1. #1
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    Default Fire based EMS - good or bad?

    I wanted to know peoples opinions and experience with fire department based EMS service. I know that most large cities do it this way, but is it the best way to do things?
    I live in between Austin and San Antonio. In San Antonio, EMS is run by the FD. Becoming a paramedic is a promotion and is equivalent to being an FAO. It is obvious that there is a greater need for paramdics than FAO's so that is where the majority of folks are sent. This also means that a lot people are essentially forced into EMS if they want to be promoted. Though the paramedics are well paid, work 24/72 and have a lot of opportunity for overtime, there are still a large number of them who joined to be firefighters and want nothing to do with EMS. Also there are people outside the fire department who are paramedics, but if they want to work for San Antonio EMS, they must join the fire department and wait to promote into EMS.
    In Austin, EMS is a third service. It is shared by the city and surrounding Travis county. Austin FD first responds. In Austin there has been some bad blood between EMS and fire lately, particularly over staffing of a new technical rescue truck. Fire says it should be staffed entirley by FD, EMS says they should have at least some personell on the truck. Ultimately neither department "owns" the truck and I don't think the staffing issues has been resolved. This morning I read in the paper that the Austin IAFF local wants the fire department to take over EMS in the city. This is in the name of job security for firefighters.
    Austin EMS is a very progressive, top notch EMS service. Personell are hired as paramedics and that's what they want to do. If the fire department takes over, you will have paramedics out of jobs, and likely replacements who don't want to be paramedics.
    I am a volunteer firefighter and paid EMT for a different agency. I enjoy both jobs equally however I think that EMS is better off as a third service. There are plenty of firefighters who do not like doing EMS. Ultimately patient care suffers when people are forced into it.

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    Default BRETHREN!

    Forced EMS is a killer. Just having to ride the meat wagon as an EMT is bad enough, but here in PG they changed the job title of Firefighter to Emergency Rescue Technician. Upon being hired you have to sign a contract saying you will acquire your Paramedic certification in a certain amount of time which is 3 years I think. This certification has to be obtained on your on time and expense. This has killed recruitment and retention here. They have already lowered the entrance exam score in order to try and attract more people. When they do get a class, by the time itís time for them to have their Paramedic certification they are leaving for surrounding departments that donít have this requirement.
    PG is now being used as a stepping stone. Get hired by PG, get trained and get some time on the job and head for greener pastures when itís time to become a Paramedic.
    EMS has always been a part of the service but itís crazy to force people that want to be a firefighter to become Paramedics also.

    Just my humble opinion, Peace!

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    Here in Rhode Island, EMS has been part of the fire depts. since the early part of 1900's. It is just an accepted part of the job. Most paid depts. have officers on the rescue (ambulance in RI) that are promoted through the same process as fire officers. Pt care doesn't suffer because the officer is the primary care giver and he is there by choice. There are guys that like it and there are those that hate it. But there is a big difference. In RI EMS is staffed by firefighters who operate as firefighters on the scene of a fire. There are 4 communities in RI that have 3rd service EMS and all but 1 use them as FF's at a fire scene. There is one FD that has a private ALS intercept but only to insure ALS care on the rescue. In RI if a private co. were to take over EMS, by RI state law they have to pay the same wages, benefits,
    pension, as the FD and provide dedicated trucks that could not do "granny runs". These are stipulations that no private will adhere to, translated; no money to be made. I am on a 103 member dept that
    has 2 rescues. I am at the bottom of the seniority, so I got forced to EMS. Do I like it? Not all the time. Do I hate it? No. I also know that if we were to get a job I am digging in. The light at the end of the tunnel is that in a year or two I can go back to a fire co. I know that in a lot of places in this country fire is now taking over EMS. To break with years of just fire is hard. But the future of the fire service is becoming every other job but fires because they don't happen like they used to.

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    Jam1902..PG requires you to get Paramedic?? Here in AA County, we're only required to have EMT. It's alot of work for someone who just wants to ride the engine, but since our engine runs some medical calls I guess it makes sense. Isn't Paramedic like 2 years of class? I don't think I could last through it.



    Megan

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    Here in South Florida our EMS is almost all fire department run. We are all firefighters and at least EMT's. Most FD's only hire ff/medics now. I have had people from all over the US on vacation stop by the sta. and drop thier jaw when they see the things we are now doing in the field. Providing the best EMS is the goal of all depts and great pride is taken in this. Private EMS companies can't give this level because it is not proffitable for them. I worked for a private system and the level of care and services provided are like night and day compaired to what the FD's provide. Private companies don't give the benefits or pensions government agencies do which is why they can't keep good people. The other thing is that we have to be firefighters which means we go to fires right behind the engine and because so many dept's run ALS engines, the medics get to ride backwards which keeps us happy. I know this dosen't happen everywhere because of low budgets or because some fire dept's want nothing to do with EMS, but I have yet to see a private service provide the level of service we get here.

  6. #6
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    Here in Massachusetts, for the most part, fire service based EMS is the red headed bastard stepchild of the fire service. For years many departments, an dunions, never wanted anything to do with EMS, now they want it to substantiate their existance or get some income into their coffers. The senior guys of the department don't care because they don't have to ride in the box and they don't want to.

    There are of course some exceptions to this. New England, as a whole, is years behind the rest of the country in EMS. Guys here take the medic courses ONLY to get a firefighter's positions somewhere. This causes a huge problem because they are not going to concentrate or care as much about patient care. And for the most part, if you are hired as a paramedic, that is where you will be until there are enough people under you so that you don't have to be on the ambulance. This is true for many services that run strictly BLS as well.

    From many things I have heard, read and the people I have talked to, Firemedic is right on. The Florida Fire Service is patient and customer oriented. If only the trend would move North and people would realize this.

    If you force people to do EMS they are not going to care about patients and the department's reputation with the citizens suffers, adn the patients suffer. I have to agree though, if you have a third service system, you have people, for the most part, that want to be there and do EMS work. Some may treat it as a stepping stone, but many will do well, so long as they are paid well, and have a many of the same pension, retirement, and health benefits as firefighters.

    In many of these third service systems, EMS crews do infinitely more runs thatn the fire departments adn are paid incredibly less. Paramedics adn EMTs are just as likely to have many of the same problems as firefighters and are much more succeptable to illness adn colds from dealing with the nature of the people we pick up.

    The long and short of it is, it is right for some cities but not for others. It is totally dependent on who you can attract.
    "Too many people spend money they haven't earned, to buy things they don't want, to impress people they don't like." Will Rogers

    The borrower is slave to the lender. Proverbs 22:7 - Debt free since 10/5/2009.

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  7. #7
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    Default Do what is best for the community

    Fire based EMS has its place in some communities. In my community the EMS is private. the fire department first responds for major medical calls (cpr, unconscious, trauma, etc.) We don't respond on minor medical calls unless all the EMS units are tied up on runs, then we cover until they arrive. Our system works really well and at an optimum cost to the taxpayers. Several of us firefighters work part-time for EMS and so it provides us with a little extra income.
    As for pay...
    Private EMS pays alot more than the fire department in our town. Insurance is better through them and costs less. Retirement is so-so for both, and most of us have taken out our own IRA's. I wanted to be a firefighter and so I don't mind working for less money to do what I love. I'm sure that some paramedics feel that way about EMS. They'd rather make a little less and work the ambulance than be forced onto a fire department and have to do that part of the job.
    We have dedicated paramedics who love their job and do it well. Excellent patient care is provided. We have dedicated firefighters who love their job and are glad to not be immersed in the EMS side of it.

    The point is this...

    Fire based EMS is not an answer to your staffing and fiscal problems. If you hire staff for an ambulance, you are still understaffed on a fire engine. If your budget was tight before, just think what the increased costs of units, personnel, overtime, equipment, etc. are going to be. You are not going to make all that back with patient bills. You have to decide what is best for the citizens in your area. If your private service sucks and they can't provide decent care, then maybe it should be run by the fire department.
    I have seen the 3rd city service EMS work really well for several communities. I have seen private EMS work really well for several communities. I have seen fire based EMS work really well for several communities.

    It all depends on what your citizens need, what your city can afford, and what the personnel want to do. It was mentioned above. Firefighters forced onto ambulances don't provide as good of care as an EMT-P who wants to be there.

    well enough ranting...



    Scott Reasor
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  8. #8
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    In our neck of the woods in Ohio, EMS has been run by the fire service for as long as I can remember and then some. Fortunatly though in the Volunteer areas we are not forced to take the classes for EMS although it is highly reccomended.
    Private EMS companies do handle some of the call base in the area for villages without fire service EMS, and there is some of a problem brewing with that since the Fire service EMS units feel that the private companies are treading on their turf. Remember this is an all Volunteer area.
    However, like alot of areas in the country, ours is no different and there is a shortage of EMS people to handle all the calls. The private companies have handled some of these calls, and you know what, in my opinion that is o.k. with me because someone is taking care of someone that needs it,a nd that is supposed to be what it is all about.
    With over 90% of our call volume being EMS oriented, I can also see the need extend to our members the idea of taking these classes, not only for the general public but to take care of our own also.
    If your employer is a Full time department that runs EMS and you are then hired, They should have given you the idea that somewhere alone the line, you would be required to do the stuff. If you were already hired and then forced to do it is somewhat of a pain in the a.., but then again folks it is a profession we chose to do, and again, it is all about helping people. But hell yeah! They should pay for the training and schedule you as needed.


    Keep doing it for the right reasons!!!!!!!!

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    Having done some further reflection on this and reading the article itself......

    I remember when the FDNY took over NYC EMS. The fire department touted that it would signifigantly reduce response times, decrease budgets, save money, and do better.

    Well, response times are minimally shortened, the budget went real nutty (before Sepember 11), money is not necessarily being saved, many firefighters can't stand the EMS bureau (Third Watch is not a true indicator of this), the equipment has diminsihed, EMTs and Medics are fleeing the service in droves, ambulances are falling apart, and from all OUTWARD appearances, the leadership of the Fire Department couldn't care less about the EMS bureau.

    I bring this up because the Austin union mentioned that the deal would save money. One must be very cautious when making this clam and have heavy evidence to back it up.

    And to top this off, the union president even stated that the move to adopt EMS would save firefighter jobs. This is, I am willing to bet, the major, if not only, substantial argument that the union has. Personally, EMS should do pt. care. The fire department should do extrication. Both services absolutely positively have to have a good, firm understanding of each other's roles in the incident. This is just a personal feeling, like I said. There is no room available in the realm of public safety for these internal ****ing contests to become public or get ot this point. I am sure that this is not a sudden revelation to the city of Austin. This can and will affect the service provided to the public and decrease the efficiency of the service provided to the customer. That is what this job is about, not who gets what, who gets to keep more jobs for the union's sake, but providing a service to the highest level of care and with the greatest level of compassion to our customer, John Q. Taxpayer.

    And before someone bashes me for being too much one sided in this argument, I am a career, union firefighter, who is also a Paramedic who does not provide ALS care with the Fire Service. I just believe that if a system is not broke, you do not fix it, and the best level of service must be provided by the best equipped agency to provide it.
    "Too many people spend money they haven't earned, to buy things they don't want, to impress people they don't like." Will Rogers

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    "As Americans we must always remember that we all have a common enemy, an enemy that is dangerous, powerful and relentless. I refer, of course, to the federal government." - Dave Barry

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  10. #10
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    Well said!!

    I too am a union firefighter, paramedic, but don't provide ALS with the fire department.
    After reading the article about Austin it kinda makes me upset. If you have highly trained paramedics who work for an EMS system that are trained in technical rescue, etc... and the city, fire, and ems leadership are working together to put a custom rescue unit on the streets, why bitch! It sounds like the rescue would be staffed with firefighters who are trained in rescue, and EMS paramedics who are trained in rescue. Sounds like the best of both worlds and that it would be great for the citizens of Austin. The unions stance seems weak at best. I am all for keeping firefighter jobs, but the article never showed a chance of firefighter jobs being lost. Well enough ranting and raving.

    Sometimes we need to remember we are in the business of saving lives, not getting what we want all the time. Grow up Austin firefighters! Remember you are hired to serve the community not yourselves!









    Scott
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    Cool

    The Fire Department-EMS system,when operated properly,is the best system to serve our customers!

    We have served our community with FD-EMS since the 1970's.We are a career,IAFF,fully paid department.In the early years,the resistance from the 'old timers',was very noticable.Therefore the EMS duties were given/bargained to the less senior firefighters.It still operates that way,if you apply here,one MUST be a Paramedic prior to hire.With seniority and/or promotions,one may relinquish his paramedic license.

    While many fire depts. tend to shy away from EMS,if you're a career dept.providing EMS with todays budget restaints,having EMS=job security.If you don't think todays economy WILL effect your department,you need to WAKE UP!Fire department budgets and jobs are being cut as I type.By 'serving'our community with as many services as we can,we just might save our jobs.Fire department/EMS is cost effective in MOST communities if managed correctly.


    Our FD has and will deliver quality patient care second to none.Not just because the IAFF tells us to for job security,but because we truly believe WE provide a better product and we are proud of our product.We have progressed in the past 10 years to provide medical services equal to or better than private EMS in our area(iearamedic first responders on our fire apparatus,12 lead EKGs,progressive and aggressive drug administration,ect).To say 'we should only extricate'our patients is hogwash.If we as firefighter/paramedics are dedicated to 'serve'our customers in the best possible way we can,we have to change our attitudes about 'EMS being a bastard child'.

    I realize the larger cities in this country where the FD/EMS systems are failing,may not share my attitudes.Larger cities have unique internal problems simply due to their size and work load.However,in your average size city of 40,000-100,000,the system only fails because We let it or the city managers let it.Why wouldn't firefighters want to produce the best product/service possible?Good service to our customers is an attitude.Many FD's must change their attitude.

    Another 2 cents.

  12. #12
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    Here, EMS is a division within the department organization. EMS does all medical runs and Fire performs every other area within the department. Fire doesn't handle first responder either. We just finished having a battle with the administration over first responder. I would like to see it stay as is, a division within the Fire Department.

  13. #13
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    Well, I think that the fire based EMS system is call system, I really don't see nothing wrong with it or anything like that. That is what we have used in my county ever since we have need emergency medical service. I think that there is only one problem with that and that is the when the tones go out some of the EMTs and such don't come in, it take a few minutes for the ambulance and such to get on the road. And if you had a private paid company doing it for you and they were already to go the would be very beneficial.

  14. #14
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    Way back in the "good ol'days", it was a crap shoot if an ambulance would even respond on a medical call. Our department took the bull by the horns and became an ALS provider in 1973. The private companies would either all race to beat each other on a fire department "inhalator" call or wouldnt respond at all. Our citizens demand and expect the fire department to provide EMS. There is no question about jurisdiction etc, because we are all firefighters. Sure, we would all rather be riding the big red rig, BUT I have saved many many more lives as a paramedic then I have as a firefighter. If you believe that alot of "old timers" are resistent to becoming medics I SAY BUNK. Most active firefighters these days have been in the fire service less time then fire based EMS has been around. There has been a continual revolving door with these private ambulance services in the Chicago area. One company buys out another and then gets bought out by yet another. Most fire departments in the region provide EMS. Some are just first responders. some are ALS with private transports, but a good percentage treat AND transport. There are many dedicated,competent paramedics that work for privates. There are just as many "just out of school" , "I cant wait to get hired by the fire department" and "lifers" who cannot get hired by the local F.D.'s out there. Which one do you want to take care of YOUR family members? This is not a slap at private ambulances,they have there place and I learned a great deal when I was employed with a private. But from what I have seen around this area, FIRE DEPARTMENT PARAMEDICS are the way to go.

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    I've already posted my opinions and pro vs. con on this subject way too many times on here and EMSVillage.Com to go through it again. So I'm gonna try to sum it up into one sentence If you are going to do it, no matter who you are, DO IT RIGHT! As a FF/Paramedic who also works Part time for a private, I'd have to say Fire Based EMS in my experience has a moderate edge over private. It has been my experience that FD medics are stronger than some I've seen in privates, and with the FD you are guaranteed that person's services, where with a private its pot luck depending on how their staffing is. Fire based also gives a municipality a little more control with QA/QI, personnel etc, where you do not necessarily know what's going on with your EMS system with a private until there is a complaint, or they are asking for an increase in the contract. But again, my bottom of the barrel point is I don't give a $hit what you are, if your gonna do it, do it right. The people we serve deserve it more than anything else.

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    The above is my opinion only and doesn't reflect that of any dept/agency I work for, deal with, or am a member of.

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    Great discussion so far. I just wanted to clarify one point, Austin EMS is a public department just like Police and Fire. It is not a private company.

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    I have a very mixed opinion on this one.....In the Austin situation, they should really leave it like it is. In general, I believe 3rd Service or FD provides a better overall EMS. I also believe there is no better way to mess up a good FD than to throw EMS TRANSPORT in it. It is a unique problem, and every case is different.
    Amazing a government wants to provide a state of the art vehicle, and everyone is still mad about it!

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    Just a little update about the situation in Austin. According to a source I have in Austin EMS, it is not the IAFF local in Austin who wants to take over EMS, it is only the local president. I was told the majority of members in the local do not agree with his viewpoint and are upset that he went to the newspaper to publish the story. Supposedly he was warned to put a sock in his his mouth or his days as the local president will be numbered. So I guess this whole thing will just blow over..... The issue of staffing on the new rescue has yet to be resolved. Last I heard the city wants to staff it with four FF and two paramedics.

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