RRV

[nremtp]

Do you guys over the pond use rapid response vehicles? i.e. a Paramedic in a car? In the UK it is common to have a Paramedic in a car backing up a technician (BLS) level ambulance.

[Ridryder 911]

Check the search function, this has been discussed in detail. Here in the Midwest, I had never heard of such until hearing described on the forums. We do have supervisor and some have initial first response until a transport unit arrives.

R/r 911

[JPINFV]

It varies regionally. In my little part of the colonies fire departments provide the paramedics. In my county, if the fire department doesn't transport themselves, most of the paramedics respond via fire engine, but I think one or two cities use an SUV or truck. In the county north of me, a lot of the cities use a truck or SUV for their paramedics.

[Dustdevil]

Here in the Midwest, I had never heard of such until hearing described on the forums.

Yeah, this is pretty much a northeastern concept, from what I can tell. It's almost unheard of in the south and midwest, except for scattered, really rural areas. You're not really going to find it in Texas, where just the opposite is true. First responders run around in mixed vehicles, while the medics are the ones staffing the ambos. This, of course, makes one hell of a lot more sense. That's why they don't do it up north.

Of course, you will learn when you get here that every frostback from Pennsylvania west calls themselves "midwestern," because they are ashamed to be a Yankee. Consequently, the term has lost a lot of its specificity with misuse. :?

[katbemeEMT-B]

In my neck of the woods, one of the major ALS services is in the process of implementing an "ALS Chase Car" to assist the BLS services in 5 communities (actually 6 because we cover a very small neighboring community). I think this is fruitless and I will explain.

Their plan: They will station the chase car at the northern end of this combined area as this is where the vast majority of the calls are (makes sense). The chase care will only respond to cardiac, stroke, and mva/major MOI calls (By the way, when asked, SOB does not constitute a cardiac call). When they arrive on scene they will board our rig and take over pt care and some one from our rig will drive their vehicle to the hospital. Additional patient care will consist of ALS drug admin if needed, pacing, and cardiac monitoring (helpful, especially with those cardiac as we have no way to tell what's going on other than they are having chest pain). They will continue patient care with the assistance of a basic until care is transferred to the receiving hospital. They will then bill out there services with ours doubling the cost. Sounds good on paper.

Now the reality of things: First off, by stationing the car where they have chosen to gain the most calls, they have put themselves 30+ miles away from us and over 40 to the small community we service. We are 7 miles away from a hospital to the north and 15 to the south. The hospital we transfer to depends on where we respond to. Now, if we have a stroke or cardiac patient (along with several others) we aren't going to putz around on the scene waiting for this chase car to show up some 20 minutes later. We are going to load and go and be to the hospital probably about the same time or close to it that they reach the town it's in. Where is our benefit? If the call is to our south the chase car would spend the entire time chasing us. I don't understand how they expect this plan to work. If the call is for an MVA/major MOI yes they have a chance of making it on scene before we are en-route as it takes time to extricate and/or package a patient for transfer. This one was thought out although we usually call for air support as the patient will more than likely be flown to a Metro hospital anyway. As for the billing aspect, I agree with sending one bill but I don't see a lot of our patients being able to pay the additional cost as most are elderly and on a fixed income or non-English speaking.

Our plan: If they want to give us the added service of an ALS chase car, then place one in each of the communities they are offering the service to. I would have no problem with that as long as they responded with us or rode on the rig with us. As for the types of calls they are willing to respond to they shouldn't get to pick and choose, I think if they were here we would use them more often. I also don't believe we would over use them as we are used to being a self sufficient service with apparently many more variances that other services don't have. It may even take some time for us to get used to the idea that we have extra help available but I think most of us would come around. Oh wait, there are those few old timers who think they know it all and need no one. Well, they'll retire soon, (I hope). When would we use them other than stated above you ask? Well, for example; for the child who fell and broke her tib/fib and was in tremendous pain. Having some one there to admin a pain med would have been great. The really sad thing is that there is an ALS rig stationed 10 miles away from another service that would be more than willing to offer mutual aid when needed. The billing issue, I don't know how that would be resolved as there is no real solution in my eyes. You can't bleed a turnip. Unfortunately, we get paid what we get paid. Maybe we leave it up to the pateint if they want the ALS service and that would put them in a binding contract. Hahaha.

By the way, they didn't like our plan and said no. So far they are going with their plan although I have heard some talk that they may change the location of where the car would be stationed.

Anyone else have some good ideas or insight? What works in your area?

[croaker260]

Well, here are my thoughts. First , regarding "their plan": It makes sense to me (except the SOB part..but I wont judge until I hear what the other agencies can do..as in are they EMT-I that can give breathing treatments? questions like that). Now I am assuming that the responding units can request ALS ANYTIME (that is the way our system works) for things like pain control, etc.

Now regarding your plan...Your plan has three issues. First, "more ALS" does not equate "better ALS", and from a system point of view....not a responder point of view...this is a consideration. I wont rehash the concept of paramedic over saturation here, but you can research it if you want. Just look at the King County Medic One approach.

Second, Stuff like a broken arm with pain is an ALS response, but not necessarily an automatic ALS response. Nor is it something a BLS/ILS unit cant handle if ALS isn't available.

Third, Your plan to stick an ALS unit in every small burb sounds good on paper but is probably not practical. I am making some assumptions on our service , but most ALS services are 30% tax based and 70% fee for service based, even "Municiple" third services and many fire based agencies. Considering this, with out supplementing the tax base with an additional local contribution (wich some places do), then there is no way you can add additional units. What you are talking about is a (assuming one RRV or Ambulance for every small community) 500-600%increase in expenditures WITHOUT the revenue to make that up. I know from looking at the cost vs benefit ratio for several of our own small communities that is the case. Now many are the first to say " how can you say that, a life is priceless"...but the ambulances have to have fuel, paramedics have to get a wage to care for their families, drugs and equipment have to be bought, training has to occur. And when it comes down to it, no budget is bottomless. And if you were an administrator, and you had funds for 6 ambulances, would you place them where volume demanded, or for rural response times?

Sorry if this isnt what you wanted to hear, but it is honest. I know that from dealing with our rural communites, they often assume motives and maliciousness where there is none, because they dont want to look at the big picture or our side of the story..because we are "the big city folks"...simply not true 99% of the time.

[katbemeEMT-B]

Well, here are my thoughts. First , regarding "their plan": It makes sense to me (except the SOB part..but I wont judge until I hear what the other agencies can do..as in are they EMT-I that can give breathing treatments? questions like that). Now I am assuming that the responding units can request ALS ANYTIME (that is the way our system works) for things like pain control, etc.

Now regarding your plan...Your plan has three issues. First, "more ALS" does not equate "better ALS", and from a system point of view....not a responder point of view...this is a consideration. I wont rehash the concept of paramedic over saturation here, but you can research it if you want. Just look at the King County Medic One approach.

Second, Stuff like a broken arm with pain is an ALS response, but not necessarily an automatic ALS response. Nor is it something a BLS/ILS unit cant handle if ALS isn't available.

Third, Your plan to stick an ALS unit in every small burb sounds good on paper but is probably not practical. I am making some assumptions on our service , but most ALS services are 30% tax based and 70% fee for service based, even "Municiple" third services and many fire based agencies. Considering this, with out supplementing the tax base with an additional local contribution (wich some places do), then there is no way you can add additional units. What you are talking about is a (assuming one RRV or Ambulance for every small community) 500-600%increase in expenditures WITHOUT the revenue to make that up. I know from looking at the cost vs benefit ratio for several of our own small communities that is the case. Now many are the first to say " how can you say that, a life is priceless"...but the ambulances have to have fuel, paramedics have to get a wage to care for their families, drugs and equipment have to be bought, training has to occur. And when it comes down to it, no budget is bottomless. And if you were an administrator, and you had funds for 6 ambulances, would you place them where volume demanded, or for rural response times?

Sorry if this isnt what you wanted to hear, but it is honest. I know that from dealing with our rural communites, they often assume motives and maliciousness where there is none, because they dont want to look at the big picture or our side of the story..because we are "the big city folks"...simply not true 99% of the time.

Our rig is staffed with three two EMT-Bs and a driver or three EMT-Bs. As basics we carry variances that allow us to admin. albuterol neb., oral glucose, glucagon, Epi-pen, baby aspirin, nitro SL, normal saline via IV access, and activated charcoal. We must be cerified through our MD. What scares me is that often times we are paged out for SOB when it is a cardiac issue or stroke. You know how that goes. What we were told the chase car will respond to the for instances stated above. We can request them if we arrive on scene and discover it is one of those but then do we sit there and wait for their arrival? I'm thinking not unless they are some place close buy. We can be to the hospital in 6 minutes max. By the way, pain management wasn't a good enough reason to request them as they are servicing several communities and have to concentrate on the life threatening calls. They figure we've been doing the broken bone thing this long we can continue.

I agree more ALS does not equal better ALS. I would love to see us forget this chase car thing and sign a mutual aid agreement with the ALS service stationed in the neighboring town. They are a great bunch of medics that strive to be the best. They are constantly challenging each other to learn more. I have recently started with this service part-time and am loving it. I am learning so much.

I also agree that putting a chase car in every community would be a financial burden. I know there has to be a solution to this problem that is why I am asking for insight and ideas from people who have chase cars in place and how do they work. I would love to be able to bring these ideas to the board. I would also love to see ALS support in our area.

[Richard B the EMT]

Some years before EMS was merged into the FDNY, due to a possibly criminal negligence, almost half of the EMS fleet was down mechanical for repairs. Central Repair was so overwhelmed, the units took up more streetside parking than the personnel then at Headquarters.

We implemented "Triage" cars, basically, EMTs in vehicles usually used by supervisory personnel. They would respond and, hopefully, close out cases by verifying no ambulance needed, or on-scene triage them, meaning via protocols, have them Refuse Medical Assistance. If the patient really needed care, they would stabilize until an ambulance could arrive.

Paralleling that, we also had "Union" cars, same story, only Paramedic personnel.

Many community-based Volunteer Ambulance Services, scanning a "Triage" or "Union" car being sent, would roll out to the scene, and effect the transport, with 1/2 the EMS personnel riding with the patient, for continuity of care. The other half would drive the EMS "command car" following to the ED.

After the merger into the FDNY, we experimented with Paramedic Response Units (PRUs). A paramedic would ride a non-transport truck, driven by a supervisor, and do much the same as already described in my recall of the "Triage" and "Union" cars. The problems were that a PRU would either be assigned to a supervisory task, then unable to medically respond, or be on a medical or trauma response, and be unavailable for supervisor's duties. With us, at that time, the experiment kind of crashed and burned.

However, within our multiple jurisdictions of the EMT City, your experiences could be a lot more positive than what we had, due to number of personnel, vehicles, geographic contributions, and other factors.

[MAGICFITZPATRICK]

Yep...they follow in a jeep...also know as a fly car.

[emt-b_wa]

We use them frequently. We call them SPRNT units ( pronounced sprint) Single paramedic response non-transport. They work well for the rual areas that run skeleton crews.