P-Medic Engine Co.

[dcfdsid]

What are everyones thoughts of having a Paramedic Engine Company in service as an ALS response unit without a paramedic on board. The department's goal was to utilize Firefighter/EMT-Paramedic or Firefighter/EMT-Intermediates as the ALS provider on these units...

As I understand to this date, an ALS unit must consist of at least one Paramedic trained individual. This includes the Engine Companies.

Should the department continue to have Firefighters go through the EMT-I course at the T/A or discontinue until the legislation catches up?


And Just for the record....There is no such thing as an EMT-I-P..you are either one or the other a paramedic or an intermediate.

Sid

[captain4life]

sid:

A PEC cannot be in service without a paramedic on board. Without a paramedic the unit should revert back to a regular engine company. This process was spell out in the memos and special orders that came out about the PEC's.
If the PEC is out of service and the DFC knows, and communications is still dispatching the out of service PEC as an ALS unit, call them and tell them that you are in service as a regular engine company.

[dcfdsid]

Capt4life....

You may have misunderstood.....


I realize what the orders say about staying in service....

My question is this...

Staffing......

Wagon Driver......
Officer.....
Lineman
Layout.....

One of these members is a paramedic so the company is a medic engine company....


The department offered the EMT-I program to its firefighters with the promise of being assigned to a paramedic engine company as the ALS provider.

This would cut down on the time that it takes to train members the paramedic level and hopefully recruit some interested members in taking the Intermediate program.....

The current PRotocols and legislation state that you must have a Paramedic on board.....

If this is the case, and the new medical director has no better luck with DOH granting the deparment permission to use the EMT-I as an ALS provider, then do you think that the department should continue to advertise its EMT-I program to firefighters?

sid

[captain4life]

The Emt-I program is a band-aid fix, this is because the dept. basically screwed up and did not get the emt-p program up and running in time to get people trained before the EMT-P training program change.
Now to become an EMT-P, it’s almost a 2 yr program.
The EMT-I training is how long?
The type of training between the two is not the same, and the two should never be confused.
The EMT-I is a helper to the paramedic; they are used to sub in for the 2nd paramedic who should also be assigned to a "medic unit"

I very much doubt that DOH is going to grant the EMT-I as a medic after going through all the trouble to upgrade the requirements for EMT-P's.
Because if they did grant EMT-I as a paramedic for DCFD, then why should every other department in the nation be granted the same requirement for EMT-I medics, then question then becomes why should a fire department have EMT-P's?

Sounds like the old first responder program of Chief McCaffery when he tried use first responders to replace the EMT - will have the same result too.

A personal view - the paramedic should again be the 5th person assigned to a PEC unit, this is because when the paramedic goes to the hospital, the engine can still remain in service as a regular engine company.

[Kobersteen]

Something interesting to note is that the new (post-1999) EMT-I program is actually very comparable to the old EMT-P curriculum. That is why the new EMT-P curriculum can only be taught in conjunction with a college or university... because they have 'upgraded' the training. Hell, the old Paramedics, like me, should be thankful they don't downgrade us to Intermediates.

I do have to agree with Sid, the whole I/P thing that people walked around calling themselves confused me greatly during my short stint on the EMS side of DCFD. :confused:

Kobersteen

[captain4life]

Kobersteen:

Then why have the EMT-P program for DCFD and every other fire/police/emergency service, if they could use EMT-I's instead? It seems that you are trying to change the paramedic program through a backdoor.

so let go back in history, lets replace all basic EMT's with first reponders.

[Kobersteen]

It seems that you are trying to change the paramedic program through a backdoor.

Make no mistake, I am not trying to change anything. I am just stating the fact. Why is DCFD traing to the P level? That I don't know, but it is a very smart move. Most of the surrounding jurisdictions are training to the NREMT-I level and calling them regular ALS providers just like the P's.

Hell, one county has to remove the lettering 'Paramedic Unit' and 'Paramedic Engine' from their fleet because there is not always an EMT-P on board. I'm not sure, but I think that was Sids original point.

As for replacing EMTs with first reponders, I'm not sure, but I don't think any 'old' EMT curriculum equates to the 'new' First Reponder. Apples and oranges.

[NorthSTAR]

While on the subject, (sort of) what's stopping anyone from assigning EMT-I's to PECs in addition to EMT-P's (WD,OIC,EMTP,EMTI)? Let's say the EMT-P is off one day, then the ALS equipment sits unused. Of course the company would not be a "real PEC", but the protocols specifically allow a EMT-I to perform at the EMT-I level 'if ALS equipment is available'. The company would respond as a regular engine on medical locals, but if the patient could benefit from an EMT-I's level of training, they have the tools on hand to deal with it! A similar thing could happen when an EMT-P or EMT-I works overtime on a BLS transport unit and an ALS unit shows up to help (supervisor, Medic Unit, PEC).

Just pondering...

[ktflame]

This entire EMT-P vs IP thing could be solved in the Nations Capitol. If and when GW takes over the Paramedic Training for the DC Fire Department, they could very easily develop a program which could meet or exceed the new EMT-I level and old EMT-P level. Along with DOH develop a District of Columbia based Paramedic Exam. This will in turn eliminate the need for the National Registry since DC does not require you to maintain it. Then the District of Columbia will be in it's own entity such as Florida, Seattle WA, etc,..

Now you have the provider you want, a DC Paramedic or whatever you want to call him or her. Then the IP level can be put to rest in the Nations Capitol.

:D

[SkyMedic]

I am guessing DC is doing EMT-I training with a bridge to P like everyone else. Some departments are slamming the I's out in 5 months of M-F classes.

Now my question is what kind of an ALS provider are you gonna get cramming all that stuff into them in a short amount of time, then sending them out to learn from grade d, sub-par preceptors only to be evaluated by someone whose only concern is to get the evals done with the person passing and being cut loose to operate totally on their own?

Have they not yet learned what can happen when you have an ALS provider out there that is just not yet comfortable or is just not cut out to be a medic and wont bow out gracefully? A person that is going to be a quality ALS provder HAS to be into the medicine and very into learning the art. You cannot truly be good in this game if your only motivating factor is a pay raise or to look better at promotion time.

It seems DC and many other jurisdictions have decreased the standard(P to I) in order to keep bodies on the units. I can almost bet the farm you will see fewer and fewer Paramedics in places that are adopting this strategey.....Just a thought, stay safe.

[Kobersteen]

If and when GW takes over the Paramedic Training for the DC Fire Department, they could very easily develop a program which could meet or exceed the new EMT-I level and old EMT-P level.

That day is closer than you think. ;)

[captain4life]

“Along with DOH develop a District of Columbia based Paramedic Exam. This will in turn eliminate the need for the National Registry since DC does not require you to maintain it. Then the District of Columbia will be in it's own entity such as Florida, Seattle WA, etc,..”

ktflame: Kobersteen

Is this a really a good thing? Will other jurisdictions recognize this type of training? The National Registry provides a set standards that is recognized throughout the US, if DC has its own set standards, how will it compare?

I have lots of questions, no answers, does anyone have any knowledge on this?

[NorthSTAR]

captain4life:
Numerous jurisdictions do not even recognize NREMT as a certification for any or all levels of training. http://www.nremt.org/EMTServices/emt_cand_state_offices.asp

Long has there been a need for a nationwide standard of care, but after 30 years of modern EMS we still arent there? It isn't just DC that has problems with training.

[Kobersteen]

Will other jurisdictions recognize this type of training? The National Registry provides a set standards that is recognized throughout the US, if DC has its own set standards, how will it compare?

You mean like the EMT-Enhanced monstrosity? :eek:

[captain4life]

Kobersteen - yes

It seems like everything else - medical standards are set at the state level, in DC, the city level. Perhaps someone should take on the cause and lobby on the hill to set up some universal standards, [I serious doubt this will happen].

The fire side is very slowly accepting NFPA and NFA standards, but universal acceptance is still far far away.

Like everything else, the standard of care will be set by legal case law.

[Loo for life]

Capt u said a mouthful...

We are soooooo much better off with the PIN HEADS of the NFPA, IAFC and lest we not forget the IAFF and any other lettered organization getting involved in the fire service!

Let's see we have Fire Chiefs so scared they do a bastard version called 2 in - 2 out! Fuck one of the fire departments primary goals of limiting property damage

All training is is SAFE Oriented so much so the majority is unrealistic

We wrap firemen up tighter n tighter and then maybe just maybe send them in farther and that is if the guy in charge who is sitting in his car worried about liability says it is ok to go in.

Letting the first in Unit Officer take command instead of doing his or her
J-O- B

So excuse me if I have soooo much desire to see what really is a simple job such as EMS turned into a class on becoming a rocket scientist. But this will occur just as you wish becasue some asshole lawyer will sue and sone group of good fucking citizens will say yes he is right and last but not least sme weak kneed fire chief or politician will make it is so.

Big Cut Big Band aid - Lil Cut Lil Band Aid --- Sticky side down on both

CPR on those not having a Heart Beat -- O2 for those not breathing --

Stabilize a neck n back or bone related injury

Enuff for now

[SkyMedic]

You think there is such a thing as too much safety? I like your theory of big cut, big bandaid. So if one of your members got hurt would you want just a big dressing for a big burn, never mind morphine for pain or advanced airway managment for respiratory involvment...Maybe a little IV fluid for the volume they are going to loose.

If you think EMS can be dumbed down and is not a realistic duty for the fire service then you should not be leading men and women in any department. 95% of the time you do not need a "rocket scientist" as you correctly say. But, the (2002) EMT-B's can make a difference, and at least one Paramedic on critical calls will actually benefit the patient. Just because the city's transport times are shorter than most, doesn't mean that the few skills DC EMS providers are permitted aren't beneficial. A heart that really wants to fibrillate needs more than electricity to get going again. If this city ever lets the medics operate to their proper level of training, it might be known as the "Save Capital" instead...

Remember, there are some EMS folks that really care about their profession the same as you care for and strive for exellance in yours.

[catseyes]

While on the subject, (sort of) what's stopping anyone from assigning EMT-I's to PECs in addition to EMT-P's (WD,OIC,EMTP,EMTI)?

Actually, that's how it should work, allowing either an EMT-I or a brand-new paramedic to gain experience under the eye of a full paramedic until they are ready to go out on their own. One of the problems with the program as it stands is that there are a bunch of brand new paramedics who were thrown onto PECs and who do not have the skill and confidence level to operate effectively. The liability issues are enormous.

[Loo for life]

Apparently you don't know me cause I am probably one of the few officers that have volunteered to be assgined to a busy Paramedic Engine, but when you have a hospital within 8 city blocks you can bet one thing I would rather have the fucking doctor work on me then a medic... Common Sense dictates they know just a weeeeee bit more. You really don't know me cause if you did you would know I have been up close and personal with death and a Lifepack Defib.

I have been an EMT since 1979 and let me pass this tidbit of info on to you, it really hasn't changed in 25 yrs, yes they now want me to start an IV but wait when I first started we could do that too then! Now I can use the AED but wait so can the Plumber or the Policeman so that doesn't make it a major break through for the EMT program, we used to give glucose and wait we will be able to do that again too. Come on the more we go forward the farther back we go ;)

As for the advanced service you tell me, where making it a 2 yr program who does it benefit other then the colleges, these are not doctors they are street surgeons who have done a good job for many a moon.

So the streets can function with the new EMT-I or old paramedic level and not bat an eye. We don't need these super Paramedics with an AA/NREMT-P patch on there shoulder, we are at most 10 minutes travel time from any hospital in the Washington Metro Area

As for too much safety.. My job as an officer is to get my firemen (definition below) home in the same condition as they came in, But it is an iherently dangerous job I accepted that fact over 27 years ago! That being said yes I believe between the litigious society we have created and book worm firemen err excuse me "Firefighters"(lightly) who run the NFPA (Consensus standard my ass), the IAFF's need for more members and the fear driven nature of the IAFC that we are being entirely too meek n mild when it comes to firefigting operations.
Swallow this statistic we have roughly lost the same amount of firemen pretty, much the same way for about 20 years and we keep them out of the building more then we did then and b4 u argue with me our record keeping methods are better now then they were but I will stand by my beliefs that Heart Attacks were the same as they are now if we are so concerned then why aren't Physical Fitness programs mandatory why isn't the IAFF saying your right make our guys fit or fire them caue they are not interested in it for that reason neither are the I-chiefs so don't even discuss the cowardice safety ideas that you feel the need to espouse.

Closing statement: If I sound like a dinosaur maybe I am...

Sorry for being long winded but to wrap this up, I care more for the men and woman under my command and the people we serve then you could ever know, but becuase we have to wait to go into a burning building they lose more of there irreplacable possesions, damage more property and possibly cost more lives then if we just did our fucking JOB!

**DC excluded cause our 2 in 2 out policy makes more sense**

[captain4life]

Loo for life:

This might sound strange, but I have to agree with you. Nothing bad can be said for experience.

In the last couple of years, the BFC promotion has been based on politics and race. Most of the BFC's have a serious problems once they get past; first due engine your attack leader, first due truck your vent leader; in fact I know of two idiots who even try to tell the first due truck where to ladder, and first due engine where to lay out before arriving on the scene, let alone the he as a bfc is still in the firehouse getting his run sheet filled out.

I not even going into the DFC level, hell they are so wrap up with who to suspend, they cannot even do their own basic job.

Lets face one fact, we do not have the same quality of chiefs we had a few years ago, no bill mould, no goldsmith, not even a dave ryan. The closest we have is Doug Smith, but even he is not the same.

Basically if it was not for the fact that the basic line officers have their shit together we will be fubar to the extreme.

Enough said about the politics of the DC Fire & EMS Dept.

[The BRC]

JVP,

As long as you opine the way you do, the rest of us don't have to!
Many feel the way you do we just can't put it in words quite as well.

[Hey Slim]

gone 4 awhile, hay capt??

we don'nt do attack leader and vent leader anymore. it's divisions now. :eek:

piggy,

tell him, u not only do ems, u lived thru it. good thing u were'nt in dc or you'd b taken a dirt nap rite now. :D

also, thats a nice post piggy. I know a little about being at a busy engine company (with medic). still can't call it u know what. spent many yrs at the dime, the last few with the medic were the worse! your right, get them 2 the hospital, there close by and they can get real professional help. not some wantabe. you know the saying by the fire dudes. if anything happens 2 me throw me on the wagon (firemen ride engines) and get me 2 the hospital before the shit box gets here!

this is bringing up bad memories of working with those ems pukes, gotta go, I'm gonna throw up. :(

thanks piggy

[captain4life]

Hey Slim:

Actually its groups not divisions, division is a location, division 4 -> 4th floor, basement division -> basement -- a group is assigned a function, I am not going into the ics system here but listen to the 2nd batt/4th batt. next time its seems they use someting like E-18 your attack group leader you have the following units, T-7 your vent group leader you have t-?, T-16 your rit group leader you have E-32 , so I shorten it up like a few BFC's to attack leader/vent leader or group like they often do in the 3ed batt- whats your point. Basically go back and take the course from Donahue again. :D

[Hey Slim]

thats y i'm fucked up on it, look who teaches this shit.

and I should've known you'd know it all, thats y u retired a capt.

[Loo for life]

Thanks GC! You feeling ok everything going good I hope? :)

Slim I can never hold a candle to the time you did in Trinidad my friend, I asked to go 16 strictly cause I like the grumpy old guy who drives me... Shit save 1 my original crew is gone I must have that affect on people hhhmmm. I got an extra puke bag off of Ambulance 16 ;) always try n help.

[catseyes]

A couple of points. The biggest difference (that there SHOULD be) between EMT-Is and Ps is that the P is supposed to know WHY they do what they do. EMT-I is cookbook medicine, some of them don't even know as much about how bodies work than the old EMTs taught under the EMT-A program.

If the medic is fast enough, they can get everything the doc will do in the first 10 minutes done on the way to the hospital. 10 minutes is a long time in a heart attack. Unfortunately, as I mentioned in my previous post, many of our medics don't operate at that level yet, through no fault of their own.

Piggy- Ask the Loo on #4 how much got done for the "man on fire" between the time the medic unit arrived on scene and the medics got out and got their gear. That's how it is supposed to work.

[Loo for life]

I love EMT-P's (it is the program I disagree with) but the need for it in the DC Fire Service is suspect strictly because what is truly needed can be done by a EMT-I or the old Paramedic (as I like to call them). They can give fluids, push cardiac drugs and shock if necessary.
As for the burning dude at the White House other then a pain killer our Advance EMT's can do the requisite fluid replacement and burn area protection til he gets to the hospital 5 blocks away.

National Registry or anyone else still can't make the sell we need Road PHD's vs. Street Surgeons with load n go capability, it is ok if they want to finish and make a degree out of it but to make that the "required" Paramedic Certification is in this humble ;) man's opinion SHIT SIMPLE.

It just doesn't change the outcome enuff to warrant a 2 yr degree, but that is why they get the big bucks and I am a LOO FOR LIFE :cool:

[Dan Dugan]

Why when there was already a national Paramedic shortage would you increase the requirements for becoming a "P" ? Sounds like the inmates running the asylum to me. Or maybe trying an end around to increase there value $$$$$$$$.

Big Cut Big Band aid - Lil Cut Lil Band Aid --- Sticky side down on both

CPR on those not having a Heart Beat -- O2 for those not breathing --

Stabilize a neck n back or bone related injury

Well said piggy