Dual roled firefighters. Continuing national trend or pitfall of the service?

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Permalink Reply by Richard C. Berger on October 14, 2011 at 2:34pm

I'll start with my opinion that departments that want to add EMS on their own usually seem to fare better than departments that are forced by the elected legislators to start doing EMS, at least within my personal observations.

1) While there will always be individuals and departments that are the exceptions, I feel that EMS and Fire Fighting are both specialties, and with limited crossover, should be mission specific. Each "side", both EMS and Fire Fighting, doing their jobs, and doing it well.

2) Due to local experiences, that will probably be up to each affected department.

3) Again, that depends.

4) While mostly dependent on each individual involved, there is a chance of resentment, as "I joined this department to fight fires, not take care of sick folks" versus "I joined to help the sick and injured, not put the wet stuff on the red stuff."

In disclosure, I mention that I was New York City Health and Hospitals Corporation EMS at the time of the "Merger" of EMS from the HHC, to the Fundy's management, under Mayor Rudy Guliani's edict.

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Permalink Reply by Bobby Halton on October 14, 2011 at 3:10pm

I'll try and I am also from a duel role fire department, not all of the members were duel role but of the vast majority were. We all had foremost a specialty in structural firefighting as well as some other type of function whether it was hazmat, emergency medicine, technical rescue, dive team or some other special function.

1) To answer your first question about firefighter medics I don't think it is an issue of having two roles as long as each role gets sufficient use, experience and training. If either role is left unattended or ignored that's a problem.

2) I do not see the trend of firefighter medics in particular changing at any time in the future for most organizations that are currently using them. I see our roles growing and other areas particularly homeland security as time goes on.

3) The communities I served in as a duel roled firefighter medic certainly benefited from the services of the departments I was on. Based on our geographic positioning we responded quickly we gave you highest level professional care possible and we truly wanted to be there whether it was a fire or emergency medical call. I cannot think of a single time that our service did not add to the value of our community it was an honor and privilege to serve as a firefighter and a medic.

4) The drawbacks that I have seen come from the structural framework that some departments use to mobilize resources, for example when medic units are used exclusively for medical calls and the firefighters on those speciality units are not properly detailed at fire scenes to working fire companies. I also see problems in systems that do not have promoted ranks within their specialty units whether it be their squads, medic units or dive teams. There is also now a very destructive trend of over dispatching engine companies and truck companies along with medic's to emergency medical calls causing excessive wear on the equipment as well as demoralizing the members who do not need to be there and do not add to the value of the call.

Hope this helps yours Bobby

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Permalink Reply by 1nqaztqe2kthl on October 14, 2011 at 5:08pm

It depends on the culture that your department has towards either discipline as Chief Halton has indicated.  Austin (TX) has a third city service system and it works well for them.  Most of the Departments in north Texas are combined and it works well.  As long as your personnel realize that one day they could be on the engine, the next shift the truck, and then the next shift the med unit, it shouldn't matter what your "role" is because you are getting the well rounded experience of what your responsibility is at any given moment at any given time.

 

As long as we continue with the budget shortfalls that we are seeing, I think the trend will continue.  Cuts are everywhere in city government and if they can combine a service they will.  It's finanically sound, but again, depends on the mentality of your departments and whether or not you have medics that have no interest in fighting fire, or firefighters that have no interest in treating the sick/injured.

 

The community benefits in my opinion.  They see their tax dollars at work and not us "playing dominoes" on the ramp.  However, they just can't seem to grasp the concept that a fire engine shows up when "I called for an ambulance".  We have 13 stations, each with an engine (medic on every apparatus), 4 trucks, and 6 med units.  Regardless of where you are in the city, we can get to you in less that 8 minutes with at least 1 medic and 3 EMT's.  The ambulance transports with the medic that did the assessment for seemless transfer of care to the hospital.  Public Education is the key...  "Why we send a fire engine on every call."  Again, Chief Halton mentioned wear and tear on apparatus.  I agree to some extent but the tires get flat if we only go to the grocery store once a day :)

 

The most significant drawback I've noticed is that some guys don't want to ride the "box" and get pissed when they get their shift on it.  It's a motivation, burnout, esprit de corp thing.  On the other hand, it's also a "I have no idea what the heck I'm doing on a truck" thing.  I was an FTO on a med unit for years.  Promoted to D/E and noticed my paramedic skills declining.  Being on the engine all the time I was still the lead medic initially, but I noticed that some of my skills started to decline because I didn't have the continued care of the transport and follow up.  It's a "give and take", but I personally think that the combined response is the most financially responsible and provides our personnel with a broader range of experience.  I've always said, "you can't expect me to have the information or experience if I've never been provided with it".  You can focus on a particular aspect of the fire service, but you have to be exposed to all of it...

 

Good luck Brother

Scott

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Permalink Reply by 2cgjunyhszlsd on October 14, 2011 at 7:32pm

1. The system I work in is a dual role model.  It works well and has developed over the years into what I consider a premiere service to the citizens we serve.  A trend that is impacting all departments is the financial loss that we are suffering.  The dual role model only makes sense to me in that we are providing personnel who are training to provide specialized services/skills on most calls we respond to.  Cross training also allows flexibility in staffing and assignments, personnel can function in any position they are assigned.  The dual role model also allows seamless transfer of patient care from the ALS first responder to the ALS transport ambulance when the personnel are interchangeable and function as a single team instead of the fire/private provider model.

2. With $ getting tighter and tighter the dual role model seems to be more bang for the buck in my mind.  I think that departments which are not embracing ALS leaves themselves open to the possibility of loss of local control…for BOTH EMS and fire.  Our department has set the mark in the Bay area in providing dual role system; we provide the ALS transport also through our department.  By providing first responder ALS then follow that up with ALS transport the care is seamless.  The key to the future is based on fire providers being able to be competitive with private providers; this is not only for EMS but slowing moving also into the suppression services provider!  Another reason to provide dual model service is the fact that with $ getting tighter and tighter many departments are cutting/closing suppression companies; with the fact being that most people are willing to put up with (risk) delayed suppression responses but they are not willing to put up with longer ALS response times!  By providing a dual role model we are able to better justify our companies and (hopefully) maintain good response times with adequate number of suppression companies.

3. The primary call requests that come via 911 are #1 –EMS and #2 – Suppression.  It only makes sense to me that we would respond to these calls with personnel that can provide professional, high quality skills and knowledge to these calls.  With our department, almost all personnel at the scene of a call are ALS; with that said at most calls you can easily have a combined experience of 30-50 years of ALS call response.  That is of extreme value to the citizens who are receiving the care.  Local control is also very important to most cities/districts; by providing the dual model system that local control can be maintained but if the ALS component is not part of the service provided that local control is quickly lost.

4. Our department has worked hard to get over (and through) the “us vs. them” attitude that usually occurs when the dual role/suppression & ambulance is provided by a single agency.  Now we have an “us” only attitude; but it has taken years to get to where we are.  I also believe that the agency that is providing the dual model service must provide support/encouragement and training in both ALS and suppression equally.  Too often one gets the focus and the other is left short; this can cause frustration and decrease morale.  Also, in busy systems like the one I work in the administration must be aware of burn out that personnel can suffer; it takes time, effort, focus, commitment and passion to keep ALS and suppression skills high.  If the support, training and focus are maintained at keeping personnel at their best the system will thrive; but if the support and training and focus are lacking the system can be very difficult to work in.

I believe the dual role system is best overall.   In Berkeley California it works very well, providing very high quality service to our citizens.  It allows the City to maintain local control which is important to us while maximizing the use of the personnel on duty at any time.  Our system is high volume, the dual role model works well here but I realize that each city/district must weigh their system and what works best for them.

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Permalink Reply by David W. Harper II on October 16, 2011 at 10:55am

Thank you for the responses!  I appreciate the time you took from your busy day to assist in discussing the issue.  

 

In 1995, when the transition occurred, we had a premier EMS and Fire division.  The EMS providers were forced to go to a fire academy and begin doing something quite foreign.  The Suppression side never like the idea of the medics, though separate, being in the same station let alone starting to ride on fire equipment.  Animosity was always there.  Nothing violent, but a very passive, condescending air was always kind of among them.  With time, it was noted that only a few could indeed do both jobs adequately.  The others just kind of muddled their way through.  When more of our speciality teams were created, now there were three jobs to contend with.  Of course, the medic side suffered the most.  I myself, once joining our Technical Rescue Team, let my ALS skills slide a good bit.  Though still fairly proficient, I noted that my true passion was, and always had been the fire and speciality side.  Which was also the case for the medics from before.  Though they had loved the gristle, hustle and bustle of the "box".  Once they learned of the rested nights, and warm meals of the engine or ladder, their skill to, had diminished.  The mind set of the past, the "screw the medics, thats what they signed up for" became the ever so evident cancer.  

 

Now, most of the older troop are gone from those days.  But, the cancer, though not so malignant, still remains.  There is light at the end of the tunnel however.  A way to get off the medic has been discovered!  Get promoted, and you can go back to being an EMT!  That has now brought a new and painful problem to the system.  Inexperienced personnel get a bugle and their worries drift away.  Thats the motivation these days for leading people into burning buildings.  I certainly will not say that is the only motivation, money, and power are still there as well.  There is however, a decent community of us that want to lead for safety, change, and progressive tradition.  That can be saved for another discussion.  

 

Back to the matter at hand.  We do still see those that come into the service because they want to ride the box and care for the sick and injured.  But, the path that was laid down long before them has poisoned a well that we all drink from.  It has become diluted through time, but exist all the same.  They also see that there is no progression for that side of the profession.  No where to go tends to push EMS people to the fire apparatus as the only place to go.  To move up in EMS, we only have 6 EMS Captains, and one EMS Chief.  As opposed to countless fire officer and Chief positions.  OJT on the medic is dangerous to say the best.  It is not unusual for a rookie to be precepting a probie on the bus these days.  Having no experience teaching no experience is a double-edged sword of horrible practice.  Some of the older precepting personnel complain about it and having to ride the box again, kills the spirit and skill.  There is no incentive for being an FTO/ preceptor.  Lack of community education is also burning out the dept. at an alarming rate.  We are seen as taxi's to the population for stubbed toes, common colds, freeloading healthcare parasites and Dr.'s appointments.  Taking the trucks from districts when true emergencies do arise.  Seeing an over-inundating generational population of millions with less equipment and no foresight or thought provoking data to attack the powers that be for more personnel/ apparatus.  EMS is typically a progressive entity, but meshed with a fire service with "a hundred years of tradition, unimpeded by progress" is also an issue.  

 

We have incentives in place for the medic side.  Extra money for being a Paramedic, and Intermediate.  Intermediate is already built in since you get trained up to the I level.  But P is only a little bit more.  And those that get Paramedic, most only do it for the money and still don't want to ride the box.  The comment has been made " If you get Paramedic and make more money for it, they should ride the bus more to give better care to the community."  You would have thought that the Paramedics house's were burned down and their dog shot!  But, does it not make sense for better care of the citizens?  They want the money and on-scene power, but not the responsibility of it.  We provide for further education/ recertification, but only on your time and not the cities dime.  There is another way to get off the medic, but only partially.  At 10 years, you can put in to become a Technician level medic.  Rule is, if selected, you still will have to ride the medic at minimum of 48 hours a quarter.  Your still not truly off the bus because there is not guarantee that will only do 48 hours do to manpower issues.  Seems like just a ploy to try'n stifle the masses.  Thats about it for EMS side incentives.

 

In short, those are most of our problems that I see.  My thoughts for improvement are as follows:

1.) EMS can exist under one umbrella and function somewhat separately.  Continue with hiring for both, but make EMS a speciality team for those that want to do it.  Pay must be higher for those doing the bulk of the work. Additional medic units to help with burnout. And premier in-services with modern/ progressive medical training.  

 

2.) Line of advancement. There must be a path for this field for people to have promotion and advancement.  Adding FTO's as Lieutenants, A few more EMS Captains and Chief officers for Battalion level, training, and support services (Billing, dispatching, EMS safety. Just ideas for positions).  This will create a ladder to climb the rungs of an EMS career.

 

3.) Fire officer reprograming.  Get them into the mind set of not bashing the medics, but promoting the positive aspects of EMS.  Being observant to those with the talent of EMS or fire and fostering those attributes to better the organization.  If they are still ALS officers, be willing to step up and help the crews in the medic rotation and show you still care about that side of the job and especially the personnel.  

 

4.) Community wide education.  Using cooperation of hospitals and clinics on how and when we are to be used.  This will be quite the daunting task since most of the population is or has turned into the "me" society.  

 

5.) Learning partnerships and cooperative agreements.  Again, asking hospitals and clinics or other entities to assist and provide training and instruction on medical techniques, special populations, and problem areas.  Also having us to do the same with them.  Showing them what we do, need and supply to create and foster a good working relationship.  Show them all aspects of what we encounter in all facets of our line of work.

 

In summary, everyones budget is in "penny pinching" mode.  Finding the cash for more personnel, trucks, and incentives is hard to be found right now.  Cities have always looked at a fire service as a money pit, until we are needed.  Then they are reminded of how important we are.  9/11/01 was a horrible event that started another stirring of reinforcing public safety.  But why did it have to take a terrorist event to spawn the flow of money for what we do everyday anyway?  Now after 10 years, we are back to being the boat anchor again and neglect has reared its ugly head.  Not to mention, being in an economic downturn with an already overextended deficit doesn't help our cause either.  

I agree with all of you, I do not see a cross-trained fire service going anywhere in the near future.  But there are easier ways to make the two co-exist in the same system.  Our problems will not be the same as any one else's, but there will be similarities.  Finding creative ways to sell some of these ideas will be the challenge.  My ideas are just that, ideas for a more cohesive future in my department hopefully.  I am quite young in my career, which you can probably tell by this elementary post.  But, I am looking for thought provoking correspondence to help the gears in my head to turn with more ways to grow and learn.  I guess that I am like any young officer.  Eager, driven, full of ideas and optimistic for the future of our organizations, especially my own.  Funny though,  I am more of a realist at heart, but I have always been very optimistic with the fire service.  Overall, our priority is the customer service we provide.  Right now, the customer service in my department is a little lacking in EMS in my opinion.  There are people out there that want nothing more than to ride a bus, be up at 2am, reading EKG's and treating crash vic's.  Lets get them into our system to get our customer care back where it should be and give our citizens what they deserve.  Better, safer, happier progressive care.

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Permalink Reply by Mike France on October 16, 2011 at 7:32pm

We work dual roles , but the Sr. FF on shift has the choice of being the Medic , all are EMT's with 1 Medic per shift. It' sthe way things are going due to the times

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Permalink Reply by 23rx7arq53npw on October 17, 2011 at 4:25pm

We have a mix of cross trained and straight fire. About half the officer corps is cross trained. For a small dept. Cross trained personnel are vital to us. In the future here cross training to atleast EMT basic will grow. With fire calls down and budgets shrinking the more one can justify their budgets at town meetings.

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Permalink Reply by Richard C. Berger on October 17, 2011 at 4:38pm

A question within the original question: Does any agency with crosstrained FF/EMT or FF/EMT-P personnel have a system of one week, an individual is on an engine, the next, the ladder/truck, the next, on the ambulance, and finish with a week on the Rescue? As already mentioned, the F D N Y is usually Mission Specific, as EMTs and Paramedics never fight fires, and Fire Fighters rarely do EMS work (outside of NY State Certified First Responder-Defibrillator calls).

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Permalink Reply by 1nqaztqe2kthl on October 18, 2011 at 5:54am

In baseball, basketball, and soccer you have to play both offense and defense at times, but you're still a team.  In football you have an offense AND a defense yet they are still a team and work together to win the game.  Our goal, as first responders, is to save a life and that is a hell of alot more important than winning a game.  We have to work together as a team regardless of our "role".

"A week on this, a week on this, and then a week on that"...  I guess it could work.  You would certainly be well rounded, but how much training do you have to do within a given shift as well?  My 6-person company did 4 hours a day on a particular topic (we work 24/48).  We ultimately worked 10 days a month and trained for 40 hours a month on a multitude of things.  One shift we did ALS, one shift we did suppression, one shift we did ropes/knots, etc.  If you don't use it, you lose it.  But it takes dedication.

I agree that there are systems that have the "us versus them" mentality from years past, but it's time to put that behind as you are trying to do.  I congratulate you on your efforts.

Great discussion topic by the way...

Scott

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Permalink Reply by David W. Harper II on October 18, 2011 at 3:13pm

Just to answer how our rotations work.  We do not have riding assignments and work a 3-4 schedule.  They may come in the future, but right now you might ride the medic one day, the engine, ladder or both for the next two cycles.  Our medic census is high and makes for nice rotations, but how much do you retain if you don't ride it often?  Most, of course, don't want to ride the "bus" anyways and a hand full would like to ride it all the time.  Officers will not let that happen cause someone may complain and get them in trouble.  Everyone is worried about 50/50 time on both when it doesn't happen due to the rotations already.  That only applies to the multiple piece houses.  The single engine house medics get hammered because their rotations are so tight.  Those houses need to have all cross-trainied personnel (including the officer) and 2 extra bodies assigned to them anyways to make for effective rotations/ responses.  

 

Thank you for the compliment on the discussion topic by the way.  Glad to receive so many responses.

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