Serious Question: Why Does Fire-based EMS sometimes produce such low results?

RocketMedic

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*Disclaimer: This isn't a slight against firefighters, and it's not necessarily targeting the high-functioning fire departments out there that do the right things, or even the fire-medics that actually do their jobs the right way.
*Disclaimer 2: I'm not a firefighter, not particularly interested in being a firefighter.

So we hear a constant stream of anecdotes from across the nation, mostly from larger cities with big fire-based EMS systems, and there's a pretty common thread- systems operating at the limits of their operational capacity constantly, long shifts, provider and patient abuse, and terrible medical practice. So, why is this happening?
 

VentMonkey

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Because John Q. Public is still reeling over September 11th, and what many fire departments seem to continuously do is bank on this fact.

I too, am no firefighter and have no interest in it. I agree there are certainly departments that actually take things seriously when it comes to what they do most- provide medical aids. I have seen and learned from some well-to-do dual roles, but they’re far outnumbered and conformity seems a whole lot easier than greasing the ol’ firehouse wheel.

What the general public will never understand is the “behind the scenes” politics, and quite frankly ugliness that goes into budget allocations at this level. When you’re willing to do whatever it costs to justify your existence—to include pretending to want to expand into the realm of prehospital care—but have no real intentions of making good on your efforts, your citizens will suffer. What makes it sad, and highly unfortunate is that, like many glossed over facades, the taxpayers cannot (will not?) see past the fluff.

The flipside, however, could include the fact that, like any large urban system, their resources are taxed; single or dual-role, yet another example of how fractured healthcare in the U.S. is.
 

DesertMedic66

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I can only speak for my area but 100% of the daily training they do is based on fire and rescue training. The only time they cover EMS is when they are forced to take a BLS CPR, ACLS, and yearly mandatory meetings by the EMS system.

We were a training center for the fire department however when we found out they were allowing their medics to recertify in BLS CPR, ACLS, and PALS in one 8 hour day, we quickly stopped being the training center for them.
 

EpiEMS

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So, why is this happening?
@VentMonkey hit it on the head - #1 is because fire departments are politically untouchable...most of what they do is EMS response, but we can't rebalance resources to EMS because, you know, who wants to be the politician taking away money from firefighters?

#2 - they, by and large, don't want to do EMS. Not wanting to do EMS means not doing it well.
 

akflightmedic

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Having worked in several counties which underwent mergers and speaking from a FL perspective....there is also the fact that being a Paramedic is nothing more than a promotion. The majority of FFs here become paramedics to get the $7500 salary bump, have points for promotion, and do their time on the box and transfer to an engine as quickly as possible thereby preventing themselves from having to do all the EMS stuff and get to have all fun by responding in an engine, few cool skills and then hand off to transport medic.

There is Medic saturation in Florida, but that is mostly due to the IAFF selling a bill of goods to the public and the ignorant public thinking 2-8 paramedics on every call is better than 1-2.
 

akflightmedic

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Statistically there was a title change many years ago....however, I long for the days when we make it official and say.....

No, I do not work for a Fire Based EMS system....I actually work for an EMS based Fire Dept. :)
 

TXmed

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Youre either a half *** firefighter or a half *** paramedic the way i see it.
 

VentMonkey

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Youre either a half *** firefighter or a half *** paramedic the way i see it.
What if you’re a half *** paramedic who wants to be a half *** nurse, or half *** pilot for half of their half *** pay?
 

TomB

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*Disclaimer: This isn't a slight against firefighters, and it's not necessarily targeting the high-functioning fire departments out there that do the right things, or even the fire-medics that actually do their jobs the right way.
*Disclaimer 2: I'm not a firefighter, not particularly interested in being a firefighter.

So we hear a constant stream of anecdotes from across the nation, mostly from larger cities with big fire-based EMS systems, and there's a pretty common thread- systems operating at the limits of their operational capacity constantly, long shifts, provider and patient abuse, and terrible medical practice. So, why is this happening?
Maybe this could be moved to the EMS Lounge or Children With Nothing Better To Do forum.
 

DesertMedic66

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Maybe this could be moved to the EMS Lounge or Children With Nothing Better To Do forum.
I think it is a completely valid question to ask and get differing view points.
 

RocketMedic

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Maybe this could be moved to the EMS Lounge or Children With Nothing Better To Do forum.
I see someone didmt get his nap and snack...
 

VentMonkey

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My own snark aside, I agree that it’s a valid question. @TomB perhaps you can enlighten us? Most of your posts are articulate, informative, and carry weight on this forum. To me this proves you’re a good fit for a debater on the other side of this fence.

I have to openly admit that the fire-based culture in my state (no idea what The Carolinas do) is chocked full of such buzzwords and catchphrases as “tradition”, “the bravest”, and “brotherhood”. They seem to be spoon fed to the public so much so that at least, here, the fire-based EMS systems can do no wrong. The fact is, many of them are doing wrong, very wrong.

Again, are there articulate, well-honed firefighter/ paramedics among them? Absolutely, but these types where I am are often drowned out by cultures that lower the standards for EMS-driven fire culture, and not the opposite.

And before this thread is chocked full of pot shots (yeah, yeah, me too), I realize how many lowly, burnt out, non-con-ed-driven single roles there are. That is why this forum offers myself, and others like me—and you—reprieve.
 
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NPO

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My paramedic textbook specifically cited Johnny and Roy as a major contributing factor to why modern EMS is often run by the FD and why the public is okay with it.

My belief is that the FD-EMS problem is multi-tiered. Most often, I think it's a budget problem. FDs adopt EMS as a revenue stream, and a way to justify larger budgets, both for self-preservation and for growth of the dept. Larger depts yield more weight for local and regional issues and elections.

The same depts also have a habit of forcing their firefighters to become paramedics and/or require shifts on an ambulance. Anytime you force someone to do something, they won't do it as well as if it was voluntary. I personally would make a very half-assed firefighter; it's not where my passion lies.

I'll close with the same thing the OP said, this is not exclusive to all FDs and FFs.
 

DrParasite

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hmmmm, where to start.... how about in most combined fire/EMS systems, EMS takes up 80% of the call volume, yet gets 20% of the budget?

Or if you have a civilian medic in the FD, the civilian medic who might need a year or two of education to get certified as a medic, will make nowhere near what the zero to hero FD makes on the engine, when the FF went through a maybe 6 month academy before being put on the engine?

many years ago I worked part time as a part time EMT for a FD that had an ambulance. every month, one full time member of the FD (who were all EMTs and one or two were few paramedics) was taken off the engine and assigned to the ambulance, and paired up with a part timer. They were paid twice as much as every part timer, had great benefits, didn't take a paycut when they were on the ambulance, and were absolutely miserable. When they took vacation time, they always did it during their EMS month. They wanted to be firefighters. And when the opportunity presented itself for them to outsource the ambulance, they jumped on it.

Lets talk about staffing..... in general terms, most urban EMS systems are understaffed. All things being equal, most 100% career FDs are pretty well staffed. They rarely have all their units on calls, and while sometimes they do run, most do get some down time during a shift. For rough numbers, any given area should have as many BLS units as engines, and ALS units as ladders. With those numbers, you wouldn't need to send all the suppression units on EMS calls, which consists of 80% of their call volume.

Let talk about budgets.... Fire departments are, historically, a black hole for money. millions of taxpayer dollars are spent, and they will never turn a profit. EMS, however is expected to make money. they bill for everything. so the budget of EMS get cut when they don't generate enough revenue. we won't put another ambulance on, if it won't be profitable. and a fire engine is seen as an insurance policy; it's there in case it's needed. an ambulance is only worth having if it's goin on a call and making money.

There are some great firefighter/paramedics. more often than not, they started as paramedics, worked as ambulance paramedics for several years, before getting hired by the fire department. some even continue to work part time as ambulance paramedics. most firefighter paramedics that I know are firefighters who got their paramedic for reasons other than to be good healthcare providers on the ambulance. they are firefighters who do just enough con ed to maintain their medic cert; and they want to be on the suppression units saving lives, not being on the ambulance.

if you force someone to be something they really don't want to do, if you treat them poorly compared to their suppression counterparts, if you don't give them the resources or direction to do the job right, and if you have accepted substandard and half-assed providers for so long, does it really surprise you that you get low results?
 
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StCEMT

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I don't necessarily have a problem with fire based EMS under one circumstance. There are FD's that run both and keep them separate. STLFD is an example of that. If I could work for a FD, get that FD money, and basically never touch a firetruck I absolutely would. Those are not the norm, but they exist and in that case I don't see an issue with it.
 

VentMonkey

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I don't necessarily have a problem with fire based EMS under one circumstance. There are FD's that run both and keep them separate. STLFD is an example of that. If I could work for a FD, get that FD money, and basically never touch a firetruck I absolutely would. Those are not the norm, but they exist and in that case I don't see an issue with it.
Right, but back to Rocket’s question- Does this mean that they’re producing desirable results, or are overall efficient? I truly don’t know. I have never been part of a fired-based EMS system like STL, of FDNY, or Philadelphia Fire, etc.

Are their EMS divisions truly focused on doing the best with what they have, and are their cadres, and medical director(s) clinically, and EBM-driven?

Are they spearheading trials, and do they remain sought after by single-roles throughout the country for their reputations as systems on the whole, versus, the benefits? IIRC, there’s a pretty well-respected EMS third service in the state capital of Texas which is slowly rebuilding its reputation as a solid EMS-only system after some tumultuous times.

Will they provide an actual career-ladder for EMS-only driven folks who truly want to only do EMS their entire career from their 20’s well into their 50’s?

Let us also not forget the paramedics who got their paramedic just to get on with a department, and see themselves as “stuck” at an ambulance service until their time comes. And even worse, what if it doesn’t? What kind of cop, nurse, etc. will they make?
 

CALEMT

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In regards to a post on here you get halfassed people regardless where you are in a career. Fire, EMS, LEO, nursing, accountants, etc... Does the majority of FFPM's get their p-card just for a job? Yeah, nobody is going to ******** that EVERY FFPM is Jesus with a stethoscope saving the world one cardiac arrest at a time. But then again not every private EMS paramedic is a excellent provider either. The wheel turns both ways.

I don't necessarily believe that John Q taxpayer is still reaming over the events on 9/11. I think its more PR than anything. I mean think about it, the FD has fill the boot, regularly holds community events, and shows up at community events. The PD/SO has coffee with a cop, shop with a cop, and will also hold community events. Now what does AMR or any other private EMS agency have for PR? A Facebook account where most of it's followers are it's own employees. EMS has little to no community PR and thats where it fails. Just think if private EMS did the PR that a FD or PD/SO did, I personally think there would be more public push for private EMS. But then again private EMS is just that... private, not a government agency. So in theory private EMS will pay less, have worse benefits, and have a worse retirement than any government agency.

Do I think the FD should completely do away with anything EMS related? Personally no. I must be one of the few who loves the fire suppression side and has a passion for expanding my knowledge in regards to EMS. Are you going to hire every FFPM who strives to be the best paramedic and the best firefighter? No, ain't gonna happen, but you do get those who do have a passion for both aspects of the job. So why are there crappy providers at every FD in the nation? Same reason theres crappy providers at private EMS companies and crappy cops, nurses, accountants, etc.
 

VentMonkey

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I don't necessarily believe that John Q taxpayer is still reaming over the events on 9/11. I think its more PR than anything.
Um, but like what’s on TV every September 11th since 2001 and stuff?
So why are there crappy providers at every FD in the nation? Same reason theres crappy providers at private EMS companies and crappy cops, nurses, accountants, etc.
...because all they wanted to do was put out a goddamn fire?:D

Sorry, I couldn’t resist, CAL.
 

Tigger

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Are their EMS divisions truly focused on doing the best with what they have, and are their cadres, and medical director(s) clinically, and EBM-driven?

Are they spearheading trials, and do they remain sought after by single-roles throughout the country for their reputations as systems on the whole, versus, the benefits? IIRC, there’s a pretty well-respected EMS third service in the state capital of Texas which is slowly rebuilding its reputation as a solid EMS-only system after some tumultuous times.

Will they provide an actual career-ladder for EMS-only driven folks who truly want to only do EMS their entire career from their 20’s well into their 50’s?
Colorado Springs Fire has all the things you talk about. The med division is larger than the fire training division. The medical director is top notch. They have EMS educators who want to be on the cutting edge. There are tons of in service training opportunities. They run "studies." Yet the average level of care provided is well, average. There is a disconnect between the line and the office. There are plenty of guys who want to be good at EMS, but few that want to focus. That just isn't why most of them joined fire, and it shows.
 

jayrutjr

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I work for a Fire service that requires you to get your paramedic to keep your job. You have three years to do so, if you don't bye bye! So that means you do have some patch medics but I can honestly say we do have people that are great fire medics. our dept has a combat side and a rescue side . I knew going in that I wanted to spend some time on the box. So I took the promotion, after all we run mostly medical calls. Fire calls are few and when we respond to fires it's such a heavy response you barely get to fight the dragon! Just like someone stated earlier your going to have half *** in any situation.
 
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