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The State of EMS
I have recently commented on a post on this site that has to do with whether volunteer departments should be doing rescues. A thread off that discussion led to talk about how different neighboring agencies compete for incidents. Where normally, I think, competition is a good thing but this gets rather heated and sometimes to the detriment of the public. I sited a particular incident I "witnessed" which I won't go into detail(if you want the details, check out the post I mentioned earlier) but to summarize it, a house literally burnt to the ground while 2 neighboring agencies debated control of the scene. I, personally, find this appalling. Has it really come down to this? We do mutual aide with other rural departments (mostly volunteer) and things go smoothly so I really don't think there is a compatibility issue here. The only agency that raised an issue about it is the paid/staffed 24 hour agency of the city. Don't get me wrong you guys. I admire and respect anyone that can do this for a living. I would love to get paid for this! However, I'm seeing a pattern developing (this may be a long on-going thing but I have only been in EMS for 4 years). Has money brought us to this? Is it so important that we have to fight for responses? It's a sad day indeed. What I think we need to do is look at the cause not the effect. Departments across the country are looking at budget short falls and lack of funding. Agencies, I presume, are rewarded for call volume by federal grants. Am I right? That federal money isn't enough. That goes, almost, without even stating it. So why isn't it enough? Why don't we look at the people that are charging a public agency, which existence is about serving the public, $1500.00 for a set of turn-outs, $300.00 for structure boots that last a year. These people are making a killing on products for EMS systems basically turning a public service into an industry. The result of becoming an industry is documented in the incident above. So instead of trying to find ways to make the money these people want, how about dropping a little reality on them. Don't tell me that these manufacturers have to make that much. Somebody is just trying to get rich and achieve the American dream and they're doing it at our expense. There's the solution, in my opinion. What do you guys think?
Replies to This Discussion
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Permalink Reply by Joe Stoltz on
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Turf wars have been plaguing the fire service since the days of the bucket brigade. It’s only human nature that it happen in EMS as well. I blame the egocentric attitude of the CEOs or chiefs or managers that flows down to all of the troops. In the example of the house burning down, who in their right mind would interfere with fire suppression operations already in progress? If the IC had the best interests of the customer in mind he or she would have just gone to work to try and achieve fire knockdown.
I have been affected by turf wars in my area. These were rivalries between ALS agencies, who have tried various tactics to beat each other to a call for ALS assist. Unfortunately this sometimes involved falsely reporting their position at the time of dispatch, and unfortunately one night an agency came from much further away than the rival would have. It was my patient (from a roll-over MVA) and I found out what had happened when we got to the ER. By the time I was done and the fur had settled, the particular medic was nursing an intense hatred for me. But the medic heard the message: the patient's health and well-being is paramount and these turf wars had better stop! The head of the agency (who was the real culprit in this case) also had an attitude adjustment, although it didn't last very long as things turned out.
I don't think it's about money, since they handle about the same number of calls and have to charge similar fees per state requirements. It’s what some would call good old fashioned competition, in which the competitors try to outsmart, out-maneuver and hoodwink each other and the rest of the system to “get there first”. The result is an utter disregard for the health and well-being of the end customer.
I also don't see where the price of PPE contributes greatly to budget shortfalls for ambulance and fire agencies. Assuming paid staff, I'd think that 80 percent of the business expense is payroll. I could see a 30 percent markup on PPE but not much more than that. The base cost of making a set of turnouts is the material ("space age" stuff like kevlar and nomex), labor (a lot of hand work), overhead (recoup of r&d cost plus bosses, buildings etc.) and the cost associated with securing and maintaining NFPA, OSHA, UL and other agency certifications. If any manufacturer makes more than 10 to 15% profit margin I would be surprised.
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By the way - I just noticed you've also posted a blog on this subject; it would be great to have the discussion in one place or the other, rather than both...
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Permalink Reply by Tim on
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Hi Joe. As I stated before, I'm really green at this. I've only been in our fire dept. for 4 years. I just have seen an increase in these "turf wars" recently and am alarmed by it. Can't we all just work together? Also, it seems there are some who believe that money does have alot to do with the competition between departments. Check the post "Should volunteer departments do rescue?" There are alot of comments stating that money is a big reason. It may not be the main one but is a big one. When I see a paid department making this more of an issue than the volunteer departments around here, it makes me inclined to agree. You obviously have more experience in pricing for PPE than I do. I just see the outrageous prices and look at that as a percentage of the reason for this mad dash for the cash. Seeing the state of our present economy and how people are getting desperate to create more profit for themselves to stay on top is recipe for disaster when it comes to quality and price of our gear. I just had to get new structure boots because the ones I got (brand new) a year ago have the seams coming apart already. These boots cost my district $300. In the last year I have been on 4 structure fires, and have been to about 30 accidents. Counting trainings I would say I donned my gear about 60 times in the last year. My point is that I have donned my gear only a small percentage of the amount of times a regular shift firefighter would yet my boots have already become inservicable. I would have to think that if I, myself, paid $300 for a pair of boots, I would hope they would last longer than a year. What about these firefighters in staffed stations that have almost 3 times the call volume? If these boots last me only a year how long do they last for these guys? I just think that a little more attention could be paid to quality for the money that is charged. It just looks bad, Joe. Thank you for your response. I started this thing to see how you guys that have been in this thing for alot longer than I, felt about this. Again, thank you for your answer. You shed some light on this subject for me. I, also, apologize for the double post. I originally posted it as a blog but didn't see a way to post it on the home page so I started a discussion to try to get more responses. Hope I don't offend anyone by doing this. Have a great day, Joe. Stay safe out there.
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For the agencies in this area, the cost of an ALS intercept is not more than about $400. While this could cover a week’s wages for a medic, for an agency that’s running 10 or 15 calls a day it’s not a lot. I think it’s just peoples’ survival instincts kicking in.
In the case of the house burning down while Company B waited for Company A to withdraw, I’d like a little more information. Like, whose call was it anyways? It appears Co. B is the career force while A was a vollie crew, so did the vollies jump the city call? I don’t see where jurisdictions would overlap to where two departments were called to the same address UNLESS an automatic mutual aid arrangement is in place. Maybe some more information would help clarify this.
Hopefully we can get some others to chime in here.
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I'm not sure who was toned on it first (the stucture fire) because I don't have the rural departments frequency on my radio. I do have the city's freq. and heard the command vehicle arrive on scene in which he stated that the rural department was already there. The area in question is north of the city by about 10 miles. This is still "in district" for the city but the rural dept.'s jurisdiction is also in the area. You are also correct in that the rural dept is staffed with "vollie" crew and, of course, the city crew is paid staff. The rural areas around here don't have the money to finance a staffed station so volunteering is the only way these stations can get staffed. I'm a volunteer and we have to keep up our certification just like any other department. We train regularly and most have the same dedication to the profession. We just don't get paid (as much) and don't have the call volume as the larger cities do. I have seen my share of "nasties" though and we get the job done. I might toot my own horn here and say that we do a pretty professional job. We get 'er done. I really don't think a "vollie" crew and a paid crew should have any differences and should be able to work together without any problem. It's just a coordination thing. One guy takes command and uses his resources accordingly. By the way, this story made the paper when it happened. I will try to retrieve it and will contact you when I do. Until then, have a good night. Be safe(I know alot of people close with that line but I like it so I'll use it).
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