Seattle/King County Fire and EMS politics.

[usalsfyre]

Well there are only 7 Medic units available in all of Seattle, and we're a prettyyyy big city, so if every Pt was to see a medic... you can see how that just wouldn't work.

A novel idea would be adding medic units....

 

[Aidey]

Well there are only 7 Medic units available in all of Seattle, and we're a prettyyyy big city, so if every Pt was to see a medic... you can see how that just wouldn't work.

I know the concept of supply and demand is hard to grasp, but I have a hunch that demand is outpacing supply significantly.

 

[NomadicMedic]

They strongly oppose adding additional medics as they believe it will lead to dilution of the call volume of acute calls for the medics and degradation of skills.

 

[Aidey]

1. Maybe if they deflated their egos a bit they would be able to fit more medic units in the city without it being a big game of bumper cars.

2. One would think that a program that has such great access to Harborview would be able to come up with a way to keep their medic's skills up.

3. Someone might want to advise them that acute call does not always equal cardiac arrest.

4. Someone might also want to advise them that the job stopped being about life and death calls a long time ago.

 

[usalsfyre]

They strongly oppose adding additional medics as they believe it will lead to dilution of the call volume of acute calls for the medics and degradation of skills.

So tier it. Medics that can handle the majority if calls on all trucks and a few advanced level medics to run high acuity calls. Like the rest of the world does....

 

[NomadicMedic]

I have always though that King County would be a perfect place for the AEMT to practice. COPD exacerbation that needs a neb would get one. Opiate ODs would get Narcan. Hypoglycemics would get Dextrose. If King County want to save the medics for the "bad ones", let EMS providers that can start immediate treatment get things moving.

Now, that would be a progressive move. Have a tiered system with first line providers able to make a definitive difference rather than just provide "the stare of life".

However, I think we'd quickly see the shine fade from the Medic One system if the paramedics aren't doing anything but RSI and Arrests.

 

[NYMedic828]

My view of getting FD out of medicine, where it doesn't belong, is no secret and I don't try to hide it to make friends. Fire departments should not do medicine. Fire departments do medicine to boost their budget.


Generalizations? Sure. But generalizations backed up by the fact that darn near every single world renowned EMS agency is NOT run through a fire department but is infact, separate of them, despite that fact that 1/3 of EMS agencies in this country are fire-based.

Municipalities that run EMS often lose money vs gain it. FDNY EMS actually costs NYC around 200,000,000 a year to keep in service. (its really 400,000,000 but we usually generate half back in transports. Meanwhile 90% of the service is convinced they make bags of money for the city left and right)

Mind you firefighters do not generate revenues outside of inspection violations they can issue and the RARE parking ticket they write but you can't exactly not have a fire department whereas EMS is easily privatized and generally profits when it is vs costing massive amounts.

 

[Shishkabob]

Mind you firefighters do not generate revenues outside of inspection violations they can issue and the RARE parking ticket they write but you can't exactly not have a fire department whereas EMS is easily privatized and generally profits when it is vs costing massive amounts.

You can EASILY have a much smaller funded FD, while providing much better funding to EMS.


Sole FD required calls (fire, HAZMAT, etc) account for less than 5% of 911 calls (more like 3%), however FD OFTEN get the lions share of a budget compared to PD, and even more compared to EMS. That make no sense in any way shape or form FDs try to spin it. Hell, include EMS calls to FDs volume, and fire calls account for 15% of their volume, but the majority of their budget and training. Again, makes no sense, but they defend it like it's a necessity.

If you're not willing to put the majority of your budget, training and time in the portion of your job you do most (medicine) then you don't need to be doing medicine. Period.




Small auxiliary FD with skeleton crews on duty, supplemented by volunteers, is what the vast majority of cities / towns can get away with, without any detrimental outcome.

 

[Veneficus]

They strongly oppose adding additional medics as they believe it will lead to dilution of the call volume of acute calls for the medics and degradation of skills.

But since BLS and not ALS is the proven life saver, ACLS aside from defib and cpr is BS, what exactly do they even have medcs for if nobody sees them?

To prove they can intubate dead people?

 

[Veneficus]

Small auxiliary FD with skeleton crews on duty, supplemented by volunteers, is what the vast majority of cities / towns can get away with, without any detrimental outcome.

While I generally agree, I don't think NYC is one of those cities.
Old and densely packed cities need effective fire coverage to do aggressive operations to save lives and property.

Suburbs and more modern cities do not.

 

[waaaemt]

I have always though that King County would be a perfect place for the AEMT to practice. COPD exacerbation that needs a neb would get one. Opiate ODs would get Narcan. Hypoglycemics would get Dextrose. If King County want to save the medics for the "bad ones", let EMS providers that can start immediate treatment get things moving.

Now, that would be a progressive move. Have a tiered system with first line providers able to make a definitive difference rather than just provide "the stare of life".

However, I think we'd quickly see the shine fade from the Medic One system if the paramedics aren't doing anything but RSI and Arrests.

amen to that! I kind of think AEMT should just be the base level. I know in Canada that's pretty much how it is, and it would be way more practical for everyone.

 

[KingCountyMedic]

You guys are killing me :deadhorse:

I haven't intubated a dead person in over a month! I only had 4 tubes in Jan. All elective intubations, everyone lived. Also none of my patients have ever died in an ambulance. Let me think, I have put patients in the back of a BLS unit after giving: Dextrose, Narcan, Zofran, combivent nebs, and Adenosine. I have also left many patients home after giving those same meds. I was in contact with Medical Control Doctors on every single patient that I treat and they agreed with my treatment and transport decisions every time. I treat my Private Ambulance folks like GOLD because I was one and it's the right thing to do. I often will take an AMB crew with me to the hospital so they can experience sick patients and get a break from running transfers and posting. We do not bill for transports. The majority of ALS providers in our state, both public and private bill so they end up starting IV's on everyone because that is how they make $$$. As I have said before, we aren't perfect but we do a pretty great job overall. I realize some of you have experience working here and if it was negative let me be the first to apologize. Others here just seem to like to be arm chair QB's and trash talk everything on a constant basis. I got nothing for you. Enjoy your selves, regardless of what you say about me or King County EMS I'm going to go to work, have fun, see sick people, be nice to others and get paid very well. PEACE!

 

[medicsb]

I know the concept of supply and demand is hard to grasp, but I have a hunch that demand is outpacing supply significantly.

What demand? Some places such as Seattle/KC target paramedics to "sick" patients, like they were originally envisioned. Is there ANY evidence that there are more sick EMS patients? As far as I can tell, there are probably fewer (likely in almost every EMS system in the US), so why would they add more?

Why would ANY place add more?

 

[Veneficus]

You guys are killing me :deadhorse:

I haven't intubated a dead person in over a month! I only had 4 tubes in Jan. All elective intubations, everyone lived. Also none of my patients have ever died in an ambulance. Let me think, I have put patients in the back of a BLS unit after giving: Dextrose, Narcan, Zofran, combivent nebs, and Adenosine. I have also left many patients home after giving those same meds. I was in contact with Medical Control Doctors on every single patient that I treat and they agreed with my treatment and transport decisions every time. I treat my Private Ambulance folks like GOLD because I was one and it's the right thing to do. I often will take an AMB crew with me to the hospital so they can experience sick patients and get a break from running transfers and posting. We do not bill for transports. The majority of ALS providers in our state, both public and private bill so they end up starting IV's on everyone because that is how they make $$$. As I have said before, we aren't perfect but we do a pretty great job overall. I realize some of you have experience working here and if it was negative let me be the first to apologize. Others here just seem to like to be arm chair QB's and trash talk everything on a constant basis. I got nothing for you. Enjoy your selves, regardless of what you say about me or King County EMS I'm going to go to work, have fun, see sick people, be nice to others and get paid very well. PEACE!

I am not trash talking I have legit questions.

I want to know what is going on there in order to justify having such service.

Since i know most EMS treatments are not definitive and pain management is a reasonable expectation for patients in 2013, I want to know how you address that?

All I ever hear about King County is their "outstanding" cardiac arrest survival, which I know is not from ALS measures, because nobody's is.

Maybe the FD treats non FD members bad, that is no different than 99% of the services I encountered. I don't care about that at all.

I am not a fan of kool-aid, tell me what you got.

 

[Aidey]

What demand? Some places such as Seattle/KC target paramedics to "sick" patients, like they were originally envisioned. Is there ANY evidence that there are more sick EMS patients? As far as I can tell, there are probably fewer (likely in almost every EMS system in the US), so why would they add more?

Why would ANY place add more?

Because the definition of sick does not equal dead. Most of the rest of the developed world recognizes that there are a variety of ALS interventions and medications that can either improve patient outcomes or ease suffering. Heaven forbid paramedics are wasted giving pain control for broken hips or CPAP and nitro for CHF or fluids in the septic patient.

 

[medicsb]

Because the definition of sick does not equal dead. Most of the rest of the developed world recognizes that there are a variety of ALS interventions and medications that can either improve patient outcomes or ease suffering. Heaven forbid paramedics are wasted giving pain control for broken hips or CPAP and nitro for CHF or fluids in the septic patient.

Where did I say that sick equals dead? The incidence of MI, stroke, hospitalization for asthma, etc. have been declining for some time. While true emergencies and sick patients exist, they're not as frequent as they were in the past. There is pretty much no need anywhere to increase the number of medics. If anything, they should be decreasing the number. And you don't need a paramedic to give pain meds, it could easily be done by an AEMT.

 

[Aidey]

I'm talking about their definition. The greater Seattle area is so obsessed with their intubation and ROSC rate they save their medics for those calls. We're talking about 7 medic units for 620k people. That isn't enough medics to run 12 leads on all the legit chest pain calls, let alone address any of the other ALS calls that come out.

No one is saying floor the system with 200 medics, but 7 is beyond insane.

 

[usalsfyre]

At this point I'm not 100% sure you're not trolling....I want to focus on some highlights of this masterpiece....

Also none of my patients have ever died in an ambulance.

Then you are either a)deluding yourself b)brand new (which would explain a lot) or c)working in such an urban area they don't have a chance to crump.

Let me think, I have put patients in the back of a BLS unit after giving: (edit) Adenosine. I have also left many patients home after giving those same meds.

I can't even begin to describe the fail involved here. Try not buying a couple of hours of monitoring or even a 23 hour obs stay after adenosine in a hospital. From a clinical supervision and medicolegal standpoint the thought of leaving an SVT patient at home without a serious, serious AMA conversation leaves me....I'm not even sure how to articulate it.

We do not bill for transports. The majority of ALS providers in our state, both public and private bill so they end up starting IV's on everyone because that is how they make $$$.

Perhaps the rest of the state has realized that relieving pain and suffering is a worthwhile enterprise....

As I have said before, we aren't perfect but we do a pretty great job overall.

Based on what? It's pretty easy to say "we're doing a great job" when you're the one building the criteria.

Enjoy your selves, regardless of what you say about me or King County EMS I'm going to go to work, have fun, see sick people, be nice to others and get paid very well. PEACE!

The "haters gonna hate" attitude is not fooling anyone. You've yet to directly answer anyone's questions, starting with how you "KNOW" everyone who trash talks KCM1 was rejected from there.

 

[KingCountyMedic]

I won't respond anymore on any of these threads. PM me if you want to have a polite conversation and ask me anything you want and I will be honest and open. I am not trolling at all.

 

[medicsb]

I'm talking about their definition. The greater Seattle area is so obsessed with their intubation and ROSC rate they save their medics for those calls. We're talking about 7 medic units for 620k people. That isn't enough medics to run 12 leads on all the legit chest pain calls, let alone address any of the other ALS calls that come out.

I think that is how you define it for them. The thing is, and I've said this before, their system is quite transparent (unlike most places). Do some googling (or pubmed searches) and you'll see that it is obvious that they treat many many patients not in cardiac arrest.

Anyhow, 1 medic unit per 80-100,000 is ideal in my opinion. There are some places that have 1 medic unit per 20,000 - that is triple super duper ridiculous insane.