46Young

I totally encourage your pursuit of either RN or RRT degree. Either will open up many possibilities and avenues.

I would discourage you from thinking about trying to get a job in the flight arena per diem. I don't know of any flight program that would hire someone without previous flight experience for a per diem position. If they did I would be looking at a different program. People who have already worked full-time in flight are ok to go to per diem but it is not a position that you should be starting and learning about in a per diem position. You will also need 3-5 years of critical care experience as either an RN or RRT or good 911 ground experience as a paramedic before you should even consider a flight position.

When you say you are looking at retiring at age 55 is that just the fire service or working altogether?

I wasn't sure if there was a market for PT flight RN's/medics.

I got on at Fairfax at age 32. I'm currently 33. Normal service retirement is at either 25 years of service at 2.8% (approx 72% of average three highest earning years minus OY), or age 55, whichever comes first. One can work in excess of 25 years to increase the multiplier, resulting in a near 100% yearly payout. I plan to work a total of 23 years, which will occur when I'm 55, and then do three more years in the DROP, to maximize my retirement.

I would keep an eye out at Montgomery College's website over the next few years as they are doing a lot in the way of a paramedic program and since they have a pretty good nursing program they might offer a bridge. The nursing school is located in Takoma Park, Maryland, which can be a little bit of a hike from Fairfax (not sure where you live). I'll shoot an e-mail to the program directors over there and see what they are thinking in ways of a bridge course. Montgomery College does however have a great Fire Science degree with one of the classes taught (last I heard) by our Chief Richard Bowers. The fire science course I took through there, equivalent to Officer I, met about once a month and almost all of the work was online. We had a career MCFRS member go through the course.

Something to look into.

I can not speak much to RN vs RT but I am a full time nursing student and just school alone (20 credits) is really kicking my butt some days. I just pulled an all nighter and I wish I could say it was my first of the semester. We have one woman in our class who works full time as an ED tech and she is barely scraping by with passing grades. It may just be the program I am in, but something to consider. A full time schedule anywhere is the equivalent to a full time job in my opinion and depending on your social life, may be hard to keep up and still do well.

Best of luck to you and don't hesitate to PM me if you have any questions about MC's programs. I know both of their department heads and they are fantastic people and paramedic volunteers in Montgomery County.

I'm currently living in Garrisonville in Stafford County, just below Quantico. I'm going to meet with the FRD's career development/education coordinator next week and see what we have set up with regional universities/colleges. I'll check out your leads as well, of course. Thanks for that.

I worked FT + an OT shift each week on average while going through my 13 month medic program, which was two 8 hour days per week with 16-24 hours of clinicals, flexible. The material wasn't anything as intensive as the RN or RT curriculum, I'm sure.

The FFM job + OT will keep us comfortable, so completing the Fire Science dergree first may be the best career wise, especially if you're only meeting once a month. Tackling an RT or RN program head on should be easier on a Tech or Lt salary, along with an ample amount of leave available. The RN or RRT licenses interest me greatly, but can be deferred if the curriculum creates too much with my current schedule and relative lack of leave in the bank. If it works out I'll do RN or RT first, but at least I know that I can do the Fire Science degree in a much more career friendly fashion at first. I also want a fallback with RN or RT if I go out on permanent injury, or to segue into FT post retirement.

20 credits is a full plate, I'm sure. Keep up the good work!

I'm having trouble with some of the non-standard acronyms you're using here. Can you define these for me?

FRD

NSLIJ

DROP

WOWOWOOOO

FRD is the Fire rescue Dept, Fairfax County to be specific.

NSLIJ is the North Shore Long Island Jewish Health System. I worked for their Center for EMS, which does both NYC 911 and IFT.

The DROP is the Deferred Retirement Option Plan

http://benefitsattorney.com/modules.php?name=Content&pa=showpage&pid=17

WOWOWOOOO is my work rotation. Each character represents a 24 hour block. W=work, O=off.

Everything clear as mud?

My nursing clinical experience was not flexible. We had practicum on Tuesday and Wednesday. We had 16 hours of practicum a week and another 4-8 hours of pre-clinical work per week. The exception was labor and delivery where we were on call and had to continue the rotation until we did a delivery.

My RT clinical experience will not be flexible either. We have practicum on Monday and Wednesday, with the exception of the summer session which is about 10 hours a day for five days a week from what I have been told.

Vent pretty much nailed the other concepts and would be a better resource if you consider the RRT route. I would not suggest settling for CRT if somebody tries to persuade you to take the shorter route. With increased competition and focus on critical and special care, the role of the CRT in many places is going away. Go RN or RRT and if you have a BS program close by and get accepted take the opportunity. I wish there was a BS program in my area.

Take care,

chbare.

Thanks again. It would have been way easier if I was still working at NSLIJ, where they are willing to accomodate a FT school schedule with a workable shift change, as long as your intended degree would benefit the Health System. I had to go with the FFM position over staying in NY to pursue a degree (or several). This made the most financial sense for my family and I, and I can still fufill my degree aspirations. It'll just be a little more taxing.

Florida and a few other states do have separate licenses with some differences in scope. CRTs don't always get to work the ICUs or do any of the "fun things" nor are they accepted to transport or ECMO programs. Rumor has it that California might finally do the right thing and only license RRTs. That would be great since CA was well known for its RT mills in the 80s and early 90s.

If the legislation is passed that the AARC has been working on, the Bachelors program will become more prominent.

The RT profession didn't wait for a mandate that they had to get a college degree in their profession. The RTs and employers just starting accepting it as the norm long before the legislation was passed for the 2 year degree. It was sorta common sense to see where a "cert" was not enough in the ICU just like the LVN. Now the 4 year degree is going the same route as more people are getting it to stay qualified in this job market.

If I decide to go RT, I'll go all the way. Money won't be a motivating factor in this anyway, so why not take the time to attain the highest level possible?

Not even close. A medic mill at least teaches you something, even if it's not much. Excelsior teaches you nothing. Zero. Zip. Zilch. Zed. Nada. Nyet. All they do is validate what you have somehow managed to learn (or fake) on your own.

To compare Excelsior to a medic mill is to insult both them and the medic mills.

I suspected as much.

You could definately do the PRN gig in nursing in almost any specialty, however I cannot speak intelligently of the RRT field. All of the RRT's I work with on the neo team are full-time, but Vent would be a great resource for that particular question. the problem isn't so much of working when convenient, but more getting to that level. As chbare states, the education is a full time one, regardless of the field. Excelsior will not prepare you for the field clinically, they expect you to come prepared. Nor does their program adequately provide the delineation from medicine and a strong foundation of the nursing process. That is the reason why many State's are thinking twice about licensing their graduates and why a good number of Paramedic's fail the CPNE. Even in an articulating students or transition program, you have to dedicate the time for class, skills, and clinicals.

Can you get creative with your schedule? Sure! Will it take its toll after a while? Probably! I'm working fulltime at two jobs plus taking a 12 semester hour load. Quite honestly, it is kicking my a$$. But I have the determination to see it through this time. Having communicated with you in multiple threads elsewhere, I could see you getting it done as you have a passion and motivation to succeed. I'd say do it!

In reference to working in the flight environment, I would strongly recommend becoming familiar with the height / weight restrictions of the agencies you are interested in. Many have a 220 - 225# weight restriction wet, meaning with suit / equipment / helmet / etc. Many also have height limitations as some of the smaller single engine airframes are not so accomodating to you taller types! I know I was tight in a Bell 206 and I'm only 5'7"!

Thanks for the words of encouragement! I remember doing several IFT txp's back in the day to LaGuardia airport to deliver a pt for fixed wing txp (I'm not sure what model) and thinking that it was really tight in there. I've heard varying accounts as to what acceptable height/weight limits are.

I'm not considering going Excelsior for RN. It's the equivalent of a medic mill, from what I've heard.

That 5 week ventilator course just introduces you to what a ventilator is. The following semesters apply what you learned from that course to the courses for introduction to critical medicine and bring it all together later. You will also get a semester of specialty ventilation/critical care theory for Peds and a semester for neonatal. As well some programs may have electives in HBO, Cath Lab and ECHO. I did all three because I just couldn't get enough. I also repeated Cath Lab later when I did my B.S. in CardioPulmonary just to see how another center known for caths did it with technology. The first was in the 80s were we still did all the calculations and manual drawings.

It is difficult to have a flexible schedule because the clinicals may actually be monitored by physicians along with the clinical educators. Most of my classes, especially ath the B.S. level, were taught by physicians.

Nursing of course can have more opportunities but the RRT can have many also. I can travel on short or long assignments in any state I care to get a license in. I have also worked PRN as an RRT most of my career as a FT Paramedic. For specialty programs such as Neonatal, they did require a serious commitment especially if you wanted to work at a higher level of competency and be on transport.

RT is a very active profession politically when it comes to lobbying for benefits for the patient and the therapists. The benefits for the patient includes home care payments from medicare for extended services. By that, whatever benefits the patient gets it helps the RRTs' future. But, the patient is always emphasized first which the profession took notes from NPs, PTs and PAs in that areas. They didn't use the "me, me, me" approach and have managed to make great strides in the past 20+ years.

The biggest thing against the Excelsior program is the clinicals. You really need to know basic nursing skills and time management. Few RNs precepting you will want to talk you through gait management and the various lines when there are so many other things to learn about the facility. The clinicals also allow you to network for a decent job.

Points noted. Cardiovascular and airway/respiratory are the systems that I took the most personal interest throughout the medic program, and I continue to hold that interest. I think that I would be happier as a RRT vs an RN. It's going to come down to being able to free up the requisite time. Taking a LOA from Fairfax isn't an option. I suppose that with major increases in educational standards, completing any of the major degrees in the healthcare field demand a full time effort, and are not particularly accomodating to those with an existing FT career/job. It seems more geared towards the young individual who may be living at home and can afford not to work, or work PT at the most. Not that it's not doable otherwise, it'll just require me to be creative.

Medic to RN bridge programs were created to accomodate the working professional, but were apparently designed poorly, leaving much to be desired. One shouldn't have to be brought up to speed when doing clinicals due to poor prep either.

I understand where you're going with the "pt first" emphasis.

FDNY EMS Command, with the hospital based additions, and the subcontracted ambulance providers working for some of the hospitals as a part of the NYC 9-1-1 system, handle roughly one point three Million calls a year. I suspect that when the year 2009 ends, the new total will probably be closer to point four.

I still believe for "Braggin' Rights", NYC may still be the busiest 9-1-1 EMS response area in the US. I yield that London, England, might be busier, on the international side.

When I first started in municipal EMS in NYC in 1985, I signed on at 3 PM. If there were more than roughly 1,500 calls in the Computer Assisted Dispatch system, we'd had a busy day.

Nowadays, by 3 PM, we're already past 2,000 calls. I am unsure of the figures, but I believe we handle about 3,000 to 4,000 calls each 24 hours, with exceptional events, like the blackout, spiking the numbers upwards of these numbers.

I am of mixed thoughts of newbies coming into the FDNY EMS Command, talking of their home agencies being "busy", with 10 to 20 calls a week, as I don't know to pity them being eaten alive by the NYC call volume, or envy them their down time between calls back home.

Just curious, how many jobs does the city actually do after adjusting for the "dupe jobs"? you know, the same job that comes in at two or more reported locations?

I was urban EMS in NYC 911 for the participating hospital NSLIJ. I ran BLS for three years on 46 Eddie mainly, along with 53 David/George/IDA/John, along with 54 George. I also did ALS for two years mainly on 46 Young, as well as 53 Y and 54 Y. I also worked 52X, 52W, 51V and 51W per diem for Flushing /Jamaica/Brookdale.

Fairfax County has a few small areas with urban flavor, but is mostly suburban with a few rural spots. I miss that grimy inner city environment. I'm considering applying for the Richmond Ambulance Authority, as my IFT job isn't all that challenging at all when compared with what I was doing on the IFT side of NSLIJ.

I was talking with my old partner today, who was telling me about a few shootings he worked, an arrest save on the street for an elderly lady who dropped dead while cleaning her yard, violent EDP's, and a few critical asthmatics and APE pts. I miss it. FxCo is boring in comparison. I enjoy helping people, even if it's only comfort care, but I need that adrenaline fix every now and then. I also hear that Chief Howie Sickles (am I spelling that right) was transferred out of Queens, where he would use any BS excuse to give us NOI's or 24 hour pt care restrictions for buffing jobs. I hear he's in Staten Island now. Miserable individual.

They pay really isn't bad at all. In fact, IIRC, we are one of the highest paid in the area, if not state. Some of our quarters are pretty nice, others, well, they leave a lot to be desired. However, checking out a SUV or Rescue body truck in the rain/snow/cold/wind really blows.

I've thought about that area.

But the prospect of cold, somehow, just dont rub me the right way.

We get like an inch of snow if we're lucky. It gets cold a little later and warm a little earlier than NY (where I'm from).

Just so you know, I'm making around 67-69 grand base + cert pay + riding pay, and I'm on track to make between 85-90k this year. I'm not killing myself either. Here in Stafford County, I'm only 35 minutes from my station, and around an hour tops from the farthest stations. My medic officer, who's a Capt I, makes exactly double my hourly (topped out), making over 120k after incentives, before OT. 1400-1500 sf Starter homes in our area go for upper 100k's to low 200k, low crime, great schools, large proportion of military and gov't workers. Unreal.

I'm only 4-5 hours from the OBX and about the same for Long Beach, Jones West End 2, or Robert Moses on LI, my favorite breaks. Much closer for LBI also.

There are good third service agencies out there, but burnout due to poor pay and working conditions seem to be more the rule than the exception. the industry does seem to eat it's young. Plenty of strong EMT's/medics in these agencies, but burnout gets a good number of them sooner or later.

NSLIJ CEMS does NYC 911 as well as good IFT/CC. There are plenty of well rounded medics there, able to do it all with the requisite knowledge base. If not for lack of a pension and job security, I'd still be there rather than looking out of state for a more secure deal.

Increased educational standards are sorely needed to make the profession an actual profession, with job satisfaction and a high rate of retention, rather than a transient job for many while looking for a better deal. Until then we can only hope to get on with a decent agency, and not some fly by night operation.

Can it happen?

Sure.

It is rare, especially when the FDs have close relationships with the Medic Mills, and require new hires to have their Medic cert/license in an unreasonably short amount of time.

Now, making Medic an option, rather then a mandate is a start.

Further, until EMS makes the living and working conditions and compensation better, EMS only services will continue to loose people at an alarming rate.

Who wants to sit on street corners all day/night, eating fast food, and maybe laying down on the cot, when they could be relaxing at a station, eating home cooked meals, relaxing in a recliner, and sleeping at night?

How about the benefits, lack of pension, and poor equipment?

I work EMS only right now, as an MICP in South Jersey.

I also hold certification as a FFI, and licensure as Paramedic in Fla. I am there right now, applying to FDs.

I want something to show for my years of service.

I want to sleep at night.

I want a day off.

Yeah, pretty much. Except for relaxing, as we keep pretty busy during the day. We average 1-2 runs after 2200 hrs. Sometimes we sleep all night, sometimes we run all night. On average, I get 4-6 hours sleep at my station. I got tired of doing the street corner thing as well. You'll need an increase in educational standards to see any real change, and organization by the industry as a whole.

Hospital based EMS seems to have the best salary, benefits, working conditions and retention, though.

Nothing's stopping you from applying to Fairfax, Prince William, Montgomery, Howard, or anne Arundel Counties in the NOVA/MD/DC area. As long as you're NatReg.

My program is an AD program that is about 27 months long. We go through the summer. Clinicals start second semester and are two days a week for three semesters. In addition, we do a five week ventilator course over the summer followed by several weeks of straight clinicals, then into the second year. I did not go through school during the summer as a student nurse; however, we spent several hours a week in pre-clinical work. All in all, we will have 1,000 hours of clinical experience. This is about as many clinical hours as my nursing program.

Take care,

chbare.

Were the second semester clincals flexible, or were they set days, such as every Tu/Thu, or could it be Mon/Fri one week, and Tu/Wed the next?

How many hours per week, on average, were you spending on nursing clinicals? Were the hours flexible, or fixed?

A five week ventilator course, huh? It makes the three hour inservice I had seem paltry in comparison. Ventmedic has mentioned that a medic needs to have, at the bare minimum, a two year medic degree to even be able to absorb and thrive in the IFT arena, let alone CC or flight. I see her point. My medic program barely even touched on vents. I had to get up to speed once in the field.

Pre-req courses are very similar for both programs. Nursing school is full of busy work while RT school seems straight foreword but more technical and physiology based. Nursing school has a broad focus, where as RT school seems to have a narrow but indepth focus. On line nursing programs seem to be the latest and greatest thing, online RT programs do not appear to be as popular. Pay for both providers is highly variable, RN's will make a bit more; however, this gap is not wide and does not exist in some areas.

I am not sure your plan to attend school for promo purposes is a great plan. Both programs are full time and not piece meal class here and there educational experiences. I am a RT student, and I am in class five days a week. My shortest day is four hours in class with my longest being around six. In six weeks I had written three large papers and completed several large reading and homework assignments. In addition, a four page APA article review is required each week. So far, I can say the commitment is similar to my prior experience as a nursing student.

Take care,

chbare.

Thanks for the input. I've looked into online RN bridge courses such as Excelsior, but I've been told that they don't prepare you well for the field, and an increasing number of states and employers won't acknowledge online degrees, due to lack of clinicals and such. I was going to do the nursing program at a local college back in NY while I was still working for NSLIJ, but I decided to leave the state in search of a secure career with a pension. Now that I'm set, I'm looking to go for either RN or RT regardless if it's for promotioal purposes or not. It just works out that the FRD values and prefers education for promotions.

Our work schedule is a 24 hour day, WOWOWOOOO. I am able to free up leave to attend class on work days if needed. I can also work OT, bank it as comp time, and use it for admin leave for school hours. I'm also wondering if all evening courses exist. I can go to day work if I absolutely have to.

Once your pre-reqs for RT are satisfied, how long is the actual program? How many hours for clinicals and how are they set up?

Here's the situation - I'm currently employed at the Fairfax County FRD. I'm eligible to test for either the apparatus tech and/or EMS tech position in another two years. I'll be eligible for an Lt promotion in another 4-5 years, depending on when the test is given. There are currently only all-hazards officer career tracks. 90% of your score on the tech promo list is the written test. The remaining 10% is based on education. Medics get 12% of that right away, and additional credits and degrees allow you to hit 100%. Education makes up 20% of the Lt score, and Capt I and above weigh education at 25%.

The FRD currently pays for one class per semester, including summer classes. This should increase as the economy recovers. The FRD has deals with local universities where some classes are held twice weekly, so employees from opposing shifts will be able to attend. Otherwise, the FRD lets you use leave while on duty to make classes. For example, you can use leave on every Wed that you're working from 1800 to 2300 to attend class. There are also numerous online classes, basically anything that doesn't require a lab. I could also go to day work to free up evenings for class, although this would result in me never being home for my family.

A fire science degree should be completed prior to becoming an officer, for the additional knowledge of building construction and other relevant topics. I'm also trying to decide between going for RN vs RT. Either of these will also satisfy the educational points for promo purposes. I don't have to worry about completing fire science for at least five years.

I'm asking for input regarding comparison of RN vs RT. I'm asking about pre-reqs, salary comparison, job description, availability of work as a per diem, length of program, evening hour availability, is any portion of either class available online, what amount of con-ed is available to recert, etc.

I would like to eventually get into flight, either an a medic or maybe RN if it's necessary to get hired. This would also be per diem. I'm planning to retire at age 55, then do three years in the DROP before leaving the service altogether. I currently weigh 225# at 6'3" lean.

Any thoughts/input/questions about the above? I'm going to look into what's available locally through the FRD. I'm figuring that I'll get some decent input here in the meantime.

This is the problem I have with the FD's version of training and education.

Do you realize how little that is when compared with even a mere 2 year health care degree? Other health care professionals also spend at least 6 weeks and usually a lot longer maintaining competencies and recert classes each year or at least every two years. In addition, those serious about medicine spend more each year learning new things and not just doing the "recerts" or mandatory stuff because the department says so. Many do this on their own time because they want to be a professional with some expertise in medicine.

This isn't exclusive to FD's, and this isn't other health care professions. When I was in NYC private, hospital based and FDNY EMS alike had the majority of individuals do a challenge recert, as there just isn't enough time to get in all the required CME's, let alone any self study. Sure, there were conferences like Vital Signs and such, but good luck getting two days off in a row, and not getting held over (mandated). Many in the greater NY area need several jobs just to survive, anyway. Who has time to fufill CME's and then do self study on top of that? All you need to do is a challenge refresher, and you're good for another three years. More time is available to work OT and per diem. I can pay the rent and eat, or I could go to CME's. Things are that tight for many in the five boroughs. It's not the way it should be, but that's the reality of how things are in NY. NSLIJ used to hold CME's regularly, and even pay OT for employees to stay after for the con-ed. After medicare reform, they dropped the compensation, and then dropped the CME's altogether. Sorry, you're SOL. You're on your own. Just do a challenge refresher. You don't need NatReg in NY anyway.

Anyone who doesn't plan to move out of state drops it anyway, as it's an utterly useless cert if you're staying local.

No one in NYC is dual role. FDNY EMS is fire based, but functions as a seperate entity, effectively a third service.

In Charleston County, we did mandatory 6 hour CME's monthly, which included alphabet recerts. Nothing more was required or encouraged.

In comparison, I feel that the Fairfax FRD does quite a bit for employees in providing quaterly con-ed sessions and in station EMS drills (both powerpoint lectures and skills) while on duty. The FFM is free to do more self study with their time, instead of using said time to fufill basic recert requirements. They're set up better than many across the country who are on their own with their con-ed. It's at least as much if not more than other places are doing, fire based, third service or anything else.

EMS isn't parallel to RN's, RT's, PA's and such, and don't do nearly as much required con-ed, nor or many motivated to do much self study otherwise. Not when the LCD is a three month medic mill. It is what it is for the moment.

I suspect many other parts of the country can draw parallels to the above situations.

So, here's how my dept works: FF and FFM alike are subject to the recruit process, including an extrance exam, CPAT, psych exam, full medical including a stress test, and one or two polys given by a detective. When hired, the FFM spends 6-7 weeks in the academy doing EMS alphabet card recerts, PT and clerical stuff. Then you spend 16 weeks in the field doing an ALS field internship on an ambulance. This is 3 12's, 0700-1900 weekdays, with 4 hours class time at our EMS training center "EMSCEP" to include lectures given by PA's, RN's, RT's, and our medical director. We must also pass a gen knowledge and protocol test, and three scenarios in real time with "Sim Man" in both a living room mock up and a scale ambulance mock up. Two failures and you're let go. For real.

We then return to the academy to join the FF's for FF 1 and 2 training. When we return to the field, we are clear to ride both the medic and an engine as the medic.

All 37 of our stations have engines, and all engines are ALS. We also have a mix of double medic units, dubbed PTU's, or Primary Training Units, and a number of "one and one's. There are currently four BLS buses in service, but the county plans to upgrade to ALS when economically feasible. A medic Lt must be staffed on a PTU at all times, on the 1&1 a FFM or E-tech of 18 months post academy tenure can ride.

Engines are typically dispatched with the medic for all ALS calls. Some houses that have trucks, towers or heavy rescues will send them instead, to keep the engine in service, thus keeping ALS coverage available in the first due. For MVA's, we send a medic unit, an engine, and sometimes a rescue in each direction. fairfax has the "mixing bowl", where I-95, I-495 and I-395 meet. There are inner and outer loops. We frequently get wrong locations, so it's prudent to send units in both directions. The engine is dispatched to offer protection by blocking the incident scene, pulling a bumper line if needed for a car fire, and of course EMS aid. The rescue is for shoring and cut jobs.

The FRD has a monthly required training matrix that includes EMS, company ops, multi unit drills, powerpoint topics, FRD manual reviews, and LODD reviews. Medics are sent on duty to EMSCEP quaterly to attend 8 hour con-ed sessions. We also do JEMS articles and have periodic off duty CME's. I'm taking in an 8 hour class for management of burn pts given by Washington Hospital at the FRD later this month, off duty. Our OMD advocates using the protocols as guidelines, and treating pts by use of best practices.

We work 24's - WOWOWOOOO. We cannot be held past 36 hours total.

Medics start at two steps above a basic FF (a little over 5 grand annualy), receive around 4800/yr in cert pay, $2/hr to ride as the engine medic, and $3/hr to ride the medic unit.

In all fairness, we have had members on the various forums who have been displaced by the FD taking over a county or private EMS system. While many were making decent money or at least adequate, more importantly they were doing something they loved as a profession. They were not forced to get another training cert...until the FD took over. Then, if they were taken in by the FD, they were forced to become FFs. Or, many were already at an age, after 20+ years as Paramedic, where the Fire academy and fighting fires were not viable options. They were out of a job and replaced by 20 y/o FFs with a PDQ medic mill cert to take up the slack. I have seen the happen many times in Florida. The reputation of EMS suffers regardless of who is providing it if experienced personnel is lost and others are forced to do a job that is not viewed as a profession. Many FFs who hold the Paramedic patch do just want the bonus and look forward to the day they can be on an engine or ladder that doesn't respond to medical calls. That is where disservice and deception are done to the public.

That I don't agree with (not you, those tactics). One's livelihood should not be forcefully taken away if they've done nothing wrong. I could see a muni taking over EMS if it's run poorly by the contracted private, but not converting a third service to fire based and THEN requiring EMS to cross train. It has been proven to displace or alienate career EMS, and attract cause FF's to complete a mill to get a hiring edge. If fire based is a good fit, a logical choice for a region, then so be it. If there's no (real) perceived benefit to a FD takeover of EMS, then leave things as they are. At least employ single role medics. That's what Alexandria Fire ans EMS does.

If it were me, I wouldn't put all my eggs in one basket by working EMS for a city or county or whatever for a private contracted by the jurisdiction, not without a lateral transfer option to another jurisdiction also run by that private. They could always stand to lose the contract.

Was that meant as a challenge?

OK here is what I have. I make more as a single role 911 Paramedic with better benefits than any fire fighter single or dual role makes within 500 miles of me. I am involved in the education process and we are able to be focused on what we do. As a result our medical care provided is constantly expanding based on evidence rather than tradition. We stay at a station rather than staging as that system has been shown to be of limited value. If we need help guess what instead of a fire truck showing up we have another ambulance with more Pre-Hospital Medical Professionals.

The fire services I see tend to have limited access to actual medicine and just rely it seems on the diesel bolus therapy.

Which is better? Based on what I have seen non fire based EMS as it allows you to actually focus on practicing Pre-Hospital Medicine rather than just being a taxi driver.

Not a challenge, just stating how things are in reality. The IAFF is good at what they do. Not trying to be a tool.

It would seem that you have a good deal where you are. Good for you. Seriously. From what I've seen, third service EMS tends to be overworked with high call volume (okay if not working over 16 consecutive hours), sometimes due to system status management, low pay, morale, etc. etc. Not saying it's everywhere, just what I've seen.

Thank you all for the good insight based on your experiences.

My experience has been you do Paramedic as a fire fighter then try and get promoted to the recliner umm I mean fire truck and never see an ambulance again.

But I still do not know why if the IAFF thinks they can be dual role Fire EMS, why they say you can not multitask when it wrote the paper opposing requiring fire to be law enforcement. That it will harm the public. Seems very hypocritical.

I make an additional 10 grand in steps and cert pay over a basic FF, and another 5-8 grand in hourly riding pay. That's incentive enough for many of us to stay active as medics.

As far as crossing FF's as LEO's, I haven't paid much attention to that, as it isn't an issue here. For one thing, the public is generally trusting of FF's and EMS. The public is generally wary and standoffish towards LEO's. If FF's are known to also be LEO's, it can create conflict in pt care, or any number of situations where you're helping victims. FF's are also stationed in and are dispatched out of quaters, like EMS is, and LEO's patrol the neighborhood.

If you had a good thing going, you'd put a spin on things to support your position too.

Unfortunately, if you have been following the headlines or the systems in CA and FL, the FD decides it wants to do EMS. The next thing you know they have contracted a medicl mill to get ALL FFs a Paramedic cert as quickly as possible.

It was not always like this and some departments prefer it to never be like this. They want those that do have an interest in being a Paramedic doing the EMS part. Some of the departments that at one time had exceptional reputations for EMS have now had them thrashed with the more is better attitude by making a Paramedic cert preferred for hire and mandatory within one year of hire. Thus, most rush through a cert program and do not get a degree or take any classes that should be prerequisites because there is a time factor to get that job or keep it.

Do you think Collier and Miami-Dade would now be appearing in print with articles concerning their training if the Paramedic cert was considered "education" and not just another training cert. I believe 46young and I had a discussion about that at another place and time.

How ya doin?

Yes, I agree with what you're saying. The majority of the fire service looks at EMS as a specialty rather than a full fledged discipline, or career, as it is for many sigle role EMS providers. I think you or someone else posted a link showing how one dept put students through their own mill, teaching them how to pass the registry and how to work with their protocols only. Sad.

Some depts value legitimate education, proficiency and accountability more than others *cough* DC, Collier Co. *cough*. Kudos to them. The only permanent solution is to advance the minimum education to a degree level, and have FD's hire only with that along with a prior single role work history. Medics that are serious about the EMS side. until then, each dept and each medic will need to be judged on a case by case basis.

I would not expect a physician to also be a plumber, a baker to also be a software designer or a pilot to also be a chef.

To that end, why should we expect firefighters to be paramedics or paramedics to be firefighters?

You send a bunch of firefighters to school for three years to obtain our Bachelor of Health Science (Paramedic) with the requirement they also meet the con-ed req's to be a Firefighter and I bet you none of them graduate.

Firefighters that are put through medic class, be it a medic mill or legit degree program will typically be taken off the road the whole time they're in class. If anything, that actually makes it easier to graduate, not the other way around. Many of us have had to work FT jobs and then some while completing a medic program, myself included. There aren't any formal con-ed reqs per se for FF 1/2, only drills and company evolutions as mandated by each dept. Students would obviosly be waived.

Again, EMS and fire don't have many similarities, but giving FF's EMS responsibilities is efficient use of otherwise copious downtime in many cases. It happens to work well, at least from my personal experiences. As such, any lack of overlap between the two disciplines matters not. It seems to work better in suburban and rural areas as opposed to urban.

If you're using EMS to justify maintaining the current fire staffing, then you won't be able to justify providing enough staff to keep proper staffing for both the EMS and fire calls. So if you have all these fire medics responding to the structure fire, who's going to respond to EMS calls?

We have a dedicated EMS txp division, which basically functions like a third service, staffed by dual role personnel. We also have mutual aid agreements with all other neighboring jurisdictions. Having units tied up, be it on an EMS incident or suppression incident is something that good depts take into account and plan for accordingly. I haven't seen any issues here.

Crap... messed that one up... I meant Kyle Orton... sorry. Seneca Wallace couldn't beat his red-headed step-child.

I agree, but there are no absolutes. There will always be someone that breaks the mold and is able to thrive, and improve no matter what system they are in. Damn curve-busters... I hated them in college.

That's what it's all about, it's up to each individual to strive for excellence. There are good and bad providers no matter where you go. It's difficult to make blanket generalizations.

If I had my way, there would be a requisite year of prior employment as a single role medic, preferably two or three, as a hiring condition.

I didn't mention that there are a good number of FDNY FF's that hold and use their medic cert or RN. They do well in maintaining/improving proficiency. Some did it prior to appointment, some did it while on the job. we're talking about graduates from Hunter College, Nassau CC, Hofstra, ect. Not some medic mill or online RN bridge.I have one friend that completed his PA while working FT at NSLIJ CEMS. He started working FT at Coney Island hosp. (I think) and had to resign to take the FDNY job. He can do PA PT now, and he has plenty of days off (26/72) to complete con-ed.

That reminds me...... how many medics do you know that are completing degrees while working FT, and how many of those are completing degrees that have little to no overlap with EMS? Examples include business admin, accounting, law, forensics, etc. Some also have families that take up a certain amount of time as well. Are they not spreading themselves too thin, like some like to say a FFM does? I didn't think so either. Remember, the FFM is getting con-ed and training through drills on the job for both disciplines, which leaves plenty of time off duty to do more self study if needed.

Of course Fire Paramedics can be "good paramedics." Can they be as good as they "could" be if they didn't have to split their time learning multiple roles? Of course not. But so what? I could be a better EMT if I spent more time than I already do bettering myself with extra education (instead of incessantly creating new and exotic chessecake ideas), but I don't. We all have other things we do in our lives. Just because we don't completely focus on one thing and one thing only, does not mean that we can not become proficient in it.

For instance... Splenac (I'm not picking on you, just using you 'cause you started the thread)... is their anything else that you do with your life? Any hobby or talent that takes you away from your EMS study? Do you think that your devout fanship of your beloved Cowboys (who are going to be upset by Seneca Wallace this week btw) is taking away from your ability to be a better Medic? I think that there is room for both in your life... so why not allow that a person can be good at fire fighting and at paramedicine?

I may not ever become the "best EMT", and I will never become the "best cheesecake maker." But I am pretty darn good at both... and that is enough.

46Young- good posts... but I think that you might have a sticky mouse button or something...

In no way am I endorsing that fire should dominate EMS, and not allow our wings to flap free... just answering the question at hand.

I see your point. I think that those who have prior medic experience before entering the fire service will typically be the strongest, having concentrated solely on the EMS side alone for a period of time. That's what I did.

And here, 46Young, is the root of my gripe with Fire-Based EMS. My chosen profession is NOT a fire specialty. It is a unique and distinct area of HEALTHCARE. Then again, you and I have been round and round on this issue more times than I care to count, so you should know this already.

I see your point. It's just how the fire service sees it. I worked single role for over five years before going over to the "dark side". I believe that 911 paramedicine alone is quite simple to maintain provided you've been educated well prior. IFT medicine, CCEMT-P and flight are a whole other side to the paramedic profession. The medic who can do it all with the requisite knowledge base is truly bada$$, a professionally complete individual. I'm going to get myself to that level at some point. Too many 911 medics fail to understand the lasting effect of their treatment and interventions have on their pt's hospital course and time to discharge. The professional medic should have a solid knowledge base to that end. Many don't nor are they really required to. As such, 911 EMS has been reduced to a "specialty" of the fire service in general, rather than it's own profession. It's up to each dept, and more so each individual to strive to be better than that.

I wouldn't even know of dual role systems if I wasn't driven by greater job security and a lucrative defined benefit retirement than was available otherwise. My choice was due in large part for the desire to provide well for my family. When I took the job, there was a dedicated EMS only track (starting with the first promotion above FF) up to BC. If I felt that fire wasn't truly for me, I planned to branch off to EMS only. Same job, way better benefits and all. The thing is, the promotional track is now "all hazards". Good thing I like fire.

That never made sense to me.

"Kapowie!! Hold on, let me go get my ambulance and make you better now."

Yes, you can be a firefighter and still be a good paramedic. The problem is not having both certifications, although I agree that it's damn near impossible to remain proficient in both disciplines as they're so different. The problem is the fire department-run three month medic mills that teach their medics to interpret whether the machine says the patient is having an MI or not, rather than interpret the 12-lead on their own and focus on skills and training rather than education.

Plus, Fire-Based EMS just leaves a bad taste in my mouth. I just want to stand outside FDNY firehouses with a bullhorn shouting "Let my people go!"

I can see how just doing a medic mill prior to a FFM appointment would make it much harder to main dual role proficiency. Maybe it's because they're not generally proficient in the first place.

My cousins both left FDNY EMS for hosp based due to how the FD screwed everything up.

Sorry about the duplicate posts. It wasn't going through, so I hit the button a few more times. My bad.

There are things that I won't deny. There are FF's that have gone to a medic mill only to get the patch for an easy in. There are firemedics that are apathetic towards EMS, and pt care suffers as a result. There are depts that push their FF's through recerts, sometimes falsifying documents or cheating on tests. There are FD's that have taken over EMS only to justify jobs, and siphon off EMS $$$'s to the fire side at the expense of EMS. There may be a lcak of QI and accountability towards some firemedics at some depts. Some union may have an interest in blocking any advance in EMS education.

These examples aren't indicative of the entire fire service, however.

IMO it isn't difficult to maintain proficiency as both a medic and a FF. A firemedic will be appointed to the position having already completed their medic cert. Bonus points for having several years experience as a single role medic prior. The FFM will also go through a fire academy, followed by a one year probationary period, where their proficiency will be improvrd by regular drilling and testing, as well as real life calls, of course. Medic CME's and drilling are done on duty as well, freeing up the FFM's time to do additinal study and attnd CME's off duty if desired.

SoWhy mix EMS and fire? Theyhave almost nothing to do with each other" The fire service looks at EMS as a specialty, much like Tech Rescue, Hazmat, Water Rescue, etc. Personnel are regularly given sufficient training in that discipline while on duty to ensure proficiency.

Here's why a mixed fire/EMS system works, if run correctly - fire calls are way down. No disputing that. A FD will seek to integrate EMS resulting in dual role personnel to save FF positions, among other things. Some ask why FD's aren't being made to downstaff given the reduction in call volume. Response times. With the new type 5 lightweight construction, it's maybe only 12-15 minutes from ignition to structural collapse. If the 911 call was to initiate immediately (it rarely does), it takes a minute or two to dispatch FD, another minute or so to get on road, maybe 4-6 minutes to get onscene, and another minute or two for the officer to take a lap and pull/charge a line. Now we're at 9-10 minutes on a good day. But this is just the first due engine. What about the rest of the box? what about RIT? Maybe units are stacked. What about if there are FH closings, brownouts, or overnight downstaffing? The first due may not make entry as quickly, and the remainder of the box will be that much more delayed. No first due truck to ladder the building, no second due truck for roof ops, no engine for water supply or RIT, no rescue for primary search/VES. Fireground tactics will be severly hampered by lack of units. Lives will be lost, both FF and civilian alike. Yes, it's a what if scenario, but you don't purchase car insurance after you crash, or life insurance while on your deathbed, do you?

Dual role fire personnel are quite versatile as they can fill either role, which ensures adequate staffing on both sides, reduces holdover, recall, OT in general, thus preventing burnout. Maintaing proficiency in both disciplines isn't nearly as difficult as some would make it out to be, especially with many in station drills (both for EMS and suppression). Having dual role personnel makes the best possible use of a FF's otherwise large amount of downtime. It's logistically and fiscally efficient. The two jobs hold few similarities, but guess what? It happens to work well if run properly. I'm fully capable of getting things done with just me and my partner, like I've done on numerous occasions in NYC 911. However, many hands make light work. Having an extra medic or two onscene (not two dozen, just one or two) and competent BLS make things go much more quickly and smoothly. It may not be financially optimal, but it's best for the pt. It's not always about the bottom line.

There is also a way lower proportion of transient employees when compared to private, third service, and hospital based EMS. The typically lucrative employment package, with a pension, 457, decent medical/disability, DROP, and superior working conditions allow FD's to hire the best possible candidate, not the LCD. Newcomers to the fire service know the importance of EMS, and any FF's that were forced to add EMS to the job description will eventually retire.

With more individuals like the Medical Director from Collier County willing to sack up, accountability for the firemedic will be upheld. With an increase in educational standards (hoping for it, but not holding my breath), new firemedics will be that much more knowledgeable and proficient in EMS.

It's getting late. i'm going to work in the morning, so I'll post about how my dept is run at some later date.

Sorry about the several duplicated posts. It wasn't going through, and I hit the button a few more times. My bad.

Nassau County, NY are mostly covered by a police-based EMS system. One of the better systems in the county IMO.

Beat me to it!

From what I've been told, each bus typically has one EMT-P or EMT-CC, who work 12 hour shifts, and get an hour break during their shift where they can actually turn off the radio.

My understanding is that when a job comes in, the lone medic will drive the bus to the scene, an LEO crosstrained to EMT-B will come to the scene, leave the cruiser there, assist in pt care, and drive the bus to the hosp. If another medic is needed, another ambulance will be dispatched to the incident. The bus will need to return the LEO to their cruiser after the run is completed.

Now, for everyone else.....

The privates just hire any medic with a pulse and a patch, the LCD. Every private system is profit driven only, and their medics are slugs, not serious at all about their jobs, and provide horrible pt care. No one cares at a private because they're either skells or waiting to finish a degree or get picked up off of a civil service list, like FD, PD, sanitation, corrections, etc.

Hospital based medics think they're superior to all others in every way, they steer insured pts to their home hospital, and dump the uninsured off to city run general hospitals.

Third service agencies all use system status management to run their employees into the ground, they all pay lousy, promotions are done only on favoritism, who your drinking buddies are, also hire anyone with a pulse and a patch to replace the frequent burnouts, their employees are only working there because they couldn't hack it or get on at a FD or PD.

Every firemedic went to a 12 week medic mill just to get "the patch" to get an easy in at an FD. As such, all firemedics are apathetic towards EMS, and their pt care sucks. Every FD that takes over EMS siphons off $$$'s to the fire side at the expense of the EMS division. these fire monkeys (hose jockeys, or whatever jealous term used) don't do anything but sit around all day on the taxpayer's dime. What good are they doing?

Got your attention? Good. These are all generalizations about each type of service. They all sound silly when you think about it. There are real life examples for each generalization, but they're certainly not indicative of the industry as a whole.

I've just discovered this thread, I've read the first page, but I dont' feel like reading through 10 total pages at the moment. I'll do so at a later point.

When I worked in NYC (on 46/53/54 Y, 51V, 51W, 52X, 52W), I would at least do enough for the pt in the residence regarding diagnostics/prophylactics ( such as O2, monitor pulse ox, maybe drop a lock) before going to the bus. I'll of course do more at the residence before removal if the situation warrants, such as an APE, MI, tight asthmatic, hypotensive pt to name a few. I rarely walk someone out to the rig, unless it's obvious that they're in no real distress. I have no problem whatsoever carrying someone down umpteen flights of stairs, also moving the equipment with us every few floors if necessary.

When treating in the residence, I figure out in my head how roughly how far away time wise the hospital is, how much I can get done in that time, and I'll generally halt pt care if appropriate at the point where I know that I can achieve the rest enroute to the hosp. Unless you're literally across the street from the hospital, there's really no excuse for not doing what you need to for the pt before delivery.

We're here to stabilize pts, do damage control, POSSIBLY reverse their condition, not just drive them to the hosp. We're not doing definitive care, but we're not merely a car service either.

Now, when I worked for Charleston County EMS, they were all about the scoop and run. My FTO said to me "Hell boy, what are we gonna do for em? Our job is just to take 'em to the hospital, where they can actually do something." WTF?

Finally, here in Fairfax County, many of our units are double medic, along with the engine medic for ALS call types. Most Lt's insist on doing a quick assessment, 12, vitals/O2 for most pt's, then doing everything else indicated in the bus onscene before leaving for the hosp. On several occasions I've had arguments with my medic officer making us stay onscene to get a line before leaving - for a legit trauma! On more than a few occasions I just sit and stare at the pt while we leave for the hosp, maybe assessing for improvements and such, having done everything already.

I can see having the engine medic square you away before departure if you're the lone medic on a one and one, but then again you can take them along for a serious pt and get a lot done while in transit. I'm lucky that the regular officer at my station thinks like I do - txp to the hosp at the earliest opportunity provided everything indicated for the pt will get done.

Having said that, things do go fairly quickly onscene with 2-3 medics and a few BLS getting things done in a rapid fashion. It sounds like a cluster****, but it's not. Everyone knows their role, and things typically go smoothly and rapidly. It works really well here.

Let me ask a question regarding the fire based ems?

Let's say that I'm a firefighter and paramedic working for a fire based ems service. I am hired completely for the ambulance and I never will work as a firefighter.

I spend all my efforts on being a good paramedic and limited time on strictly keeping up my firefighting certs.

Does that automatically make me a bad paramedic or sub-par paramedic just for being a firefighter and a paramedic?

How about you start a thread on the subject? I can offer good discussion on the matter, as can others that are on the other side of the fence. The main problem that I see in the forums are individuals taking a particular FD's shortcomings and extending it to the entire fire service, like it's supposed to be the same everywhere. There are stellar examples of both fire based and third service EMS, as well as debacles of both. We can provide numerous case studies across the country to support either side of the argument, depending on what articles you cherry pick and what spin you put on it.

No matter where you work, it's up to the individual to strive for excellence. I've seen plenty of skells throughout my travels on both sides.

Well, have you met Dust or others here. your description of yourself describes many on this board, and some of those it describes are married so don't count yourself out yet.

The "basic questions about the EMS field" thread has five different muni third service EMS agencies from FL listed. Maybe you could consider moving there after graduating medic class, just for kicks, to be a little adventurous. I moved out at 22, it's not as scary as it would seem, especially with your P- card. As far as your love life, there's plenty of "potential" down there, I'm sure.

Hello, everyone, I'm new to this site. It looks way more promising than other sites I've been to.

A little about myself - 33 y/o, married, one daughter (5) and one on the way (girl), currently employed as a firemedic in Northern Va. I got my start in EMS at Hunter Ambulance-Ambulette inc. an IFT company in Inwood Queens per diem, for around 6 months. Next, I was a EMT-B for three years FT at the NSLIJ CEMS, a combo nyc 911/IFT agency, hospital based. After that, I worked for two years as a medic for the CEMS concurrently with a stint as a medic at the Flushing/Jamaica/Brookdale hosp system. I secured my NREMT-P and then relocated to Charleston SC and worked as a medic for their county run third service 911. Finally, I was hired as a firemedic at Fairfax County FRD, and have been here for the past year and a half.

My career development goals include moving up in rank at the FRD as an All-Hazards officer, maybe up to Capt II. I would also like to get into EMS education here, as I would like to ensure that educational standards and proficiency are continually improved at the FRD. I'm also debating going for either RT or RN. The FRD is very pro education, weighs it heavily for promotions, and will allow me to use leave to attend class on work days if needed. If I go RN, I may seek to do flight on the side, either as a medic or RN, whichever results in a job offer.

I hope to contribute positively to the site, as well as improve my proficiency as a medic. I believe strongly in fire based EMS (only if run well, for the right reasons), and having secure employment with a defined benefit (pension), good working conditions, unionization, and a livable wage. The main motivating factor for going to the fire side was for those reasons. I've found, luckily, that I enjoy fire almost as much as EMS, maybe 60% for EMS, and 40% for fire.

I have respect, in general, for the employees of all versions of single role EMS agencies, to include volunteer. The problem arises when the fire bashing starts, and also when individuals preach how EMS in general doesn't deserve a livable wage or any decent benefits. I think that, even though educational standards may be low at the moment, that doesn't excuse employers from paying us welfare wages. Hence my pro union, or at least pro political organization stance, to protect the little guy (and gal), and give them a fair shake when dealing with management. Any problems I have with private or third service EMS are generally not with the employees, but rather how they're run, and how poorly the employees may be treated.

I know that this post has been long winded, but I just want everyone to know where I'm coming from when posting. Thanks for viewing.