Why Fire? Why not Fire?

[Guest guest]

I would like to speak on this topic.

I work for both - 1) I am a paid paramedic for a Private Ambulance

service. It has it's good & bad points. Good in that its license is a duel

role. We do both emergency calls and transfers. So, it can be a " money

maker " on both sides. The bad side is that the company owner is " so tight

with his money that he squeeks when he walks " . We have good equipment but

have to work that much harder to keep it in good shape.

I am an unpaid professional firefighter/paramedic that works along

side a 3rd service EMS service (County run). They have a tax base that

supports the non- " money making " runs. This service is strictly an

" Emergency Medical Service " , no transfers at all. (There are private

services (including the one I work for) that take up the slack on transfers.

The county run ememgency medical service works and in hand with the

unpaid professional fire departments that they are associated with. Many

times have I seen the " Medic " being the pump operator on a house fire. While

his/her partner is helping with rehab.

The down side to this is the county (Parish - I live in Louisiana)

actually loses some money because they do not do transfers.

Mike Stockton, AAS - EMT-P

Firefighter/Paramedic/911 Dispatcher

Arklatxemt@...

[Guest guest]

Henry, good discussion topic.

The Austin is a good example of two independent systems that are tied at the

hip. Austin fire, as well as all the county volunteer fire departments,

provide first response as part of the Austin/ County Emergency Medical

Services system. Austin/ County EMS provides transport, medical

direction, administration, etc. This works well because you can have a medic

on the scene within minutes without having to invest in a huge number of

ambulances. The only down side, is that while the county volunteers respond

on all EMS calls, the city FD only responds on the more serious medical or

where rescue is needed. This could be considered a decrease in service to

areas that are annexed since all of the county's medics have to pass the

same system tests to practice within the system. (I say this as a former

county VFD member who's house was annexed into the city, so I'm speaking

from personal experience.)

Personally, unless the either EMS or FD was going down the tubes

administratively to the point where the department would be unable to

function, I can see no real reason to merge them. Some of the economic

benefits would already been realized by sharing stations (which Austin does)

without having to build duplicate facilities. Otherwise, why introduce the

turmoil that comes with change into systems are that are functioning well?

Sure, there's some adminsitrative duplication that can be reduced(purchasing

and HR for example) but unless those systems are extra-ordinarily huge or

have the capacity to take over the other's activities, you would simply be

moving one agency's personnel into another agency to do the same functions

they did before the merger.

Now if there is a move to merge EMS/FD/PD into one Public Safety type agency

where everyone is cross trained for all activities, aka DFW Airport, then

all bets are off since that's a change in not only the functions but the

mission of the departments. To me that's a great move towards providing more

comprehensive emergency services to the public.

Why Fire? Why not Fire?

I would like to see a thread on the list that addresses why a city or

county should go to a fire based ems system (merge).

I would also like to see some discussion as to why not go to a fire

based ems system (merge)

Please speak only to or in the context that the city or county already

have both an established fire department and an established EMS system

in place by different providers.

A good example would be Austin fire and Austin EMS. Why should they

become one or why not?

P.S. Not picking on Austin. They have a reputation for execellence in

both departments.

Henry

[Guest guest]

It would depend on the performance of the current situation. There are

Negatives and Positives for each.

Fire Dept EMS:

PROs:

Existing infrastructure, including stations, dispatch, and 24-hr emergency

response is already there. So they can easily add this capability.

There is no profit motive for a public service. This is good and bad. The

good is, if they have the responsibility, they have to find a way to do it.

Pay tends to be better, because of civil service rules.

CON:

They are FIREFIGHTERS, not doctors (to echo what I've heard a lot of times).

EMS is PART emergency service, PART medical service. Part fits with the

emergency services mindset, part does not.

If a FD has no history of EMS, the culture works against it.

It means a LOT more calls.

Billing for calls? A whole infrastructure MAY be needed.

Money can be a significant issue, as budgets don't change easily, and even if

adding this significant capability, that's a lot more money, and voters tend

to look at only dollars and percentage of budget change.

PRIVATE SERVICES:

PRO

May be more flexible, not hampered by civil service rules and such

(unfortunately, pay scales are a factor sometimes).

They have one mission, not two (Fire and EMS). More focused.

May be able to take advantage of economies of scale for big providers.

In THEORY, there is a cost advantage to private services, and even with that

EVIL profit motive, they still should be cost effective. But doesn't often

work that way.

CON

There is almost NO way to make money as a private EMS service. Sad, but

true.

If a city changes from FD to private, there is a VERY high expectation of the

advantages of private enterprise.

Private services may tend to reduce services, because they have more cost

pressures and are theoretically run like a business, where a public service

has service first, budget second (right!).

I don't buy the argument that the quality of care is directly related to the

TYPE of service. It is related to the INDIVIDUAL service and their

management.

=Steve=

BARBER wrote:

> I would like to see a thread on the list that addresses why a city or

> county should go to a fire based ems system (merge).

>

> I would also like to see some discussion as to why not go to a fire

> based ems system (merge)

>

> Please speak only to or in the context that the city or county already

> have both an established fire department and an established EMS system

> in place by different providers.

>

> A good example would be Austin fire and Austin EMS. Why should they

> become one or why not?

>

> P.S. Not picking on Austin. They have a reputation for execellence in

> both departments.

>

> Henry

>

>

[Guest guest]

Barry is so right. If a system works, there's no need to fix it, in my opinion.

-Wes Ogilvie

[Guest guest]

--- BARBER wrote:

> A good example would be Austin fire and Austin

> EMS. Why should they

> become one or why not?

>

> P.S. Not picking on Austin. They have a

> reputation for execellence in

> both departments.

>

Speaking as a former member of Austin EMS and a

current member of the Austin Fire Department...

IMHO, the only REAL reason to merge departments

is a legitimate service delivery problem, such as

an EMS system that is unable, for whatever

reason, to provide service.

Cross Trained/Dual Role firefighters are, on

paper, very effective. We're able to provide

fire protection and advanced life support for one

salary. In practice, however, very seldom does a

firefighter assigned to an ambulance fight fire,

so you're paying for fire training for a person

that doesn't fight fire, and the paramedic

assigned to an engine company still needs an

ambulance crew to take a patient to the hospital,

so you're paying for a paramedic who doesn't

transport patients. The advantage only comes

into play in that very very very small number of

patients whose lives are honest-to-God saved by a

3-minute Firefighter/Paramedic rather than a

3-minute FF/EMT and a 6-minute EMS paramedic.

Using your example, Austin EMS does, in fact, do

an excellent job of providing service throughout

County, and they're getting better now

that the county is putting more money into the

system (there are now several trucks in the

non-city areas of the county, and more to come).

If AEMS and AFD were to merge, in theory the only

real savings would be in the upper echelons of

the management structure. In theory, there would

be no need to pay an EMS Director AND a Fire

Chief; one person could run the resulting single

department. There are probably a few more

positions that could be eliminated using the same

logic.

The other side of the coin is that I'm one of

about 20 or 30 Paramedics employed by AFD, while

there are somewhere around 250 or 300 Paramedics

working for AEMS. Translation: There are 300

people in Austin who know how to run EMS, and all

of them work for Austin EMS. Right now, I

honestly don't believe that Austin Fire

department has the logistic capability or

personnel to take over transport EMS without

absorbing the vast majority or the EMS employees

to perform that function. Basically, it would be

exactly what happened a couple of years ago in

New York City.

In many of the cases we read about in which a

Fire department starts providing transport EMS,

they're actualy assuming that role from either a

private service who is unable to provide service

(for whatever reason) or a city has grown so much

that the city's fire department takes over

service inside the city to relieve a county EMS

system of some of their workload. Other than

NYC, I can't remember any large municipal systems

in which a municipal fire department absorbed or

merged with a municipal EMS (which doesn't mean

there aren't any; I just don't remember them).

Many Fire Chiefs want to take over EMS because

EMS is an expanding market, while fire

suppression is moderating and in some cases

shrinking. They see EMS as a method of

maintaining and/or increasing their staffing,

equipment, and budgets. While the staffing,

equipment, and budget may increase with the

addition of transport EMS duties, I don't believe

that these are legitimate reasons to merge

departments unless a community finds itself in a

position where that's the only way it can afford

to continue both services.

Alan Brunacini, Chief of the Phoenix FD, pointed

out a few years ago that when a Fire department

moves from EMS First Response to EMS Transport,

the department changes from a Fire department

that runs EMS calls to an EMS department that

runs fire calls. Very few people are willing to

do that.

just my twice pennies.

phil

__________________________________________________

[Guest guest]

> Phil has an excellent post.

Thanks, Chris.

> ...that

> the current management teams have the necessary

> skills to provide leadership

> and management to a combinded organization.

I agree whole-heartedly. I speak from experience

when I say that a Fire Chief from a non-transport

FD doesn't hav the " been there, done that "

credibility to lead Paramedics, and EMS

Commanders who have never been firefighters don't

have the " been there, done that " credibility to

lead firefighters. The right person in the right

circumstance with the right agency could pull it

off, but it's not a task for a mere mortal like

me to tackle.

> * Lack of Quality Services-probably a good

> reason to step in from

> either direction, but the same issues apply. I

> doubt most fire command staff

> would believe that an EMS command staff member

> could step in and assume the

> role of Fire Chief, but the reverse happens all

> the time. Logically, if 60%

> of the fire department activity is EMS response

> and 100% of the EMS system

> activity is EMS response, who better to lead a

> combined organization whose

> activity is 80-90% EMS response...the manager

> who knows EMS or Fire

> Suppression? A tough question in light of

> history and culture, but certainly

> an interesting one. Here is the alternate

> question as well...what happens

> when EMS is providing a very high quality

> service but the fire department

> has substantial problems? Does EMS 'assimilate'

> the fire department?

makes a good point with this bullet. I

think that the reasons that FDs assimilate EMSs

is because the assimilated EMS is frequently a

private-sector agency (but not always) while the

FD is a " wholly-owned subsidiary " of the city.

Therefore, the FD has the inside track with the

Mayor/City Mgr.

Something else to consider with this bullet:

While Warren is the Chief of the Austin Fire

Department, I really don't care if he is, was, or

ever will be a good firefighter. He is the

Chief. His job is not to spray water; his job is

to make sure that there are people available to

spray water. I care that he is a good manager

and leader of a large city agency.

Bearing in mind that young firefighters follow

old firefighters and young medics follow old

medics, I honestly don't see that running one

city department is any different from running

another city department, assuming that the

departments in question are large enough that the

Boss doesn't have to perform street level tasks.

As an example, Sue was the Director of

Austin EMS for several years. Sue is an

expert in municipal management; she's never

worked a shift on an ambulance unless it was a

ride-out; she's never been certified as an EMT or

Paramedic.

Also, EMS is a relatively new field when compared

to the fire service. There are firefighters

still on the streets who put sick people in the

back of hearses in downtown Austin, Tx., for

transport to Brackenridge Hospital. Austin EMS

has been around since 1976.

> * Merging two departments providing quality

> services for the sake of

> efficiency invariably fails to achieve

> efficiency and very likely ruins two

> previously effective and efficient departments

> (there are occasional

> exceptions to this rule).

I agree. I don't think you'll find a department

that provides true quality service that's also

inefficiently managed; I believe that, to an

extent, good management and good service go

hand-in-hand. When two efficiently managed

departments are merged for the sake of

efficiency, what generally happens is that you've

fixed two departments that weren't broken.

> * ation and visionary leadership can

> achieve greater

> effectiveness and efficiency in public safety

> response than a merger.

Example: Many Austin Firefighters want to

provide a higher level of care without being

assigned to ambulances. There is a system in

place in Austin/ Co. to allow that. The

outcome is that the patient gets better service

and the provider stays happy.

> Now...if we want to talk about something really

> interesting...how about fire

> service based EMS where the paramedics are

> considered 'civilians' and are a

> segregated group within the department <grin>.

Is that your crystal ball speaking?

phil

__________________________________________________

[Guest guest]

Actually, no, I just think it would be interesting to hear from those who

have worked in that environment and what it was like...I know my personal

experience as I did my paramedic internship with DC Fire, it would be

interesting to hear from others.

Chris

> Now...if we want to talk about something really

> interesting...how about fire

> service based EMS where the paramedics are

> considered 'civilians' and are a

> segregated group within the department <grin>.

Is that your crystal ball speaking?

phil

__________________________________________________

[Guest guest]

Interesting topic. Most of the diuscussion has been centered around larger

cities. Which has been great, but when your done what about doing the smae

thing in small town? Can costs really be saved? You still have to people

available for EMS and Fire right? Whats the opinion of trying to merge EMS &

Fire in a small town where you have 1-2 paid firemen & 20-30 volunteer

firemen trying to merge with a small EMS service who has 10 paid EMTs &

Paramedics? One of those things that might look good on paper. Just My 0.2

_________________________________________________________________

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