How can we improve EMS

[rchristi]

I am putting this out as a question since I have seen a lot more posts about what is wrong with the way things are presently being done than posts about what we would like to do to improve things.
My hope is for this to focus on positive steps we can urge upon our leaders and state organizations. Bashing each other is a great way to be stuck with the status quo.
An example that comes to mind would be to create a level of provider that would be attainable and supportable at a volunteer level, but with enough education and training to provide basic medical interventions without having to resort to multiple level of upgrades or as is being done in my home state, routine variances. I would love to hear from some of you who have these upgrades as to which ones you think are most valuable to your patients.
Along those same lines, do we need a national system that eliminates the patchwork of certificates and training based on state and county rules.
What is the best way to ensure that individuals who choose EMS as a profession are fairly and adequately compensated.
Again, I would like to keep this positive and focused on improvements.
Thanks

 

[BLSBoy]

I shall expand upon it later, but for now

MORE Education
LESS Volunteers.

 

[Ridryder911]

An example that comes to mind would be to create a level of provider that would be attainable and supportable at a volunteer level, but with enough education and training to provide basic medical interventions without having to resort to multiple level of upgrades or as is being done in my home state, routine variances

= Oxymoron

1). It's simple. Abolish EMT level except to the first responder agency level. NO EMT's are allowed on EMS units except for EVO responsibility.


2.) Get involved in local, State, Federal organizations that have lobbyist to present bills for EMS legislation and funding bills.

Otherwise shooting the B.S. on forums and debating is just that B.S.!

Either be part of the solution or part of the problem, you can't be in the middle.

R/r 911

 

[Foxbat]

Statewide or countywide EMS systems may be helpful by "spreading" the costs of operation so poor areas may afford to have paid staff 24/7 (athough I have a suspicion that then state/county may decide to close, say, rural station that covers 50 mi^2 and runs like 100 calls a year; and then ETAs will become even worse than they were with staff responding from theit homes).

I do not see volunteerism per se as evil; volunteer services that staff their stations 24/7 or combination departments that utilize both paid and volunteer staff should continue to operate as such.

As of EMTs, I think there is a place for them as a secondary caregiver; Israel, for example, uses volunteer hovshim (roughly analog of EMT-Bs) as extra pairs of hands in an ambulance, while paramedic or physician is a primary caregiver. Russia uses (or at least used, until the funding became a problem) sanitars (~nurses aides?) on ambulances to assist a physician or a feldsher (~paramedic).

 

[rchristi]

= Oxymoron

1). It's simple. Abolish EMT level except to the first responder agency level. NO EMT's are allowed on EMS units except for EVO responsibility.


2.) Get involved in local, State, Federal organizations that have lobbyist to present bills for EMS legislation and funding bills.

Otherwise shooting the B.S. on forums and debating is just that B.S.!

Either be part of the solution or part of the problem, you can't be in the middle.

R/r 911

So the solution is to scrap most of what we presently have and start over?
It sounds like we have a lot of work ahead of us to get the money from whatever sources are available.

 

[Ridryder911]

So the solution is to scrap most of what we presently have and start over?
It sounds like we have a lot of work ahead of us to get the money from whatever sources are available.

Let's look at it logical.. alike what Dr. Phils says.."Is what your doing working?"....

Its very apparent what we are doing is NOT working. How freaking embarrassing is it that so many places in the U.S. still does not have ALS. Now, really think about it. The old show "Emergency" could deliver more advanced care thirty four years ago, than what is delivered in a lot of the U.S. today!

Anyone else see a problem with that?

R/r 911

 

[gicts]

Let's look at it logical.. alike what Dr. Phils says.."Is what your doing working?"....

Its very apparent what we are doing is NOT working. How freaking embarrassing is it that so many places in the U.S. still does not have ALS. Now, really think about it. The old show "Emergency" could deliver more advanced care thirty four years ago, than what is delivered in a lot of the U.S. today!

Anyone else see a problem with that?

R/r 911

Do you believe private services should do away with EMTS as well?
Though a noob, I agree partially. There should be a big motivation or regulations to complete ALS skills. Perhaps something along the lines of after a reasonable time as an EMT if you don't advance your edu, you are cut to part time to focus on studies? :unsure:

 

[Ridryder911]

Even where I am private services have Paramedics. The only reason to continue for Basic Level in EMS is costs factors not patient care. Unfortunately, the EMT curriculum is not strong enough to provide more than just the initial care.

Nothing wrong for first responder type services using them but for transport and continuation of care a Paramedic should at least evaluate.

R/r 911

 

[mycrofft]

Good approach and question. I'm sort of doing this at my work.

How about EMT's for medi-van and basic convo and other ground level non-superemergency jobs? And stairstep paramedic up from EMT. Go back to the original two tier system (EMT-A, EMT-P). Upgrade basic first aid and first responder training, but stop using them where EMT-A or EMT-P would be better for the public.

Places like Cherry County Nebraska and other heavily rural areas will still need homegrown volunteer units, but state level licensing and funding needs to be "looked at" where professional and volunteer interface, or there is an adequate econmic base to support professional ALS....(then try to hire people to work there!!).

I've said elesewhere here that most often an EMT can do where a paramedic is called. However, if paramedics are not used they become unavailable, and they are indispensible if they fit into the EMS plan.

Another wrinkle comes to mind: the extinction of local and rural clinics and little hospitals, not to men tion the paucity of med school grads who will work anywhere but LA, NYC, Chicago, Miami, or Dallas/FortWorth.

 

[emtlady76877]

I agree with rydrider that the they do need to go als because I volunteer for one while I'm going to school,as an emt-b & the first thing we do if we have anything that amounts to anything is call for the the paramedics from the next town.Which helps me because then I get to go with them as a paramedic student.

 

[FFMedic1911]

First make all ems fire based.No make it all third service.Wait I mean private.Sorry couldn't resist.I think the first thing we could do is have a national protocol that we all follow so we are on the same page.

 

[JPINFV]

How about EMT's for medi-van and basic convo and other ground level non-superemergency jobs?

What about them? The EMT-B is still a poor education base for non-emergent jobs. There isn't enough focus on proper body mechanics, geriatric medical care and too much emphasis on "if it's not normal, haul butt to the hospital" (which is completely the wrong mindset when dealing with patients that have multiple chronic diseases and disorders).

 

[Ridryder911]

First make all ems fire based.No make it all third service.Wait I mean private.Sorry couldn't resist.I think the first thing we could do is have a national protocol that we all follow so we are on the same page.

Although it sounds like it would be a good idea, in reality it would suck. Seriously, do you think that the medics of New York protocols should be those of in Montana? I may have a transport time of 50 minutes or more and next time maybe 15 minutes. My treatment and procedures are definitely different dependent on the case and where I am.

I personally like the least number of pages of protocols. I will no longer will work for a service with more than 20 pages of protocols. Medicine is medicine and not everything should have be covered as a protocol. We should develop standards of care that is nationally standardized i.e. splinting, check for pms, suctioning, oxygen administration in other words generally most of all basic material, and probably over half of the advanced level as well. Do we really need a protocol to place oxygen or in fact when to establish an IV? When there are national standards in place.

The same reason I am totally against any State having statewide protocols. They have left the medical director and their local community out of the loop. What might be needed in one community may not be needed or may needed more in another.

Something to think about....

The first requirement to change within EMS is professional standards. The ability to demonstrate one can read and write and have at least high school science level. Then all advanced level license (not certification) has to be a graduate of an accredited college degree program.

R/r 911

 

[BossyCow]

One of the deal breakers for ALS is the 24/7 availability. A lot of rural agencies respond to less than 200 calls a year. You can't pay for 24/7 availability at a wage high enough to keep the personnel from quitting to get a 'good job' and stay solvent.

 

[Ridryder911]

One of the deal breakers for ALS is the 24/7 availability. A lot of rural agencies respond to less than 200 calls a year. You can't pay for 24/7 availability at a wage high enough to keep the personnel from quitting to get a 'good job' and stay solvent.

What about regionalization? I believe alike hospitals, communities will soon learn to keep any type of provider they will have to regional and combine services alike everyone else in the health care industry.

I know we are looking at the same thing. We are now covering areas that are up to 40 miles away (not normally in our coverage area) with a substation. Water rates have increased $9.00 a month to pay for a Paramedic unit to be there. We have lost over 40 EMS services within the past five years and prediction is we will loose almost that much within the next year. So regionalization is not just talk but will have to be a way for the future. Not all communities will get to have their own EMS.

R/r911

 

[BossyCow]

What about regionalization? I believe alike hospitals, communities will soon learn to keep any type of provider they will have to regional and combine services alike everyone else in the health care industry.

I know we are looking at the same thing. We are now covering areas that are up to 40 miles away (not normally in our coverage area) with a substation. Water rates have increased $9.00 a month to pay for a Paramedic unit to be there. We have lost over 40 EMS services within the past five years and prediction is we will loose almost that much within the next year. So regionalization is not just talk but will have to be a way for the future. Not all communities will get to have their own EMS.

R/r911

And who staffs the substation? 24/7? Most of our citizens are on private wells, so no infrastructure there to tap. Our latest levy attempt failed so property taxes are out. The nearest agency just drastically reduced its service/coverage area dropping from ALS to BLS and the privates can't make a profit so they aren't interested.

 

[rchristi]

And who staffs the substation? 24/7? Most of our citizens are on private wells, so no infrastructure there to tap. Our latest levy attempt failed so property taxes are out. The nearest agency just drastically reduced its service/coverage area dropping from ALS to BLS and the privates can't make a profit so they aren't interested.

So what things could be done that would help your service and others like it to provide better patient care and outcomes? I understand how hard to operate on a shoestring budget. From what I have read in your posts, you have a lot of experience and are really committed to EMS in rural settings. I would like to hear how you would change things. Thanks for all you add to this discussion

 

[BossyCow]

So what things could be done that would help your service and others like it to provide better patient care and outcomes? I understand how hard to operate on a shoestring budget. From what I have read in your posts, you have a lot of experience and are really committed to EMS in rural settings. I would like to hear how you would change things. Thanks for all you add to this discussion

We figured that the main stumbling block is the awareness of the public to the problem. Since our department has always been extremely press shy, no one was aware of what we did and how. We have started to change that with more public education. We do presentations at the local Grange, we teach classes at the high school and we are planning a program of community education classes on both first aid and fire prevention.

We hope by getting more of the public into the building, and familiar with the personnel its a stepping stone to more awareness of what kind of work we do on how little money. We hope to increase our volunteer participation and maybe even eventually pass a levy!

 

[rchristi]

Even where I am private services have Paramedics. The only reason to continue for Basic Level in EMS is costs factors not patient care. Unfortunately, the EMT curriculum is not strong enough to provide more than just the initial care.

Nothing wrong for first responder type services using them but for transport and continuation of care a Paramedic should at least evaluate.

R/r 911

My concern with a solely Paramedic EMS would be the risk creating a system where getting people certified as Paramedics for the least cost would become a competitive advantage. The numbers crunchers in both the public and private sectors tend to be less concerned with quality than with bottom line cost.
I am not saying that this is an unworkable plan, I do feel that it would require close attention to accreditation and testing to keep the Paramedic standard of care high.
I would also suggest that the EMT Basic curriculum should be strengthened. I realize that NREMT has changes in the works, but will they be sufficient? Even after a long absence from EMS I thought I was presented with very little more information in my EMT-B class than I had in my First Responder class back in the late 80s. I would still like to elicit suggestions from this group as to whether EMT can be made strong enough to make a difference in care offered and outcomes achieved. If this is not possible then maybe it is a dinosaur whose time has passed.

 

[FFMedic1911]

Although it sounds like it would be a good idea, in reality it would suck. Seriously, do you think that the medics of New York protocols should be those of in Montana? I may have a transport time of 50 minutes or more and next time maybe 15 minutes. My treatment and procedures are definitely different dependent on the case and where I am.

I personally like the least number of pages of protocols. I will no longer will work for a service with more than 20 pages of protocols. Medicine is medicine and not everything should have be covered as a protocol. We should develop standards of care that is nationally standardized i.e. splinting, check for pms, suctioning, oxygen administration in other words generally most of all basic material, and probably over half of the advanced level as well. Do we really need a protocol to place oxygen or in fact when to establish an IV? When there are national standards in place.

The same reason I am totally against any State having statewide protocols. They have left the medical director and their local community out of the loop. What might be needed in one community may not be needed or may needed more in another.

Something to think about....

The first requirement to change within EMS is professional standards. The ability to demonstrate one can read and write and have at least high school science level. Then all advanced level license (not certification) has to be a graduate of an accredited college degree program.

R/r 911

That is what i was getting at.Thanks for placing it in that context.Much better worded.