46Young

I wasn't implying anything about universal health insurance in particular, but rather the illegals (they're called illegals for a reason) and those that receive gov't assistance and choose not to work. Not those that can't work, but those that choose not to. Neither group contributes anything in the way of taxes and other fees to support our gov't. These are the leeches of society. Take, take, take, and give nothing back in return. And we continue to cater to these populations. No suprise, as that's where the votes are when election time comes around. I agree with you that those with legitimate insurance through an actual job are made to follow many rules regarding their health care. I understand that those with gov't aid aren't subject to the same rules, and can get whatever they want if they say and do the right things. the system enables medicaid users (abusers) to use the ER attending as their PCP. They'll get what they need at little to no cost. We need to pay out all the time for what we need. Of course we do. Decent people want to keep their credit intact, and avoid foreclosure and repossesion of their possessions. Someone who's illegal or on (abusing, not legitimate, I understand the difference) Gov't assistance isn't going to be concerned with damaging their credit, and may be working off the books (to show no official income), so what can creditors possibly take? They get a good laugh every time a bill comes in, like it's a joke. If we don't pay, then what happens to us? What I don't understand is how the illegals and the poor (that choose not to work) get everything handed to them, and I'm expected to pay for everything I need. When my wife was pregnant (still my fiance at the time, we had to speed up our plans) I joked that we should stay unmarried, we could live together, my name wouldn't go on the birth certificate, she could go on welfare, medicaid and WIC, and also work off the books. I wouldn't want to do section 8, but still, think of the money we could save! At my job, the medical premium cost for a single person was free, and my "baby momma" could get the caid for both of them. Free formula, diapers, food, and some welfare funds. Remind me again why I bother to work, at least on the books. Once again, I understand someone's legitimate need for public assistance; I'm referring to those that have the ability and the means to be productive members of society, but choose not to.

Thats exactly why - a lot of companies look to "surge" their 911 to help out IFT, where the money is. It's not okay to just keep a minimum coverage for 911. Call volume can spike, and response times are affected. Having dedicated 911 and IFT units prevents any conflict of interest, so to speak. If the private company wants the 911 contract, then give 911 the proper amount of resources. At some point a lack of coverage will be noticed by the citizens or gov't, and then the EMS services will be reclaimed by the local gov't. If 911 needs the additional units, then the company isn't properly staffing with respect to call volume. If the company wants to run the bare minimum in their IFT division, they can't look to cannibalize their 911 ops, which results in compromised coverage. 911 does 911, and IFT does IFT. If either division has shown a trend towards higher call volume during peak hours, you can run "enhancement units", OT rigs that run for 5 or 6 hours or so, during typical periods of high call volume. Allowing 911 to help out IFT will always present the temptation to take emergency units OOS to run the IFT money jobs. Especially if that's the only division making money. So on the one hand, you have fire based EMS with it's abundance of units, both ambulances and ALS suppression pieces, to ensure a timely 911 response. Overkill, maybe. But certainly not understaffed. On the other end of the spectrum, you have the private company that does 911 and IFT at the same time. Being a private, for profit business, they'll naturally look to put as few rigs on the road as possible. Payroll is typically the largest part of any operating budget. When you have a 911 unit sitting in a poor area where they're running in the red, they'll think nothing of taking that unit and sending it on an IFT run that would otherwise be turfed. The question is how much of that can they get away with before someone notices and takes action? You know that this goes on all the time. The majority of privates can't be trusted. Having seperate 911 and IFT keeps them honest to some extent.

You're welcome. From what I understand, most of FL EMS is fire based. Try Lee County, or any other quality municipal agencies that you know of. You could get your RN, then challenge out the medic, just a thought. In any event, regarding the long term (just get your foot in the door somewhere for now), stay away from private EMS. Acadian in LA/TX/MI is decent, though. Observe the example of Rural Metro in Atlanta. The operation could pack up and leave at any time, leaving you without a job.

Yeah, pretty much. It serves them right for trying to play the local gov't. They want to serve the affluent areas, with a greater reimbursement and less call volume. They want to drop the ghettos, where they run a high percentages of the either uninsured or those on gov't plans that reimburse poorly. You can't have your cake and eat it too in this case. Why someone would choose to make a career out of private EMS is beyond me. The whole operation could fold, as is the case in this example. These soon to be former employees would have to move to the Carolinas to get decent third service work. The local gov't lets them work in the area because they don't want the burden of managing EMS in the area. It's naive of Rural Metro to think that the city would willingly assume the liability of running EMS in the poorer areas and leave them with only a lucrative, low volume (requiring less units naturally) district. What Rural failed to consider is that if Atlanta was able to turn a profit from EMS, they would do it with either third service EMS or fire based. Why would they give away free money? Why would Atlanta willingly assume a poor, low reimbursement area and leave them with the "money" area? That would defeat the purpose of contracting out EMS in the first place. As far as other privates assuming 911 EMS in the area, who would want to take over a region that runs in the red? They could always do IFT. But, if they have units that run both 911 and IFT on the same shift, that brings along it's own set of problems. That practice should not be allowed under any circumstances. Have dedicated 911 units, and dedicated IFT units. For a career in EMS, go muni with a pension. Govts rarely fold.

When I worked NYC EMS we rarely had any apparatus to block the scene, unless it was a cut job. I've almost been killed on several occasions. The way we do it is to position the ambulance IFO the scene, by the shoulder if possible. The engine takes two lanes, angling towards the scene so that the rear of the vehicle sticks out into traffic. If hit, the apparatus will rotate away from the scene. If we get more pieces onscene, we'll take another lane. Remember, at night, red is the first color to go.

So long as the gov't does nothing to discourage people from using our services and not paying into our system, this scorge of uncompensated cases will cause more and more hospitals to close. It's sad how those that choose to game the system by receiving these free services and not giving anything back end up costing those that work for a living their source of livelihood. It looks like St Vincent's will close down, just like St. John's on QB and Mary Immaculate, who are (were) part of the SVCMC chain. Hopefully this won't be a domino effect for other area hospitals that now face the increased liability of extra uncompensated cases. When you're that deep in debt, it just snowballs out of control, eventually past the point of no return. It's the reverse of compound interest, where your money grows exponentially. In this case, much like our national debt, the hosp's debt is increasing exponentially. I'm not too optomistic about the hospital's chances.

I've thought of yet another consideration. You mentioned some time ago that you may relocate to NYC. I don't know if you still plan to go there, stay in FL, or are open to other regions. When discussing compensation, salary vs cost of living is important. Taking a lower salary with the rationalization that it's an area of lower cost may be a mistake. Let me explain: Let's say that you earn 50k/yr, and your monthly cost of living is 2k. Assuming no disposable income is squandered, that leaves an additional 500/month for investment or even more if you invest in in deferred comp pre tax. This is based on 24 pay periods, the other two would be for clothes, recreation, dining, etc. Your pension benefit at 50% would be 25k/yr for the rest of your life. Now, let's say that you earn 100k/yr, and your monthly cost of living is 4k. You now have an additional 1000 post tax for investing. Your monthly pension benefit will be 50k/yr rather than 25k. You've now doubled your annual pension, and an increased your deferred comp (DC) due to compound interest. How much so? Let's assume a 500/month contribution to your DC, starting with 6k at the end of the first year, and an additional 6k added yearly for the next 29 years, at a realistic yet underwhelming 7%. After the 30 years total, you'd have $603,450. Now do 1000/month, or 12k/yr, for 30 years total as above at the same 7%. You'll have $1,206,900, or double the previous calculation. So, when choosing two regions based on cost of living vs salary, be aware that you'll retire much wealthier, providing the pricier area has a more or less proportional cost of living to salary ratio to the less expensive area. This is where those earning meager salaries in inexpensive areas lose out in the long run. You can always leave the expensive area after retirement and move somewhere both desireable and cheap.

Edit: the last post should read that I could retire at 55, or 58 w/DROP. Anyway there are a few more things: Starting salary - if it's unusually high for the area, check if that is a tactic to distract from the inadequacies of the dept. Schedules - are they 24's, 16's 12's, 8's? A 24/48 or other variants will be a 56 hour workweek. Be careful with a 24/48, as they can mandate you to stay for up to an additonal 24 so you're working a 36/36 or 48/24 if vacancies abound. For a busy system, 12's and 16's are more desireable. At Charleston, where I worked a 24/48 (no kellys) if I took a day off, or called in sick, that reduced my OT hours. In a 56 hour week, 16 hours are OT. When I took a day off, those OT hours would convert to straight time. This is unacceptable. What's also unacceptable is being paid on call for the overnights. You're paid for the first 16 of a 24 hour shift, and for the last eight you're only paid for the time you run calls. The employer gets over on you for this. The rig is staffed, but they only pay if a call comes in. Don't work for a place that nickle and dimes you like this. If they're cheap with work hours, they'll fall short in other areas as well, I can assure you. Another major factor is if they change schedules periodically. When I worked for NSLIJ hosp in NYC, they would wipe the slate clean every two years and bid out tours on a seniority basis. CCEMS did it every six months. My employer only does it if you're promoted to a new position. Changing schedules can add travel time, or thwart one's plans for child care, school, side jobs, etc. Uniforms and equipment - do they give you uniforms, boots equipment, etc? If they only give you a couple of shirts and maybe a windbreaker, then they're cheap. They'll also be cheap in other areas as well. Equipment - are their rigs fully stocked? Is their medical equipment state of the art, or do they just supply with the bare minimum to pass a state inspection? Are their rigs kept in good repair with regular maintenance? Or are they falling apart. If an agency doesn't keep their apparatus and equipment well maintained, then where else are they cutting corners? Protocols - progressive evidence based, or stuck in 1984? Is there a full time medical director? Is the director accessible for questions? Continuing Ed and training - How do they provide (do they provide?) continuing ed, new equipment/protocol inservices and alphabet card recerts? On duty, off duty or are you on your own? With NSLIJ, we had inservices and ABC card recerts, but no CME's. CCEMS held monthly all inclusive inservices, for 6 hours each, mandatory, but only for straight time, not OT. My employer sends us to EMSCEP, the EMS Continuing Education Program for eight hours quaterly, at a facility run by PA's, RN's and an RT, with a living room and ambulance mock up with SimMan/SimBaby, for lectures, skills instruction/testing and ABC recerts. We also do monthly in station EMS training with both lectures/powerpoints and skill drills, and also quaterly EMS multi unit drills at the fire rescue academy. Is you ConEd free, or out of pocket? Quality employers care about their employees and getting them to re3cert without any financial insult. Discipline - is it progressive discipline, or does it differ on a case by case basis? It ought to be progressive discipline - a verbal warning, a written warning, another written warning with someone in upper management, and then a meeting with the head of dept which typically results with a termination. Of course, the seriousness of the infraction can land you at step 2,3, or ever 4. Union or non union? You need someone to watch your back, to level the playing field with management. $30-50 bucks a month in dues for an extra 10 to 10 grand in salary plus benefits and protection. I'm sold. Stay away, far far away, from agencies with system status management. It's a way for employers to do the most with the least amount of resources. Translation: you'll be worked to the bone, but not see any additional financial benefit from being more "efficient". For pensions, as mentioned in my previous post, the Carolinas have many single role EMS third service agencies. There's also FDNY EMS, but the working conditions suck. It'll be really fun for the first few years, then you'll burn out. Another word on career advancement - you may want to focus in on hospital based EMS if you want to advance out of EMS. Hospital systems afford that opportunity, as well as fixed schedules, that can be tailored to school. It's good to have that option in case you burn out with EMS. I've outlined what I think are the main considerations, from a career development and economic standpoint, regarding EMS agencies. It's up to you what you'll tolerate in choosing an EMS agency, as it's highly unlikely that you'll find all of these qualities in a single agency. That's a huge reason why I went fire based, to enjoy all the positive qualities in an employer as described above.

+1 on Everything kiwimedic said, especially taking A&P and pharm, maybe patho. From an economic and career standpoint, this is my short version of what to look for in applying to an EMS agency: Look into what the benefits are, what is the pension, what is my starting salary and what is the pay progression to top pay? What are the opportunies for promotion in the job? Starting salary - ask them how they determine compensation; experience based, step based, case by case basis? How do they progress to top pay? step based, merit based, favoritism? If not step based is it percentage based? This is a good thing due to the compound interest effect. Any COLA's? Benefits - what medical plans do they have, PPO, HMO, OAP, monthly premiums, any deductibles, percentage of coverage out of pocket limit, prescription coverage, etc. How many sick days, admin days, and holidays? What is the process for requesting leave? Are you actually able to use your days, or do they make it prohibitively difficult to take any days off? What are their policies regarding injury leave and opportunities for light duty? Retirement - defined contribution, as in the 401k or 403b was originally designed for the affluent in the corporate world as an additional tax shelter, nothing more. The thing is, these corporations realized that they could save a bundle by discontinuing their defined benefit programs, pensions and instead offer 401k's. Unless you're young and earning six figures with low overhead, you have absolutely no chance in saving enough to sustain yourself in retirement with a defined contribution plan. Especially someone such as yourself with college age children. You'll be living on an EMT salary for a few years and then a medic salary afterward. Enough to pay the bills, but you'll retire poor. You absolutely, without question, need a pension. When looking for a pension, there are several things to consider; what's the multiplier, required years of service, and also number of years to be fully vested. For example, when I worked at Charleston County EMS they were on the state retirement system. You can retire at 28 years of service or 65 years of age, whichever comes first, provided you're vested with five years of service. The multiplier is 1.8 x years of service x average three highest earning years (or one year, I forget). This works out to about 50% of your salary as a yearly pension benefit, plus 1-2% COLAs. They also have the TERI program, which is similar (maybe the same) as our DROP, more on that later. http://www.retirement.sc.gov/scrs/active/basicinfo/default.htm At my employer, we have a 25 and out with a 2.8 multiplier, or 55 years of age. This works out to be 70%. We can also continue to work afterward, to increase the multiplier up to the point that we get 100% as a yearly benefit. Since I was hired at 32 y/o, I can retire fully vested at 53 years of age, with the multiplier adjusted as if I worked 25 years. We also have the DROP, like the TERI in SC. How this works is that you "retire", but then continue to work for up to three additional years. You continue to earn your salary and benefits, and also receive the full amount of your pension checks in a deferred comp account! It's a great way to save up a few hundred grand at the end of your service years, in addition to your deferred comp. You'll also have a 457, which is the same as a 401k except that the employer won't typically contribute anything, since they're helping fund your pension. Also, what percentage of your salary are you required to contribute to your prnsion? We pay 7%. Anything over 9% is a ripoff. If you were to invest that 9% in a deferred comp instead of the pension fund, and received a generous 10% compounded return, you'd still break even after 7 or 8 years, and then the pension would continue to pay until you expire. So, what looks better, a 401k where you need to contribute money that you probably can't spare, and maybe have some clue as how to invest, or a pension that's guaranteed for life, possibly with a DROP or TERI? Think "ENRON" as an extreme example. Promotional opportunities - Are promotions awarded off of a list, where the scores are based on a written exam and maybe an oral interview; or are promotions subjective, with favoritism as the main selection criteria? And what is the actual opportunities for advancement? Are there admin positions available? Or maybe only dispatch? Hospital based and fire based services generally offer the best opportunities for career advancement.

I don't need to imagine, as my dept devotes much time to training, both in the day room and on manipulative skills. We also periodically go out of service for day long multi unit drills, and we also have all the suppression study materials you could ever want for your viewing pleasure. It's an adequate allocation of our time. We also spend time on EMS drills, both in class, on multi unit EMS drills, and at our EMS training center quaterly. Yes, we make time to train while on duty. If we're still lacking, we have 20 days a month to catch up. You see, unlike many single role EMS depts, we get to do our CME's and recerts on duty, at no cost to us, so we're not burdened with such matters while off duty. Our employer takes care of us, and creates the best possiblr environment to excel. How much time does the typical EMS provider have for self study when they're being forced into OT, both holdover and recall, while also working voluntary OT and side jobs to augment their anemic salary? When I worked in NYC, I frequently worked OT side work, and watched my toddler daughter while my wife worked. There was absolutely no way I would have had the time to do CME's for recert. I got my NREMT-P, attained reciprocity in SC and I was good. If I were to have stayed in NY, I would have done the challenge refresher like many others in the area who don't have any time available for CME's. Now, by contrast, I work 10 days a month maybe two additional days of OT if I feel like it, and maybe 12-24 hours at my IFT side job if OT is slow. I remain proficient and improve on both suppression and EMS while on duty. Piece of cake. It's even easier since I was already a medic for a couple of years in NYC, where there's a high call volume, and they're all ALS job types. I entered the fire service already well versed in the ways of EMS. Piece of cake.

I see your point. it would probably piss me off too if I saw well paid, well benefitted individuals with superior working conditions, career advancement and retirement doing the same job as I do, getting paid way more to do it, while also doing a whole other job at the same time. Yes, there are a number of depts that treat EMS poorly, but there are also many that do it well. That wouldn't sit easy with me if I saw someone else doing what I do for a career just as well as I do, while also being responsible for proficiency in a whole other career. I'd probably make the same excuses and insults as to why that shouldn't be if I were in those shoes. There's no evidence that shows fire based EMS (the concept, not case studies of certain depts) to be an inferior delivery model to single role. Sure, there are depts and even whole regions (FL, LA) who do it poorly. But there are also depts, such as mine, who excel in EMS delivery, and do much more for their employees than most single role services, as mentioned in previous posts. What's important is that the concept of fire based EMS works well, as long as the dept runs it correctly. Successful fire based EMS depts are evidence of this, just like depts in FL and CA are evidence that it doesn't work if run poorly. When you think about it, you can make anything not work well if you run it poorly. Substandard fire based EMS depts are not representative of the entire fire service, and therefore prove nothing regarding inferiority of fire based EMS. I suppose that was what Tom B meant by hose envy. He's not saying that everyone wants to be a FF, but most would like to have similar working conditions, benefits, career advancement, job satisfaction and longevity, etc. As mentioned earlier, single role EMS employers are as much to blame for the lack of educational standards as is the fire service. In most cases, neither one requires a degree for entry or gives preference to those that do. Sure, one or two people can chime in and say that their dept gives preference to degreed medics, but that's but a miniscule fraction of the industry. That's right, EMS in it's entirety has itself to blame. So sue me for going fire to make this a sustainable, enjoyable, fufilling career. Foreigners can keep going on about their advanced educational status for EMS, but meanwhile I'm gainfully employed and quite happy. It would be great, in all seriousness, if we could get to that level, but I'm happy here nonetheless. I'm completing my EMS AAS just in case. It certainly can't hurt, and I can do it a class at a time if I want.

I think that my dept has shown that they don't agree with those statements, given the attention, training, staffing and funding to EMS the willingness to fire recruits who don't pass EMS training, and also sending interested FF's to medic school. Other depts in the area hold EMS in the same regard. Those IAFC statements seem like they come from places like FL and CA. It suprises me why places like FL and CA wouldn't require potential FF medics to have degrees, since so many applicants already have their medic. Especially in FL, it would be simple to thin the herd, and bring in more qualified, degreed ALS providers, especially with negative press from Collier Co and such. I'm happy to hear that NZ has Masters degrees available in EMS. As far as clinical knowledge we have only the EMS AAS. For admin, we have the EMS BA. No one can answer me as to why our clinical education practically stops at the two year level. That isn't the Fire service's fault, though. Blame the universities and lack of demand for a higher level of clinical expertise from employers. This increased clinical expertise would be intended for IFT, CC, and flight, naturally, areas where the fire service has no vested interest. Yes, I believe that the interfacility industry, as well as single role 911 EMS providers are as much to blame as anyone for keeping educational standards low, and not requiring a two year degree for entry into the field. How many third service, hospital based, private, and flight EMS require degrees as a condition of hire? Hardly any. They're as much to blame, actually much more so than a few fire service statements, since all these single role employers have the power to require a degree for employment. But very few do. Very few. No place I've ever been hired previously (this is my first and only fire based job) has given any consideration toward a degree, only if you have your certs, references, experience, and can you pass your medical. I was hired by Charleston County EMS in two weeks flat, from start to finish. I could've pulled my medic card out of a cracker jack box, and they wouldn't have cared. How about assigning blame towards them and other like minded single role providers for keeping the standards low? https://jobsweb.char...ncylisting.aspx Look at their educational requirements. You can even have a GED LOL. Check most other employers and you'll find the same. The argument was why couldn't a FD, in this case mine, split fire and EMS, that EMS delivery would be superior with seperate EMS and fire. I posted the current fire and EMS staffing for my dept. My point was if you split my dept, those 37 ALS engines would need to be replaced by at least 37 paramedic staffed chase cars, to equal the same level of EMS service that currently exists. I went on to point out that splitting EMS and fire would cost the county an unecessarily large amount of money in hiring 37 more medics, complete with pensions and benefits to pay for, as well as 37 chase vehicles. But thanks for bringing that up. Oops. I guess you could have your cost savings if you downgrade the current level of EMS delivery, but certainly not if you intend to keep the EMS response the same. The ALS engines, that may or may not have significant downtime depending on the area, are available to do the job of the chase vehicles without having to hire additional personnel. We all know that payroll is the largest part of the budget, far ahead of apparatus, equipment, and everything else.

Apparently you haven't read the numerous discussions on vollie vs paid, where the main argument against vollies is the lack of mandated training. EMS and fire. I can see that you have no clue regarding suppression operations, other than what you think and guess might be going on. Talk to me about the differing tactical considerations for the SFH, high rise, garden apts, commercial building, strip mall, etc. Talk to me about interior ops, how to coordinate an attack while search crews are doing a primary, why it's vital that the officer does a lap around the structure before going in, vent for life vs vent for fire, when to VES, the importance of RIT, training on RIT procedures, such as SCBA emergency drills the Columbus drill, Denver drill, etc. Two in two out.How about maze training? Even throwing ladders and humping hose up a ladder? How about ropes & knots, and emergency bail out procedures? How about gas leaks and hazmat incidents? Elevator rescues? These are all important, and need to be trained on regularly. Complacency kills. This is as true as ever in the fire service, as it is in EMS. We also train EMS regularly. We do in station powerpoints for EMS topics, and suppression topics as above. We do company drills and multi unit drills for the topics above as well. We do EMS skills drills, both BLS and ALS as well. We go quaterly OOS, for a day of CME's. We were also allowed to go out of service twice, for two blocks of two hours, to review our new protocols with other medics in the batallion. Your scenario with the "big strong firemen" shows that you know nothing about suppression. So how is it then that you make statements like "I love seeing fire justifying themselves?" You have no knowledge as to what we do (over here), and what training we do on a regular basis, and as such cannot offer a valid opinion on the matter. I'll take any future comments where they're coming from. So, you work 10 hour days, 365 days/yr and are on call for the other 14 each day? You're basically a prisoner at home, since you can't go anywhere far, unless you take vacation or something. I hope you're getting rich doing this (sincerely). So, you have FF's on retainer each month, and they're paid on call? That's what many vollie depts here do to provide fire protection. There's the problem of dwindling participation, which provides coverage problems. When you respond from home, there can be quite a delay in response time, since you need a minimum crew to show up and man the apparatus. How many minutes does that waste? It's a horrible, outdated system. There's a reason why more and vollie depts lose ground to paid depts every day.

You're right about most of it. Of our eight heavy rescues, 4 are Hazmat, and 4 are TROT, which stands for Technical Rescue Operations Team. Hazmat has it's own truck in addition to the rescues, since we get enough work on I95/I495 and such. For TROT, there's actually several supply trucks in quaters, with no driver assigned. If there's a tech rescue call, one of the TROT techs will drive the supply truck to the scene along with the rescue. Bingo on the rehab trailer, although there aren't any ice baths. The canteen and rehab units go hand in hand.

If sanitation medics and FF/sewer workers worked well, then the practice would be widespread. But, unlike fire/EMS, it's not. I can count the number of known EMS/PD organizations on my one hand for the same reason. Same for PD/fire. In these tough economic times I'm sure that all options have been considered. Just because the FD may be more idle than not with respect to calls, it doesn't make the FD any less valuable when needed. People conveniently forget forget that we train often, training vital to maintain proficiency, maintain the station and apparatus, and do indoor lecture type drills while on "downtime" in between calls. Our days are in fact quite busy. How does a slower call volume make the FD response any less important? Seconds count with a structure fire. Type 5 construction that is so prevalent today, with it's large fire load void spaces oriented strand board, and trusses held with 1/4" metal gusset plates, rapid fire spread and structural collapse happen quickly, maybe in 15 mins or less. So, let's say that the emergency call comes in at the exact time the fire is set (which it rarely does). It takes around two minutes or so to take the info from the caller and put it in the system. Then the fire companies are dispatched. Now it's at 3-4 minutes. Add another 3-4 as a response time, on average. Now it's 8 minutes. The crew pulls a line as the officer does a 360 degree lap. The crew advances the line at around 10-11 minutes (in a best case scenario). Other companies are needed as well, an engine for water supply one for a backup line, one for RIT. A truck for ladders and utilities, and maybe a primary search or VES if the heavy rescue is delayed. A second truck for ventilation. Each engine needs a crew of at least four to work efficiently, the same for a truck. Each unit is vital to the overall effort. It takes way more than one or two companies to handle a decent fire, with searches and potential rescues, water supply and such. Now what happens if you downstaff the FD based solely on call volume? That 12 minutes can become 15 to 20 or more, where the building is a write off, and the crew cannot make any saves due to interior conditions. Your water supply engine is extended, so you may run out while doing an interior attack, or when protecting the stairs for the search crew. Will there even be additional engines/trucks? How about RIT? It takes over 12 FF's to rescue one that calls a mayday. More goes into suppression activities than you realize. Fire suppression is just as important as EMS. Call volume is irrelevant. When they're needed, lives and property are at stake. If call volume was the deciding factor in staffing, then rural areas wouldn't have any fire protection whatsoever. That was long winded, but many don't realize what goes into suppression activities, or the importance of a timely, adequate response. If FF's were retained or POC these response times would be much higher, and any response would be just to surround and drown (exterior attack) and tough luck for anyone stuck inside. Speaking of time sensitive, how much do you think it would mean for a family displaced by a fire if we could save something as simple as their irreplaceable family photo albums or important documents due to our well organized, timely response? No one thinks about that, either. What do you mean by "retained" or on call? Do you mean POC vollies where they respond from home? That greatly extends response time obviously, and the number of FF's responding can vary greatly. Or do you mean that the crews aren't paid on the overnight unless there's a call? There are a number of shady EMS agencies that do this already. If I'm at work, I'm not at home, and I'm also not free to leave the station and do as I choose. Even when sleeping I'm not at home. I'm also ready to respond immediately. This needs to be compensated for, as it is during daytime hours. POC and restructuring of work hours similar to system status management has been shot down numerous times by our unions, so there's nothing to worry about. But maybe you're right. Fire shouldn't be a 24/7/365 option. We'll tell the caller to reschedule their emergency to when there's actually someone on duty, maybe in a few hours or so. Sorry for the inconvenience. Thanks. Now if someone could tell me why any progressions past the EMS AAS are mostly admin related (in the states), I'd appreciate it. We're told that we have only a paltry two year degree with which to base our medical proficiency on, and that we're ill equipped to do any stand alone critical care txp, flight or even run of the mill IFT. We don't have any four year EMS degrees, to my knowledge, that seek to improve us as clinicials, only to groom us to be supervisors. It puzzles me.

Run like a business, huh? Look at NYC. That worked real well for St. John's on Queens Blvd, Mary Immaculate, Parkway Hospital , and St. Joeseph's to name a few in Queens alone. http://www.nydailyne...pital_clos.html These hospitals were run like businesses, and they went under. I wonder if other area hospitals will be able to weather the storm, namely the scourge of uncompensated cases. EMS and fire are vital municipal services, and can't be dissolved like a business. They must be funded. Sure, you could outsource EMS. But, if it's not profitable for the new private company they'll leave as well. If it was in fact profitable, the local gov't wouldn't have outsourced EMS in the first place. So, how would you run a police dept like a business? Revenue from ticketing wouldn't even come close to the funding needed to staff even a quater of any existing dept. If a PD was run like a business, you would have to lay off more than 3/4 of the workforce to stay in the black. Vital municipal services are not businesses, and can't be managed as such. Sure, control the budget and trim the fat but there needs to be a minimum level of service regardless of the current financial situation. Otherwise, the entire district would burn, crime would run rampant, many would be without EMS transport, there would be mountains of garbage on the street, the water would be undrinkable due to lack of staffing for water treatment. Infrastructure costs as well, so the roads will remain in disrepair. Our medics are competitive at the least with any single role EMS agency regarding knowledge and competency. We attract many from single role environments. I took great care in stipulating that out incumbent FF/EMT>medic upgrades are voluntary and are sent to an EMS AAS program. Sure, you have problems with many depts in FL or CA, but not at my dept or surrounding counties. Many personnel are required to rotate regularly between the ambulance and the medic, so no one rots away on an engine. No one here in the States has post grad education in clinical EMS, as it doesn't exist, as far as I know. We have only the EMS AAS and the EMS BA, which is mostly admin when compared with the AAS. So, the EMS AAS is really the highest available education for an EMS field provider here unless one wishes to be educated abroad, or earn a degree in nursing/PA/RRT and then go into EMS (highly unlikely). Although, I used to work with a former ER physician who worked as a medic FT only to screw his ex-wife out of a lucrative divorce settlement and alimony. Bizarre, but true. Dr Dave at FHMC (Queens NY) for anyone in the know.

We don't need to call for a fire truck to assist because we already have one. Fire and EMS are both county services. Whether they're combined or seperate the same number of personnel will be riding each piece. Combined services have the added benefit of versatility of it's employees to do either job. As far as the problems facing third service EMS, as mentioned above, sure there wouldn't be those problems if these agencies were properly funded. There are plenty of agencies that have their own identity and representation. The thing is, most agencies aren't funded well, and run their budget at the bare minimum of what's needed to get by. There's no strong organization in place to change things. As such the EMS worker has a much better deal with the fire service. I'll favorably compare my working conditions benefits, retirement, salary, and overall job satisfaction with any overseas dept. Again, my dept does more for EMS and it's employees than most if not all third service organizations in the U.S. Things need to change in EMS over here for sure, but any significant change will take decades. Not enough people in the EMS industry care enough to organize. Of course my dept could split EMS and fire, but it runs well as it is, and divorcing the two wouldn't result in any signifcant improvement in service. The same amount of people would staff the same amount of units each day. The difference is that the engines would no longer have medics. Still minimum staffing of four per engine, but no medics riding. Now you've lost 37 ALS first response units. You would need to create an additional 37 positions, hire 37 more people to ride chase cars to equal the previous service. Each new employee would have to go through an EMS academy, be paid a salary, medical, holidays, sick/vacation days, pension funding, gear, along with the cost for 37 ALS quick response vehicles. More supervisor positions would be needed as well, and each position incurs additional cost as above. OT both on suppression and EMS divisions would increase, both voluntary and forced, as personnel are no longer dual role, not versatile and each division has a smaller number of employees to work with than previously. Meanwhile, suppression units stay largely idle where they were being used for EMS (saving the cost of 37 + positions as above). Splitting EMS and fire would cost the county dearly, provided the same level of service was maintained. Combined service saves money as above, when compared to seperate services in the same jurisdiction.

You, like many others, like to point out that EMS call volume trumps fire call volume and that EMS receives vastly more revenue as well. The thing is, fire and EMS, along with PD, sanitation, water & sewer, parks, and various other agencies & services are all funded from the municipal budget, in my case the county budget. Revenue from various depts, where applicable, are pooled into the general county fund. As such, it's irrelevant who does more of what. Some agencies will naturally bring in more revenue than others. That doesn't make any agency any less important than others. The county isn't a corporation, and it's vital services aren't businesses either. Each of these services are vital, and need to be funded properly. If a dept's revenue dictated staffing, EMS might break even, there would be but one firehouse in the whole county (the only revenue is from fire investigations), and 3/4 of the police force would be laid off. In crosstraining our personnel, it just so happens that the county saves money in staffing, benefits, OT gear & PPE, and more. Sure, we could seperate fire and EMS, but there's no need to. Our personnel who are assigned to the ambulances for the shift essentially function as a third service EMS, with the added benefit of versatility, should they need to set in staging on a high rise fire, to throw ladders at a fire while idle, and be available to holdover or voluntary OT for either EMS or suppression. The EMS division runs as efficiently if not better than any third service. As far as taking medics off the engines, an engine brings four people with it. If they're not needed, we'll cancel them onscene. I posted the daily staffing for the county because you asked me how many are assigned to fire, and how many are assigned to EMS. At my dept it's not about who controls the dept, EMS or fire. It's never been about that. The county has always run fire and EMS together. Both admin and my union alike have personnel who are ALS and suppression. Everything is intertwined here. The attitude here is that EMS and fire are one and the same, that FD = EMS and suppresion alike. Since everyone is crosstrained, and are rotated regularly from suppression and EMS apparatus then no one is really doing more of the work, as we're doing work from both sides. Again, it works well. EMS functions as well if not better than the average third service EMS. Same for suppression. No need to seperate. Problems that plague third service EMS, such as understaffing, mandatory holdover, inadequate salary/benefits, working conditions, subjective promotional practices and such don't exist here. Sure, most pt's conditions aren't time sensitive, but many hands make light work. If I'm lifting pt's one quater of the time that I would be doing in a single role system, then I'll be at decreased risk of injury. It's nice to have extra hands, along with another medic to consult at 0300. We can also use the engine medic to ride in the back to the hospital if needed. Proper staffing and mutual aid agreements allow us to do this without a negative impact on coverage. Perhaps single role EMS could work here, but it's not necessary. Besides, our union wouldn't allow that. Our firefighter EMT's and firefighter/medics are compensated way more as dual role than we would ever be as either single role FF's or medics/EMT's. We intend to keep it that way. Another thing, no one here is trying to hold back EMS in any way. We revise our (liberal, evidence based) protools every two years, we give our new medics a 16 week ALS internship on ambulances only, complete with lectures from PA's, RN's, and a RRT. We have a tough written exam and rigorous practicals. We will fail you out of the academy if you fail to perform. We hold numerous EMS admin meetings to improve our services. We take our crews OOS for CME's and other training, to ensure that everyone remains proficient. In fact, we send all qualified, voluntary selected incumbents to medic school at NVCC MEC, which is a degree program. That's right, if we upgrade (voluntarily) our FF's to medics, it's through a degree program only. How many third service agencies do this? We run EMS well and have many happy satisfied employees. I had to relocate from NYC for this job. If EMT's and medics locally want to complain that there's no single role 911 work then relocate as I did. No sympathy here. Straight up. NYC, Philly and the Carolinas all have single role positions, as do other areas.

How much revenue a vital municipal service realizes is irrelevant to the amount of services needed. Sanitation might give out a ticket or two, I'm sure that the PD doesn't cover it's expenses with their ticket writing alone, but that doesn't mean that their services can be cut. As much as people like to argue to the contrary, fire suppression is an insurance policy toward life and property. If you base funding and staffing solely on revenue, then the FD's response would be extended and undermanned for many incidents. Lives would be lost, and much property would be lost as well. A citizen may only need the FD once in their life, if at all, and there should be an adequate, timely response. I may never crash my car but that doesn't mean that I'm allowed to waive insurance. My house may never catch on fire, I may never need to be cut from a car, but the FD needs to be there just in case. It's not proper to run emergency services like a business for the above reason, among others. I don't know the suppression expenditure as compared to EMS, but I can say that both divisions are funded well, just like they would be if they were seperate depts. One doesn't siphon from the other. We have the best equipment, uniforms, PPE, apparatus, and quaters for both sides. For each shift, we have 37 medic engines (one for each fire station), 14 trucks/towers, eight heavy rescues, a few boats, a bunch of tankers for water supply, two Hazmat units, a few TROT supply trucks, two canteen units, a rehab trailer, 7 BC's, an ops DC, and an Asst Chief for suppression. We have 33 medic units, four BLS units, five EMS captains, and two EMS BC's for EMS. Our EMS training facility employs several EMS LT's as well as three PA's a couple of RN's and a RRT. Population is about one million, with much industry and Gov't agencies in the area. Each engine has four on it, one of whom is always a medic. The trucks have three. The Rescues have four, as does the Hazmat units. The tankers have one driver each. The TROT truck, rehab and canteen will be driven by someone off of one of the suppression pieces. The ambulances are a mix of double medic, one and one, and double EMT for the four BLS units. Since all personnel are crosstrained, and some officers are also medics, this saves money on forced OT and vacancies in general. No units get run down, each unit is run 24/7/365 unless a short OOS time is necessary for mechanical issues or injury. I spend about half of my time on an ambulance, and the other half on an engine as the engine medic. As far as seeing EMS as a seperate entity being a negative, I don't necessarily think that way. I've said before that I don't agree with FD takeover of EMS, unless the private, hosp based, and/or third service agency proves inadequate. I started as single role hosp based, and decided that I wanted to be municipal, mainly for the pension, superior benefits, and job security. While testing for my FD, I worked for a third service in South Carolina. I wasn't impressed. My base salary here is in line with what they're compensating for at the asst director level (68k base + incentives) and I can retire in 23 years not 28 as previous, and have the DROP. Most important though is that I get all this while doing exactly the same job (when I'm on the ambo) with an organization that provides better service and better working conditions than the third service agency. It was an easy decision to make the move to the fire side. More often than not, I've found that muni single role EMS is understaffed, and are treated worse than FD personnel. That organization may be more "efficient" regarding number of personnel and budget but FD's (at least ones in my area not so much in FL and CA I suppose) provide better service. Not cheaper, but better. By service I mean a timely response with as many personnel as is needed. Many hands make light work. I'm capable of handling most calls with only myself and my partner, but having the extra hands reduces the number of times I need to lift a heavy load in awkward positions; more importantly, though it greatly reduces onscene time. Not the most cost effective, but the best available service. Everyone knows their roles and things go smoothly. As far as education, uneducated field providers typically won't make the best supervisors, more so in upper management. Those with adequate education but limited field experience typically make lousy supervisors as well. I suppose that the best thing would be to require adequate education with an adequate amount of field experience, at least 5-7 years or more.

That's sad. What did he mean by "EMS is nothing without fire"? I would think that since EMS is a part of many FD's, and many of them belong to the IAFF or other unions, then EMS by default is represented (more in some places than others) by these unions. Also, what did he mean by saying that people like you were going to be the downfall of EMS? It's too bad that this is really the only sizeable nationwide EMS organization. This is why I advocate unions for EMS. No one else is looking out, apparently even the NAEMT.

Apparently many medics aren't in it for the long haul, as evidenced by the transient workforce currently in place. Many start with the intention of retiring from EMS, but get fed up with things and look for a better deal. Yes making the long haul more viable should be of paramount importance. I understand having a free membership, and then a fee option later on. Perhaps they can help with campaigning, charities, public service and such. The problem is, however that the organization needs significant funds to effect change with politicians. That's the only way to change things rapidly as the NAEMT seeks to do with salary, benefits and such. Politicians respond to contributions, help with re-election and anything done by the organization that makes them look good (which helps them get re-elected). Politicians put re-election as a main priority, and the organization's contributions and favorable PR assosciated with these politicians come back to the organization with better pay, benefits, perhaps thwarted FD takeovers, increases EMS funding etc. etc. Financially backed political organization is what gets rapid results.

For one, I'm sure that physicians are in it for the long haul, and will be more active in advancing their position. You're right about the lack of NAEMT marketing. I'm sure that many don't even know they exist. The catch 22 with political organization is that it costs money. People want to join for free, and then expect results. $30/yr isn't going to do squat when attempting to gain persuasion with politicians. That's why I'm more than happy to pay my union dues each month. For a small amount, I'm enjoying a generous salary and everything else. Hook ups are the way of the world. Those who don't realize that will remain in the same position while life passes them by. Politicians hook up unions and similar political organizations.

Great move, I like to see political action. I see that the NAEMT has only 30,000 members. That makes it tough to gain the influence of politicians for better pay benefits, etc. Just think how powerful the NAMET could be if most everyone joined, and also became politically active within the organization. Perhaps the NAEMT could call itself a union as well. Just look at the IAFF. In many parts of the country the IAFF organizes in right to work states, Virginia included. Results are realized by political action, campaign contributions lobbying, endorsements for politicians as well as community service and charities. Using my local as an example, we recently helped the county's BOS chairperson get re-elected, and she looks out for us at every opportunity. There are numerous other examples of collaboration with local state and federal politicians. The public holds us in high regard, due in large part to community service, charities, and social functions that we're requested to attend. My dept used to pay poorly, with so-so benefits and we worked two 14's and two 10's each week, thw 14's being day shifts and the 10's at night. We now have a fantastic benefits, pay that rivals if not exceeds professionals with 4-6 year degrees locally; we work 24's 10 days/month a three year DROP, 25 year retirement at 75%, fantastic policies regarding forced OT, scheduling for paid time off, an objective exam based promotional exam to name a few things. This was due in huge part to the work of the IAFF and members taking an active role. The NAEMT could be the same if it wants to. Instead of complaining about the IAFF, do what they do. It obviously works well, you have to admit. Yes, I know that increased educational requirements should result in increased pay and benefits but that will take a long time if at all due to the transient workforce. While this change is supposed to happen, probably over 15-20 years or more how does that help those with time on the job, say 15, 20 years or more? The holy grail of better pay benefits job security degrees as minimum entry and such is realized a year or two after these tenured employees retire. That would infuriate me if that was my situation. What about families that are barely making ends meet, and desperately need the income boost along with benefits and job security? Political action gets results NOW not 20 years for now. I wasn't willing to wait it out for an uncertain result, as in no guarantees. So I joined the fire service. That makes me one of many transient individuals who left the single role EMS market. From the article: "Due to the rising cost of living and increased educational requirements, compounded with stagnant wages and benefits, EMS practitioners are being forced to migrate to other professions that provide adequate wages, benefits and the opportunity for advancement." That describes me well, as it does for many others. So stop complaining about how the IAFF dominates all, and follow their model. It takes action, not venting frustations on an internet forum. Join the NAEMT, be politically active, or remain inactive, resigned to things staying as they are. You decide.

Let me break it down for you. Your ultimate goal is RN, RT, or PA. It's way easier in the long run to get your degree in one of the above disciplines rather than go back later. If you get your RN, you can challenge the medic quite easily. It doesn't work the other way around though. Many here feel that tech schools are inadequate when compared with EMS degree programs, and certainly when compared with higher level medical degrees. That's right you can get your RN and then challenge the medic, and have both in the next two years, rather than go to medic school and then RN, RT, or PA. But it's not that simple for you. There's a new baby to provide for. You need more of a paycheck than an EMT salary provides, and you need it ASAP. Everyone's overlooking this very important detail. I understand. Your medic school is free. It's easier financially to work towards a degree on a medic's salary. Many with real issues such as providing for a family need to make the quick money. Going to school for a few years while working on a welfare salary doesn't cut it. Really it's up to you. Only you know what the best route is when considering family and finances. Quick medic money and get your degree later (the long road) vs getting your degree right away and making everything way easier career wise (the efficient route). I had similar goals as you some time ago. I was an EMT, with RN and medic aspirations. My wife became pregnant and we had a daughter. My income was inadequate to support a family. I had a decision to either go to RN school (2+ years) or medic school for 15 months. I chose the latter. Two years after graduating medic class I wanted to go back for my RN or RT. This very lucrative firemedic position came available. I again deferred college. I'm now completing my EMS AAS while gainfully employed, and I'm planning to knock out RN school starting in the next two years at the latest, so I'll have a decent paying side job, and also a fallback in case of injury. Take everyone's opinion for what it's worth, and decide for yourself what's most important - the quick money or the degree. The quick money is out of necessity, and the degree is the most intelligent thing to do career wise.

Like JPINFV said, different regions experience different weather issues. Being out in the field for a week straight or whatever should have been in your job description. It's something you should've taken into consideration before taking the job. You don't want to deal with the cold, heat, rain, wet boots and wet shirt? Cry me a river. Try doing an interior attack straight from PT where you're dehydrated and wet, getting soaked, coming out to temps in the teens, rehabbing for 20 minutes and then doing several rounds of overhaul in soaking wet bunker gear. 5 hours of fun or more. Then reracking hose out in the elements while in the same gear. I changed my hood and my socks. But I don't whine about it. We run in Northern Virginia, where we're subject to a full range of climate conditions. I've worked both suppression and EMS in 100 degree plus humid heat, and I've worked for 48 hours straight through two blizzards here, one for 19 inches and one where we just got two feet. I rode the ambulance exclusively during both events. We get the occasional hurricane and airplane crashing into buildings as well (Pentagon, remember?) But no one here whines about it. For comparison's sake, we're issued two sets of structural gear, one Scott facepiece, four pairs of nomex pants, three short sleeve polos and three long sleeve, three short sleeve uniform shirts and three long sleeve, a pair of work boots, hat, one pair of coveralls, and one half length coat. Now, if we get our gear contaminated with BBP, we send it in to be cleaned. When I used to work hospital based EMS, the same place as in the video link above, we were advised to red bag any clothing that couldn't be decon'ed with hydrogen peroxide, and to take it to the dry cleaners. Only a reTARD would try and wash them at home. Oh, and we were all given the BBP/infectious control lecture at orientation as well as EMT school and also paramedic school. Everyone also knows not to kneel down into any mystery puddles. It's called common sense. When I worked NYC 911, we could be outside for a fire 75/MCI 22 for several hours in single digit temps, and also lengthy cut jobs, in only a uniform, turtleneck, coat, and a perp hat (skully). If you can't hack it out in the elements, perhaps it's time for a new career. Or carry several changes of clothes with you. In the unlikely event that numerous pts vomit, bleed, and smear feces on you, forcing you to run through four to five uniforms or whatever, thern put yourself out of service due to BBP contamination. Those in the FDNY EMS system do it all the time, go OOS BBP. If your employer expects you to work in contaminated gear, then work somewhere else, preferably where it's always 70 degrees and sunny, with light winds, where it only rains when you're off duty. Anyway, you're not suppression, you're EMS. I find it hard to believe that you're doing one week tours or whatever. I've haven't heard of EMS working more that 48 to 72 straight. Four uniforms plus a pair of coveralls should suffice for BBP issues.