rescue25

An ALS ambulance is always simultaneously dispatched along with the engine. It's just that the engine has a higher chance of being closer to the call. As I said before, I hope this practice dwindles with the increase in the number of ALS ambulances in the county, but this is the way it's done now. Probably because it helps justify the fire department's budget. Not saying I think it's all that efficient or the best way to do things, but I don't think this setup is terribly uncommon, either.

I will read that tonight, thanks. Also, I completely agree, but unfortunately I have no sway over the fire department and the county's thinking on the issue. I know that recruitment has been an issue... fire just can't seem to keep ALS providers. Either the pay is too low, or FF's don't want to run EMS and paramedics don't want to fight fires. The cross-training does scare off a lot of folks, myself included. But try telling the FD that... What would also help is a better dispatch system. The majority of the calls dispatched as ALS/Code 3 (priority 1) could easily be handled by a BLS crew and without a hot response. Talk about a dilution of resources... but that's an issue for another thread.

The fire department here started first responding on calls with their engines in the late 80s. At the time, EMS was entirely volunteer. Beginning about 7 years ago, fire started adding ALS ambulances to some of their stations. Part of the problem was that the call volume had increased such that the volunteer squads couldn't cover all of the calls for service. Instead of pursuing a 3rd service or other model, the county decided that it would be easier to roll it into fire since they were already somewhat involved in EMS anyway. Of course, a lot of the reasoning behind that is as described above: fire calls (particularly "real" calls for working fires) were and are way down, so the department has to have some reason for their rather handsome budget. The saddest part is that many of the firefighters I've talked to who got their ALS certs and ride the ambulance don't really want to be doing EMS. They'd rather fight fires, but becoming an EMT-I or paramedic and doing "rig duty" is the only way they can get a raise and move up. Forget management if you're not ALS - the department requires it to become a battalion chief or higher. I know that I would certainly apply for a paid EMS position - and even go back to school to get my NREMT-P cert - if I could do so without having to become a firefighter in this county. As Ridryder said, there's just no real correlation between the two careers.

Because every fire station has an engine, which is composed entirely of FF/EMT-Bs. Therefore, the theory is that they can get on scene more quickly than the paid fire ALS (or volunteer ALS) unit that is responding with them, because not every fire station has an ambulance. It's the first responder concept, and that's why I was asking about how the vollie first responders work in Rid's system, because it probably wouldn't make much sense here, given the system we have right now. But it's an interesting "compromise" so to speak should we ever not have the first due engine responding on EMS calls.

I just want to say, too, that I find it unfortunate that there are a lot of people here that are equating volunteer with: All I can say is that none of these are the case with the volunteer system in my area. We staff a station 24/7 and make it to the vast majority of calls in our first due in under 8 minutes, we don't respond from home (unless it's a truly rare circumstance/MCI/etc. that requires a large number of providers), and we stay busy and have regular training opportunities, so skill retention isn't that much of an issue. I know there are plenty of agencies out there that resemble the bullet points, but let's not paint with such a large brush? That said, I agree that volunteer agencies will slowly die off. And I agree that there are probably many areas of the country that would benefit from a full time, paid EMS service -- and they're not getting it largely due to tradition and a good 'ole boy network of self-important volunteers.

Can you describe how this works in your system? In my county, all fire personnel are EMT-B as a minimum, and the engines first respond to all ALS/priority calls. So I'm not sure there would be much use for volunteer first responders here. But it is an interesting idea.

You couldn't get me to live in Northern Virginia if you tried.

I really hate to continue talking about my own county, because I realize our experience may not be representative and it's a bit of a tangent, but that said: Many of the volunteers here are also paid healthcare providers, either in private transport services, other paid fire departments, or nurses. But they volunteer too; maybe there's something in the water down here and we're all crazy. In the end, though, the vollies aren't much of a threat to the paid guys at this point. I predict we'll be essentially gone in this county, for better or worse, in the next 5-10 years. The county administrators are well aware of their volunteer network, since it's been a strong tradition here for almost half a century. They support us, but times are changing and eventually it will be 100% paid. Such is life. At least being involved in EMS has hooked me into pursuing a career in healthcare. If I still have an opportunity to volunteer after getting my RN, I probably will. I, too, understand your point, and don't want to take away anyone's paycheck. I guess my overall point is that the fire department has been reluctant to provide the appropriate incentives to recruit and retain paid ALS providers while at the same time trying to get rid of the volunteer system. Here at least, it's never been so much an issue of "well, the volunteers will do it for free, let's pay our guys s**t." The FD would prefer that EMS was all paid and still pay their providers s**t. The net result is that we lose providers... and with no backup in place... there won't be enough trucks to answer the calls. If the FD would provide incentives for their FFs to get or retain their ALS certs and ride the ambulance, it would be less of a problem. I appreciate the conversation but I've been long-winded enough for one night! (Oh, and I never claimed we were self-sufficient! In fact, I made a point that the volunteer squads can't, by themselves, address the call volume we currently experience. We need the paid guys, without a doubt.)

You're certainly right about that: we've got 3 Autopulses and a gaggle of providers at every cardiac arrest, <10 minutes out to any hospital. I wish we could donate them to an underfunded agency in an outlying county who would definitely benefit from having them, but we all know that isn't gonna happen.

I guess I must have deleted it when I was editing my post for speeeling errors. :?

For some reason the paragraph you quoted is gone from my post? At least I'm not dreaming, I was sure I wrote about that. Anyway... Obviously the scenario I'm presenting is very localized and isn't necessarily applicable to the larger universe of EMS, but just some follow up points to your reply: 250 volunteers, but that's what we have. For reference, our squad runs about 7,000 calls per year. The county as a whole answers about 45,000 EMS calls per year. The fire department's budget is $37 million. It costs the county little to nothing to have the volunteers in the system, which leads me to... [*]I'm not sure what you mean about reimbursement for keeping up certs; the county doesn't subsidize the volunteer squads at all. We operate entirely on donations from the community. We don't get a thing from the county (personally or the squad as a whole) [*]Actually, the fire department administration has been fairly persistent in trying to kill off the volunteer squads. As I said, we've built good relations with the individual paid professionals, but the administration is a somewhat different story. [*]911 EMS in my county is "free" to the end user (the fire department medics are paid through property taxes, the volunteers get nothing aside from donations). I personally think this isn't the best system... without any sort of supplemental revenue recovery, you're solely charging county residents for a service that a huge number of non-residents use. While I certainly respect your opinion, I also feel that fixating on volunteers as the source of all problems in EMS is missing the point a bit. Volunteer agencies that hold the profession back by crying foul whenever someone brings up higher standards for EMT education ARE part of the problem, but this certainly doesn't represent every service's goals or interests.

My agency has several, and I actually just used it today on a patient. My opinion on the Autopulse is mixed. One one hand, it is very helpful considering it frees up a provider to do something else. And of course you don't have to worry about getting tired doing chest compressions. On the other hand, it's pretty bulky and can be more trouble than its worth if you don't have much room to work. We've also had a few quality control issues... in one instance, a plastic piece on the compression band snapped off WHILE the AP was doing compressions on a pt. It flew into the air and almost took out an eye on one of our providers. :shock: Needless to say we had to switch to good old fashioned CPR at that point. So basically, I think they're useful but considering the price... I don't know that I would necessarily recommend buying them, unless you have extremely long txp times to the hospital (which we don't; there are 3 hospitals within 5 minutes drive time, going code 3, and several more within 10 minutes).

Let me start off by saying that I'm currently a volunteer EMT-B. My county's EMS system consists of fire department medics as well as 3 independent vollie rescue squads that provide ALS 24/7/365. Up until about 6 years ago, the county (which is suburban and has a population of nearly a quarter million) was entirely dependent on volunteers for 911 transport. The paid FD first responded, but they didn't have any ambulances or ALS providers of their own. Up until recently, this system worked well -- but then the call volume exploded. Now we're a combination system. As much as I hate to admit it, I realize that there is no way an entirely volunteer system could carry the entire EMS workload these days. Recruitment and retention are, generally speaking, down. Not sharply, but it is noticeable. So I appreciate the fact that we have paid personnel working with us. We've worked hard to establish a good rapport with the career FD/EMS folks. I feel that some of y'all are being too harsh on volunteers in general. There are certainly valid points raised here, and some areas are far worse than others, but I don't think volunteer EMS - at least in my area - is the death of this profession. Speaking for my squad only, we spend a great deal of time training, taking CE classes, upgrading our certs, etc. We have to be on par with our career colleagues. It ain't a choice here. A relatively high call volume allows us to keep our skills fresh, though. I can see how it would be a problem in rural areas with a low call volume, but unfortunately skill decay wouldn't be confined to vollies in this situation. Volunteers have to face reality that change is coming - some will be good and some will be painful. Some will be good AND painful. But that's just how it goes. All I'm saying is, there's generally no need to throw the baby out with the bathwater. There will always be bumps in the road, but vollie can work alongside career if everyone works together. Also -- I don't know how rural volunteer EMS tends to work, but we don't respond from home, by POV, or get to pick and choose which calls we take. We play by the rules of the career system here, or we get shut down. Which is how it should be. In my opinion, if you want to improve this profession, I say lobby for higher standards for EMT education and training. Speak out to get a paramedicine bachelor's degree, like nursing. If some volunteers bitch because they can't keep up, well, that's too bad. Feel free to disagree with me, but that's the only way I see EMS gaining more respect.