FD EMS and take overs

[austxmedic]

Need to feel everyone out. Let me know if you have been a part of an EMS take over by an FD. Weather it was good or bad and examples of each if ya got them. Working on gathering data, Also if you would like to be contacted by phone send me an email. Thanks

[DaSharkie]

Don't forget to talk to places where the FD absorbed or took over EMS but later split again, San Francisco and the area around St. Louis, MO just happen to leap to my mind.

[andy101]

We are in the middle of the same thing here in Wisconsin. I am both a fire fighter and First Responder and have seen reasons for the two units being linked.

The problems we are having are things like money, who is responsible for what, and government. What I can tell you is that it is very pollitical when you get to this point. Make sure you do what is best for both and not just for one.

What I can tell you about our situation is that if we joined now, it would put the first responders, who are good with money and their government, in a bad possition because we would have to split everything with the FD.

[FirstDueCTVol]

Look at the many examples of FDs that took over or tried to supplement the EMS being provided by private companies. In many cases the towns and cities thought it would be a win win - more calls and ALL THAT money from runs.

In many cases they have begged AMR, etc, to come back in - after realizing that EMS isn't all profit - in some cities it is a huge loser. AMR made it work because they had all the nursing home and hospital transports to balance the sheet.

Well, the FDs in some cases got the liability ridden and debt encrusted 911 work and the privates kept their profitable work. Then all of a sudden the fire administrators said "holy hell" this is killing us and the guys HATE running ems all night. Where is all the dollars that the union said we could make in this??

There are so many stories of this in MA it is ridiculous.

[CaptainMikey]

we had something like that happen where I live. There was a county ambulance service and a department within the county that also ran ALS, on a call there would usualy be 2 ALS units, wasting resources. So they combined the units with the FD buying the unit, The coiunty the supplies, and it is staffed by a FD FF/Medic, or FD Medic and a county medic. From what I can see, it worked.

[swrr88]

In 1990-2000 I was a medic in Lincoln, Nebraska working for Rural/Metro. They had been the sole provider of EMS for the city since EMS started...formerly Eastern Ambulance. The Fire department decided they wanted to take on EMS and make it part of themselves. They spent tons of money and lots of political pull. They got EMS on the promise they would do it faster, better, cheaper, blah, blah, blah.

They took EMS and immediately went into the hole. They had to buy ambulances and start service. They were supposed to make a profit and have since lost tons of cash. The fire chief that made all the promises and smiled when they took EMS was fired this year after a fire truck scandal broke. The city has even mentioned going back and investigating the EMS take over, too, as it has turned into a fiscal diaster for the city.

Most of the people I knew left. The city had plenty of their own medics. They didn't need all of us. They didn't take everyone, didn't take the office people, and managers except for one. We scattered around. If you are in Austin then some of my old co workers went there...ask them, too.

[swrr88]

Austx medic,

Tried to email you but it says you don't want email sent to you so I couldn't...check your profile.

[DaSharkie]

Oh yes, lets not forget a few other things:

1) The senior guys on the department couldn't care less about the ambulance because they are not going to be riding it, since more often than not the junior guys are put on the ambulance until another slot opens up for them to get off the box.

2) The amount of money reimbursed for Medicaid/Medicare is going to be staying put. With the high number of Baby Boomers hitting the age of coverage, the feds are only going ot have so much money to dole out. What the department says they will get in reimbursements will not necessarily be as much as you might think.

3) FirstDueCTVol is dead on about the SNF calls. They pay a lot of the money when trucks are idle. AMR and others run the crews ragged because when you aren't doing emergency runs, you are running granny calls. And a lot of firefighters and unions are not going to tolerate that happening.

[FTMPTB15]

If you want information about an ongoing battle between two agencies, look for information about Charlotte Fire Department and MEDIC (Mecklenburg EMS Agency). CFD wants to combine, MEDIC is against it. :rolleyes:

There have been studies, locally, about this. I'll see if I can locate some quickly.

Here are some articles featured in JEMS:
http://www.jems.com/jems/31-7/110608/
http://www.jems.com/data/pdf/Charlotte-EMS.pdf (original 1997 article)
I'll see what else I can find. :cool:

Another:
http://www.emsresponder.com/publication/article.jsp?pubId=1&id=1354

[mitllesmertz1]

How bout we talk about private companies that have fought to take over city-run EMS from a FD, and then claim bankruptcy a few years down the road, thereby screwing over everyone in the area? Leaving the FD to franticalkly try to replace the service?
I hear both sides.

[swrr88]

Just wondering about MEDIC in Charlotte and Austin EMS....I didn't believe either was looking at being taken over. MEDIC, at least according to the JEMS article this year, is pretty safe as a third service due to the investment and commitment by the county. Austin Travis County is pretty organized and been around a long time.

So, this take over talks...are these fire departments wishing to take over systems?

Neither one, I assume, is very vulnerable to a take over. There are lots of fire departments who want to take over EMS to continue their staffing and resources in a ever decreasing fire world....look at my experience in Nebraska. We were pretty weak in Lincoln. We did more with less but weren't properly staffing EMS in Lincoln which made us vulnerable to take over. Also, we were not city/county employees so we didn't have the loyality of government officials for which we didn't work for.

If you are covering your runs and doing it properly within your budget then I can't see why anyone could take you over. It is isn't going to save any money to do it and it won't make any difference in care so what is the point?

[FTMPTB15]

Just wondering about MEDIC in Charlotte and Austin EMS....I didn't believe either was looking at being taken over. MEDIC, at least according to the JEMS article this year, is pretty safe as a third service due to the investment and commitment by the county. Austin Travis County is pretty organized and been around a long time.

So, this take over talks...are these fire departments wishing to take over systems?

Neither one, I assume, is very vulnerable to a take over. There are lots of fire departments who want to take over EMS to continue their staffing and resources in a ever decreasing fire world....look at my experience in Nebraska. We were pretty weak in Lincoln. We did more with less but weren't properly staffing EMS in Lincoln which made us vulnerable to take over. Also, we were not city/county employees so we didn't have the loyality of government officials for which we didn't work for.

If you are covering your runs and doing it properly within your budget then I can't see why anyone could take you over. It is isn't going to save any money to do it and it won't make any difference in care so what is the point?

Let's see... I'll do my best to answer this minus any personal opinions/thoughts on the subject, as it has been the source of several (local) heated debates.
This has been an ongoing issue here in Charlotte since (I would guess) mid 90s. Back when Mecklenburg County EMS (now known as Meck. EMS Agency) was struggling and having problems with response times, funding, etc. This is the first time (that I know about) that CFD suggested any type of merger. The reasons were to improve response time (especially to the areas near the city/county border), help improve funding, and (hopefully) to just generally improve the service to the community. The idea was that with a MEDIC unit running out of each station (and I'm sure some would have more than 1), the response times would become a lot better than what they were. I'm not 100% sure how the units would be housed outside of the city limits. If you are familiar with MEDIC's unit assignments right now, housing one at each station could very well reduce the response times greatly within the City of Charlotte (In some cases).
Since the mid 90s, MEDIC has continued to (obviously) be opposed to any type of merger with the Fire Department. Charlotte Fire Department has continued to try and work out some type of merger. CFD has and is willing to train FFs as Paramedics. In fact, right now there are several FFs who are certified as Medics, some of whom actually work part-time for MEDIC, life flight, etc. Obviously, with CFD only being an EMT level agency, these firefighters can not operate at Medics while on-the-job at CFD.
Pretty much, as I understand it, it really all seems to boil down to response time. MEDIC tries to respond to (at least) 90% of their Priority 1 calls within 10min59sec. They also try to respond to (at least) 90% of their Priority 2 calls within 12min59sec. And finally, they try to respond to (at least) 90% of their Priority 3 calls within 20min. On the other hand, CFD is able to respond to incidents in 6min or less (obviously depending on availability of "first-in" trucks). Obviously when MEDIC is responding to certain parts of the city/county border, their response time is long. MEDIC *used* to be dispatched before CFD, but these days, it's pretty close to simultaneous. However, CFD consistently arrives on scene before MEDIC (usually several minutes). Not saying MEDIC never arrives before CFD, just stating a fact. Don't believe me? Listen to CFD's radio online, you will hear each unit on a medical call say, "EngineXX to Alarm... MEDIC is on scene." They announce when MEDIC arrives, they also announce if MEDIC is already on scene when they arrive. It's just a way to keep track of response time numbers. :cool:

**Just my personal opinion** It does appear that the response times for EMS would decrease (within the City) if MEDIC combined with CFD. Again, I'm not exactly sure what would happen in the County... I haven't really been paying attention. MEDIC does cover the entire County so obviously their response times are going to be extended. Does it suck for the Paramedics who can't perform ALS functions on a critical patient while they wait (minutes) for MEDIC? Yes. Am I a Paramedic? No. Do I think CFD and MEDIC should combine? Hmm.. I think I'll plea the fifth.. :D

[DaSharkie]

**Just my personal opinion** It does appear that the response times for EMS would decrease (within the City) if MEDIC combined with CFD.

Those same response times would decrease with more units and a re-vamped, truly tiered response system instead of an ALS provider on every freaking truck.

And the concept of an engine company arriving before the ambulance is exactly what a CFR system is supposed to be about. Firefighters, for the most part, are not as busy responding to calls as EMS units are to EMS incidents. Not to mention that there are usually more fire units strategically placed around a city.

[FTMPTB15]

Those same response times would decrease with more units and a re-vamped, truly tiered response system instead of an ALS provider on every freaking truck.

And the concept of an engine company arriving before the ambulance is exactly what a CFR system is supposed to be about. Firefighters, for the most part, are not as busy responding to calls as EMS units are to EMS incidents. Not to mention that there are usually more fire units strategically placed around a city.
I do agree with you. I was just trying to explain the reasons that CFD wanted to merge with MEDIC, obviously there are few-to-no reasons that MEDIC wants to merge.

In regards to your last sentence, that's why CFD feels like the merger would provide better care. More units, strategically placed, equals shorter response times, and quicker advanced care. I'm not saying that the current system isn't working, because obviously it's doing ok. Could it be better? Yes. Is combining with CFD the answer? Only time will tell... :cool:

[Dave1983]

I like the way we do it. We have 17 FDs in county, all are ALS. We also have a county ambulance service (again all ALS) managed by a private company.

The FDs provide ALS first response with ALS engines, squads (heavy rescues) and some truck companies. Some of the FDs also run what we call rescues, which is an ambulance type rig.

FD does not transport patients, except in an emergency (disatser) or if the county ambulance service has nothing available. In any case, FD does not do anything other then 911 calls.

The county ambulance provides transport, both 911 and routine calls (like transfers) and secondary ALS first response.

The FDs are funded by a countywide EMS tax. The county service is run on the remaining portion of the county EMS tax.

Its nice. THe FDs are fully funded by taxes so there is no loss due to billing issues. The private company running the ambulance service is fully funded and again, has no billing issues. The county handles the billing and whatever they bring in through transport fees is profit which is put back into the general fund.

The trick too makeing this work is the EMS tax is for ALS first response only, not transport. This is why our ambulance service is all ALS and set up to run first response when required.

The system has been set this way since 1987 and has yet to finish a year in the red.

[mitllesmertz1]

Imagine how much better off the county would be if they actually had some BLS transport units, and used a BLS rig to transport the BLS pt, instead of wasting an ALS unit for this.
Wouldn't that save some money?
Of course, you couldn't tell the citizens that it's an all ALS county anymore, but that's not what matters, right?
It's more important to get the right level of care to the right pt, isn't it?
It's more important to utilize the tax dollars in the most efficient manner possible, right?
It's more important to use the extra money on things that are proven to save lives, like public education, public access AED, etc, right?
Or is it better to have ALS units on every street corner, with medics that spend the vast majority of their day treating BLS pts?
Just a few thoughts...

[FTMPTB15]

Imagine how much better off the county would be if they actually had some BLS transport units, and used a BLS rig to transport the BLS pt, instead of wasting an ALS unit for this.
Wouldn't that save some money?
Of course, you couldn't tell the citizens that it's an all ALS county anymore, but that's not what matters, right?
It's more important to get the right level of care to the right pt, isn't it?
It's more important to utilize the tax dollars in the most efficient manner possible, right?
It's more important to use the extra money on things that are proven to save lives, like public education, public access AED, etc, right?
Or is it better to have ALS units on every street corner, with medics that spend the vast majority of their day treating BLS pts?
Just a few thoughts...
I totally agree! I guess it doesn't help that locally, the ALS service now handles both ALS care and BLS transports. I went to the doctor the other day and guess what I saw... A Paramedic crew sitting in the waiting room with their patient sitting on the stretcher. When the PT was called back, the crew pushed them back to their room, and came back out to the waiting room and sat. That sure looked good... It made no sense to me and I know joe-blow citizen wouldn't understand why they were doing that either. There used to be a BLS company that would handle most/all of those "routine" transports, now the ALS company is being used as a medical taxi... not only to take people to the ER.

[DaSharkie]

Mitlle,

You have an uncanny nack for clouding the issue with the introduction of facts, do you know that? ;)

[DaSharkie]

In regards to your last sentence, that's why CFD feels like the merger would provide better care. More units, strategically placed, equals shorter response times, and quicker advanced care. I'm not saying that the current system isn't working, because obviously it's doing ok. Could it be better? Yes. Is combining with CFD the answer? Only time will tell... :cool:

As Mitlle said, this makes no sense. All of those Paramedics sitting around with minimal skills. There is no need, even for a city/county the size of Charlotte/Mecklenberg to have an all ALS system. No need for any city.

A BLS rig covering a small area, with an ALS system tiered to cover several BLS response areas. More ALS rigs, means fewer ALS skills for the providers, which means weaker Paramedics, which means a poorer patient outcome.

Someday, someone with some brains will understand this concept. Not anytime soon, but someday.

Charlotte Fire wants this for no other reason than call volume, money, and manpower substantiation. Just like many other fire-based services.

I am not saying that they will not/can not do an effective job with the system, but lets stop kidding ourselves and put it all out in the open here.

[FTMPTB15]

DaSharkie.. I understand your points and of course there are other politics involved. What's the Public Safety field without politics?! As for why MEDIC feels the need to run ALL the calls in the County.... I couldn't tell ya! Heck, the Raleigh/Durham area has TOOOONS of BLS Transport services. I'm not exactly sure why NuCare (I think it was) got run out of the area. Maybe they went broke.. who knows.. I don't keep up with them. Maybe they got run out of the area.. who knows.. :confused: I do agree though, there is no need to send an ALS truck on a:
I can't pee call -OR-
My toenails are yellow -OR-
I can't go to sleep call
Then again, does everything MEDIC does make sense?! Nope, not to me at least. In FY2005 MEDIC ran roughly 83,000 calls, while CFD responded to 78,655 calls. How many of those were routine BLS transports to/from the doctor, nursing home, etc.? I couldn't tell ya, but I can say that CFD responded to 47,367 EMS calls. I don't think that combining CFD and MEDIC will increase the call volume for CFD. If they combined, I HIGHLY doubt that they would continue doing BLS Transports.

Again, as I stated in an earlier post, this has become a heated issue in the area. I don't want that to happen here. Everyone has their own opinions about what would work best and why. In the end, it comes down to the heads of both Admins. and the local council to make those decisions. We can only hope that those individuals will keep the safety/care of the citizens in their thoughts. Not to hijack this thread anymore...

Here is the original poster's request, anyone else have any information?

Need to feel everyone out. Let me know if you have been a part of an EMS take over by an FD. Weather it was good or bad and examples of each if ya got them. Working on gathering data, Also if you would like to be contacted by phone send me an email. Thanks

[ghent11047]

I work for an EMS company that is VFD based. When I first started, I thought "what did I get myself into?" After working here for a while, it isn't so bad. We do have our divisions and problems. Some fireman would like to see us out the door, some want us here. They feel EMS is a drain on resources, but when the accounts are checked EMS is always the one with the dough for a new fire truck. This causes some hard feelings, especially now that we need a new or newer EMS unit and they do not want to fork over the money because they just bought a new pumper tanker.

Overall, we all get along. The only people with issues are the older fireman who are strictly volunteer fireman and they are too busy fighting over who is going to be an officer.

As far as making profits, we do the occasional private transport. That is indeed our money maker. 911 does tend to hinder finances, as insurance companies try to avoid payment.

Someone mentioned in a previous post about private companies trying to takeover EMS. We have 3 private companies operating 911 pagers in the county. 2 of those companies are constantly circling the perverbial drain and the other is so large they want to absorb them and the 2 other VFD based EMS companies. That isn't going to happen. Our funding is mostly from EMS. Another company has tried to get a 911 pager, but they have always been declined.

Overall, I'm happier working for an FD based EMS service. I do know that others are not. For example, DCFD has a major politics problem that has no foreseeable end. I would have to say it boils down to what works for you.

[SBrooks]

In the most general of terms, the denser the population, the more separate fire & ems makes sense.

Conversely, the sparser the population, the more combined fire & ems makes sense: UNTIL you get to the point that volunteers make more sense than career personnel. In this case, usually, a volunteer FD can usually 'stay in business' in more situations than a volunteer EMS agency - a couple of hundred fire calls per year vs. a couple thousand EMS calls per year.

It seems to me that, if your Fire based EMS system has specialty EMS personnel who always ride EMS units and never fight fire, it should probably have a dedicated EMS agency. I would include those systems where, even for a single tour at work, people on EMS units aren't used for firefighting. IOW, unless you need to use personnel on EMS units for fireground staffing, they should probably have their own ball game and budget stream.

[swrr88]

I am not trying to start anything but it seems that both CFD and AFD would want ems solely for call volume. In DC where Adrian Fenty, the soon to be mayor, said he plans on separating EMS and Fire after elected in November the first response was it would cause fire stations to close. In Louisville, they separated fire and ems last year or so and since have talked about staffing on fire. Why? A whole lot less fires these days. Gotta find something to justify their being there. EMS taken over solely to save a fire department is not an EMS department you want to be part of. They don't really want to do ems but just use it to justify their needs. It is a sure fire way to cause trouble...ie: San Fran out west, DC, Louisville, FDNY.


As for times...BLS rigs are the answer but politicians and unions turn it around to say you are downgrading care. the public buys it so places stay ALS. BLS rigs and Triage cars or response vehicles could manage call volume just as well as CFD or AFD first responders. It is very common for fire departments to say we get there first all the time...heard it in Lincoln, NE too. Point is...they are supposed to! That's why they are called first responders. Recent articles have shown that qualified, well trained BLS providers with qualified ALS response after had better save rates than early ALS only. First responders are an important part of the equation. Unfortunately, too many times people like to use that first response to tear apart quality EMS systems for their own needs.

[Weruj1]

Debate Set on Oklahoma City EMS Service

Sep. 19--Who should operate ambulances in Oklahoma City?

Representatives from the Emergency Medical Services Authority and the Oklahoma City Fire Department will give presentations to the city council today that could determine whether ambulances will continue to be run by EMSA, a joint venture of Oklahoma City and Tulsa.

If Oklahoma City Council members want to consider ending their partnership with Tulsa, they must notify Tulsa officials next month. Some have suggested the service could be performed more cheaply and efficiently by the city's fire department.

The city has subsidized EMSA the past six years. The city will pay $3.4 million to subsidize ambulance service this year, more than double what it paid when the city first began subsidizing EMSA in 1999.

Each Oklahoma City resident pays about $7 annually in sales taxes for ambulance service.

After today's presentations, the council is scheduled to discuss the issue. Any action would take place at a future council meeting, City Manager Jim Couch said.

One council member questioned Monday whether the public was given enough notice of today's meeting. The meeting was posted on a bulletin board in front of the city council chambers last week as required by state law.

The law also requires meeting notices and agendas be posted on the city's Web site. No such notice was posted until after city officials were questioned about the law by The Oklahoman on Monday afternoon.

City Attorney Kenny Jordan said the law doesn't say how long in advance of a meeting the online notice must be posted. He said he is confident the city met open meeting requirements.

"While we may have complied with the letter of the law by getting this posted today, it certainly doesn't comply with the spirit of the law," Ward 4 Councilman Pete White said. "We certainly ought to make some special effort to afford the public an opportunity to talk about it at a regular council meeting."

[Dave1983]

Imagine how much better off the county would be if they actually had some BLS transport units, and used a BLS rig to transport the BLS pt, instead of wasting an ALS unit for this.
Wouldn't that save some money?
Of course, you couldn't tell the citizens that it's an all ALS county anymore, but that's not what matters, right?
It's more important to get the right level of care to the right pt, isn't it?
It's more important to utilize the tax dollars in the most efficient manner possible, right?
It's more important to use the extra money on things that are proven to save lives, like public education, public access AED, etc, right?
Or is it better to have ALS units on every street corner, with medics that spend the vast majority of their day treating BLS pts?
Just a few thoughts...

BINGO!!

But does it surprise you that "the powers" here dont see that? Or perhaps, they know they have a cash cow...

Ill go with MOOOOOOOOO... ;)

[DrParasite]

there are a couple more factors to consider:

in an urban EMS system, BLS is a money loser. It won't make a profit as a whole, usually due to numerious BS transport, coupled with many transports being uninsured city residents.

if BLS is run by a private company, then they will lose money. if they lose money, they go belly up. unless they are subsidized by the city or some other place, they will continue to operate in the red.

if BLS is city based (either FD or municiple), then it is funded by tax dollars, and operating in the black becomes less important (since their revenue is now from taxes, instead of insurance returns).

I still say, an all ALS systems ensures any patient who needs ALS care gets ALS care. A tiered ALS/BLS system WILL fail, when a patient who needs ALS care is treated and transported by a BLS ambulance because an ALS unit is unavailable. I work in a tiered system, and have seen it happen first hand (both in the cities and the suburbs).

It's like (rough guess), 95% of the time, an ALS unit is dispatched and able treat a patient who needs ALS. The other 5% of the time there is no ALS available, and a BLS ambulance has to take a patient who needs ALS in BLS only.

Fire department's as first responders tend to bandaid a problem with EMS; namely, they don't have the resources to do the job. The fire service generally has more apparatus than EMS, while EMS tends to have a signifigantly higher call volume than the fire department (subtracting EMS calls, of course).

As a final note, a first responder's job is stablize a patient until an ambulance arrives. ALS first responders are a waste of resources. BLS is good, at least until an ALS ambulance arrives, IMO.

[mitllesmertz1]

I still say, an all ALS systems ensures any patient who needs ALS care gets ALS care.
And an all Doctor service would be better still, right?
At some point the budget restraints must draw the line.
Unti lthere is hard evidence, not anecdotal stories, that all ALS has an improved outcome on overall pt survival, the discussion is clear cut.

[DaSharkie]

And an all Doctor service would be better still, right?

Careful now, I might take offense to that.

At some point the budget restraints must draw the line.
Until there is hard evidence, not anecdotal stories, that all ALS has an improved outcome on overall pt survival, the discussion is clear cut.

An all ALS system wastes resources. In the vast majority of systems TRUE ALS calls are roughly 30% of the call volume. No need for every single rig to have a Paramedic on it.

And good BLS is just as effective in the vast majority of ALS incidents as anything else. While I may use a few interventions to treat my patient, I still will often go with oxygen, ASA, and NTG with a suspected MI. (imagine that - BLS skills in most places.)

A properly tiered ALS system WILL benefit patients so long as the system is set up properly. And by properly, this includes proper and efficient call taking and EMD so that ALS units are not sent when they are not needed.

And if BS BLS calls are not paid for, and people opt ot not pay for the BLS calls, exactly how do you think that they are going to pay almost double for an ALS call. You will still go bankrupt. Subsidized by the taxpayers or not. If you take that away - you still are in the red. By using that tax funding, you are just playing a financial shell game. No different than a private service running transfers when not running 9-1-1. You are just subsidizing the numbers.

[DrParasite]

And an all Doctor service would be better still, right?
At some point the budget restraints must draw the line.
Unti lthere is hard evidence, not anecdotal stories, that all ALS has an improved outcome on overall pt survival, the discussion is clear cut.welll, an all doctor service would be even better (if i'm not mistaken, that is how several european EMS systems operate), but your right, it would be cost prohibitive. but there are certain things that docs can do and meds that an MD can push that a medic can't (thrombolitics come to mind, at least for my service).

An all ALS system wastes resources. In the vast majority of systems TRUE ALS calls are roughly 30% of the call volume. No need for every single rig to have a Paramedic on it.right. however what happens when you get that full arrest and there is no ALS available? then is the patient getting the best possible care?And good BLS is just as effective in the vast majority of ALS incidents as anything else. While I may use a few interventions to treat my patient, I still will often go with oxygen, ASA, and NTG with a suspected MI. (imagine that - BLS skills in most places.)your BLS can give ASA and NTG? damn, in NJ, we can only give oxygen and transport to the ER. can your BLS intubate too?A properly tiered ALS system WILL benefit patients so long as the system is set up properly. And by properly, this includes proper and efficient call taking and EMD so that ALS units are not sent when they are not needed.in a systems where ALS and BLS are sent from the same agency (only 4 or 5 such places in NJ), as well as having that agency handling the EMD/dispatching, I would agree. however, in some parts of the world, local PD takes the 911 calls, they dispatch the local BLS ambulance, and request ALS from the regional ALS agency. and yes, some of the local towns have idiot dispatchers, who over request ALS.
And if BS BLS calls are not paid for, and people opt ot not pay for the BLS calls, exactly how do you think that they are going to pay almost double for an ALS call. You will still go bankrupt. Subsidized by the taxpayers or not. If you take that away - you still are in the red. By using that tax funding, you are just playing a financial shell game. No different than a private service running transfers when not running 9-1-1. You are just subsidizing the numbers.it's called an ABLS ambulance, staffed with a paramedic and an EMT. if it's an ALS call, the medic treats, if it's a BLS call, the EMT treats. billing is handled according to who treats.

That being said, most urban EMS (particularly BLS) agencies don't make money, for the reasons I stated above. This is often supplemented by ALS to the urban areas and suburban areas, as well as non-emergency transports (which are all insured, so you know you are getting paid for them), which helps make additional money to make up for the running in the red for BLS call. Further, if an agency is city based, it gets additional income through taxes. if it's hospital based, it can draw upon additional funds from the hospital to stay afloat. if it's completely 3rd party, well, that is when you need to either be subsidized or have some other way to make up the costs.

[SBrooks]

There's no economic difference between running an EMS agency paid for with taxes and contracting that service out and paying for it with taxes (subsidizing it), except that the contracted company has strong reasons to control costs.

In Washington, DC, a multiple tiered system (BLS Engine/Truck, ALS Engine, BLS Ambulance, ALS Ambulance + ALS Rapid Response & ALS Supervisors) 49% of transports are ALS.

According to dispatch, 51% of medical incidents are 'Critical'.
47% of dispatches are "Delta" or "Charlie" ALS indicated responses.
Engines & Trucks respond on 88% of medical incidents.
The reliable response time for the first engine/truck is roughly 4 minutes.
The reliable response time for the first transport unit is roughly 10 minutes.

The difference between an EMT's pay and an EMT-I's pay is roughly $5K/yr.

The difference in cost between staffing 2 ALS/BLS ambulances and a BLS and an ALS ambulance is negligible.

As much as you medics think you're above running BLS calls, there's no real justification for it. Dispatch isn't always right. If it's BLS, it's opportunity for you to take a break from PT care, and help the BLS provider learn something.

If you want to stop running BLS calls, get promoted to supervisor.

If you want to stop running BS calls, enact a call reduction program.

That being said, I do think that there should be a relatively large number of supervisors, who are real paramedics, are well paid, have a broad scope of practice, and who are closely monitored by the OMD. Call it a tiered system with ALS & BLS Engines, ALS/BLS Ambulances, and 'Super'-Paramedics.

[DaSharkie]

welll, an all doctor service would be even better (if i'm not mistaken, that is how several european EMS systems operate), but your right, it would be cost prohibitive. but there are certain things that docs can do and meds that an MD can push that a medic can't (thrombolitics come to mind, at least for my service)..

I was busting his stones since I am a Phsycian Assistant as well as a Paramedic.

Many of the European systems also treat on scene, something most services do not do in the United States. For good reason - definitive care for the patient does not happen on scene. It happens (hopefully) in the bick brick building with all of the happy doctors, nurses, NPs, and PAs. Now if we could just convice some providers on the street of that.............

right. however what happens when you get that full arrest and there is no ALS available? then is the patient getting the best possible care?.

The patient gets the care that is available. It happens all the time that an ALS unit is not available, even in a tiered system, because all of the "ABLS" rigs are tied up on a stubbed toe. And BLS will usually manage the cardiac arrest quite well - electricity is infinitely more likely to revive a cardiac arrest than most medications that an ALS unit will carry.

Since we have been speaking anecdotally - I have worked codes at the BLS level simply because all of the ALS units were tied up. Even in a P/B system such as your "ABLS" system. It is a stopgap, and does nothing to change the outcome in the grand scheme of things (at least in my observances having worked in these systems for several years.) Although - I would love to see a study on this matter done.

your BLS can give ASA and NTG? damn, in NJ, we can only give oxygen and transport to the ER. can your BLS intubate too?.

Yes they do. And they can Combi-Tube as well. Even give IN (no typo) naloxone. Amazing what happens when you fight to get proper care for your patients and have a medical director / state OEMS that does not have its head up its @$$.

in a systems where ALS and BLS are sent from the same agency (only 4 or 5 such places in NJ), as well as having that agency handling the EMD/dispatching, I would agree. however, in some parts of the world, local PD takes the 911 calls, they dispatch the local BLS ambulance, and request ALS from the regional ALS agency. and yes, some of the local towns have idiot dispatchers, who over request ALS.

So instead of saving money and properly training people who are dispatchers, we just put more ALS trucks on the street because it is "easier" than actually having appropriately trained dispatchers who are held to a high standard.

I know from whence I speak - I have worked in the past for 6 years as a police/fire/EMS dispatcher. If you are properly trained by your employer, and actually are held accountable by your employer for your actions you get results. And I did have to call outside agencies for our ALS since we were a BLS town-run service. You do what is right, not what you want.

[QUOTE=DrParasite]it's called an ABLS ambulance, staffed with a paramedic and an EMT. if it's an ALS call, the medic treats, if it's a BLS call, the EMT treats. billing is handled according to who treats..

But if you are not going to be paid by your patient for a BLS call, then you are not going to be paid by your patient for an ALS call - regardless of how you are staffing your ambulances. Broke is broke.

As I said, I worked in an "ABLS" system (we called it working P/B) for 8 years and nothing changed between 2 or 3 P/B units from the Paramedics riding in a Bronco (which had BALLS :D ) dispatched APPROPRIATELY to incidents by PROPERLY trained dispatchers from SEVERAL communities. The Bronco covered 6 or 7 towns with a population of about 120,000 and the situations you spoke of rarely occured. And I dare say that outcomes would not have changed in a code - because dead is dead.

It all depends on the system the agencies want, and people doing what is right.

[DaSharkie]

There's no economic difference between running an EMS agency paid for with taxes and contracting that service out and paying for it with taxes (subsidizing it), except that the contracted company has strong reasons to control costs.

Exactly. The service is "subsidized" by taxes, or in the case of Richomnd, VA by doing interfacility transports. I can show you I am in the black anytime so long as you supplement my income/collections/costs.

Who is fooling who?

In Washington, DC, a multiple tiered system (BLS Engine/Truck, ALS Engine, BLS Ambulance, ALS Ambulance + ALS Rapid Response & ALS Supervisors) 49% of transports are ALS.

I understand that in an urban system the ALS proportion of calls is usually higher, but I always question how many calls are what I call "truly ALS." Just dropping a line in someone means nothing, and technically by using a SaO2 monitor in some places it is an "ALS" call. Putting a monitor on a patient makes it ALS.

But how many are truly ALS calls? Probably about 30%-40% given the poor demographics of D.C. along with the higher incidence of violence, asthma, and compacted region of any urban environment.

According to dispatch, 51% of medical incidents are 'Critical'.
47% of dispatches are "Delta" or "Charlie" ALS indicated responses.
Engines & Trucks respond on 88% of medical incidents.
The reliable response time for the first engine/truck is roughly 4 minutes.
The reliable response time for the first transport unit is roughly 10 minutes.

What is truly sad is that 10 minutes for an ambulance to arrive is accepted by the fire department, city hall, and the population as being "OK." Again, more BLS rigs to handle the BLS calls with more ALS units handling a larger repsonse area.

The difference between an EMT's pay and an EMT-I's pay is roughly $5K/yr.

Again, quite truly sad. No wonder D.C. can't get people to ride the trucks.

The difference in cost between staffing 2 ALS/BLS ambulances and a BLS and an ALS ambulance is negligible.

We are not talking about financial costs, we are talking an appropriate utilization of resources. Every call does not require a Paramedic, so why send one on every call? That actually does make poor fiscal sense.

As much as you medics think you're above running BLS calls, there's no real justification for it. Dispatch isn't always right. If it's BLS, it's opportunity for you to take a break from PT care, and help the BLS provider learn something.

Be careful where you tread. No one here has said anything about being above BLS calls. I am pretty sure that the vast majority of "us Paramedics" have no problem running calls that "you Basics" can handle without us. It is a matter of keeping ALS providers available for calls that are appropriately dispatched.

And how do I get to "take a break from PT care" if I am running the call or taking care of the patient? And I have no problem helping a BLS provider learn something, which I can also do while intercepting you in a non-transporting unit when we have a call together. Which I did quite often when I worked on an intercept unit.

If you want to stop running BLS calls, get promoted to supervisor.

Or leave the profession.

[croaker260]

As much as you medics think you're above running BLS calls, there's no real justification for it. Dispatch isn't always right. If it's BLS, it's opportunity for you to take a break from PT care, and help the BLS provider learn something.

If you want to stop running BLS calls, get promoted to supervisor.

If you want to stop running BS calls, enact a call reduction program.

That being said, I do think that there should be a relatively large number of supervisors, who are real paramedics, are well paid, have a broad scope of practice, and who are closely monitored by the OMD. Call it a tiered system with ALS & BLS Engines, ALS/BLS Ambulances, and 'Super'-Paramedics.

1st, its not about dodging BLS calls, its getting as much critical experiance as possible to be the best medic I can be. Education is vital, but so is experiance. Would you rather have a medic intubating you who has two tubes last year, or 20?
Would you rather have the medic who has done 1 RSI (or none because the service has a success rate of 70%!!!) or one who has done 30 last year, and can actually do a cric when needed.

Its not about economic savings, although you are using your money better....not less...but better...

Its really about patient care.

You mentioned a "super medic"..that is what we are talking about. But you only become a "super medic" through patient contact. And I am sure even you will agree that a good EMT is better than a bad medic. Thats why services with a ton of medics hve crappy ETT rates and are not allowed to tube kids, and places like seattle have intubation rates up there with the anesthesia docs. Thats the problem...there are a lot of bad medics out there because EMS today is about quantity ...not quality........ which is what your are suggesting..a medic on evey call for the "what if".

So lets go back to "super medic" concept. This is the very basis of the very successful Medic One program. Their medics really do see a lot of critical calls, a lot of intubations, a lot of education and responsibility. Their EMT's are involved and empowered to do their JOB too.

Its not that the EMT's are "below" the medics, or the Medics are "too good" for the BLS calls. Its that every one has a role to do. You dont see a cardiologist on every ER patient for a "what if" dop you? Why..becuase its a cost issue...but also because its a waste of a rescource. And if that same cardiologist did spend his time seeing the flu in the ER, how good would he get compared to the cardiologist that uses that same time doing caths and critical cardiac patients?

You dont have to be a captain, a supervisor to do this. (In fact, I can say as a supervisor, my command functions are distinctly different and often a destraction from or an opposition to my job as a health care provider when Im on scene.)

Bottom line ...when medics run more critical calls, with good education and selection...they become better medics and the patient benifits. The EMT's get to be EMT's, and still run 911 calls, they too become better. A good QA program and a good doc ensure all benifit, espeically the patient.

Since you cant alter the hours in a day...and there are only so many calls you can run in a given amount of time, the only way to improve their patient care expeirance (and make them better medics) is to improve the ratio of critical calls. Thats is the only variable you can change.

A tiered response system does this...if done right.

The saftey net for dispatch screw ups is a strong dispatch QA program, and a rapid, solid BLS foundation. You need BLS there with in 4 minutes, and BLS transport with in 10. ALS only when needed as determined by BLS on scene or in initial call information. Remember even most serious ALS calls will do fine BLS to a nearby hospital in an urban enviroment. Especially if the BLS can do combitube, nebs, NTG, and know their job!.

The dynamics change somewhat in a suburban enviroment, but not a lot.
Rural is a different animal.

[SBrooks]

I think we may be in agreement after all, especially if you consider the advanced level of BLS care you folks are talking about.

I agree in the tiered concept, except that I think that the 'basic' ambulance should be able to ETC, Naloxone, IV Glucose, EPI 1:10,000, etc. No cardiology. "Basic" advanced airway care, if you will. In this area, as of now, this requires an "ALS" provider.

I also agree in conserving experience - putting the few & proud on the few important runs, in order to gain experience and to put that experience where it is needed. We may disagree on this though: if you're not riding solo in a sedan, you and your partner should be capable of transporting without tying up one of the BLS transport units.

10 minutes is pretty fast for a transport unit. What's the benefit of arriving earlier? (When the FD has 4 minute early intervention securely in hand)

[Scotttt]

http://www.aemj.org/cgi/content/abstract/7/5/476
Impact of Paramedic Deployment Strategy on Cardiac Arrest Survival in a Large Urban EMS System
Academic Emergency Medicine Volume 7, Number 5 476

David E Persse, et al.

ABSTRACT
Objective: To examine the effect paramedic deployment strategy on VF cardiac arrest outcomes. This study hypothesizes that an EMS system using targeted deployment (TD) of paramedics (EMT-Ps) to critical incidents while sending basic EMTs (EMT-Bs) to less critical incidents yields better outcomes from VF cardiac arrest than a system using a uniform deployment (UD) of EMT-Ps to all incidents. TD may allow the system to function with fewer EMT-Ps resulting in more experienced EMT-Ps that perform better than EMT-Ps in a UD system. Methods: Retrospective review of all 1997 VF arrests in a large urban city employing a comprehensive electronic database system that automatically logs response intervals (RI) and patient information. The majority of the city is a busy, urban area with a high utilization/unit hour (U/UH) ratio that uses TD. Outlying areas of the city are suburban, have a lower U/UH ratio and use UD. All areas have first responders equipped with AEDs. Outcomes are compared using Utstein criteria between 18 ALS ambulances in an area exclusively using TD and seven ALS ambulances in an area exclusively covered with UD. Results: See table.
Conclusions: There is a significant survival and procedural skill advantage for TD of EMS resources over UD.

-----

http://www.aemj.org/cgi/content/abstract/13/5_suppl_1/S55-a

Cardiac Arrest Survival Rates Depend on Paramedic Experience
Acad Emerg Med Volume 13, Number 5_suppl_1 55-56
Michael R. Sayre, et al.

ABSTRACT

Objective: Out-of-hospital cardiac arrest (OOH-CA) survival varies widely among communities. We compared OOH-CA survival rates among 5 North American cities to identify factors that influenced survival.

Methods: The AutoPulse Assisted Prehospital International Resuscitation (ASPIRE) Trial was a multicenter randomized comparison of the effectiveness of manual chest compression versus AutoPulse during resuscitation of OOH-CA. Adults with OOH-CA were enrolled in five cities. Survival data collected in each city for patients in the manual arm of the trial were compared. Regression using generalized linear models was used to adjust for covariates.

Results: Younger women with witnessed ventricular fibrillation (VF) arrests in public locations who had short first response times had the best chance of survival. Victims receiving bystander cardiopulmonary resuscitation (CPR) had a trend to better survival. Time to advanced life support (ALS) vehicle arrival was not significant. The mean regression residual by site correlated with cases per paramedic per year (Pearson R = 0.97, p = 0.006).
Conclusions: Significant variation exists among the cities even after known predictors of survival are controlled. A positive correlation exists between more cases treated per paramedic and survival to discharge. Whether that relationship is causal or a marker for some other factor(s) cannot be determined.

[DaSharkie]

We may disagree on this though: if you're not riding solo in a sedan, you and your partner should be capable of transporting without tying up one of the BLS transport units.)

But you can turn around that ALS interceptor (with 2 Paramedics on it) very rapidly. Also, if you have the Paramedic unit transport, then you lose that educationsal perspective that should be there. While I am riding in my patient, I can pimp my Basic on causes of the issues, diffferential diagnoses, courses of treatment. I do it now with students.

Plus you get an extra set of hands in the back of the truck, and the Basic gets to learn that way as well. This works phenominally well when you have Basics in Paramedic school so they get more experience, and get more thrid ride time than the measly amount required by the state. (FYI - in Massachusetts, you are only required to ride 100 hours during Paramedic school - albeit with a set number of skills to obtain.)

10 minutes is pretty fast for a transport unit. What's the benefit of arriving earlier? (When the FD has 4 minute early intervention securely in hand)

10 Minutes is too long when you look at most standards being under 8 minutes. Even the almighty IAFF and NFPA want times under 8 minutes for a bus.

The benefit to arriving earlier is quicker scene time (in most cases scene time should not be more than 15 minutes - and that is generous), producing a shorter duration of call, and getting the patient where they need to be more quickly.

Additionally, the ALS intercept vehicle can meet enroute and screw immediately to the ED. Handling calls and patients is dynamic. And one of the best experiences for an EMT-Basic to get is to have a critical patient crump in their hands before an ALS provider arrives. This sounds like poor patient care, but it is not.

[FTMPTB15]

10 minutes is pretty fast for a transport unit. What's the benefit of arriving earlier? (When the FD has 4 minute early intervention securely in hand)
That's great!! :D :rolleyes: Rely on the FD to get there within their 4min response time so that the 10min response time from the medic unit doesn't seem so bad. :rolleyes: That's all well and good, HOWEVER, since most FDs only operate on a basic level, there are only a limited # of tasks they can do. Granted, most of the general public is just grateful that they are getting attention. However, it's ALWAYS great to come across a patient that says, "What the heck is taking the ambulance so long to get here..." Gotta bite our tongue when we're asked that! :D

[SBrooks]

FTM, look back a few posts, and read up. The number of units you need to reliably provide a response time increases rapidly as the time constraint diminishes. For a given level of activity, you need roughly four times as many units to provide a 4 minute response than you need for an 8 minute response. If you've got too many units, the units you're getting aren't going to be as experienced. The first 5 minutes are BLS anyway, with the exception of a few skills that are *probably* going to be unsuccessful if performed by a medic that only covers a 4 minute area.

DS: found another thing to disagree on. While I agree that 2 Paramedics is better than one, I cannot believe that they're cost effective, especially if we're talking about 'super' paramedics. I'd rather have double the capacity, or more resources per medic, or any of a number of things before I'd put a Paramedic behind the wheel. On the 1% of EMS calls that you need 2 paramedics, you get a supervisor, FTO, or another unit.

[DaSharkie]

DS: found another thing to disagree on. While I agree that 2 Paramedics is better than one, I cannot believe that they're cost effective, especially if we're talking about 'super' paramedics. I'd rather have double the capacity, or more resources per medic, or any of a number of things before I'd put a Paramedic behind the wheel. On the 1% of EMS calls that you need 2 paramedics, you get a supervisor, FTO, or another unit.

The reason that you have 2 Paramedics on an Intercept unit is to halve the workload, and since you are covering a much larger number of "ALS" calls due to covering a much larger area you increase your likelihood of having more critical calls. And having had to wait for another unit is rediculously time consuming. Since you cover a much larger area, the likelihood of getting that other unit in such a rapid time is diminished tremendously. In these instances, the provider is right there. It is a logistical matter, as much as for improved patient care.

Having worked in this type of system, I can tell you most assuredly that it works quite well.

Orange County, NC uses a similar tiered response system with 4 or 5 BLS units and there are 4 Paramedics in Intercept vehicles throughout the county. It works well, considering that there is a relatively low need for so many Paramedics in our society.

By putting so many Paramedics with a Basic, you diminish the experience level. Your newly minted Paramedic is inevitably placed with a newly minted Basic - this makes for badness. A 2 Paramedic system such as described allows for the mentoring that is critically lacking in EMS at the current time. It allows for a better learning curve and more guidance for both the old & new BLS adn ALS providers.

There is no Paramedics shortage as you see pasted about all over. There is a resource utilization problem.

The more Paramedics you have out there running fewer ALS incidents, the less proficient they are in their skills. This has been pointed out in past posts. The more Paramedics, the less successful the provider is in their interventions, the more errors they make, and the worse patient outcome gets.

And the concept of your "Super Medic" should be changed - every Paramedic should have the most experience possible within their system. Our patients deserve it. And our patients deserve the best system for their overall care and improved outcome. (Given that EMS hasn't necessarily changed a whole lot by way of improving overal M&M in the past 40 years.)

[SBrooks]

DS- I don't doubt that two Paramedic Intercepts works well, what I wonder is, is it worth it? Would it be better to have two one-Paramedic Intercepts, or two more One Paramedic transports?

You bring up the idea of maximising Paramedic experience, and then halving the Paramedic workload.

Clarification: My 'Super' Paramedics would be all the fully trained & turned over Paramedics in a department. Field training time would wind up with 2 Paramedics riding together, and there'd be a lot of this.

Question: In the systems I'm familiar with, ALS is indicated on dispatch nearly half the time. How do you defend the practice of not sending an ALS unit on the call? Or, if you do, how do you justify having relatively few ALS units? If you don't have relatively few ALS units, how do you justify not having transport ability on nearly half your units?

It seems to me that systems with a high proportion of ALS calls are perfect for the 'Uniform Deployment' model, using a Mid-Level ALS (EMT-I) Provider and a BLS Provider to provide the 'standard' service, backed up by very experienced FTOS & Supervisors - who are full Paramedics and see and practice a lot.

[FTMPTB15]

FTM, look back a few posts, and read up. The number of units you need to reliably provide a response time increases rapidly as the time constraint diminishes. For a given level of activity, you need roughly four times as many units to provide a 4 minute response than you need for an 8 minute response. If you've got too many units, the units you're getting aren't going to be as experienced. The first 5 minutes are BLS anyway, with the exception of a few skills that are *probably* going to be unsuccessful if performed by a medic that only covers a 4 minute area.
I do agree with that. MEDIC currently runs (at least) 34 ALS trucks during "peak hours." At night, the number of units on the street drops to somewhere around 14-20. If I'm not mistaken, MEDIC has a fleet of approximatley 45 ambulances.

Just as a side note, if MEDIC still configures their crews as they did several years ago, they operate with 1 Paramedic and 1 EMT. Some crews are 2 Paramedics. Never is a "new" Paramedic placed with a "new" EMT. There is 1 "Crew Chief" assigned to each unit who is a Paramedic with experience. Becoming a "Crew Chief" is considered a promotion, I guess equivalent to a Lt or Capt in the Fire Service... they are in charge of the unit and (obviously) their crew. Generally, if it is a BLS call the EMT handles it and ALS the Paramedic handles it. If the medic needs more assistance they will have the FD drive them in and the medic/EMT will be in the back... additionally, they might ALSO ask for another FF to help in the back. Also, the MEDIC Supervisors are all Paramedics who have "done their time" in the field and have been promoted to Operations Supervisor. Just like a Battalion Chief in the FD, they respond to any call which has "potential" to be serious (I.E.- pin-ins, high/low angle rescues, 2+Alarm fires, etc. etc.). Basically, they have the freedom to respond to whatever they want... heck, if they are close to a "rountine" type call, they might even respond to that as well. I've heard of cases where the Medical Director, Dr. Blackwelder, was <1min. from a call and arrived o/s before Fire/EMS and reported to dispatch pt info for the incoming crews. YES... talk about making sure you have your "i's" dotted and your "t's" crossed!! I guess the Operations Supervisor would be what you consider a 'Super Paramedic.' They do (if needed) ride in with the crew to assist in the back. So overall, I believe MEDIC operates the way you are describing.

[Dave1983]

Let me add a few things...While Im convinced the main reason we have an all ALS system is so the county can bill to the higher level (ALS) for ALL patients transported by the system (which I think is insurance fraud, but thats another subject), keep in mind that in Fla we only have 2 levels of certification. EMT (BLS) and paramedic (ALS). No EMT-A or EMT-I or whatever. And its a HUDGE difference in what each is allowed too do.

EMTs are only permitted to splint/bandage, give O2 and use AEDs. Thats it. No meds, no airways (other then nasal trumpets), nothin. So here a BLS unit is extreemly limited on what care they can provide when compared to ALS.

So, you cant really compare Flas multitude of ALS providers the same way you can other states. With EMTs that are barely more then first responder level in other states, you have to go ALS if you want to provide even a basic level of definative care.

[mitllesmertz1]

Conclusions: There is a significant survival and procedural skill advantage for TD of EMS resources over UD.

Whether that relationship is causal or a marker for some other factor(s) cannot be determined.
don't ya just hate it when people actually have evidence to support what they do, instead of just using fear ("what if a cardiac arrest happens and there's not enough ALS units")

Again, nothing has ever shown that all ALs does anything other than make crappy medics, oh, and waste money.

[shfd739]

It seems like it all depends on what works for your area.A local city fire dept runs double paramedic ambulances.They screen calls using NAEMD protocalls and only respond ambulances to serious calls.Their engines run on everything though and bls calls get rolled over to the local private services.Their medics like it because for the most part they dont run bs calls.The city is making a ton of money off the calls they do transport.An engine is usually on scene in first due area in less than 4 minutes.An ambulance is in its within 5-7 mins.Probably half the fire stations house an ambulance.The private service I work for has sole provider contract with our county.We run emergencies and transfers.Our contract is broken down into 8min,15 min and 20+ min zones with compliance requiring time of call to onscene i believe 85% of the time.We run crews with one basic and one medic,occasionaly double stacked if someone is working extra.Our basics ride transfers and bls emergencies.The medic only rides calls that need their level of care.Local fds provide basic level first response but most of the time we run when they get dispatched and get on scene together.This works for this county because it is cheaper to subsidize us than to run its own service or have the 4 or 5 small cities run a transport service.it all comes down to what works for you.

[biggravy]

Whether it be by 3rd service or private service, I would totally agree with the statement that EMS/Fire is better off split in an urban environment. In my current system, 31 ALS units support 57 pumpers and 25 trucks. We run out of units daily, the last time we ran out of pumpers was uhm, never! But its okay, we tell the public, because if we don't have that many pumpers your house may burn down! If it takes a unit 20 minutes to get across town someone just dies. NO big deal. The FD has been using EMS to make money for new shiny pumpers for so long that the public just sees things as the way it is. A third service would be held to higher standards b/c the "look we trying to do fire and ems" excuse wouldn't fly.
I can also totally back up the "dilution" of the paramedic talent pool standard. 87% of our calls are BLS, yet we are constantly told by admin that it "makes more sense" to put a medic on every unit, and fire equip. only if we have extras. We have a tiered medical dispatch in place where first responders are only sent to the "serious calls", potentially putting a medic on scene quickly, but they are busy staffing all the ALS units that usually arrive about the time the cardiac arrest vic is becoming rigored. Alas, EMT's don't really provide care anymore. Their scope of practice seems to be limited to securely holding the clipboard and writing down information when on the box or putting O2 on someone and standing there when on the pumper as they "are firefighters, not paramedics". BLS units would make not only the system better, but improve our personnel as well. Alas, it will never happen b/c the message of "we send you an ambulance with a paramedic whenever you call 911, no matter what for" will continue to produce high public approval ratings which translate to more shiny pumpers. A non-FD service would have this issue, nor the issue of medics who average 1 true ALS run per 16 calls.

[austxmedic]

Sorry the mail was not set up right, email or give me a shout, thanks

[austxmedic]

Some in AFD want to take us over, it's the IAFF and TAPFF that is screwing us be trying to pass a law under the TX senate/congress nose that would place 3rd service in the FD. Yet like everyplace else, They want our $$$, but don't want the 136,000 call we run either... we are gearing up for a David Vs Goalith Fight down here everyone keep your ears on...

[swrr88]

Some in AFD want to take us over, it's the IAFF and TAPFF that is screwing us be trying to pass a law under the TX senate/congress nose that would place 3rd service in the FD. Yet like everyplace else, They want our $$$, but don't want the 136,000 call we run either... we are gearing up for a David Vs Goalith Fight down here everyone keep your ears on...


are you serious? they are really trying that one?

[ptfd121]

Wow. I'm glad we don't have these problems were I'm at. The F.D. in our area(not only our F.D. but the surrounding F.D.s as well) run E.M.S. We feel we do a great job at it. Our response times are quick, and every patient gets the proper care. All our units are ALS, but I think there should be BLS units as well. The comment about ALS providers with diminishing skills is right on. If you oversaturate an area with medics, they won't get the "good" runs that they would get in a split system. I do see that problem in our county.
Although we charge for patient transports, it's only soft billing. If the insurance doesn't pay or the patient can't, we don't persue it. We don't use the income from the billing to support our F.D. That's what the residents' taxes are for.

[FTMPTB15]

we are gearing up for a David Vs Goalith Fight down here everyone keep your ears on...
Hmm... sounds familiar... :cool: