Keeping the Fire in EMS Response

RedBlanketRunner

Opheophagus Hannah Cuddler
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What is even more disconcerting is the majority of FFs are volunteer and take EMT courses on their own time and dime. And maybe more disconcerting yet, if the states or Feds would consider some sort of funding assist there would be the possibility of a fustercluck of biblical proportions. Emergency response has always relied upon a great deal of individuals efforts and I can't see political red tape improving matters.
 
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DrParasite

The fire extinguisher is not just for show
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blah blah blah blah. Seriously.

Here are some facts:
1) the majority of fire departments have transitioned from fire departments to EMS departments that fight fires too. And often those EMS departments are only stopping the clock until the ambulance arrives. While I do think that the expansion of FDs from strictly firefighting to fire rescue is a good and logical progression, transitioning to EMS (especially by force) has been hurt the FDs.
2) ALS fire response has not shown to save any lives, but it's super expensive. and it helps justify FD staffing. But if you ask most FFs, they would give up their paramedics certs and stop going on EMS calls tomorrow if they could.
3) the busy cities that see a lot of fire still send their companies on more EMS calls than fires (there are a few exceptions to this, but they are by far the minority)
4) FD wouldn't need to go to so many EMS calls if EMS has enough units to cover the call volume. but it's cheaper to bandaid an understaffed EMS system with an engine or QRV to stop the clock than actually provide enough ambulances to handle the EMS call volume.

Disclaimer: I am a firefighter. I ride the BRT to fire and EMS calls. I present at EMS conferences. I am a state certified EMS instructor. and at 3am, I would much rather be sleeping than going on an EMS call (or a fire call for that matter). The opinions presented are mine and do not reflect my employer or any city, county state or nation that i have lived in, worked in, or ever driven through.
 

E tank

Caution: Paralyzing Agent
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Fire Chief's associations use(d) EMS to bolster funding credibility for their departments as a necessary evil. Good for the capital budget, staffing, etc. It's one of the reasons many engine companies are more interested in showing everyone who's boss than taking good care of patients. Now there's a fireman from Providence that sees a problem. Hard to be sympathetic.
 

Peak

ED/Prehospital Registered Nurse
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I think that part of it just boils down to being a professional.

The reality is that EMS and Fire (as well as law enforcement for that matter) have far more in common than many would like to admit. They both require a dedication to the science of the material, but also the art of applying the material in constantly changing environments. They both require the ability to stay calm under pressure. They both require the ability to make the best out of a poor situation. They both involve hard work often for long hours.

In both cases you will find people who do the minimum and then play on their phones, play video games, or whatever else. Regardless of whether this exists in fire, EMS, or a combination department (as well as volunteer or career) it is not a professional behavior.

My bias is that I was a former fire/medic that saw a pretty even split between fire and EMS. I think that on both sides we provided good service to the community. When we showed up with an ambulance or a fire apparatus we were trusted to be able to perform our job well both by the general public and other departments. Ironically if I showed up in one if the ambulances to a fire department they treated us like they would their contracted third service (not well), and if we showed up in a type 3 to a EMS agency we were treated as the dumb firefighters.

I can think of plenty of people that were great at both roles; be it in EMS and volunteered in fire, had a dual role job, or were in fire and had a EMS side job. I'd like the idea where we continue to advance the training and education for both EMS and fire, and perhaps both will not be doable in the future, but currently in the US I think it is very possible to be both. I also think there are plenty of sub par EMS providers and firefighters, but typically this is because they are not professionals, not because they are dual role.
 

NomadicMedic

EMS Edumacator
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Morse should stay retired and stop shooting his mouth off. He was a burnt out Providence RI cardiac tech/FF and knows nothing other than the screwed up Rhode Island system. He's made his name on selling the, "we're burnt out and broken heroes" trope. I find most of his writing to be very off-putting.
 

BobBarker

Forum Lieutenant
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Couple things I don't like about fire and ems together is when there is a major call such as a technical rescue, structure fire or gas leak, you have all your engine companies going there and they are also the ems providers. So when medical calls come out during that event, the patient has to suffer and your mutual aid department is down a unit running a medical in your district. It reminded me of a call where a city sent all their units to a structure fire and about 6 minutes into the call, an elderly female had a stroke on the other side of town. BC had dispatch call another department (5mi away) to provide mutual aid for the medical and the delay between all the phone calls added time to.
I understand the fire unions do a damn good job protecting their employees. If EMS and fire is separate, you would probably get higher patient outcomes and you wouldn't have to worry about calling mutual aid for medical calls when your FF/EMT/P's are tied up on non-medical calls but FF's would have little to do compared to now and probably get paid less than now.
 

DrParasite

The fire extinguisher is not just for show
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It reminded me of a call where a city sent all their units to a structure fire and about 6 minutes into the call, an elderly female had a stroke on the other side of town. BC had dispatch call another department (5mi away) to provide mutual aid for the medical and the delay between all the phone calls added time to.
What are you talking about? the city fire units were on a call already, so of course mutual aid was requested. it's no different than all of your EMS units being tied up on medical calls. if another medical call comes in, guess what, you need to get a mutual aid unit to handle it.

focus on real issues, not made up complaints.
 

BobBarker

Forum Lieutenant
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What are you talking about? the city fire units were on a call already, so of course mutual aid was requested. it's no different than all of your EMS units being tied up on medical calls. if another medical call comes in, guess what, you need to get a mutual aid unit to handle it.

focus on real issues, not made up complaints.
Certainly can happen, but usually not all ems personnel are directed towards one call that takes all resources like a structure fire, gas leak or technical rescue. Since a majority of calls are EMS in nature, it's easier to adjust staffing based on volume/time of calls and hopefully avoid that. I just don't see why someone would not want Fire and EMS separate other than it might reduce your salary/hours/workload.
 

CALEMT

The Other Guy/ Paramaybe?
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Couple things I don't like about fire and ems together is when there is a major call such as a technical rescue, structure fire or gas leak, you have all your engine companies going there and they are also the ems providers. So when medical calls come out during that event, the patient has to suffer and your mutual aid department is down a unit running a medical in your district.
A little late to the discussion but you know how many times I've been diverted to a medical aid when responding to a fire? Granted not every department is the same, but where I work if theres an active fire, TC cut and rescue, or any extended incident we'll have engines (typically engines housed with truck companies or engines at slower stations) move up and cover so theres no lack of response on our part.
 

DrParasite

The fire extinguisher is not just for show
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but you know how many times I've been diverted to a medical aid when responding to a fire?
I'm guessing 0 times? In most places, once you are assigned a run, that's your run until you clear, unless you have a dispatcher who is on his or her game and has the authority to redirect you to a higher priority call before you make it on scene. So if you are dispatched to a structure fire, the chances of you being diverted to a medical aid are slim to none.

@BobBarker As I have said numerous time on here, fire wouldn't need to go to so many EMS calls if EMS was simply given the staffing and funding to handle their routine call volumes, but it's cheaper to bandaid an understaffed EMS system with a fire responder to stop the clock.

As for your question about single incidents utilizing a large amount of resources, structure fires typically get 2 ambulances to respond (and our MCI/rehab truck), MVAs with pin get 2 ambulances and a boss, ditto shootings and stabbings. and a nursing home evacuation can get a bunch of ambulances and an ambulance bus. And yes, it's typically the closest units that are dispatched first. now, if you have "historic hot spots" for routine calls, you can station multiple ambulances in the same station, so if three calls go out in the span on 10 minutes, you have 3 ambulances to respond. And if you need to do a temporary relocation or moveup to cover a hole or for a big incident, than that's what you do. It's not really rocket science here. In some counties in NC, if your system has 0 available units, or a lower number of unacceptable units, they will proactively request a mutual aid system to stage a unit on the county border for a bit, just in case they are needed (which is pretty much was FDs do with cover assignments).
 

BobBarker

Forum Lieutenant
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I forgot to even mention sending 3-4 FF/EMT’s or Paramedics in a fire engine with an ambulance as opposed to just sending the ambulance if EMS/FF were seperated. Another cost to the taxpayers especially in cities with tons of runs per day.
 

justin1232

Forum Lieutenant
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I use to work in a city that when medical happened, due to way of staffing, me and my partner ( both BLS) respond with ambulance and Two! Medic engines respond since you had to have two medics on scene and was only one medic per engine
Granted, once first arrives they can cancel other but still. Showing up on scene for a chest pain or SOB with an ambulance and two engines was kind of ridiculous
 

KingCountyMedic

Forum Lieutenant
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I've never heard of that Morse guy, just read a few of his articles. Glad he's retired. He should go get a hobby. The majority of our firefighters are great at EMS and Firefighting. They break down their training so they have months dedicated to EMS and months dedicated to the fire side, tech rescue, etc. The majority of the fire service in my opinion does it all wrong. There should never be a paramedic on an Engine or Ladder Company. Paramedics should take care of and TRANSPORT sick people period. The problem with most of the fire based EMS around the country is lack of leadership. You need dedicated Physician oversight for both BLS and ALS operations and you need EMS officers that are committed to patient care. Too many fire service folks view the EMS supervisor roles as something they have to do in order to get further up in the ranks. The other problem with the fire service in most areas is that they feel the more paramedics they have the better they are at EMS. This has been pushed hard by our Union. A FF paramedic is worth more $$$ than a FF EMT......

I'm glad to work in a system that does EMS pretty good for the most part, and I'm glad that I'm getting close to being done so I can sit on a beach and let the next generation deal with it. Happy Thursday!
 

DrParasite

The fire extinguisher is not just for show
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Actually your guess is incorrect. More often than not I’ll get diverted. Medical aids trump everything else.
wow, thats.... wow.... So I guess you guys aren't a fire department, but an EMS department that goes to fires?

Or is your EMS system so shortstaffed and underfunded, that without the FD to "stop the clock" people would be dying left and right due to the extended ETA of the ambulance to the scene?

I'm pretty sure if we got dispatched to a structure fire with people trapped in our first due, and we were diverted enroute to a medical assist, my captain and chief would not be happy.... and the public would then ask why a FIRE truck was diverted to a non-FIRE call when a FIRE was burning with peopled trapped.
 

CALEMT

The Other Guy/ Paramaybe?
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wow, thats.... wow.... So I guess you guys aren't a fire department, but an EMS department that goes to fires?
Isn't every west coast fire department an EMS department that sometimes goes to fires?

Or is your EMS system so shortstaffed and underfunded, that without the FD to "stop the clock" people would be dying left and right due to the extended ETA of the ambulance to the scene?
I wouldn't say dying left and right but I work in a county that runs about 150,000 calls a year. Naturally 80% of those calls are medical in nature so thats 120,000 medical aids a year spread out of about 90 something stations. So yeah, not only are we (the FD) taxed, but AMR as well who not only runs with us being the county FD but all the municipal cities that don't contract. So AMR's call volume is even more than ours.

I'm pretty sure if we got dispatched to a structure fire with people trapped in our first due, and we were diverted enroute to a medical assist, my captain and chief would not be happy.... and the public would then ask why a FIRE truck was diverted to a non-FIRE call when a FIRE was burning with peopled trapped.
Statically how many fires have you gone to with an active rescue? Cause for me they're few and far in-between. I can't say for certainty but I would imagine if there was reports of victims trapped then thats a life-safety issue and I couldn't imagine being diverted as a first or second due apparatus. Third or fourth due then yeah maybe.

Oh and a nomenclature thing for me being a west coaster but fire trucks typically don't get diverted... fire engines on the other hand will.
 

Achilles

Forum Deputy Chief
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blah blah blah blah. Seriously.

Here are some facts:2) ALS fire response has not shown to save any lives, but it's super expensive. and it helps justify FD staffing. But if you ask most FFs, they would give up their paramedics certs and stop going on EMS calls tomorrow if they could.
source?
3) the busy cities that see a lot of fire still send their companies on more EMS calls than fires (there are a few exceptions to this, but they are by far the minority
ok....

)
4) FD wouldn't need to go to so many EMS calls if EMS has enough units to cover the call volume. but it's cheaper to bandaid an understaffed EMS system
under staffed or overused?
 
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