Combining EMS and fire to be able to afford full-time professionals

[kristo]

Now, we've gone through numerous conversations in the past about how volunteers hurt EMS. We all agree on this. Also, it seems to be a general consensus that in order for EMS professionals to be proper healthcare workers, they should not be forced into another profession (fire fighting). Additionally, most of us agree that system-wise, the EMS side of things will often suffer when combined with fire fighting.

What I'm asking for on this topic is not another debate on those things. There are a lot of threads for that.

In some areas, there is not enough money to have a professional fire department AND professional EMS. Sure, if there's a will, there's a way, if they can afford sanitation services, they can afford EMS...all very valid arguments. Maybe the problem isn't so much that they can't, maybe the simply won't.

Anyway. Often, at least in my fairly large (roughly the size of Kentucky) and underpopulated (~300 thousand people) country, this will be the case. Those communities need fire suppression and they also need EMS. Here, municipalities are responsible for fire suppression but the government is responsible for EMS (as part of healthcare in general). The Ministry of Health usually outsources EMS in each community, usually to the local fire department.

It may not be a good thing for EMS (or even fire, for that matter) to combine the two, but often it will be enough for the fire department to go from one part-time fire chief with part-time firefighters to a professional department with full-time staff and training. What I mean by part-time firefighters here is people who show up for a minimum of X training sessions or courses per year for a certain fee. If there's a call, they will respond if able/willing at the time (like the US volunteers) and get paid for calls they attend. They will almost always have other jobs. Sometimes they can leave for a call, sometimes they can't.

So, the question. Which is better for the community? To have the janitor from the hospital or some local volunteers drive the ambulance (no kidding), often without even EMT-B training, and a part-time fire department, or a full-time combined fire/EMS? They wouldn't get very many calls, so the free time could be used for training.

I'm a bit torn between the two options myself. On one side, I'm all for EMS as a standalone healthcare profession. On the other side, I see communities with rather questionable fire suppression capabilities AND well, sometimes it will be less-than-optimal EMS as well, vs. at least slightly better combined fire/EMS. Sure, EMS is being used as a crutch for fire, in a way, but let's face it. The fire department needs that crutch and it is good for the community to have proper fire suppression.

To make a long story short; out of two evils, volunteerism and combined fire/EMS, which is the lesser one?

[Doctor_Phil]

We all agree on this.

We do? Who appointed you speaker for the masses?

[Dustdevil]

By "we all" I believe he was referring to his fellow intelligent professionals, who make up the vocal majority here, not to the masses of whackers.

Edited March 26, 2009 by Dustdevil

[HERBIE1]

The biggest obstacle in combining EMS and fire is within fire itself. The old guard- especially those who run the show at the national level- simply does not consider themselves anything but firefighters and EMS is a necessary evil to them. Yes, that attitude is changing, but at a snail's pace in many instances.

We talk of education, and that is exactly what many in fire suppression is afraid of. EMS folks are used to studying and taking tests- it comes with the territory. Many of the old guard are afraid of being overrun by those "damned doctors". They know if EMS providers begin filling their ranks, they will outperform them on promotional exams and quickly "take over" what they consider to be their domain. For those who are interested, read up on the issue of organizational culture and it explains why old attitudes are hard to change. The fire service is a very old and well established tradition, which makes changing attitudes very difficult. What makes that profession great also makes it highly resistant to change.

Look at it from a cost standpoint. Beyond the initial expense of medical equipment and training, once a city/state/county has a dual trained workforce, they realize a savings because one person can perform 2 jobs.

As for volunteers- I simply don't see that as a threat to anyone. There will always be a need-just as for volunteer firefighters.

[WelshMedic]

Hello Kristo,

Where are you? Which country are you talking about?

WM

[kristo]

Hello Kristo,

Where are you? Which country are you talking about?

WM

I'm from Iceland. Sorry for the confusion, I'm not used to this new EMT City yet, the old one had the location below my screen name for every post...

By the way - I never did get used to the "old" EMT city, either. I miss the circa 2003 EMT City (ems-online.net, as it was called back then).

[WelshMedic]

I'm from Iceland. Sorry for the confusion, I'm not used to this new EMT City yet, the old one had the location below my screen name for every post...

By the way - I never did get used to the "old" EMT city, either. I miss the circa 2003 EMT City (ems-online.net, as it was called back then).

It's OK, I was just confused because your english is so good! I thought you were a native speaker (maybe you are...). Talking of 2003, were you in that group of Icelanders in Baltimore that we met at the meet and greet before the JEMS conference? If so, you still owe me a beer, haha!

WM

[kristo]

It's OK, I was just confused because your english is so good! I thought you were a native speaker (maybe you are...). Talking of 2003, were you in that group of Icelanders in Baltimore that we met at the meet and greet before the JEMS conference? If so, you still owe me a beer, haha!

WM

Hah, actually, I've never been to Baltimore. However, if I do run into you at some point, I'd be more than happy to buy you a beer. Thanks for the compliment on my English by the way, it's my second language.

Anyway - anyone with comments on the lesser of two evils? Volunteers vs. combined fire/EMS?

[wrmedic82]

[WelshMedic]

Hah, actually, I've never been to Baltimore. However, if I do run into you at some point, I'd be more than happy to buy you a beer. Thanks for the compliment on my English by the way, it's my second language.

Anyway - anyone with comments on the lesser of two evils? Volunteers vs. combined fire/EMS?

It's a deal!

Just to give my 2cents worth on this subject - I think that neither option is attrective, but if that I had to choose then I would go for professional. They are generally more accountable and have more time to train and hone their skills.

WM