Report: FIRE doing EMS should come to an end.

DrParasite

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It is instead a mater of using already existing fire apparatus to augment the EMS response, or more typically make up for a lack of deployment on the EMS side.
so if you deployed more EMS resources, or a more appropriate amount of EMS resources, you wouldn't need so many existing fire apparatus.
Most departments have 70% to 80% calls dispatched as EMS. What most people fail to realize is that a fair number of suppression calls require more than one fire apparatus (box alarms, inside gas leak, pin job, fire alarm, Hazmat, CO alarm, things like that). EMS typically gets an ambulance with two people on it at a minimum.
I call BS on this entire statement. A Box alarm gets 4 engines, 2 ladders, 1 rescue, & 1 chief on dispatch, but most calls are downgraded to maybe 1 engine and 1 ladder once the first unit gets on scene and confirms it's BS. Most inside gas leaks get a box response, but can be handed with 1 engine and 1 ladder once the gas company gets on scene. Pin jobs require 1 engine and 1 rescue. CO alarms require maybe an engine. major hazmats are like structure fires: very manpower intensive, require a lot of resources, and are relatively rare compared to the overall run volume.

I would wager than many calls "could" be handled by one apparatus; however it's more efficient to have two or three units working together to achieve a common goal.

EMS has two people on an ambulance, compared to 3 to 5 on the fire apparatus. And it's rare to get more than one ambulance on a scene for one patient.
A more fair way to compare suppression vs. EMS call volume would be to count the total number of ambulances that received a call over a year vs. the total number of suppression units that received a call over a year (excluding medical aid of course). That would tell a very different picture than the old "80% of calls are EMS, so take away engines and put more ambulances on the street."
not sure what you mean.... if you compare the UHU of a fire unit and an EMS unit, i'm pretty sure the EMS unit's would be higher.
Don't get me wrong, I feel that most places don't put out enough ambulances to handle call surges, much less give the average unit some downtime (#SSM/PUMsucks). The truth is, most employers are going to put out just enough ambulances to handle normal call volume.
I would argue that most don't put out enough, and use the FD to pick up the slack.
FWIW, regarding the disdain of fire crews towards having to do EMS txp, from what I've seen and heard, the issue isn't so much of hating to pt. care per se. The bad attitude towards txp is more because of the nature of many of the calls, how they're typically non-acute, typically situations where an ambulance was not needed. This viewpoint is not exclusive to fire. These types of calls routinely burn out career EMT's and medics as well. The EMS people are pretty much stuck with having to run these nothing calls all of the time, whereas the fire people desire an escape from these time draining, unnecessary calls by getting off the ambulance onto a suppression piece.
agreed

Realize that I got my start in NYC 911, three as a basic, two as a medic, and another 7 in my current system as a medic. When I started out I envisioned myself as a career medic, but the all-ALS system has killed my enthusiasm for txp. Life is much better as an engine medic. Every firehouse in my system has an ALS engine and a medic unit, and four stations have an extra medic unit. We chase the medic on the majority of our calls (we have the same EMD system being used by dispatchers with no EMS experience). If the medic needs me to txp, it is because the pt. is in some sort of real distress, so I get to do pt. care, and the txp. medic gets stuck with cleanup (I do what I can until the engine shows up) and the report, and I get to go in-service. A 90 min. call is only a 30 min. call for me.
truer words were never spoke. I spend the first 15 years of my career on an ambulance. Since I relocated, and accepted a new position, I'm almost entirely on the engine for an EMS call (or Rescue if that is dispatched). We also have an ALS ambulance in our firehouse, so they are usually there within 5 minutes of our arrival. We also only go on life threatening calls. It's so much better than being an the ambulance. and it's more fun.
That is why I, and the majority of fire based EMS people try to avoid working txp.
I've said this before, and I will say it again.... if a FF says they are an experienced EMS professional, and they have never worked on an ambulance, I don't trust them. They haven't done EMS; first responding and then turning the patient over to the ambulance crew for transport is much different than handling patient care from initial contact until you arrive at the ER.
Fire people escape from that by going into different job functions. Single role EMS get into dispatch, promote (rare), educate/promote into another area of healthcare, or just quit. 13 years in the field, with well over 13 yrs worth of txp time (based on a 40 hr workweek), I'm over doing non-acute BLS or VOMIT (vitals/O2/Monitor/IV/Txp) as the vast majority of calls. Give me my old ALS job types with no dispatched BLS, running out of a station that has beds, shower, gym, kitchen, a 24/72 schedule, with NY money, with FD retirement and benefits, I would be okay doing txp for the long term. That does not exist.
I'd be happy for a BLS job where I got the same amenities you describe, but still have enough downtime to sleep in a bed, work out, shower, and learn new things about my job. Bonus points if I can be housed in an EMS station, instead of being a guest in the house of another agency.
 
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#truth
 

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I Am of the opinion that EMS should provide pre-hopsital medical care and fire departments should put out fires.

Staffing an engine with 4 EMTs to first respond to a medical call when i could put that same manpower out with 2 transport units seems far more logical when 90% of our calls are medical. I also am strongly against the FD involvement in rescue operations. Both my EMS jobs provide rescue services as do many other jurisdictions because rescues are patient care activities. I do not need an engine with 4 guys and a rescue with 4 guys. I can run a pin job with a 2 person ambulance and a 2 person rescue, which is how we run at all my jobs, its how most EMS rescues run, a 2 man crew. I dont need them on MVAs ever. Our fire departments are suppression only agencies and this is how it should stay.

Maybe we should have EMS-based fire!
 

Martyn

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No... the point is... stop putting paramedics on fire trucks all together. Stop forcing all the firemen to go to medic school.

Everyone now will be grandfathered in of course, they will never get away with getting rid of folks for being over qualified. No matter how hard they pushed, but implementing new rules. Then you'd save a ton by cutting the salary 5, 10, 20 percent (I dunno, I'm not an economist) on new hires, and in turn reduce the pensions, etc... You'd also save by not having to buy ALL of your apparatus ALS equipment, you could also spend less on purchasing 2-3-4 more ambulances versus a single pumper or ladder truck. All of these things are pretty much mentioned in the article.

And stop all the medics having to go to fire school. I joined EMS as an EMT NOT a firefighter.
 

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“If this was about patient care,” van Pelt says, firefighters “would be advocating to the politicians to increase EMS money, increase hospital money.”

Well, derrh....er, yeah
 

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Interesting Article regarding Firefighter/Paramedic matters in Ontario that was published in the Huffington Post:
By: Michael Kruse
Paramedic, Science Advocate

The Dispute Between Fire Fighters and Paramedics Threatens Patient Safety
Posted: 07/29/2015 12:58 pm EDT Updated: 07/29/2015 1:59 pm EDT

This is a longer post than most, but this is complex subject that required a full-throated rebuttal. This post does not necessarily reflect the opinions of my employer.

No doubt you have been aware of the conflict that has arisen again in Ontario between paramedics and fire fighters. At issue is a proposal from Ontario Professional Fire Fighter's Association (OPFFA), the fire fighter's union, to the Ministry of Health (MoH) that outlines a pilot program to introduce a full suite of "symptom relief" medications to front line fire fighters. Medications identical to those carried by primary care paramedics in order for "fire medics" to start treatment before the arrival of paramedics.

This has paramedics in Ontario steamed for many practical reasons but I think what has us really mad is the success that the OPFFA and their president Carmen Santoro have had in selling this to the media and the public. Fire fighters have a lot of cultural and political power, and we don't like it one bit.

Read the rest here: http://www.huffingtonpost.ca/michael-kruse/fire-medics-will-fail-in-_b_7891754.html
 
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Interesting article reflecting the FD in EMS in The Washington Post. That is, however, a subtopic in this article, which mainly focuses on the lack of need for such large departments with excessive payrolls and budgets. The comments are hilarious, the firefighters are up in arms that someone (a university law & economics professor) put some statistics together and is seemingly anti-paid FF and anti IAFF. I think he makes a lot of sense, but I don't agree with every point. Valid questions are raised.

While I agree that FD budgets and salaries are too high, and that there should be less fire engines and more ambulances, I do not agree that all FDs should be volunteer.

I post the article and its flaming rebuttal - seriously... This guy has got these firemen all fired up! (pun intended)

Article:
https://www.washingtonpost.com/opin...c647a395_story.html?postshare=901441781301698

Rebuttal: (one of many as you can imagine)
http://www.statter911.com/2015/09/0...ton-post-should-be-ashamed-for-publishing-it/
 

46Young

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Interesting article reflecting the FD in EMS in The Washington Post. That is, however, a subtopic in this article, which mainly focuses on the lack of need for such large departments with excessive payrolls and budgets. The comments are hilarious, the firefighters are up in arms that someone (a university law & economics professor) put some statistics together and is seemingly anti-paid FF and anti IAFF. I think he makes a lot of sense, but I don't agree with every point. Valid questions are raised.

While I agree that FD budgets and salaries are too high, and that there should be less fire engines and more ambulances, I do not agree that all FDs should be volunteer.

I post the article and its flaming rebuttal - seriously... This guy has got these firemen all fired up! (pun intended)

Article:
https://www.washingtonpost.com/opin...c647a395_story.html?postshare=901441781301698

Rebuttal: (one of many as you can imagine)
http://www.statter911.com/2015/09/0...ton-post-should-be-ashamed-for-publishing-it/

Seriously, that's the best that you can do, there are less fires, so replace reduce staffing and deployment, and somehow reverse the trend of dwindling volunteer participation and replace the career members? I almost spit my drink all over my computer when the author used the rationale that the Revolutionary War soldiers were volunteers, so firefighters should be the same. Using that logic, we should replace EMS, police, nurses, and perhaps even incoroprate volunteers into our Armed Services to replace paid soldiers. At least he admits that firefighter salaries can more than double with OT. So, with that admission, we can take his LA average salary of $142,000, and realize that the pay before any OT would be $70k/yr or less, not really out of place in a region with a high cost of living such as LA. Realize as well regarding OT budgets that if the OT burden becomes too great, they will hire more employees. There is always a balancing act where it costs less to pay out OT rather than hire more people, since it cost $$$ to hire, train, gear, pay benefits, and retirement to more employees. To a point, paying existing employees 1.5x is the cheaper option.

Also, it's not "the firefighters are up in arms that someone (a university law & economics professor) put some statistics together," it's Dave Statter, a civilian reporter that runs a fire blog, not a member of service.

I've explained numerous times on this forum that the fact that fires are less frequent is not a justification to reduce staffing and deployment of suppression resources. Fires still occur, and many residential building s do not have sprinklers. Fires burn much hotter, and much more rapidly than before, due to the proliferation of type V construction (lightweight wood construction) which has a high fire load, and a large degree of synthetic materials in most homes, which also burns hotter, faster, and gives of more toxic byproducts than natural materials that were found in older homes. If anything, there needs to be a more rapid response time than there has been in the past, and there needs to be an adequate number of firefighters on each apparatus to quickly accomplish vital fireground tasks upon arrival.

Don't take my word for it, look instead at these two links. The first is a NIST video from UL that compares a legacy room to a modern room, and the difference in time to flashover. The second video is from the NIST studies that we did in Crystal City in Arlington VA. I participated in this study. The purpose of the study was to show how different staffing and deployment scenarios affected the timeliness of various fireground tasks.

http://www.firefighternation.com/videos/legacy-and-modern-fire-behavior

http://www.nist.gov/fire/staffstudies.cfm

The author also chose to focus on figures regarding confirmed structure fires, and conveniently overlooked all of the other supression-related calls. I don't see how terrorism training would significantly increase staffing levels. He's reaching really far with that one. Just like fire has it's "food on the stove," smells and bells, minor outside fires and such, EMS gets it's share of false alarm medical alarms, pt. refusals, no pt. found, things like that, and also what I would call a scourge of unnecessary transports, which would be patients that are able to transport themselves to urgent care of their PCP, for conditions that will not have a change in outcome from using (abusing) EMS resources to txp to the ED.

This was also a regurgitation of a similar article from 2002. I can say from personal observation, at least in the Northern VA/MD/DC area, that there has been a decrease in volunteer staffing/participation, and an increase of career staffing for area departments. More and more stations that were formerly 100% volunteer now have daytime paid crews, and combo stations progressed to 24/7/365 paid crews. For example:

http://www.wboc.com/story/9693807/gainesville-volunteer-fire-department-dissolved

Fred's old article:

http://www.econlib.org/library/Columns/Mcchesneyfire.html

I challenge you to review Dave Statter's response, and show how/where he is inaccurate. I agree with Dave when he says that the article was "Truly one of the dumbest articles ever written about firefighting & the Washington Post should be ashamed for publishing it." I was astonished at how overwhelmingly ignorant that piece was. To someone that doesn't know any better, the article would seem interesting, but when you look at the actual facts his logic fails in grand fashion.
 

46Young

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All fired up... See....

How dare we question the failing economical and antiquated model of the fire service and the dwindling need for the hoards of union firefighter across these here United States of America! An Engine AND a ladder on every stubbed toe! :rolleyes:;) With spare units in every station in case of a national disaster! Terr'ism and backdrafts can come out of nowhere!

(Those are my sarcasm faces).

Listen, you can get mad all you want... The part where I said firefighters are up in arms was not directed at the rebuttal blog, but rather the thousands of combined comments by fire service members on the various media outlets where the article and other rebuttals are published online. I.e Social media, blogs, and The Washington Post's own website.

This going to be a fiery and explosive debate without regards to the actual fundamentals and basis for the query.
Jobs and salaries are being called into question as well as why fire trucks are rolling on knee pain calls... So I fully expect the defensive posture.

The bottom line is that we all agree that something needs to change. And nowhere in my commentary did I say I think he was 100% right. I was merely presenting an article, and a rebuttal, to highlight the growing concerns over the way the fire service currently operates and its need for its own overhaul. The public is taking notice and politicians are taking notice. Save for another post 9/11 hero syndrome, this isn't going away.

I am in the middle of the road on the issue. I don't think they ought to lose their jobs, but I do think we need more ambulances and less fire service vehicles when it is absolutely clear that around 90% of all calls are EMS related. If you ignore that little factoid then your words are hallow. I'm not "anti-fire" at all, but the current model is unsustainable. These are the questions/thoughts we have been asking/thinking as a public service community for a long time, and now the issue has captured the attention of people who have new ideas and make decisions. That's the best I can do.
 

46Young

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All fired up... See....

How dare we question the failing economical and antiquated model of the fire service and the dwindling need for the hoards of union firefighter across these here United States of America! An Engine AND a ladder on every stubbed toe! :rolleyes:;) With spare units in every station in case of a national disaster! Terr'ism and backdrafts can come out of nowhere!

(Those are my sarcasm faces).

Listen, you can get mad all you want... The part where I said firefighters are up in arms was not directed at the rebuttal blog, but rather the thousands of combined comments by fire service members on the various media outlets where the article and other rebuttals are published online. I.e Social media, blogs, and The Washington Post's own website.

This going to be a fiery and explosive debate without regards to the actual fundamentals and basis for the query.
Jobs and salaries are being called into question as well as why fire trucks are rolling on knee pain calls... So I fully expect the defensive posture.

The bottom line is that we all agree that something needs to change. And nowhere in my commentary did I say I think he was 100% right. I was merely presenting an article, and a rebuttal, to highlight the growing concerns over the way the fire service currently operates and its need for its own overhaul. The public is taking notice and politicians are taking notice. Save for another post 9/11 hero syndrome, this isn't going away.

I am in the middle of the road on the issue. I don't think they ought to lose their jobs, but I do think we need more ambulances and less fire service vehicles when it is absolutely clear that around 90% of all calls are EMS related. If you ignore that little factoid then your words are hallow. I'm not "anti-fire" at all, but the current model is unsustainable. These are the questions/thoughts we have been asking/thinking as a public service community for a long time, and now the issue has captured the attention of people who have new ideas and make decisions. That's the best I can do.

No one's getting mad, nor is this "fiery and explosive." Dave Statter, Barry Greer and myself have presented facts to refute McChesney's article in totality. I do agree that we need more ambulances - I've said this on numerous occasions. However, it shouldn't come at the expense of de-staffing fire suppression personnel. "The 70%-90% calls are EMS so scale back fire" position has already been debunked.

Again, where in Statter's or Greer's rebuttals were they inaccurate? Let's discuss the facts, not personal opinion.
 

46Young

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I Am of the opinion that EMS should provide pre-hopsital medical care and fire departments should put out fires.

Staffing an engine with 4 EMTs to first respond to a medical call when i could put that same manpower out with 2 transport units seems far more logical when 90% of our calls are medical. I also am strongly against the FD involvement in rescue operations. Both my EMS jobs provide rescue services as do many other jurisdictions because rescues are patient care activities. I do not need an engine with 4 guys and a rescue with 4 guys. I can run a pin job with a 2 person ambulance and a 2 person rescue, which is how we run at all my jobs, its how most EMS rescues run, a 2 man crew. I dont need them on MVAs ever. Our fire departments are suppression only agencies and this is how it should stay.

Maybe we should have EMS-based fire!

Pin job - best practices, engine blocks the scene, and staffs a hoseline to protect the patient and Heavy Rescue crew. The other engine bucket person can go into the car for pt. care, if the txp crew wasn't issued PPE. The txp crew is better off not getting dressed anyway, at least not in hot weather - it can be distracting to pt care to be soaked in sweat, overheated, and in heavy turnouts. The Heavy Rescue - the driver sets up lights if needed, and humps equipment to the car. The rt bucket grabs the tools and generator if needed -we use Holmatro. The left bucket brings cribbing and begins stabilization. Two bucket people should be used - one cuts, and the other one spreads. For stabilization - we use Res-Q-Jacks typically - you need one person on each side with the officer controlling the lift on each side with commands. Airbags - two bucket people cribbing, the driver operating the airbag, the officer giving lift commands. Less than 4 people and you're getting away from best practices. A side out should only take a few minutes, a routine dash lift or roll, 5 minutes for a routine operation.

As far as MVA's, anyone who doesn't want a suppression unit to block is endangering everyone at the scene. First responders and victims can get hit by traffic trying to squeeze by, or by distracted drivers that plow into the scene at full speed. Research how many cops, EMS, and fire get hit and sometimes killed by other cars while working the scene.
 
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Stats can be manipulated to fit any argument. I don't need to debate everyone's articles to know there is a problem. I am basing my opinion on my own experience in 3 different urban US EMS systems. I don't care what Statter or Greer or McChesney say... they all have statistics and opinions. I've read what they said, they all paint nice pictures that support their agenda. As I said, the fire service feels threatened, and the defensive posture is expected.

My intent is not to come to a conclusion with you that solves the issue right here on EMTlife.
Again, I'm just pointing out that the issue is becoming public domain, and the people who are going to make the decisions (read: not you, not I) are taking notice. That is the only fact I care about. I will be well into grad school way before any real changes take place. Right now, it's all just beating chests.

Also... everyone has an opinion.
 

46Young

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Stats can be manipulated to fit any argument. I don't need to debate everyone's articles to know there is a problem. I am basing my opinion on my own experience in 3 different urban US EMS systems. I don't care what Statter or Greer or McChesney say... they all have statistics and opinions. I've read what they said, they all paint nice pictures that support their agenda. As I said, the fire service feels threatened, and the defensive posture is expected.

My intent is not to come to a conclusion with you that solves the issue right here on EMTlife.
Again, I'm just pointing out that the issue is becoming public domain, and the people who are going to make the decisions (read: not you, not I) are taking notice. That is the only fact I care about. I will be well into grad school way before any real changes take place. Right now, it's all just beating chests.

Also... everyone has an opinion.

If their positions are simply a matter of agenda and manipulating statistics, it should be rather simple to disprove them, and lend credibility to McChesney's position. Strengthening McChesney's position would give power to the position of reducing the FD budget (reducing personnel) to upstaff EMS. I simply asked for valid rebuttals against the response to McChesney's article, and you haven't been able to do that thus far.

Again, I have said time and time again that there needs to be more ambulances. Most EMS agencies, whether they're privates, hospital based, or muni Third Service, typically try to get by with the least amount of ambulances possible. SSM/PUM, and the reliance of automatic/mutual aid or calling up private ambulances for call surge on a continual basis is a strong example of that. Every so often someone comes along and says to decrease fire staffing/funding to fund EMS positions. I find that ignorant, as in lacking knowledge of the subject, not in a derogatory way. The point of my earlier responses is that it goes way deeper than a simple call volume ratio of 70%-80% in favor of EMS, and employee salaries. I'm asking to be shown how the numerous other considerations (the responses to the article) should be marginalized or not considered whatsoever, which would make the 70%-80% call volume thing a strong enough reason alone to do what you advocate. But it's not.

Does the fire service put substantial energy and resources into protecting and advancing our careers and benefits? Yes, we do. This is why it's so quick and easy to source valid rebuttals with data and sometimes studies to support our position. These studies and data are useful when it comes to writing grants, or protecting our budget allowance with the Board of Supervisors. For example, from the NIST study I posted earlier, we were able to add a fourth person to 8 of our ladder trucks, and we've had another grant approve to hire for the remaining six units. We have those 14 positions reserved for an ALS provider. It may not affect pt. outcomes most of the time, but it sounded good to the politicians. We were also able to add an extra fire station recently with an engine, medic unit, and a tanker. ISO trials helped us out there. Every time we get an engine, we also get an ambulance. We would be going backwards, and getting our pay reduced if we based staffing and deployment solely on the number of calls dispatched EMS, and the number of calls dispatched non-EMS. It's not that simple.
 

46Young

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Post #481:

http://www.emtlife.com/threads/aust...ying-them-as-basics.31397/page-24#post-588864

I compared ATCEMS (single role EMS, regarded as one of the best in the nation), vs. my department. We have less than half of the square miles, about the same population, 5 more ambulances, all of which are ALS and 24/7/365, vs their system, which has 37 ambulances, not all of which are full time. Their EMS call volume is double ours. Their fire department has 45 stations, so maybe 45 engines at the most, probably less. We have four more ambulances than we do fire engines (38 engines, 42 ambulances). Basically, we provide more than double the ambulance coverage than one of the most highly regarded single role EMS systems in the nation. Yes, it's not cheap, but if it were, you would have a situation in Austin, with rampant turnover, frequent forced OT, documented depression and ETOH issues, and very sadly, two suicide (RIP Brothers). Our IAFF Local has lobbied to keep and increase job positions, which is easier to do when you demonstrate your worth to the public, instead of letting things like reduced fires and having the bulk of dispatches being ALS gut your staffing levels. We successfully fought off a reduction in force of over 100 positions the same year that I finished the fire academy. Now, we have safe staffing levels for our ladder trucks, ambulance deployment more than double that of ATCEMS, which keeps our call volume down to 4.45/unit/24 hrs, and we've been able to hire enough new medics to quiet down the mandatory hold/recall OT that was beginning to become a problem, although not as bad as ATCEMS.

I left EMS and joined fire, partly because it's a significantly more secure career, with much better working conditions. Firefighting wasn't my first choice of a career. I had done six years in EMS before going fire. I saw/experienced what kind of deal the typical single role EMS provider can expect, and I wanted out in a bad way. Other medics in my recruit school that were also EMS refugees all said that they would never go back. If nothing else, if I had to do EMS only in this department, it's very cushy compared to what I've seen on the non-fire EMS side. That was my plan if I found out that suppression wasn't my cup of tea.

Also, the Austin FD runs 70% medical calls, not 80% or 90% like some people say:

http://www.austintexas.gov/department/fire/about
 
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I know you have a well articulated argument, and you really want to debate this issue. I am not the guy. Debate is great, but no one is changing their minds on this issue - no firefighter is ever going to say, "You know, I make too much..." or "You know, they're right. I really don't need to be here today. I'll volunteer for a brownout." That said, I have no desire to beat chests and see who can scream the loudest, use the biggest words, and/or frighten the populace the most that they may burn to death if we take a single engine out of service. I don't care to debate that with you further. Times are changing - this is happening, and the IAFF and its members are going to have to swallow the pill the hard way, or have it forced down their throats. You may disagree, but this is happening. Overall, nationwide, the IAFF and fire service has had held the reigns of its own destiny for too long, and has gotten out of control.

I have my own opinions based on my own experience; you have yours. Taking statistics from a single department or two or three does not exemplify anything of substance. It is merely statistical bias and sample bias, and really is not a measure of the systemic issues nationwide. Sure, you think FD is doing it right - you're a firefighter... I am not shocked. I see things from a different lens than you do. Do I hold a bias against the fire service? No, I whole heartedly do not have a bias against the fire service. However, as a taxpayer I believe the fire service is chewing through an insane amount of public funds that does not match or commensurate with the actual tangible requirements for fire and emergency protection. I also see a different perspective, coming from dual-response services where, indeed, engines and ladders are rolling out to chronic abdominal pain et.al. patients which is just plain wasteful.

As a taxpayer and a man on the inside I see a need for overhaul. Your vigorous defense and the IAFF's vigorous defense is not surprising, as I have beaten to death that point. I think a lot of things need revision... The fire service just happens to be one of those items.
 

Bullets

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Pin job - best practices, engine blocks the scene, and staffs a hoseline to protect the patient and Heavy Rescue crew. The other engine bucket person can go into the car for pt. care, if the txp crew wasn't issued PPE. The txp crew is better off not getting dressed anyway, at least not in hot weather - it can be distracting to pt care to be soaked in sweat, overheated, and in heavy turnouts..
Transport crew should make contact with the patient and maintain that for the entirety of the call. We issue our EMS turnouts. Our Engine arrives, block and pulls the handline for suppression, maybe throws some speedy dry for fluids. 2 man rescue arrives, driver does the 360 and starts throwing stabilization with the assistance of the other transport EMT. We use Rescue 42s, so he'll throw 2 if the vehicle isnt upright. We dont lift with our struts. 2 man will start the PTO and select his choice of 5 preconnected tools. Once the driver has his stabilization secure, removal will begin. Wtih the ambulance or 2 and the rescue, that gives us 4-6 people more than enough to do 90% of what we encounter

And we also have electric combi tools on the ambulances, so our first due can perform a door pop and cancel the whole response withing 90 seconds of arrival. Cuts down on the amount of code 3 driving, makes everyone safer.

Institutionally, we feel that we are cutting this car, jumping in the water, rappelling down to get a patient who needs medical attention. Why would we send someone trained to put out fire to provide medicine? Do you let your mechanic work on your teeth? If the person was on fire then we would call someone trained to fight fire. My experiance has been that the fire departments solution is to throw as much manpower at a problem and hope it works out. I would rather have 2-3 highly trained rescuers than 6-8 average trained ones.
 
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SandpitMedic

SandpitMedic

Crowd pleaser
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And there is more than one way to eat a Reese's....

Or... something like that.

Good post @Bullets
 

46Young

Level 25 EMS Wizard
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In reading the most recent thread about ATCEMS, and how their working conditions are undesirable, it made me realize that their conditions are common throughout EMS. I'm referring to things like frequent mandatory holdover and recall (forced OT), high call volume, too high to do much drilling, self-study, or rest at night, 24 hr. shift in a busy system, adversarial supervision, uneven discipline from one employee to the next, no job security/protection, pay lower than fire or police, and very high turnover with employees burning out, developing alcoholism and depression (see the ATCEMS article on suicides). Having progressive guidelines are great, but not if you're using your KSA's only very infrequently, which is increasingly becoming the case as employers move to a fleet of all ALS (MB staffing).

ATCEMS isn't a ghetto, low funded department, it's top 10 in the nation IMO. If working for a fire department was off the table for me, ATC would be on my short list of places that I would apply to, and follow up aggressively with. The fact is, the fire service has much more influence to prevent many of the undesirable pay/benefits/working conditions that plague EMS. It stinks, but it's also true. EMS should enjoy the same influence as a FD or PD, but somehow EMS got passed by in the race for funding and employee organization (unions and such). I'm sure that there are plenty of FD's that would be happy to leave someone on the ambulance all of the time if that's what they want. After 6 years in EMS, I realized that I'll make out better in the long term by aligning with fire, who offers a much better employment package than nearly all of EMS. It wasn't my original intention, but I want a decent standard of living when I retire.

Ideally, EMS could pull of what nurses did, which is to increase the barrier of entry to a degree, sell the notion that this education benefits the patient, and then command a higher salary with better benefits and job security. Unfortunately I don't see how this will occur. Not too many people want to go to college for 2-4 years to make $12-$15/hr, and bet on that changing in time to plan for a secure retirement. Hence the short average tenure in EMS, where people typically move on to a different public safety profession, a different medical profession, or something else entirely.
 

Martyn

Forum Asst. Chief
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Pin job - best practices, engine blocks the scene, and staffs a hoseline to protect the patient and Heavy Rescue crew. The other engine bucket person can go into the car for pt. care, if the txp crew wasn't issued PPE. The txp crew is better off not getting dressed anyway, at least not in hot weather - it can be distracting to pt care to be soaked in sweat, overheated, and in heavy turnouts. The Heavy Rescue - the driver sets up lights if needed, and humps equipment to the car. The rt bucket grabs the tools and generator if needed -we use Holmatro. The left bucket brings cribbing and begins stabilization. Two bucket people should be used - one cuts, and the other one spreads. For stabilization - we use Res-Q-Jacks typically - you need one person on each side with the officer controlling the lift on each side with commands. Airbags - two bucket people cribbing, the driver operating the airbag, the officer giving lift commands. Less than 4 people and you're getting away from best practices. A side out should only take a few minutes, a routine dash lift or roll, 5 minutes for a routine operation.

As far as MVA's, anyone who doesn't want a suppression unit to block is endangering everyone at the scene. First responders and victims can get hit by traffic trying to squeeze by, or by distracted drivers that plow into the scene at full speed. Research how many cops, EMS, and fire get hit and sometimes killed by other cars while working the scene.

Totally agree with above having attended more than a few MVA's, however...

(Purely hypothetical of course...)...'911, whats your emergency', 'My husband is having a heart attack'....Dispatch then sends engine 220 (a ladder truck), a few minutes after that they then send Medic 72. Meanwhile on scene Mrs X is waiting. The fire truck is 15 minutes away (rural-ish). The ambulance is only 7 minutes away but because they got toned out AFTER the fire truck it takes them 20 minutes to get there after initial 911 call. Meanwhile, on scene Mr X is becoming a smurf, Mrs X doesn't know CPR and is panicking too much to listen to 911 operator. Engine 220 gets on scene and medic starts his magic. 10 minutes after he starts his magic the ambulance arrives...its not looking good. Just across town Mrs Y's son is having an epileptic seizure. She calls 911 and pumper 211 is toned out. A few minutes later medic 74 is dispatched. 20 minutes later Mr J calls 911....'My house is on fire'. Oops, no fire trucks nearby (they are all on medical calls, remember?) so dispatch sends medic 34...don't worry, all the ambulances carry a fire extinguisher!!! And we can always call for backup from the next county. Or we could call the fire off the medical calls, but the fire is just across from engine 220's station and it will take them 25 minutes to get there. Just another busy night, hey ho, we can't save them all.

Having ridden with county ambulances it ALWAYS amazed us how fire beat us on scene 9 times out of 10 and we were only 2-3 miles away from incident, fire was at least 6-7 miles away...turbo charged fire trucks? Or fire getting toned out before EMS just to justify sending a ladder truck for a pimple?

By the way, if ambulances were only sent on medical calls Mrs X's husband might have made it, Mrs Y's son wasn't too bad anyways and Mr J's house might not now be a pile of ashes.

See below
 
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