# Detroit EMS



## HotelCo (Sep 16, 2010)

http://detnews.com/article/20100916/METRO08/9160409




> ...
> It happens all too often in this city. You call 911. Granny fell, you tell the operator. Or a woman's been shot. Or a man has gone into cardiac arrest. Then you wait for an ambulance. And you wait some more.
> No one really knows what the ambulance response time is in Detroit, but for people who work in the ambulances for a living, they say it is unacceptable.
> ...


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## DrParasite (Sep 16, 2010)

yeah and???

an old lady fell on the streets, and it took the paramedic unit 15 minutes to get there.  that's a great response time!!!  If that happened where I worked, if we were busy, you can wait 30 minutes or more for an ambulance.

The sad truth is most urban cities (Philly, DC, NYC, Newark, etc), the EMS system is grossly understaffed, and this stuff happens.  it happens more often than the public wants to believe.

Not only that, but the public won't fund and push for appropriate staffing until they experience the need to an ambulance personally.  Then they make a huge deal about it.

It happens.  Until the public realizes that EMS is a critical part of public safety, and needs to be funded as staffed as such (and not be band aided by PD or EMS as a first responder), this stuff will continue to happen.

And Detroit isn't the only City that doesn't have a FD or PD first responder.  There are others.


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## Hockey (Sep 17, 2010)

Did you read the article fully Dr?

Its not just 15 minutes.  Its hours sometimes

You may understand it, but the public doesn't.  Glad the DetNews is getting it out there


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## DrParasite (Sep 17, 2010)

I read the article.  it doesn't change what I said.

this HAPPENS ALL THE TIME.  It's not different than philly FD's circle of death (when the engine company stands around a dying patient because no ambulance is available).  Or how in Philly, PD freqently transports GSW victims to the hospitals, because EMS has an extended response time.  Detroit is not unique in this problem.

Many places have a non-transporting FD unit babysitting hoping an ambulance shows up.  But it doesn't help get the patient to the hospital.

Many agencies hold BLS calls (such as the elderly fall victim) especially if they are holding higher priority life threatening calls.  Most  of the time the patient doesn't suffer (die) because of this, they might wait longer than that want, but they don't die.

The AHJ decides what level of EMS service they want.  most understaff and underfund their EMS system, and it seems Detroit is no different.  The fault in this lies in the management and politicians who under staff the system, and the public who permit this to happen.

again, no one complains until it takes the ambulance too long to show up for THEIR emergency.


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## FLEMTP (Sep 18, 2010)

DrParasite said:


> I read the article.  it doesn't change what I said.
> 
> this HAPPENS ALL THE TIME.  It's not different than philly FD's circle of death (when the engine company stands around a dying patient because no ambulance is available).  Or how in Philly, PD freqently transports GSW victims to the hospitals, because EMS has an extended response time.  Detroit is not unique in this problem.
> 
> ...



+1 on that. I worked in detroit... this is nothing new and has been going on for YEARS. Yes you read that right.. YEARS!

Im glad i left when I did!


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## LonghornMedic (Sep 19, 2010)

I've worked EMS in two large cities and this very rarely happened. You can have urban EMS and still provide excellent service. Obviously Detroit is completely mismanaged and is an embarrassment to all EMS professionals. Our *non-code 3* responses are around 12-15 minutes. Code 3's average less than 7 minutes. Maybe Detroit EMS should be removed from the fire department. That would be a good start.


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## 94H (Sep 21, 2010)

I know for a fact that at some time last yr FDNY EMS had 30 calls holding in the CAD. FDNY EMS also does not do mutual aid to it means loooooooooooooooooong wait times. Personally Ive waited 45 minutes for a pediatric trauma (broken arm).


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## ohnoyoudidnt (Sep 21, 2010)

Buffalo is the same way, nightly you will hear fire dispatch say no ambulance available and most of the time there are a ton of calls holding, though our response times are slow there "normally" is never more than a 20 minute wait. But then there are "those" nights when you might wait up to an hour or more if dispatch deems you to be non critical during their EMD'ing. Its not just a Detroit thing, its in allot of cities, though Detroits EMS I think leads the race to "horrible".


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## 46Young (Sep 21, 2010)

94H said:


> I know for a fact that at some time last yr FDNY EMS had 30 calls holding in the CAD. FDNY EMS also does not do mutual aid to it means loooooooooooooooooong wait times. Personally Ive waited 45 minutes for a pediatric trauma (broken arm).



You waited 45 minutes for medics? Why not transport? As BLS, I was never onscene for more than 10 minutes on the average, unless something prevented me from departing, such as difficult removal, a multi story walkup, etc.

In NYC 911, they'll hold the priority 7's and 8's, and maybe a sick job or two if the call volume spikes. Did the peds injury come over as an injury major or injury minor? The major is a 5, and the minor is a 7, IIRC.


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## lightsandsirens5 (Sep 21, 2010)

DrParasite said:


> It's not different than philly FD's circle of death (when the engine company stands around a dying patient because no ambulance is available).  Or how in Philly, PD freqently transports GSW victims to the hospitals, because EMS has an extended response time.  Detroit is not unique in this problem.
> 
> Many places have a non-transporting FD unit babysitting hoping an ambulance shows up.  But it doesn't help get the patient to the hospital.



In this state (WA), our RCWs and/or WACs (can't remember which) state that if a transport licensed vehicle is delayed to the point that a patients life if put in danger, any vehicle, preferably an emergency one, should be used to transport the patient to the hospital. I know this is rarely done, and rarely if ever enforced, but it is still an out for us. We have done it in my county. We had a situation a while back where all of our ambulances were out and the next nearest one would take an hour to arrive. The guy sure a heck didn't have an hour. Maybe 10 minutes. Well, he rode to the hospital in a fire engine that day. No FD circle of death for him. The law basically says that you could transport someone in anything from a  fire engine to a cop car to a pickup truck to a Subaru Justy and everything in between if you need. 

I admit that 90% of the time that law is utilized in rural areas. I'm not sure if it ever gets used in Seattle, or Olympia. I can see how this could be an issue in a city the size of Philly, they prolly would not want engines out of service for that kind of stuff, but all I'm saying is that in WA at least, it seems to be working.


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## DrParasite (Sep 21, 2010)

lightsandsirens5 said:


> In this state (WA), our RCWs and/or WACs (can't remember which) state that if a transport licensed vehicle is delayed to the point that a patients life if put in danger, any vehicle, preferably an emergency one, should be used to transport the patient to the hospital.


There are NUMEROUS problems with a protocol like this.  The biggest by far is the liability of transporting a sick patient in a vehicle not designed to transport.

Lets say you do scoop and run in the fire engine or police car.  do you have the equipment to properly secure said sick person?  maintain an airway?  bag someone?  and lets say the person dies.  then the lawsuit comes.  

did they die because you didn't wait for the appropriately equipped unit to arrive, or because you transported a sick person in a vehicle not designed for sick people?  

The protocol is good in theory.  it really is.  The problem is ANY time an ambulance is delayed, it could be used.  the person is having chest pain, EMS is 10 minutes out, well, lets scoop and run to the hospital, since the 10 minutes could put the life in danger (neglecting the fact the the hospital  is 40 min away).

If a civilian wants to transport in a POV, then that is their prerogative.  but if a trained emergency responder does that, and he or she is doing that because the EMS system is not staffed enough to handle the call volume (which rural systems are, but not having a close enough ambulance) than that's a recipe for an expensive lawsuit.


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## Rottweiler (Sep 23, 2010)

It is way worse than you all think.

Corruption, no money, what are shocks? Broken lighting..  

You should see what the Police cars look like.

Oh and when you need something fixed?  hahahhaha  2 3 months?


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## ohnoyoudidnt (Sep 24, 2010)

Rottweiler said:


> It is way worse than you all think.
> 
> Corruption, no money, what are shocks? Broken lighting..
> 
> ...



I hear horror stories daily from the couple friends I have working in the city. The most recent story being one of the medic rigs not being able to stop do to bald tires & no brakes sliding into an intersection t-boning another truck. On that same night another crew hit a pot hole, one of the bald tires on their rig blew and they drove into the side of a bridge ripping the box of. It's not a place I want to work anytime soon.


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## CAOX3 (Sep 24, 2010)

DrParasite said:


> if a trained emergency responder does that, and he or she is doing that because the EMS system is not staffed enough to handle the call volume (which rural systems are, but not having a close enough ambulance) than that's a recipe for an expensive lawsuit.



Whats a more expensive lawsuit?

Waiting 30 minutes for an ambulance or transporting them in a fire truck?


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## DrParasite (Oct 7, 2010)

http://www.myfoxdetroit.com/dpp/news/sound_off/fox-2-focus_detroit-ems-response-time


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## EMDispatch (Oct 7, 2010)

DrParasite said:


> There are NUMEROUS problems with a protocol like this.  The biggest by far is the liability of transporting a sick patient in a vehicle not designed to transport.



Depends where you are in Pennsylvania it's specifically addressed in the Good Samaritan Law: _"Any person who renders emergency care, first aid or rescue at the scene of an emergency, or moves the person receiving such care, first aid and rescue to a hospital or other place of medical care, shall not be liable to such person for any civil damages as a result."_


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## Tincanfireman (Oct 7, 2010)

MCERT1 said:


> Depends where you are in Pennsylvania it's specifically addressed in the Good Samaritan Law: _"Any person who renders emergency care, first aid or rescue at the scene of an emergency, or moves the person receiving such care, first aid and rescue to a hospital or other place of medical care, shall not be liable to such person for any civil damages as a result."_


 
Now for the rest of the story, specifically, exception 1.  Here's the link: http://www.concentric.net/~Maxfax/files/law2.htm.  

Good Samaritan laws are normally designed to protect laypeople from liability in cases where they attempted a good-faith effort to provide care, not to cover woefully inadequate government services funded by taxpayer dollars.  


8332. Nonmedical good Samaritan civil immunity.
(a) General rule.--Any person who renders emergency care, first aid or rescue at the scene of an emergency, or moves the person receiving such care, first aid and rescue to a hospital or other place of medical care, shall not be liable to such person for any civil damages as a result of any acts or omissions in rendering the emergency care, first aid or rescue, or moving the person receiving the same to a hospital or other place of medical care, except any acts or omissions intentionally designed to harm or any grossly negligent acts or omissions which result in harm to the person receiving the emergency care, first aid or rescue or being moved to a hospital or other place of medical care.
(b) Exceptions.--


This section shall not relieve a driver of an ambulance or other emergency or rescue vehicle from liability arising from operation or use of such vehicle.
In order for any person to receive the benefit of the exemption from civil liability provided for in subsection (a), he shall be, at the time of rendering the emergency care, first aid or rescue or moving the person receiving emergency care, first aid or rescue to a hospital or other place of medical care, the holder of a current certificate evidencing the successful completion of a course in first aid, advanced life saving or basic life support sponsored by the American National Red Cross or the American Heart Association or an equivalent course of instruction approved by the Department of Health in consultation with a technical committee of the Pennsylvania Emergency Health Services Council and must be performing techniques and employing procedures consistent with the nature and level of the training for which the certificate has been issued.


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## EMDispatch (Oct 7, 2010)

my bad,
I totally forgot exception 1...


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## Nakia (Oct 8, 2010)

CAOX3 said:


> Whats a more expensive lawsuit?
> 
> Waiting 30 minutes for an ambulance or transporting them in a fire truck?



You may be surprised. Not having any contact with the pt. may get you a lawsuit. Being under trained, ill-equipped, and not safely transporting a pt. after contact with the pt. is made, is also a very expensive lawsuit. 
Could go either way.


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## Nakia (Oct 8, 2010)

lightsandsirens5 said:


> In this state (WA), our RCWs and/or WACs (can't remember which) state that if a transport licensed vehicle is delayed to the point that a patients life if put in danger, any vehicle, preferably an emergency one, should be used to transport the patient to the hospital.
> 
> I admit that 90% of the time that law is utilized in rural areas. I'm not sure if it ever gets used in Seattle, or Olympia. I can see how this could be an issue in a city the size of Philly, they prolly would not want engines out of service for that kind of stuff, but all I'm saying is that in WA at least, it seems to be working.



I doubt Seattle has used this. Thumbs up to their King County EMS. They have had some of the top numbers in the nation for years as far as overall response times. And they ARE (again) the nation EMS leaders in success for reviving cardiac arrests. Their cardiac protocols must be top notch!:usa:


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## eynonqrs (Oct 9, 2010)

*It's all about Mutual Aid*

I can't understand if this has been going on for so long, that they can not sign a mutual aid agreement with neighboring towns. I am sure in the larger cities there has to be plenty of private services. Where I work at we provide services for the city of Scranton, as well as another service. We get dispatched by the county. If none of our units are available and the other service is not as well, they dispatch other services from outside the city to come in. It's not rocket science. Is the service that greedy for money that they will put pt care aside ? Maybe, maybe not. What it boils down to is a lot of factors, such as staffing, turn around times from hospitals, etc.. If the service is strapped and can't provide enough units, they should raise the white flag and say they need help.


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## Tincanfireman (Oct 9, 2010)

*Can DFD EMS get a Do-over?*

Uh-oh, they talked to the press...

http://www.myfoxdetroit.com/dpp/news/local/detroit-ems-workers-in-trouble-after-appearing-on-fox-2


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## 46Young (Oct 9, 2010)

eynonqrs said:


> I can't understand if this has been going on for so long, that they can not sign a mutual aid agreement with neighboring towns. I am sure in the larger cities there has to be plenty of private services. Where I work at we provide services for the city of Scranton, as well as another service. We get dispatched by the county. If none of our units are available and the other service is not as well, they dispatch other services from outside the city to come in. It's not rocket science. Is the service that greedy for money that they will put pt care aside ? Maybe, maybe not. What it boils down to is a lot of factors, such as staffing, turn around times from hospitals, etc.. If the service is strapped and can't provide enough units, they should raise the white flag and say they need help.



The issue with having multiple providers in the same area is that each dept/agency may have different hiring standards, equipment, proficiency standards for their employees, meds, or even protocols. For example, in NYC, we had CPAP back in 2005 (maybe early 2006, can't remember exactly). May other providers didn't. We carried ativan; others had versed. FDNY does a complete background investigation, medical, psych, a PAT, etc. Another dept may only want a pulse and a patch, a passing score on an entrance exam, some bloodwork and a neg PPD, and no felonies. FDNY puts their recruits through an academy. Other places just do an orientation and maybe a one month field internship, but typically just throw you out there; that's why these hospitals generally require 911 experience to apply. NYC's protocols are mother-may-I, and any deviation requires telemetry contact, and a detailed presentation. I believe this is due to the numerous providers in the area. There's no uniform standard between the various depts. Additionally, a FDNY Conditions Boss can issue a NOI (notice of infraction) to a voluntary (hospital/private) unit, but it means little. The employee's supervisor can choose whether or not they want to discipline the employee. Usually it's just the boss trying to flex their muscle. If it's a pt care issue, then the employee can be put on pt care restriction, until they're cleared by their own medical director. So, even in the event of a pt care error, FDNY leaves the remediation process to the hospital, with a different medical director than the city's. See what I mean?

Where I work now, we had the full FD routine: CPAT, poly, med/psych, etc. If INOVA hospital or the local txp companies were to turn out units in our system, they would be doing so through a less rigorous and selective hiring process. Employee morale (better in the FD, noticably less with a private company) can also affect pt care.

QA/QI, discipline and general standard of care are difficult to control in an environment with multiple providers.


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## usalsfyre (Oct 9, 2010)

46Young, multiple agencies DO run calls in your area though. All of the neighboring agencies have different protocols, hiring standards, equipment, medical directors, QA/QI and remediation processes. Heck, one agency even has single role providers. In certain areas of NOVA before I left it was not unusal for three different agencies to run a call to the same location on different days because call loads had the first due units out. Granted, that may have changed. 

Also, who determines what a patient care error is. According to the local doc in a box I regularly commit patient care errors for medicating patients, instead of just grabbing and running (what the previous service did). My medical director and supervisor have yet to have a problem with my patient care (knock on wood). 

It's workable, and at times needed to have backup providers. Dispatch is the biggest difficulty, as the transferring process tends to slow down getting approprite units out the door.


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## 46Young (Oct 9, 2010)

usalsfyre said:


> 46Young, multiple agencies DO run calls in your area though. All of the neighboring agencies have different protocols, hiring standards, equipment, medical directors, QA/QI and remediation processes. Heck, one agency even has single role providers. In certain areas of NOVA before I left it was not unusal for three different agencies to run a call to the same location on different days because call loads had the first due units out. Granted, that may have changed.
> 
> Also, who determines what a patient care error is. According to the local doc in a box I regularly commit patient care errors for medicating patients, instead of just grabbing and running (what the previous service did). My medical director and supervisor have yet to have a problem with my patient care (knock on wood).
> 
> It's workable, and at times needed to have backup providers. Dispatch is the biggest difficulty, as the transferring process tends to slow down getting approprite units out the door.



Yes, you're right, we can get mutual aid from P. William, Alex, Arlington, Loudon, and Montgomery Co. MD. What I was talking about was having only one dept running a particular municipality. These mutual boxes are only a small percentage of the total call volume for us, maybe less than 5%. We typically have our engines on these mutual aids as well, and one of our EMS Captains onscene for an MVA w/ entrapment, an arrest, or any other significant incident. That is standard for all our calls, not just mutual boxes. The protocols, capabilities, and hiring standards between agencies are nearly identical, anyway. 

When I worked in NYC, it was two privates, a bunch of hospitals, and the FDNY. They all worked under the same protocols and SOP's. Pt care error is commited by protocol violation, med error, neglect, and pt steering to or away from the voluntary provider's hospital, depending on where the benefit lies. A FDNY Conditions Boss can restrict the crew. The telemetry doc can also mandate the crew to advise the Boss of the violation. The crew or single provider will be restricted to just BLS, or restricted altogether, pending approval by that dept's medical director to return to service. The difference lies in what that dept's medical director requires from that provider to clear them vs what FDNY would do with theirs. These individual depts may flag more or less ACR's than FDNY would. One dept may give the medic a simple slap on the wrist. Another may suspend them, maybe put them on probation, maybe restrict them to IFT for a while, or "ask them to resign." Are FDNY EMS personnel held to a higher standard, or are the hospitals? Is it only certain hospitals, or all of them? Depending on what neighborhood you work, you'll want either a FDNY bus taking care of you, or maybe the hospital instead.

FDNY doesn't do mutual aid. Neither did the third service agency I worked for in SC. One had strict protocols with no variance allowed, or jumping protocols depending on how the pt reacted to therapies, without OLMC contact and a detailed report. In SC the protocols were noticeably more liberal, and we were free to treat according to best practices as long as we adhered to the state's drug formulary, and could justify it. The SC job had only one ALS txp provider.

In the case of Detroit, I believe that calling on the privates to provide txp isn't the answer. You need one uniform standard of EMS delivery, at least where ground txp is concerned. Bringing in various privates can result in poor delivery due to differing standards, capabilities and equipment, employee morale and experience, availability of units, and more. It would also cost the city money to use these providers. They're profit driven, and won't do 911 for a loss. Better to spend that money hiring more of their own rather than pay other agencies.


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