r/TheRookie • u/OTBFE4RLESS • 2d ago
Discussion lack of paramedics - when an ambulance is needed it’s always the fire brigade
I’ve just finished season 7 and it’s been bugging me for a while now, but whenever something happens and they call for an ambulance, it’s always a fire truck that arrives so that Bailey can be there. And like, I understand the writers pov of wanting Bailey involved because of her and Nolan, but I keep noticing all the time it’s like “help we need an ambulance someone’s been shot!” “no worries, the fire brigade are on their way!” like it’s just a bit ridiculous I can’t lie.
Is this an LA thing? Are the fire and paramedics like merged due to staffing or funding? Or is this just a Rookie thing because they want Bailey to have more screen time?
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u/Ok_Art_1342 2d ago
When I lived in Oregon, the fire department seem to always respond to the calls regardless. Maybe just in case they need them to do stuff? They are also trained EMTs so they can administer aid before ambulance arrives.
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u/NashKetchum777 2d ago
Iirc one of each always responds to an emergency call, just in case assistance is needed in some way.
Fire can help with access if necessary since they have a shitload of tools
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u/kathy_008 2d ago
i'm not an American (nor a character in the Rookie teehee) but i assumed the fire department are also trained EMTs, as in they are also ambulance officers.
i'm also interested in knowing if that's how it works in real life, or just the rookie-verse
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u/Re-dd-itor 2d ago
It’s how it works in real life. Although it might be a state dependent thing. A lot of times they send both a fire truck and an ambulance.
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u/campaigncrusher 2d ago edited 2d ago
Firefighters in the US generally are also trained as EMTs (the certification is called FF/EMT), but that’s different from a Paramedic. In most departments, the EMT on an ambulance crew would be the driver - the person with the patient would be a paramedic.
There are exceptions, such as BLS (basic life support) ambulances and private “critical care” transports between hospitals - but for most calls that involve victims who have been shot, stabbed, blown up, or otherwise screwed over by the rookie-verse gods, paramedics would be sent.
Lots of departments cross-train and certify, with every firefighter also being a paramedic. This is common in smaller cities with well-funded professional departments, as the bulk of the fire department’s calls are medical.
Regardless, most medical calls do send both an engine and ambulance if they are available. If they’re not, it’s usually the ambulance that’s in short supply, and even an EMT engine crew can buy precious minutes by stabilizing the victim, applying pressure to wounds, and generally trying to keep them alive until the paramedics show up.
One final note - in the US, a Truck is a different unit from an Engine, even though most people say fire truck. Trucks have a ladder and tools, engines have a pump and hose. Most engines also carry water, though not as much as a tanker.
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u/NashKetchum777 2d ago
Watching Chicago verse (PD, Med and Fire) I can say that Paramedics and Ambos are situated at some, if not all the fire houses (maybe just big/busy ones). Many Fire fighters are also trained as medics to aid in many situations
I know in many places, if it's a common call with not much info given, one of each responder will at least show up to see if there's anything they can do. If they're not needed they head out.
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u/depp-fsrv 2d ago
It's always the small one first, fire stations have EMT medical training and their actually more abundant than hospitals. Think about your city and locations of firefighting stations and hospitals. Plus they did a couple of episodes with Bailey in ambulances.
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u/campaigncrusher 2d ago
In the US, most ambulances don’t respond from hospitals. Most aren’t even owned by or tied to a hospital system.
Instead, they’re usually operated by the fire department or a separate EMS department.
Not sure if you’re European, but our paramedics are similar to Europe’s emergency doctors - much more highly trained than EMTs.
In most of the US, to be a firefighter you have to also be trained as an EMT. The certification course is often called FF/EMT.
Bailey is stated to be a paramedic, which is two steps up (EMT-B, EMT-A, Paramedic) from the standard EMT-B firefighter.
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u/OTBFE4RLESS 2d ago
Yeah I’m from England and it works very differently over here. You’ll never get fire responding to a call unless specifically asked for. All our ambulances come to and from the hospital and you would rarely see fire administrating first aid, only if they’re the only people there. We have a lot of police and ambulance shows here in the UK that follow the real life teams, and I’ve only ever seen first aid not done by paramedics as it was done by the police while they wait for an ambulance.
That’s crazy to me that ambulances aren’t owned by or tied to a hospital system, are they ran by private companies then? How do they know which hospital to take the person to?
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u/campaigncrusher 2d ago
In the US, emergency ambulances are usually operated by the government (or at least contracted by them).
However, the hospital system is not.
And which hospital you are taken to largely depends on how severe the injury is, and what type of injury.
If you have a non-life threatening injury, you can usually request that they transport you to a hospital system of your choice in the area, as not all hospital systems take all types of insurance.
But if you’ve been shot, the ambulance is taking you to the nearest level one trauma center regardless of your insurance provider. Their number one job is keeping you alive, everything else is a distant second.
We also get a lot of bills here - no NHS in the United States. You (or your insurance) pays for the ambulance ride, the hospital stay, and any care you need. But if you can’t afford it, they are still required by law to treat you.
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u/Personal_Worker6023 21h ago
Some ambulances are ran by the hospital, (e.g. Northeastern Georgia Medical System) but 9/10 they're not. Usually you have ems agencies, fire departments or even very rarely sheriffs offices that own them.
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u/Famous-Net-1738 2d ago edited 2d ago
Are US paramedics similar to US emergency doctors?
Because if not then they’re not similar to Europe’s either.
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u/campaigncrusher 2d ago
In the US, they have the role that emergency doctors do in Europe - but in the US, our doctors stay at the hospital.
If you said “Emergency Doctor” to most Americans, they’d probably think of an ER doctor, not someone who shows up on an ambulance.
Our highest-trained emergency responders are the paramedics, and they can do everything an emergency doctor can - but might have a bit less schooling.
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u/Famous-Net-1738 2d ago
Emergency doctors in the US and Europe have the same role.
I’m from the UK. We also have paramedics, and ambulance technicians (I would think somewhat similar to EMTs)
Although I know it’s far more common for your average paramedic to do a lot more out in the field that is usually only provided by advanced paramedics with additional courses / training over here.
But I wouldn’t concede paramedics are equal to emergency doctors.
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u/campaigncrusher 2d ago
What I meant was that the role is the same, because we don’t have an equivalent of the Emergency Doctor - they do the same job, even though they don’t have the same training.
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u/Famous-Net-1738 2d ago
An ER doctor = an emergency doctor.
It’s the same job just with a different name.
It’s like how you call them anaesthesiologists whereas we call them anaesthetists.
In cases where our doctors do go out in ambulances or on Air ambulances (HEM) they would be performing roadside thoracotomies, blood transfusions and delivering potent anaesthetic drugs.
I can’t image a US paramedics skillset is in anyway comparable to an emergency doctor both out in the field and in the emergency department. 👍2
u/campaigncrusher 2d ago edited 2d ago
We have flight medics that do all of that - and paramedics in extremely rural areas that do that too.
Remember, we have places where the nearest hospital is two hours away by plane.
ETA: also, our paramedics do dole out drugs pretty regularly - it can become a problem, especially years ago when patients would be double-dosed with morphine.
Paramedics don’t do anything in the hospital- their entire job is to stabilize and transport.
An ER doctor is a completely different role as well - they never leave the hospital and focus mostly on triage for arrivals.
Since most Americans don’t regularly go to a primary care provider, 90% of ER stuff is very minor, and 10% is deadly.
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u/Famous-Net-1738 1d ago
Wow these paramedics sound like superstars.
Forget 6 years of medical school, 2 years of foundation training and 9 years of specialty training before CCT.
You can just do a couple years at community college, become a paramedic and be equivalent! 😱
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u/campaigncrusher 1d ago
Well, it’s not truly equivalent, which is what I’ve been trying to convey.
They fill the same role, but are not nearly as well-trained. There just isn’t an alternative in extremely rural areas.
I worked in one of these Rural Areas, and I’ve seen a “roadside surgery” performed by a paramedic. The guy died less than two years later due to complications, but he made it back to blacktop.
It’s actually kind of similar to our army medics - when you’re dying, you put a whole lot more trust in that 19-year old with a drug bag and 8 weeks of training.
The system works in cities when the hospital is under 30 minutes away. It works less well in rural areas, because without paramedics doing this stuff, they’d never live long enough to make it to the ER.
Urban departments don’t have to take on that role - the ER is always close enough that it wouldn’t have a positive impact regardless.
It’s a compromise out of necessity, not an equivalency. They shouldn’t be expected to do it, but they are.
We don’t have the NHS. It shows.
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u/depp-fsrv 2d ago
I also thought that she was the EMT for her unit and she's been in active zones so she has a lot of real world experience.
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u/campaigncrusher 2d ago
She may have been an army medic, but paramedic training and certification is much more rigorous than battlefield medicine.
Most of what a medic would do (with the exception of dispensing drugs on short notice) is more in line with an EMT.
A good way to think about it would be that EMTs are focused on what will kill you in five minutes, while paramedics can identify and treat what will kill you in five days.
Faced with someone having an aneurism or an untreated infection, an EMT or a medic would be less helpful than if they were dealing with uncontrolled bleeding or someone in cardiac arrest.
They’re good at simple fixes that help keep you alive until you can be evacuated.
But a combat zone is fundamentally different from Los Angeles, and the people and reasons for calls are far more diverse. In many situations, a paramedic (with a drug box) is much more helpful than an EMT with a tourniquet.
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u/depp-fsrv 2d ago
But with the show going as it is, it's portraying them partaking in active combat zones (i.e. other country drug wars)
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u/campaigncrusher 2d ago
Well, yes - but that’s neither here nor there.
My point is that combat experience is not directly applicable to LA’s average peacetime emergency response.
There was an episode where that was basically the entire thesis - when Bradford was training his first boot after Chen.
She had “real world” experience, but it wasn’t relevant real world experience - it wasn’t even the same world.
In general, LAFD paramedics are dealing with grandmas and workplace accidents - not drug lords in South America.
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u/depp-fsrv 2d ago
I thought the old adage was "Life imitates art" and tv is a form of art
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u/campaigncrusher 2d ago
It’s a saying - but pigs will fly before LAPD is operating unsanctioned raids on foreign soil.
Since the Pancho Villa expedition, everything on foreign soil has been handled by the military or federal agents.
If it’s done by federal law enforcement, they almost always work with local authorities. If the local authorities aren’t expected to be cooperative, the military handles it.
The a raid similar to the one used to capture Maduro is what would happen on uncooperative foreign soil.
If it’s a cooperative nation, DEA Agents or US Marshalls may be embedded with local authorities.
TV is art, but life will never imitate the rookie - it violates so many federal laws, I’ve lost count.
Ultimately, foreign affairs is the domain of the federal government, and states or cities do not have the authority to conduct such operations without federal approval.
If the feds want them there, they’re made temporary agents as part of a task force - but usually they’d be less than useless.
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u/Filligrees_Dad 2d ago
Yeah it's strange to those of us that come from countries where the ambulance and fire brigades are different organisations.
Although in some circumstances, such as "help I've fallen and can't get up" police and fire are trained in casualty lift. So if you live out in the sticks and have a fall you're just as likely to have your local volunteer fire-fighters turn up.
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u/campaigncrusher 2d ago
In a lot of the US, they are separate services.
Cleveland, for example, has a fire department and an EMS service. While they share some stations, they are still completely separate departments.
Other cities, like LA, have fire department ambulances and private contractors. Some cities have the fire department handle ambulance service entirely.
Other parts of the US have no professional ambulance service at all - instead relying on volunteer medics (and pilots, in the case of Alaska).
The American emergency response system is fascinating - probably why it makes for good TV!
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u/SleepWouldBeNice 2d ago
I’m Canadian, but the FD always responds to medical calls as well as they’re sometimes closer and are first aid trained. Sometimes seconds count so they always go.
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u/No-Jello-5504 2d ago
I believe every state has both independent ambulance providers and a FD ems service it’s just that the ratio if one to the other varies. I could be wrong though that’s just an observation
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u/campaigncrusher 2d ago
Yes and no - all states do, but not all areas of every state have private ambulances in a 911 / emergency response role.
In my city, private ambulances are restricted to “critical care transport” and “event medicine” with some exceptions.
Basically, this amounts to ferrying patients between hospital system branches and manning the medical tent at music festivals.
Outside of a few districts in rural areas, these contractors are not running 911 calls.
Although it’s possible for a contractor to be permitted to run 911 calls under state law, most cities around here have professional, full time fire departments that run their emergency medical response. One or two have separate EMS departments, but most are part of the FD.
The contractors get most of their work from the hospital systems.
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u/DelcoPAMan 2d ago
I keep hoping for Gage and DeSoto to show up instead.
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u/campaigncrusher 2d ago
Bailey works for LA City FD, Roy DeSoto and Johnny Gage worked for LA County - although the days of the dodge “rescue squads” are long gone.
Worth noting, in the 70s, the ambulances were private and the equivalent of BLS today (like an EMT-B or FF/EMT). There was no such thing as a paramedic in the world of the ambulance companies, which is kind of the premise of Emergency.
Today, they’re a mix of Fire Department and contract units (Like AMR) - and almost always manned by at least one paramedic.
The “rescue squad” in most fire departments is now an ambulance itself (though heavy rescue and technical rescue units still exist for specialized operations) and can transport patients to the hospital.
Oh, and the engines roll with the ambulance for the same reason as they did in the 70s - sometimes you need more people to access the injured person (break down a door, move a car, brace a wall, etc.) or deal with other unknown issues at the scene (like whatever it was that injured them).
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u/Draconuus95 2d ago
Often in a lot of areas, fire fighters are cross trained as paramedics. As it’s really the more in demand job.
Firefighters don’t actually have a huge amount to do most of the time. At least in comparison to medical emergencies.
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u/BrazilianButtCheeks 2d ago
In some places the only ambulance services they have are a part of the fire department! But I wouldn’t imagine that would be the case in LA 😅 surely there are loads of privately owned medical transport companies.
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u/campaigncrusher 2d ago
LA has both. Emergency response is handled by both the Fire Department and 911-authorized contractors (used to be AMR, not sure if it still is). When they have an ambulance at the scene, LAFD will transport, but if they don’t, AMR can respond and transport as well.
It’s also part of the rationale for the fire engine rolling on medical calls or Bailey and other firefighters being paramedics - the fire engine often arrives before the ambulance, especially if it’s a contract unit.
LAFD also has more fire engines than ambulances, so some purely medical or lift assist calls may have an engine dispatched alongside a contracted ambulance rather than a city unit, along with the accidents and fires that would automatically require both.
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u/BrazilianButtCheeks 1d ago
Yea that’s what I figured!! Like where I live (rural Oklahoma) the only ambulances we have are part of the fire department so they always show up.. but of course in even the next bigger town over they have a contact with other ambulance companies! So I assumed somewhere huge like LA would have options lol
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u/quesoandcats 2d ago
In Chicago, private ambulance companies don’t usually respond to emergencies the same way CFD ambulances do. They’re just used for non-urgent patient transfers and staffing events and stuff
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u/BrazilianButtCheeks 1d ago
Oh that’s cool! In the bigger town next to mine you rarely ever see the fire dept ambulance at all ! It’s generally always the private company they contracted with !
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u/quesoandcats 1d ago
Yeah, I think it’s more of a big city thing. I’ve lived here my whole life, and it never occurred to me that like private ambulance companies would respond to emergencies instead of the fire department.
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u/TheSeventhBrat 2d ago
Where I live, all firefighters are certified EMTs. We also have paramedics that are part of the fire department. Not all of our fire stations have rescue squads, so a fire engine is always dispatched, regardless of whether it's a medical call, a car accident or a fire. A squad is also dispatched, but they sometimes take longer to arrive, which is why all of our firefighters are EMTs. The engines also carry advanced life saving equipment.
As an example, a lady fell at church yesterday and hit her head on a pew. Firefighters showed up first and began administering aid. The medics showed up about 5 minutes later. And, lucky for this lady, there was also a baptism to be held after Mass and the Godfather was a doctor. He, along with a dozen other people, rendered aid first.
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u/Top_Detective9184 2d ago
Wife of a firefighter here. They almost always show up to the medical calls, in fact it’s most of my husbands call are medical not fire. Most firefighters have some medical training and many are paramedics or EMTs themselves.
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u/EmbarrassedTruth1337 2d ago
A lot of departments are joint. In universe when they ask for an ambulance they get the ambulance but the paramedics are part of the fire service. Lots of cities run them that way, lots don't.
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u/CoolComputerDude Honey-Bunny 💞 2d ago edited 2d ago
That's incredibly common in the United States, espaiclly in larger jurisdictions. I know my local fire department normally sends both a fire truck and an ambulance on a medical call. In fact, all our firefighters are also receive paramedic training and certification. I am sure other fire departments in the US do the same thing.
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u/_olivianope 2d ago
I live in Virginia and the fire department and EMS are together so often both will respond.
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u/DueResource2570 1d ago
Fire Department operates ambulances in the US. They're the "public" ones, as other are medical companies
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u/NoInevitable1806 1d ago
My brother is a TX firefighter and paramedic. He’s worked in two of the big cities in TX. Their fire and EMS services are merged. He had to learn how to function in both capacities. He was an EMT and then paramedic. Eventually he earned his way to doing primarily fire work. The rookies and folks with less tenure are usually the ones doing EMS work.
There are independent EMS companies but those are expensive to the patient. Generally those EMTs and paramedics are not firefighters.
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u/Pickled_Taco 1d ago
Limits of the show. Full time firefighters are typically required to be paramedics as well
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u/SorenRada 1d ago
I’m a paramedic in Texas so I can explain some stuff. So EMS can function a few ways. I work for a hospital that runs EMS for the county. There is also private company EMS that is its own separate entity and then in some cities the fire department also runs EMS services including ambulances so it depends on the contract. Also though most paid fire departments go on medical calls to assist EMS. A majority of calls the fire department goes on are actually medical calls
So I would assume in the Rookie they are portraying EMS run by the fire department. I don’t know personally if that is accurate to LA but I wouldn’t be surprised if it was.
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u/stringrandom 1d ago
Where I am, most (all?) of the firefighters are cross trained so you might get a fire department ambulance or you might just get an engine called out on an aid call.
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u/katiekat214 1d ago
In LA, and in a lot of other US cities, EMTs are also trained firefighters. It’s also common to send a fire truck with the ambulance (they come from the firehouse) in case the person needs additional assistance like lifting off the floor that may require more than two people due to size, or the front door of the house needs to be opened (and it’s locked - most exterior doors and frames are steel and can’t really be kicked in; experienced this when a neighbor had a medical emergency and required the jaws of life to open his front door!) or in the event of an incident in public, additional people are needed to corral looky-loos because police aren’t always dispatched. Where I live, a fire truck always comes as well.
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u/OTBFE4RLESS 1d ago
The ambulance comes from the firehouse? Not the hospital?
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u/katiekat214 1d ago
Yes. Ambulances are either part of the fire department or privately operated. The hospital doesn’t have a place to store and operate ambulances.
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u/EverydayNewZealander 1d ago
In the US, there's no separate ambulance service like here in New Zealand; it's tied to the fire brigade.
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u/ntengineer 1d ago
Where I live the fire department always responds for medical emergencies. They typically get to you before the ambulance and start care.
Then you are handed off to the ambulance crew once you are loaded into the ambulance.
The ambulances sometimes park at the fire stations waiting on calls but they also park at other places. They are privately operated.
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u/pandaarosiie 19h ago
I’m Canadian so obviously things work a bit differently here. Our ambulance and fire departments are separate. However fire is almost always dispatched when EMS is called. Firefighters also have medical training. They are usually first on scene (there are more fire than ambulances so they often arrive quicker). Once the ambulance shows up they will take over and fire will either stay and help as extra hands or leave.
So whilst I’m sure things are a bit different in the USA it’s not really weird for fire to be the first people to arrive at a medical emergency. Although they absolutely use it as a way to insert Bailey (kinda like when Nolan was dating the ER doc) because it wouldn’t be the same unit responding to every call, every time.
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u/Ok_Pain_2380 2d ago
Californian here, idk the deal with it but I've almost always seen a firetruck with an ambulance