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

[RocketMedic]

So when I think of good Fire departments, I think of systems like Harris County's ESD-48....but for every ESD, there's a Houston Fire that sets the bar really low.

 

[VentMonkey]

@Tigger that sounds unlike most FD’s I know of in terms of the efforts put towards their EMS division. To have all of that at your disposal (even my own service isn’t that lucky), and still fall short of what I would imagine is put into the medical aspects is unfortunate.

I’m not knocking individuals as firefighter/ paramedics, I’m simply saying on average the culture within most of the departments certainly seems to overshadow the paramedics that do fancy themselves “medics first”. I really don’t know what the big deal is about realizing that the overall sum does not reflect the ability of individual parts to be able to provide good ALS care.

It seems more of a blow to their pysche perhaps, but even given all of the proper training, funding, and tools- to still have an “I’d still rather fight fires” sort of attitude, clearly the big picture is being missed.

I think if they focused on being the best MFR/ EMT they could be enthusiastically so much so that they realize what exactly ALS care doesn’t do we would all be better off, and I don’t mean that as a knock. There aren’t many EMS-only agencies that fight fires, or train their paramedics to fight fires “just in case”, but why is it ok to have 5 or more (arguably inactive) paramedics on a call...”just in case”?

 

[PotatoMedic]

I saw something on the "send paramedics" Facebook page linking to a report that firefighters have a faster dispatch to enroute time to dumpster fires faster than cardiac arrests. I'm trying to find it again but I know I saw it.

 

[EpiEMS]

I saw something on the "send paramedics" Facebook page linking to a report that firefighters have a faster dispatch to enroute time to dumpster fires faster than cardiac arrests.

It seems likely for FDNY...

 

[FiremanMike]

I think we're glossing over the fact that there are terrible providers in third service and private systems just as there are in fire based systems. Conversely, there are also rock stars in each of these environments.

Under-performing EMS "professionals" exist, and not just on the fire department.

 

[VentMonkey]

I think we're glossing over the fact that there are terrible providers in third service and private systems just as there are in fire based systems. Conversely, there are also rock stars in each of these environments.

Under-performing EMS "professionals" exist, and not just on the fire department.

Hardly glossing. I openly admitted this fact in one of my other posts. Also, who’s to say (statistically) how many of those providers are, or aren’t jaded would (never) be firefighters?

On the whole, regardless of their professionalism, how many boots they raise, blood pressures they check, CPR’s they train, or public services they provide—fire-based EMS does not operate, nor function nearly the same as a single paramedic unit trained to provide ALS care sans fire prevention education, and training.

That is a fact that I feel is glossed over by many-a-fire departments to the general public in their respective districts.

 

[EpiEMS]

fire-based EMS does not operate, nor function nearly the same as a single paramedic unit trained to provide ALS care sans fire prevention education, and training.

And costs a *lot* more, I'd wager, especially if you're running million dollar ladder trucks to BLS calls.

 

[FiremanMike]

Hardly glossing. I openly admitted this fact in one of my other posts. Also, who’s to say (statistically) how many of those providers are, or aren’t jaded would (never) be firefighters?

On the whole, regardless of their professionalism, how many boots they raise, blood pressures they check, CPR’s they train, or public services they provide—fire-based EMS does not operate, nor function nearly the same as a single paramedic unit trained to provide ALS care sans fire prevention education, and training.

That is a fact that I feel is glossed over by many-a-fire departments to the general public in their respective districts.

I did miss your concession of under-performers in all agencies, my apologies.

As for the rest of your post, with due respect, I think your statement of fact is more of an opinion, difficult if not impossible to actually quantify, and probably regional. In this area, the relatively few number of single role EMS agencies are subjectively at an equal level of competence when compared to fire based systems. Additionally, I would say that the fire based systems are slightly better equipped than the single-role EMS agencies.

 

[FiremanMike]

And costs a *lot* more, I'd wager, especially if you're running million dollar ladder trucks to BLS calls.

**my answer is regional and based on my area

That million dollar ladder truck is probably going to be sitting there whether they're taking first responder runs or not, and those ladder guys are getting paid their hourly rate whether they're on the EMS run or not. I'd wager a guess that the cost of fuel to drive that truck within it's little 5 square mile bubble to take the first responder run for the medic probably isn't that much after all.

 

[EpiEMS]

@FiremanMike

You're right - the marginal cost of driving and staffing that ladder truck is probably pretty low*.

*But when you dispatch 4 FF/EMTs and an officer to a medical call, they can't respond to a fire call...so you have to have *more* fire apparatus around to cover the slack. And, let's go back to why we even bothered acquiring a ladder truck in the first place. What was the cost of the truck (over its life) per life-year saved? $100,000? $50,000? $25,000? Why do we have so many fire companies when we have so few fires? What if we could cut back fire staffing by a couple FTEs and upstaff EMS?

 

[VentMonkey]

As for the rest of your post, with due respect, I think your statement of fact is more of an opinion, difficult if not impossible to actually quantify, and probably regional.

Fair enough, and points well taken, but myself and others in this thread are from regions all across the country, yet we seem to cite similar experiences with regard to the thread topic. So, why such a commonality?

Additionally, I would say that the fire based systems are slightly better equipped than the single-role EMS agencies.

Define “better equipped”, and please explain exactly how this translates into higher-than-average results versus the non-fire-based EMS agencies?

 

[FiremanMike]

@FiremanMike

You're right - the marginal cost of driving and staffing that ladder truck is probably pretty low*.

*But when you dispatch 4 FF/EMTs and an officer to a medical call, they can't respond to a fire call...so you have to have *more* fire apparatus around to cover the slack. And, let's go back to why we even bothered acquiring a ladder truck in the first place. What was the cost of the truck (over its life) per life-year saved? $100,000? $50,000? $25,000? Why do we have so many fire companies when we have so few fires? What if we could cut back fire staffing by a couple FTEs and upstaff EMS?

So, this is where my own regional experiences come in to play. Every firehouse here has an ALS Ambulance usually with two paramedics. Several firehouses actually have 2 ALS ambulances. For the most part, they put fire companies in positions so that they can get to locations within their individual run districts in a timely fashion so as to prevent significant fire spread. I can't think of a fire company in the last 20 years that was put in around here who's primary purpose is to provide ALS first responder capabilities.

*ETA, I did think of one local scenario where an ALS ambulance was removed from a firehouse to move it to a different part of the district, leaving a fire truck alone in that station to take fire runs as well as EMS first responder runs. Ironically, it's a ladder truck, lol

 

[FiremanMike]

Fair enough, and points well taken, but myself and others in this thread are from regions all across the country, yet we seem to cite similar experiences with regard to the thread topic. So, why such a commonality?

<shrug> maybe I really am blessed to work in an area where fire based medics, on the whole, are doing a good job. I truly say that with no sarcasm intended.

Define “better equipped”, and please explain exactly how this translates into higher-than-average results versus the non-fire-based EMS agencies?

It wasn't my assertion at all that better equipped equals higher than average results, and my statement about equipment was more of a response to some earlier statements that EMS received less funding than fire in fire based systems. I'm also not trying to imply that our local single-role brothers are poorly equipped, by the way.

The two most recent examples that come to mind that would qualify the statement "better equipped" would be power-load cots and powered stair chairs, which found their home in some of the fire-based trucks around here before making their way to the single role trucks (although I'm still not sure they have them?)

 

[gonefishing]

Different strokes for different folks. I've seen some horrendous care by fire medics and crews over the years and majority of those just do it for the pay or because gaining a P card was an entry to getting hired to ride big red in the first place and could honestly care less for running medical aids. I have also seen a minor majority that take pride in the craft of emergency medicine and are some outstanding providers but that's few and far in my experiences. Nothing like a fire captain chewing out your nurse wife for calling 911 on somebody having a possible drug fueld psychotic episode. I guess per that captain psychiatric emergencys are for cops not medical. I've seen some outstanding private services and providers though and would place my life or my familys lives in place of them over any fire provider. Just my oppinion and experiences though.

 

[FiremanMike]

C'mon now, if we really wanted to start swapping stories, I think everyone's service model would be embarrassed by the tales.

 

[gonefishing]

C'mon now, if we really wanted to start swapping stories, I think everyone's service model would be embarrassed by the tales.

True, reason why I said different strokes for different folks. Everyones got bad apples in the bunch.

 

[VentMonkey]

Bullsh*t aside, medicine, I’m talking medicine. Because there really is a big difference in how the fire-based delivery model does things vs. what I personally would mostly not do/ practice.

Think Jems vs. pretty much any well-respected EBM journal...

 

[GMCmedic]

@FiremanMike

You're right - the marginal cost of driving and staffing that ladder truck is probably pretty low*.

*But when you dispatch 4 FF/EMTs and an officer to a medical call, they can't respond to a fire call...so you have to have *more* fire apparatus around to cover the slack. And, let's go back to why we even bothered acquiring a ladder truck in the first place. What was the cost of the truck (over its life) per life-year saved? $100,000? $50,000? $25,000? Why do we have so many fire companies when we have so few fires? What if we could cut back fire staffing by a couple FTEs and upstaff EMS?

ISO ratings. It all comes down to the cost of homeowner insurance in the response district.

 

[FiremanMike]

I guess I’m curious what you mean by “how Fire based delivery model does things”?

 

[VentMonkey]

I guess I’m curious what you mean by “how Fire based delivery model does things”?

Well to be frank- it’s watered down. Everyone blindly getting high-flow O2, IV’s when not warranted, no IV’s when they most likely would be. I could go on and on, but it’s fruitless.

I’ve sat in on con-ed with plenty of fire departments, and the way things are explained to many of them aren’t what I’ve come to find as exactly forward-thinking; let’s just say it leaves a lot to be desired.

Is it my mind, and opinion? Sure, but I highly doubt I am alone. But! To be fair, I roll pretty solo even at my service with what I consider prudent, forward-thinking practices.

I think that most fire departments willing know (at the “brass” level) that when you’re teaching a group of individuals who are taught to fight a “dragon” you don’t exactly to need to go as in-depth on many of the topics that the paramedic-only-paramedics see daily.

So, again why do you need 5, or more, paramedics on a single medical aid?