Fire Trucks at medical scene

[dave3189]

Wow Linuss, that was quite a witty burn! So let me guess? hmmmm... since you're arguing against Fire Based/EMS does that mean you're not a FF? I'm quite the astute observer aren't I? You gotta be kidding me?

JP, the point with youtube was to simply point out that (especially these days) it isn't difficult to find many viewpoints to support your argument. We could go back and fourth all day sharing sources, much the way it is done with debate on the economy and politics.

What I find funny is how you guys are such haters when it comes to Fire. While I am an advocate of fire based EMS (and I'll admit it partly has to do with the fact that i work in it) I don't think that the non fire based EMS folks are any less skilled are qualified. I just like the system better. Although there is no empirical evidence to show F/B EMS are any less skilled are efficient than their counterparts, I continue to see the hater-ism on here. Really does beg the question if there are some sour grapes cause someone couldn't get hired as a FF?????

 

[dave3189]

Hey JP, off the heated debate for a while, what is the idea behind the Medics in SO Cal not transporting? I have a buddy that works for Care AMB out there and he was telling me that he transports ALS with a Medic in a Care Rig. So different than here, our Medics tx themselves. It just seems easier to be in an ALS rig with all your meds, etc. thoughts?

 

[46Young]

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.



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.

I'm trying to understand exactly to what extent that ATcEMS operates at tech rescue and Hazmat incidents. From the link you provided, it says that they provide medical care in the various rescue situations. That's not the same as being able to set up lowering systems, shoring for trenches and building collapses, for example. Besides, you need a truck to be able to position a stokes basket for a high angle rescue, anyway.

Same for Hazmat. It says that they integrate into hazmat incidents with the AFD Hazmat team. Being able to go on air, set up a decon station and carry a four gas meter is only scratching the surface on a Hazmat.

I don't know about other depts, but in ours our rescues are either hazmat or TROT (tech rescue) equipped. They're rolling toolboxes. ATcEMS has these, and they train their people to use all that, without fire involvement? If not, then you do in fact need fire for rescues.

 

[JPINFV]

JP, the point with youtube was to simply point out that (especially these days) it isn't difficult to find many viewpoints to support your argument. We could go back and fourth all day sharing sources, much the way it is done with debate on the economy and politics.

I'd agree if Dr. Ex-Medic (I'm not sure if he posts here, but he posts on a handful of other forums) didn't cite everything he used to counter while the FD video didn't cite anything if I recall correctly.

Really does beg the question if there are some sour grapes cause someone couldn't get hired as a FF?????

Only if I can ask the question if paramedics are self-loath because they couldn't get into medical school.

 

[46Young]

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.


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




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?

We know that the vast majority of EMS systems use the bare minimum amount of ambulances to cover call volume. SSM is the most extreme example of this. What I'm saying is that good depts staff and deploy adequately. Sure, a private can come in and say that they can do it for less, but how drastically are they cutting corners to fufill that obligation? Less units? Poorer equipment? Fewer employees? Employees with much lower average experience due to high turnover caused by substandard compensation, benefits and working conditions?

As far as hiring more and having them sit around a little less, it isn't the case. In my dept, we have X amount of positions for each function. EMS txp gets a certain number, as does suppression staffing, Hazmat, TROT, fire investigations, the academy, admin, etc. For EMS, the medic in an EMS job slot may also do suppression work, but then the engine medic also does transport. It evens out. What's important is that there are two spots, staffed by two people. They may flip flop, but it's still two spots. Where the cost savings come in is with hiring and schedule gaps. If each side was seperate, more OT would be generated since there are less people that are qualified for each spot. Also, with ALS first response, less txp units are needed. That's using relatively idle suppression personnel instead of hiring more txp personnel. Upstaffing EMS txp would be ideal, but it's not the most cost effective route.

No one else has publicly downplayed the importance of education, but no one is advocating for it, either.

The problem with systems that have a "no need for EMS" disposition where the crew can deny txp due to no medical necessity is that it only takes one major lawsuit to derail the program.

 

[46Young]

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.

That's actually a good point. We're often called for a suspected drunk, an EDP, an assault victim, MVA pts, the decedent, prisoners that feign Cx pain, dyspnea and such in an attempt to delay a court appearance.

 

[46Young]

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

The reason for that, for the most part, is that most employers don't require a degree, so many don't bother taking the extra time to get one, since time is money. Literally, the extra time is lost revenue.

 

[46Young]

Wow Linuss, that was quite a witty burn! So let me guess? hmmmm... since you're arguing against Fire Based/EMS does that mean you're not a FF? I'm quite the astute observer aren't I? You gotta be kidding me?

JP, the point with youtube was to simply point out that (especially these days) it isn't difficult to find many viewpoints to support your argument. We could go back and fourth all day sharing sources, much the way it is done with debate on the economy and politics.

What I find funny is how you guys are such haters when it comes to Fire. While I am an advocate of fire based EMS (and I'll admit it partly has to do with the fact that i work in it) I don't think that the non fire based EMS folks are any less skilled are qualified. I just like the system better. Although there is no empirical evidence to show F/B EMS are any less skilled are efficient than their counterparts, I continue to see the hater-ism on here. Really does beg the question if there are some sour grapes cause someone couldn't get hired as a FF?????

It's more so that we're taken care of better. Even if I had little interest in fire, I probably would have gotten into fire based EMS just for that reason. Same exact job, for much more in pay, retirement, etc. if I trade out with others that want to ride an engine most of the time. Also, I can promote off of the street much quicker in a fire based system. Two promotions and only five years on the job, and I can become an EMS LT and teach at the academy FT. In EMS only, the odds are that I would be riding the box until I retire or go out on disability.

 

[46Young]

Only if I can ask the question if paramedics are self-loath because they couldn't get into medical school.

The bitterness may be because they're stuck, and can't really go into anything else without going into debt.

 

[dave3189]

Treating a patient as a duel role EMS/Law Enf. Officer has inherent problems that anyone who has been on this job for a while has seen. Telling a suspected O/D patient "I'm not the police, you need to tell me what you took so I can treat you"... How is that going to work when you're a cop? Trying to treat the patient/suspect that you as the cop just tased or used force on? Again, good luck with that. And then there would always be the argument that the EMT/Police Officer didn't try to resuscitate the suspect/Patient that shot at or shot an officer? Bottom line, this concept of L.E./EMS duel role is ripe with problems, perceptions, and conflicts.

 

[dave3189]

Not sure what comparing a Medic to an M.D. has anything to do with what environment or system an EMT or Medic works in? ;|

 

[JPINFV]

Hey JP, off the heated debate for a while, what is the idea behind the Medics in SO Cal not transporting? I have a buddy that works for Care AMB out there and he was telling me that he transports ALS with a Medic in a Care Rig. So different than here, our Medics tx themselves. It just seems easier to be in an ALS rig with all your meds, etc. thoughts?

I've always been of the opinion that if you want to run EMS, run the entire thing. As such, the vast majority of EMS in the Greater LA Area (since the medics on the engine, private company provides 2 EMTs and an ambulance is common in both LA and OC areas) has always made absolutely zero sense to me.

 

[JPINFV]

The bitterness may be because they're stuck, and can't really go into anything else without going into debt.

What's wrong with debt if you're getting a degree that isn't along the lines of ethnic studies? If the only people who went to graduate professional schools (law school, medical school, pharmacy school, etc) were people who could pay out of pocket, there would be a lot less physicians, lawyers, pharmacists, etc.

 

[JPINFV]

Not sure what comparing a Medic to an M.D. has anything to do with what environment or system an EMT or Medic works in? ;|

About as much as implying that the only reason people are against EMS based fire suppression is because they can't become fire fighters.

 

[Shishkabob]

Wow Linuss, that was quite a witty burn! So let me guess? hmmmm... since you're arguing against Fire Based/EMS does that mean you're not a FF? I'm quite the astute observer aren't I? You gotta be kidding me?

Hmm.. who said I wasn't an FF? Do you have any evidence of such that I'm not involved with a fire department in any way? Hell, who said I was totally against ever being an FF?


I was just pointing out your clear and obvious bias in the fact that makes every argument you type laughable at being called an "argument".

 

[LucidResq]

What I find funny is how you guys are such haters when it comes to Fire. While I am an advocate of fire based EMS (and I'll admit it partly has to do with the fact that i work in it) I don't think that the non fire based EMS folks are any less skilled are qualified. I just like the system better. Although there is no empirical evidence to show F/B EMS are any less skilled are efficient than their counterparts, I continue to see the hater-ism on here. Really does beg the question if there are some sour grapes cause someone couldn't get hired as a FF?????

At least in my case you're making a huge assumption here. I in no way shape or form hate the Fire Service, or the firefighter EMTs/medics. In most cases, they don't do a bad job either. I just think the system could be much better if EMS was a third service facilitated by the municipality or a hospital system.

My future husband is a volly firefighter/EMT who will soon be going to Medic school and will be a career Fire Medic one day. He's one of the handful of people these days that actually is more interested in the EMS stuff than the "cool" firefighting and rescue stuff. Do I support him? Abso-****ing-lutely because I want him to actually make a livable wage. I've actually thought of going that route myself. I don't hold anything against those who make that decision because I don't think anyone should be expected to put up with outrageously low wages and poor treatment if they don't have to, to "protest" a system that could be better. It's not like it would make a difference anyways.

Some of the best medics I've ever met are fire medics. I think you need to stop taking it personally and realize that this is a debate about the system not the people. I'm not even saying that fire-based EMS systems suck, because most are good, but in medicine (and EMS is medicine) you don't settle for good, you aim for excellence. You clearly are of the opinion that EMS is best facilitated through the fire service, but you'll find on here that many people disagree and think it could be better done as it's own entity based more in public health and medicine.

 

[LucidResq]

In simpler terms...

I ain't hatin' on you playa, or yo' boyz. I be hatin on the game.

 

[jgmedic]

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.

When did Grove get ALS ambos? They also use Care for transport, Also, IIRC, a OC unit is not truly a medic unit unless it has two medics, anything else is considered a PAU and while some depts will send one, like FVY, every ALS call is supposed to have 2 medics riding in the hospital.

 

[LucidResq]

I'm trying to understand exactly to what extent that ATcEMS operates at tech rescue and Hazmat incidents. From the link you provided, it says that they provide medical care in the various rescue situations. That's not the same as being able to set up lowering systems, shoring for trenches and building collapses, for example. Besides, you need a truck to be able to position a stokes basket for a high angle rescue, anyway.

Same for Hazmat. It says that they integrate into hazmat incidents with the AFD Hazmat team. Being able to go on air, set up a decon station and carry a four gas meter is only scratching the surface on a Hazmat.

I don't know about other depts, but in ours our rescues are either hazmat or TROT (tech rescue) equipped. They're rolling toolboxes. ATcEMS has these, and they train their people to use all that, without fire involvement? If not, then you do in fact need fire for rescues.

I'm definitely not arguing for the fire service to hand over all rescue/extrication stuff to EMS and handle fire suppression only. It doesn't have to be all or nothing. Just look at TEMS.

For the vast majority of SWAT calls, the ambulance staged down the street is just fine (fairly similar to rescue calls, in which medical attention may be needed, but the rescuers can take the patient to EMS without hampering pt care). Then LE agencies started looking at that small percentage of SWAT calls in which having a paramedic able to go in along side them would be beneficial.

Did they start sending their cops to paramedic school? No. Did EMS systems start taking over all SWAT operations? No.

They trained a few of the paramedics in the EMS system some essential SWAT things, provided the equipment they needed to go in, and now they have a few medics able to go in with the SWAT team, who do the bulk of the operations and all of the coordination.

 

[jgmedic]

I'm definitely not arguing for the fire service to hand over all rescue/extrication stuff to EMS and handle fire suppression only. It doesn't have to be all or nothing. Just look at TEMS.

For the vast majority of SWAT calls, the ambulance staged down the street is just fine (fairly similar to rescue calls, in which medical attention may be needed, but the rescuers can take the patient to EMS without hampering pt care). Then LE agencies started looking at that small percentage of SWAT calls in which having a paramedic able to go in along side them would be beneficial.

Did they start sending their cops to paramedic school? No. Did EMS systems start taking over all SWAT operations? No.

They trained a few of the paramedics in the EMS system some essential SWAT things, provided the equipment they needed to go in, and now they have a few medics able to go in with the SWAT team, who do the bulk of the operations and all of the coordination.

Actually, some PD's, LACoSD, CHP, and a few others do have full time medics to staff SWAT, SAR, flight and the like. I'm not disagreeing with you at all actually though, in reference to the other poster about ATCOEMS, I believe they have rescue ambulances that can handle all but the most tech rescues, god I want to work there so bad. Anyways, why not have EMS handling basic rescue situations, less resource utilization per call should save the municipalities some cash, right?