judging from some of the horror stories I have heard on here, and the reason for the limited protocol and scope, I would probably disagree.
To clarify, there's a difference between medical protocols ("treat this by A, B, and C") and system policies (e.g. licensed emergency departments must be capable of treating peds (OC does, LA doesn't), DNR policy, requiring a workable mutual aid policy, etc).
I can, and I can also see the reasons not being what you are thinking. Aside from the whole "staff enough units to handle the routine call volume" argument that i have been making for years.
If only 1 department runs EMS, than you have control over the system. you know everyone has the same training level, same protocols,and same equipment. you know everyone passed the same competancy tests to be on the ambulance. an agency knows everyone has valid certificates, were trained in house the same way (regarding city operations and navigating the city, etc). Once you start involving agencies where you DON'T have control over what equipment they are bringing in, or what training they have, the host agency and citizen can expect one level of service, and get something vastly different. heck, can the private companies even communicate directly with dispatch, or do they need to go through the IFT dispatcher or call 911?
Everyone in urban California systems have the same protocols and the same minimum training level. If you're working at an IFT company in LA, you have the same basic protocol as if you're working at the 911 services. There are a few variations between companies, but none that can be said as being uniquely present at the 911 services.
You aren't going to see non-EMTs or paramedics responding to medical emergencies because of a lack of people. As far as valid certification, if they're responding on an ambulance, then they are supposed to be licensed by the state as an EMT or paramedic. The fact that some services might skirt the rules regarding this isn't restricted from occurring at fire departments. For example, it wasn't just the private services involved in the MA CE scandal a few years back.
Furthermore, if city X is contracting with service 1 to provide primary ambulance service and service 2 for backup service, then the contracts for both can specify what ever is deemed mutually agreeable, hence giving control to the city over what systems responds to emergencies in their territory.
If we are calling any local ambulance service, you don't know who you are getting. Can you imagine sending Jack and Jill, two EMTs who typically do dialysis runs, and send them into a double shooting?
Since many services out here run both primary 911 and IFT, then Jack and Jill may very well be sent anyways by the primary 911 system. It definitely can't be worse than the low volume volly systems where you can have the same "OMG, what do I do" in experience reaction. Additionally, and for better or worse, out here many of the IFT EMTs are better than the 911 EMTs at handling medical calls because we aren't reliant on the fire medic umbilical cord to make decisions.
Personally, would I feel comfortable running a double shooting? Probably. Would I feel comfortable running a multicar TC? At this point no. Let me run a few as a primary unit, though, and I imagine I'd get it down pretty quickly. On the other hand, let me throw the average 911 EMT who's reliant on the fire medic into a nursing home with a strange DNR situation or the pulmonary edema patient who's been sitting in distress for a half an hour before anyone was even called and watch them try to make a coherent decision on whether to transport or call for paramedics and I'm willing to bet they aren't nearly as smooth as I was in those calls after I got a minimal amount of experience.
Of course, if all the ambulance crew does is freak out and transport, it's better than having the patient sit on scene because no one is available. At least the patient will, relatively quickly out here, reach the ED where an appropriate level of care can finally be established. I'm not a huge fan of the proverbial "diesel bolus," but it's better than nothing. Nothing is what the overloaded EMS system who refuses to ask for help is offering them.
and you don't see them calling private fire trucks when the 1st due areas are tied up right? ever wonder why? and there are career FDs that will call other stations in their department from further away before they call their neighbor department for a fire. happens all the time.
If you want to make all 911 EMS municipal, then that's a separate argument than this. Private, non-industrial fire departments are rare, and in the places that have them I hope to God that the municipal services won't think twice about enlisting their help when they need them.
Municipal services who would rather risk their citizen's lives than call for the fire department next door is insane, stupid, and dangerous. Granted, the urban situation in So. Cal. is somewhat unique compared to other areas. There are 8 cities in this
map screen (Tustin, Santa Ana, Garden Grove, Huntington Beach, Costa Mesa, Westminister, Irvine, Fountain Valley) which makes up the north half of the county I grew up in. The cities range from geographically small (60k people, 9 sq miles) to several hundred thousand people. Try to draw the political boundaries.
I use this to show that often the only way to tell you left one city and entered another is a little sign saying, "Welcome to ____." There's no reason not to pool resources. There's no reason for the city of 60k to have an air/light unit, USAR team, technical rescue team, etc when mutual aid can easily cover for these units. Similarly, if a neighboring city needs additional fire units for a structure fire, the closest unit will be sent regardless of agency. This isn't because the home agency is out of units, but because it's the height of lunacy to ignore the unit 2 miles away and call for the one 6 miles away simply because of a geographical border.
Of course maybe So. Cal. realizes that it's about the citizens and not agency pride. I happy I've never been in an area so politically malignant that they would put their pride over the health and safety of their citizens. Sure, we have our fun out here between "Drop Me in the Pacific," the "Care Bears," "Another Moron Responds," and "The Lynch Squad," but I'll be damned if I don't access the resources I need for my patient because those resources may come in a different colored ambulance and wearing a different color uniform.
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