medic417
The Truth Provider
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But with federal mandates would come federal funds. Allowing all rural areas no more excuses for not staffing at an ALS level.
Nationalization or federalization of EMS
- Thread starter JJR512
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But with federal mandates would come federal funds. Allowing all rural areas no more excuses for not staffing at an ALS level.
JPINFV
Gadfly
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Federal funding? Ever heard of an unfunded mandate?
Do you have a hospital in your rural area?
Any healthcare professionals working at that hospital?
Doctors? Nurses? Medical Lab Technologists? Radiology Technologists? Physical Therapists? Respiratory Therapists? Speech Therapists?
Maybe the highest level of care in the hospital should be the CNA if we use the same excuses EMS does.
How about lawyers or accountants in your area?
Do you think any of these professionals were allowed to cry "but we are rural and shouldn't be required to be educated"?
It is not unreasonable to provide some resemblance of good healthcare even in rural areas. Florida has managed to provide ALS to all of its 911 services.
medic417
The Truth Provider
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No funding then we see the states revolt. Wow who whould have ever thought EMS could affect so much?
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Can anyone tell me the last time the federal government got a program right the first time, without causing a bigger problem than they were trying to solve?
"I'm from the government and I'm here to help"....
Ha! they'd have to fund the mandate - Just like no child left behind, right? Unless the USFG acutally takes over the ALS services, I doubt enough funds will come rolling in...and as someone mentioned, that's another whole can of worms. Even if they took it over I doubt it would be fully funded...the feds dont' even pay fully through medicare now.
That said, if the government acutally took over EMS, what you say about funding care might be true. However, I don't really know that I want some pencil-pusher in DC dictating the way care will be provided in North Dakota or Maine. There is a good argument for local control of EMS based on community needs, though there is also a good argument for increased educational requirements.
I wonder what sort of access the government would provide for outlying areas - in addition to having less money, rural areas places also have less people, and thus less congresspeople representing them and lobbying for them (and less money to put into campaigns in general...basically less political power). I think its likely that major urban areas would get the vast majority of the EMS budget and pork barrel money, leaving rural areas holding the short end of the stick again.
Similarly, I'm not comfortable with taking away the control of a local med. control physician. I like the idea of national requirements of a BS, but if there were to be national protocols, I'd have a problem. I think the physician who is "donating" his liscence to be used for EMS should retain ultimate control over the actions of his/her medics.
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States revolt - haha! nice idea, unfortunately I think not. more like news story for one day and then everyone forgets...
Ha! they'd have to fund the mandate - Just like no child left behind, right? Unless the USFG acutally takes over the ALS services, I doubt enough funds will come rolling in...and as someone mentioned, that's another whole can of worms. Even if they took it over I doubt it would be fully funded...the feds dont' even pay fully through medicare now.
That said, if the government acutally took over EMS, what you say about funding care might be true. However, I don't really know that I want some pencil-pusher in DC dictating the way care will be provided in North Dakota or Maine. There is a good argument for local control of EMS based on community needs, though there is also a good argument for increased educational requirements.
I wonder what sort of access the government would provide for outlying areas - in addition to having less money, rural areas places also have less people, and thus less congresspeople representing them and lobbying for them (and less money to put into campaigns in general...basically less political power). I think its likely that major urban areas would get the vast majority of the EMS budget and pork barrel money, leaving rural areas holding the short end of the stick again.
Similarly, I'm not comfortable with taking away the control of a local med. control physician. I like the idea of national requirements of a BS, but if there were to be national protocols, I'd have a problem. I think the physician who is "donating" his liscence to be used for EMS should retain ultimate control over the actions of his/her medics.
EDIT:
States revolt - haha! nice idea, unfortunately I think not. more like news story for one day and then everyone forgets...
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They may have more than a CNA, but I know that many small rural community hospitals don't have, for example, PT's, RT's, speech therapists, or any physicians beyond GP's (or fancy imaging technology to be operated by rad. techs). Specialists are reserved for the big hospitals...sometimes multiple hours away. Thus the push for increased telemedicine in these areas.
I don't know how rural Florida gets...but if you do manage 100% ALS coverage at outlying places - how? who pays for it? Is this a state funded thing, or through fire departments?
Florida is very rural in many areas. We got ALS through good tax base allocation and districts. We are also very much Fire Based EMS.
Yes, even rural hospitals have at least 1 - 2 of each (RT, SP, PT and definitely radiology technologists and Dieticians). I would also hope they have RNs and not just CNAs or LVNs. There are a basic set of standards for staffing a hospital that must be met by state and Federal requirements or NO Medicare reimbursement. It is NOT an option.
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mycrofft
Still crazy but elsewhere
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I'm only skimming herer
JRM818 I liked your post, particularly since I have agreed with it here and privately.
The EMT-A and EMT-P were federal creations but then the states stook off with them. The military reserves and Guard medics shold be used to furnish medical care for those without, it's the government's job to do the work other's won't but is required. Besides, it will give them invaluable experience. If the emergency departments don't shape up, they will need nationalization.
My ignorant guess is that the cost for the set-up year might cost the same as two weeks' air ops over Iraq.
JRM818 I liked your post, particularly since I have agreed with it here and privately.
The EMT-A and EMT-P were federal creations but then the states stook off with them. The military reserves and Guard medics shold be used to furnish medical care for those without, it's the government's job to do the work other's won't but is required. Besides, it will give them invaluable experience. If the emergency departments don't shape up, they will need nationalization.
My ignorant guess is that the cost for the set-up year might cost the same as two weeks' air ops over Iraq.
mycrofft
Still crazy but elsewhere
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Roger that Flight.
Wanna work for a year in South Dakota or Watts-Willowbrook?
Wanna work for a year in South Dakota or Watts-Willowbrook?
lightsandsirens5
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That isn't what I ment. I'm saying that basics in rural areas are more educated than basics in more populated areas. And federal regulation would shut the door for rural countys to expand their scope of practice.
Also, no offence, but Washington has alot more rural areas than Florida and the people in this state arent going to want to pay enough taxes to staff every agency with full time ALS crews. That just dosent work. Especally when you have very rural agencys that might get ten call outs a week.
I'll concede the point about RT's PT's and SP's... (till now) I was pretty sure they weren't required. I tried looking quickly to get an idea of the requirements, but couldn't easily find them so I'll trust your greater experience and knowledge and presume they were. (side note: wtf? Why a speech pathologist? not that I dare knock SP's...my mom is one, and spent many years being educated, but why a requirement for every hospital?)
That said, I am certain that many rural hospitals don't have much in the way of physician specialists, or imaging toys that exist at larger hospitals. They may have a physical therapist...but try finding a neurologist or getting an MRI. In the emergency care arena, the specialists are likely to be even more important than the staff you mentioned. The hospital may have access to such specialists via some sort of telemedicine/consult arrangement, but may have none acutally on staff (warm body in the building).
I'm gathering from your response that the fire-based EMS has a large role in increasing the rural access. I'm curious if you think that is a good model...given the attitude towards Fire/EMS on this site in general.
Huh?
So those in the city with easy access to colleges are just a bunch of uneducated fools for providing ALS when we could be just EMT-Bs with a few more "skills"?
Explain..
lightsandsirens5
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At my hospital we have 1 MD on call and maybe 1-2 RTs, 1-2 RNs. The other people are just ER tecs. There is also a mobile MRI that might get delivered every three weeks for a few days. If not, the nearest MRI is a two hour transport time away. We take tons of pts to the city because 8 out of 10 days in the winter, the air ambulance service can't fly here.
lightsandsirens5
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No no no....... I mean rural EMT-Bs have the oppurtunity to be more educated.
I dont want to get into an arguement and get banned here, but that is just my take.
Sasha
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There are a couple of different levels for Speech and the edcuation goes to doctorate. The doctorate level practitioner may not be necessary. Why send a stroke patient 2 hours by ambulance to the city for a swallow study or therapy post intubation or CVA? Some hospitals may share one if they are with the same system but usually one hospital can work their tail off with inpatient and outpatient.
If the hospital does X-Rays, they need a Radiology Technician or Technologist. Most hospitals, in the 21st century, have at least a basic CT Scanner which requires that RT to be certed in.
If the hospital has ventilators, there should be at least one RRT in house or available on call.
The Radiologists or Neurologists don't need to be onsite to read a scan or X-Ray.
Pull up any small hospital website and look at the services they offer. Many little hospitals make their money by outpatient services which pay the bills. PT, OT, Respiratory, HBO, EKG/Cath, Pulmonary Lab, Sleep Lab, Speech... all good money makers...now.
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TheMowingMonk
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This is getting off the topic of EMS standardization, I dont see why everyone jumps straight to need to federalize it, I think a good first step would just be standardising on the state level. Because places like california were you can travel an hour and pass through 3 counties all with drastically different protocals, just having a standard within the state that all counties followed i think would be a good step, then from there move towards federalization.
Problem: California
Solution: Cut em loose! Let the state float left a few more miles. ha...kidding...
Seriously though - some states have wide variations in their environments. PA for instance has two big cities at either end...and a whole lot of nothing in the middle. The protocols we use in the city with 10 -15 minute transport times probably don't fit the middle of the state with transport times measured in hours.
just as an example...insulin as mentioned in another thread. Around here its no big deal for a hyperglycemic pt. to wait a few minutes to get to the hospital...preferable for the titration to be done there. If we're an hour plus away, that cost/benefit analysis begins to shift in favor of insulin admin in the field.
America is too diverse for a one-size fits all approach. national educational requirements...sure...as long as there's some way to preserve rural access. National protocols? No thanks.
Of course the answer to me is: OK, national protocols with allowances for regional variations
my answer: that's the staus quo, pretty much. I think the lack of education is a far greater problem than different protocols, and the arena best suited by some sort of national standardization (I still favor private "college" type...rather than USFG regulation). The government has no business diddling with medicine, imho.