Nationalization or federalization of EMS

[lightsandsirens5]

Wow! Fly a helicopter to a scene and take it out of service for a ground transport? If you had a Paramedic already on board, you would save your district a lot of money by not putting the helicopter into flight and also endangering the crew with a patient that could go by ground.

This is probably the best argument I have heard so far on this thread as to why ALS is needed in some areas.

OK, look. You want to fix EMS? Go ahead and try. I'd absolutly love ALS in rural areas. I just dont think it is always going to be feasible! What is next best? *Gasp!* BLS and ILS!!!!!!

 

[VentMedic]

Why is it that some in EMS continue to argue against the advancement of medicine while other professions are continuously striving to find ways to improve healthcare in their professional areas and communities?


jrm818,
You need to broaden you view about healthcare and learn how we do provide medical care to millions of people who are poor. EMS should not discriminate its 911 services based on the size of the patient's wallet.

Luckily the Freedom House Ambulance service did not use your logic and saw the need for Paramedics over 40 years ago.

 

[VentMedic]

OK i lied...after this I am leaving

that is not an argument for the "need" of ALS, but a benefit of ALS. "need" would be proven by demonstrating that ALS care makes demonstrable positive changes in overall population health in a cost effective manner.

E.G. if the money for ALS could also be spent increasing primary care access, and it was shown (as i bet it would be if this could ever be acutally quantified) that every dollar spent on PCP access has more of an effect on overal population health than every dollar spent on ALS, than I'd say ALS is not "needed" at all.

So you justify flying a helicopter to a BLS truck just so they have a Paramedic to ride in the ambulance with them to the hospital?

Do you know how much the helicopter and what each flight costs?

 

[Aidey]

Why is it that some in EMS continue to argue against the advancement of medicine while other professions are continuously striving to find ways to improve healthcare in their professional areas and communities?

Because we, more than any other medical service in the US, are accountable directly to the tax payers. If the tax payers won't support it, we can't do it. We can't force them to fund ALS if they don't want to. It doesn't mean that people don't want to advance or make things better, but it creates a ceiling there that can be difficult to break through.

Alternatively, we are also hampered by fire based EMS systems run by fire fighters who see EMS as the red-headed step child who is only good enough for the left overs.

 

[lightsandsirens5]

You need to broaden you view about healthcare and learn how we do provide medical care to millions of people who are poor. EMS should not discriminate its 911 services based on the size of the patient's wallet.

Do you actually think this? Do you actually think that my service or any of the rest of us volly and or rural services really do this? :angry:

Does BLS/ILS not count as medical care in your book? I sincerely hope that this isn't the view of most of the rest of you that are in this discussion.

 

[VentMedic]

Do you actually think this? Do you actually think that my service or any of the rest of us volly and or rural services really do this? :angry:.

Did you bother to read what it was in context to?

Does BLS/ILS not count as medical care in your book? I sincerely hope that this isn't the view of most of the rest of you that are in this discussion.

Again, as I have already pointed out, those who hold a title will argue that their title is the best. EMS has held on to its titles, all 50+ of them, and have continued to argue that their title is the best regardless of its limitations. If you, yourself, were to advance to a higher level, you might be able to do a whole lot more when it comes to providing care to the patient. At this time and for your level, you may not even know what all you don't know.

 

[VentMedic]

Alternatively, we are also hampered by fire based EMS systems run by fire fighters who see EMS as the red-headed step child who is only good enough for the left overs.

So be it. If the FD is the only option available to provide ALS care in a rural region, then they should. You can not blame all EMS problems on Fire. Many providing the arguments here are strictly ambulance and still do not want to advance their education to make their point of who can provide better care.

 

[Sasha]

Alternatively, we are also hampered by fire based EMS systems run by fire fighters who see EMS as the red-headed step child who is only good enough for the left overs.

Why do people want to blame all of EMS problems on EMS based fire service?

 

[lightsandsirens5]

Again, as I have already pointed out, those who hold a title will argue that their title is the best. EMS has held on to its titles, all 50+ of them, and have continued to argue that their title is the best regardless of its limitations. If you, yourself, were to advance to a higher level, you might be able to do a whole lot more when it comes to providing care to the patient. At this time and for your level, you may not even know what all you don't know.

What does the 50+ thing mean? :unsure:

I am trying to advance, I'm taking an ILS class this spring.

 

[VentMedic]

What does the 50+ thing mean? :unsure:

I am trying to advance, I'm taking an ILS class this spring.

There are over 50 different EMS certifications/licenses in the U.S. with each state being "creative" for whatever purpose to do a piece mill patch work that has severely fragmented EMS. To further complicate matters, some states change titles and "skills" every couple of years so it is difficult to even know who is doing what or who is called what. This leads to confusion not only amongst the EMS providers but the public as well as the politicians who want to help but can't figure out all the different levels.

http://en.wikipedia.org/wiki/Emergency_medical_responder_levels_by_U.S._state

Washington state has at least 6 or 7 different levels.

This is by far more damaging than what Fire-EMS can be blamed for since many of the FDs do strive for their FFs to be Paramedics and provide ALS. Granted the way some FDs approach it is not always perceived to be the best, but the right general concept is there.

Don't stop at ILS. Go straight to Paramedic or whatever it is called in your state.

 

[A140160]

Anyone that knows me, (and I seriously doubt any of you know me ) knows that I hate all this flowery talk my way around the other person crap, so I'm going to say it very clearly hear: Please, stop playing my guns bigger than your gun with everyone! There is no need for us to be picking at each other about what's better. Sure, ALS can provide better care, but in reality, not everyone warrents an ALS response. Mrs. Jane Doe doesn't need a paramedic to treat her because she stubbed her toe! On the other hand, Mr. John Doe could definately benefit from an ALS response while having a huge MI! This thread has gone from how we might be able to do something, to lets try to insult someone because their different from us. You can't change incomes or demographics with words, and therefore you aren't going to be changing the range of ALS with bickering among each other as to who's better.

 

[VentMedic]

Sure, ALS can provide better care, but in reality, not everyone warrents an ALS response.

_____________________________________
You can't change incomes or demographics with words, and therefore you aren't going to be changing the range of ALS with bickering among each other as to who's better.

Regards of not every call is ALS, a community should have access to ALS without waiting for a helicopter to bring a Paramedic. This is about providing quality medical care which often gets confused with the terms EMS has dished like labels that belittle patient care.

These arguments would never fly if a hospital was to decide it could be ran with only CNAs and LVNs instead of RNs.

To change what happens iin an area, the providers themselves must change and grow as medicine changes. They must accept that the world is changing and people in the U.S. can ask for better care. If the providers themselves are giving the arguments against advancing the level of care, what message are they giving the people that do hold the tax dollars at both the private citizen and government levels?
"We've done just fine without no big city ideas". Great attitude to keep your community hidden from all those scary things in the real world.

I have been there and seen communities out in the middle of nowhere go from volunteer BLS to an all paid ALS. Some residents of those communities were as poor as they could be without living on the street and some were even homeless. Yet, their community had ALS and an improved chance for survival if they did have a medical emergency.

Enough with which patient should have ALS or BLS. They need MEDICAL CARE. You don't know what a patient needs until an assessment is done and then without the proper education, you still probably won't know. If you do assess something more is going on, what can you do to make a difference?

So, there are times when some EMS providers themselves are the reasons why EMS has not come together with the single goal of doing what is best for THE PATIENT. Everyone has their own agenda and set of excuses.

 

[Veneficus]

Vent,

This goes to the can of worms of public safety vs. public health. (which implies medicine)As you know I am squarely in the public health/medicine camp. For a long time we have tried to show people our perspective and they will be dragged kicking and screaming, as examples look at what wake county just instituted or the advanced practice scope developing in Britain. The idea of BLS vs. ALS is a naïve argument perpetuated by those who do not understand anything more than what their skill testing sheets require.

This thread, which I have been following, but largely holding my tongue, is preposterous. Legally and practically nationalizing EMS is impossible. Could you imagine the US fire Service as a federal agency? It works here in Europe because states are divisions of a country, whereas in the US, the country is actually a federation of largely independent states.

Somehow from that the thread digressed to the ALS vs. BLS and what is affordable argument. That can only lead to the education argument. Then in classic predictable form, those who know the least about medicine have the most to say about how it should be done.

Our current concept of an EMS safety net has not worked, is not working, and will not work in the future. A new safety net that includes primary care needs to be put into place in all communities. As there is not enough physicians to put on ambulances, there are not enough “mid level” providers to go around either. More detailed knowledge of medicine and autonomy (and commensurate responsibility for such) is the only realistic way forward for both economics and patient care.

As for paying for it, I think our brethren down under have a solution workable in the US. There must be a state EMS agency. Just like there is state police, and a state fire marshal. Now I know that many states are economically challenged, but healthcare needs to be a higher priority than parks and recreation, transportation, and other expenditures. Unhealthy people cannot work, they cannot learn, they cannot travel, and they cannot overall contribute to making their community better. The US has more sociological consumers than producers. That is going to get worse before it gets better. The public, aka patients, are no longer served by an expensive taxi ride to the hospital, which is what skill based EMS is. It is no wonder in most places there is little public support for EMS. As it stands It is largely not worth paying for.

Anyone who wants to help a patient needs to forget IVs and ET tubes, LMA, medications, etc and start learning biology, chemistry, anatomy, physio, patho phys, etc. There is a reason basic science is a prerequisite for every level of healthcare provider all over the world. (except US EMS apparently) Medicine is not like working a saw or welding, you have to know how and why things work, not just what to do when you see sign X and symptom Y. >90% of all “emergencies” are not life threatening. Why do we spend so much time, money, and effort on less than 5-8% of what we do?

My antagonists will argue they are saving lives. But they don’t even realize how flawed that perspective is. But they do need the mental security of thinking they had a positive part to play greater than a ride.

 

[lightsandsirens5]

There are over 50 different EMS certifications/licenses in the U.S. with each state being "creative" for whatever purpose to do a piece mill patch work that has severely fragmented EMS. To further complicate matters, some states change titles and "skills" every couple of years so it is difficult to even know who is doing what or who is called what. This leads to confusion not only amongst the EMS providers but the public as well as the politicians who want to help but can't figure out all the different levels.

http://en.wikipedia.org/wiki/Emergency_medical_responder_levels_by_U.S._state

Washington state has at least 6 or 7 different levels.

This is by far more damaging than what Fire-EMS can be blamed for since many of the FDs do strive for their FFs to be Paramedics and provide ALS. Granted the way some FDs approach it is not always perceived to be the best, but the right general concept is there.

Don't stop at ILS. Go straight to Paramedic or whatever it is called in your state.

Ahhh...I get you. I have heard that my stste is doing away with Intravenous Therapy Technician, Airway Management Technician, and IV/Airway Technician to make things simpler. So, a leeettle step in the right direction?

Soooooo.......you say skip ILS? I was thinking of it, but I can get the class for free and I can't afford a medic course right now, so I may do it just for the heck of it. (Besides I can get college credits for taking the class.)

 

[Ridryder911]

Wow! I did not realize we had so many experts in EMS development! (satire) Amazing, so many immediate Systems Developers that do not know squat about establishing EMS Systems and what is required or payment structures. Then yet want to proclaim National EMS Standard (patient protocols) when they have NO correlation at all. National Standards of Treatment and Protocols would be disastrous! Until we have a standardization of education, thinking of such is asinine! Making statements such Medical Doctors or comparison of such demonstrates poor knowledge of EMS Systems. Especially considering the history of how EMS was developed, and the role of the providers as physician representatives.

How many of these so called "hurting services" actually have a adequate coding and billing department? If you offer services for free then quit whining and change it! Your potential patients deserve better! You don't even bill insurance companies? If not, its not just foolish its stupid! Sorry, services costs and it would be nice if things in life where free, but the old saying "what you pay for, is what you get". If its in your charter, change it!

My service offers a full time with double Paramedic 24/7 in a poverty town of < 1000 people. They pay addtional $9.00 a month for EMS + also get a bill if used. The reason? They understand after such services in the past such as volunteer, then fly by night EMS services that do it cheaper but leave in the middle of the night, its much cheaper to have one in the long run. The run volume has increased due public talk of professional services, and with the public utility subsidy and payments, we break even and with small profit. So yes, it can be done!

If it is a true frontier and rural area, then the those that live in that area need to recognize the risks of living in such. Alike I said, first responder is one thing but don't acclaim to be an EMS. Rendezvous with ALS either ground, flight can be a standard procedure.

Patient care and those that treat should NEVER SHOULD BE COMPROMISED or CHANGED BECAUSE OF THE INADEQUACY TO MEET THE DEMANDS! When one does this, they have not only failed the system but the patients as well.

If you really want to have a real discussion, then study systems development, regionalizations, EMS Systems and Administrative practices. One should have knowledge of medical administration and full understanding of how the health care systems operate.

R/r 911

 

[Foxbat]

Vent,
Could you imagine the US fire Service as a federal agency? It works here in Europe because states are divisions of a country, whereas in the US, the country is actually a federation of largely independent states.

It does not have to be federal agency de jure. Federal government may, for example, offer more financial assistance to departments if they conform to certain standards; it can even "force" states to regulate their EMS just like it "forced" them to set drinking age at 21. But who has the political will to do that?

As for paying for it, I think our brethren down under have a solution workable in the US. There must be a state EMS agency.

Yes. At least at state level. Maybe, in like 30 years there will be a new white paper showing how many preventable deaths occur from lack of ALS in poor communities and how much money it costs to the country. But even then then "goverment is the enemy" attitude may prevail.

My antagonists will argue they are saving lives. But they don’t even realize how flawed that perspective is. But they do need the mental security of thinking they had a positive part to play greater than a ride.

You mean that if all patients will be transported by taxis with red lights on top with only driver up front, outcomes won't change?

 

[Veneficus]

You mean that if all patients will be transported by taxis with red lights on top with only driver up front, outcomes won't change?

I am suggesting that without proper education and a focus on knowledge rather than skills, EMS is nothing but a glorified taxi service.

 

[Veneficus]

If you really want to have a real discussion, then study systems development, regionalizations, EMS Systems and Administrative practices. One should have knowledge of medical administration and full understanding of how the health care systems operate.

R/r 911

I want to have a real discussion on it.

We both agree that education is a must and that a national scope would be a disaster.

I think the role of the EMS provider needs to and is evolving.

I am also very aware that in the next 10 years the current payment system of US healthcare is not going to be the same. Prehospital providers may want to start increasing their role so when renumeration is overhauled they have enough value to society to not only have a position but a livable wage as well.

 

[ffemt8978]

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

So what makes you think they're going to contribute an extra $5/month if they won't approve a tax levy?

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]​

Big difference between billing 1400 calls a year and 300 calls per year...

 

[VentMedic]

Big difference between billing 1400 calls a year and 300 calls per year...

But, if you used that same logic, all the medical professionals living in rural regions could say they can't provide good patient care because they don't see enough patients. Fortunately, other professionals know what education/skills they need to keep current and have enough ambition and/or professionlism to maintain them. They don't use their chosen place of residence as an excuse. The other healthcare professionals also acknowledged what their chosen profession consisted of and the education it required. They obtained their education and continued on with their career in their chosen place of residence. Many prefer to take their advanced education, knowledge and skills back to their home towns to provide the highest possible quality medical care for their facility/agency.

A small town hospital can still excel in patient care even if it doesn't have the latest technology or world renowned surgeons. I also know many of the surgeons from these smaller hospitals come to the big city facilities to practice new skills/techniques to take back home. It just depends on how hard you want to work for your career or to be a quality healthcare provider.