Fire Trucks at medical scene

[Shishkabob]

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.

?

Ever think that's because fire gets a bigger chunk of the money? And that's because they fudge the numbers?


Heck, id trust my life with ATcEMS over austin fire any day.


ATcEMS, Rockwall county and Hood county....thee places that are proof positive that EMS can do more of the technical rescue stuff and excel at it.

 

[46Young]

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.)

I'm a firefighter/medic, so that career ladder is within the EMS service, just not a single role one. We have EMS techs, EMS LT's, EMS Capt I's EMS Capt II's, EMS BC, EMS DC. We also have dual hatter positions for all of those positions as well. We also have several all hazard DC's and an AC who climbed the ranks via the EMS ladder. The two sides, EMS and suppression are intertwined, not in a power struggle.

As I said before, the vast majority of hosp based, third service, and private EMS have done next to nothing to promote EMS educational advancement. It's hardly just a fire thing.

Like I told JP, at least the fire service gives it's medics a career advancement ladder. We can promote to EMS tech, TROT tech, Apparatus Tech, or Hazmat Tech after only two years of service. With each position, we can and still do EMS txp. After five years we can become EMS LT's or All-Hazards LT's. Seven years to make Capt I, two more for Capt II, and so on. If I was still at my old hospital I'd be jerkin' the gherkin as a field medic forever. The supervisor positions are few and far between. One person that was hired at around the same time as me back at my old hospital was just made field supervisor. We were hired in early 2003. That's seven years and change, and that was only one position. Just one. I'll have my first promotion in a couple of months, only two years out of the academy. Me and about 15-20 others. If I was hired here in 2003 instead, I'd likely be a LT or Capt I in those same 7 + years.EMS LT/Capt if I wanted.

 

[46Young]

Ever think that's because fire gets a bigger chunk of the money? And that's because they fudge the numbers?


Heck, id trust my life with ATcEMS over austin fire any day.


ATcEMS, Rockwall county and Hood county....thee places that are proof positive that EMS can do more of the technical rescue stuff and excel at it.

I'm sure that your local case study is true, but fire based ALS first response still hasn't shown to cause an adverse affect on pt outcomes.

We spread our money evenly over fire and EMS here. The two sides are intertwined, not at odds and having a power struggle. A few of our top brass came up the ranks as medics.

 

[sir.shocksalot]

I'm sure that your local case study is true, but fire based ALS first response still hasn't shown to cause an adverse affect on pt outcomes.

We spread our money evenly over fire and EMS here. The two sides are intertwined, not at odds and having a power struggle. A few of our top brass came up the ranks as medics.

I don't believe there has been any study done regarding BLS vs ALS first response. And there certainly hasn't been any study done on fire based ALS vs other ALS response.

Also the policies of your department are not idicative of fire based EMS as a whole. Neither are the policies of the fire based EMS that I work with. Your department may provide great pt care, I know for a fact that the one I work with is atrocious. Does that mean every fire department in colorado is terrible? No, not at all. But saying that all privates or hospital based EMS is bad is not very fair. There are plenty of non-fire services that have a good EMS career advancement, from EMT to Medic to FI to CCT medic, etc. I have even heard of places that will help employees go to nursing school or PA school. Also the IAFF isn't leaping at the idea of community paramedics, or CCT medics, or really medics that do anything other than respond to emergencies.

Fire fighters have a huge lobby group who will work hard to keep firefighters on top, EMS has no such group, and EMS is so divided that we can't really organize ourselves to advance the careers of single role paramedics. So any Paramedic who wants to advance their career in MEDICINE, they move on to nursing, or PA, or MD and so EMS continues to stagnate as our best and brightest move on to bigger and greater things.

 

[firetender]

It's not about rivalry

Police protect and serve.

Fire fights fire.

EMS needs to be re-structured from the ground up to reflect what it actually provides; Emergent Medical Intervention. Emergency intervention is only a small part of the reality of what EMS has become;a strictly medical concern within the context of a greater societal service.
This would clearly be a specialty which would take its place as one of three vital protection agencies with an identity (and accountability) completely its own.

We haven't quite figured that out yet because we got hung up on the Emergency thing; we think that's what we actually do! Fire Departments have capitalized on non-Fire's inability to accurately describe the service we provide. Aren't emergencies what FD's are all about? Logic says that's what Fire does now, so why not let them handle more?

Because that's not what needs to be handled.

The populace we serve is not limited to those in need of emergency intervention; it has now expanded to include those with nowhere else to turn. In fact, they have become the majority of our cases. True emergencies seem to sneak in to our work load.

The end result is that EVERYBODY wants to handle the GOOD STUFF and NOBODY wants to handle what's really out there.

EMS must assert that these are the people and ailments we really serve. We must educate ourselves to serve them better, elevating the profession as we go. We must re-design our systems of response and back up to provide a few "tiers" of support to draw from.

Once we re-define (and expand) what we do, you can bet that Fire Departments will back off on trying to take over EMS. Why? Because their "mission" has nothing to do with placing people where they belong, and that, in a nutshell, is the work that needs to be done.

I'm not saying non-Fire services are better. I'm actually saying ALL OF US need to wake up, get rid of the childlike impression this is all about emergencies and develop something that works!

 

[Dutch-EMT]

I think in many other countries outside US there is enough proof that FF and EMS can be split in two different professions. Well, i'll take the Dutch system for example again :wacko:...

Only towns and cities with a higher residence than 70000 have a professional fire department. That means that between 7.30AM and 6.00PM there is professional staff at the station while the voluntaire firefighters go to their daily job. Between 6.00PM and 7.30AM the voluntairy fire fighters get the fire calls.
Cities over 12000 residents have 24hour professional firefighters.

The EMS system (ambulance services) are 100% professionals. The driver of the ambulance (graduated EMT-B ) and ambulance-nurse staff the ambulance.
In our region (150000 residents, see picture) there are 7 ALS ambulances driving 24hours a day.

They do emergency calls and interclinical rides. There are 2 BLS ambulances driving interclinical and discharge rides only between 8.00AM and 5.00PM.
There are no professional fire fighters in the region. The biggest town residents 65000 people.
Ofcourse our EMS system is a lot different than the paramedic based system (see this link: http://emtlife.com/showthread.php?t=15481).
The costs of the ambulance calls are payd by the health-ensurance.
In the Netherlands everybody it is obligatory to have a basic health-insurance (costs are about $100 to $125 for this year for 1 person).

Well... it works here! Ofcourse our system isn't always perfect...

 

[medic417]

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.

Actually very wrong. Some of the best insurance rates are in communities with volunteer fire. Yes some communities with volunteers are at the highest insurance rate. And you find communities with paid fire all up and down that rate ladder as well.

 

[Seaglass]

I've gotten pretty familiar with a handful of places now, and they all had issues. I think the best way to set up EMS depends on the area, though.

One was a medium-sized city that had a fire department with way too many medics. Pointless engine responses and medics who'd forgotten most of their skills were really common, as each engine seemed to have a medic or two who always handled every call. They also had a thriving, terrible third service. In this case, I'd support losing the third service entirely, and having only one or two medics per engine or fire ambulance.

Another was middle of nowhere department, with mostly volunteer and a handful of paid employees. About half were FF/EMTs, with only a few FF/ALS of any sort, and the others were either EMS or fire only. It worked pretty well, as nobody had to perform a job they didn't actually care about. Engines did respond to medical calls when they were closer than the nearest ambulance--and in that area, "closer" could make a difference of half an hour or more"--but the only FFs who engaged in patient care were the ones who were trained for it. Given the area, it made sense and worked well. But it had other issues... namely that convincing crusty old rednecks to keep skills current in either field can be really hard.

Another was a big city fire service which did great fire, and horrifying EMS. Riding the ambulance was required, and the FFs really resented it. They tended to express that pretty openly, even to patients. I'd support making EMS a third service there any day.

 

[DrParasite]

They also had a thriving, terrible third service.

out of curiosity, why were they terrible? was it due to being overworked and under paid, or was their clinical skill lacking due to lack of dealing with sick patients?

Engines did respond to medical calls when they were closer than the nearest ambulance--and in that area, "closer" could make a difference of half an hour or more"--but the only FFs who engaged in patient care were the ones who were trained for it.

again, bandaiding an under staffed EMS system with firefighters. how about putting an EMS unit at those fire stations, so when you have a time sensitive call (cardiac arrest, MI, CVA, major trauma, etc) you have a unit that can transport to definitive care (ie, an MD and/or surgeon) instead of just performing the circle of wait until EMS actually arrives?

This is the problem with the US EMS system, we have let the fire service in, and now that they "do ems" more funding gets sent their way (in the form of equipment, salaries, and units in service), and they get sent to "stop the clock" so they get their first and more EMS units don't need to be paid for or implemented to cover the area.

just for numbers, the ratio of fire calls to EMS calls is something like 4 EMS calls to every 1 fire call. yet, most fire departments have something like a 2:1 or 4:1 ratio of fire apparatus to EMS apparatus covering the same area. not everywhere, just most places. So EMS does much more calls than fire (subtracting the EMS runs that the FD goes on), yet they have fewer units to do the job.

And people wonder why EMS can't be considered an equal in the public safety field

 

[socalmedic]

...This is the problem with the US EMS system, we have let the fire service in, and now that they "do ems"...

lets not forget that LA county FIRE DEPARTMENT, Orange county FIRE DEPARTMENT, Seattle FIRE DEPARTMENT, and Miami FIRE DEPARTMENT where the original players in paramedicine. you didn't let the fire department into anything, we got there first.

 

[JPINFV]

It's just too bad that LACo and (if you mean OC, CA) OCFA haven't moved very far past the days of Jonny and Roy. Heck, they're still calling in and asking the base hospital for orders on everything worse than a stubbed toe.

 

[socalmedic]

JP- I couldnt agree with you more, however with soo many thousands of paramedics in LA county I can see why the med director wants to keep it restricted. there is no way to control that number of paramedics with such a vast experiance level (my long time mentor at LAFD just retired after 36 ish years as a medic, PTI class 3). orange county has no excuse they have maby 500-700 medics. for the record LAFD now has 60% of field employees trained to the paramedic level that is roughly 3500. ICEMA does have some good protocols, as well as reach and mercy air. look on the bright side, LA just got approved for IO. another thing to think about in LA and OC a TRANSPORTING ambulance in O/S in less than 8min 90% of the calls with an average transport time to the hospital of less than 10 min what all do you have time to do in the back.

for those of you not familiar with the LAcoFD system, the closest fire engine, the closest paramedic squad (pick-up truck with 2 paramedics), and the closest ambulance (dual EMT-B) gets dispatched. If the squad beats the engine they can cancel.

 

[JPINFV]

Encouragement of field termination of cardiac arrests and selective spinal immobilization (including expanding selective spinal immobilization to the EMT level) from the paramedics (since both of those are already options). Require the paramedics to obtain enough proficiency that anything that isn't worse than a stubbed toe gets base hospital contact (and, for the unfamiliar, a Southern California base hospital contact is essentially dictating the PCR over the radio to a MICN. 9 times out of 10 it's a complete waste of time). I would love to see crics done (last time I checked, it was in LA LEMSA's protocol, but not OC LEMSA's protocol) just because it's one of the handful of procedures that, when indicated, a 10 minute transport time is a long time.

 

[MrBrown]

If I have crushing chest pain or severe shortness of breath I am putting my foot on the gas and hoping I make it to Oregon man, seriously.

 

[terrible one]

for the record LAFD now has 60% of field employees trained to the paramedic level that is roughly 3500.

Dude where are you getting your numbers?!?!?
LAFD has just over 3500 TOTAL uniformed personnel and only 747ACTIVE paramedics

http://lafdtraining.org/ems-s/wp-content/uploads/2009/08/ems-history.pdf

There is NO WAY that OCFA has 500-700 paramedics either since OCFA is about 1/3 the size of LAFD. (too lazy to look up those numbers)

 

[46Young]

just for numbers, the ratio of fire calls to EMS calls is something like 4 EMS calls to every 1 fire call. yet, most fire departments have something like a 2:1 or 4:1 ratio of fire apparatus to EMS apparatus covering the same area. not everywhere, just most places. So EMS does much more calls than fire (subtracting the EMS runs that the FD goes on), yet they have fewer units to do the job.

And people wonder why EMS can't be considered an equal in the public safety field

People get hung up on the whole call volume/staffing thing with EMS vs fire. Suppression staffing and deployment objectives need to be met. True fire/rescue calls may be few and far between, but when they do happen, time is truly of the essence.

http://blog.iaff.org/post/2010/04/28/Fire-Fighter-Staffing-and-Deployment-Study-Released.aspx

http://www.youtube.com/watch?v=a_K-K6o5cGc

There may be only a few fires, a gas leak, CO, etc in an area each year. But if there is a delayed response, more than a few lives can be lost among other things. To say that fire suppression staffing and deployment should be pared back due to call volume shows ignorance of what fire suppression does and why an adequate, timely response is crucial regardless of call volume.

Now, I'd personally prefer to have more ambulances on the road, QRV's and such, rather than suppression pieces. This could be through an adequately third service EMS, or through the EMS division of the local FD, doesn't matter. The problem is that many local governments want to get by with as little EMS txp staffing and deployment as possible, regardless of the provider. That gives rise to ALS/BLS engines stopping the clock, etc. I see it all over the place. ALexandria Fire and EMS has only five ambulances at the present. Richmond Ambulance Authority does SSM to use as few buses and employees as possible. Charleston County EMS runs the bare minimum and uses FD EMS aid from MT Pleasant FD(ALS), Awendaw, James Island, St. John's, St. Andrews, Charleston City, North Charleston FD's, etc. FDNY EMS gets FDNY engines on many ALS jobs as an automatic dispatch as well.

 

[46Young]

JP- I couldnt agree with you more, however with soo many thousands of paramedics in LA county I can see why the med director wants to keep it restricted. there is no way to control that number of paramedics with such a vast experiance level (my long time mentor at LAFD just retired after 36 ish years as a medic, PTI class 3). orange county has no excuse they have maby 500-700 medics. for the record LAFD now has 60% of field employees trained to the paramedic level that is roughly 3500. ICEMA does have some good protocols, as well as reach and mercy air. look on the bright side, LA just got approved for IO. another thing to think about in LA and OC a TRANSPORTING ambulance in O/S in less than 8min 90% of the calls with an average transport time to the hospital of less than 10 min what all do you have time to do in the back.

for those of you not familiar with the LAcoFD system, the closest fire engine, the closest paramedic squad (pick-up truck with 2 paramedics), and the closest ambulance (dual EMT-B) gets dispatched. If the squad beats the engine they can cancel.

FDNY EMS has a similar problem. There's the FD, two privates, and a bunch of different hospitals providing 911 EMS txp in the city. As such, it's mother may I via a call to the doc-in-the-box for anything that requires deviation from the cookbook in the slightest. There are too many different providers, and each employer has different hiring and QA/QI standards.

 

[Shishkabob]

JP- I couldnt agree with you more, however with soo many thousands of paramedics in LA county I can see why the med director wants to keep it restricted. there is no way to control that number of paramedics with such a vast experiance level

Sure there is. Way more selective hiring, and a better FTO program.


If other cities can do it, why is LA the exception?

 

[JPINFV]

There is NO WAY that OCFA has 500-700 paramedics either since OCFA is about 1/3 the size of LAFD. (too lazy to look up those numbers)

I believe he was talking about all of OC, not just OCFA. However, if you're a paramedic in OC, you're a fire fighter. No way around that one as even the flight medic has a different title.

 

[Seaglass]

out of curiosity, why were they terrible? was it due to being overworked and under paid, or was their clinical skill lacking due to lack of dealing with sick patients?

Let me count the ways...

A great deal of attention to the bottom line at the expense of everything else, like decent equipment, employee education, salary, benefits, and sometimes even initiating care before getting an insurance card. Abusive supervisors, an extremely rigid pecking order, and a culture that fostered a complete lack of respect for patients didn't help. Their response times also somehow managed to be slower than fire even though they were often responding from a closer staging location.

again, bandaiding an under staffed EMS system with firefighters. how about putting an EMS unit at those fire stations, so when you have a time sensitive call (cardiac arrest, MI, CVA, major trauma, etc) you have a unit that can transport to definitive care (ie, an MD and/or surgeon) instead of just performing the circle of wait until EMS actually arrives?

Actually, the ambulances did run out of fire stations. The usual setup was one BLS engine, one ALS ambulance, and one ALS chase car. They went alone to medical calls most of the time. But if the ambulance was out on a call already, it could be a long time before the next station's could get there. So you'd send the engine, along with the chase car if warranted, while dispatching the closest ambulance. It wasn't all that common. Call volumes were low to begin with.

By total number of apparatus, or units in service, we had more EMS vehicles than fire suppression. A few stations also housed PD, but I don't know what the numbers looked like there. Some of them were trained as EMTs as well, but it was extremely rare that they acted as such. Law enforcement calls were way more common than fire, so it wouldn't make sense to tie those resources up unless both EMS and fire were already busy, which pretty much never happened.