Just wondering which states besides NJ (if any) only have hospital-based ALS. I've found it to be a bit cumbersome having this restriction as it seems to reduce the availability of ALS and increase on scene times. Anyone have experience in NJ and another state as far as how this works/doesn't work?
Any states besides NJ that only have hospital-based ALS?
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Increase on scene times?
I personally like the systems and think its financially a good idea. Each county has its medic units, some more or less based on call volume. To pay a medic to be on every truck would be rediculous in my opinion because a lot of our patients can go by BLS.
As for the increase for on scene times, I hope there is none. In both areas that I work, it is general practice that we do not wait around for the medic. If it is an ALS call why wait for medics to get on scene and delay the definitive care of a hospital. Worst case scenario is you never rendevous, however most cases you can make that happen.
I personally like the systems and think its financially a good idea. Each county has its medic units, some more or less based on call volume. To pay a medic to be on every truck would be rediculous in my opinion because a lot of our patients can go by BLS.
As for the increase for on scene times, I hope there is none. In both areas that I work, it is general practice that we do not wait around for the medic. If it is an ALS call why wait for medics to get on scene and delay the definitive care of a hospital. Worst case scenario is you never rendevous, however most cases you can make that happen.
medic417
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No other state is so messed up to restrict Paramedics so much that I am aware of. Even as bad as Cali is it seems better than NJ. Sorry.
Hospital Based EMS and specifically ALS intercept is a fairly common model of care. NJ is unique in its requirement that all ALS be hospital based, and I have a sense you have a beef with one particular system, but overall, its an effective system design.
I'm happy to name several systems in my area which execute it well if you're interested.
The effectiveness comes from the thought that EMS is really more healthcare or public health than an arm of emergency services. Hospitals are well positioned to provide high efficiency, high quality medical care with quality assurance as a priority, medical equipment and supplies at higher quality and lower cost, and unit utilization during downtime as ED techs, etc.
I'm happy to name several systems in my area which execute it well if you're interested.
The effectiveness comes from the thought that EMS is really more healthcare or public health than an arm of emergency services. Hospitals are well positioned to provide high efficiency, high quality medical care with quality assurance as a priority, medical equipment and supplies at higher quality and lower cost, and unit utilization during downtime as ED techs, etc.
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medic417
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There is a big difference in hospital based and the system used by NJ. I to can name many quality hospital based services.
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I would have to disagree. The ALS hospital system in NJ is strictly hospital based. It might be different than others but still hospital based. What is it that you do like about the hospital based system for ALS that NJ provides?
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The questions was directed at medic417 but your input is also welcome. I was asking, what is it that is so wrong with the NJ ALS hospital based system?
medic417
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Simple it limits a proper assessment and timely proper management of patients that could benefit from Paramedic level care. I hate the statement well bls can take the patients for care. A Paramedic could help treat pain, help reverse diabetic emergency, etc. Yes those patients will live being transported by bls but their care could have been so much better and in many cases the issue fixed had a Paramedic been there. In all honesty the way NJ does it they might as well not have Paramedics.
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So you believe every EMS call requires ALS for proper assessment and treatment?
medic417
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In a perfect world a doctor would be on every call, in a near perfect world a Paramedic would be. Why? So when there is something needed it can be done.
When the caller does not need a Paramedic or a Doctor they should be refused transport. Being a taxi is not the purpose of EMS yet that is pretty much all NJ allows EMS to be.
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So you agree that a paramedic is also not the model, there should be doctors only? Why should we refuse transport if its an ALS call? Isn't BLS care better than no care? There might be little we can do in BLS but there is some.
I would bet that the average NJ medic can run circles around most medics in this country and they can do it while jumping through the silly hoops NJ has in place (e.g. calling for certain orders). The average NJ medic likely sees more actual sick patients in a year than you do in 4 - ALS in NJ is only dispatched to ALS calls and medic units average nearly 4000 calls a year, statewide. I feel pretty confident, after having worked in NJ (and in PA, which is about the opposite of NJ), that the problems with EMS are not because of how ALS services are regulated. If anything, the tiered system is a huge plus (NJ probably has the lowest per-capita medic population in the US, which is a good thing in my book). I'd probably prefer that county-based, tax-payer funded ALS systems be allowed, but I'd go with hospital-based over private for-profit, FD, or PD based ALS.
One thing I've noticed on this board is that people seems to judge a services quality by what medics are allowed to do in terms of procedures and drugs and whether or not they have to, god forbid, call someone first. This is all a little bit on the side of comparing penis sizes. None of those are necessarily quality markers and could easily indicate that the services are dangerous to patients (this I'd be more likely to suspect based on available research).
For fun...
When I worked NJ, EVERY medic unit in the state was 12 lead capable and all could transmit them. Every medic unit had IV pumps. Every one had CPAP, supraglottic airways, and capnography.
The majority of MICU projects have RSI. My drug bag contained valium, ativan, versed, etomidate, ketamine, vecuronium, succs, metoprolol, labetalol, thiamine, flumazenil, fentanyl, morphine, solu-medrol, narcan, NTG, ASA, atropine, lasix, epi, D50 & D10, CaCl, dopamine, cardizem, verapamil, benadryl, lidocaine, amiodarone, MgSO4, albuterol, ipratropium, terbutaline, glucagon, adenosine, Ringers, NSS, mark-1 kits, and cyanide poisoning kits. (For sure, many of these drugs were very rarely used and some have finally been removed.)
There are some MICU projects that carry insulin for hyperK and some that carry heparin for STEMIs (which I think is actually stupid, but I'm sure some of you would stroke yourselves over being allowed to do that).
I could access port-a-caths, picc lines, and AV fistulas. We could cric and decompress chests. We had ETTs and actually used them regularly with success better than 90% (usually around 95%).
We had the tools to do what we needed to do, but, sure, we had to call for some of those things. (I'm not convinced, with the present education standards for paramedics, that they should be allowed to operate with complete autonomy, anyways.)
Bonuses: We had tough-books for documentation. My uniform was completely paid for - shirts, pants, jackets (winter and raincoats) and boots (good ones, too).
Anyhow, I know first hand that there are many problems with EMS in NJ and I would say ALS is pretty low on the problem list (though, it does need to be improved). Also, there has been a concerted effort to improve EMS in NJ and the biggest opposition to this has been the volunteers ambulance squads - that is the goofiest thing about NJ EMS.
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DrParasite
The fire extinguisher is not just for show
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please show medical research that too many ALS providers is better than too few. or any study that shows that a medic on every street corner has resulted in better patient outcomes that a medic that only treats acutely sick patients.
you made the claim, lets see you back it up. Personally, i think you are just talking out of your a$$, but if you can show me I'm wrong, and show me the scientific evidence supporting it, I will gladly admit you are correct.
medic417
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It doesn't take science to back up what I stated, common sense takes care of it. I did not state that more is better for taking care of acute level patients. You can not deny that having a Paramedic relieve the pain or correct low sugar or other similar actually helps patients more immediately that just transporting (unless your head is far up the place you claim I made my statement from). Sadly studies only focus on immediate life threats, but if I am the patient in severe pain I know myself and anyone with common sense would want that treated before you start moving me and telling me I'll have to wait for a doctor to see me to get relief.
No, that is not all NJ allows EMS to be, but yes the "taxi" aspect is no more prevalent there as anywhere else in the US.
(You're talking much from your hiney-hole in this thread.)
NomadicMedic
I know a guy who knows a guy.
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Attention all: know the the CLs have taken an interest in this thread.
Please stay civil and on topic.
Please stay civil and on topic.
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Play nice
medic417
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Wow you're friends with parasite?
At least many of the 911 taxis in other parts of the USA have capabilities to provide help to patients.
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As medicsb stated, NJ does have one of the lowest paramedic per capita rates it is also the most populated state per square mile. Not every call requires a medic and not every call requires an EMT either. Some people call 911 fore the ride, and you know it happens.
It almost seems as if you think ALS is not present at all. We do have ALS on calls that have life threats such as the ones you listed. Again BLS does have ability to assist some of those life threats if ALS is not available. As for low BGL, oral glucose is carried.
What I like most about the model NJ has is that just because a call starts as ALS does not mean it ends the same. The NJ model allows us to recall medics if they are not needed and allows medics to triage back to BLS if the patient is not ALS. If you work in a system with 1emt/1medic or medic/medic that medic will be on every truck regardless of call type. Financially not sound.
It almost seems as if you think ALS is not present at all. We do have ALS on calls that have life threats such as the ones you listed. Again BLS does have ability to assist some of those life threats if ALS is not available. As for low BGL, oral glucose is carried.
What I like most about the model NJ has is that just because a call starts as ALS does not mean it ends the same. The NJ model allows us to recall medics if they are not needed and allows medics to triage back to BLS if the patient is not ALS. If you work in a system with 1emt/1medic or medic/medic that medic will be on every truck regardless of call type. Financially not sound.