Rig staffed with Medic and EMT

[gaelicfirefighter]

...and there is the argument used to put EMTs on fire engines and FFs on ambulances. I respect FFs to no end, but it irks me when management tries to fit the round peg in the square hole to make their bottom line look better. FFs want to fight fires, EMTs want to treat patients. I cannot think of two more completely opposite professions to try and integrate.

My apologies for the thread derailment. I really tried....I swear....

We have paramedics on ALS engines and trucks as well and no ff's on ALS ambulances. We have emt's on BLS ambulances.

If people stay with your integration thought, they will be left out in the cold with skills no one wants. There must be a reason evey major city is looking for cross-trained personnel.

I can olnly comment on what I see at work and not what is commented on in here. I believe the EMS and FS&R is slowly merging into one body that can get along and can act as one. Old school firefighters do not like medical runs. We all know this. Not all, as that would be categorizing everyone the same, and I do not do this. But if you asked 100 old school firefighters, 90 would probably say they were hired to fight fires and not chase ambulances.

With the realization that over 75% of our calls are medical, many agencies, including Chicago have gone to dual role firefighters. Most, if not all, suburbs around here only hire firefighter medics. These individuals work both ambo and fire apparatus. Chicago's last test (2006) was for the position of firefighter/emt-b. These people must keep their emt license for the duration of their employment. Classes prior to this could drop after a two year period following initial employment. Before I leave this department I guarantee you that this will become only ff/medic positions.

Saying this, I feel people hired by the city of Chicago over the last couple of years accept the fact that most of the calls are EMS and these people take medical training as serious as fire training. The new staff is a more well rounded bunch and will have better training than those hired off old lists. They are more educated and therefore more valuable to the city and to its citizens. It doesnt matter what we think. Te people want a rig to show up and help them with any and all emergencies that arise. We are RESCUE. Fire or ems.

I feel this attitude will create harmony in the ems and fs&r fields as we will all be closer to being the same, rather than being considered two totally different disciplines as we seem to be now. Single role medics and single role firefighters will be a think of the past here in the city and in major urban areas like chicago and surrounding communities. Private service and rural areas, I am not so sure how this will go.

There were no real medics prior to the Korean War. Since then, the ems field has exploded and changed. There will be great changes in the future as well. If you are a student or young paramedic you should take ff clases and get your certs. If you want to be a ff, you should go to medic school as well. Become more marketable and more valuable.

These are just my thoughts, Take em or leave em.

[p3medic]

Why not do law enforcement too? A sick CHF patient, a structure fire and a bank robbery are all completely different jobs. The reason fire departments want to do EMS is for the sake of fire fighter jobs, nothing more. Cities like New York and Chicago wanted nothing to do with ems 30 years ago, its been in the past decade or so with the steady decline of fires and a bloated budget and workforce that cities across the nation began gobbling up third service and private ems agencies as a job saving tool, nothing more. The IAFF have made it their mission to take over ALL EMS across the nation. I respect your passion for EMS, and that of your fellow dedicated dual role medics, but the two jobs should be totally seperate IMHO.

[jsadin]

There must be a reason evey major city is looking for cross-trained personnel.

Yeah, a better looking bottom line. As I stated before, I respect FF's for what they do and most of them take firefighting very seriously and do it well. When my local chief asked me to become a FF I looked him straight in the eye and said "I don't believe I can do both EMS and firefighting while giving each the dedication they deserve". I spend mucho time every day just learning more and keeping current with EMS related info...I can't imagine having to do the same with fire science on top of that. Once I have my medic (I'm at the intermediate level now), that will be even more true.

On a side note, since 90% of the calls are EMS related, shouldn't dual-role folks be called medic/ff's, not the other way around?

[Asysin2leads]

Gaelic, right now I'm in a position where I am really pissed off at the whole firefighter/medic thing. I'll be okay in a few days about it but right now I am pissed off beyond words.

Here's my position. For the past 10 years I have basically eaten and slept EMS. I have an associates degree in it. I have worked in one of the busiest systems in the country. I have several commendations and not a single complaint. I've decided its time I relocate. So with all of that you'd think, hey, this is an attractive candidate for a 911 position, right?

Wrong. Instead, if I want to do the job I have been doing, I have to go through and be lumped in with every single tobacco drooling moron who wants to be teh fireman. I have no problem with firefighting. I enjoy it. I don't mind getting back in shape. But I do resent the fuck out of having to go through entry level fireman bullshit just to do the job I've been doing for a couple years now. I

Asys is angry. Very angry. Angry at somehow scoring very lowly on an entry fire exam. Angry because being able to differentiate between fine v-fib and asystole, in the weird, wacky world of fire/medic, means less than if you can respond appropriately when someone puts their socks in the laundry before you or how to stop the argument over macaroni and cheese. I am angry.

[mstovall]

I work for a service that has a run volume of about 12,000-13,000 clals per year. We are the 911 service provider, yet we are a third party contractor. We run alomost PB trucks. Here are the good things I see about it:

1)The EMT-B is able to get things set up and handle the BLS skills. You be come great at you ABC's.

2)As a PB team you can fill in the scheldule easier as we have a shortage of paramedics in our area.

3)The paramedic is left with the ALS parts of treatment while the basic handles the immediate life threats.

Remember we are all EMT's first. We should thus be giving the BLS treatment first. If you don't control the basics, how can you move to your ALS skills. ALS is to handle situations that call for more than a BLS approach, but require a time period to set things up. Sure the person not breathing on the bed may need to be tubed, but what about opening the airway first and maybe try a breath or two while someone is getting the airway kit out. What about a few chest compressions prior to shocking an individual, it takes a while to get the leads on anyway.

The one thing that medic school has taught me is how to be a better EMT-B first. While the additional skills help me take better care of a patient, we should all start with our basic skills.

I have ridden on some PP trucks and I see a different attitude. There seems to always be the one to be more assertive on every scene. PB trucks are more role oriented. In our town, the B takes some vitals, takes care of transport (getting them to the truck), helps get history from the family/by-standers, and is not afraid to jump in and strat working the ABC's on really bad calls.

I think the mixture would be great if the B's chose to hone their skills and care for the patient. If it was allowed to become a issue of "I get more pay than you" then you will self implode.

Dusty, I have become a better care giver by practicing in the truck. However, I do agree that my education made me better prepared to give care. Until you get some true emergency back ground under your belt, it is hard to see the big picture. The 12 leads in the field are always a lot noisier than those in the text book. That is what is so great about exceptional preceptors. They take the book knowledge and tie the big picture together. If an individual has only worked granny shuffles started riding a emergency truck, they would then get to finally see how emergency medicine is applied on a daily basis. This is a good idea for every medic student. I don't believe every potential medic student should be on a truck prior to medic school, but I do think it is good to understand the pressures and demands at some point in your schooling.

JMHO,

Michael

[JPINFV]

Remember we are all EMT's first. We should thus be giving the BLS treatment first.

...

While the additional skills help me take better care of a patient, we should all start with our basic skills.

Since the board has been over the "BLS before ALS" nonsense ad infinitum before, enjoy this clip of Dr. Cox.

The treatment you should start with is the most relevant treatment without regard to if that treatment is "ALS" or "BLS." If an paramedic level treatment is the most important, then you should be focusing on providing that treatment, not waiting to see if a basic level treatment works.

Now, yes, numerous treatments start off with basic level skills (e.g. preoxygenation), but you start off with doing the "basic" stuff not because "everyone's an EMT-B first," but because it's appropriate patient care. On a witnessed VF/VT arrest, do paramedics start CPR first (basic skill) or just jump straight to manual defibrillation (medic skill)?

[Asysin2leads]

Asys angry. Asys in process of cleaning out apartment. Asys find old flash cards, stacks and stacks of, and notebooks, stacks and stacks of, meticulously filled out and filed, from paramedic class. Asys reminded of labor of paramedic class. Asys eat bad EMT's saying BLS before ALS now. Asys angry and hungry.

[Scaramedic]

Remember we are all EMT's first. We should thus be giving the BLS treatment first.

Actually we should be using an education based differential diagnosis first.

The one thing that medic school has taught me is how to be a better EMT-B first. While the additional skills help me take better care of a patient, we should all start with our basic skills.

It's not about 'skills' a monkey can start an IV but he cannot understand why he started the IV. How many times have I had to say that on this forum so far?

I have ridden on some PP trucks and I see a different attitude. There seems to always be the one to be more assertive on every scene.

P/P units are kind of like lesbian couples. There is always the butch and then there is her bitch.

PB trucks are more role oriented. In our town, the B takes some vitals, takes care of transport (getting them to the truck), helps get history from the family/by-standers, and is not afraid to jump in and start working the ABC's on really bad calls.

:roll:

[Dustdevil]

PB trucks are more role oriented. In our town, the B takes some vitals, takes care of transport (getting them to the truck), helps get history from the family/by-standers, and is not afraid to jump in and start working the ABC's on really bad calls.

Problem is, until you are that P, your ability to comprehend the fallacy of your view is limited. While a B (at least a really GOOD B, which is rare) is indeed capable of doing those things you mention, unfortunately, that is all he is capable of doing. His utility -- like your perspective -- is extremely limited.

So, I have a choice between a B partner who can take vital signs for me, bandage, splint, and apply oxygen, all upon my direction, or a P partner who can actually share the total workload with me, as well as share in the assessment and making decision making. Is that really a serious choice to anybody? Is there any intelligent, educated medic who is secure in his competency that would not rather have a PARTNER than a mere helper?

The bottom line is, a B is not a partner. He's just a helper. He brings nothing but braun (if I'm lucky) to the scenario. A P is a partner who brings everything the B brings, plus infinitely more. It's like the difference between a Porsche and a Yugo. It's not a serious choice. It's a moot point. And anybody who debates that looks every bit as silly as somebody who continues to point out the virtues of the Yugo.

[mshow00]

One last question from me on this topic: Would you rather have a fully trained moronic Paramedic partner or a knowledgeable albeit limited in skills EMT?