California and Maine: Two Anti-Firefighter Anti-Public Employee Headlines
Two headlines from this past week got me thinking about just how far the anti-firefighter anti-public employee message has driven public opinion. One headline was about a California civil grand jury that concluded it was wasteful to send engine companies with 4 firefighters on EMS runs. The concern cited in the article was that fire engines cost $500,000, nearly five times the cost of an ambulance. The other was from the state of Maine, where City Councilman Michael Farrell from Auburn followed a city engine company with a video camera to document that the firefighters were wasting taxpayer money driving around their district.
The problem is not that the average person has an unfounded concern over taxpayer funds being misused. I am a taxpayer and I am concerned about that. The problem is that a judicially empanelled investigative body in California and an elected official in Maine – folks who should be responsible enough to fully investigate matters before they make public pronouncements – reached their conclusions seemingly without understanding the basic economics underlying what they were talking about. It leaves me to wonder whether both headlines were the product of people who had a certain agenda and were content to twist the facts to fit their ideology.
Let’s look at what both the California grand jury and the Maine councilman ignored in their effort to reach their conclusions that it is too costly to put engine companies on the road.
There is a basic cost for a community to have a fire department, and (since both cases involve engine companies), lets specifically focus on engine companies. Neither the grand jury nor Councilman Farrell argued that engine companies are unnecessary, nor suggested that their community had too many engine companies. Rather their focus was on what they claim was the unwarranted use of an engine going on EMS responses in California and driving around the district in Maine.
So what are the real economics? Let’s first look at the cost of an engine company. Fire apparatus generally do not wear out from being driven too many miles, but rather they reach a level of obsolescence before they wear out. It is not uncommon for apparatus to have surprisingly low mileage despite advanced age. As a result, mileage is not a fair way to amortize the cost of a fire truck. Most fire apparatus have a life expectance of between 10 and 15 years. Admittedly many departments get more out of an apparatus, but for planning purposes, you cannot count on getting 20 to 25 years out of a piece of fire equipment – particularly today with on-board computers, componentized parts, etc.
Most experts agree that ten years is a reasonable expectation for the service life of a front line engine, which should leave some serviceable years as a reserve piece to follow. If we assume the cost of a new engine is $500,000 (that figure was mentioned in the California article so we will use it), amortizing that cost over ten years translates to $50,000 per year, $961.53 per week, $137.36 per day, $5.72 per hour.
Routine maintenance to apparatus (annual service test, brakes, tires, oil changes, filters, tune up) range $2,500 per year up to $10,000. When you factor in the need for a major repair every other year (pump overhaul, springs, transmission, fuel injectors, etc.) a sound annual maintenance allotment for an engine is $25,000. Following the same rational, that breaks down to $2.86 per hour.
Let us further assume that the fire apparatus is properly staffed with four personnel, an officer and three firefighters (a huge assumption these days but again that is what the grand jury cited), and the personnel are being compensated reasonably. Let’s assume the officer makes $60,000 per year and the firefighters each make $50,000. Keeping in mind that total cost of an employee for health care benefits, pension, vacation, sick leave, workers compensation costs, uniforms, etc. is usually twice the employee’s salary, we come up with a total cost for each employee as follows:
- Officer salary = $60,000 Total cost (salary and benefits) = $120,000
- Firefighters salary = $60,000 Total cost (salary and benefits) = $100,000
Assuming the officer and firefighters work 56 hours per week (let’s leave FLSA out of this for now):
- Officer’s hourly wage = $20.60 per hour Total Cost = $41.20 per hour
- Firefighters hourly wage = $17.17 per hour Total Cost = $34.34 per hour
So the cost of an engine company broken down this way is roughly as follows
- Apparatus amortization $5.72 per hour
- Apparatus maintenance $2.86 per hour
- Personnel: $144.22 per hour.
- Total Cost: $152.80 per hour
This is a fixed cost. It does not change if the firefighters stop responding to EMS calls or remain in quarters 24/7. The fixed cost would be notably higher in jurisdictions where firefighters are paid more, and where personnel work fewer than 56 hours per week. The calculation also ignores the costs of training the firefighters, maintaining their fire station, and providing the department infrastructure (chiefs, supervisors, administrators, payroll, dispatchers, 911 operators, insurance, etc.). In other words, $152.80 per hour is a low ball figure for the cost of an engine company.
Yet somehow a California grand jury and an elected official in Maine concluded that it is wiser to spend $152.80 an hour to have an engine company sit in quarters than spend an additional $4 a gallon in diesel fuel. In their infinite wisdom it is wiser to save the $4 a gallon, rather than have the engine (a) respond promptly to a life threatening medical emergency in their district, or (b) drive around the district (which incidentally has innumerable benefits to department, including driver’s training, district inspections, building familiarization, etc.). Funny thing – neither of the articles happened to look at the economics this way.
Maybe I am missing something – and if I am, then by all means someone clue me in. The fixed cost of having an engine company will not change by discontinuing the dispatch to EMS calls, or locking down the company from all non-incident related driving. The incremental cost is fuel, the other expenses are fixed…. and while fuel is expensive at $4 a gallon – we are not talking about it costing the taxpayers $5,000 per EMS run, or $500 per EMS run, or even $50 per EMS run….
I also cannot help but wonder if the California grand jury heard testimony from real life paramedics (not the arm-chair type or private sector EMS providers seeking to cash in on a new revenue source) on how many people it takes to properly handle an advanced life support incident, or what we refer to as a code. Where will those extra needed hands come from? From a nearby EMS unit? If so California will need to add a boatload of additional EMS units!
Admittedly, heart attacks and trauma codes are like structure fires, statistically a small part of our total responses, but that merely begs the question – what type of incident should we be prepared for? Should a fire department plan for the best? Should we only dispatch apparatus to types of incidents where statistics tell us they are needed? Should engine companies be staffed to only respond to false alarms if that is what most incidents turn out to be statistically? If that is the case let’s hire senior citizens in powered wheelchairs to be firefighters. Heck – their apparatus will probably be funded through medicare. Can you imagine an emergency room that is only prepared to deal with someone with the flu? How about a passenger jet with no emergency exits and life vests under the seats? Statistics say engines aren’t need on EMS runs? Are you kidding me?
The public’s cynicism toward what we do is disturbing and disheartening, but when elected officials twist reality and perhaps subvert a judicial process to advance a political ideology – that is beyond normal cynicism and spinning the facts. It borders on fraudulent misrepresentation.
And then there is Councilman Farrell in Maine: an elected official pandering to frustrations of the public instead of demonstrating true leadership. Why do I say he is pandering? There are two ways an official can go when he sees possible wrongdoing in a fire department. The first is to discuss it with the fire chief or someone in the fire service to understand the issue, and get it straightened out if appropriate. The other is to make a big splash in the public’s eye. What Councilman Farrell did when he posted the video on YouTube was in essence to say “Hey voters, look at me – I’m a good politician. I know you are upset at high taxes and here is why. Those rotten no-good firefighters are wasting diesel fuel. Aren’t you glad I’m here protecting your interest.” Seriously?
But here is what bothers me the most about the Councilman Farrell’s pandering – and it is totally unfair to expect that he would realize this – so I cannot fault him personally – but firefighters know what I am talking about.
The fire service is a cross section of society, nothing more, nothing less. We have highly motivated firefighters, we have middle of the pack firefighters, and we have some slugs. The slugs don’t want to do anything, and will only do what they have to do – and even then they do it begrudgedly. The middle of pack folks pretty much go with the flow.
More than likely, on June 6, 2011 Councilman Farrell was tailing a crew of highly motivated firefighters who were out in their district at 2:30 pm. When I was a company officer we were out in the district as much as possible, looking at new construction projects, road closures, learning where utility crews were working, tracking events, activities, or anything else that could impact our ability to do our job.
In his quest to alert the public to this outrageous waste of taxpayer funds, who did Councilman Farrell spank without realizing it? I’ll bet it was high performers. The slugs were more than likely back in quarters. And guess who probably thinks it is hilarious? The slugs in the fire department who don’t want to go out and do a thing. And who will the middle of the pack folks follow? Councilman Farrell inadvertently demotivated high performing employees and rewarded and reaffirmed the low performers. And we wonder why things are so screwed up for public employees.
It reminds me of an article written by Steven Kerr back in 1975: “On the Folly of Rewarding A While Hoping for B”…. definitely a good read for the chiefs out there.
So, what is next. Will a new California grand jury consider the cost of sending police cars on fire and EMS calls to be excessive since they do very little when the get there? Gasoline is not that much cheaper than diesel you know. And will Councilman Farrell unleash his video camera on the cops in Auburn for wasting too much gasoline driving around aimlessly? Maybe the paramedics can be caught wasting oxygen on patients?
How pathetic that I am even stooping to such a level – I apologize. Its just so frustrating. Probably like you I am tired of the anti-firefighter anti-public employee attacks. I am tired of poor “leaders” who cannot accept personal responsibility for poor decisions, and instead point the finger of blame at us, knowing that the public’s attention span can only process an easy explanation. Long explanations like I have provided here don’t stand a chance. At the same time I am tired of the slugs, and frustrated that folks like Councilman Farrell unwittingly provide them with aid and comfort. Sadly, he probably tells his supporters privately that we are all slugs.
No easy answers here, but a lot to think about. For now I’ll have to be content to dream a lawyers dream – about the chance to cross-examine one of these characters on my turf……
Maine is requiring all firefighters driving fire apparatus have 8 hours training in each vehicle they are to operate. Just how wo these firefighters get that training without driving them. I feel that the Stat of Maine is required to fund that law. It is an unfunded mandate and we the people voted a few years ago that the State fund all mandates. However, they still have to drive. Drive to get used to driving that truck, drive to learn the routes, and in this case drive to plan a training exercise. The councelman is totally and completely out of line and needs to be replaced.
Thanks Chief
Interesting, I was not aware of the minimum hours requirement. There are so many benefits that go along with fire trucks spending a reasonable amount of time every day on the air.
Its one thing for an uninformed citizen to make a big deal about something like this – out of ignorance, it is another thing entirely when an elected official does it.
Here is Glenn Usdin’s take:
http://firetruckblog.com/2011/06/18/justified-trips-or-waste-of-gas-town-official-follows-fire-truck/
There are some additional costs, including non-monetary costs, when it comes to fire department first response.
If it’s a paramedic response that duplicates the paramedics on the ambulance, there’s the cost for the paramedic equipment, especially the cardiac monitor and replacing medications as they expire.
How many positions are created to oversee the EMS side of an agency providing first response? Is there going to be an officer(s) and training staff devoted to EMS? How much continuing education is the department reimbursing for? Are fire fighters going to be paid more because they are running EMS calls or because they are paramedics?
How much extra staffing is needed to respond to calls? It’s one thing to say, “Hey, we’re sitting in station anyways” and another thing to say, “We’re running so many calls (most of which being EMS) that we -need- an extra engine.” Now the cost for that entire engine, crew, and station is entirely attributable to EMS, not just the extra cost of fuel and maintenance.
What happens when the engine crashes? Responding emergently is dangerous, even without the OC Fire Rescue knuckleheads who tried to run another car off the road while flipping the bird (granted, that attitude is rampant in all of emergency services, not just the fire service). So that $500,000 engine may be good for 10-15 years, unless it gets crashed 3 years in.
What about skill dilution? If you get x amount of, say, intubations a year, is that enough to support twice the number of paramedics?
Finally, and this is the killer, the only real evidence that response time matters is around 4 minutes for cardiac arrests, which is largely unobtainable for any sort of economically feasible deployment scheme anyways. This is, of course, ignoring the fact that the police are in a much better position to respond to cardiac arrests than the fire department anyways (especially since the only thing that really matters is compressions and defibrillation, so throw an AED in the back of every squad car, require CPR/AED certification for police officers, and call it a day). First response programs normally save very little time for an appropriately funded EMS agency, and certainly not enough time to be clinically significant. Even limited to the “true” emergencies, seconds do not normally matter, and the ones that due EMS is already behind the 8-ball. Sure, seconds count for cardiac arrests, but for the unwitnessed arrest those important seconds are already gone.
Finally, even assuming that response time matters, what matters even more is time to transport for the “true emergencies.” Time to ASA isn’t nearly as important for a STEMI as time to cath lab, and if it comes between a new engine (which normally can’t transport, and do so poorly when they can)and a new ambulance in order to respond to a growing number of EMS calls, I’d take the new ambulance any day of the week.
Hi Joe
Interesting perspective. You seem to be suggesting that firefighters should not have EMS training, but that police officers should? And police have the time and resources to devote to that responsibility? Training wise and response wise? I guess we will have to agree to disagree on that one.
I understand your point that when engine companies become so busy that it detracts from their fire related responsibilities, and perhaps creates a demand for additional units – but that is a red herring. We have to look at what is driving that level of demand for services. Many times it is a lack of social services available for a certain segment of the population – and if the needs of that population can be addressed the demand can be better managed. A different discussion – but a problem that exists in every major urban area in the US. That is the kind of thing that should have been addressed by the CA grand jury.
I suggest that for cardiac arrests (which is the most significant time sensitive emergency with the unique condition that the best treatment is extremely basic. The officer does not need to be trained to an EMT or paramedic level, but simply CPR certified, which they should be anyways), the police department is better deployed than the fire department and stand-alone EMS agencies (be it private service or 3rd government agency) simply by the nature that they are often in their squad car patrolling their area. However, this is limited specifically to cardiac arrests and not all calls in general.
If the fire department wants to provide EMS, then they have to do it correctly. This means running ambulances, not the “We’ll provide paramedics on engines and contract with private companies to provide an ambulance and 2 EMTs” scam that Southern California does.
This means limiting paramedic positions only to what is needed, not “everyone is a paramedic.” Is everyone in the fire department specialized in hazmat or specialized in swift water or specialized in technical rescue? No. Why is it appropriate to require (either written requirement or a de facto requirement by giving points for hiring) everyone to be specialized in EMS (read “be a paramedic”)? If you wouldn’t trust a paramedic who’s a fire fighter only because he wants to respond to EMS calls with your back in a fire, why should I trust my life with a fire fighter who is only a paramedic so he could be hired to fight fires? This also goes into the concept of skill dilution.
This means that if response standards aren’t being met by ambulances, that more ambulances are deployed, not a fire engine first response band aid.
This means that everyone involved with EMS needs to buy into it as being a core part of the mission. The concept that Fire Department ABC fights fires while responding to EMS calls on the side is inappropriate and dangerous to the patient. The attitude that the ambulance is the place for the new guy until he gets enough seniority to bid off the ambulance or a punishment position is inappropriate. This is the sentiment behind changing DCFD to DC FEMS, however changing an established culture is much more difficult than simply changing the name.
Sacrificing fire suppression for the sake of EMS is inappropriate just as sacrificing EMS resources for fire suppression is inappropriate. Unfortunately, too many fire departments who do EMS treat EMS as a side job and not a primary part of their mission.
I do agree that many EMS calls could be prevented by additional social services. However, could this be prevention done or coordinated by an EMS agency? Would assisting to coordinate social services be comparable to fire departments who commit resources to fire prevention? Additionally, wouldn’t this be a reason for diverting funding for fire department first response to social services to prevent the calls in the first place (thus driving down demand)? Is it necessarily a valid assumption that all of the engines currently in place would still be needed for fire suppression if the EMS demand is significantly reduced?
Joe
I can appreciate that you are in favor of making EMS a 3rd service, and your arguments make perfect sense from that perspective.
I have spent 39 years in fire departments where EMS is an integral part of what the fire department does. Fire based EMS works – and taxpayers do not need to underwrite the buracracy of a 3rd service, but if you start off with the premise that a 3rd service is better, I do not believe anything I say could say would change your mind.
As far as police officers doing EMS, that is in my opinion not feasible except in suburban to rural areas where the law enforcement demand is low. Police have annual recertification requirements that they struggle to meet(fire arms, tasers, use of force, pursuits, DWI, evidence/law etc. etc. etc.) that would make EMS recertification an additional difficult if not impossible burden… and then there is the activity level of many police departments that is just insane. Providence Fire handles roughly 38,000 runs a year with about 24,000 being EMS calls. Providence Police handle roughly 200,000 incidents a year. Suggesting that we take 24,000 runs away from fire to give to the police is…. well the numbers speak for themselves.
You express concern about firefighters being pulled away from firefighting duties to handle EMS runs… how about police? They will be pulled away from their law enforcement duties, patrol duties, etc…
You are right, if fire is going to do EMS, then they have to do it right. DC is a special problem – no doubt about that. I do not suggest that fire based EMS is the best solution for every jurisdiction but I know it can work.
I think we’re missing the connection of where I see the police fitting into EMS. I’m advocating using police first response in a very limited, very specific role (cardiac arrests), and not much else (and definitely not as a primary response and/or transport agency). However cardiac arrests is the standard “second count” scenario thrown out, even if many times those seconds are gone before the 911 call even occurs.
To be honest, my view (which was originally staunchly anti-fire) has evolved to a “what ever system works” view. As an EMT who is now a medical student who’s interested in emergency medicine and prehosptial care, I don’t have the “they’re taking our jobs” issue that’s involved in the fire/non-fire debate on both sides.
I agree that DC is a special case, but many of the issues with DC aren’t just limited to DC. My understanding (which is honestly second hand) is that FDNY has serious friction between their EMS crews and fire crews essentially because the fire crews don’t believe that the EMS crews are “worthy” of being a part of FDNY. Also, and straight from FDNY’s website, why is it considered a “promotion” to go from being a paramedic to a fire fighter? Why do fire fighters top out at $76k after 5 years and paramedics at $56k?
I agree that fire-based EMS can work just as well as non-fire with my earlier stated caveat that EMS isn’t viewed as something done while waiting for a fire, but as a core part of the department’s mission. I’d also like to throw in the idea that it’s significantly harder for fire departments when EMS is viewed as being more than just a ride to the hospital (which makes dual hatting more difficult), but I both don’t want to move the goal posts after the fact and that this is a concept that is difficult for most non-FD EMS services to consider.
Joe
Good luck with med school. I am a former pre med major, and seriously considered med school even after I got my law degree. And trust me – I do not have a “they are taking our jobs” mentality either.
You have hit upon the biggest stumbling block for fire based EMS, in that where historically there has been a separation between fire and EMS, it can be difficult (culturally) to bring them together. However, in the big picture, it is just a stumbling block not a total barrier and hardly grounds to conclude it won’t work.
Fortunately, in the organizations I have worked with, EMS is totally integrated into fire. A firefighter might one day work on an EMS unit, and the next work on an engine. That is not happening in DC or FDNY and open warfare would break out if someone attempted it. But attitudes can and will change and just because it is a problem in DC or FDNY doesn’t mean it can’t work.
There is a huge benefit to such integration. The FD buracracy can handle the additional apparatus and people with minimal additions (maybe an EMS chief and EMS training officer which in smaller departments might not even be necessary). The stations are already there and the cost for maintaining the stations are fixed. The FD must already be providing some level of EMS training to its people so its really of question of building upon what is there.
Probably the biggest benefit that I see (and maybe its just my perspective because I have never heard of anyone else saying this is a great idea) has to do with EMS burnout. Folks who work EMS get burned out. By allowing EMS personnel to rotate (say) to an engine company for a period of time, back to EMS, then to a ladder, the emotional burden can be spread among a larger pool, and their skills can still be drawn upon on the incidents that the engines and ladders respond to – which are likely to be fewer in number (although that is not always the case). This assumes a total integration between fire and EMS – where every firefighter can do EMS. The Santa Clara grand jury concluded that was a lousy idea.
As for limiting the dispatch of police to heart related incidents, the challenge is figuring out which incidents are truly heart attacks and which are gastric reflux or some other issue (physical or psychological). The impossibility of figuring it out up front – is what causes the statistics to show fire companies are not needed (according to the Santa Clara grand jury)at over 90% of EMS incidents. Why would it be any different of the police respond?
Until your house burns down, or you have a 300 kg patient to lift, or a jaws run with fire involved. You can probably get the Police to carry AED’s but it will be another thing to get them to use them in a timely manor. They signed on to fight crime not run EMS calls or fight fires, otherwise they would have went to work for the FD or the EMS.I have been in the business for many years and you can not tell me you would rather have a Fireighter that is a Paramedic in you neiborhood with a good piece to respond to a call to your house cause I can promise you the first time they don’t show up in a timely manor when your family is standing on the roof wanting down because the first floor of you house has the stairwell blocked. Or your wife is haveing chestpains passes out and your all that is there. She is to heavy to get her in the car and the Police are working a robbery in progress down the road with your AED, with all the EMS units tied up on calls. The reason I say this you will be the first person to place blame it all on someone else.
Leroy
I think you are right. EMS is a much better “fit” for fire. Attitude wise, job wise… Plus – its not like firefighters don’t have to have some minimum level of EMS skills. We have to have EMS training even if we don’t do EMS transport… Maybe you don’t have to be a paramedic but it sure doesn’t hurt.
How could anyone seriously entertain the thought of having 4 EMTs sitting in a fire station around the corner from someone having a heart attack and calling in another ALS unit from across the city to assist??? Because the engine costs $500,000 versus $100,000 for an ambulance… seriously? People can’t see there’s some other agenda going on here?
How many fire fighters use the line, “I signed up to fight fires, not take Granny to the ED for a UTI”?
What would I like for a medical call? I’d like a paramedic who’s primary job is being a paramedic who has a command of basic medical science (anatomy, physiology, pharmacology, etc), clinical medicine as appropriate to EMS, an understanding of and ability to apply evidence based medicine, and additional education as appropriate (at least an understanding of psychology, a course in technical writing, etc). This would require a minimum of an associates degree, and probably more towards a bachelors degree (and is also more in line with EMS education standards in other developed countries). I want a paramedic who can think outside the protocol, instead of following the protocol like a cookbook similar to a McDonald’s fry chef following the cookbook for running the fryer.
I want a paramedic who wants to be on the ambulance because s/he likes EMS, not because it’s a pathway to riding on the BRT. I want a paramedic who wants to be on the ambulance, not one who is on the ambulance because he made the captain mad or because it was “his turn.”
For a non-cardiac arrest medical call, I want an ambulance, not a fire engine acting as a ‘clock stopper.’ Sending a fire engine as a “first responder” for the vast majority of medical calls as a “fix” for not enough ambulances makes as much sense as sending an ambulance to a structure fire for the same reason because the ambulance has a fire extinguisher on it.
For system design, I want a system that doesn’t dilute the area with paramedics to the point of skill atrophy. I want a system that is run off of evidence based practices and the evidence shows that after a point, more paramedics is harmful. I want a system that recognizes that there comes a point when one can be a “jack of all trades, but a master of none,” and even then a point where the demands to stay proficient precludes even a jack of all trades approach.
Strangely, I don’t see many cross-trained departments meeting those requirements, especially for the fire departments only runs first response instead of providing transport. While, yes, these are also valid criticisms of plenty of non-fire services, if you show me a fire service that meets these requirements, I’d be more than happy to voice support for that specific service.
Joe
What you want in your ideal system – is really no different than what any firefighter would like… in fact any sane person would like. The problem is no community in the world can afford to provide that level of EMS coverage on top of fire coverage and law enforcement coverage.
What we are discussing is the next best alternative to having the idyllic system you describe. I think fire based EMS rates alot higher than you do – but that is probably a function of the systems I have seen work, and the systems you have seen fail.
As for a fire based system that provides such a perfect EMS system – no system (fire, 3rd service or private) can guaranty delivery of a caring, competent provider 24/7. All systems suffer problems with quality control, funding, poor supervision, bad attitude etc. etc. issues (want to see some “you can’t make this stuff up” lawsuits from each type???).
But there are many fire based systems out there that do a fine job. Phoenix Fire is one. Seattle is another. In RI, we all use fire based EMS and the system works well.
You have made a number of comments that imply that you believe EMS is somehow an “additional duty” for firefighters, that knowing EMS requires firefighters to be a “jack of all trades”, and that EMS is something that firefighters “did not sign up for”. I totally disagree.
EMS is an inherent part of being a firefighter. Even a firefighter in a department that has no EMS response – no EMS transport, no assist with carries, no dispatch what so ever to EMS incidents – still needs to be trained in EMS. It is part of the basic requirements of being a firefighter (NFPA 1001) and common sense.
EMS issues come up at fires, explosions, accidents and various other incidents we respond to. Admittedly, firefighters do not have to be paramedics or even EMTs but they need EMS training because they have to perform EMS related duties incident to their firefighting duties.
My point here is EMS is not an “extra” duty – it is part of the primary mission. It is that fact which makes EMS a natural fit for fire departments. I do not understand how anyone could become a firefighter without expecting to do EMS. Wanting to ONLY do EMS… that is a different story. You do not have to want to ONLY do EMS to be good at EMS. I’ll fight you all day on that one because I do not want to do ONLY EMS, but I am good at EMS.
And then there is the skill atrophy argument….
What I hear you saying is “We’ve got to have paramedics … but we can’t have too many”. How does that square with your call for more ambulances to replace the fire responses to to heart attacks?
Perhaps the real question is does the area you service need paramedics, or can lower level responders, or perhaps a tiered level of response, better service the community. That is a question fire based providers have to face as well. Everyone does not have to be a paramedic.
In RI, we all use fire based EMS and the system works well.
Factually as well as practically incorrect. Yes, RI’s system works very well for the firefighters who have enough seniority to avoid it entirely, not so well for the guys who wish they could be doing anything else.
Unfortunately, the FD-dominated system has also led to obscenities like 30 years of EMT-Cardiacs, a level of care that never should have been allowed in the first place, and a complete lack of any practical QA or oversight whatsoever from the state thanks to the IAFF control of the General Assembly. Although I will admit there has been recent improvements- your former department is finally using backboard straps for more than passing the state equipment inspection, for example.
In terms of factual error, you’re forgetting South Kingstown EMS, Westerly EMS, Cumberland Rescue, Foster Ambulance, Hope Valley Ambulance, Charlestown Rescue, Exeter Rescue, and Jamestown EMS.
One thing athat nobody’s brought up yet is “public safety model” systems, which the IAFF fights till they turn blue in the face, on the grounds that firefighters should not be police officers since the jobs are so different. I would submit that a hose and a gun have as much in common as a hose and a stethoscope.
but if you start off with the premise that a 3rd service is better, I do not believe anything I say could say would change your mind.
Curt, if you’re going to tell me you’re being objective about this subject, I’m just going to start laughing. I’ve got more respect for you than that, so I’m trying hard not to.
BH – why don’t you list the fire departments that DO provide EMS transport in RI? It is a much much much longer list. And incidentally – I do not think I am factually incorrect. The question is providing fire based EMS response, not just EMS transport.
The communities you mention do dispatch their fire departments to assist EMS. The whole point of this posting is whether that practice should be discontinued as too expensive. The California grand jury concluded that it would be cheaper to dispatch a second ambulance to assist with a serious medical incident/code or even a carry rather than dispatch the closest engine company.
I never said I was totally objective about this issue. I feel strongly that fire based EMS works. I understand in some places other models work – and that is fine. I don’t propose trying to fix what is not broken. But if you know me – you know I will not pretend to be objective if I have a clear bias – and I believe fire based EMS makes sense.
BTW – for all the private sector advocates out there – just got this one in and I’ll be posting a blog shortly. Its right on point: http://www.news-journalonline.com/news/local/southeast-volusia/2011/06/21/chief-under-fire-for-transporting-patient-to-hospital.html
http://firelawblog.com/2011/06/florida-fire-chief-in-hot-water-over-ems-transport/
http://www.ems1.com/ambulances-emergency-vehicles/articles/1067423-Boys-death-prompts-emergency-response-changes-in-SC/
“Boy’s death prompts emergency response changes in SC
Move comes 2 years after 3-year-old’s death where firefighters had to wait for second ambulance to arrive”
Bottom Line;
1st.The Santa Clara Co. Grand Jury Report came out at the time when the City of San Jose FD is laying off Firefighters.
Think that had an impact on this?
2nd.The Auburn,Maine City Councilman, Michael Farrell, doing his “Secret Squirrel”
photography, Probably Violated one or more Traffic Laws in that State.
Seems appropriate for the closest public service agent to respond to a cry for help, be it PD or FD as appropriate. Where you are smoking the public is lowballing FF pay. Leaves the impression that firefighter labor costs in California are reasonable.
Where am I “smoking the public”? Seriously? RAN, did you read the entire article? If I used the higher salaries of firefighters in places like California it would HELP TO MAKE MY CASE, not hurt it!!!! I was trying to be reasonable – but fine – use the salaries in California – so why should a community spend $400/hour to have an engine company sit there unused while a private ambulance or paramedic interceptor comes from across town to assist. Does that somehow get rid of the smoke?
Sir, yes I read the article. We are clearly in agreement that the closest unit respond. A Fire company is a powerful do-all fixit resource. A public agent, under flag of state authority should command all ‘cries for help’. I do suggest that the labor cost of firefighters is a legitimate topic for discussion. Thank You Sir…RAN
OK Ran
Labor costs are high, no doubt, but to have that highly compensated crew sitting in quarters and have another highly compensated crew come to assist on EMS related runs defies logic. It is an unnecessary redundancy. I understand you and I agree on that – but there are many out there who don’t seem to get it.
holy crap you all are getting stupid.. anyway down where i work, i have had the opportunity to work with both good and bad experiences with both. but being a ff i am bit bias toward fd based ems.
with both parts the grand jury and the councilman. it seems either an agenda or lack of education on the matters of the job whether it being a fd based ems or stand alone ems system, private or public.
this is for ran—what is your occupation and general location of your job, is your ems third party or what. i do not think curt is smoking any body, a generalization of pay is needed due to varying pay all over.