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Paramedic Engine companies or not?

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  • #16
    First off, I am not a Paramedic.

    I believe Paramedics are an important part of the Fire Service. Some like to think that you can't be a good Medic and a good Firefighter... Forgive me, that makes me laugh alot!.

    ALS apparatus should (in my humble opinion), have at least 1 Paramedic assigned to it. Each Firehouse should have two paramedics assgned to it allowing some sort of rotation of the duties, and allowing 2 Paramedics on most scenes very quickly. It also allows the Firehouse to remain inservice w/ ALS response more of the day.

    I also have strong feelings that Paramedics, as well as Firefighters should not be assigned to slow apparatus for long periods of time. There should be some way for everyone to gain whatever experience they need.

    Well.. I hope that helps....


    • #17
      First off, I am not a Paramedic.

      I believe Paramedics are an important part of the Fire Service. Some like to think that you can't be a good Medic and a good Firefighter... Forgive me, that makes me laugh alot!.

      ALS apparatus should (in my humble opinion), have at least 1 Paramedic assigned to it. Each Firehouse should have two paramedics assgned to it allowing some sort of rotation of the duties, and allowing 2 Paramedics on most scenes very quickly. It also allows the Firehouse to remain inservice w/ ALS response more of the day.

      I also have strong feelings that Paramedics, as well as Firefighters should not be assigned to slow apparatus for long periods of time. There should be some way for everyone to gain whatever experience they need.

      Well.. I hope that helps....

      So... to answer the original question, I really think training all firefighters is overkill. There is too much information that you do need to keep training on, and requiring people to maintain that certification is kinda wasteful.


      • #18
        My opinion,

        I get paid $50,000 a year to work 10 days a month as a firefighter-paramedic.

        EMS sucks, false alarms suck, mopping the kitchen sucks.....

        but I would ride a bicycle with flat tires to EMS calls all day long to work for the FD.


        • #19
          I used to think it was a waste..."put medics on ambulances and let them transport" was my thought. My girlfriend, who is a firefighter/paramedic in Pinellas County Fla where they capitalize on ALS engines has made a beleiver out of me...(she beat me......just kidding)... I dont think all need to be trained as medics but 2 is a minimum on a unit. Although my girl will argue that sometimes two is 1 too @[email protected]%# many. It is the wave if the future folks and we may as well accept it. Get on the bus or walk.... Face it...8-85% of your calls are EMS!
          09-11 .. 343 "All Gave Some..Some Gave ALL" God Bless..R.I.P.
          IACOJ Minister of Southern Comfort
          "Purple Hydrant" Recipient (3 Times)
          BMI Investigator
          The comments, opinions, and positions expressed here are mine. They are expressed respectfully, in the spirit of safety and progress. They do not reflect the opinions or positions of my employer or my department.


          • #20
            Here is the opinion of another non-medic.

            Do ALL firefighters need to be trained as medics. No. I think all firefighters should be trained as EMTs and fire departments should be part of a tiered EMS system. As far as I know, the King County model of emergency medicine produces the best pt outcomes and that is (or should be) the bottom line.
            In King County (Seattle and vicinity) Fire Depts do BLS with engines, trucks or aid cars. Some Depts transport, some do BLS transports by AMR. Depts have FF/PMs or PMs from another public agency for ALS and do all ALS transports except those by air. If stations are placed for 4 min response times for fire and BLS, only aboout 1/3 of stations will need an ALS unit to meet the AHA recomendation of 8 min for the ALS unit. This means fewer medics see more ALS pts, use their ALS skills more often, get to more direct attention from the doc and really hone their skills. Response times may go down by only putting ALS units out of service for ALS calls.

            Frankly, the current popularity of ALS fire companies worries me. Those in favor of ALS engines piont to medics on sceen with the first unit but most of the time those few extra min are spent with medics providing BLS treatment. It may be a good solution in a semi-rural area but in urbanized locations I haven't heard of anyplace that produces the results of a tiered system with FF/EMTs for BLS and medics on dedicated ALS units. County wide 25% of VF pts go home fron the hospital and some cities in the greater Seattle area have exceeded 35% for several years running. If you know of an ALS everthing system that has exceeded 20% please post it, I haven't heard of any yet.


            • #21
              Lot's of good opinions here, on both sides.

              One question though...

              How many calls does it take to keep your ALS profeciency up...or for that matter, meet requirements for certain numbers of needle-sticks, etc. ?

              Do your engine companies make enough runs that a medic on one platoon gets enough experience?

              Most of all, comes down to your local situation -- good ALS ambulance coverage, EMT Companies probably can handle the ABCs while waiting a few minutes for the Medic. Long waits for a rig, ALS probably makes more sense.
              IACOJ Canine Officer


              • #22
                Axe, are you saying you respected my post? Or are you trying to say that I posted unfactual opinions? You asked questions and I answered them, and I gave my opinion towards Pfr's question. Now on your opinion..are all fire calls emergencies? And give me a situation where if I make a wrong decision that the patient would be no worse off. Like say I decide to give you, 1:1000 epi, Sub-Q cause I think your having as asthma attack that I can't control with Albuterol via Nebulizer. And you have a heart condition that I didn't pay any mind to. What do you think would happen. Or how about if they simply are having an MI, and I give them Aspirin and they are allergic to it. Fact is I do make life or death decisions. And I haven't forgotten what my duties are. I am a good firefighter, and a great truckie. Besides in 2000 fires were down 3.6% nationwide. Anyone want to tell me what EMS calls were? I caught 3 structure fires in 2000, I did nearly 750 EMS calls which over 300 of them needed some form of ALS treatment. In my area, the public needs me, on both sides.

                You are correct, but every paramedic regardless of what unit type you run on, engine/ambulance/flycar, you always spend the first moments doing BLS skills. BLS before ALS, is the creed of every instructor who teaches in Paramedic Programs. There are things like applying oxygen, listening to lung sounds, defibrillating, etc. that gets done by BLS, that we must accomplish first before providing advanced level care. They are "tiered" together like you state. Even doctors start in this manner through interviewing and assessing a patient.

                JoeJoe, I can't agree wholeheartedly with your post. Being a Firefighter/Paramedic to me won't help you anymore on the suppression side then a Firefighter/EMT who has the same level of education and experience. What has helped is that there are more FF/Medics who have become supervisor, who understand the system, treatments, etc.

                Dal, the only way I can equate your questions is like this. How many fires does it take to keep your proficiency up? I get more ALS skills in a week then I do fires. But just like with our shift fire training, we also do monthly QA/QI "call audits," as well as reviewing skills and conditions.
                But you are right on the head, with the same thing I say. It all depends on your area and coverage.

                And again, why stop anyone in your department from advancing themselves?

                The above is my opinion only and doesn't reflect that of any dept/agency I work for, deal with, or am a member of.


                • #23
                  Answered in 2 words.

                  HEL! NO !!!


                  • #24
                    I feel that each side has a good arguement, but also it depends on how your department runs. If you a six man crew at each station running 1 squad and 1 engine, the squadies should both be medics. There should also be one medic on the engine as well. I feel that every firefighter should be at least a basic EMT(and many departments are going that way) But to have all members be medics, that is getting out of control. Just as someone said in an earlier reply "if these departments want to pay for training but not SUFFICIENTLY pay these people, they will look elsewhere". This is true. There are departments that will only hire ff/medics and pay them 35-45,000 a year, others wont. Overall ----no everyone should not HAVE to be. If they want to it should be their choice.
                    K.A. Dempsey
                    [email protected]
                    "If you want to make God laugh, tell him what you are doing tomorrow"


                    • #25
                      I don't believe every firefighter should have to be a paramedic. A person who is going to be at the paramedic level truely needs to have an interest in medicine. Predominantly because of all the material that gets cramed down your throat. However, I do believe that having at least one paramedic response from an engine company (with all the toys required) is a good idea. Especially where FD does not transport. For example: The city near me is approximately 100,000. The ambulance service is provided by a private corporate giant. They average 4 ambulances on the street to cover the city plus an occasional incident in the unincorporated county area. By the same token the city fire department has 10 stations through out the city. Who's response time is better? (This department actually has 3 ALS stations)

                      One other consideration is the availability of ALS for your own crew on large working projects. Most FD's will request a standby ambulance. However, it depends on the availability of the ambulance.

                      The moral of my babling??????
                      What are your local needs and resources.


                      • #26
                        ALS FIRE, I respect your opinion as I do others opinions, but i'm not sure you gave any facts, just your opinion. JoeJoe, as for medics making decisions, so do my kids, and my statement that if you cannot decide on treatment you can call a doctor on the radio is absolutely a valid argument...as for the armchair chief statement, your proving MY point with each statement. When an engine co. pulls to the front of a structure the officer must quickly make correct decisions period. not call and ask the chief what to do or consult on tactics. and banging a second alarm is for manpower and rescources based on conditions not conversations. I also believe that you were the one who brought up the fire science classes not being an asset , I believe, as you, that education and experience are both necessary . And no I am not a medic but I will repeat, I am not against all medics just some. Captstanm the medics response that 80 to 85 percent of calls are ems is subject to opinion as well. Do you know what they consider a vehicle accident with heavy damage requiring extrication ? I do , EMS and how much ems does the truck or heavy rescue perform while extricating the victims ? NONE, but the call is considered a medical call. I can give more examples such as on water rescues, tech rescue etc. I have read some of your other posts and feel that much of what you write is in an attempt to gain your girlfriends approval. Torched said it when he mentioned local needs. Stay safe.


                        • #27
                          The only firefighters that should be trained as medics are the ones that WANT to be trained as medics.

                          Forcing a FF to become a medic is bad for everyone. It is a job that you have to want to do, people that hate EMS should not be forced to treat patients 10 times a day.

                          If you hate EMS and are lucky enough to work for a Fire only dept., that's great. But most of don't have that luxury, and HAD to become medics just to get a job in the fire service, and are glad to ge a pumper shift once in a while.


                          • #28
                            90%+ of the costs of running a fire department are personnel costs.

                            Anytime you have a response time requirement for a system, your resources are going to have down time. The tighter the response time requirement is, the more down time you get. A fire department with a 4-minute/90% response time goal, will NOT be on runs more than 70% of the time. City administrators try to get more "bang for the buck" by having the field units do inspections, prevention, education, station maintenance, making trashcans, etc.

                            Systems with looser response time requirements such as 8 or 10 minutes / 90% of the time, can be used on calls up to and beyond 50% of the time. If you add in time to initially stock the units, administrative functions, transfer times, and breaks, there's not much time left for other duties.

                            In areas with sparse call density, the need for services is almost entirely based on geography. That is to say that if a response takes more than 4 or 8 minutes, it is because the station was too far away, NOT because there were no units available.

                            All this builds to the point...in areas with fairly high call density, specialization is the key...for ems this means: Firemen for the first 5 minutes on 10% of the EMS runs, and EMS alone within 8-10 minutes on the rest of the runs. This way you are not paying a paramedic "premium" that is wasted sitting in a station, but you do gain the benefit of rapid BLS (Defib,etc), especially if EMT firefighters are given some advanced airway management skills (ET or ETC).

                            Can someone tell me what skills might be administered in the 4 minutes prior to the arrival of a paramedic transport unit?

                            Can you tell me what the improvement in mortality / morbidity is when this skill is used 4 minutes earlier?

                            Can you tell me on what fraction of total ems responses these skills are needed?

                            Can you tell me how much is spent training and paying for 1-2 paramedics per shift per engine company?

                            It seems to me that the only real benefit of "fire-based" ems is that: FF/PMs can be worked up to 56h a week before overtime sets in, and the paycheck premium on FF/PMs is relatively small over FFs.

                            I think this is generally far outweighed by:
                            5y on an ambulance, and you're a LT, and have never seen a fire.
                            15y on an ambo and you're a BFC, and have never seen a fire. (happens in Fairfax)

                            as well as the following two mutually exclusive statements:
                            Firefighting should be the #1 priority in the operations of any Fire Department.
                            EMS deserves to be the #1 priority in the operations of its agency.


                            • #29

                              Can you describe what parts of my original post that you feel isn't at all factual and just opinion?

                              Double, you always do bring up good points. As far as what can be done in 4 mins. before ALS arrives. A lot depending on the nature of the call you are on. Obviously, ABC's being the most important and critical if need be. Airway Management, Defib, and there are medications that can and may need to be delivered in the 4 to 5 minute range. For example Adenosine for SVT's, Epi/Benadryl for Anaphalaxis, NTG/Aspirin for Chest Pain/MI's. As far as the percentages you know as well as I do they are not very high. However, in my opinion it still is a vital service, for my area. If you only have to wait 4 minutes for a bus on every call. Hats off to your EMS transport provider. I and more importantly my patients (customers) do not have that luxury. But let me add this also since we are on percentage kicks. Out of all total alarms, how many are: Structural fires, with entrapment? To me almost same theory, we look at it as a call is a call.

                              The above are my opinions only and don't reflect that of any dept/agency I work for, deal with or am a member of.


                              • #30
                                No, not every call is a structural call, with entrapment, very few in fact. I'm not looking to get the entire complement of vehicles on scene in four minutes either. Give me an engine in 4 minutes, a truck in 6, and another 2 engines and a truck in 8 minutes. For Reports of fire, that is.

                                For EMS give me:
                                Ambulances with an Intermediate and EMT
                                Supervisors with a PM and EMT
                                Engines with 4-5 EMTS, Defib, Combi-tube

                                Alpha, Bravo, Charlie calls: Ambo, 10 minutes call to o/s 90% of runs.
                                Delta calls: Engine, 5 minutes call to o/s 90%, Supervisor and Ambo 10 minutes call to o/s.

                                I believe the cheapest way to do that is with Paramedics and Firefighters, not FF/PMs.

                                If I had my 'druthers, I'd eat the cost savings up with more training, better equipment, and performance bonuses.

                                You could say that making one or two of the firefighters paramedics wouldn't cost that much more than leaving them as firefighters, but in addition to the extra pay, there is also the extra down time for each company, the extra busy time for each company, and the extra training for the company and each paramedic, for something that is "above the standard".

                                I'd be amenable to training FFs to have a few additional skills, especially airway skills, but I think that a true paramedic, particularly one with ALL of the possible skills that entails, should be reserved for only the most important calls, and not sent on every engine company or ambulance response. (Sort of like most cities treat their Rescue Companies)

                                I do like the one BLS and one ALS person staffing on ALL ambulances.

                                I don't like the idea of a paramedic on an engine having to weigh the need for him to transport vs. the need for his company to return to service.

                                I don't like the idea of a company running with less than it's allotted staffing, or splitting a crew and returning to service.

                                I don't like the idea of 3-4 guys on an engine being out of service for an hour rather than 20 minutes, because their paramedic transported.

                                I don't like the idea of a BLS Lt. being a supervisor to a FF/PM.

                                I don't like the idea of making everyone paramedics...it weakens the profession, and usually provides poor paramedics.

                                I have no doubt that there are places where the citizens are best served (both operationally and economically) by dual role / cross trained firefighters and paramedics, but I believe that those places will be suburban to rural, rather than urban to suburban.


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