Which SHOULD come first FIRE or EMS?

[JPINFV]

I also don't see why allot of people are so against fire medics

Example on why having fire medics is plain idiotic:

Boston EMS has taught its 62 paramedics to interpret an ECG "manually"; and in a study, they performed as well as a "blinded" emergency physician and a cardiologist who reviewed their prehospital ECG readings (Feldman JA, Brinsfield K, Bernard S, et al: "Real-time paramedic compared with blinded physician identification of ST-segment elevation myocardial infarction: Results of an observational study. American Journal of Emergency Medicine. 23[4]:443-448, 2005).

"But we have 2,500 paramedics [and 27 provider agencies] in L.A. County," Rokos said, "And obviously we can't train everyone to read ECGs." So Los Angeles County has paramedics rely on an automated computer ECG interpretation. "All they have to do is read ***Acute MI, and that's their ticket to go," he said.

-Paramedics Activate Cath Lab for STEMI Patients in Some Areas, EMS Insider February 2007 Vol. 25 Issue 2. http://www.jems.com/news_and_articles/articles/Paramedics_Activate_Cath_Lab_STEMI_Patients.html

Guess which system has the fire medics? Would you trust a fire fighter to have your back when going into a structure fire if you knew that the only reason he was a fire fighter was to work EMS and actively avoided anything remotely fire related?

Example 2:
Who is one of the major opponents of advancing requriments for paramedics? If you answered "the fire service," you're correct.

The IAFC EMS Section expresses concern regarding the following points in the draft education standards:

• The IAFC EMS Section would like to see substantiation on why there is an increase in training hours and how the new hour level was determined.

• While the IAFC EMS Section supports higher education and the aim of increased professionalism in EMS, it is concerned that the general move toward college-based courses, the increase in hours and resulting financial impact will adversely affect departments’ ability (especially volunteer departments) to meet the goals of the standards.

-International Association of Fire Chiefs, Re: Formal Comments on the National EMS Education Standards, Draft 1.0, http://www.iafc.org/associations/4685/files/ems_NtlEMSeduStandardsSectionComments070731.pdf

So, essentially his points are:
1. The average fire fighter is too stupid to require more hours.
2. The average fire fighter is too stupid to complete college courses.
3. The current requirement (110 hours (NHTSA, and thus NREMT, standard per National Standard Curriculum) for EMT-B and a suggested 900 or so hours for EMT-P) is enough training and education. (if you actually think that 110 hours is enough please start a thread, I'd be happy to discuss this there).

Yes, I have a problem with systems that put having more numbers and more useless trucks (hey, I bet if you had as many ambulances as fire engines that the "benefit" of having the fire department respond would go away quickly and yes, a fire engine on a medical call is about as useful as having a tow truck at a structure fire) above providing good patient care and higher standards.

 

[marineman]

This is news to me.If this is true i make a vote we stop this silly practice and go back to the days of being ambulance drivers.Wow i knew this als stuff was the devil.

Wow, maybe I was unclear in my wording so I'll say it again (read it slow if it helps). I believe ALS in the field is absolutely fantastic and the quicker we can initiate ALS the better it is for the patient. My problem lies between local protocols and engines carrying ALS equipment (it has nothing to do with fire medics that work on an ambulance). My protocols state that I must; no matter what, absolutely without fail get two (2) sets of vitals before initiating therapy to establish a baseline. And no matter what, one (1) of those sets of vitals must be done by me and me alone; no machines, no first responders, no firefighters even if they moonlight as paramedics or ER docs. If a first responder initiates O2 therapy I have to stop the O2 for 3-5 minutes, then take a set of vitals to establish my baseline (I can use the one the first responders took for my second). Therein lies the problem of the engines initiating ALS procedures; many are irreversible to get a true set of baseline vitals.

In the particular system that I work in this is not an issue because engines don't carry ALS equipment and our average response time is between 6 and 7 minutes. In a different system I think a change within the SOP would be rectified if some of those variables were changed however in my current system that is my stance that engines and ALS drugs are not a good combination.

And my stance on the original question remains the same that the ambulance does the most good for the patient so they should be first out.

 

[reaper]

Wow, maybe I was unclear in my wording so I'll say it again (read it slow if it helps). I believe ALS in the field is absolutely fantastic and the quicker we can initiate ALS the better it is for the patient. My problem lies between local protocols and engines carrying ALS equipment (it has nothing to do with fire medics that work on an ambulance). My protocols state that I must; no matter what, absolutely without fail get two (2) sets of vitals before initiating therapy to establish a baseline. And no matter what, one (1) of those sets of vitals must be done by me and me alone; no machines, no first responders, no firefighters even if they moonlight as paramedics or ER docs. If a first responder initiates O2 therapy I have to stop the O2 for 3-5 minutes, then take a set of vitals to establish my baseline (I can use the one the first responders took for my second). Therein lies the problem of the engines initiating ALS procedures; many are irreversible to get a true set of baseline vitals.

In the particular system that I work in this is not an issue because engines don't carry ALS equipment and our average response time is between 6 and 7 minutes. In a different system I think a change within the SOP would be rectified if some of those variables were changed however in my current system that is my stance that engines and ALS drugs are not a good combination.

And my stance on the original question remains the same that the ambulance does the most good for the patient so they should be first out.

You are kidding on that statement, I hope. That is the most ridiculous thing I have ever heard of. So if an asthmatic is on O2 when you arrive, you stop O2 for 3-5 minutes to determine if they really need it?

 

[JPINFV]

Just curious, Marineman, by chance are your protocols online and if so, can you post a link?

 

[triemal04]

Unfortunately, what JPINFV fails to realize (again, as usual) is that both IAFC and IAFF do not dictate policy for individual fire departments, (similar analogy here and maybe food for thought for some: http://www.emslive.com/articles/49/1/Private-v-Fire-EMS-The-Final-Word/Page1.html) and also that (another failure in understanding)all the article proves is that LA County has a lousy EMS system...duh...no arguement here. Unfortunately for him it does not show that all fire-based EMS services have issues anymore than me posting an article about disgruntled private paramedics or private paramedics making mistakes would indicate that all of them are angry or poor providers.

(this is where I once again toss out the challenge for someone to show me a third service/private/hospital based EMS system of the size of LA City or LA County that is problem free...I'm still waiting on that one from the last time I asked)

I can do a quick search and find lots of problem fire departments where EMS is concerned...funny how often the articles are usually about the same few departments. I can also do a search and find lots of private/other type services that have problems. As I said though, this doesn't prove anything about either one, except that in ANY type of service, there will be good ones, and bad ones out there. (I know, I know, sucks to admit, but there it is)

 

[JPINFV]

Triemal, how many systems openly brag about their short comings though? Similarly, this isn't LaCo Fire or City of LA Fire issue. Those treatment policies are a standard for ALL paramedic agencies in LaCo, regardless of if they are fire departments and private companies. It's an entire region (and I'll throw in Orange County's emergency medical system as well because there are tons of stupidity there too). Furthermore, pointing out mistakes on an individual level is a non-seqitor. It doesn't matter how good or bad a provider is if they are handcuffed to such a low level that they don't actually have to draw any conclusions about their patient. The machine does it for them and the system administrators are proud about it. Granted, though, most of the emergency medical responses in La Co (and all in OC) are through the fire department. This is not an individual department that's screwed up, it's an entire region. A region dominated by EMS based fire suppression.

As far as IAFC dictating policy, you're right, they don't dictate local policy. Of course the National Scope of Practice isn't a local policy either. Besides, your side stepping that one of the major problems with EMS is the abysmal, almost non-existent, education requirements that the IAFC was opposing. Honest question, how many fire departments require all of their paramedics to have an associates degree or higher education in paramedicine? I doubt many, if any at all, do.

Of course why stick with So Cal. We could always bring Collier County. You know, the place making waves because the fire medics failed a pharmacology exam forcing the medical director to reduce their role to the level of EMT-Bs. If the fire fighters truly cared about patients, they would have passed the exam. After all, they had a month to study for it. Instead they are openly protesting that the medical director is no longer allowing them to put the public at risk.

 

[triemal04]

I don't know if I'd call that bragging or not, but regardless...I suppose since those poor standards include private ambulances as well, based on your way of thinking (as your posts show) I can be safe in believing that all privates are poor providers...since there are those that can only rely on a machine to interrpret ecg's for them. Of course that'd be wrong, but oh well.

I didn't think you'd be able to see the point of the link; but to be blunt: there will be good fire department run ambulances and bad, just like every other kind. The problem you have (especially here) is that you used one example from an area that is horrible at EMS (apparently at all levels and kinds) to justify saying that ALL fire-based EMS is bad. Would have thought you'd know better. Edit: it ends up being the choice of the individual departments like it will be of the individual; do we maintain high standards, or allow them to become lax? Like with an individual: do I allow my standards to drop because my service says I can, or do I maintain them at as high a level as possible?

Poor education requirements for fire departments? How many privates require associates degrees? How many services period accept a paramedic no matter where they were trained? That's a hollow arguement there. (and every fire department in Oregon requires an associates...weird how when that's the standard it get's followed...and weird how it's possible for that to become standard even though the big bad IAFC says don't do that)

Feel free to bring up Collier (though it was only 1 department that actually failed the pharmocology exam), it still shows that you are unable to grasp this simple premise:

I can do a quick search and find lots of problem fire departments where EMS is concerned...funny how often the articles are usually about the same few departments. I can also do a search and find lots of private/other type services that have problems. As I said though, this doesn't prove anything about either one, except that in ANY type of service, there will be good ones, and bad ones out there. (I know, I know, sucks to admit, but there it is)

 

[marineman]

You are kidding on that statement, I hope. That is the most ridiculous thing I have ever heard of. So if an asthmatic is on O2 when you arrive, you stop O2 for 3-5 minutes to determine if they really need it?

Sadly there is no joke involved. I do not agree at all with it and you can take a guess at how often we follow that particular protocol but that is what it says and that is why ALS engines in my coverage area would not be beneficial.

 

[FFMedic1911]

So if the pt. is intubated you pull the tube and wait 3-5 so you can get vitals.Your protocols suck.
PS. Thanks for helping me to remember to read slow.I'am a hose jockey and as such very stupid.

 

[Flight-LP]

So if the pt. is intubated you pull the tube and wait 3-5 so you can get vitals.Your protocols suck.
PS. Thanks for helping me to remember to read slow.I'am a hose jockey and as such very stupid.

You either need some self esteem or a better technique for sarcasm, that was lame..........

 

[FFMedic1911]

Thanks flight! I'am trying.This is hard stuff.I married a nurse hoping one day I could become great.Maybe between her and your posts I will reach my goals.

 

[Jeremy89]

Not sure how everything works in everyone's respective EMS systems, but here we dispatch an engine and rescue at the same time. Usually the engine gets there first, but I've seen a rescue respond, begin treatment, then 5 mins later, the Fire Dept rolls up, which seems somewhat pointless to me but I guess its protocol around here.

What should happen first? I think the current system we have in place works fine. If fire shows up first, they can begin pt treatment and even cxl a rescue in route, so as to not waste resources.

 

[mbcwgrl]

Well... Where I work Fire and EMS get toned at the same time... We all go "together" I work for a private service and most FD's that we run with are city. We have come to work together and have Fire's radio in our dispatch center. (Fire has ours as well, although I dont think they listen to them). If you cant change how things are dispatched and one HAS to go before the other... I say EMS. (unless there is a fire or immediate HAZMAT situation). Where I work all EMS have some (and some have alot) of training in stabalizing a scene and extricating victims. I am a firm believer of working together but when agencies refuse to, you still need to do whats best for the pt(s). Rapid medical intervention would be the best for any pt regardless if it injury or illness.

 

[sabbymedic]

I work in Ottawa Canada and our policy is to send Fire on most if not all collisions. The reason behind this is in the event that someone is trapped or there is fluid or fire you have the proper agency on scene to deal with such an emergency.

We are all dispatched through different centres meaning that 911 gives the call to the appropriate dispatch centre. The units responding are enroute fairly quick for all agencies responding.

 

[knxemt1983]

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...

so why come here and ask our opinions if you already have your mind made up?

there is not really a debate here. we deal witht eh emergency at hand, there is not that much of a danger to the general public in the 2 minutes it takes to get both departments rolling. ever thought of a 3-way calling system so both agencies can be notified at the same time.

 

[Desert Ranger]

Our protocols in the National Park I work in are that all incidents involving motor vehicles will have both fire and ems personnel on scene. It can take up to two hours for either to arrive depending on where the incident occurs. Just because there is no fire in the vehicle, doesn't mean the possibility doesn't exist.

 

[wolfwyndd]

We are all (probably) going to have differing opinions on how this should be handled due to various jurisdictions working differently.

In the jurisdiction that I live (and work) we dispatch fire and EMS at the same time for an MVA. Response times for both fire and EMS can take up to 10 minutes, seriously, depending on how far out on the country roads the MVA happened. Of the three fire stations we have in our township, only ONE of them has full timers and that's only M - F 8am - 5pm. Our ONE EMS Squad is one full time crew 24/7/365 so most of the time EMS gets there first. EMS gives a general scene size up but usually doesn't cancel fire even if there is no fire / extrication / whatever needed because our EMS uses fire for scene safety and traffic control and clean up. Oh, and let's not forget the cutting of the battery cable. Whether air bags have deployed or not, the vehicle still needs to be de-energized and stabilized. Police? Oh, they'll show up eventually, but unless they are chasing the vehicle that was involved in the accident, they're usually the LAST to show up.

 

[Anomalous]

I enjoy having the FD or PD on scene before I arrive for the reasons you listed in the original post.

1. Scene safety.
2. Extrication.
3. Triage.
4. Initial vitals.
5. Availability for lift assist.



And those are all well within a first responder role....

Sounds great. How do you get them to do 2,3 and 4? They are always willing to help lift though.

 

[Hal9000]

I like to have fire and PD on scene for MVAs. I had one MVA where a crewmember almost got taken out by some maniac because there was no one for traffic control. The dispatcher said she'd sent a SO, but he was 20 minutes out. So I got on the radio and w/i 4 minutes we had two engines to help with traffic.

I like help, as long as it isn't just some Joe Blow there for excitement. Some care is better than none; highest level of care always.

 

[himynameismj]

I can't believe this is going on for so long. Try this one.. train your dispatchers to know when he should need to call both at the same time. The winner of the race can always cancel the other if need so be.