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The reality is all services, regardless of stand alone or a combined service, every service does run close to the wire. Rostering & Operating levels generally are determined from historical data. These are then suplimented when a planned event takes place. All it takes however is a strange set of circumstances, & your service is pushing shit uphill. Here, most tourist coaches carry a maximum of 44 passengers each. What happens when 2 of them collide head on. This happenned here, 21 years ago. Information is available here. This is in a rural area, low call volume, minimal crews, is this a normal event? Is this an event that can be sucessfully planned for? More recently, September 11 2001 saw all New York emergency services completely overwhelmed. Can this be planned for? The simple answer is no. To cater for these extraordinary events & have crewing levels for it daily is cost prohibitive. Again, this is exclusive of seperate or combined service. Pandemicsof different types gastroenteritis, flu etc, will also cause major problems. Some of these are not the fault of EMS. When a pandemic hits, it not only effects EMS, but also hospital systems etc. This then causes back ups for EMS with no beds available. This of course is not a situation exclusive to medical. Police are in the same position. Fire can be in the same position, considering the range of work they have taken from everyone else. I hope this answers your question.

This still does not justify a combined service. If a private service is poorly run, or a shady agency, as you describe, surely the responsibility falls back to those who awarded the contracts. When any contract is issued, there are Key Performance Indicators that MUST be met or a please explain issued. If they are continually not being met, then there is justification to terminate the contract. If you contract someone to do some work for you, & they do not met the expectations that are set for them, they you find someone else. This is a business fundamental. If your Fire Service repeatedly failed to surpress fires, would there not be some sort of inquiry as to why, to identify problems, then resolution either through remedial action, counselling, demotion, dicipline or if the problem remains ultimatley termination. This is a pointless argument & serves no purpose here

This is the service that allows 46young to live the dream....... Sounds more like a nightmare I do however wish a speedy recovery

Yes you are right in that historically it was most probably a good idea at the time, but we also need to remember that this was a time when we did not use evidence based practice, presented evidence was not scutinised (look at tholydamide) & people held what the almighty doctor said as gospel. This was also a time when EMS had nominal skills & interventions that are of benefit, education levels were much lower than they are today. The entire medical profession has moved forward, however I find it concerning that myths that were once relevant but are not so, are still being taught as gospel. Part of the problem here si that they still have to teach to the lowest common denominator. The idiot factor. The moron medics who believe that they know better & like to stay & play rather than scoop & run. We need to remember that while we are better educated, we are not MD's, never will be.

I fail to see loss of jobs. They may be lost to fire, but, provided they were suitibly qualified, surley they would be picked up for EMS work. Put simply, those with a dual role would have to choose. Fire or EMS. If anything there would be a need for more staff in EMS to cope with the call volume. There are those who will choose to who have taken on EMS to try to increase their pay packet, but there are those who have had to take on fire because they want to undertake EMS but have no option.

stcommodore, while there are some differences between city & country, there is still the abuse of calls, there is still problems with accessing patients. In some cases it can be more difficult to maintin appropriate 'staffing' numbers in country areas because of the insistance that they be vollies. Put simply, the more calls you get, the more crews you have. Abuse of the system will happen no matter what your call volume, no matter what your shift numbers are. I addressed this, in a small way in an earlier post when Richard said there was no way any vehicle could have accessed any patient. How many times do you think this happens, as a percentage so we can compare the 2 to rural crews as well? I myself have seen people simply walk away after an MVA that had them trapped by confinment for 2 hours, had all services there & with the cuts on their head, simply got into a mates care & took themselves to hospital. It happens everywhere. To think this is a unique problem to metro EMS is putting your head in your a......... EMS will always be predominatley reactionary. There is only so much education you can do, but at the end of the day, people will still take risks, people will still drive drunk, etc. I have also said however that they need to plan for this type of thing & put forward suggestions. What you have said here is not unique to any 1 service, but a common EMS problem. it can be overcome, in some ways, but I doubt it will be in our lifetimes.

Lets pick the facts from the BS here. The reason your department has 37 vehicles on the road is because they have to cover EMS calls. In reality, you could have 1/3 the number of vevicles, 1/3 the number of hose monkeys, because, acording to you, they do 1/3 of the work. Your reference here is a nonsense. Your argument eminates from assuming (remember assume makes an ASS of U & ME) that fire numbers (staffing) would remain the same, not decrease accordingly. See my comment above about reducing the size of the Fire service. Once you do that there is no reason why you cant have skills mix & run a medic & EMT to increase you coverage in a dedicated ambulance. (OMG - an different way of thinking).Straight awa I have negated you argument of cost. 2/3 less Fire aparatus & FF's to pay will coer it nicley I think. Personally I think the whole US system in general needs revising. I think the days of the EMT (no disrespect to those members here that are EMT's intended) should be numbered. There is a need for more people to be seen & treated poroperly, not work on the 3P's (Pick em up, Pack em in, Piss em off). A classic example of this is Suspected Myocardial Ischaemia. Put simply what the person attending sees as a possible cardiac event. Allow them to treat the patient with ASA & Nitro enroute. There is a thread here about nitro & its advantages & we know minutes mean muscle. We also know the advantages of both ASA & nitro. That would be a start. I will stop there, this is not the appropriate place for that discussion. Increasing the skill level means that your patients will be getting better care. Better care across the board. So your whole argument is based on what benefits are available for you, not about whats best for the patient. Now we know your real motivation, I can understand your point of view, now I ask you to consider reality, without it all being about you & your benefits. There are 2 points in this paragraph that need to be seperated. 1. . It does make sense. Like it or not divorce them & fund EMS by downsizing fire is viaible, is practicle & is cost effective. No one has sought to put you on the employment line at all from what I have read. Meerly presenting arguments that you are not capable of understanding purely because you are so closed minded & slanted by IAFF to believe that Fire/EMS is the only way to go. More than one person here has shown that is not the case, but you will not consider it & insist that a video that talks about increasing fire crews is relevant to EMS in some strange way. 2. You have shown that you defininition of a winning team relates to what is in it for you. Not patient care. 46young. I have now shown that a 66% reduction is practicle, viaible & effective & funding is the withdrawn from fire & handed to a seperate EMS service that can be upskilled to improve patient outcomes, patient journeys (that is whole of health journey of which we are the first part). The ball is back in your court to prove me wrong. It is interesting but there are a number of ambulance services around that can, through appropriate questioning at a call centre level, determine with good accuracy the level of care needed. Maybe your service would benefit from that, the you will not need ALS & people will realise that there is no need for ALS on every call. Affluent or not, it is not needed. People should have the appropriate level of care for their condition. The do not need a fireman in full turnout gear acting like a complete tosser.If a person needs BLS care they get BLS care. BLS can also assist ALS & provide immediate ABC when needed.

CBEMT, this means that he will continue to dribble the IAFF BS because he cant debate a point properly.

Where is the EMS reference? All I see is dribble about fighting fires. This discussion is about the validity of your arguments to justify combined EMS/Fire services, not increasing the number of people from 3to 4 on your Fire Trucks. What relevance is knowing how to fight a fire in this discussion????? That was 9 minutes & 22 seconds of my life that I will never get back. Thanks for the waste of time, that told me nothing, other than the fact that these guys seem to be lacking in common sense. (if it aint safe, dont do it). I will keep saying it until you can prove to me, not through rehashed dribble, that there is a real benefit to the community in a merged system. I have not seen 1 argument for it that I can honestly agree with. I have seen a video from you tube that recommends 4 FF's on a truck, & if thats whats needed for safety, great, I will back you. But there was not 1 reference to EMS. If you want to be taken seriously on this issue, not just by me, but the others contributing & those who are following this thread (it has been viewed 791 times at the time of writing) then you show us how the combined systems actually benefit anyone except the fire company that runs EMS. Remember, you stated your company is 70% EMS, 30% Fire.

IAFF has agian provided a smoke screen to deflect frm the real discussion. Is havin combined EMS/Fire really in the best interes of the general public, or is it best for the fire department because it increases their rofile, increases their workload & gaurentee's their jobs. I give them 10/10 for trying to preserve their members jobs, but to tell lies about it being in the best interest of public is takng it a bit too far. 46young has already told us, is either this thread or another, that 30% of their workload is fire surpression. 30%. So where is the bulk of the work? EMS. But it is a good excuse to et the BRT out so everyone can see it, so people will think they are more important than they really are. Now, what is better for he public, stand alone EMS, orglory seeking firemen justifying theor jobs?

Richard, these are a needs fit. It takes a relativley short period to fit each vehicle, so the only storae you have is for the tracks. Thismeans the units are available through the non snow season as a regular unit. This means that as needed you can convert a unit(s) between track & wheel. I am not talking full fleet, however, a selected number gives you unprecedented access. The main snow of consequence we et is in the southern mountain areas. We use the vehicles i put in the pic as well as skido's & Paramedics on skis. Richard, your arument isnt from a can do perspetive, it is from a we have never done it, they will never consider it, so why talk about it attitude. Maybe if you printed the pic & planted a seed of thought it may happen in years to come.

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While it may be old news, it is good to see that the study has been don & thaks squint for putting it on here. It never ceases to amaze me the number of (new) people who are still taught & believe that this should be adhered to. I have said repeatedly that you need to think. Do not delay your time on scene, but there should not be any time restriction. Most know when to scoop & run or stay & play.

Richard, my response was to your comment You yourself have now said you knoew they were available & now the debate can continue. Put simply & in response to herbies comment on cost, in places where there is a likley possibility that this sort of event could occur, this is the sort of option that some forward planning would take care of. If the appropriate authorities decided that this was the sort of thing they needed, then over a period of time, an appropriate number of these that could be retrofitted as required, to exisiting vehicles. I am sure that you had more than a days notice & like most services, there are spare vehicles that, when you have a couple of days notice, can be selectivly fitted ready for use. It isnt rocket science. It just takes some planning. Something that in some cases seems to be all too difficult.

Herbie, did you actually read what I posted? They are not a retro fit, they are an extra fit. If you live in an area that has problems with snow, then this is a solution. My reply was directed primarily to Richard whose comment was to show there are solutions, solutions that you may not have thought about. -1 for not reading the post properly.

I thought you had some intelligence. This shows what I have been saying all along. Its only about more revenue coming in. They say that. IOt is also about Fire doing more 'Hero' work so they cant be out of peoples minds. Lets have a reality check. Take all medical from them, run it seperate, with no input or involvment, then we will see how they go.

Thats a pretty big statment Richard. Maybe before you commit like that, you should look at this. This vehicle is converted from standard 4WD in about 2 hours. I gaurentee this would get through.

What Bushy said.....

Not always Herbie, there may be a selection of vehicles, but, as was described in stcommodores thread, This also happens in rural areas, where the 4WD or AWD vehicle(s) is/are not available. Having worked out of many of these, they are not, especially the 4WD vehicles, really the most desireable vehicle to workout of. When all hands are on deck, so are all vehicles. What I am commenting on is more the attitude demonstrated where people have blinkers on & can't see past what they live with daily & don't want to listen to what others have to say. The problems described, in many cases are faced by rural EMS on a daily basis, if not snow, rain, poorly maintained rods etc. Remember many roads that are not seald do not always require te type ofvehicles you described & for a)patient comfort & b)space needed, a 2WD vehicle will suffice.

Why is it any different to anywhere else. The issue is that is it difficult to access the patien, resources are tied up for longer, hospitals get overloaded. These are not unique to urban areas & to think they do shows complete ignorance & lack of understandin of what hapopens elswhere. Again, as I have said to another poster in this thread, remove thy head from thy nether regions, look outside of where you live & consider, in this case, the problems that maybe encountered by your rural colleagues. For example, where all your roads are sealed, theres are not, many rural properties have long driveways that are unsealed. They have extended times to scene anyway & these delay them even longer. Why would a major snow dump, as is being discussed here, not have an impact on non urban areas? Your comment is just plain dumb.

But nothing says it better than shoving yr head where the sun dont shite & declaring 'It will never change so now I am an advocate for a failing system'

Here we go again with the rhetoric for fire claiming (trying anyway) a pay rise at the expense of EMS. Bushy quite rightly say it could be Make the tossers actually work for their money, justify their existence. It is dribble like this that breeds complete & utter contempt for those who are competent people dedicated to EMS that are forced to train as a hose monkey as well. What is amusing about his comment is that it is already being done in Australia. MICA & Rapid Responders are already working, no need for a full crew of hose monkeys in a large 'aparatus', or should I say BRT. I vehicle, with lights & sirens, in some cases motorcycles, that provide initial Paramedical care until back up can arrive. But it must not be any good. It isnt Fire based. 46young, maybe you need to remove your head from somewhere so that you can see that other countries, other services, & other people have ideas & operations that will & do rival what is provided pre-hospital in the US. Services that do not need fire attached. People that still have a passion for EMS, not fire & are dedicated to this profession. Open your eyes & your mind.

The rest of us have a life.

A woman went to her doctor for advice. She told him that her husband had developed a penchant for anal sex, and she was not sure that it was such a good idea. 'Do you enjoy it?' the doctor asked. 'Actually, yes, I do.' ''Does it hurt you?' he asked. 'No. I rather like it. ''Well, then,' the doctor continued, 'there's no reason that you shouldn't practice anal sex, if that's what you like, so long as you take care not to get pregnant.' The woman was mystified. 'What?!?! You can get pregnant from anal sex???' 'Of course, 'the doctor replied. 'Where do you think politicians and lawyers come from?"