My Little Story About FD vs EMS

[Shishkabob]

So, several months ago I posted in the 100% directionless thread about an incident that really irked me. Let me regale you in the story, and how it pissed me off.


My partner (who has been doing EMS since before I was born) and I were sitting at a post when a call came out for an MVC. We start heading that direction thinking it was no big deal because it was in a residential area. We then get told that there was entrapment. We are the first unit to arrive (with several cop cars present, but no FD). Smell of natural gas in the air (turns out the MVC broke a gas line in a building).

We see a van at about a 45* angle on the hood of a semi. (Can't get into specifics of how this happened because of privacy, etc). FD arrives shortly after and quickly shuts off the gas line, but the smell is still present.


I walk up to the drivers side where I find the drive, unconscious, agonal, and a heart rate of 150, pinned and bleeding. I go for a BVM to assist the patient while my partner grabs a c-collar to put on. Suddenly, a firefighter from the first engine yells (yes, YELLS) at us to get away from the patient due to the gas leak. Keep in mind, half the FFs on scene are wearing nothing more than tshirts and shorts.

We back off, telling him to get someone in there to bag the patient. Doesn't comply. After a short bit, I go back in to try and bag again, just to have this same guy yell at us again, as if we were little kids playing with matches around the gas leak. Keep in mind, my partner and I were both Paramedics, while the FFs were EMTs. At this time, I radio dispatch telling them that FD is preventing us from taking care of our patient (I wanted this on a recorded line incase something was brought up in the future, we'd have evidence).

Eventually we get one of our supervisors on scene, and FD has their battalion chief show up, and the battalion chief is still reluctant about going near the vehicle due to 'safety', but listens to use as far as patient care. Now, this FD shares the same medical control and same exact protocols as us, and those protocols state that although FD is 'in charge' of the scene, the ambulance Paramedic is in charge of all patient care, period, and in the event of a disagreement, the ambulance Paramedic will be found right.


It takes 40 minutes to extricate this one patient in particular, and only after they are out does FD put on a c-collar, and we can get in to start bagging.



After this incident, my partner and I sent several emails, knowing full well that likely nothing were to be done. However, in my last email to a couple of my supervisors, I made it clear that in a future similar situation, I would not leave the patients side, as FD has no control over me, has no duty for my safety, and they can not physically remove me.

This call made me miss working with volunteer FDs, where they know EMS has a job to do and would not get in the way of EMS doing said job to assert their 'authority'. And this is why rescue should be EMS based, if not at the very least, EMS cleared. If the on scene Paramedic doesn't like it and its potential harm to the patient, it should not be done.



Simply put, if the patient doesn't survive the extrication, there's no reason to extricate, it then becomes a recovery.

 

[RocketMedic]

^^^

Sadly, I think this is what happens when EMS is treated as separate-but-notionally equal. Some departments, like El Paso, do great medicine. Others, like OKCFD, integrate well with EMS. Some, like yours, don't do either. And that's a shame.

 

[rescue1]

I agree, that is a shame. EMS not having a say in rescue is absurd, and there's no ILDH hazard if the FD isn't suited up. Also, EMS should always be in charge of patient care.
Is there no oversight to make the FD play nice with others, or are they the big dog in town?

 

[NYMedic828]

Where I come from, we have FDNY EMS and FDNY fire.

We all work together under the same patch. Fire and PD know we are in charge ultimately of patient care. Mind you, a fire officer is still my superior and administratively I must obey them. 9.9/10 times we play well in the sandbox together.


Another thing I actually like about FDNY is that the only real way these days to ensure you get hired is to work for EMS and take a promotion to firefighter. Many places have firemedics that never work on an ambulance and thus never get any real experience as an EMT or medic. In our service, you get to see how the other half lives, learn, experience it and then become a firefighter after 2 years minimum on the street.

Granted all firefighters are considered CFR/EMR/MFR whatever term you prefer even if they are actually a medic.

 

[Chief Complaint]

I thought that the DFW area was all fire based EMS? Looks like I was wrong. Sucks that you guys don't have a better working relationship. We are fire based here and its a very healthy relationship when it comes to scenes like that. 100% team effort.

 

[Shishkabob]

I thought that the DFW area was all fire based EMS? Looks like I was wrong.

East side is mainly fire based (With AMR in some other areas) , west side is mainly 3rd service.

 

[Frozennoodle]

Rescue is EMS based here. I guess we're lucky. Also our fire guys are very respectful and helpful. I'm sorry you had this experience.

 

[abckidsmom]

So you approached an unstabilized vehicle in the vapors of a gas leak and wanted to work in/around it?

I get being pissed off, it's extremely frustrating when you have a sick patient and you don't feel like you're doing anything for them, but was the scene safe?

You just can't work in a vehicle like that without it being stabilized, and I would be loathe to use struts in a cloud of natural gas before it had dissipated. I'm sorry the firefighters weren't in gear, but I'm not sure what would have gone differently at that moment if they were.

 

[abckidsmom]

Eventually we get one of our supervisors on scene, and FD has their battalion chief show up, and the battalion chief is still reluctant about going near the vehicle due to 'safety', but listens to use as far as patient care. Now, this FD shares the same medical control and same exact protocols as us, and those protocols state that although FD is 'in charge' of the scene, the ambulance Paramedic is in charge of all patient care, period, and in the event of a disagreement, the ambulance Paramedic will be found right.

But what if he's wrong? I'd hate to be an engine medic in this setup. If I saw someone making gross errors in patient care, and called them on it, and they dug in to their position, I'd be wrong? Sure thing.

And what if it was less of an error, and more of a disagreement on how things were being done, like a style thing? If I said something, I'd be the wrong one, from the start? Ooookay.

I have the ability to address and communicate patient care issues on the scene, I usually always get people to see things my way, or easily see that my way actually is not the best, and change my position.

If providers in the system have as much animosity as your post actually has, I can see why things don't go terribly well.

It takes 40 minutes to extricate this one patient in particular, and only after they are out does FD put on a c-collar, and we can get in to start bagging.

[snip]

After this incident, my partner and I sent several emails, knowing full well that likely nothing were to be done. However, in my last email to a couple of my supervisors, I made it clear that in a future similar situation, I would not leave the patients side, as FD has no control over me, has no duty for my safety, and they can not physically remove me.

Providers without gear should not be participating in the extrication of a patient in a vehicle on a 45 degree angle on the hood of a semi in the cloud of a natural gas leak. Seriously. But if they are, they should act on the well informed advice of the medic who will be receiving the patient. It sad to hear how poorly the two departments interacted.

This call made me miss working with volunteer FDs, where they know EMS has a jobff to do and would not get in the way of EMS doing said job to assert their 'authority'. And this is why rescue should be EMS based, if not at the very least, EMS cleared. If the on scene Paramedic doesn't like it and its potential harm to the patient, it should not be done.

Simply put, if the patient doesn't survive the extrication, there's no reason to extricate, it then becomes a recovery.

And sometimes circumstances dictate that it will be a recovery. Just saying that it's not always best to just go right in there and do the work.

 

[Veneficus]

When I started working for EMS only agencies, I often couldn't believe the risks that nonfire EMS providers take on a regular basis.

Most of it is from not knowing what they don't know. That the scene is more dangerous than it looks.

(I once asked my partner who wanted to "park closer to the patient" if he really thought driving into the scene and parking in the puddle of fluids leaking from both cars was a good idea and he replied "this isn't the FD, we do it all the time.")

Unfortunately, it is not until you get official training that you really understand it. The dangers change over time. I remember when there were no suck things as airbags in cars. I remember being intoduced to dual stage airbags.

One of the parts of my early fire career was being forced to watch videos (for hours) of things that go horribly wrong when firefighters get complacent.

Obviously I wasn't with you so I cannot judge what was right or wrong, but I can tell you that you should never be working on unstabilized vehicles.

I can tell you that a fog stream does not prevent sparks.

99% of the time nothing will go wrong. But you don't want to be the feature of the "what happens when things go wrong" videos.

Sounds like a couple of smoke ejectors would really have helped though.

 

[the_negro_puppy]

Perhaps the firefighters should have, you know, donned their protective gear and or breathing apparatus and assisted the pt. They will run into a burning house to save people but won't bag a pt with gas around?

 

[Veneficus]

Perhaps the firefighters should have, you know, donned their protective gear and or breathing apparatus and assisted the pt. They will run into a burning house to save people but won't bag a pt with gas around?

there is a difference between structural firefighting turnout gear, proximity gear, and entry gear.

The silver stuff used at the airport to stand around burning fuel is proximity gear.

Entry gear is very rare to even have, provides temporary ability, and takes about 15 for 2 people to dress one person in it.

If that is your safety gear, the patient is definately dead.

 

[abckidsmom]

Perhaps the firefighters should have, you know, donned their protective gear and or breathing apparatus and assisted the pt. They will run into a burning house to save people but won't bag a pt with gas around?

They will run into a burning house up to the point where the atmosphere ignites. Depending on the density of this gas (which, if it's natural gas, will dissipate very quickly), this atmosphere could be at risk of igniting. That's a no-go area. Or absolutely no spark area, which could look a lot like not doing anything.

 

[abckidsmom]

there is a difference between structural firefighting turnout gear, proximity gear, and entry gear.

The silver stuff used at the airport to stand around burning fuel is proximity gear.

Entry gear is very rare to even have, provides temporary ability, and takes about 15 for 2 people to dress one person in it.

If that is your safety gear, the patient is definately dead.

Which is my other thought. How could someone have agonal breathing for 40 minutes and not be dead?

I seems like there is missing information from this story. I also don't want to armchair quarterback, but I definitely do want you (Linuss) to understand that it's quite possible that you just don't understand the 18 ways this scene was not safe. Just judging from your OP.

I love cases like this, where I'm pissed off, and I may or may not know everything I know to properly address the issues as I saw them, because the research I do in writing my emails always sticks in my brain forever. Something about this kind of stress opens up my neurons for permanent impressions.

 

[mycrofft]

Where I come from, we have FDNY EMS and FDNY fire.

We all work together under the same patch. Fire and PD know we are in charge ultimately of patient care. Mind you, a fire officer is still my superior and administratively I must obey them. 9.9/10 times we play well in the sandbox together.


Another thing I actually like about FDNY is that the only real way these days to ensure you get hired is to work for EMS and take a promotion to firefighter. Many places have firemedics that never work on an ambulance and thus never get any real experience as an EMT or medic. In our service, you get to see how the other half lives, learn, experience it and then become a firefighter after 2 years minimum on the street.

Granted all firefighters are considered CFR/EMR/MFR whatever term you prefer even if they are actually a medic.

Wow. I see so much potential systmic badness here, and so much reliance on good men and women to make the system work properly.

I'm presuming these "always medics" (my term) are keeping up on their continuing education and getting enough clinical and field time to be somewhat sharpened up? And good fire applicants don't get ramrodded or pencil-whipped through EMS to get onto a rig?
=========================================================
OP: L, just because Fire is running with scissors, don't you do it too. If a fire sparks, then the pt is dead as well as everyone who gets burned badly enough. I did something like that once, and while it is a treasured example of my wildman days, I'd never do it again and never advise anyone else to do it.
I'd have done as you did later, get it on the record (recorded radio also has times so that issue is settled), then let the bigger heads make the decisions as to who needs some remediation.

 

[VFlutter]

Are you guys issued any type of turnout gear for scenes?

So there was a gas leak, that was shut off, in an open air environment?

 

[mycrofft]

Partial turnout gear as they often get for EMS workers is like half a condom. remember one service which as an interim measure issued turnout coats but nothing else, wearing polyester/cotton pants, thin stayprest shirt, running shoes or lace-up boots.

Wish I could find a photo from an aircraft igniton at a crash at Van Nuys airport . Professional firefighters showed up out of gear, and the fuel ignited.

 

[Shishkabob]

So there was a gas leak, that was shut off, in an open air environment?

Yup, open air, gas shut off within 2 minutes of arriving on scene.

Which is my other thought. How could someone have agonal breathing for 40 minutes and not be dead?

I've seen stranger :lol:

All I know is the patient was alive at the hospital, however we never found out the extent of neurological issues, or if they even made it to discharge.

but I can tell you that you should never be working on unstabilized vehicles.

So you approached an unstabilized vehicle in the vapors of a gas leak and wanted to work in/around it?

Who said anything about unstabilized?

I get being pissed off, it's extremely frustrating when you have a sick patient and you don't feel like you're doing anything for them, but was the scene safe?

As safe as it could be, considering. You've been in EMS long enough to know it's never 100% safe and there are risks that are taken, and it's up to each individual provider to decide on their own what level of risk they will accept.

However, it's my decision and not some FFs that not in anyway in charge of me.

But what if he's wrong? I'd hate to be an engine medic in this setup.

I'm going to go with the fact that the ambulance medic is the higher credentialed provider, and that their name is attached to the patient in the end.

If providers in the system have as much animosity as your post actually has, I can see why things don't go terribly well.

Thing is, it generally (99% of the time) is not that way. A perfect storm, perhaps?

And sometimes circumstances dictate that it will be a recovery. Just saying that it's not always best to just go right in there and do the work.

Agreed, but in the end it's my decision, not someone elses.

I seems like there is missing information from this story. I also don't want to armchair quarterback, but I definitely do want you (Linuss) to understand that it's quite possible that you just don't understand the 18 ways this scene was not safe. Just judging from your OP.

Like I said, couldn't include too much without divulging the actual incident, the agencies involved, etc. However, at 4 years doing this, I'd like to think I would not be compared to an ignorant kid running around a dangerous scene playing with matches...

 

[NYMedic828]

Wow. I see so much potential systmic badness here, and so much reliance on good men and women to make the system work properly.

I'm presuming these "always medics" (my term) are keeping up on their continuing education and getting enough clinical and field time to be somewhat sharpened up? And good fire applicants don't get ramrodded or pencil-whipped through EMS to get onto a rig?
=========================================================
OP: L, just because Fire is running with scissors, don't you do it too. If a fire sparks, then the pt is dead as well as everyone who gets burned badly enough. I did something like that once, and while it is a treasured example of my wildman days, I'd never do it again and never advise anyone else to do it.
I'd have done as you did later, get it on the record (recorded radio also has times so that issue is settled), then let the bigger heads make the decisions as to who needs some remediation.

Many firefighters are nurses, PAs, RTs, EMT/medics.

The trouble is that those who are, often keep it to themselves. They don't want it to be known that they may have a clue what is going on and how to help the patient. Mind you, they are under no circumstance permitted to act past the level of a CFR. Their purpose on scene is to help life and carry and to assist with CPR.

As far as keeping skills sharp, they usually work elsewhere on the side. Like I said they just keep that to themselves on jobs.

As far as applicants, there are plenty of good applicants. 41,000 of them this year to be exact. Unfortunately with a job so desirable, if you want to get it you are going to have to serve your time in EMS. If you aren't willing to put in that extra minimum 2 years in EMS effort, then you must not want it THAT badly.

 

[mycrofft]

Partial turnout gear as they often get for EMS workers is like half a condom. remember one service which as an interim measure issued turnout coats but nothing else, wearing polyester/cotton pants, thin stayprest shirt, running shoes or lace-up boots.

Wish I could find a photo from an aircraft igniton at a crash at Van Nuys airport . Professional firefighters showed up out of gear, and the fuel ignited.

http://www.airdisaster.com/reports/ntsb/AAR76-17.pdf
Accident report, see page 11. No photos.