sent to me by a physician

[JPINFV]

This ensures that no units are run down due to staffing. You give upstaffing a negative connotation. What, exactly, is wrong with the way my dept handles vacancies? As far as my dept is concerned, being upstaffed IS being properly staffed. No units will be run down.

That's not what you said. You said,

Once again, we have crews dedicated to EMS units. No one's cannabalizing ambulance crews for suppression duties. We upstaffed for this purpose.

which gives the impression that providing enough personal to properly man ambulances and engines is considered "upstaffed" and not "normal" staffing.

As far as "upstaffing" is concerned, what happens when more people call out sick? Right now Boston FD is averaging something around 13 people calling out sick a day, which is more than they are currently upstaffed for. Since they don't have enough money to pay for overtime, they've resorted to closing up to 4 companies a day to meet needs. Thank God Boston FD doesn't run EMS.

 

[JPINFV]

Tell me how TSEMS is superior, both from the public's vantage point, and that of the employee. Serving the public is why many of us chose this path, I've vollied in the past as well, but this is how I provide for my family.

There's a reason why not every fire fighter is trained for swift water, hazmat, technical rescue, high angle rescue, etc. There's value in specialization, especially in fields that require a lot of background knowledge like medicine. You don't need to be a physics expert to go rope climbing. To provide competent medical care, you do need chemistry, physics, anatomy, physiology, biochemistry, and breadth courses. Alternatively, is your idea of providing competent prehospital medical care involve just being able to read at an 8th grade level and being able to paint by numbers?

From the employee standpoint, it's all about not being forced into a field that they would otherwise not enter, unless you deny that that happens.

 

[46Young]

By upstaffed, I mean that there are sufficient personnel to cover vacancies. A proactive approach. Personnel can be held for 12 additional hours, for a cap on 36 consecutive hours, if needed. This is infrequent, and is only on a one-for-one basis. Are you advocating employee holdovers to plug scheduling holes instead of hiring the necessary personnel? Like I said, each house will be upstaffed(which means those over minimal staffing - 4/engine, 3/truck, 2 for medic, 4 for heavy rescue) by one or two people to cover vacancies.

We don't currently have the problem that Boston has. Until the current economic crisis took hold, Fairfax County FRD ran four academies per year to keep staffing up as we added firehouses and apparatus. Currently, we have nine firemedics graduating at the end of the month, with 20 more being hired for the next class, beginning their internship this August.

Enough with the upstaffing fetish. I don't know how to better explain it, nor can I find any error with my dept's reasoning with this policy.

 

[46Young]

Our FF/EMT's and medics have been crosstrained for some time. This is nothing recent. Anyone who has been hired knows that EMT is part of the job description. There are some old timers that weren't required to take EMT, but most of our staff is trained to at least that level.

I've seen our firemedics and medic Lt's work, and they do both sides equally well, on the whole, from what I've seen. Firemedic prehires are required to have NREMT-P or VA EMT-P prior to hire. Similar requirements, I would think, if one were to apply to any EMS only agency. I don't get what you're trying to prove by the paint by numbers and 8th grade comment. I already stated that new medics do a 16 week internship with weekly classroom sessions, and aren't allowed to ride lead until 18 months post academy. This is way more than most agencies are doing, and this includes EMS only.

No one is being forced to work here. There are fire based single role medics, as well as plenty of third service agencies with pensions. North Carolina is full of them.

I have a good handle on what constitutes good prehospital care. I worked five years for North Shore LIJ CEMS doing both NYC 911 and interfacility txp. Ask someone. I've also worked at CCEMS as stated earlier. I've worked private EMS as well. I've seen enough to tell competent work from incompetent, thank you.

 

[46Young]

I still haven't heard any convincing arguments as to why TSEMS is superior to FBEMS. TSEMS typically has rotating schedules, so you're screwed with attending school, unless you use mutuals or paid time off. Fixed schedules seem to be a selling point for hospital based/private EMS, but that only facilitates attririon when the employee completes their degree and moves on.

 

[atropine]

If you let the privates run ems, you get low wages, and low wages = sub par employees, where if you have a nice pay garde and benifits you get more qualified applicants, who provide and lets face paramedicine is not rocket science service, that is my take on it. I guess too many privates would bid for contracts and medics would be making min wage.

 

[rmellish]

If you let the privates run ems, you get low wages, and low wages = sub par employees, where if you have a nice pay garde and benifits you get more qualified applicants, who provide and lets face paramedicine is not rocket science service, that is my take on it. I guess too many privates would bid for contracts and medics would be making min wage.

Third services aren't necessarily privates. It is possible to have an EMS service run by a municipality which is not under the auspices of the fire service. Incidentally, I think it's the best option.

Privates aren't necessarily for profit. My service for example, is a private not for profit in essence a third service only partially supported by the county. For profit EMS doesn't seem like the best idea when it comes to 911 providing though, based on personal experience.

Also, if Fire "does it better" then why do so many fire based EMS providers hire "civilian" techs and medics? If they do that they're pretty much a third service...

 

[46Young]

If you let the privates run ems, you get low wages, and low wages = sub par employees, where if you have a nice pay garde and benifits you get more qualified applicants, who provide and lets face paramedicine is not rocket science service, that is my take on it. I guess too many privates would bid for contracts and medics would be making min wage.

Pulse and a patch, it's all about keeping warm bodies on the rig. Turnover isn't a problem, as there are five more waiting to take your place.

 

[46Young]

Third services aren't necessarily privates. It is possible to have an EMS service run by a municipality which is not under the auspices of the fire service. Incidentally, I think it's the best option.

Privates aren't necessarily for profit. My service for example, is a private not for profit in essence a third service only partially supported by the county. For profit EMS doesn't seem like the best idea when it comes to 911 providing though, based on personal experience.

Also, if Fire "does it better" then why do so many fire based EMS providers hire "civilian" techs and medics? If they do that they're pretty much a third service...

The best option? Perhaps you haven't seen Charleston County EMS or FDNY EMS(under FDNY, but operates essentially as a third service).

Hiring civilian techs or not, the service is still fire based. The FD is hiring and providing the goods. They'll typically have suppression personnel, typically trained to at least med first responder, to run medical aid.

Care to provide reasons as to WHY a PROPERLY run TSEMS trumps a PROPERLY run FBEMS, other than "personal experience"? Things vary from region to region, I'm referring to the TSEMS vs FBEMS concepts in their purest form.

 

[46Young]

No one has given any good reasons for the superiority of TSEMS, other than a few examples exclusive to the particular dept being referenced. Almost every dept has something that could be improved, fire and EMS alike. That's why I stated earlier to compare properly run models for each type.

 

[JPINFV]

Do you have any evidence that fire based saves money or is superior? I find it next to impossible to believe that sending a fire engine to every medical call is cost efficient.

 

[rmellish]

Let's approach this from another angle. How can EMS advance as a profession if it's always seen as the :censored::censored::censored::censored::censored::censored::censored: stepchild of the fire service?

 

[46Young]

Let's approach this from another angle. How can EMS advance as a profession if it's always seen as the :censored::censored::censored::censored::censored::censored::censored: stepchild of the fire service?

How about you attempt to answer my question as above on post # 90 instead of speaking in cliche? I'm still waiting for a convincing argument as how to why TSEMS is superior to FBEMS.

EMS is far from :censored::censored::censored::censored::censored::censored::censored:ized where I work. Try again.

 

[46Young]

Do you have any evidence that fire based saves money or is superior? I find it next to impossible to believe that sending a fire engine to every medical call is cost efficient.

I asked you first. Don't try to flip it on me without providing effective arguments for your position.

Better to have more help than is needed, than to summon help after the fact. It's probably not cost effective to send ALS on every call either, as many third service agencies do, either.

 

[firecoins]

No one has given any good reasons for the superiority of TSEMS, other than a few examples exclusive to the particular dept being referenced. Almost every dept has something that could be improved, fire and EMS alike. That's why I stated earlier to compare properly run models for each type.

Why should Fire be its own service? We can EMS run fire better than fire can. Police can run fire better than fire can. Sanitation can run fire.

Why not merge all local government departments and have 1 department do everything?

 

[JPINFV]

I asked you first. Don't try to flip it on me without providing effective arguments for your position.

Better to have more help than is needed, than to summon help after the fact. It's probably not cost effective to send ALS on every call either, as many third service agencies do, either.

Kinda of hard to sit here and justify things to someone who will brush off every justification, and then change his opinion to be self serving. After all, you just backtracked from

. Cutting FF positions will cost property/lives. Provided they're properly trained, using personnel in an EMS capacity is more efficient then having two seperate entities.

to "Oh, it'snot all that cost effective after all."

As far as sending paramedics to every call, next time you go to the emergency room, as for the ER tech to examine you to see if you need a specialist. After all, you would hate to spend extra money for a physician.

 

[VentMedic]

Do you have any evidence that fire based saves money or is superior? I find it next to impossible to believe that sending a fire engine to every medical call is cost efficient.

It is not efficient and Florida realizes we have some serious issues with that. However, with the way the ALS engines are placed through the community, we don't have to rely on a volunteer ambulance company that has minimally trained first responders who must call for intercepts after playing on scene with whatever "tools" their state has allowed them to carry.

So I see no problem with the engine being used as a first response vehicle that is ALS capable until the FD ambulance arrives from another station. I do see a problem if the engine is running from the same station and the call is for a sprained ankle. I also see a problem with an engine, FD ambulance and private ambulance running to that same call. These are the issues currently being addressed in Pinellas County, FL by the FDs and Sunstar.

South Florida has been trying to clean up its response somewhat and have prioritized their call dispatching in some counties.

 

[JeffDHMC]

Round here people simply just don't know any better. Same reason people get fleeced by mechanics, they just don't know any better. I could talk your ear off with stories that support just the opposite.

And around these parts, faced with a leg amputation, I would rather hobble myself to the hospital rather than have a certain few private companies take me.

I think it's a very broad generalization to say fire-based EMS is always bad. It definitely, definitely works well in some areas.

Funny how you don't hear an uproar among communities that are served by fire-based EMS, they seem to be satisfied with the service they are receiving.

Is fire based EMS always bad? I'll guess not, it just does not work all that well a lot of the time. BUT, it is the fault of EMS that we must suffer these attacks, say what you will about FD EMS, they market themselves much better. If we would have jumped right instead of left years ago and forgone the perceived need to stay alive by billing for service we would be much better off now.

 

[rmellish]

So I see no problem with the engine being used as a first response vehicle that is ALS capable until the FD ambulance arrives from another station. I do see a problem if the engine is running from the same station and the call is for a sprained ankle. I also see a problem with an engine, FD ambulance and private ambulance running to that same call. These are the issues currently being addressed in Pinellas County, FL by the FDs and Sunstar.

South Florida has been trying to clean up its response somewhat and have prioritized their call dispatching in some counties.

I do have a problem with a $500k engine or worse a ladder being used as a first response vehicle to EMS runs. These EMS runs are recorded the same as fire runs, and this "run volume" is used to justify the purchase of new engines and ladders. It would seem far more cost efficient to send a SUV, Rescue, or even a fly car on ALS first response. That way the community won't be paying for new engines and ladders as often.

 

[VentMedic]

I do have a problem with a $500k engine or worse a ladder being used as a first response vehicle to EMS runs. These EMS runs are recorded the same as fire runs, and this "run volume" is used to justify the purchase of new engines and ladders. It would seem far more cost efficient to send a SUV, Rescue, or even a fly car on ALS first response. That way the community won't be paying for new engines and ladders as often.

So you suggest the FD buy at least 60 additional vehicles if it has 60 stations for just the EMS calls besides their ambulances?

At least even with an ALS engine, they are getting more than BLS trained providers. Again, many FDs have streamlined to where these engines only run if they are needed for response time and are the closest unit. Although, many FDs now have enough ambulances where an engine is not always dispatched.

You can not look at how CA, especially Southern CA, does things because other FDs do things a lot more efficiently. Seattle is also a very good example of this. So don't bash all FDs at be wrong.