What is your EMS system?

EpiEMS

Forum Deputy Chief
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Unmotivated undereducated providers. Pretty sure it's not just my system...

It seems to be a national epidemic. <_<
There must be some areas that aren't as bad (thinking Wake, and parts of Texas).
 
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ItsTheBLS

Forum Probie
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Non-traditional Public Utility Model with 14 first responder fire agencies as help, varying from BLS-vollies to full Paramedic staffing.


Typically 1 Paramedic and 1 other provider on a truck.

So on most of your calls you get FD? Also, do you find it harder handling 911 calls with only an EMT-B partner?
 
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ItsTheBLS

Forum Probie
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Just for clarification, by "hospital-based" it is meant that the ALS services are administered by a hospital or hospital system. In most cases, the medic unit is not actually stationed at a hospital. For example, the MICU I worked for now staffs 9 FT medic units and 3 PT units. Only one is actually stationed at a hospital. A MICU project to the south had 2 of 7 actually stationed at hospitals, and one to the north had 1 of 5 stationed at a hospital. Some places might have units based at a hospital, but it is typically for shift change and restocking with the medic units posting at various locations (IIRC, this is how it is done in Newark and Jersey City).

What is your opinion on Jersey's 2-medic fly car system? Do you or anybody else here think it's something that's going to last for much longer? Is it something that's simply going to stay isolated? Or something that will expand?
 

rescue1

Forum Asst. Chief
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What is your opinion on Jersey's 2-medic fly car system? Do you or anybody else here think it's something that's going to last for much longer? Is it something that's simply going to stay isolated? Or something that will expand?

I always thought it was kind of silly. The only reason to have two medics is for high acuity calls which don't occur often enough to justify constant 2 medic staffing, especially since you can just call for the second medic who is just in another vehicle.

I've only worked in systems with single medic fly cars, so maybe I'm biased, but we never had an issue with not enough medics on scene, assuming the EMTs also had their stuff together.
If the EMTs didn't, it was gonna be a cluster anyway.
 

NomadicMedic

I know a guy who knows a guy.
12,129
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Who came up with that schedule and why?

My circadian rhythms would be so messed up you would never want to be anywhere near me.

Why is it bad? This week I work dayshift on Monday and Tuesday, and Wednesday night and Thursday night. I have Friday, Saturday, Sunday and Monday off. We're not so busy that we're getting crushed, I usually sleep at night. It works for me. It's certainly better than 24 hour shifts.
 

Trashtruck

Forum Captain
272
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Unmotivated undereducated providers. Pretty sure it's not just my system...

Agreed. I don't think my system(or giant cesspool of entropy)is even real. It's more of a forced reality when I go into work.
Fire based. I think that covers everything.
 

Medic Tim

Forum Deputy Chief
Premium Member
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Why is it bad? This week I work dayshift on Monday and Tuesday, and Wednesday night and Thursday night. I have Friday, Saturday, Sunday and Monday off. We're not so busy that we're getting crushed, I usually sleep at night. It works for me. It's certainly better than 24 hour shifts.

This.
 

Shishkabob

Forum Chief
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So on most of your calls you get FD? Also, do you find it harder handling 911 calls with only an EMT-B partner?

Depends on the call and on the city, but yes, most calls do get FD, though I cancel them as soon as I can as they really aren't needed / beneficial on most calls. If I could keep them from getting dispatched to all but the most serious of calls (or fat people), I would in a heatbeat.


Nope, not hard with 'just' an EMT. I was pretty much raised in a rural system where I had an EMT and a bunch of vollies, so I had to learn self-reliance early on anyhow. Now if the call is BlS, I don't have to work it. With a second medic, we typically switch every other call which gets annoying.
 
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DrParasite

The fire extinguisher is not just for show
6,226
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Who came up with that schedule and why?

My circadian rhythms would be so messed up you would never want to be anywhere near me.
some fire department, to ensure no one got stuck working days or night or weekends. it's great if you can sleep at night, and if it's slow, but it does get old if you are doing 12 calls during your night shifts. typically they do 10s and 14s, 10 hour days and 14 hour night shifts.
What is your opinion on Jersey's 2-medic fly car system? Do you or anybody else here think it's something that's going to last for much longer? Is it something that's simply going to stay isolated? Or something that will expand?
as a Jersey EMS provider, I can say with near certainty that NJ's 2 medic fly car system isn't going anywhere. the only thing that will change is those two medics will start driving around in ambulances, especially with more an more ALS projects starting their own BLS system.

you won't see 1&1 anytime soon. in fact, many of the studies show that a paramedics who see only acutely sick patients are better than those who spend 80% of their shift dealing with non-life threatening patients.

as for those calls that it helps to have 2 paramedics, how about any person you cpap? or a multi system trauma with airway control? or a cardiac arrest? or someone you RSI? or a seizure patient who keeps twitching? or just a patient where you can't seem to get the IV, and want someone else to try?
 

ExpatMedic0

MS, NRP
2,237
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Who came up with that schedule and why?

My circadian rhythms would be so messed up you would never want to be anywhere near me.

I worked this for a year and it sucks. I was an ALS fly car covering maybe 4 ambulance stations, so I never got a break.
 

RocketMedic

Californian, Lost in Texas
4,997
1,462
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FD based EMS.

911 only, no transports.

Staff 2 medics on the box.

EMS works 24/72, Fire works 24/48

Almost all calls get Fire as first responders. The majority of fire crews now will have a paramedic on the first responder unit. So if :censored::censored::censored::censored: hits the fan, EMS will have plenty of manpower (sometimes too much).

Major city with roughly 20 hospitals, including two Lvl 1s, so transport times are typically pretty short- 5-15 minutes.

Do you turf low-priority calls to private ambulance (Acadian), or is it a dual-response system?
El Paso Fire Department turfed quite a few patients (non-critical patients) to Elite/Life/Dominion, which I thought was a good idea. I still think the world of EPFD, they were excellent on my rides with them and they provided my wife with excellent care.
 

shfd739

Forum Deputy Chief
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I'll toss mine in.

Private service with multiple 911 agreements in and around a large Texas city. Also multiple hospital agreements to include a children's hospitals teams. 2 other counties have us for 911/sole provider. Those 2 counties are rural and tend to be slow.

Staffing is medic/basic on ALS units and basic/basic on BLS transfer units. 3 CCT units are CCT medic/basic. Bari unit when needed is staffed by a mainline crew just for that call.

Most shifts are 12 hours on a 2-2-3 rotation. Assigned day or night. Only way to switch is to wait for an opening and have a request on file.

Street corner posting. We are so busy and move around so much that having stations wouldn't be that beneficial. Crews would just complain they didn't get to stay long.

Fire department first response on all 911 calls. Mix of volunteer, paid, combo. Most are BLS level. Couple are ALS level and can be scary when they decide to play before we get there. Most calls we can beat fire onscene and cancel them.

Areas range from city to rural with 5 min to 45 min transports. 2 helo services when needed. 2 level one trauma centers,multiple pedi hospitals etc. No lack of hospitals.
 

Christopher

Forum Deputy Chief
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I work for 3 systems.

County 1:
- County-based ALS transport (12h shifts, 6 24x7 ALS, 3 peak ALS, 1 supervisor QRV), primarily P+P, sometimes P+I/B
- County-based BLS patient care transport service
- 15+ volunteer/paid fire departments (mix of FR, B, and I level)
- 2 Paramedic transporting fire departments (I work for one of these), primarily P+B, 24x72's at both of them
- 2 hospitals in county, 3 hospitals in neighboring counties (2 are the trauma/pci centers we use)

County 2:
- Hospital-based ALS transport (12h shifts, 7 24x7 ALS, 4 peak ALS, 3 QRVs, 1 supervisor QRV), 99% P+P
- Hospital-based interfacility transport and HEMS
- City fire all EMT-B
- County fire all EMT-B
- One volunteer EMT agency does limited transport B+B
- 2 hospitals in county (1 is trauma/pci center)

Industrial:
- BLS transporting ambulance (volunteer staffing, 24x7x365 as folks are on shift for regular work)
- Member of County 2's mutual aid plan, utilizes same radio system/protocols/equipment/training schedule
- Technical rescue / industrial fire brigade as well
 
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RUABadfish002

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A couple of BLS ambulances staffed with 2 EMT-B's.

The rest are all ALS units staffed with dual medics, I/P. We still have I/99's here but due to the changes in the national scope that will soon be implemented, I/99's will be upgrading to P over the next few years.
 

Tigger

Dodges Pucks
Community Leader
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Our 911 contract where I work is covered by one dedicated ALS ambulance (all company ALS units are double medic).

Another ALS ambulance and three BLS units are also based in that town, but are all available for transfers.

When the dedicated truck is out, if an ALS ambulance is in town, they will drive to the fire station for coverage and cannot take transfers. If only BLS is in town, they will go into coverage until relieved by another company ALS unit that comes in from elsewhere or the dedicated truck returns as soon as they cross town lines.

ALS can turf to BLS if transport is not "significantly delayed" by waiting for BLS to arrive.

The contract also mandates providing ALS intercept to a neighboring town with POC BLS ambulance. This must be done by the dedicated unit, even if a transfer ALS unit is available, which makes no sense.

The nearest trauma center and specialty hospital is in metro Boston which is a 45 minute transport. There are several non-designated community hospitals in the 15-20 minute range. One has a cath lab, and all are stroke centers.

Where I live now in Colorado Springs, AMR is the contracted provider for El Paso County. They provide ambulances to the city, other towns with no fire based ambulance, and unincorporated areas. One town contracts with another private company.

Colorado Springs has 20 ALS engines, 7 sometimes ALS trucks, and two ALS non-transporting ambulances in areas with high medical call volume.

Other towns have ALS Fire first response and AMR transport, or fire-based transporting ALS. Some towns are BLS first response only.

Peak AMR staffing county wide is 14 ALS ambulances I believe.

Two Level II specialty hospitals in town, one has a pediatric hospital as well. Two Level IIIs in the northern and less populated area of the county.
 

the_negro_puppy

Forum Asst. Chief
897
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we work:


Paramedic / Paramedic

or

Paramedic / Student Paramedic

We also have Intensive Care Paramedics that work on Helos and fly cars. They have extra cardiac drugs, cardioversion, pacing, intubation etc.

No fire involvement.
 

EpiEMS

Forum Deputy Chief
3,844
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we work:
We also have Intensive Care Paramedics that work on Helos and fly cars. They have extra cardiac drugs, cardioversion, pacing, intubation etc.

No fire involvement.

So, who handles heavy rescue down undah? Do PD and FD go to life-threatening calls to start CPR and early defib, etc.?
 

med51fl

Forum Lieutenant
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Ok so here it is:

Place #1-County-wide fire based EMS 24 / 48 shifts
-3 paramedics on the ambulance (all ALS)
-All 911 ALS transport, no IFT
-4 people on the fire truck (ALS), minimum of 2 paramedics, the others EMTs
-Ambulance first out to high accuity calls, fire truck out if ambulance already on a run
-Fire truck first out on low accuity calls
-BLS transport done by private ambulance
-HEMS done by fire department (as well as rescue / water-drops) manned by 2 pilots (EMT / paramedic) and 2 paramedics
-Ambulance crews also perform fireground duties (interior search / rescue, assist with fire attack, etc.)
-5 to 10 minute transports

Place #2-City EMS only department
-total transport with some IFT
-1 paramedic, 1 EMT crew configuration
- 20 to 30 minute transports
 

fast65

Doogie Howser FP-C
2,664
2
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Private 911/IFT


  • 1-Basic/1 medic, on occasion we'll have a dual medic car.
  • 24/48, 4 ambulances on 24/7, in the summer we bring up a 12 hour car. We have quarters.
  • We're the sole 911 provider for the county, and handle 99% of the IFT's. For CCT's we'll typically send out a page for a third person to meet us at the hospital.
  • FD's around here are mostly volunteer, but have a few paid staff. Rarely do we get another paramedic on scene.
 

46Young

Level 25 EMS Wizard
3,063
90
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Fire based, dual role with EMS transport

37 ALS engines

41 ALS ambulances, 14 are dual medic

Volunteers can put a BLS or ALS ambulance in-service

14 ladder trucks/TL's, all BLS

8 Heavy rescues - all have ALS equipment, can be ALS if Trot/Hazmat tech happens to be ALS

Seven EMS supervisors in chase vehicles

Typical txp is 5-20 mins

Liberal mutual aid agreements with surrounding jurisdictions. Most give as much as they take, but two counties in particular use us all the time and rarely, if ever, give anything back. Other than mutual aid, the county does all EMS txp.

Schedule 24's - on, off, on, off, on, off x 4, no Kellys. Cannot work in excess of 36 scheduled hours
 
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