How to restructure EMS

[FireZoneOnly]

I have been reading in here for a long time but have never registered or posted. I would like to explain how our department has structured its EMS system and get some feedback on it. First off, we have a large city department that provides fire protection and EMS. The ambulance runs with two paramedics. To become a paramedic one must promote from the rank of firefighter to driver. Once you are on the list to promote, you have opened yourself up to being "drafted into EMS" because there aren't enough volunteers. What ends up happening is firefighters who have zero interest in being a paramedic are now forced to pass the paramedic class and do an indefinite amount of time in EMS. This is straight EMS, no fire at all. The only way back to fire is to promote to Lt., put in for a specialty position or do several years in EMS and hope they will let you out eventually. If someone wants to be a paramedic only and not a firefighter, he would still have to be firefighter for at least 2 years and take the promotions exam and volunteer to go to EMS. If a firefighter only wants to be a firefighter/EMT, then he would be smart to never attempt to promote. This seems to me to be a waste of resources. A firefighter who does not wish to be a paramedic riding the box every shift will take his first opportunity to leave EMS to go back to fire. A potential applicant who wants to be a paramedic or is already trained as one
won't apply because he/she will have to train to be a firefighter and then work as a firefighter for as long as it takes to promote. Have you heard of any other dept. structured this way and what is the best way to do it? I have some ideas and people have had ideas over the years but it always falls on deaf ears. What so you think?

[randsc]

I have been reading in here for a long time but have never registered or posted. I would like to explain how our department has structured its EMS system and get some feedback on it. First off, we have a large city department that provides fire protection and EMS. The ambulance runs with two paramedics. To become a paramedic one must promote from the rank of firefighter to driver. Once you are on the list to promote, you have opened yourself up to being "drafted into EMS" because there aren't enough volunteers. What ends up happening is firefighters who have zero interest in being a paramedic are now forced to pass the paramedic class and do an indefinite amount of time in EMS. This is straight EMS, no fire at all. The only way back to fire is to promote to Lt., put in for a specialty position or do several years in EMS and hope they will let you out eventually. If someone wants to be a paramedic only and not a firefighter, he would still have to be firefighter for at least 2 years and take the promotions exam and volunteer to go to EMS. If a firefighter only wants to be a firefighter/EMT, then he would be smart to never attempt to promote. This seems to me to be a waste of resources. A firefighter who does not wish to be a paramedic riding the box every shift will take his first opportunity to leave EMS to go back to fire. A potential applicant who wants to be a paramedic or is already trained as one
won't apply because he/she will have to train to be a firefighter and then work as a firefighter for as long as it takes to promote. Have you heard of any other dept. structured this way and what is the best way to do it? I have some ideas and people have had ideas over the years but it always falls on deaf ears. What so you think?

Now, right up front, let me admit/acknowledge that I know nothing at all about your city and how they do things, and that what I am about to say is simply my opinion based on what you have presented so far. It is a shame the we have reached the point where such a disclaimer is necessary, but...

My opinion based on what you have written is that your city has fire department staffing levels that are supported and justified largely on the basis of EMS runs. Otherwise, it is difficult to see why people who want to be paramedics can't be hired to be paramedics, rather than drafting unwilling firefighters.

As long as EMS is fire-based in your city (and for the record, I believe there are many places where it needn't be), you are unlikely to make much headway on this issue. And it will be frustrating, because you will never feel like you are getting a straight answer (and you won't, because no one can go on the record admitting this).

So short of changing the fire-based EMS system, I would recomend trying to get everyone to realize that, in the absence of EMS, there would likely be many fewer firefighter positions, and that in some meaningful way, spending part of your career in EMS is the price you pay for a firefighting job.

Just an opinion. No guarantees, express or implied. Your milage may vary. Etc, etc.

[hwoods]

Well...........

I have been reading in here for a long time but have never registered or posted. I would like to explain how our department has structured its EMS system and get some feedback on it. First off, we have a large city department that provides fire protection and EMS. The ambulance runs with two paramedics. To become a paramedic one must promote from the rank of firefighter to driver. Once you are on the list to promote, you have opened yourself up to being "drafted into EMS" because there aren't enough volunteers. What ends up happening is firefighters who have zero interest in being a paramedic are now forced to pass the paramedic class and do an indefinite amount of time in EMS. This is straight EMS, no fire at all. The only way back to fire is to promote to Lt., put in for a specialty position or do several years in EMS and hope they will let you out eventually. If someone wants to be a paramedic only and not a firefighter, he would still have to be firefighter for at least 2 years and take the promotions exam and volunteer to go to EMS. If a firefighter only wants to be a firefighter/EMT, then he would be smart to never attempt to promote. This seems to me to be a waste of resources. A firefighter who does not wish to be a paramedic riding the box every shift will take his first opportunity to leave EMS to go back to fire. A potential applicant who wants to be a paramedic or is already trained as one
won't apply because he/she will have to train to be a firefighter and then work as a firefighter for as long as it takes to promote. Have you heard of any other dept. structured this way and what is the best way to do it? I have some ideas and people have had ideas over the years but it always falls on deaf ears. What so you think?

I'm familiar with your type of situation, and I think it is a lot more common than most people realize. Problem is, there is a limit on money, no matter where you are. Some Cities are laying off Firefighters and closing stations, others OF THE SAME SIZE are building new stations, and hire on a regular basis. Guess which type does EMS, and which type does Fire only. EMS is a route to Survival, in a lot of places. I'm an old goat, 48 years on, still working, but I've been told my attitude on EMS doesn't match my age group. I firmly believe ALL EMS should be Fire based. Period. Fire should also be involved with Tech Rescue, HazMat, Bomb Squad, You Name It. In short, the Fire department should become the Everything department. BUT, the Everything department MUST change it's hiring practices so that people are hired to do what they want to do. If the Department has X number of vacancies in the EMS Division, hire the appropriate number of people who want to do EMS. Same for Fire, etc. I'm a strong believer in having everyone trained to the EMT-B level, but above that, it should be an individual's choice. Same for Medics, if they don't want to do Firefighting, so be it. But, in the end, ONE department should handle all Emergency functions in the Jurisdiction, other than Law Enforcement.

[tfd181]

If all of your medics are firefighters, why isn't there either some sort of rotation OR provision made to use the ambulance crews at fires? More specifically where is the resistance to using the ambulances for fire duty? Is it the administration or the members who won't let it happen?

In my department the ambulance is paired with the truck company on the fireground (unless there is a victim requiring transport). Also every attempt is made to rotate the ambulance crews to fire apparatus when able (and ship the OT to the ambulance). The ambulance Lt's also fill vacant engine and truck officer spots.

The problems of finding willing volunteers to ride the ambulance seems to happen in any department that has them! However your ambulance crews already have fire experience, so why not use them?

[Catch22]

Although I'm a big proponent of fire-based EMS, I do think they need to be segregated somewhat. Fire operations have their personnel, EMS has their's.

From what you're describing, I can't imagine how you get applicants or why anyone tests to promote if they want to be firefighters. Although I bet there's no shortage of guys testing for Lt. spots.

I just really don't see the logic behind that kind of system. If you've got someone who wants to ride the box for a career, he has to be a firefighter for two years, then promote to driver. Why mess with it? I'd imagine most go somewhere else to work? At the same time, if a guy wants to stay on the firetruck, why in God's name would he test for driver if he's going to get put on the bus?

[FireZoneOnly]

Waste of resources

I have no problem with Fire running EMS. The problem I have is using valuable tax dollars to train a recently promoted driver to be a paramedic (thousands of $$$$ a head) against his/her will only for that driver to leave with that training at the first available opportunity and never use that training on an official basis ever again.

#1 Why can't there be a way for the rank level of firefighter to volunteer to be a paramedic?

#2 Why can't the dept. hire people who want to be paramedics and not firefighters?

#3 Switching between Fire and EMS is an option. I don't think it would be popular in the rank and file.

The main obstacles to change are the administration and the union both. I also think it may not be as high on the to do list for the rank and file.

There is no question that the fire dept. needs EMS for funding.

Wouldn't you be nervous to know that the medic working on you doesn't want to be there and probably barely passed the class to earn his certification.

There has to be a better way!

Thanks for the comments!

[johnny46]

There's no reason to disallow rotation from apparatus to ambulance. When I promoted to chauffer, I was assigned first to an ambulance and I drove one for three years before I got an apparatus. It's understood that that's going to happen, whining not expected or accepted.

Put firefighters in charge of patient care and make newly promoted chauffers take an initial assignment on an apparatus until a position opens up on an apparatus. Of course, if it's not a large department, I reckon it could be a long wait.

[FFFRED]

Once you are on the list to promote, you have opened yourself up to being "drafted into EMS" because there aren't enough volunteers. What ends up happening is firefighters who have zero interest in being a paramedic are now forced to pass the paramedic class and do an indefinite amount of time in EMS.

Brother,

How is it your members are "forced" to pass an exam that apparently wasn't required when they took the job? If you don't understand the material you don't pass...period. What is your union doing about this?

FTM-PTB

[pete892]

I hate to disagree with Harve

Harve has seven years on me so I should respect my elders, but:

What is wrong with a true third service? My area has a third service that is govt. operated. It is owned by 17 governmental units and provides service to 20. We operate with two paramedics per ambulance and also do transfers, critical care transports and operate a fleet of wheel chair vans.

Fire departments and police departments provide medical first response on priority one calls. They seldom are tied up at the scene for any length of time onless a full arrest requires one to drive to the hospital.

We have one of the best collection rates in the state and have 8 months operating funds in the bank.

At some point, EMS will gain its rightful place as a true third leg of emergency response. It seems to me that firefighting suffers when fire departments get into ambulance transport. I see many departments that, in reality, are ambulance operations that once in while go to a fire.

Fire, EMS and Police should all be equal in the emergency response field.

Stay safe,

Pete

[BLSboy]

Well, as one who works on third service EMS, and has worked as Fire-Only, here is my Humble Opinion.
EMS should be a third service provider, BUT, paired WITH the Fire Dept. Meaning, housed in quarters, train along side with, and congregate with the Firefighters. This means that they know who they are working with on scene, get to know their working partners, and have the level of training that they need.
EMS needs to be trained at a minimum of FF1, so they know what to expect, and be able to help out the FD if needed (eg catch a plug, help with extrication) and the FD needs to be,and a minimum EMT-B, so they can get in a car and stabilize a pt, provide EMS 1st Responce, for when the bus is out and unable to provide timely responce, and respond on the "priorty" calls
The FD also needs to know how to drive a bus like an expert. I dont know how many times I have needed to have a FF drive me into the hospital, but I was thrown around alot in the back.
Finally, there should not be "forced" training. If you dont want to work on the bus, or on an Engine or Truck, you should not be made to. If you dont want to learn something, you wont be good at it, simple as that. And if I am calling 911, I want whoever is coming to be a g*ddamned expert!

[ChicagoFF]

Well, as one who works on third service EMS, and has worked as Fire-Only, here is my Humble Opinion.
EMS should be a third service provider, BUT, paired WITH the Fire Dept. Meaning, housed in quarters, train along side with, and congregate with the Firefighters. This means that they know who they are working with on scene, get to know their working partners, and have the level of training that they need.

And why is this? Why not let them run out of the hospitals or off the street? Shouldn't they get to know the cops they will be working with on scene too? Let 'em run out of police stations then.

EMS needs to be trained at a minimum of FF1, so they know what to expect, and be able to help out the FD if needed (eg catch a plug, help with extrication) and the FD needs to be,and a minimum EMT-B, so they can get in a car and stabilize a pt, provide EMS 1st Responce, for when the bus is out and unable to provide timely responce, and respond on the "priorty" calls
The FD also needs to know how to drive a bus like an expert. I dont know how many times I have needed to have a FF drive me into the hospital, but I was thrown around alot in the back.

The last thing in the world I need is a medic to make my hydrant. Why would I need or want this??? As for driving an ambo, there not much mystery there.

Finally, there should not be "forced" training. If you dont want to work on the bus, or on an Engine or Truck, you should not be made to. If you dont want to learn something, you wont be good at it, simple as that. And if I am calling 911, I want whoever is coming to be a g*ddamned expert!

I agree 100%

[BLSboy]

And why is this? Why not let them run out of the hospitals or off the street? Shouldn't they get to know the cops they will be working with on scene too? Let 'em run out of police stations then.

1) When EMS needs help, when there is a priority call, who is co-dispatched 99% of the time? Fire Dept.
2) Fire and EMS need to work together on alot of calls, and they need to understand each other, and they way they work. Fire has the corner on Tech/Vehicle/High Angle Resuce, and EMS knows what to do for medical emergencies working together can facilite a better understanding of this.
3) Nobody likes cops.

The last thing in the world I need is a medic to make my hydrant. Why would I need or want this??? As for driving an ambo, there not much mystery there.

In the ideal world, there would be proper staffing for Fire Depts. However, in some communities (such as the one I serve), there are volly depts that have low turnout/undertrained members who dont know what they are doing.
On several occasions, we have had EMS people (who are also Firefighters) catch plugs and help set up on fires.

[johnny46]

I'm sure it should be area specific, but fire based EMS works just fine, even with the whiners. It won't increase fire volume to put EMS out of fire control, and the run volume justifies (to the city) the increased need for manpower.

[FireZoneOnly]

Whiners?

I'm sure it should be area specific, but fire based EMS works just fine, even with the whiners. It won't increase fire volume to put EMS out of fire control, and the run volume justifies (to the city) the increased need for manpower.

I hope you are not referring to me as a whiner. I carefully wrote my post to avoid coming across that way. I simply think the way it is done here could be done better. As I have stated before, it is a waste of resources, monetary and manpower, to train someone for a job he does not want to spend the rest of his career doing. It is also a disservice to the citizens who pay for this important service.

To clarify for a post earlier questioning being "forced" to pass an exam. When a FF takes the driver promotions exam, he knows there is a big chance of going to EMS. There is also a chance of being assigned to a fire apparatus. A handful of drivers will get lucky and stay in fire, the rest on the list will go to a 6 month paramedic school and then be on the street as a paramedic. There are 2 medics to a box. They take turns driving or being with the patient. Nobody just drives the ambulance as someone mentioned before. If you make the promotions list and are drafted to EMS, the only way to avoid it (other than applying for a special assignment like a Chief's driver) is to turn down the badge and remain a firefighter. I don't know of anyone who has turned down a promotion. I guess it wouldn't be so bad if you knew exactly how long a tour in EMS will last. Do your time and get out without having to promote out.

It seems that most are in agreement that our dept. staffs EMS in a messed up way. I would like ideas of how to do it better so we can maybe plead with the brass up stairs and get the union behind us 100% and change some things.

[Catch22]

The FD also needs to know how to drive a bus like an expert. I dont know how many times I have needed to have a FF drive me into the hospital, but I was thrown around alot in the back.

Not to pick on just one thing (it is a bit of a pet peeve of mine, though), but if in your ideal situation, why can't the FF ride the back of the box? After all, he's an EMT. Unless you run double medic rigs, there's no difference, and the EMT that's used to driving the bus can do so.

I actually see this a lot where I work (EMS runs split crews, EMT and medic). It happens all the time, they grab the FF (EMT is required to get hired on) and have him drive. I've even been on codes where they grab an EMT to drive and put the EMT attendant in the back of the box, while the medic on the engine goes back to the firehouse instead of helping the medic in the back. It's actually improving a bit now that they have Oxylators and AutoPulses on the bus. The medic actually doesn't have much to do, other than push a button or a drug here and there on the way to the ER.