FireMedic049

I absolutely agree that EMS personnel can be trained to provide care in a "rescue" situation and the examples you provided are clear examples of that. However, where a truly integrated full service system has an advantage is in the control/oversight of the personnel involved. When you have multiple independent agencies involved in the process vs a single agency, do you necessarily have the same level of assurance that the personnel involved in the "rescue" are adequately trained for it? I'm quite familiar with Pittsburgh EMS's rescue service since they are in my region and have several friends in both Fire and EMS in Pittsburgh. They are certainly capable of providing competent full service EMS, however one thing lacking in their system is true flexibility. In their system, non-structural fire related "rescue" is the exclusive domain of the EMS. What this means is that if you were in a MVA in Pittsburgh in front of a fire station and trapped in your vehicle, you would have to wait until one of the two city-wide heavy rescues (staffed with 2 paramedics) arrived to be extricated from your vehicle.

I have checked out their website in the past and you've proved my point. They may be a high quality EMS system, but they are not an integrated full service EMS agency which was pretty much the basis for the opinions in the video. I can't say how many, but every EMS agency I've been associated with offers this in some fashion.

FYI, fire-based EMS does not exclusively translate into fire-base EMS transport. Couple of points.Healthcare in this country is not government run (except for maybe the VA and military facilities). As such, these "private" healthcare systems from a financial standpoint, benefit most when a 911 patient is transported to their facility (they get to bill them or their insurance). Preventing what are essentially "customers" from using their facilities and services runs counter to basic business principals. Like it or not, at the executive management level, healthcare is typically about money first, patient second. I wholeheartedly agree that EMS should be able to do things to facilitate reduced ER visits for "minor" issues. Unfortunately, our litigation happy and egocentric society prevents a lot of this. I frequently transport patients that don't need to be transported via ambulance and/or could be adequately served by an urgent care center or their PCP. This happens because our hands are figuratively tied on the matter and it's simply a lot less of a hassle to just take them to a nearby hospital than to "refuse" to do so and deal with the "battle" and PR issues that that can create. The "E" stands for "emergency" for a reason - dealing with prehospital emergent and urgent care is where EMS started and where it should stay. Now this doesn't mean that an EMS agency shouldn't be involved with preventative care, outreach, education and some of those other things. However, it should be handled for the most part as something separate from the emergency response part of the operation. And believing that it is only for self-preservation is at least equally naive.

Yes, but are they a fully self-sufficient EMS system? If they are providing their own rescue services along with patient care on an incident, then I would submit that they are more of an exception rather than the rule. That's kind of the point of the video - integrated full service EMS delivery by a single agency. Most non-FD EMS agencies are not capable of providing that.

I don't believe that was the message of the video. The message I saw was that fire based EMS was the "best" way to go. Other than pointing out the fact that non-fire based EMS typically doesn't have the ability to provide full service care from start to finish like fire-based EMS can, how was it a disservice to them? You are correct that putting the patient first and providing excellent care matters most. However, in many situations providing excellent care means that you have to take the care to the patient and doing that requires more than just showing up with an ambulance and some medical equipment. Typically, non-fire based EMS is not trained and equipped to provide care at the point of contact in all "rescue" situations. This inability could translate into providing the patient less than "excellent" care overall.

As a non-IAFF member, you are in no position to comment on what the IAFF's primary concern is or any concern for that matter. Fire-based EMS does more than what you claim. Fire-based EMS involves more than just first response services. In some departments it may be just BLS or ALS first response. In some departments it may be BLS and/or ALS transport. In some departments it may be a combination of some sorts. Additionally, in some departments the transport aspect of their EMS is actually provided by non-firefighter personnel.So, to say the result of fire-based EMS is "FORCED ALS" is quite misguided, especially considering that many fire departments are not running ALS fire apparatus. So fire-based EMS results in "forced medics" and that's "bad"? I would tend to agree that a person who is "not interested" in a particular task, may not perform as well as one who is. Well, let's look at this from a different angle.I'm not aware of any fire department that actually "forces" it's firefighters become paramedics, however I am aware of a fair number of fire departments that require their prospective recruits to be paramedics. I suppose I could be wrong about the force thing, but requiring that applicants be paramedics is not actually "forcing" someone to be a paramedic. It simply means that if a person wants to be a firefighter in that particular fire department, then they will need to become a paramedic. There are still some fire departments that do not routinely provide EMS response (mine being one of them). What about firefighters that only care about going to fires being forced to do other things like vehicle/technical rescue, hazmat response, building inspection/code enforcement, fire prevention/education services among other tasks? Maybe we should have separate departments and personnel to handle these things since "being forced" to do something is so "bad"? How is the provision of EMS in the FD so different from the provision of any of these other non-fire things in the FD? Why is it acceptable to require a firefighter to be trained for, respond to and operate at a hazmat incident, but not acceptable for them to be trained for, respond to and provide care at an EMS incident? Maybe you should expand your horizons and become well versed in EMS history also. If you would do so, then you'd know that many of the first paramedics trained in the US were firefighters. Johnny and Roy may have been fictional characters in a 1970s TV show, however there was nothing fictional about paramedic-firefighters in the LA County FD in the 1970s. You'd know that many FDs have been providing EMS in some fashion for 40+ years, long before anybody had the inkling to accuse them of "call padding", "justifying jobs" or any of the other ridiculous assertions of un-altruistic motive.

Is it necessarily any different than car dealers selling multiple brands?

From my understanding of the intended use along with info in other posts, this engine and an ambulance are housed together and primarily serve a large portion of an interstate. The engine is intended to be a secondary transport option for them given the fact that the next due ambulance isn't just "down the block". I'm unclear as to whether or not this will also be a rescue pumper, however if it is, they are a county FD and would more than likely have other ambulance(s) responding to transport and additional fire resources coming too, plus there's a pretty good chance that a patient with life threatening injuries would be flown by helicopter off the interstate.

So what would be the correct staffing for them? My question to you, which you didn't answer, was not an I'm right, you're wrong kind of thing. You asserted that the use of this vehicle was "plain silly and dangerous". I was simply asking why you felt that way and was hoping for a reasonable answer explaining what was "silly" and what was "dangerous" about the operation of this vehicle. Maybe you were seeing something that I wasn't? There was no need to make the half-hearted concessionary statement as if I'm being the "unreasonable" one unless you have nothing to substantiate your claim.

Why is it "plain silly and dangerous"? Uhhhhmm, they do. As was mentioned earlier in the discussion, this station's primary response area is a large amount of an interstate, has an ambulance assigned to it and the unit in question is to be a secondary option for transporting patients.

Sure, but is this that much different than being pushed sideways in a hard turn? Well............Pretty all of the public buses in my area have some sideways seating and it does get used. Stretch limos have some sideways seating. Some private jets have sideways seating. I've even seen sideways seating in some fire trucks and pretty much every ambulance has it for the care providers in the back. How do you know for sure that a patient transported in this unit will not get a safe, comfortable ride? I'm not interested in arguing either, but I will challenge what I think are essentially baseless or incorrect assertions.

True, some aspects of a vehicle fire, specifically the fuel is Class B. I'll concede that the synthetics may not be Class A, but I really don't think they qualify as a flammable/combustible liquid or gas. That aside, you'll find lots of foam and plastics in building fires and plain water, CAFS and other Class A foam products seem to work, so I'm not sure if Class B foam is necessarily the better option.Sure, in all likelihood an ambulance will not be carrying much water/foam, but is that necessarily a problem if the goal is occupant protection vs actual extinguishment? Maybe in some cases it won't be enough. Is it better than a handful of extinguishers? I don't know, but it's definitely better than nothing or the state required fire extinguisher for an ambulance. Yes, I'm aware of this, however I don't believe this is what he appeared to be talking about and definitely wasn't what I was referring to. He appeared to be referring to ambulances with firefighting capability (small CAFS units) replacing suppression units and that it was not an isolated situation. I don't believe that's happening.

Probably not since it's a secondary transport unit. A reserve engine is probably put in service, so only the secondary transport aspect is lost. How do they feel riding backwards? Is this really that much different than the patient being moved sideways because of a hard turn? Besides, if a hard stop throws your patient off the board/cot, then you didn't secured them properly.

Your experience may not have been favorable with medium duty ambulances, however my 10 years experience working in them along with working in pretty much every (american) style ambulance over 18+ years says they work very well as an ambulance. What is it that they "don't do well" regarding having a CAFS unit on board? Sounds like a design problem to me. The ones I've worked in have had just about everything I needed within arms reach. Depending on what's being put on, where's the problem with carrying more stuff if you aren't leaving something essential off the unit or overloading the vehicle (weight wise)? Please show us where this has taken place. I seriously doubt that any significant number of meetings has taken place where somebody is legitimately trying to eliminate a full-fledged suppression unit in favor of an ambulance with CAFS.

I don't believe that all car fires are class B fires. Class B is flammable or combustible liquid/gases. The vast majority of vehicle fires I've dealt with have not directly involved Class B materials and plain water has easily extinguished them. So I'm not quite following your thought.

What corners are being cut with EMS by deploying this vehicle? An ambulance is the primary transport unit for that area. The engine is a secondary transport unit option. If FL EMS laws are anything like PA, then the unit would have to meet all of the requirements that ambulances have to meet in order to transport a patient - including the appropriate certifications for those staffing the unit.

I can't say how it will work out and don't know much about their operation. As for doing the transport in this unit, I suppose it's probably better than sitting on scene for 20+ minutes with a critical patient waiting for an ambulance to get there. Why is CAFS on an ambulance dumb? How does CAFS on an ambulance leave you with "a vehicle that doesn't do either job well"? What are the two jobs that it isn't doing well? An EMS and Rescue service near me acquired two atypical ambulances a year or so ago. (A little background - The service a large township (with lots of MVAs) operating traditional ambulances and a heavy rescue style vehicle. Back when they started, they provided the rescue services to the township, predominately with home response personnel including people who were also FD members. Over the years, the various VFDs in the township have over-duplicated the rescue services. These days, they are mostly a career department and I don't think they rely on "off-duty" personnel to staff the unit, so there are times in which their rescue may not be able to respond and are reliant on the VFDs. However, the VFDs suffer from the same response issues that most other VFDs do and are thus inconsistent with their responses.) The two ambulances are on medium duty chassis and have a small CAFS system and a HRT with a small power unit. Aside from having a different layout, the units are fairly identical to units I've operated at other EMS agencies and have performed well as an ambulance. Now if these units were designed to replace a structural pumper and a heavy rescue truck, then sure they'd have a hard time doing those jobs well. However, they weren't designed to replace those units. They were designed to address the response issues of the VFDs. The CAFS is not for fighting a house fire, it's predominately for patient/crew protection in the event of a MVA/vehicle fire. The rescue tools carried are not intended for them to work a heavy entrapment by themselves (and then clean up before transporting), they are predominately intended for minor extrication situations, like a simple door pop, where the VFDs are slow to respond and their rescue doesn't have staffing. They can quickly pop the door and get on with taking care of the patient instead of "wasting time" waiting for them to arrive and perform a "30 second extrication". Seems to be working so far. Combination units do typically tend to represent a certain degree of compromise compared to separate units, but that doesn't necessarily automatically translate into not being able to do different jobs well. Sometimes they aren't intended to do everything and can do what a department needs them to do quite well.

From what I recall regarding this unit on another forum, this unit is going to more remote location in the county along I-95 that doesn't have an ambulance assigned to this station. Supposedly, the engine will not be a primary transport unit, but was given the ability to do so if need be.

If it makes you feel any better, I just read this thread and recognized the quote immediately. Good stuff.

I made no such implication. I clearly stated that under both the current system and the proposed system, a career staffed unit would be responding to each call. The issue in question is the volunteer response to these incidents. Under the current system, 15% of the time a unit from the VFD itself and staffed by volunteers did not respond, however a career staffed SFRD unit did. Under the proposed system, 15% of the time a unit from the "VFD" staffed by career FFs will respond, but no volunteer staffed unit will respond. The primary difference between these two situations is this: in one scenario the VFD looks bad because their apparatus did not leave the station and in the other, the "VFD" looks good because their apparatus responded to the call and created the illusion that the volunteers responded to the call. I don't think anybody is necessarily disputing the fact that there are calls that do not require more than one engine. What is in dispute is whether or not this new system will actually change anything or just make it look like it did. The career response aspect is basically a wash since 50% of the time, the career response would be the same as now and the other 50% it would be with one less FF. The only other difference would be the apparatus being used for the response - one belonging to SFRD vs one belonging to the "VFD". The volunteer response would still be very much in question unless each station is going to be staffing volunteers in-station 24/7 because otherwise nothing has changed except the name on the apparatus and the employer of the career FFs. Oh yeah, there's still that issue of where the new career staff will be coming from. Will it be from the current roster of volunteers and even further impact the volunteer response in a negative fashion? Additionally, the reason a career staffed unit is responding in those areas now is because of the lack of response to calls by the volunteers. An 85% response rate by any Fire Department is something to be ashamed of.

You just did the same thing that you accused them of. Unless, the volunteers in the new department will be staffing their stations 24/7 (in conjunction with the career FFs), the residents will still need to worry about that 15%. The 15% refers to the number of times that the volunteers (in that district at least) opted not to provide a response for an incident. As I understand things, the North Stamford residents are already getting a career response to all incidents from SFRD units (with higher staffing levels than what is proposed for the new "VFD"). Integrating career FFs into the current VFDs rather than having them staffing separate SFRD units as they do now isn't "solving" the volunteer attendance issue. In fact, I think it's highly probable that volunteer attendance could decrease - specifically on the lower priority calls because the volunteers would know that their apparatus would still respond to the call even if the volunteers didn't respond. Maybe you think that an 85% response rate is "pretty good", but I think the citizens would disagree - particularly those whose incident falls into that 15%. Anything less than a 100% response rate from a Fire Department is more like "not good enough". That might be true, but I think there's still "something to argue about" with the article as it is given that you were trying to make the argument that the article was skewing and ignoring the facts.

The "benefit" that comes from this is not specifically for the kid. The "benefit" is the deterrence of other kids doing the same thing because they see the consequence of doing so, essentially the "scared straight" factor. Reducing and/or eliminating these incidents also have "benefit" for us and the community by not having units responding to unnecessary calls and the potential risk involved regardless of how careful we drive. I agree, he's only 12, but 12 is absolutely old enough to know right from wrong on something like this (and a number of other things too). As mentioned, he will likely get pleaded down to a minimal charge and that's fine for the most part, at least for a first offense, however there's a good chance that "the point" was made. Without knowing more about this particular facility, I'd assume that pointing them "in the right direction" is a primary intent of the program and the kids may already be being directed towards community service duties and mentoring opportunities. As far as "social responsibility" with these kids goes, at what point should they become socially responsible for themselves and their actions? In order for society to "rehabilitate" them, they have to be a willing participant. Kind of like dealing with a person with an addiction. If they haven't reached the point of wanting to change their ways, then there's really not much you can do. Without that willingness to and active participation to change their behavior, it's no longer about society not caring about them. Personal responsibility/accountability for one's actions has to be an early and integral part of the process.

We have seen similar results with a facility like this in my city. Most of the kids are "troubled youth" and some are now ones that would normally be in the Juvenile Detention facility, but due to space issues get transferred to this facility instead. We frequently ran fire alarms there for all sorts of stuff - pull stations, smoking and other malicious acts that would trip detectors. Multiple trips per week and sometimes per day. Between us and the PD we started to prosecute the ones responsible and now the alarms there an infrequent occurrence. Not sure whether they have been charged with felonies or misdemeanors or what the final outcome is, but once charged they are removed from the facility (with the support of the staff/admin) and moved to less favorable accommodations elsewhere. If I'm not mistaken, they've had a few instances in which they will hold "roommates" accountable for an incident (within the shared room) if there's no clear proof of who did it and nobody will confess or point the finger. Typically that's enough incentive to get things sorted out quickly. I agree that these kids being convicted of a felony (in most cases) for merely pulling a fire alarm (assuming no pattern of such behavior) is a little extreme, but there has to be real consequences for this type of behavior that puts others at risk.

Who is the "we" that you are referring to? The fire service I'm familiar with does focus on the victim and their family when tragedy strikes one of our own.

I think you may be using the wrong term. The act of turning 21 doesn't suddenly make one "qualified" to drive fire apparatus, it merely makes one "eligible" to drive fire apparatus (after proper training of course).