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

[DrParasite]

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.

no one ever said you trash talk the ambulance, but let me ask you this: your a single company house, and in your first due you get two calls at the same time, one for a cardiac arrest, and one for a structure fire in a vacant dwelling....... its your decision, which are you going to?

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.

honest answer? I would trust them to handle any traumatic injury..... would I have the same level of confidence in treating a Tricyclic Antidepressant overdose? ehhh......

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.

so you advocated for your patients, and filed a complaint with the department of health right? forcing patients to go to the hospital against their will is kidnapping (a criminal offense), and if you have medics who are threatening their patients, than they don't deserve to be medics, and should have their certs yanked.

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.

So you or your supervisor had a chat with their battalion chief right? In all honesty, if the ambulance is already there, there is no need for first responders (unless there is a need for additional hands). But if they are cancelling themselves inappropriately, why have their not been formal complaints raised up the chain of command?

We have fire crews who will decide to enter an unsafe scene we were staging at because PD was taking too long.

define an unsafe scene..... an overdose? an assault? a drunk? a medical call as a location with a history of violence? ehhh, I've been first in on all of those, rarely with an issue. Plus if I'm on an engine with 4 people, I'm pretty sure we can handle it. even a shooting or stabbing on the outside, do a drive by and see what is going on. Now if you are talking about active assault in progress, active gun fire, penetrating trauma inside a structure, or whatever, that's their issue and that sounds more like an organizational culture issue.

 

[akflightmedic]

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.

First, it is SEAL. Never, ever lower case it.

Second, hands down I would absolutely trust them for trauma. Medical....well, when the general population they see are the healthiest and fittest of the healthiest and fittest. I am not quite sure Grandma's chest pain and other comorbidities is within their immediate wheelhouse.

Poor comparison.

I have worked both sides of the equation as relevant to this discussion (Single Role Medic versus FireMedic) in several different departments both paid and volunteer. There is a very real disparity in how EMS calls are viewed versus Fire calls...even from the Fire Medics. I still standby an old post I have made several times actually...this goes to biology and human psychology.

There is something primal about fire and leading the fray. Then there are natural care giver type personalities. Some people have a little of both, a lot of both or just one or the other. The fire service and EMS are two completely different mind sets and personalities. "We" conform them/ourselves to make it fit cause we have been told to do so, however it is an outdated practice, one that was done with the mindset of saving dollars with no real thought or analysis given to the actual career and the types of people who enter these careers.

It is almost like holding onto a declining stock and refusing to sell. We have pumped the model so much and invested time, energy and funding into it...no one wants to be the one to say "You know, this really is not the best utilization of our public services...let's try something different...". Humans are resistant to change for the most part.

 

[DesertMedic66]

so you advocated for your patients, and filed a complaint with the department of health right? forcing patients to go to the hospital against their will is kidnapping (a criminal offense), and if you have medics who are threatening their patients, than they don't deserve to be medics, and should have their certs yanked.
So you or your supervisor had a chat with their battalion chief right? In all honesty, if the ambulance is already there, there is no need for first responders (unless there is a need for additional hands). But if they are cancelling themselves inappropriately, why have their not been formal complaints raised up the chain of command?
define an unsafe scene..... an overdose? an assault? a drunk? a medical call as a location with a history of violence? ehhh, I've been first in on all of those, rarely with an issue. Plus if I'm on an engine with 4 people, I'm pretty sure we can handle it. even a shooting or stabbing on the outside, do a drive by and see what is going on. Now if you are talking about active assault in progress, active gun fire, penetrating trauma inside a structure, or whatever, that's their issue and that sounds more like an organizational culture issue.

Making complaints against the fire departments goes no where at all, believe me I have tried.

Fire views us as “less than they are” so our supervisors have zero power to do anything.

Unsafe scenes where we have zero information about the call and are told to stage by Dispatch or for confirmed assaults/domestic violence and are once again advised to stage. Domestic violence calls are some of the most dangerous calls that law enforcement responds to.

 

[FiremanMike]

Ok, which one of you f-er's are sitting behind your keyboard and praying that things start going poorly at my department????

This week has been an absolute ****storm..

On the plus side, everything is being taken seriously and issues are being addressed

 

[VentMonkey]

I hardly wish bad on any department, let alone one with a seemingly involved EMS coordinator. I seriously don’t care if it’s fire-based or not. Is it good to, and for the community it serves? Shouldn’t this be all that truly matters?

 

[Melbourne MICA]

*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?

Hi all,

Have a lot of interest in this topic from the point of view of the mixed models of EMS operation used in the US especially private EMS companies and subcontracting to other service industries like, firefighting. Is there an argument to suggest EMS is best served by a dedicated industry sector not tied to profit driven operations or as an appendage to other organisations where EMS is a secondary activity next to their primary service and mainly used to generate another income stream/public relations bonus? Are the mentioned failings resulting from a insufficient enthusiasm and oversight because of these contrasting agendas? Fire services In Australia have been keen to expand into EMS but there is very little enthusiasm from the troops on the ground, just from the bosses who see personal political and prestige gains from taking on EMS rather than a genuine interest or understanding of pre-hospital emergency care. When people apply to ambulance anywhere in Australia they know it is a service oriented industry run by the state for the public good, no other reason. Funding models through our universal health care system/ government funding and small subscriptions to ambulance (around $80 AUD/year) keep ambulance going profit or not, such is the public attachment to this industry. Suggested attempts to privatize ambulance in the past have met with enormous public backlash. I'm not suggesting fire services in the US or similar agencies can't do pre-hospital health care well. Rather,is the non centralised nature of EMS in the US an encumbrance to smooth operations and oversight to maintain standards short of designing practices around reducing risk of litigation? Less than 50% of US states have a standard set of protocols and even where these exist they are not uniformly or universally used by services in the those states. And you have a dozen or more EMS models employed. Short of setting up practices that might get you sued why wouldn't a private company want their operation aligned only to their agendas? Hope I'm not coming across as disparaging. Not my intention. I've done a lot of work on burn injury 1st aid/Rx, published some material and discovered CPG's and practices in this area in the US can only be described as a basket case from a clinical point of view. You can cross a county line and have different service provider operation, different payment system and a burn may not even get the same first aid delivered by the different EMS company. Interested in opinions.

 

[RocketMedic]

Dude, you can literally cross a street here in the USA and get wildly different care. If I get hurt in Houston, HFD will probably send a BLS truck and they might let me bite down on Kerlex or something for pain management. If I'm in Cy-Fair's area, I'll probably get a few micrograms of fentanyl...but if I am able to drag myself across the road into Cypress Creek/ESD48/Northwest (Tomball) or MCHD, I'm getting the world's best care.

 

[Melbourne MICA]

Dude, you can literally cross a street here in the USA and get wildly different care. If I get hurt in Houston, HFD will probably send a BLS truck and they might let me bite down on Kerlex or something for pain management. If I'm in Cy-Fair's area, I'll probably get a few micrograms of fentanyl...but if I am able to drag myself across the road into Cypress Creek/ESD48/Northwest (Tomball) or MCHD, I'm getting the world's best care.

Thanks Rocketmedic.

I know there have been major attempts at standardising protocols more than once. Which begs the question - why haven't things changed because I was reading about these same issues back in the early 1990's. My perspective is the issue has a broader dimension - its because US citizens can't accept a universal health care system which of course entirely changes the funding for health care and hence the resourcing landscape. Its madness. Universal health care doesn't mean commies and state control of everything. Ours started in 1973 - smack bang in the middle of the Cold War. This idea has been a figment of the American imagination as long as I've been alive.Just about every other Western country has one although not all of course run public only ambulance models. I appreciate their are local nuances, but while everyone is fixated on making money and being "individual" concerns like those noted here will go on and on. Total BS.

 

[FK911]

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.

And a good attorney will hang them at a jury trial.
This question will be asked on cross examination
How many hours a month do you spend on training?
How many hours of that is in fire suppression and rescue?
Can you produce training logs to vailidate your answer?
How many hours are spend on EMS training?
Can you produce logs to validate your answer?
What percentage of calls are fire and rescue?
What percentage of calls are EMS?
“We all know most calls are EMS and they drilll on fire rescue” we just need th jury to know this...

Then the attorney will say..
based on your answers your Training time is possibly inadequate in relation to the type of calls your running.
Please answer the question... you are under oath!
Defense will object
Jury has a picture in there mind.
That’s all that’s needed
City will settle?

 

[needsleep]

I know I'm late to the party, but as a new "brother" (gag me) to a Fire-based EMS system, patient care is often times an atrocity. I'm in one of the biggest career departments in my (large) state. If you enjoy EMS you are looked at as a p**s* who must be scared of fire or mentally deranged. Were told to "quit talking about ambulance crap, we're firefighters." We do have a very, very, very, very, small number of passionate providers but they are only here until the next nursing classes start. Extremely discouraging and disappointing

 

[RocketMedic]

I know I'm late to the party, but as a new "brother" (gag me) to a Fire-based EMS system, patient care is often times an atrocity. I'm in one of the biggest career departments in my (large) state. If you enjoy EMS you are looked at as a p**s* who must be scared of fire or mentally deranged. Were told to "quit talking about ambulance crap, we're firefighters." We do have a very, very, very, very, small number of passionate providers but they are only here until the next nursing classes start. Extremely discouraging and disappointing

Sad, isn't it?

 

[needsleep]

I asked one of the guys who has been in the fire service for a while why it is that way. He stated to me there was " no masculinity in EMS." I guess its not "manly" to have a desire to actually help others vs. sitting in a recliner all day watching porn on your phone except for the once a day you leave on the engine to go get groceries.

 

[DrParasite]

but as a new "brother" (gag me) to a Fire-based EMS system

You know, your might not like the brotherhood mentality, but it works in the fire service, it works in law enforcement, and it helps build cohesion, something that is frequently lacking in EMS, and leads to retention, limited loyalty to your employer, and a general feeling that this is a job, not a career.

patient care is often times an atrocity. I'm in one of the biggest career departments in my (large) state. If you enjoy EMS you are looked at as a p**s* who must be scared of fire or mentally deranged.

Truth be told, I know of many EMS people that are a little out there..... But I do agree, that patient care tends to suck, especially among people on the engine who don't want to be on the engine. If they don't want to do it, if they don't care about it, and if their supervisors don't enforce that they need to be good at it or they should find another job, well, this is what happens.

Were told to "quit talking about ambulance crap, we're firefighters."

Again, the culture of the fire service is that they are the fire department; it won't change until they change from a fire department that runs EMS calls to an EMS First responding department that runs fire calls

We do have a very, very, very, very, small number of passionate providers but they are only here until the next nursing classes start. Extremely discouraging and disappointing

Which is even worse, because they are only using their current status as a stepping stone to a nursing career. EMS has a rough time retaining our best, brightest, and our most passionate providers.

 

[DrParasite]

Making complaints against the fire departments goes no where at all, believe me I have tried.

So you filed a complaint with the department of health and it went nowhere? wow, now that's impressive. Most departments I am aware of don't have the pull to quash a regulatory agency investigation

Unsafe scenes where we have zero information about the call and are told to stage by Dispatch or for confirmed assaults/domestic violence and are once again advised to stage. Domestic violence calls are some of the most dangerous calls that law enforcement responds to.

I'll repeat my earlier advice: dispatch is often overly cautious. If they tell me to stage, and I, using my own judgement, experience, and situational awareness, decide to ignore their advice, that's my decision.

If the FD (or anyone really) wants to enter a potentially unsafe scene, that's their issue, not your concern. Just look at the Aurora Colorado movie theater shooting.... all the EMS crews staged in a safe location, and many fire crews went directly to the scene before the cops even knew what was going on. In all reality, until they get burned by doing it, and a firefighter gets injured or killed, and during the investigation the statement of "dispatch told you to stage, and you didn't; as a direct result of your personal negligence, we are terminating your employment and you are personally liable for any civil liabilities that arise," nothing will change.

But it's still not your issue, so you shouldn't concern yourself with their actions.

 

[EpiEMS]

that's my decision.

Your employer may not like it...and it should probably be part of their SOP to stage for calls on scenes of violence, no?

You know, your might not like the brotherhood mentality, but it works in the fire service

Yes, that's true. But EMS doesn't work like the fire service (mostly) - 2 people in an ambulance, often of equal provider levels, working as a pair is so very different than the dynamic of 4-6 people on an apparatus with clearly defined different roles (engineer, officer, etc. etc.). Hence, the "team style" brotherhood concept is more of an equal partnership - a "marriage", if you will.

 

[DrParasite]

Your employer may not like it...and it should probably be part of their SOP to stage for calls on scenes of violence, no?

So back when I was on the ambulance, pysch calls, assaults, overdoses, man down/unconscious person calls generated an EMS response, and units were sent when they were available. The only time EMS was not sent was to psych calls where the patient was KNOWN or REPORTED to be violent or armed, assaults that were currently in progress, or any time when the call taker was told that there was an active threat on the scene; in those cases, a request was made to PD, and they were told to contact us when they were on scene (which often took a while). The only calls we staged units for were stabbing and shooting calls. That was their written policy. Everything else we told PD to call us back when they got on scene, regardless of if it took 5 minutes or 3 hours

And as I stated earlier, my employer doesn't care as long as I didn't get hurt in the process, and I suspect that is the same line of thinking that the FD is applying.

Yes, that's true. But EMS doesn't work like the fire service (mostly) - 2 people in an ambulance, often of equal provider levels, working as a pair is so very different than the dynamic of 4-6 people on an apparatus with clearly defined different roles (engineer, officer, etc. etc.). Hence, the "team style" brotherhood concept is more of an equal partnership - a "marriage", if you will.

You're right.... they work more like the police: two person teams, equally trained, working together for an entire shift? And they have their LEO "brotherhood"

The brotherhood isn't between you and your partner; it's between you and the industry as a whole. Very big difference.

 

[VentMonkey]

The brotherhood isn't between you and your partner; it's between you and the industry as a whole. Very big difference.

You know? I get teamwork, collaboration, and all of the important things that go along with it, particularly with critical or difficult calls, but why does EMS need a “brotherhood”?

I mean think about, it’s ultimate purpose is primary prehospital care in the out of hospital setting. There’s a stronger need for a universally adopted level of clinical-based providers at a standardized, and increased level. This seems much more prudent than a sense of “belonging” within prehospital services, respectively.

I’m not saying that mentality is bad, I’m saying I don’t think it’s as pertinent to this particular public service. The sooner we realize this, and focus on the paragraph above, the better off our respective services will be.

 

[EpiEMS]

You're right.... they work more like the police: two person teams, equally trained, working together for an entire shift? And they have their LEO "brotherhood"

Fair enough. That said, I don't know many cops that work in pairs (at least in suburbs or rural areas).

You know? I get teamwork, collaboration, and all of the important things that go along with it, particularly with critical or difficult calls, but why does EMS need a “brotherhood”?

The whole "brotherhood" thing is nice, but I'd settle for higher education requirements

 

[VentMonkey]

The whole "brotherhood" thing is nice, but I'd settle for higher education requirements

Yup, and EMS wasn’t founded on things such as this. Again, it doesn’t make these qualities wrong, or less than. It just doesn’t fit into EMS as a public service. But more specifically, it prohibits the full extent of the services that we could potentially provide by trying to fit our square into the other’s (proverbial) cultural hole.

God forbid I ever have to call for an ambulance, but if I did I sure wouldn’t be thinking: “Man, their medicine was marginal, but I’m sure glad they displayed a sense of ‘brotherhood’ throughout that call.”...

 

[EpiEMS]

It just doesn’t fit into EMS as a public service.

ACEP says "EMS holds a special position at the intersection of public health, health care, and public safety."
I think this is right. We've got elements of all three. From an organizational perspective, the last is...an unfortunate, if necessary one - you're going to a place emergently, and people associate lights and sirens with public safety.