The biggest reason the FDs have for adding medics is mainly to do with union/labor bargaining politics and trying to maintain indispensability (regardless of public benefit) in this age of shrinking bugets (especially when you look at theirs).

Simply put, adding paramedics puts more chips on the table to add union members and gain public support in contract negotiations. Since this means ever increasing expansion, and its an easy sell to the uneducated public, eventually a medic on every responding engine, truck, and squad.

Unfortunately, this does not equal better medical care and there are a variety of strong arguments that suggest that it. The most common argument is that of “over saturation”.
Basically, too many paramedics for too few patients equals a poorly trained and skilled paramedic with dangerous tool.

Simply put, adding paramedics is a labor strategy, not about patient care. If it was about patient care, perhaps we should be doubling the number of basic life supper responders, as that, not paramedics, is what has been shown to impact patient care.

Perhaps the FDs should add a couple of BLS squads (like what Eagle has, only seperatly staffed) to cover holes for medical response when another unit (those half million dollar tanks discussed n another BG article) go out. That would have a real impact, not paramedicss on fire engines.

Or even better…..Perhaps we should have an aggressive, appropriately managed police officer based AED program like other cities have to supplement the current FD and EMS response. In some cities that use the same dispatch system as Ada County Uses this is called an “echo” response. Simply put, the closest AED equipped unit, not the closest half million dollar fire truck, is the priority. Since the number of actual Echo calls is not that large…the increase in work load isnt that significant for the benefit. And since a number of these require police after the fact, they would already be there anyway.

This strategy, not paramedics on every fire engine, has been clinically shown to DRAMATICALLY reduce response to cardiac arrest(in some cases by over 2 minutes), and improve cardiac arrest survival significantly as well.

In fact the only study I am aware of that failed to show a clinical benefit was in rural Indiana where response times were excessive for all responders. Even then Police response was 1.9 minutes sooner than any other responders (including fire).

Something proponents of the IAFF (a labor organization for fire fighters) supported paramedic engine concept have been unable to reproduce on any meaningful scale.

References:

Impact of Community-Wide Police Car Deployment of Automated External Defibrillators on Survival From Out-of-Hospital Cardiac Arrest, Circulation, 2002;106:1058

Police AED Programs Are Cost-Effective, Journal Watch Emergency Medicine, Vol. 2002, Issue 313, 9 March 13, 2002

AEDs for Police First Responders — A Shocking Development!Journal Watch Emergency Medicine, Vol. 2005, Issue 726, 5 July 26, 2005

Cost Effectiveness of Suburban Police Early Defibrillation Programs – 7 Years’ Experience Academic Emergency Medicine Volume 7, Number 5 430,

It’s ALWAYS about bargaining power and $$

Nemo – I don’t quite understand your argument. Fire MANAGEMENT is not part of the union, so why would they, the staffing decision makers, want to add paramedics to increase the bargaining strength of the union? Perhaps you, or Tam, can explain…? Thanks!

Thanks, Tam. That helps.

So okay, now I understand the basic premise of the argument, but I guess the bottom line is that I just don’t buy it. I don’t subscribe to the world view that the only reason human beings ever take action is for some very specific self-serving purpose, unless you consider as self-serving the idea that they feel good about doing the right thing, or helping others.

I suppose it is possible that in this situation, some of the fire protection providers realize that the majority of their calls are medical, so they want to move their organizations in that direction. But I still don’t really see this so much as self-serving as it is trying to provide the community with the most needed services in exchange for our tax dollars.

Until someone produces the documentation to show that there is a more malevolent motivation for the fire providers to want to add paramedics, I just can’t find fault with them for the idea.

Obviously, Tam and Nemo are Ada County Paramedics as they demonstrate their ignorance to labor negotiations and cite subjective “facts” to what they believe F.F. motivations are.

Whether F.F.’s, Fire Administration, or the IAFF gain anything from adding Paramedics to fire engines is purely conjecture. The negotiation process is a process between two very different bodies that represent to very different interests. The F.F.’s (Local #149) and the IAFF’s job to represent Firefighters. In this case, the City of Boise’s job is to represent the interests of the citizens of Boise by providing a lean Budget that provides for services that they believe the public want or need.

Unfortunately, for Tam and Nemo, the current EMS system in place in Ada County is the most expensive way to provide the service. That is why, nationally, cities and counties are moving toward either a fire based system, a fire based / private agreements, or private based ALS system.

Unfortunately, the ordinance pushed through by Ada County Commissioners removes any chance of improving the EMS system unless system changes are a benefit first to Ada County Paramedics. Don’t be fooled by soundbites, it has nothing (in my humble opinion) to do with improving patient care.