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IAFF, IAFC Fire-based EMS
Editors Note: It is not the intent of this post, nor other JEMS webteam posts, to fuel passionate arguments or beat the 'virtual' dead horse. Instead we offer various forum discussions to promote a constructive dialogue. Occassionaly, like below, we offer some questions connected to the related news story. We understand that the EMS vocation crosses many lines; career, volunteer, fire-based, private contractor, hospital-based. Through constructive posts, each has the opportunity to be understood.
IAFF, IAFC Show Support for Fire-based EMS
On November 2, 2009 the above fire service organizations issued a statment of support for fire-based EMS, specifically ambulatory transport as provided by a fire department. In light of the nation's economic condition and the various employment settings many of you have we ask:
- if you are employed by a private or contract EMS service, how does this affect you and the communities you serve?
- how do you suppose that fire departments, many which have undergone staffing reductions and station closings, promote this message to their civic leaders?
- is it possible, considering the IAFF, IAFC support, that given the majority of fire department responses, EMS can achieve a higher position of respect within fire departments?
IAFF, IAFC Show Support for Fire-based EMS
On November 2, 2009 the above fire service organizations issued a statment of support for fire-based EMS, specifically ambulatory transport as provided by a fire department. In light of the nation's economic condition and the various employment settings many of you have we ask:
- if you are employed by a private or contract EMS service, how does this affect you and the communities you serve?
- how do you suppose that fire departments, many which have undergone staffing reductions and station closings, promote this message to their civic leaders?
- is it possible, considering the IAFF, IAFC support, that given the majority of fire department responses, EMS can achieve a higher position of respect within fire departments?
Replies to This Discussion
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Permalink Reply by Joe P. on -
Wow. You mean that the IAFF and IAFC supports issues that will give the IAFF more members? Color me shocked! I'd consider them "leaders" and "respectful" of EMS when they (specifically IAFC) actually realize that education and not simple training is needed to provide emergency medical care.
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Permalink Reply by Chance Gearheart on -
Things like this make me angry. Very, very angry. And I take it personally that just because I have a situation that doesn't permit me to become a full time, smoke eatin', water shootin ABC shift working Fire/Medic, I shouldn't be allowed to work in a 911 system? Personally, If I were to try out for Memphis Fire right now, I'd have to quit my college education towards a BSN, and eliminate my critical care pathway of education for the next several years. Should I have to do that just to help others?
Fire based EMS has it's place, but it's not a cover-all, every case scenario. Every situation is different. What works for a large city, will not work for a small town or rural county.
To somehow insinuate that because someone holds a Firefighter I/II/III, that someone will automatically be a better provider in EMS is idiotic, and violates the sheer nature of correllation vs causation. Very few fire based (Very FEW period) services have passionate, progressive individuals that put forward EMS and are in a leadership position to do so - Politics and Rank. It also borders on the discriminatory for the people in EMS who do not qualify for Fire Service in places that crosstrain due to injuries or illnesses that make them unable to participate in fire services, such as interior attack or hazmat. Before I go on, I'm a volunteer Firefighter. Fire is what caused me to get into EMS, and where I found a passion for prehospital medical care - But until the fire service wants to take on ALL aspects of EMS, not just 911-based transport and response, stop cherrypicking. The main issue is jobs. Firefighters are being laid off because their numbers cannot be justified in comparison to their costs. And I know some pretty GREAT fire medics, and some pretty pathetic private/third service paramedics - But the IAFF/IAFC doesn't speak for every situation or area.
Talk to me when A) Fire Departments start performing interfacility and minor medical transports, B) Specialty and Critical Care Transport, or C) Specialty Paramedic Services, such as industrial or dive services.
Private and third party services provide a valuable and irreplacable service to the community that a Fire-based service doesn't. Many rural areas couldn't afford to pay a fire service, expecially a paramedic's competative salary, and many fire departments around the country do NOT want anything to do with EMS Transport. In addition, you have the big "T" word - Tradition. Fire is big on the tradition side of things, with many providers reflecting that. When your job depends on you just getting past your 6 month probationary period, then you don't really have much incintive to be a nice guy to that grandma at 4 am.
That said - Everyone I've seen that "JUST" got their paramedic so they could be a firefighter does a relatively horrible job at patient care or customer service. EMS has to be as much of a passion as a job.
Also, I'd love the IAFC/IAFF to back up their claims. "Best" practice? As evidenced by what? Otherwise, you're just spewing anectodal rhetoric.
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Permalink Reply by Scott RB on
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There is nothing news-worthy about the "article". It is simply propaganda. The IAFF and IAFC do not have any peer-reviewed data to back up their claims. The choice to pass this on as "news" is insulting. We should not be asking whether EMS can achieve a higher position of respect within fire department, we should be focusing on achieving a higher level of respect among the field of public services, the healthcare industry, and the public. EMS under FDs hinders any of that. There is a reason that EMS is gaining much ground and respect in other countries - because they stand on their own. Although FD-delivered EMS may work well within certain communities, it still does little to help the EMS profession as a whole. (FDs can have a role in EMS as first-responders for which studies have shown them to be effective - but only at the BLS level.)
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Permalink Reply by Skip Kirkwood on -
Sorry, but I gotta say it. A "news story" about an opinion piece does not cause me to think much of the publishing media.
How about a call for proof? This subject would never get a single line in a respectable scientific publication, because there is not a single iota of evidence. When the IAFF and IAFC can prove, in a manner that withstands external scrutiny, that their model offers superior patient outcomes, then I'll be listening.
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Permalink Reply by Jasen Adam on -
I too Chance take statements like this very personally. 1/2 of the firefighters on our city FD started at our dept and left because they didn't want to be paramedics, but firefighters. They respond with us on "some" calls right now, but only if it is convenient for them. If it doesn't sound like something major or they are on a fire call then will never see them. I have even had them REFUSE to respond for us (all of our units were on emergency calls) because a possible intoxicated patient wasn't deemed an emergency by the duty Capt. Now they want to pick up my profession as an ala carte item that just pisses me off. I want to know when they will be able to handle the CE hours, because if you talk to them they spend a majority of their day doing fire-based training. I have a feeling training will be something that is not taken as serious as it needs to be. Look at what just happened in FL.
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Permalink Reply by Ben Waller on -
Chance, why should any EMS system be forced to provide services outside the ones that are in their business model? Interfacility skills don't have universal overlap with scene calls, for example. If an EMS system is in a small market and has only one receiving hospital, why should they be forced to strip their 911 coverage area in order to do an interfacility transport?
We don't force med-surg nurses to do OB-GYN or OR nursing. We don't force emergency physicians to be neurosurgeons or dermatologists. Why should we force EMS scene call specialists to do interfacility transports?
And "dive services" as part of EMS??? Why should a special operations team that will seldom do anything other than recover evidence or the occasional DOA have any connection to EMS. Most dive functions are law enforcement, not EMS.
As for why someone should have to be both a firefighter and paramedic to work in a fire-EMS system, a) that's not always the case and b) if the system is designed for fire/EMS overlap, then that system, not the applicants, get to choose the qualifications that the applicants must have or acquire to obtain and maintain employment with that agency.
I don't think that "The firefighters in my area don't really want to be paramedics" is going to pass the peer-review scrutiny test, either.
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Permalink Reply by Skip Kirkwood on
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There IS a very real issue of viability.
Only in the largest communities is there enough of "it" to be viable if subdivided. The reality of most communities is that if you take away the emergency work, an organization can't maintain a workforce. If you take away the non-emergency work, then you loose the profitability that can (and often does) subsidize the existence of adequate ambulance resources for the emergency calls.
The "dive" piece doesn't pass the straight-face test with me, but the viability issue does. EMS doesn't have sufficient breadth to (again, except in the largest of communities) have "scene call specialists" and "inter-facility specialists." How thin can you split a toothpick?
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Permalink Reply by Joe P. on
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Ben Waller said:We don't force med-surg nurses to do OB-GYN or OR nursing. We don't force emergency physicians to be neurosurgeons or dermatologists. Why should we force EMS scene call specialists to do interfacility transports?
...
b) if the system is designed for fire/EMS overlap, then that system, not the applicants, get to choose the qualifications that the applicants must have or acquire to obtain and maintain employment with that agency.
Do I really need to comment here?
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Permalink Reply by Ben Waller on
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Skip,
The scene-only systems who do things other than EMS have a variety of revenue streams that are not dependent upon transports. If we're going to push for EMS revenue that is not based solely on transport, then we need to recognize that in some systems, those "future" revenue sources are in place now.
As for "splitting the toothpick", that's already the norm in many places.
There are any number of locations where the 911 system either doesn't do interfacility transports, or only does the uber-critical ones when the primary interfacility service isn't available. I've worked in four different systems in three different states where that was the case, and am familiar with numerous similar systems. The 911 systems, interestingly, were all county 3rd services.
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Permalink Reply by Nathan on -
I no longer have a strong opinion either way because I have been able to find FDs that run a good EMS system and are putting emphasis on good EMS education for their people. So if the power mongers want more meat, whatever as long as they are willing to step up to the plate with higher standards. I have my doubts about that. If we want to think of ourselves using the Marines analogy we should be a jack of all trades. Dialysis and other non emergent calls can easily be provided to a community without stripping the 911 trucks. In many cases this set up enables for the rapid activation of more trucks than a system with just enough to cover the usual 911 volume.
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Permalink Reply by Ben Waller on
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Nathan,
I agree that whoever provides EMS should try to provide a good system with evidence-based protocols, practices, and standards. They should try to provide the best possible customer service in a cost-effective manner, and they should hire people who want to participate in the type of model for which they apply.
However, in places that specialize in scene calls of all types, and whose funding model isn't dependent upon interfacility transports, dialysis or convalescent transports, etc., there are good reasons for not getting into that type of work in a lot of places. Scene work for those departments doesn't just involve EMS calls. If your workforce also runs fires, hazmat, technical rescue, fire alarms, and service calls like restoring sprinkler systems to service, the non-scene call workload segment is busy enough that the non-scene work tends to hamper the emergency part of the operation. That is especially true for systems that do on-duty training in order to control overtime costs and for systems with limited manpower.
The complaints about people who want to be firefighters, not paramedics are sometimes valid, but there are thousands of people who want to be both and who work hard to be good at both. The people who want to only be firefighters are going to have a smaller and smaller job market, because single-function fire departments are obsolete. That wish is unrealistic...just as the typical paramedic "we save lives" mindset is obsolete. Most of what EMS does is not lifesaving, it's just taking care of a patient with an acute problem. Unrealistic expectations are not limited to fire paramedics - the non-fire ones just tend to have a different set of unrealistic expectations.
Nathan said:I no longer have a strong opinion either way because I have been able to find FDs that run a good EMS system and are putting emphasis on good EMS education for their people. So if the power mongers want more meat, whatever as long as they are willing to step up to the plate with higher standards. I have my doubts about that. If we want to think of ourselves using the Marines analogy we should be a jack of all trades. Dialysis and other non emergent calls can easily be provided to a community without stripping the 911 trucks. In many cases this set up enables for the rapid activation of more trucks than a system with just enough to cover the usual 911 volume.
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Permalink Reply by Robert Sullivan on -
Lets pull cops into this too. This reminds me of the fire scene in Gangs of New York.
http://www.jems.com/news_and_articles/news/09/mercy_flight_files_su...
They forgot to mention all the evidence supporting heliocopter transports for trauma patients, quick response times to trauma scenes, and RSI for head injuries (tongue firmly in cheek).
So now we're going to drag competing delivery models into court. How's that for visability?
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Hi everyone, I have been working a Fly Car now for 2 years. I also like the concept. In fact, the hospital that I am working in (Bangkok, Thailand) is the only hospital base ambulance that operate this type of vehicle with multi-tasks.
If you work in a "fly car" or "first responder" this is the place for you. Say hello, get to know each other, share experiences good or bad. A good place to vent or just learn what we all do in our regions.
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