Which do you like working for ?

[mellowdnb]

Do you like working for the private services or for the fire department ? What's the difference ? Why would you choose one over the other ?

:cool:

[Number43]

I currently work in a Fire District EMS system as a Firefighter/Paramedic. In years gone past, I did work in the commercial ambulance service. What we all need to remember is that the basic mission of the 2 types of services are different. Yeah, we all say we're there for the public, however the commercial services must turn a profit or else they close their doors. Hey, nothing wrong with making a profit, this is America. Most commercial services survive by doing inter-facility transports. Thats their bread and butter. Many do emergency service work to just keep their name in the public's eye. A form of advertising. Now being that commercial services function because of routine transports, that is were they assign most of their resources. This is how you do business. It's a fact of life. As a result, emergency service for the commercial based EMS service tends to get put on the back burner. Units available for emergency response tend to cover more and more territory causing an increase in response times.
On the other hand, public supported EMS systems, such as those associated with the Fire Districts, etc, rely on tax money to keep the doors open. This has the result of keeping units available for emergency response as oppossed to doing inter-facility transports. Although there is a small number of public systems that do charge a fee to the patients they treat.
Trying to compare public based systems to private based systems is like comparing apples to oranges. Both fruits are tasty, and good for you. However they do have different flavors. I personally prefer to stay working for the Fire District as a Firefighter/Paramedic.

[kghemtp]

I know great providers in the private transport service, so I can't dog that kind of establishment too much. I have seen very poor choices being made in commercial services, where volume is job one. I see profit-based EMS as someone's exploitation of medical necessity, and it's a cutthroat world where (in past experiences) heads of services have advocated bashing other services in hopes of bolstering business. Heck, I actively participated in the removal of pens & calendars of the competition at various facilities to be replaced with that of my service, at my employer's direction. You don't see bashing of neighboring fire departments' EMS transport setups. Sure, some departments have political axes to grind or whatever, but it's not competition over interfacility contracts. I find the fire service a much friendlier atmosphere when it comes to EMS, treatment of patients & fellow providers.

[Toering]

I dig working for a private service. However, I'm speaking with only working in a private servces. I have nothing against Fire or City based services. They can both offer excellent care, but they can both offer rotten care as well. Anyways, the reason I like working here, at this private is because everything here is so laid back and unstressful for me and my crew. We all know the job that needs to be done, and no one has any problems doing them. We offer excellent care and we have fun doing it. I will note.... and I'm sure alot of guys around here will agree..... There are some private owners that can be real bearcats. I know of alot of private owners that can be a real sore to work for. I'm thankful that we don't have much goverment here at the private I work for. So, in a nutshell.... less goverment means more freedom, and more happiness (at least here anyway) . Your bound to hear that privates suck..... I'm here to tell you thats not true.
Keep it real!!

[btroutm]

I currently work for a private, but I would definately prefer to work for a fire department. Unfortunately, fire departments around here do not offer the flexibility in scheduling that my private service does. While I enjoy the decent pay I receive from my private service, that's about the only thing I enjoy. I've got a long list of complaints about my company, ranging from uniforms and ambulances to dispatching and the nature of the calls we run. Of course, I can't forget to mention upper management...they're at the top of my list.

BRT

[dburnemti]

I work for a private service here in Alberta right now and things are fairly good all around, fairly laid back. But there are some changes happening here.The gov't in all thier infinite wisdom is taking responsibility for EMS away from municipal responsibility and giving it to the various health regions. This means there will probably be no more integrated Fire/EMS services(so we hear right now). The only info we have right now is this is going to happen as of April 1/2005. In our health region there are 14 sevices all to be funded by the Calgary health region. I can forsee quite a headache coming as the region is only required to fund to the BLS level. As I say this is very early in the process and I hope there is going to be some more info soon because there are alot of us that are quite worried about job security and placement. Has anyone else ever been through anything like this in past years?

[Dave1983]

Here we have a dual ALS system. An ALS unit from fire and a county ALS ambulance (run by a private contractor) respond on all emergency (911) calls.

I work full time for an FD and part time for the ambulance service. Which is better? Lets put it this way, I couldnt work for the ambulance service full time. I would lose my mind (what little is left:D). The stress level is MUCH higer, as is the work load. Your non stop most days (good luck on geting something to eat).
No going back to the station to "chill", 12 hours straight stuck in the rig.

They also dont seem to care much about the employees. Being a private company, they can (and do) fire people at will. They finaly got a union in (IAEP) and are working on a contract, so maybe things will improve.

Its a great part time job as far as working around my FD shifts, and the pay isnt bad but thats the only good things I can say about it.

Dave

[MEDIC247]

I work in the same system as Dave and work full time on the Ambulance side. I have been a Firefighter-Paramendic also and I personally prefer the Ambulance side. We recently changed companies from AMR to Paramedics Plus and the atmosphere is improving. :) I agree with Dave it would be nice to have a station to chill in between calls but in one of the highest call volume systems in the country it is not really possible. Here a total Fire system would be impossible due to the cost. The EMS authority will not let in other private providers and has said if the Fire Departments want to transport then they get them all inculding the inter-facility calls which make the firemen run and hide.

Which is better.... it is all your point of view and preference... both have up sides and down sides.

Frank

[PtsMedic]

Is there a reason that you are limiting the discussion to the two worst choices in EMS? What about third services or hospital based EMS?

I have worked for private companies in 2 states covering dozens of cities. Both states had fire as ALS first responders with either ALS or BLS private ambulances providing transport services. I have yet to see a fire department provide the quality of care that I would accept for myself or my family. I think this system is broken and needs to be fixed. If I ever have to call 911 for me or my family then I will guarantee you that I will end up suing the city because of how the system is set up.

Fire departments only provide EMS to justify large budgets. Few of the firefighters I know care about EMS and their patient care shows. The system is set up so that the fire department will arrive first. They have twice as more than many units on the street than there are ambulances. They run the scene even if the ambulance gets on scene first, no matter what the call is. The ambulance crews are not allowed to cancel the engines because if the ambulance can provide quality patient care without the engine crew, why should the city waste millions of dollars on 30 engines and hundreds of firefighters for 5 fires every year? The private service won't fight to change the system because it would cost them more money and if they challenge the fire department, they might choose another provider.

Most of the firefighters don't care about EMS. It is something they have to do between fires. They don't train for EMS because they are firefighters. The fire department provides 2 hours every month of EMS training and 5-8 hours every week of fire training. EMS training is optional, fire training is mandatory. Ninety-five percent of the fire department's calls are EMS. How can they be experts at something for which they never train? Jack of all trades, master of none.

The fire fighters always run through their entire algorithm before allowing the patient to transported to the hospital. The most important thing a paramedic does for the patient is provide safe transport to the hospital. The fire departments can't provide that because they don't have ambulances. The one local department that does have ambulances seems to have forgotten that fact because the engine is always dispatched first and if the patient is going to be transported, then the ambulance is sent. Definitive care is delayed to justify the cost of the engine and it's crew.

We don't trust the firefighters. The doctors and nurses at the ERs don't trust them either and we expect the public to trust them with their lives? And we can't even suggest a better system because it would cost us our jobs.

I support a tax based, municipal EMS system along the lines of Boston EMS, or Austin-Travis Co. EMS. I don't think the fire departments or private services should be involved unless the community absolutely has no other options.

[BKDRAFT]

Is there a reason that you are limiting the discussion to the two worst choices in EMS? What about third services or hospital based EMS?

I have worked for private companies in 2 states covering dozens of cities. Both states had fire as ALS first responders with either ALS or BLS private ambulances providing transport services. I have yet to see a fire department provide the quality of care that I would accept for myself or my family. I think this system is broken and needs to be fixed. If I ever have to call 911 for me or my family then I will guarantee you that I will end up suing the city because of how the system is set up.

Fire departments only provide EMS to justify large budgets. Few of the firefighters I know care about EMS and their patient care shows. The system is set up so that the fire department will arrive first. They have twice as more than many units on the street than there are ambulances. They run the scene even if the ambulance gets on scene first, no matter what the call is. The ambulance crews are not allowed to cancel the engines because if the ambulance can provide quality patient care without the engine crew, why should the city waste millions of dollars on 30 engines and hundreds of firefighters for 5 fires every year? The private service won't fight to change the system because it would cost them more money and if they challenge the fire department, they might choose another provider.

Most of the firefighters don't care about EMS. It is something they have to do between fires. They don't train for EMS because they are firefighters. The fire department provides 2 hours every month of EMS training and 5-8 hours every week of fire training. EMS training is optional, fire training is mandatory. Ninety-five percent of the fire department's calls are EMS. How can they be experts at something for which they never train? Jack of all trades, master of none.

The fire fighters always run through their entire algorithm before allowing the patient to transported to the hospital. The most important thing a paramedic does for the patient is provide safe transport to the hospital. The fire departments can't provide that because they don't have ambulances. The one local department that does have ambulances seems to have forgotten that fact because the engine is always dispatched first and if the patient is going to be transported, then the ambulance is sent. Definitive care is delayed to justify the cost of the engine and it's crew.

We don't trust the firefighters. The doctors and nurses at the ERs don't trust them either and we expect the public to trust them with their lives? And we can't even suggest a better system because it would cost us our jobs.

I support a tax based, municipal EMS system along the lines of Boston EMS, or Austin-Travis Co. EMS. I don't think the fire departments or private services should be involved unless the community absolutely has no other options.


Your speeking for your specific area, it's run different out here in California. I don't even know where to begin.

Yes, private companys are still in it for profit, that is why all EMS service does need to be provided by a public agency. Now that doesn't mean that firefighters have to work on those ambulances, they can hire non-sworn EMS personnel to work on the ambulance. This is the best thing for the public and I see EMS heading in this direction.

[streetmedicsx2]

EMS has long past its original goals and is in need of restructuring. I don't think the system can mature and be a recognized healthcare provider if it continues to stay in the NHTSA. It will not fit in with fire fighting since it will always be the secondary function of those agencies. EMS needs to have its own department within the DHS along side of the fire fighters and law enforcement. We really don't need more associations, registries, or organizations "to create a stronger EMS" these entities all have their own goals and desires and only reach small percentages of EMS providers.
We don't accept each other largely because of the organizations that further create division because we all don't belong to the association or registry. We are all taught the national curriculum and passed testing so why can't we work anywhere in the nation? A nurse can basically go anywhere with training from the persons home state. We have 5 counties surrounding ours and all of them are in a different system, which means I can't work in their county without going through their system, but we all have licenses from the same state.............??
I think we should continue with a national curriculum via the Department of Homeland Security and have nationally recognized licenses.
I have seen both good and bad while working for private- with fire dept.bls response, hospital- with local rescue dept response, and government funded- with in house rescue assist response.
Privates do need the call volume and don't hesitate to do transfers of any length at any time, at the cost of responding to 911 calls, which other companies in town pickup.
Hospital based rely on your service in house along with responding to 911 calls, and doing transfers. These can be long shifts since you are expected to function in the ER as soon as you are back in service.
Government agencies for me have been the best, a lot less pressure when it comes to need of call volume, but we have limited resources which make me feel uneasy. We have a local hospital that receives patients from three other counties. Our hospital is a critical access hospital so it is limited to what it can acutally admit and care for. If the patient needs to be sent on to a larger hospital ALS then I would take it, but it leaves our county with EMT-B/D coverage until the ALS unit returns which is normally almost 3 hours. This has been this way since the start of the service and seems to be accepted.
This is something that I would like to see changed too.
If we can't get over obstacles in our own state how can we become a strong national system?
Lets get it together. Don't you think anywhere you work will be better if your license is recognized nationally like other healthcare providers are?

[PtsMedic]

Your speeking for your specific area, it's run different out here in California. I don't even know where to begin.

Yes, private companys are still in it for profit, that is why all EMS service does need to be provided by a public agency. Now that doesn't mean that firefighters have to work on those ambulances, they can hire non-sworn EMS personnel to work on the ambulance. This is the best thing for the public and I see EMS heading in this direction.
Hate to disappoint you, but California is the state where I started my career. I have worked in Los Angeles and Orange Counties. The fire departments there are worse than here. They don't have ALS ambulances responding to 911 calls in those counties because if there were other paramedics on scene, the fire departments make sure that the public knows that only the fire departments are capable of providing care. But the firefighters don't want to run EMS. It is a chore they are stuck with while waiting for the next big fire that almost never comes. LA City Fire Department is one of the most incompetent EMS agencies I have ever seen. I wouldn't trust them with my care if my life depended on it, because it would, no matter what my chief complaint was.

Fire has no business doing EMS, period. I agree with you that EMS should be provided by a public agency, but it should be one dedicated to EMS and only EMS.

[croaker260]

Your Now that doesn't mean that firefighters have to work on those ambulances, they can hire non-sworn EMS personnel to work on the ambulance. This is the best thing for the public and I see EMS heading in this direction.
Thank you for proving Ptsmedics point on EMS being secondary to fire. By "non sworn" what you mean is" poorly paid, poorly treated, grunts who do most if not all of the BS end of the fire service..and dont even get the benifits! Fire once again wants the benifits of our work, while keeping us as far away from them and trheir antiquated ways as possible.

I have said it before...The fire service had a chance to change EMS for the better, like a new stepfather with a young child. The chance for a new family and a new begining. Well like the step child we are, the fire service has brutalized and dismantled all the progress made by the visionaries of the 70's.

ALS level EMS needs to be a third service civil service organization, far away from the IAFF and their parasitic union stewards as possible.

[PtsMedic]

Now that doesn't mean that firefighters have to work on those ambulances, they can hire non-sworn EMS personnel to work on the ambulance.
Thank you Croaker for pointing out what I missed. This sentence is the biggest problem with fire based EMS. Firefighters think they are too good to be paramedics. When they work on the ambulance it is because they "have to". What kind of paramedic does that make? Someone who resents the patient because they are being forced to do a job they don't want to do in the first place. And God forbid they miss a fire because some stupid @$$hole should choose to have their MI at the same time as a fire kicks out.

Something I have noticed that nontransport paramedics don't realize is how important being with the patient the entire time is. Engine medics never think about how their treatments affect patient outcome. The patient has a chief complaint and the fire department has an algorithm to treat that chief complaint. Sorry, but few of your patients have actually read your algorithms. Not every stubbed toe needs high flow O2. Most firefighters I have worked with don't even realize that high flow O2 causes vasoconstriction and actually decreases systemic perfusion over relatively short periods of time. But their algorithm says high flow O2 is good and dammit, that's what the patient is going to get.

How often do the fire fighters you work with actually talk to the nurses or doctors about the patients? How much follow up do you do? As a transport medic, I talk to the doctors and nurses on EVERY patient. You would be surprised at how much you can learn about medicine just by giving your report to the nurse or doctor.

How often do you give a complete report to the transport medic? When I respond with an engine, I NEVER get a complete report. It is rare that I even get history, allergies and medications. The firefighters usually write, "see list" without providing a list. I've seen patients almost killed because some lazy firefighter didn't report that a patient was allergic to a med. that is in the algorithm but they can't be bothered to do a thorough job. Even the best medic, who cares about EMS, is going to forget from time to time and what is best for the patient is the minimum number of times care changes hands.

The only reason the fire department has to argue that they should do EMS is because they state they can get on scene first. They can only get on scene first because they have manipulated the system into bloating their departments while preventing a service that would do a better job from even being created. What is best for the patient is to have one EMS crew assess, treat, and transport the patient, without interupting care, until the patient's care is transferred to the ER staff.

[peon30]

Pts medic............doc beaker is that you?

[PtsMedic]

No, it is not.

[OCFirePM]

You obviously are another disgruntled medic who cannot get a fire job. So goes the story once again....

There are two types of paramedics, those who are firefighters and those who can't be.

Care to guess which one you are?

[JHR1985]

You obviously are another disgruntled medic who cannot get a fire job. So goes the story once again....There are two types of paramedics, those who are firefighters and those who can't be.

Care to guess which one you are?

I laughed so hard at this. Good point

[PtsMedic]

You obviously are another disgruntled medic who cannot get a fire job. So goes the story once again....

There are two types of paramedics, those who are firefighters and those who can't be.

Care to guess which one you are?
I have never wanted to be a firefighter and I never will. Not all firefighters are ignorant morons like you, but enough of them are that I will never call 911 for myself. I might get stuck with you. Now, instead of throwing insults, maybe you can answer with something constructive to justify delaying definitive care by dispatching an engine first and having firemedics treat a patient when they resent the fact that they are stuck doing a job they don't want while waiting for the next fire.

[OCFirePM]

I work in a system where the fire department provides all ALS level care with paramedic engine companies or squads, with at a minimum of two paramedics( more often than not everyone on the engine is a medic) and ambulance transport is provided mostly by private companies who provide BLS level care. If the call is an ALS follow up, a medic will ride with the patient to the hospital, bringing ALS gear with him and the engine follows to the hospital.

We take pride in being paramedics, have many hours of CE each month, just as much as fire training. We have EMS coordinators, QI/QA, and a full effective customer service oriented system.

Every run sheet is audited and all of our stats are kept track of through this system, thus if someone developes a deficiency in a particular field, then it can be identified and remediated to assure proper care is given.

Being a ff/pm is a promotion above ff and a good bonus is given for maintaining your license. My department has been the sole provider of ALS EMS since the 1970s. Many officers have been paramedics for 20+ years and still enjoy helping out with patient care.

Your critique of fire department based EMS is way too generalized, while I do agree that there are fire medics out there somewhere who may not enjoy their position, you cannot finger the entire fire service and label us the way you have. In fact, I would argue there are just as many private medics out there who hate their job as well. It is a two way street.

My county has embraced EMS to the fullest extent, and have a created an entire fire based EMS system. Some agencies use paramedic engines/squads, some use paramedic ambulances as well as paramedic assessment engines.

Why must you have an ALS ambulance on every call? You just need an ALS unit and that can be provided in many different fashions. An ALS engine with a BLS transport is just as effective as an ALS ambulance. Plus, having BLS units as transport, affords the ALS unit the opportunity to send a BLS patient with the BLS unit and keep the ALS unit in service. This ensures the maximum amount of ALS units are kept in service for timely reponses, where in my county the average response time for an ALS unit to be on scene is 5 minutes. Can you say your current system can maintain those standards?

Being the Fire Departments are the sole EMS provider maintains better budgets for the best equipment possible, as we are not driven for profit and all proceeds collected are immediately put back into the fire budget for better care/equipment and training. Everything we use is the top of the line, assuring the best tools possible to provide patient care.

I have been a private paramedic, an assessment engine medic and now a medic who is the sole provider on an engine company and I can tell you I love my job, I love patient care, my department has awesome relationships with area hospitals and I love every day I go to work.

All of your comments are generalizations and are not applicable to the ENTIRE fire service, and all of your comments seemed to be geared in the San Bernardino/Riverside County areas of Southern California. (Tell me if I am wrong). In my area firefighters love providing EMS, EMS is only 85% of our call volume, we train just as much on EMS as we do fire and EMS training is mandatory! If I were to be a betting man, I bet I had more EMS training last year than you did. I average 3-6 hours a WEEK of mandatory classes/ skills stations.

Please keep your generalizations down, don't lump all firefighters together in your negative world, just cause you hate going to work doesn't mean everyone has to.

Have a great day!

[PtsMedic]

"Why must you have an ALS ambulance on every call? "
Why do you need an engine on every call? You still haven't answered my question. The vast majority of all EMS patients need a doctor, not a paramedic. The most important thing paramedics do is provide transportation to the hospital. Yes, we provide care and benefit the patient in that respect, but the patient really needs a ride and a fire engine can not provide that service. By developing a system that is dependant on having a fire engine respond to all EMS calls, you are creating a system that delays definitive care and harms patients.

"
Being the Fire Departments are the sole EMS provider maintains better budgets for the best equipment possible, as we are not driven for profit and all proceeds collected are immediately put back into the fire budget for better care/equipment and training. Everything we use is the top of the line, assuring the best tools possible to provide patient care."
No, what you do is create a system where the fire department has the best budget and equipment and EMS is left to suffer. How well funded are the ambulance providers in your area? Since Orange County depends on private ambulance companies to provide transport, the ambulances are dependant on what the employer wants to spend and spending money is not profitable. What happens when the BLS ambulance with substandard equipment is first on scene? If the patient needs ALS, care and transport will have to be delayed until the engine arrives, again harming the patient. I have worked Orange County. Yes, it is better than LA, SB, or Riverside counties, but that does not make fire based EMS the best for the community.

I stated in an early post in this thread that a municipal EMS service, seperate from the fire service would be the best for the patient. You obviously made your comments without reading what was said. And you still haven't given any reasons why a fire based service would be better than a third service. You only compared fire to private. My original post stated that those two choices were the two worst of all EMS systems.

"Please keep your generalizations down, don't lump all firefighters together in your negative world, just cause you hate going to work doesn't mean everyone has to."
I never said all, I said most and I stand by that statement. I have met some fire medics that were great paramedics and good people. They are the exception. But even if every firemedic were just like them I would still argue that fire based EMS causes too many problems that a thrd service would fix. A municipal third service would get all of the budget benefits that you stated is the strong point of fire service EMS.

"There are two types of paramedics, those who are firefighters and those who can't be."
You commented about my generalizations did not reflect the attitudes of OCFA, yet your original statement has the same exact attitude I commented on in the previous post. You state that OCFA is better than other departments in your area and you don't like being lumped in with inferior departments, but it is obvious from your statements that you have the same exact ego issues that I mentioned.

"we train just as much on EMS as we do fire and EMS training is mandatory! If I were to be a betting man, I bet I had more EMS training last year than you did. I average 3-6 hours a WEEK of mandatory classes/ skills stations."
Do you devote that much training to all of the skills the fire department has assumed? 3-6 hours for EMS, 3-6 hours for fire supression, 3-6 hours for hazmat, 3-6 hours for TRT, 3-6 hours for swift water rescue? When do you have time to work? And if you spend so much time training on so many different areas of specialization, how do you prevent the training in one specialty from distracting from the others? Jacks of all trades, masters of none.

So far you have been nothing but a bag of hot air. You seem to take offence that I criticized fire based EMS, but you will only compare it to private EMS. How about comparing it to a municipal EMS agency, staffed by sworn personnel, utilizing an EMS budget of comparable proportions? How about explaining why it is best to keep a patient having an MI from the cath lab, while your engine crew waits on an ambulance, when a third service could initiate transport any time after arrival?

[croaker260]

You obviously are another disgruntled medic who cannot get a fire job. So goes the story once again....

There are two types of paramedics, those who are firefighters and those who can't be.

Care to guess which one you are?
I am going to reply to your other IAFF propaganda ridden post later, but I will reply to this today. I too am NOT a firefighter, don’t want to be, never had wanted to be. I am competent, I am fit, and most of all, I realize that every day I am witness to the best profession in the world. AND IT ****ES ME OFF THE WAY THE FIRE SERVIICE HAS DESTROYED IT. I have had enough contact with firefighters to generally consider them dishonest bullies until proven otherwise, but lets focus on the your post.

Your statement illustrates all that is wrong with the fire service..that if your not a fire fighter, you aren’t $HIT. It completely escapes you that there might be a better way of providing EMS than a 1/2 million dollar behemoth running to every call, filled to the rim with paramedics while the ambulance comes by to transport, and if they have time, kiss your @ss while doing so.

Wouldnt it make sense that as complex as the art of medicine is, that it should be a specialty? Or is the only profession that deserves your utmost dedication is that of firefighting? Everything is cake when your walking on water?

Let me ask you , if every FF is a medic, assuming that you only get a set number of calls a shift, unless you are running 20 calls a shift, how do you stay current? How many tubes, real field tubes, do you get? How many RSI's a year. How many truly critical calls do you get to manage. How much real experience do you really get?

If we can agree that patient contact, from start to finish, is as important as lots of training, then how do you believe you are doing your fellow medics justice in reaching their potential or doing your patient s justice when you provide them ALS care.
Now at this time you are probably thinking ...but not every call is a challenge, what is the value of THAT experience...well in there lies the second half of the argument against ALS engines...if your running only a few calls a day, and even fewer of those are real ALS calls, then why do you need medics on those engines. Wouldn’t it be money better speant on transport units?

While it makes a good sound bite, you do not need a paramedic on every scene. It is a waste of resources to do so, and its bad on the medic as well. The only group it benifits is the IAFF. Why not follow some variation of the King County Medic One's model, with the only paramedics in the system going on ALS call after ALS call, after ALS call, with BLS fire and transport handling everything else?

Ohh ...I know...then emphasis in funding and training would be where it needs to be, in EMS helping people.....then Fire and EMS would be doing their own specialties, and working together happily, instead of you guys trying to keep good men and women down because they are not like you. Well it only makes sense if your real goal is protecting jobs, promoting your sophmoric brotherhood, and not the public well being.

In your other post you try to make it sound like its just a few bad apples who are treating medics bad. How can you say that after you yourself make the statement that you have. You have yourself implicated yourself in supporting the fire service's exploitation of EMS.
Well its not a "few bad apples" ...it is a SERVICE WIDE PROBLEM that puts good medical care second. It is a CULTURE dysfunction. After all your service (the fire service) has opposed every significant step in the progression of EMS over the past 10 years. How can you say you personally truly embrace EMS when your concept of a good medic is based solely on if they are a fire fighter and not on their medical skills? If you are a representation of your service (both your service and the fire service), how can you even believe that you embrace EMS?I would say that that perception that EMS is second to fire service is not just your problem, but your chosen professions problem, and therefore not an over generalization but an insight into a crisis in the coming years.

[OCFirePM]

First, there will always be more fire engines than ambulances, fire stations are closer and more available than ambulances. Typically there is one ambulance for every 2-3 stations in my county. That is if the Fire Department is providing the entire service, private ambulance companies can keep a fairly large amount of BLS ambulances available for calls, but 95% of the time the Fire Department here will arrive first and being we utilize a paramedic engine system, then you have ALS at the door in 5 minutes or less. The private ambulance companies have a contract to be on scene is less than 8 minutes over 90% of the time.
Paramedics will assess and begin treatment, transport arrives fairly quickly and the patient is loaded onto the gurney by the EMTs and transport is initiated in a timely manner. We have an average on scene time of around 10 minutes from beginning to end. Thus, being you have ALS care on scene in around 5 minutes and transport initiated soon after, how is patient care compromised in this system? Care has never been delayed, we get ALS on scene FASTER than most systems in the country, probably even yours with transport being available quickly in another 3 minutes.
What is your system's response times and what area?

AS for equipment, we have the best of everything, not a dollar is spared in the EMS system, we carry the latest cardiac monitors, best gear, equipment, drugs, any assessment tool. If something is updated, we purchase it. The Fire Department here is EMS, thus a large amount of our budget is spent in this avenue.
What does a private ambulance need? O2, blood pressure cuff, BLS airway,AED, they have all the basic tools to provide a basic assessment, and being they make it on scene first less than 5% of the time, they really do not utilize it that much.

While a third service is an option, you would need to demonstrate its cost efficiency vs the Fire Department. By creating a whole new system, you create a whole new DIVISION of people, who will pay for all of this? Don't the tax payers pay enough already, why have two separate divisions, each with its own budgets when the fire department can do the same level of service for around half the price? That is a lot of money is pensions, OT, etc. Why pay a firefighter and a paramedic salaries when you can pay a firefighter/paramedic in between the two and get the same level of service, same response times, same level of care, etc.?

As for training, I do so many hours for firefighting and EMS per week, I am not on the HAZMAT team, I am not USAR, I am not swift water, but those guys who do, have to do the extra training and they have VERY busy schedules. This is why they are paid additional for participating on these teams. They sacrifice a lot to do it.

As for everything else, I would imagine a third service is great, but who pays for it? If I had my way, we would have an ambulance in every station but it is not cost feasible for us. You come up with these perfect world scenarios but we do not live in that world, there are no endless budgets. The Fire Department has proven time and time again that is can provide the same level of care with the same response times and transport times as a third service and can do it cheaper since the fire system is already in place.

How many systems can have ALS on scene in an average of 5 minutes with transport on scene in less than 8 minutes over 90% of the time?

Did you know LAFD has announced it plans to place a paramedic ambulance in every station? Would this satisfy you? Would that make the fire based EMS service of LAFD ok in your book since transport is right there following the engine to the call?

As for the MI scenario, I would assess my patient including a 12 lead, treat the chest pain according to protocols, make base contact and when confirmation is made of MI with the 12 lead, initiate transport directly to a cardiovascular receiving center where a cardiac team the size of a trauma team is waiting to take the patient immediately to the cath lab. ALS on scene in 5 minutes, transport on scene 3 minutes after that, off scene in 7 minutes, 5 minute average transport time to cardiovascular center, into cath lab minutes after that. Total time elapsed from 911 call to cath lab 20-25 minutes.

And as for my other funny comment, I could tell you guys weren't fire because you took so much offense to my joke. Gotta have thick skin sometimes, learn to laugh.


As for you croaker, I am too tired to talk to you, so be safe out there, and have a great day!!!

[RescueTrash]

In my area the average cost of running a BLS ambulance is around $300,000 per year. If your citizens will foot the bill for a new service then have at it. A local county will put just such a measure on the ballot this year, everyone in the county will fund the service and those who use it will also be charged transport fees. Currently only those being transported are paying for it. My guess is that it will go over like a turd in a punch bowl.

Don't fool yourself-there are good and bad providers in every type of service. The last non-fire service in the area used to dig through garbage cans for our used equipment, wipe it off and put it back on their rigs. If I made a generalization that your service and the majority of the non-fire providers out there do this I sound like an idiot.

[PtsMedic]

"First, there will always be more fire engines than ambulances, fire stations are closer and more available than ambulances. Typically there is one ambulance for every 2-3 stations in my county."
That is only true if you have a bloated fire department that is preventing funding from reaching departments that would be more appropriate. If fire were to not run EMS and they were staffed appropriately, then EMS would beat fire every time. The fire departments manipulate the system to make sure they seem to have the shortest response times. Where I work, we can get in trouble with the fire department if we beat them onscene. It eliminates their argument that fire has to be the one running EMS.

"While a third service is an option, you would need to demonstrate its cost efficiency vs the Fire Department. By creating a whole new system, you create a whole new DIVISION of people, who will pay for all of this?"
The city I currently work in has 28 fire supression vehicles, with 5 more stations planned to open in the next 5 years. We currently have 14 ambulances. The city fights make 20 major structure fires each year. How much does an engine cost? $500,000? How much does an ambulance cost? $100,000? Now, add the cost of supplies. How much do hoses and saws and pumps cost? The city needs half of the supression units for it's fire needs. For less money, you could have twice as many transport capable EMS units, staffed with the same number of paramedics and EMTs, have less problems with competition for skills. What additional costs are you talking about? HR? The city should have one HR department that handles FD, PD, EMS, and all other city employee needs. Management? The fire department needs a captain on every unit. EMS needs far fewer. It would be much less expensive to have an EMS agency.

[OCFirePM]

The goal of any public service industry is to have the shortest response time. Why you try and state that my department is "bloated", my department demographics are based on the national industry standard for the population and size. Therefore, you would have to say that all fire departments are "bloated".

What qualifications do you have to determine if a system is bloated? Are you a member of OSHA or NFPA? How do you make your determination?

As for you other statements as for what things cost, engines vs ambulances, you are VERY off in your estimates, have you ever sat on an apparatus committee? Have you ever purchased an engine or ambulance? How do you know what the costs are? Ever served on an equipment committee? Ever purchased any items for your department, done the research ,collected bids and presented them through the chain of command? Just taking a stab at it?

You are making a lot of statements and you have not shown you possess any knowledge or training to make the statements you have about what things cost, or how much fire protection a city needs.

Being you are not a firefighter, never have been, nor want to be, I think it best you stay away from any statements about what fire protection is needed, being you have no knowledge or education to back your "claims".

As for additional costs for a separate EMS division, lets break it down in a very rough fashion:

A building or area for offices.
Administrative staff for all paperwork and admin functions
Office supplies for an entire department
Billing department/ Insurance specialists for collections or contract outside company.
A chief or head of department.
Operations Manager/ Division Chief/ PIO
EMS Coordinator
QI/QA
Vehicles for all of these people
EMS Captains for field supervisory roles, MCI issues, etc.
Front line personnel (Two paramedics per rig to satisfy county requirement)
Salaries, benefits, overtime and retirement package for all employees
Benefits average about 50% value of employees salary. (50,000 yr +25,000 year for medical, retirement packages.
Separate hiring exams, background checks, medical exams, etc.
Separate training for all these employees.
What about insurance, since you are not part of the Fire Department, you are not under their liability plans, unless the City is self-insured, then you may have a chance with those costs.


Do I need to keep going?


Yes, I have served on an apparatus committee, I have helped purchase engine and ambulance apparatus, I do know what these things cost.


Using your line of thinking maybe we should start removing fire hydrants, being we don't use them that much, it would be cheaper to place them every 1000 feet in residential neighborhoods instead of the standard 500, we can cut them in half. But then your fire insurance doubles due to decreased water supply. Engines have to purchase more supply line for the longer lays, which is more maintenance cost, and increase weight on the engine which will use more fuel and increase wear on the engine, causing the engine to breakdown more and now you have to pay OT to the mechanic to get it back in service..... Oh well, I guess we cannot have it all.

[PtsMedic]

You are right that I have never served on am apparatus committee for purchasing fire engines. I have, however, for ambulances. The new Braun ambulances we just bought were about $140,000. According to the newspaper report, though, the ladder truck that Phoenix FD destroyed last year in a traffic accident cost $1,000,000. Seems to me that a $140,000 ambulance is more cost effective than a $1,000,000 truck.

As far as the other costs you listed, yes, there will be a slight increase in office supplies, servicing 2 departments, but you can subtract that from the $860,000 savings from not buying that new ladder truck. Many of the administrative staff can be shared among all 3 public safety departments and other city services. Those that can't would cost more, but not as much as you think. Look at command staff. Mesa FD has a captain on every unit, plus several roving captains, 2 or 3 battalion chiefs for each shift (3 shifts) and the chief. That makes close to 130 supervisors. An EMS agency for a city the size of Mesa would need 1 chief and 2-3 field supervisors per shift. So and EMS agency would have 10 supervisors compared to the 130 for the fire department. Does you fire department bill customers? If the EMS agency does decide to bill, those costs would be covered by insurance. Most tax based fire departments I know of do not bill for engine responses as it is covered by taxes. All of the other costs are true for the fire department too. And if the fire department is reduced in size, then the savings would come from not paying for the bloated fire department's extra costs.

You are correct that I don't know what the fire supression needs of a community are. What I do know is that they need to have enough units able to respond to put out the fires in the area. From what I have seen, the local fire departments use 4-5 engines and trucks on a typical fire. As long as there are enough units to cover the fires that break out with some to spare, along with mutual aid agreements, then the city should be covered. since fires are a rarity, having 28 engines for 1-2 major structure fires definately seems bloated.

Now what happens where there is a fire and the EMS units responsible for providing care to the community can't respond because they are too busy fighting the fire? Two years ago, San Diego was threatened by wildfires. All but one of their ALS engines were dedicated to fighting the fire. The city is designed to be dependant on having an engine respond to every EMS call. There was one engine available to run EMS in a city with a population of 1.2 million. Are you telling me that 1 engine is capable of competently covering that many people? They had to run PSAs begging the citizens to not call 911 unless they were actually dying. How is that providing the EMS care the department promised. They were lucky they weren't sued. If EMS was run by a seperate agency then EMS wouldn't have suffered because of a fire.

[JHR1985]

Seems to me that a $140,000 ambulance is more cost effective than a $1,000,000 truck.

I have to disagree with that comment. Number one: engines can be kept for a lot longer amount of time. For example, that engine may be front line for the next 5-10 years but can be a reserve for another ten years. Where as a ten year ambulance... is like a rental car: rode to $#%*. On our department, a 5 year old ambulance is the step-child because its on its last leg. To be honest, every 4 years is when we try to get new ones.

Our reserve trucks are nearing twenty years and still running. Our reserve ambulance.... I'll just say that I dont put it on high idle because the i'm afraid I'll blow the engine.

And a million dollar firetruck.... to me seems kinda high. That may be a million with all the equipment we can be taken off and put on another truck.

[PtsMedic]

If you replace the engine every 300,000 miles, at $14,000 today, then the ambulance can and will last a long time. The ambulance I am currently on has been in service for 8 years and runs great. If you take care of your gear, it will last.

As far as the $1,000,000 truck, that was what was reported by the news media. It was a top of the line truck with an extra long ladder, but it doubt it is that much more than most trucks.

Since OCSuperhero has been on the committee to buy engines, let's have him tell us what the average engine costs.

[OCFirePM]

Yes, I am aware of a 1,000,000 tiller quint truck. However, last time I checked, an ambulance cannot access 9-10 story windows, does not ventilate buildings, does not perform high angle or rope rescue, does not perform forcible entry/exiting, does not provide lighting on the fireground, pump water, carry a full complement of ground ladders, have a water tank, perform auto extrication, etc. etc. Ladder trucks are a necessity according to the NFPA and you need so many ladder trucks per area and special trucks are needed for certain hazards in the first in district, for instance high rise will need the longest ladder possible to access windows for any rescue situations.

As for your other comments, City Hall is busy enough and if you have never worked for a City in administration, you have NO idea how busy those great folks are. One department cannot possibly handle three different public safety divisions, this is an impossible task. Each division maintains its own administration.

I imagine you probably learned that in your public administration class, oh wait, you have no background in City Administration so there goes that.....

You are missing the point for the superivsors. The Fire Department will always maintain its current supervisory level and staffing. By adding on your "EMS Agency" you will need to hire ADDITIONAL supervisors to cover these new areas that you have created which are currently under the realm of the current administration, hence additional cost.

Every engine or truck has a Captain. Every 6-8 stations will maintain a Battalion Chief, every 2-3 Battalions will maintain a Divison Chief. Each operational section of the Fire Department, administration, training, prevention, operations, will maintain a supervisor (Division Chief) to maintain a chain of command. Many forget the Fire Department is ran like a Police department in being a paramilitary organization with a chain of command and span of control.

Your "EMS Agency" would need to maintain at least a Chief, Operations Chief, Training Chief, EMS Coordinator, Administration, Legal, Billing/Financial, QI/QA, Field Supervisors (Captains) and still maintain a sensible span of control....

You probably learned about this in your ICS classes, oh wait, you don't have a background in fire administration, I forgot.....

As for your other comments about fire response levels and all that stuff I cannot begin to start the learning for you about how a Fire Department is resourced. If you really want to learn take an ICS class and see how it works.
Hell, why not go to your local fire station, bring some cookies, ask for 30 minutes and ask the local engine company how does it all work? Instead of just speculating and throwing our ridiculous statements in your lack of knowledge of how a fire system is set up.

As for the San Diego Fires, buddy, I was in the Cedar Fire and you have NO idea as to what the hell you are talking about. You want to pick the worst firestorms in the HISTORY of the state of California and talk about how the fire department did not provide adequate service? That was the worst fires that area has ever seen, and hopefully only a one time event. The Fire departments did the best they could with what they had. It is just like running an MCI, you make do with what you can, triage, and try not to be overwhelmed with the situation. Except this MCI ran for over a WEEK!!!! I fought fire with guys while they were on the phone with their wives who ere telling them their house was burning down.

Take 9/11, how much of the EMS resources in Manhattan were directed to the lower part of the island? DId you know they actually could not take 911 calls during the attacks? They recorded a message saying sorry, can't help you and that is what you got when you called 911. Medical calls were still out there and they did the best they could with what they were dealing with. Would you blame the EMS agencies in New York for not having enough resources to deal with a disaster of that magnitude?

Now, I am in no means comparing the San Diego Fires with 9/11. I am just trying to use an example on how it is unfair to judge an agency based on the worst incident they ever had. It would be like picking Oklahoma City during their bombing, or NOFD and NO EMS during Katrina, they did the best with what they could, same as all of those guys in San Diego.

You want to judge a system ,look at its daily performance records, I'll bet SDFD has some great resonse times for ALS on scene.


I would have to say I have enjoyed our little debate here on this forum. We are both the products of a system we were raised in and I would suggest trying to find a system you would enjoy working in and go there, as opposed
to downgrading a system you "feel" is inadequate. I am in the same boat however, I am passionate in the quality of the system I work in and I personally feel it is the greatest around and will defend it.

Why don't you go find a third service and sign up? It seems you would be much happier there and might enjoy your career a lot better there. I bet you have had MANY converstation with people about this same topic, sitting in the rig or at the hospital talking to other crews about firemedics and how you don't like them, eh? And if I had a nickel for every time you probably have, I would not need to put money into deferred comp. Bagging on Fire and arguing about how you think they suck and all that jazz is a waste of your time. One of the fun freedoms of being a medic is you have the opportunity to find a system you enjoy working in, sign up and be a part of it. Some like my system, some like the system you are in right now, some like third service, hospital based, etc.

Again, I enjoyed our discussion, as I am sure many others have too. I hope you have a long fun career as a paramedic, enjoy your time out there, be safe and I will agree to disagree with you my friendly foe, this ends the debate for me, but one last observation.....


Isn't it ironic that this whole topic of Fire based EMS vs others took place on a FIREHOUSE forum, I was just trying to figure out, since you are against fire so much, what the hell were you doing on this website in the first place?

Have a good one!

[PtsMedic]

I am amazed at how much you comment and how little you actually read.

Much of what you are saying is proving my point. EMS and Fire are apples and oranges. They are two totally seperate fields and need to be kept seperate.

Yes, I know how the ICS works. I have worked probably as many MCIs as you have. Have you ever worked a rollover where the coyotes' van, stuffed with 25 people, and you and your partner were the only ones available to work it for the first 30 minutes? Try working rural EMS. I have been IC on 5 car MVAs. I know how to run an MCI.

Yes, you are correct, the nice, expensive ladder truck can reach very tall buildings, but can it transport a patient? Can it provide a safe environment to assess and treat a patient? No. It is designed for firefighting and not EMS, so why send one on an EMS call? Why risk a million dollar piece of equipment by having it run lights and sirens to every medical call that kicks out? Why endanger the public by having a large, clumsy truck respond to every EMS call? When Phoenix wreck their's it was responding to an EMS call.

As far as supervisors go, you seem to forget that under this plan, the fire department would be no where as large as it currently is. The savings from downsizing fire would pay for the smaller increase in EMS management.

Now, I didn't mean to disrespect what SDFD did during the firestorm. They did a great job, as do almost every department during fires. But my point is that they couldn't provide EMS during the fires. You compared it to 9/11. Yes, FDNY's capabilities were reduced, but they did still have the capability to run EMS. There were still EMS units available to run calls, where SDFD did not. They had to rely on the transport agency to handle all the calls. They later announced about how well the system worked during the crisis. What they didn't realize was they were pointing out how well the system worked without them. Imagine how much better the system would have worked if it had been set up to have EMS seperate from fire in the first place.

You said that I am a product of the system I was raise in. You forgot that the system I was raise in is your's. I started my career in SoCal and I have worked with OCFA. I agree that they are one of the best in CA, but that isn't saying much.

As to how I found this forum, I did a search for an EMS topic and this was one of the results. How much EMS research do you do outside of your official training?

I would go find a nice thrid service to go work for, but unfortunately, the IAFF is doing it's best to run ever nonfire EMS agency out of the business. Or you might be interested in the article in today's paper that is talking about how the fire department's unions are afraid to stand up to a former union leader who is now a scab. http://www.eastvalleytribune.com/index.php?sty=49538

[RescueTrash]

Downsizing the Fire Department sound like a great deal on paper - ask most city governments. Can you really expect to cut a department from 28 engines to 4-5 plus some spares and still protect the city?

The reality is that by doing so you put the public and the firefighters at risk. To effectively work a structure fire you need all the crews there quickly, not responding from all the corners of the city.

When the city's ISO ratings go down and everyone's insurance premiums go up will you complain?

When you need more hands - extrication, heavy patients, MCI's etc. will you complain about slow response times?

[PtsMedic]

And yet, when the fire kick out, and all the fire crews are responding to the fire, who is left for EMS? I am not talking about reducing the fire department below what is safe, but to levels appropriate for their fire fighting needs. By having the fire department run EMS and fire, you are causing the same problems you just mentioned. Most of the fires I have witnessed required crews to respond from all over the city because the local crews were busy with EMS calls. How safe is it to have one engine trying to fight a fire alone because the rest of the engines are all busy running EMS? And what kind of patient care do you think the patients get when the firefighters treating them find out there is a fire in their response area? Care becomes rushed and sloppy because the firefighters want to get to the fire. I've seen that in every system I have worked, including from OCFA's firefighters.

The fire department needs to justify their budget based on what the fire service needs and they need to leave EMS to EMS.

[RescueTrash]

Just like "Time is Muscle" you have to get enough people on scene in a very short period of time to get the job done on the fireground. Cutting back the levels as you suggested = major increases in response time.

Do you really understand why it takes such a large crew to fight a fire?

At the vast majority of medical scenes our engine crews can be cut loose to respond to the next call, which they will eagerly do whether it is a fire or medical.

In the last year our department gave up a captains and a firefighters slot and replaced them with 2 paramedic slots-our guys are fighting each other to get the medic slots.

Rushed and sloppy care-not from my department if you want to work here you take the calls as they come. If we seldom fight fires then how many medical calls can be affected?

Try as you will but you won't convince me that my service sucks-try finding one you want to work for.

[PtsMedic]

You are missing the point. If an engine is on scene of an EMS call, they are not capable of responding to a fire call or another EMS call. They are stuck on that scene until care has been transferred. That means that an engine from farther away will have to respond to the fire. Unless the department takes that into consideration and has enough engines to cover fires and EMS. If they have more engine to cover both, then they are bloated. Having the engines necessary to run fire calls and having a seperate agency running EMS would be more cost effective because you are not paying for all the extra fire crews. If the city needs 12 supression units to realistically fight all the fires and then some, why should the city pay for 28?

[RescueTrash]

Here's the way it works in my department-BLS calls get an engine and ambulance, ALS gets an engine, ambulance and rescue(2 man ALS squad). If the engine is there first they initiate care, once the other units are on scene the engine can cut loose for the next call, almost always in a few minutes. The one exception is our transport engine(which makes a lousy engine and a lousy ambulance).

There are no third-service's anywhere close to me. How are manpower intensive calls like a full arrest handled?

[PtsMedic]

How many people does it take to run a code? I've run a code successfully with just me and my partner, not idea but not all that difficult. In the rural parts of town where fire doesn't respond unless the patient is on fire, 2 ambulances are dispatched to a code. If we had portable ventilators then we really would only need one ambulance.

[RescueTrash]

The one ALS ambulance that we run (the rest of our area we run BLS rigs with ALS squads) serves an isolated valley, if the engine is busy more hands are a minmum of 20 minues out. The AutoVent makes a huge difference but chest compressions for 30 minutes sucks. We have had so much turnover lately that I haven't been using the vent, been wanting to see how some of the new guys do with the BVM. Last week we had 6 year old auto-ped, the ambulance techs first trauma and he did well. I like my department, the BLS crews get enough experience that I can concentrate on my job.

Doesn't 4 guys racing across town in $300,000 worth of rigs sound like bloat? ;)

[kramelop]

see next post

[kramelop]

Man, I'm glad I dont have a dog in this fight. All I can say is that in my small rural Maine town, our service (the fire/EMS) exists as it does because of EMS. My town decided that 33 years ago they would commit to paying for and staffing a full time EMS. We have evolved to the point where all EMS employees are crosstrained as Firefighters ( not the opposite). We exist within the fire department building and are responsible for the care of all the vehicles and the building. Our service Chief is also the Fire Chief. My pard is a Captain and I'm a LT. on the Department. EMS calls are 4 to 1 in ratio to fire calls.

Our ambulance rolls with ALS onboard to every call. An Engine accompanys the Ambulance to all MVAs and to any calls we feel it would be appropriate for. Believe it or not staffing is not a problem. While recruitment is a problem around us, our roster is 95% filled (many are EMS cross trained). Most of us have 10 or more years in. Because we are a bit slower (numbers wise) then most, a bit of personal responsability is called for when keeping knowledge up to date. We are the only "Fire-based" ALS in the central Maine area and serve as the primary back-up to the other private services around us. Sometimes I think we have a harder time maintaining repect among our private based EMS peers, then they do (maintaining respect) from all the local fire services. Unfortunately, You can have bad personnel no matter which system you operate under.

I think the biggest concept to keep in mind here is that different regions of the states may demand different systems. Now I won't and don't claim to be an expert on this, but I know if we were any more rural then we are, our system wouldn't fly. I also know that the private services around us wouldn't be there if their current system didnt work. Thats not to say that through growth and need, change wont occur. Rather then argue which system and/ or its employees are better, why not discuss what seems not to be working for you and then let other's chime in with ideas on how to remedy it. That said, I'd rather be constructively critical then destructively critical. Mark :cool:

PS. Where codes are concerned...many hands make light work!

[JHR1985]

All of our frontline guys are trained as FF/Medics. Have a rotation between box and the sweet engine days. The engine goes with us on anything cardiac, unconcious, assault, jail, and a few other things. The engine actually runs more calls than the medics at the end of the year. ALS ambulance at every call. In my opinon, thats best way to do it.( not the ALS every call but have an engine there in calls that you might need them)

It may cost the city a lil extra but it raises the level of care. As it was brought out, you dont need 5 guys on an arrest but it sure makes things easier

[PtsMedic]

"It may cost the city a lil extra but it raises the level of care. As it was brought out, you dont need 5 guys on an arrest but it sure makes things easier"
Maybe it makes things easier, but that doesn't mean better. Studies are showing that having an ALS fire department reduces the quality of care provided during a cardiac arrest. The argument is that the more medics you have on a call, the more competition you have among the medics to perform less frequently used skills, therefore you get fewer opportunities to perform those skills. When you have 4 paramedics on scene of a code, you have to rotate through skills, such as entubation. This means that you get 50% fewer opportunities to entubate than if there were 2 medics on scene. And if you work in a system like mine, then if you aren't a firefighter, you get to entubate on 1% of the codes because the firefighters sure aren't going to give up their opportunity to practice.

"Have a rotation between box and the sweet engine days."
This is a typical response I hear from firefighters in systems that have fire department run ambulances. The engine is the preferred job and the ambulance is something you have to do. Do you really want the person taking care of you to be there because they have to until they get their turn on the "sweet engine days"?

[JHR1985]

Do you really want the person taking care of you to be there because they have to until they get their turn on the "sweet engine days"?

Okay, I am normally working between 3 and 4 24 hour shifts a week. I do like a break. Those long 30 minute transports at nighttime get really old and that occasional day when I dont have to do them, I enjoy it.

The argument is that the more medics you have on a call, the more competition you have among the medics to perform less frequently used skills, therefore you get fewer opportunities to perform those skills

that is a possibility but when you have one guy get the IV, One tube, one do compressions, one pull up drugs and one who is in charge, all the skills get done quicker, allowing for a quicker enterance into an ER.

And if you work in a system like mine, then if you aren't a firefighter, you get to entubate on 1% of the codes because the firefighters sure aren't going to give up their opportunity to practice.

Just shows that you are slow to get there

[OCFirePM]

I hate to get dragged back in but oh well, first, even if my engine has four medics on it, not all are working in that capacity. The two firefighters are the paramedics for the day, handling all patient care/skills. Even though the Captain and Engineer may still be licensed, they have other roles on EMS calls, like talking to family, PD, scene safety, etc. The Captain and Engineeer/ Paramedics have been medics for a long time and it is always nice to have someone to bounce ideas off of when difficult situations arise.

I have been a medic for a while now, and it is always nice to have someone who has been a medic for MUCH longer than me to talk to and get ideas from and learn from at the same time. I know I haven't seen it all, but I know my Captain has.

So, we don't have "Skills Competitions". Onle the FF/PM handles the skills, assessment and patient care.

As for you thinking you have ran as many MCIs as me, or comparing your experience to mine, my friend, I ran 5 MCIs in the last 6 months. You don't know my experience level, but rest assured it is MUCH longer than yours. Yes, I have worked in a rural EMS system, ran calls for a long time by myself with an EMT partner, hell, running whole codes where I am the only medic. Good times, pain in the butt.

As for sending an engine to EMS calls with an ambulance, that is how things work here. The paramedics are on the engines, the EMTs provide transport, if a medic follows up on the call the engine goes to PAU status. Two apparatus to one scene provides enough manpower for EVERY EMS call out there. Only a truck and BC on a heavy rescue would be additional units.

We have six personnel who each have a role on the call.

The two medics to provide patient care ONLY. One patient, one radio.
The two EMTs to load the patient onto the gurney, move the patient around the house, gurney work etc.
The engineer to strip IVs, watch the apparatus on scene for safety issues, set anything up in the amblance the medics may need.
The Captain to talk to family, PD, facility staff, get the patient's belongings, lock up and secure the patient's residence before transport.

A pretty efficient system if you ask me. We get things done, customer service is at an all time high, attention to detail is key and the medics can provide patient care without having to deal with anything else.

As for your SDFD example, you should know, the transport is SDFD/Rural Metro. It is a joint partnership alliance between SDFD and Rural/Metro. The ambulances are staffed in station by Firefighter/Paramedics, and the medic rescue ambulances which carry heavy rescue gear are staffed by Medic Captains and Medic Firefighters. Occasionally, there will be a FF/PM and a FF/EMT on the ambulance. Rural/Metro employees staff the 12 hour units with PMs and EMTs. Occasionally, Rural/Metro employees staff a 24 hour unit, but not often.

So, SDFD is a FIRE based EMS system with ALS ambulances with FF/PMs and every engine is an ALS engine with one FF/PM. SDFD chose the ALS engine format to improve ALS response times. So, during the fires, even though their ALS engines were unavailable for calls, their ALS ambulances with FF/PMs did what they could with less manpower.

In fact, ALL engine companies stopped running EMS calls during the fires county wide to supplement the fire attack. AMR was sending ALS ambulance and BLS ambulance to every call. Interesting?


Ok, off the bandwagon, I hated to get sucked back in, but couldn't help it. i am not here to try and convince you that my EMS system is the best, and I will never believe yours is either, in fact, who really knows what EMS system works the best nowadays?

And it is INTUBATION, not Entubation.....

And also, it is possible to like running EMS and fight fire. Each have their own positives and negatives, just because I like to work on an engine does not mean I do not like working on an ambulance. You have to stop stating that all firefighters hate EMS, this is just not the case.

Along your lines of thinking I should be assuming your patient care is suffering because you hate fire medics, get ****ed off when they take your skills from you and then you are in a bad mood when you finally get to treat a patient. I know the type of system you work in and I know A LOT of ****ed off private ambulance dudes all disgruntled at fire, disgruntled at their pay, disgruntled that fire medics make 3 times more money than they do, disgruntled fire medics take all their tubes, whatever.

Isn't it better for a patient to have an ALS airways established as soon as possible, if the firemedic is there to do it first, then more power to them....

LOVE YOUR JOB!!!!!

[kramelop]

Maybe it makes things easier, but that doesn't mean better. Studies are showing that having an ALS fire department reduces the quality of care provided during a cardiac arrest. The argument is that the more medics you have on a call, the more competition you have among the medics to perform less frequently used skills, therefore you get fewer opportunities to perform those skills. When you have 4 paramedics on scene of a code, you have to rotate through skills, such as entubation. This means that you get 50% fewer opportunities to entubate than if there were 2 medics on scene. And if you work in a system like mine, then if you aren't a firefighter, you get to entubate on 1% of the codes because the firefighters sure aren't going to give up their opportunity to practice.

Well I guess those firefighters in your system ought to be better at their skills then you would have us believe... if they really do get to perform 99% of the skills. Maybe we should question yours seeing as the practice is lacking...lol!

"Have a rotation between box and the sweet engine days."
This is a typical response I hear from firefighters in systems that have fire department run ambulances. The engine is the preferred job and the ambulance is something you have to do. Do you really want the person taking care of you to be there because they have to until they get their turn on the "sweet engine days"?


PtsMedic... Just so you know... I like my Job. I live in a small enough community that my frequent fliers know that there is a likely chance that I will be the medic caring for them. I like knowing many of my patients well enough to know when something is out of the ordinary.

Maybe the system you work in fosters the competition you feel as well as the whining I am hearing from you about the circumstances you seem to work under. I worked a code... 3 weeks ago... with 3 medics and an intermediate. Slickest code I have worked in a year or so. Each of us took a specific skill (as was mentioned in another post). I normally show up with an intermediate and myself. I have to call for more personnel if needed and then most are basics. As far as 'competition' goes... I give up IV starts all the time to my intermediate pard. He needs an equivalent amount of starts to keep his skills up. His Intubation skills are excellent (he did a tube on the rd...moving... just a short time back). I don't mind sharing skills opportunities. Plenty here to go around.

As far as the Firefighting end of things go...I have plenty of EMS to go around. The firefighting thing is like a change of scenery for me. Every once in a while I just need a change of pace. I find it to be a good stress reliever believe it or not. But just because I like it, doesnt diminish my desire to help others when running the ambulance. :cool:

[PtsMedic]

Kramelop

"Well I guess those firefighters in your system ought to be better at their skills then you would have us believe... if they really do get to perform 99% of the skills. Maybe we should question yours seeing as the practice is lacking...lol!"
That is exactly my point. Do you really think it is in the public's best interest to have a system where we have to question any provider's skill? Why have a system that promotes that?

OCFirePM

Where did I say that all firefighters hate EMS? I have said that many do. I have also said that I have worked with many that enjoyed EMS and were great medics. My point is that having a system where people have to do a job other than what there title is encourages this. If you have 2 seperate departments, one strictly EMS and one strictly fire, if someone dislikes EMS, then they have no reason to join EMS. If they dislike firefighting, they shouldn't join the fire department. I know too many firefighters, including some from OCFA, that hate having to be paramedics. Why did they become paramedics? Because it is almost impossible to get hired by a fire department in California if you are not a paramedic and if you do get hired on as an EMT, good luck getting promoted. So they are forced to do a job they didn't want in order to get the one they did want.

As far as comparing our MCI skills, you stated that I have no idea how an MCI works. That was the point of pointing out my experience with the ICS system. I never said you didn't know what you were doing, only that I did too. Yes, it is easier to work an MCI or a code with more people, but it is possible with just one unit. And nowhere is it written that you can't have 2 ALS ambulances running that code.

Have you ever seen a little old lady get uncomfortable by having 6 large men towering over her when she is having a medical emergency? If a patient is having an MI, is it really in her best interest to increase her stress level? You said, "Two apparatus to one scene provides enough manpower for EVERY EMS call out there." On most calls except MCIs and codes, two units is one too many. If there isn't a reason for the extra manpower, why waste resources by having them there? Why put the public in danger by having multiple units respond code 3 for every call?

I am quite aware of how SDFD's system works. but to emphasize my point, "In fact, ALL engine companies stopped running EMS calls during the fires county wide to supplement the fire attack. AMR was sending ALS ambulance and BLS ambulance to every call. Interesting?" Yes, it is interesting that when the fire department was unable to send engines to any EMS calls that the system still worked and worked well. So why waste the money and resources and why increase the likelihood of an accident by sending multiple units code 3 to every call?

Oh, and very mature correcting my spelling. I am a paramedic, not an english teacher. Perhaps you should go spellcheck your posts because there were many spelling errors there, too.

"Isn't it better for a patient to have an ALS airways established as soon as possible, if the firemedic is there to do it first, then more power to them...."
Wouldn't it be better to have a system where EMS has the resources to get there first and not have to rely on having the fire department as first responders? If we were to use the fire departments' arguments as to why they need to be involved in EMS, then we should stop having the fire department respond and start havomg PD respond. In most of the cities I have seen, PD has significantly more units on the road and can arrive faster than even the engine, and they don't have to stage for a scene to be secured.

JHR1985

"Just shows that you are slow to get there"
When the fire department is dispatched first, then we are dispatched by their dispatcher second, they are dispatched code 3 on all calls and we are dispatched code 2, when they complain to our managers that we beat them on scene, and when we do beat them on scene and they physically push us out of the way, just so they can justify their reason for being there, what do you expect.

[RescueTrash]

The $64,000 question - Why are you working in a system you detest?

[PtsMedic]

The $64,000 question - Why are you working in a system you detest?
Because it is the only system here. And instead of running from a broken system and abandoning the citizens of my community, wouldn't it be better to fix the system?

[OCFirePM]

What are you doing to "fix" your system? Besides complain that it should be something else on an open forum?

And I want SPECIFICS!!!! Let's see what your true intentions are....

[kramelop]

PtsMedic

Sometimes that error has unintended results...much like a poorly fielded ball in a baseball game where a runner scores or makes it to base safe. You have to admit, 'Entubation' vs 'Intubation' is a pretty glaring error ( the E and I aren't even close on the keyboard) for a medic who should be plenty familiar with the procedure and its spelling. We have to be carefull on our end though, how we judge based on appearances. I have to admit my 1st thought was "if he can't even spell 'Intubation' right..." Benefit of the doubt is yours this time.

I also would be interested to hear how you think the problems in your system arose, and how you feel they might be corrected. By the way that was a joke on my part about your skills. You just raised the fur on a lot of backs when your initial posts seemed aimed at FF/Medics, and not really the system you're in and how it has created the issues.

You know the problems run both ways here. I know a private service that has had its share of problem employees. One in particular recently stands out. The worst part was that we here (at the fire station) and even this employee's peers knew. But management kept him/her around...??? Why is a good question. There is a strong chance they were keeping a warm body in the open slot. But this is only a symptom, not the actual problem. The actual issue begins with their management not removing problems in a timely fashion.
In this case it wasnt untill a "big enough" problem occured that they finally had to let the employee go. The trail of little problems prior to this event should have added up to enough to deal with before this.

I think it really ends up being a management issue. Making the hard choices that have to be made, and fostering an atomosphere where growth to potential can occur, positive attitudes abound, and stamping out the little fires before they grow out of control.

[JHR1985]

You just raised the fur on a lot of backs when your initial posts seemed aimed at FF/Medics, and not really the system you're in and how it has created the issues.

That is true.

And I agree with your post. I have seen some large private EMS providers come in with the bare minimum done to a serious pt. So it goes both ways. But the thing to remember is that every department and service has both good and bad guys and its up to you to try to change, not them, but the new guys coming in who will make a difference in a few years

[rumedic1]

My question is why must you have a 300 thousand + fire truck and a crew of firemen to go on medical calls that could be handled by an Ambulance and 2 crew.

And remember we are talking about government base fire and EMS. We are not talking PRIVATE or hospital based EMS


I like the system they use in Savannah Georgia (eventhough it is hospital based) The fire department does not respond to call unless there is a flame coming from it. They do respond to MVC's with confirmed intrapment by either Law Enforcement or EMS. Thesystem actually works imagine that

[OCFirePM]

Because in my system the Fire Department is EMS, the medics are on the engines and the ambulance is staffed by two EMT-B.

You asked the same question that has been debated to the ground in this thread. Go back and read the thread.

And also, my system works too, so what?

[croaker260]

It still amazes me that after all this discussion, not one fire fighter who came into this discussion as pro-fire has admitted there is any problem with the fire department culture and its approach to all things EMS.


Such is the power of the big red myth. The fire service can do no wrong. Until the fire service can admit there is a need for change, there never will be. And one thing I continue to see on this site, and in the fire based trade journals, is a continued denial for any change. EVen when someone tries to bring it up, he is ridiculed for it...

One of the earlier post asked what should be changed in the fire service.

Well there is a lot of things. But if I was to pick one thing, just one thing, understanding that this wont fix all problems,, it would be this.

I would make paramedics in the fire service, the so called firemedics, fire unions, and fire services in general...accountable for the medicine they provide. Truely accountable. From start to finish.
FF/medics would not be hired based solely on how good of physical shape they are in, or how good of a fire fighter they may be, but on their medical competence above and beyond a simple NREMT assessment. Once hired, a FF/Medic could be disciplined up to and including termination for sloppy care, not meeting education commitments, and similar causes. They would be subject to a medically based FTO program to evaluate their MEDICAL COMPETENCE.
FD's, in the same vein, would be required to insure that their medics perform and train like medics, with the same vigor they attack fire training. They would go to the OR every year. They would ride the ambulance at least 50% of their time regardless of thier senority as long as they held their medic liscense. They would have lectures from recognized experts in medical fields, not canned videos. They would be required to meet or exceed the national minimum standard of care. Their medical/QA practices would have complete transparency with the medical community, and they would develope their medical practices in accordance with involvement of all levels of EMS and emergency medical community. And when they failed to do so... their chief officers would be held accountable.
The IAFF, in its bargining agreements would stipulate minimum medical training allotments, instead of worrying about getting 9/11 off. They would not keep FD's from firing crappy medics. In short they would be a positive force, instead of a negative force, in medicine.

That would be a start.

Are there third services and privates who could do this as well, sure. But at least in those sectors there is a chance for change.

[rumedic1]

I think I need to be clear on where I stand and my intent..
First off I have no doubt the ability of fireman medics they received the training we all did to get there. Also, there are some services where they ride frequently and have Inservice Training available.

Now with that said. My issue with fire based EMS is they are trying to be experts in two PROFESSIONS this is extreamly hard. How can a fireman be certified in Hazmat, Auto extercation, Pump Opps, Fire Marshall, Ventalation, high angle rescue, confined space resque, FF1, FF2, Senoir FF..and on and on and on retain all of this knowledge.
Now we add Paramedic training, ACLS, PPLS, BTLS, Infection control, 12 Lead ECG, and on and on and on..
How can this fireman maintain all this knowledge and skills and at the same time train Equaly to a Paramedic level. I just don't see this person has being as effective in either.

In the medical feild we rarely see a general doctor. They specialize in everything. Why so they can be more effective in that area of expertise. We need to see that this applies here. I am not saying that fireman are not capable of learning but everyone has a limit on retention. I would be much more at ease with a doctor specializing in cardiac do heart surgery than one that works at a "doc in the box" as a general doctor that does it all.. It just makes common sense...

I am sorry that your profession has put itself out of business (reduced call volume) by doing a great job and reducing fire's but do not try to branch out and make up for it with EMS.

Remember when the refrigator came out the ice man had to find another job. Times do change and in the EMS world they are changing fast and you better have your running shoes on and be totally dedicated in keeping up with it or you will be let behind.

This is not to slight fireman it is to show that everyone has there limits and that we are dealing with peoples LIVES here.It is getting hard enough to keep up has a Paramedic alone now with CPAP, 12 lead, RSI, new stroke meds and evaluations, can you imagine what the next few years will show!!

[kramelop]

Now with that said. My issue with fire based EMS is they are trying to be experts in two PROFESSIONS this is extreamly hard. How can a fireman be certified in Hazmat, Auto extercation, Pump Opps, Fire Marshall, Ventalation, high angle rescue, confined space resque, FF1, FF2, Senoir FF..and on and on and on retain all of this knowledge.
Now we add Paramedic training, ACLS, PPLS, BTLS, Infection control, 12 Lead ECG, and on and on and on...How can this fireman maintain all this knowledge and skills and at the same time train Equaly to a Paramedic level. I just don't see this person has being as effective in either.

You ever see someone redo his lawn, only to leave it unwatered for the summer, killing it in the process. Whats the sense in the accomplishment of the new lawn only to destroy it with neglect?

I started off my part in this debate by stating that if it weren't for the EMS end of things, my department wouldnt exist as it does. My small town made a commitment to staffing a full time ambulance service to provide coverage for our town (30+ years ago). We are a bit to far from the larger local towns for a timely response. (You should see the 20-25 minute plus response times for the outlying towns here who chose to go with a large private service.) The EMS service here is the backbone of the volunteer fire department. About 12 years ago it was decided that the fulltime EMS employees would also be cross-trained to State of Maine FF1 certs. You ask how can a person be certified in multiple disciplines. Let me tell you it takes alot of personal responsability and time to maintain skills and knowledge levels.

My best example to date might be the fact that the computer I'm typing this on is one I built and set up myself. I have no formal training, but each year I pay attention to the technology and update my knowledge. Just as sure as I can build you a computer, I can preform many of the skills you listed above. As far as being effective in one or all... I can't afford not to be proficient. I have also learned that many times, my partner is strong in areas which may not be my specialty, and with a bit of trust I can lean on him. I personally have certs in FF1, Wildland FF, Pumps, Hazmat Ops (partner is a tech), SCBA Tech (Scott paks), and Vehicle Extrication (and a couple more I forgot, plus yearly classes on other non-cert'd topics). On top of all this is my paramedic with all the skills certs you listed above.

You're right it is hard to keep up with. It takes personal diligence to keep up with all these. I have to reflect now and then on all these and then decide what needs to be brushed up on and what needs to be practiced. The small town that I serve depends on me being somewhat of an "expert" in these areas. We're pretty used to performing multiple skills here from para-medicine to FF'ing. It comes right down to why don't we excercise trust first in our fellow providers, at least until it is lost. Unfortunately, the dialog here, given the view point of a few, is that a couple of bad apples spoil the whole barrels worth.

We have only two persons on at any given time due to the nature of our system. We pull off at a working scene and while we are waiting for the volunteers to show up and begin filling in we have to set it up for ourselves. This gets back to the trust issue... my partner isnt the greatest where it comes to getting water out of a truck (levers and hydraulics arent his thing), but he knows that if I'm on, (and since I live a block from the station I'm usually around) that setting up supply and pumping are second nature to me. By this same token I know his knowledge on Hazmat far outdoes mine. We trust each other's strengths rather then focus on our weaknesses.

Now I have taken this round about way to get to a point. Isn't it about time we quit questioning whether dual citizenship is a good or bad thing. Fine if you want to be a medic only, more power to you. If you want to be a FF only, great too. But this continued sniping about combined/multiple discipline employees is gonna get old. I understand that without personal diligence, one's skills could get rusty, but let's not be critical of personal ambition. My beef is with anyone who has skills, but fails to maintain them.

Croaker...I would be amiss if I didnt admit we have our frailties, not necessarily from multiple roles, but more then likely stemming from a lack of personal accountability and management failing to act timely and responsibly. As I alluded to earlier though, this happens in both the fire service and in the private sector. You don't have to kill the bull running loose here... you just have to corral him.

[OCFirePM]

I feel the system I work is is very effective and efficient. We are dedicated to proper care, quick response times and excellent customer service.

We take immense pride in being professional/career ff/medics. It requires immense dedication and sacrifice to perform both duties, but we do it and we do it well, as do tens of thousands of other FF/medics all over the country every day. Just because you choose to do one profession does not mean that is the only way to do it. And another thing, we are NOT doctors. I have never claimed to be one, I would never compare myself to one. To become a paramedic we go to school for 1 year, doctors go to school for at LEAST 6-8.

Paramedicine is not rocket science. We do not diagnose, we assess, treat what we see and can and transport. We are not "healers" we are temporary fixers and problem solvers, doctors are "healers". It is not a difficult job to be a paramedic, just takes dedication and patience. If you want to go to cardiac surgery become a doctor, if not then just learn what wheezes sound like and give albuterol for it. How difficult is that?

As for our hiring processes, we go through written test (medic and fire), oral interview (medic and fire), paramedic assessment center (where you will perform skills and assessments according to NREMT-P protocols), physical agility, chief's interview (personal), medical, psych, full background investigation and a polygraph.

As a new medic you are considered "probationary" during your first year. You will ride with a senior medic partner who will evaluate you EVERY shift during your first year, there are also major evaluations too. You perform drills in front of the station not only on fire equipment, but medic equipment as well. You will do drug drills, protocol drills, EMS policies, all to be signed off by your Captain. You will show competency in ALL skills prior to passing probation.

We are required to go to mandatory EMS classes, which are given in lecture and skills format. We have OB/GYN teach thier field, Peds RN for peds, etc, etc. We earn approx 50-100 hours of CE each YEAR, up from the national standard of 48 hours every two to renew your license.

We have opportunities to go to OR, OB/GYN, Peds for CEs and learning opportunites. Doctors at local hospitals will always let you intubate in the ER if the opportunity presents itself while you are there, in case you haven't had too many lately.

We keep statistics so accurate I can call up and find out how many IV sticks I have attempted this year, how much medication I have pushed, how many tubes, etc. We have a QA/QI system that follows up with every patient transported so you can get an evaluation from the patient on your performance.

I can only account for the system I work in, which is a Fire based ALS EMS system. We do not have private medics, or third service. Some agencies have ALS transport, some have ALS Engines with BLS private transport.

We are accountable to the citizens of the cities we serve every day, DIRECTLY. Their tax dollars pay for the service we provide and we make sure that each citizen is treated to the best of our abilities. We have accountablilty not only through the chain of command in the Fire Department, but also to the City directly through use of funds, etc. We provide an excellent cost efficient service that has the greatest level of care possible, and does not drain the bank on the City's budget.

And if I recall correctly, the FIRST paramedic programs in the country were from fire departments, Miami and LA County FD. I appreciate those who want to be just paramedics for a career, that is great. I enjoy being a medic, but I like physical work too, hence being a FF/medic that satisfies both is right up my alley and that is what I am.

The system I work in has always had Fire based ALS EMS, since the early 70's. As for change, we update our equipment and protocols every year, and the eternal question, if it ain't broke why fix it?

[croaker260]

Paramedicine is not rocket science. We do not diagnose, we assess, treat what we see and can and transport. We are not "healers" we are temporary fixers and problem solvers, doctors are "healers". It is not a difficult job to be a paramedic, just takes dedication and patience. If you want to go to cardiac surgery become a doctor, if not then just learn what wheezes sound like and give Albuterol for it. How difficult is that?



Therein lies a major problem with the firebased approach to EMS. "Paramedicine isn’t rocket science" so I guess anyone can do it, any fire fighter, right? Its not that hard?
The view of Paramedicine you describe as a cook book job (you see this, you do this) is outdated, thankfully. In today’s world, we may not be "healers" in the old sense of the word, but neither are the doctors in the emergency department. We are all problem solvers. Therefore shouldn’t we hold ourselves to the same standard as physicians should? We should be better educated than the medics of years past. We should be morally accountable for the care we provide. We must initiate care in some cases, and withhold therapies in others, to best optimize the patients total outcome, not just while we have them in the rig. It is not enough to give a Albuterol to any wheezes we hear, we should be able, no we MUST be able to look and say is that Asthma, or COPD? Then Albuterol is good, with some solumedrol and Atrovent. Mag if it is asthma. Is that CHF?...then perhaps Albuterol is second line AFTER nitrates, MS, and lasix, (I know there are people who give Albuterol early in CHF...different discussion ..OK?), Is it pneumonia? Then perhaps some Albuterol, some fluids is the order of the day. And this is a simple every day dilemma. Not that complex. The decision and complexity increase by an order of magnitude when we talk RSI, thrombolytic, chosing the best antiarrhythmic in tox situations, dysreflexia, agitated delirium, etc etc etc. Sure "tincture of transport" is the best medicine in some cases, but it is not the only therapy. Yet too many weaker medics resort to this for no good reason.

The point being that Paramedicine is at a level of complexity (and growing) that Medics not only do physician level skills, but in some cases must demonstrate physician level critical thinking. The dedication both for the individual and the service this requires today to do this **right** (as opposed to "good enough), not to mention what will be required in future generations of medics, is not something I see of the fire service.

Example: The absolutely horrible intubation studies out of California with fire based services, with serious system flaws exposed. Case of it done right: The recent intubation studies done in the Medic One system in Seattle, a truly MEDICALY driven system.



As for our hiring processes, we go through written test (medic and fire), oral interview (medic and fire), paramedic assessment center (where you will perform skills and assessments according to NREMT-P protocols), physical agility, chief's interview (personal), medical, psych, full background investigation and a polygraph.



As a side note, I think we can all agree (I hope) that the NREMT is a starting point for certifying entry level medics, and should not be construed as a standard of care in a truly medically driven system. If your service uses NREMT as a measuring stick for its own performance, perhaps there in lies the problem.
But what about after that, is there a quality FTO process. Ongoing QA? After they are hired if they dont cut it as medics, are they let go? Generally not in most fire based systems. In my system they definitely are.
One final thing that irks me is that in a fire service how good of a fire fighter they are matters as much as how good a medic they are, and usually is the only thing that matters.
At my service, granted we have strict standards of care and expectations of medical excellence that is peer driven....but I can think of half my department that because they are female or other physical reasons they would never make it on a fire department. They aren’t all fat bodies (although a few are overweight)...some are simply too old to lug hose....but mainly because we are 40% female..and they all passed their physical agility test for the job ...but they are ALL EXCELLANT MEDICS. FAR ABOVE MOST I HAVE SEEN IN FIRE BASED SYSTEMS. The care and diligence they provide reduces liability, improves outcomes, and even on occasion saves lives that would be lost by lesser medics. Some have over 20 years of service in a high performance system. You cant buy experience like that!!! And in the fire model EMS, they would be out of a job when lesser medics would not. For no other reason than they don’t fit in with the fire service. Or they would be "non sworn" medics and not offered the same benefits, protection, advancement, or treatment as "fire fighter" medics. And the thing that ****es me off the most is you guys are Ok with that???
YOU GUYS WOULD KICK A BETTER MEDIC TO THE SIDE FOR SOME PEICE OF CRAP MEDIC WHO CAN LUG HOSE FASTER....AND BE HAPPY ABOUT IT! HOW CAN YOU CALL THIS EXCELLANCE?
(..and no, I am not bitching over some job that I was passed over for in some fire service...This is a real gripe!)

In summary:
Is putting water in a straight stream the solution for all fire fighting? No ...of course not. Yet that’s what they did 40 years ago. Now you have different fog patterns, CAFS, RIT, etc Etc, ETC...THAT IS CALLED BEING A PROFESSIONAL in your field of fire fighting,,,, choosing the best approach for the situation. Yet why do so many fire services, fire chiefs, and fire medics approach EMS with the old straight stream works for everything approach? This is true in hiring, protocol development, training, QA issues, medical standards, and patient care. And since EMS is 80% of your business, this is a critical issue for every member of the fire service...and most DONT CARE!
I think because its a cultural issue in the fire service that is as ingrained as racism is in the south (I'm from KY and TN...so don’t BS me, I know its there!) that I fear will never change.

...and the eternal question, if it ain't broke why fix it?
There in lies the delima, the only ones who think it isnt broke, are in the system. I think its very broke. So do many who have made medical excellance a part of their lives...both in and out of the fire service.

[JoeMZ191]

Just my thoughts on this;

1. Fire departments run EMS calls because they have to. It boosts their run numbers and justifies their jobs. Some like doing it, some hate it. It's pretty obvious who's who on this. Try telling your mayor or city manager he's paying $3 million a year for the 20 fires you had last year.

2. Firefighters, career or volunteer, can "usually" be on scene before an ambulance. Whether it's ALS or BLS is irrelevant. Something is being done to help the patient.

3. I have had FD based transporting EMS providers tell me they "don't trust private services." I think this is because they consider them a threat. It's a lot cheaper to run a first responder, ALS or BLS, engine than an ambulance. A private company is (normally) more cost effective.

4. Every area is different. What works well in Madison, WI might not work in Hershey, PA. Budgets, manpower and call volume all play a part. Are you going to spend a million dollars for an ALS ambulance service that runs 200 calls a year? Probably not.

5. There are good and bad EMTs and Medics no matter which way you go. I've seen and worked with people I would trust with my life and others I wouldn't let put a band-aid on me. Just the nature of the beast. The bonehead from Engine 1 that spent 15 minutes trying to get an IV could easily be the guy from Medic 1 last week.

6. This is an emotionally charged debate. Both sides consider the other a threat to their job. The bean counters might say they can save money by contracting with AMR. Now some firefighters get laid off. I'm sure you see my point. There's not a right or wrong answer here. Our priority should be to patient care. Period. It doesn't matter who's doing it.

Thanks for listening.

Joe

[kramelop]

Just my thoughts on this;

1. Fire departments run EMS calls because they have to. It boosts their run numbers and justifies their jobs. Some like doing it, some hate it. It's pretty obvious who's who on this. Try telling your mayor or city manager he's paying $3 million a year for the 20 fires you had last year.

I agree... no EMS here in my town =/means no job for this employee.
But you know it just seems natural that we'd be the ones here to provide the service. What better way to get the protection you need in a timely fashion.

OCfire,

Hate to say it, but Croakers more in-tune on this one. Basics are more in a 'see it and treat it' mode. The Docs I'm seeing at the ER are looking to us to paint them a picture of whats happening. Many of them ask "so what do you think is going on?" and several have taken a couple of minutes to get my take/impression of the incident when I arrive in the ER. Right or Wrong, up here in central Maine they are looking for a diagnosis, and to show we have an underlying knowledge of the affected systems.

[gatewayhoward]

There are departments out there where EMS is hated by the department and treated like ****. Then there are others where everyone gets along and does their job. I'm newer to ALS so I don't have too many strong opinions or assumptions yet and hopefully never like some burnt mother ****ers get. It seems to all depend on the different area.
I'm starting to like systems like Charlotte where EMS is separate from firefighting but EMS is still city run. Atleast there you won't see stupid **** like departments forcing firefighters to be EMT-I's. That's ****ing bull****.
Also, something about private EMS companies running 911 doesn't sit well with me. The private service I work for only does BLS and ALS critical transports. I can't see them running 911 well.

[Mikelev69]

I work for a Commercial Service that was recently purchased by a combination of 2 different Health Care systems that own equal shares. Thus we remain "Commercial" and not Hospital Based, as neither Health Care group wants to change the name of the company. We're also staying in our stations, as opposed to parking the buses at the ED and working inside while not on calls. I must say that I enjoy working for the Commercial service and I do not mind doing the transfers. I personally feel that the people we transfer need our service just as much as an Urgent ALS patient, they just need different aspects of it. These people we give rides to would be stuck without us, and in my district if there were no Commercial Service there would be no one at all to bring these people home, or to the SNF, or to the cath lab when they needed it. I DEFINITELY prefer my employer over the City, because we have a boss who is open to suggestion, and the senior staff are extremely proactive at keeping "ahead of the Jones's" so we have the latest technology, the newest gadgets, etc. This means we have no union, which is SO much better. Union means fixed salaries, fighting over wages and benefits, and a poor employer/union relationship. In our current state of affairs, we get our increases without having to bicker with our boss. The only benefit we do not have is a municipal pension plan. I have a 401k, but that comes nowhere near the 25 year payout that the FD and PD gets. The only difference between them and us is that they work for the town. We go on nearly all runs together, take care of the same patients together, etc. We do much more volume because the EMS units cover the whole city, whereas the FD only goes on calls nearest their firehouse. We also intercept with outside towns to provide ALS service, whereas the FD provides ALS only within their district in the city and never leaves town unless our company runs out of ALS units (which is extremely rare). So that opens the question of a tax based third service. The pros- we would get a pension, the workload would decrease, we would be working for the town which carries other hidden fringe benefits. The cons- we would definitely be unionized. The hospitals own the company and would never allow our units or employees to be simply turned over to the town (that would be a huge blow to the profit margin). If the towns simply abandoned the contract and started transporting themselves nearly all of us would be laid off (911 runs are 60-70% of the workload). The towns couldnt just snap a finger and begin transporting either because they dont have nearly enough firefighters to staff ambulances. We would have to stop doing outside intercepts and transfers (thereby cutting a vital service to outlying towns and the hospitals we assist by taking their patients home and to other facilities). I guess the point Im trying to get to is that no one has it perfect. I would love to do ALS 911 calls only, but I would lose my job, because even though transfers are the minority of the workload, they represent a much larger portion of the profit, which is my job security. Besides, I love to listen to the radio as the FD goes to house lockouts and car fires in the middle of rainstorms and blizzards (we dont go to fires unless its a structure, heh heh).

[medic2k3]

One should consider third service EMS (Paramedic level). Where billing is not the priority (most of the time it is paid by taxes). Use caution when removing other companies materials as I have had a friend that was written up and susspended by doing that. The hospital caugh wind that this was happening and filed a complaint. He claimed it was at his employers wishes. His employer left him out in the cold and denied ever ordering this behavior. Good luck and stay safe!

[lfdc2chv]

Hate to disappoint you, but California is the state where I started my career. I have worked in Los Angeles and Orange Counties. The fire departments there are worse than here. They don't have ALS ambulances responding to 911 calls in those counties because if there were other paramedics on scene, the fire departments make sure that the public knows that only the fire departments are capable of providing care. But the firefighters don't want to run EMS. It is a chore they are stuck with while waiting for the next big fire that almost never comes. LA City Fire Department is one of the most incompetent EMS agencies I have ever seen. I wouldn't trust them with my care if my life depended on it, because it would, no matter what my chief complaint was.

Fire has no business doing EMS, period. I agree with you that EMS should be provided by a public agency, but it should be one dedicated to EMS and only EMS.


You want to get into how the bad certain areas are with regards to EMS care. I hate to be the bearer of bad news to you, they are everywhere. I will admit that some fire departments do a bad job at working EMS calls. SO DOES EMS SERVICES! I work for a public ALS first responce Fire Department. When I have worked calls where the Paramedic told me to wait to get an IV on a chest pain patient, (then waited 16 minutes to do the IV in the back of the truck, I timed him), or a paramedic on an ambulance defibs PEA 3 times Prior to the arrival of another Paramedic on the Fire Department to stop him. These are problems. I know you could probably go on and on about sub standard care and skills. They are on both sides of the house and all across the country. In stead of complaining about sub standard care, how many times have you tried to train with these fire departments. Or even tried to help (in a non- condescending way) their level of care. Why not get involved and try to get minimum training requirements, ride alongs, or policies changed. My grandfather used to say to me "Son in stead of sitting in the dark complaining that you cant see, why dont you do something about it and flip on the switch or change the lightbulb"

[PtsMedic]

In stead of complaining about sub standard care, how many times have you tried to train with these fire departments. Or even tried to help (in a non- condescending way) their level of care. Why not get involved and try to get minimum training requirements, ride alongs, or policies changed. My grandfather used to say to me "Son in stead of sitting in the dark complaining that you cant see, why dont you do something about it and flip on the switch or change the lightbulb"Because challenging the FD is a guaranteed way to get you fired. Also, you only argued against part of my complaint against fire based EMS. Every system I have seen has been designed to have an engine on scene quickly while delaying the ambulance. Here, the engines respond code 3 (L&S) while the ambulance responds code with (w/o L&S). It doesn't even matter who is closest. I have even been told to stage while the fire department assesses and treats the patient and not to come on scene until they are ready to transport. Or how about the Phoenix system? I hear nothing about Phoenix except the fact that they are a ground breaking department that other departments are modeling themselves after. Yet if you call 911 in Phoenix, you get 2 engines and no rescue. Why? Because the department spends all of the budget it gets for EMS on fire suppression, not EMS. The majority of their calls are for EMS, but they won't bring up enough ambulances to get a rescue on scene first. Why? Because if an ambulance can get on scene first, why do you need 2 engines as first responders? The city will realize they are wasting tax dollars and cut their budget.

Fire based EMS promotes delaying definitive care. This is causes harm to the patient and violates the basic principal of medicine, do no harm.

[lfdc2chv]

Because challenging the FD is a guaranteed way to get you fired. Also, you only argued against part of my complaint against fire based EMS. Every system I have seen has been designed to have an engine on scene quickly while delaying the ambulance. Here, the engines respond code 3 (L&S) while the ambulance responds code with (w/o L&S). It doesn't even matter who is closest. I have even been told to stage while the fire department assesses and treats the patient and not to come on scene until they are ready to transport. Or how about the Phoenix system? I hear nothing about Phoenix except the fact that they are a ground breaking department that other departments are modeling themselves after. Yet if you call 911 in Phoenix, you get 2 engines and no rescue. Why? Because the department spends all of the budget it gets for EMS on fire suppression, not EMS. The majority of their calls are for EMS, but they won't bring up enough ambulances to get a rescue on scene first. Why? Because if an ambulance can get on scene first, why do you need 2 engines as first responders? The city will realize they are wasting tax dollars and cut their budget.

Fire based EMS promotes delaying definitive care. This is causes harm to the patient and violates the basic principal of medicine, do no harm.
Well I dont know about other locations. Here the fire department has Paramedics on board and treat pts not just see if the ambulance is needed. The reason that a fire truck beats an ambulance to the scene is many reasons. 1. Fire stations are strategically placed throughout a community to be on scene within 5-8 minutes of a call for service. EMS here only has 1 station and that is on the far end of town by the hospital, so they didnt have to spend more money on a building. 2. Fire departments maintain a strict response criteria (1 minute or less here). and I work private EMS too, and they lolly gag to the truck and complain that they have to go. 3. Ambulances are transporting pts to hospitals or doing non-emergency transports. In this community the local hospital will send all 4 ambulances(all available)on out of town transfers, leaving the closest ambulance providing coverage 20 minutes away. Tell me that is definitive care or causing no harm and I will recommend a good psychologist for you to see. There are down sides to every responce area on both sides of the house.

With regards to commmunities spending large amounts of money on fire trucks. That will never end. Communities rely on fire departments to handle ALL types of emergencies. As a community evolves so must the department, not just for fire call. Here we handle EMS, Fire, Haz-mat, and all technical rescue. We have expanded to try and handle all hazards. That means that we need to spend more money on equipment to handle these jobs. Does EMS do anything other than treat patients and transport them? (not counting community education) The fire service as a whole realize long ago that when you diversify your skills you are needed more.

With regards to Pheonix fire, if you dont get a box, it is because it is an area where the box is on the way to the hospital and they are waiting for a back fill truck, or the ambulance that covers the area is not from Pheonix fire.

Also I wanted to talk about your comment you made earlier about only 2 from an EMS crew can handle a call in the community. With the public in general now being very "robust" for lack of proper terms, more are needed for just the lifting aspect. Only having 2 people on a scene is stupid. More is always better. Wether it is for lifting, assisting with pt care, or just making sure the Medic (either fire or EMS) is following policy and protocol, it doesnt matter. More heads are better than one. More ALS trained personnel are also better than only 1. The only think that suffers is the Ego, and here we overcome that by working as an emergency responce TEAM, not as individual agencies.

If you are having problems fighting the "fire department", I think that you havent tried. Most of the time if you talk to somebody at the fire department, they will listen and something good may come of it. I do have some advice though. If you go in with an attitude or an accusing or demeaning tone, you will get shot down. We are all adults and professionals, talking like adults and dealing with problems as adults will help things get done. If you come into a problem with a positive attitude you would be amazed at how far you can go.

Remember- if you think that you are beating your head against a concrete wall, prisoners at Levenworth pen turn big rocks into little ones by persistantly beating the big rocks with hammers, so keep trying.

[PtsMedic]

"The reason that a fire truck beats an ambulance to the scene is many reasons"
I suggest that you reread your previous response to my post. Just because the private ambulance company is doing things wrong in your area doesn't mean that most do. We have a 1 minute response requirement. Our stations are placed strategically throughout the city. And we are forbidden from running nonEMS calls if we are on an ambulance dedicated to running EMS. Also you missed my earlier point that I don't think private ambulance companies should be running EMS. EMS should be run by a municipal department dedicated to EMS only.

"With regards to Pheonix fire, if you dont get a box, it is because it is an area where the box is on the way to the hospital and they are waiting for a back fill truck, or the ambulance that covers the area is not from Pheonix fire."
Wrong. The reason you don't get an ambulance is because Phoenix fire has 112 fire suppression units and only 32 rescues. Many of which are BLS and many of which are only up during peak times. The vast majority of Phoenix's calls are for EMS. Why do you get 2 engines and no ambulances? Because the fire department mentality is to get as many engines as you can, even if it means endangering the public by neglecting what the community really needs. Also, the only time you will get a nonPFD ambulance in Phx is when they decide that they aren't going to waste their resources on the call. This usually means minor calls that should go POV.

"Here we handle EMS, Fire, Haz-mat, and all technical rescue. We have expanded to try and handle all hazards."
So your FD is going to start taking over law enforcement too? Just because a department can take over a call type doesn't mean it is the best for the job.

"more are needed for just the lifting aspect. Only having 2 people on a scene is stupid. More is always better."
In my experience, that is incorrect. It is rare for us to use more than 2 people to lift a patient, even when we have 10 people on scene. This is why proper lifting technique is needed, but not overfilling the scene with people.

"Wether it is for lifting, assisting with pt care, or just making sure the Medic (either fire or EMS) is following policy and protocol, it doesnt matter. More heads are better than one"
No, it isn't. It is rare that I need more than just my partner and me on a call. As far as making sure that the medic is following policy and protocol, that is what QA/QI is for.

Having too many people on scene can bad for patient care, too. Too many times I have seen a little old lady, complaining of chest pain, get so overwhelmed by being surrounded by 6 large men, talking about her using words she doesn't understand, get freaked out when the crew should be trying to keep her calm.

"More ALS trained personnel are also better than only 1. The only think that suffers is the Ego, and here we overcome that by working as an emergency responce TEAM, not as individual agencies."
So then why are all the studies saying that too many paramedics on scene is a bad thing? When we are all on the same scene, we have to take turns performing ALS skills. This results in less frequently used skills being performed even less frequently, resulting in less practice and paramedics not being proficient in those skills. When I worked the county islands, without FD response, I would average 10 IV starts a shift and 8 tubes a year. In the last 4 months, since I was transferred to a city ambulance and have to compete with FD medics for skills, I have probably started 5 IVs total and not even gotten to attempt a tube. Why? Because the FD medics are not going to let someone else have the opportunty to perform a skill they need to get.

[PtsMedic]

http://www.sun-sentinel.com/news/local/southflorida/sfl-pfireresponse30dec30,0,5331859.story?coll=sfla-home-headlines

Oh, I forgot to mention that departments are finding it difficult to respond to fires when they have all their units tied up in EMS calls.

[OCFirePM]

Interestingly enough, the article does not mention once about the fire department being tied up on an EMS call while the fire was breaking. In fact, it showed a GREATER need for fire stations in that area, because of the population growth, and the fire department being stretched thin in resources due to a population growth greater than the department can build stations to meet the needs.

This is the situation in a lot of areas in the country. There is a population boom going on and fire departments are doing their best to keep up with the demands of the community they serve. This has been an ongoing struggle for decades, a government trying to keep up with the demands of the community.

I enjoy it when ptsmedic gets on the soapbox to bash on FD EMS. His rants are truly amusing, completely lacking in any experience regarding fire department economics, administration or city government.

Ptsmedic, you were challenged by me in early october of 2005 to come up with some solutions to what you claim to be a "problem EMS system". You were silent for a while and now have resurfaced to bash Fire EMS once again.

I bet it just gnaws on you doesn't it? You show up and Fire EMS has taken all your glory? That sick feeling you get in your stomach when you know an ALS Engine beat you to the scene and stole your "precious IV start", or your "tube". I bet it is all over your face when you walk in the door. I know that look, and have seen it many times from private medics when I worked on a paramedic assessment engine in a different county. It is classic, just a look of complete devastation that you won't be probably doing anything on this call. "Where is my place in all of this?", you probably wonder. You know what, nobody cares...

Why?

Because the Fire Department will always have control over their city. Sworn city personnel who have been tested rigorously and have had complete thorough background checks have this responsibility. Your private company only cares that they get the transport, and they get to bill. Your company does not care if you get to do skills, just put them in the ambulance and go to the hospital. In fact many private companies helped start newer FD ALS First Response systems, so that they can increase their response time so they can use more units to do private transports, which is the guaranteed money maker.

Think about it, give Fire EMS 500,000 year for first response EMS (just picking a number here..) so that you can increase your response time so now you can bring in 1.5 million a year (another number..) more in revenue for interfacility transfers. Now, you still have a medic on scene quickly with fire, you can increase your response time to almost 10 minutes, because it usually takes that long to get most of an assessment done and beginning treatment on board (this includes 5 minute FD response time, then 5 minute assessment and treatment) anyway. This also decreases the "fines" the private company receives for not being on scene in the alotted time. Increasing the response times, decreases the possibility of losing money in fines.

Why would a company do this if it cared about its medics and their skills. By the way if you are from southern ca, you know exactly what county this happened in and what large private ambulance company promoted it. One of the most progressive EMS counties in the state.

Ptsmedic, I enjoy our conversations, I hope the hits keep on coming from you. Your rants and raves truly bring a smile to my face, you can almost feel your frustration in your words. How much longer you have left in your career, 25 years???? I am sure it will fly by for you.

You know, there is always a nursing shortage, why don't you grab some scrubs.....

[PtsMedic]

Why do you keep acting like I am pro-private ambulance? I think that a private ambulance company is the second worst choice for an EMS agency, second only to a fire based EMS agency. Private companies put profit first. Fire puts engine crews first.

I have also told you what my preferred solution would be, a municipal EMS system with sworn personnel that only run EMS. They would have all the same benefits you just suggested make fire better, background checks, tax based, etc. But, they would put EMS first. You wouldn't have 112 engines and 32 ambulances for a city that runs EMS as 85% of it's calls.

[lfdc2chv]

Why do you keep acting like I am pro-private ambulance? I think that a private ambulance company is the second worst choice for an EMS agency, second only to a fire based EMS agency. Private companies put profit first. Fire puts engine crews first.

I have also told you what my preferred solution would be, a municipal EMS system with sworn personnel that only run EMS. They would have all the same benefits you just suggested make fire better, background checks, tax based, etc. But, they would put EMS first. You wouldn't have 112 engines and 32 ambulances for a city that runs EMS as 85% of it's calls.

First-My part time job is working for a Municipal EMS system that is tax based. Hate to be the bearer of bad news to you, but I have heard "we need to save money" stated more times that "do whats best for the patient". So that may not be your savior solution to handling EMS calls.

Second- No we are not looking into handling Law enforcement duties, however we assist PD and train with them as well. You know that whole train as a TEAM and work like a team concept. No matter where you work, you need to work with all that are there (Law, Fire, and EMS).

Third- A survey can show you anything you want. Its just a matter of what you are asking and how the answers are worded. Research a little and you will find surveys that tell you more ALS hands are beter than one. So remove the "S" from your chest and take off the cape. I can admit that I have missed an IV or two, and it was nice to have another medic on scene who can try or obtain if you are unable to. There are also studies that show that EMT-B's only on an ambulance have a better survival of trauma patients that they transport versus EMT-P's, cause medics try to do more where an EMT will just give them the accelorator treatment. So does this mean that we should do away with Medics all together? I think not.

Fourth- With lifting with proper lifting techniques, yeah that is nice, but having help is less strain on the crews. If nobody else lifts the cot, try asking. I dont think I have ever asked a firefighter to do something and they havent tried.

Fifth- I used to do QI/QA and I can tell you that medics can make a chart look like they are incredible. The few times I have had to council an employee is when their partner or another medic has told me about one of their mistakes. So yes QI/QA can help discover problems with charting and sometimes pt care, but not all the time.

Sixth- Skills, you say. I average 10 IV's a month and over 4 tubes a Quarter (3 months). I work in an area (Fire Service) that serves less than 20,000. In the taxed based EMS system that work for I have the same average for near the same population. My success rate on IV's is running in the 90% area for both services, and my tubes are at 100% for both services. I work as a training officer and Deputy Chief. I only work 8 hours a day and dont have to run near the calls my staff does, but guess what I train on a regular basis, refresh on seldom used skills (i.e Crics, chest decompressions, needle crics). I do that every quarter with my staff and with EMS. So your skills only suffer if you let them suffer.

Last but not least- I agree with OC, get some scrubs. I hear that there are some good bridge programs from medic to nurse, but that might require more training!

[rumedic1]

I have read most of the comments here and agreed with some. In my area the fire departments run first responder to all EMS calls. Fire has a mixture of first responders, EMT's and a few paramedics. Now there is no consistant level of medical response you could get any level of care when fire responds.

With that said, EMS is "housed" in the fire stations through out our county. They (EMS) are not fire related at all, it just saved the tax payer from building and maintaining more buildings. Now we have about 26 fire stations and EMS is housed in 9 of these. We (EMS) run paramedics on all units. We get along pretty good with most firefighters.

What I can not understand is why the fire department needs to run "first responder" to call's that the ambulance leaves right next to them at the same time. Every run is code 3 lights and siren response. EMS can have a call for a Pt with a cold and we get this response.

Now if the fire department is not just doing this to increase call volume so they can justify there existance then tell me why this is needed.

I will agree that the stations with out a EMS unit MIGHT need first responders to respond depending on the call type.

Both Fire and EMS are a county based system NO for profit or private services here.

[jtkmedic69]

Or, you can do what our county does. Who has responded to a call lights and siren and come to find out it was a non emertgent call? Cancel FD please, patient will be transported and go to triage or intermediate care upon the request of the ER staff. We are a county EMS system that runs over 55,000 per year. In true number I hope we all will agree that 80 to 85 percent of the calls are non emergent. Our county switched to the national standard of priority dispatch. This in a nutshell means we respond cold " no lights and siren" to non emergent calls and hot "lights and siren" to emergent calls. The system is and has been in use for over a decade in this country and there has been minimal negative feedback and an outpour of positive feedback from the systems and comminuties themselves. This has cut down on first responder call outs because who needs them on non emergent calls? Who can justify using tax payers money to send out an engine to:

1) minor laceration
2) cold and flu syptoms
3) back pain
4) minor mvc (without hazards)
5) abdominal problems
6) gyn problems
7) general pain
8) psych patients (non violent)
9) I dont have a ride to the hospital
10) confirmed DOA

These are the most comon non emergent calls EMS will have. This does not mean FD or a QRV unit can not be dispatched either. It is up to dispatch and the priority guidelines to determine what resources are needed. Now all these calls can be upgraded by our dispatch and / or the unit on scene. As I have read in the past readings here, FD is has a minimal response time and therefore would not be a problem to have them repsond if requested. In the time I have spent here with this agency, I have not seen or encountered any problems with priority dispatch. In our EMS system we have 14 ALS ambulances, 5 ALS QRVs, 3 ALS Rescue Trucks, and a lieutenant 10-8 in our county at all times. I don't know what the other agencies resources are and it may not work for them due to lack of EMS resources. All I can say is that it works here and it cuts down on useless resources. How this affects the FD's Budget is TBA.

Me personaly, I would not mind fire and EMS being one entity. It's another certification on my wall next to my high angle rescue, paramedic, trench I and II, Hazmat Tech, collapse building entry rescue, and CISD certifications. And yes, I do keep up with them according to county and state fire academy standards. I'm just never home.

[ProMedic138]

This is in response to PtsMedic and OCFirePm "disagreements"...

One i agree with PtsMedic that fire and ems should be seperate. Why should firefighters have to become paramedics just to fight fires? They shouldn't, so they become paramedics to get on a FD. You can't honestly master both carees in lifetime. May become good at one or they other but not both.

Same for a paramedic, why should they become a firefighter to work in EMS?

I have a lot of respect for firefighters, they do preventions, extracations, rescues, fires, you name it. Firefighters have a lot of specialties they can train for.

EMS is a health care provider lets not forget that. We are part of the Allied Health Team and should get respect for that. On a call of a EMS run the EMT's/Paramedics should in control of the call not the firefighter no matter what your rank/experience is!

FDs need their equitment and we need ours. Weither its the FD's million $$ trunk or our $140,000 ALS ambulance. For the price of that fire truck responding to an EMS call you could get 6 ALS ambulance.

On anverage(just to keep numbers even) an ALS ambulance cost $160,000 a year to run where i live and thats for two medics top of the line equiment and this is for a private company.

Take the city of Chicago for an example. The city started to cross train their firefighter to become medics and vice versa to keep up with the call volume. Is it going to work? I dont know. But I dont think its a good idea because the old timers dont like change. I think whats going to come out of it is poorer pt care(it already sucks and wouldnt trust the city with my dogs life).

The M is EMS is Medical not fire!! Fire services should have their own funding and same for EMS.

[lfdc2chv]

This is in response to PtsMedic and OCFirePm "disagreements"...

One i agree with PtsMedic that fire and ems should be seperate. Why should firefighters have to become paramedics just to fight fires? They shouldn't, so they become paramedics to get on a FD. You can't honestly master both carees in lifetime. May become good at one or they other but not both.

Same for a paramedic, why should they become a firefighter to work in EMS?

I have a lot of respect for firefighters, they do preventions, extracations, rescues, fires, you name it. Firefighters have a lot of specialties they can train for.

EMS is a health care provider lets not forget that. We are part of the Allied Health Team and should get respect for that. On a call of a EMS run the EMT's/Paramedics should in control of the call not the firefighter no matter what your rank/experience is!

FDs need their equitment and we need ours. Weither its the FD's million $$ trunk or our $140,000 ALS ambulance. For the price of that fire truck responding to an EMS call you could get 6 ALS ambulance.

On anverage(just to keep numbers even) an ALS ambulance cost $160,000 a year to run where i live and thats for two medics top of the line equiment and this is for a private company.

Take the city of Chicago for an example. The city started to cross train their firefighter to become medics and vice versa to keep up with the call volume. Is it going to work? I dont know. But I dont think its a good idea because the old timers dont like change. I think whats going to come out of it is poorer pt care(it already sucks and wouldnt trust the city with my dogs life).

The M is EMS is Medical not fire!! Fire services should have their own funding and same for EMS.

If we are "Allied Health Team" members as a Paramedic then why do the ER nurses and Docs treat us the way they do. We are far from being part of their "team". They think of us as taxi drivers and cant see why we have to handle an emergency call in stead of taking one of their interfacility transfers. We might also get paid alot more money as a Profession. Yet we still put the meter on and collect less pay than a manager at Miccy D's. Do you realize that X-ray Techs, Lab Techs, and Surgery Techs go though just as much training as a Medic and get paid 2 times the salary. Yeah they (Medical Profession in General) think we are Allied Health Professionals.

Yes Communities will keep spending money on "million" dollar fire trucks. They have more than one capability. How many does the average ambulace have? Oh yeah two, medical treatment and transport (with or without the meter). If you want to talk about being a better steward of the communities money, then why not combine. Fire departments already have the stations, the experience, and most of the personnel. Plus they have better pay, benefits, and career advancement opportunities. What can a medic do.......Be a supervisor (few openings), become a training officer (again few openings), or Bridge to nursing and be part of the stick your nose in the air "Allied Health Care" team. OOH, OOH where can I sign up!!

[ProMedic138]

Yes Communities will keep spending money on "million" dollar fire trucks. They have more than one capability. How many does the average ambulace have? Oh yeah two, medical treatment and transport (with or without the meter). If you want to talk about being a better steward of the communities money, then why not combine. Fire departments already have the stations, the experience, and most of the personnel. Plus they have better pay, benefits, and career advancement opportunities. What can a medic do.......Be a supervisor (few openings), become a training officer (again few openings), or Bridge to nursing and be part of the stick your nose in the air "Allied Health Care" team. OOH, OOH where can I sign up!![/QUOTE]

Is it ok for a doctor to have two specialties? Why not? He can master 2 trades right? The only thing that will suffer is his pt care! Your right FD have the stations, experience? I dont know about that.

You have a fire service that has firemen, LT, Captian, Different level of chiefs(not sure on all of them) Why cant you have the same for an EMS service. EMT-B/P FTOs, captian and so?

Over time EMS will evolve to be a more respectable but we need to get away from the fire service which and can hold us back!

[croaker260]

If we are "Allied Health Team" members as a Paramedic then why do the ER nurses and Docs treat us the way they do. We are far from being part of their "team".

Do you realize that X-ray Techs, Lab Techs, and Surgery Techs go though just as much training as a Medic and get paid 2 times the salary. Yeah they (Medical Profession in General) think we are Allied Health Professionals.


First your basic assumption is incorrect...not all those professions have 2 years of schooling, nor do they make two times what medics do..at least where I work. I will conceed that this is not always the case elsewhere. Your point would have been better served comparing us to Nurses, but then I would have countered that they only prospered as aprofession AFTER they made degree requirements mandatory and moved out from under the shadow of doctors and hospitals. Just like EMS needs to do with the fire service.
But lets assume that the basic point that you are trying to make is correct, The way I se it there are two reasons for this, the first is that we do not have a degree requirement...Why? Hmmm because too many people inside our ranks think of this as a vocation and not a profession. They approach it the same way the fire service looks at EMS. Hmmmmm. If we ourselves treat EMS like a vocation, and we let others do so...like the fire service...then why are we surprised when we get paid like one?
And the second reason is BECAUSE we are associated with the fire service. 90% of people (the public) think paramedics are fire fighters in their area...they dont know the complexities of either job....therefore they dont have a basic respect for what paramedics do.
Remove the profession from the fire service, treat it like other professions in degree requirments, etc..and this would change (slowly...but it would change).



Yes Communities will keep spending money on "million" dollar fire trucks. They have more than one capability.

yeah, of that 500,000 fire truck or rescue, how much of it is truely specialized for EMS...uhmm...none. Just a compartment if we are lucky...in many cases the equpment is stowed in the crew cab. So I would counter that...as one local fire service has already done, that it would be more cost effecient to send 30K chase car than a 500K tank to a medical call that is 80% of your run volume, using the same crew and saving wear and tear...oooppss.
Anyway...Thank you for proving my point. Your post seems to forget, like many fire fighters try to do, that EMS is 80% of your job! Yet many fire services pour only 10-20% of rescources into it! This has been rehashed and rehashed previously, and if you want to see those better spoken than I discuss it, just look back in this very thread...but the point remains...in many fire systems EMS plays second fiddle to fire...and it seems like (based oun your post) it does to you too.



Fire departments already have the stations, the experience, and most of the personnel. Plus they have better pay, benefits, and career advancement opportunities. What can a medic do.......Be a supervisor (few openings), become a training officer (again few openings), or Bridge to nursing and be part of the stick your nose in the air "Allied Health Care" team. OOH, OOH where can I sign up!!

Hmm, in my department, we have one of our feild staff with a degree in marketing filling our marketing director posiiton. We have a full time education department, we have HAZ MED (tox medic), TAC MED (swat medic) and SOT (tech rescue, back country rescue)...we have a formal FTO corps (training officer) that is seperate but works with the education department, We have Captains (step up supervisors), Majors (full time supervisors), Assitant directors and directors all from field staff. They are ALL involved in numerous prevention and deployment projects.
We also have a standards of care committee made of of appointed members from all levels of experiance and rank that review our protocols and equipment.
We also have the same retirement as our fire based counterparts, and we work less hours a week.
I could go on and on and on.
The point being that when I look at my department, and I look at other "proffesional" fire departments accross the nation, in my department I see at least the same promotional opportunities, diffferent specialties, and ability to make the department better from all levels of the department.
Further more , unlike a fire service I dont have to be a fire fighter to do it.
In many fire services, you have to be a fire fighter to make a difference, even if your love is paramedicine. Why? Because you work with fire fighters who neither like, nor respect, EMS. In fact at least in our local fire service , if a mission does not directly support the fire rescue mission, like TAC MED, or being an FTO, it would not occur.

One final point on my service as an example: There is not a doubt in my mind that if we had been absorbed into the fire service not one of these opportunities would be available to me or my fellow medics with out being a fire fighter first, and going through fire training that I neither wanted nor needed to do my job better. Furthor more, looking at my local fire service as an example, if we were absorbed into the fire service, there would be plenty of career developemnt opportunities as a FF, but very few as a medic. Finally the requirement to be a firefighter would exclude many of our ranks due to their age/height/or sex getting in the way of passing the FF physical agility that has NOTHING to do with being a paramedic. We are not talking about the grossly overwight, we are talking normal people of all heights and body styles, many of whome are athletic (running, biking, nordic skiing) but not power lifting hulks...and We are not talking average paramedics, we are talking GREAT medics with years..some times DECADES of experiance ... all that would be cast away to private service oblivion because they didnt fit the fire service mold. And try to tell me that any fire based EMS program would not be better with their experiance...but again its the fire service mentality. Your a fire fighter or your nothing. No thanks.

In fact I would say that my service is one of the best in the nation BECAUSE it has developed seperate from the fire service.

SO when I look at a fire service, and I look at my own career experiance, the choice is not only simple, it is glaringly obvious.

[rumedic1]

First, there will always be more fire engines than ambulances, fire stations are closer and more available than ambulances. Typically there is one ambulance for every 2-3 stations in my county. That is if the Fire Department is providing the entire service

You are making our point. Why is there more fire engines than ambulances?? if EMS calls are 80-90% of calls why so many engines. If a person, a human life, can wait for an ambulance I think someones property can wait for a fire engine. We have this so backwards.

While a third service is an option, you would need to demonstrate its cost efficiency vs the Fire Department. By creating a whole new system, you create a whole new DIVISION of people, who will pay for all of this? Don't the tax payers pay enough already, why have two separate divisions

The fire departments in my area that are thinking about EMS. They will have to add a training officer, billing department and some senior staff to manage this staff. What is the difference? I tell you what it is. If they were EMS only you wouldn't have to pay more money for a firefighter cert that is not needed. And if you argue that we can't remove all those people from the fire department because it would be short staffed than it must already be short staffed. If you are assigned to an ambulance, you lost your firefighter for that shift. If you pull a paramedic from an ambulance to do firefighter related duties on a firescene than who is going to respond in that ambulance to emergencys on scene (thats why they standby). I have seen fire/ems respond to a house fire and pull the paramedic off the ambulance and use them as an interior attack firefighter. Who is going to treat the injured, better yet what if he becomes the injured one HELLO


Why pay a firefighter and a paramedic salaries when you can pay a firefighter/paramedic in between the two and get the same level of service, same response times, same level of care

WHAT?? because you need to look at it this way. An ambulance at say station one (for example) needs 2 EMS persons. The fire response need lets say 4 persons. Now if you pay the 4 firefigher's their salary and the 2 paramedics theirs you have saved money. Because you would be required to have the SAME number of person at that station. But your way we are paying more because the firefighter/Paramedic is going to make more than a stand alone firefighter. The only way around this is to lower your level of service by trying to rob off one apparatus to run another. I don't know how that can be done when you tell citizens that the fire department needs xxx number of people to to make minium staffing Thats why we need XXXXX dollars in salarys. But now if we get busy we can use less people. I don't think so, is that not when you need more people??

First Service (I hate to think of myself has third) EMS is the way to go and fire departments are learning this Louisville KY is an example.

[lfdc2chv]

First your basic assumption is incorrect...not all those professions have 2 years of schooling, nor do they make two times what medics do..at least where I work. I will conceed that this is not always the case elsewhere. Your point would have been better served comparing us to Nurses, but then I would have countered that they only prospered as aprofession AFTER they made degree requirements mandatory and moved out from under the shadow of doctors and hospitals. Just like EMS needs to do with the fire service.
But lets assume that the basic point that you are trying to make is correct, The way I se it there are two reasons for this, the first is that we do not have a degree requirement...Why? Hmmm because too many people inside our ranks think of this as a vocation and not a profession. They approach it the same way the fire service looks at EMS. Hmmmmm. If we ourselves treat EMS like a vocation, and we let others do so...like the fire service...then why are we surprised when we get paid like one?
And the second reason is BECAUSE we are associated with the fire service. 90% of people (the public) think paramedics are fire fighters in their area...they dont know the complexities of either job....therefore they dont have a basic respect for what paramedics do.
Remove the profession from the fire service, treat it like other professions in degree requirments, etc..and this would change (slowly...but it would change).



yeah, of that 500,000 fire truck or rescue, how much of it is truely specialized for EMS...uhmm...none. Just a compartment if we are lucky...in many cases the equpment is stowed in the crew cab. So I would counter that...as one local fire service has already done, that it would be more cost effecient to send 30K chase car than a 500K tank to a medical call that is 80% of your run volume, using the same crew and saving wear and tear...oooppss.
Anyway...Thank you for proving my point. Your post seems to forget, like many fire fighters try to do, that EMS is 80% of your job! Yet many fire services pour only 10-20% of rescources into it! This has been rehashed and rehashed previously, and if you want to see those better spoken than I discuss it, just look back in this very thread...but the point remains...in many fire systems EMS plays second fiddle to fire...and it seems like (based oun your post) it does to you too.



Hmm, in my department, we have one of our feild staff with a degree in marketing filling our marketing director posiiton. We have a full time education department, we have HAZ MED (tox medic), TAC MED (swat medic) and SOT (tech rescue, back country rescue)...we have a formal FTO corps (training officer) that is seperate but works with the education department, We have Captains (step up supervisors), Majors (full time supervisors), Assitant directors and directors all from field staff. They are ALL involved in numerous prevention and deployment projects.
We also have a standards of care committee made of of appointed members from all levels of experiance and rank that review our protocols and equipment.
We also have the same retirement as our fire based counterparts, and we work less hours a week.
I could go on and on and on.
The point being that when I look at my department, and I look at other "proffesional" fire departments accross the nation, in my department I see at least the same promotional opportunities, diffferent specialties, and ability to make the department better from all levels of the department.
Further more , unlike a fire service I dont have to be a fire fighter to do it.
In many fire services, you have to be a fire fighter to make a difference, even if your love is paramedicine. Why? Because you work with fire fighters who neither like, nor respect, EMS. In fact at least in our local fire service , if a mission does not directly support the fire rescue mission, like TAC MED, or being an FTO, it would not occur.

One final point on my service as an example: There is not a doubt in my mind that if we had been absorbed into the fire service not one of these opportunities would be available to me or my fellow medics with out being a fire fighter first, and going through fire training that I neither wanted nor needed to do my job better. Furthor more, looking at my local fire service as an example, if we were absorbed into the fire service, there would be plenty of career developemnt opportunities as a FF, but very few as a medic. Finally the requirement to be a firefighter would exclude many of our ranks due to their age/height/or sex getting in the way of passing the FF physical agility that has NOTHING to do with being a paramedic. We are not talking about the grossly overwight, we are talking normal people of all heights and body styles, many of whome are athletic (running, biking, nordic skiing) but not power lifting hulks...and We are not talking average paramedics, we are talking GREAT medics with years..some times DECADES of experiance ... all that would be cast away to private service oblivion because they didnt fit the fire service mold. And try to tell me that any fire based EMS program would not be better with their experiance...but again its the fire service mentality. Your a fire fighter or your nothing. No thanks.

In fact I would say that my service is one of the best in the nation BECAUSE it has developed seperate from the fire service.

SO when I look at a fire service, and I look at my own career experiance, the choice is not only simple, it is glaringly obvious.

First- Here we do have a 2 year degree program, I have my AAS in Paramedical Technologies. A Degree is encouraged but not mandatory for senior Medics. The new medic students come out of class with a degree. I was told by one very rude ER Doc that I have "Expensive toilet paper". Thats all my degree is and that my "real job" is to take his patients from his hospital to another following his orders with no deviations. This is after I was transporting a patient who developed chest pain enroute with ST elevation on a 12-lead and I called and got orders for a cardiac work-up (Heparin, NTG gtt, Morphine, ASA, and Retavase) for the patient from the recieving hospital. He told me not to think, that I was paid to drive and/or babysit, not think. He said this in front of the ER director, who agreed with him. The patient had a positive outcome and our medical director stood her ground against him and sided with me. So here (dont know about alot of other locations) we are treated like cab drivers. This is with my part time job as a Medic/FTO at a Tax based EMS system- separate from the fire dept.

Second- Here we have spent almost 30% of our budget on EMS equipment and Training. The rest is a mixture of salaries/benefits, fire training, etc. We spend more money annually on EMS than fire. Our Engines/Ladders all have special insulated and heated EMS compartments with all the equipment we will or could use. Narcs, Jump bags- meds, Airway bags, C-collar bags, Keds, LSB, IV drip devices, Suction, and LP-12 with all the trimmings. The special EMS compartments are wired for recharging equipment while sitting or running. The compartment is easily excessible to personnel dismounting the truck. With regards to training, here we train 25% of the time on EMS, 25% on Fire, 25% on haz-mat, and 25% on rescue. We spend 60% of my training budget on EMS Training, and the other 40% is broke down with fire, haz-mat, and rescue. EMS is a priority here, 86% of the call volume, and we spend more money on EMS with regard to budgeting.

Third- Here we only have a few steps for EMS personnel (tax based EMS system)- They can be a instructor- Last promotion was 8 years ago. There is low turnover in education personnel. Supervisor- again low turn over. Go to the fire department. Go to Nursing school. They can become a FTO, but you can only use that if you have a student or new hire. If you do have one of those students or new hires, you dont get extra pay for them working with you. You also have to fight to get one. So where you are it sounds great, honestly if we had the kind of EMS service you say you have I wouldnt mind working there part time. I have always loved fire service, and work hard to get where i am in the fire service. I left EMS as a full time EMS supervisor to get here, took a temporary pay cut for 1 year. (EMS supervisors are making what a what a starting firefighter/medic makes) I really like being a medic as well. Mother is still a medic, kinda in the family. Here the fire department is the way to go, due to more abilities to specialize in what you are interested in. Not just specialize but be able to use the specialties. Here EMS waits for the fire department to complete the rescue, extrication, etc before they make pt contact. This is due to EMS company policy, training issues, and ppe issues.

Fourth- There definately would be a problem with older employees if services here were combined. The reason is like you have said we have very experienced veterans that would not fit the mold, so to speak. These employees are so set in their ways that they forgot that this service (fire and EMS) is about change. If people arent willing to change then they may get lost in the shuffle. With the requirements part, well nobody is supposed to be discriminating based on some of the topics you have mentioned, you know that whole federal discrimination law thing. The fitness part, most fire department physical agility testing (my area), tests for stamina and ability to comprehend when tired, not strength. We most power lifting in the testing here is pulling a 1 3/4 line 150 feet.

Your service sounds like it is a great place to be a Medic. Here just being a Medic is not so great. Fire is better, by comments are based on my experiences in my system. I am sure there are other places where the situation is flipped. So thanks for the comments and be safe.

[rolandthunder]

Im on a hospital based vol. service. Its sort of the best of both worlds. The hospital owns the trucks and buys our supplies. We run the service ourselves and buy equipment. This lets us have a voice in everything that is done, When we want new equipment we decide what we want to buy and then we pay for it. On more expensive items like AEDs the hospital will pitch in some money. Every desicsion made about our service is brought to the monthly meetings where it is discussed in the group and all members are allowed to vote on what to do. This gives us a feeling of ownership in the service. We also dont have to answear to chiefs or captains on a call we are all equal. No matter how long you have been on or what level of care you can offer. ALS maybe running the call but they confer with BLS the entire time. Its a great way to work.

[PtsMedic]

"If we are "Allied Health Team" members as a Paramedic then why do the ER nurses and Docs treat us the way they do. We are far from being part of their "team"."
From what I've seen, that's what they think of firemedics. I get treated great. Why? Because I take care of my patients. I don't spend 30 minutes on scene of a chest pain patient before transporting. I don't abandon the patient the second we get through the door because a fire just kicked out and if we hurry we can get assigned to it. Paramedics that work as part of the health care community get treated with respect from the doctors and nurses. Paramedics that do it between fires don't.

"Second- Here we have spent almost 30% of our budget on EMS equipment and Training."
30% of your budget goes to 80% of your call volume? That is the biggest problem with FD EMS.

[OCFirePM]

You still are such a hater aren't you? I love it!!!!!!!

You come up with such examples here about how fire sucks and you are "super medic". But yet, once again, you have provided no physical proof or studies ar ANYTHING that what you say is the case with fire medics.

My theory is you really wanted to be a fire medic but cannot get hired, or already got fired. Now, even better you work in a system that has First Response FD ALS who steals all your thunder on your calls. Wow, the world comes full circle once again.

I could actually feel the desperation coming from you. I bet when you get a call the first thing that comes to your head is, "I gotta beat the FD," so I can do stuff. When you turn the corner in your ambulance and see the fire medics already walking in the door do you still get that sick feeling in your stomach? You walk into the house with your head down dejected on yet another EMS run where you cannot show off your "SUPERMEDIC" skills.

In my service I work on a medic engine with BLS transport. We are the ONLY ALS provider. We run our calls the way we want, emphasizing proper care and customer service. I get to the hospital, say hi to all the staff that I know, ask when the next river trip is for us. Transfer care, talk to the staff, go into the break room, get a cup of coffee, mingle with the PD and laugh about the next upcoming FDvs PD softball game. Then I get back in the ambulance and have the EMTs drop me off at my station, where the engine stayed in service as a three man PAU.

No sinking feeling for me, no gut checks. I am a part of a true "family" of personnel including Fire, PD, Hospital, etc. And this is a Fire based EMS system!!!!!!!! A lot different than what you deal with.

And on occasion I get to make an interior attack on a ripping structure, or work the Truck and get to do the fun stuff.....

[croaker260]

So who's a "hater"?

It seems to me that someone is a bit insecure around third service medics, perhaps....or maybe its just anyone who doesnt buy into the big red myth?

OC...its not just that in most fire services EMS is plays second fiddle, Its the solid insitance that the fire way is the only way, and the snubbing of anyone who isnt fire...as manifested by your statement that the ONLY reason that someone would doubt the fire based EMS dogma is that they werent good enough to get on a fire service.....

If you were ever going to have a good discussion on this...and this assumes that you even want to discuss this.....you are not going to get far because you cant see past the glow of your own ego. Perhaps ...just perhaps...and I know this is a stretch for you to admit....people feel this way not becuase fire snubs them (although that contributes to the problem), but because they truely believe there is a better way for patient care. Until you...and those like you...get over yourselves and look at all sides of the issue...EMS will never evolve.

And if there is any gut check involved when I see a fire service unit on scene with a medic...its because I know that instead of taking care of my patient politics may yet again rear its ugly head and there is a good chance one of the fire fighters on scene is going to make a snide comment (such as when am I going to be a real man and join the fire department...true story), question (rudely mind you, in front of the patient) what I am doing, or otherwise be less than helpful and patient care focused. This is not to mention that some (not all) are rushing to do their ALS skills before we get there (now who is rushing to beat who?) neglecting the BLS...like v/s's.
Fortunately most of the things I mentioned above are (so far) isolated to our neighbors...but only because from the beginning the neiboring Fire ALS experimant was a classic example of everything NOT to do....

Now this situation is slowly fixing itself...but it does happen..and its not just isolated to the ALS engines, but many BLS units too. This implies that it is not an ALS fire problem..but simply a Fire problem.

So back on topic, and the topic is WHICH DO I LIKE WORKING FOR....I work for where I work and not a fire agency because...I like being a medic. I like doing medic things. I like doing them in a system that rewards the years of extra EMS based education (both teaching and as a student) and the quality of care I provide....I like working for my agency because it has a career ladder, advancement opportunities, and diversity (we are 40% female). These are things I simply didnt find to my satisfaction in most fire services.
Dont blame me, look around at your bretheren. Have the balls to take an introspective look at your "brotherhood", see the flaws...and work to correct them...instead of slamming those who sit here and chose a different path and try to have a dialog about it.
You do that..and it will make your own service stronger...regardless whether any "unworthy slugs" like me try to join or not...but only IF YOU AND THOSE LIKE YOU ARE WILLING TO LISTEN...something your service has never been good at on any important issue...not just EMS.
Why is it so hard for many FF's to admit that if you want to do better EMS...you need to focus on EMS?

Oh and BTW, contrary to your statement....there is a very good argument that the oversaturation approach most fire services take to EMS is counterproductive. Notice that for the sake of civility I did not say fire services, just the approach that most fire based services take. Example: the recent (mar or may of '05) intubation studies out of King County when compared to the Intubation studies from LA? Why did one system succeed and one system fail?

If you want to have a discussion based on that ..a logical thoughtful discussion devoid of names like "slug" (and I will try to avoid comparing the IAFF to fanatical terrorists) and attaking me because I chose a different path, then I welcome it. But if you want to "be a hater" ...well you will certainly fit in with your fellow firefighters, and you will fit in to the forum....but from a debate point of view as well as helping your profession(or mine) out your pretty much screwed.

have a nice day.

[OCFirePM]

I could care less what service anyone works for. I am only standing up in defense of my system and brotherhood that was attacked by our friend on the board here.

I did not mention anything about third service medics. I did not even mention anything about other medics not being as good as fire medics. A medic is a medic is a medic.

I will however, stand up when my system is attacked. When people say:


"From what I've seen, that's what they think of firemedics. I get treated great. Why? Because I take care of my patients. I don't spend 30 minutes on scene of a chest pain patient before transporting. I don't abandon the patient the second we get through the door because a fire just kicked out and if we hurry we can get assigned to it."


This paragraph is an attack on a fire medic system. I gave him a gut check, but not once did I say his care is substandard, or that I am a better medic than him.

I DON'T CARE!!!!!!!!!


I do my job, I love it, I will do it as long as I can. I enjoy being a medic, I educate myself every day. It is a great job. When I worked in a First Response Fire ALS system, I did not have to ruch to the scene cause we were always first, and if we weren't, I did not care. Anyone can do the stuff, just do it right.

And by the bay, snide comments do not come from just Fire, but from other ambulance services who come up on scene and start questioning everything we did without getting a turnover first. Don't even start and say that this is a one way street, you very well know it is not.

I don't care if someone goes fire or not. That is why there are different ways to being a medic. You can work for a fire service and do it if you want to be a firefighter too, or you can work for another service and be a medic only, or swat medic or haz medic, whatever.

Not everyone is cut out for the fire service, just like everyone is not cut out to work on an ambulance only. I like the aspect of being on a medic engine. It does not mean it is the only way to go, just a way.

And no, I do not want to get into a whole argument about what system is better, etc. because there is no "one perfect system." Each one needs to be tiered for the area it serves. The system for seattle is not the same for new york and not the same for LA and not the same for midwest, etc....

And as for Ptsmedic, I just like messing with him.....He comes on the board every now and then when he is ****ed and bashes firemedics, which is in turn who I stand up for. That is it, plain and simple.

So, have fun debating somewhere else, I got better things to do....

[croaker260]

A medic is a medic is a medic.

....

Your kidding right?

[PtsMedic]

"This paragraph is an attack on a fire medic system. I gave him a gut check, but not once did I say his care is substandard, or that I am a better medic than him."

No, it was an observation based on personal experience. When I was an EMT on a BLS ambulance, I had a patient complaining of chest pain. The fire medic rode in with me, providing ALS care to the patient. We arrived at the ER, the firemedic gave his report, got his signiture, took the patient off his moniter, and left. When I protested, the firemedic threatened to call my supervisor and have me fired. So there I was, an EMT, with a cardiac patient, without a monitor, or any way of providing ALS care.After 15 minutes, the nurse came to tell my patient's medic that a bed was ready. When she found out that the firemedic left, the got angry at me for "letting him". Guess what fire department it was, OCFA.

That paragraph you quoted was based on my observations of nurses complaining about fire department paramedics. I rarely hear them complaining about the private or thrid service medics in the state. Why don't they complain about us? Because we don't do the things I stated in the original paragraph. You accuse me of being a hater and a glory hound, when it appears that is true of you. You can't seem to accept the fact that your precious fire department might not be better than God. You have made arguments that the fire department will always be best because they are sworn employees, tried and tested. But that would be true of a third service with sworn staff. You have stated that the fire department will always be first on scene because they have more stations and engines, yet that is only true because the fire department has lied to the goverment and citizens so that they think that is true.

"Ptsmedic, you were challenged by me in early october of 2005 to come up with some solutions to what you claim to be a "problem EMS system". You were silent for a while and now have resurfaced to bash Fire EMS once again."
I did give you a solution, but you didn't like it because it would take excess funds away from your precious fire department. My solution has been tried successfully in many cities, large and small. Very few of the systems running FD-EMS are successful. Also, you never answered why it is a good idea to have 2-3 units on the road, increasing the danger of accidents, for all EMS calls.

According to the Arizona Republix newspaper, "Since 2002, the city has paid almost $4 million to civilians in auto liability claims stemming from Fire Department accidents, plus an additional $730,000 to fix fire vehicles. That cost doesn't include $863,500 to replace a ladder truck destroyed when it was rolled by a speeding firefighter in 2003. " I can't provide a link, because they want you to buy the article to view the archive.

So having 2 fire engines and an ambulance all racing down the street, getting into accidents, and causing wake accidents is really in the public's best interest? Paying to have 112 fire engines for a city that might have 1 structure fire a day, but only 32 ambulances for a city that has hundreds of EMS calls a day is in the taxpayers' best interest? Delaying having an ambulance get on scene to transport a patient that really needs a doctor, not a medic is in the patient's best interest? Having the fire engines tied up on EMS calls when a fire breaks out it best for the community?

You think this is about my ego. I think this is about the safety of my family.

"And as for Ptsmedic, I just like messing with him.....He comes on the board every now and then when he is ****ed and bashes firemedics, which is in turn who I stand up for. That is it, plain and simple."
And this is why other medics don't like fire medics. I don't come here when I am mad. Nor do I bash firemedics. I criticize a system that doesn't work. You take it personal.

And this attitude is one of the problems with the fire department. I have a former coworker that is going through the fire academy right now. He has been in the avademy for several weeks. He has done physical fitness and been tested on the "unwritten rules" with which he has to comply, such as, shining the other FF boots for the first year, not sitting on the reclyner before 1700, etc. They have yet to cover trivial things such as fire suppression, rescue techiques, or any of the other things a firefighter might actually need to know.

It's good to see my tax dollars so well spent.

[mitllesmertz1]

Paramedics that work as part of the health care community get treated with respect from the doctors and nurses. Paramedics that do it between fires don't.

ROFL!!!!!!!!!!!!!!!!!!
I see we have a new mouth-breather in the forums!!
I have learned that, amazing as it sounds things are different all over. Go figure.

Consider this, my new paint-chip-eating-friend:
1. In my county, there are NO, ZERO NONE,NADA private medics. They aren't allowed here.
2. Private ambulances here are only allowed to transport BLS, they make about $8.00/hr, and that's overpaid for what the public is getting.
3. A common phrase heard by private bambulance drivers here is, "Wait by your rig, we'll tell ya when to come in".

Making rather bold statements about how a certain group of providers are worse than others is never a good idea.

So relax. Someone might call you an ADD-ADHD/lead poisoned/wanna-be-fireman/frustrated-bambulance-attendant/mouth-breathing/horizontal-taxi-driving/$30,000 per year earning looooser.
Because that's what the doctors and nurses would call you around here :)

Good thing I've learned it's not nice to make those kinda statements!

[lfdc2chv]

"If we are "Allied Health Team" members as a Paramedic then why do the ER nurses and Docs treat us the way they do. We are far from being part of their "team"."
From what I've seen, that's what they think of firemedics. I get treated great. Why? Because I take care of my patients. I don't spend 30 minutes on scene of a chest pain patient before transporting. I don't abandon the patient the second we get through the door because a fire just kicked out and if we hurry we can get assigned to it. Paramedics that work as part of the health care community get treated with respect from the doctors and nurses. Paramedics that do it between fires don't.

"Second- Here we have spent almost 30% of our budget on EMS equipment and Training."
30% of your budget goes to 80% of your call volume? That is the biggest problem with FD EMS.

30% of the budget for 65% of our call volume. Then read on.....60% on Saleries and benefits......and for those of us that can do math....that leaves 10% on fire and haz-mat...So yes we spend more on EMS than anything else with the exception of salaries.


Also these comments from nurses and docs came from taxed based EMS ONLY! Not the fire side. The local hospital docs and nurses like the firemedics, cause we treat pts. We dont put an EMT with the patient when they are in pain or when they have weakness or dizzyness. Again the comments that I post are from THE SERVICE AREAS THAT I WORK IN, not those of other service areas that i am not familiar with. Firemedics or just medics only all over the world can have it good or bad, it comes down to what you put into the job, and how your system works.

[PtsMedic]

lfdc2chv

"30% of the budget for 65% of our call volume. Then read on.....60% on Saleries and benefits......and for those of us that can do math....that leaves 10% on fire and haz-mat...So yes we spend more on EMS than anything else with the exception of salaries."
60% salaries (weren't you the one criticizing my spelling?) That salary is for firefighters. What percentage of that is the paramedic bonus? That is the only part that should be considered EMS. That money is going to pay for captains, engineers, hazmat techs, etc. that wouldn't be needed by a dedicated EMS agency for the EMS positions.

mitllesmertz1

"Consider this, my new paint-cheap-eating-friend:
1. In my county, there are NO, ZERO NONE,NADA private medics. They aren't allowed here.
2. Private ambulances here are only allowed to transport BLS, they make about $8.00/hr, and that's overpaid for what the public is getting.
3. A common phrase heard by private bambulance drivers here is, "Wait by your rig, we'll tell ya when to come in"."

Yes, outlaw non-fire medics. That shows just how fair the system is. What happens when a patient needs to be transported ALS between hospitals? You have to have an RN transport a patient that only needs a monitor? So your corrupt system is why my health insurance premiums are so high? Just because your insecure fire department can't handle the threat of a private company paramedic doing a better job than you, showing that maybe firefighters are not the best choice?

As far as that moronic comment about waiting by the rig, yes, I have been told to do that, too. Those are usually the firemedics who's mistakes we have to fix once they turn over care.

[RyanEMVFD]

I like our system here. Enough said.

[mitllesmertz1]

Yes, outlaw non-fire medics. That shows just how fair the system is. What happens when a patient needs to be transported ALS between hospitals? You have to have an RN transport a patient that only needs a monitor? So your corrupt system is why my health insurance premiums are so high? Just because your insecure fire department can't handle the threat of a private company paramedic doing a better job than you, showing that maybe firefighters are not the best choice?
I love this guy!!!!!!!!!
Clearly some of the best entertainment on the boards in weeks.
Allow me to retort, please:
1. There is no fairness here, just the best service possible.
2. We don't do inter-facility,although we will take a critical pt if the RN cars are tied up; a private company staffs multiple RN cars here, so they make out quite nicely.
3. Your insurance premium is high because you work for a private company that has a bad benefits package; not my fault, but I can understand why you're so bitter. I'm sorry you made the career choices you did.
4. Our fire department is one of about 20 that are in the County, the County decides who (whom?) gets to practice ALS in this area.
A decision has been reached that we only accept paramedics that have been through the UW/Harborview Paramedic Program. You can find it online.
5. No, my Fire Department isn't insecure.
But it sounds like you are...

As far as that moronic comment about waiting by the rig, yes, I have been told to do that, too. Those are usually the firemedics who's mistakes we have to fix once they turn over care.
Again, you state the reality in your little world.
My world is entirely different. And for some reason I would be willing to bet there are more Google hits for my system,more papers published, and more articles printed about the qaulity of care here than whatever little farmland you live in.

I pointed out, with a heavy dose of sarcasm, how idiotic you look by making these sweaping generalizations.
Yet you continue to make them.
Your level of intelligence is showing again...

[PtsMedic]

"1. There is no fairness here, just the best service possible."
I'm talking about fair to the taxpayer. Your system is making them pay more for an RN ambulance when they don't need an RN. Your system is costing me, as a taxpayer, more money because medicare now has to pay for a nurse rather than the medic that was needed, all because your fire department doesn't want competition.
"4. Our fire department is one of about 20 that are in the County, the County decides who (whom?) gets to practice ALS in this area."
The county bends to the political blackmail of the fire department. If you don't support what the IAFF and local FD wants, they campains against the candidate accusing them of being against public safety. As an IAFF member, I get material on how to do this fairly oftern.

"My world is entirely different. And for some reason I would be willing to bet there are more Google hits for my system,more papers published, and more articles printed about the qaulity of care here than whatever little farmland you live in."
My agency was named provider of the year recently by the very magazine running this forum. When was yours? Since you haven't mentioned what agency you work for, I can't check your claims, but having articles written about you isn't necessarily a good thing. The largest of the municipal FDs in the county here has had quite a few articles written about them lately. Most of them are about how their bad driving, lack of training, and lack of discipline is costing the city millions of dollars in settlements because of all the people they have killed.

[mitllesmertz1]

http://www.metrokc.gov/health/ems/
http://www.aemj.org/cgi/content/abstract/11/1/71
http://www.clinicaltrials.gov/ct/gui/show/NCT00219687
http://circ.ahajournals.org/cgi/content/full/97/21/2106
http://www.uwmedicine.org/Facilities/Harborview/Overview/Research/esdfaqs.htm
http://circ.ahajournals.org/cgi/content/abstract/109/15/1859
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=2312978

http://www.informedpharmacotherapy.com/Issue1/ArrestEBPReview.htm
http://depts.washington.edu/surgery/synopsis/archive/vol11issue1/p6.html

We have reported that with the aid of paralytic agents to facilitate intubation, the Seattle Medic One program has the highest success rate for intubation in the literature at 98.4% and the lowest surgical airway rate at 1.1%. (J Emerg Med, 2002).

Take your best shot.
Do a little research.
Get back to me with what ya find out.

When I call the ED to give a report, I talk to an MD, not an RN. That's the County policy.
How bout you?

We were in the MITI, ARREST,REACT,Cerebral Hypothermia, and initial PAED studies, just to name a few.
How bout you?
Oh, and you said this initially:From what I've seen, that's what they think of firemedics. I get treated great.
Bottom line is here, it's the exact opposite.

Until you can recognize that your statement is invalid in other areas of the country, you will continue to sound like a bitter ambulance attendant.
But keep trying...

[montet202]

Mittle also forgot to mention that his system DOES NOT CHARGE for transports like most Fire based systems that transport. They also have the LOWEST tax rate in the entire state.

Can't say (As a taxpayer here) that this is a service extorting the public.

[PtsMedic]

"When I call the ED to give a report, I talk to an MD, not an RN. That's the County policy.
How bout you?"

We're offline. It is very rare that I have to call for orders. The only thing I do is give them a heads up that we are bringing them a patient

montet202
"Mittle also forgot to mention that his system DOES NOT CHARGE for transports like most Fire based systems that transport. They also have the LOWEST tax rate in the entire state."
So they do interfacility transports and don't charge them? And they don't let the private ambulance companies charge for interfacility transports? Unless that is true, then they are cheating taxpayers across the country, not just that county. Medicare is paid by federal taxes. Medicare pays for those nurse transports because that county won't allow private paramedics. Taxpayers across the country have to pay higher taxes because this fire department doesn't want competition with private paramedics.

[montet202]

[QUOTE=PtsMedic
We're offline. It is very rare that I have to call for orders. The only thing I do is give them a heads up that we are bringing them a patient

So they do interfacility transports and don't charge them? And they don't let the private ambulance companies charge for interfacility transports? Unless that is true, then they are cheating taxpayers across the country, not just that county. Medicare is paid by federal taxes. Medicare pays for those nurse transports because that county won't allow private paramedics. Taxpayers across the country have to pay higher taxes because this fire department doesn't want competition with private paramedics.[/QUOTE]


It's the same for calling in in King County as well. I would be VERY surprised if you have even close to as liberal and autonomous protocols.

And if you could clarify the last paragraph that would be great. You're not making a lot of sense. The medic units don't do interfacility transports unless the county is out of CCT cars. When they do transport they don't charge. The privates obviously charge when they transport, why else would they staff a CCT car? What difference does it make that those transports are done by a private CCT car or a private paramedic?

As for not wanting competition---are you really that nieve? What on earth would they be competing with? Money? THEY DON"T CHARGE AS IT IS! Read these threads in this forum. How many of the problems come down to QA issues? King County has arguably the best handle on QA anywhere. They have next to no turnover. They have to have one of the most competative and intense medic programs with the most stringent pre requisits anywhere that I am aware of.

[PtsMedic]

By not allowign private paramedics, the county is forcing the private ambulance companies to use a nurse car when it should be a medic car. This costs more money, money that is paid by taxpayers across the country. I have to pay more taxes so medicare can pay a nurse to transport a patient that only needed to be on a monitor. This is a medic call, not a nurse call.

Why won't the county allow private paramedics? There is no reason to ban them, unless they are bowing to pressure from the FD to stop competition. Is there another legitimate reason? Who are they competing with? If the taxpayers knew that they could pay less taxes by having a private company do the same job, the FD would have to fight for their jobs.

As far as how liberal our protocols are, yes, I think that WA has more liberal protocols than we do. That doesn't impress me. I have a vent. that is never used. I used my doppler once. Fire has RSI, we don't. I have yet to see them use it in a way that doesn't end up on the medical director's desk. From what I have seen, the more liberal your protocols, the more likely you are to spend more time on scene instead of transporting the patient to the hospital where the patient really needs to be.

[mitllesmertz1]

Why won't the county allow private paramedics?
the medical director decides who he wants working under his license; he has decided that due to the hiring practices of privates (got a pulse?ya got a job!), and the way they are run in this area, that he only wants publice service employees under his license.


There is no reason to ban them, unless they are bowing to pressure from the FD to stop competition.
Once again, taxi driver, the County runs EMS, their is no single fire dept in charge. You seem to have a black-helicopter thing goin on- conspiracy theory everywhere. :rolleyes:

Is there another legitimate reason? Who are they competing with? If the taxpayers knew that they could pay less taxes by having a private company do the same job, the FD would have to fight for their jobs.
Read my lips you Thalidomide Child: THEIR IS NO FIRE DEPARTMENT IN CHARGE OF EMS.

As far as how liberal our protocols are, yes, I think that WA has more liberal protocols than we do.
Wow, there's a shocker- we receive better education, we get paid more, and we have excellent freedom to think, and we are highly respected. But it's not like that where you live, so it can't be true? hmmm

Fire has RSI, we don't. I have yet to see them use it in a way that doesn't end up on the medical director's desk. From what I have seen, the more liberal your protocols, the more likely you are to spend more time on scene instead of transporting the patient to the hospital where the patient really needs to be.
Again, the Fire Department where YOU work gets to do things you can't, so your angry and bitter at all fire based EMS.
And it's a lack of training and education, which I fear you may be suffering from, that causes improper use of protocols.

So, to sum it up one more time, you just can't (or won't) acknowledge that your sweeping indictment of all fire-medics is wrong. You only speak of your little area.
I have learned that there are some excellent private medics out there, some are on these boards.
Sadly, you simply come across as angry, bitter, and small minded; any valid point you may have had gets lost in your vitriolic diatribe.

Again, I wish you well, but this is getting pointless.

[montet202]

By not allowign private paramedics, the county is forcing the private ambulance companies to use a nurse car when it should be a medic car. This costs more money, money that is paid by taxpayers across the country. I have to pay more taxes so medicare can pay a nurse to transport a patient that only needed to be on a monitor. This is a medic call, not a nurse call.

Why won't the county allow private paramedics? There is no reason to ban them, unless they are bowing to pressure from the FD to stop competition. Is there another legitimate reason? Who are they competing with? If the taxpayers knew that they could pay less taxes by having a private company do the same job, the FD would have to fight for their jobs.

As far as how liberal our protocols are, yes, I think that WA has more liberal protocols than we do. That doesn't impress me. I have a vent. that is never used. I used my doppler once. Fire has RSI, we don't. I have yet to see them use it in a way that doesn't end up on the medical director's desk. From what I have seen, the more liberal your protocols, the more likely you are to spend more time on scene instead of transporting the patient to the hospital where the patient really needs to be.


Hey Corky...How many patients are transported from the field compared to between hospitals? Have you ever pulled your head out long enough to think that they are SAVING the public money? THERE IS NOT ONE SINGLE BILL GENERATED FROM THE FIELD TO THE PATIENTS. NOT ONE patient transported from the field is EVER hassled by collections. Yes the four or so CCT cars cost more for the one transport that they do to the ten that Medic One does.

Have you heard of oversaturation of paramedics? This is a problem. Find me one medic in King County that tubed less than thirty patients last year. Do they over tube? No They just have fewer medics to fight for tubes over. The end result is a county full of experienced medics. The medics on those cars have been on those cars for YEARS. Not weeks.

Also...at least half of King County is public third service (South King County Medic One) ALS only. (I think you said you were a proponent of this.) Having run calls with EVERY service there for several years, at the start of my career, I have seen every medic work, and there is no less standard of care from the third service to the fire based side.

You sound pretty jaded. Those scrubs must not have shown up yet.

[DrParasite]

You guys are weird. so much anger, so much animosity, so much built up frustration. makes you wonder.....

anyways, I work for a hospital based EMS agency, that provides BLS service to an urban city, and ALS service to the city to several surrounding municiplaties. I also volunteer at a BLS EMS agency in another town.

that being said, I think both 3rd party non-profit and municiple fire based service have their perks, but they do ahve their drawbacks. and keep in mind, almost all my knowledge and experience is based on the NY/NJ/PA systems, so it might not apply to the west coast.

I think if fire based service is to be used, then EVERYONE needs to be a medic. both the engine guys and the ambulance guys. no more of "ok, the two junior guys are on the bus," but rather everyone rotates (except the officer), everyone keeps their skills up, and everyone does EMS. I saw a system in Florida like this, in a house, they had 1 engine with 2, 1 ladder with 2, and 1 ambulance with 3. all were firefighters, all (even some of the old guys) were certified medics, and all rotated from ambulance to engine to truck.

if you don't do this, then I like having a 3rd party doing EMS, with FD sending the closest unit as a first responder (BLS only) to emergency calls. hopefully, the ambulances can be stationed in a station instead of a street corner (like many systems do), but that's just a dream. and there are enough ambulances to handle the load, instead of forcing rigs to be running back to back to back to back jobs.

but that's just my opinion, you got to use whatever works for you in your particular area.

[croaker260]

WOW.

I leave for a few days and this thread gets way too hostile. May I recommend some trans-internet administration of a benzo de jour?

Mittle, I think that even you will admit that the Seattle/King County Medic One Expieraince is far and away very different from most, if not all EMS (fire, 3rd service, and otherwise) anywhwere in the nation...even those next door to you. Therefore is not a true apples to apples comparison.

It is a good example of what an agency can do if its willing to think way outside the box, fight the good fight, and take some lumps doing it.

I certainly agree that teh Seattle/KCM1 model is one to follow. But it must be stressed that it is not truely represenative of the fire based approach nationally.

As a side line, do you think that your agency would look the way it does EMS-wise if it had not been for some early pioneers....what would it look like if it was simply a fire based operation with no outside influences?

Discussion and comments welcome.

[byoakum]

The best thing that can happen is for a city to contract the EMS out to a private company. The Fire and EMS to not mix well here. The demand for medics is high. The attitudes most of them carry kill the moral of a firehouse. They are the most arrogant, unhappy, whiniest people I have ever been around. It is a headache that never ends. They know they are wanted and because of that they get away with EVERYTHING. I wish we would go to a private service and crosstrain the good medics to the fire side. The is no such thing as a paramedic/firefighter. Only a firefighter/paramedic! I understand the level of care will go down in the community, but we will still be first responders until a private service arrives. EMS=Even More #!#!

[croaker260]

The best thing that can happen is for a city to contract the EMS out to a private company. The Fire and EMS to not mix well here. The demand for medics is high. The attitudes most of them carry kill the moral of a firehouse. They are the most arrogant, unhappy, whiniest people I have ever been around. It is a headache that never ends. They know they are wanted and because of that they get away with EVERYTHING. I wish we would go to a private service and crosstrain the good medics to the fire side. The is no such thing as a paramedic/firefighter. Only a firefighter/paramedic! I understand the level of care will go down in the community, but we will still be first responders until a private service arrives. EMS=Even More #!#!


BYOAKUM:

You post illustrates much of what is wrong with Fire-EMS paramedic relations. Especially "The is no such thing as a paramedic/firefighter. Only a firefighter/paramedic! " .
Most medics I know...hell most people I know.... feel, work, and perform better if they feel like they are valued, their mission/job is valued. By you own statement, you devalue the role and function of the paramedic in your service.
If they are whiny, then ask why. Not saying that the surface complaint is the issue, but perhaps their sense of worth in the overall fire mission is significantly lacking.

When even the line people in a service feel that "EMS=Even More #!#!", no wonder its a miserable place to be a medic.

This is a common characteristic in many fire services.

[mitllesmertz1]

Therefore is not a true apples to apples comparison.
I agree,that's why I felt the post from PTS saying that firemedics are pathetic was so out of line, and I pointed out that his reality may be different from others.
You just can't make blanket staements like that, there are too many variables.
I have learned that there are excellent priavte EMS systems, even though ours are horrible.

As a side line, do you think that your agency would look the way it does EMS-wise if it had not been for some early pioneers....what would it look like if it was simply a fire based operation with no outside influences?

LOL, probably alot like LA County or any one of the other places with a medic on every street corner.
It's the wave of the future, right? :rolleyes:

Yes, I am very fortunate to work in a system with a strong leadership, with an exdellent foundation.
I know how bad it can be elsewhere, just read some of these posts...

[montet202]

I have learned that there are excellent priavte EMS systems, even though ours are horrible.

Have you looked around much? Their counterpart on the other side of the hills are MUCH worse. (The two worst calls in Pt care regards I have witnessed in eleven years were there.) They are (In Seattle), for the most part good EMTs, but the attitudes are horrible. Something to do with how corporate treats them. I have still yet to hear about an emplyee from that private getting in trouble for poor pt care. But fill out that insurance information incorrectly and boy look out! Watch those heads roll...And all those medic dumps...(OK That one was a joke!)

[mitllesmertz1]

And all those medic dumps...(OK That one was a joke!)

Hey!
If they made it to the hospital alive, they were BLS! :)

[lfdc2chv]

[QUOTE=PtsMedic]lfdc2chv

"30% of the budget for 65% of our call volume. Then read on.....60% on Saleries and benefits......and for those of us that can do math....that leaves 10% on fire and haz-mat...So yes we spend more on EMS than anything else with the exception of salaries."
60% salaries (weren't you the one criticizing my spelling?) That salary is for firefighters. What percentage of that is the paramedic bonus? That is the only part that should be considered EMS. That money is going to pay for captains, engineers, hazmat techs, etc. that wouldn't be needed by a dedicated EMS agency for the EMS positions. QUOTE]

Well I could get into the large dynamics of budgeting, salaries, and benefits with you but I dont have the time. By your statements I can tell you arent in management or participate in the budgeting process. Ask your boss (who does a budget) what percent is for EMS equipment and training. I bet you will find out that you only spend about 30% of your budget on 100% of your calls. Here the percentage for Paramedic bonus is about 20% higher than an EMT-B. There is also pay increases for the officers positions, but you have to be a medic before promotion. With each pay raise your benefits go up. So my question for you is what percent of your salaries budget goes to Paramedics? By your statement what salaries are for just EMT's, Field supervisors, educators, and administration staff. There is absolutely no department in the world that will spend 60% of its budget on EMS equipment and EMS training with the exception of a volunteer agency (no not even yours if you researched it before you replied) Salaries are a whole different animal. That part of your budget cant be counted into what you spend on EMS. I will tell you here we spend more money on new EMS equipment and EMS training than fire and hazmat put together and doubled.

Again I will state the painfully obvious like it has been stated several times in these boards. THIS IS BASED ON THE AREA WITH WHICH I WORK!! THE BELIEFS I HAVE ARE BASED ON THAT!!!! I AM SURE THERE ARE PLACES TO WORK WHERE EMS IS BETTER THAT FIRE!! HERE IT IS BETTER TO BE FIRE THAN EMS!!

[medic1448]

Your speeking for your specific area, it's run different out here in California. I don't even know where to begin.

Yes, private companys are still in it for profit, that is why all EMS service does need to be provided by a public agency. Now that doesn't mean that firefighters have to work on those ambulances, they can hire non-sworn EMS personnel to work on the ambulance. This is the best thing for the public and I see EMS heading in this direction.


"Non-sworn personnel." That's just the problem. EMS is frequently considered second-best at many fire-service agencies. Why are EMS personnel not sworn public servants as well, especially when they run 66-75% or the average fire service agency's calls? I wouldn't ask a cop to fight a fire, so why do we ask firefighters to be paramedics (and vice-versa)? I'd love to work for a municipal agency however, I don't have the overriding goal of fighting fires as my objective so I'm pretty much excluded from municipal service in my area. Like many others in EMS I'm looking at furthering my education in a healthcare-related field to more adequately provide for my family and future. It's unfortunate how many talented EMS workers leave the field because there is little-to-no opportunity for advancement outside of the fire service in many parts of the country. Firefighters and paramedics can and should work together but to make an occupation (paramedicine) simply a pre-requisite for another occupation (firefighting) will only serve to keep EMS from advancing with the rest of the healthcare system. I applaud firemedics who love their jobs and excel in both areas but it would be great if there were more opportunities for single-role providers on both sides.

[k9kazoo]

Does anyone have any links or contacts to friends, family members, co-workers, etc... to forums, websites, email, etc... Looking for persons who work for or used to work for San Diego, LA, or Tucson?

Looking for info ASAP based on what has happened to Paramedics within these services currently and previously.

bleach74@mts.net

Thanks in advance for any guidance.


B.

[montet202]

"Non-sworn personnel." That's just the problem. EMS is frequently considered second-best at many fire-service agencies. Why are EMS personnel not sworn public servants as well, especially when they run 66-75% or the average fire service agency's calls? I wouldn't ask a cop to fight a fire, so why do we ask firefighters to be paramedics (and vice-versa)? I'd love to work for a municipal agency however, I don't have the overriding goal of fighting fires as my objective so I'm pretty much excluded from municipal service in my area. Like many others in EMS I'm looking at furthering my education in a healthcare-related field to more adequately provide for my family and future. It's unfortunate how many talented EMS workers leave the field because there is little-to-no opportunity for advancement outside of the fire service in many parts of the country. Firefighters and paramedics can and should work together but to make an occupation (paramedicine) simply a pre-requisite for another occupation (firefighting) will only serve to keep EMS from advancing with the rest of the healthcare system. I applaud firemedics who love their jobs and excel in both areas but it would be great if there were more opportunities for single-role providers on both sides.

This is not a question of public vs. private vs. fire vs. fire medics. This is a leadership issue. Nearly every department in our state employs fire medics who transport their own patients. Emphasis lies equally on EMS as well as Fire. Medical care is excellent and suppression is excellent. Medics are respected by administration, ER staff, etc. It is ridiculous to think that you can't be a professional in both fields and work in a system where the administration and the union both support and respect you. Someone in one of these posts compared it to an MD specializing in two fields; not even close. Combine EMT, EMT-P, FF1, FF2, Haz-Mat, Extrication, and whatever else and you still haven't reached a full four years of college related education, let alone post grad work and residencies. It can be done, it is just a matter of sucking up egos and looking at what is BEST for your community in both service and cost respects.

[croaker260]

Ok, how is being "non sworn" personel, without the same beifits, same advancement opportunities, equlivent working conditions and training opporutnities, and same parity of pay mean "respect" by the union and fire service?

Because that is the simple reality with most fire services I am aware of.

I absolutely aggree with the commens about one proffession being a prerequisist for the other sets the wrong tone from the start. Not to mention attracts the wrong type (or maybe the right type the fire service is loking for) of canidates.

[montet202]

Because that is the simple reality with most fire services I am aware of.

I absolutely aggree with the commens about one proffession being a prerequisist for the other sets the wrong tone from the start. Not to mention attracts the wrong type (or maybe the right type the fire service is loking for) of canidates.

I am not saying this is not the case in many places. I am saying it is a leadership issue, as well as an attitude issue. If a department goes into a hiring proccess with as much emphasis on medicine, and GOOD medicine, as it does fire fighting, than these issues are a mute point. I know several here hire entirely on your competence as a paramedic and then teach you firefighting. Not the other way around. Then paramedics are used as first in suppression and they are out and back in service for ALS runs while the rest mop up their mess.

Keeps cost down and service up. It can be done, but in an area where firefighting is the most important thing and EMS is a second class service, the transition may take an eternity.

[croaker260]

I am saying it is a leadership issue, as well as an attitude issue.

Amen, My point exactly.

[medic1448]

This is not a question of public vs. private vs. fire vs. fire medics. This is a leadership issue. Nearly every department in our state employs fire medics who transport their own patients. Emphasis lies equally on EMS as well as Fire. Medical care is excellent and suppression is excellent. Medics are respected by administration, ER staff, etc. It is ridiculous to think that you can't be a professional in both fields and work in a system where the administration and the union both support and respect you. Someone in one of these posts compared it to an MD specializing in two fields; not even close. Combine EMT, EMT-P, FF1, FF2, Haz-Mat, Extrication, and whatever else and you still haven't reached a full four years of college related education, let alone post grad work and residencies. It can be done, it is just a matter of sucking up egos and looking at what is BEST for your community in both service and cost respects.

When a man tries to be all things to all people, he ends up being nothing to nobody. In my system, the IAFF makes frequent attempts to fun over non-union medics solely for union solidarity. Dual-role may provide a negligible cost savings but isn't the best service model. When I began I would have agreed wholeheartedly with dual-role providers until I witnessed several cases of exrtemely poor care by FF/ PMs who had no love for EMS or medics forced to fight fires or, worse yet, talented FFs or PMs who were unable to use their skills becuase they could not (or would not) cross-train. To compare FF/PM training to a 4-year degree isn't possible. I have a 4-year degree with 2+ yrs of other educational experience. A degree, residency or other academic pursuit focuses on a specific field (business, nursing, fire science) whereas EMT-P, FF, Hazmat, etc. are all separate and very different areas of specialization in many cases. It is rediculous to think that one can fully excel in numerous fields, or to force those interested in such different fields (vastly different demographics, true FFs and EMSers) to learn things they don't have as their passion. I don't want a medic forced FF saving my home or a FF forced medic saving my family. IF paramedicine has a hope of evolving into what it can be and what the public needs it will almost certainly require a 2 or even 4 year degree, which will allow for an expanded scope of practice, tougher standards and respect like other healthcare providers have come to expect. Yes, the fire service needs EMS to survive with any hope of a budget in the future but subverting it as we do in Northern Illinois to second-class status, a pre-req. for a firefighter job, isn't the answer.

[medic1448]

Ok, how is being "non sworn" personel, without the same beifits, same advancement opportunities, equlivent working conditions and training opporutnities, and same parity of pay mean "respect" by the union and fire service?

Because that is the simple reality with most fire services I am aware of.

I absolutely aggree with the commens about one proffession being a prerequisist for the other sets the wrong tone from the start. Not to mention attracts the wrong type (or maybe the right type the fire service is loking for) of canidates.

Why is it that most FFs I know look down on medics and their union frequently tries, in many locales, to subvert EMS for the appearent gain of the union. Not that unions are entirely bad though I've had bad experiences with union die-hards. All I want is for my career to have a way to grow, just as the fire service has, without being forced to hump hoses (an impossibility currently in my region). Unfortunately the IAFF doesn't seem to be going the way of the UAW anytime soon so I'm not holding out much hope.

[recruiting]

I worked at Boston EMS for 10 years (until recently), that is until uncle sam got me 100%. :D

Anyway, BEMS is a well funded third service with OUTSTANDING equipment. The entire rank and file of BEMS are members of the police union (BPPA=Boston Police Patrolman's Association) and are happy to be there.

Several years back we had MANY WARS with BFD. In the mid 90's when I graduated from the BEMS academy it was a HOT situation. The BFD wanted the call volume and they REALLY wanted the city EMS service to get their call volume up. At some calls there were fist fights, yes fist fights. It was a frickin mess..

When the city of Boston disbanded the Department of Health and Hospitals is when BFD made their move to get the agency.
After discussions with the BPD they were glad to take us into their union and soon after, the Boston Public Health Commission was formed(thank god). After that took place BPHC EMS was officially a third service with major support of an oversight group investigation as well as the current mayor (mumbles).

Since then the agency has more than doubled in size and they run rescue "type" trucks now. Take a look --> http://www.boston-ems.com/NewGMC.htm

This agency (BEMS) had a lot of hard times with the BFD over “possession”, but now "seem" to have finally figured out that BEMS is just that, Boston's third municipal service. As of my last chat with a former co-worker (4 days ago), they (both depts.) now work pretty well together. Understanding that It's not fire EMS (god rest NYEMS) or the "back up service" but Boston's only commissioned EMS provider made things quite a bit better for all concerned. New blood will tend to do this! In the end the residents win!

As far as the Commissioned NON-Commissioned thing, I guess since BEMS is a commissioned city emergency service, they “all be commissioned” too. IMHO, I believe only Police Officers are commissioned personnel as they can arrest your ***.

By the way my brother is BFD (injured FOREVER-whatever) so I have seen this battle from every angle. His words in 1997, we need ya toy's bro-, "CALL VOLUME = NO LAYOFFS". Ahhhh, ok Bro-

BFD: Outstanding at firefighting
BEMS: Outstanding at EMS

What's so hard to understand.. :eek:

[medic1448]

I am not saying this is not the case in many places. I am saying it is a leadership issue, as well as an attitude issue. If a department goes into a hiring proccess with as much emphasis on medicine, and GOOD medicine, as it does fire fighting, than these issues are a mute point. I know several here hire entirely on your competence as a paramedic and then teach you firefighting. Not the other way around. Then paramedics are used as first in suppression and they are out and back in service for ALS runs while the rest mop up their mess.

Keeps cost down and service up. It can be done, but in an area where firefighting is the most important thing and EMS is a second class service, the transition may take an eternity.

I agree fully, I only wish it was that way in the Chicago area. Attitudes need to grow and egos need to shrink on both sides of the fence.

[ProMedic138]

I agree fully, I only wish it was that way in the Chicago area. Attitudes need to grow and egos need to shrink on both sides of the fence.

Medic1448 i agree with the egos of the CFD are very bad. I work for a private in Chicago and my partner and i watch the CFD bring their pts to the hospitals and i myself by just watching them would not trust them with my life. I know CFD runs a lot of EMS calls but it doesnt mean they have to give second rate care. BUT what i am talking about is watching the crew members WALK someone in the ER who is having resp. problem(a neb going and a bag hung) i have even seen them bring in a pt in arrest doing insufficient cpr and their BVM not hooked up to O2. Chicago what i hear is tring to help the problem by putting paramedics on fire trucks to respond to calls, but how is this helping? Instead of putting paramedics on trucks why not buy more ambulances to cover the calls? The only thing that suffers is pt care.

[montet202]

When a man tries to be all things to all people, he ends up being nothing to nobody. In my system, the IAFF makes frequent attempts to fun over non-union medics solely for union solidarity. Dual-role may provide a negligible cost savings but isn't the best service model. When I began I would have agreed wholeheartedly with dual-role providers until I witnessed several cases of exrtemely poor care by FF/ PMs who had no love for EMS or medics forced to fight fires or, worse yet, talented FFs or PMs who were unable to use their skills becuase they could not (or would not) cross-train. To compare FF/PM training to a 4-year degree isn't possible. I have a 4-year degree with 2+ yrs of other educational experience. A degree, residency or other academic pursuit focuses on a specific field (business, nursing, fire science) whereas EMT-P, FF, Hazmat, etc. are all separate and very different areas of specialization in many cases. It is rediculous to think that one can fully excel in numerous fields, or to force those interested in such different fields (vastly different demographics, true FFs and EMSers) to learn things they don't have as their passion. I don't want a medic forced FF saving my home or a FF forced medic saving my family. IF paramedicine has a hope of evolving into what it can be and what the public needs it will almost certainly require a 2 or even 4 year degree, which will allow for an expanded scope of practice, tougher standards and respect like other healthcare providers have come to expect. Yes, the fire service needs EMS to survive with any hope of a budget in the future but subverting it as we do in Northern Illinois to second-class status, a pre-req. for a firefighter job, isn't the answer.

Sorry...can't disagree more. I can't speak for your system, but I have never seen a FF forced to be a medic or a medic FORCED to fight fire. Around here if you want a decent career you go througha medic program and go test fire fire departments. They provide the best care, the best equipment (NO VANS OR MINI MODS) the best pay, the best training, the best benefiets, and the best employee appreciation. Privates can't hold a candle to the public services here. And let's get realistic here...becoming a good paramedic does not take that much skill, time, or brains. Being able to be trained in several different technical skills is not that difficult. Excelling at them is no that difficult. I am a good medic, a good firefighter, a good EMS insstructor, and I have a lot of room left in my brain to learn a few more skills.

It goes back to leadership. If our medics perform poorly they are suspended, written up, and fired if need be. Real simple. But it takes strong leadership.

[DaSharkie]

I worked at Boston EMS for 10 years (until recently), that is until uncle sam got me 100%. :D

Anyway, BEMS is a well funded third service with OUTSTANDING equipment. The entire rank and file of BEMS are members of the police union (BPPA=Boston Police Patrolman's Association) and are happy to be there.

Several years back we had MANY WARS with BFD. In the mid 90's when I graduated from the BEMS academy it was a HOT situation. The BFD wanted the call volume and they REALLY wanted the city EMS service to get their call volume up. At some calls there were fist fights, yes fist fights. It was a frickin mess..

When the city of Boston disbanded the Department of Health and Hospitals is when BFD made their move to get the agency.
After discussions with the BPD they were glad to take us into their union and soon after, the Boston Public Health Commission was formed(thank god). After that took place BPHC EMS was officially a third service with major support of an oversight group investigation as well as the current mayor (mumbles).

Since then the agency has more than doubled in size and they run rescue "type" trucks now. Take a look --> http://www.boston-ems.com/NewGMC.htm

This agency (BEMS) had a lot of hard times with the BFD over “possession”, but now "seem" to have finally figured out that BEMS is just that, Boston's third municipal service. As of my last chat with a former co-worker (4 days ago), they (both depts.) now work pretty well together. Understanding that It's not fire EMS (god rest NYEMS) or the "back up service" but Boston's only commissioned EMS provider made things quite a bit better for all concerned. New blood will tend to do this! In the end the residents win!

As far as the Commissioned NON-Commissioned thing, I guess since BEMS is a commissioned city emergency service, they “all be commissioned” too. IMHO, I believe only Police Officers are commissioned personnel as they can arrest your ***.

By the way my brother is BFD (injured FOREVER-whatever) so I have seen this battle from every angle. His words in 1997, we need ya toy's bro-, "CALL VOLUME = NO LAYOFFS". Ahhhh, ok Bro-

BFD: Outstanding at firefighting
BEMS: Outstanding at EMS

What's so hard to understand.. :eek:


Boston EMS is a fine agency, closely followed by UMass Memorial EMS in Worcester. Must be the brown uniforms that do it. ;)

Both agencies would probably be better if it weren't for OEMS - but that is a different story that I have gotten my BP up over many a time.

I heard many stories about the BFD and BEMS getting into it on calls when I worked in Mass. Pretty sad that many fire departments see EMS as a money source and call volume source to substantiate staffing, and nothing more.

I tend to think that third service EMS is the way to go. Having worked for privates supplying 9-1-1, two fire service based EMS departments, and currently for a County run third service, I have to say that I thoroughly enjoy the County EMS better than the other two. The training is better, the life is better, the respect is better.

I have experienced mostly poor care in every case that I have seen FD medical care rendered. I have seen good and bad care at the private, and with my current gig (albeit part-time) I see very good care by most folks, though the younger folks have a steeper learning curve due to the 30,000 call volume.

It is an attitude thing, and I tend to see and experience better attidtudes if EMS is a third service. Although, the city fire department that we predominantly run with are excellent. I have NEVER seen a more aggressive and well trained group of firefighters run EMS. Of course half of the under 35 group work for us part time so that may be a big contributing factor.

My opinions are formed on my experiences and I make no apologies for any of them.

[mitllesmertz1]

As I am a ff/pm, my personal view is that we are Gods, and we provide the best service out there.

That being said, I am starting to see the benefits of a 3rd service (ie County) based EMS department that is solely deidcated to running EMS.

There are many people that either don't want to, or can't, become firefighters, but love doing EMS.
They could give excellent service if allowed, but in our area are relegated to doing non-emergency interfacility, or backup up the FD with BLS transport.

I doubt the FD's will willingly give up the stranglehold they have on EMS, and in my case I'm glad.

[montet202]

As I am a ff/pm, my personal view is that we are Gods, and we provide the best service out there.

That being said, I am starting to see the benefits of a 3rd service (ie County) based EMS department that is solely deidcated to running EMS.

There are many people that either don't want to, or can't, become firefighters, but love doing EMS.
They could give excellent service if allowed, but in our area are relegated to doing non-emergency inter-facility, or backup up the FD with BLS transport.

I doubt the FD's will willingly give up the stranglehold they have on EMS, and in my case I'm glad.

Third service has its place. I can't see it working in a large city. Seattle, LA, Chicago, etc. But it seems to work great in outlying areas around these cities where there are a lot of smaller municipal departments that can't financially justify the number of medics needed to keep response up. (South King County, areas around Denver, etc.)
I work for a third service providing ALS to nine rural departments that run from 100 to 700 calls per year. There is no way they can afford an ALS unit on their own. And they want better care than a private can provide.
This is an issue of what works best for any given area, not if a provider is overburdened with diverse training. Any inteligent individual with any kind of dedication to their job can, through the course of their career learn to fight fire, provide ALS care, haz-mat, rope rescue, teach, IMS, ICS, whatever. Over a twenty-plus year career you can perfect all of these skills if you choose.

[DaSharkie]

Third service has its place. I can't see it working in a large city. Seattle, LA, Chicago, etc.

Eh hem. Boston EMS, UMass Memorial EMS, Austin/Travis County EMS, Durham County (NC) EMS, Wake County (NC) EMS, Mecklenberg County (NC) EMS, Charleston SC, the former NYC EMS (before being destroyed by FDNY), and numerous others are third service agencies that work quite well as seperate agencies.

I know there are many more as well but my sleep deprived brain just can't work right this morning.

As for those towns that run 700 or 1000 calls per year, personally they should not be running ALS for lack of sufficient numbers to maintain proficiency for everyone around. But that opinion probably won't go over well.

[croaker260]

Actually , IMHO, third service is an excellant choice for the largest departments. It is the smaller departments that a mixed service may be benificial, but that is situation and approach dependant.

I do agree that by the time you get under 2k calls a year, you have a hard time justifying medics. The way the flight services adjust is through patient acuity levels (kinda paralels the argument to send medics only on ALS calls, huh?), training levels and clinical opportunities, as well as competence based/medically focused hiring practices.

Points that any service, fire based especialy**... but any service, should take note of.

**(Not trying to slamm fire services too much but they are major offenders for hiring medics for reasons like physical fitness and fire fighter competence while ignoring medical competence)

[montet202]

As for those towns that run 700 or 1000 calls per year, personally they should not be running ALS for lack of sufficient numbers to maintain proficiency for everyone around. But that opinion probably won't go over well.

That is why they are pooling their money to pay for one third service to cover ALL of them. That call volume leaves, between two medic units covering nine districts, 1000-1200 ALS calls per year each. (And ZERO BLS calls for us.) And our ALS patients are usually prety sick. (14 tubes for me in the last ten months) So it is easy to justify our existance.

[croaker260]

This is an issue of what works best for any given area, not if a provider is overburdened with diverse training. Any inteligent individual with any kind of dedication to their job can, through the course of their career learn to fight fire, provide ALS care, haz-mat, rope rescue, teach, IMS, ICS, whatever. Over a twenty-plus year career you can perfect all of these skills if you choose.

Mont, Perhaps you are super medic (someone accused me of being a super medics earlier...maybe its the sushi I eat), but I am not. I however consider myself a very smart and motivated individual. And I still try learn every day. I'm not talking about the noble statement like" I learn from every call". I am talking about research, reading, etc.
I mean seriously, our profession is developing so quickly, medicine itself is developing rapidly, its hard to keep up sometimes. The new stuff on CPR and ATP, hemostatic agents, blood substitutes, the latest in airway management (etomidate only vs paralytic intubation is just one debate for example), Adult IO's,the list goes on and on. And these are relatively uncomplicated topics. None of it is black and white.

How can any one say that you can master this profession, not to mention this and another one as well?

Now I am also an active member of our Tech rescue team as part of my duties. I get by but I am not a rope master by any means. Lot of changes there too. And I teach. EMS. Add my family in there too.
I have been in EMS for almost 16 years, a medic for 11. My first 7 years was working either two full time EMS jobs...or damm close. Lots of patients. Lots of experiance. I also work for a reasonably busy service with high standards.

I am closing in on that 20 year mark you mention. I work HARD to stay current.

When does this perfection you speak of occur?

The point being that it is very possible to be overburdoned, to be diverted, to be a dabbler.
Mastery doesnt come to those who dabble. And that is what we should be striving for. Mastery or our art. Ever elusive, it should be our goal.If you (not you personally, speaking generally) dont want it, then practice at a lower level , make room for someone who does to move up. At the ALS level , why do we tolorate those who do just that...dabble? Yet that is what many services and the common fire based model not only accept, but promote.

Comments welcome.

[MobileTeleTech]

Your speeking for your specific area, it's run different out here in California. I don't even know where to begin.

Yes, private companys are still in it for profit, that is why all EMS service does need to be provided by a public agency. Now that doesn't mean that firefighters have to work on those ambulances, they can hire non-sworn EMS personnel to work on the ambulance. This is the best thing for the public and I see EMS heading in this direction.

Sounds like the incompentence I see in LA County where To many times I see FF/PM's Degrading Ambulance Crews rather than focusing on good patient care the Ambulance crews happen to be private and BLS providers, And the sad thing is these Aspiring Paramedics or Firemen (Newbie EMT's) take that type of treatment, In addition these private BLS crews get stepped on by not just fire crews, they get it from Nurses their own supervisors as well, because private Co. cater to these Fire Depts. for the sake of keeping their contracts, Fortunately for me I'm out of the loop since I do IFT's in the Capacity ofaparamedic so I'm just An Extra ambulance that they can bill more for the IFT's, On Occasion when their BLS crews are low they will send me in to fill in for a 911 call usually the Fire Personell have ****ty attitudes and treat me like a baggage handler until one of their PM figures out that I'm a Medic and their attitude changes and that's when you see that they like to prey on the scape goats (Private EMT'S), Quite Frankly these clowns in turnouts are not very high caliber Firemen just their paychecks alot of these guys are not very well conditioned very sloppy guys that lead from the rear in my time when I was a Jarhead I could have had any young private out do these guys for under 15K LOL,
In contrast in the surrounding counties the roles are reversed the private companies provide ALS and most of the Firemen are BLS I must say everybody is usually pretty sharp Private and Municipal Fire perssonell there is a better relationship between all agencies involved and in return there is teamwork and ultimately the public is better served wich is why where all here for.they sayit all started in LA Co. it's also where it's all ending just look at our protocols in comparison to other counties I wonder why? Only DHS knows the type of medics they have as first IN as first responders. little advise don't get hurt in LA Co. if you do AMA or drive to Ventura, San bernardino or Riverside Counties where Paramedics actually have protocols and a Scope and better yet brains not just a fat Paycheck LOL. I would like to ad there always is an exception to the that rule and there is also some awesome firemen and Medics but not enough.

[MobileTeleTech]

I work in a system where the fire department provides all ALS level care with paramedic engine companies or squads, with at a minimum of two paramedics( more often than not everyone on the engine is a medic) and ambulance transport is provided mostly by private companies who provide BLS level care. If the call is an ALS follow up, a medic will ride with the patient to the hospital, bringing ALS gear with him and the engine follows to the hospital.

We take pride in being paramedics, have many hours of CE each month, just as much as fire training. We have EMS coordinators, QI/QA, and a full effective customer service oriented system.

Every run sheet is audited and all of our stats are kept track of through this system, thus if someone developes a deficiency in a particular field, then it can be identified and remediated to assure proper care is given.

Being a ff/pm is a promotion above ff and a good bonus is given for maintaining your license. My department has been the sole provider of ALS EMS since the 1970s. Many officers have been paramedics for 20+ years and still enjoy helping out with patient care.

Your critique of fire department based EMS is way too generalized, while I do agree that there are fire medics out there somewhere who may not enjoy their position, you cannot finger the entire fire service and label us the way you have. In fact, I would argue there are just as many private medics out there who hate their job as well. It is a two way street.

My county has embraced EMS to the fullest extent, and have a created an entire fire based EMS system. Some agencies use paramedic engines/squads, some use paramedic ambulances as well as paramedic assessment engines.

Why must you have an ALS ambulance on every call? You just need an ALS unit and that can be provided in many different fashions. An ALS engine with a BLS transport is just as effective as an ALS ambulance. Plus, having BLS units as transport, affords the ALS unit the opportunity to send a BLS patient with the BLS unit and keep the ALS unit in service. This ensures the maximum amount of ALS units are kept in service for timely reponses, where in my county the average response time for an ALS unit to be on scene is 5 minutes. Can you say your current system can maintain those standards?

Being the Fire Departments are the sole EMS provider maintains better budgets for the best equipment possible, as we are not driven for profit and all proceeds collected are immediately put back into the fire budget for better care/equipment and training. Everything we use is the top of the line, assuring the best tools possible to provide patient care.

I have been a private paramedic, an assessment engine medic and now a medic who is the sole provider on an engine company and I can tell you I love my job, I love patient care, my department has awesome relationships with area hospitals and I love every day I go to work.

All of your comments are generalizations and are not applicable to the ENTIRE fire service, and all of your comments seemed to be geared in the San Bernardino/Riverside County areas of Southern California. (Tell me if I am wrong). In my area firefighters love providing EMS, EMS is only 85% of our call volume, we train just as much on EMS as we do fire and EMS training is mandatory! If I were to be a betting man, I bet I had more EMS training last year than you did. I average 3-6 hours a WEEK of mandatory classes/ skills stations.

Please keep your generalizations down, don't lump all firefighters together in your negative world, just cause you hate going to work doesn't mean everyone has to.

Have a great day!

You seem to know what your talking about, I worked in OC as an EMT while I was in PM School in Riverside County; I must say OC has the most incompetent medics I have ever seen I could be here all day telling you the stories, the Fire Dept has so much influence over DHS it's a joke, It is so political in that county, not to mention the protocols worse than LA Co which I thought was not possible LOL

[MobileTeleTech]

"If we are "Allied Health Team" members as a Paramedic then why do the ER nurses and Docs treat us the way they do. We are far from being part of their "team"."
From what I've seen, that's what they think of firemedics. I get treated great. Why? Because I take care of my patients. I don't spend 30 minutes on scene of a chest pain patient before transporting. I don't abandon the patient the second we get through the door because a fire just kicked out and if we hurry we can get assigned to it. Paramedics that work as part of the health care community get treated with respect from the doctors and nurses. Paramedics that do it between fires don't.

"Second- Here we have spent almost 30% of our budget on EMS equipment and Training."
30% of your budget goes to 80% of your call volume? That is the biggest problem with FD EMS.

PTSMedic You are so on it man, I thought I was the only one that was surrounded by moronic FireMedics I feel like I'm in the Eye of the storm
I worked in OC and LA county I'm not really sure which one came first,
They both have Medics that require base contact to even start an IV or for OC ASA is w Base hospital Order, So basically they don't have a scope pretty pathetic I would call myslef a medic.

[jasper45]

Actually , IMHO, third service is an excellant choice for the largest departments. It is the smaller departments that a mixed service may be benificial, but that is situation and approach dependant.




You may find this hard to believe, but I agree with you 100%, in this instance. I won’t say that it should be separate from the fire department, but paramedics should not be firefighters and vice versa, in larger departments. Smaller departments I believe it will work fine, and may even be economical; however, the more fire duty a city does, the less reliance there should be on dual trained roles.
I see it first hand; the department I work for has about 150 dual trained fire/medics who work 13 “boxes”, and about 25 ALS engine companies.
I am only going to discuss this from my perspective, as a firefighter. I have seen the argument about the need for quality in paramedics, and I agree. I will also make the flip side argument; I want the guy next to me on a roof, or in a search to want to be there, as well. I don’t want someone who is only there because they want to be a med. We have more than a few who fit this description.
Working in a department that has dual role personnel, it becomes very divisive. There are different pay scales, there are different policies with over time, there are different directions taken at every union meeting. In short, there is a lot of infighting, as opposed to co-existing. We also have enough fire-duty, that if we were to rely on our paramedics for staffing reasons, we wouldn‘t be able to. The reason for this is simple, our paramedics are busy as well; in short, they’re usually on some type of run. As it is, they operate as a third service, except for many of the problems I have pointed out.
A separate third service, with its own chain of command, promotion structure, and bargaining unit can be very successful in a larger department. Those points are essential, though. People need to be driven, in order to be successful. Promotional opportunities are the key to this. Established chains of command are essential, as well.
EMS and the fire service are not very different from each other. Both deal with emergencies in which time is a real life or death issue. Seconds literally can mean life or death, for both. Part of the reason the fire service is so successful in retaining members, is the promotions, the chain of command, the adding on of responsibilities.
Keep in mind, I am not saying that fire departments should not have a role in EMS; they just don’t need to be the primary provider. Doing what is best for the public is what is most important. If a third service med unit will take 10 minutes to arrive on scene, there is nothing wrong with firemen doing BLS, as first responders, and so on.

If you want more details on how the system I work functions, please ask.

[mitllesmertz1]

Sounds like the incompentence I see in LA County where To many times I see FF/PM's Degrading Ambulance Crews rather than focusing on good patient care the Ambulance crews happen to be private and BLS providers,
Umm, work with me here: there is a cool little punctuation tool available, it's called a period. Looks like this. It might make your rambling post a little easier to read.
Back to your post, I'll try to summarize:
1. The firebased medics are overpaid, lazy, and utterly incompetent, particularly when compared to the skills you provide when working on your inter-facility cabulance.
2. Firemedics in your area treat the ambulance EMTs poorly, until they see you arrive. When they recognize your superior status as a cabulance medic, they quickly give you much respect, as you so clearly deserve.
3. Not only are the firemedics bad, but the firemen/EMT's really aren't very good either, and a typical PFC in the Marines is a better fireman.
4. LA County in general is a poor place to be injured.
5. Outside LA County, where Private providers such as yourself provide ALS, the care is great, the private medics are nice to everyone, their protocols are the best on the planet, and the firemen recognize there own lower status and act accordingly.

I have a sneaking suspicion that others in LA County EMS might have a slightly different point of view than you.
Tell me, your career ambition was to work on an Interfacility ambulance/cabulance/taxi?
Do you find that giving Granny a ride from the nursing home to the wound clinic and back is a good way to keep up your ALS skills?
Is there any chance that you would join the overpaid firemedics if given a chance?
Or do you like that interfacility stuff so much that the lower pay, lower benefits,longer hours, and lack of a good retirement plan are just a small price to pay?
Personally, if I had to work in a system as horrible as yours, I would take my valuable interfacility skills elsewhere, where I would be truly appreciated.
Isn't Yellow Cab hiring?

[ProMedic138]

[/QUOTE] Or do you like that interfacility stuff so much that the lower pay, lower benefits,longer hours, and lack of a good retirement plan are just a small price to pay?
Personally, if I had to work in a system as horrible as yours, I would take my valuable interfacility skills elsewhere, where I would be truly appreciated.
Isn't Yellow Cab hiring? [/QUOTE]

I would like to say yes a private is just a taxi cab 95% of the time. The pay is bad, the benifits suck. I worked for a private as an EMT-B that our company does not let EMTs do emergency calls(most of our EMTs get complacant and lose skills). But however as a paramedic you get good medical calls. Trauma i believe is a basic skill with limit als skills. Plus medical calls make you think and wonder whats causing something. Our senior medics for our company will make 65K-100K a year with little OT. 24/48 off is what most medics work. benifits get a little better but not close to a pension. We have a divsion of our company that handles contract 911 service and let me say those medics think they are better then the rest of our company. Not to say they take a paycut to work the 911-service. Its what you want. We have instructors that teach our EMT class and soon paramedic class that have been in this field for over 15 years. Many of them have worked 911.

I just recently looked at my towns fiire department web site(my town pop is close to 28K). Our fire department has 23 career firefighters/paramedics(two are administraters). To what the web pages says they run close to 200 fire calls in 2004 and they dont say what kind of fires or if they where false alarms or whatever. EMS calls push close to 1300 calls in the same year. Why should our time keep a full time fire department for those little fire calls? Keep a 24/7 ambulance up and put fire personel as POC. Our town is strapped for cash and doesnt see a problem with that.

The city of Chicago is 35 miles north of me and to fix a problem with shortage of ALS ambulances they started to train firefighters as medics and put them back on the trucks! How does that help when it will still take an ambulance crew depending on severity of the call 6-7 mins to 45mins. Now that truck cant leave that pt until an ambulance gets there. What happens if a fire breaks out in their section? Face it firefigthers there are less fire calls and more EMS calls. Why sould EMS money support the fire department and the firefighters who sent on the butts most of the shifts?

[jasper45]

The city of Chicago is 35 miles north of me and to fix a problem with shortage of ALS ambulances they started to train firefighters as medics and put them back on the trucks! How does that help when it will still take an ambulance crew depending on severity of the call 6-7 mins to 45mins. Now that truck cant leave that pt until an ambulance gets there. What happens if a fire breaks out in their section?


It’s called getting help on scene to a patient as quickly as possible, how is that a bad thing? That is after all the goal of any fire department/EMS service, rapid, professional, and quality service. If a fire does happen in a particular engine company’s first due, while they are on a medical assist, the next closest company is dispatched. The same as if that particular engine was tied up on any other assignment. It happens all of the time, every single day in larger departments.


Why sould EMS money support the fire department and the firefighters who sent on the butts most of the shifts?

Maybe firefighters in your city sit on their butts all day, but that is certainly not the case where I work. In fact, where I work the majority of problems in the department stem from the EMS side of things. I could list them out for you, but there really is no need to. You have demonstrated your lack of professionalism plenty.

[mitllesmertz1]

I would like to say yes a private is just a taxi cab 95% of the time.
While your reply about the great working conditions you enjoy is fascinating, my comments were directed to a poster that stated he worked an Interfacility Transport Unit. If you feel that interfacility trips are a valuable arena to excercise your ALS skills, great. I didn't ask, nor particularly care, what valuable experience you have, or what experience your instructors have. My comments were rather to the point, regarding one particular poster's views.

Did I mention I have a Golden Retriever?
(see, that's irrelevant, huh?)

[croaker260]

Its also worth noting there are different types of interfacility. There s the critical care level of transfer from a lower level hospital to a tertiary care center ICU/CCU...by ground and fixed wing as well as rotor...and then there is the granny /renal shuffle.

I think most of us assume the latter while forgetting the former...much the same way many fire fighters on here seem to forget that not all non fire based EMS is private for proffit.

A little off topic but what the hell, im just moving with the crowd.

[lfdc2chv]

Umm, work with me here: there is a cool little punctuation tool available, it's called a period. Looks like this. It might make your rambling post a little easier to read.
Back to your post, I'll try to summarize:
1. The firebased medics are overpaid, lazy, and utterly incompetent, particularly when compared to the skills you provide when working on your inter-facility cabulance.
2. Firemedics in your area treat the ambulance EMTs poorly, until they see you arrive. When they recognize your superior status as a cabulance medic, they quickly give you much respect, as you so clearly deserve.
3. Not only are the firemedics bad, but the firemen/EMT's really aren't very good either, and a typical PFC in the Marines is a better fireman.
4. LA County in general is a poor place to be injured.
5. Outside LA County, where Private providers such as yourself provide ALS, the care is great, the private medics are nice to everyone, their protocols are the best on the planet, and the firemen recognize there own lower status and act accordingly.

I have a sneaking suspicion that others in LA County EMS might have a slightly different point of view than you.
Tell me, your career ambition was to work on an Interfacility ambulance/cabulance/taxi?
Do you find that giving Granny a ride from the nursing home to the wound clinic and back is a good way to keep up your ALS skills?
Is there any chance that you would join the overpaid firemedics if given a chance?
Or do you like that interfacility stuff so much that the lower pay, lower benefits,longer hours, and lack of a good retirement plan are just a small price to pay?
Personally, if I had to work in a system as horrible as yours, I would take my valuable interfacility skills elsewhere, where I would be truly appreciated.
Isn't Yellow Cab hiring?


Well stated! I havent laughed that hard in a while.

[gunnyv]

Quite Frankly these clowns in turnouts are not very high caliber Firemen just their paychecks alot of these guys are not very well conditioned very sloppy guys that lead from the rear in my time when I was a Jarhead I could have had any young private out do these guys for under 15K LOL,.

That's some attitude you've got there. You must have been one of those Super Secret Recon Snipers, probably made Master Gunny in 8 years, but you can't say because it's classified, right? :rolleyes:

I was a PFC once too. Now I'm a MSgt, and I'm in better shape now after being a FF for 14 years than I was as an 17 y/o PFC. And since you seem to know very little about the job, how can you judge whether any fireman is "high caliber" or not"?

I personally don't care to be dragged into the cesspool with you. If you have any pride in the Corps, don't use it to justify your ignorance.

[BKDRAFT]

I'm not going to argue which medics are better. But what I do notice is that Fire medics are happier, and more professional while the ambulance medics are tired, and burnt out. Everyone knows there are horrible fire and ambulance medics everywhere. EMS needs to be handled by the city and not by private corporations owned by shareholders that are in the business for money.

We need to have ambulances that are part of the fire department with EMS only personnel operating them, period.

[DaSharkie]

We need to have ambulances that are part of the fire department with EMS only personnel operating them, period.

Um yeah........Whatever......It does not work everywhere.

[croaker260]

I'm not going to argue which medics are better. But what I do notice is that Fire medics are happier, and more professional while the ambulance medics are tired, and burnt out. Everyone knows there are horrible fire and ambulance medics everywhere. EMS needs to be handled by the city and not by private corporations owned by shareholders that are in the business for money.

We need to have ambulances that are part of the fire department with EMS only personnel operating them, period.


Isnt what you are thinking of ideally a 3rd service?

[DaSharkie]

Isnt what you are thinking of ideally a 3rd service?

No because it would be different by saying "Fire Department" on the side of the truck. Just by doing that it would be all better.

Every place is different, and not everything that works in one place works in another place.

[bossteen]

better for whom? the fire depts budget? if we acknowledge that seperate ems only personel should do ems, then why not a third city service, with a budget and staff made up of ems professionals, not as a civilian branch with fire dept control.....how about an ems system running the fire service, as a branch of the ems agency? fire fighters would do the fire stuff, emt's would do the ems stuff, just managed by the ems system? better because it says "fire department" on the side is just silly....

[croaker260]

No because it would be different by saying "Fire Department" on the side of the truck. Just by doing that it would be all better.



I FEEL THE URGE TO VOMIT.......


Every place is different, and not everything that works in one place works in another place.

Exactly the reason to try for third service...

[ProMedic138]

Well after reading this whole section again, something just dawned on me: Firefighters and Nurses are afraid of paramedics. Firefighters must train as paramedics and vice versa paramedics need to train as firefighters to be on a fire department. If the fire services didnt count on EMS for a budget the fire service wouldnt be as big as it.

Nurses are afraid of us because we can do the same things they can with half the pay.

If nurses and firefighters stop holding back EMS, EMS itself would become a great thing. paramedics/emts would one get better pay, be taken more seriously in the health field.

EMS should be free, of all strings so it can do what it does best, help patients. As long as you have "beefs" between good paramedics and good firefighters patients suffer.

These are my opinions and not to be shared with all.

[montet202]

Well after reading this whole section again, something just dawned on me: Firefighters and Nurses are afraid of paramedics. Firefighters must train as paramedics and vice versa paramedics need to train as firefighters to be on a fire department. If the fire services didnt count on EMS for a budget the fire service wouldnt be as big as it.

Nurses are afraid of us because we can do the same things they can with half the pay.

If nurses and firefighters stop holding back EMS, EMS itself would become a great thing. paramedics/emts would one get better pay, be taken more seriously in the health field.

EMS should be free, of all strings so it can do what it does best, help patients. As long as you have "beefs" between good paramedics and good firefighters patients suffer.

These are my opinions and not to be shared with all.

We would get a lot more respect if we could string together just a few sentences that weren't chocked full of grammatical errors. I can understand a few typos due to the nature of writing on a forum, but this is ridiculous. Is English your second language?

It is hard to accept someone as a professional when they can't read or write. Which brings us back to the problem I think you are addressing. If we, as professionals, want the credit we deserve we need to start acting like it. Look around at some of these posts..."Playing music to calls," it is no wonder we are where we are.

Another reason to limit the number of paramedics and maintain a division of labor. This allows for more selective hiring, higher standards, and eventually respect.

[PtsMedic]

No because it would be different by saying "Fire Department" on the side of the truck. Just by doing that it would be all better.
Then explain why Philly and DC are fighting bad press because of all the people dying because the ambulances that say "Fire Department" have 30-45 minute response times when an engine has been on scene with a 4-5 minute response time? Or why cities like Phoenix and LA have to pay off citizens to keep them from suing to prevent the bad press from their 30 minute+ response times for their ambulances?

The only reason why a fire department should run EMS is when they need to increase their budget. FD EMS systems have failed miserably in almost every major city.

[DaSharkie]

I think you mistook my sarcasm. By and large, I am against fire service based EMS.

But communities need to fund these agencies appropriately, regardless of the agency model. But agencies need to APPROPRIATELY staff their units - this means not having a Paramedic on every friggin' truck because they want to. It simply has no observed effect on patient outcome.

[PtsMedic]

But communities need to fund these agencies appropriately, regardless of the agency model. But agencies need to APPROPRIATELY staff their units - this means not having a Paramedic on every friggin' truck because they want to. It simply has no observed effect on patient outcome.
But it has had an observed effect. The effect is fire departments don't staff enough ambulances so they can argue that they need more engines. By having too many engines for the city's needs, but not enough ambulances, they can argue that an engine can beat an ambulance to the scene, but then people die because they have fire medics on scene that can't get the patient to the hospital.

The observed effect is that having the fire department run EMS kills the citizens they are sworn to protect.

[OCFirePM]

I imagine you have proof of your accusation that the Fire Department is acutally killing people. That is a pretty bold statement. Where is your documentation and case studies?

Or are you just full of crap AGAIN?????

Another fire medic take your tube again?

HAHAHAHAHAHHAHAHAHHAHAHAHHAHA

[DaSharkie]

I imagine you have proof of your accusation that the Fire Department is acutally killing people. That is a pretty bold statement. Where is your documentation and case studies?

Or are you just full of crap AGAIN?????

Another fire medic take your tube again?

HAHAHAHAHAHHAHAHAHHAHAHAHHAHA

Very nice.

Lets see, as with many agencies the EMS systems are overloaded, but it seems that those administered by fire departments are chronicly in the news for a variety of (bad) reasons. Philadelphia, DCEMS, FDNY, Chicago.

This is not to say that the providers are necessarily bad, but that the fire departments that administer EMS are bad and destroying the system.

Good and bad all around, having worked all 3 sides of the equation, I prefer third service, and I dislike fire-based EMS. No need to be juvenile with your comments. It is his opininion.

[PtsMedic]

I imagine you have proof of your accusation that the Fire Department is acutally killing people. That is a pretty bold statement. Where is your documentation and case studies?

Or are you just full of crap AGAIN?????

Another fire medic take your tube again?

HAHAHAHAHAHHAHAHAHHAHAHAHHAHA
http://cbs3.com/topstories/local_story_125235951.html
Here is one story about Philly's FD having a patient die because the FD ambulance was on another call while the engine crew couldn't do anything to save him.

http://www.philadelphiaweekly.com/view.php?id=12076
Here's another one.

http://www.nbc4.com/news/9153107/detail.html
Here's one of DC FD's broken system killing someone.

http://www.philly.com/mld/dailynews/14429838.htm
Oh shoot, Philly has screwed up again.

http://www.philly.com/mld/inquirer/news/local/states/pennsylvania/14437156.htm
Same story, but it shows the problem.
"He said crews arrived within four minutes to aid school reformer Rotan E. Lee, who died after a heart attack."
"...and 18 minutes before an ambulance was on the scene to transport him."
The engines can't do what almost every patient needs most, transport.

Now, how many of these do you need? Because if you were to read something other than the IAFF newsletter, which only runs stories about how great firefighters are and who they need to blackmail to keep fire in power, I know, I get the newsletter, being an IAFF member, maybe you might actually have heard about some of these stories. It is happening in almost every major city that has FD running EMS.

[OCFirePM]

Great, so you sided TWO departments with isolated cases. I am sure YOUR private ambulance company has never had an issue, or that AMR has never had an increased response time to an incident that led to something bad happening.

With millions of patients being transported by Fire FDs every year, I am glad you found 5 cases. What is that like .00000001%.

Where is your major study that shows Fire Departments are killing people? So far you have NOTHING. Every department/company has isolated issues. You still offer no PROOF other than your anti-fire blanketed statements with no studies to back it up.

Face it, you got caught on this one and still only offer isolated cases. No studies, nothing of science or fact.

By the way, my fire system has an ALS response of less than 5 minutes over 90% of the time? How is your going?

[PtsMedic]

I suggest you read the news sometime. These aren't isolated cases. Philly and DC have had quite a few cases like those in the stories. Phoenix has had several until local 493 pressured the news media to stop printing stories portraying them in such a bad light. LA city was averaging at least 1 story each week when I was there.

You seem quite fond of stating that there has to be a study to prove an argument. Where is your study to show that having the FD run EMS is the best way? I admit, I have to rely on my personal experience and what I read in the news media. But, I read stories like the ones listed in my previous post all the time. I have been on calls where LAFD strapped a patient to a backboard, then had her sit there for 30 minutes until their rescue arrived on scene because they didn't want to allow any other agency transport in their city. I have been on scene with OCFA for 35 minutes with a patient having chest pain because they had to get an IV and start treatment before they transported. I have been called in to transport for Phoenix FD for an MVA, only to arrive on scene to find that there was no engine, only a person strapped to a backboard with a PCR stuffed under a strap. These are things I see all the time. I don't see these type of things when we run without fire. I haven't heard anything about any third service agency having these problems. Why is it that it only happens in areas where fire is in charge of EMS?

You are right, a study needs to be done. We need to see what type of system works best. We need to see what type of system allows a paramedic to initiate transport as soon as possible. We need to see what type of system allows paramedics to focus their training on medicine. It should be done by an independent, unbiased institution. But, I would be willing to bet that most fire department models would not do well in this study.

Also, I am quite familiar with OCFA. Yes, you average an engine on scene in less than 5 minutes 90% of the time, but what it your average time to initiate transport? When I was there it was well over 25 minutes from the time that the engine arrived on scene. That was your department and that violates national standards. Maybe OCFA has improved, but when I responded with them that was the norm.

[OCFirePM]

Well, if you worked the private ambulance then you know according to your contract that the ambulance is there in less than 7 minutes over 90% of the time. If the ambulance company fails the standard, then they get fined. How many times did you have to document on the radio why your eta was delayed? This is because there are "outs" for things like trains, weather, etc.

About your claim of 25 minute on scene times, do you have official numbers to back it up or AGAIN, are you claiming things you have no factual basis to back up??? (By the way average is 13 min 45 sec, depending on pt severity, that is from patient contact to driving away)

Do you have any proof that Phoenix FD squashes stories or is this another blanketed anti-fire statement?

You are the king (or queen?) of throwing out insane accusations without any proof. You must get into trouble a lot with people you work with calling out your B.S.

I feel a fire based EMS system works the best in my area. I have said before that not every city needs to be like me, it just works here. There are areas that a third service is probably great, but out here where I am, fire based EMS works awesome. No private/ third service medics here, fire controls EMS and does it well.

As for your personal experiences with various southern ca departments, I know there are good and bad medics in EVERY system. I have said this before too. I can tell you so many stories of bad private medics in riverside county that it would take up the whole thread, but I do not say AMR overall is bad because there are some who are not very good at their job. You make accusations that every fire medic is a dumb *** and that private/third service medics are gods. I am sure you are an advocate for southwest ambulance or whereever you work in AZ and that is great, but if you are so disappointed in where you are, then why don't you go to a third service system?

Or get more educated, get a better job and change the system from within, probably a lot better than spending your time in this forum, bitching about fire medics ALL THE TIME!!!

[mitllesmertz1]

Cmon, do ya really want to start a thread about private ambulance screw ups?
It would be never ending in our area.
They're the junior varsity for a reason...

[montet202]

Cmon, do ya really want to start a thread about private ambulance screw ups?
It would be never ending in our area.
They're the junior varsity for a reason...

Always stirrin' the pot...but you do have a point!

[DaSharkie]

Cmon, do ya really want to start a thread about private ambulance screw ups?
It would be never ending in our area.
They're the junior varsity for a reason...

I could say the very same about numerous fire-based EMS systems in Massachusetts.

Yet when I cross the state line into New Hampshire, Fire Based EMS is a very good delivery method.

It all depends upon where you live. I am used to outstanding care from Boston EMS and UMass-Memorial EMS in Worcester, MA.

[yowzer]

Cmon, do ya really want to start a thread about private ambulance screw ups?
It would be never ending in our area.
They're the junior varsity for a reason...

Oh, we have just as many bad experiences/They did what?!? stories about fire emts/medics as you do about us.

Everyone has their moments.

[Quadrider400]

In 1989 I did my exit interview with the private provider GM. He said "do you really think you will be better off with the fire serivce...."

I smiled and said
1. I will be starting at $500.00 more a month than I earn here after 5 years.
2. My uniforms will be provided.
3. My continuing education required classes will be paid for (not out of my pocket)
4. When I work OT it will be at time and a half.
5. When I leave I will have a retirement I can live on... rather than the $1500.00 I have so far with you after 5 years.
6. I can advance and not have to be a transporting Medic if I chose to.
7. I will get 10 shifts off a year to start.
8. I won't have to put up with poor out of date equipment or medic units.
9. I will have some job protection via a union so I can not be terminated 'cause you don't like me.
10..... He stopped me here and thanked me for my honesty.... then asked if I would still work part time... I smiled and walked out... never looked back...
While I was there I loved the work, the crews I worked with ... we made due with what we had and gave great patient care. We were there because we cared.. It was the lack of care at the managment level that drove people away.... Most private companies are nothing but a stepping stone and a training ground for the fire service... There is just no long term incentive...

Where I am now we have just changed from a Fire based transport to a private service however the area is still ours... they work for us and have contractual (sp) obligations. Further, we are the primary providers they staff with one Paramedic and one Basic... critical calls we go with them even some no critical ... .why cause they are a training ground some of the medics if you ask them how long they have been a medic they look at there watch and ask if they should count today... Additionally, we are the back-up to high call volume times... if they are short we still have 3 medics that we can put in service within minutes...
I have been with the Fire service for the last 16 years and will be here for the next 10... its the only way to go... at least in this area... :D

[StreetMedicLA]

..3LA City Fire Department is one of the most incompetent EMS agencies I have ever seen. I wouldn't trust them with my care if my life depended on it, because it would, no matter what my chief complaint was.

Sadly, I have to agree with you on this. I have worked in EMS in various locations and have been extremely disappointed by LAFD's EMS capabilities. The problem is, as you put it, the vast majority of paramedics with the department simply don't care about medicine or EMS. They got forced into becoming paramedics due to LAFD's firefighter/paramedic program. Instead of allowing single-function paramedics, which would in turn draw from a larger pool of medically-minded individuals, people are forced to be firefighters first...medical providers last.

This results in a paramedic staff that views EMS calls as a nusance and a distraction from what they're really there to do...fight fires. Fire/EMS was the WORST thing to happen to medicine since blood lettings.

I have witnessed gross negligence time and time again in my (routine) interactions with LAFD. I have been apalled by their laziness (including signing off patients who were obviously altered and incompetent to make such decisions, presumeably because they wanted to get back to their cozy station houses). I have witnessed gross incompetence with regard to spinal immobilization (just recently I saw a photo in JEMS of an LAFD scene where patients were immobilized improperly).

The EMS system in California (especially LA County) needs to be completely revamped. The system tolerates a great deal of incompetence and panders to the almighty fire unions while putting patient care and public safety last on the list of priorities. This is the scathing reality of EMS in Los Angeles County.

Recently, pedatric intubation was stripped from the LA County ALS scope of practice. Surgical airways are no longer permitted. Many ALS agencies are not allowed to perform transcutaeneous pacing. Only a handful of meds are authorized. These meds do not include basic necessities such as Magnesium Sulfate or many commonly accepted antiarrythmics. There is no field treatment for eclampsia (since Mag is not authorized for any use except as part of the "FastMag" CVA clinical trial). The list goes on and on.

LAFD (and surrounding agencies) continue to hold back EMS as a legitimate medical field. In my conversations with several medics I have found nearly 100% of those I've spoken with don't even care about this state of affairs. They are happy with their limited scope because they don't have to work as hard or think as much. I've only ever met one LAFD paramedic who complained about not being able to practice medicine compared to other parts of the country. His partner, of course, started spewing propaganda about hospital proximity, etc. justifying the lack of interventions and autonomy.

The real culprit, and the reason why medical directors will not expand the scope in places such as this, is that fire departments have taken on EMS as a necessary evil. LAFD in 2005 responded to very few fire calls. Nearly 90% of their activity was EMS. Without getting their grubby little hands on EMS they would have to lay off fire fighters and close down stations. EMS is their life blood, but they hate it. They want the money, but they don't want the responsibility.

When you are a paramedic you are a PARAMEDIC/firefighter....NOT a FIREFIGHTER/paramedic. It's time the EMS community stands together as one and DEMANDS a national standard scope of practice and legitimacy. There is no reason nursing should be more recognized than paramedicine.

That's my $0.02, however unpopular it may be.

[bikenmedic]

Wow, this thread has been going on for a year and a half. Nothing like beating a dead horse.

[chicagoambo]

I've worked as a rent a medic on a suburban fire dept, now AS A FULL TIMER ON cHICAGO FIRE FOR THE LAST 20 YRS!YOU Can"t COMPARE PAY AND BENEFITS,GREAT GUYS BOTH PLACES.

[mitllesmertz1]

Amazing, just noticed this little thread, still chugging along, still full of disgruntled medcs bitching about how other guys are screwing up.
Since I was bored, I actually read through the entire thread, all 9 pages.
What becomes blindingly obvious is that NO ONE SYSTEM WORKS FOR ALL AREAS!
There is no "best" solution.
For every post about how Fire/EMS sucks, there are dozens of departements that have never been heard of, because you don't get in the press for just doing a good job. Same thing goes for how bad private EMS is.
So let's sum it all up here:
1. If it works in your area, it's a good program.
2. If it's not working, a different plan might be better, but might not.
3. Any system that trains it's crews well, pays them well, and treats them well, will ultimately provide good service, irregardless of the modality.

Wow, that was tricky, huh?

[OCFirePM]

Sadly, I have to agree with you on this. I have worked in EMS in various locations and have been extremely disappointed by LAFD's EMS capabilities. The problem is, as you put it, the vast majority of paramedics with the department simply don't care about medicine or EMS. They got forced into becoming paramedics due to LAFD's firefighter/paramedic program. Instead of allowing single-function paramedics, which would in turn draw from a larger pool of medically-minded individuals, people are forced to be firefighters first...medical providers last.

This results in a paramedic staff that views EMS calls as a nusance and a distraction from what they're really there to do...fight fires. Fire/EMS was the WORST thing to happen to medicine since blood lettings.

I have witnessed gross negligence time and time again in my (routine) interactions with LAFD. I have been apalled by their laziness (including signing off patients who were obviously altered and incompetent to make such decisions, presumeably because they wanted to get back to their cozy station houses). I have witnessed gross incompetence with regard to spinal immobilization (just recently I saw a photo in JEMS of an LAFD scene where patients were immobilized improperly).

The EMS system in California (especially LA County) needs to be completely revamped. The system tolerates a great deal of incompetence and panders to the almighty fire unions while putting patient care and public safety last on the list of priorities. This is the scathing reality of EMS in Los Angeles County.

Recently, pedatric intubation was stripped from the LA County ALS scope of practice. Surgical airways are no longer permitted. Many ALS agencies are not allowed to perform transcutaeneous pacing. Only a handful of meds are authorized. These meds do not include basic necessities such as Magnesium Sulfate or many commonly accepted antiarrythmics. There is no field treatment for eclampsia (since Mag is not authorized for any use except as part of the "FastMag" CVA clinical trial). The list goes on and on.

LAFD (and surrounding agencies) continue to hold back EMS as a legitimate medical field. In my conversations with several medics I have found nearly 100% of those I've spoken with don't even care about this state of affairs. They are happy with their limited scope because they don't have to work as hard or think as much. I've only ever met one LAFD paramedic who complained about not being able to practice medicine compared to other parts of the country. His partner, of course, started spewing propaganda about hospital proximity, etc. justifying the lack of interventions and autonomy.

The real culprit, and the reason why medical directors will not expand the scope in places such as this, is that fire departments have taken on EMS as a necessary evil. LAFD in 2005 responded to very few fire calls. Nearly 90% of their activity was EMS. Without getting their grubby little hands on EMS they would have to lay off fire fighters and close down stations. EMS is their life blood, but they hate it. They want the money, but they don't want the responsibility.

When you are a paramedic you are a PARAMEDIC/firefighter....NOT a FIREFIGHTER/paramedic. It's time the EMS community stands together as one and DEMANDS a national standard scope of practice and legitimacy. There is no reason nursing should be more recognized than paramedicine.

That's my $0.02, however unpopular it may be.


1) Have you surveyed the "vast majority" of paramedics? Or is this another blanketed statement? You cannot voice for the entire paramedic rank of LAFD, this is unfair to them and insane by you.

2)The majority of new LAFD paramedics signed up for PM school. In a class of 35, 32-33 will have signed up for it, the "draftees" if they do not like it, usually find a way to fail themselves to stay out of the program.

3)I would love to know how you had "interactions" with LAFD, being you are not a member of LAFD. Just because they wouldn't hire you, don't be mad at all of them.....

4)You saw a photo in JEMS eh? Good for you, as we all know you are the greatest paramedic ever and have NEVER done anything wrong. Was this picture of an MCI? Maybe resources weren't there at the time, who knows, but one thing for sure, YOU ARE A PERFECT PARAMEDIC!!!!

5)Pediatric intubation was taken away from a study that has proven to be improperly done, and a new study is currently in the planning stages. Wow and that was many years ago....glad to see you are as up to date as you claim to be.

6)Surgical airways are also in the process of being re-entered through a study.

7)TCP and IO are in the 2007 update...glad to see you are still on top of things....

8)If you spoke with "several medics" that would leave me to suspect you talked to three people, (of the hundreds of paramedics in LAFD), so according to your numbers 2 of the three did not care about the state of affairs (66% hardly almost 100%), and one did care a lot.....glad to see your small numbers are a true reflection of the feeling of the LAFD

9) In 2005 LAFD responded to THOUSANDS of fire calls, hardly the few you claim. And percentage of EMS is in the low 80s like everyone else, not 90%.

10)No fire stations would be closed if EMS is lost, just losing EMS units only. Fire Stations are placed for FIRE coverage, with the number of EMS units needed being lower than number of fire units needed. But, let system status management figure all that out....

11) Firefighters can be certified EMTs, or licensed paramedics. Hence the terminology of Firefighter/EMT and Firefighter/Paramedic. Same as an Engineer/Paramedic or Captain/Paramedic. We are firefighters who hold a medical license or cert and can perform the skills we are trained to do. There are many firefighters who do not provide any medical skills, these positions are strictly firefighters, same as there are paramedics who do not have fire suppression skills. So, you have a firefighter class, who have different medical skills, thus there level of medical training is shown after the original position they hold....FIREFIGHTER/PARAMEDIC....it has nothing to do with what you do more. Just because you enjoy paramedicine more, does not mean EVERYONE has to follow what you think....get a clue hoss.

12) YOU ABSOLUTELY HAVE NO IDEA WHAT YOU ARE TALKING ABOUT!!!! Your two cents is not unpopular, just more like idiotic.....

13) Why don't you go visit many different LAFD stations and talk to the real crews. Go visit a whole battalion and get the real scoop from the real guys, instead of making blind posts criticizing a group you do not work for, have never worked for and apparently know nothing about.

[mil1982]

They removed the surgical airway that they had because it was not a very effective airway and more importantly there were less then ten cases per a year that required it. They looked into usage before they decided to pull it. I seem to recall several topics here and elsewhere that talk about skills needing to be used or practiced frequently to be able to competantly perform them. I have worked with several medics in LAFD and also with SMFD in LA County and found them to be highly competant and really do enjoy their jobs. Most of them that I worked with had several years on the department and could easily have gotten a spot on the engine if they so desired. Some parts of LAFD's stations are in areas that run 18-24 EMS runs a shift. These medics are truely dedicated to what they do. Some people may think that they are abrasive, but it isn't much more then the standard "I know what I am doing back off" policy that most of us have.

[SBrooks]

As a one-time proffessional observer of departments, a one-time ALS provider, a degreed engineer, and a professional firefighter, I have a few observations about fire-based EMS.

1) The frequently stated 'Majority of Incidents' argument is flawed. Fire suppression units are needed for the fire threat, other things that fire departments do are generally for economic efficiency. The fire threat requires that fire stations are placed throughout the community, ideally to meet a <4 minute drive time. Often, this level of saturation leaves fire units with low call volumes. This 'spare' time should be used for training - especially since the low call volume leaves less opportunity for field experience. In many cases, there is still 'spare' time, even with adequate training and pre-fire planning. So the Fire Department takes on extra value-added activities: EMS, HazMat, Technical Rescue, etc. HazMat and Technical Rescue are low frequency events that require much training and drill for competency, similar to firefighting. EMS is a high frequency event, with much classroom training required, but with, generally, many opportunities to practice.

2) The proportion of EMS/Fire responses made by suppression units is largely a function of the administration. There's little clinical indication for justifying a 4 minute response to most of the MPDS-categorized incidents. However, there is a great deal of evidence supporting a 4 minute response to some incidents. Where the administration chooses make this divide can change a 80% EMS fire department to a 30% EMS fire department overnight. Similarly, if the administration decided to send a full structure assignment to every fire-related call, the proportion could be skewed.

3) It is almost always a good idea to send Fire Trucks on Echo & Delta runs. It may be good idea to send them on Charlie runs. It's probably not a good idea to send them on Bravo runs, and definitely a waste of resources to send them on Alpha runs.

4) As for Firefighter/EMTs and Firefighter/Paramedics: these are good ideas where they are used as both Firefighters AND EMS personnel: specifically when they ride fire trucks, and respond as suppression personnel or EMS personnel depending on the call type. Where they ride Ambulances, and are not responsible for fire suppression while riding the ambulance, they should generally be replaced by full-time dedicated EMS personnel, especially if the 'system' they would participate in is large enough to justify it's own agency.

5) I find little justification for paying for a full-time professional single-role EMT, unless they are actively pursuing advanced training.

6) I've never seen firefighters sitting around the kitchen table discussing the relative efficacy of one medication or technique over the other. I'm not saying it doesn't happen, but I've never seen it, and I've looked.

7) I think that EMS *COULD* be a rewarding and life-long career choice. However, in most jurisdictions, many EMS personnel are going to want to move on to greener pastures. I believe that turnover is the nature of the beast in busy departments - while many EMS advocated clamor for a pension, I believe that a pension would not be in their best interest, as it would tend to require that they stay in one place longer than they'd otherwise want to - and reduce their ability to shop around for a better job.

8) EMS personnel are certainly under paid. This does not have to be that way. If some of the productivity measures used by private EMS providers (PUM, SSM, automation/IT etc.) were used by a governmental, non-profit, or cooperative agency, the 'profit' normally due to a for-profit provider could be shared through higher wages or profit-sharing. Looking at Washington, DC, with improved collections and a modest per capita subsidy of $25/y; EMS personnel could average over $100,000/yr in compensation.

9) Conversely, in some areas, the population does not justify both a fire department and in EMS agency. Generally this is because the population is not dense enough to allow for a sufficient number of taxpayers to fall within each station area. Perhaps in such cases, the tax base would only support 2 firefighters and 1 EMS person per useful response area. In these cases it would be an excellent idea to have fire-based EMS or EMS-based fire. In these situations it would be neccessary for the majority of on-duty staff to wear two-hats all the time: either ambulances would be dispatched to fires and gear up for work, or the staffing for fire trucks would slide accross the floor to staff an ambulance when such a call was received.

10) Universal health insurance, for good or bad, will drastically change the face of EMS.

[mitllesmertz1]

Most of what you posted is rather obvious, but I will comment on a few points:


5) I find little justification for paying for a full-time professional single-role EMT, unless they are actively pursuing advanced training.
If I read this correctly, a full-time single-role EMT is a waste of money?
The only ones worth the money are paramedics?
So are you advocating having ALS responders as the only full-time providers, when ALS makes up approx 30% of all calls?
And this makes fiscal sense how, exactly?

6) I've never seen firefighters sitting around the kitchen table discussing the relative efficacy of one medication or technique over the other. I'm not saying it doesn't happen, but I've never seen it, and I've looked.
And I've never seen nurses sitting around discussing the advantages of 2 1/2" lines either.
Unless the firefighters are cross-trained as EMT-B or EMT-P, I fail to see your point here.
You have never seen a dual role ff?
Better look harder, we discuss both aspects of our job every day.


7) I think that EMS *COULD* be a rewarding and life-long career choice. However, in most jurisdictions, many EMS personnel are going to want to move on to greener pastures. I believe that turnover is the nature of the beast in busy departments - while many EMS advocated clamor for a pension, I believe that a pension would not be in their best interest, as it would tend to require that they stay in one place longer than they'd otherwise want to - and reduce their ability to shop around for a better job.
If they worked for a good agency, with good pay and benefits, why would they need to look around for other jobs?


9) Conversely, in some areas, the population does not justify both a fire department and in EMS agency. Generally this is because the population is not dense enough to allow for a sufficient number of taxpayers to fall within each station area. Perhaps in such cases, the tax base would only support 2 firefighters and 1 EMS person per useful response area. In these cases it would be an excellent idea to have fire-based EMS or EMS-based fire.
By definition, isn't this the vast majority of departments in the country?
We all talk about FDNY, Wa DC, etc, but in reality most departmetns are waaay smaller than that.

In these situations it would be neccessary for the majority of on-duty staff to wear two-hats all the time: either ambulances would be dispatched to fires and gear up for work, or the staffing for fire trucks would slide accross the floor to staff an ambulance when such a call was received.
As long as someone is staffing the engine and truck at the station and bring them to the fire, I guess having your ambulance respond to the house fire is fine.

10) Universal health insurance, for good or bad, will drastically change the face of EMS.
And then will EMS try to take over fire departments, yelling about how the amount of runs have decreased, and there is no longer a need for EMS units?

[SBrooks]

Let me clarify my point mittle, we may agree on something.

I see little point in a little extra to staff every EMS unit with an ALS provider - an INTERMEDIATE. Such a cert only carries a $3-5K/yr premium.

I DO AGREE with the idea that some specialized EMS Paramedics, preferably with an advanced scope of practice, should augment those "ALS" transport units on the 5-15% of runs where they'd be needed. These advanced Paramedics would cover a large area, and accrue a lot of experience and practice with their skills. Additionally, they'd have a one-on-few relationship with the OMD. Their time would be filled responding to the serious cases, or waiting for the serious cases. They would not be wasted on BLS transports. They would not be wasted on Alarm Bells, Brush Fires, or other fire duty. They'd be 100% serious EMS all the time.

Another way to look at my 'Ideal' system would be to take a classic Tiered Response system (FD F/R, BLS, ALS) and bump up the training level: FD would be EMT-B (EMT-I in hard to cover areas and very busy areas), Transport units would be EMT-I, Paramedic FTO/Supervisor/Additional Medic would be advanced EMT-P's.

The public should be educated & have access to AEDs.
The FD should arrive w/in 5 minutes to roughly 20% of the most serious runs, and should be able to do those thing needed in the first 5 minutes, namely ensure open airway, AED, and provide a hand.
The Transport should arrive in 8 minutes, and should be able to handle 80% of the EMS workload. This requires some ALS - as the ALS workload, at least by dispatch, is 40-50%.
The Medic should arrive in 10-15 minutes, and should damn near walk on water. Their response protocol should limit them to roughly the same calls the FD is dispatched on - however, they should probably be 1/5th as few as the engine companies.

(I say FD to refer to the suppression companies, such a system could work entirely within the actual Fire Department.)

I'm also assuming a fairly urban or suburban department where:
An Engine might cover 20,000 people, and make 400+ EMS runs/y. The 4-5 EMT-I on this company would treat ALS patients only 80 times a year each, and would require intensive practical training to compensate.

An Intermediate Ambualance might cover 40,000 people and make 3500 EMS runs/y. These 4-5 EMT-I's needed to staff this unit (with a BLS partner) would treat ALS patients 280 times a year each.

An advanced Paramedic repsonder might cover 150,000 or more people, and make 3500 runs/y. These would be the most serious runs. The 4-5 EMT-P's needed to staff this unit would treat challenging patients 700 times a year each. This small, manageable, and elite cadre of ALS providers could and should meet very frequently with the OMD for M&M sessions, etc.

Thats where I'm coming from. Specialize as much as your budget and density / response times allow. Make EMT-I the 'standard', but not the gold 'standard'. Set the bar for real Paramedics very high.

[arronliptak1]

I worked for the privates for a long time and found out that, at least here in the cleveland area, there isn't much of a living in the privates. I'm not saying I'm in this for the money, everyone knows that's not it, but when you now have a wife and two kids...
To make a getting by living you need to be in a fire house. I found too that you are able to make more money and less stress in the ED's than in the squad. Plus your exposed to a higher number of critial cases than on the truck. ED medics learn a great deal more, medically anyway, from being around the Doc's all day than from CEU books. That's just my opinion anyway. I do miss the street though....

[irescueu88]

Ok I know this thread is an old one but I just gotta chime in. I have worked for both. I am retired now and here are my opinions.Both have their advantages and disadvantages. I liked working for a municipality because it is harder to lose your job most of the time.I never had a problem with job jeopardy with either in that aspect. But with a Private they can and will fire you for most any reason. Now I must say I liked the privates for a couple reasons.One was the pay was higher in my area with a private. I personally enjoyed the work load. Yes the privates are profit motivated some are not so good to work for because the bottom line profit is all they care about.Some others actually cared about the employees. Those were the good svcs. Now in private the work load is much much heavier due to doing transfers.But with most I have been with emergency services didn't suffer. One because we usually had a unit that was not far from the scene.
Now working for a fire dept. I enjoyed running mainly emergency calls even though as we all know 92% of the calls were taxi svc more than needed ems.I liked the chance to "chill" at times but waiting on the phone to ring get boring.I liked the constant running of the private because the time went by quicker.Now one private I worked for would rotate us.We would run the gomer totes and then would get rotated to strictly emergency calls.So both have their good and bad points.If I had to make a choice today I would probaly go with a private.Don't get the wrong idea.Just because it was a private we maintained professionalism at all times.Sometimes the fire dept is the way to go if you don't want to run allot of calls in a day.If you like the action of being more relaxed and doing transports then private is the way to go.In my area in TN the privates pay much better. Althought the privates are starting to slowly fade away now that some of the counties here are starting to see the money is in the interfacility transfers. A one time very large private here is now only running about 3 different counties .At one time they ran about 17. You have more job security with a fire dept or county owned svc. Due to the fact your job is protected better than a private. One other private I worked for was one that cut corners on many things to survive.Like stocking just what the state required and didn't keep much inventory.With a municipal this is normally just the oposite.These are just my opinions & experiences after 22 yrs in the service.

[mitllesmertz1]

Interesting points.
Obviously, things are different everywhere.
Privates here make about 1/3 what fire-based make.
If we **** off 1 citizen, the whole world falls in around you.
Privates here look and act like they just got their certs yesterday, then went out drinking all night to celebrate the new job.
I would love to sit around awhile, maybe I should move to TN.

[LTA2323]

Your speeking for your specific area, it's run different out here in California. I don't even know where to begin.

Yes, private companys are still in it for profit, that is why all EMS service does need to be provided by a public agency. Now that doesn't mean that firefighters have to work on those ambulances, they can hire non-sworn EMS personnel to work on the ambulance. This is the best thing for the public and I see EMS heading in this direction.

I guess it depends on where in Ca you live from 1970 to 2001 my family owned and operated a private 911 contract ambulance service in northern ca,
since 2001 the city and county are providing 911 services and also putting
the city and county in major debt 5.5 million a year X 5 almost six years and you want to talk about profit the city's amby bill is about 221 dollars more than what we were charging. down in the Sacramento valley the fire dept suck and they don't provide any better service than AMR here in Roseville and sorrounding areas. SO IMHO fire guys should stick with the hoses and leave EMS to the real Emt's and Medics.

[Firemedic574]

Idont know if anyone has ready about it in any of the fire or ems mags, but I work for a City Fire Department that has just entered into a contract with the local private ambulance service...But this isnt your usual contract. This ambulance service called HEMSI stations an ambulance in our fire station, eats sleeps, and lives with us, and provides one crew member. This is depending on the difficulty of the day as to which level crew member they will send, either basic or paramedic. The fire department staffs the other crew slot on the ambulance. This company pays the city a sum of 287,000.00 per year to hire and employ 6 people. In turn we run about 35-40% of the calls in our city jurisdiction, and the remainder all over the county, both in huntsville and madison county. We are assigned to post in the city of Huntsville so we can cover for whatever station needs it and run boat loads of BLS transfers. We have actually had fire department employees "written up" by HEMSI for supposed defficiencies and We DONT EVEN WORK FOR THEM!!! I have been a firefighter for my city for 4 years now and I have worked for HEMSI for almost 7 years. I am still loyal to the private sector but my heart is with the fire department!!!

[StreetMedicLA]

In response to OCFirePM's scathing reply to my original post...

First, I'm glad to see that this thread has gotten some response...a large part of my initial posting was to spark a discussion and raise an issue. Thank you for responding as candidly as you did.

I can assure you that I am not bitter with LAFD because they did not hire me. Nor is my not working for that agency the result of my being incapable of filling the position. It may be true that the majority of new LAFD paramedics are volunteering for paramedic duty, however that does not negate the large number of currently serving paramedics who are not part of this current trend. I agree, however, that making a blanket statemnt without surveying hundreds of uniformed personnel is unfair by me.

Regarding my interactions with LAFD. There are many ways to interact with EMS/Fire providers without being a member of that agency. I have worked in the privates in standby roles where we routinely call upon LAFD (and other surrounding agencies) to transport our patients. Most are minor, but there have been many cases from my personal experience and the experiences of my partners where the patients were certainly not minor or routine. It seemed from my own observations that unless the patient was suffering from a textbook MI or from major trauma, the level of care was not very high. I agree that this is not the case with all providers, but I can only speak from the experiences that I have had personally. I have interacted with dozens of providers, which yes...is not a very lage sampling of the hundreds employed by LAFD.

However, during my interactions I found the majority of the paramedics and firefighters that I encountered on scene to be very condescending toward me, presumably assuming that I am an unqualified, poorly trained, private service EMT. My reports were routinely ignored, and I witnessed many patients provided with inferior quality of care. I have personally worked in a high volume urban EMS system as a primary 911 responder (on the east coast) so I understand the stresses of the job, but that never interfered with my level of care.

I won't get into specific incidents because I don't have the time here, though if you private message me I'd be more than happy to share my experiences. Perhaps you could shed light on why the providers act the way they do. I assume you work for LAFD based on your response.

The JEMS magazine article that I saw was indeed at the scene of an MCI. However, despite the lack of resources being a possible issue, if you had the time to perform spinal immobilization in the first place, there is no reason to "forget" to complete that procedure on several patients. The disposable headblocks used come prepackaged so the only reason not to have the head completely immobilized when complete would be, presumably, laziness. I am certainly not a perfect paramedic, nor do I claim to be. However, when I witness improper spinal immobilization routinely by LAFD personnel I have to ask myself why. I have seen patients walked around with only collars on (why put the collar on if you're going to walk your patient?). I have had LAFD personnel get mad at me because I begun spinal immobilization and now they had to finish it.

Regarding pediatric intubation and needle cricothyrotomy, I was unaware that these may be potentially reintroduced into protocol. These were merely examples though, and I am aware that needle crics are not used very often. However, the issue of protocol restriction as the solution to lack of practice/training is the point. Other procedures, such as RSI and CPAP have been shown to have tremendous impact on patient outcome, yet CA protocols do not allow for them. Additionally, there are many medications that have been shown to also improve patient outcome, yet LAFD's drugbox is virtually stripped. It's great that they participated in a clinical trial for FastMAG in the case of CVA, but what about MgSO4 for eclampsia or asthmatics in certain instances? LAFD carries virtually no antiarrythmics relative to other agencies in the country. Perhaps this will changes with the latest ACLS changes, however the point is that it takes a mandate for the change to take place. The fault lies with the medical director, of course...but providers also need to be advocates for their patients. I have heard a number of LAFD paramedics (about 12 that I've personally spoken with) tell me that they prefer to have fewer interventions because it means less liability.

As far as the numbers go, 80% or 90% is irrelevant. It's still an overwhelming majority of EMS vs. fire calls. My point stil stands. You're right though, fire stations in LA would not close (though in other places the trend could be different) if fire was no longer a major part of EMS response. However, the number of actual fire staff would decline with EMS becoming the primary personnel.

I am fully aware that there are single-function firefighters, firefighter/emts (as is the minimum for LAFD), and firefighter/paramedics. However, if patient care is your true goal then you are best not to force competent EMS providers of jumping through the hoops of being a firefighter first, a paramedic second. Yes, I know it's tradition....but times are changing. Nevermind the fact that there is virtually no need to send the amount of resources on so many runs that LAFD does. Or, if they want to send the resources, perhaps the ambulance crews might realize that once you realize your call doesn't require 10 people....YOU CAN RELEASE THE ENGINE COMPANY.

[mitllesmertz1]

We have actually had fire department employees "written up" by HEMSI for supposed defficiencies and We DONT EVEN WORK FOR THEM!!!
You work for the FD, and a private company disciplines you?
Do you have a Union?
Isn't there a written protocol for disciplinary process?

[mitllesmertz1]

It seemed from my own observations that unless the patient was suffering from a textbook MI or from major trauma, the level of care was not very high.
Not sure about LAFD medics, but if we arrived on scene of a pt that wasn't critically ill, you wouldn't like our attitude either. Something along the lines of, "Why the hell are we here?" might be heard. Is that possibly the problem?

However, during my interactions I found the majority of the paramedics and firefighters that I encountered on scene to be very condescending toward me, presumably assuming that I am an unqualified, poorly trained, private service EMT.
I hate to generalize, but I do it often anyways.
If you routinely deal with private providers that are unqaulified and poorly trained, there is a good chance that after awhile you would tend to assume that they are unqaulified and poorly trained. Occasionaly you run into one that is good at their job, and it throws you off your game plan. damn.

My reports were routinely ignored
Again, sorry, but it happens often here too.
Many times I used to listen to some private guy babble on incoherently for 5 minutes trying to tell me what's wrong, when 1 sentence would have done the job. So now I often cut them a little short when they launch into their "report".
Sounds like it happens to you too.

and I witnessed many patients provided with inferior quality of care. I have personally worked in a high volume urban EMS system as a primary 911 responder (on the east coast) so I understand the stresses of the job, but that never interfered with my level of care.
I guess you're just better than them. Make ya feel better? Your welcome!

[StreetMedicLA]

Not sure about LAFD medics, but if we arrived on scene of a pt that wasn't critically ill, you wouldn't like our attitude either. Something along the lines of, "Why the hell are we here?" might be heard. Is that possibly the problem?


I don't think you understood my point correctly. I am not saying that ALS providers should be cheerfully happy when they are called when they are obviously not needed. What I was referring to, however, were emmergent but not critical medical conditions. Things that are not necessarily major trauma or the obvious "big one". Things that have more subtle presentation, that require additional time to assess For example, the silent MI patient whom I called LAFD for but when they arrived they were convinced he had simply been drinking too much. Of course, after I continued to express my concern for a cardiac (ya know, I'm just a dumb private service EMT), they finally hooked him up to a 12-lead to prove me wrong. Man, you should have seen the looks on the three paramedic's faces when they finally looked at the strip. Oops!

Those are the kinds of situations I'm referring to. Situations that require a little bit more critical medical thinking. I'm not talking about the runny nose patient who thinks they're dying.


Again, sorry, but it happens often here too.
Many times I used to listen to some private guy babble on incoherently for 5 minutes trying to tell me what's wrong, when 1 sentence would have done the job. So now I often cut them a little short when they launch into their "report".
Sounds like it happens to you too.


You're absolutely right. There is a problem with the quality of care throughout the EMS spectrum. That is a point that I'm trying to make. It's not just fire EMS that is a problem, it's all of it. We have too many providers who are in this field (at the private level) who don't want to be their either. They are using it as a stepping stone to "greater" things, including the fire service. As a result, they don't have it in them to really perfect themselves as a clinician.

If you ask me, the EMT-B certification should be completely abolished with the minimum level of care being that of the Intermediate level. Of course, that's a completely different topic of discussion.

[MontvilleFire39]

It still amazes me that after all this discussion, not one fire fighter who came into this discussion as pro-fire has admitted there is any problem with the fire department culture and its approach to all things EMS.


Such is the power of the big red myth. The fire service can do no wrong. Until the fire service can admit there is a need for change, there never will be. And one thing I continue to see on this site, and in the fire based trade journals, is a continued denial for any change. EVen when someone tries to bring it up, he is ridiculed for it...

One of the earlier post asked what should be changed in the fire service.

Well there is a lot of things. But if I was to pick one thing, just one thing, understanding that this wont fix all problems,, it would be this.

I would make paramedics in the fire service, the so called firemedics, fire unions, and fire services in general...accountable for the medicine they provide. Truely accountable. From start to finish.
FF/medics would not be hired based solely on how good of physical shape they are in, or how good of a fire fighter they may be, but on their medical competence above and beyond a simple NREMT assessment. Once hired, a FF/Medic could be disciplined up to and including termination for sloppy care, not meeting education commitments, and similar causes. They would be subject to a medically based FTO program to evaluate their MEDICAL COMPETENCE.
FD's, in the same vein, would be required to insure that their medics perform and train like medics, with the same vigor they attack fire training. They would go to the OR every year. They would ride the ambulance at least 50% of their time regardless of thier senority as long as they held their medic liscense. They would have lectures from recognized experts in medical fields, not canned videos. They would be required to meet or exceed the national minimum standard of care. Their medical/QA practices would have complete transparency with the medical community, and they would develope their medical practices in accordance with involvement of all levels of EMS and emergency medical community. And when they failed to do so... their chief officers would be held accountable.
The IAFF, in its bargining agreements would stipulate minimum medical training allotments, instead of worrying about getting 9/11 off. They would not keep FD's from firing crappy medics. In short they would be a positive force, instead of a negative force, in medicine.

That would be a start.

Are there third services and privates who could do this as well, sure. But at least in those sectors there is a chance for change.

Come work where I work.

[emt161]

Come work where I work.

Ok, I'll bite. Why?

[91medic]

OcfirePM you coudn't have put it better. I don't know about engine medics going with the transport bls unit but if it works for your area who am i to say negative things about the way you do things. I perfer first response ALS engine or truck followed by a ALS transport agency (fire or private), with the engine medic riding with the transport medic on serious medical or trauma calls, that way two rigs aren't out of service on a transport just the one.
As I'm not a fire/medic just yet I'm working real hard to get there because the equipment generally is top of the line and it just seems like a better environment to me. Cause on the private side for me as a medic there are too many bitter medics i run in to that hate that fire departments are now the primary ALS providers and their not anymore.
The simple fact is that i have met many fire/medics that love the ems side of their job, some more so then the fire side of the job. I feel everyone is responsible for the relationships between fire departments and private agencies to keep positive communications present.

[croaker260]

OcfirePM you coudn't have put it better. I don't know about engine medics going with the transport bls unit but if it works for your area who am i to say negative things about the way you do things. I perfer first response ALS engine or truck followed by a ALS transport agency (fire or private), with the engine medic riding with the transport medic on serious medical or trauma calls, that way two rigs aren't out of service on a transport just the one.
As I'm not a fire/medic just yet I'm working real hard to get there because the equipment generally is top of the line and it just seems like a better environment to me. Cause on the private side for me as a medic there are too many bitter medics i run in to that hate that fire departments are now the primary ALS providers and their not anymore.
The simple fact is that i have met many fire/medics that love the ems side of their job, some more so then the fire side of the job. I feel everyone is responsible for the relationships between fire departments and private agencies to keep positive communications present.


Dude, as I am wont to remind Mittle, where you work (King County Area) is not representative of all fire service (or any other type of service really) by any means. It is a beast all of its own, and if that s your primary experience, then your assumptions based on that experience are going to be very skewed.
Not slamming it, I really think that we nationally should take lessons learned there and apply it everywhere...just stating if you think all FDs (or even most) are like those in the KCM1 system in regards to approach to EMS, you are very wrong.

Also, why is it that anyone who really likes fire always thinks there are just two types of EMS, fire and private? As many other post have mentioned, there is of course third service.
And as for the fire vs private vs third service battle, fire does its own part to contribute to that fight as well as any of the rest....

OK ,Stepping off soap box.

[91medic]

croaker260.....yes i am very aware that there are ems systems out side of king co. I'm just a volly firefighter in king but I'm a medic in pierce, did my intership east of the mountains with hospital time down in portland. I've visited fire departments down south and have looked very hard into other systems just cause i plan on leaving washington. I'm a true believer that KCEMS can learn alot from systems around the country. And i will admit that i have along way to go befor i'm well educated about ems across the country but i'm working on getting that experance.

[santapaula]

Well unfortunately he is not an idiot, wrong, or crazy. I have been in EMS in or around Los Angeles County for 15yrs. I have seen both sides of the coin. And yes there are poor medics on both sides. But the reality is the majority of the LAFD medic students volunteer because they get a bonus on their pay checks. Not because of some pride in EMS. I have instructed many LAFD classes and the phrase 80% gets you 17% was a phrase that I heard too often in the halls as they middled around on breaks. That alone shows a lack of pride in the profession of EMS. Listen, the reallity is that 80-90% of any fire departments call volume is EMS. It's not a rumor. It's a fact. But what do all fire departments spend most of their budget and time training for? A fire department in reallity is an EMS department that responds to the occasional fire. Why is this so hard to comprehend? If you disagree, then your nuts, and in denial. That IS the reallity. Why would you make someone that just wants to be a firefighter, a profession in it's self, and force them to do something that they don't want to do? I think that question go's beyond being fair. LAFD stated they have a Paramedic shortage. That is b.s. There are roughly in Southern, CA alone close to 12 Paramedic schools, churning out fresh meat on a regular basis. Not to mention all the personnel sitting and waisting away on private ambulance companies. The resources are there. The problem with LAFD and every other F.D. that needs to dual function their Firefighters, is the hiring practices. If the fire department wants EMS fine, then hire fire department single function paramedics. The fire department still gets the EMS budget and they get personnel that genuinely want to do the job. Not because they want a pay bonus or promotion. EMS is a profession, and should be treated as one. Unfortunately in Southern, CA it is not. 1) Have you surveyed the "vast majority" of paramedics? Or is this another blanketed statement? You cannot voice for the entire paramedic rank of LAFD, this is unfair to them and insane by you.

2)The majority of new LAFD paramedics signed up for PM school. In a class of 35, 32-33 will have signed up for it, the "draftees" if they do not like it, usually find a way to fail themselves to stay out of the program.

3)I would love to know how you had "interactions" with LAFD, being you are not a member of LAFD. Just because they wouldn't hire you, don't be mad at all of them.....

4)You saw a photo in JEMS eh? Good for you, as we all know you are the greatest paramedic ever and have NEVER done anything wrong. Was this picture of an MCI? Maybe resources weren't there at the time, who knows, but one thing for sure, YOU ARE A PERFECT PARAMEDIC!!!!

5)Pediatric intubation was taken away from a study that has proven to be improperly done, and a new study is currently in the planning stages. Wow and that was many years ago....glad to see you are as up to date as you claim to be.

6)Surgical airways are also in the process of being re-entered through a study.

7)TCP and IO are in the 2007 update...glad to see you are still on top of things....

8)If you spoke with "several medics" that would leave me to suspect you talked to three people, (of the hundreds of paramedics in LAFD), so according to your numbers 2 of the three did not care about the state of affairs (66% hardly almost 100%), and one did care a lot.....glad to see your small numbers are a true reflection of the feeling of the LAFD

9) In 2005 LAFD responded to THOUSANDS of fire calls, hardly the few you claim. And percentage of EMS is in the low 80s like everyone else, not 90%.

10)No fire stations would be closed if EMS is lost, just losing EMS units only. Fire Stations are placed for FIRE coverage, with the number of EMS units needed being lower than number of fire units needed. But, let system status management figure all that out....

11) Firefighters can be certified EMTs, or licensed paramedics. Hence the terminology of Firefighter/EMT and Firefighter/Paramedic. Same as an Engineer/Paramedic or Captain/Paramedic. We are firefighters who hold a medical license or cert and can perform the skills we are trained to do. There are many firefighters who do not provide any medical skills, these positions are strictly firefighters, same as there are paramedics who do not have fire suppression skills. So, you have a firefighter class, who have different medical skills, thus there level of medical training is shown after the original position they hold....FIREFIGHTER/PARAMEDIC....it has nothing to do with what you do more. Just because you enjoy paramedicine more, does not mean EVERYONE has to follow what you think....get a clue hoss.

12) YOU ABSOLUTELY HAVE NO IDEA WHAT YOU ARE TALKING ABOUT!!!! Your two cents is not unpopular, just more like idiotic.....

13) Why don't you go visit many different LAFD stations and talk to the real crews. Go visit a whole battalion and get the real scoop from the real guys, instead of making blind posts criticizing a group you do not work for, have never worked for and apparently know nothing about.

[brnsknFF]

I'm new to this thread so excuse me if i repeat a few opinions already stated. I've only read a handfull of the posts.

In my opinion, i agree with the third party EMS provider. Concidering it has the proper management and funding. I believe FDNY-EMS is the best thing that "COULD HAVE" happened to Pre-Hospital care had it not been so poorly managed. This could have eliminated the many problems found in the Fire/EMS and Private EMS systems.

I believe this because it would have offered; job stability, benefits, decent pay, and let dedicated employees provide medical care to the community as the common goal of the workers AND management. It could integrate Fire for extra manpower and special operations requiring their expertise and special equipment/training as a way to work together and so they can keep their job and funding also.

But in the interest of the community and the press, EMS jobs are underappreciated unless "YOU" are currently having a heart attack. So, because of politics, the press, and 9/11; EMS HAS BEEN TOSSED TO THE SIDE TO GIVE WAY TO THE FIRE DEPARTMENTS. just take a look at the AFG grants. Its sad to say but it's something we'll all have to put up with for a long time.

I work for the private EMS agencies contracted with LA County FD. AMR then McCormick. They both had their up and downs. But the common problem which remains with all private companies. Priority of making money of quality of care. Which in turn greatly affects the pay, benefits and high turnover rates of the employees.

But working in LA County and also in my experinence volunteering with Riverside County FD, I've noticed a huge problem in the 911 system. ALL CALLS REGUARDLESS OF NATURE GET A MINIMUM OF 2 UNITS (ENGINE AND TRANSPORT UNIT) and usually a squad also ALL RESPONDING CODE 3. Now, this may not seem like a big deal. But concider an Engine and Ambulance speeding past your house 6-10 times a day (15-20 if it's a busy area) every day. Because on average, that's what you'll see. And it makes you think. Are there really that many fires or people dying or are they just trying to get food every now and then. It's time for the 911 system as a whole to be changed in order to provide the best care.

Look at the stats for Fire/EMS agencies. They use call volume to determine budgets and support. But, they don't diffenenciate the major emergencies from the minor emergencies from the non emergencies. the most you'll see is false alarms (as in false fire alarms). Not EMS cancels, or transfers from ALS to BLS care. All that you see is they run 80-90% EMS runs, but you wont know that many of those are in no need of transport or treatment by an emergency staff.

Priority dispatching with Paramedic/Emt dispatchers would be a great help. ALS only, BLS only, or the Combination of the resources can be dispatched depending on the nature of the emergency. Of course it's not that easy, it would take alot of planning, and resources to be effective but in the end it would have a great outcome. Though it may require FF pay reduction in order to provide for the other resources (but FF salaries are the largest part of the FD budget and alot of Dept's are slightly overpaid). [ sorry for those i've offended but firefighting has changed greatly with the new technology and all the safety precautions and laws implimented ] but changing the way the money is spent can call for a more cost effective and customer orriented EMS service and Fire Protection.

I

[Niftymedic911]

Hey Y'all,

I just want to add my two cents worth for whatever it may be. Fire based EMS has its place and so does 3rd service and private based EMS. These are all primary delievery methods of EMS. It just dependes on what works in your particular area.

For instance, I live in Fort Myers, Lee county, FL. I'm a medic and I work for Lee County EMS. We're a 3rd service based EMS system that is completely seperate from fire. We have 33 ALS trucks and 2 ALS helicopters responding to over 75,000 calls per year. We also hold the only CON for interfacility transfers crtical/non-critical in the county. Lee County has a population of over 800,000 full time residents. All of our funding is tax based, but we do collect operational fee's and the like to offset our budgets. The biggest cash cow is of course the interfacility transfers. Last year alone LCEMS had a 48 million dollar budget, we recooped over 69% of those funds back. ( So you "could" say we operate like a private, but with a very nice salary and benefits package) We also have many technological and medical firsts. Each of our rigs cost $174,000 a piece, Freightliner medium duty MedicMasters by ALF. The system in Lee county works well for this area. But as stated preivously might not work for Tampa or Orlando, or LA.

Many FF's are my friends that work in this area. Many work for the agencies that very well want to take over transport (only to justify their budgets). As stated from a Lt. "EMS is the only thing keeping us going, if we can't transport then we get earn that extra income".

All in all, one way or another EMS is still EMS, wether it's a FF/medic or a single cert medic. Patient calls 9-1-1, someone responds, care is established, and transport is commensed. Wether your a FF or Medic. The fact of the BLOMMIN matter is that we are in this field to be public servants and to be "saviors" in times of need.

If you don't agree with that paragraph you have absouletly NO REASON to be in this field!!!!!!!!!

[triemal04]

I love threads like this. I like it even more that they usually end up the same way. Someone will come out with "my way is the only way to do it," and someone else will tell them why they are wrong. All the people that say things like, "what works in one place may not work in another," or "there's good privates, third service, and fire based systems, and bad ones out there" are ignored.

Sure there's definetly lousy fire-based systems out there, but put aside LA, LA County, FDNY and DC for a sec. Aside from Bostom EMS (it's not quite big enough) can anyone tell me about a private or third service that coveres an area as large as those departments and has no problems? (and don't try New York EMS) Any system that runs those numbers in a large urban setting is going to have problems. Period. That's not to say that the departments may not have done themselves any favors, but to say that because they are fire-based is the root of all the problems is just...well...stupid. Honestly, how many small private companies have the same problems as larger fire departments? The bigger you get, the harder it will be to maintain your medic levels, maintain your pay levels, maintain a good and EFFECTIVE QA/QI prorgram, ensure that only motivated, dedicated people are hired, maintain educational levels and training, and improve on those levels. Not to say that it can't be done, but it doesn't get any easier with size.

To all the people who say that third service is the way to go, have you really never heard of a third service with problems? Do you honestly think that problems that privates and fire-based systems have could never happento you? It's also funny to watch the comments about how it's just another firemedic sticking up for the fire service, when the exact same could be said for those of you working in a third service.

And for everyone who blames problems with EMS on the IAFF, specifically someone who mentioned the negotiating tatics...it's funny, but at least around here each local works on it's own contract, there is no involvement at the national level. And given how privates ran EMS in it's infancy, is anyone really shocked that fire departments ended up running it? Granted, it hasn't been brought along like it should, but it's still better than what could have happened if the dash for the cash was all that people ever saw of EMS.

Bottom line: there's good and bad systems of all types. No one system will work everywhere right now, and each one has done good for ems, and hurt it.

[jefferson136]

I believe that fire based ems our any type of municipal based ems can provide a better level of care and other programs to the public they protect. Private based ems needs to turn a profit, fire based does not. I work as a firefighter/paramedic in a city fd, we are als first responders and when the private ambulance arrives on-scene they assume pt care either when the pt is put in the back of the medic unit or when we turn care over to them. They have kicked us out of their ambulances because we would report them for late response times, poor pt care, etc. Our department paramedics hold ourselves at a very high standard. We go above and beyond what is required for ceus and other training. What I have seen of private services is that do what they have to to get by. Fire based EMS I would say is the best to work for

[bacfire]

I like the system they use in Savannah Georgia (eventhough it is hospital based) The fire department does not respond to call unless there is a flame coming from it. They do respond to MVC's with confirmed intrapment by either Law Enforcement or EMS. Thesystem actually works imagine that


We have the same system, except that it doesn't work in the patients' best interest. We've had more than a few people choke to death, die from MIs, etc., only a couple blocks from a fire station with a BLS rig. 1-2 min vs 10-15response time.

MVCs go like this: 911 call to dispatch & transfer to private EMS dispatch (1-2min), private EMS response (5-20 min), FD response after EMS crews often stand by doing nothing due to "scene safety" considerations (3-5 min). Would it not be better for the 911 dispatcher immediately place a radio call to FD and have a BLS crew with extrication tools onscene well before an ambulance gets there?

BAC

[RicanMedic78]

I believe that fire based ems our any type of municipal based ems can provide a better level of care and other programs to the public they protect. Private based ems needs to turn a profit, fire based does not. I work as a firefighter/paramedic in a city fd, we are als first responders and when the private ambulance arrives on-scene they assume pt care either when the pt is put in the back of the medic unit or when we turn care over to them. They have kicked us out of their ambulances because we would report them for late response times, poor pt care, etc. Our department paramedics hold ourselves at a very high standard. We go above and beyond what is required for ceus and other training. What I have seen of private services is that do what they have to to get by. Fire based EMS I would say is the best to work for

I agree 100%. Although hospital based EMS works ok as well, it still needs to turn a profit and as a result, a patient may end up in the ambulance's hospital verse the closest hospital suited for the job.

but here in NY.... the pay is better

[LTA2323]

Fire has no business doing EMS, period.

I guess I don't need to say anything else

[TedEMTP]

I don't believe it has anything to do with systems, or who runs what -- as someone else on this thread has mentioned, every type of system lauded or lambasted here, from fire to private to hospital-based, has examples of systems that work well and those that don't.
I think the single most important factor in whether a system works or not has to do with the motivation of the people in the buses or on the apparatus.
I currently work hospital-based urban 911 and fire-based ALS, and I think the biggest thing that separates the two (aside from call volume, which is itself both an obstacle and a boon) is motivation.
The hospital-based medics I work with love EMS and medicine in a way the fire-based guys don't and never will, and there's no denying that that difference shows up in the back of the bus -- maybe not on the milk runs involving an IV, monitor and 5cc of life-saving saline, but definitely on the truly sick patients.
The guys I work with at the FD are great guys whose hearts are in the right place, but they don't have a passion for EMS and most of them would jump for joy if the department got out of the EMS biz and they could still keep their jobs.
Having said that, I know a couple local fire departments that do an excellent job at EMS, but guess where most of their medics got their start?
The bottom line, IMHO, is that you can't be truly great at a job you hate or simply tolerate.
Until fire-based EMS systems give EMS its due, they will always be mediocre at best.

[ChicagoAnthony]

Hey I love working for the private ambo services in Chicago! We make about min. wage, have ghetto partners that can't speak english (let alone take a BP), run medicars 99% of the time, have broken down rigs, and managers that can't seem to schedule except the days I have a clinical. Gotta say I love it!!!!!!!!!! Although I have not yet worked for the Fire Dept so I am unsure how much orse off they are then us.

[River]

I work for a Hospital Based Ambulance Service operated by a Level One Trauma Center. Ours is a unique situation because we hold a number of 911 contracts. We staff two Fire Departments with our paramedics using their equipment/contract to three departments stationed in there territory/ stations using our equipment. Our independent stations run private calls,Hospital calls, nursing home calls, and back up the local Fire Department which has 5 ambulances and sometimes need more help. We have never had any problems with the agencies we work with. I have been with this company for 15 years and plan to stay. Our wages are comparable for this area (which we all know are not enough compared to what our job descriptions really are) Benefit package is comparable to the city's with retirement/401K contributed to by employer/life and disability/dental insurance/education funds/other perks that go along with having a hospital at your finger tips. Our retirement is not as good as their pension and we do not get to keep health insurance for free as they do. I can compare this pretty accurately because my better half is career union FireFighter. Draw backs: Yes we have grunt runs like all privates. If you go to hospital with a patient from a 911 call you might end up with a transfer out of the hospital to a nursing home before you get back to your district. We do have a fleet of buses that rotate into contract areas when one is out of area. I don't mind these calls I'm there for 24 hours and the more I do the quicker time passes. We do not have a union and according to administration we are employees at will. This is just a phrase to let you know you can be fired for just about anything. I don't like the feeling of never knowing if my job is safe or not. I just try to do things right and cause no harm.