Report: FIRE doing EMS should come to an end.

[triemal04]

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.

Oh good, I'm glad that wasn't what you meant. I'm sure you can see how an unscrupulous person would take what you said to mean that though...

If you don't mind, would you mind answering the questions I asked? Specifically, why having a paramedic on an engine is appropriate; and not anecdotal examples if you can, but real reasons why having a paramedic on an engine would be beneficial. And, how often is your department actually cancelling the paramedic unit, plus how long are they arriving before the ambulance? As well as, if the people on the engine want to be elsewhere, and 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?

 

[Martyn]

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.

Barbecue?
(Sorry, couldn't resist it)

 

[medicsb]

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

Actually, there is NO EVIDENCE. I've yet to find even an abstract to support the practice (and I've looked). Simply, there is NOTHING efficient about sending fire apparatus with paramedics. There's no efficiency involved with sending an ALS SUV when there are already ALS ambulances (e.g. Memphis FD). Despite what all the Gary Ludwigs of the US might say, it's nothing more than wishful thinking.

 

[DPM]

...There's no efficiency involved with sending an ALS SUV when there are already ALS ambulances (e.g. Memphis FD). Despite what all the Gary Ludwigs of the US might say, it's nothing more than wishful thinking.

The only time that I can see this working is when an ALS supervisor responds with the Ambulance on high acuity calls. I think London Ambulance safely showed that the single SUV responder is a bad idea.

 

[Tigger]

Actually, there is NO EVIDENCE. I've yet to find even an abstract to support the practice (and I've looked). Simply, there is NOTHING efficient about sending fire apparatus with paramedics. There's no efficiency involved with sending an ALS SUV when there are already ALS ambulances (e.g. Memphis FD). Despite what all the Gary Ludwigs of the US might say, it's nothing more than wishful thinking.

Indeed you are correct, I was going after political correctness points.

I guess you could argue that some tiered systems use non transporting fire as their ALS but even that is not all that common outside of California. And those models miss the point of a tiered system in not having a billion paramedics.

 

[46Young]

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.

Seriously, that's the best that you can do, there are less fires, so replace reduce staffing and deployment, and somehow reverse the trend of dwindling volunteer participation and replace the career members? I almost spit my drink all over my computer when the author used the rationale that the Revolutionary War soldiers were volunteers, so firefighters should be the same. Using that logic, we should replace EMS, police, nurses, and perhaps even incoroprate volunteers into our Armed Services to replace paid soldiers. At least he admits that firefighter salaries can more than double with OT. So, with that admission, we can take his LA average salary of $142,000, and realize that the pay before any OT would be $70k/yr or less, not really out of place in a region with a high cost of living such as LA. Realize as well regarding OT budgets that if the OT burden becomes too great, they will hire more employees. There is always a balancing act where it costs less to pay out OT rather than hire more people, since it cost $$$ to hire, train, gear, pay benefits, and retirement to more employees. To a point, paying existing employees 1.5x is the cheaper option.

Also, it's not "the firefighters are up in arms that someone (a university law & economics professor) put some statistics together," it's Dave Statter, a civilian reporter that runs a fire blog, not a member of service.

I've explained numerous times on this forum that the fact that fires are less frequent is not a justification to reduce staffing and deployment of suppression resources. Fires still occur, and many residential building s do not have sprinklers. Fires burn much hotter, and much more rapidly than before, due to the proliferation of type V construction (lightweight wood construction) which has a high fire load, and a large degree of synthetic materials in most homes, which also burns hotter, faster, and gives of more toxic byproducts than natural materials that were found in older homes. If anything, there needs to be a more rapid response time than there has been in the past, and there needs to be an adequate number of firefighters on each apparatus to quickly accomplish vital fireground tasks upon arrival.

Don't take my word for it, look instead at these two links. The first is a NIST video from UL that compares a legacy room to a modern room, and the difference in time to flashover. The second video is from the NIST studies that we did in Crystal City in Arlington VA. I participated in this study. The purpose of the study was to show how different staffing and deployment scenarios affected the timeliness of various fireground tasks.

http://www.firefighternation.com/videos/legacy-and-modern-fire-behavior

http://www.nist.gov/fire/staffstudies.cfm

The author also chose to focus on figures regarding confirmed structure fires, and conveniently overlooked all of the other supression-related calls. I don't see how terrorism training would significantly increase staffing levels. He's reaching really far with that one. Just like fire has it's "food on the stove," smells and bells, minor outside fires and such, EMS gets it's share of false alarm medical alarms, pt. refusals, no pt. found, things like that, and also what I would call a scourge of unnecessary transports, which would be patients that are able to transport themselves to urgent care of their PCP, for conditions that will not have a change in outcome from using (abusing) EMS resources to txp to the ED.

This was also a regurgitation of a similar article from 2002. I can say from personal observation, at least in the Northern VA/MD/DC area, that there has been a decrease in volunteer staffing/participation, and an increase of career staffing for area departments. More and more stations that were formerly 100% volunteer now have daytime paid crews, and combo stations progressed to 24/7/365 paid crews. For example:

http://www.wboc.com/story/9693807/gainesville-volunteer-fire-department-dissolved

Fred's old article:

http://www.econlib.org/library/Columns/Mcchesneyfire.html

I challenge you to review Dave Statter's response, and show how/where he is inaccurate. I agree with Dave when he says that the article was "Truly one of the dumbest articles ever written about firefighting & the Washington Post should be ashamed for publishing it." I was astonished at how overwhelmingly ignorant that piece was. To someone that doesn't know any better, the article would seem interesting, but when you look at the actual facts his logic fails in grand fashion.

I'm all for more ambulances, but decimating fire staffing and deployment is not the answer (see above).

 

[Tigger]

I'm all for more ambulances, but decimating fire staffing and deployment is not the answer (see above).

Most here are not suggesting that, and I have emphasized that numerous times. Still does not mean that fire engines should be responding to every medical call, nor should they have paramedics onboard.

 

[DPM]

A City FD in my area staffs ALS Rescue Squads, which are type 3 ambulances. I recently responded with this agency and found an Engine and a Rescue Squad (read: Ambulance) already on scene. I think this is the worst example of this practice, but a perfect example of the duplication of effort that we face.

An ambulance, equipped as such, with all the capabilities to transport sick and injured patients, but not doing that. I can't get my head around this.

 

[DPM]

I should add: I work for the county's EMS provider, so once I was on scene we had an engine and two ambulances, but one of the ambulances was never going to transport.