Which SHOULD come first FIRE or EMS?

[slawson]

Been a while since I have posted. I have been kinda out of ems for a while then got back in - worked for a jacked up private service - yada yada. But my interest level is coming back (thankfully).

I have been debating this for a while locally here and want everyones opinion.

Let me set the scene. Our fire district is diverse. We have a US highway, and dirt roads with steep cliffs and hairpin turns. Our dispatch comes through the local state police post. (We don't have a "county dispatch" per se`). I have worked there as a dispatcher before and let's just say things always don't go as they should. But the accepted protocol is to dispatch the private ambulance service to the scene of an accident BEFORE sending your local fire departments. In our district, EMS is around 15-20 minutes out. Our FD response time is on average 5(ish).

In one instance, I heard EMS clearing en route to an accident in our area BEFORE we were even notified. This means the call had to come in to dispatch, the dispatcher get the information, 911 dispatcher hang up with the caller, pick up the phone, call the ems service dispatcher, give them the information, the ems service dispatcher picks up the phone and calls the closest ems station, gives the crew the information, the crew gets out of the station into the unit and gets on their way and then keys up the radio and says they are all in route. ALL of this happens THEN we were notified to go to the call.

My point is this. Fire departments have the ability to effect the outcome of the scene more than any other agency. As ems, we can't do anything if the car is on fire, victim trapped. If fire is not an ems agency (such as our case), the least they can do is stabilize the scene, remove any obvious hazards and prevent other accidents.

The extra time it takes to notify the ems agency, is the amount of time you are delaying the first agency to be on scene. And in my opinion anything you can do to delay the first agency arriving on scene is a wrong decision.

If you guys don't care, let me know what you think and give me some examples.

THANKS!!!

Sean
EMT-B
AHA CPR Instructor
Firefighter I

 

[medic417]

If people are hurt they need medical professionals more than they need firefighters. I think you send the medical first and support people second. Or if you really want to waste tax dollars automatically dispatch both at same time for all calls.

 

[slawson]

2 Questions....

Do you think that only EMS should go to accident scenes?

It seems that you may think that way from the comment below.

Or if you really want to waste tax dollars automatically dispatch both at same time for all calls.

Do you think that fire should be dispatched second (if at all) even though they are closer to the scene and can have it secured (and safe) prior to EMS arrival?

Thanks for your reply!

 

[JPINFV]

If you can't provide transport, then yes, the ambulance should be notified first unless rescue or fire suppression is needed.

 

[medicdan]

I think the important factor here is arrival times... if it takes the ambulance, on average 15 minutes to arrive, compated to ~5 for fire, they should certainly be rolling first. Train you FFs as CFRs or EMTs, and throw some BLS equipment onto the engine and you are good (in Boston we are always happy to arrive on scene to find the patient already boarded by fire!).

 

[slawson]

If you can't provide transport, then yes, the ambulance should be notified first unless rescue or fire suppression is needed.

Interesting.

The way I thought about is this..

If an accident happens a couple hundred feet from a fire station, why would you not notify the FD to stabilize the scene/pt first. Given, we are only speaking of 2-3 minutes of difference between each, but to me it seems logical to get an agency on scene (regardless of role really) as soon as possible. Without anyone on scene so many hazards exist that put the pt as well as other motorists in harms way??

We all know Joe Citizen can't tell if a rescue situation or fire suppression is truly needed. Sometimes we get good info, but would we want to judge it by that?

I am NOT trying to sway anyone my way here - I just want to look at all angles.

THANKS FOR THE REPLIES!

 

[slawson]

I think the important factor here is arrival times... if it takes the ambulance, on average 15 minutes to arrive, compated to ~5 for fire, they should certainly be rolling first. Train you FFs as CFRs or EMTs, and throw some BLS equipment onto the engine and you are good (in Boston we are always happy to arrive on scene to find the patient already boarded by fire!).

Just to clear it up - you think if fire can get there sooner - roll fire first or did I just selectively interpret that? haha

Thanks...

 

[Flight-LP]

Been a while since I have posted. I have been kinda out of ems for a while then got back in - worked for a jacked up private service - yada yada. But my interest level is coming back (thankfully).

I have been debating this for a while locally here and want everyones opinion.

Let me set the scene. Our fire district is diverse. We have a US highway, and dirt roads with steep cliffs and hairpin turns. Our dispatch comes through the local state police post. (We don't have a "county dispatch" per se`). I have worked there as a dispatcher before and let's just say things always don't go as they should. But the accepted protocol is to dispatch the private ambulance service to the scene of an accident BEFORE sending your local fire departments. In our district, EMS is around 15-20 minutes out. Our FD response time is on average 5(ish).

In one instance, I heard EMS clearing en route to an accident in our area BEFORE we were even notified. This means the call had to come in to dispatch, the dispatcher get the information, 911 dispatcher hang up with the caller, pick up the phone, call the ems service dispatcher, give them the information, the ems service dispatcher picks up the phone and calls the closest ems station, gives the crew the information, the crew gets out of the station into the unit and gets on their way and then keys up the radio and says they are all in route. ALL of this happens THEN we were notified to go to the call.

My point is this. Fire departments have the ability to effect the outcome of the scene more than any other agency. As ems, we can't do anything if the car is on fire, victim trapped. If fire is not an ems agency (such as our case), the least they can do is stabilize the scene, remove any obvious hazards and prevent other accidents.

The extra time it takes to notify the ems agency, is the amount of time you are delaying the first agency to be on scene. And in my opinion anything you can do to delay the first agency arriving on scene is a wrong decision.

If you guys don't care, let me know what you think and give me some examples.

THANKS!!!

Sean
EMT-B
AHA CPR Instructor
Firefighter I

If the vehicle is not on fire, does not have individuals entrapped, does not have hazardous fluids on the ground, nor requires manpower for large individuals, then a fire response is not needed. You are dead wrong in your belief that fire is the almighty that saves the scene. I have worked thousands of MVA's and very few required the FD. Your dispatch is correct in sending EMS first, after all, they are the medical professionals who will directly intervene in the pts. life. Assistance is always appreciated, but immediate needs should be dispatched first. EMS for the pt., Police for scene control, wreckers to clear the scene, and then maybe the FD. Sorry, if none of the above are required, then you are at the bottom of the totem pole..................................

 

[JPINFV]

I say transport because the vast majority of time critical (if the patient isn't time critical, then does it matter the order that response agencies get notified?) patients can not be helped prehospitally. Oxygen and c-spine isn't nearly as important in a patient with critical internal injuries as prompt transport to a trauma surgeon.

 

[medic417]

2 Questions....

Do you think that only EMS should go to accident scenes?

No. Fire should go so if there is entrapment or even the extremely rare fire they can assist. If not needed they can do traffic control.

It seems that you may think that way from the comment below.


Do you think that fire should be dispatched second (if at all) even though they are closer to the scene and can have it secured (and safe) prior to EMS arrival?

Yes fire should be dispatched second because medical professionals are needed. Fire based on your numbers will still get there first. So they can still have some fun prior to the medical professionals arrival. You are only talking 30-60 second delay for fire dispatch after EMS anyway. And again why not have it set up for EMS/Fire both to be toned same time when it is a crash.

Thanks for your reply!

Your Welcome!

Comments in Line

 

[slawson]

If the vehicle is not on fire, does not have individuals entrapped, does not have hazardous fluids on the ground, nor requires manpower for large individuals, then a fire response is not needed. You are dead wrong in your belief that fire is the almighty that saves the scene. I have worked thousands of MVA's and very few required the FD. Your dispatch is correct in sending EMS first, after all, they are the medical professionals who will directly intervene in the pts. life. Assistance is always appreciated, but immediate needs should be dispatched first. EMS for the pt., Police for scene control, wreckers to clear the scene, and then maybe the FD. Sorry, if none of the above are required, then you are at the bottom of the totem pole..................................

Don't get me wrong - in NO WAY do I think that fire is an almighty scene saver - I am an EMT too - I have been there where FD is useless - just trying to get everyone's opinion.

Here thought FD does traffic control, police do reports! haha

 

[slawson]

Comments in Line

Very good response. I am beginning to think I am wrong on this one guys!

 

[KEVD18]

when you're cooking a large meal with different types of food, you want them all to be done at the same time so everything arrives at the table while its still hot. so you start the things that are going to take the longest to cook first, then the nexty longest etc.

95% of the time, fd is wasted on ems runs. flight pretty much nailed it in his post.

 

[FireResuce48]

I like having the engines and or ladders on scenes of a wreck. It's nice to have some barrier protection and it's always nice to have some extra hands especially when you know those extra hands know what they are doing.

 

[JPINFV]

Extra hands who knows what they're doing? Strange how the only time I've heard the term "cosmetic backboard" was from a firemedic.

 

[EMTWintz]

I dont think this was said but in my town both fire and rescue are vollie. We have several FF who are First Responders. But def. if there is a wreck you may like having FF there to run traffic

 

[TransportJockey]

EMS first. Police can run traffic around the scene. Unless the pt needs extrication or the car is on fire, keep FD away

 

[41 Duck]

We don't have a choice, here. FD is always dispatched with us for MVAs--sadly, we can't even cancel them. 90% of the time, they're not needed and are merely in my way.


Later!

--Coop

 

[firecoins]

I think tow trucks should come first.

 

[rmellish]

Its all situational. At the rural county service I run with Fire is only dispatched when there is a possible hazmat, 10-50, or fire in the city. EMD also dispatches them as manpower for known or suspected cardiac arrests. Police are dispatched for "Life Alert" tags in case forcible entry needs to be made into a residence.

In the outlying county vollie FD is dispatched as first response due to longer response times.

Ideally the decision to dispatch fire should be made on a case by case basis. EMS should be notified first on EMS calls.