FD Launches In-House Paramedic Education Program

[MemphisE34a]

We already have people waiting ridiculous amounts of time for an ambulance because EMS funds were instead spent on fire trucks. Considering that very, very few people ever actually need a fire truck in their entire lifetime, I'm thinking the odds of your scenario are a lot less likely than what we have now. And let's not forget how much faster those trucks could get to fires now if they weren't so often tied up on EMS runs they have no business on. The statistics are against you on this argument. The IAFF would do well to hire a mathematician or two.

Sorry I didn't respond earlier, had a doctors appointment. At any rate, we are much closer to being on the same page than you think. Your earlier post above echoes NEARLY all of my sentiments, but you don't have me completely figured out or the reasons for feeling that way.

I have all along stated that I am pro-fire, but that doesn't make me against any of you because you choose not to be or because you are pro-EMS. You are correct, I would be absolutely fine with the ambulances being a 3rd party service and all of our paramedics were left to ride fire apparatus all of the time. I cannot speak for any of them. Some would be for it and some would not. That only seems like natural progression. Riding an ambulance here is like getting a swift kick in the balls on a regular basis. Why do you consider it wrong to be paramedic and not ride the ambulance? Do you also wish that fire had no EMT's? I will say that the county here uses that system and it doesn't seem to work nearly as well, but hey if making $10/hr. sitting at the Circle K or behind the station in the ambulance waiting for your next call is progress, so be it.

I also conquer with the needless response of fire equipment on EMS calls. I never mind going when there are situations where we can make a difference, but that is about 15% of the time. That would play interesting into the statistics for everyone always saying that runs are 80% EMS. Lets take out the 85% that are pure BS that fire or EMS for that matter, really don't need to be making.

As far as never needing a fire truck in your lifetime, depends where you live and on the situation. I work in a very deprived, urban environment. Additionally, sometimes you need a fire truck even on that occasional EMS run. Its all relative.

[spenac]

So did we solve the problem yet?

[CBEMT]

Why do you consider it wrong to be paramedic and not ride the ambulance?

I thought we'd made this clear- it's because the paramedics on fire companies will never have the technical proficiency that those on the ambulance do. The more medics in a system, the worse off each of them are, AND the patients. It's been proven again and again.

Let me ask you this. Since EMS is 80-85% of your call volume (I would imagine, following the national trend), why is EMS not 80-85% of your training time, 80-85% of your funding, your apparatus.... Get where I'm going?

We know why. Because it's not what you (and your colleagues) want to do. You want to fight fires. And that's fine! There's nothing wrong with it, and I think you should be able to do that.

I just think your patients deserve care from someone who WANTS to do EMS. Lives it, breaths it. Not somebody who thinks it's "a kick in the balls on a daily basis."

[MemphisE34a]

[defib_wizard]

You do of coarse realize that Johnny Gage and Roy Desoto never rode the ambulance.....right?

Yes and back then Bicarb was given in all codes and they carried enough syrup of ipecac to make a fraternity kegger party jealous.

This was also in the 1970s I do hope you have continued your education beyond those ideals.

Here's the deal Lt (its time for a reality check ) You are a firefighter and proud to be one. That is fine and I commend you on that. I was a certified firefighter but decided I didn't like it. I believe in being able to think for myself and not worry what the chief might think. I also found that I love taking care of people more than polishing paint and spraying water.

We are not going to agree on this at all. You have said over and over that we don't live there so we don't know. Your right I don't live there and because of you I wont visit there either.

You seem to be intelligent so I'm going to try this approach to you. Why not staff more ambulances with more full-time paramedics. Staff the engines with an engineer and bls personnel. They don't leave the station unless they are needed. That equals less wear and tear and operating costs. You said yourself that ems was 75-80% of your calls why not invest in it with more ambulances and more paramedics. Hey you can even use them on the fire scenes if they want to become firefighters. If not they can be your rehab and treatment sector.

If you were to hire already certified paramedics you could save all the money from the class your sponsoring and buy a few more fully stocked ambulances. Then send the ones through your academy that want to go. ( Yes I know I'm repeating myself here but you don't seem to get it ! )

[spenac]

Hey don't forget to go to the 2 sites on page 1 and voice your concerns. Of course they will probably get deleted there like mine did. I was even nice and polite but because I expressed an anti- Fire message mine were deleted.

In fact here they are to make it easier:

http://www.emsresponder.com/article/articl...p;siteSection=1

http://www.commercialappeal.com/news/2008/...ass-in-session/

[MemphisE34a]

You seem to be intelligent so I'm going to try this approach to you. Why not staff more ambulances with more full-time paramedics. Staff the engines with an engineer and bls personnel. They don't leave the station unless they are needed. That equals less wear and tear and operating costs. You said yourself that ems was 75-80% of your calls why not invest in it with more ambulances and more paramedics. Hey you can even use them on the fire scenes if they want to become firefighters. If not they can be your rehab and treatment sector.

If you were to hire already certified paramedics you could save all the money from the class your sponsoring and buy a few more fully stocked ambulances. Then send the ones through your academy that want to go. ( Yes I know I'm repeating myself here but you don't seem to get it ! )

First of all, its funny that out of my entire post you only quote the part where I was obviously being sarcastic. Secondly, most of the stuff you are mentioning that I quoted above is being done, except some companies offer a higher level of service. There are 88 fire companies in the city. Of these, 34 are capable of being ALS, the other 54 are BLS. Fire companies are dispatched on a fairly accurate EMD system. Even though city wide EMS calls are like everywhere else, 75%-80% of the total call volume, my engine which is one of the busiest companies in the city maintains about a 50-50 ratio. We do not make every medical call in our area.

The paramedic compliment has been dramatically increased over the last couple of years and more are being hired on a steady basis. Additionally, all new hires are required to become paramedics.

Ambulances are dispatched on all working fires. Larger scenes will automatically get two: one to set up medical and one to be ready to transport.

Last year, we bought 16 new fully stocked ambulances. There are currently 8 new fully stocked units at our shop waiting to be put in service. Our entire fleet is replaced about every 3 years. Can your service say that?

Lastly, the Fire Administration has lobbied and convinced the city council to include placing a new ambulance in service every time a new fire station is built whether it be an additional station or one built to replace an existing one.

Is it the very best plan? Probably not, but I think they have done pretty good do be a bunch of fireman who don't care about EMS........right?

[p3medic]

MFD has done a good job in ensuring fire department jobs, not providing the best delivery of emergency medical services in my opinion. One of the problems is requiring every new hire to be a paramedic. Think about it, you are a kid who grew up dreaming of being a Memphis firefighter. Now, to live the dream you have to go to Paramedic school. Well, putting out fires and providing advanced medical care in the streets are two entirely different jobs. The kid who wants to fight fires is now required to learn medicine too. Remember the subjects in school you disliked? You did enough to pass, but nothing more. The same can be said for the firefighter "required" to learn paramedicine in order to secure his dream job. He will learn enough to pass, will provide care as required hating every minute of it, and do his best to "promote" to suppression and get away from the ambulance. Your best and brightest medics will also advance in rank, and leave the medicine to the new kids, the ones who don't want to do it, and have minimal experience. You will never have a core of well educated, experienced paramedics in this system.

I realize there will be exceptions. Some of your firefighters will enjoy the medical calls, and excell, however I'm afraid to majority will flee the ambulance as soon as allowed.

[VentMedic]

It was still puzzling as to why Memphis FD had a difficult time hiring people when other FDs have kids starting to put their names in the hat in 10th grade for a department. Most FDs have an abundance of applications that they must weed through. Miami has a surplus of 6000 applications with the majority of them having Paramedic since it is recognized as a plus. The same with other departments that now only look at applications with the Paramedic box checked. So, I asked the question on a couple of FF forums and got the document linked below. Apparently MFD has had its share of problems with the EMS part being a step child but I think most of us had figured that out by the MemphisE34a's attitude. The new equipment he just spouted off probably came out of this study in 2005 and not out of the kind, caring attitude of the Fire Administration towards EMS.

Memphis Fire Department

An Assessment of the

Emergency Medical Service System

http://www.cityofmemphis.org/pdf_forms/assessmentOfEMSS.pdf

(Pages 3,4,5 of the document are a list of 38 major recommendations that were made for this FD)

Unfortunately, certain components of the Memphis Fire Department EMS system have

suffered from neglect or inattention for years. It is our belief that the reason EMS has

been allowed to deteriorate is because of administrative and cultural views that EMS

was not as vital or as important as fire suppression.

In order to address the challenges and the opportunities that will be brought forth in this

document, a top-to-bottom cultural attitude change toward EMS needs to take place

within the fire department.

Key to this top-to-bottom cultural attitude change begins with the Director. The Director

of the fire department will set the tone for how EMS is viewed now and into the future.

Breaking down a culture that has existed for decades requires strong leadership from

the Director. This new attitude should be reflected through the ranks, all the way down

to the fire fighter position. The cross-training of paramedics as fire fighters has helped

to move this process forward, but there is still much to accomplish.

Unfortunately, prior to the appointment of the current Director, as a result of the neglect

and inattention of certain components of the EMS system, there has been deterioration

in operational, training, and administrative effectiveness. This decline is evident with the

number of lawsuits that is currently in litigation against the Memphis Fire Department for

standard of care issues. There are currently four major lawsuits. Three out of the four

lawsuits involve the death of a patient.

Since FDs departments fall within a state immunity clause, these lawsuits had to be the result of gross negligence for them to occur.

There is no defined management structure in place for EMS operations in Memphis.

Through attrition since 1998, the EMS management structure has virtually been

eliminated to the present-day system where there is no true EMS management structure

in place to deal with the day-to-day operations of emergency medical service.

EMS is currently under the direction of the Deputy Chief of Emergency Operations. The

highest ranking EMS officer is a battalion chief who serves as the Quality Improvement

Coordinator. As a result of being the highest ranking EMS officer, he has been thrust

into many roles that should traditionally be handled by other management positions.

There is no field supervision of individuals performing medical care in the field. As a

result, processes that should be in place to provide in-field direction and/or identify

individuals who are deficient in the performance of their medical care are not in place.

Additional positions should also be developed and structured to support the

management of the EMS Bureau. These positions include field supervision on all three

shifts. Following the principles of “Unity of Command” and “Span of Control,” there

should be a total of 5-6 field supervisors on each shift for the 31 medic units. These field

supervisors should hold the rank of Lieutenant and be given all authority and power

commensurate with the rank of Lieutenant. Additionally, these individuals should be

licensed paramedics.

MemphisE34a is not but still supervises the busiest station for EMS.

The quality assurance program for the Memphis Fire Department is limited in nature.

Three fire fighter/paramedics and a quality improvement coordinator are assigned to this

section. Unfortunately, these four individuals fulfill many other roles because of a lack of

management structure and a lack of individuals dedicated to EMS training. The quality

assurance coordinator, by default, has been forced to handle the myriad of EMS

management issues that arise because he is currently the highest ranking EMS officer.

Three fire fighter/paramedics assigned to quality improvement are currently acting as

EMS instructors for the fire fighter recruit classes. As of this writing, there are four

concurrent recruit classes. As a result, their abilities to dedicate time to quality

management issues are limited.

The quality management program is not based upon risk assessment. The quality

management program has very limited standards established for performance based

upon accepted industry standards. Protocol compliance is reviewed only for cardiac

arrest patients when quality improvement personnel are available and not doing EMS

instruction for recruit classes.

Patient outcomes are not monitored. Customer satisfaction and feedback is not

incorporated into the system. Appropriate medical destinations are not incorporated as

part of the patient care standards.

Recommendation 7.7: Establish relationships with hospitals, academic

institutions, and other higher centers of learning to enhance skill levels of

personnel.

The Memphis Fire Department should establish relationships with hospitals, academic

institutions, and other higher centers of learning to enhance skill levels of EMTs and

paramedics. According to the EMS Agenda for the Future, “Providers of EMS education

should seek to establish relationships with academic institutions (e.g., colleges,

universities, and academic medical centers). Such relationships should enhance the

academic basis of EMS education and facilitate recognition of advanced level EMS

education as an accomplishment worthy of academic credit.”

http://www.cityofmemphis.org/pdf_forms/assessmentOfEMSS.pdf

I do want to thank the members of the Memphis FD that emailed me this study. It answers some of my questions and sheds light on their hiring problems. They also made some other comments but I'll take spenac's advice to be kinder and gentler...this time.

[MemphisE34a]

MemphisE34a is not [a paramedic] but still supervises the busiest station for EMS.

http://www.cityofmemphis.org/pdf_forms/assessmentOfEMSS.pdf

I see your still making stuff up. I never made that statement.

Yes, you pulled a study that is nearly 4 years old that outlined many problems with the EMS system at that time. You left out the part that the administration hired that nationally and highly regarded EMS professional that conducted the survey, made him a Deputy Chief of EMS who answers to only 2 people on the entire department, and told him to fix it!

Since being hired, he divided the plans for improvement into 3 phases and has secured millions of dollars from the city council in order to implement the first two of them.

I know its not the perfect plan, it could be a whole lot better if you were here to go on the 85% of the EMS calls that are pure BS.