Is It Time?

[MrJones]

Just as parents hope to give their children the best possible start in life before watching them take what they've learned and head out to make it on their own, is it time for EMS to thank Fire for getting us through our formative years and then take what we've learned and strike out on our own, so to speak?

Discuss.

 

[Angel]

itd be nice, but i doubt itll happen. more and more places are going for fire based EMS instead of the opposite. EMS is missing something as far as being as strong as fire/police/nursing not sure what, but itll be difficult to 'survive' or be a worthwhile career until that happens

 

[SandpitMedic]

It has been time for that for a while now. A 1/2 million dollar ladder tiller has exactly zero business stomping down the road for a patient with "rib pain" et. al.

It's also time for the police to start taking psychiatric patients (with no true emergency) to a designated facility instead of calling for an ambulance and said fire trucks. (At least in my area that's how it works- I'm not debating your policies and practices- just venting my opinions) ETOH patients as well, to a place called the drunk tank.

It is time for educational standards to be hoisted up to a collegiate level of an associates at least for paramedics. CCEMT knowledge should be common knowledge for Paramedic level providers, also.

It is time to raise wages and offer better benefits to EMS providers. Tell me why a degenerate recurrent BS complaining pt on Medicaid should get free/better medical care than I do?

It's time for treat and release or treat and refer protocols to become a common and proactive approach to those said patients.


I understand that these views are what I would think would progress private EMS levels in my own locality. Lower the burnout, lower the dangers, increase the standard of care, and set ourselves up for success.

Every area has its own issues and only some are widespread. Being overrun by BS and treated like step children by FD is a common denominator I believe though.

 

[SandpitMedic]

I also share Angel's morbid outlook. It will never happen. Fire has "it".. Whatever "it" is... Perhaps PR or tradition or what have you. They also have politicians in their midsts and require justification for those big tires and budgets.

Which is why I keep my nose straight and keep moving upward and onward back out of the private 911 arena. It's a stepping stone. Everyone knows that.

 

[EMS1]

Unionize?

My heart has always been with the fire dept first but I've taken the EMS seriously over the last few years since 99% percent of our calls are EMS related.

I started off by getting my EMTB and I'm trying to figure out to go further. I will admit that I have a lot of pride when my fellow FF's look at me to take charge before the Ambu arrives.

We're paid call county FF's but even our full time paid county guys and gals make very little compared to the big city metro FF's. Even some of the full time county FF's can not afford the health insurance that's provided.

Not sure what the solution might be, but I guarantee before the wages and beni's goes up, I'm sure we'll be required to have more education behind us.

 

[drjekyl75]

Unions aren't necessarily the answer. I work for a private company without a union and make on average $3 more an hour than medics working for the union represented private company 5 minutes up the road.

I think a higher education standard is a great start. I see the new class of EMT-B's coming through as student riders and as new-hires during the FTO program. Most of the new hires aren't sure what they want to do as a career and felt like it was the military or EMS so they became a basic. The classes they come from take their money and offer poor educational opportunity and I'm sick of hearing, "You'll learn that from the company you work for" I hear that far too often from students and new hires. Even though it would probably push costs up. I think a more community college based type of 2 year program would provide a better foundation of education. I don't dislike the private EMS academies, but wonder if they see beyond the $$$ lately as I'm seeing worse and worse students every 6 months.

The other issue with the company I work for is tattoos. I know the issue has been beaten to death, but anyone with tattoos below sleeves on short sleeve shirt are required to wear long sleeves year round. First impressions are big especially when entering someone's home. A lot of people make assumptions when they first see someone and tattoos don't always make the best first impression. Personally, I have 5, but not one can be seen by the public.

 

[rmabrey]

It has been time for that for a while now. A 1/2 million dollar ladder tiller has exactly zero business stomping down the road for a patient with "rib pain" et. al.

It's also time for the police to start taking psychiatric patients (with no true emergency) to a designated facility instead of calling for an ambulance and said fire trucks. (At least in my area that's how it works- I'm not debating your policies and practices- just venting my opinions) ETOH patients as well, to a place called the drunk tank.

It is time for educational standards to be hoisted up to a collegiate level of an associates at least for paramedics. CCEMT knowledge should be common knowledge for Paramedic level providers, also.

It is time to raise wages and offer better benefits to EMS providers. Tell me why a degenerate recurrent BS complaining pt on Medicaid should get free/better medical care than I do?

It's time for treat and release or treat and refer protocols to become a common and proactive approach to those said patients.


I understand that these views are what I would think would progress private EMS levels in my own locality. Lower the burnout, lower the dangers, increase the standard of care, and set ourselves up for success.

Every area has its own issues and only some are widespread. Being overrun by BS and treated like step children by FD is a common denominator I believe though.

This.

 

[terrible one]

Won't ever happen (at least on the west coast). Fire unions are too strong and politicians are too spineless to do anything against said unions.

 

[JPINFV]

It's also time for the police to start taking psychiatric patients (with no true emergency) to a designated facility instead of calling for an ambulance and said fire trucks.

1. Sometimes psych issues aren't just psych issues.

2. Acute psych breaks are emergencies.

3. Chemical restraints are better than handcuffs.

4. Just because paramedics are trying to divest themselves from psychiatry because it isn't OMG TRAUMA or OMG STEMI cool beans doesn't change the fact that psychiatry is medicine.

5. Just because properly handling and restraining patients with acute psychatric disorders is one of many holes in EMS education doesn't mean that it isn't EMS's place to deal with emergent brain disorders. It simply means that it's a hole in the education.

6. Why are psych patient's the police's job if they aren't going to jail?

 

[SandpitMedic]

Always one guy....I appreciate you playing devil's advocate on this particular issue.

"....who are not having a true emergency..."

True emergencies as you just described I do not have a problem with.
If there is an indication of medical cause then, sure. Acute manic psychosis included.

Police departments offer additional training and sometimes have crisis intervention officers better suited to de-escalate a potentially violent person.

Additionally, the person can be transported by the officer in a contained and safe environment in which he can be easily manipulated and or subdued should erratic behavior ensue.

Police officers also have the power to arrest/detain and place individuals on legal holds, therefore should remain in the custody of that officer.

98% of the psych patients I am called to are repeat offenders who say the right things to get to their 3 hots and a cot in the emergency room. Or they seek rehab or other non-emergency form of treatment. Some are just drunk :censored::censored::censored::censored::censored::censored::censored:s who say stupid things. Some are children who apparently are victims of bad parenting and lack discipline. Some guy who is sad who wants to kill himself because his computer froze, et. al.

Generally, all psych calls are code 3 lights and sirens as well, in which a fire apparatus and private ambulance respond. Even with an officer on a safe scene with a stable person.

That, in my opinion, is an uncalled for response, policy, and practice that wasted resources, finances, and time. As well as an unnecessary risk driving code 3 for what is not a true emergency... And most of the time not even an untrue emergency. As in most of the time is is BS as stated above.

The EMS system, to include the EMERGENCY department(s), were not designed nor intended to service this type of person. It puts an unnecessary strain on the system from top to bottom. Not to mention most of these patients are on some form of public assistance which, in this country, is eating away and contributing to the erosion of the economy and state of the union. It is unsustainable as it stands now, as a provider I disagree with it and as a tax payer I disagree with it.

I am not saying that these people don't need assistance. They very well may. However, the assistance they need is rarely emergent and is not what our current system was designed for. Perhaps a special, as I stated, designated psychiatric facility that can offer the services needed would be a better suit.

I'm calling a spade a spade. You are assuming every "patient" who calls 911 is having a real emergency requiring advanced intervention beyond a good talking to and an ambulance ride. I don't judge my patients. I don't know their struggles. I don't treat them differently based on whether they are bleeding out or just a drunk fool. It is what it is. And I don't think it is a job for EMTs or paramedics. I am not a psychiatric professional, nor do I have any desire to be. That is why I went to paramedic school.

To compare; it is in essence the same priciple of forcing FFs to be paramedics to be FFs. Forcing Paramedics to adapt and become crisis counselors.

Obviously there are many other variables and this is a single topic we could debate for days. And only one facet among many things that would help EMS be better EMS. I am keen to the fact that some BS comes with the territory. However the high concentration of it facing providers these days is a considerable contribution to the problems with EMS and provider well being.

 

[Drax]

Won't ever happen (at least on the west coast). Fire unions are too strong and politicians are too spineless to do anything against said unions.

Isn't it cheaper to have fire also do EMS? I mean...we've got to be at the station on call anyway. Or is the argument to remove paid firefighter jobs and create non-fire EMS/better paid non-fire EMS jobs?

I like doing both. And should we have non-fire EMS standby when we're dealing with structure fires? Are you going to go into a burning building to save someone? Without the training, you wouldn't know if it was safe ENOUGH to do so and we wouldn't know the best way to take care of them (beyond the good ol' drag and pull). Medical training helps up do our job better as well when having to deal with patients at the scene of a fire or massive incident.

Frankly I don't object to split cultures. I think, for example, cities like New York and Detroit are good in the way that they are broken up. But the fire guys are still EMT. I think things went that route in the first place for a very good reason. If you're going to be the primary response to all situations involving the need for medical attention, you're going to need to have firefighter training (which includes non-fire aspects of the job). In other words, you go ahead and cut the patient out of the car after stabilizing it, you're also gonna need to crawl into it too. Call me IF and only IF it catches on fire. As a whole, non-fire EMS folks are gonna need to be much more mechanically inclined to say the least.

 

[azbrewcrew]

The IAFF will never allow this to happen. Fire departments need EMS to survive these days. Stuff doesnt burn nearly as much as it used to, so EMS is their budget justification for new apparatii and fire palaces on every corner. Its an antiquated model that fleeces the hell out of taxpayers, but the fire unions play thr "think of the children" card and we keep throwing them money.

 

[Drax]

The IAFF will never allow this to happen. Fire departments need EMS to survive these days. Stuff doesnt burn nearly as much as it used to, so EMS is their budget justification for new apparatii and fire palaces on every corner. Its an antiquated model that fleeces the hell out of taxpayers, but the fire unions play thr "think of the children" card and we keep throwing them money.

Absurd, try working fire in a rural area. Fire stations are not as common as starbucks by any stretch of the imagination.

That aside, the IAFF has nothing to do with volunteer fire departments.

 

[azbrewcrew]

Ive done rural fire/ems as well as urban EMS. I should have clarified my post. My statements were more geared towards metropolitan areas. In many rural areas it makes sense just based on response times/staffing.

 

[JPINFV]

Police departments offer additional training and sometimes have crisis intervention officers better suited to de-escalate a potentially violent person.

Is it too much to train EMS to do this? Heck, being able to deescalate is useful for non-psych patients who may be uppity.

Additionally, the person can be transported by the officer in a contained and safe environment in which he can be easily manipulated and or subdued should erratic behavior ensue.

Which is safer... chemical restraints or physical restraints?

Police officers also have the power to arrest/detain and place individuals on legal holds, therefore should remain in the custody of that officer.

...and it's relatively stupid that EMS can't make a medico-legal decision. (side note: In California, physicians can write the same hold and individuals designated by the county health department can also write holds... i.e. RNs on psychiatric evaluation teams).

98% of the psych patients I am called to are repeat offenders who say the right things to get to their 3 hots and a cot in the emergency room. Or they seek rehab or other non-emergency form of treatment. Some are just drunk :censored::censored::censored::censored::censored::censored::censored:s who say stupid things. Some are children who apparently are victims of bad parenting and lack discipline. Some guy who is sad who wants to kill himself because his computer froze, et. al.

...yet all of them are going to be evaluated by a psychiatrist...

Generally, all psych calls are code 3 lights and sirens as well, in which a fire apparatus and private ambulance respond. Even with an officer on a safe scene with a stable person.

That, in my opinion, is an uncalled for response, policy, and practice that wasted resources, finances, and time. As well as an unnecessary risk driving code 3 for what is not a true emergency... And most of the time not even an untrue emergency. As in most of the time is is BS as stated above.

So your system's dispatch protocols suck. That doesn't change the fact that it's a medical problem, not a law enforcement problem.

The EMS system, to include the EMERGENCY department(s), were not designed nor intended to service this type of person. It puts an unnecessary strain on the system from top to bottom. Not to mention most of these patients are on some form of public assistance which, in this country, is eating away and contributing to the erosion of the economy and state of the union. It is unsustainable as it stands now, as a provider I disagree with it and as a tax payer I disagree with it.

By "this person" do you mean acute psych breaks or people playing the system?

What does your opinion "as a tax payer" have to do with this? Do you think that emergency medical care should be provided based off of insurance or presumed value?

I am not saying that these people don't need assistance. They very well may. However, the assistance they need is rarely emergent and is not what our current system was designed for. Perhaps a special, as I stated, designated psychiatric facility that can offer the services needed would be a better suit.

I'm calling a spade a spade. You are assuming every "patient" who calls 911 is having a real emergency requiring advanced intervention beyond a good talking to and an ambulance ride. I don't judge my patients. I don't know their struggles. I don't treat them differently based on whether they are bleeding out or just a drunk fool. It is what it is. And I don't think it is a job for EMTs or paramedics. I am not a psychiatric professional, nor do I have any desire to be. That is why I went to paramedic school.

You actually just judged your patients a few paragraphs up...

Are every patient who calls 911 having a real emergency? No.

Are the etiology of every patient always obvious? No. It's relatively easy to dismiss the obvious meth psychosis until you get the elevated T4 indicating that the psychosis could easily be thyrotoxicosis. It's relatively easy to dismiss the patient with chronic schizophrenia... and then realize that his old records shows 2 large meningiomas putting mass effect on the frontal lobes that the patient was refusing surgery for the year before.

You say that you're not a psychiatrist, yet you're in a field that, by it's very nature, involves dealing with emergencies in all fields... including psychiatry. You can't pick and choose which fields you want to treat emergencies from.

To compare; it is in essence the same priciple of forcing FFs to be paramedics to be FFs. Forcing Paramedics to adapt and become crisis counselors.

Except FF isn't medicine. Psychiatry is medicine. Some psychiatry is emergency medicine.

 

[Handsome Robb]

Drax.

Then why are we the ONLY country in the World that combines fire and EMS?

 

[MrJones]

So far, it appears that the IAFF is being held up as the primary roadblock to doing the right thing. But what about the International Association of Fire Chiefs (IAFC)? Or the National Fire Prevention Association (NFPA)?

And a related question that was inspired by the excellent discussion thus far....

Do you believe that dual fire fighter/medics can excel at either? Or will they be merely adequate at both?

 

[Handsome Robb]

I know a few fire medics who are exceptional at both jobs.

It's not the norm. Seems to be one or the other but it can be highly dependent on department culture as well.

 

[UnkiEMT]

Do you believe that dual fire fighter/medics can excel at either? Or will they be merely adequate at both?

I present a third possibility: They can excel at one or the other

I hate with a burning passion those that are firefighters first and 'medics after, I feel their dispassion brings shame on my profession.

Those that are 'medics first and firefighters after, I smile upon for their dedication to what matters, and grant them dispensations for their frailty.

I've never met such, but if I were to hypothesize one who equally exemplified the qualities of a 'medic and a firefighter, I would treat them as the latter.

 

[azbrewcrew]

One of my old partners said it best..."there are great medics,and there are great firemen, but very rarely are there great fire medics". When 80% of their training and drills are preparing for the fire they likely wont get, its hard to perfect your other craft, which is prehospital medicine