r/Firefighting • u/Launch_Rockface • Jul 10 '25

General Discussion Unpopular Opinions In the Fire Service

I am curious what other peoples unpopular opinions of the fire service are? I know there are alot of things we are doing or trying to do to improve the fire service as far as training and wellness, but I also know alot of it is just not that great in my opinion.

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u/McthiccumTheChikum FIREFIGHTER/PARAGOD Jul 11 '25 edited Jul 11 '25

All transports should be closest appropriate facility.

If your medics can't discern "appropriate facility" you have much bigger problems.

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u/Mediocre_Daikon6935 Jul 11 '25

It is more complicated than that. I can’t tie a unit up because some idiot had a surgery 4 hours away.

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u/BetCommercial286 Jul 11 '25

Not really. Why would you have to that far? Traumas should got to a trauma center and flown if required. Same with burns or GI issues. Your doing your pt a disservice and harm by taking a GI bleed to a place that can’t scope or stop a bleed. Or an eptomic pregnancy to a non OB center EMTALA takes time and sometimes it matters.

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u/trapper2530 Jul 11 '25

That's not what anyone's saying. Those would be closest appropriate hospital. They're saying bc theybahd surgery 2 weeks ago and now have abdominal pain they dont need to go to big city hospital when the smaller hospital is capable of handling it. Therefore the closest appropriate facility. They are 37 weeks pregnant and the hospital 3 blocks away doesn't have OB then you go to the one 15 min away. Closest appropriate.

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u/Mediocre_Daikon6935 Jul 11 '25

Emtla takes time is a lie, used by bad systems to justify their poor practices and performance. 

major traumas should go to a trauma center.

As to GI, if it is a legit emergency they need blood, and more than we can carry.  More likely it is a chronic issue. And many times it is handled conservatively, with medications and an occasional transfusion.

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u/BetCommercial286 Jul 11 '25

Yes but that management is best done at a GI center that can scope them. Sure the critical access hospital can start Octriotide and give blood but not fix the issue pt would have been better off with you driving the extra 20 min to the correct hospital.

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u/Mediocre_Daikon6935 Jul 11 '25

They’re most likely doing to be discharged and scheduled for a scope at a later date, unless they require significant transfusion.

All you’re doing is tying up an EMS unit for an extra hour for a routine out patient procedure, that, at it’s soonest, is going to be done the next day, but more likely a week, later.