A Weighted Issue – The Fire Service Helping Private EMS

There has been quite a bit of buzz lately over a story that happened pretty close to my generic neck of the woods. It’s been featured on www.JEMS.com as well as www.EMS1.com and has blown up the twitter streams. I was made aware of it by the JEMS Facebook fan page posting the link two days ago.

Before I link to the article, I’d like to say that I was immediately on the side of the private ambulance company and I jumped right on the JEMS facebook comments thread to state my case. I figured that there would be some dissention, but that most people would share my view.

But that’s not exactly what happened…

Apparently there is a vast chasm in opinions out there on this issue, and it’s not just the Firefighters vs. the non-firefighters like I thought it would be. The comments section is up to 61 comments as I write this and the discussion is poignant and well reasoned. I still believe in what I said… but I’m willing to revisit the issue

Here’s the article: http://www.jems.com/article/news/illinois-fire-department-refus

So… do you see the discord there?

The private ambulance service, which is a pretty new company that runs only one or two ambulances was started by a paramedic with a dream (yea, really). It took the patient from a rehab hospital to a private residence in Springfield, IL. I don’t know the exact road mileage, but I do know that Springfield, IL is a good 4 to 5 hours away from where the rehabilitation hospital is located. The patient was reported to have been on Medicare and Medicaid and weighed approximately 700lbs.

Yep, this ambulance crew had to take a 700 pound patient on a long distance transfer. I feel their pain.

The crew couldn’t get the patient from their ambulance into the residence when they got there and called the Springfield FD (SFD) for assistance moving the patient. SFD refused to assist them.

Ultimately, the private ambulance crew arranged for another private ambulance from a Springfield area company to come and help them. The job got done and everyone was happy, right?

Well, no… of course that’s not what happened. Someone alerted the media and the story popped up on the wire. Now there’s debate flying all over the interwebs and I for one want to keep it going. Viva debate. Viva discussion.

Here’s my comment from the JEMS Facebook Page:alled “community service” which I guess is something they don’t understand in Springfield.

There is nothing wrong with private ambulances and even the staunchest fire service EMS person would agree that no fire department would accept a long distance transfer (in this case, probably a good 5hrs) discharging a Pt from a rehab hospital to home. Some service has to exist to do this type of work, and Mercy Ambulance stepped up to do it. The patient was a TAXPAYING CITIZEN of Springfield FD’s area and Mercy was returning that taxpaying citizen to his or her home. This person has already paid for Springfield FD’s services and they refused to provide them.

I would guess that SFD regularly responds to other so-called “Nusaince calls” all the time, or have they stopped responding to Activated Fire Alarms, dumpster fires, and CO alarms as well?

Mercy Ambulance wasn’t doing this for the money. The reimbursement from Medicare is laughable and the “reimbursement” from IL medicaid is pretty much non-existant. They did this because the patient needed to get home. The reimbursement system is such that they would have had to eat the cost of additional crew and making the assumption that the SFD would respond for the “Public Assist” of one of it’s tax-paying constituents is reasonable.

SFD gets a letter in the file for this one.

I’m actually familiar with the ambulance service in question. In the area that it mainly operates within, the Fire service is always happy to help out the private ambulances with these types of cases. It has to do with providing something called “community service” which I guess is something they don’t understand in Springfield.

There is nothing wrong with private ambulances and even the staunchest fire service EMS person would agree that no fire department would accept a long distance transfer (in this case, probably a good 5hrs) discharging a Pt from a rehab hospital to home. Some service has to exist to do this type of work, and Mercy Ambulance stepped up to do it. The patient was a TAXPAYING CITIZEN of Springfield FD’s area and Mercy was returning that taxpaying citizen to his or her home. This person has already paid for Springfield FD’s services and they refused to provide them.

I would guess that SFD regularly responds to other so-called “Nusaince calls” all the time, or have they stopped responding to Activated Fire Alarms, dumpster fires, and CO alarms as well?

Mercy Ambulance wasn’t doing this for the money. The reimbursement from Medicare is laughable and the “reimbursement” from IL medicaid is pretty much non-existant. They did this because the patient needed to get home. The reimbursement system is such that they would have had to eat the cost of additional crew and making the assumption that the SFD would respond for the “Public Assist” of one of its tax-paying constituents is reasonable.

SFD gets a letter in the file for this one

That has been “liked” six times since I wrote it.

The rub here for the Defenders of the Fire Service™ is that they say that the “Medical Transportation Industry” is an “Industry” and therefore should have their own plans in place to deal with this type of case. They say that they shouldn’t diminish their ability to respond to emergency requests in order to help out a private business with a client. They say that they would expose themselves to liability, expose themselves to potential injuries of their employees, and that they would be providing this service for free. They say that this isn’t their job and that they shouldn’t be spending taxpayer dollars to help out a private entity.

And… I might concede that to them if I thought it was genuine. I mean, does the fire service help out the towing and recovery industry with cleaning up car wrecks? Do they help out the private fire alarm business by responding to and resetting false alarms? Do they provide private residences with smoke and carbon monoxide alarms?

Yes, of course they do all that. They do other things too. They help out all kinds of community entities, both public and private, for-profit and not-for-profit all the time. The Defenders of the Fire Service™ keep trumpeting their statement that they are an “All-Hazards” emergency response agency that is constantly adapting to meet “the needs that the public are demanding from them”.

All of those community entities the fire service assists have one thing in common, they pay taxes. Some of them pay property taxes, some of them pay rent that goes in-part to pay property taxes, and some of the straight not-for-profits provide services that help the people paying property taxes.

And last time I checked, the SFD does receive property taxes.

Here’s one thing with what I said though… The “All-Hazards response” idea is for responding to “hazards” and I can see where a private ambulance needing a hand isn’t exactly a hazard or an emergent need.

Would any of the Fire Departments I’ve worked on have done it? Yes, absolutely. A citizen needed an assist and we would have marked it as a “Public Assist”. We would have responded non-emergent, helped, and it would have been a non-issue. The person pays tax dollars and we would have looked at it as the same as responding with an engine for a 911 lift assist.

However, I will concede that the Private ambulance service would have been more proactive if they would have called the SFD and asked them if they would help them before they loaded the patient. If the SFD told them “no” at that time, they could have arranged for alternate methods at that time. Instead, they just assumed. They transported the patient to someone else’s sandbox and just hoped that they would play nicely.

And the SFD doesn’t play the way that Mercy Ambulance is used to playing.

If you can’t tell, I’m on the side of Mercy Ambulance here. Although I say that they should have dropped the dime and rang the SFD to ask them before they just assumed they’d help.

One thing’s for sure though, this issue isn’t going away and it will probably become more common. There’s a ton of differing opinions out there as shown by the comments that news story received and it shows that there are EMS professionals on both sides of the fence that have strong and reasoned opinions. This is an issue that would benefit from some discourse and that’s why I’m bringing it up.

What are your thoughts?

  • http://thehappymedic.com the Happy Medic

    CK and I differ on this and that’s why I love him.
    “Some service has to exist to do this type of work, and Mercy Ambulance stepped up to do it. The patient was a TAXPAYING CITIZEN of Springfield FD’s area and Mercy was returning that taxpaying citizen to his or her home.”
    Mercy Ambulance should never have taken this job. they knew when they agreed to take this person home they were unable to complete the job they are billing for. They were relying on the tax payer funded service to back them up free of charge.
    The person is a tax paying citizen, but in the same way we won’t send the Sheriff to block the road when the ambulance arrives or repave the road in front of her new house simply to accommodate her. Why not, she’s a tax payer? The tax payer argument is a non starter.
    Mercy should be able to provide the service they bill for. Period. If they do require the fire department, road department or police assistance they should be billed, just like hey bill the patient.
    And all those false alarms you speak of? I think fire departments should charge for those the same way ambulances charge. There is no difference. For profit EMS in this case failed.
    I do call into question the “readiness” issue some will fall back on, claiming fire rigs shouldn’t be helping in case of an emergency. If your system is in jeopardy because of 6 people helping a private for profit company do something they knew they couldn’t do in the first place, you need to rethink what your people are doing.
    Long story longer: Ambulance Company should not have taken a job they could not complete. Fire Department should climb down off their tower and help. Then send a bill.

    • Ckemtp

      Interesting but true fact: Happy and I don’t always agree.. But He and I both love the debate.

      The tax issue is very much at play here. This whole trip is being payed for by the tax rolls. Medicare and Medicaid don’t just print the money they occasionally use to pay with (or do they?) and certainly no ambulance company gets rich off of their level of “reimbursement”. If profit was the only motive here, I’d agree with you Happy… But it obviously isn’t. There’s just not enough money here to justify the added expense. Mercy ambulance is most probably providing this transport at a loss, if not completely a loss in the cost/payment side it is almost certainly a loss in opportunity costs wherein they could have made 3 or 4 short transports in the time they took to do that one.

      Should Mercy have turned it down in favor of having a Springfield Ambo service drive up? Well… Maybe… But we don’t know if the discharging facility attempted to contact one and the Springfield service turned it down. Knowing what I do about the area, it seems plausible that this happened, but I do not know for sure.

      At any rate, Mercy took the patient where he/she needed to go. They didn’t get rich from it and probably lost money on it overall.

      Should they have tried to bill Medicare extra (which wouldn’t work, but just for discussion)? Maybe… But is one form of tax more valuable than another?

      (Sent from my bberry, please exuse any typos)
      Sent from my U.S. Cellular BlackBerry® smartphone

      • Rhunic_Carver

        I’m not a billing expert but as far as I know medicare pays $11.00(ish) a mile for transports with no cap on mileage. Mercy would have had at least a 200mile drive, that they were getting paid for. Mileage pays 100% of what’s billed. 200x$11=$2200.00 minimum amount paid. I have no doubt they were making money on that trip.

    • http://sixlettervariable.blogspot.com Christopher

      My thing would be it is unsafe by any standards for 2 EMTs/Paramedics/Anybody to handle a 700 lbs patient. A bare minimum of 5 providers should be present for the transport and care of the patient.

      On the other hand I agree SFD should have helped a taxpayer stranded by a short sighted ambulance company.

    • bubba

      I am a member of the Springfield Fire Dept. I don’ speak for the dept but as a taxpayer.

      SFD runs 911 non-transport engines. Never had ambulances. (911 transport services are provided by private ambulance companies.)
      The privates used to have SFD help with NON-EMERGENCY transports but we quit after a couple of injuries and THE FIRE ENGINES BEING OUT OF SERVICE FOR A STRUCTURE FIRE and also another time a cardiac arrest.

      City Ordinance prohibits the use of city personnel in for profit enterprises. 911 CALLS DON”T count here, get over the apples to oranges comparisons.

      Due to the ongoing economic problems here and like everywhere else, The SFD is running understaffed. We are short two engines, why should the taxpayers risk subsidizing a for profit firm at the risk of their own safety? Also at the time of the call, ( this was dropped in the SFD lap at the last minute, rigs were already out of service for training.

      The patient in question was NOT a taxpayer, never lived here.

      Mercy ambulance abused the Rockford fire department and they now have the same policy.
      Mercy had to pay a private firm $75 to help with a coach call. If Mercy can’t afford that then they can close up shop.

      For the record I am a paramedic with over 20 years of service.

      • PEsmond

        As one of the owners of Mercy Ambulance, I want to set the record straight. At no time has Mercy Ambulance “abused” the Rockford Fire Department. Mercy Ambulance and the Rockford Fire Department have a good working relationship and have had no problems to date. Rockford Fire Department has been extremely professional and provides excellent service to all their citizens. As a side note their was no “75 dollar” charge for the other Springfield private ambulance to assist us, and we would not charge another service to assist them with a patient either. It is called “professional courtesy”.

        • Thescreamingtrout

          I was employed as a private paramedic 18 years before finally seeing the light and going to the fire side. ALL privates are alike. PROFIT driven and corner cutting everywhere to save costs. If taxpayers only knew the inside of how private ambulances work- and treat employees (a step above 1800s mill workers), surely your industry would suffer. I’m sure you will spin it as your not profit driven but “patient care” driven (lol), but anyone in healthcare knows private owners and their henchman are bottom of the barrel.

      • BoxerRob

        20 yrs employment perhaps. ‘Service’ is something you have yet to embrace…Again, your duties and what your department will and won’t do should be directed by civil authority. You guys can’t be trusted to do what is proper.

    • BoxerRob

      Nasty for-profit-company. Down with capitalism, power to the people, Ambulance Service lost money on this call. They did it because it was the honorable thing to do. A gene you missed in telophase. Now for my universal answer: Fire Service must be better managed by civil authority. Snotty plug who refused to respond should not have that decision making authority. 

  • PeteWine4142

    This is how I see it, and I’ve said several times since this story came out. Moaning and complaining about the weight of the patient (“Oh, they should respect themselves and not get fat! They should be just cut out of the house! Let them di…e! – Yea, I saw that one…) are not going to help. They are a part of the business. Like the drunk that you always find sleeping on a car, or the old lady who calls because she’s lonely. If this patient realizes that a private service cannot help them, they will then turn to 9-1-1 for assistance. (Even if it is BS) And the fire department will end up coming out there anyway.

  • Scott Cook1

    Having worked for a company that routinely abused the FD years ago, i side withe the FD on this.

    I wonder… If a taxpayer is paying for the FD services with their taxes. If the FD provided an ambulance then wouldn’t EMS services already be paid for as well?

    • http://davidkonig.com Dave Konig

      Actually no.

      The FDNY is a tax funded entity yet they will charge you $600+ for a BLS ambulance trip and put you into collections if you don’t pay in 30 days.

      • http://thehappymedic.com the Happy Medic

        Dave brings us back to the core issue of why on earth EMS has to justify it’s existence fiscally.
        How much did the PD lose last year?
        How much did Fire lose last year?
        Dog Catcher, Public Defender? Is any other public agency expected to cover it’s own expenses?
        Perhaps parking enforcement or transit, but why is it always EMS that has to bring in the bucks I wonder?

        • http://davidkonig.com Dave Konig

          Lol… is this an attempt to make me take over Chris’s blog or write another blog post?

          The short answer is that, traditionally, EMS is horrible in communicating. We’re horrible in communicating our value, what we can and cannot do, what the cost of not funding that value is, and how we provide it effectively.

          One of the problems with the fiscal requirements is that when we think in terms of EMS we think in terms of only fiscal loss. When the public thinks in terms of Fire and LE (just examples), they think in terms of fiscal cost vs. value loss. Property damage from a fire can be reduced with a fire service, and property loss can be reduced with law enforcement. People do not make the connection of fiscal loss with their health.

          It’s a challenging roadblock to overcome… but nothing’s impossible… impossible just takes a little longer.

  • http://www.firegeezer.com Mike “FossilMedic” Ward

    Fire company providing a non-emergency assist to get a 700 pound patient INTO home from private ambulance.

    Hmm, some considerations:

    1) What happens when a firefighter gets hurt?

    How to I explain to the state worker comp office or municipal risk manager that an expensive MUNICIPAL emergency service employee suffers a lingering, chronic disability for a task that is NOT within the existing description of the nature of a firefighter’s work.

    … helping out a COMMERCIAL company that is compensated for providing ambulance transportation.

    2) What unacceptable liability is the municipality assuming to engage in this activity?

    Does the municipality provide specialized training or patient transfer equipment for a 500 to 900 pound patient?

    The municipality has the deepest pockets if there is a bad outcome event.

    <<<<<<<<<<<<<<<>>>>>>>>>>>>>>>>>>>>>>

    I have been on both sides of this, on a private ambulance with a home-to-hospital transfer that needed more resources (without a pre-alert from dispatch), and on a fire company assisting a private ambulance while BOTH ambulance employees refuse to assist with the patient transfer.

    I agree with Happy that the fire department should assist, and bill the ambulance company. It would be a good idea to develop a bariatric transfer capability – with equipment and a billing policy/procedure.

    Mike

    • BoxerRob

      Alright risk-manager para-legal. This is outside the job description how?  There is a 700lb person in a jam in your response area. In an ideal world, the fire service would be pissed if the ambulance crew failed to notify proper public authority(that’s you) of such a crisis. I’m so different than you, I like fixing problems. Of course, I’ve never sipped the IAFF Kool-Aid. We can’t let you guy’s decide what you will and won’t do.

      • Ckemtp

        Hi BoxerRob, I’m the author. This one borders slightly on the realm of a personal attack… which I try to monitor here. Also… Fossilmedic has not, in fact, drank the IAFF’s kool-aid. If anything, he’s a sound, logical voice for EMS.
        This isn’t a repremand. It’s just an injection of opinion. Thank you for commenting.

        Sent from Yahoo! Mail on Android

  • http://twitter.com/nick_911 Nick

    My service does this on our interfacility units, if necessary. If there are no other units available, or if the location is outside the metropolitan area, they will contact the local fire department.

    Personally, I try and avoid this as much as possible. I would rather not wake an engine company up in the middle of the night and put them out of service for a lift assist. That being said, if there really is no other help available and I don’t feel comfortable attempting the lift on my own, what choice do I have?

    • Thehappymedic

      Call a moving company, plain and simple.

  • http://firecritic.com Fire Critic

    I agree with @thehappymedic and @fossilmedic on this one…

    However, I am thinking of moving to CKEMTP’s area. That way if I have a roof job to complete or a new deck to build I will just call the fire department because I am a tax payer!

  • http://davidkonig.com Dave Konig

    It’s definitely an interesting situation, but sadly it is hardly unique.

    While I think it’s great that this Fire Department is getting back to it’s traditional values of saving property and not helping people, I also find it interesting that there is no mention about what they would do if the patient was in the house and needed to get out. Would they refuse to remove him because he weighs 700 pounds? Would they call in for additional resources from another city, and would they then receive a bill from said city?

    For that matter how many cats have been rescued from trees? Sure, maybe the 700 pound patient is not as cute or cuddly as a kitten, but how many non-emergent duties does a Fire Department perform on a daily basis that can place their members at risk for injury?

    Having worked for a private company that transported a morbidly obese patient because the city service refused to do so, I can’t help but feel that this is just another example of poor service to a community. This department strikes me as a group who will cite job descriptions, emergent duties that may or may not exist, and union contract clauses instead of doing what needs to be done to make it happen for the citizen when it clearly was in their power to do so.

    And of course… we’re not even mentioning what this has done to the patient and THAT is the true crime.

  • CTmedic

    I’m curious. If I’m getting a tree cut in my yard, and the tree service that I hired couldn’t reach the top with their cherry picker, can I call the FD for their ladder truck?

  • Oemschief

    In my 30 plus years in EMS and public safety, I have encountered only a few situations that rose to this level of discussion and frustration… but I certainly fully understand the arguments made by all parties on all sides. This is not an easy problem to resolve simply because EMS over the years have evolved over the years into both a public safety and a transportation business performed by both tax based and pay-for-service organizations. What I do see is an opportunity here to develop a system that ensures the end product – the patient is serviced appropriately. With that said, we do first have to look at the existing failures, gaps and of course the strengths that already exist. Here are some failures that I (an assumption based on limited info) see in this situation.. 1) the discharging facility failed to inform the private transport service and help them develop a plan to meet the patients needs; 2) the private service may have not gotten adequate information and continued regardless; 3) the private service and/or the discharging facility failed to determine the local capabilities and resources before taking the patient home. Remember, this was not an emergency and therefor there should have been plenty of time to plan. 4) the local fire department developed policies without fully studying the impact on the community – in an effort to protect their own employees.
    A terrible pun but no-one seems to want to discuss the elephant in the room… that being the patient. Sometimes patients put themselves into situations that go far beyond the average and ones that require not only special services but some understanding and patience by the patient! I was one that made a comment on non-emergency transports are an industry – if it were not there would not be so many mom and pop (and a few large) services out there. Contracts with facilities are the bread and butter… and the good often comes with the bad as in this case.

    I dont have a complete solution but I do think that if there is good communication and information sharing up front – and services take the time to investigate and plan the call – all things will work out the majority of the time.

  • Ashford

    The sarcastic comments, about using the fire service for frivolous tasks, are not cute and not helpful.

    Moving an ill patient is not a frivolous task. And just because obesity is mostly self inflicted, does not mean it is not an illness.

    The ambulance service should have called the fire department before they transported.

    But I am willing to speculate that the fire department would have still refused. 700 lb patients do not ussually just sponaneously appear in your zone. The patient might have gained some weight at the hospital, but not 700 lbs worth. I am confident that the fire department was familiar with this particular patient, and has probably lifted that patient on many occassions before. They probably even have a pre-plan for how many trucks to dispatch to the house when they are called there emergently.

    We are fortunate enough in our district, that the fire departments and ambulance districts are humble about where our paychecks are coming from. We are all public servants. Though we might crab about it back at the firehouse and ambulance base when we get home, we are always willing to help eachother out to keep our citizens and team mates safe.

  • Easyduzit25

    personally I am on the fence because it doesnt matter if its a private ambulance company or a publicly funded ambulance company this should have never become an issue because if the ambulance crew was doing thier job they would have either setup another crew to go down there with them OR called ahead to the fire department and police to ask for assistance ahead of time and because it wasnt handled right by the ambulance crew in the first place who should have been dotting the I’s and crossing the T’s is probably why the fire department reacted the way they did.
    HOWEVER, even if they sent a crown vic out with 4 fire fighters just to lend a hand 9 times out of 10 you arent going to get a 5 alarm fire in the 15-20 min it may take to get that person into the house and if you do have that kind of luck atleast get the pateint into thier house they can roll around from there and the Ambulance crew can get them from there make sure to send a response bill to the ambulance company who can then bill the patient/insurance,
    As for the possible injuries incured, I would be afraid to call 911 i weigh 250 pounds so someone might get hurt carrying me out so I would be afraid they wouldnt make the effort to save me.
    So i guess who did either one of you serve by acting the way you did the ambulance company now has a reputation that they arent taking care of things they need to take care of enroute. And the fire department now has to prove to thier community that they are going to be able to take care of them in an emergency be it fire or MVA which brings up a whole new set of fears for me now that I have mentioned it…….isnt it supposed to be police, fire, and ambulance are all part of the EMS system police bring the law and arrest people who are out of hand and secure the scene Fire department handles ALL Hazardous materials,heavy lifting and auto deconstruction, ambulance help by assesing patients and determining the need for aditional ambulances and helicoptors maybe I am not with the times but arent we all supposed to work together?

  • wormbutt

    We can argue this back and forth for months, but there is no clear cut answer. Morally, I would have a hard time turning anyone down who asked for help – whether it was emergency help or otherwise.

    Outside of that, who is suffering most? The ambulance company? Amb crew? Fire Dept? taxpayers? Noooo, the patient! Could you imagine the discomfort that patient was in being transported for 4-5 hours in a bumpy ambulance with her own weight pushing on her? Imagine the fear the patient felt wondering if she was going to be dropped… I almost cried thinking about the embarrassment this has caused that patient. I’m sure she isn’t proud to be so big. Now to be slung into the middle of a high profile story must be devastating.

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  • Guest

    I’m fairly new in the EMS field and I have a question about all this. Could the patient sue the ambulance service for refusing the transport on the reason of the patient’s obseity? What if all the ambulance services refused the transport?

  • Nate Q.

    While I can understand liability being a concern, it shouldn’t prevent us (FD) from doing something in our job description…helping others. The semantics here are, to me, minute.

    This is the same type of run as a “citizen assist”, common for many FDs. Though the pt. didn’t call us directly, they are still requesting our assistance. Would it have been nice for a heads up? Yes, but the FD still should have responded instead of making THEIR citizen wait.

    I would argue that the actual moving of this pt. is like moving any other large pt.’s we encounter, and covered in our job descriptions. We’re required to lift/move things in myriad ways, from myriad positions, in myriad situations. We have had this call many times before, and it is dispatched out with a ticket number, tones, etc., making it like any other call.

    We (cities/FDs/etc.) can hide behind the liability and training issues all we want, but at some point common sense has to kick in. The solution is simple: Get the right number of people there to lift, use proper lifting techniques, and smile to YOUR customer. Then, when you’re walking back down the driveway, smile and hand the private transport a bill for not having their act together.

  • http://firecritic.com Fire Critic

    The only amicable answer I can find here is this:

    Provided the FD is willing to cover their employees if one of them is injured during this incident, the FD could offer to assist the private ambulance company for a fee.

    What is the cost of taking an engine or truck company OOS to assist them?

    Many on here are pointing to the supposed fact that we are here to help anyone with anything. That is complete Bullshit.

    IF this person were having an emergency it would be up to the 911 system (whether or not the FD is part of the EMS system here) to get the pt. to the hospital if needed.

    That is NOT what is going on here.

    The fault is on that of the private ambo company.

    As for all the comments on the feeling. I feel certain that this transport home didn’t all of the sudden make this person realize they are morbidly obese. I am sure they already knew that.

    If it were to be an eye opener for the pt. to then get the help they need to help control their weight and lose the weight it would be a positive.

    My dept. runs more and more bariatric patients. We have a bariatric ambulance with a bariatric stretcher and have even had to build a make shift stretcher out of plywood and 2x4s. These incidents have been for emergencies…not to transport the pt. to the grocery store or doctors office.

    All of those pointing the finger at the FD need to get over yourselves. If the private ambulance company is unable to mitigate the transport, they should not have taken the transport in the first place.

  • Topv7051

    I don’t have a problem helping any of our citizens. The FD is a service paid for by the taxpayers. I’ve been on the obese folks and I’ve made breakfast for the old guy who fell out of bed. I’ve followed the cops in to extract people and I’ve picked up people so combative or filthy that the ambulance personnel wouldn’t touch them. But where do we draw the line? We don’t do cats in trees anymore, and we don’t do lockouts unless there is a life/property hazard. Why? Because there are non-emergency services that other entities provide. (some of which are taxpaying businesses). If the locksmith-who pays taxes- needs help fixing a door-for a tax paying resident- should he call the FD too? Each is a taxpayer, each has a need.

    The FD established a policy that they would not perform patient lifts for ambulance companies. It is not an emergency service, and that service has private providers available to perform that task. Just because the private company cannot charge enough to provide this service profitably is not the FD’s problem. The lift policy existed before the call, and is based on a risk management analysis. The ambulance company failed to perform due diligence and plan their operation. That is not the FD’s fault.

    The comparisons of other non-emergency services doesn’t hold water. Fire alarms are installed for the sole purpose of notifying the FD in the event of an emergency. The FD resets alarms, it doesn’t repair or install them. I’ve never seen an FD assist a towing company beyond laying down absorbent and moving debris from the road, which fall into public safety-removing a hazard. As far as smoke and CO alarms, those fall into our primary mission of life safety. Lifting the stretcher at a routine transfer to home is not an emergency, and is not a public safety activity. Perhaps next you would suggest we deliver oxygen tanks and hospital beds to homes?

    A private ambulance company exists to make a profit. A non-profit ambulance company exists to make a profit for some other entity-eg, they are owned by a hospital that uses them for all their transfers. Either way, the CEO is making a bunch of money. The way he makes money is by keeping his costs down, which usually means they take advantage of the local FD to provide free manpower and first response. This screens the public from the realization that they are subsidizing the private company.

    Based on the above, how do private ambulance companies treat FDs? Their employees deride them as “stretcher fetchers” and take credit for the treatment given by the FD before their arrival, while telling the ER staff the FD is a bunch of fools. As if that is not enough, AMR and others denigrate FD based EMS and attempt to displace them to gain contracts, eg Dallas. While they do everything they can to enrich themselves at our expense, the fire service is supposed to roll over for “the benefit of the patient”?

    I am sympathetic to the patient in this case, however, the fault in this case lies with the ambulance company, not the FD.

  • Mwilk923

    Has Springfield heard of mutual aid agreements. In most states for your department to be licenses you have no choice but to sign mutual aid agreements. Way to drop the ball SFD.

  • Medic38k

    I’ve worked for a private amulance company before and we NEVER called for help from the FD. Normally its the FD calling us to transport ‘their’ pt because they requested to go to a hospital outside the FD’s area. We find out FIRST if it is a bariatric pt and dispatch our own lift assist as necessary. The one time I was blindsided my partner and I had no choice but to man up and do it ourself, we were 50 – 60 minutes out and rush hour was approaching. Thankfully the VOLUNTEER Department helped us at the pt’s home, what does that say about the difference in mindset between the two?
    I wholeheartedly disagree with comments made in Topv7051′s last paragraph. I’ve know I have never denigrated the local FD skills or abilities, and was always glad for any assistance they gave. I know of at least 2 families who have them to thank for a child that is still alive due to their quick and correct actions. But I do question the sense of sending a pumper, ambulance and Chief’s car to an EMS call. Really, are ALL those people required, or is it just a case of trying to justify the budget? You can’t cry $$$ when things like that are done.

  • http://twitter.com/in_the_city Angelo

    I’ve written 3 different comments. One was pithy. One was snarky. And one was full of so much rage that I stood yelling in my kitchen explaining the situation when my wife asked me what I was doing.

    I’ve decided that I have two things to say.

    Number 1
    Fire based, hospital based, non-profit, for profit, volunteer, third service, cops, robbers, run by your uncle Bill… We’re all supposed to be on the same team. My pants are black, his pants are blue, his pants are yellow and held up by red suspenders. It shouldn’t matter.

    A request, inconvenient yes, but reasonable was made by one Emergency Services entity to another. YES this wasn’t an emergency. YES the private should have planed for this themselves. But it would have taken the responding companies less than 20 min to get this job done. How is this different from any number of BS calls we answer every day? We are ALL part of the same family. We ALL respond. We ALL are supposed to want the same things. Like any real family, we may not like those crazy cousins from up north, but family is family and when they ask for help, help should be freely given.

    We’re all supposedly in this for the same reasons, to help our fellow man. It sounds like, underneath the political back talk, that the SFD would really rather drive really fast with the pretty lights to a fire somewhere so everyone can see how heroic they are than get their hands dirty lifting a fatty.

    Number 2:
    For everyone nay saying the private provider:

    Unless you’ve worked for an evil, crocked, IL based Private Company, shut your mouth.

    It’s a unique many headed monster. Constantly understaffed, over worked, and looked down upon by Hospitals, Fire Departments, and the public in general.

    If those Private Medics had refused to do that call due to lack of resources, they would have been fired.
    Most times there is NO back up ever.
    Calling ANYONE for help, is admitting that you’re not good enough to get the job done.

    The system may be broken, but its the only system we have.

    That patient had to get home. That’s what her physician said anyway. You don’t have to go home, but you cant stay here.

    For those bashing the private profit driven ambulance services, I ask you to give me an alternative for this patient to get home.

    The entire system failed.

    And it failed the patient.

    The patient who had to be told that: “No, help is not coming. The Fire Department, those heros from TV refuse to help us help you. No I don’t know how we’re going to get you back into your house.”

    ALL of us need to get over ourselves.

    Its not about ME.
    Its not about my COMPANY.
    Its not about my DEPARTMENT

    Its about others.

    Bitch about it if you want to. Complain after over coffee. Drink a beer and tell the story about your aching back on the weekend.

    Man up and do the job.

  • http://lookingthroughapairofpinkhandledtraumashears.com Medic Trommashere

    My big question is: Did they know the size of the patient prior to arriving there? Having worked in a private transport company before, I went to many transfers only to find out that the patient was morbidly, and I mean morbidly obese.

    Best example: Went on a non-emergency tx for a patient, the nursing staff gave a weight of 300lbs. With an extra hand or two in the nursing home, we would’ve been fine. When we arrived, we were pulled aside and asked how we were supposed to get the patient onto ‘that’ stretcher (old school Ferno, need I say more?) Come to find out, the nurse who called it in didn’t want the transport denied, so they subtracted three hundred and sixty-four pounds off the patients’ weight.

    We were stuck taking the transport. We called everyone we could think of enroute to the doctors’ office with no avail. We didn’t know what the fire department was where we were going, so we had to wait until we arrived, then I had to call 911. They weren’t happy about it, but they came out to help.

    Angelo is right: Most privately owned, for profit, transport companies are staffed by a majority of providers who hate, who absolutely loathe their job. The supervisors are in it to make a buck; if a provider gets hurt, so what? They still made that money on the transport. They can find others who are willing to work at a piss poor company for the money that they shell out.

    Yes, I will admit, they should’ve called and tried to figure something out on the 4-5 hour trip, but there may not have been much they could’ve done. The Fire Department needs to get their pee-pees’ smacked; how would they have felt if it was one of them, or one of their family members? I just don’t understand how the fire cheif can say that helping to move a bariatric patient leads to more back injuries than just participating in normal, firefighting activities.

    I’ve been there; I’ve had to sit with a bariatric patient in the ambulance for almost an hour, trying to explain to them why we can’t get them out, why no one is coming to help, even with the frantic phone calls for help.

    In the end, I wish we could all play together nicely. While things could’ve been done differently, I’m sure they were done to the best of their abilities.

  • Scott Cook

    My point exactly, Dave. The “they pay taxes” arguement only goes so far. I don’t know of a single fire department taht provides an EMS service that does not bill for those services.

    The Glen Rose (TX) VFD used to not bill for their services until a few years ago. They’d would actually drive you anywhere you wanted to go because you were a taxpayer.

    • http://davidkonig.com Dave Konig

      Scott,

      The case of Glen Rose VFD is not uncommon. For that matter the volunteer ambulance corps that I belong to provided its service to the community free of charge for 30 years and it is NOT tax payer funded. We will transport you within an hours distance one way with no notice and provided your condition permits it. Distances greater than that are dependent upon crew availability and we are limited to pick up locations due to the local state regulations even if you are a resident.

      Sadly, due to the demographic switch in the community and more of a nomadic trend donations decreased and we had to turn in 2000 to “Third-party billing”. If patients of our service have insurance, we’ll bill the insurance. If the insurance doesn’t cover the cost or the patient doesn’t have insurance we send them a letter and then write it off as a loss. We never put patients into collections.

      The fact is that a FD fire operations side is often tax supported while their EMS service is self-supporting or is helping to subsidize their fire operations side as well, and their service level is very specific to a location. Therefore when there is a call from within that specific location, whether it be emergent or non-emergent, there needs to be very careful consideration before refusing a request for service in their area… and when I talk about consideration I’m talking about determining whether you have the ability to fulfill the request and whether or not you are the best public service to perform the job. In this case, the only other possible public service that may have been better suited to perform this task would be a Sanitation service, but since many cities contract those services out to private companies that may not have been an option.

      • http://twitter.com/S_Cook_EMTP Scott Cook

        Dave,

        Do we agree or disagree?

        Scott

        • http://davidkonig.com Dave Konig

          Scott,

          We disagree because you are siding with the FD’s right of refusal and I disagree with that… which all tangent conversations aside is at the heart of the matter. While I do hold the EMS agency at a higher level of fault, in no way am I willing to exonerate a tax supported entity for failing to deliver when they could have.

          Unprofessionalism + unprofessionalism does not equal professionalism, no matter which way you add it up.

          • http://twitter.com/S_Cook_EMTP Scott Cook

            Intersting take.

            For an FD to not provide a non-emergent service is unprofessional?

            For a private entity to be discourteous and not request FD support in advance is unprofessional?

            I would agree that it is not the smartest policy the FD has. And, technically it is not in line with their mission statement.

            But it is hardly unprofessional. The simple fact is the FD can have the policy. No where in state or federal law does it prohibit such policy (shaky in regards to the ADA issue in my opinion).

            This was not an emergency in any shape form or fashion any more than it would be if Joe’s Cab took her home.

            And from what I’ve found, each of Springfield’s ambulance services claims to provide non-emergent medical transport.

            So that I understand your position better: Is it your position that there an FD should have NO right for refusal for a service call?

          • http://davidkonig.com Dave Konig

            My position is very simply that this is botched from both ends. While I lay more fault on the ambulance service for calling ahead, I cannot give amnesty for the fire department that is a tax funded resource. While the legality of the policy is questionable, most jurisdictions will hold you accountable for not just your actions but also your inactions. From my viewpoint, the inaction of the fire department to provide direct assistance or to find a suitable alternative is a liability.

            As for the FD’s right to “refuse” service, I think that if the request is made to the FD that is out of their capabilities, then yes they can refuse service. Some examples of that may be to apprehend a criminal, to haul off a dumpster of trash, or to repair a pothole in a street. These are services that the FD does not perform regularly, are not equipped to perform, nor should they be expected to perform.

            I would however expect the FD to take that request and call the proper resources being a Police Department, Sanitation Department, or whichever department handles road repair for that jurisdiction. Moving people on the other hand is something that the FD, in theory, performs regularly, are equipped to perform, and are expected to perform… UNLESS that FD is getting back to the original Mission of the Fire Service which is to protect property, and not people. And while I think “Mission Statements” are great, using a “Mission Statement” as a shield for selective inaction would make me question the true purpose of that “Mission Statement”.

            So if that FD in fact has a mission statement that directs it to protect property with no regards for people, then that’s great and rock on with tradition. If that mission statement has anything to do with protecting lives, then you have just violated your mission statement in favor of a policy that was enacted a whopping year ago.

            As for the nature of the call, emergent vs. non-emergent, please see my comment to FireCritic for my view on that aspect.

          • http://twitter.com/S_Cook_EMTP Scott Cook

            The Deputy Chief states that the FD has had “[s]everal firefighters had received workers’ compensation because of back injuries suffered while lifting obese patients under those circumstances…” (http://www.jems.com/article/news/illinois-fire-department-refus)

            So, it is known that these types of non-emergent calls have resulted in injuries to FF’s in the past, and the FD does something to protect their employees.

            The primary job of the FD is to respond to emergencies. If a firefighter or firefighters are injured while on a non-emergent call, that puts the company out of service and unable to perform their primary job.

            The FD has the responsibility to protect its workers as best as possible, and maintain their core service. SFD has done so with what is (in my opinion) a bad policy.

            But, their argument for having the policy is perfectly valid, and reasonable. And, as Mercy is, the FD is obligated to ensure their employees safety while on the job. Mercy chose to try and save a few nickles at the expense of the Springfield taxpayer. (Personally if I was SFD I would rewrite the policy and bill private EMS for 1/2 of all calls the FD responded to with them.)

            “Esmond said Medicare and Medicaid, which often cover patients Mercy Ambulance transports, don’t pay him enough to justify sending more vehicles to help the two paramedics in a single ambulance.”

            Mercy wanted free labor. The owner of the company even says as much in the article..

            “Esmond said he never before was refused free assistance from a municipal fire department…”

            “Fire departments in those towns have been willing to spare several workers, at no charge…”

            “Esmond said he hoped the [other EMS] company would help at no charge.”

            Instead of Mercy eating the cash, he wanted the taxpayer to soak it up.

            They knew the patient weighed 700#’s before they ever went to get her, and failed to staff their vehicle adequately to perform the task they were HIRED to do because it would have cut into their profit.

            I don’t think the FD policy is smart, but the total fault here lies only with Mercy Ambulance.

  • Scott Cook

    And…

    While I do support the FD having a policy in this case, I am not commenting on the wisdom of that policy.

  • http://www.nottrainedbutwetryhard.blogspot.com FireCap5

    I am going to side with the FD on this one. If the private wants the work, they need to be prepared and equipped to complete the job.

    Public Safety Departments shouldn’t be subsidizing a for profit company. As for my VFD, we would likely end up helping. ONCE.

    Think about from a Volunteers viewpoint.

    If I get hurt and can’t work;

    I could lose my paying job.

    Who will cover my lost wages?

    How will I pay my bills?

    Who will pay for formula for my infant daughter?

    How will I make my truck payment?

    Why were we there in the first place???

    From a moral standpoint, the person needs help and some one should help. From an emotional standpoint we want to help.

    But at what cost?

    Someone once said, “A lack of planning on your part, does not constitute and emergency on my part.”

    Seems pretty applicable here.

    • http://davidkonig.com Dave Konig

      Every volunteer agency should be providing workers comp coverage for their volunteers. Although the workers comp provisions vary state to state, there are other options that will provide equal if not greater coverage for any business. If your volunteer agency does not offer this kind of protection, its time to inquire to the officers as to why not and how soon can the agency rectify that.

      Just because you are a volunteer service does not remove the responsibility of being professional both from the aspects of being responders or as management.

      • http://www.nottrainedbutwetryhard.blogspot.com FireCap5

        My volunteer agency does provide workers comp insurance as required by state law. We also provide a retirement program (it is modest to be sure, but better than nothing).

        Workers Comp only pays a percentage of your pay, so the concerns are still valid.

        • http://davidkonig.com Dave Konig

          Very true.

  • http://twitter.com/in_the_city Angelo

    Rumor and hearsay are two things i traffic in more than most.
    Talked to a guy who talked to one of the people who did this trip.
    (Isn’t 3rd party rumor the best kind?)
    That policy that the SFD has in place, not to help a Private Ambulance… first time they’ve ever used it.
    Also in retrospect he says they should have called ahead and checked.
    So i guess lessons learned all around?

    And for everyone saying what would the fire guys do if they got hurt helping.. What difference does it make if you get hurt moving a fat person or rolling a bunch of hose?

    A job related injury is a job related injury.

    • http://firecritic.com Fire Critic

      Angelo, I brought up the injury possibly not being covered because I know of departments doing some pretty sneaky things.

      Especially in this situation where there is a “policy” against this practice, what if someone were to be hurt while disobeying a policy.

      I am not saying they wouldn’t be covered, but I would sure as hell make sure I felt confident that my dept. would take care of me before doing something like this.

      I should also add that my dept. has helped hoist a morbidly obese pt. into their coffin after their death. Did they have to? No, but they did it anyways.

      I do not know if we billed them or not.

      The point is that if FD’s want to do this then ok, but we should not be expected to. Nor should the FD be bashed by EMS professionals for not helping out this transport company.

    • http://www.firegeezer.com Mike “FossilMedic” Ward

      Hi Angelo:Thanks for you post. Worker compensation regulations are complex and detailed, with unionized labor organizations spending the last 40 years fighting to improve the coverage of career firefighters. It is different for every state and large municipality.Which is why many states have cancer presumption regulations for firefighters but not mechanics, even though both are exposed to cancer causing agents while doing their municipal jobs.For example, in the 1970′s a career battalion chief in my department was denied coverage after suffering a disabling heart attack. Because he asked for medical assistance hours after working a fire, but while still on duty, coverage of his medical bills and provision of a disability retirement were denied. In the 1970′s you had to be actively working an emergency to get state benefits – because the state treated all firefighter claims as if we were volunteers.”Risk management” is the process where the state, or the self-insured municipality, works to REDUCE the financial obligation of the state/municipality when employees are injured. For example, if you are injured in a vehicle collision and NOT wearing your seat belt – the county will not cover your medical expenses related to the incident.Helping move a 700 pound patient from a commercial ambulance to a private residence is an activity NOT within the job description of a municipal firefighter. Getting hurt while picking up wet fire hose is within a firefighter’s job description.Helping move a 700 pound patient suffering a medical emergency, that has generated a municipal incident number, into an ambulance is within a firefighter’s job description.Mike

  • http://www.nottrainedbutwetryhard.blogspot.com FireCap5

    Bottom line here is, if you cannot do the job, don’t accept it and expect someone to come bail you out for free.

    Remember folks, what goes on in one jurisdiction does not necessarily go on in another. IE; EMS providers bashing FD EMT’s as stretcher fetchers. I am sure no one’s comments are directed at a specific person here in these responses.

    Unfortunately, there is truth in all of these unseemly examples of disrespect and loathing. This type of poor behavior creates divisions in our ranks as Fire/ EMS responders and holds back our profession on all fronts.

  • http://twitter.com/in_the_city Angelo

    This entire situation makes me very aware of how like High School the entire public safety field is. It seems to me that that these transport company medics are being treated like the chess club. That makes the fire and other 911 providers the jocks. Me? I’m taking my buddies from the AV club and going for a smoke.

    In a perfect world, it wouldn’t matter which TYPE of paramedic or emt these people were.
    I don’t dispute that this entire situation reeks of poor planning.
    And I’m trying very hard not to bash or generalize every Fire Department.

    All I’m going to say is that if I had been there, I would have helped.
    I understand following departmental policy.
    I just don’t like a department that puts forth such a policy as this one.

    I’ll go back to my nerds, and wait patiently for my perfect world.

    • http://firecritic.com Fire Critic

      This isn’t about egos or anything like that.

      How would you feel if someone started up a transport company and staffed it with a driver. . Every time they got to the house they call the FD to help get the stretcher out to get the customer into the house.

      This is nothing different that that.

      Private company cuts cost and makes more money. They stress the 911 system and already short staffed FD’s to do more.

      • Medicsully

        I know I’m reading a response from a year ago, but how can you say that private companys stress the 911 system. In my area, Chicago, private services run thousands of emergent nursing home calls a month, meet up with the fire biased municipal EMS to take patients from their homes to further hospitals. Yes the are trying to profit, but is the few times they ask for help really stressing system?

  • http://twitter.com/scoolgirl101 Amanda Salinas

    Coming from a private ambulance company, working at a VFD; I am not siding with anyone on this one BUT, I will say this:

    I hope a lawsuit comes from all of this. NOT to bash the SFD or put down the private ambo company, but to make the public and the people of CAN make a difference in our system wake up and see that we have a serious problem in our hands for both sides. Privates can’t keep “coming up short” on their patient care [by not being able to move the patient in the home.] and FDs can’t be help up because of it [for free.] To my knowledge, FDs DO charge a company for falsely activated alarms, public or private. One thing here = Time is Money. For everyone.

    Another thing, this situation could have been handled a little better even if SFD declined to help. I’m sure Mercy (being a new company) wouldn’t know who else to call in that certain area for help, but I’m sure SFD does. A proper, “I’m really sorry, we can’t help you with that BUT I KNOW A COMPANY/SOMEONE who can.” would have been substantial. Like I said, not the help they intended on getting, but they got something. A little something called Customer Service.

    We’re brothers and sisters. We should stick together.

  • http://notesfrommosquitohill.com mack505

    I’m going to go in a different direction here and slam our entire medical system. I see three parts to this issue:

    A. Morbidly obese patient is discharged home from a rehabilitation facility.
    B. Private EMS service takes the call and can’t get it done with the resources at hand.
    C. Local FD refuses to assist.

    We’re all so busy fighting over B & C that no one has noticed where the failure really occurred: back at A. If this patient is so morbidly obese that two crew members can’t get her into the house, how is she supposed to perform any ADLs?

    How will this patient survive at home? Who is taking care of her? Why was she discharged home to begin with?

    Sadly the answer is usually one of “you don’t have to go home, but you can’t stay here.” Medicare/medicaid, private insurance, or a doctor decides that the patient no longer needs rehab. Home may not be the right place, but it’s the only other choice.

    BTW, who has EMS responsibility now that the patient is home? Does SFD run the ambulance, or will they be refusing to help some other service in the coming weeks?

    • http://twitter.com/in_the_city Angelo

      you sir, said the things I wish I could have said. An accurate description of a broken system. Good show

    • bubba

      SFD does not provide transport services period.

    • BoxerRob

      this has been my thought all along. discharge planner? Fire/civil detention may have had a case for not allowing such an imminent hazard to continue. Were there 2-3 skilled bodies staying w/her 24/7? I’m so curious to know how many days it was before Fire was called to this time bomb.

  • Tacmed85

    Let me preface this by saying that I’ve got 7 years in EMS and plan another 20ish, I love what I do and can’t imagine doing anything else. I’ve worked in both private and Fire based EMS and see several advantages and major downsides to both. That being said I’m going to sum it up with this. EMS sucks. Fire based EMS sucks. Private EMS sucks. The two trying to work together without giving up anything to the other really sucks. Here is why, we pretend that we are there for the patients but at the end of the day we are just here to line the pockets of some company owner somewhere or inflate the stats of the Fire department so they can justify that grant/pump truck/extra staff/whatever. While the individual medic’s goal may be to help the patient there is always someone higher up who’s motives are very different. This particular case brings that into the light rather clearly, Fire won’t help because there is no money in it for them, private company sends two people on a call they know they can’t handle so they can make more(or at least minimize losses). So the question become what can we do about it? Its a pretty important question to answer because this is the exact same thing that is going to kill any hope of EMS 2.0 ever becoming a reality.

    • http://firecritic.com Fire Critic

      Tacmed,

      First off, if EMS sucks get out of it.

      However, I don’t agree with you on this.

      What people are failing to realize is that this is not EMS. This has nothing to do with EMS.

      This is a cab ride for a fat person. Plain and simple.

      Because of the size of this person and inability to ambulate themselves, they have to rely on a transport company to move them. No EMS required.

      • http://davidkonig.com Dave Konig

        Yeah, not so fast. I’m not going to address the obvious problems with that statement because I think that you know what is wrong with it and it was probably said out of a moment of passion instead of reason.

        EMS, as I understand it, is a multi-faceted service fulfilling a number of different needs to meet the medical challenges as they come. Just because the word “Emergency” is in there does not mean that we are just caring for patients with acute conditions. For that matter, it also depends from who’s perspective you want to define “Emergency”.

        For patients experiencing an acute medical condition, getting to a hospital can be perceived as an Emergency.

        For patients suffering from a chronic condition that has worsened, getting to a hospital can be perceived as an Emergency.

        For patients with the inability to self-ambulate or sit in a wheelchair, getting home from a hospital can be perceived as an Emergency.

        For hospitals with a limited bed capacity, NOT getting a patient discharged home can be perceived as an Emergency.

        All of those situations currently require the intervention of an EMS agency to resolve them. Now there are some EMS agencies that specialize in the first two types, some EMS agencies that specialize in the second two types, and some EMS agencies that will resolve them all. Just as all Doctors are primarily called Doctors as opposed to their specialties (including Oncologists, Surgeons, and General Practitioners) nor should we categorize EMS agencies according to specialty… because in the end they are all providing EMS services as viewed from the perspective of those who are placing the call.

        For that matter, if we were to correctly label departments based on the majority work that they do, there are many Fire Departments who would no longer be considered Fire Departments. They would then become EMS Agencies and the fire apparatus would become part of an EMS-based Fire Service.

        Now my curiosity is seriously piqued though Rhett, how do YOU define EMS?

        • http://firecritic.com Fire Critic

          @DavidKonig EMS to me is Emergency Medical Services. Transport companies might be staffed with EMS professionals, but unless they are on a 911 call it is not EMS. That is my take.

          I know what many will say…what about the BS calls. Well if it is perceived as an EMS call by the caller or call taker (911) then it is an emergency until the EMS unit can determine otherwise. At that point it goes to policy. Some departments transport bs calls, others pass it off to 3rd party private companies.

          I still stand firm on this situation not requiring the FD.

          As for all the people bashing the FD or saying “what if” the obese person needs 911…I say this – if it were a 911 call it is up to the EMS system to mitigate the emergency.

          This transport company needs to redefine its policies. One local agency here where I live has a policy that every 50 lbs. over 300 gets another person on the call. 700 lbs = initial unit (2 personnel) and 4 more transport units with 2 people each = 10 people total.

          If our FD had the same policy, in order to assist the transport company we would have to send 3 apparatus which would be either medic trucks (2 personnel) , engines (3 personnel), or ladder companies (3 personnel).

          How can you justify that to help a private company make their dime?

          For everyone =

          If you are following EMS 2.0 and all the initiatives, ideals, and advances that so many are hoping for this situation taking that many companies out of service to help a private company do business then this is a step in the wrong direction = EMS -1.0.

          • http://davidkonig.com Dave Konig

            Thanks for explaining your definition of EMS. While it’s a very traditional and popular, albeit misguided, view of the service nonetheless it is important to understand one another’s perspective.

            I have to agree with you regarding the calls received as emergent but of a non-emergent nature. The perspective of the caller is that they are experiencing an emergency and need an emergency response with some sort of intervention by us on their behalf. However the same holds true for those in hospitals with no way home or at home with no way to get to a doctor’s appointment or clinic. We are able to mitigate alot of the risk of these transports with proper discharge planning and working with facilities to schedule their transport needs so that they can continue to receive the patient on the corner experiencing what they perceive as an emergency. Failing to recognize the system as a whole and only focusing on one aspect of it is, at its best, tunnel vision.

            Consider for a moment if there were no private EMS services. How long will it take before your local hospital is no longer able to accept patients from your acute emergency crews? A day? A week? A month? No matter which time frame you pick, it is only a matter of time and then what?

            Just as importantly, when your region is inundated from a man made or natural disaster who gets called in for mutual aid? Perhaps in a local disaster you are able to get resources in from a neighboring town or city but in a regional disaster all of their resources will undoubtedly be tied up and in need of help themselves. It is often overlooked that private EMS helps to fill that need, but again that’s a bigger picture viewpoint which I encourage you to expand your vision to.

            Finally, in regards to your EMS 2.0 comment, EMS 2.0 means different things to different people. To me personally it means progressing EMS beyond the traditional definition that you provided above. It also means an end to this type of selective service as demonstrated by the FD mentioned above. Now, if you are insinuating that the EMS 2.0 initiative such exclude private EMS providers, well that is a whole lot of people. The approach not to exclude has been one of the main forces behind the proliferation of EMS 2.0 and there is no quicker way to see something die than to exclude more than half of its stakeholders.

            Continuing to hold on to your traditional definition of EMS is, in my opinion, EMS 1.0 and I encourage you to expand those views and look at it from the full perspective of others… specifically those who you intend on serving with that model because the involvement of EMS does not necessarily end at the ED door.

          • http://firecritic.com Fire Critic

            Agreed, EMS 2.0 is many things to different people.

            I will give it to you that in the big picture transport companies can be identified as part of the EMS system in some systems.

            However, failure to complete a task will not get them a warm reception.

            I still stand firm with…

            Fire Departments and EMS Departments have too much to worry about doing more and more with less and less. We simply cannot be taxed by private companies shortcomings.

            As for “what if” the transport companies didn’t exist…that is preposterous. Where there is that much money to be made, there is someone willing to make it!

            Remember this was a non-emergent transport for a woman back to her house.

            HERE IS ANOTHER POINT TO PONDER….

            If the company owner is that fumed over the fact that they didn’t get any help…The next 911 EMS call the County gets, they should call Mercy Ambulance and have them run the call, transport the pt. and then the County can turn in the billing to insurance or otherwise to collect…How do you think the owner of Mercy would feel about this? Working for free and doing someone else’s job?

          • http://davidkonig.com Dave Konig

            Not to constantly be repeating myself here, but I agree that the private ambulance company in this case was also in the wrong. For that matter I would hold their accountability higher than that of the fire department due to inept communication and planning, but that still does not excuse the inaction of the fire department.

            I do want to address one specific part of your comment:

            As for “what if” the transport companies didn’t exist…that is preposterous. Where there is that much money to be made, there is someone willing to make it!

            Actually that is not preposterous. Private ambulance companies see on average a profit margin of between 3%-5%. Some years are slightly better, some years are slightly worse but that’s generally what the average is. With the continual reductions in Medicaid and Medicare since the 90′s they have been doing more with less longer than most municipalities. So do not be surprised if one day your local private ambulance company closes and your municipality is placed in the position of doing the non-emegency transports… or close your local hospital to incoming emergent patients.

            I’ve already addressed the perspective of emergent vs. non-emergent, but in closing I will say that as far as I can tell had the Fire Department provided the assistance the firefighters would still be getting their paychecks at the end of the week and the department would still have their budget at the end/beginning of the year funded by taxpayers for the services they are to provide. The same way that the Mercy Ambulance medics would get their check, and Mercy Ambulance would have a fiscal budget at the end/beginning of the year funded by the insurance companies for the service they provided as opposed to have yet to provide… hopefully.

            At the end of that call though, the one who truly suffered was the patient who spent 8-10 hours (based on Chris’s travel estimates) strapped to a stretcher, 4-5 of those hours undoubtedly embarrassed and depressed at the seeming hopelessness of her situation.

            That to me is the greater crime, if there has to be one.

          • http://firecritic.com Fire Critic

            Obviously you know more about transport companies (and I knew that going into this discussion)…It just seemed to me in my area that the companies aren’t hurting. Although going on the current healthcare trends and projected stats read in magazines I can understand the lack of growth.

      • Geekymedic

        Wow. Your comments are very telling of your attitude toward patients in general. “This is a cab ride for a fat person. Plain and simple.” This is perhaps the most jaded view of the people we serve I have ever seen. I sincerely hope this is not your view. As the leader of an EMS organization, people that talk like that don’t last long. It is a shame and perhaps the saddest depiction of your jaded view is that you said “No EMS required”

        Your view is the heart of the problem with our industry. We really need compassionate health care providers not a light and siren chasing adrenaline junkies.

        • http://firecritic.com Fire Critic

          I don’t work for a company that transports people from the hospital home. I work for a public service department that runs calls for anyone who wants to call 911.

          We don’t have priority dispatchers, and our dispatchers are trained in first responder at best. They have SOP’s to follow on who goes on what.

          If someone calls 911 they get any or all of the following: PD, Medic Truck, Engine Company.

          I have a great attitude, I have great pt. care, and I am a great EMT. I am compassionate and I am great at what I do. I don’t work for a private ambulance company, Lowe’s, or McDonalds and I don’t intend to do their jobs if they think that is what the FD is for.

          What bothers me most about all of these comments is that so many EMS professionals complain about BS calls in the middle of the night but they have no problem with helping out a company complete their task that THEY are getting paid for. If they need 10 people to move the person then they need to call their boss to find them. Not 911.

          If this person had an emergency you better believe that I would break my back getting them into the ambulance and to the hospital. That is what I do….Our EMS system is a one way fare as I believe that most are with the exception of departments like the Richmond Ambulance Authority (911 and non-emergent xport).

          I apologize if you don’t like my candor on this forum. I just find it hard to believe that anyone is making any headway with progressing EMS with much of the mindset on this forum.

          I also imagine that many of you are pulling your hair out at my comments. That is fine. I am only hanging around because I really want to hear some COMPELLING argument why this situation is ok.

          • Geekymedic

            This situation is ok because it is the right thing to do.

          • Geekymedic

            Perhaps I am seeing your issue. What if the paramedic had called the local captain or bat chief and asked for help? Is it ok then?

          • http://firecritic.com Fire Critic

            GeekyMedic,

            I don’t have an issue if a department decided to help out. I have a problem with the entitlement of some of the comments and mostly with the attitude of the business man who runs the ambo company in the original article for free labor.

            It isn’t even about calling the local BC or Captain vs. 911. It is about the owner having a problem with the FD saying no, having a policy against it, or just plain not doing it because it isn’t their job.

          • Geekymedic

            Ummm..you just made the argument for the against. Policies are not black and white they are guides and this Chief is hiding behind them because his people made a bad decision. I am not defending the private guy, rather I am going after the FD for poor PR, poor decision making and all around not caring.

            As for not their job, I bet we all do things every day that aren’t in our job descriptions. It is called doing the RIGHT THING.

          • http://firecritic.com Fire Critic

            You keep bringing up the not caring part…If the private ambulance crew had cared they would have had the forethought to have some help when they got to the destination to get the person into the house.

            What kind of planning goes into a transport that long without thinking about what they are going to do when they get there?

            Why go after the FD for poor PR? Why not go after the private ambo company for poor planning, irresponsibility, poor decision making, and not caring? Is the FD that easy of a target that you are willing to overlook the wrong doing of the private ambo company?

            Sure, we do stuff every day in our ever expanding job description but we have to be able to draw the line in the sand somewhere!

          • http://firecritic.com Fire Critic

            You keep bringing up the not caring part…If the private ambulance crew had cared they would have had the forethought to have some help when they got to the destination to get the person into the house.

            What kind of planning goes into a transport that long without thinking about what they are going to do when they get there?

            Why go after the FD for poor PR? Why not go after the private ambo company for poor planning, irresponsibility, poor decision making, and not caring? Is the FD that easy of a target that you are willing to overlook the wrong doing of the private ambo company?

            Sure, we do stuff every day in our ever expanding job description but we have to be able to draw the line in the sand somewhere!

      • Tacmed85

        I thought I made the point in my post but I guess not so let me be a bit more specific, the business side of EMS sucks. Both private and fire based EMS systems are using EMS as a means to an end instead of using what is truly best for the people they serve be the driving force in their decisions.

      • BoxerRob

        face it, you’re the first guy to call it like it is. Via a highway of pizza and porkchops this person now demands public service for her every activity of daily living. Want to roll over? Call the state. You know this type of eating and inactivity(that’s the equation for obesity) can stop the state from executing you as a death row customer. Also prevent your deportation to Mexico…

  • Tooldtowork

    Several years ago Gary Ludwig, talked about what a great PR move it was for the St. Louis FD (which didn’t do EMS at the time) to pick up cardiac arrest survivors and drive them home IN A FIRE ENGINE. Of course his motivation was to puff up the fire service as America’s Heroes, not really improve EMS. Apparently, the 21st century fire service wants to engage in EMS, but only the lights and siren, gets on TV kind.

    The suggestions about calling the FD to help with home repairs are as silly as my suggestion a couple of years back that instead of EMS, the fire service do building, plumbing, and electrical inspections between fire calls. After all, most fire fighters I know have some sort of side job (or is the FD the side job?) in one of the trades. Only my suggestion was facetious, not serious. If the fire service wants to be an “All Hazards, All Things to the taxpayers” service, then helping a private company bring a citizen home is part of the mix.

    In EMS, we get called by the police and even the fire department when they can’t figure out what to do. We’re the people that they call when they have a problem they can’t figure out. I’ll qualify that by saying a problem with a person who hasn’t committed a crime or isn’t on fire. Most of the time it’s not really an EMS problem, but we respond and do what we can to help. Maybe that means that EMS is the “All Hazards, All Things to all people” service that the fire department poses as.

    We don’t do transfers of any kind, so I’m not familiar with this specific problem. When we have a morbidly obese patient, we call for more EMS personnel. Moving patients is a bit more tricky than moving inanimate objects, so we call for more people who understand that. Oh, and who will listen to directions, which for some reason fire fighters often have a problem with when non fire fighters are involved.

    • http://thehappymedic.com the Happy Medic

      By reading your response here I can only assume you agree with the FD that the EMS company should handle it on their own.
      Had this been a public agency, would you feel differently?

    • Tacmed85

      Very good point, I currently work for a private EMS company running 911 in a very large area(multiple cities). We respond to fires to stand by just in case someone gets injured all the time without billing the FD for it(this is the second private company I’ve worked for and both did this). I spent a few years working as a SWAT medic, when SWAT went out we were sent by the private EMS company I was working for to be there for the police once again with out charge. Both Fire and Police call us all the time, we expect them to be there to help us when we need as well. If a Fire department writes a policy stating that they do not help EMS there is a huge problem going on in that area, we should all be on the same side because you never know when we’re going to need each other. The higher ups who wrote the policy have no business being in public service.

  • http://twitter.com/in_the_city Angelo

    I just want to throw something else out there.

    (Its a billing issue, something I understand all to well so bare with me)

    In order for a private to be able to bill insurance in this state (IL) a Physicians Certification Statement must be completed explaining why this person meets ambulance transport criteria.

    A private would NOT have transported unless they had one.

    So legally this person NEEDED an ambulance.. at least as far as our broken system of health care defines need.

    so.

    Offer me an alternative.
    An alternative to 2 paramedics, one who I would be willing to personally vouch for, and an ALS unit being made to transport this person.

    The PCS specifically asks if a patient can be transported by taxi, so I’m crying shenanigans to that comparison.

    Lets hear it people, who else or how else does this patient get “home” from the hospital.

    If we can’t all get along to get the patient into the house, maybe we can all get along to solve a different problem.

  • http://twitter.com/in_the_city Angelo

    I had another thought. Meditate on this question for a minute.

    If a 700 lb patient falls in in the SFD response area, and can not get up but is uninjured, who will help them?

    Or maybe the question should be:

    A non tax paying visitor to the SFD response area has a heart attack. Since their taxes don’t contribute to the municipality, who responds then?

    Because at least in my eyes, thats the precedent that’s being set.

  • http://firecritic.com Fire Critic

    To everyone who is pointing to tax payers and public service and the FD being their for tax payers….

    Blahhhhhhhhhhhhhhh

    I guarantee you this… If I ever need my EMS and/or FD system for myself or my family and they aren’t their to respond because they are out helping a private company lift some morbidly obese person into their house because they can’t do it themselves (person or company)…

    %^$@#^$%#^%$#^%$#^%$#^%$#

    Just think of the litigation, responsibility, and legal liability potential in this situation.

    We have to draw the line in the sand somewhere.

    • Geekymedic

      As far as this idea goes. It is their call. What if the call was to help lift you or your family member into bed after a surgery? Your argument is one that happens over and over again in the Fire service. “be available for the next call” What about the current call? It seems to me that this person pays taxes too is a citizen and deserves all the compassionate care we can give. Sometimes this includes lifting a person up, cleaning a person up or just flat out being there.

      • http://firecritic.com Fire Critic

        Great point Geekymedic,

        And my answer is that the call for lift assist should have never been made…

        Under your train of thought, I will buy all the construction materials and then call 911 to build my house…the call goes in so they have to do it right?

        Obviously I am exaggerating a little bit, but I think it proves my point on this… frivolous unnecessary calls. I guess that is where EMS education comes in…

        • Geekymedic

          Again, your thought process is falling apart at the seams, and you are trying to rescue it with hyperbole.

          The call should have been made and the FD should have been more than happy to do it. This is a great way to show compassion, GREAT PR (it is a PR nightmare now) and makes the person receiving the service grateful.

    • http://lookingthroughapairofpinkhandledtraumashears.com Medic Trommashere

      But what makes your emergency any more of an emergency than helping another company? If a 2 person crew does the lift/move by themselves, they can get seriously injured. Now you have three patients instead of taking the twenty minutes to do what needs to be done.

      In this situation, we can’t think about the call that hasn’t happened yet, but the call that is happening.

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  • http://everydayemstips.com Greg Friese

    When someone tells me, “that’s not my job.” I have two replies 1) Then what is your job and 2) What else don’t you do? Rhetorical traps that almost inevitably lead to the refuser doing the job anyway or really wishing they had just done it in the first place.

    I had enough to say about this that I wrote a post http://www.everydayemstips.com/?p=3736

    Thanks Chris for sparking and encouraging this discussion.

    • Ckemtp

      Thank you, Sir, for keeping it going. I’ve been pretty quiet on the comments but I’ve been earnestly reading every one. (Comments come to my blackberry)

      This is obviously an issue that must be faced and I am very happy to see everyone discussing it. This situation will be more common in the near future, and won’t go away simply because it’s inconvenient.

      Keep it up guys, this kind of discourse… This positive, thoughtful discussion, is exactly why I started blogging. Y’all have made my day.

      Thank you

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  • Anonymous

    http://rescuingprovidence.com/2006/11/03/dignity/

    Here’s a little blast from the past. Send the FD, lift the lady and let the ambulance company bill the patients insurance. It’s not like it happens every day, why do we make such a big deal out of little (well, maybe not so little) things. I haven’t read all the commentary here, that’s a lot of comments!

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  • chiefreason

    “Oh, look at the nice firefighters getting that camel out of the sinkhole”.
    “What this; another fire department got that horse unstuck from the mud?”
    “And you’re telling me it took how many hours to get that little dog out of the storm drain?”
    Firefighters gave HOW MUCH MONEY to Jerry Lewis’ kids this year?
    Hey; who’s going to win the Firefighter Combat challenge this year?
    Don’t forget; the world’s strongest firefighter competition this year either.
    This is the year of health and wellness in the fire service.
    Oh and according to our medical community; obesity is at epidemic proportions.
    You realize that they make LIFTING equipment for heavy lifting?
    Know what a pre-plan is?
    If you know your areas, then you know where the big ones reside, possibly?
    I understand that cutbacks might leave some departments short, but there is mutual aid, even MABAS.
    Ambo screwed up, but so did SFD.
    When you look at all the good PR a department gets for getting animals safely delivered, then why can’t we show our fellow human beings at least the same considerations as the animals…or Jerry’s kids for that matter?
    I’m done here.

    • http://twitter.com/hybridmedic Russell Stine

      MFD made a call here because they were called by a private service for help removing a patient from a house that was well over 1/2 ton. It turned into a rescue because we had to remove part of a wall to get them out. It was interesting to see Memphis Fire ambulances, engines, trucks, and heavy rescues parked next to private rigs. Everyone at work, everyone with a job to do. No concern was paid to who is getting paid, the only concern was doing a rescue of a person in distress.

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  • http://510medic.com 510medic

    It seems to me like there is a happy medium in here somewhere. The fact remains that this woman needs to wind up at home. Since she is likely bed confined, she meets the Medicare requirements for ambulance transport. If the fire-based ambulance is unwilling to drive 5 hours to pick her up (as is their right as they are not contractually obligated to do so) someone has to do it.

    I will certainly grant HM that the ambulance service was foolish to take a job they knew they could not complete but think the FD is equally as foolish for turning down a “public assist” call. People call 911 for all kinds of ridiculous things. Most of those things get a response from fire, PD or ambulance. I fail to see the difference between this woman needing a “lift assist” to get into her house and her needing a “lift assist” after sliding out of her recliner. The only one in my mind is that she would have activated 911 on her own for the second call.

    I don’t necessarily buy the argument that the ambulance company took this call for the right reason. Not knowing the billing scheme for that particular system, I think that it is likely that the provider is reimbursed a base rate and then paid for mileage. A five hour transport is a good money maker, particularly for a small, upstart service. Like any call, it is incumbent on the provider to ensure that they can complete the call they accepted. They didn’t send enough resources to the call, same as if a BLS crew responded for an interfacility transfer for a patient on a vent and a balloon pump.

    At the end of the day, both parties are at fault. The BLS provider assumed that help would be available and the fire department just isn’t playing nicely in the sandbox. As much of a cliche as it is, we’re all on the same team. I have routinely picked up 911 patients in one town and transported to a receiving facility in another and requested a FD life assist, I have not yet been turned down.

    As far as the fire department charging for the response, I can see both sides. I think that fee for service fire response is a dangerous road to go down but there is certainly precedent. Many search and rescue programs (particularly ski patrols) will charge for those of us foolish enough to go out of our way to get lost. Businesses with frequent burglar alarm activations are charged after a certain number of responses.

    It’s a tough argument either way you look at it, but ultimately it is incumbent on us to do what is right for the patient.

  • http://twitter.com/JonEMTP Jon B.

    I had a twitter discussion with Happy Medic about this last night.

    My take on it is that, given the extenuating circumstances (Long Distance run, etc)… the FD should have just done the lift assist, and they then spend the next weeks sending harshly worded letters back and forth.

    I’ve been on both sides here – my 911 ambualnce was called by a private because they needed a lift assist. We did it… and managment addressed the issue so it didn’t happen routinely.

    The private I currently work for has bariatric capabilities, including the super Stryker strecher, ramps and winch kit. That whole kit gets deployed with at LEAST 4-6 people. And more will be needed, depending on how we have to move the patient. I can’t fathom a private company accepting a transport like this in my area without sending 2+ units. It almost sounds like the transport company was trying to suck up to the hosptial and take a run as a “favor” so they get more work.

    I will say that I don’t think this should be a routine expectation of the local FD. However, in extenuating circumstances, I don’t see why a taxpayer can’t get some help from the FD in a time of need.

  • Topv7051

    It would seem that there are other ambulance providers in Illinois. Would not one of the others have done the job without expecting FD assistance? Take “patient” and “EMS” out of this and look at it as a service provided on condition of payment.

    A private company accepted work they could not do, that others were fully capable of, with the expectation that their manpower deficiencies would be remedied by free labor from a municipal agency. Do that on any other contract for service and see how long you stay in business.

  • http://www.firedaily.com Fire Daily

    What drew my ire on this story (and I posted on it today without knowing about the hornets nest in here) was the air of entitlement bellowed out by the owner of a private company to demand the taxpayers bail his ass out for not being able to complete the job he got paid for. By the taxpayers.

    God bless America.

  • chiefreason

    John:
    Sometimes I think that residents should have “personal” accounts for tax paid benefits.
    It seems all too often that 20 percent of the residents use 85 percent of the services.
    Maybe we give them a “piggy bank” and once it’s gone, they pay more?
    In this case, taxpayers were paying for the transfer (Medicare/Medicaid) and additional service was needed. Maybe an additional fee was appropriate.
    It is a sticky wicket for sure.
    But, I will say that an entity who is not part of the community has no right to the tax-supported benefits of that community without paying for them. If that same ambulance service were involved in an MVA, they would get the service, but they would also get a bill.
    I pay taxes in my fire district for ambulance service. Does this give me a free ambulance ride? No; I paid $650 for a ride.
    My point is that just because there is tax money involved doesn’t mean that the service is paid in full with no limit on the number of uses.
    There has to be guidelines.

    • BoxerRob

      …no right to tax supported benefits…man, we gotta get your kind outta here. too insular and parochial for me. Again, fire service needs close management by civil authority. We can’t trust y’all to decide what you will and won’t do while your at work, you know getting paid and all. but we know how some whiners operate, give them a task they don’t like and poof, injured. coming close to a private ambulance is especially painful

  • Steve Whitehead

    Let’s stop talking about SFD as if they, in this single action, represent the spirit of the American fire service. They don’t. Did they have a right to do what they did? Yes. Was it the right thing to do? No.

    This is one big EMS service fail.

    When people get stuck in a bad situation that they can’t get themselves out of, they call the fire department. When private EMS services get themselves stuck in a bad situation, they call the fire department. And we come. And we fix it. Every time. All across America, right now, firefighters are helping people out of bad situations.

    Shame on the ambulance service for getting the patient into a bad situation. Shame on the fire crew for not helping them out of it.

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  • http://twitter.com/RVaMedic Elle Künstlerin

    Sadly, SFD isn’t the only fire department to refuse to help with lift assists. The fire department in a city where I once worked refuses to help the *public* EMS agency, so private services have less than zero chance for help. What does the EMS agency do if they need a lift assist? They send extra ambulances, which means there are fewer ambulances to respond to 911 calls. I was in shock the first time I was told that the FD doesn’t help with lift assists since every other FD I’ve worked with, volunteer or paid, is happy to help. Why take three ambulances out of service when the responding ambulance and *one* fire engine will suffice in most cases? Stupid. I’d never run EMS in a system where the FD and EMS didn’t work together as a team and not as separate entities. This department, like SFD, also hides behind the “traditional” role of the fire service. It’s really a disservice to the citizens because they will not get the emergency care in a prompt manner because multiple ambulances are moving an obese patient.

    • Rhunic_Carver

      There is a large difference between a FD refusing to help EMS 911, and a private prescheduled transfer to a residence. I hope that were you worked your FD has a change of heart towards their EMS providers on 911 calls, because that is a very bad problem.

  • Anonymous

    Couple things. 1) The SFD was following a policy that had been in place for over a year prior to this incident and was created because of injuries to their personnel. Everyone is complaining about taxpayer money, what happens when a couple firefighters are injured moving this patient and then go out on disability? The taxpayer is being hit twice in that scenario. 2) My department has had several of these pt’s in town over the years. The last one that we dealt with on a regular basis resulted in the department dispatching a full-still assignment when she called. 2 Engines, a Truck and an Ambulance. Most times our Squad company would also be special called. Now, the difference is that this happened when she called 911 because she couldn’t breathe or had another ailment. Never once when she was coming back home from a stay in the hospital.

    Risk is risk. But there is calculated and non-claculated as well. When someone calls 911 and you are thrust into a situation that is non-calculated and you adjust on the fly or go off past experience, SOG’s etc. When you face a situation enough times you develop a plan for handling it, calculated. The plan in this case was to not expose personnel to undue risk of injury in the event a private, for profit, entity called for non-emergent assistance. They wrote a rule and reg or SOG and it was followed. Period.

    Had the situation been reversed and the pt were at home and decided to call a private for transport because, say she wanted to go to a hospital that is outside the FD or local EMS agency’s area, and the private called for help once they got there, different story. In that situation the pt is seeking medical treatment for an emergency, severe or not, and wishes to go to the hospital for treatment. Then, SFD would have been obligated to help. My department does that exact kind of thing regularly. To get someone back home, however? I’m with the FD on this one. Someone at Mercy should have looked at the big picture and done some planning before this transport. A phone call to the FD ahead of time by someone at the private and no one would know about this.

  • Rhunic_Carver

    Was the private ambulance involved behind the eight ball by not calling ahead to the local FD or a local private ambulance company to ensure that they would recive lifting assistance upon arrival to the patient’s residence? Yes for sure, but I have never personally worked for or known of a private ambulance company that is actually PROACTIVE in their approuch to diffacult transfers. Not that it makes it the company in question any less at fault, but I am not surpised about the fact that they were waiting till they arrived at the patient’s residence to call for assistance at all.

    I do not think the fire dept was wrong to deny them the lift assist. They obviously had a policy put in place outlining that specific situation for a reason. My guess would be that they were routinely being called for lifting assistance from local private ambulance companies and that on more than 1 occasion someone on the engine/truck got hurt and was out on worker’s comp . It is NOT the local FD’s direct responsability to help a private ambulance company carry an obese patient back INTO their home. It is the private ambulance company’s responsablity to ensure that their crew will have an abundence of lifting assistance at the patient’s residence prior to that crew even arriving at the facility in question to pick up the patient. I feel bad for the unfortunate patient who had to wait outside his/her home for additional help to arrive, but I am glad that the fire dept stood by their policy.

    The problem here is not that the fire dept did not help a private ambulance with a prescheduled transfer home upon their arrival at a patient’s residence.

    The problem is that private ambulance companies in general are reactive, not proactive. The lesson learned here should be that they must be proactive in their thinking about what exactly they are going to need to complete each and every transfer prior to the arrival of a crew when they have the ability to do so. I think that everyone who is bashing the fire dept is completely missing the big picture of the situation. You don’t leave your station in the morning without doing a rig check to make sure that everything you need to fuction is in operational condition. You don’t wait until after you see blood/emesis/other nasty to put your gloves on. You are proactive, you think about what you are going to need for your dispatched call prior to even seeing the patient. You put your gloves on before you touch your patient. Private EMS needs to see this for what it is, a wake up call. STOP BEING REACTIVE. START BEING PROACTIVE.

    Bottom line is that if it took 5hrs to get their patient home, there is no excuse to not have comfirmed help before the company even accepted the transfer.

    I can go on for days, and I don’t care about billing because you can bet your life they had all the billing figured out before they accepted that transfer.

    I just hope that instead of just writing off that FD as a bunch of ass-holes and then going back to business as usual, Private ambulance companies can actually find the moral of the story.
    Reactive=bad, Proactive=good.

  • Luke_31

    Being a medic at a private IFT company and having experience with working for a 911 company also I can easily see both sides. SFD’s policy is well within their rights to have. The private service should have not relied on the FD do provide the extra manpower. However the fact is that taking three rigs out on one call for however many hours the call actually took. Not just getting the patient from the hospital to home, but also how long did it take for the crew to get back. In my experience typically when you get a call that takes four or five hours to get to the destination, it becomes an all day task. Should the private service taken the call…. probably not. More then likely what happened was the crew arrived onscene and requested additional crews for help and were told that they would need to call the FD when they got the patient home.

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  • http://burnedoutmedic.com burnedoutmedic

    i remember some years ago there was fire department ambulance that responded to a 911 call on the freeway. a pt had just received a call from an organ transplant team that an organ was in and that she had to get to the hospital about 45 minutes away. so this pt got on the road with his spouse and, of course, drove right into a giant traffic jam. not sure what to do, they called 911.

    the fire department ambulance from one city refused to transport them to the transplant hospital 45 minutes away because they didn’t want to leave their own city with one less unit. so they called the private ambulance agency that runs 911 in the next city over for mutual aid so they can transport them instead.

    isn’t that trippy?

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Chris Kaiser aka "Ckemtp"

I am a paramedic trying to advance the idea that the Emergency Medical Services can be made into the profession that we all want it, need it, and know it deserves to be.

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