The perfect system.

[cosgrojo]

This is not a gripe thread... this is not a thread meant to argue.

My challenge to the people here at EMTCITY is to describe to me what the perfect EMS system is.

I hear much on these boards about how this system sucks, and that system sucks, but very little in the way of solving this situation, or even quantifying why it sucks.

I want a comprehensive post including everything that you need to provide the best care possible for your community. Be specific and realistic.

To set the rules a bit further, I will give you the sample community (that way there can be no mis-understanding). This is municipal EMS of a large city with equal parts inner-city urban territories and outer-laying suburban sections. You live in a community that values their safety, and local government does not mind spending money on public safety.

So you have money, and you have carte blanche. Have fun!

Repeat... this is not meant to become a ALS vs BLs thing, and try to respect others opinion on this matter, it's easier to actually learn something then.

I know many of you are involved in the administration of EMS so I am particularly anxious to read what you post.

[Code 8 Paramedic]

Awww the perfect system...

1) EMD that ACCTUALY gets the nature of the call

2) The abillity to treat and release

3) The abillity to tell people you dont need an ambulance or ER!

4) Progressive Medcon with good CME's

5) Good working relationship with MD's and RN's at Hospital

6) Educated Medics and EMT's

What it is to dream! :D/ :brave:

[HellsBells]

EMD's with some Medical knowledge, or training, not just a week long dispatch course.

Administration interested in continuing education, I.E. an in house Paramedic program for EMT level employees.

[Dustdevil]

This is municipal EMS of a large city with equal parts inner-city urban territories and outer-laying suburban sections. You live in a community that values their safety, and local government does not mind spending money on public safety.

Well, you already doomed your system to failure.

Step one would be to make it a MEDICAL profession, and not a public safety job. :wink:

[croaker260]

Clearly ,a tiered approach is optimal.

Well , I think a system with BLS or ILS first responders, and ILS ambulances , with a few , highly trained and highly utilized medics staffing a few ALS ambulances running only priority ALS calls. The BLS/ILS units handle 80% of volume (with a goal of 90% accuracy to be responding on BLS/ILS call), and the ALS units responding with a goal of 90% accuracy for ALS calls. BLS/ILS ambulaces transport anything not handled by ALS. As the system is refined, somethings only the BLS/ILS first responder would role on and evaluate, with transport called PRN.

For cardiac arrest, the closest defibrillator would be called...be that ALS, BLI/ILS, or a police car equipped with a defib, or the fire marshal with an AED doing his rounds.

All request of 911 assistance gets as a minimum BLS/ILS first response unit. The transport unit is either an ALS or an BLS/ILS unit based on call type.

Therefore the ALS units only are first in on priority calls, Since you dont have a lot of ALS units, there are still plenty of calls to keep what ALS units you have busy.

This results in a highly experienced ALS core, and as a side note a very refined BLS/ILS core as well. Why is this important? Well, remember that it has been constantly shown that all the high risk skills (i.e. intubation) success rate is directly dependant on EXPERIENCE with the procedure as well as whatever training/education you throw at the system. You cant have one with out the other.

A tiered, targeted (not just tiered, but tiered and targeted) system provides the experience requirement.

BLS /ILS handles everything else. Remember in an urban/suburban system, your mostly not more than 15 minutes fromt he hospital , probably less.

The system will provide JOINT training at all levels, and JOINT QA. BLS providers and first responders will be reviewed as stringently as the ALS providers, to see that they did more than simply wait for the ambulance. They are after all , health care providers too. They will be reviewed to see that they call ALS when needed, and dont call when it is not.

The ALS providers will be QA-ed to be sure they dont practice lazy medicine, and be sure they don't turf any ALS patients to BLS, or take BLS patients that dont need to go. (They can wait for a BLS/ILS transport if it is reasonably quick).

The pre employment standards will ensure that only people who want to do medicine make it to the ALS level, not those who simply want a job. Providers at all level of the system will be paid a living wage and with good benefits and retirement.

The service will have an intensive FTO program for those who are hired. Those who dont cut it will be retrained, those who still dont cut it will be cut loose.

The doctors will be on a first name basis with the medics, the medics will work only 36 hours a week (Average) scheduled with 4 hours clinical time (rounds, OR time, lectures, labs , PR, PAD/CPR classes, or teaching) every two weeks. Since there is a huge educational burden on this system at all levels, there is always someone needing teaching . In the unlikely event there is to many medics to do all the tasks, they will be tasked with following up on patients and assisting in research.

Full time education department with all CE and training provided. No minimum 48 hours per two years and some class-in-a-can refresher course. There will be so much documented education in so many venues, the only hassle about recertification will be writing it all down. In addition, exceptional employees and specialty teams will go to national conferences to bring back the latest. The education department will also be the hub agency for all research in the area for EMS.

[croaker260]

Step one would be to make it a MEDICAL profession, and not a public safety job. :wink:

This is the first time in recent weeks you and I have been in total agreement.

[Dustdevil]

6) Educated Medics and EMT's

A truly educated EMT is a medic. :wink:

[AZCEP]

A truly educated EMT is a medic. :wink:

Aw crap, not again :roll:

Medical control that knows what medics are capable of and support it.

Medics that spend more time with current information than a bi-yearly ACLS/PALS/PHTLS class.

EMT's that are attending paramedic school. (See there Dust, there is a place for them.)

Receiving facilities that have bed space for patients to be placed in.

[Dustdevil]

EMT's that are attending paramedic school. (See there Dust, there is a place for them.)

Hmmm... :-k

I think you may be on to something here.

Senior nursing students are hired as nurse techs. Senior medical students work pretty much solo in some clinicals. Gives the facility extra people and the student valuable experience.

Can we agree that these would be senior year students who have already finished all prerequisite courses, and that continued employment would be contingent upon graduating from paramedic school and getting licensed? Otherwise, you'll end up with drop-out partners. Those that couldn't hack it, or were too eat up with working overtime and volunteering that they drop out and stay EMTs forever.

[cosgrojo]

The doctors will be on a first name basis with the medics, the medics will work only 36 hours a week (Average) scheduled with 4 hours clinical time (rounds, OR time, lectures, labs , PR, PAD/CPR classes, or teaching) every two weeks. Since there is a huge educational burden on this system at all levels, there is always someone needing teaching . In the unlikely event there is to many medics to do all the tasks, they will be tasked with following up on patients and assisting in research.

Full time education department with all CE and training provided. No minimum 48 hours per two years and some class-in-a-can refresher course. There will be so much documented education in so many venues, the only hassle about recertification will be writing it all down. In addition, exceptional employees and specialty teams will go to national conferences to bring back the latest. The education department will also be the hub agency for all research in the area for EMS.

Not only is this a fantastic idea... I'm curious if this is the norm anywhere? This is a completely foreign idea to the region I work in. Any truly good system would be clearly improved by a concept like this.

I have often read people describe the tiered response system, and in all honesty I don't have many examples in the area I work in (primarily rural in nature). But in coming to an understanding of what it is, I feel that this system would also be appropriate for rural areas as well.

Great post! Thank you! Very comprehensive in nature, I hope there are things people can add on to.