Skip Goulet

I'm seeing some very interesting comments here. "Way back" in the old days when we did mostly load and go, it was quite common to see a patient on a board with NO collar and vice-versa. They just weren't teaching proper c-spine immobilization back then. Now that's basically unheard of! However, I work as a first responder in my part of the county. I'm an EMT, and will be a paramedic when I repeat the NR exam! A few months ago I responded on an oilfield accident where a worker was hit in the head with a 6" plastic pipe. Knocked him down, and he was out for a minute or two. When I drove up another worker was holding him to keep him still, but wasn't immobilizing the neck. I could hear the ambulance coming, so I applied traction to the neck and had to keep the guy still. When the medics got there, they put on a collar and put him on the backboard. I looked around and said, "Where are your spider straps?" The medic said..."OH, we don't use those things.....they're too much trouble. We'll strap him down when we get him in the rig." I was apalled. This was a large metropolitan Fire/EMS with no spider (or other) visible straps! The department where I worked during my most recent EMT (I've been certified as an EMT since 1974!) re-cert and in going through paramedic training, spider straps were pre-attached to the backboard. No question about it! For those of you who would like a look at how ambulances were operated in the '60s and '70s, my friend Steve Loftin in More,OK, has a video that runs about an hour and a half with a lot of ambulance footage taken by a news cameraman between 1962 and 1972 in Corpus Christi. He has these videos on VHS and CD for about $30. There's a lot of footage showing the old stationwagon ambulances, full size and short-wheel-based, coaches, suburbans and early hightops. These are 16mm films converted to high quality video and in full color, but no sound. Contact Steve Loftin at: steveloftin@sbcglobal.net for further information and orders.

If first responders are certified as they are here in Texas as ECAs (Emergency Care Attedants), then, by all means, they should be allowed to operate in an ambulance. Many communities in West Texas are so small that the only emergency personnel they have are ECAs. These guys have paid for their own training, pay for their own supplies,etc. And in many cases, those in higher places can't be bothered with getting EMT...much less Paramedic....for these people. Yeah....let 'em work! It's not the best situation, of course, but you've gotta make do!

Thanks for your comments, Red. I understand fully that certified ambulances quite often work standby events,too. Superior Ambulance and MedTech in Odessa are two good examples, and both are fine ambulance services. The point I was trying to make is that there are numerous standby organizations here in Texas that work sporting events with non-certified ambulances: knowing fully well, of course, that they can't and won't transport. All they do is provide care and stabilization until another ambulance gets there. For that matter, when Superior and MedTech work sporting events, the ambulance working the event does not leave with a patient. Again.....they care for the patient until another of their units gets there and the second unit transports. What I'm trying to say is, with so many organization working standbys utilizing non-certified vehicles, why are we being singled out when we have done nothing wrong. As I think I pointed out before, the ambulance service I ran for many years in the Panhandle utilized licensed ambulances, and we did transport from the events we worked. On occasion we had an ambulance at events that wasn't certified, but we were allowed by TDH at the time to transport with it. The only restriction was that we could not run "hot" with an uncertified ambulance. Texas did not attempt to regulate non-emergency ambulance at the time; and I've been told that the state has yet to draft legislation requiring non-emergency transports to be done with certified-only vehicles. I also pointed out the fact that there are numerous "stretcher van" ambulances in Texas that make inter-facility transfers with patients. These vans have the bare minimum: a cot and O2 equipment. Again....these are unlicensed as ambulances and are not regulated by TDH. With this in mind: again, why are we being singled out. Pure politics with a power play mixed in. Thanks again for your comments.

Woody: Ordinarily I would agree with you; but in this instance, you're a bit off base. While TDH requires all emergency ambulances to be licensed (EMS provider's license), the state has never (and still doesn't) require certification/licensure for non-emergency or non-transport ambulances (which is where we fit in). Via this board, I spoke to a gentleman who lives somewhere near Dallas and is with a group called "North Texas Paramedics". Like us, they provide standby service for local sporting events...mostly motocross from what I understand. They have a Type II van that they use at these events, but like our unit, it is unlicensed and is not used for transport. TDH doesn't bother these guys. Likewise, the people who own the dragstrip at Penwell (west of Odessa) have their own ambulance vehicle which, again, is unlicensed and not used for transport. They contract with Odessa Fire Dept paramedics for standby service (off-duty Medics, I should add). They use this vehicle in and around the racetrack environs and for on-track transport purposes, and to provide a sheltered area for patients. Obviously they stabilize as necessary and wait for a city truck to arrive for transport. I managed a standby-only service in the Panhandle for more than 20 years. Our units were certified and we did provide transport. There's a big difference there. It's just my opinion, and not biased so, that we simply pissed someone off in the administrative chain one way or another and they're using us just to make an example. I only mentioned two examples of non-transport, unlicensed ambulances here but there are numerous others in Texas. Does TDH think they can shut all of us down? The guy who was ramrodding things yesterday had the opinion that simply because the ambulance van looks like an ambulance and still had a stretcher that it was illegally "advertising" itself as a TDH licensed entity. It doesn't, and we weren't. It's that simple. Unless the van is marked with "AMBULANCE" or "EMS" or "Paramedic" (you get my drift) wording or lettering, then it's not "advertising" anything. Regardless, under most circumstances you would be right. I just tend to disagree on this matter. And here's another one that I really don't know how to describe. A certain Odessa-based ambulance co. is contracted to provide transport for patients to and from River Crest, a specialized facility for mental and detox patients in San Angelo. They use a "stretcher van" that is totally unmarked and has no emergency equipment. They have a roll-in cot and O2 for patients requiring it. While the co. is a licensed EMS provider (they have a large fleet covering Odessa and now Lubbock), this particular van is not certified. Seems like that is fine with TDH. I'm beginning to wonder where all this will eventually lead. Richard, good to see you on here, too. I figured if you saw the post you would have comments, which are always welcome. The downside of all of this is that it puts us out of business for the most part. We can still provide standby personnel for our events. We just can't take our van with us. Most of the events insist on having an ambulance vehicle present, even if just for looks to satisfy some of their safety requirements, so that knocks us out for the moment. As I said in my original post, the only reason the van isn't permitted is for lack of medical direction, which the doctors are all saying isn't necessary! It seems that at TDH no one can quite agree. As I said, it's costing us our business and is putting my EMT cert. on probated suspension for a while. That's totally unfair and uncalled for.

I have worked standby events in Texas for more than 30 years and have just gotten the slats pulled out from under me, and I would like to hear from other people in the state who do standby service. For the past couple of years we have sat with our van ambulance at the local racetracks for standby only (no transporting), as we've been unable to certify the ambulance. We can't get medical direction, and the docs all say that since we're doing BLS only, we don't need medical control. TDH says differently. They are trying to shut us down because we have an "ambulance vehicle" with us at the standbys which is unlicensed. They say that just having the van present (although unmarked :no ambulance decals,etc) is illegally "advertising" ourselves as a licensed service when we're not. They've gone so far as to now give me a probated suspension of my EMT cert. for the past standbys we've done. I would think that this is a bit out of line for them, and would like to see if anyone else has run into a similar situation and how you've worked it out, if at all. Under their their terms, it puts us totally out of operation. Let me hear from you guys and your opinions, experiences.