You're right, my statement applies more to certain municipalities in my region. I'm not against FD ALS first response by any means, however in some cases it could be delivered in a more efficient manner.
sent to me by a physician
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You're right, my statement applies more to certain municipalities in my region. I'm not against FD ALS first response by any means, however in some cases it could be delivered in a more efficient manner.
I agree.
That is why I will use Pinellas(FL) and Collier (FL) counties as well as LA in some of my examples.
Edit:
Almost forgot Washington, D.C. and their contribution to making FDs look like idiots when it comes to EMS.
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JPINFV
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I would argue that combining an engine company with a first response SUV (since, either way, that unit would be out of service during a medical call. Engineer stays with the engine and, if a fire call occurs during a medical run, the SUV and engine can meet at the fire) would save money by decreasing the cost in maintenance, gas millage, and ultimately extending the life of the engine. Yes, there would be a large upfront cost, but it's a long term investment that makes more sense then replacing an engine where over half of the millage occurred responding to a medical call.
So you also now want ANOTHER vehicle responding?
An ALS engine, an ALS SUV, an ALS FD ambulance and maybe even a private ALS ambulance going to the scene? Where is the cost saving to the FD buying another SUV for each station? What is with all the intercepts? ALS is on scene and not EMT-Bs. At better run responses, the ALS engine is optional and not a requirement. Essentially, there will be a FD ambulance and maybe a private ambulance which may be called to transport.
JPINFV
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No. The SUV responds in place of the engine.The only time BOTH the SUV and engine would respond to an incident is if a call comes in while the SUV is out on a medical call and the actual engine is needed. This would also reduce the need to send an engine to go grocery shopping.
I also don't see the point in having 2 ambulances respond as a first response.
I also don't see the point in having 2 ambulances respond as a first response.
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Only one ambulance may be the first response. However, if the ALS engine is closer then that is toned out for the first response vehicle. It does not run if the FD ALS ambulance is closer.
Our FDs are very large and what you are suggesting would still involve buying over 60 additional vehicles as well as staffing for those 60+ vehicles.
Many patients may not need a bunch of Paramedics in the back to care for them. Usually one Paramedic will suffice from the private service if that is how the response is set. The FD ambulance will return to service to still be a first response vehicle. Some do not have private ambulances running and it is just the FD ambulance.
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JPINFV
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...because Southern California EMS is the model system for what not to do.
daedalus
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LAcoFD is a JOKE everywhere else in the country. They may go around thinking they are badasses, but hardly justified. Just look at LA county paramedic protocols compared even too Ventura county, or to Washington State.
well thats my point, if it's that bad as everyone who matters says it is, why has it not changed in the last 30+ years?, I'll tell you why, because thier protocols are practical, plus we all operate under some MD's license anyways so were really not all the great as we think we are.
reaper
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How long have you been a medic?
JPINFV
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Alternatively, did you stay at a Holiday Inn Express last night?
EMTinNEPA
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I feel a terrible disturbance in the force... as if millions of brain cells just cried out in terror... and were suddenly silenced.
Ridryder911
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Brought to you by the makers of "just read what the machine interperts the ECG" ... and other antiquated ideas. LACFD could had and should had, but did not.
R/r 911
OKAY..... (I work as an EMT, but also have fire experience and experience as a dispatcher) having read over the entire discussion, here is what I can deduce:
1.) EMS is relatively new in comparison with FD and LE services and as such is still very much "in the works" and a really streamlined way of providing a nationally standardized EMS response is far from complete.
2.) Due to the great lengths that the FD has gone to in regards to fire prevention, the number and severity of fires that are being responded to are greatly diminished and as such, fire needs a way to not only justify it's existence (and size) but also a way to generate additional revenue. EMS seems to be a great way for this, especially when hard facts are laid out: in the majority of regions nation-wide, medical calls comprise nearly 80% of an average FD's total runs.
3.) As some have mentioned previously in this forum, third service EMS is unfortunately very often used as a stepping stone for aspiring EMTs and medics to move on to bigger and better (paying) jobs in fire. Often, many in the biz move on to fire not so much because they don't like the EMS side of it, but because TSEMS doesn't pay nearly as well as a fire job and you really can't beat FD benefits.
4.) EMTs and Paramedics working for both TSEMS and FBEMS have the same level of training and have to pass the same national registry exam, so in both arenas the personnel responding are equally skilled and both systems find it possible to meet their mandated response times, so the whole argument about a faster response is moot (to those who doubt, talk to FFs in areas where the FD acts as first responder to a TSEMS company and ask them how often they are able to initiate ALS care before an ambulance shows up [not often] and then ask if that impacts the difficulty in keeping up their medic cert. Besides, as we all know, seconds don't really count but for maybe 1% of the calls, probably less. See what I'm driving at?)
These points are why FBEMS is gaining in popularity.... BUT DO THESE THINGS MAKE EITHER FBEMS OR TSEMS SUPERIOR OVER THE OTHER?
The answer: hardly.
In some regions FBEMS works great, in others, TSEMS seems to be best, but from the perspective of someone who has seen both in action, a third solution that I have yet to see suggested appears to be better than either. While there are pros and cons with both systems, what we really need is for EMS to move away from privatized companies and to be run by county/regional/city/state governmental systems and be run more like a fire dept, not dependent on how much money can be gleaned from medicare or restricted by a FD that views EMS as secondary to fire. AHHHHH!!!!! I KNOW!!! Scary, huh?
The problem is that TSEMS are run by private companies who are, to be honest, out to make a buck. I know, I know, hardly a new idea and not fair to all those "virtuous and honest" private EMS companies out there. But in the process of increasing profit margins, the employees and sometimes even the patients suffer for it. So why not make EMS a FD-like entity, something funded by our tax dollars (and what medicare begrudgingly pays out)?
It's true that sending an engine out to every sprained ankle is a waste of money, just as it is true that it is better to have all the necessary resources on hand rather than having to call for them later, so why not have both fire and EMS run by the same region, although separately, and use the dispatching protocols that are already in place in many areas implemented so that EMS can be dispatched and have fire dispatched as well when appropriate or expedient?
Just a thought.
1.) EMS is relatively new in comparison with FD and LE services and as such is still very much "in the works" and a really streamlined way of providing a nationally standardized EMS response is far from complete.
2.) Due to the great lengths that the FD has gone to in regards to fire prevention, the number and severity of fires that are being responded to are greatly diminished and as such, fire needs a way to not only justify it's existence (and size) but also a way to generate additional revenue. EMS seems to be a great way for this, especially when hard facts are laid out: in the majority of regions nation-wide, medical calls comprise nearly 80% of an average FD's total runs.
3.) As some have mentioned previously in this forum, third service EMS is unfortunately very often used as a stepping stone for aspiring EMTs and medics to move on to bigger and better (paying) jobs in fire. Often, many in the biz move on to fire not so much because they don't like the EMS side of it, but because TSEMS doesn't pay nearly as well as a fire job and you really can't beat FD benefits.
4.) EMTs and Paramedics working for both TSEMS and FBEMS have the same level of training and have to pass the same national registry exam, so in both arenas the personnel responding are equally skilled and both systems find it possible to meet their mandated response times, so the whole argument about a faster response is moot (to those who doubt, talk to FFs in areas where the FD acts as first responder to a TSEMS company and ask them how often they are able to initiate ALS care before an ambulance shows up [not often] and then ask if that impacts the difficulty in keeping up their medic cert. Besides, as we all know, seconds don't really count but for maybe 1% of the calls, probably less. See what I'm driving at?)
These points are why FBEMS is gaining in popularity.... BUT DO THESE THINGS MAKE EITHER FBEMS OR TSEMS SUPERIOR OVER THE OTHER?
The answer: hardly.
In some regions FBEMS works great, in others, TSEMS seems to be best, but from the perspective of someone who has seen both in action, a third solution that I have yet to see suggested appears to be better than either. While there are pros and cons with both systems, what we really need is for EMS to move away from privatized companies and to be run by county/regional/city/state governmental systems and be run more like a fire dept, not dependent on how much money can be gleaned from medicare or restricted by a FD that views EMS as secondary to fire. AHHHHH!!!!! I KNOW!!! Scary, huh?
The problem is that TSEMS are run by private companies who are, to be honest, out to make a buck. I know, I know, hardly a new idea and not fair to all those "virtuous and honest" private EMS companies out there. But in the process of increasing profit margins, the employees and sometimes even the patients suffer for it. So why not make EMS a FD-like entity, something funded by our tax dollars (and what medicare begrudgingly pays out)?
It's true that sending an engine out to every sprained ankle is a waste of money, just as it is true that it is better to have all the necessary resources on hand rather than having to call for them later, so why not have both fire and EMS run by the same region, although separately, and use the dispatching protocols that are already in place in many areas implemented so that EMS can be dispatched and have fire dispatched as well when appropriate or expedient?
Just a thought.
However, EMS should not be compared with the FD and LE when talking about medicine and that is regardless of which service is doing it. EMS is actually older than many medical professions who have their acts together. At 40+ years it is time to stop using the "in the works" excuse. Also, if a FD has just started doing EMS, it is new to them regardless of how long the FD has existed. There are however, FDs that have been doing EMS for 40+ years and do it right. Unfortunately LA has stayed somewhere around 1970 and has not advanced much past the "train some FFs to get there real quick".
Other than that, good post.
It sounds like you may have spent some time in Ontario. Up here our municipalities/counties run the EMS service as a separate entity from fire. BUT, unlike not having fire as backup except on MVCs, as someone suggested would happen if this were the case, they have a tiered response system. Fire are recognized as first responders and are trained as such, sometimes with BTLS or some such trauma cert. - that way those fire boys who want to focus on fighting fires don't have to remember too much medical business, just enough to make them useful for their EMS support role. Fire is codispatched with EMS to any unresponsive call (and often arrive first, as there are more fire stations) and when EMS arrives, they take over, with fire as support. While some of the EMS crews aren't fond of fire being 'in the way' at some of their calls, this does seem to be an effective way of keeping EMS services dedicated to EMS, without losing the extra manpower of a handy, first-response trained, fire service.
Of course, the US medical system in general is rather different from ours here, with obviously a much greater focus on private providers (from EMS to the hospitals), so it's not really a surprise that gov't-run EMS is not big down there. And from the sounds of it, both FDNY-style EMS and private services (and even that whole fire-trained-as-EMS thing seems to work for some, though it still boggles the mind a little, having never seen it in action) have their benefits/costs, and EMTs/medics can be good/bad no matter what service they're in...
firecoins
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P.A.s, respiratory therapists or what have you have other b.s to put up with but not the municipality being the main employers.
Many hospitals are part of a government system such as the VA, public trusts, county and city. They must still put up with the budget and tax issues when it comes to staffing. SF recently had several layoffs from their healthcare facilities since the city budget is messed up. Other hospitals rely on a trauma tax and compete for money with other agencies.
It all depends on what your area has become accustomed to. Florida is primarily Fire. There are very few private ambulances that provide 911 EMS in the state. And, it is all ALS.
Some areas will argue their volunteer BLS ambulance is sufficient. However, it is often the EMT volunteers that play a role in saying BLS is good enough and the public may trust what the home town vollies are saying. Our FDs also have excellent PR to keep people informed that they are there and for what purposes. The door to door smoke detector checks that many FDs have been doing recently is a great public safety campaign as well as getting some photo ops with the senior citizens.