EMTinNEPA
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:unsure: lolwut?
So somebody who solely does EMS work ISN'T a full-service provider? They are shorting the patient and the public? Also, if you don't enforce the law, are you a full service provider?
Why is EMS mixed with FD?
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:unsure: lolwut?
So somebody who solely does EMS work ISN'T a full-service provider? They are shorting the patient and the public? Also, if you don't enforce the law, are you a full service provider?
Full service as in I can do ALS as well as rescue victims from a burning structure, burning car, below grade/high angle rescue, extrication, removal from an oxygen deficient environment, etc. etc. and so on. Full service as far as rescue and pt welfare is concerned as I'm not restricted to EMS only and can potentially save life and limb in many other ways.
What I'm trying to say is that a firemedic can help a pt/victim in other ways than EMS only. You knew what I meant, as I'm sure others do, but you felt the need to question me anyway.
EMTinNEPA
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I felt the need to question you because you are implying that those who do only EMS are somehow not fulfilling their responsibilities to the patient. As someone who is striving to be the best provider I can be and a militant fire-EMS separatist (as you and I have discussed in detail in the past), I find that extremely insulting.
Ridryder911
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To the original post, The reason EMS is placed into the Fire Service is because City Leaders are ignorant about EMS. Sorry, there is just so many hats one can wear and be proficient at and if they are proficient at EMS then they are lacking somewhere else.
It was not that long ago that that the majority of EMS snubbed their noses at EMS. Until the late 80's most of the Fire Services had no desire to have EMS within their ranks. Yes, few cities absorbed the ambulance service or had rescue squads but at the same time many hospitals as well provided the service. It was not until administration foreseen the potential lack of funding and fire responses decreasing that any real sincerity was placed into having Fire Based EMS.
It is ludicrous to have them mixed. Yes, the Fire Service has done a great job of snowballing most cities into the "what if" game. I will admit that they were able to form unions and contracts to obtain great benefits and as well as great marketing scam to continue the on going process.
In comparison to other corporations or city services that when their need has decreased the division is down sized or abolished yet the Fire Service continues to grow. I will admit that they were definitely smart as in the PR and marketing tool as well. Each labor day we always see the public servant obtaining money for Jerry's kids or at Halloween handing out candy to the kids... You bet those things matter when deciding to increase tax revenues and city commissioner and manager votes. Unfortunately, most EMS services are too busy responding to calls to be able to perform those tasks and the crews are too tired to perform these off duty. As well, there is no accountability of what they do is really necessary or if they did a great job or not. The public assumes that the structure was a loss because of the fire... not knowing it was improperly attacked or poorly ventilated. Each major fire has a PSO officer that will inform the press and the thousands watching reminding on how heroic the members were each and every time. Seriously, they were just doing their job, yep very smart marketing tool.
I was at a conference the other day and this same discussion was made. Possible we should re-name Fire Service to EMS with fire trucks. Why not? Since the majority of responses are EMS calls with approximately only 25-35% of fire services response are fire related. Why can't EMS absorb the fire departments and manage them? I know of cities that the fire service attempted to take over a well established EMS and when the EMS offered to manage and operate the fire department at a cheaper and more efficiently the Fire Service dropped all interest in the take over.
I do believe we will see a shift. Citizens are tired of extreme taxes. Especially seeing multiple rigs on medical calls and even on MVC with a more than 3 or 4 responding... I even ask .. why? More and more are asking; Why should we have so many if they are not responding and fire suppression numbers are down? Why should blue collared non-degree person that will be making a 6 figure income with great benefits and only have to work 120 days a year? Not a bad gig.
EMS is medicine. Nothing more or nothing less. Not all fire services are bad in fact few are but their interest is and as it should be is fire suppression. EMS should be EMS, a third party division that can operate well that should be partially funded for overhead expense but can make it on billing and providing services. Each should be accountable upon its own.
Work with other emergency services to provide care. It should not be a competition or just another division to provide. EMS is and needs to be independent upon it's own, accountable to itself.
R/r 911
It was not that long ago that that the majority of EMS snubbed their noses at EMS. Until the late 80's most of the Fire Services had no desire to have EMS within their ranks. Yes, few cities absorbed the ambulance service or had rescue squads but at the same time many hospitals as well provided the service. It was not until administration foreseen the potential lack of funding and fire responses decreasing that any real sincerity was placed into having Fire Based EMS.
It is ludicrous to have them mixed. Yes, the Fire Service has done a great job of snowballing most cities into the "what if" game. I will admit that they were able to form unions and contracts to obtain great benefits and as well as great marketing scam to continue the on going process.
In comparison to other corporations or city services that when their need has decreased the division is down sized or abolished yet the Fire Service continues to grow. I will admit that they were definitely smart as in the PR and marketing tool as well. Each labor day we always see the public servant obtaining money for Jerry's kids or at Halloween handing out candy to the kids... You bet those things matter when deciding to increase tax revenues and city commissioner and manager votes. Unfortunately, most EMS services are too busy responding to calls to be able to perform those tasks and the crews are too tired to perform these off duty. As well, there is no accountability of what they do is really necessary or if they did a great job or not. The public assumes that the structure was a loss because of the fire... not knowing it was improperly attacked or poorly ventilated. Each major fire has a PSO officer that will inform the press and the thousands watching reminding on how heroic the members were each and every time. Seriously, they were just doing their job, yep very smart marketing tool.
I was at a conference the other day and this same discussion was made. Possible we should re-name Fire Service to EMS with fire trucks. Why not? Since the majority of responses are EMS calls with approximately only 25-35% of fire services response are fire related. Why can't EMS absorb the fire departments and manage them? I know of cities that the fire service attempted to take over a well established EMS and when the EMS offered to manage and operate the fire department at a cheaper and more efficiently the Fire Service dropped all interest in the take over.
I do believe we will see a shift. Citizens are tired of extreme taxes. Especially seeing multiple rigs on medical calls and even on MVC with a more than 3 or 4 responding... I even ask .. why? More and more are asking; Why should we have so many if they are not responding and fire suppression numbers are down? Why should blue collared non-degree person that will be making a 6 figure income with great benefits and only have to work 120 days a year? Not a bad gig.
EMS is medicine. Nothing more or nothing less. Not all fire services are bad in fact few are but their interest is and as it should be is fire suppression. EMS should be EMS, a third party division that can operate well that should be partially funded for overhead expense but can make it on billing and providing services. Each should be accountable upon its own.
Work with other emergency services to provide care. It should not be a competition or just another division to provide. EMS is and needs to be independent upon it's own, accountable to itself.
R/r 911
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Ridryder911
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Let's be truthful. How many real rescues did you perform last year or better your department? I mean life saving high angle death defying rescues? In those rescues how many could be treated with first responder level care immediately then care turned over to EMS?
Let's start comparring actual events versus potential. Be prepared you bet, but one can "what if" to death. If EMS used this philosophy then there always would be an extra crew sitting around awaiting the "big one". Again, accountability and performance. If Fire Service pay was based upon per response and performance, what do you think the salaries would be?
R/r 911
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I'm paid for my potential. Same as when I was EMS only previously. Some days are chill, some days you're earning your paycheck and then some. That's the nature of the business. My typical workday isn't an episode of Ladder 49, Backdraft, Emergency or Rescue Me. Just like a typical workday in NYC EMS was hardly like an episode of Third Watch. That's why I said "potential".
Emergency services are in fact paid based on the "what if" factor. I certainly don't have a crystal ball that can predict when and where my dept's calls will occur and what those calls will entail.
As far as treating rescues at the first responder level and then turning it over to EMS, it's not necessary. I can and have jumped in the box to perform ALS immediately after performing suppression duties. We can do both, no need for outsourcing. We've got it covered.
All of that hero stuff may happen very infrequently, but we're paid to step up to the plate without hesitation when we're needed.
Emergency services are in fact paid based on the "what if" factor. I certainly don't have a crystal ball that can predict when and where my dept's calls will occur and what those calls will entail.
As far as treating rescues at the first responder level and then turning it over to EMS, it's not necessary. I can and have jumped in the box to perform ALS immediately after performing suppression duties. We can do both, no need for outsourcing. We've got it covered.
All of that hero stuff may happen very infrequently, but we're paid to step up to the plate without hesitation when we're needed.
I've said it several times, it's really not that difficult to maintain proficiency in both EMS and suppression. Weak argument there. It's really dependent on the individual if they're motivated to keep their skills and knowledge up.
Yes, including EMS to justify staffing, use otherwise idle personnel and receive revenue from billing is a great thing, so long as an appropriate share of $$$ goes to the EMS side. Why give that revenue away to a third party provider when the jurisdiction can use the revenue to their benefit? Win-win situation.
You say snowballing and marketing scam. I say effective campaigning, good PR and strong collective bargaining. "What if" is the nature of the business, as I've said earlier. Just like people can't buy insurance only when a car accident, house fire or devastating illness/injury occurs, we can't predict when and where an emergency will occur, and know exactly how many personnel to staff each day to cover on a day to day basis.
As far as accountability, our EMS is constantly QA/QI, is answerable to our OMD, and we are just as accountable in a court of law as any other EMS provider. Our suppression officers are required to follow manuals pertaining to any number of emergencies, not unlike EMS protocols, and can also be questioned in court for their decisions/deviation from the manual.
There are several reasons as to why we run multiple pieces on an MVA. Fairfax County has I-95, I-395, I-495, and I-66. Where 95 395 and 495 converge is affectionately referred to as the "mixing bowl". These highways have inner and outer loops. Many out of state drivers pass through. When an MVA occurs, there is frequent issue as to where the incident actually is. Oftentimes the caller gives a bad location. This area can be quite confusing to a native, let alone transient traffic. The answer is to send a medic, engine, and possibly a heavy rescue in each direction. When the incident is located, the remainder of units are places inservice.
An engine is always dispatched for any highway incident. It blocks several lanes of traffic, offers additional hands for pt care (typically more than one pt on an MVA) and protection for a vehicle fire with the bumper line. If it's a potential pin job, a heavy rescue will be sent for extrication. That's why you'll see numerous apparatus on an MVA. In NY oftentimes only my ambulance was onscene. I've been nearly run over on several occasions.
You're right, it's not a bad gig. Why shouldn't a blue collar worker make in excess of 100k/yr? You sound resentful. Yes, I'm scheduled to work around 120 days per year. These are 24 hour days, for an average of 56 hours/wk. So base that 100k on an extra 16 hours per week. When I was clued in as to how we're hooked up in fire based EMS, I almost fell over. I was all over that, believe me.
I realized pretty early in the game that EMS only gigs weren't sustainable for a career, due to burnout, low pay, working conditions, and lousy retirement compared to fire based. I talked my wife into moving for Charleston County EMS, citing a 24/48 work schedule, state retirement, decent pay for the area. My wife and daughter hardly saw me as I'd be stuck working an extra 12-24 hours after my shift. I would come home spent and need to sleep when I actually was home. Weak potential for advancement there, with an entirely subjective promotional system, based on whether they like you or not. Now, I return home somewhat rested, and I never spend more than one day away from home, unless by choice. My salary will allow us to afford a house, provide my children for down payments for their own, the opportunity for vacations. If I decide to enter the DROP, we canuse that money, along with my pension, to buy another home down south to enjoy our retirement. third service EMS has let me down, so I've changed my reality for the better.
What's not to like about working fire based EMS from the employee's perspective? Most houses would probably be happy to let you ride the box exclusively if you want.
We don't need to partner up or outsource our EMS. We have a whole EMS division that functions like a thirs service. It just so happens that our personnel are crosstrained and can ride on either side as staffing requires.
The fire service has sustained layoffs, pay freezes and pay cuts do to the economic downturn. These proportionally miniscule compared to jobs cuts in the business sector, however. It's all perspective.
If there's this supposed shift away from fire based EMS, I haven't seen any indication of such. Fire based EMS uses idle suppression personnel to provide EMS. Crosstraining providers helps stem OT and forced OT. The jurisdiction won't want to give up the EMS revenue. If EMS happens to run in the red, I don't see how an outside provider would be willing to assume responsiblility anyway, as they would go out of business. There can always be single role fire based EMS, effectively a third service with FD benefits. A career medic or EMT would be foolish not to jump on that.
If there's a movement on the horizon to divorce EMS from suppression, you could've fooled me. Firemedics continue to be hired across the country. We faced a potential of 89 uniformed layoffs this year back in April. We've since graduated 9 firemedics and hired 20 more. FF/EMT positions are currently unavailable.
Some rural areas depend on volunteer EMS almost entirely. Hit or miss if you get ALS coverage, let alone EMS at all. Paid firemedics at local FD's would be a valuable resource.
If there's this supposed shift away from fire based EMS, I haven't seen any indication of such. Fire based EMS uses idle suppression personnel to provide EMS. Crosstraining providers helps stem OT and forced OT. The jurisdiction won't want to give up the EMS revenue. If EMS happens to run in the red, I don't see how an outside provider would be willing to assume responsiblility anyway, as they would go out of business. There can always be single role fire based EMS, effectively a third service with FD benefits. A career medic or EMT would be foolish not to jump on that.
If there's a movement on the horizon to divorce EMS from suppression, you could've fooled me. Firemedics continue to be hired across the country. We faced a potential of 89 uniformed layoffs this year back in April. We've since graduated 9 firemedics and hired 20 more. FF/EMT positions are currently unavailable.
Some rural areas depend on volunteer EMS almost entirely. Hit or miss if you get ALS coverage, let alone EMS at all. Paid firemedics at local FD's would be a valuable resource.
Another thing, some argue that fire based EMS providers offer substandard care. If accountability is emphasised and personell receive proper ConEd/QI there's no reason why a firemedic can't provide the same proficiency in care that a single role provider does. I've witnessed plenty of poor care from single role EMS providers, so inferior care from fire based EMS if given QI/ConEd is a weak argument.
I guess that if EMS is your sole area of expertise, it can be tough to swallow the notion that someone else could do your job well while also assuming other important responsibilities.
There's no reason why others can't go fire based, maybe just single role. EMS providers shouldn't have to work several jobs, usually in a constantly fatigued state to make a livable wage. Washington State and I think Oregon have solid third service organizations. East coast you could check out Alexandria Va, LeeCounty EMS (FL), maybe Baltimore or Philly (I don't have much knowledge of either service).
I guess that if EMS is your sole area of expertise, it can be tough to swallow the notion that someone else could do your job well while also assuming other important responsibilities.
There's no reason why others can't go fire based, maybe just single role. EMS providers shouldn't have to work several jobs, usually in a constantly fatigued state to make a livable wage. Washington State and I think Oregon have solid third service organizations. East coast you could check out Alexandria Va, LeeCounty EMS (FL), maybe Baltimore or Philly (I don't have much knowledge of either service).
mycrofft
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WuLAb and Pudge nailed "why" first-out...plus "history".
Because fire depts offered the most cost effective means to implement EMS when it started burgeoning at the beginning of the Seventies, the command structure lends itself to running the organization, and it makes money sense to use FD on something when they are not drilling, cleaning, cooking, sleeping, or actually responding to fires and other emergencies, and to provide EMS then and there rather thean waiting.
The problem is that Fire moves non-medical professionals into the professional end of the EMS operation, acting as administrators, affecting program and personnel actions hinging upon medical-professional issues versus fire/paramilitary organization issues. Some depts force firefighters to work as EMS when what they are good at and want to do is fight fire, extricate, and pet the Dalmatian (plus a dozen other very worthwhile and taxworthy public safety pursuits).
Because fire depts offered the most cost effective means to implement EMS when it started burgeoning at the beginning of the Seventies, the command structure lends itself to running the organization, and it makes money sense to use FD on something when they are not drilling, cleaning, cooking, sleeping, or actually responding to fires and other emergencies, and to provide EMS then and there rather thean waiting.
The problem is that Fire moves non-medical professionals into the professional end of the EMS operation, acting as administrators, affecting program and personnel actions hinging upon medical-professional issues versus fire/paramilitary organization issues. Some depts force firefighters to work as EMS when what they are good at and want to do is fight fire, extricate, and pet the Dalmatian (plus a dozen other very worthwhile and taxworthy public safety pursuits).
wyoskibum
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Two words, consolidation & infrastructure
The fire service has been around a lot longer than EMS. In a lot of communities, the Fire Dept has the infrastructure and the tax base already in place. Why two separate departments when you can consolidate them and have one Fire/EMS Chief instead of a Fire Chief and a EMS Chief? Why build an EMS station next door to an existing Fire Station? Why have a fire fighter and a EMT when you can have a Firefighter/EMT?
Now, before anybody jumps all over me, let me add this disclaimer: I don't necessarily subscribe to such logic, but I have heard elected officials cite the above reasons.
boingo
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Yeah, and the first time there is a fatal structure fire and the first due companies are "tied up" on EMS runs the FD will cry to the city that they need more FF's, more aparatus, more $$$ etc....You don't see any big city FD's looking to merge with PD's to "save money", in fact the IAFC recently released a position statement adamantly opposed to the merger of FD's and PD's, although have no problem with EMS. Perhaps FD's should look to stay busy patching roads or working for the water and sewer department?
If a FD and EMS agency are to merge, EMS should absolutely be the ones running things.
If a FD and EMS agency are to merge, EMS should absolutely be the ones running things.
That post was not meant to belittle EMS efforts. when I decided to become a medic, part of the reason was to be able to do more for my pts. Adding suppression capabilities is a continuation of that line of thinking from my perspective. I can provide ALS, and I can help pts/victims in even more ways.
If I'm a single role provider, when I'm first onscene at a vehicle fire with trapped occupants, I can't do jack. Suspected CO posioning in an apartment with unconscious pts inside, can't do jack. Car runs down an embankment, lands in such a way that critically injured pts are trapped, can't do jack. First onscene at a house fire and a mother runs outside and advises that her child is stuck up in the bedroom. Can't do jack.
alphatrauma
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You my friend, along with many others (FF/Medic) like you, are the minority... in my experience. Most FF I've talked to, and precepted under, HATE EMS and only do it for the pay increase (or because they have to). They want to fight fires and ride the engine, not deal with patients... and it shows, through their apathetic attitude and pisspoor patient care. I will admit, there are those who enjoy/excel at both, but they are few and far in between.
Just doing your job and doing it well, are two entirely different matters. What is really tough to swallow, is the fact that governments/municipalities would rather fund exorbitant retirements and ridiculous pay bonuses, rather than fund/fortify a standalone progressive EMS system.
Aint that the truth. I had no qualms in telling station crews (Capts/LTs etc), during my field rotations, that I had absolutely no interest in firefighting and wanted to do EMS only... didn't go broadcasting it, but if asked I pulled no punches about my thoughts of firebased EMS. Seemed like it made them want to recruit me that much more. They appreciated my honesty and joked that I could ride the medic everyday if I wanted.
Sure, I (or any other medic) could join a fire service for the money and perks... but at what cost? I'm sure FFs don't want someone standing next to them, at a structure fire, that doesn't want to be there. And I damn sure wouldn't want some hack riding with me on serious calls. How does one maintain proficiency and excel at something they don't want to do? Maybe I should just join a fire service and rake in the dough... I'll just sandbag anytime I have to roll in turnout gear.
Ridryder911
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As well in the role of a F/F can't do jack either. Sorry, poor analogy. You have a CO patient, you will have to gear up and go get the patient, remove the patient and then when in a safe area treat the patient.
Guess what? I'll be there waiting for the patient to do the treatment.
Car runs down embankment. Not in FD but never has stopped me or any of the EMS I have been in to be the first inside the vehicle when the it is secured. Don't see your point.
Extrication and or rescue is not EMS. Totally separate issues. One does not have to be medically educated to perform any of those task. Simple first aid can temporary treat until professional help. One is not to establish an IV inside that CO house or inside an house fire.
I understand your desire to do rescue. I was a Fire Officer for a while and entered Fire Service with a degree and cert.'s to do it the right way. I too at one time believed I should be able to deliver care when and where it was needed. I was wrong. I had fellow firefighters that was no more than first responders that taught me different. Very little treatment is going to be performed while in the rescue portion. Oxygen, simple splinting and bleeding (all within EMR) and then patient to a safe designated area where more aggressive treatment can be performed. In reality if EMS is there they can perform the ALS tx needed and you can return to the rescue or rest as one should.
As well, how many times has one induced asthmatic or respiratory problems by having smoke or chemical smell off the bunker or equipment? How well is the manpower of many Fire Services not needed those additional two persons for the line?
Again, there is no reason to force Fire Service to be any higher than EMR. Even EMT would be stretching it. Do to their fast responses simple treatment with simple equipment has demonstrated the best outcomes. CPR, oxygen, simple controlling of bleeding and immobilization within the first few minutes all of these can be provided by good first aid care. Followed up by good sound medical care by EMS (ALS level).
Flooding the staff with Paramedics within the fire service does not demonstrate any advantages rather the opposite in decreasing skill levels. Having extra hands at such scenes, yes is beneficial and again there would be no change except the line firefighter could resume their primary role as the patient is cared for or transported. Thus reducing the number needed.
R/r 911
downunderwunda
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Answer me one simple question.
How many proper Fire calls are attended annually, & how many EMS calls do you run annually?
Now, calculate how much it costs to run a fire service & the income generated from those calls.
Repeat for EMS.
REALITY CHECK - EMS SHOULD RUN FIRE.
EMS needs to stay EMS. Fire Dept's have no business to run EMS. This is all a ploy to jack up response numbers to keep firehouses open, and get fancy toys. I know of a few "fire dept" based ambulances, either paid or volunteer that want to break away because they are tired of the non sense. I am glad that I work for and volunteer for a non fire dept based service. We have better equipment, proper training and don't have to answer to smoke eaters that have no clue how to run a proper EMS service.
Yes, a single role FF can't do much for the pt after pulling them from a hazardous environment. When I said that a firemedic can help pts/victims in more ways than medics, I didn't necessarily mean using both EMS and suppression skills at the same time. I have done that on occasion, however. Like the time I pulled the bumper line for a quick knock on a car fire. The Lt ordered me to jump on the one-and-one medic to txp the pt to the hosp (I stripped out of my bunkers, due to off-gassing). What I'm trying to say is that I'm able to do other things to help that are past the medic's scope and role. I don't mean to belittle medics, I just want to be capable of more. It's loosely analagous to medics striving for an increase in scope of practice. Having the ability to do more good.
I've climbed in many a car with trapped occupants. What I meant is that you may have no access to a pt without extrication. I'm not TROT, but we do carry cutters/spreaders, sawzall, and a small amount of shoring equipment on our engines. No extrication, no stabilization of the vehicle, no access to the pt. We do drills with the Tower for stokes basket operations as well. The medic hooks in and rides with the pt in the basket.
Yes, extrication, rescue, and EMS are seperate disciplines. Being trained in each gives one the opportunity do more for a pt or victim than a single role provider. Just because it isn't straight up EMS doesn't mean that the pt isn't being helped in other important ways that may directly affect their well being.
If I was exposed to an IDLH, I'll always strip my gear before pt care. If I'm toned out during PT I don't respond in bunker pants, I'll use my coveralls.
I'll have to agree with you on the problem of flooding the scene with medics. In addition, the paramilitary structure has Lt's in the lead role, oftentimes with the second or third medic being "skills medics" only, not having to do any critical thinking. It's better than having too few, or none at all in some cases, however.
The fire service and single role EMS agencies both have many examples of well run EMS and piss poor EMS. It's too difficult to just say one is definitively better than the other. Same thing for FD's taking suppression pieces out of service to run EMS calls. Is the service resource rich, or will response times suffer severely? Would there be medic coverage otherwise, would there be no ALS available for an extended period of time if not for an ALS engine?
We could go on ad nauseum all day with examples of depts that are run well to support our positions, as well as depts that are run horribly to discredit the other side's position. Things vary too much from place to place to be able to make blanket statements such as "All EMS should be seperate from fire", "Fire based EMS is the best", "Fire/EMS should be run by EMS not fire", "All private EMS are only profit driven and have lousy pt care", "FF's shouldn't be trained over EMR", "Third service EMS providers are burnt, and don't take their job seriously as they're just using it as a stepping stone" or "Doing both EMS and suppression well is impossible as you're spreading yourself too thin". We can all find examples supporting each blanket statement, as well as examples to the contrary.
nomofica
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My PD has TEMS. Although our FD and EMS aren't integrated, I know that one of our suburb communities' FD and EMS are (my EMR instructor was a FF/EMT-P with said community).
My stance on the integration is big city = no go, rural/suburb community w/ lower population = probably not a bad idea.