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The Roanoke Fire-EMS is not perfect, it probably will never be. That is okay with me. I accept that for us perfection is an unobtainable goal. GASP. SIGH. If indeed you know of a perfect Fire/EMS Department please let me know. I will pack my bags at once… I did not think so.

The Department which I call home, is experiencing issues that are not uncommon in the Fire/EMS World. Occasionally my Brothers and Sisters need a reminder of that. We get complacent, we get comfortable thinking that we are the only ones around experiencing problems.

We are not. I assure you of that. I hope we can all agree on that fact. If not, I can give you references, however at this time I will not air out other departments dirty laundry for all to see.

One of the biggest issues effecting the department right now is the need for ALS Providers.

Brief explanation: ALS stands for Advanced Life Support, both Paramedics (EMT-P) and Intermediates (EMT-I) are recognized as being ALS certifications. The Cardiac Tech (EMT-C) is ALS, however it is being phased out and the Cardiacs are having to become Intermediates. The Paramedic and Intermediate certifications are National Registry certifications and are recognized across the Nation. For simplicity, I will refer to ALS provider as a Medic.

Fire Departments across the Nation are having problems procuring enough Medics to run the calls. Interestingly enough the growing trend is for Medics to go to work at Departments who pay more. Sound familiar, kind of like Major League Baseball. Although Municipalities have a definitive Salary Cap, and not too often is there a big differential in pay from one Medic to the other.

Just think for a minute what it would be like if Medics were drafted, oh wait, we cannot have contracts in Virginia. Or can we. It seems to me that the IAFF Locals are unable to bargain with Localities. On the other hand, the Localities are able to place “contracts” on its employees individually. Interesting.

Do not get the impression that all of our Medics are jumping ship. They are not. However, if there was a better gig close to home, they probably would migrate to the better deal. Here in Roanoke the options for a Medic are as follows:

Fire/EMS Departments – (Full Time) Roanoke City, Roanoke County, Salem, Vinton, Franklin County, Botetourt County – All of these Medics are trained Firefighters as well.
Fire/EMS Departments – (Part Time) Roanoke City, Salem, Franklin County, Botetourt County
Private Transport Companies – Carilion, United, LifeLine

I apologize if I left anyone out, but this is not a job fair.

If you were to look at the rosters of the various departments/companies above you will see the same names once, twice, even three times. This is not a big shock, since there are not too many Firefighters who do not have second or even third jobs. These Medics work second jobs in an industry they know.
If there are not enough Medics, why not just make all the new Firefighters be Medics?
Well actually the City, County and Salem already do this. Salem only hires a couple a year, therefore it is not too hard for them to get their hands on Medics. The City and County have both made the new recruits sign contracts stating that they will get their EMT-I within three years. Now that many recruits are nearing or already passed the three year period, we will find out if indeed this process has worked or not.

Why aren’t the Firefighters who don’t have to become EMT-I getting it as well?

Simple, it isn’t worth it Medics ride 2-3 days a cycle on the ambulance. FYI, our cycles are only 3 days long. We have a company that has only one Medic for the ambulance. He has to ride it every day. Why would a Firefighter give up riding on the Engine or Ladder truck to ride the ambulance all the time, and only for $1,796 more a year. If indeed you have your EMT-Paramedic you are looking at $3,796 more a year.

Where have all the Medics gone?

Nowhere really. Most of them are still here, they just work in other capacities. Most have been promoted. Of the original Merger Medics, from the Fire – EMS merge in 1995, there are only 3 or 4 who are still Medics. Most of them are Captains now. The Medics who hold rank, and therefore a different job description, might have to ride every once in a while to keep up their rank. These Medic/Officers are not counted as the actual Medics who ride the ambulance though. There have been Medics who have quit though. We just lost 3 recently. Two went to work for Franklin County, and one went to work for Ablemarle County.

Interestingly enough, I have heard rumors of making the Engines ALS. Ha, dreamers. I don’t mean to be rude, but if there aren’t enough Medics for 6 ambulances, where are you going to find enough for 12 Engines. But I think this is all rumor. I might have inadvertently started it myself. At the last round of Cluster meetings (the one at 10- C- Shift) I asked about ALS Engines. The Chief stated that this is not a possibility.

There will be a study done the middle of January. The study will be conducted by System Planning Corporation. The study will look at pay, response, staffing, stations, etc. It will be interesting to see how it ends up.

Maybe the study will site a need for more ambulances.
What is the answer?
We all have a solution. More money? Definitely! If I were a Medic, I would be getting together with all the other Medics and discussing it to come up with a formidable solution that the majority agrees on. Then I would get the group together to deliver the plan to the Chief. I am not talking a mutiny or anything drastic like that. I am talking a decent plan, with a well written explanation of your reasonable ideas.

Just my two cents worth.

Update: Check out this Article from

Here is a preview:

Reluctant Bedfellows

There’s no question that the fire service is good at what it does. We all know about the success of fire prevention and the decreasing need for fire suppression. But among many in EMS – not only those working for third services, privates and volunteers, but even among some in fire-based systems – there remains unease with the notion of assimilation. The medical mission and the fire mission are just too different, many say. In a survey conducted by this magazine last summer, just 5% of respondents thought the U.S. Fire Administration a desirable home for any new federal EMS entity.

Why such discomfort? You can probably cite several factors. Powers – who reported agreement with his separatist stance from most of his correspondents – touched on some:

  • The M is for medical. EMS is essentially a healthcare undertaking, not public safety.
  • EMS can be subsumed in fire-based services. In some cases, it’s been given short shrift.
  • Cross-trained providers can’t be expected to truly master such distinctly different and difficult trades as firefighting and EMS. Each is tough enough to require full-time attention to be good at.

There are other factors as well. There are differences in the types of personalities drawn to firefighting and EMS work. These providers must approach their jobs differently: Firefighters are structured, disciplined and must function as reliable links in a chain. EMSers need to be devil’s advocates, outside-the-box thinkers and largely self-directing. It can be hard to reconcile such profound inherent differences, not only in single cross-trained providers, but even within combined departments.

On a macro-level, there’s the larger issue of EMS identity. Just who and what is EMS? With the fire service’s interest in assuming EMS and established advantages in such areas as funding, manpower and infrastructure, will there ultimately be room left for third services? For privates? For any non-fire models?

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