Thursday, September 10

"How can they do both?"

Just saw an ad for the NBC Nightly news tonight that talked about how "Our nation's bravest" (Showing pictures of fires) are being taken out of the firehouse to care for the nation's poor.

And this is news now?

Seems to me the article mentioned all over from DC E10 has made it to the airwaves. The problem is the public still has no idea what the mission of the modern fire service is. Is it fires? Is it EMS? Is it code inspection?

I'm sure there are many an IAFF local that would like nothing more than to stop providing EMS services from their fire apparatus, but have they looked at the ink those calls bring? When I run the numbers in my department, there would be no way to justify half the resources we have deployed if they no longer responded to EMS runs. Plus, who will wait on scene 40 minutes for a private ambulance to arrive?

Are we at the crossroads where EMS can be lifted out of the fire service and if so where do we put it? Our pal CK mentions an EMS based EMS system, but my area doesn't have the resources to deploy EMS without the pre-existing resources staffed by the fire service.

Believe me friends when I say that if there is a more efficient way of providing our services, let's get to it. But to my readers who are "hardcore firemen" and dislike providing EMS in between your increasingly infrequent fires, just remember it's your job to provide that service. When that service is no longer part of the expectations of the community you will have serious trouble justifying all those big red trucks when the bells no longer ring.

Without EMS runs our 3 busiest engines and one of the nation's busiest ladder companies will drop off the list completely. But it's not all about how busy we are, but are we providing a valuable service to the community in the most efficient manner possible?

I'll be tuning into NBC News tonight to see the story, curious to see what they report. The timing of the story is also very interesting, considering tomorrow.


Anonymous said...

"CK mentions an EMS based EMS system, but my area doesn't have the resources to deploy EMS without the pre-existing resources staffed by the fire service."

"Without EMS runs our 3 busiest engines and one of the nation's busiest ladder companies will drop off the list completely"

Those two quotes tell me something.

There is no dedicated service in place for EMS because there are not the funds for one. Fire Fighters spend so little time fighting fires that they have time to go on EMS runs, in fact more EMS runs than Fire runs.

Logical conclusion - reduce funds, staffing, resources etc. to Fire, and remove EMS runs from their remits. The people left in the FD will deal with more fires, and funds will be saved.

Use the funds saved by reductions in staffing (redundancies as less work to be done), apparatus (fewer required as less staff for them, and less work for them to do), estates (some firehouses can be closed, as there are not the apparatus/staff to house in them) and fuel (no EMS runs means only running to fires, means travelling less) costs to fund a seperate EMS service. There is no reason that this couldn't be run under the auspices of FD, but they should be dedicated to EMS, and run on ambulances, not Fire apparatus.

"who will wait on scene 40 minutes for a private ambulance to arrive?"

With an adequately resourced, dedicated, Emergency Ambulance service, response times can be equal to that of Fire.

"it's not all about how busy we are, but are we providing a valuable service to the community in the most efficient manner possible?"

You can provide a better Fire service and a better Medic service by having them dedicated to their own jobs. Take the example of a person with the potential to be amazing at both. If he dedicates x amount of time to improving himself in his job as a FF/Paramedic, he will be less competent at each role than if he'd dedicated the entirety of his development time to either discipline.

Anonymous said...

You will see when you come over here the very obvious differences that sseperate two groups of staff on the same station - the Fire Fighters and the Paramedics. We occupy the same station but alot of each side dont mix very well.

We are two seperate entites with our own specialities. Its hard enough to ensure my own staff are up to date with training etc, never mind if I had to consider fire training.

In fact there is nooooooo way that a paramedic on my station or any other urban station in my area would ever have time to do any Fire training.

Maybe it will happen one day, I even heard a rumour the other day that some politician mentioned that the only way the two would merge would be if the NHS took over the fire service!!

John said...

An FD is just like the military-why do we keep all those guys around when there's no war on? Because you can't get enough of them fast enough when you need them. Just like the military, FDs conduct training, PR, education, and humanitarian efforts when in between major assignments (wars or fires).

An average EMS call threatens exactly one person and no property, and requires 2-4 personnel to respond within 5-10 minutes. My health insurance couldn't care less about what I do to protect my health, e.g. exercise, and I've never been asked by my health insurance co. how close I live to a hospital or EMS.

A fire requires 12-20 FFs and multiple apparatus in the first 10 minutes, and often threatens not only multiple people, but also increasing amounts of property. A fire can extend quickly and, in the case of commercial property, the loss can affect the tax base of the community and the employment of many of its taxpayers. Insurance companies routinely rate FDs and base rates on these ratings and measures taken by an owner to minimize damages. A properly resourced fire dept saves its taxpayers money that they would otherwise pay in increased fire insurance costs.

FDs have gotten into EMS for 2 reasons 1) it fits with our mission of saving lives 2) it helps justify and pay for the manpower on a DAILY basis for what we have to do OCCASIONALLY. Without EMS, we don’t have resources to fight fires and other emergency incidents that are manpower intensive (hazmat, technical rescues, MCIs) Here's the problem-you take all the funds from the FD and make some super-duper EMS only service. No FD can take that hit and provide the services the insurance companies base their rates on, so now citizens pay higher insurance rates for their property, with no corresponding break in their health insurance for that increased service.

So how many firefighters does that leave? In my area, not many. Volunteers aren't the answer-take away the full time FD and watch 90% of the volunteers dry up, because they are in it to compete for the full time job. Same with private EMS-many, maybe not a majority, but a substantial number are biding their time for the fire tests.

My dept of 5 stations and 75 FFs responds to about 9000 calls annually. Probably 7500 are EMS. We are usually back in service from an EMS call as soon as the ambulance arrives(10-15 mins), whereas the ambulance has to transport and will be gone an hour or more. Occasionally we get caught on a medical when a fire (or another medical) comes in, but the next rig over responds first due and the rig on the medical responds once the ambulance arrives. Where does that next rig come from when we get cut by 80%?

Okay, so now you're public EMS only agency is recruiting. What's the pay? Can a paramedic make a decent living? Most people don't see EMS as dangerous as fire or law enforcement-I'm not agreeing with that-but perceived risk is a major reason why fire and police wages are what they are. With all the other careers in the medical field that pay far better than paramedic with only a bit more schooling, how many of the good ones stay? Especially when your day consists of sitting on a street corner between transfers to nursing homes?

Bottom line: taking the $$ from the FD isn’t the answer. Getting it from the hospital or health insurance providers is. Maybe you can resource EMS from the hospitals by having medics work as orderlies in the ER, so the hospital can charge for it. Home health care could also be another method. But chances are whatever you do will pull EMTs/Medics out of their ambulances to fill the rest of their day with billable activities. How many will want that? Either way, this is should be a far more important part of the health care reform debate than the BS about “death panels”.

Greg Friese said...

I really appreciate and enjoy the thoughtful comments of readers to this blog. It is a big part of why I read almost every post. Thanks everyone.

Another component is changing the expectation of how quick a response should be. Many patients can and maybe should wait more than 8 minutes for an ambulance. While there is usually just one patient in an EMS incident many lives and much property is at risk due to efforts to respond to calls in less than 8 minutes.

I was thinking about this last week when the ambulance in VA (or maybe MD) was unable to locate the scene to transport a patient while an engine company was waiting on scene for more than 30 minutes. It was nice for that patient to have care during that entire time, but if we fly above the anecdote and think about all BLS patients what is an acceptable amount of time for them to wait for both a medical first responder (regardless of the cert) and then for a transport unit.

Again these are ideas circling in my head. Thanks for the venue to start talking them out with other professionals.

brendan said...
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