Is It Proper For Federal Agency To Compete With Local EMS?

[Doczilla]

No, I don't see any real problems with this, apart from the fact that your agency is getting fewer calls and less experience. The NPS, like other federal agencies that operate on federal land, do not need to seek local/state certification for their EMTs. Our military medics that operate ambulances on military bases follow similar rules. The same thing for federal law enforcement officers, with a few exceptions.

I don't see a problem with them billing for it, either. Any EMS service, whether fire based, government 3rd service, or private, has the right to bill for the medical services it provides. The Center for Medicare and Medicaid services has a universal fee schedule for ambulance services for just this reason. I don't know why an ambulance run by the federal government should be any different. Because of this set fee schedule, reimbursement from emergency runs will almost never equal expenditures for proper staffing and short response times.

There is nothing that says the government can't run its own ambulance service, even if there is another service nearby, particularly when it operates on federal land. Local governments can do this, state governments can do this, so its logical that the federal government can too. Local governments have started taking back their territory from private ambulance companies because of response times and other issues, and the private services have essentially no recourse. Local governments have handed over EMS from private agencies as well as government run 3rd services to the fire department, and that's again their prerogative.

'zilla

[DwayneEMTP]

It seems to me that he was asking if it's ok for the Federal government to unseat local business when it has no requirement to participate in fair competition.

The "if the patient gets care faster, then what's the problem?" is a great attitude if it's not your mortgage or groceries that they have just eliminated from the local economy.

I don't know the laws, but am willing to believe that those above me do. I'm actually on board with you on this medic511. Had it been me the first thing I would have done is research ways on making these guys miserable and making it common knoweledge in the community.

Is it fair. No way, it sucks.

Can you do anything...Eeeh, probably not..but that doesn't mean you can't try!

Good luck.

Dwayne

[Just Plain Ruff]

It seems to me that he was asking if it's ok for the Federal government to unseat local business when it has no requirement to participate in fair competition.

The "if the patient gets care faster, then what's the problem?" is a great attitude if it's not your mortgage or groceries that they have just eliminated from the local economy.

I don't know the laws, but am willing to believe that those above me do. I'm actually on board with you on this medic511. Had it been me the first thing I would have done is research ways on making these guys miserable and making it common knoweledge in the community.

Is it fair. No way, it sucks.

Can you do anything...Eeeh, probably not..but that doesn't mean you can't try!

Good luck.

Dwayne

I understand your thought processes Dwayne and I too would be concerned if my mortgage or groceries were on the line.

Instead of making it hard on the competing company which it sounds like that ambulance service is there to stay, why not collaborate on things.

Instead of making their lives miserable why not find ways to increase participation and the like.

Remember, they can make your life as hard as you try to make theirs. If it turns out that both services cannot play well in the sandbox together then petty differences often hurt no-one but the patient.

I feel this guys and his co-workers pain but unfortunately they are going to have to find a common ground in the great land of parkville and work together.

I would bet that their call volume is not going to greatly decrease because now that the park rangers have double the work load they cannot be available for every call.

I wish his service the best though.

[medic511]

Thanks for all the input.

This is NOT a case in which the Park necessarily provides better or quicker care. Response times are about the same, depending on where in the Park the calls are and where the Rangers are in the Park when paged. The town limit and the Park boundary are the same line, so it is NOT that our EMS comes from the hospital -- quite the opposite, it's more like a straight line with the hospital at one end, the Park at the other end, and us touching the Park but between the Park and the hospital.

I guess it's a political issue but it is so contrary to what the Founding Fathers envisioned 230 years ago. (The federal government providing a uniquely local service and one that is already being adequately provided locally.) Golly, if only the Feds were so interested in universal healthcare.

[JPINFV]

Well, to be fair, providing universal healthcare isn't part of the powers granted to the federal government either. You can't be a strict constructionist only when it suits your needs.

[asrnj77]

This is taken from the association of national park ranger newsletter - just thought it was relevant...

"EMS Clinicals and Ride-Alongs — Unlike full-time EMTs and paramedics, most ranger/EMTs do not treat patients every day they go to work.

Some work at parks that are busy year-round, such as Great Smoky Mountains and Shenandoah, and see their share of sick and injured people. But often, the ranger/EMT is able to transfer patient care to ambulance personnel within five minutes of arriving on scene. Plus, they frequently bear scene safety, traffic direction and accident investigation responsibilities.

Others work at parks in remote settings where ambulance personnel may not have access to patients, such as Lake Mead and Glacier, in which cases the ranger/EMT usually is the primary care provider for extended durations. But oftentimes their EMS caseload is significant only during peak visitation periods, not year-round.

We are committed to providing the highest quality of treatment to our patients. The best way to achieve this is to maintain our skills. In turn, the best way to do this is to treat patients often. So, we have a quandary: How do we maintain our perishable EMS skills, thereby ensuring our patients receive the highest quality of care?

One answer lies in clinical rotations and ambulance ride-alongs. This means we immerse ourselves, several times a year if possible, into an environment where we are surrounded by full-time medical professionals, we observe them as they work, and we treat patients ourselves. Lots and lots of patients.

There are five arrangements available to most ranger/EMTs. Of course, each is contingent on an approved agreement among supervisors, the cooperating entity and park medical directors.

Emergency Room Clinicals. By far, spending time in a hospital ER is the most effective way to increase hands-on, face-to-face interaction with patients. Though not the best setting for improving field skills such as patient packaging, it cannot be surpassed in terms of patient volume and its wide spectrum of chief complaints, medical and trauma. Outstanding opportunities exist for conducting patient assessments (an imperative skill that is often glossed over), airway management, CPR and other procedures. For park medics, a 12-hour ER shift will usually yield six to 10 IVs and meds administrations. With every patient, lay a hand on their wrist, obtain vitals, listen to breath sounds and ask lots of questions. Spend time with patients and listen to them.

Operating Room Clinicals. In many cases, rangers can augment their ER time with time spent in the hospital’s OR. The primary — and often only — procedure rangers will perform in the OR is endotracheal intubation, and this will be limited to parkmedics, paramedics and possibly intermediates with advanced airway management training. Additionally, the OR is a sterile setting, and rangers can learn much about sterile fields simply by observing OR personnel at work. Though the scope of skills covered in the OR is more narrow than that of the ER, its value to ranger/parkmedics is indispensable: In several hours’ time, one can perform maybe a half-dozen intubations. For most ranger/medics, it’ll take a year or more to do the same number in the field.

Ground Ambulance Ride-Alongs. Second only to time in the ER in terms of overall value is time spent doing ride-alongs with a local ambulance service. Ranger/EMTs will not only contact a lot of patients, they’ll do so in a field environment, and they’ll usually be permitted to perform any skill they’re certified in. Additionally, they will acquire a fair amount of exposure to radio transmissions between paramedics and ER docs — again something most rangers do not do enough of. It’s amazing how much we can learn just by listening to the medic call in his or her patient assessment and to the physician’s questions and orders.

Air Ambulance Ride-Alongs. For parks close enough to an aeromedical ambulance service, conducting ride-alongs on flight missions is another medium in which rangers can expand their EMS experience. Often rangers are limited strictly to observation. However, much can be learned from watching, especially considering most incidents requiring air evacuation are serious in nature, and flight personnel are often the best of the best. And as a bonus, rangers will further their helicopter experience, which only serves to strengthen us as well.

Ski Patrol. Rangers volunteering as ski patrollers can also improve their EMS skills. Again, not all rangers work near ski areas, but for those who do, volunteering as a patroller provides an almost ideal setting, one that in many ways mimics some of the problems rangers face in backcountry EMS incidents, such as similar injuries, inclement weather, rugged terrain and possibly limited equipment.

We can never provide care for too many patients, and each one we treat increases our experience level and confidence. We have a responsibility to ourselves and, to a greater degree, our patients to remain as skilled rescuers. The above efforts will help us emerge as more competent EMS providers. Our patients deserve that much."

~ Kevin Moses, Big South Fork

[medic511]

providing universal healthcare isn't part of the powers granted to the federal government

That's certainly true, but neither is providing ambulance transport. If the Feds want to be be involved in clearly local issues like EMS transport, then they should certainly be willing to provide other, clearly less-local functions within healthcare, like universal healthcare. Of course, I guess "emergency transport" is a lot "sexier" than boring old primary healthcare.

But often, the ranger/EMT is able to transfer patient care to ambulance personnel within five minutes of arriving on scene. Plus, they frequently bear scene safety, traffic direction and accident investigation responsibilities.

That's EXACTLY my point. Transport IS immediately available by local ambulance. Always has been. Seems the NPS and the citizens they serve would be better served by the Park using its limited resources to perform their primary functions, like traffic control and enforcement, accident investigation, backcountry policing, search and rescue, and -- how quaint an idea -- interpretation and education about the Parks and their natural and historic features.

[Just Plain Ruff]

NO NO NO NO NO NO NO NO NO NO NO TO UNIVERSAL HEALTHCARE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

no no no no no

It will be too expensive and will be run like anything else the government does --- poorly.

Look at Massachusetts - their universal healthcare has cost way more than the original cost estimate. Plus now they are fining the people in the state who did not sign up.

Just take a look at massachusetts and you will see what the fed's will do when they get universal healthcare going - but multiply it by 500% in terms of cost.

I am adamantly against universal healthcare and I will be voting in the election for whatever candidate is also against it.

You think your ambulance and ER abuse cases are bad now, just wait

[DwayneEMTP]

I agree. But how do you collaborate with someone that has no motivation to compromise, nor any incentive to create greater success through that collaboration?

Again, like above. They have the motivation to take more of your work, to justify next years boated budget, without the motivation to do it as well or better than you. And none to create future quality/financial/managerial/patient outcome improvements. The less efficient they work this year, the more money they get next year. Tough to compete with that.

You simply have nothing to offer them when negotiating. Though at times they have been known to cave to public pressure.

[Amhet1]

Im going to toss out a shotgun blast and see if I hit anything. I found a 2005 memo from NPS discussing EMS within the parks.

http://www.nps.gov/policy/DOrders/DO-51.html

Of note, in section 4, there are these lil gems:

4.3.1 Assistance Agreements

Superintendents may assist other agencies with emergencies that occur outside parks. Parks are encouraged to pursue written general agreements with such agencies where requests for assistance occur on a regular or frequent basis. NPS employees who are directed by their supervisors to provide emergency medical assistance to such agencies outside their area of jurisdiction will be considered to be acting within the scope of their employment.

4.3.2 EMS Needs Assessment

The EMS Needs Assessment is the fundamental tool used in the development of a park's EMS program. Each superintendent must assess the emergency medical resources available to them, and ensure that their EMS program has been developed and maintained so that all persons have access to emergency medical care as per current standards. It is important that each park's EMS program be evaluated on a continuous basis and to make adjustments as necessary. The EMS Needs Assessment will be completed or updated by the Park EMS Coordinator and submitted every three years to the superintendent or designee. The Needs Assessment will conclude with a recommended level of service (Type I through Type VI) and justification.

4.3.3 EMS Plan

Each superintendent will develop and maintain an EMS Plan to serve as their guideline for EMS. The EMS Plan may be independent or part of an over-arching document such as the park's Emergency Operations Plan. Where appropriate, the plan should address circumstances under which the park will recover the cost of services rendered.

This tells me that the Superintendent of the Park was supposed to talk to someone in the community as have some sort of plans written, and especially some sort of mutual aid agreement.

As far as rangers training and experience, I read somewhere that after their initial training, a ranger will spend an average of 3 months a year in recurring training. As I understand it, ranger training is close to the AF Pararescue where it takes around 17 months to complete the basic schools. At that point, they go off to their squadrons and spend the next 2 years getting fully qualified, and THEN they are considered operational.

OK, as usual, I headed off on another of my tangents, but suffice it to say, the rangers have significant training.