Fire based EMS

[trents289]

Seen linked on another site:

http://www.cfsi.org/EMS_Coalition/emsadvoc...se_06_12_07.asp

Thoughts?

-be safe

I read over the paper it is nice that the major dates are before EMS was ever in effect. And most of the fire departments use EMS calls to up there call volume so they can receive more money for there departments. I know of departments that have both Fire and EMS and they cant keep there Paramedics because they get burnt out and have no time to recover between calls. If they want to do this they have a lot of work to do. In final closing How many Fire departments go to all the I stubbed my toe so i called 9 1 1 just to have them look at it. They talk about CPR we all know that is not the majority of the calls.

[trents289]

Seen linked on another site:

http://www.cfsi.org/EMS_Coalition/emsadvoc...se_06_12_07.asp

Thoughts?

-be safe

I read over the paper it is nice that the major dates are before EMS was ever in effect. And most of the fire departments use EMS calls to up there call volume so they can receive more money for there departments. I know of departments that have both Fire and EMS and they cant keep there Paramedics because they get burnt out and have no time to recover between calls. If they want to do this they have a lot of work to do. In final closing How many Fire departments go to all the I stubbed my toe so i called 9 1 1 just to have them look at it. They talk about CPR we all know that is not the majority of the calls.

[AnthonyM83]

Well, look at what you all have been talking about while I've been away.

As someone who works in Los Angeles County system (I work for one of the private ambulance companies that either transports patients BLS or FF/Medics with patient ALS), I have to comment.

I'll start off by saying we have a few really good, skilled medics who truly care about their patients and I'm always happy to work with them. Then there's the majority who seem like they aren't really interested in the job, BLS all they can, do the bare minimum, no in-depth care, and burned out outlook even though they've only been doing a few years. Then there's the horrible medics who either are incompetent or know what to do, but don't give a crap. It's a bell curve, I'd say...slanted to the right.

FFs are recruited to medic school against their will, sent to a painfully simplistic medic school (learn only 22 drugs, I think), then forced to work the medic squad. We have people going to medic school to become better FF applicants even though they "hate medicine and the medical side of fire".

Things that have been sent BLS by LACoFD:

-Multiple Stab Wounds, including upper back

-GI bleed patient who has coded 5 times prior at hospital

-Falls from over 15 feet to hard surface (trauma criteria here)

-Patient left on street corner with PCR taped to chest (might not have been LACoFD, but another Fire based system we do backup for)

-Traffic Collisions with positive loss of consciousness

-Difficulty Breathers including ones with audible wheezing and 4-5 word dyspnea without even an O2 reading or proper eval

-Substernal chest Pain, radiating to left side

I've heard so many more, though, that's just what came to mind.

My point: FFs who are forced to become medics will be subpar medics and a liablity. As is the case in LA, it will force county to have a very narrow scope (to limit what they can screw up), providing substandard medical care (if citizens only knew). And is a waste of resources and money. You don't need 9 people crowding a living room on a chestpain call.

[CBEMT]

I don't normally defend FD-based EMS except in rare cases, but there are a few things here I felt are worthy of a response.

Things that have been sent BLS by LACoFD:

-Multiple Stab Wounds, including upper back

Needs a surgeon. ALS is statistically no help at all, and probably a detriment. The studies done in your own town tend to prove it.

-GI bleed patient who has coded 5 times prior at hospital

I don't understand why the hospital is calling the FD. If this was a home call, and the patient had a HISTORY of such, then it depends on the presentation NOW. Someone actively vomiting blood with a BP of 80 is going to get different treatment from me than someone who saw some blood in their stool this morning and is hemodynamically stable.

-Falls from over 15 feet to hard surface (trauma criteria here)

If he needs anything, he MIGHT need a surgeon. ALS is statistically no help here either. Again, stop treating people by MOI. Treat the patient not the protocol- he hasn't read it.

-Patient left on street corner with PCR taped to chest (might not have been LACoFD, but another Fire based system we do backup for)

I'll give you that one. Not necessarily an ALS issue, but a "WTF are you doing" issue. I think we covered this within the first 8 hours of Basic school.

-Traffic Collisions with positive loss of consciousness

Again, trauma. What is it exactly that you want the medic to do? Backboard and transport? Oops, you can do that too! A just-because IV isn't going to do much here. If the LOC precipitated the crash, than a workup would be justified.

-Difficulty Breathers including ones with audible wheezing and 4-5 word dyspnea without even an O2 reading or proper eval

Depends on history and presentation. A routine COPDer is usually within BLS scope here (not that BLS would be dispatched, but if I have them on my truck I may let them handle it). You also shouldn't be putting too much stock in that "O2 reading," especially in a COPDer. But you knew that already. I hope.

-Substernal chest Pain, radiating to left side

Probably give you that one.

[frontcrawl]

I don't know much about the system in LA there, but is the FD responding in a ambulance and turfing the calls or showing up in some kind of non-transporting vehicle ala "Emergency!"? Asinine either way.

[captainstandup]

Fire folks would do well to investigate the history of the effects on fire protection when they decide to get into the EMS business. One common occurrence when fire gets into EMS is that city, county, parrish, commonwealth bean counters typically screw the fire service in favor of supplying, equiping and staffing the revenue producing EMS. This isnt to imply the activtes of fire or ems are of more importance than the other.