I called for an AMBULANCE!

[uglyEMT]

That's because you got taken for a ride in a horton.

Our last truck [2009] was a full custom ambulance and it cost 142k

heheheh yup We do it in a Horton

Ok enough of a derail sorry about that!!

It is amazing though to see a shift in thinking. It is a good sign at least

[HERBIE1]

Sounds great on paper, folks but I wouldn't hold my breath on this. We had a $250K, 3rd party study here that essentially came to these same conclusions and a whole bunch more. That was over a decade ago, and little has changed since then. Few of the recommendations ever came to pass, and the same problems exist today.

Politics, organizational culture, politics- too many factors to get in the way of change. Will it happen? Someday, maybe, if the stars are aligned, and is as likely as someone who wins the lottery 3 months in a row, AND is struck by lightning 3x's in one day.

Am I cynical? Yep. Seen firsthand how difficult it is to implement change. Does it mean we should stop trying? Of course not, but I simply suggest folks- especially ones new in the field- be realistic about what they hope to accomplish and how quickly.

[Bernhard]

To be honest, the cost argument is totally misleading: the fire trucks are located to meet a certain time-to-scene on fire calls. So, they are there if there is a fire in this area or not. Since fire/tech. rescue is not as much to keep the firehouse busy they really have the timeslots to perform additional tasks anyway. Since not every thing can be cleaned, painted, trained etc. any time, there is a cool task to fill: additional EMS response!

Primarily, this really doesn't cost extra: the people are there anyway, the apparatus too. Just add a little bit fuel to the cost, OK. No, it's not a real waste of tax money to get an already existing fire truck with already existing staff out on the street.

Secondly, the fire chief has a lot more arguments to defend the existing units - because now, there are a lot of calls! Call volume is high, you don't really have to clearly point out that the majority is EMS and the fire chief has a statistic to wave in front of city offiicials. Since the time-to-scene criteria becomes a weak one, when it gets into the hands of a cost saving consulter, the fire department simply needs something other to proof their existence all over the city. Plus, intensely running calls with a fire truck provides immediate public attention and is cool anyway...

It's not the cost, but the call volume pushing what makes me angry, since fire departments virtually cheat here. If combined with a certain "allmighty" attitude and even underperfomance on scene, it get's worse instead of really beeing a help (BTST).

Otherwise, if training level is wishfully high on EMS stuff, this training time almost certainly is shorter for firefighting/technical rescue stuff - especially on rarely used techniques with need to be trained often. This directly affects fire fighter "core competence" and even their safety. Just for statistics?

In my opinion, this is the real argument - not the cost. But I've been in such discussions often enough to know that fire departments have far better political relations as other public services and they really know how to use them.

[stcommodore]

The "first reaponder" concept enables not having enough ambulances. Its useful to have ema trained backups and the concept isnt totally bad but its kept this back to.

[Dustdevil]

Bernhard, I understand where your assumptions come from, but your conclusions are dead wrong. If you were correct, we wouldn't be arguing this 40 years later, and governments wouldn't be complaining about the costs and the quality, as they always are. You have to see it first hand to get it, because the theory alone simply never works.

Are they sitting around doing nothing if there are no fires? Yes. But that's where the validity of your theory ends. Every valid study tells us that the ONLY thing we provide that consistently improves mortality and morbidity is TRANSPORTATION. PERIOD. So the problem is not that there enough hands on-deck, but that we don't have enough stretchers on the road. That is what people are bitching about. They're tired of waiting so long for an ambulance. Even the firemen are tired of it. So more first responders, incapable of transport, is wholly irrelevant to the equation, no matter how you add it up.

Then the problem is multiplied by the extension of your logic to the ambulances. "Hey, they're not always on an emergency, so they should run a non-emergency taxi service in-between EMS runs!" So now, not only are you running too few ambulances for the need, but you are tying up half the fleet on BS. And the same thing happens with half the FD fleet, which is ow unavailable for fires because of EMS. Then, when the quarterly numbers reveal this (as they always do), the knee-jerk reaction is to always blame the underfunded and understaffed EMS, and give yet more money to the FD, who without ambulances, have zero potential to fix the problem, no matter how well they are trained.

You have to look at the big picture, mein freund.

[Bernhard]

Dustdevil, don't take me wrong. I know the issue of firefighters desperate of entering the EMS field from first hand experience here as well. And I'm against it, since EMS is a complete own profession. I'm lucky to live in a state which sees this the same way - there are other states in Germany where fire departments have their hands on EMS. This motivates the local fire associations representatives to long for EMS related business here as well, and therefore I've had my share of discussions on this topic with a lot of people the last decades...

This said, I simply warn of bringing the cost argument to top. This is too easy to disprove, in the way I wrote: otherwise idling firefighters and trucks don't cost significantly more when first responding.

So the problem is not that there enough hands on-deck, but that we don't have enough stretchers on the road. That is what people are bitching about. They're tired of waiting so long for an ambulance. Even the firemen are tired of it. So more first responders, incapable of transport, is wholly irrelevant to the equation, no matter how you add it up.

Correct. My statement is not that I want to have more cost neutral firefighter first responders (beware!!!), but that the cost argument (beeing a large issue in the mentioned article) will easily be disproved. So, for me it's a dangerous argument in the discussion.

And the same thing happens with half the FD fleet, which is ow unavailable for fires because of EMS.

THAT is an argument in such a discussion.

But one of my main arguments remains quality of service and especially the lack of time for training in firefighters core disciplines when they're sufficiently willing to be trained in EMS stuff. This mostly is an eye opener in such discussions, because that's not what a fire chief wants or wants to be made public.

Then, when the quarterly numbers reveal this (as they always do), the knee-jerk reaction is to always blame the underfunded and understaffed EMS, and give yet more money to the FD, who without ambulances, have zero potential to fix the problem, no matter how well they are trained.

I agree, this is totally stupid, but supports my thinking that fire associations are far more political knowledged than EMS or other public services.

You have to look at the big picture, mein freund.

I do, Dustdevil, I do.

I'm very lucky to live in a state, where a dense net of ALS ambulances, helicopters and BLS transport units is required by law ("...within 12-15 minutes each street accessible place must be reached by ALS...") and their effectiveness is reviewed every few years. Plus, it is NOT a business of the fire departments but of private organizations/companies BY LAW (except only one large FD, for historical reasons). BTW: thanks to the U.S. troops covering the southern states of Germany after WW2 (who licensed ambulance business to private organizations instead of FD as in other german states)! But this is tried to be turned around by fire associations ever since. And there are numerous approaches to "infiltrate" EMS - by getting FD's hands on the dispatch centers or by organizing local first responder units (if senseful or not).

And especially with all those volunteer departments here (but in principle the same is valid for career depts) the training factor is a very good argument, I often use against them: they simply can't spent as much time on "fire fighter core business" training when they have to spend significant time on EMS training, thus weaking their effectiveness and even their security in fire calls. And if they don't have a certain level of emergency medicine education, then their first responding remains more or less senseless. Logical discussions often stop at this point going over to political arguments...

Again, I think, the cost argument as given in the mentioned article is very weak. There are better ones.

Is my intention more clear now?

[Just Plain Ruff]

I think I would be very very pissed off if I paid for fire service and all the closest fire trucks were out taking care of slips and falls and other medical calls and my house could have been saved had there have been less firemen on medical calls and more on fire duty.

Case in point, one of the local towns in our area has a first responder system. They respond to medical calls.

Usually they respond with one fire truck (they only have 2) and they also respond with a rescue truck. That takes 4-5 Firemen.

That's about the response they can get during a weekday.

So they are on a ems call 10 miles north of their city limits. A house catches on fire, they can't get anyone to respond to the station because the regular guys are already on a call 10 - 15 minutes away.

So the house gets really rolling, the occupants are trapped inside. They perish. The fire truck out in the county gets there just in time to provide the city with it's newest in ground swimming pool and to assist with body recovery.

Does anyone see an issue with something like that?

Take away the fatalities and you get the same issue. A house lost to fire because the fire department/first responders were out there in the county picking grandma up with a fractured hip or someone being sick and they aren't available to fight the fire.

Not saying that the above situation has happened but having two or three medical calls in the close vicinity has happened.

I'm not saying it's ever happened though. Thank goodness.

Dustdevil, don't take me wrong. I know the issue of firefighters desperate of entering the EMS field from first hand experience here as well. And I'm against it, since EMS is a complete own profession. I'm lucky to live in a state which sees this the same way - there are other states in Germany where fire departments have their hands on EMS. This motivates the local fire associations representatives to long for EMS related business here as well, and therefore I've had my share of discussions on this topic with a lot of people the last decades...

This said, I simply warn of bringing the cost argument to top. This is too easy to disprove, in the way I wrote: otherwise idling firefighters and trucks don't cost significantly more when first responding.

Correct. My statement is not that I want to have more cost neutral firefighter first responders (beware!!!), but that the cost argument (beeing a large issue in the mentioned article) will easily be disproved. So, for me it's a dangerous argument in the discussion.

THAT is an argument in such a discussion.

But one of my main arguments remains quality of service and especially the lack of time for training in firefighters core disciplines when they're sufficiently willing to be trained in EMS stuff. This mostly is an eye opener in such discussions, because that's not what a fire chief wants or wants to be made public.

I agree, this is totally stupid, but supports my thinking that fire associations are far more political knowledged than EMS or other public services.

I do, Dustdevil, I do.

I'm very lucky to live in a state, where a dense net of ALS ambulances, helicopters and BLS transport units is required by law ("...within 12-15 minutes each street accessible place must be reached by ALS...") and their effectiveness is reviewed every few years. Plus, it is NOT a business of the fire departments but of private organizations/companies BY LAW (except only one large FD, for historical reasons). BTW: thanks to the U.S. troops covering the southern states of Germany after WW2 (who licensed ambulance business to private organizations instead of FD as in other german states)! But this is tried to be turned around by fire associations ever since. And there are numerous approaches to "infiltrate" EMS - by getting FD's hands on the dispatch centers or by organizing local first responder units (if senseful or not).

And especially with all those volunteer departments here (but in principle the same is valid for career depts) the training factor is a very good argument, I often use against them: they simply can't spent as much time on "fire fighter core business" training when they have to spend significant time on EMS training, thus weaking their effectiveness and even their security in fire calls. And if they don't have a certain level of emergency medicine education, then their first responding remains more or less senseless. Logical discussions often stop at this point going over to political arguments...

Again, I think, the cost argument as given in the mentioned article is very weak. There are better ones.

Is my intention more clear now?

So this crap happens in other countries as well. Talk about long reach of the IAFF and it's influence.

[Bieber]

I'm one hundred percent behind this.

EXACTLY. Yes, the extra manpower is nice, but you know what? There are much, MUCH cheaper alternatives to sending a fire engine to medical calls. And believe me, while the fire departments (yes, that's right, we have two of them here) do generally send their squads for medical calls, it is not rare or unheard of to see whole engines on scene for a purely medical patient.

I hope more cities read this article and begin to put two and two together. Like Kiwi said, ambulance versus not an ambulance. It's as simple as that.

[Bernhard]

I think I would be very very pissed off if I paid for fire service and all the closest fire trucks were out taking care of slips and falls and other medical calls and my house could have been saved had there have been less firemen on medical calls and more on fire duty.

...

I'm not saying it's ever happened though.

That is the point with this argument: it doesn't really happen - and if it happens one rare occasion, it would be just another valid reason (from a fire chiefs point of view) to get more fire trucks! This would be even a good argument to get more firetrucks in advance because run reports clearly show, that the trucks are outside the station doing duty for the public. So, they simply need more firetrucks/-fighters! That's one of the basic argumentation lines fire associates follow. If made clear and loud then neither the public nor some politicians get the real reason...

To prevent misunderstandings: that's not my state of mind - I just cite fire arguments. And: I'm not against fire fighters! But I want them to be able to do their fire fighter job perfect and safe and at the same time I want to have a high quality level for emergency medical service - which simply doesn't mix. Lucky me, in my state that's more or less the status quo, but it requires constant arguing...(and in some other german states, the case is lost already).

So this crap happens in other countries as well. Talk about long reach of the IAFF and it's influence.

Yes, but I wouldn't blame the IAFF (only), it's a general understanding of fire dept's self-importance, rather implicite with beeing a fire department. I even see the real reason behind (at least here in Germany), because fire departments are an integral part of every city and village public authorities, mandatory to exist (large city: paid/career, smaller city or village: volunteer, but equipment always funded by the city). So, they have an important political weight just by existence, beeing an integral part of the city system. Private organisations/companies are trusted a little bit less, naturally...

I even know one fire association political representative personally, beeing a close neighbour. He exactly knows the reasoning and is aware that fire departments argument's are weak if viewed closely. He even is against medical involvement of fire departments...but only in private! In the public he never ever would agree to that and he always would be an engaged lobbyist for "fire departments should do anything!". I could tell stories about discussions we had, as well in private as in public...

What's the solution? Better political work, public relation and a good standing of local EMS organizations plus coordinated lobby work on all political levels. However, we face several implicite difficulties with that but mostly, we just seem to miss real self-confident superiors or willing EMS associations. Instead we have shy superiors afraid of disturbing relationships and multiple EMS associations fighting each other. Media awareness helps, but it should not give weak arguments (as those false cost calculation).

All in all this is not the picture we should present to the public as professional and high leveled emergency medical care providers. Nobody outside the field understands it anyway. No wonder, any good organized fire association can play on their own rules...