Are there any strong EMS public systems that don't require fire standards?

Question

I am currently in emt school (florida) and I believe that to work in a public system here, in most all counties, you must also have fire standards are well. I have no intention of going to fire school and want no part in it. Are all systems going to be slowly converted to fire rescue? I would like to keep going and become a paramedic on a box, but do not want to go to fire school.

Answer 1

There are lots of non fire based EMS services in the US. Unfortunately for you, the Sunshine state is dominated by fire department EMS. In southeastern Pennsylvania (the suburbs of Philadelphia) most EMS is provided by "Volunteer" ambulance associations or squads, whch are basically staffed by full-time career personel. They usually cover multiple muncicpalities and are big organizations. They are big turnover jobs, and they are constantly hiring, if you are interested.



The associated debate is pretty funny, however. I was in the police business long before most of you guys were alive, and EMS was a haphazard mix of hospitals, funeral homes, VFW posts (yes VFW posts), police and anybody else who could afford a custom Cadillac ambulance. the Seattle stuff is pure propoganda, however. They were also the "safest city" because the FD was teaching everybody CPR. But, the rest of the country didn't march to the same beat, and I pushed around a police wagon hauling sick and injured people for years.



If you want to find some bitterness, check out New York. "The New York City Emergency Medical Service. Established in 1970, to provide comprehensive, state of the art pre-hospital care to the sick and injured citizens of NYC." (from the web site) "Over 2,500 very dedicated men and women, consisting of Emergency Medical Technicians, Paramedics, supervisory personnel, and support and technical staff effectively patrolled the streets and respond to over 3,000 calls for assistance daily. Each year, NYC*EMS responded to over 1.3 million 911 calls for help making NYC*EMS the largest, and busiest 911 municipal system in the nation if not the world. "



(also from the web site) "Former Mayor Giuliani never liked NYC*EMS and when the Fire Department was having budget problems he wanted a way to bring new funding into FDNY. He felt a forced merger of EMS into FDNY would be the way to solve a lot of FDNY's problems. Former Mayor Giuliani decided that he could use EMS as a money maker in order to save Firefighter

jobs."



You see, in lots of places, like New York, EMS and Fire never wanted to merge. The city wanted it. the firefighters surely did not want it, and EMS did not want it either.



And EMS is the most profitable public safety operation of all, because ambulance fees are routinely paid by insurabnce carriers, medicare and medicade. Lots of fire department managers were happy to take on EMS, at over $350.00 a ride, the FD budgets grew enormously.



EMS user fees, and the justification of having firefighters riding ambulances instead of drinking coffee, along with the considerations posed by America Burning like the one guy suggested is what put ambulances in firehouses. Not some stroke of genius on the part of Seattle or Miami FDs.

Answer 2

Just an international perspective on this, fire based EMS is almost an entirely US idea. Most modern EMS systems are provided by the country's/state's department or ministry of health. Fire science is technical, prehospital emergency care is street medicine, you cannot combine both and remain an expert in both fields.

almost all european and australian systems are university paramedic bachelor of science programmes and these medics work on their own licenses, not physician extension.



And by the way, EMS was actually born in Roman times in the legions as a horse drawn service, but if you mean modern EMS than that was born in Europe also before the founding of the US.

Answer 3

If you intend to stay in Florida, I can't recommend too much. Like Impaler 19120 said, most of southeastern Pennsylvania has EMS provided by so-called volunteer squads that are staffed by paid EMTs and paramedics. There is almost no fire based EMS in the area, other than the City of Philadelphia and a handful of fire house based ambulances in Delaware County. Same thing in most of southern New Jersey. Most of the ambulances are called volunteer squads, but they have paid EMTs. At least in south Jersey, your paramedic units run out of hospitals. Some of the career fire departments run ambulances, but not there are not that many full time career fire departments. In the parts of south Carolina that I am most familiar with, there are County EMS providers, and I have never seen a fire based EMS unit there, but of course, I haven't been in every part of the state. Charleston County EMS is always advertising openings for EMTs. South Carolina's weather might be more appealing to a Floridian. I am not sure what the certifying standards are in all states, but if you pass the national registry test, it opens the door to reciprocity in some states.

Answer 4

Look I am not going to get involved in this whole argument of Fire vs. EMS but I will say this. There are TONS of places all over the US that the fire department and EMS are seperate divisions. My state of NC is one of them. I can not think off the top of my head of one city in NC where the fire department and EMS systems are combined. Usually both systems are county (sometimes city) based. Meaning they are funded by the local government, unlike the private ambulance services. Which is good from the way I see it. It allows the EMS service to focus more on patient care like they should be, and not the bottom dollar, and profit like many of the private services. Also many of the services are on the forefront of EMS research, with aggressive protocols. I think the best example of this I could offer would be Wake County EMS (Raleigh, NC) They are constantly doing research and have some of the top cardiac arrest resuscitation rates in the country. A shocking 35 to 40% resuscitation rate from Asystole! I believe if you look at the data they are second behind Seattle in these rates. But Seattle is very selective with who they include in their statistics, where Wake County includes every cardiac arrest patient treated. So I guess what I am trying to say is come on up to NC! Get away from all those Fire departments, and private ambulance companies! ;-)

Answer 5

Fire Based Ems

Answer 6

If you are actually in EMT class, you should know more about what is going on in your region that we do. EMS does not require fire training. Fire departments have had EMS dumped on them, because it is the cheapest way for government to provide EMS, and maintain full strength fire departments at the same time. So, the city hires firefighter/EMTs and they can have them running EMS calls instead of sitting in the fire house.



Even FDNY got stuck with EMS in NYC, but, FDNY EMTs are NOT firefighters, although firefighters on a engine companies run QRS calls. There are EMS systems all over the country that are not fire service controlled. But, as time goes by, more and politicians are screwing fire departments and making the take on the responsibility of municipal EMS.



PA4545 must be a little youngster:



There is a big country out there, well beyond Seattle. From the Civil War on, most ambulance services were hospital based. Some cities, like Philadelphia, used polcie wagons to transport. In some areas, competing ambulances fought for city contracts. It was like that until very recently in LA (FD Medics respoded to the scene, but contract EMS did the transporting). The first publication of America Burning (http://www.usfa.fema.gov/downloads/pdf/publications/fa-264.pdf) made the first strong recommendations that EMS become a fire based system as a opposed to police or private entities. PA4545 needs to learn a little bit about where this came from before the 1970s. Firefighters don't wan't to ride band aid wagons in most places. It was forced on them as a cost saving measure, and it has stuck as part of the fire culture since the 70s. (Was there...live it)

Answer 7

Not many EMS systems that aren't fire based in the US. The private ambulance companies keep losing contracts and changing owners, names or whatever.



PA4545 is right. Modern EMS was born in Seattle and Miami in the 1960s. LA's only claim to fame is a TV show in the 70s and somehow has managed to stay stuck in the 70s for 40 years for EMS even though it is fire based EMS. Only one hospital based service gained any fame in the US in the 1960s and that was Freedom House which only lasted a few years until the city FD took over. Police, nurses and funeral homes played a large role in EMS so I would not say hospital based services dominated prior to 1970.



I would not say the FD is a cost saving measure since it is rather costly to operate a FD. In the 1960s the concept came about due to the location of the fire stations and the ability to get to the patient quicker. That still holds true today. The FD has been around for a long time and will continue to be around. Private ambulances come and go too often to even remember who last year's contract was.

Answer 8

Generally, an EMT-B certificate is all that's necessary to get into EMS. Let the firefighters deal with the fires, and they'll let you deal with the crippled victims.



Even if you are planning on working for a department which requires its EMTs to simultaneously act as firefighters, you should get all the training you need from the department or an academy they use.

Answer 9

EMS was born in the Fire Departments. Fire Departments like Seattle and Miami were the birth place of EMS. It was not dumped on them.



Florida is a proud Fire Based EMS state. EMS belongs to the Fire Departments.



Just work for one of the big ambulance companies like AMR or RM.



@Impaler



Of course mergers don't work. The privates don't have the same standards as the FD. When you have a department where everyone must be a firefighter and a Paramedic, you get much more harmony. Taking on a bunch of EMTs and Paramedics from a private service that has been poorly run with crap oversight, of course you get problems. That would be like a Police department taking in a department of rent-a-cop security guards and telling them they are now just the same as the Police Officers.

Answer 10

In Florida probably not. Even the few that are will probably be taken over by Fire shortly.