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

Bullets

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Cops without CPR? Crazy stuff...
But they all have 36 doses of narcan and love using their personal tourniquets on any extremity wound.....

Imagine you're driving a tesla and you have to work with someone who insists on using a Model T, and thinks that the Model T is perfectly fine for todays travel and thinks the Tesla is actually witchcraft. Thats the current EMS/PD relationship.

When i went into management i thought the hardest part would be dealing with my staff. Its actually dragging people kicking and screaming into the 21st century. Which wouldn't be so bad if they were in the 20th century, but they are actually in the 19th century....
 

Summit

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I don't love doing compressions while moving...once we get a LUCAS, sure, I'm ok with that. But generally, shouldn't we (BLS folks) be working on scene for a couple of cycles (3)?
I'm with you... I hate the idea of interupting compression in the loading process and the sometimes subpar compression while moving... then unloading.

If I was medical director, I'd say if no LUCAS/Autopulse, then BLS work it on scene until ALS shows up... unless it meets termination protocols...

Can someone tell me why we don't have telemetry with all of our modern high bandwidth communications, SSM, GPS tracking, CAD, toughbooks, and electronic PCRs? Why is Telemetry so Johnny and Roy? Telemetry = remote termination order for BLS made easy. Many ambulance EMTs have taken a 3-lead EKG course in my state. Hell, most of our EMTs could facetime med control and point the phone at the monitor. See? Asystole in two leads!
 
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VentMonkey

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Circling back to the thread topic and tying in to my viewpoints, since it was mentioned that there were several rants, and tangents:

Fire-based EMS on the whole is typically on the lower end of the performance threshold because in my opinion, too many of them creates skill dilution. The fact that many, not all, many don’t really care for EMS to begin with only catapults the results in general.

Can it be effective? Absolutely, just like single-function systems can be ineffective. But again, when all single-functions focus on is, well, a single function, they’re naturally honed with duties set forth by their employer, and not tasked with it as some sort of “hiring commitment”, which to me sure sounds like a great reason to become good at something you never intended to become, let alone excel at.
 

Tigger

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Agreed! Something like 5 cycles, no shockable rhythm, no bystander CPR, not witnessed...etc.
We have and use that here. 5 cycles with three consecutive no shock advised notifications.
 

FiremanMike

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Man I'm sorry I've not had a chance to respond today.

Let me add this, after the day I've had today, it's pertinent to mention that we're definitely not perfect. We do have stupid crap here just like everywhere else.
 

VentMonkey

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Man I'm sorry I've not had a chance to respond today.

Let me add this, after the day I've had today, it's pertinent to mention that we're definitely not perfect. We do have stupid crap here just like everywhere else.
Understandable, humans are certainly nothing short of infallible. That said, I just think that the paramedic per capita has gone way up, and it really needs to go way down.

It would not only better serve the community—which I think we can agree we all want—but it would also raise the bar for the provider, and increase entry-level standards and requirements. I certainly think that the fire department will always serve as an integral role as first-line, first responders, and rightfully so.

Giving them, and (hopefully) one day law enforcement, the ability to order either an ALS or BLS unit depending on the severity of complaint would be so much more ideal than how almost every system in the U.S. functions. But again, less ALS units would more than likely dictate proper EMD protocols—a good thing.

If we cannot educate the public, we may have little left in terms of realistic options when it comes to “forcing their hand” at proper prehospital care, and/ or treatments.
 

RocketMedic

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I think Fire based ems can actually potentially be very much better than single-role. Funding, PR, alternative career models, deployments, and even the health and physical-exercise traditions of the fire service can potentially be a lot better for employees and communities than contracted private providers. I even sort-of like the team approach to EMS many fire services bring- and to disagree somewhat with VentMonkey, although I don't think that it is necessary to have paramedics literally everywhere, I don't think that it really contributes too much to skill degradation either. It is pretty inefficient though. Fire-based services can be exceptional too- good people, good care, etc. The probelm is that so many of them are NOT of high quality, and proceed to set a minimalisrtic standard of care that is woefully inadequate even by their own protocols. Houston Fire, for example, can provide fairly generic levels of care- think CA-standard, which isn't that bad- and yet, they often don't, because it is easier for them to do the minimum possible. Other departments, like Dallas and Los Angeles County and a lot of other places, are just as bad, to the point where we can sharpshoot them online with a high degree of confidence.
 

Colt45

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I'm sure this has been stated, and I've tried to read through majority of this thread, but the topics have been so sporadic I didn't know how I wanted to point my reply. But besides some very basic hose monkeys, every fire based paramedic that works in my state that I have worked with have exceeded my expectations. It's kind of opposite here honestly. Our county IFT is looked down upon in many ways- but not for good reasons. Where I'm from Fire based EMS is the golden standard and they provide medical care for the surrounding areas in their jurisdiction. And most of the people are outstanding paramedics. There are also amazing paramedics on our private ambulance systems who work with the fire medics on calls, but ultimately it's the fire medics who are running the calls because they are legally bound to providing that care in that area, and if anything were to go wrong it's on them not the private agency. So i guess it just depends where you're from. To say all fire based EMS systems are less efficient in delivering care overall is kind of a biased statement. Especially when you're practicing in one area. Same goes for me. I shouldn't and don't think every fire based EMS department is a golden star, but just from what I'm used to working around that seems to be the facts I see when witnessing the patient care rendered.
 

RocketMedic

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I mean, all I really have to measure Fire EMS by is Houston Fire, which is stunningly mediocre.
 

RocketMedic

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I don't think its the providers that are bad, I think it is the system that they are working in that is bad. Systems like HFD, LACoFD, etc...for some reason, they allow their people to become poor providers. Why?
 

VentMonkey

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I call bullsh*t on the “it’s a system’s fault overall” mindset. No one forces these providers to become mediocre once they’re licensed. Everyone has a choice, system or not.

I have seen good LACoFD paramedics make a watered down system work for them, why? Because their ability to, or not to, give certain medications hardly defined their patient care abilities. Most were medics in a previous life, some were not. Either way, these folks chose to make miracles happen in a notoriously troubled system.

Saying it’s a system as a whole I feel only further serves as a testament to the generation we’ve become. The individuals may not make the system, but that doesn’t mean they’re always overlooked. Accountability, man.
 

Summit

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Sure its a system problem! A system set up to prioritize Fire and attract those who prioritize Fire is a kind way to describe the average FF/EMS system.
 

VentMonkey

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Sure its a system problem! A system set up to prioritize Fire and attract those who prioritize Fire is a kind way to describe the average FF/EMS system.
Lol, I took the @RocketMedic post more along the lines as referring to the system, i.e., county that they function in. He can clarify for us, and I’m typically hit or miss with reading into some posts.

I think you’re referring to the fire-based culture, which yes, overall leaves lots to be desired. It really does suck for the guys and gals that grind it out trying to do right by their patients; I’ve witnessed it firsthand—I think most of us have.
 

RocketMedic

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I don't necessarily think it's Fire culture. In fact, Fire culture has a lot to be praised: a focus on employee rights and quality-of-life (in excess of the average private service, at least), a sense of comraderie that is generally non-toxic and positive, solid community engagement, ownership and funding, a sense of professional purpose and a deployment model that can facilitate real, positive mentorship and professional development beyond the two-man team. In fact, there's a lot of fire departments that I reckon I'd really enjoy being a part of, and part of me wants to get the minimal Fire training to get hired as a medic (or single-role medic lol).

With that being said, some of these departments build incredibly disrespectful, minimalistic cultures that do not emphasize quality care, patient advocacy or even basic medical fundamentals. I don't think it's because they're busy...plenty of small departments have similar workloads on a per-unit basis. I don't think it's a quality-of-person issue; most of the firefighters I've met are very intelligent, capable people and EMS isn't exactly rocket surgery. I don't even think it's a regional issue; as VentMonkey pointed out, there's good medics who provide good care everywhere, regardless of protocols (and most of the most egregious faults against fire-based EMS aren't necessarily failures to push the upper limits of what can be done, but failures to even begin to start what can and should be done...ie non-medicated open isolated extremity fractures, brushing off chest pain, etc). Why is this? Is it that urban fire departments are less capable of providing good service than their rural counterparts? Is it just bad luck?
 

VentMonkey

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Rocket, you make good points about the culture that the fire service does bring, but as I eluded to in another post- do they really need to be so involved with ALS care in such settings?

Now, again smaller departments aside may really have no choice other than to provide ALS services to their communities; I am referring mainly to major metropolitan FD’s. I don’t know how many times that the departments in my county want to “go ALS” because there’s no ALS ambulances available, not ambulances, ALS ambulances.

To me this says (at least here) they’re severely lacking the knowledge possessed to comprehend what not only paramedics can bring, but what paramedics can’t bring, what a good BLS ambulance can, or even what their own proper BLS care can do. They’re selling their selves short, and way overselling the value of a trade that may, or may not be entered in a 5-10 minute ride to the hospital.

I don’t necessarily feel that having that comradeship as paramedics—in EMS—if there were less of us, used appropriately, and able to fit in to part of their BLS team is all that important. A specialzed skillset called upon properly and accordingly in an urban/ suburban setting makes much more sense to me. Isn’t that what is was intended to be, and not what we’ve seen it become?

I think we can both agree that some of the larger fire-based system’s ineffectiveness does nothing for the populations that they serve. Sure they may take it seriously, but they will never take it more seriously than a fire, and that’s ok. What is not ok is these over saturated systems pretending that it is.

And yes, having seen how they often pass many of their fellow “brothers” while the intern who actually puts time, and effort into their internship is heckled and ridiculed leaves no doubt in my mind why their care is often subpar. If that isn’t cultural, then I don’t know what is.

In essence, as a whole, the larger FD’s I have seen are very incapable when compared to their counterparts.
 

RocketMedic

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I don't think it's actually an ALS vs BLS split, VentMonkey. The crappy Fire care I've witnessed has been crappy care in general, and the fact that it wasn't really good care in the first place was the only thing that made it BLS, not necessarily the certification level of the call. If anything, I think a lot of HFD and LACoFD's problems (to cherry-pick two) are because they do have the belief in a tiered BLS-centric system, where the vast majority of calls are BLS.
 

Tigger

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I don't think it's actually an ALS vs BLS split, VentMonkey. The crappy Fire care I've witnessed has been crappy care in general, and the fact that it wasn't really good care in the first place was the only thing that made it BLS, not necessarily the certification level of the call. If anything, I think a lot of HFD and LACoFD's problems (to cherry-pick two) are because they do have the belief in a tiered BLS-centric system, where the vast majority of calls are BLS.
I agree. A failure to embrace EMS as a core mission happens to all levels of providers. It is amazing to watch three FF/EMTs crap all over their own medic for trying to do right for the patient just because they look at EMS as something beneath them.
 

gonefishing

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If such large departments that im use to like LAFD/LACO went to single role and had a division..... oh wait! They did! LOL they phased out their single role providers and most are on forced retirement now. It worked and from what I heard too well. They needed to justify shifts for fireman vs single role emts and medics.
 

Uclabruin103

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I'm one of the much despised fire medics, and it feels like a lot of the non-fire medics on here are the ones who create this divide between us when there's no need for it. If you guys think we sit at the station and talk trash on the ambulance, you're wrong.

First off, I've worked for both fire and privates. Training for both is usually just the minimum mandated by the licensing agency. So I'm asking, how many hours a month do the single role medics spend on training? What's the training consist of; video, live instruction, online?

As was mentioned earlier, there's good and bad providers in all aspects of healthcare. Hell, I'm trying to pick a pediatrician for my kid and there's horrible providers and excellent providers, and those are MDs. Why would medics be different? Navy seal medics are cross trained and spend a majority of their time on combat. Do you think they're poor medics because of it? I'm sure you'd trust one with you family's life.

The whole slow response issue. Again, that's seen everywhere. I've seen just as many ambulances slow roll as engines.

Can't we just agree that there's good and bad people in all fields?

Stop with this silly arguing. It's counter-productive to the advancement of EMS.
 

DesertMedic66

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I'm one of the much despised fire medics, and it feels like a lot of the non-fire medics on here are the ones who create this divide between us when there's no need for it. If you guys think we sit at the station and talk trash on the ambulance, you're wrong.

First off, I've worked for both fire and privates. Training for both is usually just the minimum mandated by the licensing agency. So I'm asking, how many hours a month do the single role medics spend on training? What's the training consist of; video, live instruction, online?

As was mentioned earlier, there's good and bad providers in all aspects of healthcare. Hell, I'm trying to pick a pediatrician for my kid and there's horrible providers and excellent providers, and those are MDs. Why would medics be different? Navy seal medics are cross trained and spend a majority of their time on combat. Do you think they're poor medics because of it? I'm sure you'd trust one with you family's life.

The whole slow response issue. Again, that's seen everywhere. I've seen just as many ambulances slow roll as engines.

Can't we just agree that there's good and bad people in all fields?

Stop with this silly arguing. It's counter-productive to the advancement of EMS.
If you take an ambulance based paramedic who has no desires to become a firefighter and compare them to a firefighter paramedic you will usually find many differences. How many firefighter paramedics on “assessment” engines who actively seek out medical educational opportunities? Are they only getting the minimum CE hours needed to recertify or are they getting much more? Are they only maintaining the bare minimum classes that are needed to stay employed (ACLS, BLS, etc)? Do they enjoy running medical aids? If they are on scene of a medical aid and a fire breaks out will they bail out as soon as the ambulance arrives? Will they even open their drug box and give a patient pain medication or “just wait until the ambulance gets here”. Do they try to take over the scene of a call regardless of who was already on scene? Do they follow directions or do what they want on medical calls?

All of the questions that I just asked are issues that my area has to deal with on a daily basis. Yes there are good firefighter paramedics however the vast majority of them are not. Heck, as long as the firefighter medic who responds is friendly that’s all I can ask for.

I was a firefighter explorer for 5-6 years (I know, just an explorer). During that time I thought we were hot **** because that is what we were trained to believe. I thought we came before God on every call and that the normal citizens should bow at our feet.

When I started working on the ambulance I was exposed to the truth (at least for my area) that the vast majority of firefighters hate medical aids and a vast number of them became paramedics just to get the fire job. In my area all firefighters have to be at least EMTs so there are a lot who became an EMT just to get hired on.

We have firefighter medics who will force patients to go to the hospital against their will. They will threaten patients. They will flat out lie and get pissed when I call them out on their lies. We have fire crews who will cancel themselves before getting on scene of a medical call because the ambulance is already there. We have fire crews who will only send in one person to the house while the rest of the crew stays in the engine. We have fire crews who will decide to enter an unsafe scene we were staging at because PD was taking too long.

Yes there are good and bad people at my company however out of all the ones who do not want to go fire, they are passionate about being a medic and are actually great providers. In my area the same can not be said about the vast majority of firefighters.
 
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