Fire Als transport vs other..

[Trashtruck]

hire single roll providers, make them separate divisions and treat them as equals, not the red-headed step children.

LOL!
But this is the FIRE Dept!!!
Somebody please, who is a single role medic with a FD, want to tell me how they're treated?

Detroit?
FDNY?
Philadelphia?

 

[CFal]

I want someone to give me a better reason other than "it should be" as to why 911 EMS should be a government agency.

If a FD wants to do EMS, fine. Like n7 said, hire single roll providers, make them separate divisions and treat them as equals, not the red-headed step children.

There's no reason a private agency can't provide equal or superior 911 services to a region.

I'd say the system I work in along with the system of a few other unnamed members are great examples of this.

FWIW I work for a private agency under a Public Utility Model.

EMS should be a public service, I think that being a government agency in general gives the best oversight and effectiveness in EMS as is does in Fire and Police, not to say there are not examples of quality EMS using other models and that every government agencies are the best, because there are and they aren't always. I just feel that government agencies do a better job more often than not, I think that it is more or less analogous to a US Army/Blackwater comparison. I also think that as a government agency it gives more credibility to the profession than a private company. On a side note I don't see any reason to think that a dual role Fire Medic cannot provide the same level of care as a single role Medic.

 

[STXmedic]

LOL!
But this is the FIRE Dept!!!
Somebody please, who is a single role medic with a FD, want to tell me how they're treated?

Detroit?
FDNY?
Philadelphia?

Our single role medics are treated just like any of the fire guys. We all get along great and have a great working relationship. I don't see the problem.

 

[Shishkabob]

In more rural areas combining coverage provides for a quicker response. In many parts of the country there are large swaths of land with fewer people per square mile. EMS calls have a larger volume, but take fewer people to respond than a fire, like how in EMS we spend most of our time training on calls that are low volume but more complex. You would have a lot of fire fighters sitting around doing nothing and EMS workers over burdened. In more urban areas you have the critical mass to support independent services.

Reason why FD beats EMS to most calls: There are more fire stations, because they have a bigger budget. Give EMS the same budget and then tell me who responds faster. Infact, my agency has 1/4 the budget of our biggest FD partner, yet we run 40,000 more calls a year than they do. Yup. Efficiency. Cut 60mil from their budget, give us just 30mil of that, and you can only imagine the greatness that could ensue. But nope, cutting FDs budget makes you un-patriotic and hate kittens.

Hell, PD has pretty close to the same budget and beats FD to most calls they're co-dispatched to. Why? More cop cars.


On top of that, FD spends less than 10 minutes on most calls, while EMS spend 1+ hour due to transport and the like. Kind of easy to be running from call to call when they don't last long at all.

not to say there are not examples of quality EMS using other models

Name me a single traditional fire-based EMS system that is world renowned for being progressive and aggressive in all parts of pre-hospital medicine.

 

[CFal]

Reason why FD beats EMS to most calls: There are more fire stations, because they have a bigger budget. Give EMS the same budget and then tell me who responds faster. Infact, my agency has 1/4 the budget of our biggest FD partner, yet we run 40,000 more calls a year than they do. Yup. Efficiency. Cut 60mil from their budget, give us just 30mil of that, and you can only imagine the greatness that could ensue. But nope, cutting FDs budget makes you un-patriotic and hate kittens.

Hell, PD has pretty close to the same budget and beats FD to most calls they're co-dispatched to. Why? More cop cars.


On top of that, FD spends less than 10 minutes on most calls, while EMS spend 1+ hour due to transport and the like. Kind of easy to be running from call to call when they don't last long at all.




Name me a single traditional fire-based EMS system that is world renowned for being progressive and aggressive in all parts of pre-hospital medicine.

The nature of fire is that it involves more people than EMS, it takes more people to respond to a fully involved house than a cardiac arrest. You run 40,000 more calls than them? If it was a combined agency the workload would be more evenly distributed, rotating people into the box.

 

[46Young]

Reason why FD beats EMS to most calls: There are more fire stations, because they have a bigger budget. Give EMS the same budget and then tell me who responds faster. Infact, my agency has 1/4 the budget of our biggest FD partner, yet we run 40,000 more calls a year than they do. Yup. Efficiency. Cut 60mil from their budget, give us just 30mil of that, and you can only imagine the greatness that could ensue. But nope, cutting FDs budget makes you un-patriotic and hate kittens.

Hell, PD has pretty close to the same budget and beats FD to most calls they're co-dispatched to. Why? More cop cars.


On top of that, FD spends less than 10 minutes on most calls, while EMS spend 1+ hour due to transport and the like. Kind of easy to be running from call to call when they don't last long at all.




Name me a single traditional fire-based EMS system that is world renowned for being progressive and aggressive in all parts of pre-hospital medicine.

A properly staffed and equipped FD will have many more employees than a properly staffed and equipped EMS department in the same coverage area. Payroll is typically the largest expense, so a fire budget will naturally be larger due to that fact alone. The apparatus, equipment and PPE are more expensive as well. We have 41 ALS units, plus a few volunteer units at any given time. We have 37 engines, 14 truck companies, and eight Heavy Rescues. Add on the Hazmat unit and the Hazmat Support Unit. All in all, for the non-supervisory field units, that's 82 ambulance personnel on duty, with 228 suppression personnel. That's almost a 3:1 ratio. That's your (necessary) budget disparity right there. We cover 395 square miles with a population of 1.1 million. The on-going NIST studies are showing the necessity of safe staffing levels, four per piece, generally speaking.

I feel that my fire based department does well with progressive and aggressive EMS. We're probably as efficient and proficient as KCM1 and Wake Co. NC, but neither is anyone else. I've worked in the NYC 911 system, which is a mix of fire based single role, hospital based single role, and private single role. I know of the sytems in Nassau/Suffolk Co's in LI. I've worked in Charleston SC as a single role medic. I feel that we do much better than those systems. There's some uneccesary expenditures, but EMS is wellfunded, very well funded.

Our pt care guidelines include Tx for various electrolyte abnormalities, versed/ketamine/Iced saline/Bicarb for agitated delerium, standing order pain management for injuries, abd pain, and ACS. We can clear C-spine in the field if appropriate. Our post arrest management includes therapeutic hypothermia, pacing, dopa, etc. We're getting the King Vision and ET Introducers for ETI, we have the QuickTrache, CPAP w/ in-line nebs, ETCO2 for ETI and sidestream NC as well. We're getting lactate meters in the near future. County policy of at least two medics present for every ALS call. There's more, but I cant think of what right now. We don't have RSI, and a few other advanced procedure yet, but that's more of a training and QA/QI issue, since we have more than 300 medics, probably closer to 400.

We have a four month field ALS internship after fire school, and regular con-ed on-duty at our training center, taught by PA's, and an NP.

There's an overabundance of resources at times, but this place is better than anywhere I've seen so far.

 

[Shishkabob]

The nature of fire is that it involves more people than EMS, it takes more people to respond to a fully involved house than a cardiac arrest.

Sure it does. Doesn't change my point in the least bit.

You run 40,000 more calls than them? If it was a combined agency the workload would be more evenly distributed, rotating people into the box.

And going back to one if my previous post, a good portion of those rotated in being forced to do something they don't want to do, being forced to be my healthcare provider when I don't want them doing it since they don't care about it.

That's your (necessary) budget disparity right there. ...The on-going NIST studies are showing the necessity of safe staffing levels, four per piece, generally speaking.

Sorry if I call out fire-union sponsored studies about fires advocating more firefighters...


The studies also show that more than 2 medics on a scene are detrimental to the patient, yet FDs keep pushing more Paramedics. Clearly they care more about property than they do about patients.

 

[ffemt8978]

The studies also show that more than 2 medics on a scene are detrimental to the patient, yet FDs keep pushing more Paramedics. Clearly they care more about property than they do about patients.

Source for these studies?

 

[CFal]

I'm not sure about that more than 2 Medics study, I would like to see that. Does it also account for multiple patients? If a mini van full of kids collides with a truck on the highway I would like to see more than 2 Medics there.

 

[DrParasite]

A properly staffed and equipped FD will have many more employees than a properly staffed and equipped EMS department in the same coverage area.

hey 46, didn't we have this exact same discussion
several months ago? in fact, we went back and forth with me agreeing with your concepts, but your basic premise was all wrong? something like what was discussed here: http://www.emtlife.com/showthread.php?t=32726

First response (whether it be ALS, BLS, FR, or MD) is not EMS. you have patient contact for maybe 10 minutes, and then you turn them to the ambulance, who deals with everything from dealing with the initial problem and handling the transport.

it's a waste of money, and many studies have continuously shown that. If you want to be a paramedic, get your *** on an ambulance and do the job 100%. it might not be as fun as being the engine medic, but that's what real ems is all about.

 

[Shishkabob]

Quick search revealed this. Arrests with more than 3 medics showed a decrease in survival to discharge of arrests patients with crews of more than 3 ALS providers. You can search for the rest if you want. So fine, I'll amend my previous statement and say more paramedics doesn't = better, and could actually mean worse.

This is not to mention the dilution of skills that happens when you split a low number of critical patients among a high number of providers, like the study my agency put out about having Advanced Practice Paramedics on an arrest, or Wake County had done about having APPs on critical patients. Things like ET success rates and the like.

If a mini van full of kids collides with a truck on the highway I would like to see more than 2 Medics there.

I've worked the MCI MVC as the only Paramedic that spent more time on scene than the time it took to load the patient and send them away. That's all that's needed for those types of MCIs.

You're confusing one patient for multiple patients. Apples to apples is the only way to play.

 

[Wheel]

I want someone to give me a better reason other than "it should be" as to why 911 EMS should be a government agency.

If a FD wants to do EMS, fine. Like n7 said, hire single roll providers, make them separate divisions and treat them as equals, not the red-headed step children.

There's no reason a private agency can't provide equal or superior 911 services to a region.

I'd say the system I work in along with the system of a few other unnamed members are great examples of this.

FWIW I work for a private agency under a Public Utility Model.

I don't think it should be a government entity, but for profit ems is a problem. There are some great private companies that handle ems. You work for one and so does Linus (I do too.) All three of these agencies are non-profits under the public utility model. There are still profits, but they're being invested into equipment, education, and provider pay, rather than into shareholder pockets.

 

[Shishkabob]

Mine hasn't been private for 8 years h34r:

 

[ExpatMedic0]

Reason why FD beats EMS to most calls: There are more fire stations, because they have a bigger budget.

haha reminds me of a funny story. I use to work part time doing special event stand by. Most of the other guys where from the FD picking up extra shifts for a little side money. One of them had actually retired. He use to be a Paramedic but reverted to EMT-B.

He told me when he became a Paramedic 30 years ago that they would respond in a fd pickup truck like on "emergency" and he would pass 5-10 other fire stations on the way to a call. However none of those stations had medics. He said as time went on and more stations acquired a medic the engine crew would just sit around and do nothing all day. Then private ambulance started staffing more medics and there was less demand.

They would just sit around and doing nothing all day. The pay was really good and he was in constant fear of losing his job. He use to tell his wife"Someone is going to catch on, this cant last forever." Then one day someone came up with the brilliant idea to save all the fireman's jobs. Put a medic on every engine and have them respond to every EMS call near there station. Since the city is covered with fire stations they normally beat the ambulance which utilized "system status management" model.

All the firemen got big pay raises, kept there jobs, and could justify there existence.

The End.

 

[Wheel]

Mine hasn't been private for 8 years h34r:

My mistake. Public utility model? My point was that optimally a company should be investing profits back into itself instead of paying shareholders or for cool fire toys.

 

[CFal]

You're confusing one patient for multiple patients. Apples to apples is the only way to play.

Cardiac Arrest isn't the only emergency we deal with, you know that. You can't cherry pick which emergencies you are going to cite studies on. Besides, correlation =/= causation, are cardiac arrests with more than 3 medics more severe which is why more medics were sent? Maybe maybe not, and even if so, it can easily be fixed by establishing protocol that Cardiac Arrests get no more than 3 Medics. There are certainly times when more that 3 medics would be very helpful in EMS.

 

[EpiEMS]

Cardiac Arrest isn't the only emergency we deal with, you know that. You can't cherry pick which emergencies you are going to cite studies on. Besides, correlation =/= causation, are cardiac arrests with more than 3 medics more severe which is why more medics were sent? Maybe maybe not, and even if so, it can easily be fixed by establishing protocol that Cardiac Arrests get no more than 3 Medics. There are certainly times when more that 3 medics would be very helpful in EMS.

Per the abstract: "All adult (>or= 18 years of age) OHCA cases of presumed cardiac etiology from January 1993 through December 2005 were eligible for inclusion in the study. Cardiac arrests resulting from a drug overdose, suicide, drowning, hypoxia, exsanguination, stroke, or trauma were excluded from the study. Also excluded were cases in which no crew configuration or responding unit was available, cases in which no resuscitation effort was attempted, and cases in which no time data were available."

It's not a "severity" issue. And the results are pretty robust insofar as arrests are concerned.

Yes, arrests are not the only metric, but they're a well studied one, and along with traumatic injuries from MVCs, are probably the two "standard cases" that EMS was designed to deal with.

 

[Christopher]

LOL!
But this is the FIRE Dept!!!
Somebody please, who is a single role medic with a FD, want to tell me how they're treated?

Detroit?
FDNY?
Philadelphia?

We're treated really well where I'm at.

 

[46Young]

Sorry if I call out fire-union sponsored studies about fires advocating more firefighters...


The studies also show that more than 2 medics on a scene are detrimental to the patient, yet FDs keep pushing more Paramedics. Clearly they care more about property than they do about patients.

What is it about the NIST data that you feel is flawed?

 

[46Young]

hey 46, didn't we have this exact same discussion
several months ago? in fact, we went back and forth with me agreeing with your concepts, but your basic premise was all wrong? something like what was discussed here: http://www.emtlife.com/showthread.php?t=32726

First response (whether it be ALS, BLS, FR, or MD) is not EMS. you have patient contact for maybe 10 minutes, and then you turn them to the ambulance, who deals with everything from dealing with the initial problem and handling the transport.

it's a waste of money, and many studies have continuously shown that. If you want to be a paramedic, get your *** on an ambulance and do the job 100%. it might not be as fun as being the engine medic, but that's what real ems is all about.

The first response thing may not improve pt outcomes unless it's in a rural, underserved area, but it certainly makes my job easier. If EMS delivery is 100% divorced from fire, the staffing and deployment is typically lacking, sorely lacking. This is why we have SSM, or systems where the ambulance runs constantly from start to finish. That's why the typical EMS employee burns out in 7-10 years, on the average.

I agree that the engine shouldn't be running on all ALS calls, or even the majority of them, but we do need to show call volume. If a suppression unit is idle for much of the time, and can be used to boost call numbers, as well as lighten the workload significantly for the txp crew, I'm all for it. I've worked in systems where it's just me and my partner for most calls. It's nice having people to help carry my equipment, load and carry the pt, etc. The other day, we went from dispatch to delivery at the ED of an obvious stoke pt in 22 mins, with a full assessment, two lines and a 12-lead completed en-route. I was able to gather Hx, while my medic partner and the engine medic worked the pt, and also did everything in the back while I called the hospital (six min txp). When I drive, I get to do all the hands-on stuff, and still not have to carry the pt. I much prefer this to having to carry all my equipment to and fro, fetch extra carrying equipment when needed, and have to carry every pt. Sometimes you're tired, and it's nice to have other medics do work while you just manage and direct the scene. It makes for a long and happy career, instead of getting beat down every day until you quit. It's nice to have your pt magically boarded and collared for you.

The units are largely idle, but still necessary to achieve deployment objectives, so it's wise to use them to boost call volume and ensure job security.

We have 41 txp units, 15 of which are double medic. Four stations have two ambulances running out of it. We have 37 ALS engines. So, that's 56 txp medics on any given day, and 37 engine medics. Our medics get plenty of time on the bus.