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How American Fire Departments are Getting People Killed
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this post was submitted on 11 Aug 2024
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Which leads to the question of why... Why are the US (and by extension, Canadian) fire trucks such yo momma fat ass large? I never understood that.
Also, why are fire truck always first responders to incidents that require an ambulance instead? It s like sending a fire truck to a bank robbery. Thanks, cool, but you're the wrong department here.
Then while talking about ambulances too... Why are usi ambulances also such oversized monster trucks? Again, look at European ambulances which are awesome and small.
EMR here so I have some insight on this.
As far as why firetrucks respond to medical emergencies, it's because they're also trained EMRs (previously called first responders) so they can provide some treatment on the scene even if they can't provide transport or do all the things an EMT or paramedic can do. In many emergency situations fire crews are also able to act where medical responders couldn't. In a car accident they can cut up the car so the patient can be removed without disturbing a potentially broken spine. In confined spaces they have SCBA gear to enter safely where normal medical responders can't do anything. Hell, if you wanted to, you could extract a patient through a second story wall with the equipment firefighters have at their disposal. There are many times where firefighters have resources that the ambulance crew don't have access to. Firetrucks, due to the fact that they are built like tanks, are also used for trafic control. If a road needs to be shut down they just park a fire truck across it. If there's an accident along a busy road they can park the fire truck between the responders and traffic so any lookielou hits the fire truck instead of the ambulance crew which is a frequent enough occurance that it is specifically covered in training. There is no better friend to EMS than a firetruck on scene.
As far as why ambulances are so huge, it's partly because they are mobile emergency rooms. They have everything you could possibly want to stabilize a patient in them plus spares and enough room to work around that patient while on the move. The other reason they're so big is because they're designed to be hit. While they aren't as indestructable as a fire truck, they are designed to come out as the winner in most car accidents because the likelihood of them being in a collision is much higher than most vehicles and they frequently carry unsecured people in the back. Ambulance accidents are also something we were specifically trained for. If it does happen then the ambulance may not always be able to take a hit and keep moving like a firetruck could, but it will almost always keep those in the back alive if not entirely unharmed.
Sorry for any spelling mistakes, that was more of a wall of text than I planned and I just woke up so my brain isn't working yet.
But European ambulances and firetrucks can do everything our firetrucks and ambulances do while also being able to maneuver through 8ft wide lanes (US lanes are 12ft wide)
Former FF, and current EMT here.
Just to add a few things, Fire Departments are also increasingly running paramedics or EMTs to be able to do more care before the ambulance shows up. It's not uncommon for the FD to beat my ambulance to a scene.
They are also great lifters and pusher pushers. One of my favorite lines is "lift with your firefighters, not your back." I can't tell you how many times their muscle has been helpful on a scene. But, they still have to respond to fires, and their understaffed, so they cant bring their SUV to my medical.
And as for pushers. Running a code, my medic will be pushing drugs, I'll be breathing for the patient, I'll have a fire fighter pushing on the patients chest, and another ff driving the rig. Three people is super obnoxious in the back of a vanbulance... it still gets tight in the back of my box that is on an f450 chasis, but way better than it could be.
Well, having watched the video, a lot of what you sy actually isn't really needed...
I... don't even know how to respond to that. Imagine if I watched a single youtube video about your field and immediately decided I knew what you did and didn't need to do your job. Maybe you didn't intend it that way but it comes across as very condescending.
I'm not sure what parts you think are unnecissary but everything I specifically mentioned (outside of the 2nd story wall thing) is.
You can't enter confined spaces without SCBA gear. People die doing that. We specifically have to watch videos of people dieing doing that to drill it into our heads not to do that.
Extracting a patient with a spinal injury from a wrecked vehicle without being able to cut up that vehicle is next to imposible without potentially paralyzing them.
People are stupid and they will plow directly into emergency vehicles and responders if you let them. Look up target fixation if you want an interesting read on that.
Emergency vehicles do get into collisions all the time ane every agency has procedures for transfering patients to another ambulance WHEN it happens.
The gear in an ambulance is all there for a reason. If it wasn't then the crew wouldn't want it there because it is taking up their space. Remember the US is massive and you may need to keep a patient stable for extremely extended periods of time to reach the nearest hospital. In the EU things aren't nearly as spread out. They can afford to not have bulky things like a LUCAS device in the ambulance.
In fact a lot of the reason our emergency vehicles are so massive basically just boils down to the services being so spread out. EMS need to be prepared for every possible situation because they frequently don't have the ability to call in backup or aditional gear in a timely manner. When you get to a scene, you have what you brought with you and that's it. By the time backup can get there the patient will be dead. Ambulances need to be geared for anything from a drug overdose to a school bus rollover. Firetrucks need to be geared for anthing from a flaming chicken coop to a derailed tanker of anyhdrous ammonia. Maybe if every single town had their own services that wouldn't be the case but the reality is most towns don't and even if they do it winds up being one firetruck or one ambulance with no budget to have specialized vehicles so you have the exact same issue.
In Europe, they treat patients at the scene, whereas the US extracts the patient and transports to nearest hospital (and stabilize inside the ambulance). These approaches require very different types of equipment and manpower.
In Europe (the Netherlands at least) they don't treat patients at the scene, unless it's something very minor. They always stabilize the patient, them transport them to a hospital.
Either way, you don't need mega ambulances for either
No, there are major differences. The classic example was Princess Diana, who spent the last hour of her life mere yards outside a hospital with an emergency room that could have probably saved her life. French protocol, as you say, is the "stabilize" the patient before moving, whereas in the US the EMS would have done a scoop-and-run.
Yeeaahh, on the Diana thing.
Scoop and run is a great way to kill a patient on the way to a hospital
https://www.express.co.uk/news/uk/10321/Diana-s-life-could-have-been-saved-says-doctor https://print.ispub.com/api/0/ispub-article/12892
Scoop-n-run vs Stay-n-play has been a long-running debate, with conflicting data and studies.
European ambulances can do everything our ambulance can do, they are just more space efficient.
One reason (at least) with two parts: US cars are too large, and fire departments in the US cover massive areas.
American care are huge, so fire services rely on their trucks to clear obstructions in an accident. In asia/europe, manual clearance is still the norm, but you just can't do that with ex: a rolled F350 that's blocking stretcher access down a two lane road. And given how remote a call might be, every second matters because its 25 minutes by air to the nearest hospital.
The other aspect is that huge coverage areas mean any given call could be in places of deep urbanization or the most remote rural bastions of podunkia. The trucks need to be able to go offroad, carry enough material to address emergencies entirely unsupported (big water tanks) and bash their way down a glorified ATV track. Dispatch areas are too large to have specialized FDs, so city roads have to be big enough to support trucks that can do both.
In short, we have to have big trucks because we won't fund enough fire departments to allow them to specialize to a specific region's geography.
There is no way you are getting a massive fire truck offroading or down an atv trail. It wouldn't have the traction or turning radius for much off roading outside of a farmers field. Smaller, lighter fire trucks equiped with all wheel drive systems would be far more effective. They could also be equiped with winches to move all those f350s that rolled over.
You're in emergency services, I take it? I'd be shocked if at least one of your engines doesn't have a winch on it. Our local dept. uses theirs all the time - after Narcan and the bolt cutters, it's probably the most used tool on our trucks.
Engines can, and absolutely do, travel off road. Look at news coverage of any wildfire for examples. Are they 4x4 offroading or ATV tracks? No, I was quite clearly being hyperbolic, as indicated by my use of "glorified" as a qualifier. But you would be amazed at what kind of off-lot mudding backroads you can get an engine down when you need to.