"You Can Cancel Fire"

[antiquefirelt 994]

Thankfully no private commercial EMS units do emergencies in our City, we are a true Fire/EMS dept. with full ALS and three transport units. The private services in our area are basically transfer trucks, with the exception of one who contracts to 3 towns and another that provides Paramedic coverage as needed to contract towns. Conversely to the way it sounds happens in your areas, our FD ambulance goes to most calls with only twp personnel and call for an engine assist as needed. We do run an engine to all MVA's, cardiac or resp arrests, any unconscious calls and any construction of industrial accidents. Similarly to some of the responses here, we do not cancel per PD or anyone but our personnel, but we do downgrade to non-emergency. We feel this is the best scenario, in that we arrive to help if needed, but do reduce our liability but not running lights and sirens after being advised we're not needed.

I think it would be interesting to see the statistics for places where EMS cancels the FD, I'm betting thats not happening nearly as often as the FD arrive first. If we did have private EMS I'd gladly cancel other than the MVA's as BNECHIS indicates. In fact if you guys could catch us before we left the house that would be just perfect! Sadly most politicians will never understand that how many runs the engine goes on has very little bearing on the number of firefighters it takes to properly staff the same engine.

[Guest FireChick4089]

If an ambulance says that on Poughkeepsie Fire - they just wasted thier breath and my air time.

When I have gone to EMS calls in the c/ Pok I love City Fire being there. Mostly because its not my agencies primary area and they are there when we arrive and from what i've experienced they are very helpful and know what they are doing!!!

[Goose 188]

When I have gone to EMS calls in the c/ Pok I love City Fire being there. Mostly because its not my agencies primary area and they are there when we arrive and from what i've experienced they are very helpful and know what they are doing!!!

Thats great but the fact is, when the City got busy, I was not going to tie up an engine on some sick call or someone who wants to be transported because they lost a tooth (actually had that there). Like i said, i cancelled them on a few occasions, and while i apparently wasted air time and my breath i never got an ounce of grief from anyone. In fact, on at least one occasion i was thanked by them.

I think 137 had a solid reply that really gets to the heart of it. But i'm biased, i'm a proponent of a third service.

Just glad i don't have to deal with it now.

Edited February 25, 2009 by Goose

[NYMedic37 22]

OK, lets say EMS arrives on a scene, cancels the responding FD, the responding FD still continues in and in the meanwhile, a structure fire comes in and now the apparatus is stuck on an EMS job where they are not needed. If its my house on fire, I would be pretty pissed if the fire appartus was tied up on an EMS job (where they are not needed) and out of the response area for a real fire. Lets all call a duck a duck.... Its all about sending FD on more runs to pad the stats.

[helicopper 1,050]

Sorry but i believe FD is dispatched because they can get to scene quicker then EMS (maybe not all the time but most times). As far as cancelling if EMS can't cancel FD then it is a wasted transmission and a waste of time

The whole premise for fire first response (not Fire/EMS but first response) is that they can get there before the responding EMS units. The point of this thread is not to debate the merits of such systems (the benefit of extra hands or EMS trained people arriving is tried and true!) but rather the unnecessary responses when EMS is first on scene and determines that no additional assistance is required.

If EMS can't cancel FD, there's something wrong with the system. There's no reason to keep units running to jobs unncessarily. It's not wasted breath or air time to inform responding resources that the situation is under control and their assistance is not required. If they choose to continue their response because that's their policy fine, but they don't need to respond with lights and siren anymore. If they continue to respond with lights and siren even after being informed the situation is under control, the liability is on them. Just like it is appropriate to say "we have a cardiac arrest" so everyone knows the status and can expedite their response to render assistance.

You can't rely exclusively on EMD; as someone else posted the EMD is only as good as the info provided by the caller. There are plenty of people who say what they think will get them a faster response and there are plenty of stupid people who simply don't have a clue.

The NRFD policy is logical and well thought out. It allows for the cancellation of resources that are not required - after a thorough assessment - but not for calls that are outside of the EMS area of expertise. So is the FDNY policy - if EMS gets there first, the CFR engine is automatically cancelled except for certain types of calls.

bnechis, one question though - if PD or EMS gets there and the MVA call is unfounded (not no patient but not there) do you still continue to respond?

As for padding numbers, some agencies (PD, FD, EMS) may do that but I would venture to guess that it's the minority. Padding numbers may inflate egos or puff up people who think numbers are important but it won't make a department better!

[Bnechis 3,961]

.... Its all about sending FD on more runs to pad the stats.

When we've told our city manger that runs are up 140% in 20 years (been doing EMS over 30), his and the 2 previous managers have said they dont look at our stats, they could care less. Our justification is there without EMS, we do EMS because its the right thing to do.

[NYMedic37 22]

When we've told our city manger that runs are up 140% in 20 years (been doing EMS over 30), his and the 2 previous managers have said they dont look at our stats, they could care less. Our justification is there without EMS, we do EMS because its the right thing to do.

So what if Fire arrives on the scene first and trys to cancel EMS? Should EMS then say "Fire can't cancel EMS, lets continue in" even if we're not needed. After all, were a private ambulance.....we're not gonna' let a municipal fd cancel us!

[Goose 188]

The bottom line is EMS can do their job - and do it well- without the Fire Department, despite what some here may think. Given that, EMS should have full discretion of what resources they require on their assignments.

[Bnechis 3,961]

bnechis, one question though - if PD or EMS gets there and the MVA call is unfounded (not no patient but not there) do you still continue to respond?

They can cancel, most times we are less than a minute out, so we drop to non-emergency mode and may continue in to assist in looking for the incident, since often we find its not unfounded, but the incident information was incorrectly given/obtained. This is at the discretion of the company officer.

Edited February 26, 2009 by Bnechis

[JohnnyOV 2]

So what if Fire arrives on the scene first and trys to cancel EMS? Should EMS then say "Fire can't cancel EMS, lets continue in" even if we're not needed. After all, were a private ambulance.....we're not gonna' let a municipal fd cancel us!

I couldn't even think of a more illogical statement to be thought of, on both sides. Who cares if it is commercial or public and what not. Down here its run with public fire and commercial private ambulance for the entire county. If one unit shows up to the scene first and determines the other is not needed, they are turned around, and a trip sheet is documented to show that.

It seems absurd that there is even a debate on this. If you're not needed, go back in service. Same thing applies with fire scenes here...turn 'em around if they're not needed.

[Bnechis 3,961]

So what if Fire arrives on the scene first and trys to cancel EMS? Should EMS then say "Fire can't cancel EMS, lets continue in" even if we're not needed.

We only cancel EMS if there is no patient (left prior to arrival or never was a patient) or this is a lift assist with no medical/trauma issue (FD is disp on these not EMS). If in the FD officers assesment (all are EMT's) the patient might be an RMA, then EMS is not canceled and we have EMS perform the RMA.

They want to continue in...fine. Rare to see it happen.

After all, were a private ambulance.....we're not gonna' let a municipal fd cancel us!

Do they work for the municipality or they just free lancing this contract?

The Commercial service wants to keep the municipal contract. Show enough attitued and they tend to bounce the EMT or Medic to another contract location or transports.

[Guest alsfirefighter]

Maybe it would be best if the fire department fought fires instead of justifying their jobs by going on EMS runs where they are not needed.

Good thought I guess spoken from a 3rd party service experienced person. Also some of the best systems in the country are fire based...not to mention that the first ones to really step up to do EMS when it was born was FD's. The mistake was how some gave it away, had it stripped or it was absorbed by other agencies (who often can no longer keep up with the volume or the monetary needs...except for profit often sadly).

Goose...you...biased towards third service...nooooooo. But you know I'm biased towards fire based systems. True fire based systems consisting of tiered response of BLSFR and transport capability. I know the song out there "I shouldn't have to be a firefighter to be a paramedic....but for all you budget people out there...dual role personnel do make the most sense and in true fire based systems...even management comes from the system and it works.

Seth's original point warrants some significant merit. The system I am in is often nuts...1 agency provides ALS with personnel from 2 agencies..the 3rd party and the FD personnel that operate within their system. Then their is the VAC, and the FD also provides BLSFR...which is a separate issue in some regards to me but that comes down to management issues that some other agencies experience with persons not involved or ever had a clue about EMS and closed minds.

Anyways...the FD started BLSFR prior to even having any ALS in the area because the VAC was having significant personnel issues. They slowly regrew and became stronger and had this huge anti FD BLS sentiment (the "they want to take over everything" battle cry which is utterly ridiculous). There were often many times when persons not even on scene or even at the VAC when picking up a bus or completing a crew would cancel the BLSFR response. So at times it does deserve scrutiny under QA/QI or to have supervisors if able to look into some of the decisions being made and if they are patient based or attitude based.

[Bnechis 3,961]

The bottom line is EMS can do their job - and do it well- without the Fire Department, despite what some here may think. Given that, EMS should have full discretion of what resources they require on their assignments.

So in a system that provides an ambulance with an EMT & medic they can provide the same level of service and the same call to door time as a system that sends an ambulance with an EMT & medic plus two or three FF/EMT's (even if to just help carry all the bags/patient back to the rig).

Unfortinatly, there are a lot of EMT's and medics in EMS who have less experience than they would like to believe. NYS DOH claims the average medic has less than 4 years experience and the average medic only does 1 refresher before expiring and leaving EMS.

A number of years ago I responded on an engine (2 EMT's and Myself) to a reported Diff Breather at 3am. Pt was in mild CHF, with all the normal findings for that type of patient. I knew the patient well having treated him 2 times before. When EMS arrived, he was on O2, and I was taking a 2nd BP. I gave a very complete report to the EMS crew including both sets of vitals (which they saw me completing) HX, PA, Rx, etc.. The crew took our BP cuff of the Pt. and placed theirs on him and started to take the pts BP. The patient asked why were they doing that since I had just given them 2 sets. The EMT advised the Pt. that they could not "Trust a firefighters ability to do it" (This answer surprised me, if they had said "company policy" what happened next would never have been an issue). The patient got very angry and told the crew that he would trust the fire officer who's been a paramedic instructor since long before this crew hit puberty. I was pretty surprised at his statement, but they were really shocked. The patient happened to be a retired cardologist and I had treated many of his patients.

Where do EMT's & Medics who work for commercial service go when they leave commercial EMS. They become FF's, PO's, RN's, PA's etc. And many of them are active on EMTBravo. So just because you think we are just firemen...............maybe we have a clue.

[Bnechis 3,961]

The system I am in is often nuts...1 agency provides ALS with personnel from 2 agencies..the 3rd party and the FD personnel that operate within their system. Then their is the VAC, and the FD also provides BLSFR...which is a separate issue in some regards to me but that comes down to management issues that some other agencies experience with persons not involved or ever had a clue about EMS and closed minds.

Thats not a system (no offense).

[Guest alsfirefighter]

Thats not a system (no offense).

None taken brother. But in a nutshell...while crazy...it is in fact a system. Just because its dysfunctional doesn't mean its not a system. lol

[Remember585 815]

What about FD cancelling EMS?

What about PD cancelling EMS?

Ahh.....more to discuss / debate.

As a currently expired EMT, if I am an FD IC I am not cancelling EMS. No way, no how. I don't want that liability. Today, we had a minor MVA and we had a Mutual Aid ALS unit coming. Under the recommendation of my CFRs I cancelled ALS, and the guy RMA'd with EMS on their arrival. If I had nobody with EMS certification there, I wouldn't of said a word. Even though I was a CFR for two years and an EMT for almost 12 years, since I don't have my certification right now, I am nothing more then a CPR / First Aid guy.

[Goose 188]

I couldn't even think of a more illogical statement to be thought of, on both sides. Who cares if it is commercial or public and what not. Down here its run with public fire and commercial private ambulance for the entire county. If one unit shows up to the scene first and determines the other is not needed, they are turned around, and a trip sheet is documented to show that.

It seems absurd that there is even a debate on this. If you're not needed, go back in service. Same thing applies with fire scenes here...turn 'em around if they're not needed.

I think he was making light of an earlier comment (a very condescending comment) about commercial (what being commercial has anything to do with it is beyond me) EMS canceling municipal fire.

[helicopper 1,050]

As a currently expired EMT, if I am an FD IC I am not cancelling EMS. No way, no how. I don't want that liability. Today, we had a minor MVA and we had a Mutual Aid ALS unit coming. Under the recommendation of my CFRs I cancelled ALS, and the guy RMA'd with EMS on their arrival. If I had nobody with EMS certification there, I wouldn't of said a word. Even though I was a CFR for two years and an EMT for almost 12 years, since I don't have my certification right now, I am nothing more then a CPR / First Aid guy.

You wouldn't even inform the incoming unit that it was a possible RMA or minor injury?

It is not unreasonable to share your size-up with EMS and/or PD and not just the fire service on FD radios. Since we're not all on the same frequencies, it is the IC's responsibility to make sure that all resources under his/her command have all the information necessary.

QUOTE(Goose @ Feb 25 2009, 04:00 PM)

The bottom line is EMS can do their job - and do it well- without the Fire Department, despite what some here may think. Given that, EMS should have full discretion of what resources they require on their assignments.

So in a system that provides an ambulance with an EMT & medic they can provide the same level of service and the same call to door time as a system that sends an ambulance with an EMT & medic plus two or three FF/EMT's (even if to just help carry all the bags/patient back to the rig).

You can't tell me that you treat a cardiac arrest or other similarly difficult call with a crew of two as well as you would with a crew of two and assistance (whether PD/FD/other). If you want to tell me that you'd call another EMS unit, I'd say that now you're taking another EMS unit out of service so you're using TWO units for the same call, hardly an efficient process.

What about the situations where the paramedic from a fly-car is forced to ride in with a patient alone because the transporting agency could only field a driver (who may or may not even be an EMT)? Hardly EMS doing their job well. I understand your sentiment about EMS but there are plenty of systems with tiered responses that are exceptional and plenty of EMS only systems that really suck.

I'll grant you that if you're the IC at the call (if you're there you're the IC) you should have the ability to request/cancel resources as necessary.

QUOTE(Chris192 @ Feb 25 2009, 07:05 AM)

bnechis, one question though - if PD or EMS gets there and the MVA call is unfounded (not no patient but not there) do you still continue to respond?

They can cancel, most times we are less than a minute out, so we drop to non-emergency mode and may continue in to assist in looking for the incident, since often we find its not unfounded, but the incident information was incorrectly given/obtained. This is at the discretion of the company officer.

An agency that's not afraid to turn off it's lights and sirens to continue responding to non-emergencies. Pity more don't operate that way.

[NYMedic37 22]

The bottom line is EMS can do their job - and do it well- without the Fire Department, despite what some here may think. Given that, EMS should have full discretion of what resources they require on their assignments.

Well said!

[NYMedic37 22]

I couldn't even think of a more illogical statement to be thought of, on both sides. Who cares if it is commercial or public and what not. Down here its run with public fire and commercial private ambulance for the entire county. If one unit shows up to the scene first and determines the other is not needed, they are turned around, and a trip sheet is documented to show that.

It seems absurd that there is even a debate on this. If you're not needed, go back in service. Same thing applies with fire scenes here...turn 'em around if they're not needed.

Makes perfect sense to me...

[Goose 188]

You wouldn't even inform the incoming unit that it was a possible RMA or minor injury?

It is not unreasonable to share your size-up with EMS and/or PD and not just the fire service on FD radios. Since we're not all on the same frequencies, it is the IC's responsibility to make sure that all resources under his/her command have all the information necessary.

So in a system that provides an ambulance with an EMT & medic they can provide the same level of service and the same call to door time as a system that sends an ambulance with an EMT & medic plus two or three FF/EMT's (even if to just help carry all the bags/patient back to the rig).

You can't tell me that you treat a cardiac arrest or other similarly difficult call with a crew of two as well as you would with a crew of two and assistance (whether PD/FD/other). If you want to tell me that you'd call another EMS unit, I'd say that now you're taking another EMS unit out of service so you're using TWO units for the same call, hardly an efficient process.

What about the situations where the paramedic from a fly-car is forced to ride in with a patient alone because the transporting agency could only field a driver (who may or may not even be an EMT)? Hardly EMS doing their job well. I understand your sentiment about EMS but there are plenty of systems with tiered responses that are exceptional and plenty of EMS only systems that really suck.

I'll grant you that if you're the IC at the call (if you're there you're the IC) you should have the ability to request/cancel resources as necessary.

An agency that's not afraid to turn off it's lights and sirens to continue responding to non-emergencies. Pity more don't operate that way.

Vast majority of places ive worked never had FD response and i never saw patient care suffer - with the exception of a handful of incidents where i was being requested M/A to a distant town with no ALS fly-car FD first response would have been helpful to bridge the gap.

On an arrest the shift supervisor would be requested if he/she didn't already respond upon dispatch. As for making the medic ride a job in, i moan and complain about it all the time. Pay people, period.

Is it really all that big of a surprise that in some systems patients receive appropriate pre-hospital care without a fire department response?

Having less than 4 years experience does not necessarily make someone a bad provider. There are people out there with cards 10+ years who are less than stellar. Just because a firefighter doesn't put out 3rd Alarm fires every other day are they bad firefighter? No, i think that would be an awfully unfair assessment.

Likewise, there will be crappy experiences on both sides, no matter where you go. About 5 years ago i did a "man down," pulled up FD told us the guy was DOA...turns out he was very much alive, hypothermic but alive. Bad experience for sure, but who cares? We can sit here all day and go back and forth - there are knuckle heads on both jobs.

I never accused anyone of not having a clue, but I'm tired of hearing how i need or should have a fire department respond because without them i apparently can't do much but drive the freaking ambulance.

Edited February 26, 2009 by Goose

[NWFDMedic 58]

A number of years ago I responded on an engine (2 EMT's and Myself) to a reported Diff Breather at 3am. Pt was in mild CHF, with all the normal findings for that type of patient. I knew the patient well having treated him 2 times before. When EMS arrived, he was on O2, and I was taking a 2nd BP. I gave a very complete report to the EMS crew including both sets of vitals (which they saw me completing) HX, PA, Rx, etc.. The crew took our BP cuff of the Pt. and placed theirs on him and started to take the pts BP. The patient asked why were they doing that since I had just given them 2 sets. The EMT advised the Pt. that they could not "Trust a firefighters ability to do it" (This answer surprised me, if they had said "company policy" what happened next would never have been an issue). The patient got very angry and told the crew that he would trust the fire officer who's been a paramedic instructor since long before this crew hit puberty. I was pretty surprised at his statement, but they were really shocked. The patient happened to be a retired cardologist and I had treated many of his patients.

That's a funny story. I know I often find myself in the same situation as a medic if I'm responding to an area that I don't know. If I'm going to be treating a patient with medications, I'm definitely going to take my own set of vitals, but there are plenty of ways to explain why rather than saying you "can't trust" another provider. Sometimes something so simple as taking a B/P on the other arm can be a good way to explain to a patient why you are taking another B/P. Or explaining that we like to watch for trends in vitals if the first responder didn't just take vitals. Or maybe something so simple as saying we generally check vitals when patient care changes hands (note that we generally DO do that, as do hospitals, etc.)

I actually did just this on a call in the City of Poughkeepsie a month or so ago. I didn't know the FD crew at all, they gave me correct vitals and a competent report (in fact, they were spot on) but not knowing them, I wanted a set for myself... especially for a patient who I thought might be having an MI. My course of action was to build in a few minutes by doing an EKG and a 12 lead, then rechecking B/P. When the patient asked why I was taking a B/P again, I told him we were looking for trends and it had been about 5 minutes since last vitals.

[helicopper 1,050]

That's a funny story. I know I often find myself in the same situation as a medic if I'm responding to an area that I don't know. If I'm going to be treating a patient with medications, I'm definitely going to take my own set of vitals, but there are plenty of ways to explain why rather than saying you "can't trust" another provider. Sometimes something so simple as taking a B/P on the other arm can be a good way to explain to a patient why you are taking another B/P. Or explaining that we like to watch for trends in vitals if the first responder didn't just take vitals. Or maybe something so simple as saying we generally check vitals when patient care changes hands (note that we generally DO do that, as do hospitals, etc.)

I actually did just this on a call in the City of Poughkeepsie a month or so ago. I didn't know the FD crew at all, they gave me correct vitals and a competent report (in fact, they were spot on) but not knowing them, I wanted a set for myself... especially for a patient who I thought might be having an MI. My course of action was to build in a few minutes by doing an EKG and a 12 lead, then rechecking B/P. When the patient asked why I was taking a B/P again, I told him we were looking for trends and it had been about 5 minutes since last vitals.

I'd call that professionalism. There's no reason to say you don't trust another provider just because you wear a different uniform. That was just stupid; perhaps a sign of immaturity.

[antiquefirelt 994]

The bottom line is EMS can do their job - and do it well- without the Fire Department, despite what some here may think. Given that, EMS should have full discretion of what resources they require on their assignments.

I find this interesting, since most of the systems in our area do not have any excess in personnel or units, so if you're stuck on the 5 th floor with two ton Tessie, you'd be on your own. So, while they handle the majority of their calls w/o the FD, they do need assistance, never mind making the scene safe at MVA's and similar rescue type calls.

I would doubt many municipal FD's would want a third service providers using them to assist making a profit, which is what it's all about on the "commercial side" with "full discretion of what resources they require." Maybe cities should, in fact I know they should, look closer at the details of the contracts for these services. Many commercial companies have come in to communities with low ball contracts saying they'll only bill the patients, only to come back later asking for tax dollars to make the deal work, after the city has disbanded its municipal EMS system.

I will note that I know there are some decent third service EMS systems and tons of decent medics working for third service providers, but from where I sit, this is not the overwhelming majority. The system is set up to provide low quality based on a for profit service.

[Goose 188]

I find this interesting, since most of the systems in our area do not have any excess in personnel or units, so if you're stuck on the 5 th floor with two ton Tessie, you'd be on your own. So, while they handle the majority of their calls w/o the FD, they do need assistance, never mind making the scene safe at MVA's and similar rescue type calls.

I would doubt many municipal FD's would want a third service providers using them to assist making a profit, which is what it's all about on the "commercial side" with "full discretion of what resources they require." Maybe cities should, in fact I know they should, look closer at the details of the contracts for these services. Many commercial companies have come in to communities with low ball contracts saying they'll only bill the patients, only to come back later asking for tax dollars to make the deal work, after the city has disbanded its municipal EMS system.

I will note that I know there are some decent third service EMS systems and tons of decent medics working for third service providers, but from where I sit, this is not the overwhelming majority. The system is set up to provide low quality based on a for profit service.

When i say third service i am not referring to commercial EMS. My idea of third service EMS is a County wide/run system and if thats not possible, a regional system would suffice - ie: a handful of municipalities serviced by 1 EMS system.

As far as the quality of providers, i think you're being unfair. It's always a lot easier to think back and pick out the bad rather than the good. No question some are skells but there are a lot of great people that have and still work for these companies. Most of us got our start in commercial EMS, it's part of getting your sea legs.

[EFFD4091-MLSS emt 13]

Why is fire dispatched to situations like this? Shouldn't EMD eliminate these types of calls?

we all know these frequent flyers may say "diff breathing" cuz it gets us there faster... they know how to manipulate the systems (sad to say)

[MerlinMedic 5]

So does anyone track this?

Obviously, this needs to be tracked. Reading the posts shows this. Common sense dictates with shrinking tax dollars and resouces (both paid & volunteer) we would be our best advocates to keep the resouces where needed.

As was posted earlier, as a commercial paramedic we often state "may cancel at their discretion". Saves hurt feelings. A lot of agnst out there by some posters towards EMS, especally commercial EMS. Moose, this area ... has issues between EMS & fire in some jurisdicitions that make those we went thru years ago look like amateur hour.

To those that feel: "It is MY sandbox!", if you want to come & pick up the local drunk for the 3rd time today, be my guest. You can also transport him to Saints and explain why he is back.