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46Young, you are accusing others of having their minds made up, and yet you still continue to spout whatever bullshit makes your point. If you want to be taken seriously in this debate you need to stop using misleading language such as, "survival of the fittest", you're not the fittest if you can take jobs without having to fairly compete. "Corporate takeover", "Increasing market share", those are private industry terms. They are used for people that have to risk their jobs to compete. Those that get to lie and cheat while spending government money have no right to them. I'm not sure now, as I've mentioned this to you several times, if you're simply too ignorant to use appropriate language, or if even you are so convinced of the impotence of your argument that you purposely continue to represent it as something that it's not. Take a chance, show that you can actually think your way through this as an individual instead of an ignorant piece of the fire machine. We have faith in you brother... It does remind me of an old joke though, but I'll have to tweek it a bit to make it work... "What's the difference between a fireman and a shopping cart?" "Every now and then a shopping cart seems to have a mind of it's own..." Use your own significant brain...stop simply flushing the same ol' party line over us that we've heard, and labeled bullshit, over and over.. Dwayne

Any EMS agency that chooses IAFF to represent the employees after the Kansas City MAST betrayal deserves to lose their jobs to the fire department. It's completely stupid to rely on a fire fighter union to look after your needs when the same union is gunning to move as much EMS as possible into the fire departments to save fire fighter jobs. This is the proverbial fox looking after the hen house.

Psst- you aren't talking to civilians or some clueless politicians here-many of us DO work in this business. You sound like a PSA bought and paid for by the IAFF. As a matter of fact, I believe that video you linked has been used by the IAFF, but I digress. Listen, I know about the push for manning- nothing new. I also know that in many areas, unless there is a life safety issue, aggressive interior attacks are a thing of the past. Things like master streams and aerial pipes are used now more than ever before- surround and drown. You are absolutely correct about when you need a firefighter, you want 50 guys to show up in less than a minute, with state of the art equipment, have a positive water supply, no frozen hydrants, no lead out problems, all having 20 years experience, hundreds of fires under their belts, and all possessing every certification known to man- from Haz Mat to swift water rescue. Now back to real life... The fire service is used to being the sacred cow- and for good reason. Problem is, times have changed, fires ARE way down, and the fire service has adapted to that by absorbing EMS. Smart for them, not necessarily what's best for the public. The fire service- and IAFF's- number one priority has always been, and will always be fire suppression and rescue. For many areas, 3-4 man companies have always been the norm, and mutual aid agreements supplement their manpower. Ideal- no, but it's reality. In today's economy, an area's police service, EMS, and a dozen other services would suffer if fire received everything they asked for. IAFF is suffering from the same thing that killed Detroit- union arrogance. When times are great, unions negotiate incredible pay and benefits packages. If anyone knows about some of the famous(and often times ridiculous) perks the UAW managed to get for it's members, you know what I mean. Even when a company is losing money, they are required to pay their members. That's fine and great for a member, but a union also needs to be realistic about it's demands and expectations. Unions like the UAW finally agreed to concessions, but it essentially was too little, too late. Big auto needed to be bailed out- their legacy obligations were killing them. I know you cannot put a price tag on public safety, but the sad reality is that it's necessary. I believe in premium pay for risking your life, responding to incidents when everyone else is running away- that's what we do and we should be well compensated for it. Sadly, too many of us are not- especially those in EMS, and just because fire has a longer history, more members, and a stronger lobbying arm, it does not mean it has the right to walk over EMS- especially when it's not providing a better option.

Not yet. However, if we end up getting dumped into one of the four functional units (as we can't have our own, and lab techs understand OH SO MUCH of what we do and deserve the same contract), HSAA can and will use the dues we pay to them to fight CUPE. ... and if the worst is realized and we are soon a part of HSAA, this is what SHOULD happen. You've got that right. If we are to be in one provincial union, why not be represented by those who understand what we do because they do it themselves? EMS knows what EMS needs. Bye bye Conservatives ...

I had this very discussion about 14 years ago with a doctor, a General Practitioner from Rural Tennessee, who for MANY YEARS was the only FT doctor in this county...who still worked the "ER" (Three total beds- Major 1, major 2, and Hallway )in the small clinic. His very astute assessment is that while there are more tools available today, todays doctors are so dependant on them they for get the most important tool...the assessment. Especially the SUBJECTIVE assessment. According to him, and I have heard it repeated elsewhere, 80% od the DX is derived from the SUBJECTIVE ASSESSMENT. I know that when I teach, I stress this point, that the assessment is as IMPORTANT as the monitor, the glucometer, or the CT. In short, we dont teach our EMT's , Medics, or even Doctors, to talk and interact to patients anymore, to assess them beyond a few basic steps. We belive that they will learn it on the job, and saddly they dont, or at least not quick enough not to have some purely avoidable mistakes occur. Like the one discussed above. I would stand right beside you and say that anyone who intubated a diabetic unconscous and hypoglycemic patient should have to explain themselves...but I would also say that there are cases where that same hypoglycemic , unresponsive diabetic patient should be intubated too....and that the total assessment, not just the glucometer, tells the whole story. To use your xample....while ultrasound/CT will prevent some surgeries, an assessment will prevent unnessessary untrasounds and CTs, and catch the need for CT's and Ultrasounds that a lesser practitioner would have missed. Yes, its not perfect. But thats why medicine is a PRACTICE and an ART as much as a science.

Here in Los Angels, California there's the same problem manifested in a different way. The fire department, for a long time, has had EMS locked up as their bailiwick. Yes, we have a few privates with "fire contracts" that do fire's transporting both BLS and ALS. (The latter with a fire medic aboard.) But Los Angeles, like the rest of California, is in such deep financial trouble I see an opportunity. For instance, the headline in today's Los Angeles Times reads, "Council Orders Drastic Cuts – Firefighters, Police not Exempt from Call to Slash 3,000 more City Jobs." And this isn't the first round. Fire is already cutting back by having fire medics cover larger areas and also offering early retirement to high ranking high paid fire officials. So myself and several other private EMTs I've recruited have embarked on a letter writing campaign that endeavors to persuade city officials that private EMS can take over some, if not all, the duties of Fire EMS at less cost to the city. I briefly talked with the heads of two private EMS companies, and while they said great we're onboard with it, they refused to get actively or publicly involved out of fear of fire retribution and the possibility of putting their existing contracts in jeopardy. Sadly, I was impressed with neither of them. Which brings up the point of who is it that speaks for us? We certainly have plenty of bosses. There's the County EMS agency, there's medical control, there's the NREMT, and even JEMS, always telling us what we should be doing. But who speaks for us? Nobody that's who. So I'm convinced we have to do it ourselves. I hear you, it'll never work. But it could work. Sure, we have a few flakes in our private company. But for everyone of them there are ten, bright, ambitious, and motivated young EMTs. And I watch as the get crushed down a little more each day until they're gone. Lost to another job or profession with a future. But the flakes, and the already retired like me, seem to stay. I mentioned above how private EMS in Los Angeles County works but the worst part isn't apparent on the face of it. Private EMTs are fire medic slaves. We are the candy stripper to their doctor, the Alfred to their Batman, and if you like Pawn Stars, the Chumley to their Old Man. It can be very demeaning being it's all stick and no carrot so the best of us bug out. But you guys know all that. We hear privates are a dead end, and a third agency is the way to go. And I agree with that, except it isn't going to happen anytime soon (at least here in LA) because there's absolutely no money available to implement it. So turning to privates might, all of a sudden and right now, look viable to certain city officials. Except to the fire department, of course. And fighting the big red machine is the toughest battle of all. If we do get some city officials on board there will be a public perception battle to win. As it is right now if a fireman rescues a cat in a tree their PIO cranks up and sends press releases out to every newspaper within 200 miles. And we don't have anything to compete with that. But there's a crack in the facade. And I'll be damned if I'm not going to stick a crowbar into that crack and hold it open. Sure, we've mounted nothing more than a small grass roots effort, a drop in the bucket, but who knows? It may just plant the seed in one city official's mind and get something started. Maybe it'll mean when I finish paramedic school I won't have to leave my home, my friends, and my life to seek employment elsewhere. Maybe it'll mean "private" doesn't have to mean "dead end" in LA. And maybe it'll make fiscal sense for the state I love. If any of you want to help and send a letter, I won't tell you what to say as I know you already know. Just don't begin, "Hey Asshole!" or use the phrase, "Fire Monkey!" LOL . . . Please pick any of the below Los Angeles City Council member and lick a stamp, and thanks! I wrote to everyone of them this week trying to say the same thing in a different way and I'm bushed . . . Ed Reyes 200 N. Spring Street, Rm 410 Los Angeles, CA 90012 Paul Krekorian 200 N. Spring Street, Rm 425 Los Angeles, CA 90012 Dennis P. Zine 200 N. Spring Street, Rm 450 Los Angeles, CA 90012 Tom LaBonge 200 N. Spring Street, Rm 480 Los Angeles, CA 90012 Paul Koretz 200 N. Spring Street, Rm 440 Los Angeles, CA 90012 Tony Cardenas 200 N. Spring Street, Rm 455 Los Angeles, CA 90012 Richard Alarcon 200 N. Spring Street, Rm 470 Los Angeles, CA 90012 Bernard Parks 200 N. Spring Street, Rm 460 Los Angeles, CA 90012 Jan Perry 200 N. Spring Street, Rm 420 Los Angeles, CA 90012 Herb J. Wesson, Jr. 200 N. Spring Street, Rm 430 Los Angeles, CA 90012 Bill Rosendahl 200 N. Spring Street, Rm 415 Los Angeles, CA 90012 Greig Smith 200 N. Spring Street, Rm 405 Los Angeles, CA 90012 Eric Garcetti 200 N. Spring Street, Rm 475 Los Angeles, CA 90012 Jose Huizar 200 N. Spring Street, Rm 465 Los Angeles, CA 90012 Janice Hahn 200 N. Spring Street, Rm 435 Los Angeles, CA 90012

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.

Diaphoresis and a general feeling of discomfort is a bad sign, especially in someone her age. At that age, she is much more likely to have an MI with no chest pain or other specific symptoms. Also she is much less likely to spike a fever if this was an infectious process with sepsis, so do not rule that out. With recent root canal surgery you must also consider bacterial endocarditis and complications associated with that. At any rate, she's earned herself a trip to the hospital to get checked more thoroughly and have some labwork done. I hope she is OK; please let us know how everything turned out, if you can.

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.

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

There are so many things wrong with this. It is not, "treat the pt, not the machine," and it is not, "treat the number, not the pt." It is a combination of both. You have to treat the machine, otherwise what the hell are you using it for in the first place? But you also have to think if the machine makes sense. I think the OP gives a great example of this. As an aside, I once saw a guy who was fully conscious and not compaining of anything with a finger stick of critical low. Repeated it 3 times with the same reading. One of the nurses checked it on herself twice and got normal numbers. Sent the chem to the lab and got a glucose of 12. Sent it again with the same result. Sometimes the info you get is not going to make sense but you have to respond to it. I don't want to find out how long he was going to remain stable for with a glucose like that. As for your comment about not being able to make a dx without 7 lab tests, you missed the boat. Most of us can make the diagnosis, which is how we figure out what tests to order. We could probably cut back on the number of tests ordered if we didn't have to CYA. Sometimes we are wrong and miss something. How do you defend yourself in court for missing something when a simple test would have changed your dx? If I knew that I could discuss with my pt what I thought was going on and what I wanted to do without fear of litigation should I be wrong, I would probably cut the number of tests I do in half. I don't want to be someone's lottery ticket.

The rest of us have a life.

After reading the eight pages in this thread I realize that there will be no solution if one stays mired within the conflict of change. I detect a common thread throughout this discussion, namely things need to be fixed; however, any solution posed is met with skepticism. If it isn't the government, then it is big business, or some other profession trying to steal our work, or it is those dam fire fighters again. Or it is ACoP. Now, what people are missing here is that the current model doesn't work. I started my career in Alberta so I know this. I know what a for profit EMS systems in Alberta look like. I started in a BLS unit that didn't have an AED as Alberta Health did not mandate it. It was EMR/EMT crew with a senior employee being someone with 2 months on the job. The service sucked, the equipment sucked, and the training level was low. The patients were the ones that paid for this. I remember sitting the ambulance station - a trailer on the reservation - watching the fax machine spit out a dozen plus resumes of EMR and EMTs who just graduated thinking to myself that here comes the next wave of fodder for the system. I was suppose to call some of those people to set up interviews but I never did as Telus cut the phones for non-payment. My partner didn't seem to mind as he was too busy getting drunk. That was my introduction to Alberta EMS. This wasn't that long ago. In my opinion anything is better that that. I say let ACoP set the national guidelines, and let the health authorities take over. Yes, things have changed in Alberta - just a bit, but not enough - so I welcome all of this. Perhaps, this will mark a change for Alberta EMS and help the profession develop as a profession. A higher level of representation will allow this to happen. I put forward that, once the dust settles, the new Alberta system will be better and stronger than what we have now.

So the crew could have been smelling ketones and they went ahead and gave d50 to a pt who was A+O X 3 ? Nope can't think of a single reason to bash anyone. ******** Next everything that was said was said as a generalized post, not to any specific crew or crews. Everything that was stated was dead on. You certainly seem to be getting very defensive considering you were not on the call. After years of not having glucometers, we got them last week, I know huge breakthrough there so my use with them is limited. So even if I was concerned about a failed reading/misreading I'm confident in seeing the 'whole picture' and treating accordingly. Had the patient been having an MI yes it could have had a poor outcome if you pushed the D50, however my question is, what was the outcome of this patient? Did they have an MI or were they just drunk or what?

One thing I hate about EMS forums and really EMS in general is that everyone is a know-it-all. And thanks Dart