RuralEMT-I

We've had the combitube for awhile now. Recently, I attended a weekend seminar called The Difficult Airway and learned about the KingLT. Got to use it on a few dummies (no not my coworkers). Its way easier to use then the combitube. One syringe inflates both barriers; its smaller, not as clumsy; you can also insert a bougee, take out the KingLT still maintaining an airway and put in an ET if you find that necessary. We are looking to changing from the combitube to the KingLT but have new physician advisors and they want to move slow on it.

Oregon EMT-B's can use a glucometer and admin oral glucose. In fact, it will soon be in the scope of practice for Firt Responders.

We are not a tax based agency. We do inhouse billing. Our collection rate is 67% of the total amount billed. Our average bill is $945.00. We have between 250-300 runs annually, 60% ALS, 40% BLS. We work with patients without insurance; as long as they pay something monthly (even $10.00) we wont send them to collections. We make a profit, all of it is put back into the business in the form of improvements or savings for improvements and special projects. We arent "rich" by any means, we just have learned to live within our budget. Planning is crucial. We plan for the worse case scenario, when looking at both expected income and expenses. Its not easy but it can be done.

Its our agency policy to not use L&S. The exception being up to the EMT incharge of patient care who will have to justify it to the EMS chief afterwards. One good thing about this policy is that if you let the ED know you are coming in L&S, they know its damn serious and will be ready for you.

The whole idea about agreeing to disagree is RESPECT. I didnt come to this forum to get a "beat-down". I came here to share ideas, thoughts, concepts and share perspectives. I knew coming in here I would not agree with everything being said by every post. I am not here to convince anyone that I know everything there is to know about EMS and everything I have to say is the way it has to be, otherwise it is wrong. I know I am coming in on the middle of a conversation. I first came to this website a couple of years ago and this same conversation was going on back then. This is also a constant topic of discussion in our agency, Im not a newcomer to the topic.

I am a paid for one agency and a volly for another..... my attitude is the same no matter whos ambulance I am in the back of.

This is what our standing orders are as well. Intermediates will be allowed to use Fentanyl in 2008, after some required training. MS is used for chest pain.

We have the Auto-Pulse in our agency and have used it once. The man was discharged from the hospital with no neuro deficets. For small agencies with limited staff, its great to have.

Our agency has the EZ-IO on board both our ambulances. We applied for a received a grant for the EZ-IO trainer as well. The company that makes them has a regional sales person and he came to our agency and did a 2 hour in service for us. Its a fantastic tool. We havent had the opportunity to use it yet in the field.

Yep, that sure is the definition of professional, I will not disagree with that. I will have to disagree that all volly agencies have to go, period. The emphasis on education, both initial and continuing, needs to be standardized. This in itself will weed out many in EMS that are just getting by. I am amazed how little hands on CE people actually do within their agencies, volly or paid. Sure, folks with lots of call volume get field experience. Not all agencies, volly or paid have that kind of volume, especially in rural areas. I am willing to agree to disagree.

There has been some talk in our county for a "user fee" to support EMS. So far, its just talk. The county does not operate the volly agencies. They are private not for profit organizations. This specific agency has 50-60 transports a year. The annual GROSS run income is approx $47,000.00 annually with a collection rate of 67%(national average is 51% according to JEMS) brings NET run income to $32,000.00. With insurance costs (Workers Comp and Liability) roughly $7,000.00 annually and fuel $4,000.00, supplies $4,000.00, rent $2,400.00 that leaves roughly $14,600.00 for the remaining improvements and set aside money to fund the replacement costs and operating costs if income should fall short. Simply put, there is no easy answer. Once again, I believe the emphasis needs to be on professionalism in EMS. There is no place for unprofessionalism in a paid or volly agency.

Spenac, sounds like you equate professionalism with being paid. I don't. I know plenty of paid paramedics that are the furthest from professional as can be. They give EMS a black eye by just showing up on scene. That said, I know plenty of volly EMT's who arent professional in their performance as well. I believe the emphasis needs to be on professionalism, not whether someone is paid or not paid. Vollys have plenty to learn from paid EMS and paid EMS has plenty to learn from vollys. I got into EMS to take care of patients who were falling through a large gapping hole in our community. The hole is still there. I do what I can. The life of vollys is short lived. The pool of people to draw from is shrinking fast. What we are doing in the community I am an EMT in is hire a base crew and suppliment it with the vollys. Is this the answer for ALL communities? No, I think not. But it works in our community. So does keeping the level of excellence in training paramount in participation. If you dont train, you dont run. We arent a perfect agency but I believe we are a good agency, an above average agency. The reason we are is we concentrate on professionalism, on training, on maintaining our standards and striving to improve ourselves constantly. That is a tall order for anyone to maintain, paid or not paid.

The volly agency supports itself by run income, nothing from the county. They also have a community membership annual fundraising. the average income in the assigned service area is less the $10,000 per household. I think its ok we disagree, as long as we understand what we are disagreeing about.

Plenty of grants available out there, some from the government, some from private organizations. Our agency is in the process of developing a plan for a new building. We just finished a new training building and now we want to build our own bay and move our business office there as well. Currently, we rent bay space in an old gross building. We are planning on half a million for this project. We will have some seed money of our own but the majority of the funds will come from grants.

Professionalism to me is performing at an expected trained level. I believe professionalism requires continued work on performance and dedication to excellence. In EMS there are basic standards we are required to obtain and maintain. Professionalism is going beyond the basic standards, minimum requirements, striving for more knowledge, better applications of that knowledge and the willingness to pass that all on to newcomers who are willing to strive for the same goals.