Monday, November 30, 2009

Shields Up

After posting about the EMT student a few days ago, I got some feedback on the subject. I like feedback. I use feedback to determine if people are picking up what I am laying down.

I often respond to comments. Either to clarify a point or to let the commenter know I am picking up what they are laying down. Sometimes, I respond to a comment just because I enjoy the social aspect of blogging and I value the reader's participation.

This post is in response to the following comment which was received regarding my post "Sorry Dude". "Sorry Dude" was basically me whining about our EMS division sending EMT students from a local community college to my station for the fire portion of their ride-alongs. What I was trying to convey was that we are going to have EMT students ride-along, lets put them where they will they will be busy. My station is a slow house and it's usually not a good use of the student's time to spend it at "The Healing Place".

I also threw in a few comments on the changing face of our EMT students and the generational gap between myself and some of the youth today.

Anonymous left the following comment regarding  "Sorry Dude":

Anonymous said...
Sounds like ALS fire companies have bad consequences even outside of patient care. I hadn't even imagined that an EMT program would be dumb enough to put their students (who are riding to learn medical care, not lawn care) on an engine. Thanks for the enlightenment, although now I feel sick.  
Maybe I am a little sensitive, but I thought I felt a shot whiz by my head as I read this. Did 
Anonymous just take a shot at us fire service EMS providers?

Here is the deal. I know there are parts of the country where great conflict exists between fire service EMS providers and single function EMS providers. That hasn't been a huge issue where I work or even where I grew up.

There are advantages and disadvantages to all types of systems, it's a matter of what a given area is willing to pay for. IAFF is lobbying for departments to become ALS providers in order to provide job security, AMR spends a lot of money marketing their services and lobbying politicians to get opersating franchises for 911 transports.Neither system is going to save humankind from anything.

I don't think the EMT program is stupid for putting students on engine companies. A big chunk of EMT students want to end up in the fire service. Even if they don't, the odds are they will have to work with the fire service. Learning how we operate and interact with the transporting agency can only be a bonus. It's just a matter of getting the students to the right engine companies.

I think we would both agree that my station is not the best place for a student. Hopefully our EMS division will recognize it and quit sending them our way.

Regardless, thanks for commenting Anonymous, I look forward to hearing from you again. BTW, I hope you're feeling better.

As always. Thanks for reading,


  1. Ignore the troll, Cap, he's probably some jerk who failed in the hiring process.

    We have 5 stations, one is a "healing place". We deliberately do not allow EMT students (or probies) to ride there. I was stuck there for a while and really missed the opportunity to mentor the kids.

  2. Dear Captain Schmoe,
    Yes, I barely understood him anyway, which must be a clue. And I'm a firm believer that it's best to know who you'll be working with and what they do. It ought to happen more often.
    Ann T.

  3. I'm no troll, John, just someone who dares to stand up to the Big Red Machine on certain issues (like my job). Sorry if that offends your sensibilities.

    Captain, my comment wasn't so much a shot at Fire EMS, and reading them a second time I can see how they could be taken as excessively snarky. My issue is with an EMT program (or, as you expounded, your EMS division) that puts EMT students with a company that whose primary mission is not EMS.

    Yes, the students get some EMS calls, and they get to see the handover from the first responder company to the EMS crew. That's all well and fine. But they could, as you point out, spend more time learning the fine art of landscaping than they do EMS. If I were the director of an EMT program, I'd never send a student to that agency again.

    IAFF is lobbying for departments to become ALS providers in order to provide job security

    And here I thought EMS was about patient care.

    Believe me, I used to work for a private. I know all about what they do. But Fire and privates aren't the only systems out there. Advocating for a fire-based systems to "protect" people from the evil private companies neglects the fact that many of the best EMS systems in the country are neither.

    Since we're on the subject, can anyone advocating ALS first response systems provide any research showing improved patient outcomes? Sorry, stopping the clock to ALS doesn't count- we already know that time to ALS arrival doesn't improve cardiac arrest survival.

  4. lmao. When I read the comment I thought it was a cheap shot. But I agree with your response here. Every system has its good and bad points and I've worked in a system that went from 3 tier down to 2 tier. It was a rocky road and a lot of feelings were hurt. BUT, does our city/county have some of the best care aroung?? Yes. Did it dimish the care in anyway?? I dont think so.

    Keep it up Capt. You make us think and thats always good. ;)

  5. Well Anon, I feel much better knowing that the whiizzing sound flying past my head wan't directed at me.

    We agree that for us providers, EMS is primarily about pt. care. For all of the other players, I am not so sure that is the case.

    For district/city/county/state/federal government, a whole lot of other influences affect EMS policy. Primarily budget driven, descisions are made all of the time that are not necessarily in the best interest of the pt.

    Can local government fiscally support seperate EMS and Fire Departments? Most cannot. The Fire Dept. is the usual choice in providing EMS services in these situations.

    Speaking of research, has anyone run the numbers to see what the per-life saved cost of EMS is? How about the per-call cost of incidents where pre-hospital care actually prevented a permenent negative impact on the pt. - one which wouldn't have happened anyway if the pt. had self transported? I would be interested in seeing the numbers.

    One other thing. We might agree on this actually. If I were King Schmoe, my firefighters would be first responders with AED endorsements. If I had ALS providers, they would be on the ambulances. Emergency Medical First Responder would be taught in high school and would be required for graduation. I would educate my subjects on self suffiecency. Why would my system be like this? Because I would be paying for it out of my royal treasury.

    Vote Schmoe for King.

    Thanks Anon for your comment and also to you John, AnnT. and PeeDee.


  6. Can local government fiscally support seperate EMS and Fire Departments? Most cannot.

    You're probably right. That's why I think county-based EMS is the way to go in a lot of cases. No one community has to shoulder the burden of independent EMS, but they still get the benefits from an agency solely dedicated to prehospital medical care.

    One other thing. We might agree on this actually. If I were King Schmoe, my firefighters would be first responders with AED endorsements. If I had ALS providers, they would be on the ambulances.

    So long as said ALS providers are carefully selected, highly educated, closely monitored and QA'd, provided progressive medical direction, equipment, and protocols, using evidence-based medicine, and are not required to be firefighters, I think we might agree as well. ;-) And I don't even think it would cost as much as you think. (The rest of it probably would, but we'll skip that for right now.)

  7. Not familiar with your system, but it's always best to get the most viable training or familiarization experience for the buck and for the time. If your shop isn't the best spot for this, perhaps you can help change that.