Archives for funding-staffing
My EMS adventures in Newcastle upon Tyne had come to an end and I had but one full day left in England. Swalwell Station Manager Peter Mudie has arranged for me and Mark to take a bit of a tour of the capabilities of the Tyne and Wear Fire and Rescue Service, so we’re up early and he’s taken us for a road safety class.
Not for me, thank goodness, but for a group of young drivers to impress upon them the importance of not drinking and driving.
Many of us have been to these presentations before. A middle aged expert prepares what to them appears to be a hip multi-media presentation and the attendees seem less than interested. I was the same way at 16, we all were.
Enter the Happy Medic and UKMedic999 and the class is now wondering what just happened.
The presentation was actually one of the best I’ve seen including some racy videos that in the end have a message about driving safely. The kids were really paying attention then. Mark and I had a chance to impress upon the gathered youth the importance of seat belts and driving safely. I think my “accent” kept their attention more than my content.
Even the locals were cold. Mrs HM knit me two hats, so I shared.
Then it was off to the yard behind the station for an extrication drill to show the new drivers what happens when cars collide.
Set up down the hill were two cars and two students were chosen to be the victims.
To say it was “balls cold”, as one student put it, would be an understatement. I’m a 6th generation Californian, 50 is cold for me. This yard was cold. Wind blowing, snow falling and me with no gloves.
The kids watched as their friends shivered in the cold while the fire appliances pulled up and began their task. I mentioned in passing to the instructor that I would have let the kids go back inside and he suddenly had a point to make to the youth suddenly more interested in each other than the hydraulic tools freeing their friends.
“AYE!” He shouted to the huddled, hooded forms, “You’re here wearing your coats and gloves, hats and whatnot, but what if you were heading back from your mate’s place and were wearing only a shirt and crashed?” He was moving around in front of them, almost pacing like a drill sergeant, “Laying in the snow, cold, tired and hurt? You wouldn’t last very long would you?”
He had their attention the rest of the morning.
The extrication was straight forward with the only difference being the use of the smaller ladders to brace the car on it’s side.
After a lunch cooked by the station’s french chef (Yes, the chef is not a firefighter) it was off to Tyne and Wear Fire Headquarters.
What an impressive building and training ground they have!
A grand foyer greets the visitor and many small groups of men are sitting in plain clothes discussing this and that. One of them, the only one wearing a shirt and tie sees my SFFD Firefighter/Paramedic jacket and does a double take.
As I surveyed the enormous complex I would assume candidates are intimidated when they enter to get their employment packets. Peter led Mark and I on a brief tour of the lower level and the man in the tie wandered over and said hello. Just a casual greeting, he seemed like a regular guy in a sea of white embroidered uniforms and street clothes.
Chief Bathgate, Yours Truly, Peter Mudie
The man in the tie wandering the lobby is none other than Iain Bathgate – Chief Fire Officer for Tyne and Wear.
blink. blink.
He offered a hand and I shook it. There I was in my uniform shirt, but buried under a sweatshirt and a jacket. Had I known I was going to meet the Chief I would have at least donned my cap and tie to show respect.
Turns out he was more interested in the back of my jacket than what wasn’t around my neck.
“You do both then?” he asked me.
“Not often at once, but yes, I am proficient in both skills” I replied, wondering if I should go into further explanation. As we spoke the other men were taking interest in the fellow with two titles on his jacket their Chief was talking to. He immediately suggested a tour of the training grounds, something his face glowed about, he was proud of it.
Through the main lobby and out another set of large glass doors was their training facility, easily 5 acres and including a wide variety of props.
There was a standard training tower that, since once at the top one could peer over to the automobile manufacturer test track next door, was rotated and modified to keep wandering eyes away.
Next to that was a high voltage power line tower prop for high angle rope drills. Under construction nearby was a large two story collapse house that can be dropped and rebuilt quickly to simulate rescues.
A number of burn buildings stood ready for recruits and in service crews alike, one of which was in service when we visited.
But the piece of equipment that caught my eye as special was their train rig. Over behind the airplane prop and the piles of wood was a full size train car half in a man made tunnel. 
I wish we had one.
Half way through my tour, Mr Bathgate dismissed himself and went back to running what appeared to be a well funded and well respected organization.
Mark, Peter and I finished the tour and the Department had a photographer come down and snap a few pictures of us in front of some of the appliances. then a few minutes later she rushed out with a stack of nice photos for me and Mark to remember our visit.
The only comments Mr Bathgate made regarding the wording on my jacket was, “Oh, we’ll not be doing that here” which is something I’m not unused to hearing from the Big Red Machine.
Same System, Different Country.
I’ve got a few more posts worth of observations and anecdotes that I’ll be saving until after the Chronicles of EMS premiere on February 12th.
It all comes down to this meeting doesn’t it. The entire project, everything I hoped to learn comes down to sitting with Mark’s supervisors and policy makers in the UK and making a solid impression that American EMS is not awash in profit driven patient care.
But then again, we kind of are.
I started the meeting starving hungry from my hours in the dispatch center downstairs and was told this would be a kind of working lunch meeting.
Sandwiches and various appetizer type dishes were brought in and my personal favorite, fresh coffee. The conference room at the NEAS appeared to have been recently remodeled or redecorated as there were literally dozens of legal sized computer generated signs reminding those reading not to place cups directly on the table.
So what do I do?
Yes, and luckily I had Peter right behind me to place a saucer beneath the cup and shoot me a “Hey stupid” look. It was in this framework that the rest of the administrative team made their way in and began a presentation on the stats of the NEAS. Population, call volume, etc.
It was made clear to me ahead of time that Fiona, the Chief Executive’s aide, had prepared the presentation and Simon Featherstone gave credit where credit is due.
Mr Featherstone, the aforementioned Chief Executive of the NEAS, seemed like any other person I had met on my travels so far and that made it very easy to listen to him discuss his system.
A few slides in he turned to the dozen or so folks in the room and suggested we do more interacting. This was, after all, common knowledge to all but one person in the room, me, and they wanted to hear from me, not their Chief Executive.
I went into a brief overview of my system in the SFFD and also explained other systems around the country. Much time was spent, and not surprisingly, with their fascination with the idea of for profit ambulance services.
Each member present asked a number of questions about billing and a person’s ability to pay and I had to remind them many a time that that doesn’t come into play until well after the call, but does drive policy decisions in the end, therefore changing our field care decisions.
Each time I snuck a bite to eat another question would have me or Mark discussing his observations of the system as well as his tales of life in a San Francisco Firehouse.
When it came to Mr Featherstone asking what differences we have observed patient care wise, I brought up CPAP and cardioversion and that those are widely used skills in the US. Pacing and cardioversion along with adenosine surely more common than CPAP, but it is such a wonderful tool more services should invest in it.
In true executive fashion Mr Featherstone turned to his clinical care person and said, “How soon can we look into doing these things?”
Bang.
Right then and there, slightly leaned back in his chair, the Chief Executive might be moving forward on something that can directly benefit the patients Mark encounters as well as giving him tools to help more people.
The meeting ended with handshakes and wishes of luck, but very little was said regarding the lack of Ted Setla and the Chronicles of EMS team in the room to record all of this fantastic learning and sharing of best practices.
But I understand that. England is a far less litigious society than the US, but they still have to concern themselves with the appearance of the service and those who function in it.
Everyone reading this post knows Mark and his blog are a source of incredible knowledge and a commitment to improving himself through new pathways. If Mark wrote a book about EMS I would buy it. If he had a radio show I would listen to it, but until those things happen (If he had a TV show I’d watch it) I will follow the media he uses to become a better Paramedic. Right now that is his blog http://999medic.com, twitter @ukmedic999 and on facebook. All media that is growing not only in popularity but usability and relevance to what we’re trying to do in the pre-hospital care fields.
I don’t expect every service in the world to be open to bloggers sharing patient care and contact stories, regardless of permissions, and the few that value the following some EMS bloggers have are doing so very carefully.
One of the things Mark and I hope to work on in the years to come is acceptance of new media and new ways to share information that still respects a patient’s privacy while allowing those doing the care to share insight and best practices in real time.
A unique airway solution is discovered in Australia, blogged about, read by an ECSW in England who passes it along to their Paramedic who posts a link to twitter where I read it. Suddenly a technique that 5 years ago would wait months to get considered for a trade journal has been seen by thousands of caregivers who are about to share it with their friends and co-workers, and all in minutes, not months.
After a morning of listening to the Pathways system work in the dispatch center, then seeing the openness of the Executives to concepts and treatments, I think Mark is in a good place with the North East Ambulance Service.
In Conclusion-
The NEAS provides a high quality service in a straightforward manner to a well informed population. Powers rest with the Paramedic at the scene to determine transport, not the patient ahead of time like in my system. Front loading and getting eyes on a patient is a reliable way to handle system resources and gauge response.
The service is not reliant on insurance companies reimbursing for the services rendered nor are their paramedics passing perfectly capable ERs to reach a certain carrier’s preferred spot.
Mark Glencorse was a gracious host and everyone I met from A&E tech to Chief Executive was welcoming and asked great questions about American systems and I did my best to represent all of us in a professional and knowledgeable fashion.
The food was great, the coffee we can work on in future visits.
Will the NEAS model work in San Francisco? I won’t know until tomorrow when I get a tour of the Tyne and Wear Fire and Rescue Service by Station Manager Peter Mudie. Fire readers, this is the post you’ve been waiting for. But like most of what we do, EMS comes first and accounts for 80-90% of what we do. Why should my UK story be any different?
RTB means Return to Base. A cuppa is slang for a cup of tea. Allocating is something I very much wanted to see first hand.
On this morning in Newcastle, my second to last, Mark has arranged for me to meet with the executive staff of the NEAS at their headquarters.
Before meeting with them, however, I’m downstairs in the bullpens. I’ve got 2 hours to sit in the dispatch center and do a “Sit-along.”
When you tell a guy who loves talking theory on systems allocation he gets to see the system work from the nerve center, he gets a touch giddy.
My first chair was at a call taker’s desk and I got plugged in.
BANG, less than 10 seconds, not even a chance to introduce myself to the call taker I’m with the first tone is in my right ear.
Before she can answer the call a timer has popped up on her screen 8:00, 7:59… the clock is running.
“Ambulance Service” she answers and begins reading from the screen the pre-ordained triage system called Pathways. As I’ve mentioned before, this dispatch system makes no attempt to diagnose the problem, but the physician designed questions can dial up or down the response in real time as the call taker asks the questions.
While she is asking and answering, a small red circle has appeared on the screen, then, a bit away, a purple one. Later I would learn that one is the location of the caller and the other the closest vehicle assigned to the call. When that vehicle arrives on scene, the timer now passing 6:15 will stop. This is their target and they take it very seriously. As I’m listening to the call, it is a very straight forward sick call and the caller is honest about it. It is then I see the benefits of the flexible front loaded system. The rapid response car, the closest resource to the caller, has been stood down since there is not an emergency at the caller’s location.
The vehicle, or cot transport capable ambulance, is continuing, however, and the target is no longer 8 minutes, but now 16 from the time the call was answered.
As more questions are answered and the system confirms the lack of life threats, a simple screen gives instructions for the caller until the crew arrives. The call taker then scrolls around her GPS monitor and finds the vehicle, then advises the caller about how far out they are. The caller thanked her and the call was terminated. Less than 3 minutes passed from the answering of the call to the triaging and confirmation of appropriate response.
At no time did a supervisor step in to augment the call taker’s classification, nor did the system err on the side of caution by upgrading the response, putting rescuers’ lives at risk, “Just in case.”
In the hour we were together I learned more about the desk I was at and the number of calls she answers in an average shift. We took mostly non-emergent calls, details of which would obviously violate privacy, but I can share with you the CALLERS.
When I explained how folks abuse our service by calling from a cell phone miles away about a person they think might have been either unconscious or sleeping, she smiled. Then, I went on, our criteria based dispatch system considers the caller’s inability to confirm consciousness to be unconscious and their inability to confirm breathing to be apnea, and 7 people are now responding code 3 for nothing.
It was just when the call taker was explaining some of the loop holes used that a care facility called to request an ambulance.
They were not with the patient so unable to observe their mental status, efficiency of breathing or if there was any bleeding. The system took this information and kept the RRC responding. Each time the call taker asked a question, the caller was already answering, knowing exactly which question comes next.
She later explained that folks have learned that if they take a cordless phone around the corner and call an ambulance, the crew arrives faster than if they honestly answer the triage questions.
“Same callers, different country.”
It was later in the morning across the room with the allocators that I saw the strength and weakness of the NEAS.
Mark and I spoke at great length about being honest but respectful when offering our observations and suggestions to improve each other’s systems. Mark was an example of this when he met with SFFD Chief of EMS Pete Howes for a kind of exit interview before leaving. I hope I can meet that example with the following paragraphs, but each time I write it it comes off preachy, so here goes.
Sitting between the allocators I watched them constantly on the radio with numerous vehicles and cars in various states of service. Each color on their screens meant something different, from enroute, on scene, RRC, vehicle, on post etc, but it was the clipboard they were passing back and forth that caused them the most frustration and, more than once, delayed allocation.
Not by a definitive amount, we’re talking 3-5 seconds, but it was the constant flipping of pages and radio traffic related to the one thing that I think the NEAS needs to change for the betterment of the system.
No more breaks.
I can hear the UK medics now “Hell no.”
Let me elaborate for my work straight through the shift American friends.
The NEAS, as a portion of their labor agreement, provides their crews with certain breaks depending on their daily activities. When they have been on post for an hour away from station, they get rotated back to the station. This was commonly referred to on the radio as “Return for a cuppa.” The basic premise is simple enough, really. People need clean bathrooms and a chance to eat since eating is not allowed in the cars or vehicles, nor are they allowed to sit down and eat in an establishment while on duty. This was evident when Mark was nervous enjoying some Pho in San Francisco.
In the car and vehicle this didn’t seem to be a big deal, we’d get a message to return to base, or that we were clear for meal break. The meal break can be interrupted, should the allocators need the resources, but they avoid it since the crew interrupted gets paid quite a bit for it and the allocators, although they wouldn’t elaborate, appear to be held accountable.
Sitting between the two allocators on the desk that morning, 50%-75% of their time was arranging rotation station breaks or ensuring crews got their meal breaks. These variables also added more color codes to the dispatch screen. This car is on dinner, this vehicle is on base rotation…etc, etc.
When a call came in they shot a quick look to the clipboard showing who gets a break when and dispatch decisions are based off of that. I did not witness it make a difference in response times, since that information is streaming in real time on giant monitors overhead, but these folks are scrambling to keep everything running smoothly.
With my limited dispatch experience it seemed like a simple change, since on the days I was on rotation in Newcastle we never had a point in the day where we were unable to reach a bathroom or food.
My head was trying to process all the information these women were basing their allocations on and one of them turned to ask me, inbetween moving a car back to base “for a cuppa,” “How do your dispatchers handle your breaks?”
When I explained we (listen to me, like I’m still in a rig), THEY are gone for 10 hours, no breaks, they froze.
It was passing the clipboard back and forth that I saw the only 2 seconds they both held still: glaring at me. It was clear I was not to repeat that statement for the rest of my time with them.
“That would make, ‘Go ahead 405′ this so much ‘thanks and to base if you please’ easier.”
Yeah, 2 conversations at once. I have trouble typing and listening to music or TV at the same time.
Mark had some family business to attend to while I was meeting the voice on the other end of the radio and he returned just before dinner time to collect me. It was an eye and ear opening experience to see the chaos that a simple concept like breaks caused the folks moving units around.
Something I completely neglected to mention over lunch with the executive team.
Told you I couldn’t screw that up. My conversation with the folks hopefully getting Mark cardioversion and CPAP, and where to put your coffee when the table is literally covered in signs that say “DO NOT PUT CUPS ON TABLE, USE SAUCER” soon.
Yeah I did.
It was reported this morning in the Cleveland Paper the Plain Dealer that Cleveland EMS will start rejecting minor calls for service unless the system is able to handle it. Writer Mark Puente reports:
“This is a huge step for Cleveland,” EMS Commissioner Ed Eckart said. “This is a step back from a long-standing culture in this city.”
And indeed a long standing culture in America on whole. I have a call into the Commissioner to get more details on the nuts and bolts of this move as I would love to know how we all can enact this kind of common sense in our own EMS systems.
Now before everyone starts wringing their hands about what is going to happen, take the time to read through the comments on the story, many of which claim to be written by local responders.
As you start to write your comment about the referred ankle pain that could be presenting as a silent MI, keep in mind that as you transport that “maybe” call, the actual crushing chest pain that IS an MI is waiting longer for a transport. We need to stop worrying about what might be and focus on what is.
The issue of liability for reducing immediate response is countered by the liability of explaining to the family of a deceased person that their ambulance was delayed because of system abusers. We call it triage. No one thinks twice about ignoring minor injuries in an MCI, why is it suddenly an issue when that decision is moved into the control center? If we let the call taker take the calls and the triage system deems it non-emergent, then let it be non-emergent.
For so long we as an industry have striven for an 8 minute goal only to see the nation expect that 8 minutes for everything. Cleveland says no more. Cleveland. No offense to the system there, I’m learning more about it now, but if you went to a conference and asked which EMS system in the Nation is out ahead of the others, Cleveland is not in my top 3. Until now.
A Tip of the Helmet to Commissioner Eckart and the Cleveland EMS system for breaking free and doing the right thing. I hope to learn more about their research and system savings in the near future. I will most certainly pass that along if I can get it. Do you have a question you’d like me to ask the Commissioner? Post it below and I’ll ask him.
There are many things I wanted Mark to see while visiting the SFFD EMS system. Not once during his trip did he experience the mad shuffle that is our resource allocation when we drop to level zero. What he did get to see was the rampant abuses in the SF 911 system and the paramedics helpless to do anything about it.
I don’t want to ruin the pilot episode of the Chronicles of EMS by telling you about specifics that Mark was able to witness (All with the patient’s full permissions of course), but I wanted to touch on something I didn’t see in the UK system in my short time there: 999 abuse.
Of all the calls we ran, I can think of only one that didn’t have a legitimate need for medical evaluation by someone higher trained than a Paramedic. Notice I didn’t say ambulance, because of the versatility of the NEAS Pathways system. This one person claimed to have a condition that he clearly did not, yet wanted the ambulance to take him in regardless. It was clear to everyone on the scene that it wasn’t necessary, but away we went anyway, just to be sure.
Most of the other persons who dialed 999 and got the tall American Fireman were simply looking for medical advice when they were scared or frightened. Does anyone remember the last time someone called 911, you responded and THEN they made their decision based on your assessment and advice? It sure as hell was more than 11 months ago, I’d wager even more than 11 years ago.
the Project has shown me how we in the EMS Profession have allowed our abilities and responsibilities to be hijacked. We are no longer help arriving in a time of need, but a means to get into the ER. Granted, the few instances when we have to say, “No, always call us if this happens” through gritted teeth to the old man who fell out of bed aside, I have been told to do my job and take someone to the hospital for the last time.
My job is not to take someone to the hospital, but to assess their complaint and devise an appropriate treatment, if necessary. Not drive someone to the hospital, especially in my new fire engine only capacity.
Imagine you drive a tow truck. Someone calls stating their car is broken down and they need a tow. When you arrive you find their stereo is broken, but they want the car towed to the shops, just to be sure. You’d hook that car and be glad you can bill them, right? But what if you ran a free towing service and other cars were actually broken down, needing you more? Another one of my bad analogies for sure, but one that always creeps into my mind when I meet folks who decide to go before I tell them otherwise.
No longer should we let our clients dictate their transport options without a complete assessment and history, condition permitting. In an emergency, we will obviously default to transport, but what about the other 95% of our business? The ones who decided to goto the hospital hours ago, but waited to call us for their stubbed toe, or cough, or fever of 101, or sprained wrist? They have grown accustomed to a level of service they do not need. They are entitled in their minds and it is not just a certain generation, this cuts across all economic and age levels.
ALS units flying through traffic to meet that magical response time, and for what? A sprained knee? Painful for sure, urgent certainly, an emergency…debatable.
Somewhere along the line lawyers wiggled their way into the medical care field, willing to pull the trigger and sue any paramedic who flinches and tries to tell their car accident victims that going to the ER when uninjured will not help them in court. I find myself practicing defensive EMS all the time, it was witnessed by Mark more than once, most notably on a minor scooter accident he can elaborate on.
But it’s easier to C-spine everybody than to learn how to clear, prove to your medical director you can be trusted, and then do it right?
Enough of what’s easy. Enough of playing to the lowest common denominator. Enough of listening to someone with ZERO training and education tell me about how the shoulder articulates, not even able to name a single bone, muscle, nerve or blood vessel in the area. Tell me what happened, what hurts and what doesn’t and let me do my job. Answer my questions honestly. At the end I’ll tell you what I think and discuss with you your options and what I believe is best.
“That will never work!” You shout at your computer. I saw it work. The problem is convincing the newly retired man that he can drive to the ER or clinic himself for the insect bite from 2 days ago, provided he stops scratching it to make it red every time I can’t find it on reassessment.
We are the reason our clients are so poorly informed. There is abuses of the 999 system, there have to be and reading Nee Naw, we know there are, but I didn’t see it in my 4 days with Mark and the NEAS.
So what can we do to make people understand we are more than a flashing lights taxi service?
That is what we need to focus on and something I hope to expand upon in the very near future.
Since most of the readers commenting aren’t so jazzed about ALS delivered by the Fire Department, I’ve devised a few new ways for the folks at the fire hall to keep busy and not get closed down.
Top 10 ways the Fire Department can look busy if not responding to EMS runs-
#10 Tree Trimming
Get those ladders out and close the bike lane, Truck 121 is going to work. With the versatility and man power offered by most truck companies these days, they should be able to make quick work of most of the trouble spots as well as whatever the Town Council needs done come the fall.
They are also for hire out to private citizens, provided you can clean up the trimmings when they’re done. They used to tow a chipper behind the ladder, but there was an incident. You know Firemen.
So call 911 today to schedule your tree trimming, free of charge.
#9 Bungee Jumps from the bucket.
All the cool kids are doing it.
And since we’re under the same expensive insurance as the unrestrained passengers on the municipal bus system, I can’t imagine the underwriters having a problem with this. After the tree trimming is through, we set up in the parking lot of the community college and make a killing. I mean a lot of money, not…well…nevermind.
It can double as a high angle rope rescue drill should something go wrong.
3…2…1…BUNGEE!
#8 Birthday Parties
Every kid dreams of climbing in the fire truck and squirting water on a fire, so why not give them what they want? Bring your group of at least 20 sugar hyped children ages 2-15 by the firehouse and drop them off for a day of fun!
They’ll learn to operate the aerial ladder platform, make and break various hose leads and how to don and doff gear in searing heat.
Each child will receive a roll of municipal toilet paper and a sticker that says “Junior Firefighter” in a gift bag. Reserve now!
#7 Fire Engine races
Nevermind.
#6 City Tours in the Engine
Load up the tourists and hit the streets. If your engines are going to cruise, might as well get some cash along the way. The crews can point out where all the best coffee is and where all the hidden alarm panels are.
For added realism, let them put on your coat and helmet. What a great photo op!
#5 Mobile Water Park
Hot day plus bored children plus 500 gallons equals fun! Combine that drafting drill with some good old fashioned water park fun! Kids can frolic in the droplets as your firefighters show what they can do with that $500,000 piece of equipment.
Your kids will be begging to go to the drill yard every day this summer, just don’t forget your towel!
#4 Demolition
Sure we tear down fire damaged houses, but don’t let us stop there. If you need concrete, wood, metal, stucco, any kind of construction torn down on site, call 911 and we’ll send one of our teams right over. Not only will they respond quickly, but they will call more teams out if the job is a big one.
Saws, poles, hooks and axes will be put to use bringing your structure to the ground. Heck, it doesn’t even have to be yours, you can place your order anonymously.
Just remember there is no haul away service included, we leave it all right where it falls.
#3 Code 3 Delivery Service
No longer assisting on that resuscitation down the block, our team is off to #4 Privet Drive to deliver a rather important letter to a rather important boy. That sounds like a great idea for a book.
Lights and sirens in a fire engine beats an Emo kid on a 10 speed everyday of the week.
When it absolutely, positively, has to get there delivered by 3 men in a shiny (not today, they need #2) red truck, call 911 and they’ll come get your package, letter or person to be delivered and whisk them away.
#2 Mobile Car Wash and Detail
When not washing their own cars on company time, why not hire the Fire Department to wash your car?
Engines are deployed throughout the metropolitan area, carrying all the necessary tools to give your car or light truck a great wash and wax.
Call now and we’ll add a burnt food air freshener with every third wash.
#1 Keep private ambulance parking spots filled
They sit at that corner all day, mainly because the coffee shop has clean bathrooms and free wi-fi, but if they receive an ALS run 25 minutes away, they need to return later to the same sweet spot.
Fire engines can be dispatched to “sit a spot” details at little charge to the ambulance agency. They will only be refused when all engines are out on fires, tours or car washes.
10% off if you mention coupon code “System Status Rules”
I’ll get the flip side next week.
In response to my Sunday Fun about marking your gear, I received comments from across the pond asking the difference between our different units in the US, since I mentioned the need to tell us apart based on task.
So for my UK friends, and maybe my few readers not in the business, I give you the American Fire Department 101.
The work horse of the American Fire Service is the Engine Company. Originally hand pulled pumps, then steam engines, these machines supply the water for the fire fight. The Engine Company carries three main elements that make it a stand alone team. A Pump, a tank and hose. 
The tank is often 500-1000 gallons, depending on the reliability of water supplies and can, if need be, draw water (draft) from a static source such as a pool or lake. The pump moves the water through the manifold and out one of many outlets to fight the fire. I can’t imagine this being much different than the UK Brigade units.
In some municipalities, the engines also offer EMS response at the Basic and Paramedic level as well as extrication using multiple power tools.
At a fire the engine company will usually arrive first, do their best to secure a water supply, deploy lines, find the seat of the fire and knock it down. Even though their mission may include other tasks, this is their main purpose, water on the fire.
The Truck or Ladder Company
AKA the Hook and Ladder Company
The truck company is often second or third to arrive at a fire and prefers to have access to the front in case the large ladder is needed. Although Happy prefers a 100 foot articulated ladder truck (with a driver in the rear to provide maximum maneuverability) ladders can also have buckets on the end, making them a different tool entirely.
Truck members will focus on ventilating the building of heat and poisonous gasses by opening windows and cutting holes in the roof they gained access to using their wide variety of ladders. These folks do not concern themselves with fighting the fire, that is not their job. If I am on an engine, shooting water on the fire, they are working above me cutting the roof, or behind me 
using thier hooks to pull the ceiling down to check for fire spread. Without them the fire could work it’s way back over our heads and emerge behind us, cutting off our escape.
Very rarely does a ladder truck carry water, and even then it is a small amount compared to the engine companies. The mission of these firefighters is not to fight fire directly, but to aid in the containment and ability of firefighters to attack the fire effectively.
At non fire scenes truck companies often provide forcible entry, advanced extrication, rope rescues and similar tasks, not to mention they are my heroes when a fire sprinkler needs to be shut down and replaced.
And intubating with an airpack on…not as hard as it looks, but no reason not to gear down first.
The Squad
I used to serve on one of these and my verdict is: You’re fooling yourself. A 60 foot elevated master stream with a framed box ladder does not a truck company make you. Ahem…
So there you have it my UK friends, a brief introduction to that which is the American Fire Service. Perhaps when MedicBlog999 gets back from his engine ride along he can explain it in more detail. Graphs and charts perhaps.
