Hypocrisy much?

I read a lot about EMS in a lot of different forums.  And invariably, almost anytime something goes wrong, there’s a debate about “this wouldn’t have happened in my system.”  That’s usually followed by the inevitable debate about what model of EMS delivery to have, whether it’s fire-based, third service, private, hospital, or what have you.

I’ve heard a lot of medics accuse the fire service of wanting to take over EMS.  Heck, I’d even say there’s some validity to those arguments. When modern construction techniques and fire safety codes have dramatically reduced the number of structure fires, you have to have something for the guys and gals at the station house to do.   I’ll also concede that many large city fire departments pay lip service to the EMS mission and have a culture that doesn’t condemn lackluster care.

But ya know what? When you, as a third service, private, or hospital-based medic automatically say that the fire department either can’t or shouldn’t do EMS, aren’t you just the flip-side of the fire chief who says that only the fire service can do EMS?  Like them, you’re dismissing, often arrogantly, the prospect that just because someone wears a certain uniform, that they’re incapable of providing clinically appropriate, compassionated medicine?

What I’ve found in EMS, at least in the USA, is that every community has different needs, different demographics, different politics, and different resources.  The EMS model that Las Vegas uses might not work in rural Kansas.  And probably neither would work in inner city Houston.  That’s the beauty of EMS.  We’re always adapting.

So, as a personal request from your favorite blogger (Oh, wait, I’m not Kelly Grayson!), I’ll ask the fire medics to chill with the “ambulance driver” comments and attitude.  But for those of us whose ambulances aren’t red, we need to drop the “hose jockey” comments and saying that our patient isn’t on fire.

And by chance, if you’re in a system where you have first responders from another agency, take the time to work with them, help train them, and eventually, they might just rise to your expectations.  Canceling them, clearing them from the scene early, or talking down to them only means that they will be utterly and completely incapable of helping when you really, really need that second set of hands on a bad scene.

Just my $0.02 after reading some pretty heated stuff the last couple of days.  At the risk of sounding overly simplistic, we’re all supposed to be on the same team.  Let’s start acting like it.

 

Comments

  1. Sorry, sir. I am going to land on the other fence of this argument..

    Far too often, we are told that someone is coming for our job and that they can do it better. Why can they do it better? Because they can “get there faster” or “they know the streets” or “the leadership of the EMS department is redundant when compared to the fire department.”

    Not once have I seen a fire department takeover plan outline how they are going to improve ROSC rates, or what they could do better to treat their community’s MI patients, or how they will work with a medical director to improve a QA/QI program and strive for clinical excellence. The only arguments that I have seen are “cheaper and faster.” Oh, and the old adage of “it works in XXX community so why wouldnt it work here?”

    Fire departments that have been at it for years, once that have gradually evolved with a now rapidly changing EMS world as compared to even fifteen years ago, have a plan and an ability to do it. Departments who are trying to get into it now, well, a lot of times I question their motives.

    So you can cry hypocrisy, but I say that I should be able to defend my service and my profession. Far too often, I see people attacked for defending their EMS centric stance (myself included). Personally, I do not think that is fair.

    Take the current situation in New Orleans, for example. One call has sparked a cry for change from the Fire Department. Now, compare that to the almost constant struggles of DCFEMS. Look at all of the chances they have been given to improve. I have never seen an EMS service given that much rope.

    If a fire department said to their community leaders, “We think we can do it better. Compare our packages and let us know.” Then that is fine, but rarely have I seen that tactic taken. Ultimately though, community leaders need to know the rest of the story and they need to know what they will be sacrificing should they make a change.

    • theambulancechaser says

      And I’m not saying the fire service does it right. Large fire services rarely do. I also think that’s as much a function of large bureaucracy as it is the fire service culture. I’ve yet to find a large EMS organization of any flavor that has a strong QA/QI/training program.

      And it’s always a turf war. How many private services have said “We can do it cheaper”?

      I’m ALWAYS EMS-centric (at least that’s my sincere hope). I just believe that every community has different needs and different approaches are going to work there.

      • I can think of two that have very progressive EMS based EMS systems in big urban settings: Boston EMS and Louisville EMS. In fact, from everything I have heard from LEMS and their implementation of pit crew CPR and a dramatic increase in their ROSC rate, I would say that they are doing a pretty good job.

        While private services have said that they can do it cheaper, there is far more evidence that this is true than there is that response times matter. For example, at my former employer, we ran a “zero bid” 911 contract in three communities. Those communities did not pay us a dime. The only money we got was from billing insurance so in essence, unless you used the service, it did not cost the tax payers one red cent.

        I know you are EMS-centric, however, I don’t think it is fair to call out people in EMS who step up to defend their livelihood. There are two sides to every story and both deserve time to be heard.

  2. dr-exmedic says

    I don’t know that it’s “hypocrisy” to point out that, given the very different nature of EMS vs fire work, the people who are good at one very frequently *aren’t* going to be good at the other.

    EMS in inherently an intellectual job, whereas fire is primarily a physical one. I could give my drug box to Arnold Schwarzenegger (or, for that matter, an untrained Albert Einstein) without getting any improvement in a patient’s condition, whereas a 3-year-old with a full bladder can put out at least a small amount of fire. (Don’t get me wrong–I understand that smart FFs will put out more fire than dumb ones, and that we all want partners who can lift their end of the stretcher.)

    I will grant you that some people can do both very well, and some FDs providing EMS are very good at making sure people good at EMS get into EMS jobs.

    But I’ve met far more which, in Skip Kirkwood’s words, think that “a paramedic is an entry-level firefighter.” Noting that those seem to outnumber the good ones is hardly “dismissing, often arrogantly, the prospect that just because someone wears a certain uniform, that they’re incapable of providing clinically appropriate, compassionated medicine.” I see myself, rather, as pointing out that FD-based care attracts a lot of people who want to be FFs, not necessarily provide medical care.

    • theambulancechaser says

      And I won’t disagree with any of this. I just think that anyone who’s been in EMS for any length of time has seen good and bad medicine delivered by a variety of models, sometimes even at the same time. I have seen plenty of people on the Facebook groups who are reflexively anti-fire. It seemed as wrong to me, intellectually, as the fire chiefs who say that only FD can do EMS.