Seattle medic one

Jim37F

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All the stories I read on here of BLS fire squads arguing with ALS third service squads...
That I don't get, we're a BLS only FD, and as far as we're concerned, once EMS pulls up, the patient is theirs. We'll assist them (either helping Cardy the patient or basic ALS assist stuff like spiking the IV bag, setting up the 12 Lead, setting up Glucometer (using the blood from the IV to get a reading) etc, IF they ask (we'll offer though, but often EMS will say they're good and clear us as soon as the patient is loaded). Absent any gross negligence I can't imagine any of our crews arguing with EMS over patient care...
 

FiremanMike

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That I don't get, we're a BLS only FD, and as far as we're concerned, once EMS pulls up, the patient is theirs. We'll assist them (either helping Cardy the patient or basic ALS assist stuff like spiking the IV bag, setting up the 12 Lead, setting up Glucometer (using the blood from the IV to get a reading) etc, IF they ask (we'll offer though, but often EMS will say they're good and clear us as soon as the patient is loaded). Absent any gross negligence I can't imagine any of our crews arguing with EMS over patient care...
I’m talking about the stories posted here and elsewhere of third service medics downgrading runs so that BLS fire will transport instead of them.
 

EpiEMS

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Reacting to your expensive labor statement

To play devils advocate, don’t most single role EMS providers make significantly less than dual role fire medics or even single role firefighters when compared within a region?

So another advantage to a fire based model is a livable wage for EMS providers. And if your heart is truly with EMS and not firefighting, there’s not too many departments where you couldn’t say “I’d like to just ride the medic” and be told no.
I think that is indeed true - on the other hand, the Seattle area has interestingly high paramedic earnings despite the data excluding firefighters, so I'd venture to say that is more about the funding model than anything else.
 

DrParasite

The fire extinguisher is not just for show
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I realize this opinion is generally shunned and hated on these forums, but it is so much less complicated when FD runs fire, EMS first response, and EMS transport under one organization.

I have heard of so many completely broken iterations of 3rd service EMS programs that overlap full time fire and I don’t think I’ve ever read of a successful program.
Do you know what's even less complicated? FD runs fire, EMS handles EMS (and doesn't need fire to "stop the clock"), and EMS is funded by the AHJ with enough units to handle 99% of the call volume, only calling the FD for a rescue assignment or for lifting assistance.

But that would require the AHJ to actually fund their EMS system properly...
 

FiremanMike

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Do you know what's even less complicated? FD runs fire, EMS handles EMS (and doesn't need fire to "stop the clock"), and EMS is funded by the AHJ with enough units to handle 99% of the call volume, only calling the FD for a rescue assignment or for lifting assistance.

But that would require the AHJ to actually fund their EMS system properly...
How is it less complicated to add a second agency? More buildings, more administrative personnel, more front-line personnel, extra line items in the budget, extra personnel. Then there’s the inevitable creep that happens when fire is available to help on a call because EMS is tied up on another call, and then the thoughts of “we have these people here anyway and they’re not taking fire runs.”

Predicable outcome is predictable.


Look for the record, I don’t particularly care. I’m in the tail end of my EMS career, but I’m smart enough to read all these stories of abomination systems here that just don’t work.
 

DrParasite

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How is it less complicated to add a second agency? More buildings, more administrative personnel, more front-line personnel, extra line items in the budget, extra personnel. Then there’s the inevitable creep that happens when fire is available to help on a call because EMS is tied up on another call, and then the thoughts of “we have these people here anyway and they’re not taking fire runs.”
That same thinking is used to combine PD and FD under one umbrella. Wouldn't that simplify things? Lets also add in DPW, after all, they drive big trucks too. Just think of the extra line items and extra personnel we could eliminate if we put PD, FD and DPW all under one organization.
Look for the record, I don’t particularly care. I’m in the tail end of my EMS career, but I’m smart enough to read all these stories of abomination systems here that just don’t work.
I agree with you 100%! look at FDNY EMS, Detroit Fire/EMS, DC Fire/EMS, LA Fire/EMS, Philly Fire/EMS, just to make a few... All combined systems, all abominations. EMS takes up 90% of the call volume, and gets 10% of the funding, and it's EMS that ends up suffering.

In a small town, it might make sense to have fire, EMS, PD and DPW all under the same entity... but for the bigger systems, it's a huge abomination.
 

Tigger

Dodges Pucks
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Do you know what's even less complicated? FD runs fire, EMS handles EMS (and doesn't need fire to "stop the clock"), and EMS is funded by the AHJ with enough units to handle 99% of the call volume, only calling the FD for a rescue assignment or for lifting assistance.

But that would require the AHJ to actually fund their EMS system properly...
Agreed.

Nonetheless in this state there is no AHJ for EMS. The only thing guaranteed to citizens in Colorado is wildfire control and law enforcement.

My FD has provided ambulance service for decades because no else was. FDs providing EMS is not always a revenue grab. At this point it's just what we do here, same for many other agencies around us.
 

FiremanMike

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That same thinking is used to combine PD and FD under one umbrella. Wouldn't that simplify things? Lets also add in DPW, after all, they drive big trucks too. Just think of the extra line items and extra personnel we could eliminate if we put PD, FD and DPW all under one organization.
Not even a close comparison. If you can't admit that fire and EMS have a very similar mission/setup and PD is completely different, then this discussion is DOA..

There simply is NO reality where fire and EMS being separate is cheaper and more streamlined. I get it, a lot of you guys don't have a desire to fight fire.. I get it, a lot of you have dealt with ****head firefighters on EMS runs, but just because riding the medic is more comfortable in an environment where you don't have to fight fire or deal with ****head firemen does not mean it is more efficient.

I keep up on whats going on in my own area and across the nation in terms of EMS and fire/EMS. Third service EMS works well in areas where FD coverage is volunteer, but I have yet to hear of a successful setup in areas where fire and ems are both full time and separate.


The major disconnect here is that many of you are arguing based on the way it should be. There are relatively few people like me who genuinely enjoy going into a burning building one day and taking care of a sick grandma the next. In an idealistic world, those who want to do just fire could do that, and those who want to do just EMS could do that in environments that support their passions and strive for top quality service.

The reality is that there's overlap in service, and when there's overlap in service, the bean counters (inside the FD, inside the EMS agency, and at the city management level) will try to start figuring out how to intermingle and save money. When this happens, it becomes an absolute abomination if the departments stay separate.

It would be spiffy if hospitals would launch more hospital based EMS, but hospitals are completely profit driven now, and quality EMS is NOT profitable. The county health departments launching EMS? Where exactly is that money coming from?
 

NomadicMedic

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Not even a close comparison. If you can't admit that fire and EMS have a very similar mission/setup and PD is completely different, then this discussion is DOA..

There simply is NO reality where fire and EMS being separate is cheaper and more streamlined. I get it, a lot of you guys don't have a desire to fight fire.. I get it, a lot of you have dealt with ****head firefighters on EMS runs, but just because riding the medic is more comfortable in an environment where you don't have to fight fire or deal with ****head firemen does not mean it is more efficient.

I keep up on whats going on in my own area and across the nation in terms of EMS and fire/EMS. Third service EMS works well in areas where FD coverage is volunteer, but I have yet to hear of a successful setup in areas where fire and ems are both full time and separate.


The major disconnect here is that many of you are arguing based on the way it should be. There are relatively few people like me who genuinely enjoy going into a burning building one day and taking care of a sick grandma the next. In an idealistic world, those who want to do just fire could do that, and those who want to do just EMS could do that in environments that support their passions and strive for top quality service.

The reality is that there's overlap in service, and when there's overlap in service, the bean counters (inside the FD, inside the EMS agency, and at the city management level) will try to start figuring out how to intermingle and save money. When this happens, it becomes an absolute abomination if the departments stay separate.

It would be spiffy if hospitals would launch more hospital based EMS, but hospitals are completely profit driven now, and quality EMS is NOT profitable. The county health departments launching EMS? Where exactly is that money coming from?

I think this is a perfect example of “if you’ve seen one EMS system, you’ve seen one EMS system.“ In south-central Pennsylvania, all of the EMS agencies are being swallowed up by hospital-based systems. Noting EMS isn’t profitable is a true statement, however it can be made profitable if all of the patient transport is rolled into one bill. Hospital systems using large spoke and hub models are affectively moving patients through the system, from initial 911 call, to a community hospital to a specialty hospital for tertiary care.

Based on current trends, in my region of South Central Pennsylvania, I see the majority of EMS systems moving to a hospital based model, albeit kicking and screaming. The large systems like UPMC and Penn State Health are building new facilities and incorporating EMS into the business model. Is that a better solution than having it run by the fire department? I believe so. If for no other reason then expediting the transition of EMS providers from public safety to healthcare.

And let’s not forget the simple fact that fire departments are in the EMS game because in the early days, there were trainable blue-collar workers that were available 24 hours a day. It could have just as easily been police officers, post office workers or taxi cab drivers. Fire departments were there and staffing units, and the doctors believed them trainable. Now that they’re in the system, they’re like bedbugs. Invasive and difficult to remove.
 

DrParasite

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I'm going to address your statements one section at a time
Not even a close comparison. If you can't admit that fire and EMS have a very similar mission/setup and PD is completely different, then this discussion is DOA..
Fire department mission: to save lives and protect property
Police Department: to serve and protect lives and property.
EMS: helping the sick and injured.

Have missions changed over the years? sure, but that's the gist of it.

Now, you mention setups:
Fire departments ride around in big trucks, work in crews between 3 and 6 people, respond from stations, have beds to sleep in on the over nights. Has a supervisor on every crew.
Police departments ride around in small trucks or cars, are posted to a zone or region, are running all day and night and if they get downtime, they find a quiet area in their zone. PD also handles most calls with a 2 person crew, and rarely has a supervisor on a scene, unless requested
EMS: ride around in small to medium sized vehicles, are posted to a zone or street corner, are running all day and night, and if they get downtime, they find a quiet area in their zone. PD also handles most calls with a 2 person crew, and rarely has a supervisor on a scene, unless requested

I don't know about you, but I think EMS's setup is more in line with PD than FD...
There simply is NO reality where fire and EMS being separate is cheaper and more streamlined. I get it, a lot of you guys don't have a desire to fight fire.. I get it, a lot of you have dealt with ****head firefighters on EMS runs, but just because riding the medic is more comfortable in an environment where you don't have to fight fire or deal with ****head firemen does not mean it is more efficient.
Cheaper =/= better. Realistically, for profit EMS agencies are the cheapest, because they pay the least in salaries. And I do agree with you, not every medical person wants to do fire... I get it. But if you polled every FD in the US (including yours) and asked them if they would have a problem if the department stopped going on EMS runs, how many people would object? maybe 7, out of a million?
I keep up on whats going on in my own area and across the nation in terms of EMS and fire/EMS. Third service EMS works well in areas where FD coverage is volunteer, but I have yet to hear of a successful setup in areas where fire and ems are both full time and separate.
From what you describe of your own department, you seem to be one of the rare ones that is doing it well. I've said it before, and I will say it again. But you are not the norm.

As for areas where FD and EMS are separate and doing it well:
Pittsburg PA
Minneapolis / Hennepin County
Wake County NC (actually, many NC EMS system are pretty decent, Wake just gets a lot more funding)
Sussex County Delaware
Many areas of NJ (it's not perfect, but it's the best that can be done with the funding and legislative support that it's given)
Boston Mass

I'm sure there are others, but those should get you started. Also, none of those systems are perfect, but they are doing a better job than if they were part of the FD (see the list I provided earlier for understaffed and underfunded EMS systems that are part of the FD).
The major disconnect here is that many of you are arguing based on the way it should be. There are relatively few people like me who genuinely enjoy going into a burning building one day and taking care of a sick grandma the next. In an idealistic world, those who want to do just fire could do that, and those who want to do just EMS could do that in environments that support their passions and strive for top quality service.
I enjoy both (ok, the burning building is more fun), and I don't enjoy doing either after 11pm.
The reality is that there's overlap in service, and when there's overlap in service, the bean counters (inside the FD, inside the EMS agency, and at the city management level) will try to start figuring out how to intermingle and save money. When this happens, it becomes an absolute abomination if the departments stay separate.
Respectfully disagree. see previous examples of merged departments and how abysmal they perform
It would be spiffy if hospitals would launch more hospital based EMS, but hospitals are completely profit driven now, and quality EMS is NOT profitable. The county health departments launching EMS? Where exactly is that money coming from?
And that's the crux of the issue. Many places won't give adequate funding to EMS, but are completely ok with giving the FD millions, despite the fact the the FD is NOT a profitable entity. It's a known black hole for money, and hasn't been profitable for centuries. So when EMS needs more money, it gets denied, so the FD gets involved, starts doing EMS, and money is allocated. It all comes from the same pot (taxpayers).

I'm actually not against the FD running EMS, and or even having the FD going on EMS calls. However, I have yet to see a big EMS system, ran by the FD, that is not an abysmal failure. I do think that small EMS systems can be part of the FD, because the call volume is low, and EMS often justifies the salaries of the firefighters.

But when I see a department that has a career firehouse with a 3 person staffed engine, 3 person staffed ladder, a BC, and a 2 person ambulance which is currently posted on a street corner, where 80% of the station's call volume is handled by that 2 person ambulance, staffed by the two junior members, I have to question if the department's priorities are in order. Ok, I'll get off my soapbox now
 

NomadicMedic

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What you're seeing is a bit of a selection bias.

Nothing you read on this forum is statistically valid. This is a group of EMS outliers who feel as though their opinions are more important than everyone else. Take that with a grain of salt. Don’t ever come to this forum looking for anything even remotely nonbiased.
 

FiremanMike

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Nothing you read on this forum is statistically valid. This is a group of EMS outliers who feel as though their opinions are more important than everyone else. Take that with a grain of salt. Don’t ever come to this forum looking for anything even remotely nonbiased.

I always try to preface my opinions with "from what I've read" or "in my experience"..
 

NomadicMedic

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I always try to preface my opinions with "from what I've read" or "in my experience"..
Exactly. All of my interaction with King County medic one have been personal and firsthand. Now that was also more than a decade ago, so I can’t tell you if the culture has changed for the better or worse.
 

E tank

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Nothing you read on this forum is statistically valid. This is a group of EMS outliers who feel as though their opinions are more important than everyone else. Take that with a grain of salt. Don’t ever come to this forum looking for anything even remotely nonbiased.
Like this post... 😁 And since when did EMS folks feeling as though their opinions are more important any everyone else's constitute the 'outlier' category?
 

E tank

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I think this is a perfect example of “if you’ve seen one EMS system, you’ve seen one EMS system.“ In south-central Pennsylvania, all of the EMS agencies are being swallowed up by hospital-based systems. Noting EMS isn’t profitable is a true statement, however it can be made profitable if all of the patient transport is rolled into one bill. Hospital systems using large spoke and hub models are affectively moving patients through the system, from initial 911 call, to a community hospital to a specialty hospital for tertiary care.
Hope that trend spreads...good news for patients and ambulance crews. It means when fire captains make the mistake of confusing a medical emergency for a working fire, they'll get a love note from a real live invested physician medical director to stay in his lane. There are systems that work just fine and need to be left alone, but even in well run and administered systems attrition rates of paramedics are abysmal. Hospital based systems are far more able to ameliorate that problem than privates, 3rd service or fire based systems. Oh yeah....'from what I've read' and 'in my experience'....😁
 

FiremanMike

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Hope that trend spreads...good news for patients and ambulance crews. It means when fire captains make the mistake of confusing a medical emergency for a working fire, they'll get a love note from a real live invested physician medical director to stay in his lane. There are systems that work just fine and need to be left alone, but even in well run and administered systems attrition rates of paramedics are abysmal. Hospital based systems are far more able to ameliorate that problem than privates, 3rd service or fire based systems. Oh yeah....'from what I've read' and 'in my experience'....😁
Damn dude, show me on the doll where the firefighter touched you.

Since your world completely removes fire from EMS, are you down for letting them sit in quarters 2 blocks away while the EMS crews come from across town to take care of grandma who’s having a COPD exacerbation?
 
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