Wow! I take the kids to the grandparents for the weekend and this thing blows up even bigger.
First, thanks for the compliment about bringing intelligent conversation and facts into the discussion earlier. Second, I couldn't keep up with all of the posts, but here are a few random comments that I have in mind:
I am like Barry in that I no longer ride the units regularly as I was promoted into a new spot. Again, promotion is something that is, or should be, available in all services whether they be fire, private, or hospital so please do not use that against the FD. However, I do still participate by making EMS calls on the truck and teaching ACLS, PALS, and ITLS.
Barry and I are part of a growing trend in the department that has helped to decrease, if not eliminate, any bias by the "old" fire guys toward EMS.
I have a friend who is a paramedic with FDNY. I understand that there is still a great bias in NYC and often times the fire companies do not even get out on an EMS call. That's their system. It isn't right, but we can't control it. Many of you got on Kramer's back because of some of his comments. As Barry said, he's very intelligent, but doesn't always present his arguments in a tactful manner. One thing you should know about him is that he is a good EMT and by being in charge of that engine company, he will tear you a new one if you even consider not making pt. contact while riding on the engine company and, again, he will wade in up to his elbows if he needs to.
Someone asked about BC's and ALS companies. As Kramer said, he is in charge of the scene, not patient care, and he knows that and doesn't try to interfere. There are EMS Lt.'s and Battalion Chief's in the field to supervise pt. care. Each house with a unit has an ALS company.
I have heard a lot about LA and the west coast also. I don't know why, but they seem to have (in general, I cannot speak to individual medics or systems) a lot of problems with some skills. I know an ER doc from southern California that says a lot of that has to do with how tightly they control what the medics do in that area and he actually pointed to the nurses unions as fighting anything to do with helping EMS in the region. Again, second hand information, but the only info that I have.
As Barry said, we have a very progressive medical director and chief of EMS. We are taught to think and given latitude in our decisions and not required to call for orders for every patient or simply follow protocol XYZ to the letter.
Someone spoke of the FD's wanting EMS to get the money. I'm not sure about your area, but money is not to be made by providing EMS in a urban area here. Most of the calls go unpaid because the pt. doesn't have money, insurance, etc.
I understand that many of you are on your side of the street and we are on ours, but I too have worked for every kind of EMS service and I think that this is the best model that I have worked for. Is that true of every FD based service? No, but there are knuckleheads that merely passed the test in every kind of service. As I stated a few days ago, we have a QI system in place to correct or weed out those people.
Just a few random thoughts............let the bashing begin.