Kind of like requiring all paramedics to consult with a MD prior to their treatments (heeeeello New Jersey), requiring MD contact to give anything more than O2 and aspirin, removing meds that are only "rarely" used, having very simplistic protocols and on and on...of course, it's non-fire-based EMS that does this...
Yes, New Jersey, is a special case. (for more than just EMS)
It has been my observation that while there are non fire based agencies that do this, as I mentioned I worked for one at one time, and it is not unique, because of the volume of fire based services compared to non fire services, and the outdated leadership and concepts, it becomes the fire service that is the major perpetuator.
But then, private EMS (and all other types) does this as well. In fact, I'd say that it's more of a systemic problem with private EMS; I know multiple people who can't remember when they last had any in-house EMS training or were given the resources to get that training and education on their own. This isn't a problem that only faces the fire service.
I think this would be a more fair statement if you remove non emergent transport from EMS. After all, there is nothing emergent about it, it is basically a healthcare safety net in the form of a trucking company. Many private agencies that do not do emergent response really have no need of continuous emergency training. However, if you do look at the primary private and 3rd service responders around the nation, you find it is a minority that do not provide adequate training.
It's not a disproportionate amount either; what people need to remember is that it's not the total number of fires that is used to justify the number of units, but how many units are needed for those fires; if it takes say, 2 engines and a truck for a fire, then those need to be staffed for that area to be adequately protected. The fire service, EMS, police, and even medical facilities, aren't staffed in a "reactive" way; the number of people working/the equipment available should be, and hopefully is, proportionate to what can reasonable go wrong. Saying cut the numbers because the volume is down would be like saying get rid of crich's because they are used so rarely. Or get rid of a CT scanner that is used only a couple times a week but is the only one available for a large area. I will admit though, that there is waste in many departments, and some units should be cut.
I respectfully disagree with this. The equipment is entirely disproportional to the need. How many 120’ ladders do you need? How many can you even use at one time? How many FDs have a bunch of engine companies with 2 or 3 guys on each? What can you do with that? What is the point of having a fire house on every block with a 5 minute response of 3-4 guys according to NFPA ½ should be outside anyway. So you have to wait the same amount of time to actually attack a fire or effect a rescue because of resources arriving from remote locations. But that is a discussion for a fire board. The trouble is they don’t want to hear the 200 year old operating model doesn’t work anymore.
The fire service attempts all kinds of crap to reduce EMS runs without commiting the resources required to serve the public health needs which lead to the activation of EMS.
Can you explain that a bit more?
I am sure you have seen it, or at least heard of it. Nurse on call, dispatch refusals, a private company contracted to transport what the FD doesn’t deem “emergent enough.”
Why? EMS abuse, and ER abuse is a very common thing. Granted, more needs to be explained, but telling someone not to call because they need a refill on their prescription is a valid reason. Educating people about what needs and ambulance and/or an ER visit is an appropriate thing to do.
It is not abuse, it has become a safety net. There is no other resource to call. When you need help dial 911. I’ll illustrate a personal example and a few others. But it can apply to many more situations.
My wife once got a UTI, a fairly common event for females. So being a healthcare provider, instead of going to the ED, I called the family doc. (and we have some good insurance) after quite a bit of arguing, they tell me they can get her an appointment in 35 days. Now think about that. Difficulty urinating from a bacteria infection for 35 days. So when you cannot urinate and become hyperkalemic (among other things) or become septic then it is worthy of an ED? You would let the problem go that long? For us, of course off to the ED we went.
According to a NEJM article the national average to see a PCP is 48 days. If you can’t wait a month and ½ the ED becomes the default. People need an ambulance to get to a doctor. Given a choice, I'm willing to bet if they had another viable option they would use it.
The example of prescription refill is utter BS. I am sorry but it demonstrates a complete lack of understanding. If granny can’t afford to get her CHF medication refilled on her fixed income and is homebound with no family care, calling 911 and getting a ride to the ED does solve the problem for everyone. In a much more cost effective and humane way then waiting until she is in crisis.
A poor person getting a ride to the ED to be educated on what OTC meds to give an infant with a fever because they honestly don’t know, is not a waste of resources, compared to letting a fever go uncontrolled in an infant. (much different in older kids and adults)
These mundane “abuses” actually save lives and large amounts of money. It costs considerably less to tie up a transporting ambulance and crowd an ED than a few days in an ICU.
The very nature of what needs an ER visit has changed.
So...you're willing to do that for ANY EMS service, right? Because anybody willing to look rationally at this is aware that problems plague all types of EMS.
Absolutely and unequivocally.
As do I. As do many fire-based paramedics I know. I get very upset when I get lumped in with some non-fire based EMS providers (I won't say what type because it doesn't matter in this case); the level and amount of care provided by some non-fire based services that I've seen is appalling, and when someone compares me to "that paramedic from XXXX" it's...well...aggravating, because I know what kind of care that service gives.
Lumped in with professional EMS providers or the dialysis derby, granny tranny trucking company? I wouldn’t be too upset to be grouped into the same category with a Lee county or Wake County EMS provider. Just as I am sure they would want to be grouped in With a King County provider. But how about being grouped in with DC? They are the fire service EMS in our nation's Capital. For all the world to see and compare to.
but in enough places that it's a problem.
More than 2/3 the population of the United States makes the Pacific Northwest fire services the exception, not the rule. I don’t know, but I am willing to bet between Los Angeles, Houston, DC, and NYC (nevermind Philly, Chicago, and the other major FDs) there is more population than in the entire state of Washington, which does have a commendable fire service EMS system.
I am more than willing to solve the problems. But when the advocates of fire based EMS think they are doing a fine job, it makes it really hard to get anywhere. I focus what seems unfairly on the FD services because they are the major provider. When you fix a major problem, many smaller ones seem to take care of themselves.
Why is it the only Fire service that tries to reduce the number of paramedics is in Washington State? Again I ask, why are other FDs not even attempting to emulate the successful model at all?
Yes, New Jersey, is a special case. (for more than just EMS)
It has been my observation that while there are non fire based agencies that do this, as I mentioned I worked for one at one time, and it is not unique, because of the volume of fire based services compared to non fire services, and the outdated leadership and concepts, it becomes the fire service that is the major perpetuator.
But then, private EMS (and all other types) does this as well. In fact, I'd say that it's more of a systemic problem with private EMS; I know multiple people who can't remember when they last had any in-house EMS training or were given the resources to get that training and education on their own. This isn't a problem that only faces the fire service.
I think this would be a more fair statement if you remove non emergent transport from EMS. After all, there is nothing emergent about it, it is basically a healthcare safety net in the form of a trucking company. Many private agencies that do not do emergent response really have no need of continuous emergency training. However, if you do look at the primary private and 3rd service responders around the nation, you find it is a minority that do not provide adequate training.
It's not a disproportionate amount either; what people need to remember is that it's not the total number of fires that is used to justify the number of units, but how many units are needed for those fires; if it takes say, 2 engines and a truck for a fire, then those need to be staffed for that area to be adequately protected. The fire service, EMS, police, and even medical facilities, aren't staffed in a "reactive" way; the number of people working/the equipment available should be, and hopefully is, proportionate to what can reasonable go wrong. Saying cut the numbers because the volume is down would be like saying get rid of crich's because they are used so rarely. Or get rid of a CT scanner that is used only a couple times a week but is the only one available for a large area. I will admit though, that there is waste in many departments, and some units should be cut.
I respectfully disagree with this. The equipment is entirely disproportional to the need. How many 120’ ladders do you need? How many can you even use at one time? How many FDs have a bunch of engine companies with 2 or 3 guys on each? What can you do with that? What is the point of having a fire house on every block with a 5 minute response of 3-4 guys according to NFPA ½ should be outside anyway. So you have to wait the same amount of time to actually attack a fire or effect a rescue because of resources arriving from remote locations. But that is a discussion for a fire board. The trouble is they don’t want to hear the 200 year old operating model doesn’t work anymore.
The fire service attempts all kinds of crap to reduce EMS runs without commiting the resources required to serve the public health needs which lead to the activation of EMS.
Can you explain that a bit more?
I am sure you have seen it, or at least heard of it. Nurse on call, dispatch refusals, a private company contracted to transport what the FD doesn’t deem “emergent enough.”
Why? EMS abuse, and ER abuse is a very common thing. Granted, more needs to be explained, but telling someone not to call because they need a refill on their prescription is a valid reason. Educating people about what needs and ambulance and/or an ER visit is an appropriate thing to do.
It is not abuse, it has become a safety net. There is no other resource to call. When you need help dial 911. I’ll illustrate a personal example and a few others. But it can apply to many more situations.
My wife once got a UTI, a fairly common event for females. So being a healthcare provider, instead of going to the ED, I called the family doc. (and we have some good insurance) after quite a bit of arguing, they tell me they can get her an appointment in 35 days. Now think about that. Difficulty urinating from a bacteria infection for 35 days. So when you cannot urinate and become hyperkalemic (among other things) or become septic then it is worthy of an ED? You would let the problem go that long? For us, of course off to the ED we went.
According to a NEJM article the national average to see a PCP is 48 days. If you can’t wait a month and ½ the ED becomes the default. People need an ambulance to get to a doctor. Given a choice, I'm willing to bet if they had another viable option they would use it.
The example of prescription refill is utter BS. I am sorry but it demonstrates a complete lack of understanding. If granny can’t afford to get her CHF medication refilled on her fixed income and is homebound with no family care, calling 911 and getting a ride to the ED does solve the problem for everyone. In a much more cost effective and humane way then waiting until she is in crisis.
A poor person getting a ride to the ED to be educated on what OTC meds to give an infant with a fever because they honestly don’t know, is not a waste of resources, compared to letting a fever go uncontrolled in an infant. (much different in older kids and adults)
These mundane “abuses” actually save lives and large amounts of money. It costs considerably less to tie up a transporting ambulance and crowd an ED than a few days in an ICU.
The very nature of what needs an ER visit has changed.
So...you're willing to do that for ANY EMS service, right? Because anybody willing to look rationally at this is aware that problems plague all types of EMS.
Absolutely and unequivocally.
As do I. As do many fire-based paramedics I know. I get very upset when I get lumped in with some non-fire based EMS providers (I won't say what type because it doesn't matter in this case); the level and amount of care provided by some non-fire based services that I've seen is appalling, and when someone compares me to "that paramedic from XXXX" it's...well...aggravating, because I know what kind of care that service gives.
Lumped in with professional EMS providers or the dialysis derby, granny tranny trucking company? I wouldn’t be too upset to be grouped into the same category with a Lee county or Wake County EMS provider. Just as I am sure they would want to be grouped in With a King County provider. But how about being grouped in with DC? They are the fire service EMS in our nation's Capital. For all the world to see and compare to.
but in enough places that it's a problem.
More than 2/3 the population of the United States makes the Pacific Northwest fire services the exception, not the rule. I don’t know, but I am willing to bet between Los Angeles, Houston, DC, and NYC (nevermind Philly, Chicago, and the other major FDs) there is more population than in the entire state of Washington, which does have a commendable fire service EMS system.
I am more than willing to solve the problems. But when the advocates of fire based EMS think they are doing a fine job, it makes it really hard to get anywhere. I focus what seems unfairly on the FD services because they are the major provider. When you fix a major problem, many smaller ones seem to take care of themselves.
Why is it the only Fire service that tries to reduce the number of paramedics is in Washington State? Again I ask, why are other FDs not even attempting to emulate the successful model at all?
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) I would be ecstatic. But that's not the case for me. Just as the fire-service has it's lousy systems, so do privates. And hospitals, third service, etc etc. 
h34r:
