TransportJockey
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I have been in that situation. I'll post the images from facebook when I get home (can't access it from work). Roof held up just fine until FD cut into it to get in from the back
Flipped an ambulance
- Thread starter harkj
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I have been in that situation. I'll post the images from facebook when I get home (can't access it from work). Roof held up just fine until FD cut into it to get in from the back
mycrofft
Still crazy but elsewhere
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Why not million dollar ambulances?
Make them extra wide and put those "WIDE LOAD" signs and rotating beacons on them, chase and lead cars...like moving a house.
I remember the motor homes being converted into mobile ICU's.
By the way, it is axiomatic that the more a pt costs to bring in, the less likely they will be able to pay the bill in by any means...and the more likely they are to die, and on your morbidity/mortality statistics.
The Suburban conversions to ambulance were made flimsily, the roof cap was not properly reinforced (ther were no standards then), but to do so would run up the cost, raise the center of gravity, and task the wheelbase and suspension. The two I worked in were very comfortable on long distance rides, even if the cruise control did hunt 5 mph up and down.:blink:
Make them extra wide and put those "WIDE LOAD" signs and rotating beacons on them, chase and lead cars...like moving a house.
I remember the motor homes being converted into mobile ICU's.
By the way, it is axiomatic that the more a pt costs to bring in, the less likely they will be able to pay the bill in by any means...and the more likely they are to die, and on your morbidity/mortality statistics.
The Suburban conversions to ambulance were made flimsily, the roof cap was not properly reinforced (ther were no standards then), but to do so would run up the cost, raise the center of gravity, and task the wheelbase and suspension. The two I worked in were very comfortable on long distance rides, even if the cruise control did hunt 5 mph up and down.:blink:
I need a spell check that does 2 languages
The reason I label it as operator error takes these into consideration. First, an ambulance is a truck, not a car, it takes longer to slow down or stop, it doesn't corner very well, and a host of other issues like blind spots that require these considerations when driving it. Some of the more reputable places have both speed governors and sensors that make the operator aware of the dangerous behaviors while driving. However, these systems are expensive and the status quo is to take an EMT with minimal driver training if any at all, and throw them behind the wheel on their first day. The age old idea is roll the dice that expensive accidents will be fewer and far between than paying for safety upfront. Especially a large number of private companies subscribe to this philosophy.
Traffic pulling over may have been the case when there were fewer cars on the road. Today there may not be anywhere to pull over too. Once more, moving with the flow of traffic is much safer than any attempt to move through an intersection, cross a double yellow line, or any of the other traffic rules that using lights and sirens allows a person to "ignore." It just creates a risk that doesn't have a justifiable benefit. Drivers get mad when people run red lights because they don't expect it. Why should somebody driving an ambulance think it would be ok for them and nobody else?
"With due regard for public safety" is a large part of emergency driving. It means you are responsible for all the idiots out there. Saving 30 seconds to a minute on a response doesn't warrant this risk. Not to mention all the private companies that use L/S for making sure they get to the nursing home or hospital on time for a non emergent pickup. It just shows dispatchers and administrators do not understand the risks and benefits involved. (anyone caught doing that should face an excessive fine that definitively deters such behavior) Some municipalities have even made it illegal for nonemergent transport to use l/s in their communities. It should be adopted everywhere.
The "oh crap" factor. Many providers do not see grotesque or life threatening emergencies on a regular basis. When they do see one, they panic (I have seen it many times) and think the situation is more emergent than it is. Their lack of comfort being the driving force in their decision and driving behavior.
Never ever assume this. The culture of US EMS is definitively and overwhelmingly pro risk. The "risking ours saving yours" and other BS slogans on the tshirts (search the web) serve as fair warning of the culture US EMS is.
In EMS, safety is given lip service. We talk about it all the time, but very few actually act on it, not just in driving. Behavior, uniforms, operating policies, and other components make up safety, not simply a device like a standing paramedic restraining belt in the back of an ambulance, or more lights. (How many EMS agencies would rather require a “nice looking” uniform over a safe one? Search around the web and see what highway workers and EMS in other countries wear. Strangely enough the interfacility people wear the same. Even in nonemergency you are standing around moving vehicles loading and unloading)
Aside from saying “gloves on scene safe” at registry testing most US EMS providers and agencies do not actually value safety. As was demonstrated in this very thread, doing things on the cheap is the driving force.
EMTs and even in some places medics are a dime/dozen. If they get hurt it is easier and cheaper to cut them loose to suffer whatever awaits them than to take care of them. Companies know this. Their business models are set up on it. Look at the pay and benefits, you really think they care about employees?
When an EMT is killed, there is usually a nice funeral, something about being a hero is said, and everything is back to business as usual that evening. How many injured/disabled EMS providers are even acknowledged?
It is cheaper to call somebody a hero than pay to prevent their injuries or take care of them in disability.
The reason I label it as operator error takes these into consideration. First, an ambulance is a truck, not a car, it takes longer to slow down or stop, it doesn't corner very well, and a host of other issues like blind spots that require these considerations when driving it. Some of the more reputable places have both speed governors and sensors that make the operator aware of the dangerous behaviors while driving. However, these systems are expensive and the status quo is to take an EMT with minimal driver training if any at all, and throw them behind the wheel on their first day. The age old idea is roll the dice that expensive accidents will be fewer and far between than paying for safety upfront. Especially a large number of private companies subscribe to this philosophy.
Traffic pulling over may have been the case when there were fewer cars on the road. Today there may not be anywhere to pull over too. Once more, moving with the flow of traffic is much safer than any attempt to move through an intersection, cross a double yellow line, or any of the other traffic rules that using lights and sirens allows a person to "ignore." It just creates a risk that doesn't have a justifiable benefit. Drivers get mad when people run red lights because they don't expect it. Why should somebody driving an ambulance think it would be ok for them and nobody else?
"With due regard for public safety" is a large part of emergency driving. It means you are responsible for all the idiots out there. Saving 30 seconds to a minute on a response doesn't warrant this risk. Not to mention all the private companies that use L/S for making sure they get to the nursing home or hospital on time for a non emergent pickup. It just shows dispatchers and administrators do not understand the risks and benefits involved. (anyone caught doing that should face an excessive fine that definitively deters such behavior) Some municipalities have even made it illegal for nonemergent transport to use l/s in their communities. It should be adopted everywhere.
The "oh crap" factor. Many providers do not see grotesque or life threatening emergencies on a regular basis. When they do see one, they panic (I have seen it many times) and think the situation is more emergent than it is. Their lack of comfort being the driving force in their decision and driving behavior.
Never ever assume this. The culture of US EMS is definitively and overwhelmingly pro risk. The "risking ours saving yours" and other BS slogans on the tshirts (search the web) serve as fair warning of the culture US EMS is.
In EMS, safety is given lip service. We talk about it all the time, but very few actually act on it, not just in driving. Behavior, uniforms, operating policies, and other components make up safety, not simply a device like a standing paramedic restraining belt in the back of an ambulance, or more lights. (How many EMS agencies would rather require a “nice looking” uniform over a safe one? Search around the web and see what highway workers and EMS in other countries wear. Strangely enough the interfacility people wear the same. Even in nonemergency you are standing around moving vehicles loading and unloading)
Aside from saying “gloves on scene safe” at registry testing most US EMS providers and agencies do not actually value safety. As was demonstrated in this very thread, doing things on the cheap is the driving force.
EMTs and even in some places medics are a dime/dozen. If they get hurt it is easier and cheaper to cut them loose to suffer whatever awaits them than to take care of them. Companies know this. Their business models are set up on it. Look at the pay and benefits, you really think they care about employees?
When an EMT is killed, there is usually a nice funeral, something about being a hero is said, and everything is back to business as usual that evening. How many injured/disabled EMS providers are even acknowledged?
It is cheaper to call somebody a hero than pay to prevent their injuries or take care of them in disability.
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Silver_Lining
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@Silver lining:
Unfortunately, despite the well-placed ideals of many, that's precisely how business often works. Take Toyota as a perfect example: they did the math, and decided that cost of lawsuits due to the defect in their accelerator pedal (that caused it to stick) would be lower than the cost of a recall. So they delayed releasing a recall until it became public knowledge that there was a fault with the pedal. This kind of thing happens all the time across every field; there are entire corporations devoted to "risk management" that run the calculations. Sometimes these firms are even used by insurance companies to determine who to deny coverage to.
And while I would argue that making broad, sweeping generalizations about any large population is dangerous, I would certainly agree with veneficus, at least in part, about the culture of danger in EMS. When people wear shirts with tough-guy slogans like "Risking ours to save yours," they aren't doing it because they learned something from a dangerous situation. They are doing it because they think it's cool - because they think the danger that they put themselves in somehow makes them superior. You could make a decent psychological argument that this is ultimately caused by their fear of their own mortality (which is a subtle twist of irony in itself) - but that discussion has absolutely nothing to do with this thread and, at any rate, is way outside the scope of this post.
I cannot agree that this culture pervades across all of the US EMS system; however, it certainly exists. There are far too many people in this business simply because they think it's cool. I have personally had the very unfortunate experience about hearing a paramedic brag about having a patient die on him because he thought it was cool. There is a culture of violence in the US: danger is cool.
As you pointed out, there are very few EMS providers in the US who are shouting for bright reflective uniforms. If you ask me, that's because they are "uncool." Even reflective EMS vests would be a massive step in the right direction - but would anybody wear them? IF I were on the highway, I sure would.* But the fact remains that, as you yourself said, nobody cries foul at this kind of unsafe job environment. It might be arrogance, it might be a culture of risk and danger... but whatever it is, the world is (unfortunately, I might add) not quite as ideal as you or I would like.
*There is some (albeit questionable) debate as to whether high-visibility could, in some situations, actually be a safety risk - if, for example, you were operating in an area that is particularly unfriendly to public servants [read: gang territory]. There are some neighborhoods that you will never enter hot - because the residents are prone to shooting at anything with lights and sirens. This is the ONLY remotely valid argument for non-reflective clothing that I have ever heard.
Unfortunately, despite the well-placed ideals of many, that's precisely how business often works. Take Toyota as a perfect example: they did the math, and decided that cost of lawsuits due to the defect in their accelerator pedal (that caused it to stick) would be lower than the cost of a recall. So they delayed releasing a recall until it became public knowledge that there was a fault with the pedal. This kind of thing happens all the time across every field; there are entire corporations devoted to "risk management" that run the calculations. Sometimes these firms are even used by insurance companies to determine who to deny coverage to.
And while I would argue that making broad, sweeping generalizations about any large population is dangerous, I would certainly agree with veneficus, at least in part, about the culture of danger in EMS. When people wear shirts with tough-guy slogans like "Risking ours to save yours," they aren't doing it because they learned something from a dangerous situation. They are doing it because they think it's cool - because they think the danger that they put themselves in somehow makes them superior. You could make a decent psychological argument that this is ultimately caused by their fear of their own mortality (which is a subtle twist of irony in itself) - but that discussion has absolutely nothing to do with this thread and, at any rate, is way outside the scope of this post.
I cannot agree that this culture pervades across all of the US EMS system; however, it certainly exists. There are far too many people in this business simply because they think it's cool. I have personally had the very unfortunate experience about hearing a paramedic brag about having a patient die on him because he thought it was cool. There is a culture of violence in the US: danger is cool.
As you pointed out, there are very few EMS providers in the US who are shouting for bright reflective uniforms. If you ask me, that's because they are "uncool." Even reflective EMS vests would be a massive step in the right direction - but would anybody wear them? IF I were on the highway, I sure would.* But the fact remains that, as you yourself said, nobody cries foul at this kind of unsafe job environment. It might be arrogance, it might be a culture of risk and danger... but whatever it is, the world is (unfortunately, I might add) not quite as ideal as you or I would like.
*There is some (albeit questionable) debate as to whether high-visibility could, in some situations, actually be a safety risk - if, for example, you were operating in an area that is particularly unfriendly to public servants [read: gang territory]. There are some neighborhoods that you will never enter hot - because the residents are prone to shooting at anything with lights and sirens. This is the ONLY remotely valid argument for non-reflective clothing that I have ever heard.
Welcome to the Clan.
-> i'm not sure on this subject..but it sounds like you're saying some companies use a sort of time tracker to see how short a time the emts get to a pick up. I don't see how a driver would listen to this timer, driving conditions providing.
You can't fly over a traffic jam, so a timer really isn't something valid to blame, imo. But if you've heard/seen many emts feeling pressured to be more reckless in driving, that's terrible.
How this usually plays out doesn’t seem so sinister. (latin for left handed) Usually a transport company has a contract. They will show up in a timely manner to pick up patients or the facility is permitted to call somebody else. So if you miss the pick up, you don’t get paid. Additionally, some facilities will not renew a company’s contract if they are habitually late. Many private services (and I am familiar with them from all over the country) have more or take contracts they do not have the resources to provide for. On the average day, they can get away with it. But with no surge capacity, they cannot keep up. Management puts stress on dispatchers to “speed things up” to get the calls handled. Dispatch then puts pressure on the Units. Nobody in the office (dispatch center) is aware of conditions and safety. Most EMTs don’t understand the safety issues with emergent response, nor the lack of benefits. If you bring up the safety component your job is in jeopardy. Remember, more EMTs than positions. Management really can afford to lose you.
Its good that some companies are doing away with this practice. I'd agree with anything that makes the emt & pt safe/r.
The rare private companies or agencies, like third service EMS or the fire service, That put a value on safety and employees have been doing it since their inception. I could name names, but I am too kind.
-> this is ridiculous. & terrible news. If this is how the emts you've seen react, than someone wasn't entirely trained properly, or shouldn't be an emt because that type of reaction would prove one not cool under pressure.
It unfortunately is the norm not only in more rural areas. The people teaching the classes usually don’t have quality experience either. Even if they have years on a service, it doesn’t matter. It is the quality of such experience not quantity. I have been part of “high performance” systems, with outrageous call volumes, that have had FTOs completely flip out over injuries or illnesses that will sit for hours in the ED or even the waiting room until they are discharged home in a few hours. This would be partially solved by accrediting hospital clinical sites and demanding more specific contacts to graduate in EMS similar to medical internships and residencies. In my home state there are hospitals that are paramedic clinical sites that don’t see 20 patients a day in the ED. When they do see something bad, it is flown away. The clinical experience is substandard. You will see.
mmm.. I still wouldn't entirely agree with this. Mainly because many people have a habit of embracing what they get &/or have rather than know how to change/fix what needs fixing or changing
This is exactly the problem. What they know and embrace is “hero, danger, self sacrifice.”
-> i've heard this complaint before. I think its plain stupidity, that the emt/paramedic who knows or feels they know what would work best for safely for their job, is not standing up for it in unison or doesn't seem to get a say in what they company uses. (acting in unison makes it harder to get fired.)
Acting in unison does make it hard to get fired. But people are cowards. You will get 100 people to support an idea around the dinner table, but not one will stand up behind you in the boss’s presence. EMS agencies consider people who speak out “troublemakers” and they are not treated well.
-> :s sick n wrong. Should be illegal to run business this way. Similar to veterans' care when their home. I don't get it, why our largest humanitarians are treated with such crap..especially if/when they need it.
Because they are humanitarian, they are easier to take advantage of by people less scrupulous. The purpose of business is to make money. A “good” business person makes the most money. There is no other measure except the bottom line. It is what it is.
-> its sickening whenever i hear about "cheap", "expensive", "money money money." & when people seem resigned or complacent to let it go on, as if they can do nothing about it. These are things i avoid when it comes to people or companies i go to. If money is all that is thought about & acted on, & the general consensus says nothing to disagree or change it, then it's really our fault. Because we're letting them get away with it. Imo. Too bad, really, because it's not that hard to make a change that counts.
If it wasn’t hard to make the change, it would have been made already. By people older and smarter than me. Change in any aspect of US EMS is near impossible. Too many people protecting their self interest. No compromises. No doing what is best.
The purpose of Medicine in any society is to keep members of the society productive and contributing to society. In 2010 that means making and spending money. Some have figured out it is cheaper to just let people rot than it is to get them to any minimal level of function again. They don’t pay to help. Especially in the US, it is all about “me.”
“Don’t raise my taxes,” “I don’t want to pay for somebody else,” doing what is best for even the smallest community is now “evil socialism.” Whether you or I like it or not, the people have chosen. Democracy worked best in Greece, where a majority of citizens were educated, community minded, and physically capable. It is a long way from that nd what we have now
.
I cannot agree that this culture pervades across all of the US EMS system; however, it certainly exists.
Unfortunately is is the majority. Don’t take my word for it, ask around.
*There is some (albeit questionable) debate as to whether high-visibility could, in some situations, actually be a safety risk - if, for example, you were operating in an area that is particularly unfriendly to public servants [read: gang territory]. There are some neighborhoods that you will never enter hot - because the residents are prone to shooting at anything with lights and sirens. This is the ONLY remotely valid argument for non-reflective clothing that I have ever heard.
And unfortunately it is not an accurate argument. Do you think you are more likely mistaken for a law enforcement officer when you are wearing turnout gear or when dressed in a “professional” public service garb? Complete with epaulettes and a badge?
It has also been my experience that communities that react poorly to EMS usually have a legitimate reason. Sometimes poor care, sometimes because EMS think they are cops or the true defenders of moral faith and society. I’d be happy to discuss this more in another thread or via private message, but like everything else. People who have already made up their minds, will not be able to put forth useful debate.
-> i'm not sure on this subject..but it sounds like you're saying some companies use a sort of time tracker to see how short a time the emts get to a pick up. I don't see how a driver would listen to this timer, driving conditions providing.
You can't fly over a traffic jam, so a timer really isn't something valid to blame, imo. But if you've heard/seen many emts feeling pressured to be more reckless in driving, that's terrible.
How this usually plays out doesn’t seem so sinister. (latin for left handed) Usually a transport company has a contract. They will show up in a timely manner to pick up patients or the facility is permitted to call somebody else. So if you miss the pick up, you don’t get paid. Additionally, some facilities will not renew a company’s contract if they are habitually late. Many private services (and I am familiar with them from all over the country) have more or take contracts they do not have the resources to provide for. On the average day, they can get away with it. But with no surge capacity, they cannot keep up. Management puts stress on dispatchers to “speed things up” to get the calls handled. Dispatch then puts pressure on the Units. Nobody in the office (dispatch center) is aware of conditions and safety. Most EMTs don’t understand the safety issues with emergent response, nor the lack of benefits. If you bring up the safety component your job is in jeopardy. Remember, more EMTs than positions. Management really can afford to lose you.
Its good that some companies are doing away with this practice. I'd agree with anything that makes the emt & pt safe/r.
The rare private companies or agencies, like third service EMS or the fire service, That put a value on safety and employees have been doing it since their inception. I could name names, but I am too kind.
-> this is ridiculous. & terrible news. If this is how the emts you've seen react, than someone wasn't entirely trained properly, or shouldn't be an emt because that type of reaction would prove one not cool under pressure.
It unfortunately is the norm not only in more rural areas. The people teaching the classes usually don’t have quality experience either. Even if they have years on a service, it doesn’t matter. It is the quality of such experience not quantity. I have been part of “high performance” systems, with outrageous call volumes, that have had FTOs completely flip out over injuries or illnesses that will sit for hours in the ED or even the waiting room until they are discharged home in a few hours. This would be partially solved by accrediting hospital clinical sites and demanding more specific contacts to graduate in EMS similar to medical internships and residencies. In my home state there are hospitals that are paramedic clinical sites that don’t see 20 patients a day in the ED. When they do see something bad, it is flown away. The clinical experience is substandard. You will see.
mmm.. I still wouldn't entirely agree with this. Mainly because many people have a habit of embracing what they get &/or have rather than know how to change/fix what needs fixing or changing
This is exactly the problem. What they know and embrace is “hero, danger, self sacrifice.”
-> i've heard this complaint before. I think its plain stupidity, that the emt/paramedic who knows or feels they know what would work best for safely for their job, is not standing up for it in unison or doesn't seem to get a say in what they company uses. (acting in unison makes it harder to get fired.)
Acting in unison does make it hard to get fired. But people are cowards. You will get 100 people to support an idea around the dinner table, but not one will stand up behind you in the boss’s presence. EMS agencies consider people who speak out “troublemakers” and they are not treated well.
-> :s sick n wrong. Should be illegal to run business this way. Similar to veterans' care when their home. I don't get it, why our largest humanitarians are treated with such crap..especially if/when they need it.
Because they are humanitarian, they are easier to take advantage of by people less scrupulous. The purpose of business is to make money. A “good” business person makes the most money. There is no other measure except the bottom line. It is what it is.
-> its sickening whenever i hear about "cheap", "expensive", "money money money." & when people seem resigned or complacent to let it go on, as if they can do nothing about it. These are things i avoid when it comes to people or companies i go to. If money is all that is thought about & acted on, & the general consensus says nothing to disagree or change it, then it's really our fault. Because we're letting them get away with it. Imo. Too bad, really, because it's not that hard to make a change that counts.
If it wasn’t hard to make the change, it would have been made already. By people older and smarter than me. Change in any aspect of US EMS is near impossible. Too many people protecting their self interest. No compromises. No doing what is best.
The purpose of Medicine in any society is to keep members of the society productive and contributing to society. In 2010 that means making and spending money. Some have figured out it is cheaper to just let people rot than it is to get them to any minimal level of function again. They don’t pay to help. Especially in the US, it is all about “me.”
“Don’t raise my taxes,” “I don’t want to pay for somebody else,” doing what is best for even the smallest community is now “evil socialism.” Whether you or I like it or not, the people have chosen. Democracy worked best in Greece, where a majority of citizens were educated, community minded, and physically capable. It is a long way from that nd what we have now
.
I cannot agree that this culture pervades across all of the US EMS system; however, it certainly exists.
Unfortunately is is the majority. Don’t take my word for it, ask around.
*There is some (albeit questionable) debate as to whether high-visibility could, in some situations, actually be a safety risk - if, for example, you were operating in an area that is particularly unfriendly to public servants [read: gang territory]. There are some neighborhoods that you will never enter hot - because the residents are prone to shooting at anything with lights and sirens. This is the ONLY remotely valid argument for non-reflective clothing that I have ever heard.
And unfortunately it is not an accurate argument. Do you think you are more likely mistaken for a law enforcement officer when you are wearing turnout gear or when dressed in a “professional” public service garb? Complete with epaulettes and a badge?
It has also been my experience that communities that react poorly to EMS usually have a legitimate reason. Sometimes poor care, sometimes because EMS think they are cops or the true defenders of moral faith and society. I’d be happy to discuss this more in another thread or via private message, but like everything else. People who have already made up their minds, will not be able to put forth useful debate.
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I'm not trying to say if it is or isn't the majority: I'm just saying that I cannot agree that such a sweeping generalization is universally accurate - particularly since I know I don't fall in that category, and I suspect you don't either. ;-)
This is precisely why I inserted the words "questionable" and "remotely valid." I agree with you that the argument is usually very flawed; however, I can think of an example or two in which I would prefer to remain unseen. But that is literally one or two examples out of thousands.
TransportJockey
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Pictures as promised
http://www.facebook.com/album.php?aid=2006885&id=110000979&l=0fa1812e2c
The cot actually stayed in place well until we tried to get it out at base.
http://www.facebook.com/album.php?aid=2006885&id=110000979&l=0fa1812e2c
The cot actually stayed in place well until we tried to get it out at base.