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

[VentMonkey]

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.

Yes, exactly what the ACEP is saying. Unfortunately @EpiEMS, you and I both know outside of this forum many of us are outnumbered at our respective services with this train of thought.

So keeping the thread on topic, we are but a pivotal hodgepodge of the trifecta listed above. We don’t train for calls the same way a fire department would train for a house vs. veg fire, or are taught to “watch our partners six” (gags) the way perhaps law enforcement does with absolutely founded intentions.

Do we, and should we look out for one another? Absolutely. Clearly without ourselves and our partners we’re an ineffective trifecta.

It’s just unfortunate that many of our co-workers and colleagues fail to see, read, acknowledge, or listen to what it is you’ve shared above that the ACEP—a seemingly credible source of EMS-info—has gracefully bestowed upon our...profession.

 

[BobBarker]

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

It's California LOL. I've filed a complaint on a hospital one time when they almost killed my father by overdosing him on Dilaudid in the ER and the nurses not knowing what to do after. I had to bag my own father for about 2 minutes until more competent staff showed up. Not to mention this same hospital was fined for overdosing and killing a patient about 3 years before our incident. Did the Department of Health care? Nope. I called and emailed the investigator assigned multiple times and never heard back in 2 years. The only good that came out of this was the hospital waived our copay/coinsurance for life (and we are forced to use them due to insurance)

 

[E tank]

It's California LOL. I've filed a complaint on a hospital one time when they almost killed my father by overdosing him on Dilaudid in the ER and the nurses not knowing what to do after. I had to bag my own father for about 2 minutes until more competent staff showed up. Not to mention this same hospital was fined for overdosing and killing a patient about 3 years before our incident. Did the Department of Health care? Nope. I called and emailed the investigator assigned multiple times and never heard back in 2 years. The only good that came out of this was the hospital waived our copay/coinsurance for life (and we are forced to use them due to insurance)

Stuff like that goes through the state board of nursing and/or medicine.

 

[BobBarker]

Stuff like that goes through the state board of nursing and/or medicine.

Well, maybe. But considering it was literally almost the exact circumstances as the fine they had received previously and the Department of Public Health was the one who handed that down, I went down that path. I forgot to mention the other things I complained about was the first 2 EKG machines didn't work and the understaffing of the hospital as well. CA actually has a minimum nurse to patient ration mandated by law. I think they also investigate it because it took place in a hospital and they investigate hospitals. I will be calling the Board of Nursing tomorrow morning, but I doubt they will even listen to an incident that occurred 2 years ago and didn't have a terrible outcome. Thanks for replying

 

[Djohnson]

I've been on both sides of the fence on this one. I started my career in a fairly big city that had an EMS system that was separate from fire. The firefighters were great at fighting fire and the paramedics were, for the most part, great EMS providers (ALS only 911 trucks). The issue was that the engine company (99% we're BLS) almost never had to perform patient care past vital signs because the ambulances were usually right behind them. Many of the firefighters became complacent and did not do much, if any, EMS training. This meant that on the calls where they did have to perform patient care, usually on critical patients, their skills just we're not there. I ended up leaving to work for a combination fire and EMS system just outside the city. The environment and culture in this department is completely different than the city. Because it is a combination system, we do fire and EMS training almost equally. There are a few narrow minded firefighters that feel like EMS was forced on them, but they are the minority.

 

[StCEMT]

I've been on both sides of the fence on this one. I started my career in a fairly big city that had an EMS system that was separate from fire. The firefighters were great at fighting fire and the paramedics were, for the most part, great EMS providers (ALS only 911 trucks). The issue was that the engine company (99% we're BLS) almost never had to perform patient care past vital signs because the ambulances were usually right behind them. Many of the firefighters became complacent and did not do much, if any, EMS training. This meant that on the calls where they did have to perform patient care, usually on critical patients, their skills just we're not there. I ended up leaving to work for a combination fire and EMS system just outside the city. The environment and culture in this department is completely different than the city. Because it is a combination system, we do fire and EMS training almost equally. There are a few narrow minded firefighters that feel like EMS was forced on them, but they are the minority.

There are a few hidden gem stations/crews like 6, but I know exactly what you mean hahaha.

 

[ParamagicFF]

I believe this all boils down to the leadership and culture of the Fire and or EMS agency. I don't think it's appropriate to make too broad of strokes here. There may be regional tendencies, but I do not think it's appropriate to say that Fire based EMS employees are inherently worse than single role employees.

I began my ems career as a hospital based ALS provider. My "preceptor" was unable to read EKGs, hadn't reviewed ACLS for at least 10 years, and in general couldn't do much more than push a cot. First week in she was unable to catch an obvious STEMI, and when I pointed it out she did not know how to treat it. I brought these concerns to management and they admitted it was a known problem, but that it hadn't caused any major problems. We were all just warm bodies in seats. The leadership was more concerned with other things than ensuring appropriate care was given. There was no CQI at all beyond ensuring billing requirements were met. Missing a run, or failing to fill out billing paperwork were the only real punishable events.

I then moved to a medium city fire/EMS agency where medics split time between transport and suppression. We drilled on fire and EMS almost equally. The culture was one of excellence and accountability in all things. The medicine was progressive, and we were all expected to keep up. It wasn't a department filled with geniuses, or all even paramedics. However, we were all expected to perform to a standard, and that standard was reviewed. We had CQI for certain events, and then random chart reviews. This was an EXCELLENT EMS system.

I now work for a big city Fire/EMS dept where there is virtually zero accountability. We split time between suppression and transport. Because of the lack of accountability, performance is based almost exclusively on each provider's personal drive. We have some truly excellent EMTs and Paramedics, and we have some that TRULY can't even push a cot effectively. We have a formal CQI process, but I don't know exactly how it works. Despite participating on MANY critical calls, I've never been contacted. I've anecdotally heard of people being contacted for trivial matters. It is not used as a training tool, and they are seperate from operations.

Sorry for the long winded post, but I believe it was all worth saying.

 

[VinceVega91]

Our city runs a third service EMS system separate from the Fire Department in an urban setting. We do all the transports, Fire shows up as a first responder, mostly BLS but some ALS pumpers, and they provide initial care before we show up to transport. The firemen are great at fighting fires and for the most part very good at medical calls. Most of them clearly want nothing to do with us or want nothing to do with a merge and neither does our department, but most of our trucks are housed at the fire stations. Some of our trucks are housed at police stations, one is eventually housing with a dog kennel lol, and the rest just roam the city and sit on a street corner. Some of the trucks that cannot fit in a fire or police station are left outside and in the winter they are left running until they get a call, and that's terrible sometimes for the trucks in terms of wear and tear. We get a lot of trucks out of service as a result too. The fire stations however, have a separate room for us EMS guys, but no sleeping quarters, because we don't get the down time they do, we run 12 hour shifts and they do 24's, and there is barely any comradery or brotherhood in the fire stations between EMS and Fire since we are separate departments. There's no animosity either, but we at least get along together and work well together on our emergency scenes and get the job done.

As far as how patients are treated is concerned, the firemen are very helpful on our more serious and critical calls such as full arrests, traumas, critical medical calls, etc. The guys are able to do IVs, give meds, interpret ECGs adequately and it really helps us out a great deal when they do that. Of course, there are older, old fashioned firemen who don't want to do much and don't help at all, but then again we have guys who won't even get out of the truck or prepare the cot for when we are at Structure Fire Standby's, so yeah there's going to be morons on both ends who don't want help each other and do the right thing and that's not cool. We strictly do EMS so we should and we do a very good job at what we do, the Firemen strictly do firefighting and do great at what they do too. So I think third-service really isn't a bad way to go especially for major cities, it's just a matter of the cities having the funding to take care of each public safety division appropriately, which our city could do a little better at. What I mean is if they want us to stay separate, then at least make separate base stations that are specifically made for us and our trucks, but that's asking for too much.

 

[EMT Rookie]

*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?

 

[EMT Rookie]

Such an interesting thread....I never really thought about the interplay between the Fire based and the EMS based systems but can see now just how different they are in terms of overall patient care and outcomes.

 

[KingCountyMedic]

You're all doing it wrong.