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Should fire and e.m.s. remain seperate departments?
In my area we have volenteer fire depts. and volenteer e.m.s. depts. I know that medical training is becoming more and more meshed with fire training. Should they stay seperate? Should e.m.s. handle all med. calls and fire only fire calls?
Replies to This Discussion
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Permalink Reply by Peter Lupkowski on
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My dept does both. I look at it as a continuity of care issue. I don't necessarily have to hand off care to anyone else before, during or after the extrication or whatever. I can accompany the patient to the hospital, help ALS and get back in time to clean up the engine. A sort of best of both worlds approach. I worry about a separation because I want to "take care of my own" and I want my brother taking care of me, not to stand around waiting for the (substitute irritating belittling phrase here) "ambulance driver." By the way the billing money is good.
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Permalink Reply by Joe Stoltz on
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There have been other discussions regarding PPE, EMS vs. Fire folks at scenes, and so on. At a vehicle crash, we create a hot zone around the vehicle and require all personnel in the hot zone to wear full PPE. I've read where the fire folks do the extrication and turn the patient over to the EMS folks outside the hot zone.
So - let's say we have a district that has separate fire and EMS agencies. The EMS folks (if dressed like some of the agencies around here) do not have structural PPE so they have to wait outside the hot zone until the patient is extricated or extracted.
This leaves the job of applying c-collar and extrication device, and backboarding for that matter, up to the fire folks. In fact, even before extrication is begun it is essential to get a baseline set of vitals.
Does it not make sense that the fire folks have basic medical training, to be able to accomplish these tasks?
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Permalink Reply by Tony P on
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And that's where local rules and practice can come in as well. Here, the Police are in control at MVA's. So we can't insist that anyone apart from our own people wear (our style) PPE. If there's fire, then we have charge until the fire is out, under overall control of the Police. Then it reverts.
Now, basic medical training? Welll the Fire Service I'm with insists that firefighters are trained in 1st Aid so that they can assist other firefighters when needed. And that's it. In practice though, we of course often have to provide aid to the public until Ambulance arrive (MVA's for instance). And as the general public have the perception that when they need help, well, there are firefighters at the Fire Station, they can give us that help can't they? Could we say to a member of the public requesting urgent assistance "not our job, ring for an ambulance"? Of course we can't say that! So yes, we (FF's) all need basic 1st Aid, plus O2 therapy and AED if we have the equipment, so that the public can get the assistance they need.
Here, there's a vast gulf between 1st Aider (and I include FF 1st Responder in this) and Paramedic - a gulf that keeps our services apart. Ambulance service having trouble with reponse times? Then they need to purchase more ambulances and/or hire more paramedics.
That's my view of the situation as it is here (Victoria, Australia) where our funding systems are so very different to those in the USA. So has little relevance to the USA except as a comparison. But it does all seem to come down to funding, doesn't it? FD's in the USA often need the ambulance work because they can charge for it?
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Permalink Reply by Engineco913 on
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Remember this one point. EMS (yes Every Minute Sucks) creates money for the department.
More money in the departments pocket means more money for things like equipment, and pay.
I say do whatever works for the department. If you run EMS, more power to you. If not and it works for you, so be it. I don't think there should be a mandate to say who can and will run the EMS.
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Permalink Reply by chele on
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Wow. Well guys, I don't think we are going to meet in the middle on this one. Obviously I apprechiate the value in being cross trained, since I am a FF/EMT. But let me put it to you this way guys. We are volunteers. And we don't have to. And I will fight to make sure it stays that way. Just because you have a huge pool of people to pull from that want to do both, doesn't mean we do! Right now there are 5 of us that are FF/EMS. Only four of us are certified FF1 and EMT-B (or above). None of us are paramedics. We have no paramedics in our entire county of 2200 people. Want to see an entire county unprotected or unserved by fire or EMS? Make cross training mandatory.
When I'm on an MVA with EMS I sure don't want anyone with me that doesn't truly want to be there, or that doesn't have the stomach for it. I don't need to increase my patient count by a FF/Tech that turned green at the sight of blood. But I'll fight fire with that same person any day of the week.
When I'm on the back of a fire truck I sure don't want an EMT on the truck with me that doesn't have the courage to do the job when it gets tough. But I'll take that tech on any ambulance call any day of the week.
It's not that they aren't willing, it's because they can't for one reason or another. Nobody is threatening to walk out or holding our services hostage!
I don't want our EMS director running the fire department.
I don't want our fire chief running EMS.
And, on our fire department, ALL the officers, including myself, are on scene fighting fire! We don't have white hats that don't get their hands dirty.
It's BECAUSE it's about the community that we don't force cross training. We'll take all the help we can get, to be sure our community is well covered when disaster strikes.
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Permalink Reply by Chris Hayden on
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Well, I thought this forum was about individuals who wanted to share their position on statements and questions. This was my opinion, not forcing it on anybody. But I bet if you check your numbers you will see that the run volumes in departments that do booth, the EMS run numbers account for 90% of their runs. By the way, I have found that no EMS is often times a vollie point of view (no offense to any vollies). I can't say that I blame those departments though; much more training, liability, and still no pay.
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Permalink Reply by bill cline on
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In my County, our fire and E.M.S. departments are seperate...should they remain seperate? I do not think so...it is very frustrating when the fire and ems visions of how things should be done collide...it would be nice if we could all cooperate and save a life!
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Permalink Reply by lutan1 on
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But I bet if you check your numbers you will see that the run volumes in departments that do booth, the EMS run numbers account for 90% of their runs.
Whilst I don't know the percentage, the annual run reports put out by Firehouse would definitely agree with that for the large majority, if not all departments that run combined services.
Some of the figures reported in those run reports are absolutely astronomical!
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I was thinking mostly of this part of your post Hayden; "Those of you who don't want to provide EMS care are a dying breed. EMS is the future of the fire service.". That comes over as a little more than an opinion. It totally discounts all the places that do things in other ways. EMS may well be the only way that many FD's in the USA can survice, I wouldn't dispute that as our situations are so different. But, and it's a big but, there's a huge world outside of the USA. And this site as[ires to a world membership.
Checking run numbers in 'departments that do both' isn't an option here. Fire and Ambulance are separate entities throughout the whole country.
I agree with some of your last statements. As a Vol, I have no desire for the extra training - a three year University degree? No thanks! Liability isn't an issue for us, we have State legislation that covers that sort of thing, for our State run services. Some of the call numbers I've seen quoted for some US volunteer FD's are huge, I don't know how the members can cope. I wouldn't want much more than the around 300 calls that my Brigade gets a year.
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This is a reply for Chele.
Very well put. I can relate to everything you've said, even though the question doesn't arise here. I've said elsewhere, it all seem to come down to funding and how you get it. Those places that are forced into EMS work because it's a source of required income, so be it I suppose. Those places that can run separate organisations, and remain viable, keep at it. I will never agree that the two services must combine in order to better serve the community. I don't think I've ever really disagreed with Mike and Ben before, but on this matter I do.
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Permalink Reply by Ben Waller on
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Chele,
Nowhere did I state that you should force cross-training on your members.
From my above post..."You can have merged departments with EMS-only members, fire-only members, and members who wish to do both."
On the other hand, merging the departments would still probably save your community money.
As for my department being large or having lots of manpower, think again. We have a minimum staffing level of 28 firefighters and 1 battalion chief to staff 8 ambulances, 7 engines, and 1 truck/rescue company per shift.
I've also spent a lot of my past in a volunteer department that ran an around 2,000 EMS calls, 400 working structure fires, 100+ extrications, and a few hundred misc. car fires, dumpster fires, hazmats, and etc. per year with about 30 to 35 active volunteers, on average. We staffed 5 engine companies, a truck company, a rescue company, and two ambulances with that manpower, so I've been in pretty much the same situation you're in. We didn't force any members to do both, but we were able to improve services and cut costs when we consolidated. Over time, we found that a lot of firefighters that initially resisted EMT training made pretty good EMT-B's, and a lot of EMTs that were scared to death of fire went to recruit school became FF 1's and 2's, and became good firefighters.
I've studied a lot of places that have lost volunteers for a variety of reasons, and the common denominator seems to be that the community will - however reluctantly - start hiring career EMS providers, then daytime engine drivers, eventually a career chief that's qualified for both fire and EMS, and then one day the community wakes up to find that they have a career fire-EMS department that still has a few volunteers.
Once you start hiring career staffing, the smart thing to do is to hire career people that are qualified as firefighters and as EMTs. That is the way to maximize individual capability to the fullest. The same goes for volunteers - if you have people that will perform only EMS or only firefighting, that's better than nothing, but it's half as effective as having people that can and will do both.
Bottom line - it's about both individual and department capability, and people with more capability are more valuable to the community on a 1:1 basis, because they're more mission-capable, more flexible, and the community gets more bang for the individual buck.
Ben
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Permalink Reply by Kyle Wiersema on
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i dont believe so. a volunteer dept is one dept its part of a protection district where everyone is on the same base. fire responds to the scene if help is needed but i personally think all fire fighters should be EMTs or at least first responders. if responding to the call fire dept can determine if scene is safe for medics but then they dont really do anything more, rather if they were trained in EMS they could at least hold C spine control bleeding etc. my opinion of this is lets get firefighters trained in EMS as well and everything can go smoother on scene.
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