fire based EMS

[mediccjh]

If you live in one of those small pockets of America where this is not the norm, then congratulations. However, my assertion holds true in the majority of the country, and especially the urban and suburban centres. It's a shame, but it's true.

Wow, so because I work in both suburbia and 2 of the biggest/busiest systems in the nation, I'm a wannabe hose jockey?

I think I just found my calling for life!!! Thank you, Dust! :roll:

[chazmedic]

Nobody likes the fire department until it's time to move the patient to the cot.

In my area, the rush to leave EMS to fire service is exactly that: a rush. Right now, 7 out of 10 new EMT's are working in EMS only to get experience to get into the fire service. The medics are leaving to go to the ALS fire departments for 3 reasons: 1) better pay 2) job security 3) better retirement. EMS is a stepping stone.

The of the 5 major cities in the area, 4 are FD EMS by choice of the city government to ensure a service that won't go bankrupt, leave in the middle of the night, or have the "emergency" ambulance tied up on a inter facility transfer. The remaining service is a 503c non profit that is having to switch to a public utility model because it can no longer maintain its financial stability. And NOBODY, citizen or politician, wants to raise taxes to save it. So it's either PUM or FD. It's all about money. EMS does not save property owners money on their insurance. FD does. Cities view EMS as a duplication of services. They want to combine it with the FD because they view it a money saving method.

[Ace844]

Nobody likes the fire department until it's time to move the patient to the cot.

In my area, the rush to leave EMS to fire service is exactly that: a rush. Right now, 7 out of 10 new EMT's are working in EMS only to get experience to get into the fire service. The medics are leaving to go to the ALS fire departments for 3 reasons: 1) better pay 2) job security 3) better retirement. EMS is a stepping stone.

The of the 5 major cities in the area, 4 are FD EMS by choice of the city government to ensure a service that won't go bankrupt, leave in the middle of the night, or have the "emergency" ambulance tied up on a inter facility transfer. The remaining service is a 503c non profit that is having to switch to a public utility model because it can no longer maintain its financial stability. And NOBODY, citizen or politician, wants to raise taxes to save it. So it's either PUM or FD. It's all about money. EMS does not save property owners money on their insurance. FD does. Cities view EMS as a duplication of services. They want to combine it with the FD because they view it a money saving method.

:glasses5: :munky2: :munky2: :munky2: :munky2: :munky2: :munky2: :glasses5:

[chazmedic]

Can't spell PROBLEMS without EMS!

[nwoparamedics]

It's all about money. EMS does not save property owners money on their insurance. FD does. Cities view EMS as a duplication of services. They want to combine it with the FD because they view it a money saving method.

Sorry guys and gals... but this is what I can't wrap my mind around. I guess coming from my background... and not knowing much about for profit agencies, but....

EMS is the most cost effective and cheapest to run out of Paramedic, Police and Fire Services.... at least here.

We don't make a cent for our taxpayers, yet our service runs at less than 1/2 the cost of our local volunteer fire department, and about 1/4 of the cost of one of our local Police Services. We are only staffed one car, 24 hours a day... the Police service has 3-4 officers on per shift, and our Fire Services only have a chief and deputy chief on during the day... the rest are volunteer (yet their volunteer stipends are almost 1/3 to 1/2 hour yearly wages).

Our Police Services are publicly funded, our Fire Services are publicly funded, as are we. The Fire Services can charge $$ when they respond to residents/accidents outside of our community, yet they are not allowed to charge to those whom already pay taxes and fund them. We sometimes get reimbursement when we pick up an out of province person... but other than that... nada.

So... I don't really understand how a community can save money by having Fire take over EMS. It is not logical, cost effective, nor sane in anyway shape or form...

I know my perspective is fairly focused due to our province, yet this variation of costs is compounded in the larger centers where Fire Services have paid staff on site. We just can't compete with budgets, equipment, buildings, nor the sheer volume of staff.

I understand the Fire Services need for their budgets... their staff, their equipment... and am truly thankful they are their to assist us when we need the help on calls. I truly enjoy the aspect that over the years they have gotten into public relations, safety training with our schools, helping out with First Response, and all the other things they have gotten into due to the downtime... and thank them from the bottom of my heart for their help in our communities.

Yet... the people I work with the most are the Nurses and Physicians of out local hospital, and our Police whom are our First Response to almost all our calls. If we have anything in common, or lets say the most in common... wouldn't it make more sense to amalgamate our EMS back into the hospital based system (arghh... gotta admit I still dread the thought of returning to that system), or amalgamating to share administrative costs with the Police?

It confuses me further when I look at this from a district wide provision of services... as we have roughly a dozen communities that fall under one administrative roof whereas our local Fire and Policing do not. We have a very lean hierarchy, very lean administrative staff... and somehow, someway... we still manage to get the services provided to our district (albeit we don't have staff to do the public education, to do first response for other services, to do building inspections, etc...). If we actually looked at amalgamation of services... it would make more sense for EMS to take over the Fire Services... eliminate all the duplication in administrative costs.

I can also understand the Fire Services delving into all these other projects since their public relations and community involvement has led to a decrease in call volumes... I'm not that naive. I can see the need for having the staff available... just in case... that is part of what they do (as do we). I also remember when tiered response was first initiated in some of our cities way back when, and the reasons for it (justification of having the sheer volume of staff available, and number of stations compared to Police and EMS). I remember the fighting that occurred when EMS budgets where halted, as the need for more EMS personal existed, yet the government found a way to get someone, anyone... to respond to the medical emergency in the quickest amount of time. But in all honesty... if it weren't for Medical related calls... the volume of Fire Related calls that a Fire Service responds to would be far less than it is today.

So... when I look at cost effectiveness... yes... by sending Fire Services personal out to EMS calls... I can see how the communities are making the most out of their paid Fire Fighters. I can see why they are involved in so many things... but I really can't get a grip on how it is cost effective to take over an already lean and cost effective emergency service provider?

And onto my next bit of confusion... wages. EMS is typically and consistently the lowest paid of Emergency Services. If for example we were to look at cross-training and combining departments.... how does the cost savings occur?

Just rough estimates thrown out here, but....

• You pay a Fire Fighter 70 grand a year

[*]You pay an PCP 50 grand a year

[*]You pay an ACP 60 grand a year

Where do you get your cost savings with the new combined, cross trained staff?

• What happens when you train that PCP in house as a Fire Fighter? Do they now get paid more?

[*]What happens when you train that ACP in house as a Fire Fighter? Do they get paid more than the PCP Fire Fighter?

[*]How do you pay a Fire Fighter his/her wage, send them back to school for 2 years while being paid?

[*]How do you pay a Fire Fighter his/her wage new PCP/Fire Fighter wage... and send them back to school for another year for their ACP training?

[*]How the heck much does an ACP/Fire Fighter make?????

So... I know the EMT/EMT-P system is quite different than ours here in Ontario (with respect to wages, college time, etc..), but the jist of the above still stands. How much more do you pay someone whom is cross-trained?

With my limited view of the system, I can see a cost savings if it were an EMS Service taking over a Fire Service (because of our lean administrative aspect and district wide provision of services).... yet I don't see how it would work otherwise. Who's all for an EMS run Fire Service?

Please someone... educate me on how Fire Services taking over EMS can be cost effective here in Ontario... other than the justification of having a service to bolster the stats.... please.

[Nate]

Fire only responds to major MVA's with us, they don't first respond to medical calls, and they don't even come out on CPR calls. If we need lift assistance they will come, but we can usually get some strong guys at the scene to help us. We don't go to their fires unless it is a working structure fire. If I worked for a department that was fire/EMS then I'd do what ever they paid me to do (although I'd rather perfer to do EMS).

[Ace844]

Well stated and written "NWO,"!!!!!! 8) 8) :occasion5: :occasion9: :wav:

[nwoparamedics]

Ha... sorry about the above post being so long... but with our recent yearly budget having problems passing at the district level, I'm getting a bit miffed at some of the misconceptions that some are spewing and that others have due to our lack of educating the public about what EMS is and what we do.

We need a modest district wide increase to maintain services that are mandated by the province, and the communities are balking at anything except cutting EMS services. Yet on the other hand... a well established, community funded service such as Policing or Fire Services with managers paid for and reporting to the community have no problems gaining additional funding and actually improving their services instead of just maintaining status quo.

While our cuts are being completated... our volunteer Fire Service just purchased a new ladder truck for the tune of almost $1 million last year (the old one was just that... although no miles or hours on it... the community had to pay more insurance as it wasn't new enough), built a brand spanking new HUGE fire hall along with bar/lounge area off limits to the public for the tune of another $1.2 million... and this is all on top of their yearly million some odd dollar budget. They get a freaking 200-400 calls a year... and it is a volunteer service. Yes... I am envious :wink: Our Police services fall along the same lines... multi-million dollar budgets, brand new HUGE station this year, new vehicles and toys... the list goes on. The community didn't even wink when their paid managers... the Fire Chief or Police Chief... asked and got the monies for these improvements.

Our EMS service as stated in the above post is staffed round the clock with a roughly 1/2 million dollar budget and our DISTRICT wide budget is roughly what our single community spent on it's Police and Fire Services in this past year.

I know... we need to get off our duffs and do public relations, we need to have our Managers sit in on town council meetings and sub-committees even if they don't want us to be in on their meetings (we are not employed by the community... funded by the district, reporting to the communities). We will never have the ear of the community mayors and council like their paid managers have (the communities are paying their Fire Chiefs and Police Chiefs, and should listen to their upper management... but should also have input from a different perspective and take all input with a grain of salt... don't we all want to better our departments?). We have a lot to do as a profession in educating the public, and especially our community leaders on how cost effective we are out of all the emergency services, and we need to take the lessons learned by our counter parts and work towards improving our services like they have.

We also have to stand up once in awhile and educate those whom are listening to their paid mangers when ideas like Fire-based EMS come up...we need to step into these private meetings and educated them on the differences between the services, not just from a Fire perspective, yet give them a view from an Emergency MEDICAL Service perspective, show them the commonality of Paramedics and other Health Care Providers, need to educated them on the possible problems associated with take-overs... and not let them be hoodwinked by those whom may be in it for other reasons.

I say... lets take over the Fire Services... lets at least save our communities in the duplication of the administration costs (we provide district services... not duplication in every community), lets streamline their services and use some of their extra funding to increase ours and put the well needed funds into getting ALS care into our communities... :wink: :wink:

We don't want to be Fire Fighters nor Police Officers, and they sure don't want to be Paramedics... but we might be able to save our communities some funds if they ran their services like we do in EMS.

Who is cost effective... EMS.

Who needs to show cost effectiveness.... ???

Nobody likes the fire department until it's time to move the patient to the cot.

chazmedic, despite my rants... I truly do like our Fire Department, they are an awesome group of guys and do a tremdous job. I just can't understand how the IAFF president can spew this balony... and have no respect for him or his followers in their stated attempt to secure job positions despite the consequences to EMS.

[ffpm41]

Most West Coast fire departments provide EMS. Having worked in both sides, 3rd service and fire departments, I'd have to say it's not about what kind of department you work at but the type of people working in your department. I have seen EMT/medics that were great and sucked in both situations. I am a medic that is a firefighter too, and love it.

If my district was covered by privates or 3rd service we would have 3 transport units spread out over 120 sq mi. as opposed to 5. I don't understand why people always have to talk down about firemedics or medics. We are all out for one thing, the better good of our citizens.

[Dustdevil]

Having worked in both sides, 3rd service and fire departments, I'd have to say it's not about what kind of department you work at but the type of people working in your department. I have seen EMT/medics that were great and sucked in both situations. I am a medic that is a firefighter too, and love it.

I agree with you, but you are missing the bigger picture. The problem with fire based EMS is not necessarily the level of care they provide. You're right, that is dependant upon the individual practitioner. The problem is how fire based EMS as a system (not as a collection as individual practitioners) keeps EMS as a whole from progressing into a profession on so many levels.

Fire based EMS is an afterthought, not a profession. Fire is the profession.

Fire based EMS is run by those with concerns other than medical concerns, leaving medical concerns inadequately managed.

Fire based EMS is dependant upon a fast, unsophisticated, technical training program. There simply aren't any big city fire chiefs out there who would want EMS if it took two to three years of FULL TIME education to become a paramedic. Consequently, they use political influence to assure that our educational standards remain the lowest in the civilised world.

So yeah, fire based EMS is certainly capable of providing the lowest acceptable level of service and maintaining it. Some -- although very rarely in a big department -- even excel. This is the case in many suburbs. But the fact is that fire based EMS is one of the leading causes of stagnation in EMS and a major stumbling block to the elevation of the profession. Like it or not, that is indisputable fact.