911

[Cory]

You're missing the point. This isn't a factual type discussion, it's hypothetical.



It's like saying "You can't argue the coolness invisibility and flying, because neither can be done". You can't say one's better because you don't have the other.




Let's say your city could choost between both private AND fire based EMS. Why would you choose fire?

UGH


Again: then my GUESS is that the large number of uninsurred people living in the inner city area would not mix well with the way some private companies do their billing. It seems like so mnay ambulance bills would go un-paid.

But then again, if you have the mind to read all of this document then you would see that costs of FD ambualnces are already getting higher, so I can't honestly say. I don't know enough about the contrast of private and FD billing.

Mind you, that is from 2005, but money hasn't gotten any easier since then.

 

[reaper]

For a private service, I would much rather have the poor pt's! They have medicaid and medicare, verses being uninsured. So, you will recoup more billing costs from them.

 

[medic417]

Okay, but I do not see how giving up an area to private companies would solve that. The FD's are still going to be there, unless you are suggesting that more FD's should close, than I understand your reasoining, but then I also dissagree with it.



-Cory-

Actually with better building codes the need for a fire station on every corner has gone away. Fire could be cut way down and the money shifted to fund a Pre Hospital Medical Professional ambulance service rather than a hose jockey I don't want to be on an ambulance but have to for future promotion taxi service.

 

[46Young]

If a private EMS provider were to take over a city in generally poor socioeconomic standing, with a poor reimbursement rate due to lack of insurance, the company would quickly go out of business.

A hospital based 911 system makes money by steering insured pts back to their hospital, not so much through insurance reimbursement for txp. They may also steer uninsured pts away from their home hosp so they don't drain their resources and take up beds that could be occupied by insured pts. It's a one two punch to stay out of the red.

There is a way for it to work, if the city can afford it - guarantee that the company receives a predetermined amount of annual compensation. If the company fails to meet that number from reimbursement, the city pays the difference. If reimbursements are greater than the target number, the city keeps the rest.

For all of it's alleged wastefulness, a FBEMS txp unit has no financial incentive to not do the right thing for the pt. Objective unbiased pt care, at least in my neck of the woods.

 

[46Young]

Actually with better building codes the need for a fire station on every corner has gone away. Fire could be cut way down and the money shifted to fund a Pre Hospital Medical Professional ambulance service rather than a hose jockey I don't want to be on an ambulance but have to for future promotion taxi service.

Consider a typical stick home, type 5 construction, with it's high fire load, rapid spread due to void spaces. Trusses fail whan any one part of the system fails. Due to quicker fire spread conditions can become untenable in a manner of a few minutes. Structural collapse can happen in as little as 15 minutes time.

So, assuming that the 911 call is placed the exact moment that the fire started (typically the call is places many minutes later), the dispatcher routes the call to the station, and the apparatus is on the road, can be 4-6 minutes. Add another 2-5 minutes to get onscene. Now we're at 6-11 minutes. The first due engine needs to lay out, the officer does their lap around the structure as the crew pulls the line and puts on their face pieces. At the same time the truck company throws ladders and pack Scott up for a VES. Now we're nearing 12-15 minutes before we can reach victims and begin suppression in an optimal situation. Remember, that's if the call were placed at the exact moment the fire started. That rarely happens, if ever.

The chances of us reaching viable victims and saving property are marginal at best given modern construction practices, under optimal circumstances. Now reduce fire staffing and extend response times by 5 minutes or more.

Yes, suppression call volume is relatively low compared to the number of staff, but proper staffing is necessary for the reason mentioned above, as well as many others. Due to relative downtime, using fire personnel for EMS activities is efficient use of personnel.

I've mentioned this before, keeping proficiency as a medic, let alone as a basic is not as difficult as some would make it out to be. Suppression is not rocket science, either. Over here we drill both EMS and suppression on duty, and receive quaterly 8 hour EMS con ed on duty as well.

 

[medichopeful]

Opinion or not, if you say something you tend to have to back it up. That's how a debate works.

Oh yeah? Where's your proof?

I kidd

 

[JeffDHMC]

Round here, FD is non-transporting BLS. 911 EMS is handled by the county hospital, works great. We handle EMS, they help us out. In the surrounding metro area, it' FD based. I have experience there too, doesn't work so well. But that's just me.

 

[Shishkabob]

"For all of it's alleged wastefulness, a FBEMS txp unit has no financial incentive to not do the right thing for the pt. Objective unbiased pt care, at least in my neck of the woods."

Just as it's stupid to say all FDEMS sucks, it's stupid to say that all private medics are biased towards the bottom dollar, pt be damned.


In reality the medics at the private won't care about the bottom dollar, and will do what's best for the pt, as evidenced by the many privates on these forums.

Just like SOME privates care about making money doesn't mean they all do, just as some fire medics suck doesn't mean they all do.

 

[46Young]

Many here from an EMS only background argue that sending more than two providers to a pt is superfluous, save an arrest or otherwise critical pt. I'll agree that sending multiple pieces to a stubbed toe or general feel-me-bads is overkill. EMS response by suppression crews ought to be for higher priority calls.

Having said that, consider how much longer you can last in the field with more hands onscene to help with lifting, diagnostics, scene safety, etc. I know of many a broken down medic, typically with either a career ending back injury or shoulder inj, or just general burnout and apathy.

When I'm on the engine, I'll carry the O2 and ALS bag, the other bucket FF will carry the monitor and airway bag. The driver will make sure the medic finds us, or bring immobilization equipment if necessary. Once inside, I'll interview the pt, do my assessment/diagnostics with any necessary ALS interventions, while my Lt records my findings. The FF will perform BP, pulse, hook up the monitor/12 lead (I interpret, of course) and BGL. The officer will gather info from the family as well as meds, and record vitals. When the medic arrives, we'll continue working, while the Lt gives them the story. We'll then assist with removal to the bus, I'll help with any further interventions, and ride to the hosp if needed. Onscene times are quite short typically. If the medic gets there first, we'll do as directed by the crew.

Having other hands to help greatly reduces the ambulance crew's burden, thereby reducing their stress and promoting longevity. 911 call to ED arrival is shortened noticeably as well.

Many private or hosp. based EMS agencies are profit driven, and will run the least amount of units as possible to increase their bottom line. Crews run extremely high call volume, in some cases for 24 hours or much more. Eventual burnout is inevitable. This can be dangerous both for the pt and the crew. Private EMS can also have staffing issues, making holdover of already overworked crews necessary. FD's with crosstrained personnel won't have anywhere the same degree of difficulty with EMS staffing.

I've worked in the NYC 911 system for years before I left. I'm quite capable of getting things done with only one partner and no other hands. It sucks at times, but you do it. When I first experienced fire based EMS I was overwhelmed by the amount of providers onscene. You have to know how to use your resources to be efficient. If everyone knows their role, things should move seamlessly and not be a cluster. Besides, why risk a career ending injury on a 300 lb plus heavy hitter when you can have all of the help you'll ever need? If you pride yourself with working a insanely high call volume for hours (days?) on end, and not needing any additional help with your pts, remember the old saying: "Pride comes before a fall". That "fall" can be an MVA, clinical error, injury, or taking out your frustrations on your pts.

 

[46Young]

"For all of it's alleged wastefulness, a FBEMS txp unit has no financial incentive to not do the right thing for the pt. Objective unbiased pt care, at least in my neck of the woods."

Just as it's stupid to say all FDEMS sucks, it's stupid to say that all private medics are biased towards the bottom dollar, pt be damned.


In reality the medics at the private won't care about the bottom dollar, and will do what's best for the pt, as evidenced by the many privates on these forums.

Just like SOME privates care about making money doesn't mean they all do, just as some fire medics suck doesn't mean they all do.

I wasn't referring specifically to the providers, rather company policy. This is typically invoked by an "unwritten rule". If you don't play the game, the company will make you miserable as a result, as in late calls, undesireable shift schedule, no pay raises, no OT, too much forced OT, amassing a paper trail to get you fired.

Again, I speak from experience. One of the NY hosps I worked for per diem operated in this manner, as well as others. NSLIJ and Cornell were on the up and up, however.