IAFF, IAFC Fire-based EMS

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Permalink Reply by dr-exmedic 8 hours ago

Ben Waller said:

Example: The UK/San Fransisco medic exchange that's the topic of another post here. The UK medic talks about SFFD doing things with a four-person engine company that would be done by two medics in a small fly car in the UK. That is true, but it omits an important part of the equation. That item is that the engine company can provide a lot of services that the fly car medics cannot, including the ability to operate in and rescue from unbreathable atmospheres, the ability to extinguish fires, the ability to decontaminate hazardous materials, the ability to force entry into vehicles and structures, the ability to gain access to areas above and below grade, the ability to operate in two teams that's required to rescue from IDLH atmospheres, and a lot of other capabilities that EMS-only units do not have.

So? Neither I nor anyone I know have ever been dispatched to any of those things at a 3rd service without simultaneous fire or rescue dispatch, with the exception of forced entry into homes, which was done by our cops. This saved a significant amount of money by only having 2 paid personnel with an idling ambulance at most scenes, instead of 4 paid guys with an engine idling in addition to of the ambulance. (We did have fire-based FRs in some districts but they responded in an SUV, not the engine.)

Incidentally, how much ability to decontaminate hazardous materials does a SFFD engine have? I'm legitimately curious as the most anyone around here has on an engine is a few bags of kitty litter to soak up gas & oil.

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Permalink Reply by dr-exmedic 8 hours ago

Ben Waller said:

doc, when you get over the fact that the electric company doesn't answer 911 calls, then you can lecture me on straw men. Until then, not so much.

Sorry, you were focusing on the difference between police and fire and EMS, not the similar thing between them, and I got a little confused because there are probably 500 differences we could count but all the ones you picked also do apply to the utility repair folks (not to mention movers, Best Buy delivery crews, some long-distance trucking services, etc)--which to me makes them inconsequential.

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Permalink Reply by Ben Waller 8 hours ago

Skip,

Sorry, the defibrillator and syringe of Sux are not in the same league with a firearm. What kind of backstop do you need to ensure that a gunshot defibrillation aimed at a running criminal patient doesn't kill someone other than the criminal patient? What kind of phalanx of police officers paramedics is going to fire tear gas and pepper balls succynlcholine into a rioting crowd head-injured patient's IV?

Arrest powers versus patient treatment...surely you don't imagine that the police power to confined people against their will for bad behavior is the same as the much more limited EMS power of implied consent for people who cannot pass a present mental capacity test??? That analogy does not hold up.

As for the two-story buildings and ladder trucks, those same communities typically have setbacks which make the aerial ladder useful for reaching horizontally to those two story roofs and keeping the firefighters safer than they'd be on ground ladders. They also have things like 80-foot communications towers and 100-foot water towers where the aerial protects helps with rescue problems.

Foot patrols and company inspections do have some limited comparisons, but the foot patrols are carried out by individual police officers while most fire departments have done away with company inspections and assign specialists (fire inspectors) to the inspection function. My department is one of several that has done so, for a variety of reasons. The first is that those companies are too busy running EMS calls to have a guarantee of an uninteruppted inspection period while the inspectors don't have that problem. Another reason is that law enforcement/code enforcement is very different for LEOs and fire inspectors. The cops have the power to enforce a wide range of laws - the entire state and local criminal code of laws. The fire inspectors have very limited code enforcement powers in a single, narrow slice of the local code, and most fire departments don't give firefighters any code enforcement powers at all.

Further, a once-every 20 year ladder truck purchase doesn't have the same economic impact as do recurrent personnel costs, and anyone who oversees personnel salary and benefit costs knows it. Recurrent costs like salary and benefits savings from built-in efficiencies inherent in a combination system saves tons of money every year, while the capital cost of a (hypothetical) million-dollar ladder truck over its 20-year service life is only 50,000 per year - the cost of around a single employee's annual salary and part of his benefits.

If you save the cost of even a single two-person ambulance crew per year by running a combination fire/EMS system, then you can buy a million-dollar ladder truck every 10 years and break even. If you save more than the cost of one two-person ambulance crew per year with the combination department, then you can buy a million-dollar ladder truck every 10 years and come out ahead both in raw expenditures and in the fire insurance savings that the ISO points for the ladder gets you.

Add the fact that million-dollar ladder trucks are fairly rare. (I'm aware of a current order from a department near where I live that is getting two 100-foot ladder trucks for approximately one million $$.)

At the end of the day, the most important thing is evidence. There's not a lot of evidence that non-fire EMS sytems are better overall than fire/EMS systems. The problems that some fire/EMS systems have are shared by non-fire EMS systems, and in some cases the non-fire EMS systems have worst records than a FD without needing to fulfil more than one specialty function. What the evidence shows is that a lot of fire/EMS systems have been around for decades, with only a single known case of a municipal fire/EMS system giving up the transport function to a stand-alone EMS system, while the track record of combination fire/law enforcement departments is that most of them have failed and seperated back into seperate fire and police departments.
That includes one or two of your neighboring cities in central North Carolina, if I'm not mistaken. (Winston-Salem and Durham) On the other hand, another one of your neighbors, Greenville, has a well-regarded fire/EMS system that has great relationships with their county hospital, the Brody School of Medicine at ECU, and the AHLS program operated jointly by all three of those entities.

The numbers show that there are few successful fire/LEO combinations, while successful fire/EMS departments are fairly common.

And...successful EMS-only departments have no impact on non-tax costs to local residents and businesses, while fire/EMS departments can save their residents and businesses piles of money through improved ISO fire protection ratings.

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