Perfect EMS

[Timmy]

Were do you draw the line with education? There’s a difference between

paramedicine and medicine. It sounds like we all might as well be doctors to run around in an ambulance.

Excuse my aussieness, but what does motel rooms got to do with anything lol?

Is that an American EMS saying or something?

[donedeal]

Treat and Release....which in turn requires paramedics to make a patient diagnosis. For complicated cases this can only be achieved through a variety of tests including blood work and radiology. In prehospital medical treatment, this is not an option as these tests 1) require expensive medical equipment not available on an ambulance 2) take a great deal of time, 3) are interpreted by doctors. However, there are a number of non emergent cases seen in the hospital which could be treated in the field. Before giving paramedics the ability to rule out conditions and release patients after an examination, they must receive higher education. They must have the ability to rule out underlying symptoms and illness. Similar to a physicians assistant, they would still be required to confer with a doctor/medical control.

By removing non emergent cases from the ER, and giving paramedics the ability to treat, release, and refer patients to primary care providers, hospitals ER's and the EMS system will be relieved of the burden that non emergent care puts on the facilities (use of healthcare resources and healthcare costs). The available funds produced can be used for continuing education of personnel and upgrading of facilities.

Without an ability to pay, healthcare costs skyrocket. For every uninsured patient who enters the ER experiencing a non emergent condition, which could have been treated and released by a qualified paramedic, costs the general public several thousand dollars in tax resources. This cost is budgeted into EMS systems and hospitals. Hospitals are required to examine all patients, regardless of ability to pay (EMTALA). But if the examination and treatment paramedics provide could fulfill the EMTALA law, millions of $$$ would be saved. This money has countless uses. Including being able to morph prehospital treatment into advanced levels of care through medical technology research to put efficient laboratory and radiology equipment on all purpose rescue ambulances.

[KIWI]

OK heres a mix ... things that I think would make ems/ambulance better ... and some responses to the posts already posted.

There is the ever present prob of funding ... was sort of 'funny' one of the reasons I joined the fire service was 'to see how the other half lived' and the deal with the fire service was way better than with ambulance .... the difference? FUNDING

As I have posted in the past ALL emergency services need to sort out the problem of having children (minors) riding on emergency vehicles or attending emergency incidents. We want to be taken seriously ... then don't as a matter of cause allow children to be present on the job (no other profession allows this).

Here in NZ we're lucky that the different levels of qualification are pretty much nation wide .... at least at a state level if not national that would be great in the US (would clear a lot of complications and mis understandings).

On a wee bit of a tangent but brought to mind from being allowed to spend some time working in with a paramedic mate in the US the multitude of services operating in the one city and meeting up with them in the varying hospitals ... was WOW an eye opener for this kiwi! Maybe more uniformity would be better for the general public ... I'm not really sure ... was just mega different for me.

And finally ... to invite the bullets and have people baying for my blood ... VOLUNTARISM ... where does it fit in modern day emergency medicine? I have worked both sides (as paid and vol) there are some communities that 'survive' on the sweat of volunteers but there are also services who constantly lower standards and under cut service because of the sweat of willing volunteers, and thats not on. They're making money of the system, the patients and the volunteers and basically as long as they are making money they don't care about anything else. This is WRONG. It undermines job, the qualifications, the service it gives all an unfair unjust deal.

The perfect EMS deal? It's an impossible dream .... patients wouldn't die, stupid people wouldn't do stupid things, innocent people wouldn't suffer for other's mistakes, CIS n PTSD wouldn't happen to the 'good guys', we would be paid enough so one job was sufficient to live on. Ambulance personnel wouldn't have to worry about assaults, robbery, blood/body borne pathogens.

But thats not how it is ... and it's never going to be. The constant change and unpredictability of the job is one of the biggest draw cards, we see people at there worst and sometimes (hopefully more than just sometimes) we are able to make a real life changing difference.

The things that could make EMS 'perfect' are 'pipe dreams' they are not a reality. Having said that emeregncy medicine has come a long way in the past 30+ years and is a growing evolving entity.

[JPINFV]

Were do you draw the line with education? There’s a difference between

paramedicine and medicine. It sounds like we all might as well be doctors to run around in an ambulance.

Excuse my aussieness, but what does motel rooms got to do with anything lol?

Is that an American EMS saying or something?

It's partly a West Coast American thing with fire based EMS. Fire runs the ALS show, but they contract out the actual transport to a private ambulance company in a lot of cities (i.e. call 911 in my county and a fire engine with paramedics and a private ambulance with EMT-Bs shows up). The private ambulance crews are generally stationed at motels with reserved parking for the ambulance.

[Dustdevil]

When I think of hospitals, I think of doctors and nurses, not EMS.

Therein lies the problem. We are therefore not considered part of real medicine by the public. Therefore, we get none of the respect of real medicine. Easily fixed, if it weren't for the IAFC.

All the education in the world won't fix anything if you aren't going to pay enough to attract people to this career.

And conversely, the people in this career aren't worth that money unless they are better educated. So again, education is the answer.

If you plan on using tax dollars, then you need to show the public that a professional and educated service is needed and beneficial. If that means that we need to pull out the dog and pony show every so often, then it's the price that needs to be paid.

The dog and pony show happens everytime the tones drop.

So, your city's management isn't professional? Your local water district/sanitation district engineers aren't professionals? It sounds like your saying that there are no professionals involved with government services.

Well then you need to improve your reading comprehension. I was speaking very specifically of public perception, not my personal beliefs. Regardless of what I think of them, the public generally does not view those people as true professionals, but simply as providers of a service that their tax dollars demand. Public servants, who are taken for granted and given no professional respect because, after all, they work for us. That may be the lifelong dream of the typical firemonkey, but not me.

Sure, the employees that you're most likely to encounter aren't professionals, but I'm sure there is someone that is considered a professional above them.

And education will ensure that EMS providers are considered professionals from the bottom up, not from the top down.

Medicine is a government service for a lot of places. In fact, you could argue that EMS IS a government mandated service under EMTALA since true emergencies [MI=emergency. Stubbed toe=not an emergency] are treated without regard to the patient's ability to pay. Unfortunately, this is why a lot of ERs are full.

I fail to see your point. Or, more likely, you fail to present a point.

Unlike police, fire, other healthcare fields [RN, MD/DO], law, politics, etc, EMS is not a field that jumps out towards college students.

I think you are seriously overestimating the professional lure of the police and fire services, but okay.

If you want college educated paramedics, then you can't just rely on people looking at EMS as a high school student. With out its own identity, EMS will never be able to attract the grads and the undecided/undeclared demographics like it needs too.

My point exactly.

[Timmy]

The private ambulance crews are generally stationed at motels with reserved parking for the ambulance.

What The!!??? You can't be serious?? What's the point of that?

Sorry but that just shocked me!

[Dustdevil]

What The!!??? You can't be serious?? What's the point of that?

Sorry but that just shocked me!

Think really hard about it. Urban environment. You seriously cannot think of any advantages to this?

Not that I am particularly fond of this concept, but I do have to admit that it is full of advantages.

If you can't handle the idea of being stationed in a hotel, just pray you are never stationed in a place like I am stationed!

[Timmy]

It's not that I can't handle it, just I've never heard of anything like that.

Now I'm not up to speed with what you Americans do but what's wrong with sleeping in the ambulance station, or taking the ambulance back to your own residence?

[Dustdevil]

Now I'm not up to speed with what you Americans do but what's wrong with sleeping in the ambulance station...

Ambulance stations are expensive to acquire, build, and maintain. And the ideal location for ambulance stations varies with time of day and shifting demographics within the community. You can get a hotel room anytime, anywhere. It takes months and lots of money to put up a station. And if priorities change, you can easily change the location of your hotel room. You can't do that with a dedicated station.

...or taking the ambulance back to your own residence?

Let me count the ways! First of all, most EMTs I have worked with, I would not want at my home! Not to mention that most people do not live in a geographically strategic location for the ambulance to be stationed. Many people do not live in their district at all. And, if my employer wants to use my home as a station, he is going to have to pay me extra for that. Does your home have a garage big enough for an ambulance?

I'm afraid I just don't get where you're coming from with these ideas. :?

[Timmy]

Whoops I forgot American EMS isn’t government funded… Sorry. :oops:

The way the station in my town works:

During normal working hours, Friday and Saturday nights, there is a crew of 2 with a Merc at the ambulance station ready to roll. With 1 on standby.

Out of hours, one medic takes home the Merc and the other takes there first response sedan, when there’s a call out they both respond to the scene.

If there’s an incident involving a lot of patients then everyone gets called in and they have a spare GMC at the station.

I do have an ambulance at my house; it lives in our barn lol… It’s a first aid unit.

There’s only 3 volunteers in my division and we have 2 ambulances so we take them home so we don’t have to use our won fuel.

There’s a pic in my profile if you wana have a look.