Come In To My Parlor, Said The Spider

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So, just left than a month ago the City of Cleveland, OH started the merger of it’s EMS and Fire Departments. As always, the stated goal is to “enhance patient care and run the new service more efficiently”.  That’s what they always say, but of course by more efficiently, they mean to the advantage of the fire suppression side of the new department. Part of the merger plan includes shutting down two of the four FD rescue trucks and replacing them with ambulances. Sounds good, especially since 70% of the fire departments calls are EMS related.

Of course the fire suppression people don’t think so, because “The rescues can do everything that the ambulance can do and more.” Well, except for the part where the ambulance can transport patients, while the rescues can’t.

It will be interesting to watch this merger progress. Can Cleveland succeed where so many other cities have failed to merge two agencies that share little in the way of work load, culture, training, and history? Probably not if we look at the history of these mergers. The list is long and made of fail.

Which is not to say that it can’t work, but to say that it hasn’t so far.

Now I’m confident that Justin Schorr and others will be along to tell me how well their mergers worked out. Funny thing about that. Seems it’s always the people from the fire suppression side of the merger who are telling us how well it’s working. It’s never the people from the EMS side that seem to think it’s so swell.

Before Justin joined SFFD, there was plenty of drama over the merger. The original configuration was heavily criticized and subsequently altered.

Way back in 1996, FDNY was going to make EMS in the city way more efficient, reduce response times, and increase cardiac survival rates. You’d think that if any of that had happened, we’d have read about it by now. Maybe I missed the article or something.

We’ll have to see what happens in Cleveland, but I don’t have any real reason to believe it will be much different.

Before you post a comment telling me that XYZ fire department successfully operates a combined EMS/fire system, I have one question? How big is the city of XYZ? I ask because it seems that some small departments have indeed successfully merged their operations. It just doesn’t seem that it works in larger cities.

While on the subject, here is a letter  Letter_to_ATCEMS_(2)-2  from the president of the Austin, TX fire union to the president of the Austin Travis County EMS union. He is inviting the EMS union to open discussions about a merger. Note the next to last paragraph here he says that the offer isn’t precipitated by any current events. Whatever does he mean by that?

Maybe this is what he isn’t referring to,

 Public Safety Commission recommends audit for EMS

The Austin Public Safety Commission is recommending a complete audit of Austin-Travis County Emergency Medical Services.

The commission cites a slew of problems with the agency and says it endangers patients and costs taxpayers money.

Commissioners voted unanimously in favor of an inspection by the Office of the City Auditor, which would study the department, its management, staffing issues and use of resources. The auditor’s office would also look at the possibility of consolidating EMS services with the Austin Fire Department, a possibility which has been discussed by both agencies.

Notice the dates of the article and the letter. As Father Guido Sarducci would say, it muust be a coincidenza.

I’m sure it’s also mere coincidence that Austin City Councilor Mike Martinez was the president of the Austin Fire Fighters union before he was elected to the Council.

It seems that the solution to problems with EMS is to merge them with the fire department. Because once you know how to put water on a fire, you can do anything.

Right.

So, here are couple of questions I’d want to ask if I were asked to evaluate a merger or proposed merger. If you’re in an EMS agency and someone is proposing a merger with the fire department you should ask them too.

1) Who makes more, a fire fighter who is not trained as a paramedic or a paramedic who is not trained as a firefighter?

Hint: The only acceptable answer is that neither should make more. They should be paid the same and have the same benefits.

2) If someone is a dual role provider, where do they work? That is, are they assigned to a fire truck, an ambulance, or can they move back and forth between the two?

3) If a dual role provider spends most his time on an ambulance and a promotion to Lieutenant comes up, what are his odds of getting promoted. Ask the same question only put that person on the fire truck and not the answer.

4) What supervisory/command ranks require paramedic certification?

5) Since EMS calls constitute 70% or more of the work load of the combined department, is the chief a paramedic? Can the chief be a non fire fighter paramedic? Can the chief be a non paramedic fire fighter?

6) In a given shift, how many calls will an Engine crew run? In a given shift how many calls will an ambulance crew run?

7) In a tiered system, what happens to the EMTs?

When you are considering your answers keep in mind that citing how dangerous fire fighting is compared to EMS you fail. Neither field broke into the top in 2010 or 2011 in fatalities. As has been true since statistics have been kept, commercial fishing and logging are far more dangerous.

Have at it.

7 COMMENTS

  1. It will fail again, and once again EMS will be the red headed step child… And unless all the EMS people ‘volunteer’ to attend the fire academy, they will be out of work… AND their ‘rank’ will not be moved across to fire, so the ones that do survive will be demoted. Not that it’s happened before or anything…

    • Thank you. That reminds me of a point that I was going to make. Time to go back an make an edit or two.

  2. For my last class, I wrote a paper about the KCFD/MAST takeover. The IAFF and IAFC have a very successful PR campaign advertising that the fire service delivers EMS better than other models. It is all fluff and not supported by any evidence, but there is no counter argument from single-role EMS people loud enough to matter. So what do we do to change that?

    • The problem is two fold. First there are more of them than there are of us. Worse, they are more organized than we are. The IAFF/IAFC (I consider them one for this purpose) have the rap down pat. They come in and talk to City Councilors who know little or nothing about EMS and they sound like experts.

      The truth is that the city council cares only about response times and cost. Nothing else is important.

      There needs to be a national organization that fills that role for EMS, but there isn’t. The NAEMT is a joke.

  3. Canada has powerful organizations representing the interests of its paramedics, lead by the Paramedic Association of Canada:
    http://paramedic.ca/about/
    Their strength comes from requiring more education and fewer delivery models. A 2-year associates degree is required to do BLS and an extra year for ALS, so their lowest common denominator medics are higher than ours in the US. Since most paramedics work for the regional governments, they don’t have volunteers who compete with privates who compete with third services. When a FD merger is proposed, a lot of people across their country get pissed.

    So how do we get some of that? While I have great respect for President Lundy and many other people at NAEMT, I understand your frustration. So our choices are to get more like-minded people to make NAEMT a stronger, and better funded organization, or to start something else. An American College of Paramedics would have a nice ring to it.

    • The NAEMT seems totally committed to perpetuating their old boy back scratching club and selling their alphabet courses that make up for the lapses in a paramedic curriculum that they hardily endorse. The few people that I now who have tried to change that have been systematically excluded from positions of power and influence. When looking at the educational standards in Canada versus the pay, I have to wonder what their ROI is?

      I don’t know the answer frankly. If I did, I’d be selling my fix everything about EMS book and not writing a blog.

  4. What possible benefit could there be for EMS or the Fire department by merging? Increased funding? A greater unifying bond betwix the two departments? Ooo, increased flexibility in treatment guidelines in an effort to move towards evidence based care? Don’t be silly, of course this is going to lead to better outcomes for patients. Cos all that lady in premature labour wants is to have her baby welcomed into this world by two fire trucks, two ambulances, a supervisor and that strange kid who doesn’t speak who inexplicably shows up to every job.

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