DC Firefighters whine about name change.

MrBrown

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As far as didactic content necessary to do both fire and EMS, I'd argue that a BSN, RRT, or a PA are responsible for more than that. How about a doctor? If it's supposedly so difficult to command the knowledge for both EMS and firefighting, how could it be possible that anyone could get through medical school?

Because the amount of knowledge required to be a Paramedic in the US is paltry and bare bones compared to the rest of the world.

A thousand hours (or less) of "skills orientated training" by PowerPoint slide, "everybody goes to the hospital" and "contact medical control" does not compare.

This does not ensure a "commanded" of that knowledge.

It's not as difficult to do both fire and EMS, or police and EMS, as you would like to believe.

Then why does no other nation outside the US have "fire based EMS", why does the London Fire Brigade, Metropolitan Fire and Emergency Services (Melbourne, Australia) and the New Zealand Professional Firefighters Union openly state they want no part of the EMS game because it is not in the interest of the profession?

Why is it we require a three year Degree for our Paramedics as well as a Post Graduate qualification in Speciality Practice for Intensive Care Paramedic and do other nations require equivalent education if its so easy to be a Paramedic, or a Paramedic and a Firefighter?
 

46Young

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Because the amount of knowledge required to be a Paramedic in the US is paltry and bare bones compared to the rest of the world.

A thousand hours (or less) of "skills orientated training" by PowerPoint slide, "everybody goes to the hospital" and "contact medical control" does not compare.

This does not ensure a "commanded" of that knowledge.



Then why does no other nation outside the US have "fire based EMS", why does the London Fire Brigade, Metropolitan Fire and Emergency Services (Melbourne, Australia) and the New Zealand Professional Firefighters Union openly state they want no part of the EMS game because it is not in the interest of the profession?

Why is it we require a three year Degree for our Paramedics as well as a Post Graduate qualification in Speciality Practice for Intensive Care Paramedic and do other nations require equivalent education if its so easy to be a Paramedic, or a Paramedic and a Firefighter?

When I say that it's not difficult to do both firefighting and EMS, that refers to the U.S. system.

I'd like to know what the stats from other developed countries, with 3-4+ years of education show in regards to pt outcomes. Is pt morbidity/mortality significantly worse in the states then it is elsewhere? As far as treat and release, or diection to a facility other than an ED, you can consult OLMD, save 2-3 years of education, and get the same result. RN's work for 911 (Richmond VA) and do phone triage and suggest alternatives to EMS txp over the phone. That's with an assasciate's. Basically, I'm trying to understand how much a four year paramedic degree, possibly with post graduate study as the case may be, affects pt outcomes over what we have in the states. With maybe 5-10% of our patients being time sensitive, and transportation decision for STEMI's and CVA's taking up much of that, I'm betting there's not much difference at all. If you want to get into billing skill hours vs mileage, then I can see the benefit of all that education. If you want to talk about community outreach/service, that's another discussion. There's an upper limit as to what we can do in the field. how much definitive care are we realistically working towards as field paramedics?
 

MrBrown

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I'd like to know what the stats from other developed countries, with 3-4+ years of education show in regards to pt outcomes. Is pt morbidity/mortality significantly worse in the states then it is elsewhere? As far as treat and release, or diection to a facility other than an ED, you can consult OLMD, save 2-3 years of education, and get the same result. RN's work for 911 (Richmond VA) and do phone triage and suggest alternatives to EMS txp over the phone. That's with an assasciate's. Basically, I'm trying to understand how much a four year paramedic degree, possibly with post graduate study as the case may be, affects pt outcomes over what we have in the states. With maybe 5-10% of our patients being time sensitive, and transportation decision for STEMI's and CVA's taking up much of that, I'm betting there's not much difference at all. If you want to get into billing skill hours vs mileage, then I can see the benefit of all that education. If you want to talk about community outreach/service, that's another discussion. There's an upper limit as to what we can do in the field. how much definitive care are we realistically working towards as field paramedics?

Look at all the studies saying Paramedics intubating people make outcomes worse; we have a near 100% success rate with intubation, have RSI and so far all our failed intubations have been managed without cricothyrotomy.

We have prehospital thrombolysis and antibiotics, unlimited drug dosages (in line with prudent professional praxis), can leave people at home and no have no "medical control".

We are well paid (compared to the US) and Paramedic is a respected and well developed career field not some skip and hop job that pays $9 an hour to sit at a gas station and get a wrecked back because Jack Stout is a **** head

Why do we have these things? Because we are well educated career Professionals with qualifications equal to that of any other allied health profession who demand respect and are trusted by our Clinical Management Group and others.

How many US Paramedics still give everybody high flow oxygen, everybody gets an IV, if you get an IV you get fluid, here is 2mg of morphine for your shattered leg, if you stand up your heart will stop beating, oh look AMLS told me to treat septic shock with permissive hypotension .....
 
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Sandog

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We are well paid (compared to the US) and Paramedic is a respected and well developed career field not some skip and hop job that pays $9 an hour to sit at a gas station and get a wrecked back because Jack Stout is a **** head

Perhaps that is because NZ population is about half that of NYC. Put things into perspective, the US population is in excess of 300 million all the while much of our tax dollars are spent maintaining international peace. If you think the latter is not true, read a history book. The money train is not running by our EMS station.

I often see that you make jabs at US EMS, well good for you, aren't you special... And for Pete's sake, why do you always speak in the third person. You obviously have a chip on your shoulder when it comes to the US and I get that, I have no problem with that, but must you constantly remind us of it? Keep in mind, many people in all countries are doing the best they can to survive this economically turbulent time with the money at hand.

I think it is great that you are prospering in EMS and I am sure many of us are envious, but things are what they are here in the US, we have little control on changing things as it currently stands, so how about cutting us some slack...
 
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mikeward

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Then why does no other nation outside the US have "fire based EMS", why does the London Fire Brigade, Metropolitan Fire and Emergency Services (Melbourne, Australia) and the New Zealand Professional Firefighters Union openly state they want no part of the EMS game because it is not in the interest of the profession?

Why is it we require a three year Degree for our Paramedics as well as a Post Graduate qualification in Speciality Practice for Intensive Care Paramedic and do other nations require equivalent education if its so easy to be a Paramedic, or a Paramedic and a Firefighter?

Hello Mr. Brown:

1) While the labor leadership of London, Melbourne and New Zealand have opposed assuming additional duties as emergency medicine caregivers, the same economic and workload pressures exist as they do in the United States ... decreasing fire workload + increasing cost of fire brigade staffing.

I have provided information to two non-US metro cities considering fire brigade based ems response, including transport. This is due to increasing response times of transport units from the ambulance agency and political issues. Cannot reveal the clients.

2) I have evaluated the three year paramedic degree used in your part of the world when considering applicants to our graduate program. Not quite apples-to-apples when considering learning outcomes and the areas covered.

The 2013 Scope of Practice model brings US paramedic education closer to your degree program.

Mike Ward
 

usalsfyre

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Mr Ward,

I respect your opinion and once upon a time I was a student in a program you were the interim head of, but, can you realistically state that the cost/benefit analysis shows fire-based EMS response to be the best option? To me no matter what uniform the employees are wearing the FTEs still exist if they are wanting response times (which is a poor way of measuring medical care, but the standard none-the-less) within 8:59. Granted some cost would be saved via reduction of administrative cost, but most metro FD's (at least that I've seen and been involved with) tend to be severely top heavy and I see EMS adding to, not taking away from that if run properly.

I understand the union's desire to protect the employee, but at some point concession will have to be made. Ideally any cuts will be made via attrition, but I for see the days of dual paramedic FD based ambulances and multiple medics on FD apparatus coming to an end, not increasing.
 
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mikeward

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Absolutely wrong. Newark NJ is a pretty big FD, and a pretty big city, and they have absolutely nothing to do with EMS.

Hello Doctor ....

"Absolutely wrong" is a pretty broad brush. Newark Fire is an outlier.

Newark is home to the only hospital-based heavy rescue company:
http://www.uh-ems.org/rescue.html

New Jersey has interesting history with ems regulations, preserving first-aid level ambulances and restricting paramedics to hospital-based systems.
 
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mikeward

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.. but I for see the days of dual paramedic FD based ambulances and multiple medics on FD apparatus coming to an end, not increasing.

So do I.

Putting 3 to 7 paramedics at an incident does not improve patient outcome and is frightfully expensive to maintain. A battalion of underexperienced ALS caregivers.

Getting an AED to a sudden cardiac arrest and continuous closed chest compressions have the biggest impact on cardiac arrest patient outcomes.

By the way, maintaining an 8:59 minute ambulance response 90% of the time is equally ineffective and expensive when we look at patient outcomes.

Thanks for the response.

Mike
 
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MrBrown

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Hello Mr. Brown:

1) While the labor leadership of London, Melbourne and New Zealand have opposed assuming additional duties as emergency medicine caregivers, the same economic and workload pressures exist as they do in the United States ... decreasing fire workload + increasing cost of fire brigade staffing.

Not really, the Fire Service has seen that its job is being the Fire Service and sticking to it, The Fire Service (at least here in NZ) is a well funded and stable organisation that is not prey to the immense political pressure that its US counterparts seem to be.

They have also recognised they are not career medical professionals and to intrude upon the Ambulance Service would be stepping on toes, and in their own words, not in the interest of the Fire Service, Ambulance or the public.

I have provided information to two non-US metro cities considering fire brigade based ems response, including transport. This is due to increasing response times of transport units from the ambulance agency and political issues. Cannot reveal the clients.

The London Fire Brigade (at least anecdotally) considered Fire first response or something along those lines to high priority medical emergencies to "save response time" but the UK is not where Brown would look for an example of effective prehospital call triage, the silly ORCON clock and all.

You will not find non US Fire agencies jumping on the Ambulance bandwagon because outside the US it seems that Ambulance is a stable entity which is well funded and not prey for the Fire Service to engulf in an effort to justify their own existence.

2) I have evaluated the three year paramedic degree used in your part of the world when considering applicants to our graduate program. Not quite apples-to-apples when considering learning outcomes and the areas covered.

The 2013 Scope of Practice model brings US paramedic education closer to your degree program.

A little bit maybe. The Fire Unions are on record as questioning the need for increased hours of education and they successfully lobbied the CoAEMSP to drop the requirement to be affiliated with a University.

Good job Fire Service.

Now, which degree did you evaluate. AUT or WP? You do realise that as our entry level qualification a Graduate is placed through an extensive on road consolidation period (ontop of the 1,200 hours of practicum they had on the degree) with an appropriate scope of practice?

Our ALS qualification is the Post Graduate Certificate in Speciality Care (Advanced Paramedic Practice) and generally takes from outset, five to six years to reach Intensive Care Paramedic level.
 

DrParasite

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Hello Doctor ....

"Absolutely wrong" is a pretty broad brush. Newark Fire is an outlier.

Newark is home to the only hospital-based heavy rescue company:
http://www.uh-ems.org/rescue.html

New Jersey has interesting history with ems regulations, preserving first-aid level ambulances and restricting paramedics to hospital-based systems.
Correct. And if you look at the run numbers found here, http://www.firehouse.com/magazine/run-surveys/2009-national-run-survey-total-calls you will find they run more fire calls (just fire, not EMS) than some of the bigger names (San Antonio Fire Department #9 overall and Clark County Nv #15 overall). So the statement that EVERY big city FD runs a first response program is "absolutely wrong."

And Newark has a Fire Department Rescue, (Newark Fire-Rescue) and Police based Rescue (Newark PD Emergency Services Unit), in additional to University Hospital's EMS Rescue. And Fire Departments still don't do any type of EMS first response.

your comments about the history about NJ and EMS are pretty accurate, but completely off topic.
 

DrParasite

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You will not find non US Fire agencies jumping on the Ambulance bandwagon because outside the US it seems that Ambulance is a stable entity which is well funded and not prey for the Fire Service to engulf in an effort to justify their own existence.
wow, this happens to be the most accurate observation I ever read from Mr Brown.
 

boingo

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Because the amount of knowledge required to be a Paramedic in the US is paltry and bare bones compared to the rest of the world.

A thousand hours (or less) of "skills orientated training" by PowerPoint slide, "everybody goes to the hospital" and "contact medical control" does not compare.

This does not ensure a "commanded" of that knowledge.


Really? 3 years here equal an associates degree, not too far off from degree programs in the states.


Then why does no other nation outside the US have "fire based EMS", why does the London Fire Brigade, Metropolitan Fire and Emergency Services (Melbourne, Australia) and the New Zealand Professional Firefighters Union openly state they want no part of the EMS game because it is not in the interest of the profession?

You ever hear of Denmark?
 

mikeward

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The London Fire Brigade (at least anecdotally) considered Fire first response or something along those lines to high priority medical emergencies to "save response time" but the UK is not where Brown would look for an example of effective prehospital call triage, the silly ORCON clock and all.

You will not find non US Fire agencies jumping on the Ambulance bandwagon because outside the US it seems that Ambulance is a stable entity which is well funded and not prey for the Fire Service to engulf in an effort to justify their own existence.

There are issues with the NHS Trust and responsiveness of some ambulance services. A 2000 court of appeals ruling KENT vs. GRIFFITHS:

A series of cases in the 1990s had held that none of the other emergency services was duty bound to go to the aid of persons in peril, albeit that in 1968 it had been decided that a sick person who managed to present at an open hospital accident and emergency unit thereby effectively created a doctor–patient relationship, and so was entitled to reasonably careful treatment. Then, in 2000, the Court of Appeal, in the case of Kent v . Griffiths, held that an unreasonably delayed response by an ambulance service to an emergency call could be actionable negligence.

Kevin Williams. LITIGATION AGAINST ENGLISH NHS AMBULANCE SERVICES AND THE RULE IN KENT v. GRIFFITHS Med Law Rev (2007) 15 (2): 153-175. doi: 10.1093/medlaw/fwm001 First published online: May 21, 2007

From a 2003 Daily Mail article by Beezy Marsh
Emergency failures highlighted

More than half the country's ambulance services are missing targets for answering the most urgent calls, it was revealed yesterday.

The Government's NHS Plan said 75 per cent of 'immediately life-threatening' cases should be reached within eight minutes and set a deadline of 2001 for trusts to comply.

But official figures for 2001-2 show 18 of the 32 NHS ambulance trusts in England missed the target, although performances did show an improvement.

The slowest response times were in London, where ambulance crews face major problems on traffic-clogged roads. Just 57 per cent of the most urgent calls, classified as Category A, were responded to within eight minutes.

Among rural services - where the problem is travelling long distances along country lanes - West Country Ambulance NHS Trust was the worst performer, achieving just 58 per cent.

East Anglian Ambulance NHS Trust managed nearly 64 per cent, and Hampshire Ambulance NHS Trust nearly 70 per cent. For other emergency calls, classified as Category B and C, 16 trusts met the aim of responding to over 95 per cent within 14 minutes in urban areas or 19 minutes in rural areas.

Demands on the ambulance service-rose over the period, with emergency calls up from 4.4million to 4.7million.

The Health Department admitted last night that it has extended its deadline, giving trusts until the end of this year. Officials said performance was improving, with figures for March showing 28 trusts meeting the eight-minute target.

Read more: http://www.dailymail.co.uk/health/article-122826/Emergency-failures-highlighted.html#ixzz1InMiHImc

It resulted in this 2005 policy document on Transforming NHS Ambulance Services

link goes to a 72 page .pdf document

The change in NHS Ambulance Trust response time in April 2008 is described in this London Ambulance Service link.

How about this:

Welsh ambulance service winter response concern

Welsh Conservatives have spoken out after the ambulance service missed the 65% target for eight-minute emergency response times in November (2010)

http://www.bbc.co.uk/news/uk-wales-12122289

Wales has the UK's slowest ambulance response times to emergency calls, figures obtained by BBC News suggest.

The average response time in Wales last year (2009) was eight minutes and 47 seconds, against a benchmark of eight minutes.

Wales also had the highest proportion of calls which took longer than both eight minutes and 15 minutes to receive a response.

The Welsh Ambulance Service Trust said improvements had been made but more work was needed.

http://www.bbc.co.uk/news/10274201

My sources are indicating some politicians are willing to compel the fire brigade to assume additional duties.

Some politicians are calling for the dismantling of the NHS Ambulance Trust - "Plaid has renewed a pledge to dissolve the Welsh Ambulance Trust and transfer its responsibilities to local health boards (LHBs) - despite saying it would not “fragment” the health service in Wales." 2011 March 29 from Health Services Journal.

Like the US, there are significant labor and compensation issues.

Mike
 
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systemet

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I'd like to know what the stats from other developed countries, with 3-4+ years of education show in regards to pt outcomes. Is pt morbidity/mortality significantly worse in the states then it is elsewhere?

I doubt that you are going to find good numbers on that. Very little in EMS has been subject to rigorous outcome-based research.

Even if you were to see a difference in mortality between the US, and, let's say, the fine land of Lichenstein, it would be difficult to know how much of this difference is due to preventative medicine, demographic factors, or in-hospital care. It's extremely difficult to control for these things.

On the surface at least, the US has a higher infant mortality and lower life expectancy than many other industrialised nations. But it also has a lot of poverty, poorer access to medical care (many uninsured versus almost all other industrialised nations having universal healthcare), lots more penetrating trauma, a much greater overall rate of violent death, and probably a greater amount of illegal immigration than many others. It's hard to reasonably suggest that this difference is due to EMS care. This isn't to bash on the US -- I'm not American, you guys choose to run your country however you want. They're just factors that would be confounders if you tried to do this sort of research.

Basically, I'm trying to understand how much a four year paramedic degree, possibly with post graduate study as the case may be, affects pt outcomes over what we have in the states.

I don't think this research has been done. At least if you're talking about hard outcomes like death, disability, etc.

As Mr Brown pointed out, there are some instances where surrogate outcomes are better in other countries, e.g. intubation success rate -- although I wonder if the numbers reported have actually been published in a peer reviewed journal? But, of course, a greater rate of putting a tube in the trachea might have nothing to do with actual patient survival.

It is possible that further education and training beyond the average in the US has little impact on mortality and morbidity. It may not be cost effective, either. I think at this point, we can only guess.

But I would suggest that professionalising EMS is in the interests of everyone working in it currently. Certainly moving toward a BScN entry to practice for the RNs has done nothing to harm their care, professionalism, income, career advancement or mobility. When you compare what a paramedic is able to do, in terms of monkey skills, to other health care providers, and the responsibility that comes with these skills, we're woefully undereducated.

If you want to talk about community outreach/service, that's another discussion. There's an upper limit as to what we can do in the field. how much definitive care are we realistically working towards as field paramedics?

I agree that there's probably an upper limit, but it's a limit that seems to move slowly upwards as time goes on. In my short time I've seen interventions like RSI become much more prevalent (actually, universal), and widespread use of thombolysis, new agents for sedation/intubation (e.g. ketamine), administration of drugs by non-paramedic providers, etc. It seems like each year we're asking paramedics (and EMTs) to do more and more complicated medicine, with the support of only a very brief training program. We risk becoming technicians, if we don't push for more education.

We have a tendency to see the benefit of EMS in terms of cardiac arrest outcomes, response times, trauma scene times and transport times, etc. In terms of that 5% of critical calls that you mention. But perhaps over the next decade or two, the area where EMS is going to expand is into diverting people away from the hospital, referring them to other agencies (home care, family physician, etc.), and treating and releasing on scene (I realise that you mention community outreach and education in your post). This is going to require a keen sense of professionalism and greater education.
 
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MrBrown

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There are issues with the NHS Trust and responsiveness of some ambulance services. A 2000 court of appeals ruling KENT vs. GRIFFITHS:



From a 2003 Daily Mail article by Beezy Marsh


It resulted in this 2005 policy document on Transforming NHS Ambulance Services

link goes to a 72 page .pdf document

The change in NHS Ambulance Trust response time in April 2008 is described in this London Ambulance Service link.

How about this:





My sources are indicating some politicians are willing to compel the fire brigade to assume additional duties.

Some politicians are calling for the dismantling of the NHS Ambulance Trust - "Plaid has renewed a pledge to dissolve the Welsh Ambulance Trust and transfer its responsibilities to local health boards (LHBs) - despite saying it would not “fragment” the health service in Wales." 2011 March 29 from Health Services Journal.

Like the US, there are significant labor and compensation issues.

Mike

Brown did not bother to actually read 99% of this

Why? Because if the target is faulty when why cry when you do not meet it?

ORCON is a joke

Tom Reynolds, Mark Glencourse. Dr Malcolm Wollard and others complain about it because its a stupid system and no wonder its never met. Millions and millions and millions of pounds has been spent in pursuit of this eight minute target and it has even resulted in a down skilling of ambulance staff (ECSW/ECA role introduction)

Therefore its moot point mate, if Brown shoots himself in the food and complains about it hurting, well more fool Brown for shooting himself in the foot!
 

usalsfyre

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Systemet is right, outcome based studies on education are likely never going to exist. I would argue that considering the results of OPALS (the closest thing we have) calling for them is, in a word, stupid.

Where education helps is the knowledge and trust to be able to direct people away from the ED to appropriate resources. Which saves money. If your saving the system money, you can request higher reimbursement (think higher pay). Right now EMS has a very low value, as all we do is cost a significant amount to transport to the most expensive area of medicine outside the OR.
 

mikeward

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Brown did not bother to actually read 99% of this

Then there is no point having a discussion with you.

It is not important if YOU agree with the NHS measurements, as it is clear that your ability to influence health policy stops at the door of your ambulance.

My point was to show the progression of the issues that would lead to (a) the dismantling of the ambulance trust model in the UK and (b) the foundation of an increased role of the fire brigade in EMS first response and (gasp!) transport.

The decision makers will dismantle a system that does not meet their requirements, even if it a clinically excellent, Brown-approved, ambulance service.

Mike
counting down the federal shutdown in the shadow of the Capital
 
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Veneficus

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Then there is no point having a discussion with you.

Funny that, I say the same thing about profire based EMS advocates who are so used to spouting their party line that reason escapes them.

It is not important if YOU agree with the NHS measurements, as it is clear that your ability to influence health policy stops at the door of your ambulance..

Brown is doing better than me, I have no ability to influence health policy. I can tell people what is best for their health, from individuals to the masses, but I have absolutely no ability to get them to comply with it.

My point was to show the progression of the issues that would lead to (a) the dismantling of the ambulance trust model in the UK and (b) the foundation of an increased role of the fire brigade in EMS first response and (gasp!) transport.

Dismantling of the ambulance trust model? Somehow I doubt it. In America it is easy to set absolutely pointless targets and get people to fall for it hook line and sinker. But in a system where there are still physicians that have influence, the medical benefits, especially given the European culture's respect for physicians, will likely always be able to add reason to the political argument.

As for B ), the US has more than demonstrated the economic waste of a minimally trained responder transporting every patient to the ED. Given the need to reduce climbing costs in NHS, as well as keeping the spending of the fire brigades low, I do not see politicians actually advocating for a system that the US clearly demonstrates is not sustainable economically, nor able to meet its own self determined targets of importance.

Even if a politician gets on TV and plays to the desires of the simple masses, as is constantly shown, it is behind closed doors where the real play happens.

The decision makers will dismantle a system that does not meet their requirements, even if it a clinically excellent, Brown-approved, ambulance service.

Again, there are simply too many variables in play. Their requirements and public perception are probably very different. As well, so long as physicians are actively interested and involved in the policy making, clinical relevence will always be a significant part.

We all know what happens when an ambulance arrives in 8:59, 90% of the time in life threatening emergencies. The patient is either dead, irreversibly dying, or could wait a few more minutes anyway.

We also are all very aware that as the demand for service rises, the ability to field enough units in a transport system whose primary benchmark is response time, is not realistic or cost effective.

We are also very aware of the costs involved once everyone with the most minimal complaints hits the door of the ED.

Also in NHS, there are certain rules that make minimally trained and incapable providers dumping on EDs completely impractical. Particularly the time limits on patient disposition.
 

medicsb

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Every Ambulance, Engine, Truck, Rescue Squad, Reserve apparatus, Chiefs car, supervisor vehicle, repair truck, etc, etc, etc now has to be taken in from the road, changeover needs to occur OR a company needs to be placed out of service so a freaking sticker can be placed on. Now factor in fuel costs, wear and tear on the vehicle, buying the stickers/decals, the cost in manpower which SHOULD be doing something else more productive. Easily tallies in the 100k mark.
And cry me a friggin river about, "private EMS this, that, and everything else." Private EMS is a SCAB, and should be relegated to interfacility transports ONLY! I was a hospital based paramedic in South Jersey , running my tail off, working bad hours because management could make me do it. I worked nights where in 12hrs, we had 30+ dispatches for service, and was there until 1030am completing my charts. I CHOSE to move, become a Fire Based Paramedic (but not a FireMedic for this dept), take a 50% pay cut, and become union protected.

Best of luck to DCFD.

Hmmm, I think I know where you worked and which medic unit you are talking about though I could be wrong. I worked in South Jersey and we had one truck that ran like said (though 30 would be an exaggeration). If you responded to 20 in a shift (which might be more characteristic of a day shift), you treated 4-6 on average and split that with your partner. Sure, on some days you treated more. In my experience, it was uncommon that night shift stayed later than 8 for charting, but pretty common for those on day shift, sure. Also, the equipment there was pretty good. It got beat-up, but that happens when the medic units run 3000-9000 calls in per year. I don't recall there being shady billing practices. After-all they don't bill for refusals (even diabetics that get treated) or for pronouncements (even if you worked them first). I'm sure we would agree on many things being wrong with NJ EMS and many problems with the hospital system in particular that I'm pretty sure you are talking about (the one over the bridge from Philly).

Anyhow, as far as union protection... The past year has shown that many workers are getting the axe despite "union protection". Though I believe in unions, the MICUs in NJ have not cut staffing anywhere. At most, I remember a few had hiring freezes for a period of time. The fire services and municipal EMS services in many places were cut or nearly cut.

Anyhow, I don't really blame you for choosing to move and get a union job at a place that is slower and that has more progressive protocols. But, your blanket statements about fire-based EMS being superior rings hollow when one considers all the different systems and the ones that have been shown to be successful. Also, if you just wanted to be a public worker protected by a union, why not just jump the bridge to Philadelphia and join PFD?

As far as DCFD vs. DCFEMS. I think a department should generally represent what it does in its name. The majority of large city fire departments primarily do EMS yet they do not include it in their name (I don't think "rescue" counts). They should change their names in my opinion. I'm glad DCFD did. They did the right thing. If they don't want to acknowledge that EMS is their primary job, then they should get out of the EMS business.
 

DrParasite

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Hmmm, I think I know where you worked and which medic unit you are talking about though I could be wrong. I worked in South Jersey and we had one truck that ran like said (though 30 would be an exaggeration).
think AC not Virtua.
Anyhow, as far as union protection... The past year has shown that many workers are getting the axe despite "union protection". Though I believe in unions, the MICUs in NJ have not cut staffing anywhere. At most, I remember a few had hiring freezes for a period of time. The fire services and municipal EMS services in many places were cut or nearly cut.
that's Fire service and municipal EMS are tax funded, and expensive, while everything else in EMS is outsourced. The call volume hasn't gone down, so it's pretty hard to lay people off in EMS, especially when you have a rising call volume. The need is still there, and if you lay off full timers, all that will happens is overtime costs skyrocket.

Also, if you just wanted to be a public worker protected by a union, why not just jump the bridge to Philadelphia and join PFD?
hahahahah! I'd rather jump off the bridge than work for PFD as a paramedic. PFD is arguably the of the worst EMS systems in the nation, grossly understaffed and overworked. Why do you think the PD transports so many shooting victims instead of waiting for the ambulance? EMS in NJ has it's issues, but it is leaps and bounds ahead of Philly EMS.
As far as DCFD vs. DCFEMS. I think a department should generally represent what it does in its name. The majority of large city fire departments primarily do EMS yet they do not include it in their name (I don't think "rescue" counts). They should change their names in my opinion. I'm glad DCFD did. They did the right thing. If they don't want to acknowledge that EMS is their primary job, then they should get out of the EMS business.
ehhhh, in the grand scheme of things, I think there are bigger battles to fight, but I think that most large city fire departments are actually EMS departments that fight fires, instead of Fire departments that do EMS, and their names should reflect accordingly....

of course, they could always separate the EMS department, fund it properly from taxes, and reduce the wear and tear on all the fire department vehicles, and you can send an ambulance to a medical emergency instead of a non-transporting fire vehicle. but that's neither here nor there.
 
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