What is your EMS system?

[ItsTheBLS]

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]

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]

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]

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]

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

The basic is pretty much just the driver.

 

[EpiEMS]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

What is my EMS system?

A non-progressive disaster.

 

[EpiEMS]

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]

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...