Twitter Question Answered

Recently I was asked a question on Twitter (my account is mostly for people to follow my blog). Agent_M18 asked me to talk a little bit more about what it's like to work as a firefighter and a paramedic. He said that where he works medics are all on the private side of things.

I've been able to work as a medic in several different systems. I've been the transporting medic that responds with a BLS fire department. I've been the medic on a squad with a BLS private ambulance company that transports. For the last several years I've worked in systems where I function as a paramedic with the fire department and the private ambulance also is ALS. One system that I don't have much experience in is where the fire department is also the transporting agency.

I'll go through some of the pros and cons that I have seen having been there.

Private ALS Ambulance/BLS Fire Department

Pros-

• Reduced cost. It's simply cheaper to have a BLS fire department (even a volunteer one) than an ALS one.
• Ambulance medics have a higher call volume and tend to keep up their skills and knowledge base better. 

Cons-

• Ambulances generally cover a larger geographic location than do fire companies. This means longer response time. On the vast majority of calls having to wait an additional 5-10 minutes for a paramedic to arrive doesn't make much of a difference. But on those rare, super critical calls, it can mean the difference between life and death.
• Fire department personnel, at times, have a hard time taking instruction from private ambulance personnel.

ALS Fire Department/Private BLS ambulance

Pros-

• Faster response times for the paramedics.
• Lower cost for the contract with the private ambulance company.

Cons-

• It's more expensive to have an ALS fire department (the cost of supplies), especially if it's a career department.
• Firefighter paramedics are not required to go to the hospital with someone that doesn't "need" ALS interventions. This encourages some medics to turf ALS calls to the BLS crew so that the medics can go back to bed, dinner, a fire.....pick your excuse. Patient care suffers.

ALS Fire Department/ALS Private Ambulance

Pros-

• Faster response times for paramedics.
• Second medic on critical calls once the ambulance shows up.
• Ambulance medics have a higher call volume and have an easier time keeping up their knowledge and skills.
• Better patient care. Every patient has a medic in attendance from beginning to end.

Cons-

• Cost. It's more expensive to have a medic on every responding piece of equipment.
• There can be a compatibility issue with varying equipment used at the FD and the ambulance company.
• Differences in opinions on patient care can lead to conflicts.

Fire Based ALS Ambulances

Pros-

• The same pros would apply here as with the private ALS ambulance and the ALS fire department.
• EMS training is all done the same so everyone is on one page.
• All equipment is the same.
• No confusion with the command structure.

Cons-

• Again, cost. Especially at career departments. Although this is somewhat offset by fees received for transporting the patient.

Because of my own experiences in each of these systems I am very much for having a paramedic on each responding apparatus. This way the patient gets the care they need with the arrival of the first unit and they will remain with a paramedic until they reach the hospital.

I have also found that the skill sets of a paramedic riding on an engine or truck differ slightly from those riding on a box. The engine medics usually arrive first on scene and tend to be better at sorting out the initial chaos found in an emergency situation. Transporting medics tend to be better at longer term patient care and patient destination decisions. I personally love being first in. I'll leave transporting to someone else, unless it's a critical patient. Then I'll go the the ER too.

For you medics out there. Which system do you work in? Which do you prefer? If you work within an EMS system that's different from the four I described, tell me about it.