What is your EMS system?

[EpiEMS]

Well, should EMS be doing (or leading, at least) rescue, or fire? I think that's an open question, no?

 

[Shishkabob]

Well, should EMS be doing (or leading, at least) rescue, or fire? I think that's an open question, no?

Most certainly EMS should be doing AND leading rescue, as rescue is a patient centered activity.


However, you'll find FDs fight tooth and nail to keep their grasp on it to justify their budget.

 

[rescue1]

I think we had a thread on who should lead rescue a few months ago, if you search for it.

The general consensus was that no-one could agree on who should<_<

 

[downunderwunda]

Here's an interesting article about Firefighters performing EMS work in NSW here:

http://www.smh.com.au/national/health/firies-say-they-cant-step-in-for-medics-20130130-2dl2t.html

FIREFIGHTERS will be asked to step in for busy ambulance officers in Sydney and major regional areas under NSW government plans to meet growing patient demand.

The Australian Medical Association and the union representing fire brigade officers are concerned the proposal will compromise patient safety.

Read more: http://www.smh.com.au/national/heal...-for-medics-20130130-2dl2t.html#ixzz2JVat4ai9

I think there are a few pointers here that need to be considered as well. This is a proposal & the most significant statment in this entire article is

''Given the O'Farrell government is already closing fire stations and refusing to replace firefighters, this policy will force firefighters to do more with fewer resources and will do nothing to improve [ambulance] response times.''

&

Darin Sullivan, the NSW president of the Fire Brigade Employees Union, said firefighters should be paid for any extra work and the issue was likely to provoke industrial action.

''It looks like firefighters will be forced to take on a role as first responder to support the ambulance service for the first time in NSW,'' he said. ''But with the O'Farrell government's wages policy, it is outside government policy for public sector workers to claim extra pay based on extra work performed. This will be a major reform requiring a formal increase in skills and training.''

The NSW Opposition Leader, John Robertson, described the proposal as ''cost-cutting madness''. ''Instead of hiring extra paramedics and putting more ambulances on the road to meet rising demand, the O'Farrell government is trying to replace them with firefighters who are already being hit with major budget cuts of their own,'' he said.

This isnt policy yet & I doubt it will get up.

 

[EpiEMS]

I think there are a few pointers here that need to be considered as well.

One of the quotes suggests some indignant firefighters don't want to be first responders to incidents to support EMS...so, what exactly do they want to do when they're not fighting fires? That is -- are they fighting so many fires that they don't have a couple hours to support EMS?

Most certainly EMS should be doing AND leading rescue, as rescue is a patient centered activity.

However, you'll find FDs fight tooth and nail to keep their grasp on it to justify their budget.

I'll take a look for the thread. I tend to see that as the most reasonable tack.

 

[downunderwunda]

One of the quotes suggests some indignant firefighters don't want to be first responders to incidents to support EMS...so, what exactly do they want to do when they're not fighting fires? That is -- are they fighting so many fires that they don't have a couple hours to support EMS?



I'll take a look for the thread. I tend to see that as the most reasonable tack.

Who kows, I have stated before we are seperate professions. We should be kept that way. it is not a reasonable tack. The NSWFB have a track record of taking other peoples jobs to justify their existance. The simple fact that they are opposed to it as well shows it is a bad idea that should be canned.

 

[the_negro_puppy]

They never beat us to a cardiac call in NSW. Why? They simply are not called. Rescue went to fire because we had a spineless CEO who wanted it gone.

Just a question puppy, who started rescue in NSW???

Hey mate sorry don't know much about NSW other than that they have Police Rescue as well?

Police and Fire are never sent to any medical calls unless rescue or restraint needed. They only do CPR for example when they beat us to an MVA / RTC involving a cardiac arrest, or police first on scene in a shopping mall etc

 

[downunderwunda]

Hey mate sorry don't know much about NSW other than that they have Police Rescue as well?

Police and Fire are never sent to any medical calls unless rescue or restraint needed. They only do CPR for example when they beat us to an MVA / RTC involving a cardiac arrest, or police first on scene in a shopping mall etc

Rescue was started by ASNSW.

Heres a thought. They say that Fire is underworked & can therefore help Ambulance, wouldnt it make more sense to REDUCE the number of BRT's (Big Red Trucks) & the number of Hose monkeys & INCREASE Paramedic resourses in the state, in line with workload of course.

 

[Wheel]

Rescue was started by ASNSW.

Heres a thought. They say that Fire is underworked & can therefore help Ambulance, wouldnt it make more sense to REDUCE the number of BRT's (Big Red Trucks) & the number of Hose monkeys & INCREASE Paramedic resourses in the state, in line with workload of course.

Seems reasonable, but in the US the fire union would have a fit.

 

[rescue1]

In fire's defense, structure fires--rare as they are these days, are much more time sensitive than medical calls.

That being said, there are definitely systems that have a clear budget imbalance. Doesn't Providence, RI have 14 engine companies and...6 ambulances? With a good 70/30 split of EMS/Fire calls.

 

[EpiEMS]

In fire's defense, structure fires--rare as they are these days, are much more time sensitive than medical calls.

That being said, there are definitely systems that have a clear budget imbalance. Doesn't Providence, RI have 14 engine companies and...6 ambulances? With a good 70/30 split of EMS/Fire calls.

Along those lines, you can safely work a serious EMS call with 2 or so people. Can't safely run a structure fire (even just pulling people out) with even 4 folks, no?

 

[rescue1]

I think the NFPA recommends 17 FFs for a residential fire. But yeah, more then 4.

I'm a firm believer in compromise and balance when it comes to fire/EMS budgeting. I don't like to see either side get shafted, I'd just like both sides to be effective.

 

[downunderwunda]

In fire's defense, structure fires--rare as they are these days, are much more time sensitive than medical calls.QUOTE]

This is one of the greatest misnomas out there. Fire is NOT time critical. Fire services & their cheifs want people to believe it. The simple reality is if a structure catches fire, it is ruined by

1. fire
2. smoke
3. water

there is very little salvageable regardless of the propoganda we are fed. The only time it is time critical is where people are unable to get out of the structure & fire regulations now are at a point where this is becoming less of a factor.

 

[STXmedic]

This is one of the greatest misnomas out there. Fire is NOT time critical. Fire services & their cheifs want people to believe it. The simple reality is if a structure catches fire, it is ruined by

1. fire
2. smoke
3. water

there is very little salvageable regardless of the propoganda we are fed. The only time it is time critical is where people are unable to get out of the structure & fire regulations now are at a point where this is becoming less of a factor.

Umm... Seriously? I've made quite a few fires in my time as a firefighter. In that time, I've contained fire to single rooms of a house, single complexes of apartment buildings, salvaged an incredible amount of belongings and kept houses/apartments tenable for the residents (if not immediately, after some renovation). Just because there is smoke on the walls and water on the carpet does not mean that we may as well have taken our time and let the structure burn to the ground. Am I biased because I am a firefighter? Sure. However, the ignorance of your stance is glaring. Fire in or on house =/= complete loss of people, belongings, and property.

 

[STXmedic]

Double post.

 

[DrParasite]

I think the NFPA recommends 17 FFs for a residential fire. But yeah, more then 4.

yes, but the most critical are the first due engine and first due truck. If they get there when it's small and knock it down, than it doesn't matter if the other apparatus come from farther away (or are requested using mutual aid, coming from another town, etc). and if it's too big that they can't handle it with the first due engine and truck, and it's probably big enough where a couple minutes aren't going to make a big difference.

If you want to go by the numbers, you should have as many ambulances as you have engine companies in a given area. than take the ratio of EMS to fire calls (in the example of Providence RI 70:30) and apply that to the ambulance engine ratio. Using this method, you would need 30 ambulances to properly cover the call volume, which means the ambulances would handle EMS calls and the FD would no longer need to go on first responder calls to "stop the clock."

I will also say, the majority of fire calls aren't structure fires, so using them as justification for anything is similar to ems using response time to cardiac arrests as setting the standard for response times. After all, if you can't breath, how long can you brain go without oxygen? and if it takes the ambulance longer to arrive, than people will die, and the EMS system has failed. after all, that's pretty much what the FD's argument is correct?

 

[rescue1]

yes, but the most critical are the first due engine and first due truck. If they get there when it's small and knock it down, than it doesn't matter if the other apparatus come from farther away (or are requested using mutual aid, coming from another town, etc). and if it's too big that they can't handle it with the first due engine and truck, and it's probably big enough where a couple minutes aren't going to make a big difference.

This I agree with. Of course, the issue there is if you have enough engine companies sprinkled around the city to meet a reasonable response standpoint, you end up with a lot of fire apparatus anyway, so it ends up working out to about the same as a deployment model meant to get the 15-20 FFs on scene for a structural fire.

 

[Handsome Robb]

Privately owned company operating under a Public Utility Model.

911 and IFT, only transport agency in the county except for one small town that's pretty isolated, geographically, from the rest of the county.

All ambulances are ALS. Paramedic/Intermediate is the standard crew but there's usually at least one Medic/Medic car roaming around.

Fire is ILS except in outlying valleys, then they are ALS, usually. Trying to get all the outliers ALS with their new round of hiring this month.

4x12s or 3x16s.

System status management with a few (read: 4) "hard posts".

Anywhere from 7, yes I said 7 ambulances all the way up to ~20 during the day/peak hours. ~ 75,000 calls per year. Covering ~6,000 square miles (lots of which is just open desert) with the help of a teeny tiny volly agency and the aforementioned FD. We do provide mutual aid as well.

We also have a HEMS service under our P.U.M. umbrella company. CCP + CCRN staffing for them.

We also do all medical standbys for special events, SAR, TEMS, have our hand in ALS ski patrol and have a well respected education center. Also starting a Community Paramedicine program this year.

 

[Shishkabob]

I think the NFPA recommends 17 FFs for a residential fire. But yeah, more then 4.

The thing is, despite the "science", it's still done by a biased organization and people still need to look at it with a skeptical eye.