Report: FIRE doing EMS should come to an end.

[SandpitMedic]

This report presents actual data and is public now- and it's saying the things we've all known for years.

Essentially- why are 4 dudes making 6 figures showing up in a $500,000 truck to treat someone who stubbed their toe or essentially may require an ambulance? That's anecdotal; just an example. It's actually much deeper and gets really, really gritty about the Fire Service not being unnecessary and cost-inefficient in running EMS calls.

I particularly like this little line:
"The result is a clear impression of firefighters as self-serving rather than community serving."

Ouch!

It's common sense logic. And the post 9/11 unwaivering and firey love of the American Hero is seemingly burning out.
It kind of takes an anti-fire tone, which I don't necessarily agree with, yet it does raise issues suggesting change on a public scale, change that we have long been discussing with our partners in the cab.

http://www.mercurynews.com/ci_18283358

 

[SandpitMedic]

To add: This will also stem the issue of everyone and their mothers becoming paramedics. Change is coming, and is necessary for the future of prehospital healthcare. We're finally heading in the right direction, no disrespect to the firemen.
Paramedics= ALS/CCT/BLS medical; Fire=fire/rescue/BLS

 

[squirrel15]

Well the article is 4 years old, anything else come of it? And the cost of an engine is irrelevant, they make it seem as though you have to pay $500,000 for an engine anytime it moves. And those 3-4 dudes making 6 figures, they will be making that no matter what. So why not pay them to respond to the medical calls instead of paying them to sit around eating sleeping and working out? Also having the extra hands on scene for our increasing obesity problem here in America is beneficial and if you end up having more than one patient, you aren't sitting around waiting for those lift assists and extra hands.

 

[SandpitMedic]

Those are great counter points. Valid as well, however, they are trying to cut costs... I don't think they'll still make that much money.

Honestly, I don't know what ever came of it. I was just happy to see this circulating today, even if it is 4 years old. It brings attention to the issue.

People need to start having this debate. Not us, in particular. On a public scale.

 

[RedAirplane]

If there is a fire, and there is a medical call, firefighters should (probably) go to the fire.

If running medical calls is straining the system, and you may have to hire more people or buy more $500K engines, then let's talk.

Otherwise... you're closer, medically trained, and not doing anything. So why not come on over?
(BTW I think the same should apply to cops, and ultimately, citizen responders, but that's a different issue)

 

[squirrel15]

Also, what about fire departments that run the ambulances? What would that be considered?

 

[SandpitMedic]

That's fine. A model like SFFD/FDNY that have medical/suppression branches type of thing.
The budget is coming up again, and that could be a reason the old article is floating around again.

 

[squirrel15]

So would those medics when on an engine work under a bls scope of practice? I guess I just don't see how it would save money by not having them respond to medical calls

 

[SandpitMedic]

No... the point is... stop putting paramedics on fire trucks all together. Stop forcing all the firemen to go to medic school.

Everyone now will be grandfathered in of course, they will never get away with getting rid of folks for being over qualified. No matter how hard they pushed, but implementing new rules. Then you'd save a ton by cutting the salary 5, 10, 20 percent (I dunno, I'm not an economist) on new hires, and in turn reduce the pensions, etc... You'd also save by not having to buy ALL of your apparatus ALS equipment, you could also spend less on purchasing 2-3-4 more ambulances versus a single pumper or ladder truck. All of these things are pretty much mentioned in the article.

 

[SandpitMedic]

Chase cars, community care ambulances (medic, cct, NP, etc), and single role providers are the wave of the future. the fire model is antiquated. 90% of the time their response is a waste of time on the medical calls we run. I don't see how you can really justify not agreeing if you've ever worked in the field. (Sure there are a lot of obese pts, still not adequate justification for all calls). Clearly, MVAs, suspected Codes, or other situations where manpower would benefit would still result in dispatching the BRE.

 

[SandpitMedic]

I'm interested in hearing the opinions of some of our forum geniuses... remi, transportjockey, DE, rocket, STX, AK, etc.

(It won't allow me to do the @tags for some reason. )

 

[ThadeusJ]

Funny, I believe Toronto just started discussions on exploring this option.

http://www.thestar.com/news/gta/201...sal-pits-firefighters-against-paramedics.html

 

[squirrel15]

So if you work for a FD ambulance, you can never work on an engine for the same FD just because you're a medic? And what department do you know of buying a truck or engine to respond to medical calls? I'd like to know how the budget is affected by fire responding other than in fuel... You wanted a discussion, sorry you don't agree with my point of view. Saying just because and engines initial costs are expensive is not a valid argument to me... Especially when you're suggesting add a chase with another paid employee...

 

[ThadeusJ]

Hey...Johnny and Roy were doing it looooongbefore we knew about it. And if its on TV, it must be right.

 

[chaz90]

So if you work for a FD ambulance, you can never work on an engine for the same FD just because you're a medic? And what department do you know of buying a truck or engine to respond to medical calls? I'd like to know how the budget is affected by fire responding other than in fuel... You wanted a discussion, sorry you don't agree with my point of view. Saying just because and engines initial costs are expensive is not a valid argument to me... Especially when you're suggesting add a chase with another paid employee...

To me, it's a comparison like "why can't I pick up shifts as a city trash collector since I work for the city as a medic anyway?"

The two are entirely different jobs. Just because they were combined in the past due to availability of firefighters doesn't mean the mix holds up in today's world. Both modern firefighting and prehospital ALS (with greater than urban transport times) are specialized fields that can have poor outcomes if employee training or education is minimized to focus on something else.

I don't mean to come off as anti-firefighter. I also care about the motivations of firefighters and ensuring they have the same passion and dedication to train in their chosen field as their EMS counterparts do. In my experience, most people are truly interested in one field or the other. The thought processes and mindsets between the two are totally different, and I think they attract different kinds of people. I don't want a "passable" firefighter who is focused on EMS leading a RIT team to rescue a downed FF or coordinating a high angle rescue, nor do I want a "minimum standards" paramedic who isn't interested in keeping up with medicine attempting to treat my grandmother in respiratory failure with an hour before they reach definitive care.

My exceptions? I have no problem with training FF to the BLS/EMT level, nor do I have a problem with separate role EMS/Suppression branches of a fire department. Honestly, I can also be convinced of the merits of a dual role AEMT/FF in urban settings, because I think the argument can be made that in certain systems full ALS paramedic scope is of little utility if transport times are typically less than 5 minutes.

 

[SandpitMedic]

He just said exactly what I was going to say, plus some.

That's the discussion... You don't have to apologize because I disagree with you, Squirrel.

Fire and EMS are two different things.
Also, I bet they would save a metric ton not having to pay for fuel, maintaining and repairing, and purchasing apparatus designed for fire suppression in routine EMS response.

 

[squirrel15]

I don't see why the fire department would have an EMS branch then. I think its something we are used to seeing at this point, but with the proposal you're making the EMS system should be completely seperate from fire, whether it be city, county, or privately run. If it is privately run, maybe there could be some saved money because of contracts and fees covered by the private company. If run by the city or county, I see it being more expensive. You would have a need for more ambulances, would need to employ more personnel, and would be stocking all of those ambulances like you would an ALS engine.

@SandpitMedic reread my last post, I didn't mean to come off as an *** like I did

 

[SandpitMedic]

It doesn't have to be provided by the fire department... and yes, that is the proposal... separate the suppression firefighters and ALS medical responders. That is the point. I have no idea where you're from, where you work, or how long you've been in this business. I am finding it difficult to understand why you cannot pry the idea out of your mind that the fire dept must somehow be involved in providing ALS medical care. I know that's how it has been done--- that doesn't mean it works or is the most efficient.

MOST firemen who work on ALS fire departments (Where the department has made it mandatory for folks to be medics) don't even want to be medics, they want to be firefighters. It shows in their patient contact, yet they HAVE to be paramedics to be firemen. Get it? This proposal will eliminate that also. Perhaps not entirely, and certainly not everywhere.

And what department do you know of buying a truck or engine to respond to medical calls?

Um, a whole lot of them.

I'd like to know how the budget is affected by fire responding other than in fuel.....

Okay, for example: staffing one engine is the equivalent of staffing two ambulances (in terms of personnel). Even if you took away two engines, and added three ambulances, you're still saving hundreds of thousands of dollars just on payroll alone by now having six responders where you used to have eight, AND you can cover more area with the additional unit. It's math... less people = less payroll/bennies/pensions/etc. That's not even counting the money saved on all that other stuff that we've mentioned...

Are you following?

 

[squirrel15]

I'm reading this as you do not want fire to respond at all. I don't believe they need to be ALS and but they should remain trained at a BLS level and respond to medical calls.

 

[WolfmanHarris]

Funny, I believe Toronto just started discussions on exploring this option.

http://www.thestar.com/news/gta/201...sal-pits-firefighters-against-paramedics.html

Not quite. The Ontario Professional Firefighters Association, their union has. It has been rejected as unsafe by the Ontario Base Hospital Group, the body of medical direction for Paramedic services in Ontario, the Ontario Association of Paramedic Chiefs has come out against, the Ontario Association of Fire Chiefs has been strangely silent, and obviously the Paramedic Associations and Unions (not the same thing here) have come out against. Politics being politics, anything can happen, but I find it extremely unlikely that this will go anywhere.

Here FF's are trained to FR or EMR (40-80 hrs) vs 2 years for PCP and a further year for ACP, it's not just a matter of them going to these calls; they're neither required medically nor do they have the adequate training to be of use. Where I work we are rapidly moving away from tiering FD to all but the most serious calls and clearing them if the Pt. isn't a cardiac arrest in lieu of using our own units for back-up. As my Chief puts it, the best back-up for Paramedics, are Paramedics. Thankfully I'm part of a very well resourced, forward thinking service.