Can Fire Paramedics be good Paramedics?

[Just Plain Ruff]

Ruff, I do respect you mate but this is BS. Why do we insist on allowing Fire to try & control us? Its cause they havent got enough of their core business to keep them occupied.

Actually Phil, I have said nothing of the sort about allowing fire to control us.

Unfortunately in many parts of this country is has been determined that the fire departments will run EMS. Be it a mandate from the county or the city that fire runs EMS but it's a fact of life that Fire will run EMS.

I have also never said I supported the fire based ems but I do support the medics and the firefighters who do the job. Even though the fire department runs EMS does not make all Fire Medics bad.

True that their core business, fighting fires has dropped significantly and they have to pick up the slack somewhere.

I am all for separating EMS from Fire but let's not do it at the expense of medics jobs. If you are a firemedic and all you do is EMS then why is it that they cannot be a good medic. The bias here on this site shows over the last many debates that you can't do both.

I'm a computer consultant, I did travelling to other cities to put ER computer systems in. I also worked on the side as a medic. Does the logic here on this site that you can't do both well apply to my situation too? I do computer work monday thru thursday and then medic work on the weekend. By that logic it would mean that I am not a good medic.

Can someone who works two distinctly different jobs not be good at both of those jobs?

If you argue that one can be good at two things then why are we arguing that you can't be a firefighter/medic too?

[spenac]

Can someone who works two distinctly different jobs not be good at both of those jobs?

If you argue that one can be good at two things then why are we arguing that you can't be a firefighter/medic too?

Very good point. I was one of the most sought after contractors for years before deciding to pursue EMS. Now I am recruited by many services to be a Paramedic for them. But I am not doing both at the same time. I am focused on doing only EMS at this time. Perhaps I will start contracting again and do EMS as well. But w/o doing it I already see how each job is distracting from the other which could mean my customers in both fields might not get my best.

I have met a few people that can master multiple different fields but not many. I have met many that are good but not great at the different fields they have chosen. I want to be a master of my chosen field not just good at it. And if my family is sick I want them seen by a master of the profession not just someone that is good.

I could see all the 'Fire is raping EMS' garbage if the fire department was driving the top of the line equipment (brand new every other year), while EMS is still stuck in the old Caddillac hearses! Both 'arguements' are more based on personal opinion than on fact, and both have been worn out long ago!

But Lone they are wearing out these large trucks responding to EMS calls not fires. Stop sending fire trucks to do EMS calls and use the EMS money to staff more ambulances.

I mean no disrespect to those that make every effort to be masters and are good at what they do. I was a firefighter before I joined EMS. But fire was separate from EMS though stationed same house. I guess I just live in a dream world where everyone is allowed to chose their focus.

Thank you to those that have chosen to try and let this be a civil discussion rather than a civil war.

[scott33]

We dont see Police EMS (for general EMS, not specialty trained tactical) do we? So why is there a mentality that fire & EMS should be bundled together?

Nassau County, NY are mostly covered by a police-based EMS system. One of the better systems in the county IMO.

[spenac]

Nassau County, NY are mostly covered by a police-based EMS system. One of the better systems in the county IMO.

Are the Paramedics actually Police officers and pull police duty rotations as well? A service near me required you to do both. And if you were on patrol and another ambulance was needed you were sent to get the other ambulance. So your whole mindset would have to change quickly or so it would seem to me.

Yes spenac is turning over a new leaf and is trying to understand other ways of doing things rather than fighting.

[46Young]

Nassau County, NY are mostly covered by a police-based EMS system. One of the better systems in the county IMO.

Beat me to it!

From what I've been told, each bus typically has one EMT-P or EMT-CC, who work 12 hour shifts, and get an hour break during their shift where they can actually turn off the radio.

My understanding is that when a job comes in, the lone medic will drive the bus to the scene, an LEO crosstrained to EMT-B will come to the scene, leave the cruiser there, assist in pt care, and drive the bus to the hosp. If another medic is needed, another ambulance will be dispatched to the incident. The bus will need to return the LEO to their cruiser after the run is completed.

Now, for everyone else.....

The privates just hire any medic with a pulse and a patch, the LCD. Every private system is profit driven only, and their medics are slugs, not serious at all about their jobs, and provide horrible pt care. No one cares at a private because they're either skells or waiting to finish a degree or get picked up off of a civil service list, like FD, PD, sanitation, corrections, etc.

Hospital based medics think they're superior to all others in every way, they steer insured pts to their home hospital, and dump the uninsured off to city run general hospitals.

Third service agencies all use system status management to run their employees into the ground, they all pay lousy, promotions are done only on favoritism, who your drinking buddies are, also hire anyone with a pulse and a patch to replace the frequent burnouts, their employees are only working there because they couldn't hack it or get on at a FD or PD.

Every firemedic went to a 12 week medic mill just to get "the patch" to get an easy in at an FD. As such, all firemedics are apathetic towards EMS, and their pt care sucks. Every FD that takes over EMS siphons off $$$'s to the fire side at the expense of the EMS division. these fire monkeys (hose jockeys, or whatever jealous term used) don't do anything but sit around all day on the taxpayer's dime. What good are they doing?

Got your attention? Good. These are all generalizations about each type of service. They all sound silly when you think about it. There are real life examples for each generalization, but they're certainly not indicative of the industry as a whole.

Edited October 4, 2009 by 46Young

[scott33]

From what I've been told, each bus typically has one EMT-P or EMT-CC, who work 12 hour shifts, and get an hour break during their shift where they can actually turn off the radio.

My understanding is that when a job comes in, the lone medic will drive the bus to the scene, an LEO crosstrained to EMT-B will come to the scene, leave the cruiser there, assist in pt care, and drive the bus to the hosp. If another medic is needed, another ambulance will be dispatched to the incident. The bus will need to return the LEO to their cruiser after the run is completed.

That is my understanding too, but often there is a 2nd cop who will follow on to the hospital with the cruiser. We normally have 1 AMT (civvy) and 2 LEOs bring the patient in to my ED. For some strange reason, they always seem to have co-operative patients...may be to do with the driver's overt 9mm Glock.

[NRPinNEPA]

Actually we do have some areas of the USA that do have police based EMS. They are dual role just like fire based.

That never made sense to me.

"Kapowie!! Hold on, let me go get my ambulance and make you better now."

Yes, you can be a firefighter and still be a good paramedic. The problem is not having both certifications, although I agree that it's damn near impossible to remain proficient in both disciplines as they're so different. The problem is the fire department-run three month medic mills that teach their medics to interpret whether the machine says the patient is having an MI or not, rather than interpret the 12-lead on their own and focus on skills and training rather than education.

Plus, Fire-Based EMS just leaves a bad taste in my mouth. I just want to stand outside FDNY firehouses with a bullhorn shouting "Let my people go!"

[46Young]

There are things that I won't deny. There are FF's that have gone to a medic mill only to get the patch for an easy in. There are firemedics that are apathetic towards EMS, and pt care suffers as a result. There are depts that push their FF's through recerts, sometimes falsifying documents or cheating on tests. There are FD's that have taken over EMS only to justify jobs, and siphon off EMS $$$'s to the fire side at the expense of EMS. There may be a lcak of QI and accountability towards some firemedics at some depts. Some union may have an interest in blocking any advance in EMS education.

These examples aren't indicative of the entire fire service, however.

IMO it isn't difficult to maintain proficiency as both a medic and a FF. A firemedic will be appointed to the position having already completed their medic cert. Bonus points for having several years experience as a single role medic prior. The FFM will also go through a fire academy, followed by a one year probationary period, where their proficiency will be improvrd by regular drilling and testing, as well as real life calls, of course. Medic CME's and drilling are done on duty as well, freeing up the FFM's time to do additinal study and attnd CME's off duty if desired.

SoWhy mix EMS and fire? Theyhave almost nothing to do with each other" The fire service looks at EMS as a specialty, much like Tech Rescue, Hazmat, Water Rescue, etc. Personnel are regularly given sufficient training in that discipline while on duty to ensure proficiency.

Here's why a mixed fire/EMS system works, if run correctly - fire calls are way down. No disputing that. A FD will seek to integrate EMS resulting in dual role personnel to save FF positions, among other things. Some ask why FD's aren't being made to downstaff given the reduction in call volume. Response times. With the new type 5 lightweight construction, it's maybe only 12-15 minutes from ignition to structural collapse. If the 911 call was to initiate immediately (it rarely does), it takes a minute or two to dispatch FD, another minute or so to get on road, maybe 4-6 minutes to get onscene, and another minute or two for the officer to take a lap and pull/charge a line. Now we're at 9-10 minutes on a good day. But this is just the first due engine. What about the rest of the box? what about RIT? Maybe units are stacked. What about if there are FH closings, brownouts, or overnight downstaffing? The first due may not make entry as quickly, and the remainder of the box will be that much more delayed. No first due truck to ladder the building, no second due truck for roof ops, no engine for water supply or RIT, no rescue for primary search/VES. Fireground tactics will be severly hampered by lack of units. Lives will be lost, both FF and civilian alike. Yes, it's a what if scenario, but you don't purchase car insurance after you crash, or life insurance while on your deathbed, do you?

Dual role fire personnel are quite versatile as they can fill either role, which ensures adequate staffing on both sides, reduces holdover, recall, OT in general, thus preventing burnout. Maintaing proficiency in both disciplines isn't nearly as difficult as some would make it out to be, especially with many in station drills (both for EMS and suppression). Having dual role personnel makes the best possible use of a FF's otherwise large amount of downtime. It's logistically and fiscally efficient. The two jobs hold few similarities, but guess what? It happens to work well if run properly. I'm fully capable of getting things done with just me and my partner, like I've done on numerous occasions in NYC 911. However, many hands make light work. Having an extra medic or two onscene (not two dozen, just one or two) and competent BLS make things go much more quickly and smoothly. It may not be financially optimal, but it's best for the pt. It's not always about the bottom line.

There is also a way lower proportion of transient employees when compared to private, third service, and hospital based EMS. The typically lucrative employment package, with a pension, 457, decent medical/disability, DROP, and superior working conditions allow FD's to hire the best possible candidate, not the LCD. Newcomers to the fire service know the importance of EMS, and any FF's that were forced to add EMS to the job description will eventually retire.

With more individuals like the Medical Director from Collier County willing to sack up, accountability for the firemedic will be upheld. With an increase in educational standards (hoping for it, but not holding my breath), new firemedics will be that much more knowledgeable and proficient in EMS.

It's getting late. i'm going to work in the morning, so I'll post about how my dept is run at some later date.

Sorry about the several duplicated posts. It wasn't going through, and I hit the button a few more times. My bad.

[NRPinNEPA]

The fire service looks at EMS as a specialty, much like Tech Rescue, Hazmat, Water Rescue, etc.

And here, 46Young, is the root of my gripe with Fire-Based EMS. My chosen profession is NOT a fire specialty. It is a unique and distinct area of HEALTHCARE. Then again, you and I have been round and round on this issue more times than I care to count, so you should know this already.

[46Young]

That never made sense to me.

"Kapowie!! Hold on, let me go get my ambulance and make you better now."

Yes, you can be a firefighter and still be a good paramedic. The problem is not having both certifications, although I agree that it's damn near impossible to remain proficient in both disciplines as they're so different. The problem is the fire department-run three month medic mills that teach their medics to interpret whether the machine says the patient is having an MI or not, rather than interpret the 12-lead on their own and focus on skills and training rather than education.

Plus, Fire-Based EMS just leaves a bad taste in my mouth. I just want to stand outside FDNY firehouses with a bullhorn shouting "Let my people go!"

I can see how just doing a medic mill prior to a FFM appointment would make it much harder to main dual role proficiency. Maybe it's because they're not generally proficient in the first place.

My cousins both left FDNY EMS for hosp based due to how the FD screwed everything up.

Sorry about the duplicate posts. It wasn't going through, so I hit the button a few more times. My bad.