Thursday, May 15, 2008

History lesson

In the beginning, life was cold and often wet. People lived in caves and huddled together for warmth. One day, Og was whacking a couple of rocks together. The rocks sparked, and started a small fire in the grass.

And life was good, and warm.

About seven and a half minutes later, the fire was burning faster and hotter, too fast and too hot actually. Og's friend Gra walked over and poured water on it.

Thus was born the first firefighter.

Gra was asked to watch the fire from then on and control it, lest it get out of control again. A few days later many of the camp were complaining that "Gra never does anything! He just sits and watches the fire and paints on the wall while we gather food and hunt and cook."

And people have been complaining about firefighters since.

If your reading this first, (thank you! thank you!) go over and see where this started on Ambulance drivers blog. Follow the link to his column on EMS1.

Back? Ready for a ride? Here we go;

Lets start with a little history of the fire service, or if you prefer, fire departments in the US.

I have to mention Roman Vigiles first, from around AD 6. Quickly I'll mention France in 1254 and the guet bourgeois. Moving right on to the "new world" and New Amsterdam in 1648.

Now the first full time, paid fire department in the US was in Cincinnati Ohio in 1853.

From that point on, especially in the North East, we see paid fire departments, or city sponsored and governed volunteers. They have a long history of doing fire suppression. As people moved west, and cities grew in the plains and western states, fire departments sprang up there too. Often based on what the bigger departments had been doing for years in the East, they started fighting fires with the same or similar equipment and techniques. Of course the West Coast had started growing and forming departments as well, often spreading their techniques and equipment desires east to the mountain states and the plains.

This expansion, growth of new cities and rural areas, and emulation of other departments is still going on today.

I mention all this because I want you to understand that we can trace the history of fire departments all the way back to Rome. How far can we trace the history of EMS Departments?

In all honesty, EMS has come late to the party. I see this as a part of the reason for what Ambulance Driver is talking about.

Back up a bit and lets talk about the history of EMS. In most places, there was no EMS as we know it. No one giving care, no field protocols, and not even first aid in most places. What we see when we look back is an ambulance to transport people to the hospital. That ambulance often was owned by the hospital and staffed by "a couple of guys" to go out and transport only. Often times, the ambulance was owned by the funeral home or mortuary and staffed by the funeral director and a helper. They only took someone to the hospital, and hoped they could get there in time for the doctor to do something.

We don't see true EMS, or Emergency Medical Service, until roughly the 1960's. The White Paper in 1966 really was the catalyst that started it all. From that point onward people realized that the "ambulance" was not just a meat wagon to haul people in. It needed to be staffed with trained providers.

Who would provide the providers?

On the West Coast in Los Angeles, the fire department trained Paramedics responded to calls, and the patients were transported in the hospital staffed and owned ambulance, with a paramedic riding with them.

Back east, the old traditional fire departments stuck to fighting fires. They let third services, or private parties train paramedics and transport the patients.

But some areas decided to have the fire department handle the EMS. Many Fire Departments in the late 1950's and 1960's were already providing the ambulance service, and would turn into the EMS providers of the area.

I tell you all this so you have some understanding when I say that there are still today many fire departments across the country doing ems and ambulance service in different ways. To paint with a broad brush and say that fire departments are having trouble with taking over EMS is just wrong. To say that EMS is looked down on by firefighters is also wrong in many many places.

Are some cities having trouble incorporating EMS into the fire service? Sure they are. If you look at the ones with the difficulty though, I think you will see that they are just now trying to do so. It's not a case of them having provided EMS and ambulance transport for years and it still not working right.

Am I a bit biased toward a dual role system? Yes I am, because I have worked in both. I have worked in an private EMS company who responded with a paid fire department. I have also worked for the same EMS company who responded with all volunteer first responders. I now work for a city that provides fire and EMS as cross trained personnel.

I can say without a doubt that the dual role is working better.

But, the question that AD asked in his column "What steps need to be taken for paramedics to achieve equality in the firehouse?"

I'll answer that and have a few more comments in my next post.

Mr Fixit


Rogue Medic said...

I approach things from a different perspective. Paramedics provide medical care and should be medical providers, not public safety providers.

There is no natural connection between fire and EMS, or between police and EMS, or between police and fire. Arguments can be made for any of them to be cross-trained. In some places they are.

Lately, these arguments are usually made by someone trying to meet a budget - the city has to cut back, so we will consolidate.

If I need help from the police, I do not want someone cross-trained as a firefighter to be the one responding.

If I need a fire put out, or to be rescued from a burning building, I do not want someone cross-trained as a paramedic to be the one responding.

If I have a medical emergency, I do not want someone cross-trained as a police officer or fire fighter to be the one responding.

Other agencies will respond, depending on the dispatch criteria. There is no need to have everyone certified to do everything, unless you are more interested in cost than quality.

Cross-training dilutes time and effort spent on training.

Why should we settle for that?

Ambulance Driver said...

"I'll answer that and have a few more comments in my next post."

I look forward to reading it, too.

In the meanwhile, quit waxing the ladder truck and do something productive, Gra. Those are my tax dollars you're wasting! ;)