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What happens in Las Vegas EMS plays out on TV. Firefighters make case private ambulance company is playing games with response times. AMR says it's proud of its record.

In Southern, Nevada some firefighters are keeping close tabs on the private ambulances they deal with every day. In Clark County, Las Vegas and North Las Vegas there are concerns that American Medical Response (AMR) wants a bigger piece of the EMS pie than they currently have. Firefighters are making the case AMR isn’t do a good job under its current contract.

AMR General Manager Mike Gorman told the Las Vegas Journal-Review, “AMR is disappointed with what we believe are unfounded political attacks of distortion by the Fire Unions to drive its agenda and to take away private sector jobs. We are extremely proud of our EMTs and paramedics. Our EMTs and paramedics serve the citizens and area professionally, honorably, and provide excellent clinical care.”

The article by Alan Choate includes statistics on response times and this explanation on the current EMS set up for the three jurisdictions:

 The three jurisdictions involved have a dual-response emergency medical system. When a medical call comes in, teams are dispatched from the nearest fire department, and a private ambulance is dispatched too. The fire department’s response time goals are faster: four minutes to eight minutes.

The system allows fire department ambulances to return to duty instead of having to transport patients to the hospital, which can take up a lot of time. But if a patient is in need of immediate care, the fire department will do the transporting.

Here are excerpts from a lengthy article by the I-Team from KLAS-TV:

“I can tell you, point blank, we have no interest in trying to privatize the fire department out of EMS. We value that relationship,”said John Wilson with AMR.

Firefighters are expected to respond within six minutes at least 90 percent of the time. It’s twice that figure for AMR, 12 minutes 90 percent of the time. If they arrive late, they can be fined.

“There are multiple times we see them arrive in 20, 25 minutes, 24 minutes. We don’t know. We can’t control them,” said Hurley.

“It is 4,687 times for the first six months. That is documented through the Ambulance Oversight Committee, that AMR and MedicWest have basically told the committee, ‘We were late this amount of times.’ So, it isn’t the union saying it. It is their records that we are using,” said Fletcher.

But, firefighters say it’s worse than that, alleging the companies play deadly games to make it look like they arrive in 12 minutes, so they can meet the standard of 90 percent.

They showed 8 News NOW records from 911 calls where AMR’s dispatch switches the designated ambulance two or three times in the middle of a single call. They say that restarts the clock. We were also shown cases where the company dispatchers change the address they are seeking, so it looks like a new call, and they can arrive in time. On some occasions, the unions say, the companies call off the fire department by claiming they are already on the scene even when they aren’t.

In one instance, a nine-year-old boy was in respiratory arrest. The ambulance company called in to say it was already on the scene and told the fire department it wasn’t needed. The firefighters kept going anyway. When they arrived, they found no ambulance on the scene.

Comments - Add Yours

  • http://ems12lead.com Tom B.

    Serious allegations. If true AMR has some explaining to do.

  • DC Questions

    The games people play. The unionized firefighters play games, the privatized ambulances play games, and the volunteers play games. Make everything open. Publish it real time to the web – scrubbed of names, exact medical complaint, apartment numbers, and the last two digits of the address. Make a downloadable so that anyone can analyze it.

  • Mike

    Sounds like a redundant system. They should do away with the private “scab” bus.

  • Taxpayer

    It seems silly to pay bloated public firefighter salaries and pensions to do a job a highschool dropout with an EMT license could do. Ambulance work is one step above driving a taxi. As budgets get tighter, expect more firefighter’s unions to lie, cheat and steal to keep their extra, non-firefighting (but dues-pating) positions. With Obamacare coming, it may be possible to operate an ambulance at a profit – fire unions have had a free ride doing a job no one else wanted. The free ride is almost over – it’s about to get ugly.

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  • hosemonkey

    So,let me get this straight a contractor/scab bus and a FD/Union bus take in the same call….Easy solution for the Union, TAKE THE DAMN CALL!

  • Jake

    Simple, strip away all the PR blurbs.
    1) Private sector’s bottom line is money.
    2) Public sector’s bottom line is service.
    3) Who would you have treat your family?

  • Ted

    The system is very redundant, and very expensive.

    Fire first response is a great thing, but responding in medium-duty fire dept. ambulances, then not routinely transporting – crazy!

    The private, for profit option is cheap for the city, but obviously corners are being cut to boost profit margins. The fire servic response is fast, but super-expensive. LVFR paramedics, last I checked, are making over $70k a year.

    This syyetm needs a private, non-profit, EMS provider to handle 100% of transport with ILS fire first response to Echo, Delta and Charlie calls. The non-profit model is more efficient and less costly than the government option, but avoids the pitfalls that come with keeping the profits up for the share-holders.

  • Taxpayer

    >2) Public sector’s bottom line is service.

    Hahahahahahahahahahahaha, ROFL. The public sector’s bottom line is: at the top – get reelected. at the bottom – don’t get fired.

    If you “Jakes” were in it for the service, you wouldn’t have bunks or loungers in the firehouses — hell you wouldn’t have firehouses, you’d be out “serving” the public for every hour that you collected a paycheck for.

  • FMCH

    The easiest thing to do, is to get rid of private ambulance companies, and make transport all FD. Right now, the private company just stands around on a fire scene or MVA. If the crew on the ambulance are dual trained FF/EMTs & FF/PMs, then you get more people on scene who can work in the “hot zone” as opposed to standing back, watching the action.

  • ME

    @ Ted,

    The private NFP is not a cost effective option. Where I live, we have one. Each year the county government continually gives them bailout money. In fact, the joke here is that the local ambulance provider is the AIG of our county.

  • Anonymous

    People have to ask a serious question to themselves. What are the core government services. If you believe that welfare and free Metro Bus is above Fire/EMS, then you get rid of the Fire Department.

  • Gadfly

    FMCH, if the ambulance is at a fire scene, then who’s going to respond to EMS calls? This is, of course, the standard flaw in EMS based fire suppression. The claim is everyone is just sitting around, but if the fire department runs full on EMS (and, for the record, outside of cardiac arrest, which should get the closest emergency unit INCLUDING having police cruisers equipped with AEDs, one service should provide all of EMS, be it the fire department, third service, private company, or other method), then they either need to down staff fire units and tie EMS crews up at fires, or higher more responders (but isn’t the supposed benefit of the fire service the responders are already hired, just sitting around?).

    Of course, it doesn’t help that the US Fire Administration (1) and the IAFC(2) are proudly against higher standards for EMS providers. 9 month medic mill paramedics are perfectly fine for them.

    Maybe what needs to happen is do away with the private “scab” ambulances, the fire based “scam” ambulances, and do a third government agency where no one is forced to ride on an ambulance and additional units aren’t sent where the only purpose is to cook the run number books.

    (1): http://www.usfa.dhs.gov/_images/nfa/higher_ed/ems_pyramid.jpg
    Yep… the fire service doesn’t even believe in properly educated EMS educators. Apparently an associates degree is just too hard, even for the educators.

    (2): http://www.iafc.org/associations/4685/files/ems_NtlEMSeduStandardsSectionComments070731.pdf
    Note page 2 where “we support education unless it takes time and/or money” and “diversity is more important than competence.”

  • Fyrecapt

    Say taxpayer what kind of work do you do?? Just curious. Because last I checked I pay a crap load of taxes every year for services in my community and for illegals and others sucking on the teet..Would you be one of those??

    You can make all the arguments you want, but the fact remains the FD is some what like an insurance policy for your home and family. You call and we will be there with bells and whistles on, willing to do anything to save a life…including yours.

    Maybe take a second, and learn what it is Firefighters really do and what it takes to do this job. It requires more than just a HS diploma.

    Either way, your statements show the ignorance you have in regards to public safety.

    I will say that unions have a different outlook on certain issues, but as a whole, Firefighters do this job to serve the public…whereas For Profit companies like AMR are looking at their bottom line. We had AMR here in SO.CAL but their response times where horrible.

    Good luck

  • Stuart

    EMS is not a one stop shop despite EVERYONE’s attempt to make it so. There have been progressive fire departments who wanted to be part of EMS from the get go, but there are tons of departments who wanted nothing to do with it until they needed a reason to justify their positions. There are privates that are trying to get by cutting corners to make more money. However, there are some doing it right and making a difference without the inflated government budgets.

    It doesn’t matter if it is the fire union or a private company. Anyone who is pushing “stats” on TV news pieces has an agenda. It might be legit or it might be they are looking to get ahead. Either way, no one is ALL right or ALL wrong.

    I work for a fire department now but I worked for a private years ago. The private operated without government funding and at a profit. We had fewer ambulances and maintained a “no more than” level of medics that kept skills sharp. Guess what? We had a higher cardiac arrest save rate than bigger fire departments. We used advanced skills and sophisticated protocols. Now, I do less with dumbed down protocols and have a lower save rate…but we got a lot of medics.

    There is no silver bullet to make great EMS…regardless of what the IAFF tells you.

  • Stuart

    @ FMCH

    I have worked on “a box” for 17 years as a volunteer, private, government 3rd service, and as a fire department employee. You know how many times I felt that being in the “hot zone” made a difference in patient care? I can’t even get to two hands thinking about the numbers. Do you know where the “action” is going to happen? On the way to the hospital 99% of the time on the medical calls that make up most of EMS runs….Or on the way to the hospital with the trauma pt who needs to get the heck to surgery instead of playing on the scene. Further, how many complicated extrications do you think fire departments make a year where more than BLS care is required until the pt is removed from the car?…and don’t count IVs because a 1000cc’s of saline or a 32 oz soda’s worth of fluid is not making a great difference in a patient who has internal bleeding and needs blood and surgery.

    My point is patients need to get out of hot zones and on the way to hospitals. I don’t care if the medic is cold, hot, or otherwise. He/she needs to know what they are doing and be good at it going down the highway. Whether or not they are wearing blue, red, white, or bunker gear makes no difference.

  • Nonprofit… NOT

    AMR left Aurora Colorado after many of the same allegations.

  • Yea

    It’s easy to rip the private company that makes a fourth of what you union thugs do from you’re firehouses while the private workers sit in gas station parking lots waiting for the next call…the notion that a firefighter (making roughly 70 grand a year) is “in it for the service” and a 12 or 18 dollar an hour emt or paramedic is “just in it for the money” is boldly laughable. Criticize the ceo’s and union leaders all you want, but to criticize these people that work their asses off for 12 hours a night in outdated, uncomfortable trucks waiting in the darkness for the next call is absolutely pathetic.

  • Yea

    “It seems silly to pay bloated public firefighter salaries and pensions to do a job a highschool dropout with an EMT license could do. Ambulance work is one step above driving a taxi.”

    High school dropout and EMT? That really doesn’t make much sense. But if you think you’re cabbie has the medical knowledge to keep you alive, then, by all means. Moron.

  • Taxpayer

    @gadfly: I appreciate the links. Where’s the evidence for increasing the educational requirements for EMS providers? I know that paramedics would like to be as ‘professional’ as R.N.s, but, is there evidence for this ‘medicine’?

    @FyreCapt: I run my own small business, and pay taxes that support all those who “suck on the teet (sic)”, firefighters included. I am quite familiar with what firefighters do. In this region we have a few departments, employing 1000s of firefighters who respond to 10s of fires. I understand that you view yourself as an insurance policy, and you’re not too far from the truth. When there’s a fire, we need 15, or 30, or 60 firefighters to respond in a timely manner. They cannot respond if they’re sitting on the scene of a diabetic, or transporting a sick person.

    None of the fire departments on this region require anything more than a GED and a clean record to get hired, or, in many cases, get promoted to fire chief (or deputy).

  • Joseph

    The same outfit(AMR) was the sole provider of EMS in Reading Pa when they decided in the middle of December of 2000 that they weren’t making enough money and dropped the city leaving the city to put together EMS service in 2 weeks. The FD took over the service and brings in 300K-400K profit a year. Private for profit do not answer to taxpayers they answer to shareholders. By the way “Taxpayer” ia a retard.

  • Fyrecapt

    Yea: I used to work private ambulance before I was hired as a firefighter, so I am very familiar how the privates operate…A sad but true statement is that the privates are in it for the money..They are a business!! Any business owner will tell you, its the bottom line otherwise why be in business, too loose money, NOT SO MUCH!! Most of the EMS systems have gone to FD because of issues with the private co. response times. Yes, pushed by unions but wouldnt you want someone at your door in less than six minutes? My quess is most of would. I know I do, thats why I am ok with paying taxes that support such a system.

    Blame the CEO’s for allowing that to happen. Remember, they are looking at profit not response times.
    Also remember that in certain parts of the country like California, the fire depts started the paramedic systems, not the privates. The reason for the “posting” at gas stations is because they run short all the time and need to post units to cover certain areas. I know how it works. Posting has been around since the 80′s. Its just away for private ambulances to not staff a lot of units in order to make a profit-FACT!

    Taxpayer: How are the FF’s sucking on the teet if they are working and paying their taxes? It would be different if they weren’t paying up..but we have all walks of life trying skip out on paying, including small, medium and large business’s/corps.

    I will agree with you, in some regions all that is required is a HS diploma/ged. However, there is a large portion that require more then that. Yes, still a blue collar job, however in today’s fire service that is just un-realistic.
    And, yes there are those times when a fire may break and the fd is treating a diabetic. But the same could be said about the FD being on a fire already and another fire breaks..What then?? We send other units. Whether it is a medical call or fire, we have stations strategically placed for those reasons.
    Ambulance co.’s do not have that capability when they get busy. They rely on the FD to cover them for their long response times.

    To say that a EMT/FF/Paramedic is equal to that of a taxi cab driver is way off base. These folks usually have a college education and are responsible for peoples lives..and do a great job at it. Most of the population would never do what these people are willing to do.

    While some are paid well and others not, its the same in all types of jobs.

  • mark

    AMR used to be johnny-on-the-spot by me. Excellent response times.

    The last couple years? Not so good.

    The last 6 months? They suck. They turn over more calls in our area than they respond to. Every bus has a supervisor and they’ve even started with just a EMT-B and paramedic instead of always, always, without fail having 2 medics.

    So, I could believe this.

  • Gadfly

    @Taxpayer: To be honest, increased education requirements would also lead to increased scope of practice and looser controls. One of the problems when looking at EMS is that a ‘mother may I’ system designed for medic mill medics should show similar outcomes for educated paramedics and mill paramedics, however a system designed for educated paramedics can put the mill paramedics in a position to be dangerous. However, there are several things we can look at. First, compared to the rest of the developed world, US education requirements are a joke. No place else are you going to find the lowest responder capable of transport (EMT in the US) with a minimum education of 110-120 hours of training (with the exception of, IIRC, Tennessee who’s base level is the EMT-IV) or the highest general level of responder (paramedic in the US) being less than a year of training with the only prereq being CPR and EMT certification. There are plenty of mill programs that don’t even require a proper anatomy and physiology courses (be it both a separate anatomy and physiology course, or A/P 1 and 2).

    The next closest place to look for the benefits of education is nursing. Unlike EMS which works mostly off of a standard set of standing PRN orders and phone orders (“protocols”), nurses work off of an individualized care plan along with department orders. However, both have the option to call the physician for orders if they recognize that the patient needs care not currently provided in the treatment plan(some systems give more leeway for paramedics, I believe this is a good thing provided proper education). However, the provider still needs to recognize the need before they either initiate the appropriate care in the more liberal protocols, or request permission in more restrictive protocols. Here’s one study that shows that increased nursing education decreases mortality in surgical patients.

    http://jama.ama-assn.org/cgi/content/abstract/290/12/1617

  • Ted

    @ME: Point well taken, non-profits often do receive some level of subsidy from government for providing EMS. I have seen the subsidy as high as 50% of the EMS agency’s budget and as low as 5% too….it should be tied to call-volume and payer-mix.

    That is, if you have a high call volume and good payers, then you need very little subsidy or none. Low call volume or a lot of medicaid and private pay – a lot of subsidy is needed.

    I stand by my assertion that the LV Valley is operating a system at extreme ends of the financial spectrum. AMR, low wages, for profit, cutting corners on deployment to increase profit margins, poor on-time performance. And, the 3 predominant fire based providers (N. Las Vegas, City of Las Vegas and Clark County Fire), are very expensive from a labor stand-point, operate $200k medium duty ambulances, and rarely transport a patient. If a 4 person ILS engine is on the scene of a cardiac arrest, do you really need a LVFR ALS ambulance and 1-2 AMR or MedicWest ALS ambulances all responding?

    Meet in the middle, fire does ALS or ILS first response with engines and ALS transport is accomplished by a non-profit contracted EMS agency that receives slight subsidy…say 12% of their operating budget.

  • MedicMorgan

    Where are you people from? GED’s for firefighters let alone Chief Officers? Our Dept is conducting a nationwide search for a Chief with requirements including at least a Bachelor’s degree in fire science and management, at least 10 years experience as at minimum Captain in a “Progressive” Dept. EMT’s and Medics High School dropout work? Taxpayer where is this region? Please tell me so the Beverly Hillbillies don’t show to my door if I have a heart attack. I work in a fire based EMS service and its the most efficient model I’ve worked in. I read duplication of services. Is sending 2 sometimes 3 MICU’s to an ALS patient efficient? Every firefighter is trained to either EMT or Paramedic and saves the other buses for other calls. Not sending an ambulance to a fire scene are you F@#%king kidding me. If a firefighter is injured God forbid seriously who’s treating him? EVERYWHERE I know of sends at least a BLS truck to fire scenes(career or volunteer). We’ve never experienced a shortage of fire apparatus because of medical assists. To Yea I feel your pain my 1st job was with an outfit like that. When the bus on the far side of district got tapped out we would have to go to a mid-point which was road salt stockpile and sit there. We ran in junk at times taking trucks OOS because we would run out of reserves. We would take non-emergency transports(at times every truck) because they were the guaranteed money and leave Emergency calls to mutual aid. Thats the reason I’m against some not all private providers because they truly do look at their bottom lines and service comes 2nd. The poster above sums it up.I’ve done my share of time in several systems and call it what you want but the Fire based system allows the most trained personnel to be sent while not sending your entire fleet of ambulances to a 400lb cardiac arrest. If you don’t need the fire apparatus you send them back easy as that. Good luck all which ever model you receive.

  • CBEMT

    Sounds like a redundant system. They should do away with the private “scab” bus.

    The system is very redundant, and very expensive.

    Fire first response is a great thing, but responding in medium-duty fire dept. ambulances, then not routinely transporting – crazy!M

    It is a redundant system, and the LVFD wants it that way. They take the “good” calls and shove everything else off on AMR/MW. Those alleged 24-minute response times only happen because LVFD sits onscene waiting… because the patient can afford to wait. If it was anything “cool” LVFD would have transported long ago.

    They’ll still use the 24 minutes as a scare tactic when they need to, but they know its meaningless.

    Gotta have medium-duty trucks too, so they can feel like “real man” firefighters. Imagine if they had to run in F-450 boxes like our local urban-area firefighters. The horror!

    The fire servic response is fast, but super-expensive.

    The service is only fast if LVFD decides you’re worthy of it. Otherwise they’ll sit there all day waiting for AMR, all the while telling you how much AMR sucks.

    Right now, the private company just stands around on a fire scene or MVA.

    Exactly where the FD wants them. If its an MVA, the patients are “trauma” and therefore “worthy” of the FD’s attention (and billing). If its a rescue from a fire, that’s a “good call” too, so we can’t let AMR have that either.

    If the crew on the ambulance are dual trained FF/EMTs & FF/PMs, then you get more people on scene

    IE, more dues-payers, since we already know the reasons for having a paramedics-stuffed agency can’t possibly be improved outcomes, since the data shows the opposite….

    who can work in the “hot zone” as opposed to standing back, watching the action.

    And how close, exactly, do you think EMS providers at a fire scene should be, considering the “hot zone” as you so dramatically call it, actually IS hot? Be they firefighters or otherwise, EMS coverage personnel at a fire scene can’t help with the fire, nor should they. Their job IS to stand around. At best, they should be setting up for rehab.

    The FD took over the service and brings in 300K-400K profit a year. </I

    But wait, I thought the public sector was all about service??? LOL

    private for profit do not answer to taxpayers they answer to shareholders.

    Don’t kid yourself. What do you suppose your contract would look like if you REALLY answered to the taxpayers?

  • MedicMorgan

    That 300-400k is a couple years old. Whats wrong with a service making money. Water,Sewer,and Parking Authorities make a bundle and they’re a service right? The point is there are always 5 ALS and 4 BLS in service at all times not taking non emergency transports. Yes private for profit answer to shareholders I’ve lived it. Contract? You’re probably right and the 12-18 dollar amount would be pushing it. With that being said no one would pay a dime until they need us including you.

  • Taxpayer

    @Joseph: you seem to have made a typo. FTFY: “By the way “Taxpayer”, I’m a retard.” As for Reading’s problems, perhaps they should have had a better bond, contract, or similar.

    @FyreCapt: Firefighters are on the ‘teet’ (as you spell it) when they are toes-up watching football, washing their cars, preparing an elaborate meal, or collecting $70,000+ pension to do a $35,000 job.

    Bottom line is that, even with a healthy 20% profit, two $35k EMTs (well paid for a HS job) can make 5-8 transports in an 8-hour day. At more than twice the cost, you’d be hard pressed to find a system of firefighters that can. Maybe at a few of the busy stations, but jurisdiction-wide, for every station that uses their staffing well, there will be 2 stations that pays their guys to hone their XBox skills.

    It’s highly unlikely that the FD will be busy on another fire. Any FD. It is *expected* that they’ll be on an EMS call. Any FD. That’s the difference. If your county expects 100 EMS calls a day, you need to have staffing to handle 100 EMS calls. EMTs cost less than half of what FF/EMTs cost. Why hire $70+/y firefighters to handle those 100 calls a day, when we could hire $35/y ambulance EMTs? When the EMTs don’t have a union that will make them work 24h shifts? When, because they’re not on 24h shifts, they can be expected to work the whole time, instead of spending time in a bunk? Where they can run a call for every hour they’re at work?

    The fires don’t happen often. The FD has to be able to handle the first fire well, and the second fire *acceptably*, perhaps not as aggressively, or by using mutual aide. OK, because it might be years before most FDs have to fight two fires at once. For larger jursidictions, maybe they have to fight the first two well, and punt on the third one. In any case, very few urban areas can afford to rely on firefighters who are assigned to ambulances — they’re just too busy. I’d rather see fewer “firefighters” on the rolls, if it mean that the ones I had to pay for were very likely to be available. Give me 80 firefighters on duty on fire trucks not doing EMS rather than 100 firefighters on duty, 30 of which are on ambulances, and 20 of which are on fire trucks at EMS scenes waiting for ambulances.

    @ME fire departments are 100% subsidized.

    @Gadfly: again, thanks for the links. You’re saying that the reason Paramedics don’t make a difference is that the studies that say so aren’t looking at systems with good Paramedics. If we had a system with good Paramedics, would it make sense for them to spend their time spraying water into dumpsters? Would a hospital with good nurses use them to perform housekeeping, or nutrition duties? How about having these nurses do rotations as security guards, and when the ED/floor got busy, pull them from security duty to use as nurses? Probably not.

    @MedicMorgan. I don’t know of any jurisdiction that requires its BLS firefighters to have anything more than a GED (except those places that require EMT or state certification as a FF). Most big FDs promote from within, and only rarely require the chief to have more than what he had to get hired.

  • Gadfly

    @ Taxpayer: I think there’s several issues, some of which are completely outside of the scope of this discussion, especially now it looks like you’re bringing the efficacy of paramedic care into question (which is valid, but not entirely limited to FD based or not). A few issues that is directly related to FD based systems (and the handful of police-based and public safety based (EMS/PD/FD combined)) is the problem with too many hats (which comes first, fire suppression or EMS when it comes to training? How much information is needed, and can you be an expert in EMS AND something completely unrelated outside of lights and sirens?), too many providers (best example is intubation. Too many providers chasing after too few tubes leads to bad outcomes), and many departments forcing people to be fire fighters (If I somehow became FF2 certified, got hired as a fire fighter, and made clear that the only thing I want to do is EMS and showed complete contempt for anything fire related, would you trust me with your back in a fire? How many medic fire fighters feel that way about EMS? Why does the fire department trust the public’s medical care to them?).

    Some are more system wide. How important is the relief of suffering? The vast majority of patients, even critical patients, in urban areas could take a taxi and be no worse off. However pain and symptom management is a large, albeit often overlooked, part of providing good medical care. Morphine doesn’t save lives, but I’ll bet it meant the world to most patients who received it. The asthma patient in an urban setting would be no worse off if instead of waiting 5 minutes, s/he was just loaded into a car and driven to the ER, even if the drive took a few more minutes. However getting nebulized albuterol a few minutes earlier than otherwise would have occurred probably means the world to that patient. Similarly, higher education and standards means more treatments can be pushed out into the field. CPAP has been around for almost 30 years, why is it only in the past 5 or so years that it has really started being used prehospitally? With additional education, we might be able start introducing destinations outside of the emergency department. However, as long as the standard is 9 months for a paramedic and 110 (I believe the new standard that is being phased in by 2013 is 150, which isn’t that much more in the grand scheme of things) hours for EMT, the question is how much latitude can be given to the average provider?

  • frogfinger

    Get to stockton ca, where over 50 percent of firefighters get over 150,000 per year. When they had transport duties, a captain could drive one, without even an emt rating, and get 1200 bucks for a 24 hour shift with no calls run.How long can working people afford this type of service.

  • Taxpayer

    @frogfinger: Well, just like most of the paid firefighters I know, those who can afford the time to commute move to areas with cheap or volunteer fire departments.

    @gadfly: I thought you had brought up efficacy. My argument is for inexpensive, efficient, largely single-role EMS personnel. If a case can be made for a few “high-end” personnel, why not just hire a PA? or a NP? or even a MD? I haven’t seen much concrete evidence supporting the need for Paramedicine, despite all the effort from the industry overachievers trying to justify their career choices. Face, it for the price of a relatively senior firefighter / medic, you can buy a Physician’s Assistant. (Median $88,000, no pension. Total employment cost for a Prince George’s County Firefighter is north of $125,000)

    Fire departments have a large amount of “production capacity” in search of demand. They should focus on preparing for, preventing, and responding to emergencies; especially emergencies that no one else can handle. Most of EMS isn’t emergency. In fact, most of EMS isn’t even medicine. For the 20% of EMS calls that might be emergent, send the Fire Department, if they’re faster. Otherwise, shift resources from the fire department to cheap and plentiful BLS ambulances. Control costs using a utility model, or some form of competition.

  • MedicMorgan

    Taxpayer I’ll ask again WHERE IS THIS REGION THAT DOESN’T AT LEAST REQUIRE HIGH SCHOOL GRADUATION FOR EMS WORK?

  • Joseph

    The reason AMR left Reading is because the money making transports dried up.

  • Taxpayer

    @MedicMorgan the blog is hosted in the Washington DC area. Back in the day when I was considering a career in the Fire Service none of the large jurisdictions around DC (DC, Montgomery Co., MD, Fairfax Co., VA, Prince George’s Co., MD, Baltimore City, MD, etc. required anything more than a GED and a clean record. From what I hear, nothing has changed. Points for being a resident, a woman, or a protected minority. Do you know of any jurisdiction that requires more? I know the florida departments usually require state certs, but no college. As for straight EMS jobs — not sure if you even need the GED, just an EMT card and 18 years of age, but I always had better options than working for a transport service. Thankfully, I had better options than working for the FD, as well.

  • MedicMorgan

    Taxpayer What ambulance service allows individuals without a minimum of EMT to be primary care providers even if its BLS?

  • Taxpayer

    @MM. GED to hire, EMT to stay employed by the public.

  • Fyrecapt

    Taxpayer: First, I am NOT a proponent of Fire based EMS transport. I have worked on both sides of transport and would rather let the private co. handle that end of it. Specially when MOST patients do not pay. That is a fact!

    I also agree with you that it is highly unlikely that most FD’s will have back to back fires occuring at the same time. It does happen, but correct, not often. Furthermore the county/city or whoever should staff accordingly to the amount of calls they will run.

    However, private ambulance companies across the country just dont operate like that. Again, it comes down to cost vs. profit. Less units staffed, means less overhead being paid out. Run short, lots of calls = more profit.

    Come on, a PA/MD, Really? For someone who says they once considered a fire career, you know as well I, that EMTS/Paramedics do make a difference. Yea, not all calls are emergent, I’ll give you that. But, you cant sit there and tell me that we should have PA’s or MD’s over Paramedics. And $88K is the first yr wages for the PA’s. I have a few friends that are PA’s and make way more than that.

    I have been in this feild for 20yrs and can honestly say I have seen lives saved because there were paramedics onscene quickly. Concrete evidence?? How about the lives that have been saved over the last 30 yrs?? Studies are ALWAYS Skewed for a certain agenda..Yes even the Unions studies.

    Yes there will always be those “overacheivers” trying to justify their existance, but that goes for all industries.

    The reason for Fire based EMS is simple. In most parts(not all)FD response is less than 6 mins on avg. compared to 12-15 mins for private/3rd party response.
    Most americans want the “insurance” policy that someone will show up quick to help them. Tell me. Wouldnt you want someone at your door within six mins rather than 12/15 mins? I think you would.

    If there is a better system, I am listening…

    As for the education piece; Yes, there are still some parts of the country that dont require much to do this job, even in good ole California. But, as a whole most are requiring more. A lot more than just a HS diploma. Try A.S./B.S. degrees for some. And in Calif. you have to have a HS diploma, EMT cert and Criminal background for employment for any EMS provider-public or private.

    By the way, EMTS/Paramedics in the private sector are part of a union. Some belong to the AFL/CIO. So that whole bit about privates not having a union to fight for them is crap.

    Listen, I will admit. My career has been great. It has allowed me and my family to enjoy a comfortable living, no question. But I am not getting rich doing this job and I dont know of anyone who is.

    What I dont understand is why is everyone pissed off at Firefighters???
    Why are people not pissed at corporations who dodge taxes or get HUGE tax breaks??? CEO’s making billions for playing xbox/golfing/buying Yachts..Come on! Sports players making bank…Without any form of education, getting arrested all the time for drugs/ domestic battery etc. And they are the role models our kids are emulating, Nice!

    At least I am trying to make a difference and not just talking about it.

    Taxpayer, what is the solution?? Do you have a feasible one? Lets hear it.

  • Stuck in the middle with you

    Those who claim that the public sector is all about serving the public….yeah right…maybe thats what the fire chief thinks…but the average Joe is worried about his pay check…why else would he join the bloated over-bearing union? EVERYONE…EVERY SINGLE PERSON involved is worried about the bottom line. The politicians, the taxpayers, the private companies, the patients and the fire fighters. Its all about the money. Why else would fire departments who have long avoided EMS service, now suddenly want a part of it? Cause there is money to be made thats why. When I was running a private service in the early 80s, we charged just $60 for a routine transport….you have any idea what they are charging now? A hell of a lot more than that I can tell you. A recent BLS ambulance ride of just 3 miles cost me over $700. Holy cow, I need to get back in the business!

  • Fyrecapt

    Stuck in the middle: I love how everyone thinks All FF’s are making over 100k a yr. News flash….Most FF’s throughout the country are making less than 80K a yr. Yes there are those of us that make more, but its the minority.

    Yes, every Tom Dick and Harry is worried about their paycheck. No question. And if you are one of the lucky ones that is fortunate not to have to worry, well then good for you. But the rest of America isnt so fortunate.

    I love the Over bloated Union comments. Please, what about all the large Corps and CEO’s making millions of dollars.. Why arent you screaming at them to pay up??

    Some FD’s have avoided EMS for a longtime-true. But many have also been providing it for a very long time. There is NO money to be made in EMS! IT IS A LOOSER!! Most people do not have insurance and Medical/Medicare doesnt pay anything anymore. So where is this money that is being made?? Ambulance Co.s make their profit from Interfacility transports.

    Most of the FD’s that transport are barely covering their operating costs. If they are making a true profit, I would like to see what they are doing different then most. I have worked in that type of system in a community that was wealthy and the Dept barely broke even.

    Look, if you have a better way, let us hear it. I am sure there are thousands of City Managers that would love to hear how you could save them money by reducing/elminating operating cost for public safety.

    If you guys/girls are so passionate about what FF’s make in pay, why arent you out fighting for better pay/benefits for our troops who barely survive on what we pay them and who are dying everyday for their beloved country???

    Well??

  • Anonymous

    1. AMR was here in Richmond VA and they were horrible….they were paying ALS provides minimla amount of money for running alot of calls.

    2. I WISH firefighters were making as much as you claim….that way I wouldnt have to work 2 jobs, and my wife wouldnt have to work 2 jobs to make ends meet. We do nto live extravagant lifestyles either I do not have an HD TV or a new car…we are a walmart family and still struggle to pay the bills on my extravagant FD salary

    3. @ Taxpayer you have no idea what goes on in the FD….just because you wanted to get on the FD once (probably couldnt hack it anyway) means you know ZERO and your bitterness is typical of a wanna be but never could. One it takes a minimum of a High School dimploma to get hired on, it takes alot more than that to get promoted. Fire Chief jobs take Masters degrees. Second getting a Paramedic cert. in VA takes 2 years and passing a very difficult series of testing and countless hours of hospital rotations. Once certified you have to recert every 3 years which you have to take time in classes in order to get the hours.

    4. Sure we are not always going to fires but we are always going on calls. The City of Richmond FD has gone on 8 fires in the past 3 days….and while companies were operating at those fires other companies were running countless EMS calls through outt he city. Sure we take a break everyonce in a while but we work for 24 hours at a time….I can not tell you the last time I got a full nites sleep in a fire station I might get a nap but typically we are up several times after midnite while most are asleep in bed. @ taxpayer you may run your own “small business” (Head Chef at Mickey D’s doesnt count) but does anyone wake you up in the middle of the nite to deal with your “small business” issue? How many Christmas eves or Days have you worked? We may doze but we never close.

    Bottom line is it may not be perfect but Fire based EMS is the best system right now….Just ask Jhonny, Roy, Dr. Brackett, and Dixie

  • Stuart

    @ Fyrecapt

    There is money in EMS for Fire Departments. The money is not what is billed and recovered. It is in budgets, salaries, and positions. You and I both know it. That is why the IAFF is the biggest pusher for Fire/EMS.

    I work for a fire department but I am just being honest. I worked for a private in another state. We were pushed out by the IAFF and fire department. Why? They wanted a new deal. City told them they didn’t compare because they didn’t do EMS like the cities they were mentioning in the talks. So, a year later they pushed out the sole provider of EMS in the city’s history to “provide better care and service.”

    EMS pushes numbers. It pushes call volumes, individual station stats, and personnel requirements.

  • Fyrecapt

    Stuart: Please! Be serious. It is a loosing proposition to have FD transport..More is lost than ever taken in-fact. Look at cities that transport, they have to hire bill collectors and put leins on patients because of the very low collection rate. Especially in todays economy, imagine what is being lost compared to what is being paid out. Now, those cities that have a “subscription” service are staying above the water so to speak, but barely.

    Yea our beloved union(IAFF)pushes transport, but only for one reason-staffing. Budgets and Salaries are way beyond want is ever recovered from transport. It was a way to push for positions when cities/counties where slashing budgets.

    You mentioned Depts in your area pushing Privates out. Thats because one of two things most likely occurred.
    1)The Fd was not responding to medical calls and needed away to justify their existance or
    2)Staffing was being threatened.

    I, like you have worked both private and public. There never ever has been money made in EMS transport. Its the other contracts that follow for the privates that make the money. FD’s use this as away to justify staffing and existance. I am and never was for us transporting. We loose way to much money and waste positions on ambulances.

    In my region, most of the fd’s have been involved in EMS since the early 70′s-So we really didnt have many depts sitting around waiting for fires. The depts that werent responding already were the ones that had issues and had to sign agreements with the privates.

    Again, I support my union/IAFF. I dont agree with everything they do either, and this is one of those that I dont agree with.

    Each group involved in this industry will always have evidence/studies/reports to back their claims that their way is better. They are ALL skewed to work in their favor. Its the american way!

    I will say this. For those depts that are slow to get into EMS or did within the last 15yrs, you better find other ways to save positions, because transporting is not the answer.

    Thanks for your opinions!

  • ltfd seattle

    The most important issue for an EMS system (of any type) is a strong Medical Director supported by State or County legislation.

    The second most important issue for an EMS system is to collect data, analyze the data, adjust your operations, repeat.

    Each region/political jurisdiction will, of necessity, staff or structure their EMS system differently. The only thing that truly matters (for the citizens) is an operation designed to optimize patient outcomes with the resources available. All of the arguing and chest-pounding does nothing to benefit the patient; patient survival is what matters.

    http://www.emsworld.com/print/EMS-World/The-Resuscitation-Academy/1$13744.

  • Jake

    Taxpayer, it may come as no surprise that myself/Jake and the other “Jakes” are also taxpayers. That being said, I will point out that my argument stands despite your “argument” that fire fighters working EMS calls is based in a wasteful/self-interested motive. You support this reasoning by pointing out there are beds in firehouses and a GED suffices for employment. At the risk of the “idiot’s dilemma” (whether you win or lose, you don’t look good fighting an idiot), I will expand:

    1) Private sector’s bottom line is money.
    Profit is the entire basis for private sector EMS delivery. Without a profit, private companies pack their bags and hoof it out of town. I have witnessed just this scenario, a city of 80,000 being left to scramble as the company beat feet.

    2) Public sector’s bottom line is service.
    If the public sector did not adequately serve the public, change would take place. Note the most recent election, ballot initiatives, etc. In fact, fire departments are consistently rated as the top government service in almost every jurisdiction. Perhaps all those other tax payers are not as superficially insightful as yourself?

    3) Who would you have treat your family?
    The recent decade of bank loans, million unit vehicle recalls, drug recalls, etc. prove the inadequacy of profit regulating service. In fact, as a small business person, I imagine you are familiar with the need for profit and, necessarily, what costs may be trimmed to ensure a profit. I can’t imagine many people would choose that their family’s well being is one of the costs trimmed.

    I am also curious whether your GED qualification argument applies to members of the armed services or members of police departments? They are also public sector agencies charged with providing for the protection of the public. I’m pretty sure there are still bunks in barracks and some service personnel have honorably served their entire careers without fighting a war.

    Gotta go cut the grass – Jake.

  • Fyrecapt

    Let me be clear. Even though I have been a fireman for 20 yrs and worked as a private Medic prior to that, I believe either system can work. It just depends on the area, the cost and what works well for that particular region.

    Some areas, like mine (west coast) benefit more from FD EMS. The Privates just cant provide the coverage/ETA’s like we can But there are regions where private Ambulances may be a better option. Again, there are many variables that play into it.

    Some how this blog took a turn into FF’s salaries. While some FF’s do make six digit salaries, they are the anomaly. Most FF’s in this country have to work 2 jobs to make ends meet.

    For those of you like to whine about our salaries, or FF’s playing xbox, etc. You better do more research. Fire stations/Houses are being browned out or closed at record pace across the country. It has even caused the deaths of several people including a child choking on a piece of candy that was 2mins away from a fire station that had paramedics until the city closed the station…It took the ambulance 12 mins to get there. Guess what happened to the child? Yea sadly he died-needlessly.

    So again, I ask you. What are you doing-beside paying taxes, to help with situation??

    Put up or shut up! Be part of the solution not the problem. Quit trying to attack the salaries, when you have no basis for your claims.

  • Fyrecapt

    It meant to say the Private Ambulances just cant provide the coverage or ETA’s like the Fire Dept. Thats why most of So.Cal has FD medics and not private as the first responders on calls. Our eta’s are generally less the 6 mins.

  • Gadfly

    Fyrecapt, do the private services not provide the coverage because they can’t or aren’t required to? If the only influence affecting fire department response times (I’m honestly not sure how ISO rankings play into it and it if so, it acts as an extra incentive to push down response times) was the same response mandate made to the private ambulance services, then how likely would the 6 minute response time be, or would the fire departments simply not receive the funding to achieve it? Similarly, isn’t the only outcome based response time less than 4 minutes, where as the vast majority of response times are irrelevant to final outcome?

    Also, if So. Cal. is so great, why is the system (which is largely FD based paramedics, regardless of who transports) such a ‘mother may I’ system?

    Finally, one thing (which I have to give the IAFF credit for) is that this debate is not JUST FD vs privates as it’s being framed. Are not third government agency just as service driven as the fire department? Also, don’t all services have to make a “profit” in the sense that they have to make at least as much money as they spend, be that money made by reimbursement or tax dollars?

    What benefit does a properly funded fire department based EMS system have over a properly funded third government agency EMS system? Similarly, if the FD complaint about public safety agencies (EMS/FD/PD cross trained providers) is too many unrelated hats to wear, how is EMS any similar to fire fighting than law enforcement? True, traditional fire fighting has nothing to do with carrying a gun and arresting suspected criminals, but it also has nothing to do with interpreting an EKG and intubating a patient.

  • Fyrecapt

    Gadfly: Without getting into a long drawn out response, the Privates are required to provide ETA’s that meet the county EMS systems requirements, which usually consult with the local Fire Chiefs for advice.

    This was/is politically driven to keep a tight reign on the privates. Several counties in Calif had numerous yrs(the 90′s)where it took ambulances 15-20mins to get to a call. So, many FD’s began tracking ambulance response times. This ultimately made the privates staff more units,which in turn put a serious dent in their profit margin.

    Also for Fire Depts that didnt already have Fire Medics, used this as away to get medics on their engines-i.e. more staffing.

    While the privates where mandated to meet these ETA requirements, the FD’s are not. Simply because there are a lot of cities and counties that staff their FD’s with career FF’s that respond quickly.

    And I dont believe I said SO CAL is great. I said that Fire based EMS works best for us. And yes, there are some counties that are mother may I, but most are on standing orders like the rest of the nation.

    I do believe everyone in this industry is service driven in one way or another. Otherwise they would not have choosen this career path. And You are correct. All services need to make a “profit” in some sense to operate, no question. But the difference being privates have share holders driving their operations.

    Like I said earlier. Not all regions will benefit from FD based EMS. Some are better served with private or third party services.

    The FD’s complaining about wearing too many “hats” are the ones that must of just started doing EMS within the last 15yrs. I have never had a problem doing EMS or Fire suppression.

    I have seen great FF/Medics and not so good ones. Similarly, I have seen great Private medics and have seen some not so good ones as well.

    Peace..

  • Taxpayer

    Re: physician assistant salaries. Salary survey = $88,000 median, all PAs, not first year. , google it. They probably make more in SoCal, but then so do FFs. And they don’t get the same bennies. I can read a budget, and have never seen a jurisdiction where a firefighter didn’t cost more to employ than a median PA. Much less a FF/P.

    Re. Cops: answer: legalize drugs. And yes, many cops could be replaced by security guards. Cops have to write reports that make convictions, do many jurisdictions require 60 credit-hours.

    Re Military: we spend more than the rest of the world combined, to defend our shores from enemies separated by at least sn ocean. No reasonable federal budget wouldn’t cut military spending. That bring said, I salute those who serve the country. Many of them have no more education than a GED. Many of them have a bunk…..but they work 80-168 hours a week for 1/4 what a CA FF makes.

    Anecdotal horror stories are just anecdotes. Just like saying I ate my mom’s bean soup and it cured my cold. It’s not science, and it’s not good enough to make budget decisions on, much less life or death decisions on. A firehouse being open might have saved a life. How many CPR classes could be taught for the cost of keeping a firehouse open? Heck, for $1M, you could PAY 10,000 new parents $100 each to take a CPR class. In any case, I’m not arguing for closing firehouses, I’m arguing for getting expensive firemen off of ambulances, and not using EMS runs to justify more fire units than are necessary for fire protection. (if you can use fire company’s idle time for EMS without adversely affecting response time, fine)

    How am I a part of the solution? I post on these forums, and let my elected officials know that nothing on the budget is sacred.

  • Fyrecapt

    TaxPayer: I like the google answer, that was perfect. like I believe everything they say or print?! Just like everything else, I take it with a grain of salt.
    I wont debate the PA salary as each region pays differently, some more than others. I will disagree with you on the basis that FF’s cost more than PA’s. Again, not ALL FF’s make what West Coast FF’s make.

    That isnt what I think, its what I know. I have friends that workout throughtout the US and trust me, they are far from making 80K a yr. They work two-three jobs to survive.

    And you are right, public safety takes a huge part of a jurisdictions budget.

    Security guards over police officers? Seriously? Last few security guards I came into contact with could barely speak english, let alone read or write!

    Our Armed forces do a great job at protecting our freedom, everyday. We are loosing kids to roadside bombs daily, yet WE will not pay them what they are worth?? GED or not, they are doing something most of us would never do-die for someone else.

    Taxpayer, I am in total agreement with you. Take Firemen off the ambulances. I was never a proponent of that system. However, FD’s all over the country respond to EMS calls daily without affecting fire response times.

    Speaking from experience, the private ambulances can never make a 6min ETA like the FD’s can. Even with strict requirements, the privates would rather pay a fine than have to staff more units in a day. Again, that is in this region. I wont and cant speak for your region.

    And I really dont want to debate about response times and if they really affect a persons outcome in the end.
    I dont know about you, but I sure dont want to gamble with my families lives, betting on what a study says. Again, they are ALL flawed, including the IAFF’s! They have agendas.

    I want that “insurance” policy, how could you not?

    Last time I went to my city council meeting was a joke. We were GIVING money away to organizations that really had no business asking for money. I was shocked at the line of people going to the podium to speak. CRAZY!!

    And we scream at public safety’s budgets..lol

    You know the funny thing? Those that bitch & Whine about public safety and the salaries, are the first ones to scream bloody murder if something happens to you or family(god forbid)and it takes someone too long to get there.

    Happens all the time!

    Taxpayer, thanks again for the debate…

    I hope you and your family have a happy thanksgiving!!

  • Taxpayer

    So, if it’s on Google, you won’t believe it, but if your buddy up in Salinas says so, it’s gospel. You are probably one of those people who don’t believe in science, the scientific method, or scientists, but believe whole-heartedly and uncritically what Rush, American Petroleum Institute, and the News Corporation tell you.

    For the Los Angeles Area, the Median PA makes around $100,000. This is total compensation.This is also verifiable through numerous salary surveys, and several job postings in SoCal. PAs, having an actual education, can take work across the country, and shop their skills around. There is less regional variation for PAs than there is for FFs. You may be right – in areas with lower salaries, you probably can’t economically replace a FF with a PA – because PAs can move and work elsewhere. But in high-salary areas, the gap narrows, and when you count overtime, seniority pay, and pensions in the mix, FF/Ps total cost can easily surpass a contracted PA.

    There are good Security guards and bad ones. Mostly they need to be law-abiding, and have a cell phone to call the police. Cops generally make more money than firefighters, and shouldn’t be used to direct traffic, or provide ‘eyeballs’, or a public display. They should be used to arrest people and build cases against criminals. (remember – when seconds count, the cops are only minutes away!)

    I’m not getting into it with you about Defense — suffice it to say, they don’t pay anyone enough to have their legs blown off.

    As for ambulance ETAs, it’s all math: number of ambulances in service, amount of time they’re available, geographic area, traffic, call volume, hospital drop times, etc.

    A single role ambulance is much cheaper to operate than a firefighter ambulance: salaries are smaller, and overhead (you don’t need to send the ambulance drivers to a week of fire school every year, or the like)
    Generally, if they are unionized, the ambulance unions are weaker than the fire unions, so they can have more flexible schedules, and more accountability — this is not always true.
    Everything else is up to the jurisdictions running them – how many ambulances, etc.

    But, ambulance for ambulance, a ‘private’ ambulance should at least be cheaper (lower wages, fewer benefits, less ancillary equipment, more flexible schedules), and likely more available than a fire department one (no ancillary firefighting duties), when doing the same job.

    The SCIENCE shows that paramedics and response times aren’t that important. The only response time that is important is a 4 minute BLS response time — this is a good wheelhouse for the fire department. If reducing the ambulance response time from 6 minutes to 8 minutes or even 12 minutes reduces the budget (and it will) that money can be used to something else that has been demonstrated to save lives (road improvements, education, public health) or, perhaps, dare I say it: left in the hands of the taxpayer.

    You don’t want to debate SCIENCE. You want to go with your FEELINGS, and how your experiences has affected them. This is not rational behavior, and it is not how my money should be spent. If fire department response times make a difference, PROVE it. If ambulance response times make a difference, PROVE it. Don’t tell me about your feelings, I don’t care. Tell me something that I can go out and verify on my own.

    Two wrongs don’t make a right. There’s a lot of wasted public money, not just by fire departments justifying positions doing prehospital universal healthcare.

  • Fyrecapt

    I usually dont believe everything on the internet. I’d be a fool if I did. I tend to read it, evaluate it, research it and go from there. And as for science, I believe some of it and other parts the jury is still out. I still dont believe in the big bang theroy, Sorry.

    Yes, PA’s in the LA are in the 100k range. And so we are on the same page. PA’s education can vary from institution to institution. There are some programs that take 4 yrs and others that can be accomplished at the Junior college level. Why did I point this out, because you said PA’s have an “actual” education. I took that as a shot that Firefighters do not have educations. Maybe not in your region, but here it is a much different story.

    And yes, the areas where salaries are high for FF/P’s, they can surpass a PA.

    I am sure there are some good security guards out there, but I have yet to come into contact with one that speaks, or understands english.
    For the west coast, Cops & FF’s are very similar in pay/benefits. Just depends on the city or county. And there are a lot of cities where the officers carry an AED.

    I was actually in agreement with you about the government and our defense system. I just have heart ache about our troops not being paid what they are worth..thats all. It was nothing towards you.

    And Taxpayer, I am in total agreement with you about the Ambulance ETA’s and cost.
    Yes, privates are cheaper to manage and operate on a daily basis than fire. Again, I am not for FD transport. EMS transports lose money. Unless that person has insurance that will pay, or the jurisdiction has a “subscription” service the FD usually eats that transport.

    I do not know what your private ambulances do on a daily basis in your region. But here, they are typically covering 2-3 jurisdictions, and doing interfacility transports. More times than not, we are waiting for an ambulance to arrive after we have been on scene for 10mins. That is the norm unfortunately.

    I am completely aware of the SCIENCE… My agency has been part of those studies in the past and I CAN tell you that they were “geared” to have a certain outcomes. We were part of a study that did not want kids to be intubated. Odd days you intubated, even days BVM only. And while we witnessed good and bad outcomes with BOTH, the study favored the BVM. Go figure!

    So its not my feelings that played a part, it was knowing how the studies were conducted that helped make my decisions. Studies will come and go, its important look at who is doing the study and what benefit they get from it. IAFF Included!

    I would like to know how your region operates, so I know what I am comparing against here.

    In my region, the FD’S typically staff the engines with 3-4 FF’s with a minimum level of EMT. Stations are staffed 24/7 and are within a 5 mile radius(avg) of each other. Some Depts, like mine, put FF/P’s on the engine with all the ALS gear. The intent is to have paramedics at your door in less the 5 mins. And yes, some depts opt to send a FD ambulance to transport. Most however, contract with a private ambulance for transport. It will be either staffed with an EMT & Paramedic. Most of the time, the patient will be treated before the ambulance arrives. The FD medic will give the patient to the ambulance crew and the FD medic unit will go available-no hospital follow up. A little redundant, yes. But it allows for two things. First, you get a responder at your door in a relatively short time. Second, the patient is transported by a private ambulance and the FD medic unit goes available and is ready for another call.

    I am all for Budgets being balanced and spent correctly. But really, put it in the hand of the taxpayers?? Most cant even balance their own finances let alone a cities. I’m being serious! 911 is the universal healthcare for most Americans today.

    I do not let my feeling affect how money is spent..That would be very foolish!
    All I can tell you is that I am not willing to bet my families lives on a study that says paramedics and response times are not important. That is just being ridiculous on all levels. When I have seen it make a difference on numerous occassions. No, its not science, but actual real life scenarios! Laugh all you want, its the truth.

    Tell me, what would be a good system in your mind?

    Going to bed, hope to see your response in the morning…

  • BH

    So who will transport between the hours of 9PM and 7AM? Without private ambulance the fire department wouldn't transport. They only transport during the day because they want to look good in the public eye. Private ambulance transports around the clock. This is just stupid, we have co-existed for so long no the unions are screwing it all up. Make FD first responders and have a transport agency transport the patient, unless the patients on fire why does a fire department need to be there?

  • bkf

    bh,
    what planet are you on? the private ambulances can't do extrication, technical rescue or any number of other items at scenes. Union firefighters and medics are cross trained professionals. In my experience with contracted paramedics (which are basically the upgraded version of the privates) most of them can handle medical calls very well. but when it comes to trauma, they are a disaster.
    ill say this too. I care about MY residents. I live in the town I work for. The people know and trust me. I dont treat them like a number or a dollar sign.I give them quality care.How many private ambulance people can say they KNOW their patients? Im betting its a small number.