Fire Als transport vs other..

[Veneficus]

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

The science of science...

Science is observational and experimental study.

One of the reasons that a single study should never be used to determine practice is because of unintentional bias.

I see EMS people do this all the time. They find a single study that favors their opinion and they run with it like it is a definitive souce.

When choosing to do a study, the methods are chosen to support the hypothesis. It is not something sinister, it is just the limitations we face.

Many things are multifactoral and our observations are the summary of different causes. It is often impossible to set up a study to account for this. Especially in biological systems.

I use the example of soup. You literally select out part of the soup that you don't like or calls into question your corellations.

One of the most validating aspects of science is it stands up to scrutiny. BUt really, who is trying to reproduce or scrutinize fire and EMS studies who do not have a vested interest in them?

Nobody.

Even if they did, the public safety, in particularly, fire service propaganda machine will swing into effect to not discredit the results, but to elicit emotional response to those results.

Take for example sepsis research. If I come up with a conclusion, other people refute, I don't start an ad campaign talking about saving lives, what if it were you, heroes, life and death risks, etc.

I go back to the drawing board with this newly found information from the people who refuted my work and try to improve the process.

At the end of all studies is a bibliography. If you truly want to evaluate a study, you must also seek out all of those studies and read them as well. You will find a lot gets lost in translation as well as selectivity.

Research is time intensive. It also often raises more questions than it answers.

All good research explans "why" not just simple causation/correlation.

Some people also are seduced by the ease of "studies" to prove a point. If something is quantified, it does not qualify it. But they like to believe it does. They use research as a crutch similar to religion, to explain things in an easy to understand and absolute truth way.

Perhaps the biggest flaw in using research is the fact that it is based on observation but the principle being observed, especially in biological system, changes over time. The same can be said for public safety system.

The major problem with these studies is they assume all providers, firefighters, etc are equal. The individual knowledge/skill/experience and team dynamics are not quantifiable or reproducable.

What it leaves you with is a study, which supporters exclaim is definitive knowledge, that really isn't worth the paper its printed on.

Bad science is not better than no science. If you think that is not true, I urge you to look at all of the science around the 1800-1900s that demonstrated things like women were not as smart as men based on cranial vault volume or any plethora of "science" published and accepted demonstrating inferiority of various races or social groups.

Even for all of this, you need somebody to accurately and truthfully present the results of good studies to people who do not understand them and convince them of their validity.

Do you take the word of a used car salesman that the used car you want to buy is perfect?

Of course not, you go and get an opinion from a mechanic. As well as a history if you are smart, and you certainly test drive a few.

 

[shfd739]

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.

That last part I can agree with.

I spent 6 years with my private company in an area where we ran from stations and generally spent time(sometimes half a day) hanging out in a station. We'd run a call and go back to a station with a regular computer to do reports on, TV, couches, etc.

Now, same company, after 3 1/2 years in an area with only SSM/street corner posting and I'm ready to quit. It's hard on the body, constantly driving around is taxing physically and I spend way too much time in a very uncomfortable truck seat. it's hard to use a toughbook and type reports while driving around at night which means I'm constantly staying late to catch up. It sucks.

Personally I can't keep this up and I'm trying to figure my next step. Either looking at flight jobs or switching to a 911 only agency that runs from stations. Leaning more toward flying so I can keep seeing CCT type patients.

 

[Amberlamps916]

I would really like to hear LA county fire's or LAFD's take on this. I haven't really seen any of their medics on this board.

 

[46Young]

The science of science...

Science is observational and experimental study.

One of the reasons that a single study should never be used to determine practice is because of unintentional bias.

I see EMS people do this all the time. They find a single study that favors their opinion and they run with it like it is a definitive souce.

When choosing to do a study, the methods are chosen to support the hypothesis. It is not something sinister, it is just the limitations we face.

Many things are multifactoral and our observations are the summary of different causes. It is often impossible to set up a study to account for this. Especially in biological systems.

I use the example of soup. You literally select out part of the soup that you don't like or calls into question your corellations.

One of the most validating aspects of science is it stands up to scrutiny. BUt really, who is trying to reproduce or scrutinize fire and EMS studies who do not have a vested interest in them?

Nobody.

Even if they did, the public safety, in particularly, fire service propaganda machine will swing into effect to not discredit the results, but to elicit emotional response to those results.

Take for example sepsis research. If I come up with a conclusion, other people refute, I don't start an ad campaign talking about saving lives, what if it were you, heroes, life and death risks, etc.

I go back to the drawing board with this newly found information from the people who refuted my work and try to improve the process.

At the end of all studies is a bibliography. If you truly want to evaluate a study, you must also seek out all of those studies and read them as well. You will find a lot gets lost in translation as well as selectivity.

Research is time intensive. It also often raises more questions than it answers.

All good research explans "why" not just simple causation/correlation.

Some people also are seduced by the ease of "studies" to prove a point. If something is quantified, it does not qualify it. But they like to believe it does. They use research as a crutch similar to religion, to explain things in an easy to understand and absolute truth way.

Perhaps the biggest flaw in using research is the fact that it is based on observation but the principle being observed, especially in biological system, changes over time. The same can be said for public safety system.

The major problem with these studies is they assume all providers, firefighters, etc are equal. The individual knowledge/skill/experience and team dynamics are not quantifiable or reproducable.

What it leaves you with is a study, which supporters exclaim is definitive knowledge, that really isn't worth the paper its printed on.

Bad science is not better than no science. If you think that is not true, I urge you to look at all of the science around the 1800-1900s that demonstrated things like women were not as smart as men based on cranial vault volume or any plethora of "science" published and accepted demonstrating inferiority of various races or social groups.

Even for all of this, you need somebody to accurately and truthfully present the results of good studies to people who do not understand them and convince them of their validity.

Do you take the word of a used car salesman that the used car you want to buy is perfect?

Of course not, you go and get an opinion from a mechanic. As well as a history if you are smart, and you certainly test drive a few.

I personally took part in two of these studies. I don't feel that their data is flawed from what I can see. They've been measuring the time for companies to complete certain time-critical fireground tasks with two, three, four, five, and six person crews. They found four to be the magic number. Three or fewer crew members was associated with a sharp increase in time, and the curve abruptly flattened out with 5 or more. The purpose was to justify a certain minimum staffing for each apparatus. I'm sure that some portion of the study was guided to achieve the desired result, but that can be said of many studies in all different fields.

 

[46Young]

That last part I can agree with.

I spent 6 years with my private company in an area where we ran from stations and generally spent time(sometimes half a day) hanging out in a station. We'd run a call and go back to a station with a regular computer to do reports on, TV, couches, etc.

Now, same company, after 3 1/2 years in an area with only SSM/street corner posting and I'm ready to quit. It's hard on the body, constantly driving around is taxing physically and I spend way too much time in a very uncomfortable truck seat. it's hard to use a toughbook and type reports while driving around at night which means I'm constantly staying late to catch up. It sucks.

Personally I can't keep this up and I'm trying to figure my next step. Either looking at flight jobs or switching to a 911 only agency that runs from stations. Leaning more toward flying so I can keep seeing CCT type patients.

I hear you. I did five years in NYC, sitting on street corners and running my but off. We were hospital based, we also had IFT shifts that were typically steady throughout the day with no breaks and usually with a late job. I had maybe 2-3 more good years in me before I would have burnt out. When I worked for Charleston County EMS, it was with a 24/48 schedule, no Kellys, and frequent holdovers for 12-24 hrs. We did frequent overnight street corner postings even though we had a station. Like you, we had to sometimes stay late to finish the ePCR reports, since we were made available upon arrival at the ED, and would frequently get the next call before we were anywhere close to finishing the current call.

SSM and having to take calls before you finish the previous one are just band-aids for systems that under-staff and under-deploy. Sure, the supply of EMT's and medics may be abundant, but that does not make the work any less tiresome.

I would either go with flight, or get into another medical field altogether, and do EMS on the side for kicks. I've yet to see an EMS system that's not really busy (which really means not enough units to address the call volume), unless it's rural, and then you're typically getting welfare wages.

 

[Veneficus]

I'm sure that some portion of the study was guided to achieve the desired result, but that can be said of many studies in all different fields.

That's what I said, only with more words.

I will not get into minimum manning studies. But I will say I doubt 4 is optimal. An odd number would make sure the company officer didn't have to be hands on.

 

[Christopher]

That's what I said, only with more words.

I will not get into minimum manning studies. But I will say I doubt 4 is optimal. An odd number would make sure the company officer didn't have to be hands on.

Realistically 4 is an odd number for an engine company. Engineer, Officer, 2-man attack crew. Second due engine, squad, or truck can build as necessary. Of course the 4 man staffing model is based on a 2-in / 2-out model...

 

[shfd739]

I hear you. I did five years in NYC, sitting on street corners and running my but off. We were hospital based, we also had IFT shifts that were typically steady throughout the day with no breaks and usually with a late job. I had maybe 2-3 more good years in me before I would have burnt out. When I worked for Charleston County EMS, it was with a 24/48 schedule, no Kellys, and frequent holdovers for 12-24 hrs. We did frequent overnight street corner postings even though we had a station. Like you, we had to sometimes stay late to finish the ePCR reports, since we were made available upon arrival at the ED, and would frequently get the next call before we were anywhere close to finishing the current call.

SSM and having to take calls before you finish the previous one are just band-aids for systems that under-staff and under-deploy. Sure, the supply of EMT's and medics may be abundant, but that does not make the work any less tiresome.

I would either go with flight, or get into another medical field altogether, and do EMS on the side for kicks. I've yet to see an EMS system that's not really busy (which really means not enough units to address the call volume), unless it's rural, and then you're typically getting welfare wages.

Yep. Plenty of units but deployment could be better to not beat crews up so bad. Typical shift has been 200+ miles/half tank of fuel in 12 hours just from being moved around so much.

Flight is what I'm leaning toward and have started taking the card classes and preparing for CCP-C test. Their pay is strong with nice schedules.

 

[46Young]

That's what I said, only with more words.

I will not get into minimum manning studies. But I will say I doubt 4 is optimal. An odd number would make sure the company officer didn't have to be hands on.

Five was better than four, but no so much better as to justify having five as minimal staffing. The study was done with the assumption hat the entire crew abandons the piece, so in reality we're really talking about a five person crew if the driver stays behind. RIT engines, Heavy Rescue squads, and most units on a high rise will take their drivers.

One thing was certain, that three person companies were much slower, and going from three to four saw the greatest time savings.

 

[46Young]

Yep. Plenty of units but deployment could be better to not beat crews up so bad. Typical shift has been 200+ miles/half tank of fuel in 12 hours just from being moved around so much.

Flight is what I'm leaning toward and have started taking the card classes and preparing for CCP-C test. Their pay is strong with nice schedules.

Good luck!

Posting and having to move every so often gets old real quick. I've spoken with a few people that either used to work at RAA in Richmond VA, or know a few that have worked there. The feeling is always the same - it's a good place for someone new to get experience, or for a casual per diem. Otherwise, it's too stressful.

 

[Bullets]

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.

I was unaware there were levels of severity in cardiac arrest...were they only mostly dead?


Let me tell you a story

We all now EMS got its big boy pants on in the 60's, however in the great Garden State we have squads that can trace their history as far back as the 1920s. Was it a hearse kept at the funeral home? Yeah, and the guys staffing it had little more then Boy Scout level training, but you did see the local Doctor on the squads and providing the care. A few squads along the shore actually started with MDs going to patients, and the system has regressed, but that is another story.

As EMS grew and expanded, and population levels rose from what was once the most bountiful farm lands east of the Appalachians to become the NYC suburbs following WWII, more squads formed and a base level of training was established. During this time there were Fire companies older then the towns they served, and there was limited fire codes and minimal fire prevention. These companies were so busy fighting actual fires that they did not have the time to provide any other service, so many EMS agencies, the industry being young and not taken advantage of like it is today, began the foray into rescue services, as they were being called to MVCs anyway, why not have a way to remove the injured patient from the situation.

Johnny and Roy come around and the DOH decides this MICU thing is a thing and begins the process of developing MICU projects. Who better then to develop a group of people providing emergency care outside the emergency room then the Emergency Room (ie the Hospitals)? Again, FD is still in the war years and have no time for these medical shenanigans so they do not pursue this and let it happen. Fire codes are updated, fire prevention happens and the FDs basically begin the process of putting themselves out of business. Call volume drops while EMS calls rise, based on a number of socioeconomic factors, and FD sees this. "We are heroes, why can we be heroes there too" says the FD and they begin to make attempts to move in to the EMS business. However they gave the EMS agencies about 30 years head start to entrench themselves, so the only places in NJ where you see FD based EMS is places where there never was a volunteer EMS agency, or where the volunteers screwed up and didnt have the ability to see the future and survive.

 

[STXmedic]

Yep. Plenty of units but deployment could be better to not beat crews up so bad. Typical shift has been 200+ miles/half tank of fuel in 12 hours just from being moved around so much.

Flight is what I'm leaning toward and have started taking the card classes and preparing for CCP-C test. Their pay is strong with nice schedules.

Who are you looking at? AirMedical? AirLife?

I'd like to at least do part time at one of the two, but I've still got about a year and a half before I hit my 5yr mark.

 

[shfd739]

Preferably REACH/Methodist Aircare.

Air Medical wouldn't be a bad part time gig.

 

[Shishkabob]

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.

And we go back to the point that all firefighters would rather ignore: Give an EMS agency even just 60% of the budget of the FD and put the money where the 911 calls are (medicine, NOT fire), and most if not all the issues you guys bring up as to why working FD is better then EMS are solved. Finite. Done. Gone.


But nope, keep spending the lions share of the cities budget on an agency that is designed for less than 5% of all 911 calls that are made. Yup. Efficiency. Way to go IAFF.

 

[46Young]

And we go back to the point that all firefighters would rather ignore: Give an EMS agency even just 60% of the budget of the FD and put the money where the 911 calls are (medicine, NOT fire), and most if not all the issues you guys bring up as to why working FD is better then EMS are solved. Finite. Done. Gone.


But nope, keep spending the lions share of the cities budget on an agency that is designed for less than 5% of all 911 calls that are made. Yup. Efficiency. Way to go IAFF.

It's not as simple as just putting money where the calls are. To have reasonable fire coverage, there needs to be certain types of suppression units a certain distance apart, and these units need to have a certain number of FF's on them. That calls for more than a 2:1 funding ratio of fire to EMS. Sure, money for EMS needs to be increased, but it can't come from fire. For fire, the call volume doesn't necessarily dictate staffing. Units can't have 15 minute response times, and they're highly ineffective with just two people per piece.

 

[Shishkabob]

It's not as simple as just putting money where the calls are. To have reasonable fire coverage, there needs to be certain types of suppression units a certain distance apart, and these units need to have a certain number of FF's on them. That calls for more than a 2:1 funding ratio of fire to EMS. Sure, money for EMS needs to be increased, but it can't come from fire. For fire, the call volume doesn't necessarily dictate staffing. Units can't have 15 minute response times, and they're highly ineffective with just two people per piece.

It sure can, and should, come from fire, for the simple fact that since 85% of FD calls are for medicine, quit running that 85% and let the budgets fall where they may. I'll even give you the 5% of the calls where FD actually is useful on a scene beyond carrying equipment. So no, an 80% reduction in calls run won't mean an 80% reduction in FD budget, but it WILL be a pretty good chunk reduced that should go to EMS.

 

[usalsfyre]

46Young, the problem with your and most of the rest of FDs in the US thought's on the subject is they assume interior attack, which is becoming increasingly idiotic as construction gets lighter and lighter.

 

[Bullets]

IUnits can't have 15 minute response times, and they're highly ineffective with just two people per piece.

Why cant they have 15min response times? Its just wood and stuff...How many fires are entrapment due to the residents being unaware? How many entrapment result because the resident went back inside the fire building?

In suburban communities where there are multiple companies per town, that is why you call mutual aid

 

[KingCountyMedic]

"Forefront" is relative, and highly dependent on which arbitrary measurement you use. If you go with SCA resuscitation, KCM1 is pretty good. Not so much if you go by "pain palliated", "respiratory distress" or "ACS/AMI recognition and treatment".

Pure garbage. Do you work in King County? If so I'd love to have a talk in person on shift. Call our on duty MSO and give the details of the last "ACS/AMI" that you saw turfed by a County Medic.

 

[RocketMedic]

Pure garbage. Do you work in King County? If so I'd love to have a talk in person on shift. Call our on duty MSO and give the details of the last "ACS/AMI" that you saw turfed by a County Medic.

I think its pretty clear that I don't work for KCM1. That being said, Im pretty sure that plenty of serious medical complaints go unattended by Kcm1. Or do you dispatch a pmed to every nausea, unknown and chest pain?