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

[TXmed]

@FireWA1

"In 2001, using stopwatches, city officials found that Washington firefighters don’t respond as quickly to medical calls as they should. Their finding prompted the city to buy global positioning equipment so officials could track the movement of rescue vehicles.

USA TODAY reviewed more than 85,000 emergency calls to examine those delays more closely. The analysis of turnout time — the time it takes for firefighters to run to their rig and roll out the door toward an emergency — shows that Washington firefighters’ median response time was faster to a dumpster fire than to a report of a cardiac arrest.

The fire crew responding to a report of a structure fire got rolling in 82 seconds, despite having to don protective boots, pants, coats and breathing apparatus. In response to a report of a cardiac arrest, which requires no special preparation, the crew took 124 seconds to reach the rig."

http://elevaed.com/archives/4585

 

[NPO]

@FireWA1

"In 2001, using stopwatches, city officials found that Washington firefighters don’t respond as quickly to medical calls as they should. Their finding prompted the city to buy global positioning equipment so officials could track the movement of rescue vehicles.

USA TODAY reviewed more than 85,000 emergency calls to examine those delays more closely. The analysis of turnout time — the time it takes for firefighters to run to their rig and roll out the door toward an emergency — shows that Washington firefighters’ median response time was faster to a dumpster fire than to a report of a cardiac arrest.

The fire crew responding to a report of a structure fire got rolling in 82 seconds, despite having to don protective boots, pants, coats and breathing apparatus. In response to a report of a cardiac arrest, which requires no special preparation, the crew took 124 seconds to reach the rig."

http://elevaed.com/archives/4585

There was a similar study at FDNY; same results

 

[VentMonkey]

I really think 1 paramedic/ firefighter per shift per day is all that is needed. And I mean literally not cross-training, let alone paying for umpteen more half-arsed “paramedics” on the training schedule.

Perhaps make it part of a formal pre-hire interview and see where their priorities lie? Nothing wrong with squeezing the paramedic-strong-juice for all of its worth. But, clearly as the article posted by @TXmed shows, we’re really doing an overall disservice to the masses with drowning people with patches.

Let’s get real, folks. A single-paramedic on an assessment engine who along with his co-working equally clinically-driven assessment medics gets the invested training needed, and takes heed would yield sooo much more than all of his “brothers” having the same medic patch with, at best, half of the paramedic value. What kind of public service is that?

 

[FiremanMike]

Alright, well it sounds like you have had some pretty bad experiences with FD medics. I maintain that this is an indictment of their training bureau and quality assurance than the big red truck in the app bay.

For my own curiosity, as I ponder why this is playing out differently outside of my little corner of the world... What is the pay like for FD medics compared to single role medics in your area(s)?

 

[FiremanMike]

@FireWA1

"In 2001, using stopwatches, city officials found that Washington firefighters don’t respond as quickly to medical calls as they should. Their finding prompted the city to buy global positioning equipment so officials could track the movement of rescue vehicles.

USA TODAY reviewed more than 85,000 emergency calls to examine those delays more closely. The analysis of turnout time — the time it takes for firefighters to run to their rig and roll out the door toward an emergency — shows that Washington firefighters’ median response time was faster to a dumpster fire than to a report of a cardiac arrest.

The fire crew responding to a report of a structure fire got rolling in 82 seconds, despite having to don protective boots, pants, coats and breathing apparatus. In response to a report of a cardiac arrest, which requires no special preparation, the crew took 124 seconds to reach the rig."

http://elevaed.com/archives/4585

So we're comparing a single incident to a single incident? n=2? No documentation of potentially mitigating circumstances (time of day, tenure of crew, etc)? Not really a fair comparison there..

 

[FiremanMike]

This coming June marks 20 years from my initial certification. During that time I've worked in a variety of different environments, including FD, two different third service EMS agencies, in the ER, in home health, and in critical care/HEMS. I have seen horrible and great training/protocols in every single one of those environments. I've seen absolute morons and absolute geniuses in all of those places. I've seen treatment/knowledge deficiencies that would make your skin crawl and absolutely remarkable things happen in all of those places. I've seen folks take forever to respond and folks sprint to the truck in all of those places.

In my experience here, there is no appreciable difference in the proportions of morons to normal medics to brilliant providers between these environment. The only difference is the patch on the shirt and the name on the paycheck.

 

[EpiEMS]

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

Certainly, this is a factor in FD staffing. But at the end of the day, color me skeptical that a better ISO rating really means material savings (it may very well just be something for fire brass to brag about)...the ratings' impact on premiums vary hugely by insurer, for one.

There was a similar study at FDNY; same results

FDNY publishes data weekly, and the story is always the same - fires get FFs moving faster than medical calls.

 

[FiremanMike]

Certainly, this is a factor in FD staffing. But at the end of the day, color me skeptical that a better ISO rating really means material savings (it may very well just be something for fire brass to brag about)...the ratings' impact on premiums vary hugely by insurer, for one.


FDNY publishes data weekly, and the story is always the same - fires get FFs moving faster than medical calls.

So, FDNY is kind of a convoluted third service where the fire truck guys aren't assigned to the ambulance and the ambulance guys aren't assigned to the fire truck. Do you think this plays into a lack of ownership for EMS and could affect run times?

 

[VentMonkey]

Do you think this plays into a lack of ownership for EMS and could affect run times?

From the left coast, so I can only speculate. But, last time I checked their EMS division was under the fire departments umbrella, so who would it really fall under?

What is the pay like for FD medics compared to single role medics in your area(s)?

Generously lopsided, but does that—or should that—have any bearing on the level of provider? I don’t think that’s why you asked this, but I ask so that this thread is kept going.

Has my experience been less than stellar? Yes, but c’mon, at some point the fire guys (and gals) have to at least admit to the fact that while yes they got into their line of work to fight fires, and took the “medic assignment” and endured it, it doesn’t mean that they’re A) any good at it, or B) even want to do it, thus rubber banding back to “A”.

Again, are there good and bad providers everywhere? Yes, but that isn’t the question at the top of this screen. The question begs to ask why the fire-based systems are lacking. I’m attempting to provide answers, or at least reasonable possibilities from what I’ve seen and dealt with.

A good friend of mine, a firefighter/ paramedic, who I actually trained at one point finally got onto a career department. Guess what his station has? A plethora of inactive patch-medics. He did hazmat, and liked it. He also has very little desire to go on and be a paramedic anymore.

So again, can you at least answer why fire departments need so many paramedics for the 3 a.m. elderly hip fx?

 

[gonefishing]

What ive noticed with most departments in my reach that do have ems spend way more time focusing training on fighting fires vs ems. I think I saw once of a rather large department spending only 3 hours a month on ems education the rest on fire. Add this to a watered down set of protocols but at the same time screaming for more paramedics because per the IAFF posters 5 medics vs 2 is a greater service so their for a justification for a tax increase is needed. Sadly those taxes go towards fire equipment like the latest greatest apparatuses vs ems tools, education or equipment. I know many would have to agree as what was taught in my fire science classes is that with the improvements of structures, code enforcements and regulations, fire will eventually be near non existent. Majority of calls are ems for these departments so why not focus on improvements? LAFD spends large amounts of dollars on a NP, 2 Paramedics on a rig for "community medicine" meanwhile in a county an hour away AMR (who I don't care mjch for) does it for way less with 1 paramedic and a pick up truck some times an emt. Why does fire have to blow money when a private corporation is doing it for half the cost with lesser man power? Maybe the IAFF and Nurses union have something to do with it who knows.

 

[Summit]

What ive noticed with most departments in my reach that do have ems spend way more time focusing training on fighting fires vs ems. I think I saw once of a rather large department spending only 3 hours a month on ems education the rest on fire. Add this to a watered down set of protocols but at the same time screaming for more paramedics because per the IAFF posters 5 medics vs 2 is a greater service so their for a justification for a tax increase is needed. Sadly those taxes go towards fire equipment like the latest greatest apparatuses vs ems tools, education or equipment. I know many would have to agree as what was taught in my fire science classes is that with the improvements of structures, code enforcements and regulations, fire will eventually be near non existent. Majority of calls are ems for these departments so why not focus on improvements? LAFD spends large amounts of dollars on a NP, 2 Paramedics on a rig for "community medicine" meanwhile in a county an hour away AMR (who I don't care mjch for) does it for way less with 1 paramedic and a pick up truck some times an emt. Why does fire have to blow money when a private corporation is doing it for half the cost with lesser man power? Maybe the IAFF and Nurses union have something to do with it who knows.

This is a quality rant for the most part... it is the classical "EMS is the cash cow and justification for more taxes too" in order to fund the primary mission that isn't the actual primary mission. So why would they provide more CE than is needed to keep the cash collectors certified? EMS isn't sexy compared to most fire fighting. Even the sexiest part of EMS, the code, isn't that sexy because dead people stay dead more often than not, also no hoses or SCBA. Saving a cat from a tree is sexier than that!

The last half you got a bit off message... a master prepared NP fills a fundamentally different role and capability than a medic. NPs don't belong to unions typically. Kinda different topic though...

Can we talk about Wildland doesn't get paid like Municipal? :-D

 

[gonefishing]

This is a quality rant for the most part... it is the classical "EMS is the cash cow and justification for more taxes too" in order to fund the primary mission that isn't the actual primary mission. So why would they provide more CE than is needed to keep the cash collectors certified? EMS isn't sexy compared to most fire fighting. Even the sexiest part of EMS, the code, isn't that sexy because dead people stay dead more often than not, also no hoses or SCBA. Saving a cat from a tree is sexier than that!

The last half you got a bit off message... a master prepared NP fills a fundamentally different role and capability than a medic. NPs don't belong to unions typically. Kinda different topic though...

Yes but! It keeps paramedics at a lower level of education and no real advancements. Increase the education and or protocols. In ems have long faced an uphill battle with the nursing unions. I get an NP can write scripts ect but do we honestly need two paramedics with an NP to do a welfare check when paramedics are doing this single handed? Educate the public, ensure the well being and they will stop treating the ed as a personal physician.

 

[Summit]

Yes but! It keeps paramedics at a lower level of education and no real advancements. Increase the education and or protocols. In ems have long faced an uphill battle with the nursing unions. I get an NP can write scripts ect but do we honestly need two paramedics with an NP to do a welfare check when paramedics are doing this single handed? Educate the public, ensure the well being and they will stop treating the ed as a personal physician.

Let's not turn this into a nursing vs paramedic thread! We can go start another thread about what a no-degree medic with a 96hr addon class offers vs a BSN prepared CHRN or a MSN/DNP NP.

If you want to look at what is holding back paramedic education, it is not nurses. It is the FD's need to cheaply and easily certify and maintain all their Paramedic FFs to keep the $ flowing.

If Paramedic was a dedicated 4 year degree or even a 3 year degree, it would put a dent in the myth that one can be a FF first and a medic second (but do both fine), not to mention the economics of having 5 of them on a 1 million dollar fire truck for non-emergent flu like symptoms.

With education comes more autonomous protocols.

Even an associates degree medic minimum would make the paramedic component twice as lengthy, not to mention the depth, of FF2s.

That will happen over IAFF's dead body.

 

[gonefishing]

Let's not turn this into a nursing vs paramedic thread! We can go start another thread about what a no-degree medic with a 96hr addon class offers vs a BSN prepared CHRN or a MSN/DNP NP.

If you want to look at what is holding back paramedic education, it is not nurses. It is the FD's need to cheaply and easily certify and maintain all their Paramedic FFs to keep the $ flowing.

If Paramedic was a dedicated 4 year degree or even a 3 year degree, it would put a dent in the myth that one can be a FF first and a medic second (but do both fine), not to mention the economics of having 5 of them on a 1 million dollar fire truck for non-emergent flu like symptoms.

With education comes more autonomous protocols.

Even an associates degree medic minimum would make the paramedic component twice as lengthy, not to mention the depth, of FF2s.

That will happen over IAFF's dead body.

LOL I agree.

 

[VentMonkey]

Educate the public, ensure the well being and they will stop treating the ed as a personal physician.

If you want to look at what is holding back paramedic education, it is not nurses. It is the FD's need to cheaply and easily certify and maintain all their Paramedic FFs to keep the $ flowing.

Both quoted for truth. And yes, we are our own worse enemy when it comes to educationally increased standards.

I just want to know when the fire service will openly admit—even on a somewhat anonymous public forum—that what they’re mostly doing has nothing to do with patient care, but everything to do with propaganda?

Also, to his credit, and I believe he is/ was a firefighter, @DrParasite was honest in his overall size up of the situation.

 

[EpiEMS]

So, FDNY is kind of a convoluted third service where the fire truck guys aren't assigned to the ambulance and the ambulance guys aren't assigned to the fire truck. Do you think this plays into a lack of ownership for EMS and could affect run times?

Certainly, it's related. That said, the FDNY (fire side) may have EMTs, they only run as CFRs, as far as I know. And there is a huuuuge gap between the pay in EMS vs. fire side (on the order of $6k starting and going up to a five-figure difference!). The real problem is the FDNY spends an insufficient amount on the EMS side...and doesn't like EMS. EMS needs to be third-service in NYC, like in Boston.

From the left coast, so I can only speculate. But, last time I checked their EMS division was under the fire departments umbrella, so who would it really fall under?

EMS is the red headed stepchild of the FDNY...
(Interesting note to demonstrate how much the FDNY actually cares about EMS, see item 6)

If Paramedic was a dedicated 4 year degree or even a 3 year degree

See: The rest of the Anglosphere, where EMS is third service & government provided

 

[gonefishing]

Both quoted for truth. And yes, we are our own worse enemy when it comes to educationally increased standards.

I just want to know when the fire service will openly admit—even on a somewhat anonymous public forum—that what they’re mostly doing has nothing to do with patient care, but everything to do with propaganda?

Also, to his credit, and I believe he is/ was a firefighter, @DrParasite was honest in his overall size up of the situation.

You mean the IAFF propaganda posters where they state 6 paramedics is better than 1 on a scene? So increase taxes no to tax cuts song and dance routine?

 

[Summit]

You mean the IAFF propaganda posters where they state 6 paramedics is better than 1 on a scene? So increase taxes no to tax cuts song and dance routine?

This one? (I thinke EpiEMS or DEmedic found it)

 

[gonefishing]

This one? (I thinke EpiEMS or DEmedic found it)

That be the one! The town that was getting these mailed in are neighborhoods with million dollar homes, old money and foreign money. They wanted to go to a private ems system for cost saving due to it being a town of 1 fire station with mutual aid from the city next door for fire protection. 2 current ambulances. The program they had for fire ems is only 12 years old. They were sold a song and dance that fit the budget. They kicked out a private service went in house with dual paramedic fire fighters, city saw the cost vs demand wanted to go back private. These than appeared courtesy of the iaff. Scare tactics.

 

[EpiEMS]

@Summit, that's exactly the one! Thanks for finding it!

Scare tactics.

Indeed. I'm scared because 6 paramedics is 4 (maybe even 5) too many! But seriously:

Paramedic #1: That's an EMT job (and also a cop job)

Paramedic #2: Definitely a medic job...and this guy could be the one pushing drugs...

Paramedic #3: doing documentation - OK, you can just get a voice recorder, or record events on the monitor, or have a EMR/EMT do that...

Paramedic #4: Bagging is an EMT job. The inbtubation can be delayed...and the same person who intubated can be getting access via IO in all of 30 seconds.

Paramedic #5: A medic isn't necessary for CPR. Get a LUCAS, or have a EMR/EMT do that.

Paramedic #6: Meh, a dedicated provider for drugs seems excessive...I guess it is nice?