How to fix EMS

[thegreypilgrim]

In the United States, that is.

(1) Transfer federal oversight of EMS from NHTSA to the Department of Health and Human Services (HHS).

(2) Convert all privately owned, for-profit ambulance companies to not-for-profit status. Compensate any investors for past investment.

(3) Convert all fire department operated EMS programs to an independent state (preferably), regional, or municipal agency. Downgrade FDs to CFR level.

(4) Commission the NAEMSP and/or ACEP to draft new principles and standards of EMS education, and introduce legislation granting HHS the authority to issue federal grants to accredited educational institutions to develop curricula based on said principles (i.e. community colleges and universities only).

(5) Change the Medicare ambulance billing scheme by requiring patients to be seen by providers trained to new NAEMSP/ACEP standards in order for non-transport to still be covered. Also replace the mileage-based structure with one based on clinical time usage.

(6) Eliminate the EMT provider level. Upgrade the AEMT to require an AS degree and Paramedic to BS degree.

(7) Staff all ambulances with two AEMTs which will be able to handle the majority of calls. Place Paramedics in rapid response vehicles with a driver (non-medically trained) for intercept - only auto-dispatched in limited set of calls.

(8) Restrict IFT services to non-emergent discharges, repatriations, or other routine pre-arranged transports for bed-ridden people (i.e. dialysis, PCP or specialist appointments, etc.). No SNF or urgent care to ED "non-emergent" transports from privately owned IFT organizations without referral from the primary emergency response agency.


Man...that's a lot of stuff to do.

 

[JPINFV]

9. Separate non-emergent medical transport from EMS both in terms of education and licensure.

 

[thegreypilgrim]

9. Separate non-emergent medical transport from EMS both in terms of education and licensure.

Indeed. The majority of IFT does not require medically trained personnel, but merely the means of physically moving patients and possibly some oxygen.

It would also be nice if we could consolidate our health insurance system into a single-payer model which would effectively eliminate the need for out-of-network repatriation.

 

[looker]

All I can say is keep dreaming as it will never happen and i am very thankfull for that.

 

[thegreypilgrim]

All I can say is keep dreaming as it will never happen and i am very thankfull for that.

What does it feel like to be an exploitative leech that contributes nothing of any real value to anyone? How many people have experienced adverse medical outcomes because of delays/obstructions in care due in large part to organizations such as yours? Do you ever think about that?

 

[fast65]

All I can say is keep dreaming as it will never happen and i am very thankfull for that.

Come now Pilgrim, let us hear his side of the story. Tell us looker, why would you be thankful for such a thing?

I personally agree wholeheartedly with you GreyPilgrim.

Sent from my mobile command center

 

[Sasha]

Come now Pilgrim, let us hear his side of the story. Tell us looker, why would you be thankful for such a thing?

I personally agree wholeheartedly with you GreyPilgrim.

Sent from my mobile command center

Because he owns a private company, if memory serves, in CA?

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[fast65]

Because he owns a private company, if memory serves, in CA?

Sent from LuLu using Tapatalk

I thought that was someone else? Either way, I'm sure you're correct

Sent from my mobile command center

 

[looker]

What does it feel like to be an exploitative leech that contributes nothing of any real value to anyone? How many people have experienced adverse medical outcomes because of delays/obstructions in care due in large part to organizations such as yours? Do you ever think about that?

Can you explain how private ambulance company cause delays/obstruction in care ? All bls company employee 2 certified emt. How is that different from any other bls ambulance? All ALS ambulance employee at minimum one emt and one medic, again how is that much different compare to other als ambulance company?

 

[looker]

Come now Pilgrim, let us hear his side of the story. Tell us looker, why would you be thankful for such a thing?

I personally agree wholeheartedly with you GreyPilgrim.

Sent from my mobile command center

I own for profit ambulance company in CA

 

[fast65]

I own for profit ambulance company in CA

I see, so basically, your disdain for EMS progression is solely based on the fact it would subtract from your profits?

Sent from my mobile command center

 

[firetender]

Get back on track

The initial post was a good start but now is getting perilously close to being fixated on one small aspect of the larger picture presented.

Let's continue to look at the Big Picture without getting hung up on one aspect. My understanding was it's a call to re-vamp the whole Enchilada, not just eliminate one part.

...and keep it polite folks!

 

[CAOX3]

I see, so basically, your disdain for EMS progression is solely based on the fact it would subtract from your profits?

Sent from my mobile command center

Yeah why would he be concerned with something that would take away the ability to financially provide for his family. Ridiculous.

Would you be thrilled if they made paramedic school a masters degree education level after you finished medic school and forced you to work as an EMT for eight dollars an hour, im sure you wouldn't.

EMS is a job, if they didnt pay me I wouldn't do it.

You want to fix it, someone needs ultimate control of it. Lets start there, until that happens you don't have a shot.

 

[thegreypilgrim]

Can you explain how private ambulance company cause delays/obstruction in care ? All bls company employee 2 certified emt. How is that different from any other bls ambulance? All ALS ambulance employee at minimum one emt and one medic, again how is that much different compare to other als ambulance company?

Well, it's really simple, looker, but you don't seem to understand so I'll explain it to you.

Many SNFs and urgent care centers have a financial and legal interest in circumventing the 911 system as much as they can, often to the point of inappropriateness. I don't think I have to go into the motivational basis for this as it's fairly clear that it exists; and, when there is uncertainty they will err on the side of non-emergent workup.

They use organizations like yours to perpetuate this process, and seeing as private ambulance companies are always willing to partake in these endeavors it makes them complicit in these grossly unethical practices. See how that works? You don't do anything to redirect that patient to a more appropriate care pathway, and indeed profit from not doing so! See where the problem is?

Note: as the author of this thread I endorse an off-topic direction of conversation.

 

[Sasha]

In all fairness, my company at least will ask the caller to consider calling 911 but due to contracts cant turn down a call.

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[thegreypilgrim]

Yeah why would he be concerned with something that would take away the ability to financially provide for his family. Ridiculous.

I have little sympathy for those who exploit the sick and elderly, sorry. This language of it being a necessity for familial support is emotive and enabling.

Would you be thrilled if they made paramedic school a masters degree education level after you finished medic school and forced you to work as an EMT for eight dollars an hour, im sure you wouldn't.

I don't know where you're getting master's degree as all I suggested was a bachelor's (you know, the entry-level requirement for basically every other career in existence), but as it happens I would. The reason EMTs are barely above minimum wage is because there are essentially no barriers of entry, leaving the market flooded with potential candidates. Requiring some semblance of a modern education would add a much needed element of professionalism to the field and transform it from a wage-slave job into a sustainable career.

EMS is a job, if they didnt pay me I wouldn't do it.

Compensation for most in EMS will never be livable as long as the status quo remains. I wouldn't do it for free either, and the fact that I have to continue to do it for such meager pay is largely due to the mentality of your reply.

 

[looker]

=thegreypilgrim;334872]In the United States, that is.

(1) Transfer federal oversight of EMS from NHTSA to the Department of Health and Human Services (HHS).

This would be fine by me

(2) Convert all privately owned, for-profit ambulance companies to not-for-profit status. Compensate any investors for past investment.

If people can't make much money why would they stay in this business? At the end of the day it's about profit.

(3) Convert all fire department operated EMS programs to an independent state (preferably), regional, or municipal agency. Downgrade FDs to CFR level.

Something tells me city would object to this

(4) Commission the NAEMSP and/or ACEP to draft new principles and standards of EMS education, and introduce legislation granting HHS the authority to issue federal grants to accredited educational institutions to develop curricula based on said principles (i.e. community colleges and universities only).

Couple of issue with this. 1) Will all current emt/medic be grandfathered? Also how much more would it cost to become emt/medic, how long etc? That would make big difference if people would go in to this field or not. Especially if all ambulance company become non profit.

(5) Change the Medicare ambulance billing scheme by requiring patients to be seen by providers trained to new NAEMSP/ACEP standards in order for non-transport to still be covered. Also replace the mileage-based structure with one based on clinical time usage.

Big problem if current emt/medic are not grandfathered in to this plan. Pay will also be bigi problem. Everything cost money to run ambulance company, lets not forget that.

(6) Eliminate the EMT provider level. Upgrade the AEMT to require an AS degree and Paramedic to BS degree.

This would eliminate big pool of people being how low emt are being paid. If you need to get bs to be a medic you might as well get some good bs degree and work in that field.

(7) Staff all ambulances with two AEMTs which will be able to handle the majority of calls. Place Paramedics in rapid response vehicles with a driver (non-medically trained) for intercept - only auto-dispatched in limited set of calls.

extra cost that is just not needed.

(8) Restrict IFT services to non-emergent discharges, repatriations, or other routine pre-arranged transports for bed-ridden people (i.e. dialysis, PCP or specialist appointments, etc.). No SNF or urgent care to ED "non-emergent" transports from privately owned IFT organizations without referral from the primary emergency response agency.

Why not make gurney vehicle paid by medicare and eliminate majority of the industry which is what will happened eitherway.


Replying so as to get discussion going a bit more on topic

 

[looker]

Well, it's really simple, looker, but you don't seem to understand so I'll explain it to you.

Many SNFs and urgent care centers have a financial and legal interest in circumventing the 911 system as much as they can, often to the point of inappropriateness. I don't think I have to go into the motivational basis for this as it's fairly clear that it exists; and, when there is uncertainty they will err on the side of non-emergent workup.

They use organizations like yours to perpetuate this process, and seeing as private ambulance companies are always willing to partake in these endeavors it makes them complicit in these grossly unethical practices. See how that works? You don't do anything to redirect that patient to a more appropriate care pathway, and indeed profit from not doing so! See where the problem is?

Note: as the author of this thread I endorse an off-topic direction of conversation.

If we come to SNF and find patient needs ALS, we call 911 and advice. Depending on how close als unit is available we either go l &s to nearest er. Get intercepted by als or just wait for them. Yes some company do not do that and they should be fined for that.

 

[fast65]

Would you be thrilled if they made paramedic school a masters degree education level after you finished medic school and forced you to work as an EMT for eight dollars an hour, im sure you wouldn't.

I would be thrilled, education is awesome


Sent from my mobile command center

 

[firetender]

Note: as the author of this thread I endorse an off-topic direction of conversation.

As CL, I say start another thread, keep it polite and really look at the issues rather than react.