Emergency medical responder vs certified first responder

[Nyfirefighter10925]

Can anyone tell me wat the differs from emergency medical responder vs certified first responder

 

[TransportJockey]

The name and credentialing body

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[EpiEMS]

Can anyone tell me wat the differs from emergency medical responder vs certified first responder

National standards and the NREMT use the nomenclature "Emergency Medical Responder." New York State, in its infinite wisdom, uses the term "Certified First Responder." The scope of practice is essentially the same, as is the educational standard, as of May 2013.

 

[VentMonkey]

You know what they both have in common? Neither are universally seen as the basic emergency medical technician.

What's the point of this cert? Really, I don't understand it, as it isn't recognized in my state.

Why not just get you basic and be a good FF/EMT?

I'm genuinely curious, and in no way trying to incite an argument.

 

[EpiEMS]

You know what they both have in common? Neither are universally seen as the basic emergency medical technician.

What's the point of this cert? Really, I don't understand it, as it isn't recognized in my state.

Why not just get you basic and be a good FF/EMT?

I'm genuinely curious, and in no way trying to incite an argument.

No EMR recognition? Interesting. What do they require for, say, cops? I think California has their Title 22 first aid training, which is below EMR, but above standard first aid...

The EMR is a useful tool for pre-transport apparatus arrival (I think a rural MVC is the best example) plus, it helps fire departments justify big budgets (40 hour class x 4 FFs + $800k truck = a massive multiple of runs that you can justifiably send them on).

Please ignore the strike-through that randomly appeared below.

Historical context for EMR is important. As we know it today, the EMR "initiate immediate lifesaving care to critical patients who access the emergency medical system. This individual possesses the basic knowledge and skills necessary to provide lifesaving interventions while awaiting additional EMS response and to assist higher level personnel at the scene and during transport." They use "minimal" equipment at the scene. We're talking truly fundamental interventions - CPR/AED, hemorrhage control, not moving the possible cervical spine injury (I know, I know, not much science on that last one). Historically, the First Responder was more of an outgrowth (downwards) from the EMT scope, as seen in the Crash Injury Management course from 1973. That eventually turned to what was the First Responder course from 1979, which is closer to what we know today.

 

[VentMonkey]

plus, it helps fire departments justify big budgets (40 hour class x 4 FFs + $800k truck = a massive multiple of runs that you can justifiably send them on).

This^.

 

[EpiEMS]

This^.

That's always gonna be the justification, in my book. It's cheaper than a true basic level response. EMR should not be the standard for BLS first response, unless you're depending on people who do it as a collateral duty (i.e. PD).

 

[gotbeerz001]

Why all the fire hate? [emoji602]


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[VentMonkey]

That's always gonna be the justification, in my book. It's cheaper than a true basic level response. EMR should not be the standard for BLS first response, unless you're depending on people who do it as a collateral duty (i.e. PD).

Sadly, from a strictly fiscal standpoint this makes sense.

Admittedly, I am not too familiar with what actually separates an EMR from an EMT, and in California, yes, many carry the "first responder" title, though some more than others, take it seriously.

It's kind of unfortunate, as I think we can all agree that simple and proper bleeding control, and CPR go a very long way in our environment.

I also feel that if theses folks were put through an EMT course vs. EMR course, even if only a few more things covered, and/ or it still being a vocational title, perhaps they would feel a tad more obligated to perform these tasks with not only a sense of pride, but also be a bit more assertive; though, I am sure there are some kick *** EMR's out there.

 

[VentMonkey]

Why all the fire hate? [emoji602]


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All jokes aside, I don't hate fire, but I think more often than not most firefighters like, well, fighting fires...rightfully so might I add.

I know a handful of good FF's and FFPM's that can do both fairly well, I just think in an environment where they're being utilized at the EMR level, it makes more sense to have said department pay for a full EMT course.

If anything, this shows love for my fellow "first responsders".

 

[EpiEMS]

Why all the fire hate? [emoji602]

Haha, it's not hate! Just pointing out the fact that firefighters, on the mean, do more sick calls than fire fighting, so they need to think about how they train, staff, and respond. An $800,000 engine with four EMR firefighters getting paid $50,000 a year (minimum...if you add in pension and other benefits, it's more like double that) to respond to your average EMS call provides about nothing in marginal benefit to the patient.

From a fiscal perspective, if you were to cut that 4 EMRs in an $800,000 truck to 2 EMRs in a $50,000 SUV, fire-based first response becomes much, much more fiscally tenable.

Sadly, from a strictly fiscal standpoint this makes sense.

Admittedly, I am not too familiar with what actually separates an EMR from an EMT, and in California, yes, many carry the "first responder" title, though some more than others, take it seriously.

It's kind of unfortunate, as I think we can all agree that simple and proper bleeding control, and CPR go a very long way in our environment.

I also feel that if theses folks were put through an EMT course vs. EMR course, even if only a few more things covered, and/ or it still being a vocational title, perhaps they would feel a tad more obligated to perform these tasks with not only a sense of pride, but also be a bit more assertive; though, I am sure there are some kick *** EMR's out there.

California has issues, for sure

I like the idea of sending your professional responders to an EMT course, but given current models of staffing, etc., it may not make sense, especially because they don't transport. (It's not like Medicaid, say, generally reimburses BLS non-transporting agencies, as far as I know)

 

[NysEms2117]

Haha, it's not hate! Just pointing out the fact that firefighters, on the mean, do more sick calls than fire fighting, so they need to think about how they train, staff, and respond. An $800,000 engine with four EMR firefighters getting paid $50,000 a year (minimum...if you add in pension and other benefits, it's more like double that) to respond to your average EMS call provides about nothing in marginal benefit to the patient.

From a fiscal perspective, if you were to cut that 4 EMRs in an $800,000 truck to 2 EMRs in a $50,000 SUV, fire-based first response becomes much, much more fiscally tenable.



California has issues, for sure

I like the idea of sending your professional responders to an EMT course, but given current models of staffing, etc., it may not make sense, especially because they don't transport. (It's not like Medicaid, say, generally reimburses BLS non-transporting agencies, as far as I know)

This is so beyond true. I can't even imagine the amount of false calls in a big college town for burnt popcorn ect.

 

[EpiEMS]

This is so beyond true. I can't even imagine the amount of false calls in a big college town for burnt popcorn ect.

Yeah, and odds are, your average fire call is actually medical in nature!
http://www.nfpa.org/news-and-resear...e/fire-department-calls/fire-department-calls

 

[gotbeerz001]

The point which I often make is that many people make the mistake of saying that medicals are most of what firefighters DO rather than stating accurately that they simply make up 60-80% of the call volume. The problem is that all calls are not created equal.

For instance, a medical aid may take 20 minutes turn-time x 3 person engine company; that is one hour of personnel time for that call.

A first alarm residential fire may get 3 engines, 2 trucks a chief and a medic unit with an average commitment of 2 hours (some at scene more time, some less). If you have 3-person engines, 4-person trucks, that's a total of 40 personnel hours... The equivalent of 40 basic medical aids.

Now while fire calls have been consistently declining over the years, the number of non-medical calls continue to increase as well. Gas leaks, rescues etc also require a significant amount of time and multiple company commitment.

All this to say, fire medics need to be proficient in their EMS duties; to speak to the contrary is idiotic. However, to say that medicals are 80% of what we do is simply false.


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[VentMonkey]

All this to say, fire medics need to be proficient in their EMS duties; to speak to the contrary is idiotic. However, to say that medicals are 80% of what we do is simply false.


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And this, IMO, speaks volumes for the type of FFPM I am sure you are.

Unfortunately, all too often this is not the case. I have worked in an all ALS system, and I had no major issues. Now I don't, and I still don't have any major issues.

 

[gotbeerz001]

Just for insight, my primary job is an Engineer/Paramedic for a smaller agency (5 stations) averaging 3 calls per 24 hr shift at slower stations and up to 14 calls at the busiest stations. We have multiple highways, significant wildland threat and serve approximately 70,000 people. We place a high value on customer service. Local hospital is less than 15 minutes away with specialty centers upwards of 40 mins by ground.

My side gig is a transporting medic in a dense urban setting. Fire crews we work with easily run upwards of 20+ calls per 24 hr shift with the average being 12 or so. 7-8 transports in a 12-hr shift is my norm. We are rarely more than 10 minutes from a hospital, most of which provide some sort of specialty.

My approach to medicine comes from existing in both these worlds. I get frustrated by lazy fire medics as much as I do burnt-out transporting medics. I feel that I treat patients appropriate to their condition. When in fire mode, I feel our role is to treat life-threatening illness/injury appropriately but allow the transporting medic the ability to treat/transport/triage the patient as they see fit. This means that I do not start an IV at scene unless I plan to put something in it. I will perform all necessary actions at scene but do not delay transport any more than necessary. When transporting, I generally want to get off-scene as soon as possible once I have ruled out injury/illness requiring a specialty center. While I get frustrated by fire medics who do not treat appropriately (this is rare), I do not hold anything against those who provided appropriate (though minimal) care.

The biggest issue we need to address is the prioritizing of calls; this is where I believe we need to focus if we want to get our resource allocation correct. The problem is that dispatching is based off the subjective info provided by a frantic public (or downplayed symptoms for some); this is why we get Delta responses for sore knees w abn breathing but get Alpha responses for sick people who have actually been septic for 3 days.

All that to say, everyone has their role. Unfortunately, transporting medics get a narrow view of what fire does because they only see us when there is a medical. Furthermore, the standard held to each other should be "safe and appropriate" care; a 20-year single-function transporting medic will always have more clinical insight than a 5-year fire medic who is required to maintain proficiency in medical, fire, rescue, fitness, vehicle operation, pumping etc etc etc... Let's just value what each brings to the table.


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[gotbeerz001]

And this, IMO, speaks volumes for the type of FFPM I am sure you are.

Unfortunately, all too often this is not the case. I have worked in an all ALS system, and I had no major issues. Now I don't, and I still don't have any major issues.

Haha. Too kind! [emoji482]


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[VentMonkey]

My approach to medicine comes from existing in both these worlds. I get frustrated by lazy fire medics as much as I do burnt-out transporting medics. I feel that I treat patients appropriate to their condition. When in fire mode, I feel our role is to treat life-threatening illness/injury appropriately but allow the transporting medic the ability to treat/transport/triage the patient as they see fit. This means that I do not start an IV at scene unless I plan to put something in it. I will perform all necessary actions at scene but do not delay transport any more than necessary. When transporting, I generally want to get off-scene as soon as possible once I have ruled out injury/illness requiring a specialty center. While I get frustrated by fire medics who do not treat appropriately (this is rare), I do not hold anything against those who provided appropriate (though minimal) care.

Just to add to this, in my experience, the quality of fire-based paramedicine that I have seen is usually dependent on high the department itself prioritizes their EMS section.

Some stellar EMS systems are delivered by fire departments fire departments, nationally.
The ones that, to this day, take this bulk of their revenus seriously though, it's those departments that unfortunately spoil the whole bunch.

In California, the fact of the matter is we have to learn to accept that fire-based EMS isn't going anywhere anytime soon, so we can either embrace it, or leave.

As a side note: just below being a flight paramedic, on my "paramedic to-do list" would be working as a FFPM for a non-transporting fire department...by the beach.

 

[VentMonkey]

Just to add to this, in my experience, the quality of fire-based paramedicine that I have seen is usually dependent on how high the department itself prioritizes their EMS section.

Some stellar EMS systems are delivered by fire departments, nationally.

The ones that, to this day, don't take this bulk of their revenus seriously though, it's those departments that unfortunately spoil the whole bunch.

In California, the fact of the matter is we have to learn to accept that fire-based EMS isn't going anywhere anytime soon, so we can either embrace it, or leave.

As a side note: just below being a flight paramedic, on my "paramedic to-do list" would be working as a FFPM for a non-transporting fire department...by the beach.

Forgive me, had to go back and edit my words. Banana hands strike again!.

 

[EpiEMS]

The point which I often make is that many people make the mistake of saying that medicals are most of what firefighters DO rather than stating accurately that they simply make up 60-80% of the call volume. The problem is that all calls are not created

I really like your explanation, it's pretty compelling!
The question it poses to me, then, is fire first response generally necessary, and, if so, at what level is it useful? I would say, generally, in an urban area, fire based first response is helpful, but could be at the EMT level, with a 2 FF/EMT team.