Report: FIRE doing EMS should come to an end.

[Martyn]

Just as an aside, I got called 911 non emergency response for a GLF, outside the residence was (if I remember correctly) a ladder truck, a pumper, the battalion chiefs vehicle a county ambulance and us (I was working with Americare at the time), I think there was one or two sheriff deputies there as well. When we got on scene my partner and I were like WTF???

Somewhere I have pictures to prove it...now, what hard drive are they on???

 

[johnrsemt]

If ambulances were only sent on EMS runs; for the most part everyone would be ok; but when EMS gets to the scene and you find out that the patient that was called in having minor problems breathing is now a smurf, and weighs 400lbs. So you can treat the breathing problem (or the cardiac arrest) while you wait the extra time for the fire crew (or 2nd EMS from the next town or other side of your town to show up to help move the patient.
My old fire department Dispatch would decide who needs extra help (per caller info, and history of the address {400lb pt, breathing difficulty, etc}) and send an engine or Ladder with an Transporting ambulance. Minor runs, got just EMS. Fire runs got no EMS, unless someone was trapped or it was marked working.
Bad thing is they taught kids in the schools if your house is on fire, pick up the phone, dial 911 and leave phone off the hook while you evacuate and dispatch would tone out a box alarm for it. Two times in about a month's period we had people do that 'cause husband was in cardiac arrest and caller didn't have time to talk on the phone. So they would get 3 engines and 2 ladders, and a chief, and usually 4-6 medics but no ambulances.

Not a perfect system but it works pretty well

 

[SandpitMedic]

How about if a caller gives limited info such as "cardiac arrest" only and hangs up they just send an ambulance and any manpower unit... 3 engines, 2 ladders, and a chief?! No transporting unit?!

... That's not a system that works pretty well... That's full potato.

I'd be happier with a transporting unit, an extra crew or engine, and a cop because no one really knows what they're truly getting.
I have no need for ladders, and no scene needs more than 5-6 providers... Let alone 21... Jeeze. (I come from urban systems, so the cops usually get dispatched on any unknowns that sound fishy and most cardiac arrests for crowd control and safety if they are available.)

 

[DPM]

I agree with these previous posts. The argument "well what if it's YOUR grandmother and she's in cardiac arrest?!" doesn't hold much water for me. What if the tables were turned, and we had a system where an Ambulance could arrive on scene within 8 mins and an Engine / other BLS fire could arrive in 12 if it was high acuity etc? Why is non transporting fire the more important responder?

My ideal system has many more ALS and BLS ambulances, and probably far fewer fire engines.

I know I'll get heat for this, but do we still need the same response times that we did in the 80's? At a quick look the number of fires has gone down by nearly 50%, and the fire protection and holding standards have increased also. It is my opinion that many fire departments are using their EMS responses to justify their pre 1980 staffing levels. I think that it is these levels, and the cost associated with them, that is preventing county EMS agencies from staffing an appropriate level of ALS and BLS transport units.

 

[MicahW]

I disagree with not having FD respond to any medicals. Although I have had some bad experiences with crews that are lazy and do not want to do anything that does not interest them, fire can be of great help. Where I work, we run 2 man rigs. Our ALS rigs consist of one ALS provider and one BLS provider. They can be great for doing compressions as well as lifting and moving. I have responded to many calls where fire is already providing crucial treatment upon our arrival and often have histories, meds, etc. ready for us. That being said, I have arrived to calls where fire has already been there for 5 minutes, and they are just sitting there with their medical bag on the ground, unopened, waiting for us. It really depends on the engine or truck responding. I do agree that EMS should be its own department, but that does not mean that we cannot receive help from fire.

 

[DPM]

You're missing my point. You're advocating early treatment, as am I. I'm also not saying that we don't need fire / help ever. I don't think it's unreasonable to say that in around 70% of cases having 3+ from an engine and 2 from the box is over kill.

If we staff appropriate levels of ALS ambulances then we could make the 8min time ourselves. Then in the relatively rare occasions where we need all hands to the pump we can dispatch fire as well. ROUTINELY dispatching them is where I think the issue lies.

 

[MicahW]

I see your point but I rarely get a call that comes in as "abdominal pain (no need for fire) but the patient is 350 pounds and at the top of a spiral staircase, so we'll dispatch fire to help you out with moving the patient". I would rather have fire there just in case I need help, and possibly not need them, than to not have them. I get that it may take up money, but for the large part, it doesn't affect us--it's their budget, not ours.

 

[DPM]

It does affect our budget though. County EMS pays ever ALS department for every medic that they have on the books. Plus, as a tax payer, you're on the hook for replacing that $10 million pumper because it's now worn out in 6 years and not 10 or 15.

Having them "just in case" isn't good enough.

 

[MicahW]

I see what you mean but I work at a private company so it definitely doesn't affect me, and even my volunteer company largely pays for itself through billing. I do think that it might be a better idea though to send maybe 2 or 3 guys in the chief's car: it's faster and cheaper and if they do end up getting called to a fire, they can just meat their rig there.

 

[Tigger]

I see your point but I rarely get a call that comes in as "abdominal pain (no need for fire) but the patient is 350 pounds and at the top of a spiral staircase, so we'll dispatch fire to help you out with moving the patient". I would rather have fire there just in case I need help, and possibly not need them, than to not have them. I get that it may take up money, but for the large part, it doesn't affect us--it's their budget, not ours.

There are two time I want fire to come. One is on time sensitive calls like an arrest, anaphylaxis, and things of that nature that they could beat us to or extra hands will certainly be needed for. Those calls are fairly identifiable via EMD and they can be dispatched immediately. The other is for complicated "patient extrication" and I can call for them to come and we will wait till they arrive without any detriment to the patient.

So why do they need to be there on every call?

 

[DPM]

The article did an excellent job of articulating the point of view that I've held for quite some time, and so far no one has been able to come up with a better counter argument than "sometimes it's nice to have lots of people on scene when you need them".

 

[SandpitMedic]

I get that it may take up money, but for the large part, it doesn't affect us--it's their budget, not ours.

I usually respect everyone's opinion, but you lost me here. You clearly have absolutely no idea what you're talking about given your last statement. Financially, someone is paying for it. It's all "our" budget... Have you never heard of taxes?

As for the rest, your entire argument is based on emotion and absent logic. The stance of, "I'd rather dispatch everyone to everything just in case" is bogus.

It also has nothing to do with interpersonal relationships between fire and EMS on scene. "I don't like fire crews" is also a bogus reason you're trying to assign to us because we oppose the idea of fire being dispatched too much.

If you actually read what we wrote we actually give real life experiences and scenario based alternatives, all of which still include fire or more hands in a timely manner during true emergencies.

 

[SandpitMedic]

The article did an excellent job of articulating the point of view that I've held for quite some time, and so far no one has been able to come up with a better counter argument than "sometimes it's nice to have lots of people on scene when you need them".

This

 

[Noncreative]

Yeah, I like the idea of Fire restructuring towards EMR/BLS, but I've got no issue with them running ALS, whoever can get there fastest works for me. I do get the cost aspect of it, if fire would send an ambulance instead of a truck they'd be way more effective. But, as Micah said, it's their budget, and I doubt the maintenance saved on the trucks would impact my taxes at all. Honestly I'd rather they send a Type 2 with three Fire, than a truck, because they could transport right off the back with a ride-along already there.

 

[NTXFF]

I'm sure I'm about to be a not so popular guy here. As someone who operates within a fire based system I'm trying to figure out where you work where you've got a battalion, engine, and truck showing up on a medical call. Cardiac arrest: engine and medic. Fall: engine and medic. Chest pain: engine and medic. MVA not on the highway: engine and medic. Our protocols far exceed and system in our area for aggressiveness and the guys here take riding the medic very seriously. We've got a high save rate and have never even had a complaint filed against our system. Reading all this fire bashing is pretty ridiculous and with those attitudes I'd hate to be fire in your area and have to work with y'all. As far as the six figure salary I'm not sure where they are even talking about. Captains are a six figure position but very few departments offer that to a FF/PM. I can understand some frustration but realistically we all have the same job and personally I support either independent EMS or fire based.

 

[Tigger]

What attitude would that be? There is no good reason for anything besides and ambulance to be sent to the majority of medical calls, regardless of the model. I suppose it is "nice" to have five or six people on scene but often it is more of a hinderance than a help and it's not a good of resources. If fire would send two people I'd be a bit more on board with that, but that doesn't happen in many places.

Let's be honest here. Fire departments that do not have ambulances only started responding to every medical call because it helps justify their existence. I don't think that's right and I don't think FDs should be forced to cut staffing because their are fewer fires (a very shortsighted argument). But when other, shortsighted people did choose to make FDs answer for their budget, this was the solution. That doesn't make it a good idea though.

 

[jwoods]

Well, coming from a Fire based organization who provides ALS transport. I can see some validity to an ALS engine being first up on a medical call. It's a double edged sword though. One, we can decide if transports even needed. Alieving our abused ALS transport units or Rescues we call them, freeing them up. However, bandaging an *** boil at 3 am when a structure fire kicks off can be a little frustrating as well. But Tigger your right, it's all about the money, and both fire and ems were never intended to generate revenue nor should they be.

 

[Tigger]

ALS first response has very little evidence to support its efficacy. Send ambulances to medical calls.

 

[triemal04]

Well, coming from a Fire based organization who provides ALS transport. I can see some validity to an ALS engine being first up on a medical call.

Like what? And not anecdotal examples if you can, but real reasons why having a paramedic on an engine would be beneficial.

It's a double edged sword though. One, we can decide if transports even needed. Alieving our abused ALS transport units or Rescues we call them, freeing them up.

Does you specific department actually do this, and if so how often? How long is an engine arriving before an ambulance? I only ask because this gets tossed around occasionally without anything to back it up.

However, bandaging an *** boil at 3 am when a structure fire kicks off can be a little frustrating as well. But Tigger your right, it's all about the money, and both fire and ems were never intended to generate revenue nor should they be.

So you're ok going to EMS calls until something more fun is going down? I'm sure that wasn't what you mean, but that's certainly how it can easily be taken. It also brings up the question of, if that's the case, and not only do the people on the engine want to be elsewhere, but in fact should be elsewhere, wouldn't the public be better served by not using that unit in a way it was not meant for?

 

[jwoods]

First, in my situation down here all medical calls are run by the fire department, We run a priority dispatch system. The majority of our Fire houses are staffed with a ALS suppression apparatus and an ALS Transport Rescue (ambulance)If a less critical priority medical call is dispatched, the engine rolls. If a high priority call is dispatched, the Rescue rolls. If the rescue is out, the ALS suppression is first up.
And I didn't say I enjoy medical calls until something more fun comes along, This system is far from perfect and does need tweeking.