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Quote from original article: The Fire Department doesn't wish to take over all emergency calls or get rid of AMR and MedicWest, Gillespie said. "This whole deal is not to hurt ambulance companies," he said. "It's to provide good service to citizens and recover some costs for what we do." Yet earlier in the article, it says: “The chief estimated that if the change is adopted, the department would go from transporting about 25 patients each month to 375. It would net about $1.6 million per year for the city, he said.” Ok, so correct me if I am wrong…. The FD call volume goes up by 350 calls/month… their income goes up by $1.6 million due to billing for those calls, calls that the private sector can no longer bill for… but they don’t want to hurt ambulance companies… WTF! How is pulling 350 calls a month, and $1.6 million in billing NOT going to hurt the ambulance companies??? OF COURSE it will. It is simple math. And, obviously, if you are only transporting 25 patients a month right now, you are not just trying to recover costs for “something we already do.” The rationale given is such a shell game, Fire Chief Al Gillespie should consider a magic show at the Sahara, or if this nonsense actually gets approved, then he is good enough to get a show at the MGM Grand. 46Young, I cannot believe that you think that cutting back services to reflect call volumes for fire departments is an evil thing… you talk about corporate fiscal responsibility (“..it's survival of the fittest. Like hostile corporate takeovers..”), yet you contradict yourself with your own statement “More of you still want fire positions cut back to reflect call volume.” If I had 2 restaurants, and one was making money, and one was losing money, why would I subsidize the one that is losing money with funds from the one that is making money? In the long run, that is incredibly poor financial management, and yet, that is exactly what FD’s are doing when they take over EMS services. They are not doing it in the interest of the public – they are doing it to shore up their FD spending. Obviously, the 2 private EMS companies are profitable in Las Vegas, or they would not be there… since the fire department doesn’t have to compete on a level playing field, their tactics are obviously not based on good fiscal management or patient care.

I respect many of your posts and believe that you are too intelligent to make this arguement, though it doesn't surprise me totally because a fireman's ability to justify bullshit often seem endless. I think it comes from believing all the crap you see on TV and newspapers... Of course we want them cut back to reflect call volume! I don't want my city to employ 3 times as many meter readers as necessary either, but that doesn't mean that I hate meter readers. And if they have too many meter readers and the public suddenly discovers this, I don't want them to take aware a fireman's job and give it to them so that they can look productive. One chose to be a meter reader and ended up in an untenable position, the other chose to be a fireman. Once should not suffer because the other chose poorly. But according to your logic, your job should then be taken because a meter reader is certainly a more important position than the average fireman...so fuck em. Right? Correct. And here again you're hoping we'll take this line of bullshit as fact, because you're used to the public doing so. If fire takes EMS jobs to shore up their own positions that is evil. Why? Because they are not required to compete fairly. And you really need to stop using corporate take over analogies as long as the fire service is playing with public money, money that they didn't have to prove that they deserved by creating a profit. If your profession has proved that it can't survive without diversity, that's awesome. But let's quite pretending that they are involved in "corporate America" when they are using my money to screw my neighbors. You can justify it because in this case rape is good for you. Awesome. But at least have the balls to approach the problem honestly, quit with the bullshit analogies, call a spade a spade, as the saying goes. I can't imagine how disappointing it must be to have worked so hard to to compete for a coveted position that allows you money, good retirement, work time leisure, unearned hero status, only to find out that you must now justify stealing from your neighbor to keep it...I hope I never know. I hope I always have more honor than that. And if sharking jobs at any cost is ok, then can you explain the IAFFs attitude in the article below, and the gazillion other's like it? http://www.dearbornf...per%20Woods.pdf Dwayne Edited for grammar correction. No contextual changes made.

In the link you provided, the entire 9 minute and 22 second video relates specifically to fire suppression, and the need for 4 people on the truck, not 3. All discussion of duties is fire suppression related. Not one single word was related to EMS operations. Not one single EMS vehicle or person was shown or interviewed. Watching the video, I cringed – I know a bit about structure fire tactics, as my husband is deputy fire chief in my area, and my father in law was fire chief in his city for many years, and had over 35 years experience before retiring. On a fire scene, having one person on a roof, or one person on an attack, or one person doing an interior search, is just plain STUPID. That is completely unnecessary risk of life and limb. THAT is the argument that was used in the video – that having 4 members would provide better care to community, and better safety to crews. I am OK with that approach. The point that you have chosen to completely ignore, is that fire departments, specifically the LVFD, are not staffing their services appropriately, and in order to staff them appropriately, are stealing from EMS. Even from your video – the question that was never asked, nor answered, was WHY Fairfax County was only staffing with 3 members.. was the reason financial? I bet it was! So, the problem is then, justifying the increased crew, and increased cost, which is a huge POLITICAL issue. Politicians and administrators don’t look at staffing as people – they are just looking at the bottom line. They don’t look at calls as real people involved – just the repurcussions if things go wrong and how it makes them look bad. The original point of this thread is that the Las Vegas FD is STEALING from EMS to justify its staffing levels and budget, rather than justify their staffing with a common sense approach and educating the public. Why are they doing this? My guess is because they can’t justify their current budget and their current toys, and now that they are in a tough financial position, they are looking for a bandaid solution (pun intended). Fire should be made to stand on its own, and justify its expenditures, exactly as EMS does, not use EMS revenues to subsidize fire. Again, refer to the restaurant analogy I used in my previous post.

I saw a woman with scleroderma / systemic sclerosis who an attending prescribed it to a few months ago. Here's a NEJM article about it, but there's a lot more out there. http://nejm.highwire.org/cgi/content/abstract/353/20/2148

Some more friendly advice - I understand that moving isn't an option. I would recommend applying to muni depts, and in the meantime getting picked up by whoever takes over the territory. I would strongly recommend going muni regardless if Rural Metro stays. In either case, you can work for the initially low paying muni dept, and pad your income by staying per diem or PT at your old employer. Many are shortsighted in that they look only at what a job is paying hourly, and maybe medical benefits. The pay may be decent, you'll pay off your mortgage, afford food, clothes, a car and such, but what about retirement? The example I gave of the 20 y/o putting 10k into deferred comp is a best case scenario. Many in their 30's and 40's don't have much in deferred comp, maybe 10k, 50k, or 100k. That won't get you far in retirement. You referred to yourself as seasoned, so I'm assuming that you're also in your 30's to 40's, and don't already have a quater mil in deferred comp. At this point, only a pension will give you an at least somewhat decent standard of living in retirement. Otherwise, you'll need to work FT into your 80's, if your health allows you. Muni depts may start at a low salary, and here's why, If an employee is going to leave the dept, using them as a stepping stone or whatever, it will usually be in the first few years. No sense paying someone top dollar when they're going to leave. Keeping the entry salary lower also allows the dept to compensate their tenured employees more generously. It's all about paying your dues. It's more appropriate for a young person to start at a low wage, but time is running out for you, and so is your opportunity to have a decent retirement.

"BLS has better patient outcomes than ALS" "You may think your a cool paramedic with all those fancy skills but remember OPALS..." I hear this and variations of this on multiple EMS forums a the time. The same people that say these things all the time like to also push the idea that BLS is solely in the domain of the EMT, and ALS is solely the domain of the paramedic. Somehow in their mind, the fact that limited scene time in severe trauma is better than stay and play equates that EMTs are the gold standard for patient care in the prehospital setting. These people also like to point out that ambu bag ventilation with a "BLS" airway may be better than intubation in some patients. True. However these same people seem to interpret that as EMTs are better for these patients than paramedics. Who is better at BVM ventilation: An EMT who bagged a mannequin a few times in class and MAYBE once during the ER observation, or, the paramedic who was an EMT and than spent time with an anesthesiologist in the OR learning the right way to hold a mask before they even touched the laryngoscope? It was in the OR that I learned that a BVM is not a BLS tool, but a medical device that required expert training to use properly. Can you get expert training in a EMT tech school that has no access to experts in airway management? It blows my mind that certain things are considered basic and advanced when they are not. They are just medical care.

RSI protocol = addition paramedic. Medical director writes medical protocol. Dispatch failing to dispatch additional paramedics without reason (was there any paramedics within a reasonable distance available to be dispatched?) means that medical care was compromised. Go up chain of command, terminating at medical director if need be.

Wow! I can't imagine a system where dispatch dictates what type of assistance you need on a call. We have some problems with dispatch, but I could not even concieve of a situation where they would refuse to send help that was requested by the crew. Its a safety issue for both crew and patient. My advice, if you are looking for a logical argument (although it doesnt sound like logic is your managements strong suit) is to fall back on the RSI protocol. It states that you are to have medical back-up for all RSI's. So if you are denied back up, then you are technically in violation of company policy. In that case either the protocol needs to be changed or dispatch has to be educated about what an RSI requires, in terms of manpower. If this argument fails to impress them, I would seriously think about leaving, as these ignorant dispatchers put both you and your patients at risk.

On the other hand, you could be the hippest homeless man on your block at 10K a year.

Some people would like their "means" to be more than living in a rented room subsisting on ramen noodles and buying their clothes at the Salvation Army. Also, you can't put much into your deferred comp on 10k a year. You work EMS, you see how the elderly end up when their money runs out. Scares the crap out of me. Rotating their meds, malnourished, can't afford heat or AC, etc. It's all about the best retirement.

I'm not FDNY EMS, but I worked for North Shore LIJ for 5 years, three as an EMT and two as a medic. I also did per diem at FHMC for a little while. I have two cousins that are ex FDNY medics, who left after the merger, one of who's husband is a FDNY EMS Capt. Conventional knowledge says that you go FDNY for the benefits, and to the hospitals for the money, better schedules, no mandations, and overall better working conditions. The quick answer for you would be to take the FDNY offer. As an EMT, you need both 911 experience and a hook to get into a good hospital, generally speaking. If you reject the offer, you'll be making 10 bucks an hour in the privates waiting to get into a hospital. Take the job, work as much OT as you can. Save up a good nut, and then go to medic school on your own if FDNY won't put you through. Then you'll have options if FDNY isn't for you. Back to the benefits. Municipal jobs generally pay less, sometimes much less than the same job in the private sector. This is made up for in benefits. The FDNY employees can give you accurate info on benefits, but I do know that it's 25 and out at 50% plus OT calculated for the highest three earning years. FDNY and NYPD have 20 and out. Look carefully into what pension plan you fall into, as Mayor Doomberg has this tier 5 garbage he's shooting for. Decide if the pension is worth the meager salary and working conditions after you get your medic. When I left NY in '07, a decent 2BR in a good neighborhood can go for 1500-1900/month or more. You may be single, but you may want a family one day. Unless your spouse is gainfully employed, forget about buying a house in the greater NY area. Nowadays, if you're not making over 100k in NY you'll find it difficult to buy a home in a good area, take vacations, and live well in general. Apartment living is no way to spend your life. I didn't realize that until I moved out of state. I lived in Bushwick, Ridgewood, Glendale and Middle Village. My point is that you won't prosper with FDNY. Your bills will get paid, but you'll never really "get ahead". If you want to get ahead in life, you'll need to get your medic, save up a good nest egg, and leave for another dept in another state. There's a whole other world out there. I had my fun there, but the quality of life is much better elsewhere. I live in Northern VA, make 68k base as a second year firemedic, made 91k in total last year, and we're looking at houses and townhomes in the low 200's in desireable area. We have a community pool, rec center clubhouse, plenty of parking and low crime. I don't have a bunch of animals living above and around me, either. No ghetto BS to deal with, been there many times. 25/55 pension, DROP, great work environment. Three others from NSLIJ work here also, as well as two ex FDNY medics. Having said that, if you don't mind mandations, ball breaking conditions bosses, and disgruntled partners, it will probably be a fun job for you. I had a blast, but I was hospital based. Same job, but different admin. We can laugh off an NOI where if you're FDNY they own you and can screw with you. If you plan to stay in NYC, and also plan to make a career in EMS, go FDNY for the benefits. Work per diem at a hospital. You'll be okay. It was said earlier not to use FDNY as a stepping stone. I suggest taking the job, working there for a while, see what the contract, benefits, and pension are, and decide where to go from there. If you want to go to medic, do it ASAP. If you can't stand FDNY after that point, you can go FT at a hospital, or move out of state for a better job. Forget about getting any degrees while OTJ, as mandations will screw up your plans. Unless you're doing 100% online stuff. I mention this just in case you dislike FDNY, but are stuck, and need a degree to make good money elsewhere. You won't know if FDNY is the career for you until you work there. Maybe he got mandated for the T1. If you're referring to backdooring your way into FDNY fire, then I agree 100%. Otherwise, one may have the best intentions of making FDNY a career, but find that they are no longer willing to tolerate the working conditions after some time. There's no pension, but the hospitals generally treat their people better, pay more, and can give you a fixed schedule that jives with school. Also, most hospitals want some 911 experience to be hired. Unless Transcare picks you up, where else will you get that experience?

You need to get your medic and start applying to municipal third service agencies. The Carolinas have a ton of them. Get yourself a state retirement with a TERI/DROP if you want to do this for a career. There's no future in the privates, and a 401k is nothing compared to a pension, unless you put away 10k or more a year, start when you're 20, get a realistic 8%/yr on average, and retire at 65. That would get you about 4,150,000. It sounds like a lot, except that inflation averages more than 3% yearly. In those 45 years, you'll need about $3.75 for every one of today's dollars to have the same purchasing power. What does that mean? Your 4,150,000 will be worth only 1.1 million or so in purchasing power. That won't last you long, considering inflation will continue on while your principal erodes. That won't last you past 15 or 20 years tops, unless you llearn to do without more and more. What many don't realize is that you need more in retirement than in your working years. What are you going to do when you're 85 and broke? It's all about the best retirement. Get yourself a pension, DROP/TERI, and max out your 457. Live well in retirement.

That's nice to have but it don't pay the bills.

It's not about the money. 1.6 million is a drop in the bucket for North Las Vegas, so this is certainly about politics and future financial maneuvering. It irritated me when he said something to the effect, "We just want to be able to get paid for what we already do..." C'mon, the reason fire started responding to all of the calls where they are seldom necessary is so that they could shore up their call numbers and get all of their fancy equipment...You're already seeing the benefit of "doing what you do" in your budget brother... It's a crazy world. I've come to be interested in the argument but have very little hope that there will ever be enough intelligent public debate to prevent Fire from playing these types of games. They have the tradition, the budget, and the media machine to keep the voting public in the dark. They will still be bullshitting my grandkids' grandkids long after I'm gone. God bless our brothers and sisters in the Fire services, but you chose wrong. You've chosen a career that is becoming in large part obsolete and can't survive without raping someone else. When you watch your unions take jobs from those that chose differently I hope that you can see that it's not because you deserve them, but because you picked the bigger bully. When you take their jobs, you haven't competed, you haven't proved that you are professionally superior, you've simply proved that you're willing to sneak in and snatch their wallet while your union is beating their head on the sidewalk. The stories that come from the fire services seem too often to be the same stories coming from the welfare population, they seem so often to be stories of entitlement. "I got this job, and that wasn't easy, so now you have to pay me forever whether you need me or not!!" For some reason firemen seem to actually believe that a fireman unemployed is just so much more tragic then a 'normal' person being unemployed... It's a crazy world.... Dwayne

Depends what you want from your EMS career. If this is a temporary job for you, and not a 25 year career, I would search for other opportunities. That's my opinion there are no "right" answers to this. If you want a better and more explained opinion, please tell me what you are looking for in your career and where you are in your career currently. ***Side note FDNY EMS will check your internet activities. I would suggest using proper spelling, grammar, and punctuation. Not to mention people from the board can and will crucify you for this.

Missing: Why it isn't surprising: Low barrier to entry with a flooded market. Additionally, poor medicare reimbursement to ambulance companies.

OK Crazy Idea here: So someone with balls, table a motion next AGM that ... (Ok ... lets follow our US brothers lead in the EMT- that EMRs must have a Field practicum and a Hospital practicum to work on Car AND be endorsed by a registered member of ACoP. The power of organised association and labour should not be underestimated, more than one way to skin a polecat. A Self regulated proffession to raise the high bar .... just remember that little dity, don't slam up the anti. CHEERS

I would not jump up and down and say this will not become a reality ... in 1993 the groundwork was laid by Nancy .... whatever the hell her name was, the Minister of Health ... oh yea Betkowski the turncoat. Just where did she go anyway ? NO CHEER. Heck, next thing you know there will be a 24 week course for foreign trained immigrent MDS to be fast tracked on the taxpayers dollar ie. FREE ..... to become REMT-P and fill the gaps ...<give me stength> WTF is the Brendan Institute anyway ? If my fellow Albertans do not believe this is far more a concern .... sheesh. ps A letter recieved from MY M.P. stated a "review" in the next budget this will be forthcoming and thanks for bringing this to my attention .... hmmm, damn good thing I say, if their credentials ie FTMDs and level of English comprehension and credentials are not accepted for medicine, then why sould they be accepted for Paramedicine ? cheers ps If it came down to it, I would rather work with an AB registered EMR (on car) than the possible alternative.

Live within your means and you will never have that problem, whether you make 10K or a 100k

Hmm, am I the only one here who's interested in listening to "da copz" and "da firemenz"? And admits it?

Hey! I resemble that remark!! OK fine then, I'm gonna go out and get a scanner today, maybe there will be a sale since it's President's Day in the US, and I'll even let y'all listen to it if you wanna come over. If you can get past the geese.

Oh no you guys want actual articulation. Well, first is learning, I admit being curious how many of what kind of calls are happening in my area and learning (by osmosis perhaps) some radio protocol. Second, it's not impossible that I could end up being a dispatcher, if I work on my Spanish. It's a useful job too. Thirdly, yeah, entertainment, nosiness, call it what you will. The scanner I got is about to be set up here at home, nope no plans to use one in a vehicle although that's legal in this state. I may end up tired of listening to the radio once I'm working as an EMT (or dispatch) sure, but for now, I think listening might be fun. I once worked at a Baskin-Robbins, ice cream became very mundane for me. But before that job, it had a definite "oh wow" factor. Besides, I've gotten a real laugh out of listening on non-scanner radios to various things, tow truck drivers, water company people, etc. It's not nearly as bad as watching TV. Got a Uniden BCT898T and picked up some wire and BNC's to make antennas with. Yay now I get to learn how to program a scanner.

OK the scanner bug is bitin' again ..... what do you all think of the idea of using a scanner radio to listen in on stuff going on around your area? I have several fire stations, cops, sheriffs, a hospital nearby, plus talkative hams and probably locals on CB. I'm wondering, does it make sense to get a scanner radio to listen in on stuff to get an idea of what's going on, what kind of calls, radio procedure, etc? How many of you have scanners?