What is your EMS system?

ItsTheBLS said:
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?
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Oh the paramedic system isnt going anywhere. Unlike the BLS agencies, the MICUs are together in most things, they lobby as a single group and have a very proactive Paramedic Association. I like having two medics. One basically records and the other does the physical assessment. On high acuity, one can tube, one can stick and bls can compress. Gets things done faster

As for me

Service #1
1 Police Department based BLS 6a-6p
backed by 4 volunteer agencies who also cover 6p-6a
2 EMS Rescues, one water, one extrication
One volunteer agency hosts significant state MCI units

One BLS engine 7a-4p that responds to any unconscious call
Backed by 7 Volunteer companies available on request between 4p-7a but not automatic

8sq miles, 30k people

Service #2
4 BLS EMS agencies serving 97k in 24sq miles
1 agency is volunteer only and respond occasionally
1 agency is 100% paid
1 agency is fire based with night volunteers, only cover 3sq with 3k
My agency has 1 paid truck at a satellite 24/7 and 2 paid trucks 6a-6p from HQ. Volunteers cover nights and can put up to 4 trucks on the road. We also run 2 heavy rescue units

FD is otherwise not involved with EMS, though they are trying to hedge in on rescue services. We do not have a good relationship
 
Bullets said:
Oh the paramedic system isnt going anywhere. Unlike the BLS agencies, the MICUs are together in most things, they lobby as a single group and have a very proactive Paramedic Association.
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This is contradictory to a lot of what I've heard. To my understanding, some insurance companies won't allow medic fly cars to bill for their services because they didn't do the transport. This may just be rumor.

I didn't even know about a paramedic association to be honest. I ask because I like the current system and look to become a paramedic in a few years and hope for that system to still be in place by the time I start working.
 
Linuss said:
Non-traditional Public Utility Model with 14 first responder fire agencies as help, varying from BLS-vollies to full Paramedic staffing.
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Sounds familiar. How long have you been there (here)?
 
ItsTheBLS said:
This is contradictory to a lot of what I've heard. To my understanding, some insurance companies won't allow medic fly cars to bill for their services because they didn't do the transport. This may just be rumor.

I didn't even know about a paramedic association to be honest. I ask because I like the current system and look to become a paramedic in a few years and hope for that system to still be in place by the time I start working.
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That isn't new, only the transporting company can Bill for the transport. Medics bill for their services provided. So when the patient receives the bill it is itemized.

As long as you need to apply to DOH for a certificate of need to run an ALS program it will remain hospital based. More ALS projects are adding BLS and some hospitals that didn't have ALS are working towards starting new or reviving old systems. If the old guard of the city FDs can't get ALS certified, and they have significant political power, then no one will change the system

Go to njmedics.com for more info
 
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Veneficus said:
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.
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It's a very common schedule in Australasia. It's ideally suited to firefighters who are tucked up in bed all night making it almost 2 days on, two nights on call, 4 off. It's absolute hell for the rest of us.
 
Private not for profit company.
We are part vollie part per diem. There are always two people at the station, usually a medic and an emt/aemt. We do twelve hour shifts.
 
Texas also has MICU ambulance which means at a minimum a basic or Intermediate with a paramedic. ALS at a minimum would be basic with an Intermediate. Or you could do two intermediates on the ALS.
 
Smash said:
It's a very common schedule in Australasia. It's ideally suited to firefighters who are tucked up in bed all night making it almost 2 days on, two nights on call, 4 off. It's absolute hell for the rest of us.
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It is also a rostering system that is starting, in ems, to go in favour of 12 hour day day afternoon night. Much more favorable :-)
 
EpiEMS said:
So, who handles heavy rescue down undah? Do PD and FD go to life-threatening calls to start CPR and early defib, etc.?
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Sorry, Fire Handle heavy rescue.

If Police are Fire are not used as first responders. If they beat us to a scene then they usually start CPR or the like.
 
Our system covers our whole province. Approx 3500 paramedics. Most are PCPs (Primary Care Paramedics) working a mix of on-call part-time or full-time depending on the town/station. There are about 200 ACPs (Advanced - similar to EMT-P I guess) in the larger centres. These are targeted response with PCP backup for the usual calls that may require ALS. The ACP crew decides if transport is required and either carries the pt or hands off to the PCP crew. We generally like this system as the ACPs consistently see and handle higher acuity calls and utilize their skills quite often (lots of intubation and zippity-zapping people).

The PCPs have a decent scope with IV, King LTD for arrests, epi, salbutamol, naloxone, D10W, ASA, NTG so can deal with a number of calls without ACP help.

This system covers roughly 4.4 million people in 1 million square kilometres with an interesting mix of metro, urban, suburban, rural, and remote areas.

Critical patients within the province are transferred by CCP paramedics who are selected from existing ACP medics with experience and trained over two years to the CCP level. They handle fixed-wing, rotor, and some ground transfers. That system is 2 CCP medics and 2 pilots. RN/RT/MD isn't used for most except in some areas where CCP can't get to or are unavailable. There are about 60 CCP paramedics in the province.

Our system handles about 400,000 calls annually.

EDIT - same as below :) And yep, 2 days, 2 night, 4 off.

The local FD in the towns generally respond to emerg calls and have first responder training.

KCCO
 
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Smash said:
It's a very common schedule in Australasia. It's ideally suited to firefighters who are tucked up in bed all night making it almost 2 days on, two nights on call, 4 off. It's absolute hell for the rest of us.
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2 days, 2 nights, 4 off is a very common shift pattern for Fire, Police, and EMS in Canada too.

My agency is the sole EMS provider for the province of British Columbia (population 4.4M). We have 480 ground ambulances based out of 187 stations (according to wikipedia ... I've never actually counted myself). Majority of cars are BLS staffed by Primary Care Paramedics with targeted ALS staffed by Advanced Care Paramedics in the urban centres. We also have 6 fixed-wing and 4 rotary-wing in the Critical Care Transport program. Obviously 911 response is our major gig but we also do thousands of mid-high acuity IFT each year. Many low acuity transfers have been contracted out to private sector "Stretcher Services." With approximately 3800 full and part time staff, I think that makes us one of the largest EMS agencies in North America.

http://en.wikipedia.org/wiki/British_Columbia_Ambulance_Service

Edit: Merck posted while I was still typing ... lol
 
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Here's an interesting article about Firefighters performing EMS work in NSW here:

http://www.smh.com.au/national/health/firies-say-they-cant-step-in-for-medics-20130130-2dl2t.html

wide-firie-20130131000421566179-620x349.jpg


FIREFIGHTERS will be asked to step in for busy ambulance officers in Sydney and major regional areas under NSW government plans to meet growing patient demand.

The Australian Medical Association and the union representing fire brigade officers are concerned the proposal will compromise patient safety.

Read more: http://www.smh.com.au/national/heal...-for-medics-20130130-2dl2t.html#ixzz2JVat4ai9
 
downunderwunda said:
It is also a rostering system that is starting, in ems, to go in favour of 12 hour day day afternoon night. Much more favorable :-)
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Much better rotation from a fatigue management point of view. I don't have a problem with 4 on, 4 off, it's just that back to back 14 hour nights are stupid and dangerous.
 
the_negro_puppy said:
The Australian Medical Association and the union representing fire brigade officers are concerned the proposal will compromise patient safety.
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The total opposite of the IAFF and those folks in the US.

I'm thinking that the A(ustralian) Medical Association and Australian FD union is right about this...
 
EpiEMS said:
The total opposite of the IAFF and those folks in the US.

I'm thinking that the A(ustralian) Medical Association and Australian FD union is right about this...
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Damn right. If they are worried about response times they need more Paramedics and more Ambulances. Simple as that. All Ambulance services are funded and run by the States. It not complex County, City and private models like you guys have in America. They are just trying to penny pinch.
 
the_negro_puppy said:
Damn right. If they are worried about response times they need more Paramedics and more Ambulances. Simple as that. All Ambulance services are funded and run by the States. It not complex County, City and private models like you guys have in America. They are just trying to penny pinch.
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Broadly, I think EMS should get behind moving US EMS to the Aussie model. But that's me, not having any experience with FD-based EMS (only third-service-based).
 
the_negro_puppy said:
Sorry, Fire Handle heavy rescue.

If Police are Fire are not used as first responders. If they beat us to a scene then they usually start CPR or the like.
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They never beat us to a cardiac call in NSW. Why? They simply are not called. Rescue went to fire because we had a spineless CEO who wanted it gone.

Just a question puppy, who started rescue in NSW???
 
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