Fire Service Based EMS, again.

[Richard B the EMT]

In the ongoing "discussion" of pros and cons of fire based EMS, I just got this link from a FEMA related site. Please note that all agencies making the report on EMS, that I've linked to, are Firematic agencies. Please read, and let's hear some more discussion.

http://www.iaff.org/Tech/PDF/FBEMSTools/FBEMStoolkit.pdf

[Bieber]

As respectfully as I can put it: I'm not a firefighter. I don't want to be a firefighter. And I will never be a firefighter. And I won't fault a firefighter for saying the same with the omission of "firefighter" and the replacement of it with "paramedic".

Some fire services do it great, a lot seem to not do it so well. I don't really see any relationship between fighting fires and medicine, which is perhaps why I've so rarely heard of a doctor or nurse who fights fires in their free time and why I suspect they're not the first ones to jump into action when a fire breaks out in the hospital.

Response time is the absolute priority for medical emergencies.

I contest that, as I think many others would as well. True, some medical conditions are time sensitive, but I think on the whole the vast majority of what we see is not time sensitive.

Firefighters are in the best position to respond quickly and provide vital services.

Depends. Greatly.

Personnel are the most expensive part of any emergency response system. Fire departments are essentially "standing armies" in their communities poised to respond to an emergency. Utilizing firefighters to provide EMS gets more bang for the buck.

You know, until you take into account that even fire departments that provide EMS still have to staff separately for fire and EMS functions--which essentially means you're still paying for the same number of personnel if you exclude administration.

The ride for the sick or injured person in the ambulance is only part of the system. A comprehensive EMS system includes rapid response, intervention, stabilization, and then transportation to a definitive care facility, if needed.

And damn, here I had been doing nothing more than loading patients up and driving as fast as humanly possible to the hospital. If only I was a firefighter, then maybe I would have known to do interventions and stabilization first. (No offense to firefighters here, the implication was the IAFF's.)

Fire service-based EMS brings the treatment to the patient – wherever they are. Treatment by firefighters begins immediately, even if the patient is trapped in a building that's on fire, pinned in a car crash, or in a collapsed structure.

I'm not sure of the wisdom of trying to do anything more than extricate a patient that's inside a burning building. But I'm just a paramedic.

Let me clarify something: I have no problem with firefighters. I love firefighters. The vast majority of firefighters that I have worked with have been professional, courteous, and respectable human beings. However, like I said, I don't want to be a firefighter, and I don't much care for propaganda that seeks to disparage my ability to provide the highest level of emergency medical care or that pushes to replace me or force me into a position to become something I don't want to be. If it works for your service, great. And if you're a firefighter, that's great too. I applaud you and thank you for everything you do. But organizations like the IAFF are only out to secure firefighter jobs in the wake of increasingly harder financial times for fire departments and they're going to say whatever they have to to do that, which I can understand, they're fighting for their survival, but all the same if their interests run counter to mine (which they do), you can bet I'm going to fight for my livelihood just as hard as they're fighting for theirs. And furthermore, I think (as you all can obviously see) that the majority of their pro-fire based EMS arguments are flimsy at best. Another point I should bring up is the question of how good of care can or will a firefighter who was forced to become a paramedic provide? And will the IAFF and fire departments advocate increased educational requirements including a minimum of an Associate's degree and more Bachelor's options? Something tells me no.

I'll also add that I wouldn't be wholly against working in a fire based EMS system if they did it right; if they really focused on making their medicine top notch, and if I wasn't forced to function as or become a firefighter as a requirement for employment. I like my ambulance and the idea of running into burning buildings doesn't appeal all that much to me. Given those, I don't care if you call it "Generic County Fire Department" or "Generic County Emergency Medical Services" or even "Generic County Ambulance Thingamajig".

[island emt]

You have to remember that in this economy with job cuts going on weekly , Schitberger and his union minions are trying to come up with any excuse or propaganda campaign to save the dues paying union jobs. If they loose dues paying members then the slush fund goes down.

There are fire departments that do top quality Emergency prehospital care that is patient centric and is their primary mission. They do EMS because they want to provide the best care to their community, & hose work is a much smaller % of what they do.

Then there are others that have undertaken the EMS mission as a justification to keeping the big red trucks staffed.

Just so you know I am currently in a fire based EMS system , so i'm not taking cheap shots .

[Richard B the EMT]

Then there are others that have undertaken the EMS mission as a justification to keeping the big red trucks staffed.

Just so you know I am currently in a fire based EMS system , so i'm not taking cheap shots .

In the case of the FDNY EMS Command, the past Mayor, in my opinion, moved the EMS out from the management of the New York City Health and Hospitals Corporation, and placed it under the management of the FDNY, to buy Fire fighter votes, using that as the reason.

As a mention, I am recently retired from the FDNY EMS Command, and was "Grandfathered in" for that reason, from the NYC HHC EMS.

Without any real data, I opine that Fire Departments that decide they WANT to increase their usefullness, and possibly keep members on the payroll, by taking on EMS duties, are better than Departments that have the decision forced on them by outsiders from the department, such as Mayors, city councils, village elders, ect.

[Bieber]

You have to remember that in this economy with job cuts going on weekly , Schitberger and his union minions are trying to come up with any excuse or propaganda campaign to save the dues paying union jobs. If they loose dues paying members then the slush fund goes down.

Oh, I know. I know they're just trying to save their own asses, but at the same time, I strongly contest that fire based EMS can, in and of itself, do it better than non-fire EMS, and would even argue that, without taking into account individual departments and their particular handling of EMS, that fire based EMS in general is bad for the system, bad for the profession, and bad for the advancement of EMS in this country.

There are fire departments that do top quality Emergency prehospital care that is patient centric and is their primary mission. They do EMS because they want to provide the best care to their community, & hose work is a much smaller % of what they do.

I believe it. And you're one hundred percent right. But, from what I know and from what I've seen of fire based EMS departments (and I'll be the first to admit that I don't have anywhere near the experience of the majority of you), I haven't been impressed.

Without any real data, I opine that Fire Departments that decide they WANT to increase their usefullness, and possibly keep members on the payroll, by taking on EMS duties, are better than Departments that have the decision forced on them by outsiders from the department, such as Mayors, city councils, village elders, ect.

I would argue that on the point that whether or not administration wants to do EMS, the average firefighter probably does NOT. And whether or not you have a jubilant, bouncing for joy admin that is all about delivering top notch EMS, it becomes a moot point if the actual street workers don't give a crap about it and begrudge being put on the meat box.

[Just Plain Ruff]

Firefighters are in the best position to respond quickly. Not in the county I used to work. Volunteer fire department 5 to 10 minutes to get the firemen to the station. Versus the full time ems agency staffed out of the hospital with a 0 minute response time. I think the medics win this one where I used to work.

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[Richard B the EMT]

RuffEMS, I think we are leaving the argument of FD based versus everyone else argument, ands reentering Volunteer versus paid/in house staffed EMS. Might I suggest or request we keep that on another string?

[HERBIE1]

Age old problem with EMS. Problem is, IAFF has the money and the clout to put out the propaganda, and as Beiber correctly puts it, this is about saving manning. The other issue is revenue. Besides things like inspection fees and fines, the fire service does not support itself and needs EMS to generate a funding stream. There are gold standards in fighting fires- manning, one in, one out, etc, but yes, this is STILL all about FF's and their needs. Fire companies are closing, lay offs are happening, and crews are running short handed. We need FF's, and we need to make sure they can do their jobs safely- meaning having enough personnel to get the job done. That said, this should NOT come at the expense of EMS. A half arsed attempt at providing EMS is also unacceptable. Again- we are such a diverse group, with various levels of training, so it's also difficult to unite under one umbrella. FF's are what they are, and their jobs are universal. They have decades of experience in politics, tens of millions in funding, and a major lobbying presence in DC and in every state legislature. We do not, and whether that changes remains to be seen.

Yes, there are places that are very progressive, and have an integrated fire based EMS system which is top notch. Unfortunately, they are still the minority.

As anyone who crunches numbers regularly can tell you, simple manipulation of data can change what those numbers say. Problem is, no amount of number crunching or tweaking changes the fact that fires are WAY DOWN, and have been for years now. That means the IAFF is desperate to stay relevant and keep the level of funding they have enjoyed for all this time. The only way to justify that funding is for them to adapt- which they are doing at the expense of 3rd service EMS providers.

I hate to sound like a defeatist, but I simply do not see EMS being able to unite and build a strong and cohesive enough voice to combat the IAFF's machine. We have made some progress over the years, but are still in our infancy in terms of political muscle and funding. Are there cracks in their armor- absolutely. A few years ago, the thought of FF lay offs and closing firehouses would have been unfathomable. Not any more- it's happening as we speak. Public safety(police, fire, and EMS) is no longer the sacred cow nobody would dare touch. Cities are broke, and they are cutting EVERYWHERE, but the IAFF has some valid points such as the fire department's infrastructure and manpower is already in place, and from a politician's perspective, the more hats a worker can wear, the more cost effective they are as an asset to their area. I know many folks do not want to be a FF, and I think EMS will always exist, but it may be relegated to IFT's, and other nonemergent transports.If that's your bag, you should be fine, but I think most folks in the business eventually want more than that.

Personally, I see the future of EMS being with the expanded scope of practice, but that means more education, more training, and a shift in our focus. Unless that extra training yields financial rewards, few people will invest time and money in something that may not pay off for their bottom lines but that education alone would separate us from the fire service where their training is very specialized. Medical education can translate into a slew of affiliated allied health possibilities, but there is little call for things like high angle rescue training or trench rescue in the private sector.

[tniuqs]

http://www.thespec.com/news/local/article/475923--firefighters-get-9-per-cent-pay-hike

Well this is going over like a LEAD BALLOON.

Agreed Ruff:

Where I pay taxes we have a 3 million dollar Firehall (plus 4 trucks) the call volume 30 calls a year serving a population of 10,000 folks, highest level of training is EMR (very basic first aider) and only 2 vollies FF out of 38 have that advanced level of care.

Closest "2" ALS unit's are a 20 minute response time away best case scenario and serving a population of < 100,0000.

Do the math in my hood and it appears something is wrong .

[Bieber]

Perhaps we've been going about this the wrong way. Many of us begrudge the IAFF (myself, for one) and bitch and moan all day long on EMS forums about how we don't want to become firefighters or engage in debates like this highlighting what we think are the shortcomings with fire based EMS. Perhaps we should be trying to learn from them--they're obviously doing something right, at least in the realm of politics.

In order for EMS to become a strong, unified, individual body that stands on its own merits, we need to look at other organizations such as the American Nursing Association and the International Association of Fire Fighters and ask ourselves: how did they get to where they are? And why haven't our organizations such as the NAEMT been able to achieve a similar kind of success?

I think that one of the major factors holding us back is a lack of motivation within the industry, which I think stems in large part from a severe lack of pride in our profession. Nurses and firefighters have been hailed for decades as national heroes, and idolized as champions of our society. In turn, people in both of these professions take tremendous pride in their work. I can't begin to explain the frequency with which I see nurses in scrubs and firefighters wearing their fire shirts while off duty, and they do so because they are very proud of what they do and also because we as a society hail them for being what they are. On the other hand, the general public has no idea who we are or what we are, and in turn I believe it leads to us becoming embittered and apathetic about our work. At least where I work, I can tell you the majority of EMTs and paramedics around here are more than content to "do their job and go home". We're not proud of what we are because nobody knows, nobody cares, and in turn the whole system becomes apathetic.

Furthermore, because there are great deal of fire based EMS systems out there, there hasn't (to my knowledge) been any national or state EMS association willing to risk the wrath of the IAFF by taking a decided stance AGAINST fire based EMS. We're so afraid of inciting the ire of firefighters that we quietly remain the neutral party while organizations like the IAFF make blatant attacks against non-fire based EMS services. We're apathetic cowards, to put it delicately. We don't care and those of us who do support advancement in EMS are too scared to speak up against a form of EMS that we perceive to be, on the whole, detrimental to the advancement of our profession.

We need to take a stance, if we want to survive in a non-fire based form. And I'm not out to pick a fight or to start making blanket statements about every fire based EMS service out there, but the IAFF has picked the fight to begin with and if it comes down to either fire based or non-fire based, I'm going to support a strong, unified and independent EMS. Neutrality from this point on is only a form of concession.

We need a national organization that is going to take a stance on this, and we need EMTs and paramedics and services that are going to stand up and forcefully say nothing worse than what the IAFF is already saying: that our way is the best. The IAFF is desperate to save firefighter jobs, which is noble, but their desperation is apparent in their weak arguments in favor of fire based EMS and I believe that none of their points are indisputable or unbeatable.

In order to become strong and independent, we have to use the same tactics that the ANA and the IAFF have used to become strong; that is take pride in our work and make our pride in our work known, become political (as opposed to remaining neutral) and take a stance on issues, be willing to fight for our way, and be willing to educate the public about who we are and why the way we do things is best (just like the IAFF is doing). If we continue to go along like we have been, independent, non-fire based EMS won't end with a bang, but disappear quietly into the night with barely a whimper.