I have been typing this throughout the day on my iPhone between (lots of) calls; I apologize if there are grammatical errors or for going off on a sudden tangent.
BACKGROUND:
In Las Vegas we run a dual response system. Every activation of the 911 system (depending on the geographical area in regards to which agency responds) will result in an AMR or MedicWest (MWA) ambulance AND an FD unit, either an Engine/Ladder or a Rescue (Mod ambulance) or both for many Delta (highest priority) level calls such as codes, big traumas, etc.
(Note: AMR and MWA are essentially the same company, but technically different at the local level; both owned by Envision- see my post in the employment section for a further breakdown of details on areas.)
Las Vegas, as most of you perceive it, is all VEGASSSSS BABYYYYY! However, the city/county boundaries are all wonky. For instance, the Strip is not part of the City of Las Vegas. It is actually the Township of Paradise, Clark County, Nevada, USA. It is an unincorporated part of Clark County, of which is about 75% of the area you all percieve as the greater Las Vegas area. The City of is very small in comparison, and that said is only about 25-35% of AMRs response area. (1/2 the County area is AMR's,including ALL of the City of Las Vegas, and the other half is MWA's, including the City of North Las Vegas. So AMR is the agency that has the contract with Las Vegas Fire & Rescue (LVFR) AKA City Fire.
Another Note: The City of Henderson (just in case you look at a map and think "well what about this area") is not included. They are self sufficient Fire/EMS and started out that way, never having private EMS.
Status quo has been that the fire agencies do not transport (unless it's a cop/FF/VIP/cool trauma they want) ever for general calls. That is why the private agencies exist, even though these fire agencies do have their own perfectly capable(in theory), although limited number, of ambulances. I don't want to bad-mouth the Fire Medics, as the FD AND CITY COUNSEL did to us, so I will do my best to keep my own opinions to myself about their quality of care vs. ours in this public forum. Mind you, we're talking about medics who have little to no regular pt care/transport outside of showing up, and maybe giving you a set of vitals. As far as them being the "quasi doctors" on scene and we're the "nurses" according to the City Counselman... Well he clearly has no idea what he is talking about... Considering we are all trained to the same standard, and now even at literally the same exact school: LVAPEC. Talk about a political clown show. My own comment about them not having regular pt ongoing assessment/critical txp experience is not the same thing... Most of them do have experience and the all are trained to the same standard. To clarify, what I mean is that they just don't do pt care... As in they don't transport... We do... They have been out of that aspect of the game for a while. Some things I see, I just shake my head.
STORY TIME:
Basically, it was shock & awe by Las Vegas Fire & Rescue (LVFR) who did not notify AMR of their intentions. A couple of weeks ago an article published in the local paper (Las Vegas Review Journal) about LVFR's Chief's plan to take over 80% of pt transports in their response area (the City) by the end of Summer. That was when AMR learned of the plan, and somewhere in the region some AMR big wigs were likely breaking stuff in their offices. AMR management was essentially stone walled by LVFR when they attempted to contact them and were told "we will call you when we need you." As of last Monday LVFR severed the CAD from AMR dispatch. Of course as you can imagine, memos are being sent out, legal action is being threatened, and big wigs are pooping bricks and banging their heads against the wall from being blindsided with the potential loss of ~25% of their transports (which honestly a lot of which is a nasty area with "customers" without health insurance anyways. Not that it makes a difference in quality of care, but rather to point out that there is no profit involved.) The current contract expires after this year, and LVFR has indicated they have no desire to renew.
On the ground level, there are numerous complications including contract provisions, Union efforts (AMR & LVFR,) citizen complaints over being billed by an agency already funded by their taxes, personnel issues, resource management and availability, supply costs, etc. LVFR has a desire to reduce their budget, and they think they're going to be taking in big bucks and cut costs by transporting. Frankly, they don't have the current man power, resources, or idea of what they're really biting off, and it's more than they can chew. They are not factoring the non-payers, Medicare/Medicade delayed and reduced payments, costs of using their own supplies, overtime, system status based rapid resource redeployment (posting,) mechanical/repair costs, their units holding the wall at the ER(s), hiring costs for the man power they're gonna need. Apparently, their Cheif's vision is now that they transport, checks will start raining on them (read: the City, not the firemen) next week...
On the day to day, since Monday, AMR crews tell me that they're still busy as hell. They are still running their butts off and call volume is not decreasing. Also, I guess this is only going on during the daytime, since LVFR runs 24hour shifts...and this is Vegas- they would literally run 24 calls in 24 hours. Most firemen are not thrilled about this either, for there will be no more gym time or the rocking of Lay-Z-Boys...
Literally last night while waiting for a bed for a pt, LVFR brought in some "un-true emergency" and had to hold the wall. In discussion with the firefighter as we sat for about 20-30 minutes he asked "Is it always like this? I've never seen it like this." When I asked how long he'd been doing this he said 8 years.... 8 YEARS! LOLz.. I replied "You've never had to hold the wall in 8 years of EMS... Welcome to reality. No more vitals and back to station... Time to work." He didn't get upset but actually acknowledged that he would indeed have no time for the gym, training, napping, etc...
In my opinion, as I said, they are biting off more than they can chew. Turning non-transporting paramedics into transporting paramedics overnight. Essentially for them, this will turn a call that used to be 15 minutes long into an hour and 15 minutes or longer call. It's just not sustainable, and also becomes a safety risk if they go for 24 hours.
The general consensus is that this will fail in short order due to the complications I've noted as well as others. The good news is that there is not yet dissent among the crews... Everyone in the field is still friendly and professional from what I have seen despite executive management throwing jabs and trying to decapitate each other.
There are many good editorials on the Las Vegas Review Journal's website on the topic with numbers and facts that have been substantiated.
Personally, I have no real dog in the fight, as its not my area, although jobs have already been threatened. To me I would imagine that LVFR (if successful) will need to expand their capabilities and hire more paramedics. Hopefully 3rd service it out or have single roll medics like FDNY or SFFD. And where one job is lost another and better one is born, and I'm all about that. On average these guys are making >80k annually without overtime and >100k with overtime. Sign me up.
Any questions? I started this post 5 hours ago.
