The best service in the country

[Dustdevil]

Yeah, I was focusing only on major metropolitan city services, not the suburban places like Cypress Creek. Cy Creek is definitely good. Also in Texas, Austin-Travis County and Beaumont are excellent, all paramedic (no basics), high volume services that would be well worth a look. No doubt.

Seattle is not without its problems. From stories I get, their people tend to cop an attitude and become lazy since they are allowed to dump the lowly, unworthy, non-emergent patients on private ambos at will. Still, if you get a good crew, your experience should be quality, and structurally, the service is an excellent model.

Heard too much bad stuff about Boston. The Northeast in general sucks.

Atlanta is good. Hospital based, which always makes for a beneficial situation. Definitely worth checking out for a Southern perspective.

I heard great things about KC back years ago, but I am not familiar with them now. I know Kansas has some of the best educational standards in the country currently (although I think Missouri is still behind the 8 ball), so KC, Kansas is worth looking into. KC, MO or St. Louis are nice places to visit, so worth a look too.

Too late to go to Phoenix this year. Too hot already. And you'd have a very hard time convincing me any FD service rates up there as a shining example of excellence anyhow. Especially with the dip$hit chief they have.

I'm not sure exactly what the goal of your visit is. If you want a good overall view of US EMS in general, you won't find it in any one place. The variation here is huge and disgusting. But there are certainly great services that do things completely different from Seattle. If you have time to check out a couple different places, I would definitely recommend it.

[mediccjh]

University of Medicine and Dentistry of New Jersey in Newark, NJ. We cover the airport, so it's close. It's the busiest per capita EMS system in the nation, with over 120,000 jobs a year, with not a lot of ambulances. A lot of sick people, a lot of trauma, and a lot of bullshit.

The University Hospital EMS

[medik8]

I heard great things about KC back years ago, but I am not familiar with them now. I know Kansas has some of the best educational standards in the country currently (although I think Missouri is still behind the 8 ball), so KC, Kansas is worth looking into. KC, MO or St. Louis are nice places to visit, so worth a look too.

Behind the "8" ball, huh? :-k No pun intended? LMFAO. No, you are right Dust. We're lacking a little...but progressing nicely these days. I'm becoming pleased, for the most part. I've heard great things about KC, MO, also!! And of course....well... :oops: I'm kinda partial to my own...

xoxoxo

Luv, 8

[AZCEP]

Too late to go to Phoenix this year. Too hot already. And you'd have a very hard time convincing me any FD service rates up there as a shining example of excellence anyhow. Especially with the dip$hit chief they have.

Gee whiz Dust, how is 85 degrees at 4 pm too hot? Overnight lows of 50+, get here quick, but not bad at the moment. After a few sub-zero winters, it doesn't sound all that bad now does it.

As for the chief, the same could probably be said for any agency, anywhere. The folks in the streets are among the best I've ever worked near. Like I said, the medical director pushes his people very hard to be the best.

[AKmedik8or]

If you are stilling open to suggestions; may I suggest Anchorage Alaska...Check out

www.afdems.net

[kristinaemtb]

philli has a high call volume but it is usually the morgue getting the ring tones.sorry-my bad didnt mean 2 offend anyone.but it is terrible how much bad stuff happens there.

[paramedicmike]

Are you suggesting Philadelphia (properly shortened to Philly...only one "i")? As in Pennsylvania? As in the poster child for how NOT to run EMS?

Avoid Philadelphia like the plague. Thinking of visiting? Don't get sick! Got sick anyway? Call a cab. You'd be better off.

And I don't mean to beat a dead horse, but it's easier to spell check then post than it is to just post. Please use the spell check feature that admin has very considerately supplied for all. Thanks.

Where in West by God are you?

-be safe.

[WelshMedic]

We didn't need to ride out in Philly as we already had something set up in Chester, PA (as you probably already know, a suburb of Philly). What I can tell you though, is that two of our FF's visited the Philly FD and were treated like kings for the day (own escort, lunch, the whole shooting match). I can't comment on the pt care, but they treated us like real guests and that we won't forget in a hurry.

As far as the city itself is concerned, it is by far and away my favorite city in the US. Culture, history, friendly natives, great bars (including Monk's - the best belgian beer bar in the US - I mean, they can even get beers that they don't serve in most belgian pubs in BELGIUM!!).Try it someday, I've visited 5 times and I still can't get enough.

Carl

[txemsdoc]

What exactly is a "mainport?" Airport, or seaport?

If you're looking for coastal, then Seattle, Washington is probably your best bet. There isn't hardly a decent coastal major metropolitan service in the country. All of California sucks. New York sucks. Houston sucks. Most of Florida sucks.

Even if you are not limited to coastal, Seattle is still probably very high on the list of your best bets.

If you don't mind me asking, what entails a 'good' system? I think our definitions would vary quite a bit, but I'm interested.

I think a good system has:

1) decent response times (though FR time is more important than ALS response times)

2) highly involved medical director(s) and other educational personnel

3) aggressive QA/QI program

4) Thorough patient followup program (esp. for cardiac arrests, but also for non-transports, patient satisfaction,etc..)

5) An attempt to minimize ALS personnel responding to non-ALS requiring patients (could be through dispatch, dual tiered system or other ideas)

6) Good cardiac arrest resuscitation #'s (and return of pulse in the field is NOT an indication of this)

What does not make a system "good"

1) Agressive care not based in evidence/science/fact (or anything more than anecdotal story) (just because something is standard care in an ER does not mean it should be done prehospital.)

So please tell me why those cities "suck."

txemsdoc

[Dustdevil]

If you don't mind me asking, what entails a 'good' system? I think our definitions would vary quite a bit, but I'm interested.

Actually, I don't think we differ much at all in our definitions. I agree with your definition wholeheartedly. I suppose that in the context of this particular discussion I was focusing on other, more field level and personnel related factors than on general systemic factors. I took the original question to be an attempt to find a service where the international visitor would find quality at the field level, as well as a pleasant experience. A rideout with most large metropolitan fire based systems isn't likely to impress the international visitor who is accustomed to a greater clinical sophistication. And I didn't think he would be looking to spend a day studying the dry statistics that are the only real evidence of the factors you mentioned.

And most of all, I would hate to see an international visitor come here only to go back home with his lasting impression of American EMS being how a major urban FD breaks down paramedic education and practise into the lowest common denominator, and then staffs it with people who, for the most part, don't even want to be doing the job.

While I certainly agree that all of the factors you mention are extremely important for a service to be "good," the two most important elements of any system will always be the two you didn't mention: Education and people.