Social and Professional Network
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
-
Permalink Reply by Ben Waller on -
Joe,
The issues you cite with the IAFC are not limited to fire/EMS, but are being used as an indictment of only that segment of EMS systems design.
The educational issues are a lot deeper than what you cited; they go to the "Joe's Garage School of EMS" issues, for example.
EMS education issues are germaine to the entire spectrum of EMS, not just the fire service.
Have you seen the revolving door at AMR and Rural Metro lately?
-
Permalink Reply by Joe P. on -
Ben Waller said:Joe,
The issues you cite with the IAFC are not limited to fire/EMS, but are being used as an indictment of only that segment of EMS systems design.
The educational issues are a lot deeper than what you cited; they go to the "Joe's Garage School of EMS" issues, for example.
EMS education issues are germaine to the entire spectrum of EMS, not just the fire service.
Have you seen the revolving door at AMR and Rural Metro lately?
Oh, I'll be honest. I think that the AMR's little "National College of Technical Instruction" and they're 2 week long A/P course is complete and utter BS. That said, I'd like to see a statement from, say, the American Ambulance Association that has a similar tone and message to the IAFC statement. There's a difference to organizations providing poor instruction that still meets the current standards or having a business practice that actively uses the high turnover as a way to control costs and actively advocating against higher standards, like college level instruction, which ia what the IAFC is doing.
-
Permalink Reply by Ben Waller on
-
Joe, how is following current practice (AAA, private-sector EMS) different than advocating for keeping the current practice (IAFF/IAFC) ???
-
Permalink Reply by Joe P. on
-
Ben, simple. They're doing what all companies do. To be fair, all organizations should work to be as slim as possible, including the government systems since all organizations need to take in more money than they send out (including fire, third service, and volunteer agencies). Now, it's not that simple because there are valid reasons to pay more than minimum wage or market wage. Using a non-EMS example from California, there's a burger place out here called In-N-Out and one of the things that In-N-Out does that other fast food joints don't do is pay their employees well. I think it's something around 9-10/hr starting, and that was when the minimum wage was $6.75/hr. Now the benefit to In-N-Out is better quality food (higher quality, more motivated burger flippers, good food), cleaner restaurants, more efficient employees (last two=motivation), and an almost cult like following of customers out here. To be honest, I've always wondered how much secondary costs (units better taken care of, better customer service from the employees, less time off, easier to fill shifts, etc) would decrease if wages were increased at many of these companies since a higher wage should shift the quality of employee that they are attracting to the right.
Unfortunately, with payers (including government contracts who often look for price over quality) looking to limit their costs as much as possible while following the law. For educational programs, it makes no sense to design training programs that few will apply to because their longer and/or more expensive than other nearby programs. Hence why a lot of paramedics decline a degree option when they can opt out at an earlier time for a certificate. Now companies have three options when it comes to reform. They can either support it (which, arguable, is not in the best interests of companies unless reimbursement goes up. Again, money in/money out and this begins an almost chicken or the egg argument over which should come first), let the chips lie where they land, or they can actively fight it (the option taken by the IAFC). To say that organizations that haven't taken a stand one way or the other tacitly supports one side or another is false for no better reason that someone can make the exact opposite argument. For example, I don't think that an argument could be made that agencies that use NREMT-I/99s automatically oppose the new levels because I/99s are going to be transitioned into NR-Ps* unless they explicitly state otherwise.
To be honest, the organizations that are supposed to represent paramedics (NAEMT and IAFF for the paramedic/fire fighters) should be arguing for higher education and use that for leverage for higher reimbursement, just like the RNs and RTs did when they moved to making college level education the standard. Unfortunately, too many workers (at all levels) fail to understand that their wage is based, in part, on what they can negotiate for and what services they can offer to their company.
*Side note, since the new levels does away with the EMT designation before paramedics, is it now just simply Nationally Registered Paramedic (NR-P) even though the proper name for NREMT includes "EMT?"
-
Permalink Reply by Ben Waller on
-
Joe,
I can't find the reference to any update on the 2007 draft IAFC document. It's likely that it has been overtaken by events.
I understand that the availability of the vocational paramedic certificate programs as the minimum standard hurts associate degree program registrations. I was in the first A.D. paramedic class in the state in which I then practiced. It was essentially a 1+1 program - one year for the paramedic certification and the second for the non-PM academics. The A.D. program didn't last long. One of the issues was that the academic requirements were a full-time semester longer than the A.D. nursing program. Because the program was new, the program designers felt that the paramedics had to prove themselves at a higher level than the nursing students or something.
Another of the issues was that the program was indirectly sabotaged by some of the regional EMS systems. They didn't want paramedics with more education than the administrators, who at the time had high school educations and the one-year paramedic votech certification - or who were business people with no medical background.
The degree program, interestingly, was revived by the same college's Fire Science/Management program. Any paramedic who has state certification can apply for equivalency credit for the PM classes, then take one year of administration/management courses with both fire and EMS applications - legal foundations, administration, personnel, standards of cover, deployment models, public sector finance, etc.
I'm not there any more, but I thought that it was interesting that a fire management degree program would bail out an EMS degree program that lost traction due to low enrollment.
The prime issue for fire departments - and a lot of non-fire EMS systems - is the volunteer sector, particularly in the northeast and midwest where a lot of those programs are at least somewhat viable. When you raise the requirements to a degree, you're going to essentially eliminate volunteers, and in areas that have the perception that the only way they can have services is through volunteers, that's a huge problem.
The IAFC recognizes this problem, since they have an EMS section and a volunteer section.
I think there's a rational compromise...
Start requiring a minimum of an A.D. paramedic in all 50 states and the territories.
Grandfather existing paramedics so that the changeover process will be gradual - as nursing's was.
Encourage the volunteer sector to stick with the EMT-B level. It might not be as comprehensive as some of us would like, but a compromise between a program that volunteers can afford the time for with the reality that the volunteers have a huge voting block in at least 1/3 of the country, and can derail the push for education if they really want to.
If we're going to throw tons of money into federalized health care, let's make sure that a big chunk of it is made available to encourage existing paramedics to pursue the A.D. upgrade. That would include tuition assistance for the students, and more importantly, reimbursement for the agencies to fund overtime and backfill to make it economically viable for both the individual and the agency to pursue higher education for the paramedics. That could be done contractually, so the program would not differentiate between system models.
-
Permalink Reply by Nathan on -
And that, Is why Im against many fire based systems. At the highest levels they strive for mediocrity. The fire service has not changed significantly in many many years. There is no room in the field of medicine for this well documented sluggishness.
Joe P. said:Ben Waller said:Joe, where did you make the mental leap to assume that I don't believe in education for EMS?
Not only do I advocate for just that, virtually every municipal and county EMS and fire system in my state has tuition assistance programs to support higher education for their employees, there is additional assistance from the state municipal association, and educated enty-level employees are increasingly the norm.
My comment is about the IAFC. Specifically lines like this.
"While the IAFC EMS Section supports higher education and the aim of increased professionalism in EMS, it is concerned that the general move toward college-based courses, the increase in hours and resulting financial impact will adversely affect departments’ ability (especially volunteer departments) to meet the goals of the standards."
So... yea... we like higher education as long as it's free education and doesn't take too long.
"EMS personnel must achieve EMT state licensure certification before advancing to paramedic training."
It's easier to have shorter paramedic programs if we don't have to teach everything. Of course essentially no other medical field requires their students to have time at a lower level. I don't know a single PA in my class right now, which is the same as saying that every paramedic should work as a basic first.
"With respect to CoAEMSP certification for paramedics under “Educational Infrastructure,” the education standards should also include certification via fire service academies accredited at the state level."
Translation? Math is hard! (i.e. we don't need none dat edumakation).
Substantiation for the above quote (not my translation): "Many fire academies have excellent education and highly qualified training staff but would not qualify if the requirement was held to a college or university setting."
Translation: We're just as good as those college folks, even if we don't have do all that thar inspection and accreditation things that allows us to give those cool little academic letters after peoples names.
All those excerpts from "Re: Formal Comments on the National EMS Education Standards, Draft 1.0" by Gary Ludwig. Now, to be fair, this is from 2007. If the IAFC has changed their tune, I'd be more than happy to read something that is published and apologize. Of course, in my view, anything short of requiring an associates degree at a minimum for medical providers who work in acute, life threatening environments without direct medical oversight (and yes, I view paramedics as being fairly independent compared to other health care workers since they don't have easy access to other health care professionals when working on scene) is a failure for education reform.
One final thought. With the nursing shortage, why isn't there a push for lower education standards like what is being called for in EMS? You don't see a big expansion in nursing certificate programs.
With the primary care physician shortage, why are accelerated medical school programs next to non-existent? LECOM has one of the few accelerated PCP programs. Of course it's shorter because a handful of rotations were cut along with just about all vacation time. Why is EMS the only health care field fighting against higher standards?
links:
IAFC comments: http://www.iafc.org/associations/4685/files/ems_NtlEMSeduStandardsS...
Accelerated medical school program: http://www.lecom.edu/pros_pathways.php/how-the-primary-care-scholar...
-
Permalink Reply by Nathan on
-
Ben Waller said:Joe,
I can't find the reference to any update on the 2007 draft IAFC document. It's likely that it has been overtaken by events.
I understand that the availability of the vocational paramedic certificate programs as the minimum standard hurts associate degree program registrations. I was in the first A.D. paramedic class in the state in which I then practiced. It was essentially a 1+1 program - one year for the paramedic certification and the second for the non-PM academics. The A.D. program didn't last long. One of the issues was that the academic requirements were a full-time semester longer than the A.D. nursing program. Because the program was new, the program designers felt that the paramedics had to prove themselves at a higher level than the nursing students or something.
Another of the issues was that the program was indirectly sabotaged by some of the regional EMS systems. They didn't want paramedics with more education than the administrators, who at the time had high school educations and the one-year paramedic votech certification - or who were business people with no medical background.
The degree program, interestingly, was revived by the same college's Fire Science/Management program. Any paramedic who has state certification can apply for equivalency credit for the PM classes, then take one year of administration/management courses with both fire and EMS applications - legal foundations, administration, personnel, standards of cover, deployment models, public sector finance, etc.
I'm not there any more, but I thought that it was interesting that a fire management degree program would bail out an EMS degree program that lost traction due to low enrollment.
The prime issue for fire departments - and a lot of non-fire EMS systems - is the volunteer sector, particularly in the northeast and midwest where a lot of those programs are at least somewhat viable. When you raise the requirements to a degree, you're going to essentially eliminate volunteers, and in areas that have the perception that the only way they can have services is through volunteers, that's a huge problem.
The IAFC recognizes this problem, since they have an EMS section and a volunteer section.
I think there's a rational compromise...
Start requiring a minimum of an A.D. paramedic in all 50 states and the territories.
Grandfather existing paramedics so that the changeover process will be gradual - as nursing's was.
Encourage the volunteer sector to stick with the EMT-B level. It might not be as comprehensive as some of us would like, but a compromise between a program that volunteers can afford the time for with the reality that the volunteers have a huge voting block in at least 1/3 of the country, and can derail the push for education if they really want to.
If we're going to throw tons of money into federalized health care, let's make sure that a big chunk of it is made available to encourage existing paramedics to pursue the A.D. upgrade. That would include tuition assistance for the students, and more importantly, reimbursement for the agencies to fund overtime and backfill to make it economically viable for both the individual and the agency to pursue higher education for the paramedics. That could be done contractually, so the program would not differentiate between system models.
Thats the most reasonable thing Ive heard you say in a long time! That "fire science" upgrade is failing fast as well. (in danger of closing due to lack of participation, its essentially a useless degree) People are simply going on and becoming a nurse.
-
Permalink Reply by Duncan Hitchcock on -
Interesting. I go away on vacation for a couple days, camping in a national forest, just me and the misses, and I come back the this site and the same ol’ same is being dragged through the muck and mire.
Even with their statement preceding the IAFC and IAFF position statement, the editor’s of jems should have known the resulting responses would quickly deteriorate to the usual beating of breasts and gnashing of teeth. And, unfortunately, out come the finger pointing, nit picking and surly comments.
The position statement by the IAFC and the IAFF is one made in a time of financially strife and the need for securing a means to survival. The influence and power of these two large organizations should not be over or under stated or allowed to wreak havoc amongst other means of providing EMS.
In my humble opinion, the focus of EMS in its role as a continuum of the health care team should be on quality of patient care regardless of the model for providing the service. Fire chiefs and the union that represents the fire fighters are waking up to the forced realization that only through expanding the service provision to the communities that they serve can the taxes that support them can be justified as necessary expenses.
I view the statement by these two groups as a “duh”. Someone finally woke up to the reality that EMS is the mainstay of the modern fire department. It’s an EMS based fire department, not a fire department based EMS. It’s the only way to survival.
-
Permalink Reply by Robert Sullivan on -
Just because JEMS publishes a press release doesn't mean it adovcates for that delivery model. Its readers can look at this more objectively than people reading about it in the mainstream press. I do have a problem when JEMS publishes bad studies. See Priority Traffic from July '09: Timing EMS: Staffing & deployment patterns matter.
The study found that more firefighter/EMT first responders on scene lead to small incremental scene time differences. It implies that this is clinically significant, which has been debunked by real scientific studies. It also concludes that more firefighters are needed on EMS scenes to achieve these insignificant results. How objective do you think the control group was?
Google scholar David Cone and see what he's found about FD first response. And I wish JEMS would turn its BS filter up a notch.
-
Permalink Reply by Marshall on -
In my humblest of opinions, and maybe this is common knowledge, but this seems more like an identity crisis for EMS. I think the majority of EMS providers who do not belong to a FD want to establish EMS is a legitimate entity separate from Fire and Police. I for one would love to see EMS a separate entity and out of the FD. I find it really sad that FD's are looking at EMS as a means to justify their existence to tax payers and local government. This doesn't mean I believe FD do a horrible job at providing service - but are they willing to do and promote research? Improve quality through objective processes? Commitment to best practices and evidence based approaches?
I guess I just find this position statement to be an attack on me personally because I'm proud of what I do and the service I work for. I don't want to be associated with a FD - otherwise I would've been a FF. From my experiences and those that I have known who work for a EMS/FD only do it because of the compensation - not because they believe EMS delivered through a FD is the best means of delivery.
-
Permalink Reply by dr-exmedic on -
Ben Waller said:
That's a huge issue, and there is also a bunch of push-back from depts which have pushed the "paramedic on every street corner" model--every time the education gets longer, their budgets suffer.The prime issue for fire departments - and a lot of non-fire EMS systems - is the volunteer sector, particularly in the northeast and midwest where a lot of those programs are at least somewhat viable. When you raise the requirements to a degree, you're going to essentially eliminate volunteers, and in areas that have the perception that the only way they can have services is through volunteers, that's a huge problem.
-
Permalink Reply by Ben Waller on
-
Actually, the people who vote for the local officials are the ones who decide what kind of EMS they get, which means that they have a very good way to look out for their own interests and to ensure that their interests are paramount. If that's not the case, all they have to do is get 51% of the vote for someone else during the next municipal or county election and they can insert a new group of elected officials to look out for the public's interest. The elected officials decide what they think is propaganda and what is not. The elected officials hear about poor customer service, dangerous emergency vehicle operators, sloppy uniforms, or bad attitudes from the medics. And, when the elected officials decide that they want to do something about it, they generally do just that.
Attend Our Next Webcast
Add Contacts Now
Invite your EMS co-workers & friends to join your network. They'll automatically be added to your Friends List. Click Now
Latest Activity
Okay...
When I worked through this scenario, the initial thinking was myocarditis following a viral URTI giving him heart failure. Tachycardia, BP and gallop rhythm are all indicative of cardiac failure. The muffled heart sounds could occur with ...
In response to Robert Sullivan,
Ultrasound in terms of use by paramedics is looking more promising.Paramedics utilzing the skill for quick look @ the heart takes about 10-20 seconds. Interupting CPR for that brief period is IMO not crucial since y...
Once again, another "discussion" has sank to the expected and predicted quagmire of "my Dad can beat up your Dad."
The names and the positions advocated can be predicted from the onset of the posting of the topic of the fourm. I am reminded of my...
I'm thinking either liver failure or a ruptured spleen.
Member Search
Search by Name, Location, Agency, Keyword
Top News from JEMS
JEMS Connect is the social and professional network for emergency medical services, EMS, paramedics, EMT, rescue squad, BLS, ALS and more.
© 2009 JEMS / Elsevier Public Safety Our Sites: JEMS.com - EMS Today Conference & Expo 2009 - FireRescue Partners Firefighter Nation
Commercial Use Limitations: Use of any content features (blogs, forums, messaging, etc) for direct self-promotion, spamming, etc. will result in account termination. Profiles are for individuals only at this time. Profile icons may not include company logos.
