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An Apology, Of Sorts

18 comments

In re-reading my last post, it occurs to me that I may have come off as condescending to my EMS brethren who happen to practice their profession within the fire department.

That was not my intention.

I’ve never made a secret of the fact that I am dubious of the dual role, firefighter/EMT delivery model, and I still hold the belief that many of our larger fire departments view EMS as nothing more than a means to justify firefighter jobs, and that many firefighters view EMS as a secondary job function, despite the fact that the call volume for most dual role departments skews 80/20 EMS calls versus fire suppression.

I also question the ability of your average EMT or firefighter to adequately serve two masters – fire suppression and medical care – and still do justice to both.

Still, that ignores the fact that I know a number of exceptional people who do manage to juggle both roles successfully, and call many of them friends.

The cause to re-evaluate the post came from commenter topv7051, although the impetus for this apology did not. In his comment, topv7051 states:

There are plenty of folks in your private/third service/EMS only agencies that have bad attitudes and poor performance, just like every other job. I could sit here and recount a hundred times that my crew and I have had to deal with incompetent private EMTs who seemed to disappear anytime a patient needed to be carried, but that doesn’t mean that you would do the same. Maybe you should stick to blogging about guns, Sumdood, and foreign made trucks. Whining about firefighters just demonstrates your jealousy and ignorance.

In my response to topv7051, I called him a troll, primarily because he never comments unless he has something ugly to say, like suggesting the fall of America is due to my choice of truck.

But in this case, he’s right, even though he stated his case like a jerk. But hey, we’re all jerks now and then, and sometimes when stating my case, I come off like a jerk.

So here you go, topv7051, my public apology for calling you a troll. I don’t much like your commenting style, and we’ll probably never agree on a damned thing, but your comment didn’t stoop to trollery, and you had a valid point.

Thanks for pointing that out.

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Posted by on March 22, 2010 • Filed under: Uncategorized
  • Medic2RN

    AD,

    I “troll” your blog. I have for while. I really enjoy all of the stories, from your awesome daughter to the gun outings to the Sumdood commentaries.

    I was quite offended by your last post about FF/paramedics and their inability to do the job(s). Currently being a FF/paramedic, who had worked just short of a decade in the private EMS sector before being hired to my current job, I can safely say that there are many people who do the Stare of Life rather well. There are plenty of FFs who want nothing to do with a stretcher and there are plenty of paramedics who want nothing to do with burning buildings.

    But as for doing both jobs rolled into one, it can be done. It take a certain type of individual who can go from having to pump multiple lines at a fire to the next call having to do the math for dopamine. Now, that doesn't happen often, OK, well never, because of my small department, but it could, I guess.

    And the reason for your original post was right on. Just because I work for one service and not the other, should not determine if I am to be held accountable when I screw up. It just boggles my mind that because I wear one color patch I can do what ever I want and not have to answer for it, but my colleagues who wear a different color patch have a different set of standards. I would like to meet that uninformed politician who came up with that idea.

    Stay Safe,
    Medic2RN

  • Ambulance_Driver

    Nah, that's not trollery, that's just lurking. And you do comment occasionally.

    In any case, my irritation in the original post was directed solely at the firefighters who think they should be held to a different, lower standard, and not at anyone who manages to successfully juggle both roles.

  • http://firefighterparamedicstories.blogspot.com/ Firefighter/Paramedic

    I didn't feel slighted in the least and don't feel that an apology is needed, but thanks. It's no secret that a lot of FF's hate…well, dislike EMS calls. That's unfortunate. I understand that as a FF/PM I will often be lumped into “that” crowd and I shouldn't be sensitive to it. I take it as a challenge. I know in my area, the ambulance medics only enjoy working with my FD because all the rest have the wrong attitude. Hopefully the attitudes of the other departments will change over time.

  • donheally

    Hey Doc, God made Paramedics because FF's need heros too!

  • http://roguemedic.blogspot.com/ Rogue Medic

    You also comment negatively about people who do a bad job in EMS, but are not dual role.

    On the other post, bobball gave an excellent explanation of the reasons to disapprove of dual role medics.

    My main reason to disapprove of dual role medics is that few places have excellent medics.

    That is few private/hospital based/third service and few FF/EMS paramedics are excellent.

    If we require medics to do other jobs, then we are distracting them from providing excellent medical care. I think the most important thing for EMS is to improve the quality of care delivered. Distracting people from

    Just because some people are capable of doing both jobs well, does not mean that it is a good idea to require that every medic in a system be cross-trained. That will drive away some good medics.

    Contrary to what divemedic wrote on the other post, not everyone in EMS wants to work as a fire fighter, regardless of the pay/benefit difference.

    If you were to defend private EMS, while criticizing FF/EMS, then you really would deserve negative comments.

    Gosh! Then you would be doing exactly what this bill calls for – treating people differently just because of the type of employer.

    If you start using that double standard, you may have to start posting under the handle topv7051.

  • CBEMT

    Psst- not helping!!!

  • http://thehappymedic.com the Happy Medic

    I enjoyed the article and felt it hit the mark in the framework of the legislation. Then again I;m one of them learned fellas.

  • reformedyankee

    I agree with you AD. I spent approximately 20 years in EMS and always felt like EMS was the red headed stepchild of the fire department. I went to work for a county run EMS service and was in hog heaven until the powers that be decided to merge EMS with the fire department. Over the course of 3-4 years, I watched the place that I loved coming to work for be torn apart by the fire department. Programs we had which worked were eliminated because the fire chain of command didn't like them. I finally left because I decided that the job wasn't worth the stress and abuse I was enduring simply because I was a paramedic. Working there was putting a massive strain on my marriage and it simply wasn't worth it. I have since resolved that I will never work for another fire based EMS service and moved on. Some things are better when they are not under fire department control and EMS is a prime example.

  • divemedic

    I agree that some FFs and their administrators have problems with EMS. Heck , I have had administrators in the fire department tell me that you cannot spell 'problems' without EMS.

    Then again, I worked in private EMS and had an administrator there tell me that the nursing homes and hospitals were our customers, and that we are there to keep the customers happy. The patients are merely cargo.

    I think the real problem in EMS and Fire is that you have about 10% of the people who are passionate about their jobs, 20% who are in it for glory and adrenaline, 10% who are disgruntled, and the remainder doing the bare minimum to get by.

    There are very few medics at the top of the game. The reason for that is being at the top of the heap requires dedication to learning, and dedication to being informed. The same goes for firefighting. There are some who are willing to go the extra mile, and many more who are not.

    You can be a good medic, and you can be a good firefighter. The path to greatness runs through dedication.

    To address a comment that I saw here about the fire department team approach not working on EMS calls- I have to disagree. I am a part of a 6 person fire crew. 4 of us are medics, 2 are EMTs. I am the senior medic. We run all of our calls as a team event, and I think we give great patient care.

    Codes- the medic writing the report is in charge. One medic takes airway, one runs the drug box and monitor, one documents. An EMT does compressions.

    Just yesterday, we ran a fully involved truck fire, followed by a 12 year old with chest pains in SVT at a HR of 200, who admitted that he has been feeling palpitations off and on for several weeks. Turns out the kid had undiagnosed WPW. How many medics in or out of fire based EMS would have caught that? Not many. We did.

    My crew discusses every non-routine call every shift. We train and review our actions CONSTANTLY.

  • Ambulance_Driver

    Divemedic, the way you describe is the way it's supposed to work, yet in my experience so rarely does. I know of a few fire/EMS departments that do it the right way. Mr. Fixit, from Texas, works in one. By your description, you work in another.

    OTOH, I also hear horror stories about major metropolitan fire departments where the single role medics are second class citizens in their own firehouse. I've seen with my own eyes a battalion chief with EMT-B certification overrule a paramedic fire captain on a matter of patient care – and the battalion chief couldn't even use the excuse that his order was correct.

    You've probably heard it said, “There is no room for improvisation on the fire ground.”

    While that may be a bit of a cliche, it does demonstrate the gulf between the FD command hierarchy and the often improvisational nature of EMS.

    That's a delicate balance that every dual role department has to strike. Many, like your department, do it well. Others fuck it up like a soup sandwich.

    It's been my experience that the latter is more common.

  • HallwaySledge

    AD, like Medic2RN I have “lurked” your blog for a while and have enjoyed it. I am a full-time FF/PM and while a certain percentage of me took exception to the last article, if I am really honest with myself I also have to agree to a certain extent. The part of me that took exception did so because I am a darn good FF/PM. Not gloating because of an overinflated ego problem but because I WORK at it and I realize that I truly am a Paramedic who once in a while gets to be a Firefighter. I enjoyed being a medic so much that I made and achieved a career-goal of flying for a highly respected hospital-based helicopter program in my area. I have no illusions.

    The part I do agree with is that when you start looking at all the different things that today's FF's and medics need to know and be proficient with you almost need to be a MENSA member to truly master them all. How many different things can one person be expected to know, and know to the point of true mastery?

    As for the dual-role debate, I would like to offer one thought that I really haven't seen anyone address before. With dual-role FF/PM's there is often somewhere for them to go after they burn out on the Ambo, to the Engine, Truck or Squad. Whether that means dropping their medic certification or simply transferring to another company it keeps someone with experience and knowledge around to mentor and train-up the newer members, even if they don't have the piece of paper anymore. Using myself as an example, I have 15 years as a medic. My dept. runs approx. 4,500 runs a year, the majority being EMS. While certainly not hugely busy it is enough of a volume that I'm pretty much done. At the earliest opportunity I will more than likely drop my medic (allowed by my dept.) and move over to the fire rigs. That doesn't mean that I automatically forget everything I learned over 15 years and am incapable of mentoring a newer medic.

    For the single-role medic what option does he or she have? Get a field supervisor position? Go into the business office or the EMS System office? Training? Or, worse yet, stay in the field and deliver declining care and become the guy/gal no one wants to work with for the shift?

    There are pros and cons to both delivery models. I really think your view is formed by the area you work. My area is FD-based EMS. Private ambulances are used for non-emergent nursing home and Doctor office visit transfers. There are 3 contract paramedic companies in the area that provide medics to FD's who don't want to run their own but they are still housed in the firehouses and respond as part of the department. Those of you that work in an area that runs hospital-based or third-party providers have a different view because of the model that you are used to seeing and being involved with. When it comes right down to it there are medics in both arenas that I wouldn't allow to touch anyone I cared about and there are those that I would want working on me or any members of my family. It comes down to personal commitment and dedication to the job.

  • mmorsepfd

    Keep telling it like it is, AD, and if you step on a few toes along the way, so be it!

  • http://SiliconeMomma.blogspot.com/ Becca

    Not that I understand anything of what your apologizing for….just wanted you to see that you have a new fan!

  • Sharon

    I don't think a dual role is a good idea. There is too much to learn in both jobs to be good in both and what happens when you have a fire with injuries? Which role comes first? I work in a .volunteer fire department. The firefighters are also First Responders. We have an ambulance with paramedics working out of our building. All work well together. Sometimes the firefigthers drive the ambulance so both paramedics can work on the patient. Sometimes the firefighters see the patients first because the ambulance is already involved with a call. Usually the paramedics go on fire calls with the firefighters in case there is an injury or burn. The firefighters gain entry to locked homes or extricate patients from vehicles for the medics. Each has its own role and they work as a team.
    However in the next county the firefighters, medics and rescue all have separate operations- even separate buildings next to each other. They do not get to practice teamwork inless it is a training session. That is even worse than a dual role in my opinion.
    PS I have read your blog for a long time now. We have sumdoods and drug seekers in South Carolina too.

  • divemedic

    I can see where a volunteer would think that it is hard to master both. You aren't even devoting all of your time to one of the two jobs, so two would seem to be insurmountable. We all know that no one can be good at more than one thing. Which makes me ask you: How can you be a good volunteer firefighter, and still be good at your paying job? Is is possible for a person to be proficient at more than one skill? Or are you telling me that volunteers either suck at their full time jobs or at firefighting?

    Asking which role comes first at a fire with injuries illustrates a large amount of ignorance of the issues. When you arrive at a fire, what do YOU do first- ventilate? Gain access? Secure utilities? Attack? Rescue? Or do you just carry out your assignment, secure in the knowledge that someone else has been assigned the other tasks?

    A fire department with EMS capabilities simply assigns appropriate units to each task as required, whether that task is fire or EMS related. One fire might see me pulling a hose line, the next sees me intubating a patient in the front yard of a burning house. Since all of our units are ALS (engines, trucks, squads, and rescues) there are plenty of firefighters and medics to go around. 4 of the 6 firefighters on my crew are paramedics.

  • CBEMT

    4 of the 6 firefighters on my crew are paramedics.

    You say it like it's a good thing, or is proven to improve outcomes.

  • divemedic

    I can see where a volunteer would think that it is hard to master both. You aren't even devoting all of your time to one of the two jobs, so two would seem to be insurmountable. We all know that no one can be good at more than one thing. Which makes me ask you: How can you be a good volunteer firefighter, and still be good at your paying job? Is is possible for a person to be proficient at more than one skill? Or are you telling me that volunteers either suck at their full time jobs or at firefighting?

    Asking which role comes first at a fire with injuries illustrates a large amount of ignorance of the issues. When you arrive at a fire, what do YOU do first- ventilate? Gain access? Secure utilities? Attack? Rescue? Or do you just carry out your assignment, secure in the knowledge that someone else has been assigned the other tasks?

    A fire department with EMS capabilities simply assigns appropriate units to each task as required, whether that task is fire or EMS related. One fire might see me pulling a hose line, the next sees me intubating a patient in the front yard of a burning house. Since all of our units are ALS (engines, trucks, squads, and rescues) there are plenty of firefighters and medics to go around. 4 of the 6 firefighters on my crew are paramedics.

  • CBEMT

    4 of the 6 firefighters on my crew are paramedics.

    You say it like it's a good thing, or is proven to improve outcomes.

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