Help me convert Ruraltown EMS from volly to paid.

[CBEMT]

You publicise the fact there may be no ambulance and explain why, and all the blue hairs will demand you get paid and politicians will listen. So no patient care is lost.

LOL. Sorry dude, but I have to call BS on one of the must naive statements I've ever seen. Seriously. WTF.

So I walk into the town council, tell them what you said. Guess what happens? They stop paying what little they do now, sell the trucks and equipment, and call the local private and tell them that all calls are now theirs.

Since I am very familiar with this service (details end there), I can tell you exactly what will happen:

• *Nobody's pay or benefits will increase at all, because there is no such thing as raises.

*Most employees have no 911 experience at all. The ones that do,

*are moonlighting full-time firefighters, many with the usual medical skills and habits. The rest are, for the most part, trying to get on a fire department and are only working there to pay what bills their meager paychecks can.

*Patients with painful injuries such as fractures will suffer all the way to the hospital, because the trucks don't carry narcotics. Splinting equipment is limited to a few padded boards. Ice packs are rare.

*Seizure patients will continue to seize because no benzos are authorized (20mg of Versed is required by the state for a WMD kit, but this company does not authorize its use for any other purpose on penalty of termination.)

*STEMIs will be missed, because most ALS units carry LP-10s, and many of the company's providers with LP-12s are not trained to recognize patients needing them, or to acquire and interpret 12-lead ECGs.

*Patients with a wide variety of medical conditions will go untreated, because the ALS trucks do not carry several important medications that the state considers optional.

*Trucks will be pulled from town for nursing home calls and private transports.

*ETAs provided to town dispatchers by the company will be false (daily occurance and unwritten company policy).

*Cardiac arrest patients may not receive drugs for roughly half the transport to the hospital, because the company's trucks don't carry enough to run codes for that long.

*Patients requiring intubation may not get it, because the ET kits are incomplete (tube sizes provided: 6.0, 7.0, and 8.0).

*Unresponsive choking patients will not have FBAOs relieved, because McGill forceps are not carried.

*Supplies used on treat-and-release calls (ie diabetics treated with D50) cannot be replaced unless the truck returns to the primary base out beyond the city, and then only during weekday business hours. There are no extras carried onboard (ie, only 1 amp of D50 per truck).

But, hey- the town will have a paid service!

Since the alternative to said private- town-run full-time paid service- is raising taxes beyond what the residents consider already unreasonable, in an economic climate where the state has a half-billion dollar budget deficit, I can safely say I'd be laughed out of the room.

Or, we could stay where we are for now- paid-per-call- and gradually work our way towards improvement.

Guess which option has less suffering and dying citizens?

[spenac]

CBEMT I call complete BS on your statements. I have done this. I've been there, done that, and gotten the t-shirt.

No private service was willing to come into town. They could not ever see making a profit. City and county just have to suck it up and pay. One community I work with was complete volly in 2000, running one ambulance. Now they have 3 ambulances staffed 24 seven ALS paid all 24 at $18/hr paramedic and $13/hr basic. How? First the vollys went and talked till blue in the face, with no results. They then gave resignations. Then they contacted the newspapers and TV stations from all over the region. Reporters rushed in. Community members began calling council members, county officials etc. The government understands that they will never even break even. We now have 2 new ambulances. They are about remount another. Plans are in the works to purchase another new ambulance next budget year. When politicians are forced to face the people they are supposed to take care of they find a way.

If you are paid per call at least it is a step in right direction. But it needs to be pushed to the next step. There is only one volly service left in my area and it is no longer a complete volly service.

People need to get a backbone and do what is right. Right for the patient, right for the profession, and right for the paramedic.

[CBEMT]

*shrug* What can I say? Education funding, usually the last thing to go, was voted down in the last election IIRC. Since there is a "viable" zero-cost alternative, that's what they'll demand the town do. And the town will be more than happy to do it out of spite if nothing else, not knowing any better than the residents do what they're in for.

Moot point anyway- I'd be the only one talking. I'm literally the only person who's even mentioned the word paid or think it's a good idea. We'd need another thousand or so runs a year before anybody'd listen.

[spenac]

*shrug* What can I say? Education funding, usually the last thing to go, was voted down in the last election IIRC. Since there is a "viable" zero-cost alternative, that's what they'll demand the town do. And the town will be more than happy to do it out of spite if nothing else, not knowing any better than the residents do what they're in for.

Moot point anyway- I'd be the only one talking. I'm literally the only person who's even mentioned the word paid or think it's a good idea. We'd need another thousand or so runs a year before anybody'd listen.

I understand resistance. Some did walk away for a while when we went paid. As far as call numbers in my area we have several communitys with paid services with run counts under 400 per year. One service has less than 20 per year. How do we stay up on skills? We do clinicals and most also work with busier services also.

Am I anti volly? Yes, but I was a volly. I understand the feelings that people keep throwing out. I disagree with the statements some make about vollies being uneducated. Some of the best educated medics I know are vollies with the last volly service in my area. I think education and skill level really depend on the person not whether they are paid or not.

I see the need for many changes so that EMS moves forward.

I do apologize that if in my efforts to improve EMS I offend. I do not mean to offend, I really want to pull us all together to force change.

[letmesleep]

First of all spenac, don't apologize for trying to make a positive change in the world. Sometimes change itself can be offensive.

I'm going to make this statement based on my own opinion, and I'm sure after SKIMMING through this forum it's going to piss off quite a few people, but here it goes, and please read the whole thing before you bend yourself into a pretzel over it.

Is it really a difficult concept for anyone to grasp in this day and age that a FT/ paid crew is going to provide better care than a volly service? Think about this for a bit, a paid crew will need to staff the station so they can get their check. Because they are at the station response times will be more regulated, trucks will constantly be maintained as well as the station itself. Walk-in PTs will get immediate care instead of hitting the call box and waiting for a response from home.....yada, yada!

It isn't a matter of intelligents, or even education at this point, it's about insuring the response and better servicing the public. I always hear about "dedication" and helping people. If your are available 24/7 to respond to the public when they call, aren't you providing them with more sufficient care? I do this job to help too, but I'm sure as hell going to get paid for my time, shouldn't you?

[CBEMT]

I do apologize that if in my efforts to improve EMS I offend. I do not mean to offend, I really want to pull us all together to force change.

I'm not offended, I just think that you're stuck in this mindset that what you did can work in any department, anywhere, tomorrow. Which just isn't true.

[spenac]

I'm not offended, I just think that you're stuck in this mindset that what you did can work in any department, anywhere, tomorrow. Which just isn't true.

Well as long as we agree to disagree I guess that is progress.

[spenac]

So what have we seen? That any area can go paid. That it may be a gradual change over but with effort and change of priorities full time paid EMS can be a reality in any location.

[crotchitymedic1986]

1. At best, your income will be around the 100,000/year mark, so work within that budget to start (start part-time at pay per call instead of per hour).

2. Go to local industry for donations, explaining that when their worker is injured there may or may not be an ambulance to respond.

3. Do bake sales, CPR classes, car washes, spaghetti dinners, golf tournaments, photography packages, anything you can do to raise money and awareness.

4. There are federal grants for rural health care, pursue those (as well as all other grants).

5. Realize that if you got what you wanted tomorrow, your department would most likely cost more than any other department (unless you have a large jail) in your county, so you have to realize you cant get everything you want on day 1; but if you made it happen over 3 years would the community not be better off than if you just threw up your arms in frustration and walked away ?

6. Raising taxes is rarely the successful option, find ways that individuals can donate. Do you have that one guy in your community that has more money than god; what if his large donation meant that the ambulance service was named "James Doe Ambulance Service", or the station was named the James Doe Station. You would be amazed at what stroking someones pride can do for your bottom line (or what if the ambulance had "In partnership with ABC Industries" on it's side ?

There is a solution, but as always it will require alot of hard work. Are you the man for the job ? I think so. GO make it happen

Edited September 20, 2009 by crotchitymedic1986

[kohlerrf]

There is very good advice here and no need to recap it. 2 additional comments I have are that you might want to form a legal nonprofit organization. This allows you to use solicited donations for the expense of payroll, however with this comes an administrative load, including but not limited to selecting a board of directors, Bi-laws, monthly meetings, business plans, customer service issues, quarterly tax reporting, payroll insurance , workers compensation insurance, health insurance and benefits for employees and the list goes on. Remember, the list is not un-doable buy those that really want to be a paid service.

Secondly, in your quest, remember you are pushing a service on the towns people that expend energy to deny they will ever need and every politician knows this. What politician in his right mind would run on the platform of "I’m Joe Blow elect me and I will get you ambulances because one day soon you are going suffer a horrible fate and need one!" I had your ambition 20 years ago when I was volunteering in a similar setting, although a little bit more urban. I had a discussion with a public official “off line” in which he asked me the following ; What do I think would cause more public outrage but the community, The volunteer ambulance not responding one time to a house 2 blocks away or the communities household garbage not being picked up this week?

Lastly, as stated in another thread here, “If the town can get this service from volunteers for free now why do they have to pay someone to do it?”

I applaud you for your ambition and urge you to follow through with it. In the big picture it is a proven fact that a paid service is more economical and “on average” has a higher standard of care and is definitely the way to go!