The best service in the country

[txemsdoc]

So am I to understand that you are saying Houston F.D. has higher resuscitation rates than agencies such as Cypress Creek EMS, HCESD-1, Cy-Fair VFD, Northwest EMS, and Montgomery County Hospital District? If that is what you are saying, then show me the numbers as I have a real hard time believing that. Medically, Cypress Creek EMS has a greater than 80% ROSC on in field worked arrests with a discharge neurologically intact rate running in the low 40's% (As of earlier this year). Trauma wise, no EMS agencies have decent resuscitation percentages. EMS doesn't save the trauma patient, the trauma center does..........

Now if your referring to Houston hospitals having a higher resuscitation rate than the outlying hospitals, then yes you are correct. It may have something to do with the fact that the only level I trauma centers are downtown :wink: . My personal opinion, Houston does suck when it comes to trauma care. It's not Hermann's fault nor is it Ben Taub's fault. It's the fact that the 4th largest city in this nation needs more, but will probably never receive.....................

Sorry, got a little off topic (hope admin didn't see it!!! )................

Umm..in a short word, yes, until these agencies can provide real numbers. I don't give a crap about ROSC in field...it's worthless. I don't want massaged numbers which look at only vfib arrests, or witnessed vfib arrests. I want all-comers, all rhythms! THEN, we can talk. The numbers you quote are not for all arrests, I can guarantee it. Oh, and tell me what your patients are doing 6 months after their arrest. What is their level of function. This is what EMS agencies should be doing (and in fact, HFD does)...One caveat to this even is the quality of the hospital.. there are hospitals in town that you have less than a 5% chance of surviving with ROSC in the field, and others which are much much better (given that there is some self-selection done by the PM's)...

I'd agree with you on trauma btw. There's recently talk of Methodist getting into the Level 2 trauma business which is, from a street standpoint, the same as a Level 1. So maybe we'll get something somewhere else. A good rule of thumb is that if you are gonna get shot, do it 'in the loop'...

txemsdoc

[txemsdoc]

Wouldn't we all! And that is really the only key advantage to an FD administrated system. If anybody knows how to run a bureaucracy, it's the fire service. Just about every big FD looks wonderful on paper, with assistant chiefs paid to sit around and write policies and procedures, and publish statistics and mission statements, and all the other fluffy paperwork that impresses the academics. But you're right. If we could combine the best of both worlds, it would be great for the profession. However, I maintain that, aside from geography and taxes, there is nothing inherently superior about HFD that does not or could not be applied to any other service.

And, as Rid says, the numbers would have to be vetted to determine a true cause and effect relationship before I could climb on board with HFD being excellent on any level. And even then, I don't think it would be impressive to international visitors that HFD's ambulances happen to all be within 10 minutes of a trauma centre. That's hardly clinical sophistication.

Well, the numbers are there and available. I wish there was a 'clearinghouse' of stats and information if only to recognize your particular service is slacking (so you'd do something to change it) or excelling. People/Entities are too afraid to stand up for themselves and be subjected to scrutiny.

As for what makes HFD different... Well, there's quite a bit...good and bad. I would admit some prejudice and argue that the high level of PM supervison by supervisors and physicians lead to better patient care and outcomes. I'm talking education/QA/real time consultation (every arrest gets called in as it is occuring) and other forms...

Yea, about the trauma.. I was speaking more of cardiac resuscitation. Although HFD units in Kingwood, Clear Lake, and out west towards highway 6 would beg to differ on the transport time

Nevertheless, my whole point of interjecting into this conversation (other than just finding this forum) was that blanket statements like "Houston sucks" aren't 100% accurate, and that there is likely no place where an international visitor can get a thorough experience of all types of EMS.

I appreciate the lively discussion.

t

[chicagoambo]

Visit Chicago and Boston ,great systems and you'll have a fun time!

[WelshMedic]

Hello everybody,

Just to update everyone on the result of this particular topic. I remember it caused quite a heated discussion at the time! We have decided to re-visit Crozer Health in Chester, Pa. and New Castle County in Wilmington, DE. I have connections with both services and so I made good use of them. Thanks to everyone for their input and it was nice to see how an simple question turned into a complex dialogue about the merits of different systems.

Take Care all,

Carl.

[fireflymedic]

Okay, as far as services go, here's my suggestions

Chicago, IL - can be great or terrible depending on where you are placed. I went there and had a blast riding with them, a friend of mine rode there, couldn't stand it.

Lexington, KY- Lexington Fire/EMS very active EMS service, only does 911 calls, very busy, and has both a rural and metro feel to it depending on the area. Plus, just an all around great place to visit. Have several friends work there and I have done some ride time with them, thoroughly enjoyed was treated wonderfully. If you get a good crew, you WILL have fun, be busy, and like every minute of it. You'll see and do it all.

Philidelphia, PA - another fun one. Stopped by just to say hey and grab a patch from 'em, and they let me ride along with 'em later that week. Great crew, great fun. It would be on my list of places to return to for sure. I've seen several others reccommend, I'd check it out.

If you don't mind rural progressive services, though they have a high call volume there are two that really stand out. I've worked with one of them.

Laurel County EMS (is actually Ambulance Inc of Laurel Co) - was KY's best service in 2003- recognized several times by state board and very active in community and education, nice station, decent trucks and a great chief, plus protocols aren't that bad either. Has decent run volume- you will run your butt off all day with lots of trauma and good medical calls. Is tiered response if needed, though primarily BLS with one or two medics per shift.

Stay away from Louisville, KY !!!!! It is bad ! There is an all out turf war going on in that area right now between the ambulance services, with two different services showing up to the same call trying to beat each other. The medics are overworked, burnt, and how shall I say this? THOROUGHLY CRISPY FRIED !!!! Go there and you WILL regret it. Not to say all medics there are bad, meerly the situation surrounding which I am sure you would rather avoid.

Don't know anything about many other services in the area, most around me are county based and pretty slow consisting of mostly nursing home/doctor offices with the occasional trauma so other than Laurel Co EMS and Lexington, I would avoid KY all together. Good luck and have fun. If you want more info about KY services, you may PM me.

[KE5EHI]

EMSA in Tulsa, OK

High Call Volume

All trucks are ALS (usually one basic and one para, sometimes two paras)

Excellent equipment

12 hour-shifts

SSM (System Status Management)

Run about every type of call in a shift (A week will usually get you just about everything from minor medical to major trauma)

We have a great working relationship with fire and PD. This is nice when it comes to working with other departments.

http://www.emsaonline.com

[BugAhaBuc]

KE5EHI is correct.

EMSA is second to none!

No argument.

I graduated from Creighton University Medical Center EMS Education in Omaha, NE.

Looked all around the country. Interviewed all over the US.

Chose EMSA in Tulsa because they are not only second to none in quality Medics, but they are also by far the best in how they treat their Medics and EMTs.

Love the company and I have worked in Fortune 500 companies as a suit and tie guy.

(Every company has its faults-there is no Perfect company)

-But-

EMSA is top notch in all respects.

[BugAhaBuc]

Sheesh

I just noticed who you are Michael?

It's me, 601 1/2

[Ridryder 911]

Let's not get too carried away... EMSA is good for those that are starting out. But, let's look at retention and the pay as well, and cookbook protocols. Even Sacra will agree. Again, they have some definite good points, but let's not paint it like a Utopia... it is far from it. That is why their always hunting for medics.....there is a reason. Between the 2 I agree EMSA East is better...

R/r 911

[BugAhaBuc]

"Starting Out"

Like it's a Medic for beginners system...? I don't think so.

Cook Book is called "Protocols"-Show me one system that doesn't have a Medical Director and Protocols.

PLEASE.

It's far Better than most systems who have to call in for medical direction for everything.

"Starting Out"

There ARE those who use it to get into Fire. Not every one wants to be a fire fighter.

All Big Fire Departments definitely pay better and has better benefits, but that's Unionized City benefit stuff.

For it's type, there is none better than EMSA.

As far as turn over, sure...it's a fast paced, high volume system.

A lot of people can't handle that.

After riding the corporate desk, and admittedly making much, much more money than I do now, I enjoy the fast paced never a rest life. The money isn't worth the emptiness of big corporate America.

If you're talking ANY EMS service is a stepping stone to be a Flight Medic/RN...then yes, all EMS systems are a stepping stone for that too, but that is a limited field.

Not everyone can do the one to two to MAYBE three patients a day life like Flight Medics do.

Maybe when I'm old and can't take the pace anymore.