EMS system in the US

[Foxbat]

I've been an EMT-B in PA for about a year now, so, being originally from Russia, I felt like writing a small article about American EMS for a Russian web site which focuses on EMS and ambulances around the world.
I know how EMS functions where I live but, since every state is different, I have a number of questions and would be very grateful for an answer:

1. How common are EMS physicians working in field, i. e. on ambulances? So far, I haven't seen anything more than a physician fly-car.

2. How common are pediatric ambulances? Are there other specialized trucks (aside from bariatric)? Do you have any in your area?

3. Is there any data on number of type 1 vs. type 2 vs. type 3 ambulances?

4. Estimations of cost of ambulances - new, used, refubrished?

5. Salary range for EMTs is $10-20 depending on state, as far as I know. What about medics?

6. Patient billing... how does it work in you area/company? Do you only charge if you transport or always, or is it free? What is the range? Do you (or authorities) make pts. pay fines for obviously false calls?

7. Paramedic training... The shortest medic course I've seen is 9 months, but it is very intensive. What is the typical length of the course? The longest course you know (I am not talking about a degree in EM)?

These are the main questions, I will probably come up with more.
Thank you. If any of you have questions on Russian EMS, I will try to answer; although I haven't worked there and the info I have is from articles, discussion boards and such.

 

[MedicPrincess]

1. How common are EMS physicians working in field, i. e. on ambulances? So far, I haven't seen anything more than a physician fly-car.

Our Medical Director runs in a QRV (fly-car), sometimes. About 1-2 times a week he will be found responding to calls with us.

2. How common are pediatric ambulances? Are there other specialized trucks (aside from bariatric)? Do you have any in your area?

Sacred Heart Childrens Hospital has a Neonatal transport unit. It is not available for 911 response, and only transports Neonates. It has to be requested through Sacred, and is only sometimes staffed.

3. Is there any data on number of type 1 vs. type 2 vs. type 3 ambulances?

4. Estimations of cost of ambulances - new, used, refubrished?

Try Google Search

5. Salary range for EMTs is $10-20 depending on state, as far as I know. What about medics?

$20 for an EMT?!? REALLY!!! Try doing a search on this forum. Salary ranges has been discussed LOTS.

6. Patient billing... how does it work in you area/company? Do you only charge if you transport or always, or is it free? What is the range? Do you (or authorities) make pts. pay fines for obviously false calls?

We use a private billing service. They are responsible for billing the insurance companies, patients, collections, ect. We charge for transports, ANY treatment on scene, and now for any call we respond to that is called in by a first party caller (i.e.- pt falls in the back yard and "thinks" they are hurt but only want to be checked out..... they get a bill).

7. Paramedic training... The shortest medic course I've seen is 9 months, but it is very intensive. What is the typical length of the course? The longest course you know (I am not talking about a degree in EM)?

Six months for EMT, 13-15 months for Paramedic.

 

[VentMedic]

7. Paramedic training... The shortest medic course I've seen is 9 months, but it is very intensive. What is the typical length of the course? The longest course you know (I am not talking about a degree in EM)?

For this one I suggest you use this link to further link to each state office for the mandatory minimum requirements of hours for Paramedic training in each state. I recommend visiting the state's website since this is 2005 data and there may be updates. EMS magazine did put out a revised update a few months ago but haven't updated the website.

http://www.emsresponder.com/survey/

Since there are 50 states there are about 50 different minimum requirements to be an EMT-P.

The other thing to look at is school accreditation by CoAEMSP and CAAHEP.

The minimum qualifications of the instructors for the programs are also important. Many "career schools" only require a certification as a Paramedic and no further education.

Even a medic mill can offer more than the minimum hours required by the state but have a poorly ran school and minimally educated/qualified instructors.

You will have to look at the total number of hours for the class. Even an EMT course of 120 hours can be stretched to look like it is a year long if it only meets a couple of hours/week.

2. How common are pediatric ambulances? Are there other specialized trucks (aside from bariatric)? Do you have any in your area?

Neonatal/Pediatric Transport is very common but the primary care givers are usually RNs, RRTs, NPs and MDs. An EMT or Paramedic may be used as the driver and to assist with the equipment. The interfacility guidelines for Pedicatric transport are issued by the American Academy of Pediatrics (AAP).

http://www.aap.org/sections/transmed/DatabaseTM.pdf

http://www.aap.org/sections/transmed/memberTM.htm

 

[JPINFV]

1. How common are EMS physicians working in field, i. e. on ambulances? So far, I haven't seen anything more than a physician fly-car.

Very location specific. Some areas will have high physician involvement, while others will have essentially none.

2. How common are pediatric ambulances? Are there other specialized trucks (aside from bariatric)? Do you have any in your area?

In the area I worked at both of the two major children's hospitals had contracted with local companies for dedicated pediatric units. The units were staffed by the ambulance company with a driver while the hospital provided the transport staff tailored to the need of the patient (RN, RT, physician was not an uncommon staffing assignment).

 

[mperkel]

Very location specific. Some areas will have high physician involvement, while others will have essentially none.
In the area I worked at both of the two major children's hospitals had contracted with local companies for dedicated pediatric units. The units were staffed by the ambulance company with a driver while the hospital provided the transport staff tailored to the need of the patient (RN, RT, physician was not an uncommon staffing assignment).

I know that my company has 2 dedicated pediatric ambulances that sit at the children's hospital waiting for a NICU or PICU call. Whoever is closest and/or most senior gets the call and picks up the "team". I went on one, it was pretty fun experience.

 

[Jon]

1. How common are EMS physicians working in field, i. e. on ambulances? So far, I haven't seen anything more than a physician fly-car.

In the county where I live, ALS is provided by a patchwork of FD's and hospital-based systems. There is 1 medical director who is active in EMS at the national level (one of the "Street Medicine Society" members, Speaking at conferences, medical editor for the EMT text, etc). He will show up on calls in his "whackered out" POV... with RSI drugs and a helping hand. He also rides the ambulance and fire trucks as his schedule permits.

In neighboring counties it is much the same... it seems that the medical directors of small services that were involved in EMS PRIOR to medical school tend to be more actively involved than a physician who only got into EMS after finishing their residency.


Additionally... if I need it... I can call the county and request a surgical team to the scene... at least 1 aeromedical program has a protocol in place for that sort of issue... but I don't know of it being used.


I guess, as a rule... we don't have docs on the ambulances. Paramedics are the eyes and ears of the command doc, and if they have trouble, they call command and speak with a doc... but they have enough training and equipment to manage most patients... at least for the ride to the ED.

2. How common are pediatric ambulances? Are there other specialized trucks (aside from bariatric)? Do you have any in your area?

All of the local childrens hospitals have a retrieval team. This is usually an ambulance and EMT/Driver supplied by a transport company, and a crew supplied by the hospital that depends on the patient they are picking up (Pediatric/neonate NP, Respiratory therapist, RN's, etc). These rigs are all staffed 24x7... but the crews often have other functions in the hospital when they aren't doing retrievals (usually float staff in the ED, etc).

2 of the large tertiary care facilities have ground transport teams with an ambulance and EMT/Driver supplied by a transport Co, and a medic or medic and PHRN as the care providers. These crews bring Trauma/ICU/CCU players from community hospitals to their facilty in the big city.

All 4 of the tertiary care facilities have an affiliated aeromedical program that handles retrievals of a longer distance, as well as emergeny scene flights.


The retrieval team rigs are state-licensed ambulances... but they aren't dispatched to scene calls. They'll stop and render aid if they come upon something... but that is the only time they would do "scene" calls. The only exception to this is that at least 1 of the teaching hospitals has a crew standing by at the hospital to handle any EMS emergencies on their campus during the day (University+hospital)

3. Is there any data on number of type 1 vs. type 2 vs. type 3 ambulances?

4. Estimations of cost of ambulances - new, used, refubrished?

I'm sure there is... but I have no clue where to look.

5. Salary range for EMTs is $10-20 depending on state, as far as I know. What about medics?

Depending on where you are in the country, it is $7.50 (minimum wage) to $20+ with seniority and experience.
I've heard of medics making $12.. and I've heard of medics making $30+ with seniority and experience.

The JEMS yearly salary survey should give you some useful numbers.

6. Patient billing... how does it work in you area/company? Do you only charge if you transport or always, or is it free? What is the range? Do you (or authorities) make pts. pay fines for obviously false calls?

Most places (around me, anyway) bill for transports... we also bill for ALS treatment onscene with a refusal (like a diabetic).
I've not heard of fining anyone for false calls... but yes, the authorities could if they felt it was appropriate. They threaten it occasionally... but it would take a HUGE issue to make it happen.

7. Paramedic training... The shortest medic course I've seen is 9 months, but it is very intensive. What is the typical length of the course? The longest course you know (I am not talking about a degree in EM)?

3 months part time for an EMT, 12-15 months for Paramedic seems normal.

 

[ILemt]

1. I have never seen an MD or DO in the field. Then again, Ive never seen a field nurse on a rig. But I have seen many flight nurses.

2. I know that there are some pediatric ALS units in IL, even a pedi-copter. But they are rare and based at pediatric hospitals.

3. Most ambulances in IL are boxes with van frames, second highest are full vans.

4. See google. However, I know that my local service spends 100 grand a year to operate its single rig.

5. Pay for EMTs in this area is 10 and under. Never seen more then 10. Average for medics is 7.50 to 15. Never seen a medic with more then 15. (Flight medics aside)


6. Patient billing... no idea, not my department, but everything is billed (even refusals and pronouncements)

7. In these parts medic is done through jr colleges with hospital arrangements. Takes two years and includes an associates of science in Emergency Medicine.

Foxbat... can you describe how EMS works in Russia?

 

[Foxbat]

Foxbat... can you describe how EMS works in Russia?

Basically, there's no volunteer EMS, only paid. All EMS in the country is one agency (except private EMS services).
There are basic ambulances which get dispatched to BLS calls and then there are specialized ones (cardiologic, pediatric, neurologic, psychiatric, OB-gyn, etc). Basic ambulances are staffed with either 2 feldschers (I'm not sure if it's closer to physician assistant or paramedic) and driver, or physician + 1 or 2 feldschers + driver. Specialized ambulances are staffed with doctor (cardiologist, neurologist, etc.), driver and at least one feldscher.
EMS in Russia is overworked and underfunded.
I can post some pictures later if you're interested.

 

[firecoins]

1. How common are EMS physicians working in field, i. e. on ambulances? So far, I haven't seen anything more than a physician fly-car.

I have seen none. in NYC or Rockland and Westchester counties in NY's Lower Hudson Valley.

2. How common are pediatric ambulances? Are there other specialized trucks (aside from bariatric)? Do you have any in your area?

Pediatric ambulances are not very common at all. They aren't cost effective to have a very highly trained crew and equipement for such. Columbia Prsbyterian hospital has a Peds truck which covers pediatric transfers who the whole NY tristate area if available.

3. Is there any data on number of type 1 vs. type 2 vs. type 3 ambulances?

Municipal dept usually use type 1s because you can replace the cabs. Sometimes they use type 3s. Type 2s are primarily used by commercial interfacility tranfers. Type 3s are used by the vollies at least in NYC.

4. Estimations of cost of ambulances - new, used, refubrished?

type IIs are cheapest which is why commercial services use them primarily.

7. Paramedic training... The shortest medic course I've seen is 9 months, but it is very intensive. What is the typical length of the course? The longest course you know (I am not talking about a degree in EM)?

11 months. I am completing it now.

5. Salary range for EMTs is $10-20 depending on state, as far as I know. What about medics?

$20 for an EMT?!? REALLY!!! Try doing a search on this forum. Salary ranges has been discussed LOTS.

$20 to $25 in NYC for a voluntary hospital. It is a union job.