Stat EMS (Flint): Don't send the closest ambulance

[WuLabsWuTecH]

I don't see a problem with this. at all.

A city or county has an ambulance service. they know who they have, they know the training. they even contract with them, so that company is responsible for EMS coverage, and are paid as a result for providing the service. as a result, why shouldn't they get the calls?

patient care has nothing to do with it.

If the "closest ambulance" policy were to happen, than any ambulance service can set up in town and start taking 911 calls. Think of every FD based EMS system; if you want to start taking calls, just put an office in their first due, and you will get all the calls.

Forget accountability, it's a potential for disaster. With one company, than in theory you have one set of rules, and everyone is playing by the same rules. one chain of command. no matter what ambulance shows up, you will be treated and billed the same. uniformity is a good thing.

As a general rule, I'm 100% in favor of closest ambulance goes. But having rouge and random ambulance services just hopping in and taking 911 calls from the AHJ (who is being paid to provide said service) is just plain wrong.

It can be done, and it's what we do here. In the county there are probably about 20ish different fire departments. We run on an "automatic aid" agreement with each other which means that the closest unit goes regardless of who's jurisdiction it is. We all have similar SOGs and Protocols and as far as chain of command goes, the first due has command until the AHJ shows up and there is a chance to turn it over. For some calls, the AHJ may never show up or if they do, the command won't ever be turned over and that's ok. The Fire Chiefs in the county have sat down and agreed on a set of rules that everyone plays by and came up with uniformity agreements (a Medic has to have at least XYZ on it, otherwise it's a squad, a Rescue has to have ABC on it, otherwise it's just an engine, etc...)

I don't know if it the privates are able or willing to do this, but we seemed to turn out all right here in our county to have this closest unit goes thing...

 

[CentralCalEMT]

Tulare County in Central California has a system where all the private units are turned over to a county wide dispatch system. (With the exception of portions of southern Tulare County in which case Kern County units are closer and respond as mutual aid.) All the Tulare County EMS units have a county GPS, radio and MDT. The entire county runs as a single system status management system. This means that county dispatchers both dispatch and post units as they see appropriate no matter what city you started in. There are, I believe, 5 private companies and 1 fire department that transport and the closest unit goes regardless. It is not a perfect system but at least when one city is busy and another is slow, units can be shifted around so no area is completely uncovered.

 

[Christopher]

If the "closest ambulance" policy were to happen, than any ambulance service can set up in town and start taking 911 calls. Think of every FD based EMS system; if you want to start taking calls, just put an office in their first due, and you will get all the calls.

Forget accountability, it's a potential for disaster. With one company, than in theory you have one set of rules, and everyone is playing by the same rules. one chain of command. no matter what ambulance shows up, you will be treated and billed the same. uniformity is a good thing.

As a general rule, I'm 100% in favor of closest ambulance goes. But having rouge and random ambulance services just hopping in and taking 911 calls from the AHJ (who is being paid to provide said service) is just plain wrong.

Funny enough this was what the county said when my FD decided to go Paramedic level. We already provided ILS response to our fire district and chased the county Paramedic crews. Our Chief decided that going Paramedic level was the right thing for the citizens in our area. The county was not pleased.

Now, did our department just up and start taking 911 calls as paramedics? No. We went step by step through a process of integrating into the County system, meeting every educational/procedural requirement through the County medical director, and since December 2008 we've provided 911 ALS care as part of the "closest available unit" system.

I believe if there is centralized medical control and a procedure in place for assuming a chunk of the 911 burden, then anybody and everybody who wishes to provide care should be allowed. You don't need one company, or even one provider. You just need one set of standards.

 

[truetiger]

This is why I'm a fan of the "one third service per county" idea. Keeps everyone on the same page. Recently I've given a private service a try on a part-time basis and absolutely hate it. My main employer is a third service that is a county district and is the only recognized provider in the county. We have one dispatch and send the closest unit. No delay in transferring the calls, no one lying about locations to snag a call, and being the only guys in town allows us to maintain good working relationships with all the fd's. The private service I've been moonlighting at is horrible. There is a huge response delay. It is not uncommon to have the ALS pumper from the city fd on scene just as we are dispatched. The working relationship with the city FD is horrible. They want to take over the ambulance service as a way of funding and they make it clearly known that they do not want us in their sandbox. Patient care suffers as a result.