EMS independant of fire or joint?

[Afflixion]

Not trying to start a debate here as I already have my own views but where you work is EMS and fire separate or joint? Just trying to get a feel of how many places have joint services... When I worked in El Paso the city had joint EMS/Fire and the county was separate EMS fire. When I worked in Tucson the service I worked for was combined but the EMS and fire acted independently of one another each had their own CPT, LTs, etc.

 

[MRE]

My town runs joint Fire/EMS. We are far too small to have separate agencies. I'm 1 of 4 EMTs and about 18 firefighters of various capabilities and experience.

 

[Mountain Res-Q]

Even has a poll:

http://www.emtlife.com/showthread.php?t=12724

In my area EMS is provided by a variety of agencies. EMS and Ambulance are not the same thing. EMS refers to a medical services of a emergent nature (not just transport).

The agencies that provide EMS (not just Ambulance) in my area:
The Hospital (Not a Trauma Center)
The Air Ambulance folks (1 in county, more on request)
The Ground Ambulance Service (an indipendant non-profit full-time ALS service with 4.5 units on duty)
Numerous Fire Agencies (All BLS non-transport First Response)
Forest Service (First Aid and a few EMTs)
SAR (BLS equipped MFRs, OECs, EMTs, Paramedics, and MDs)
Boat Patrol (BLS/Advanced First Aid Staffed w/ some EMTs)
Several private and federally run Ski Patrol Groups (OEC and EMT)
JUST TO METION A FEW!

However, if you question was meant to be "where you work is Ambulance and Fire separate or joint?" then... My county and local counties are entirely indipendant 3rd service 911 ambulance transports. There are a few Fire run Ambulance services, but mostely in the larger cities hours away from me.

 

[Afflixion]

in my humble opinion fire isn't EMS unless they xport. But that's just me everyone is entitled to their own opinions though. But yes for the question is ambulance joint or separate for fire

 

[Mountain Res-Q]

in my humble opinion fire isn't EMS unless they xport. But that's just me everyone is entitled to their own opinions though. But yes for the question is ambulance joint or separate for fire

IMHO, EMS means EMERGENCY MEDICAL SERVICES and has nothing to do with transport (although transport should be a part of all EMS). If an ambulance responds to a call, provides care (like bandaging woulds, and then signs the patient AMA... was this still an EMS call even though they didn;t tranport but did provided EMS level care? That is all that Fire, SAR, Ski Patrol, etc... does, provide EMS care with out transport. Ambuance provides EMS care with transport. Or we can take Hospitals as an example. ERs do not transport, but are we saying that they don't provide EMERGENCY MEDICAL SERVICES? EMS and Ambulance are not interchangable terms... or at least shouldn't be. In fact, look around the forums. How many here are EMSers providing Emergency Medcal Care in settings that are not transport? I would say that 1/4 of the members here are currently working Ambulance. The rest work First Response in Fire, SAR, Prisons, Law, Military, Recreational Facilites, etc... or work in Hospitals and other medical facilites. Just becasue we don't tranpsort by Ambulance doesn't mean we are not EMS.

So the question (for clarity) is "Is your Ambulance Service private or Fire based?"

 

[JPINFV]

Defining what is EMS can be tricky. On one extreme you can claim that only transport and immediate receiving facilities (ER and ambulance) is EMS. On the other extreme there are people who are willing to claim that ICU and SICU are a part of EMS because that's where our critically ill patients eventually end up.

The same extremes can be said in the field. Is the police department a part of EMS because they do traffic control at accident scenes with patients? Does it matter if the police department carries an AED on all of their patrol cars? Is extrication EMS? Does it matter if the person extricated refuses to be transport (in essence does not become a patient)? At the extreme end, can anyone with a CPR/AED card claim to be a member of EMS?

There has to be a logical line drawn someplace. Yes, bystander CPR and PADs essentially make or break cardiac arrests, but I'm not going to call every Tom, ****, and Jane who took an ARC CPR course a member of EMS. I'm not prepared to say that any basic working first aid for an amusement park is truly a member of EMS (clarification: Dedicated first aid standby neither qualifies nor disqualifies someone to be a part of EMS. Someone can work both an EMS job and a first aid job). Similarly any IFT company that does not run a significant number of emergency transports (private/SNF, 911, or emergent CCT. "Emergency transport" defined for non-CCTs as the destination being the emergency room. Acuity, origination, and use of emergency lights are not a factor) is not a member of EMS.

On that note, responding to a medical call as a "first responder" does not automatically qualify as a member of EMS. Case in point, fire departments who's on scene time beats the ambulance by a few minutes (say urban area's with non-fire ambulance) should not qualify. Area's where EMS might be a significant distance away (rural/frontier areas) should count.

The line of what is and is not EMS is not clear cut.

Here's a question:
Would every person that owns a fire extinguisher be considered a part of the fire service?

 

[Mountain Res-Q]

IMHO...

Is the police department a part of EMS because they do traffic control at accident scenes with patients?

No that is Emrgency Service, but they are not providing that middle word MEDICAL.

Does it matter if the police department carries an AED on all of their patrol cars?

Yes, then they are part of the EMS system and are providing a emergency medical service.

Is extrication EMS?

Once again, are the ones doing the extrication doing so in the course of providing medical care or are they doing it to get the patient out of that situation so that someone can provide MEDICAL CARE?

Does it matter if the person extricated refuses to be transport (in essence does not become a patient)?

Were they evaluated by a EMS-level provider? Then yes. For instance, in SAR, when we rescue a victim (no matter what the call) we always havemembers of the medical team evaluate the patient before we end teh call. But EMS was provided because patient contact was made by and EMT or Medic, even if we didn't treat or transport.

At the extreme end, can anyone with a CPR/AED card claim to be a member of EMS?

Technically, they are the first link in the chain of survival. Joe Blow on teh street witnesses an arrest and provides CPR for 5 minutes before the First Responders show up, then yes, they are (for that moment) part of teh EMS system, but since providing that care in an offical capacity (such as Ambulacne, Fire, Rescue, SAR, LE, etc...) is not part of their normal job, then they are not EMSers.

I'm not prepared to say that any basic working first aid for an amusement park is truly a member of EMS (clarification: Dedicated first aid standby neither qualifies nor disqualifies someone to be a part of EMS. Someone can work both an EMS job and a first aid job).

So, real example (and there are numerous like this). I am 9in teh winter) a part-time manager / EMT Supervisor at a Snow Park. We run BLS calls all the time (spinal, MI, fractures, seizures, etc...). Last year on Christmas we had an MI. It took Fire First Response 30 minutes to get on scene and ambulance another 15 minutes. It took anotehr 30 minutes to fly him out to a cath lab. Are you saying that the BLS care that I provided (the same taht the EMT First Responders did) is not EMS? First Aid stations manned bty EMTs and Medics are often BLS or ALS equipped, not just First Aid w/ band Aids. In fact, there are many Ambulacne Agencies that make a busness out of these large event standbys and transport via their own ambulance to hospitals. Are they EMS?

Similarly any IFT company that does not run a significant number of emergency transports (private/SNF, 911, or emergent CCT. "Emergency transport" defined for non-CCTs as the destination being the emergency room. Acuity, origination, and use of emergency lights are not a factor) is not a member of EMS.

Disagree. I worked for a compnay where I did IFTs, 911 ALS, and CCT, depending on the day of the week. Are you saying that I wan't EMS on the days I was on IFT? What if I was transporting a patient to a SNF and came across a MVC? I stop and teh driver requests a 911 response, triages, and runs the call until Medis arrive. How can they do that if they are not EMS? Are they just playing First Aider, even though they have a L&S equipped Ambulacne, 911 radios, BLS equipment, and a uniform that doesn't distiguish between 911 and IFT? I put on the uniform and I was a EMS provider regardless of what call I was running (or if I was at Jack in the Box getting a soda). Hell, in the event of an MCI while running IFT, IFTs got sent to the call for manpower and transport. But we are not EMS? Ha.

On that note, responding to a medical call as a "first responder" does not automatically qualify as a member of EMS. Case in point, fire departments who's on scene time beats the ambulance by a few minutes (say urban area's with non-fire ambulance) should not qualify. Area's where EMS might be a significant distance away (rural/frontier areas) should count.

So, if a Fire Depatment (non transport) is Medic Staffed is that EMS? Is it EMS if they are EMT staffed? Is it EMS if they are MFR staffed? If any first response agency, regrdless of time on scene, provides medical care, it is EMS. They weren't called to put teh fire out. They were called to provide medical services, even if that is just O2, a set of vitals, and helping the medics transfer to the rig.

Would every person that owns a fire extinguisher be considered a part of the fire service?[/

Not a correct analogy. Does owning a stethescope automaticlly make you a Doctor? It's like saying, does owning a book make you a professor or does owning a car mean you are in NASCAR. Hell, my grandma owns a glucometer, does that make her a nurse?

The line of what is and is not EMS is not clear cut.

Maybe not for some. But a contend that if your job, even a small part, is providing any type of emergency medical service, then yes you are EMS. In SAR we run search for hours or days, rope rescue for hours, warter rescue for hours, helo rescue for hours, and medical care when all is said and done for 10-15 minutes. Yet we are certified to the same standards as Ambulacne EMTs and Medics and are just as equipped. We are still EMS providers, because part of our job is to provide emergency medical service, if not tranport.

I guess my argument is based on th fact that everyone here on the forums provides EMS in some fashion, but not eveyone is Ambulance, yet questions like this assume that Ambulacne is the only way to provide EMS. Not transporting = not EMS?

 

[JPINFV]

When I'm talking about IFT companies that 'aren't a part of EMS,' I'm talking about the companies where the crews can count the number of times they've seen the inside of an ER in the past 6 months on one hand. It's a company wide division, not a day to day or unit by unit division. Most large IFT companies, by virtue of running emergency calls out of their contracted health care facilities (assisted living, SNFs, etc) are a member of EMS.

In regards to the traffic accident, define assessment. Not everyone is going to get the n'th degree assessment if they claim to be uninjured and fine. For example, if I'm in fender bender and EMS shows up, I am not a patient just because EMS is there. If EMS decides to transport me against my wishes, I better have something seriously wrong in the end, or else I'm forwarding all of my bills to the ambulance company and the providers who treated me.

So, why is a person providing CPR, even "for the moment," (what ever that means. You either are or aren't), why isn't someone extinguishing a fire with a fire extinguisher not a member of the fire service, even if for just that moment? Shouldn't I get to claim to be a fire fighter if I ever use the extinguisher in my ambulance? After all, if anyone who's job is to put a band aid on a patient is a member of EMS, then shouldn't anyone who puts out a fire be a fire fighter?

For fire department first response, if that medic is only on scene for a minute or two at most (99% of the time) before handing off treatment, then no, it's not EMS. That's just the fire department padding it's call volume and we should call a spade a spade.

 

[Afflixion]

well in regards to the "private ambulance" thats not entirely true there are city run ambulances that are solely ambulance services no involvement with fire at all. and sorry for raising such a "ruckus" on the definition of EMS. Guess the saying curiosity killed the cat is true in this one... can't we all get along or smile and wave and pretend we are?

 

[mycrofft]

Back to the threat, er, thread!


Currently, I live where fire dept also furnishes EMS, by way of paramedics and their trainees riding modular ambulances owned operated and controlled by the FD. AMR also works here and does not do as good a job with true emergencies, starting with response times sometimes four times that of fire EMS.
I worked in Lincoln Nebraska when Bryan Memorial Hospital furnished their "Heart Team", an ER nurse, paramedic, and EMT or p[aramedic driver of their Suburban which did not transport. The ambulance comopany operated on a contract with the city supplying transport, and EMT-Ambulance level care. Fire Dept had just (1980) made EMT mandatory for all firefighters and was losing some good troops. This could get hairy, but it managed to cover a very wide area (with the assistance of rural vollies, god bless em) with the minimum of resources and the best results for that time (pre-AED, MAST trousers were "in", and Pebbles and BamBam were still in their playpen in Bedrock).

 

[Afflixion]

see in my experience (not as much as some but enough) the FD has performed rather poorly on the medical side (not going to say EMS lol) with long response times, their EMTs medics not knowing what they're doing, rude to the ED nurses, etc. I did like how Green Valley FD (out of Tucson) ran their EMS though it was integrated but separate 1 chief 1 deputy chief but different CPT and LTs for the medical portion. I'm not sure I do not have to much knowledge on other cities but in El Paso if you need medical emergency your kind of screwed. Granted there are some (not going to say a few because theres more than that) good EMTs and medics for EPFD but most of them are just kids who wanted to do Fire only and got stuck doing ambulance work as well they make it like a chore for them giving them "mandatory time" on a truck.

 

[Mountain Res-Q]

JPINFV, I diagree with your analogys for several reasons, but I say that if providing emergency care is part of your job than you are EMS. Putting on a band aid or providing CPR for a few minutes doesn't make you a EMSer unless you are doing so on the course of joing you duty. Owning a gun doesn;t make you LE and owner a fire estiguisher doesn't make you a firefighter, unless you are using those items in the course of you duties assosiated with that agency. Is providing EMS, Fire Protection, LE, part of your job? Clearly you have a different idea of what constitues EMS than I do, but as long as we are all clear that while Ambulance provides EMS (and transport) and aren't EMS by themselves, then whatever... I don't currentlty work Ambulance, but I am sure as hell EMS and am far more capable of providing emergency care than many of teh folks that I know working Ambulance or Fire. IMHO, but all type A personalities are capable or passionately arguing their beliefs.

Afflixion, couldn't agree more. While I likewise have no intention of going on a fire-Based / Private Ambulacne rant... I have had less then positive experiences working with Firte First Response in my area; and can't imagine handing transport over to the local fire boys. As I have said, that isn't and attack on the great Fire/EMS boys on the forums, just my experience in my corner of paradise. When you make working EMS mandatory for Firefighters who have no interest in EMS, then you are screwing your patients over. I do what i do becasue i want to, not becasue I have to, as I am sure most of you are.

See this closed thread for a rather passionate discusion on "the future of Fire based EMS":
http://www.emtlife.com/showthread.php?t=12382

 

[mycrofft]

Mndatory EMT's aren't happy EMT's

I would bet my nonexistant window punch if I had one (?) that many fire "EMS" as in systems are not properly under medical control, and I know fmo personal experience that when fire depts started doing that, seasoned and motivated firefighters moved or retired to get away from it.
Now, the majority of runs are medical, and how do you earn your tax dollars...getting the picture?
Coaxially located and dispatched FD and emergency medical responders and firefighters are a good deal (effective use of dispatch, many points in existence to position ambulances) , but FD's just have to run stuff themselves.

 

[Ridryder911]

Actually, prehospital care is just a very small, tiny part of the Emergency Medical Services Systems.

For some reason, we tend to forget that it is a system not a segment of care. For example the surgical crew that really did repair the trauma patient, the trauma ICU that mended to the patients physical and mental needs to overcome mortality and then rehabilitive care that is the final touch of the patient will make it back into society as to see if EMS was a sucess or not.

Somehow we tend to forget we just the start of the phase NOT the whole thing.

R/r 911

 

[Mountain Res-Q]

Somehow we tend to forget we just the start of the phase NOT the whole thing.

THANK YOU! EMS is a system with so many components that help ensure that a single goal is achieved: The safety and health of the patient is maintained! No matter what position in EMS we have, we all play a role in (hopefully) making a positive difference in someone’s life, but we can't do it all on our own. It is a group effort that starts with the educators, the person who calls 911, the dispatchers, the first responders (in their many forms), the ambulance (ground or air), the ER folks, the surgical folks, the allied health care professionals, the rehab folks, etc... And to single out those who work on a Ambulance as being the end all and be all of EMS is conceded and self-centered. All of the efforts on an Ambulance mean nothing without the many other links in the chain of survival.

 

[JPINFV]

It is a group effort that starts with the educators, the person who calls 911, the dispatchers, the first responders (in their many forms), the ambulance (ground or air), the ER folks, the surgical folks, the allied health care professionals, the rehab folks, etc...

So basically every part of health care is a member of EMS then? So should nursing homes that provide rehab services to trauma victims be allowed to ask for EMS grant funding?

 

[Mountain Res-Q]

So basically every part of health care is a member of EMS then? So should nursing homes that provide rehab services to trauma victims be allowed to ask for EMS grant funding?

Okay, Okay... take out the nursing home and rehab folks from teh EMS system. but leave in every hospital staff member from the ER through radiology, through surgery, all the way to the ICU as part of the emergency system.

 

[Ridryder911]

So basically every part of health care is a member of EMS then? So should nursing homes that provide rehab services to trauma victims be allowed to ask for EMS grant funding?

I have seen very few true nursing homes that really would be considered a rehabilitation centers with Physiatrists.

There is a far difference between a true trauma rehab center that deals with post traumatic injuries such as TBI, burns, pelvic fractures, etc. and those that are for general supportive care.

It does no good to "save" one if we do not finisht the product. In reality, in a perspective what good did we really do? Yes, anyone that has studied trauma and EMS systems realizes the importance of regaining and rehabilitation.

R/r 91

 

[Afflixion]

If you want to get technical a mom who throws a band-aid on a kid could be considered EMS all the way through to as said nursing homes. Though due to this thread and those similar my views have changed as what should be considered EMS (something hard to do...get me to change my views) I never really considered non x-port fire EMS, but I realize they are still responding with me to most calls and helping with C-spine and etc..

 

[Ridryder911]

If you want to get technical a mom who throws a band-aid on a kid could be considered EMS all the way through to as said nursing homes. Though due to this thread and those similar my views have changed as what should be considered EMS (something hard to do...get me to change my views) I never really considered non x-port fire EMS, but I realize they are still responding with me to most calls and helping with C-spine and etc..

Actually not EMS. As first aid and emergency medical are different. EMS is division of Emergency Medicine as should hold the responsibilities of delivering accurate and thorough care and prehospital is one of the first phases, along with public education of having taught commen layman first aid and recognizing when it is necessary to place the patient into the EMS system.

R/r 911