Wednesday, February 16, 2011

Ask Capt. Schmoe, Eppisode #2

Rob, a reader from down under asks:
Something I have always wondered about you Americans. In Australia it has always been that the fire brigades handled fires and the ambulance service sick people. Recently in Melbourne the government has trained a number of the fire brigades to be able to responded to 000 calls (and ambulance will be sent as well) with the idea that the fire fighters may be able to get there sooner and that can make a difference.

What do you think are the advantages or disadvantages of both systems? This is coming about in Australia because theres a lack of ambos was this the case in the US or did it come about for more noble reasons? 


A good question, Rob. Anon. gave a good answer, one well thought out and accurate as did  CBEMT.

Here is the Schmoe point of view: It is sure to offend EVERYONE.

The fire service wants the call volume from EMS to justify staffing. In some cases, there is income from 911 transport, but in most urban areas, this is a money pit. Illegal aliens and the working poor often do not have insurance and medi-care only pays 30 or 40 % of the bill.

Private ambulance providers (including a few huge corporations) are in it for the cash, primarily that earned doing inter- facility transfers and non-emergrncy transports.For them, 911 transports are often a necessary evil, required by the licensing authority who requires it before they will issue a license to do inter-facility transports.

Non-fire, publicly provided EMS systems, such as county or Emergency Medical Authority run systems are a rarity around where I live/work. I believe they will become rarer as budget constraints become more severe. From a budgetary standpoint, it doesn't make any sense to have two separate bureaucracies to screw up administer an EMS delivery system when one can screw it up just as well.

EMS regulatory agencies try to keep the various providers in line by issuing restrictive protocols, ridiculous documentation policies and CYA edicts which enables them to create powerful fiefdoms, wreaking fear and havoc on the actual providers.

What is the solution? Here is the Schmoe solution. Hint: don't vote for me when I run for King of America. It won't be pretty.

The EMS delivery system would consist of two parts, both run under the management of the local fire/ems provider.

First responders with AEDs would respond on the closest fire unit. ALS/transport would be provided by single function medics riding on CCT ambulances. The medics would be public employees, with the same benefits and same type of career path that the fire service enjoys.

All EMS units would carry a black leather bag, filled with quarters, taxi tokens and bus passes. Non emergent 911 callers would, after evaluation, be provided a quarter to call a taxi and a token to pay for it. That should ease a good portion of the burden that is placed on EMS delivery systems in today's world.

Did I leave anyone unoffended? Oh yeah, attorneys. Attorneys would be banned from advertising on daytime television. During the first year of my reign, one half of the licensed civil attorneys in my state would be required to forfeit their license or be shot. Year two , 25% of the remaining civil attorneys would have to make the same choice, find another line of work or be shot. By year three, the numbers of practicing civil attorneys should be at a more manageable level.

The reality is that the overwhelming majority of 911 requests for emergency medical service do not require the services of EMS providers. We have created a world where people believe that dialing the magic numbers will cause their problems to be solved. It is our fault, it is what we have created. Like many other well intentioned social programs, it has grown out of control and is unsustainable.

The myriad of EMS delivery models are often driven by budgets, politics and power. Nobility rarely has anything to do with it. Now that the money is running out, these less than noble influences will have an even greater role.

I told you it wouldn't be pretty.

Thanks for reading,
Schmoe

8 comments:

  1. Well said Capt.

    I have had conversations that discussed a glorious EMS system like the one you described.

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  2. HUZZAH!!!!

    SCHMOE FOR KING OF AMERICA!!!!!

    HUZZAH!!!!

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  3. You stole (part of) my post over at firelaw! I like the idea on the lawyers-it will have the concurrent effect of reducing the number of political office seekers.

    But how long before they start spreading the word about the free cab rides? And will the cabbies revolt when they never get tipped?

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  4. Just a thought...to streamline the process and all...
    Instead of dealing with quarters and cab tokens, (Do pay phones still exist? And can you make a call for two bits?) why not just program the MDT to automagically request a cab to your location when you press the Complete Waste of Time/Clear button.

    BGM.

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  5. Hang on to your britches Cap- I think I'm about to surprise you.

    Non-fire, publicly provided EMS systems, such as county or Emergency Medical Authority run systems are a rarity around where I live/work. I believe they will become rarer as budget constraints become more severe.

    Strange thing is, I thnk they may become MORE common in my area. Taxpayers are starting to complain about paying firefighters [insert pretty generous wage and benefit packages here] to do medical runs, especially in suburban towns that don't see much fire duty. A few towns have gone so far as to propose changing to a municipal EMS system and making the fire department volunteer like they were 30 years ago.

    From a budgetary standpoint, it doesn't make any sense to have two separate bureaucracies to screw up administer an EMS delivery system when one can screw it up just as well.

    I dunno, I think Boston, Austin/Travis County, and Wake County may disagree.



    First responders with AEDs would respond on the closest fire unit. ALS/transport would be provided by single function medics riding on CCT ambulances. The medics would be public employees, with the same benefits and same type of career path that the fire service enjoys.


    Ready for the shocker?

    I don't have a problem with that. What I DO have a problem with is what FDNY did with that same idea- they turned NYC EMS into where people who can't pass the FDNY exam go to take the "promotion" exam into the Fire side. And they do it because the guys doing a million runs a year are getting paid slave wages compared to what the firefighters are making, among other reasons (such as getting treated like something a firefighter stepped in on the sidewalk by said firefighters).

    So as long as there is pay and benefit parity, solid medical direction, and a progressive attitude towards EMS with buy-in by the administration AND the field personnel on BOTH sides of the station, I'm completely ok with your idea.

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  6. CB - you probably shouldn't vote for me when I run for king. I'm just sayin.

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  7. Here's another thought... Assuming the number of true fire incidents and the demographics allow this. (And plase don't kill the messenger)

    First response provided by cops that carry AED's. Fire backs up the cops when appropriate such as cardiac arrests where more hands are needed, and traffic accidents that require extrication. Otherwise, no fire response to EMS incidents.

    Paramedic transport ambulance provided by hospital based EMS. Paramedics employed by hospital, whether it is a private hospital or tax supported county hospital.

    You can see this in action in many of the Minneapolis metro area suburbs and it seems to work just fine. Many fire departments are staffed by paid on call firefighters who respond from home, stations not typically staffed. Most cities have sufficient police resources on the road on a 24/7 basis to handle this. Paid on call staffing is sufficient and cost effective for many of the suburbs. The cost of ambulance service is borne by the patient and billed through the hospital system.

    ... and I would vote for you!

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