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EMS as a Profession?

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Here is a hot topic for you – Should EMS be a profession? Some have even dubbed it EMS 2.o (originally coined by The Happy Medic according to the comments) as if the future is in the works and testing needs to be completed.

If you look around the EMS blogosphere you will see a lot of writing about it recently.

They are using a very broad brush to paint the picture of just some of the issues with Pre-Hospital care. Some of these guys/gals work in EMS and others in Fire based EMS. Either way, it matters! It matters because it is what we do.

I admit it; I like the EMS part of my job. I don’t like it as much as the Fire side of things but I came to terms a long time ago that EMS is a large part of my job.

I am not a Medic, still something I struggle with not doing but I don’t have any reason to now. I won’t get paid any extra for it because I am ranked. It would be a personal achievement, but it isn’t worth it to my family. I don’t see them enough already. Maybe down the road…someday.

I work in the Fire based EMS side of things (City w/ population 100k). I have worked in an EMS only system (RAA) which was actually part of a review by the NHS (.pdf doc here) and a hotbed for medics doing ride alongs to see how Richmond Ambulance Authority does it.

Back to EMS 2.0.

This is my thoughts on just one part of it after reading some of the posts…

  1. At what point in advancing more in-depth treatments, on scene surgical protocols, more advanced medicine treatments, and all around increase in skills will the Paramedics be required to go to longer schooling? This longer term in schooling might mean that many decide to go the route of a PA, Nurse Practitioner, or MD.
  2. At what point will this increase in overall medical knowledge require higher paying salaries?
  3. At what point will these increased salaries be realized as waste for taking nose bleeds (BS calls) to the hospitals?

One thing that a Battalion Chief I know (and all around philosophical being) always likes to bring up for discussions sake is the need for EMS prevention. Similar to the model of fire prevention, EMS prevention would educate people on when to call, what to call for, and what is an emergency.

This EMS prevention MIGHT decrease BS calls. It won’t stop them. The realization of a free ride to the hospital for people who can’t afford to pay the actual costs usually outweighs any education on whether or not it is a real emergency.

One other thing is prioritized dispatch and then some. The Richmond Ambulance Authority’s dispatchers are all Paramedics (who are/were field paramedics and know the job). This cuts down on the amount of ambulances running lights and sirens to calls. It doesn’t cut down on BS calls though, because the RAA bills for transports and also takes care of the majority of non-emergent transports in the Richmond area. The BS calls might be culled to transport agencies if you don’t do non-emergent transports.

What do you think?

Fire Chiefs and Statistics

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Some Fire Chiefs have devised a great way of showing success in their careers and within their departments. By altering the reporting criteria for call data they can manipulate the data. That data compared to former data (history) will show change. The problem is that by changing the criteria we aren’t comparing apples to apples anymore.

For example…

The prodigal department would more than likely show an increase in fires up until the post “America is Burning” era of the 70′s and 80′s. This steady increase was due to the increase in population and growth of cities and counties (more people and more houses = more chance of fires). The culmination of the report “America is Burning” was basically that this is going to increase until departments create fire prevention education. Through fire prevention education, firefighters have been able to save thousands of lives over the past 30 years by preventing fires.

Once we hit the bottom on preventing fires the decrease in fires leveled off. This created a problem for Fire Chiefs. All of that hard work that started 30 years ago with the beginning of fire prevention had paid off and had reached its limits on decreasing fires. I don’t mean that we should stop doing it, it has just done all it can do and as long as we continue on with fire prevention we will continue to stay where we are. That is a good thing.

I know that some of you are probably saying that we can do more in preventing fires and I agree. However, it is outside of the realm of the fire prevention education we all know. Think earlier detection, non combustible products and building construction, among others.

So here we are with Fire Chiefs trying to show how good they are and how good their department and fire prevention programs are and the fires aren’t decreasing. What is a Fire Chief to do? The answer that many of them found is to increase the loss criteria for structure fires. Whereas for the past 100 years the typical kitchen fire that burns the stove and cabinets above was a “structure fire” when reporting total fires is not included in those statistics anymore. If you raise the loss to say above $5000 or $20,000 to deam it a structure fire we have in fact removed many fires from the data. This in turn shows a decrease in fires. This type of thing is not done overnight. A Fire Chief might make the criteria go up a couple thousand dollars each year before meeting the goal amount.

These statistics are a problem within the fire service. This is a false sense of protection. These statistics have been used all across the globe to decrease staffing, apparatus, and stations.

The altering of criteria runs a lot deeper than the example I gave above. We see it in all facets of our jobs. Anywhere we can make things look different than they are to benefit the people holding the data it can be seen.

Response times is another big example of using statistics to show what “they” want it to show. Fire Chiefs and other administrators have found that by recording the on scene time for EMS calls works out a lot better than utilizing the much more exact “patient contact” time. Who are we kidding. On EMS calls we mark on scene when pulling up to the address, however how long does it take to get the gear and stretcher and take the elevator to the 21st floor to the patient. In reality, we should be utilizing both times. However, if we are only using one then the “patient contact” time should actually be the “on scene” time.

What do you all think?

Sparta Volunteer Ambulance Squad Loses Trucks in Fire

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The Sparta Volunteer Ambulance Squad lost 2 ambulances in a fire that swept through their apparatus bay. One other vehicle sustained damage. The estimates are that  the ambulances could cost $200,000 to replace…each.

At least one member was at the station at the time of the fire along with a yoga class. The member was quick to notify the class of the fire and get them out of the building. No one was injured.

The only other saving grace was that the squad’s third ambulance was out on a call at the time of the fire and was not involved in the fire.

Sparta police said today that their preliminary investigation showed that the fire started onboard one of the ambulances as an oxygen tank was being checked for pressure. There was lightning in the area around that time, prompting initial speculation that the stormy weather played a role, but authorities did not indicate any connection. Read the entire story here.

Erica Patrick / For the Daily Record

Erica Patrick / For the Daily Record

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It seems as though ambulance losses are becoming a daily event nowadays. Between accidents, fires, and being stolen the trucks have become an insurance nightmare. Unfortunately, most municipalities are self insured which means that they have to be repaired without any payoff from an insurance company. All of this does not help at all with the economic woes of today….but then again thankfully no one was hurt.