Why Are Firefighters First Responders To Medical Calls In Stamford?

[Gator596]

I don't like to make generalities, because every area is different.

True - but the trend of having FDs do EMS seems to be universal.

Then with the recognition of the importance of EMS in pre-hospital care, especially related to auto accidents, more and more fire departments began assuming a larger role in EMS, whether through first response or transport.

You know what happens when people assume...

Look at it this way: there are some cops who hate writing traffic tickets, they are others that live for it...the police department as a whole is still successful, though.

I understand the point you are making, but it unfortunately reminds of the other weird trend in FFing towards having FDs have an enforcement branch to write tickets for fire code violations. Don't get me started on THAT can of worms.

I'm lucky to work for a department that takes both firefighting and EMS equally serious, and work with members are able to (and want to) deliver both services exceptionally well.

The citizens in your area are lucky then - as long as the two agencies genuinely "play well together" in the FIELD (not just in the newspaper and at city hall) towards delivering good service. That does not happen everywhere.

I'm not looking at the world through rose colored glasses, and understand that are still departments in the US that don't embrace EMS strongly.

Its NOT just about how the FDs feel about it. Consider how EMS feel about it.

However, that being said, fire-based first response is still an important part of EMS today, for any number of reasons that one might decide.

Where it is needed and where it works, which is NOT everywhere.

 

[BoxAlarm187]

I understand the point you are making, but it unfortunately reminds of the other weird trend in FFing towards having FDs have an enforcement branch to write tickets for fire code violations. Don't get me started on THAT can of worms.

I'm interested to hear the viewpoint of fire code enforcement from someone who isn't associated with the fire service.

 

[Gator596]

I'm interested to hear the viewpoint of fire code enforcement from someone who isn't associated with the fire service.

lol... I said Don't get me started...
You have been very frank in discussing the EMS issue and I admire that, but I think (hope) there is more ground to cover on that issue before moving on.

 

[izzyj4]

Gator, having been in EMS for as long as I've been in the fire service (20 years) and also a certified 911 dispatcher, your "APCO equivalent" for EMS is what we use out here. And yes the card system we utilize have here are particularity accurate as our OEMS is very particular and made up of medical personnel, not politicians. There is a reason why CT was one of the first states in the US (along with California) to adopt such strict standards.

The "APCO equivalent" is the same set used by the majority of 911 centers in this state. Besides, APCo recommends the use of a particular set of card systems for liability reasons.

 

[BoxAlarm187]

lol... I said Don't get me started...
You have been very frank in discussing the EMS issue and I admire that, but I think (hope) there is more ground to cover on that issue before moving on.

I like your response. ;-)

One of your earlier responses was dead-on, which is my view of fire-based EMS versus non-fire-service EMS (using that term to encompass municipal service, third-party, and private services). I get the impression from talking to a lot of EMS providers that aren't associated with the fire service that there's a certain amount of fear of the fire service. Fear? Yes, based on the national trend of fire-based EMS, and the potential that their jobs could be threatened by a local government who's sold a bill of goods by the fire department that the FD can do the job cheaper, more efficiently, and better than the existing EMS system.

I think that this fear is very justified for some EMS providers, and not so much for others. There will inevitably be some FD's that will (or have already) assumed a primary EMS role in the community, and patient care has potentially been compromised in the interest of money. I completely disagree with that - if a community has an excellent EMS system in place, supported by the community, the hospitals, and is proven with a good ROSC rate (one of the nationwide benchmarks for EMS measurement), then it shouldn't be the goal of the FD to assume primary EMS role.

On the other hand, there are some excellent fire-based EMS systems in the US, that aren't constantly in the news for lawsuits and/or poor patient outcome.

Although I am a member of the IAFF, I don't support the times when it's agenda includes the absorption of EMS in a community where the EMS system doesn't need to be rescued. I think each community needs to be evaluated on it's own merits. There are as many crappy private/third party EMS systems out there as there are good ones. Austin/Travis County (TX) EMS is one the model EMS agencies in the US, as is Wake County, NC in my opinion.

I have a good friend who works for a large, progressive, well-known EMS agency in the US. His agency is being "encouraged" by the City Council to see what needs to be done to allow EMS to assume all first response, and knock the FD back to first response on cardiac arrests only. I'm keeping a close eye on this to see if/how it works out.

 

[Citywide173]

As a lieutenant in a large east coast fire department with very aggressive EMS protocols (all transport is provided by fire-service ambulances staffed by one FF/EMT and one FF/PM), I tried to stay out of this debate until now.

It's clear you have a beef with fire-based EMS first response, and that's your prerogative. However, making a blanket statement that only Seattle Fire has proven success with ROSC is completely inaccurate. My department in particular, through the use of hypothermic IV therapy, ALS first response on life-threatening emergencies, RSI, BLS-level application of 12-leads for early STEMI recognition, along with other protocols are resulting in ROSC percentages that mirror any third-party tiered system or private EMS provider out there.

I would further argue that we're not the anomaly, we're reflecting the more serious approach to EMS (both first response and transport) that fire-based EMS has taken over the past several years.

Couple of points here, and I'm really not trying to be a jerk, but I know I'm going to be labeled one.

I know I don't support the P/B or one medic one basic model of EMS strictly for liability reasons. Who do you confirm your meds with? Who do you bounce treatment ideas off of? Every paramedic has their own level of competency, and I'd rather take the odds of getting 1 out of 2 competent medics than the Russian Roulette of putting all of my faith into one. I don't know who's coming to care for me, but I know I'd rather a full ALS truck to a P/B truck. In fact, in most cases, I'd put my faith into a competently staffed BLS truck over a P/B truck.

As far as ROSC, that isn't the measured standard. The Utstein Criteria is. How does your system perform to that standard? Most agencies that point to their ROSC numbers actually perform relatively poorly when Utstein is applied to those same patients.

To those who say people don't stay in EMS, I've been an EMT 18 years, almost 15 in a third service municipal department. I have no intentions of going anywhere.

 

[BoxAlarm187]

Couple of points here, and I'm really not trying to be a jerk, but I know I'm going to be labeled one.

Not at all.

I know I don't support the P/B or one medic one basic model of EMS strictly for liability reasons. Who do you confirm your meds with? Who do you bounce treatment ideas off of? Every paramedic has their own level of competency, and I'd rather take the odds of getting 1 out of 2 competent medics than the Russian Roulette of putting all of my faith into one. I don't know who's coming to care for me, but I know I'd rather a full ALS truck to a P/B truck. In fact, in most cases, I'd put my faith into a competently staffed BLS truck over a P/B truck.

About a decade ago, our department took the step, at the behest of the county board of supervisors, to have an ALS provider on every suppression piece at all times. It took a few years, but we've now gotten to that point at least 90% of the time. Therefore, on life threatening emergencies, we're getting an engine with an ALS provider, plus the B/P transport unit. If the patient is especially sick, we'll grab the ALS provider off of the engine/truck to go to the hospital as a second medic. (if not mentioned earlier, we are a fire-based EMS transport agency).

Our system expects our basic providers to be very progressive in their KSA's...I can hand a 12-lead to most BLS providers we have and they can identify a STEMI. Maybe not a 3rd degree block, but at least they can give the P some help.

Our EMT-I's get 10% incentive, and P's get 15% pay incentive. Riding double P rigs for us would be quite a financial undertaking.

Our EMT-I's and EMT-P's operate under the exact same protocols (with the exception of RSI and chric), and very, very rarely have to consult with medical control for anything but cease resuscitation orders on a cardiac arrest. I think the last time I called a doc for orders was about 4 years ago for Geodon, which our protocols require an order for.

As far as ROSC, that isn't the measured standard. The Utstein Criteria is. How does your system perform to that standard?

My point about ROSC was it was one benchmark....I'll have to look into our comparison to the Utstein Criteria, I'm not sure.

To those who say people don't stay in EMS, I've been an EMT 18 years, almost 15 in a third service municipal department. I have no intentions of going anywhere.

I think one different you have is that you work for the one of the premier EMS agencies in the US. Even with many of the union and pensions issues that once existed in that city, it's still a good EMS agency to work for. I see the same thing with one of our well-respected 3rd party municipal neighboring EMS agencies...they've got medics who've been there for 20 years.

 

[ASTRO_Man]

Wow! I didn't know I would lure in 46 responses.

 

[CAR44]

Stamford

I am also a Stamford EMS Paramedic. As was mentioned earlier. We are not part of Stamford Fire Rescue Department. We are a not for profit organzation thats exists only to provide EMS to Stamford and by extension Paramedic service to Darien. That being said we enjoy a close working relations with all the Stamford Fire Departments. 2 of our units are stationed in fire houses and 1 SFRD engine ( Engine 9)is quatered in our headquaters.
We funtion as one team at the scene of an emergency. Our actions are seemless.
All requests for EMS in Stamford are processed using Emergency Medical Dispatch Proticols. If it is determined that a life threatening emergency might exist the computer aided dispatch systems indictes the closest fire engine (or truck or rescue) and both are sent similtaniously by radio and computer.
The FDs are almost all EMT's and are equiped with O2, AEDs and assorted BLS equipment. If they arrive first they start assesing the patient and providing BLS care and often continue assisting with care with the medic unit crew even when transporting the most critical patients.
If the medic unit arrives first and find they dont need the FD they can cancel the company responding.
EMS is a labor intensive activity. Having the extra hands on these calls means care starts as soon as possible. It makes removing the patient from the building is safer for everyone involved ,especialy the patient and alows care to continue while the patient is being moved to the ambulance.
Fire companies responding to EMS calls is nothing new Many departments have been doing it before anyone started calling it EMS. Milford CT, my home town, has been doing it since the 1950s. maybe even earlier. They used to call the resusitator calls.

 

[CAR44]

Wow! I didn't know I would lure in 46 responses.

You asked a good question. I hope you understand the system better now.

 

[Cskib32087]

This would be great in the CT- FIRE/EMS boards.

We all know Gary hates the FD and Bernie loves it.

Lets move on to scanner topics

 

[Gator596]

I like your response. ;-)

One of your earlier responses was dead-on, which is my view of fire-based EMS versus non-fire-service EMS (using that term to encompass municipal service, third-party, and private services). I get the impression from talking to a lot of EMS providers that aren't associated with the fire service that there's a certain amount of fear of the fire service. Fear? Yes, based on the national trend of fire-based EMS, and the potential that their jobs could be threatened by a local government who's sold a bill of goods by the fire department that the FD can do the job cheaper, more efficiently, and better than the existing EMS system.

I think that this fear is very justified for some EMS providers, and not so much for others. There will inevitably be some FD's that will (or have already) assumed a primary EMS role in the community, and patient care has potentially been compromised in the interest of money. I completely disagree with that - if a community has an excellent EMS system in place, supported by the community, the hospitals, and is proven with a good ROSC rate (one of the nationwide benchmarks for EMS measurement), then it shouldn't be the goal of the FD to assume primary EMS role.

On the other hand, there are some excellent fire-based EMS systems in the US, that aren't constantly in the news for lawsuits and/or poor patient outcome.

Although I am a member of the IAFF, I don't support the times when it's agenda includes the absorption of EMS in a community where the EMS system doesn't need to be rescued. I think each community needs to be evaluated on it's own merits. There are as many crappy private/third party EMS systems out there as there are good ones. Austin/Travis County (TX) EMS is one the model EMS agencies in the US, as is Wake County, NC in my opinion.

I have a good friend who works for a large, progressive, well-known EMS agency in the US. His agency is being "encouraged" by the City Council to see what needs to be done to allow EMS to assume all first response, and knock the FD back to first response on cardiac arrests only. I'm keeping a close eye on this to see if/how it works out.

That sums it up!
Thanks for your candor. It has been rare (in my experience, anyway) to hear a FF tell it like it is on this subject.

 

[Gator596]

This would be great in the CT- FIRE/EMS boards.

We all know Gary hates the FD and Bernie loves it.

Lets move on to scanner topics

Done;
Scanner listeners will be able to spot the phony Paramedics / EMTs and/or the presence of a “stat race” between EMT services and FDs by the following
- The first service to get on scene makes it a point to tell dispatch they are “first in” and when they have made “patient contact”.
- The FD comes on the air a few minutes after going on scene asking to confirm that EMS has been notified.
- EMS comes on the air and cancels fire attendance at a call. You then hear fire attend anyway. Sometimes still with siren on in the background.

 

[izzyj4]

This would be great in the CT- FIRE/EMS boards.

We all know Gary hates the FD and Bernie loves it.

Lets move on to scanner topics

We could add this to the ongoing thread about the city too you know!!!! ;-)


Oh that would stir the pot up real good!