Amhet1

My retardation now preceeds me :oops: At least you and I knew what I meant. Hey, at least I got the name right... and thats something that you really need to do when having sex. Um, I think thats a different thread...... disregard.

Damn! I brought this up Denver the other day another of my long-winded rants! 22 ambulances 500,000 people 150 sq miles I think Denver Fire said 44 fire trucks from 31 stations in 6 divisions not including DIA And then theres DIA..... 1 FT ambulance assigned with 5 personnel 27 fire apparatus (politically correct fire term) 87 personnel assigned WendyT is from that area and knows more about the situation than I do, but as she pointed out, there are a large number of privates that are riding the Denver Health gravy train. When DH is maxed out on 911 calls, they hand them off to the privates. I beleive I read that it was SouthMetro Fire than that has the best of all possible worlds... They have ALS ambulances and Action Care ambulance responds with them. If South Metro doesnt want the transport (boring BLS call that wont pay anyway), they let Action Care have it. The other little surprise I found out was that Northglenn and Platte Valley are the only CAAS certified providers in the Denver area..... and interestingly, there are only 5 (yes, 5) FD run EMS services with CAAS certification! Im too lazy to look right now, but I think I remember there are only about 300 services in the US that meet those standards. FMI: http://www.caas.org/ Oh and for the discussion at hand.... The President of the City Council probably needed that 6 years to get into a position that he could ensure a complete screwing of Denver Paramedics. And just think, LT, IF Denver Fire integrates Denver Paramedics, they can have an ambulance at every station and another 10 or 20 in reserve and increase their manning by at least another 300 people (crosstrained on fire too) and give them complete justification to bbuild another 10 stations and add another complete division with all the admin support staff and on and on and on.... and with that one change there will be no more unemployment in Denver. [/sarcasm] I would love to walk into a scene and announce myself as an EMT with Denver Housing Paramedics. :shrugs:

Looks like i need to spend more time looking at fly-over country

Thank you for your comments Wendy. My thoughts got a little heated as I formulating comments. My attempt was to compare the "government" services. THe privates are definitely needed to support the government service as the government cant support it. It kinda sucks looking at the issue from 1500 miles away but the internet does help. It also is a great help having someone with some first-hand knowledge! Thanks for your help!

I hope I didnt offend you with my comments. I was fully in tune with the sarcasm, but I had just got done with a post that had me rather irritated where there were a few people beleiving that EMS should ONLY be run by Fire...... I felt obligated to point out the "wonderful" EMS services provided by such departments as FDNY, LA, DC, Phili, and others.... We are both on the same page, and no offense was intended whatsoever! Actually, there were others on here I was hoping to push some buttons with because old basics like us have alot more to offer than some of these young whippersnapper hosedraggers.

SOOOOoooooooooooo typical..... one is charged with saving a life, the other is charged with saving a foundation..... and who gets paid more? I guess brawn is more valuable than brains :shrugs:

I was trying to be tactful..... :wink:

Hey Richard, no offense intended, but I would like to recommend a different term than to "advance" from EMT/Paramedic to FF.... When you want to move from EMS to Fire within the same department, a more appropriate term would be a "Lateral" move. "Advance" means to move UP in a department and moving from Medic to FF is definitely is NOT an advance. Id be more than a lil POed if a FF was making more than me as a Medic!

Surfbum wrote "And then he has the nerve to come down to the wildfires and shake our hands, and call us heros. Maybe if DoF was better funded, we wouldn't have lost 60 something homes!" At least ya'll saved the foundations. I also saw a comment about why cops call cops for back up and fire calls fire for backup.... When EMS needs backup who do we call? We call fire because the rest of our units are busy and theres a fire truck on every street corner (OK, i realize they sit around comfortable, air conditioned stations with cable, internet, kitchens and real beds, while we sit on streetcorners sucking deasel exhaust, but who's complaining) and there are few fires to fight. It is our own (EMS) fault that we don't have a union like the IAFF to tell our local governments that we have to have enough ambulances to respond to every 911 call i less than 9 minutes. It our own fault that we didnt say NO Paramedics on Fire Trucks. If we could have 9-minute coverage, fire could remain BLS. But unfortunately nobody cares that Denver has 22 ambulances to support 150 sq miles and half a million people. Denver Fire has twice that many vehicles and 6 times the staff(estimated)! Denver International Airport has an additional 27 trucks and 87 staff where EMS has 1 ambulance and a staff 5 total. So tell me, who's understaffed and who is really suffering. Public safety requires EMS in the best way for that community. But the community needs to KNOW what they are getting BEFORE they change their system. I have found NO documentation of a successful merger of Fire and EMS. There are far more reports similar to Philidelphia and DC Fire Departments. I dont blame the fire departments for poor EMS operations. Fire guys will always be fire guys and EMS is NOT Fire! As we see in this forum, there is and will always be anamosity between fire and EMS and that does not change when EMS is merged into Fire. That is a personnel issue, but there is an equally troubling problem that has been discussed here too.... Funding. Fire wants EMS to increase funding, but unfortunately, EMS loses out because the money is spent on more personnel, bigger fire trucks, and increased waste in overhead. Maybe its just the american way.... we put more into saving "stuff" (fire), and not enough into saving "lives" (EMS).

"Since we're tossing out shameless plugs, The University of Western Carolina has an Online Bachelors EMS degree with focus in Health Services Mgmt. or PreMed. " Thats excellent! I havent heard about that program, but I was looking specifically for BS EMS programs. Ill have to be sure and take a look at it. Yea Ms Wendy, We're leaving the sunny beachs of the FL Panhandle and headed for Denver at the end of the month! I was stationed at the AF Academy for 9 years and loved every minute of it! This will be a drastic change for my wife. She has lived her whole life here in the panhandle. Im really looking forward to getting back to the mountains! The only drawback is I really cant apply for much since I dont have a CO cert yet and I let my NR lapse. As it stands right now, Ill probably look for an admin job til I get certed then see about splitting time between QA and the street. My first choice would be Pridemark, but Denver Health would be OK for a while. I know DH is really suffering right now from manning shortages. Im trying to find more about that, but my initial impression is that they are trying to do too much with too few trucks. They are trying to cover half a million people and 150 sq miles with 22 peak load trucks..... IF they use peak load scheduling.... Anyway, theres a few reasons I like the "Pridemark way" is that the entire system is built on 2 things... patient satisfaction and quality. The other big thing is that they use the suite of Zoll software (The old Pinpoint). The entire program from dispatch/call-taking to billing is completely integrated. Even from the "street level", Pinpoint is obvious. The AVL/GPS saves crews from having to pull out mapbooks, etc to get to the call and monitors feed data directly to the ePCR. The other shamelees plug for Pridemark is that they are a beta center for testing the Pinpoint products.. if youre into that sorta thing =) Im going to look at the CO schools for an EMS program. Emergency Management isnt a bad idea, but Im looking more specifically for EMS management. EM is more broadbased, and most schools Ive looked at are more directed towards fire management.....

Im going to throw out a shameless plug for someone looking to advance their schooling and still stay within EMS.... There are a couple of BS and at least 1 MS program that I know of online. UofTx has an online BS EMS program. I dont recall if it requires paramedic or not. I have looked at the program at George Washington University which does NOT require a Paramedic certificate. http://www.gwumc.edu/healthsci/programs/ems_bs/ Mike Ward, Associate Professor and Director of the program has put together an excellent program! Take a look and see if it fits into your educational goals. When applying or getting more information, you will get access to the blackboard system and actually see what you'll be doing in one of the classes. The one major drawback is tuition..... $1600 a class (roughly). Personally, i will be applying to start in the fall of this year =) The Masters program is in Emergency Management with an emphysis in EMS Management. You can find more at the GWU website also. I could tell you more its already packed =/

I really cant comment much on your situation, but your quality guru should be able to pull up numbers from prior to ya'll being in the ER to now. If your crews are able to drop the patient directly on ya'll in the ER, there should be a significant differernce in drop times. If ya want to impress him (or look like a complete fool) ask him/her for a control chart showing drop times from prior to ya'll being in the ER to now. He should have that at his fingertips. You should have enough resources available to find similar information either on the web, or more likely, a few calls to the provincial EMS bigwigs. I know ya'll are lightyears ahead of us in training requirements, tho it sounds like protocols are similar. I was wondering if ya'll are watching the progress on our NEMSIS project? http://www.nemsis.org/ We are FINALLY getting a national standardized dataset for charting/quality/reporting. We have a long way to go to improving our EMS system, but this will be a good start for us. Once we have that operationalized, we can start getting standardized quality definitions! Right now we have each manager defining his own data such as when the clock starts and stops on responses. Wow, I only went off-topic once (I think)

Dang Marilyn, I would have to say that you seem the be the epitome of aggressive collections! My hat is off to you! Just for gee-whiz, have you ever tracked what it costs you or your service for all the time you have to put in to generate your level of reimbursement on a typical bill? (This question is for any billers out there willing to an old EMT a new trick) My other question has to do with the actual coding and billing going to Medicare and private insurances. (Mind you, this is coming from an old EMT that knows about as much of billing and coding as I do about performing an episotomy on llama's).... Last time I actually applied myself to learning Medicares rules, they just wanted the HCPCS code without all the ICD-9 and CPT codes. I know that AAA and others are pushing for some sort of ICD-9 system for EMS. Bear with me while I attempt to actually develop a cogent question or 2.... What is Medicare etal wanting on the HCFA 1500 in support of the HCPCS these days? I realize that what is valid today may not be tomorrow, and this question could generate a rather verbose answer.... But if you can, try and keep it simple for us slow folks In case that question wasnt as big a pain as I expect, heres another one. In ya'lls ventures into EMS billing, have you seen any trends in documentation that could make things easier for the billing side? The more I think about this, the more questions I come up with! How much of ya'lls workload is paper billed vs software? What software are you using now or used previously? What do you like/dislike about it?

Theres an easy one-word answer to her..... EMTALA :shock:

It is unclear what it is you are asking. Depending on what it is, I have 3 different responses. The easiest thing to do would be to give us a working thesis statement and we can build from there. By offloading area, are you talking about the design of the parking area/drop off for the ambulance and patient or (my personal guess) somewhere to take the patient within the ER to pass report and drop the patient (Sort of a triage/holding area)? I have seen some discussions on Google/NEMSMA about extended times at ERs because they couldnt transfer care to the ER staff. There were some times discussed where drop off would range from 30 minutes (quick) to an excess of over 2 hours! Because of those kind of drop times, members of the group came up with 3 options. An EMS/Fire service actually put a paramedic in the ER to accept the patients and get the rig back in service. This was tried for 2 months and the service found a dramatic decrease in drop times. This program was dropped because the ER started thinking that the PM was theirs to do with what they wanted. It ended up creating more animosity than it was worth. Another area found their drop times so bad that they went to the medical control board and had all of the hospital CEOs sign off that any times greater than 30 minutes waiting to hand off a patient to get the rig back in service would be billed to the hospital. They all agreed to it but I doubt the service ever got any money out of the hospital. The 3rd option, again approved by the hospitals, was that the ranking supervisor would had the option to call the CEO AT HOME when drop times were excessive. You would see how motivated the ER would become when the CEO is screaming over the phone at the shift supervisor of the ER. Not on topic, but an interesting side note.... There are some hospitals out there that have a habit of going on divert. In some of those cities, when one hospital goes on ER divert, they other hospitals do the same so they wont get an overload. Many services have made it clear that if more than 2 hospitals in the same city are on divert, the divert is null and void. This is frequently the call of the Comm Center. If you would a bit more on this and EMTALA, take a look at http://www.pwwemslaw.com/content.aspx?id=234 Keep us informed what direction you want to head it, Im sure you will find plenty of help from some of us "old guys".

"If you hang your BVM off the end of a King or secured ETT while you move your patient, you can be pretty sure the airway will still be patent when you pick the bag back up. Not so with an LMA." Excellent point. I hadnt considered that "twist" factor..... As far as the study I cited, it was the closest thing to support my point. I does show the minimal risk of gastric insufflation. That doesnt decrease any real risk of regurg tho. I do understand the concerns you all point out with using the LMA as a primary airway device. That said, i still have concerns with the studies Ive seen with 5-10% ET displacement/ misplacements. And as a basic, anything is better than nothing! I would have to say it looks like we all pretty much agree that this something that need further study. Im just glad to see that Univ Kansas (as opposed to the other UK) is working on research on it! If I were really smart, Id say theres alot more we could research, but Im not so I wont!

In my local area the preemployment test is to see if youre breathing. I am aware that Austin-Travis County has an extensive preemployment and predeployment program. The guys at Pridemark in Denver have about a half-day interview process to include 4 separate interviews covering various aspects of the business. You may not know for a few days or more if they are even going to offer you a position.

Rules? I dont need no stinkin rules! j/k, its just kinda cool the way the boxes layout in the comment area.... I dont think Id want to look at them too long while on drugs.

EMS Tax = Subsidies paid thru property tax, car registration, fines, etc. The theory is that EMS should be self-funding thru reimbursement.... If ya beleive that, look at the state of private providers..... even the big privates have a hard time making it without some sort of support. All you have to do is look at the mess Galveston has, or how many fire departments are getting into the EMS business. btw... what was the topic again?

So how many of these funky lil squares can you get in one comment box?

Speaking of flashbacks! The old 747's were the bomb! And ya, the Dyna Med boxes were about crap. Any of ya'll remember the old "SPARK Kit"? It weighed about 4 tons! I think it was popular in the hospitals for a lil while until they found out you couldnt just replace the contents.... you had to replace the entire thing! I dont remember why it was, but I think it was some sort of contract thing. I do remember all the Bristoject meds fit into compartments in the sides of the doors and it had 2 disposable ET blades.....

I guess I too was in a unique position at my last AF assignment. Just before I moved to that assignment there was a lightning strike on the flightline that hit 11 guys simultaneously. As a small outpatient clinic this became a mass casualty incident. At the time of the incident, the clinic has 3 LP5's. Because of the lack of capability, they ran out and got half a dozen LP300s and 3 additional LP5's... another occasion for overkill too late. Luckily, all of that equipment met its life expectancy and we got the opportunity to decide what we wanted to replace them. We invited Zoll, MRx, HP, and the Physio guys out to demonstrate their equipment for us. MRx had no interest whatsoever. Our "committee" was all of the Med Group IDMTs, the EMS crew, EMS OIC , Med Control Doc and myself (IDMT and NCOIC EMS). I was also the supply guy with some control of the budget =) I personally called MRx half a dozen times to the local rep and got no reply. Zoll showed some interest but missed our first appointment and the second time showed up but forgot half the stuff for the demonstration. Our rep from from Physio was very interested and bent over backwards to accomodate us. I talked to the HP rep one time. He told me in no uncertain terms that the HP contract with the AF required us to buy nothing but HP and told me what options I could get on the monitors. I said "thanks, Ill get back to you". We all got the opportunity to see the Zoll and play with it a little bit. We had 2 consistent complaints with it. The footprint was too large for our needs and the screen was too busy to keep things simple (all the colors were really pretty tho). I wasnt real excited about all the cables plugging into the top. The LP12 really met our needs better. We needed one real basic one for our dental clinic with just monitor/defib/AED. The rest we needed the basics, SpO2, EtCO2 and NiBP. 4 of them we got cell transmission for 12 lead. The last one had hardline 12lead for the ER crash cart. Under the GSA contract, I think we got them for about $12,000. Zoll quoted us close to $19,000 each. The Physio guy came out twice to provide real indepth training to our crew, all of our nurses, and third time to address our Pro staff. Everyone from the Group Commander on down were very happy and impressed.

Oh, so much fodder for a long verbose rant.... but i wont..... "Starting an ambulance company in Southern California. Anyone able to help me in what i should be charging for BLS service? having trouble finding info online. Any help would be great! Thanks." Option 1 is getting a big board, and throwing a dart at it and wherever it lands is what you can charge. Option 2 is see what other services are charging and figure out the estimated workload. From there you should be able to estimate a ballpark rate. From there calculate the cost of providing the service with vehicles, eqipment, staff, etc. From there you can calculate what the base rate would need to be based on your estimated workload. You also have to figure out if you want to do billing in-house, or outsource. Option 3 is estimated workload, payor mix and ballpark distances loaded. Figure out Medicare reimbursement and see if its really even feasable. Now back to the original reason for the topic.... What service A charges really has no bearing on what service B charges. The variables are so diverse that it would take a few pages to chronicle. An FD may charge $800, a volunteer service may charge $0. Both services may serve the same demographic and geographic area separated only by a governmental line on a map. (New tangent) A service can charge whatever they want to charge. This charge has absolutely no correlation to what they are reimbursed. The person above may decide to charge $800 for a BLS transport but in all actuality may find that when they get reimbursed, it will be more like $241 (or whatever the current rate Medicare is allowing. The drawback to $0 charge is that was part of the calculation used by Medicare to set reimbursement rates for EMS. Instead of looking at the average of the bills they get, they got figures from an array of services and pulled an average outa their collective butts and said "suck it up".

Heres a response that should push some buttons...... Calculate the entire cost of providing the service and divide that by all of the Cardiac Arrests that walk out of the Hospital with mental function intact (I think its defined as CPC Level 1). The answer is the real cost of providing the service. I use Cardiac Attest because that is the best defined standard we have going. ALS is supposed to provide 100% ROSC, mentation intact, and delivered with 8:59. Whether we staff one ambulance with volunteers, or 60+ ambulances with 2 or more fully qualified paramedics (or nurses, or docs), the expectation is that we will save every life. Thinking we have a save everytime our patient doesnt leave the hospital in a bodybag is rubbish. You may think that saving a multi-trauma or intubating the first time every time is a save, but its not. Those are meerly expectations of any ambulance. Any ambulance is expected to save the patient, minimize pain and suffering, and consoul the family, and that applies equally whether your population density is 2 people per square mile to 3000 sq/m. 95% of the patients we transport are treated and streeted (some before we can even get back in service). The other 5% end up in the OR, ICU, floor and luckily, only a few leave horizontally. Back to the point.... Is it really cost effective to provide 100% ALS to 100% of the US? Far from it. Is it cost effective to have ALS Fire and ALS Ambulance? Doubtful. (Withholding personal opinion) A case could be made that some level between full BLS and full ALS would meet the criteria necessary save more lives, be cost effective, and meet the communities needs and expectations.

Im going to toss out a shotgun blast and see if I hit anything. I found a 2005 memo from NPS discussing EMS within the parks. http://www.nps.gov/policy/DOrders/DO-51.html Of note, in section 4, there are these lil gems: 4.3.1 Assistance Agreements Superintendents may assist other agencies with emergencies that occur outside parks. Parks are encouraged to pursue written general agreements with such agencies where requests for assistance occur on a regular or frequent basis. NPS employees who are directed by their supervisors to provide emergency medical assistance to such agencies outside their area of jurisdiction will be considered to be acting within the scope of their employment. 4.3.2 EMS Needs Assessment The EMS Needs Assessment is the fundamental tool used in the development of a park's EMS program. Each superintendent must assess the emergency medical resources available to them, and ensure that their EMS program has been developed and maintained so that all persons have access to emergency medical care as per current standards. It is important that each park's EMS program be evaluated on a continuous basis and to make adjustments as necessary. The EMS Needs Assessment will be completed or updated by the Park EMS Coordinator and submitted every three years to the superintendent or designee. The Needs Assessment will conclude with a recommended level of service (Type I through Type VI) and justification. 4.3.3 EMS Plan Each superintendent will develop and maintain an EMS Plan to serve as their guideline for EMS. The EMS Plan may be independent or part of an over-arching document such as the park's Emergency Operations Plan. Where appropriate, the plan should address circumstances under which the park will recover the cost of services rendered. This tells me that the Superintendent of the Park was supposed to talk to someone in the community as have some sort of plans written, and especially some sort of mutual aid agreement. As far as rangers training and experience, I read somewhere that after their initial training, a ranger will spend an average of 3 months a year in recurring training. As I understand it, ranger training is close to the AF Pararescue where it takes around 17 months to complete the basic schools. At that point, they go off to their squadrons and spend the next 2 years getting fully qualified, and THEN they are considered operational. OK, as usual, I headed off on another of my tangents, but suffice it to say, the rangers have significant training.