Interesting Perspective on Fire-based First Response EMS

[Bieber]

It seems like it could be a continuity of care issue. As the transporting paramedic who is responsible for that patient and for providing the hospital report, I personally don't want to have to explain why treatments were given that I didn't give--especially if they're incorrect treatments (of course excluding CPR and AED use). Around here fire responds with us on all medical calls (unless we get there first and decide to call them off if we don't need them), and there are some FF/Paramedics but they can only act as basics.

[fakingpatience]

It seems like it could be a continuity of care issue. As the transporting paramedic who is responsible for that patient and for providing the hospital report, I personally don't want to have to explain why treatments were given that I didn't give--especially if they're incorrect treatments (of course excluding CPR and AED use). Around here fire responds with us on all medical calls (unless we get there first and decide to call them off if we don't need them), and there are some FF/Paramedics but they can only act as basics.

In some of our coverage area we respond w/ ALS fire departments, both paid and volunteer. Some of them are the most incompetent providers I have ever encountered. I have had coworkers force the ALS first responder to ride in to the hospital in the ambulance w/ us to explain to the doctor why they gave what ever incorrect med/ treatment that they did... I personally much prefer responding with a BLS first responder than an ALS one

[NYCEMS9115]

If that's the policy, so be it. Nothing can be done; if the service wants to delay the Ambulance response so the Fire Service can have 3minutes patient contact time; so be it. If that is how you better a provider's care; then so be it. Let the public know that and see how they feel. That policy is the most retarded thing I've ever heard. I am lying but it is pretty retarded. It's things like this, that hurts the profession. I am truly sick of all the stupid policies which hinder productivity and growth. This is definately one of them...

[WolfmanHarris]

If they want to delay EMS in order to "hone" their skills, why don't they just leave the ambulances where they were initially and have them always respond without lights and sirens to the scene? The science suggests very few calls are actually time sensitive, being restricted primarily to cardiac arrests, strokes and MI's, and at least this way in addition to fire getting to practice you get the added (and much more important) benefit of EMS crews being at reduced risk of getting into a car accident.

But the continued risk of a much larger, less responsive vehicle rushing to calls with L&S?

Besides, while the science is certainly there, dispatch is still incredibly fallable. As a result I've ended up at a more than one VSA that came in as a "not responding normally" or "drowsy." The failure point here is almost impossible to fix since we rely on information from the public; L&S to scene may remain a dangerous reality of our job for quite some time. Now as far as L&S to hospital, I couldn't agree more that there is little to no need. I'd say less than 5% of calls in my area go back L&S.

[Bieber]

But the continued risk of a much larger, less responsive vehicle rushing to calls with L&S?

Besides, while the science is certainly there, dispatch is still incredibly fallable. As a result I've ended up at a more than one VSA that came in as a "not responding normally" or "drowsy." The failure point here is almost impossible to fix since we rely on information from the public; L&S to scene may remain a dangerous reality of our job for quite some time. Now as far as L&S to hospital, I couldn't agree more that there is little to no need. I'd say less than 5% of calls in my area go back L&S.

I don't disagree with you about it being unwise for fire to run lights and sirens either, and to be honest I don't see the sense in taking an engine to a medical call--a lot of risk for zero benefit, if you ask me. I'm not sure what VSA is, but you're correct that we rely on fallable dispatch information, however I still don't think that running lights and sirens to all calls is a wise idea.

[usmc_chris]

Thanks for all the replies. You pretty much have all said what I was already thinking. Unfortunately for the company, they must do what they are told or risk losing the contract on the next go-around... in my state, legally, the fire departments are responsible for EMS. If they choose not to run their own ambulance service, then they contract for a service to provide the ambulances within their district. There are at least two other services in the county (one is another for-profit, the other a non-profit 3rd service) that would bend over backwards to take this business from the company I work for, so quite literally, the management does whatever the fire chief tells them to do. If he wanted our ambulances to be painted solid purple, then they probably would get painted that way. Furthering the problem is that this is one of the biggest money-makers for the company - it's not a response area that management would make a moral stand over.

Fortunately for me, I no longer work in this response area, so don't really have to "deal" with the problem. Furthermore, I don't really expect to be in the area for much more than another 6 months.

I truly don't believe that this department wants to run transporting EMS - at least until this state allows fire districts/departments to bill for services. However, they do want to maximize their run numbers in order to justify additional firefighter jobs and a higher tax rate. If that's what they want to do, whatever... but I think that there are better ways to ensure "adequate patient contact" time for their firefighters.

Unfortunately, in any for-profit business, "the customer is always right." I can't wait to go to a state that's a little less screwed up than this one...