Will Fire-based EMS become a nationwide practice?

[Jayy]

What do you all think about Fire-based EMS becoming a nationwide practice? Here in South Florida, pretty much every agency that runs 911 calls is fire-based.

I think it has it's ups and downs. Some of the benefit is that departments can be extremely selective in who they hire. With deep background investigations, polygraphs, etc... more than likely you're getting pretty motivated, level-headed people on the job. Also because of the competitiveness of the job market down here, only the most skilled medics are likely to make it through the testing and year-long probationary period.

Some of the drawbacks are again, the competitive nature of the selection process and the fact that you're not only going up against prospective medics but also those who are more interested in the firefighter aspect of the job. I guess one could also argue that those who are in it for the fire side aren't as interested in EMS and won't do the job as well. But again, I think to make it through medic school and onto a department, you have to have some interest in EMS and be a proficient operator.

All in all it's a very competitive job market. Unless you want to go private and work mostly IFT, you're more than likely going to be testing for months, possibly years, before you make it into a department. But if and when you do make it on the job, the perks and pay are great.

Anyway, hope everyone had a happy new year!

 

[DesertMedic66]

I don't see the entire county going to a fire based system.

The fire departments in my area who transport are starting to run into problems because the fire department is funded through taxes however the departments are starting to charge patients.

 

[sir.shocksalot]

It will be interesting to see where the next few years go for EMS. The IAFF and the IAFC have been lobbying very heavily for fire-based EMS as the only way to go for every community in the names of firefighter jobs and colossal department budgets. On the other hand the economy is still pretty bad and many communities can't keep supporting expensive city departments, salaries, pensions, and other expenses.

With the changes to medicare and medicaid reimbursement to hospitals it would seem that hospitals should want to start getting into community paramedicine and ambulance services but I haven't seen much push for it yet around here. Although there is fierce competition between hospitals with ambulance services in northern Colorado and I wouldn't be surprised if they tried to spread their ambulance services to other communities.

There has always been some back and forth between who's providing ambulance services over the years ambulances have been around. Without some drastic changes on the federal level I don't foresee the back and forth changing any time soon.

 

[Angel]

But again, I think to make it through medic school and onto a department, you have to have some interest in EMS and be a proficient operator

Not at all. Most if not all firefighters become medics because thats what fire departments want. Most of the time they just half *** their assessments and have terrible patient care. Ie sitting behind the patient in the bench seat and never doing an assessment or talking to the patient. They do just enough to not get sued.

For many medic school isn't hard, and it's almost all putting on a facade to get hired and make it through probation.
Because fire can charge less for transports and EMS justifies their budget so... most fire departments are leaning toward becoming transporting agencies.
So I think yes in the areas that can afford it, they will.

 

[EMTinCT]

More like a transition to private EMS nationwide.

 

[drjekyl75]

There's a few different set-ups in the area I work in. The county I work the road in is 100% private ems for all 911 calls. Due to a huge change in the tax base over the last 20 years there is not enough money in the budget to fund full time fire/ems. The county where I work in the hospital is almost all fire/ems. Higher tax base and because the fire dept. gets tax money, some will only bill residents health insurance and anything not paid by insurance is waived. Fire based seems to work best in areas with higher tax base that can sustain. In my experience, fire based agencies don't generate enough revenue to self sustain on 911 alone.

 

[cprted]

The other thing is that the job of firefighter and the job of paramedic require different ways of thinking. People who make the best firefighters don't normally make the best paramedics and people that make the best paramedics don't usually make the best firefighters.

This is a quote from J. David Badgett, an assistant chief with the Los Angeles Fire Department:

"The typical firefighter is a very linear person," Badgett says. "They see a problem, they defeat the problem, they leave a winner. On a fire you do that. Emergency medicine isn't like that."

 

[Calico]

Our township fired our fire department last September. ;_; And our county hospital outsourced all EMS runs to a private agency. The county directly north of us just voted to privatize its ambulance because of issues of their own. A lot of it is budget and what people are willing to not only pay for, but what they think is appropriate. My husband said it great today, "If the cape is too long, you just trip over it." Our firemen can treat as MFRs, but even those who are Basics and Advanced are not permitted to transport because they are fire and people want the fire guys to do fire stuff and the medical guys do medical stuff. Even if one of the firemen ends up on an EMS call, he can't do anything without proper EMS supervision (because he is with the fire dept. after all) and we have to wait for city medics to come out anyway. Would it be nice if he could transport then? Absolutely. But I think the roles really need to be defined so everyone has his part and not everyone has all parts. Too many chiefs and not enough indians.

 

[Angel]

as much as a agree with @Calico and @cprted, it just seems the complete opposite in CA. more fire agencies seems to be taking over transport than the way around. Wish it was different.

 

[Burritomedic1127]

Fire departments are putting themselves out of business with better building codes, permits, and fire prevention. EMS seems like the logical easy solution for these departments. Doing something for the wrong reason will hopefully put departments like mentioned in their place. Were I'm from even FF/medics will tell you they're a FF first rather then a medic, while riding the rescue and hating medicals. It's one thing if the department truly wants to bring paramedicine to "better serve their community." But I feel that's a cover phrase to numb the public of a scam to continue getting paid to sleep on tempurpetic mattresses and watching hd tv in their rooms.

 

[Burritomedic1127]

Both are two different respectful professions? If its done right for the right reasons it could work, just hire single role medics for the department. If not, let fire fight fire and leave the medicals to EMS

 

[TransportJockey]

More like a transition to private EMS nationwide.

No everywhere. Here in TX, third service EMS (either city or county based) are doing well. And some places (like Indy) went to a third service EMS agency, taking it away from fire and hospital based.

 

[gotbeerz001]

There is money in transport. You better believe the departments are going to try and get some of that in the wake of dwindling budgets.

As I have said before, the effectiveness of this will be determined by the individual medics; for every ****ty fire-medic, there is a burnt out single-role. Both provide poor service, just in different ways.

 

[Burritomedic1127]

As I have said before, the effectiveness of this will be determined by the individual medics; for every ****ty fire-medic, there is a burnt out single-role. Both provide poor service, just in different ways.

Fair. But what about the good fire medic who gets burnt out and can't switch over to suppression based on staffing, seniority, budget, etc? If you have a burnt out single role they can transition to other medical fields easier whenever they want, not decided by rank and retirements

 

[gotbeerz001]

The best systems have them doing both, switching every other tour: one set on suppression, one set on transport.

Share the load. Keep all skills active.
Departments should not make transporting seem like a punishment or "paying of dues".

 

[Christopher]

What do you all think about Fire-based EMS becoming a nationwide practice? Here in South Florida, pretty much every agency that runs 911 calls is fire-based.

North Carolina is the opposite. Fire departments providing transport is rare and providing ALS transport is nearly unheard of (I work for one of the few). We're mostly municipal 3rd service.

The nationwide "practice" you have observed is due to the individual legislative frameworks (or lack thereof) that dictates which authority must deliver "EMS" (if even specified) in the given jurisdictions. These same frameworks dictate which authority gets the funds (or distributes the funds). Understanding those frameworks will help you understand the "why" behind EMS delivery in your area.

I think it has it's ups and downs. Some of the benefit is that departments can be extremely selective in who they hire. With deep background investigations, polygraphs, etc... more than likely you're getting pretty motivated, level-headed people on the job. Also because of the competitiveness of the job market down here, only the most skilled medics are likely to make it through the testing and year-long probationary period.

There is no known "right way" to provide EMS. Most of the Ups you listed are standard here even without fire departments running it.

Some of the drawbacks are again, the competitive nature of the selection process and the fact that you're not only going up against prospective medics but also those who are more interested in the firefighter aspect of the job. I guess one could also argue that those who are in it for the fire side aren't as interested in EMS and won't do the job as well. But again, I think to make it through medic school and onto a department, you have to have some interest in EMS and be a proficient operator.

Those are drawbacks with the institutional culture and employees rather than the delivery model. You can change both of those.

All in all it's a very competitive job market. Unless you want to go private and work mostly IFT, you're more than likely going to be testing for months, possibly years, before you make it into a department. But if and when you do make it on the job, the perks and pay are great.

The job market is competitive because the barriers to entry are extremely low: low educational requirements, and the relatively low cost for the schooling.

The only reason FD's tend (not universally) to pay better is the fire service receives a much larger chunk of tax revenues even in areas with municipal 3rd service EMS. If the funding ratios were consistent with risk assessments, then EMS would have the perks and the pay. (My dept is roughly 80% fire funding, 20% EMS funding; volume: 70% EMS calls, 25% non-fire suppression calls, and 5% fire suppression)

 

[Tigger]

There is money in transport. You better believe the departments are going to try and get some of that in the wake of dwindling budgets.

As I have said before, the effectiveness of this will be determined by the individual medics; for every ****ty fire-medic, there is a burnt out single-role. Both provide poor service, just in different ways.

It will not be determined by the medics but rather by the culture they work in. If a fire department can develop a culture where EMS is a priority that ensures that its providers will provide excellent care and service, things will be fine. Unfortunately, most fire departments are not very good at this simply because they have given themselves too many missions that they also need to balance. Note how I say most. Some can do it, but not all. If you leave it up to individual providers, you're not going to provide a quality service.

 

[Tigger]

What do you all think about Fire-based EMS becoming a nationwide practice? Here in South Florida, pretty much every agency that runs 911 calls is fire-based.

I think it has it's ups and downs. Some of the benefit is that departments can be extremely selective in who they hire. With deep background investigations, polygraphs, etc... more than likely you're getting pretty motivated, level-headed people on the job. Also because of the competitiveness of the job market down here, only the most skilled medics are likely to make it through the testing and year-long probationary period.

None of these benefits are exclusive to fire departments.

 

[Burritomedic1127]

The only reason FD's tend (not universally) to pay better is the fire service receives a much larger chunk of tax revenues even in areas with municipal 3rd service EMS. If the funding ratios were consistent with risk assessments, then EMS would have the perks and the pay. (My dept is roughly 80% fire funding, 20% EMS funding; volume: 70% EMS calls, 25% non-fire suppression calls, and 5% fire suppression)

Don't know if its just me but those numbers are painful to look at. Granted I know this is one department and not all, but I'm sure these numbers are pretty close all around. 80% of funding goes to something that happens on 5% of calls seems assbackwards. With FDs talking about dwindling budgets and cuts, the proof is in the pudding, fire calls are rapidly declining while EMS calls are increasing exponentially. Should make sense to fund EMS more but i know a lot of departments don't want that to happen cause they're FF only. Would it make sense to have LEO dual role FF 1 and 2 trained to put out small fires taking calls from the FD? Or FFs who get LE training to make arrests on the wire down call? Guarantee you neither sector wants to lose calls especially to someone in the same town. So why is it ok for EMS agencies to lose providers/contracts/calls?

Side note, if EMS raised they're education standards and call percentages continued trending in this pattern, EMS might just get the respect and pay everyone has been looking for for awhile.

 

[MonkeyArrow]

The problem with cutting budget from fire is that they need (relatively) more expensive equipment to do their job than their EMS counterparts. I don't know specifically how much money is given to whom, but a new fire pumper/engine can run in the 300K-500K range and a new ladder truck in the 750K-1M range. You can't justify cutting apparatus because then response times become egregious and houses burn down. To put out a fire, you really need (multiple) engines and ladders on scene. Therefore, the problem lies in the fact that you must be equipped to handle that 5%, and equipping to handle said 5% costs a lot more than handling the 85%.