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

[Bosco578]

To answer the original question, because EMS allows it to happen,and to an extent EMS management allow it.

 

[Veneficus]

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.

I am not disagreeing with you, but I would like to point out that some departments (many I have seen) will pad call volume by counting multiple aspects of a single call as multiple calls.

An example would be: Original response to a structure fire, recall of off duty persons, call for mutal aid, units responding after clearing other calls, and the call for post incident investigation get counted as 5 fire calls instead of 1.

I think that is a blatent self serving practice that undermines the respect of the fire service in the organizations that practice it.

 

[46Young]

To answer the original question, the fire depts that absorbed EMS (there are quite a few that have done both suppression and EMS for many years) do it to both protect/increase safe staffing levels and also to save money.

If suppression apparatus are idle a fair amount of the day, the rationale is that they could be used to augment EMS delivery during their downtime, instead of being otherwise unproductive. Most single role EMS departments don't adequately staff end deploy EMS transport units to begin with (SSM for example), and the fire service is no different. By using ALS engines, which are already in place and available, the municipality can get by with less transport units, right or wrong. It's a matter of adding ALS equipment and the additional salary bump and training for the engine medic, as opposed to buying and equipping an ambulance, and also the costs of two more employees, to include hiring, training, equipment, benefits, paid time off, injury or sick leave, retirement, etc.

In the case of a dual role department that does transport, money is also saved by crosstraining their people. Details are easier to fill, and OT is reduced. By not hiring as many people to staff the ambulances, since the ALS engines are taking their place to extent, money is saved on personnel as above.

Perhaps outsourcing to a private EMS provider would cost less money, but they can't cut corners to protect profits. They need dedicated 911 units, more than what already existed since they're doing it without ALS engines, that can't be redirected to IFT's. They can't count on IFT's to handle 911 overflow and get away with lower deployment of 911 units; it's too risky, as these units may be tied up with transports. If X amount of units are needed for proper coverage, then X amounts of units need to be deployed by the company for the price they're quoting. No gimmicks like SSM, or blurring the lines between IFT rigs and 911 rigs. Their training, hiring standards and equipment need to be the same as the municipal system they replaced. Otherwise, they're not providing the same coverage as the former dual role system was; they're providing an inferior product on the cheap. Also, if they no longer turn a profit, they'll either walk away, or they'll need a more generous subsidy from the municipality, which defeats the purpose of outsourcing in the first place. To suggest a reduction in force of suppression staffing and deployment to pay for more EMS in that situation shows one's ignorance of the fire side and what they do.

 

[46Young]

I am not disagreeing with you, but I would like to point out that some departments (many I have seen) will pad call volume by counting multiple aspects of a single call as multiple calls.

An example would be: Original response to a structure fire, recall of off duty persons, call for mutal aid, units responding after clearing other calls, and the call for post incident investigation get counted as 5 fire calls instead of 1.

I think that is a blatent self serving practice that undermines the respect of the fire service in the organizations that practice it.

I haven't seen it, but I'm sure it goes on. The closest thing I've seen is with FDNY and FDNY EMS. We would cancel the FDNY CFR engine, but they would mark onscene first and then go available, to be able to add the call to their numbers. If duplicates to a certain call go out, fire or EMS, each call will be recorded. For example, we could get multiple calls for an MVA, each with a slightly different location, with a different unit dispatched. It could be "GCP/LIE" "LIE/Little Neck" or "LIE/CIP." That's three EMS calls, with three different incident numbers, for the same call. Even if units are cancelled by others that know the area and recognize it as a duplicate job, they still get added to the city's stats. Right or wrong, that does show an increased call volume, which helps their case when confronted with the bean counters. In today's environment of severe budget cuts and layoffs, I can't fault a department for padding their stats for self preservation. It's like pulling teeth to get any form of increased staffing for EMS or fire, but it's all too easy to have that taken away. The messed up part is that to regain these staffing levels afterward, concessions will need to be made in the form of salary and benefits.

 

[Veneficus]

I haven't seen it, but I'm sure it goes on. The closest thing I've seen is with FDNY and FDNY EMS. We would cancel the FDNY CFR engine, but they would mark onscene first and then go available, to be able to add the call to their numbers. If duplicates to a certain call go out, fire or EMS, each call will be recorded. For example, we could get multiple calls for an MVA, each with a slightly different location, with a different unit dispatched. It could be "GCP/LIE" "LIE/Little Neck" or "LIE/CIP." That's three EMS calls, with three different incident numbers, for the same call. Even if units are cancelled by others that know the area and recognize it as a duplicate job, they still get added to the city's stats. Right or wrong, that does show an increased call volume, which helps their case when confronted with the bean counters. In today's environment of severe budget cuts and layoffs, I can't fault a department for padding their stats for self preservation. It's like pulling teeth to get any form of increased staffing for EMS or fire, but it's all too easy to have that taken away. The messed up part is that to regain these staffing levels afterward, concessions will need to be made in the form of salary and benefits.

I don't think the politicians and bean counters fall for it though.

That's the trouble.

Then when you have no credibility and need something desperately, your pleas fall on ears who don't believe you.

Even worse is when they pull the card that they already gave you something you asked for but didn't need so you aren't getting your most recent request.

 

[jmc519]

I'll add my $.02, though I'm heavily debating doing so at this point.

I'm on a paid-on-call fire department, that has no medical whatsoever. The EMS agency in our area is a separate entity. For certain calls (MVA with injury, or a PIA), we're automatically dispatched to the scene. Otherwise, EMS has to call for us (as with lift assists).

Our purpose on those PIA calls is to ensure the safety of the EMS crew and the patient. We disable the car (either cut or remove battery cables, depending upon damage to the car). We extricate if necessary.

At our point of arrival to a scene, yes, we establish command. But, we don't do this in lieu of the EMS personnel who are there (and they have better response time than us, we have to report to the station, then go to scene, they're staffed). We do what we're trained for, and that is making sure that the vehicle and scene is secure, that traffic is handled (which should be PD), etc.

Furthermore, the medics and EMTs on our local EMS agency know they can work hand in hand with us for the benefit of the patient. They tell us what they need to have happen, and we get it done, while they control the medical aspect.

Sure, sometimes someone steps on someone else's toes, but we get it worked out so it doesn't happen again in the future. And yeah, there are things we don't agree on, both personally and professionally, but when it comes down to it, we make what we have work.

My experiences here sound drastically different than what I've read on this thread. And maybe my opinions will change when I start work as an EMT-B with our local EMS agency (which should be in the next week or two). I don't know. Things always look different from the other side of the fence.

Just thought I'd share.

 

[emt seeking first job]

Earlier in life I would probably have typed 2 pages on the complexities of this and the long term consequences.

But now I am of the mind to just say "go for it, and let me know how it works out in about 10 years."

Medicine is a business, and if you increase the cost of labor, ultimately the people paying the price are the people paying for the medicine because nobody along the chain is going to eat the increased labor cost.

In the US that is medicare, medicade, (both tax funded) insurance premiums, and of course aggresive billing practices regarding private payers.

Those cost increases you will be bearing, and will exceed by a considerable margin, the increase in your pay.

I envision a system where EMS and Health Care will be a public service. Just like k-12 Public Education, Police and Fire.

If someone wants to enhance the basic level of service, then just like one get get private security, education they can pay and get it.

It can easily be paid for by legalizing and taxing gambling and all drugs.

http://www.leap.cc/cms/index.php

It can also help if the people formerly investigating the baove go after tax avoidance, both of the off the books construction guy, and the upper level buisness owner.

No more tax avoidance. At least limit it.

No more cruise ships registered in Liberia. Thats insane. Is the friggin Liberian Navy going to rescue a cruise ship in distress ? NO !! The US Navy will. Therefore the ships should pay US Taxes and charge the passengers more.

By virtue of being in the USA, everyone gets free care to stabilize them. Then an assessment is made if they should be here. If not fly them back to their country of orgin. If that country wont take them, no more foreign aid.

Fly them back. IT HAPPENS ALREADY !!!!!!!!!!!

Just place them on a plane and fly the plane to where they are from.

http://www.nytimes.com/2008/08/03/us/03deport.html

It is just framed differently.

EMS is a new phemomena.

Health care could be free to all. The people who perform it could even get paid more than private health care if they organize, just like private secuirty and private teachers get paid less than public ones....