Ems Service Thru Fire Dept

[fireant]

Ok couple years back heard Norman and Okc was thinking of running the Ems service out of the fire depts. I think it makes since you would have better trained people responding to incidents not to take away from Emsa not being well trained just from people I know with EMSA some are really well trained and dedicated while others know just enough and don't care about learning more. I think by going through the fire dept's response time would be improved. Does anyone know what ever became of this issue?? I have a big problem though with a for profit agency operating in the public safety sector and fighting fire depts when they want to take over Ems service other states have seen the benefits of this why are we still doing it the other way?? Just a thought not insulting EMSA just wondering what ever became of the concept here in Oklahoma.

fireant

 

[WX5JCH]

Yea we had talks with Okc FD back when I was with Amcare in 1980 about this, FD wanted all the glory and none of the work. No nursing home transfers, no VA calls, nothing but emergencies -ones that make the news, and make them look good to the taxpayers. FD is not the answer -if they have that attitude.

However, here in Elk we just converted to a FD based system and I have to say they are handling it quite well, for now, cant wait for the tax bill however.

 

[KK5FM]

OKC fire still wants to do *emergency* ambulance service. They aren't putting Paramedics on the fire engines for nothin'. And, they haven't built a two-bay fire station in years... they need somewhere to put the ambulances.

 

[K5MAR]

Yea we had talks with Okc FD back when I was with Amcare in 1980 about this, FD wanted all the glory and none of the work. No nursing home transfers, no VA calls, nothing but emergencies -ones that make the news, and make them look good to the taxpayers. FD is not the answer -if they have that attitude.

However, here in Elk we just converted to a FD based system and I have to say they are handling it quite well, for now, cant wait for the tax bill however.

Interesting. Stillwater Fire runs the ambulances in this area, and last year they successfuly fended off an effort by a private concern that wanted to set up an ambulance service locally that would siphon off the transfers and such, leaving SFD to handle the emergency activity. SFD fought hard to keep the bread & butter stuff, as it helps pay the bills. There may not be glory in the nursing home transfers, but there is money! :lol:

Mark S.

 

[KD5WLX]

One ongoing problem with this is burnout. Many (but not all) firefighters want to be firefighters first, and handle EMS only because it's part of the job. They all but burn out on running with the ambulance on every call, and mostly just help load the gurney (unless EMSA is late!). They get their EMT training (same as EMSA, by the way, it's a state cert) because it's a job requirement. The EMSA paramedics are there because they want to be, and the FF/paramedics did it for the extra pay, but really don't want to do medical. That's not always the case - there are EMSA EMTs that squeak by the refresher training, and FF's that love EMS work - I'm just saying that's not always the case.

The other problem, unless the department requires ALL FF to be EMT qualled, is that once you have the EMT cert, if they're short paramedics, you get "stuck on the bus" and can't get back to firefighting. Tulsa FD resisted a move to put the ambulances under the FD - not because they couldn't do it (all new TFD recruits must get EMT-B anyway) but because they didn't want two career tracks. Once you get recognized as a "good" EMT, they want to keep you on the ambulance, but that limits cross training, FF experience, and thus opportunities for command and advancement. In other words, the "good" EMT becomes an EMT forever, and his only promotion option is EMS Chief. Even the guys that like the med stuff don't want to lock themselves out of the normal FF stuff (which has several other career paths - Hazmat, Rescue, Battalion Chief, Training, etc.

 

[CommShrek]

One ongoing problem with this is burnout. Many (but not all) firefighters want to be firefighters first, and handle EMS only because it's part of the job. They all but burn out on running with the ambulance on every call, and mostly just help load the gurney (unless EMSA is late!). They get their EMT training (same as EMSA, by the way, it's a state cert) because it's a job requirement. The EMSA paramedics are there because they want to be, and the FF/paramedics did it for the extra pay, but really don't want to do medical. That's not always the case - there are EMSA EMTs that squeak by the refresher training, and FF's that love EMS work - I'm just saying that's not always the case.

The other problem, unless the department requires ALL FF to be EMT qualled, is that once you have the EMT cert, if they're short paramedics, you get "stuck on the bus" and can't get back to firefighting. Tulsa FD resisted a move to put the ambulances under the FD - not because they couldn't do it (all new TFD recruits must get EMT-B anyway) but because they didn't want two career tracks. Once you get recognized as a "good" EMT, they want to keep you on the ambulance, but that limits cross training, FF experience, and thus opportunities for command and advancement. In other words, the "good" EMT becomes an EMT forever, and his only promotion option is EMS Chief. Even the guys that like the med stuff don't want to lock themselves out of the normal FF stuff (which has several other career paths - Hazmat, Rescue, Battalion Chief, Training, etc.

Well if I didn't know better (wait, maybe I do) I'd say that you might actually have some real world experience on this subject. That being the case, be careful. Lots of folks around here get nervous when people who have "been there, done that" share thier life experiences.

 

[KD5WLX]

twobravo,

Yep, worked as a volunteer in KCMO metro area for 8 years. Almost all the departments in that area (and likewise around Tulsa) have either pumpers with EMT-Bs that respond as first responders to med calls, or a "squad" or Q/R (ours looked just like the Squad 51 from the old "Emergency 51" TV show!), but separate "contract" ambulance services that do the transports. In the suburban and rural areas, it's not uncommon for the FD to get there considerably before the ambulance, so they do a lot of "stabilize and package" and have the patient ready to go when the ambulance gets there.

In those (rural) cases transport is a problem, because while the volume of calls is relatively low, a couple of ambulances can be "posted" to an area, and respond to calls for several suburban departments. If they'd tried to run their own, their ambulance would be out of district for an hour or more by the time the run to the hospital, clean, restock, and then drive (non-emergency) back to their post. Much better to have the regional contractor just start an in-service bus from "downtown" our way when the one out on our call starts to the hospital. It spreads the ambulances thin, and increases response times, but requires less hardware. That works because the FDs with the first reponse duty don't have the long response times.

This model breaks down somewhat in the city itself, though. Generally, there are a high enough volume of calls in the city center that (no matter how spread out the Posts) there is always a bus available. This means that the ambulance frequently beats (or ties) the FD to the scene. That gets frustrating for the pumper crews (get there just to watch the ambulance drive away, or cancel them) but is nice for the ambulance when they need "more hands". In the city, moving the ambulances to direct control of the FD changes very little (but messes up the rural areas that depend on the city's support to provide the hardware!). But what it does do is set up turf wars between the FF's that run the bus, vs the FFs that ride the trucks.

So that's the trade off - do you have FFs w/EMT training that do First Response, and separate ambulance service, and then have turf wars between the FD and EMS service? Or do you have FF/EMT first responders on the pumpers, and OTHER FF/EMTs on the ambulances and have turf wars between the guys on the bus (that want to be on the truck) and guys that want to be on the bus and resent the extra training they have to go through to fight fires?

Catch-22!

 

[tomokla]

TFD actually campaigned TO take over ambulance service in the 1990's when many of EMSA's issues first came to light. Although many people speculate that either OCFD or TFD MIGHT take over EMS transports (either emergency & NE or just emergency) remember that the implication of this is far more reaching. EMSA Eastern Division will likely be responding to a larger geographical coverage area in the years to come as Medicare reimbursments to EMS providers silently kill many of the "mom and pop" providers. I would entertain the notion that the scenario is likely the same in OKC. The budgetary impact of having firefighters staff ambulances is astronomical compared to the business EMSA runs. When you consider the constant staffing, pension contributions, and the general assumption that nearly all FDs pay better then EMSA (which is not a shot at EMSA but merely a fact that a person who does two jobs FF/Paramedic versus just Paramedic SHOULD be paid more) you can bet that the general fund in most cities would see an enormous impact. Also, remember if OKC FD took over EMSA - would Edmond get ambulances too? I doubt Edmond is interested in having OKC fire ambulances running in their city. How about Tulsa - you think Sand Springs, Jenks and Bixby are ready to take over EMS transports or want TFD running ambulances in their city. I enjoy the discussion on the subject because it is interesting, but realize that although solutions seem simple - they likely have quite complex implications.

 

[CommShrek]

TFD actually campaigned TO take over ambulance service in the 1990's when many of EMSA's issues first came to light. Although many people speculate that either OCFD or TFD MIGHT take over EMS transports (either emergency & NE or just emergency) remember that the implication of this is far more reaching. EMSA Eastern Division will likely be responding to a larger geographical coverage area in the years to come as Medicare reimbursments to EMS providers silently kill many of the "mom and pop" providers. I would entertain the notion that the scenario is likely the same in OKC. The budgetary impact of having firefighters staff ambulances is astronomical compared to the business EMSA runs. When you consider the constant staffing, pension contributions, and the general assumption that nearly all FDs pay better then EMSA (which is not a shot at EMSA but merely a fact that a person who does two jobs FF/Paramedic versus just Paramedic SHOULD be paid more) you can bet that the general fund in most cities would see an enormous impact. Also, remember if OKC FD took over EMSA - would Edmond get ambulances too? I doubt Edmond is interested in having OKC fire ambulances running in their city. How about Tulsa - you think Sand Springs, Jenks and Bixby are ready to take over EMS transports or want TFD running ambulances in their city. I enjoy the discussion on the subject because it is interesting, but realize that although solutions seem simple - they likely have quite complex implications.

I can't speak for anyone else but I know that Bixby Fire used to run the ambulance at one time. I also know they are considering it an option again. At least it's a consideration.

 

[KE5EHI]

I thought the city (Tulsa) was contracted with EMSA for a number of years. Wouldn't that eleminate the possiblity of putting ambulances at stations since they are already bound with EMSA?

 

[tomokla]

EMSA is simply a board trust authority for EMS response. EMSA contracts with Paramedics plus for the people and services that make "EMSA" work. The contract is reviewed at regular intervals and I believe has to be reviewed in 2007 or 2009.

 

[GlacierClipper]

EMS should be provided through the Fire Dept. The taxpayers would get alot better services and the would get money back into the system when the users of the EMS paid their bills for the services.

EMSA is just another government contractor which is out to rake in the profits.

 

[BigMacFire]

Glacier Clipper -

If you think there is any profit in EMS - then you are sadly mistaken.

Those who have health care available to them rarely use EMS - unless they are in a dire emergency. Those with a lower 'socio-economic' standing - usually without regular healthcare, medical insurance, etc... are the ones that are 'frequent fliers' and call the ambulance when they have a head cold - to go to the emergency room....

Oh yeah -- in order for the fire department to 'get money back into the system' they would need to set up and staff an accounting department, and pay those individuals as well.... never mind all of their associated infrastructure (Computers, billing software, postage fees, collections fees....)

But - I do love the statments that you guys all say.... "If the FD took it over it would be better..."

 

[BoxAlarm187]

Fire Based EMS!

As you said, if you want to make profit, all you have to do is charge for service, like a great number of counties and cities here in the Old Dominion have done over the past 5 years. Want to talk about the MILLIONS of dollars that Chesterfield County Fire & EMS brings in each year using thier fee-for-service program? The infastructure paid for itself in a year, leaving nothing but profit afterwards.

For the most part, it's hard to argue that fire-based EMS delivery is any worse than private party/contracted service. That's not to say that in the right areas, third-party (private) service doesn't work well, but if fire-based EMS wasn't generally better, wouldn't we have seen a slow-down in the number of fire-based EMS agencies over the last decade?

There ARE a handful of FD's in the nation that are doing non-emergent transports, but they're definately the exception to the rule. Why tie up a FD ambulance toting grandma from the nursing home for a check-up, when there are dozens of private services that could do this?

 

[CommShrek]

Glacier Clipper -

If you think there is any profit in EMS - then you are sadly mistaken.

This statement right here proves just how much you DON'T know. So if there's not profit in EMS, explain to me why these private ambulance services are in business. It's not out of the goodness of thier hearts. Those trucks don't run on water, and the employees don't work for free. I guarantee you there is profit...and big profit to those who can run thier business right.

 

[K5MAR]

BoxAlarm187 wrote:

There ARE a handful of FD's in the nation that are doing non-emergent transports, but they're definately the exception to the rule. Why tie up a FD ambulance toting grandma from the nursing home for a check-up, when there are dozens of private services that could do this?

For the money! How my local FD does it. In addition to the duty ambulances at each fire station, my FD maintains two older units that are used for transfers, ball game standbys, or fill-in units if one of the duty units is sidelined. Local transfers are handled by on-duty firefighter-EMTs, out of town transfers are crewed by off-duty call-ins. May not be a perfect system, but it works, and the money made goes into the FD operating budget.

Mark S.