Fielding more calls, city EMTs often attacked, injured

[DrParasite]

Fielding more calls, city EMTs often attacked, injured

By David Abel, Globe Staff | August 29, 2007

One had his nose broken four times. Another was attacked with cinder blocks dropped off the roof of a housing project. Others have been stabbed with drug-filled syringes, chased by dogs, and strafed by gunfire after arriving at crime scenes before the shooting stopped.

Boston's emergency medical technicians, who often run red lights and speed through the opposite lane of traffic to save lives, are trained to confront broken bones and cardiac arrest.

But EMTs, who are responding to more calls each year, often become victims themselves as they face Boston's rampant street violence without the guns, mace, and nightsticks that police officers carry.

Last year, 28 percent of the 193 injuries suffered by city EMTs were the result of violence, a figure that has held constant over the past five years, according to Boston Emergency Medical Services. This year EMTs have been injured in 24 attacks.

Since 1994, four EMTs have left the department as a result of injuries from violence.

Nationally, no one tracks the number of EMTs and paramedics -- highly trained EMTs -- injured in violence on the job, but the National EMS Memorial Service, a volunteer group in Virginia, said 30 EMTs have died because of violence since 1993, 14 of them while responding to the terrorist attacks on Sept. 11, 2001.

"Violence isn't something an EMT should have to deal with," said Richard Serino, chief of Boston EMS, who noted that more than half of last year's total number of injuries left his employees out of work for a day or more. "One EMT injured as a result of an assault is too many."

Last fiscal year, the city's 333 EMTs responded to 99,266 calls and made a record 68,943 trips to hospitals-- an increase of about 5,000 since 2002 -- without a significant change in staff.

Many EMTs said they are overworked and undertrained for what they confront. They said they are increasingly sent to calls that in the past may have been answered by the police -- such as a report of a "man down" or someone drunk in the street -- and too often must work without police assistance to subdue hostile patients or others interfering with their care.

When they encounter trouble, they have only a radio to call for help and handcuffs to restrain the attacker. Their radios, they say, aren't much help, because they can't call police directly; they must wait for an EMS dispatcher to e-mail police dispatchers.

James Orsino, who has suffered a broken nose four times during his 23 years as a city EMT, said he has dodged bullets after being caught in the crossfire and been punched more times than he can remember. Like other EMTs, he has also been injured by people not willing to accept his help; he once tore his rotator cuff in a struggle with a man trying to jump off the Massachusetts Avenue Bridge.

"We're in a time when there's a lot more going on in the street, and you can feel it," said Orsino, president of the EMS division of the Boston Police Patrolmen's Association. "With everyone's resources stretched thin, we often arrive on the scene before police. Those are classic cases to get hurt on."

Boston EMS, overseen by the Boston Public Health Commission, dispatches teams of two medical technicians from an office adjacent to police dispatchers at police headquarters. When a 911 call comes in, an operator determines whether to transfer the caller to a specially trained EMT dispatcher.

The department, which has a $37 million budget this fiscal year, offers EMTs the opportunity to take a two-hour self-defense class, but Orsino and others contend it's not enough. He said the city should require EMTs to be certified annually in self-defense, as they are for defensive driving and CPR. He said the department should also outline standard procedures for how to deal with violent patients.

EMTs also worry about fighting back for liability reasons, he said, which is why they don't carry mace.

"When someone is violent in a hospital, six people are used to restrain the person," he said. "In the street, it's you and your partner. There's no one else, nothing to help you out. Whatever comes out of it is what happens, which is why so many people get injured. It's a crazy situation."

Nearly every city EMT has a story about being attacked.

Jim Allen, 33, who has worked as an EMT for 11 years, said it's not uncommon for people to start yelling as his ambulance passes and to "make violent gun gestures."

"I've been bitten by more people than dogs," he said. "It seems every other call they dislike you for something. I think it's because of the badge we wear."

Alcohol and drug abuse are fueling the violence against EMTs. Zach Schiess, 29, who has worked as an EMT for six years, said he was called to a bar in South Boston after a man's arm was twisted in a fight. When he arrived, he said, the man and his girlfriend started swinging at him and his partner, forcing them to lock themselves in their ambulance.

"You can never take for granted what can happen when someone is drunk," he said.

City EMTs receive at least eight months of training, from life support to how to use the radios to how to operate the ambulances. The advanced EMTs, or paramedics, receive two years of training, which includes more advanced life-saving techniques.

Serino said all EMTs are trained to manage aggressive behavior, but he said, "We're always looking for ways to improve our training."

To cope with the stresses of the job, one city paramedic is writing about his experiences on a blog, "Other People's Emergencies: Random Thoughts of an Urban Paramedic."

Jay Weaver, a 22-year veteran and the author of urbanparamedic.blogspot.com, has been stuck with a needle by an AIDS patient, confronted people wielding guns and knives, and dragged three blocks by a man who grabbed him through the window of a car.

On his blog, he covers subjects ranging from how EMTs deal with drunken doctors interfering at scenes, how they subdue people trying to commit suicide, and among other things, how they handle grumpy patients and drivers who cut off their ambulances.

At the end of a December entry titled "Danger," the 47-year-old paramedic wrote: "We are forever one misstep away from serious injury or even death. The next time we fly through an intersection, the impact might be more powerful. The next time I get stuck with a needle, it just might contain a lethal virus. The next time I walk through a door in the projects, there might be a lunatic waiting for me on the other side with a handgun or a knife. I'm not going to dwell on any of this. You can't do the job if you're afraid of each call."

On a recent shift, Weaver and his partner weaved through rush-hour traffic. They raced through streets that looked like parking lots for calls that required them to do everything from subduing a large psychiatric patient who began beating his social worker on Boston Common to treating a father who was stabbed while taking his 2-year-old son for a stroll in Charlestown.

At the end of the night, as their radio continued to squawk, Weaver said the key to surviving was expecting the unexpected.

"We have family members screaming in our face and people throwing things at us," he said. "You just don't know what you're going to experience on any call."

David Abel can be reached at dabel@globe.com.

http://www.boston.com/news/local/articles/2007/08/29/fielding_more_calls_city_emts_often_attacked_injur ed/

[bassman48]

wow, i cant imagine what its like being an EMT or Paramedic in Detroit!

[DrParasite]

Detroit, Chicago, Newark, Camden, St. Louis, parts of NYC, and you know, even smaller urban cities have similar problems. It's not just the big cities that have these problems.

Urban cities just have the annoying habit of not having a cop available to respond to all EMS calls, as opposed to suburban towns which can often send one as a first responder or to make sure the scene is safe (or just to fill out a report to increase their run numbers)

[RicanMedic78]

sounds like theres an argument to be made... that in many cases, merging EMS with PD might make more sense than the ladder.

btw, I'm new here. Glad to be aboard...

Jason

[armymedic571]

Sounds like they got a few system problems in Boston....

[jasper45]

Believe it or not, this situation actually makes the case for fire-based EMS.

Our paramedic units never run alone, they’re always with an engine company, meaning there are four more people on the scene with you every time. And, on the occasions in which it turns into a hostile scene, and you call for help, the nearest truck company is only a moment or two away.

Almost without exception, we are always waiting for the police. Even for high priority violent crime incidents, we are always there before ‘the man’.
If nothing else, it gives us a numbers advantage, and should you do get into a wrestling match, the old adage of “many hands make light work” rings true.

[DaSharkie]

Believe it or not, this situation actually makes the case for fire-based EMS.

Our paramedic units never run alone, they’re always with an engine company, meaning there are four more people on the scene with you every time. And, on the occasions in which it turns into a hostile scene, and you call for help, the nearest truck company is only a moment or two away.

Almost without exception, we are always waiting for the police. Even for high priority violent crime incidents, we are always there before ‘the man’.
If nothing else, it gives us a numbers advantage, and should you do get into a wrestling match, the old adage of “many hands make light work” rings true.

Makes the case for fire based EMS? Hardly.

If the scene turns hostile and you have not made patient contact, you leave. If you have made contact and you are in a threatening situation, you leave.

I don't care how many people are on scene with you, if it is hostile - then you leave.

And not every call gets a bucket. Even it did, then you still have the hands that you claim you need.

Every call does not need an engine company.

[Brian1023]

Believe it or not, this situation actually makes the case for fire-based EMS.

Our paramedic units never run alone, they’re always with an engine company, meaning there are four more people on the scene with you every time. And, on the occasions in which it turns into a hostile scene, and you call for help, the nearest truck company is only a moment or two away.

Almost without exception, we are always waiting for the police. Even for high priority violent crime incidents, we are always there before ‘the man’.
If nothing else, it gives us a numbers advantage, and should you do get into a wrestling match, the old adage of “many hands make light work” rings true.

Well, H&H is technically PD based... I don't think I ever see them on calls without PD back up. So, no. Not really.

[jasper45]

Makes the case for fire based EMS? Hardly.

What I should have said was that it makes a case for it, not the case.



If the scene turns hostile and you have not made patient contact, you leave. If you have made contact and you are in a threatening situation, you leave.

I don't care how many people are on scene with you, if it is hostile - then you leave.

It's not always practical or feasible to leave, nor are you always able to leave. Some times a scene turns ugly before you get a chance to react. I'll take the 4-6 people on a scene rather than two, sorry.



Every call does not need an engine company.

Now that would depend on the system your city runs now, doesn't it? If you run out of a tiered system, then the system is very dependent on engine company first response.

I also should have clarified, I'm talking about what I work with, not Boston. I have no idea how Boston works. The city here is also a high volume, high crime system, that is tiered and very successful.
Personally, I want the extra hands on scene. I've been on both sides of the fence, having worked on two person squads. It is hands down far safer for everyone.
I also wasn't advocating for Boston to take up our system, just pointing out a system that works well.

[DaSharkie]

Actually you were advocating for your system. You said that this makes the point for a Fire-Based system.

A total crock of shyte.

What the system needs is the removal of petty union politics and everyone actually working together to do what is right.

The vast majority of instances I worked, I had way too many people on scene. Just my two cents.

Of course, I guess firefighter-EMTs never get assaulted on scene.........

Oops. I recall the instance a couple months ago in California where a 19 year old injured several firefighters and a Sheriff's deputy. I guess that makes a case against it using your logic.


I guess since the number of violent patients coming to emergency departments and being violent to the staff in the United States is going up, that we should use your logic and have Fire Based EDs huh? :rolleyes:

[bossteen]

First off, Boston EMS is NOT PD based, its is a third service under the Boston Public Health Commision, has been since Health and Hospitals ceased to exist in 96 I believe. Police do not go to every call, neither does fire. Its a tiered system, ALS calls get an ALS and BLS response (usually) and some call types will get a fire first response. I don't think the answer is to send more people to calls in case someone decides to act up. If that is the answer, please send someone with a gun, not a fire truck. The fact is people are going to act up, they do it with us, they do it with the cops, and they do it with fire. In a perfect world everyone would be safe, no one would have to take risks and everyone who assaulted a cop/ff/emt would get prosecuted.

[DaSharkie]

Well, H&H is technically PD based... I don't think I ever see them on calls without PD back up. So, no. Not really.

As Bosteen stated, the police department has nothing to do with BEMS.

The EMTs and Paramedics of BEMS are members of the Boston Police Patrolmen's Association - as union membership.

This may be where the confusion comes from.

http://www.bppa.org/

http://www.bppa.org/EMS_Division/default.asp

http://www.cityofboston.gov/ems/

[jasper45]

Actually you were advocating for your system. You said that this makes the point for a Fire-Based system.

A total crock of shyte.

Well, since we're a fire-based sytem, how is it a crock of sh*t?


Of course, I guess firefighter-EMTs never get assaulted on scene.........

Oops. I recall the instance a couple months ago in California where a 19 year old injured several firefighters and a Sheriff's deputy. I guess that makes a case against it using your logic.

I never said it was perfect, I said it was safer. There is just as much violent crime here, if not more than in Boston, according to the FBI crime statistics. The majority of EMS runs we go to has a minimum of an engine company with four people. We have violent interactions with patients, but the extra people gives you more eyes and ears, and an extra set of hands if we need to subdue someone.
I can only talk about here, because I know here. If you don't want to listen, that's fine, but stop interjecting then.
Is it that you don't want to listen, or are you just ****ed about the other thread about the IAFF endorsement?

I thought I had something to add to the discussion.

I guess since the number of violent patients coming to emergency departments and being violent to the staff in the United States is going up, that we should use your logic and have Fire Based EDs huh? :rolleyes:

Do you want to have a discussion, or do you just want to be a jag?

[ShuckingGome]

It's not safer. All it means is that now instead of 2 people potentially getting hurt, there's 6 people potentially getting hurt.

[jasper45]

It's not safer. All it means is that now instead of 2 people potentially getting hurt, there's 6 people potentially getting hurt.

Honestly, it's not even worth discussing with you. I've read other posts you've written, and I have a reasonable idea of where your opinion is, and I couldn't really care what you think. I'm just tired of watching you, and a few others constantly berate paramedic firefighters, and call them incompetent etc..., when in fact they're not. I'm not a med, but I do know many meds who are extremely competent. Our save rate reflects that, as well.

Your post here shows that you don't have enough knowledge about what your talking about to make any kind of a criticism.
You want to believe what you want, that's fine. My opinion is that more people make it a bit safer. Is it a cure all for violent assaults on EMS workers? No, and I never claimed it was. I have however, seen first hand the benefit of the additional staffing at run's.
I have also worked on ambulances with only two people, and I'll take the extra staffing, thank you very much. Either way, this topic is not worth 'discussing' any more, I see it as dead in the water.

[LasVegasEMS]

Honestly, it's not even worth discussing with you. I've read other posts you've written, and I have a reasonable idea of where your opinion is, and I couldn't really care what you think. I'm just tired of watching you, and a few others constantly berate paramedic firefighters, and call them incompetent etc..., when in fact they're not. I'm not a med, but I do know many meds who are extremely competent.
Most firefighters and FF/Paramedics advocate Fire-Based EMS as the ONLY way to go, this is why there is some anamosity around the issue. The fact of the matter is that different parts of the country have different needs and so one model of EMS will never work for everyone. Fire-Based EMS works for some and doesn't for others.

My longstanding believe is that EMS, and medicine in general, is way to complicated, requires a consistent amount of pt. contacts, and is so ever changing that it IS stupid to expect someone to be both a fireman and a Paramedic. <b>Not to say that there aren't good ones out there,</b>, but as a whole FF/Medics lack the pt. care skills that are required for good adequte care, not because they're dumb but because their expected to do both and be good at both.


Our save rate reflects that, as well.

This is not a good indication of whether or not your FF/Medics are competant or not. Your system, protocols, Code Procedures, and the like play a bigger role in this number then the medics themselves; any moron can run a code.


Your post here shows that you don't have enough knowledge about what your talking about to make any kind of a criticism.
ANd who exactly has enough knowledge to comment on it...


You want to believe what you want, that's fine. My opinion is that more people make it a bit safer. Is it a cure all for violent assaults on EMS workers? No, and I never claimed it was. I have however, seen first hand the benefit of the additional staffing at run's.
I have also worked on ambulances with only two people, and I'll take the extra staffing, thank you very much. Either way, this topic is not worth 'discussing' any more, I see it as dead in the water.
In reference to an earlier statement that sometimes it isn't practical to run, if you are ever in a position where you can't escape you need to rethink how you approach and manage a scene. This is not to say someone with a weapon controls the scene but you should always be able to beeline for the door or a window in an instant. And if a pt. or family member is what makes the situation threating, i'm not beyond knocking either one of them out on my way to those exits.

[DaSharkie]

Well, since we're a fire-based sytem, how is it a crock of sh*t?

Because it does nothing of the sort. It makes the case for ensuring that a scene is safe before entering it, that all agencies involved with a response act together, and that all members of said agencies act appropriately to ensure no one gets injured.

Couldn't care less haow many agencies are involved or how many people are there. Has nothing, not one iota to do with substantiating or making a case that Fire-Based is going change a damned thing. That is why it is a crock of shyte.

I never said it was perfect, I said it was safer.

Of course it is safer to have more people on scene. But do you think that is going to make a damned bit of difference which agencies those people are from? Honestly, do you?

The majority of EMS runs we go to has a minimum of an engine company with four people.

Whoopty doo. Has nothing to substantiate your statement that Fire-Based services would change this.

We have violent interactions with patients, but the extra people gives you more eyes and ears, and an extra set of hands if we need to subdue someone.

And this means what? Having them be firefighters makes the delivery of the service in this situation better how?

I can only talk about here, because I know here. If you don't want to listen, that's fine, but stop interjecting then.

Do not tell me what to do. You want to take your own experiences and push them on everyone because it works where you live. Does not work everywhere, and you admitted as much. Yet you still want to push your system on everyone else.

Is it that you don't want to listen, or are you just ****ed about the other thread about the IAFF endorsement?

Not ****ed. Has ntohing to do with it. But if you think that I am that shallow, go ahead and believe your delusions about me. You'll just be wrong.

I thought I had something to add to the discussion.

Never said you didn't. Yet you get in a huff when I challenge your opinion and statements. Of course you ignored the point I made about the injured firefighters and Sheriff's Deputy that kind of was a case making the point AGAINST Fire Based EMS.

Do you want to have a discussion, or do you just want to be a jag?

I'll be a jag, but you do not answer the question. Just extrapolating - and it is not a far leap - to use your logic to make this point.

[jasper45]

It makes the case for ensuring that a scene is safe before entering it, that all agencies involved with a response act together, and that all members of said agencies act appropriately to ensure no one gets injured.


And what happens when your inside a building with no easy or fast way out? Scene safety is not always guaranteed, or feasible 100% of the time. If you think it is, maybe you need to get out of the hospital every now and again.
If you're talking about a violent crime scene, sometimes you make things worse by waiting for the police. I've had rocks thrown at us as we were staged down the street waiting for the police to show. The people on the streets remember that.
We're also never confused with the police, as an ambulance attendant that happened to me several times. I didn't particularly care for that.





Of course it is safer to have more people on scene. But do you think that is going to make a damned bit of difference which agencies those people are from? Honestly, do you?

Go ahead and put four people on an ambulance then, or whatever you want. I really don't care. I had some different ideas I was willing to share and talk about, but don't listen. It's nothing off from me or my life.
The point of the thread was dealing with assaults on EMS workers. Had you taken the time to ask, or maybe even listen, I would have expanded my point to say that fire based doesn't have to 100% fire run. There are combinations that I think work very well. However, it's just much easier to jump to a conclusion and take the "anti-fire" argument.





And this means what? Having them be firefighters makes the delivery of the service in this situation better how?

For one thing, it puts more than just two people on scene right away. It puts people who don't look like police there. It happens all of the time here with the privates, their uniforms are confused with those of the police or sheriff. Many of our meds have gone to wearing their turnout pants in an effort to look more like firefighters as a result. People seem to relate better to us, maybe that's the reason, I don't know, but it seems to work.

And before you give me the argument that firefighters don't want to do EMS, I can tell you that there are plenty of EMS workers here who don't want to do EMS. I don't think this area is any different than any where else. It's also called professionalism in our job. There are alot of things we do that aren't particularly fun. EMS is part of the job here, and we perform it just like all other aspects of our job. We knew it was part of the job when we applied for the position, just like responding to fires.



Do not tell me what to do. You want to take your own experiences and push them on everyone because it works where you live. Does not work everywhere, and you admitted as much. Yet you still want to push your system on everyone else.

My, aren't we the testy one. I was offering up an example that works very well, and you chose to instigate a battle. I responded, no big deal. Had you taken the time to actually ask a question or two, I would have provided examples from other cities with which I am very familiar, that I think are also cost effective and of good quality. Again, no big deal. I wasn't pushing my system on anyone, just offering up some experiences with it. Versions of it are being used in several cities, and with a lot of success. Believe me, if I were telling you what to do, you would know it.



Not ****ed. Has ntohing to do with it. But if you think that I am that shallow, go ahead and believe your delusions about me. You'll just be wrong.

Hmmm, anything to do with the IAFF, or fire and EMS together, and you get bent out of shape ... it's not real hard to see a pattern there.



Never said you didn't. Yet you get in a huff when I challenge your opinion and statements. Of course you ignored the point I made about the injured firefighters and Sheriff's Deputy that kind of was a case making the point AGAINST Fire Based EMS.

Again, I wasn't in a huff. You didn't ask any questions to further the discussion. Oh well, again, no big deal. I also didn't ignore anything, I just decided there was nothing more to discuss, and I feel that way now. It's a pointless discussion. As I said before, it just gets old watching the same people claim that paramedic firefighters are not as professional, not as competent, blah, blah, blah. I'm not a big lover of our meds, and I'm not a med myself. In fact, they would probably be shocked to see me supporting them here. My brother is med for a suburban department, and I have worked with plenty of meds from my department in the field, and I guarantee they are as good and as competent as any on here claim to be. I know they're better than any of the private meds in the city here, I've also seen those buffoons at work.



I'll be a jag, but you do not answer the question.


Somehow I knew that would be your answer. We'll just have to part ways and leave it at that, I guess. No big loss at all.

[DaSharkie]

And what happens when your inside a building with no easy or fast way out? Scene safety is not always guaranteed, or feasible 100% of the time. If you think it is, maybe you need to get out of the hospital every now and again.

Gee thanks for letting me know that you know what I do and what I do not do.

I agree wholeheartedly with your points about having more people on scene, but your entire premise of your post was that it should be Fire-Based. I challenged you on that. Then you tell me that I should ask more questions about it. Perhaps you should have made your casse better.

My disagreement with you is your entire premise of the initial post that you made which heavily implied that if it were a Fire-Based system - regardless of civilian EMS or actual buckets on the truck - was that it would change this situation. I totally disagree with that premise.

Yes, the liklihood of being battered by a person goes down with more help on scene - but you do not acknowledge that it does not matter where those people are from, you only stated that it should be firefighters.


If you're talking about a violent crime scene, sometimes you make things worse by waiting for the police. I've had rocks thrown at us as we were staged down the street waiting for the police to show. The people on the streets remember that.

You are right, you get stuff thrown at you in the truck, but if you are telling me that I should go into the scene of a shooting, stabbing, gang fight, domestice dispute (the second leading cause of death after motor vehicle stops for police officers) I have to tell you that there is no way in Hell I would advocate for you or anyone else to do such a thing.

You are right, scenes can deteriorate, but I would prefer to have the police there if it is a known violent scene or event. I guess we just disagree with that issue.


We're also never confused with the police, as an ambulance attendant that happened to me several times. I didn't particularly care for that.

But this happens many places all the time. I don't care if you are public, private, FD, third service, or whatever you are running. Some people do not care. This is not about how you are dressed, it is about people wanting to hurt someone - regardless of which agency they are a member of. One can attempt to delineate oneself from the PD or SO, but it may not matter.

Your posts have continued to make the case that Fire-Based (in whatever combination of service) is the way to go. I see no divergence from that.

You justify your case very well, but in doing so you make it seem that it should be Fire Service only.


Go ahead and put four people on an ambulance then, or whatever you want. I really don't care. I had some different ideas I was willing to share and talk about, but don't listen.

You did have A (not some) different idea. If I put 4 people or 10 people on a truck, it might not change the outcome. That is my point. You only rail that it should be fire-based EMS, but it happens to most places eventually.

I did listen, but you don't see that. Your points are valid, I am challenging the notion that it has to be Fire-Based. That is all. That is where this started. Re-read your initial post with an open mind, I think you will see where I took your topic and went with it.

I am not a fan of Fire-Based systems. This is largely because of my experiences as a Private, Third-Service, and (career) Fire Service EMS provider.

I am a supporter of the best service for the taxpayer's dollar, and the best service for the taxpayer's health. I don't care who runs it - but it needs to be done right, and it needs to be done well. I have seen services that do this both ways.

I do not get how you think that I am saying that it should not be Fire-Based. I am saying that just because it is Fire-Based does not mean that people are not going to get hurt.


The point of the thread was dealing with assaults on EMS workers. Had you taken the time to ask, or maybe even listen, I would have expanded my point to say that fire based doesn't have to 100% fire run. There are combinations that I think work very well. However, it's just much easier to jump to a conclusion and take the "anti-fire" argument.

Never took the 'anti-fire" argument. I challenged the assertion that because it is Fire-Based that it would not happen.

Not every fire department sends a company to every medical. Many do, but I dare say that most do not. Regardless of who is running the EMS unit. Any call can deteriorate rapidly, but it does not mean that every call warrants an engine company - again, regardless of who is running the EMS unit.


For one thing, it puts more than just two people on scene right away. It puts people who don't look like police there. It happens all of the time here with the privates, their uniforms are confused with those of the police or sheriff. Many of our meds have gone to wearing their turnout pants in an effort to look more like firefighters as a result. People seem to relate better to us, maybe that's the reason, I don't know, but it seems to work.

I agree that it puts more people there, but teh EMS unit does not have to be Fire Based. That was the assertion that you made in your initial post. I disagree with that. Your premise is that every call should then get at least an Engine Co. I disagree with that - but I agree that more people on a scene does decrease the chance of assault and battery.

But the EMS unit does not have to be Fire-Based.

Already addressed the uniform issue.


And before you give me the argument that firefighters don't want to do EMS, I can tell you that there are plenty of EMS workers here who don't want to do EMS. I don't think this area is any different than any where else. It's also called professionalism in our job. There are alot of things we do that aren't particularly fun. EMS is part of the job here, and we perform it just like all other aspects of our job. We knew it was part of the job when we applied for the position, just like responding to fires.

I was never even going to say buckets did not want to do EMS. While your department acts in such a manner - I know several that do not. Some FFs want to do EMS, some do not. Like I said, I was never even going to mention that because it never crossed my mind about this discussion until you brought it up.


My, aren't we the testy one. I was offering up an example that works very well, and you chose to instigate a battle. I responded, no big deal. Had you taken the time to actually ask a question or two, I would have provided examples from other cities with which I am very familiar, that I think are also cost effective and of good quality. Again, no big deal. I wasn't pushing my system on anyone, just offering up some experiences with it. Versions of it are being used in several cities, and with a lot of success. Believe me, if I were telling you what to do, you would know it.

I did not instigate a battle. I am not testy.

I should not need to ask a question, you failed to substantiate how these situations advocated a Fire-Based system. You should have made mention that it advocated YOUR system. Your system works well, but the vast majority of departments that run EMS do not send a Co. with every EMS unit.

"versions of it are being used" that is fine, but just because it works for you, does not mean that it works everywhere else. Just because Fire-Based works in Nashville, LA, or NYC does not mean that it will work in Raleigh, Boston, Billings, or New Orleans.

That is the entire premise of my response to you. You should have made your case better than you did so that I should not have to ask questions. You made the blanket statement that it was a case for Fire-Based services. I said that it wasn't simple as that.


Hmmm, anything to do with the IAFF, or fire and EMS together, and you get bent out of shape ... it's not real hard to see a pattern there.

I don't get bent out of shape. I challenge the IAFFs assertion that Fire-Based is the only way to do it. The IAFF stands up for its members, but just because you are a firefighter does not automatically mean that you are going to be exeptional at everything that you do.

Again, I am biased based upon my experiences. Just as you are biased based upon your experiences.


Again, I wasn't in a huff. You didn't ask any questions to further the discussion. Oh well, again, no big deal. I also didn't ignore anything, I just decided there was nothing more to discuss, and I feel that way now. It's a pointless discussion. As I said before, it just gets old watching the same people claim that paramedic firefighters are not as professional, not as competent, blah, blah, blah. I'm not a big lover of our meds, and I'm not a med myself. In fact, they would probably be shocked to see me supporting them here. My brother is med for a suburban department, and I have worked with plenty of meds from my department in the field, and I guarantee they are as good and as competent as any on here claim to be. I know they're better than any of the private meds in the city here, I've also seen those buffoons at work.


Like I said, I shouldn't have needed to ask for you to clarify your point.

I never even implied that firefighters are not competent. Show me where I implied this. Yet you apply a blanket statement to the Privates in your area. I see the hypocracy.


Somehow I knew that would be your answer. We'll just have to part ways and leave it at that, I guess. No big loss at all.

You called me a jag, so I must be one. I was merely making an extrapolation of your theme. Yet you insult me, and do not defend it.

[jasper45]

You are right, scenes can deteriorate, but I would prefer to have the police there if it is a known violent scene or event. I guess we just disagree with that issue.

No need to disagree. There are many times in which the nature of the run we take in is not the same as what the actual problem is. There are times in which were sent for trouble breathing, and find out the trouble breathing is from a knife wound. An extreme example, I know, but a very real situation. This also extends to domestics, and just about every other run we take. Especially now, since we have a brand new, multi-million dollar dispatch system with a computer voice, that can only say preprogrammed words. We have very little actual, workable knowledge about what we’re responding to. Investigating a run has taken on an all new meaning here. Waiting for the police is simply not an option, as we can and do wait 15-20 minutes for police on a known shooting, stabbing etc…


but in doing so you make it seem that it should be Fire Service only.

That was more or less a catch your eye statement. I am a big believer in having a municipal funded service, not private companies. I worked for the private providers here, and the public is not the priority. I saw that first hand. Believe it or not, and had you asked, I would have told you that I am a fan of the system the City of Denver operates. Fire runs EMS first response, along with Denver health providing the meds; all firefighters are EMT’s. It’s a good alternative to the system here that is all fire-based, except for the BLS transport. Everything I have seen and heard from Denver, is that the relationship is good, and help is on the scene very quickly.

The problem with having dual services is the duplication of command staff and administrative personnel. I guarantee communication will be a problem, also. It always is when you have two different agencies working, people are never on the same page.

You did have A (not some) different idea.

I didn’t share them, because the discussion didn’t seem worth it at that time.

I am saying that just because it is Fire-Based does not mean that people are not going to get hurt.

Absolutely. The remark I made was based on what I had learned with talking to the Denver people. As far as I know Boston runs their own separate EMS, and I think you posted the same.
Fire-based to me, is that fire is involved. The EMS doesn’t have to be done entirely by fire, but it should have a role. In the context of the article, I believe that the EMS workers in Boston are being harassed and assaulted because they have no numbers with them. A very quick and easy way to help out, is to place an engine on scene with them. It would take very little for that to happen, realistically speaking. Obviously I made some assumptions about the BFD. However, this is a discussion of opinions and ideas only.



but it does not mean that every call warrants an engine company - again, regardless of who is running the EMS unit.

And not every run needs a box. Engine companies are based in neighborhoods, for a quick response. Every system gets taxed at times, and the more duality of service you have, the more likely it is the resources you need will be there. If on arrival, you don’t need the engine, pick ‘em up, and the same goes for the box. We do it every day. If you need the help though, it’s awfully nice to have the help.

You made the blanket statement that it was a case for Fire-Based services. I said that it wasn't simple as that.

It never is simple, and yes, I made a broad statement. I was hoping to expand on the discussion more.
You see, I am a tax payer also. I don’t like to waste money, and I want high quality fire service, EMS, sanitation, and all the other services that I pay for with my taxes. As such, I want the highest quality service possible, but I won’t write a blank check. I think we get a very high quality system, all the way around, for a reasonable price tag. We'll see what the next budget crunch brings, as far as reductions, cuts, etc... That's part of the reason we're looking extensively at models being run in other cities.

Like I said, I shouldn't have needed to ask for you to clarify your point.

Why shouldn’t you? How often is it that a person makes all of their points with one post? Maybe you can, but at times I’m a borderline short bus candidate. If you ask questions, both of us might learn something. I would think you would want to ask as many questions as you could, especially considering the viewpoint I have with this subject.

You called me a jag, so I must be one. I was merely making an extrapolation of your theme. Yet you insult me, and do not defend it.

Go back a read the context of the post again, it was in post #12. I asked a question, and it was a sarcastic one due in large part to your eye rolling. I asked if you wanted to have a discussion, or if you were just going to be a jag.

[clark918]

I don't think Jasper is saying the firefighters are better in any way. The point he is trying to make is that if an engine company responds as well, then there are 6 people on scene. Would you feel safer with 5 others or 1? I'd take 5.

He never said he'd feel safer with firefighters over EMTs, but that's all that could logically happen. Would your service really be able to afford to send 3 ambulances to a call for one patient because the patient could be drunk? The fire department can send an engine during dangerous calls because the engine isnt out on fire calls as often as the ambulances are on EMS calls.

[DaSharkie]

Jasper, the Boston political system and Local 718 will never - and I do mean N E V E R - allow for an engine or ladder company to be sent with every ambulance.

It was not more than 3 or 4 years ago that there were literal fist fights between the buckets and BEMS providers because of the lack of help provided (we'll say that just to make it easier on us all.)


Denver is an interesting situation. I do take caution with your remark about duplicate command services and structures and the lack of communication. My last employer in EMS was a County run third service. I have not ever seen a service where everyone got along and worked together. The city PD, county SO, city FD, county EMS, and the little minions in between got along well, trained, ate, worked, partied, and did EVERYTHING together. A rare breed I know, but it can and is done very well. The people involved - from the newest probie, to desk sergeant, to shift commander have to want it that way. From the top down.

Sad thing is that old habits die hard, and people make the conscious decision to not do what it is in the best interest of the community that they serve. Thus, we have this issue everywhere we look.

Interestingly enough, there are several locales nationwide that have problems with the single command and joined department issue. San Francisco is a big one - the FD took over EMS a few years ago and now they are trying to divest themselves of the EMS issue. DCEMS is full of unhappiness because they feel the Fire side of things screws them royally (I tend to agree if even half of the crap I have seen is true). FDNY and (if I hear correctly) Chicago as well as Philly are in the same boat. These are all "EMS Divisions" of the municipal fire department.

Of course these are the big ones that get all of the press, but there are good and bad all over in every sort of EMS model that is run.

Pretty sad state of affairs really.

[DaSharkie]

In the context of the article, I believe that the EMS workers in Boston are being harassed and assaulted because they have no numbers with them.


To a point, yes. But the useless, moronic, bumbling, incomprehensible mayor of Boston, one Thomas M. Menino (a.k.a. "Mumbles") has depleted the Police Department unmercifully over the past 10 years he has been mayor.

More than 200 police officers have retired or left the department and NOT been replaced. Crimes are not being investigated, neighborhoods are not being patrolled, crime is truly skyrocketing, murder rates are increasing at astronomical rates, and the useless Suffolk County DAs office is doing nothing to presecute crimes.

All of this has a trickle-down affect on things and now people who are trying to help out other people get attacked.


One of my Paramedic insturctors (many moons ago that was I tell you) worked the streets of the City of Worcester. Got bitten a worthless piece of human filth stealing oxygen from the rest of us well intentioned folks and bit him. Got Hepatitis C from this piece of *****. Now he has the wonderful pleasure of taking rejection medications so that his liver is not rejected since he required a transplant specifically due to this crap. And this was on the way to the hospital. This crap has been going on for years, but the more calls we run, the more we get hurt.

Society's downward spiral into Hell is bringing it all about. Or else we would not need vests on trucks.

[LasVegasEMS]

And what happens when your inside a building with no easy or fast way out? Scene safety is not always guaranteed, or feasible 100% of the time. If you think it is, maybe you need to get out of the hospital every now and again.
If there's no easy or fast way out you make one, drag the pt. out to the living room or make them walk. Or at least have your O2 bottle near by and your partner watching everyone.


If you're talking about a violent crime scene, sometimes you make things worse by waiting for the police.
I'm sorry but this is just a stupid a** statement. First, if I feel like having PD at EVERY call I go to then i'll ask for them and wait; not feasible but you get the point. Second, if you haven't made it on scene yet, how can the scene be made worse by waiting for PD. If you are going on any violent crime scene without waiting for PD first, you're a moron; I don't care if it's mom, dad, little boy or grandma, if they are shot and dying, i'm gonna wait for PD. No ones life is more important then mine.

[QUOTE=jasper45;858521]
I've had rocks thrown at us as we were staged down the street waiting for the police to show. [QUOTE]
Again, for those who are new and reading this. If this is happening to you, YOU ARE TO CLOSE TO THE SCENE. Why in the world would you be close enough to a scene to be having angry people throw rocks at you. If this happens to you often, might want to consider moving back a little bit more.

[jasper45]

I'm sorry but this is just a stupid a** statement. First, if I feel like having PD at EVERY call I go to then i'll ask for them and wait; not feasible but you get the point. Second, if you haven't made it on scene yet, how can the scene be made worse by waiting for PD.

I wasn’t going to respond, but then you go and call me a moron. I love a class act, I really do. I really am glad you decided to interject with your ‘expert’ opinion, and answers for all.

Have you never had more than a single run on the same block? Have you ever been on one scene, and have a car pull up and throw a guy out with half of his head missing? Have you ever been staged three or so blocks away and had parts of a crowd come down and find you accidentally? You can ask for police all you want, they only get there so fast. They are kind of busy, well, at least they are here.
You’ve got some great text book answers there, too bad the book doesn’t always translate into real life.

YOU ARE TO CLOSE TO THE SCENE. Why in the world would you be close enough to a scene to be having angry people throw rocks at you.

And how in the world would you know how close we are to a scene? How long have you been doing this job, because it sure sounds as if you’re fairly new to it, or work in a perfect setting. It’s not real hard to find a fire truck sitting somewhere in a neighborhood. Especially if someone has been shot and they're waiting for help, and particularly when they know we stage somewhere close but out of sight. The people who live in these neighborhoods know what the deal is, and it ****es them off. We've basically watched plenty of people die in the streets.


I tell you what, I just went and read your profile, and I’m done with this thread and you, at least till you get some time on the job, kid. Don't you have some popcorn to make?
Five years, and your gonna tell us how it’s done?
I haven’t laughed this hard in a while, thanks. A five year wonder or, is it a one year-either way, ya gotta love it! GFY, kid.

[LasVegasEMS]

I wasn’t going to respond, but then you go and call me a moron. I love a class act, I really do. I really am glad you decided to interject with your ‘expert’ opinion, and answers for all.

Have you never had more than a single run on the same block? Have you ever been on one scene, and have a car pull up and throw a guy out with half of his head missing? Have you ever been staged three or so blocks away and had parts of a crowd come down and find you accidentally? You can ask for police all you want, they only get there so fast. They are kind of busy, well, at least they are here.
These are all things that no one can control, and yes we have to deal with it and it can become real unsafe real quick. My prior response was to your statement that "If you're talking about a violent crime scene, sometimes you make things worse by waiting for the police." Again I will say, if you're entering a <b>violent crime scene</b> without waiting for PD, you, or anyone else, is a moron. This is the whole reason we stage!


You’ve got some great text book answers there, too bad the book doesn’t always translate into real life.
The text book never translates into real life, anyone who's been on the streets can tell you that. However, scene safety has nothing to do with textbooks but everything about common cents and experience.



And how in the world would you know how close we are to a scene? How long have you been doing this job, because it sure sounds as if you’re fairly new to it, or work in a perfect setting. It’s not real hard to find a fire truck sitting somewhere in a neighborhood. Especially if someone has been shot and they're waiting for help, and particularly when they know we stage somewhere close but out of sight. The people who live in these neighborhoods know what the deal is, and it ****es them off. We've basically watched plenty of people die in the streets.
I never commented on how close you actually were except to say you were too close.My question is this, if you know this happens, why don't you park 2 miles away. Thats along was for a crowd to travel without any heads up warning. Also, if you see them coming, why not turn around and run the other way?

People dying in the street isn't anything to be concerned about, who cares, especially if someone else is trying to hurt you. I've had pts. family members become so irrate on MVA's that i've had to leave pts' on a backboard and strapped to a stretcher in the middle of the road because they made it unsafe. Usually that gets them to calm down when I start to walk away.


I tell you what, I just went and read your profile, and I’m done with this thread and you, at least till you get some time on the job, kid. Don't you have some popcorn to make?
Five years, and your gonna tell us how it’s done?
I haven’t laughed this hard in a while, thanks. A five year wonder or, is it a one year-either way, ya gotta love it! GFY, kid.
Would this be you being a jag? I'm just trying to clarify the meaning.

Although I have not been around as long as you have, five years is plenty of time to know what you're doing and be knowledgable enough to comment and have a discussion. One thing I have learned in my SHORT 5 yrs. is that just because someone has been around for awhile it doesn't make them a good or great medic, I have seen a ton of "Old Timers" around me that are not good medics, have lots of experience, but are just not good medics; not only my opinion but others as well, just so you don't think i'm smarting off or whatever.

And last, be done with the discussion, fine, but don't have to be an *** on your way out.

[the1141man]

Whoa. PAUSE!!!

Jasper says:
Especially now, since we have a brand new, multi-million dollar dispatch system with a computer voice, that can only say preprogrammed words. We have very little actual, workable knowledge about what we’re responding to.

WTF?!?!?!

And just what the hell was the point of that piece of genius??? Surely you must be kidding.

What's next? You call 9-1-1 and get, "Thank you for calling 9-1-1. Para espanol, oprima el numero dos. To continue in English, press 1."
*1
"If you'd like to report a fire, press 1. To report a crime, press 2. To request an ambulance, press 3."
*3
"You pressed 3. An ambulance will be sent shortly to the address you're calling from. Is the patient breathing? Say 'yes' or 'no'."
"NO!!!!"
"I'm sorry, I couldn't understand you. Is the patient breathing, say 'yes' or 'no'."
"NOOO damnit, he's dying!!!"
"I'm sorry, I can't understand you. Please lower your voice and answer calmly. Is the patient breathing? Say 'yes' or 'no'."
"F*&K this!!!"

LOL Then people will really be throwing rocks at you when you go on-scene. ;)

[armymedic571]

1141,
I think that say's it all.

[the1141man]

1141,
I think that say's it all.

Well, it says that some dumb姧 politico in Jasper's area needs to GTFO of office.

Personally, if this were to happen in my agency...the initiating chief officer or politician would have a funny tickling feeling in the back of their throat...which would be my toes wiggling after I give them 1,000,000,000mg steel toed boot, PR.

[grnresqjeep]

At least Boston has Radios. Granted the city I work for is much smaller then Boston but I work at a system were we are still dispatched on VHF low pagers. No one carries radios because if you try talking no one can hear you. No one down here sees a problem with this except for me. I come from a rural system were you always have a radio with you on scene. I understand not wanting to carry the huge bricks that make up the VHF low system but there has to be a cheap answer since no one really has the money to spend. How about you guys, how many depts rural or metro carry portables on your person on shifts?

[bossteen]

Everyone is issued a personal portable radio and two batteries with charger...it is required equipment when on duty.

[croaker260]

Two radios per unit, plus pagers, plus cell phone for unit. Each radio has the new 700 mhz and the emergency button programed with dispatch able to tell exactly which radio sounded the emergency.

[DrParasite]

at urban BLS job units are given two minitor pagers, two portable radios, and an alpha pager.

suburban BLS job units are given one nextell (which no one carries) and two radios that communicate directly with PD on the PD channel.

at volunteer squad, one portable radio per unit, with officers having their own assigned radios.