46Young

By "taking it in the other direction" I was referring to depts that have had EMS for some time. Mine, for example, has been both fire and EMS since they first employed paid personnel. Divorcing fire and EMS from depts that have had it for a long time would be putting some out of work, yes, if the now stand alone FD was downstaffed due to call volume. That would be taking my job. Not that it's a concern here. Just on some people's wish lists. If a FD took over EMS in the not too distant past, and then had to give it up, that wouldn't be taking FF jobs, since they took those jobs in the first place. I've stated repeatedly that I don't agree with this practice taking over EMS only for funding and positions, unless the existing EMS service is legitimately run poorly (a shady private agency, not a third service in the same district), and the FD takeover is run appropriately.

Owned on an anonymous internet forum. I'll go sob softly into my pillow tonight. Have fun in your messed up system while I go back to work in a couple of days and have a blast doing it, while also living comfortably. Just to put things in perspective. Remember who has a safe, well entrenched, enjoyable position and who's obviously frustrated. Go ahead, break my balls some more.

You'll like these, too http://www.youtube.com/watch?v=XVIfW6DQouQ&feature=related

Here's a response xtranormal video style regarding that douche reporter that was breaking balls about the FF's getting lunch at the supermarket:

Fire needs to be properly staffed, both with the number of apparatus and at the company level. That's what the video addresses. EMS runs 50-75% greater call volume than suppression units in many cases. Many EMS agencies choose to put the bare minimum of units on the road. Suppression units are largely idle. It costs less to have one FF on an engine train to ALS along with the equipment than a chase medic with vehicle, or another txp unit (which will never exist regardless since the agency staffs at the minimum). ALS first response fills the voids with already existing, relatively idle units. From the other side, I've already shown that, should you divorce fire and EMS from an existing combo dept, it costs much more to match that level of service with seperate depts. If you can't find that post, ask and I'll dig it up for you. I can't remember which thread I addressed this, but I gave valid reasons why divorcing a fire and EMS agency will be cost prohibitive if the same level of coverage is to be maintained. If it costs more to divorce fire from EMS and have the same coverage, then it would still be just as expensive to have that coverage from a single role EMS agency without ever having had FD involvement. Of course, if the local gov't would actually staff it's EMS properly and adequately, and also be okay with having the proper number of well staffed suppression units in service for timely coverage, even with low call volume, then fire based EMS wouldn't be necessary. I'll admit that. The fact of the matter is that many muni and private third service agencies seek to get by with the least amount possible. System status management in it's various forms is evidence of this. If units are running all day and night on a normal day, than any insult to the system, as in an MCI, spike in call volume, or inclement weather, will cause the system to have significant coverage gaps. These agencies roll the dice every day hoping that they have enough units to not draw attention to lack of coverage. Not to mention the burnout, poor working conditions, and poor job satisfaction of it's employees. Workers get held over frequently for 12's and 24's, the dept is always hiring because of turnover. They make it easy, oh so easy, for the fire service to take over. Out of my class and the two after me, over 80% of the firemedic recruits were from single role agencies. These penny pinching agencies will keep losing their best talent, either to fire depts or different careers. You're left over with a high percentage of mutants and burnouts.

The reason I said that was due to an earlier argument. I was questioned as to why can't EMS and fire be seperate? The service could be seperated and be covered just as well. I used my dept as an example. I took my dept's current EMS coverage, both the ambulances and the ALS engines. I presented the scenario that the FD and EMS divorced. My dept has 37 ALS engines. To provide the same exact EMS coverage as before the split, I gave two scenarios. First, you can put 37 more ambulances on the road. Second, you could put 37 ALS chase vehicles on the road. I then went on to prove how either of these options, which would maintain the current EMS response, were both grossly cost prohibitive. CBEMT came along and tried to sidestep that whole matter by saying that ALS first response hasn't been proved to be beneficial to pt outcomes. But the argument was why can't EMS and fire be seperated, not the need for ALS first response or lack thereof. I was comparing apples to apples, and CBEMT was going with apples to oranges. Given the choice, I'll go with more coverage rather than the bare minimum. Especially when this coverage costs pennies on the dollar when provided by pre-existing suppression units when compared to EMS chase vehicles. Again, I used my dept as the example since I know how the dept is run, and how competent the EMS component is. In many third service EMS agencies the minimum amount of units that are necessary are put on the road. The system will be stressed during periods of high call volume. There will be coverage issues from time to time. ALS first response fills in those gaps. Gaps that are there because these agencies refuse to put enough rigs on the road. I don't know how often ALS first response actually makes a differenceor not, but at least where I work the engine medic and their crew will already have a Hx, assessment, med list and demographics, diagnostics and a line if the EMS unit is significantly delayed. This happens from time to time. The EMS unit shows up and needs to do little more than package the pt and txp. In other cases, both units arrive at around the same time. things go a lot faster with a second or third medic onscene. when on the medic unit, I've needed another medic on more than a few occasions. I did NYC EMS for five years where oftentimes it was just me and my partner. We can and did get it done, sure. But it's nice to have the extra hands. Things go so much better and smoother. I've stated several times that I'm playing for the winning team. I've explained how single role EMS didn't provide what I wanted from a compensation, benefits, and retirement standpoint. I also don't need to worry about losing my job. We had a layoff "scare" last year, and we put through two academies during that fiscal period. I chose to work where I don't have many of the issues that plague EMS in general. I mean both compensation and proficient, well staffed EMS operations. CBEMT called me arrogant. Perhaps it is arrogant, but more than a few on these forums are basically seeking to put me on the employment line by first divorcing EMS from fire and at the same time downstaffing fire based on call volume, like that makes sense. By saying that I'm playing for the winning team, I'm giving that back and saying that they can keep wishing to put me out of business, because it isn't happening. I chose a career, which includes what I already want and enjoy doing (EMS txp), that holds much less of a chance of being taken over, disbanded, suffering a worsening of working conditions and such. So, CBEMT brought up the ALS first response and pt outcomes thing again. CBEMT never acknowledged, or attempted to argue against my position that splitting fire and EMS would cost much more for the same EMS service. I responded in the most arrogant way I could think of, by saying that I don't need to validate ALS first response, because the hiring trend here suggests that everyone here's on board with it. It's the NY in me. When my balls are broken I like to return the favor. Edit: Even if ALS first response shows no additional benefit in pt outcomes, the public will still want and expect it, at least here. Fairfax is an affluent county. If a caller is waiting for 10, 15, 20 minutes or more, or get someone with just air and a chair, there will be hell to pay. Also, it comes down to having better working conditions. I've done the whole run your ass of for 24, 36, or 48 hours with no help, lifting every pt, flying around like a whirling derbish, doing everything at a feverish pace between the pickup and the hospital. It promotes longevity, greatly reduces burnout, and lessens the chance of injury and clinical misjudgment (fatigue induced) when you have the extra hands to both help with ALS assessment, Tx, and lifting the pts. not to mention that if you shave ten minutes or more off of each onscene time, multiplied by the number units and their daily run volume, how much more time will there be units inservice? Ten minutes saved per call, times 10 calls, is enough time saved to run two more calls. Two calls that have the ALS first response help, making 50 minutes per call a realistic figure. Assuming a realistic call volume of 10 per unit in a 24 hour period, if each unit shaves enough time to allow two more runs, every five units effectively remains inservice to eaqual another whole unit. 5=6. Or 5=7,8, or whatever depending on the average call volume from system to system.

Sticks and stones. Firehouse was a great resource in getting me hired. I've been on there since '07. I moved my whole family from NYC to South Carolina and now Virginia in search of the Holy Grail. We're hooked up pretty well now. And since my dept continued (continues) to hire firemedics despite the previous threats of layoffs, my job is safe. I have no problem saying that I play for the winning team. I went where the power and money is. I have a family to support, that count on me to take care of their needs. If I stayed in NYC or SC we would be renting for the rest of our lives, and I would never be home as I would need to work all these hours just to maintain. I don't have to worry about some other agency or dept taking my job. 91k last year without trying too hard. Single role EMS will never compare to the deal I have now. I tried, but I was less than impressed. If single role muni EMS gave what the fire service does, I would have never even heard of a firemedic. If you can't beat 'em, join 'em. I'm riding the firemedic gravy train. We're living quite comfortable. Not bad for a former college dropout. Arrogant enough for you? And I see no reason or need to prove that ALS first response improves pt outcomes. We're still short firemedics, not fighting to validate the need for their positions. 10 in the 127th, 20 in the 128th, and another 20 or so this spring for the 129th. We've had EMS since we became paid; it's not going away anytime soon.

Yes, we like to go through the lock, so that the cost to the homeowner to secure their home is minimal. Also, it's always a great idea to punt to the PD or FD for entry. deflect the blame. Name of the game. The FD can throw ladders and gain entry through an unlocked window or balcony. Also, knock as hard as you can, as the elderly can be extremely hard of hearing.

I didn't mean attaching to the IAFF. what I meant was that the fire service keeps gaining market share with EMS, and their dual role medics are with the IAFF and not a strictly EMS organization. What happened in Kansas City? I'm ignorant to that story. I'm assuming that the IAFF didn't represent them or the converted them to fire based?

The only differences are no collective bargaining, and no union security provision. Everything else is the same. No one's forced to join. We pay dues to the IAFF Local 2068. http://www.fairfaxfirefighters.org/index.cfm?section=1 Many of the IAFF locals are in right to work states. I've repeatedly said that EMS needs some real organization. They could do what the IAFF does, instead of having it's professionals enveloped in fire unions in ever increasing numbers.

I posted the link in response to the claim that FD staffing should be based on call volume, not the community's need. The IAFF has been fighting for safe staffing levels for some time. People like Aussiephil like to say things like "justify their existence". This link went off on a tangent in regards to the thread topic, but it is an answer to these repeated sentiments. We originally had three on the engine, now we have four as minimal staffing. We had planed to upstaff the trucks to four with the next few academies, but hiring has slowed down considerably. We're currently hiring only firemedics, and they ride only the ambulance or engine, typically 50/50. We were running four academies a year to keep up with the population growth. We wanted to hire even more to have the necessary people to upstaff the trucks. When I worked in Charleston SC for third service EMS, Charleston City was running three on the engine, and I never saw a truck. The Awendaw FD had only one or two per piece, tops. Anyway, I never said that it's right that the NLVFD is doing what they're doing, only that I wouldn't choose a career with the privates because it's survival of the fittest. I also said that I went fire based for the same reason. I've stated that my dept was fire and EMS from the point it went paid for the first time. No one lost their job for us to run EMS. Unions in the private sector and those in the municipal arena that are forbidden to strike are two different things. My local isn't really a true union as we're in a right to work state. We get results through political influence. One hand washes the other, and it works well. No matter what you're shown, your mind is already made up. Anything anyone employed by the fire service must be lies. If you're told by a FF that the sun rises in the morning, you'll argue back that the moon will rise instead. The video explains the position of an increased need for staffing and a timely response quite well.

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.

Here's a video from my dept that does a great job of explaining the importance of safe and proper staffing levels. You need to watch the entire video, as many important points are made, and are explained in simple laymen's terms. The video clearly shows the importance of having the proper number of FF's on each unit, how crucial the response time is, and also why it's also vital to have enough units to respond. Downstaffing personnel and units will result in loss of life and property. Even if one structure isn't able to be saved, as some have mentioned due to the new type 5 construction, there are many cluster homes, townhomes and other such exposures that need to be protected. No one who has any real knowledge of suppression knowledge can dismiss or discredit the content of the video. These are real world examples and experiences of which they speak, not propaganda or fantasy. I challenge anyone here to explain to me what part or parts of the video are propaganda and fabricated lies. Explain why, contrary to the video's content, it's a smart move to pare back FD staffing and amount of units due to call volume alone. You can go a week, or even a month without a structure fire, but they don't burn any slower when the area has a low call volume. I don't understand how using call volume as a guide for FD staffing makes sense. When the call comes in, it needs a proper response, no matter how few and far between the calls come in. When one of you loses a family member or your life's possessions in a fire, it'll become instantly clear to you. A person may need the FD once in their life, but when they do, it can be life or death. Key word here is "need". Not want, or nice to have, but need. A downstaffed, extended response is inappropriate.

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.

No, I chose right, at least from a career standpoint. I tried hospital based EMS. The pay was decent, and so were the working conditions. No pension though, only a 401k, little room for advancement, and the hospital could lose it's 911 contract, or even go belly up. So, I briefly considered FDNY EMS, thought better of it, and chose municipal third service. We were limited to east coast states by my wife. Charleston County EMS hired me. They pay well, but the working conditions were undesireable for me, I had a $1000 deductible on my medical, and it was 28 and out. Lee County FL wasn't hiring, and most other east coast agencies pay crap, especially in the Carolinas. I define crap as under 40k to start (in the south, outside FL, and a top out of under 70k. I had been testing for my current employer at the time, as I always have a plan B. 53k in the academy, 12k/yr in ALS incentives, and another 4k courtesy of a step increase give me a base of 68k. Next year I'll take the EMS tech promo exam, and add on another 6k to that. About 300/month in medical pre tax, no deductibles, Cigna OAP. 25/55 retirement at a 2.8% multiplier, and a three year drop. The best working conditions one could ever hope for, and the sky's the limit with promotional opportunities. I'm making as much as the hiring range for an Asst Director at my old service. My point is, nothing I've found in the single role world can compare to what my employer offers. I know nothing of entitlement. I researched what they were offering, and found it to my liking. So I decided to go with the winning team. I wasn't willing to spend an unknown amount of time, maybe 10-20 years or more as a single role provider with no guarantee of things ever improving. Call the fire service bullies, thugs or whatever, but it's survival of the fittest. Like hostile corporate takeovers. I can do the same exact job I was doing in the third service, for a whole lot more than they were offering on many levels. I always had an interest in fire. I reasoned that if I didn't like suppression, I could follow an EMS career track, ride the ambulance exclusively, and then promote into EMS admin. Same job, with actual career advancement opportunities. Officers make more than some with masters degrees. At least they now require degrees for these positions. No one stole any jobs around my way, since the local depts have been fire based since they first went paid way back when. I didn't destroy anyone's livelihood in taking this job. I didn't know the fire service did that before reading these EMS forums. I thought that all fire/EMS depts started out that way. The only adjacent dept that has screwed single role EMS is Alexandria Fire and EMS. They seek to crosstrain all single role personnel, and have them work suppression as well. What the rest of the country does doesn't concern me. I chose a well run dept, where no one was forced out of a job. The current trend in the fire service is for medics to be afforded greater opportunity for career advancement. Old, set in their ways fire admin are to blame for the current attitude toward EMS, like those IAFC EMS statements. As medics climb the promotional ladder, things should change. A good number of admin personnel in my dept are/were ALS. I think this explains why my dept runs EMS well. Other depts need to follow suit for self preservation.

I never said that I endorse what the NLVFD is doing. What I did say is that when you're facing unemployment, self preservation kicks in. Especially with the lack of available jobs out there. Survival of the fittest. No different than a corporation trying to gain as much market share as possible, I suppose. In fact, I've said that I don't agree with FD takeovers of pre-existing EMS, except when the existing system has proven itself inept and/or inadequate. If your system is working well, there's no need to change it. Adding EMS/ALS first response to save jobs and increase productivity is one thing, but putting people on the unemployment line is a whole different matter. Again, I don't endorse a FD takeover in this case, as things are working well as it is, at no cost to the city. I don't know about you, but I wouldn't make a career in a private service, especially where 911 is concerned. As I said earlier, it's the choice of the local gov't as to who runs EMS. A private service vs an established fire organization, it's really no contest. If I were working FT for a private, I'd be sure to have a plan B. That was my thought process when I worked hospital based 911/IFT in NYC. The FDNY could take back their 911 spots, like FHMC's 46 Frank, when they were steering pts. The hospital itself could close, as did St. John's on QB, Mary Immaculate, St Joes, and probably St Vincent's in the city. That's why I went municipal third service EMS, and then fire based when I saw how much better they have it (and being slapped around by the service). If I were able to find an available third service with the same benefits, compensation, working conditions and retirement, I would have went there. It's all about the best retirement. If your company loses it's contract, you maybe have a little bit in a 401k if you can afford it. Some retirement. Many of you want the fire service out of EMS. More of you still want fire positions cut back to reflect call volume. Being that I'm not quite two years in, that would result in me being laid off. If you all had your way there would be massive fire service layoffs. Loss of firemedic positions, and suppression positions due to call volume. Fire takes EMS jobs and it's an evil thing. But taking it in the other direction is perfectly fine.

Survival of the fittest. This is why I don't recommend the privates as a place to make a career in EMS. The local gov't ultimately reserves the right to run EMS as they see fit. I hate to see people lose their jobs, but it's an "us or them" mentality. If it's a choice of my job or the next guy's, I choose to keep mine. I'm not going to let my family starve if I have a way to prevent that. The IAFF uses yellow shirts to provide high visibility by choice. Because it works. Look at the video. Who jumps out at you, and appear to be in greater number?

It's nice to play for the winning team. You can all complain about fire based EMS, but it's here to stay. I've seen no trends to the contrary. Same for the absorption of volunteer depts. Start with some POC, hire some paid personnel for day shifts, then some 24's, then 100% paid in low participation houses, then you have only a few vollies that do some friday nights or saturdays. Going back to vollie depts to save money won't fly with the public. Many local gov'ts have chosen to go the professional fire based EMS route rather than various single role options. Arguing in favor of fire based EMS is what we do. My union does it on a national level with great success. Many argue against it, so I go back at everyone. But it doesn't matter when you're playing for the winning team. No one wants to listen to me and organize/unionize. Unions are evil so on and so forth, and education will magically solve everything. You need both, or things will pretty much stay the same. Not that I'm against education, actually I would enjoy the additional clinical knowledge that is currently lacking in the EMS AAS to BA EMS progression. A higher barrier to entry would force out or deny a lot of the mutants currently working in EMS. A rise in educational standards wouldn't affect my job status. In fact, it may even raise my compensation somewhat. Requiring degrees will dry up the ALS applicant pool, making my position all the more valuable. Think about it. Every FF/medic will have a degree. And educational proponents say that having an EMS degree makes one a competent provider. I should see a salary boost at my IFT per diem job as well. EMS progressing as a profession with all due benefits and compensation would work out well for me. If EMS were to become "legitimate", meaning on par with FD's and PD's in term of benfits and working conditions and the scope and respect of other medical professions, I would recommend to my children to go that route. I wouldn't suggest it as a career as it stands now, only if fire based for the benefits and perks. I plan to retire at 55, fully vested. Then I'm going to do the three year DROP. After that, I'd like to work for an EMS agency for another five years, admin if conditions suck, or in the field if working conditions, staffing and call volume are acceptable. This would be for a state retirement, most likely. You're vested after 5 years. I'll hopefully find a 55/5 dept, so I'll only have to do 5 years. Then I'll have two decent pensions. Ka-ching! Make the system work for you. Name of the game.

The fire based ALS first response works well when run correctly, so get over it. It's not crap, since I work in a fire based system and see firsthand how well it can run. My case is that if there was a fire based first response, they sure as shit wouldn't have cancelled themselves and turned around, there would have been three or four to do the job, and their medic would have actually have been able to assess and treat the pt, something that didn't happen otherwise. You see, we solve chaos. we don't throw up our arms and say "oh forget it, there's no way". You can call us bucket fairies, hose monkeys, or whatever cute, jealous nicknames you can conjure up, but it changes nothing. We're here to stay, so get over it. You see, over here, the amount of volunteer coverage and participation has shown a steady downward trend. More and more volunteer companies are being replaced by paid depts, typically fire based EMS depts. So, as you can see, your ill conceived volunteer FF plan can't work. The trend is quite the opposite. Many local gov't have seen the benefit of using idle units to augment the EMS response, and also the cost savings of dual role personnel. And yes, having an ALS first response is an answer to the "what if" scenario, but "what if" is a reality, and both fire and EMS calls and call volume can't be accurately predicted. If you can see the future, let me know so I can play lotto or make some good investments. The reality is, in addition to the usually bare minimum staffing of EMS in most places, you can do one of three things: You can put more ambulances on the road, along with the cost of apparatus, two new employees, complete with salaries, medical benefits, paid days off, and pensions to pay for. You can add a fleet of ALS chase vehicles. This again requires the hiring of more employees, with all salary and benefits due, as well as a vehicle and ALS equipment. Or, you can give an existing FF a pay raise, maybe 20-30% the cost of a FT employee, ALS equipment, and send the engine to help, which is more idle than EMS txp units in the first place. There's also the added cost savings with scheduling and OT reduction with dual role personnel. Which option is the cheapest? I'm afraid that you've misunderstood. We don't get this type of storm, maybe every 10 years or so. We typically get an inch ot two or three as a rule. This year we got not only one storm of the decade, but two. My point was that we almost never have to deal with this type of situation, let alone twice in two months. Pittburgh has experience handling snow, something my area does not. A city that gets a fair amount of snow, on average, ought to be proficient in accessing pts and victims in case of emergency. We don't have the plows, dump trucks, and other vehicles available for snow removal that Pittsburgh ought to have. VDOT doesn't factor snow removal into it's budget. All we had was our chains and 4X4's with plows attached. No help from the state whatsoever. No plowing until the storm was almost over. My daughter's school was closed for literally two weeks this month, no exaggeration. This was their first day back. Stafford County actually had to hire construction crews from NYC after the last storm to remove the snow from our county's streets. We don't budget whatsoever for snowstorms, and we lack the quipment for effective snow removal. Pittsburgh does not. So again, what's Pittsburgh's excuse? I'm willing to bet that Pittsburgh gets more snow than NYC on average, and we managed to get to our pts. Oh, about the fire based thing, the article made mention about including first response in the future, and some were trying to draw the FD in on the blame for not responding or something. The discussion was going to go fire based at some point, so why wait? The thing is, the crew didn't even try. They asked the pt to come out to them. Who does that? Now, if you get to their residence, see that they are ambulatory and fit to walk, and there's absolutely no other way out to the bus, then assist them in ambulating to the rig. Don't be lazy and say "come out to us". If there were so many of these urgent calls in the lineup, then the abd pain would have naturally been a low priority, and wouldn't have even been dispatched. Let alone several times. Sounds like a cover up. FDNY EMS conditions bosses have attempted to give me poor pt care direction, and I've repectfully disagreed and went on about my business. What's important is who the courts will find at fault.

Where I work, in Northern VA, we maybe get a decent snowstorm every ten years or so. This region is certainly not facing such conditions every year as Pittsburgh does. The thing is, we had no issue in reaching pts during both of our snowstorms, which both dumped around two feet each. All our units, ambulances and apparatus alike, have on spot chains, Z-cables, and heavy snow chains. We carry shovels on our pieces. We had 12 or so 4WD utility vehicles, each equipped with plows and also two FF's, to be johnny on the spot with any access issues. I've driven in many a NY snowstorm in mini mod's, with no chains or anything, and managed. Having chains made it a joke to get around. You need to know your first due, to have the foresight to know that you won't make it up a particular hill or bridge, and react accordingly. We had suppression units routinely doing ALS assessments (and tx if necessary) and bringing pts out to the ambulances, either by carrying or by ambulation if appropriate beyond doubt. Not bad for a dept that hardly ever gets even one storm, let alone two that were each around two feet. What's Pittsburgh's excuse? Maybe lack of available units, since restricted access resulted in repeated cancellations, rather than sending another unit from a different direction? FBEMS ALS first response really helps when conditions are poor, and also when units are scarce, which is the intention of having ALS first response in the first place. I've seen this firsthand through two storms, and things worked great. The concept works well if applied properly, with competent individuals. The alternative, of course, is working with the bare minimum, and getting jammed up on occasion, where sometimes preventable injury and death occur. I'm willing to bet that there wasn't four feet of snow on the ground when the first 911 call was made in this incident. Since snowstorms in Pittsburgh are a given, the plows should have been out, and I can't see there being more than 6 inches or a foot down at the time, at least up to a block away from the residence, which is within walking distance. If you can't manage through even a foot of snow with a monitor and a couple of bags between two people, then you're physically incapable of working period. I've had to carry pts on a scoop or reeves a block or more to the rig with just my partner, as plowing from previous storms blocked any other egress (in NY). If I can carry someone a block or more in a foot of snow, you can't walk with just a couple of bags? This particular situation makes a great case for ALS first response (I'm talking about fire based, of course). You get three or four physically capable individuals, ALS capable as well (how capable varies from dept to dept, but still), and additional resources if needed. Speaking of additional resources, to get someone out of a house during a snowstorm it's real simple. You can use either a reeves or a stokes. Use 4-6 people to carry. Wrap the pt in blankets, and don't forget to cover the head. If a car ejects a pt down a steep enbankment (such as I-26 in North Charleston) a stokes and some ropes do wonders in getting a pt out. Imagine what a stokes will do on the horizontal? Get a utility truck with a plow if you need to. I find it hard to believe that the city of Pittsburgh has no such thing.

There shouldn't be. There's nothing illegal, to my knowledge, with working in two different states. It's not like you have to hand in your state cert when you move. When I moved from NY to SC I would have been able to work in both states, if I wanted to travel. I reciprocated to VA six months later, and had certs in three states in addition to my NR-P. Tht Valley Health System out in VA, WV and MD employ EMS with dual state certs. The only issue might be state residence with SC, although I don't know for sure. Call the state and find out.

Without a suppression piece to block the scene, you're taking your life into your own hands. For one, take a second lane with flares. The most important rule to follow is to never turn your back on traffic. If you need to go back to the ambulance, walk backwards, and wave your light back and forth to draw attention to yourself. Having PD onscene helps, as their blue lights are highly visible at night. One thing's for certain, each motorist sincerely believes that they're the most important, the center of the universe so to speak. They'll squeeze through any space that you leave them to get through the scene. As far as getting off of the road quickly, it wouldn't be a bad idea to place the pt on a board, maintain manual C-spine, get the pt in the back of the bus, keep C-spine while your partner pulls the rig to a safer location, and then the two of you can finish the spinal motion restriction properly and safely. In the winter, when it's below freezing, we routinely hold C-spine on the cot/LSB and finish in the back of the bus, so our pts don't freeze. I've almost been murdered several times on the Jackie, the ever popular GCP/CIP, LIE/GCP, and the dead man's curve on the GCP EB just past LaGuardia (111 st? I forget).