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    Default ALS Engine Companies

    Just want to see how many departments out there are going to ALS Engine companies operations.

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    we are 4 days out of the week. Our neighbors are ALS, or ILS at least, 7 days a week.

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    Our goal is ALS on every engine and truck company every day. We meet this about 85% of the time I'd estimate.
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    We keep as many as possible each shift as ALS companies. While we don't have enough medics to put one on every truck every shift, we have at least 3 trucks on every shift as ALS.

    In order to achieve that goal, our powers-that-be are going so far as to send two personnel per year to medic school and anytime there's two medics on a truck from a trade or OT, one is moved to a station without a medic.

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    virtually everyone in my area (tampa bay) is ALS 24/7. this primarily includes pinellas county (approx 20 fire dept's), pasco county, hernando county, spring hill (within hernando) hillsborough county (hillsborough county fire, tampa fire, temple terrace, plant city), polk county is at some stations but not others, they are currently in the process of merging fire/ems departments, orange county and orlando, seminole county, sarasota county are ALS. manatee county is still seperate as far as I know (bls fire dept's with a county EMS/ALS system)

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    Way too many...unproven, absolutely useless concept. I'd rather see good BLS responders. Just my take.

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    Everyone in my area ( Chicago subs ) has AlS equipment on every engine. I have been doing this for 11 yrs and it has always been this way. Although i can count on one hand the amount of times it has truly been needed.

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    We are a small enough department that it has been needed on several occasions. We staff two squads every day, three when we can. There are times when we have 5-6 in the City at one time. Yes we are a relatively small City, 4.5 sq miles, 3600+ runs. But, there have been times when our engine gets there enough in advance to start IV's, do EKG's etc. We carry full ALS on our engine. All but two of our guys are medics.
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    We currently run 5 ALS engines 24/7/365. Mine engine is one of them.
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    Quote Originally Posted by wag11c View Post
    Way too many...unproven, absolutely useless concept. I'd rather see good BLS responders. Just my take.
    I think you're being a bit overly dramatic with this comment. I would agree that there may be some systems in which the deployment of ALS engines may be a bit of overkill, but I'm equally sure that there are some systems in which they are a good resource and are found to not be "useless concept".

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    Nineteen ALS Engines, adds a nice rotation from the rescue to engine every other shift.

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    Memphis Fire Dept. - 34 ALS Companies per shift (Engines or Trucks)

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    We LFD have 10 ALS Engine Companies (out of 22.) However, every company has a small ALS bag (enough to do one round of ACLS medications on a code and for anaphylaxis.)

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    Fairfax Co. Va has medics on all of their engines, either as a left bucket firefighter, or a dual hatter(driver or officer). The county would like to place medics on trucks and rescues, if the economy recovers.

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    In Memphis, on paper there are 34 ALS companies daily with 33 ALS ambulances. It has its use at time due to extended response time for the ambulances during periods of heavy call volume. While the company I am on routinely establishes IV acces, obtains an EKG, etc..., I can sya that it is only occasionaly truely "needed". It has it's plus side and is the reason why I have a job, but it definetly has it's downfalls to.

    Quote Originally Posted by jbrescue View Post
    We are a small enough department that it has been needed on several occasions. We staff two squads every day, three when we can. There are times when we have 5-6 in the City at one time. Yes we are a relatively small City, 4.5 sq miles, 3600+ runs. But, there have been times when our engine gets there enough in advance to start IV's, do EKG's etc. We carry full ALS on our engine. All but two of our guys are medics.
    This is becoming the nationwide trend in fire based EMS. I personally disagree with this. With so many paramedics, how many critical thinking decisions are made and how many non routine skills are performed by the paramedics. With multiple paramedics on scene the division of labor leads to reduced skill attempts and decisions made reducing the overall quality of care. This also leads to people becoming paramedic who do not want to be a paramedic. Therefore EMS becomes second fiddle to many and all you here is ****ing and whining about riding the ambulance.

    If you want to be a firefighter, become one and be the best damned firefighter you can be. If you want to be a paramedic, become one and be the best damned paramedic you can be. If you want to do both, then find a system that allows such and flourish. Do not become on to be the other. It is unfair to your coworker and more importantly those who pay your salary.
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    I beg anyone to prove that the "ALS" engine company has any impact on prehospital survival rates. However, I do admit it does help increase FF salaries. Worked on an ALS engine for 15 yrs and don't think I ever saw a case where simple BLS followed by ALS ambulance justified us. Work now on a "box" and spend most of my time correcting the mistakes of ALS engine crews.

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    Quote Originally Posted by wag11c View Post
    Work now on a "box" and spend most of my time correcting the mistakes of ALS engine crews.
    Sounds like a training issue, or justification to rotate the medics between the medics and engine/tower.

    As for ALS engines/towers, our county manager dictated to us that we'll have it, so FD doesn't have much choice, "proven or not."
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    Quote Originally Posted by wag11c View Post
    I beg anyone to prove that the "ALS" engine company has any impact on prehospital survival rates. However, I do admit it does help increase FF salaries. Worked on an ALS engine for 15 yrs and don't think I ever saw a case where simple BLS followed by ALS ambulance justified us. Work now on a "box" and spend most of my time correcting the mistakes of ALS engine crews.
    While I have never been able to find any studies done on ALS engine companies and their effect on prehospital survival rates, I know that at least twice in the last 5 or so years we've had an ALS engine show up to severe allergic reactions 15 to 20min before the closest available rescue.. The medics on these engines were able to treat the patients who would never have lived if they had to wait for the rescue to provide ALS care. My dept has the strictest and hardest protocol testing in the county as well as QA of every report. We also have an intubation rotation system in place that is mandatory for ALL medics regardless of their assignment as well as mandatory medical directors meetings. Our medical director is very much aware of what goes on and has relived paramedics of their ability to function under his license, he also rides out without warning.

    That being said, I think that over saturation of paramedics is a HUGE problem, especially in S.Fla. I don't remember when a dept hired EMTs, its medic or no job which I think is BS. All governments know that people will go to medic school on their own so they won't have to pay for it. The quality of medics has dropped of sharply in the last 8 or so years because the private schools that have popped up to take advantage of the situation, which is another issue and thread.

    The biggest problem that I see is that the politicians and town/city/county managers want to boast the highest level of care in their municipalities. So to them saying they have 120 paramedics for 5 stations of 3 shifts is better than saying they have 40 paramedics to staff the same number of units. They do not like to be told what is better overall, just ask them. They see supremacy in numbers and that means more votes, even when the FD and the union.......yes I said the union........ tells them otherwise.
    If your going to cry about doing the job you signed up for do us all a favor and quit, there are plenty of dedicated people standing in line for the best job in the world.

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    FM61....Perhaps the answer is strong BLS (in many places, they can carry Epi Pens), and adding more Rescues.

    Hmmmm......
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    Quote Originally Posted by BLSboy View Post
    FM61....Perhaps the answer is strong BLS (in many places, they can carry Epi Pens), and adding more Rescues.

    Hmmmm......
    That depends on the area, as well. Rural areas and smaller cities don't have the call volume and revenue to fund more rescues. At the same time, for as many places that carry Epi Pens and allow BLS providers to use them, there's just as many or more that don't allow it.

    I can account for several times that myself or another medic on an engine company saved lives due to a longer response from EMS. The whole point is that there are typically fire stations spread out in the area while EMS stations are centrally located with all units there.

    My pride and joy was a 2 year old boy that was a drowning. We (the ALS engine company with a medic and three EMT's) were able to get some signs of life before EMS arrived, 10-15 minutes later. We never heard more than he would live, but might have brain damage in the days/weeks afterward. The local newspaper did a story on the 1-year anniversary that he made a full recovery, thanks to the EMS crew and the docs at the ER.

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    Quote Originally Posted by BLSboy View Post
    FM61....Perhaps the answer is strong BLS (in many places, they can carry Epi Pens), and adding more Rescues.

    Hmmmm......
    The Epi-Pen is only one part of treating anaphylaxis. There is diphenhydramine (benadryl), IV therapy, IV or oral steroids, and additional doses of epinephrine to complete the therapy.

    One epi-pen is not going to cure anaphylaxis. It is a time buying medication until ALS can arrive on scene, nothing more.

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    Quote Originally Posted by lexfd5 View Post
    The Epi-Pen is only one part of treating anaphylaxis. There is diphenhydramine (benadryl), IV therapy, IV or oral steroids, and additional doses of epinephrine to complete the therapy.

    One epi-pen is not going to cure anaphylaxis. It is a time buying medication until ALS can arrive on scene, nothing more.
    Agreed that one epi-pen is not gonna save the day, but the steroids (Solu-Medrol) generally take up to 2 hrs to kick in.
    If the BLS crew administers the Epi, that should take care of the pt until the ALS crew gets on scene.

    I do believe that under NJ OEMS guidelines, BLS rigs carry 3 Adult, and 3 Pedi Eip-Pens, if they have received the training, and blessing from the medical director.

    Use of an Epi Pen is an automatic ALS treat, unless the distance to the hospital is less then the time for ALS to get on scene.
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    AJ,

    Hows the job hunting going? Good I hope.

    Like you and many others I think that strong BLS is very important and we can look at systems like Tulsa and Seattle as examples. Adding more Rescues to the system, even if only during peak hours, would cut back on the wait time without a doubt. The problem with that is $$$$$$$. Figure one Rescue costs $150K plus equipment, maintenance, fuel, etc and then you need to pay for a minimum of 1 medic and 1 EMT(Palm Beach County does not allow BLS units to operate within the county)Compare that cost adding ALS equipment to an engine which already on the road and budgeted for, and put a medic who is already getting paid to be there as a FF, DE, or officer adding no additional salaries, benefits or OVERTIME. Throw Amendment 1 into the mix and tell me what option FDs are going to pick. We know what the best answer is but when you have 8,000 unemployed FF/PM and double the amount of FF/EMTs running around the state and the older guys retiring who are still mostly EMTs, who do you think is going to get hired. Mark my words, there will come a time soon when there are no more EMTs working in the fire service in S.Fla and governments will make EVERYTHING from brush trucks to air units ALS because it will stop them from having to put more Rescues on the road. And with auto or mutual aid agreements in place no one will care if it takes 20min+ for the Nurse Wagon to get there because another ALS unit from the FD was there in less that 8min.
    If your going to cry about doing the job you signed up for do us all a favor and quit, there are plenty of dedicated people standing in line for the best job in the world.

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    I took a job up in Jersey with AtlantiCare Regional Medical Center's MICU. Nothing but ALS calls. I damn sure miss the cold weather, but I am learning a lot!

    Perhaps a solution to the budget concerns would be moving away from the all ALS idea.

    It costs more to pay a Medic, to keep ALS equipment, to keep the education current, and so on.

    How much would be spent on all the ALS equpiment for 3 Engines, and the salaries, and OT for Medic on those Engines?

    I reckon you could almost buy a new Rescue for that.

    There are some instances where it would be smart to have an ALS Engine, but pick and choose, don't paint with a broad brush.
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    Please stop: Was on an ALS engine lat nite, we do not make a difference in outcomes, nor does "ALS" as we know it make any change in pt survival. We should go back to the days of load and go..think about it

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