As I have said elsehwere, the Fire Service is not the root cause of the problem but they but one of the factors. They may infact be one of the larger ones given the strength of the Fire Union's promotional power.
How does it disregard any facts about the history of EMS in the USA?
In the late 1960s Dr Eugene Nagel wanted to get out-of-hospital defibrillation for cardiac arrest in Miami. When he is interviewd in "Making a Difference: The History of Modern EMS" he states it was out of convienence more than anything to use the Fire Department because they were in the streets, had radios and a network of vehicles and a disclipine; all he had to do was teach them some medical skills.
Cobb and Cohen in Seattle/King County turned to the Seattle Fire Department to create Medic One in 1969.
It was in 1970 that Los Angeles County wanted to get a Paramedic system running but the locals complained bitterly about any sort of taxation to fund it because they were already overtaxed at the local level. The Los Angeles County Fire Department figured they had a lot of spare capacity because they only spend a couple of percent of thier time fighting fires and doing prevention work and could run EMS.
Then if we look at Los Angeles City they had single-role civillian Paramedics up until 1992.
You're missing the point. One or two of the documents might be a few years old (and I agree they are) however one must consider that these documents come from the IAFC EMS Section and the IAFF websites so should represent that which is current.
The other point is that the evidence (studies) the IAFC EMS Section use are very old (one is from 1990) and they are no longer clinically relevant evidence because a lot has changed since 1990 which makes the particular study in question void.
In 1990 EMT-Ambulance (EMT-Basic) could not use an AED nor where they widely avaliable (PAD/BLS with AED) and the study looked at arrival times and ROSC in cardiac arrest for those treated by civillian EMS vs Fire based EMS.
We all know anybody with an AED who rolls up be it the Fire Service, Jack Armstrong the All American Boy or the cops is probably going to have a positive impact upon rate of ROSC. I think its common knowledge cardiac arrest survival rates don't go on ROSC they go on neurologically intact people who walk out of hospital post community arrest; the Fire Service however chose not to use that proper marker of effectiveness for whatever reason; probably so they could get higher numbers and make themselves look better.
You will notice the Fire Service are very deceptive and refer to that study as proving that they offer superior patient care; they do not state in what context i.e. ROSC from cardiac arrest given fire-service AED first responder programs in 1990. Therefore, it is very misleading.
The USA Today published a rather large article a few years back which showed cardiac arrest survival rates for 50 large American cities that presented data. With the exception of Seattle, the lowest numbers were Fire Department based EMS cities.
The recent intubation studies that come out of Miami show horrendously low succes rates, and they are, a Fire based EMS system.
I see what you are saying, but, turn that around and say the same thing to the IAFF, where is thier evidence?
No of course not, thats why they use the word "time" in there and why it is called, the "golden hour"!
The point is the golden hour has been proven to have no basis in evidence (Bryan Bledsoe did a good presentation on it a few years back plus there have been several studies that say it has no real relevance) and be a myth without any solid foundation.
It is just another example of deceptive marketing by the IAFF to promote Fire Based EMS; oh we can get there quicker and stop the golden hour clock.
It was horrendously difficult to find this paper, there are some obscure references to it around the internet but I cannot find the actual article itself.
Notice the IAFF again left out the full APA reference for that study? I am not saying it was deliberate but sure is highly convienent.
The problem is that the Standards affect all levels of practice and many fire departments use Basic and Intermediate EMTs on thier staff. So it's a bit niave to say it only affects Paramedic level care.
I can sort of see where you are coming from in that at the end of the day the system only has two outputs (transport or get a refusal) and that an increase in knowledge will not change that (specifically as a result of the changes in that document).
It is however very disturbing that the Fire Unions are questioning the need for an increase in knowledge given that the US standards are some of, if not the, lowest in the developed world.
It's true and I fully agree not every crappy medic patch factory for warm pulses is associated with the Fire Service; I have never said that.
We all know the Instructor certifications are again woefully inadeuqate in the US and that many are simply teaching what they were taught because they have no greater understanding of the material than when they were taught it.
To affiliate programs with a College or University system would demand higher level qualifications for Instructors and weed out those who are simply regurgitating from thier own knowledge or the PowerPoint slides.
Paramedicine faculty here in New Zealand, in Australia, the UK and Europe have Masters Degrees or higher and Paramedic education is part of the University system.
If the vocational education system works so well then why have other developed nations removed it and insisted every Paramedic go to University?
What original idea or concept would you like me to come up with? I don't forsee anything I could think up that has not been thought up before by somebody else because they recognise the same problems as I do.
