Ambulance Crash, buckle up guys.

[dzmohr]

"Upon the arrival of Sykesville fire and EMS crews, the private ambulance crew had self-extricated themselves from the wreckage."

"Two members of the private ambulance crew were treated on the scene and then flown to Shock Trauma by Maryland State Police Troopers #2 and #3."

Why were these people flown? They got themselves out and were stable enough to be treated on scene. Was there truly any need for HEMS or was this a courtesy transport? I'm all for helping out fellow EMS'r, but it sounds like a misuse of resources to me.........

Just my humble opinion................

Maryland EMS ships are also State Police patrol units that are almost always in the air. It is quite likely they dropped them off on the way to base. It would not be unusual to fly them in as a professional courtesy.

[JPINFV]

Unless I need to move about (rare, but it happens. Take vitals, go sit in captins chair, do paperwork, shift back for v/s, patient care/comfort things, etc. V/S on right side in vans

veryone always place shuts/IVs/PICC lines on the left side when the left side is the only side easy to get to in a vanbulance?), my seat belt is on. Why would I wear my seat belt up front, but not in back?!?

You never know, sometimes it is (normally report consists only of "Patient very sick, you take patient now"). I had a code 3 CCT (transfer only, not response) transfer last week for a malfunctioning pacemaker. (patient transvenously paced, but the RN at the transfering hospital was an idiot and screwed it up doing breathing exercises (pacer was set to maximum amperage to keep capture) and not securing the wiring juctions to the shunt. The patient was BIB paramedics earlier that day). Over the radio today I heard a unit transporting BLS a full code with BP 60/40. no medics, 15-20 min ETA, code 2. I would love to hurt that crew...

[EMS49393]

If you read the article, there was no patient on board at the time of the accident. It is against the COBRA regulations in Maryland to run "code" or priority as we call it, to a facility for a patient in a private ambulance. That is why the state has 911 ambulances and MSP helicopters. If a nursing home calls for a patient transfer and they report the patient unstable in any way they are directed to call 911 for their closest emergency ambulance. The state doesn't want private ambulances running emergent calls, period.

As for the BLS crew transporting that particular patient, I hope that is one of the run forms MIEMSS pulls and questions. MIEMSS started making private services do Commercial MAIS forms just so they could keep an eye on these private ambulance providers. If it had been an ALS crew, it would have been acceptable for them to continue patient care and transport, however a BLS crew should have contacted 911 themselves, and had a rendezvous with an 911 ALS ambulance if their patient was in that much trouble. That's the regulation.

Carroll County has 14 fire companies and they are no more then 15 minutes apart. All but one company has a paramedic unit. Harney doesn't have any ambulances, but they are out in the middle of no where and I believe still house their fire engine in a barn. Several stations have 2 staffed paramedic ambulances, including Sykesville. Westminster staffs three paramedic ambulances. I'm sure county 911 has the emergency ambulance business covered in Carroll County.

I lived in Maryland a long time. I worked private ambulance part-time there for more years then I want to admit to. I know the rules and regulations set forth by the state inside and out because I was one of the few providers unwilling to break regulations for my company to make an extra buck. It was never worth my certification to do so. Hated by management, loved by timid providers for taking a stand on numerous occasions. I was never fired by my company either, simply because I had copies of the regulations with me, and I wasn't afraid to call MIEMSS for clarification if need be. This cowboy wanna-be EMS garbage is why private ambulance has such a bad reputation in Maryland. Private ambulances do transfers, that is their job. If that critical care patient is in such bad shape they are either flown to the appropriate facility or taken by a specialized critical care transport team out of University or Hopkins. In all my years both BLS and ALS we NEVER had to run a patient into a facility priority.

[Nate]

If you read the article, there was no patient on board at the time of the accident. It is against the COBRA regulations in Maryland to run "code" or priority as we call it, to a facility for a patient in a private ambulance. That is why the state has 911 ambulances and MSP helicopters. If a nursing home calls for a patient transfer and they report the patient unstable in any way they are directed to call 911 for their closest emergency ambulance. The state doesn't want private ambulances running emergent calls, period.

What is the difference between a private ambulance and a county ambulance? Aren't the paramedics and EMT's the same? It just seems kind of stupid to say you can't run hot because your a private service. Maybe they need to look into their certification/inspection process, sounds like a lawsuit just waiting to happen. I could see it now, a family sues the state because their mother died. The nursing home called 911, the ambulance was 15 minutes away, the private service was 5 minutes away but wasn't called because they can't be called for emergencies. If Maryland has no faith in their private services, then it is their own fault for not trying to correct the problem, and prevent further instances.

Yet another reason why I'm glad I live in Texas. It might not be the best EMS system, but at least there isn't as much of the "I'm better then you" attitude.

[flight-lp]

Well spoken Nate! Personally, I think the Paramedics that work interfacility transfers actually provide a better level of care with critical care calls (i.e. LVAD / IABP, Pedi / Neonate, CVP monitoring, etc.) vs. most 911 medics. To say that one form is better than another is just sheer immaturity. Maryland needs to grow up and while their at it, they need to stop wasting taxpayer money and risking the lives of their personnel by needlessly flying people who have absolutely no need to be flown (more fuel for Bledsoe and his croonies!)..............

[EMS49393]

Nate,

A private ambulance is never 15 minutes from a nursing home in Maryland. The average ETA is generally better then 2 hours for a transport, which is why the facilities are directed to call local 911. One reason this Bulter ambulance is under scrutiny right now is because they have a policy to guarantee they will be at a facility to transport in under one hour. That's a hard ETA to keep considering they have contracts both in the greater Baltimore and the greater DC area. With traffic as it is there it's difficult to go that 40 to 60 mile distance in under one hour, safely. Whereas, a 911 ambulance is generally less then 15 minutes away from nearly any facility, and quite often, even closer.

The system there was designed this way for a more reasons then I can illustrate in a forum board. It is not perfect, however no system is perfect anywhere.

[EMS49393]

Well spoken Nate! Personally, I think the Paramedics that work interfacility transfers actually provide a better level of care with critical care calls (i.e. LVAD / IABP, Pedi / Neonate, CVP monitoring, etc.) vs. most 911 medics. To say that one form is better than another is just sheer immaturity. Maryland needs to grow up and while their at it, they need to stop wasting taxpayer money and risking the lives of their personnel by needlessly flying people who have absolutely no need to be flown (more fuel for Bledsoe and his croonies!)..............

Since you were not a responding provider to this call, how are you able to judge whether the crew should have been flown or not? It is not up to anyone to judge that unless they were the paramedic in charge of the incident.

You do not know anything about the private services in Maryland. You have no idea the type of provider that generally ends up working for those places. I was turned loose to function after 2 hours of "training" at my first job there. I worked part-time for a few services there off and on for some extra money and I'd rather have a vet take care of me then most of the full-timers they had working for them. Ask anyone in EMS in Maryland, most private ambulances are a laughing stock, because they do ridiculous things like let 18 year old drivers speed in construction zones for no reason. If I did that in my current job I would be dismissed, before my shift even ended.

A quick story... Several years ago Maryland went through a welfare reform program. They told all the single mothers of multiple children that they could either be trained as a CNA or an EMTB, and that they would place them in jobs when they were finished. You didn't go to school and get a job, you lost all of your benefits. Most became EMTBs and ended up at the private ambulances in the greater Baltimore area. They were consistently late, constantly out of uniform, sloppy, inadequate providers that could care less about a job. They used their kids as an excuse to NEVER work nights or stay late on any calls. They gave the all of the private services a bad name there. You don't have to pass National Registry to become an EMTB in Maryland, you only have to pass a state test administered by your instructor. Now, you tell me what kind of quality they can put out with standards like that.

If you've never lived and/or worked there you have no right to scrutinize the system for downing it's providers. It dumbs them down enough on their own by not having unbiased and set standards for passing exams and becoming certified.

Incidently, the specialized critical care programs are run by University and Hopkins. They hand pick their providers and train them extensively from the private company they contract them from. I went through over 3 months of training to be allowed to work on those teams including floor time in the TRU. There is no question how good the CCT EMT-Ps and nurses are. The problem is with the BLS end of the services.

[Nate]

Nate,

A private ambulance is never 15 minutes from a nursing home in Maryland. The average ETA is generally better then 2 hours for a transport, which is why the facilities are directed to call local 911. One reason this Bulter ambulance is under scrutiny right now is because they have a policy to guarantee they will be at a facility to transport in under one hour. That's a hard ETA to keep considering they have contracts both in the greater Baltimore and the greater DC area. With traffic as it is there it's difficult to go that 40 to 60 mile distance in under one hour, safely. Whereas, a 911 ambulance is generally less then 15 minutes away from nearly any facility, and quite often, even closer.

The system there was designed this way for a more reasons then I can illustrate in a forum board. It is not perfect, however no system is perfect anywhere.

If long ETA's are a problem, then it shows one of two things (maybe both).

[*]There is a high demand for private ambulances.

[*]There is a low return on the investment, thus keeping the number of private ambulances low.

Either way, I think the health department or government regulation agency in charge needs to get involved. Lets face it, often nursing homes don't have the most intelligent staff. I know that I've had several "non-emergency" calls to a nursing home that were in fact an emergency.

Since you were not a responding provider to this call, how are you able to judge whether the crew should have been flown or not? It is not up to anyone to judge that unless they were the paramedic in charge of the incident.

In the defense of flight-lp, I think he was suggesting that if they were up walking around after the accident, then mostly likely they probably did not meet flight criteria.

You do not know anything about the private services in Maryland. You have no idea the type of provider that generally ends up working for those places. I was turned loose to function after 2 hours of "training" at my first job there. I worked part-time for a few services there off and on for some extra money and I'd rather have a vet take care of me then most of the full-timers they had working for them. Ask anyone in EMS in Maryland, most private ambulances are a laughing stock, because they do ridiculous things like let 18 year old drivers speed in construction zones for no reason. If I did that in my current job I would be dismissed, before my shift even ended.

If I am not mistaken, you admitted in previous posts that you were employed by private services, just as you have in the quoted text above. So who is to say that you are not any better then those you bash...or that any of us are any better then them? I would caution you to watch what you say in regards to a generalization. You are right, most private services are a joke in the eyes of many professional EMS personal, that includes those who work for reputable private services.

I consider myself lucky to work for a city service that does 911, as well as a private service that does transfers and 911. Furthermore, my education through paramedic included preparation to function as not only a transfer paramedic, but a 911 paramedic. For years paid and volunteer's have fought, and transfer and 911 have fought. Truth be told, they are two different worlds with one common thing; they use an ambulance to get from point a to point b. When I do a transfer often my IV route is there, my airway is secured (if they are on a vent), and I know everything about this patient because they were at one hospital for the past three days. However, I have to take into consideration several factors you don't often find on the scene of a 911 call as you know. The same goes for 911 scenes, I'm there with someone who I know nothing about, might not be able to find out anything about, and might not even know what is truly the cause of what is wrong with them and why they appear the way they are. Either way, with out a well equipped paramedic or EMT (both mentally and physically) the patients chance of survival is greatly lowered.

There is just as much bullsh*t in 911 as there is in transfers. I do not see myself as better then the paramedics I work with who only do transfers, or somewhat less then those who only do 911 because I do both. It is pointless to try to belittle the people who carry the same patch as you. What those of us reading your comments see is someone who comes off as cocky, arrogant, and might not know when to ask for help or his limits. Now, I'll give you the benefit of the doubt, after all I don't know you from any other paramedic or EMT on this board (so just consider it a personal observation that you could appear this way).

Usually around here, EMT's and rookie paramedics don't stand a chance doing 911 (outside of volunteer) until they have a few years under their belts. Simply put, a test score isn't going to get you a job.

So instead of bashing private services, you a former employee of one (at least from what we have been told) should try to work with them to raise the standard of care. You are just as much at fault for the reason why your state's system is the way it is as those you bash. Speak up, work for change, its the only way things are going to get done and the patients of your state will have a better life.

[EMS49393]

So instead of bashing private services, you a former employee of one (at least from what we have been told) should try to work with them to raise the standard of care. You are just as much at fault for the reason why your state's system is the way it is as those you bash. Speak up, work for change, its the only way things are going to get done and the patients of your state will have a better life.

I didn't personally bash anyone, re-read my post for clarification. I explained why things are how they are in Maryland. I've been in this career for over 10 years, and through that time I worked hard to change the way things were done. Instead of assuming I'm at fault for not making the place better for all those involved, why don't you move to Maryland and see if you can do any better then I did. I was one of the few that lobbied for instituting the National Registry exam for basics. I was shot down every time I brought it up. I led by example. I drove several hours through several states to take the National Registry exam eight years ago only to be told I couldn't have the NR part on my name tags because it's not recognized and it never will be. They stated too many people wouldn't be EMTs anymore if they had to pass that exam. So coddling them through a state test was the answer to a shortage in EMTs just as having CRT was an answer to the shortage in ALS. One person can only do so much.

I have since moved from Maryland and I am quite active in my new system. My only hope is the bad press will draw attention to the many problems there and open some eyes up to the changes they need to make for the sake of their citizens, including my own parents.

[SSG G-man]

I am currently an EMT-B in Maryland. I thought the state exam was pretty tough. There were a lot of failures. The practical portion of the the exam served as the practical for my NR exam, which I took and passed. The EMT exam is not given by your instructor. It is given by people sent by the state. I have always heard Md was a leader in prehospital care, like having the troopers and Crowley Shock Trauma center.

One of the reasons they may have been flown is MD protocols list rollovers as MOI to consider flying. A lot can be going on inside that can not immediately be seen. Better safe than sorry. I have flown persons who have self extricated, do to MOI, especially if there is ETOH.

Just my $.02 (why is there no cent sign on keyboards?)

Sarge