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Old 11-12-2012, 12:57 AM   #1
46Young
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Stand alone EMS vs combo departments for career development


I'll probably start some beef with this, but I feel that EMS is better off being merged with either police or fire. Why? The career development benefits alone blow away what's available with single role EMS.

For example, in my dept, there are many positions for officers with ALS certs. That fufills the job requirement in a lot of places for EMS management. They ask for "X" amount of years in a supervisory role. It's way, way easier to get a gold badge in a fire department than in single role EMS, where the promotional opportunites are severely restricted. If you want to retire from or leave your current department to be a supervisor or even run an EMS department somewhere else, you'll need supervisory experience, and probably a degree. Good luck getting that necessary experience in most places, where promotions past field provider are few and far between. No one's hiring a career road EMT or medic from somewhere else to run a department.

We have Inspector positions in the Fire Marshall's office, and also Investgation and Code Enforcement positions that require the employee to go through our county's police academy, paid at your regular rate, of course. There's plenty of six figure gov't and private positions available for someone with this type of fire and LE experience. All the better if you have Hazmat or USAR experience, which goes nicely with an Emergency Management degree, which will surely edge out someone with the same degree who has only worked EMS transport in comparison (which the fire/EMS applicant has also done.)

There's plenty of open doors for the EMS/LE employee as well.

Don't believe me? Check out usajobs.gov, filter for jobs over $100k, then filter for positions that can be filled with fire or LE experience as above. Do the same at the state level, and also municipal. Don't forget consulting work as well. How about the FBI? They hired three from my department last year.

Single role EMS offers none of these benefits. This is what smart people do - they retire from their first job, ge tthe pension, then move on to something much more lucrative.

Career development's where it's at! Most EMS employers top out at $60k/yr for medics if you're lucky. I don't know about you, but I can't live on 50% of $60k or less in retirement. That's $2500/month or less pre-tax! If you don't like fire, I would suggest applying for LE positions, and keep EMS on a part-time basis. Some places do LE based flight, such as Montgomery Co. MD and Fairfax Co. VA, for example.


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Old 11-12-2012, 01:10 AM   #2
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But it's impossible to be both a good firefighter and paramedic, the jobs are just too different!

I cannot stand when EMS talks about having more control of HAZMAT and rescue scenes and then turns around and says that firefighters make crappy paramedics because they have too much on their plate.

I'm applying to the FD out here for an FF/EMT position. While I find firefighting interesting, it's never been at the top of the list for professions I want to be in. But working for a very EMS oriented FD makes good sense to me. I can still work in EMS and make a great living, where as a single role EMT I cannot. Any promotion I would have to pay for by getting my medic on my own. With fire I could get my paramedic for free, and with my upcoming bachelors also be in a great position to advance through the department into other not on the line roles. In the meantime I could diversify my workdays learning different rescue disciplines and whatnot.

Frankly it is just not sustainable to stay in EMS in this area for me. The opportunities for promotion are few and far between and the prospect of working 2+ jobs for the rest of my life is not appealing. If the Fire thing doesn't work out (strong chance of that) I will stay in single role EMS until I have had enough and then head back to school.
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Old 11-12-2012, 02:04 AM   #3
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But it's impossible to be both a good firefighter and paramedic, the jobs are just too different!

I cannot stand when EMS talks about having more control of HAZMAT and rescue scenes and then turns around and says that firefighters make crappy paramedics because they have too much on their plate.

I'm applying to the FD out here for an FF/EMT position. While I find firefighting interesting, it's never been at the top of the list for professions I want to be in. But working for a very EMS oriented FD makes good sense to me. I can still work in EMS and make a great living, where as a single role EMT I cannot. Any promotion I would have to pay for by getting my medic on my own. With fire I could get my paramedic for free, and with my upcoming bachelors also be in a great position to advance through the department into other not on the line roles. In the meantime I could diversify my workdays learning different rescue disciplines and whatnot.

Frankly it is just not sustainable to stay in EMS in this area for me. The opportunities for promotion are few and far between and the prospect of working 2+ jobs for the rest of my life is not appealing. If the Fire thing doesn't work out (strong chance of that) I will stay in single role EMS until I have had enough and then head back to school.
Bingo! I would also suggest that you begin chipping away at an Emergency Management degree. You can do a whole lot with it, even with just an EMS background.

LOL about the Hazmat and Rescue (presumably all TROT components as well as extrication). If EMS/TROT or fire/medic is too much for someone to handle, then a four year degree of any kind would be practically impossible to earn! My paramedic education was 13 months, which was two 8 hour days and an average 16 hours/week of clinicals for maybe ten of those months. Fire school was 22 weeks FT, with an additional 16 weeks of field ALS internship. That's maybe equivalent to a two year degree, tops. People make it out to be way tougher than it really is to do both jobs. I submit that those that can't learn and do both probably would have a tough time earning a college degree as well. I believe that it's not so much having two functions as it is the capacity of the individual to learn both functions. Not everyone has that minimal level of aptitude (we're not talking about attorney, MD, IT Specialist, MBA, or Engineering level aptitude, BTW). Really, the paramedic and fire suppression didactic material is presented at a 6th grade reading level, and is hardly fast-paced - there's plenty of time built in for the material to be absorbed, and cognitive skills to be mastered.
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Old 11-12-2012, 02:11 AM   #4
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I wouldn't say I have a beef with it. But I think you are combining 2 seperate issues.

What is best for EMS and what is best for EMS providers are completely seperate.

What is best for EMS is an increased educational requirement with a shift in focus from emergent response and transport to a proactive and chronic management out of the hospital role. (where emergency response is secondary)

Both Police and Fire have had considerable success with this. In doing so though, it becomes a job with responsibilities that preclude being able to effectively multitask in either a fire or LE role.

Undeniably what is best for EMS providers is to get a combination job. For the reasons you have discussed. The only drawbacks are that such positions are very few compared to the number of applicants and not every area of the country could afford such a gravy train.

What you make a year is impossible for most cities to pay. The only solution for them would be to go volunteer. (where the pay really sucks because it doesn't exist) or to cut staffing. Which makes it even harder to actually get a job.

Not to mention it would almost certainly decrease the effectiveness of EMS service when you only have a handful of employees.
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Old 11-12-2012, 02:25 AM   #5
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Originally Posted by Veneficus View Post
I wouldn't say I have a beef with it. But I think you are combining 2 seperate issues.

What is best for EMS and what is best for EMS providers are completely seperate.

What is best for EMS is an increased educational requirement with a shift in focus from emergent response and transport to a proactive and chronic management out of the hospital role. (where emergency response is secondary)

Both Police and Fire have had considerable success with this. In doing so though, it becomes a job with responsibilities that preclude being able to effectively multitask in either a fire or LE role.

Undeniably what is best for EMS providers is to get a combination job. For the reasons you have discussed. The only drawbacks are that such positions are very few compared to the number of applicants and not every area of the country could afford such a gravy train.

What you make a year is impossible for most cities to pay. The only solution for them would be to go volunteer. (where the pay really sucks because it doesn't exist) or to cut staffing. Which makes it even harder to actually get a job.

Not to mention it would almost certainly decrease the effectiveness of EMS service when you only have a handful of employees.
Correct on all accounts.

If EMS had the increased educational requirement and shift in focus, I would have probably not looked to move out of state.

If the firefighter/medic position paid maybe $15,000/yr or less than it does now, I probably would have went back to school to be a PA or NP, or applied for LE. I was also considering NYPD as a resume builder at the time. I was already investigating these options when I was told of this department. I chose to work right near the "center of the universe" (DC) for a reason! I wouldn't do this job in the Carolinas, Michigan, FL, or anywhere else that pays less than what a nurse makes, plus a pension. Basically, I was making $60k/yr in NY, so I wouldn't want to make that or less elsewhere at the start. I learned the hard way in Charleston SC that a lower cost of living does not validate a lower salary. The difference in the cost of living, the pension and deferred comp considerations and such were too great to justify a 25-30% salary reduction.
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Old 11-12-2012, 07:15 PM   #6
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I'll probably start some beef with this, but I feel that EMS is better off being merged with either police or fire. Why? The career development benefits alone blow away what's available with single role EMS.
When it comes down to it, there are many reasons that extensive career ladders haven't been created and why "non-combined" aren't as luxurious. One is increased educational requirement are notoriously stifled by fire departments and volunteer-based organizations, which would help bring a natural much needed decrease in the number of paramedics. Combined services are favored by poor paramedic education since it allows them to hood-wink the public out of tax money with stupid (yes, stupid) services such as "paramedic engines".

FDs also have decades and sometimes centuries of history behind them. They unionized and fought over many years for what they have, and since they want to take over EMS, it is easy to entice EMSers from other services that have only been around for a fraction of the time and have yet to be able to naturally progress as FDs once did. Of course, EMSers are more than happy to ride the coat-tails of an FD, and of course the FD will gladly take the coat-tail riders since it helps ensure THEIR future (but not necessarily EMS' future).

I don't blame anyone for coat-tail riding and jumping to services that provide great pay and benefit since people need to make a living and provide for their families. But, I still think it sucks that it happens.
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Old 11-12-2012, 10:33 PM   #7
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When it comes down to it, there are many reasons that extensive career ladders haven't been created and why "non-combined" aren't as luxurious. One is increased educational requirement are notoriously stifled by fire departments and volunteer-based organizations, which would help bring a natural much needed decrease in the number of paramedics. Combined services are favored by poor paramedic education since it allows them to hood-wink the public out of tax money with stupid (yes, stupid) services such as "paramedic engines".

FDs also have decades and sometimes centuries of history behind them. They unionized and fought over many years for what they have, and since they want to take over EMS, it is easy to entice EMSers from other services that have only been around for a fraction of the time and have yet to be able to naturally progress as FDs once did. Of course, EMSers are more than happy to ride the coat-tails of an FD, and of course the FD will gladly take the coat-tail riders since it helps ensure THEIR future (but not necessarily EMS' future).

I don't blame anyone for coat-tail riding and jumping to services that provide great pay and benefit since people need to make a living and provide for their families. But, I still think it sucks that it happens.
Aren't most non-fire based EMS departments also to blame for stifling increased educational requirements? How many private EMS departments, Third Service EMS departments, or even hospital based departments require degrees? How many give special consideration in hiring to an EMS degree holder? How many give a stipend for holding an EMS degree? Statistically speaking, likely less than 1% across the board. I've worked for seven EMS organizations, one of which is fire based, and have applied to six others throughout my career. Not one of them have stated any degree requirements, additional pay for a degree, or even a hiring preference for a degree holder. Not one.

Let's give blame where blame's due - All types of EMS departments are interested in getting the cheapest qualified labor as possible. What's important to them is if your certs are current, if your criminal history is clean, if your driving record is acceptable, and if you have field experience.

But, you're right that fire departments use EMS as a way to justify their jobs by showing a higher net utilization. This becomes more relevant as you move to a more rural locale. The recent rural EMS thread highlights this fact - the expectations are a long response time, probably no help as in just you and your partner, long txp times, etc. What if your unit is out on a call? Is the next unit an hour away? Sounds like fire based ALS first responders could be of benefit here, both in bridging the EMS txp coverage gap, and also having another medic to help if your bus is medic/EMT. I would hesitate to say that it's just fire that wants reasonably cheap labor, though. It's all types of delivery models that have this same goal.

If not, then why do I see numerous Third Service EMS employers in the Southeast offering pay in the $30's/yr for medics, with only a GED and some certs as a requirement? What about private EMS paying medics $12/hr? Any one of them could turn around and require degrees, but then no one would work for them, at least not with them paying so low.

I do feel that for the employee, EMS as a long term career is only beneficial if it's attatched to a fire or LEO organization. Increased educational requirements would be great for EMS in the long term, but I don't see that happening quick enough to make a single role EMS career a lucrative one like fire or LE. Kudos to the EMS departments that include Hazmat Ops, TROT, and vehicle extrication. That's definitely a step in the right direction. That should hopefully give rise to officer positions in those disciplines, as well as upper level supervisors for those same special services. This is a rarity, however. But, the same argument could be made that EMS and special services are two different jobs. Those special services require entry into an IDLH environment in many cases. EMS is about scene safety and stabilizing patients, not putting yourself in harms way to deliver the pt to a controlled environment. My point? A job description does not have to be comprised of all inter-related functions. A job description can have completely different aspects, so long as it works.

The EMS/fire thing is convenient because the staffing and deployment models are similar enough that dual role staffing and deployment works. This is untrue of LEO and EMS, due to their different staffing and deployment situations. As an example, look at Nassau County PD's EMS. The EMT-P or EMT-CC drives to the call, starts pt care, hooks up with another medic from another bus, and the EMT-B/LEO ditches their cruiser and drives the medic to the hospital. That doesn't sound too efficient. LEO's on patrol have a high net utilization; fire suppression units have considerably less net utilization. Which one makes more sense as a first responder and possible extra rider to the hospital?
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Last edited by 46Young; 11-12-2012 at 10:35 PM.
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Old 11-13-2012, 12:32 AM   #8
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See, I agree with everything you say, but still think your main premise is 100% wrong.
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Originally Posted by 46Young View Post
We have Inspector positions in the Fire Marshall's office, and also Investgation and Code Enforcement positions that require the employee to go through our county's police academy, paid at your regular rate, of course. There's plenty of six figure gov't and private positions available for someone with this type of fire and LE experience. All the better if you have Hazmat or USAR experience, which goes nicely with an Emergency Management degree, which will surely edge out someone with the same degree who has only worked EMS transport in comparison (which the fire/EMS applicant has also done.)
Great examples. Do you think EMS would benefit from a code enforcement position? not the fire code, but a proactive group of people whose job is to be out interacting with the public doing welfare checks on potentially sick people. How about investigations? could EMS have people assigned to do accident reconstructions? maybe even OSHA people, EMS personnel whose job is to investigate on the job injuries. And to be paid their hourly rate to attend this type of training? it's no longer a job, the field is now a career!!!!

The bare bones truth is that EMS is much busier than firefighting, yet most areas have more fire trucks than ambulances. most single role firefighters are paid more than single role EMTs or paramedics, despite the latter doing more emergency assignments. and the budgeting for fire and EMS is usually $4 given to fire for every $1 given to EMS. Why does EMS require a 2 years degree and you have to be already trained to get a decent job, when the FD will take someone with a HS diploma and pay them a salary while they are in the academy? And the truth is, in most areas, firefighting is a career, and treated like a career by the city managers (and tax funded as such), while EMS is a job that is funded as poorly as possible, and if it gets too expensive, they just lay off the city EMS workers and bring in a private company for low pay and crappy benefits.

EMS does not, and should not be part of FD or LE. It SHOULD have its own command staff, it should have a proper tax funding model, it should have enough units to allow for both downtime and surge capacity. it SHOULD have positions for transfer, and it SHOULD pay for education time just like the FD and PD often do.

Why is it that I am taking a class, that I had to juggle to get the time off for (which comes out of my vacation time), that I am paying out of my own pocket and hoping i get reimbursed, and the police department employee (who I went through EMT class with 10+ years ago) is being paid her hourly rate to attend, given the following night off (since we both work nights, and on the same rotating shift), and the class is applicable to both our jobs?

Every EMS agency should have a full time public information officer. not a supervisor who does PIO in addition to his other duties, a dedicated person who just does that. Every EMS agency should have at least one training supervisor. a QA supervisor. a bls equipment supervisor, in charge of all the trucks and bls equipment. a medication and ALS equipment supervisor, in charge of all the ALS equipment. a special operations supervisor, in charge of Rescue, HazMat, WMD, confined space, MCI, and other other Spec Ops thing you can think of. And every one of these people should have staff assigned to them, so they aren't doing all the work by themselves. and I'm sure you can think of more jobs. most of the Fire Departments have them. But EMS doesn't, because no one wants to give them the money to do the job right.... they would rather do it half assed.

My old job did about 18,000 ALS calls (covering about half the county), BLS did about 25,000 calls (among the 4 towns that we cover), and our communications center received 55,000 calls for service last year. We had 4 supervisors, and 4 managers (including our director). And during my time there they increased to 6 supervisors. That's 10 supervisory personnel for 250 employees, with close to 15 vehicles in service during the week all over the county with 2 supervisors. How many Battalion Chiefs do you have? How many Captains do you have county wide? How many police Sgts and Lts and Captains do you have county wide? See the disparity?

EMS doesn't need to be part of FD or LE. But if it were to be treated and funded and staffed on similar levels, it would go a long way to becoming a career, and not a stepping stone job.
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Old 11-13-2012, 01:53 AM   #9
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See, I agree with everything you say, but still think your main premise is 100% wrong.Great examples. Do you think EMS would benefit from a code enforcement position? not the fire code, but a proactive group of people whose job is to be out interacting with the public doing welfare checks on potentially sick people. How about investigations? could EMS have people assigned to do accident reconstructions? maybe even OSHA people, EMS personnel whose job is to investigate on the job injuries. And to be paid their hourly rate to attend this type of training? it's no longer a job, the field is now a career!!!!
Cut for brevity.

I agree with everything you say.

I think though that you overlooked an important aspect of why EMS is treated differently.

Fire and Police are agents required by society.

Fire protects lives and property. The lives thing is really just a bonus.

Police maintain the order of society, which also protects property. now and again they save a life.

EMS does not protect property. It is basically help for an indivuidual. (or a handful of them at a time)

Because modern US medicine drains wealth from individuals instead of preserving it, no matter how important we tell ourselves we are, the truth is EMS is a luxury item.

Always follow the money my friends.

No matter how altruistic our intentions, somewhere in our little world somebody is counting the beans.
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Old 11-13-2012, 09:55 AM   #10
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Originally Posted by DrParasite View Post
See, I agree with everything you say, but still think your main premise is 100% wrong.Great examples. Do you think EMS would benefit from a code enforcement position? not the fire code, but a proactive group of people whose job is to be out interacting with the public doing welfare checks on potentially sick people. How about investigations? could EMS have people assigned to do accident reconstructions? maybe even OSHA people, EMS personnel whose job is to investigate on the job injuries. And to be paid their hourly rate to attend this type of training? it's no longer a job, the field is now a career!!!!

The bare bones truth is that EMS is much busier than firefighting, yet most areas have more fire trucks than ambulances. most single role firefighters are paid more than single role EMTs or paramedics, despite the latter doing more emergency assignments. and the budgeting for fire and EMS is usually $4 given to fire for every $1 given to EMS. Why does EMS require a 2 years degree and you have to be already trained to get a decent job, when the FD will take someone with a HS diploma and pay them a salary while they are in the academy? And the truth is, in most areas, firefighting is a career, and treated like a career by the city managers (and tax funded as such), while EMS is a job that is funded as poorly as possible, and if it gets too expensive, they just lay off the city EMS workers and bring in a private company for low pay and crappy benefits.

EMS does not, and should not be part of FD or LE. It SHOULD have its own command staff, it should have a proper tax funding model, it should have enough units to allow for both downtime and surge capacity. it SHOULD have positions for transfer, and it SHOULD pay for education time just like the FD and PD often do.

Why is it that I am taking a class, that I had to juggle to get the time off for (which comes out of my vacation time), that I am paying out of my own pocket and hoping i get reimbursed, and the police department employee (who I went through EMT class with 10+ years ago) is being paid her hourly rate to attend, given the following night off (since we both work nights, and on the same rotating shift), and the class is applicable to both our jobs?

Every EMS agency should have a full time public information officer. not a supervisor who does PIO in addition to his other duties, a dedicated person who just does that. Every EMS agency should have at least one training supervisor. a QA supervisor. a bls equipment supervisor, in charge of all the trucks and bls equipment. a medication and ALS equipment supervisor, in charge of all the ALS equipment. a special operations supervisor, in charge of Rescue, HazMat, WMD, confined space, MCI, and other other Spec Ops thing you can think of. And every one of these people should have staff assigned to them, so they aren't doing all the work by themselves. and I'm sure you can think of more jobs. most of the Fire Departments have them. But EMS doesn't, because no one wants to give them the money to do the job right.... they would rather do it half assed.

My old job did about 18,000 ALS calls (covering about half the county), BLS did about 25,000 calls (among the 4 towns that we cover), and our communications center received 55,000 calls for service last year. We had 4 supervisors, and 4 managers (including our director). And during my time there they increased to 6 supervisors. That's 10 supervisory personnel for 250 employees, with close to 15 vehicles in service during the week all over the county with 2 supervisors. How many Battalion Chiefs do you have? How many Captains do you have county wide? How many police Sgts and Lts and Captains do you have county wide? See the disparity?

EMS doesn't need to be part of FD or LE. But if it were to be treated and funded and staffed on similar levels, it would go a long way to becoming a career, and not a stepping stone job.
I was a little disappointed with what I saw during my stint at my former Third Service employer. When I took the job, I expected there to me much more opportunity for laterals into different divisions and opportunity for supervisory promotions. There were 20 stations or so IIRC, so there were 20 Ist LT positions, but that doesn't really qualify as supervisory experience on a resume when applying to another department for a management position. There was a bike team I think, but no special services per se.

Contrasted with a FD, depending on the department it's typical for each engine, truck, and heavy rescue to have an officer assigned. There can be 2-3 officers each shift in a large station. EMS may have one road supervisor per shift, two if they're lucky, but a FD will have serveral BC's, maybe a safety officer, etc. Many, many promotional opportunites. There's also merit promotions such as FF to technician or technician to master tech/master ff, for example, as well as tech promotions into TROT, Hazmat, etc. We also have EMS techs and master techs. There's also the fire academy. An EMs department may have a training officer, maybe a few adjunct instructors, but a fire academy will have a whole staff of techs and officers assigned to the training division. More promotional opportunites and resume building positions.

As far af funding, it's true that EMS gets only pennies on the dollar. Part of it is the culture of marginalization of EMS, and part of it is that a FD will simply have many more employees and apparatus than EMS txp units. Payroll is typically the largest business expense. For every bus, you have probably two engines, a truck, and maybe a heavy rescue here and there. Even if these units are destaffed to two people on each, that's still many more fire employees than EMS. People trip out if a fire station is too far away, so there will always be a fairly ample amount of firehouses. As far as EMS, the buses can sit on street corners for all anyone cares. Many people think that fire stations house ambulances anyway, so no one thinks about it, so long as the response time is decent.

There's simply too little variance in the function of an EMS transport department to afford many promotional opportunities, I'm afraid.
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