AMR cant staff, fire/ sheriff transport

CALEMT

The Other Guy/ Paramaybe?
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So on the topic of AMR staffing issues. It's not just in the LA area. On Facebook I saw a post regarding AMR's response times in the city I reside in. Apparently they've gone level 0 365 times between 7/2-9/28. I guess on multiple occasions the Fire department and local PD had to transport pt's because of ETA's from 30 minutes to an hour. I get that everyone is hurting from local govt to private.

Also from my understanding is its ALS across the board up here. ALS fire with ALS AMR and AMR is the sole provider for the area up here.
 

VentMonkey

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And yet none of this is still enough to restructure our approach to public education regarding the proper utilization of clearly depleted resources.

It seems as though CV-19 is less of a pandemic than this is. I guess it’s not as easy of a sell to our fear-mongered society as a virus.
 

DesertMedic66

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And yet none of this is still enough to restructure our approach to public education regarding the proper utilization of clearly depleted resources.

It seems as though CV-19 is less of a pandemic than this is. I guess it’s not as easy of a sell to our fear-mongered society as a virus.
Public education needs to increase, EMD utilization needs to improve, EMS crew initiated refusals need to start, 911 patients should be transported to closest most appropriate and not bypassing 5 other appropriate hospitals for preference, alternative destinations for transport, the list goes on and on.

For my ground job starting in Nov we are now going to be doing TeleDoc conferences for our low level Medicare patients and discharging them on site and also transporting them to alternative destinations if needed. This is going to have us staying on scene longer but might reduce the ED overcrowding a little bit which will help reduce bed delays.
 

FiremanMike

EMS Coordinator
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EMS crew initiated refusals need to start
Ugh, from an administrative standpoint, these a nightmare. We had it in our protocol for about 6 months, it was not a good thing.

Look at some of the patients your people turf now, then make it worse because you're actually empowering them to refuse to transport..
 

Jim37F

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Public education needs to increase, EMD utilization needs to improve, EMS crew initiated refusals need to start, 911 patients should be transported to closest most appropriate and not bypassing 5 other appropriate hospitals for preference, alternative destinations for transport, the list goes on and on.

For my ground job starting in Nov we are now going to be doing TeleDoc conferences for our low level Medicare patients and discharging them on site and also transporting them to alternative destinations if needed. This is going to have us staying on scene longer but might reduce the ED overcrowding a little bit which will help reduce bed delays.

Of course this is LACoFD, where even if the reason all the ambulances are not available is because they're all on 4+ hour bed delay waits at the hospitals, and someone who called to get checked out and is now saying "Ok, well I don't really think I want to go to the hospital anymore" County will literally sit there and argue with the patient until they decide to just go to the hospital, where inevitably the hospital won't allow them to go to the waiting room instead stay on the gurney holding the wall for however many hours, and County will turn around, go to the next call wondering why there's such a long response time....

So yeah, I don't see them embracing refusals and alternate destinations anytime soon
 

E tank

Caution: Paralyzing Agent
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When ambulance companies are offering sign on bonuses at the level hospitals were for RN's not that long ago and counties still want nothing to do with EMS aside from telling them how to do their jobs, there's a fundamental problem. With the exception of the rare excellent payor mix county, most want nothing to do with EMS.

When some well intentioned individuals in the late 60's and early 70's thought that they could graft some genteel and sophisticated hospital medicine onto street level delivered service in the police and fire response models, they had no idea what they were getting themselves into.

The idea that there was no meaningful difference between calling the fire department for a drunk neighbor's winter beater being on fire and your renal failure grandpa in hyperkalemic arrest was delusional at best...on too many levels to articulate here.

The logical progression of such good intentions is evident the state of affairs we now find ourselves in in regions where the inherent flaws can declare themselves outright. That other systems don't manifest the problems identified in this thread doesn't mean they don't exist there. They just haven't reached the stress thresholds necessary to expose them yet.

Pre-hospital ALS does not make money. What money it does generate (via door to door service for cath labs and operating rooms), it sees exactly zero dollars and the not for profit hospitals laugh all the way to the bank. Meanwhile paramedics in the field for less than 5 years already have their sights set on something bigger and better.

The answer? There isn't one, especially for dense metropolitan centers. I do think hospitals should start paying their fair share...better medical oversight (skin in the game) and maybe even hospital based EMS as a rule instead of the exception. They can decide the level of care their employees will provide and when. Not going to happen, though...I know.

Funeral homes used to transport to hospitals and as far as I can tell, a ride in the back of a hearse would be more comfortable than on a hose bed.
 

jgmedic

Fire Truck Driver
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I dont think any of this is a surprise to anyone who's ever been involved with EMS in LA/OC or even most of CA. When these companies brown out units or dont hire because UHU's are too low, then act surprised when they cant respond when volume is higher, what else is going to happen. Not to mention all sucking at the teat of LACoFD, and the least common denominator protocol approach. As said above, until these places take a far different tack to EMS, this will only get worse.
 

Aprz

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I kept thinking this pandemic would make things better, expose the flaws, give better recognition to EMS, but it hasn't. In general, we seem to operate as business as usual, totally acceptable to be understaff, late, and paid poorly.
 

CALEMT

The Other Guy/ Paramaybe?
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totally acceptable to be understaff, late, and paid poorly.

It’s like this across the board and not just exclusive to public service. Imagine that, the government shutting down business and paying people to stay at home and now there’s shortages in the workforce.
 

OG EMT

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Just a few observations about this subject. That day in the area was a notable fluke. I have not seen that same thing happen before or since. But in general the Antelope Valley has always been a difficult place to run an ambulance company. It's a huge area, with a lot of poor people, and 2 to 8 hour waits for beds at the ER. How many ambulance companies bid on that EOA last time? Zero. Only AMR was interested. Nobody in the ambulance business (frontline workers) was paid to stay home. We are in the second year of a world wide pandemic. Only 10% of the usual number of EMTs were graduated last year. So, low staff, large numbers of 911 calls, many ambulances stuck offloading at the hospitals. That's what happened. Its not as much fun as hacking on AMR, but probably a more accurate explanation of that day.
 

jgmedic

Fire Truck Driver
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That’s no excuse for AMRs constant issues, maybe they wouldn’t have staffing issues if they paid their employees a living wage rather than the bare minimum. So it’s a busy poor area? Great, pay people more and staff enough ambulances, let’s not pretend there’s an EMT shortage in southern CA. People don’t work there because they can make more money and not get treated like gurney monkeys elsewhere
 

DrParasite

The fire extinguisher is not just for show
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It's a huge area, with a lot of poor people, and 2 to 8 hour waits for beds at the ER. How many ambulance companies bid on that EOA last time? Zero. Only AMR was interested.
Sounds like a great reason for the town/county to start their own third service EMS agency, funded by taxpayer dollars... I bet you wouldn't need so many fire units, since you had more than enough EMS units to handle the call volume without the FD needing to stop the clock at every single call.
 

GMCmedic

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Sounds like a great reason for the town/county to start their own third service EMS agency, funded by taxpayer dollars... I bet you wouldn't need so many fire units, since you had more than enough EMS units to handle the call volume without the FD needing to stop the clock at every single call.
I've never worked in California EMS but I feel like I read here that it's pretty common for ambulance companies to Pay the county, as well as pay Fire and then bill the patient and try ro recoup money?

If that's the case, why would any county ever get into EMS? Not to mention the fire unions will never allow it.
 

VentMonkey

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I've never worked in California EMS but I feel like I read here that it's pretty common for ambulance companies to Pay the county, as well as pay Fire and then bill the patient and try ro recoup money?

If that's the case, why would any county ever get into EMS? Not to mention the fire unions will never allow it.
We don’t pay for fire here. In fact, I’d imagine our management would balk at this idea. Some of our EOA’s have been grandfathered and cannot be put up for bid at all.

I don’t know if this is specific to all of the AMR divisions in Cali (I doubt it), but def not how it works in my county.
 

DesertMedic66

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I've never worked in California EMS but I feel like I read here that it's pretty common for ambulance companies to Pay the county, as well as pay Fire and then bill the patient and try ro recoup money?

If that's the case, why would any county ever get into EMS? Not to mention the fire unions will never allow it.
It really depends what is written into the contract for the private company. For example my local AMR division has to pay the county fines for every minute they are late to a call. There are very few exemptions that the company gets for it. There is also other monthly and yearly fees the company pays to the county EMS agency. Another part of the contract is that the AMD division buys all of the fire departments medical equipment/supplies since AMR gets a better price on them.
 

johnrsemt

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Fireman Mike: Crews can't initiate refusals? Wow, so when someone calls 911 because they stubbed their toe, the crew can't say no, go to the Urgent Care in the morning. Or "Not going to transport you because the funny feeling you are having is because you smoked pot for the 1st time"?
Wow, half of our refusals would have to be transports at $6,000 each and 5-6 hours round trip.


Glad we don't get in trouble for our en-route to scene times: some of them run up to 2 hours.


I sit and laugh when I read about CA EMS: it is sad that you can't work county to county. When I worked in Indiana, I could work anywhere in Indiana: yes the protocols may be a little different, and I would have to brush up on them, but I didn't have to recertify to work in another county
 

FiremanMike

EMS Coordinator
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Fireman Mike: Crews can't initiate refusals? Wow, so when someone calls 911 because they stubbed their toe, the crew can't say no, go to the Urgent Care in the morning. Or "Not going to transport you because the funny feeling you are having is because you smoked pot for the 1st time"?
Wow, half of our refusals would have to be transports at $6,000 each and 5-6 hours round trip.


Glad we don't get in trouble for our en-route to scene times: some of them run up to 2 hours.


I sit and laugh when I read about CA EMS: it is sad that you can't work county to county. When I worked in Indiana, I could work anywhere in Indiana: yes the protocols may be a little different, and I would have to brush up on them, but I didn't have to recertify to work in another county
Correct - If the person wants us to transport them, we cannot refuse and tell them they need to make other arrangements.

We can obviously help educate them on options and potential outcomes of those options (and thus we obviously don't transport everyone), but if the patient says "no, you need to take me" it's "ok, hop in".
 

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