DCFD Non-Training

[DCFF/PM]

At least I'm keeping the EMS stuff seperate from the Firefighting forum...


I do not support or in any way condone the 'west coast' style of firefighting, or anything for that matter. It is interesting, though, to see what other jurisdictions are doing compared to what we're doing. Why can't we steal some ideas and improve our situation? The 'RUBE' wants 33 paramedic engines ASAP, yet how many medics has he brought into the department since his arrival? How many have left the job? Take a look at what LAFD is doing - read page 2 of their 'weekly bulletin'.

I personally don't think that our EMS operations will function with 33 pecs and no ALS transport units. I do believe that given a better pay incentive, and an operational plan that includes PEC's and a majority of transport units being ALS, that more members would volunteer for the training.

LAFD Bulletin (http://lafd.org/bulletin/wb2007-51.pdf)

[NorthSTAR]

What does this have to do with Chief Rubin? The last 3 people to occupy that job have also wanted 33 PECs. Going by the personnel actions, not too many have left the agency by choice in the last 365 days, and everybody knows that FEMS is not the only reason we have trouble hiring people for ANY position (DCOP).
Thanks for that link, thats pretty interesting reading. Also nice to see a department get the word out so often. Weekly newsletters seems like a cool idea, maybe someone should suggest these things thru official channels?

Personally, I wouldn't mind 33 PECs AND 33 1+1 ALS transport units backed up by 6 battalion located rapid/expanded scope medics.

[Kobersteen]

LAFD has an extraordinary PIO, he is a LAFD firefighter/paramedic by the name of Brian Humphrey. He runs the LAFD News & Info blog also: http://lafd.blogspot.com/

Not to slight Etter, by any stretch...

[DvlsAdvct]

I can tell you that there are measures being taken to get medics here. But I do not think the plan is fair to us. Sure, we may get 15, 20 or even 25% for the FF/PM in the next go round. Who knows, I am totally not privy to any of that info. But I have HEARD that some of the powers that be want a sign on bonus and maybe even relocation money for new hires. Some numbers thrown around have been up to 5k sign on bonus.

Leaves me with one question. What about us? What about ones who have been here paving the way and running up and down the road all night long for 2 or 3 or 5 or whatever years?

[StrikeTheBox]

You will never really be able to be competitive in recruiting medics till you get rid of the age limit in DC. I see it going away by the courts if someone pushed it. Explain how if someone 35 years old cannot apply to be a Firefighter, but could get hired as a EMT then apply to be a Firefighter in crossover and get hired. The courts will eat that up if it ever gets to that.

DC was doing open applications for FF/PM. They were tested each month. Not any more, there is no open announcements for any spots on DCFD now?

[firedog7-365]

Sorry guys I do not think PEC'S are the answer. But the 1and1 transport unit are a good start. :)

[Truth]

Sorry guys I do not think PEC'S are the answer. But the 1and1 transport unit are a good start. :)
So why are PEC's not the answer, besides the fact that you don't like being detailed. How is putting these medics on wagons and getting them on the scene of medicals faster not the answer. Please give us a better plan. The only problem I see with the current plan is that PECs should be run with five man staffing.

[firedog7-365]

PEC'S are not the answer because of the way they are being used. For example if a delta or echo run is dispatched a PEC and a basic ambo will be placed on the run and in the same breath a medic unit will be put on a ALPHA SIC. SO no it has nothing to do with details and everything to do with gross misuse of the unit!!!!! :mad:

[Truth]

PEC'S are not the answer because of the way they are being used. For example if a delta or echo run is dispatched a PEC and a basic ambo will be placed on the run and in the same breath a medic unit will be put on a ALPHA SIC. SO no it has nothing to do with details and everything to do with gross misuse of the unit!!!!! :mad:
So the PEC is being used correctly in your scenerio. The unit not being used correctly would be the Medic unit.

[firedog7-365]

All right Truth you got me on that but please explain why a PEC is sent way out of there first due for a medical then a box is struck in there first due report of victims trapped and units have to come from farther out. So can you help me understand that? P.S. the only reason for the PEC being sent on the medical was because of its PEC status.

[Truth]

All right Truth you got me on that but please explain why a PEC is sent way out of there first due for a medical then a box is struck in there first due report of victims trapped and units have to come from farther out. So can you help me understand that? P.S. the only reason for the PEC being sent on the medical was because of its PEC status.
Because the department fucked up and let communication get taken away from us and given to the OUC. If dispatchers knew what the fuck was going on and could be held accountable for there actions then alot of issues would be resolved.

[firedog7-365]

Copy that sir :D :D

[crabby1]

And if there were 33 PECs, there would be less likelihood of you being sent 'way out' of your first due.

[firedog7-365]

Is it just me or have you paid atten to the fact that if a PEC down grades to a basic engine and another med is dispatched the medical box assignment that is sent in its place 2 engines and ambo. That in my opinion eats even more resources. NOT A SERMAN JUST A THOUGHT

[DvlsAdvct]

Here is a thought on recruiting and retaining ff/pm's. Many hospitals and EMS systems do this and it works.

So you want medics that have some experience, say 5 years. Why is it fair for a medic who has been certified for 6 months to make the same as a medic with 5 years experience just cause they started a new job the same day. Do you think that gets people here when the pay is below average? No, it does not. So, what you do is pay ALS providrs as if they have been with DC for whatever time they have been cetified. So if you have a guy that comes in with 5 years of experience then you pay him at 1C step 4 or whatever.

And you dont just do it for the new people. You take everybody that is an ALS provider and make their pay reflect their years of experience.

The other option is to increase the medic differential up to 30% or higher and make this place so damn financially attractive that people will be climbing the walls to get in.

You also need to increase the pay for the firefighters that are EMT advanced.

All options are expensive. But the city needs to realize what the hospitals have known for years, it aint cheap to do anything in healthcare. If you are going to operate a system with experienced, type a providers then you need to make sure that they can have a nice lifestyle and keep them happy. If you want to pay below average, well you get what you pay for. A lot of us go above and beyond everyday we are at work for this below average pay, but its getting old fast.

[MinorThreat]

Can anyone argue that 1+1 staffing on units wouldnt fix all of these problems? Disband the medic units and use the personnel to staff 1+1 units.

As for getting new medics, People say things are being done, but what? I havent seen anything, have you? What I did see was a large color add for the upcoming cadet program in the Washington Post Express. If we can advertise that why not FF/Medic positions?

[DvlsAdvct]

Ok. Every transport unit 1+1. For this conversation assume its all 1+1. Ambo/medic 33, 25, 15 and 32 all at or enroute to the hospital. Cardiac arrest in the 4700 blk of 1st St SW. What ALS resource is now available? There will ALWAYS be times when transport units are tied up and not around. One needs to remember that the way DC is using the PECs is not the way they were meant to be used when concieved. PECs are to get a medic there fast, thats all. This buisness of getting off the engine and going to the hospital is stupid.(see #3)

Keep in mind that part of retaining medics is not burning them out on BLS crap calls. Good medics want to take care of sick patients and not be transporting bullshit all the time. As far as I am concerned medics in this system need to be dynamic. Be it on an engine or in a car, they need to be able to say "hey, you dont need me for this patient, I am going back". It is total waste for an ALS resource to be with a BLS patient waiting for a bed. We will likely have a shortage of medics for some time, strapping them to a transport unit would be counter productive.

I do feel that there is a better way to do things than is being done now though. We need more medics first.

1)5th man on PECs. I dont have to take the wagon to the hospital much, but I also have lots of ff ambo's around me. Other than codes and shootings I have taken the wagon to the hospital less than 10 times over the last year. This is not the case in other areas though.

2)Staff all the PECs that you want

3)Assign a second medic to any PEC that has its own ambo in house. Both medics do a day/night rotation, just like everybody else. Now you have a unit to transfer care to and you can be around for the next potential ALS emergency.

[dcfdsid]

Here is a thought on recruiting and retaining ff/pm's. Many hospitals and EMS systems do this and it works.

So you want medics that have some experience, say 5 years. Why is it fair for a medic who has been certified for 6 months to make the same as a medic with 5 years experience just cause they started a new job the same day. Do you think that gets people here when the pay is below average? No, it does not. So, what you do is pay ALS providrs as if they have been with DC for whatever time they have been cetified. So if you have a guy that comes in with 5 years of experience then you pay him at 1C step 4 or whatever.

And you dont just do it for the new people. You take everybody that is an ALS provider and make their pay reflect their years of experience.

The other option is to increase the medic differential up to 30% or higher and make this place so damn financially attractive that people will be climbing the walls to get in.

You also need to increase the pay for the firefighters that are EMT advanced.

All options are expensive. But the city needs to realize what the hospitals have known for years, it aint cheap to do anything in healthcare. If you are going to operate a system with experienced, type a providers then you need to make sure that they can have a nice lifestyle and keep them happy. If you want to pay below average, well you get what you pay for. A lot of us go above and beyond everyday we are at work for this below average pay, but its getting old fast.


A very simple fix is that your medic pay is a percentage of YOUR current salary AND NOT step 1 Firefighter pay. That to me is a disgrace. With the new automated peoplesoft, this should not be anything more than a stroke of the keyboard.

Sid

[Loo for life]

Bravo both Sid and DvlsAdvct well said by both of you!!! ;)

[Backstep]

1)5th man on PECs. I dont have to take the wagon to the hospital much, but I also have lots of ff ambo's around me. Other than codes and shootings I have taken the wagon to the hospital less than 10 times over the last year. This is not the case in other areas though.

2)Staff all the PECs that you want

3)Assign a second medic to any PEC that has its own ambo in house. Both medics do a day/night rotation, just like everybody else. Now you have a unit to transfer care to and you can be around for the next potential ALS emergency.

So basically you're saying if you want to ride a fire engine you'd better get promoted to WD, LT, or become a medic. Oh no, there's no room in THIS department to put firemen on fire engines. Oh wait, if we get approval for the 5th man there will be room for 33 firemen per shift.

[DvlsAdvct]

Hey Backstep.

I think what I am getting at is that putting two FF/PM at each PEC with an ambo does two things.

1)It makes the PEC work like its supposed to with regard to transfering care and remaining available.

2)It allows me to take my turn on a transport unit, just like you and the rest of my friends that ride it.

The 5th man speaks for itself. Sure we may need some new peeps to fill that void, but we are already pretty well staffed I think. Its another riding position for you.

[antagonist]

Here is a thought on recruiting and retaining ff/pm's. Many hospitals and EMS systems do this and it works.

So you want medics that have some experience, say 5 years. Why is it fair for a medic who has been certified for 6 months to make the same as a medic with 5 years experience just cause they started a new job the same day. Do you think that gets people here when the pay is below average? No, it does not. So, what you do is pay ALS providrs as if they have been with DC for whatever time they have been cetified. So if you have a guy that comes in with 5 years of experience then you pay him at 1C step 4 or whatever.

And you dont just do it for the new people. You take everybody that is an ALS provider and make their pay reflect their years of experience.

The other option is to increase the medic differential up to 30% or higher and make this place so damn financially attractive that people will be climbing the walls to get in.

You also need to increase the pay for the firefighters that are EMT advanced.

All options are expensive. But the city needs to realize what the hospitals have known for years, it aint cheap to do anything in healthcare. If you are going to operate a system with experienced, type a providers then you need to make sure that they can have a nice lifestyle and keep them happy. If you want to pay below average, well you get what you pay for. A lot of us go above and beyond everyday we are at work for this below average pay, but its getting old fast.

I agree with what you are saying in theory, but think about this. If the department started paying new hire FF/P's more money based on the years of experience that they had, then you know that all of the FF/EMT's would demand that they be paid based on how much previous experience they have. After all, someone with 5 years EMT experience starts at the same rate as someone that gets "trained" at the academy. Further, what you are saying would only really work for single role providers, since they would be getting paid to perform EMS only. Since the department has decided to phase out single role providers, and hire only dual role providers, your proposal would not work. Otherwise, you would have to add incentives for everyone with EMT or medic experience, PLUS everyone with previous FF experience. And if someone had both (FF/P or FF/EMT) you would have to add even more incentives.

One thing that the department could do to improve the quality of EMS is require that ALL new hires be EMT's at the time of application. By doing this, they could do a number of things. First, they would ensure that everyone was already trained and already has at least some experience working EMS. Second, they could focus the EMT Basic cirriculum (sp?) at the academy to become a refresher (geared to DC protocols and the way we operate), where at the end everyone who isnt already NREMT takes the NREMT (probably with a much higher initial pass rate). Lastly, it would increase the quality of BOTH firefighting and EMS because it would ensure that all individuals applying would at the least be more highly motivated, since I cant imagine anyone who isnt highly motivated going out and paying for an EMT class or volunteering somewhere to get their EMT, solely to have a chance get a job that they are not very enthusiastic about doing their best at.

[Backstep]

Hey Backstep.

I think what I am getting at is that putting two FF/PM at each PEC with an ambo does two things.

1)It makes the PEC work like its supposed to with regard to transfering care and remaining available.

2)It allows me to take my turn on a transport unit, just like you and the rest of my friends that ride it.

The 5th man speaks for itself. Sure we may need some new peeps to fill that void, but we are already pretty well staffed I think. Its another riding position for you.

Oops, sorry. I misinterpreted the taking turns part. I thought both medics would be on the backstep at the same time.

[Brooks]

There doesn't seem to be much consensus on how fast ALS has to arrive to be any good, or even if it does any good at all. The most common 'goal' for ALS response is 90% of such runs get ALS on the scene within 8:59. Some puget sound area departments seek to have ALS "available" (no associated response time indicated) a certain portion of the time. The IAFF, via NFPA 1710 seeks to have TWO ALS providers within 8:00. One peer-reviewed study shows that ALS shows a significant benefit when it arrives within 4:00 - but I believe that was in an all-ALS system - so their first responders arrived w/in 4:00 as well.

1&1 units:
Currently we're getting transport units to calls within 13:00 97% of the time. If we were willing to accept ALS on the scene within 12:00 90%+ of the time, we could switch to 1&1 units tomorrow. This would probably be as good for patient care as anything, but would leave the city open to accusations of reducing service. We could probably reduce the response times to 8:00/90% with aggressive peak shift scheduling & dynamic move-ups. We have about 170 non-supervisory medics now, or enough to staff approximately 30 1&1 units, which could be enough with the aggressive peak schedules. 1&1 units are more difficult to staff, as you need to get exactly one ALS person and one BLS person to report for duty at the same time - vs. staffing the back of a fire truck by sending 3-4 people to fill 2 spots, assuming they'll all get there early, and then sending one elsewhere. Staffing 1&1 units would be easier if multiple units were put in service at the same location and at the same time.
As for the 3rd Battalion problem mentioned earlier: you'd do the same thing you'd do for the engines - you'd move some from across the river.
Total Paramedics needed (given 117,000 runs, demand matching and dynamic deployment, 7 runs per 12h, and 5.65 staffing factor): 126
Each medic would provide care to 480 Charlie and Delta patients each year.


33 PECs
Our engines get to the scene of medical calls within 4:00 about 75% of the time. I'd guess that they get to the scene within 6:30 about 90% of the time. I'm not sure how often PEC medics transport when faced with a BLS transport crew: I'd guess that they'd do so less than half the time when dispatched on a Charlie or a Delta. I think that for a total PEC system to work, you'd need a few other sources of ALS in the busy areas, or else your engine is OOS for half the day. I'm totally against changing crews at the scene - disrupting unit integrity 5 times a day has to be worse than taking daily details.

33 PECs, Medic is 5th Man:
Need 187 Paramedics, & 187 More FTEs for the 5th Man.

33 PECs, Medic is 4th Man: Need 187 Paramedics (17 more non-supervisory paramedics than we have now).

In either case, each medic would treat 325 Charlie & Delta patients. Unless there were additional ALS resources, which would dilute this further.

I think the ALS first responder / BLS transport idea will work on paper, but will prove unworkable due to its effects on the Engine companies: constantly out of position, difficulty in staffing (4 guys rotating through 1 spot), or constant hourly unit personnel changes. Having the PM as the 5th man would probably by unworkable from a financial perspective, and there'd be little point in having an 'extra' guy on each engine - why not put him in his own car, etc.

ALS Flycars:
Paramedics deployed in single Paramedic Fly Cars could provide ALS service with 53 paramedics, assuming they used peak schedules, dynamic deployment, staffing factor of 5.65, and responded to 9 ALS calls per 12 hour shift (and transported on less than half of those). Each of these medics would treat 1150 Charlie & Delta patients each year.


MY TAKE, assuming we must provide ambulance service:

Ideally:
Individuals could get certified at EMT-Advanced, Intermediate, and Paramedic as their capability and desire for responsibility indicated. They'd be paid for their efforts. They'd act at their level of certification wherever they happened to be.

If we must provide transport service, everyone would be in the rotation for ambulance duty - if a medic happened to be aboard, it'd be a medic unit.

Experienced medics could compete for the Expanded Scope program - and be assigned to a SPRINT (Single Paramedic Rapid Intervention Non-Transport) car.

Alphas and Bravos could be handled by a single transport unit, if they're close enough, with engines available to be called to the scene.

Charlies would be handled by the closest transport & SPRINT car.

Deltas would get the closest engine, transport unit, and SPRINT car.

If OUC were competent, i'd fudge the unit selection by 2 minutes to send ALS transports to ALS calls and BLS transports to BLS calls.

My transport units would be busy, 5500 runs per year: but these guys would spend less than 25% of their time on ambulances. Heck I might even make the detail lengths measured in number of transports rather than number of weeks.

[Brooks]

A bit convoluted, I suppose. The short version:

33 PECs:
Advantage: Shorter ALS response time (no, or questionable medical benefit). Could be put in service tomorrow.
Disadvantage: Requires either taking engine companies out of their assigned areas with regularity, or making up crews on the spot to rotate the Medic to the transport unit. Medics assigned to slow companies will treat fewer than 100 ALS patients a year.

1&1 Units:
Advantage: Send the closest unit(s). Keep unit integrity throughout shift. Fire truck response not required for Charlie medical calls (~35% of medical locals)
Disadvantage: hard to rotate medics off of the transport units, so they'll be hard to recruit. If FFPs split their time evenly, we'd require 374 of them, even more than those necessary for the 33 PEC system.

SPRINT Cars (and come-as-you-are ALS/BLS Engine Companies & Transport Units)
Advantage: requires 53 paramedics. Eventually these could be Super-Paramedics, winning fame & glory for the DCFD. Send the closest units: Engines as first-responders, Transport units as transport units, and SPRINT cars as ALS.
Disadvantage: requires competent medics. requires additional vehicles. Must find something for 50-some existing supervisory (out of practice) Paramedics to do. Requires aggressive shift planning.

[Mike Ward]

. Must find something for 50-some existing supervisory (out of practice) Paramedics to do. I am almost afraid to ask, what jobs (or positions) are the 50 some non supervisory single-role paramedics doing now?

[Brooks]

I am almost afraid to ask, what jobs (or positions) are the 50 some non supervisory single-role paramedics doing now?

Mostly field supervisors - who don't supervise that much; and preceptors - who don't turn anyone over as cleared for field duty.

[DvlsAdvct]

They are in those positions for what I would call a "reduction in clinical liability"....lol.

[Backstep]

You can cruntch numbers all day Brooks, it don't mean much on the street and it don't mean much to our administration. They don't care how well the system works as long as it "appears" to the citizens to work.

The best intervention is a rapid transport, ALS or otherwise I don't care the answer remains the same. The BEST intervention is a rapid transport.

[Brooks]

"as long as it 'appears' to the citizens to work." -- This is how democracy works.

Apparently the citizens think that ALS works.

[bunkroombandit]

I am almost afraid to ask, what jobs (or positions) are the 50 some non supervisory single-role paramedics doing now?

They are answering phones, reading paperwork, trying to screw over firefighters, attempting to teach classes (though some doing instruction aren't bad), and they also "teach" that ridiculous EPCR class. That's a waste of time.

[DvlsAdvct]

So Sean, what you are saying is that there is no place for ALS? Granted more than a few of our providers dont do appropriate care but a good bunch do too. I am talking about care that is above and beyond the DC cutural minimum. I am talking about medics that are not afraid of dopamine, mag, epi drips and thinking outside the box. I can tell you that when I have a sick ass patient my ALS makes a difference and they get a little better by the time we get to the hospital.

AMI patients need ALS. You could say rapid transport to GSE or Sibley, etc right? No, those hospitals cannot take care of that patient. So you have to drive a little further and do ALS on them. A good number of our asthmatics need a lot of medicine very quickly. 5 minutes can mean the difference with them.

I will ask you this. As a BLS provider riding the ambo have you ever had an asthmatic or CHF patient that was in severe distress and they continued to get worse and when you arrived at the ED they were unconcious and in need of intubation? Good, aggressive ALS care would likely change that picture.

Perhaps your experience is with subpar medics that do not know or care enough to give good, competant care.

[Brooks]

I never said there was no place for ALS. You got the wrong guy.

[Backstep]

I won't dispute that my idea of "The BEST intervention is a rapid transport" has to do with the DCFD bred, sit-on-the-scene for 25 minutes, punching a patient full of holes trying to get a line, busting up all the patients teeth trying to intubate, non-pharmicolgy knowing, 1 finger to the chest does this hurt, and arriving at the hospital with still no IV or tube street doctors. There may be a few truly amazing medics out there but it is sickening how long the on scene time is for some of these patients who, if transported appropriately, could be being treated by an appropriate specialist.

Regardless of what the "steet doctors" think, the REAL doctors with all the neat machines and drugs are in the hospitals and the pt. is better off if you don't dick around on the scene all day. Do what you gotta do and LETS GO ALREADY.

[DvlsAdvct]

I will agree with you on your take on this when it comes to surgical patients(trauma, hot bellies thoracic and abdml anyeurisms, etc) they need hot lights and cold steel.

I will not agree that a good medic cant make a difference on medical patients. We have most things needed for sick respiratory, cardiac and medical patients. Minus a few things. We still need our scheduled drugs to include fentanyl, RSI and some type of beta-blockers, one for hypertension and one for MI salvage.

Those of us that have good experience can get an epi shot, start a 5 dose neb, get a line, give solumedrol and a mag drip in about 5-7 minutes. This is of course while making radio calls and assessing the patient.

This is just one example and there are many more. Medical calls are stay and play, esp. a cardiac arrest. No reason to hurry to the hospital if all is going well. If things are not going well, be it from the medic fucking up or its just a bad day, then run to the hospital. Pay attention to what the hospital does for a medical cardiac arrest. Its not all that different than what we do in the streets. All the drugs are the same.

Again, you must not be used to running with a good medic, if you did you might feel different.

I will also tell you that in the past had I not done ALS to a patient they may not have gotten it anytime soon. Have you been the ER's of some of our usually better hospitals? I have put patients in bed before at WHC that were having ST elevation chest pain(emergency issue) that I had treated and made the pain go away and the elevations come down. Well after doing my toughbook and getting all the signatures and packing my bag and monitor back up I went in to see the patient before leaving. She was now having 2/10 pain again that was previously gone. Before I treated her it was 9/10. Nobody hadbeen in to see her. It shows that rapid transport with no ALS might have killed her because she would have gotten no nitrates at all. Amazing what is happening to what used to be one of the best cardiac ER's in town. But thats a whole seperate issue there.

Trust me any naysayers, ALS works when done right. Doing it right better than 50% of the time is where the issue is.

Sorry Brooks. I did have the wrong guy. I will buy you a beer or something to repent....lol.

[dcfdsid]

Paramedic Engine Companies (running on 5) with an ALL 1+1 transport fleet is the absolute key. We take our highest trained members and force them into liability situations on a daily basis because they do NOT have another ALS member with them. If we want our members to thrive, and we want to be able to be shielded with Teflon when the lawyers come hunting, There SHOULD be two ALS people with their hands on any critical patient. I am not talking about 1 medic driving and 1 medic ridind with the patient. I am talking about TWO (2) medics in the back of the transport unit with their hands on the patient.

Now with that said, we have some great EMT-B's out there. I work with a lot of them. But when you have that critical patient, or maybe that patient that presents with something non-traditional, it is always nice to have a check and balance to bounce an idea or diagnosis off of someone else's brain.

One of these days we will get someone in a position of authority that actually unerstands how to do this ALS stuff and do it correctly.

Sid

[Brooks]

Dvls:

I don't think we have enough patients such that every engine could 'support' a high-level ALS provider. Nor do I think that, once such a high-level ALS provider was created, their special skills should be wasted on BLS Responses, Transports, Administrative Duties, Driving Vehicles, Laying Out, Alarm Bells, BLS Training, Food on the Stove, Building Fires, etc. This level shouldn't be a ticket-punching certification for promotion.

Such a provider (somewhere north of a current DC Paramedic) should either be employed on a Medic unit in a tiered system with Ambulances, or in a Fly Car.

In either case, they should be dispatched to less than half of medical incidents, and transport on less than half of those.

Of the two, I prefer the Fly Car - I think that Ambulances tend to try and 'Turf' some patients to the Medics. There's very little reason to wait for the medics if they can't transport.

All this being said, the remainder of the department could be some level better than standard EMT-B. Particularly, their level of education and assessment skills could be improved, and they could be given all the high-payoff / low-risk / low-practice skills.

We'd wind up with a small group (~55) of ES Paramedics, and a department with a mix of other certifications: Assessment Paramedics, Intermediate Paramedics, and Enhanced EMTs, and Enhanced EMTs-in-training.

Remembers, the certification levels are determined at the state level - we can do what we want here in DC. Remember also, that at the mecca of Prehospital ALS - King County, your registry PM doesn't mean much. I suggest that NREMT-P reciprocity would only get you to the Assessment Paramedic level.

[DvlsAdvct]

I am with you on the fly car thing. Like I said, medics needto be dynamic. Perhaps I's on the engines and EP's in the cars. Either way the engine medic should not go to the hospital unless its a bad patient and hands are needed. If I could be certified to such a level in DC and have all the drugs and equipment I am supposed to have I would be all for it. I, of course, would have to be paid in a manor consistant with the services I was providing though(think PA level). Not to sound like an ass, but I am not doing the PCP or ED docs job for peanuts...lol.

Just dont hem the medics up with transport units.

The EP thing will take more commitment than I think the city has for training. The TA has no resources or buisness training providers to this level. It would be like doing 3/4 of PA school in a year or even 6 months. Perhaps there are some military courses that address this kind of thing. The armed forces medics are trained for more than emergencies, they do all the sick calls too.

Yeah, NR is just a door opener. It doesnt mean much today when it comes to local protocols. Most states have a system that allows each services OMD to decide what is done and not done.

[Brooks]

Sid, I'll give you two medics on critical calls, as long as you admit that critical calls represent less than 10% of our EMS call volume - in other words, there are plenty of 'ALS' calls that aren't 'critical'.

That being said, while I wouldn't turn down a 5th man on an engine (which we need for other reasons), 1&1 and totally PEC wouldn't be too bad -- IF
1) you could cut out the worst of the abuse / misuse
2) you could entice / train enough paramedics to maintain at least a 50:50 rotation of Engine to Medic Unit time. (360 or more, if they're busy on the transport units).

I'll take the 5th man any day for firefighting reasons. If we have to use ALS as the excuse, then so be it.