Nationalization or federalization of EMS

[JJR512]

In the same way Medicare/Medicaid was meant to be a national system to help solve problems?:wacko:

I don't actually know very much about Medicare, so I can't really comment. It's my understanding that Medicare could use a bit of an overhaul itself.

Look, I'm not saying that a national EMS system with real and true authority (including the power of enforcement) needs to be a part of the government. I'm just not sure how a private association can get that level of power. What akflightmedic [post=118612]proposed earlier[/post] could/might work.

 

[lightsandsirens5]

Nobody likes the prospect of higher taxes, but suppose this national system was federalized, giving it the ability to be funded through taxes. The total national cost of EMS can be calculated and put into the federal budget. Alternatively each state can fund their own agencies through state taxes.

What fed. budget? The one that is only a few tens of billions in the whole?
*said with a hint of sarcasim*

Boy JJR512, you sure got some of us going with that thread starter!!!:wacko:

Yes, I can definately see how it would benifit in some ways, but I also see how it could hurt. So l am for keeping it, at least for the momet (sp?), state regulated. Maybe in the future we will have to go to a federal system. Who knows?

 

[Summit]

I see this perpetual discussion continues.

And we see people holler "NO! Someone might take my acts allowed away!" whenever something is proposed without stopping to think that higher standards mean more skills DONE RIGHT - Better Care(tm). And of course the more education sends shivers down the spines of those who have their c-card and expect to do nothing but the bare minimum.

A basic is not a blind un-educated person

Not uneducated, most are (way) UNDEReducated. And so are many medics when you think about it and compare to other countries.

There have been interesting discussions elsewhere on the net in regards to this.

Here is a snippet of a proposal from an ERDoc who is very proactive in EMS education, standards, etc.

How about this for a solution (of course this plan only applys to the US, sorry to all of our foreign friends). Start out by making a college like the rest of medicine has. Let's call it the American College of Prehospital Medicine (ACPM), similar to the American College of Emergency Physicians (ACEP). Initially, to gain any strength or legitimacy this college would have to fall under the auspicies of a stronger, more established organization such as ACEP. They will set the standards as to what it takes to become board certified. Let's establish the requirements as:
1. obtain a bachelors degree in prehospital medicine from an accredited college/university (not Joe's Online College).
2. pass a written and oral exam

The requirements for the bachelors degree would be established by ACPM/ACEP and would obviously encompass necessary courses but at the same time the student would be required to meet the college/university's general education requirements. Those who have been working in the field would be allowed to be grandfathered in by a process to be determined by ACPM/ACEP but would include the written and oral board exams. The grandfather clause would be closed at a predetermined point in time.

So, now we have a bunch of college educated, board certified paramedics running around. How do we get the ambulance companies to hire them? Seems simple enough. We have ACPM/ACEP lobby congress to change the billing/fee process (all that money that I donate to ACEP/EMPAC might as well go somewhere). Make it mandatory for full payment that a pt be cared for by a board certified paramedic. Those that are not will only recover, say, 25-33% of what the board certified medic would recover. Set the payment schedule up similar to what we have in the ER. There would be certain levels of billing depending on the severity of the pt. No company would want to collect up to 75% less so they would be forced to hire the board certified medics. With the small supply of board certified medics the salary would go up. Given the current economic climate in the US, congress would love to be able to cut costs.

Eventually as it aged, ACPM would become an independent entity in the American Board of Medical Specialities. I've only given the topic a little thought, but it might work. I'd love to hear some feedback.

Very interesting proposal... I love it... but the IAFF & Private EMS vs ACEP/EMPAC lobby battle would be brutal.

As to worries about the one size fits all approach. From what I know about Canada, it can be made to work. After all, with in depth education, you can teach to the extremes and then each agency can make its own protocols as necessary.

Similarly, the access to ALS in remote areas could be solved by the way I understand it is done in Canada, whereas working for the state one might serve rotations in rural areas. This idea is predicated on society deciding that top level EMS is a NECESSITY rather than a luxury.

It COULD be made to work. It would be a miracle though (I'm never optimistic about fed.gov involvement, but I see no other way here) or at least take a great deal of work and commitment to get the kinks worked out and there would be a period of adjustment.

 

[lightsandsirens5]

Similarly, the access to ALS in remote areas could be solved by the way I understand it is done in Canada, whereas working for the state one might serve rotations in rural areas.

Say you lived in the city, are you going to be willling to leave your family behind to go work in a rural area for a week or more?

Are you sure this is the way it is done in Canada?

 

[BossyCow]

First you bill for all calls whether transported or not. First we pursue insurance, medicaid, Medicare, etc. We allow people to pay whatever they can afford each month, you would be surprised how much that adds up after a while.

Our charter forbids us from charging for services. We were able to institute third party payer which allows us to bill the insurance company for any services for which the patient is insured. Because the insurance company is not within our district and does not pay taxes here, they are expempt from our no bill language.

Second the citizens all voluntarily contribute an extra $5/mth.

Before you can get the citizens to contribute you have to have a vehicle for billing them for it. In many places its an add on to the water bill or other utility. We don't have those available to us.

Third you use grants for any supplys. While there are not grants for payroll there are grants for supplys and equipment. That leaves the money budgeted for supplys available to be put back into payroll.

Who does your grant writing? I'm the only one here able to write them and if I try to meet my day to day supply budget through them I'd have no time to do patient care. But then, since I'm unable to bill the citizens of my district, I'm having to purchase all those supplies out of pocket. I do currently get about $5000 a year in grant monies from grants I've written. But that barely makes the expenses of our non-payroll BLS budget and isn't going to pay for ALS

Much will have to ajusted in community/county budgets.

In order to get money from community/county budgets you have to have access to those funds. My community is not a city or incorporated area but is what is known as an unincorporated area of my county. The county itself absents itself from EMS funding and those services are supposed to be handled through local junior taxing districts. Our taxing district is currently putting together another attempt to pass a levy to meet our BLS expenses.. so tell me again how I'm going to squeeze ALS payroll out of a budget that can't quite make its expenses for BLS volunteer service.

And I could go on and on. Its there

It may be there in your area, but it isn't in mine. There are no community leaders to convince because we are not a community but a piece of land outside those juristictions. Not only can we not associate with those adjoining us, but one dropped a whole chunk of service area that they couldn't serve and dropped it in our lap.

Perhaps start off only paying 1 person then each year add 1 more etc, less shock to the budget makers that way.

I'm sorry, but do you have any awareness at all about the rules regarding a government agency payroll? You cannot have two people doing the same work and pay one of them and not the other. There has to be a clear delineation of the differences between their jobs. For instance, you can have a volunteer staff who's job is to assist the paid staff, but the job descriptions need to delineate who's responsible for what with the paid staff taking precedence in both responsibility and liability.So you can't gradually add paid staff one at a time. A volunteer cannot be made to commit to being available for a specific period of time, and has to be able to not go on a call if life intervenes. Otherwise they are on-call personnel and have to be compensated by an hourly wage set by the state. In order to be an ALS agency you have to provide 24/7 coverage which means a minimum of 3 paid staff.

Now take it a different route. Why can your vollunteer agency not go ALS?

See the above

You as volunteers would be out money for the education but monthly expenses really would not go up drastically for service.

out the money for the education, plus since the closest medic school is a 4 hour drive (one way) they would be out of the district for the length of the program. So you are suggesting that I ask my volunteers to take a year of their lives, take time away from family and their jobs to drive 8 hours a day to attend a medic school so they can come back here and give me that skill for free? The few that have gone to school have been hired by other sytems and we never see them again.

Yes initially adding EKG etc would be an expense but you might be surprised at what some big city services are willing to give away to small towns for free or at low cost.

We currently have an EKG and other ALS equipment that was used when we had two vollie paramedics who lived in our district and worked elsewhere. So that's not the issue. The issue is the day to day maintenance costs of running a full time 24/7 ALS service.
You have repeatedly tossed off how it can be done and how easy it is if I get creative .. but I'm beginning to think you really have very little understanding of the administrative side of the equation. Because

When I started in EMS as a volunteer we were ALS.

and it had all been done prior to your arrival at the agency.

 

[A140160]

You know, at least to me, it seems that the primary issues in this thread have become garbled after long discussions. Personally, I work for a company that gets approx. 350-400 calls/year. We run 1 ambulance, and just about all of us are farmers. However, ALS is provided between the 3 ambulance companies in the area by the closest city. I don't know how far you are from a bigger city/town, but that may be one way to go. The management section of EMS is not exactly my specialty, I just show up on scene in my truck and get to work, so I won't even pretend to know what's up about that.

The issue with standardizing EMS is seeming to be the area where everyone is at everyone's throats.

In my opinion, the quality of care provided by healthcare practitioners is something that should not, and can not be under appreciated or over stressed. With a higher standard with which to train our EMS providers, our patients will receive better care. However, national standardization of the protocols for us is not in the best interest of the patient. For urban settings, many EMS providers do not need to be able to do some things that many rural providers do (I mean no insult by this, as you will see in a moment).

Urban EMS tends to have ALS support just about whenever they need it, which, accompanied with a short transport time, means that the EMT does not need to be able to provide longer term care.

Rural EMS, such as my company, does not have ALS very often. Because our only paramedic is shared by 2 other ambulance comapnies in the county, many times our BLS people hear "It's John Wayne time", and may have to provide treatment for long transports. Because of this, rural EMS can make use of protocols that an urban setting can't, and all of our providers have training in their additional certifications.

The only possible solution that I have thought to this problem (while watching the Super Bowl and typing a reply!) is that if EMS did get national standardization, stipulations could easily be placed into the protocol allowing more advanced treatment to be provided by the BLS unit providing certain criteria were met. To put it another way, the Good Samaritan law lets the practitioner be allowed to do something when they believe in good faith that it will benefit the patient. In this way, the protocols could be written in such a way that if a longer transport was required, certian skills would then become available to the EMT.

 

[JJR512]

Just for clarification, I was not proposing that there be a national set of protocols to be followed universally by all.

In fact, I'd like to go out on a limb here and say that, for the most part, protocols might not be necessary at all.

What exactly are protocols? A protocol (in the EMS world) is an instruction that says, "If you have this, this, and this, then do that." Compare this to EMS education, which says, "If you have this, this, and this, then do that, and here's how you do it." The protocols that I'm familiar with (those for Maryland EMS providers) don't really tell me anything I shouldn't already know from EMT-B class, in terms of general patient care.

And this is something that doesn't have to just be a benefit of a nationalized, uniform EMS system, either. EMS classes are usually tailored to local protocols, so in any jurisdiction, the protocols could probably be mostly done away with, for the most part being replaced with a simple instruction: "Do what you've been taught." Of course, the benefit of a national unified system would be that all providers at the same level would be taught the same thing, so if you move, or go to help out at a disaster in another area, you'll be able to work seamlessly together with the other providers there because you'll all have been taught the exact same thing.

And please understand that this does not exclude the possibility of having certain skills taught and made available that are over and above the baseline standard of your level if the needs of your particular jurisdiction requires it. In those situations, there would probably need to be protocols describing when those special skills can or can't be used, with it always being made clear that those are special skills to be used in the local jurisdiction only.

 

[Summit]

^

Like I said above, with indepth and high level education standardized across the country, you can educate providers to all types of treatment modalities, even to the extremes, then each agency can make its own protocols more restrictive if necessary.

 

[BossyCow]

Personally, I work for a company that gets approx. 350-400 calls/year. We run 1 ambulance, and just about all of us are farmers. However, ALS is provided between the 3 ambulance companies in the area by the closest city. I don't know how far you are from a bigger city/town, but that may be one way to go.

That is pretty much what we have here. But our ALS agencies have recently dropped service and limited their responding units. I was responding to the posts that say "Just get ALS, its easy if you try." which frankly I'm sick of hearing.

The issue with standardizing EMS is seeming to be the area where everyone is at everyone's throats.

Yes it does. Because when you standardize, you have to pick one to fit all.

Rural EMS, such as my company, does not have ALS very often. Because our only paramedic is shared by 2 other ambulance comapnies in the county, many times our BLS people hear "It's John Wayne time", and may have to provide treatment for long transports. Because of this, rural EMS can make use of protocols that an urban setting can't, and all of our providers have training in their additional certifications.

Which according to some means all your farmer vollies need to man-up and go to paramedic school.

The only possible solution that I have thought to this problem (while watching the Super Bowl and typing a reply!) is that if EMS did get national standardization, stipulations could easily be placed into the protocol allowing more advanced treatment to be provided by the BLS unit providing certain criteria were met. To put it another way, the Good Samaritan law lets the practitioner be allowed to do something when they believe in good faith that it will benefit the patient. In this way, the protocols could be written in such a way that if a longer transport was required, certian skills would then become available to the EMT.

We have that in place currently. Which is why the current system isn't totally unworkable. I will continue to be the voice for the out of the way rural volly district which so many seem to be set on eliminating. What is a problem in the busy urban district is sometimes the solution in the out of the way backcountry districts.

 

[medic417]

[I'm sorry, but do you have any awareness at all about the rules regarding a government agency payroll? You cannot have two people doing the same work and pay one of them and not the other. There has to be a clear delineation of the differences between their jobs. For instance, you can have a volunteer staff who's job is to assist the paid staff, but the job descriptions need to delineate who's responsible for what with the paid staff taking precedence in both responsibility and liability.So you can't gradually add paid staff one at a time. A volunteer cannot be made to commit to being available for a specific period of time, and has to be able to not go on a call if life intervenes. Otherwise they are on-call personnel and have to be compensated by an hourly wage set by the state. In order to be an ALS agency you have to provide 24/7 coverage which means a minimum of 3 paid staff.



You have repeatedly tossed off how it can be done and how easy it is if I get creative .. but I'm beginning to think you really have very little understanding of the administrative side of the equation. Because and it had all been done prior to your arrival at the agency.

Many services are Paid/Volly combinations nationwide. What I have found in many places they initially start off with a paid administrator. Then a paid assistant administrator. You have created a distinction by having extra requirements such as remaining at the station while the volunteers still respond from home. Plus the paid people do grant writing. They file state reports. They attend the meetings with various government entitys to get your voices heard. You can create additional such as maintenance etc etc to have a distinction above the vollys. Be creative.

I actually have a lot of administration experience. Yes there may be variations in the laws. You may need to petition your state to make a new ambulance license if it does not have it like what Texas has that is known as a BLS with MICU capable. With that a service can staff with basics only but if they have a paramedic they can then operate ALS.

I actually have found it takes very little extra time on the various small grants available for supplys and equipment. Some of them only require a 1 page application.

The other issues you mentioned may require you getting laws changed in your area and also changes to your charters.

Comply with all rules, regulations, and laws and you will find you can use them to get what you need.

 

[BossyCow]

Many services are Paid/Volly combinations nationwide. What I have found in many places they initially start off with a paid administrator. Then a paid assistant administrator. You have created a distinction by having extra requirements such as remaining at the station while the volunteers still respond from home. Plus the paid people do grant writing. They file state reports. They attend the meetings with various government entitys to get your voices heard. You can create additional such as maintenance etc etc to have a distinction above the vollys. Be creative.

What you folks aren't getting is that I'm being creative and working towards improvement. But we are not able to become ALS just because some urban posters here think we should. We do have a paid part time administrative assistant who does some filing etc. But she is primarily clerical. The meetings are attended by myself and the other chief officers of the department on our own time as vollies. We recently planned to go to a paid chief but the failure of our recent levy and the again reduced amount of both timber tax monies and property tax monies, forced us to re-evaluate. And that's what we need to remain BLS, not advance to a higher level of service

I actually have a lot of administration experience. Yes there may be variations in the laws. You may need to petition your state to make a new ambulance license if it does not have it like what Texas has that is known as a BLS with MICU capable. With that a service can staff with basics only but if they have a paramedic they can then operate ALS.

Our state allows something similar to that and if you read my post, I mentioned at one time we had vollie medics. But the response again, was directed at those insisting that my small rural district can and should become ALS.

I actually have found it takes very little extra time on the various small grants available for supplys and equipment. Some of them only require a 1 page application.

That's true, and I write them. But, to imply that grants are going to be able to turn us into ALS overnight is unrealistic.

The other issues you mentioned may require you getting laws changed in your area and also changes to your charters.

Comply with all rules, regulations, and laws and you will find you can use them to get what you need.

What I need is for others to understand that a lack of ALS is not a sign of lack of education, lack of dedication or so help me gawd, Creativity. Sometimes its just a factor of the geology and demographics. I'm spending all day on March 9th in my state capital trying to address some of these issues. On my own time btw. Not only not getting paid, but burning a vacation day from my day job to go.

 

[VentMedic]

What I need is for others to understand that a lack of ALS is not a sign of lack of education, lack of dedication or so help me gawd, Creativity. Sometimes its just a factor of the geology and demographics. I'm spending all day on March 9th in my state capital trying to address some of these issues. On my own time btw. Not only not getting paid, but burning a vacation day from my day job to go.

There are areas much more rural than yours that did see a need to become ALS with PATIENT care in mind. Parts of Alaska, rural Idaho and a 124 mile stretch of the Florida Keys are examples. While they do still have volunteer FDs on some islands in FL, controversial at best, they do have access to ALS care. Yes, there was a political battle that had to be fought but the need for appropriate EMS should be stressed when the nearest trauma/cardiac center is over an hour away by helicopter...after the helicopter reaches the scene.

If you do not have an ALS education to provide ALS care, then you are lacking in education. Multiple BLS certs are not enough education to provide for appropriate medical care in a rural region. The hours spent doing piece mill certs could have gotten one a Paramedic cert and a more solid foundation to build for advanced care. Once the foundation is poured, the rest gets a lot easier.

This is one of our few volunteer ambulance services left in Florida and yes, they are ALS.
http://klvac.com/

[FONT=Arial, Helvetica, sans-serif]The mission of the Key Largo Volunteer Ambulance Corps. is to be recognized, trusted, and praised by our community for providing compassionate, professional, and progressive medical care at the best possible cost, by focusing on our long history of volunteerism and training. KLVAC responds to more than 1,400 ambulance calls a year with typically two ALS (Advanced Life Support) ambulances, staffed with a minimum of one paramedic and one EMT 24 hours a day, 7 days a week, 365 days a year. [/FONT]​

 

[Aidey]

I support a nationalization of EMS, but maybe not to the extent that some other people do.

I think there needs to be one standard set of certifications/licenses for all 50 states. Period. If that means using the current NREMT levels, ok. Or a revised set of levels or something. But it needs to be standardized.

Also, each level should have standard education across the board. Same number of hours for each level no matter what state you are in, same skills learned etc.

All of this will be run and monitored by a national agency, preferably under Health and Human Services and not DOT.

The agency in charge would set standards for equipment, and what needs to be on an ambulance for it to be considered a BLS, ILS or ALS ambulance. There would be a standard set of minimum protocols for BLS, ILS and ALS. There should also be something for first responder services who may not use ambulances.

Protocols could be expanded from those minimums, but could not drop below those minimums. If they did, the agency would loose their ambulance service certification for that level. To expand protocols certain criteria would need to be met, and it would have to be approved by the state EMS agency. (Which is pretty much how it works now when you expand your protocols).

This will allow for one standard system that can be regulated (and understood) as a whole. It will also make it much easier for people who move to obtain reciprocity from state to state.

 

[BossyCow]

There are areas much more rural than yours that did see a need to become ALS with PATIENT care in mind. Parts of Alaska, rural Idaho and a 124 mile stretch of the Florida Keys are examples. While they do still have volunteer FDs on some islands in FL, controversial at best, they do have access to ALS care. Yes, there was a political battle that had to be fought but the need for appropriate EMS should be stressed when the nearest trauma/cardiac center is over an hour away by helicopter...after the helicopter reaches the scene.

If you do not have an ALS education to provide ALS care, then you are lacking in education. Multiple BLS certs are not enough education to provide for appropriate medical care in a rural region. The hours spent doing piece mill certs could have gotten one a Paramedic cert and a more solid foundation to build for advanced care. Once the foundation is poured, the rest gets a lot easier.

This is one of our few volunteer ambulance services left in Florida and yes, they are ALS.
http://klvac.com/

[FONT=Arial, Helvetica, sans-serif]The mission of the Key Largo Volunteer Ambulance Corps. is to be recognized, trusted, and praised by our community for providing compassionate, professional, and progressive medical care at the best possible cost, by focusing on our long history of volunteerism and training. KLVAC responds to more than 1,400 ambulance calls a year with typically two ALS (Advanced Life Support) ambulances, staffed with a minimum of one paramedic and one EMT 24 hours a day, 7 days a week, 365 days a year. [/FONT]​

Look at the tax base of the states you cite as examples. a lot higher than mine! I'm not against making our system ALS. I just chafe at the pedantic patronizing tone of those who talk about how easy it is. I've been fighting this fight for about 7 years now and the pat answers of "you can do it if you try" and 'You just have to be more creative' from those who have never walked in my shoes irritate me. I spend hours every week trying to keep an underfunded system alive because without it the citizens have nothing. Those sittiing in urban systems, who have never attended a legislative session or county board meeting or gone door to door to promote a levy only to watch it fail, have no right to judge, or to dictate to me what my system 'should' be.

 

[medic417]

There are areas much more rural than yours that did see a need to become ALS with PATIENT care in mind. Parts of Alaska, rural Idaho and a 124 mile stretch of the Florida Keys are examples. While they do still have volunteer FDs on some islands in FL, controversial at best, they do have access to ALS care. Yes, there was a political battle that had to be fought but the need for appropriate EMS should be stressed when the nearest trauma/cardiac center is over an hour away by helicopter...after the helicopter reaches the scene.

If you do not have an ALS education to provide ALS care, then you are lacking in education. Multiple BLS certs are not enough education to provide for appropriate medical care in a rural region. The hours spent doing piece mill certs could have gotten one a Paramedic cert and a more solid foundation to build for advanced care. Once the foundation is poured, the rest gets a lot easier.

This is one of our few volunteer ambulance services left in Florida and yes, they are ALS.
http://klvac.com/

[FONT=Arial, Helvetica, sans-serif]The mission of the Key Largo Volunteer Ambulance Corps. is to be recognized, trusted, and praised by our community for providing compassionate, professional, and progressive medical care at the best possible cost, by focusing on our long history of volunteerism and training. KLVAC responds to more than 1,400 ambulance calls a year with typically two ALS (Advanced Life Support) ambulances, staffed with a minimum of one paramedic and one EMT 24 hours a day, 7 days a week, 365 days a year. [/FONT]​

You are right there is no excuse for remote areas not to have ALS. Honestly you could argue they have greater need for it than do citys. We may not have near the call volume of citys but when you spend a minimum of 90 minutes with every patient basics can basically only sit and hold a dieing persons hand. But a medic might be able to convert that bad rythym and the person live.

In this day and age Paramedic can even be attained with much of the class work by distance learning.

 

[VentMedic]

Look at the tax base of the states you cite as examples. a lot higher than mine! I'm not against making our system ALS. I just chafe at the pedantic patronizing tone of those who talk about how easy it is. I've been fighting this fight for about 7 years now and the pat answers of "you can do it if you try" and 'You just have to be more creative' from those who have never walked in my shoes irritate me. I spend hours every week trying to keep an underfunded system alive because without it the citizens have nothing. Those sittiing in urban systems, who have never attended a legislative session or county board meeting or gone door to door to promote a levy only to watch it fail, have no right to judge, or to dictate to me what my system 'should' be.

These islands are not heavily populated, nor are the incomes particularly high with many being retirees. Property value and income are disportionate and if you looked at the volunteer service link, a special district was created. Assistance is still needed from the state.

You've been fighting a fight but what fight? You don't seem to be pro-Paramedic in many of your posts and still argue that your BLS service provides good compassionate and professional care just like the big city ALS companies.

If you were a Paramedic, do you not think you might be able to present some arguements more effectively from a different point of view? We have read all the EMT vs Paramedic arguements on the forums with each having their passionate stances for their title. Maybe it is time to lead by example and get your own Paramedic certificate if you are passionate about representing your service to provide a higher level of medical care.

 

[Sasha]

You are right there is no excuse for remote areas not to have ALS. Honestly you could argue they have greater need for it than do citys. We may not have near the call volume of citys but when you spend a minimum of 90 minutes with every patient basics can basically only sit and hold a dieing persons hand. But a medic might be able to convert that bad rythym and the person live.

In this day and age Paramedic can even be attained with much of the class work by distance learning.

By just putting a medic on a truck, you are not providing ALS. You still need the money to supply this Medic with all the equipment and drugs preform the ALS care. Which costs money that some places just don't have.

A medic on a BLS truck is really no more useful than a basic.

 

[medic417]

By just putting a medic on a truck, you are not providing ALS. You still need the money to supply this Medic with all the equipment and drugs preform the ALS care. Which costs money that some places just don't have.

A medic on a BLS truck is really no more useful than a basic.

Honestly most drugs that we as medics use are not expensive and have a good shelf life. You said in another post you have most of the equipment from when you had paramedics. So really other than the first month because of having to order all the drugs it would not add much expense.

I know you want it, and I know your trying. Hopefully our battles will either give you a new idea or at least help others that are new to the fight to improve rural EMS get ideas on how to start. Never give up.

 

[jrm818]

These islands are not heavily populated, nor are the incomes particularly high with many being retirees. Property value and income are disportionate and if you looked at the volunteer service link, a special district was created. Assistance is still needed from the state.

You've been fighting a fight but what fight? You don't seem to be pro-Paramedic in many of your posts and still argue that your BLS service provides good compassionate and professional care just like the big city ALS companies.

If you were a Paramedic, do you not think you might be able to present some arguements more effectively from a different point of view? We have read all the EMT vs Paramedic arguements on the forums with each having their passionate stances for their title. Maybe it is time to lead by example and get your own Paramedic certificate if you are passionate about representing your service to provide a higher level of medical care.

I'm not even in this fight anymore but this struck me as kind of insulting. How would you feel if someone told you to stop playing make-believe doctor and go get your MD, in the interest of best patient care blah blah.

What is this "pro-paramedic" nonsense? The reality is that EMS is not the most important thing for most areas to spend their (often lacking) money on, and just because some places are willing to sacrifice for ALS does not mean they all are. Is being "pro-paramedic" the same as being "anti-doctor," as in, you don't think everyone deserves to have an MD respond on the ambulance? MD response is done in some places - the fact that paramedics even exists indicates that EMS as a whole is ready to sacrifice some educational and training requirements in the interest of cost effectiveness. In some cases paramedic may not be the cost effective answer. Heck, look at the call volume for your "rural" example - 1400/year! Bossy has already said they run less than 20 calls a month. Not quite a fair comparison.

With that volume, how on earth are these theoretical volunteer medics going to keep their skills up? The only volunteer paramedics i've ever met or heard of have full time medic jobs somewhere else for that reason exactly. It sounds like that is probably not an option in her area.


I think this little fight is the best argument against nationalized EMS. People in one area decide that they know the best way to run things in areas they have no connection to besides hearing about them once or twice, and start issuing proclamations about how things should be done, based on thier own experience in a different area. This country is so freaking big that the regional variations are beyond anything that can be well handled by a nationalized system. Base level educational requirements perhaps...but certinaly not a central administration.

Bossy - it sounds like you are doing a phenomenal job given the resources available to you, and that you have more personal passion for good quality EMS than many of the 'pros" here. How many brag about how they want nothing to do with EMS or providing even basic care when they are not at work being paid for it. For you it sounds like this is more a calling than just a "job."

The personal jabs at bossy cow / bossy cow's system need to end. I'm pretty surprised to see them aimed at her from this forum.

 

[medic417]

With that volume, how on earth are these theoretical volunteer medics going to keep their skills up? The only volunteer paramedics i've ever met or heard of have full time medic jobs somewhere else for that reason exactly.

Where I started in EMS we had a bunch of volly Paramedics. They did not work elsewhere and we did fewer than 20 calls a month many times with multiple Paramedics on the ambulance. They maintained skills and education by doing clinicals and attending classes though most of that required days away from home and paid work. Yes now they are doing as I described slowly going paid.