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.
