# What do you think of this?



## Fish (Oct 13, 2011)

Have you read this article yet?

http://www.jems.com/article/news/philadelphia-official-ems-response-still

What do you think of the budget distrobution of the Fire Budget?

Do you think that the recomended 70 Ambulances is the Answer?

That is crazy that Medic 8 runs over 9k calls a year, it takes 4 ambulances to run that many calls in most systems!


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## bigbaldguy (Oct 13, 2011)

That's 25 calls a day average, how is that even possible?


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## DrParasite (Oct 13, 2011)

Fish said:


> What do you think of the budget distrobution of the Fire Budget?


that's typical in FD based EMS systems.  EMS units run the bulk of the calls, but only get a fraction of the funding.


Fish said:


> Do you think that the recomended 70 Ambulances is the Answer?


absolutely.  they need more ambulances to handle the call volume.  Whether it means adding a BLS division or just added more ambulances, it needs to be done.





Fish said:


> That is crazy that Medic 8 runs over 9k calls a year, it takes 4 ambulances to run that many calls in most systems!


The top 10 in 2009 are:

1. Philadelphia, PA....................................... M8.............................. 9,011
2. Baltimore City, MD.................................. M7.............................. 8,063
3. Chicago, IL...............................................A10.............................. 7,931
4. St. Louis, MO.......................................... M10.............................. 5,928
5. Toledo, OH............................................ RA17.............................. 5,886
6. Paterson, NJ..............................................A91.............................. 5,839
7. Miami-Dade County, FL...........................R2.............................. 5,663
8. Orlando, FL.................................................R2.............................. 5,570
9. Washington, DC......................................A10.............................. 5,443
10. Cincinnati, OH........................................A12.............................. 5,439

and that's not including my agency, which i'm sure would place in the top 10 if we submitted our numbers, but like a lot of system that are short staffed on the admin side, we don't.

they also need a better dispatch system, to send units by priority and not by who calls in first.  but the biggest thing is still they need more ambulances, more staff, and more units to handle the call volume.


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## Fish (Oct 13, 2011)

I believe more Units, with most of them being BLS and a Priority Dispatch system with proper system status management would be a great benefit. That being said, they are losing Medics, retention needs to be a focus.


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## Fish (Oct 13, 2011)

bigbaldguy said:


> That's 25 calls a day average, how is that even possible?



Extremely fast turn arounds, this Ambulance might be stationed out of a Hospital, or it has one right down the road from its station that has Trauma, Stroke, and Cath capabilities. That way they don't travel far for their patients.


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## DrParasite (Oct 14, 2011)

bigbaldguy said:


> That's 25 calls a day average, how is that even possible?


as I said in another thread, that's nothing.  Our busiest units can do 20 assignments in 12 hours, including RMAs, cancels, and ambulatory patients who meet you at the curb and you drop off in triage.

btw, my list of the top 10 busiest ambulances isn't the top 10 busiest in the US.  those are just the top 10 busiest Fire Department-based ambulances.  it doesn't count any private service, hospital based, or municipal EMS system, some of which are probably busier than those listed.


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## Fish (Oct 14, 2011)

I am glad we run nowhere near that many, I was extremely busy in CA. So glad to be away from that.


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## systemet (Oct 14, 2011)

bigbaldguy said:


> That's 25 calls a day average, how is that even possible?



I had a friend who worked there about 10 years ago.  They were driving huge freightliners (can't imagine a more impractical vehicle to do inner-city EMS in.  Well, maybe a fire truck), and had a ridiculous amount of equipment on each truck so they didn't need to restock that often.

Their PCR was a one-page check box.  The space for their narrative was about 3-4 lines, and most of my friend's narratives consisted of "found pt. apenic, gave 4mg narcan IM, patient ran away".

And they have a ridiculous amount of hospital resources condensed into a really small area.  So transport times were a non-issue.  Turnover was quick.  Paperwork was minimal.  And there was an extremely high percentage of cancellations.

From my friend's stories, it sounded like a great place to do a lot of skills, get horribly burned out, learn some appalling patient care habits, and fry yourself crispy.  The general goal seemed to be to get a bit of seniority and apply for a promotion (!) to firefighter, with a pay increase (!).

[Of course, I'm sure there are people who thrive in this environment, and I regard my friend as being a good paramedic.  I just couldn't imagine working 30 years in that system and not becoming a raging alcoholic or worse.]


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## Fish (Oct 14, 2011)

systemet said:


> I had a friend who worked there about 10 years ago.  They were driving huge freightliners (can't imagine a more impractical vehicle to do inner-city EMS in.  Well, maybe a fire truck), and had a ridiculous amount of equipment on each truck so they didn't need to restock that often.
> 
> Their PCR was a one-page check box.  The space for their narrative was about 3-4 lines, and most of my friend's narratives consisted of "found pt. apenic, gave 4mg narcan IM, patient ran away".
> 
> ...



Was the pay and retirement decent though?


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## dixie_flatline (Oct 14, 2011)

systemet said:


> Their PCR was a one-page check box.  The space for their narrative was about 3-4 lines, and most of my friend's narratives consisted of "found pt. apenic, gave 4mg narcan IM, patient ran away".



I just choked on my lunch for the second time in as many minutes.


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## dixie_flatline (Oct 14, 2011)

Fish said:


> Extremely fast turn arounds, this Ambulance might be stationed out of a Hospital, or it has one right down the road from its station that has Trauma, Stroke, and Cath capabilities. That way they don't travel far for their patients.



In quarters, Medic 7 in Bawlmore City is approximately 1.1 miles from Johns Hopkins, which is, let's see - a level 1 trauma center, the regional peds trauma center, the eye center, and just about everything else a hospital can be.

If things are bad at Hopkins, they're less than a mile from Mercy, and less than 2 from Shock Trauma.  2.5 to the Hand Center (Union Memorial), and just under 4 to the Burn Center at Hopkins Bayview.  So yeah, they have every specialty center pretty much in their back yard.

Plus, if you've never been to Hopkins before, it borders on some decidedly not-so-nice neighborhoods (which is pretty much all of Baltimore City, but I digress).


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## Fish (Oct 14, 2011)

dixie_flatline said:


> In quarters, Medic 7 in Bawlmore City is approximately 1.1 miles from Johns Hopkins, which is, let's see - a level 1 trauma center, the regional peds trauma center, the eye center, and just about everything else a hospital can be.
> 
> If things are bad at Hopkins, they're less than a mile from Mercy, and less than 2 from Shock Trauma.  2.5 to the Hand Center (Union Memorial), and just under 4 to the Burn Center at Hopkins Bayview.  So yeah, they have every specialty center pretty much in their back yard.
> 
> Plus, if you've never been to Hopkins before, it borders on some decidedly not-so-nice neighborhoods (which is pretty much all of Baltimore City, but I digress).



Shock Trauma always tends to be built in the Nasty Hoods, and System Status Always sends units to post at the Shock Trauma. Therefore, lickity split turn around


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## b2dragun (Oct 14, 2011)

Running 9000 calls is nothing.  My busiest shift was a 12hr, we drove over 200 miles, dispatched to 32 calls, on scene to 20 and transported 5.  I have had quite a few 12hr shifts that I have transported 9.  I would say on my avg 12hr truck I do 12-15 calls and transport 5-6.


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## Fish (Oct 14, 2011)

b2dragun said:


> Running 9000 calls is nothing.  My busiest shift was a 12hr, we drove over 200 miles, dispatched to 32 calls, on scene to 20 and transported 5.  I have had quite a few 12hr shifts that I have transported 9.  I would say on my avg 12hr truck I do 12-15 calls and transport 5-6.



9000 is a lot, 12-15 is what we ran in my old system as well.

Dispatched the 32 and only transported 5? Thats sounds Janky! How did this happen


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## b2dragun (Oct 14, 2011)

Fish said:


> 9000 is a lot, 12-15 is what we ran in my old system as well.
> 
> Dispatched the 32 and only transported 5? Thats sounds Janky! How did this happen



I only made it on scene to 2020 so there goes 12, fire prob transported some of those, we get alot of drive by callers for sleeping bums, blood pressure checks, and who knows what else.  If I remember correctly we only had 1 or 2 AMA's.  We get alot of people transported to the jail by the police and alot of no medical needed in there.  Like I said that was a rare day...12-15 is average.


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## epipusher (Oct 14, 2011)

My personal record is 23 dispatches/14 transports in a 12 hour shift.


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## Fish (Oct 14, 2011)

Mine is 23 dispatches, 19 transports in a 24hr shift.


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## 325Medic (Oct 15, 2011)

When I was precepted in "99" with P.F.D., I was @ Medic-11 and ran at least 18 calls a night (whichwas South Philly). Most were legit calls but some were curb jobs.

325.


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## Fish (Oct 16, 2011)

325Medic said:


> When I was precepted in "99" with P.F.D., I was @ Medic-11 and ran at least 18 calls a night (whichwas South Philly). Most were legit calls but some were curb jobs.
> 
> 325.



What were the legit calls mostly? Did you see a lot more Trauma than Medical?

Did you ever consider working there? What was pay/benefits like?


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## medicsb (Oct 17, 2011)

systemet said:


> I had a friend who worked there about 10 years ago.  They were driving huge freightliners (can't imagine a more impractical vehicle to do inner-city EMS in.  Well, maybe a fire truck), and had a ridiculous amount of equipment on each truck so they didn't need to restock that often.
> 
> Their PCR was a one-page check box.  The space for their narrative was about 3-4 lines, and most of my friend's narratives consisted of "found pt. apenic, gave 4mg narcan IM, patient ran away".
> 
> ...



Some things have changed in 10 years... super baby steps I suppose.  They do electronic charting now.  I think that is about the only thing that has changed.  Oh, they finally caved and upgraded from LP10s a few years ago.  I think they finally have CPAP.  They can do 12 leads, but seem to not do it unless there is a student riding along.  

As a correction, to go from medic to firefighter is not a promotion.  Medics have been paid 10% more than FFs since the 70s or 80s, which was the incentive to get FFs to become paramedics before they created the Fire Service Paramedic position, which all medics now are (and have been 15-20 years, I think).  From what I remember (I did my medic ride time with PFD), medics lose their medic pay and drop down to the starting FF salary (20-30,000/yr pay cut) when they become a FF.  Medics could apply to the fire side after 5 years of work as a medic and they'd get 10 extra points on the exam, so it wasn't guaranteed that they could transfer.  Once a FF, they're not a medic in any way for the department (yes, even if placed on an ambulance, they can only use BLS skills).  Most will work ALS out in one of the adjacent counties.  

I guess for clarification, medic 8 is no longer ALS.  They were changed to BLS about 5 or 6 years ago.  I used to work with a medic who was assigned to the Medic 8.  They were known as "the narcan task force"; they supposedly gave more narcan than any other medic truck in the city.  Plenty of cancels and plenty of patients walking to the ambulance and letting themselves on board.  Anyhow, I think medic 2, 8, 13, and 22 have generally been the busiest.   One of those trucks peaked around 9400 in the middle of the last decade.  

Anyhow, pay isn't bad and the benefits are pretty good from what I've heard, but the city nor the union really cares about EMS.  The medics were being screwed out of OT and they went to the union for help and were basically told screw off.  Around 300 medics were part of a class-action lawsuit, which they won.  The city retaliated by changing their work hours and kicking them out of the union, though the union does want the medics.  Most FFs seem to resent the medics for sticking up for their own rights.  I know one former PFD medic who is waiting on over $50,000 in OT that he is owed.  Another killer (in my opinion): the medic units are supposed to be staffed with 2 medics, but most run as "limited MICs", where the second crew member is an EMT/FF.  When that occurs, the medic must ride with EVERY patient and do all the paper work, while the EMT/FF basically serves as a driver and not much else.  In 5 weeks of ride time (48 hours per week), not one medic ever encouraged me to join the department.  Some said if I did, to stick it out five years and then go somewhere else or try for the fire side.  It's no wonder that, despite residency requirement being waived, they can't fill all the positions.

Some observations from when I rode: the narc box wasn't locked but wrapped with 2 inch tape.  It never got opened.  My preceptor went through the pediatric bag with me and the prefilled vials were mostly expired with some even broken.  CIDs and long board straps were almost non existent.  If it weren't for hospitals letting them restock, we would have run out of supplies.  20 minute response times were not uncommon.  Despite the medic unit being in the center city area, it would end up in Northeast Philly or Southwest Philly or Roxborough.  To be sure, the guys that precepted me were good guys and no doubt they could handle what was thrown at them when it hit the fan, so I think it is important to remember there are some great medics with PFD who love the job and do not live up to all the bad stories that get tossed around.  As usual I'd cite the city, the FD admin, and the general FF culture for the crap chute that is EMS in Philly.


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## Fish (Oct 17, 2011)

I thought that they'd be more progressive than that, when you say Decent pay what numbers are we talkin here?


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## medicsb (Oct 18, 2011)

Fish said:


> I thought that they'd be more progressive than that, when you say Decent pay what numbers are we talkin here?



I don't think progressive could ever be applied to pfd ems.  From what I can tell, their medical director is a douche - a yes man to the city.  Anyhow, their pay scale can be found at phila.gov.  They start at 40ish and max out at 59ish based on a 40 work week.  They get 2 hours OT every week so actual pay is higher.  It's not spectacular, but it's more than most (all?) jobs in the surrounding counties.  I think you max out after 5 years, but I could be wrong. OT is plenty so it's not hard to bank a lot more (I have heard plenty about medics making over 100k thru OT).  Not totally sure of their benefits.


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## 325Medic (Oct 18, 2011)

Fish said:


> What were the legit calls mostly? Did you see a lot more Trauma than Medical?
> 
> Did you ever consider working there? What was pay/benefits like?



Well, back then, on the one side of Broad St. (which is a large thorofare) we got alot of medical, large italian population with CHF and M.I.'s. On the other side was the knife and gun club, butting up against a large amount of  projects (which have been torn down now ) and S.W. Philly with Universiy Of Penn. Trauma a little ways away. I will not comment on the way P.F.D. is run for I do not work there / I work in the burbs but I know quite a few medics that work there that are unhappy / a few that went to the fire side of things. I wanted to work there when I ETS'd from the Army but decided to work the county. The way I see it. Too few medic units, crazy amount of B.S. calls and abuse of the system big time.:glare:

325.


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## systemet (Oct 19, 2011)

medicsb said:


> To be sure, the guys that precepted me were good guys and no doubt they could handle what was thrown at them when it hit the fan, so I think it is important to remember there are some great medics with PFD who love the job and do not live up to all the bad stories that get tossed around.  As usual I'd cite the city, the FD admin, and the general FF culture for the crap chute that is EMS in Philly.



I should emphasise that I have no first hand knowledge of the system.  And I don't want to talk badly of the people working there.  It just seemed from my friend's stories that they were under a huge amount of stress, and working in a very difficult environment.

Thanks for correcting me where I was in error!


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