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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?

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So Navy SEALs can't specialize in underwater demolition and hostage rescue? It just isn't possible?

Tom

dr-exmedic said:
Ben Waller said:
...and let the firefighter-paramedics specialize in both.
If you do more than one job, you aren't specializing any more.... :)

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Not valid.

Same skill sets (shooting and blowing things up) in different environment and a different (but very common) transportation method (swimming)..

More relevant - SEAL corpsmen. They start with expert hospital corpsmen, THEN training them to work in the SEAL environment. They don't start with physically fit shooters and make them learn medicine, nor do they take people who don't want to be corpsmen and force them to get a medical credential so that they can be allowed to ride an SDV and shoot an automatic weapon.

Just sayin......

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The study discussed time to defibrillation, which very important and done by FR first responders. But it also looked at how long it took to get an IV, intubate, or manage a trauma scene time. The researchers proclaim that municipalities can base their response patterns on this data, but clinical significance of these has been questioned in peer-reviewed literature.

Ben Waller said:
Skip, nowhere in the point I made did I specify that sending adequate numbers of responders was tied to a given system model, vehicle type, or vehicle paint scheme.

In a lot of places, the fire service is going to be well-positioned to provide the manpower, regardless of the vehicle the manpower rides, the system model in use, or the paint color.

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Actually, SEALS have many different transportations methods - riding SDVs, locking out of submarines, swimming, hiking, parachuting, flying in helicopters, fast roping, rappelling, driving cars or trucks...

The transportation methods are many.

Using large amounts of explosives (underwater demolition) is a VERY different skill set from hostage rescue (close-quarters battle).

The SEAL corpsman analogy is a good one.

So are a civilian SWAT paramedic's divergent skill set.

Ditto for athletes who play more than one sport - Deion Sanders playing safety for the Falcons and the outfield for the Braves is one of the more notable examples, but not the only one.

Ditto for the people who work as whitewater raft guides in the summer and as ski patrollers in the winter.

There is nothing wrong with specializing in only one thing if you wish, but stating that you cannot specialize in more than one thing flies in the face of the facts.

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There is no reason someone can't do multiple things. Some exceptional people can do multiple things well as an average person can do specializing in one. However, for any given person, they're going to be better if they focus on one thing than if they spread their interests. The Olympic decathletes are a perfect example: they are truly world class athletes that I will never be able to compete with, but no world records in the 10 separate events are held by decathletes.

Of course, the easier something is, the easier it is to do it well. My contention has only been that paramedicine is (or, in some areas, is rapidly becoming) complicated and sophisticated enough that I don't want to be touched by anyone who doesn't do it full-time. Given a choice between a medic who's seen 800 pts in the last year and one who's seen 400 because they spent half their time doing something else (and I don't particularly care what that is, be it fighting fires or sitting behind a desk administrating or just having a wealthy enough spouse to allow them to work PT), on average, I'd rather have the one who's seen 800.

I realize there are people who are really sharp and are better medics on 400 pts than others on 800. But I'm dealing with averages, not individual cases--and until we have enough hypercompetent (a word I've kind of invented/adopted to mean those people who are good at everything they touch) people to staff every ambulance, we're going to have to deal with mere competence. :)

As for the SEAL analogy that's been going on, yeah, those guys do a whole bunch of things, often times really quite well, and I give them credit for that. But not everyone in the Navy is SEAL caliber, and better than half the people who even qualify for BUD/S in the first place "ring the bell."

That's not to say that there isn't something to be gained by knowing something about other jobs. And in exurban to rural areas, there may be some advantage to having the flexibility of multiply-proficient personnel, if you're willing to either 1) train the snot out of them or 2) accept that they'll be a little less skilled, but cheaper, than specialized personnel.

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Ben Waller said:
If R/M's Scottdale fire business isn't either bankrupt or out of business, why does Scottsdale have its own municipal fire-rescue department and why were their long-term Scottsdale fire employees (allegedly) left holding worthless R/M stock and pension plans when R/M pulled out of Scottsdale - R/M's home office location, incidentally?
Hmm, did they actually set up Scottsdale as a different company (wholly owned subsidiary or something like that)? Because it's quite obvious that R/M Fire as a whole is neither bankrupt nor out of business--they have FF jobs posted as recently as 11/12. If the stock took a nose dive after the Scottsdale pullout, that would be another way to end up with essentially worthless stock in a company that isn't out of business (according to this, their stock has spent the last year as low as 50 cents but as high as $5.70, so it's not inconceivable).

The "toxic" part of the environment was from R/M's standpoint, incidentally--i.e. they left because the political environment was becoming "toxic" to their interests. Probably not the best word choice ("unfriendly" may have been better), but it was the first thing I could think of that could get across that they probably saw that there was a good chance they were going to be replaced--and wanted to do so on their terms instead of fighting the inevitable. I do agree that losing their own home city's contract is a move that looks terrible.

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doc,

Regardless of the details, when R/M's home city replaced their model with a public-sector one, it's not a great advertisement for privatizing fire services.

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Do you think that Scottsdale's decision was a "rational actor" decision or simply the result of a focused group applying intense political pressure. Just because you're strong doesn't necessarily mean that you're right.

I don't need instruction on the capabilities of the SEALs, but using them as a case for "multi-function" in other organizations is absurd. If your organization was starting out with a pool of personnel as unique as the SEALS do (near world-class athletes with out-the-top IQ and a collection of rare and unique personality traits) it might work. And remember, until very recently (and I don't know how the change is working out), individuals were rated petty officers with journeyman technical skills, and positive performance evaluations, or commissioned officers who met lots of standards BEFORE they became SEALs. Not the opposite.

Even so, most EMS and fire organizations start out with a pretty regular pool of people, not a population that has been first self-selected, then competitively selected through multiple very intense filters. It isn't so.....

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Both Scottsdale's citizens and their firefighters and firefighter-paramedics seem to be happy with the change.
That sounds pretty rational. And...R/M was in financial trouble in Scottsdale prior to pulling out. The citizens and the yet-to-be-formed city fire department were not responsible for the private model's failure there. If there was a "focused group" putting pressure on R/M's private model, it certainly wasn't a career fire department that did not yet exist.

And if you'll look at how Seattle, Miami-Dade, and a lot of other combination Fire/EMS departments select paramedics, they choose firefighters who are intelligent, who have good technical skills, and who have positive performance evaluations - and sometimes officers with the same kind of history and ability.

People who want to be either firefighters do indeed self-select by applying. They typically go through exhaustive written, physical ability, and other testing just to get hired. They then go through the fire academy, and not everyone makes it through that process.

The process is repeated through competitive applications for a limited number of paramedic slots as another layer of competitive testing. Firefighter-paramedic selection doesn't have Hell Week, but it does indeed have competitive, multi-layer application processes and procedures for weeding out those who can't handle both skill sets.

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In my opinion, the competitive argument could carry more validity in individual systems and agencies. Unfortunately, the quantity and mininmum competency levels of the average Paramedic being churned out doesn't up hold a generalization at this point.

The argument against people becoming competent in different and diverse skill sets is almost funny. For reference I offer the ability to walk and chew gum without falling or choking. Add to this the ability to begin triage while calling for additional resourses and deciding that this person you're leaning over can wait but that next guy looks really bad.

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Ben Waller said:
The process is repeated through competitive applications for a limited number of paramedic slots as another layer of competitive testing. Firefighter-paramedic selection doesn't have Hell Week, but it does indeed have competitive, multi-layer application processes and procedures for weeding out those who can't handle both skill sets.
Only among FDs that have a limited number of medic slots to begin with, and choose the best to become medics. :) Where I'm from (in someone else's words), a paramedic is an entry-level FF. It's in those kinds of systems that you see the most problems with people unable to handle both jobs or people who do the very minimum at one because they want to be the other.

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doc, there's a simple solution to that...don't be where you're from.

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