# DC FEMS using Privates for low-acuity calls



## 46Young (Oct 13, 2015)

http://www.wusa9.com/story/news/loc...approves-private-ambulance-services/73466154/


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## TransportJockey (Oct 13, 2015)

I'm starting to think that they should use private companies for all calls, since they have such a hard time getting ambulances that work on the road.


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## 46Young (Oct 13, 2015)

Agreed


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## Jim37F (Oct 13, 2015)

There's perpetual rumors and "water cooler" gossip that LAFD is looking at replacing their 800s (BLS ambulances) currently staffed by firefighters with either private company(s) or hire single role EMTs to staff instead of FFs.....of course I believe I'm more likely to get a killer deal on beachfront property in Arizona than see thathe happen anytime soon...


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## RedAirplane (Oct 17, 2015)

How do you know a call acuity until you get there?


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## RedAirplane (Oct 17, 2015)

Any why only low acuity? If they're going to play with the privates, why not send any ambulance of the correct staffing (ALS or BLS) to the call?


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## NomadicMedic (Oct 17, 2015)

RedAirplane said:


> How do you know a call acuity until you get there?



Priority medical dispatching. In a large metro, the majority of 911EMS calls triage out as low acuity.


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## RedAirplane (Oct 17, 2015)

DEmedic said:


> Priority medical dispatching. In a large metro, the majority of 911EMS calls triage out as low acuity.



Isn't it a big joke on this forum how inaccurate such trusting is?


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## NomadicMedic (Oct 17, 2015)

RedAirplane said:


> Isn't it a big joke on this forum how inaccurate such trusting is?



It's usually pretty accurate. There _are_ issues with it, including BLS priority calls being given to ALS based on a poorly worded question on a card. For example, a low acuity 33 call, normally an IFT, will get coded as a 33Charlie1 ALS response if questions like "has this patient been evaluated by a medical professional" or "is this a new problem" are answered as a yes. In many cases it's a silly low priority call that was upgraded because the nurse told the CNA to call for an ambulance because the patient isnt acting quite right. Everyone knows it, but a 33c1 is the dispatch code on the card, so everyone goes. 

True ALS level calls are almost always dispatched correctly and if they're not, BLS can stabilize a patient and meet ALS enroute.


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## Tigger (Oct 17, 2015)

DEmedic said:


> True ALS level calls are almost always dispatched correctly and if they're not, BLS can stabilize a patient and meet ALS enroute.


Exactly. 

In an urban area it's less of a big deal if the patient turns out to be in bad shape as there should be some ALS nearby. It's in rural areas that it's an issue when the BLS ambulance arrives to find they need help and the nearest paramedic is a long way away.


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## johnrsemt (Oct 22, 2015)

Hard to keep running ambulances on the road; and hard to get them there in the first place:  sometimes DC has worse response times than we do, and we may be an hour away from a scene


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## RedAirplane (Oct 22, 2015)

So, to clarify, is the proposal BLS privates and ALS fire ambulances?

That isn't stated anywhere, but if both are the same level, why would the acuity of the call make a difference?


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## 46Young (Oct 22, 2015)

RedAirplane said:


> So, to clarify, is the proposal BLS privates and ALS fire ambulances?
> 
> That isn't stated anywhere, but if both are the same level, why would the acuity of the call make a difference?



Either they don't trust the privates to run truly sick patients (I know this is laughable, as this is DC FEMS we're talking about), or that the acutely ill will typically be older, and will typically be insured, at the least Medicare. Calls with ALS interventions can be billed with a higher rate. $$$

IDK if they're using ALS privates, but if they're dispatching privates to low acuity calls, I would imagine that it'll be BLS. Any reporting on this new plan doesn't say specifically.


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## EpiEMS (Oct 22, 2015)

Seems pretty clear that FEMS will run ALS: https://www.washingtonpost.com/loca...562498-6ba5-11e5-b31c-d80d62b53e28_story.html
"A basic-life-support ride, which the private company will handle under the new plan, costs $428; advanced life support, which the District’s EMS will continue to manage, can cost either $508 or $735, based on the level of care given. "


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## TransportJockey (Oct 22, 2015)

EpiEMS said:


> Seems pretty clear that FEMS will run ALS: https://www.washingtonpost.com/loca...562498-6ba5-11e5-b31c-d80d62b53e28_story.html
> "A basic-life-support ride, which the private company will handle under the new plan, costs $428; advanced life support, which the District’s EMS will continue to manage, can cost either $508 or $735, based on the level of care given. "


That makes no sense. If anything FEMS should run the calls that are lower priority. Less chance of them screwing them up


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## NomadicMedic (Oct 22, 2015)

This is how all of King County Washington runs calls. BLS is turfed to the privates and ALS is run by County Medic One in the or the various fire agency Medics, like Seattle or Bellevue fire.


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## Grozler (Oct 23, 2015)

DEmedic said:


> This is how all of King County Washington runs calls. BLS is turfed to the privates and ALS is run by County Medic One in the or the various fire agency Medics, like Seattle or Bellevue fire.


The key component in the turfing of patients to privates in King County is BLS patients being evaluated by a BLS engine first. DC's chief came from Seattle so it would make sense he's trying to emulate that system but do they have the staffing and political guts to do so?


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## NomadicMedic (Oct 23, 2015)

Grozler said:


> The key component in the turfing of patients to privates in King County is BLS patients being evaluated by a BLS engine first. DC's chief came from Seattle so it would make sense he's trying to emulate that system but do they have the staffing and political guts to do so?



Oh, that's right. The firemen on the BLS engine can evaluate the patients much better than the guys on the private BLS ambulance. They use a TIC right? 

Thy King County system is a HUGE waste of resources.


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## Tigger (Oct 23, 2015)

Grozler said:


> The key component in the turfing of patients to privates in King County is BLS patients being evaluated by a BLS engine first. DC's chief came from Seattle so it would make sense he's trying to emulate that system but do they have the staffing and political guts to do so?


How can a BLS engine turf to a BLS ambulance if they also have no idea what they are looking at?


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## Grozler (Oct 23, 2015)

Not saying it's a perfect system by any stretch. If anything it's representative of the arrogance of the Medic One system. But saying Medic One is arrogant is repetitive in itself.


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## EpiEMS (Oct 23, 2015)

Seems like even the most fly-by-night private operators would be a better system than what DC already has...


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