# City ponders extra $6.5 million paid for paramedics over basic EMTs



## MMiz (Apr 6, 2009)

*City ponders extra $6.5 million paid for paramedics over basic EMTs*

For some, a bee sting can escalate from scary to fatal in matter of minutes.

That's why Columbus paramedics are trained to recognize and treat anaphylactic shock.

But a recommendation that the city compare the costs and quality of advanced life support (what paramedics provide) and basic life support (what firefighters provide) could change everything.

*Read more!*


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## trevor1189 (Apr 6, 2009)

I like how it is setup around here. We have BLS and ALS rigs. BLS is usually dispatched from the fire depts closest to the call and there are several ALS rigs positioned at certain depts which respond a few minutes behind the BLS rigs if ALS might be needed. Also, BLS can always upgrade the call and request a medic to come. Seems to work well. Not everyone needs ALS, but it is definitely nice to know they are only a few minutes away if needed.


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## SauceyEMT (Apr 6, 2009)

In my area, Southeastern Massachusetts, there are several agencies both public and private that have trucks staffed with one medic and one basic. If the call requires ALS, it's there, if it only requires BLS, thats there too.


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## JPINFV (Apr 6, 2009)

trevor1189 said:


> Not everyone needs ALS, but it is definitely nice to know they are only a few minutes away if needed.



Really? Last time I checked those BLS patients are still going to see a physician at the hospital. (Side question, can NPs and PAs do the EMTALA mandated screening exam?)


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## Sasha (Apr 6, 2009)

> I like how it is setup around here. We have BLS and ALS rigs. BLS is usually dispatched from the fire depts closest to the call and there are several ALS rigs positioned at certain depts which respond a few minutes behind the BLS rigs if ALS might be needed



You could cut out the need for two trucks responding by putting a medic on every truck. Not everyone needs ALS, but everyone deserves an ALS assesment. Many basics can't recognize the need for ALS, as patients who need it don't always present gasping for air or clutching their chest. They could present with stomach discomfort, arm pain, swollen legs or light headedness or headaches or many other symptoms that could be nothing.


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## trevor1189 (Apr 6, 2009)

JPINFV said:


> Really? Last time I checked those BLS patients are still going to see a physician at the hospital. (Side question, can NPs and PAs do the EMTALA mandated screening exam?)


Yes they are going to see a physician. But that doesn't need they need a medic to transport them. 


Sasha said:


> You could cut out the need for two trucks responding by putting a medic on every truck. Not everyone needs ALS, but everyone deserves an ALS assesment. Many basics can't recognize the need for ALS, as patients who need it don't always present gasping for air or clutching their chest. They could present with stomach discomfort, arm pain, swollen legs or light headedness or headaches or many other symptoms that could be nothing.


Again in a perfect world every agency would be able to do that. But that's not the case. Heck, why not just get rid of paramedics and emts all together and staff ambulances with doctors since that is what they really need. It's not cost effective. With limited medics they are reserved for calls that need them. Also if BLS is on scene and has any hunch they need ALS a paramedic "chaser car" can meet them on scene or enroute within minutes.


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## JPINFV (Apr 6, 2009)

trevor1189 said:


> Yes they are going to see a physician. But that doesn't need they need a medic to transport them.



So the government doesn't trust decisions over the stability of a patient to anyone lower than a physician, but should trust essentially the same decision to people with 110 hours of first aid training?


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## TransportJockey (Apr 6, 2009)

I think every ambulance should have at least 1 medic on it to even be considered an ambulance. A BLS truck is a first aid vehicle, nothing more


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## Sasha (Apr 6, 2009)

> It's not cost effective.



But sending out two trucks is cost effective?

Short supply of paramedics? Heck, advertise the openings in Florida. There are tons of paramedics sitting on the butt twiddling their thumbs waiting on call backs from R/m and EVAC.


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## Shishkabob (Apr 6, 2009)

MICU--- answer to everyones demands (Not really but I like the abbreviation)


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## Sasha (Apr 7, 2009)

Linuss said:


> MICU--- answer to everyones demands (Not really but I like the abbreviation)



Mexican Intensive Care Unit.


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## Shishkabob (Apr 7, 2009)

Sasha said:


> Mexican Intensive Care Unit.



Marijuana Injected Co-urinary. 

Jeez, Sasha, get with the times.


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## BLSBoy (Apr 7, 2009)

Sasha said:


> But sending out two trucks is cost effective?
> 
> Short supply of paramedics? Heck, advertise the openings in Florida. There are tons of paramedics sitting on the butt twiddling their thumbs waiting on call backs from R/m and EVAC.



Not every call gets 2 trucks. 
Stubbed toe, ETOH, assault, sick person, are BLS calls. 
CP, SOB, unk. medical emergency, diabetic, etc, are ALS calls. 
Your BLS call volume will outnumber the ALS call volume. As a consequence, you will need more BLS then ALS trucks. 

Minimum daily staffing here in Atlantic City is 3 BLS, 1 MICU, and 1 MICU/SCT, however, that can be sent on SCT/CCT jobs. 
Overall, we have 3 MICU/SCT and 4 MICUs for the entire county. 
As for BLS ambulances........ is alot a number?

And as for Florida "Medics", you know as well as I do they are taught to pass the medic exam. 
Very few "schools" teach in depth.


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## Sasha (Apr 7, 2009)

BLSBoy said:


> Not every call gets 2 trucks.
> Stubbed toe, ETOH, assault, sick person, are BLS calls.
> CP, SOB, unk. medical emergency, diabetic, etc, are ALS calls.
> Your BLS call volume will outnumber the ALS call volume. As a consequence, you will need more BLS then ALS trucks.
> ...




Even so, they're jobless and would leap at the opprotunity to work, even if it meant moving away. You know as well as I do that everyone deserves an ALS assesment, and the best and most effective way to do this is to put a paramedic on every truck.


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## Sasha (Apr 7, 2009)

Linuss said:


> Marijuana Injected Co-urinary.
> 
> Jeez, Sasha, get with the times.



What the heck is a Co-urinary?


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## TransportJockey (Apr 7, 2009)

Sasha said:


> What the heck is a Co-urinary?



Do you really want to know?


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## EMTinNEPA (Apr 7, 2009)

Sasha said:


> Even so, they're jobless and would leap at the opprotunity to work, even if it meant moving away. You know as well as I do that everyone deserves an ALS assesment, and the best and most effective way to do this is to put a paramedic on every truck.



What if the service in question can't afford to staff EMTs 24/7, let alone paramedics?

And just so you know, I agree with you.  In a perfect world, there would be no need for EMT-Bs and everybody would be at the paramedic level.  But sadly, this isn't a perfect world.  It's a ball of suck.  Suck-coated suck with suck filling.


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## JPINFV (Apr 7, 2009)

It's a big suck-coated suck in large part because we accept the suckage. Instead of fighting for change, we simple stand up and beg, "Please sir, may we have some more."


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## EMTinNEPA (Apr 7, 2009)

JPINFV said:


> It's a big suck-coated suck in large part because we accept the suckage. Instead of fighting for change, we simple stand up and beg, "Please sir, may we have some more."



I fought for change and it got me sent to the unemployment line.  Sorry, but food in my belly and a roof over my head is more important to me.  If only somebody with power would fight for change, but that's not going to happen any time soon.


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## reaper (Apr 7, 2009)

BLSBoy said:


> Not every call gets 2 trucks.
> Stubbed toe, ETOH, assault, sick person, are BLS calls.
> CP, SOB, unk. medical emergency, diabetic, etc, are ALS calls.
> Your BLS call volume will outnumber the ALS call volume. As a consequence, you will need more BLS then ALS trucks.
> ...



Those very few schools are some of the best around!


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## CAOX3 (Apr 8, 2009)

I dont even get this article.  Half of your calls for service wound up in no transport?

Of the 50,000 calls 35,000 required ALS.  What?  65% ALS call volume in an urban area?I highly doubt that.


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## el Murpharino (Apr 8, 2009)

CAOX3 said:


> I dont even get this article.  Half of your calls for service wound up in no transport?
> 
> Of the 50,000 calls 35,000 required ALS.  What?  65% ALS call volume in an urban area?  I highly doubt that.



From the article:  "In 2008, the Division of Fire responded to 110,739 medical calls. Of these, 35,028 were taken to the hospital needing advanced life support and 17,370 required basic care.  There were about 50,000 runs during which no one was transported."

The figure is more like 31% that needed ALS, not 65.


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## CAOX3 (Apr 8, 2009)

I think the percentage of ALS transports would be derived from the actual number of transports.  Not the number of calls for service.

I would think.


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## el Murpharino (Apr 8, 2009)

CAOX3 said:


> I think the percentage of ALS transports would be derived from the actual number of transports.  Not the number of calls for service.
> 
> I would think.



I'm not an EMS statistician, but in statistics class, I considered the total sample size and went from there.  As long as we both know what page of music we're on...


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## CAOX3 (Apr 8, 2009)

el Murpharino said:


> I'm not an EMS statistician, but in statistics class, I considered the total sample size and went from there.  As long as we both know what page of music we're on...



I hated statistics and probability......Not my cup of tea.

It would be interesting to know the formulas they used, or any city for that matter, to come up with these statistics.


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## PotatoMedic (Apr 9, 2009)

CAOX3 said:


> I hated statistics and probability......Not my cup of tea.
> 
> It would be interesting to know the formulas they used, or any city for that matter, to come up with these statistics.




You know 90% of statistics are made up on the spot!

(sorry could not resist...)  ((I really need to go to bed..  ))


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## Juxel (Apr 9, 2009)

JPINFV said:


> (Side question, can NPs and PAs do the EMTALA mandated screening exam?)



Short answer is yes.  Long answer is that it's up to each individual organization.  EMTALA does not define who must perform the exam other than to say a "qualified medical person" and it leaves it up to each organization to define that as they see fit.

Physicians are the obvious choice, but my organization allows NPs and PAs to do it with the provision of making docs accessible should we want to consult.  Some organizations choose to limit a "qualified medical person" to strictly a doc, others will let a nurse midwife do OB patients, others let NPs and PAs handle cases.  

It does open you up to further liability as an organization, but the benefits certainly outweigh the risks, at least for an organization such as mine.


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