Redundant Fire and EMS response in Florida

[EMS179]

please dont insult your own intelligence and make it seem like this is the only senario where having additional hands would be useful. comments like that really dont help situations on either side of the argument. If you are working in Iraq on a pt and you have only you, or you have you and 2 other corpsmen working on a multi traumatic pt, which would you prefer? Maybe you only see 2 a month, does that warrent not putting the extra 2 with you just because of the frequency of critical pts? yes Im aware my numbers are probably off, but then again so are yours.

another example, rescue 51 is transferring care at ORMC east (hospital in orlando). Pt. w/ chest pain comes through in your local. You have a 9 min. response time through heavy traffic and highway utilization. Next closest rescue is 11 min. away. 3 ALS fire trucks are 3 minutes away in quarters. Do you put your life and the life of all the people on the road at risk responding to the call alone? Or utilize the ALS truck to go to the scene while you are responding at a slightly slower pace because you know you have units on scene w/ ACLS capabilities to take care of anything life threatening. Truck gets there, pt. ends up having indigestion, RMA secured. Cancel the rescue. just saved a moderate risk code 3 response now you can divert to that MVA that you are 5 minutes away from, instead of going to the RMA chest discomfort.

[JPINFV]

1. What are you doing transporting a "workable code" if you have a medic on scene. Shouldn't they be, you know, working the code?

2. So every medical call gets a ladder truck now 'just in case?'

3. We shouldn't challenge the system because it's styled in a manner to your pleasing? Strange how the IAFF and IAFC don't share the kum-by-yaw approach when challanging non-fire based EMS.

4. What's stopping your ladder truck from being at an accident at the time of the call anyways? Oh, fire based EMS doesn't respond to accidents now? Alternativly, is it because fire-based EMS decides that instead of buying more ambulances (the things that actually transport patients. See Chicago's New Years Eve incident) they buy more fire suppression and complain about the ambulance wait times.

[EMS179]

1. What are you doing transporting a "workable code" if you have a medic on scene. Shouldn't they be, you know, working the code?

2. So every medical call gets a ladder truck now 'just in case?'

3. We shouldn't challenge the system because it's styled in a manner to your pleasing? Strange how the IAFF and IAFC don't share the kum-by-yaw approach when challanging non-fire based EMS.

4. What's stopping your ladder truck from being at an accident at the time of the call anyways? Oh, fire based EMS doesn't respond to accidents now? Alternativly, is it because fire-based EMS decides that instead of buying more ambulances (the things that actually transport patients. See Chicago's New Years Eve incident) they buy more fire suppression and complain about the ambulance wait times.

1) What would you rather do? Stay and play for 15 minutes or move the pt. to definitive care?

2) Yes, every medical call gets a piece of apperatus, just in case

3) you dont like it? Write a letter to Orange County and explain to them why someone that has no remote affiliation to OC, florida, or the department thinks that the system should get changed because it doesnt make sense to you.

4) You arent there. Maybe the MVA has adequate resources, maybe the truck co. is standing around, command can easily release them from the scene if they arent needed. what takes priority? Working code or extra truck at an MVA? Furthermore, since OC dropped R/M, they are putting on a bunch more rescues, Ill give you 3 guesses why.

[p3medic]

I seem to remember reading in Annals a few years back about a 20% unrecognized esophageal intubation rate in Orlando, a medic on every red truck is NOT the answer to providing top notch health care, well educated, well trained EMS providers are. LA has a medic on every street corner too, and there numbers suck worse.

[EMS179]

fair enough. Listen, im done arguing this point. The system works for them. Thats all that matters is that the pt's get the help they need, thats why we are in business. everyone can think and feel what they want, there is no use in arguing who is right, because in the end, noone is. it is a matter of preference, staffing, quality of care, policy, ect. I prefer fire-based EMS, obviously alot of you dont. Great, dont think Im wrong because I do and you dont. I see everyone's point here, but I just dont understand how you can be making all these ASSumptions and criticizing things when you really dont know anything about the system, it really is a shame. We are professionals , can we please act like it? There is no use in saying "Well what about that one time where the 267Lb. person fell in the manhole and he was 2cm to wide to get him out blah blah blah" yeah, we can argue every conceivable senario and everyone will have a different view and solution. /end topic. (or at least my involvement in it)

[JPINFV]

1) What would you rather do? Stay and play for 15 minutes or move the pt. to definitive care?

Well, with paramedics on site treat till ROSC or call the patient. It is impossible to preform good compressions while moving a patient and the time it would take to extracate to the ambulance and transport would be the final nail in the coffin for the patient. In the vast majority of cases, if EMS fails at resuscitation than the hospital will fail as well. Cardiac arrests don't get better with time.

2) Yes, every medical call gets a piece of apperatus, just in case

Do the police respond as well, just in case it gets violent?

3) you dont like it? Write a letter to Orange County and explain to them why someone that has no remote affiliation to OC, florida, or the department thinks that the system should get changed because it doesnt make sense to you.

Yep, no one should say or discuss anything. That's the key to advancement! No discussion, no nothing. Just bury our collective heads in the sand.

4) You arent there. Maybe the MVA has adequate resources, maybe the truck co. is standing around, command can easily release them from the scene if they arent needed. what takes priority? Working code or extra truck at an MVA? Furthermore, since OC dropped R/M, they are putting on a bunch more rescues, Ill give you 3 guesses why.

Well, if the engine wasn't needed at the MVA then why would it be released in a fire based system and not a single service system? Pick one. Either the truck is out on a call for both systems or available for both systems. You can't sit here and pretend that the truck isn't needed at the MVA in one situation and not in the other.

I think you're failing to realize that Florida is just one of the more recent battlegrounds in the war between single function EMS and EMS based fire suppression in this country. It's a topic very worthy of discussion, but there's no point in talking to someone who just wants to ignore every comment with "You're not here!" or with scenarios that the alternative fails to address as well.

[JPINFV]

Fair enough. Listen, I'm done arguing this point. The system works for them. That's all that matters is that the pt's get the help they need, because that's why we are in the business. Everyone can think and feel what they want, but there is no use in arguing who is right[s:c8d9c610c1],[/s:c8d9c610c1] because in the end, no one is. It is a matter of preference, staffing, quality of care, policy, ect. I prefer fire-based EMS, obviously a lot of you don't. Great, don't think I'm wrong because I do and you don't. I see everyone's point here, but I just don't understand how you can be making all these ASSumptions and criticizing things when you really don't know anything about the system. It really is a shame. We are professionals, can we please act like it? There is no use in saying "Well what about that one time where the 267Lb. person fell in the manhole and he was 2cm to wide to get him out blah blah blah" yeah, we can argue every conceivable scenario and everyone will have a different view and solution. /end topic. (or at least my involvement in it)

Yes, let's all act like professionals please. Also, why not discuss scenarios that YOU put forth? You were the one that brought up the 400 lb code on the 5th floor scenario. Let's also knock off the personal attacks (i.e. "ASSumptions"). We're supposed to be professionals, not 3rd graders.

[EMS179]

I understand your point about discussing things, but, why us? There is a difference between a bunch of EMS providers on a forum VS. the people who actually make the decisions in the departments. Sure, lets discuss it. You really mean to tell me you all don't see any logic in any of my points? That is honestly really hard to believe. All we are doing is going back and fourth with hypothetical scenarios, what if's , and so on. You want to talk, lets talk. If you go back and look at this conversation I didn't start the hostility in this thread, someone irrationally started giving me an attitude because he doesn't like how this system is run. I don't mind discussing a system, but everyone saying I'm right your wrong isn't a discussion. Just to address the last set of points, yes in many cases PD does respond to all calls. At least here in NJ where I am currently living. 911 calls come through the police station, then are transferred to the proper dispatch point. PD is dispatched to the scene prior to EMS. It is just the way it is. I have no problem talking about things in a civilized manner, I do have a problem with people jumping down my throat because they don't like the way a system is run. So, to put this discussion back on track, what do you propose to do in a situation like the one I presented?

[paramedicmike]

You really mean to tell me you all don't see any logic in any of my points?

I really mean to tell you I see no logic in any of your points. It's not that hard to believe if you remove yourself from the small slice of experience you have and look at not only the wider picture but include the medical side in it as well.

At least here in NJ where I am currently living. 911 calls come through the police station, then are transferred to the proper dispatch point.

There's another problem. EMS in NJ is so messed up it's almost beyond comprehension. Using this as your basis of comparison is laughable at best.

I do have a problem with people jumping down my throat because they don't like the way a system is run.

If you think any response you've received has been hostile you're terribly mistaken. Actually, I'd be willing to bet punches were pulled in any response you've received.

So, to put this discussion back on track, what do you propose to do in a situation like the one I presented?

Which one? The one about the 400 pounder on the 5th floor? Two providers can work that effectively to one of three end points. The first is the code isn't even started. The second, and possibly more likely to occur, is that the code is worked and then called due to no ROSC. The third, and least likely, is that there is ROSC and then the patient is moved to the hospital.

Or are you referring to having an engine 3 minutes away and an ambulance 11 minutes away? To this I would suggest that the system is broken. If there are not enough ambulances on the street to handle the 911 medical calls then the mismanagement of the system in question borders on criminal neglect. If you can't send the appropriate resources to a call (and an engine, a non-transporting unit, is not an appropriate resource for a 911 medical call) then the system is broken.

You can "what if" yourself to death. That does nothing but produce broken systems very similar to those being discussed in this thread. And just because people disagree with you and your limited volly BLS experience doesn't mean that we're all wrong and you aren't. People who've responded in this thread have been doing EMS longer than you've been alive. That experience and knowledge is worth more than you're giving it credit for being.

-be safe

[thatoneguy]

Just my.02: I do not currently work in OC, I do however work further south. Down here the majority of depts have opted to provide 3 personnel to every rescue. I can understand the thinking with this idea, however on big calls, they still send an engine, an EMS capt., and a bn chief. On top of this, they also send a "community action team" of 2 people to handle pt family, as well as a division chief if the call is an MVA/shooting, ect. My argument is this: If you insist on staffing the ambulance with 3 people, why still all of the extra hands on what is essentially an upper level als call?

To top this off, the county I am speaking of has given the Paramedics the option of downgrading any pt to BLS and call a private transport in order to be available, as long as they meet certain criteria. In my experience this leads to a lot of Paramedics looking to meet BLS criteria instead of performing a thorough and complete assessment.

While I am not fundamentally against fire-based EMS, I am against poor pt care. What further pisses me off is the constant bickering on all levels. Instead of worrying about who is going to transport a pt, why don't we concentrate instead on providing the absolute best pt care we can, regardless of which entity is providing it? I think everyone involved needs to take a step back and reassess what is going on (myself included).

I challenge everyone here to go out in their respective area and ask the general public if they have any idea what is involved with an ems response. In my experience most people just have no idea, no matter if they are rich or homeless. I think there is a lesson to be learned here, why don't we start a concentrated effort on public education?

These are just my rambling thoughts and I apologize if they don't make sense.