Comments on: Fire Based EMS vs. Private EMS

By: Dean

Dean — Thu, 03 Nov 2011 14:23:49 +0000

First, I would like to say that the article is well done and stimulates good discussion. My opinion of the purpose of this well written essay was to shed light on the fact that the public and private sectors serve or could serve vital rolls on their respectitive EMS system. That they may be even being able to work together. In fact, they do and should under any model in order to fulfill our purpose to the sick and injured.
There are hundreds if EMS models that are currently in place and most that participate in those EMS models would show some form of bias as to which is better. The fact is when profits, union jobs, tax subsidies, fees for service, and contractual agreements are involved, the complexities of where one would stand on these issues is certainly relevant. After reading the article and the responses to the article it still leaves me with the tone that it will be difficult for change because there are two camps. The fire unions vs. privates. Both have their deep seated motives to advance their cause. I know in our system it would in the best interest of the fire based EMS professionals to work with the private services. The tax payers have had enough, the tax wall is a pond us, so now what. One other little tid bit that should be brought out from my team position. In our area the 911 areas are exclusive to one service designation. The non-profits charge, the fire services charge and the private’s charge. I hope you see my point here. The non profits and fire services are no different than the privates. In a sense, they are full scale competitors, ALL after MONEY. My camp often here’s this, “those dirty private profiteers. making money off sick people”. Come now, really! My emotional come back could be. “How much does your exact same service cost, that’s right, three times more”.
I will end with this. This article suggests that we all can work together. I agree with that to a point. There are currently more needs for service than any of us can provide. Another words, there is plenty of business for all of us. We can argue forever who is better, has a better response time, the best price, and so it goes. I vote for both advocating a working relationship amongst all parties involved. This puts us all on the side of the angles when being there for some in need of ambulance service.

By: BoxerRob

BoxerRob — Fri, 09 Sep 2011 22:15:22 +0000

Save a couple of wonderful exceptions, EMS systems are driven by the EMT’s. Fire brass, ambulance managers. Not exactly Wharton School of Business/Mayo Clinic doc kinda people. I’ve worked military medic, private ambulance medic(3), fire service, and hospital RN. And Pizza Hut manager while in college. Guess which gave me the best skills in system management? Extra cheese please. First and foremost, civil authority must regain control of the fire services. They are wildly independent and self serving. So, no I can’t kumbya. The fire chief must report to the mayor every morning, hat in hand. Christ, in my city the Batt Chiefs carry guns. No commission/permits. They just do it…get my point?

By: Robert

Robert — Mon, 06 Dec 2010 23:49:55 +0000

The fire based EMS model could work, but normally it doesn’t. The idea is great, but look at whats going on. Talk to the firefighters that are being “forced” on the ambulance. If you don’t know any, read the discussions by firefighters in a fire-based EMS system at firehouse.com. The problem is simple, fire departments are so caught up in absorbing the ambulance service for their own security, they forget the most important part…making it work.

By: Joshua Barkley

Joshua Barkley — Mon, 20 Sep 2010 01:06:06 +0000

I see it as a limited point of view. x or y..In our area, neither is sufficient. I find it amusing that Private paramedics are viewed as Privates while they are certified and regulated by the state. I find in concerning that Private Corporations have free reign over taxpayer money. Fire Departments that are delivering emergency transport are losing money across the board. Fire departments generally do not view EMS Transport as part of thier job and the “continutiy of care” position was over before it started. Both are on scene at the same time and it’s not a matter of continuity of care, its a matter of manpower and resources. The days of the 1.5 million dollar truck with chrome rims, repsonding to grandma’s fall injury are nearing the end. I would think, for the best interest of all, the whole system should be scrapped and realigned. EMS should have it’s own government Branch, as does Fire and Police. The money should be regualted and put back into the system for improved performance. Standards should be raised and Providers should have the same or better benefits than the people the work on. EMS is it’s own culture and it gets pulled on from all sides, strictly to use the revenue to support less needed but more expensive programs and services. County wide systems with good oversight, ALS ambulances with State certifed medics recieving a prevailing wage and benefit package. Good working relationships with Fire Departments that respond in appropriate vehicles with appropriate manpower.

By: Sean Fontaine

Sean Fontaine — Wed, 11 Aug 2010 02:53:21 +0000

Drew,
I admit it there are those guys, I’ve worked w/them and I’m one of the firefighters who happens to love medicine. However, I’ve also worked w/medics who only went to p-school to get a raise due to poor pay in private EMS. There are also the ones in both fire based or private EMS that no longer care, but don’t move on and find another job. The unfortunate reality is that there are the ones who only do it for the pay every where, and there in lies the faults in all the systems.

By: Drew

Drew — Mon, 09 Aug 2010 00:30:14 +0000

I have to agree with what AJ is saying. Whether you want to admit it or not, there are plenty of fire fighters who only view EMS as a necessary evil. That, in my opinion, is what keeps fire based EMS from ever being the perfect model. Do you really want someone who views EMS as job security for their “real job” taking care of your loved ones?

By: AJ

AJ — Thu, 05 Aug 2010 06:56:47 +0000

I don’t have any answers, but I think two things are important: 1. Places are different – so there probably isn’t a system that will work best in both Prairie City, SD and Manhattan. They have different needs in terms of coverage, response, call volume, etc.
And 2. I think it’s important the people be allowed to do what they want to do. I know some fire-EMS services require everyone to be fire and everyone to be EMS, which means working shifts on engines and working shifts on rescue. I think that’s bad for EMS. Now, if someone whats to be a ff-emt, or ff-medic, that is awesome, more power to them, but if you just want to be a ff and you get stuck working rescue once every two weeks, that means for that shift, some patients are not getting the best care. It also means if i want to work EMS, they’re going to have fool behind a hose. I a not interested in fire science, and don’t want to learn about it, and wouldn’t make a good fire fighter because of that.

By: The EMT Spot » The July EMS Roundup

The EMT Spot » The July EMS Roundup — Wed, 04 Aug 2010 18:00:35 +0000

[...] Here When You're Ready To Head Back To The Home Page Previous Post: Fire Based EMS vs. Private EMS [...]

By: michael

michael — Tue, 03 Aug 2010 13:39:14 +0000

We need to return EMS to Emergency Medical Services. People legitimately need rides to the hospital. either they are unable to do so themselves or have no other way to get to where they need to go. Sending a rescue vehicle with lights, sirens and all the bells and whistles like we do in Providence is a waste of time, money and a danger to the community.

In my opinion, Fire Departments are the best answer for emergency response, simply due to the strategic placement of qualified help. Transport is another service altogether.

Proper triage is the answer. And proper resources for either non emergency transport of critical care. Taxpayers should not be on the hook for every ride to the hospital. The public needs to know the difference, and be confident that the proper response is on the way when they call for help. I’m tired of taking non critical, or even barely injured or sick people to the ER while critical patients wait for a help because all of the available responders are busy taking intoxicated people to the ER for the tenth time this week.

So, to sum up this rambling rant, Fire Department for crisis, not because we are any better than anybody else, we are not, but because we are in better position generally to get to the victims faster, and private companies for transports. Some privates are better equipped for critical care transports, that is their forte’ and they should get the call.

Thanks for putting me in the July Roundup, I appreciate it. I’ve been waiting to put my two cents in here, but time flies and before I knew it a week had gone by.

By: Sean Fontaine

Sean Fontaine — Tue, 03 Aug 2010 02:43:17 +0000

Way to stir the pot on this one. I’ve worked both private and fire based EMS, both agencies alongside one Steve Whitehead. Both systems had their strengths and faults. I haven’t been employed by a true third party system, but I’ve worked in one as a paramedic student. I believe as well that all parties involved in pt care need to advocate for and support one another; my snotty caveat to this however is that I believe both within my agency and those outside of it should not only be trained to the highest standards, but should maintain their skills to the highest standard at all times. This stems from my belief that the pt doesn’t care that you don’t have high acuity/call volume or that you run 2 calls/day or that home life has been hectic and you couldn’t reread your cardiology about fasicular blocks lately, when they need your help they’re depending on you to recognize and treat what is causing their Sx, not just give them a high speed taxi ride w/an IV.
That soap box aside, people dial 911 and don’t expect anything more than top level medical care, they don’t look @ the graphics on or color of our rigs they just know that someone shows up to help them.
I like Justin’s idea of non-profit EMS, because I hate patients trying to refuse in the face of death due to not being able to pay and my explanation that I could care less about finances and only about getting them the care that they need at that moment, the reality is I don’t see the bill either way, they do, so what kind of a bastard am I selling this story. The reality I’ve seen over the last 10 years though is that, medicine needs money, there is poor at best state/government remittance on services rendered. Our systems need to operate more seamlessly from one to another, but where does this dialogue begin and how I don’t know. Far from an answer my idea of the perfect system (which just by calling it that creates faults within it) is one w/progressive protocols, a pt forward/advocate position, takes pt finances into account when billing, and has a seamless flow from BLS-ALS (if needed)-transport (if needed)-receiving facility and trust from one level to the next throughout that chain to avoid the 2 steps back @ each hand off.
This is a great topic, one filled with more uncertainty than answers.