Fire Trucks at medical scene

[JPINFV]

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???

How, exactly, is it symbiotic? What relationship does fighting fires have with the provision of prehospital medical care again short of, "Hey, we're sitting around anyways."

 

[JPINFV]

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.

Last I checked, KC/MAST didn't want to merge either, but that didn't stop the fire service/IAFF.

 

[46Young]

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?


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?

Reactive airway, APE, STEMI, and the like would be cases where the engine stays on scene. If the dept only has engine medics, then they need to allow for the engine medic riding to the hospital, and plan accordingly regarding staffing/deployment.

I'm not sure that many representing delivey systems outside the fire service care if instructors are educated or not, either. It's proven each and every time an employee is hired with less than an EMS degree.

That right response line is quite effective. Since we've had no real opposition to it, we'll keep using that angle. It seems to be working. Good for job security.

I kile the homeboy delivery system. Really, all we're needed for are true cardiac/respiratory issues, and for those that truly can't move under their own power. Most others would be better off going by POV, ambulette, or by actually walking if the hospital is a few blocks away. The time lost in calling 911, driving to the scene, getting to the pt, doing the assessment, and packaging them is way more than if they got in a cab or had someone just drive them.

 

[46Young]

Last I checked, KC/MAST didn't want to merge either, but that didn't stop the fire service/IAFF.

Well, one wanted to. I was talking about both parties having a mutual interest in staying seperate.

 

[JPINFV]

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

This might help.

http://www.fireserviceems.com/videos.php

2 part video from a medic turned physician debunking IAFF, et. al. claims.

http://www.youtube.com/watch?v=kEpcMyM8_0c

http://www.youtube.com/watch?v=ad80GcWSJC0

On a side note, I sent a request a few years ago for IAFF et. al. source for their claims. They never responded.

 

[dave3189]

OK JP, although obvious to all viewing, here we go with the Parks Dept. issue. Ya see Fire and EMS are part of Emergency Services... and the Parks Dept isn't... see? Get it now? The problem with using an analogy to make a point is that it actually needs to be analogous My point about CA, is that I hear that its cookbook all the time. Since we don't have that problem here in WA, I'm assuming it’s a CA problem. And finally, and strangely, you ask why I throw in "Fire Based" in my argument. Well, again... here it goes so try to keep up... we have been debating fire based EMS vs. non-fire based? Weird that I would make a point about that???

 

[46Young]

How, exactly, is it symbiotic? What relationship does fighting fires have with the provision of prehospital medical care again short of, "Hey, we're sitting around anyways."

An increase of net utilization of otherwise idle crews, which allows cost savings in hiring/payroll. Similar deployment structure as well. It comes down to $$$, of course. It ultimately does in most cases.

 

[socalmedic]

PSO (public safety officer= FF/PO/PM) has been tried and has failed. I currently only know of one city left in the state of CA that has PSO (it is in the bay area, i will have to look it up in the morning), and they don't even work as both, they specialize in FF/PM or PO.

JP you have sparked my interest, could you provide a link for that info. i am curious as to what units those are that arent running any calls, I can think of a few off the top of my head that are 1-2 per day but none that run slower than that. you also have to remember that they are staged based on response time not unit call volume, if they where transporting medic units they would still be stationed there and run just as many calls.

 

[JPINFV]

Reactive airway, APE, STEMI, and the like would be cases where the engine stays on scene. If the dept only has engine medics, then they need to allow for the engine medic riding to the hospital, and plan accordingly regarding staffing/deployment.

Of course to do so also throws the entire, "We save lives while saving you money" argument out of the window. Isn't cost effectiveness the huge argument for EMS based fire suppression? You're no longer taking fire fighters who are just sitting around doing nothing and having them respond, you're hiring more providers and having everyone sit around on average just a little bit less (normally due to an over response.), however with still more proverbial mouths to feed.

I'm not sure that many representing delivey systems outside the fire service care if instructors are educated or not, either. It's proven each and every time an employee is hired with less than an EMS degree.

However how many services besides the fire service have come out publicly and said, "We don't need any education outside of management."

I kile the homeboy delivery system. Really, all we're needed for are true cardiac/respiratory issues, and for those that truly can't move under their own power. Most others would be better off going by POV, ambulette, or by actually walking if the hospital is a few blocks away. The time lost in calling 911, driving to the scene, getting to the pt, doing the assessment, and packaging them is way more than if they got in a cab or had someone just drive them.

I'll largely agree that plenty of people who call 911 should transport themselves. However how many people who should be calling 911 are we going to allow to be persuaded to not call to cut down on abuse?

 

[LucidResq]

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???

Just to throw in something here... I'd like to point out that I see PD calls evolving in to medical calls much more than I see Fire calls becoming medical.

I can't tell you how many times I've seen a PD call for an assault, welfare check, domestic, etc etc end up being sent over for an EMS response or an ambulance transport for a mental health hold. I have yet to see any of the various structure fires, alarms, lockout assists, water problems, etc require an EMS response beyond the standard stand-by on fire scenes...

MVAs are in a different realm because they always get at least a PD response.... at least around here Fire only goes if there's a reason like injuries, damage to structure, leaking fluids, trapped parties, etc... even in that case police almost always beats Fire to the scene.

So the "Symbiotic Relationship" between Fire and EMS is not any more obvious than that between LE and EMS, in my opinion. Yes, you can point out the rare technical rescue where it's helpful to have the front line rescuers also trained to a higher level of medical care as well, but those calls are rare (and even rarer are the calls that having a paramedic, for example, involved in the initial rescue efforts is even useful) and there's no reason strictly EMS providers can't participate in such rescues with additional training.

 

[dave3189]

Wow, a couple youtube videos! Now I've been put in my place! You mean you were able to scour the internet and find something to support your contention? Gee, If only I could find something to support Fire Based EMS?
I mean for God Sakes, if you want to start playing the cheese ball game, 60 Minutes said back in 1974 that with Seattle Fire's Medic One program, that Seattle was the best place in the nation to have a heart attack.

 

[dave3189]

Gee JP, I wasn't aware that FFs do nothing other than supression? Vehicle extrication, confined space rescue, high angle rescue, low angle rescue, Haz Mat?

 

[JPINFV]

PSO (public safety officer= FF/PO/PM) has been tried and has failed. I currently only know of one city left in the state of CA that has PSO (it is in the bay area, i will have to look it up in the morning), and they don't even work as both, they specialize in FF/PM or PO.

JP you have sparked my interest, could you provide a link for that info. i am curious as to what units those are that arent running any calls, I can think of a few off the top of my head that are 1-2 per day but none that run slower than that. you also have to remember that they are staged based on response time not unit call volume, if they where transporting medic units they would still be stationed there and run just as many calls.

Sorry about that... I meant to include it in the bottom of that post.

http://www.ochealthinfo.com/docs/medical/ems/2006_annual_system_activity_report.pdf

PDF page 8-11 (report page 7-10 due to table of contents not being a "page")

I'm sure that some of the units are temporary units to replace apparatuses that went out of service, however I felt that there's just too many to argue that for every single digit response unit.

 

[JPINFV]

Wow, a couple youtube videos! Now I've been put in my place! You mean you were able to scour the internet and find something to support your contention? Gee, If only I could find something to support Fire Based EMS?
I mean for God Sakes, if you want to start playing the cheese ball game, 60 Minutes said back in 1974 that with Seattle Fire's Medic One program, that Seattle was the best place in the nation to have a heart attack.

If you can't see the difference between a piece in 1974 and a contemporary piece, then I don't see any reason to continue discussing anything with you. You wanted to know where that argument was coming from and I provided said source (unless, of course, the various fire organizations end up throwing their icons on everything) as well as a rebuttal. Do you have anything to argue counter to the rebuttal besides the fact that it's on Youtube?

 

[MrBrown]

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.

Also blame the majority of employees who don't see value or the importance of advanced education.

 

[socalmedic]

JP- good report. I hove some info on the low numbers though.

first those are not the number of responses those are the numbers of ALS Transports (no not transports where a paramedic rides in, a transport where an "ALS skill" is utilized beyond assessment, IV and ECG 3 or 12 lead). further more many of those are units that are not usualy staffed as MEDIC. they may have been used as a medic because of staffing shortage or because there where other engines out of county on wildfires ect. below i have listed some of the "outliers" and the lease utilized actual ALS units

Anaheim 4-3, 4-4, 1-1 i have no idea what these units are as they use medic engines and contract with CARE ambulance for transport.

fountain valley truck 31 this is primarily a BLS unit however it is stationed with an ALS engine and the FF/PM can rotate making both units ALS

Garden Grove engine 2R is a reserve engine, the primary engine for that station was most likely in the shop. E3, E6, E7 primarly BLS however are stationed with ALS ambulances which allow FF/PM to rotate making both units ALS.

LAcoFD- only squad 191 is ALS Transporting, and they only reported calls ran in orange county. (to all of you out of the area, a few citys in Orange county have contracted for fire serviced from LA county fire causing these medics to respond to both LA and Orange county, they hold accreditation in both countys and follow their respective protocol)

Orange City some engines are ALS some are BLS however there is an Ambulance at the majority of the stations so they usualy make the call in since they are the transporting unit they get the count.

OCFA- heres the big list, unless it says MEDIC it is BLS the lowest numbers for ALS engines where 189 for E9 and 157 for E57. these are both in semi secluded affluent areas where the majority of the residents will transport themselves.

so with 157 being the actual lowest number for actual ALS units, i agree that one ALS skill every other call isnt enough to keep skills sharp, but lets be honest its Orange County what can they do anyway. it is a good report and i can see how the unit numbering can get confusing.

 

[JPINFV]

A few quick comments.

I wonder if Anaheim 4-3, 4-4, and 1-1 are their Downtown Disney units since they aren't engines.

LACo. I actually didn't realize that LACo ran primary units in OC. I just figured that they were mostly mutual aid calls and ignored LACo statistics completely (I'll admit to being biased, but at least I try to be fair when it comes to things like this). Which, of course, also confused me as to why they were included since mutual aid calls are done via home county protocols and procedures, including base contact.

My one comment on OCFA is that the report only discusses paramedic, not EMT, transports, so the multiple zeros at best, then, were EMT units that temporarily went online as paramedic units and were never utilized. While some slack is a good thing, too much excess resources is not. I was going to comment about Medic 27, but I just looked them up on OCFA's website and they opened in 2007, which would make sense if the unit was licensed, but not operational at the end of 2006. Their 2009 volume, per OCFA's website, was 397 for everything (no breakdown between fire, extrication, EMS, etc or "medic van" [which destroys the cost argument alone, but that's a separate rant about running ambulances and not using them for transport] vs engine).

 

[socalmedic]

hahaha, yea the whole medic van concept is lost on me. they have full stocked ambulance staffed with 2 FF/PM but dont transport... they are now buying type 3 mods to use as medic vans. at least LAcoFD uses pickup trucks. you have to remember for the cost utilization that many of these citys will low call volume are either because they want to feel exclusive and can afford to pay for the fire engine for only their neighborhood, or it is a PCF/volunteer engine which cost relatively nothing to have (for instance station 3, sunset beach)

 

[Shishkabob]

Gee JP, I wasn't aware that FFs do nothing other than supression? Vehicle extrication, confined space rescue, high angle rescue, low angle rescue, Haz Mat?

Dave---
http://atcemsce.org/home/index.php?...n-the-austin-travis-county-ems-team&Itemid=27


You don't need fire to do ANY type of rescue. Period.

Yes, you can point out the rare technical rescue where it's helpful to have the front line rescuers also trained to a higher level of medical care as well, but those calls are rare (and even rarer are the calls that having a paramedic, for example, involved in the initial rescue efforts is even useful) and there's no reason strictly EMS providers can't participate in such rescues with additional training.

And that, my friends, is exactly what ATcEMS does, and they do it damn well from anyone you may ask, and they are a 3rd service that will NEVER be combined with fire. Each department knows it's role down there. Fire as first response, EMS as, well... medicine.




Dear dave:

That is all.

 

[JPINFV]

hahaha, yea the whole medic van concept is lost on me. they have full stocked ambulance staffed with 2 FF/PM but dont transport... they are now buying type 3 mods to use as medic vans.

Seriously? What the hell? I always found it queer (damn it, I'm reclaiming this word for it's original meaning. I like this word for it's original meaning, it just fits too well sometimes) that, at least when I worked in OC, cities like Santa Ana were running the huge medium duty ambulances while cities like Newport Beach were running regular type 3s. At least both SA and NB both transported themselves instead of having a private company come in and handle transport.