Paramedic Engine companies or not?

[distchief60b]

AX.....I realized a vehicle accident with heavy damge or any vehicle accident in fact, is considered EMS....extrication or not. I dont dispute that those doing extrication are NOT doing EMS...... I was just saying that a large majority of the calls are EMS related..... Therefore the best way to provide the quality customer service we desire is to gear up to provide the service. Hence the creation of ALS Engines in an atmosphere like Pinellas where Private Ambulance Service Transports. I realize your Department (if you work in clearwater) has TX units or at least what appears to me to be TX units in my travels.

I do not think ALL personnel should be trained as Paramedics. Takes some desire to do that as well as a clear mind(I lost that years ago). And there are lots and lots of things to remember on top of the firefighting stuff. And yes....a simple mistake can cause someone their life. So...not all should be medics...and we certainly should not force people to be medics to just get a job. But I do think that the ALS Engine is the wave of the future. It also seems the trend is for Departments to "want" you to be medic certified when they hire you.

More power to a person who wants to be a medic. I respect those that do it with the intention of improving themselves....but questions those who take it to just be doing something different. I enjoyed being an EMT and once said never never (ok twice said)to being a Paramedic. But, even though I am older now, if I could get the backing...I would do it.

(Ax...I bet we have some mutual friends if you work in Clearwater)

[joejoe33]

My title is fire fighter/paramedic. I have 15 years experience in suppression. What makes me a good fire fighter isn't the 21 weeks of rookie school I've had, or the fire science classes I've taken, it's my knowledge and experience.
The paramedic school I attended isn't what makes me a good paramedic. I have 13 years on the street as a paramedic. My knowledge and street experience influence my decision making.
Paramedic engine companies aren't for everybody. Our department has them. I've stated my position on that.

AXEYAZ: As a Lieutenant I assume you make your fireground decisions based on your knowledge and your 12 years of experience.
As a company officer you passed a test and put your knowledge and experience to work for you right?
95% of what officers do is in the station.
Brother, your conflict resolution skills are lacking. Can you agree to disagree without being confrontational? This shows your maturity level.
Your comment about most EMS runs not being real emergencies is questionable.
Have you ever made a run on a downed fire fighter? Or have you ever made a run on a police officer involved a police car rollover? How about a police officer with a GSW to the head? How about a fire victim? I have.
We owe it to ourselves as brothers in the profession to take of our own and the citizens we serve the best we can.
If one paramedic on a "Paramedic Engine Company" is the answer,then I'm all for it.
Does every fire fighter need to be a paramedic? Do all engines in every fire department need to be paramedic engine companies? I don't think so. Our administration seems to think that we need to be crossed trained as paramedics. But, that's another story.
When the alarm hits we'll all be in it together. Keep it safe brothers and sisters!

[ 08-10-2001: Message edited by: joejoe33 ]

[ALSfirefighter]

When, as a profession should you ever not want to be "above the standard?"

Double, I agree with the staggard arrival. In fact, thank you. We run EMS where I am simply due to the fact that the ambulance can take some time to arrive. So if we arrive at 3-6 mins. and the ambulance arrives in 10. Then that is the same type of situation you described as your first due at 3 mins. 2nd Truck at 6 and the others at 8 minutes.

Secondly, I never weigh a decision about patient care with my company or what is going around me as influence. That is where you can get in trouble. I also understand that it comes with experience. Also, if a medic transports and it places an entire company out of service. The it is a poorly organized and managed system. If you cannot do EMS the right way, then you shouldn't do it at all. Whether its at a CFR level or ALS. If we stopped at the standard, we wouldn't be doing ALS. We are the only ones in my county. Plus we are currently working on achieving getting our EMT-B's upgrading to I, to be all "als."

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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.

[AXEYAZ]

Captstamn, you said "IF" twice in your post,WHAT'S UP WITH THAT?, does this mean you don't believe me? You will find i'm a proud member of the 48 truck..And yes we do have three transport capable rescue trucks, but you should know that we don't transport, although we have the ability to do so if the need arises. JOEJOE are you wearing your feelings on your sleeve these days ?

[toneloc177]

hey joejoe, we're all claiming to be adults here so let's not play the, 'I can top that' game referring to calls we've gone to. I'm pretty sure most people who take the time out to read and respond to some of these postings are reasonably experienced. This ain't time to be condescending.

Constructive criticism . . . right?

Speaking of postings - ALS engine companies? Eh, guess it depends on alot more mittigating factors that are being mentioned. If an ALS Eng pulls up to an MI, and the bus pulls up sometime afterwards . . . is the bus staffed w/ ALS or BLS, and would the eng co be losing members for transport? What would the response be? on both fronts! Amb & FD/Eng.! Do the eng's roll to ALL aided cases in their area, or just certain and specific ones (similar to the CFR Eng in NYC)? What is the responsibility of the eng co? Begin pt care and paperwork, or assisting w/ getting the pt into the bus (granted, it's a stretch for an ALS eng)?

Also, what was this nonscence (where is the god damn spell checker?!?!?!?!?!?!?!?!) about HAVING to be a medic in order to promote to driver/chauffer/lieutenant? Being a good tech doesn't mean you'll be a good ff,chauffer,or line officer! And if you make it a pre-requisite < > to becoming a ff, chauffer, or line officer, you are and will get people who didn't want the training, and will do as little as possible to be a 'rubber-stamped' tech, who only took the course to get the next rung in their career ladder!

Now what have you accomplished? Oh, but 'steve will come around'. PLease. I'm not a paid ff, just vol. I'm a paid tech, and vol, and I sure as hell ain't counting the days till my retirement . . . i'm counting the days till the bbd (bigger better deal) comes along. EMS for 20+ years, not me - I praise all you who can and have, but not for me. Not as a proffesion for more than two decades to come!

[Double_Local]

Hey ALSff:

I think any time you (the PM) go with the pt, you affect the readiness of your crew: either by taking it out of service during that time, or making it short staffed.

Your department's staffing available for firefighting shouldn't depend on the level of recent EMS activity. This is particularly worrisome in busier systems, and at the busier stations in these systems...Your busiest station is probably most likely to be first due to a fire, and also most likely to be short staffed...a bad system design.

If you run with 4 men, and lose one (the PM) to a transport, and don't go out of service, well you've just proven to the beancounters that it's O.K. by you to run with 3 men.

If you run with 4 men, and go out of service when you lose the PM, well you're then paying 3 men to do nothing (or paying 6 people to do what 2-3 could do)

[ALSfirefighter]

Double,

I've never disagreed with your posts on the personnel issues. There are a lot of depts. who attempt to provide EMS with one arm behind their backs. Whether its because they want or have to do it that way. However the major argument of our anti-EMS'ers here is they try to utilize arguments on staffing for only approx. 5% of the overall call volume. I would never argue that what works here would work there. Its like I said, it all depends on where you are, what your situation is. All I've argued is in my opinion, no one should ever stop at the "standard." Nor should anyone prohibit someone from advancing themselves by any means professionally. I dealt with that with my old dept. when I went to medic school. All I wanted was a few hours every now and then when I was on shift and we had a 7th man. (4/engine 2/BLS ambulance, 1 left over). No comp time, no OT, no tuition reimbursment. I filed a grievance and won. When we limit ourselves to training and advancement, how can we question management/municple leaders for limiting money and equipment?

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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.

[distchief60b]

AX....was not saying i did not beleive you. And Yes..I know you are TX capable but do not unless you have to and rely on SUNSTAR.... I was just not sure after reading the profile if you lived in Clearwater and worked elsewhere or if you were actually a Clearwater F&R Employee.

Nice truck! I like it..I been to your station a few times... We do have mutual aquaintenances I am sure. By the way....I love Truck work....man...I miss it!

[Double_Local]

If I had to guess, MAYBE 40% of ems calls can use ALS. Of those, probably less than 5-10% of those definitely benefit from ALS in 4-8 minutes rather than at 8 minutes.

Now if your system can't provide a transport unit within 8 minutes, there may be something wrong with it.

[Badge of Honor]

Running EMS justifies more $$$, personal, and equipment for Fire Departments. One Paramedic per Engine or Truck Company, backed up with EMT’s utilizes all company personnel.

[ALSfirefighter]

The argument of how the patient benefits within 4 mins. compared to 8 mins. is a difference of opinion, and of operational attitude. If you are talking about a true emergency, I want a medic there in 4. Brain cells start to deteriorate and die within 6 to 8. As well as with AMI, time is muscle. As far as some other not so acutely serious medical conditions, maybe the extra 4 mins. doesn't make an immediate differene in patient condition. But it does towards overall patient outcome. From reduced ER stay times for many, which is good not only for the patient, but for our congested ER's also. That's great that they say ALS is acceptable if it arrives in 8 mins. But that is a "recommendation." I can walk into a room with 10 of you with my NFPA books, and you'll all say "ahh, that's just a recommendation." Usually to everything except for manning/equipment/ and all the bells and whistles on fire apparatus.

Why stop or accept the standard." If you call 911, and your wife or kid is on the ground, are you thinking "its okay, they will be here in around 8 mins." If your house is on fire you want a engine there in 4 mins. But if your wife, kid, mother goes down 8 is acceptable. Not for us.
As far as having to wait for an ambulance, that is the name of the game for the areas that we provide ALS for Volunteer Ambulance Corps.

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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.

[Double_Local]

Absolutely, 4 minutes IS BETTER than 8 minutes. The question is: how much better, and is it worth the additional cost.

What it boils down to, In MY system, In MY opinion, the pros for making FFs (on suppression units) paramedics:
Faster Paramedic Response time
Is outweighed by the cons:
Additional Paramedic training for nearly a quarter of our field personnel (cost, just for $5k "bonus" a year would be $1.3M, and I don't think $5k is enough)
Additional "down time" for units on transports : (Our median engine company already makes 3785 runs)
Opportunity for patients to be transported with or without paramedic depending on paramedics opinion
Failure to "fix" the EMS system as it is

I believe that in a system where engine companies already have a lot of "not busy" time, but are needed for geographic (or political) coverage, it would be advantageous to get higher utilization from the companies by making them provide ALS. I dont think this is justified in DC.

I also think that ALS engines would make a lot of sense in a small city, with no opportunity for mutual aide...and only a few ambulances.

[ALSfirefighter]

Double, at least we agree to disagree on many topics. But I do have to say, especially from being a former Virginier who spent a lot of time in DC. I have to agree with your opinion on your dept. You guys have enough staffing/equipment problems to deal with. Although I still think that someday in the future if you guys ever get it worked out, you may see ALSFR in DC. Believe me I know what you are going through. The PD wasn't in all that great shape over the past 10 years either. I never did figure out how they thought 5 patrol cars would be enough for the 7th District. Chipping in for fuel. Or when I would talk to you guys, and I saw the bald tires, guys bringing in their own TP. So in the end I do have to say I agree with you on DC. But like you said, for smaller cities like me, it works. And most of our citizens understand the impact that we do actually make.

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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.

[Double_Local]

ALS, agreeing to disagree is a facet of an open forum.

[FHandz17]

I do know this,

While sitting out front after running 10 EMS calls before dinner Saturday, a guy came in and said.

"Boy, you guy's sure do run alot of fires, I see that rescue squad going all the time. Hey, didn't the voters approve a 7 million dollar bond issue last year for all new stations and all new trucks for you guy's?"

I said, "Yes we do, and Yes they did, by 80%"

Paramedic Engine Co.'s do have indirect benefits.