Required Reading; The Cost of EMS

It's time they realize that our responsibilities are their responsibilities. That we're serious about taking care of the public. That we're not the fire service's junior varsity, and that it's ludicrous to expect good, professional people to provide good, professional emergency medicine for free.
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I like this article.
 
Now hold on and wait a darn minute! You mean to tell me that someone actually had the audacity to state that volunteer systems are failing across the country?!?! Is it actually true that the message that some of us have been preaching for some time is a truthful representation?!?!

It is nice to see that views are finally being published and presented in a non biased, yet truthful realistic way. Maybe now more people will truly see the issues with volunteerism and identify the possible solutions. Or maybe people will continue to be egoistic and bullheaded, thus again slowing down the progression of EMS.

I enjoyed the article, hope to see more progressive views in the future.........
 
Very good article. Hopefully it is a small step in the right direction to fixing a system we all know is broken. It read as unbiased and did a good job of making sound arguments for the problems we face and what we can do to begin to fix those problems. Now, if only we could quit fighting amongst ourselves and come together as a united group to definatively define who we are, where we want to go as a profession, and figure out the best ways to move in that direction.

Thanks for sharing, Ryd!
 
I think volunteer organizations are appreciated, But by the goverment are they? hmmmm thats a book all on its own.

I do see the point when the article stated that most families can't function without 2 incomes. And that is a good point on why being a volunteer is rough. Your doing a job your not getting paid for. Kinda makes me wonder why people volunteer, and why I started volunteering.

Volunteers are great B)
 
Topher38 said:
Kinda makes me wonder why people volunteer, and why I started volunteering.
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I believe this was part of the emphasis of the article. Why do volunteers do this? I can understand remote areas, there is NO one else and the chances that professional services is slim to none. In areas that can and could be serviced by a professional service, I believe it is all about egos and tradition

If EMS was removed, would these same people perform services such as meals on wheels, pick up trash, even dig a hole for the city water line?
So when volunteers describe how they are only doing it for the community... I say hogwash!

Topher38 said:
Volunteers are great B)
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Apparently, you disagree with the article. Again for those that serve in area that have to depend upon volunteers (such as remote areas) then yes.. they are a Godsend! To others, they are a demise to the EMS profession. Unfortunately, they do not understand that and most do not care.. again, many are more truly concerned about their self satisfaction than the patients and the community.


R/r 911
 
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Ridryder911 said:
I believe this was part of the emphasis of the article. Why do volunteers do this? I can understand remote areas, there is NO one else and the chances that professional services is slim to none. In areas that can and could be serviced by a professional service, I believe it is all about egos and tradition

R/r 911
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While you and I rarely see eye to eye on this issue, I completely agree with this statement. I doubt that we would agree on the definition of "remote areas", though. Again, it is a case of ideal world vs. real world.
 
well, for my district and all those neighboring, we are considered rural.

there is not a single paid ems provider for at least 60 miles...

is that considered remote?

communities here have relied on volunteerism historically...

there have been no issues of service provided, as paramedic and numerous ALS are available, albeit also on a volly basis.

and, all calls are answered in a timely fashion, backed up by our mutual aid plan with our neighbors.

does this fit into your "exemption" Rid?
 
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Not really. The problem is most communities want their own EMS. Alike the perception of having an hospital, schools, etc. it is no longer cost effective or productive. It is much better to have consolidation on many things, including EMS. Your area even has a better reason to have a paid service ALS provider in comparrision than larger cities. Why do the U.S. still provide less than ALS care on any EMS responses? Consider this. Many communities receive lower than the care given by the old tv show Emergency. Shameful and inexcusable. It is the priorities that determines upon what is important or not.

You did not include population. Cities that have over a population of 10-12K can usually adequately have a paid professional ALS/EMS providers. How is transfers made to regional hospitals?

Just because one lives in rural area, is not an excuse for having inadequate lower care and for providing the best ALS possible. In fact, some of the most progressive EMS care I worked at was a community of < 8,0000 and about 60 miles from a large metro area. So yes, it can be done... Easy? No, but can be achieved.

Communities will have to learn and understand that we are just as important as the Sheriff patrol, the County library and the local school bond. This is where the change has to occur. We can and should no longer depend on medical care upon the common laymen. We don't ask for volunteer staff for nursing homes, clinics, county health departments; but we do for EMS? Why are we different?

Sorry, don't shoot the messenger but it will change. There is no way it can't; the systems is broke and hemorrhaging and unless we take care it, someone else (non EMS) will change it for us. The statistics of the baby boomer will increase the responses by four fold this is not theory but the facts.

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
 
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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.
 
well, our town has a population less than 2000....

the other point you don't seem to be hearing, is that is is not bls...

we have ALS on almost every call... they are just volly...

perhaps that is bothering you because they do the same job for free, but the level of care is NOT less than on "emergency!"...

you are merging two issues into one...
standard of care, and volly ems...

in our case, the standard of care is met... but by volunteers.
 
And in a community of 2000 that system may work good for you.

How many ALS providers do you have in that 2,000?
Is it guarenteed that 24hrs a day an ALS provider will be around and able to respond?
What is the average ALS response time?
Average response time from time of 911 call?
What is your call volume?
Do vollies staff the station or respond from home?
How far is the nearest ER?
How far is the nearest town and what kind of Mutual/Auto AID systems are in place?
Does your community have Police? Other Public services provided? Are they provided by your town? County? State? Who? and why is EMS considered non-essential or something that vollies should do?

Standard of Care and Volly EMS is one issue, just because ALS is available, waiting 20+ minutes for ALS or more is not accepatable, or waiting for an intercept. Times have and need to change. Time and training is tissue.
 
I guess it’s my turn. The article made some good points. Usually, I push for the “anti-volunteer” point of view. This is because a lot of people can’t conceive of anything other than their volunteer system. This article opens people up to ideas they might not have otherwise considered. For this reason, I like the article. But…

A good rule in life is to be suspicious when someone gives you an absolutist opinion, answer, solution, etc. This article does just that, and it is way too biased. There are many great arguments for volunteer systems and combination systems. Let me give an example. Over the weekend, it was dry and windy. Any firefighters on here know what that means--brushfires. So, at my volunteer fire department, we got way more calls than usual. Because it was a volunteer company, we were able to easily handle the increase in call volume without having to skimp on service or go to another department. We just had more people respond from home. Overall, we provide great service. We save our local government 600K conservatively per year in taxes (our first due area is only 1/5 the size of the county). Our members live balanced, healthy lives.

So, the article makes some good points, but it forgets to mention all the great volunteer and combination systems that work just fine. And what was the motivation for writing the article? Was it to increase quality of care? If so, great. However, I suspect it could have also been an attempt to increase jobs, pay, leverage, etc for paid ems providers. Doing this by destroying functional volunteer agencies isn’t so great.
 
It is interesting to read about the way things are done in the US. I find it interesting that the public is not clammoring for better EMS. Not just wanting full time available EMS. But raising the minimum standard of care. You wouldn't expect the nurses and Dr's to volunteer their time at the hospital.

I know it can be done. I live in eastern Canada in a small province about the size of West Virgina with half the population. So we have lots of rural. We have a full time government funded EMS system. We are even CAAS acredited. Every one of our approx. 130 ambulances is staffed 24/7 with full time crews. Even the little town of Canso with hardly 1000 people has a small hospital and a full time Paramedic base. It gives eight people a full time job.

Our "basic" (Primary Care Paramedic,PCP) paramedic from what I understand from this forum, has about ten times the education hours, a much wider scope of practise. and better pay. Our base rate is about $43,000 per year.

No one takes a ambulance home with them, no half pay for night shifts. Every truck has gps and electronic mapping, electronic patient charts, defibs that transmit 12 leads. Its not a mickeymouse system. Nova Scotia is considered by central and western Canada to be a have not province. I beg to differ. Our system cost about $79,000,000 per year including our air ambulance and communications center. With 950,000 people thats about $83.00 each. (2005/2006 http://www.gov.ns.ca/health/ehs/homepage/EHSAnnRep2005-2006.pdf)

You can have a better system IF you want it and are willing to pay for it. Otherwise its "You Call, we haul. You bleed we speed." I know that system because thats what we had ten years ago.

Our system is not perfect, but it is light years ahead of what we had.
 
Outbac1 said:
It is interesting to read about the way things are done in the US. I find it interesting that the public is not clammoring for better EMS. Not just wanting full time available EMS. But raising the minimum standard of care. You wouldn't expect the nurses and Dr's to volunteer their time at the hospital.

I know it can be done. I live in eastern Canada in a small province about the size of West Virgina with half the population. So we have lots of rural. We have a full time government funded EMS system. We are even CAAS acredited. Every one of our approx. 130 ambulances is staffed 24/7 with full time crews. Even the little town of Canso with hardly 1000 people has a small hospital and a full time Paramedic base. It gives eight people a full time job.

Our "basic" (Primary Care Paramedic,PCP) paramedic from what I understand from this forum, has about ten times the education hours, a much wider scope of practise. and better pay. Our base rate is about $43,000 per year.

No one takes a ambulance home with them, no half pay for night shifts. Every truck has gps and electronic mapping, electronic patient charts, defibs that transmit 12 leads. Its not a mickeymouse system. Nova Scotia is considered by central and western Canada to be a have not province. I beg to differ. Our system cost about $79,000,000 per year including our air ambulance and communications center. With 950,000 people thats about $83.00 each. (2005/2006 http://www.gov.ns.ca/health/ehs/homepage/EHSAnnRep2005-2006.pdf)

You can have a better system IF you want it and are willing to pay for it. Otherwise its "You Call, we haul. You bleed we speed." I know that system because thats what we had ten years ago.

Our system is not perfect, but it is light years ahead of what we had.
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Wonderful post! It is nice to see a representative example of how exactly IT CAN WORK! $83 / year is a very economical rate per person for a professional ALS EMS service. Plus the helicopter is also included, very nice!

Now let the BLS vollie rebuttal of how it wont work for them begin! :)
 
Guardian said:
I guess it’s my turn. The article made some good points. Usually, I push for the “anti-volunteer” point of view. This is because a lot of people can’t conceive of anything other than their volunteer system. This article opens people up to ideas they might not have otherwise considered. For this reason, I like the article. But…

A good rule in life is to be suspicious when someone gives you an absolutist opinion, answer, solution, etc. This article does just that, and it is way too biased. There are many great arguments for volunteer systems and combination systems. Let me give an example. Over the weekend, it was dry and windy. Any firefighters on here know what that means--brushfires. So, at my volunteer fire department, we got way more calls than usual. Because it was a volunteer company, we were able to easily handle the increase in call volume without having to skimp on service or go to another department. We just had more people respond from home. Overall, we provide great service. We save our local government 600K conservatively per year in taxes (our first due area is only 1/5 the size of the county). Our members live balanced, healthy lives.

So, the article makes some good points, but it forgets to mention all the great volunteer and combination systems that work just fine. And what was the motivation for writing the article? Was it to increase quality of care? If so, great. However, I suspect it could have also been an attempt to increase jobs, pay, leverage, etc for paid ems providers. Doing this by destroying functional volunteer agencies isn’t so great.
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G, you have a valued point, but comparing EMS to Fire is apples to oranges. Volunteer fire is just fine in my personal opinion. Nothing chaps my arse more than a fire department with a multi million dollar tax based budget, brand new trucks, high pay, and yet they sit on their butts all day long doing nothing productive until they get called. Then you have the EMS system that is contracted for the same district and they receive less tax money, have older and more heavily used equipment, and are busting their butts 24 / 7. So I have to ask why? Why am I paying for a service that I do not need, yet potentially cannot get one that I do? Why does the public place higher value on fire protection vs. EMS protection? (Actually, don't answer that one, I found my next topic to be posted!)? Honestly, I have a pretty decent fire policy, if my home burns,I don't want it stopped, my possessions partially consumed, then have a rebuilt burnt, used house. IF it burns, let it go to the ground, I want the new house!!!!!! Sound warped, maybe. But I want to maximize on my insurance investment, any logical financially prudent person would. In fact, you may be surprised to find the number of folks, including government types who agree with me and are now questioning the financial side of fire. Something to think about.....................
 
I am glad to know that people are becoming active in seeking more recognition for the hard work done in the EMS. I have been working on raising a fuss about this for some time now, although I haven't even begun a career in the medical field. Go to
http://www.rallycongress.com/letter2congress/698/
to write free letters to congress people regarding these issues.
I included the link to the EMSmagazine article mentioned here in my letter today. I hope thy will take the time to read it, and I hope that a petition will be successful in raising pay for EMS personnel. I get really mad when I see the adverse effects trauma has on my friends who get paid 50 cents per hour higher than minimum wage, while dispatch gets paid $8 per hour higher. I think EMS personnel deserve a heck of a lot better for all the S%*! they go through to be there for people.
 
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Flight-LP said:
Honestly, I have a pretty decent fire policy, if my home burns,I don't want it stopped, my possessions partially consumed, then have a rebuilt burnt, used house. IF it burns, let it go to the ground, I want the new house!!!!!!
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Believe me, everyone says this except the people whose house is burning down. I'll save the rest of my fire related comments for another thread.
 
Instead of arguing every little provincial issue, I’ll just give you my dream for the future of ems. I think some places would do fine with a 100% volunteer system, whereas others might do better with a combination system or a 100% paid system. The question is, how do we decide who needs which? My answer is democracy. But as we all know, for the people to make the best decision, they must know what they’re getting. People should know the difference between ALS and BLS. People should be aware of their hometown ems resources, response times, training levels, etc. Then, they should decide what they want and need. The answer is to put volunteer and paid agencies on a politically level playing field. This will force volunteer agencies to increase quality or die. This will also force paid (especially governmental) agencies to justify growth and de facto killing of volunteer agencies. This is an especially big problem in the firefighting side where governmental firefighting departments are expanding unnecessarily.
 
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
 
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