My most likely last day on the transport unit was… a blast. My partner was a friend and we made the best of it. The entire day had the feeling we described as the last day of school. Even if the teacher told you to clean the entire place top to bottom, you would, because it was the last day.
But at the same time, there was a slight fear as to what would happen tomorrow. Much like a high school graduate still waiting to hear if he’s been accepted to the fall semester at University.

The day started with a code 3 critical cardiac, allergic to nitro, who had a massive anteriolateral MI probably 3 days ago. We meandered through cardiac cases, a motorcycle accident with unique presentation (she had no right ulna so the arm looked horribly broken, but was fine) and even a decent mechanism fall down the stairs of an elderly woman in the middle of the night. We were awoken just after 4 AM for a difficulty breathing call and, wouldn’t you know it, another massive MI. Every patient we encountered needed ALS intervention from the time the first person walked in the door. Nothing that would fit with the theme of my blog. That is, until the last call.

As if she knew the day was going splendidly a young mother vomited and wasn’t sure what to do, so she called 911. Our perfect last day ended with convincing a young woman that throwing up is perfectly natural and doesn’t always need an ambulance. Almost on cue her 1 month old spit up and I said, “See, happens all the time. Call your doctor and double check your diet.”

We limped back to quarters skirting the 8 o’clock shift change by moments.

If only everyday could be like yesterday.

But things are changing here. As I promised a few readers, a quick general history of my system’s troubles over the past 100 years.

The first fire companies were established soon after the City was founded and organized into a municipal force in the 19th century. The first Doctor to climb in a wagon with an attendant happened 20 years after that. The systems were uniquely separate with fire doing their thing and the ambulance corps doing theirs until the 1970s. The fire department began sending EMT equipped engines on medical responses, at first, augmenting the extra hands of the rescue squads at major emergencies.

In the late 1990s, the idea was floated to merge the 120 year old fire department and the 100 year old ambulance service into one. The “Merger” took persons who had been trained as Paramedics and put them onto fire engines as probies, some of them with upwards of 20 years of service to the community. Those displaced firefighter/EMTs became ambulance attendants. Ambulances were moved off the streets and into the fire houses, painted a different color and all was well. What could possibly go wrong?

The combination was fraught with complications from non acceptance of “F’ing Medics” in the firehouse, to complaint after complaint from firefighters who claimed they never signed up to drive an ambulance.

As the years went on there was improvement in the working relationships and some medics chose to return to a few scattered 12 hour cars downtown. As the need for more Paramedics became apparent in a plan to get every engine ALS, the Department looked for previously experienced “Lateral” hires who could hit the ground running in both the fire and EMS arenas.

Along comes your pal Happy, in the market for a good job in a struggling system. I see the articles about the difficulties the system is having, I do a ride along and learn about the hardships, but from what the medics are saying, this is the place to be in the next 5 years.

5 years after that we were fighting tooth and nail to get off of our probationary status in time for the Lieutenant’s test. Seems there were folks who thought being a Paramedic gave you an unfair advantage at test taking and sought to postpone eligibility for a small class. Others fought harder than me and they got us through our probationary status (mine after 6 years, normally 8 months) and a number of my colleagues did very well and were promoted. I did not sit for the exam.

When the budget axe came swinging through in the last couple of years, the positions left vacant as Paramedics were promoted to fire officers were never filled. 2 classes of single role Paramedics and EMTs had been hired to take the heavy load off of our stressed 24 hour cars and the firefighters were transferred back to the fire engines, displacing remaining paramedics to dual medic 24 hour units. Nothing is more wasteful in my opinion than paying a Paramedic to drive another Paramedic to the hospital. It was during this time I clocked my busiest day at 24 jobs in 24 hours on an ambulance.

The thought was that more time on an ambulance would “keep our skills up” even though we have seen no real change in care. The slackers still slack and those who want to be there still do their best every day.

But there is a constant push by some organizations to eliminate Paramedics from the fire engines all together, returning to the system in place when they were hired or how they think it “should be.”
Big problem is, I see merit in what they say, but not their logic in arriving at this conclusion. Sending 10 people to the scene of a reported emergency just to get 2 paramedics is overkill, but currently the only way to meet our response mandates. I am in the minority of Firefighter Paramedics interested in taking the Paramedic Supervisor exam and see myself in that role in the next 5-10 years. That will be the end of my suppression career, but hopefully the start of something far more interesting.

Whether I will still have the opportunity to serve in the capacity I hope remains to be seen.

There is no concrete plan as to how the system will evolve, let alone adapt to the budget woes so many other municipalities are suffering through. It is a bad time to be suggesting sweeping changes in the way we deliver our service, even if those ideas are cost saving in the long run.

In response to Medicblog999’s post about the role of the Firefighter/Paramedic, it has to be all or none. You can’t limp into the idea of ALS from a fire engine unless all resources are able to supply the same level of service. Otherwise you have, again, 10 people where 5 would do just fine.

And to make a point 999, It all depends on the base lego man is built on as to whether he will stand tall or fall.

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