ALS added with all co's in service?

[riverlinetk]

Our job as ff's is inherently dangerous. Just last week a ff suffered a heart attack and died enroute to a response on the apparatus. Also, an FDNY lt was killed on the 14th floor of a high rise fire. The point being here that we don't do enough on our own end to support and have resources ready to take care of our own if injured at an incident, especially a working fire.

In many other counties across the country you get an ALS unit as part of the working fire dispatch, the "all companies" here. Why is it that we don't have this here? I was give the answer before by several people that we "do not have the ALS resources" available to use b/c there are only five of them, coupled with the fact that "the medics don't think their job is to stand by on a fireground". Part one of that their are not enough units available is bunch of crap. The food chain goes me, you, and them. If we don't take care of each other then we aren't able to provide that service to anyone else. Part two about it not being their job, well i don't know if that true or not, but i'm sure they don't all think that being as many of them are ff's in other places.

I bring this up as there was a ff injury on mt. holly the other night on the bispham st. fire. He was not seriously injured, but that wasn't known to begin with and in no way should we have to wait for a medic unit to be dispatched, located, and arrive for their service. What if we run into none available in our area? Start them on the all companies and we can be sure they'll be their until their services have been released by command. Sorry for my rant but I think this is inexcusable and needs to be addressed. Let's hear everyone elses input on this.

[glow=red,2,300]SEE ALSO:[/glow] RIC Taskforce www.burlcofire.proboards55.com/index.cgi?board=general&action=display&thread=1199976081

[Click Click 27]

well, i can tell u this. when i finally got off the ladder. i did remember medic 300(or 100 as some say) was there, actually he was there pretty much all night from the beginning, also they placed a chopper on stand by, i don't know why (little known marques fact: I'm terrified of flying and i would of been fighting everyone if i had to go in a chopper) and i believe the medic 31 was call (medic 31 is stationed in mount holly.bout 2- 3 blocks away) but was recalled.

i think medics should be called in all co's but they should have it like they do with hazmats, swat assignments, and special events, and what virtua does is have what they call medic 36 which is 2 medics that stay on scene the entire time

[opsoverkill]

I would have to respectfully disagree!! Having ALS on all companies in services would be a waste of money and a waste of a limited resource. Face it, when you break it down to the simplest form what does ALS more then BLS during the first few minutes of an injury or medical issue. Remember it is all about the ABC Airway, Breathing, and Circulation BLS can handle them also; the only difference is that ALS has more tools in the toolbox.


Let us take the worse case scenario with the Mount Holly Fire. Instead of getting g pinched by the rungs of the ladder, it amputates his leg. They only thing ALS will do different would be. Start IVs and maybe give pain meds. All that the delay being dispatched would not make the difference with the overall outcome. Yes there are of things the ALS can do like tube him and defib etc. but BLS keep the airway open and breath for him and all have AEDs.

I guess you have to have the belief that you will be getting competent EMTs from the local EMS to respond. This county has to get away from the Medic Dependency and do what you are certified to do.

Now going off topic a little, would you fly him?? I would not!!!! Reason-Flying him would almost guarantee him going to Cooper due the Cooper rules etc. I will transport to ground to Jefferson who specialize with this type of injury. Is there a delay yes with the initial transport but that is nothing compared to the delay getting him the proper treatment after he gets to Cooper. Just some thing to keep in the back of your head.

So, if you think ALS still needs to be dispatched on all companies for the “just in case” I will finish with this. I submit that we should all change are grids to reflect that the All Companies in Service Box be dispatched for any received call “JUST IN CASE.”

[WebBoss]

opsoverkill said:

I would have to respectfully disagree!! Having ALS on all companies in services would be a waste of money and a waste of a limited resource. Face it, when you break it down to the simplest form what does ALS more then BLS during the first few minutes of an injury or medical issue. Remember it is all about the ABC Airway, Breathing, and Circulation BLS can handle them also; the only difference is that ALS has more tools in the toolbox.


Let us take the worse case scenario with the Mount Holly Fire. Instead of getting g pinched by the rungs of the ladder, it amputates his leg. They only thing ALS will do different would be. Start IVs and maybe give pain meds. All that the delay being dispatched would not make the difference with the overall outcome. Yes there are of things the ALS can do like tube him and defib etc. but BLS keep the airway open and breath for him and all have AEDs.

I guess you have to have the belief that you will be getting competent EMTs from the local EMS to respond. This county has to get away from the Medic Dependency and do what you are certified to do.

Now going off topic a little, would you fly him?? I would not!!!! Reason-Flying him would almost guarantee him going to Cooper due the Cooper rules etc. I will transport to ground to Jefferson who specialize with this type of injury. Is there a delay yes with the initial transport but that is nothing compared to the delay getting him the proper treatment after he gets to Cooper. Just some thing to keep in the back of your head.

So, if you think ALS still needs to be dispatched on all companies for the “just in case” I will finish with this. I submit that we should all change are grids to reflect that the All Companies in Service Box be dispatched for any received call “JUST IN CASE.”

Respectfully, then why do we dispatch RIT Companies "Just in Case" then?

With the way things have been going, I don't see any wrong doing at all with adding an ALS unit to standby. Protecting our asses should be the paramount priority, and this is a good way to ensue that when the shit does hit the fan, we will have all the help we could possibly have.

I do understand that there is sometimes a shortage of ALS units, but that's Viruta's problem, not ours.

[riverlinetk]

well, if you wanted to take shots then go ahead, take shots as you had no problem doing here. however, if your point is right no target why are there so many other counties and major departments across the country that do have no problem allocating that resource for our own incidents first? You're going to tell me that pulling a trapped ff out or severly injured ff out doesn't need als care right then and there? I would like to think but simply know that our emts on many units in this county are not as competent even with their bls skills as compared to those als providers. It's easy to say you could use anything for the "just in case" scenario. However, if that's the case then why even have a bls unit.

Better yet, if you don't need anything just in case: on your initial dispatch use just your own station, then if its work then call all of your mutual aid companies. Aren't the mutual aid companies coming for the "just in case" call anyways? They are only being used when it's work or you have a significant investigation to locate the problem. And as noted, the same goes for RIT.

All i was pointing out here is that for the amount of work we see in this county (certain not an abundance) there is no reason we can't have an als unit dispatched with the working fire. I wasn't using the incident in Mt. holly saying that medics were in fact needed, it was a starting point for this.

[mumbles181]

I would agree with Opsoverkill. In our "lovely" state we have a 2 tiered system. ALS is, sadly, a luxury. Epecally in an system like Virtua's. If we had SCTUs (MICN) to back up the MICUs like a majority of the rest of the state then I would say yes, send a ALS unit (MICU or SCTU) to all in service calls. However, b/c Virtua has not................... "elevated" themselves to that level of service we are limited to just 4 1/2 chase vehicles and their service are needed elsewhere for those calls that are not "just in case".

[opsoverkill]

Had no attention on taking shot at you just active discussion on the topic. I have always had a problem with the PC tactic and I am very straight and to the point. Sorry if I offended

I have been an EMT for years and take great pride in my knowledge and my skills set. I feel I can handle any situation given to me just as well as the medics. I have treated many FF through my years in this business. BLS can handle and start treatment and meet the medic if necessary. I remember a statement that Dr. Ross from Cooper Trauma Told me as we were waiting for another city unit and the medic treating a GSW. He said what are they doing onscene that long tell them to stop doing the BS scene treatment and get them here to me. What they are doing onscence is not going to make a bit of difference. I remember as if that was yesterday. When I am on a serious call I stabilize do the ABC and transport period. Waiting for ALS or staying on location with ALS treating is a waste of time. There is a reason they are MICU units and that is keeping them MOBILE.

As for other counties and the country. This is due to the regulation by the State of NJ. This state should deregulate and open the door to having a EMT-B and a EMT-P make up a ALS unit that can transport. That is why the rest of the country has transporting ALS. The only ones I know of in NJ is Newark that responds as a transporting ALS.

[wellingcountry]

I'll have to agree with ops on this one. With us having the limited resources availiable on the ALS side we can not afford to have an ALS unit standing by on the scene when there are calls out there that people do need ALS treatment. If we where like the other states such as PA I know that at all working fires they have an ALS unit added but they run with one EMT-B and and a Paramedic in transport ambulances. If the state is to ever switch to Transporting ALS then I am all for ALS on the "All companies" as we will not be as stripped for resources.

[riverlinetk]

So again we are back to the "we don't have enough resources to have an als unit on the scene of working fires"? Thats C R A P!!! If you really think that'll stand up to a family or your own conscious if god forbid we were to lose someone and you think for even half a second that having a medic on the scene could have made a difference you're wrong. If i can run with this logic then I would also assume that we should never be dispatching an als unit on any type of call. We should wait until the ambulance gets on the scene and then call them. We need to be proactive not reactive to what happens, especially when we are talking about our own guys. It's very easy to say we don't have the resources available, but it's even easier to say well this is what i need so i'm using it. It's their problem to back fill not yours. This is not an attack on anyone, but I do not find it acceptable to state that we don't have the resources to do this.

[wellingcountry]

All right now look at the facts

things that ALS can do:
Start and IV
Defib/Monitor the hear
CPR
Give O2
BP
Pulse ox
Give MEDS
Control bleeding

Now
BLS
CPR
AED
O2
Pulse ox(some)
Control bleeding

Now what exactly more do we gain from having ALS on scene of a working fires. We gain the oppertunity for them to start meds and to actually see exaclty what the persons heart is doing. If a firefighter was to have a heart attack on the scene and go into cardiac arrest EMTS can still start CPR contol the airways and Defib with and AED. Once medics arrive they can give start and IV and give MEDS. I have a question for you how is this any diffrent than any other ALS call that BLS responds to? Think about that because how many times dose the BLS get there first begin care and either wait for ALS to arrive or transport and meet ALS enrout. It happens all day long all accross the county so I say to you if this firefighter was at home and had a ALS problem would the treatment be any diffrent because they still have to wait for BLS and ALS to arrive and begin treatment. Yes Backfill is not our problem but ALS but there are only so many ALS personal on a shift at a time and unlike fire where the members respond from home to the station close by ALS would have to call around to find providers that are available at that time to come into work and where every they may have to come from to get to the station they are assigned will take time in the end by the time everything is in place the fire maybe over.

[riverlinetk]

Ok, now you think about this: Why should one of our own being injured or sick be treated the same as any other other BLS call we go on? I never said i was 100% right or wrong, but i'm not vehemently defending a position on why we can't do more for our own.

[hp4l]

I've been reading over this thread and I have to say that both sides present good arguements. And it's nice to see it not getting out of hand. I would have to say that I personally would like to see the Medics on All Co's assignments. God for bid something happens to one of us, I would hope that every measure is taken to help him or her. Not saying BLS can't help, but ALS can do more. Maybe not much, but it's still more. Isn't the A in ALS Advanced? I want advanced care for all ff's on the fireground. I hope everyone here would. That's why we have beefed up grids and RITs coming in. Why not a Medic unit?

[voyager9]

All else being equal I would want ALS there for the reasons posted above. The problem is we live in a world where there isn't enough ALS available in the county to justify having them standing by at a scene.

A question: what happens more, 1) An EMS call that requires ALS. 2) An All-Companies call that requires ALS? More importantly, how many ALS calls come in during a typical All-Companies time frame? I've seen the argument used that how would we feel if a Brother died because ALS was not available. Obviously everyone would feel horrible but we have to also consider the opposite. How would we feel if a citizen died because ALS wasn't available? I think that situation is much more likely. Now here's the rub: How would that citizen's FAMILY feel when they find out their family member died because the medics were standing by at a scene where they weren't used? Would this open us up to litigation? (unfortunately everything comes down to that).

Now how about this as a middle of the road: Dispatch the closest ALS on the All-Cos but have them "available on scene" for other calls. If they're going to be standing by at the station waiting for a call they might as well be at the scene but at least this way they're available for additional runs.

[opsoverkill]

I see and agree with what your saying river but that is in the perfect world. It would be great to have ALS on every All companies inservice. But when the management side kicks in its all about the big picture and how the resources at hand can be used the most effective manner.

Having them stand by available on scene good option. In Camden County there is always a Medic on or around the scene. Officially no but buffing the job yes. I remember having Medic 3,4,5 at one fire scene So unofficially it is done.

Now having the Supervisor respond to the scene and stand by is a option but thats right they are not allowed to have drugs in their unit because there is not two of them.

That would be the best option have Medic 100 etc. respond and have a unit dispatch when needed. The supervisor could start treatment and transfer Pt care to the ALS responding. Only if the State would allow that.

[RngrVnc33]

If ALS wasn't a limited commodity, then absolutely, but not the way our system works now! HOWEVER I would like to see a dedicated ambulance for every RIT team. There should be a crew with stretcher and equipment at hand standing with the RIT crew at all times. This way if the RIT needs to go into service there is no scramble for a transport, and you are not taking away from firefighter rehab or other essential tasks required from EMS on the fireground!

[wellingcountry]

River I agree in a perfect world it would be great but right now its not a perfect world. I do like the idea of having the medic unit on standby in the area but availiable for other calls or even just the medic supervisor there just in case but right now I dont see any of that happening becasue of the call volume and the way the state runs the ALS system.

[hp4l]

rngrvnc33 said:

If ALS wasn't a limited commodity, then absolutely, but not the way our system works now! HOWEVER I would like to see a dedicated ambulance for every RIT team. There should be a crew with stretcher and equipment at hand standing with the RIT crew at all times. This way if the RIT needs to go into service there is no scramble for a transport, and you are not taking away from firefighter rehab or other essential tasks required from EMS on the fireground!

I will second that. That is an excellent idea.

[opsoverkill]

I third that!! That is really already accounted for in the ICS system. But rarely used because it is in The Logs Service Branch and people forget they can activate any group if needed on assignment. And that group would be the Medical Group.

So, All of us IC's let remember to request that extra ambo and tell the Ems Group Supervisor that you want a RIT ambo for the Medical Group.

[RngrVnc33]

I have brought this suggestion to the attention of the County EMS coordinators and some area Fire Chiefs but no bites! But rest assured the next worker that Im at on the ambo I will be requesting an additional AMBO (other then the 1 onscene for transport, and the 2nd for rehab) specifically for the RIT and NO other purpose.

[tootall]

Everyone has made excellent points and I would like to add my own.

Does every working fire need a Medic Unit? Use your judgment. If the fire is out in 10 minutes cause its a room and contents release the medic. But if we are talking about prolonged incidents than yes I think we should.

As Marques said when the County Hazmat team goes out we get a medic unit...why not the same for fires?

#1 We need to take care of #1. OUR OWN! If that means finding a Medic Unit somewhere than find it.

#2 Can BLS do what ALS can do? NO! If someone has inhalation burns you may only have only a few minutes to get that tube because the airway will swell. Lets face it Shawn not all EMTs are competent like you. Do you want one of our own sitting waiting for a green EMT to decided what to do in that high stress incident?

I sure as hell don't!!!