Thoughts on tiered FD/EMS systems vs solo EMS

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AceBlueChip

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I live in Orange County, Florida where the EMS system is run together with OCFD, I know that not all systems are run like this and wanted to know what people's opinions are on having EMS run out of Fire-stations.

I'm currently just a EMT-B student and all of my clinical ride alongs are with the Fire Department. I do have some opinions of my own now that I've done half of my ride alongs, but I wont say anything yet until after I've heard other people's opinions.
 
Are you talking about them just being stationed together? It doesn't really make a difference. It's nice to have the extra hands on scene at times since they seem faster at getting out of the station than us.
 
What opinions I wanted to get were what are some of the benefits and drawbacks of having EMS incorporated with the Fire Department as opposed to having EMS run independently as a third service.
 
As someone who has been working in Orlando for several years now, I don't think you're phrasing the question properly (or fully understand how stuff works here).
What point are you really trying to make here?

The fire departments have priority on all 911 EMS. They pass off the transports they don't want to Rural/Metro, who has a contract with many cities/counties in the area. There is no "incorporation" here, as with Lake County (who staffs Lake EMS rescues in their fire stations, which works fantastically).
 
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Soo, I still don't get what question we're supposed to be answering. Do you want to know what the benefits are of an FD run EMS or of EMS stationing out of FDs but being private or do you want to know the pros/cons of a selective transport FD/EMS system?
 
Underoath87 said:
As someone who has been working in Orlando for several years now, I don't think you're phrasing the question properly (or fully understand how stuff works here).
What point are you really trying to make here?

The fire departments have priority on all 911 EMS. They pass off the transports they don't want to Rural/Metro, who has a contract with many cities/counties in the area. There is no "incorporation" here, as with Lake County (who staffs Lake EMS rescues in their fire stations, which works fantastically).
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Sorry if I'm phrasing it poorly. Just to be clear I know that when someone makes a call whether its a medical call or trauma call; the fire department responds with the appropriate measures. Either a rescue unit alone for a simple medical call or a rescue unit and an engine if its a trauma call or if the medical call is to someone who might have trouble getting out of their home (like severe difficulty breathing but lives on the 3rd floor of their apartment building)

I understand that private companies pretty much only do IFT between hospitals or nursing homes, but my question is what are the benefits and drawbacks of having EMS stationed with the firedept as opposed to there being a separate 3rd service EMS that is independent but contracted with the county as a public service just like OCFRD.

One last question do you mind telling me what your role is with OCFRD? Are you a FF/EMT, a FF/Medic, or a Medic?
 
MonkeyArrow said:
Soo, I still don't get what question we're supposed to be answering. Do you want to know what the benefits are of an FD run EMS or of EMS stationing out of FDs but being private or do you want to know the pros/cons of a selective transport FD/EMS system?
Click to expand...

I guess what I'm trying to figure out are the different kinds of EMS services out there in the field and what people's opinions are on each type. I know the main ones are where EMS is run out of a firestation such is the case in the County I live in. Or 3rd service where EMS is run as a separate entity from the FD either through a public contract with the County or privately from hospitals.

What I want to know are what are people's opinions on how the different systems are run.
 
AceBlueChip said:
Sorry if I'm phrasing it poorly. Just to be clear I know that when someone makes a call whether its a medical call or trauma call; the fire department responds with the appropriate measures. Either a rescue unit alone for a simple medical call or a rescue unit and an engine if its a trauma call or if the medical call is to someone who might have trouble getting out of their home (like severe difficulty breathing but lives on the 3rd floor of their apartment building)

I understand that private companies pretty much only do IFT between hospitals or nursing homes, but my question is what are the benefits and drawbacks of having EMS stationed with the firedept as opposed to there being a separate 3rd service EMS that is independent but contracted with the county as a public service just like OCFRD.

One last question do you mind telling me what your role is with OCFRD? Are you a FF/EMT, a FF/Medic, or a Medic?
Click to expand...

For the record, I said I work in Orlando, not for Orlando (OFD). I work for American Ambulance (and we do a bit more than just discharges to nursing homes, especially on the ALS/CCT level).

Fire usually responds with a rescue and the engine (if they can spare the engine), just for the extra manpower on scene.
You seem to be under the impression that the FD rescues are somehow separate from the fire dept (like how nearby Lake county has Lake EMS and Lake Fire/rescue as separate entities that operate in conjunction).
For 911 in the Orlando area, the rescue is owned, operated, and staffed by fire personnel. They're just the crew designated to ride on the ambulance, as opposed to the engine (more often females, medics that don't have fire certs yet, or just the ones who like EMS or drew the short straw).

There are tons of threads on here about FD based 911 EMS vs a dedicated county-funded 911 EMS service (which we don't have here). The difference is mainly a question of politics and budget, though many will argue that having them separate improves quality of care, as the rescue is staffed by people passionate and dedicated to EMS, rather than the possibility of FF/FM who got "stuck riding on the box".
 
Underoath87 said:
...There are tons of threads on here about FD based 911 EMS vs a dedicated county-funded 911 EMS service (which we don't have here). The difference is mainly a question of politics and budget, though many will argue that having them separate improves quality of care, as the rescue is staffed by people passionate and dedicated to EMS, rather than the possibility of FF/FM who got "stuck riding on the box".
Click to expand...

And, since this seems destined to be yet another thread on that topic....

I'll believe that Fire Departments are truly interested in quality patient care and not just the budget that EMS provides when they stop requiring Paramedics to also be fire fighters (and visa versa). First Responders or EMTs? Sure - that makes some sense. Paramedics? Not so much
 
For a pretty good overview and pros/cons of all the different types of systems, I recommend that you red chaz90's post on "Which is better: working for a private ambulance company or a fire department?".

I will just chime in on the system that I know well in my neck of the woods. In Johns Creek, we run fire based first response with R/M transport. The fire department (3 stations, 3 engines, 2 ladders, 2 QRV) will respond first with either a fly car or with a quick response vehicle the latter capable of transporting BLS if needed. The FD will usually do the on-scene treatment up to and including packaging the pt. and loading them into R/M's ambulance at which time R/M takes over and transports. I have never seen the FD transport a pt. although they theoretically could. The pros of this system include having multiple agencies able to provide care/ redundancy, having lift assist, saving the FD money, and always ensuring there are enough ambos to cover the area (if there aren't enough, the private company has to provide more). The cons include a discontinuity of care from FD to transport including varying equipment, protocols, etc.
 
EMS as part of Fire

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Historically, prehospital EMS grew up as part of fire and rescue because it was a way to get the techs out there fast and in force, with pre extant stations and communication and other infrastructure.

GOOD: lots of bodies, gets more money for firefighters, marries rescue with EMS for integrated ops, cuts complexity of dispatch.

BAD: can distract fire assets, fire officials may come to view EMS as vassals they control, accent upon "cowboy EMS" (extrications, tourniquets, trauma) versus the majority of EMS (grandma fell down and her hip hurts, or the baby ate a camera battery).
 
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