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Permalink Reply by Rob on January 18, 2009 at 5:59am

Well, depending on the size of the department and the call volume I can see both sides. Myself I feel that at least EMT-B is good for LT, but I run for (and have run in the past for) small, mostly volunteer departments. If you have 13 ems units in your department I guess you should count your blessings it is not required to get on the department. If played right by management it could prove to be a good incintive for some EMT-B's to get the P behind their name. I for one have stopped at EMT-I, but that will cover about 90% of the ALS calls I face. I just do not have the time to go for the P. I already face the con ed requirements for the stack of certs I have and work a full time job on top of it.

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Permalink Reply by FETC on January 18, 2009 at 8:56am

T-Man,

It depends on your organizations set-up. Some use an LT on the bus and it is a promotion/raise to offset your paramedic training. These guys are usually married to the bus and good luck to them.

For a Fire based EMS service, that uses LT's to cross man an engine, ladder or even the bus. A paramedic officer either Captain or Lieutenant is non-productive on the bus. If they are in a supervisory role and the only paramedic on scene, they can't possibly be in command and perform ALS efficiently.

Major Car Accidents, MCI, are they are expected to be the incident commander? What if they are on arrival of a person who needs ALS immeidately? What is their Duty to Act with the patient? Does ICS suffer?

If married to the bus around here, the Paramedic LT is reponsible for the supervision of his one basic EMT assigned with him. Multi-unit responses are arriving with senior officers anyway.

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Permalink Reply by The T MAN! on January 18, 2009 at 9:22am

Well we really have so many paramedics that our paramedic LT's don't ever have to get on the bus, mostly just paramedic SGT's and an EMT-I. EMT-I is mandatory to work for our department, and now we just started a program called "ZERO TO HERO". this is were as you are out of rookie school the county PAYS for you to go to PARAMEDIC school, ON SHIFT. Unfortunately I missed this program. I would love for the county to pay for me to go to paramedic school, especially on shift.

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Permalink Reply by Ben Waller on January 18, 2009 at 9:52am

We require all Lieutenant candidates to be either a National Registry paramedic or an EMT-B with a Associate's Degree in Fire Science or something closely related. We cross-staff engines and medics with the same personnel, so every firefighter we have gets plenty of EMS time as well.

When the officers ride the medic, they function as paramedics even at major MVAs or MCIs, unless they have a second paramedic on the crew. We run three-person staffing on most of our medics, and the third crew member is a second paramedic around half to 2/3 of the time.

If we have a major MVA or MCI, the 1st-due engine officer takes command until a chief officer arrives. The medic crew does their job - triage, treatment, and transport.

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Permalink Reply by sully on January 18, 2009 at 5:05pm

I SEE BOTH SIDE. I AM ON A DEPT THAT YOU HAVE TO BE A PARAMEDIC TO TOO EVEN GET AN APPLICATION FOR HIRE. SOME FIRE DEPARTMENTS WILL PAY FOR THE MEDIC CLASSES, BUT SOME JUST DON'T HAVE THE BUDGET TO SEND PEOPLE WHO WANT TO BE ON A BUS ALL DAY, AND MISS OUT ON A FIRE OR A BIG INCIDENT. I LIVE IN ST.LOUIS COUNTY MO, THE CITY OF ST.LOUIS HAS THERE OWN FULL-TIME PARAMEDIC'S THAT ALL THEY DO IS EMS CALLS ALL DAY, BUT THE PUMPER ALSO GO ON THE SAME EMS CALLS AS THE PARAMEDIC'S BUT THEY ONLY HAVE TO BE EMT-B THATS ALL. SO THERE IS A GOOD AND BAD TO THE STORY. AS AN LT THATS IS JUST MORE ON YOUR SHOULDERS TO TAKE CARE OF. AND MAKE YOUR YOUR GUYS ARE DOING THE JOB RIGHT. SO IF SOME DOES HAPPEN AND THE FAMILY COME AFTER YOU FOR SOMETHING THA WENT WRONG. YOUR THE ONE THEY COME TO FIRST, BECAUSE YOU WERE THE ONE IN CHARGE OF THAT SCENE..

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Permalink Reply by Ben Waller on January 18, 2009 at 9:31pm

Another consideration is that supervisors should be technically proficient in the skills their subordinates are expected to perform. A lot of fire departments have found out that it's difficult for non-paramedics to supervise paramedics effectively. That would be similar to having non-firefighters supervise firefighters.

If the department is committed to firefighter-paramedics, then requiring that supervisors has both skill sets makes sense.

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Permalink Reply by FETC on January 19, 2009 at 12:09am

Problem we have is the Lieutenant whether a medic or not is required to be a supervisor and not the attendant. We run a 3 man bus, LT and two attendants. A Paramedic LT skills are dramatically reduced when he is promoted to a supervisors role and taken out of the primary medic role. I have seen many let it go as they were promoted up through the ranks.

I do not agree with your analogy about non-medics supervising medics as I for one fall right into this scenario. Once on scene, I am in command of the incident. The Paramedic is in charge of patient care for the patient. He is soley responsible for the treatment and care of his one patient. He reports to me, if he screws up or does something wrong, it is a protocol issue with the medical control doctor and the state protocol board. If I were making sure every med draw was correct, then I couldn't possibly be supervising the overall incident.

Then again another paid department around us uses Paramedic LT's but it is a two man bus, he is the only medic on the rig and he is the supervisor for the one other subordinate - his driver...

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Permalink Reply by Ben Waller on January 19, 2009 at 2:50pm

There's a difference between a formal Command situation in a multicompany response and a paramedic - of whatever rank - participating in two-on-one or three-on-one patient care.

If the Lieutenant is the only paramedic or if he's one of two, he is still going to be participating in hands-0n patient care in our system. If you only have two or three people on a medic call, it doesn't make sense to have one just standing there playing the "I'm in charge" game. If it's a multi-unit response, we send an engine with the medic, and the engine officer is going to be in charge so that the entire medic crew can focus on patient care.

You refer to a paramedic making a mistake and the mistake being retroactively addressed by the medical control doctor or state protocol board. If the supervisor is a paramedic, then the supervisor can proactively intervene and make sure that the patient care error doesn't happen in the first place. That's better for the patient, it's better for the organization, and it's better for the crew. If the problem is nipped in the bud at the scene, then no mistake will occur and there will be no need for medical control physician or protocol board intervention after the fact.

Paramedic officers can help prevent ALS mistakes that non-paramedic officers may not recognize as mistakes.

Another point is that if you're a non-paramedic officer and the paramedic screws up patient care, who do you think is ultimately responsible? That's right, the officer is. If you're going to be responsible, you might as well have the qualifications to prevent mistakes, improve patient care, and ensure that the person in charge is qualified at the same level as is his/her crew.

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Permalink Reply by Paul on January 19, 2009 at 3:59pm

That’s kind of a strange requirement. I am very pro EMS, and believe me a take a beating for it. I can understand requiring medic at time of application, that’s really common by me. But for a promotion, I don’t understand that logic. If it is for the purpose of staffing the ambulance, then as stated, you should be one at the time of hire. The only sense I could see, is that when the department you work for is applying for it budget or grants, your departments credentials play a role in that. Do they say why it’s a requirement?

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Permalink Reply by Ben Waller on January 19, 2009 at 5:32pm

It's not strange at all.

Many departments have this requirement. It creates a situation where the company officers have all of the competencies that their subordinates have. EMS doesn't necessarily equal "ambulance". Many places run paramedic engines, paramedic rescues, or cross-staff an engine and a medic with the same crew. In all of these, the paramedic can be anyone on the crew through the rank of Captain.

When hiring, the department needs to find people that can pass all of the required entry-level testing. Most of the successful candidates will not be paramedics. That creates the necessity for training and certifying paramedics from the existing firefighter pool. If everyone who wants to be promoted gets paramedic certification, the department meets two objectives with one program.

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Permalink Reply by The T MAN! on January 19, 2009 at 5:52pm

The reason they require this, is because they want the supervisors to have as much knowledge as the officers/firemen that he is supervising. Whether it be a Fire scene or medical. Considering about 80-90% of our calls are in fact EMS related then it makes TONS of since to me.

And Our LT medics don't have to ride the bus. We have plenty of Fire medics and SGT medics to be on all buses. We staff our buses with a Paramedic (whether its a fireman medic or a Sgt medic) and a EMT-I. Occassionally we will put a third rider on for training purposes. Usually this third rider is in EMT school. Now, who ever the medic is on the bus is considered "Officer in Charge". if its a fireman paramedic, which happens alot, then he makes out of class pay because in fact he is "acting sergeant". Complicated but makes sense.

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Permalink Reply by The T MAN! on January 19, 2009 at 5:53pm

and we do have ALS Engines. Which is staffed, usually, with a paramedic LT. Which makes it ALS!

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