# 911



## kecpercussion (Aug 2, 2009)

I think it would be interesting to hear which ambulance companies handle the 911 contract in your areas and some comments about them...

Care to share?


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## medichopeful (Aug 2, 2009)

kecpercussion said:


> I think it would be interesting to hear which ambulance companies handle the 911 contract in your areas and some comments about them...
> 
> Care to share?



In my town, the fire department handles the 911 calls.  They run 2 ALS ambulances, staffed by 2 paramedics (I believe).

I don't know for sure, but I think mutual aid can come from other towns or the privates around here.


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## kecpercussion (Aug 2, 2009)

Yea it seems like a lot more counties are being handled by FDs


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## HNcorpsman (Aug 2, 2009)

in tucson, AZ the tucson fire department runs the 911 calls... usually a ambulance (medic/medic) will respond as well as a engine (4 EMTs). once the medics assess the situation they decide if the PT needs a ALS unit or a BLS unit. if BLS then they call southwest ambulance (private) the engine waits with the PT until the BLS unit arives... the ALS unit leaves and goes back in service when they initially called the BLS unit.


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## kecpercussion (Aug 2, 2009)

Here in Riverside we only run ALS... we don't even have BLS rigs... as far as AMR is concerned


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## EMT11KDL (Aug 2, 2009)

ALS units, ran by the County. Staffed with either 1 medic and basic, 1 medic and Advanced, or 2 medics


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## Shishkabob (Aug 2, 2009)

Fort Worth, Texas.

MedStar, a private, runs it here.  Most places around DFW are fire based, but there are a couple private and 3rd service.


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## kecpercussion (Aug 2, 2009)

I think it's way more practical to have private companies take over in largely populated cities


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## Mountain Res-Q (Aug 2, 2009)

Non-profit third party ALS.  4 1/2 Ambos (type 2 vans)staffed Medic/EMT.  Fire does BLS First Response Only.  Ambo side works great (usually), but I have issue with the way Fire trys to boost the call volume in order to keep funding up.  There are areas in the county where a typical response to any medical call (from stubbed toe to Arrest) will get 2 Engines, a Squad, and a Chief in addition to the Ambo (all code 3); or some similar response.  Even an arrest doesn't require 10-12 FFs and the Ambo crew!


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## Cory (Aug 2, 2009)

kecpercussion said:


> I think it's way more practical to have private companies take over in largely populated cities



I can't think of any logical reason why private companies are more practical than FD ambulances in largely populated areas. Seeing as a lot of emergencies that EMS respond to can involve situation that FD EMS are trained to handle, but not private. Example: fire


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## medic417 (Aug 2, 2009)

Cory said:


> I can't think of any logical reason why private companies are more practical than FD ambulances in largely populated areas. Seeing as a lot of emergencies that EMS respond to can involve situation that FD EMS are trained to handle, but not private. Example: fire



Your age and lack of experience are showing.  Only a small percentage of EMS calls require more than the two Paramedics in the ambulance to show up.  It is a waste of tax payer money to dispatch so many pieces of equipment on all calls.  It is just a way for obsolete fire departments to stay open.


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## kecpercussion (Aug 2, 2009)

Cory said:


> I can't think of any logical reason why private companies are more practical than FD ambulances in largely populated areas. Seeing as a lot of emergencies that EMS respond to can involve situation that FD EMS are trained to handle, but not private. Example: fire




IMO if you have ever worked in the field you will notice that FDs respond to way too many of the calls. It's like for the smallest call you get at least an engine with 4 crew members...so unnecessary if you ask me... but im not saying the FDs aren't helpful cuz i think they are great and couldn't do much without them


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## Shishkabob (Aug 2, 2009)

Cory said:


> I can't think of any logical reason why private companies are more practical than FD ambulances in largely populated areas. Seeing as a lot of emergencies that EMS respond to can involve situation that FD EMS are trained to handle, but not private. Example: fire



No one is saying fire can't be a first response agency, such as we have here in Fort Worth.


Calls are in 3 categories-- priority 1, 2, and 3.  3 is sick person ie non-emergent.  All priority 1's and 2's get FW Fire dispatched along with the private ambulance. 

 FD usually beats MedStar to the scene and initiates pt care.  MedStar comes and their paramedic is then in charge of pt care, and they do the transportation.




Not only does it save money, but saves un-necessary pieces of equipment (engines) from being in the road, running L&S, for no reason.


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## Cory (Aug 2, 2009)

Okay, but none of you touched on my argument. Why is a private company responding any different than if a FD ambuulance responds. Regardless of if the FD sends more, that is most likely going to happen regardless of the first responder. But you seem to forget that FD's in large cities, as was the topic of the post I responded to, don't send every engine they have to a scene. That is more common in less buisy areas.



> Only a small percentage of EMS calls require more than the two Paramedics in the ambulance to show up. It is a waste of tax payer money to dispatch so many pieces of equipment on all calls. It is just a way for obsolete fire departments to stay open.



Okay, but I do not see how giving up an area to private companies would solve that. The FD's are still going to be there, unless you are suggesting that more FD's should close, than I understand your reasoining, but then I also dissagree with it.



> No one is saying fire can't be a first response agency, such as we have here in Fort Worth.


umm, re-read the post I responded to:


> I think it's way more practical to have private companies take over in largely populated cities







> Your age and lack of experience are showing.


You just can't bark without the bite, can you?


-Cory-


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## daedalus (Aug 3, 2009)

Cory said:


> I can't think of any logical reason why private companies are more practical than FD ambulances in largely populated areas. Seeing as a lot of emergencies that EMS respond to can involve situation that FD EMS are trained to handle, but not private. Example: fire



I kindly ask how you are qualified to make such an assessment. I have worked in the field for a few years now, and in my experience, I disagree with you. I could go on about the economic, quality of care, environmental, and other reasons, but I think they have been hashed out before. 

Anecdote: two days ago I had a CCT call to a small hospital to bring a girl to a trauma center. She had been involved in a motor vehicle accident. When I got to her  bedside, she started crying, begging her mom to not let more paramedics touch her. I asked why, and the reason ended up being that the fire fighters had brought her in, and treated her horribly. They inflected more pain and emotional harm by the way they handled her, and said rude things to her. I spent the next half hour apologizing on behalf of my profession to the family, some of whom overheard the outrageous statements made by the firefighter. "Quit crying would you, your being dramatic" and "This is going to hurt a to more if you do not co-operate with me" were some of the highlights.


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## kecpercussion (Aug 3, 2009)

Yea sometimes i feel like showing up first on the scene of a very minor house fire with three of my ALS rigs and helping the FD haha i kid i kid


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## Sasha (Aug 3, 2009)

daedalus said:


> I kindly ask how you are qualified to make such an assessment. I have worked in the field for a few years now, and in my experience, I disagree with you. I could go on about the economic, quality of care, environmental, and other reasons, but I think they have been hashed out before.
> 
> Anecdote: two days ago I had a CCT call to a small hospital to bring a girl to a trauma center. She had been involved in a motor vehicle accident. When I got to her  bedside, she started crying, begging her mom to not let more paramedics touch her. I asked why, and the reason ended up being that the fire fighters had brought her in, and treated her horribly. They inflected more pain and emotional harm by the way they handled her, and said rude things to her. I spent the next half hour apologizing on behalf of my profession to the family, some of whom overheard the outrageous statements made by the firefighter. "Quit crying would you, your being dramatic" and "This is going to hurt a to more if you do not co-operate with me" were some of the highlights.



I have heard similar comments from third servie paramedics. There are bad medics everywhere, and they are not limited to fire based EMS.


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## daedalus (Aug 3, 2009)

Sasha said:


> I have heard similar comments from third servie paramedics. There are bad medics everywhere, and they are not limited to fire based EMS.



Totally. However, I notice that when I go to the hospitals in LA City Fire's call out area, patients are distressed by my presence much more than other areas. Anyone in an ambulance is the same to them. Since I work exclusively CCT now, I deal with the bad decisions of first responders daily at work. Also, that was not meant to be evidence to expel the fire service, just one of my more recent observations of their work.


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## kecpercussion (Aug 3, 2009)

I could imagine...i love first responders if they actually help with some vitals or something ya know? And they need good patient manner so we don't get stuck with angry patients


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## Shishkabob (Aug 3, 2009)

Cory said:


> Okay, but none of you touched on my argument. Why is a private company responding any different than if a FD ambuulance responds. Regardless of if the FD sends more, that is most likely going to happen regardless of the first responder. But you seem to forget that FD's in large cities, as was the topic of the post I responded to, don't send every engine they have to a scene. That is more common in less buisy areas.



All the fire based EMS I've seen around here don't send "just" an ambulance.  They send an engine AND an ambulance.  That's 6 paramedics, at minimum, on every call, from a simple "I stubbed my toe" to a "A shark bit me", from a single station.   That, good sir, is a waste.


Fort Worth?  An engine on the most major of calls, with 2-3 EMT's and a medic, and 1 private ambulance with an EMT and a medic.   I


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## kecpercussion (Aug 3, 2009)

Yea FDs tend to go pretty overboard with engines to small scenes. Waste of time and resources IMO


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## Sasha (Aug 3, 2009)

daedalus said:


> Totally. However, I notice that when I go to the hospitals in LA City Fire's call out area, patients are distressed by my presence much more than other areas. Anyone in an ambulance is the same to them. Since I work exclusively CCT now, I deal with the bad decisions of first responders daily at work. Also, that was not meant to be evidence to expel the fire service, just one of my more recent observations of their work.



Sweetie, I see it too. (we transfer god knows how many patients from the ER to the appropriate facility just a little ways further each day. ) however don't paint the all FF with the same broad brush because the ones in your area sucks. GENERALLY the ones in my area are pretty good. I notice that the ones from the larger dept are usually a little more below standard than the ones from smaller departments.


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## daedalus (Aug 3, 2009)

Linuss said:


> All the fire based EMS I've seen around here don't send "just" an ambulance.  They send an engine AND an ambulance.  That's 6 paramedics, at minimum, on every call, from a simple "I stubbed my toe" to a "A shark bit me", from a single station.   That, good sir, is a waste.
> 
> 
> Fort Worth?  An engine on the most major of calls, with 2-3 EMT's and a medic, and 1 private ambulance with an EMT and a medic.   I



Get this. I have been on a call where LA County Fire sent a paramedic squad (2 FF/paramedics), a patrol truck (2 FF/EMTs), and an Engine ( 1 medic, 3 FF/EMTs). I was also on scene with my partner and a trainee (3 EMTs from private ambulance). 11 people and 4 response vehicles, sent to a home, for an elderly women who became upset after cleaning her bathroom with bleach.

Can you imagine 11 people barging into your home?


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## kecpercussion (Aug 3, 2009)

All those people would give me an anxiety attack and then we would have a real emergency haha


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## Shishkabob (Aug 3, 2009)

I'd hate to see the bill on that one!


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## daedalus (Aug 3, 2009)

Sasha said:


> Sweetie, I see it too. (we transfer god knows how many patients from the ER to the appropriate facility just a little ways further each day. ) however don't paint the all FF with the same broad brush because the ones in your area sucks. GENERALLY the ones in my area are pretty good. I notice that the ones from the larger dept are usually a little more below standard than the ones from smaller departments.



I am not. What I am doing is trying to show Cory that it is not appropriate to say that Private EMS is clearly "illogical" according to him, when he has never been in the field or EMS management. I do not disagree with fire based EMS, but I do advocate what is best for our patients and is sustainable for society. I believe that in California, budget cuts for our fire departments are in order because it is un-needed to have a station on every corner and to send out the world for every granny in distress. It is expensive and excessive, however the public will never vote contrary because the fire departments can easily run scare campaigns of a child falling and getting hurt and the neighborhood fire station rapidly showing up on scene to save the boy. Plays well on TV.


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## Cory (Aug 3, 2009)

I refuse to believe all FD based medics are bad because you have had a few bad run in's with them. If that is suppossed to be reason for me to be biased towards private companies, it didn't work. 

I saw a movie last week and it sucked. But for some reason, I don't think all movies suck.

Get my point? And you can play on my lack of experience all you want, but common sense is still existant outside of EMS.


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## Cory (Aug 3, 2009)

daedalus said:


> I am not. What I am doing is trying to show Cory that it is not appropriate to say that Private EMS is clearly "illogical" according to him, when he has never been in the field or EMS management. I do not disagree with fire based EMS, but I do advocate what is best for our patients and is sustainable for society. I believe that in California, budget cuts for our fire departments are in order because it is un-needed to have a station on every corner and to send out the world for every granny in distress. It is expensive and excessive, however the public will never vote contrary because the fire departments can easily run scare campaigns of a child falling and getting hurt and the neighborhood fire station rapidly showing up on scene to save the boy. Plays well on TV.



I never said they were illogical, I said they were no more logical than FD's in a big city.

And I guess in your area people support the fire department, but in my area they aren't asking for anyone's vote. They are shutting the stations down anyway. And it will be a loss, especially because most private companies around here, if any, do 911 response.


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## Sasha (Aug 3, 2009)

> I am not. What I am doing is trying to show Cory that it is not appropriate to say that Private EMS is clearly "illogical" according to him, when he has never been in the field or EMS management.



I really hate it when people with zero experience comment on how EMS should be run.



> I do not disagree with fire based EMS, but I do advocate what is best for our patients and is sustainable for society.



Sorry, I misinterperted your posts and jumped down your throat. You know how I love a good discussion with you.


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## kecpercussion (Aug 3, 2009)

Yea i don't think you can actually have an opinion unless you've been in the field and see what a mess it can be


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## Cory (Aug 3, 2009)

kecpercussion said:


> Yea i don't think you can actually have an opinion unless you've been in the field and see what a mess it can be



I can, and I do.


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## Shishkabob (Aug 3, 2009)

Cory said:


> I refuse to believe all FD based medics are bad because you have had a few bad run in's with them. If that is suppossed to be reason for me to be biased towards private companies, it didn't work.



No one says all FD based are bad.  Never say all, every, or none.  


One of the biggest arguments against fire based EMS is the fact that they don't worry about just medicine... they spend as much time, if not more, training for fires.  Also how many FF's view medic as just another hurdle to get hired on AS an FF, and have no real interest in doing the job of a medic.




Not, just to make it clear to you, that doesn't mean all fire based medics think like that.  Heck, one of my teachers is a fire based medic, and thinks EMS should be separate from fire, but the only way to make a decent living and retirement as a medic here in DFW IS to be a FF.


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## kecpercussion (Aug 3, 2009)

Then you can see that it gets messy a lot. Thats pretty hard to dispute


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## Shishkabob (Aug 3, 2009)

Cory said:


> I can, and I do.



Mind if I ask where, and how?


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## daedalus (Aug 3, 2009)

Cory said:


> I refuse to believe all FD based medics are bad because you have had a few bad run in's with them. If that is suppossed to be reason for me to be biased towards private companies, it didn't work.
> 
> I saw a movie last week and it sucked. But for some reason, I don't think all movies suck.
> 
> Get my point? And you can play on my lack of experience all you want, but common sense is still existant outside of EMS.


I did not say that the fire department paramedics are bad at what they do. I provided you with an very small picture of what I see in my day to day run ins with them. They tell me they do not want to be EMTs or Paramedics. They tell me everyday. 

How do you know that the Fire service is better for your community? Can you provide evidence? Private EMS offers an economically viable solution to providing emergency medical services to large and small communities, and creates an environment where tax payers are not billed for service, but rather individual patient's insurances are. (insurance and health care billing is a whole different beast so I won't go into it). Private EMS agencies bid for contracts, creating a free market system in which the local government can pick the agency that works best for them all while saving millions of dollars that could be spent on education and city renovation. Paramedics have the potential to make better wages in these systems with increasing educational demands, which hopefully will be recognized in the future by medicare and private plans, reimbursement may go up. Also, paramedics will not be forced to wear the hat of another professional, and can concentrate on providing patient care. This also frees the Fire service to concentrate on fire fighting and rescue.


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## Cory (Aug 3, 2009)

Linuss said:


> No one says all FD based are bad.  Never say all, every, or none.
> 
> 
> One of the biggest arguments against fire based EMS is the fact that they don't worry about just medicine... they spend as much time, if not more, training for fires.  Also how many FF's view medic as just another hurdle to get hired on AS an FF, and have no real interest in doing the job of a medic.
> ...



I am not doubting there are too many FF's doing medic work just to look good as a FF. Trust me, there is a fair share of volunteer only FD's around here that are almost all this way. But look at some FD EMS, for instace FDNY. They have a very qualified and dedicated group of FD medics and a group of FF's with EMT cert. just because. And there will always be a mix. But in an area like mine, they are the only 911 responders. And the cities do a d$%^ good job of selecting who will go on most medical runs, and who will go on most fire runs. For instance, I live in a very ver small suburb, the FD engine shows up for everything. Sometimes there is never even an ambulance there. But in the big city just miles from my town, it is different. Medics are out constantly, and the FF's keep to the fires. 

It is not right to make a statement about the quality of FD medics throughout the country. There are different people and variables everywhere. What is true of one area is not true of another.


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## Cory (Aug 3, 2009)

daedalus said:


> I did not say that the fire department paramedics are bad at what they do. I provided you with an very small picture of what I see in my day to day run ins with them. They tell me they do not want to be EMTs or Paramedics. They tell me everyday.
> 
> How do you know that the Fire service is better for your community? Can you provide evidence? Private EMS offers an economically viable solution to providing emergency medical services to large and small communities, and creates an environment where tax payers are not billed for service, but rather individual patient's insurances are. (insurance and health care billing is a whole different beast so I won't go into it). Private EMS agencies bid for contracts, creating a free market system in which the local government can pick the agency that works best for them all while saving millions of dollars that could be spent on education and city renovation. Paramedics have the potential to make better wages in these systems with increasing educational demands, which hopefully will be recognized in the future by medicare and private plans, reimbursement may go up. Also, paramedics will not be forced to wear the hat of another professional, and can concentrate on providing patient care.



yes, because private companies don't respond to 911 here.


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## kecpercussion (Aug 3, 2009)

That is true. It mainly depends on density of the city and amount of resources


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## Cory (Aug 3, 2009)

Linuss said:


> Mind if I ask where, and how?



I can, and I do as in I can have an opinion and I do. And I certainly don't care if you like it or not.


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## daedalus (Aug 3, 2009)

Cory said:


> yes, because private companies don't respond to 911 here.


The fact that private companies do not run in your area is not evidence that private EMS is not a better system! Just as the fact that private companies running in Ventura in California does not prove that Fire is not a viable option for the community. 

I gave you a thoughtful reply and you give me a one sentence phrase that proves and means nothing. Also, do you mind trying not to be so rude to other members? This will cause the community leaders to close this thread, which will mean we can no longer discuss this as adults. I would like to continue our conversation rather than prematurely end it.


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## Cory (Aug 3, 2009)

daedalus said:


> The fact that private companies do not run in your area is not evidence that private EMS is not a better system! Just as the fact that private companies running in Ventura in California does not prove that Fire is not a viable option for the community.
> 
> I gave you a thoughtful reply and you give me a one sentence phrase that proves and means nothing.





You said:


> How do you know that the Fire service is better for your community?



So I responded with:


> yes, because private companies don't respond to 911 here.






And btw: Cincinnati is one of the most poverty stricken cities in America, debatably the poorist, so I don't think insurance is too common among the drug addicts and gang members that are commonly picked up by our EMS. Is it true that a private company won't transport if the patient has confirmed to have no insurance on scene? (don't jump down my throat if I'm wrong, just answer the question)


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## Sasha (Aug 3, 2009)

daedalus said:


> The fact that private companies do not run in your area is not evidence that private EMS is not a better system! Just as the fact that private companies running in Ventura in California does not prove that Fire is not a viable option for the community.
> 
> I gave you a thoughtful reply and you give me a one sentence phrase that proves and means nothing.



Of course it does. It just means that the EMTs are so inferior at a private company that they are not allowed to touch REAL patients.  That is just my factpinion.

Seriously though, I think both systems have their place if they can provide their response area with quality ALS service. I don't care if they're private, county, or fire.


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## AZFF/EMT (Aug 3, 2009)

I work for a fire district, we have 7 rescue ambo's 1 ff/emt and 1 ff/medic per. We cover approx 2000 sq. miles and serve 2 other fire districts and 1 town of approx 70k people. 

Every call gets 1 engine 2emt & 2medics and a rescue. Exception is a large prison we cover that only gets a rescue except on code's, stabbings, shootings. 

At times 6 guys on scene is a little much, but captain usually stands back or helps family members with information or anything they need. Engineer stands back usually as well, so only 4 are treating/charting. I like it our o/s times are usually pretty short compared to other areas that send engine first, then special call ambo's.


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## daedalus (Aug 3, 2009)

Cory said:


> You said:
> 
> 
> So I responded with:
> ...


So the fact that Private EMS does not run in your community means that Fire service EMS is better for your community? I do not see the logic. 

I will use an analogy to clarify. Police in New York are forced to drive aging and broken down fleet of crown victorias. You are the chief of police. A Dodge salesmen comes to the department and says to you " I got a great deal for your department on some of our police equipped Chargers. They are better for your community than the old Fords"
You reply "No, they are not"
To which the salesmen says "Why do you say that, you fleet is breaking down and un usable"
Your reply "Because we use old Fords in our community, therefore, they are better"

This is the logic I am seeing from you, and I do not understand it. Just because something is done the way it is, doesnt make it better than an alternative solution.


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## Cory (Aug 3, 2009)

daedalus said:


> So the fact that Private EMS does not run in your community means that Fire service EMS is better for your community? I do not see the logic.
> 
> I will use an analogy to clarify. Police in New York are forced to drive aging and broken down fleet of crown victorias. A Dodge salesmen comes to the department and says to you " I got a great deal for you department on some of our police equipped Chargers. They are better for your community than the old Fords"
> You reply "No, they are now"
> ...




I am not debating that private EMS should run emergency here, that is hardly an option in this city. So, therefore, FD EMS is better than NOTHING.


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## Shishkabob (Aug 3, 2009)

That's not the debate though.  The debate rest pretty much around this:



> I never said they were illogical, I said they were* no more logical than FD's in a big city.*






I saw where daedalus stated his side, but you haven't backed yours up yet.


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## reaper (Aug 3, 2009)

Cory said:


> You said:
> 
> 
> So I responded with:
> ...



First off, there are decent FD's that handle EMS and there are decent privates that handle EMS. With that said, I would much rather see EMS handled by a county third service over all others. There is no conflict of interest with them. FD medics, must be FF's and cannot concentrate their full time to EMS. Private companies are out for the bottom dollar and will never put pt's above all else. A third service concentrates fully on EMS and is not as worried about the bottom dollar, as they are partly tax based.

BTW- I have lived in the cincinnati area and yes, it is a bad place. But, I have seen much worse and much poorer areas. Cincinnati is an average American city, not bad and not good, just average!


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## Shishkabob (Aug 3, 2009)

How bad can it be if it invented the Cincinnati Stoke Test?  ^_^


I mean, aside being in Ohio....


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## Sasha (Aug 3, 2009)

> Is it true that a private company won't transport if the patient has confirmed to have no insurance on scene?



No.

Diez Chars.


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## atropine (Aug 3, 2009)

daedalus said:


> I did not say that the fire department paramedics are bad at what they do. I provided you with an very small picture of what I see in my day to day run ins with them. They tell me they do not want to be EMTs or Paramedics. They tell me everyday.
> 
> How do you know that the Fire service is better for your community? Can you provide evidence? Private EMS offers an economically viable solution to providing emergency medical services to large and small communities, and creates an environment where tax payers are not billed for service, but rather individual patient's insurances are. (insurance and health care billing is a whole different beast so I won't go into it). Private EMS agencies bid for contracts, creating a free market system in which the local government can pick the agency that works best for them all while saving millions of dollars that could be spent on education and city renovation. Paramedics have the potential to make better wages in these systems with increasing educational demands, which hopefully will be recognized in the future by medicare and private plans, reimbursement may go up. Also, paramedics will not be forced to wear the hat of another professional, and can concentrate on providing patient care.
> I know fire based works, because it hasn't changed in the past 100 years, and no of the community is complaining about, as far as the privates go nobody wants to make 12.00 an hour forever, so with high turn over the wages won't increase and the privates will still be able to afford cheap labor.


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## daedalus (Aug 3, 2009)

Cory said:


> I am not debating that private EMS should run emergency here, that is hardly an option in this city. So, therefore, FD EMS is better than NOTHING.



Ok, I see where our communication is failing. If your city decided that private EMS would save them money one day (this is hypothetical) there would be a few companies that would start bidding for the contract ASAP. Just because there are no companies there now, does not mean that AMR or RuralMetro or other national EMS agencies could not be there in a few months to gladly take over.


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## ke5wrr (Aug 3, 2009)

Police Dispatcher handles 911 and we transfer calls according to response needed EMS, FD, other cities, or other counties!!B)


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## Shishkabob (Aug 3, 2009)

atropine said:


> I know fire based works, because it hasn't changed in the past 100 years



Fire based EMS has been around for 100 years?  

Wow... learn something new every day









/sarcasm.





Read up on the history of EMS.


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## Cory (Aug 3, 2009)

reaper said:


> BTW- I have lived in the cincinnati area and yes, it is a bad place. But, I have seen much worse and much poorer areas. Cincinnati is an average American city, not bad and not good, just average!



As I do agree to some extant, that staement is still debatable:
[YOUTUBE]http://www.youtube.com/watch?v=ctg0S_CniqQ&eurl=http%3A%2F%2Fwww%2Eyoutube%2Ecom%2Fuser%2Fwlwttv&feature=player_profilepage[/YOUTUBE]

This video is not whole proof, and it is almost 2 years old, but my statement still stands that there is a large number of insurance-less people.


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## reaper (Aug 3, 2009)

Considering that EMS has only been around for 40 years, I guess fires been making it up for the other 60?


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## Sasha (Aug 3, 2009)

Cory said:


> As I do agree to some extant, that staement is still debatable:
> [YOUTUBE]http://www.youtube.com/watch?v=ctg0S_CniqQ&eurl=http%3A%2F%2Fwww%2Eyoutube%2Ecom%2Fuser%2Fwlwttv&feature=player_profilepage[/YOUTUBE]
> 
> This video is not whole proof, and it is almost 2 years old, but my statement still stands that there is a large number of insurance-less people.



Welcome to America where there is a large number of uninsured people everywhere.

Also do you have a source more reputable than some snippet of an unidentified (as far as I heard) news cast on youtube?


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## daedalus (Aug 3, 2009)

atropine said:


> daedalus said:
> 
> 
> > I did not say that the fire department paramedics are bad at what they do. I provided you with an very small picture of what I see in my day to day run ins with them. They tell me they do not want to be EMTs or Paramedics. They tell me everyday.
> ...


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## Shishkabob (Aug 3, 2009)

Cory said:


> This video is not whole proof, and it is almost 2 years old, but my statement still stands that there is a large number of insurance-less people.



Hate to digress but....


How does lack of insurance make a city bad?




Have you ever been to Detroit or Flint?  You're telling me Cincinnati is worse then the two cities who have held the top spots for the most dangerous violent crime cities in America for several years now?


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## Cory (Aug 3, 2009)

Cincinnati FD was first official department in the nation, established April 1, 1853


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## Cory (Aug 3, 2009)

Linuss said:


> Hate to digress but....
> 
> 
> How does lack of insurance make a city bad?
> ...



nononono, I am saying that is most likely a large reason why private EMS is not present in Cincinnati 911 resonse yet.


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## Sasha (Aug 3, 2009)

Cory said:


> Cincinnati FD was first official department in the nation, established April 1, 1853



Annnnnnd?

diez chars.


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## Shishkabob (Aug 3, 2009)

Cory said:


> Cincinnati FD was first official department in the nation, established April 1, 1853




Funny, last I checked, Ben Franklin made the first known fire department in Philly, over 100 years prior.


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## Cory (Aug 3, 2009)

Sasha said:


> Annnnnnd?
> 
> diez chars.








> Fire based EMS has been around for 100 years?




2009 - 1853 = 156


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## daedalus (Aug 3, 2009)

Cory said:


> Cincinnati FD was first official department in the nation, established April 1, 1853



And?

Objection your honor! Relevance!?

Couldn't help myself hehe. 

FYI : They were not doing EMS in 1853


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## reaper (Aug 3, 2009)

That's because he was burning down the city with lightening!


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## ffemt8978 (Aug 3, 2009)

Cory said:


> Cincinnati FD was first official department in the nation, established April 1, 1853



No, it wasn't.



> On April 1, 1853, the Cincinnati, Ohio (USA) Fire Department became the first full-time paid professional fire department in the United States, and the first in the world to use steam fire engines. [1]


 Source:  http://en.wikipedia.org/wiki/History_of_firefighting

It was the first full time paid, not the first official department.


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## Cory (Aug 3, 2009)

Linuss said:


> Funny, last I checked, Ben Franklin made the first known fire department in Philly, over 100 years prior.



That was not an official government funded service or anything. It was a new idea on the rise.


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## Sasha (Aug 3, 2009)

Cory said:


> 2009 - 1853 = 156



Annnnnnndddd? 

EMS is something relatively new... and was originally done by funeral services, not the FD.


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## Shishkabob (Aug 3, 2009)

Cory said:


> 2009 - 1853 = 156



"Fire based" = "Fire based EMS", not "Fire Department".  EMS has not been around in it's current form for 100 years, and it sure as heck hasn't been in the FD longer then it has existed as an entity.


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## Cory (Aug 3, 2009)

Hmmm, the CFD patch lied to me !!!! :sad::sad::sad:

Seriously though, I stand corrected.


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## Shishkabob (Aug 3, 2009)

Cory said:


> That was not an official government funded service or anything. It was a new idea on the rise.



You said first official, to which I proved that it was not.  You never qualified what you meant as "official" with "government funding" or any other qualifier.


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## Sasha (Aug 3, 2009)

Cory said:


> nononono, I am saying that is most likely a large reason why private EMS is not present in Cincinnati 911 resonse yet.



Don't blame the uninsured. A 911 service CANNOT refuse care or transport based on inability to pay. EMTALA, anyone?


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## ffemt8978 (Aug 3, 2009)

Cory said:


> Hmmm, the CFD patch lied to me !!!! :sad::sad::sad:
> 
> Seriously though, I stand corrected.



Word of advice...don't use what you see on a patch as a basis for an argument.  You should always do your own research and support your arguments with facts.


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## Cory (Aug 3, 2009)

Sasha said:


> Don't blame the uninsured. A 911 service CANNOT refuse care or transport based on inability to pay. EMTALA, anyone?



So tell me, what is the process that happens after an uninsured person is transported by private EMS?(other than care, I mean as far as paying the bill and all)


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## Sasha (Aug 3, 2009)

Cory said:


> So tell me, what is the process that happens after an uninsured person is transported by private EMS?(other than care, I mean as far as paying the bill and all)



They are evaluated and treated appropriately at the hospital. It's done case by case. HERE it's usually a tax write off or they can try and get the money, but no use trying to get turnip juice out of blood.


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## Cory (Aug 3, 2009)

ffemt8978 said:


> Word of advice...don't use what you see on a patch as a basis for an argument.  You should always do your own research and support your arguments with facts.



Oh come on, do you really think I just got that from a patch? I just mis-read the information. And in a way I was still right, depending on what extant the argument entailed (look at the original posts, I am not quoting them all right now)


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## reaper (Aug 3, 2009)

Cory said:


> So tell me, what is the process that happens after an uninsured person is transported by private EMS?(other than care, I mean as far as paying the bill and all)



They bill them. If it is not paid, it goes to collections. If it is still not paid, they write it off!


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## Shishkabob (Aug 3, 2009)

If they are uninsured, they get a bill in their mailbox.  They are then to work out a payment plan with the providing agency.  That's IF the name and address given to the crew is real.


You DO know some fire based EMS bill people as well, right?  Just because it's fire based doesn't mean it's free.


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## Cory (Aug 3, 2009)

Sasha said:


> They are evaluated and treated appropriately at the hospital. It's done case by case. HERE it's usually a tax write off or they can try and get the money, but no use trying to get turnip juice out of blood.



no use... you can't tell me everyone just forgets about it. And that doesn't seem like a good situation for a high poverty area where insurance is less than common.


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## Sasha (Aug 3, 2009)

Cory said:


> no use... you can't tell me everyone just forgets about it. And that doesn't seem like a good situation for a high poverty area where insurance is less than common.



Did you miss where I said they use it as a tax write off?


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## ffemt8978 (Aug 3, 2009)

Cory said:


> So tell me, what is the process that happens after an uninsured person is transported by private EMS?(other than care, I mean as far as paying the bill and all)



That depends upon a lot of factors.  Some areas have it written into the contract that they sign with the government that they receive payments from the city or such for every patient they transport, some only receive reimbursement if the patient doesn't pay (either on their own or their insurance), and some bill only Medicare/Medicaid/Insurance.


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## Cory (Aug 3, 2009)

Linuss said:


> If they are uninsured, they get a bill in their mailbox.  They are then to work out a payment plan with the providing agency.  That's IF the name and address given to the crew is real.
> 
> 
> You DO know some fire based EMS bill people as well, right?  Just because it's fire based doesn't mean it's free.



Yes, I am aware, I was under the impression that private companies handled it differently though, no?


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## kecpercussion (Aug 3, 2009)

Only about 60% of ambulance bills are actually paid...no joke!


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## reaper (Aug 3, 2009)

Cory said:


> no use... you can't tell me everyone just forgets about it. And that doesn't seem like a good situation for a high poverty area where insurance is less than common.



Have you heard of Medicaid? They are getting some of the cost and that is better then none!


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## Shishkabob (Aug 3, 2009)

Everyone handles it differently.  It all depends on their contracts, regulations, guidelines, and local laws.


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## Sasha (Aug 3, 2009)

Linuss said:


> Everyone handles it differently.  It all depends on their contracts, regulations, guidelines, and local laws.



If you're really curious about your area there's this thing called google... or calling up and asking your local services.


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## daedalus (Aug 3, 2009)

Cory said:


> So tell me, what is the process that happens after an uninsured person is transported by private EMS?(other than care, I mean as far as paying the bill and all)



The answer to this question is contained within the text of EMTLA. Look it up.


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## Cory (Aug 3, 2009)

Wow, I love how you all answer the question, then b&*^% about having to answer it afterwards.


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## Shishkabob (Aug 3, 2009)

That's just how we roll, G.


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## Sasha (Aug 3, 2009)

daedalus said:


> The answer to this question is contained within the text of EMTLA. Look it up.



I'll even provide the link.

http://www.emtala.com/

But seriously, you gotta do your own research sometimes.


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## Cory (Aug 3, 2009)

Linuss said:


> That's just how we roll, G.



mmmhmmm, well its nothing to be proud of <_<


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## kecpercussion (Aug 3, 2009)

kecpercussion said:


> I think it would be interesting to hear which ambulance companies handle the 911 contract in your areas and some comments about them...
> 
> Care to share?



What happened to this!!! haha


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## Sasha (Aug 3, 2009)

Cory said:


> mmmhmmm, well its nothing to be proud of <_<



Neither is the fact that you ask questions you can easily find the answer to by a google search, but try and police the responses you get.

Ask a question, fine, but don't whine about the answers.


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## Sasha (Aug 3, 2009)

kecpercussion said:


> What happened to this!!! haha



Rural Metro is the only 911 ambulance company in my immediate area, with Health Central Ambulance covering Universal/Sea World and Ocoee/Winter Garden. There are a couple private/third services in So. Flo and many more in No. Flo. Reedy Creek EMS does Disney. Although they are Fire they do have an EMS only division. THey ride golf carts in the parks. The rest is covered by respective county and city fire services.


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## Cory (Aug 3, 2009)

Sasha said:


> Neither is the fact that you ask questions you can easily find the answer to by a google search, but try and police the responses you get.
> 
> Ask a question, fine, but don't whine about the answers.



Give an answer, fine. But don't whine about giving it.


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## Shishkabob (Aug 3, 2009)

I saw no one complaining about giving you an answer.  Just disdain for you not searching for it first.


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## Sasha (Aug 3, 2009)

Cory said:


> Give an answer, fine. But don't whine about giving it.



No one is whining about giving it, just pointing out you could have found the answer yourself and avoided confrontation.


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## Cory (Aug 3, 2009)

> there's this thing called google



You are telling me that sarcastic comment has no air of complaint to it?


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## Shishkabob (Aug 3, 2009)

None at all.   You're confusing sarcasm for complaining.


Sasha is a very sarcastic girl, even more so when actually conversing.  Just something you get used to, or drives you mad and you run away screaming. 


But that wasn't even close to the amount of sarcasm you think it was.  I've seen worse.  Much much worse.  Girls are E-V-I-L.


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## Sasha (Aug 3, 2009)

> Sasha is a very sarcastic girl, even more so when actually conversing. Just something you get used to, or drives you mad and you run away screaming.



She also yells really loud when she doesn't have a keycard  Right?


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## daedalus (Aug 3, 2009)

Cory said:


> You are telling me that sarcastic comment has no air of complaint to it?


This is not an meant to sound like an insult, but you have displayed a big lack of understanding into how EMS systems are operated. We have attempted to answer your questions with advice based on our years of collective experience, but you argued back and never backed up your statements with evidence. I, and others, are happy to answer questions, but not when our answers are treated like you have treated them.


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## Sasha (Aug 3, 2009)

daedalus said:


> This is not an meant to sound like an insult, but you have displayed a big lack of understanding into how EMS systems are operated. We have attempted to answer your questions with advice based on our years of collective experience, but you argued back and never backed up your statements with evidence. I, and others, are happy to answer questions, but not when our answers are attacked by someone who has no experience.



Plus Uno!!!


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## Cory (Aug 3, 2009)

daedalus said:


> This is not an meant to sound like an insult, but you have displayed a big lack of understanding into how EMS systems are operated. We have attempted to answer your questions with advice based on our years of collective experience, but you argued back and never backed up your statements with evidence. I, and others, are happy to answer questions, but not when our answers are treated like you have treated them.



You and I have had one total communication breakdown a while ago in this argument. If I have left a question un-answered, tell me so.


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## Shishkabob (Aug 3, 2009)

Sasha said:


> She also yells really loud when she doesn't have a keycard  Right?



No keycard with melting ice cream if I remember correctly.  




"I FORGOT MY CARD!  LET ME IN!"


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## kecpercussion (Aug 3, 2009)

I would like to congratulate everyone on reaching over 100 POSTS!!!!!!

keep up the good work!


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## Sasha (Aug 3, 2009)

Linuss said:


> No keycard with melting ice cream if I remember correctly.
> 
> 
> 
> ...



No no no... to the growing line behind me as I pulled off to the side "I DONT HAVE A CARD... NO.. I DONT HAVE A CARD. GO AROUND. I DONT.HAVE.A.CARD" I repeat that peformance several times a week.


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## Shishkabob (Aug 3, 2009)

It was what, 3 months ago? Sue me ^_^


I also remember something about rain and a cake.B)


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## Sasha (Aug 3, 2009)

Cory said:


> You and I have had one total communication breakdown a while ago in this argument. If I have left a question un-answered, tell me so.



He isn't talking about a communication breakdown. He is talking about you arguing with us when we give you answers.. answers that are based on experiences in the actual field, and not an opinion with no factual basis.


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## Cory (Aug 3, 2009)

Sasha said:


> He isn't talking about a communication breakdown. He is talking about you arguing with us when we give you answers.. answers that are based on experiences in the actual field, and not an opinion with no factual basis.



...uh-huh, partially. And he also claimed I have yet to give any evidence to whatever it is he is talking about. And I am willing to try ad give evidence, but I do not know what I have left un-answered.


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## HotelCo (Aug 3, 2009)

Depends on where you go. We have Fire-based, Private, County, fire first response with private transport... It all depends on where you go around here.


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## kecpercussion (Aug 3, 2009)

Where is that? USA? I can't tell by your location haha


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## Shishkabob (Aug 3, 2009)

Cory said:


> ...uh-huh, partially. And he also claimed I have yet to give any evidence to whatever it is he is talking about. And I am willing to try ad give evidence, but I do not know what I have left un-answered.



No, I was the one claiming you didn't give evidence to what you were stating, which was that "private based is no more logical then fire based".



kecpercussion, he's in Michigan.


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## Cory (Aug 3, 2009)

Linuss said:


> No, I was the one claiming you didn't give evidence to what you were stating, which was that "private based is no more logical then fire based".
> 
> 
> 
> kecpercussion, he's in Michigan.



Oh, well as has been said, it is a matter of opinion mostly depending on the area. Hmm, I have a tendncy to get off-topic.


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## Shishkabob (Aug 3, 2009)

Opinion or not, if you say something you tend to have to back it up.  That's how a debate works.


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## daedalus (Aug 3, 2009)

Cory said:


> ...uh-huh, partially. And he also claimed I have yet to give any evidence to whatever it is he is talking about. And I am willing to try ad give evidence, but I do not know what I have left un-answered.



Evidence is all the rage in medicine and even EMS now in days. You should learn about it now, and you will be ahead. No longer is it ok to just say that fire EMS is better, or that backboarding all patients is a good practice, or that system status management improves response times. These things require research or at least expert consensus to be debated on.

Evidence is something like this: A 2002 study showed that fire based EMS had statistically faster response times, and better patient outcomes, than private third service agencies in a large multi city project.

The above is fictional and no such evidence exists.


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## Cory (Aug 3, 2009)

Linuss said:


> Opinion or not, if you say something you tend to have to back it up.  That's how a debate works.



What more are you expecting me to say? I have said how FD is more practical in my area. You have said how private is more practical in your area.


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## Shishkabob (Aug 3, 2009)

Cory said:


> What more are you expecting me to say? I have said how FD is more practical in my area. You have said how private is more practical in your area.



I never said private is more practical in my area.





But as you just said, you think FDEMS is "more practical" in your area.  Why?  What leads you to such a conclusion?


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## Cory (Aug 3, 2009)

Linuss said:


> I never said private is more practical in my area.
> 
> 
> 
> ...



Because at this current time, ther is no 911 resonse private companies. If there was, then I would say the poverty rate woul make for a bad situation with the way some private companies handle billing. Then someone jumped down my throat about how I was wrong, as you are about to do.


My argument still stands though. I was responding to someone who said private is more practical for all large cities. And I said I don't understand the reasoning, seeing as that can be true some places and not others.


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## reaper (Aug 3, 2009)

Exactly, How do you know that FDEMS is the best thing for your city, when you know of no others? Just because it has not been changed there, does not mean it works the best!


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## Shishkabob (Aug 3, 2009)

Cory said:


> Because at this current time, ther is no 911 resonse private companies.



You're missing the point.  This isn't a factual type discussion, it's hypothetical.



It's like saying "You can't argue the coolness invisibility and flying, because neither can be done".  You can't say one's better because you don't have the other.




Let's say your city could choost between both private AND fire based EMS.  Why would you choose fire?


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## Cory (Aug 3, 2009)

Linuss said:


> You're missing the point.  This isn't a factual type discussion, it's hypothetical.
> 
> 
> 
> ...



 UGH


Again: then my GUESS is that the large number of uninsurred people living in the inner city area would not mix well with the way some private companies do their billing. It seems like so mnay ambulance bills would go un-paid.

But then again, if you have the mind to read all of this document then you would see that costs of FD ambualnces are already getting higher, so I can't honestly say. I don't know enough about the contrast of private and FD billing.

Mind you, that is from 2005, but money hasn't gotten any easier since then.


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## reaper (Aug 3, 2009)

For a private service, I would much rather have the poor pt's! They have medicaid and medicare, verses being uninsured. So, you will recoup more billing costs from them.


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## medic417 (Aug 3, 2009)

Cory said:


> Okay, but I do not see how giving up an area to private companies would solve that. The FD's are still going to be there, unless you are suggesting that more FD's should close, than I understand your reasoining, but then I also dissagree with it.
> 
> 
> 
> -Cory-



Actually with better building codes the need for a fire station on every corner has gone away.  Fire could be cut way down and the money shifted to fund a Pre Hospital Medical Professional ambulance service rather than a hose jockey I don't want to be on an ambulance but have to for future promotion taxi service.


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## 46Young (Aug 3, 2009)

If a private EMS provider were to take over a city in generally poor socioeconomic standing, with a poor reimbursement rate due to lack of insurance, the company would quickly go out of business. 

A hospital based 911 system makes money by steering insured pts back to their hospital, not so much through insurance reimbursement for txp. They may also steer uninsured pts away from their home hosp so they don't drain their resources and take up beds that could be occupied by insured pts. It's a one two punch to stay out of the red.

There is a way for it to work, if the city can afford it - guarantee that the company receives a predetermined amount of annual compensation. If the company fails to meet that number from reimbursement, the city pays the difference. If reimbursements are greater than the target number, the city keeps the rest.

For all of it's alleged wastefulness, a FBEMS txp unit has no financial incentive to not do the right thing for the pt. Objective unbiased pt care, at least in my neck of the woods.


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## 46Young (Aug 3, 2009)

medic417 said:


> Actually with better building codes the need for a fire station on every corner has gone away.  Fire could be cut way down and the money shifted to fund a Pre Hospital Medical Professional ambulance service rather than a hose jockey I don't want to be on an ambulance but have to for future promotion taxi service.



Consider a typical stick home, type 5 construction, with it's high fire load, rapid spread due to void spaces. Trusses fail whan any one part of the system fails. Due to quicker fire spread conditions can become untenable in a manner of a few minutes. Structural collapse can happen in as little as 15 minutes time.

So, assuming that the 911 call is placed the exact moment that the fire started (typically the call is places many minutes later), the dispatcher routes the call to the station, and the apparatus is on the road, can be 4-6 minutes. Add another 2-5 minutes to get onscene. Now we're at 6-11 minutes. The first due engine needs to lay out, the officer does their lap around the structure as the crew pulls the line and puts on their face pieces. At the same time the truck company throws ladders and pack Scott up for a VES. Now we're nearing 12-15 minutes before we can reach victims and begin suppression in an optimal situation. Remember, that's if the call were placed at the exact moment the fire started. That rarely happens, if ever. 

The chances of us reaching viable victims and saving property are marginal at best given modern construction practices, under optimal circumstances. Now reduce fire staffing and extend response times by 5 minutes or more. 

Yes, suppression call volume is relatively low compared to the number of staff, but proper staffing is necessary for the reason mentioned above, as well as many others. Due to relative downtime, using fire personnel for EMS activities is efficient use of personnel. 

I've mentioned this before, keeping proficiency as a medic, let alone as a basic is not as difficult as some would make it out to be. Suppression is not rocket science, either. Over here we drill both EMS and suppression on duty, and receive quaterly 8 hour EMS con ed on duty as well.


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## medichopeful (Aug 3, 2009)

Linuss said:


> Opinion or not, if you say something you tend to have to back it up.  That's how a debate works.



Oh yeah?  Where's your proof?

I kidd


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## JeffDHMC (Aug 3, 2009)

Round here, FD is non-transporting BLS. 911 EMS is handled by the county hospital, works great. We handle EMS, they help us out. In the surrounding metro area, it' FD based. I have experience there too, doesn't work so well. But that's just me.


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## Shishkabob (Aug 3, 2009)

"For all of it's alleged wastefulness, a FBEMS txp unit has no financial incentive to not do the right thing for the pt. Objective unbiased pt care, at least in my neck of the woods."

Just as it's stupid to say all FDEMS sucks, it's stupid to say that all private medics are biased towards the bottom dollar, pt be damned. 


In reality the medics at the private won't care about the bottom dollar, and will do what's best for the pt, as evidenced by the many privates on these forums. 

Just like SOME privates care about making money doesn't mean they all do, just as some fire medics suck doesn't mean they all do.


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## 46Young (Aug 3, 2009)

Many here from an EMS only background argue that sending more than two providers to a pt is superfluous, save an arrest or otherwise critical pt. I'll agree that sending multiple pieces to a stubbed toe or general feel-me-bads is overkill. EMS response by suppression crews ought to be for higher priority calls.

Having said that, consider how much longer you can last in the field with more hands onscene to help with lifting, diagnostics, scene safety, etc. I know of many a broken down medic, typically with either a career ending back injury or shoulder inj, or just general burnout and apathy.

When I'm on the engine, I'll carry the O2 and ALS bag, the other bucket FF will carry the monitor and airway bag. The driver will make sure the medic finds us, or bring immobilization equipment if necessary. Once inside, I'll interview the pt, do my assessment/diagnostics with any necessary ALS interventions, while my Lt records my findings. The FF will perform BP, pulse, hook up the monitor/12 lead (I interpret, of course) and BGL. The officer will gather info from the family as well as meds, and record vitals. When the medic arrives, we'll continue working, while the Lt gives them the story. We'll then assist with removal to the bus, I'll help with any further interventions, and ride to the hosp if needed. Onscene times are quite short typically. If the medic gets there first, we'll do as directed by the crew.

Having other hands to help greatly reduces the ambulance crew's burden, thereby reducing their stress and promoting longevity. 911 call to ED arrival is shortened noticeably as well.

Many private or hosp. based EMS agencies are profit driven, and will run the least amount of units as possible to increase their bottom line. Crews run extremely high call volume, in some cases for 24 hours or much more. Eventual burnout is inevitable. This can be dangerous both for the pt and the crew. Private EMS can also have staffing issues, making holdover of already overworked crews necessary. FD's with crosstrained personnel won't have anywhere the same degree of difficulty with EMS staffing.

I've worked in the NYC 911 system for years before I left. I'm quite capable of getting things done with only one partner and no other hands. It sucks at times, but you do it. When I first experienced fire based EMS I was overwhelmed by the amount of providers onscene. You have to know how to use your resources to be efficient. If everyone knows their role, things should move seamlessly and not be a cluster. Besides, why risk a career ending injury on a 300 lb plus heavy hitter when you can have all of the help you'll ever need? If you pride yourself with working a insanely high call volume for hours (days?) on end, and not needing any additional help with your pts, remember the old saying: "Pride comes before a fall". That "fall" can be an MVA, clinical error, injury, or taking out your frustrations on your pts.


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## 46Young (Aug 3, 2009)

Linuss said:


> "For all of it's alleged wastefulness, a FBEMS txp unit has no financial incentive to not do the right thing for the pt. Objective unbiased pt care, at least in my neck of the woods."
> 
> Just as it's stupid to say all FDEMS sucks, it's stupid to say that all private medics are biased towards the bottom dollar, pt be damned.
> 
> ...



I wasn't referring specifically to the providers, rather company policy. This is typically invoked by an "unwritten rule". If you don't play the game, the company will make you miserable as a result, as in late calls, undesireable shift schedule, no pay raises, no OT, too much forced OT, amassing a paper trail to get you fired.

Again, I speak from experience. One of the NY hosps I worked for per diem operated in this manner, as well as others. NSLIJ and Cornell were on the up and up, however.


----------

