Fire Service Based EMS - IAFF Video

[firedude 985]

Came across this video...

From the Info box:

The Advocates for Fire-Service Based EMS Coalition believe that fire-service based EMS systems are strategically positioned to deliver pre-hospital emergency medical services that incorporate time critical response and effective patient care. Fire-Service Based EMS emphasizes responder safety, competent and compassionate workers, and cost effective operations.

When decisions are made at the national, state and local levels of government, remember that the most common and effective means of delivering 9-1-1 emergency medical care throughout the nation is through fire-service based EMS systems. Policies that protect, support and enhance the capabilites of fire-service based EMS systems are critical.

Any thoughts?

Edited October 2, 2011 by firedude

[Future Fireman 4]

As much as I am for getting into Fire-EMS, the IAFF is in it for the wrong reasons.

Yes, that will piss some union members off, but hear me out.

The IAFF is concerned about 1 primary thing: Keeping or expanding their union base and bringing more benefits to their members. Their point is that NFPA standards are already place stations in places for quick response times.

However, the result of this Fire based EMS most often, is FORCED ALS, since it seems that every department wants to proudly promote that they provide EMS at the Paramedic level by putting "PARAMEDIC" on the side of the engine. (Who needs those silly basics anyways?)

Do we need a paramedic on every fire truck like they have in abundance out in California and in Florida and in various parts of the rest of the country?

If your ambulance is coming just as quickly, no, you don't. Maybe if it's 30 minutes out. But it is a rather expensive WANT rather than a genuine need.

All FD provided ALS first response does is make your service more expensive to provide and give uber-redundency in the duplication of services.

Now, if you think I have a vendetta against Fire Based EMS or the IAFF you're wrong. I was an explorer for 4 years with a FD that did transporting EMS, and I love both sides. But everyone is quick to put PARAMEDIC on the side of the engine when they don't need to.

So, what am I getting at? If the FD operates at the ALS first response level, that usually makes for alot of forced medics (IIRC, Dallas is setup this way. You MUST be a medic to get hired or even get promoted.) What does this lead to? A downgrade in patient care. All these medics care about is getting a FF job or getting promoted. They don't give a crap about the patients they treat. All they care about is going to fires.

Personally, I am a big fan of ALS transporting ambulances and BLS engines & other first responders.

I'm no expert in Fire or EMS, and I don't claim to be, but I'm less than thrilled about why most FDs get into EMS (the typical padding their call volume & ensuring funds/staffing - which is what NFPA 1710 & 1720 [for VFDs] are for.)

I'm sorry if I pissed anyone off, but as a EMS newbie that is well versed in EMS news, it ticks me off that some agencies out there are providing EMS for the wrong reasons. I'm sure I'll get some angry rebuttals from this, but I'm just gonna shut up from here on out.

Edited October 2, 2011 by Future Fireman

[Danger 160]

I'm just gonna shut up from here on out.

Probably should have instituted that policy earlier

[CTFF 65]

I love when a non IAFF member explains what the IAFF is all about.

Can you explain where you've acquired this knowledge? I've been around the IAFF almost all my life and have yet to hear a let's jump into the paramedic game to increase the union base and benefits.

While I'm not doubting you've heard people say this, I doubt their feelings on the issue accurately reflect the position of the IAFF as an organization.

[Bnechis 3,961]

However, the result of this Fire based EMS most often, is FORCED ALS, since it seems that every department wants to proudly promote that they provide EMS at the Paramedic level by putting "PARAMEDIC" on the side of the engine.

So which is it the IAFF or the Department that wants it? They are not one and the same and often they are on opposite side of many issues. NYS has 100 depts that are career or combo and only about 6 provide ALS. I dont think you have studied this enough.

Do we need a paramedic on every fire truck like they have in abundance out in California and in Florida and in various parts of the rest of the country?......But it is a rather expensive WANT rather than a genuine need.

Who are you to determine what a community should think is valuable and is willing to pay for?

If the FD operates at the ALS first response level, that usually makes for alot of forced medics (IIRC, Dallas is setup this way. You MUST be a medic to get hired or even get promoted.) What does this lead to? A downgrade in patient care. All these medics care about is getting a FF job or getting promoted. They don't give a crap about the patients they treat. All they care about is going to fires.

All of Florida "forces" everyone to be FL. firefighters to get hired or promoted, does that make for a down grade in firefighters?

So you've inteview all these ff's and determined this? I've been a paramedic and an instructor for over 25 years (firefighter & officer for similar), but my agency is BLS. I became a medic because I wanted to. My medic training makes me a better fire officer and my fire training makes me a better medic.

I know many depts that its highly competative to even get into medic programs.

I also know a number of non fire based medics, that are burned out, or want to be an RN, Cop, FF and the medic will be dropped when they get there. The medic is just to pay the bills for now (some are good and some are not....and many are forced by Mommy & Daddy because they need a job).

I'm no expert in Fire or EMS, and I don't claim to be, but I'm less than thrilled about why most FDs get into EMS (the typical padding their call volume & ensuring funds/staffing - which is what NFPA 1710 & 1720 [for VFDs] are for.)

Then how can you make claims about the entire fire service? Since the majority of EMS in the US is fire based and has been that way for 40 or more years when is this padding going to have any effect?

I'm sorry if I pissed anyone off, but as a EMS newbie that is well versed in EMS news, it ticks me off that some agencies out there are providing EMS for the wrong reasons.

Yes you are clearly a newbie and reading a bunch of articles maybe only has given you a small view of whats really out there.

So its better to provide it for profit like the big commercial services?

BTW, I'm not pissed off, Its common to see inexperienced people try to prove a point here.

[DWC295 70]

Not sure where to start on this. Saying that fire based EMS is the only way to go is tough to swallow. I think this video does a disservice to those that work in non-fire based EMS. Are we on the same side or not? There are a lot of excellent providers at all levels in those services. I included a link to a blog post which touches on this topic as well. To me putting the patient first and providing excellent care is what matters, not the uniform or vehicle you arrive in.

My link

[FireMedic049 597]

As much as I am for getting into Fire-EMS, the IAFF is in it for the wrong reasons.

Yes, that will piss some union members off, but hear me out.

The IAFF is concerned about 1 primary thing: Keeping or expanding their union base and bringing more benefits to their members. Their point is that NFPA standards are already place stations in places for quick response times.

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.

However, the result of this Fire based EMS most often, is FORCED ALS, since it seems that every department wants to proudly promote that they provide EMS at the Paramedic level by putting "PARAMEDIC" on the side of the engine. (Who needs those silly basics anyways?)

Do we need a paramedic on every fire truck like they have in abundance out in California and in Florida and in various parts of the rest of the country?

If your ambulance is coming just as quickly, no, you don't. Maybe if it's 30 minutes out. But it is a rather expensive WANT rather than a genuine need.

All FD provided ALS first response does is make your service more expensive to provide and give uber-redundency in the duplication of services.

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.

Now, if you think I have a vendetta against Fire Based EMS or the IAFF you're wrong. I was an explorer for 4 years with a FD that did transporting EMS, and I love both sides. But everyone is quick to put PARAMEDIC on the side of the engine when they don't need to.

So, what am I getting at? If the FD operates at the ALS first response level, that usually makes for alot of forced medics (IIRC, Dallas is setup this way. You MUST be a medic to get hired or even get promoted.) What does this lead to? A downgrade in patient care. All these medics care about is getting a FF job or getting promoted. They don't give a crap about the patients they treat. All they care about is going to fires.

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?

Personally, I am a big fan of ALS transporting ambulances and BLS engines & other first responders.

I'm no expert in Fire or EMS, and I don't claim to be, but I'm less than thrilled about why most FDs get into EMS (the typical padding their call volume & ensuring funds/staffing - which is what NFPA 1710 & 1720 [for VFDs] are for.)

I'm sorry if I pissed anyone off, but as a EMS newbie that is well versed in EMS news, it ticks me off that some agencies out there are providing EMS for the wrong reasons. I'm sure I'll get some angry rebuttals from this, but I'm just gonna shut up from here on out.

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.

[FDNYDCHI 38]

"future Fireman"

From looking at your profile I assume that you are in school taking fire science or something along those lines. You make very broad generalizations in your post.

I am no paramedic, however I know the time and training is long and hard. So if you are investing all this time and money into becoming a paramedic your logic of pt care would be "downgraded". Then Why do it then? Last time I checked in the EMS world for standard of care it Goes:

CFR, EMT, Medic.

good luck

Chris

[FireMedic049 597]

Not sure where to start on this. Saying that fire based EMS is the only way to go is tough to swallow.

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.

I think this video does a disservice to those that work in non-fire based EMS. Are we on the same side or not? There are a lot of excellent providers at all levels in those services. I included a link to a blog post which touches on this topic as well. To me putting the patient first and providing excellent care is what matters, not the uniform or vehicle you arrive in.

My link

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.

[x129K 1,393]

I FIRMLY beleive that an IDEAL EMS system are like those run by the LaGrange and Arlington FD's. Those taxpayers truly get what they pay for and from what I have seen over the past 2 decades, make a difference.

[ny10570 745]

Fire based is absolutely not the best way to go. A dedicated 3rd service EMS is the ideal way to go. However it is more expensive to implement and maintain such a service. Once municipalities start looking at EMS as more than just a ride to the hospital and use it as an integrated part of their healthcare system, benefits emerge that cannot be accomplished with an agency trying to also serve as police or firefighters. In other countries and in a growing number of communities here EMS is used as an outreach to reduce ER visits, able to mitigate minor illness and injury on scene rather than transporting, and provide local services like education and vaccination.

The IAFF is absolutely only pushing EMS because it keeps their members busy and helps to protect them from budget cuts. If cities were burning like they did 30 years ago there is no way this would be anywhere near their agenda. Why would they seek to add more work to an already busy workforce? EMS is a perfect fit as fire companies are already distributed throughout the community and already somewhat familiar with EMS due to the nature of the job. This is not to say that fire based systems don't work. That's just flat out stupid as they are currently performing very well through out the country. But to suggest the IAFF began aggressively pursuing EMS for anything other than self preservation is naive.

[firedude 985]

Wake County, NC is known to have one of the best EMS systems in the coutry. It's a county wide system with no relation to FD.

[FireMedic049 597]

Wake County, NC is known to have one of the best EMS systems in the coutry. It's a county wide system with no relation to FD.

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.

[Goose 188]

Wake County EMS is probably the premiere service in the nation (followed close behind by others like Austin Travis County EMS). I never worked for them, but have a close friend that did and my understanding is that some of the discord you see in this topic doesn't exist there, FD and EMS work rather well together and complement each other where and when applicable. Wish it was this way everywhere.

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 understand what you're saying, but i just don't see it as being necessary to complete a call- granted things are established and run properly on both sides of the isle. The way things are set up down there make it work, operationally speaking, as well as it does. Besides, the rescue operations side of it is only part of the picture - i'm not really sure Wake County (sticking with this example) would clinically be where it is if it were part of some other agency - simply because that their entire focus has been on propelling prehospital patient care and awareness forward based on the most cutting edge equipment, techniques and science.

I think there are many ways to deliver EMS to the public (thats more or less a fact) and naturally an FD based solution is one of those. Its clearly applicable in some regions, while other regions are served equally as well both other models. I don't think it's accurate to generalize and say that fire based medics don't care about their patients and only care about fires - there are medics in every form of system who are in it for the wrong reasons and simply don't do the right thing. Personally, i think that an autonomous third service is what EMS needs to be - especially in this area. But again, that's just my opinion.

Edited October 3, 2011 by Goose

[firedude 985]

Yes, but are they a fully self-sufficient EMS system?

Yes they are. Check out their website, here.

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.

Be careful with the term "rescue", it has different meaning around the country. But I think I understand what you are trying to say. Wake County EMS does not provide their own rescue service, only patient care and transport. They work very well with the FDs down there since they both respond on medical calls. If you go through their website, you'll learn a lot.

Like Goose said... these are my opinions, you are entitled to yours

How many EMS agencies do this...

The Wake County Rescue Squad EMS Fund

Fortunately, Wake County Emergency Medical Services offers all residents of Wake County relief from direct cost of ambulance services. For $60 per year, you and all permanent residents of your household can receive emergency 911 ambulance service anywhere in Wake County as many times as needed. Your annual subscription fee relieves you of any direct costs of 911 ambulance service not paid by your insurance. The plan covers all members of your household from October 1 to September 30 of the following year.

In addition to the coverage your family receives, all of the money from your subscription membership is returned to Wake EMS or the rescue squad that serves the area where you live. This provides valuable operating funds to ensure the continued high level of emergency medical care that you have come to expect.

Edited October 3, 2011 by firedude

[FireMedic049 597]

Fire based is absolutely not the best way to go. A dedicated 3rd service EMS is the ideal way to go. However it is more expensive to implement and maintain such a service.

FYI, fire-based EMS does not exclusively translate into fire-base EMS transport.

Once municipalities start looking at EMS as more than just a ride to the hospital and use it as an integrated part of their healthcare system, benefits emerge that cannot be accomplished with an agency trying to also serve as police or firefighters. In other countries and in a growing number of communities here EMS is used as an outreach to reduce ER visits, able to mitigate minor illness and injury on scene rather than transporting, and provide local services like education and vaccination.

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.

The IAFF is absolutely only pushing EMS because it keeps their members busy and helps to protect them from budget cuts. If cities were burning like they did 30 years ago there is no way this would be anywhere near their agenda. Why would they seek to add more work to an already busy workforce? EMS is a perfect fit as fire companies are already distributed throughout the community and already somewhat familiar with EMS due to the nature of the job. This is not to say that fire based systems don't work. That's just flat out stupid as they are currently performing very well through out the country. But to suggest the IAFF began aggressively pursuing EMS for anything other than self preservation is naive.

And believing that it is only for self-preservation is at least equally naive.

[FireMedic049 597]

Yes they are. Check out their website, here.

Be careful with the term "rescue", it has different meaning around the country. But I think I understand what you are trying to say. Wake County EMS does not provide their own rescue service, only patient care and transport. They work very well with the FDs down there since they both respond on medical calls. If you go through their website, you'll learn a lot.

Like Goose said... these are my opinions, you are entitled to yours

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.

How many EMS agencies do this...

I can't say how many, but every EMS agency I've been associated with offers this in some fashion.

[Goose 188]

Just as an addendum to my initial comments - it's not like EMS members are incapable of being trained on providing care in "rescue" situations. FDNY*EMS has the haztac units and rescue medics. The latter proved themselves at the crane collapses in manhattan a few years back. UMDNJ EMS operates what looks to be a pretty impressive rescue branch of their EMS system which serves Newark. Pittsburgh EMS also operates similarly specialized units.

UMDNJ EMS

Pittsburg EMS Rescue Divison

Again, these solutions are unique to their regions and fill voids and provide flexibility to those regions. It's not applicable everywhere, but it's not as if its impossible....the tone of the video would have you think otherwise, thats the only thing that bothers be a bit.

Edited October 3, 2011 by Goose

[ny10570 745]

Why do EMS agencies need to provide their own rescue services? How many fully self sufficient fire departments are there handling their own investigation and prosecution? Members trained to work with firefighters in rescue operations is just as effective. Or should firefighters be providing the rescue, treatment and transport for all fire victims while EMS handles the MVAs? What about a car accident involving fire? Police are capable of investigating accidents after fire performs the extrication. EMS handles victims of crime without PD taking over treatment and transport. Why is an accident or building collapse, fire victim any different?

Fire based first response is just a stop-gap way of filling a gap in coverage. Some of the bigger changes in EMS recently have been the emphasis on prompt transport to appropriate facilities. Great, you have the medic there but what good is that medic without a bus for your CVA, MI, GI bleed, etc. Wouldn't the patient be better served providing a paramedic ambulance rather than a paramedic engine? If fire based is truly a better service, why allow the patient to be handed off to a lower quality provider for transport? But this goes back to my original assertion that the IAFF did not get into this for altruistic reasons. They found a need, communities needed to get care to their patients faster; that fit their needs, they needed more productivity for their members. People still need that fast initial response, but they also need rapid transport.

Healthcare is absolutely government run. The biggest single customer in any hospital system is Medicaid and medicaid dictates many of the policys and procedures hospitals and the insurance industry follow. On a more local level the single biggest hospital system in NYC is HHC running many of the city's larger hospitals and all over the country there are municipal hospital systems. On every insured patient or cash patient that can't afford the full bill, the hospital loses money if they are not admitted. Hospitals want as many patients as they can because that means more admissions. They do not want the minor complaints that are choking these over crowded emergency rooms. Find them a way to keep the hospital packed and ER empty and they will jump at the opportunity.

Not too long ago the idea of specialty referral centers for EMS was seen as just as risky as transport refusal and treat and release programs. Things change, and agencies across the country are trying different means of keeping the BS out of the system. Saying that EMS should only be used for Emergencies is ridiculous. 911 should only be used for emergencies. Just as fire departments have evolved to handle more than fires EMS needs to adjust and handle more than just "emergencies".

[FireMedic049 597]

Just as an addendum to my initial comments - it's not like EMS members are incapable of being trained on providing care in "rescue" situations. FDNY*EMS has the haztac units and rescue medics. The latter proved themselves at the crane collapses in manhattan a few years back. UMDNJ EMS operates what looks to be a pretty impressive rescue branch of their EMS system which serves Newark. Pittsburgh EMS also operates similarly specialized units.

UMDNJ EMS

Pittsburg EMS Rescue Divison

Again, these solutions are unique to their regions and fill voids and provide flexibility to those regions. It's not applicable everywhere, but it's not as if its impossible....the tone of the video would have you think otherwise, thats the only thing that bothers be a bit.

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.

[efdcapt115 1,511]

Look, most fire departments have been providing some level of EMS far longer than people even know about. In my district, the hospital used to provide the ambulance, but first response was always the cops and firemen. "Inhalator Calls." Matter of fact, it was members of the fire department that started EVAC. For decades the north end firehouse was home to the VAC ambulance.

Now to the future fireman. Small piece of advice. You are pursuing a career in the fire service, yet you are trashing the IAFF's position on fire based EMS. It would be wise for you to begin purging those thoughts from your head, as if you do get on the job you aren't going to make a lot of friends coming into the firehouse and badmouthing the organization that works for your workplace safety and rights.

And the IAFF's position on fire based EMS is their opinion. That's all. Just like other organizations have their opinions and positions. As much as the IAFF advocates for firefighters' rights and workplace issues, they ultimately do not make any decisions for any fire departments.

Fire based EMS surely is the best system for many areas of the country. In other places, as some of you have mentioned, other systems in place may work better. There is no one answer, one size fits all, for the entire country. Again, the IAFF has an organizational opinion, and they aren't hesitant to put it on a video and make it available for people to see.

But let's not get into this trashing of the IAFF, and this idea that they only advocate for things that will improve their membership. Many, many positive changes in the fire service have come about because the IAFF had an opinion, a position, and they advocated for it, lobbied politicians for it, and ultimately got improvements in the workplace implemented as a result.

They did pro bono work in the aftermath of 9/11 that helped the FDNY locals set up funds for the victims families. They believe passionately in what they do, they believe they are advocating for what is best for the people the locals serve.

Yes, it's a union, but union is not a dirty word in America. Don't believe what the Koch Brothers would have you believe; that unions are only out for their own self preservation. I'd fancy to say that the IAFF locals around this country do more charity work for burn victims, burned children's camps, fund raising for muscular dystrophy, the list goes on of things IAFF locals do for others while the Koch Brothers and the other billionaires who sit around plotting how to destroy organized labor in this country, do very little to nothing for others, except try to inflict more misery on working people.

[FireMedic049 597]

Why do EMS agencies need to provide their own rescue services? How many fully self sufficient fire departments are there handling their own investigation and prosecution? Members trained to work with firefighters in rescue operations is just as effective. Or should firefighters be providing the rescue, treatment and transport for all fire victims while EMS handles the MVAs? What about a car accident involving fire? Police are capable of investigating accidents after fire performs the extrication. EMS handles victims of crime without PD taking over treatment and transport. Why is an accident or building collapse, fire victim any different?

Nobody is saying that EMS agencies need to provide their own rescue services. The point (opinion) of the video was that it was better for the patient when a single agency handles their situation from initial contact to delivery at the hospital. Additionally, the "investigation and prosecution" angle is not appropriate for comparison. Criminal investigation of an incident is not an integral part of the rescue, treatment and transport of a patient outside "preserving evidence" as best as possible.

I agree that personnel trained to work along side the FD in a rescue situation can be just as effective. However, that can be the "sticking point" in the discussion. When two independent agencies need to work in that fashion, is there necessarily the guarantee that all personnel are adequately trained? Let's say you have a high angle rescue situation. Unless all EMS personnel in the agency are trained in "rescue" as a job requirement, how do you ensure that the paramedic that wants to go to the patient is properly trained to do so? Do you just take his/her word that they know what to do?

Fire based first response is just a stop-gap way of filling a gap in coverage. Some of the bigger changes in EMS recently have been the emphasis on prompt transport to appropriate facilities. Great, you have the medic there but what good is that medic without a bus for your CVA, MI, GI bleed, etc. Wouldn't the patient be better served providing a paramedic ambulance rather than a paramedic engine? If fire based is truly a better service, why allow the patient to be handed off to a lower quality provider for transport? But this goes back to my original assertion that the IAFF did not get into this for altruistic reasons. They found a need, communities needed to get care to their patients faster; that fit their needs, they needed more productivity for their members. People still need that fast initial response, but they also need rapid transport.

Yes, certain medical situations do call for emphasis on prompt transport, however the reality is that the vast majority of patients calling 911 do not have ailments that necessitate immediate transport in order to influence the outcome.

Yes, in those situations requiring a prompt transport, an ambulance would be better than only a paramedic engine. However, what you seem to be overlooking is that the patient is getting an ambulance too. The paramedic engine is providing interim care and it's arguably better for the patient to get care sooner rather than later if prompt transport is that important for that patient. If you take away the first response component for that patient and only send an ambulance, then the patient is likely still waiting the same amount of time for the ambulance to arrive, however they are doing so without receiving any care. I think it's pretty obvious which situation is better, even if it doesn't definitively affect patient outcome.

Healthcare is absolutely government run. The biggest single customer in any hospital system is Medicaid and medicaid dictates many of the policys and procedures hospitals and the insurance industry follow.

As you stated Medicare and Medicaid are customers. As such they do not actually run the healthcare systems, however they may have influence on the system as a consumer and this is not the same thing as the government actually running the healthcare system.

On a more local level the single biggest hospital system in NYC is HHC running many of the city's larger hospitals and all over the country there are municipal hospital systems.

When you say "municipal hospital systems" are you saying that the hospital system is owned & operated by the municipality in the same way that they "own & operate" the local FD, PD, DPW, etc. and ultimately operate under the Mayor/City Council or equivalent?

On every insured patient or cash patient that can't afford the full bill, the hospital loses money if they are not admitted. Hospitals want as many patients as they can because that means more admissions. They do not want the minor complaints that are choking these over crowded emergency rooms. Find them a way to keep the hospital packed and ER empty and they will jump at the opportunity.

I disagree that hospitals don't want the "minor complaints". The ER staff may not want the "minor complaints" that should be handled via urgent care centers or PCPs, however this desire is probably not shared by the executive management. What the hospital management doesn't want "choking" their ERs is patients without the ability to pay, whether via insurance or self-pay.

Not too long ago the idea of specialty referral centers for EMS was seen as just as risky as transport refusal and treat and release programs. Things change, and agencies across the country are trying different means of keeping the BS out of the system. Saying that EMS should only be used for Emergencies is ridiculous. 911 should only be used for emergencies. Just as fire departments have evolved to handle more than fires EMS needs to adjust and handle more than just "emergencies".

I didn't say that EMS should only be used for emergencies. There are plenty of "non-emergent" complaints in which the use of EMS is appropriate or reasonable. What I said was that things like preventative care should be handled separate from the emergency response aspect of the operation.

Maybe it's an issue of semantics, but to me there is a difference between "EMS" and "EMS agency". I don't disagree that it may be appropriate and/or necessary for EMS agencies to evolve and "handle more than just 'emergencies'". However, this does not necessarily mean that their "emergency" response resources (EMS) should be tasked with those new services. To continue the Fire/EMS comparison a little further, it may be appropriate for the FD to conduct it's own arson investigations, but should those investigations be tasked to the line companies and be held OOS for additional responses until the investigation is completed? I would submit that the most effective/efficient way to handle the arson investigation would be to have a dedicated unit to handle it just like it may be the most effective/efficient way to handle preventative care/outreach type services with resources that are separate from the emergency response resources. Now, this doesn't mean that "response personnel" can't be utilized for these tasks, just that when doing so, routine emergency response shouldn't also be "on the menu".

[Guest alsfirefighter]

As much as I am for getting into Fire-EMS, the IAFF is in it for the wrong reasons.

Yes, that will piss some union members off, but hear me out.

The IAFF is concerned about 1 primary thing: Keeping or expanding their union base and bringing more benefits to their members. Their point is that NFPA standards are already place stations in places for quick response times.

However, the result of this Fire based EMS most often, is FORCED ALS, since it seems that every department wants to proudly promote that they provide EMS at the Paramedic level by putting "PARAMEDIC" on the side of the engine. (Who needs those silly basics anyways?)

Do we need a paramedic on every fire truck like they have in abundance out in California and in Florida and in various parts of the rest of the country?

If your ambulance is coming just as quickly, no, you don't. Maybe if it's 30 minutes out. But it is a rather expensive WANT rather than a genuine need.

All FD provided ALS first response does is make your service more expensive to provide and give uber-redundency in the duplication of services.

Now, if you think I have a vendetta against Fire Based EMS or the IAFF you're wrong. I was an explorer for 4 years with a FD that did transporting EMS, and I love both sides. But everyone is quick to put PARAMEDIC on the side of the engine when they don't need to.

So, what am I getting at? If the FD operates at the ALS first response level, that usually makes for alot of forced medics (IIRC, Dallas is setup this way. You MUST be a medic to get hired or even get promoted.) What does this lead to? A downgrade in patient care. All these medics care about is getting a FF job or getting promoted. They don't give a crap about the patients they treat. All they care about is going to fires.

Personally, I am a big fan of ALS transporting ambulances and BLS engines & other first responders.

I'm no expert in Fire or EMS, and I don't claim to be, but I'm less than thrilled about why most FDs get into EMS (the typical padding their call volume & ensuring funds/staffing - which is what NFPA 1710 & 1720 [for VFDs] are for.)

I'm sorry if I pissed anyone off, but as a EMS newbie that is well versed in EMS news, it ticks me off that some agencies out there are providing EMS for the wrong reasons. I'm sure I'll get some angry rebuttals from this, but I'm just gonna shut up from here on out.

And you know what reasons the IAFF "is in it" how exactly? Fact is while what you mentioned is partially correct...most of it is about exactly why I am pro fire based EMS...quality customer service and simplification of services. The IAFF as a national has little to do with ther services at the local level once instituted. The other bottom line...no matter what the reason as why its being done...as long as its being done right is all that matters.

As far as putting Paramedic on the side of the engine. Heck why put anything on the side of them. What's the need? Oh that's right you're not a professional firefighter or an IAFF member so you don't deal with budgets, etc where the public rarely understands what we do. All and any advertisement of what your services are is a huge plus in any arena. And before you make assumptions about agencies patient care...that is a management issue and QA issue...not a system issue. Maybe when you actually have mroe time in fire and EMS then most of us on here have waiting for water...you will understand that.