Progressive EMS Systems

[UMSTUDENT]

I'm interested in hearing about the particular EMS system you work for, and why or why not you think it is progressive. If you're willing to elaborate, please include your starting pay, a website (if your organization provides one), and information on the hiring process. I have a specific interest in progressive, highly competitive EMS organizations. A complex hiring or testing process is not of concern.

Also, please include the type of delivery system. Does your system use a fly-car system that upgrades BLS units? Is it a PUM? Third party? Fire based? Please elaborate on the delivery system. Also, if at all possible, does your system currently utilize CPAP, RSI, aggressive IO administration, pain management protocols, or any other indicator of your system's scope of practice. I'd really appreciate it.

[Timmy]

Hey UMSTUDENT- I’m a volley with St John Ambulance in the state of Victoria, Australia, our main role is providing event coverage to events such as MX, speedway, festivals, sporting events, you name it were there. We also back up the state ambulance service in such events as bushfire, plane crashes ect. We have around about 3000 volunteers both adults and cadets. I think it’s progressive as they’ve just brought in drug protocols and are updating our fleet and state wide radio communications. They also undercut, bribe, you name it to provide coverage at the ‘good’ events. To volunteer you need to be appropriately qualified, pass a fitness test and sit an interview with a regional officer.

Our service is mainly BLS, we do have a lot of Health Care type people in the organisation who can do what ever there qualified in, even open heart surgery in the middle of a mosh pit if they wanted to lol so I guess you could say our scope of practise is what ever your qualified in. Our fleet has around about 100 Stretcher ambulances some 4x4 and there heaps of sedans and station wagons.

We do not transport to hospital. We charge $32 an hour to have and ambulance and 2 first aid staff there.

Website- www.stjohnvic.com.au or www.stjohn.org.au

[medic_ruth]

Hi UMstudent. (I'm hoping that UM is for University of Michigan but if not, I'll give you some info anyway.

I am a rural EMSer so this maybe a different perspective for you. Our system is ALS. there are only 3 ALS services in our county so we cover 166 square miles. our mode of transport is all ground here due to some laws governing helicopters in restricted air-space (long story) though patients can be transferred out of our local hospital via fixed wing if need be. Our protocols allow us to do IOs and needle crichs in the field. we also run and interpret 12leads we do not do RSI yet. Our transport time is anywhere from 15-60 minutes to the only hospital. We carry quite a few drugs and I will list them in case you have any questions or comments about them:

ASA

Activated charcoal

Adenosine

Albuterol

Atrovent

Atropine

Calcium Chloride

D 50

Valium

Benadryl

Dopamine

Epi 1:1000 and 1:10000

Romazicon

Narcan

Lasix

Glucagon

Lidocaine bolus and infusion pre-mix

Procainamide

Magnesium Sulfate

Morphine

Demerol

Versed

Solu-Medrol

Nitro tab and drip

Sodium bi-carb

phenergan

terbutaline

thiamine

verapamil

lopressor

We run a medic/EMT crew at the very least and work in shifts of 56 hours on 112 off. Starting wage for an EMT basic is 10.95 per hour and for a medic is 14.14 per hour full timers get paid vacation, sick and personal hours and the medical is Blue cross/Blue shield (not bad) free. (dental and vision you have to pay for)

We are a private not-for-profit owned by an indian tribe. not affiliated with the fire service but respond with them and vice-versa.

Hope that was helpfull.

[JPINFV]

Fire based system with a 75/25% split between cities that contract out transport (ex private company provides ambulance, FD provides paramedics. Paramedics and ambulance responds separately) and cities that transport themselves. Medical oversight (protocols, licensing, certification) provided at the county level instead of having a medical director for each service/company. No online medical control at the BLS level and mandatory base contact, regardless of a need for procedure/medication approval, of for a wide range of patients except for one city that is the test case for all standing orders (base contact not required, but still an option if the paramedic wants to consult).

Also, if at all possible, does your system currently utilize CPAP, RSI, aggressive IO administration, pain management protocols, or any other indicator of your system's scope of practice. I'd really appreciate it.

No. Infact, the medics can preform a 12-lead ECG, but cannot interpet them.

Edit:

In conclusion, my area's not progressive. Limited treatment and employment options with a rather high level of oversight via required base hospital contact.

[Dustdevil]

Just to re-focus the thread:

I'm interested in hearing about the particular EMS system you work for, and why or why not you think it is progressive.

So far, only Timmy has made any attempt to answer the question, and he's not even in an EMS system.

[K9kazoo]

Progressive Services:

Calgary Alberta

Edmonton Alberta

Ottawa Ontario

Nova Scotia EHS

Stone Age:

The Winnipeg Fire Paramedic Service

Google is your friend...

B.

[flight-lp]

I'm interested in hearing about the particular EMS system you work for, and why or why not you think it is progressive. If you're willing to elaborate, please include your starting pay, a website (if your organization provides one), and information on the hiring process. I have a specific interest in progressive, highly competitive EMS organizations. A complex hiring or testing process is not of concern.

Also, please include the type of delivery system. Does your system use a fly-car system that upgrades BLS units? Is it a PUM? Third party? Fire based? Please elaborate on the delivery system. Also, if at all possible, does your system currently utilize CPAP, RSI, aggressive IO administration, pain management protocols, or any other indicator of your system's scope of practice. I'd really appreciate it.

www.ccems.com

CPAP, RSI, I/O, Pain Management - Yes

Progressive system - In my mind absolutely. To me progressiveness has little to do with what cool things you can do or how many drugs you carry. I believe that progressiveness involves a system that is consistant with its mission and care, provides longevity and stability to both its employees and the community, and one that upholds itself to the highest most professional standards possible. My system has been in place for over 30 years as the same entity, operating with the same mission. We have never "privatized", we never have been forced to do non-emergent transfers to maintain our budget (and thus reducing our availibility to our citizens), yet we still have all of the goodies. A frontline fleet that is less than 2 years old, quality diagnostic and treatment equipment, excellent support and equipment availability for our 1st responders, a superb quality improvement program that involves all parties from our doc on down to the EMT, and CE opportunity paid for by the company. Our field support from the supervisors and management is top notch. Both our operations manager and our medical director routinely respond with the medic unit. Benefits are excellent and most are paid for by the company. Pay is commensuate with the local COL and is negotiable. We currently run MICU only, however as our district is the largest ESD in Texas, we are having to grow with the times and are considering a tiered system. Employment information is available on the website, PM me if you have any additional questions.

[p3medic]

Boston EMS, www.bostonems.com, links to other sites, including the boston public health commision, who is the city agency we fall under. The hiring process involves a written test, practical exam and oral interview, all candidates must be Mass certified EMT-B or higher. All new hires are as EMT's, regardless of your level of cert, all ALS positions are filled from within the ranks, no direct hire of medics. If one passes the entry requirements, including criminal background check, driving record, drug screen, you spend I believe 10 weeks in our academy, mostly didactic work, with some hospital and field clinical time as well, covering all aspects of the job, interagency familiarization, hazmat, subway ops, airport response, police dept stand by with eod/entry, fire ground operation, etc...after the academic portion new hires are entered into the field preceptor portion, responding to calls with a fto and another cadet, or perhaps an fto and experienced emt, things are currently being changed, so i'm not completely sure how the current class is going to do this...anyway, the field portion is 9 weeks, with a possible extension depending on circumstances. If you pass all that, you get your badge and are a probie for 1 year. In order to compete for a medic spot you must be employed for at least one year, be a Mass certified EMT-P, pass written, practical and oral interview. Selected individuals spend a month in class, another several weeks in clinical rotation in hospital, (OB/GYN, OR, NICU, PICU, EW, Ped's etc...) The field internship is 9 weeks, then an exit interview. If selected you are a probie medic for 6 months with 100% chart review, and must work with a medic with at least 1 year BEMS experience. The testing process is very competitive, we have a large number of our BLS providers that have ALS certs, so having a medic ticket is only good for the chance to compete, it is no guarantee you will ever wear a white shirt.

The system is a third service provider, with limited first response on certain call type codes by BFD/BPD. We on average staff 15-20 BLS trucks and 5-6 ALS, BLS trucks are staffed by 2 EMT's, ALS by 2 medics. We also have a north and south side division supervisor (Lt.) that are experienced EMT's, and a shift commander (Dep Superintendent) an experience medic. We staff BPD boats with EMT's and medics during the summer months or during special events as well. There are two tactical response units, tango 1-2, with trailers for specific equipment, i.e scba cascade system, mci, bike trailers, comm's, hazmat, etc...I'm not exactly sure of the pay scale, but starting EMT's are about 22/hr, medics 29/hr, after 5 years medics are just under 33/hr, not including built ins like haz duty, shift diff, etc...or OT. We are negotiating a contract currently, so these will change, hopefully a lot! but i won't hold my breath.

CPAP is in stock, yet hasn't been fielded yet, should be on the street before the new year, but i've heard this before, we'll see...RSI, IO utilizing the EZ-IO, great tool in my opinion. Pain management is aggressive at the ALS level, nothing at the BLS level, yet....

We conduct internal training every month, ACLS/PALS/BTLS/ Refresher all paid OT. We are fortunate to be in a city with several teaching hospitals, so are invited to attend training that is difficult if not impossible to get at other services. Medical examiners office, Boston Medical Center, Mass General, Brigham and Womans, Shriners, Beth Israel, Childrens, NEMC have all extended lectures or programs to our membership. We have a strong Union, good health benefits, 15 paid holidays, 15 paid sick days, 3-6 weeks paid vacation depending on longevity, a support services section, special ops, communications (dispatch center with BPD) tqi/tqa program, a research oriented training department, Medical director and Associate medical directors with active participation in training and research, and EMS fellows, who conduct research as well...We also teach AED to the community and businesses, and some outreach programs to populations at risk....

[uncle_salty]

http://www.rollwithit.com

Here's another nail in the coffin that's just bound to attract high-quality individuals to EMS.

[Niftymedi911]

Lee County Emergency Medical Services Fort Myers, FL

www.lee-ems.com/ems/deafult.htm

Lee County Emergency Medical Services (EMS) is a Florida certified ground and rotor-wing Advanced Life Support Provider. Lee County Paramedics and EMTs provide care on-scene and during transport to the most appropriate medical facility.

Lee County EMS covers more than 1,100 square miles with 30 ALS ambulances, two twin-engine helicopters, two ALS non-transport units, and on-call bicycle paramedics. Each ambulance consists minimally of a State-certified Paramedic and EMT. In 2005, Lee County EMS responded to 74,996 emergency calls and transported more than 1000 patients by air. Lee County's western border is composed of seventy five (75) barrier islands that dot Southwest Florida's gulf coast.

Our Mission:

To provide the highest quality out-of-hospital emergency medical care and transportation for the residents and visitors of Lee County, Florida. Our highly trained professionals use the best technology to meet the needs of those who require assistance.

Lee County EMS has cutting edge medical protocols, including a agressive RSI program called CAM (Crash Airway Management). CAM is a advanced system to manage a failing airway due to trauma etc. We use in order Etomidate, Succ's at its appropriate dosage, and hang a Dripivan drip to keep p/t sedated. CPAP, and the EZ-IO modules has been in use for over 2 years, we have a very aggressive pain mangement protocol.

All ambulances are minimally staffed of a State-certified Paramedic and EMT.

LCEMS has currently 4 geographical sectors North, South, Cape, and West and each sector has 1 Paramedic Lt. Supervisor

Pay:

EMT's $39,803 >> $57,790 per yr // Paramedics $43,903 >> $72,512 per yr

Hiring Process:

All applicants are required to successfully complete the Lee County EMS New-Hire Assessment Center. This assessment process is broken down into four phases.

PHYSICAL AGILITY: The physical agility requires individual proficiency with 10 push-ups, 10 sit-ups, 10 jumping jacks, 10 squat thrusts and carrying a drug bag or monitor/defibrillator up three flights of stairs. With a partner, applicants will be required to carry a boarded patient down three flights of stairs. Strap the patient to the board and wheel the patient to and load the patient into an ambulance. With a partner, applicants will be required to carry a boarded patient a distance of about 20 yards. Perform 2-person CPR for a designated time limit and return the boarded patient the about 20 yard distance.

WRITTEN EXAM: A 100 question, general knowledge exam based on current state criteria for position applied. A 25 strip, ECG general knowledge exam for Paramedic applicants. EMT applicants must achieve a minimum passing score of 70%. Paramedic applicants must achieve a minimum passing score of 80%.

PRACTICAL EXAM: A scenario based exam pertaining to the position for which applicant has applied.

ORAL INTERVIEW: Applicants who have successfully completed all other phases shall be eligible to sit for the oral interview. The interview consists of general knowledge questions and situational scenarios, both operational and medical.

All applicants must successfully complete each phase of the assessment in succession beginning with the physical agility test in order to continue with the assessment process.

Results are tabulated and candidates are ranked in a comparative analysis.

Thorough background and reference checks are completed to assure validity of application.

All candidates must possess a current State of Florida Paramedic license or EMT certificate. (florida paramedic and emt reciprocity) prior to being offered a position. Beginning May 23, 2005, the Florida Department of Health offers the Florida paramedic exam in 12 locations across the state and also available throughout the United States and its possessions. When determining an appropriate testing site, use the Florida Department of Health and FLDOH-FLPMD – Florida Paramedic Exam as your selection options.

Candidates within the specified ranking are offered employment, but still must complete a post-offer pre-employment health exam, drug testing and criminal background check prior to beginning work. This process may take several weeks. For information regarding certification, education requirements or programs, please see the following sites: State of Florida, Office of Emergency Medical Services and Edison College, Ft. Myers, Florida

New employees must complete a two week, in-house Orientation Program in preparation for duty. New employees attend a 3 week, 8 hour/day Orientation Academy. This program allows the new employee to become familiar with the general equipment and operations they will be exposed to in their job. Sample Orientation topics include EVOC, HazMat, communications, BLS / ALS equipment review, and lifting / moving patients. Once the new employee has completed Orientation, they are assigned to a Field Training Officer and scheduled to ride as a third person on an ambulance, until they have completed the necessary objectives including understanding of the Lee County EMS medical guidelines to allow them to work alone as lead paramedic or EMT.

Work Shifts:

Lee County EMS currently has two (2) primary work shifts:

1. 24 hours on / 48 hours off work shift beginning at 0700 hours.

2. 12 hour work shift on a 3 days on / 2 days off, 2 days on / 3 days off in a rotation for 48 hours on one week and 36 hours the following week. Shift times are 2000-0700, 0930-2130 and 1030-2230.

Representation

In addition to being employees of Lee County, Lee County EMS EMTs, Paramedics, Pilots and Ambulance Maintenance Worker are represented by Local 1826 of the Southwest Florida Professional Firefighters and Paramedics.EMS Collective Bargaining Agreement

To apply for a job with Lee County EMS, you can apply on-line or call 1-888-889-8799.

Below is a copy of our medical protocols for your gander

[web:f4fff115c8]http://internet.lee-ems.com/intranet/publications/documents/medical_guidelines.pdf[/web:f4fff115c8]