Captain Renault: I’m shocked, shocked to find that gambling is going on in here!
As shocked as Captain Renault was, I’m more shocked at this.
A white paper released in 2007, titled Prehospital 9-1-1 Emergency
Medical Response: The Role of the United States Fire Service in Delivery and Coordination, states that fire departments are best equipped to deliver emergency medical service. The report was written by Franklin Pratt, MD, medical director of the Los Angeles County Fire Department; Steven Katz, MD, associate medical director of Palm Beach County (FL) Fire Rescue; Paul Pepe, MD, Southwest Medical Center in Dallas; and David Persse, MD, City of Houston EMS physician director/Public Health
Authority.
As Captain Renault also said, “Round up the usual suspects.”
This is a reaction to the efforts of Advocates for EMS to foster the formation of a “US EMS Agency” to oversee EMS.
“The paper came about after some major fire organizations formed a coalition in September 2006 to address concerns about the ongoing effort by EMS advocacy groups to form a U.S. EMS Administration. This would move EMS responsibility from the agencies that currently have it into a single administration, which we feel is unnecessary,” says Chief Dennis Compton of the International Fire Service Training Association.
If, and to me it’s a very large, If, there is going to be a federal roll in EMS, then it should be under one agency, not a mish mash of competing ones. Nor should the fire service try to tie EMS to their profession.
Frankly the fire service should concentrate on improving their delivery of patient care. DC Fire/EMS had the Rosenbaum incident, Philadelphia Fire/EMS has chronic response time problems. Rogue Medic comments further about PFD problems. Even the Comptroller finds response inadequate. EMS in Los Angeles is not without it problems either.
My point is not to bash fire based EMS systems, because some fire departments run good services. In fact, I’ll quantify my statement a bit more. The problems that we see seem to be endemic to big city fire departments that run EMS. San Francisco had a well functioning third service EMS system that was converted to a not so well functioning fire based system. A couple of years ago the city effectively threw in the towel and reconfigured EMS. Anyone who takes even a casual interest in EMS knows what happened when NYC EMS was merged with the fire department.
Although the IAFF has long advocated for a larger role of the fire service in EMS, it always seems, at least to me, for the wrong reasons. In the speeches and position papers I’ve read the argument always seems to jobs, money, and finally “response times”. The logic on the last one seems to be fuzzy, especially combined with the argument that the real treatment is done by the FD first responders and all the ambulance crews do is “drive the patient to the hospital”. Nor do I buy into the myth that the FD can be “anywhere in the city in two minutes”. I can tell you from experience when I worked the night shift that 50% of the time we were on scene before the FD first responders showed up. You can’t be first responders if you arrive second.
Finally, the “put a paramedic on every engine and every ambulance” approach comes with it’s own problems. Primary among which is “rust out” because there are only so many skills to be split among so many paramedics. I’m not convinced that a paramedic who only intubates one patient every three years or so is going to be as skilled as one who does a dozen or so intubations every year.
The fire based coalition would have a lot more credibility if they would publish some peer reviewed studies showing better cardiac arrest survival, improved door to balloon times, and decreased length of in patient stays for their systems as opposed to non fire based ones. Paul Pepe should understand that as he hosts a conference every year where medical directors from top level EMS systems across the country come to compare notes and present their research. I wonder if the position he champions would survive such rigorous scrutiny.