L.A. County EMS Laws
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daedalus
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I prefer to work and live in a county where Paramedics do not have to call for orders from a nurse to do anything more than a set of standing orders that fits on half a page of paper (check Procedures Prior to Base Contact) (doctors do not even bother answering radios in LA, next time you are in a ER in the county ask why).
Yes, I can point to the fact that becoming a paramedic in Los Angeles does not require college anatomy and physiology. Becoming a paramedic in Los Angeles does not require any college education at all or let alone a AS degree (most places do not but where I work now you are looked down on for doing the bare minimum of education). I can point to the fact that many fire department paramedics are not happy preforming their duties on the rescues or squads and are just biding time until they get on an engine, and then the paramedic cert gets dropped. Does patient care thrive in such an environment?
One has to look no further than the fact that paramedics in Los Angeles are not allowed to read 12 leads, not allowed to intubate pediatric patients, not allowed to treat patients based on their field diagnosis, and have to call nursing control (one cannot call it medical control because no doctors answer the other end) to get permission for their third round of drugs in a code (hint no one else has to do this). It seems like year there is another bulletin from EMS talking about new cuts to the paramedic scope of practice.
Can I provide studies to demonstrate poor outcomes? No. I wish I could and I would bet a pretty penny that most other systems in California would far surpass the Los Angeles and Orange County systems. However, based on my work history as an IFT, and then 911, and after that a CCT unit EMT in the county, I have seen the results of the care provided to patients before, during, and after 911 calls. I have transported patients on CCT who were nearly killed by fire paramedics. I have worked with paramedics who BLSd me intracranial bleeds (a very bad thing to do). I have a friend who was given a STEMI patient by an LA County Fire medic while they went back to the station. The doctor in the receiving ER actually drove to the fire station to have a words with that crew, who threw him out of the station. I know what an LA county Paramedic patient assessment looks like, and they are pretty poor. Day in and day out I saw things that made me question my place in EMS and in medicine in general if these things I saw was how emergency medicine was practiced everywhere. To regain my sanity I moved to a system north of Los Angeles, and it is night and day up here. We are accountable to physicians for our actions. We are expected to provide quality care, unlike in Los Angeles where the RN feels like she has a good paramedic if they bothered to start a line (when needed). We can think independently and have protocols on par with that. The paramedics value education.
I am someone who values quality patient care. I chose to leave Los Angeles county because of poor patient care. I have a better paying job now, with more respect from other medical professions. We are seen as professionals in their eyes, this is something i have never felt in Los Angeles.
daedalus
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Oh, and I find it funny that local malls and gyms can provide a higher level of care to cardiac patients than EMTs in Los Angeles who do not work for one of the three-four ambulance companies (out of around 90) who carry AEDs.
JPINFV
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That's not 100% accurate. I used to volunteer at a base hospital in Orange County and there was an RN and physician assigned to the radio. While the RN handled all of the radio communication and could issue most of the base hospital orders by themselves, they were linked via a Nextel to the designated physician. In 6 months, I think I observed the radio RN discuss something with the physician once. The vast majority of the calls to medical control were calls because they were forced to based on protocol.
Edit: Base hospital contact and transportation guideline: http://ems.dhs.lacounty.gov/policies/Ref800/808-1.pdf
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Iam glad someone values patient care, but patient care isn't going to pay my bills, bla bla bla, if the system is so bad why doesn't anyone fic, must not be broken Iam sure all the medical directors in LA Ciunty would jump on improvement, but wait we still have operate under a Dr. I guess up north in Ventura they don't do that? I guess there are no fire medics up north just private heros that operate on there own agenda, man I got to go there and be a cowboy.
JPINFV
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Nice false dichotomy there by saying that all fire medics are heroes and all private medics are cowboys.
Now, my question is, "Why do counties that don't use fire medics for the majority of EMS (like, say, Riverside County outside of a few areas) have more progressive (ok. You got me. "progressive" and "California EMS" doesn't belong in the same sentence, but still...) and liberal treatment protocols than LA and Orange County?" Again, I'll note that in Orange County, if you're working as a paramedic, you work for the fire department.
Now, my question is, "Why do counties that don't use fire medics for the majority of EMS (like, say, Riverside County outside of a few areas) have more progressive (ok. You got me. "progressive" and "California EMS" doesn't belong in the same sentence, but still...) and liberal treatment protocols than LA and Orange County?" Again, I'll note that in Orange County, if you're working as a paramedic, you work for the fire department.
Shishkabob
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Because people like you advocate less education, less responsibility, and in general don't care about being a medic. You'd rather put blue on red then handle medic calls, which ironically enough, is more than 70% of your call volume.
And you're telling me there is nothing wrong with that picture?
Wow. You do realize that in this one paragraph, you validated everything that Daedalus said about fire-based EMS in your area, right? And everyone else that has posted here over the years saying that for firefighters, it's all about getting a bump in pay and a patch, and not much about making sure that sick people live.
So, patient care doesn't matter, as long as you get paid well? I'm glad to know what your priorities are. I'll take the cowboy who actually gives a crap and keeps his skills up to date.
daedalus
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I am referring to Los Angeles County. Most docs I became friendly with would laugh at the prospect of listening to a paramedic's report. That is sad. RNs with the MICN training answer the radios here and the paramedics never call for consultation or for potential creative solutions to problems, just for orders to continue down a pre-established protocol they cannot even follow without permission. (note, this is a complicated are for LA County. There are two fire departments in the whole county that are allowed to follow very limited protocols, but all others must call for orders for very basic things. Look into SFTPs for more info)
**atropine. I never said I worked in Ventura. I live here, and I might work here, or I might work in Kern or Santa Barbara or San Luis.***
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Hey man chill out I am just saying that I enjoy my money thats all, I can't pay my bills with protocols thats all Iam saying, and yes again if it's so broken why haven't any of the medical directors try to fix it?, valid question I think. The reality is we have to get paid and why not make the best of it, if you want to make $13.00 an hour as a private medic with progressive protocols although you still have to do what an MD tells you to do then thats your right I guess. Hey man just saying I like the money thats all people will live and people will die, not my problem.
The medical directors are limited because there are too many that should not be Paramedics but unfortunately somehow got the job as a FF and many of them should not be doing that. When medical directors are presented with those who have the attitudes about education and patient care such as you they have little choice but to have a nurse give you permission to do a protocol or if necessary have them read the protocol to you. Quite possibly if there wasn't a union protecting you for doing so little or nothing at all but show up, the medical director could do something about improving the system.
In other systems the medical director writes the protocols and allows the Paramedics to think for themselves what protocol to do. The nurse or doctor doesn't have to read the protocol to the Paramedic on each call.
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Not to defend anything to do with Southern California EMS (or California EMS period) or what atropine has said, but a couple of things said by daedulus do need to be addressed as he is, in essence, saying that terrible patient care is the standard throughout the country.
Again, I'm not saying that EMS in that area ISN'T horrible, just that grandstanding claims and baseless rhetoric don't do anyone a lot of good. You want change...this isn't how to do it. Get your facts and arguments straight, and then present them. The more you go based off emotion the worse off you will be.
The vast majority of paramedic programs don't require college level A&P or a degree of any sort. I guess that means that everyone from those places performs terrible patient care.
I can point to the fact that many private, hospital based and third-service paramedics are not happy performing their duties and are just bidding their time until they retire or move on to something else. Does patient care thrive in such an environment? Once again by this reasoning, apparently lot's of places perform terrible patient care.
Huh. So it's all anecdotal evidence that you, someone admittedly biased against the fire service and EMS in So. California are providing. While you may be right, don't you think that this creates just a small problem with your credibility?
Again, I'm not saying that EMS in that area ISN'T horrible, just that grandstanding claims and baseless rhetoric don't do anyone a lot of good. You want change...this isn't how to do it. Get your facts and arguments straight, and then present them. The more you go based off emotion the worse off you will be.
triemal04,
Tell us all now, have you even been to Californa or more specially the Southern part? Do you know anything at all about these FDs? Have you even taken the time to research CA's statutes or the LA protocols? Probably not. You are just spouting emotional stuff again about something you have no knowledge of just to look like a tough fire fighter which you probably aren't one either but would like to be.
There are reasons why RNs do the majority of CCT and flight in that state as well as giving the Fire Paramedics permission to do their protocols.
Educate yourself before attacking another forum member's credibility.
Tell us all now, have you even been to Californa or more specially the Southern part? Do you know anything at all about these FDs? Have you even taken the time to research CA's statutes or the LA protocols? Probably not. You are just spouting emotional stuff again about something you have no knowledge of just to look like a tough fire fighter which you probably aren't one either but would like to be.
There are reasons why RNs do the majority of CCT and flight in that state as well as giving the Fire Paramedics permission to do their protocols.
Educate yourself before attacking another forum member's credibility.
Daedalus, the last time I checked, the NREMT didn't require a degree to test, let alone just A&P or pharm. Anyone from any state can go through a mill, get their state card, get the registry, and work at any agency in the country whose state recognizes the NREMT-P for reciprocity.
The vast majority of medics in NYC that I've come across hold no degree whatsoever. NREMT-P isn't required to be employed, either. Having NYC 911 experience on one's resume will definitely raise an eyebrow most places you go (for 911).
The vast majority of medics in NYC that I've come across hold no degree whatsoever. NREMT-P isn't required to be employed, either. Having NYC 911 experience on one's resume will definitely raise an eyebrow most places you go (for 911).
reaper
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No, most decent systems are looking for medics that advanced their education. If I look at a resume, I could care less if it has NYCEMS listed on it. I will go off the persons abilities and education first!
You MUST be kidding. I know plenty of people who have left NY for other places. Easily hired. Let's face it, regarding 911, where else do you have medic units that are required to always be double medic, only get dispatched to ALS call types, and have a high call volume (high acuity as well, worth mentioning) at that?
Everyone knows that working in NYC gives you a steep learning curve relative to time in service. Your job types for the shift are diff breather, asthma critical, cardiac condition, arrest, AMS, multi trauma, unconscious, OB out, etc. etc. You may not see every call type each shift, but you'll get your fill of legit jobs throughout the course of the week. Some nights that's actually what I've run. Compare that to the resume of someone who works out in the sticks. Actually, compare that to someone who works in a busy system, who is subject to mostly BLS, with good, legit ALS jobs being few and far between (maybe even a 911/IFT hybrid). They're doing sick calls, minor injuries, EDP's, BS MVA's while the NY medic is spending that same time learning from higher acuity and critical pts. The NY 911 experience speaks for itself, no one can deny that.
Really, how many medics out there actually have degrees anyway? One in 10? One in 20? One in 100? How many of those actually stick around in EMS for their entire career? More likely if they're applying to flight or CC, but we're talking about 911 prehospital medicine here. We all know that the industry has a high turnover as it is. Many agencies, even quality ones, go through medic shortages from time to time. Most places only look for the NREMT-P card or state. I've never been asked where I went to medic school, and neither has anyone else I've spoken to. That's because no one cares. If you've got the card, you're good. What DOES count is experience. Most places will give you a general knowledge exam prior to hire, maybe a scenario/protocol based oral board, maybe some skills stations before release to internship on the street. That's it.
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DrParasite
The fire extinguisher is not just for show
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using that logic, being a medic in NJ would be just as valuable as NYC experience, since all NJ medics work in the exact same system that you just described. and for some reason, we have many NY & PA medics that come to jersey (probably has something to do with the better pay with less BS)
actually i know medics in NJ that can run all those calls in a single shift (except for OB, those are BLS calls), plus a GSW or stabbing.
one thing to remember about NYC EMS: you have a hospital every 7 blocks. your transport times are often super short, and how much ALS can you do in under 15 minutes? or to clarrify, how many interventions can you perform, see the changes, and then perform additional ones for?
don't knock the rural guys, when you have a sick patient, treating them for 20-45 minutes is a lot more difficult that treating a sick patient for a 3 minute transport.
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NYC is better known across the country (world), although NJ medics may be just as qualified.
I know that the pay and working conditions suck in NY. That's why I left, as have many others.
We do plenty onscene if we're up a few flights and we have reservations as to whether the pt will remain stable for the trip down to the bus. The city's goal is 20 mins onscene, otherwise they start calling for updates. If you've got two good medics, they can assess and bang out most of the interventions onscene, and complete the rest enroute to the hospital. I would keep a mental picture of how much time I have when enroute to the hospital to get stuff done. I'll do the rest onscene with my partner. sometimes we can't get to everything, but often we do. We're not held back by having to call the receiving hosp while enroute to the ED either. The driver gives a quick note to the dispatcher (age, sex, CC, ETA, ALS established) freeing the medics to work.
A hospital every seven blocks is a gross overexaggeration. My txp times averaged between 4-10 minutes, sometimes longer depending where we're coming from. You can't fly down city streets, either, with all the potholes and such. In Queens alone I've seen St. Joe's (Union Tpke), St. John's (Queens Blvd), and Mary Immaculate close. That leaves Mt. Sinai of Queens, Elmhurst, Jamaica, Flushing, Forest Hills, NYHQ, LIJ and NSUH Manhasset (actually 3-5 minutes into Nassau County) for the entire borough of Queens.
As far as the rural guys, how many of these critical pts are they actually transporting on a daily (monthly, yearly) basis? I had a taste of that in Charleston County, in McClellanville, John's Island, and similar places. They have RSI, they have medevac available weather dependant, but the typical practice there is to quickly load up and literally do everything enroute to the ED. So, in NY we treat onscene for 15-20 minutes, plus another 5-10 enroute to the ED. The rural crew spends five minutes onscene, and transports for 20-30 minutes, with a medevac option usually available for a critical pt. 20-30 minutes average for the urban crew, vs 25-35 minutes for the rural crew. Not much difference. The only drawback is that you may be the only medic there. Even still, I don't see a rural area running constant high acuity pts for long distances. Certainly not enough to surpass the urban medic's general proficiency.
daedalus
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Say what you want, but I actually worked in LA. I can only offer you the truth from my eyes, the way I saw things, and I recognize that my truth may be blasphemy at another's ears. Like I said, I got the opportunity to see the results of prehospital care on emergent CCT transports. I got the opportunity to deal with patients being discharged as well. And than I got to work with the paramedics themselves on a LA BLS 911 car. I got to see many facets of the system and I got to learn from many different RNs, RTs, Paramedics, and doctors (we sometimes took residents and even attendings on our transports). I tell you what I can based on the sum of this experience. I do not have goal of knocking down fire departments. My aim is to increase the quality of my own care to patients.
You are trying to disprove my subjective experience. I am not offering any proof, just personal observations. I went into my job not aware of the problems facing EMS and got to learn about them myself. I had the gift of a broad view of medicine before even starting in EMS and I got to work around some very passionate people in public health and family medicine. I found the very opposite to be true in Los Angeles and am still sick to my stomach remembering the nights I spent second guessing my place in health care. I have regained sanity and focus where I am now, and it is people like the ones in this thread that drive me to continue towards my goal of becoming a medical director to restore the medicine to EMS.
Please don't belittle my experiences and observations in a busy EMS system without first spending some time here yourself. And like I and Vent have said, just look at what they allow paramedics to do (or rather, not to do) in LA. You will see that they are not trusted to do much at all.
You are trying to disprove my subjective experience. I am not offering any proof, just personal observations. I went into my job not aware of the problems facing EMS and got to learn about them myself. I had the gift of a broad view of medicine before even starting in EMS and I got to work around some very passionate people in public health and family medicine. I found the very opposite to be true in Los Angeles and am still sick to my stomach remembering the nights I spent second guessing my place in health care. I have regained sanity and focus where I am now, and it is people like the ones in this thread that drive me to continue towards my goal of becoming a medical director to restore the medicine to EMS.
Please don't belittle my experiences and observations in a busy EMS system without first spending some time here yourself. And like I and Vent have said, just look at what they allow paramedics to do (or rather, not to do) in LA. You will see that they are not trusted to do much at all.
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Really what do plan to restore in ems?. I only ask because there are several medical directors in the LA county area and things have been working just fine for the past 30 plus years. Again if people want to work for peanuts and go else where more power to them, I worked in Tulsa Oklahoma and it sucked money wise, but the calls and protocols were decent, but I don't mind calling the micn. I get to support my family and toys so I am cool with that, this talk about change and standard well I believe it when ems gets rid of system status.