Las Vegas Fire looking to take over transports from AMR

[rails]

<snip> There's very few fire medics I'd let touch me or my family.

It really seems to depend on the area. In my area, the fire medics are generally very good. The same can't be said of all areas, though. I imagine that call volume (and resulting experience) plays a part.

 

[TransportJockey]

It really seems to depend on the area. In my area, the fire medics are generally very good. The same can't be said of all areas, though. I imagine that call volume (and resulting experience) plays a part.

Exactly. Plus where I've worked there are no fire medics. Private ambulance or third service had all the medics and all the experience

 

[rails]

Exactly. Plus where I've worked there are no fire medics. Private ambulance or third service had all the medics and all the experience

Yep, I'd believe that. Especially in rural/semi-rural areas in Texas, it's pretty common for private services to exclusively run the 911 medical calls.

 

[TransportJockey]

Yep, I'd believe that. Especially in rural/semi-rural areas in Texas, it's pretty common for private services to exclusively run the 911 medical calls.

And rural new Mexico too.

 

[Handsome Robb]

Apparently Nevada as well besides Las Vegas.

 

[SandpitMedic]

North Las Vegas Fire Dept, with their 2 rescues (ambulances), have taken a play out of Las Vegas Fire & Rescue's playbook.

They are now transporting, although with their limited resources they are doing only 5 transports per day, and are not able to cover the massive area alone. This has caused about zero disturbance on the ground at MedicWest.

However, Northtown (as we call it) has big plans apparently. They have a vision of a full fleet of fire based EMS/third service ambulances and are seeking to hire a full regiment of single role paramedics in the near future to staff this endeavor. They only lack one thing... Money. They are seeking a grant or grants, supposedly for 2 years of initial funding. After that who knows... That city has nearly filed for bankruptcy several times in the last few years. The PD & FD, as well as other public services have taken major cuts to funding, so it is hard to imagine they will be able to successfully sustain a new EMS division from the ground up after that grant cash runs out.

All these municipalities think the paper is going to start raining down if they take over transporting. Who knows.?

 

[TRSpeed]

Thing is medicare reimbursement rates are higher or are going to be for public services. I think. But don't remember where I read that or else Id site the source.

 

[SandpitMedic]

I'm interested in seeing the source on that.

 

[46Young]

Certainly there are pros and cons to a split system. On the one hand the ffmedic would get back to the action faster if they turn over care. On the other hand can they guarantee continuity of care for their patient. Yes, on paper a medic is a medic, however, we have all seen paper medics. FF/ medics in all area are held to a higher standard they everyone else. They do not ride the lazy boy or hang out in the gym all day. when they are not on a call they train and train and then they train some more. We are still the Johnny and Roy of old who perform on multiple levels am do it well. As for the money side of it, municipalities that bill patients do so under the same guided lines as private care companies including the handling of medicare and medicaid. The bottom line is that 80% of fire calls are EMS related and the departments should be capitalizing resources that direction while maintaining a fire ready status. Keep in mind they are only running 911, they are not running the other 98% of the private calls like interfacility transports, dialysis runs, and clinic visits. I have been in the system for 30 years so I have seen it all, don't be afraid AMR be happy you can now dedicate to the other 98%.

I agree that in an ideal situation, the first-in medic should continue care during txp. However, it's a detriment to staffing if your only medics exist on the suppression apparatus. It's unreasonable to give up the engine medic for every patient needing ALS. If a fire department insists on providing the best patient care, and providing tx/txp in a timely fashion, the department will staff their ambulance with either one or two paramedics, preferably single role. In an EMS system where every employee is an employee of that jurisdiction, they're all held to the same training standards. There should be a system in place to properly give report and hand off the patient. In that case, the second (transport) medic is perfectly capable of continuing care without any hiccups. The transporting medics will likely be working with the same fire crews, so transfer of care should be smooth.

The problem is when you have only firemedics on apparatus, and a private agency transporting, because the hiring standards and training are inconsistent, and the average tenure of their employees are typically short (generally newer, inexperienced medics). I've worked for several privates, and the training is typically poor. You may get a brief inservice for a new procedure or piece of equipment, and this typically occurs on a different day, not while on shift. Their days are spent running constant calls.

I find it hard to believe that the firemedics "train train train" all day in EMS when not on a call. I'm a firemedic. We get 8 hour continuing ed. three times a year, on duty and OOS, quarterly on-line training, and some occasional in-station drills, probably for an hour or two twice a month. That's probably more training than most privates, and probably the same amount of training that a third service does. This is a department that is is training-intensive. Firemedics are no more proficient than a third service or hospital based medic. If anything, the firemedic has more job security, so the QA/QI is more lenient, and the testing can be less strict as well.

If anything, the firemedic has to devote equal time to suppression training. This isn't too difficult to do, so long as you actually devote at least an hour to training in either fire or EMS every day (not including a street drill). From experience, I can say that wearing multiple hats becomes very difficult when you add additional specialties, such as TROT, Hazmat, and Heavy Rescue Squad training. There's just too much training to be good at three or four things.

The above all relies on the firemedic taking EMS seriously, and not as a necessary evil in order to do fire. I find that our most proficient medics are those that started in single role EMS and escaped to fire, or those that joined the FD because there's no other good EMS employers where they live. I also see firemedics that truly enjoy EMS initially, but grow to resent it years later because they keep getting detailed to an ambulance when they would prefer equal time on a fire piece. That would somewhat describe me. We spend most of our time running BLS, so I tend to become disinterested in EMS (not outright resentment - yet), and this results in doing less training and reading about emergency medicine. It takes a good tour or two of good ALS calls to renew my interest in EMS. Understand that I started EMS in NYC, where an upgrade to ALS means that you see mostly ALS patients, and you aren't dispatched to any BLS calls. That was an important benefit to going ALS - way less "nothing" calls. Now, that's 80-90% of my call volume. Recently, though, I had a V-tach with a pulse, a respiratory arrest, and two patients with agitated delerium where I got orders for ketamine and versed. I might not see that degree of action again for three or four months.

All-ALS transport systems (fire or single role) suck for that reason, IMO. Also, realize that single role medics typically burn out in 7-10 years on the average, so the problem of becoming disinterested in EMS after some years is not specific to the fire service, not in the least. I have 12 years in EMS, with at least full time hours on an ambulance, so I can vouch for the 7-10 year estimate for burnout. If I was still sitting on street corners doing EMS in NYC, I would be burnt as well.

 

[DrParasite]

AMR, Vegas Fire Department reach deal
By JANE ANN MORRISON
LAS VEGAS REVIEW-JOURNAL
Las Vegas’ dual response system for emergency ambulances is dying.

A 911 call for a medical emergency no longer will receive a response from both the Las Vegas Fire Department and American Medical Response. One or the other will be dispatched, not both.
After more than a month’s negotiations between the department and AMR, each side gave a little for this proposed contract, which is expected to be signed and presented to the council at its Sept. 3 meeting.

“It sounds like there’s peace in the valley,” Councilman Bob Coffin said. Fire Chief Willie McDonald said there will be a division of labor: The department will respond to more serious emergency calls while AMR responds to less serious calls. He predicted that means the department will handle 60 percent to 65 percent of the calls, instead of the 75 percent he originally sought.

http://www.reviewjournal.com/news/fire-rescue/amr-vegas-fire-department-reach-deal

 

[gonefishing]

Whats a "serious" call? Would that be a full arrest etc and a non serious call being that of another fallen drunk? lol

 

[chaz90]

Does Vegas use PMD codes? It almost sounds like they're going to send AMR to the Alphas/Bravos and fire to the Charlie/Delta/Echos. Sucks to be an AMR medic in Vegas...

 

[SandpitMedic]

Does Vegas use PMD codes? It almost sounds like they're going to send AMR to the Alphas/Bravos and fire to the Charlie/Delta/Echos. Sucks to be an AMR medic in Vegas...

Yes

EMD coding utilized here.

Unknown what codes exactly. As it stands it is any MVA and any Delta. I do not know yet how/if that will change.

 

[SandpitMedic]

Yeah, thats gonna suck. Honestly though, I've had many more a serious Alpha, Bravo, Charlie than legitimate Deltas.

 

[Bullets]

Exactly. Plus where I've worked there are no fire medics. Private ambulance or third service had all the medics and all the experience

And in NJ, Fire/Medic is not a thing, all ALS is third service privates

Yeah, thats gonna suck. Honestly though, I've had many more a serious Alpha, Bravo, Charlie than legitimate Deltas.

How many 'Chest pains" turn out to be MI? how many "sick" patients end up being something serious like sepsis, MI or something. At least around here, we dont code our calls but ii find im requesting ALS more for calls that start as BLS than keeping them for calls that are sent as ALS.

 

[SandpitMedic]

This editorial is spot on! Here's the latest. From a source at AMR, they will run only Alphas and Bravos.

http://m.reviewjournal.com/columns-blogs/glenn-cook/city-amr-shut-and-drive

 

[terrible one]

http://m.reviewjournal.com/columns-blogs/glenn-cook/city-amr-shut-and-drive

City to AMR - shut up and drive

 

[DrankTheKoolaid]

Read the Fitch report. Expect change

 

[Rick Tresnak]

Wow so much for a Governmental agency not being in direct competition with private enterprise. Sounds like the DOG SIT mentality. I bet Mark is beside himself.

 

[SandpitMedic]

The storm: Las Vegas Fire Facing Two Federal Court Wrongful Death Suits Over EMS Response

http://www.firelawblog.com/2015/07/...court-wrongful-death-suits-over-ems-response/

Interesting. It will be very interesting to see how this plays out. One of the most notable cases was the death of a man stabbed, where an AMR rig was literally 20 seconds away near a McD's parking lot, but did not get the call. It was given to a fire unit, which was farther away, delaying treatment by several minutes, resulting in the death of the patient.

I predict this will go on and on and on for a long time. Settlements are not what they're after.