1. #1
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    Default Incorporating EMS into an FD

    I'm reaching out to you guys for a little insight into adding EMS service to an agency that is currently Fire/Tech Rescue.

    The powers that be in our community are approaching the fed up stage with our current volunteer EMS provider and are exploring options for improving service.

    The situation is this... Vol. EMS agency covers, in whole or in part, 3-4 towns with our town being the highest volume of their calls. All towns contribute a certain amount financially to come up with an operating budget for this group. Our town fathers feel that since they contribute the most financially and have the majority of the calls(ranging from 500-600 annually), that their should be at least one BLS unit stationed in our town. The agency won't go for it.

    Given the stance the EMS agency has taken, the township committee has come to us and asked if we would be willing to become Fire and First Aid if they purchased the equipment to get us properly equipped.

    With equipment addressed, the situation becomes staffing. Just as the EMS agency is all volunteer, so are we. We have a handful of members who are members of both organizations currently as well as some members of the EMS agency who would be willing to jump ship and come over to serve only the town they live in.

    My question really goes towards the operational sides of things. For any of you who have made a similar change, how did you address staffing(ie. what's an EMS crew). How did you address leadership(an EMS Captain and and EMS Lt with the Dept Fire Chief being overall dept head is what we are thinking)

    These are just some immediate thoughts, I'm also open to words of wisdom, pitfalls to watch out for, etc.

  2. #2
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    I would buy alot of pacifiers. Paramedics tend to whine alot.
    RK
    cell #901-494-9437

    Management is making sure things are done right. Leadership is doing the right thing. The fire service needs alot more leaders and a lot less managers.

    "Everyone goes home" is the mantra for the pussification of the modern, American fire service.


    Comments made are my own. They do not represent the official position or opinion of the Fire Department or the City for which I am employed. In fact, they are normally exactly the opposite.

  3. #3
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    We added ambulance transport to an ALS first responder service 3 years ago. We now run 2 dual medic ALS ambo's in a 3 station district.

    We initially hired 3 more medics to help staff them, but have lost all 3 spots thru attrition this year.

    We make about $600K a year off the ambo billing ($600 flat fee), of which 100% goes back into the city general fund, and we don't see a dime. They also cut our FD budget by 10% ($300K) due to a lack of revenue city wide.

    It was a major maorle buster, everyone hates it, and will do anything to get off of it (the ambulance). We lost several good people to other dept's that pay better. Their rationale is "if you have to ride the ambo here, why not ride it there and make more money".

    Our back injuries have more than doubled in 3 years, so have our bio exposure incidents. A guy on my crew has been on short term disability 3 times in 3 years with a bad back. We discovered that the biggest person on every call is usually the patient. I'm surprised at the number of old women that are taller and heavier than me (6' 220lbs). All that training in carrying fire victims out of buildings comes in handy, you do it on the ambo 6 times a day!

    So, I guess it summary,

    - It is a source of revenue
    - It will pad your run numbers
    - It will triple your liability
    - It will double your on-duty injuries
    - It will chase some peole off the dept.

    Just our experience.

  4. #4
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    Originally posted by MemphisE34a
    I would buy alot of pacifiers. Paramedics tend to whine alot.
    Hey, I resemble that remark.

    I foresee a lot of whining on both sides over this. To take on EMS, or to continue to provide good, proper EMS care is a mindset. Everyone has to want to do it and keep on doing it. After a year you will see overall how it has gone. Proper eval needs to be done often to ensure that things are OK and to adapt the system to the needs of the community.
    "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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  5. #5
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    Default Been there, done (and still doing) that...

    First the demographics. We're a volunteer municipal department that protects a 50 square mile area. Our town has a population of 1200 and makes up the geographical and industrial heart of our district but the unincorporated area contains a population of 3000 or so more people. We operate out of 1 station, have 30 volunteers, and responded to 275 fire and EMS calls last year.

    Now for a brief history of EMS in my town during the last 15 years or so:

    Volunteer EMS agency (not affiliated with the town) - closed down. Private provider located in town - closed down. Town-based EMS agency - closed by the Town when it got in a financial tight. Replaced by a private provider. Actually, three in rapid succession, each of which (everyone say it with me) closed down. During the gaps in coverage, transport was provided by a private and another city's service. Typical response time was around 25 minutes (that's not a knock on them, they have a long way to come).

    From the moment the Town-based service was shut down in 1998, we started planning EMS as part of the FD. Quite simply, we knew our town didn't have the call volume to support a private provider and they wouldn't stay. When we started, the FD did no EMS except for extrications and the occassional assist (ie, tote the big folks).

    Here's how we've done it so far. Step 1, start providing a non-transporting First Responder level of service out of the FD. This was relatively easy because most of our folks were already trained at the FR level and it accomplished three major goals. First and most importantly, it got our folks some field EMS experience. Our department was very scared of EMS, but they got more comfortable operating within the limited scope of practice and gained very useful insight into EMS operations. Second, it gave us a chance to see just what we would be talking about in terms of supply usage and call volume. We registered as a service with the state and completed patient care reports and thus we knew exactly what to expect. Third, we got TONS of public contacts and without even trying we created a hugh grassroots demand for the return of local EMS.

    Step 2, "Grow your own" training. We're fortunate to have an EMS and EVOC instructor on the department so we began conducting in-house FR and EVOC classes. We also contracted for an in-house EMT-Basic class that many of our now-experienced FRs took (8 of 9 passed national registry on the first attempt).

    Step 3, transition to transport. In early 2004, we transitioned to a transport service. Because of the work done earlier, it was just about as simple as buying a bus and getting the state license. Everything else was in place.

    Step 4, ?????. We're about 18 months into transporting. The one thing we've readily identified is the need to continue 'growing our own'. Quite simply, not too many seasoned EMTs are knocking down the door to volunteer so we gotta keep training the newbies. We're considering scholarships to send basics to medic school and newbies to basic school.

    When we expanded, we felt it was absolutely CRITICAL that the new transport service be a part of the FD. By being part of the same command structure, there would be no infighting over the volunteers and any future town government would be less inclined to shut the service down because of the stability offered by its incorporation into the FD. They may cut the funding, but they won't shut the doors.

    Leadership
    We created an EMS division, to be led by an EMS director that was subordinate only to the fire chief. The director is responsible for EMS training, etc but does not hold any fireground authority UNLESS the director also holds an officer's position in the suppression division.
    Staffing
    The EMS division operates in scheduled shifts, 6a-6p, 6p-10p, 10p-6a. The mini-shift is usually covered by folks that can't risk catching a 5:50 run and being late for work. It is a decent trade-off because that's also one of our busiest windows. We have a minimum coverage of 1 EMT-B and 1 EVOC driver but the typical coverage includes this plus an ALS provider either on the truck or on-call as needed. We can't guarantee ALS 24/7/365 but it is pretty good. In 18 months, we've only had to call for ALS intercept once.

    The EMS director is a paid paramedic position that also covers the 6a-6p shift 4 days a week, everyone else is completely volunteer. That paid spot sure helps with scheduling.
    Pitfalls
    -> You've got to have the department on board, if they don't want to do it you're doomed from the start. Also, if you've got fire guys that just plain don't want to do EMS (and you probably will), don't pressure them. Likewise, include your EMS-only volunteers in all department functions. Just like the guy that only drives the tanker (all us little vollies have one), they must be part of the family.
    -> We use a third party billing service. They're much better equipped than us to recover monies.
    -> Plan and budget worst-case. Just because the town's for it now doesn't mean they will be later on. Make sure you have a plan for the 'what-ifs'. Also, make sure you let them know drugs and supplies expire. There will be a continuing additional expense involved. Also, make sure you've got the folks to handle the loss of a provider or two.
    -> Don't burn bridges with the current provider. Everyone needs a backup.

    Sorry for the long post, but I'm really proud of what we've done and it seemed to fit your situation almost to a T.
    Last edited by EFD840; 07-05-2005 at 05:56 PM.

  6. #6
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    FFTrainer, it's a bad idea. NJ is a one of a kind state. Fire is Fire, EMS is EMS, and the two usually only work together at motor vehicle accidents.

    a couple of things to keep in mind:

    if you take over EMS, your call volume will probably triple. if EMS gets 600 calls a year, i would guess you get maybe 200-250. can your department handled that type of call volume increase?

    how are things going to be different if the FD is running EMS? the squad is having trouble answering calls. now, your going to start from scratch (having a few people doing the FD to run EMS calls), but you will still have the same problems that they had. and i'm assuming you will be staying volunteer, so you will have additional daytime issues.

    you might think you can pull it off now, but it will cause a huge strain on your department, one that you might not relize. just because the ambulance moves from an EMS agency to a fire one doesn't mean all the problems that the EMS agency had would magically disappear.
    If my basic HazMat training has taught me nothing else, it's that if you see a glowing green monkey running away from something, follow that monkey!

    FF/EMT/DBP

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    My department got out of the EMS business in the 80's, and have no plans to return to it. Hard enough to recruit and retain just firefighters...don't even want to think about how hard it would be to recruit EMS personnel in our area...

    USFA/FEMA has a book on it...

    Title: Implementation of EMS in the Fire Service
    FA #: FA-167
    Item #: 9-1106
    Subject(s): Emergency Medical Services, Fire Service Administration
    Media: Manuals and Reports
    Cost: Free
    Read Online/Download: (This publication is not available for download.)
    Description: This manual and accompanying videotape have been designed to assist chief fire executives and other local government leaders in planning for and implementing EMS in a fire department.
    IACOJ

    "And let us not grow weary while doing good, for in due season we shall reap it if we do not lose heart."

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    We are going through a very tough time with AMR. We have discussed putting ambulances in our firehouses. But most of our firefighters hate doing non-transport EMS. The only way our dept. will ever put ambulances in our firehouse is if they staff it with paid EMTs.

  9. #9
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    Unless the VAST majority of your membership supports it, is willing to go to EMT and run the calls.. DON'T! What is in it for your FD? What is the town going to give you? What does your general membership think?

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    Are you talking about running EMS first-response or transport ?

    If you are talking about first response let me give you some advice, as a former member of a department that has gone through the transistion recently:

    EVERYONE must be on board. This includes the officers who will make policy, control funding and schedule training. It also includes the membership ... if only 20% of your firefighters want to do this, it will not work.

    OVERBUDGET by 20%.

    Buy enough equipment to provide service. If you are going to outfirt only 1 truck that is a mistake. You need to be able to outfit the trucks that will be in a posistion to respond while driver training or in-service returning from other calls. have enough equipment to deal with 2 calls at the same time. There is nothing worse (from a PR and professionalism standpoint) than having a in-service piece just around the corner from the call and having the EMS gear back at the station (either on a shlef ready to go or on another truck).

    Have sufficiant staff. As I said before, if only 20% of the department wants to be part of the EMS component, you will not be able to cover calls or burn them out. I would say you need at least a 50% COMMITMENT (thats both night and DAY staff) for it to work.

    Dedicate an officer to supervise EMS. I would recoomend a Lt. or Captain in a volunteer department. This person will be responsible for getting the ball rolling and should have the power to schedule training and purchase equipment (within budget) without having to "go through" someone else.

    As was said, once you make this step you can't go back. it will change your department forever and may put substancial strains on it's membership. It may truly **** some people off who don't want to deal with this "crap", and it could cause deep rifts within the department. it does have it's pluses though .. but there are costs.

  11. #11
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    thanks for the insights. Some of which I was aware of and some were new, but that's why I tossed this out there.

    A couple of questions that came up:

    Why are the powers that be fed up with the current provider? Best I can say is getting what you pay for. The politicians don't feel that they are getting sufficient return on their investment. My town accounts for around 65-70% of the calls for the current agency and yet their HQ is in a different town. The politicians have offered a new substation and were told "we can cover you from where we are, we always have" the stakes were raised and the politicians added a brand new rig to park in the substation and still - "we're not moving there" To some extent it is a power struggle and the politicians feel that they can bully them and want to prove it(which is negative and we know that) however the pro-active words that come up repeatedly when the politicians are asked why is "We currently make up 65-70% of your calls. There are 3 new subdivisions of 250 to 600 units each either under construction or breaking ground in the next year so that number is only going to go up, we want a BLS presence withing the community not responding in from outside"

    This would be a leap to transport since I don't see a way of transitioning because there is going to be an initial rift created by some hurt feelings. Keeping them to the minimum is going to be a goal.

    As far as command and control, someone mentioned a seasoned EMT. We have about a half dozen current suppression members that are EMT's elsewhere either by career or in another BLS volunteer squad and out of all of them the least experience is 7 years however he is a career FF/EMT who sees a lot of work on the job and can bring the experiences back to us.

    As for membership support, we have that from Chief to newbie. We have a couple of guys that say "F-EMS I'm sticking with fire. You guys do what you want I'll drive a rig if you need me to but other than I'll be with the engine." Which is fine. They don't want to do it personally but they support the organization doing it.

    DrP -- isn't NJ great!??! Since this issue has arisen, I have had the very same thoughts, but then I look around and see a handful of groups in my area operating as Fire & First Aid and they make it work with similar demographics.

    It may never happen as it may all be political BS, but rightfully so, we are looking to be as prepared as possible because as with most other issues in the Fire Service if the time comes, this will be dumped on us with minimal warning and we will be expected to run with it so the more info we have up front the better prepared we will be should this materialize.

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    A few more background questions about your current EMS provider:

    How far is thier current station from the border of your town ?

    Is thier current station centrally located in THIER EMS district ?

    Do they run with one scheduled crew from the station or is it a "whomever shows up" system ?
    (important question as if they run with one scheduled crew, a substation will not help the situation)

    What is thier average response times ? Have response times been an issue ?

    Do thier off-duty members who live in your fire district "jump" calls (basically acting as first-responders)when they are not assigned to the ambulance ?

    Are there truly issues or is this just a power struggle ?

  13. #13
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    How far is thier current station from the border of your town ?
    About a mile from the border but about 3-4 miles from the proposed location which is closer to the middle of our town.

    Is thier current station centrally located in THIER EMS district ?
    Not really. Its only advantage is it has relatively easy access to main roads.

    Do they run with one scheduled crew from the station or is it a "whomever shows up" system ?
    Duty crews with response from home for the overnight hours and whomever shows up for daytime runs

    What is thier average response times ? Have response times been an issue ?
    I don't have that information, but it will come up if this goes further. Response times are an issue from time to time.

    Do thier off-duty members who live in your fire district "jump" calls (basically acting as first-responders)when they are not assigned to the ambulance ?
    Yes. If it is in their neighborhood they go direct or if they have to pass it to get to the rig they go direct as long as someone else is on the air going to get an ambulance.

    Are there truly issues or is this just a power struggle ?
    My personal opinion is that it is more of the latter, but we are trying to do our part and be prepared. Understand this, we will accept the responsibility if called upon, but by no means are we initiating the change.

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    FFTrainer, in a small way, I'm going through something a little similar involving Extrication. It's NJ, that's handled by lots of EMS agencies, not FD. Due to manpower issues, we're looking at some alternate routes.
    "This thread is being closed as it is off-topic and not related to the fire industry." - Isn't that what the Off Duty forum was for?

  15. #15
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    We already went through the extrication thing a couple years ago. We have grown that to the point we are going to a full rescue vehicle(not just for extrication but for ice rescue, tech. rescue, etc) rather than a rescue pumper as soon as the firehouse addition is done and we have somewhere to park it.

    If this goes through, hopefully it will go as smooth as the extrication takeover

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    All of our local fire departments are Fire/Rescue and Transport BLS; or Fire and Quick Response BLS; ALS is separate non-transport. There are a few positive things to point out. With EMS in place, we have had a lot more people join for both fire and EMS, where as they may not have joined just for fire. The cash flow is pretty good, and it benefits both fire and EMS. If the fire went broke, we would still be able to fund everything with EMS. Most surrounding counties do have fire and EMS in the same department/company/w-ever. One was forced to separate because their "fire association" didn't want EMS to get their grants. A lot of companies suffered financial loss from that, and many of the ambulances folded up b/c people were discouraged from being a member of both fire and ems. Now these companies are getting back in the game with these voluntary certifications from the PA DOH. Such as the Voluntary Heavy Rescue Cert and Quick Responder Service. A lot of the time these guys can be on the scene 10-20 minutes before a transport unit, so we know that the programs are saving lives.

    I really have never been in a fire dept. that didn't run an ambulance.

    Our community has had them since the funeral homes decided that it would cost too much to train their embalmers as EMT's. Maybe they were afraid it would hurt their business? Get it? ha ha.

  17. #17
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    Default EMFD

    Our experience is as follows.... 1999 began service as a Fire only department....2000 Added first responder as our small department is the only game in town for the first 30 minutes (something about customer service?) ...2000-01 added emt-b and received licensure....2001 added emt-i because of the 45 minutes in the canyons awaiting either and ambulance or helo....2002 added ambulance because our citizens insurance is supporting another agency and 40 minutes plus waiting for the reserve ambulance to arrive on a pediatric seizure....2003 added firefighter emt-i 12 hours a day m-f ... 2004 added paramedic service 16 hours a day....2005 july 24..adding 24/7 paid part time ff/pm ff/emt-i to reduce our response times 2 ff/emt-i from home with brush trucks and a full time chief staffing now 4 24-7... headache = yes....bargining chip (250K into the general fund) = yes... pays for part time staffing fire = yes... deleveloped value for the tax rates = yes... will allow a department of 6 years to go from nothing to two stations, three engines, two brush trucks, 1 water tender, two ambulances.... 9 part time paid staffing (daytime) and 22 part paid reserves.. to 24-7 2 in the station 2 from home. It is expensive to start up, a challenge to administer but rewarding when you save a life that would have perished otherwise... What value does a human life bring? many questions and it's not easy but we as a community would never go back to the days when the pager went off and you hoped someone would respond. Stay Safe and Keep Low, jack

    More info at www.emfire.org

    PS that is the worlds longest run on sentence !!!!!jack
    Last edited by dchomen; 07-07-2005 at 11:03 PM.

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    dchomen hits the nail on the head...customer service. What is best for YOUR customers (taxpayers)?

    My department runs both fire and ems..around 2500 calls for service each year. We have a private transport agency that is at best horrible. But we the fire department respond on all medical calls along with the ambulance in order to provide the best service we can. 50% of our staff are EMT-B level. The other 50% are First Responder level. We bill all parties who require service who are not tax-payers within our district.

    My opinion is this:
    1. Run EMS. Even if it is non-transporting. Start small and with experience build upon it.
    2. Do not create a seperate division within the department for EMS. Rather, create a position (an officer) and designate that person as the EMS coordinator.
    3. If you go non-tranporting, have your transporting agency sponsor you. They can provide the training and oversight if needed. It's a good PR thing for them to do this.
    4. Do not forget about about a medical director, liability insurance and third party billing.

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