Getting EMT-B cert for Firefighting?

[Veneficus]

I'm not sure quite how to read the distinction between Civilian and non-civilian? In King County (Medic One) the FDs have full time designated Medics that are assigned to the Medic Units. Some (maybe even most) came from the Fire ranks but some did not. That being said, I wouldn't consider these guys & gals to be civilian.

I think the distiction has to do with the terms of their employment. Some fire departments employ paramedics in a way similar to a contractor and not a member of the municiple fire service. Not to beat a dead horse but DC was doing that prior to starting their currently incomplete merger. It is also done in parts of IL, with several private agencies "hirng out" ALS memebers.

The long and short of it is, they do not get the same pay and benefits as the Fire fighters but they are not required to have fire training and obviously do not take part in non medical activities such as rescue or suppression.

In places I have seen this in action, the medic is basically a second class employee in all respects. Both in pay and benefits, managerial support, and almost total lack of respect by the municiple firefighters.

As opposed to a firefighter/paramedic who is assigned to a ALS transporting unit full time in the same way a person can be assigned to an engine company, truck company, etc.

If you are going to have a dual role agency, the firefighter/paramedic model with dedicated assignment seems to be a better implementation model.

 

[TransportJockey]

Interesting article, thanks for providing it. There are a couple glaring inconsistencies in it however. For one, it states that the EMT-I level is the minimum nationally accepted level for ambulance care. What planet are they from? Second, it states that they have BLS units staffed with EMT-I personnel. Ummm, wouldn't that make these units ILS level???

In CA EMT-1 is equal to EMT-B everywhere else. They didn't mean EMT-I as in Intermediate, just as a roman numeral 1

 

[armywifeemt]

In CA EMT-1 is equal to EMT-B everywhere else. They didn't mean EMT-I as in Intermediate, just as a roman numeral 1

Yeah. Same story in Alaska. We have EMT-I, EMT-II, and EMT-III with advanced levels for each of them that with a medical directors sign off allows them to expand their scope of practice by a few more skills. Essentially I is equivalent to basic, II is equivalent to intermediate, and III is somewhere between intermediate and paramedic. Paramedics aren't very common up here.

 

[triemal04]

I wouldn't call it hatred, I don't hate the FD, I just don't like the spouting how they are so great at EMS but they cannot live up to their propaganda. IF you are going to say you are the best, you better be able to back it up no matter what industry you are in.
I won't argue with that. The service model that is used by most fire departments is better than most other types though; don't know about the best. Unfortunately, the delivery of that service can be lacking.

From my personal perspective. Changing a unionized FD is near impossible. Changing the culture of the fire service is near impossible.
It's not impossible, but it does take time. Potentially a long time in some dept's. It in no way excuses what happens, I don't mean that, but this is something that people forget when complaining about the treatment of EMS by fire depts. Sudden changes often create varying amount of dissent, anger and confusion, more so when the system changing it has a long and tradition filled history; there will be growing pains. This doesn't only affect the fire service either. San Francisco is a good example of this; they went from providing very little EMS responses to suddenly providing the full range in a short amount of time, and incorporated a large number of people into the dept who didn't want to be there, and didn't have any understanding of the difference in working for a fire dept and a non-fire EMS agency. Of course that will create problems! Of course it won't be fixed overnight, and not in 10 years either! Can it be fixed though? Yes, if BOTH sides are willing to change, but if one or both aren't willing to make concessions, then no, you get what you have today. But then, look at dept's that have always provided EMS and you may find a different story. Unfortunately, you may not. Of course, you can look at services that only exist to provide EMS and are horrible at it too.

Getting rid of a private service that doesn't measure up is easy. Just don't renew the contract or at contract negotiations demand certain things.
It's not that easy; generally bids for that type of thing have to be taken, and the lowest costing one is often the private, or another one. Add in the complete lack of public understanding of EMS, and it's even more problematic. Lot's of time the deciding factor is who can put on ambulance on-scene the fastest and for the least money; response times matter for that kind of thing. It's not right, but it does play a huge part in determining who covers an ASA. Same for the demands; people have to know what to demand, and have to have the knowledge to be able to really check to see if their demands are met. Say you want an ambulance staffed with 2 ALS providers...you might get a medic and an EMT-I which is technically allowable.

Not all privates increase the bottom line by slashing. Some actually expand their service realms as well as offer a higher level of care. But I agree a majority do slash service, equipment, etc. Like I said though, fixing a private is really easy.
Some do, but many, many don't. And not just privates either.

As well, fixing a poor third service is just as easy, just threaten to merge them with the FD. They will change.
Meant as a joke or not, that's funny!

Replies in red. When looked at objectively, fire-based EMS is a model that CAN work and work well. It just has to be done correctly, like anything in medicine, or life. When done wrong, it's bad, when done right, it's good.

 

[Veneficus]

Replies in red. When looked at objectively, fire-based EMS is a model that CAN work and work well. It just has to be done correctly, like anything in medicine, or life. When done wrong, it's bad, when done right, it's good.

Without a doubt. But like I said, more often than not, it is wrong. 2 out of 3 departments I served with did EMS very wrong. The evidence is even worse than my anecdote. What's worse is they have no desire to change. The real icing on the cake is when they really believe they are doing nothing wrong.


I won't argue with that. The service model that is used by most fire departments is better than most other types though; don't know about the best. Unfortunately, the delivery of that service can be lacking.

I think that is speculation. I gave examples of third service that is done right. Particular Private services (no names here) have also done outstanding work.

I also think that the future of EMS in order remain economically viable will have to transition to a more public health type role. But whether my prediction is right or wrong, (though it is really starting to look accurate) I just don’t see the fire service embracing it. Even if they do I think it will be difficult to implement. Just as accepting EMS has been. You simply cannot be the best if you are constantly 30 years behind the times. It is also a waste of money to pay for outdated service.

It's not impossible, but it does take time. Potentially a long time in some dept's. It in no way excuses what happens, I don't mean that, but this is something that people forget when complaining about the treatment of EMS by fire depts. Sudden changes often create varying amount of dissent, anger and confusion, more so when the system changing it has a long and tradition filled history; there will be growing pains. This doesn't only affect the fire service either. San Francisco is a good example of this; they went from providing very little EMS responses to suddenly providing the full range in a short amount of time, and incorporated a large number of people into the dept who didn't want to be there, and didn't have any understanding of the difference in working for a fire dept and a non-fire EMS agency. Of course that will create problems! Of course it won't be fixed overnight, and not in 10 years either!

So we should pay for an accept an agency that provides what they want, not what is needed or valued by the people paying? I cannot accept that.

The problem that arises is medicine changes much faster than the FD does. As I stated above the very mission of EMS is likely and seems to be changing. If a major group of FDs are already behind the curve, where will they be in 10 years? Meeting another outdated need with a service model no longer applicable?

It's not that easy; generally bids for that type of thing have to be taken, and the lowest costing one is often the private, or another one. Add in the complete lack of public understanding of EMS, and it's even more problematic. Lot's of time the deciding factor is who can put on ambulance on-scene the fastest and for the least money; response times matter for that kind of thing. It's not right, but it does play a huge part in determining who covers an ASA. Same for the demands; people have to know what to demand, and have to have the knowledge to be able to really check to see if their demands are met. Say you want an ambulance staffed with 2 ALS providers...you might get a medic and an EMT-I which is technically allowable.

That is exactly why municipalities need to hire experts in the know to help negotiate the terms. The public doesn’t want to become EMS system experts. They want capable help when they call at as little cost as possible. But value also justifies cost. So if you have to spend a little more to get a lot more, people are generally accepting. Look at buying a car. If I told you the tricked out model was a couple thousand more than the stripped down version, just on raw features to price ratio most would see it is a better deal.

But hiring some of these consulting firms that actually nothing more than advocates for a specific type of service regardless of local need (I am too kind to name names here) doesn’t constitute the expert help a municipality needs.

As well, fixing a poor third service is just as easy, just threaten to merge them with the FD. They will change.
Meant as a joke or not, that's funny!

Funny or not, it is the truth. When their livelihood is on the line, they will step up or move out. If they can't produce I will be leading the charge for the FD takeover. My priority is the quality of the medicine/service. My antagonist is the substandard no matter who the provider is. I am also not concerned with jobs, if you cannot provide a quality and valuable service, you find a new job.

 

[dave3189]

Without a doubt. But like I said, more often than not, it is wrong.

Veneficus, You claim other people are using speculation... what about your comment above? That is also speculation. We live in a big nation. Your particualr experiences with Fire Based EMS is not even close to being emperical evidence to support your contention. This is especially true considering the vastly different ways that different parts of the country structure EMS

 

[triemal04]

Overall I don't see it as being an unwillingness to change, but more of an issue of change coming slowly. Which can be a problem with medicine. But that doesn't mean that things are the same everywhere as they were 5, 10 or 20 years ago. Different departments have embraced EMS and have changed how they deliver it. People focus on the large dept's that make the papers, but tend to ignore the smaller ones that don't and provide the bulk of fire-based EMS. Hell, if EMS could actually speak with one voice and give a good, accurate, factual reason for changing things, and then follow through with it, then change would be the only option.

There are multiple examples of each type of service providing both high and low quality care; what I meant was the way a system can be set up in a fire dept vs somewhere else. Working for a municipality the pay/benefits are often better than elsewhere (though this often is true for third services), there is a steady source of money to support the service and it's needs, the infrastructure of the dept doesn't have to be duplicated, and because of this, the quality of applicants can be higher, and the length of time they stay in that position/dept can be longer. Not having to be only concerned with profits but quality. Being more answerable to the public. I will admit that a third service can provide many of these same benefits though and is also a great model.

It's not that you need to accept the problems or that they are right; just that people need to understand why some of the problems have occurred. Again, the fire service isn't the big bogeyman people think it is, and isn't alone in causing problems with EMS.

I agree; whoever determines who gets a contract should be well informed. But all to often aren't. And while the public doesn't need to be an expert on EMS, they absolutely MUST be well enough informed to understand what is happening. If Joe Blow doesn't know or care who runs the ambulance, then what he gets may very well be a lousy service. But if Joe Blow knows enough about EMS to care who does it, he may start complaining to elected officials and causing a stink. Public education is absolutely vital to the future of EMS. If you want to pay more to get more, then it needs to be justified, and the public must be able to understand why it happens. If all the public knows is that Service X can get an "ALS" unit there in 7 minutes, and Service Y will take 8 (but provide a better service), they'll probably choose Service X.

That depends. Some do step up and increase the level of service they provide. Others don't, either because they can't, or it isn't needed. Others can provide proof that the current system works and doesn't need to be changed. I agree though, if you provide a service that is surpassed by someone else, then you shouldn't be doing it anymore.

See...once again this has stayed on the topic of "fire depts are bad and shouldn't be in EMS" when the topic ought to be "EMS is in a bad way and needs to change."

 

[Veneficus]

Without a doubt. But like I said, more often than not, it is wrong.

Veneficus, You claim other people are using speculation... what about your comment above? That is also speculation. We live in a big nation. Your particualr experiences with Fire Based EMS is not even close to being emperical evidence to support your contention. This is especially true considering the vastly different ways that different parts of the country structure EMS

you should read a few pages up where I point out the populations covered by ineffective fire service EMS.

 

[dave3189]

Not sure how you designate what is effective EMS and what is not? afterall, it isn't black and white. That being said, you still stated a generalization about Fire Based EMS that is unsupported and unfounded. I can point out some private services here on the west coast that many consider substandard EMS. I don't apply those opinions to the whole country and make assertions about private EMS as a whole.

 

[Veneficus]

See...once again this has stayed on the topic of "fire depts are bad and shouldn't be in EMS" when the topic ought to be "EMS is in a bad way and needs to change."

I think you misunderstand my contention.

It is not simply fire departments are bad. You are correct, it is an EMS problem. But it doesn't change the fact that most EMS is fire based in the US. Therefore, most is all but synonomous with the fire service. If there is any hope of change, it must come from the majority.

When many smaller departments are mentioned, I don't think the argument can hold. There are entire states full of fire departments that run EMS, even if they were the greatest in the world, their combines volumes cannot compare patient contact with the volumes of a NYC, LA, or DC. EMS is patient driven, giving population considerable significance in the equation. If suddenly there was change in standards in large departments, smaller ones would have to follow suit or they would not be providing standard of care.

If a small department runs 20 calls a day, one of the larger ones could exceed that in 1/2 hour. Even including the volunteer departments, I just can't see the numbers adding up to the major cities.

Applying the Seattle system I also cannot possibly see the equation of a bunch of low volume departments having the provider skill of high volume ones.

I am not trying to be mean, but does anyone suggest skill atrophy is not a factor and patient contact is not absolutely required to be proficient?

I just don't think the time frames you suggest are required to bring the fire service as a whole up to speed demonstrates anykind of value or meets the demands of providing medical care. Depending on healthcare spending reform, it may not even be viable.

If the goal of EMS is simply transport to hospital, the expenses involved with ALS may not even be worth it.

If the problems of EMS are to be solved, it must be embraced as medical care. Not simply a taxi for people deemed "worthy" of an emergency response. Both the police and fire services have embraced prevention. In the coming years, medical prevention will be even more important. Fire and even crime does not take up 1/6 of the GDP.

The measurement of quality medical care cannot be made up by the fire service, it must be measured by the same standards as the rest of medicine.

Do you see major fire departments embracing that? Do you see money for smaller ones to embrace that?

I can think of several solutions to the problems faced, that most certainly could include the fire service. But as long as a whole the fire service resists, they will be the major obstacle which must be targeted, and they will make their service obsolete.

I agree there are departments embracing and trying to change the status quo. But until they break from the ranks of the organizations resisting the change, they will never have any momentum to push for it.

I am not nor have I suggested that private service would be the answer, nor have I suggested the answer must be third service or hospital based.

I have identified the problem and it is the fire service's culture of resistance to change and meeting the demands of today.

I really think the national advocates of fire service sees EMS as an add on patch or skill like hazmat or tech rescue. That mentality or culture or whatever you want to attribute it to is not conducive to medicine.

I beleive it was Columbus, Ohio that recently first put forth the idea of downgrading from ALS to only BLS only for economic savings. That proposal should be a wakeup call for every fire department in the country. But instead of demonstrating the value of ALS, they just tried the usual scare tactics, while it may seem like a viable short term solution. It seriously damages the good will given to the fire service and could really haunt it later on.

I'd be more than happyy to try and help the fire service, but like a patient, you can't help those who don't want it.

 

[Veneficus]

Not sure how you designate what is effective EMS and what is not? afterall, it isn't black and white..

It is very black and white. The purpose of medicine is to maintain producers in society. If you spend more than you save, you might as well do nothing. Medicine is not some ideological altruistic money losing endevor.

If you are turning people away, cannot keep up with volume of requests for help and appropriately and cost effectively manage these requests, then your agency is a weak link in the health care system. That makes it ineffective.

There is some old school thinking that EMS is life saving measures during an acute emergency and transport to "definitive care." But is definitive care the hospital ED? Clearly not in all cases. Have the major EMS agencies (which are all fire based) made measurable advances in better disposition of patients?

If you claim to embrace EBM, look at all the studies on the effectiveness of morbidity and mortality of prehospital ALS. With the exception of Washington State, the numbers are quite grim. So by even the "old measure of EMS" it is a failure. The only measure which is globablly successful among fire based EMS is response time. Which a growing body of evidence shows as inconsequential.

So if a practice is continued inspite of evidence it doesn't positively affect outcome, the practice is ineffective.

It is not the only weak link. But it must be part of the solution.

That being said, you still stated a generalization about Fire Based EMS that is unsupported and unfounded. I can point out some private services here on the west coast that many consider substandard EMS. I don't apply those opinions to the whole country and make assertions about private EMS as a whole.

But my generalizations are based on the population centers of the United States.

I never argued that private EMS wasn't largely substandard. Infact by the same measures it is. Nor did I state any other model was superior. But if the fire service advocates are going to state they are better, then they will have to demonstrate that. All I have seen out of anywhere but washington state is piss and wind.

Again my contention is that US EMS is ineffective by the measurements of medical care. If EMS of anytype thinks it can come up with its own standards of measuring its medical care it becomes nothing more than a selfserving, glorified, over priced taxi.

If you think my observations of fire based EMS are unfair, you could call up some union brothers, or go to some conventions and push for them to get with the program Washington champions. By all the measures listed it is a superior system.

 

[EMTzimp]

I took my EMT class in Mission Viejo, CA. Link 2 Life Emergency Training.

Website.... Link2Life.org

Class was 14 days in a row 10-12 hours a day.

No math involved at all.

Good Luck!

 

[MrBrown]

It's not so much an issue of quick patch mills it's more an issue of the Fire Service being pro-EMS when it suits them because it increases thier budgets and keeps the mayor off thier back about the ring of chairs around the telly but seem to be anti-EMS when it comes to providing the service.

The IAFC EMS Section and the IAFF actively sought to keep down the amount of education required in the National EMS Education Agenda and to remove the need for Paramedic programs to be accredited through a College or University. They also use out dated evidence which is no longer valid to support thier agenda and use very deceptive marketing to promote Fire based EMS.

To the Fire Service it very much seems that there is nothing wrong with the horrendously inadequate education that passes muster in the US.

So, how do we know I am not talking out my arse, why lets go to the horses mouth! *neigh

FROM THE IAFF AND THE IAFC THEMSELVES .... (with sources so you can CHECK I am not, unlike the first statement, making up lies)

It is no surprise that study after study has shown that fire department-based prehospital emergency medical care systems are superior to other provider types.

Source

And yet, I am unable to find any evidence of this nor do they site any reference for such studies.

IAFF (Emergency Medical Services: A guidebook for fire-based EMS Systems)

The “Golden Hour” describes the precious time period from time of injury through location and transportation to definitive care of a
critically injured trauma patient to minimize death and permanent disability

Source

UBER FAIL, the IAFF is selling a nicely packed idea which has no evidence to support it and has been flamed by the medical community as being about as relevant as ham soup to promote its product

IAFF (Emergency Medical Services: A guidebook for fire-based EMS Systems)

Fire fighters not only respond more rapidly than their single-role EMS counterparts, but are also more effective in terms of patient outcomes (Braun 1990).

Source

I notice the IAFF convienently left out the full APA source for that study; after extensive Googling it appears this study published TWENTY YEARS AGO looked at single third service EMS survival from cardiac arrest vs. Firefighters with AEDs in a first response cabability.

MEGA UBER FAIL; what a bunch of retards, of course ANYBODY showing up with an AED is going to improve survival rates. Without considering the context or timing of this research, the IAFF uses it to promote itself as being superior, FAIL!

IAFC EMS Section

One of the biggest concerns fire service-based paramedic programs were concerned with was the apparent mandatory need to be affiliated with or sponsored by a college or university and that previous standards didn’t allow fire departments or fire/EMS academies to be considered in this process.

http://www.iafc.org/displayindustryarticle.cfm?articlenbr=40545

Why is the IAFC against have to have Paramedic programs affiliated with a college? Why do they want to continue the back room training of ambo's by ambo's?

IAFC EMS Section

...[The IAFC EMS Section] question... whether the increase in knowledge gained through the draft [National EMS Education Standards] will have a real effect on the actual field practice

Source

OMG how retarded do you have to be to get onto the IAFC EMS Section? Are they SERIOUS?????

IAFC EMS Section

The IAFC EMS Section would like to see substantiation on why there is an increase in training hours

Source

Maybe because the United States has the lowest standards in the developed world which still count "hours of training" and were written in 1994, 1985/1999 and 1998 (EMT-Basic, Intermediate/85, Intermediate/99 and Paramedic respectively)?

But as said in #2, the IAFC obviously cannot understand the difference between KNOWLEDGE and SKILL because they are retards and a couple hundered hours of skills based training seems to be adequate for them.

IAFC EMS Section

The IAFC EMS Section...is concerned that the general move toward college-based courses, the increase in hours and resulting financial impact will adversely affect departments’ ability...to meet the goals of the standards

Will the increase in education standards further impact the pool of people who can complete the requirements?

Source

Then by all means, lets WATER DOWN THE STANDARD so a bunch of firefighters can meet it and it won't cost the fire daprtment too much lord knows we can't have that, that's a wonderful idea, never mind the fact that it might further deprofessionalise EMS and negatively effect patient care; but the IAFC doesn't seem to think that is important; see #2

If you can't meet the standard, maybe you should not be in the game? But of course the fire department can't have that now can they?

IAFC EMS Section

With respect to CoAEMSP certification for paramedics under “Educational Infrastructure,” the education standards should also include certification via fire service academies accredited at the state level. Many states have “Technical/Vocational” schools that are not colleges/universities but provide a great deal of the EMS education. Many fire academies have excellent education and highly qualified training staff but would not qualify if the requirement was held to a college or university setting.

Source

Again, how retarded and arse-backward do the IAFC EMS Section have to be? They are supporting the old tech school medic courses which elsewhere in the world have not existed for at least a decade. As for the staff, oh yes LETS CONTINUE TO WATER STANDARDS DOWN so a bunch of minimally educated fire service or tech mill paramedic instructors don't have to get a REAL EDUCATION and know WTF they are on about.

I guess it's acceptable to keep teaching smokeys about "Sidney Sinus", that CPAP "pushes lung water" and so on and so forth because that is what they learnt.

Never mind that in the UK, Australia and New Zealand all college Paramedic instructors have a Masters Degree or above.

Contrast the clinical competence and knowledge of one of our Intensive Care Paramedics who has a Post Graduate qualification, has to submit evidence of at least 40 hours of CCE per year and undertake re-validation in each skill every two years to one of the "Firefighter/Paramedics" who might intubate one patient a year because they ride on a non transporting "ALS Engine".

If Fire/EMS works so well why have both the New Zealand Fire Service Commission and the Professional Firefighters Union fought so hard to stay away from doing any medical calls stating it is not in the best interest of either profession?

I am so disheartened and outraged.

 

[Veneficus]

It's not so much an issue of quick patch mills it's more an issue of the Fire Service being pro-EMS when it suits them because it increases thier budgets and keeps the mayor off thier back about the ring of chairs around the telly but seem to be anti-EMS when it comes to providing the service.

The IAFC EMS Section and the IAFF actively sought to keep down the amount of education required in the National EMS Education Agenda and to remove the need for Paramedic programs to be accredited through a College or University. They also use out dated evidence which is no longer valid to support thier agenda and use very deceptive marketing to promote Fire based EMS.

To the Fire Service it very much seems that there is nothing wrong with the horrendously inadequate education that passes muster in the US.

So, how do we know I am not talking out my arse, why lets go to the horses mouth! *neigh

FROM THE IAFF AND THE IAFC THEMSELVES .... (with sources so you can CHECK I am not, unlike the first statement, making up lies)




And yet, I am unable to find any evidence of this nor do they site any reference for such studies.



UBER FAIL, the IAFF is selling a nicely packed idea which has no evidence to support it and has been flamed by the medical community as being about as relevant as ham soup to promote its product




I notice the IAFF convienently left out the full APA source for that study; after extensive Googling it appears this study published TWENTY YEARS AGO looked at single third service EMS survival from cardiac arrest vs. Firefighters with AEDs in a first response cabability.

MEGA UBER FAIL; what a bunch of retards, of course ANYBODY showing up with an AED is going to improve survival rates. Without considering the context or timing of this research, the IAFF uses it to promote itself as being superior, FAIL!



Why is the IAFC against have to have Paramedic programs affiliated with a college? Why do they want to continue the back room training of ambo's by ambo's?



OMG how retarded do you have to be to get onto the IAFC EMS Section? Are they SERIOUS?????



Maybe because the United States has the lowest standards in the developed world which still count "hours of training" and were written in 1994, 1985/1999 and 1998 (EMT-Basic, Intermediate/85, Intermediate/99 and Paramedic respectively)?

But as said in #2, the IAFC obviously cannot understand the difference between KNOWLEDGE and SKILL because they are retards and a couple hundered hours of skills based training seems to be adequate for them.




Then by all means, lets WATER DOWN THE STANDARD so a bunch of firefighters can meet it and it won't cost the fire daprtment too much lord knows we can't have that, that's a wonderful idea, never mind the fact that it might further deprofessionalise EMS and negatively effect patient care; but the IAFC doesn't seem to think that is important; see #2

If you can't meet the standard, maybe you should not be in the game? But of course the fire department can't have that now can they?




Again, how retarded and arse-backward do the IAFC EMS Section have to be? They are supporting the old tech school medic courses which elsewhere in the world have not existed for at least a decade. As for the staff, oh yes LETS CONTINUE TO WATER STANDARDS DOWN so a bunch of minimally educated fire service or tech mill paramedic instructors don't have to get a REAL EDUCATION and know WTF they are on about.

I guess it's acceptable to keep teaching smokeys about "Sidney Sinus", that CPAP "pushes lung water" and so on and so forth because that is what they learnt.

Never mind that in the UK, Australia and New Zealand all college Paramedic instructors have a Masters Degree or above.

Contrast the clinical competence and knowledge of one of our Intensive Care Paramedics who has a Post Graduate qualification, has to submit evidence of at least 40 hours of CCE per year and undertake re-validation in each skill every two years to one of the "Firefighter/Paramedics" who might intubate one patient a year because they ride on a non transporting "ALS Engine".

If Fire/EMS works so well why have both the New Zealand Fire Service Commission and the Professional Firefighters Union fought so hard to stay away from doing any medical calls stating it is not in the best interest of either profession?

I am so disheartened and outraged.

I would just like to add the National Fire Academy is not accredited either.

Other than that, I would like to adopt Brown.

 

[MrBrown]

...Other than that, I would like to adopt Brown.

Momma will be so proud

 

[Radioactive]

Maybe this thread will come back around. I can see the merit in all of the arguments here. There are good points being made about the ongoing issues, but the constant conflict puts some of us in the middle.

In my area, there are 2 semi-large private ambulance companies and the FD. I call them private ambulance companies because they own and operate ambulances, but what they really are is non-emergent transport companies. For actual emergency care, there only seems to be 2 options, Local ED or FD.

I might come off as a bit of a wacker here, but I'm not getting in to the game to practice non-emergency medicine. I already did that for a decade. I'm tired of hospitals, so that leaves me with FD. I find this unfortunate, but not horrible, mostly because I will need to be a firefighter before I can become a actual emergency medical provider. I agree that I think my skills as a firefighter will suffer due to my lesser interest in that subject (although I am interested in the fire industry.) I do plan on becoming a Paramedic, and my goal is to actually provide emergency care as opposed to collecting urine samples in an ED.

For those of us not blessed with the circumstance to be involved in a purely EMS service, how can we better function in the role of a FD Paramedic?

 

[Veneficus]

I might come off as a bit of a wacker here, but I'm not getting in to the game to practice non-emergency medicine. I already did that for a decade. I'm tired of hospitals, so that leaves me with FD.?

I think you may be sorely dissapointed if you think "emergency medicine" is exciting. Even in the busiest trauma centers and biggest emergency departments. It is hours and hours of caring for non emergent patients punctuated by the occasional emergency. Some days you have a run and get a few good ones. But even if one comes in, you may not be assigned to be a provider for them.

EMS is exactly the same. Easily more than 90% of the patients you see will be people who think they have an "emergency" but would be better served by other areas of healthcare or social services.

as I mentioned earlier, EMS is trending towards less "emergent" and more preventative or primary care both formally and in patient value.

For those of us not blessed with the circumstance to be involved in a purely EMS service, how can we better function in the role of a FD Paramedic?

Move. just kidding

The best thing to do is first to get done what you need. You can become a firefighter in around 240 hours. Unless you work for a dept. that sees a lot of fire regularly, you disinterest will not make you any less capable than the skill atrophy of your peers. It helps to get to at least operation level hazmat and I very much enjoy technical rescue work because you are always rescuing a patient.

If you are working in a department that doesn't see or accept EMS as the primary mission, everytime you break from the routine or look deeper you will be met with resentment. You will be reminded it is not a hospital, you just treat signs and symptoms, or that you outright suck. If you persevere through this 5 or so years you will generally find acceptance and just labeled as "quirky." After a very long time (a decade or more) you will probably be recognized as a the department EMS Guru and you will be celebrated. (unless you become the EMS officer or some other form of QA, then no matter what you do you "will not get it")

If the department does value its EMS duties, you will probably enjoy it very much and find many like minded and highly capable people.

It has been my experience that many capable providers find EMS (especially rigid fire based systems) too limiting and choose to move on or are strongly encouraged to. There is much written on the brain drain in EMS. I was told several times firefighting (largely by firefighters) it is not a job for the very smart or the ambitious. There are many former firefighters in medicine, especially in leadership positions I have noticed.

If you want, PM and I can be more specfic.

 

[Radioactive]

I think you may be sorely dissapointed if you think "emergency medicine" is exciting. Even in the busiest trauma centers and biggest emergency departments. It is hours and hours of caring for non emergent patients punctuated by the occasional emergency. Some days you have a run and get a few good ones. But even if one comes in, you may not be assigned to be a provider for them.

I actually have worked primarily in the ED as a radiographer, and did so for quite a while. I am familiar with the day-to-day there and I am under no delusion that EMS will be super-fast and exciting. Its not the pace or the excitement, but the content, that interests me.

If the department does value its EMS duties, you will probably enjoy it very much and find many like minded and highly capable people.

It has been my experience that many capable providers find EMS (especially rigid fire based systems) too limiting and choose to move on or are strongly encouraged to. There is much written on the brain drain in EMS. I was told several times firefighting (largely by firefighters) it is not a job for the very smart or the ambitious. There are many former firefighters in medicine, especially in leadership positions I have noticed.

All I can do is hope that I find like-minded folks. The drain is something that I am fairly worried about. I think of myself as fairly smart, but not terribly ambitious. All I ever wanted for my life is a career that I could be proud of and know that I am making a difference. But honestly, I'm still getting way ahead of myself. I haven't even finished mt EMT-B yet.

 

[triemal04]

<snip>It is not simply fire departments are bad. You are correct, it is an EMS problem. But it doesn't change the fact that most EMS is fire based in the US. Therefore, most is all but synonomous with the fire service. If there is any hope of change, it must come from the majority.
I don't know that it is. If you consider non-transporting units, then yes you're right. But in reality, those are the places that have (should have I suppose) the least impact on the future/current state of EMS. This comes down to, again, a lack of public education, and a lack of a cohesive EMS voice. If the public understood EMS, less credibility would be applied to the fire dept that has 4 medics on a unit but only provides 2 minutes of pt care. And with a cohesive EMS voice, that info could be gotten to the public.

When many smaller departments are mentioned, I don't think the argument can hold. There are entire states full of fire departments that run EMS, even if they were the greatest in the world, their combines volumes cannot compare patient contact with the volumes of a NYC, LA, or DC. EMS is patient driven, giving population considerable significance in the equation. If suddenly there was change in standards in large departments, smaller ones would have to follow suit or they would not be providing standard of care.
If all you focus on are numbers of pt's treated, I'd bet that more pt's are treated/transported by non-fire EMS than by fire depts, so that would mean that non-fire EMS should have the most impact and responsibility for the current state of affairs. Yes, those areas do make it into the news which doesn't help the image of EMS, but beyond that, what impact do they really have? If the bolded were true, then everyone would be modeling their system of those places you mentioned. Thankfully, this isn't the case. False argument, sorry. While it doesn't help public perception, the practices followed aren't trickling down; change is still coming from the bottom up more than anything.

<snip>

Applying the Seattle system I also cannot possibly see the equation of a bunch of low volume departments having the provider skill of high volume ones.
Depends. I agree, without experience performing your job you will never reach the same level you would if you did it daily. But that doesn't change the fact that, lower call-volume or not, fire dept's are providing similar types and levels of service as the King Co Medic 1 system (not quite that high though). Numbers don't account for everything; you ought to know that.

I am not trying to be mean, but does anyone suggest skill atrophy is not a factor and patient contact is not absolutely required to be proficient?
Oh god no. It's a very real thing. Hence why having 4 medics on a non-transporting unit is asinine. This is one of the area's that some (not all) fire dept's fail at; more is not always better.

I just don't think the time frames you suggest are required to bring the fire service as a whole up to speed demonstrates any kind of value or meets the demands of providing medical care. Depending on healthcare spending reform, it may not even be viable.
I wish it wasn't so, but, it is a real thing. And it doesn't affect only fire depts; if you've been around long enough, can you remember back to when ER doc's started to intubate on a regular basis? I've heard about the huge backlash from anesthesiologists, and that is STILL an ongoing problem in some areas, though not as bad. My point being, there will almost always be a lag time in ALL services and businesses when change occurs, especially if it's a dramatic one. Nobody change effectively change overnight, and, if you'll notice, as I said before, it's often the more tradition-bound dept's that have the hardest time changing, but they also don't have a lot of effect on the overall state of EMS.

<snip>

If the problems of EMS are to be solved, it must be embraced as medical care. Not simply a taxi for people deemed "worthy" of an emergency response. Both the police and fire services have embraced prevention. In the coming years, medical prevention will be even more important. Fire and even crime does not take up 1/6 of the GDP.
I concur. Hopefully this is the direction EMS moves in. And, hopefully as that happens, and the education increases, you will start to see a decrease in the number of transporting fire depts.

The measurement of quality medical care cannot be made up by the fire service, it must be measured by the same standards as the rest of medicine.
It isn't just the fire service; don't start believing the bogeyman theory. All EMS is judged differently than the rest of medicine. And all of EMS is at fault for that happening.

Do you see major fire departments embracing that? Do you see money for smaller ones to embrace that?
Possible. Like with good/bad care, that would come down to a case by case issue; some might be able to do it, and some won't.

I can think of several solutions to the problems faced, that most certainly could include the fire service. But as long as a whole the fire service resists, they will be the major obstacle which must be targeted, and they will make their service obsolete.
As a whole the fire service isn't resisting; that's what you aren't understanding. Some areas don't do EMS well and resist change, but then, so do other service models. Some national org's write position papers, but those org's don't enforce policy for the depts in this country. While they can affect national policy, they don't affect what each dept does, and really...where is the response from the rest of EMS? If the policy changes are so wrong, it should be easy to refute. But that doesn't seem to be happening. Blame fire, sure, but blame the rest of us as well. As things change it won't just be fire depts that have trouble adapting.

<snip>

I have identified the problem and it is the fire service's culture of resistance to change and meeting the demands of today.
It's not just the fire dept's resistance to change though, you don't seem to be seeing that. While part of the problem, the fire service is not the root cause or the deciding factor.

I really think the national advocates of fire service sees EMS as an add on patch or skill like hazmat or tech rescue. That mentality or culture or whatever you want to attribute it to is not conducive to medicine.
It's not, but as I said, they don't set policy. And where are the people to speak up and point out that what they say is wrong?

<snip>

I'd be more than happyy to try and help the fire service, but like a patient, you can't help those who don't want it.

Don't mistake what some places do for what all do or want. Don't think that what the IAFC and IAFF national offices say is what is happening, or what depts want. Don't think that other service models wouldn't be adversely affected by change and may not be as strong proponents as some would think.

You say the fire service as a whole provides substandard care? Can you prove that? Can you prove that some other service as a whole provides good care? And if you can, then why isn't it being shared publically? Prove what is good and what is required of EMS, make it so crystal clear that nobody can come up with a reason to not do it, and then you'll start to see change. But...who's doing that again? Who's educating the public? Who's speaking for EMS? Oh yeah...nobody.

If you want to see change, you need to show why it must happen.

 

[triemal04]

I see poor brown subscribes to the bogeyman theory; the fire service is evil! Everything that is wrong with EMS is their fault! If they didn't exist EMS would be perfect! They are the only ones holding EMS back! :censored::censored::censored::censored:e. That belief of course disregards almost all facts, the current state and the history of American EMS.

I also can't help that brown will complain about the fire dept using dated evidence, and yet does the same thing with several of his links. The stink of hypocrisy is rising again... Oh well. Let's look at those things again.

"It is no surprise that study after study has shown that fire department-based prehospital emergency medical care systems are superior to other provider types." No self-respecting devil's advocate or anyone with a brain could help but wonder, where is the study that shows the fire service is inferior when it comes to EMS? Not anecdotal evidence, or evidence gleaned from 1 or 2 depts, but as a whole?

"The “Golden Hour” describes the precious time period from time of injury through location and transportation to definitive care of a critically injured trauma patient to minimize death and permanent disability" That actually is what the concept of the golden hour is. It has nothing to do with time per se, and I don't believe that's how it was referrenced by the IAFF.

"Fire fighters not only respond more rapidly than their single-role EMS counterparts, but are also more effective in terms of patient outcomes (Braun 1990)." So...where is your actual proof to refute this and show that it's not true. Do you have anything, or is this just ranting and raving? If you want to argue that something is wrong, you had best be able to show why it is, not just complain and rave.

"One of the biggest concerns fire service-based paramedic programs were concerned with was the apparent mandatory need to be affiliated with or sponsored by a college or university and that previous standards didn’t allow fire departments or fire/EMS academies to be considered in this process." Ok, that's pretty dumb. Nevermind.

"...[The IAFC EMS Section] question... whether the increase in knowledge gained through the draft [National EMS Education Standards] will have a real effect on the actual field practice" Will it? That is actually still an unknown at this time and a valid question. The change in paramedic level education is pretty small all things considered. How much impact will this actually have? As steps forward go, it's a small one. Future steps may change things more, but this doesn't do a lot.

"With respect to CoAEMSP certification for paramedics under “Educational Infrastructure,” the education standards should also include certification via fire service academies accredited at the state level. Many states have “Technical/Vocational” schools that are not colleges/universities but provide a great deal of the EMS education. Many fire academies have excellent education and highly qualified training staff but would not qualify if the requirement was held to a college or university setting." It's actually a valid question. If a school meets all the requirements of CoAEMSP except for being associated with a college and provides all the education required by the new standards, should they be denied? For what reason? Of course, followers of the bogeyman theory will of course assume that all schools where firefighters are taught have Bubba as the head of the program. Sad. People who have a real understanding of the challenges facing EMS here will already know that there are a huge number of crappy so-called schools that aren't associated with any fire dept. It's not exactly a problem that affects only one group.

Which leads me to a burning question I have. Not to get personal mrbrown, but why is it that, when discussing American EMS, you are only able to reference or discuss things that other people have brought up? You can't seem to have an original thought on this issue, but parrot what you hear on...an internet forum. An anonymous one at that. What's the reason? Inquiring minds want to know. You've said you do know about EMS here, and yet, all you can talk about is what someone else talks about first.

**I don't agree with just about everything that's quoted in this post, but there are some...inconsistencies in how brown interprets them. If you actually know what you are talking about, it's much easier to have an informed discussion, versus freaking out with only a bit of the needed info.**