If FDs don't start stepping up to the plate and spending more effort with medicine and less with suppression this is going to continue to increase across the nation. If an FD wants to embrace a new role which EMS must become to remain economically viable, then I am all for it. But you as well as I know that The fire Service is reluctant in a majority of cases. Otherwise The model of King County wold be everywhere from FDNY to Columbus.
I don't disagree at all. It was just the automatic reaction to blame the FD for decreasing the service level when that wasn't the case.
The major "flaw" is the level of education between canadian "basics" and american "basics." But having said that, there was a washing DC study showing the only statistical difference in bls vs als outcome was length of hospital stay. (which was shorter for ALS) However, the cost of the difference was not compared. So it is possible that money could be saved with an increased hospital stay over the daily operations of such a large ALS department. But at this point we do not know.
It'd be interesting to see the numbers on that. But I'm bettring that it'd cost more for someone to stay in the hospital than it would to operate 1 ambulance for the same amount of time. Also have to consider that, if you went with a BLS unit because it was cheaper, now the hospital will have to pick up the lost money when the pt doesn't pay. And any study done in DC...yeah...maybe it should be done somewhere with halfway decent paramedics and a good system. 
Undoubtably a private ALS service could come in and save the city money. A hospitl based service properly set up might also. (big IF on that though) But unless a realistic way to pay for ALS service is found, the current economic trend does not support business as usual.
Again, I don't disagree. But that does not mean that the level of service should be decreased to save money. Fewer units dispatched to calls...maybe 1 medic/1EMT per ambulance...there are other ways to do it.
But Columbus acts like a glorified taxi service now with ALS. You are absolutely right, a medic can and should have better assessment skills, but they are not being used at this time. it is "you call we haul" Though last I heard they had a refusal of care in place, it was only after a response. So you are paying a lot of medics to drive around and hand out taxi vouchers. If you are dispatching a squad and an engine, you would probably save money driving the patient to the hospital just dispatching a squad. Especially with the fuel and maintenence of an engine.
I know squat about CFD, you've got me there. Like I said above, there are ways to save money without decreasing the service, and only sending 1 unit to the vast majority of calls...no problem with that. Even in a lousy system though, I think the benefits that a medic can bring are enough to justify having them.
As for reversable in the field, like I said, you could easily be well on the way to a hospital with a load and go mentality. If the transport times were longer I would agree, in this specific case, the response is the issue, not the transport. You could take a tanker full of narcan to an OD, but if they weren't breathing and it took you 6-12 minutes to get there, who cares? There are many places that could benefit from ALS care, but it is likely, that Columbus isn't one of those places.
They could have made a much stronger case for the ALS FD, but they reverted to dogma. "We save countless lives." If that were true they could have dropped some concrete data to trump the report and the headline would have read something like "penny pinchng lawyer makes citizens less safe."
You have to admit, the statements by FD oficials were pretty weak.
They were, but we also don't know if they said anymore than what was reported; the entire article was a bit low on real facts, so who knows what got left out..
