DISQUS

brendan · 1 year ago

Fuck em if they can't take it.< />< />Fight the good fight, my brotha.

brendan · 1 year ago

Fuck em if they can't take it.< />< />Fight the good fight, my brotha.

Rogue Medic · 1 year ago

Great article.< />< />Maybe it will be correctly seen as an article that is about improving EMS and not about attacking fire fighters.< />< />EMS certainly needs a lot of improvement.

Rogue Medic · 1 year ago

Great article.< />< />Maybe it will be correctly seen as an article that is about improving EMS and not about attacking fire fighters.< />< />EMS certainly needs a lot of improvement.

CrankyProf · 1 year ago

Well, with a recommend like THAT, who wouldn't read?< />< />Can I get a pair of nomex britches?

CrankyProf · 1 year ago

Well, with a recommend like THAT, who wouldn't read?< />< />Can I get a pair of nomex britches?

Dick Carlson · 1 year ago

In all seriousness, could someone explain to a normal citizen why a call for one little old man with a scraped knee results in two huge firetrucks, one little firetruck, an ambulance, and two police cars?< />< />I pay a huge amount of taxes, and just about every other public service is triaged based on need and the level of risk. If I have a home break-in it takes the police hours to show up to write the report. If the guy is standing here with a gun they'll arrive in minutes with several cars.< />< />But how do fire trucks with ladders and hoses help sick old people? I agree they are entertaining, and the grannies like to see the buff young men in the straining shirts, but couldn't they be out picking up litter or doing something useful until next week's fire?

Dick Carlson · 1 year ago

In all seriousness, could someone explain to a normal citizen why a call for one little old man with a scraped knee results in two huge firetrucks, one little firetruck, an ambulance, and two police cars?< />< />I pay a huge amount of taxes, and just about every other public service is triaged based on need and the level of risk. If I have a home break-in it takes the police hours to show up to write the report. If the guy is standing here with a gun they'll arrive in minutes with several cars.< />< />But how do fire trucks with ladders and hoses help sick old people? I agree they are entertaining, and the grannies like to see the buff young men in the straining shirts, but couldn't they be out picking up litter or doing something useful until next week's fire?

Capo del Fuoco · 1 year ago

Ambulance Driver,< />< />With respect and from another perspective:< />< />“What will it take for medics to achieve equality in the firehouse?” – I would argue that when medics perform the same or similar wide range of skills that “fire medics” do, then you will have “equality”. This issue is primarily related to organized labor and their power issues more than it is some perception or misperception that management holds. When you have an employee that does one job well versus an employee that does several jobs well, the later will be paid more and have a higher level of respect. The camaraderie aspect of the fire occupation is significant and medics will have a hard time earning full respect in the firehouse milieu without that exposure. < />< />“Obviously, the relationship between fire suppression and EMS is dysfunctional. Everyone except the proponents of dual-role systems realizes it. The question is, can the relationship be mended?” – I would argue that a forced marriage will not work (look at San Francisco as an example). The argument cannot be supported that there is an inherent dysfunction because there are numerous examples where it does work. The organizational stars have to be in alignment. It is not a black and white issue…there are many shades of gray here and the decision needs to be made on a case by case basis. < />< />“This attitude is an object lesson in why EMS receives no respect from other healthcare professions; not only do we have a propensity for impotent bellyaching…” – Well said and very true. Is this article an example? It is not like firefighters and cops don’t bellyache just as much…maybe we all need to stop bellyaching and do what is best for the public and put our petty turf issues aside.< />< />“If you want to look at the economic reality of fire-based EMS, the EMS runs make up roughly 80 percent of the run volume for departments that do both fire suppression and EMS transport. Yet you will find that nowhere in this country exists a fire department that funds its training and operations that way.” – While our department did not do transport (though I have respectable experience in the arena), our fire training budget was far more than 80% expended on….EMS (ALS). Your statement is not very accurate. In fact, I had a fulltime RN on staff for QA/QI and training. The RN had a battalion chief rank and was an important and valued member of our team. I know of many other fire departments that have a similar record.< />< />“The blunt truth is, for most fire departments in this country, EMS is a means to an end — nothing more. It makes for a handy way to pad run volumes when the time comes to ask the taxpayers for raises or shiny new ladder trucks.” – Please tell me that this is an attempt at sarcasm or humor. This statement does a disservice to your readers that are not familiar with how fire services are managed. Fire got involved in EMS a long time ago as a response to the public who wanted better response times through resource distribution and not based on profit. While having justified several multi-million dollar budgets, I was never asked to justify them based on call volume…ever. That metric has little meaning.< />< />You wrote an opinion piece. You are certainly entitled to your opinion but you are not entitled to you own facts. I feel that this piece does not represent the normally well thought and written work that you have done in the past. Maybe it is time to look at the issue through another lens and to deal with your apparent bias with regard to the fire service.< />< />Respectfully,< />< />Capo del Fuoco

Capo del Fuoco · 1 year ago

Ambulance Driver,< />< />With respect and from another perspective:< />< />“What will it take for medics to achieve equality in the firehouse?” – I would argue that when medics perform the same or similar wide range of skills that “fire medics” do, then you will have “equality”. This issue is primarily related to organized labor and their power issues more than it is some perception or misperception that management holds. When you have an employee that does one job well versus an employee that does several jobs well, the later will be paid more and have a higher level of respect. The camaraderie aspect of the fire occupation is significant and medics will have a hard time earning full respect in the firehouse milieu without that exposure. < />< />“Obviously, the relationship between fire suppression and EMS is dysfunctional. Everyone except the proponents of dual-role systems realizes it. The question is, can the relationship be mended?” – I would argue that a forced marriage will not work (look at San Francisco as an example). The argument cannot be supported that there is an inherent dysfunction because there are numerous examples where it does work. The organizational stars have to be in alignment. It is not a black and white issue…there are many shades of gray here and the decision needs to be made on a case by case basis. < />< />“This attitude is an object lesson in why EMS receives no respect from other healthcare professions; not only do we have a propensity for impotent bellyaching…” – Well said and very true. Is this article an example? It is not like firefighters and cops don’t bellyache just as much…maybe we all need to stop bellyaching and do what is best for the public and put our petty turf issues aside.< />< />“If you want to look at the economic reality of fire-based EMS, the EMS runs make up roughly 80 percent of the run volume for departments that do both fire suppression and EMS transport. Yet you will find that nowhere in this country exists a fire department that funds its training and operations that way.” – While our department did not do transport (though I have respectable experience in the arena), our fire training budget was far more than 80% expended on….EMS (ALS). Your statement is not very accurate. In fact, I had a fulltime RN on staff for QA/QI and training. The RN had a battalion chief rank and was an important and valued member of our team. I know of many other fire departments that have a similar record.< />< />“The blunt truth is, for most fire departments in this country, EMS is a means to an end — nothing more. It makes for a handy way to pad run volumes when the time comes to ask the taxpayers for raises or shiny new ladder trucks.” – Please tell me that this is an attempt at sarcasm or humor. This statement does a disservice to your readers that are not familiar with how fire services are managed. Fire got involved in EMS a long time ago as a response to the public who wanted better response times through resource distribution and not based on profit. While having justified several multi-million dollar budgets, I was never asked to justify them based on call volume…ever. That metric has little meaning.< />< />You wrote an opinion piece. You are certainly entitled to your opinion but you are not entitled to you own facts. I feel that this piece does not represent the normally well thought and written work that you have done in the past. Maybe it is time to look at the issue through another lens and to deal with your apparent bias with regard to the fire service.< />< />Respectfully,< />< />Capo del Fuoco

Rogue Medic · 1 year ago

"When you have an employee that does one job well versus an employee that does several jobs well, the later will be paid more and have a higher level of respect."< />< />I guess that has a lot to do with the perceived importance of the role. Why would any sane person want to cross-train paramedics? Cross-training decrease the amount of specific training on patient care. Do you create more time for this? < />< />What do you do with the person who is not good at two, or more, roles, but is very good at patient care? Do you deprive patients of the very good care in order to have someone who fits the fire department mold?< />< />Cross-training is aiming for the lowest common denominator.< />< />"I had a fulltime RN on staff for QA/QI and training."< />< />Another problem in EMS. Why is it presumed that the training of medics is so low that they must be cross-trained, but the care delivered requires a nurse to teach it, or to QA/QI/CYA it?< />< />Is the nurse cross-trained? < />< />Is the nurse paid about the same as the other single function personnel in the fire department?< />< />Is the nurse told "You will only be respected when you can do more than one task?"< />< />"The RN had a battalion chief rank and was an important and valued member of our team."< />< />This suggests that the paramedics are not important or valued.< />< />If paramedics are doing something that requires a nurse to evaluate the care, and the nurse is made a battalion chief to do this, why is the work done by medics not enough by itself?< />< />If your medics are so good at what they do - never misplace a tube, always diagnose correctly, never have any patient care problems - that you need to find other stuff to train them to do, which will dilute their patient care skills, then you do not seem to place much importance on patient care.

Rogue Medic · 1 year ago

"When you have an employee that does one job well versus an employee that does several jobs well, the later will be paid more and have a higher level of respect."< />< />I guess that has a lot to do with the perceived importance of the role. Why would any sane person want to cross-train paramedics? Cross-training decrease the amount of specific training on patient care. Do you create more time for this? < />< />What do you do with the person who is not good at two, or more, roles, but is very good at patient care? Do you deprive patients of the very good care in order to have someone who fits the fire department mold?< />< />Cross-training is aiming for the lowest common denominator.< />< />"I had a fulltime RN on staff for QA/QI and training."< />< />Another problem in EMS. Why is it presumed that the training of medics is so low that they must be cross-trained, but the care delivered requires a nurse to teach it, or to QA/QI/CYA it?< />< />Is the nurse cross-trained? < />< />Is the nurse paid about the same as the other single function personnel in the fire department?< />< />Is the nurse told "You will only be respected when you can do more than one task?"< />< />"The RN had a battalion chief rank and was an important and valued member of our team."< />< />This suggests that the paramedics are not important or valued.< />< />If paramedics are doing something that requires a nurse to evaluate the care, and the nurse is made a battalion chief to do this, why is the work done by medics not enough by itself?< />< />If your medics are so good at what they do - never misplace a tube, always diagnose correctly, never have any patient care problems - that you need to find other stuff to train them to do, which will dilute their patient care skills, then you do not seem to place much importance on patient care.

Mr. Fixit · 1 year ago

WOW!< />< />(it took me 5 minutes to come up with that comment)< />< />I think I understand your position, but I have to ask;< />< />Have you worked in a fire based EMS System? ever?< />< />To make your point about misunderstanding by fire fighters, you (I think) do the same thing. Namely, make statements based on misunderstandings.< />< />Hmmmm< />< />I guess I'll address this in a post of my own.< />< />Mr Fixit

Mr. Fixit · 1 year ago

WOW!< />< />(it took me 5 minutes to come up with that comment)< />< />I think I understand your position, but I have to ask;< />< />Have you worked in a fire based EMS System? ever?< />< />To make your point about misunderstanding by fire fighters, you (I think) do the same thing. Namely, make statements based on misunderstandings.< />< />Hmmmm< />< />I guess I'll address this in a post of my own.< />< />Mr Fixit

Ambulance Driver · 1 year ago

Fixit, I've never worked in a dual role system.< />< />I was however, trained by instructors from one, and they have been FD medics for 25 plus years.< />< />I've also done contracted EMS training for a number of dual role FDs. They were less dysfunctional than some of their brethren, but dysfunctional nonetheless. My observations don't come from within the FD, but neither are they of an ignorant outsider looking in.< />< />Don't just stop with the first column in the series, brother. I have many more argument to make - both for and against fire-based EMS - in future columns in the series.

Ambulance Driver · 1 year ago

Fixit, I've never worked in a dual role system.< />< />I was however, trained by instructors from one, and they have been FD medics for 25 plus years.< />< />I've also done contracted EMS training for a number of dual role FDs. They were less dysfunctional than some of their brethren, but dysfunctional nonetheless. My observations don't come from within the FD, but neither are they of an ignorant outsider looking in.< />< />Don't just stop with the first column in the series, brother. I have many more argument to make - both for and against fire-based EMS - in future columns in the series.

Sara · 1 year ago

"While having justified several multi-million dollar budgets, I was never asked to justify them based on call volume, ever."< />< />Capo-< />So if your call volume dropped permananently by 80% because of third service EMS and your engines didn't have wear and tear from responding to medical calls, your budget wouldn't change? < />< />I think AD is on the right track. EMS as it's own service, Fire as it's own service. There's really no drawback.< />< />And I'm a paramedic and an RN. My opinion only- having a RN make battalion chief pay to review EMS runs makes almost as much sense as having a single duty medic make batt chief pay to review your structure fires.

Sara · 1 year ago

"While having justified several multi-million dollar budgets, I was never asked to justify them based on call volume, ever."< />< />Capo-< />So if your call volume dropped permananently by 80% because of third service EMS and your engines didn't have wear and tear from responding to medical calls, your budget wouldn't change? < />< />I think AD is on the right track. EMS as it's own service, Fire as it's own service. There's really no drawback.< />< />And I'm a paramedic and an RN. My opinion only- having a RN make battalion chief pay to review EMS runs makes almost as much sense as having a single duty medic make batt chief pay to review your structure fires.

Mr. Fixit · 1 year ago

Hey bro,< />Check your email.< />< />Fixit

Mr. Fixit · 1 year ago

Hey bro,< />Check your email.< />< />Fixit

Capo del Fuoco · 1 year ago

Ambulance Driver,< />< />Thank you for the reply to my comment and the tone of your response. No flinging of poo here…much appreciated.< />< />I am quite cognizant of the interests of medics that want to be medics and fire laddies that don’t want to do EMS. This is the crux of why the forced consolidations won’t work. During the transition over time where we see these consolidations going on, this will be an issue. In the future (after the consolidation of systems that are likely to consolidate), employees will self select like they do in the military. Fire personnel (in other than the Metros) already pretty much know and have accepted that the job includes EMS. The fire only jobs are far and few between. People that want to specialize in EMS have many other avenues to do only EMS…they can work in a medical facility as you do as an example. The reason that they should not be allowed to specialize is not because of the expertise or skills that they would have, but rather, because public safety service delivery is very expensive and “specialization” is not very efficient. < />< />You are right, I operate under the belief, based on extensive observation and actual practice, that one person can be both a good firefighter and a good medic. I understand your perspective about why they should be separate…but cannot concur. Public safety service delivery is not based on having “masters” deliver the service and most if not all communities could not afford that even if were possible. Honestly, the most important in-field services delivered are BLS anyway. It is not to say that we do not need medics, we do. But we do not need Dr. Kildare parachuting in to save the day on every rig in the country either, somewhere in between is desirable and achievable. Our difference of opinion is significantly influenced on how we see the end state…this part of the discussion is valuable in understanding those differences.< />< />There are many fire transport systems that work and work well. I can think of dozens in CA and San Diego County in particular (I am not from San Diego County). I can think of few if any that are in Metro’s however and this is where our perspectives may be very different. If you are envisioning Metro’s…then I will cede my point. However, of the 33,000+ fire departments, few are Metro’s and many of those do transport just fine. I am looking at the entire fire transport scheme and not Metro’s in particular when I make my points. I like the special district model of service delivery the best for both fire and EMS. I like and support the direct accountability to the voters and the elimination of ancillary politics of city hall, but know that this is unlikely to gain widespread popularity. < />< />With regard to: < />“First of all, I support the concept of FD first response. But, you're telling me that in a FD that does only ALS first response, you spent over eighty percent of your entire FD training budget on EMS training? That's hard to believe, but if it's true, it's laudable. It's also rare.”< />< />Hard to believe or not….it is true. When we had severe budget cuts, the fire training position went and the EMS training position stayed. It is not as rare as you think. I am not trying to posit that this is the norm by any means, but there are many fire departments that spend huge chunks of time and money on EMS…it is 70% of the call volume and as you are aware, very knowledge intensive. I respected that and budgeted accordingly. I am not the exception by any means either. I don’t know what the performance is of most of the thousands of fire departments, it is probably not knowable. We are both dealing with generalities, which is not to say that the points do not have merit. I would ask for better qualification of the opinion…based on x, I feel that y…When it comes across as being declarative and you being a recognized expert, somehow the opinion morphs into “fact” for many readers. All that I was doing was trying to offer a contrarian perspective in a non-argumentative way and I think that you took it that way, thank you. I am not saying that I am entirely right or wrong…just that portions of what was stated was clearly not right based on my 30+ years of necessarily limited experience. < />< />Given that there are 33,000+ fire departments, it would safe to assume that there is the same number of fire chiefs. All of them prepare budgets and struggle to find budget justifications for their organizations. I will be the first to say that I am not condoning or encouraging the budget rationale that you have noted. Literary grenades aside, the statement was declarative and much more broadly scoped than your explanation. While it may have served a purpose with your primarily EMS focused (I assume) readership, it takes away credibility for those of us in the fire service. I assume that you didn’t want the discussion to degenerate into a food fight, so why start it?< />< />In conclusion, “Without those, this is just us bickering about our feelings, isn't it?”… The reason that I didn’t respond with “numbers, figures, concrete examples” etc. is because the piece was not written that way. I am called upon to provide such data, but you are not? It is not that I couldn’t, it is just that I responded with my opinion in a similar fashion to your article, two professionals sharing their respective opinions. Thank you for the discourse and opportunity.< />< />Have a safe day< />< />Capo

Capo del Fuoco · 1 year ago

Ambulance Driver,< />< />Thank you for the reply to my comment and the tone of your response. No flinging of poo here…much appreciated.< />< />I am quite cognizant of the interests of medics that want to be medics and fire laddies that don’t want to do EMS. This is the crux of why the forced consolidations won’t work. During the transition over time where we see these consolidations going on, this will be an issue. In the future (after the consolidation of systems that are likely to consolidate), employees will self select like they do in the military. Fire personnel (in other than the Metros) already pretty much know and have accepted that the job includes EMS. The fire only jobs are far and few between. People that want to specialize in EMS have many other avenues to do only EMS…they can work in a medical facility as you do as an example. The reason that they should not be allowed to specialize is not because of the expertise or skills that they would have, but rather, because public safety service delivery is very expensive and “specialization” is not very efficient. < />< />You are right, I operate under the belief, based on extensive observation and actual practice, that one person can be both a good firefighter and a good medic. I understand your perspective about why they should be separate…but cannot concur. Public safety service delivery is not based on having “masters” deliver the service and most if not all communities could not afford that even if were possible. Honestly, the most important in-field services delivered are BLS anyway. It is not to say that we do not need medics, we do. But we do not need Dr. Kildare parachuting in to save the day on every rig in the country either, somewhere in between is desirable and achievable. Our difference of opinion is significantly influenced on how we see the end state…this part of the discussion is valuable in understanding those differences.< />< />There are many fire transport systems that work and work well. I can think of dozens in CA and San Diego County in particular (I am not from San Diego County). I can think of few if any that are in Metro’s however and this is where our perspectives may be very different. If you are envisioning Metro’s…then I will cede my point. However, of the 33,000+ fire departments, few are Metro’s and many of those do transport just fine. I am looking at the entire fire transport scheme and not Metro’s in particular when I make my points. I like the special district model of service delivery the best for both fire and EMS. I like and support the direct accountability to the voters and the elimination of ancillary politics of city hall, but know that this is unlikely to gain widespread popularity. < />< />With regard to: < />“First of all, I support the concept of FD first response. But, you're telling me that in a FD that does only ALS first response, you spent over eighty percent of your entire FD training budget on EMS training? That's hard to believe, but if it's true, it's laudable. It's also rare.”< />< />Hard to believe or not….it is true. When we had severe budget cuts, the fire training position went and the EMS training position stayed. It is not as rare as you think. I am not trying to posit that this is the norm by any means, but there are many fire departments that spend huge chunks of time and money on EMS…it is 70% of the call volume and as you are aware, very knowledge intensive. I respected that and budgeted accordingly. I am not the exception by any means either. I don’t know what the performance is of most of the thousands of fire departments, it is probably not knowable. We are both dealing with generalities, which is not to say that the points do not have merit. I would ask for better qualification of the opinion…based on x, I feel that y…When it comes across as being declarative and you being a recognized expert, somehow the opinion morphs into “fact” for many readers. All that I was doing was trying to offer a contrarian perspective in a non-argumentative way and I think that you took it that way, thank you. I am not saying that I am entirely right or wrong…just that portions of what was stated was clearly not right based on my 30+ years of necessarily limited experience. < />< />Given that there are 33,000+ fire departments, it would safe to assume that there is the same number of fire chiefs. All of them prepare budgets and struggle to find budget justifications for their organizations. I will be the first to say that I am not condoning or encouraging the budget rationale that you have noted. Literary grenades aside, the statement was declarative and much more broadly scoped than your explanation. While it may have served a purpose with your primarily EMS focused (I assume) readership, it takes away credibility for those of us in the fire service. I assume that you didn’t want the discussion to degenerate into a food fight, so why start it?< />< />In conclusion, “Without those, this is just us bickering about our feelings, isn't it?”… The reason that I didn’t respond with “numbers, figures, concrete examples” etc. is because the piece was not written that way. I am called upon to provide such data, but you are not? It is not that I couldn’t, it is just that I responded with my opinion in a similar fashion to your article, two professionals sharing their respective opinions. Thank you for the discourse and opportunity.< />< />Have a safe day< />< />Capo

Mr. Fixit · 1 year ago

"Don't just stop with the first column in the series, brother. I have many more argument to make - both for and against fire-based EMS - in future columns in the series."< />< />< />Are you kidding? I'm hooked!< />< />Seriously, it's a deep subject, with no right or wrong for everyone. I went ahead and weighed in on my blog.< />< />Fixit

Mr. Fixit · 1 year ago

"Don't just stop with the first column in the series, brother. I have many more argument to make - both for and against fire-based EMS - in future columns in the series."< />< />< />Are you kidding? I'm hooked!< />< />Seriously, it's a deep subject, with no right or wrong for everyone. I went ahead and weighed in on my blog.< />< />Fixit

Sara · 1 year ago

I should have asked this before I wrote my snarky comment, but does "dual role" refer to the same people running EMS calls on the ambulance and running fire calls on the engine, or does it refer to two different groups both working for the Fire Department?

Sara · 1 year ago

I should have asked this before I wrote my snarky comment, but does "dual role" refer to the same people running EMS calls on the ambulance and running fire calls on the engine, or does it refer to two different groups both working for the Fire Department?

Gary · 1 year ago

I tried, but failed to resist, commenting here. < />< />I think you asked the wrong question AD. The question should be, what does the fire service need to do to become respected by EMS? < />< />The notion that EMS providers have to prove that they can multi task or master multiple skill is absurd. It's what we do every day. < />< />As a third service provider for almost 30 years, my experience is that the fire service only wants EMT involvement when they see run volume dropping. Other than that, they aren't interested. Nor, generally do they do a good job. < />< />Mr. Fixit talks about the west coast leading the way in paramedicine. Indeed, they were the among the first, but they are hardly among the best. There is a difference between training paramedics and teaching paramedics. The best systems in the country teach their medics, they don't train them. California medics in particular are famous for being trained, not taught. Which is why their skill set is limited and seems to be getting more so as time progresses. < />< />Capo comments on successful FD/EMS mergers, but doesn't name any. San Francisco, New York City, Louisville, Winnipeg are all mergers which have either failed or been pulled back. DC and Philadelphia FD EMS systems are frequently in the news, and not for innovative or excellent care. < />< />When Al Whitehead talks about fire EMS, he talks about jobs, run volume, higher salaries. He doesn't talk about better patient care. The reason would seem to be that the fire service cares about run volume, not quality of care. < />< />Good fire/EMS systems are like the pot of gold at the end of the rainbow. Everyone has heard the story, but no one has actually seen one. < />< />Gary

Gary · 1 year ago

I tried, but failed to resist, commenting here. < />< />I think you asked the wrong question AD. The question should be, what does the fire service need to do to become respected by EMS? < />< />The notion that EMS providers have to prove that they can multi task or master multiple skill is absurd. It's what we do every day. < />< />As a third service provider for almost 30 years, my experience is that the fire service only wants EMT involvement when they see run volume dropping. Other than that, they aren't interested. Nor, generally do they do a good job. < />< />Mr. Fixit talks about the west coast leading the way in paramedicine. Indeed, they were the among the first, but they are hardly among the best. There is a difference between training paramedics and teaching paramedics. The best systems in the country teach their medics, they don't train them. California medics in particular are famous for being trained, not taught. Which is why their skill set is limited and seems to be getting more so as time progresses. < />< />Capo comments on successful FD/EMS mergers, but doesn't name any. San Francisco, New York City, Louisville, Winnipeg are all mergers which have either failed or been pulled back. DC and Philadelphia FD EMS systems are frequently in the news, and not for innovative or excellent care. < />< />When Al Whitehead talks about fire EMS, he talks about jobs, run volume, higher salaries. He doesn't talk about better patient care. The reason would seem to be that the fire service cares about run volume, not quality of care. < />< />Good fire/EMS systems are like the pot of gold at the end of the rainbow. Everyone has heard the story, but no one has actually seen one. < />< />Gary

Cheating Death · 1 year ago

Good Stuff. This disfunctional family that we live in could use some counseling...

Cheating Death · 1 year ago

Good Stuff. This disfunctional family that we live in could use some counseling...

Ambulance Driver · 1 year ago

"I should have asked this before I wrote my snarky comment, but does "dual role" refer to the same people running EMS calls on the ambulance and running fire calls on the engine, or does it refer to two different groups both working for the Fire Department?"< />< />It refers to any department that requires all of their medics to be cross trained as firefighters, and to a lesser extent, requiring all firefighters to be trained to some level of EMT -even if they'd rather never render any patient care.

Ambulance Driver · 1 year ago

"I should have asked this before I wrote my snarky comment, but does "dual role" refer to the same people running EMS calls on the ambulance and running fire calls on the engine, or does it refer to two different groups both working for the Fire Department?"< />< />It refers to any department that requires all of their medics to be cross trained as firefighters, and to a lesser extent, requiring all firefighters to be trained to some level of EMT -even if they'd rather never render any patient care.

Mr. Fixit · 1 year ago

Where I am, cross training (in this context you are refering to) means everyone at the basic rank of firefighter is both fire and paramedic certified. EMT-basic is not an option.< />< />To be really honest, around where I work in DFW, being a fireman is a defacto comment that you are also a paramedic.< />< />Cross training around here often means fire and police training such as a public safety department like DFW Airport or Highland Park.< />< />Fixit

Mr. Fixit · 1 year ago

Where I am, cross training (in this context you are refering to) means everyone at the basic rank of firefighter is both fire and paramedic certified. EMT-basic is not an option.< />< />To be really honest, around where I work in DFW, being a fireman is a defacto comment that you are also a paramedic.< />< />Cross training around here often means fire and police training such as a public safety department like DFW Airport or Highland Park.< />< />Fixit

Rogue Medic · 1 year ago

Why would anyone want every fire fighter to be a paramedic?< />< />Where is the benefit?< />< />Our problem is that there are far too many medics not too few.

Rogue Medic · 1 year ago

Why would anyone want every fire fighter to be a paramedic?< />< />Where is the benefit?< />< />Our problem is that there are far too many medics not too few.

Gary · 1 year ago

Rogue Medic, you are absolutely right. Systems with fewer medics have medics with better skills. Systems with too many medics mean that the high value skills are few and far between. That means that skill competence is harder to come by. < />< />Gary

Gary · 1 year ago

Rogue Medic, you are absolutely right. Systems with fewer medics have medics with better skills. Systems with too many medics mean that the high value skills are few and far between. That means that skill competence is harder to come by. < />< />Gary

Herbie · 1 year ago

I loved the article. The truth hurts.

Herbie · 1 year ago

I loved the article. The truth hurts.

Gnome from the Ice · 1 year ago

< />< />In my area, a FF/EMT or FF/medic can make anywhere from $45k/yr and up, depending on OT and some other considerations. That equates to about $21/hr. A thrid party, private ambulance service EMT-B makes about $7.50/hr (no counting shift differential) and a medic makes about $13/hr. Hospital based EMS workers (which in the great state of MD must be paramedic level unless you take a CNA class) make slightly more. So while EMS workers who don't wish to train as firefighters DO have other options, those options are usually not economically feasible. < />< />That said, this is in my state and area only (DC metro area) as I have researched, experienced, and learned about. Mileage may vary in different parts of the country. < />< />Good discussion! Thanks for the opportunity. I look forward to more in the same vein.

Gnome from the Ice · 1 year ago

< />< />In my area, a FF/EMT or FF/medic can make anywhere from $45k/yr and up, depending on OT and some other considerations. That equates to about $21/hr. A thrid party, private ambulance service EMT-B makes about $7.50/hr (no counting shift differential) and a medic makes about $13/hr. Hospital based EMS workers (which in the great state of MD must be paramedic level unless you take a CNA class) make slightly more. So while EMS workers who don't wish to train as firefighters DO have other options, those options are usually not economically feasible. < />< />That said, this is in my state and area only (DC metro area) as I have researched, experienced, and learned about. Mileage may vary in different parts of the country. < />< />Good discussion! Thanks for the opportunity. I look forward to more in the same vein.

Medicmarch. · 1 year ago

Good entry man. Sadly, you inspired me to make my own little smudges in the dirt and throw a post up on mine, so I decided to try and figure out a way to shamelessly pimp my blog out to ya.< />< />Oh wait. Here it is.

Medicmarch. · 1 year ago

Good entry man. Sadly, you inspired me to make my own little smudges in the dirt and throw a post up on mine, so I decided to try and figure out a way to shamelessly pimp my blog out to ya.< />< />Oh wait. Here it is.

Medicmarch. · 1 year ago

Holy crap. I got an honorable mention on the excellence in ems thingie. They must've had...what, three submissions?< />< />Uh, wait, I mean some guy, named Chance, who is not me, did something. He and I are not the same guy.< />< />For reals.< />< />-MM

Medicmarch. · 1 year ago

Holy crap. I got an honorable mention on the excellence in ems thingie. They must've had...what, three submissions?< />< />Uh, wait, I mean some guy, named Chance, who is not me, did something. He and I are not the same guy.< />< />For reals.< />< />-MM

chaos culprit · 1 year ago

Hey AD... I just read your Top Ten Signs It's EMS week.. it was fantastic!!!!

chaos culprit · 1 year ago

Hey AD... I just read your Top Ten Signs It's EMS week.. it was fantastic!!!!

macmedic · 1 year ago

< />What?! Where? A little linky, please?

macmedic · 1 year ago

< />What?! Where? A little linky, please?

born_yesterday · 1 year ago

http://www.ems1.com/ems-products/consulting-man... />there ya go y'all

born_yesterday · 1 year ago

http://www.ems1.com/ems-products/consulting-man... />there ya go y'all

Divemedic · 1 year ago

I work in Florida, where FF's are at least EMT-B's in most areas of the state. Many departments require a FF to be a medic in order to be promoted.< />< />When fire and EMS departments were split, they made much less money. The more skills an employee brings to the table, the more they are worth. < />< />In my department, where fire and EMS have been merged for over 20 years, medics are still treated badly. No one likes getting up for the 4th call after midnight for toe pain, so they blame the medics.

Divemedic · 1 year ago

I work in Florida, where FF's are at least EMT-B's in most areas of the state. Many departments require a FF to be a medic in order to be promoted.< />< />When fire and EMS departments were split, they made much less money. The more skills an employee brings to the table, the more they are worth. < />< />In my department, where fire and EMS have been merged for over 20 years, medics are still treated badly. No one likes getting up for the 4th call after midnight for toe pain, so they blame the medics.

Liz · 1 year ago

I have a slightly different perspective to this. I am a fire EMT wife and mom. We have been part of a couple of different systems. We began in a combined EMS/fire system which was also a sucessful vol/paid combo system(PGFD). We are now in a completely seperated wholely volly system. The way I see it is a big part of the problem stems from one thing, MONEY. The fact that EMS runs are chargable and fire runs are not. This leads to external forces pitting the two against each other. Which then leads to the chiefs feeling pitted against each other etc etc.

Liz · 1 year ago

I have a slightly different perspective to this. I am a fire EMT wife and mom. We have been part of a couple of different systems. We began in a combined EMS/fire system which was also a sucessful vol/paid combo system(PGFD). We are now in a completely seperated wholely volly system. The way I see it is a big part of the problem stems from one thing, MONEY. The fact that EMS runs are chargable and fire runs are not. This leads to external forces pitting the two against each other. Which then leads to the chiefs feeling pitted against each other etc etc.

CountyRat · 1 year ago

We have to consider the fact that fire fighting and emergency medical care require different aptitudes, and so, attract different folks. There is self-selection by personality, and that is a good thing. However, the qualities of personality that makes one a good fire fighter, might not make the same person a good medic, and vice versa. Citizens are probably best served when people are allowed to pursue their interests and capabilities, even though that is less efficient. Efficiency is desirable, but the best way to save a life might not be the most efficient. Life saving trumps efficiency.

CountyRat · 1 year ago

We have to consider the fact that fire fighting and emergency medical care require different aptitudes, and so, attract different folks. There is self-selection by personality, and that is a good thing. However, the qualities of personality that makes one a good fire fighter, might not make the same person a good medic, and vice versa. Citizens are probably best served when people are allowed to pursue their interests and capabilities, even though that is less efficient. Efficiency is desirable, but the best way to save a life might not be the most efficient. Life saving trumps efficiency.