Required Reading; The Cost of EMS

Vote upon the type of care they should receive? Ridiculous! You mean you should allow of what type of care one can receive by voters? Really want that outcome vote to determine if your child gets an IV for septic shock or maybe no oxygen at all.. (since the public will determine the type of care). You would allow the public to actually consider modalities of treatment? Would you allow them to consider the type of fire suppression attacks that FD can perform. Medical care is not a republic action.

The public is ignorant and stupid of medical care. They depend an entrust upon us to make the right determination for them. It should be made for the community by the medical community and those educated within it.

There is NEVER an excuse for a BLS unit alone to ever respond upon an emergency call. That is the fact. Period. Patients and citizens deserve an advanced examination and treatment of ALS immediately if needed. Paid or professional will be quickly determined after the continuation of increasing calls and demand for a degree level before allowed to even before licensing to provide patient care.

The communities that have to depend upon volunteerism as previously discussed will always fall through the cracks. Unfortunately, that is part of the risks living in that environment.

There is no easy answers, but lets not regress.

R/r 911

So, democracy isn't your answer, and that is the reason you have failed to be successful. You forget, we live in a democracy. Name one public service where public opinion isn't pivotal—just like you described in the fire vs. ems thread. Keep relying on ems providers to change things and ignore the public, and see where that gets you. The real policy makers don't care about the paramedics opinion, they care about public opinion. And that's the way it should be.
 
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You forget, we live in a democracy. Name one public service where public opinion isn't pivotal—just like you described in the fire vs. ems thread.

You forget that the Founding Fathers were wise enough to make the country a republic, and the authors of state constitutions followed their lead.

Public opinion is important. That's why there are people whose job it is to shape it.
 
Public opinion is important. That's why there are people whose job it is to shape it.

Yes, and if you go back and actually read my post, that is exactly what I am suggesting we do. Because, obviously, our elected representatives are not. And if you think they will take on this new issue out of the goodness of their heart, then I’ve got some land to sell to you.
 
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Actually I disagree. I can assure you working with law makers this past month, they don't care about the public's opinion, they care about the vote. Totally separate issues.

To suggest the public in general is responsible enough to make rationale decisions in medical care is asinine. Would we allow them to make decisions upon what procedures should be available to be provided in hospitals?

We do NOT have a democratic society, we have a republic government. We rarely vote upon most issues. How often or ever have you voted upon the type of services that is provided by municipalities, or medical care? Probably never... one might vote to give additional funding but not to define the type of services provided. Do we allow the public to decide if the Police should have jailers, detectives, or if the FD should have a HazMat unit? No, it is under the determination of operations that the city offer the best for the public that they can afford and provide.

Public Health Codes, Engineering decisions are never brought up to the public for certain reasons. Mainly, the public is ignorant and entrust those with the speciality to decide for us.

We only get to vote only very few items and agendas, in fact a petition is usually needed to be able to vote upon items.

R/r 911
 
Actually I disagree. I can assure you working with law makers this past month, they don't care about the public's opinion, they care about the vote. Totally separate issues.

To suggest the public in general is responsible enough to make rationale decisions in medical care is asinine. Would we allow them to make decisions upon what procedures should be available to be provided in hospitals?

We do NOT have a democratic society, we have a republic government. We rarely vote upon most issues. How often or ever have you voted upon the type of services that is provided by municipalities, or medical care? Probably never... one might vote to give additional funding but not to define the type of services provided. Do we allow the public to decide if the Police should have jailers, detectives, or if the FD should have a HazMat unit? No, it is under the determination of operations that the city offer the best for the public that they can afford and provide.

Public Health Codes, Engineering decisions are never brought up to the public for certain reasons. Mainly, the public is ignorant and entrust those with the speciality to decide for us.

We only get to vote only very few items and agendas, in fact a petition is usually needed to be able to vote upon items.

R/r 911


Obviously (or so I thought) by public opinion, I meant vote--which are in fact one and the same. But go ahead, keep biting at their heels along with every other little activist without the weight of public opinion, and let me know how that works out for you.

I’m looking at this on a macro level. Not what kind of construction should be used for a bridge, but whether or not we should put up a bridge. Likewise, not whether or not little Suzie should get an IV, but whether or not we should have a paid verses volunteer system. Big macro decisions can only be made with public backing. Period.
 
Never mind...the point has already been made.
 
Flight-lp thank you for the positive reply.

Public opinion is important. But you need forward thinking politicians and the civil servants behind them to make it an issue. The public will blissfully go on their way ignorant of what they could have until its an issue on the front page and 6 o'clock news. Then everyone can weigh in and push for change, or not. The details of the service should be left to the EMS professionals. The public first has to know that better is available then they can speak, ultimatly with their vote.

On the fire side I think there is a happy medium. They generally do fewer calls than EMS. But when you need them, you NEED them. Some paid full time members at the station to get the ball rolling I think is good. Then the rest can go directly to the scene. If the house burns to the ground I'll be sad. There is some stuff I'd like to have. If someone is trapped inside I want someone there to suit up and go in PDQ,(pretty damn quick).

If you live more rural chances are the volunteers don't all work in the community and will take longer to respond. Its the price you pay to live where you do.

I know that when we head out for a call in one of the rural communities we still often beat the first responders to the scene as we are on duty with a mandated < 59 second chute time 90% of the time.

Volunteers are important but I think they should supplement required services, not be them.
 
I agree with rid on this one. There can always be a place for volunteers to augment a system and help out, but relying on it by itself is scary to me. Think if the police were all volunteer, or public works. When a water main breaks and it doesn't fit into some of the guys schedule and you get three guys to show up and no one can operate the advanced machinery, and the basic stuff. I think our cities, counties and states should all provide paid professional ALS EMS services. Yes some rural areas just can't but when you have cities back east with 25k residents and a single vollie first aid squad it kinda scary.


OHHH, Now I see what you guys are talking about, at first I didnt quite get it after reading the article.

I can see where it is scary, but if you think about it, alot of volunteers in VFDs have the same training as that of a Paid Fire fighter, isn't really the only diffrence the fact that one gets paid and one doesn't?

*Don't bash me for asking questions* Thank you.
 
Communities will have to stop getting the milk for free, the cow is dried up. Time to Anni up and be responsible for their citizens.

Again very.... very rural areas will have to continue upon volunteer EMS. That itself is a different situation.

R/r 911

First off.. it's ante up not anni up (My name is Annie so I'm sensitive, and yes, Annie IS okay)

Since when is 8,000 population considered rural? We're talking about communities of 1000 or less.

And to address your comment about will those of us who volunteer with EMS do meal on wheels, clean streets etc. The answer there is yes. I do a street cleanup twice a year for my adopted area of road, I also have volunteered countless hours with homeless kids, tutoring in schools, sewing costumes for the local high school and college drama department. Coached soccer teams, gave blood, doorbelled for the Cancer Society, and teach first aid and CPR at a local homeless shelter for those who need the cards for potential jobs.

In really rural areas, we understand that its us or nothing. We rely on each other in so many ways, and we know each other. There is no anonymity in a rural area. Your neighbor's pain affects you personally.

There is also no expectation that the government will provide. There is no expectation that the school will keep going. There is no local food bank, but there is an exchange of garden produce from those who's gardens are extra generous. There is no thrift store, but there is a hand-me-down network of outgrown kids clothes that makes goodwill seem understocked. There is no local nursing home, but there are neighbors who will come over and sit with your elderly mom for you while you run to the store. When someone is terminally ill, the network of meal support, fill in for hospice and neighbors signing up to do everything from walk your dog, to change the pt's diapers is generally longer than the people you need. The school has more parents in the classroom than paid staff. The coaches, art teachers, music teachers, are unpaid parents. Office staff is 50% volunteers.

I do what I do for my community. Not for myself, not for glory or the measily $7 per call that I get. I do it because the community is willing to pay to train me, and the community gets the benefit of that training. Now, will this tiny community of under 1000 people ever have a full time staffed EMS agency, probably not. Will we have a hospital, doctors clinic or bank? Nope! We don't even have a post office, just a collection of post office boxes in the corner of the general store.

People who whine because their care isn't the best, ambulance takes to long to show up, takes them to the wrong facility, or doesn't care enough, don't get a lot of pity from me. Sounds like a case of too-high expectations. People die. It happens to all of us.

In the meantime, a segment of society is going on, taking care of themselves, relying on their neighbors and working together to make a real community. I can't see this as a bad thing. I wouldn't trade being able to get 20 people together to repaint a widow's house for having a faster response from ALS. I wouldn't trade knowing the names of almost every kid I see at the local blackberry festival for having a higher level of Trauma center. I prefer living in a community where we take care of each other, with our own time than one where we work 60 hours a week to be able to pay a stranger to do this for us. What happened to self reliance?
 
Nevermind...........Please erase
 
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Actually rural is considered and based upon population and location of MSA (Metropolitan Service Areas) so even population of above 10k ca be considered rural.

Sorry about the ante, I guess when I performed spell check it corrected it. I am glad you provide more volunteer service than EMS. Again, if you read my full text, I described that there will be those in the rural and remote areas that will be and have to be exempted. I know of those areas where there is nobody else, but in comparison of most communities this is not the norm. Again, as I stated I honor those that perform those services in the remote actually technically called frontier areas.

There is services that provide EMS as volunteer because they choose to not because they have to. Services that only provide BLS and volunteers that have to respond from homes and definitely could have an full time paid ALS but choose not to because of tradition. There is no valid argument that BLS is better for the patient care than ALS, especially when a community could provide it.

If given the opportunity any community will choose the cheaper one. Again, the community asks us and depend upon us for direction. It is ludicrous for us as health care providers to even suggest or recommend any lower level of care to patients and believe that it would be comparable or sufficient enough. Especially for those communities that could afford differently. Seriously, what type of provider would we be to recommend anything other than the best for the patient? Volunteered or paid is irrelevant.

Personally, I believe those that continue to associate with agencies and do not attempt to change within the system to have them progress into an ALS or provide a better EMS system is actually a hindrance to EMS. Change can occur much easier from than the inside than from the outside. I would like to see those of are associated with such agencies move forward, it can be done. It would be better than seeing those involved in the EMS do it, rather than someone else do it.

R/r 911
 
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I noticed that alot of more experienced people on this site say that when someone says, "I do it for the community" They get bashed for it. I remeber when I was on another EMS site and I stopped posting there because of it, I was bashed for saying that I like helping people and thats why I do it. And they bashed me for saying that. They said I was full of crap and no one does it for that.

Sorry this is way off topic but I was reading bossycow's comment and it reminded me.
 
Wow.

I read the article too, and think it is mostly non-biased. I like it, and I think it makes its point.

I think volunteer EMS has a place, and a combination department with a reasonable response time (crews on-station) and a 'professional' group of volunteers can be as good a a group of paid BLS providers. I do agree that ALS is the ideal standard of care.... but some patients DON'T need a medic. Right now, my area doesn't have enough paid medics to have a medic on every call.

I do consider what I do "serving the community" but I also get benifit from it... both experience and ego, to a point. I don't run with the company where I live BECAUSE of petty politics... I'll only put up with so much B.S. before I walk away, whether it is paid or vollie.
 
Good thought provoking article Rid.

I think the main difference between EMS and Fire protection is money and insurance companies.

As corporations can see a difference in the bottom line if they only have to repair water damage, this is something they can put a dollar value on.

An employee's life or quality of life isn't something they can quantify with money, so doesn't rate.

Democracy, sadly missing in the free world, other wise we would have vote's on important issues. This would strip the politicians of power and truely give it to the people, so, even though we could all spend a couple of hours a week looking at major intiatives online and vote accordingly, we will never see such a radical idea.

I wonder, would there have been an invasion of Iraq if everyone had a vote on it?

Volunteer ALS makes me wonder, are there volunteer Doctor's also?
 
Thanks R/R...I agree with Jon and others that the article you have brought us is pretty unbiased. I always appreciate a new unbiased look at a part of my world. Its a wonderful way to grow and gain new perspective.
 
Volunteered or paid is irrelevant.

Not according to the article you posted. It was making an argument that volunteerism in ems was a possible root cause of problems with ems. How can you write that volunteer or paid is irrelevant and then support an article that says the opposite?

Now are you people starting to see why I think the article is biased?
 
I think volunteer is viable in frontier areas whether that be a 500sqmi county with 2000 residents, no clinic, and regular loss of road access to other counties... or whether it is wilderness medicine provided by SAR.

Otherwise, I definitely see their point on volunteers.

24 hour shifts are good for the right system and not good for other systems.

I was disappointed when the bulk of their suggestions after the long rant with the core of many of our systems were:
1. love your family
2. don't forget about your family
3. talk to your family
4. love your family
5. don't forget to love your family
6. talk about loving your family
etc etc etc
 
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