What is the best EMS system model

[flucas82]

A plan in development by officials in Oklahoma City and Tulsa could lead to higher efficiency and increased cooperation between fire, ambulance, and other agencies involved in emergency medical response.

The plan, referred to as the Strategic Based EMS Blueprint, is an attempt by the Emergency Medical Services Authority (EMSA), the Oklahoma City Fire Department, and the medical community to center themselves around a set of values and a clearly outlined system designed for emergency medical system providers.

How it happened

Dr. John Sacra, medical director for EMSA, said the blueprint started taking shape about two years ago when EMSA’s contracts with Oklahoma City and Tulsa were up for renewal.

There were discussions at the time of fire departments taking over EMSA’s contract to provide emergency medical services.

"It gave us a window of opportunity,” Sacra said. "The medical community wanted to make sure that if there was a replacement it would be as good as or better than what we already had in place.”

The result was an idea for a system that encompassed emergency medical service guiding principles, core issues being faced by service providers and planning elements to carry out changes.

"You can have the best trained medics with the best equipment and medical protocols, but if you don’t look at the system design they’re not going to be the best they can,” Sacra said.

According to officials, the cost of adopting the blueprint will be minimal as its main focus is to make for a more efficient system and most aspects of it will be internally addressed.

AS An EMSA employee I am trying to come up with what I think would be the best system for OKC and Tulsa Areas I would like some input in what works best and what doesnt.

First things First I would get rid of SSM it doesnt work sitting in a truck for 12 hours in sometimes the most dangerous parts of town doesnt get us to any emergency any faster than a station. We do have two 24hr stations at EMSA west in Yukon and Mustang, and my response times dont differ. So finding stations would be the #1 priorty, IE (hospitals, Fire stations). A recent study that the ocfd did showed 29 of its 34 stations have room for ambulances.

Shifts- I would put 24 hr trucks in the outer slower parts of the area and 12 hour trucks in the busy areas. So you would work one 24 hr shift a week and two 12 hr shifts this would help in Burnout, and be able to put more ambulances in to service as of right now in the west we have anywhere between 12 to 20 trucks in service at a time and that is to cover OKC, Yukon, MUSTANG, EDMOND,Bethany THE Village, Nichols Hills, Warr accers, All paid FD plus vollie FD like DEER Creek, Piedmont, Richland. ADD all that up there has to be aleast 45 engines staffed with 4 people. With each Depts run volume being 80 % medical why have more engines than ambulances I dont know the math doesnt add up. So with that being said I think there should always be aleast 30 trucks covering the area 15 being 24 HR and 15 being 12 HR that would be a total of 45 people working on the ambulance a day.

Next would be response there is no getting around it fire will be apart of are response. I think OCFD and mustang do a very good job with EMS calls. And I enjoy running calls with them. But I dont see a need in sending a big fire engine to a BS call. Mustang has a rescue that is equipped with not only medical equipment but they have rescue and SCBA and there bunker gear on board it seats two people and is on a F450 frame. They staff it with one ONE PMED and one Basic. The system works great. Out of all the FDs we run with this one works the best. So I would think it would be cheeper to in long run for depts like OCFD two have about 25 of these in different stations. Houston has FLY cars like these and it seems to work really well there.

THe other part of response would have alot to do with dispatch. When the call is taken dispatch should as fast as they can put it in a response catagorery. For example

Code 1- Full arrest, Trama, CVA, ETC would get fires fly car going lights and sirens, and an Ambulance going lights and sirens.

Code 2 - SOB, Chest pain, etc would have FD Fly car running lights and sirens and ambulance started that way non lights and sirens. IF FD gets on scene and determines that it is life threating radio the ambulance and tell them to step it up

Code 3 - Ambulance only response lights and sirens fall, broken bones,

Code 4 Ambulance only non lights and sirens Toe pain, Bum who just wants a ride, ETC From What I understand Starting in 2010 We will be able to deny transport to non life threating calls for Service.

This Step All depends on how well dispatch gets Info from the call taker

Another Idea I had was putting BLS ambulance in the mix somewhere maybe for the code 4 response

The thing Iam having the most problem with is funding should EMSA stay PUM or go under the city somehow. I know we deserve the same pay as nurses and the same pension as firefighers. I could see how going under fire would help there and I think they would cross train the people who would want to do fire and let the people who just wanted to work the ambulance work the ambulance

I know OCFD will really be pushing for it in the next couple of years. IF SB357 passes this spring they will have a better shot of taking over service from smaller depts like bethany, Village, Mustang Etc

Anyways this is just a rough draft any input would be helpful.

[p3medic]

How about sent the ambulance with lights and sirens and non l/s for fire? If EMS needs fire, have them step it up, otherwise cancel them. Merger? Its worked great in places like NY, DC, SF....

[ERDoc]

I think this is probably a good source for different EMS models.

[ambodriver]

I like it the way it is here, Fire Department based, with single role medics.

[fiznat]

I don't understand why there is "no getting around" sending firefighters to medical calls. ...Especially sending them lights + sirens while the ambulance moves with the flow of traffic, that really makes no sense to me.

I would cut firefighter response to all medical calls except those for which fire might actually be useful- MVAs, gas odor, extrication scenarios, MCIs, etc. That would also help cut down on that ridiculous (imo) four tier response system. A response is either hot (lights + sirens) or it is cold (no lights + sirens). I think playing with intermediate levels just confuses things.

I think EMS ought to be city run as a true third service. If you want to put ambulances at fire houses for financial and response reasons, that is fine, but keep the crews separate. You are either a firefighter or an EMT/Medic. The service should have it's own transport trucks and be capable of handling the majority of the 911 volume in the service area on it's own. I don't think there is any point in running a third service if you rely on private ambulances to transport or to provide coverage on a regular basis. This means no medics on engines and there needs to be enough crews/ambulances to get the job done. Think Boston EMS.

Pay WELL. This isn't just a selfish thing. Good pay (even if only a few bucks an hour over the average) brings competition for jobs and quality applicants. It gives the city the opportunity to pick the best instead of just whatever comes their way. City jobs should come with pensions and all the other benefits fire and police receive.

Your distribution of 24/12 hour shifts seems fine to me. That should really be area-specific and it is always something you can work on and tailor to your needs as the system gets up and running.

[Dustdevil]

I don't understand why there is "no getting around" sending firefighters to medical calls. ...Especially sending them lights + sirens while the ambulance moves with the flow of traffic, that really makes no sense to me.

What's not to understand? It's the way we've always done it!

[RatPack]

Come on a 26,000lb truck flying down the road for no intended purpose. Whats the problem?

[spenac]

While I have not decided the best system, I do know the worst system is one that includes fire in any way.

[RatPack]

The best system is one that professionally and competently services the needs of their community.

[p3medic]

Even Seattle, argueably the best of the fire-based EMS systems doens't staff ALS engine companies...