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In Other News: Water Is Wet, Sky Is Blue

A Santa Clara County civil grand jury finds fire department response to medical calls incredibly wasteful:

A report by the watchdog panel found that 70 percent of fire department calls are medical emergencies, and just 4 percent are fire-related. But even so, firefighters respond as if they are heading to a fire, sending a crew of three or more on a truck or engine costing an average of $500,000 — five times the cost of an ambulance.

Typically only one of the three arriving firefighters has medical training, the report said. That creates a "mismatch between service needed and service provided," with fire departments deploying "personnel who are overtrained to meet the need" — that is, paramedics also trained as firefighters.

Hang on a moment while I try to remember where I put my shocked face. Read the whole article, since it may take me a moment to find it…



Ah, there it is!

Seriously, the only thing shocking about this news article is that it took the media so long to realize what most of us (outside fire departments anyway) have known for years: this isn't about providing medical care, it's about justifying staffing levels and shiny new fire engines.

I'm sure this will cue a nasty fight in comments, including the requisite number of "Ambulance Driver hates fire department EMS" opinions.

Which isn't true, by the way.

I've spent my career working in private EMS, and I do a fair amount of teaching and consulting for fire departments that provide EMS first response and/or transport, yet my personal belief is that municipal third-service EMS is the superior system model. It's not the best fit for everywhere, but in those places with sufficient call volume to support a full-time paid EMS system, I think the best way to provide it is through an EMS system that is separate from police and fire.

I guess my biggest beef is that the attitude I see fostered in so many fire department EMS systems is that EMS is not their core mission, but rather a means to an end.

And as long as 80% of their call volume is EMS, yet 80% of their funding, promotional pathways, and training are devoted to fire suppression, that opinion is not going to change.

Chime in with your comments, but keep them civil or you'll eat Ban Hammer. If the most constructive statement you have to offer is calling someone a hose monkey or a stretcher fetcher, or yet another tired iteration of "private EMS cares more about money than people" or "firefighters are a bunch of testoterone addicts who suck at medical care," find another forum, please.

Chris Kaiser does a nice, even-handed job of summing up my major beefs with fire department EMS here.

Happy Medic's eminently reasonable take on the issue.

My series about fire department EMS, with some excellent comments from both sides:

Marriage Counseling Part I: The Dysfunctional Fire/EMS Relationship

Marriage Counseling Part II: The Dysfunctional Fire/EMS Relationship

Marriage Counseling Part III: Detente in the Dysfunctional Fire/EMS Relationship



Comments - Add Yours

  • Guest

    My first thought is where are they getting a Paramedic equipped ambulance for 100,000?  With out any equipment a quality truck is going to run around 130,000-170,000 and that does not include that expensive monitor or anything else.  Flawed study from that point of view.

    This appears to me to be the beginning of justifying cuts for the department in the very near future.

    As far as the Fire Based EMS goes, I could care less who runs the EMS service as long as those that make up the EMS service are competant and prepared individuals.  The last person I want showing up at 3am with an attitude is the medic that is a medic so they could get hired on the FD and now are stuck on the ambulance with a huge chip on their shoulder.  I have worked EMS for 15 years in a part-time paid and volunteer position and am now in medic school because I love the job and have a passion for it.  If  your passion is being a FF and EMS is the niusance you have to endure to get there you will be an ass at 3am because you do not feel it is worth your time.  Just my .02.

  • Anonymous

    These are the same results we were hearing in the late 70’s… sigh… And it IS about money and promotions… Third party e.g. stand alone EMS is the best idea, but it’s hard to convince anyone of that fact.

  • Anonymous

    Of course a first alarm for a fire is probably 3 or 4 engines, a truck company, a rescue and a battalion chief, but why let the facts get in the way of self-righteousness.

  • muledung

    The obviousness of the argument seems to preclude debate… but the fact that something is obvious has never deterred the IAFF from taking an unreasonable position. That someone has once again pointed out that the sole reason for FD based EMS is to provide fire types with shiny new toys is interesting. It is a tact that has never worked before, but is still interesting.

    • Anonymous

      I’m not saying it’s the only reason.

      It’s just the most common one.

      Ambulance Driver

  • Addy

    I would MUCH rather work for the F.D then a private ambulance company. My FD doesn’t charge for a ride on an ambulance (which they always send along with the chief or asst. chief)-whereas the private company I worked for charged 1500 dollars for a BLS ride to a hospital not even a half a mile away. Hello, price gouging. That’s why I quit and went to work for an all volunteer FD, who is now paying for my FF I cert. It was a matter of principal, to me. People shouldn’t go broke because of an emergency.

    So while I TOTALLY see where you’re coming from with this. . . not al FD’s are like that, man. Some of us really do care about our calls-fire or no.

  • Addy

    While I do see what you’re getting at here, not all FD’s are like that, dude. Mine doesn’t charge for an ambulance ride (we always send an ambulance and a chief truck)-we’re an all volunteer department-and it doesn’t matter if it’s an EMT on it or a Medic. We’re all there for the same reason: to help people who need it.

    I quit working for a private ambulance company when I found out that they charged $1500 dollars for a half-mile BLS trip to the hospital. Hello price gouging much? I’d much rather work for free and run into burning buildings then break people because of an emergency. Seriously.

    • Anonymous

      I’m not talking about volunteer fire departments at all, Addy.

      And the rates the privates charged are not price-gouging. In fact, they might be reasonable for your area.

      The reason they charge so much is because they the vast majority of ambulance transports are reimbursed by Medicare/Medicaid, and for years Medicare has reimbursed at 30% less than the actual cost of doing an ambulance run, and Medicaid only pays about 20% of what Medicare does.

      And the reason Medicare gets away with setting its rates so low is because it calculates the average cost of an ambulance run, nationwide, and sets fee schedules based on that. And that average is dragged down drastically because over half the EMS in this country is supplied by volunteers (thus no personnel costs), and many of those systems do not charge for a ride.

      So while you’re feeling noble about being a volunteer and not charging for an ambulance ride, consider also the fact that you’re a big part of the reason that ambulance rides cost so much in other areas.

      That’s not me bashing volunteers, that’s just how you happen to fit into reimbursement metric – by artificially deflating the actual cost of providing EMS.

      Emergency Departments have the same problem. They have to charge an arm and a leg to the uninsured and privately insured, because they lose money on Medicare and Medicaid reimbursement.

      So yeah, those greedy capitalistic private EMS services could charge less… but then they’d go out of business, and even more areas would be without EMS coverage.

  • Anonymous

    Holy Cow, I could rant on this subject for days, but I won’t.  First of all I’m a firefighter/emt-I, with 10 years experience, currently in paramedic school.  I started as a vollie firefighter in a rural dept.  There were 10 paid/300 volunteers in the fire department and a separate county ems system.  Believe it or not it worked, lots of fire calls, LOTS of ems calls.  We first responded for ems, in my district an ambulance was 40 miles away.  I loved being a volunteer firefighter, but quickly discovered I loved ems even more.  A year and a half later I had my first paid job with a dept that was combining at the time, rude awakening, really really rude!!  It was a nightmare for me.

    Through the years I’ve worked every possible job, firefighter (massively bored), non-emergent transport (beats WalMart so far), combo depts (HATE IT) and county 911 ems.  While working non-emergent transport at the beach, I made a comment to a captain with the county fire/ems system that I wished I could work for them but the agility test was too much.  His response was, “We have the agility test to keep out women and the written test to keep out N…. (blacks)”.  I was so stunned that for once there was nothing to say.  In my part of the world this is the sad reality and I wouldn’t work for an organization like this for any amount of money.  The department I started with as a volunteer was forced to combine and very shortly they lost all of their older experienced medics and all but one of the women.  While this system looks good from the outside; what’s really going on makes me sad, morale sucks and patient care is nothing like it used to be.

    The bottom line is these two services don’t do well together.  They attract very different types of people and as a whole the mesh doesn’t mix.  While I finally came to understand the need for the paramilitary sir yes sir BS in the fire department, it is the absolute opposite of what makes a good medic.  I don’t play well in that enviroment, mostly because an intelligent outspoken female is about as welcome as the plague.  I don’t hate the fire department; I just don’t fit in that sandbox. I do really well in the back of a truck with a sick patient that needs the care of someone who loves this job.  I wouldn’t be going through medic school, at my age after 10 years, if I didn’t love this job.  I have alot to offer many patients in the future.  They can be sure that my focus is totally on their medical needs and all of my training will be devoted to being the best possible medic I can be.  I just wish I could be sure that the providers who might help my loved ones felt the same way!

  • Hilinda

    I suspect it depends a LOT on what fire department, what municipality you’re talking about. The size of the dept may play a large role, too.

    The paid fire dept near here runs EMS calls, sending an engine, BUT they made a decision in the last couple of years to coordinate with the ambulance service so that if it would be helpful to have  the engine there, they go, and if not, they don’t. It has to do with where everyone is, where the call is, what kind of call it is.

    All the firefighters are required to be EMTs.  Many of them run with the ambulance service as well, and quite a few are medics.  It’s a pretty great group of people, who all know and respect each other, and it works very well, from what I can see.

    I don’t think the fire dept does much, if any, EMS training, (I could be wrong) but as I said, many of them work on the ambulance anyway, and get training there.  A lot of them volunteer as well, so they train with their volly depts if they are fortunate enough to be in a good one.

  • Islandmedic1

    A very wise instructor from the national Fire Academy EMS class that I took many years ago said ” The mindset needs to change. We are not a Fire Department making EMS calls. We should be an EMS department that ocasionally makes Fire calls.” Why have 20% of your department making 80% of the runs? I have seen good services go bad because of the FD first mentality. More empahsis should be spent improving what you do most, not what you do on an occasional basis. Firefighting is not hard folks. Put the wet stuff on the red stuff. But trying to sort out a sick, complicated patient encounter some how takes a back seat to hose operations…. And they wonder why their public opinon is low. We should be publicizing and showcasing what we do the most. And thats taking care of people.

  • Medic 72

    Again proof that that most career fire departments need to prove their worth at the taxpayers cost.  This is an issue that has been out there for a long period of time.  One reason why the taxpayer has been at the cause of the pain is because of the post 9/11 mentality.  Yes this was a tragedy.  But we do not need to have all fire departments small and large across this wonderful country to have equipment and staffing to levels that are not needed.  A simple view of being conservative in spending the fire departments do would be a great improvement.  The fact is that building codes and regulations have improved so much from the 1970’s to present that yes there aren’t as many fires.  No we don’t experience BACKDRAFT the movie everyday and pull a Kurt Russel and say “You go…..I go.”  Let’s stop trying to take the taxpayer for their hard earned money and get back to the realization that we as professionals provide a service to all people of our communities regardless of race, sex, creed, religion, sexual orientation that we are here to help.  EMS is exactly what it stands for Emergency Medical Service.  We don’t call the city trash worker to repair our kitchen sink, we don’t call a police officer to put a roof on our house.  The Taxpayer has felt like a hostage in a bad dream for so long with the roles that the fire department unions play in scaring the communities into thinking we have not improved our ability to decrease fires in our homes.  I have talked with many firefighters and EMS providers across this country and the shocking thing is that we all differ.  You go to the east and visit Pennsylvania you will find Fire Departments that are Volunteer that run as much if not more calls than a large city department out west and they do not collect any tax money from the citizens.  They charge per call response fees.  You visit departments in small town South Dakota and they do not even have enough bunker gear to go around.  In New York City the fire department is different from the ambulance.  Yes they both say NYC FD but the Paramedics are just that and the Firefighters are actual firefighters.  You visit a small community in Colorado that has just gone paid and they are asking for large mill level raises because the need a 100 foot platform truck with all the bells and whistles so that it will look cool in the eyes of the public responding lights and sirens to a person that has fallen in the local nursing home.  Really?  Yes they take a million dollar piece of apparatus run it around town and and it may have 100 hours of actual fire fighting use then it is time to replace it, because it has to many miles from driving to nursing homes. I know you are thinking there is another angry paramedic.  No.  I have experience in wildland firefighting, search and rescue, private non profit ambulance volunteer and paid, and volunteer firefighter.  I am proud to be an EMS provider for over 20 years.

  • Promedic92

    I think this is a perfect example of fire using EMS to justify thier exsistence. Don’t get me wrong, I have seen quality fire based EMS achieved before but if a fire department got into EMS within the last 5-10 years they are padding numbers! It is just my opinion, but maybe its time fire set aside the halo that they seem to feel they wear and reduce staffing to a force of both paid, and paid on call (volunteer) personnel. That “should” open a budget to allow 3rd service EMS “WITH” separate management. While this thought could get me shunned for life by my people I consider friends it is a valid solution to the growing epidimic of “million dollar manpower” for a fallen little ole lady.