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  1. #1
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    Smile Is Fire based EMS better than private?

    I can hear the screams already!!! I have worked both and am currently fire based. Which do I think is better? Hard to say. I think I was a smarter medic when I worked private, but I have more fun working fire based. I started a blog on this http://isfirebasedemsbetter.blogspot.com hoping for a real discussion instead of people just getting mad and venting. Venting from both sides of the coin.


  2. #2
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    Depends. I cant say one or the other is better. Depends on the system you work under. fire based ems may be more experienced with the fan hitteth runs because they are primary 911. But then again the private may be better at pt relations, as they may talk to their pts more. You have good and bad medics in both. as to say one is better than the other is like saying Cleveland is better than columbus...

  3. #3
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    in b4 the lock

    How could you be a smarter medic when you worked private, but now you have more fun. Working on an ambulance is working on an ambulance. If the kind of patient care you are delivering has deeclined that is a personal problem - not a systemic one

    I'm just going to guess.

    Went from Sioux City to CBFD or AA in CR to WDMFD?
    Last edited by Geinandputitout; 02-24-2008 at 06:56 PM.

  4. #4
    Forum Member HeavyRescueTech's Avatar
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    define better.

    privates typically cost less to run than FD based. this is better for the taxpayer (lower costs for the level of service).

    FD based typically are paid better, and are funded better. they also are typically stationed in firehouses, while privates are posted. this is better for the employee.

    each has their advantages and negatives, depending on your point of view.

    and if you are going to compare, might as well throw in hospital based systems, municipal 3rd party service, and the volunteers.
    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!

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  5. #5
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    Quote Originally Posted by Geinandputitout View Post
    Working on an ambulance is working on an ambulance.
    I'll agree that if you are answering the same type of calls, then sure an ambulance is an ambulance.

    I think some additional clarification may be in order for this discussion. What does firemedic130 mean by "private" EMS? Is he talking about a private company that is contracted to provide municipal 911 service and maybe non-emergency transports or is he talking about an ambulance service that pretty much only does NETs and the periodic nursing facility "emergency"?

    In my neck of the woods we have a few "privates" that could be categorized into one of these descriptions. From a strictly call type/pt care standpoint, there is a big difference. When I worked for one of the privates, 90+% of my calls were routine NETs and very few of the "emergencies" at our contracted nursing facilities were actually medical emergencies. We saw essentially no trauma patients other than slip and falls at the nursing home.

    In my current position with a municipal 911 service, I do essentially no NETs and I see a wide range of medical and trauma calls from minor to severe along with the environmental challenges that go with calls that aren't coming out of a medical facility.

    There is also a noticable difference in the overall quality of provider between these two situations. Both have their good and bad people, but these "privates" here have noticably poorer providers on average.

    To say that working on an ambulance in both of these environments is "the same" is ridiculous at best.

  6. #6
    Forum Member DrewOnFire's Avatar
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    I think having Fire and Ambulance services separate is best.

    Advantages;
    - The medics train to do medical things, they become subject matter experts in their craft, advanced life support and prehospital care.
    - Firefighters are able to train on fire, rescue, HAZMAT, Technical Rescue, all the other things, and BLS life support.
    - You don't have ****ed off firefighters that get "stuck" on the box, and vise verse.
    - Fire can still provide First Responder BLS service, spreading the wealth of coverage.

    I do understand that there are some advantages; mostly on the administrative and QA/QC side of the house, but if the two separate entities have a great working relationship, even operate out of the same quarters, then these advantages of Fire Based Ambulance are opaque at the worker bee level.
    Drew Lyman,
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  7. #7
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    I have worked both. Lets start with the obvious, Private = for profit, non-private (fire based) = tax dollars. I started at the private to get my feet wet and get some experience in the back of the bus. The problem though, they didn't really push patient care. All they wanted was to turn the calls over quicker. I myself hated that. On the fire based, I get less pay for one, but have been A LOT HAPPIER. The deputy in charge of EMS doesn't really care what we do, as long as it is in the best interest of our patient and that I like.

    I think fire based EMS is the way to go. I know that in my home town were I am a volly, they have a private service. They are a hospital based service that usually handles 95% of there calls. The volly dept does not do any EMS. I believe in the next few years, its going to be harder for my chief to justify certain things especially when the call volume is not there. We just barely got approved to get a new tower. Now, if we had a fire based ems you would also get more bang for your buck. Right now the private just shows up and sits in the rig waiting for command to tell them to do something. And were I am a paid person, they have a combi dept. So more times then not we are the first in on a lot of fires. I know another town just south of us that hired a secretary that was also an EMT so if there was a back up call and the on duty medic was tied up, she could handle the call with the chief. And they are possibly going to hire FF/EMT to an IT position for the town. Again, multi role saves town money.

    In just my opinion, I like fire based EMS better then private.

  8. #8
    makes good girls go bad BLSboy's Avatar
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    Quote Originally Posted by DrParasite View Post
    and if you are going to compare, might as well throw in hospital based systems, municipal 3rd party service, and the volunteers.
    3rd service municipal. Hands down. If only every city/township/county had the funding for it....
    No arguing that one at all. I dare ya.
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  9. #9
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    Fire based EMS:
    Too manys FD buffs that only care about fighting fire and let patient care suffer
    and/or
    Too many EMS buffs who could care less about firefighting and cant handle a 2 1/2 to save their lives.

    Both are highly technical fields that take a lifetime to master. No reasonable human can be proficient at one without letting the other skill set suffer. I only see FD based EMS justifiable in a smaller community where their isnt enough fire duty to justify full time firefighters, and then only for the BLS level.

    Private/hospital based EMS:
    Good place to start an EMS career, or bide time while waiting for FD or PD list. However, lifers tend to be skells who cant pass psychological or physical tests for civil service positions.

    Volunteer EMS: While well meaning, usually lack experience and make poor decisions resulting in sub par patient care, also not reliable unless they have riding crews in station. They are a good place to gain experience before taking a paid position. If willing to ride with less than top of the line apparatus, they are probably the best bang for the taxpayer buck.

    3rd party municipal service:
    In my opinion the best option if well funded. They dont have to worry about the profit margin as much as privates, and have employees completely dedicated to EMS and EMS training. The downfalls-can be costly to smaller communities and often the stepchild to the more glamorous FD and PD.

  10. #10
    MembersZone Subscriber MalahatTwo7's Avatar
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    Having worked a bit with private, and now with fire based, each has its own merrits and should be accepted accordingly. I will agree that in a fire based system, you do get your "Grumpy Groans" (FF's) who dont like riding the box, but then you also get those who dont like Engine work either. So thats a fair trade off (if only Management would get on track with that? LOL) {and NO I am not Union}

    Currently I am enjoying the combined system. I can ride either unit, with the Career staff in the Medic or Engine and I can ride with the Vol staff, so personally I think its about as close to the best of both worlds as it can get.

    But in the end, I believe that the question to ask is "What is best for the people we serve in terms of service quality?" that should matter. And both systems provide for that in their own way. Whatever works best for you in your town is all that is important.
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  11. #11
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    Quote Originally Posted by BLSboy View Post
    3rd service municipal. Hands down. If only every city/township/county had the funding for it....
    No arguing that one at all. I dare ya.
    No arguing it at all? Hands down? Read up on Seattle/King County. Largely fire based, and probably the best EMS system in the US.

  12. #12
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    While I'm definitely not a fan of the "jack of all trades" situations we end up in, I do like the Fire based EMS system for the quality service it delivers.

    We have plenty of personnel in my dept. who either have or still work for private EMS services, some municipal EMS only services, a few third service private EMS. Given my exposure I've drawn the following conclusions:

    Municipal EMS Only: The management and mission is good, trying to provide the best quality service for the community. The personnel start off great and burn out. Fulltime EMS while sometimes rewarding, is often frustrating. No one likes dealing with drug seekers, drunks, druggies and people who'd rather call a "free ambulance" than a taxi for the scratch on their knee. When this is all you do, burnout is inevitable. Toss in some transfer trucks to help pay the bills and then listen to the whining. Smaller system allow for less advancement. Less structure than FD, but still organized as a municipal entity . Municipal pay is not as good, but the benefits are usually decent.

    Private for Profit EMS: First and foremost is that they have to make money, so unless the system is very busy and the customers are above the poverty level, the service needs to keep costs low. This results in older equipment, less pay, personnel that can't make it elsewhere or newbies looking to work while applying for every other Fire/EMS job around. The burnout rate is probably even higher as the cost cutting measures tend to be a real downer compared to the others with nice new toys and going to all the conferences. Trucks tend to have much longer overall response times due to the shortage of trucks and personnel as to be profitable the trucks can't sit around. Very little career advancement opportunities compared to other systems. Run like a business, not a structured organization. While pay may be higher, the offer of a retirement is almost laughable as the percentage of retiring EMSers from private companies seems extremely low.

    Fire based EMS: Management and mission are great as the system is community based. Providing the highest quality service within the budget is the name of the game. Because personnel are dual roled they cost less on the EMS side so the "profit" of patient billing can help the tax base or go back into the EMS system to keep it top notched. The personnel are less prone to burnout when they can rotate between assignments. There is generally a true career ladder. Fire based systems have more paramilitary structure. Pay is genereally decent, benefits better, good chance this a true career.

    That's what I've noted in my small part of the world. I'm sure there are plenty of other systems that can or do work, but I'd like my family protected by a fire based service.

  13. #13
    makes good girls go bad BLSboy's Avatar
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    I have only see one person really hit the nail on the head, and that is TheStreets.
    That the Ambulance is often called the Pus Bus, the Penalty Box, among many other unsavory names, is not for no good reason. There are VERY few Firefighters that actually have the want, and desire to excel at BOTH fire and EMS. You can have one of the best FireMedics taking care of you after you suffer an MI, MVC, or any other emergency, but when your house catches fire, they are JAFO.
    Same goes for the fire side. A GREAT FireMedic knows his first due inside and out, is the best nozzleman, and teaches the probies all the tricks of the trade. But when he is up for rotation to the Box, the pts just don't see the quality care that they deserve.

    Fire based EMS HAS created alot of jobs for our profession. But at what cost to the citizens that we serve? They have outstanding fire protection, but when they call 911, for a medical emergency, they don't receive the best care. Or their house burns down cause everyone is so good at EMS, they forget their jobs.

    Everywhere I have traveled, or worked, and I have talked to the firefighters that are on the Box, they all tell me they same story.
    GET ME OFF.

    Do YOU want them taking care of you?
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  14. #14
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    Yes.

    private service is for a side job.

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    Quote Originally Posted by BLSboy View Post
    I have only see one person really hit the nail on the head, and that is TheStreets.
    That the Ambulance is often called the Pus Bus, the Penalty Box, among many other unsavory names, is not for no good reason. There are VERY few Firefighters that actually have the want, and desire to excel at BOTH fire and EMS. You can have one of the best FireMedics taking care of you after you suffer an MI, MVC, or any other emergency, but when your house catches fire, they are JAFO.
    Same goes for the fire side. A GREAT FireMedic knows his first due inside and out, is the best nozzleman, and teaches the probies all the tricks of the trade. But when he is up for rotation to the Box, the pts just don't see the quality care that they deserve.

    Fire based EMS HAS created alot of jobs for our profession. But at what cost to the citizens that we serve? They have outstanding fire protection, but when they call 911, for a medical emergency, they don't receive the best care. Or their house burns down cause everyone is so good at EMS, they forget their jobs.

    Everywhere I have traveled, or worked, and I have talked to the firefighters that are on the Box, they all tell me they same story.
    GET ME OFF.

    Do YOU want them taking care of you?
    Once again, I must point out sucking at your job is not a systemic problem. It is a personal problem. If you don't like, want, or can't do it. Quit.

  16. #16
    Forum Member sfd1992's Avatar
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    Quote Originally Posted by OneL1L View Post
    No arguing it at all? Hands down? Read up on Seattle/King County. Largely fire based, and probably the best EMS system in the US.
    Not gonna argue on performance, but to call King Co. largely fire based is subjective, and semantics.

    South King County Medic One, (I believe the largest ALS provider in the county) is a county-run third service.

    Seattle Fire medics for the most part work ONLY on medic units, no real firefighting time. Fire based, yes, but not what most people would describe as "dual-role" FF/PM.

    Not sure on how Bellevue and Shoreline work their medics.

  17. #17
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    Default Believe me I saw this a mile away.

    I knew this would be a very interesting topic, and I am sure it will be 20 years from now. I will have to say that I did miss title this. I should not have used the word better and said "what do you prefer." As far as what I do now, I have been promoted to engineer so my days on the squad are limited. Everyone has brought up great points. As far as me saying I was a "better" medic in the private side, I meant that I knew my meds (pt meds) much better and that I was top notch on my protocols and trees. Am I a bad medic now? No, the pt care always comes first. Even if there is a pie or turkey in the oven at the fire house. I think I have become lax on some of these things now since I have other medics on scene to help with pt care. Private side it was my decision only. There was no "what do you think." I will and should have said earlier that in my opinion, the "fun" is gone. What was new is no longer. Does that make me a crabby piece of poo? No. I still enjoy a good resp call that you have to diagnose and tx correctly. It is just the 10 stupid calls before that that gets to you. Now back to the topic at hand. I do, or should I say did, enjoy having a break from the bucket when it was my time to ride backwards. Private side, it got old fast. I realize that is purely personal. My brother is a medic and would live in the back of a squad if he could. I guess what I am asking at the end is do you like working fire based or private (which includes everything else other than vol). No vol only because there is no pay.

  18. #18
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    Anything is better then a for-profit company providing EMS.

  19. #19
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    Quote Originally Posted by TheStreets View Post

    Both are highly technical fields that take a lifetime to master. No reasonable human can be proficient at one without letting the other skill set suffer.
    Call it a pet peeve or whatever, but I hate it when people try and use this arguement to try and justify the seperation of Fire and EMS.

    I agree that firefighting and pre-hospitial medical care ar both highly technical and take time to master. I don't disagree that there are some bad eggs out there. I just have a problem with this notion that if one does both, then they automatically can't be very good at both.

    If this were really true, then every volunteer fire or ems worker holding any sort of "technical" civilian job must either be bad at their job or bad at firefighting or ems. The same would have to be true for every career FF or EMS person holding an unrelated second job. From personal experience, this just isn't true.

    If a person can do both jobs compotently, why is that not good enough?

  20. #20
    55 Years & Still Rolling hwoods's Avatar
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    Quote Originally Posted by FireMedic049 View Post

    I agree that firefighting and pre-hospitial medical care ar both highly technical and take time to master. I don't disagree that there are some bad eggs out there. I just have a problem with this notion that if one does both, then they automatically can't be very good at both.

    If this were really true, then every volunteer fire or ems worker holding any sort of "technical" civilian job must either be bad at their job or bad at firefighting or ems. The same would have to be true for every career FF or EMS person holding an unrelated second job. From personal experience, this just isn't true.

    If a person can do both jobs compotently, why is that not good enough?
    I THINK WE HAVE A WINNER!!......... Very Good Points.

    In this area, EMS is Fire Based. Period. There are a few private, for profit, Ambulance Services around, but they only do "routine" transportation between facilities, etc. A Private running lights and siren is a rare sight in these parts, they simply don't do Emergency calls. By Law, in Maryland, you have to call 911 for an Emergency, and 911 only sends FD/VFD Units. Not to say that a Private won't help if needed, they do quite often, since many of their Employees are members of a VFD, and have some street smarts.

    My personal preference is for Fire Based Everything. If ONE agency can handle all Emergency Services in a Community, except Knives and Guns, everyone benefits. Here, we do it all, Fire, EMS, Hazmat, Rescue, Bombs, you name it. As a result, there is very, very, little interagency squabbling over anything. And that's the way it should be.
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