Non-transporting ALS or ALS chase

[Nate]

A bad chief is a bad chief regardless of whether or not it is a fire based service.

-Nate

[flight-lp]

Why do you think it has such a poor execution? What are the specific problems associated with that system? I've heard that EMS runs a high call volume with not enough rigs. Is that still the case? Didn't TriData do a study of that system some years back? DId they actually address the problems the report brought up, or correct any deficiencies?

I'm not arguing, just trying to compare problems. I would bet the HFD's problems are not unique to that city either.

1. Piss poor medics that were thrown through a minimalistic half assed run course with piss poor preceptors.

2. Piss poor equipment, crappy protocols that do not address even the basics of patient care.

3. A Fire Department that places little emphasis on caring about the medical needs of the community.

4. Poor and minimally involved medical direction that is not current on evidence based medicine.

5. A city that has decreased faith in the department due to multiple political and racial scandals.

Need I continue????

The study did try to address the logistic issues, but many turned a blind eye and listened to a Fire Chief with no EMS background and one who had no interest in EMS. Add to that a time where medical direction was weak and with its own scandal, it all added up.

These folks are over worked in an undercaring system. I'm not sure it can be saved...................

[s.papabathini]

I live in Rural New York and we use "Fly Cars" in certain areas. I spent many hours, during paramedic training, on one. They are useful in certain situations. Where I live we have many small ems agencies that only go to the BLS or I level. The company I work for staffs ALS/BLS ambulances and then uses them to provide ALS linkups with various BLS agencies. That seems to work the best. If the agency can't get a crew, we are fully staffed and can take the call.

[SA_Medic]

Its interesting to see how many of you are not in favour of this type of system. In South Africa, in fact most of Africa that does have medics run a "rapid response" vehicle with the ALS on it. In Namibia for instance, we have a total of 5 ALS staff actively working in EMS, this to cover the whole country.

The Ambulances (not the specific built trucks you have) are manned mostly by BLS crews as there's even less ILS staff in the country. The "rapid response" vehicle is dispatched together with the Ambulance and will in most cases arrive first on scene and start treatment. Obviously once the Ambo arrives the BLS crew will assist me or the other ALS where needed.

It seems to work perfectly fine for us, but then again, I can't compare our situation with where you guys work, I am after all in darkest Africa.....

[Diazepam618]

1. Piss poor medics that were thrown through a minimalistic half assed run course with piss poor preceptors.

2. Piss poor equipment, crappy protocols that do not address even the basics of patient care.

3. A Fire Department that places little emphasis on caring about the medical needs of the community.

4. Poor and minimally involved medical direction that is not current on evidence based medicine.

5. A city that has decreased faith in the department due to multiple political and racial scandals.

Need I continue????

The study did try to address the logistic issues, but many turned a blind eye and listened to a Fire Chief with no EMS background and one who had no interest in EMS. Add to that a time where medical direction was weak and with its own scandal, it all added up.

These folks are over worked in an undercaring system. I'm not sure it can be saved...................

Most of 1-5 sounds like opinions, rather than facts. I mean piss poor medics unless you ride out with each and every one of them how do you know?, as far as the equipment well thats just opinion, as far as the department placing little emphisis on the needs of the community, well that is upper level politics and mission statement type of stuff again opinion. Those are not fact evidence of why you , in my opinion don't like HFD.

[Nate]

It does seem like he has something against HFD. I've worked with HFD many times on my scene and even a few of them work PT over at my department. They are good paramedics.

-Nate

[flight-lp]

It does seem like he has something against HFD. I've worked with HFD many times on my scene and even a few of them work PT over at my department. They are good paramedics.

-Nate

Now Nate you know better than that, we've discussed this very topic to some length a couple years back......................

Diazepam - Your right, I do not like HFD as an EMS entity. They're great firefighters, I don't contest that or the ISO 1 that the department holds. While some of my semantics earlier may be perceived as opinion, I can attest from having directly working with quite a few of their Paramedics for the better part of the last 20 years, I can attest quite a few shortcomings. Especially when you compare them to some of their neighboring counterparts which are rated as some of the best in the nation.

1. Equipment - Their Frazer boxes are old and remounted several times over. Most generators are inefficient in providing climate control, many have base frame damage from previous MVA, many also lack appropriate working restraint systems in the patient compartment. I have seen several stretchers that fail to operate as specified by the manufacturer, Sharps containers simply taped to walls or mounted on bars, and they lack equipment that is standard in all hospitals in the Houston area such as saline locks and needless IV systems.

2. Education - As a former preceptor for Houston Community College I can tell you that compared to both Lone Star College and San Jacinto College, their NR pass rates are lower and that the overall cirriculum is watered down, even compared to their civilian paramedic program counterpart. Their CE requirement is minimal, their protocols minimal to bare-bones ALS care, and on more than one occasion as supervisor had to be present to utilize their ALS skills.

3. Morale - Ask most Paramedics about their career goals and being on the medic unit or squad is not their answer. Most do it because they have to and because they get paid more to do it. If you look at their internal statistics, not many paramedics are career ones, most are out the door when they test for EO.

Now granted, Dr. Persse is trying some new things and listening to some new ideas. Slowly over time, things may improve. To me this is objective fact, I appreciate your view and perception of it being opinion. But I stand behind my belief either way.....................

[Diazepam618]

Well equipment is just that equipment doesn't make or break a service you buy what you can afford, as for education, well because ems has no standard that is up for grabs, I work for a very large FD in southern California and I do have a paramedic license and use it to my adavantage and make a good penny, as far as medical direction my department has it's own MD, as well as the county of Los Angeles has it's own MD, so lots of oversite, so it when people say LA is all messed up, if that were the case with all our medical direction /commitees and so forth things have not been so drastic in my opinion or those who have the pay grade to make changes if infact change is warranted. HFD is just in my opion probably in the same metropolitan catagory as that and lacks some other form of a higher pay grade to make changes if they are warranted.

[HERBIE1]

1. Piss poor medics that were thrown through a minimalistic half assed run course with piss poor preceptors.

2. Piss poor equipment, crappy protocols that do not address even the basics of patient care.

3. A Fire Department that places little emphasis on caring about the medical needs of the community.

4. Poor and minimally involved medical direction that is not current on evidence based medicine.

5. A city that has decreased faith in the department due to multiple political and racial scandals.

Need I continue????

The study did try to address the logistic issues, but many turned a blind eye and listened to a Fire Chief with no EMS background and one who had no interest in EMS. Add to that a time where medical direction was weak and with its own scandal, it all added up.

These folks are over worked in an undercaring system. I'm not sure it can be saved...................

Clearly the Tridata report was ignored then. Nothing new.

Well, TriData makes the recommendations but there is also no mandate to use the information or implement any of those ideas. A city spends 200K on a study that outlines needs and deficiencies, but the suggestions go unheeded. The problem is, in a fire based system, you need to change the emphasis from fire to EMS, and unless the changes benefit the majority(FS&R), they will not happen. You still need leaders to buy into the concepts before anything is changed, and for reasons well documented here, the old school attitudes are slow to change.

We argue here over possible solutions, but I don't really know what the answer is.

Most of 1-5 sounds like opinions, rather than facts. I mean piss poor medics unless you ride out with each and every one of them how do you know?, as far as the equipment well thats just opinion, as far as the department placing little emphisis on the needs of the community, well that is upper level politics and mission statement type of stuff again opinion. Those are not fact evidence of why you , in my opinion don't like HFD.

The upper level politics and mission statement stuff you refer to is what sets the tone- and the operational agenda for a department. If the leaders do not see providing quality EMS as a priority, then it sets the tone for all decisions made. There is no commitment to having a progressive, proactive EMS system, and that attitude is relayed to the providers when they do not have quality recruits, standards, or substandard equipment.

Think about the name "Fire based EMS". Where do you think the emphasis is in a system like this? FSR came first, and EMS is an after thought or considered to be a necessary evil in

too many places. Yes, there are progressive systems that buck that trend, but ask any single role who works in a big city about the dominant culture or paradigm where they work.

[jonas salk]

My service has PCP's (BLS) running the PRUs and ACP's working on transport trucks. A large number of our supervisors are ACPs as well and they can self dispatch to calls if they so choose.