Fire Trucks at medical scene

[socalmedic]

terrible one, my numbers come from Captain Wells, paramedic captain @EMS training division (now retired as of may). paramedic/engineres, paramedic/captains are not counted in their active medic count. what i said was 60% of personells are Trained to the paramedic level, not working as a paramedic, however they are allowed to perform ALS interventions as long as they are a paramedic. If i got my numbers wrong it is either 60% of 3500 or 60% is 3500, idk, your a big boy figure it out. the numbers are used more as an image of how many paramedics there are in this one system.

 

[DrParasite]

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.

agreed 100%. and true EMERGENCY medical calls are much more frequent, and ALL need an emergency room, not a fire truck

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

two links to union materials aren't good sources, esp when the last one is about a 4th FF on a truck company. they are biased (not that they aren't right, just biased).

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.

delayed responses in any field can result in loss of lives.

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.

this is the same fear mongering that unions use to say that every firehouse that closes will result in the loss of lives. It's not true. It DOES increase the chance, but that's the gambit the people in power make. It can be said that a certain hypothetical department has too much fire protection, and maybe they are right? no one ever says that.

The ideal situation is a firehouse with an engine, truck and rescue on every street corner, with 6 guys on each unit. that's ideal, but also not realistic. So the powers that be determine how many and where the suppression units should be located. again, above my paygrade.

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.

me too.

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.

and therein lies the problem.

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.

That's what I'm talking about. look at the majority of FD's, how many of their total runs are EMS based? I think for FDNY, they had something like 1.2 million runs last year, of which 800,000 were EMS related (I can't find the actual numbers off the top of my head). Imagine how often those fire suppression units are unavailable for fire jobs due to being on EMS jobs in their first due? and I know it is the same way all over.

as I said before (and you said also), municipalities want to get by with as little EMS as possible. THIS IS WRONG. This mentality needs to change. EMS should be staffed properly, to handle the call volume, as well as the peaks and surges. But they won't, and instead use the fire department to bandaid an understaffed EMS system, which costs more lives than fire related deaths, because a fire truck can't (well, shouldn't, some resort to) do what the patient needs, and that is transport to definitive care, which is a hospital ER.

thank you, you just supported the point I was trying to make.

 

[nomofica]

Here in Edmonton, Alberta, Canada, FD is always dispatched along with EMS on chest pain, respiration problems, falls or any other sort of call where there is a foreseeable need for some brute strength and many hands. That being said, all firefighters in Alberta are required to possess a valid Emergency Medical Responder (EMT-Basic) certification by the Alberta College of Paramedics and thus all firefighters are medical responders. Pretty sure this same concept of EMS and fire response is all across the board for Canada, though I cannot be certain as I'm extremely unfamiliar with the workings of the eastern provinces.

 

[DNR 1]

Nicely put sir!

 

[Dutch-EMT]

But when talking about money...
It is a lot cheaper to have an ambulance with an ambulancecrew than have a large fire engine with a couple firefighters...
I mean: an ambulance, completely equiped costs about €150.000,= MAX!
An fire engine costs €1.000.000,= minimum!
When EMS is in the FD. Why they don't buy an extra ambulance and sell one of the Engines? When most of the calls are EMS, it looks more logical in my oppinion. You save on a engine and on staff, and there is an extra ambulance on the roads...

 

[terrible one]

If i got my numbers wrong it is either 60% of 3500 or 60% is 3500, idk, your a big boy figure it out.

Not sure exactly what this means, but I did figure them out in my link. As for your 60% of 3500 personell are paramedics I even question that since there are only 747 paramedic positions in LAFD and once you promote to an engineer/captain you are not required to keep your P-card. Maybe your talking about 60% of 3500 are former and current paramedics I'm not sure but I highly doubt that over half of their personell has an active medic license especially when you don't even need an EMT card to get hired.

 

[dave3189]

Can't believe we are talking about this again?!

The point about privates doing it at no cost to the city is a moot point! Guess why that is, hmmmm because they are charging for the transports which is exactly what most F.D. BLS and ALS units do. That being said, there is still no cost to the taxpayers as a whole because the patients are paying the bills. As for the tax payer money savings issue goes, here we go again! For you EMS only people, I suggest you visit a Fire house and go on some ride alongs so you can see how rare fires are in the U.S. Most F.D.s run about 80% EMS calls. That being said, if they dont do EMS are they supposed to sit around all day and do nothing. Then someone is going to respond to this post that they should have less FFs and more EMS people working at the F.D. Not true, again complete ignorance as to Fire Operations. To use an analogy, we have had a lot of military people sitting around the world doing nothing throughout the years simply because when they are needed, we need a certain staffing compliment. It's the same with Fire Fighting. When there is a fire, we need FFs. The beauty is, that when not fighting fires, we can work EMS. It aint that tough to be cross trained in these two disciplines people. It always has to come down to the turf wars! Bottom line, spew all the stats and stories... at the end of the day you are kidding yourself if you are actually going to make the arguement that cross trained Fire/EMS isnt more effecient and a cost saver.

 

[JPINFV]

However, why EMS? Have the fire department take over part of the parks department. Unlike EMS calls, when a fire or extrication call comes in, the fire department can easily leave the grass half cut, however they can't leave the EMS call. Similarly, when there is a fire call and all of the paramedics are working the fire, who is left to respond for EMS calls? Opps, sorry. All of the engines were at a fire, so it took 30 minutes longer for mutual aid to arrive. Hope that extra heart muscle that died during your MI was worth the non-savings of the fire department running EMS.

Additionally, I'll argue that to provide competent prehosptial medical care is harder than most people want to admit. Thankfully, most EMS providers are happy with the responsibilities of being a para-technician following cookbook protocols and procedures instead of being actual prehospital professionals. I personally refuse to be a para-technician, which is why I'm on the road I'm currently on.

Also, when 80% of your calls are EMS, you're an EMS department that fights fires, not a fire department that does EMS.

 

[46Young]

The point about privates doing it at no cost to the city is a moot point! Guess why that is, hmmmm because they are charging for the transports which is exactly what most F.D. BLS and ALS units do. That being said, there is still no cost to the taxpayers as a whole because the patients are paying the bills. As for the tax payer money savings issue goes, here we go again! For you EMS only people, I suggest you visit a Fire house and go on some ride alongs so you can see how rare fires are in the U.S. Most F.D.s run about 80% EMS calls. That being said, if they dont do EMS are they supposed to sit around all day and do nothing. Then someone is going to respond to this post that they should have less FFs and more EMS people working at the F.D. Not true, again complete ignorance as to Fire Operations. To use an analogy, we have had a lot of military people sitting around the world doing nothing throughout the years simply because when they are needed, we need a certain staffing compliment. It's the same with Fire Fighting. When there is a fire, we need FFs. The beauty is, that when not fighting fires, we can work EMS. It aint that tough to be cross trained in these two disciplines people. It always has to come down to the turf wars! Bottom line, spew all the stats and stories... at the end of the day you are kidding yourself if you are actually going to make the arguement that cross trained Fire/EMS isnt more effecient and a cost saver.

That sounds about right.

As for the whole crosstraining debate, I suppose that the single minded people feel belittled to an extent when they see people doing their job along with another. Granted, there are quite a few that get the P-card just for an easy in with a FD, and did the bare minimum to pass, but that's not the argument. The argument is whether or not one can do fire and EMS and be good at both. I haven't heard one good argument as to why you can't, just vague offerings such as "you're spreading yourself too thin," or "they're different skills sets." Irrelevant. Some folks are just going to have to swallow that it's not that difficult to be proficient in both fire and EMS as a combined career in this country. It's not to slight single minded medics, it's important work and not everybody can get through the EMT-P program, but I found the program to be less than challenging.

Think about it. An EMT-P program typically lasts from 6 months to 2 years. A typical fire academy that trains FF1 and FF2 lasts from four months to six months. That's two and a half years of education/training. that's about the same amount of time it takes to get an RN degree, let alone a BSN. In addition to that, medics either come to the FD with P-card in hand, or are detailed out of ops to focus solely on the medic program. If you have experience as a medic prior to being hired by a FD, then all the better! Also, many large FD's regularly schedule companies for OOS training, This can be company ops, multi unit drills, whatever. This is in addition to doing a few daily drills at the station each day while in service. Maybe pump ops, ropes, throwing ladders, building preplans and walkthroughs, various powerpoints on the numerous operating manuals such as high rise, garden apts, strip shopping centers, gas leaks/meters, etc. This is all on duty, remember? Add EMS drills and scheduled ConED, either on an off day or preferably on duty and OOS. EMS runs more calls, so we're keeping our skills sharp through repetition, right?

 

[MrBrown]

If I need an Intensive Care Paramedic (ALS) at one am for some guy upside down in a ditch or on his floor struggling to breathe who needs intubating then I have total faith in the Officer who comes towards me.

Why? because he is not a Para-technician with a big thick cookbook and piss poor education. Our Intensive Care Paramedics (well, all our Ambulance Officers) are amongst the most highly educated and experienced in the Western world and many already have, and will be required to obtain, a Bachelors (Paramedic) or Advanced (ICP) degrees in Paramedicine.

They have the knowledge and experience to be autonomous practitioners of advanced prehopsital medicine and not follow a recipe book which is devised for the lowest common denominator (read: biggest clinical risk) to follow.

 

[46Young]

However, why EMS? Have the fire department take over part of the parks department. Unlike EMS calls, when a fire or extrication call comes in, the fire department can easily leave the grass half cut, however they can't leave the EMS call. Similarly, when there is a fire call and all of the paramedics are working the fire, who is left to respond for EMS calls? Opps, sorry. All of the engines were at a fire, so it took 30 minutes longer for mutual aid to arrive. Hope that extra heart muscle that died during your MI was worth the non-savings of the fire department running EMS.

Additionally, I'll argue that to provide competent prehosptial medical care is harder than most people want to admit. Thankfully, most EMS providers are happy with the responsibilities of being a para-technician following cookbook protocols and procedures instead of being actual prehospital professionals. I personally refuse to be a para-technician, which is why I'm on the road I'm currently on.

Also, when 80% of your calls are EMS, you're an EMS department that fights fires, not a fire department that does EMS.

In areas with mutual aid, unless you're in Detroit, it's highly unlikely that there are no engines available during simultaneous box alarms. Good depts plan for this. Relocations are effective, and we go to condition two or three if call volume surges. We push back all the low priority calls, and also scale back suppression responses, A report of fire may get two engines and a truck instead of 4 engines, two trucks, a rescue, a medic unit, BC and EMS supervisor. If it's legit, then they'll fill the box. As it stands, our fire and EMS deployment is adequate to withstand call surges. EMS Capt's can also respond to EMS runs instead of engines if they're tied up.

A suppression unit could just as easily be tied up at an alarm bell, cut job, or a gas leak when a box alarm comes through, as they could on an EMS run. And haven't studies shown that ALS first response has neither been proven nor disproven to affect pt outcomes? Unless it's something time sensitive or labor intensive, the medic crew could always release the suppression unit if feasible to run a fire. Can't do that on a suppression call, but it can be done in EMS if it's not going to harm the pt. I did just fine back in NY with just me and my partner, I'm sure the medic crews here will be okay as well in most cases. How many cases are really time sensitive, needing more than a crew of two? Maybe like 5%?

As far as the low educational standards in EMS, go complain to every employer that hires those without degrees, which include every type of delivery model, not just fire.

 

[dave3189]

The Parks Dept. analogy is silly, I won't even dignify it with a response. As far as your issue with running out of resources, again silly and moot! You could run out of resources regardless of them being fire, EMS or cross trained as both. As far as the cookbook issue, sounds like a CA problem? All I hear is how CA Medic protocols are cookbook. I got news for ya, it aint a Fire problem it's a CA problem. In WA state, we aren't cookbook and we have some of the most progressive and best (Fire Based) Medic resources in the world. Brown, you're spewing the same tired nonsense you've been saying for months! I hate to tell you, but nobody knows or really cares about the N.Z EMS system! With such a supposedly great program, don't they have any network sites over there?

 

[46Young]

If I need an Intensive Care Paramedic (ALS) at one am for some guy upside down in a ditch or on his floor struggling to breathe who needs intubating then I have total faith in the Officer who comes towards me.

Why? because he is not a Para-technician with a big thick cookbook and piss poor education. Our Intensive Care Paramedics (well, all our Ambulance Officers) are amongst the most highly educated and experienced in the Western world and many already have, and will be required to obtain, a Bachelors (Paramedic) or Advanced (ICP) degrees in Paramedicine.

They have the knowledge and experience to be autonomous practitioners of advanced prehopsital medicine and not follow a recipe book which is devised for the lowest common denominator (read: biggest clinical risk) to follow.

Like I told JP, blame each and every employer that chooses to hire without an EMS degree for the lack of educational standards. Outside of Oregon, the percentage of employers requiring degrees to be hired are likely in the single digits. The best we have clinically in the U.S. is the EMS AAS, which is basically a mill with A&P, pharm, ENG, and PSY thrown in, for the most part.

 

[JPINFV]

"you're spreading yourself too thin," or "they're different skills sets."

It's ironic, though, because those are the exact arguments the fire department uses against combining fire with law enforcement. I'd argue that hoses, pumps, and ladders have as much to do with handcuffs and side arms as they do with IV catheters and cardiac monitors.

EMS runs more calls, so we're keeping our skills sharp through repetition, right?

Provided not every apparatus is an ALS response unit with everyone on each apparatus is a paramedic. Unfortunately, 2006 was the last time Orange County LEMSA posted an annual report (and, no, I'm not going to add up the calls from the 4 quarterly reports in 2007). Call volumes for paramedic units (paramedic units are limited to the fire departments, which makes it an easy comparison), ranged from 1265 to 0 calls in 2006 (note: I was originally going to just report a few low digit numbers along side the lowest decent sized call volume, which I was hoping to be at least in the hundreds, in case it was a special situation, however there were too many units in the single digits to just ignore the single/null digit units. Additional note, I'm not counting the out-of-county units that did mutual aid calls, so I ignored the LA County Fire count). Exactly how sharp are the skills of the medics on the units running 0 calls or a handful (under 10) calls in a year? Yes, they most likely rotate, but doesn't the fact that they are rotating from units that run, on average, 3.5 calls a day to a unit that runs zero calls in a year drastically dilutes the individual provider's call volume that much more?

 

[46Young]

The Parks Dept. analogy is silly, I won't even dignify it with a response. As far as your issue with running out of resources, again silly and moot! You could run out of resources regardless of them being fire, EMS or cross trained as both. As far as the cookbook issue, sounds like a CA problem? All I hear is how CA Medic protocols are cookbook. I got news for ya, it aint a Fire problem it's a CA problem. In WA state, we aren't cookbook and we have some of the most progressive and best (Fire Based) Medic resources in the world. Brown, you're spewing the same tired nonsense you've been saying for months! I hate to tell you, but nobody knows or really cares about the N.Z EMS system! With such a supposedly great program, don't they have any network sites over there?

NYC, the largest EMS system in the country, has been all about the cookbook since way before the fire merger, and it's the same now. The syetem has hospital based, a couple of privates, and of course FDNY EMS, which are 100% single role EMS for txp. My old medic gig down in Charleston was single role county third service, and they were cookbook as well.

I agree, that Parks Dept analogy was weak. I'm waiting for someone to mention FF/garbage men, or the PSO's. That always gets dragged up.

 

[dave3189]

And of course this debate wouldn't be complete without the tired, ignorant, silly and overused Fire/Law Enforcement contention!? For those of you out there that can't see that the relationship with Fire/Rescue and EMS is obviously symbiotic in contrast to Law Enforcement... well, I'm not sure your reasoning abilities are as sharp as your EMS abilities hopefully are???

 

[JPINFV]

And haven't studies shown that ALS first response has neither been proven nor disproven to affect pt outcomes? Unless it's something time sensitive or labor intensive, the medic crew could always release the suppression unit if feasible to run a fire. Can't do that on a suppression call, but it can be done in EMS if it's not going to harm the pt.

1. I'd argue that patient outcomes matter besides life and death. Yes, an EMT crew can load and go the reactive airway disease patient with likely no long term harm, however I'm willing to bet that the patient would absolutely love to have an albuterol treatment now instead of 10-15 minutes from now. They might not die from lack of a treatment, even if they feel like they're about to suffocate. Similarly, narcotic pain control doesn't save lives, however I'd argue that it's barbaric to deny a patient pain control because all of the paramedics were doing their other job.

1.2 Heck, there are studies that show that BLS doesn't save lives over POV transport. Let's get rid of ambulances to begin with. Is there any study that shows that anything besides an attendant trained to CPR/AED saves lives? So EMS doesn't save lives. Homeboys delivering their shot-up homies themselves to the ED saves lives.

2. You're assuming that there are paramedics on the ambulance when plenty of systems just have paramedics on engines. Are you going to release the fire engine to go fight a fire with just 2 fire fighters on it?

As far as the low educational standards in EMS, go complain to every employer that hires those without degrees, which include every type of delivery model, not just fire.

I have yet to see the privates release a "Private Ambulance, The Right Response" chest beating video. You (the fire service) wants to claim that you're the "right response" fine, live up to it. However the US Fire Administration doesn't even believe that instructors need to have an education. Do I need to post their little chart again?

 

[46Young]

It's ironic, though, because those are the exact arguments the fire department uses against combining fire with law enforcement. I'd argue that hoses, pumps, and ladders have as much to do with handcuffs and side arms as they do with IV catheters and cardiac monitors.



Provided not every apparatus is an ALS response unit with everyone on each apparatus is a paramedic. Unfortunately, 2006 was the last time Orange County LEMSA posted an annual report (and, no, I'm not going to add up the calls from the 4 quarterly reports in 2007). Call volumes for paramedic units (paramedic units are limited to the fire departments, which makes it an easy comparison), ranged from 1265 to 0 calls in 2006 (note: I was originally going to just report a few low digit numbers along side the lowest decent sized call volume, which I was hoping to be at least in the hundreds, in case it was a special situation, however there were too many units in the single digits to just ignore the single/null digit units. Additional note, I'm not counting the out-of-county units that did mutual aid calls, so I ignored the LA County Fire count). Exactly how sharp are the skills of the medics on the units running 0 calls or a handful (under 10) calls in a year? Yes, they most likely rotate, but doesn't the fact that they are rotating from units that run, on average, 3.5 calls a day to a unit that runs zero calls in a year drastically dilutes the individual provider's call volume that much more?

Our Fire Marshalls all go to our county's full fire academy and then additional training in detective work. No one's had a problem with that, as far as I know. Soe are medics as well, ans continue to do OT in the field in either role and have had no issues.

The convenient thing for us is that most PD's don't want to merge with fire and vice versa. The deployment for EMS and fire are more similar than either one with PD, so fire/EMS makes sense to that end.

I don't know much about L.A. but when I worked in Charleston, medic 10 and medic 6 were so slow (rural ends of the county)that they may get one call, or maybe none whatsoever in a 24 hour period. Considering how few of our pts require anything past V.O.M.I.T. how many good calls are they seeing? I'm sure this is the case in other areas as well in rural regions.

 

[dave3189]

Wow, JP... I'm an educated Man... but I'm afraid I can't make heads nor tails of that last rant!? Huh?

 

[JPINFV]

The Parks Dept. analogy is silly, I won't even dignify it with a response.

Really? Why should fire fighters respond to EMS calls any more than requests from the Parks Department? A shovel has more to do with fire fighting than an IV and cardiac monitor.

As far as your issue with running out of resources, again silly and moot! You could run out of resources regardless of them being fire, EMS or cross trained as both.

As far as the cookbook issue, sounds like a CA problem? All I hear is how CA Medic protocols are cookbook. I got news for ya, it aint a Fire problem it's a CA problem. In WA state, we aren't cookbook and we have some of the most progressive and best (Fire Based) Medic resources in the world.

California has a strong regional system with regional (county) protocols. I originally worked in an area where the only paramedics were with the fire department except for the few "air ambulance attendant" (they weren't issued county accreditation to work as "paramedics") flight paramedics. Tell me again how the cookbook protocols are anyone but the fire department's fault? Similarly, I like how you have to specify that it's the best "fire based" system.

Brown, you're spewing the same tired nonsense you've been saying for months! I hate to tell you, but nobody knows or really cares about the N.Z EMS system! With such a supposedly great program, don't they have any network sites over there?

Strange, I thought that this was an EMS site, not an United States EMS site.