Firemonkey Madness

[Eydawn]

Very good points, lfdcaptain! In response to the term "Professional EMT" being an oxymoron... there are many of us here who believe that EMS providers are undereducated, having only a bare minimum of training (the 120 hour course sound familiar)?

Ergo, until we have a professional level of education akin to those that many RN's receive, EMT's cannot be considered to be professional providers. Trained providers, kind of like a CNA has training, but not educated because we don't have the anatomy/physiology, pharmacology, cardiology to back up our treatments etc.

I think the problem that some people have (myself included in Colorado) with fire based EMS is that there are many guys who are *excellent* firefighters, who really just got into this for the fire side of things, who are "brute forced" through an EMT class that is designed to get them to bare-minimum pass their National Registry and State exams.

There are many firefighters who just do the EMT thing "because they have to" and really don't do a lot to try to further their education afterwards. Ergo, they provide sub-standard or mediocre medical care when they're on scene, and there your feud begins...

I can attest to the "brute force" tactic because unfortunately, with the way my schedule worked at the time, I ended up in a summer EMT class. 10 weeks, only 3 of us in there really wanted anything to do with EMS as a career. It sucked. If I hadn't had some good foundational A and P from college and learned the physical skills as a First Responder, I'd probably have been $h!t outta luck.

Oh, we all passed the NREMT (eventually in some cases), but it wasn't a class that was trying to EDUCATE good providers. It was trying to train these guys so they could get hired on with the local FD.

A lot of us don't know what to do to solve the problems that we see, both with education and poorly run Fire/EMS systems. But the first step is acknowledging that there is a problem and trying to see what the roots of it are. Personally, I'd like many fire departments to drop their EMS requirements, or at least step it back to the First Responder level, especially in urban areas that have adequate EMS-only coverage.

I think the benefits of them getting to scene faster would still apply... doing CPR on someone in cardiac arrest or putting O2 on the asthmatic goes a long way, and unless you are a transport agency, that's about all you'll end up doing plus some history, vitals etc... all First Responder skills.

That's where some of the issues lie... hope it made sense! And, well written post and way to see through Dust's vinegar to the actual issues. Most folks take about 3 weeks before they get to that point!

Wendy

CO EMT-B

[Dustdevil]

Dustdevil' date=' as I expressed in an earlier post, please forgive my newness to this arena. My reaction and subsequent communication, was "knee-jerk" at best and an ineffective attempt to defend a system, (Fire/EMT), that I firmly believe in. This is your arena and I reacted badly.[/quote']

Not a problem, Bro. I may spend more time here than others, but it's still as much your home as it is mine. Don't feel like you are just a guest here. I think the comments about my seniority here were not so much an assertion of superiority, but just an observation that my opinions are well known here, so people immediately notice if someone attempts to attribute opinions to me that don't exist. And, because my opinions are so well known here, I too tend to have a "knee jerk" reaction to whomever accuses me of something I never said. Again, I never said that fire departments should get out of the EMT business. It was just one of three choices on the poll I put up for entertainment value.

You're not really out of the loop on that one. Honestly, I haven't seen much of that animosity in the field either. It's probably been over 25 years since I've seen an FD and EMS agency taking potshots at each other on scenes and behind the scenes. Sure, there are individual conflicts, but agency wide, you just don't see that kind of thing much because those involved are more disciplined than that. But what does exist in a great deal of the US is the undercurrent of hostility between the agencies, as each gets territorial about the other stepping on their toes. Way too many FDs have stepped in and taken over EMS in their city when the chief realised how much he could expand his budget by doing so, for anybody to have not noticed by now. Of course, there are entire states where FD run EMS is almost unheard of -- as well as entire states, like Kalifornia, where non-FD run EMS is almost unheard of -- but the rest of the country knows this conflict.

My primary personal objection to FD run EMS is not about territory or jobs. It is about the growth of the profession. And as long as the IAFF and IAFC fight progressive educational standards for EMS providers, the fire service will be an enemy of professional EMS. Period. Yes, there are many ultra fine firemonkey medics out there who make a personal commitment to educational and professional excellence. No doubt about that. I considered myself one of them. And there are plenty of non-FD providers out there who suck too. But until EMS becomes a focused profession, with professional educational and practice requirements, instead of a side-business for firemonkeys and a hobby for volunteers, EMS will continue to suck, as it currently does. Both of those entities are standing firm in the way of progress. If they want to support progress, I am happy for them to be on board. But, as it currently stands, they are detrimental to professional EMS, so I oppose them.

Currently, the National Registry is a joke. Yet the failure rate is still huge. It certainly is not -- despite what they want us to believe -- any benchmark of quality education. Using it as such is a laugh.

Anyhow, where that perceived difference comes from is, of course, from the big city FD systems that make EMS education a very low, rock-bottom minimum priority. Take the lowest possible level of education, and give that to somebody who really has no desire to be a medic in the first place, and you have a recipe for less than mediocrity. Los Angeles (or almost anywhere else in Kalifornia). Dallas. Miami. DC. All crap systems where the FD won't invest any more than 6 months of wham-bam tech school training in their medics, with no educational foundation. And the day those guys sew their patches on, most of them are already counting down the days until they can take it off again, for good. That is where the perception of quality difference comes from. But, unfortunately, the FDs holding those educational standards low results in a trickle-down cheapening of the job. Now everybody who comes to EMS -- public, private, and otherwise -- are all looking to enter at that lowest common denominator. This results in even the people in the profession refusing to respect it as a true profession. And when we ourselves fail to respect it, it amazes me that anybody is surprised that the public won't respect it either.

Plus 5 for that.

Absolutely. And again, there are good and bad in every system of every type. But there remains two factors that hurt the fire service's ability to provide quality EMS: first, they frequently discourage education beyond the bare minimum. And second, their providers are given EMS only as a side-job, with no priority put on it for their professional development. Consequently, fire providers commonly lack a professional focus on medicine because their career is focused on fire suppression, and they do not plan to stay a paramedic for long. If both of those factors were eliminated from FD EMS, they would have every bit as much potential for excellence as everybody else. But it just rarely happens, which keeps FD run EMS saddled with seriously limiting baggage.

What reasons are you referring to? I'm not really sure I understand.

It's a fact. Read the minutes of any DOT or NAEMSE or state EMS board committee meeting. What you will read are line after line of the fire representatives opposing increased educational standards, so that they can remain competitive in the EMS business. Read the IAFF and IAFC platforms, where they openly talk about how they are the "best" suited entity for the provision of EMS in this country. You cannot possibly have been a professional firefighter for twenty years and not heard any of this.

They should. There is a reason that the dentists separated from the barbers a hundred and fifty years ago. Because a professional focus on one vocation results in a better provider than trying to turn blue-collar labourers into multi-taskers to perform a medical profession. Again, it is indisputable fact.

Can you please point out a post anywhere on this forum that says that? I read just about everything posted here, everyday, and I haven't seen it. I have seen specific references to specific systems and their inadequacies, and I have seen broad generalisations that are based upon the above observations. However, I have yet to see anybody say what you are saying. I think you may be a little hypersensitive to the issue to imply otherwise.

Can you clarify that point? I don't get what you are saying.

Good! I wish everybody here were inclined to look at that next logical step, which is action. But hey... bitching is a start! It beats the hell out of all this phoney kum-by-yah nonsense, where so many people naively suggest that everything is just fine, and if we all just hold hands and be "united" that things will improve. The first part of solving a problem is admitting you have a problem. Here at EMT City, we are into admitting the problems, which is a giant leap above other forums I have been to. I think you're good enough to run with the big dogs, so come join us!

You've got it, Bro. I think your overall viewpoint of EMS suffers from a limited exposure to EMS nationwide. You seem to not realise just what problems we face, and on what scale they exist because, lucky for you, they do not exist in your area. But, on the positive side, I like your obvious commitment to excellence, which I believe to be the most important factor in growth. For that, you have my respect. Perhaps we can help each other grow.

As all the volunteers out there constantly whine, it takes a lot more than a paycheck to make one "professional". On that point, I agree with them. So I don't buy the theory that somebody is a professional just because they are making a living as an EMT. And beyond that, I don't buy the theory that anybody with a mere 3 weeks of advanced first aid training is a professional, regardless of their pay status. Emits are not medical professionals. There are all sorts of appropriate names for them, depending on what they actually do, but none of them are a profession. EMT is just a job. Those who want to be professionals need to demonstrate a great deal more commitment than a simple EMT course. That's not a personal shot at any of them. They are as welcome to go get an education and become a professional as the rest of us. But either they do it, or they don't. The choice is theirs.

[1835wayne]

I think the benefits of them getting to scene faster would still apply... doing CPR on someone in cardiac arrest or putting O2 on the asthmatic goes a long way, and unless you are a transport agency, that's about all you'll end up doing plus some history, vitals etc... all First Responder skills.

In my FD's area, we have to wait 10 minutes or more for an ALS rig to reach us. For a cardiac, we have defib and combitube to add to the"First Responder skills". We have had two saves this year. Can we do it by ourselves? Of course not! But having BLS non-transport agencies respond provides our county EMS with several things; rapid response of Defib and manpower to lift the fatties and help on full arrests. The First Responders have helped our county EMS to be ALS provider of the year for Indiana 5 times. Our Chief was one of the pioneer Paramedics in the state of Indiana and is a firm believer in Fire based EMS.

With more manpower, and dropping the silly requirement that all EMS personnel should have to be a Firefighter , EMS providers as a separate entity could cease to be.

First. If I have an MI, the most likely response (in my area) will be a fire truck with 6 people trained to the basic level in a couple of minutes, while I wait 5-10 minutes for medics with ALS knowledge and supplies to arrive? Why is that a good thing?

The answer is simple, early defib, early CPR. Is it ideal?? No. But it is the best that can be done with the monies available and the limited numbers of Paramedics in the country today.

As a citizen only, I would love to halve the number of firehouses and double the number of medic units and reverse the above scenario.

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Wow. I am shocked and dismayed by this comment. It takes so many people and pieces of apparatus to fight a house fire. No matter where in the world you live, fire burns the same way. Cutting the FD like that would only result in more fatalities(Civilian and Firefighter) and bigger burn wards. Fire triples in size every 5 minutes. Cut the number of firehouses and trucks and people will die. Even though the numbers of fires are down over the last ten years, it still takes the same work to save lives and property. Delaying response due to fewer companies and less apparatus is IMHO a recipe for death and destruction. Shamefull suggestion.

Now, where I get confused is on the flip side of this. I've just completed my phase one clinicals with a private company, and with very few exceptions, when on scene, wished that I had been attached to the fire medics (who were all women, which surprised me for some reason) instead of the units I was with. I saw much more aggressive treatment, compassion and professionalism from the fire medics than the crew (singular experience) I was riding with.

I am not going to comment on the negatives you noticed with the crew you were with, but as to why the Fire Medics might have been more aggressive, etc.......

The fire service is, by definition, an agressive orgnization. We crawl into burning building while the rats are crawling over us to get out. You have to be aggressive. Or just plain nuts.

[Dustdevil]

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Wow. I am shocked and dismayed by this comment. It takes so many people and pieces of apparatus to fight a house fire. No matter where in the world you live, fire burn the same way. Cutting the FD like that would only result in more fatalities(Civilian and Firefighter) and bigger burn wards. Fire triples in size every 5 minutes. Cut the number of firehouses and trucks and people will die. Shamefull suggestion.

You're thinking selfishly one-dimensional, my friend. The number of people whose lives are saved by being dragged out of a burning building by a firefighter each year is dwarfed by the number of people whose lives are lost because they had to wait too long for an ambulance. Sure, what you do is important, but keep it in perspective.

Is Dawn's suggestion an ideal solution? Of course not. And she's too smart to suggest that it is. But the numbers don't lie. Although she meant it in jest, she has an extremely valid point, and there is simply no way you can intelligently dispute it if you think beyond your own personal interests.

And after spending a little time here, you will notice that many of us who use the "firemonkey" term are, in fact, firemonkeys, former firemonkeys, and retired firemonkeys ourselves. Learn not to take yourself too seriously. :wink:

[DwayneEMTP]

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Wow. I am shocked and dismayed by this comment. It takes so many people and pieces of apparatus to fight a house fire. No matter where in the world you live, fire burn the same way. Cutting the FD like that would only result in more fatalities(Civilian and Firefighter) and bigger burn wards. Fire triples in size every 5 minutes. Cut the number of firehouses and trucks and people will die. Shamefull suggestion.

Why is it better to have fire lift the "fatties" instead of other medics?

Fire burns, of course, but how many fires do you fight compared to the number of medicals that you run? The national average is what? 80%-92% medical calls for fire depts (depending on who's numbers you use)? Why does it make sense to have fire running those calls, as stated above, instead of medics?

Is it your opinion, as it seems to be, that simply "someone" showing up is acceptable? So if your house is on fire, you'll be satisfied if they send an ambulance immediately, while you wait 10 mins for fire suppression professionals? I mean, after all, the ambulance has a fire extinquisher! (akin to the firetruck having an AED)

If we didn't have a firehouse every few blocks (but very few fires) then the money 'might' be available for the training of medical professionals to respond to medical calls.

Cut the number of firehouses and people will die? How many died in fires last year (civilian and fire) compared to trauma and cardiac issues (civilian and fire) that basic units are not equiped or educated to deal with?

As long as you come with the same, tired, "you need us because we fight what you fear!" nonsense...this conversation will go nowhere.

Dwayne

[Eydawn]

Oh oh! Here comes round 2 for n00b reorientation.... (no offense intended!)

Don't take any comments that say "firemonkey" as insults, they're not directed at you personally. And be aware that your perspective may not be agreed with, and that the types of responses you give will affect the types of responses you get.

I do agree that early defibrillation is key... but a First Responder with an AED/CPR cert can do that very easily. As for the Combitube, there are many schools of thought on that particular airway adjunct... and many people have expressed a preference for trying to get the ET tube *first* and using the Combitube as a backup device.

Personally, I think I'd rather see my cardiac arrest patient being managed with BLS only airway devices (NPA/OPA) and good BVM technique, rather than a medic having to pull the Combitube to establish that definitive airway. The less we screw with the inner workings, the lower risk of trauma to that airway. Just my opinion, however!

I'm a little confused about your statement regarding "more manpower... and dropping the silly requirement that all EMS providers have to be firefighters"... are you advocating combining the two departments permanently, but having the EMS be their own thing within the fire department? So would you then drop the requirement that all firefighters have to be EMS? Not sure where you are going with this.

As for the need for fire personnel... I am not a FF and will probably never be one, so I will not venture to comment on what could be considered adequate staffing for a several alarm fire. Don't know enough, gonna keep my mouth shut. I will say that I've seen a lot more overstaffed kitchen and dumpster fires and a lot of very bored extra fellows on scene when I've been at a fire scene, but again, I don't know enough about how the fire side works.

A comment on the aggressiveness of Dwayne's fire-medics and theories as to why: I don't necessarily think that just because they're FF/Medics and therefore more "aggressive" due to being in the fire field that they're more aggressive MEDICAL providers. Perhaps they know the inadequacies of certain transport crews and choose to try to make that difference in patient care before they have to transfer care? I would argue that aggressive patient care is motivated by education and caring, not by balls o' steel and the willingness to risk personal danger... because I've seen many fire-medics who were avid firefighters, willing to wade through the lava and rats, who just plain SUCKED at medical care and were not aggressive enough with treatments.

I do believe that stating they were more aggressive because they were firefighters was a bit of a non-sequitir there.

Alright, Wayne... your turn! Just remember that no one hates you here, it's not a personal attack, and yes, people ARE going to tell you that you're wrong and not paying attention in the next few posts. Be ready for it- don't knee jerk react and think about how to COUNTER it in discussion. Welcome to the City!

Wendy

CO EMT-B

[Eydawn]

Clarification: DWAYNE was the one with opinions regarding reducing FF numbers... just don't want that misquote to stand, Dusty, lol! Not that I disagree with him but I didn't say it.

Wendy

CO EMT-B

[DwayneEMTP]

Paramedicks...You have to admit...that's pretty dang funny.

[DwayneEMTP]

Clarification: DWAYNE was the one with opinions regarding reducing FF numbers... just don't want that misquote to stand, Dusty, lol! Not that I disagree with him but I didn't say it.

Wendy

CO EMT-B

It's ok Wendy, I take credit for things you say all the time! (Don't tell anyone)

Dwayne

[JPINFV]

I'll bite. Are you defining saves as "made it to the hospital with a pulse" or "walked out of the hospital with limited neuro deficits?" There's a big difference and one of those options is not a save. Also, what is a BLS non-transport unit going to do for a cardiac except O2?

Furthermore, how does providing a BLS service help a county win ALS of the year? That kinda of seems bass ackwards.

+5 for being honest that it's EMS based fire suppression and not fire based EMS. [i.e. EMS being forced to be fire fighters].

I've never bought the argument using limited paramedics. There's a limited number of doctors and nurses, but you don't see medical school or nursing school (side note: community college ADN is doing a good job of limiting the number of graduates by using a lottery based system instead of pure merit) dumbing down their educational requirements to get more people through. The simple fact is that by increasing educational levels and separating EMS from fire, you will see wages increase. As wages and prestige increase (hint: would most college grads rather be a PA or EMT-P?), you'll be able to tap other labor populations that would go a lot further in increasing supply than the current system is doing.

??????????????????????????????????????????????????????????????????????????????

Wow. I am shocked and dismayed by this comment. It takes so many people and pieces of apparatus to fight a house fire. No matter where in the world you live, fire burns the same way. Cutting the FD like that would only result in more fatalities(Civilian and Firefighter) and bigger burn wards. Fire triples in size every 5 minutes. Cut the number of firehouses and trucks and people will die. Even though the numbers of fires are down over the last ten years, it still takes the same work to save lives and property. Delaying response due to fewer companies and less apparatus is IMHO a recipe for death and destruction. Shamefull suggestion.

Keep the number of ambulances and EMS professionals low and people will die also. Personally, I'd rather have more ambulances than fire engines. The ambulances get used much more often for their intended use (I still have never understood why fire departments send engines to medical aid calls). Delaying EMS due to limited material and professionals will kill more people than delaying fire responses. By the way, nice appeal to ridicule there at the end.

Now, where I get confused is on the flip side of this. I've just completed my phase one clinicals with a private company, and with very few exceptions, when on scene, wished that I had been attached to the fire medics (who were all women, which surprised me for some reason) instead of the units I was with. I saw much more aggressive treatment, compassion and professionalism from the fire medics than the crew (singular experience) I was riding with.

I am not going to comment on the negatives you noticed with the crew you were with, but as to why the Fire Medics might have been more aggressive, etc.......

The fire service is, by definition, an agressive orgnization. We crawl into burning building while the rats are crawling over us to get out. You have to be aggressive. Or just plain nuts.