What should we do to improve EMS

[SpotsyMedic]

I didn't say (or mean to say, at least) that they were spending $8-9M... I said they were SAVING that much by having the 200+ trained volunteers handled the nights and weekends. This is money that can now be spent on other county necessities, since the county is now operating at a deficit...

There is room for both volunteer AND paid career EMS services, and nothing will ever change that. It would be better for all involved if the paid career EMS people would acknowledge that.

 

[PapaBear434]

Sorry, but if your county is large is enough for such service; then its large enough for a fuill time paid EMS. Why only half the time? Kinda like a half time Fire Department.


Sorry, not going to cut it.

p.s. if you are spending 8-9 million for a half time service, time for new management!

R/r 911

There are places out there that you could argue HUGE call volume with little to no money available. At the far end of that spectrum of this would sit Detroit. That city can barely keep their police on the road these days. Volunteers are about the best they can do these days.

Granted, that's an extreme example.

 

[Ridryder911]

I didn't say (or mean to say, at least) that they were spending $8-9M... I said they were SAVING that much by having the 200+ trained volunteers handled the nights and weekends. This is money that can now be spent on other county necessities, since the county is now operating at a deficit...

There is room for both volunteer AND paid career EMS services, and nothing will ever change that. It would be better for all involved if the paid career EMS people would acknowledge that.

Saving or spending, either way poor budgetary expenditure. As well, 200+ people? I know of EMS that have less than 200 members and serve a city of million +. How many do you need on a truck? Hopefully, no more than 2.

Excuses. Do you still have a dog catcher? How many volunteer LEO do you have? Again, would these 200+ be willing to cut back on other services to fund EMS full time? ..

More volunteers, I don't believe we will see more. The interest in just keeping your own job and as well increasing education and work requirements will demand total dedication to the profession. Will these volunteers be willing to go back for the transitional course and re-test the certification in two years?

Again, look at my surgeon analogy.

There are places out there that you could argue HUGE call volume with little to no money available. At the far end of that spectrum of this would sit Detroit. That city can barely keep their police on the road these days. Volunteers are about the best they can do these days.

Granted, that's an extreme example.

No poor example, alike using D.C. as one.

R/r 911

 

[Ridryder911]

The old saying .."We are our worst enemies".. is never more true. NO other health care profession would tolerate non-professional status! Yet, we will... Why? Because, we always look for the easy way out. The easiest way to use an excuse.

Even more, to debate to place non-committed individuals, not because of location or areas, but because of tradition and easiness, is mind blowing.

It is bad enough our education or lack of; is fragmented (again look at the reason why) but not to want to improve.. is baffling.

Then you wonder why EMS is treated and not respected as it is? Really... do you think?

Examine who operates and manages such services. What education and experience in EMS and the medical field do they have? ...

Want to be treated as a stepchild, then don't act as one and don't ask to be.

 

[PapaBear434]

The old saying .."We are our worst enemies".. is never more true. NO other health care profession would tolerate non-professional status!

Even more, to debate to place non-committed individuals, not because of location or areas, but because of tradition and easiness, is mind blowing.

It is bad enough our education or lack of; is fragmented (again look at the reason why) but not to want to improve.. is baffling.

Then you wonder why EMS is treated and not respected as it is? Really... do you think?

Examine who operates and manages such services. What education and experience in EMS and the medical field do they have? ...

I brought up Detroit as more of a joke, as the city is a sinking pit of despair these days, but the fact of the matter is that they CAN'T afford to run a full service outside of the fire department these days. Hell, half the FD has been laid off due to budget cuts.

But I will agree that having a fully professional system would be nice. Would be great, actually. And the argument I have been trying to make with you this weekend and across multiple threads isn't so much that I disagree, but you can use the current system (or lack thereof) in the mean time while building the new system you envision. My system, which you already know and won't go into again here, is a prime example. Yes, volunteer based due to saving money in the city budget and tradition, but working on trying to move everyone up to medic status and a college degree.

I just think there's a happy middle ground between vollies being necessary and being the end of existence. At least until the system is restructured. It's not going to happen all at once, it's something that's going to have to change as a process.

I believe it was you that asked, in another thread, that if Vollies would still do their thing if there was a hard date at which their service would be banished in place of a full medic service. I think if we were to go to a service like our's, that answer would be "Yes." Because they know that they themselves could get their education in the mean time, and have their medic license (if they ever get licenses rather than certifications) before that cut off date and get a job out of the deal.

It's a process that would use what we got while we move to what we want, and not leave a huge gap in care and coverage to the public in the mean time.

 

[medic417]

As long as volunteer services exist communitys will refuse to go paid or to increase pay for the ones they pay. Why they see it being done for free. To correct that requires a well pubilzed closing announcement. Quickly the community will find a way to cover the cost of having a paid service. Again seen it many times in one of the poorest areas in the nation. So it works.

 

[PapaBear434]

As long as volunteer services exist communitys will refuse to go paid or to increase pay for the ones they pay. Why they see it being done for free. To correct that requires a well pubilzed closing announcement. Quickly the community will find a way to cover the cost of having a paid service. Again seen it many times in one of the poorest areas in the nation. So it works.

There is already a medic shortage. There is no way to do that all over the nation without causing such a glut on the market that people would almost begging for medics.

Bad news for the communities that were unlucky enough to get one. Great news for those of you that are already medics, because supply and demand would be HUGELY in your favor.

 

[Ridryder911]

There is already a medic shortage. There is no way to do that all over the nation without causing such a glut on the market that people would almost begging for medics.

Bad news for the communities that were unlucky enough to get one. Great news for those of you that are already medics, because supply and demand would be HUGELY in your favor.

Unfortunately, you are singing the same song hospitals and communities say about nurses and physicians. Guess what, they get them. Even nursing homes has RN's .. know why? They have to.

Point being, we need to quit looking for excuses not to meet the demands and to provide quality care. We need to look for solutions on how to meet those demands without compromising.

Again.. "If you are not part of the solution, your part of the problem".

R/r 911

 

[ffemt8978]

Unfortunately, you are singing the same song hospitals and communities say about nurses and physicians. Guess what, they get them. Even nursing homes has RN's .. know why? They have to.

Point being, we need to quit looking for excuses to meet the demands and to provide quality care. We need to look for solutions on how to meet those demands without compromising.

Again.. "If you are not part of the solution, your part of the problem".

R/r 911

So what about the communities that don't have doctors, nurses, or clinics but still have EMS?

 

[PapaBear434]

Unfortunately, you are singing the same song hospitals and communities say about nurses and physicians. Guess what, they get them. Even nursing homes has RN's .. know why? They have to.

Point being, we need to quit looking for excuses to meet the demands and to provide quality care. We need to look for solutions on how to meet those demands without compromising.

Again.. "If you are not part of the solution, your part of the problem".

R/r 911

Their system has been in place longer, so even with the shortage they can manage. Us switching over all at once wouldn't give enough time to prepare unless we started training those volunteers now to be medics later.

But what you say is true. Nurses and Doctors manage. I just don't think you can have an "All or Nothing" switch in the time frame you guys seem to want.

 

[medic417]

So what about the communities that don't have doctors, nurses, or clinics but still have EMS?

Then they need to pay EMS darn good as that is the only medical help they have. Keep EMS people happy so you don't lose them.

 

[medic417]

Their system has been in place longer, so even with the shortage they can manage. Us switching over all at once wouldn't give enough time to prepare unless we started training those volunteers now to be medics later.

But what you say is true. Nurses and Doctors manage. I just don't think you can have an "All or Nothing" switch in the time frame you guys seem to want.

You can go paid and start with the Basics you have. All our Basics are paid. Then hire in Paramedics and pay for your better students to go on to Paramedic. Soon you will have a paid ALS service.

 

[medic417]

There is already a medic shortage. There is no way to do that all over the nation without causing such a glut on the market that people would almost begging for medics.

Bad news for the communities that were unlucky enough to get one. Great news for those of you that are already medics, because supply and demand would be HUGELY in your favor.

Actually there is a surplus of Paramedics but most leave the field because of lack of pay. But again you do not have to start out paid ALS you can start off paid BLS and pay some to go on to Paramedic.

 

[Ridryder911]

But what you say is true. Nurses and Doctors manage. I just don't think you can have an "All or Nothing" switch in the time frame you guys seem to want.

Don't know; ask those from Canada. They were smart and ditched our system, as well as those in Africa and Australia. They actually have medics that work for decades...and yes, retire from EMS.

R/r 911

 

[Ridryder911]

So what about the communities that don't have doctors, nurses, or clinics but still have EMS?

That's even better. You are the sole health care provider; even more reason the best system should be delivered.

I have worked in areas such. The citizens were aware the need of having the best. Also there are more available grants from rural health care and funding for education. I would be hitting my public health department (I am sure you have at least this), State EMS, Project Homeland, Senator and Legislature.

Ironically, when asked most EMS personnel have never asked or investigated with the process of legislation.

R/r911

 

[AJ Hidell]

Bingo. It is incredibly short-sighted to maintain that we are wholly incapable of achieving what almost every other civilized country in the world has achieved. Even more short-sighted to maintain that we cannot achieve what every other medical profession has achieved. Not a single one of these silly excuses holds up to those comparisons.

 

[ffemt8978]

So, given the fact that there are over 25,000 towns, villages, and cities in the US (http://answers.google.com/answers/threadview?id=509183)and that it would take approximately 3 medics per community to provide 24/7 ALS coverage at one ambulance per community, that would mean we would need to have at least 75, 000 medics in the US alone.

Now consider that there are approximately 48,000 ambulances in the US (http://answers.google.com/answers/threadview/id/784884.html), that means you would need approximately 125,000 to 150,000 medics to provide that coverage.

Can it be done? Yes. Should it be done? Yes. Will it be done? Probably not. Especially when you consider something like this:
http://www.usatoday.com/news/health/2006-05-21-paramedics_x.htm

 

[Aidey]

That last link brought up a very good point, no one knows what the "best" ratio of MICPs to people is and until that is established we aren't going to be able to start forcing anywhere to change how they operate their systems.

I have a feeling if the economy stays in the dumps for more than a year or two cities who have a tiered or ALS engine response ahead of the ALS ambulance are going to start rethinking if they really have the budgets to be paying for those systems.

If places start eliminating their ALS engines to save money it will be interesting to see what the statistics start showing.

 

[Ridryder911]

So, given the fact that there are over 25,000 towns, villages, and cities in the US (http://answers.google.com/answers/threadview?id=509183)and that it would take approximately 3 medics per community to provide 24/7 ALS coverage at one ambulance per community, that would mean we would need to have at least 75, 000 medics in the US alone.

Now consider that there are approximately 48,000 ambulances in the US (http://answers.google.com/answers/threadview/id/784884.html), that means you would need approximately 125,000 to 150,000 medics to provide that coverage.

Can it be done? Yes. Should it be done? Yes. Will it be done? Probably not. Especially when you consider something like this:
http://www.usatoday.com/news/health/2006-05-21-paramedics_x.htm

Please, please let's cite credible information. C'mon. Look at the citations. Zoll & Montgomery County EMS? Let's research through the State EMS Directors and see the numbers and what projection should be. Within the same Internet quotation there are 35k with monitors or AED and that leaves only 10,000 without them? B.S.! I am sure there more than 10K without AED or Monitors. Are they also including private ambulance or non-911 or multiple EMS within a city?

The USA today article that was cited was also taken way out of context. Something those involved with OKC & Tulsa (which is cited) still regrets. This is the reason they are service I was referring to that are paying salary for a person while attending school for their Paramedic. Even moving and recruiting bonuses are negotiated . More is less...I don't think so.

Now, figure this there is alone over 5,000 EMT's alone in my state and its a rural state. There are over 17,000* NREMT/P alone; this does not include those that are not Registered or involved as a NREMT.

Does this mean there is a shortage, you bet. Since there is; should we allow a compromise to short change our profession, the system, and worse patient care? There is far more a shortage of nurses as the average age of a RN is now 49*. Thus approximately over 15% will be retiring within the next ten years.. so we shall allow volunteer nurses aides to perform RN jobs. Yeah, I can see the nursing industry allowing that to happen. NOT.

The difference is they are a profession composed of professionals. They will not allow such compromises. They will not "dilute" their system or profession. Even the "crash courses and on-line" programs will be coming under more scrutiny and we will probably see less and less states allowing license from these. I know that my state alone has added additional requirements to ensure that the RN candidate has met the "minimal" safety requirements.
Ever seen who governs their profession? Nurses and no one else. Each state has a Governing Board. Now, compare that with EMS.

I wish EMS had the gonads to do such. Nope, we will develop some form of pseudo acronym or another excuse (we are good at that) to cover up the blunders. Public assume that because it has lights & sirens there is a Paramedic in it. We also make sure that they are unaware of this as well. Yeah, there is one thing we are good at... not educating the public and definitley not making them aware of the difference.

Maybe a new insignia should be incorporated with the Paramedic (without the EMT referrence) and marketed and publicized. If you don't see this, you don't have Paramedic. Hmmm.. wonder what the community perception would be?

R/r 911

* NREMT 2007 Fiscal Reports
** ANA 2008 Review

 

[ffemt8978]

The original post, which was never answered in this thread has been moved to it's own thread here.
http://www.emtlife.com/showthread.php?t=11590

This thread will be allowed to continue on it's present course, but do not hijack the other one.