# Stat EMS (Flint): Don't send the closest ambulance



## Hockey (Jul 9, 2012)

This place is a joke.  And their lawsuit is proving it

GENESEE COUNTY, MI -- A Genesee County Circuit Court judge could decide whether 911  dispatchers continue to send the closest available ambulance to emergencies -- regardless of whether another company has a contract to serve the area.

STAT EMS has asked Judge Geoffrey Neithercut to require the county 911 Consortium to end its practice of sending the closest ambulance to calls for help when local service  contracts are in place.


Read More:
http://www.mlive.com/news/flint/index.ssf/2012/06/stat_ems_asks_judge_to_require.html


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## Anjel (Jul 9, 2012)

Hockey said:


> This place is a joke.  And their lawsuit is proving it
> 
> GENESEE COUNTY, MI -- A Genesee County Circuit Court judge could decide whether 911  dispatchers continue to send the closest available ambulance to emergencies -- regardless of whether another company has a contract to serve the area.
> 
> ...



Wow.

I would never in a million years work for them.

And just so others can enjoy. This is what their ambulances look like....


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## usalsfyre (Jul 9, 2012)

Ehhh, its sensationalized and doesn't really tell enough to make a judgement. What if the other company only keeps a basic level truck in town vs an ALS truck that the original company provides, and back up is only a couple of minutes farther out? There are compelling reasons to stay with a single provider at times. Without more info I'll reserve judgement.


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## DrParasite (Jul 9, 2012)

I don't see a problem with this.  at all.

A city or county has an ambulance service.  they know who they have, they know the training.  they even contract with them, so that company is responsible for EMS coverage, and are paid as a result for providing the service.  as a result, why shouldn't they get the calls?

patient care has nothing to do with it.

If the "closest ambulance" policy were to happen, than any ambulance service can set up in town and start taking 911 calls.  Think of every FD based EMS system; if you want to start taking calls, just put an office in their first due, and you will get all the calls.

Forget accountability, it's a potential for disaster.  With one company, than in theory you have one set of rules, and everyone is playing by the same rules.  one chain of command.  no matter what ambulance shows up, you will be treated and billed the same.  uniformity is a good thing.

As a general rule, I'm 100% in favor of closest ambulance goes.  But having rouge and random ambulance services just hopping in and taking 911 calls from the AHJ (who is being paid to provide said service) is just plain wrong.


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## medicdan (Jul 9, 2012)

DrParasite said:


> I don't see a problem with this.  at all.
> 
> A city or county has an ambulance service.  they know who they have, they know the training.  they even contract with them, so that company is responsible for EMS coverage, and are paid as a result for providing the service.  as a result, why shouldn't they get the calls?
> 
> ...


I absolutely agree, with one caveat, of course. If the problem is that the contracted ambulane service isn't maintaining trucks in the service area, or consistently isn't meeting response time guidelines, this would make sense. It seems that the variation in response time between services in seconds, or >2min. 
As with any municipal contact with a private service, it should remain the responsibility of the contracted service to call for assistance if they need it, or activate a set mutual aid system through the dispatch center... 

How is the dispatcher seeing where the MMR rigs are in relation to the calls?


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## Anjel (Jul 9, 2012)

emt.dan said:


> I absolutely agree, with one caveat, of course. If the problem is that the contracted ambulane service isn't maintaining trucks in the service area, or consistently isn't meeting response time guidelines, this would make sense. It seems that the variation in response time between services in seconds, or >2min.
> As with any municipal contact with a private service, it should remain the responsibility of the contracted service to call for assistance if they need it, or activate a set mutual aid system through the dispatch center...
> 
> How is the dispatcher seeing where the MMR rigs are in relation to the calls?




The system is horrible. Currently the dispatchers have to call services, ask if they have a close car. Services lie, say they do, because they need business

I think gen. County needs contracts. But not with Stat. They are the trashiest unprofessional service out there.

There are at least 6-7 privates in that area. They are all shady. Like usalfyre said. 

Anyone comes in and starts taking calls, because they are the "closest". 

There needs to be contracts, with minimum staffing guidelines.


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## Anjel (Jul 9, 2012)

Also, no one regulates ALS or BLS. 

Outside my paramedic class a lady was having a stemi. My teacher had done the 12 lead, and called 911.

A bls truck from stat was sent, because they were the closest. But they had told the dispatcher they were sending ALS.


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## DrParasite (Jul 9, 2012)

Anjel1030 said:


> Also, no one regulates ALS or BLS.
> 
> Outside my paramedic class a lady was having a stemi. My teacher had done the 12 lead, and called 911.
> 
> A bls truck from stat was sent, because they were the closest. But they had told the dispatcher they were sending ALS.


Not for nothing, but this is either a State Dept of Health problem, or a county issue (if the ambulance is indeed lying to the 911 dispatcher).  

BLS shows up first, loads the patient, and starts going to the hospital (meeting ALS enroute).

or BLS shows up, goes straight to the hospital with the stemi paperwork in hand.

either way, it's better than waiting for an ambulance and having no ambulance show up for an extended period of time.

Plus, you have at least people trying to get the information. 1) the caller, 2) the 911 dispatcher 3) the ambulance dispatcher, all trying to get info, all hoping the other person is telling the accurate information.

Want to fix the problem?   do what Wake Co NC did, have create a county run and county funded EMS system.  it costs money, but you tend to raise standards, especially with good pay and consistent rules.  Or you can keep using the "shady privates" that keep popping up, and having one dispatch center lying to another in order to get the job, etc.  But remember, in order to do a good job, the government is going to have to spend money, and be held accountable for any problems.


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## OzAmbo (Jul 9, 2012)

Anjel1030 said:


> Wow.
> 
> I would never in a million years work for them.
> 
> And just so others can enjoy. This is what their ambulances look like....


I actually look at that and think "wow, hi visibility... wouldn't mind more dayglo on my own truck"


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## medicdan (Jul 9, 2012)

STAT must be doing something right... it looks like they have CAAS accreditation.


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## Anjel (Jul 9, 2012)

The entie EMS system in the Flint area is a mess. 

There are so many things wrong with the system.

I am not blaming Stat. But to think, they want to take over, is a scary thought. They are a bad company. Plain and simple.

And everyone in Gen. Co is CAAS. 

I think it should always be the closest ambulance sent. There is talks about gps devices in all vehicles, so that the 911 dispatcher can see where the closest car is. 

I think that may be the best solution, besides solid contracts.


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## Tigger (Jul 10, 2012)

I can't say I've ever heard of any county or town entering into an ambulance contracts with six separate companies, that seems absurd. Put the contract out to bid, give it one company. If they can't hack the requirements, dump them. That's how most of private EMS works.


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## ffemt8978 (Jul 10, 2012)

Tigger said:


> I can't say I've ever heard of any county or town entering into an ambulance contracts with six separate companies, that seems absurd. Put the contract out to bid, give it one company. If they can't hack the requirements, dump them. That's how most of private EMS should work.



Fixed that for you.


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## rwik123 (Jul 10, 2012)

OzAmbo said:


> I actually look at that and think "wow, hi visibility... wouldn't mind more dayglo on my own truck"



Is it just me or is that rig lacking a lightbar.


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## DrParasite (Jul 10, 2012)

Tigger said:


> I can't say I've ever heard of any county or town entering into an ambulance contracts with six separate companies, that seems absurd. Put the contract out to bid, give it one company. If they can't hack the requirements, dump them. That's how most of private EMS works.


cough cough: FDNY/New York City EMS/Voluntary EMS System: cough cough


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## ffemt8978 (Jul 10, 2012)

rwik123 said:


> Is it just me or is that rig lacking a lightbar.



I didn't see it either, but with that paint job it's hard to tell for sure.


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## TRSpeed (Jul 10, 2012)

Wtf this would be a total disaster. I'm just thinking of how this would work in Los Angeles. Haha with literally over 50 ambo companies. I would never want to call 911 there.

Its hard enough keeping one ambulance company in check. Now imagine any Joe shmo company responding to a 911 because they are closer. It will be nearly impossible to monitor.


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## OzAmbo (Jul 10, 2012)

rwik123 said:


> Is it just me or is that rig lacking a lightbar.


How many lights do we actually need?

Perhaps EMS should stop looking at the number of flashy lights on your vehicles that blind drivers off the road and produce livery that is actually visible


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## Anjel (Jul 10, 2012)

TRSpeed said:


> Wtf this would be a total disaster. I'm just thinking of how this would work in Los Angeles. Haha with literally over 50 ambo companies. I would never want to call 911 there.
> 
> Its hard enough keeping one ambulance company in check. Now imagine any Joe shmo company responding to a 911 because they are closer. It will be nearly impossible to monitor.



And then throw in that Flint is the murder capital.


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## Christopher (Jul 10, 2012)

DrParasite said:


> Want to fix the problem?   do what Wake Co NC did, have create a county run and county funded EMS system.  it costs money, but you tend to raise standards, especially with good pay and consistent rules.



To be fair to other systems, NC does things a bit differently. In NC it is the County's responsibility to provide EMS to its citizens and you get 1 medical director per county. The county can choose to contract it out or they can run it themselves. Regardless, It doesn't matter how many services provide 911 at any level, you still answer to 1 medical director.

So while Wake County has a "county run" system, they still have non-Wake County units providing 911 ALS care (Apex, Cary, and Eastern Wake). However, these units must answer to the same medical director.

In one of the counties I work we have a county based ALS system, plus 2 FD's providing ALS and a number of rescue squads providing BLS or ILS. All paramedic units in the county run on "closest unit dispatch," regardless of affiliation. So if it is 3am and my ALS FD truck is the closest unit to a call 20 miles away in the county, I'm getting woken up to run that call.

This all requires coordination, and I'm not saying we played nice to get where we are today, but it seems to work.


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## WuLabsWuTecH (Jul 10, 2012)

DrParasite said:


> I don't see a problem with this.  at all.
> 
> A city or county has an ambulance service.  they know who they have, they know the training.  they even contract with them, so that company is responsible for EMS coverage, and are paid as a result for providing the service.  as a result, why shouldn't they get the calls?
> 
> ...



It can be done, and it's what we do here.  In the county there are probably about 20ish different fire departments.  We run on an "automatic aid" agreement with each other which means that the closest unit goes regardless of who's jurisdiction it is.  We all have similar SOGs and Protocols and as far as chain of command goes, the first due has command until the AHJ shows up and there is a chance to turn it over.  For some calls, the AHJ may never show up or if they do, the command won't ever be turned over and that's ok.  The Fire Chiefs in the county have sat down and agreed on a set of rules that everyone plays by and came up with uniformity agreements (a Medic has to have at least XYZ on it, otherwise it's a squad, a Rescue has to have ABC on it, otherwise it's just an engine, etc...)

I don't know if it the privates are able or willing to do this, but we seemed to turn out all right here in our county to have this closest unit goes thing...


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## CentralCalEMT (Jul 10, 2012)

Tulare County in Central California has a system where all the private units are turned over to a county wide dispatch system. (With the exception of portions of southern Tulare County in which case Kern County units are closer and respond as mutual aid.) All the Tulare County EMS units have a county GPS, radio and MDT. The entire county runs as a single system status management system. This means that county dispatchers both dispatch and post units as they see appropriate no matter what city you started in. There are, I believe, 5 private companies and 1 fire department that transport and the closest unit goes regardless. It is not a perfect system but at least when one city is busy and another is slow, units can be shifted around so no area is completely uncovered.


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## Christopher (Jul 10, 2012)

DrParasite said:


> If the "closest ambulance" policy were to happen, than any ambulance service can set up in town and start taking 911 calls.  Think of every FD based EMS system; if you want to start taking calls, just put an office in their first due, and you will get all the calls.
> 
> Forget accountability, it's a potential for disaster.  With one company, than in theory you have one set of rules, and everyone is playing by the same rules.  one chain of command.  no matter what ambulance shows up, you will be treated and billed the same.  uniformity is a good thing.
> 
> As a general rule, I'm 100% in favor of closest ambulance goes.  But having rouge and random ambulance services just hopping in and taking 911 calls from the AHJ (who is being paid to provide said service) is just plain wrong.



Funny enough this was what the county said when my FD decided to go Paramedic level. We already provided ILS response to our fire district and chased the county Paramedic crews. Our Chief decided that going Paramedic level was the right thing for the citizens in our area. The county was not pleased.

Now, did our department just up and start taking 911 calls as paramedics? No. We went step by step through a process of integrating into the County system, meeting every educational/procedural requirement through the County medical director, and since December 2008 we've provided 911 ALS care as part of the "closest available unit" system.

I believe if there is centralized medical control and a procedure in place for assuming a chunk of the 911 burden, then anybody and everybody who wishes to provide care should be allowed. You don't need one company, or even one provider. You just need one set of standards.


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## truetiger (Jul 13, 2012)

This is why I'm a fan of the "one third service per county" idea. Keeps everyone on the same page. Recently I've given a private service a try on a part-time basis and absolutely hate it. My main employer is a third service that is a county district and is the only recognized provider in the county. We have one dispatch and send the closest unit. No delay in transferring the calls, no one lying about locations to snag a call, and being the only guys in town allows us to maintain good working relationships with all the fd's. The private service I've been moonlighting at is horrible. There is a huge response delay. It is not uncommon to have the ALS pumper from the city fd on scene just as we are dispatched. The working relationship with the city FD is horrible. They want to take over the ambulance service as a way of funding and they make it clearly known that they do not want us in their sandbox. Patient care suffers as a result.


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