Words are not sufficient to describe this FAIL!

[DwayneEMTP]

You know what I drives me crazy about these conversations is that people have a hard time understanding that we can not like a system, but not dislike ALL of the people in it.

I'm not a fan of volly system, and very much not of fire fighters, yet my partner and friend is a basic, medical responder volunteer and chief of his volly fire dept. And I couldn't like or respect anyone more than I do him.

He's smart, really smart, dedicated, is working, as he has been for several years, to turn his dept paid, and is willing to admit to all of his personal failings as well as those of the paid and volly systems he works within. Yet, some people are still sometimes shocked when I throw him the drug bag when we go on an arrest and simply acknowledge as he calls out the drugs he's about to push while I spend my time doing other things...(I rarely transport CORs unless we get ROSC.) Should I not allow him those responsibilities because he's a basic and a volly and, God forbid, a hosemonkey?

People hate some medics because they're ignorant, lazy, and arrogant. I'm not, so I'm not offended by those comments for the most part. Many vollies are lazy, idiotic, hero seeking idgits...if you're not, then let that pass and continue the discussion of the systems without personal offense.

There are many, many really, really good people inside of bad systems, but those people, no matter how good, don't make the SYSTEM good, See??

Take a breath folks, separate individuals from groups, and don't take offense. We're all part good, part idiot, part competent, part asshole...if you're not being singled out as a majority of one or another, then take a pill...OK?

Dwayne

Edited May 16, 2010 by DwayneEMTP

[spenac]

Interesting. I was under the impression that the minimum required staffing for a Texas BLS ambulance was two EMT's.

It's not even close to an EMT class. It's based off the NREMT First Responder curriculum.

Did you take ECA? I did. Really you go over the same skills in emt but you get a little bit of explanation as to why you do things. Biggest true difference is the number of hours. So I still hold ECA= emt lite.

From the state of Texas as to staffing:

(g) Minimum Staffing Required.

(1) BLS - when response-ready or in-service, authorized EMS vehicles operating at the BLS level shall be staffed at a minimum with two emergency care attendants (ECA)s.

(2) BLS with ALS capability when response-ready or in-service below ALS two ECA's. Full ALS status becomes active when staffed by at least an emergency medical technician (EMT)-Intermediate and at least an EMT.

(3) BLS with MICU capability - when response-ready or in-service below MICU two ECAs. Full MICU status becomes active when staffed by at least a certified or licensed paramedic and at least an EMT.

(4) ALS - when response-ready or in-service, authorized EMS vehicles operating at the ALS level shall be staffed at a minimum with one EMT Basic and one EMT-Intermediate.

(5) ALS with MICU capability - when response-ready or in-service below MICU shall require one EMT-Intermediate and one EMT. Full MICU status becomes active when staffed by at least a certified or licensed paramedic and at least an EMT.

[croaker260]

How do they afford to fund the public schools there? Since they have no money, are they allowed to simply let their kids work the fields through their childhood instead of attending school?

Of course, I'm being facetious because we all know they have schools. And paid teachers. And paid school bus drivers. And paid athletic coaches. And paid janitors.

If the people there thought EMS was important, they'd fund it. They don't, so they won't. It's that simple.

Respectfully, not an apples to apples comparison.

1- Schools (and school districts) are mandated, though the quality is debatable. EMS is mandated too, but not the way schools are.

2- School districts in rural settings receive HEAVY subsidies from both the state and federal government EMS has not since the 1980s when Reagan shut that down. (Still love the man though!!!)There are no subsidies for EMS. This is not a local issue, but a state/Federal one, and cannot be pinned on the locals "not thinking EMS is important". Interestingly enough, most of these agencies subside ONLY on donations, so someone thinks their important.

3- By contrast, EMS is a mandated service for every county to provide , but unfunded by either the state or federal government, a fact we all are of aware of here, nor does the mandate say the county has to provide good EMS.

Ironically, many of these rural EMS agencies would get more money if they simply bought an old fire engine, added the words "Fire and Rescue" to the end of their name, and applied for SAFER grants.

I AGREE THAT AS A NATION THIS COUNTRY PUTS FAR TO LITTLE EMPHASIS ON EMS IN COMPARISON TO FIREFIGHTING AND LAW ENFORCEMENT...but thats a federal issue. And its not just funding, but minimum standards (when will degrees become mandatory for medics dammit!!!), legislation, and other forms of support too. But thats not the focus of THIS thread.

The focus of THIS thread, as I read it, is some feel that the use of ECAs on the ambulance is an EPIC FAIL. Usually (making assumptions here) this is by people with little of no frame of reference to the challenges and start realities of some parts of thsi country. Everywhere is not California, Dallas, New York, or Saint Louis. You dont have a trauma center in every state (Ex. There is no LEVEL I TRAUMA Center in Idaho, ANYWHERE). You dont have taxing districts, or first responders, or even law enforcement when you need it.

My point was to provide a frame of reference. RIGHT OR WRONG, these services are serving isolated pockets of humanity with populations less than some of our apartment complexes. There are seem fiscal realities that go with that situation.

In these unique situations, staffing an ambulance is a challenge, and using ECA's so you can have an EMT in the back is a victory in some parts of the country. I was curiosu and did some basic research....Looking at the population base of the community mentioned in the OP, the population density, and the median income, this is likely one of those situations.

Is it ideal, no. But stomping our foot and demanding that somehow things change wont help it. Demanding that we put more money in the situation and have "Paid" EMTs wont help either when there is no money to put in there.

I work with these rural EMTs on many occasions (well nto the rural EMTs mentioned in the article, but here in ID). Sure there are some things that could be improved on. IMHO, the limited $$$ could be stretched way farther with regional cooperatives. But the independent spirit that has kept these communities alive in the face of significant adversity often gets in the way of cooperation. But this is true in many rural communities and even urban ones, not just in Idaho.

So my point is that if my service chose to staff ECAs to scrape an extra $$, it would indeed be a fail. But for these communities its not a matter of scraping a dollar, its about getting bodies in the door, and hooked on EMS, so you can get them on to be EMTs later. Other than the use of the term "driver" (which we all universally hate) this is a community EMS trying to recruit and keep their ambulances staffed and on the road. SO, best of luck to them.

Again, respectfully Submitted.

- Steve

Edited May 16, 2010 by croaker260

[DwayneEMTP]

Man Croaker, great replies!

I think I get what you're saying, though you're certainly debating at a level well above my ability to participate with my scant knowledge of the subject.

But, as mentioned before, is poor EMS better than no EMS in these areas? Are people better off believing that when they call 911 that someone is coming that is going to add more benefit to their morbidity/mortality than if they'd simply just had a friend drive them to the hospital without a wait?

I'm not sure really...

Dwayne

[AnthonyM83]

There's been worse ideas.

I actually don't think it's that bad. I'd rather have a driver-only person on the ambulance so my partner and I can be in the back. As long as he gets the same training a full-time EMT would get and drives safely and smoothly and can maybe lend a hand on-scene (carrying, holding doors open, picking up equipment, gathering medications, and doing proper CPR), then it's better than just having you and you EMT/Medic partner. Now, if he's REPLACING the EMT/Medic partner, then that's a FAIL.

[Dustdevil]

There's been worse ideas.

LOL! That's an astute, but sadly true observation! You could take me to the best system in the state, and I'd find you a worse idea within an hour. Bad ideas are not exclusive to rural communities. Far from it.

But Steve, the ECA issue is not really what this thread was about either. It's about non-medical volunteer ambulance drivers. It's about the way the idea is marketed to the public, basically putting out an all-call for whackers to come play with the siren. Hell, the ECAs are probably the least failure in the equation.

And I agree with Spenac, that ECAs are indeed EMT lite in Texas. Of course, I took it in 1973, so I'm sure it's changed since then. And I haven't even known an ECA in over twenty years, as they don't really exist in urban Texas.