How to combat private ems

[cfd045]

Our community is considering privatizing our EMS portion of our service. We currently have 16 medical personnel in our department. Their primary job is to handle EMS calls. The city council is looking to outsource our ems division. I am looking for advice on how to prevent this. Our department provides service to the city and the county. Rural Metro is the largest provider; we also have some smaller providers. Thanks in advance for your assistance.

[captT52]

I am no expert on this subject but here is my opinion.

For EMS to be part of the fire department only makes sense. It makes sense for financial reasons and it works well. There are all kinds of problems with other systems. I don’t know why a city would choose any other system. By integrating EMS into the fire department you avoid several headaches and save money. A paramedic who is a firefighter, under FLSA, can work 53 hours a week without being paid overtime. ALS engine companies blend right in with the firefighters on the MICU or rescue company. There is no starting treatment by one agency and then handing the patients over to another. I could go on and on with advantages to a fire department based system. But does this mean that private, or third service, paramedics are less likely to do a good job when your mom has a heart attack? I don’t believe that at all.

There might be good arguments for VOLUNTEER fire districts to have a private ambulance service. But if you have a competent, full time paid, fire department, it should probably also be your EMS provider. There are hundreds of success stories to bear this out. I have never seen a city give up on having the fire department run EMS and go to a private system. I have, however, seen many cities give up on having private EMS companies and give it to the fire department. It happens all the time. Shouldn't we learn from this?

None of the arguments about which system produces better PMs holds water. I truly do believe that most arguments, on this subject, are based upon protecting self-interests. Someone is not going to be a better or worse care giver just because he or she happens to also be trained, or not trained, in something else. Competent, intelligent, dedicated people are just that and they will be good at whatever they do.

You may read a comparison between different types of EMS systems at:
http://www.captainmica.com
I don’t know how much pertains to this topic. But there are also links to examples of several kinds of systems there. This site does talk a little about some of the problems encountered with private and third service systems.

[HewittC4]

"For EMS to be part of the fire department only makes sense. "

How so? For the fire department to include EMS usually requires that the fire department increase the number of fire engines to handle the increased call volume. This causes a huge drain on tax dollars.

For the fire department to include EMS usually requires that the fire department send firefighters to run EMS calls. Most firefighters don't want to run EMS calls, they want to fight fires. Take for example, the letter written by Sacramento City Firefighter Aaron Dean in the 9/06 issue of EMS magazine, the EMS side parent of this site.

"And, when we were fourth on scene to a structure fire approximately 10 houses down the street from the firehouse at 3 a.m. because we were on a bogus medical aid call at a woman's shelter for a 25-year old female who had been feeling ill for three days, it really grates on me to know that there are people like you who actually think that most firefighters WANT to do EMS. EMS is a necessary evil in the fire service."

In my experience, this is the normal attitude among most fire fighters regarding EMS. What kind of care do you think Mr. Dean provides? If this was one of your loved ones, would you want him taking care of her?

I have been in EMS a long time. There are no bogus calls, only calls that don't meet our definition of an emergency, but when I am training new EMTs and medics, one thing I try to impress on them is that this isn't our emergency, it is the patient's.

EMS has no place in the fire service. When they try to run EMS, you get a department full of Aaron Deans.

[emt161]

For EMS to be part of the fire department only makes sense.

Says who?

It makes sense for financial reasons and it works well.

Funny, I thought EMS was based on patient care.

There are all kinds of problems with other systems.

Such as?

ALS engine companies blend right in with the firefighters on the MICU or rescue company.

Actually they lead to poor paramedics in an over-saturated system where nobody is getting enough skills to retain them.

There is no starting treatment by one agency and then handing the patients over to another.

I agree with you there, but maybe it should be an agency whose sole purpose is patient care.

I could go on and on with advantages to a fire department based system.

Mainly run numbers=jobs=union dues.

But if you have a competent, full time paid, fire department, it should probably also be your EMS provider.

How about a competant, fulltime paid fire department and a competant, fulltime paid EMS department? Nobody gets forced to do what they don't want to do, and they get to focus on being the best at their job.

There are hundreds of success stories to bear this out.

And thousands of horror stories.

I truly do believe that most arguments, on this subject, are based upon protecting self-interests.

Including yours. My arguments are always for the patient. If the fire department employs patient-focused providers in a system that expects, enforces, and provides superior patient care, power to them.

I just haven't seen it yet. What I have seen is fire departments holding on to EMS by their claws in a system where the EMS providers are firefighters too junior to get themselves into the "real" slots, no one is held accountable, and the patient care is horrible. The only reason they still have control of EMS is because the union has control of the politicians.

"Why do they keep EMS if everybody hates it?" Because without the run numbers, they wouldn't be able to justify the big red trucks- which is all they really care about. So you have 10% of the department doing more work than the other 90%, and the 90% using the 10% to keep themselves in business. The 10% get burned out, ****ed off, and the result is incompetance.

You may read a comparison between different types of EMS systems at:
http://www.captainmica.com
I don’t know how much pertains to this topic. But there are also links to examples of several kinds of systems there.

A fire-based site that sings the praises of fire-based EMS. Shocking.

This site does talk a little about some of the problems encountered with private and third service systems.

Boy, didn't see that coming.

[LasVegasEMS]

Says who?



Funny, I thought EMS was based on patient care.



Such as?



Actually they lead to poor paramedics in an over-saturated system where nobody is getting enough skills to retain them.



I agree with you there, but maybe it should be an agency whose sole purpose is patient care.



Mainly run numbers=jobs=union dues.



How about a competant, fulltime paid fire department and a competant, fulltime paid EMS department? Nobody gets forced to do what they don't want to do, and they get to focus on being the best at their job.



And thousands of horror stories.



Including yours. My arguments are always for the patient. If the fire department employs patient-focused providers in a system that expects, enforces, and provides superior patient care, power to them.

I just haven't seen it yet. What I have seen is fire departments holding on to EMS by their claws in a system where the EMS providers are firefighters too junior to get themselves into the "real" slots, no one is held accountable, and the patient care is horrible. The only reason they still have control of EMS is because the union has control of the politicians.

"Why do they keep EMS if everybody hates it?" Because without the run numbers, they wouldn't be able to justify the big red trucks- which is all they really care about. So you have 10% of the department doing more work than the other 90%, and the 90% using the 10% to keep themselves in business. The 10% get burned out, ****ed off, and the result is incompetance.



A fire-based site that sings the praises of fire-based EMS. Shocking.



Boy, didn't see that coming.

Dido........Also liked the little section "Common issues expressed with private or third service EMS systems" under EMS. Made for a good laugh.

[AZCEP43]

If your administration is considering outsourcing the provision of EMS, perhaps it is because they realize it is a money losing proposition. A pure 9-1-1 provider can not expect to maintain much profitability. Even with the promises of payments that come with interfacility transports, the profit margins are dangerously thin.

Private EMS tends to be better at collecting reimbursements, since they are relying on them to maintain operations.

[DrParasite]

Private EMS isn't always a bad things. In fact, it might not be something you should be combating at all.

painting with a really broad brush:

private EMS tend to be use as a stepping stone to bigger and better things

private EMS ambulances tend to have older ambulances and ones with more miles on them. they tend to buy a used rig and run it into the ground before replacing it with a new used one.

private EMS ambulances tend to be not as well stocked as their municipal and volunteer counterparts.

private EMS tends to look at the bottom line, where making a profit is all that counts.... even at the expense of the employees

private EMS tends to pay it's employees poorly, at least compared to municipal and fire based ones

private EMS tends to have overworked and underpaid employees, leading to quicker burnout rates

now for reasons to outsource to private EMS:
it's cheaper for the township

it's one less headache for the township to worry about

it's one less liability for the township (let the private service worry about it)

the township doesn't have to pay for insurance, training, uniforms, maintenance, for the ambulances.

instead of the township losing money for having a rig staff and not on calls, it's something the ambulance service has to deal with.

advantages/disadvantages to fire based EMS:
junior guys are riding the rig, usually waiting for a spot on a suppression company

if the FD runs the EMS division (as in FDNY, etc), the EMS people are not looked upon as equals. They may have the FD name on their patch, by they are not treated as such.

most department trainings focus on fire supressoin, rather than EMS.

many line firefighters don't want to deal with EMS, it is forced upon them by the higher ups.

fire-based employees tend to cost more than 3rd party employees

btw, many fire departments have taken over EMS. but that doesn't necessarily mean that the situation has vastly improved. in fact, there have been departments that initially merged fire and have since spun off EMS into a separate agency.

btw, Rural/Metro provides EMS for the city of Syracuse and the city of Rochester and the city of Buffalo. why not ask some of the locals what has been the ups and downs of using them?

[GFD940]

In my experience, this is the normal attitude among most fire fighters regarding EMS. What kind of care do you think Mr. Dean provides? If this was one of your loved ones, would you want him taking care of her?

To you and Mr. Dean, You are both wrong.

I have been on all sides of EMS. I started out with the vollies, then got hired by the privates then moved on to career fire-based. Guess what? There were ****-poor providers at all of them!

Even though I am an IAFF Fire EMS provider I still volunteer. Why? Because I love what I do-helping others whether it be a fire or a "BS" medical call. I know many others that feel the same.

Yes, there are good private companies out there but there are many that pay more attention to dollars than lives. Where I worked, they would rather leave 40,000 people without EMS care in order to get a good paying interfacility transport. To me this is unacceptable. I will never knock someone who works for a private or volly provider but I will slam any management that puts lives at risk to make a few bucks.

No two communities are the same and no one plan works everywhere. No matter what your community does, ensure that the best patient care is the priority!

[captT52]

OK, First off, I would like to say (again) that a private EMS company is NOT more likely to have poor Pt care than any other system. I have no problem with a third service system either, when it comes to PT care. There are pros and cons to any system. The website, I mentioned, just pointed out some of the reported logistical issues FIRE DEPARTMENTS encounter with other systems. As you pointed out it is a fire site, not an EMS site. I don't have a problem with that.

Many of the (good) things that that were brought up here about NON-fire based EMS systems are either true or probably true. That is not the point.

As I read it, the originator of the thread wanted information about how to protect his fire department from giving up EMS.
He said >"I am looking for advice on how to prevent this."
He did not ask which is better. There is already a place to have that discussion, on this website. And I would encourage him to look there if he wants to.
He also did not ask for people with issues to vent their hatred for fire departments.

He asked a political question and I attempted to give him logistical issues. After all, that is what his city will be looking at. I attempted to give him what he asked for. (Perhaps I failed.)

I also pointed out that BOTH sides often argue which is best for PT care, based upon protecting their interest.

Some of you guys really puffed up and got ugly fast.
>"EMS has no place in the fire service. When they try to run EMS, you get a department full of Aaron Deans."
-WOW!

Some of you guys basically said (I paraphrase) "Fire department EMS systems are terrible."
Your animosity demonstrates the problem with having two systems providing patient care. One side seems to always have problems with the other.

Remember I said >"I could go on and on with advantages to a fire department based system. But does this mean that private or third service, paramedics are less likely to do a good job when your mom has a heart attack? I don’t believe that at all."
Perhaps I should have said"...logistical advantages to a fire department having EMS." (Or something like that.)

I have worked for both private and fire department EMS systems. I can tell you horror, or success, stories about both. But that is not what he asked.

Do fire departments hold on to EMS in order to help their budgets? OF COURSE. Do private EMS companies expect to make a profit? SURE. But there is nothing wrong with that, either. Money is always an issue for both.

Someone said-
>"So you have 10% of the department doing more work than the other 90%, and the 90% using the 10% to keep themselves in business. The 10% get burned out, ****ed off, and the result is incompetance."

Is there a study supporting any of this?

While your message is somewhat correct, a majority of the runs are sometimes being done by a minority of the force, I dispute your numbers for many cities. There are all kinds of ways to interpret the numbers. For example, in my city, 70% of the calls are for EMS but an engine goes on almost all EMS runs also. So the fire apparatus is making fire and EMS runs. Who is making the most runs? (Doing the most work?) Over 30% of my department’s people are paramedics.

In my department, there are three paramedics at each engine station. Each will spend two shifts on a MICU and one on the engine. If there is a truck and an engine at a station, then there are four PMs and they spend 50% of their time on an MICU. Everybody gets plenty of time on all skills. We have very little turnover, or burnout. But of course we historically only hire about the top 1% of applicants. (And they know that they will be going to PM school. This has been true since 1980 that I know about.)

In the early years there was lots of resistance from the older members. But that has changed. Almost all of our officers were once MICU paramedics. Our current chief is a former MICU paramedic and still maintains his certification. One VERY large department (2000+ members) near me sends all of their recruits to PM school as part of the rookie school. This makes their school 16 months long. EMS/Patient care is first and foremost. If you are not ready to be a good paramedic and firefighter you will not make it.

I agree that FDNY is probably a good example of how NOT to run an EMS system in a fire department. (And I blame the union. I know, heresy!) But there are FD systems that are very good. (Just like there are good and bad private systems.) I see the problem with cities like NY as NOT cross-training. If you separate the jobs then that causes problems. Each side will look down upon the other. That is NY’s, and many other town’s, mistake. (Again, unions fault.)

Perhaps cfd045 should have posted this in another location, if he wanted a real answer to his question.
- He has probably quit checking this thread by now.
...So will I.

[emt161]

Where I worked, they would rather leave 40,000 people without EMS care in order to get a good paying interfacility transport. To me this is unacceptable.

By pure chance while at work today I happened to come upon an MVA in the city I usually talk about when referring to fire-based EMS (the 90/10 city in my post above). Two patients, minor neck and back. My partner and I assessed and provided stabilization- AFTER we called 911 for the FD so as not to cause a problem with them. Wouldn't take much to be accused of sharking their runs.

Engine, ambulance arrive. Ambulance takes patient 1 and leaves. I stayed with the engine and patient 2 until a fire department EMS unit from the next town over arrived to take him- better that a union ambulance take him than me, the lowly private. Despite the fact that I could've had the patient to any of 3 different hospitals before the out of town unit even got there.

Don't get me wrong, the engine crew was nice enough, which was refreshing. But as usual, patient care was not on the menu.

[emt161]

Almost forgot:

While your message is somewhat correct, a majority of the runs are sometimes being done by a minority of the force, I dispute your numbers for many cities. There are all kinds of ways to interpret the numbers. For example, in my city, 70% of the calls are for EMS but an engine goes on almost all EMS runs also. So the fire apparatus is making fire and EMS runs.Who is making the most runs? (Doing the most work?)p

The EMS units are running 5-6000 per unit per year.

The busiest engine is slightly more than half that.

[armymedic571]

I think we can all agree that there are many different models out there that work. The point is that no matter what the model type is, its success of failure is up to the participants. Generally speaking, when you have a third party provider. Whether it be a hospital based or Municipal service, fire or private. Or a tiered system, failure is usually based on the working relationships between the higher ups. Meaning no matter what you do; put your personal agenda aside and think about the pt.

PS- I have run for municipal, hospital based, private and fire based. All which were successfull. It is what YOU make it.

[OCFirePM]

Says who?

Says the person who is posting, everyone is entitled to their opinion. I feel the same way he does, Fire-Based EMS utilizing Firefighter/Paramedics is the way to go. Nothing wrong with thinking that, my system has been using this model since EMS was developed and it does it well.

Funny, I thought EMS was based on patient care.

Cmon, you very well know that communities provide the best care possible for what the community can afford. Communities with more tax dollars have better schools, better roads, better infrasturcture and better public safety equipment/staffing.
If you have firefighters there, licensed as paramedics, you pay them a 15% bonus for being a paramedic. This makes more financial sense, than creating a whole other EMS department, with more full salaries/benefits/etc.
The Fire Department has minimum staffing/station requirements set by ISO and NFPA for community sizes. This is one of the costs a city must cover to provide fire protection. Same as having a certain number of police officers. The firefighters will always be there, and with fire volume down, then there is the opportunity to provide other services like EMS and do it in a cost efficient way for the city to provide excellent service for a good price.
Remember, fire protection is deep rooted with hundreds of years on the books. EMS is a new baby, still in its infancy, finding its place in public safety. It will take a while to integrate it perfectly into the public safety system.
Some EMS systems today are like the old school bucket brigades, trying to provide a good service with what they have. For now, until things balance out, you have to do the best you can, and for many cities, it is using your firefighters as paramedics.


Such as?

What are you kidding? Everyone has problems from the so called "Aaron Deans" of the fire service, to the burned out/grizzled/don't give a crap private medics. Everyone has issues, no one is perfect, no system is perfect.

Actually they lead to poor paramedics in an over-saturated system where nobody is getting enough skills to retain them.

I believe his system is one utilizing a paramedic on the engine and a medic/emt ambulance combo. This provides two medics on scene for each call and plenty of skills to go around. I would imagine the engines run less calls than the ambulances, so the medics get to rotate from engine to ambulance for an even balance. This also decreases burnout and lets the boys fight some fire and break stuff on occasion.
How does this system lead to poor paramedics, or oversaturation? Two medics on each call is over saturation?


I agree with you there, but maybe it should be an agency whose sole purpose is patient care.

My agency provides not only fire protection, but EMS as well. It has provided EMS since its infancy, even before paramedics were created. On fires our purpose is life safety and putting the fire out, on EMS calls our number one priority is patient care and providing excellent customer service. How do we differ from you when it comes to EMS? We like EMS, we have been doing EMS since EMS was created...

Mainly run numbers=jobs=union dues.

So, you do not have a self interest too? Afraid you may not have a job someday because fire departments will control EMS and you do not want to work for the FD?
You bash FDs providing the service to protect your own interests for a having a job in EMS that is not part of the FD. Of course self interests are a piece of the puzzle, but how about citing reasons why FDs should NOT provide the service as a rebuttle instead of the old "Big Bad IAFF" routine that pops up here all the time?

How about a competant, fulltime paid fire department and a competant, fulltime paid EMS department? Nobody gets forced to do what they don't want to do, and they get to focus on being the best at their job.

Great, create the tax and pitch it to the good citizens of your city to pay for it. Creating an entire BRAND NEW department within the city, offices/staff/equipment/etc. Who covers the start up cost?
How about if the FD likes providing EMS like mine? There are many FDs that enjoy it you know...

And thousands of horror stories.

Just like everywhere, not just the FD...

Including yours. My arguments are always for the patient. If the fire department employs patient-focused providers in a system that expects, enforces, and provides superior patient care, power to them.

I just haven't seen it yet. What I have seen is fire departments holding on to EMS by their claws in a system where the EMS providers are firefighters too junior to get themselves into the "real" slots, no one is held accountable, and the patient care is horrible. The only reason they still have control of EMS is because the union has control of the politicians.

"Why do they keep EMS if everybody hates it?" Because without the run numbers, they wouldn't be able to justify the big red trucks- which is all they really care about. So you have 10% of the department doing more work than the other 90%, and the 90% using the 10% to keep themselves in business. The 10% get burned out, ****ed off, and the result is incompetance.

The big red trucks have been justified for a LONG time. It is part of the ISO and NFPA requirements for fire protection for cities. The FD will always be there, it is always needed. EMS, the infant child of public safety is still finding its place in the world. Some areas have it nailed, some are still trying to figure it out. Everywhere is different....
At my department nobody hates EMS, most officers held the paramedic position, our chiefs were former paramedics, we do not have burnout, guys can promote out if they desire, and being a paramedic is considered a promotion you must test to have.
Your comments are too broad as my FD is the exact opposite of all of your comments made above.

A fire-based site that sings the praises of fire-based EMS. Shocking.

I am sure there are websites that praise privates and third service too, so what???? It is his site, he can do what he wants...

Boy, didn't see that coming.

It is his website with his opinions, so what???


Many on this board want this system where everything is perfect and there are EMS Departments who only provide EMS and they pay well, with good benefits and retirements. They want the same funding as Police and Fire. That would be a perfect world I am sure, but number one, nobody can afford it. Especially as something new to start up. The financial costs alone would be staggering, along with making sure the system can pay for itself and not drain the city's general fund.
If the cities did not jump on this back in the 70's/80's and create a self-sufficient EMS department, then they will never be able to afford it now.

I say this, if you want a separate EMS Department, put the idea together and place it on your city's ballot for the tax increase and see where it goes. If the public will pay then go for it....

[ElectricHoser]

Enough with the ****ing match already.

Focus on the original question.Our community is considering privatizing our EMS portion of our service. ... I am looking for advice on how to prevent this. ... Thanks in advance for your assistance.

[emt161]

I say this, if you want a separate EMS Department, put the idea together and place it on your city's ballot for the tax increase and see where it goes. If

Wouldn't be that bad. Move the fire department's EMS budget to the EMS department, and billing should cover most of the rest. Logistics costs are low, because the ERs have to restock whatever we use.

There are many FDs that enjoy it you know...

Unless you'd turn down a fire for a medical, sell it somewhere else.

Enough with the ****ing match already

Ok dad... lol :p

[OCFirePM]

Wouldn't be that bad. Move the fire department's EMS budget to the EMS department, and billing should cover most of the rest. Logistics costs are low, because the ERs have to restock whatever we use.

Ok, so you take 40 existing fire personnel you are paying a 15% bonus too for being a medic and you hire 40 NEW EMS personnel at full salary/benefits/retirement, which can be a package worth 75-100k each. You have to have offices, administration, EMS Captains and EMS Chiefs separate from fire for oversight at full salary/benefits/retirement. How about office equipment, phones, faxes, computers, etc. Where do you house the new department, is there room in city buildings or do you have to build a separate building for them? What about uniforms/separate dorms/can station handle MORE personnel or do you have to build separate stations?
Remember, Fire Protection must remain constant according to NFPA/ISO standards.

Show me the cost effectiveness of your plan. How does it save the good citizens money and provide excellent service?

Also, we do not buy our supplies from hospitals, we have a distributor we purchase supplies from. This is they way it is done out here, no one gets supplies from hospitals....

Unless you'd turn down a fire for a medical, sell it somewhere else..

You do not know me or my department. I have guys here who were in the first medic classes EVER, and still retain their license. Can you say that about your department/company? Guys been doing it since the 70's. We have always done EMS, we enjoy EMS and take immense pride in our EMS system delivery. We do it very well.
Everyone loves fighting fire of course, but I have missed many fires being on medical calls and you know what? That is the way it goes sometimes, but to compromise patient care here to go to a fire will get you fired faster than you can believe. QI/QA will be all over your butt. Every PCR here is reviewed, every stat recorded. It just does not exist here....

[emt161]

Show me the cost effectiveness of your plan. How does it save the good citizens money and provide excellent service?

I'll be totally honest, it's never been attempted in my lifetime that I know of. There are two non-volunteer third service agencies in the state, and I have no idea whether they just always existed in some form and they've just managed to stay that way, or what. I wish I had an example to go one but I don't. Too young I guess. :p

That does NOT mean, however, that it's a bad idea. It's just never been attempted due to the stranglehold that the IAFF has on this state.

Also, we do not buy our supplies from hospitals

Neither do we. They get our patient, we get back the one-time use supplies used on said patient. Even trade. Only thing I can think of that they aren't required to give us is gloves, AED pads and disposable headblocks (most places use the Ferno blocks anyway). They'll give you hands-free pads for the monitor, but if the hospital doesn't use the same kind of monitor you're SOL.

[Geinandputitout]

If you guys are IAFF contact the technical services division. I don't know who is running it anymore, but Jonathon Moore (sp?) was quite helpful when we had this issue come up.

There is also a publication printed by the IAFF and the chief's group that has everything you will ever need to put together a proposal, things to think about, and ways to deal with questions as they come up.

Good Luck.

[lexfd5]

I think you basically have to prove your worth to the local powers that be. If you can prove that you are needed and effective you might be alright. Good luck with your presentation.

[TedEMTP]

I've worked for private ambulance companies, third-service non-profits, and hospital-based regional ALS systems, and even spent one loooonnnnggg year as a flight paramedic for a program in the northeast.

I recently "sold out" and went to the dreaded fire department, which my hospital-based colleagues have derided for years as substandard and unsuited for EMS.

True, assignment to the ambulance isn't seen as a great gig, but for someone like me, who loves the ambulance and could care less if I never see so much as a wisp of smoke for the rest of my career, it's great. I never have to wrestle anyone to work on the bus.

And true, the medics at my last hospital-based gig were better paramedics on average then the guys I work with now, but the truth is that they aren't that much better.

What's the payoff?

I work 8 days a month instead of 20.

I get paid a few grand more, but my retirement is guaranteed; if I get hurt on the job, I'm taken care of; time off is plentiful and easy to come by, meaning I get to spend way more time with my kids than ever before.

In short, the fire service offers me a chance to make a great living and have a great family life, all while giving the same excellent patient care I gave at the hospital-based service.

Maybe fire department EMS is more expensive than privates or not as skilled in general as regional hospital-based systems.

So what?

You can have your idealism and cost-benefit analysis. My most important priorities are four-years and 18-months old, and no EMS system on Earth can touch the fire service when it comes to taking care of them.

[HewittC4]

"Maybe fire department EMS is more expensive than privates or not as skilled in general as regional hospital-based systems.

So what? "

Will you still be saying "So what?" when it is you or your loved one that has been injured or killed by a "not as skilled" fire medic? My parents are getting old. My father has DM, my mother, HTN. They WILL need EMS in the near future and it scares the hell out of me to know that I will have to trust their lives to people that I have seen kill patients with their incompetence.

[TedEMTP]

If you think that my loved one is not as likely to be hurt or killed by the incompetence of your average hospital-based medic as any firemedic, then I'd say you have to get out more.

And, having worked for them, I think the privates are even worse.

There is no system construction that gives superior patient care in all cases.

Let's be honest -- it's all luck. For a good outcome, you have to get hurt or become ill in the catchment area of a good service and have it be during a good medic's shift.

When I say "so what," what I mean is that it doesn't matter who you work for, a good medic is a good medic and a dope is a dope, and no one type of service has a monopoly on either.

But why would I root against the fire service, where I can provide the patient care to my own high standards while also providing for my family in a way that AMR is never going to?

Also, unlike privates, which are turnstiles, fire departments have lower turnover and a commitment to the community that privates can't match.

(BTW, I think hospital-based systems are like fire systems in this regard)

This is not because they are better people or altruists, but because most firefighters -- with public retirements and the accrual over time of incredible benefits -- are with their departments for the long-haul.

Most people at privates are on their way somewhere else, whether it be a fire department or medical school or nursing school or a field not involving sick people at all. There is nothing wrong with this (indeed, this is exactly what I did), but in its way it is inferior to fire EMS, where we treat people on Monday and see them in the grocery store on Friday. We have to look our patients and their families in the eye every day. In all my years as a medic (at privates, a couple hospital-based services and as a flight medic), I have yet to come into contact with any QA/QI tool as effective as that...

[HewittC4]

When I worked for a private ambulance company, there were three different environments you could work.

First was interfacility. There was no way a medic was going to get a spot on an interfacility spot. Why? Because the medics that had those spots wouldn't give them up. They were dedicated to their craft. They didn't have to put up with fire's crap and they got to focus on medicine.

The second place you could work was in a municipal EMS system. These were the transport ambulances that responded with the fire departments. There was no motivation to be a good medic, because you didn't get to be a medic. You responded to the scene, sat by the gurney, waited for the fire department to spend 30 minutes trying to get an IV on the STEMI or CVA, then wait for them to run through their entire algorithm, then put the patient on the gurney and drive 5 minutes or less to the hospital. Most of the medics that worked here were trying to get hired by the fire department and wouldn't do anything to rock the boat for fear of risking their chances of getting hired. Patient care was usually poor, both on the FD side and the ambulance side.

Finally, you could work in a rural area. This was an area that only had the ambulance responding. If additional manpower was needed, a second or third ambulance would be sent. These medics took great pride in their job. They studied frequently, constantly discussed cases with the ER staff, etc. If an ambulance was dispatched to a call and another ambulance was closer, that ambulance would jump the call. The municipal crews would do everything to get out of running calls. If a municipal crew worked overtime on a rural car and tried to pull that, they would catch hell from every other crew.

The reason why you see so many bad medics working for private ambulance companies is because they are there trying to get hired by the fire departments. Take that motivation away from them and they wouldn't be medics. Leave EMS to EMS professionals, not to someone who does it because it is a necessary evil to justify a bigger department. OC likes to point out the fact that the fire departments have minimum staffing requirements that the cities have to follow to comply with codes. That is enough to justify a department's size. Leave EMS alone.

[Geinandputitout]

Who and where are these guys that just want to do interfacility transfers? I've worked in EMS for 10 years on both sides of the aisle, and I have never met a paramedic that just wants to do interfacility transfers.

Look - private ems (blah, blah, blah, blah) fire based (blah, blah, blah, blah)
third service (blah, blah, blah, blah)

Take care of the friggin patients.

[HewittC4]

"Who and where are these guys that just want to do interfacility transfers? I've worked in EMS for 10 years on both sides of the aisle, and I have never met a paramedic that just wants to do interfacility transfers."

Go to Arizona. Granted, there aren't a lot of them, but they exist. I would prefer to work interfacility than to work on an EMS ride in a municipal system like I described. EMS is overrated. You do an assessment, make a treatment, then drive them to the hospital. There is very little learning available. A chest pain is a chest pain. You can do a follow up with the ER, but you aren't going to learn much more. In interfacility, a chest pain becomes an inferior wall MI, with the full set of diagnostics, treatments, etc. If you want to learn anything about medicine beyond being just a trained monkey, interfacility is where you should be. Interfacility units do run a lot "boring" calls, like discharges, but they also get just as many, if not more, real EMS calls. The calls usually come from facilities, but you get the MIs, CVAs, codes, broken bones, etc. And you don't have an entire engine crew full of paramedics crowding the patient.

Also, if you read what I wrote, these are the medics that don't want to be firefighters. They don't want to put up with fire's crap. Interfacility allows them to be medics without having to do that.

[Geinandputitout]

Nursing school?

[emt161]

Interfacility units do run a lot "boring" calls, like discharges, but they also get just as many, if not more, real EMS calls. The calls usually come from facilities, but you get the MIs, CVAs, codes, broken bones, etc.

Before I got my EMT and went to work for a local private, I couldn't figure out why so many privates were running around with their lights and sirens. I knew they weren't doing 911 (no private 911 contracts here), it just didn't make sense.

Now I know. Some of these contracted nusring homes call us for some unbelievable things. The emergency transfers are hair-rasing too.

I've gone places I'd never thought I'd go (Sloan-Kettering in NYC, the ICU at Boston Children's, etc) and done things I never thought I'd do (AMI the nursing home thought was a GI bleed, CHFers heading for the drain, unresponsive septic shocks that go apneic, cath lab transfers with all kinds of meds hanging, very very sick PICU transports, multi-system trauma, active CVAs) working for an interfacility service.

Will I spend my career there? Hell no, at least not for this company. But I'll never be sorry I started there.

[scfire86]

I can give you one great reason. When their model no longer becomes profitable private EMS thinks nothing of pulling the plug and leaving. In one case here in OC a private ambulance company gave the city 72 hours notice and then left 48 hours later.

I doubt this is a unique occurrence.

[AZCEP43]

So instead of providing a profitable service, it is better to suck tax dollars away to provide more fire department jobs that don't want to do what they are paid for?

[Geinandputitout]

Profitable Service v. Necessary Service

I live in a community with 110,000 people in it. They are the only show in town, during the day they have 5 units available and at night they have two units available.

If the FD ran it we would have six units most of the time and five units all the time. That way we could actually respond to a car wreck, and another call at the same time without depleting every resource in our community.

If the FD runs it, we will staff it appropriately without freaking out about ensuring a 70% utilization rate. If we focus on a number it will be on response time, door-to-drug, etc. Something that will actually improve the care delivered to people that need help.

[scfire86]

So instead of providing a profitable service, it is better to suck tax dollars away to provide more fire department jobs that don't want to do what they are paid for?

What's your point? The privates have shown that when profitability ceases they have no compunction of leaving a municipality unprotected. Hence the biggest and most significant difference. A municipally run entity protects the citizens all the time.

I'm not sure what the rest of your post means. Who says FD personnel don't want to do what they're paid for? It is the privates who run when it isn't worth their while.

I like the "suck tax dollars" line. In CA the state Constitution reads that "public safety is the first priority of government." So the providing of EMS is not "sucking tax dollars." On the other hand, the privates have shown they don't consider that belief to apply to them.

[AZCEP43]

When a tax supported entity, whether it is fire or EMS, ends up not being able to provide the service for the allotted budget, they present themselves to the bean-counters to ask for more money. Even private services that are contracted to provide service, with the bonus of tax subsidies, will not hesitate to ask for more.

The performance of those that are being forced to provide a service that they do not particularly care for is not to the same standard. When fire departments are forced to take on EMS, because the government has decided it is a good idea, they do it without wanting to.

[scfire86]

The performance of those that are being forced to provide a service that they do not particularly care for is not to the same standard. When fire departments are forced to take on EMS, because the government has decided it is a good idea, they do it without wanting to.
Maybe at first. I remember when EMS came to OC. There was a lot of resistance. Now its considered part of the culture.

Biggest difference. If privates don't get the subsidies they request they leave. Putting the public at risk. Something local government can not do.

[Geinandputitout]

Who do you think pushes to get EMS services into the Fire Department? Most city officials don't know crap about providing adequate police coverage, fire protection, or Emergency Medical Services. The Fire Departments that take over EMS do it because they have members that push to get it and maintain it.

Motivation isn't the issue. The care provided is the issue, and as some one pointed out earlier that is truly a luck of the draw regardless of where you are at when you need Emergency Medical Care.

[AZCEP43]

If a government entity needs more money and can't get it, do you really think that sevices won't suffer?

It might be one less man per truck, or reduced benefits for non-union laborers, but I assure you, at some level services will be cut or consolidated.

[HewittC4]

Who do you think pushes to get EMS services into the Fire Department? Most city officials don't know crap about providing adequate police coverage, fire protection, or Emergency Medical Services. The Fire Departments that take over EMS do it because they have members that push to get it and maintain it.

From what I have seen, it is usually the fire chief that pushes for EMS because he wants to increase his budget and political clout.

[scfire86]

From what I have seen, it is usually the fire chief that pushes for EMS because he wants to increase his budget and political clout.
There might also be an interest in providing public safety to the public. This might surprise you, but that is a factor in some decision making.

[jasper45]

There might also be an interest in providing public safety to the public.


The problem with using private companies is not the people who work for them. The problem is the style or business of making a profit off of a life saving service.
A private company makes it’s money by turning a profit, something we all know. Private ambulance companies keep their overhead low by paying poor wages, no benefits, and keeping a minimum number of ambulances staffed and able to take in runs.
A municipal/taxed based agency isn’t worried about making money, and will keep stations or rigs staffed based on response areas, rather than on how much money they can make off one rig.
Unfortunately, we use several private companies to provide BLS transports. There are plenty of times in which we wait on scene for 20-25 minutes for a private to show up and transport.
All of our medics are where they are because they want to be there, and they all voluntarily went into the paramedic program by their choice. All of our MED units are where they are based on response time, not by profitability. Profit should never be a deciding factor for a life saving service.
Every citizen deserves the same high level of care as the next, no matter if their nearest engine house takes in 8,000 runs a year, or 500.
Keep in mind, I'm not advocating or condemning fire-based EMS, I am promoting municipal based EMS, be it fire or third service.

[HewittC4]

"There might also be an interest in providing public safety to the public. This might surprise you, but that is a factor in some decision making."

Take a look at what is happening in Chandler, AZ. The BC has pushed the ambulance companies to put the FD medics on the ambulances "for consistency in training", even though most of the medics have gone to the same paramedic school, they all go through the same CE classes, etc. The ambulance companies have to pay the salaries and benefits for the firefighters, they have to pay rent to the FD for keeping the ambulances in the fire stations, even though the ambulance companies already have stations strategically placed throughout the city.

The state attorney general declared this contract to be illegal and puts the public in jeopardy. ""These additional and unnecessary costs," he wrote, "if unchecked, will undermine the constitutional and statutory authority of the Department to set rates and charges for ambulance services, will jeopardize the financial health of ambulance providers, and could damage the overall health of the EMS system in Arizona." http://www.phoenixnewtimes.com/2006-11-09/news/emergency-brake/

The BC's response was that the ambulance companies had better be prepared to spend a lot of money to change the AG's mind. "And, Clark added sternly, the companies better be prepared to fight to spend money on Chandler's behalf." same article.

When I worked in Chandler, it was common knowledge that Chief Clark wanted his own ambulance service. He can't get the proper permit, called a "Certificate of Necessity" or CON, as long as one of the ambulance companies that has a CON is capable of doing the job. The rumor among the firefighters was that Chief Clark had a plan to prove the ambulance companies couldn't. That was when the RFP was released that demanded all the "enhancements" listed above. These "enhancements" are designed to put the ambulance companies out of business. The entire purpose of the CON system is to prevent this from happening. Do I think Clark has public safety in mind? No. In fact I think he is putting the public at risk, not just in the city of Chandler, but in every city in Maricopa County.

His demands that the ambulance companies pay the FF salaries and rent to the city violate CMS regulations prohibiting kickbacks.

His claim that CFD's FF are better trained is untrue. Bill Loughran is the director of the EMS division at CFD, he is also one of the instructors at Southwest Ambulance's training department. The training director for SWA is Barbara Aehlert. Maybe you have read one of the books she has written. http://search.barnesandnoble.com/booksearch/results.asp?z=y&ATH=Barbara++Aehlert

It is obvious that this is simply a political plot to remove the ambulance companies from the city and allow Chief Clark to increase his political power and his budget. He doesn't care who he hurts, as long as he wins.

"The problem with using private companies is not the people who work for them. The problem is the style or business of making a profit off of a life saving service.
A private company makes it’s money by turning a profit, something we all know. Private ambulance companies keep their overhead low by paying poor wages, no benefits, and keeping a minimum number of ambulances staffed and able to take in runs."
That is true about every possible service. Fire departments are just as concerned with being profitable as private ambulance companies. They have to operate within budget or argue for a budget increase. A private company, however, is obligated to fulfill the terms of the contract. We had state of the art equipment, our ambulances were newer and better kept than the FD's engines, we had more strict training requirement, and our salaries and benefits were comparable to the FD's. Yes, we even had a pension plan allowing for retirement after 20 years. The biggest difference between having us and the fire department run EMS, we were required to do a better job. Our documentation had to be complete and legible. If it wasn't, our employer didn't get paid and couldn't do QA. We were required to provide proper treatment to the patients. If we screwed up, our boss got sued and "since they are in it for the profits", they aren't going to just throw money at everyone who files a complaint. I read a news story years ago that stated that Phoenix FD averages $4 million dollars every year just to settle lawsuits.

If the private ambulance companies aren't doing the job properly in your part of town, then I would say that it is because your city council members aren't doing their job. In most cases, I see better care provided by the private providers than I do from the FD.

[jasper45]

Fire departments are just as concerned with being profitable as private ambulance companies. They have to operate within budget or argue for a budget increase.


Yes, departments are concerned with budgets, but it is nothing like what a private company is worried about.
We have paramedic units here that respond close to 5,000 runs annually, but we also have some that respond to under 1,000. All of those rigs will be staffed everyday, whether they treat and transport 25 people, or 1 person. Every day. A private company will never staff like that; I used to work for a private company, and saw first hand what goes on.
A private company has to make a profit, so everything they do is geared towards making money. If that ambulance is sitting in a station, no revenue is being generated. A municipal/budget driven rig is staffed no matter what, and it doesn’t matter how many runs it takes in. All of our MED rigs are based on response times from the engine house they are quartered in, not by run volume (read profitability).
A municipal based service will also respond to all runs as they come in, not sit and pick and choose what they want. A private company will ‘hold’ on a 911 originated run so an ambulance can take a guarantee pay out inter-facility transport, every time.

I read a news story years ago that stated that Phoenix FD averages $4 million dollars every year just to settle lawsuits.

So what? What are you trying to say here?
A city is an easy target for lawsuits, mostly because they offer payouts to save money from fighting these lawsuits, no matter how frivolous the suit is.
I have been in court for several accidents in which the city (dept.) is 100% in the right, and they still offered an out of court settlement to the people suing. The reason for settling is purely what costs the least amount of money, and the public know this, and use this.

I see better care provided by the private providers than I do from the FD.

Then you are certainly the exception to the rule, because the complete opposite is true everywhere I have seen. Private companies have a role, just not in EMS.


I can't believe I'm discussing EMS, I must be bored. :p

[scfire86]

If the private ambulance companies aren't doing the job properly in your part of town, then I would say that it is because your city council members aren't doing their job. In most cases, I see better care provided by the private providers than I do from the FD.
I won't restate Jasper's points. Private ambulance companies are only concerned with profit. PERIOD!!!

You blast the chief in Chandler for wanting to provide public EMS to increase his political clout. Did it ever occur to you he's seen more than one horror story of a private ambulance company pulling the plug and leaving a locale almost overnight and putting the citizenry at risk. And just maybe he doesn't like the possibility of his department and the citizens he swore (I don't recall a private company ever taking an oath) to protect being exposed.

Spare us your platitudes and conspiracy theories.

[LasVegasEMS]

Yes, departments are concerned with budgets, but it is nothing like what a private company is worried about.
We have paramedic units here that respond close to 5,000 runs annually, but we also have some that respond to under 1,000. All of those rigs will be staffed everyday, whether they treat and transport 25 people, or 1 person. Every day. A private company will never staff like that; I used to work for a private company, and saw first hand what goes on.

As with anything in medicine, never say never. The ambulance companies here staff just like that, whether they're running calls of not, they have to cover the various areas. Just the other day I spent 5 hrs. of a 12 hr. shift sitting around. Be careful with those always/never statements, maks you appear somewhat ignorant to the rest of the world.


A private company has to make a profit, so everything they do is geared towards making money. If that ambulance is sitting in a station, no revenue is being generated. A municipal/budget driven rig is staffed no matter what, and it doesn’t matter how many runs it takes in. All of our MED rigs are based on response times from the engine house they are quartered in, not by run volume (read profitability).

I agree that profit is what a privfate company is after, after all it's their bottom line. However, remember the various municipalities that took over EMS only to find that wasn't do-able do to budget. Everyone who transports pt's is concerned with profit in some way, shape, or form. To not be concerned with it would only be setting up a service for failure.


A municipal based service will also respond to all runs as they come in, not sit and pick and choose what they want. A private company will ‘hold’ on a 911 originated run so an ambulance can take a guarantee pay out inter-facility transport, every time.

There is that every time blanket statement, this is not true. Most services i've seen who have 911 contracts know the consequence of not sending a unit to a 911 call. The payment from one transport isn't enough, usually, to cover the fine for not responding a unit. In my area for sure, and most of the others I've seen and studied as well.


Then you are certainly the exception to the rule, because the complete opposite is true everywhere I have seen. Private companies have a role, just not in EMS.
Not only is this a stupid statement, it's ignorant. To say privates have no place is dumb. How would your statement apply to cities where the FD is only full of basics, or a city that can't afford to transport.

And, the "rule" certainly isn't that FD provides better care overall, you have good, great, and shi*ty medics everywhere. Working for one or the other doens't make you good. I've seen all of those types on all the various dept. and private here in town, as well as the country.

[jasper45]

Not only is this a stupid statement, it's ignorant. To say privates have no place is dumb. How would your statement apply to cities where the FD is only full of basics, or a city that can't afford to transport.


Yeah, ok … whatever. I was speaking from my personal experience, which does extend beyond my own city’s borders.
Go back and re-read my earlier posts, I wasn’t necessarily advocating for fire-based ems, I was advocating that EMS be municipal based, rather than a private company on contract.
Each city has to do their own thing that works for them. I don’t want any private company doing anything emergency wise for a city, be it police, fire or ems.
Your feelings are hurt? Oh, well. Every exposure I have had with private companies doing ems has been very negative, and we won’t even mention companies doing fire.

Most services i've seen who have 911 contracts know the consequence of not sending a unit to a 911 call.

That’s great, but I have seen it done time and again. 911 originated calls simply don’t pay as well as when grandma needs to go in for an x-ray. The majority of people who use the system here have no insurance and no way to pay for their ride to the hospital.

Everyone who transports pt's is concerned with profit in some way, shape, or form.

This entire concept is wrong, as well. I have a real issue with billing people for service, especially considering the amount we pay in taxes. Our paramedics bill for transport here, as well and, I have a real issue with it. I also take issue with fire departments billing for accidents, fires, water usage, and so on. People should never be worried about a dollar amount when they need emergency services. When bills are passed along, this is what happens. I can’t tell you how many times I have heard it, particularly from the elderly, with legit medical needs, their refusal for transport in an ambulance because they were worried about the cost. Especially when you have the ****-roach in the ear, who doesn’t think twice.
Sorry, you’ll never convince me.

The ambulance companies here staff just like that, whether they're running calls of not, they have to cover the various areas.

Well again, that’s great. Your case is the exception to the rule, whether you want to believe it or not.

[LasVegasEMS]

Yeah, ok … whatever. I was speaking from my personal experience, which does extend beyond my own city’s borders.
Go back and re-read my earlier posts, I wasn’t necessarily advocating for fire-based ems, I was advocating that EMS be municipal based, rather than a private company on contract.
Each city has to do their own thing that works for them. I don’t want any private company doing anything emergency wise for a city, be it police, fire or ems.
Your feelings are hurt? Oh, well. Every exposure I have had with private companies doing ems has been very negative, and we won’t even mention companies doing fire.

Feelings hurt, nahhh. Take more then the likes of an online forum haha. And your "feelings" aren't a legit model for emergency services.



That’s great, but I have seen it done time and again. 911 originated calls simply don’t pay as well as when grandma needs to go in for an x-ray. The majority of people who use the system here have no insurance and no way to pay for their ride to the hospital.
Same goes for here, as well as many other large metropolitian areas. Homeless and indigint people as well as the elderly usually get a "free" ride because they can't afford it. Doesn't change the fact that they are entitled to it. Depending on the local contract, ambulance services may or may not choose transports over 911 calls, but it is not a blanket system across the board. And any city, town, or county whose contract allows the ambulance company to do this is, IMHO, at fault for allowing it.



This entire concept is wrong, as well. I have a real issue with billing people for service, especially considering the amount we pay in taxes. Our paramedics bill for transport here, as well and, I have a real issue with it. I also take issue with fire departments billing for accidents, fires, water usage, and so on. People should never be worried about a dollar amount when they need emergency services. When bills are passed along, this is what happens. I can’t tell you how many times I have heard it, particularly from the elderly, with legit medical needs, their refusal for transport in an ambulance because they were worried about the cost. Especially when you have the ****-roach in the ear, who doesn’t think twice.
Sorry, you’ll never convince me.
The concept is not wrong, as you so nicely stated. The concept is entirely correct, it's just your opinion and feelings that make you think differently, which is fine. But you can't honestly sit here and tell me that municipalities and FD aren't concerned with overhead, money margins, and profit in general from transports. Like I said before, if they are not concerned over these things then they are setting themselves up for failure.



Well again, that’s great. Your case is the exception to the rule, whether you want to believe it or not.
And who exactly set this rule, you? Is there evidence supporting it?

[HewittC4]

"I can't believe I'm discussing EMS, I must be bored."
Why? Because you don't feel EMS is as important as fire?

Our staffing is determined by 2 things, response times and contracted units. We have to meet both. If we can't meet our response times with the number of units specified in the contract, we have to bring up more units to meet those response times. If we don't, we get fined. If it happens often enough, the contract is terminated and we lose money.

"You blast the chief in Chandler for wanting to provide public EMS to increase his political clout. Did it ever occur to you he's seen more than one horror story of a private ambulance company pulling the plug and leaving a locale almost overnight and putting the citizenry at risk. And just maybe he doesn't like the possibility of his department and the citizens he swore (I don't recall a private company ever taking an oath) to protect being exposed."

The same ambulance company has served the community for 20 years with no problems and no threat of going under. This same company has served the majority of central Arizona for 20 years. The company is financially stable and is not a threat. EMS units are forbidden from running anything other than 911 calls. The only time you will see an EMS unit at a nursing home is if the nursing home called 911 and the fire engine is there too.

Oh, and guess what, there are plenty of stories about fire departments taking over EMS and not being able to cover it. But firefighters are never willing to accept the fact that that happens.

"Go back and re-read my earlier posts, I wasn’t necessarily advocating for fire-based ems, I was advocating that EMS be municipal based, rather than a private company on contract."

Ok, I'll agree with you there. I don't think that under ideal conditions that a private ambulance company would be the best choice. However, I think the fire department is an even worse choice. I see very few firefighters that actually want to be paramedics. Most of them will only discuss EMS when they are bored. While many of them, even the bored ones, can be excellent medics, having EMS provided by people that want to be there will provide for better care.

[scfire86]

The same ambulance company has served the community for 20 years with no problems and no threat of going under. This same company has served the majority of central Arizona for 20 years. The company is financially stable and is not a threat. EMS units are forbidden from running anything other than 911 calls. The only time you will see an EMS unit at a nursing home is if the nursing home called 911 and the fire engine is there too.
So what? Are you privvy to their financials? How long did Rural Metro service (no pun intended) Scottsdale before they finally decided that providing that service no longer fit their business model? It was about as long.

Oh, and guess what, there are plenty of stories about fire departments taking over EMS and not being able to cover it. But firefighters are never willing to accept the fact that that happens.
Name eight of them in a city whose population exceeds 500,000. Because I can name several cities where privates just up and left (with all their supposed financial security). If the municipality wasn't able to cover the responsibility it could only be as a result of poor planning. Something that can be overcome. The same can't be said for when a private pulls out and leaves folks high and dry.

However, I think the fire department is an even worse choice. I see very few firefighters that actually want to be paramedics. Most of them will only discuss EMS when they are bored. While many of them, even the bored ones, can be excellent medics, having EMS provided by people that want to be there will provide for better care.
Really. OC has completely Firefighter based EMS delivery. We are the 5th or 6th most populous county in the country. Your stories are anecdotal and therefore meaningless. Every six months the department has openings to send firefighters to be trained as paramedics, and every six months more apply than spots available.

I really believe you have no idea what your talking about.

[HewittC4]

"So what? Are you privvy to their financials?"
Yes, they are a public corporation and their financial statements are a matter of public record. Also, the union reviews the financial records everytime the contract is renewed.

"How long did Rural Metro service (no pun intended) Scottsdale before they finally decided that providing that service no longer fit their business model?"
Rural Metro left Scottsdale after being pressured by the firefighters to leave so the firefighters could become city employees. This was a big, public story.

"Name eight of them in a city whose population exceeds 500,000."
Philly, Chicago, Phoenix, DC are four. It's late and I am writing a term paper so I really don't feel like looking it up, but the news is frequently littered with stories about fire departments who can't maintain EMS. All four of these cities are having trouble getting an ambulance on scene in a reasonable amount of time. People have died because of this. Add Mesa to that list. They are currently struggling to come up with a solution to keep their response times. The fire department might not be able to just up and leave, but they still have the responsibility to provide the services they assume.

I am also curious as to why you are limiting it to cities with populations over 500,000. Do you feel that small towns are less deserving of EMS coverage?

"Every six months the department has openings to send firefighters to be trained as paramedics, and every six months more apply than spots available."
So because it is a requirement or advantage to be a paramedic to get a promotion, that means that OC firefighters prove that fire based EMS is best? And I am sure you will now provide facts to show that OC firefighters are the best paramedics in the world and they defecate solid gold. Just because you make it a requirement of the job does not prove anything.

"I really believe you have no idea what your talking about."
And I believe that you have absolutely no idea what you are talking about. This article discusses one of the problems with fire based EMS. http://www.emsresponder.com/article/article.jsp?id=5021&siteSection=1
The fire department has created a shortage of paramedics because many fire departments are requiring people to already have their paramedic cert. before they can get hired. It used to be that only the best of the best could get hired by fire departments. Now, anyone with a patch and a pulse can get the job. More and more the news is littered with stories about firefighters committing crimes, from stealing from patients to child pornography and attempting to met with detectives for sex with minors. Why is this happening so often now? I suspect that it is because of what I said above. Anyone with a patch and a pulse can get hired.

Please don't get offended by my including the mention of the criminal activities. It was not meant to be an attack on firefighters, but it is an observation about what is happening. People that should never have been hired have been getting hired.

[scfire86]

"So what? Are you privvy to their financials?"
Yes, they are a public corporation and their financial statements are a matter of public record. Also, the union reviews the financial records everytime the contract is renewed.
And I'm sure they give out records that are true and accurate. You clearly have no concept of how corporate finance operates. i.e. Enron. Even as they were circling the drain their financial reports showed them being as solid as Gibralter. And they were scoffing at anyone suggested otherwise. You might want to check out "The Smartest Guys in The Room."

"How long did Rural Metro service (no pun intended) Scottsdale before they finally decided that providing that service no longer fit their business model?"
Rural Metro left Scottsdale after being pressured by the firefighters to leave so the firefighters could become city employees. This was a big, public story.
Now I know you have no idea what you're talking about. Rural Metro spent significant sums defeating an initiative that would have forced the city to convert to a public FD. And it lost. Not less than a year later they announced they were leaving. After they beat the firefighters.

"Name eight of them in a city whose population exceeds 500,000."
Philly, Chicago, Phoenix, DC are four. It's late and I am writing a term paper so I really don't feel like looking it up, but the news is frequently littered with stories about fire departments who can't maintain EMS. All four of these cities are having trouble getting an ambulance on scene in a reasonable amount of time. People have died because of this. Add Mesa to that list. They are currently struggling to come up with a solution to keep their response times. The fire department might not be able to just up and leave, but they still have the responsibility to provide the services they assume.
Even if this were true, what makes you believe private EMS would be better?

I am also curious as to why you are limiting it to cities with populations over 500,000. Do you feel that small towns are less deserving of EMS coverage?
Geography alone allows for easier delivery of EMS since a minimal amount of infrastructure is required. Sorry to disappoint. You were hoping for an elitist comment.

"Every six months the department has openings to send firefighters to be trained as paramedics, and every six months more apply than spots available."
So because it is a requirement or advantage to be a paramedic to get a promotion, that means that OC firefighters prove that fire based EMS is best?
Only disproving your claim that firefighters don't want to do EMS.

And I am sure you will now provide facts to show that OC firefighters are the best paramedics in the world and they defecate solid gold. Just because you make it a requirement of the job does not prove anything.
Envy is a deadly sin.

"I really believe you have no idea what your talking about."
And I believe that you have absolutely no idea what you are talking about. This article discusses one of the problems with fire based EMS. http://www.emsresponder.com/article/article.jsp?id=5021&siteSection=1
The fire department has created a shortage of paramedics because many fire departments are requiring people to already have their paramedic cert. before they can get hired.
What a crock. FD's are looking to hire folks with medic certs because it saves them the cost of sending them to school. It is a business decision.

It used to be that only the best of the best could get hired by fire departments. Now, anyone with a patch and a pulse can get the job. More and more the news is littered with stories about firefighters committing crimes, from stealing from patients to child pornography and attempting to met with detectives for sex with minors. Why is this happening so often now? I suspect that it is because of what I said above. Anyone with a patch and a pulse can get hired.
We still do hire the best that apply. Unfortunately like all professions, FD are forced to have the human race as potential hiring pool. Are you going to tell us none of these problems occur in private EMS?

Please don't get offended by my including the mention of the criminal activities. It was not meant to be an attack on firefighters, but it is an observation about what is happening. People that should never have been hired have been getting hired.
See above post.

[Geinandputitout]

Hey C4, how many people apply for each medic spot that comes open at your company. We had 400 take out apps the last time we had three openings...

[HewittC4]

"And I'm sure they give out records that are true and accurate. You clearly have no concept of how corporate finance operates. i.e. Enron."
And who was in charge of watching Enron? No one. Who is in charge of watching the ambulance company? The state, the local FDs, our union, who goes over every financial record with a fine tooth comb.

And to add to this issue, there are more than one private ambulance companies in town. If one pulls up and leaves, the other is more than ready to swoop in and save the day. There is no reason to even suspect that the public will be put in jeopardy, however by pulling this stunt, the city of Chandler has put the entire county in jeopardy.

"Now I know you have no idea what you're talking about. Rural Metro spent significant sums defeating an initiative that would have forced the city to convert to a public FD. And it lost. Not less than a year later they announced they were leaving. After they beat the firefighters."
The timelines were unrealistic and the whole mess put RM in such a bad position that they didn't want to stay. They did stay after their deadline because the city FD was not ready to take over yet.

"Even if this were true, what makes you believe private EMS would be better?"
This was in response to your argument that a FD would never fail a city. Fire is failing many cities. Yet more and more fire departments are forcing EMS workers out of business, many of whom have served the community successfully for decades, all because they want a bigger slice of the tax pie and they don't care who gets hurt. The IAFF has forced their own union brothers out of work. And I am supposed to think they are heroes? They are hypocrites who will do whatever it takes to increase their profits and power.

"Geography alone allows for easier delivery of EMS since a minimal amount of infrastructure is required. "
Completely irrelevant. EMS works the same no matter where you go. The only difference is that in very rural areas your stations are farther apart.

"Only disproving your claim that firefighters don't want to do EMS."
How? This disproves nothing. All it proves is that firefighters will do whatever it takes to get a promotion. Wanting to be a captain does not prove that someone wants to do EMS.

"Envy is a deadly sin."
This is what I think the problem is. You firefighters see yourselves as heroes and you think everyone else sees the same thing. I have never wanted to be a firefighter and I never will want to be a firefighter. This isn't envy. It is anger that I lost my job to someone who swore they would never take it. I am an IAFF member. I lost my job because another IAFF local wanted my job. It is against the rules for one IAFF local to take jobs away from their union brothers, but when it is IAFF firefighters taking jobs away from nonfirefighter IAFF members, no one cares.

"Are you going to tell us none of these problems occur in private EMS?"
I never did. It is happening in private EMS, only as many firefighters here like to point out, fire is the cream of the crop, they are perfect, they never make mistakes, but private medics are the lowest scum of the earth.

[scfire86]

You got a lot of problems there dude. Envy is a deadly sin, and so is anger.

Only five to go.

[LasVegasEMS]

You got a lot of problems there dude. Envy is a deadly sin, and so is anger.

Only five to go.

Is this guy serious?

[croaker260]

And I am supposed to think they are heroes?

Dude, they arnt Hero's, just celebrities.

[AZCEP43]

You got a lot of problems there dude. Envy is a deadly sin, and so is anger.

Only five to go.

Check your source. Anger is not a deadly sin, wrath is.

You might also want to check your pride. It's the devil's favorite.

[HewittC4]

You got a lot of problems there dude. Envy is a deadly sin, and so is anger.

Only five to go.

Maybe you should ask if I have a just reason to be angry. I lost my job because my union "brothers", the IAFF, decided to use their political power to take it. They broke their own rules to do so.

Now I think you should look at the responses you got from this. I especially like Croaker's response. Firefighters are not heroes, they are celebrities. And like so many celebrities, they let it go to their heads. Most people consider people like Britney Spears and Lindsey Lohan to be jokes. Why? Because they think they are so important that they are above everything else. That is the same attitude you are displaying. I pointed out that the IAFF, including President Schaitberger, and since he represents all IAFF firefighters, all firefighters, have decided that they don't have to follow their own rules when it suits them. As a result, firefighters can not be trusted. When I brought up this point, you ignored it, as did ever other firefighter here. Why? And if you believe that you guys are as great as you say you are, why haven't you done anything about it? Have you written to Schaitberger telling him that it is an outrage that he would allow one IAFF local take jobs from another IAFF local? Have you contacted Chandler Fire Department and told them that they are disgracing firefighters everywhere?

Or are you going to be just another person who feels that it is ok to break the rules, as long as you are not the one losing out?

There is a reason why most nonfire paramedics dislike firefighter/paramedics. It is because most of the time, that dislike is deserved.

[scfire86]

Maybe you should ask if I have a just reason to be angry. I lost my job because my union "brothers", the IAFF, decided to use their political power to take it. They broke their own rules to do so.
Boo hoo hoo. And I've seen conservative groups use their political power to take union jobs away as well.

There is a reason why most nonfire paramedics dislike firefighter/paramedics. It is because most of the time, that dislike is deserved.
Sorry to hear about your personal problems. Would you like some cheese to go with that whine?

To get back on topic. Private EMS thinks nothing of throwing in the towel and leaving a community at risk. Municipal EMS doesn't have that luxury.

I'll take my chances with public EMS.

[croaker260]

I'll take my chances with public EMS.


Just a long as you realize that fire based EMS is not the ONLY version of public EMS.

[DrParasite]

To get back on topic. Private EMS thinks nothing of throwing in the towel and leaving a community at risk. Municipal EMS doesn't have that luxury.While this may be true, a smart city council/local government will sign a contract with the private provider stating that either side will need to give 30/60/90/120 days notice prior to terminating the contract. and if the private company just quits overnight, the towns sues the crap out of them.I'll take my chances with public EMS.While I tend to agree with you, as a taxpayer I don't like paying for services that I am not using. That means if I don't have to pay for the salaries and such of all the EMS employees, and it lowers my taxes, then I'm game. Let the private company bill those who use it's services.

There is a reason why many corporations are outsourcing various processes. using a 3rd party EMS service is no different, substituting the municipal government for the corporate body.

[scfire86]

While I tend to agree with you, as a taxpayer I don't like paying for services that I am not using.
So have you driven the entire length of the Interstate Highway System? Have you been protected by the military stationed in Europe? Have you used electricity from the TVA? The list goes on. Government is not a business. It is there to provide for the safety of all persons whether they ever use the services or not.

Were it not for government subsidies of numerous infrastructur programs the US would be a third world country at best. I thank my lucky stars we had visionary individuals like Roosevelt, Truman, and Eisenhower to do the things they laid the foundation for what our nation is today. Despite our problems, we are still the envy of the rest of the world.

[AZCEP43]

Your analogy is weak, at best.

The taxes taken to support the services you list do benefit those not directly using them. The highway system? Individual states wouldn't have them if they weren't provided on a national level. The military? By keeping our enemies in check, they do protect us wherever they may be stationed. The TVA? It allows for electric service to more than just the Tennessee valley.

Tax subsidized programs should not be relied on until the private sector proves they are unable to provide the needed services. If a local government feels that they can save tax dollars for other programs by contracting with private industry for the same service, why would that be a negative?

[LasVegasEMS]

Government is not a business.
hahahaha, take a Political Science 101 class at any of your local colleges and you'll see how ignorant this statement truely is.

[scfire86]

Your analogy is weak, at best.

The taxes taken to support the services you list do benefit those not directly using them. The highway system? Individual states wouldn't have them if they weren't provided on a national level. The military? By keeping our enemies in check, they do protect us wherever they may be stationed. The TVA? It allows for electric service to more than just the Tennessee valley.

I agree with your points. But the analogy thrown out by libertarians (mostly) is why should I pay for a highway I'll never use? Or the military in Europe. I could (but again I agree with you to their necessity) ask you to prove they've kept anyone in check?

That is the point I was trying to make. Just because I might not ever use a program doesn't mean it might not be for the greater good.

Tax subsidized programs should not be relied on until the private sector proves they are unable to provide the needed services. If a local government feels that they can save tax dollars for other programs by contracting with private industry for the same service, why would that be a negative?
That's all fine and dandy until the time comes when their is no profitability. And I've seen that happen more than once where private enterprise just walked away putting the citizenry at risk.

[scfire86]

hahahaha, take a Political Science 101 class at any of your local colleges and you'll see how ignorant this statement truely is.
Not ignorant at all. Government doesn't make a profit. However, government is the great procurer. And more than one business benefits hugely at being able to win contracts for goods or services.

[emt161]

Maybe when these OC firefighters that are so gung-ho about EMS get ASA as an approved med, then maybe they can come talk to us about how progressive their system is.

[mitllesmertz1]

It's so fun to pop into these threads after not reading them for a month or so.
Sadly, nothing has changed except the level of rhetoric.

[HewittC4]

Boo hoo hoo. And I've seen conservative groups use their political power to take union jobs away as well.


I think you are missing the point. The lying, cheating bastards that stole our jobs were our own union brothers. They broke their own rules to do so.

[profire1]

I am no expert on this subject but here is my opinion.

For EMS to be part of the fire department only makes sense. It makes sense for financial reasons and it works well. There are all kinds of problems with other systems. I don’t know why a city would choose any other system. By integrating EMS into the fire department you avoid several headaches and save money. A paramedic who is a firefighter, under FLSA, can work 53 hours a week without being paid overtime. ALS engine companies blend right in with the firefighters on the MICU or rescue company. There is no starting treatment by one agency and then handing the patients over to another. I could go on and on with advantages to a fire department based system. But does this mean that private, or third service, paramedics are less likely to do a good job when your mom has a heart attack? I don’t believe that at all.

There might be good arguments for VOLUNTEER fire districts to have a private ambulance service. But if you have a competent, full time paid, fire department, it should probably also be your EMS provider. There are hundreds of success stories to bear this out. I have never seen a city give up on having the fire department run EMS and go to a private system. I have, however, seen many cities give up on having private EMS companies and give it to the fire department. It happens all the time. Shouldn't we learn from this?

None of the arguments about which system produces better PMs holds water. I truly do believe that most arguments, on this subject, are based upon protecting self-interests. Someone is not going to be a better or worse care giver just because he or she happens to also be trained, or not trained, in something else. Competent, intelligent, dedicated people are just that and they will be good at whatever they do.

You may read a comparison between different types of EMS systems at:
http://www.captainmica.com
I don’t know how much pertains to this topic. But there are also links to examples of several kinds of systems there. This site does talk a little about some of the problems encountered with private and third service systems.

I agree 100%...The proof is inthe numbers. Fire based ems is faster and more efficient. It also provided BETTER standards of care..WHY? Many private ems services dont pay very well and they have revolving doors. they attract the bottom feeders of ems. SOME do pay well, They attract GREAT ems personel. Overall, Fire based ems IS and will continue to be the rule not exception. More and more private ambulance services ARE STOPPING ems service and only doing tranfers.

[HewittC4]

I agree 100%...The proof is inthe numbers. Fire based ems is faster and more efficient. It also provided BETTER standards of care..WHY? Many private ems services dont pay very well and they have revolving doors. they attract the bottom feeders of ems. SOME do pay well, They attract GREAT ems personel. Overall, Fire based ems IS and will continue to be the rule not exception. More and more private ambulance services ARE STOPPING ems service and only doing tranfers.

Once again another hosemonkey forgets that there are other nonfire EMS services besides private. More and more, fire departments are getting themselves into trouble because they have firefighters that are being forced to do EMS, a job they don't want to do.

http://www.emsresponder.com/article/article.jsp?siteSection=1&id=5377

This article discusses how fire departments in Los Angeles and Orange County are under investigation for significant medical errors.

http://www.nbc4.com/news/13317511/detail.html

Here's one about a fire department that is actually suing to not have to run an ambulance.

Mesa FD is having a critical issue with response times.

Fire departments across the country are having problems because of EMS. EMS should be left in the hands of dedicated providers who can focus solely on EMS.

[profire1]

Once again another hosemonkey forgets that there are other nonfire EMS services besides private. More and more, fire departments are getting themselves into trouble because they have firefighters that are being forced to do EMS, a job they don't want to do.

http://www.emsresponder.com/article/article.jsp?siteSection=1&id=5377

This article discusses how fire departments in Los Angeles and Orange County are under investigation for significant medical errors.

http://www.nbc4.com/news/13317511/detail.html

Here's one about a fire department that is actually suing to not have to run an ambulance.

Mesa FD is having a critical issue with response times.

Fire departments across the country are having problems because of EMS. EMS should be left in the hands of dedicated providers who can focus solely on EMS.
Well, Its a losing cause for you. The trend is not only "more fire based EMS" But more and more Privates are stopping ems service and only doing "non emergency" transfers. They have a too much turnover and for the most part attract the bottom feeders of ems. NOW, Hospital bases ems is fine. Good pay and good EMT's and Medics.
It seems like whenever this subject comes up its the private "vollies like" ems types that get thier panties in a wad..Why is that? INSECURITIES that what. Goodness..

[malana1]

I am no expert on this subject but here is my opinion.

For EMS to be part of the fire department only makes sense. It makes sense for financial reasons and it works well. There are all kinds of problems with other systems. I don’t know why a city would choose any other system. By integrating EMS into the fire department you avoid several headaches and save money. A paramedic who is a firefighter, under FLSA, can work 53 hours a week without being paid overtime. ALS engine companies blend right in with the firefighters on the MICU or rescue company. There is no starting treatment by one agency and then handing the patients over to another. I could go on and on with advantages to a fire department based system. But does this mean that private, or third service, paramedics are less likely to do a good job when your mom has a heart attack? I don’t believe that at all.

There might be good arguments for VOLUNTEER fire districts to have a private ambulance service. But if you have a competent, full time paid, fire department, it should probably also be your EMS provider. There are hundreds of success stories to bear this out. I have never seen a city give up on having the fire department run EMS and go to a private system. I have, however, seen many cities give up on having private EMS companies and give it to the fire department. It happens all the time. Shouldn't we learn from this?

None of the arguments about which system produces better PMs holds water. I truly do believe that most arguments, on this subject, are based upon protecting self-interests. Someone is not going to be a better or worse care giver just because he or she happens to also be trained, or not trained, in something else. Competent, intelligent, dedicated people are just that and they will be good at whatever they do.

You may read a comparison between different types of EMS systems at:
http://www.captainmica.com
I don’t know how much pertains to this topic. But there are also links to examples of several kinds of systems there. This site does talk a little about some of the problems encountered with private and third service systems.


Actually, we have a private company staff our station and run only EMS. It save us thousands and makes thousands for them. PLUS, the firefighters don't have to run EMS.

[HewittC4]

Well, Its a losing cause for you. The trend is not only "more fire based EMS" But more and more Privates are stopping ems service and only doing "non emergency" transfers. They have a too much turnover and for the most part attract the bottom feeders of ems. NOW, Hospital bases ems is fine. Good pay and good EMT's and Medics.
It seems like whenever this subject comes up its the private "vollies like" ems types that get thier panties in a wad..Why is that? INSECURITIES that what. Goodness..

So forget about using private services as your argument. Municipal third services provide better care than fire based EMS for a lower cost. Now, look at the fire based EMS agencies in the major cities across the USA. Everyone of them is having problems. Los Angeles City and County are both under investigation. Removing EMS from DCFD was the major campaign point for 2 candidates for mayor. FDNY has been plagued with problems ever since they took over EMS and they haven't been able to accomplish their promises to improve service. Phoenix FD is plagued by lawsuits and has to staff an extra person on each ambulance because of it. The list goes on and on.

Now, you want to talk insecurities, why is it that firefighters can't accept the fact that fire based EMS is a colossal failure? First, the fire service attracts mostly egotistical people that can't take constructive criticism. Second, without EMS the fire service would not be able to argue that they need more money, nor would they have the political clout they want. The fire service has proven time and again that they are only interested in themselves and are willing to endanger the public to get their way.

[profire1]

So forget about using private services as your argument. Municipal third services provide better care than fire based EMS for a lower cost. Now, look at the fire based EMS agencies in the major cities across the USA. Everyone of them is having problems. Los Angeles City and County are both under investigation. Removing EMS from DCFD was the major campaign point for 2 candidates for mayor. FDNY has been plagued with problems ever since they took over EMS and they haven't been able to accomplish their promises to improve service. Phoenix FD is plagued by lawsuits and has to staff an extra person on each ambulance because of it. The list goes on and on.

Now, you want to talk insecurities, why is it that firefighters can't accept the fact that fire based EMS is a colossal failure? First, the fire service attracts mostly egotistical people that can't take constructive criticism. Second, without EMS the fire service would not be able to argue that they need more money, nor would they have the political clout they want. The fire service has proven time and again that they are only interested in themselves and are willing to endanger the public to get their way.
You can list all the "issues" you want to. The bottom line is this..
1. Fire based ems= faster response time, PROVEN
2. Better quality employees..Why? Higher pay, Better background "vets,college grads" more qualified.
3. Fire based ems is NOT a revolving door of folks. PROVEN
4. It is more efficient for the tax payer. This has been proven over and over.
5. It is the trend NOT the other way around, Every year more cities go to fire based ems.
You can list all your arguments but that wont change a thing. Anyone can sue for anything which im sure is the case in MOST of your examples. I actually know alot of HOSPITAL bases ems guys and we all seem to agree on one thing...Private ems folks are just simply bottom feeders..just like nursing home r.n.'s they are at the bottom rung of respect. As they should be.
Last but not least..Its the private companies themselves who is getting out of ems..WHY? NO money...Talk about greed? Huh?

[HewittC4]

You can list all the "issues" you want to. The bottom line is this..
1. Fire based ems= faster response time, PROVEN
2. Better quality employees..Why? Higher pay, Better background "vets,college grads" more qualified.
3. Fire based ems is NOT a revolving door of folks. PROVEN
4. It is more efficient for the tax payer. This has been proven over and over.
5. It is the trend NOT the other way around, Every year more cities go to fire based ems.
You can list all your arguments but that wont change a thing. Anyone can sue for anything which im sure is the case in MOST of your examples. I actually know alot of HOSPITAL bases ems guys and we all seem to agree on one thing...Private ems folks are just simply bottom feeders..just like nursing home r.n.'s they are at the bottom rung of respect. As they should be.
Last but not least..Its the private companies themselves who is getting out of ems..WHY? NO money...Talk about greed? Huh?

1. Where is this proof? Show me the study that shows that fire departments have a faster response time than a dedicated EMS agency, such as Boston EMS.
2. Most third services have similar entrance requirements as fire departments, so you get the same quality of employee. Also, using the article I provided as an example, why are these "high quality employees" you keep talking about killing patients by scolding them for calling 911 and refusing to allow them to use an ambulance to go to the ER? These are your firefighters. I have witnessed firefighters do things like this all the time. I have witnessed more medical errors by firefighters than private providers. I have never seen a private paramedic tell a patient they can't take an ambulance.
3. Third services are not revolving doors either. Once again, the hose monkey isn't smart enough to realize that there are more than just two options.
4. How is it more efficient for the taxpayers to have more engines than necessary for fire suppression? Most cities that use fire-based EMS could reduce the number of engines they have and replace them with two ambulances for each engine, have the same response capabilities, faster transport times, for less money. Not to mention all the money they will save on lawsuits. That sounds like a better way to handle tax dollars to me.
5. And every year more cities are having issues with with their fire-based EMS agencies.

Finally, it shows that you really don't have a clue how to argue when you keep focusing on why fire is better than private and you refuse to respond to the arguments that third service is better than fire. Firefighters kill patients. That is proven.

[Firemedic 61]

\
Now, you want to talk insecurities, why is it that firefighters can't accept the fact that fire based EMS is a colossal failure? First, the fire service attracts mostly egotistical people that can't take constructive criticism. Second, without EMS the fire service would not be able to argue that they need more money, nor would they have the political clout they want. The fire service has proven time and again that they are only interested in themselves and are willing to endanger the public to get their way.

A colossal failure? Are you kidding? Maybe you've never seen the way it works down here. After all the first PARAMEDIC training was at the University of Miami and was made up of Miami Fire Department firefighters. Egotistical people? Some of the most egotistical people I've met were at AMR. Yes, without EMS the FD could not ask for more money, but why would we need it without extra EMS personel.
People have said on here that FD EMS training lacks. When I worked for AMR the only training we got was CPR and ACLS. The rest of out training we had to pay for to get our CEU's. The FD realizes that the majority of our calls are medical so the majority of training is EMS. Everyone is about money, private or public. But when I worked for AMR it was more about the money than pt care. We ran interfacility, BLS transport for the county and first responce. PAYING interfacility came before 911 FIRST RESPONCE, every time. Why, because interfacility ment $$$$$. To bash FD based EMS without looking at the whole picture is BS! In many places Fire Department EMS works better than private, for proffit EMS.

[profire1]

1. Where is this proof? Show me the study that shows that fire departments have a faster response time than a dedicated EMS agency, such as Boston EMS.
2. Most third services have similar entrance requirements as fire departments, so you get the same quality of employee. Also, using the article I provided as an example, why are these "high quality employees" you keep talking about killing patients by scolding them for calling 911 and refusing to allow them to use an ambulance to go to the ER? These are your firefighters. I have witnessed firefighters do things like this all the time. I have witnessed more medical errors by firefighters than private providers. I have never seen a private paramedic tell a patient they can't take an ambulance.
3. Third services are not revolving doors either. Once again, the hose monkey isn't smart enough to realize that there are more than just two options.
4. How is it more efficient for the taxpayers to have more engines than necessary for fire suppression? Most cities that use fire-based EMS could reduce the number of engines they have and replace them with two ambulances for each engine, have the same response capabilities, faster transport times, for less money. Not to mention all the money they will save on lawsuits. That sounds like a better way to handle tax dollars to me.
5. And every year more cities are having issues with with their fire-based EMS agencies.

Finally, it shows that you really don't have a clue how to argue when you keep focusing on why fire is better than private and you refuse to respond to the arguments that third service is better than fire. Firefighters kill patients. That is proven.
you lost this agrument LONG ago. We all know you just didnt have what it takes to join a real Dept. Furthermore, ALL the facts i pointed out are and will continue to be 100% accurate. Private EMS is rapidly becoming a thing of the past. Whether you like it or not. When you say "Firefighters kill patients" That clearly shows you are nothing more than a wanna be. Get a life..You have lost your credibility about 2 pages back on this topic.

[HewittC4]

A colossal failure? Are you kidding? Maybe you've never seen the way it works down here. After all the first PARAMEDIC training was at the University of Miami and was made up of Miami Fire Department firefighters. Egotistical people? Some of the most egotistical people I've met were at AMR. Yes, without EMS the FD could not ask for more money, but why would we need it without extra EMS personel.
People have said on here that FD EMS training lacks. When I worked for AMR the only training we got was CPR and ACLS. The rest of out training we had to pay for to get our CEU's. The FD realizes that the majority of our calls are medical so the majority of training is EMS. Everyone is about money, private or public. But when I worked for AMR it was more about the money than pt care. We ran interfacility, BLS transport for the county and first responce. PAYING interfacility came before 911 FIRST RESPONCE, every time. Why, because interfacility ment $$$$$. To bash FD based EMS without looking at the whole picture is BS! In many places Fire Department EMS works better than private, for proffit EMS.

One more reason why, firefighters obviously can't read or spell. How many times have I said, third service is better than fire. I am not arguing private vs. fire, even though the private provider I used to work for spent more money on EMS than the local fire departments, we had a better training department than the fire departments, and we had better personnel than the fire departments. One other reason is that every time someone criticizes FD-EMS, someone mentions how Miami had the first paramedic program. Yet, they always forget that EMS was started by the military and civilian EMS was started by private companies long before the fire departments got involved. You want to use history as an argument, learn some first.

[HewittC4]

you lost this agrument LONG ago. We all know you just didnt have what it takes to join a real Dept. Furthermore, ALL the facts i pointed out are and will continue to be 100% accurate. Private EMS is rapidly becoming a thing of the past. Whether you like it or not. When you say "Firefighters kill patients" That clearly shows you are nothing more than a wanna be. Get a life..You have lost your credibility about 2 pages back on this topic.

How so? You made all kinds of claims and won't provide any data to support you claims. My claim that firefighters kill patients is supported by the article I linked. Or did you not read it? Or should I point out the patient that DCFD killed with their negligence that caused their problems to be publicized? How about the ones killed by Philly fire? Read the news once in a while and you will know about these things.

One other thing that gets me about hose monkeys, why is it that every time someone in EMS criticizes the fire service, they are accused of being a wannabe that couldn't get hired? Do you know how many fire departments I have applied to? None. Why? I have absolutely no desire to be a firefighter. I had enough of that in the Navy.

[profire1]

How so? You made all kinds of claims and won't provide any data to support you claims. My claim that firefighters kill patients is supported by the article I linked. Or did you not read it? Or should I point out the patient that DCFD killed with their negligence that caused their problems to be publicized? How about the ones killed by Philly fire? Read the news once in a while and you will know about these things.

One other thing that gets me about hose monkeys, why is it that every time someone in EMS criticizes the fire service, they are accused of being a wannabe that couldn't get hired? Do you know how many fire departments I have applied to? None. Why? I have absolutely no desire to be a firefighter. I had enough of that in the Navy.

You're like a mallard duck,Quack quack.....and NO sense.

[HewittC4]

You're like a mallard duck,Quack quack.....and NO sense.

I get it now, I'm debating with a 3 year old. What doesn't make sense? You made claims. I said you need to support your claims. I supported mine.

[FireDawgEMT22]

Less than a week on the forums profire and you act like this. Has webteam been around here, If you disagree with someone, attack the idea, not the person. You lost credibility as soon as I read your first post.

[DocVBFDE14]

Firefighters kill patients. That is proven.

Please provide overwhelming proof of this statement.

[HewittC4]

Please provide overwhelming proof of this statement.

Read the links I listed. The story about the California fire departments lists a few incidents where their incompetence resulted in patients' deaths. Refer to the story from DCFD where the fire department's paramedics both missed the call and the ones that showed up decided that the patient (a well known journalist) was only drunk, even though he was a victim of assault and died as a result of his injuries. a death that could have been prevented if the firefighters had done a halfway decent assessment and treated the patient instead of dismissing him because they didn't want to do their job.

http://cbs3.com/investigations/local_story_315001548.html
Here's one where Philly FD's attitude towards adequately staffing EMS units resulted in someone's death.

Or we could go with personal experience. I have witnessed FD medics refuse to start an IV on an HIV+ patient who had severe NVD x3 days, hypotensive, tachycardic, pale, etc. telling the patient that he didn't need one, leaving it for me in the back of the ambulance, also leaving me to explain why I was starting an IV after the firefighter told him he didn't need one. Or how about the fire-medic that pushed narcan on a patient who's only complaint was decreased appetite and "loopiness" while on a narcotic to treat lung CA. The patient was on the narcotic because it hurt to breath without it. AOx4, RR20, airway patent. He pushed narcan over my protests, the was shocked when a few minutes later, the patient stated that she couldn't breath and her RR jumped to 40. Or how about the firefighter that decided to do a surgical cric on an unconscious trauma patient during an MCI, because RSI wasn't in his protocols. Patient had a patent air but had a head injury. Firefighter made a transverse incision over the cricoid cartilage, though the jugulars. I have seen firefighters delay transporting level 1 traumas so they could run through their algorithms. I could go on and on.

[jasper45]

Or we could go with personal experience.

Real good, solid, compelling evidence there.
You make an idiotic statement that ‘Firefighters kill patients. That is proven.’, and we’re supposed to take it ‘from your experience’?
Go find yourself a life. How many runs a year does DCFD, LA City, or LA County take in? These are just one or two examples, and certainly are not the majority. Even your beloved Boston EMS makes mistakes, as did NYC EMS before joining FDNY. No one is perfect, and I guarantee that you are not either. So take your attitude, and stick it.

The debate from the original thread was how to combat PRIVATE EMS. Any large city out there will have problems with EMS at some point or another, that is a fact.

[profire1]

Read the links I listed. The story about the California fire departments lists a few incidents where their incompetence resulted in patients' deaths. Refer to the story from DCFD where the fire department's paramedics both missed the call and the ones that showed up decided that the patient (a well known journalist) was only drunk, even though he was a victim of assault and died as a result of his injuries. a death that could have been prevented if the firefighters had done a halfway decent assessment and treated the patient instead of dismissing him because they didn't want to do their job.

http://cbs3.com/investigations/local_story_315001548.html
Here's one where Philly FD's attitude towards adequately staffing EMS units resulted in someone's death.

Or we could go with personal experience. I have witnessed FD medics refuse to start an IV on an HIV+ patient who had severe NVD x3 days, hypotensive, tachycardic, pale, etc. telling the patient that he didn't need one, leaving it for me in the back of the ambulance, also leaving me to explain why I was starting an IV after the firefighter told him he didn't need one. Or how about the fire-medic that pushed narcan on a patient who's only complaint was decreased appetite and "loopiness" while on a narcotic to treat lung CA. The patient was on the narcotic because it hurt to breath without it. AOx4, RR20, airway patent. He pushed narcan over my protests, the was shocked when a few minutes later, the patient stated that she couldn't breath and her RR jumped to 40. Or how about the firefighter that decided to do a surgical cric on an unconscious trauma patient during an MCI, because RSI wasn't in his protocols. Patient had a patent air but had a head injury. Firefighter made a transverse incision over the cricoid cartilage, though the jugulars. I have seen firefighters delay transporting level 1 traumas so they could run through their algorithms. I could go on and on.
This guy is so full of ****....Mallard, Quack Quack....

[DocVBFDE14]

Read the links I listed. The story about the California fire departments lists a few incidents where their incompetence resulted in patients' deaths. Refer to the story from DCFD where the fire department's paramedics both missed the call and the ones that showed up decided that the patient (a well known journalist) was only drunk, even though he was a victim of assault and died as a result of his injuries. a death that could have been prevented if the firefighters had done a halfway decent assessment and treated the patient instead of dismissing him because they didn't want to do their job.

http://cbs3.com/investigations/local_story_315001548.html
Here's one where Philly FD's attitude towards adequately staffing EMS units resulted in someone's death.

Or we could go with personal experience. I have witnessed FD medics refuse to start an IV on an HIV+ patient who had severe NVD x3 days, hypotensive, tachycardic, pale, etc. telling the patient that he didn't need one, leaving it for me in the back of the ambulance, also leaving me to explain why I was starting an IV after the firefighter told him he didn't need one. Or how about the fire-medic that pushed narcan on a patient who's only complaint was decreased appetite and "loopiness" while on a narcotic to treat lung CA. The patient was on the narcotic because it hurt to breath without it. AOx4, RR20, airway patent. He pushed narcan over my protests, the was shocked when a few minutes later, the patient stated that she couldn't breath and her RR jumped to 40. Or how about the firefighter that decided to do a surgical cric on an unconscious trauma patient during an MCI, because RSI wasn't in his protocols. Patient had a patent air but had a head injury. Firefighter made a transverse incision over the cricoid cartilage, though the jugulars. I have seen firefighters delay transporting level 1 traumas so they could run through their algorithms. I could go on and on.


So let me get this straight. You have taken isolated incidents and used them to portray widespread patient neglect? Philadelphia answers how many EMS calls a day, week, month, year? FDNY answers almost six digits I believe. Washington DC answers tens of thousands a year. And you can only find a few isolated incidents.

If "Firefighters kill patients. That is proven" is correct, you should have NO problem finding at least 25% of all patient contacts between firefighters and the public, where firefighter neglect has caused death. Hell I'll be a nice guy. Find me 1% and I'll believe you. Problem is you can't do it.

"Or we could go with personal experience. "

Yes we could. But you are the doctor.

[HewittC4]

Real good, solid, compelling evidence there.
You make an idiotic statement that ‘Firefighters kill patients. That is proven.’, and we’re supposed to take it ‘from your experience’?
Go find yourself a life. How many runs a year does DCFD, LA City, or LA County take in? These are just one or two examples, and certainly are not the majority. Even your beloved Boston EMS makes mistakes, as did NYC EMS before joining FDNY. No one is perfect, and I guarantee that you are not either. So take your attitude, and stick it.

The debate from the original thread was how to combat PRIVATE EMS. Any large city out there will have problems with EMS at some point or another, that is a fact.

If personal experience isn't a good enough example for you, then why aren't you attacking the other firefighters who have used that as their reason for why they are criticizing private EMS? As for the other examples, those mistakes are the ones listed in the media. There are enough in the SoCal cases to cause the entire system to be investigated. DCFD had so many problems that it was the major campaign issue for two mayoral candidates. For a while there, Philly FD was in the news almost weekly because of how bad their system was.

I agree that any system is going to have problems at some time. That is why I have only included incidences that have been chronic. I could easily link articles stating that this firefighter was arrested for child molestation or that firefighter was arrested for arson, but I am not going to let one idiot be my entire argument. But when an entire system is broken, that is a good enough argument for me to believe that it should be changed.

Now, I was asked to provide some kind of evidence for my claims and I did. I also asked that those that made claims provide evidence to support their claims. I'm still waiting for that evidence.

[HewittC4]

So let me get this straight. You have taken isolated incidents and used them to portray widespread patient neglect? Philadelphia answers how many EMS calls a day, week, month, year? FDNY answers almost six digits I believe. Washington DC answers tens of thousands a year. And you can only find a few isolated incidents.

If "Firefighters kill patients. That is proven" is correct, you should have NO problem finding at least 25% of all patient contacts between firefighters and the public, where firefighter neglect has caused death. Hell I'll be a nice guy. Find me 1% and I'll believe you. Problem is you can't do it.

"Or we could go with personal experience. "

Yes we could. But you are the doctor.

DC & Philly have both been in the news frequently for being unable to respond in a reasonable amount of time. I have access to the information presented in the news media. They only mention the specific incidences that I listed, but they have also listed the constant problems with getting an ambulance on scene quickly.

[jasper45]

If personal experience isn't a good enough example for you, then why aren't you attacking the other firefighters who have used that as their reason for why they are criticizing private EMS? As for the other examples, those mistakes are the ones listed in the media.


Because there is no proof. I work everyday (unfortunately) with private ambulance companies, and see the buffoonery daily. I'm not going to throw that out there, unless some dope comes in here making stupid claims.
YOU make a statement like you did, and I will call you out on it. Firefighters kill patients. GFY
Besides, it's not called personal experience, it's called making unfounded allegations with no evidence to back your statement up. Your quote was direct insult to me.

Your criticsm of these high volumes systems leads me to believe that you've never worked in a system such as these.
Beside the point, I will give a brother credit until proven otherwise. A private ambulance employee is not a brother.

[DocVBFDE14]

DC & Philly have both been in the news frequently for being unable to respond in a reasonable amount of time. I have access to the information presented in the news media. They only mention the specific incidences that I listed, but they have also listed the constant problems with getting an ambulance on scene quickly.

So you have changed your tune. Now the ambulance is just delayed and that is the problem? Guess what, name a place where ambulance arrival is NOT the problem?

Gee from "personal experience" we wait for ambulances all the time here in Va Beach. Guess what, they are volunteer and not fire department run! Guess what, Norfolk Fire Rescue only has 14 medic units for that city, guess what they have to wait once in awhile. Portsmouth the same. Cheasepeake the same. Dallas the same. San Fran the same. Guess what, you should already know there are alot of useless 911 EMS calls bogging ambulances down. Everyone has to wait once in awhile.

You stated that "Firefighters kill patients. That is proven"
You have yet to provide widespread data to prove consistent gross patient neglect by firefighters.

Why not just save face, admit you were speaking out of emotion and your rectum and call it a day?

[profire1]

Hewittc4 is nothing more than a 1 run a day wannabe. He hasnt be able to move up the ladder of success and he is mellow about that...He spends all day doing the "book work" but when it comes to actually performing real world duties he stumbles and bumbles. Try harder next time...you may actually pass the physical agility part.

[Firemedic 61]

HewittC4
Thank you so much for showing overwhelming proof that we kill patients.
I read your articles and they showed a few intances, they also showed that a private ambulance company that was involved. I could also find more than a few intances of ER DOCTORS that kill patients. Oh, by the way, are Philly and DC EMS crews even firefighters? You posed a link for an article about Kentland trying to sue to no run an ambulance. Aren't they a Vollie service, not paid? So evey "new" service added to thier list spreads their members thinner. Both sides can go on and on and on, it's like a paid vs. vol. argument. But again I have to say your blanket statment about FD run EMS being a failure is wrong. Thier are many places where it works great. And yes I have been on both sides, third service and FD, and without a doubt FD EMS is superior. Everyone has personal experience to prove thier point, so put that back in your pocket. Yes EMS started with civiliains, in fact some of the earliest accounts are from 1912 Russia, when a Doc and a nurse would render aid from an ambulance. Infact modern day EMS has many roots in Europe. Oh by the way, your right my spelling isn't always the greatest and my spell check isn't working but believe it or not we firefighters can read. Infact I think this was about how to combat private EMS, so to cfd045 contact the IAFF if you haven't already. They have people to help you with this problem.

[DrParasite]

Oh, by the way, are Philly and DC EMS crews even firefighters?EMS in Philly is run entirely by the FD (PFD paramedics handled all EMS calls). they are dedicated ambulance people, they don't ever get off the bus. Last I checked, DCFD/EMS handles all EMS calls in DC.Yes, without EMS the FD could not ask for more money, but why would we need it without extra EMS personel.because municipalities love bandaiding an under staffed EMS system (with too few ambulances) with having fire departments first respond, especially since structure fires area down in recent years.The FD realizes that the majority of our calls are medical so the majority of training is EMS.BULL*****. Unless your department that different than every other department in the US, that's a BS statement. most of your training is in fire-related stuff. maybe once a week you train on EMS? and if you are that different, please provide the e-mail address of your department's training officer, as an outrageous statement like that needs to be verified by a third party. but I still think you are making that up. With all the things FDs need to train on (fire suppression, extrication, rope rescue hazmat to name a few) I don't believe the majority of your training is EMS.Everyone is about money, private or public. But when I worked for AMR it was more about the money than pt care. We ran interfacility, BLS transport for the county and first responce. PAYING interfacility came before 911 FIRST RESPONCE, every time. Why, because interfacility ment $$$$$.you know, I find that a little hard to believe. what probably happened was your area was contracted to provide x number of ambulances for 911 service. or maybe x number to be available for 911 service. they had additional ambulances doing inter facility runs. if a 911 call came in, and an interfacility truck was available, they would take it. however, if they were committed to an interfacility run (which are also a contract with the facilities), one of the contracted 911 trucks was sent.

you shouldn't blame AMR for that, blame the municipality for not contracting for more trucks.FDNY answers almost six digits I believe.If I'm not mistaken, the FDNY EMS system answers close to seven digits.You can list all the "issues" you want to. The bottom line is this..
1. Fire based ems= faster response time, PROVEN
2. Better quality employees..Why? Higher pay, Better background "vets,college grads" more qualified.
3. Fire based ems is NOT a revolving door of folks. PROVEN
4. It is more efficient for the tax payer. This has been proven over and over.
5. It is the trend NOT the other way around, Every year more cities go to fire based ems.
1. ehhh, maybe. you have a unit on scene faster. sometimes it's an engine or non-transporting rescue. it's not always the ambulance.

2. ehhhh maybe. better quality employee? absolutely. better quality EMS provider? well, when you have the low man on the totem pole banished to the bus, until he can get a spot on a suppression piece.... or when you have a FF who really doesn't want to be on the ambulance, but is forced to because the mayor wants the department to do EMS..... so yeah, might not get a better EMS provider...

3. Agreed. a FD EMS provider might get 70,000 a year. a private service might get 35,000 a year. FD has a better pension and generally better working conditions. any ideas why it's not a revolving door? and besides, if you got 70 grand a year to do EMS, would you give it up?

4. actually, here you are wrong. a FD EMS provider might get 70,000 a year. a private service might get 35,000 a year. both do the exact same job. which is more economical for the tax payer? lets also remember, a tax payer pays the salary of that FD EMS provider. a private service EMS person is paid by their company; tax dollars are not involved. so tell me how it's more economical for the tax payer?

5. while this may be accurate, how many can say they are better off now that the FD is running EMS? how many can say they are worse off? and how many say the level of service stayed the same, but is more expensive since you are now dealing with FD level salaries?

You can list all your arguments but that wont change a thing. Anyone can sue for anything which im sure is the case in MOST of your examples. I actually know alot of HOSPITAL bases ems guys and we all seem to agree on one thing...Private ems folks are just simply bottom feeders..just like nursing home r.n.'s they are at the bottom rung of respect. As they should be.agreedLast but not least..Its the private companies themselves who is getting out of ems..WHY? NO money...Talk about greed? Huh?ummm, it's got nothing to do with greed, but rather paying your expenses. for the for profit ones, it's about being accountable to your stock owners. Fire based EMS gets money from their taxpayers. private EMS providers get all their money from the revenue they get from charging insurance companies for services rendered. For profit companies are there to make a profit; BLS in urban environments tend not to be profitable (I know in my service it isn't). heck, ALS isn't either. and Private for profit companies don't have the millions in tax revenues that FDs get to keep themselves in the black. don't forget that.

[wakehead]

Wow a very heated debate!:eek:

I will change this up a bit on the same topic though!

My expierience, my opinion!

I have worked for all Four, A Private, A Third Service, A Hospital Based and of course a Fire Dept. Some of these were only a PT gig though!

1. The Privates are pretty much the company's who treated there folks like poop, and paid the least=high turnover rates, and newbies right out of school who didnt know poop!

2. The Third services provided good care and had good people, but were very under staffed with busses 3 buses for a population of almost 70,000 people running over 12,000 calls per year.....OUCH! The Local BLS FD was always waiting on us to get there!

3. Hospital Based was OK but the bottom line was profit for that particular division of the hospital.

4. Fire Based was and always been MY FAVORITE to work for: lots of manpower when needed, all marching to the same drum, great benifits, great protocols, Medics who have been on the street for years and then getting promoted and being able to pass on that expierience to the rookies, Great retirement, always more busses than needed, we ran 15 busses for 120,000-150,000 people back in south Fla, running 18,000 calls per year, and to top it off there were always additional FF available per house because of those Fire Medics, actually saving tax dollars instead of Paying FD and a Third Service....

of course this is just my 2 cents though, not a fact, just my opnion...so go ahead and FLAME ON!!!!!!!

or debate nicely!!!!

Signed a Fire Medic

[croaker260]

It doesnt take an expert to know that fire based ems is the most professional and best way to go. Hospital based is my 2nd choice.

Actually, it does take an expert , because the IAFF has the public saturated with propaganda.

Get out a bit, Fire based EMS is not the only way to a professional organization...and don't count out third service EMS either...the option that the IAFF would prefer would just go away.

[EasternMedic057]

In response to the statement that it is finacial benificial for a municipal fire department to run an ambulance service, I think you may want to review your facts or consult with someone before speaking on that topic. If you refer to the Congressional study relased this week you will note that an ambulance service, utilizing payment from medicare/medicaid will operate at a minimum of a 6% loss, this does not even begin to take into account the no-pays that you may transport. As history has proven municipal services generally are not efficient and do not provide the best finacial solution to a given area. By privitizing these services the municipality will decrease its spending, liability, and manpower costs. Although, I do not agree with the results that may occur as a result of the cut, you need to look at the prospective of a tax-payer. The fire department is a tax funded agency and yet they charge you for the EMS transport services provided. You need to keep in mind that once insurance companies catch up to the times you may see Transport reinbursment disappear altogether for tax funded programs. In regards to preventing the council from privitizing your EMS services, I suggest that you utilize a PR approch, as the desicion makers are all elected officials, and remember they need your votes too.

[mitllesmertz1]

Guess what, Norfolk Fire Rescue only has 14 medic units for that city, guess what they have to wait once in awhile.

Bored and reading this thread, couldn't help but notice this.

A comparison, if you will:

Norfolk Fire Rescue: 14 medic units, 10 ALS Engines.
http://www.norfolk.gov/NFR/FireEMS.asp
Norfolk Population 2000:234,403
http://norfolkva.areaconnect.com/statistics.htm

Seattle Fire Dept: 7 medic units, 0 engines
http://www.seattle.gov/fire/deptInfo/deptProfile.htm
Seattle Population 2000: 563,374
http://seattle.areaconnect.com/statistics.htm

Now that seems a little odd, doesn't it? Double the population, half the medics.
Hmmm, wonder who has a better survival rate....

[Mikelev69]

I work in an area with multiple complex issues involving the concept of a fire based EMS service. The current system is as follows:

Two cities that border each other with separate career fire departments. They're both about the same size and demographic (the poverty rate is about the same). EMS runs make up about 85% of all runs over all when Motor Vehicle Collisions are included. Actual working structure fires are less than 5%. Serious fires are even rarer than that. The Fire Department provides Paramedic level EMS service. The ambulance company is a privately held commercial service that is contracted through each city. The ambulance service is also Paramedic level, and we provide 3 services: BLS units to cover the two cities, and the Fire Medics ride in with the patient when ALS is necessary; 2: Paramedic units to intercept with the outlying ring of suburbs that surround these cities and provide ALS care for towns that have only BLS service; 3. provide interfacility transport in the local area. At night, all the ambulance units are ALS, which means there are several Paramedics responding to any given call. The Fire Department Paramedics have rules that state they must ride in with an ALS patient even if the responding ambulance is ALS also. This practice has several pitfalls.
1. For one of the cities, there is a community hospital in town. The medics tend to gravitate towards this hospital even if the patient needs a Level 1 center for trauma, cardiac or stroke. This is done to reduce transport and turnaround time, because their fire units are woefully understaffed. In a perfect situation, even when no calls are in progress, if a fire comes in, they have to call mutual aid for a working fire. So sending their Paramedics on EMS calls makes no sense when they dont have enough people to work fires in the first place.
The other city must always transport out of its borders because they dont have a hospital in town. This means that if 3 or 4 ALS calls are going on (which happens multiple times every single day), they are short the equivalent of one company for any fire that comes in.
So: If these fire departments are leaving themselves short of firefighters to do EMS calls, sooner or later someone is going to get hurt in a fire because there werent enough men, because they were off on EMS calls. The ambulance service has ALS units that can respond to these calls, and we are not firefighters. We have no other duty besides EMS.
2. The second issue is much more disturbing. The Paramedics for both of these Fire based EMS services can best be described as abysmal. Gross negligence and misconduct occurs almost hourly. This is not any kind of exaggeration or embellishment, these fire medics have been sued repeatedly and their departments forced to make millions in settlement payments for proven malpractice. The problem is that when these Paramedics get hired by the Fire Departments (in our area one must already be an experienced Paramedic to have a shot at getting hired), they quickly figure out that they have a golden ticket to be lazy and slack off on their patient care. They know this because if anything happens the union will step in and huff and puff on their behalf. And so far, they have not failed to get away with it. The hospital that provides our medical control knows this too well, and despite their best efforts the medical control authorization for these Fire Medics cannot be taken away because everyone is scared to death of the union.

The Paramedics on the ambulance service, however, are widely regarded as the best in the state, and those bragging rights are hard won. Our reputation is that we will intercept with anyone, anywhere, for anything, while simultaneously preventing the Fire Department from killing anyone. These Fire Medics are also becoming a burden, because our protocols and scope of practice cannot expand as long as people who cannot provide adequate care have valid medical control. The hospital desparately wants to do this, but cannot out of fear of a lawsuit should anyone get hurt by the Fire Departments incompetence.

The moral of the story is that while Fire Based EMS may work in some areas, it doesnt work in all of them, and it DEFINITELY does not work in mine.

[wakehead]

This issue is MUTE, If I reply it will be Fire Based, if Croaker replies it will be Third service...and so on, and so on, even though this is quite the debated tread, in my opinion it just doesnt seem like this will ever go anywhere except your own opnion's....

Bottom line I would ratter stick a hot poker in my eye than work for anything but a Fire Dept...

but this is only my opinion, and I could be wrong!

[JohnWE]

From my perspective, that of a new EMT trainee, with quite a few more years of life experience than most I'd wager, the biggest issue is the terms
all of you are using in this "debate".

When you toss the word "combat" into what could and probably should be a legitimate question for debate, you've already staked out territory and pretty much announced to the world where your sentiments are.

While I'm positive that everyone involved in this discussion has tons more EMS working experience than I do, some of you clearly don't have a whole lot of experience in diplomacy or in trying to settle contentious issues without resorting to ad hominem attacks.

Perhaps doing the best one can do in whatever work place one chooses to work in is all any one person should be concerned about.

But as someone else wrote, that's just my opinion and I could be wrong.

John E.

[DrParasite]

Bottom line I would ratter stick a hot poker in my eye than work for anything but a Fire Dept...but is the question who is best to work for, or what services the public the best? a FD might pay the best, but a 3rd party/hospital based (or even for-profit) might be what is in the best interests (either financially or patient care wise) of the taxpayer.

[emt161]

Private, fire, third service.... In the end, any provider regardless of employer who responds to the call because he or she wants to provide the best medical care possible is, in general, better for the patient than someone responding to the call because they don't have enough seniority not to.

[CaptainGonzo]

In many communities, there is fire based EMS because there isn't enough call volume nor profit for the private companies to station a bone box there.

Just in my own community, I have also seen the big fish eat the little fish syndrome in private EMS, only to see the quality of patient care go downhill because the dollar and profit was put ahead of doing what is right.

Hewitt, I have seen some excellent paramedics, and some who I wouldn't allow to treat the family pet. I have dealt with medics who think they are either doctors or God, and worked with some I would trust with my life.

Get off of your high horse, the rarified atmosphere isn't doing you any good.

[hiletm1]

In my experience, this is the normal attitude among most fire fighters regarding EMS. What kind of care do you think Mr. Dean provides? If this was one of your loved ones, would you want him taking care of her?

To you and Mr. Dean, You are both wrong.

I have been on all sides of EMS. I started out with the vollies, then got hired by the privates then moved on to career fire-based. Guess what? There were ****-poor providers at all of them!

Even though I am an IAFF Fire EMS provider I still volunteer. Why? Because I love what I do-helping others whether it be a fire or a "BS" medical call. I know many others that feel the same.

Yes, there are good private companies out there but there are many that pay more attention to dollars than lives. Where I worked, they would rather leave 40,000 people without EMS care in order to get a good paying interfacility transport. To me this is unacceptable. I will never knock someone who works for a private or volly provider but I will slam any management that puts lives at risk to make a few bucks.

No two communities are the same and no one plan works everywhere. No matter what your community does, ensure that the best patient care is the priority!

This hit the nail on the head. It depends on where you are. I know, in PA, there is alot of money in mergers, so for rural volunteers, who are already struggling as it is, it makes sense to pull resources. As for the case of firefighter-emt's and firefighter-medics being "****-poor" (as stated early in the thread) I don't see how that makes any sense. It just means that the emergency services worker (I use this term becuase thats what fire and ems are becoming, more broad) is a more well-rounded and knowledgable rescuer.

As for private vs. municipal/unionized, at least private EMS services don't tell you who to vote for.

[azemsdiva]

Because there is no proof. I work everyday (unfortunately) with private ambulance companies,

Beside the point, I will give a brother credit until proven otherwise. A private ambulance employee is not a brother.





Oh Hell!!! Whats up with all this juvenile crap???

People people people, We are all in the same business!

Enough already!

Grow up!!!:rolleyes:

[SkipKirkwood]

Here's something to think about.

1. "Ambulance" and EMS are not the same thing.

2. EMS = ambulance operations + "other stuff" (EMS special operations)

3. You can privatize ambulance but you can't privatize the rest of EMS. Why not? You can't bill for it, so where does the money come from.

4. Where you have private ambulance, you typically see fire departments doing the "other stuff" - providing the medics for the tactical team, the hazmat team, the USAR team, providing fireground and other incident rehab, planning and protecting the incidents.

5. It is possible to have a complete, independent EMS agency providing excellent care across the whole EMS spectrum - ambulance operations + special operations.

Check out www.wakegov.com/ems

Skip

[TedEMTP]

Hey Rod, you must be really bored. Thanks for giving me a chance to clarify my earlier post in this thread before you copied it out of context to that other discussion board. Of all the people I ever thought would blue falcon me, you were not one of them. Live and learn, I guess. By the way, since you seem to have the time, I wrote some really scandalous stuff in my high school yearbook in 1988. Maybe you can post that somewhere, too...

[Geinandputitout]

Here's something to think about.

1. "Ambulance" and EMS are not the same thing.

2. EMS = ambulance operations + "other stuff" (EMS special operations)

3. You can privatize ambulance but you can't privatize the rest of EMS. Why not? You can't bill for it, so where does the money come from.

4. Where you have private ambulance, you typically see fire departments doing the "other stuff" - providing the medics for the tactical team, the hazmat team, the USAR team, providing fireground and other incident rehab, planning and protecting the incidents.

5. It is possible to have a complete, independent EMS agency providing excellent care across the whole EMS spectrum - ambulance operations + special operations.

Check out www.wakegov.com/ems

Skip


That has been a difficult model to implement

[LTA2323]

[QUOTE=AZCEP43;785233]So instead of providing a profitable service, it is better to suck tax dollars away to provide more fire department jobs that don't want to do what they are paid for? You are sooooooooo right.

[LasVegasEMS]

I dont know why someone decided to bump this thread, but reading through it again, agonizingly, I'm glad that some of these posters have decided to stay under the radar and haven't resurfaced much.

I just think everyone sucks :)