What kind of schedule do firefighting crews work?
All firefighters and EMS crews work 24-hour-shifts, beginning at 8:00 a.m. on one day and ending at 8:00 a.m. the next day. All personnel work one of three crew shifts, identified as A, B, or C, in a rotation pattern, with each shift scheduled in a repeating pattern regardless of weekends or holidays, so that all personnel know what to expect, schedule-wise, for the calendar year. Each month, two crew shifts work nine days and the third works 10 days (rotating). This translates to a 56-hour work week.
What do firefighters do when they’re not fighting fires?
Kirkwood Fire Department crews are busy. They start the day by checking safety equipment, tools, and vehicles and addressing any maintenance issues. Since 911 emergency calls are not predictable, crews schedule other activities with the knowledge that they may be interrupted. Some other things the KFD crews do include: Ongoing fire and EMS training; visiting schools, parks, and community groups; participating in special events; inspecting commercial buildings; and flushing fire hydrants.
They also do grocery shopping and prepare meals since they must eat all three meals at the Fire House, and they make sure they get regular exercise to stay in shape for whatever emergency calls they may get. KFD crews also keep their home-away-from home clean – they do the daily cleaning in the kitchen and bathroom, take out the trash, and vacuum. After chores, the crews often watch television and movies together, and then, just like at home, it’s bedtime. Most crews are up by 7:00 a.m. to get ready for the shift change. Of course, ANY and ALL activities are put on hold whenever a 911 call comes in – including sleep.
In fact, a lot of calls do come in at night, and all crews must get up, get dressed, get their vehicles started, know where they are going, and start driving to the 911 location – all in under two minutes, and sometimes from a dead sleep.
Why does a fire truck also show up when I call 911 for an ambulance?
Fire trucks are dispatched in addition to an ambulance whenever the nature of the call may be life threatening. Examples of life threatening calls include difficulty breathing, heart problems, decreased consciousness level, stroke, diabetic issues, significant trauma, motor vehicle accidents, rescues, and in any other situation deemed necessary by the 911 dispatcher. During such life threatening calls many activities need to occur quickly. EMS has to identify the magnitude and nature of the problem—the number of patients on the scene, adequacy of resources, and whether additional fire/EMS crews are needed. The EMS crew must gather information on the patient’s history and condition to narrow the cause(s) and therefore determine the best course of treatment. Additional personnel may also help prepare the patient for transport to a hospital.
Time is of the essence when initiating patient care and may become a critical factor in the patient’s survival. The goal is to spend 10 minutes or less on the 911 scene for patients in serious condition and to get the patient to the hospital for more extensive and definitive care from a doctor and hospital staff to ensure long-term recovery and a healthy outcome.
There is another reason why a fire truck might be dispatched. If the servicing ambulance for that response area is already on another 911 call, the dispatcher can send a fire truck that has the same life saving equipment as an ambulance. This kind of trucks is an Advanced Life Support (ALS) pumper. The next closest available ambulance is also dispatched, but the fire truck may arrive first and begin initiating medical care and, if needed, life-saving measures. The Kirkwood Fire Department staffs all fire trucks with at least one paramedic on board.
Why did I have to go to the closest hospital rather than one of my choosing?
Patients who have life threatening conditions or those who may be in stable but critical condition need to be transported to the closest hospital that is best equipped to treat the patient’s condition. The determination is made by the paramedic based on the nature of the illness, the medical condition of the patient, and whether or not the patient’s condition could deteriorate if there is a delay transporting to another (farther-away) hospital.
Patients can request transport to a hospital of their choosing, but a hospital may also decline receiving that patient and request the ambulance divert to the closest hospital, a request that may be in the interest of patient survival. If, however, a patient insists on being taken to a different hospital, the EMS will ask the patient to sign a “refusal-of-care” form.
Other Factors: If a patient requests a hospital that is so far away that the ambulance and crew are significantly delayed in getting back into service, it could potentially put other patients at risk, and the EMS crew may choose a closer hospital. Also, known road construction, hazards, or detours may impact the choice of where to take a patient for hospital care. Finally, if a patient’s condition suddenly or unexpectedly deteriorates while en route to a hospital, an immediate diversion may be made to the closest hospital while the ambulance is in transit.
Why can’t I go to the hospital where my doctor works and my records are?
In an emergency situation, a patient will probably not be seen by his or her Primary Care Physician (PCP) upon arrival by ambulance at the hospital, even if the PCP has hospital privileges at the receiving hospital. The patient will be seen and treated by an emergency room physician, who will attempt to contact the patient’s PCP as time permits. Likewise, having a patient’s records on hand at a particular hospital, while important, is only one of many factors affecting transport of patients to specific hospitals, for all the reasons listed above.
Aren’t some hospitals better equipped than others?
The State of Missouri sets standards for equipment, staffing, and resources for hospitals to have and operate an Emergency Department. Some hospitals may be better equipped in certain areas than others. For example, one hospital may be better able to help heart attack patients, while another may be better equipped for trauma or stroke. To make the best use of regional resources, It would be redundant to have all hospitals equally capable of providing the expertise and specialized equipment for unique medical care. Currently, the State of Missouri is further refining and defining regional hospitals in terms of which ones will be designated to specialize in certain areas of health care. Based on these higher levels of specialized care for each hospital, EMS crews may bypass a hospital to get to one that can provide the best care for the medical needs of the patient.
Isn’t Fire and EMS tax funded? If so, then why am I (or my insurance company) being billed for EMS?
Fire, Rescue, and EMS services provided by Kirkwood FD are tax funded. Citizens pay taxes to make these services available, which they access through the 911 system. There are other services Kirkwood FD provides, such as blood pressure checks and CPR training, that can be accessed with a call to our administration office and which are paid for with your tax dollars. EMS calls are billed as a per-use basis, which means that only those citizens that use the service are billed for that specific incident or EMS call. However, Kirkwood FD only bills citizens if the ambulance transports them to the hospital. If there is no emergency need for an ambulance to transport a patient to the hospital, there is no bill to the citizen.
Sometimes patient care is provided on the scene (e.g., a diabetic with low blood sugar is treated and they are medically stable and no longer need medical care). Even though patient care is provided and medical supplies are used, the citizen still does not receive a bill for the service. Only when a patient is transported to the hospital is there a charge for the service. In most cases, the patient’s medical insurance company is billed directly by a third-party service. If the patient is unconscious or cannot provide medical insurance information, the bill will be sent directly to the home address.