FDNY firefighters banned from responding to potential coronavirus cases

[DrParasite]

The department issued an order Friday temporarily relieving firefighters from responding to calls of the second highest priority for patients with fever, coughing, difficulty breathing or even those who are unconscious.

but don't worry, FDNY EMS will still be answering the calls

FDNY firefighters won’t be dispatched to potential coronavirus cases

They’re not the Bravest when it comes to the coronavirus. The FDNY won’t dispatch its firefighters to potential coronavirus patients, leaving its paramedics and EMTs to handle them alone, The Post …

nypost.com

 

[CCCSD]

Smart. Leaves them available and not exposed, thereby maintains staffing levels. It’s an ambulance call anyway.

 

[Tigger]

We are also supposed to cancel the engine on these calls if there is any suspicion of COVID-19. One job has gone to great lengths to limit cross contamination to the point that no inter-station visits by crews are permitted...

 

[Summit]

Minimize the number of exposed providers. What is the problem?

Oh wait... the problem is sending 8 people to every call in the first place?

 

[DrParasite]

While I am typically a staunch advocate that EMS should be able to do their job without an engine, NYC EMS historically has long response times, and uses engine companies to "stop the clock."

According to the article, first responders won't be sent on " difficulty breathing or even those who are unconscious." I mean, it's not like an engine company can be taught how to evaluate the patient for a corona virus and then update the ambulance crew accordingly

 

[Summit]

The problem isn't that the engine EMTs can't assess, it's just about minimizing personnel means less opportunity to have a PPE failure. Keeping disease out of communal living situations (firehouse) is a key mitigation measure. It is also a way to conserve PPE. It makes sense unless a patient is in extremis.

But forcing a long response time on an unresponsive respiratory patient is a bit brutal

 

[Peak]

My understanding is that the vast majority of FDNY firefighters are EMRs and that EMT or higher training is the exception anyway.

 

[DrParasite]

My understanding is that the vast majority of FDNY firefighters are EMRs and that EMT or higher training is the exception anyway.

Your understanding is incorrect. FDNY Engines are credentialed at the FDNY EMR level, but there are plenty of EMTs and Paramedics who are functioning at the EMR level because they are on engines. Plus, with the process where FDNY EMS people can "promote" to the suppression side, you likely have even more EMTs and Paramedics (and a couple former ones that let their cert laps and just maintain their EMR, because it's job required) throughout the suppression side.

Personally, I don't understand why FDNY doesn't just train every new recruit as an EMT in the academy, like many other career FDs do, but that's neither here nor there.

 

[Peak]

Your understanding is incorrect. FDNY Engines are credentialed at the FDNY EMR level, but there are plenty of EMTs and Paramedics who are functioning at the EMR level because they are on engines. Plus, with the process where FDNY EMS people can "promote" to the suppression side, you likely have even more EMTs and Paramedics (and a couple former ones that let their cert laps and just maintain their EMR, because it's job required) throughout the suppression side.

Personally, I don't understand why FDNY doesn't just train every new recruit as an EMT in the academy, like many other career FDs do, but that's neither here nor there.

What is the percentage of EMRs vs EMTs or higher? What equipment or meds does FDNY supply to allow EMT or higher to function beyond a EMR scope? Are those EMTs or higher covered by insurance and department policy if they act beyond the EMR scope? What percentage of emts and paramedics that swear into firefighting what to keep up an EMT or higher scope of practice anyway versus those that simply used it to get a fire job?

In a large city like New York, Chicago, Denver, Paris, or Tokyo what does training fire in EMS really bring to the citizens? I loved my time as a fire medic, but I think that utility really is limited to the suburban/interface environment. In a well established large city the value dimishes quickly.

 

[DrParasite]

I don't have exact numbers.... however there are 11,033 uniformed firefighters in FDNY. 900 FDNY paramedics and EMTs have left to become firefighters in 2018. In 2020, the FDNY EMS Chief says they lose 1,200 EMS worker every 4 Years to the suppression side. So you do the math.

Equipment is likely the same, no clue on meds, protocols are likely similar and most life saving interventions are ABC related. IIRC, NREMT uses similar practical exams for EMR and EMT. However, an EMT has more knowledge than an EMR, so even if they don't have all the tools, they should be able to perform a halfway decent assessment, and determine what is going on with the patient.... in theory anyway.

I agree, fire medics on the engines are generally a waste of time and money.... however, having competent firefighter EMTs can make things run smoother, and have a generally positive impact on the EMS system, especially when EMS has an extended response time.

 

[Peak]

I don't have exact numbers.... however there are 11,033 uniformed firefighters in FDNY. 900 FDNY paramedics and EMTs have left to become firefighters in 2018. In 2020, the FDNY EMS Chief says they lose 1,200 EMS worker every 4 Years to the suppression side. So you do the math.

Equipment is likely the same, no clue on meds, protocols are likely similar and most life saving interventions are ABC related. IIRC, NREMT uses similar practical exams for EMR and EMT. However, an EMT has more knowledge than an EMR, so even if they don't have all the tools, they should be able to perform a halfway decent assessment, and determine what is going on with the patient.... in theory anyway.

I agree, fire medics on the engines are generally a waste of time and money.... however, having competent firefighter EMTs can make things run smoother, and have a generally positive impact on the EMS system, especially when EMS has an extended response time.

I think you are making an assumption that those former EMS guys want to do EMS, which is largely untrue in very large fire departments. Those guys want to be smoke eaters.

I highly doubt the supplies are the same. Fire probably has a bvm, nrb, basic wound supplies, and maybe a functional AED; far less than a BLS ambulance.

Tell me, what difference does having an EMR versus EMT assessment make when you are waiting for the ambulance?

The city I work in has a BLS fire service with little interest in EMS. They are good at fire and rescue, which is their job. EMS is a robust third service who performs essentially all patient care, fire will assist with CPR but that's essentially it. There are paramedics and nurses who have joined the fire department but they joined because they want to play fire.

Extended EMS response times in a large city is an EMS problem, not a fire problem. It should be addressed by increasing ambulances, not sending 400K 3mpg chrome chariots to belly pain calls. This is different in suburban, interface, and rural departments; but this is about real big city fire.

 

[Sled Driver]

As said above, many FDNY EMS personnel going into EMS as the "back door" way of getting into the Fire side of the house. They are able to take the test to get hired rapidly and transfer after 2 years on the EMS side. When they go to the Fire side, their pay dramatically increases. Starting base pay for FDNY EMT in 2017 was $34,300, while for F.F. it was $45,300.

If you try to go directly into the Fire side the wait is a lot longer than the 2 years that must be spent on the EMS side. The 1,200 personnel lost every 4 years is also after a recent policy change that reduced (stop loss) the number of people transferrring to Fire, by limiting the age at time of transfer to under 32 YOA.

 

[Carlos Danger]

Virtually everyone is going to be exposed to coronavirus that causes COVID-19 before long anyway, just as we are virtually all exposed to the coronaviruses and rhinoviruses that cause the common cold and the influenza viruses that cause the flu. Just like with the common cold and the flu, very, very few of us will become seriously ill. Those of us who work in healthcare have little choice but to view increased exposure to these pathogens as an expected occupational risk.

About 100,000 people have developed COVID-19 and about 3500 have died worldwide. The vast majority of people who are infected with this novel coronavirus will never develop any symptoms at all, and for those that do, most will be mild. OTOH, so far this season in the US alone, an estimated 34 MILLION people have been sickened by the flu and TWENTY THOUSAND PEOPLE have died from it.

I'm not saying we should be flippant about any of this, or that we should come to work if we might be sick with COVID-19 or the flu. I guess what I'm saying is that I'm not sure why, with the possible exception of paying extra attention to hand hygiene, equipment cleaning, and proper PPE, we aren't pretty much just doing business as usual.

 

[Jim37F]

This seems somewhat relevant:

https://www.firehouse.com/safety-health/news/21128932/fdny-emt-tests-positive-for-coronavirus

If FDNY is like us, sure we have a number of former EMS EMTs and Paramedics, and those from out of state, but as a BLS only FD, we only carry BLS gear on the trucks. Oxygen, AED, basic trauma supplies, etc. I'm sure FDNY has many members with higher certification than First Responder, but that doesn't change that on an Engine/Ladder company a former (or even current licensed Paramedic) is only capable of acting as an MRF/EMR whatever level.

Depending on the severity level of any difficulty breathing that resulted in the 911 call, BLS first response can help stabilize a difficulty breather, but realistically, the most a Suppression company offers for the majority of Flu Like Symptoms patients is Basic Lifting Services (which certainly isn't unimportant, especially for bariatric patients, but generally isn't a game changer for these patients).

 

[DrParasite]

I think you are making an assumption that those former EMS guys want to do EMS, which is largely untrue in very large fire departments. Those guys want to be smoke eaters.

I NEVER made that assumption. In fact, I'd say you were 100% correct that if the FD could stop responding to EMS calls tomorrow, 95% of all firefighters would support it.

But it's not about what the Firefighters want to do (or don't want to do), it's what in the best interest of the patient, and the citizens of the city.

I highly doubt the supplies are the same. Fire probably has a bvm, nrb, basic wound supplies, and maybe a functional AED; far less than a BLS ambulance.

without speaking for FDNY, on our BLS engine, we have a BVM, oxygen, an AED, a crappy electronic suction, wound supplies, albuterol, pulse ox, thermometer, stethoscope, NRB/NC/neb masks, BP cuffs, and all the bleeding control items. We also have a reeves folding stretcher for some reason. not as much as on an ambulance, but enough to do a decent assessment, and more than you are describing.

Tell me, what difference does having an EMR versus EMT assessment make when you are waiting for the ambulance?

in theory, the EMT assessment could actually determine if the patient was sick, and possibly rule out an infection, where the EMR could apply oxygen and that's about it. Remember, it's not always about what you can do, it's about what you know, and how you use that information.

Extended EMS response times in a large city is an EMS problem, not a fire problem. It should be addressed by increasing ambulances, not sending 400K 3mpg chrome chariots to belly pain calls. This is different in suburban, interface, and rural departments; but this is about real big city fire.

Extended EMS response is a city problem, not an EMS problem. Yes, more ambulances are needed, but many cities would rather pay stop the clock with an engine than actually fix the problem.

About 100,000 people have developed COVID-19 and about 3500 have died worldwide. The vast majority of people who are infected with this novel coronavirus will never develop any symptoms at all, and for those that do, most will be mild. OTOH, so far this season in the US alone, an estimated 34 MILLION people have been sickened by the flu and TWENTY THOUSAND PEOPLE have died from it.

Because the media is inspiring fear in the general public, and everyone is panicking.

Treat it as business as usual, or like a really bad case of the flu, and you will be fine. I think this whole thing will blow over in a few months