How to improve EMS professionalism

[NREMT-Basic]

Rid-

I can understand where youre coming from, but I still think it doesnt hold water. I mean esentially your argument is something like, if the town can thrown a veterans day parade, they can afford to pay their volunteer fire/ems. Not so, and I think you know that. We have a town about a hundred miles from where I live. It has a population of 110 people. They have little town picnics, etc and I think a bus might run through their every few days. Until a few years ago, they had no fire/ems response locally at all with the nearest responders being 30 miles away. So, the people of the town got together, got a firetruck (forgive me for not using FF terminology) and one ambulance. Then before using it, they send 4 of the towns men to FF school and there are 2 women in this little burg that have gone to medic level. Thats their emergency response system. But they cant afford to pay them. They need things like road salt and to pay someone to keep the weeds by the side of the road cut down because the state says they have to. I would honestly like someone to show me a study that says that across the board, volunteer EMS is no good...that it somehow sacrificies the quality of the care that it provides the inhabitants of its community. Or what about the towns closer to me but next to that little one...they have a Fire-Rescue service, all volunteer, called Win-Bur-Sew Fire Rescue, for the names of the towns they serve. Their fire fighters and EMS personnel make no money at what they do. they leave their jobs in the middle of the day and their homes in the middle of the night to put out house fires, tend to patients having acute MIs and deliver babies, among the million other things they do every day. Do you really have the conceit to say that they are no good or that the towns they live in are slacking off because they cant afford to pay these dedicted folks. Not everplace is NYC or Chicago or LA...alot of communities really do have to make do...do you honestly believe that having no EMS is better than volunteer. Pheh! I say.

[Asysin2leads]

For all those who are saying "My town can't afford...", lets break it down at a community level. Someone quoted to me that the cost of running a 24 hour ALS response ambulance staffed by two paramedics is around $1,000,000 a year. I think that may be a little high, especially since the person was talking about in the greater NYC area where prices of everything increase substantially. But lets use $1,000,000 a year for round the clock ALS service and transport. Okay, so if we broke it down evenly over a populace, which of course given tax rates wouldn't be the case, but lets say we break it down evenly over a populace, in a city of 20,000 people, the cost per person per year is $50.00. Yes, $50.00, or 13 cents a day per person to have round the clock, professional advanced life support at your beck and call, and that doesn't even take into account the fact that unlike a police or fire department, EMS can actually generate some of the revenue back. Certainly not $1,000,000 a year, but enough to defray a good portion of the funding. For instance, if you averaged 3 calls in a 24 hour period, your call rate for the year would be 1,095 calls for the year. If you billed $500.00 for each transport and only half the people or their insurance company ponied up the dough, you would generate $273,750 dollars a year. This leaves your operating costs at $726,250, or $36.31 per person per year for the ALS service, or roughly ten cents a day. Now, I ask you, is it really all that expensive to go paid ALS? And to be perfectly frank, if a town of 20,000 people doesn't want to pony up ten $.10 to $.13 cents a day to have me risk my damn neck, wreck my knees and back and leave me with a headful of bad memories, then honestly, f--k them. If they want something for free, I will gladly say "I told ya so!" afterwards.

Oh, and as Lt. Columbo would say, just one more thing sir. I have never understood this. If you don't want to be a paramedic and do all you possibly can to treat the sick and injured, why exactly did you get into EMS? I mean, if you have true desire to help others by providing prehospital emergency care, wouldn't you want to be able to do all you possibly could for your patient? Doesn't it bug you just a little that your patient may be suffering or even dying because of your lack of skills? This really isn't a slam against EMT's. It's honestly something I never quite got.

[mediccjh]

For all those who are saying "My town can't afford...", lets break it down at a community level. Someone quoted to me that the cost of running a 24 hour ALS response ambulance staffed by two paramedics is around $1,000,000 a year. I think that may be a little high, especially since the person was talking about in the greater NYC area where prices of everything increase substantially. But lets use $1,000,000 a year for round the clock ALS service and transport. Okay, so if we broke it down evenly over a populace, which of course given tax rates wouldn't be the case, but lets say we break it down evenly over a populace, in a city of 20,000 people, the cost per person per year is $50.00. Yes, $50.00, or 13 cents a day per person to have round the clock, professional advanced life support at your beck and call, and that doesn't even take into account the fact that unlike a police or fire department, EMS can actually generate some of the revenue back. Certainly not $1,000,000 a year, but enough to defray a good portion of the funding. For instance, if you averaged 3 calls in a 24 hour period, your call rate for the year would be 1,095 calls for the year. If you billed $500.00 for each transport and only half the people or their insurance company ponied up the dough, you would generate $273,750 dollars a year. This leaves your operating costs at $726,250, or $36.31 per person per year for the ALS service, or roughly ten cents a day. Now, I ask you, is it really all that expensive to go paid ALS? And to be perfectly frank, if a town of 20,000 people doesn't want to pony up ten $.10 to $.13 cents a day to have me risk my damn neck, wreck my knees and back and leave me with a headful of bad memories, then honestly, f--k them. If they want something for free, I will gladly say "I told ya so!" afterwards.

Oh, and as Lt. Columbo would say, just one more thing sir. I have never understood this. If you don't want to be a paramedic and do all you possibly can to treat the sick and injured, why exactly did you get into EMS? I mean, if you have true desire to help others by providing prehospital emergency care, wouldn't you want to be able to do all you possibly could for your patient? Doesn't it bug you just a little that your patient may be suffering or even dying because of your lack of skills? This really isn't a slam against EMT's. It's honestly something I never quite got.

=D> =D> =D> =D> =D> =D> =D> =D> =D> =D> =D> =D> =D> =D>

[Ridryder 911]

Great posts Asysin2leads ! Very true.

The costs is all relevant for what region you are living in. So the true dollar amount is negotiable and should not be stated as such. I know of two local "small towns" population of < 2000 each , that contracted with an EMS service and have a 24 hr paramedic staffed truck for $6,200 a month. The "difference" is made up on billing to patient.

Sorry, a township of less than 100 people does not need an EMS. It can't afford nor warrant enough call volume to support anything. Now, combining with other communities as described might be able to support something. That is the risks one takes when determining to live in such an area.

Now, what I do ask is there not any professional EMS services within 20 to 30 miles of these communities ? That small communities could have a first responder program to initially treat and summon a rendezvous ALS EMS ?

Just like all other communities, one has to weigh what the community can have and expect. Townships that are composed of a total less than 500 would love to have several things, hospitals, sewer plants, etc.. as well as a EMS. However; unless they receive grant or work other similar townships it is not feasible or expected to be able to provide those services.

Again, many do not explore options. Rather they feel that it must be that "they" have to provide such service or nothing at all. In my area there very few volly EMS. In fact, many places are now going without EMS, which is more a problem. They will volunteer for F.D. but not EMS. So many larger services are now combining areas to provide extended coverage or remote stations in those areas. It can work, but one has to be more open than to one mindset.

R/r 911

[shira_emt]

Don't start with me on that EMSxray.

[emaxray]

Don't start with me on that EMSxray.

:?: :?: If any of it was incorrect, by all means...

Asysin2leads wrote:"If you don't want to be a paramedic and do all you possibly can to treat the sick and injured, why exactly did you get into EMS? I mean, if you have true desire to help others by providing prehospital emergency care, wouldn't you want to be able to do all you possibly could for your patient?"

I can't count how many times (and recently) I Have heard you say you got into EMS to help people. I was simply wondering the same thing. A very valid question as well.

[Dustdevil]

Don't start with me on that EMSxray.

Shira, don't be absurd.

You know why they pay people to mow the courthouse lawn? Empty the courthouse trash cans? Change the oil in the police cars? Pave the roads? Answer the phones at city hall? Because nobody volunteers, that's why. Are you seeing a pattern here yet?

Do you think the city attorney works for free at those towns with volunteer EMS services? I think not. Neither does the city secretary or the people who built city hall. Does your community have any volunteers running the water department? Interesting, but somehow they always manage to find money for trash collectors when nobody volunteers to pick it up for free on their off hours from their real job.

And you don't think they can afford professional EMS? If you really can't figure that one out, then it's probably a good thing you don't want to go to medic school. You're hurting the profession enough as it already is.

[NREMT-Basic]

Great posts Asysin2leads ! Very true.

The costs is all relevant for what region you are living in. So the true dollar amount is negotiable and should not be stated as such. I know of two local "small towns" population of < 2000 each , that contracted with an EMS service and have a 24 hr paramedic staffed truck for $6,200 a month. The "difference" is made up on billing to patient.

Sorry, a township of less than 100 people does not need an EMS. It can't afford nor warrant enough call volume to support anything. Now, combining with other communities as described might be able to support something. That is the risks one takes when determining to live in such an area.

Now, what I do ask is there not any professional EMS services within 20 to 30 miles of these communities ? That small communities could have a first responder program to initially treat and summon a rendezvous ALS EMS ?

Just like all other communities, one has to weigh what the community can have and expect. Townships that are composed of a total less than 500 would love to have several things, hospitals, sewer plants, etc.. as well as a EMS. However; unless they receive grant or work other similar townships it is not feasible or expected to be able to provide those services.

Again, many do not explore options. Rather they feel that it must be that "they" have to provide such service or nothing at all. In my area there very few volly EMS. In fact, many places are now going without EMS, which is more a problem. They will volunteer for F.D. but not EMS. So many larger services are now combining areas to provide extended coverage or remote stations in those areas. It can work, but one has to be more open than to one mindset.

R/r 911

Unfortunately, you have once again presumed to prescribe a method that will work in all communities all of the time. The situation they have works for them, its an older community and as I believe I said, the nearest EMS/Fire responders outside of this town are 30-40 miles away...and as of the last time I checked they were working on a grant from Homeland Security to combine departments, but the wheels of the government grind slowly and exceedingly dumb. Im always surprised at the closed-mindeness of some of the Citys most experienced and voluminously posted "veterans." Do you think a town of 100 souls can afford $6200/month...of course not. But they found a situation which works for them, raised the money for one truck and one engine and they save lives and property. This is obviously a super-rural community...should they let a COPD patient weight 40 minutes for a rendezvous....should a house, farm and someones livelihood be allowed to burn to the ground while they wait. Again...my new favorite response...Pheh! Double Pheh!

[NREMT-Basic]

For all those who are saying "My town can't afford...", lets break it down at a community level. Someone quoted to me that the cost of running a 24 hour ALS response ambulance staffed by two paramedics is around $1,000,000 a year. I think that may be a little high, especially since the person was talking about in the greater NYC area where prices of everything increase substantially. But lets use $1,000,000 a year for round the clock ALS service and transport. Okay, so if we broke it down evenly over a populace, which of course given tax rates wouldn't be the case, but lets say we break it down evenly over a populace, in a city of 20,000 people, the cost per person per year is $50.00. Yes, $50.00, or 13 cents a day per person to have round the clock, professional advanced life support at your beck and call, and that doesn't even take into account the fact that unlike a police or fire department, EMS can actually generate some of the revenue back. Certainly not $1,000,000 a year, but enough to defray a good portion of the funding. For instance, if you averaged 3 calls in a 24 hour period, your call rate for the year would be 1,095 calls for the year. If you billed $500.00 for each transport and only half the people or their insurance company ponied up the dough, you would generate $273,750 dollars a year. This leaves your operating costs at $726,250, or $36.31 per person per year for the ALS service, or roughly ten cents a day. Now, I ask you, is it really all that expensive to go paid ALS? And to be perfectly frank, if a town of 20,000 people doesn't want to pony up ten $.10 to $.13 cents a day to have me risk my damn neck, wreck my knees and back and leave me with a headful of bad memories, then honestly, f--k them. If they want something for free, I will gladly say "I told ya so!" afterwards.

Oh, and as Lt. Columbo would say, just one more thing sir. I have never understood this. If you don't want to be a paramedic and do all you possibly can to treat the sick and injured, why exactly did you get into EMS? I mean, if you have true desire to help others by providing prehospital emergency care, wouldn't you want to be able to do all you possibly could for your patient? Doesn't it bug you just a little that your patient may be suffering or even dying because of your lack of skills? This really isn't a slam against EMT's. It's honestly something I never quite got.

You assume that everyone who gets into EMS wants to become a paramedic...the Paragod complex rears its head. Thats like saying that every person who goes to nursing school to work in an ER actually wants to be a trauma doctor. And you think a town/city of 20k can run one rig, staffed by two ALS providers for .13 cents a day. I live in a town of 30k and it takes two services running 5 rigs each to take care of the assistance load 24 hours a day. On rig and one crew dont work in a town of 20-30k and you know that to be true. Thats just a worthless suggestion. That would bring us back to 40 minute response times. And if you dont want to hurt you back and your neck, and if you cant handle some unpleasant memories, then be a florist. Thats what EMS is about. If you work in NYC or Dynamite Springs, BFE, these things are going to happen. Is your back any less hurt or your memories any less disturbing for 45k/year than for a lesser amount. Pheh! and minus 10 for faulty reasoning and figures not based on fact. The fact is that even you, in your "infinite wisdom" couldnt provide adequate service to a town of 20k with one rig...and its not like it wold be one crew running 24/7/365...you would probably need something more like 3 crews to covers time off, sick leave, family emergencies. The city of 30k I live in has 3 extra crews on each service just to cover such eventualities. And if you have that one rig and its on its way to say, an acute MI call, and it gets hit going through the intersection....how much cardiac muscle will your patient burn when there is no back up. There are enough holes in your plan to drive that rig through. And even if it worked...do you honestly think they are at the communities "beck and call." Double Pheh!

[Ridryder 911]

Unfortunately, you have once again presumed to prescribe a method that will work in all communities all of the time. The situation they have works for them, its an older community and as I believe I said, the nearest EMS/Fire responders outside of this town are 30-40 miles away...and as of the last time I checked they were working on a grant from Homeland Security to combine departments, but the wheels of the government grind slowly and exceedingly dumb. Im always surprised at the closed-mindeness of some of the Citys most experienced and voluminously posted "veterans." Do you think a town of 100 souls can afford $6200/month...of course not. But they found a situation which works for them, raised the money for one truck and one engine and they save lives and property. This is obviously a super-rural community...should they let a COPD patient weight 40 minutes for a rendezvous....should a house, farm and someones livelihood be allowed to burn to the ground while they wait. Again...my new favorite response...Pheh! Double Pheh!

I have worked and managed EMS in areas that was even more less populated than rural, it was classified as frontier country, so I am very familar with very rural settings. Wanting and getting is one thing. How competent are those medics and skill level on a town of 100 people. If they were to run 5 calls a month that would be over half of their population! Now, you tell me their going to maintain skill levels enough to justify existence and expenses ?

Again, it the "closed mindness" thinking that they deserve and should get monies from the fed grant (which it was never designed for) because they want and think they deserve something. My EMS general response is in areas 30-40 miles everyday... One does not need a transport EMS to help people! As well I bet it takes at least them at least 10 -20 minutes minimum to arrive at the scene. So now we are at only 15 to 20 minutes difference from ALS arriving. Having qualified First responders, should be able handle the situation for the first 20- 30 minutes until ALS until arrives. Guess what there is little difference in a BLS EMS unit responding than having a first responder responding...

In the real world.. not everybody gets what it wants...That is the choice one makes when they choose to live in remote areas. I can speak personally, since I as well live in a rural area.

I much rather see a tiered response with good BLS and ALS intervention, so everyone gets a real chance of survival than every town thinking they have to have a ambulance in their community or fire station.

R/r 911