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  • #16
    Issue 3: Internal Culture. If both the front line staff and the executive staff aren't running a fire and EMS department (regardless of the name on the side. I find both sides of the DC FEMS debate to be hilarious since one side thinks that changing the name changes things and the other side doesn't want to recognize that the vast majority of their calls have nothing to do with fire, even when lumped into "EMS" vs "everything else"), then they're dangerous. They're either running an EMS department that dabbles in fire fighting (dangerous on the rare fire scene), or a fire department that dabbles in EMS (dangerous to their patients). If you can't serve 2 masters, stop trying. If a fire scene gets screwed up and someone says, "That's what happens when you let an EMS department fight fires," then the opposite argument is equally valid.

    Issue 4: Education and requirements of the job.
    I'm sure most have seen the EMS Professional Development Model put together by the USFA and FEMA. Here's the problem with it. It takes the strategy/tactics/tasks model used for fire fighting and forces it on EMS. The problem is that the paramedic in charge needs to be doing all of those. EMS is medical care and medical care cannot be cookbook. The education level for paramedics needs to be, at a minimum, an associates degree, and the paramedic needs to be able to justify why they're picking their interventions for reasons other than "protocol." The fact that the US Fire Administration doesn't even think EMS instructors need a college education is nothing short of frightening. I need my paramedic to be able to and empowered to think outside of the box with his interventions, and not limited to "cook book, or call medical control." Medical control for consultation? Good. For "mother may I?" Bad. If the fire service can't support increased education requirements, then I have no use for them.

    To add to the education debate, here's IAFC weighing in on the EMS Education Agenda.
    The IAFC EMS Section would like to see substantiation on why there is an increase in training hours and how the new hour level was determined.
    • 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.
    • Will the increase in education standards further impact the pool of people who can complete the requirements? Will potential student populations with impaired socioeconomic status be adversely affected such that they will be essentially prevented from entering the EMS field?
    http://www.iafc.org/associations/468...ents070731.pdf

    So the IAFC doesn't, apparently, care that EMS education requirements are laughably low prior to the current changes, agrees with college education for paramedics unless it affects their hiring pool, and thinks that the color of the paramedic's skin or how much their parents made is more important than their ability to do the job, including commanding enough knowledge to appropriately do the job. ...and I'm to support this?

    Issue 5: False arguments.

    Fire service EMS advocates conveniently ignore 3rd government agencies, opting to always frame the battle between profit seeking evil private companies and the all cuddly fire service. Ok, I'll definitely grant that from a PR standpoint this is the ultimate way to frame the debate and they're doing an awesome job. It won't, however, win friend and influence people who actually understand EMS. The simple fact is that every agency must "make a profit." Even the fire service needs to make more money, be it fee for service or tax dollar subsidy (which isn't necessarily a bad thing) than they spend. However if I'm paying X dollars for EMS, I expect X dollars for EMS. Not X-Y dollars for EMS and Y dollars being siphoned off for fire protection.

    Fire EMS vs Fire-Police ("public safety"):

    Fire departments argue against "public safety" departments because the intellectual, training, equipment, and day to day demands for fire fighting and police services are drastically different. Yet a gun and a fire hose share just about as much in common as a defibrillator and fire hose. Similarly fire science shares about as much in common with criminal justice as fire science does with prehospital medical care.
    Last edited by Gadfly; 05-25-2011, 05:05 AM.

    Comment


    • #17
      All valid points.

      I would submit that many fire departments got/get into the EMS business because they were worried about the public seeing the BRT's sitting around most of the time, staffed by who-knows-how-many firefighters, waiting for an ever-decreasing number of actual fires (although the AFA's seem to be holding in there).

      We don't want the public to wonder if we really need all those BRT's and firefighters. So we start running EMS calls to keep those BRT's fresh in everyone's mind.
      Opinions my own. Standard disclaimers apply.

      Everyone goes home. Safety begins with you.

      Comment


      • #18
        Originally posted by backsteprescue123 View Post
        In the county where I work there are roughly 30 ALS Engine Co., 6 ALS Truck Co., 20 BLS Ambulance, 15 ALS Medic Units, and 10 County Life Squads (ALS). (just some quick guesstimation)
        What is the difference between an ALS Medic Unit and a "County Life Squad"?

        Comment


        • #19
          Fire based EMS is the only reason I have the job I have. I like it because we all work together whether we're on the bonebox or on the truck, you know the guys that'll be showing up to help. Since we all work together, we all know the equipment so there's no confusion on runs.

          Comment


          • #20
            Fire departments argue against "public safety" departments because the intellectual, training, equipment, and day to day demands for fire fighting and police services are drastically different. Yet a gun and a fire hose share just about as much in common as a defibrillator and fire hose. Similarly fire science shares about as much in common with criminal justice as fire science does with pre-hospital medical care.
            You won't get an answer to that, there aren't any Schaitberger talking points that apply (or slogans that could easily fit on a plywood-mounted posterboard) .

            Originally posted by tree68 View Post
            We don't want the public to wonder if we really need all those BRT's and firefighters. So we start running EMS calls to keep those BRT's fresh in everyone's mind.
            So the reason you want responsibility for pre-hospital medical care..... is so that you can justify spending taxpayer dollars and other valuable resources on personnel and equipment which by their nature are not designed for pre-hospital medical care. Ok.

            Tell me again how "running an EMS system so we can have more firefighters/dues-paying union members" is SO much higher on the moral food chain than "running an EMS system for profit"?

            Since we all work together, we all know the equipment so there's no confusion on runs.
            I'm sure you don't know most of your local police officers, or are familiar with their equipment and procedures, but I bet you get along just fine.

            The answer to not being familiar with personnel and equipment from a two different but co-responding agencies (like, say a fire department and private ambulance company) is training and cooperation.

            But that would mean the FD might have to treat them like human beings.

            Comment


            • #21
              Originally posted by emt161 View Post
              Tell me again how "running an EMS system so we can have more firefighters/dues-paying union members" is SO much higher on the moral food chain than "running an EMS system for profit"?
              It's both. A fire department that has both ALS first response and ALS transport with crosstrained members will certainly have more dues paying members. But there are cost saving measures involved with that:

              Dual role providers cut down on OT, forced or otherwise, by alleviating staffing issues. Departments that plan well to achieve their staffing and deployment objectives will typically have one or two pad personnel per station. These pad personnel can be detailed to fill suppression spots or EMS spots, as vacancies dictate. This allowance for pad personnell is sorely lacking in EMS only organizations, who prefer instead to dole out forced OT to cover sick leave, vacation leave, injury leave, etc.

              Many, many EMS only organizations seek to staff and deploy the least amount possible to save on costs. The fire service is no different in many cases. Since minimal deployment is standard for the field, the fire service chooses to use otherwise idle suppression apparatus to augment their EMS response, regardless if the calls are of a time sensitive nature or not. The personnel and apparatus are already in place, so it only makes sense to increase their net utilization hours to boost the jurisdiction's EMS delivery. The only extra cost involved is for the paramedic incentive pay for one person per ALS company, and the ALS equipment. No additional people have to be hired, and no new vehicles need to be purchased. Sure, adding ambulances would me a much better way of improving EMS delivery, but single role EMS departments refuse to do this, so it would be unreasonable to expect the fire service to do the same. In addition, the public has come to expect this level of service in many areas. When I'm the engine medic, and we're onscene for a diff breather, MI, CVA or something potentially time sensitive, one of us will explain that we're the engine crew, that we have nearly the same ALS capabilities as the ambulance, and that we're there to start treatment until they arrive. I've yet to hear a citizen complain that we were ther instead of the ambulance; they were just happy to have us there to help them.

              Costs are saved in hiring by preventing burnout, injury leave, permanent disability, and other forms of attrition. When I worked single role EMS, it was typically just me and my partner lifting and carrying everything. We had six floor walkups with the chair, our air, our bags, and the monitor. There are tight apartments and stairs that we had to navigate on our own with no spotters. We did it, but it will eventually burn you out or cause you to throw out your back, blow out your shoulder, knee, etc. With our dual response, we have 5-6 people to share the load rather than just two. If I'm riding as OIC, I'm not doing any lifting at all, except maybe one of my bags. That is huge in preventing breakdown or burnout. Being able to go between EMS and suppression also prevents burnout. The average EMS only person lasts only 7-10 years before leaving the field. The fire service has many who keep their ALS certs for much longer, typically for their entire career if they can switch between roles. Reduced injury and attrition saves money in hiring and OT.

              To suggest that suppression coverage be scaled back and replaced dollar for dollar for the EMS side due to call volume numbers shows a profound ignorance of suppresion operations and why timely coverage is vital. Also, some may say that suppression vehicles on an EMS run can prevent them from running fire calls, which is their main function. Good departments plan for this through proper staffing and deployment, mutual aid agreements, and modified dispatch protocols during times of high call volume. When I'm the ambulance OIC, if the pt's condition isn't of a time sensitive nature, I can handle with just myself and my partner. If another call comes in, be it suppresion or another EMS incident, I'll release the engine from our call. It's my call to do that, not the engine OIC, btw.
              "The democracy will cease to exist when you take away from those willing to work and give to those who are not." Thomas Jefferson

              Comment


              • #22
                Originally posted by edpmedic View Post
                The fire service is no different in many cases. Since minimal deployment is standard for the field, the fire service chooses to use otherwise idle suppression apparatus to augment their EMS response, regardless if the calls are of a time sensitive nature or not. The personnel and apparatus are already in place, so it only makes sense to increase their net utilization hours to boost the jurisdiction's EMS delivery. The only extra cost involved is for the paramedic incentive pay for one person per ALS company, and the ALS equipment. No additional people have to be hired, and no new vehicles need to be purchased.
                Emphasis added.

                Paramedic equipment, which includes many perishable medications that are often hardly used to begin with (just based on call makeup), isn't cheap or free. Similarly, more use of the apparatuses means more wear and tear and higher fuel costs. It's hardly free and for non-time sensitive calls (which are the case more often than not and the calls that are time sensitive are often not quite as time sensitive as we'd like to believe), you're providing a service of dubious benefit. If cutting non-essential first response saves fuel and maintenance enough to save a fire department job or keep the library open, then it's something that needs to be considered. Just because the engine is sitting around otherwise collecting dust does not mean that it's a free lunch solution for long response times. This is, of course, ignoring the wrong tool for the job issue.

                Sure, adding ambulances would me a much better way of improving EMS delivery, but single role EMS departments refuse to do this, so it would be unreasonable to expect the fire service to do the same. In addition, the public has come to expect this level of service in many areas. When I'm the engine medic, and we're onscene for a diff breather, MI, CVA or something potentially time sensitive, one of us will explain that we're the engine crew, that we have nearly the same ALS capabilities as the ambulance, and that we're there to start treatment until they arrive. I've yet to hear a citizen complain that we were ther instead of the ambulance; they were just happy to have us there to help them.
                So because the citizen who is ignorant of how EMS works is happy, then that's fine? Additionally, out of those things you've mentioned, only the patient with difficulty breathing is time sensitive from a first response standpoint. STEMIs and CVAs are time sensitive from a transport standpoint, unless you've added a cath lab or CT scan and neurosurgical capabilities to your fire engine. Saying a fire first response saves CVA lives is like saying an ambulance first response to a structure fire saves lives because the ambulance carries a fire extinguisher. It's simply the wrong tool for the job and having the 'circle of death' standing around on scene does not stop any sort of meaningful clock.

                Costs are saved in hiring by preventing burnout, injury leave, permanent disability, and other forms of attrition. When I worked single role EMS, it was typically just me and my partner lifting and carrying everything. We had six floor walkups with the chair, our air, our bags, and the monitor. There are tight apartments and stairs that we had to navigate on our own with no spotters. We did it, but it will eventually burn you out or cause you to throw out your back, blow out your shoulder, knee, etc. With our dual response, we have 5-6 people to share the load rather than just two.
                ...however not all calls are on the 10th floor of some sort of small slum like apartment. Targeted response? OK. Every response? Waste of resources. Additionally, lift assists do not need paramedics, they need people who can lift, so there's no need for a first response set of paramedic gear to maintain.


                If I'm riding as OIC, I'm not doing any lifting at all, except maybe one of my bags. That is huge in preventing breakdown or burnout. Being able to go between EMS and suppression also prevents burnout. The average EMS only person lasts only 7-10 years before leaving the field. The fire service has many who keep their ALS certs for much longer, typically for their entire career if they can switch between roles. Reduced injury and attrition saves money in hiring and OT.
                Wee... lots of people with paramedic certs not providing paramedicine! Sounds like the perfect recipe for skill degradation and dilution. I'm going to go out on a limb and say that not everyone at your department are specialists in hazmat, confined rescue, AND swift water. Why not? After all, once someone gets trained in hazmat they should be able to switch from any other role and back to hazmat freely, just like plenty of fire departments do with EMS.

                To suggest that suppression coverage be scaled back and replaced dollar for dollar for the EMS side due to call volume numbers shows a profound ignorance of suppresion operations
                To suggest that ambulance coverage can be scaled back (or, as often is the case, simply never meeting the demand) because there are fire engines collecting dust shows a profound ignorance of medicine.

                Comment


                • #23
                  Originally posted by Gadfly View Post
                  Emphasis added.

                  Paramedic equipment, which includes many perishable medications that are often hardly used to begin with (just based on call makeup), isn't cheap or free. Similarly, more use of the apparatuses means more wear and tear and higher fuel costs. It's hardly free and for non-time sensitive calls (which are the case more often than not and the calls that are time sensitive are often not quite as time sensitive as we'd like to believe), you're providing a service of dubious benefit. If cutting non-essential first response saves fuel and maintenance enough to save a fire department job or keep the library open, then it's something that needs to be considered. Just because the engine is sitting around otherwise collecting dust does not mean that it's a free lunch solution for long response times. This is, of course, ignoring the wrong tool for the job issue.



                  So because the citizen who is ignorant of how EMS works is happy, then that's fine? Additionally, out of those things you've mentioned, only the patient with difficulty breathing is time sensitive from a first response standpoint. STEMIs and CVAs are time sensitive from a transport standpoint, unless you've added a cath lab or CT scan and neurosurgical capabilities to your fire engine. Saying a fire first response saves CVA lives is like saying an ambulance first response to a structure fire saves lives because the ambulance carries a fire extinguisher. It's simply the wrong tool for the job and having the 'circle of death' standing around on scene does not stop any sort of meaningful clock.


                  ...however not all calls are on the 10th floor of some sort of small slum like apartment. Targeted response? OK. Every response? Waste of resources. Additionally, lift assists do not need paramedics, they need people who can lift, so there's no need for a first response set of paramedic gear to maintain.



                  Wee... lots of people with paramedic certs not providing paramedicine! Sounds like the perfect recipe for skill degradation and dilution. I'm going to go out on a limb and say that not everyone at your department are specialists in hazmat, confined rescue, AND swift water. Why not? After all, once someone gets trained in hazmat they should be able to switch from any other role and back to hazmat freely, just like plenty of fire departments do with EMS.



                  To suggest that ambulance coverage can be scaled back (or, as often is the case, simply never meeting the demand) because there are fire engines collecting dust shows a profound ignorance of medicine.
                  Sorry but I have to disagree! If an ALS engine arrives before the ambo on a stroke or MI it saves a lot of time. The Engine can do a 12 lead prior to the ambos arrival which will decrease scene time. For the stroke the engine can complete a pre-hospital stroke scale prior the the ambos arrival and also decrease scene times. As we know there is nothing we can do for a stroke in the field. In my system we do not give 02 to a stroke/MI unless the SP02 is less then 94% (if you wonder why read up on it). Our goal for stroke scene times are 10 minutes or less. 9/10 times a IV will be started en-route becuase what meds does a stroke pt. need? Also if the engine arrvies first and is able to provide ACS medications such as ASA, & Nitro, 02, the sooner those meds are on board the better the Pt. outcome. There is many times where are ambos are at the hospital or out of the station on a call in another district. Our ALS engine which carry most of the stuff the ambos carry can start Pt. care.
                  Last edited by TruckSixFF; 06-17-2011, 06:18 PM.
                  FDNY 343 9/11/01 WILL Never Forget!

                  (W-6)

                  "We Lucky Few We Band of Brothers." William Shakespeare

                  "let no man's ghost return to say his training let him down. "

                  D-P-T

                  Comment


                  • #24
                    Originally posted by TruckSixFF View Post
                    Our ALS engine which carry most of the stuff the ambos carry can start Pt. care.
                    The only items with documentation to support improved patient outcomes by arriving at the patient's side before the ambulance is CPR-trained individuals and an AED. Sorry.

                    Because I'm a nice guy, I'll spot you a BVM, O2, ASA, and an Epi-Pen.

                    If we want to be treated like the medial professionals we think we are, we need to stop spending time and resources on things that have no basis in medical evidence. If firefighters don't care about being medical professionals because it doesn't fit their business model, well.... that's another issue entirely.
                    Last edited by emt161; 06-28-2011, 01:00 AM.

                    Comment


                    • #25
                      Originally posted by tree68 View Post
                      All valid points.

                      I would submit that many fire departments got/get into the EMS business because they were worried about the public seeing the BRT's sitting around most of the time, staffed by who-knows-how-many firefighters, waiting for an ever-decreasing number of actual fires (although the AFA's seem to be holding in there).

                      We don't want the public to wonder if we really need all those BRT's and firefighters. So we start running EMS calls to keep those BRT's fresh in everyone's mind.
                      If it weren't for fire based EMS.. many commuinities would not have EMS on either the BLS or ALS level at all...

                      A for profit company will not station crews in an area unless they can turn a profit. They may respond from a base station, but that response time could be anywhere between 10 minutes to half an hour.

                      by the way.. my FD started doing EMS runs in the 1950's when the engines were equipped with the old E&J Resuscitators...
                      ‎"The education of a firefighter and the continued education of a firefighter is what makes "real" firefighters. Continuous skill development is the core of progressive firefighting. We learn by doing and doing it again and again, both on the training ground and the fireground."
                      Lt. Ray McCormack, FDNY

                      Comment


                      • #26
                        Originally posted by emt161 View Post
                        The only items with documentation to support improved patient outcomes by arriving at the patient's side before the ambulance is CPR-trained individuals and an AED. Sorry.

                        Because I'm a nice guy, I'll spot you a BVM, O2, ASA, and an Epi-Pen.

                        If we want to be treated like the medial professionals we think we are, we need to stop spending time and resources on things that have no basis in medical evidence. If firefighters don't care about being medical professionals because it doesn't fit their business model, well.... that's another issue entirely.
                        With all due respect please do not post unless you actually have a clue about what your talking about because it is obvious you don't. There are MANY situations where my ALS engine has started ALS care that directly improved the Pt's outcome. The ambo out of my station runs on average 10 EMS runs a shift...leaving a lot of time for them to be at the hospital, or on a call in another's stations district. For instance I have given atropine and paced a very severe bradycardic Pt., turned around 2 anaphylaxis Pt's with Epi, fluids, and Benadryl , worked a hand full of full arrests before an ambos arrival where we had a IO, ET tube, and a round of meds before the ambos arrival, delivered a baby, and have controlled major bleeding, and given fluid bolus for a Pt. who was in shock after cutting his arm off with a table saw....And not to mention like I stated before, if an ALS engine can do a 12 lead, pre-hospital stroke scale, get medications on board, or even get a Pt. hx prior to the ambos arrival that decreases scene times and improves Pt. outcomes. Also I know when I am on the ambo I love having the ALS engine on every EMS call with me. It is nice to have an extra medic or 2 from the engine because it takes a huge load off the two medic on the ambo. And for the issue of cost...the EMS system supplies us with everything except for a few things such as the cardiac mointers which I believe grants paid for all those. And as far as firefighters not wanting to be paramedics, it is a requirement to be a paramedic to receive an application. If the candidate does not want to be a paramedic, well that's his own fault no one forced him to take the job and there is plenty of guys behind him that would love to have it.
                        FDNY 343 9/11/01 WILL Never Forget!

                        (W-6)

                        "We Lucky Few We Band of Brothers." William Shakespeare

                        "let no man's ghost return to say his training let him down. "

                        D-P-T

                        Comment


                        • #27
                          Originally posted by emt161 View Post
                          The only items with documentation to support improved patient outcomes by arriving at the patient's side before the ambulance is CPR-trained individuals and an AED. Sorry.

                          Because I'm a nice guy, I'll spot you a BVM, O2, ASA, and an Epi-Pen.
                          And what about the 12-lead capable monitor, RSI meds, cardiac meds, and chilled saline infusion? These are all real-world engine company based treatments that are available.

                          While any of these treatments by themselves may or may not have an immediate impact on the patient's status, they will have a greater chance of long-term survival and recovery.
                          Career Fire Captain
                          Volunteer Chief Officer


                          Never taking for granted that I'm privileged enough to have the greatest job in the world!

                          Comment


                          • #28
                            Originally posted by TruckSixFF View Post
                            With all due respect please do not post unless you actually have a clue about what your talking about because it is obvious you don't. There are MANY situations where my ALS engine has started ALS care that directly improved the Pt's outcome.
                            Anecdotes are not evidence. Time to join the rest of medicine.

                            And as far as firefighters not wanting to be paramedics, it is a requirement to be a paramedic to receive an application.
                            So basically you're encouraging people to take the fastest, cheapest, easiest medic school they can possibly find so they get the patch and ride the BRT like they actually want. You're doing nothing but contributing to skill dilution and medical care provided by people who don't actually want to be doing it.

                            In Seattle and Boston, being a paramedic is a promotion that not everyone gets, whether they have it at time of hire or not. Their save rates regularly hover in the mid 40's, their care is consistently on the cutting edge, and research on what's next in EMS happens on their trucks all the time. You don't get that in departments where everybody and the janitor is a paramedic. You can't, because the same quality just isn't there.

                            Comment


                            • #29
                              Originally posted by BoxAlarm187 View Post
                              And what about the 12-lead capable monitor, RSI meds, cardiac meds, and chilled saline infusion? These are all real-world engine company based treatments that are available.

                              While any of these treatments by themselves may or may not have an immediate impact on the patient's status, they will have a greater chance of long-term survival and recovery.
                              Jury is still out on pre-hospital cooling in general- I highly doubt a couple minutes sooner than the ambulance will make a difference if the ambulance's initiation of treatment hasn't made any. Engine 12-leads is a maybe. In the urban department near me that most recently went to ALS engines, there hasn't been a manual BP taken since the monitors hit the trucks. $25,000 vital sign machines. RSI- no way in hell. How are the medics staying current if every idiot with a patch can do it? How many tubes is each medic getting per month? If the medical director doesn't know the first name of every RSI-qualified paramedic, they shouldn't be doing it. Cardiac meds will expire in the box before you use most of them- doesn't sound like a great idea to me. The guys in Florida couldn't even pass a written test they had notice for on what they were carrying on the engine. Sounds like a great idea!

                              Again, it's all about skill maintenance, QI, evidence-based medicine, etc. ALS engines either detract from or don't meet the findings of pretty much all of them.

                              Comment


                              • #30
                                Originally posted by emt161 View Post
                                Engine 12-leads is a maybe. In the urban department near me that most recently went to ALS engines, there hasn't been a manual BP taken since the monitors hit the trucks. $25,000 vital sign machines.
                                Our 911-to-Balloon time is averaging 55 to 65 minutes. We're alerting the ER that we're bringing them a STEMI before the ambulance has even arrived. With an expecation of a 12-lead application within 7 minutes of the arrival of the first unit, there's no way we'd give up a monitor on the engine. And if there are departments using them as a matter of convenience, shame on them.

                                RSI- no way in hell. How are the medics staying current if every idiot with a patch can do it? How many tubes is each medic getting per month? If the medical director doesn't know the first name of every RSI-qualified paramedic, they shouldn't be doing it.
                                As a matter of fact, he does. We have 524 members, 189 of them are ALS, and 47 of them are RSI qualified. Ironically, the RSI medic on my shift completed his 8 hours of RSI CEU's today, which included both classroom review and scenario-based practical sessions. Who leads the program? The medical director himself.

                                Cardiac meds will expire in the box before you use most of them- doesn't sound like a great idea to me.
                                If you see the box is going to expire, trade it for one of the boxes on the ambulance. It ain't that hard.

                                The guys in Florida couldn't even pass a written test they had notice for on what they were carrying on the engine. Sounds like a great idea!
                                Sounds like they need more accountability.

                                Again, it's all about skill maintenance, QI, evidence-based medicine, etc. ALS engines either detract from or don't meet the findings of pretty much all of them.
                                You're talking to a guy that works for a department that employs two full-time QA managers - one for ALS providers, and one for BLS providers. A department that has installed gyrometers in the ambulances to study the effectiveness of CPR in a moving ambulance. We take EMS seriously, and constantly review our depolyment models to ensure that the most effective EMS is being delivered to our taxpayers - and this often times includes ALS engine companies.
                                Career Fire Captain
                                Volunteer Chief Officer


                                Never taking for granted that I'm privileged enough to have the greatest job in the world!

                                Comment

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