The song that never ends

The International Association of Fire Chiefs and the International Associtaion of Fire Fighters have written another white paper “re-affirming” their belief that the fire based model of prehospital medicine should lay in the hands of the fire departments.

http://www.iafc.org/displayindustryarticle.cfm?articlenbr=40957

The NEMSMA email list has been hyperactive with opinions on the topic and I have read some great discussion points. I believe that there is NO one service model that will work for every community.

I don’t truely believe that a fire based model is the best. The IAFC & IAFF are just trying to keep funds and jobs. I cannot fault them for wanting to find reason to maintain current staffing levels, especially in this financial climate. Several communities have reduced staffing for the fire service citing financial woes. I don’t really see the fire department providing critical care transport between facilities and I’m sure the IAFC would say that is not a function of prehospital medical care.

So I’ll give them that weak argument and allow them to keep ALL 911 service calls. I have worked and lived in three states, been a fire fighter for 15 years and I’m a member of the IAFF. In the areas that I have seen fire based service, being assigned to the ambulance has been a punishment more than a desired position. Fire departments that run EMS are requiring their new recruits to take an EMT or Paramedic course as a contingency for employment. This only produces EMTs and paramedics who want to “get through” their two years on an ambulance so they can finally get assigned to a truck or engine. The personnel don’t like making ems runs and, not coincidentally, provide poor patient care. They try to convince the patients that they really don’t need to go to the hospital. I have had several fire fighters tell me the only reason they have EMT or medic numbers was to get a job with a fire department. Is this how we want our ambulance personnel to feel?

Not all fire based EMS is like this and certainly not every firefighter/paramedic feels this way. I was overjoyed to find Happy Medic’s blog. There are a few fire medics that enoy both.

Additionally there is the training hours problem. The fire department I used to work for had issues maintaining proficency for all certifications. I was. Firefighter, Hazmat technician, confined space rescue technician, rope rescue technician, swiftwater rescue technician, EMT, fire inspector, fire instructor, trench rescue technician, and a member of the Urban search & rescue team. I enjoyed all of the specialties I was allowed to take part in but maintaining proficiency was a major pain in the ass. I had would constantly say to my officers that we needed to train more to remain proficient. I was a rope rescue instructor, time and again I proved that my crew needed more training. With all our other responsabilities, testing hydrants, painting hydrants, inspecting businesses, hose testing, weekly truck checks we were struggling with training hours.

My department was a small suburban service with less than 30 employees and 20 paid on call (volunteers). We had EMS continuing education training provided by the local 911 agency but it wasn’t enough.

So I wonder, has the IAFF & IAFC considered these issues?I want to keep current staffing levels for fire departments. I know that we need minimum staffing levels to keep fire fighters safe. I also know that 75% of the run volume for fire departments are EMS (thus justifying the need for paid staff).

I don’t believe fire based EMS is the answer to our problems. I don’t believe that ____ based ems is the answer. Patient driven, science based, EMS based EMS will always work.