Orange County, CA IFT ALS Unit proposal Call for Review

[JPINFV]

So Orange County, CA has decided to start allowing paramedics to operate on private company, interfacility ambulance units. Prior to this point, the only paramedic provider allowed in the county was the fire departments running 911 calls. Private companies used EMT-Bs (EMT-I [one]), RNs, and RTs to meet the needs of interfacility transports, including transports going to the emergency room.

Now for people who aren't familiar with the screwed up California system, direct EMS system management is left to the "Local EMS Authority" which is either the county or a group of counties. There are three levels, EMT-I (one, EMT-, EMT-II (two), and EMT-P. There is a list of expanded skills for EMT-B which must be approved by the state. Similarly, counties can only use EMT-IIs [known as "limited advanced life support"] if they absolutely can not provide paramedics and only after approval by the state.

Here is the current proposal:

http://ochealthinfo.com/docs/medical/ems/i...ort%20units.pdf

I can't, for the life of me, see how this is useful. The drug list is essentially limited to glucose, nitro, saline, albuterol, ASA, narcan, and EpiPen. No ACLS drugs. No pacing. Only combitubes. SAED monitor (not sure if they'll allow manual defib). Probably the best part is if the patient crashes, the medic has to request a 911 medic. Why even use a medic for this? Why even apply for a medic spot with these restrictions?

Call for comments memo:

http://ochealthinfo.com/docs/medical/ems/45dayreview.pdf

Edited March 17, 2009 by JPINFV

[AnthonyM83]

Not to defend SoCal EMS, because a lot or most of it is retarded, but there is probably a reason?

Wonder who pushed for it.

Would this cover a lot of hospital to hospital transfers, like ped asthmatics in ER transferring to pediatric hospitals. A lot of patients are 'stablish' according to hospital, but require a monitor en-route. Least private medics can do just a tad more now . . . ?

[JPINFV]

Not to defend SoCal EMS, because a lot or most of it is retarded, but there is probably a reason?

Wonder who pushed for it.

Would this cover a lot of hospital to hospital transfers, like ped asthmatics in ER transferring to pediatric hospitals. A lot of patients are 'stablish' according to hospital, but require a monitor en-route. Least private medics can do just a tad more now . . . ?

Probably not. Both CHOC and University Children's Hospital (UCI) has established transport teams with backup contracts. It would probably still be ran by RNs.

One of my major problems is that if a patient crashes, they need help now, not in the 5 minutes it'll take to either reach a hospital or the fire department to reach them.

[fiznat]

In my experience, interfacility ALS transport usually requires *more* expertise, not less. I suppose there is a small niche of calls that private IFT companies would be able to run due to this change (basic IV with NS/O2/Monitor transports), but beyond that it seems pretty much useless. These providers are not adequately equipped to handle any sort of critical patient, which is probably the point. I'm having a hard time seeing the motivation for something like this other than for protection of turf.

[Diazepam618]

WOW this is a sorry attempt to get private ALS in the county, Iam suprised that the IAFF has not stepped in yet and tried to block this from happening. The current model they have is working just fine. I used to work on a CCT car as an EMT with an RN and we didn't even run that many calls in OC to justify our existance LOL (AMR). I guess if it creates more jobs in this current economy, more power to the privates.

[JPINFV]

As someone who worked for one of the major interfacility companies in OC (red vans, not blue stripes), I have to disagree that the current system works. Right now, unless a SNF calls 911, the response is going to be EMT-Bs regardless of the chief complaint unless a ventilator is involved (then it gets kicked to an RT led CCT team). Congestion? BLS call. Unstable V/S (I did once get a call where the CC was a B/P of 70/40. The facility knew this, the patient was full code, and they called for a non-emergent transport to the ER)? BLS call. Electrolytes out of wack? Abd pain? ALOC? BLS, BLS, and BLS simply because that is the only option available without accessing the 911 system. These are calls that basics should not be running alone on a consistent basis in a county of 3 million people. Unfortunately this setup does not address the massive gap in service between basics and RN led CCT calls.

[Diazepam618]

I get what your saying I to have worked for the RED ambulance White stripe and have ran on those type of calls, but in defense of OC there is a hospital with in 5-8 min everywhere. Still I think the privates should have paramedics, but I can't see the IAFF allowing this or anything even close to a standard that does not envolve calling 911.