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Sep 4, 2009 05:55 PM | 18
Firefighters responded to at least 10 times more medical emergencies than fire-related calls across the U.S. last year, The New York Times reported yesterday.
What's more, the number of medical calls that have sent firefighters flying down the fire pole has more than tripled since 1980.
Often faster to arrive on scene than an ambulance, firefighters are now some of the more frequent medical first responders—a dubious promotion, which has turned them, like some ER care providers, into quasi-regular doctors for those who lack health insurance and regular medical care.
In cities such as Washington, D.C., where some neighborhoods have many uninsured residents, some fire engine companies bill as many as 80 percent of their emergencies as medical. The calls can be for anything from passed-out drunks to assaults to stomach pains, the Times reports.
Like many aspects of the health care debate, there is hesitancy to err on the side of cost effectiveness when life may be on the line. "People call and say, 'I'm having trouble breathing,'" Dennis Jenkerson, the St. Louis, Mo., fire chief, told the Times. "Can they afford to wait five and a half, six minutes for an ambulance? No. Seconds count with most medical emergencies."
Doubts on the front lines, however, can run high. As one D.C. firefighter told the Times: "I joined the force to battle blazes, not to be an emergency room doctor… It just seems like so many people use us as their primary care providers."
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18 Comments
Add CommentI agree with much of this article; as a 15 year Firefighter/Paramedic and an officer in a major metropolitan city, I've not seen it all but close. I could write for days on this subject; though, I'll keep it short: just try taking away these curbside services, when you do it I suggest you step back and take cover. People will get belligerent!
Reply | Report Abuse | Link to thisAs a fire officer, I can tell you that nobody is more frustrated with this state of events than firefighters. Most of the firefighters I know got into the career to fight fires, not transport dialysis patients week after week to the care center or e.r. of their choice.
Reply | Report Abuse | Link to thisIn most cities, and engine company is sent with the ambulance crew most medical calls. In addition to being EMT's, they provide lifting assistance and scene safety.
All that said, the firefighters are not increasing the cost. They are being poorly utilized to make up for the fact that reasonable and prudent health care services are not otherwise available. Emergency services followed by E.R. provided care are the most expensive was to see and treat patients -- but they're the only ways left for patients who can't buy insurance.
Lucky I live in Australia. 1.5% of my earning gives us in Auz a good ambulance service and free medical care.
Reply | Report Abuse | Link to thisMedicare taxes on cigarettes, alcohol, fatty foods, sugary colas, chocolates and similar unhealthy foods and addictions can enhance funds available to provide medical services plus reduce their consumption.
Those choosing to opt out of the system should be given the opportunity, but never allowed to get any benefits, even when not doing so will cause them to die or be incapacitated for the rest of their life.
A few decades ago, when fire call numbers were declining; fire chiefs started to provide engine responses to first aid calls. This was done I remember to prevent communities from cutting firefighters or reducing budgets. As firefighters were responding to fewer fire calls, the first aid responses would build up the numbers of calls each department responded to each year.
Reply | Report Abuse | Link to thisIn rural France Sapeurs Pompiers provide both services, using appropriate vehicles. In the UK calling the emergency number directs the caller to the correct service (police, fire or ambulance). It's probably too much to expect the US to look at what other countries do!
Reply | Report Abuse | Link to thisThat we are even asking this question is proof about how broken our medical system is.
Reply | Report Abuse | Link to thisI personally know three FAMILIES whose finances have been ruined by medical costs, who doesn't?
It's more like a resouse waste.Obviously,firefighter should be there ready for the fire-relate calls or there will be not enough firefighter available for the fire emergency.What's more the medical aid should be provided by more professional persons not the quasi-regular ones.
Reply | Report Abuse | Link to thisAs an ER nurse I can sympathsize with firefighters. I became a ER nurse to take care of patients with true emergencies, not to provide care to those with colds, toothaches, flu symptoms, etc. The ER has become primary care for those with no insurance or those who are too disorganized to make an appointment with their doctor. With fire related emergencies reduced from years ago maybe medical responses provide job security but I'm sure it's frustrating for firefighters. One paramedic told me the patient she transported asked them to stop at Starbucks on the way to the hospital. Some emergency....
Reply | Report Abuse | Link to thisFire Dept.s raisng healthcare costs? HOW? I'd say it was just the opposite. We only charge for medical service calls when we actually transport a patient. And the taxpayers pay the same for our service 24/7/365 whether we are at the station, or on a fire / medical call. I guess we could do away with the ambulances altogether. That would save tax payers money. And thus healthcare costs. It would also greatly increase the mortality rate..... I can see it now. 911.... Please help, there is a bad wreck and my mom's bleeding really bad.... Ok, just stay calm, your only 5 miles from a hospital. Can your mom walk that far? Or should I call you a taxi... Get real! We need to be available, if we are utillized or not. That is the nature of emergency services. Be it the F.D., or the E.R. And yes they cost money. You only get what you are willing to pay for, no matter who's plan you use.
Reply | Report Abuse | Link to this@Forlornehope - don't be so snide. Calling 911 pretty much on any phone in the US will connect you to emergency services -- we're working on systems that will even auto-route VoIP calls. Cell calls are tracked by the tower in most places as well. That number is for use with any health/safety issue including fire, medical, police, hazmat, etc. In most (sadly not yet all) cases, the operating has your exact location by the time the call is answered (in fact, calling and hanging up, or calling and saying nothing will likely get you a pretty full fire, police, and ems response).
Reply | Report Abuse | Link to thisAs to the ECONOMICS of firefighter employment, it's tricky. The job isn't like any other. To handle a single family home on fire, you need as many as 20 or even 30 people, you need multiple engine companies, a ladder company, RIT, rehab, medical, water supply, traffic control, incident command, and so on . That's a lot of people on short notice -- now figure a city of a couple hundred thousand people would need maybe three or four times that many on staff at a given time around the city.
The thing is, you only need all those guys on rare occasions. MOST of the time you don't. How do you justify paying 90 salaries (30 people x 3 shifts) when 95% of the time there's no fire? Well, one way is to find ways to make use of those guys doing things that are related. The career firefighters in the city near where I live, are now pretty much all required to have their "intermediate EMT" license. That's one license down from "Paramedic" and requires a good deal of work to archive and maintain. Most of them that I know don't like doing that kind of work, but it's part of the job. Taxes go up, people look around and say "Hey, we're paying 90 people to sit around (not actually the case) and WAIT for a fire?" So, EMS calls it is.
So NO, firefighters are SAVING the costs a little bit -- because you have to have them standing by anyway, you may as well use them for EMS calls. The costs are high because EMERGENCY response is always much more expensive (and dangerous) than is routine care.
Sending an engine company to an EMS call is also useful for lifting assistance and scene safety. You never know what you're going to run into. That ankle injury may have been caused by a domestic fight just as easily as a slip. Did the person fall down the stairs or get pushed? The part that doesn't make sense.
Less sensible is putting wear and tear on a $300,000 fire engine (or $750,000 ladder truck) that needs to last 20 years.
I began my career as a firefighter at the age of 18. I was damn good at it too and, not to toot my own horn, was awarded twice in 18 months for my actions (one award for actions during a flood, oddly enough). It's been 14 years since I left and a week has not gone by that I don't think about it and miss it. I left for these same reasons. I was a damned good fire fighter but I absolutely loathed being a medic.
Reply | Report Abuse | Link to thisMedical calls increasing threefold since 1980 is not surprising, considering most fire departments didn't even offer medical service in 1980. This article is very deceiving in several ways. Ambulance cost < Urgent care < ER visit. Plain and simple. As cities look for excuses to cut budgets in these tough economic times, they are reaching for BS concepts like this one to justify compromising public safety. Please, SciAm, don't encourage them.
Reply | Report Abuse | Link to thisAndrewJayPollack, sorry you think I'm being snide. The Germans deal with your economic dilemma with "Freiwilligerfeuerwher" most medium size towns have these. The French Sapeurs Pompiers are volunteers. The British have "retained fire-fighters" which is much the same. You seem to have all the telephone technology (at last) but still turn up with the wrong people and the wrong kit. Perhaps its time to question some of your assumptions, for example whether you need totally full time staff on stand by; volunteers can muster quickly enough to provide the necessary service with a small number of full timers.
Reply | Report Abuse | Link to thisAndrewJPollack describes the situation as it is, but does not include that most people joining the fire service know they will be doing mostly medical calls. In fact, most departments require EMT basic as a minimum job requirement and some require progression to paramedic within a short time. Washington DC inspired the NYT story because it is only now making the transition to full spectrum emergency response. Ten years ago and twenty years ago the District was rated lowest quality emergency medical provision of any large city in the US (EMS Magazine). Changing that, as the former Atlanta Chief (Rubin) is finding out, involves stepping on a few dinosaur toes with an attitude that the fire service is run according to what they would "like" to do, not what is needed..
Reply | Report Abuse | Link to thisWith regard to the Fench and German fire services, their fire codes are a good deal more strict, construction standards higher, and fires are not completely insured. They are definitely not viewed as a misfortunate act of God, but rather as preventable and blame-worthy.
If the economics are the decision drivers for fire service then it should be viewed as part of the insurance cost, and perhaps run as a regulated utility paid for by insurance. With the exception of the utility model, the early fire service in the US *was* paid for by insurance companies - and they set premiums and fire department rates based on risk.
A final note: the expensive vehicles last the same amount of time for which they were designed when used as when left to gatehr cobwebs. They are a "sunk cost", meaning the money is already spent. Running them more frequently might marginally increase operating and maintenance costs, but that pales in comparison to paying their high front-end costs and then *not* using them. That's navy submarine thinking - we'll spend billions on a sub but then "hope we never have to use it". If we spent half a million of a fire truck, we ought to be using it as much as possible for any beneficial purpose we can.
It is obvious that we will have to provide comprehensive health care to the poor, who cannot afford it in the current system. Does Congress understand that? We have to provide ten times more expensive service to the uninsured, we lose productivity in our economy, and we are wasting money in our current system, money which could be used for other things. Does Congress understand that?
Reply | Report Abuse | Link to thisFirst, the headline is terrible. Why not something along the line of, "Overuse of Emergency Services a Hidden Factor in Rising Cost of Health Care." Not really sure how the is Scientific American's area. I'm really confused why the fire department gets thrown under the bus and then qualifications of firefighters as first responders is questioned.
Reply | Report Abuse | Link to thisNext time your pinned in your car, I'll make sure to send a paramedic with a sharp pair of scissors.
As for the "Dubious promotion," and being "Quasi-regular Doctors," it has been said: no more so than any EMT. I can only speak for Oklahoma City, but firefighters must keep a current EMT-2 license. Because of tuition reimbursement, and the benefits of widened skill sets, many choose to get their paramedic license.
It is not the fault of the firefighters. The headline is misleading. It is how our "first-responder" policies are implemented. This is why we need sensible healthcare in the USA, instead of price-gouging by insurance companies who take 20% of every dollar paid in overhead/administration, whereas medicare and the healthcare policies in other first-world countries only take 6-8% for administration costs. Why are people allowed to make money on illness? Ibelieve they should be paid to keep people well. (on a side note: Why are people allowed to make money on war and murder, and imprisonment? These should not be growth industries!)
Reply | Report Abuse | Link to thisIt is a very mixed debate when asking whether or not Firemen should respond to medical calls. So many hospitals are understaffed and overworked, in this regard, yes it is better to have firemen arrive on the scene. They are more likely to arrive within the necessary time frame for the person/persons in need. The medical industry is in need of an overhaul right now and until that happens, citizens need assistance.
Reply | Report Abuse | Link to thisThe medical industry is wrought with overspending and suffers from a lack of intercommunication and many professionals believe that. Dr. Eva Mor says, "The administration of the existing health delivery system is bloated with waste and unnecessary cost. If information was shared by all providers of health services and all insurers by using computerized systems to store all medical records, it would cut costs and reduce errors that would save and improve lives.
What we need in a health system is uniformity in pricing for procedures and services and modalities of provision of testing and procedures for diagnosis and treatment. By providing coverage to the uninsured, which initially will cost the taxpayer, it eventually will save us hundreds of millions of dollars." http://www.ourblook.com/component/option,com_sectionex/Itemid,200076/id,8/view,category/#catid107