Can Fire Paramedics be good Paramedics?

[spenac]

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.

[46Young]

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.

Edited October 4, 2009 by 46Young

[VentMedic]

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

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.

Edited October 4, 2009 by VentMedic

[spenac]

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

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.

[46Young]

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.

[VentMedic]

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.

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.

[Kiwiology]

To practice as an advanced life spport practitioner here (Intensive Care Paramedic) you must complete a 3 year degree and an 18 month internship aftewards.

That's 3,600hrs over the 3 years with 2,400 classroom and high fidelity simulation and 1,200hrs in ED, OR, CCU and on the road plus an additional 2,000 hours of clinical mentoring during the internship period (164 12hr shifts).

So that's .... 5,600 hours of education and experience to practice as an IC Paramedic.

How many firefighters are going to want to do that? ... there's your answer.

[46Young]

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.

[Lone Star]

Most counties in Michigan (don't know about other states) have a 'Paramedic Division' with the county Sheriff's Department.

GCSO Paramedic Division

[Flasurfbum]

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.