Originally Posted by edpmedic
Paramedic equipment, which includes many perishable medications that are often hardly used to begin with (just based on call makeup), isn't cheap or free. Similarly, more use of the apparatuses means more wear and tear and higher fuel costs. It's hardly free and for non-time sensitive calls (which are the case more often than not and the calls that are time sensitive are often not quite as time sensitive as we'd like to believe), you're providing a service of dubious benefit. If cutting non-essential first response saves fuel and maintenance enough to save a fire department job or keep the library open, then it's something that needs to be considered. Just because the engine is sitting around otherwise collecting dust does not mean that it's a free lunch solution for long response times. This is, of course, ignoring the wrong tool for the job issue.
So because the citizen who is ignorant of how EMS works is happy, then that's fine? Additionally, out of those things you've mentioned, only the patient with difficulty breathing is time sensitive from a first response standpoint. STEMIs and CVAs are time sensitive from a transport standpoint, unless you've added a cath lab or CT scan and neurosurgical capabilities to your fire engine. Saying a fire first response saves CVA lives is like saying an ambulance first response to a structure fire saves lives because the ambulance carries a fire extinguisher. It's simply the wrong tool for the job and having the 'circle of death' standing around on scene does not stop any sort of meaningful clock.
Sure, adding ambulances would me a much better way of improving EMS delivery, but single role EMS departments refuse to do this, so it would be unreasonable to expect the fire service to do the same. In addition, the public has come to expect this level of service in many areas. When I'm the engine medic, and we're onscene for a diff breather, MI, CVA or something potentially time sensitive, one of us will explain that we're the engine crew, that we have nearly the same ALS capabilities as the ambulance, and that we're there to start treatment until they arrive. I've yet to hear a citizen complain that we were ther instead of the ambulance; they were just happy to have us there to help them.
...however not all calls are on the 10th floor of some sort of small slum like apartment. Targeted response? OK. Every response? Waste of resources. Additionally, lift assists do not need paramedics, they need people who can lift, so there's no need for a first response set of paramedic gear to maintain.
Costs are saved in hiring by preventing burnout, injury leave, permanent disability, and other forms of attrition. When I worked single role EMS, it was typically just me and my partner lifting and carrying everything. We had six floor walkups with the chair, our air, our bags, and the monitor. There are tight apartments and stairs that we had to navigate on our own with no spotters. We did it, but it will eventually burn you out or cause you to throw out your back, blow out your shoulder, knee, etc. With our dual response, we have 5-6 people to share the load rather than just two.
Wee... lots of people with paramedic certs not providing paramedicine! Sounds like the perfect recipe for skill degradation and dilution. I'm going to go out on a limb and say that not everyone at your department are specialists in hazmat, confined rescue, AND swift water. Why not? After all, once someone gets trained in hazmat they should be able to switch from any other role and back to hazmat freely, just like plenty of fire departments do with EMS.
If I'm riding as OIC, I'm not doing any lifting at all, except maybe one of my bags. That is huge in preventing breakdown or burnout. Being able to go between EMS and suppression also prevents burnout. The average EMS only person lasts only 7-10 years before leaving the field. The fire service has many who keep their ALS certs for much longer, typically for their entire career if they can switch between roles. Reduced injury and attrition saves money in hiring and OT.
To suggest that ambulance coverage can be scaled back (or, as often is the case, simply never meeting the demand) because there are fire engines collecting dust shows a profound ignorance of medicine.
To suggest that suppression coverage be scaled back and replaced dollar for dollar for the EMS side due to call volume numbers shows a profound ignorance of suppresion operations