Detroit EMS

[eynonqrs]

It's all about Mutual Aid

I can't understand if this has been going on for so long, that they can not sign a mutual aid agreement with neighboring towns. I am sure in the larger cities there has to be plenty of private services. Where I work at we provide services for the city of Scranton, as well as another service. We get dispatched by the county. If none of our units are available and the other service is not as well, they dispatch other services from outside the city to come in. It's not rocket science. Is the service that greedy for money that they will put pt care aside ? Maybe, maybe not. What it boils down to is a lot of factors, such as staffing, turn around times from hospitals, etc.. If the service is strapped and can't provide enough units, they should raise the white flag and say they need help.

 

[Tincanfireman]

Can DFD EMS get a Do-over?

Uh-oh, they talked to the press...

http://www.myfoxdetroit.com/dpp/news/local/detroit-ems-workers-in-trouble-after-appearing-on-fox-2

 

[46Young]

I can't understand if this has been going on for so long, that they can not sign a mutual aid agreement with neighboring towns. I am sure in the larger cities there has to be plenty of private services. Where I work at we provide services for the city of Scranton, as well as another service. We get dispatched by the county. If none of our units are available and the other service is not as well, they dispatch other services from outside the city to come in. It's not rocket science. Is the service that greedy for money that they will put pt care aside ? Maybe, maybe not. What it boils down to is a lot of factors, such as staffing, turn around times from hospitals, etc.. If the service is strapped and can't provide enough units, they should raise the white flag and say they need help.

The issue with having multiple providers in the same area is that each dept/agency may have different hiring standards, equipment, proficiency standards for their employees, meds, or even protocols. For example, in NYC, we had CPAP back in 2005 (maybe early 2006, can't remember exactly). May other providers didn't. We carried ativan; others had versed. FDNY does a complete background investigation, medical, psych, a PAT, etc. Another dept may only want a pulse and a patch, a passing score on an entrance exam, some bloodwork and a neg PPD, and no felonies. FDNY puts their recruits through an academy. Other places just do an orientation and maybe a one month field internship, but typically just throw you out there; that's why these hospitals generally require 911 experience to apply. NYC's protocols are mother-may-I, and any deviation requires telemetry contact, and a detailed presentation. I believe this is due to the numerous providers in the area. There's no uniform standard between the various depts. Additionally, a FDNY Conditions Boss can issue a NOI (notice of infraction) to a voluntary (hospital/private) unit, but it means little. The employee's supervisor can choose whether or not they want to discipline the employee. Usually it's just the boss trying to flex their muscle. If it's a pt care issue, then the employee can be put on pt care restriction, until they're cleared by their own medical director. So, even in the event of a pt care error, FDNY leaves the remediation process to the hospital, with a different medical director than the city's. See what I mean?

Where I work now, we had the full FD routine: CPAT, poly, med/psych, etc. If INOVA hospital or the local txp companies were to turn out units in our system, they would be doing so through a less rigorous and selective hiring process. Employee morale (better in the FD, noticably less with a private company) can also affect pt care.

QA/QI, discipline and general standard of care are difficult to control in an environment with multiple providers.

 

[usalsfyre]

46Young, multiple agencies DO run calls in your area though. All of the neighboring agencies have different protocols, hiring standards, equipment, medical directors, QA/QI and remediation processes. Heck, one agency even has single role providers. In certain areas of NOVA before I left it was not unusal for three different agencies to run a call to the same location on different days because call loads had the first due units out. Granted, that may have changed.

Also, who determines what a patient care error is. According to the local doc in a box I regularly commit patient care errors for medicating patients, instead of just grabbing and running (what the previous service did). My medical director and supervisor have yet to have a problem with my patient care (knock on wood).

It's workable, and at times needed to have backup providers. Dispatch is the biggest difficulty, as the transferring process tends to slow down getting approprite units out the door.

 

[46Young]

46Young, multiple agencies DO run calls in your area though. All of the neighboring agencies have different protocols, hiring standards, equipment, medical directors, QA/QI and remediation processes. Heck, one agency even has single role providers. In certain areas of NOVA before I left it was not unusal for three different agencies to run a call to the same location on different days because call loads had the first due units out. Granted, that may have changed.

Also, who determines what a patient care error is. According to the local doc in a box I regularly commit patient care errors for medicating patients, instead of just grabbing and running (what the previous service did). My medical director and supervisor have yet to have a problem with my patient care (knock on wood).

It's workable, and at times needed to have backup providers. Dispatch is the biggest difficulty, as the transferring process tends to slow down getting approprite units out the door.

Yes, you're right, we can get mutual aid from P. William, Alex, Arlington, Loudon, and Montgomery Co. MD. What I was talking about was having only one dept running a particular municipality. These mutual boxes are only a small percentage of the total call volume for us, maybe less than 5%. We typically have our engines on these mutual aids as well, and one of our EMS Captains onscene for an MVA w/ entrapment, an arrest, or any other significant incident. That is standard for all our calls, not just mutual boxes. The protocols, capabilities, and hiring standards between agencies are nearly identical, anyway.

When I worked in NYC, it was two privates, a bunch of hospitals, and the FDNY. They all worked under the same protocols and SOP's. Pt care error is commited by protocol violation, med error, neglect, and pt steering to or away from the voluntary provider's hospital, depending on where the benefit lies. A FDNY Conditions Boss can restrict the crew. The telemetry doc can also mandate the crew to advise the Boss of the violation. The crew or single provider will be restricted to just BLS, or restricted altogether, pending approval by that dept's medical director to return to service. The difference lies in what that dept's medical director requires from that provider to clear them vs what FDNY would do with theirs. These individual depts may flag more or less ACR's than FDNY would. One dept may give the medic a simple slap on the wrist. Another may suspend them, maybe put them on probation, maybe restrict them to IFT for a while, or "ask them to resign." Are FDNY EMS personnel held to a higher standard, or are the hospitals? Is it only certain hospitals, or all of them? Depending on what neighborhood you work, you'll want either a FDNY bus taking care of you, or maybe the hospital instead.

FDNY doesn't do mutual aid. Neither did the third service agency I worked for in SC. One had strict protocols with no variance allowed, or jumping protocols depending on how the pt reacted to therapies, without OLMC contact and a detailed report. In SC the protocols were noticeably more liberal, and we were free to treat according to best practices as long as we adhered to the state's drug formulary, and could justify it. The SC job had only one ALS txp provider.

In the case of Detroit, I believe that calling on the privates to provide txp isn't the answer. You need one uniform standard of EMS delivery, at least where ground txp is concerned. Bringing in various privates can result in poor delivery due to differing standards, capabilities and equipment, employee morale and experience, availability of units, and more. It would also cost the city money to use these providers. They're profit driven, and won't do 911 for a loss. Better to spend that money hiring more of their own rather than pay other agencies.