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I am looking for some insight, experiences, thoughts, ideas, etc... How do your departments handle the balance of Fire and EMS operations? What I mean by that is, is there one with higher priority, are there any promotional positions relating to just one area (can you promote with only EMS?), what are the positions for EMS as compared to Fire, how are training requirements accomplished or better yet training needs met, are you able to meet the serviced community needs, and are there any other thoughts? Obviously I'm going somewhere with this. My department is currently in a time of change. New medical direction is coming soon. Along with that are discussions on operations. Basically, one side says that EMS is just a step child of the department with no room to grow and given little or no attention from administration, (Only enough to get by) while a different point is made that fire operations can not be reduced or set aside due to EMS. I can see both points, but hold the opinion that both are important. This question does not even mention specialty team operations such as Haz-Mat, dive, swift water, and and the various technical rescue team requirements. Just to give an idea of size there are 90 line personnel operating out of five stations. (not big, but not small) We operate an ALS fire based EMS. I'm looking for ways to bring this together.
Thanks for any replies, Ed

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A big debate in my FD indeed. We run two ambulances that provide ALS level service. They are cross manned by FIrefighters at the paramedic level, other wise they go BLS with an ALS back up. There is no promotional positions except for the EMS coordinator, who has to be a paramedic and that is at Deputy Chief's pay. the Paramedics also make 13% more than the back step firefighter grade.

There is a huge focus on EMS and less so in regards to fire. EMS brings in about $800k to the city coffers and is the 8th largest producer of revenue to the city. Most of the training priorities is to EMS training and EMS equipment. The biggest training issue is that you can't put the up front ambulance out of service for training. We operate the up front ambulance as part of the ladder crew. They become the interior search crew @ a worker BUT with all the EMS runs, everytime you try to train them in Fire skills, they are out the door. There is also a jealousy factor that they make more than the back step guy.

It's been alot of growing pains but I do think it is coming together. The biggest issue is when both ambulances are out on EMS runs, the ladder truck goes to a driver only.
This has been a thorn in the side of departments for many years and will be for years to come. The only wisdom I can offer is this......When the citizens think of the fire department in your area, what do they think they are paying for? If they're concern is the fire aspect, then so should yours. If they expect EMS to be the priority then priority it shall be. I'm also struggling with this here at home. I'm the EMS Director for the department and I play second fiddle to fire operations on a regular basis. And so it should be. The citizens of my county expect when they call for fire, that they receive the best, most highly trained personnel, who eliminate risk and maximize protection to their lives and property. When they call for an ambulance, they expect to receive the best trained individuals, in life saving techniques and speedy transport abilities. Now fortunately, I do not have to mix the two that much as our department does not at this time do EMS transport. However, it appears there is a strong possibility of that becoming the case soon. All that aside, it is imperative that you know what that taxpayers want from you. Do they want Fire or do they want EMS? Both is OK but when they come into conflict, what does Joe Public expect you to do. GOOD LUCK!!!!
My Fd only did first response EMS until 1986 then they began to integrate "FIre Medic" units into the system.

Today we have 13 Fire Medic units that run 24/7/365. Everyone in the Dept. is at minimum an EMT-B. The goal is for every fire station to one day house a medic. Everyone (even officers) take there turn on the medic.

We have officer positions that handle EMS but they are not promote as specifically EMS. They are promoted and assigned to the EMS section.

In today's fire service EMS is part of the business mabey not as sexy as house fires but they are just as important and we must master them as we master every other skill.

How to bring it together??? Embrace Embrace Embrace. Get your Chief to ride a shift on the ambulance if he/she is willing to do it then no one else can complain. Have EMS training, make sure the dept takes care of recertifying the firefighters EMS level, give an incentive for goign ALS (My dept does and extra 15% for being a paramedic), Make EMS cool get the lates and greatest equipment and protocols. If its a money thing make the class available to everyone and really play up that everyone has thie opportunity to make this amount of money they choose to no its there fault.

These are just some ideas from my world and they work pretty good.
Thanks Robert, 1986 is also when we integrated ALS medics into operations. We probably have not come as far as your department, but a priority has been put on EMS to improve and find the best balance of operations. You gave good valid points, I appreciate it. Thanks for the info and thoughts.
I guess I'm a little unsure about what you mean by "priority". If you mean what is more important, I would say that whatever your department is called on to do at the incident is the priority. The citizens who call you for service decide what the priority is. If you mean what is more important to train on, fund, staff, etc. I think you have to look to the department to more clearly define their mission. That may require a little research. Find out what your strengths and weaknesses are and maintain your strengths and improve on your weaknesses. For example, if you do a bunch of calls that require basic skill sets (EMS or Firefighting) and they have been going pretty successfully, then it is more skill maintenance. However, if you are starting to do a bunch of diabetic calls or high rise responses and the troops aren't performing the way they should, you have to make those more advanced skills a priority. Low frequency/ high risk are the calls that really bite us either physically or legally so you have to put some emphasis there. My department is 220 strong. We provide EMS transport at an ALS level. Unfortunately, FD management here only looks backward in defining how we provide our EMS/ALS. They actually have moved in the opposite direction than the rest of the country by forcing all their ALS providers to ride ambulances even though the majority of transports are BLS. Engines and ladders that used to have ALS providers on them, now respond to medical calls and have to wait for the ambulance to provide ALS. My advice to to you is to make the citizen's need the priority and stay away from "who is more important than who". Cross training and cross staffing are essential to having consistent skills in the department. If your ALS calls get a fire company response, put your ALS resources there and staff the transport units with basics. It saves the medics from burnout, spreads the ALS around your community, and often means a quicker response of ALS providers. Good luck with everything
Chris, Thanks for the input. Let me attempt to give a little insight. We provide ALS transport service from 3 of 5 fire stations. All engine and truck companies are ALS staffed, so our coverage and abilities are not in question. What we are going though currently is a question of where priorities for providing EMS lie and are they meeting needs of the community. These questions have been raised by personnel who I feel make some valid points. Mainly being that our EMS division is not performing to a level that could be provided. The concerns come from attention given to the EMS operations including but not limited to priority of the service in the department, training needs, and promotional opportunities, and administrative structure. Of the 100 employees in my department over 90 percent are paramedics. I am simply looking for what ever information I can get on the subject. Thanks agian, Ed
Wow 90% paramedics! Excellent work! I think I have a little clearer picture of your situation. I think the key to all of your questions may rely on really good Q.I. I think it was Montgomery County Maryland that had a really interesting Q.I. program that really addressed the needs of the providers as well as compiling statistics to figure out where they were at with their service. In our department we have a training division that consists of 2 Captains; one fire and one EMS. Both do a good job of balancing the training schedule. We've just instituted a back to basics company training program where we alternate weeks (one week EMS, the other fire training). These are more skills refreshers than anything and usually take about 1/2 an hour. Unfortunately, the other training we do isn't really based on anything other than, "well, we haven't done this in a while." The Q.I. program that Montgomery County had was done in conjunction with their hospitals and was really specific and measureable. That way they could accurately say how many calls, of what type, they were doing and they were also able to track skills success rate etc. The focus was never punative, always educational. You have to know where you are to know where you're going. It doesn't make sense to tell a bunch of medics that they need I.V. training, if you don't know how they are doing. Is your EMS division cross-trained and do they have duties other than passing out drinks on the fireground? If you do have cross-trained personnel, but they ALWAYS ride the transport unit or they ALWAYS ride a fire apparatus I think you might be on the path to burning out or rusting out your providers. If they are not cross-trained, and the divisions are truely separate, maybe a path to go from one discipline to the other needs to be created which might help open up promotional opportunities. If you need to create promotional opportunities in your EMS division, get the medical director on board and go for promotions into a Q.I. role or a training role. As we know, it's a lot of work to keep everyone's license up. I don't know if I helped you out at all, but if you want more info check with the IAFF EMS director Lori Merril. Again, good luck!

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