A report I'd like to see more often

[Dustdevil]

Yes he is,, however, think of it this way, over 4,000 responses a year for BS, if he lost those responses, his staffing would drop, and then he would lose people, less people, makes him less important (i think that might be his logic, anyway.)

LOL! Now HERE's a man who obviously understands bureaucracy!

If you wanna beat the bureaucrats, you have to get inside their heads.

Unfortunately, as true as this all is, there is just damn little we can do about it right now. The level of education that most providers have is simply too inadequate to entrust them with deciding who gets care and transportation and who does not. Every system that allows it, finds itself in the news because some lazy, ill educated slug who doesn't wanna be arsed with another PCR no-rides a headache that turns out to be a stroke, or an "I don't feel good" that turns out to be an MI.

This is another in a long line of serious problems in EMS that can only be addressed AFTER we address education. Once the preponderance of our providers are intelligent, well educated medical professionals, instead of blue collar union, "public safety" labourers who colour by the numbers, we can start trusting them to triage patients properly and safely. Until then, sorry, but transporting everybody who calls is really about the only way I feel comfortable with the system we have today too. You wanna be something more than a glorified taxi driver? It's up to you to obtain the education necessary to do that.

[captainstandup]

Damn Dust, "color by the numbers" your brutal! Correct, but brutal! Keep fighting the good fight.

asyn2leads said:

Its a scam, people, it is. The reason we haul a-holes with minor emergencies from the ghetto and the trailer park is because we gets paid when we do.

He is right, it is a scam, but the fallacy here is that if DMA or CMS or many of the private insurers decide that transport by ambulance was not medically necessary, they will deny payment.

[AnthonyM83]

The level of education that most providers have is simply too inadequate to entrust them with deciding who gets care and transportation and who does not.

Can we trust doctors to make the decision? It seems to be working for the EMS system that they interviewed as a contrast system in the news video.

Also, while fewer BS transports means less pay, it also means they have to keep fewer ambulances on the road if they start denying the BS transports.

[Mateo_1387]

It won't be too long until the EMS system is way overtaxed that its impossible to keep up with. Especially with people always leaving EMS for bigger and better things its going to be hard to have employees. Mandatory overtime will be all too common. Something will have to change and I am sure it will be that we will have to deny transport. I also think it will also include EMS rendering treatment on scene.

[AnthonyM83]

Naw, at least here, there's always fresh new faces looking to get hired as EMTs so they can be firefighters and an ample supply of firefighters to be ordered to medic school, so I can't see us running out of manpower. It'll probably just become less profitable, though.

[captainstandup]

EMS has been overtaxed since the "white paper" was written in 1966. We began behind the eight ball and have never caught up. As the population has increased and stratified into scum, parasites, working poor, lower middle class, middle class, upper middle class and wealthy groups so has the demand for services anyway.

We are overwhelmed with calls in minority and white trash neighborhoods where crime, violence, diseases (treated and untreated), poor nutritional habits (the malnourished or morbidly obese) drugs and a prevailing attitude of entitlement to services from the man, is perpetuated through generations. These neighborhoods typically "consume" far more resources than all other socioeconomic classes and often pay nothing for services received due to their being uninsured, illegal, wanted by LE or simply not giving a damn.

Response time goals are often a "pie in the sky fantasy" in most metropolitan areas. I have friends in several cities and they relate stories of getting back into the rig only to find a dozen or more priority 1 calls waiting. These may include choking children or cardiac arrests all the while ambulances are tied up taking some fat lazy, wouldn't work as a taster in a pie factory, looser to the hospital because she has a rash on her legs that onset two years and 150 pounds ago!

We desperately need a national model for proper utilization of EMS resources. It must include education and a serious public relations campaign. We must be empowered ( i hate that word) to deny transport to patients that do not need it without the fear of reprisal. There are a great number of calls that should end with the paramedic referring the patient to their personal MD, a clinic, the ER, but not by ambulance.

The argument that reduced calls will result in reduced funding doesn't hold water. As I stated earlier most of the folks dont pay a dime for services.

[Niftymedi911]

The reason we haul a-holes with minor emergencies from the ghetto and the trailer park is because we gets paid when we do.

Did you forget to mention if we don't transport they'll call back 20 min later saying the same thing.

[Asysin2leads]

Did you forget to mention if we don't transport they'll call back 20 min later saying the same thing.

Law responds to economy. If it started being in the financial interest of a municipality to only transport emergent cases, law would adjust to support it. In some places, abusing 911 will land you in jail. Yet, somehow, in large cities, where the government is more than willing to reimburse you for whatever taxi ride you give the ghetto dwellers via Medicaid, they have a "you call, we haul" policy. Maybe its coincidence.

[captainstandup]

Asysin2leads, what percent of the calls you respond to in the big apple would you say actually meet your definition of medical necessity?

[Asysin2leads]

I can't give a real percentage, but lets put it this way;

They trot out the fact that we answer 1.4 million calls a year, 500,000 of which are level 1 or 2 "critical" emergencies. If you want to be truly cynical and say that only those 500,000 people needed an ambulance, that's roughly 33%, but then you have to factor in calls like an "injury", its not a life threatening emergency, but if you have a broken leg or a fractured hip or arm, yeah, its still a legitimate need for an ambulance. Honestly its hard to estimate citywide.

Its not going to end here anytime soon. The UFA profits off of it by keeping its call numbers up and its firehouses open, the city profits from it to the tune of approximately $130 million dollars a year in revenue. On one side you have the powerful fire unions coupled with the power of the city's coffers, on the other side you have a small group of medical professionals, doctors, nurses, paramedics, and EMTs going "Hey, up triaging these calls is really wrong..." Who's going to win?