The role of EMS in the rescue assignment

[Jon]

I've seen rescue done all sorts of ways.

In PA, every ambulance is required to have some form of toolbox with tools, including a tool for cutting/prying for rescue. I know of IFT companies that have gotten away with an old lawnmower blade.

I've seen some agencies that expect EMS to be in the vehicle, providing care, and as the medic, I've been looked at by the Fire OIC to "direct" the rescue - do we go slow and carefully, or as rapid as possible, or somewhere in between.

I've also seen services where the Rescue company FF's are mostly experienced EMS providers, and the Fire guys end up in the car, and direct the rescue, with limited input from EMS.

I've seen other systems that are in between.


I've also seen a unified County service, where (almost) EVERYONE is at least an EMT, and many folks on the ambulance are also Fire folks. Rescue is left to the Rescue staff, with some consult by medics, and there is happiness and sunshine.

 

[Veneficus]

How is a FF going to know what interventions may be immediately necessary or what extrication techniques are best for getting the patient out time wise if they don't understand the gravity of the patient's condition?

Rescue is 100% focused around the patient with a very strong MEDICAL element as Linuss has stated.

how many paramedics actually understand the gravity of the pt condition without over exaggerating it?

I am not saying EMS cannot do rescue, there are some very fine agencies that do.

But how is it going to be paid for? Most EMS companies/departments don't make huge margins.

How do you bill for rescue? How do you collect? From whom?

All of that equipment and training, along with retraining costs a lot.

If some community wants to financially support it, then I am all for it. But how are you going to force providers and agencies to train and equip themselves?

We can't get EMS providers to agree on a minimum education, now we are going to start taking over fire's job?

I see a lot of EMSproviders get upset when fire absorbs local EMS, often with the cry "I don't want to go into a burning building!"

How often do you think fire departments do that anymore?

Sure there are some departments that do. They are usually big cities, that certainly can't pull an ambulance off the street to get 2 or 3 guys for suppression duty.

If EMS can be too complex for a fire department to have EMS providers, how is this argument not saying the same?

Are you willing to pay for the training yourself?

How about the equipment?

Constant retraining?

 

[18G]

how many paramedics actually understand the gravity of the pt condition without over exaggerating it?

I am not saying EMS cannot do rescue, there are some very fine agencies that do.

But how is it going to be paid for? Most EMS companies/departments don't make huge margins.

How do you bill for rescue? How do you collect? From whom?

All of that equipment and training, along with retraining costs a lot.

If some community wants to financially support it, then I am all for it. But how are you going to force providers and agencies to train and equip themselves?

We can't get EMS providers to agree on a minimum education, now we are going to start taking over fire's job?

I see a lot of EMSproviders get upset when fire absorbs local EMS, often with the cry "I don't want to go into a burning building!"

How often do you think fire departments do that anymore?

Sure there are some departments that do. They are usually big cities, that certainly can't pull an ambulance off the street to get 2 or 3 guys for suppression duty.

If EMS can be too complex for a fire department to have EMS providers, how is this argument not saying the same?

Are you willing to pay for the training yourself?

How about the equipment?

Constant retraining?

The whole reason there is a rescue to begin with is because a patient is involved which 99% of the time requires medical care, correct? The highest level medical provider onscene has the responsibility to access the patient and ensure they are taken care of during the rescue.

Im not saying every ambulance company needs to buy a rescue-squad but having at least rescue awareness and the ability to function on a rescue scene is a bare minimum requirement. If an ALS provider is on the scene they have a legal and professional obligation to the patient. It's hardly acceptable for a trauma pt. to not have their airway appropriately managed because they are still inside the car. Agree?

I wish EMS would provide rescue services more than they do. My one neighboring county does do that actually. They are "rescue companies" and provide ALS and heavy rescue services. Pittsburgh EMS is another.

 

[Veneficus]

The whole reason there is a rescue to begin with is because a patient is involved which 99% of the time requires medical care, correct?

This I agree with

The highest level medical provider onscene has the responsibility to access the patient and ensure they are taken care of during the rescue.

This I do not always agree with.

Having been involved with rescue for some years myself, and it being my favorite part of the fire service, I think there are times when just getting the person out before medical care is the best option.

There is also the feasibility of the highest level medical provider accessing the patient. I don't want an untrained person putting themself in harms way to access a patient. That is how you wind up with 2 patients and no medical providers.

In this particular circumstance, I think a provider with enough training to follow some type of medical direction, whether from an onsite medic or other, is the best solution when you do not have dual trained providers. (which as I stated above is ideal)

Im not saying every ambulance company needs to buy a rescue-squad but having at least rescue awareness and the ability to function on a rescue scene is a bare minimum requirement.

I agee with this.

If an ALS provider is on the scene they have a legal and professional obligation to the patient. It's hardly acceptable for a trauma pt. to not have their airway appropriately managed because they are still inside the car. Agree?

Can a BLS provider not manage the airway with something as simple as a jaw thrust or if need a king airway?

Is it the gold standard of intubation, no, but my first field tube ever was inserted digitally in a guy trapped in his car that he ran under somebody's porch. (I was the only guy small enough to fit in the hole) The patient was still pronounced dead at the hospital, so I am guessing that ET tube didn't do much for him.

Knowing what I know know, I am going to say that the patient needed way more advanced medicine than we (dual trained providers) were able to provide at all. In circumstances like that, it needs to be brought to the scene.

I wish EMS would provide rescue services more than they do.

Me too, but I need to see a realistic plan to make it happen.

Especially in areas that have full time paid EMS and volunteer fire.

 

[Bullets]

A volunteer EMS squad in my home town provides vehicle extrication, FDs only job is to pull a hand line and standby. The system works fine. I think FD isn't happy about it, and 2 FCs have crappy old hand operated jaws on their their engines.

My squad houses a jetski, a 30ft dual outboard rescue boat, and a dive rescue truck and have agreements with other townships to provide water rescue for 15 miles of atlantic ocean and associated feeding streams and bays and are the primary mutual aid to the State Police and Coast Guard. Water rescue is a solely EMS activity.

All other rescue services are provided through the township OEM. They are the primary Hazmat for half the county, and keep most of the equipment used in rope, trench, EBS, confined space, ect. They use members from one FC and one EMS squad to supplement their equipment and capabilities

That said, NJ has many volunteer EMS agencies that have always managed to provide heavy rescue for decades, so it's possible to do so as a non-profit.

 

[DesertMedic66]

Then there's a breakdown in communication and the relationship between EMS and the FD that needs to be addressed.

There's no reason the medic can't be in charge of pt care while fire is in charge of rescue provided there are good, open lines of communication between the two groups.

Agree. I guess it's not an issue in my area seeming how every fire engine has at least 1 paramedic with the other firefighters being EMTs.

We pretty much get on scene, take the gurney out of the ambulance and wait for fire to do their thing. Sometimes the fire medic will have the ambulance medic do patient care and sometimes the fire medic will do it.

And I also do agree with Corky about it being Emergency Medical Service.

 

[NomadicMedic]

I guess I'm lucky. In my system, rescue is done by the fire department with patient care being managed by the paramedic on scene. In 99% of the cases the rescue effort is led by the paramedic offering "advice" to the incident commander.

I've been trained in vehicle rescue, I enjoy vehicle rescue. I love cutting up cars as much as the next guy... However, leaving vehicle extrication in the realm of the fire department allows another opportunity to justify their existence. And frankly, I have to carry enough gear on the truck.

As long is there's no kerfuffle over patient care, I don't particularly care who cuts the car.

 

[rescue1]

Ideally, the FD cuts and EMS treats and advises, in my book. Both sides should have knowledge of what the other is doing--for fire this should be something like EMT-B or at the very least MFR, and for EMS this should be rescue awareness training at the minimum--preferably more.

That way everyone has a part to play, we don't crowd our ambulances with cribbing and Hurst tools, and there are no pissing contests about "who gets to cut", like the NYPD and FDNY have.

If there was some precedent for firefighters hating rescue assignments and generally making a mess out of it, that would be one thing, but with fires on the decrease, adding technical and vehicle rescue to the FDs toolbox makes perfect sense. It's a technical skill, like firefighting, there's space on the trucks, and it allows paramedics to focus their efforts on patient care and medicine.

 

[Veneficus]

Rescue ICU...

The field medical treatments during a rescue operation are so simple, I cannot see any reason why the people doing the cutting are not perfectly capable to be trained to provide them.

When it comes to the medical capacity of many FDs, as a former sinner myself, I am not impressed.

But the treatments available in the field, along with effectiveness that I doubt would stand up to serious scrutiny, a lot of medical knowledge is not really required to apply them.

If you had the opportunity to use blood products, could perform surgical procedures, or administer procedural sedation, I would have a different opinion. But as it stands, I am not sure a paramedic is even needed for vehicle extrication, and only rarely in other types of rescuers.

While I agree fully with 18g, that resuce is patient centered, the first and formost goal needs to be freeing the patient from whatever is entrapping them, not to provide medical care in a dangerous environment or prolong the rescue.

My opinion comes from retrospective knowledge on what I have done. Having done all kinds of things like intubate trapped people, start IVs in holes I could barely crawl into myself in the dark, etc, I really question if it ever makes a difference in all but the most rare circumstances.

Even then, the treatment provided, may not be what is needed. For example, I have never administered warmed IV fluids to a prolonged entrapment in any weather or circumstance, but that would probably be more beneficial to reduce/prevent hypothermia than administering chrystalloid to a patient in stave III or IV shock.

 

[DrParasite]

incredidbly bored, felt like posting pictures

You asked the role of EMS on a rescue assignment? maybe you should ask these career guys:

 

[MrJones]

I, on the other hand, didn't notice that this was an old thread

...Heck, why not just throw a pump, tank, and hand line on there too so one two man crew and pull up and handle it all....

You thought you were kidding?

Volusia County’s new pumper/ambulances are built on 2011 Spartan MetroStar chassis with a 2011 Patriot module and Waterous CAFS. The units can carry 300 gallons of water and 30 gallons of foam. Additionally, there is a hosebed and a large transverse compartment in the cab behind the driver and officer for extra fire and extrication equipment storage.

The ambulance module features custom all-aluminum interior cabinets with Meganite countertops and rounded edge corners. The units also feature Braun’s VitalMax lighting system for shadowless light to aid in patient care, the EZ Glide sliding side-entry door for enhanced crew safety, the MasterTech IV electrical system, and the SolidBody construction.

source

 

[rescue1]

You asked the role of EMS on a rescue assignment? maybe you should ask these career guys:

Apparently Pittsburgh is thinking of transferring its rescue work over from EMS to the fire side of things.

http://www.firehouse.com/news/10812112/pittsburgh-officials-medic-contract-risking-rescues

 

[Chief Complaint]

Doesn't seem logical to me to have EMS take control of rescue operations. Agencies have a hard enough time training their medics to provide adequate patient care. Giving them technical rescue, high angle rescue, swift water rescue, extrication, etc. responsibilities would be overload IMO.

The fire department didn't take control of rescue ops because it made us look cool. Its because nobody else really wanted to do it, or was unable to do it correctly.

The fire department has the resources to train on rescue procedures, busy EMS agencies are busy doing what they do, patient care. Very little time for extensive training, which is what technical rescue requires.

 

[Shishkabob]

Doesn't seem logical to me to have EMS take control of rescue operations.

Says the firefighter....

Agencies have a hard enough time training their medics to provide adequate patient care. Giving them technical rescue, high angle rescue, swift water rescue, extrication, etc. responsibilities would be overload IMO.

Says the firefighter AND paramedic?

So, a Paramedic can't do rescue because it would be "overload", but having a firefighter ALSO do rescue and ALSO be a paramedic is ok? Your bias is clearly showing...




ATcEMS trains their medics in rescue. Wise County has extrication tools on their rigs. Pittsburgh handles rescue. I've never heard of a single complaint about EMS doing rescue from anyone EXCEPT FDs and their unions.


You have done/said nothing that convinces me that FD should have a monopoly over rescue. It is simply just an exercise in trying to justify a bigger budget.

 

[rescue1]

I agree with CC. With the decline of fires due to better prevention, the FD also has more time to train for rescues, and more space on their apparatus for equipment. Meanwhile, medical calls are increasing, and ideally (hopefully) the educational requirements for EMS will also be increasing.

EMS should still be familiar with rescue operations though.

 

[STXmedic]

I agree with CC. With the decline of fires due to better prevention, the FD also has more time to train for rescues, and more space on their apparatus for equipment. Meanwhile, medical calls are increasing, and ideally (hopefully) the educational requirements for EMS will also be increasing.

EMS should still be familiar with rescue operations though.

So because there are less fires, fire departments should train less on firefighting and start selling off their equipment? :unsure:

And to the education standards and increased medical runs: Are fire departments not running medical runs? Are they not also EMTs and Paramedics that need to meet the same education requirements?

I'll echo Linuss' statement about ATcEMS. They have a rescue team, and their team is damn good. Amazingly, they are still good even though they never learned how to extinguish a structure fire...

*Coming from a fire medic

 

[Chief Complaint]

Says the firefighter....

Says the firefighter AND paramedic?

So, a Paramedic can't do rescue because it would be "overload", but having a firefighter ALSO do rescue and ALSO be a paramedic is ok? Your bias is clearly showing...

ATcEMS trains their medics in rescue. Wise County has extrication tools on their rigs. Pittsburgh handles rescue. I've never heard of a single complaint about EMS doing rescue from anyone EXCEPT FDs and their unions.

You have done/said nothing that convinces me that FD should have a monopoly over rescue. It is simply just an exercise in trying to justify a bigger budget.

Well of course i'm biased!

I'm just saying that if it ain't broke, don't fix it. Plus it should be, and is, a joint effort. Fire and EMS both have their roles on the scene of a tech rescue.

Also, generally speaking, career fire departments hold their employees to a higher fitness standard than a private EMS company does. Technical rescues can be very taxing on the body so it is of great importance to have highly trained personnel who are in peak physical shape to affect such a rescue.

Lastly, single role EMS agencies would not be able to fund the training and equipment costs that it takes to put together a top notch tech rescue program. From what i hear, many of them can barely keep their EMS equipment stocked due to lack of funding. Large career fire departments have the money to send their FFs/EMTs/Paramedics to lengthy courses in order for them to become proficient in tech rescues, as well as the money to buy quality tools for such jobs. Private companies will never be able to come up with that kind of funding.

 

[rescue1]

So because there are less fires, fire departments should train less on firefighting and start selling off their equipment? :unsure:

And to the education standards and increased medical runs: Are fire departments not running medical runs? Are they not also EMTs and Paramedics that need to meet the same education requirements?

I'll echo Linuss' statement about ATcEMS. They have a rescue team, and their team is damn good. Amazingly, they are still good even though they never learned how to extinguish a structure fire...

*Coming from a fire medic

Obviously not. But fires account for about 5% of the run volume for most fire departments.

Assuming a separate fire and EMS agency, to me it seems more logical to place the rescue work with the agency that runs less calls. Also, like structural firefighting, rescue is a very technical skill, and some of the tools used for rescue can also be used for firefighting.
It's not a dig against EMS only rescue teams, I just think that fire running it is more efficient.

Obvious with a single department running fire and EMS it's not an issue.

 

[JPINFV]

Lastly, single role EMS agencies would not be able to fund the training and equipment costs that it takes to put together a top notch tech rescue program. From what i hear, many of them can barely keep their EMS equipment stocked due to lack of funding. Large career fire departments have the money to send their FFs/EMTs/Paramedics to lengthy courses in order for them to become proficient in tech rescues, as well as the money to buy quality tools for such jobs. Private companies will never be able to come up with that kind of funding.

Obviously the solution isn't to defund what you admit are overly funded fire departments, and increase funding to what you admit are underfunded EMS departments.

 

[usalsfyre]

Obviously the solution isn't to defund what you admit are overly funded fire departments, and increase funding to what you admit are underfunded EMS departments.

The IAFF will Jimmy Hoffa you for that kind of reasonable logic...