EpiMedics, to the Rescue!!!

[phyrngn]

Well, things keep getting better and better for the Fire Medics in my town. The Lancasater County Medical Society, who wanted to Reduce the Number of Paramedics in Lincoln, helped the third party medical oversight agency, EMS, Inc. implement standards for all system Paramedics. They were as follows (some of these are estimates for a six-month period): ALS Calls, where an ALS Intervention took place: 24. Intubations: 4. IVs: 12. Funny thing is, none of the 48 Paramedics on the Fire Department were able to meet these standards. However, the 23 R/M Medics in town were able to achieve these goals. Sound fishy yet? Lincoln Fire Medics that work for another agency (such as LifeNet, a local Helicopter service) were NOT allowed to count the numerous skills that they received working in the Critical Care venue (probably because it helped them to meet the standards.) For two months, the Doctors have been saying that the LFD medics don't get enough Intubations and IVs...then, yesterday, they pass a rule stating that the LFD Medics can Intubate and start IVs, but the only drug that they can give is Epinephrine.

Oh yes, I forgot to mention. If a R/M medic walks in and sees an LFD Medic Initiating treatment, he/she receives credit for the "skill" (the IV or tube), even if he/she didn't perform the skill. A lot of the time, however, they nudge the Fire Medic out of the way and don't allow them to assist with patient care.

The media in our town is nonchalant about the whole deal...they seem to be adamant supporters of R/M. I have friends that work for R/M and they have said that their management has told them to "nudge" us as much as possible.

Sorry...just needed to vent some steam...what a $#&*'d up EMS System!!!

The opinions expressed are my own and not necessarily those of the agencies and associations that I work for or belong to.

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[9m18]

Somebody please find out how much R/M "donates" to the county medical society!
And fast!

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Stay Safe.
You asked for my opinion, now you have it. It's mine and mine only. Any similarity to another opinion...living or dead...is purely coincidental.

[fireman116]

This is a bunch of crap!!! What does your union officials think of this? What about the mayor or council? I wish you guys could just take over the ambulance in your city but it sounds like that would be a real fight instead of these cheap shots the docs are taking at you! Best of luck and keep us informed. Where can we send our support letters to for you guys?

[phyrngn]

fireman116...I'll e-mail you those addresses, as soon as I find the people with whom it might make a difference.

Thanks for your support!!! Keep the posts coming!!

BTW...the Union is very much in this battle. The whole process for our attempt to get the ambulance service has put Fire Administration and the Union "Hand in Hand." Things are going very well, so far...let's hope we can keep up the fight!!!

[spunk639]

What are your statewide protocols? how can your advisors deviate so far from them without any oversight from your state EMS or Public Health agency. This sound insane you can tube and start a line but only give epi?, not to be cynacal but is there something your not telling us. I'll admit I'm no big fan of Fire Dept. EMS, but compared to a private that is an ambulance service where profits is the motivator I'm all for Fire based EMS if no third service or hospital EMS exists. But your post sound fishy wether it be your advisors or incidents on your side. If it is the advisors and this being motivated by a private company R/M giving donations, contact your Attorney General or State Police/Investigations. That activity sounds like corruption and kick backs. If it is your guys with bad skills weed them out.

[phyrngn]

Spunk 639...back in the early 90's, our City Council voted to develop an independent medical oversight agency, comprised of a board of physicians and citizens that have no financial "stake" in the EMS System. They developed protocols for our Fire Department and the Incumbent Provider. A couple of personnel were hired for this independent, city-funded corporation. These people were (ahem) former private service EMS providers (one worked in my town with the current provider, the other worked for MedTrans in another City). These gentlemen were charged with setting up the Quality Improvement program, meaning that they are to review all charts and ride with ALS providers and offer suggestions, and other things that QI people do. They are to provide this for the approximately 70 Paramedics that are in the EMS System. My fire department has 14 Engine Companies...each is staffed with a Paramedic 24/7. Our rule is to have ALS treatment to every citizen within 3.5 minutes. We have met that goal for the past several years. The private provider has 3 ambulances (4 during peak hours) for a city of almost 230,000 people and a County of over 500 square miles.) Seven years ago, the Private Service was staffing their units with 3 personnel (an A, I, and a P) and they weren't "making any money." Long story short, the City trained Paramedics to give citizens a faster ALS response time, and thus eliminating the need for the third person on the Ambulance crew (increasing their cost savings.) Since then, many FD Paramedics have been treated unprofessionally and sometimes downright "beligerently" on calls. Many Private Medics will interrupt or supersede FD medics on appropriate ALS treatments that have already been initiated. We were also waiting way too long for the arrival of an ambulance. The FD decided that they had had enough of this, so a bid proposal was submitted for the ambulance service. Many physicians, the independent medical oversight, and current provider knew that we intended to provide the service, so they staged a multi-prong attack on the FD and the FD Medics. First, the Oversight agency initiated Priority Dispatch (which is not a bad idea, except it was being used for the wrong purposes), which made it "ok" for a >8 minute response time (our philosophy is, if someone perceives it to be an emergency, then we'll give them the benefit of the doubt.) Secondly, the City Dispatched the "System" Medic units up until a few months ago, and kept track of their response times. The independent Medical Oversight agency was not penalizing the Private Provider for poor response times...ever. Now, the private provider keeps track of their "own" response times, and there is no way for anyone else to know if their records are being doctored or not. Thirdly, the Local Physicians associated proposed "skill" requirements, meaning that all Paramedics in the System are required to have a certain number of ALS contacts, IV's, and Intubations to continue practicing as Paramedics in the system. The numbers picked were derived from the number of total calls in the City and divided by an arbitrary number of providers. Interestingly enough, ALL of the private providers met the standard. NONE of the FD Medics met the standard. Incidentally, if an FD medic arrives first on the scene of a Cardiac Arrest and Intubates a patient, the Private Provider is the Lead Medic, and so he/she also receives credit for the Intubation, even if he/she did not perform the skill. Funny thing is, most of these standards in regards to skills and dispatching occured just a little over two months ago...when the FD announced formally that they wanted the ambulance service and the Mayor gave his support.

Did I mention that the hospitals in town own 49% of the Local Private Provider Franchise?

Sounds like Politics as usual.

The opinions stated are my own and do not necessarily reflect those of the agencies or associations with which I serve.