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Ambulance crew as RIT
Does your department assign RIT to the ALS ambulance crew, and what are your thoughts on this practice?
Replies to This Discussion
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Permalink Reply by Shareef Abdu Nur on
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Excuse me sir, but I strongly disagree! We take pride in all of our operations and I would hold our EMS skills against any sole role paramedic service. We move faster and are accustomed to thinking outside of the proverbial box. If anything, we offer a better service because we are fully aware that the objective is definitive care so we do not waste time on scene "playing doctor" like so many sole role paramedic services. We load and go when necessary and we stay on scene when necessary but every movement and decision is based on two things: patient care and getting back in service. The truth of the matter is that our communities and departments do not have the luxury of financially maintaining 2 separate services so we are tasked with more responsibilities and opportunities. I love being a Firefighter but I take as much pride in being a very good paramedic as well.
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I'm glad somebeody here understands.
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Permalink Reply by Ben Waller on
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What is there to understand? EMS is about taking care of other people's lives. So is firefighting. Both RIT and EMS assignment at fires are about taking care of OUR lives. Both are equally important. If you have enough fire-qualified EMS units to put an ambulance crew up as RIT, that's fine...as long as...
1. Another Ambulance covers the Rehab/Medical assignment.
2. There is an Ambulance ready to transport firefighters - QUICKLY - if needed.
3. The EMS crew has SCBA (many do not)
4. There is a source of RIT equipment for the EMS crew with that assignment present on scene. (The ambulance probably doesn't carry RIT gear.)
The bottom line - you don't need ALS on the RIT, but you do need ALS on the Rehab/Medical assignment. Most fireground LODDs and serious injuries are not preventable by RIT intervention, but many of them are preventable by Rehab/Medical intervention. I've yet to see a RIT that can rehydrate a firefighter with heat stress as part of their duties, for example.
With most fire departments running 80% to 90% of their workload on EMS assignments, it's a little mind-boggling that someone would support a "firefighter first, paramedic second" mentality.
I'm both, I'm proud of both, and I don't put the value of one above the value of the other.
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Permalink Reply by John Crabbe on
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Well stated Shareef.
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Also well said Ben and I think that is the concept I was trying to expand upon. Every place does things a bit different, but also just because one is assigned to the ambulance doesn't mean they will be strictly rehab/EMS. Yes, it does involve having a second ambulance on the scene to provide such service, but things can be adjusted accordingly as well.
For instance rehab isn't necessarily an incident priority, should be thought of, but not necessarily a first in assignment. In some cases the incident can be mitigated quickly and the first in ambulance crew can may not be needed for fire suppression and thus a second rig not needed. However, if the crew is trained as FF's, why not utilize them if needed, vs bringing in another pump etc.
I'm not a fan of having the ambulance crew as a RIT, such an assignment is better left to an engine or truck company depending on amount of personnel. Definately agree RIT does not need to be ALS.
For us the ambulances used to be the primary fire unit. When the dept only had a few SCBA's it was the ambulance crew that would pack up and go in. When the fire was out, the ambulance would be the first to be released. Well times changed and no longer like that but the ambulances here do have some FF tools like a set of irons, pickhead axe and SCBA's. There have been a few times the ambulance crew was first in and had to perform rescues, search, and even suppression with an extinguisher, etc. It is good to have the versatilty to mitigate as much as possible.
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Most ambulances only have a two-person crew. That isn't nearly enough people to properly staff RIT.
The other thing is that some of the replies indicate that there is confusion between "2 In, 2 Out" and "RIT". They are not the same thing.
Also, have you seen the Phoenix studies that show that RIT isn't rapid, it isn't really intervention, and the need for it is rarely limited to just one team?
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Shareef, does your EMS system follow Evidence-Based Medicine? If so, that means that you will treat some patients on the scene with treatments that have been scientifically been shown to be beneficial to the patient. That has nothing to do with "playing doctor:.
Treatment decisions for Patient A should never be based upon the next call where you might have to take care of Patient B. One example is that some places transport non-emergency patients with lights in sirens due to system status. That's legally very iffy, at best. If you have an ambulance wreck on a call where the patient condition didn't dictate the emergency traffic, that's likely a Born Loser when your service goes to court. EMS should be based on the patient's condition, on evidence-based medicine, and on protocols and SOGs that are legally and medically sound. "Getting back in service" as a goal is unlikely to be either.
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Permalink Reply by Steve Fischer on
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No!! our first in ambulance crew is used in a fire ground role because our second in ambulance is less than 5 minutes out, they will be triage/medical upon arrival. If there are no available second ambulances in service. The first in ambulance is medical only. Regardless of your ambulances role, I hope there's an ambulance on hand when the downed firefighter is brought out.
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Most ambulances only have a two-person crew. That isn't nearly enough people to properly staff RIT.
The other thing is that some of the replies indicate that there is confusion between "2 In, 2 Out" and "RIT". They are not the same thing.
Also, have you seen the Phoenix studies that show that RIT isn't rapid, it isn't really intervention, and the need for it is rarely limited to just one team?
I agree. There is a big difference between 2 in 2 out and RIT and a RIT team should be comprised with a minimum of 4 personnel. However, even this does not mean there will be enough. I believe the Phoenix study showed it took about like a 12:1 for a RIT operation.
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Permalink Reply by capcityff on
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Nope. The ALS ambulance isn't staffed with firefighters. It might have a firefighter/emt driving but the medic is a civilian ems only employee. This is starting to change but it will take a while for all to be like this.
The BLS ambulance on the initial box alarm is supposed to only be there for EMS. Depending on your battalion chief and the crew, they might throw a ladder or two or hump some hose.
RIT team consists of 5th due engine on the initial box and the truck on the working fire dispatch.(3rd truck on scene)
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Permalink Reply by Capt. Chris W. Button on
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OK, suppose your RIT team needs to make entry to make a save (or two). They come out with one victim but need to get the other out. Who will treat the patient and who will make entry for the other victim? Seems like a bad idea all the way around.
Another thought, is there enough room on an ambulance to carry all the proper RIT gear (air packs, forcible entry tools, turnout gear, etc.) along with that pesky medical stuff?
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Permalink Reply by Jonathan Danzer on
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At my department the second ambulance handles the patient and YES the ambulance has all that equipment that you listed.
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