I am troubled by some of the misleading and false comments posted by Nemo and others in reference to the efficacy of fire-based EMS. There is plenty of research backing up the common sense approach of utilizing the existing infrastructure that fire departments possess. According to the American Heart Association, survival rates for patients with life threatening medical emergencies are dependent upon two predictors. First is the response time of the EMS system, and secondly, the service level provided by the responders. For medical emergencies such as airway obstruction or cardiac arrest, survivability depends on response times no greater than 4-6 minutes. Considering the average time required to activate the EMS system and dispatch units is 1-2 minutes, this leaves a required response time of 2-4 minutes to arrive and provide adequate care to potentially survivable patients. The American Heart Associations claims are strongly supported by the survivability data collected in Ontario, Canada during the Ontario Pre-hospital Advanced Life Support Survey (OPALS 2005).

In 1992 the Journal of Emergency Medical Services produced a report from the Emergency Care Information Center. The study analyzed responses from 468 EMS personnel from 10 different EMS systems. Each of the subjects responded to a questionnaire that was designed to determine factors in the emergency medical care work environment that contributed to job stress and satisfaction. The study produced data measuring the effect job stress has on patient care. Table 3 on page 16 of appendix 20 compares the instances of clinical errors and patient complaints by cross-trained/dual-role firefighter paramedics versus single-role paramedics. It reveals that the average number of incidents per shift for dual-role paramedics was .99 % compared with 1.69 % for single-role paramedics. Patient mistreatment was 1.94% to 3.91% respectively. According to the study, cross-trained/dual-role fire fighters were nearly 40% less likely to make stress induced clinical errors and 50% fewer stress induced instances of patient complaints than single-role paramedics. When an EMS system is stretched as thin as we see with ACEMS in terms of budget dollars and response efficiency, the employees and patients both suffer.

Don’t forget the County’s own Blue Ribbon Task Force advised them to utilize the fire department infrastructure and consolidate EMS and fire. In 2007 a coalition comprised of representatives from the Congressional Fire Service Institute, the National Fire Protection (NFPA), the International Association of Firefighters, the National Volunteer Fire Council, and the International Association of Fire Chiefs released their white paper study advocating the use of fire based EMS. Below is a link to download the study in its entirety.
http://www.cfsi.org/EMS_Coalition/emsadvocates_release_06_12_07.asp
Why should the taxpayers of Ada County pay to duplicate infrastructure of a separate EMS operation. The County has been clear in their actions against consolidation of services. The cities and fire districts should therefore move towards providing their own cooperative fire based transport system. Without the transport revenue from the cities and fire districts the County cannot continue operations. This will force the necessary change that needs to occur.

There are the fire departments and there are fire fighter unions. They are not necessarily in agreement on many many things.

Fire Departments are creatures of cities and/or districts and as such are theoretically committed to providing good service for as few tax dollars as possible. I say theoretically because it seems anymore that most politicians are big taxers and big spenders. It’s so easy to do that with other people’s money.

Firefighter unions are not into the mindset of spending less money. They are designed to suck out as many tax dollars as possible. They see the wave of the future is medical services. Most of the calls in the Boise department (70%+ and higher) are for medical reasons – NOT fires. This rationale is used for two purposes, one is to get a higher rate of pay for a more specialized training and two, as Nemo says, to add another person to the current 3 man truck.

It may be we get to a different way of delivering paramedic services in this County, but again, understand that we are already paying taxes to the county for paramedic services. I would hate to end up paying for something I can’t even use.

This is not new. This has been a goal of the union for over 10 years.

For those who don’t usually deal with the fire service let me explain the unspoken innuendo…
A (VERY) common response of the fire service to its detractors in the public safety community is that the “Haters” are that way because “they arnt good enough to get on the fire department” or “Your not part of the brotherhood, you wouldn’t understand.” SO the implication is that I am a “hater” because I couldn’t cut it, not because my points have validity.

BAck on topic…

It has been my observation that this BOCC, and the BOCC in general, has been far more supportive of a systems wide approach..and would eb far more receptive of a Dr. Copass, than the fire service. As anyone will tell you in the King County area, Dr. Copass has to routinely bash the FDs figurative heads as well. And Dr. Copass’es vision of EMS so far has been so far and away ahead of any other EMS in the nation, it is unfathomable to many just how different (or just how successful) such a system is, or how it would look in their own area.

So, Clippity and others…It is obvious that the fire services neither want, nor will support anything other than the “Standard” fire service approach to EMS (Paramedic ENGINES) for reasons discussed.
It is also apparent that The fire service will not work with ACEMS on any significant change to the current EMS system, or even to maintain the current EMS system.

So Short of “giving up”, letting the system we have today become another cali-clone….what else but legislation will ever make the fire services go along for a real progressive EMS?

Even if Dr. Copass himself were to show up today, without the political and legislative authority to “knock some heads” and get everybody playing together (like a bunch of kids on the playground…sometimes you got to knock some heads together, and pull a few ears too!)that the ordinance would help establish…the fire services here would thumb their noses at Dr. Copass just like they have at ACEMS for 20 years.

Because Dr. Copass’s ideas (and ACEMS’s ideas) don’t mix well with standard FD strategies, FD traditions nor union labor political priorities.

Too much accountability, too little hero worship.

I hope that Ada Coutnty appeals the decision, or the people wake up and put some grass roots pressure on the fire service to be a positive force for meaningful change, not the adversarial factor they have been in the past.

Again the ironic thing is that there is a meaningful role for the FD in a Copass like EMS system. Equally important, or more so. It just doesn’t involve paramedic engines. And it involves too much cooperation and too little union agendas

Cities across the country have this same ordinance and have developed a true EMS system – able to monitor and control the quality and prevent the “fly-by-night” services from functioning. Government needs to be able to provide this level of control. I find it funny that you can control which cable company comes into your city, but you can’t control the EMS.

And lets look at these fine fire districts – they are taking a tax money and providing a service that is above and beyond their original intent – if they have enough money to staff paramedic ambulances, maybe you should ask to lower the district tax and have then stick to fire.

Maybe there will be an appeals court with a little more common sense and able to see the big picture.

You know quite a bit about the fire service responses. Haven’t you interviewed more than once for a paramedic/firefighter position in the fire service.

Anyway, while there were better ways to go about forming a system collaboratively, those means were attempted, and at every turn the fire districts have said one thing and done something else, keeping their eye on the dissolution of ACEMS.

In this type of enviroment, what else was left but legislation?

For once you and I are closer in opinion but let me ask you, why is no one pointing the finger at the fire districs for their role in preventing a truely great EMS system from fluorishing?

ACEMS is doing their part…when does anyone say to the fire service…STEP UP AND DO THE RIGHT THING (And if the King County example is to be followed, Paramedic Engines AINT it!!!)

We simply cannot legislate a Medic One system — it must evolve under dedicated leadership who sees patient care as job one. That leadership should be involved with training and coordinating with other fire districts that ACEMS does not serve, until such a time as one system can successfully function.