Thoughts on two-tier EMS systems?

[chute]

Does your city use two tier EMS systems and what do you think about it? I have worked systems that have Fire respond for manpower, car crashes and to assist EMS and I have worked with two-tier systems where an ambulance responds with Fire (city or county depending on where the call is) and Fire has ultimate scene command. My experience is two tier systems are more challenging (too many cooks in the kitchen many times) and lots of unnecessary scene time and conflict. Two examples are Las Vegas NV and Albuquerque NM.

[Christopher.Collins]

I have never had a problem as far as working along side fire (as EMS) and visa verca. Fortunatley most agencies around here are either joint under fire or people belong to both the fire and ambulance service. So working together rarley becomes jurisdictional or political.

In most cases fire is the first responder to all calls. In nearby Westerly, RI however the ambulance corps has the rescue unit and fire generally only responds to fires.

Of course nothings perfect. Theres always at the very minimum, ball busting twords people partial to one or the other type service.

[Richard B the EMT]

I say again the New York City is a rule and law unto itself.

Depending on the call type, a CFR-D (certified first responder-defibrillator) engine company, a BLS ambulance, an ALS ambulance, or combinations of the three will respond.

Our call types are prioritized in advance, for call type "A", CFR-D Engine with BLS ambulance, "B" gets BLS/ALS response, "C" gets ALS only, "D" gets BLS only, and "E" gets the "Triple" of CFR-D/BLS/ALS.

The FDNY EMS EMD has 50+ call types, with, for example, "ARREST", for a cardiac arrest being a Priority 1, an "EDP" (emotionally disturbed person) a Priority 7, and, for administrative purposes, an ambulance "down" (out of service) for mechanical/electrical/flat tire reasons is a Priority 9.

[Derek]

Most of the municipal FDs in my area have a Paramedic-Firefighters exclusively. I actually checked on this thinking I would like to get into my local department but was told they don't hire standalone EMTs. Where you will find that sort of thing is in Hospital-based or some of the county departments have the two-tiered system.

I will probably be looking outside the state for two-tier since I would love to work EMS for a major city dept. but would rather not be a firefighter (not that there's anything wrong with that).

[parapupp63727]

I have worked in two-tier systems. The first of the systems ran a BLS 1st Responder/Rescue Truck. It was easy to deal with cuz the person on the rescue truck was always an EMT. The ALS unit of course had a medic so issues of scene control were nill.

now I live in a system that has BLS and ALS engines from a few different fire depts and scene control can be a bugger!! But I have a good rapport with the fire medics so it hasnt really been an issue for me.

[JTpaintball70]

My experience is being the third tier so to speak on a few MVAs here in ABQ. My company does interfacility and backup 911, so we don't work too often with AFD or AAS, so being first on an MVA always causes some interesting time

[CBEMT]

It may just be a matter of semantics, but I was under the impression that a "two-tier" system was ALS and BLS ambulances, and a "First Responder" system had, for example, Fire preceding the ambulance (a rule that Fire typically puts in place to artificially extend EMS response times while shortening their own).

[parapupp63727]

It may just be a matter of semantics, but I was under the impression that a "two-tier" system was ALS and BLS ambulances, and a "First Responder" system had, for example, Fire preceding the ambulance (a rule that Fire typically puts in place to artificially extend EMS response times while shortening their own).

Well you are kinda right but the problem that was being made is basically scene control. If you have a two tiered response system that is owned or operated by the same entity it is easy to set up an ICS system or a scene control cuz you know who is in charge from the outset. But the problem arises when say you have an ALS ambualnce on scene, an ALS engine company on scene and a rescue truck that is also ALS. That's 3 different paramedics from three different agencies and all jockeying for control of the scene. It can be an absolute MESS!!!! The one thing we all agree on is the cops are there for traffic control lol!!!

[CBEMT]

But the problem arises when say you have an ALS ambualnce on scene, an ALS engine company on scene and a rescue truck that is also ALS. That's 3 different paramedics from three different agencies and all jockeying for control of the scene. It can be an absolute MESS!!!!

Just three? Most places in California that have that system you'd be seeing a half-dozen paramedics on that scene. :roll:

[JTpaintball70]

Depending on how call out's get done here you can have the following:

2 medics on an AFD rescue

1 medic on AAS truck

1 medic on ALS Engine

1 medic on BCFD rescue

possibly 1 medic from my company on scene.

Maybe more if oyu just get that crazy and have a flight crew, then 1 CFP and CFRN