# Why private industry has no business in EMS



## thegreypilgrim (Nov 9, 2009)

(1) Conflict of interest - obligations toward providing quality equipment, personnel, training, management, etc. versus "business needs" of profitability.

(2) Utter lack of any recognizable form of professional management - particularly when it comes to the issue of disciplinary action.

List your reasons


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## Chimpie (Nov 9, 2009)

#1 is an interesting point, but #2 is strictly an opinion most likely based on something you observed.

Can you go into more detail?
_*
Please note that we can already see how this thread can go in the wrong direction.  Keep it on topic and post responsibly. *_


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## Shishkabob (Nov 9, 2009)

Because every street level medic is always in agreement with their COO and don't give a rats butt about any of their patients, right?


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## thegreypilgrim (Nov 9, 2009)

Linuss said:


> Because every street level medic is always in agreement with their COO and don't give a rats butt about any of their patients, right?


 Not at all, my statement was directed at the people who run ambulance companies. Apologies for the vagueness.


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## Shishkabob (Nov 9, 2009)

But you're saying privates have no business in EMS.  In my experience, private AND fire are both bad at certain things.


Sure, you have the tops of private agencies who want profit, but that doesn't much effect the street provider.  They aren't in it to get the company the most profit they can... they still tend to be in it for the patient.


Flip around to the firebased style, and you have people who have no interest in patient care, being forced to be on an ambulance and to work as a medic that they don't want to do... and complaining about it all the time.




Call me crazy, bit I'd rather have the person who actually cares about their duties and willingly do it working on me.


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## thegreypilgrim (Nov 9, 2009)

Linuss said:


> But you're saying privates have no business in EMS.  In my experience, private AND fire are both bad at certain things.


 I didn't say anything about fire-based EMS. For the record, however, I agree and really am just trying to blow off some steam here...




> Sure, you have the tops of private agencies who want profit, but that doesn't much effect the street provider.  They aren't in it to get the company the most profit they can... they still tend to be in it for the patient.


 Of course they are. I'm just saying private EMS management makes it exceedingly difficult for us street level medics to enjoy our jobs and they can affect our patient care capabilities in terms of the equipment they supply us with, policies they enact, trying to squeeze in as many IFT's between 911 calls as possible (thus, ensuring quicker burn-out). The list goes on.




> Flip around to the firebased style, and you have people who have no interest in patient care, being forced to be on an ambulance and to work as a medic that they don't want to do... and complaining about it all the time.


 Couldn't agree more. I honestly think that neither the private sector, nor FD's have any business "doing" EMS. It should be a public, stand-alone, third service agency. I'm just picking on the private sector at the moment because that's where I work and don't like it. 




> Call me crazy, bit I'd rather have the person who actually cares about their duties and willingly do it working on me.


 What, cowboys with cool patches don't make you feel better?


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## Seaglass (Nov 9, 2009)

If we don't like fire, and we don't like privates, and we don't like volunteers, all we're left with is publicly-funded/non-profit paid third-service. How common or feasible are those, in reality? I only know of one, and it's a combination department that almost certainly couldn't afford a full career staff. 



			
				Linuss said:
			
		

> Sure, you have the tops of private agencies who want profit, but that doesn't much effect the street provider. They aren't in it to get the company the most profit they can... they still tend to be in it for the patient.



Agreed. It's not like the street medics tend to see any money they save directly put into their paycheck, anyways. They do directly see patients needing care.

However, the people who run a company do see the bottom line a lot more directly, and they're the ones who make decisions on gear and wages, which really do impact the care that a street medic can provide.

(All opinions here are only for the sake of debate. I think there are good providers and bad in every service, and I haven't decided for myself which models are best as of now.)


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## Shishkabob (Nov 9, 2009)

Ah, well we're in agreement then.  I'm sure I could find some bad things about 3rd service... but I'm all tired from another forum debate going on.


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## thegreypilgrim (Nov 9, 2009)

Seaglass said:


> If we don't like fire, and we don't like privates, and we don't like volunteers, all we're left with is publicly-funded/non-profit paid third-service. How common or feasible are those, in reality? I only know of one, and it's a combination department that almost certainly couldn't afford a full career staff.


 Hell man, nearly the rest of the developed world has managed to pull this off in creating EMS systems that make those of the US look like baskets attached to bicycles (Australia, Canada, United Kingdom, New Zealand, etc.)


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## Seaglass (Nov 9, 2009)

thegreypilgrim said:


> Hell man, nearly the rest of the developed world has managed to pull this off in creating EMS systems that make those of the US look like baskets attached to bicycles (Australia, Canada, United Kingdom, New Zealand, etc.)



I'm familiar with the ones overseas. American spending and healthcare follow very different models, though, and the fields have evolved differently. So I'm not too interested in it being done elsewhere. I'm much more interested in whether it can be done here, and how.


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## 46Young (Nov 9, 2009)

I've never agreed with privates that employ the practice of having their rigs do both 911 and IFT on the same shift. If you want to do both sides, there needs to be a dedicated 911 division and a dedicated IFT division. That way, the 911 service doesn't suffer at the expense of IFT call volume. Staff could do either, depending on the shift. It works well at NY Presbyterian (Cornell) and North Shore LIJ CEMS, although those are hospital based systems. Transcare does the same thing, as does AMR in Brooklyn, and they're both privates.


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## RyanMidd (Nov 9, 2009)

thegreypilgrim said:


> (1) Conflict of interest - obligations toward providing quality equipment, personnel, training, management, etc. versus "business needs" of profitability.



I work for private EMS, and I think my arguments to the contrary are pretty strong.

- (Personnel) Every medic that works is working underneath their own accreditation If you screw something up, its YOUR license on the line, not the company's. To me, this dictates that my patient care is gold-standard.

- (Attitude) The EMS communities in Canada are provincial; there is a good chance you work for more than one agency at any given time, and much networking occurs. Your reputation as a medic is at stake if you do not take your work seriously, and it will show when your contracts start to dry up.

- (Management) At a patient-contact level, there IS no management or profit margin. You are working on-car, in uniform, and not thinking about what your employer's revenue for this quarter is.

- (Profitability) Many new EMTs turn to the private industry to earn experience prior to going urban. This means these young medics are out to prove how valuable they are on-car, not how astute they are at billing contruction/oil/sports management companies.

- (Training) I don't know how specific American legislature is, but in Canada, if you are providing healthcare for patients, you are REQUIRED to have up-to-date, valid, and exhaustive certification. There is NO grandfathering, exceptions, etc. If a new drug enters your scope of practice, you cannot be gainfully employed until you have been certified in its use. You cannot simply "work without that drug" until you are trained. Again, its YOUR license, the private company you work for will trade you for somebody with updated skills in a heartbeat. CMA (Canadian Medical Association) accreditation keeps the schools up-to-date, and if the school defaults, CMA pulls their accreditation from that institution. Additionally, provincial legislature holds private care to the same standards as public, including equipment, hours, and even use of lights & sirens.

- (Equipment) The equipment provided by most private EMs providers in this area is comparable to urban/rural services; who wants to be the EMS company that is known for having last decade's models for everything? No, we have Lifepak 12s, spider-straps, auto-injectors, fresh meds, and the works on our rigs, because the clients want the best for THEIR employees.


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## firecoins (Nov 9, 2009)

thegreypilgrim said:


> (1) Conflict of interest - obligations toward providing quality equipment, personnel, training, management, etc. versus "business needs" of profitability.
> 
> (2) Utter lack of any recognizable form of professional management - particularly when it comes to the issue of disciplinary action.
> 
> List your reasons



this complete utter nonsense. Government agencies in EMS are slow, beurocratic organizations that are slow and mismanaged in every manner you say privates are mismanaged.  The only difference they don't need to make money.  To think of it, I can't find a government agency local state or federal in the US that isn't mismanaged.  

Right now there are FDNY EMS ambulances with 2 man stretchers which should be illegal at this point. A private agency providing ALS care in Rockland, NY carries is the first area to carry lifpack 15s and CPAP.  Government agencies count on government money which is being cut. 

Every paramedic pays for their own schooling. They can't work unless they remain certified.  Hence each medic is responsible for his training reguardless of the employer.


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## firecoins (Nov 9, 2009)

46Young said:


> I've never agreed with privates that employ the practice of having their rigs do both 911 and IFT on the same shift. If you want to do both sides, there needs to be a dedicated 911 division and a dedicated IFT division. That way, the 911 service doesn't suffer at the expense of IFT call volume. Staff could do either, depending on the shift. It works well at NY Presbyterian (Cornell) and North Shore LIJ CEMS, although those are hospital based systems. Transcare does the same thing, as does AMR in Brooklyn, and they're both privates.



Empress does both as well for Yonkers.


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## ZVNEMT (Nov 10, 2009)

Some private companies do more to provide quality service, equipment, employees, than others. my company in particular is in it all for profit. EVERY employee is part time, yet works 5 days a week on 10 hour shift and some for 32 hour shifts. no benefits. old equipment. company doesn't not provide us with gloves, and when we bring our own and forget to secure them, they end up on the supervisor's(the owner) ambulance. i don't believe the company pays for anyhting other than refilling O2 bottles, fuel, and insurance/licensing expenses.

EMTs are lured in with promises of "call bonuses" and "paid vacation" and "yearly bonuses". all of which only applies to full time employees, which there are none.

when we respond to calls from an ECF we are instructed to take the pt where their private physician wants them to go.... so detroit receiving might be a mile or two away... but we gotta take them to a hospital 10-15 miles out of the way(we refuse to abide by these instructions, but i've worked with the supervisor and he'll do it... claiming "his pulse is 160 because he's septic, its ok" or some bull like that. i think he gets kickbacks from certain doctors for providing them with business, but i can't prove anything.

the eqiupment is out dated. the stretchers are low, and small. not all of our patients fit, we MAKE them fit. not all of our patients want to go, the boss MAKES them go.

its all just a quick buck for the owners, they don't give a rat's *** about the PT, EMTs, or any applicable laws.


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## thegreypilgrim (Nov 10, 2009)

I guess I should have clarified from the start.

I'm _*NOT*_ trying to argue that the paramedics who currently work for private agencies have no business working in EMS. I'm trying to argue that no paramedic should be subject to the drudgery of having to work for a private ambulance company.

The two worlds of EMS (which is a public service) and private industry simply do not mix. The private ambulance service, when it comes down to it, is simply part of the corporate world where the ultimate end-game is to maintain a profit margin. Everything else is subordinate to this goal. As such, being an employee for such an agency is inherently hazardous and incongruous with one's career motivations. 

EMT's and paramedics become medical professionals because they have a desire to do a public good, have an intellectually stimulating career, and other sources of motivation that do not include any features of commercial industry except for the most vague possible connections like "customer service" (although I question this). We are not "business" minded people. It's not any of our concern. We became EMT's and paramedics to be exactly that: EMT's and paramedics.

It is my experience that private industry is more of a hindrance to the deployment of prehospital medical care than anything else. The people who run these operations are in it for the money and nothing more. Most of these ambulance services actually seem more like rackets used for nothing other than latching on to the hemorrhagic cash-machine that is MediCare/Medicaid. All operations are set to maximize this purpose. Hence, the continued use of ambulances so that the engines/transmissions are in excess of 300k miles, corner-cutting on supplies (i.e. not allowing crews to have access to supply cabinets without going through a supervisor), purchasing of lower-quality equipment, saddling field personnel with needless clerical work to expedite billing (i.e. photocopying pt insurance cards), enacting draconian disciplinary action policies (sometimes it seems like infractions are simply manufactured), running crews into the ground by making them run IFT's in addition to 911 calls (this and the previous seem to be designed to maximize burn-out and attrition so as to avoid having to pay wage step increases), and never, _*ever*_ having an employee's back whenever there is a conflict with a staff member (who was probably quite rude and disrespectful from the start) of a contracted facility or agency. I could go on and on.

The point is, private industry should not be involved with EMS because its business interests are directly counter to the professional goals of the field personnel employed by them. This can indirectly hamper the crew's capabilities to deliver the best care possible. Private EMS also stifles professional development, and would like nothing else but to maintain the status quo of EMS as it currently functions.


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## JPINFV (Nov 10, 2009)

ZVNEMT said:


> Some private companies do more to provide quality service, equipment, employees, than others. my company in particular is in it all for profit. EVERY employee is part time, yet works 5 days a week on 10 hour shift and some for 32 hour shifts. no benefits. old equipment. company doesn't not provide us with gloves, and when we bring our own and forget to secure them, they end up on the supervisor's(the owner) ambulance. i don't believe the company pays for anyhting other than refilling O2 bottles, fuel, and insurance/licensing expenses.
> 
> EMTs are lured in with promises of "call bonuses" and "paid vacation" and "yearly bonuses". all of which only applies to full time employees, which there are none.
> 
> ...




If it's so bad, why do people work there? On one hand, yea the companies that are leeches make me sick, but at the same time if everyone who worked there just upped and left one day, then they would have major issues and might have to rethink their ways.

As far as the ECF calls go, I agree with the idea of taking patients to their home hospital in non-emergent cases. Now, yes, the case you cited (septic patient) should go to the closest. However, most patients do not have to go to the closest. The only thing that refusing requests to transport to a home hospital in non-emergent cases does is increase cost to the patient (the closest hospital might not honor the patient's insurance), reduced care (the patient's physician might not have practice rights at that hospital), and produce extra transports to get the patient to their home hospital.


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## medichopeful (Nov 10, 2009)

Seaglass said:


> I only know of one, and it's a combination department that almost certainly couldn't afford a full career staff.



Boston EMS seems to be working out pretty well


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## firecoins (Nov 10, 2009)

thegreypilgrim said:


> The two worlds of EMS (which is a public service) and private industry simply do not mix.


I disagree.



> The private ambulance service, when it comes down to it, is simply part of the corporate world where the ultimate end-game is to maintain a profit margin. Everything else is subordinate to this goal. As such, being an employee for such an agency is inherently hazardous and incongruous with one's career motivations.


 I do not see how a government agency's goal is *your* career.  No agency public or private is centered around the EMT or medic and their career path. The goal of a private company is to make a profit.  Since their is ample supply of the EMT-B, there is no reason to make extra for this.  Medics are not in short supply either.  This affects the career path.



> EMT's and paramedics become medical professionals because they have a desire to do a public good, have an intellectually stimulating career, and other sources of motivation that do not include any features of commercial industry except for the most vague possible connections like "customer service" (although I question this). We are not "business" minded people. It's not any of our concern. We became EMT's and paramedics to be exactly that: EMT's and paramedics.


that can be said about doctors, nurses and a number of other professions.  However the jobs are in the private sector. Customer Service might be called a bedside manor in the medical field.   



> The point is, private industry should not be involved with EMS because its business interests are directly counter to the professional goals of the field personnel employed by them.


 Interfacilty transfers are not EMS and public agencies tend not to them. 

And private companies/privte hospitals can and do provide quality EMS in 911 systems. Private doctor groups provide Emergency physicians, PAs and NPs.


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## daedalus (Nov 10, 2009)

firecoins said:


> I disagree.
> 
> I do not see how a government agency's goal is *your* career.  No agency public or private is centered around the EMT or medic and their career path. The goal of a private company is to make a profit.  Since their is ample supply of the EMT-B, there is no reason to make extra for this.  Medics are not in short supply either.  This affects the career path.
> 
> ...


All you have done is stated your political opinions against large government and have provided no facts to back up a lot of what you are saying. I can think of a few FDs (government agencies) that do run IFTs around where I live. Most notable is Big Bear City Fire Department. Even this one example disproves what you have said about public agencies not preforming IFTs.


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## guardian528 (Nov 10, 2009)

ZVNEMT said:


> company doesn't not provide us with gloves



can't tell if you meant this double negative or not. if you didn't mean it, and they aren't providing you with gloves, i'm pretty sure thats illegal


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## JCampbell (Nov 10, 2009)

thegreypilgrim said:


> I guess I should have clarified from the start.
> 
> I'm _*NOT*_ trying to argue that the paramedics who currently work for private agencies have no business working in EMS. I'm trying to argue that no paramedic should be subject to the drudgery of having to work for a private ambulance company.



Those poor paramedics should move here to America. In THIS country we all have the right to choose where we live and work. No one forces us to work anywhere.


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## thegreypilgrim (Nov 10, 2009)

firecoins said:


> I disagree.


 That's very nice.



> I do not see how a government agency's goal is *your* career. No agency public or private is centered around the EMT or medic and their career path.


 I never said that it was, but it's certainly much more employee-friendly than private industry is. They're often much better funded so they don't whine when you actually use supplies or force you to adhere to minimum stocking standards so that you can actually treat more than one patient before having to re-supply. They don't try to force you to go into service without the necessary supplies or with expired ones. They typically use better quality equipment and vehicles. The living quarters provided by public services are actually dwellings which aren't hostile to human life or something you'd worry about catching necrotizing fasciitis from. The list goes on, because they aren't hampered by the need to turn a profit - whatever revenues they do generate go back into the needs of the service. 


> The goal of a private company is to make a profit.  Since their is ample supply of the EMT-B, there is no reason to make extra for this.  Medics are not in short supply either.  This affects the career path.


 I can't see how this is relevant toward refuting my argument. 



> that can be said about doctors, nurses and a number of other professions.  However the jobs are in the private sector. Customer Service might be called a bedside manor in the medical field.


 This is a weak analogy. It is much harder for abuse or corner-cutting to take place while running a hospital than it is with ambulance companies. Operating something like a hospital is so heavily regulated that they almost are public facilities. And despite this, nurses, doctors, & other healthcare professionals who work for private hospitals likely _*do*_ experience similar nonsensical affronts to their professional & ethical concerns brought up by the corporate aspects of their institution which they did not sign up for.    



> Interfacilty transfers are not EMS and public agencies tend not to them.


 I'm not sure what you're getting at here. Private ambulances often do both 911 and IFT's, and in working for these services you get caught up in both. Public agencies sometimes do them as well if an urgent transfer out of an ED from a "doc-in-the-box" hospital is needed.



> And private companies/privte hospitals can and do provide quality EMS in 911 systems. Private doctor groups provide Emergency physicians, PAs and NPs.


 I'm sure some actually do, but the fact is most don't. My whole point is that people should think of EMS as they think of fire departments or police departments. I'm sure that there are some private fire protection agencies and private security firms that provide quality services, but I'm sure nobody would be comfortable with privatizing the fire service or the police service for the general public. That's just a Pandora's box waiting to be opened. I'm not going to comment any further on physicians/nurses/PA's/NP's/etc. who work for private hospitals as I've already pointed out I think this isn't a good analogy.


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## thegreypilgrim (Nov 10, 2009)

JCampbell said:


> Those poor paramedics should move here to America. In THIS country we all have the right to choose where we live and work. No one forces us to work anywhere.


 Gee, thanks for that rigorous analysis. Why didn't I think of that? Oh I know - because that would be a gross oversimplification of the economic factors that determine availability of jobs and the negotiating equity between employers and employees.


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## downunderwunda (Nov 11, 2009)

I would have thought in a First World, Economic leading country like the US, basic healthcare, including pre hospital healthcare, would be a basic human right. This is without socio-economic factors contributing. 

Why should a person with chest pain (not diagnosed at  this point) be scared to call an ambulance because they cant afford it? Minutes mean muscle. If we provide them with free pre hospital health care, with a transport & subsequent admission, we may save muscle & that person can then be a continuing contributing member of society.

Why is it that every other First World country has free healthcare & the US doesnt?


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## ZVNEMT (Nov 11, 2009)

guardian528 said:


> can't tell if you meant this double negative or not. if you didn't mean it, and they aren't providing you with gloves, i'm pretty sure thats illegal



er... yea.. thats what i meant. but it'd be kinda difficult to nail them for it, and i looked up the laws on it. in this area an ambulance is required to have a minimum of 2 gloves on board. 

and im sure theres a private stash of gloves somewhere in the office so they can cover their asses.


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## Seaglass (Nov 11, 2009)

ZVNEMT said:


> er... yea.. thats what i meant. but it'd be kinda difficult to nail them for it, and i looked up the laws on it. in this area an ambulance is required to have a minimum of 2 gloves on board.
> 
> and im sure theres a private stash of gloves somewhere in the office so they can cover their asses.



I suspect OSHA would be all over that...


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## reaper (Nov 11, 2009)

He is right. Michigan state EMS only requires two pairs of gloves on the truck! That is the most asinine thing I have seen from a Health Dept.

We are required to have two BOXES of each SIZE on the trucks!


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## firecoins (Nov 11, 2009)

thegreypilgrim said:


> That's very nice.


Why post a thread if you dismiss disagreement with "thats very nice"  maybe just start a blog.  



> I never said that it was, but it's certainly much more employee-friendly than private industry is.


You certainly implied that private industry cares about "careers" and the evils of profit.  

Government organizations running EMS in this area are hardly ever above minimums stocking standards. The equipment used is often sub par.  They are more career friendly if you don't mind a supervisor making sure every one of a 1000 plus rules are enforced over common sense.   



> This is a weak analogy. It is much harder for abuse or corner-cutting to take place while running a hospital than it is with ambulance companies. up for.


 Ill take your word for it.  



> I'm not sure what you're getting at here. Private ambulances often do both 911 and IFT's, and in working for these services you get caught up in both. Public agencies sometimes do them as well if an urgent transfer out of an ED from a "doc-in-the-box" hospital is needed.


Yes only doc in the box hospitals need urgent transfers.  The crappy public hospitals are always prepared.  



> I'm sure some actually do, but the fact is most don't. My whole point is that people should think of EMS as they think of fire departments or police departments.


 We should be thought of as medical professionals.  Not as cops or firefighters.


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## ah2388 (Nov 11, 2009)

The school I attended is operated by a service that is I believe what you guys are calling a third party service, being that they are not fire based and from what I can tell, serve an entire county.

They have a full command staff, and from my limited experience it appears that they more or less operated independently from the fire/police in the area.  With that being said, they promote a "team environment" between leo's and fire personnel because we need them as much as they need us.


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## lsingleterry (Nov 25, 2009)

I find your opinion of private industry ems quite judgemental.  I work for a private company, and we are EMT-IV's and Paramedics with the same license and training as any other EMT or Paramedic.  We were trained to do the same skills, and we issue the same drugs.  What makes us less qualified?  Professionalism is up to the individual to show the public, and his/her coworkers.  Try to judge people as individuals, don't blame the organization for the acts of individuals.


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## wolfwyndd (Nov 25, 2009)

thegreypilgrim said:


> (1) Conflict of interest - obligations toward providing quality equipment, personnel, training, management, etc. versus "business needs" of profitability.
> 
> (2) Utter lack of any recognizable form of professional management - particularly when it comes to the issue of disciplinary action.



I haven't read the ENTIRE thread (about 1/2 so far) but going back to the original statements, I disagree, on BOTH counts.  

EVERY agency in the health care field has to keep an eye on their 'bottom line.'  Using the conflict of interest argument then hospitals should also not be in the health care business.  Hospitals are private sector companies that need to make a profit.  If they don't, they start closing hospitals or moving them to areas that are more profitable.  

In regards to 'professional management,' as a blanket statement, I disagree there too.  I know of some EMS places, both public AND private, that pay for every tiny little class you even THINK you wanna go too.  And I also know some EMS places, both public AND private, that you pretty much have to beg, borrow, or steal equipment that you NEED, not just WANT.  

It varies from company to company, and agency to agency.  While we all may work in the same field, it is sometimes difficult to judge one against another.  Companies, agency's, and even STATES, are as individual as. . . . . . individuals.  They're all unique.


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## thegreypilgrim (Nov 25, 2009)

lsingleterry said:


> I find your opinion of private industry ems quite judgemental.  I work for a private company, and we are EMT-IV's and Paramedics with the same license and training as any other EMT or Paramedic.  We were trained to do the same skills, and we issue the same drugs.  What makes us less qualified?  Professionalism is up to the individual to show the public, and his/her coworkers.  Try to judge people as individuals, don't blame the organization for the acts of individuals.


Nothing at all. I work for private EMS too, and I'm quite sure you guys are great EMTs and paramedics. My comments are directed mainly at the managerial aspects of EMS agencies and the "working environment" that predominately goes with privatized EMS.


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## thegreypilgrim (Nov 25, 2009)

wolfwyndd said:


> I haven't read the ENTIRE thread (about 1/2 so far) but going back to the original statements, I disagree, on BOTH counts.
> 
> EVERY agency in the health care field has to keep an eye on their 'bottom line.'  Using the conflict of interest argument then hospitals should also not be in the health care business.  Hospitals are private sector companies that need to make a profit.  If they don't, they start closing hospitals or moving them to areas that are more profitable.


 Not all hospitals are part of the private sector - many are public and others are private but non-profit organizations. I suppose I just take issue with the notion of healthcare being regarded as a "business" that someone could capitalize on and profit from. Something about that doesn't sit well with me.  



> In regards to 'professional management,' as a blanket statement, I disagree there too.  I know of some EMS places, both public AND private, that pay for every tiny little class you even THINK you wanna go too.  And I also know some EMS places, both public AND private, that you pretty much have to beg, borrow, or steal equipment that you NEED, not just WANT.
> 
> It varies from company to company, and agency to agency.  While we all may work in the same field, it is sometimes difficult to judge one against another.  Companies, agency's, and even STATES, are as individual as. . . . . . individuals.  They're all unique.


This is no doubt true, but really this is a red herring. I have found that the problems of a lack of professional management, "corner cutting" on supplies, treating crews like dirt, and running them into the ground on units that should have been retired long ago seem to go more with private EMS organizations than public ones.


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## loadngo (Nov 25, 2009)

thegreypilgrim said:


> (1) Conflict of interest - obligations toward providing quality equipment, personnel, training, management, etc. versus "business needs" of profitability.
> 
> (2) Utter lack of any recognizable form of professional management - particularly when it comes to the issue of disciplinary action.
> 
> List your reasons



Did we used to work together? Sounds familiar.

I'm convinced - private companies have no buisness running 911 calls.


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## Thindian (Nov 25, 2009)

I find it funny that people think the government has the money to pay for the EMTs, Paramedics and ambulances that are otherwise provided by private ambulance companies throughout the country.


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## reaper (Nov 25, 2009)

Geez, maybe because it happens all over the country?


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## loadngo (Nov 27, 2009)

Thindian said:


> I find it funny that people think the government has the money to pay for the EMTs, Paramedics and ambulances that are otherwise provided by private ambulance companies throughout the country.



I find it kinda funny that you don't realize that 90% plus of private ambulance bills are paid by "the government."


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## rescue99 (Nov 27, 2009)

loadngo said:


> I find it kinda funny that you don't realize that 90% plus of private ambulance bills are paid by "the government."



Yep, Medicare / Medicaid controls payment but, EMS workers sure don't get state or federal pay! The only contract (I think) that requires wages to be in line with federal standard is VA transports. Never known of anyone to actually get paid more for VA transports but the EMS agencies contractually agree to pay more.


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## loadngo (Nov 27, 2009)

rescue99 said:


> Yep, Medicare / Medicaid controls payment but, EMS workers sure don't get state or federal pay! The only contract (I think) that requires wages to be in line with federal standard is VA transports. Never known of anyone to actually get paid more for VA transports but the EMS agencies contractually agree to pay more.



I've done some VA IFTs and got no extra money for them.

Around here the VA employs some EMTs(all levels) to do IFTs and their pay is outstanding. Of course those jobs are very difficult to get.


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## firecoins (Nov 27, 2009)

In an industry where EMTs work for free, how long can we blame private companies for low wages?


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## rescue99 (Nov 27, 2009)

firecoins said:


> In an industry where EMTs work for free, how long can we blame private companies for low wages?



Three things are needed to be where FD/PD are today. Education, organization .......not necessarily in that order. The third thing? Takes solidarity.....something EMS sorely lacks.


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## MagicTyler (Nov 27, 2009)

I see no reason why this is any different than a private hospital. An agency sending one of their ambulances on a non-emergent transport when the agency also does 911 is no different than a hospital using an OR for an elective surgery when a trauma may come in.


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## redcrossemt (Nov 27, 2009)

thegreypilgrim said:


> (1) Conflict of interest - obligations toward providing quality equipment, personnel, training, management, etc. versus "business needs" of profitability.



Disagreed! Government-funded services have the same issues. I've worked for private services who have been all about the profit, and I've worked for private services who provide quality equipment, training, and management because they know the bottom line (i.e. profit) depends on quality patient care, satisfied/happy employees, and good customer service. I think you'll find "conflicts of interest" in all services - no matter how they are funded, or whether overseen by a CEO, governing board, or mayor.



thegreypilgrim said:


> (2) Utter lack of any recognizable form of professional management - particularly when it comes to the issue of disciplinary action.



Again, disagreed! Who's to say that giving someone the title of "Chief", "Lieutenant", or anything else makes them an effective leader, or that it creates professional management? I've seen lots of poor excuses called "management" at government-funded agencies, both fire and third-service. I've also seen poor management at private agencies. But, as an argument to your point, I currently work for an excellent private agency that has excellent, experienced EMS management staff in an effective, organized structure. We have a reasonable disciplinary action policy that is enforced. And medical errors and protocol problems are brought to an outside regional medical control authority for review.



thegreypilgrim said:


> This is a weak analogy. It is much harder for abuse or corner-cutting to take place while running a hospital than it is with ambulance companies. Operating something like a hospital is so heavily regulated that they almost are public facilities. And despite this, nurses, doctors, & other healthcare professionals who work for private hospitals likely _*do*_ experience similar nonsensical affronts to their professional & ethical concerns brought up by the corporate aspects of their institution which they did not sign up for.



I think your analogy is actually the weak one. Look at public county hospitals in poor cities! They are the best examples of lacking equipment, poor facilities, etc. And all of this despite the heavy regulation you talk about. Corner-cutting does occur in these facilities, and typically much more than in the private facilities that can choose which patients and insurances to accept.



thegreypilgrim said:


> I'm not sure what you're getting at here. Private ambulances often do both 911 and IFT's, and in working for these services you get caught up in both. Public agencies sometimes do them as well if an urgent transfer out of an ED from a "doc-in-the-box" hospital is needed.



Public agencies in many areas do non-emergency basic inter-facility transports. It just depends on the region, the system, and the needs and capabilities of available agencies.

I work for a private ambulance service. Our 24-hour cars are station-based and expected to do almost solely 911. We do occasionally do emergency inter-facility or critical care transfers when needed; and we occasionally do basic inter-facility runs during high call volumes. Our 12-hour ALS cars are expected to do a mix of all sorts of calls, and they do. I don't see how doing inter-facility transport calls causes burn-out any faster than doing 911 calls...


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## downunderwunda (Nov 28, 2009)

At the end of the day, the question that really needs to be answered is what should be the _primary_ role for EMS.

Should it be to provide initial & primary care, developing over time to extended careto all people, regardless of socio-economic status, or should the concern be for billing & profit.

There is no reason why government departments cannot be run as a business enterprise, with the focus being on service delivery, rather than profit. 

This does not mean the EMS should have an open cheque book, but would make the accountable for the funds they do spend.

The other side to this is that if people are provided with a free or subsidised service, not just EMS service, but full medical service, they will acheive better outcomes from things like myocardial ischaemia, not having to decide if they scould afford to have surgery etc will aloow them to again be a contributing member of society & the taxes they pay help the next person who is need.

This is social medicine. It is provided in the third world & most first world countries, with the exception of the US. It is far from perfect, but then again, so is choosing to suffer with an AMI because you cant afford the treatment, from ambulance to hospital.


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## ExpatMedic0 (Nov 28, 2009)

I would think the number of Paramedics who prefer to work for a private EMS company over some kind of municipal department such as FIRE, PD, or 3rd party EMS would be an extremely low percentage. 

IMO, a municipal EMS 3rd party system by far makes the most since, such as Boston EMS, Or Honolulu EMS. 

Lets face it, most of the time in most areas of the U.S. your going to get paid WAY less working for say AMR for example vs the fire department medics in your town, your not going to get a pension of any kind, maybe some crappy 401k you could never even consider to retire on alone, If you get an affordable health care plan your lucky,  burn out, moral, and turn over is always going to be a huge problem in private vs municipal for all those reasons and many more.

But above all else, like the guy who stated the thread said on the first post, conflict of interest for a private company with profit and business needs.


Would you like your Police Department or Fire Department to be contracted private company's?


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## PotatoMedic (Nov 28, 2009)

schulz said:


> Would you like your... Fire Department to be contracted private company's?


Some are and from what I have heard.  The workers hate it!  The only reason they are there is because it is a job.  Pay is nothing, training is nothing, equipment may be good but that means nothing if you cant use it.


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## redcrossemt (Nov 28, 2009)

schulz said:


> But above all else, like the guy who stated the thread said on the first post, conflict of interest for a private company with profit and business needs.



But the point has been made that fire department and other governmental EMS agencies have the same problems... Municipal funding is being cut in all areas, it's hitting EMS providers hard, and many of these departments no longer have all the great equipment and training they once did. Chiefs are forced to balance their lines in the city budgets. There's lots of good examples in the news right now of municipal EMS staffing/deployment shortages with increased run volumes for those still working.


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## rescue99 (Nov 28, 2009)

redcrossemt said:


> But the point has been made that fire department and other governmental EMS agencies have the same problems... Municipal funding is being cut in all areas, it's hitting EMS providers hard, and many of these departments no longer have all the great equipment and training they once did. Chiefs are forced to balance their lines in the city budgets. There's lots of good examples in the news right now of municipal EMS staffing/deployment shortages with increased run volumes for those still working.



Seems so many FD's went ALS without realizing the need for funding to support long term cost increases. I  know our FD doubled in size nearly.  Which means so did the cost. The biggest question that had to be answered 15 years before they went ALS was; how are we going to ensure funding 10, 15, 20 years from now and beyond? City planners were smart enough to realize ALS isn't self supporting in itself. 

Future planning realistically takes into consideration ebbs and flows of the local, not necessarily, national economy. Plans must take into consideration that insurance pays FD's exactly the same as it will an EMS service. Payment for services is also dependent on a patients ability to pay thus, how are negative revenue calls going to be absorbed?? Unfortunately, many FD's are discovering the high price of doubling man power with promises they cannot financially keep. Cut backs and lay offs are hitting some areas pretty hard because of poor planning.  

EMS services make money in call volume. Municipalities are only as profitable as the call volume within it's own area. EMS adds an deletes workers as their business flows. The IAFF wasn't thinking about that when it lobbied for ALS. There's alot more to being ALS than securing FD jobs and providing care. 

Just my random thoughts on the subject....


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## downunderwunda (Nov 28, 2009)

redcrossemt said:


> But the point has been made that fire department and other governmental EMS agencies have the same problems... Municipal funding is being cut in all areas, it's hitting EMS providers hard, and many of these departments no longer have all the great equipment and training they once did. Chiefs are forced to balance their lines in the city budgets. There's lots of good examples in the news right now of municipal EMS staffing/deployment shortages with increased run volumes for those still working.



If funding is hitting the government sector, wont it also be hitting the private sector??????

A government run organisation should have a charter for minimum standards of care. This is passed on to the patients, funding becomes secondary.

Private companies it is the primary concern. This is a problem.


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## rescue99 (Nov 28, 2009)

downunderwunda said:


> If funding is hitting the government sector, wont it also be hitting the private sector??????
> 
> A government run organisation should have a charter for minimum standards of care. This is passed on to the patients, funding becomes secondary.
> 
> Private companies it is the primary concern. This is a problem.



LOL..we must come from different worlds! I see minimalization in standard of care being provided by way, way too many FD's...which are municipalities! 
A few are decent but, few are keeping up on low volume skills and practice.

Ever see a 15 year fire/medic stick a 20g angio into a pacemaker, give it fluids and drugs while 3 co-workers looked on and atta-boy'd him? Bent it into a huber first of course! If it wasn't so pathetic it could have been funny. There were 4 dummies, not just a single fool on duty in one station! Stunned and amazed! All I could think was; God help us all!   

While I know bad service and skill can be seen everywhere, by shear volume of calls, the better skills and knowledge favors privates. I'm fairly certain most can at least tell the difference between a pacer and a med port anyway.  ^_^


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## redcrossemt (Nov 28, 2009)

downunderwunda said:


> If funding is hitting the government sector, wont it also be hitting the private sector??????
> 
> A government run organisation should have a charter for minimum standards of care. This is passed on to the patients, funding becomes secondary.
> 
> Private companies it is the primary concern. This is a problem.



My point is exactly that -- funding issues effect BOTH governmental and private EMS agencies, and the problems faced are similar.

Minimum standards of care... Hmmm... Not sure exactly what you mean. Around here, EMS agencies are regulated by the state and, in my state, local medical control agencies. Both governmental and private agencies are required to provide the same level of care, meet the same staffing and training requirements, etc. As said previously, I've seen lots of great municipal agencies that put patients first, but I've also seen the opposite. Same holds true for private agencies -- there are good and bad.


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## redcrossemt (Nov 28, 2009)

rescue99 said:


> Ever see a 15 year fire/medic stick a 20g angio into a pacemaker, give it fluids and drugs while 3 co-workers looked on and atta-boy'd him? Bent it into a huber first of course! If it wasn't so pathetic it could have been funny. There were 4 dummies, not just a single fool on duty in one station! Stunned and amazed! All I could think was; God help us all!



I haven't laughed this hard in a while! 

I'm glad he bent the needle first, at least...


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## downunderwunda (Nov 29, 2009)

Minimum standards of care set a benchmark. Government organisations, free of the profitability shackels tend to be more progressive with implementation of new treatments & options.

Private industry waits til they have no choice to increase profitability.

Profitability should not be a part of anyones healthcare journey, rather the focus should be on wellness & reducing the stress on the patient to ensure full healing.


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## vquintessence (Nov 29, 2009)

WARNING:  OPINIONS in my post.



downunderwunda said:


> Minimum standards of care set a benchmark. Government organisations, free of the profitability shackels tend to be more progressive with implementation of new treatments & options.



This is where our worlds completely differ my friend!  The feds & state gov't serving under my Old Glory have two primary concerns/attitudes:  Status Quo & maintaining it's own Beurocracy.  Those minimum standards that are set, are more often than not, what is implemented and followed.  *Over time, those minimum standards become a lost objective* when it comes to forward progress because change (at gov't level) is an expensive political risk and has the potential to create power shifts from within.  

To quote Oscar Wilde "Bureaucracy expands to meet the needs of the expanding bureaucracy."  It's so easy to get lost behind red tape.  Now Private Industry on the other hand... change, can mean more money.. which is the reason private industry exists.  New treatment paths, potentially create new billing.

Example:  Private service I work at has obtained project waivers from the state for BLS to administer Narcan as standing order for very specific situations.  So BLS unit administers naloxene, calls for ALS intercept.  ALS arrives and provides appropriate care.  In the end of the call: the company bills for BLS level 2 and ALS level 1.

A cyncial perspective would assert that's an extra wad of cash for the company.  A humane perspective is that the pt got their respiratory drive and GCS back that much sooner due to BLS interventions; perhaps reduced risk of aspiration?  Perhaps reduced risk of barotrauma from BVM?  In the end, my service has done a justice to the pt as well as themselves.




			
				downunderwunda said:
			
		

> *Government* waits til they have no choice to *adapt*.



IMHO, I fixed the above quote for ya.


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## reaper (Nov 29, 2009)

rescue99 said:


> LOL..we must come from different worlds! I see minimalization in standard of care being provided by way, way too many FD's...which are municipalities!
> A few are decent but, few are keeping up on low volume skills and practice.
> 
> Ever see a 15 year fire/medic stick a 20g angio into a pacemaker, give it fluids and drugs while 3 co-workers looked on and atta-boy'd him? Bent it into a huber first of course! If it wasn't so pathetic it could have been funny. There were 4 dummies, not just a single fool on duty in one station! Stunned and amazed! All I could think was; God help us all!
> ...




Once they told him it was a pacer. Did they also tell him there is more to a Huber then just a bend!


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## downunderwunda (Nov 29, 2009)

vquintessence said:


> WARNING:  OPINIONS in my post.
> 
> 
> 
> ...





The quote didnt need fixing.

The health system needs fixing, begining with the notion that everyone must pay & get billed for every pimple on their ***.



> when it comes to forward progress because change (at gov't level) is an expensive political risk and has the potential to create power shifts from within.



Change, at any level of government is there as a whim of the people. The people who vote them in.

If (&this is a generalised comment to everyone worldwide) people were not so apathetic, then the status quo would not remain. People can force change. People will not get off their fat asses to effect change because they have been told, wrongly, that the US has the best system in the world. Until the masses believe otherwise, & it has to start from inside the health system, you will NEVE effect any change & your system will get worse.


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## rescue99 (Nov 29, 2009)

downunderwunda said:


> The quote didnt need fixing.
> 
> The health system needs fixing, begining with the notion that everyone must pay & get billed for every pimple on their ***.
> 
> ...




Gosh, I was hoping we'd get a little thanks for all of the free healthcare support we spread around the world. I tend to minimize comments made by people who have to vote or face being fined!


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## redcrossemt (Nov 29, 2009)

downunderwunda said:


> The quote didnt need fixing.
> 
> The health system needs fixing, begining with the notion that everyone must pay & get billed for every pimple on their ***.
> 
> Change, at any level of government is there as a whim of the people. The people who vote them in.



So the problem is that fire departments, third services, and private providers ALL bill the individuals. That's how the system is in America. I'm not sure it's the best system out there, but it's what we have. And, with what we have, I can't say that the government-run agencies do any better than the private agencies. The status quo is that all of the agencies, no matter if they are government or not, depend on revenue, and have to balance their budgets.


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## rescue99 (Nov 29, 2009)

reaper said:


> Once they told him it was a pacer. Did they also tell him there is more to a Huber then just a bend!



Kept suggesting that fading spike was not artifact but in fact, was a pacemaker. Poor old soul was so thin I could almost read the serial number! The huber bend was a classic!


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## downunderwunda (Nov 30, 2009)

rescue99 said:


> Gosh, I was hoping we'd get a little thanks for all of the free healthcare support we spread around the world. I tend to minimize comments made by people who have to vote or face being fined!



Its great you consider it the right thing to do to provide free healthcare in other countries, for foreign nationals in their country, yet your healthcare system does not see itself as a basic right for a first world country.

Well done.


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## downunderwunda (Nov 30, 2009)

redcrossemt said:


> So the problem is that fire departments, third services, and private providers ALL bill the individuals. That's how the system is in America. I'm not sure it's the best system out there, but it's what we have. And, with what we have, I can't say that the government-run agencies do any better than the private agencies. The status quo is that all of the agencies, no matter if they are government or not, depend on revenue, and have to balance their budgets.



So a company that runs for profit, at the end of the financial year has a responsibility to their shareholders. These fine upstanding people have invested money in the company & expect a return on their investment from the maximised profits. Failure to return a profit sees the company go bankrupt & all the associated mess that goes along with that.

A government run service, that is free of the profitability shackle, that provides the same level of service to all people, does not look at the bottom line for a profit. Yes they are accountable for the money spent, however, they are not there for a profit, they are there to provide a service to the community.


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## rescue99 (Nov 30, 2009)

downunderwunda said:


> So a company that runs for profit, at the end of the financial year has a responsibility to their shareholders. These fine upstanding people have invested money in the company & expect a return on their investment from the maximised profits. Failure to return a profit sees the company go bankrupt & all the associated mess that goes along with that.
> 
> A government run service, that is free of the profitability shackle, that provides the same level of service to all people, does not look at the bottom line for a profit. Yes they are accountable for the money spent, however, they are not there for a profit, they are there to provide a service to the community.



Wow...brain washed socalists......they're so cute!


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## rescue99 (Nov 30, 2009)

downunderwunda said:


> Its great you consider it the right thing to do to provide free healthcare in other countries, for foreign nationals in their country, yet your healthcare system does not see itself as a basic right for a first world country.
> 
> Well done.



When you say "right" it sounds like the echos of our 3rd generation welfare queens, illegals and indigent foriegners looking for a free ride on U.S. Most working families do not favor a plan that puts us in the same gorssly high cost of living ditch that other countires slid into. Once yer in, ya can't get out and the only tow truck is owned by Uncle Sam! No thanks.

We have many social programs that are free to low cost avialable. People here want both free and free choice. Neither of which much of the world has without our support....you're welcome!


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## redcrossemt (Nov 30, 2009)

downunderwunda said:


> So a company that runs for profit, at the end of the financial year has a responsibility to their shareholders. These fine upstanding people have invested money in the company & expect a return on their investment from the maximised profits. Failure to return a profit sees the company go bankrupt & all the associated mess that goes along with that.
> 
> A government run service, that is free of the profitability shackle, that provides the same level of service to all people, does not look at the bottom line for a profit. Yes they are accountable for the money spent, however, they are not there for a profit, they are there to provide a service to the community.



But the "accountability for money spent" ends up with governmental-run services pushed to cutting jobs and cutting corners... Look at the Detroit EMS system. They are technically a division of the fire-department, but pretty much a third-service with separate management. Definitely government-run with taxes backing them. In this system, you'll find severely overworked medics with less than state-of-the-art equipment, because the service cut jobs, took trucks off the road, and doesn't replace equipment in order to save money.


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## downunderwunda (Dec 1, 2009)

rescue99 said:


> Wow...brain washed socalists......they're so cute!



Negative.

I am all for profitable private enterprise. 

However, i am also acutley aware that there are some functions that should NEVER be run for profit.Healthcare, Education & Emergency services are 3 of those functions.


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## downunderwunda (Dec 1, 2009)

rescue99 said:


> When you say "right" it sounds like the echos of our 3rd generation welfare queens, illegals and indigent foriegners looking for a free ride on U.S. Most working families do not favor a plan that puts us in the same gorssly high cost of living ditch that other countires slid into. Once yer in, ya can't get out and the only tow truck is owned by Uncle Sam! No thanks.
> 
> We have many social programs that are free to low cost avialable. People here want both free and free choice. Neither of which much of the world has without our support....you're welcome!



I am not the one who hides behind the 'Bill of Rights', the American institution. So if you want to consider anyone claiming their Rights as a 3rd generation welfare queen, then you have just insulted any of your fellow Americans who love to claim their rights.

What I am talking about is more than a right to bear arms, or a right to free speech. I am talking about a right to access healthcare, regardless of socio-economic status. These are Human Rights, something that I would have thought would have been part of anyone in EMS having an interest in fighting for.


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## downunderwunda (Dec 1, 2009)

redcrossemt said:


> But the "accountability for money spent" ends up with governmental-run services pushed to cutting jobs and cutting corners... Look at the Detroit EMS system. They are technically a division of the fire-department, but pretty much a third-service with separate management. Definitely government-run with taxes backing them. In this system, you'll find severely overworked medics with less than state-of-the-art equipment, because the service cut jobs, took trucks off the road, and doesn't replace equipment in order to save money.



So when we have a financial crisis, recession or economic downturn, & EMS companies go broke cause no one can afford to pay the bill, who picks up the slack? Who is laying off workers then? 

EMS Should not be part of fire. Fire has a vested interest in seeing EMS fail. Let Fire concentrate on their core business of fighting fires. Let EMS Stand alone.


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## rescue99 (Dec 1, 2009)

downunderwunda said:


> Negative.
> 
> I am all for profitable private enterprise.
> 
> However, i am also acutley aware that there are some functions that should NEVER be run for profit.Healthcare, Education & Emergency services are 3 of those functions.



NAAAA, you're just for being told where, what and how to breath or even if you can breath at all. Sorry, socialized medicine is worse than our current medicaid system. It often decides who lives or dies through selective intervention. I have 3 aussie friends who had 2 choices for their cancer treatment in the last 2 years...the one they were handed or buy it themselves!! I have several friends and family of friends in Canada who had the same thing happen. Either they weren't allowed treatment or, diagnosis was too slow to enable proper treatment. Several died over the years because they could not get treatment. In fact, one died recently, at the age of 43 because he wasn't diagnosed early enough. Age limitations placed on screening left him to die even though he paid high taxes for his insurance like everyone else. NO...sociaized medicine isn't a good idea. It's costly and people die. 

"Free" society means we have choices and make our own decisions...including the freedom to vote and have our say in politics/policies. Granted, politics always screws things up but, we're still more solid than 99% of the rest of the world. 

We vote without fear of fine or punishment because we are free. No one fines us or forces us. We vote, don't vote, it's a choice but, I am not interested in any opinion from someone who does not bother to cast their's. I'd bet that half the people demanding to be handed a freebie, doesn't bother to vote or isn't a citizen and has no right to make any demands. The other half deserve to be heard. 

Those who cannot do for themselves, we help here. There are already social programs in place. Can we expand? Yes...some. Should we, to an extent. Those who won't or we don't owe anything to, we have no obligation to help nor should we help! Those who can, ought to darned well be taking care of their own family members. I will gladly help support their needs if, it enables a family to keep a loved one at home whenever possible. We need that option available. It isn't possible for some families and we should help. For the rest, it's just plain ole selfishness. Guess if they can afford it of course but, don't ask me to pay for it. It is NOT the govt.'s (tax payers) responsibility to take care of our family...it's ours! I would be glad to expand any financial/healthcare program that puts family first. Billions could be saved if people would just take care of their own! We've been spoiled and lazy for the last 45 years..... too busy taking vacations and buying bigger houses and televisions to give a tinkers damn about those who helped build our great country. Change really does need to begin at home.


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## firecoins (Dec 1, 2009)

downunderwunda said:


> However, i am also acutley aware that there are some functions that should *NEVER* be run for profit.Healthcare, Education & Emergency services are 3 of those functions.



Most of the time anything with always or never is wrong.


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## redcrossemt (Dec 1, 2009)

firecoins said:


> Most of the time anything with always or never is wrong.



LOL


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## redcrossemt (Dec 1, 2009)

downunderwunda said:


> So when we have a financial crisis, recession or economic downturn, & EMS companies go broke cause no one can afford to pay the bill, who picks up the slack? Who is laying off workers then?
> 
> EMS Should not be part of fire. Fire has a vested interest in seeing EMS fail. Let Fire concentrate on their core business of fighting fires. Let EMS Stand alone.



I'm still not sure what the difference between government and private run EMS agencies is in regards to finances... Both types of service lay off workers, shut down cars, buy less equipment, etc. when financial times get tough.

I agree that EMS should not be part of fire, and should stand alone for many reasons. However, I'm not convinced that governmental agencies, even EMS-only third services, can do any better job than the privates.


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## downunderwunda (Dec 2, 2009)

rescue99 said:


> NAAAA, you're just for being told where, what and how to breath or even if you can breath at all. Sorry, socialized medicine is worse than our current medicaid system. It often decides who lives or dies through selective intervention. I have 3 aussie friends who had 2 choices for their cancer treatment in the last 2 years...the one they were handed or buy it themselves!! I have several friends and family of friends in Canada who had the same thing happen. Either they weren't allowed treatment or, diagnosis was too slow to enable proper treatment. Several died over the years because they could not get treatment. In fact, one died recently, at the age of 43 because he wasn't diagnosed early enough. Age limitations placed on screening left him to die even though he paid high taxes for his insurance like everyone else. NO...sociaized medicine isn't a good idea. It's costly and people die.
> 
> "Free" society means we have choices and make our own decisions...including the freedom to vote and have our say in politics/policies. Granted, politics always screws things up but, we're still more solid than 99% of the rest of the world.
> 
> ...



So you think it is OK for people to be denied medical treatment because they can not afford the insurance?


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## rescue99 (Dec 2, 2009)

downunderwunda said:


> So you think it is OK for people to be denied medical treatment because they can not afford the insurance?



Absolutely. In the right circumstances sure do!


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## rescue99 (Dec 2, 2009)

redcrossemt said:


> I'm still not sure what the difference between government and private run EMS agencies is in regards to finances... Both types of service lay off workers, shut down cars, buy less equipment, etc. when financial times get tough.
> 
> I agree that EMS should not be part of fire, and should stand alone for many reasons. However, I'm not convinced that governmental agencies, even EMS-only third services, can do any better job than the privates.



You're right...it is a bigger job than one entity can manage alone and the risks of doing business are equal to all parties.


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## Chimpie (Dec 2, 2009)

rescue99 said:


> Absolutely. In the right circumstances sure do!


Please list some examples of 'the right circumstances'.


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## rescue99 (Dec 2, 2009)

Chimpie said:


> Please list some examples of 'the right circumstances'.



Some mentions have already been made.


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## wolfwyndd (Dec 2, 2009)

rescue99 said:


> [snippage for brevity]
> It often decides who lives or dies through selective intervention.
> [snippage]


And how is that any different then the system we have now?  INSURANCE companies decide who lives and who dies by selective intervention.  "IE, WE don't think this intervention will benefit you so we're not going to approve / pay for it."


rescue99 said:


> NO...sociaized medicine isn't a good idea. It's costly and people die.


And let me repeat myself.  How is that any different then the system we have now?  The system we have now is costly and people die.  So, if we converted the American system to a socialized system, what will change?  NOTHING.  We will simply have DIFFERENT people making the same decisions.  I honestly don't like the idea of a FOR PROFIT employee making those decisions. (Theoretically) Gov't employees aren't keeping (as close) an eye on the bottom line as a FOR PROFIT insurance company.  I'd rather have someone like that making health decisions.  


rescue99 said:


> [snippage] . . . I am not interested in any opinion from someone who does not bother to cast their's. I'd bet that half the people demanding to be handed a freebie, doesn't bother to vote or isn't a citizen and has no right to make any demands. The other half deserve to be heard.


I agree that voting is a civic RESPONSIBILITY in the US, but just because they don't vote doesn't mean they can't voice their opinion.  Voting or not, freedom of speech extends to everyone.  When I signed up to defend my country, I didn't sign up to defend ONLY the US citizens that voted, I signed up to defend ALL US citizens.  At some point we have to look PAST our constitutionally provided rights and look at the HUMAN rights.  When I roll up on the scene of a gunshot victim my responsibility is scene safety first and treating that victim.  No where in my teaching or local protocol is 'check citizenship' addressed.  It's not there because it doesn't need to be there.  I believe that we need to cover the health care costs of EVERYONE in need, not just some.


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## rescue99 (Dec 2, 2009)

I agree that voting is a civic RESPONSIBILITY in the US said:
			
		

> Sure it does! Don't bother voting then don't complain. Do not try to excersise a right you already blew off. That time has passed. Freedom of speech is already expressed loud and clear the moment any of us decide to walk away from our privalege to help decide on matters that affect each of us, our community, state and our country.


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## JPINFV (Dec 2, 2009)

Chimpie said:


> Please list some examples of 'the right circumstances'.




Elective cosmetic surgery.

Diseases that are unambiguously the fault of bad decisions by the person.


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## VentMedic (Dec 2, 2009)

JPINFV said:


> Elective cosmetic surgery.


 
That could affect alot of our soldiers where their insurance have now agreed to surgeries that can restore them to a better appearance although they may not be medically necessary. The same for some prosthetics. 



JPINFV said:


> Diseases that are unambiguously the fault of bad decisions by the person.


 
There are many decisions made by people every day including driving a car that could also be considered "bad" if it was not for some absolute necessity. Also, should a child be denied because of the bad decisions of the parents? Maybe the babies born with the severe birth defects be euthanized or have medical care withheld since their parents did drugs and alcohol.  Look at the enormous cost for a Specialty team to transport one of these babies knowing they will never become productive citizens and will require millions of dollars in care during their lifetime.


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## JPINFV (Dec 2, 2009)

VentMedic said:


> That could affect alot of our soldiers where their insurance have now agreed to surgeries that can restore them to a better appearance although they may not be medically necessary. The same for some prosthetics.


Ok... what ever the terms that need to be used to differentiate between reconstructive surgery and a breast enhancement surgery or face lift. 



> There are many decisions made by people every day including driving a car that could also be considered "bad" if it was not for some absolute necessity. Also, should a child be denied because of the bad decisions of the parents? Maybe the babies born with the severe birth defects be euthanized or have medical care withheld since their parents did drugs and alcohol.  Look at the enormous cost for a Specialty team to transport one of these babies knowing they will never become productive citizens and will require millions of dollars in care during their lifetime.



There comes a point, though, where personal responsibility needs to come in to play. People shouldn't be able to get a free ride when there was things that they could have done to prevent injury and disease. Yes, things happen, but drunk drivers, for example, should be liable at the very least in part for the cost of the injuries they cause.


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## VentMedic (Dec 2, 2009)

JPINFV said:


> Ok... what ever the terms that need to be used to differentiate between reconstructive surgery and a breast enhancement surgery or face lift.


 
So it is okay for a male soldier to have a little work done to make whatever was damaged but if it is a female it is wrong even if it is done post accident or defect? The reconstruction to some function has been done at military hospitals but the question is do we leave them disfigured which would then fall into the catagory of comestic surgery by privately contracted specialists? I guess since you would call that cosmetic, these soldiers should just do without. 



JPINFV said:


> There comes a point, though, where personal responsibility needs to come in to play. People shouldn't be able to get a free ride when there was things that they could have done to prevent injury and disease. Yes, things happen, but drunk drivers, for example, should be liable at the very least in part for the cost of the injuries they cause.


 
Who is to be the judge on right or wrong? Marijuana may soon be legalized and where does that place those who you consider wrong the day before and the day after legalization? Drunk drivers can be held liable for the cost of injuries they cause but once they are in jail, their ability to pay is rather limited.  Anybody can be held liable by a court judgement for just about anything. 

If I work with an EMS partner who smokes and develop some airway disorder like Asthma or COPD, who is responsible? Should I requested he stop smoking when working on the truck and at the station even if it is his right to smoke? (Yes, in some areas you can still smoke even when driving the ambulance.) We all know we don't want to impinge upon the rights of the smoker. If you over eat and are overweight should you pay the full costs of your medical bills for your MI and should the ambulance have the right to refuse to treat your chest pain because you are fat? Who will be the judge and jury? 

For the hospitals, private companies and FDs that have banned smokers and have instituted fitness programs, there will always be those to criticize and justify their "rights" to do whatever.


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## rescue99 (Dec 2, 2009)

VentMedic said:


> That could affect alot of our soldiers where their insurance have now agreed to surgeries that can restore them to a better appearance although they may not be medically necessary. The same for some prosthetics.
> 
> 
> 
> There are many decisions made by people every day including driving a car that could also be considered "bad" if it was not for some absolute necessity. Also, should a child be denied because of the bad decisions of the parents? Maybe the babies born with the severe birth defects be euthanized or have medical care withheld since their parents did drugs and alcohol.  Look at the enormous cost for a Specialty team to transport one of these babies knowing they will never become productive citizens and will require millions of dollars in care during their lifetime.



Now  you're being silly. War injuries and children are victims of events. Drunks who falll down go boom is not an plausable excuse to get a new nose! Choosing to be a welfare queen is not a plausable excuse to stay that way. Fields need picking and streets need cleaning....earn the medical coverage!

I'll am happy to pay my share of taxes to bridge those who cannot help themselves due to significant illness, injury, age, accident or unavoidable circumstance. I would be more than happy to bridge those who help themselves. Paying for drunks, druggies and those who won't help themselves is not what our programs were ever meant to support.


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## VentMedic (Dec 2, 2009)

rescue99 said:


> Now you're being silly. War injuries and children are victims of events. Drunks who falll down go boom is not an plausable excuse to get a new nose! Choosing to be a welfare queen is not a plausable excuse to stay that way. Fields need picking and streets need cleaning....earn the medical coverage!
> 
> I'll am happy to pay my share of taxes to bridge those who cannot help themselves due to significant illness, injury, age, accident or unavoidable circumstance. I would be more than happy to bridge those who help themselves. Paying for drunks, druggies and those who won't help themselves is not what our programs were ever meant to support.


 
*I am ABSOLUTELY NOT being silly.*

These are ethical questions discussed everyday in every NICU in this country as well as others. What do we or should we consider viable? We also discuss these everyday when trying to approach end of life issue for the very young, the very old and the very ill. This is NOT a laughing matter just because YOU don't always see the bigger picture. 

And, as for as the soldiers, that again is a very big issue. We will fix the injuries to a better appearance and function of our enemies because their countries will pay for a specialty here but will not always give our own soldiers the same opportunity because a specialist may not be covered. 

EMS education is so very limiting and some do not do enough reading to see the bigger picture of medicine. The only few situations that some look at are their "worst BS" patient but yet few may actually know the extent of their diseases. How about those in EMS and the FDs that suck up benefits for being over weight or just fat and then claiming "on the job injury" but yet probably aren't fit to even be do the job? For some, they should be held at a higher standard and be responsible for their own blunders since they should know better.


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## JPINFV (Dec 2, 2009)

VentMedic said:


> So it is okay for a male soldier to have a little work done to make whatever was damaged but if it is a female it is wrong even if it is done post accident or defect? The reconstruction to some function has been done at military hospitals but the question is do we leave them disfigured which would then fall into the catagory of comestic surgery by privately contracted specialists? I guess since you would call that cosmetic, these soldiers should just do without.



There's a difference between reconstructive/plastic surgery secondary to injury or disability and there's a difference between a similar surgery because someone is unhappy with their looks. I almost can't believe that you would compare reconstructive surgery secondary to burns on the same level as going from a 34AA to 34C. 


> Who is to be the judge on right or wrong? Marijuana may soon be legalized and where does that place those who you consider wrong the day before and the day after legalization? Drunk drivers can be held liable for the cost of injuries they cause but once they are in jail, their ability to pay is rather limited.  Anybody can be held liable by a court judgement for just about anything.


What's the alternative then? On demand healthcare at the expense of the tax payers? Oh, sorry you were a complete idiot and was a drunk driver. The government (read: taxpayers) will pay for you until you get back on your feet. Never mind not drunk driving in the first place. 

...and yes. As long as marijuana is illegal, people need to not smoke. Now, yes, this becomes a problem in medical marijuana states with the current issues between local laws, federal laws, and just how far the commerce clause can be stretched. However, it's the duty of citizens to follow the law outside of egregious miscarriages of justice. Civil disobedience is one thing for civil rights and a completely different issue for things like which mind altering substances the government will let citizens use.  



> If I work with an EMS partner who smokes and develop some airway disorder like Asthma or COPD, who is responsible? Should I requested he stop smoking when working on the truck and at the station even if it is his right to smoke? (Yes, in some areas you can still smoke even when driving the ambulance.) We all know we don't want to impinge upon the rights of the smoker. If you over eat and are overweight should you pay the full costs of your medical bills for your MI and should the ambulance have the right to refuse to treat your chest pain because you are fat? Who will be the judge and jury?
> 
> For the hospitals, private companies and FDs that have banned smokers and have instituted fitness programs, there will always be those to criticize and justify their "rights" to do whatever.



Since when is smoking a right? The smoker should be able to abide by simple requests, such as limiting smoking to outside, including not in the vehicle. 

Who's to decide what is medical necessary then? Should I be able to demand and receive any medical procedure that I want at the expense of the tax payers? If I want a third ear grafted onto my chest, why shouldn't I get it at no direct cost to me if all medical procedures are considered a right?


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## VentMedic (Dec 2, 2009)

JPINFV said:


> There's a difference between reconstructive/plastic surgery secondary to injury or disability and there's a difference between a similar surgery because someone is unhappy with their looks. I almost can't believe that you would compare reconstructive surgery secondary to burns on the same level as going from a 34AA to 34C.


 
Most "true cosmetic surgeries" are self pay. I have yet to know of an insurance that pays for one.  However, injuries can also be discriminated against because of the "cosmetic" surgery misunderstanding such as what you are failing to see.  For many decades, many vets have not be able to have any form of this surgery by a specialist and have had to live with some pretty disfiguring injuries because they couldn't afford to pay cash. 





JPINFV said:


> What's the alternative then? On demand healthcare at the expense of the tax payers? Oh, sorry you were a complete idiot and was a drunk driver. The government (read: taxpayers) will pay for you until you get back on your feet. Never mind not drunk driving in the first place.


 
Do you not understand the criminal and civil law alternatives in this country?  The person is tried, convicted and can be held liable for their actions.   If we don't imprison the person then the system is being too easy and if we do they don't earn money to pay.  






JPINFV said:


> ...and yes. As long as marijuana is illegal, people need to not smoke. Now, yes, this becomes a problem in medical marijuana states with the current issues between local laws, federal laws, and just how far the commerce clause can be stretched. However, it's the duty of citizens to follow the law outside of egregious miscarriages of justice. Civil disobedience is one thing for civil rights and a completely different issue for things like which mind altering substances the government will let citizens use.


 
So why did you move to California?




JPINFV said:


> Since when is smoking a right? The smoker should be able to abide by simple requests, such as limiting smoking to outside, including not in the vehicle.


 
How many have argued this on this forum already?  You should very well know where I stand on the issue.  As long as it is legal in an area, they DO NOT have to put out that cigarette just because you are present and some will take that to test.



JPINFV said:


> Who's to decide what is medical necessary then? Should I be able to demand and receive any medical procedure that I want at the expense of the tax payers? *If I want a third ear grafted onto my chest*, why shouldn't I get it at no direct cost to me if all medical procedures are considered a right?


 
Now who is being ridiculous?  Again, cosmetic surgery is largely self pay...that means the person pays cash and no insurance.   However, even for events of war and "accidents", the insurance may only have to pay to get you to functioning and NO MORE.  You can still find work if your face is scarred.   However, what some would like is to see our soldiers do get the benefit of being the best they can still be after being severely disfigured but again, for decades out country has not felt that way.  Now, they are become somewhat more lenient and referring out. However, if some like yourself have a say these soldiers should just be happy with what they got already and go away.


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## rescue99 (Dec 2, 2009)

VentMedic said:


> *I am ABSOLUTELY NOT being silly.*
> 
> These are ethical questions discussed everyday in every NICU in this country as well as others. What do we or should we consider viable? We also discuss these everyday when trying to approach end of life issue for the very young, the very old and the very ill. This is NOT a laughing matter just because YOU don't always see the bigger picture.
> 
> ...



Number 1 Vent, we (hubby and me) are the parents 2 of the sort of ill children you mention, not just a unit worker. We've made decisions no parent should ever have to make more than once. We've let God's will be done and we've chosen to risk the odds. My view would never be the same as your's nor could a mere worker even come close to saying he/she comprehends what it's like unless he/she too, has walked the same mile. I've taken my voice to Lansing and spoken to our leaders, pushed for more education on life planning for multiply impaired children. THAT...is seeing the bigger picture! 

Secondly, soldiers are covered by VA benefits, which is not what we're talking about. VA has their own set of rules and those are improving each and everyday finally. It's been a long time coming. Our nation is getting better, making improvements. Thanks to huge public demands, our soldiers are starting to receive better treatment. I've been in D.C. attending Veteran's Day rallies..I see what the voices can do. Just wish it didn't take so many rallies to be heard though. At least we are being heard eventually. 

What about EMS, Fire and PD? That's private insurance, which is employer provided. Those rules are negotiated and set by the employer, insurance provider and employee representatives. Citizens have every oportunity to attend meetings when municipale matters are being discussed. 2nd and 4th  Tuesday (here) of every month 7 P.M.!! Be there or be square! Voice an opinion! Some policies are set in provider's stone while others are settled in talks. Citizens have a voice..use it or lose it.


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## VentMedic (Dec 2, 2009)

rescue99 said:


> Number 1 Vent, we (hubby and me) are the parents 2 of the sort of ill children you mention, not just a unit worker. We've made decisions no parent should ever have to make more than once. We've let God's will be done and we've chosen to risk the odds. My view would never be the same as your's nor could a mere worker even come close to saying he/she comprehends what it's like unless he/she too, has walked the same mile. I've taken my voice to Lansing and spoken to our leaders, pushed for more education on life planning for multiply impaired children. THAT...is seeing the bigger picture!


 
Then you should know that this is not "silly stuff". We deal everyday in the NICU as to whether a 22 or 23 week baby should be resuscitated. The parents look to the doctor and not always God in a time of immediate crisis. There is often not time to wait for a sign for God since we must either begin resuscitation and put the baby on life support or back off. We do however know how much it will cost if that baby goes on life support. 




rescue99 said:


> Secondly, soldiers are covered by VA benefits, which is not what we're talking about. VA has their own set of rules and those are improving each and everyday finally. It's been a long time coming. Our nation is getting better, making improvements. Thanks to huge public demands, our soldiers are starting to receive better treatment. I've been in D.C. attending Veteran's Day rallies..I see what the voices can do. Just wish it didn't take so many rallies to be heard though. At least we are being heard eventually.


 
Why is it not what we are talking about? Aren't they entitled to specialists that are not always within the VA system? Rallies are great but there are veterans who would like to have their insurance reexamine their rights to go outside the system for some things and to recognize that some surgery should not be frowned upon because some think it is "cosmetic" or that they can get along fine with a WC so there is not need for any prosthetics.

Also, like post Vietnam, we will again see many of these young veterans on the street. They will be at the mercy of EMS providers who will consider them just some BS drunk or druggie or nut cases who are not worthy of any treatment or even the time of day from some in EMS. 



rescue99 said:


> What about EMS, Fire and PD? That's private insurance, which is employer provided. Those rules are negotiated and set by the employer, insurance provider and employee representatives. Citizens have every oportunity to attend meetings when municipale matters are being discussed. 2nd and 4th Tuesday (here) of every month 7 P.M.!! Be there or be square! Voice an opinion! Some policies are set in provider's stone while others are settled in talks. Citizens have a voice..use it or lose it.


 
But why are some in EMS wanting the public held to a different standard of health than what some themselves can not adhere to? Some EMS workers smoke, drink and are fat. They have habits that should be controlled but if JP is correct, they should not be allowed to suck up workmen's comp or raise insurance rates which is passed on to all either. There have been numerous times when we have done the cardiopulmonary testing for fitness, insurance and workmen's comp claims for EMS/FD providers and many should not be working but often do squeak by the low standards provided by some agencies. Others beg us to fail them so they can suck up a few more months of disability insurance.


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## rescue99 (Dec 2, 2009)

VentMedic said:


> Then you should know that this is not "silly stuff". We deal everyday in the NICU as to whether a 22 or 23 week baby should be resuscitated. The parents look to the doctor and not always God in a time of immediate crisis. There is often not time to wait for a sign for God since we must either begin resuscitation and put the baby on life support or back off. We do however know how much it will cost if that baby goes on life support.
> 
> 
> 
> ...



I know for a fact VA sends people outside for services they cannot provide. 
You're wrong about that. I have transported dozens and dozens myslef. 

EMS, PD and Fire...again, provider, employer and employee negotiated. 

You want change? Join your local civic organizations. Hack, be a volunteer! Get elected to your local board of trustees and start working on change. When yer done there..head to the state house then to D.C. Be active and help make a difference. ^_^


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## wolfwyndd (Dec 3, 2009)

rescue99 said:


> Sure it does! Don't bother voting then don't complain. Do not try to excersise a right you already blew off. That time has passed. Freedom of speech is already expressed loud and clear the moment any of us decide to walk away from our privalege to help decide on matters that affect each of us, our community, state and our country.


ANY of our Bill of Rights, including the right to freedom of speech, freedom of religion and our '5th amendment' rights can be exercised AT WILL.  If you give up one in one circumstance, you can exercise that right 30 second from now.  So despite the fact that you didn't vote, you still have the right to voice your opinion and go worship whereever and however you choose.  

Given your argument once someone gives up that right ONCE then they can never decide to vote again.  I know a lot of women who did not vote in the last presidential election, does that mean we should take away their right to vote?  Let's just repeal the 19th amendment, it's only been around for 100 years.  If they don't vote, they won't miss it, right?  I skipped church, does that mean I give up my right to practice my religion?  Come on now.


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## VentMedic (Dec 3, 2009)

rescue99 said:


> I know for a fact VA sends people outside for services they cannot provide.
> You're wrong about that. I have transported dozens and dozens myslef.
> 
> EMS, PD and Fire...again, provider, employer and employee negotiated.


 
I have worked for both the VA and the hospitals that receive these patients. I have done the VA's 12 hours transports to another facility and often it is not for the reasons you think. Only a few make it through the system to be transferred and that is generally because of bed availability rather than need of the patient. A few TBIs are now going to the appropriate centers and we did get a couple of hand reconstructions but the wife's private insurance was listed as the primary and not the soldier's VA benefits.

The very few patients that you transport are not the only veterans in need of specialized care and frankly the VA system is overwhelmed right now. Chances are they were just shuffling the patients rather than determining appropriateness for a level of care. Not all rehabs centers are equal and not all plastic/reconstructive surgeons are equal. 



rescue99 said:


> You want change? Join your local civic organizations. Hack, be a volunteer! Get elected to your local board of trustees and start working on change. When yer done there..head to the state house then to D.C. Be active and help make a difference. ^_^


 
Been there and done that. Why do you think I have given out links to meetings and national organizations? I belong to various organizations and committees as do some of the other seniors on this forum (or no longer) who have sought change. But, it is those who refuse to see any problem with any health care system including EMS that are our own worst enemies when it comes to change. I seem to be wasting time even discussing these issues since some in EMS have made up their mind they are in a perfect world and even though belief in God is good, it isn't enough to change the health care system.


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## eynonqrs (Dec 8, 2009)

Well here is some of my insight for what it's worth:

In my area where I am from there are 3 private services. A long time ago, the City of Scranton Fire used to run an ambulance service. Dunmore Fire Ran an ambulance. CMC and Mercy Hospital ran hospital based MICU's. There were volunteer ambulances that were part of fire companies. And guess what ? They are no longer. 911 calls do not make money, IFT's do. I work for a private service as a dispatcher. We do 911's for the city of Scranton, Dunmore, ALS intercepts with BLS paid and volunteer units. There are nights that we don't do hardly any 911, but we do alot of IFT's, and then it can be the reverse. How can a service that only does 911 survive when you know as well as I do that in some areas you get "self pay" or insurance that dosen't pay squat, therefore you need IFT's to pay the bills and salaries. Yes there are private companies that are greedy, there are those that good too. The grass sometimes is greener on the other side. People here are complaining that volunteers keep paid salaries down. That is not true. If you sat down and figured out how much it costs to run an ambulance service it would blow your mind + low insurance reimbursment + other factors. I agree 100% that the fire service should not have a hand in EMS. Like I stated before there were fire dept's in my area that had ambulances and dumped them. Now they want them back. Why ? Because they want to save their own jobs or to by shinny new toys.


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## rescue99 (Dec 8, 2009)

eynonqrs said:


> Well here is some of my insight for what it's worth:
> 
> In my area where I am from there are 3 private services. A long time ago, the City of Scranton Fire used to run an ambulance service. Dunmore Fire Ran an ambulance. CMC and Mercy Hospital ran hospital based MICU's. There were volunteer ambulances that were part of fire companies. And guess what ? They are no longer. 911 calls do not make money, IFT's do. I work for a private service as a dispatcher. We do 911's for the city of Scranton, Dunmore, ALS intercepts with BLS paid and volunteer units. There are nights that we don't do hardly any 911, but we do alot of IFT's, and then it can be the reverse. How can a service that only does 911 survive when you know as well as I do that in some areas you get "self pay" or insurance that dosen't pay squat, therefore you need IFT's to pay the bills and salaries. Yes there are private companies that are greedy, there are those that good too. The grass sometimes is greener on the other side. People here are complaining that volunteers keep paid salaries down. That is not true. If you sat down and figured out how much it costs to run an ambulance service it would blow your mind + low insurance reimbursment + other factors. I agree 100% that the fire service should not have a hand in EMS. Like I stated before there were fire dept's in my area that had ambulances and dumped them. Now they want them back. Why ? Because they want to save their own jobs or to by shinny new toys.



You are absolutely correct. ALS Fire is, and always has been about job security. Can't blame them for trying I suppose.


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