Collier fire-EMS merger may get resuscitated Monday

[CBEMT]

http://www.naplesnews.com/news/2008/dec/06...scitated-monda/

[JPINFV]

“We run one ALS engine with three people on board. We run one ALS Aerial, and we run EMS transport, which we have begun to run with three people,” Murphy said.

Now, Murphy reiterates the question many taxpayers ask? “Why do we send all these units?”

“We don’t need to send five or six units,” Murphy said, talking about a trial program in which a fire truck will be sent out, and the paramedic aboard will determine whether a transport vehicle is necessary.

Why don't they just send the ambulance to begin with? It's much cheaper to operate than a fire engine and the vast majority of calls will require an ambulance anyways. For the record, I'm not going to hold my breath for someone to provide a good answer on this one.

[WolfmanHarris]

Is that a Fire thing, or an American thing, or what? Since when does EMS assume that transport isn't necessary until shown otherwise? Decide on scene if an Ambulance is needed? What?!

Why does someone call EMS? Because they want to go to the hospital.

Yes it should be a goal of EMS to eventually have some discretion on this. But education isn't there yet and this is back asswards.

[FormerEMSLT297]

I'm wondering if they get a lot of refusals or unfounded calls down there,, why else would you wait to send the transport unit unit the FD arrives ....

My small dept. in NY did that in the 60's to 90's because they had a lot of fake unfounded calls.

The only run/ran 3,000-4,000 medicals a year, but in 1994 they stopped this process for the exact reason that they were simply delaying the transport of a ptient to definitive care.....

I DO NOT UNDERSTAND that line of thinking either.

Seems like they are burning a lot of fuel to do that ...

[Arizonaffcep]

Agreed, it should be a "transport until proven otherwise" thought process. At least that's how mine has always been. After all, how many MVC's with reports of ejection do you roll on without transporting someone? Phx Fire does something very similar. Engines roll first and call for transport if needed.

[Dustdevil]

Ya know, the worst thing to happen to American society in the last twenty years was for them to make 911 cellphone calls free. Now, every idiot and his kid is calling in every stalled car on the shoulder as a "major accident". Every guy trying to change a tire is now a "auto-pedestrian". Every guy checking his mail is a "suspicious person". Every steamy air-conditioner unit is a "structure fire". It's farking ridiculous. It is the reason that they can get away with even suggesting this criminal approach to triage. They need to put a button at 911 call centres that, if the operator presses it, you get charged a hundred dollars on your cellphone bill for phoning in an unfounded call. Or we could do it firemonkey style and charge everyone a hundred dollars for calling 911 until it is proven that the call was not unfounded.

[crotchitymedic1986]

Its called boosting your FIRE statistics. By bogarting the EMS calls, they can say our ladder truck ran 5000 calls last year, looks like we need to allocate another $750,000.00 to buy another one, in case we get a fire call while this ladder is tied up. Whereas, if the ladder only responded to structure fires greater than two stories tall, the truck would roll out of the station only a few times per month.

[Christopher.Collins]

Why don't they just send the ambulance to begin with? It's much cheaper to operate than a fire engine and the vast majority of calls will require an ambulance anyways. For the record, I'm not going to hold my breath for someone to provide a good answer on this one.

Cost and need aside... it'd be delaying further care. Its one thing to have an ambulance held up because of outside factors.... its completley different to send medical units there with no means of transport, just because they want an assesment before making the call.

edit: Especially if that patient NEEDS to be at a hospital 5 minutes ago.

[crotchitymedic1986]

Although this is obviously an attempt to grow union jobs, sending a fire truck first is not always a bad thing. In many departments, you do not have an ambulance in every fire station, so the fire trucks may be the closest ALS unit. In one urban 911 system I worked in, there were 24 fire stations, but only 14 ambulances on the road -- now realize that many of those stations had an engine, ladder, air&light, and/or rescue truck. And it is smart to send a BLS rescue truck to "toe jam" versus tying up one of your ALS ambulances.

What struck me as odd in this story was the possible consideration for EMS to go under The Sheriff's department. I dont know how it works in Florida, but in many states, the Sheriff's/Jail budget can not be limited by commissioners, the sheriff gets what he wants. It might be a nice twist to have an EMS Department that doesnt have it's budget restrained by the commissioners.

*** Lesson to all: If your EMS is losing millions, you always have to fear privatization or mergers. If you want to keep your job, transport more than the average 50-60%, or start running convalescent calls too (if you cant make up the budget difference with proper management).

[WolfmanHarris]

That's some backwards thinking there Crotchity. It accepts a crappy situation and then uses it to justify a worse one. 24 fire stations with 14 ambulances means that the FD running things has its priorities all F'ed up and rather than put more Ambulances on the road, they accept the shortage as unavoidable and put the engines to work. Heck equipment aside, if each of these engines has a medic on then and you took them off and put them in the Ambulance that's five more on the road with only equipment costs not salary. Put non-medic FF's on the engine or close one engine and redistribute the staff for no net-loss of job and only one apparatus down.

I don't have a problem with Fire on its own. But I prefer the way FD is utilized here. They are tiered for MVC's and other Fire-Rescue calls, Cardiac or respiratory arrest and choking, EMS response delayed (especially in rural when call volume's brought the county units into the city) and Cardiac and Respiratory calls (though I don't think they're actually needed on these in most cases). Bring FD in when their extra hands could be utilized, when their skills and equipment are needed or when EMS will not be able to make it.

As far as funding goes, I know this always comes up and I can't seem to wrap my head around EMS funding in the states. Here it's a budget item for the county. EMS gets x number of millions for the year with 50% coming from the province (in theory) and 50% coming from the municipality. The co-payment collected does not go back to the service directly and you never get a memo saying "Hey folks, billing's down so if you could make sure everyone get transported and hey try to use a bit more oxygen to bring that revenue up." EMS is not a money making proposition any more than Police, Public Health or Fire should be. To make money doing it you'll have to take Libertarianism way further than I'm comfortable with as a lefty-pinko-canuck.