Young]

I have often wondeed if we measured the clinical knowledge and skill of a group of international Paramedics where each would rank and how we could fairly and accurately do such a thing.

My observation is that US Paramedics do not have to think, they have a cookbook to follow which ends in the patient going to the hospital, if things get out of depth you can always default to ringing up a Doctor on the ambo-phone and so long as you can slip in a drip, recognise a few rhythms and screw one end of the prefilled syringe into the other you can go an entire career without anybody realising.

Does that mean some are not capable of advanced clinical reasoning, no not at all.

More like we're handcuffed. I'd like to increase my clinical knowledge as it pertains to EMS, but there's nothing available in the U.S. past the EMS AAS. The whole cookbook thing is mainly the medical director being aware of our laughably brief medical education, which varies from a 12 week patch factory to a two year degree at the most, and likes to keep things simple to protect their license.

 

[JPINFV]

More like we're handcuffed. I'd like to increase my clinical knowledge as it pertains to EMS, but there's nothing available in the U.S. past the EMS AAS. The whole cookbook thing is mainly the medical director being aware of our laughably brief medical education, which varies from a 12 week patch factory to a two year degree at the most, and likes to keep things simple to protect their license.

Too bad that the US Fire Administration sees absolutely no reason to change from the 12 week patch factory technician to a prehospital medical professional with a degree. Notice where the concept of a college education comes into play with this. It isn't at the paramedic level... Hell, the fire service doesn't even see a need to have the educators have a real education.

So, the whole cookbook thing is thanks to the fire fighters fighting to keep from requiring a real education.

 

[Shishkabob]

If you're going to use the argument of money and efficiency to support mergers, then you also have to support fire being a part of EMS and not the other way.

Its ridiculous to think that a portion that gets 80% of the calls is seen as the lower and less important of the two.



If places truly wanted to save money, fire would be volunteer, period.

 

[BLSBoy]

If places truly wanted to save money, fire would be volunteer, period.

Then you would see what little you save through tax reductions go bye bye in either A) insurance "adjustments", or B) go up in smoke when the structure catches fire, and you're now dropped insurance is worthless.

It IS a very delicate balancing act, and yes, many areas ARE doing it wrong.

Making all career EMS and all volunteer FD is no better then making every FF become a Medic.
This requires the ****s to get put away, the brass removed from collars, jurisdictions brought down, and common sense brought into play.

 

[46Young]

Too bad that the US Fire Administration sees absolutely no reason to change from the 12 week patch factory technician to a prehospital medical professional with a degree. Notice where the concept of a college education comes into play with this. It isn't at the paramedic level... Hell, the fire service doesn't even see a need to have the educators have a real education.

So, the whole cookbook thing is thanks to the fire fighters fighting to keep from requiring a real education.

I'm sure that the number if third service EMS depts, hospital based EMS depts, and private EMS agencies outnumber the number of EMS inclusive FD's, both in number of depts and number of employees. What have these employers done to support EMS requiring a "real education?" Nothing! It's a pulse and a patch in most places. No one asks where you went to school, only if your certs are valid, your background is clean, your driving record is acceptable, relevant work history, and maybe passing an entrance exam. They're just as guilty in suppressing the educational standards of EMS as the fire service is being accused of.

At least the fire service either requires or gives weight to education for career advancement. At least the fire service has career advancement. Where I work they send FF's to a degree paramedic program. We also provide Insructor I and Officer I courses, as well as Ins. 2 and 3, Off. 2 and 3. Educational points count towards the total score for our promotional exams. A technician w/o education can only score 90%. An LT 85%. Capt I 80%. Capt II 75%. This is for tests where .10% can seperate several candidates. What EMS employers do this? What EMS employers have any sort of real career/promotional ladder?

Edit: At least that chart shows some sort of professional development model. What is the typical EMS agency's model? EMT > medic > rare supervisor if you're in the right click, maybe a lateral move to dispatcher, skills instructor, or class instructor > burn out in 7-10 years and leave.

 

[sir.shocksalot]

Maybe someone can explain to me how a fire based EMS service saves money? Private services often provide EMS services at no cost to the city, which strikes me as cheaper than a fire based EMS service. Also a municipal service would be far cheaper than a fire based service, single role paramedics are typically cheaper than career firefighers, let alone FF/medics, and street corner posting 12 hour shifts (while not ideal) would save needing more than one station. Even purchasing new stations for EMS are probably of comparable price to expanding current fire stations to accommodate an extra crew and vehicle.
The main argument I hear is that cross training saves money, but I just can't see how. An engine needs to be staffed with 3-4 FFs and ambulance needs at least 1 medic and one FF to drive; so how is that cheaper than using a municipal service to staff 1 medic and 1 emt in an ambulance and keeping 3-4 FFs on an engine?

In my experience typically the problem with Firefighters in EMS is not the Firefighter him/herself, but the great big beast of a union they belong to. The IAFF has consistently taken a stance of taking over EMS wherever it goes by fudging numbers and lying to citizens by saying Fire based EMS saves money and lowers response times (which it might, but no better than an equally funded 3rd or private service could do.) I have found good and bad firemedics, however EMS will always be secondary in the fire service, and the IAFF will never advocate for advancement of the EMS profession, since it hurts professional firefighters; so long as that is the case I will never advocate for fire based EMS.

 

[MrBrown]

The problem with an "Associate" degree is that it's not even a real Degree in whatever you have one in, lets say Paramedicine.

I have seen a lot of two year Paramedic degrees where you have to take a lot of other subjects like computers, English, history or whatever which mean your two year Paramedic degree really only has about a full year of Paramedic education in it.

Our Bachelors and Advanced Degrees for Paramedic and Intensive Care Paramedic are exactly that - they are a Paramedic Degree. You don't have to take any computer classes or learn about history, every class is a specalist one. You actually study Paramedicine for three years not a bit here and a bit there and oh look some underwater basket weaving over there.

Our old Intensive Care Paramedic Diploma was two full years of Paramedic education and that was introduced in 1995.

 

[46Young]

If you're going to use the argument of money and efficiency to support mergers, then you also have to support fire being a part of EMS and not the other way.

Its ridiculous to think that a portion that gets 80% of the calls is seen as the lower and less important of the two.



If places truly wanted to save money, fire would be volunteer, period.

The way EMS is run with nepotism, lack of career advancement, pulse and a patch quality employee standards, using the absolute least amount of resources to barely do the job and wear out their crews, no thank you to EMS running the show.

BTW, call volume in no way lessens the importance of having adequate staffing and deployment on the suppression side. Call volume is irrelevant. How much of that call volume is medicaid abuse and/or the medically ignorant calling for things that are easily serviced by a trip to the urgent care, a PCP, or a ride to the ED via POV?

 

[sir.shocksalot]

I'm sure that the number if third service EMS depts, hospital based EMS depts, and private EMS agencies outnumber the number of EMS inclusive FD's, both in number of depts and number of employees. What have these employers done to support EMS requiring a "real education?" Nothing! It's a pulse and a patch in most places. No one asks where you went to school, only if your certs are valid, your background is clean, your driving record is acceptable, relevant work history, and maybe passing an entrance exam. They're just as guilty in suppressing the educational standards of EMS as the fire service is being accused of.

At least the fire service either requires or gives weight to education for career advancement. At least the fire service has career advancement. Where I work they send FF's to a degree paramedic program. We also provide Insructor I and Officer I courses, as well as Ins. 2 and 3, Off. 2 and 3. Educational points count towards the total score for our promotional exams. A technician w/o education can only score 90%. An LT 85%. Capt I 80%. Capt II 75%. This is for tests where .10% can seperate several candidates. What EMS employers do this? What EMS employers have any sort of real career/promotional ladder?

Edit: At least that chart shows some sort of professional development model. What is the typical EMS agency's model? EMT > medic > rare supervisor if you're in the right click, maybe a lateral move to dispatcher, skills instructor, or class instructor > burn out in 7-10 years and leave.

The career advancement you just highlighted is within the fire service, not the EMS service. EMS doesn't have much of a career advancement because there is no prehospital provider beyond the level of paramedic. In Australia, England, and New Zealand however a paramedic and go on and become an Intensive Care Paramedic, a Community Care Paramedic, Paramedic Practicioner etc.
Also there are plenty of EMS agencies who look for more than a pulse and a patch. One can argue there are just as many fire agencies who could care less where you went to medic school as long as you hold the cert.
The point most of us "anti-fire" guys is not that firefighters are dumber than single role paramedics, just that your union and fire brass will do everything to prevent EMS from becoming a huge burden on a fire department, or evolving into its own agency that has no place in a fire department. (therefore costing firefighters their jobs.)

 

[46Young]

Maybe someone can explain to me how a fire based EMS service saves money? Private services often provide EMS services at no cost to the city, which strikes me as cheaper than a fire based EMS service. Also a municipal service would be far cheaper than a fire based service, single role paramedics are typically cheaper than career firefighers, let alone FF/medics, and street corner posting 12 hour shifts (while not ideal) would save needing more than one station. Even purchasing new stations for EMS are probably of comparable price to expanding current fire stations to accommodate an extra crew and vehicle.
The main argument I hear is that cross training saves money, but I just can't see how. An engine needs to be staffed with 3-4 FFs and ambulance needs at least 1 medic and one FF to drive; so how is that cheaper than using a municipal service to staff 1 medic and 1 emt in an ambulance and keeping 3-4 FFs on an engine?

In my experience typically the problem with Firefighters in EMS is not the Firefighter him/herself, but the great big beast of a union they belong to. The IAFF has consistently taken a stance of taking over EMS wherever it goes by fudging numbers and lying to citizens by saying Fire based EMS saves money and lowers response times (which it might, but no better than an equally funded 3rd or private service could do.) I have found good and bad firemedics, however EMS will always be secondary in the fire service, and the IAFF will never advocate for advancement of the EMS profession, since it hurts professional firefighters; so long as that is the case I will never advocate for fire based EMS.

On the fire side, staffing and deployment objectives need to be met, irrespective of call volume. This leaves units with a low net utilization in many areas. Crosstraining FF's as EMt's and medics saves money in a few ways. Dual role FF's save money on staffing and OT since they're versatile and can plug holes in the schedule on either side. Less personnel need to be hired if employees can do both jobs. Each job is another pension, equipment, training and hiring costs, paif time off, insurance, etc. It's cheaper to train one FF to the paramedic level and then put a monitor, drug bag, O2, airway kit, BLS bag, portable suction, a backboard and immobilization equipment on an engine than it is to buy a new ambulance, hire two medics (or medic/EMT) with all those additional costs I just mentioned, and all the equipment that goes with that. Employee retention with dual role FF/EMT's is much higher than that of single role EMS, saving on hiring costs. As far as OT, up to a point it's cheaper to allow OT to cover scheduling holes rather than hire. Dual role personnel offer an advantage to that end. they can ride the ambulance or an engine, truck, whatever.

I don't see how adding on to an apparatus bay is more expensive than building a new EMS station.

If the privates are providing EMS at no cost to the city, that means they're turning a profit. A profit that the city might as well keep. The privates are known to be profit driven by nature. How many stories do you hear of the privates using 911 buses to do IFT's? NYC hospitals and privates participating in pt streering? How do they treat their employees? Overworked and underpaid. That's who I want showing up to help me, two sleep deprived, burnt out, underpaid and disgruntled techs. Or maybe a pair that are waiting on a fire job and could care less about their current one? How many privates pack up and leave when the contract is no longer profitable, leaving the local gov't scrambling to reassemble an EMS delivery system?

Like I said before, I'd rather have more ambulances on the road, but the local politicians and bean counters won't allow this. As such, ALS first response fills the gaps when they're likely to be otherwise idle. It's cheaper than adding more buses and less hiring is needed to boot, when compared to having a seperate third service EMS.