There are some big differences between the fire-based ALS providers in King County (such as Seattle Medic One) and the 3rd service one in South King.

You say that stand alone EMS makes fire based EMS look bad, and I find that funny because around here, it is the opposite. I think Rural Metro in this area looks bad.I have the advantage of having worked in states other than the one I am in now, and I have worked in areas with private EMS, with public EMS, and with fire EMS.One thing that I have noticed is that the quality of EMS depends far more on the practitioners skill, drive, and professionalism than it does on who signs the paycheck.

Divemedic,Although committed, quality, practitioners certainly are a component of a great EMS system, they alone can not make the entire difference. Systems that tolerate crappy care or even worse, institutionalize it, will experience that as the norm despite great EMTs and paramedics scattered here and there. It just seems as if that sort of thing is more prevalent in the FD based systems than in other models.

You say that stand alone EMS makes fire based EMS look bad, and I find that funny because around here, it is the opposite. I think Rural Metro in this area looks bad.That's a private, not a third service.

Just to note the 3rd service ALS agency in South King County (Public-Health) has a bad reputation for dumping ALS patients on private BLS ambulances. Four of the five fire-based ALS services don't have that reputation. Vashon Medic One has that reputation because they're on a remote island with only one medic unit.

1 In this area, Rural Metro runs as third service to Orlando Fire (Orlando fire runs ALS engines and ALS rescue trucks, Rural Metro does the hauling)2 I once worked for an EMS company that told me "We always take care of the customer. The customer comes first. The hospitals, Dr's and Nursing homes are out customers. The people we haul are just cargo."So don't think that any one service has cornered the market on institutional crappy care.The good paramedics become the good supervisors of tomorrow, the crappy paramedics become the crappy supervisors.

To add: I once saw a Health Central (hospital based EMS) paramedic pull a knife out of a patient. When her partner pointed out that she shouldn't remove impaled objects, she STUCK IT BACK IN.So private EMS does it as well. I am not saying that one is better than the other, I am saying that they are all run by people, who are flawed.

"When her partner pointed out that she shouldn't remove impaled objects, she STUCK IT BACK IN."Oh. Em. Gee.Stupid like that should burn, or something.Minor quibble, though: The situation you describe with R/M and Orlando Fire is not a classic third service model. They're still a private, with ALS first response by the FD.By "third service," he means a municipally owned (not a private, publicly administered abortion like Public Utility Models) stand-alone EMS system, one of the three public safety systems run by the city – of which police and fire are the other two.

AD-What you talk about was tried at my employer (although I admit it was years before I started there) and talking to the old timers, it was an unmitigated DISASTER.EMS had a different retirement system, payscale, and benefits. They ran an average of 15 calls per unit, in a time when the (then) rural runs could take over an hour.The EMS crew would return to the station at 11 pm (after running all day) to find the fire crew (who averaged 3 calls per week)telling them "we did most of the station cleanup and saved the bathrooms for you"So I can understand where the animosity comes from. At least around here, the medics are universally disliked by everyone except other medics (and you know how we eat our young) non-fire medics get lower pay, uglier working conditions, and crappy benefits.A good parallel is the PA versus ARNP rivalry, or perhaps the MD versus DO debate.

Divemedic, you make a good point. One that I'll probably blog about in the near future. It could have been so much different if the fire service in general, the IAFF, and the IAFC had taken a different approach to EMS. The fact that they took a completely debasing and antagonistic approach to non fire fighter EMTs and medics merely underscores that they don't care about patient care one bit, but do care about preserving jobs for fire fighters who also don't care about patient care one bit. Their actions completely belie their words about really wanting to be EMS providers and providing excellent care. The vast majority of fire service EMS systems fight any sort of medical oversight or accountability. The very worst examples of incompetent care occur in fire service based systems, whether the providers are FF/medics or "merely" civilian medics.

The biggest problem I have with fire service EMS is the cross training. I do not believe that EMS should be cross trained until after we can demonstrate excellence at patient care. The problem is that acquiring and maintaining excellence at EMS is a full time job. Where do we come up with the time to include a bunch of training that is unrelated to EMS and maintain the level of excellence that patients deserve?The reality is that many places have EMS that is not excellent. Private, 3rd service, and fire service. They all have problems, but at least the EMS-only organizations are not trying to train EMS in an unrelated field that will distract the EMS personnel from the EMS.Do I want to have a fire fighter, who also happens to be trained in EMS, provide patient care when my life is on the line? What about when it is my family?Do I want to have a paramedic, who also happens to be trained as a fire fighter, try to rescue me from a burning building? What about when it is my family?Do I want to go to a surgeon, who cuts back on time in the OR, so that he can maintain cross training as an accountant, operate on me? What about when it is my family?Do I want to have my criminal case handled by a lawyer, who cuts back on his time in the court room, so that he can maintain his dual role as a pilot, defend me against criminal charges? What about when it is my family?If we want people who are excellent, we want people who spend a lot of time on what they do. We do not want people who can't make up their minds about what they want to be when they grow up. Some of them may be good, some may even be great, but most will be worse at both jobs, than they would be at just one job. I believe that it is a myth that most cross trained people will be excellent at both jobs. Does anyone have any evidence to support this supposed dual excellence?Even the postal workers just do postal work everywhere except where they can't afford full time postal workers.We do not need hobbyists in EMS. We need professionals. If we need volunteers, because we can't afford full time EMS, we do not have a choice. If we have a choice and we choose cross trained EMS, then decision making is not our strong point. Maybe we should not be making patient care decisions.

Or, to rephrase some advertising that I just saw – Quality is never job one, because we're cross trained. We only multi-task.

Not buying it. The last 2 posts were over the line. Saying that I can't be good at both jobs is simply elitist horseshit. If you are a paramedic, you can't be good at anything else? Or are you really trying to say that you can't walk and chew gum?Are you REALLY saying that EMS takes up 100% of your time? That you are so wrapped up in the job that if you were ever to try and learn a new skill, that you would have to forget one already learned?Some of you really need to get off the "I am better than you" elitist attitude. It is posts like that that make me believe that some others are right- and it really is a jealousy thing.In this neck of the woods, firemedics make 2 1/2 times what a non fire medic makes, and there is a saying: What do cops and EMS medics have in common? They both want to be firemen.and you know what- when they say that I defend medics, just like I am defending firefighters when it goes the other way.

The reason we have that attitude is because by and large single role EMS systems out perform fire based dual role systems in every facet except maybe response times. And that depends on how the system defines response times. In your neck of the woods, both cops and medics seem to be underpaid and fire fighters seem to be overpaid. Which has more to do with the presence and strength of unions than it does with medical or any other skill.

Anonymous,Not buying it. The last 2 posts were over the line. Saying that I can't be good at both jobs is simply elitist horseshit. If you are a paramedic, you can't be good at anything else? Or are you really trying to say that you can't walk and chew gum? No. Training people at 2 unrelated jobs is going to produce people who are less capable at the 2 unrelated jobs. Less time for training at both.If you think that either fire fighting or EMS are the equivalent of walking or chewing gum, then you are only making my point. Are you REALLY saying that EMS takes up 100% of your time? No.Are you claiming that You are excellent at both fire fighting and EMS?I expect that you aren't claiming excellence at literacy, because you have already demonstrated otherwise. That you are so wrapped up in the job that if you were ever to try and learn a new skill, that you would have to forget one already learned? No.Few people will be excellent at both jobs. Most people would be much better at one job or the other job.Of course, if you do not take what you do seriously, then it doesn't matter how many jobs you are cross trained for. Some of you really need to get off the "I am better than you" elitist attitude. It is posts like that that make me believe that some others are right- and it really is a jealousy thing. See my earlier response about literacy. In this neck of the woods, firemedics make 2 1/2 times what a non fire medic makes, and there is a saying: What do cops and EMS medics have in common? They both want to be firemen. Then you definitely need to cross train the police as fire fighters, too.After all, why should we deprive the police of your cross trained quality? Or are you claiming that you do not have the ability to take on another job? That you are so wrapped up in the jobs of fire fighter and paramedic that if you were ever to try and learn a new skill, that you would have to forget one already learned? and you know what- when they say that I defend medics, just like I am defending firefighters when it goes the other way. This has nothing to do with defending fire fighters or defending medics. This is about doing the job the right way.If you want quality, you do not want cross trained. Some people can do a great job at both, but they are rare. Why should a police officer have to also be a paramedic and a fire fighter, just to be a police officer?How does that improve the quality of the law enforcement?Why should a fire fighter have to also be a paramedic, just to be a fire fighter?How does that improve the quality of the fire fighting?Why should a paramedic have to also be a fire fighter, just to be a paramedic?How does that improve the quality of the patient care?

@ Roguemedic:Evidence. Since medicine is science based, lets see the evidence that EMS only paramedics are better at delivering care than fire based medics. You say that you can't be good at 2 jobs- lets see the study that confirms this.Until then, this "EMS is better than fire" meme is just another form of penis envy.

Anonymous,@ Roguemedic: Evidence. Since medicine is science based, lets see the evidence that EMS only paramedics are better at delivering care than fire based medics. You say that you can't be good at 2 jobs- lets see the study that confirms this. I did not write that you can't be good at 2 jobs. I wrote – Few people will be excellent at both jobs.Most people would be much better at one job or the other job.Of course, if you do not take what you do seriously, then it doesn't matter how many jobs you are cross trained for.I do not accuse all fire fighter/paramedics of having poor literacy, by why are so many of the most vocal defenders of cross training so poor at communicating in English. Maybe we should raise the literacy standards.I understand that you might be frustrated in your desire to be the premier hair stylist/fire fighter in the country. I'm sure there are a lot of benefits from combining the two. Higher pay, more respect, more vibrant colors (red is so passe), getting into the trendiest bars, and letting out all of the other things you have been repressing all of these years.Don't let me get in the way of your empowerment. This is all about you, so be the best hair stylist/fire fighter you can be!It is important that the government not trample on your dreams as our tax payer dollars are spent to allow you to realize your dreams. Here in the Peoples' Republic, there is no need to use any form of logic. We should expect that matching unrelated jobs will always produce the highest quality. It's all about the empowerment! Until then, this "EMS is better than fire" meme is just another form of penis envy. I love it when you use Freud to defend a crazy idea.Since you are such a fan of psychoanalysis, imagine if you were to combine the psychoanalysts and the fire department in your community. You could arrive at the fire and be overwhelmed by the phallic symbolism. Then you could contemplate how you feel about that. You could analyze the role your mother may have played in this. Meanwhile the fire continues to burn as you skillfully put your cross training to work figuring out how you really feel about putting out this fire and what it symbolizes. Silly? Of course, but you are the Freudian venting your Id.