# What should we do to improve EMS



## AJ Hidell (Feb 27, 2009)

ericcoch said:


> What do you think? What do you do?


The system is broken, and it can't be fixed.  Don't waste any time or effort trying.  Let it collapse, forcing your community leaders to join the 20th century and provide full-time professional EMS.  It's the best thing you can do for your community.  And that's who this should be all about, right?


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## ericcoch (Feb 28, 2009)

that is just sad for someone to think that way.  There are many, and I would gather to guess the volunteer squads are the majority of providers, so I think that it is sad for someone to have that view point, I just hope that people do not have that same thought, and I also hope that it is not your town that does that and your loved one who suffers while the system fails.  I think that I and others are willing to do the job for FREE, and that saves my town money that can be spent on the parks or schools or even salt for my street.  

So please to anyone else out there who are not giving up, how do you welcome and train new members before they can take a FR or B course?


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## medic417 (Feb 28, 2009)

Please do not encourage people to harm my profession by asking them to do the job for free.


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## Ridryder911 (Feb 28, 2009)

ericcoch said:


> that is just sad for someone to think that way.  There are many, and I would gather to guess the volunteer squads are the majority of providers, so I think that it is sad for someone to have that view point, I just hope that people do not have that same thought, and I also hope that it is not your town that does that and your loved one who suffers while the system fails.  I think that I and others are willing to do the job for FREE, and that saves my town money that can be spent on the parks or schools or even salt for my street.
> 
> So please to anyone else out there who are not giving up, how do you welcome and train new members before they can take a FR or B course?



So parks and salt is more important than a professional EMS? Wow! I am dishearten that someone has such low priorities of EMS. 

Thank you, you just proved our point. If one was really interested in patient care and development of EMS, there is money out there. Geez... salt and parks more important than citizens health. 

R/r 911


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## ericcoch (Feb 28, 2009)

yes what little money is around in a small town can be better spent when there are people willing to do the job for free, not a pay check or credit or anything else, but to help our neighbors.  We have all levels of training and all do it for free, from paying for the training our selves and taking what little time we have to keep up with continuing ed and taking the courses in the first place.  I have worked for both paid, paid on call, and now run with my home town for FREE.  And the volunteers out there do it all the time to help people, not for pay.  So do not look down at the volunteer departments because they every where and you know what we do not even charge or bill, a lot of our residents do not have insurance so the tax dollars pay for supplies, gas, and new ambulances every few years.  And when the tones go out so do we, just like everyplace else.


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## medic417 (Feb 28, 2009)

Ridryder911 said:


> So parks and salt is more important than a professional EMS? Wow! I am dishearten that someone has such low priorities of EMS.
> 
> Thank you, you just proved our point. If one was really interested in patient care and development of EMS, there is money out there. Geez... salt and parks more important than citizens health.
> 
> R/r 911




LOL.  He made your point w/o even realizing it and now after your posts continues to make it again.


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## AJ Hidell (Feb 28, 2009)

ericcoch said:


> So please to anyone else out there who are not giving up, how do you welcome and train new members before they can take a FR or B course?


So you don't think that EMS is worth paying for?  You don't think the weakest and most vulnerable of your citizens would be better served by someone who chose to complete a couple of years of formal medical education, than by someone who had to be talked into attending a 40 or 120 hour first aid course?  You don't think that people suffering a critical cardiac event, anaphylaxis, or respiratory distress could benefit from something more than oxygen and a ride to the hospital in an ambulance being driven by people with little to no training and experience, who rely on dangerous and often fatal "diesel therapy" to compensate for a lack of medical sophistication?  Is that really all you think your friends and family are worth?

But guys mowing the grass and picking up trash at those parks are a more important expenditure than EMS?  You don't even value yourself and your services, and you think I am sad?

Now tell me again which one of us is sad.


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## MMiz (Feb 28, 2009)

As has been sent to a few posters in this thread:

Our Community Rules state:


> We take the "be polite" rule VERY seriously! We do not tolerate ANY rudeness, profane or offensive language whatsoever. Any member who is intentionally unpleasant or disruptive may be suspended or banned.



Continuing to take every thread off topic to push an agenda serves no one, and will ultimately lead to loss of posting privileges.  Really, if you don't have anything positive or helpful to post, just don't post.

Back on topic, you could teach members CPR/First Aid/AED/O2, Hazmat, Extrication, Communicable Diseases, Communications, Assisting ALS crews, Medical Terminology, and a few others.


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## Dustoff (Mar 1, 2009)

My Mama taught me if I had nothing good or positive  to say, then one is to keep quiet but I see not everyone was brought up that way:sad:
Volunteers have a special place in my heart and in the community, I gave 2 years for my country so you could "rant & rave" on this board.


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## AJ Hidell (Mar 1, 2009)

Dustoff said:


> My Mama taught me if I had nothing good or positive  to say, then one is to keep quiet but I see not everyone was brought up that way:sad:


You're questioning the parentage of your fellow forum members here?  Very nice start.

Just because you disagree with an opinion does not make that opinion bad or negative.  I would call trying to silence others opinions a bad and negative thing though, would you not?


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## Dustoff (Mar 1, 2009)

My apologies Captain, I just see a lot of personal attacks from certain individuals and fell into the pit. I will restrain and refrain.


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## medic417 (Mar 1, 2009)

Dustoff said:


> My Mama taught me if I had nothing good or positive  to say, then one is to keep quiet but I see not everyone was brought up that way:sad:
> Volunteers have a special place in my heart and in the community, I gave 2 years for my country so you could "rant & rave" on this board.



Are you saying you served the country for free, that you refused a check?

Because if you volunteered to serve in the military but accepted a check you are not a volunteer.  



Now to origional post if you are wanting to let people see what is involved you could as mentioned just do a CPR course and include HIPAA, patient priv acy then have them ride along to get a taste.  They would then see what the job is about.  Now the problem with that though is w/o education it could scare away some good people.


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## fortsmithman (Mar 1, 2009)

Ridryder911 said:


> So parks and salt is more important than a professional EMS?
> 
> R/r 911


Also some community leaders think that roads and sidewalks are more important.  The service I'm with is paid on call.  Here in the NWT there are some communities that have no EMS.  Most of those communities are not connected to the highway system.  They can only be reached by air.  I believe only 7 out of 25 communities here in the NWT have any type of EMS from trained to untrained.  When the medevac plane reaches those communities without any EMS they are met either by the guy who owns a van, or RCMP, or by a snowmobile and sled if in winter.  Also here in the NWT we have no territorial legislation regarding EMS, so my service we use the Alberta College of Paramedics for licensing.  Also I'm wondering how long this thread wil last before getting locked by a CL


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## ffemt8978 (Mar 1, 2009)

fortsmithman said:


> Also I'm wondering how long this thread wil last before getting locked by a CL



Not very long unless people remember our forum rules.


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## PapaBear434 (Mar 1, 2009)

I'm going to ignore the usual "Vollies Suck" noise and stay with the original topic.

My service is volunteer, but it has a huge retention rate.  Simply because they offer free schooling to anyone who wants to advance.  If you go all the way, they provide you with a four year degree.  If you manage to make it to medic when they lift the periodical hiring freeze, you get hired in to actually get paid for your duties.

They do this in exchange for four twelve hour shifts a month.  If you can at least get them to pony up the money for the education incentive, you might be able to get people to stick around.  The more you learn, the more addictive it gets, and the higher up people will go.

In the end, you end up with a decent fleet of medics and EMT-I's.  

It also helps to get a couple actual ambulances in your possession, if all you have are your POV's.  Nothing says "amateur" like showing up in a rusty pickup with a jump bag.  Get yourself official sanctioned by the state, get an incorporated charter and regular inspections, and a real ambulance or two.  The exchange we have with our city is that we buy the rigs and the equipment via fund raising and grants, and they pay for fuel, repairs, and dispatch center.


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## Ridryder911 (Mar 1, 2009)

I believe you will see more and more of these "beasts" for sale. The federal funding that was scammed for such devices has bit most cities in the butt to keep them running. As well, common sense soon comes in and one realizes there are few to if ever a response that needs such a truck 

I ask this; can the degree be in anything or has to be EMS/ or fire related? 

There is such a Paramedic shortage in my area, many services are paying not just for school but duty pay while your in school. So yes, you get paid for going to school + your school, as long as you make a five year commitment. 

Not a bad gig for many. 

R/r 911


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## PapaBear434 (Mar 1, 2009)

Ridryder911 said:


> I believe you will see more and more of these "beasts" for sale. The federal funding that was scammed for such devices has bit most cities in the butt to keep them running. As well, common sense soon comes in and one realizes there are few to if ever a response that needs such a truck
> 
> I ask this; can the degree be in anything or has to be EMS/ or fire related?
> 
> ...



Would sign up for that in a heart beat.  Too bad the Navy keeps us moving around so damn much.

As far as the truck goes: It actually got a lot of use.  Any fire, extrication, other unusual case or mass casualty situation it got called out to and was used as the command center.  It got so much use, in fact, that the fire department decided they wanted one of their own instead of always using ours.  

Since we are a volunteer service that sustains itself with donations and federal/state grants, it just makes more sense to sell it and pad our coffers a bit.  Which sucks, because I just got done with my extrication training and certification.  Now I don't get to play with the jaws.  Regardless, the money we get from that can pay for pretty much brand new LifePacks for all the ambulances, as well as fully supply the brand new fifth ambulance we just bought and is set to be delivered this summer.

Not to mention, with the fifth ambulance coming in, we need the room in the bay.


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## PapaBear434 (Mar 1, 2009)

Ridryder911 said:


> I ask this; can the degree be in anything or has to be EMS/ or fire related?
> 
> R/r 911



Missed that part, sorry.  It is a BS in nursing, essentially, but the degree is actually titled "Acute Care and Pre-Hospital Paramedic Medicine."  In addition to winning the "Longest Title of a Degree" award, you can also take a two semester course after you have it (only one class a week, shorter if you take the accelerated course) to bridge it to RN (though you don't get the RN degree, obviously.)

The fire department pays their folks to get degrees in in the fire stuff, though we can take some of those classes as an elective.

I SUPPOSE you could offer the deal to get a degree in anything, but it wouldn't really be worth it to the EMS service in question.  The idea is that you are raising the level of care, and ultimately trying to groom medics out of them.  That makes it worth paying for their schooling.  Hell, the military takes four years of CONSTANT commitment for them to pay for your degree in whatever you choose.  

In our case, most of the medics that get their degree and go on to other cities for better pay or hospitals for better hours still volunteer with us.  Either they like it, or are just gluttons for punishment.


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## SpotsyMedic (Mar 1, 2009)

AJ Hidell said:


> You're questioning the parentage of your fellow forum members here?  Very nice start.
> 
> Just because you disagree with an opinion does not make that opinion bad or negative.  I would call trying to silence others opinions a bad and negative thing though, would you not?



I'm a brand-new member here, but have been in EMS since 1988, off and on.  I've spend many years as an ALS provider (and volunteer) and am currently getting my ALS certs back.  

Having run in both good and bad volunteer agencies, I can tell you from first-hand experience that the key to attracting good people and keeping them involves organization, activity, training, and recognition.  The squad I run with now is one of the best I've ever seen.  It is highly organized, and provides free training to members.  It has a robust, well-developed program for taking people with zero experience and giving them plenty to do between riding along as observers to completing training prior to their EMT-B class.  It also owns all of its own equipment... approx. 20 ambulances.  Our county provides the buildings and support and career staff from 0500 until 1800 during the week... the volunteers run everything from 1800 until 0500 and all weekends and holidays... on their own trucks.  The savings to the county is profound... $8-9M per year.

Being careful not to step on any career toes, but the opinion that volunteers are 2nd class citizens somehow, and that only career EMS can (or should) provide EMS services is very naive and extremely short-sighted.  It is also not grounded in reality.  Many communities simply cannot afford career services, nor does their call volume warrant them.  Especially now, when the economic downturn is becoming deeper and more disastrous, volunteers are becoming more and more important for vital services to continue in many communities.  Simply stomping your feet and grousing about their obviously misplaced priorities doesn't help, other than to remind many of why we have such an intense dislike for the arrogance of career medics.

I really think that the most productive approach here is to recognize the relative worth of each type of service... and actively work to increase the quality of EMS rendered, regardless of who's getting paid for it, instead of consistently tearing the other down as worthless and "2nd class."  Just my 2 cents.


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## Ridryder911 (Mar 1, 2009)

Sorry, but if your county is large is enough for such service; then its large enough for a fuill time paid EMS. Why only half the time? Kinda like a half time Fire Department.


Sorry, not going to cut it. 

p.s. if you are spending 8-9 million for a half time service, time for new management!

R/r 911


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## SpotsyMedic (Mar 1, 2009)

I didn't say (or mean to say, at least) that they were spending $8-9M... I said they were SAVING that much by having the 200+ trained volunteers handled the nights and weekends.  This is money that can now be spent on other county necessities, since the county is now operating at a deficit...

There is room for both volunteer AND paid career EMS services, and nothing will ever change that.  It would be better for all involved if the paid career EMS people would acknowledge that.


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## PapaBear434 (Mar 1, 2009)

Ridryder911 said:


> Sorry, but if your county is large is enough for such service; then its large enough for a fuill time paid EMS. Why only half the time? Kinda like a half time Fire Department.
> 
> 
> Sorry, not going to cut it.
> ...



There are places out there that you could argue HUGE call volume with little to no money available.  At the far end of that spectrum of this would sit Detroit.  That city can barely keep their police on the road these days.  Volunteers are about the best they can do these days.  

Granted, that's an extreme example.


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## Ridryder911 (Mar 1, 2009)

SpotsyMedic said:


> I didn't say (or mean to say, at least) that they were spending $8-9M... I said they were SAVING that much by having the 200+ trained volunteers handled the nights and weekends.  This is money that can now be spent on other county necessities, since the county is now operating at a deficit...
> 
> There is room for both volunteer AND paid career EMS services, and nothing will ever change that.  It would be better for all involved if the paid career EMS people would acknowledge that.



Saving or spending, either way poor budgetary expenditure. As well, 200+ people? I know of EMS that have less than 200 members and serve a city of million +. How many do you need on a truck? Hopefully, no more than 2. 

Excuses. Do you still have a dog catcher? How many volunteer LEO do you have? Again, would these 200+ be willing to cut back on other services to fund EMS full time? ..

More volunteers, I don't believe we will see more. The interest in just keeping your own job and as well increasing education and work requirements will demand total dedication to the profession. Will these volunteers be willing to go back for the transitional course and re-test the certification in two years? 

Again, look at my surgeon analogy. 



PapaBear434 said:


> There are places out there that you could argue HUGE call volume with little to no money available.  At the far end of that spectrum of this would sit Detroit.  That city can barely keep their police on the road these days.  Volunteers are about the best they can do these days.
> 
> Granted, that's an extreme example.



No poor example, alike using D.C. as one. 

R/r 911


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## Ridryder911 (Mar 1, 2009)

The old saying .."_We are our worst enemies_".. is never more true. NO other health care profession would tolerate non-professional status! Yet, we will... Why? Because, we always look for the easy way out. The easiest way to use an excuse. 

Even more, to debate to place non-committed individuals, not because of location or areas, but because of tradition and easiness, is mind blowing. 

It is bad enough our education or lack of; is fragmented (again look at the reason why) but not to want to improve.. is baffling. 

Then you wonder why EMS is treated and not respected as it is? Really... do you think? 

Examine who operates and manages such services. What education and experience in EMS and the medical field do they have? ...

Want to be treated as a stepchild, then don't act as one and don't ask to be.


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## PapaBear434 (Mar 1, 2009)

Ridryder911 said:


> The old saying .."_We are our worst enemies_".. is never more true. NO other health care profession would tolerate non-professional status!
> 
> Even more, to debate to place non-committed individuals, not because of location or areas, but because of tradition and easiness, is mind blowing.
> 
> ...



I brought up Detroit as more of a joke, as the city is a sinking pit of despair these days, but the fact of the matter is that they CAN'T afford to run a full service outside of the fire department these days.  Hell, half the FD has been laid off due to budget cuts.

But I will agree that having a fully professional system would be nice.  Would be great, actually.  And the argument I have been trying to make with you this weekend and across multiple threads isn't so much that I disagree, but you can use the current system (or lack thereof) in the mean time while building the new system you envision.  My system, which you already know and won't go into again here, is a prime example.  Yes, volunteer based due to saving money in the city budget and tradition, but working on trying to move everyone up to medic status and a college degree.  

I just think there's a happy middle ground between vollies being necessary and being the end of existence.  At least until the system is restructured.  It's not going to happen all at once, it's something that's going to have to change as a process.  

I believe it was you that asked, in another thread, that if Vollies would still do their thing if there was a hard date at which their service would be banished in place of a full medic service.  I think if we were to go to a service like our's, that answer would be "Yes."  Because they know that they themselves could get their education in the mean time, and have their medic license (if they ever get licenses rather than certifications) before that cut off date and get a job out of the deal.  

It's a process that would use what we got while we move to what we want, and not leave a huge gap in care and coverage to the public in the mean time.


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## medic417 (Mar 1, 2009)

As long as volunteer services exist communitys will refuse to go paid or to increase pay for the ones they pay.  Why they see it being done for free. To correct that requires a well pubilzed closing announcement.  Quickly the community will find a way to cover the cost of having a paid service.  Again seen it many times in one of the poorest areas in the nation.  So it works.


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## PapaBear434 (Mar 1, 2009)

medic417 said:


> As long as volunteer services exist communitys will refuse to go paid or to increase pay for the ones they pay.  Why they see it being done for free. To correct that requires a well pubilzed closing announcement.  Quickly the community will find a way to cover the cost of having a paid service.  Again seen it many times in one of the poorest areas in the nation.  So it works.



There is already a medic shortage.  There is no way to do that all over the nation without causing such a glut on the market that people would almost begging for medics.

Bad news for the communities that were unlucky enough to get one.  Great news for those of you that are already medics, because supply and demand would be HUGELY in your favor.


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## Ridryder911 (Mar 1, 2009)

PapaBear434 said:


> There is already a medic shortage.  There is no way to do that all over the nation without causing such a glut on the market that people would almost begging for medics.
> 
> Bad news for the communities that were unlucky enough to get one.  Great news for those of you that are already medics, because supply and demand would be HUGELY in your favor.



Unfortunately, you are singing the same song hospitals and communities say about nurses and physicians. Guess what, they get them. Even nursing homes has RN's .. know why? They have to. 

Point being, we need to quit looking for excuses not to meet the demands and to provide quality care. We need to look for solutions on how to meet those demands without compromising. 

Again.. "If you are not part of the solution, your part of the problem". 

R/r 911


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## ffemt8978 (Mar 1, 2009)

Ridryder911 said:


> Unfortunately, you are singing the same song hospitals and communities say about nurses and physicians. Guess what, they get them. Even nursing homes has RN's .. know why? They have to.
> 
> Point being, we need to quit looking for excuses to meet the demands and to provide quality care. We need to look for solutions on how to meet those demands without compromising.
> 
> ...



So what about the communities that don't have doctors, nurses, or clinics but still have EMS?


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## PapaBear434 (Mar 1, 2009)

Ridryder911 said:


> Unfortunately, you are singing the same song hospitals and communities say about nurses and physicians. Guess what, they get them. Even nursing homes has RN's .. know why? They have to.
> 
> Point being, we need to quit looking for excuses to meet the demands and to provide quality care. We need to look for solutions on how to meet those demands without compromising.
> 
> ...



Their system has been in place longer, so even with the shortage they can manage.  Us switching over all at once wouldn't give enough time to prepare unless we started training those volunteers now to be medics later.

But what you say is true.  Nurses and Doctors manage.  I just don't think you can have an "All or Nothing" switch in the time frame you guys seem to want.


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## medic417 (Mar 1, 2009)

ffemt8978 said:


> So what about the communities that don't have doctors, nurses, or clinics but still have EMS?



Then they need to pay EMS darn good as that is the only medical help they have.  Keep EMS people happy so you don't lose them.


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## medic417 (Mar 1, 2009)

PapaBear434 said:


> Their system has been in place longer, so even with the shortage they can manage.  Us switching over all at once wouldn't give enough time to prepare unless we started training those volunteers now to be medics later.
> 
> But what you say is true.  Nurses and Doctors manage.  I just don't think you can have an "All or Nothing" switch in the time frame you guys seem to want.



You can go paid and start with the Basics you have.  All our Basics are paid.  Then hire in Paramedics and pay for your better students to go on to Paramedic. Soon you will have a paid ALS service.


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## medic417 (Mar 1, 2009)

PapaBear434 said:


> There is already a medic shortage.  There is no way to do that all over the nation without causing such a glut on the market that people would almost begging for medics.
> 
> Bad news for the communities that were unlucky enough to get one.  Great news for those of you that are already medics, because supply and demand would be HUGELY in your favor.



Actually there is a surplus of Paramedics but most leave the field because of lack of pay.  But again you do not have to start out paid ALS you can start off paid BLS and pay some to go on to Paramedic.


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## Ridryder911 (Mar 1, 2009)

PapaBear434 said:


> But what you say is true.  Nurses and Doctors manage.  I just don't think you can have an "All or Nothing" switch in the time frame you guys seem to want.



Don't know; ask those from Canada. They were smart and ditched our system, as well as those in Africa and Australia. They actually have medics that work for decades...and yes, retire from EMS. 

R/r 911


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## Ridryder911 (Mar 1, 2009)

ffemt8978 said:


> So what about the communities that don't have doctors, nurses, or clinics but still have EMS?



That's even better. You are the sole health care provider; even more reason the best system should be delivered. 

I have worked in areas such. The citizens were aware the need of having the best. Also there are more available grants from rural health care and funding for education. I would be hitting my public health department (I am sure you have at least this), State EMS, Project Homeland, Senator and Legislature. 

Ironically, when asked most EMS personnel have never asked or investigated with the process of legislation. 

R/r911


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## AJ Hidell (Mar 1, 2009)

Bingo.  It is incredibly short-sighted to maintain that we are wholly incapable of achieving what almost every other civilized country in the world has achieved.  Even more short-sighted to maintain that we cannot achieve what every other medical profession has achieved.  Not a single one of these silly excuses holds up to those comparisons.


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## ffemt8978 (Mar 1, 2009)

So, given the fact that there are over 25,000 towns, villages, and cities in the US (http://answers.google.com/answers/threadview?id=509183)and that it would take approximately 3 medics per community to provide 24/7 ALS coverage at *one ambulance* per community, that would mean we would need to have at least 75, 000 medics in the US alone.

Now consider that there are approximately 48,000 ambulances in the US (http://answers.google.com/answers/threadview/id/784884.html), that means you would need approximately 125,000 to 150,000 medics to provide that coverage.

Can it be done?  Yes.  Should it be done?  Yes.  Will it be done?  Probably not.  Especially when you consider something like this:
http://www.usatoday.com/news/health/2006-05-21-paramedics_x.htm


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## Aidey (Mar 1, 2009)

That last link brought up a very good point, no one knows what the "best" ratio of MICPs to people is and until that is established we aren't going to be able to start forcing anywhere to change how they operate their systems. 

I have a feeling if the economy stays in the dumps for more than a year or two cities who have a tiered or ALS engine response ahead of the ALS ambulance are going to start rethinking if they really have the budgets to be paying for those systems. 

If places start eliminating their ALS engines to save money it will be interesting to see what the statistics start showing.


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## Ridryder911 (Mar 1, 2009)

ffemt8978 said:


> So, given the fact that there are over 25,000 towns, villages, and cities in the US (http://answers.google.com/answers/threadview?id=509183)and that it would take approximately 3 medics per community to provide 24/7 ALS coverage at *one ambulance* per community, that would mean we would need to have at least 75, 000 medics in the US alone.
> 
> Now consider that there are approximately 48,000 ambulances in the US (http://answers.google.com/answers/threadview/id/784884.html), that means you would need approximately 125,000 to 150,000 medics to provide that coverage.
> 
> ...



Please, please let's cite credible information. C'mon. Look at the citations. Zoll & Montgomery County EMS?  Let's research through the State EMS Directors and see the numbers and what projection should be. Within the same Internet quotation there are 35k with monitors or AED and that leaves only 10,000 without them? B.S.! I am sure there more than 10K without AED or Monitors. Are they also including private ambulance or non-911 or multiple EMS within a city? 

The USA today article that was cited was also taken way out of context. Something those involved with OKC & Tulsa (which is cited) still regrets. This is the reason they are service I was referring to that are paying salary for a person while attending school for their Paramedic. Even moving and recruiting bonuses are negotiated . More is less...I don't think so. 

Now, figure this there is alone over 5,000 EMT's alone in my state and its a rural state. There are over 17,000* NREMT/P alone; this does not include those that are not Registered or involved as a NREMT.

Does this mean there is a shortage, you bet. Since there is; should we allow a compromise to short change our profession, the system, and worse patient care? There is far more a shortage of nurses as the average age of a RN is now 49*.  Thus approximately over 15% will be retiring within the next ten years.. so we shall allow volunteer nurses aides to perform RN jobs. Yeah, I can see the nursing industry allowing that to happen. NOT. 

The difference is they are a profession composed of professionals. They will not allow such compromises. They will not "dilute" their system or profession. Even the "crash courses and on-line" programs will be coming under more scrutiny and we will probably see less and less states allowing license from these. I know that my state alone has added additional requirements to ensure that the RN candidate has met the "minimal" safety requirements. 
Ever seen who governs their profession? Nurses and no one else. Each state has a Governing Board. Now, compare that with EMS. 

I wish EMS had the gonads to do such. Nope, we will develop some form of pseudo acronym or another excuse (we are good at that) to cover up the blunders. Public assume that because it has lights & sirens there is a Paramedic in it. We also make sure that they are unaware of this as well. Yeah, there is one thing we are good at... not educating the public and definitley not making them aware of the difference. 

Maybe a new insignia should be incorporated with the Paramedic (without the EMT referrence) and marketed and publicized. If you don't see this, you don't have Paramedic. Hmmm.. wonder what the community perception would be? 

R/r 911

* NREMT 2007 Fiscal  Reports
** ANA 2008 Review


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## ffemt8978 (Mar 1, 2009)

The original post, which was never answered in this thread has been moved to it's own thread here.
http://www.emtlife.com/showthread.php?t=11590

This thread will be allowed to continue on it's present course, but do not hijack the other one.


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## AJ Hidell (Mar 2, 2009)

Whoa!  You blew my mind there for a moment!  I was like, "When did I start that thread, and how did it get to five pages this fast?"  

Thanks for the assistance!


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## ffemt8978 (Mar 2, 2009)

Ridryder911 said:


> Please, please let's cite credible information. C'mon. Look at the citations. Zoll & Montgomery County EMS?  Let's research through the State EMS Directors and see the numbers and what projection should be. Within the same Internet quotation there are 35k with monitors or AED and that leaves only 10,000 without them? B.S.! I am sure there more than 10K without AED or Monitors. Are they also including private ambulance or non-911 or multiple EMS within a city?
> 
> The USA today article that was cited was also taken way out of context. Something those involved with OKC & Tulsa (which is cited) still regrets. This is the reason they are service I was referring to that are paying salary for a person while attending school for their Paramedic. Even moving and recruiting bonuses are negotiated . More is less...I don't think so.
> 
> ...



So, which statistics do you think aren't credible?  I was just trying to get a ball park figure to work with, but if you have any more accurate ones, than I'm more than willing to use them.  For the record, I too, believe there is a shortage of medics.  But I also realize that saying every agency should be paid ALS without considering all apsects of it is just as irresponsible as dumbing down the educational standards just to put bodies in the vacancies.

There are 25,000 towns, villages, and cities in the US, and that is from the US Census Bureau.  Given that any quality paramedic program is a two year program, and that you need at least 3 medics to provide 24/7 coverage, how many years will it be before enough medics are trained to provide everyone ALS coverage?  Or would you prefer that some communities not have ALS present in them, and have to wait for an ambulance from the next town over to respond?

Take my county for example.  We have a total county population of around 25,000 and are one of the largest in size in the state.  We have three paid ALS services in the county...two of them in the largest city (one city fire and one a fire district).  The other ALS agency is a hospital based agency in the 3rd largest community in the county.  Interestingly enough, the second largest community contracts with the fire district to provide their ALS coverage.  These three agencies between them are only able to staff 5 to 6 ALS rigs 24/7.  Another interesting tidbit...the hospital based ambulance is the only one that can't always provide 24/7 ALS...the FD's can.


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## AJ Hidell (Mar 2, 2009)

Aidey said:


> If places start eliminating their ALS engines to save money it will be interesting to see what the statistics start showing.


Don't expect the IAFF and IAFC to let that happen without a major political fight!

Here's how the thinking goes:Not enough ambulances = send fire trucks
Fire trucks on EMS runs = not enough fire trucks
Not enough fire trucks = add more fire trucks
Add more fire trucks = no money for the ambulances that were needed to fix the problem in the first place​The fire chiefs create their own artificial shortage and demand this way, doubling their budgets while leaving EMS with the same problem it had to begin with, which is not enough ambulances.  Then they run around bad mouthing all the evil capitalists who try to make money off of EMS, as if their motives are somehow more altruistic than AMRs motives are.  Puhleeze.


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## Aidey (Mar 2, 2009)

I'm aware of that, and how fire can play the system to justify their existence. 

However, if voters wake up and say "Hey we are paying twice for paramedics. once to the city and once for the private company, and the private company only charges the people who use it, lets stop funding the city" things are going to change whether IAFF IAFC likes it or not.


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