Thread: Fire-based EMS?

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    Default Fire-based EMS?

    There are so many private ems folks out there that scoff at fire-based ems, saying knuckledraggers (their term, not mine!) belong in the red trucks and not the ambulance. I'd also heard over the years that the ambulance was historically the punishment assignment. What do the line folks out here think about EMS? Are there many people who feel fire should stay fire, or is there acceptance of EMS along with all of our other duties? I'm quite curious what people think.
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    Default Do you want a cookie cutter answer or the real one?

    While I would prefer not to do EMS it has become a nessary part of the paid fire service. Some of those reasons for better or worse revolve around what is best for the taxpayer and may or may not have the best interest of the PT. in mind. While many firefighters bitch about doing it, they know that in order to survive they must do what is right for the public. I came from a volunteer ambulance based service into the fire service 18 years ago and have watch the ambulance service change to a 90% paid corp and have seen my fire department change to a paramedic sevice from basic EMT sevice in just 5 years. The winners in this game is the public because are recieving the best possible trained people for thier tax dollar. There will no doubt be more change for the fire service in the years to come and there will be some out there who will buck change, but remember this "the more things change the more they stay the same".
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    Default no cookie cutters here!

    Well that's exactly who the "winners" should be, the public. I can see a much greater versatility in the fire service with most being actively involved (either first response or transporting) in medical calls. The evolution, as you described, of many departments HAS been very quick, some going full ALS in just a few years.

    I actually have an odd position here where I work a municipal fire-based EMS for my town, but the neighboring towns contract us to transport for them as they do first response to calls.
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    I think the outlook on fire-based EMS is a generational one in many departments. The older guys became firefighters so they could fight fires... not be "cot jockies." Folks hired in the last 10 years (or more in progressive cities) know that fire trucks roll on medicals and accept that role more so. If you aren't yet a firefighter and don't want any part in EMS... your hiring options are greatly reduced.

    However, "knuckledraggers" do remain out there. Look at the recent USE Today report on EMS response. One department (DCFD?) left the station more quickly for a dumpster fire than they did for a cardiac run. Even in my department, where EMS has been a part of our operation for years, there are folks that will hustle to the rig for an AFA but drag their feet when it's a EMS run.

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    I think that's called "assdragging"...nothing to do with knuckles. Medical calls, among other things, are the future for the fire service. It's here, and it's staying. Get used to it. There's a lot of sour grapes surrounding this issue. As far as being on the ambulance being punishment assignment, there are a lot of firefighters who see it that way. This is a situation that should be resolved if it exists in one's department. Patient care will eventually suffer if it isn't taken care of, one way or the other.

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    Good point-- municipal EMS is not generally something the fire service is given a choice about. Often, I imagine, it hinges a great deal on what the current chief & administration think, but certainly not the membership who could be content sticking to fires & car crashes. I do applaud those who rise up to the patient care arena when it is thrust upon them, as I know it's not what many signed up for 10-20 years ago!
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    Someone told me that Phoenix makes new firefighters ride the ambulance for a certain number of tours in an effort to make them understand the importance of EMS. Anyone know if that's true? And how long that assignment is?

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    I think this question depends on the city's size, density of population, socio-economic conditions, history of fires, non-medical emergencies and medical reponse's . This is especially true in todays needed and sometimes required training in technical rescue responses related to high angle, trench and confined space rescue, not to mention RIT and HAZ-MAT which in my department is solely handled by the Firefighting Division and not the EMS Division. The only area in which we have Medics completly involved and trained in but not in charge of the situation is level 3 HAZ-MAT incidents. I feel that larger viable and well run urban areas and larger cities with lower socio-economic conditions (a politically incorrect phrase) should have a separate EMS based system as a division within the Fire Department. The Firefighting Division in my department doesn't do first responder but are trained to that level (long but interesting story). A Firefighter is a Firefighter and a Medic is a Medic. This allows for each one to be highly efficient at the duties they perform and yet still allows them to work together effectively when necessary (MVA's etc). In smaller cities, townships and villages, I can see fire personnel doing both.

    To add a little to this we don't do meds and they don't do fire. The Medics actually belong to a separate union and not the DFFA and IAFF.
    Last edited by FireLt1951; 09-11-2003 at 08:57 AM.

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    Cool We Already Do It All.........

    No Question here. We have had a Fire based EMS service since 1929, and we're damn proud of it. We believe that ours (PG Co Md) was the first County Wide, Volunteer, EMS service in the world. We also believe that we are the largest System in the world to use volunteers extensively. Our county has a population of 830,000 and a land area of 430 Square Miles. EMS Transport is handled by 12 ALS and 49 BLS ambulances operating from 47 Fire stations. Those same Fire stations house the usual array of Fire apparatus, 22 Ladder companies, 91 Engines, 12 Heavy Rescues, and a whole herd of other stuff. CY 2002 provided us with a run total of 308,000 responses. We wouldn't have it any other way.

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    The career Fire Department I work for does not run Ambulance or transport in any such way. It staffs a BLS ambulance with reservists on the weekends in a ski resort community during the winter. That is as close as we come. The paid guys run no ambulance.
    The department is in the process of trying to obtain a BLS license from the state. The older guys don't support the ambulance, feeling as if it is a punishment. They have no ambition to ride on the ambulance. The thing is, the older guys are Captains and Engineers. They have virtually no chance of riding the ambulance. It is the young guys, the firefighters and some engineers, with less then 5 years on who want to run the ambulance.
    I, myself, personally do not want to run the ambulance day in and day out. A shift or 4 a month would be ok, but I don't want to be assigned to ride an ambulance until I'm promoted to Engineer. I knew the layout and how this department operated when I hired on. That was more incentive for me to pursue a career with this department.
    This isn't to say I don't support this ambulance deal. I support it whole-heartedly. I will work on this ambulance and make the program work when we get it. It will take the FD forward, make us more progressive. That is the only way this department can go. I will do what it takes to better the department I work for. I love running good medical calls but would take a fire any day....

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    Cool

    I'm enjoying all of the feedback, and I certainly didn't want to push my OWN agenda here! It's good to hear the point of view from people in the fire service about EMS, as I so often hear people of EMS complaining about fire-based systems. Some departments, such as the city of Keene (NH), regularly rotate assignments from ambulance, engine, and rescue or ladder, whether a paramedic or not. Granted, the paramedic might get bumped off the BRT if the department is down a medic on ambulance that day, but the system sounds pretty fair and quite diverse that way. Keep the ideas flowing!
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    I have to say that I have come to be against fire service based EMS. Now I come from a fire service background. I have worked for two career departments, both of whom operate a BLS ambulance.

    In the first department, the junior men were on the ambulance - period. The bottom 8 guys were on the box, no ifs, ands, or buts. We routinely ran 20 - 24 runs in a 24 hour shift. We were lucky if we got 2 hours sleep while on the 24 hour shift while the other companies - 3 engine and one stick - ran 3 or 4 calls in the 24. No rotation of duties or training for the ambulance crews.

    The second department was a 5 man per shift department and everyone, except the Captain rotated positions. I actually learned to be firefighter here. Go figure huh? Most of these guys despised EMS but realized that if it weren't for the box, they would not have a job.

    In many places EMS works when under a fire department. Every time an ambulance service is absorbded by a fire department morale for EMS decreases. FDNY, St. Louis, Seattle, San Fran, DC, they all have tremendous problems with morale and EMS - which actually makes money for the city and department, gets very little money for equipment, training, and the like.

    I currently work for a private EMS agency as a Paramedic and do 9-1-1 for several communities. Most of the fire departments that I have interacted with and observed doing first responder runs can barely handle that. I was on a chest pain run a few weeks ago and a firefighter told me that will no longer carry patients down on stair charis because their contract does not state this is thier job. This os not the first or only firefighter from this department to do so either. These guys want their own ambulance too. SHUDDER.

    The days of going to smells and bells is here and the days of workers every few days is LONG gone. Bottom line is it works some places, but not others. I find that the number of places that it does work is smaller than the number of places that it doesn't. Again, my opinions made from my observations in New England.
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    Originally posted by FireLt1951
    I feel that larger viable and well run urban areas and larger cities with lower socio-economic conditions ... should have a separate EMS based system as a division within the Fire Department.
    I don't think having a seperate EMS Division within the fire department is a good idea... Unless you can offer the EMS employees parity with the fire employees. I think NYC has issues between the fire and EMS guys... and I know they aren't alone.

    You've never seen people more miserable until you tell them, "You are part of our department but you are not the same as us. Your pay is different and you don't have as many promotional opportunities." I know this from personal experience.

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    Cozmo brings up a great point. As a firefighter/paramedic, I want the same opportunity to rise up the ranks as a firefighter as anyone else, IF and only if my abilities merit promotion. I don't see myself different than a firefighter who hasn't gone to paramedic-- it's like a module or just another "skill" that I did. Some have high angle rescue, some have confined space rescue, and I happen to have paramedic as something that goes along with my firefighter certs. People should be paid on certification & merit, time & dedication to the department. I have no problem with a firefighter who has training I don't have to make the same pay I do when I have paramedic. I think we ALL could be paid more, but that's another thread! Great ideas, folks. Take care
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    The situation here is, EMS doesn't want to do Fire and Fire doesn't want to do EMS. Everyone seems to be very content with this and I personally can't see anything wrong with it. It works well for us. When EMS started up in 1973 we tried to get involved and the Medics they hired(the city didn't want to take the time and pay to train the Firefighters, they just went out and hired certified medics) didn't want anything to do with being Firefighters or belonging to any Firefighters Union, they voted to join a separate union. They got what they wanted and I'm fine with that and everyone else seems to have that same opinion. It's a long dragged out story regarding the beginning of the separate divisions system. What I find funny is we've had many Medics take the test and became Firefighters but we have never in 30 years had a Firefighter take the test to join EMS as a Medic and there are actually more certified medics in the Firefighting Division than the total number of certified Medics in the entire EMS Division.

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    Thumbs up Excellent Point, Coz.........

    The key to a good working relationship among all members of an organization is Parity in all aspects of the job. While a good portion of our people are Volunteer, the career segment of the Department has an EMS division. This makes some things easier, in particular the chain of command, where a medic reports to a medic Lt., Capt. B/C, Etc. People are able to rotate in and out of any division, according to the needs of the department, County personel regulations, and the labor contract. All career employees hired in the past several years have a 4 year window from date of hire to become certified as EMT-Ps. The only downside here is that the call volume is such that your butt is whipped at the end of the shift (24 on/72 off). Stay Safe....
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    Default EMS AND FIRE COINCIDE

    I TOTALLY AGREE WITH THE FIRE BASED EMS SYSTEM. LIKE SAID BEFORE, THE PUBLIC IS THE MAIN PRIORITY. I COME FROM AN ECONOMICALLY DEPRESSED INDUSTRIAL AREA. THE VALLEY THAT I SERVE IS AN OLD MILLING VALLEY, ONCE ONE OF THE BIGGEST AND MOST PREVALENT AREAS IN THE US. NOW, JUST A BLACK HOLE IN SOUTH WESTERN PA. TODAY, MORE AND MORE FIRE DEPT.'S ARE GETTING INTO RUNNING PRIORITY, QRS DISPATCHES, AND AED RESPONSES ALONG WITH OUR EMS SERVICE AND OTHER EMS SERVICES. NOW, MORE THAN EVER
    IS IT GREATLY APPRECIATED IN OUR AREA OF THIS. TODAY, AS IN THE REST OF PA, EMS PERSONEL ARE DWINDLING. WITH THE NEW STANDARDS SET FOURTH BY THE HEALTH INSURANCES, NO LONGER ARE WE GETTING PAID THE MONEY WE USED TO FOR TRANSPORTS. THESE FUNDS HAVE BEEN CUT SIGNIFICANTLY BY HUNDREDS OF DOLLARS. THIS INTERN, IN MY EMS COMPANY AND OTHERS I KNOW, IS NOT LETTING EMS SERVICES SERVE MORE RAISES, BETTER PAY STARTS, OR EVEN BETTER HEALTH CARE PACKAGES DUE TO THE DECLINE IN MONIES. AND, SINCE WE ARE IN A DEPRESSED AREA, MOST OF THE RESIDENTS HERE WHO EITHER DON'T HAVE INSURANCE, OR INSURANCE THAT WON'T PAY FOR TRANSPORTS, END UP NOT PAYING THEIR OWN BILLS FOR THE SERVICES. THIS INTERN IS DWINDLING OUR EMS FORCES IN OUR REGION. UNLESS ANY EMS SERVICE IN THIS ARE IS RUN BY A HOSPITAL, AND THERE ARE ONLY ABOUT TWO, THEN HARDLEY ANY MONEY IS BEING APPROPRIATED.
    EMS CERTIFIED PERSONEL ARE NOW FINDING JOBS IN BIGGER CITIES WITH HOSPITALS THAT INCORPERATE PARAMEDIC AND EMT JOBS ON FLOORS AND SPECIALTY UNITS IN PLACE OF SOME NURSING JOBS. I CAN HONESTLY SAY THAT WITH OUT THE HELP OF THE AMOUNT OF VOLUNTEER FIRE DEPT.S IN THE ARE ON EMS, GRAVE CONSEQUENCES WOULD COME ABOUT. AND ALL THE FIRE DEPT.'S IN THIS VALLEY ARE NOW ALL VOLUNTEER. JUST ABOUT EVERY FIRE DEPT. HAS TAKEN THE INITIATIVE TO TRAIN THEIR MEMBERS IN FIRST AID, FIRST RESPONDER OR EMT. OTHER INDIVIDUAL FIREFIGHTERS TAKE IT TO THE NEXT LEVEL WITH EITHER PARAMEDIC OR RN. THE LUSTER OF BEING A FIELD EMT OR MEDIC TODAY IS JUST NOT THERE.
    SO YOU SEE, EMS AND FIRE IN THIS REGION WORK TOGETHER WELL, AND I HOPE WILL CONTINUE. SOMETIMES WITHOUT THE VOLLIES ON A CALL, I DON'T KNOW WHAT I WOULD DO. THE OLD ADDAGE OF A FIREMAN IS JUST A FIREMAN AND NOTHING ELSE, DOES NOT APPLY ANY LONGER. THE TERM FIREMAN, OR FIREFIGHTER(FOR PC PURPOSES) HAS TAKEN ON A WHOLE NEW DEFINITION. AN INDIVIDUAL THAT IS MORE DEFINED AS AN EMERGENCY RESPONDER. HAZMAT, FIRE,TECH. RESCUE, RESCUE OPPS., WMD,AND EMS.






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    I will start by admitting that I havent read all of the previous 16 posts. I will do so when I have more time.

    Here is my view.

    Fire based EMS, at least the way it is done in my part of the world is the best option the patient has. I don't know of any private ambulance company that sends 3-5 paramedics to a call in under 5-6 minutes. This helps reduce scene time for all calls. This delivers the patient to the ER/OR in less time.
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    I have a few issues with fire based EMS when personel rotate bertween the ambulance and fire roles.

    Namely, when you are doing both jobs, you have twice the amount of continuing education required. Therefore if a person has 100 hours available a year for training, they will spend 50 on fire and 50 on EMS.

    When your house is on fire, do you want the person with 150 hours of fire training with the last 3 years there or the person with 300? When your the trauma victim, same applies.

    We may be running our departments as cheaply as possible, but are we getting the best possible service? With the best possible trained personel? When a firefighter is on a nozzle, all those hours spend learning to read cardiac rythyms are useless, but some extra FF survival training or fire control training would be usefull. When that medic is at a trauma scene, knowing how to put of a LP gas fire doesn't do him much good, but some extra con-ed on the type of trauma he faces may make a difference.

    We run first responders at all departments at BLS level, and all our EMS units (seprate org) run ALS. In NC (how are other states?) ALS treatment CANNOT begin untill an ALS transport unit is on scene, so having paramedics of fire trucks does not do much good.

    Not flaming here, but just wondering if that aspect is considered much? In both games you cannot have too much knowledge, and when we start paying peopel to be jack-of-all-trades we may end up spending less, but do we get less?

    Don't even get me started on those "public safety" departments where personell rotate between police, fire, and EMS!

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    It seems to me that this question must be looked at in a regional perspective. Thought must also be given to what type of department is involved(career vs. volunteer vs. poc).


    Therefore if a person has 100 hours available a year for training, they will spend 50 on fire and 50 on EMS.

    I perform in dual roles and would put my skills and those of my company up against any single role FF or medic. I don't buy the line that you are better because you don't have to serve two roles. I have worked in a single role job in the past. I am a better medic now than I was then. My dual role job allows me plenty of time for training in both fields.

    In NC (how are other states?) ALS treatment CANNOT begin untill an ALS transport unit is on scene, so having paramedics of fire trucks does not do much good.

    I now feel sorry for my relatives in NC. How is the patient getting the best possible treatment if advanced interventions cannot be performed by the first unit to arrive? Certainly the public would be better served by having as many paramedics on the street as possible regardless of what type of vehicle they are assigned to.
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    Im the same as hwoods..... PG station 34 here.. we run or ambo out of the firehouse... damn that thing lol

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    I have been invloved in Fire based EMS all of my professional career. The first was what we call a 2 tier system. It had medics on our Rescues who could provide ALS until the transport arrived. The pro's were that the FD units were out of service for shorter periods of time. The con's were that critical patients would be dependent on the private companies response, and the private company billed the patient. The system I am working with now is a transport based system. The advantages are that medics are able to provide care and then transport the patient. Our collection rate is about 60%. This generates a significant amount of revenue for the system itself. It is not enough to fund it completely but it is enough to utilize those funds not needed in EMS to the Fire needs. We have 6 rescues county wide now and are adding 2 more rescues and 2 more engines this fiscal year. Another plus is that we all work and train together which means a lot fewer problems on scene. All systems have their good points and bad. The best system is the one that benefits our customers (taxpayers) the most.

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    I stand corrected on the ALS transport thing, in NC you must ahve an ALS UNIT in place to begin treatment, so a ALS fire truck would qualify.

    Duffman, I have no doubt you are a better medic now than you were before, we all get better with experience, but the question is are you a better medic now than you would have been had you been able to focus only on medical training and continuing ed, instead of fire and medical?

    Can you honestly say you are a better medic than you would be with more training? What if all the opertunity for training for both jobs was available for one job?

    That was my whole question about the system.

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    Originally posted by DaSharkie
    FDNY, St. Louis, Seattle, San Fran, DC, they all have tremendous problems with morale and EMS - which actually makes money for the city and department, gets very little money for equipment, training, and the like.
    With all due respect, when it comes to Seattle, I don't think you know what you're talking about. I live in King County, and I've never heard of morale problems when it comes to EMS. Particularly considering that it can easily be argued it's the best EMS system in the world, as evidenced by the recent USA Today series. I think all the firefighters in the EMS system here know exactly what they're getting into when they join the fire service, as most departments require applicants to have an EMT cert BEFORE they apply.

    In the city of Seattle, there has never been a third service EMS system. Firefighters have always been medical providers, so you don't have the problems of integrating third service EMS providers into a fire department the way you do now in other places, which in my opinion causes most of the problems taking place with fire departments and EMS. I have no idea what is going on in the other departments you mention, but in Seattle/King County, I really don't think morale problems exist due to EMS. And to me, that makes it a model for other departments to follow.

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    radioguy, I unfortunately have to 100% disagree with what you are saying, I'm a dual role FF/EMT and have never let either training or knowledge interfer with one another, When I have a nozzle and I'm in a burning structure my mind is 150% focused on my safety, my partner's safety and what we are doing. Same with EMS if I'm focusing my mind on my safety, my patient's care and safety,In our department it is an option as to what you want to do, there are those who are strictly fire and those who are strictly EMS but there are those who are FF/EMT's and we have never had a problem with it,It may be just how our area is our has just adjusted to it but for us Fire Based EMS works
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