Why Are Firefighters First Responders To Medical Calls In Stamford?
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N1SQB
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Help is help!
When I worked for the State in the courthouses to be exact,when we called 911, 9 times out of 10 the FD got to the scene before the Medics. I never saw any difference in the level of care. We never, in the almost 10 years I was there, had any incident or issue with someone suffering or getting worse because the FD gave less than adequate care. We were glad to see someone, anyone, PD,FD,EMS, arrive to assist. Same goes for my personal family. If I am in need, or heaven forbid my wife or one of my kids are in need, I will be glad to get any and all help regardless of what department they are associated with. Help is help! Just my opinion!
Manny
When I worked for the State in the courthouses to be exact,when we called 911, 9 times out of 10 the FD got to the scene before the Medics. I never saw any difference in the level of care. We never, in the almost 10 years I was there, had any incident or issue with someone suffering or getting worse because the FD gave less than adequate care. We were glad to see someone, anyone, PD,FD,EMS, arrive to assist. Same goes for my personal family. If I am in need, or heaven forbid my wife or one of my kids are in need, I will be glad to get any and all help regardless of what department they are associated with. Help is help! Just my opinion!
Manny
radioman2001
Member
First a little background on Stamford EMS. My brother in law is a Paramedic there and has been there since they opened their doors in 1986:
Most of the the big businesses that are now located in Stamford came from the NYC area. They were used to the level of prehospital care that their employees received in NYC, apparently they received a rude awakening when they moved to Stamford. (Stamford in the 60's,70's and early 80's was to some extent a slum.) The entire city was undergoing a transformation, and that's why these businesses had moved there. Through the local chamber of commerce these businesses came up with a plan to introduce the same level of care, namely Paramedics that they had in NYC. The city said they could not afford to provide that level, so the businesses created a not for profit organization, (Stamford EMS) that had it's own Paramedics and fly cars, actually suburbans. The not for profit was funded by these businesses for about 10 years total, even though the city was supposed to take it over after 3 years. The Paramedics had some early problems with the local hospitals but eventually proved themselves.
Originally the Paramedics who were stationed in the local firehouses would respond together with a FD ambulance, since the fire department ran the ambulance service,so after the Paramedic treated the patient the FD transported. There were also some volunteer ambulances that did transports too.
There were a few times that Stamford EMS was going to be disbanded because of money, but the hospitals stated that they would not accredit any other agency to cover Stamford, so eventually money was found. About 10 years ago Stamford EMS was disbanded and absorbed by the FD.
So to sum it up, the Stamford Paramedics are actually FD employees, and the FD runs the ambulance service. That's why FD is dispatched with the Paramedics.
There is also the other reasons of having extra manpower,response times, and it looks good on paper to show how many calls the FD did when budget time comes around..
Most of the the big businesses that are now located in Stamford came from the NYC area. They were used to the level of prehospital care that their employees received in NYC, apparently they received a rude awakening when they moved to Stamford. (Stamford in the 60's,70's and early 80's was to some extent a slum.) The entire city was undergoing a transformation, and that's why these businesses had moved there. Through the local chamber of commerce these businesses came up with a plan to introduce the same level of care, namely Paramedics that they had in NYC. The city said they could not afford to provide that level, so the businesses created a not for profit organization, (Stamford EMS) that had it's own Paramedics and fly cars, actually suburbans. The not for profit was funded by these businesses for about 10 years total, even though the city was supposed to take it over after 3 years. The Paramedics had some early problems with the local hospitals but eventually proved themselves.
Originally the Paramedics who were stationed in the local firehouses would respond together with a FD ambulance, since the fire department ran the ambulance service,so after the Paramedic treated the patient the FD transported. There were also some volunteer ambulances that did transports too.
There were a few times that Stamford EMS was going to be disbanded because of money, but the hospitals stated that they would not accredit any other agency to cover Stamford, so eventually money was found. About 10 years ago Stamford EMS was disbanded and absorbed by the FD.
So to sum it up, the Stamford Paramedics are actually FD employees, and the FD runs the ambulance service. That's why FD is dispatched with the Paramedics.
There is also the other reasons of having extra manpower,response times, and it looks good on paper to show how many calls the FD did when budget time comes around..
It's fair to say that some areas are well served by qualified FFs who either flat out "do" medical calls from start to finish or who can credibly stabilize a patient or otherwise assist for a dedicated EMS crew.
In other areas - not so much. In fact, in some places the FD are fooling the public and their political masters into believing they are more medi qualified and equiped than they really are by going on lots of runs and giving victims oxygen and a few compressions before the ambulance arrives to take over.
In the end it boils down to "your mileage may vary".
In other areas - not so much. In fact, in some places the FD are fooling the public and their political masters into believing they are more medi qualified and equiped than they really are by going on lots of runs and giving victims oxygen and a few compressions before the ambulance arrives to take over.
In the end it boils down to "your mileage may vary".
Why? Politics, not medicine. The truth is that the greatest benefit to first responders is that they can provide CPR and an AED before the ambulance gets to the scene. Other than that, there is absolutely no science to show that first responders have any benefit in patient survival. Even the benefits of early Oxygen administration to patients is coming into question as several studies have shown that high flow Oxygen has significant downsides in terms of patient survival as well as mortality and morbidity.
Still, the FD will continue to be sent because they give the appearance of doing something of value.
Still, the FD will continue to be sent because they give the appearance of doing something of value.
rexgame
Member
Lifts and general assistance, extra set of hands comes in handy, ever seen a police unit respond to a medical crisis? Same reason. Heck in the Northeastern U.S. a good deal PD's send their kids to EMT.
Then of course, politics. If a kid goes into shock at 8 minutes and dies later, and a fire truck was 5 minutes away and an ambulance 10 minutes away, the municipality doesn't want to be stuck with a wrongful death claim asking why the fire dept didn't help (these are usually brought ignoring the fact that a fire truck isn't an ambulance).
Then of course, politics. If a kid goes into shock at 8 minutes and dies later, and a fire truck was 5 minutes away and an ambulance 10 minutes away, the municipality doesn't want to be stuck with a wrongful death claim asking why the fire dept didn't help (these are usually brought ignoring the fact that a fire truck isn't an ambulance).
Very interesting point of view.
Even if as you suggest, the Fire Dept ONLY responds to lend the 'appearance' of doing something of value, I'll take it. I suppose if I was the one hit by a car lying in the street, or having a heart attack, I'd rather be at least comforted by my fellow hose jockeys and I would be convinced they're doing something of value, while waiting for an out of position, or overtaxed ambulance that is more than likely, tied up somewhere else.
Your statement contradicts itself. I am sure you could find study after study that early defibrillation saves lives. All those fire engines carry AED's.
In my experience of being both a paramedic and fire guy, the more dramatic 'saves' are generally by the AED and not all our fancy ALS gear. A team of firefighters with a jump kit and an AED can make their way to a patients side (say on the THIRD floor) LOOOONG before two EMS guys load up their 75 pounds of ALS gear onto their stretcher, lumber into the lobby, find the elevator, wait for it, ride up, and join their firefighter brethen at the patients side.Then once the EMS crew gets up to that third floor patient, it's awfully nice to have some of those same hoseheads help carry the 75 pounds of ALS gear, the 300 pound patient, and the 120 pound stretcher down to the ambulance...
I wont argue the oxygen issue, you're probably right on that one...
There are also studies that show taxicabs have a better patient survival rate than transporting ambulances.
I think you may be able to see the point.
bernie
The problem with that is manpower and costs....where do the two people in the smaller squad come from? Are they pulled off of a pumper to handle the EMS call? If so, what happens to pumper? Is it out of service, while the rest of the crew is at the station waiting for the other two to come back? That doesn't seem too efficient, and you're still taking the entire pumper out of service.
One the other hand, if the two on the smaller squad are in addition to the already existing pumpers in the department, then you are increasing costs to the city (2x additional personnel times the number of shifts (usually 3 shifts) plus the costs of a squad truck (around $75K, plus at least one spare)) . So, sending an engine with a full crew is BOTH more efficient and more cost effective than a separate squad....unless your town has a whole lot more money than my city does.
Two agencies racing....... Umm im not sure where your from but we have this wonderful thing called districts & that department which covers that district gets the call its not freelancing all over the county & so that puts one firetruck & one EMS unit o/s to every medical call & most other calls for that mater & im pretty sure thats probably how it works just about every where!
Not to forget i think its a nation wide mandate that one FD & one EMS unit is dispatched to medical calls together & if not it should be its personal safety & then if you get there & have something completely different then what came over dispatch ( which happens constantly ) you have enough personal to handle the seen until more units can arrive
But i have never herd of agencies racing to pick up a call & i would bet that it never happens in the fire service, & EMS i know from experience that private EMS company's will jump county or department EMS for the fact there closer or right on top of the call also they will do it as mutual aid! But we don't race to the scene to get the run so we get more money & it don't even work like that funding is based off about 30 factors not just run numbers
Nate - I'm glad to hear everything works well where you are from. It's not like that everywhere. Stats play a big part in some areas.
As opposed to funding for more ambulances which means you'd get actual treatment and transport more quickly. Interesting take, form over function.
Not at all, I specifically said that the only proven treatments were CPR and AEDs. So, sending the closest first responders, be they FD or PD or Water and Sewer, makes sense. Sending first responders routinely for other medical emergencies doesn't.
We beat the FD in to scenes about 60% of the time in my system. A big part of that is because the city has funded expanding the service over the past several years. More ambulances = shorter response time.
Not to mention the wear and tear on fire apparatus that was never designed to be operated the way it has to in a medical operation. Or the danger to the public (and the fire fighters) sending 60 foot ladder trucks to calls for babies with a fever.
I wouldn't know since again, other than cardiac arrests, we dismiss the fire and use our BLS personnel to assist us.
No, I'm definitely right. Check the newly released AHA guidelines on cardiac disease, cardiac arrest, and stroke. I can provide other references by PM if you're really interested.
Please cite them. The only one I'm aware of is from Malaysia, done in the 1990s and related specifically to injuries from motor vehicle accidents. In fact, it showed that patients who were not immobilized on back boards did better than those that were. It was also a retrospective chart review, so limited in value.
This is amusing, so I'll bite.
If whereever it is you work, ambulances are beating neighborhood based fire units 60% of the time, it has to be a volunteer fire system. There are very, very few places in the United States, let alone the world, that there are ample ambulances, and in career communities firehouses are generally well spaced out.
It sounds like you also work in a system where they do not have EMD, hence you cite Ladder Trucks going to sick babies. In the majority of Fire Systems in CT I know of, the Fire First Responders go to Life Threat type calls, "Charlies" , "Deltas", "Echoes", or "ALS HOT" whatever system they tend to use. While you're on being fiscally responsible, and not sending the $1M Ladder to sick baby, why are we sending a $200K ambulance with paramedics to the same call? Send a freakin' taxicab!
Sure it's dangerous for fire trucks to run RL&S through the streets, it is for ambulances as well. Plenty of ambulances kill plenty of people in traffic accidents all year long, that statistic is not held only for fire trucks.
The whole system is broke, not just the fire side.
When you say "we dismiss fire and use our BLS guys", again I think you're referencing a volunteer system. Most urban, paid (commercial or muni) systems only have two people in an ambulance, driver + technician. Again, in many of the fire systems, the hoseheads (term of endearment) are those "BLS guys".
More Ambulances would equal more disgruntled EMS workers in my experience. Sitting on the side of the road "posted" doesnt really make for happy employees. I am not sure about your experience, but in mine, many EMS workers migrate on to Fire, Police, and Nursing jobs. There aren't a whole lot of people who 'retired' after a full career in EMS. Haven't seen too many people say they're quitting the PD or FD to become a full time paramedic. Just doesn't happen.
Form versus function? I would take dual role, crossed trained firefighters any day as a municipally funded, Public Safety Readiness Model. If you are simply worried about cost savings, then of course you balance out your private ambulance 911 costs on the backs of all the transfers the service does as well, to offset the lack of payors in the 911 system.
At the end of the day, as we probably both agree, it's all about money. If a city wishes to pay for career firefighters who also assist on EMS calls, thats a good thing. If a city pays for a bunch of ambulances, or a commercial service works on it's profit margin while serving a city, hey, that's the American way.
I saw that Malaysian study, I would tend to agree, toss 'em in an ambulance and haul 'em to the hospital, chances are you wont make their broken spine any worse..
Bernie
How do you mean "never designed to be operated the way it has to be in a medical operation"? In fact. operating a fire engine on an EMS call is actually LESS wear and tear than on a fire. The mode of response is the same...over the same streets and the same conditions regardless of whether it's an EMS call or a fire.
If the fire engine is operating at a fire, it's engine is running at high RPM's (powering the pump or other equipment) for an extended period of time, or idling for longer periods of time than if it is at an EMS call. The whole "wear and tear" issue isn't an issue at all.
The pumpers in my city are in first line service for 10 to 15 years, operating fire and EMS calls. We keep them in first line service 5 to 10 yeas over NFPA recommendations. Hardly sounds like going to EMS calls is killing our apparatus.
Nope, major east coast city. BLS crews usually do about 10-12 calls in an 8 hour shift. Blows the whole UHU thing out the window.
Nope, we use the APCO equivalent of EMD. Those "card" systems aren't particularly accurate, not that they were intended to be. They were designed to be repeatable and defensible in court. That's true not just in my system, but in many around the country.
Fear of liability, politics. Take your pick.
Only the fire trucks aren't necessary on most medical calls, especially ones that they are sent to.
Yep, but sending fire trucks isn't going to fix it, although it might mask if for a while.
Once again, assuming facts not in evidence. Tiered, third service system, not volunteer.
I'll be retiring in the not too distant future, along with a bunch of other guys who started back in the late 1970s or early 1980s. I'll grant you that a lot of people leave EMS, but that's changing. Not as fast as it should, but it's changing. We had over 300 people apply for about 20 jobs in EMS. Must be something to it.
Those are the worst from a patient care and survival standpoint. With the exception of Seattle, fire based systems have the worst cardiac arrest survival rates. They also have the highest rate of litigation. Houston, Dallas, Chicago, are all frequently and successfully sued. I think it was Chicago that lost a suit because they didn't have working batteries in their monitor/defibrillators. Dallas and Houston are pretty routinely sued for paramedic initiated refusals.
We don't do transfers, but we make money.
C Spine immobilization is over used in the US. Not only that, but there is a growing body of evidence that it not only doesn't do good, but it often harms patients. Elderly patients in particular seem to be harmed by immobilization, but even healthy young people suffer neurological injuries from the process, not the original accident.
As a doctor I know frequently says, "Half of what we know is wrong, we just don't know which half."
Im glad it works out here to response time in my area is 4 to 6 mins & some EMT or higher is o/s & saving your life..... Generally it's the FD & EMS shows up a few mins later
KB1JHU
Member
Stamford EMS is not part of the FD or a municipal agency. They are still a not-for-profit organization.
Stamford EMS Home Page
Stamford EMS
Ok. For the record, I am a full time paramedic for Stamford EMS, which is a not-for-profit third service agency that is the sole provider of 911 ambulance service in the City of Stamford, and the ALS intercept provider for the Town of Darien. We are the ONLY transporting 911 service within Stamford. That out of the way, I am very much a fan of SFRD's and the volunteer departments first response in Stamford on calls. The level of enthusiasm and care provided by the individuals showing up has made the difference on many of my calls, whether routine or truly emergent. As a value-added service, first response BLS from the fire service in Stamford is a win-win for all concerned, in my opinion. Have there been differences in opinion on both sides at scenes, have people bumped heads, do egos come into play, and is first response needed on all of the calls? Boy, we could hash this one out for hours. Bottom line: it works, people benefit, and fire availability does NOT suffer.
Ok. For the record, I am a full time paramedic for Stamford EMS, which is a not-for-profit third service agency that is the sole provider of 911 ambulance service in the City of Stamford, and the ALS intercept provider for the Town of Darien. We are the ONLY transporting 911 service within Stamford. That out of the way, I am very much a fan of SFRD's and the volunteer departments first response in Stamford on calls. The level of enthusiasm and care provided by the individuals showing up has made the difference on many of my calls, whether routine or truly emergent. As a value-added service, first response BLS from the fire service in Stamford is a win-win for all concerned, in my opinion. Have there been differences in opinion on both sides at scenes, have people bumped heads, do egos come into play, and is first response needed on all of the calls? Boy, we could hash this one out for hours. Bottom line: it works, people benefit, and fire availability does NOT suffer.
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.
So what was going on before the more serious approach?
I don't like to make generalities, because every area is different. However, there used to be a lot of firefighters who were hired before EMS was any part of a firefighter's job, aside from an auto accident or assisting the EMS folks with a lift assist. 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.
However, a lot of firefighters in the late 70's and 80's weren't as quick to embrace EMS as their department's administration, instead making statements that they weren't nurses, they didn't want to go to heart attacks, etc. However, if you look at those personnel who've been hired in the past 20 years, most of them have never known the fire service without EMS being a part of it. Now, I'm not going to pretend that all modern-day firefighters fall all over themselves to deliver EMS, but medical care hardly still has the stigma that it once does. 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'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. 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. 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.
Different subject: related to some of the previous questions in this thread, many fire engines are carrying all of the same equipment and drugs that the ambulances are, and are staffed with at least one advanced life support (ALS) provider. This allows the engine company to start invasive medical care prior to the arrival of the ambulance, which is common in many areas of the US.
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