Fire Service Based EMS, again.

[Bieber]

As far as single role vs fire based, I say that whatever the system was originally, it should stay that way. If it was fire based back in 1950, then it should stay that way. If it was third service from 1973, then it should always be so. You shouldn't make moves that negatively affect another's livelihood. Having said that, I'm of the opinion that EMS ought to be municipal, not private or fire based. For profit interests (not-for-profit still runs like a business) can have a negative impact, if not a direct conflict of interest in pt care. Besides, other than the voluntary hospitals in NYC, I can't think of any hospital based, or private EMS that were there from the start. I say this having worked five years at a combo NYC 911 participating/IFT hospital, NS-LIJ. NS didn't do any pt steering, but quite a few other hospitals did. If you were uninsured, you went to the city hospital. If you were insured, you were steered away from city hospitals, and also the other competing private hospitals. EMS should be municipal only. Right now, Bloomberg is demending payment from the NYC 911 participating voluntary hospitals, based on their number of 911 slots, up to two million a year, starting in 2012. NS-LIJ is telling the city to go scratch; they can have their 10-11 911 spots or whatever. They're huge already, and don't need the 91 division anymore. If anyone needs a good hospital based EMS job, apply to NS-LIJ. They're hiring.

As respectfully as I can say this, I haven't heard an idea that made me cringe as much as that in a long, long time. That's equivalent to saying that we shouldn't change ANY part of our practice if it could affect people's jobs. Science says transporting dead people is bad? Too bad, keep doing it, 'cause the hospitals might have to lay people off if they're not making enough money from continuing field codes. EMS isn't about saving people's jobs, least of all firefighters', and I for one am not going to advocate the maintaining of a system, no matter how long it's been around, if it's no longer the kind of system that's going to move EMS forward or benefit our patients. I'm not out to help maintain anyone's livelihood but my own, and this attitude of neutrality with respect to fire-based EMS has to stop--because I guarantee you that, from what the IAFF promotes, they're not out to protect the livelihood of anyone but firefighters.

I've said it before and I'll say it again, the biggest reason why EMS is run by everyone else BUT EMS is because we are too damn neutral. We're all a bunch of cowards too scared to stand up to the IAFF and our national organizations are too scared to take a stance AGAINST fire based EMS. But you know what? We are the only ones who don't think there's a war going on for control of EMS. The IAFF has made itself clear: they are out to take EMS, and they'll use whatever tactics they have to to get a hold of it. If you want to see EMS grow and prosper and progress as a profession, then YOU have to be willing to say NO to any person or any organization that would seek to lower EMS educational standards.

[Kiwiology]

Fire Service based EMS is evil, it is driven by a labour union who is looking to protect workers and jobs but does so at the expense of quality medical care and the development of Paramedic as a health profession in the United States.

Are Firefighters prepared to go to school for six years to become a Paramedic like our Intensive Care Paramedics?

How many Fire Service based EMS systems are doing tightly controlled, highly successful RSI and thrombolysys?

How many Firefighter/Paramedics can professionally describe fluid homeostasis, thromboxonase and glyconogenesis?

How many Fire Service based EMS systems encourage or require anything more than a couple months at some patch factory?

Once again, Fire Service based EMS is evil.

[46Young]

As respectfully as I can say this, I haven't heard an idea that made me cringe as much as that in a long, long time. That's equivalent to saying that we shouldn't change ANY part of our practice if it could affect people's jobs. Science says transporting dead people is bad? Too bad, keep doing it, 'cause the hospitals might have to lay people off if they're not making enough money from continuing field codes. EMS isn't about saving people's jobs, least of all firefighters', and I for one am not going to advocate the maintaining of a system, no matter how long it's been around, if it's no longer the kind of system that's going to move EMS forward or benefit our patients. I'm not out to help maintain anyone's livelihood but my own, and this attitude of neutrality with respect to fire-based EMS has to stop--because I guarantee you that, from what the IAFF promotes, they're not out to protect the livelihood of anyone but firefighters.

I've said it before and I'll say it again, the biggest reason why EMS is run by everyone else BUT EMS is because we are too damn neutral. We're all a bunch of cowards too scared to stand up to the IAFF and our national organizations are too scared to take a stance AGAINST fire based EMS. But you know what? We are the only ones who don't think there's a war going on for control of EMS. The IAFF has made itself clear: they are out to take EMS, and they'll use whatever tactics they have to to get a hold of it. If you want to see EMS grow and prosper and progress as a profession, then YOU have to be willing to say NO to any person or any organization that would seek to lower EMS educational standards.

What I was trying to say is that one type of service should not try and take over another, with the end result being a loss of employment for the system that's on the outs. Replacing a fire based system with a third service is no different than a FD taking over a third service. Jobs would be lost either way. Fix the system you have. Properly fund the dept, whatever it may be, properly staff and deploy units (rather than cost cutting SSM like measures), hire a medical director that believes in evidence based medicine, and have a solid QA/QI program with accountability towards it's field providers. This concept will work for either a third service or a fire based system. I know this to be true, because I work in a fire based system that, IMO, has achieved these goals. We've actually went a little overboard on staffing and deployment.

We have 37 medic units, 14 of which are double medic, four BLS ambulances, 37 ALS engines, one EMS supervisor for each battalion, four heavy rescues with ALS providers, and a solid mutual aid agreement. Our protocols reflect the latest AHA standards, we have liberal SO's for pain management, CPAP for APE, asthma and COPD, inline nebs, nasal ETCO2 capnography and capnometry, double doses of NTG until therapeutic endpoint or adverse effects, just to name a few. Our protocols are better than NYC's, and Charleston County EMS, two places I've worked previously. NYC EMS cannot be accurately classified as 100% fire based, since there are many hospitals and two privates in the system, and the FDNY EMS are single role. We have a 16 week ALS intership, which is classroom time taught by PA's and BSN's, with 36 hours/wk of time on a txp unit, and we do fail out weak providers. We send those interested (no one's forced) to NVCC's EMS AAS program. We're requiring degrees for career advancement now. A fair number of our recent hires are coming in with an EMS AAS, since it both helps with hiring, and with promotions as well. How's that for increasing educational standards? Who else is sending their ALS hopefulls to degree programs on their dime? How many systems give hiring preference with degrees? Require degrees for promotion? Certainly not the privates or most third service providers. I know that Charleston County EMS sends theirs to Trident, a nine month cert program.

Fire Service based EMS is evil, it is driven by a labour union who is looking to protect workers and jobs but does so at the expense of quality medical care and the development of Paramedic as a health profession in the United States.

Are Firefighters prepared to go to school for six years to become a Paramedic like our Intensive Care Paramedics?

How many Fire Service based EMS systems are doing tightly controlled, highly successful RSI and thrombolysys?

How many Firefighter/Paramedics can professionally describe fluid homeostasis, thromboxonase and glyconogenesis?

How many Fire Service based EMS systems encourage or require anything more than a couple months at some patch factory?

Once again, Fire Service based EMS is evil.

Replace "fire based EMS" with U.S. third service, hospital based, and private EMS (which outnumber the number of fire based transporting depts in the U.S.), and I could ask you the same questions.

Once again, you're generalizing.

[Kiwiology]

Once again, you're generalizing.

Yes I am but it seems the Fire Service are the worst ... altho EMS in the US seems to suck except for one or two areas seriously, the Fire Service are worse than the borg.

Now if I need a car turned into a convertible or somebody extricated from a funny place the Fire Service are great, love them to bits and will go across the street to the station for dinner with them every night but when it comes to EMS they are the borg seriously.

[DwayneEMTP]

46young, I get what Bieber is saying, that this is a war of efficiency, productivity and evolution not an exercise in unemployment management.

Fire, unfortunately as a national union wishes to draw EMS backwards, make it more ignorant where everyone can play without too much effort, like back in the 'good ol' days' as they may see it. That is not what's good and/or healthy for EMS.

I was talking to a fireman the other day and we were having this argument, in an amazingly good matured way, (Meaning not once did he imply that I held my opinions because I was rejected by the fire dept, or that a fireman had slept with my wife.) and he made a really great point. His original argument was that there was no way to stop fire from taking over EMS, but later theorized that either fire would leave EMS or would begin to be pro education as the 'old guard' that defends ignorance (an unfair generalization. All respect to those that don't fit this but we all know that many do) are retiring now, and the young up and commers are those that were forced to go to at least medic school and many to college, so their respect for education will likely be different. I thought that that was an awesome point and the first inspiring thing in the EMS/Fire conflict that I've heard in years.

Young master Bieber is the future my friend. He's smart, and he knows it, and intends to get smarter. He's tough and he knows it, and is pissed of at the status quo, so the old guys are going to have to figure out how to deal with him.

Dwayne

[HERBIE1]

46young, I get what Bieber is saying, that this is a war of efficiency, productivity and evolution not an exercise in unemployment management.

Fire, unfortunately as a national union wishes to draw EMS backwards, make it more ignorant where everyone can play without too much effort, like back in the 'good ol' days' as they may see it. That is not what's good and/or healthy for EMS.

I was talking to a fireman the other day and we were having this argument, in an amazingly good matured way, (Meaning not once did he imply that I held my opinions because I was rejected by the fire dept, or that a fireman had slept with my wife.) and he made a really great point. His original argument was that there was no way to stop fire from taking over EMS, but later theorized that either fire would leave EMS or would begin to be pro education as the 'old guard' that defends ignorance (an unfair generalization. All respect to those that don't fit this but we all know that many do) are retiring now, and the young up and commers are those that were forced to go to at least medic school and many to college, so their respect for education will likely be different. I thought that that was an awesome point and the first inspiring thing in the EMS/Fire conflict that I've heard in years.

Young master Bieber is the future my friend. He's smart, and he knows it, and intends to get smarter. He's tough and he knows it, and is pissed of at the status quo, so the old guys are going to have to figure out how to deal with him.

Dwayne

Well, I happen to agree with the FF's assessment that there probably is no way to stop fire from taking over EMS. I see no evidence that EMS is organized enough to put up much of a fight- it's the typical David vs Goliath scenario. Will fire based EMS work in all places? Will it provide better care? To both questions, I would say probably not, but yes, I know there are exceptions.

The old guard in FSR ARE leaving now. Education is becoming more important than it used to be. Haz Mat training, NIMS, and medical training are becoming the standard, so the days of simply fire suppression are long gone, and the ones who like it that way are also becoming extinct. Whether or not the new guys will step up and change the organizational culture of the fire service to embrace education is still an unresolved question. As you note, guys like Bieber ARE the future, and hopefully they can succeed where so many others have failed. I would say EMS is in it's adolescence, and as such, needs proper guidance, good leadership, and probably most important- POSITIVE role models and mentors. It's up to the old timers to keep this in mind when dealing with new folks. Even after all this time- as frustrated as I get with this business- I still do it right. I hear grumbling from a couple new guys who do not understand why I care, or why so many others cut corners.

I tell them I do it the way it's supposed to be done, and as long as they are with me, that is how things will go. I cannot control how others will act, but all I can do is lead by example. Hopefully some of that will rub off on a young impressionable soul.

[Richard B the EMT]

After the EMS/FDNY "merger", a website came on line, showing a Star Trek "Borg" wearing a fire chief's helmet, captioned, "You will be assimilated".

While I seem to not be able to access the picture to reproduce it here, I suspect the person who created the (previous to Septemnber 11, 2001) highly anti-FDNY site is a member of EMT City. He, or she, remains annonymous, by choice.

[46Young]

46young, I get what Bieber is saying, that this is a war of efficiency, productivity and evolution not an exercise in unemployment management.

Fire, unfortunately as a national union wishes to draw EMS backwards, make it more ignorant where everyone can play without too much effort, like back in the 'good ol' days' as they may see it. That is not what's good and/or healthy for EMS.

I was talking to a fireman the other day and we were having this argument, in an amazingly good matured way, (Meaning not once did he imply that I held my opinions because I was rejected by the fire dept, or that a fireman had slept with my wife.) and he made a really great point. His original argument was that there was no way to stop fire from taking over EMS, but later theorized that either fire would leave EMS or would begin to be pro education as the 'old guard' that defends ignorance (an unfair generalization. All respect to those that don't fit this but we all know that many do) are retiring now, and the young up and commers are those that were forced to go to at least medic school and many to college, so their respect for education will likely be different. I thought that that was an awesome point and the first inspiring thing in the EMS/Fire conflict that I've heard in years.

Young master Bieber is the future my friend. He's smart, and he knows it, and intends to get smarter. He's tough and he knows it, and is pissed of at the status quo, so the old guys are going to have to figure out how to deal with him.

Dwayne

I'm beginning to see the paradigm shift towards degrees in the fire service. The older members are complaining that you need a degree to place high enough on the promotional list to get made. They're getting left behind by the more educated. On the EMS side, more and more of our newer ALS hires either have EMS degrees already, or are obtaining an EMS AAS or RN as a means of maxing out their educational component of their promotional score. We also have more and more medics here that are fed up with admin's ineffective and convoluted EMS policies. We need to lose these old timers to attrition, and get some forward thinkers in positions of power. There are quite a few medics in positions of power in my dept, but these are individuals that got their cert in 1985 or so, and haven't seen the inside of an ambulance in 10-15 years. The only thing at the moment that would stop the fire service's assimilation of EMS at the present is at least an EMS AAS required to cert as a medic. The ironic thing is that the fire service nowadays is trending towards giving increasing weight towards education (in general) for hiring and promotion, which is something I'm seeing little of from the third services, privates, and hospitals. The hospitals at least will structure your work hours to not conflict with school, but this is usually for a medic program, or for a degree that will result in another career within their health system, not a promotion per se.

After the EMS/FDNY "merger", a website came on line, showing a Star Trek "Borg" wearing a fire chief's helmet, captioned, "You will be assimilated".

While I seem to not be able to access the picture to reproduce it here, I suspect the person who created the (previous to Septemnber 11, 2001) highly anti-FDNY site is a member of EMT City. He, or she, remains annonymous, by choice.

Welcome to the FDNY EMS website. Click here for the latest rants and cartoons....