sent to me by a physician

[firecoins]

I don't see respiratory therapy becoming part of the FD anytime soon. Yes resipratory therapy is done at various government installations but it isn't restricted to that.

Private EMS IFT aren't either but you can have 1 employer for major metroplitan areas where many medical facilities that hire RTs or PAs exist.

 

[VentMedic]

I don't see respiratory therapy becoming part of the FD anytime soon. Yes resipratory therapy is done at various government installations but it isn't restricted to that.

Private EMS IFT aren't either but you can have 1 employer for major metroplitan areas where many medical facilities that hire RTs or PAs exist.

Why are you wanting to put RRTs in FDs?

RRTs are on Specialty and some HEMS.

But, I don't see what your point is here.

 

[rmellish]

The problem is that TSEMS are run by private companies who are, to be honest, out to make a buck. I know, I know, hardly a new idea and not fair to all those "virtuous and honest" private EMS companies out there. But in the process of increasing profit margins, the employees and sometimes even the patients suffer for it. So why not make EMS a FD-like entity, something funded by our tax dollars (and what medicare begrudgingly pays out)?

Third service doesn't necessarily equal private. The best solution, I think we're agreeing here, is making EMS it's own entity, seperate from the FDs, many of whom use EMS as yet another way to get tax dollars.

 

[VentMedic]

Third service doesn't necessarily equal private. The best solution, I think we're agreeing here, is making EMS it's own entity, seperate from the FDs, many of whom use EMS as yet another way to get tax dollars.

Yes some do but in all fairness, areas like South Florida birthed the modern Paramedic in the FDs because the fire stations were closest to the people. The ambulances were few and stationed at hospitals, which were also few, or at a funeral home. The FFs could get there quicker and that is still true in many areas today. Getting help to the people the quickest was the idea the doctors, such as Dr. Nagel, had in mind and not this BS between the different providers/services we have today. The design was also to raise the standard in the community to have "ALS" or Paramedic providers go to scene before the minimally trained care of the ambulance attendants. But some still fight that concept for advancement which was the vision of the founders of the modern Paramedic.

At that same time, the U.S. did have a great model for a hospital based Paramedic EMS service know as Freedom House. However, it was never accepted probably due to issues other than medicine and rarely gets even a small note in EMS history.

quote from article I recently posted.
http://www.silive.com/healthfit/advance/index.ssf?/base/living/1246872608231790.xml&coll=1

Dr. Sheldon Jacobson, or "Shelly" as most of us knew him, is considered the "Father of paramedics." In 1974, he took a small group of young men working as ambulance drivers and attendants and transformed them into professionals who became the foundation upon which much of New York City's pre-hospital emergency medicine was built.

It was later that NYC got into teaching "ambulance attendants" to be Paramedics. Again, this was the concept to put better trained providers on the street and to get away from just the "BLS" that was available. Still today, that concept is argued against but not by those who may need EMS care but by some EMS providers. So heaven forbid if the FDs see a need and want to carry on with the design of providing ALS care to the people in their community.

 

[46Young]

I believe mendo's post and vent's reply to be accurate. I was waiting for someone to acknowledge that either FB or TS EMS could work equally well if ran properly. For the public's benefit, timely delivery of ALS care, by competent providers is desired, with adequate txp units available. This can be accomplished by TS fly cars, or FD medics on suppression apparatus. As long as the end result is the same, who is showing up is unimportant.

NYC EMS, with FDNY units, hosp units, or private units, strive to keep response times short by having many units posted on street corners throughout the city, for a quicker response than if you were coming from a station. FDNY engine crews are CFR-D only, and aren't really necessary on most of the calls they are dispatched to.

CCEMS, a municipal third service agency in SC, runs every unit ALS out of stations dispersed throughout the county. Charleston City, N Charleston, James Island(very competent), Awendaw, St. John's, and St. Andrews FD's give BLS backup for extended response times. No ALS with the exception of Mt. Pleasant FD, who seek to have txp units of their own in the furure.

Fairfax County FRD operates as I've stated previously, with a small contingent of vollie ALS/BLS buses.

These are personal experiences of which I draw my opinions from.

As an employee, your goals will be either to do EMS as a stepping stone, go EMS only as a career, or go fire(EMS). Many do go FBEMS for superior working conditions, pension, bennies, $$$'s, solid medical coverage, DROP, etc. The paramilitary structure is beneficial in some areas, but not so much for pt care.

TSEMS municipal could potentially be just as satisfying for the employee as FB, but EMS doesn't have the political clout or collective bargaining strength of the FD's. Medics are becoming a dime a dozen if not so already(Ohio and FL come to mind) courtesy of medic mills. As such, the employer is under no obligation to improve your $$$/bennies, as there are plenty of warm bodies to fill your spot when you get fed up and leave.

There's also nothing wrong with a muni TSEMS using the local FD for ALS back for timely ALS care. That could work just as well as EMS in Fairfax.

FBEMS with crosstrained personnel will typically have the advantage with staffing, as personnel are versatile, to reduce forced OT and putting units OOS. TSEMS tends to burn out their employees with high call volume, holdovers, and micromanaging. The employer will seek to get the job done with as few units as possible, with little regard for the employee.

If one wants to do EMS as a career, as a lifer, I highly recommend going municipal TSEMS, or FB single role EMS(Alexandria Fire and EMS for example). On the whole, since employers have gone largely from defined benefit(pension) to defined contribution, it's been proven over and over again that people do a poor job of managing their retirement.

Most municipal employers, to my knowledge, have state/city retirement, with an optional deferred comp(457) with no employer contribution. A 401k/403b will eventually run out. a pension, especially with yearly COLA adjustments, will not. You don't want to grow old, have to take out a reverse mortgage on your house, and rotate meds due to financial difficulty.

 

[firecoins]

Why are you wanting to put RRTs in FDs?

I am not.

But, I don't see what your point is here.

I forgot what point I was making. I was responding to something you said but I can't remeber at this point.

 

[46Young]

If anyone knows of decent EMS only agencies, be it TS or FB, post it at my quality EMS agencies thread. Maybe it will help some. North Carolina has quite a few, but I don't know of the quality. I've heard Acadian is good, also.

 

[reaper]

I believe mendo's post and vent's reply to be accurate. I was waiting for someone to acknowledge that either FB or TS EMS could work equally well if ran properly. For the public's benefit, timely delivery of ALS care, by competent providers is desired, with adequate txp units available. This can be accomplished by TS fly cars, or FD medics on suppression apparatus. As long as the end result is the same, who is showing up is unimportant.

NYC EMS, with FDNY units, hosp units, or private units, strive to keep response times short by having many units posted on street corners throughout the city, for a quicker response than if you were coming from a station. FDNY engine crews are CFR-D only, and aren't really necessary on most of the calls they are dispatched to.

CCEMS, a municipal third service agency in SC, runs every unit ALS out of stations dispersed throughout the county. Charleston City, N Charleston, James Island(very competent), Awendaw, St. John's, and St. Andrews FD's give BLS backup for extended response times. No ALS with the exception of Mt. Pleasant FD, who seek to have txp units of their own in the furure.

Fairfax County FRD operates as I've stated previously, with a small contingent of vollie ALS/BLS buses.

These are personal experiences of which I draw my opinions from.

As an employee, your goals will be either to do EMS as a stepping stone, go EMS only as a career, or go fire(EMS). Many do go FBEMS for superior working conditions, pension, bennies, $$$'s, solid medical coverage, DROP, etc. The paramilitary structure is beneficial in some areas, but not so much for pt care.

TSEMS municipal could potentially be just as satisfying for the employee as FB, but EMS doesn't have the political clout or collective bargaining strength of the FD's. Medics are becoming a dime a dozen if not so already(Ohio and FL come to mind) courtesy of medic mills. As such, the employer is under no obligation to improve your $$$/bennies, as there are plenty of warm bodies to fill your spot when you get fed up and leave.

There's also nothing wrong with a muni TSEMS using the local FD for ALS back for timely ALS care. That could work just as well as EMS in Fairfax.

FBEMS with crosstrained personnel will typically have the advantage with staffing, as personnel are versatile, to reduce forced OT and putting units OOS. TSEMS tends to burn out their employees with high call volume, holdovers, and micromanaging. The employer will seek to get the job done with as few units as possible, with little regard for the employee.

If one wants to do EMS as a career, as a lifer, I highly recommend going municipal TSEMS, or FB single role EMS(Alexandria Fire and EMS for example). On the whole, since employers have gone largely from defined benefit(pension) to defined contribution, it's been proven over and over again that people do a poor job of managing their retirement.

Most municipal employers, to my knowledge, have state/city retirement, with an optional deferred comp(457) with no employer contribution. A 401k/403b will eventually run out. a pension, especially with yearly COLA adjustments, will not. You don't want to grow old, have to take out a reverse mortgage on your house, and rotate meds due to financial difficulty.

This is one of the better posts I have seen on the issue. Kudos to you.

 

[46Young]

This is one of the better posts I have seen on the issue. Kudos to you.

Thanks. Being a part of fire based EMS, I can't help jumping in when some start taking shots at FD's. I actually don't have a problem with TSEMS, it's just no longer for me.

Repeatedly during this thread I was asking for proof that the third service concept was better than fire based. The correct answer is that they can both be equally effective. TS or FB agencies both have the potential to deliver superb service, but there are many examples of failures from both sides. The only real advantage seems to be from the employee's perspective with FD benefits.

I've heard that Seatlle does TSEMS well. It would be great if others could follow their lead.

There are fire based single role medics(Alexandria Va), which would be the best of both worlds, from the worker's perspective.

 

[reaper]

I agree. While I am not a fan of FD EMS, I will say that there are some that work fine. But, there are a majority that fail big time. When You discuss TSEMS, I look only at City or county run services, That is third service. I know quit a few that make it work and have the pay and benefits to match FD's. But, there are also a lot of third service EMS that fail big time!

CCEMS is an example of failure. A good service watches out for the employee and their safety. I work for the largest one in that state and have no problems with it.

Metro-Dade fire/rescue is well known for it's superb service. They have been this way for many years and have it down to a science.

Private services are mostly jokes. There are a few around the country, that have made it work. Acadian is one that does fairly well.

While I am against Fire based EMS, I also know that there are some that do it right. In a perfect world all EMS would be a third service city or county based. I have nothing against a fire/medic, I just think they would be better off with one discipline.

 

[46Young]

I can see how there is concern that learning both paramedicine and suppression will hinder one's ability to do either one well. I wrote earlier that there should be an experience prerequisite of 1-3 years or so of medic experience prior to a firemedic appointment. Having experience as a medic will allow one to spend a larger percentage of their efforts studying suppression.

At Fairfax, we get to go to cont. ed. on duty for quaterly 8 hour sessions. There are EMS drills incorporated into the monthly mandatory training matrix. Medics are not permitted to ride lead until 18 months post academy. New hires do a 16 week ALS ambulance internship with weekly classroom sessions prior to suppression school.

Experience pre-reqs and dedicated EMS training as above helps with the "spreading oneself too thin" thing. Worth mentioning is that firemedics here are well compensated for the additional requirement of maintaining proficiency in both disciplines.

A question for those knowledgeable about existing PSO programs: are those crosstrained for any combo of EMS/fire/LE compensated for the additional responsibilities? For example, is a FF paid at a higher grade for LE training? Or EMS to LE?

 

[EMTinNEPA]

I've heard that Seatlle does TSEMS well. It would be great if others could follow their lead.

Actually, Seattle is one of the few who do Fire-Based EMS properly. But then again, Seattle is one of the national leaders in EMS, period. If you look at the video in this thread where the physician responds, Seattle boasts a 45% survival rate for out-of-hospital cardiac arrests that present in v-fib.

 

[46Young]

Actually, Seattle is one of the few who do Fire-Based EMS properly. But then again, Seattle is one of the national leaders in EMS, period. If you look at the video in this thread where the physician responds, Seattle boasts a 45% survival rate for out-of-hospital cardiac arrests that present in v-fib.

Question about Seattle, just curious: What are their criteria for working/not working an arrest? Do they induce post arrest hypothermia? Do they work asystole as an initial rhythm? In traumas?

 

[Ridryder911]

Actually, Seattle is one of the few who do Fire-Based EMS properly. But then again, Seattle is one of the national leaders in EMS, period. If you look at the video in this thread where the physician responds, Seattle boasts a 45% survival rate for out-of-hospital cardiac arrests that present in v-fib.

I will not debate Seattle has been percieved a leader and yes they have done studies. It those studies and statements that need to be reviewed carefully.

R/r 911

 

[46Young]

I will not debate Seattle has been percieved a leader and yes they have done studies. It those studies and statements that need to be reviewed carefully.

R/r 911

That's what I was getting at. If you have certain exclusion criteria, you can make the numbers do whatever you want.

 

[VentMedic]

Actually, Seattle is one of the few who do Fire-Based EMS properly. But then again, Seattle is one of the national leaders in EMS, period. If you look at the video in this thread where the physician responds, Seattle boasts a 45% survival rate for out-of-hospital cardiac arrests that present in v-fib.

There's a key work missing here: "witnessed".

 

[EMTinNEPA]

There's a key work missing here: "witnessed".

Ok, true. I forgot that. Thanks for pointing that out.

 

[JPINFV]

Do the Utstein!

 

[CAOX3]

There's a key work missing here: "witnessed".

In that case

We have a 100% survival rates for witnessed v-fib arrests with bystander CPR, underneath a telephone pole with an AED station, in front of an ambulance with a transport time of 45 seconds to a staffed interventional cath lab on middle age males with a hx of heart disease.

See we are the bomb too

Playing with the criteria to achieve the desired effect, there is a new idea. The fact of the matter is short response times and bystander CPR saves lives and it is the only thing that has been proven to signifigantly increase survival rates.

-posted from my phone

 

[JPINFV]

^
Well, that is the elephant in the room for a lot of EMS statistics. Namely, if you look at 100 systems self reporting numbers (any number), you will have 100 different criteria. You see the same thing with response times. Does the response start at 911 dispatch, ambulance dispatch, crew dispatch, or enroute? Does it end when the ambulance reaches the scene or at patient contact time?

You have a bigger issue with cardiac arrest patients since there's the gap between the patient showing obvious signs of death and the proverberal point of no return. If an unwitnessed arrest is found 10 minutes after collapse, it is already too late but the crew will end up working the patient and throwing up another point is the "loss" column even though the crew never had a chance. At least with the Utstein criteria (witnessed v-fib arrests), you now have a standardized criteria that accounts for the "never had a chance" population.