# What is your EMS system?



## ItsTheBLS (Jan 28, 2013)

EMS systems vary dramatically from one part of the world to the other. 

Some variations are 911 and transport, 1 Basic+1 Medic = ALS ambulance, 2 EMT=BLS ambulance, 2 medics=ALS ambulance OR medic fly car. 

Some people have bases that they can go to during their downtime, others require the staff to stay in the trucks. 

What I'm wondering is- what is the most common system through out the country? What type of system do you work/volly for? Fire based, hospital based?

Also, do you ever have 2 ambulances go with each other to the hospital? Such as in the case of a BLS ambulance meeting with an ALS one with the BLS driving the trucks and the medics in the back with the patient.

My system is as follows:
-Hospital based ALS. Municipality/private/hospital based BLS.
-2 EMT-B per ambulance, 2 Medics per fly car, SCTU (specialty care transport units) staffed with 1 medic, 1 basic and 1 nurse do ALS level transports.
Most places around here have people staffed in buildings. 
-Bergen County, New Jersey, USA


----------



## DesertMedic66 (Jan 28, 2013)

Private 911/IFT company. Run with ALS fire. 

1-2 medics on each 911 ambulance. Normal is 1 medic and one Basic. 
2 Basics on our BLS ambulances. 
2 basics and an RN on our CCT transports. 

We do street postings but have a couple of comfort stations and 24-48 hour crews who stay at houses. 

We will have 2 ambulances go to the hospital together if the patient weighs a lot. If a BLS crew did an ALS intercept. Or other special circumstances. 

Supervisors are all Medics that have been with the company for 20+ years. They will respond to ambulance accidents, MCIs, calls that sound cool or weird, and when they are bored. 

All people in management are all current or have been medics for the company for a long time.


----------



## ItsTheBLS (Jan 28, 2013)

Do you believe that 1 medic + 1 basic could handle a call where a patient is circling the drain (for lack of better words) as efficiently as 2 medics?


----------



## EpiEMS (Jan 28, 2013)

ItsTheBLS said:


> Do you believe that 1 medic + 1 basic could handle a call where a patient is circling the drain (for lack of better words) as efficiently as 2 medics?



Maybe. There are diminishing returns to ALS personnel, but I think 2 is where you get the best return on your money. I gotta find that study... (PubMed time)


----------



## DesertMedic66 (Jan 28, 2013)

Fire responds on all medical calls so if we need 2 medics we borrow fire. 

The basic is pretty much just the driver.


----------



## EpiEMS (Jan 28, 2013)

firefite said:


> Fire responds on all medical calls so if we need 2 medics we borrow fire.
> 
> The basic is pretty much just the driver.



That's the advantage of having ALS engines, I guess. Not sure it's cost-effective, though.


----------



## DesertMedic66 (Jan 28, 2013)

EpiEMS said:


> That's the advantage of having ALS engines, I guess. Not sure it's cost-effective, though.



Gotta justify the fire departments budget somehow


----------



## EpiEMS (Jan 28, 2013)

firefite said:


> Gotta justify the fire departments budget somehow



As per my favorite chart, surely do. 
	

	
	
		
		

		
			





I think NJ's systems are some of the most, shall I say, *interesting*, in design.  I don't quite see the advantage of only having hospital-based ALS when ALS could be spread a bit more widely.


----------



## abckidsmom (Jan 28, 2013)

We are a EMS-based fire system, with 3 24 hour medic units (basic + medic) in a county with 500 + square miles, supplemented with 2 more medic units on weekdays and hit or miss volunteer units on weekday evenings till 2300 or so.

Transports are 30-50 miles, response times hover around 12 minutes average.


----------



## NomadicMedic (Jan 28, 2013)

County Based ALS only Third Service.

8 stations with dual medics in squads, no street posting. 

All ambulance transport is BLS provided by volunteer fire, usually staffed with 2 paid EMTs. 

HEMS is State Police, with a ground medic flying to manage intubated/critical patients. 

Coverage area about 950 square miles.

We work 12 hour shifts. 4 platoons which means 2 days, 2 nights, 4 off.  

Mostly rural with some suburban areas, transport times vary, but average 20 minutes.


----------



## STXmedic (Jan 28, 2013)

FD based EMS. 

911 only, no transports.

Staff 2 medics on the box.

EMS works 24/72, Fire works 24/48

Almost all calls get Fire as first responders. The majority of fire crews now will have a paramedic on the first responder unit. So if :censored::censored::censored::censored: hits the fan, EMS will have plenty of manpower (sometimes too much).

Major city with roughly 20 hospitals, including two Lvl 1s, so transport times are typically pretty short- 5-15 minutes.


----------



## Veneficus (Jan 28, 2013)

n7lxi said:


> We work 12 hour shifts. 4 platoons which means 2 days, 2 nights, 4 off.



Who came up with that schedule and why?

My circadian rhythms would be so messed up you would never want to be anywhere near me.


----------



## abckidsmom (Jan 28, 2013)

Veneficus said:


> Who came up with that schedule and why?
> 
> My circadian rhythms would be so messed up you would never want to be anywhere near me.



2 days, 2 nights, 2 days of nap.  Perfect if you want to be useless on your days off.


----------



## EpiEMS (Jan 28, 2013)

abckidsmom said:


> 2 days, 2 nights, 2 days of nap.  Perfect if you want to be useless on your days off.



Gotta make it tough to be a parent or work a second job.

For those in FD-based ALS non-transporting systems, who manages the transports? BLS privates with FD ALS riding with them, ALS privates, etc.?


----------



## Shishkabob (Jan 28, 2013)

Non-traditional Public Utility Model with 14 first responder fire agencies as help, varying from BLS-vollies to full Paramedic staffing.  


Typically 1 Paramedic and 1 other provider on a truck. (CCT/SCT gets another advanced Paramedic).  Anywhere from 25-45 trucks on at any one time, depending on the day/time.


Over 400 sq mi. with typical transports from the parking lot of the ER to 35 minutes away.  No quarters for the providers. 100,000+ calls a year.


----------



## medicsb (Jan 28, 2013)

EpiEMS said:


> I think NJ's systems are some of the most, shall I say, *interesting*, in design.  I don't quite see the advantage of only having hospital-based ALS when ALS could be spread a bit more widely.



Just for clarification, by "hospital-based" it is meant that the ALS services are administered by a hospital or hospital system.  In most cases, the medic unit is not actually stationed at a hospital.  For example, the MICU I worked for now staffs 9 FT medic units and 3 PT units.  Only one is actually stationed at a hospital.  A MICU project to the south had 2 of 7 actually stationed at hospitals, and one to the north had 1 of 5 stationed at a hospital.  Some places might have units based at a hospital, but it is typically for shift change and restocking with the medic units posting at various locations (IIRC, this is how it is done in Newark and Jersey City).


----------



## medicsb (Jan 28, 2013)

Veneficus said:


> Who came up with that schedule and why?
> 
> My circadian rhythms would be so messed up you would never want to be anywhere near me.



The Philadelphia Fire Dept. uses this schedule for the fire fighters and used to use it for EMS.  They were using it when I did my internship there and I thought it was stupid.  It was 2 10 hour days followed by 2 14 hour nights.  It was nice for the days off, but that was it.  Really, when you look at the days you actually work, it is more like 5 days on, 3 off (you actually work 8 hours of your first day "off").


----------



## NYMedic828 (Jan 28, 2013)

What is my EMS system? 

A non-progressive disaster.


----------



## EpiEMS (Jan 28, 2013)

NYMedic828 said:


> What is my EMS system?
> 
> A non-progressive disaster.



What's your least favorite component of it, if you can single out one particularly bad aspect?


----------



## NYMedic828 (Jan 28, 2013)

EpiEMS said:


> What's your least favorite component of it, if you can single out one particularly bad aspect?



Unmotivated undereducated providers. Pretty sure it's not just my system...


----------



## EpiEMS (Jan 28, 2013)

NYMedic828 said:


> Unmotivated undereducated providers. Pretty sure it's not just my system...



It seems to be a national epidemic. <_<
There must be some areas that aren't as bad (thinking Wake, and parts of Texas).


----------



## ItsTheBLS (Jan 28, 2013)

Linuss said:


> Non-traditional Public Utility Model with 14 first responder fire agencies as help, varying from BLS-vollies to full Paramedic staffing.
> 
> 
> Typically 1 Paramedic and 1 other provider on a truck.



So on most of your calls you get FD? Also, do you find it harder handling 911 calls with only an EMT-B partner?


----------



## ItsTheBLS (Jan 28, 2013)

medicsb said:


> Just for clarification, by "hospital-based" it is meant that the ALS services are administered by a hospital or hospital system.  In most cases, the medic unit is not actually stationed at a hospital.  For example, the MICU I worked for now staffs 9 FT medic units and 3 PT units.  Only one is actually stationed at a hospital.  A MICU project to the south had 2 of 7 actually stationed at hospitals, and one to the north had 1 of 5 stationed at a hospital.  Some places might have units based at a hospital, but it is typically for shift change and restocking with the medic units posting at various locations (IIRC, this is how it is done in Newark and Jersey City).



What is your opinion on Jersey's 2-medic fly car system? Do you or anybody else here think it's something that's going to last for much longer? Is it something that's simply going to stay isolated? Or something that will expand?


----------



## rescue1 (Jan 28, 2013)

ItsTheBLS said:


> What is your opinion on Jersey's 2-medic fly car system? Do you or anybody else here think it's something that's going to last for much longer? Is it something that's simply going to stay isolated? Or something that will expand?



I always thought it was kind of silly. The only reason to have two medics is for high acuity calls which don't occur often enough to justify constant 2 medic staffing, especially since you can just call for the second medic who is just in another vehicle.

I've only worked in systems with single medic fly cars, so maybe I'm biased, but we never had an issue with not enough medics on scene, assuming the EMTs also had their stuff together.
If the EMTs didn't, it was gonna be a cluster anyway.


----------



## NomadicMedic (Jan 28, 2013)

Veneficus said:


> Who came up with that schedule and why?
> 
> My circadian rhythms would be so messed up you would never want to be anywhere near me.



Why is it bad? This week I work dayshift on Monday and Tuesday, and Wednesday night and Thursday night. I have Friday, Saturday, Sunday and Monday off.  We're not so busy that we're getting crushed, I usually sleep at night. It works for me. It's certainly better than 24 hour shifts.


----------



## Trashtruck (Jan 28, 2013)

NYMedic828 said:


> Unmotivated undereducated providers. Pretty sure it's not just my system...



Agreed. I don't think my system(or giant cesspool of entropy)is even real. It's more of a forced reality when I go into work. 
Fire based. I think that covers everything.


----------



## Medic Tim (Jan 28, 2013)

n7lxi said:


> Why is it bad? This week I work dayshift on Monday and Tuesday, and Wednesday night and Thursday night. I have Friday, Saturday, Sunday and Monday off.  We're not so busy that we're getting crushed, I usually sleep at night. It works for me. It's certainly better than 24 hour shifts.



This.


----------



## Shishkabob (Jan 28, 2013)

ItsTheBLS said:


> So on most of your calls you get FD? Also, do you find it harder handling 911 calls with only an EMT-B partner?



Depends on the call and on the city, but yes, most calls do get FD, though I cancel them as soon as I can as they really aren't needed / beneficial on most calls.  If I could keep them from getting dispatched to all but the most serious of calls (or fat people), I would in a heatbeat.  


Nope, not hard with 'just' an EMT.  I was pretty much raised in a rural system where I had an EMT and a bunch of vollies, so I had to learn self-reliance early on anyhow.  Now if the call is BlS, I don't have to work it.  With a second medic, we typically switch every other call which gets annoying.


----------



## DrParasite (Jan 28, 2013)

Veneficus said:


> Who came up with that schedule and why?
> 
> My circadian rhythms would be so messed up you would never want to be anywhere near me.


some fire department, to ensure no one got stuck working days or night or weekends.   it's great if you can sleep at night, and if it's slow, but it does get old if you are doing 12 calls during your night shifts.  typically they do 10s and 14s, 10 hour days and 14 hour night shifts.





ItsTheBLS said:


> What is your opinion on Jersey's 2-medic fly car system? Do you or anybody else here think it's something that's going to last for much longer? Is it something that's simply going to stay isolated? Or something that will expand?


as a Jersey EMS provider, I can say with near certainty that NJ's 2 medic fly car system isn't going anywhere.  the only thing that will change is those two medics will start driving around in ambulances, especially with more an more ALS projects starting their own BLS system.

you won't see 1&1 anytime soon.  in fact, many of the studies show that a paramedics who see only acutely sick patients are better than those who spend 80% of their shift dealing with non-life threatening patients.

as for those calls that it helps to have 2 paramedics, how about any person you cpap?  or a multi system trauma with airway control?  or a cardiac arrest?  or someone you RSI?  or a seizure patient who keeps twitching? or just a patient where you can't seem to get the IV, and want someone else to try?


----------



## ExpatMedic0 (Jan 29, 2013)

Veneficus said:


> Who came up with that schedule and why?
> 
> My circadian rhythms would be so messed up you would never want to be anywhere near me.



I worked this for a year and it sucks. I was an ALS fly car covering maybe 4 ambulance stations, so I never got a break.


----------



## RocketMedic (Jan 29, 2013)

PoeticInjustice said:


> FD based EMS.
> 
> 911 only, no transports.
> 
> ...



Do you turf low-priority calls to private ambulance (Acadian), or is it a dual-response system? 
El Paso Fire Department turfed quite a few patients (non-critical patients) to Elite/Life/Dominion, which I thought was a good idea. I still think the world of EPFD, they were excellent on my rides with them and they provided my wife with excellent care.


----------



## shfd739 (Jan 29, 2013)

I'll toss mine in. 

Private service with multiple 911 agreements in and around a large Texas city. Also multiple hospital agreements to include a children's hospitals teams. 2 other counties have us for 911/sole provider. Those 2 counties are rural and tend to be slow. 

Staffing is medic/basic on ALS units and basic/basic on BLS transfer units. 3 CCT units are CCT medic/basic. Bari unit when needed is staffed by a mainline crew just for that call. 

Most shifts are 12 hours on a 2-2-3 rotation. Assigned day or night. Only way to switch is to wait for an opening and have a request on file. 

Street corner posting. We are so busy and move around so much that having stations wouldn't be that beneficial. Crews would just complain they didn't get to stay long. 

Fire department first response on all 911 calls. Mix of volunteer, paid, combo. Most are BLS level. Couple are ALS level and can be scary when they decide to play before we get there. Most calls we can beat fire onscene and cancel them. 

Areas range from city to rural with 5 min to 45 min transports. 2 helo services when needed. 2 level one trauma centers,multiple pedi hospitals etc. No lack of hospitals.


----------



## Christopher (Jan 29, 2013)

I work for 3 systems.

County 1:
- County-based ALS transport (12h shifts, 6 24x7 ALS, 3 peak ALS, 1 supervisor QRV), primarily P+P, sometimes P+I/B
- County-based BLS patient care transport service
- 15+ volunteer/paid fire departments (mix of FR, B, and I level)
- 2 Paramedic transporting fire departments (_I work for one of these_), primarily P+B, 24x72's at both of them
- 2 hospitals in county, 3 hospitals in neighboring counties (2 are the trauma/pci centers we use)

County 2:
- Hospital-based ALS transport (12h shifts, 7 24x7 ALS, 4 peak ALS, 3 QRVs, 1 supervisor QRV), 99% P+P
- Hospital-based interfacility transport and HEMS
- City fire all EMT-B
- County fire all EMT-B
- One volunteer EMT agency does limited transport B+B
- 2 hospitals in county (1 is trauma/pci center)

Industrial:
- BLS transporting ambulance (volunteer staffing, 24x7x365 as folks are on shift for regular work)
- Member of County 2's mutual aid plan, utilizes same radio system/protocols/equipment/training schedule
- Technical rescue / industrial fire brigade as well


----------



## RUABadfish002 (Jan 29, 2013)

A couple of BLS ambulances staffed with 2 EMT-B's.

The rest are all ALS units staffed with dual medics, I/P.  We still have I/99's here but due to the changes in the national scope that will soon be implemented, I/99's will be upgrading to P over the next few years.


----------



## Tigger (Jan 29, 2013)

Our 911 contract where I work is covered by one dedicated ALS ambulance (all company ALS units are double medic).

Another ALS ambulance and three BLS units are also based in that town, but are all available for transfers.

When the dedicated truck is out, if an ALS ambulance is in town, they will drive to the fire station for coverage and cannot take transfers. If only BLS is in town, they will go into coverage until relieved by another company ALS unit that comes in from elsewhere or the dedicated truck returns as soon as they cross town lines. 

ALS can turf to BLS if transport is not "significantly delayed" by waiting for BLS to arrive. 

The contract also mandates providing ALS intercept to a neighboring town with POC BLS ambulance. This must be done by the dedicated unit, even if a transfer ALS unit is available, which makes no sense. 

The nearest trauma center and specialty hospital is in metro Boston which is a 45 minute transport. There are several non-designated community hospitals in the 15-20 minute range. One has a cath lab, and all are stroke centers.

Where I live now in Colorado Springs, AMR is the contracted provider for El Paso County. They provide ambulances to the city, other towns with no fire based ambulance, and unincorporated areas. One town contracts with another private company.

Colorado Springs has 20 ALS engines, 7 sometimes ALS trucks, and two ALS non-transporting ambulances in areas with high medical call volume. 

Other towns have ALS Fire first response and AMR transport, or fire-based transporting ALS. Some towns are BLS first response only. 

Peak AMR staffing county wide is 14 ALS ambulances I believe. 

Two Level II specialty hospitals in town, one has a pediatric hospital as well. Two Level IIIs in the northern and less populated area of the county.


----------



## the_negro_puppy (Jan 29, 2013)

we work:


Paramedic / Paramedic

or

Paramedic / Student Paramedic

We also have Intensive Care Paramedics that work on Helos and fly cars. They have extra cardiac drugs, cardioversion, pacing, intubation etc.

No fire involvement.


----------



## EpiEMS (Jan 29, 2013)

the_negro_puppy said:


> we work:
> We also have Intensive Care Paramedics that work on Helos and fly cars. They have extra cardiac drugs, cardioversion, pacing, intubation etc.
> 
> No fire involvement.



So, who handles heavy rescue down undah? Do PD and FD go to life-threatening calls to start CPR and early defib, etc.?


----------



## med51fl (Jan 29, 2013)

Ok so here it is:

*Place #1*-County-wide fire based EMS 24 / 48 shifts
-3 paramedics on the ambulance (all ALS)
-All 911 ALS transport, no IFT
-4 people on the fire truck (ALS), minimum of 2 paramedics, the others EMTs
-Ambulance first out to high accuity calls, fire truck out if ambulance already on a run
-Fire truck first out on low accuity calls
-BLS transport done by private ambulance
-HEMS done by fire department (as well as rescue / water-drops) manned by 2 pilots (EMT / paramedic) and 2 paramedics
-Ambulance crews also perform fireground duties (interior search / rescue, assist with fire attack, etc.)
-5 to 10 minute transports

*Place #2*-City EMS only department
-total transport with some IFT
-1 paramedic, 1 EMT crew configuration
- 20 to 30 minute transports


----------



## fast65 (Jan 29, 2013)

Private 911/IFT



1-Basic/1 medic, on occasion we'll have a dual medic car.
24/48, 4 ambulances on 24/7, in the summer we bring up a 12 hour car. We have quarters.
We're the sole 911 provider for the county, and handle 99% of the IFT's. For CCT's we'll typically send out a page for a third person to meet us at the hospital.
FD's around here are mostly volunteer, but have a few paid staff. Rarely do we get another paramedic on scene.


----------



## 46Young (Jan 29, 2013)

Fire based, dual role with EMS transport

37 ALS engines

41 ALS ambulances, 14 are dual medic 

Volunteers can put a BLS or ALS ambulance in-service

14 ladder trucks/TL's, all BLS

8 Heavy rescues - all have ALS equipment, can be ALS if Trot/Hazmat tech happens to be ALS

Seven EMS supervisors in chase vehicles

Typical txp is 5-20 mins

Liberal mutual aid agreements with surrounding jurisdictions. Most give as much as they take, but two counties in particular use us all the time and rarely, if ever, give anything back. Other than mutual aid, the county does all EMS txp.

Schedule 24's - on, off, on, off, on, off x 4, no Kellys. Cannot work in excess of 36 scheduled hours


----------



## Bullets (Jan 29, 2013)

ItsTheBLS said:


> What is your opinion on Jersey's 2-medic fly car system? Do you or anybody else here think it's something that's going to last for much longer? Is it something that's simply going to stay isolated? Or something that will expand?



Oh the paramedic system isnt going anywhere. Unlike the BLS agencies, the MICUs are together in most things, they lobby as a single group and have a very proactive Paramedic Association. I like having two medics. One basically records and the other does the physical assessment. On high acuity, one can tube, one can stick and bls can compress. Gets things done faster

As for me

Service #1
1 Police Department based BLS 6a-6p
backed by 4 volunteer agencies who also cover 6p-6a
2 EMS Rescues, one water, one extrication
One volunteer agency hosts significant state MCI units

One BLS engine 7a-4p that responds to any unconscious call
Backed by 7 Volunteer companies available on request between 4p-7a but not automatic

8sq miles, 30k people

Service #2 
4 BLS EMS agencies serving 97k in 24sq miles
1 agency is volunteer only and respond occasionally
1 agency is 100% paid
1 agency is fire based with night volunteers, only cover 3sq with 3k
My agency has 1 paid truck at a satellite 24/7 and 2 paid trucks 6a-6p from HQ. Volunteers cover nights and can put up to 4 trucks on the road. We also run 2 heavy rescue units

FD is otherwise not involved with EMS, though they are trying to hedge in on rescue services. We do not have a good relationship


----------



## ItsTheBLS (Jan 30, 2013)

Bullets said:


> Oh the paramedic system isnt going anywhere. Unlike the BLS agencies, the MICUs are together in most things, they lobby as a single group and have a very proactive Paramedic Association.



This is contradictory to a lot of what I've heard. To my understanding, some insurance companies won't allow medic fly cars to bill for their services because they didn't do the transport. This may just be rumor.

I didn't even know about a paramedic association to be honest. I ask because I like the current system and look to become a paramedic in a few years and hope for that system to still be in place by the time I start working.


----------



## PsychoJoe (Jan 30, 2013)

Linuss said:


> Non-traditional Public Utility Model with 14 first responder fire agencies as help, varying from BLS-vollies to full Paramedic staffing.



Sounds familiar. How long have you been there (here)?


----------



## Bullets (Jan 30, 2013)

ItsTheBLS said:


> This is contradictory to a lot of what I've heard. To my understanding, some insurance companies won't allow medic fly cars to bill for their services because they didn't do the transport. This may just be rumor.
> 
> I didn't even know about a paramedic association to be honest. I ask because I like the current system and look to become a paramedic in a few years and hope for that system to still be in place by the time I start working.



That isn't new, only the transporting company can Bill for the transport. Medics bill for their services provided. So when the patient receives the bill it is itemized. 

As long as you need to apply to DOH for a certificate of need to run an ALS program it will remain hospital based. More ALS projects are adding BLS and some hospitals that didn't have ALS are working towards starting new or reviving old systems. If the old guard of the city FDs can't get ALS certified, and they have significant political power, then no one will change the system

Go to njmedics.com for more info


----------



## Smash (Jan 30, 2013)

Veneficus said:


> Who came up with that schedule and why?
> 
> My circadian rhythms would be so messed up you would never want to be anywhere near me.



It's a very common schedule in Australasia.  It's ideally suited to firefighters who are tucked up in bed all night making it almost 2 days on, two nights on call, 4 off.  It's absolute hell for the rest of us.


----------



## JMorin95 (Jan 30, 2013)

Private not for profit company.
We are part vollie part per diem. There are always two people at the station, usually a medic and an emt/aemt. We do twelve hour shifts.


----------



## xrsm002 (Jan 30, 2013)

Texas also has MICU ambulance which means at a minimum a basic or Intermediate with a paramedic. ALS at a minimum would be basic with an Intermediate. Or you could do two intermediates on the ALS.


----------



## xrsm002 (Jan 30, 2013)

MICU-Mobile Intensive Care Unit. In case anyone was curious.


----------



## downunderwunda (Jan 30, 2013)

Smash said:


> It's a very common schedule in Australasia.  It's ideally suited to firefighters who are tucked up in bed all night making it almost 2 days on, two nights on call, 4 off.  It's absolute hell for the rest of us.



It is also a rostering system that is starting, in ems, to go in favour of 12 hour day day afternoon night. Much more favorable


----------



## the_negro_puppy (Jan 30, 2013)

EpiEMS said:


> So, who handles heavy rescue down undah? Do PD and FD go to life-threatening calls to start CPR and early defib, etc.?



Sorry, Fire Handle heavy rescue.

If Police are Fire are not used as first responders. If they beat us to a scene then they usually start CPR or the like.


----------



## Shishkabob (Jan 30, 2013)

PsychoJoe said:


> Sounds familiar. How long have you been there (here)?



Year and a half.


----------



## Merck (Jan 30, 2013)

Our system covers our whole province.  Approx 3500 paramedics.  Most are PCPs (Primary Care Paramedics) working a mix of on-call part-time or full-time depending on the town/station.  There are about 200 ACPs (Advanced - similar to EMT-P I guess) in the larger centres.  These are targeted response with PCP backup for the usual calls that may require ALS.  The ACP crew decides if transport is required and either carries the pt or hands off to the PCP crew.  We generally like this system as the ACPs consistently see and handle higher acuity calls and utilize their skills quite often (lots of intubation and zippity-zapping people).

The PCPs have a decent scope with IV, King LTD for arrests, epi, salbutamol, naloxone, D10W, ASA, NTG so can deal with a number of calls without ACP help.

This system covers roughly 4.4 million people in 1 million square kilometres with an interesting mix of metro, urban, suburban, rural, and remote areas.  

Critical patients within the province are transferred by CCP paramedics who are selected from existing ACP medics with experience and trained over two years to the CCP level.  They handle fixed-wing, rotor, and some ground transfers.  That system is 2 CCP medics and 2 pilots.  RN/RT/MD isn't used for most except in some areas where CCP can't get to or are unavailable.  There are about 60 CCP paramedics in the province.

Our system handles about 400,000 calls annually.

EDIT - same as below   And yep, 2 days, 2 night, 4 off.

The local FD in the towns generally respond to emerg calls and have first responder training.

KCCO


----------



## cprted (Jan 30, 2013)

Smash said:


> It's a very common schedule in Australasia.  It's ideally suited to firefighters who are tucked up in bed all night making it almost 2 days on, two nights on call, 4 off.  It's absolute hell for the rest of us.


2 days, 2 nights, 4 off is a very common shift pattern for Fire, Police, and EMS in Canada too.

My agency is the sole EMS provider for the province of British Columbia (population 4.4M).  We have 480 ground ambulances based out of 187 stations (according to wikipedia ... I've never actually counted myself).  Majority of cars are BLS staffed by Primary Care Paramedics with targeted ALS staffed by Advanced Care Paramedics in the urban centres.  We also have 6 fixed-wing and 4 rotary-wing in the Critical Care Transport program.  Obviously 911 response is our major gig but we also do thousands of mid-high acuity IFT each year.  Many low acuity transfers have been contracted out to private sector "Stretcher Services."  With approximately 3800 full and part time staff, I think that makes us one of the largest EMS agencies in North America.

http://en.wikipedia.org/wiki/British_Columbia_Ambulance_Service

Edit: Merck posted while I was still typing ... lol


----------



## the_negro_puppy (Jan 30, 2013)

Here's an interesting article about Firefighters performing EMS work in NSW here:

http://www.smh.com.au/national/health/firies-say-they-cant-step-in-for-medics-20130130-2dl2t.html







_FIREFIGHTERS will be asked to step in for busy ambulance officers in Sydney and major regional areas under NSW government plans to meet growing patient demand.

The Australian Medical Association and the union representing fire brigade officers are concerned the proposal will compromise patient safety.

Read more: http://www.smh.com.au/national/heal...-for-medics-20130130-2dl2t.html#ixzz2JVat4ai9
_


----------



## Smash (Jan 30, 2013)

downunderwunda said:


> It is also a rostering system that is starting, in ems, to go in favour of 12 hour day day afternoon night. Much more favorable



Much better rotation from a fatigue management point of view.  I don't have a problem with 4 on, 4 off, it's just that back to back 14 hour nights are stupid and dangerous.


----------



## EpiEMS (Jan 30, 2013)

the_negro_puppy said:


> The Australian Medical Association and the union representing fire brigade officers are concerned the proposal will compromise patient safety.



The total opposite of the IAFF and those folks in the US.

I'm thinking that the A(ustralian) Medical Association and Australian FD union is right about this...


----------



## PsychoJoe (Jan 30, 2013)

Linuss said:


> Year and a half.



Took a bit to figure out who you are. Guess I could have just asked.


----------



## the_negro_puppy (Jan 30, 2013)

EpiEMS said:


> The total opposite of the IAFF and those folks in the US.
> 
> I'm thinking that the A(ustralian) Medical Association and Australian FD union is right about this...



Damn right. If they are worried about response times they need more Paramedics and more Ambulances. Simple as that. All Ambulance services are funded and run by the States. It not complex County, City and private models like you guys have in America. They are just trying to penny pinch.


----------



## EpiEMS (Jan 30, 2013)

the_negro_puppy said:


> Damn right. If they are worried about response times they need more Paramedics and more Ambulances. Simple as that. All Ambulance services are funded and run by the States. It not complex County, City and private models like you guys have in America. They are just trying to penny pinch.



Broadly, I think EMS should get behind moving US EMS to the Aussie model. But that's me, not having any experience with FD-based EMS (only third-service-based).


----------



## downunderwunda (Jan 30, 2013)

the_negro_puppy said:


> Sorry, Fire Handle heavy rescue.
> 
> If Police are Fire are not used as first responders. If they beat us to a scene then they usually start CPR or the like.



They never beat us to a cardiac call in NSW. Why? They simply are not called. Rescue went to fire because we had a spineless CEO who wanted it gone. 

Just a question puppy, who started rescue in NSW???


----------



## EpiEMS (Jan 30, 2013)

Well, should EMS be doing (or leading, at least) rescue, or fire? I think that's an open question, no?


----------



## Shishkabob (Jan 30, 2013)

EpiEMS said:


> Well, should EMS be doing (or leading, at least) rescue, or fire? I think that's an open question, no?



Most certainly EMS should be doing AND leading rescue, as rescue is a patient centered activity.  


However, you'll find FDs fight tooth and nail to keep their grasp on it to justify their budget.


----------



## rescue1 (Jan 30, 2013)

I think we had a thread on who should lead rescue a few months ago, if you search for it.

The general consensus was that no-one could agree on who should<_<


----------



## downunderwunda (Jan 30, 2013)

the_negro_puppy said:


> Here's an interesting article about Firefighters performing EMS work in NSW here:
> 
> http://www.smh.com.au/national/health/firies-say-they-cant-step-in-for-medics-20130130-2dl2t.html
> 
> ...



I think there are a few pointers here that need to be considered as well. This is a proposal & the most significant statment in this entire article is



> ''Given the O'Farrell government is already closing fire stations and refusing to replace firefighters, this policy will force firefighters to do more with fewer resources and will do nothing to improve [ambulance] response times.''



&



> Darin Sullivan, the NSW president of the Fire Brigade Employees Union, said firefighters should be paid for any extra work and the issue was likely to provoke industrial action.
> 
> ''It looks like firefighters will be forced to take on a role as first responder to support the ambulance service for the first time in NSW,'' he said. ''But with the O'Farrell government's wages policy, it is outside government policy for public sector workers to claim extra pay based on extra work performed. This will be a major reform requiring a formal increase in skills and training.''





> The NSW Opposition Leader, John Robertson, described the proposal as ''cost-cutting madness''. ''Instead of hiring extra paramedics and putting more ambulances on the road to meet rising demand, the O'Farrell government is trying to replace them with firefighters who are already being hit with major budget cuts of their own,'' he said.



This isnt policy yet & I doubt it will get up.


----------



## EpiEMS (Jan 31, 2013)

downunderwunda said:


> I think there are a few pointers here that need to be considered as well.



One of the quotes suggests some indignant firefighters don't want to be first responders to incidents to support EMS...so, what exactly do they want to do when they're not fighting fires? That is -- are they fighting so many fires that they don't have a couple hours to support EMS?



Linuss said:


> Most certainly EMS should be doing AND leading rescue, as rescue is a patient centered activity.
> 
> However, you'll find FDs fight tooth and nail to keep their grasp on it to justify their budget.



I'll take a look for the thread. I tend to see that as the most reasonable tack.


----------



## downunderwunda (Jan 31, 2013)

EpiEMS said:


> One of the quotes suggests some indignant firefighters don't want to be first responders to incidents to support EMS...so, what exactly do they want to do when they're not fighting fires? That is -- are they fighting so many fires that they don't have a couple hours to support EMS?
> 
> 
> 
> I'll take a look for the thread. I tend to see that as the most reasonable tack.



Who kows, I have stated before we are seperate professions. We should be kept that way. it is not a reasonable tack. The NSWFB have a track record of taking other peoples jobs to justify their existance. The simple fact that they are opposed to it as well shows it is a bad idea that should be canned.


----------



## the_negro_puppy (Jan 31, 2013)

downunderwunda said:


> They never beat us to a cardiac call in NSW. Why? They simply are not called. Rescue went to fire because we had a spineless CEO who wanted it gone.
> 
> Just a question puppy, who started rescue in NSW???



Hey mate sorry don't know much about NSW other than that they have Police Rescue as well?

Police and Fire are never sent to any medical calls unless rescue or restraint needed. They only do CPR for example when they beat us to an MVA / RTC involving a cardiac arrest, or police first on scene in a shopping mall etc


----------



## downunderwunda (Jan 31, 2013)

the_negro_puppy said:


> Hey mate sorry don't know much about NSW other than that they have Police Rescue as well?
> 
> Police and Fire are never sent to any medical calls unless rescue or restraint needed. They only do CPR for example when they beat us to an MVA / RTC involving a cardiac arrest, or police first on scene in a shopping mall etc



Rescue was started by ASNSW.

Heres a thought. They say that Fire is underworked & can therefore help Ambulance, wouldnt it make more sense to REDUCE the number of BRT's (Big Red Trucks) & the number of Hose monkeys & INCREASE Paramedic resourses in the state, in line with workload of course.


----------



## Wheel (Jan 31, 2013)

downunderwunda said:


> Rescue was started by ASNSW.
> 
> Heres a thought. They say that Fire is underworked & can therefore help Ambulance, wouldnt it make more sense to REDUCE the number of BRT's (Big Red Trucks) & the number of Hose monkeys & INCREASE Paramedic resourses in the state, in line with workload of course.



Seems reasonable, but in the US the fire union would have a fit.


----------



## rescue1 (Jan 31, 2013)

In fire's defense, structure fires--rare as they are these days, are much more time sensitive than medical calls. 

That being said, there are definitely systems that have a clear budget imbalance. Doesn't Providence, RI have 14 engine companies and...6 ambulances? With a good 70/30 split of EMS/Fire calls.


----------



## EpiEMS (Jan 31, 2013)

rescue1 said:


> In fire's defense, structure fires--rare as they are these days, are much more time sensitive than medical calls.
> 
> That being said, there are definitely systems that have a clear budget imbalance. Doesn't Providence, RI have 14 engine companies and...6 ambulances? With a good 70/30 split of EMS/Fire calls.



Along those lines, you can safely work a serious EMS call with 2 or so people. Can't safely run a structure fire (even just pulling people out) with even 4 folks, no?


----------



## rescue1 (Jan 31, 2013)

I think the NFPA recommends 17 FFs for a residential fire. But yeah, more then 4.

I'm a firm believer in compromise and balance when it comes to fire/EMS budgeting. I don't like to see either side get shafted, I'd just like both sides to be effective.


----------



## downunderwunda (Jan 31, 2013)

rescue1 said:


> In fire's defense, structure fires--rare as they are these days, are much more time sensitive than medical calls.QUOTE]
> 
> This is one of the greatest misnomas out there. Fire is NOT time critical. Fire services & their cheifs want people to believe it. The simple reality is if a structure catches fire, it is ruined by
> fire
> ...


----------



## STXmedic (Jan 31, 2013)

downunderwunda said:


> This is one of the greatest misnomas out there. Fire is NOT time critical. Fire services & their cheifs want people to believe it. The simple reality is if a structure catches fire, it is ruined by
> fire
> smoke
> water
> ...



Umm... Seriously? I've made quite a few fires in my time as a firefighter. In that time, I've contained fire to single rooms of a house, single complexes of apartment buildings, salvaged an incredible amount of belongings and kept houses/apartments tenable for the residents (if not immediately, after some renovation). Just because there is smoke on the walls and water on the carpet does not mean that we may as well have taken our time and let the structure burn to the ground. Am I biased because I am a firefighter? Sure.  However, the ignorance of your stance is glaring. Fire in or on house =/= complete loss of people, belongings, and property.


----------



## STXmedic (Jan 31, 2013)

Double post.


----------



## DrParasite (Jan 31, 2013)

rescue1 said:


> I think the NFPA recommends 17 FFs for a residential fire. But yeah, more then 4.


yes, but the most critical are the first due engine and first due truck.  If they get there when it's small and knock it down, than it doesn't matter if the other apparatus come from farther away (or are requested using mutual aid, coming from another town, etc).  and if it's too big that they can't handle it with the first due engine and truck, and it's probably big enough where a couple minutes aren't going to make a big difference.

If you want to go by the numbers, you should have as many ambulances as you have engine companies in a given area. than take the ratio of EMS to fire calls (in the example of Providence RI 70:30) and apply that to the ambulance engine ratio.  Using this method, you would need 30 ambulances to properly cover the call volume, which means the ambulances would handle EMS calls and the FD would no longer need to go on first responder calls to "stop the clock."

I will also say, the majority of fire calls aren't structure fires, so using them as justification for anything is similar to ems using response time to cardiac arrests as setting the standard for response times.  After all, if you can't breath, how long can you brain go without oxygen?  and if it takes the ambulance longer to arrive, than people will die, and the EMS system has failed.  after all, that's pretty much what the FD's argument is correct?


----------



## rescue1 (Jan 31, 2013)

DrParasite said:


> yes, but the most critical are the first due engine and first due truck.  If they get there when it's small and knock it down, than it doesn't matter if the other apparatus come from farther away (or are requested using mutual aid, coming from another town, etc).  and if it's too big that they can't handle it with the first due engine and truck, and it's probably big enough where a couple minutes aren't going to make a big difference.



This I agree with. Of course, the issue there is if you have enough engine companies sprinkled around the city to meet a reasonable response standpoint, you end up with a lot of fire apparatus anyway, so it ends up working out to about the same as a deployment model meant to get the 15-20 FFs on scene for a structural fire.


----------



## Handsome Robb (Feb 1, 2013)

Privately owned company operating under a Public Utility Model. 

911 and IFT, only transport agency in the county except for one small town that's pretty isolated, geographically, from the rest of the county. 

All ambulances are ALS. Paramedic/Intermediate is the standard crew but there's usually at least one Medic/Medic car roaming around. 

Fire is ILS except in outlying valleys, then they are ALS, usually. Trying to get all the outliers ALS with their new round of hiring this month. 

4x12s or 3x16s.

System status management with a few (read: 4) "hard posts".

Anywhere from 7, yes I said 7 ambulances  all the way up to ~20 during the day/peak hours. ~ 75,000 calls per year. Covering ~6,000 square miles (lots of which is just open desert) with the help of a teeny tiny volly agency and the aforementioned FD. We do provide mutual aid as well.

We also have a HEMS service under our P.U.M. umbrella company. CCP + CCRN staffing for them. 

We also do all medical standbys for special events, SAR, TEMS, have our hand in ALS ski patrol and have a well respected education center. Also starting a Community Paramedicine program this year.


----------



## Shishkabob (Feb 1, 2013)

rescue1 said:


> I think the NFPA recommends 17 FFs for a residential fire. But yeah, more then 4.



The thing is, despite the "science", it's still done by a biased organization and people still need to look at it with a skeptical eye.


----------

