How to evolve EMS

[Qulevrius]

Government has as much (or more) nepotism (loosely defined) as anywhere else, I'd say...and the good old boy's club is as active in PD and FD as it is in healthcare (but healthcare is, on average, better educated and more diverse).

Government is an entirely different beast, and we should thank the Affirmative Action for it.

 

[akflightmedic]

Possible solution: would you be opposed to putting emt-B level training in the police academy, having Leo's respond, and they can determine if it's life or death enough for the new style ambulambs we talked about?

No. Bad idea. Here is why. People who become cops, people who become firefighters are "typically" a very different personality type. Yes, fire rescue exists but if you have spent anytime in those departments you will see those who are more EMS than Fire. The professions require very different processes of thoughts and typically very different physical actions (muscle memory stuff).

In short, let cops be cops. Let firefighters be FFs. And let Medical folk be medical folk!!!!

And your thinking of a cop being on scene and making determinations on which ambulance to send, simply because he is a basic is very flawed reasoning. It is similar to another discussion we had a while back where EMT-Bs respond first and then call for ALS if needed. This is backwards!!

If anything, an ALS provider should ALWAYS be first and then handoff to an EMT-B if their scope level is not required. But you do not KNOW this until after an ALS assessment is completed. The old adage of you do not know what you do not know applies here.

You have done no favors to the patient by sending in BLS first and then determining ALS is needed.

 

[NysEms2117]

I think public safety does. Pensions, better pay, government benefits, ability to operate with a negative operating income due to influx of tax funds (just like the PD and FD), agency head is equal to the other two agency heads, you can look out for your own people without having to worry about what others in healthcare think, makes for a good CAREER.

I was actually explaining to a few other people before that the way we police, and do our prison systems, if that can change(and is in the process of changing to a more "community policing") That will free up billions and billions of dollars, which we could then aim at FD or maybe even a billion or 2 in EMS.

Healthcare has better pay and benefits than public safety if you look outside of EMS. What you mean to say is that at the current EMS level of entry requirements, public safety provides an inflated compensation package.

I personally think that PD has the best benefits out of any field. My pension, salary, and health benefits are through the roof, not to mention feds(when you dont have to pay into S.S, and you step up the GS scale awfully fast).

Government has as much (or more) nepotism (loosely defined) as anywhere else, I'd say...and the good old boy's club is as active in PD and FD as it is in healthcare (but healthcare is, on average, better educated and more diverse).

Believe it or not nepotism is more common at the state legislative level then federal, due to the fact you can over ride pre-reqs at the state level, but have to jump through many many more hoops at the federal level.

Now what I'm talking about is the potential of having emergency medical services available to any tax payer, but tax payer only. It means no freebies, no handouts and no BS. You live in a city and pay your healthcare fees = you're eligible. That would be geared towards getting rid of welfare queens and people who otherwise mooch off of the system.

I agree to a certain extent, but do we give people cards saying if your dying we'll save them, but not the other folks? We live in an established country, which most don't just let people die.

Right now, LE + FD are rather lucrative jobs because of their benefits and pensions, but what about EMS ?

Also agree, EMS was literally left in the dust. My pension grew and grew, and EMS sank and sank.. I think im based off of 25 years in state corrections of any kind, and i start at 75% of my top 3 years, +1% every year over.

 

[DrParasite]

If it were up to me, I'd rather be part of a public health department...or maybe a public hospital system (like Boston or NYC*EMS prior to the FDNY merger), might help get the best of both worlds.

Boston EMS is a 100% municipal EMS agency, and falls within public safety. NYC EMS was mostly hospital based, however look at how was for the residents of NYC.

Healthcare has better pay and benefits than public safety if you look outside of EMS. What you mean to say is that at the current EMS level of entry requirements, public safety provides an inflated compensation package.

Ummm, yeah.... with the current system, when you compare the salary of a hospital based EMS system, and a government funded EMS system (IE, public safety), you will almost always find better benefits and better pay with the government system, because it is tax funded, while the hospital systems are expected to make a profit, or at least break even (the non profits can only operate in the red for so long)

And don't be jelous of the inflated compensation package.... you are only calling it inflated because you don't get it

 

[NysEms2117]

And your thinking of a cop being on scene and making determinations on which ambulance to send, simply because he is a basic is very flawed reasoning. It is similar to another discussion we had a while back where EMT-Bs respond first and then call for ALS if needed. This is backwards!!

I understand the actual process is backwards, my only thought there was the fact it's so much easier for an LEO to get on scene faster, 1. simply faster cars 2. more training in EVOC 3. not a "ton" of extra weight. Would you have any solutions on fixing the problem of sending highly skilled people to "stubbed toe" calls? to save the almighty $ of course.

 

[Qulevrius]

I agree to a certain extent, but do we give people cards saying if your dying we'll save them, but not the other folks? We live in an established country, which most don't just let people die.

I'm a sworn heinleinist when it comes to this sort of things, and I will stick to my guns. No pay = no play.

 

[akflightmedic]

I understand the actual process is backwards, my only thought there was the fact it's so much easier for an LEO to get on scene faster, 1. simply faster cars 2. more training in EVOC 3. not a "ton" of extra weight. Would you have any solutions on fixing the problem of sending highly skilled people to "stubbed toe" calls? to save the almighty $ of course.

Sure. Put the Medic in a fast car with necessary gear.

Some systems do this.

 

[NysEms2117]

Sure. Put the Medic in a fast car with necessary gear.

Some systems do this.

My system does... Theres more calls then medic fast cars. not for nothing either, whenever our CCT rig has gone to a call with a sprint car medic, he hasn't done jack, and if he has my CC-P or CCRN has to re-do whatever they have done.

 

[akflightmedic]

Well then that seems to be either a system/department issue or an education issue.

 

[NysEms2117]

Well then that seems to be either a system/department issue or an education issue.

Agreed, should it be a paramedic or CCRN in said sprint cars?

 

[DrParasite]

You have done no favors to the patient by sending in BLS first and then determining ALS is needed.

But that is the opposite of what a tier system is designed to do. Let BLS handle BLS calls, and let ALS handle ALS ones. You have done the paramedic no favors when they spend most of their time dealing with BLS patients. That will make them good at dealing with BLS patients, but when they get a really sick patient, when are are all used to BLS patients, how sharp will their skills be?

Think of it this way: I don't go see a cardiothoracic trauma surgeon when I need to get my cholesterol checked.... similarly, if I were to get shot 3 times in the chest, going to my family doctor might not be the best option.

 

[DrParasite]

My system does... Theres more calls then medic fast cars. not for nothing either, whenever our CCT rig has gone to a call with a sprint car medic, he hasn't done jack, and if he has my CC-P or CCRN has to re-do whatever they have done.

that's because ALS in flycars is a waste of time and resources. Almost as much of a waste as a paramedic on a fire engine. Show me some studies that support the otherwise, and I will gladly retract my statement. and buy the first round

The truth is, the first responders should be first responder, until the ALS arrives. IE, keep the patient from getting worse until more help arrives. Bleeding control, airway management, CPR/Defib, these things are what has statistically shown to save lives, and you don't need a medic to do that. Putting a single medic in a flycar and have them zooming to save lives has never been shown to definitively improve patient outcomes. Yes, we can all quote "well, I had this call, where the medic arrived and saved the guys life" but the reality is that is the exception and not the rule.

There is a reason paramedics in tiered systems have better intubation numbers compared to paramedics who put two paramedics on every ambulance in a system. Without enough sick patients, it's tough to maintain competency.

 

[EpiEMS]

If anything, an ALS provider should ALWAYS be first and then handoff to an EMT-B if their scope level is not required.

Sure. Put the Medic in a fast car with necessary gear.

I have my disagreements with this for certain* settings, because in a resource-limited situation I'd rather have enough BLS units and no medics than no BLS units and a few medics, but generally this makes good sense - sprint car/Charger D) single medics responding first to either downgrade to BLS or start interventions and transport with BLS.

*Very few - I'm thinking places where they can barely afford an ambulance but need lots of them.

Boston EMS is a 100% municipal EMS agency, and falls within public safety. NYC EMS was mostly hospital based, however look at how was for the residents of NYC.

I think BEMS falls under the Boston Public Health Commission, technically, though they are municipal. That doesn't make them public safety, strictly, but I would argue they're definitely not "healthcare" based either. Public health, sure.

that's because ALS in flycars is a waste of time and resources. Almost as much of a waste as a paramedic on a fire engine.

I agree with the latter -- not so much with the former.

Putting a single medic in a flycar and have them zooming to save lives has never been shown to definitively improve patient outcomes.

Maybe not improve patient outcomes, but systemically, it can have a big benefit - it's cheaper to release patients to BLS or perform a quick intervention without transporting where possible. Most of the Anglo-American systems allow for this, I believe.

 

[Summit]

Ummm, yeah.... with the current system, when you compare the salary of a hospital based EMS system, and a government funded EMS system (IE, public safety), you will almost always find better benefits and better pay with the government system, because it is tax funded, while the hospital systems are expected to make a profit, or at least break even (the non profits can only operate in the red for so long)

And don't be jelous of the inflated compensation package.... you are only calling it inflated because you don't get it

I worked for a municiple third service.
I worked for fedgov.
Now I work for a private nonprofit hospital making more than I did working for fedgov with similar bennies.

But that's apples and oranges because we are talking about RN vs EMS.

I am saying is that if you look at healthcare providers who have entry requirements above vocational level training, like RN or MD, government jobs do not usually pay the best. If we want EMS to be healthcare instead of public service, we need to raise our standards to the point where, yea, the private sector will be willing to offer compensation competitive with or superior to tax based services.

Where I am, medics, FFs, and PD are all paid quite similarly.

I do think that many metro FDs offer compensation packages significantly to massively out of line with what the market would bear based on the available qualified applicant pool.

 

[EpiEMS]

Where I am, medics, FFs, and PD are all paid quite similarly.

I do think that many metro FDs offer compensation packages significantly to massively out of line with what the market would bear based on the available qualified applicant pool.

I'd tend to think that, all else equal, given current levels of education and practice, entry level EMS compensation should match PD and Fire (perhaps "prorated" for EMTs, since EMT-level educational requirements are quite a bit lower than PD and Fire). This is not usually the case, nationally, based on the data I've seen.

On the PD front, I totally agree -- but that's government for you

I am saying is that if you look at healthcare providers who have entry requirements above vocational level training, like RN or MD, government jobs do not usually pay the best. If we want EMS to be healthcare instead of public service, we need to raise our standards to the point where, yea, the private sector will be willing to offer compensation competitive with or superior to tax based services..

This requires the revenue models to be different, though, no?

 

[Summit]

This requires the revenue models to be different, though, no?

Yes... well... maybe?

You wouldn't think that tax payer funded FD EMS could bill their taxpayers the exact way that private services do... but... they do even when in direct competition with the private market. Where else is that allowed to happen in the economy?

I always found that funny...

 

[NysEms2117]

I'd tend to think that, all else equal, given current levels of education and practice, entry level EMS compensation should match PD and Fire (perhaps "prorated" for EMTs, since EMT-level educational requirements are quite a bit lower than PD and Fire). This is not usually the case, nationally, based on the data I've seen.

We would run out of money... especially if everybody matches PD's pension/health plan...

 

[EpiEMS]

We would run out of money... especially if everybody matches PD's pension/health plan...

We already are... (for example)

Yes... well... maybe?

You wouldn't think that tax payer funded FD EMS could bill their taxpayers the exact way that private services do... but... they do even when in direct competition with the private market. Where else is that allowed to happen in the economy?

I always found that funny...

No disagreement there.

More directly to the original point, though: Why are private employees often better compensated than government ones? Well, I think the issue is different for your average white-collar private sector worker vs. a similar government worker than it is for public EMS vs. private EMS. In the first case, private sector wages are often higher -- but benefits aren't as generous, while for public EMS versus private EMS, the case is that public EMS has good wages and good benefits (and is likely to be unionized) while private EMS is churn and burn of low-wage employees.

 

[Qulevrius]

We already are... (for example)

Bailout, anyone ? Oh wait...

 

[NysEms2117]

We already are... (for example)

MORE money.... lol For example you can't afford people like my bosses pensions in EMS... 98% of top 5 years at 200k+. +health... again that won't be everybody, but my uncle who's a fire chief in WNY, won't even be near that... he's going to be close percentage wise, but not even close in the realm of salary.