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

[DesertMedic66]

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.





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.

But the fact is that the ambulance crew couldn't have made it on scene in the same time as fire.

 

[Shishkabob]

and the main reason FDs are in EMS in the first place.

Albeit under extremely false and convoluted pretenses.

 

[Shishkabob]

But the fact is that the ambulance crew couldn't have made it on scene in the same time as fire.

Because fire gets the funding instead of EMS to put a proper number of ambulances on the streets.

 

[usalsfyre]

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.

I agree, it doesn't really sway mine either. But when you start talking system design, it's vital your willing to understand there is such a thing as "acceptable loss".

 

[DesertMedic66]

I agree, it doesn't really sway mine either. But when you start talking system design, it's vital your willing to understand there is such a thing as "acceptable loss".

That's the reason I am not going higher up into the system. Im staying on a field personal level as either an EMT, Medic, Fire/EMT, or Fire/Medic.

 

[usalsfyre]

That's the reason I am not going higher up into the system. Im staying on a field personal level as either an EMT, Medic, Fire/EMT, or Fire/Medic.

A word of advice, it's easy to say this at 19 years old and just starting out, but at some point in your career I can almost assure you that you will want some control of your destiny.

 

[DrParasite]

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.

your logic is faulty, because it is limited by the current system.

What your system didn't need was a fire medic first responder, what they needed was another transporting ambulance. maybe your town needs two trucks 24/7, I don't know, but it seems like a better answer would be having a second ambulance instead of a 4 person fire medic engine.

not only that, but in your example, the Engine either has to follow the ambulance to the hospital to pick up their medic, or has to operate down a FF until the medic makes it back from the hospital. this is also assuming the ambulance doesn't get dispatched for another job (or possibly a mutual aid job) before they drop off the fire medic. so when you get the fire, your engine company doesn't even have a full crew to work with.

Plus, the patient has a PE... what can the fire engine do? the person needs an ER, and an ambulance to take them there, not a fire engine to babysit until the ambulance can get there.

Because fire gets the funding instead of EMS to put a proper number of ambulances on the streets.

that's the exact same thing I have been stating for years.....

 

[DesertMedic66]

your logic is faulty, because it is limited by the current system.

What your system didn't need was a fire medic first responder, what they needed was another transporting ambulance. maybe your town needs two trucks 24/7, I don't know, but it seems like a better answer would be having a second ambulance instead of a 4 person fire medic engine.

not only that, but in your example, the Engine either has to follow the ambulance to the hospital to pick up their medic, or has to operate down a FF until the medic makes it back from the hospital. this is also assuming the ambulance doesn't get dispatched for another job (or possibly a mutual aid job) before they drop off the fire medic. so when you get the fire, your engine company doesn't even have a full crew to work with.

Plus, the patient has a PE... what can the fire engine do? the person needs an ER, and an ambulance to take them there, not a fire engine to babysit until the ambulance can get there.

that's the exact same thing I have been stating for years.....

Ambulance is a private company. They don't have the means to have another unit on the road. A VST drives the fire medic to where ever he needs to go. I'm no medic but im going to take a huge jump for an EMT and say extremely low O2 stats should be treated as soon as possible. That was done by the engine crew.

 

[usalsfyre]

Ambulance is a private company. They don't have the means to have another unit on the road. A VST drives the fire medic to where ever he needs to go. I'm no medic but im going to take a huge jump for an EMT and say extremely low O2 stats should be treated as soon as possible. That was done by the engine crew.

Poor system design is not an excuse for expensive ALS first response.

 

[DesertMedic66]

Poor system design is not an excuse for expensive ALS first response.

So since it's a poor system then there should be no ALS first response?

 

[usalsfyre]

So since it's a poor system then there should be no ALS first response?

Take the money differential between four fire/medics and four fire/basics a shift. Increase the subsidy of the EMS service by that amount. See if they can add another truck.

 

[DesertMedic66]

Take the money differential between four fire/medics and four fire/basics a shift. Increase the subsidy of the EMS service by that amount. See if they can add another truck.

Here we run 1-3 EMTs and 1 medic. And the problem with that is that fire is funded thru taxes. EMS is private and paid for by the people we transport. If we cut down on fire EMS still won't see any money from taxes because Cali is in so much debt.

 

[Shishkabob]

I'm no medic but im going to take a huge jump for an EMT and say extremely low O2 stats should be treated as soon as possible. That was done by the engine crew.

Just FYI, if it WAS a PE causing low o2 sats... supplemental O2 has little effect on it.

 

[blogspoter507]

Fire Vs EMS

I personally have never had any problem with Firemen on scenes. Even during MVA and patient extraction our Firemen have always been helpful....

With that said I think its important to explain that my EMS service and Fire department are separate services.

Although I haven't personally experienced problems with Fire Departments I know its a common complaint in the EMS world. I don't believe that Fire and EMS should be together because when you force a Paramedic to be a Firemen or vise versa then the patient is the one that ends up paying the price.

In the world of public service you must want to do the job. It requires both motivation and compaction to provide the best patient care.

 

[DesertMedic66]

Just FYI, if it WAS a PE causing low o2 sats... supplemental O2 has little effect on it.

I'm not sure if the PE was causing the low O2 sats but I know the sats were going up extremely slowly without O2. I wanna say they were 86% when fire first arrived and a couple mins later they were 89%. They placed a NRB and it went up to 99%-100%.

 

[RanchoEMT]

Your Logic is questioning at times....

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.

Let’s set the golden rule down… On a medical call, you will need every time, an ambulance to TRANSPORT the patient to the hospital, every time.

You say Big Bear has 6 ambulances and 2 of them are being used at any given time. By the numbers, 4 of them are collecting dust, while the engine crew with 2-4 medics on board goes out with the 2 In-service AMBULANCES and does….. an assist with the ambulance. (Not Needed)

These 2-4 Medics are doing what on that engine that they couldn’t being doing on an ambulance???

You must realize that this is like the example I provided in my previous post. The Fire Engine that is for Fire Fighting Operations staffed with capable ‘Medical Medics’ is redundant. These 2-4 medics are rolling out in an engine while leaving 4 capable AMBULANCES back at the fire house….

“Well You Need A Fire Engine Available Always/Anyways for Fires” argument….
All of this because the Fire Engine(staffed with Medics) needs to be available not for *600 or so Medical transports but for the *17 or so fires that pop up year to year…… ready with medics……. On a Non-transporting vehicle….. with medics…….

*Figures aren’t available for the exact Medical vs. Fire calls ratio for Big Bear, so I will still use the Montclair Fire Dept. figures as a baseline, as the outnumbering medical calls are typical with every fire dept.

Please Note: This is almost implying that preparing for a fire is more important that preparing and adequately staffing for Medical calls, which are significantly more probable and occurring with 30:1 odds…. Almost Emphasizing: A Salvage Property before Life philosophy.

The reason that fire has a good response time is because they don't have to transport.

Did the ambulances that came from the same fire house as the engine not get there at the same time and transport?! Please enlighten me…. Why did the engine roll out again??? If there is an ambulance staffed with a competent Medic that is able to run the call with or without the Fire Engine, Once again why oh why is a Fire Engine responding to a Medical Call???

They can be on a medical call for under 5 mins before they go back in service.

The Fire Engine can. The ambulance that transported cannot. So now you have an engine rolling around the city with 2-4 medics (Please Note: 1 medic needed per ambulance to provide ALS care, with 4 ambulances with transport capabilities sitting in the fire house somewhere in the dark). The engine is going to get a call, and these 2-4 medics are going to respond without the capability to transport the patient, almost as if to say after waiting for upwards of 20 minutes, Completely munsoned on scene looking around waiting for a transport to arrive, “Wish we had an ambulance right now.” Not to mention they are out of service for other calls that pop up while they wait!

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?

Are you talking about the Fire Engine that we left alone back in Big Bear that is going to get to the call and have to wait for an ambulance??? That’s weird you would think they would need an AMBULANCE UP THERE ASAP…. Like 2-4 of them….. But where would we find such resources???...... hmm…

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.

Any company that has 2-4 medics driving around on a non transporting Fire Engine in my mind is overstaffed or dumb staffed. One medic per ALS call is adequate, everyone else is just an assist. Those ambulances you talk of that sit there doing nothing can serve more purpose than that fire engine that roles around providing professional first assessments. Its cheap in its holistic capabilities. You bring up your family member that benefitted so much from the Fire Engine coming to your house. Let me ask you, and be honest. Next time, if there was an AMR ambulance available and Fire Engine available up in big bear with the same en-route time as either, which would you prefer to show up at your door? The Fire Engine or a transporting ambulance with load and go capabilities, the same drug box, a gurney, and a generic Medic?

 

[DesertMedic66]

Let’s set the golden rule down… On a medical call, you will need every time, an ambulance to TRANSPORT the patient to the hospital, every time.

You say Big Bear has 6 ambulances and 2 of them are being used at any given time. By the numbers, 4 of them are collecting dust, while the engine crew with 2-4 medics on board goes out with the 2 In-service AMBULANCES and does….. an assist with the ambulance. (Not Needed)

These 2-4 Medics are doing what on that engine that they couldn’t being doing on an ambulance???

they cant have all the firefighters on ambulances because if they do get a fire or a TC well then they would have to drive back to the station to get the engine for the extrication tools.

its extremely hard to carry a LSB in snow and ice with 2 people let alone do it safely.

you must realize that this is like the example I provided in my previous post. The Fire Engine that is for Fire Fighting Operations staffed with capable ‘Medical Medics’ is redundant. These 2-4 medics are rolling out in an engine while leaving 4 capable AMBULANCES back at the fire house….

4 capable ambulances that can NOT be staffed. you have to have at least 1 ambulance staffed and 1 engine staffed. once again if you would like to staff all the ambulances but not the fire engine then thats good. but wait!!! what if there is a TC with entrapment????? you dont have a staffed engine with the extrication tools. looks like that patient is out of luck until another citys fire engine arrives.

“Well You Need A Fire Engine Available Always/Anyways for Fires” argument….
All of this because the Fire Engine(staffed with Medics) needs to be available not for *600 or so Medical transports but for the *17 or so fires that pop up year to year…… ready with medics……. On a Non-transporting vehicle….. with medics…….

*Figures aren’t available for the exact Medical vs. Fire calls ratio for Big Bear, so I will still use the Montclair Fire Dept. figures as a baseline, as the outnumbering medical calls are typical with every fire dept.

Please Note: This is almost implying that preparing for a fire is more important that preparing and adequately staffing for Medical calls, which are significantly more probable and occurring with 30:1 odds…. Almost Emphasizing:A Salvage Property before Life philosophy.

umm how is having a fully staffed fire engine making it "A Salvage Property before Life philosophy"? fire responds to alot more then just fires.

Did the ambulances that came from the same fire house as the engine not get there at the same time and transport?! Please enlighten me…. Why did the engine roll out again??? If there is an ambulance staffed with a competent Medic that is able to run the call with or without the Fire Engine, Once again why oh why is a Fire Engine responding to a Medical Call???

the engine rolled out for support. do you not want any support on calls? you have a 300lb patient up on the 4th floor, are you not wanting support with that call? you get a TC with entrapment and fire doesnt respond, are you superman? are you going to be able to roll the dash or cut the roof off? ummm no. if you get a full arrest are you going to want 1 person doing compressions and airway at the same time because you only sent out one ambulance? or are you going to want 1 person doing compressions and another person doing airway??

The Fire Engine can. The ambulance that transported cannot. So now you have an engine rolling around the city with 2-4 medics (Please Note: 1 medic needed per ambulance to provide ALS care, with 4 ambulances with transport capabilities sitting in the fire house somewhere in the dark). The engine is going to get a call, and these 2-4 medics are going to respond without the capability to transport the patient, almost as if to say after waiting for upwards of 20 minutes, Completely munsoned on scene looking around waiting for a transport to arrive, “Wish we had an ambulance right now.” Not to mention they are out of service for other calls that pop up while they wait!

so what your saying is either cut the engine out or have more firefighters on duty?? yeah i see major problems with both of those "plans" of actions

Are you talking about the Fire Engine that we left alone back in Big Bear that is going to get to the call and have to wait for an ambulance??? That’s weird you would think they would need an AMBULANCE UP THERE ASAP…. Like 2-4 of them….. But where would we find such resources???...... hmm…

so once again cut fire or add more firefighters? hmmmmmmm. ambulances do such a great job at getting people out of cars or putting out fires. and adding more firefighters. california is in debt and you wanna add MORE firefighters when they are already being laid off?!?!?! i hear a 5150 hold being called out........

Any company that has 2-4 medics driving around on a non transporting Fire Engine in my mind is overstaffed or dumb staffed. One medic per ALS call is adequate, everyone else is just an assist. Those ambulances you talk of that sit there doing nothing can serve more purpose than that fire engine that roles around providing professional first assessments. Its cheap in its holistic capabilities. You bring up your family member that benefitted so much from the Fire Engine coming to your house. Let me ask you, and be honest. Next time, if there was an AMR ambulance available and Fire Engine available up in big bear with the same en-route time as either, which would you prefer to show up at your door? The Fire Engine or a transporting ambulance with load and go capabilities, the same drug box, a gurney, and a generic Medic?

the call for my family member was not up in big bear and big bear fire did not respond. and obviously i would want the ambulance. BUT that was not the case. fire was 5 mins out and AMR was 10-15 mins out. let me ask you a question now. if your family member lets say went into full arrest would you want fire to respond who is 5 mins away followed by AMR or would you want AMR to respond who is 10-15 mins away with no help until then? they both carry the same equipment the only differences is that AMR can transport and fire cant. hmmmmmm if only we knew which one has the likelyhood of a better out come

 

[RanchoEMT]

firefite, It appears everyone else has given up and I'm not going to argue with you anymore either. Your mind is already made up and I feel you misinterpret almost everything that is said to you. I wish no more time lost in your company... To you sir, have a good day and an excellent fire career.

 

[46Young]

Two things:

First, if fire and EMS staffing and deployment are lacking that much, you need to go to a single pull system. Members leave their gear on the middle of the floor. If an EMS run comes in, two people throw their gear on the bus and go. If a second EMS run comes in, two more members do the same. That leaves two others to take the engine out. If a fire comes in, they could at least do a search or VES for victims, or set up an exterior attack. After clearing from the hospital, the members can show up in the ambulance, with their gear, and join in. That's the best you can do with six members.

Second, fire isn't only responding to 17 calls out 891. what about the hazardous conditions calls, public service calls, good intent calls, and false alarms? That's 268 out of 891, or 30% of run volume. Fire calls are presumably actual structure fires, car fires, brush fires, etc. Hazardous conditions would be gas leaks, CO calls, and the like. Good intent would be wellness checks, replacing smoke detectors, etc. Public service would be picking a citizen up off the floor and back into bed or their wheelchair, if no injury or medical etiology is suspected, or other issues, such as a flooded basement where they need you to get down there and shut off the water. False alarms are not actually false alarms until proven to be so, either by the suppresion unit onscene, or by cancellation via phone by the homeowner/manager.

That 70%/30% split can also be misleading. The 70/30 breakdown only represents the number of calls on each side, not the amount of resources used for each call. An EMS response may be just an ambulance or an ambulance and engine. Fire calls can involve many more resources than just one or two apparatus. A more realistic measure would be to take each individual unit, and break down the percentage of EMS and non EMS responses. Truck companies, heavy rescues, tankers, Hazmat units, light and air, rehab units, etc must all be taken into account.

 

[DesertMedic66]

firefite, It appears everyone else has given up and I'm not going to argue with you anymore either. Your mind is already made up and I feel you misinterpret almost everything that is said to you. I wish no more time lost in your company... To you sir, have a good day and an excellent fire career.

Thanks. And you too but I am not in a fire career as of right now. Purely EMS.