Detroit EMS?

[Lone Star]

I grew up at Fenkell and Lahser... I know the area a bit too well. Everyone who knew me when I was living in the area, hoodlum, "straight up", or otherwise, at least acknowledged that we were all in the same situation. Mutual respect, if you know what I'm saying. Granted, that was 15-20 years ago, and you probably wouldn't know that unless I mentioned it. Usually the mention of my old address raises eyebrows with people who are familiar with the area.

In any case, thanks for the advice and the knowledge. That's a really good idea about distinguishing ourselves as EMT, NOT police. I'd rather not get shot/stabbed/punched by some crackhead who sees a badge and freaks out. On the flip side, I'll really take the respect and treatment aspect to heart. People don't live in the ghetto for it's appeal and resale value, but they still need to be treated with the same level of respect and dignity as if we were pulling a CEO out of his high rise office.

Thanks!

Well said!

Respect isn't all that terribly difficult to give, and it means worlds to the person on the recieving end.

There is no real reason that our patients (despite their geographical location, socio-economic class, etc) shouldn't receive respect, especially if it's being withheld based on those criteria.

[logos]

Detroit EMS as it is currently is a mess. I work at one of the recieving hospitals where the vast majority of our ambulance traffic comes from Detroit EMS.

Essentially they are in the process of converting to a BLS system from an ALS system. The idea is that their transports are generally short and Detroit has many hospitals. However, this is very frustrating in situations where having a medic would make a big difference. Probably the most common situation is a hypoglycemic diabetic where they are powerless to do anything about it. Often the know the sugar is "lo" based on the patients own glucometer but even then our EMS has not way to give glucose or recheck the sugar unless it is one of the two or three remaining "alpha" advanced units. I suspect that these few remaining units will be phased out as paramedics quit.

Its not the EMTs themselves that are the problem but the system as a whole in Detroit that is a mess. Detroit EMS is essentially the largest system in Michigan yet they are the only system that is not doing reporting of electronic run data as mandated several years ago by the State. They can get away with this because they are so large and the state knows that if they take any regulatory action to shut them down a huge number of people will be without EMS service. Other issues relate to ambulance availability where over half of the fleet is in for repairs at any one time. Further complicating this is the abuse of the system in Detroit where patients call an ambulance for nearly any complaint, no matter how minor. Worsening this, until recently Detroit EMS did not prioritize their dispatches. This mean that that the my finger hurts cases got the ambulance before the GSW because they called in 1 min earlier. We still recieve transports of patients by police because no ambulance was available, although i'm told its less than in the past.

Unlike fire based EMS at placed I have been in the past, our medics do not rotate with the firefighters and are not dispatched with fire. Meaning that when they go to a cardiac arrest or other complicated care the only folks on scene to help with transport and treatment are the two EMTs on the ambulance who have to do CPR, place the combitube, ventilate the patient, load the patient and then drive while the other takes care of the patient. Other places would send firefighters who are otherwise just sitting around to help with CPR and moving the paitent.

I like most of the folks I've met that work Detroit EMS and they generally seem competent at what they do but they are in a tough situation. I feel bad that my hospital is perhaps their least favorite hospital to bring patients to because of the very small number of patients we bring to the resuscitation room on the basis of the EMS call.

Ultimately I think the best solution would be to dissolve the Detroit EMS organization and contract with a private company. There are several operating in Detroit and every once in awhile they end up getting a 911 type call of some sort of another. They tend to be paramedic based and very competent. Which is odd that most of the medics in Detroit are doing interfacility transports and not 911 runs.

[Richard B the EMT]

Half the fleet down for what, mechanical? NYC EMS had that (pre-merger) circa 1988. The NYC Health and Hospitals Corporation, which then ran the EMS, fired the chief in charge, hired a guy with fleet management experience (he also had been an EMT), hired enough mechanics for 3 tours, 24 hours a day Monday thru Fridays, with small crews daylight Saturdays, and farmed out units for repairs to the Central Repair Services of the FDNY, the NYPD, and the Sanitation Department, all located within a few miles of the EMS CRS, until the numbers of "downed" vehicles became a lot more "normal". (It also helped that they stopped purchasing ambulances whose "specs" books were almost 2 foot thick.)

We also instituted a Preventive Maintenance program, which was suggested by FDNY, which continues even now, as EMS is under FDNY management.

While I remain not a fan of the merger, this was a good thing.

[Lone Star]

Detroit EMS as it is currently is a mess. I work at one of the recieving hospitals where the vast majority of our ambulance traffic comes from Detroit EMS.

Essentially they are in the process of converting to a BLS system from an ALS system. The idea is that their transports are generally short and Detroit has many hospitals. However, this is very frustrating in situations where having a medic would make a big difference. Probably the most common situation is a hypoglycemic diabetic where they are powerless to do anything about it. Often the know the sugar is "lo" based on the patients own glucometer but even then our EMS has not way to give glucose or recheck the sugar unless it is one of the two or three remaining "alpha" advanced units. I suspect that these few remaining units will be phased out as paramedics quit.

When I was working for a private carrier in Detroit (in the mid 90’s), one had to be an EMT-S or EMT-P in order to be considered ‘eligible for hire’ by Detroit EMS. The reasoning behind this was because Detroit EMS was converting to an ILS-ALS only system.

As far as not being able to give glucose to the hypoglycemic patient, Oakland and Wayne county protocols allowed for this, so explain to me how they weren’t able to treat the hypoglycemic patient appropriately. Granted, the EMT-B couldn’t perform a ‘finger stick’ because it was considered an ‘invasive procedure’, if hypoglycemia was confirmed by ‘assisting’ the patient to check their own BGL levels with their own equipment, there was no reason they couldn’t treat the patient appropriately

Its not the EMTs themselves that are the problem but the system as a whole in Detroit that is a mess. Detroit EMS is essentially the largest system in Michigan yet they are the only system that is not doing reporting of electronic run data as mandated several years ago by the State. They can get away with this because they are so large and the state knows that if they take any regulatory action to shut them down a huge number of people will be without EMS service. Other issues relate to ambulance availability where over half of the fleet is in for repairs at any one time. Further complicating this is the abuse of the system in Detroit where patients call an ambulance for nearly any complaint, no matter how minor. Worsening this, until recently Detroit EMS did not prioritize their dispatches. This mean that that the my finger hurts cases got the ambulance before the GSW because they called in 1 min earlier. We still recieve transports of patients by police because no ambulance was available, although i'm told its less than in the past.

I personally know of more than a few incidents where the Detroit EMS crews were ‘milking the clock’ by dropping off patients and hanging around the hospital (either in the ED or sitting outside in their trucks, putzing around so they didn’t have to take that next call waiting. Another factor in Detroit EMS being such a mess was the transporting crews ending up being investigated for theft from the patients.

Unlike fire based EMS at placed I have been in the past, our medics do not rotate with the firefighters and are not dispatched with fire. Meaning that when they go to a cardiac arrest or other complicated care the only folks on scene to help with transport and treatment are the two EMTs on the ambulance who have to do CPR, place the combitube, ventilate the patient, load the patient and then drive while the other takes care of the patient. Other places would send firefighters who are otherwise just sitting around to help with CPR and moving the paitent.

How is this different from what a crew from any other private carrier faces? If a crew from Universal, Community EMS, or any of the others can do it, why should Detroit EMS be any different?

I like most of the folks I've met that work Detroit EMS and they generally seem competent at what they do but they are in a tough situation. I feel bad that my hospital is perhaps their least favorite hospital to bring patients to because of the very small number of patients we bring to the resuscitation room on the basis of the EMS call.

You must be in the DMC. Hutzel, Detroit Receiving and a couple other hospitals are usually inundated by ‘walk ins’ that they are ‘Status C’ more often than they’re not on diversion.

Ultimately I think the best solution would be to dissolve the Detroit EMS organization and contract with a private company. There are several operating in Detroit and every once in awhile they end up getting a 911 type call of some sort of another. They tend to be paramedic based and very competent. Which is odd that most of the medics in Detroit are doing interfacility transports and not 911 runs.

If Detroit EMS is going to do IFT’s, then they need to utilize their resources better. In private carriers in Detroit (like Community EMS and some of the other smaller services), the EMT-B crews are the primary source of the IFT crews.

[HERBIE1]

I grew up at Fenkell and Lahser... I know the area a bit too well. Everyone who knew me when I was living in the area, hoodlum, "straight up", or otherwise, at least acknowledged that we were all in the same situation. Mutual respect, if you know what I'm saying. Granted, that was 15-20 years ago, and you probably wouldn't know that unless I mentioned it. Usually the mention of my old address raises eyebrows with people who are familiar with the area.

In any case, thanks for the advice and the knowledge. That's a really good idea about distinguishing ourselves as EMT, NOT police. I'd rather not get shot/stabbed/punched by some crackhead who sees a badge and freaks out. On the flip side, I'll really take the respect and treatment aspect to heart. People don't live in the ghetto for it's appeal and resale value, but they still need to be treated with the same level of respect and dignity as if we were pulling a CEO out of his high rise office.

Thanks!

Absolutely spot on statement and don't ever forget it.

I tell my students and new folks on the job- EVERYONE gets a chance with me. I am nice to everyone- be it the guy lying in his own urine, or the big time CEO you speak of. Actually I often prefer dealing with every day folks- they have no agenda, they generally appreciate even the littlest things you do for them, and they do not expect- or even demand- to have their arses kissed or treat you as if you are one of their subordinate employees. That does NOT go over well with me.

Am I always nice- yep- right up to the time when it's no longer time to be nice.

[Medic433]

Hmm, I'm almost morbidly curious about Taylor Ambulance. My EMS instructor worked from them (I believe in the early 80s) and he claims he got out "right about when things started getting bad". Some of the stories he tells are pretty shocking, regarding things that were done or said with patients present. He actually mentioned one of their trucks getting shot up so I wonder if that's the same incident.

Ah, the good ol' Taylor Ambulance. I ran with TA from '74-'92 and it was an expirience. I wish I could say I wasn't one of the people that mistreated patients, but I can't. Unfortunately, a lot of us got burned out around the same time, maybe back around 88 and the patients pretty much bore the brunt of it. At that time we did a lot of running in Highland Park and detriot, but a good portion of my time was on the Belleville truck. All that said, we weren't the most professional of EMT's, although I'm guessing most private ems providers weren't at that time, with it being a new industry and that. I remember one of our guys telling a guy who had been shot and was still conscious that he was going to die, and I cringed but probably said worse things.

Your post brought back a lot of memories, good and bad.

[CPhT]

Ah, the good ol' Taylor Ambulance. I ran with TA from '74-'92 and it was an expirience. I wish I could say I wasn't one of the people that mistreated patients, but I can't. Unfortunately, a lot of us got burned out around the same time, maybe back around 88 and the patients pretty much bore the brunt of it. At that time we did a lot of running in Highland Park and detriot, but a good portion of my time was on the Belleville truck. All that said, we weren't the most professional of EMT's, although I'm guessing most private ems providers weren't at that time, with it being a new industry and that. I remember one of our guys telling a guy who had been shot and was still conscious that he was going to die, and I cringed but probably said worse things.

Your post brought back a lot of memories, good and bad.

That's awesome! You should send me a private message. I'd be willing to bet that you know (or ARE) my instructor, or maybe you knew his partner.

[Medic433]

That's awesome! You should send me a private message. I'd be willing to bet that you know (or ARE) my instructor, or maybe you knew his partner.

Will do. I wouldn't be surprised, because I ran with Taylor for several years and got to know most of the crews. I'm pretty sure I'm not your instructor, since I haven't taught a basic class for 2 years. Anyways, I'll message you.

[Richard B the EMT]

I had to go back and reread the entire string, seeing a Taylor Ambulance Service mentioned. I used to work for a Taylor Ambulance, out of Roosevelt Hospital division Roosevelt/Saint Lukes Hospital, Manhattan, NY 1977-1980.

Going behind someone, and "lighting up" with siren added? Who does that crew think they are, the "F&B Ambulance Service" unit being driven by Bill "'Mother' Tucker" Cosby, Racquel "Juggs" Welsh, and Harvey "Speed" Keitel?