Are some geographic regions more screwed up than others????

[Flight-LP]

O.K. so I am going to be out of the loop for a week or two traveling. I thought that I would leave you with a typical Flight-LP debatable question.........................

Is EMS more screwed up in some geographic regions than in others? Specifically, in the Northeast U.S.?

I find that most posts that make us scratch our heads and wonder WTF come form EMT's in the N.E., with the two most common being New York and New Jersey. Now we all are painfully aware of some of the more interesting issues that the State of New Jersey faces when it comes to EMS, but when I read threads that include issues such as non medical personnel treating patients and "which LED light should I put in my vehicle next", or the best yet, "despite knowing it was wrong, I did it anyways". It really has me questioning any remote level of professionalism. Then I read about having to scrounge up an ambulance crew, and a BLS one at that, just to make a 911 call, because there isn't enough volunteers available. I am just really shocked at the service that some call "their EMS" system. I've heard the arguements, financial, "we can't bill or tax", "I can't afford to leave my day job to go on to medic school", etc. I just don't get it.

Texas has some of the most rural areas found in this country. Yet for some reason, most staff a fulltime EMS service and the majority of them are ALS services. So I still stand behind the logic and reasoning that yes it can be done, if you and your community truly want it..........................

So without turning this into a bashing thread, which I know will occur, probably within the next 24 hours, tell me what you think. Do you also see differences in the various areas of the US? Nor'Easterners, what are your thoughts? Can you provide some insight? Is this a tradition thing that stems back to the antiquinated belief that fire should run all. Speak your mind, and I'll chat with y'all in a week or two.....................

Try to keep it civil!

Flight

p.s. Sorry CL's, but it was time for someone to bring this up. Besides, I haven't been very active lately, this makes up for lost time!!

 

[mycrofft]

Oh, HAY-UHL Yes!!!

I'm not NE USA (stayed overnight in Maine going to UK one annual training) but I worked eastern central Nebraska and central California. I refer in the title both to the clientel, the the service, and the EMS structure. EMS is all about culture and accountability, and clientel is all about sociopathy, education,mental health, income and chemicals.
Then, again, so is EMS....

 

[mikeylikesit]

i think you're right Flight. because half of the call that i get, most people wouldn't and vice versa. i don't know how many other people have been toned out to a man...stuck in an animal. just as i don't witness too many shootings.

 

[Hastings]

Well, I don't know how northeast you're speaking, but I'm very proud of the EMS system throughout the state of Michigan. Lansing's program is positively known throughout the country, and every area I've been to has had very professional, intelligent, and skilled paramedics and a solid system through all kinds of different types of calls. Up here, we really do have the best services possible, with several very professional agencies that work well with fire, and the highest standards for all employees, regardless of level.

So all in all, I haven't seen every part of the state, of course, but I am VERY proud of what I have seen in this state.

 

[Ridryder911]

I agree AK. A horrible situation especially in the N.E. portion. Services still refusing to advanced first aid level, all in the name of tradition. Who could acclaim that their state EMS is great, when you still have first aid squads? What is more sad is EMS is NOT a new profession anymore. It has been active with Paramedics for several decades now.. so the excuses are drying up.....Especially when examines the money spent on accessories and funding of equipment, etc..

Sorry folks, AK is right. even in my state there is very few vollie EMS in comparison to Fire Services. Yeah, even in the boon-docks we have services with 2 Paramedics on a truck. Tough to stay open... you bet, but their there.

Whenever and if ever people in this so called profession stopped worrying about tradition and their self serving egos... then and only then we will see a change...

R/r 911

 

[MAC4NH]

OK, I live and work in NJ. The best way I can sum it up is to reference the comedian Gallagher. In one of his acts he pointed out that that Americans who were not happy with things tended to move west while those that were content with the status quo stayed in the east (it was very funny when he said it). This is what we live with out here. Our system is this way because it has always been this way. Any proposed changes have to go up against almost 400 years of inertia. Therefore change happens very slowly and painfully.

The first fire departments in the USA started as volunteer fire brigades in the northeast. When emergency medical transport became an actual organized activity (it began in 1860s during the civil war but it took off after WWI) it was generally modeled on the existing fire companies (generally paid in the cities and volly in the burbs). The volunteer EMS system worked very well for almost 50 years. Most of the squads were very tightly run. The members had to train regularly and were held to a high standard.

The problems started in the late 70's when the changing economic situation forced many females into the work force because their families needed a second income. These women were the backbone of most volunteer first aid squads at the time and they answered most of the daytime calls. Added to that, we had the "me" decade and the "me" generation and people became less concerned about helping their neighbors. The shortage of volunteers forced many squads to cut back training schedules and relax certain rules and regulations to make it easier for people to join. This eventually resulted in squads that were less efficient, less professional looking, less professional acting and members that were more interested in how much candlepower they could stuff into their POV than in how to properly secure a patient to a long board.(BTW, there are still a few old-school squads that don't put up with any nonsense. Their EMTs are first-rate)

Many people agree the system needs to change but we could (and probably will) spend the next ten years arguing over how to do it. There are many entrenched interests here each with their own agenda. This means that any change is, by necessity, incremental. I know that this is a difficult concept for people not from this area to grasp but it is our reality.

The EMS system in NJ today is changing by default. Many squads can't field a dependable supply of 24/7 manpower, forcing the municipalities to either bring in an outside vendor or to organize a paid service. This is expected to continue and each year we have been seeing a few volunteer squads drop out of the picture. So the short story is that we will be going to a fully paid system eventually.

Our system of primarily BLS units with intercepting hospital-based ALS units is probably not going away anytime soon, at least in northern NJ for the simple reason that it (mostly) works for us. We have a relatively small and densely populated state and the nearest hospital is not that far away. If the hospitals were to field a few additional ALS units it would work much better.

BTW, don't expect volunteer fire departments to go away in our burbs anytime soon. Most of these departments have no problem with membership and they can get an adequate response at any time of day. The other reality is that these departments are very powerful politically, especially in the smaller towns. Nothing that threatens them in any way survives past election day. Also, don't expect too many of these departments to take up the EMS slack. The majority of the volunteer ff's I have met have less than 0% interest in anything medical. The whole concept of a ff/emt is totally alien to them. (Why? Because it has always been that way! - see above) By the time this attitude changes, the volly EMS system will have already been dead and buried.

While it's easy for you guys from out west to bash us, just understand that there are reasons why our system is the way it is and why its not going to change overnight.

 

[Ridryder911]

The problem of it is, this has nothing to do with regard of patient care, rather ego's and self centeredness. Seriously, can one imagine still performing leech therapy because.."hey, it always worked for us".. attitude?

Part of the problem is the general attitude of the North East. No, not all but even those from there will agree the attitude is much different from other parts of the U.S.. More shameful, many are proud of the ."Don't tell me!.." type of thinking, even when confronted with facts. Now, that is bad enough, but worse not all those affected are from that area.

So yes, MAC4NH I do understand your frustration; but no; I will never understand the attitude of refusing to change... especially if it meant to save lives...

R/r 911

 

[Hastings]

Well, thankfully I don't encounter that type of attitude here. Everyone is always adapting to new procedures and methods and is always eager to learn a new way of doing things. That's the reason why a lot of them joined EMS; it's a constant learning experience and it's always changing. I find it exciting, and so do most of the people (in private services) that I've met around here.

 

[firecoins]

Please cite specific examples with the facts. We will discuss it. Please drop the whole or most of the Northeast has an attitude problem type deal.

 

[Ridryder911]

Well, thankfully I don't encounter that type of attitude here. Everyone is always adapting to new procedures and methods and is always eager to learn a new way of doing things. That's the reason why a lot of them joined EMS; it's a constant learning experience and it's always changing. I find it exciting, and so do most of the people (in private services) that I've met around here.

It is hard to classify all and would never attempt to do so, however; as AK described this is not a new thing. Alike many areas that started the ball rolling, they dropped it mid-court. Things and ideas progressed while they did not. Now, unfortunately many in the "power to be" section refuse to change or even worse acknowledge the need to change.

One has to be very careful in this business of complacency and becoming stagnant. Sure, everyone loves to become comfortable and adjusted but that is not a good thing in EMS. Hopefully, things will turn around with increasing volume of calls, the required level of education, etc that will be mandate changing.

We will find out...

R/r 911

 

[MSDeltaFlt]

I think I'm going to have to call Bravo Sierra on this one. I'm not sure it's a regional thing. True. There maybe some individuals who are %$#@-ed up more than a lefthanded football bat, and prove it everyday. We've all seen them. Those who have pulled stunts that may be so unconsciounable that their peers, supervisors, managers, and even med control can only stand there speechless with their eyes wide open and mouths agape thinking "WTF?!?!?"

But these people are everywhere. Unfortunately they are the ones who have fallen through the cracks and still ended up getting the patch. Some will listen to their peers, supervisors, managers, med control, and learn... over time. Unfortunately some will not. It is the nature of the beast, and one of the reasons why EMS has the problem it has with professionalism today.

 

[akflightmedic]

I agree AK. A horrible situation especially in the N.E. portion. Services still refusing to advanced first aid level, all in the name of tradition. Who could acclaim that their state EMS is great, when you still have first aid squads? What is more sad is EMS is NOT a new profession anymore. It has been active with Paramedics for several decades now.. so the excuses are drying up.....Especially when examines the money spent on accessories and funding of equipment, etc..

Sorry folks, AK is right. even in my state there is very few vollie EMS in comparison to Fire Services. Yeah, even in the boon-docks we have services with 2 Paramedics on a truck. Tough to stay open... you bet, but their there.

Whenever and if ever people in this so called profession stopped worrying about tradition and their self serving egos... then and only then we will see a change...

R/r 911

For the record, AK has not posted in this thread until now.

But thanks for thinking of me Rid...

 

[Ridryder911]

For the record, AK has not posted in this thread until now.

But thanks for thinking of me Rid...

Doh!.. Sorry to you & FLight...

R/r 911

 

[firecoins]

New York has a "reputation" of being rude. If you think this is true well chick you :glare:

 

[firecoins]

So without turning this into a bashing thread, which I know will occur, probably within the next 24 hours, tell me what you think. Do you also see differences in the various areas of the US?

Flight

Its hard to answer your questions becuase there are differences on different sides of the street much less geographical areas.

 

[BossyCow]

Yeah, even in the boon-docks we have services with 2 Paramedics on a truck. Tough to stay open... you bet, but their there.

Whenever and if ever people in this so called profession stopped worrying about tradition and their self serving egos... then and only then we will see a change...

R/r 911

Rid, please be aware that its not always ego and tradition that determines level of care. Please tell me how a medic who runs less than 200 calls a year is going to maintain their skills. Now tell me how a population of less than a thousand with property values far below the national average assesses enough of a tax to afford ALS 24/7. Around here, to be an ALS agency, you have to staff the rig 24/7. So that's at least 2 medics, probably three to allow for sick time and vacation.

There are also state regulations to be met regarding who can charge for what services and how much. As a junior taxing district, our state has consistantly tied our hands regarding our assessment so that it is currently operating at less than half of what it was only 5 short years ago.

We arranged for an adjoining district to provide ALS and we pay for each call to the tune of about $600-$800 a call. After several years of that bleeding out the cash reserves, we were finally able to implement a third party payer program that allows us to bill insurance. But if the pt we see doesn't have insurance, we are S.O.L. and forbidden to charge for services.

Last month the ALS support we have been utilizing through a private company has decreased its response area, effectively cutting us out of the loop. This is not a tradition or ego related. This is fiscal management at almost $5 a gallon for gas on a 60 mile trip.

I believe that if an agency is sub-par its because its management is willing to settle for sub-par skills. If EMTs are under-trained its because the agencies they work for are willing to pencil whip training instead of actually teaching. Its up to the management of an agency to determine the level of skill and professionalism. If the manager of an agency, as told in another thread is willing to drive around with her dog in the car, I don't have a lot of hope for the level of professionalism set for the employees.

 

[Jon]

I think Flight's got a point. I live and work outside of Philly... where the Volunteer Fire Service got its start (thanks Ben!). Around here, we have lots of places where there is "50 years of tradition, unhampered by progress". There are plenty of Chiefs with kingdom complexes... and the individual municipalities are allowed to create their own response cards for the most part... so there are instances where the next comapny over isn't 2nd or 3rd due... ever - because someone doesn't like someone. This happens on the fire side and the EMS side... and I see it in the county I live and the county I work.

I don't think it is JUST a northeast issue - but I think that in my area, we are seeing the volunteer system fail because of expanding suburbs. I personally feel that white-collar workers don't seem to care as much about protecting their neighbors then the good-ol-boy Red, White and Blue Americans (Red-neck, Blue Collar!). I've got no facts to back this up... but I don't see a lot of bankers and lawyers driving the local fire trucks - it is the tow truck guys, the road crew guys, and the landscaping guys... the ones who aren't afraid to go out, get dirty, and work. (I've seen some white collar guys too... but at my old vollie squad and others in the area, it seemed like an unfair division compared to the local population).

Anyway - I think that in the suburban Northeast - we are seeing a decline in "good quaility" volunteers coupled with an increased call volume because of urban sprawl. Some places are willing to admit they have staffing problems and get outside help... while others are OK with letting their ambulance or fire trucks miss calls because no one shows up when the pager goes off.

Jon

 

[BossyCow]

I don't think it is JUST a northeast issue - but I think that in my area, we are seeing the volunteer system fail because of expanding suburbs. I personally feel that white-collar workers don't seem to care as much about protecting their neighbors then the good-ol-boy Red, White and Blue Americans (Red-neck, Blue Collar!). I've got no facts to back this up... but I don't see a lot of bankers and lawyers driving the local fire trucks - it is the tow truck guys, the road crew guys, and the landscaping guys... the ones who aren't afraid to go out, get dirty, and work. (I've seen some white collar guys too... but at my old vollie squad and others in the area, it seemed like an unfair division compared to the local population).

Jon

My vollie SAR group has 2 engineers, a psychologist, 2 career ff/paramedics, and a scientist.

 

[Medic Morgan]

Different styles

Im new to this, i just got my license like 2 weeks ago, have an interview for an ambulance company tomorrow.


Anyways... i heard a story about a guy who moved out to orange county, CA from New York as a firefighter, where firefighters fight fire. In orange county, firefighters respond to everything, on his first shift they had like 10 or 15 medical calls(more or less average), and was freaking out cause he thought it was a terrorist attack or something was seriously wrong.

i just that it was kinda funny how different it can be from one area of the country to others.

 

[JPINFV]

Q. Which part of the nation doesn't expect their paramedics to interpet 12 lead ECGs for STEMIs?

A. Orange and LA Counties in California!