Why the does fire have control on a medical incident???

[DesertMedic66]

firefite I think you’re missing the big picture, the theoretical “what could be” Picture that were visualizing, and I'm not saying that because your taking a different stance on the issue, but your arguments aren't making sense...

Let’s look at AMR Rancho where you did your ride along.
You have Fire Engines with 3-4 firefighters on them in this city. And you have an ambulance with a medic and an EMT.

There are three possibilities for patient care here.
1. An ambulance comes and takes the patient to the hospital providing the same care on scene and on the way that ANY medic would.
2. Fire gets on scene and provides care until an ambulance gets on scene and takes the patient to the hospital, assuming patient care all the way to the hospital.
3. Fire gets on scene and an ambulance doesn’t come and they sit there forever providing care.

First was an ambulance response, second was both an ambulance and a fire engine, third is where the problem lies. The second example has its problems to with 3-4 FF to many on scene, but example three is just stupid. The only good reason to have an engine role out is response times… Which I believe is your argument.
SURE! Currently fire can provide a quick response with medics, but that is CURRENTLY do to their city specific stationing and coverage. But why not work towards a system where an ambulance is available to respond from every city in that 3-5min. window instead of a fire engine?? We’re looking at a theoretical system in which’ let’s say in every “fire House” there is an ambulance crew. (some places already do this.) Why send an engine when you could send the ambulance??? The ambulance HAS TO COME ANYWAYS TO TAKE THE PATIENT… And if an engine responds from the same location that an ambulance does why oh why send an engine???

***Point being, Fire sticks their heads into medical matters that are none of their business. We’re not out to trample on FF’s, hell let’s take those same FF out of their bunker gear and into some blue polos and have them run some ambulance only runs. Let’s keep people who know what there doing employed.

Let’s look at a Fire dept. you may have ran with during your ride along…

Montclair fire dept.
http://www.ci.montclair.ca.us/depts/fire/current_year_to_date_calls_for_service_statistics.asp

There were over 600 Medical Calls which all of them REQUIRED an Ambulance on scene to take the patient. This is compared to 17 Fire Calls that year that REQUIRED the engine.

Once again the point is: why would an engine with FF need to respond unless requested for additional help and/or access??? Why can’t an ambulance (WAY CHEAPER) provide the same patient care that ANY medic unit would?

Doesn’t it seem that 600:17 medical calls would necessitate the need for some serious re-workings to the current system with some more emphasis put towards providing better medical care and less on the million(s) spent on the Big Red Truck and its crew???? 600 medical calls, you would think the high call volume would also necessitate the need for better salaries for the medical specific guys but what’s been set in motion must come to an abrupt and well fought stop if that’s to ever happen. i.e. pay 17:600 wage differences between FF and transporting Medics.

Side Note: HELL Why Not Put an AMBULANCE in every fire house?! Like LA City.

If you want to look at individual fire departments then how about Big Bear. They have a total of 6 ambulances with normally at least 2 of those being staffed. When they get a medic call they roll out one ambulance and their fire engine. They only hire fire medics there. So you will have 2 medics in the ambulance and then 2-4 medics on the engine.

The reason that fire has a good response time is because they don't have to transport. They can be on a medical call for under 5 mins before they go back in service. Ambulances transport which normally means they are out of service for a longer time unless the patient AMAs.

So does it make sence to have an ambulance crew waiting at the hospital to drop off a patient while having another 911 call on hold? Or would it make sence to have that same ambulance crew waiting at the hospital while a perfectly capable ALS engine crew respond to that 911 call?

In my honest opinion I don't see fire separating from EMS operations anytime in my area and I am perfectly fine with that. When I had to call 911 for my mom I wanted help as soon as possible. I would have been soo mad if a fully capable ALS fire engine didn't respond because "fire should have nothing to do with EMS" and that caused me to wait longer for help.

I know I'm not thinking about it from a money stand point. That's because I hate dealing with money. Yes it would be cheaper to do alot of things but cheaper doesn't mean a system will work better.

Yes having an ambulance crew with 3-5 min response times to every place would be nice. But it's extremely hard when an ambulance gets taken out of service for a long time to have that response time. You would have to have a really overstaffed company for that to happen.

Where I work at right now we have a 30-45 min response time to some areas that we cover. And that response time is with every unit just being posted and no units on a call elsewhere.

 

[usalsfyre]

When I had to call 911 for my mom I wanted help as soon as possible. I would have been soo mad if a fully capable ALS fire engine didn't respond because "fire should have nothing to do with EMS" and that caused me to wait longer for help.

Yet it probably made no difference in outcome. May I ask, what did the FD do for your mom? Arguments based on emotion are part of the problem with EMS.

I know I'm not thinking about it from a money stand point. That's because I hate dealing with money.

Here's where you and 90% of other line level providers fail. I know that thinking of people's pain and suffering in terms of dollars and cents is uncomfortable. But someone is doing it I assure you. Until EMS as a whole begins to see, in monetary terms, why the current system is flawed and why change is needed EMS will continue down the path to failure.

 

[DesertMedic66]

Yet it probably made no difference in outcome. May I ask, what did the FD do for your mom? Arguments based on emotion are part of the problem with EMS.


Here's where you and 90% of other line level providers fail. I know that thinking of people's pain and suffering in terms of dollars and cents is uncomfortable. But someone is doing it I assure you. Until EMS as a whole begins to see, in monetary terms, why the current system is flawed and why change is needed EMS will continue down the path to failure.

She had a PE due to birth control meds. Caused her to have a panic attack and start posturing from the lack of oxygen. Fire arrived on scene and started a line, 12 lead, O2 because her stats were low, administered a drug (I don't know what it was), and calmed her down. When the ambulance showed up and was on scene for less then 2 mins before transport to hospital. Life flight from that hospital to another one with a working MRI and caught the blood clot on it's way back into the heart.

 

[sir.shocksalot]

She had a PE due to birth control meds. Caused her to have a panic attack and start posturing from the lack of oxygen. Fire arrived on scene and started a line, 12 lead, O2 because her stats were low, administered a drug (I don't know what it was), and calmed her down. When the ambulance showed up and was on scene for less then 2 mins before transport to hospital. Life flight from that hospital to another one with a working MRI and caught the blood clot on it's way back into the heart.

As Usalfyre pointed out, none of what was done by the FD would make any difference in outcome. Hyperventilation is usually self limiting, eventually you will pass out and resume a normal respiratory pattern.
I think you are missing what people are saying. Response times haven't proven to change anything, even with flights. So whether a fire truck gets there in 5 mins or an ambulance in 10, the outcome of the pt won't be changed.
Also getting an ALS engine there for pain meds is completely irrelevant when most protocols won't allow for adequate pain control. Heck, just the other day the local fire department transported a dislocated shoulder that was having spasms with only 100mcg of Fentanyl on board because "thats the protocol", when I asked why they didn't give Valium for spasms they said "it's against protocol". So the argument for early pain meds is moot when most services have completely inadequate pain control protocols.

Also, 6 Paramedics on scene? Holy skill dilution Batman. I wonder when was the last time one of those guys got a tube?

 

[Shishkabob]

Not to mention, very few EMS agencies can do anything for PEs, let alone first responding fire departments... and that's even if you can discern a PE from some other condition going on before it's too late.

 

[DesertMedic66]

Not to mention, very few EMS agencies can do anything for PEs, let alone first responding fire departments... and that's even if you can discern a PE from some other condition going on before it's too late.

They didn't know at the time that it was a PE. The medic told my mother that's what he thought it was but couldn't confirm it. Having fire on scene allowed for a much faster transport time. You said "before it's too late" that is referring to time. So having a quick transport time did save on time to the hospital.

 

[usalsfyre]

Having fire on scene allowed for a much faster transport time.

Explain

 

[DesertMedic66]

As Usalfyre pointed out, none of what was done by the FD would make any difference in outcome. Hyperventilation is usually self limiting, eventually you will pass out and resume a normal respiratory pattern.
I think you are missing what people are saying. Response times haven't proven to change anything, even with flights. So whether a fire truck gets there in 5 mins or an ambulance in 10, the outcome of the pt won't be changed.
Also getting an ALS engine there for pain meds is completely irrelevant when most protocols won't allow for adequate pain control. Heck, just the other day the local fire department transported a dislocated shoulder that was having spasms with only 100mcg of Fentanyl on board because "thats the protocol", when I asked why they didn't give Valium for spasms they said "it's against protocol". So the argument for early pain meds is moot when most services have completely inadequate pain control protocols.

Also, 6 Paramedics on scene? Holy skill dilution Batman. I wonder when was the last time one of those guys got a tube?

If response times haven't been proved to change a pt's outcome then why are there studies that say the faster CPR is started on an arrest the better chance that person has of surviving?

 

[usalsfyre]

If response times haven't been proved to change a pt's outcome then why are there studies that say the faster CPR is started on an arrest the better chance that person has of surviving?

Unless you can get to the patient within 4-6 minutes of witnessed arrest, they don't matter...

 

[DesertMedic66]

Explain

Gladly. Ambulance was off loading another patient to the ER when I called. The fire department got here in under 5 mins. An ambulance from the next city responded in about 10-15mins. Fire had everything done her by the time the ambulance showed up. Once the ambulance got here they loaded her up in less then a min. The fire medic rode in the ambulance giving his report to the EMS medic on the way to the hospital.

If fire didn't respond then it would have been longer time to transport because the ambulance crew would arrive and have to do all the interventions fire did and then transport.

 

[DesertMedic66]

Unless you can get to the patient within 4-6 minutes of witnessed arrest, they don't matter...

But once again that is dealing with time. So on some calls time does in fact make a difference on the possible outcome of a patient.

 

[usalsfyre]

So the medics can't perform interventions enroute?

 

[usalsfyre]

But once again that is dealing with time. So on some calls time does in fact make a difference on the possible outcome of a patient.

Around 1% if I'm not mistaken. Comes back to cost/benefit. Plus a CPR card and AED make as much (or more) difference as ALS care.

 

[DesertMedic66]

So the medics can't perform interventions enroute?

They can. Normally they like to do everything on scene. I have never seen an ambulance crew be first on scene and not do some kind of assessment (that takes times) before they load the patient up. I have never seen a primary assessment done in the back of the rig. For me it has always been in on scene.

 

[usalsfyre]

I'm going to do my own assessment matter who I'm taking care from. How else do you know if the assessment has changed or is wrong if you don't?

 

[DesertMedic66]

Around 1% if I'm not mistaken. Comes back to cost/benefit. Plus a CPR card and AED make as much (or more) difference as ALS care.

There aren't too many AEDs for the publics use here. So the quickest access to AED is by the unit that gets on scene first. I'm not one to count money (I know that's a problem for some people).

 

[usalsfyre]

There aren't too many AEDs for the publics use here. So the quickest access to AED is by the unit that gets on scene first. I'm not one to count money (I know that's a problem for some people).

Whether you like counting money or not, it's the reality in the US, and the main reason FDs are in EMS in the first place.

 

[DesertMedic66]

I'm going to do my own assessment matter who I'm taking care from. How else do you know if the assessment has changed or is wrong if you don't?

I agree with that. But it allowed for the ambulance to do their own assessment on the road rather then on scene thus saving time.

 

[Shishkabob]

They can. Normally they like to do everything on scene. I have never seen an ambulance crew be first on scene and not do some kind of assessment (that takes times) before they load the patient up. I have never seen a primary assessment done in the back of the rig. For me it has always been in on scene.

Ok, here's the flaw in your rational:


You're stating that fire saved time because they did the assessment so the "ambulance didn't have to"

If fire didn't go, the ambulance crew would have done the assessment.

If the ambulance could get on scene in the same time limit as the engine, they could theoretically take just as much time doing the assessment as the engine.

They can. Normally they like to do everything on scene. I have never seen an ambulance crew be first on scene and not do some kind of assessment (that takes times) before they load the patient up. I have never seen a primary assessment done in the back of the rig. For me it has always been in on scene.

And that's bad how? Too many people think of EMS just as a transport. If I can diagnose and treat on scene and not transport, I view that as a win.

I will do my own assessment, and I will stay on scene as long as I deem I have to, to do my job well. Depending on the nature of the call, I can go in, grab the patient and run, go in, stabilize the patient and run, or take my time. None of the above is wrong.


No delay.

 

[DesertMedic66]

Whether you like counting money or not, it's the reality in the US, and the main reason FDs are in EMS in the first place.

Yeah I know that as well. But I'm not in the back of the rig thinking "hmmm he doesn't really need this right now so im gonna let the hospital do it so I can save money". I don't think about the costs of stuff when I am doing something nor am I going to let it sway my judgment.