EMTcity EMS

[Dustdevil]

As far as uniforms, my old service's uniform seems to meet most of your criteria. What do you think?

Not really a fan. Don't like Polo shirts. Don't like dark shirts. Don't like monotone uniforms. Don't like reflective trim.

Brent, I think he is refering to a uniform that is white with sewn in creases, epaulets like this one. Don't think we should use the tie or captain ranks though lol.

Exactly. The Van Heusen Aviator shirt is a badass shirt. As mentioned in my previous post, it lacks the sewn in creases, scalloped pocket flaps, badge tabs, and sewn down epaulettes that are standard on cop shirts. Cleaner appearance (especially if you install zippers and sew the pockets shut) and lighter weight. I like the epaulette ranks in a large system, where co-ordination with multiple agencies and large staffs that don't all know each other, like in a big metropolis. In a smaller system, they aren't particularly functional, and a simple "SUPERVISOR" embroidered on the shirt is sufficient. And all of our people will be paramedics, so there is no need to signify levels. A simple "PARAMEDIC" Embroidered on the sleeve and/or pocket is sufficient for identification. Nobody but other medics ever read patches anyhow. I don't like ornamentation that is not functional.

Great ideas, AZCEP. I too like mandatory helmets in the patient compartment. Possibly even in the cab when running hot. I have looked at quite a few. Obviously, there is nothing manufactured and certified specifically for this purpose. Until that happens, we have to make due intelligently with what is available. Ideally, it would be something of the quality of a racing helmet, with full coverage. However, that is not practical in our work environment. Next most logical would be something along the lines of a BMX or sk8ter helmet, with the ears uncovered. That is what the military is using for special ops now. They are lightweight, rugged, and available in complimentary colours that will blend well and not make us look like clowns.

Along those same lines, body armour will also be issued. Wear it, every shift, all shift long, or find a new job.

Agreed on the flight suits. Although, I have adapted to wearing 4.5oz Nomex all day long in the Iraqi sun, so I would think that Arizonians would have too, lol. But yeah, I reek at the end of the day. That's why a two-piece uniform is much better way to go in most cases.

Nothing wrong with Navy pants. It would be my second choice. It would just be nice to have something unique to us that makes a statement of independence, and is still associated specifically with medicine by a great many people. It would certainly make it harder for somebody to impersonate our personnel if it isn't something you can buy from Gall's, and a dark Kelly green fits that bill. I'm talking about a very deep green, so deep that you can't hardly tell it's green from a glance. Not the forest green or olive green crap the Kalifornia cops are so eat up with.

For protection and simplification, all medics will be issued a mid-level Nomex or PBI turnout coat in a completely different colour from the firemonkeys. It will serve as both a protective garment, a rain garment, and a primary cold weather coat.

As Brent said, we're not in it to make a buck. I don't intend to be the one essential public service in the community that people expect to turn a profit. I wouldn't set up a service in a community that could not get past that midset in the first place.

There is good and bad associated with being hospital based. It seems to work best in smaller communities and suburban or rural areas. In urban centres, it seems to eventually implode, with the EMS becoming more and more separated from the hospital until they are at war with each other. If you are not in an urban centre, hospital based can indeed be the best way to go, and I would encourage that. At that point, we become a part of the continuum of care, not a bunch of cowboys out doing our own thing far removed from the world of medicine. Benefits are easier to administrate because of association with a larger employer (which is the simple reason that city benefits are better than private benefits. More employees = cheaper benefits). And, just like many flight services, hospital based ambulances become a billable extension of the facility, simplifying billing and increasing reimbursement. It also establishes an atmosphere of medical professionalism, that gets peoples heads right, and decreases the "public safety" mentality that produces wankers and burnouts. Only if we were hospital based would I entertain the possibility of an IFT operation. Whether it would integrated into the EMS operation, or separate, I would have to figure out on a case by case basis, depending on workload and whether we were urban or rural.

I'm wide open to electronic charting. I just have very little experience with it. I definitely love the benefits it provides. I just don't like dumbing the documentation process down to a bunch of boxes to be checked, which is what I have seen in those few systems I have observed. I agree that there must be a good system out there that combines the benefits of both, and I'd love to see it.

As for medical control, we're running this thing in-house, aren't we? We have three qualified Emergency Physicians here on board with paramedic experience. I'll let them fight that part out among themselves.

[firedoc5]

You would have loved our uniforms. They were identical to the Duke's of Hazzarrd. Light blue with dark blue pockets and shoulder lapels.

But as a joke on my first day they went to Wal Mart and got me Garanimal pants, like the kids wore. They got me size 16-18. But guess what? They fit. I wore them for two years. Joke was on them. :thebirdman:

[triemal04]

Having a doc that was strictly in-house wouldn't be a bad thing neccasarily (assuming of course that you had a good one who was suitable for the job), but having one that was based out of a local hospital, even if it meant that you had to be associated with it to some extent might not be bad either. It'd probably be easier to get medic's time in the OR if they needed to maintain their intubation skills (which would also be mandatory for the service-12 successful, live intubations per year minimum, no if's, and's or but's), as well as into hospital based case reviews of patients that had care initiated prehospital. Might be easier to get medic's into any classes offered to hospital personnel that they otherwise wouldn't get. I'm sure there could be some downsides, but so far...

[Mateo_1387]

How about this uniform, no polo, no badges, and I think everyone can get over the patch.....

[brentoli]

Only if Dust and AK both will wear it.

Here is the current rundown

Staffing: Medics only

IFT's: NO

Education: Handled in house, with medic school, possibly working out a degree program witl a local college.

Uniforms: No wacker uniforms. Flight suits or scrubs?

Dispatch: In house with trained call takers

Management: Front line supervisors in office, with QRV access if needed, but not a primary responder.

What about trucks? Billing? Protocols? Support services?

[Niftymedi911]

Response:

ALS First Response (I reccomend putting our ALS medics on FD trucks, thus completely elminating the need for FF"s to be medically certified or at the very least basic) // ALS Transport

Levels:

9-1-1 // IFT // AeroMedical // Critical Care

24 hour fixed stations for the more rural areas with also 12 hour fixed stations for the more urban areas.

Closest Unit Response

EPCR:

Image Trend EMS Bridge ver 2008

Dispatch:

Combined one dispatching system and center for all of FD/EMS/PD/SO.

Preimere MDC by Motorola with ATM/GIS mapping and SIREN technology. Re-banded 800 mhz Smart-zone radio system and Sprint Air cards.

CAD/ MDC / MPDS (better triaging of priority calls and thus hopefully elminating the Lights and Sirens response to BLS calls.)

Ability for Medics to fill in voids in dispatch during low staffing or high demand incidents. (Overtime!!!!!)

Medical Direction:

One set of guidelines for the entire county/city.

"Guidelines"........ I would also like to see PA's in the field with QRV's. Thus being able to provide total medical care. Due to the fact of EMS being the primary line of healthcare for most of the population, if we can incorporate 2 or 3 PA's that work under the medical director, but can respond to your scene if you need assistance. Or even better, instead of "you call, we haul" syndrome. Let's say you respond to a personal injury to an 76 y/o/w/m. After careful assessment, the only thing you can find is a 3" lac that needs suturing. Instead of transporting him to clogg the hospital system even further. You can radio for the patient be seen by a PA, have the wound sutured, prescribe pain meds if necessary and can appoint a follow-up MD for further evaluation. Thus hoepfully only transporting patient's who really need to go to the hospital. (Ii will never always happen but at least its a shot in the dark).

Administration:

Director of Operations

Director of Training

Director of Quality Assurance

Director of Special Incident Response

Director of Information Systems/Technology

All would form a region council of directors, instead of one blabbing chief. Field Supervisiors would eventually be responsible for their persective sector or zone. Captains would be responsible for scheduling and day to day operations of the fleet. A Transport Advisor, for hospital designation for units on a seperate tac channel. They help control the flow of the fleet to different hospitals to aviod extreme offload times. Thus allowing EMS to control the ER's from "diverting" units due to being busy.

Completely integrated EMS billing department and system that also can interface with the hospital systems allowing to get 100% of all insurance info and personal info. Hopefully gaining that necessary boost in collection rates.

Education and Training:

20,000 sq indoor/outdoor regional training facility. County(or city)wide for all responders to train and educate under one set of guidelines, equal equpiment, and get to know personel better. The buidling will house seperate quarters for all of the training department staff. Will also house an accredited ASS degree program for EMT through Medic conditioning. The training center will also house a state-of-the-art scenario room. Will have numerous divided rooms and also ambulance boxes will manikins and equipment for every year conditioning. Every year, the training department will apply a re-conditioning course for all road crew to keep up their skills and necessary assessment skills. Also, with house EVOC, HazMat, and Critical Care programs. Allow FTO's to ride as third crew member on sporadic or spontaneous units to better view the overall performance of personnel, to see wether or not certain items need to be inserviced individually and agency wide. Monthly in-services with Cardiologists, Trauma Surgeons, Neurologists, Pediatrics, and most importantly OUR Medical Director.

Uniforms:

Poly-Pro high performance Polo shirts with custom lettering.

Logistical:

100,000 sq ft. Warehouse // Maintainence Facility

Uniforms, Backboards, KED's, Furniture, Support supplies, Office supplies, EVERYTHING!!!!

Numerous supply depots positioned throughout the county/city. Online ordering of supplies and afternoon delivery to your assigned depot.

Every 45 days the trucks are taken out of service, detailed, deconed, fixed, oil change, tire rotation, computer diagnostic, Washed/waxed/buffed.

[JakeEMTP]

Some good ideas Nifty.

I'm not sure though I would want to be aligned with the FD. Yes, we do have to work with them, but I disagree with us being on the engine.

Since we will be doing our own dispatching ( I think I read that on several posts) I'd like to see medics doing that too. As you are all aware, you can't work in the field forever, dispatch and call taking is a good place to move into, for obvious reasons.

I wonder about your re-supply idea. Can't we just re-supply at the ED? I mean, I'd hate to have a call while leaving the hospital and need a medication and not have it.

By all means, lets do our own billing. Aggressive billing is crucial. I mean, we won't take peoples cars or houses, but if you use our services, you have to pay.

[brentoli]

Some good ideas Nifty.

I'm not sure though I would want to be aligned with the FD. Yes, we do have to work with them, but I disagree with us being on the engine.

Agreed.

Since we will be doing our own dispatching ( I think I read that on several posts) I'd like to see medics doing that too. As you are all aware, you can't work in the field forever, dispatch and call taking is a good place to move into, for obvious reasons.

Is that called being put out to pasture? Dispatching isn't for everyone. It could be a light-duty task, based on personality.

I wonder about your re-supply idea. Can't we just re-supply at the ED? I mean, I'd hate to have a call while leaving the hospital and need a medication and not have it.

I like both ideas. Have a supply at your station, and a supply at the ED both. Keep meds at the ED and HQ under lock. Also this is a good reason to have QRV's available at HQ for the front line supervisors. They can take supplies to restock an unit in the field in an emergent or just extremely busy situation.

By all means, lets do our own billing. Aggressive billing is crucial. I mean, we won't take peoples cars or houses, but if you use our services, you have to pay.

I think this is one of Dust's pushes to be hospital based. Use their billing system. Then you get your all in one bill, better chance of payment, and easier collections.

I don't like the idea of putting our people on FD trucks. We will be calling the FD, extracations, codes, heavy pt's. But no need to have them on everything we do. In fact, I don't think we should even have an automatic dispatch with the FD, only on request.

[brentoli]

Interesting discussion from my region.

http://www.andersonfreepress.net/anderson-...s/politics/5987

[Just Plain Ruff]

think of how good this would have been for a contest.