Thanks Fire! For Screwing us over... yet agian.

[spenac]

Michael great post on why EMS Fire need to be separate. Wonderful illustrations.

NREMT-Basic your posts bring another perspective that when, as most on this topic are, giving your point without an attacking attitude I enjoy reading even if I disagree with them. That is the fun part of this site that we all work in different environments, have different levels of experience, etc, that work to form our opinions of EMS. As to your attack first attitude that you mention working on, I changed so I am sure you can to. I sometimes write out my initial reaction that bashes somebody then I keep editing it till it is much nicer.

[NREMT-Basic]

Michael-

While I appreciate the elegance of your extended metaphor, I cant say that I agree. I think firefighting and EMS share much more overlap than you express and are not, as you seem to suggest, mutually exclusive.

More than one poster so far has expressed upset that firefighters or fire departments should stay away from EMS. From a practical standpoint, I can say that its not going to happen for a VERY long time, if it ever does.

Further, would you say that a combat medic, who in this day an age is trained in as much combat as he is in medicine (he is, after all, a soldier...a combatant) does not possess the subtlety to detect subcutaneous emphysema secondary to a blast lung injury? Would you say since he is trained in the use of rifle and bayonet and grenade that he does not and cannot possess the delicacy required to tend to a thermal burn in the field?

You seem to say that one can either be a brute or a poet, but never the twain shall meet. I am first and foremost an EMT and am now receiving firefighter training as a part of my overall emergency services career. But to somehow suggest that because I can use a halligan bar or an axe, I cannot also use a delicate Morgan flush lens really doesnt seem to ring true. I have a rather extensive liberal arts education and an affinity for Sufi poetry. Does that mean that I can also not muster the force of will and body required to fight an internal structure fire? I will be trained to cut apart a car, but does that mean that I cannot exercise the delicacy required to evaluate and care for the infant extricated from that vehicle.

The old image of the brutish firefighter who is always covered in soot and grime whether or not he is on the fire ground died a long time ago. Unfortunately, the perception of those not associated with the fire service that this is what a firefighter is has not. I work with and around firefighters who hold master's degrees. One is a nurse. One is an English teacher. Some are auto mechanics and garbage collectors. But I assure you, when it comes to medical care they are not some kind of fumbling oaf simply because prior to rendering that medical care the forced open a door with a sledge hammer. Their sensitive perceptions have not been scarred by the 3500 degree heat of a burning propane tank so that they cannot exercise the delicacy required to care for a frail elderly patient or coach a frightened parent through CPR over the phone. The blast furnace of an industrial fire does not melt their ability to think in the subtle ways necessary to render emergency medical interventions.

Would you have the same attitude regarding someone who is an urban search and rescue operator or a collapsed structure rescue technician and also a paramedic? It seems that such ideas are more based on the on the old historic biased view of the brutish firefighter than in any real fact, but sadly, the opinions you express seem to be, in large part, the reason that non-fire service paramedics have disdain for fire service based paramedics.

[JPINFV]

The opinion that fire and EMS should be separate comes more from the numerous fire fighters who want nothing to do with EMS [which, I have no problem with people not wanting to work in EMS], but feel that they have to in order to either get hired with a fire department or get promoted.

Similarly, I imagine that if being a fire fighter was considered a promotion in an EMS agency, and, in essence, all paramedics were required to be fire fighters to get hired [regardless of if the medic wants to be a fire fighter], that fire suppression would be worse than it currently is.

[Eydawn]

Michael, very well put. Your writing is always a joy to peruse .

Wendy

CO EMT-B

[Eydawn]

It is not the literal delicacy that Michael refers to but rather the mental challenges associated with both fields. The firefighting field takes a strong personal resolve, persistance through physical challenge, and some sense of fulfillment in challenging personal danger. That's what I believe, and what I think Michael was trying to illustrate.

The medical profession takes subtlety of thought, the ability to be empathetic while still protecting yourself to some degree from your patients' suffering, and a yen to challenge the unseen enemy (metabolic breakdown, pathogens, failing heart tissue) with persistence.

EMS combines some elements of the two, but at heart remains more oriented towards the medical aspects and the strengths requisite therein. Yes, we face physical challenges, personal danger, and must react quickly, as many firefighters do. The challenges we face are inherently different, with different risks associated with failure.

There will *always* be individuals who fall into both categories. People who thrive on danger and enjoy the mental challenges associated with medicine. People who are empathetic, but find joy in fighting a larger visible "enemy" as well.

This is not to say that all people involved in either field have that yen, or that melding of personality traits. There are those who will thrive on working in both environments, because they happen to have the right combination, and there are those who will fail and combust from the inside as they try to fit into a world they don't belong in.

In my personal experience, I have met many more firefighters who wanted ONLY to fight fire than I have firefighters who wanted to be medical practitioners. That's me. You might know several who are great medical practitioners... but the system itself is not ideal, because it eliminates several candidates who would be excellent at one profession or the other. And with the shortage of good medical care that seems to be endemic in many places, limiting your medical providers to those who are also good firefighters is counter-intuitive.

Wendy

CO EMT-B

[mrmeaner]

Michael-

While I appreciate the elegance of your extended metaphor, I cant say that I agree. I think firefighting and EMS share much more overlap than you express and are not, as you seem to suggest, mutually exclusive.

More than one poster so far has expressed upset that firefighters or fire departments should stay away from EMS. From a practical standpoint, I can say that its not going to happen for a VERY long time, if it ever does.

Further, would you say that a combat medic, who in this day an age is trained in as much combat as he is in medicine (he is, after all, a soldier...a combatant) does not possess the subtlety to detect subcutaneous emphysema secondary to a blast lung injury? Would you say since he is trained in the use of rifle and bayonet and grenade that he does not and cannot possess the delicacy required to tend to a thermal burn in the field?

You seem to say that one can either be a brute or a poet, but never the twain shall meet. I am first and foremost an EMT and am now receiving firefighter training as a part of my overall emergency services career. But to somehow suggest that because I can use a halligan bar or an axe, I cannot also use a delicate Morgan flush lens really doesnt seem to ring true. I have a rather extensive liberal arts education and an affinity for Sufi poetry. Does that mean that I can also not muster the force of will and body required to fight an internal structure fire? I will be trained to cut apart a car, but does that mean that I cannot exercise the delicacy required to evaluate and care for the infant extricated from that vehicle.

The old image of the brutish firefighter who is always covered in soot and grime whether or not he is on the fire ground died a long time ago. Unfortunately, the perception of those not associated with the fire service that this is what a firefighter is has not. I work with and around firefighters who hold master's degrees. One is a nurse. One is an English teacher. Some are auto mechanics and garbage collectors. But I assure you, when it comes to medical care they are not some kind of fumbling oaf simply because prior to rendering that medical care the forced open a door with a sledge hammer. Their sensitive perceptions have not been scarred by the 3500 degree heat of a burning propane tank so that they cannot exercise the delicacy required to care for a frail elderly patient or coach a frightened parent through CPR over the phone. The blast furnace of an industrial fire does not melt their ability to think in the subtle ways necessary to render emergency medical interventions.

Would you have the same attitude regarding someone who is an urban search and rescue operator or a collapsed structure rescue technician and also a paramedic? It seems that such ideas are more based on the on the old historic biased view of the brutish firefighter than in any real fact, but sadly, the opinions you express seem to be, in large part, the reason that non-fire service paramedics have disdain for fire service based paramedics.

First, this is not intended to be a response on Michael's behalf. Considering his penchant for wordplay, I'm sure he can post a reply that would make mine look as though it were drafted on an Etch-a-sketch.

With your comparison of fire-medic and combat medic, I agree that learning one skill set does not necessarily mean another cannot be learned. However, it does not guarantee that it can be learned either. Just because some running backs studied and performed ballet doesn't mean that the offensive line should be performing Swan Lake.

Also, a big difference between fire medic and combat medic is the former was created out of convenience and the latter was formed out of necessity.

[mrmeaner]

It is not the literal delicacy that Michael refers to but rather the mental challenges associated with both fields. The firefighting field takes a strong personal resolve, persistance through physical challenge, and some sense of fulfillment in challenging personal danger. That's what I believe, and what I think Michael was trying to illustrate.

The medical profession takes subtlety of thought, the ability to be empathetic while still protecting yourself to some degree from your patients' suffering, and a yen to challenge the unseen enemy (metabolic breakdown, pathogens, failing heart tissue) with persistence.

EMS combines some elements of the two, but at heart remains more oriented towards the medical aspects and the strengths requisite therein. Yes, we face physical challenges, personal danger, and must react quickly, as many firefighters do. The challenges we face are inherently different, with different risks associated with failure.

There will *always* be individuals who fall into both categories. People who thrive on danger and enjoy the mental challenges associated with medicine. People who are empathetic, but find joy in fighting a larger visible "enemy" as well.

This is not to say that all people involved in either field have that yen, or that melding of personality traits. There are those who will thrive on working in both environments, because they happen to have the right combination, and there are those who will fail and combust from the inside as they try to fit into a world they don't belong in.

In my personal experience, I have met many more firefighters who wanted ONLY to fight fire than I have firefighters who wanted to be medical practitioners. That's me. You might know several who are great medical practitioners... but the system itself is not ideal, because it eliminates several candidates who would be excellent at one profession or the other. And with the shortage of good medical care that seems to be endemic in many places, limiting your medical providers to those who are also good firefighters is counter-intuitive.

Wendy

CO EMT-B

Had I just waited for this reply I wouldn't have had to respond from my phone.

[Michael]

Further, would you say that a combat medic, who in this day an age is trained in as much combat as he is in medicine (he is, after all, a soldier...a combatant) does not possess the subtlety to detect subcutaneous emphysema secondary to a blast lung injury?

NR, your post was a pleasure, even an honor, to read. Here's my best effort to do it justice.

My point was not about native incapacity nor about training that precludes inability, but rather about inclination. I tried to make that clear by saying that those inclined to double should do so, and that to a limited degree everyone needs to generalize, and I gave examples. I'm against imposing duties, and the more so when others may be intimate victims of providers' apathy or even resentment. Since individuals served by ems are at least temporarily captives of their attendants, they should be exposed to those who are interested primarily in nurturing their immediate well-being.

Would you say since he is trained in the use of rifle and bayonet and grenade that he does not and cannot possess the delicacy required to tend to a thermal burn in the field?

Nope. I said that I'd rather be cared for by someone whose main interest is is providing care rather than in killing (fires or people), and that conversely I'd rather be lethally defended by someone who is drawn to combat rather than by a reluctant conscript. If someone wants to and can do both, heave-ho, I said.

You seem to say that one can either be a brute or a poet, but never the twain shall meet.

No, I said that if you want to be a brute, people looking for poetry should not be forced to rely on your conscripted poesy, and that if you want to be a poet, both you and people in need of brawn shouldn't be forced to turn to you for it, unless you want to and can provide both.

I am first and foremost an EMT and am now receiving firefighter training as a part of my overall emergency services career. But to somehow suggest that because I can use a halligan bar or an axe, I cannot also use a delicate Morgan flush lens really doesnt seem to ring true.

Good thing I didn't say so then!

I have a rather extensive liberal arts education and an affinity for Sufi poetry. Does that mean that I can also not muster the force of will and body required to fight an internal structure fire? I will be trained to cut apart a car, but does that mean that I cannot exercise the delicacy required to evaluate and care for the infant extricated from that vehicle.

Nope and nope.

The old image of the brutish firefighter who is always covered in soot and grime whether or not he is on the fire ground died a long time ago. Unfortunately, the perception of those not associated with the fire service that this is what a firefighter is has not. I work with and around firefighters who hold master's degrees. One is a nurse. One is an English teacher. Some are auto mechanics and garbage collectors. But I assure you, when it comes to medical care they are not some kind of fumbling oaf simply because prior to rendering that medical care the forced open a door with a sledge hammer. Their sensitive perceptions have not been scarred by the 3500 degree heat of a burning propane tank so that they cannot exercise the delicacy required to care for a frail elderly patient or coach a frightened parent through CPR over the phone. The blast furnace of an industrial fire does not melt their ability to think in the subtle ways necessary to render emergency medical interventions.

Have you, or has anyone, ever encountered anyone's reluctance to apply emergency medical skills whose practice was imposed on its practitioner? "Oh, Hell, I was finally startin' to whup that fire, using my rare aptitude and developed skill, but now I'm stuck here with a patient, and I can't stand the smell and I can't hide my gross-out and I don't have a reassuring manner and I have no idea if he's faking and don't care and Omigosh there's my buddy passing out in the burning building and I'm the only guy here big enough to carry him but I've got to take this guy's vitals again."

It seems unfortunate enough when patients are subjected to doctors who became doctors only because their parents wanted them to, but outside of emergency medicine, the patient can (for the time being, anyway) at least fire his doctor.

Would you have the same attitude regarding someone who is an urban search and rescue operator or a collapsed structure rescue technician and also a paramedic?

I have the same attitude regarding someone who wants to be a dermatologist and is forced instead to be a neurologist. But if someone wants to do both and also be a brickmason and trapeze artist, and can, I'll pay good money to watch.

It seems that such ideas are more based on the on the old historic biased view of the brutish firefighter than in any real fact, but sadly, the opinions you express seem to be, in large part, the reason that non-fire service paramedics have disdain for fire service based paramedics.[

So far as I know, my idea is based on my observation that people do best what they want to do. While every vocation contains many interrelated facets that its competent practitioners must master, I don't think of all rescue operations as part of one job. Putting out fires doesn't look to me like a subset of medicine, nor the reverse.

To voluntary and capable polymaths like yourself, I doff my hat.

[Michael]

Why did I bother writing when I could have just waited?

[DwayneEMTP]

Man, there's two threads that historically would have devolved into hate fests resulting in their being locked, that instead have become the most intelligent, productive threads we've seen here in a while...

Thank goodness for the intellect and compassion of those on the City that can make these threads happen....as well as Admin being slow to hit the "locked" key...

You are all talking well beyond my ability to participate, but I'm grateful for being able to take the ride!

I can't wait to watch these topics evolve.

Dwayne