Tries At Becoming A Firefighter

[Ridryder911]

I believe Fire Service EMS will be on the way out. Only one of the advantages of the economic crisis.

Sorry, I have only seen a few Fire Services that ever offered EMS that ever took patient care services seriously. The majority is for keeping the tax revenue and justification of FTE and equipment costs.

I find it ironic, that both of you would be supporting Fire Service EMS when both agree that medic mill programs (that Fire Service promotes) is detrimental to EMS.

Why not have third party? Sorry, you charge for Fire EMS as well, albeit in tax payments and or billing as well. Imagine EMS that has the same benefits and actually better pay structure than Fire? Why not? Why should one have to be placed under another industry that has no relation to health care?

I work for a third party. We only receive tax revenue <$100,000 a year and our billing is comparable to hospital payment structure. With good management (yeah, a strange concept) we are able to have enough in reserve to operate for a year and a half without additional payments. Our staff is paid near or equal to firefighters and our equipment is up to date as well. Imagine, we only do what we are educated to do ... peform EMS!

We work well with local Fire Services for first response. They do NOT want EMS, as they recognize the demand and call volume is extreme in comparrision. As well, they enjoy and do what they joined the fire service for.. fire control and suppression.

There is no management in my company that is not medically assosicated, no one in management that is not wanting EMS to suceed nor do we have to justify any employee or equipment in competition for another division.

It's 2009. Let's let the fire service do what they are supposed to do. They are trained for fire suppression, rescue, hazardous materials, and so forth. Why should we want them to wear an additional hat? It is as cheap to do it the right way.

Look at Austin Travis County and other sucessful EMS. I know of EMS now offering to manage Fire Services at a major cost reduction and better response. You suddenly see local unions and Fire Services remain quiet.
R/r 911

 

[EMTinNEPA]

EVERY patient deserves an ALS assesment. When your third service can fund itself, not overcharge the patients, and provide a paramedic on every call then I'll conceed that you have the better system.

No such thing as "overcharging". If anything charging the patients for services is a deterrent for system abuse. And my service CAN provide a paramedic on every call. It's county that decides whether to send a paramedic or not.

 

[boingo]

http://www.ncbi.nlm.nih.gov/pubmed/18584496

Systems oversaturated with paramedics, (think LA) perform poorly when compared to systems with fewer paramedics, reserved for higher acuity calls. The falacy of fire based EMS being the be all, end all of EMS delivery because they can promise a medic on every fire truck is just that, a falacy. Rapid, BLS response with AED and early CPR makes a huge difference, more paramedics do not.

 

[VentMedic]

I believe Fire Service EMS will be on the way out. Only one of the advantages of the economic crisis.

Sorry, I have only seen a few Fire Services that ever offered EMS that ever took patient care services seriously. The majority is for keeping the tax revenue and justification of FTE and equipment costs.

I find it ironic, that both of you would be supporting Fire Service EMS when both agree that medic mill programs (that Fire Service promotes) is detrimental to EMS.

Yes, I am very much against medic mills as I have seen what it has done to EMS in my state. I also know that is not how the FDs initially started out. If it had been, I probably wouldn't have wasted two years getting a degree in EMS in the 70s to get hired by the FD. And yes, I do know how difficult it is to be torn between two totally different professions. But then, you also have quite a few on this forum who want EMS to be involved in the responsibilites of LEOs also. I honestly don't believe there are that many in EMS who know what they want. This, again, goes back to education or lack of and ease of entry.

boingo

Systems oversaturated with paramedics, (think LA) perform poorly when compared to systems with fewer paramedics, reserved for higher acuity calls. The falacy of fire based EMS being the be all, end all of EMS delivery because they can promise a medic on every fire truck is just that, a falacy. Rapid, BLS response with AED and early CPR makes a huge difference, more paramedics do not.

For LA, you have to look at the entire state of California. See the posts JP and I have been exchanging as well as the links.

Someday it would be nice to do away with the ALS and BLS labels. Those that continue to promote these terms do not do justice to advancing EMS to provide a higher level of service to all the citizens.

I am very surprised at both of you for wanting "BLS" services instead of wanting to provide a higher level of medicine. What you fail to see is once an area becomes accustomed to "ALS" service, the people will expect it. Whatever flaws in a system can get ironed out eventually once standards are raised. If the Paramedic ever gets to a two year degree for entry, many FDs may decide it is no longer feasible to do EMS. However, do you think the people will want a volunteer BLS system instead? Doubtful. Thus, the FDs have at least paved the way for continued "ALS" regardless of who provides it. Speak out for education and let the chips fall where they may. Don't advocate BLS only services for a state that can provide all "ALS". What type of mixed messages are you sending people? Why "ALS" when "BLS" is all you need? With the inconsistency amongst those in EMS, how can we expect people to put their support fully behind any type of EMS?

I don't like the way quite a few FDs (and some counties or privates) do EMS but I do like having the tax statutes in place with the support of the public that provides for ALS until better options are in place.

 

[EMTinNEPA]

Methinks you're missing the point, VentMedic. We are not advocating doing away with ALS. We are saying that ALS should be provided by private services. Have a paramedic on every ambulance.

 

[VentMedic]

Methinks you're missing the point, VentMedic. We are not advocating doing away with ALS. We are saying that ALS should be provided by private services. Have a paramedic on every ambulance.

Then why haven't the private services stepped up to fight for higher education and a larger piece of taxation? Many are in the same boat with the FDs when it comes to medic mills since many ambulance companies also mill their own. You also already stated in your area it is a hit or miss system for when a Paramedic goes to a call.

Even in parts of CA, the state opened up some counties to allow private services to bid along with the FDs. How many do you think actually have? Most know where their revenue can be made and there is an endless supply of EMT-Bs to help them accomplish that. Many also know the responsibilites of a mandated response time. It is a huge order to carry out. If it was as easy as you say, why do we still have volunteer systems even in cities? Why do the citizens go along with it? Many do because of the messages those volunteers and BLS providers dish out. At least our FDs have gotten the message out about paid ALS even if the system is sometimes flawed. It is when they cross the lines of greed and unrealistic benefits that support diminishes for FDs.

 

[EMTinNEPA]

You still have volunteer systems because amateurs won't give up their favorite hobbie.

The hit or miss is nothing to do with the service, but with county and their protocols. We could easily have a paramedic on every call.

 

[boingo]

I'm not for a BLS only system. I am for a medically based system providing a tiered response. I whole heartedly agree with increasing educational requirements. The current paramedic should be the entry level responder (ambulance) with a smaller number of higher educated providers to respond to higher acuity calls. Think Canada.

 

[VentMedic]

I'm not for a BLS only system. I am for a medically based system providing a tiered response. I whole heartedly agree with increasing educational requirements. The current paramedic should be the entry level responder (ambulance) with a smaller number of higher educated providers to respond to higher acuity calls. Think Canada.

Florida also only has two levels, the EMT and the Paramedic. It doesn't have all the 3 hour extra "cert" levels as recognized by other states. I believe WA and a few other states have over 7 different levels all based on skills.

While I do disagree that all FFs should be Paramedics, they did raise the entry from EMT-B to Paramedic. Granted, it would be nice if Florida's Paramedic program was more than 700 hours to make it more of a challenge to obtain. As I stated before, it used to take a degree to make Paramedic in a good FD. Once the education standards are raised, it will be the survival of the fittest and who or which service is willing to put forth the effort. However, the ALS service as a standard for the citizens of Florida has been established with the expectation of a Paramedic if needed.

 

[boingo]

If needed for what? A not too long ago study suggested a 25% unrecognized esophageal intubation rate in the Orlando area, an oversaturation of medics competing for skills was one of the items identified as part of the problem. If you have 100 tubes, it is better to split them among 10 medics than to give 1 to 100. If you want to argue for the FD model, look to Seattle. They don't staff ALS engine companies, utilize BLS transport for non acute patients and have a small number of well educated (trained?) medics. Now, look at cities with all ALS fire based EMS. There survival rates are piss poor, despite good response times. While cardiac arrest survival probably isn't the best indicator of quality EMS services, it is a glaring anomaly when compared to services that don't provide ALS only service.

 

[VentMedic]

If needed for what? A not too long ago study suggested a 25% unrecognized esophageal intubation rate in the Orlando area, an oversaturation of medics competing for skills was one of the items identified as part of the problem. If you have 100 tubes, it is better to split them among 10 medics than to give 1 to 100. If you want to argue for the FD model, look to Seattle. They don't staff ALS engine companies, utilize BLS transport for non acute patients and have a small number of well educated (trained?) medics. Now, look at cities withall ALS fire based EMS. There survival rates are piss poor, despite good response times. While cardiac arrest survival probably isn't the best indicator of quality EMS services, it is a glaring anomaly when compared to services that don't provide ALS only service.

Did I not list Medic One in Seattle earlier?

Blanket statements discredit any validity in your post.

I didn't say the way some of the FDs do things are always correct. However, I do believe that the citizens of a state should have the benefit of an ALS provider. I do not believe in sending a BLS unit first to have a looksy with a "BLS" assessment and then call for an ALS truck to meet somewhere down the road.

And here's a news flash for you. The Paramedics on the engines can also do "BLS" without "ALS". Imagine that! A Paramedic that can actually do CPR and place an AED. You don't have to be only an EMT-B to do these "skills". Many of the FDs do recognize they have alot of patch only Paramedics which is why some work the engines and some work the ambulances. The better services will allow those with no desire to be Paramedics to be professional FFs. It is absurd to think you can keep 1000+ Paramedics current in skills. I have no disagreement about "skills" competency for that many Paramedics.

I am one of the most outspoken against FDs like Memphis that petitioned the state of TN to allow the Paramedic education to happen outside of the colleges and accredited schools. Their sole purpose is to mill as many Paramedics as quickly as possible to get on the streets. That is a step backward. But it is also a step backward to tell a state that they shouldn't be offering ALS service to their citizens because BLS will suffice and they can call a Paramedic to meet up on the interstate later if an EMT-B by their BLS assessment believes it is warranted.

BTW, I also posted the stats for Orlando but that again is from a FD that was milling their own. I posted it because I am against medic mills which means that also includes a lot of private ambulance services that provide ALS.

Again, argue for higher education standards and let that determine how many good paramedics are left. Don't reduce services to BLS with a "will call" type to waste time.

There is also something to be said when so many "so called dedicated EMS only providers" preach a big line against the FDs but few have become Paramedics themselves and some have little or no desire to become one. Yet, the Paramedic program appears to be so easy anyone who wants to be a FF can pass it regardless of any medical ambitions. Does anyone not see a problem in this? If you want to provide good medical care you too should have the ambition to raise your cert level and education especially if you are EMS only.

 

[boingo]

I think we are 99% in agreement on this. I don't believe in the ALS intercept if needed crap either. I don't agree with ALS engine companies or all ALS ambulances in high call volume areas. The data is out there. More does not equal better. How many medics are enough? That is debatable.
http://www.cmemsc.org/doc/Insights-TooManyParamedics.pdf

http://www.usatoday.com/news/health/2006-05-21-paramedics_x.htm

As far as the Orlando intubation data, I'm sure the medic mill zero to hero programs are part of the problem, however the "skill" of passing a tube into the trachea v.s. esophagus is a practice makes perfect activity. The educational aspect aside, when it comes down to it, its placing a tube in a tube. With too many medics and not enough experience, one can't be expected to be proficient. You can spend 4 years in school and still be terrible at intubating if you only do one a year.

 

[Ridryder911]

You can spend 4 years in school and still be terrible at intubating if you only do one a year.

I totally agree, but we still allow physicians to do such.

R/r 911

 

[boingo]

True, and we shouldn't. If you are a GP in a clinic, and haven't intubated in 10 years, you should be using a basic adjunct or supraglottic airway until someone skilled in intubation shows up. Inexperienced Doctors screwing around with a scope and et tube are just as dangerous as inexperienced paramedics.

 

[VentMedic]

At least the original poster will be aware of the issues of being a FF and a Paramedic if he decides to become both.

boingo

True, and we shouldn't. If you are a GP in a clinic, and haven't intubated in 10 years, you should be using a basic adjunct or supraglottic airway until someone skilled in intubation shows up. Inexperienced Doctors screwing around with a scope and et tube are just as dangerous as inexperienced paramedics.

Our doctors must have all of their advanced skills approved by a Critical Care Medicine doctor, Intensivist or the medical director for the unit who are usually also Pulmonologists (or Neonatologists - NICU) before they can put them to use. This also includes the ED physicians.

 

[reaper]

We need to look at some things. Third Service EMS is not Private. It is an EMS service that is run by County Government.

I am against Private run EMS, the same as I am against FD run EMS.

The state of FL has done a great job of providing ALS response, in the entire state. Does not matter how poor the county is, they have ALS response. There are some great ALS third service EMS systems in FL. They provide EMS the way it should be provided. They are tax based, just like FD.

Yes, the medic mills are a product of the Fire/Rescue systems. Central and South FL are loaded with Fire/Rescue services and where are all your medic mills? North FL and the Panhandle Still remain Third service EMS. There are no medic mills in the entire area. Paramedic and EMT classes are all provided by colleges. Everyone does offer a degree, but it is not yet mandatory. The only medic mill in the North FL area is in Jax and that is because they are Fire/rescue. So, yes they are the reason for medic mills.

I think FL is one state that is way ahead of the game in EMS. The advancement in EMS that the state provides is top notch. The state has pushed to standardize alot in EMS, statewide. I have worked in EMS for 20 years and I have never had to work for a FD, just to provide EMS. I was a FF in my younger years. I have nothing but respect for FF's for what they do, When it comes to Fighting fires! EMS should be left as a stand alone service for those that truly want to provide medical care.

 

[Ridryder911]

At least the original poster will be aware of the issues of being a FF and a Paramedic if he decides to become both.

boingo
Our doctors must have all of their advanced skills approved by a Critical Care Medicine doctor, Intensivist or the medical director for the unit who are usually also Pulmonologists (or Neonatologists - NICU) before they can put them to use. This also includes the ED physicians.

That would be nice if it was mandated or at least investigated from AMA. I doubt we will ever see that though. We don't even have Critical Care Internist except at the teaching hospitals and I can list the total number of Board Certified Pulmonologist within the whole state.

Unfortunately, it is those same GP and pseudo ER Doc's that maybe EMS Medical Directors and read such studies of poor intubation rates. The same ones that themselves have not intubated for a decade but will still acclaim to be proficient.

I am glad to read that not all of Florida has medic mills as I presumed. I had the same opinion of LA until I recently met one of the clinical professors for UCLA and LA Co. Paramedic. They have to go through an intense intubation rotation clinicals and up-date to maintain their skill levels.

I do wish the National EMS Educators would develop program listings per state and their requirements. Facts and not myths.

 

[VentMedic]

I am glad to read that not all of Florida has medic mills as I presumed. I

I have mentioned at least a hundred times on these forums that Florida was one of the first states to have the degree program for EMS in the 1970s and almost every community college in Florida has a degree program. I, myself, have mentioned many times getting a degree as a Paramedic way back in 1979 and there were already several classes that had graduated before me. Many of those became Fire Paramedics since that was about the only option in Florida at that time besides a few BLS volunteer services. Back then, a degree was necessary to be a Paramedic with a good FD.

http://www.doh.state.fl.us/demo/ems/TrainTest/FloridaApprovedTrainingPrograms10-2008.pdf


Medic mills are open to anyone. AMR has its own chain of medic mills. The FDs are not the only ones that use them. I am against both private and FD owned/sponsored medic mills.

That would be nice if it was mandated or at least investigated from AMA. I doubt we will ever see that though. We don't even have Critical Care Internist except at the teaching hospitals and I can list the total number of Board Certified Pulmonologist within the whole state.

That explains alot of things about your state especially with the comments you have made about RRTs. If your hospitals do not provide much for critical care services, there is little need for those that specialize in critical care medicine. I just hate to think your hospitals allow GPs to manage ventilators and sick intensive care patients. That is more backward then saying a FD can not do EMS. There should be some expectation of a higher level of care offered at a hospital that has an ICU. Having a GP manage critical care patients is like having an EMT-B do an IABP and medicated drips on CCT without an RN or Paramedic.

 

[Ridryder911]

I have mentioned at least a hundred times on these forums that Florida was one of the first states to have the degree program for EMS in the 1970s and almost every community college in Florida has a degree program. I, myself, have mentioned many times getting a degree as a Paramedic way back in 1979 and there were already several classes that had graduated before me. Many of those became Fire Paramedics since that was about the only option in Florida at that time besides a few BLS volunteer services. Back then, a degree was necessary to be a Paramedic with a good FD.

http://www.doh.state.fl.us/demo/ems/TrainTest/FloridaApprovedTrainingPrograms10-2008.pdf


Medic mills are open to anyone. AMR has its own chain of medic mills. The FDs are not the only ones that use them. I am against both private and FD owned/sponsored medic mills.



That explains alot of things about your state especially with the comments you have made about RRTs. If your hospitals do not provide much for critical care services, there is little need for those that specialize in critical care medicine. I just hate to think your hospitals allow GPs to manage ventilators and sick intensive care patients. That is more backward then saying a FD can not do EMS. There should be some expectation of a higher level of care offered at a hospital that has an ICU. Having a GP manage critical care patients is like having an EMT-B do an IABP and medicated drips on CCT without an RN or Paramedic.

I was not where you obtained your Paramedic either in Florida or California.

As well, many others need to recognize it is not the norm of health care to have such specialities. When comparing state to state it is only the highly populated areas that usually offer such specialities. Yes, I have internists but they will be the first to inform you that they rather not care for such patients and send them to another area so they can be cared for. I can personally count on both hands that have Intensive Services in house in my whole state. I could probably could count as well at least four surrounding states in the same predicament.

Not all areas can afford the luxury of having such specialist. Do they wish to have them? Sure but I know of areas that are elated to even have a P.A. Also realize there are areas that rely upon FNP and P.A.'s to staff ER's and cover ICU's for staff. Is it the best? No. Would I love to change it.. you bet! Will it change within the next decade? No.

Ironically, I have found some true GP's better at intensive care over family practice and even internists whom assume they know but have not taken care of a serious ill patient for years.

While discussing this situation, one of our oldest and most respected Speciality Flight Teams was abruptly informed last week they had only two weeks left in their position. Some had been on such speciality team such neonate, etc. for over 28 years; now will be either placed back into the hospital or they can apply hoping they can be rehired by the new company overtaking them.

I believe we will see more and more of this occurring as costs are reviewed more and more. Private companies that can offer to perform the same service and the hospital will still receive the patient no matter who brings it. Why not save the money? Not that I always agree but money is money...

R/r 911

 

[VentMedic]

Not all areas can afford the luxury of having such specialist. Do they wish to have them? Sure but I know of areas that are elated to even have a P.A. Also realize there are areas that rely upon FNP and P.A.'s to staff ER's and cover ICU's for staff. Is it the best? No. Would I love to change it.. you bet! Will it change within the next decade? No.

I can see why you have very few RRTs in your state since their medical director must be a Pulmonologist or a Cardiologist if their department is Cardiopulmonary. Few self respecting therapists would work under such conditions. I can't imagine any of the other professionals such as radiology, lab or PT working under the license of a GP either. I can't imagine that even being legal. I take it your RNs are also very limited without having a critical care doctor of some type to authorize their protocols. Nursing practice covers only so far.

EMTALA also specifies when an NP or PA will not always do and when a Specialist or some doctor must be involved. How do these hospitals get around that?

Speciality Flight Teams was abruptly informed last week they had only two weeks left in their position. Some had been on such speciality team such neonate, etc.

If I remember correctly your state only has one dedicated neonatal Specialty team. The other team that considers itself a "specialty" team is a jack of all trades that also does neonatal along with everything else probably should not be transporting sick babies allow those who are dedicated to NICU do the transport.

It seems like your state has a lot of issues which are bigger than Florida's FDs providing EMS. Florida's hospitals may not all be perfect but at least we do manage to provide dedicated specialty teams and hospitals for sick babies and kids.

Guess I don't have to be reminded twice to scratch Oklahoma off my list of places to travel.