Getting EMT-B cert for Firefighting?

[Shishkabob]

dave3189, you know why your argument is invalid? Because if you truly wanted efficiency, and save money on the budget, you'd be pushing for LE based EMS and making fire volunteer. It'd save money more then your idea.

Why not make all LEOs EMT and Medic certified? They have to be on the road anyhow, and they will always beat fire to the scene.

 

[dave3189]

Linuss, that's a silly argument and anyone who is reading this knows it. I'm not going to entertain your slippery slope fallacy argument of efficiency with respect to merged services! What's your next silly suggestion, merge Fire, EMS, LE, all utility companies, NGOs, Coast Guard, Life Guards, etc? Bottom line, you are making assertions about the effectiveness of Fire based EMS with absolutely no facts or empirical evidence to support your contention. I don't know which type of EMS provides better overall patient care on a nationwide scale... nobody does? My opinion is based on the fact that Fire based EMS cuts down on beaurocratic and Incident Command red tape and again, since we need FFs (regardless of improved fire standards) why not have them working in a dual capacity. I have had a great experience with Fire based EMS. Unlike you however, I understand that my own experiences are a small microcosm of the big picture and don’t necessarily represent the "big picture". Again, you might want to do some studying on statistics and research methods. In the end though, I respect your opinions and appreciate all of our efforts to better our profession. Happy Easter!

 

[Shishkabob]

Bottom line, you are making assertions about the effectiveness of Fire based EMS

I never ONCE commented on the effectiveness of Fire based EMS.

My opinion is based on the fact that Fire based EMS cuts down on beaurocratic and Incident Command red tape

And again, if that is your view, that having 2 functions in one job cuts down on the red tape, why not combine EMS and LE and make fire volunteer since it isn't used as often? Again, 2 functions, 1 job.


You can't argue against that logic since it is your logic.

 

[joeshmoe]

Combine LE and EMS? hahaha. Thats a good one.

So you object to firefighters doing EMS, because their heart isnt really in it or whatever, but you think the typical cop has a burning desire to be a paramedic?

 

[dave3189]

Your contention is that most FFs don't like EMS. I think common sense would dictate that someone who doesn't like their job is not as effective as someone who is passionate about their job. Again, you have no stats or empirical evidence to support that most FFs don't like EMS.

Your merging of services argument is a slippery slope. Why don't you just suggest that the US Government have one nationwide agency to deal with everything from crime, fire, ems, hazmat, pandemic outbreaks, natural disasters, terrorism, ECT? I would encourage you to brush up on your NIMS courses, or if you have not had them maybe take them. Specifically, Nims 100 (Introduction to Incident Command). Pay special attention to the discipline of span of control. It will give you some insight into the matter.

 

[TransportJockey]

Your contention is that most FFs don't like EMS. I think common sense would dictate that someone who doesn't like their job is not as effective as someone who is passionate about their job. Again, you have no stats or empirical evidence to support that most FFs don't like EMS.

Your merging of services argument is a slippery slope. Why don't you just suggest that the US Government have one nationwide agency to deal with everything from crime, fire, ems, hazmat, pandemic outbreaks, natural disasters, terrorism, ECT? I would encourage you to brush up on your NIMS courses, or if you have not had them maybe take them. Specifically, Nims 100 (Introduction to Incident Command). Pay special attention to the discipline of span of control. It will give you some insight into the matter.

Keep in mind not everyone is reqiured to do NIMS. Hell, until I moved to CO and started looking for a job, I hadn't even heard of the damn things.

 

[Shishkabob]

Combine LE and EMS? hahaha. Thats a good one.

So you object to firefighters doing EMS, because their heart isnt really in it or whatever, but you think the typical cop has a burning desire to be a paramedic?

I don't know how I can explain this any differently for you to understand:


Dave says fire should do EMS because otherwise fire would be sitting around all day doing nothing. He says them doing 2 roles makes sense financially because when not doing fire, they can do EMS. Again: 1 job doing 2 things to save money is his idea.


If he's for that, than why would he be against LE doing EMS? I mean, again, it's LE doing EMS when not busy doing something else. Than, when LE has EMS, we can make fire purely volunteer.


There, money saved. Made 3 services in to 1.5 . Fire only needed when there is a fire, and LE can do EMS when called. You cannot argue against that plan, then argue for fire based EMS to 'save money' or circumvent the 'red tape'.

Your contention is that most FFs don't like EMS.

Where did I say most? Heck, I remember stating in a reply to your first accusation that I never once made a single inference to any quantitative figure. Translation: I never gave a number. So quit stating I did, quit infering I did, and quit making that seem like my argument.

 

[Veneficus]

The ever present EMS vs. fire argument...

If I could once more add some perspective having argued both sides.

Many fire services I know of or have been personally involved with see EMS as an add on duty. Like various techinical rescues. Basically a "paramedic" is a card that allows you to follow a larger set of treatments than a CPR card.

This is all neatly filed under the term "public safety."

What I have seen (many many places over the years) is that Fire based EMS attempts to simplify the science of medicine into a stepwise progression. Then further limits the art of the practice by limiting as much decision making as possible. (in other words, simplifying.)

Having said that I know of at least 2 and have served on 1 3rd service EMS agency that did the same. So it is not restricted to the fire service.

Likewise, I know of a handful of fire departments that focus on EMS. So clearly it is possible to have the fire service provide some level of it.

But here is the rub.

There have been more advances in medicine over the last 10 years than in the entire prior history of man. It takes a lot of time and effort to keep up with that. In fact, people spend their entire professional lives trying.

The fire service with all of its many responsibilities largely neglects medicine. They do not treat patients, they have treatments that epidemiologically should help the most patients. Outlying individuals have become "acceptable losses." But nobody likes to talk about that.

Many fire departments do not devote the required resources to EMS. Look at a vast majority of places. The amount of fire apparatus they have compared to fire call volume is completely disproportionate. With far more fire units than is called for. If you truly wanted to argue cost savings, you would eliminate many fire positions and stations.

At the same time there is considerable EMS runs with a handful of ambulances.

The fire service attempts all kinds of crap to reduce EMS runs without commiting the resources required to serve the public health needs which lead to the activation of EMS.

You hear often that 911 is for emergencies. Don't call for EMS if you don't have an emergency. Strangely enough, a FD wouldn't tell you not to call if you smelled smoke but didn't see fire. They then turn around and tell you not to call if you have a medical problem unless you are dying. I find that behavior to demonstrate a lack of commitment to EMS.

Of course everyone thinks their FD is different, that they do it right. sadly they are mistaken. Often they don't even know what issues they have, and even if they do, make minimal efforts to correct it.

If you think your FD does things properly, I challenge you to put it to the test. Fly me out to your place. See if you can prove me wrong. I know a thing or two about medicine, EMS, and firefighting. I have yet to find a FD that will put their money where their mouth is. Talk is cheap.

At the same time, you have professionals, both in the US and abroad, who are rightly insulted by being labeled "the same" as the FD paramedics. They should be. They devote considerable time and energy, accept personal responsibility for their decisions and actions, and in the effort to do the most for their patients, spend all their time focusing on the ever evolving world of medical knowledge.

Dual role providers simply cannot measure up. It would be like comparing a family practice doc who is also a lawyer to a neurosurgeon or a trial lawyer. Simply by having to devote time to other things, lessens the time spent in the specific field and creates a less able professional.

Inevitably somebody will say they know a great firefighter, paramedic, who is also a lawyer, or some other "professional" and does all of them well. But do they?

Can they fight fire with the proficency of an inner city firefighter who sees multiple working fires a day?

Can they provide medical care comparable to a professional who sees 40+ patients a day?

Can they then perform their third function as well as a person spending all their time doing it?

Obviously the answer is no. Whether it is the lack of fire, lack of technical rescue, lack of patient contact, or whatever, decision making and skill atrophy occur. Every minute you spend practicing firefighting, is a minute away from medicine or vice versa.

If you lose 1/4 of your patients, from just being the minimum or "good enough" of a paramedic, how many more lives are lost than in the last structure fire you had to fight? How often are those fires? In 10 years you could lose hundreds more people from second rate medical care than second rate fire suppression. It is even worse if you do neither well.

Just some things to consider.

 

[dave3189]

I'm not sure where you are referring to as far as Fire neglecting EMS and lacking the most current training and protocols? In Seattle and Western Washington in general, our EMS (Fire Based) is absolutely top notch! You can take any type of service and find places where the quality of care sucks, including hospitals, LE, Fire, EMS, and on and on. This can specifically include Fire Based EMS, Privates, hospital based and so on. The point is, there is nothing inherent to Fire based EMS that reflects a propensity toward a lack of care.

As for Linuss, again read up on span of control, unity of command, incident command. It's one of those things, you get it or you don't!

"

 

[Veneficus]

I'm not sure where you are referring to as far as Fire neglecting EMS and lacking the most current training and protocols? In Seattle and Western Washington in general, our EMS (Fire Based) is absolutely top notch! You can take any type of service and find places where the quality of care sucks, including hospitals, LE, Fire, EMS, and on and on. This can specifically include Fire Based EMS, Privates, hospital based and so on. The point is, there is nothing inherent to Fire based EMS that reflects a propensity toward a lack of care.

As for Linuss, again read up on span of control, unity of command, incident command. It's one of those things, you get it or you don't!

"

But when you compare the population of Seattle and Western washington with the populations of Houston, Phoenix, DC, NYC, Philly, and a large part of all the miniture midwest departments every block, the amount of capable fire service is significantly dwarfed by the incapable.

It would be like saying all basketball players were as good as a handful of all stars.

All the fire service like to Hold Seattle out as the example, but how many make any effort to emulate them? How many 6 month paramedic programs do you have out there?

 

[Shishkabob]

As for Linuss, again read up on span of control, unity of command, incident command. It's one of those things, you get it or you don't!

"

So, are you for or against LE based EMS? Why or why not?

 

[dave3189]

So, are you for or against DOT based EMS? Why or why not?

p.s. It fits your requirements? They are out on the road 24/7 and would beat FD to the scene.

 

[TransportJockey]

So, are you for or against DOT based EMS? Why or why not?

p.s. It fits your requirements? They are out on the road 24/7 and would beat FD to the scene.

WA has DOT on the road 24/7? Wow, beats NM.

Besides that, DOT would make sense... after all EMS is born from DOT

 

[LucidResq]

Although I don't think EMS merging with LE is a good idea, I don't think that's what Linuss is arguing for. It does, to me, make about as much sense as having EMS combined with the fire department, if not more sense.

The fact is, a fire department that does not provide EMS, has very limited utilization today with the advent of fire codes and fire prevention. LE is used much more often. So if we're talking about saving money, I agree, cut fire down to a very small paid staff, or on-call, and merge EMS with LE. Maximum efficiency right there.

I've worked extensively with the fire department in my area. They do have relatively high standards, and I would say that I would be comfortable having one of their medics taking care of me or a family member. I don't think anyone here is arguing that all fire-medics are piss poor providers. However, I think it's hysterical that they have their enormous engines and ladders and squirts responding to almost every medical call, simply because they only have a few ambulances but a paramedic on every rig so the engines are often the closest. Then you have to wait for either their ambulance to show up to transport or a private ambulance. Efficiency at it's finest, right? Wonder how much gas that wastes.

By the way, can you please explain why on Earth you keep belligerently arguing that we know nothing about statistics or ICS? I have no idea what this has to do with the conversation as you have not mentioned any numbers, nor related ICS in a meaningful way to what you're arguing.

And yes, I have taken college statistics and all of the ICS classes.

 

[Shishkabob]

Although I don't think EMS merging with LE is a good idea, I don't think that's what Linuss is arguing for. It does, to me, make about as much sense as having EMS combined with the fire department, if not more sense.

So if we're talking about saving money, I agree, cut fire down to a very small paid staff, or on-call, and merge EMS with LE. Maximum efficiency right there.

Ding ding ding. Been trying all day for him to realize that, but instead keep getting posts about slippery slopes and DOT.


I thought I had dysphasia...

 

[Melclin]

Exaggerate much? I guess now it should take 8 years of education to work on an ambulance? I wonder how many of our forum members got their first ambulance job after 8 years of medical education....im gonna take an educated guess and put the number at ZERO.

I should have been clearer. I meant 8 years in the same sense that it takes a doctor ~13 years to become an attending/consultant physcian including both experience + formal education. It actually does take ~8 years to become a fully qualified paramedic (ALS) here:
-3 years of university,
-1 year internship,
-no less than 2 years experience our basic level (although often more, and to be granted entry to the ALS graduate course, you need to have inpressed your peers enough to be nominated for it),
-1 year in grad school, followed by an ALS internship. So you could say that 8 years is conservative.

Given that they autonomously manage treatment modalities that are very much physician only and that even most physicians have oversight for, it is not at all unreasonable.

or taken an NREMT exam?

Yes. After 1.5 years of my undergrad degree, I could easily pass the practice exams. Most of the time because the questions are written at such a low level, one can figure it out even if you don't know the answer. After a little over two years of our degree, I rarely get any questions wrong. Its absurd that I should be able to this without any formal ALS specific education and unfortunately this is not a reflection on me, but on the inadequacy of the test. If someone had trouble with that test, I wouldn't let them near me with a thermometer let alone 100 of sux.

10 Char

 

[dave3189]

Out here in WA, we don't have a medic on every rig so we are not running engines and trucks on aid/medic calls. We have designated Aid units and Medic units that respond accordingly. The problem with your suggestion about making Fire mostly Vollie is that guess why some people work in that capacity currently? You guessed it...! They’re trying to get exp to get hired full time. Take that carrot away and many of those vol FFs go away as well. As far as my reference to stats is concerned, I have not made any assertions about who likes EMS and who doesn’t, etc. I was merely pointing out to Linuss that one's own experiences don't mean much in the bigger picture. I have responded to the LE/EMS question, albeit sarcastically hence my point about merging EMS with DOT. By the way, according to Linuss' logic it makes about the same sense. They are out on the road, responding to emergencies, and they don't drive those big gas guzzling engines & trucks you guys hate so much!

 

[atropine]

Dearest OP, if you want to be be selective on where you want to land that dream gig here in Cali, you need to be a paramedic, and have a FF1 acdemy and nothing less.

 

[atropine]

If someone has FF1 but doesn't have medic and the FD sends them to medic school.

most departments if not all departments in southern Cali are not sending anyone to medic school anymore due to the economy.

 

[triemal04]

The ever present EMS vs. fire argument...

If I could once more add some perspective having argued both sides.

Many fire services I know of or have been personally involved with see EMS as an add on duty. Like various techinical rescues. Basically a "paramedic" is a card that allows you to follow a larger set of treatments than a CPR card.

This is all neatly filed under the term "public safety."

What I have seen (many many places over the years) is that Fire based EMS attempts to simplify the science of medicine into a stepwise progression. Then further limits the art of the practice by limiting as much decision making as possible. (in other words, simplifying.)
Kind of like requiring all paramedics to consult with a MD prior to their treatments (heeeeello New Jersey), requiring MD contact to give anything more than O2 and aspirin, removing meds that are only "rarely" used, having very simplistic protocols and on and on...of course, it's non-fire-based EMS that does this...

Having said that I know of at least 2 and have served on 1 3rd service EMS agency that did the same. So it is not restricted to the fire service. Glad you at least can recognize that, but I'm gonna continue so bear with me...

Likewise, I know of a handful of fire departments that focus on EMS. So clearly it is possible to have the fire service provide some level of it.

But here is the rub.

There have been more advances in medicine over the last 10 years than in the entire prior history of man. It takes a lot of time and effort to keep up with that. In fact, people spend their entire professional lives trying.

The fire service with all of its many responsibilities largely neglects medicine. They do not treat patients, they have treatments that epidemiologically should help the most patients. Outlying individuals have become "acceptable losses." But nobody likes to talk about that.
But then, private EMS (and all other types) does this as well. In fact, I'd say that it's more of a systemic problem with private EMS; I know multiple people who can't remember when they last had any in-house EMS training or were given the resources to get that training and education on their own. This isn't a problem that only faces the fire service.

Many fire departments do not devote the required resources to EMS. Look at a vast majority of places. The amount of fire apparatus they have compared to fire call volume is completely disproportionate. With far more fire units than is called for. If you truly wanted to argue cost savings, you would eliminate many fire positions and stations.
It's not a disproportionate amount either; what people need to remember is that it's not the total number of fires that is used to justify the number of units, but how many units are needed for those fires; if it takes say, 2 engines and a truck for a fire, then those need to be staffed for that area to be adequately protected. The fire service, EMS, police, and even medical facilities, aren't staffed in a "reactive" way; the number of people working/the equipment available should be, and hopefully is, proportionate to what can reasonable go wrong. Saying cut the numbers because the volume is down would be like saying get rid of crich's because they are used so rarely. Or get rid of a CT scanner that is used only a couple times a week but is the only one available for a large area. I will admit though, that there is waste in many departments, and some units should be cut.

At the same time there is considerable EMS runs with a handful of ambulances.
Unfortunately that is sometimes true, but again, not always, and it's not limited to the fire service. I could point out the non-fire EMS agencies that are removing ambulances from an already overworked system, cutting pay and benefits which decreases the quality of their new employees, but that would be cheating.

The fire service attempts all kinds of crap to reduce EMS runs without commiting the resources required to serve the public health needs which lead to the activation of EMS.
Can you explain that a bit more?

You hear often that 911 is for emergencies. Don't call for EMS if you don't have an emergency. Strangely enough, a FD wouldn't tell you not to call if you smelled smoke but didn't see fire. They then turn around and tell you not to call if you have a medical problem unless you are dying. I find that behavior to demonstrate a lack of commitment to EMS.
Why? EMS abuse, and ER abuse is a very common thing. Granted, more needs to be explained, but telling someone not to call because they need a refill on their prescription is a valid reason. Educating people about what needs and ambulance and/or an ER visit is an appropriate thing to do.

Of course everyone thinks their FD is different, that they do it right. sadly they are mistaken. Often they don't even know what issues they have, and even if they do, make minimal efforts to correct it.

If you think your FD does things properly, I challenge you to put it to the test. Fly me out to your place. See if you can prove me wrong. I know a thing or two about medicine, EMS, and firefighting. I have yet to find a FD that will put their money where their mouth is. Talk is cheap.
So...you're willing to do that for ANY EMS service, right? Because anybody willing to look rationally at this is aware that problems plague all types of EMS.

At the same time, you have professionals, both in the US and abroad, who are rightly insulted by being labeled "the same" as the FD paramedics. They should be. They devote considerable time and energy, accept personal responsibility for their decisions and actions, and in the effort to do the most for their patients, spend all their time focusing on the ever evolving world of medical knowledge.
As do I. As do many fire-based paramedics I know. I get very upset when I get lumped in with some non-fire based EMS providers (I won't say what type because it doesn't matter in this case); the level and amount of care provided by some non-fire based services that I've seen is appalling, and when someone compares me to "that paramedic from XXXX" it's...well...aggravating, because I know what kind of care that service gives.

Dual role providers simply cannot measure up. It would be like comparing a family practice doc who is also a lawyer to a neurosurgeon or a trial lawyer. Simply by having to devote time to other things, lessens the time spent in the specific field and creates a less able professional.

Inevitably somebody will say they know a great firefighter, paramedic, who is also a lawyer, or some other "professional" and does all of them well. But do they?

Can they fight fire with the proficency of an inner city firefighter who sees multiple working fires a day?

Can they provide medical care comparable to a professional who sees 40+ patients a day?
I hope to god that there isn't a paramedic dealing with 40+ pt's a day...though with some privates out there it's getting to be within the realm of possibility...

Can they then perform their third function as well as a person spending all their time doing it?

Obviously the answer is no. Whether it is the lack of fire, lack of technical rescue, lack of patient contact, or whatever, decision making and skill atrophy occur. Every minute you spend practicing firefighting, is a minute away from medicine or vice versa.

If you lose 1/4 of your patients, from just being the minimum or "good enough" of a paramedic, how many more lives are lost than in the last structure fire you had to fight? How often are those fires? In 10 years you could lose hundreds more people from second rate medical care than second rate fire suppression. It is even worse if you do neither well.

Just some things to consider.

Replies in red. I'm not going to argue with that last couple of paragraphs because...well...you're right. Having to know and be an expert in multiple different fields is not appropriate, and while it can and is done (sorry, but it is) it shouldn't be. Hopefully at some point the educational level (of both providers and the pubic) will advance enough so that it isn't necessary to do so. But right now, with the way then entire system is, what's being done by the fire service can and does work. Just as what's being done by non-fire EMS doesn't work. And of course the reverse is also true.

Unfortunately, what you've said is right. Not everywhere, but in enough places that it's a problem. And even more unfortunate is that it's right no matter what type of service you bring up; fire-based, private, third service, hospital-based and so on. Just think...if people would stop getting so worked up about this issue, realize that the problems extend well beyond any one type of provider and work on fixing the actual root causes instead of the symptoms, then something might actually be done! But no...instead what happens is the same old bickering.