Diazepam618

1. Piss poor medics that were thrown through a minimalistic half assed run course with piss poor preceptors.

2. Piss poor equipment, crappy protocols that do not address even the basics of patient care.

3. A Fire Department that places little emphasis on caring about the medical needs of the community.

4. Poor and minimally involved medical direction that is not current on evidence based medicine.

5. A city that has decreased faith in the department due to multiple political and racial scandals.

Need I continue????

The study did try to address the logistic issues, but many turned a blind eye and listened to a Fire Chief with no EMS background and one who had no interest in EMS. Add to that a time where medical direction was weak and with its own scandal, it all added up.

These folks are over worked in an undercaring system. I'm not sure it can be saved...................

Most of 1-5 sounds like opinions, rather than facts. I mean piss poor medics unless you ride out with each and every one of them how do you know?, as far as the equipment well thats just opinion, as far as the department placing little emphisis on the needs of the community, well that is upper level politics and mission statement type of stuff again opinion. Those are not fact evidence of why you , in my opinion don't like HFD.

Nice article I came across. Interesting article.

Shows that the UK provides better primary care than the US. So why are so many people under socialized medicine coming to the USA for care?

It's a long read, but the most important parts are in the first couple of paragraphs.

US performs poorly against UK and other developed countries in primary care

From: The British Journal of Healthcare Computing and Information Management | November 05, 2009

The UK has been ranked as having one of the best primary health care systems in the world in a survey by the leading US think tank the Commonwealth Fund and published online today in the journal Health Affairs [1].

The survey queried more than 10,000 primary care physicians in 11 developed countries: Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States).

Fifty-eight percent of primary care doctors in the US report their patients often have difficulty paying for medications and care, and half of US doctors spend substantial time dealing with restrictions insurance companies place on their patients’ care, according to findings from the 2009 Commonwealth Fund International Health Policy Survey published online today in the journal Health Affairs.

The majority (69%) of US doctors report that their practices do not have provisions for after-hours care, forcing patients to seek care in emergency departments (compared to 97% in the Netherlands and 89% in New Zealand and the UK that do have after hours care).

US doctors were also far less likely to use health information technology that helps reduce errors and improve care — only 46% of U.S. doctors use electronic medical records compared to 99% of doctors in the Netherlands and 97% of doctors in New Zealand and Norway.

The NHS was rated highly in a number of key areas including being the only country where the majority of doctors feel the quality of healthcare is improving.

The annual survey of international healthcare comparisons this year polled primary care doctors for their views on their health systems. The UK was rated top in several categories including:

improvements in quality over the past three years;

least likely to report long waiting times for patients referred for specialist care;

managing chronic conditions with specialist teams;

using financial incentives to reward doctors for good patient experience;

the use of patient satisfaction and experience data to improve services; and

the use of comparative data to review doctors’ clinical performance.

Speaking from Washington at the Commonwealth Fund’s 2009 international health symposium, Health Secretary Andy Burnham said: “This is an important moment for the NHS. The journey to overhaul the quality of care over the last ten years has paid off. Clinicians now say they are confident they are treating and caring for patients in ways that match the best healthcare systems in the world. The NHS is not perfect but it has moved from poor to good and I want to see it go from good to great on the next stage of the journey.

“Primary care services are at the heart of the NHS, preventing illness, managing disease and helping people live healthier lives. Most recently our GPs have been doing a fantastic job at the forefront of our response to the swine flu outbreak starting the vaccination programme.

“We will build on these great achievements, and focus on the challenge for the next decade – greater choice, more personalised and high quality care, taking the NHS from good to great.

“I would like today to pay tribute to the hard working NHS staff across the country and congratulate them for this magnificent achievement. This is a proud day for NHS staff and for the millions of patients they look after so well.”

During a three-day visit to Washington the Health Secretary will also be discussing key global health challenges such as the swine flu pandemic, the health effects of climate change and the shared challenge of obesity with his US counterpart and other opposite numbers.

The state of primary care in the US

"We spend far more than any of the other countries in the survey, yet a majority of US primary care doctors say their patients often can’t afford care, and a wide majority of primary care physicians don’t have advanced computer systems to access patient test results, anticipate and avoid medication errors, or support care for chronically ill patients," said Commonwealth Fund Senior Vice President Cathy Schoen, lead author of the article.

"The patient-centered chronic care model originated in the US, yet other countries are moving forward faster to support care teams including nurses, spending time with patients, and assuring access to after-hours. The study underscores the pressing need for national reforms to close the performance gap to improve outcomes and reduce costs."

The survey describes a US primary care system that is under stress and highlights areas where the US can learn from other countries. Notably, the US could look to improve by using financial incentives to improve quality and efficiency, expanding access to health care and simplifying insurance, expanding the use of health information technology to prevent medical errors, and using a medical home approach to primary care where patients have options for care at any time of day or night, teams of health care providers to manage conditions, and continuity of care.

Many of the areas in which the US lags would be addressed by proposed health reform legislation currently under consideration in Congress.

"Access barriers, lack of information, and inadequate financial support for preventive and chronic care undermine primary care doctors' efforts to provide timely, high quality care and put the US far behind what many other countries are able to achieve," said Commonwealth Fund President Karen Davis.

"Our weak primary care system puts patients at risk, and results in poorer health outcomes, and higher costs. The survey provides yet another reminder of the urgent need for reforms that make accessible, high-quality primary care a national priority."

Survey Highlights

Access and barriers to care

More than half of U.S. physicians (58%) report their patients often have difficulty paying for medications or other out-of-pocket costs, compared to between 5% and 37% in the other countries.

U.S. physicians are also 4 times or more as likely as physicians in some other countries—Australia, Netherlands, Sweden and the U.K.—to report major problems with the time they or their staff spend getting patients needed medication or treatment due to insurance coverage restrictions. About half (48%) of US physicians report this is a major problem, compared to just 6% in the UK.

Twenty-eight percent of US doctors report their patients often face long waits to see a specialist — a rate similar to that reported by Australian (35%) and UK (22%) physicians, the lowest rates in the survey. Three-quarters of Canadian and Italian physicians reported long waits.

After-hours care outside the emergency room

Most US primary care doctors say they have no arrangement for access to care after normal office hours except for directing patients to a hospital emergency room. Just 29% of US doctors report any arrangement for patients to see a doctor or nurse after hours, a drop from 40 percent in the 2006 Commonwealth Fund International Health Policy Survey.

In contrast, nearly all doctors in the Netherlands (97%), and large majorities in New Zealand (89%) and the UK (89%) report after-hours provision, as do more than three of four doctors in France (78%) and Italy (77%).

Health information technology

While nearly half (46%) of U.S. primary care doctors report using electronic medical records (EMRs) — up from 28% in 2006 — US primary care practices, along with Canadian doctors, continue to lag well behind other leading countries. EMRs are nearly universal in the Netherlands (99%), New Zealand (97%), the UK (96%), Australia (95%), Italy (94%), Norway (97%), and Sweden (94%).

In addition to basic EMRs, the survey asked about a range of 13 possible computer functions, including electronic medication prescribing and alerts for medication errors, ordering lab tests and viewing test results, and support and prompts for preventive care and follow-up care with patients.

Here country results varied widely, ranging from nearly all to half of doctors reporting at least nine of 14 possible computerized functions in New Zealand (92%), Australia (91%), the UK (89%), Italy (66%), and the Netherlands (54%), to one fourth or fewer practices in the U.S. (26%), Canada (14%), France (15%), and Norway (19%).

Notably, in the United States, advanced information capacity was concentrated in larger group practices and those affiliated with integrated care systems. In contrast, in the seven countries with near universal use of EMRs, there was little or no difference in advanced health information technology use by practice size. The authors note that in these countries national policies and standards have supported wide adoption of information technology in primary care practices.

Financial incentives to improve quality

Every country in the survey, to some degree, uses financial incentives to improve primary care, preventive care, or disease management. Primary care physicians in the US, however, are among the least likely to report that they receive financial incentives for quality improvement, such as bonuses for achieving high patient satisfaction ratings, increasing preventive care, use of teams, or managing patients with chronic disease or complex needs.

Only one-third of US physicians reported receiving any financial incentives for the six quality improvement measures in the survey. Rates were also low in Sweden and Norway. In contrast, significant majorities of doctors in the UK (89%), the Netherlands (81%), New Zealand (80%), Italy (70%) and Australia (65%) report some type of extra financial incentive or target support to improve primary care capacity.

Use of care teams and systems to care for patients with chronic illness

Teams that include health professionals such as nurses serve an important role in managing care, especially for chronic conditions. The survey results indicate that use of teams is widespread in Sweden (98%), the UK, (98%), the Netherlands (91%), Australia (88%), New Zealand (88%), Germany (73%) and Norway (73%). Use of teams was far less frequent in the United States (59%), Canada (52%), and France (11%) based on primary care physician reports.

Use of evidence-based guidelines for chronic disease was high in all countries for diabetes, asthma, and hypertension but notably lower for depression. Yet, providing written instructions for patients to manage care at home is not yet routine in any country — gaps exist in all. Only in Italy did more than half of physicians (63%) say they routinely provide written instructions to chronically ill patients for managing care at home.

Quality reporting and feedback

Many countries in the survey have also been investing in information on performance to provide incentive and benchmarks. The authors note that "information that peers have met with success is often instrumental to guide and drive innovation."

Asked about comparative information systems, doctors in the U.K. are most likely to routinely receive and review data on clinical outcomes (89%), followed by Sweden (71%), New Zealand (68%), and the Netherlands (65%). Less than half of doctors in other surveyed countries — including the US at 43% — report such reviews.

UK physicians (65%) were by far the most likely to report they receive data on how they compare to other practices and, along with Sweden and New Zealand doctors, the most likely to have information on patient experiences. Notably, US doctors lagged well behind these leading countries on feedback on both clinical quality and patient experiences.

Tracking medical errors

The study finds that half or more primary care doctors in Canada, France, Germany, Italy and the Netherlands report not yet having a process to identify "adverse events" and take action.

Just one in five U.S. primary care physicians say they have a process that works well to identify risks and take follow up actions; one third said they have no process. At 56 percent, UK physicians were most likely to say they have processes they think work well, followed by Sweden (41%), New Zealand (32%), and Australia (32%).

Looking across survey results, the authors conclude that national policies have been instrumental in the leading countries to achieve round-the-clock access, information systems, and advance primary care teams. They note that "overall, the survey highlights the lack of national policies focused on US primary care. Unless primary care practices are part of more integrated care systems, they are on their own facing multiple payers with uncoordinated policies."

Pressing need for US reforms

Following survey findings that point out lagging US performance, Commonwealth Fund President Karen Davis noted that key national reforms could make a significant difference by:

Covering everyone, with a set of benefits that emphasizes primary care and prevention and which remove financial barriers and support primary care physicians as well as their patients;

Providing financial incentives focused on value and health outcomes;

Supporting primary care practices and their capacity to serve as ― medical homes with 24-hour access, use of teams of health professionals, and continuity of care;

Accelerating the adoption and use of health information technology, including electronic medication prescribing to reduce risks of errors;

Simplifying insurance to reduce complexity and paperwork for doctors and their staff; and

Investing in information systems with quality reporting and feedback to spread improved care and safety.

Reference

1. Cathy Schoen, M.A., Robin Osborn, M.B.A., Michelle M. Doty, Ph.D., David Squires, Jordon Peugh, M.A., and Sandra Applebaum. A Survey of Primary Care Physicians in 11 Countries, 2009: Perspectives on Care, Costs, and Experiences. Health Affairs Web Exclusive, Nov. 4, 2009, w1171–w1183. The full article is available at: http://content.healthaffairs.org/cgi/content/abstract/

hlthaff.28.6.w1171

Further information

Further information on the study from The Commonwealth Fund, including an online charting tool using international health data, is available at:

http://www.commonwealthfund.org/Content/Publications/

In-the-Literature/2009/Nov/A-Survey-of-Primary-Care-Physicians.aspx

Well their not coming here to the US for medical care , as they are for the American Dream type of thing would be my guess.

The guys in the back of these ambulances are making over 100k a year.

first of all where are you from?, depending on the need of a company they still may hire you, however public employers will not, but a private may still. I know my surrounding are the private companies can;t get enough applicants.

This is a unfortunate situation, however very preventable with the use of a backer, I know my department has a backing policy in place, audible, code lights, and backer (which must be visable at all times) before any movement takes place.

Hopefully this will create a department policy and or the use of a civil suite may create such change.

It also often results in the inevitable problems of the treating agency looking for excuses to dump patients on the transporting service,

It's not an excuse if the patient doesn't require an ALS transport, plus it allows ALS resources to still be available and the patient still gets the needed transport to the hospital via BLS. I think everyone on this site can say that they are tierd of runing BS calls, and this system allows us to weed that out.

Yeah, busy with things like traffic control. They'd never interrupt that to jack up a fireman.

http://www.youtube.com/watch?v=1LC6oqLhbr0

Never say never.

Again I can say never will happen, this type of stuff happens in the midwest and orther messed up parts of the country, you know places were Toby Keith is king.

The problem with your premise is that you assume all ambulances, emts, paramedics, and systems are the same, and interchangeable.

Well as far as I know all medics in the US are directed by a medical director, don't really see the big deal between transfers and 911 as far as certs/ protocols, the only thing is that in some systems the privates do both or one, and the FD's do 911, and no tranfers. zi guess what it comes down to what you really want to do, if you want tranfers then work for a company that does transfers, and if you want 911 work for a company that does 911.

Everyone is right stealing is stealing and should not be tolerated, I just thought that the tax payers and public shouldn't take the hit for bogus incident.

What a waste of tax payer $$$, staging incidents and tying up medic units, so who cares he took a hundered dollars, don't put the public at risk buy wasting resources is my opinion.

I hear philly FD is hiring.

I too agree that transfers and 911 should not be seperate, and maybe in a perfect world they would not be. I can tell you that it wouldn't hurt me to pick up a medical chart, hook up some drips and go but where I work and live the privates do all the inter-facility stuff.

Atropine I will be the first to laugh when it does.

Never will, lol, I hope, CHP, and LAPD have other crimes too worry about than messing with a medic unit, these redneck troopers must be way bored or just crazy.

More trolling from the Troll Master.

Are you stupid, or just illiterate?

They're not private. Non-fire does not mean private.

What the hell is trolling, look old man I am just saying that maybe the trooper thought they were an easy target to pick on, and being out in the sticks he probably thought nobody would see him act that way let alone be recorded. I can say with 100 percent certainty that this would never happened to me or any of my crew members

1. Creek Nation isn't a private entity. It's technically a third service.

2. Traffic enforcement in So Cal is just different.

I guess your right about traffic enforcement, but I should change my post I mean CHP, would never pull over any of our medic units, but why is traffice enforcement so different.

I still think that if these medic had the same wages/union/ and or some public saftey type of authority, this thing would have played out very differntly. Just some pig trying to be tough.

Can't help and wonder that if they wern't a private ems unit that this would have happened in the first place, I mean LAPD wouldn't pull over any of our medic units.

these pigs are idiot's

Okay cool, cool, so with 5 mg of midazolam on board I would follow with benadryl of some other form of a anti-nausea specific med like zoran, have to say her vital signs seem stable, I would not be to worry with the ekg inturpetation at this point the only other thing I might do is put on a nasal cannula at 4lpm and transport, ofcourse I am about 5 minutes away from the er.

Okay so again, the scene is safe, is the patient in any acute distress ie; activley seizing, if not is she awake/alert, abc's vital signs are in order, if the patient can give a Hx get if not see what you can get from the frat house ho's, then basic ALS Iv, blood glucose, ekg, and O2 sat at the very least you have a line for transport just in case she starts to seize again.

The STFU doesn't mean anything on this site, and if you don't like the current wages wherever you work then GET OUT, plan and simple.

ofcourse this wouldn't pass, in this tough economic era nobody wants any more taxes.

I hope the creek nation sues the hell out iof this redneck trooper, too bad Johnny C wasn't around to take the OHP to court.

True. However, my 2400 sq. ft home cost me approx. $180,000.00 in NC. A comparable home in SoCal is approx. 750,000.00. It's all relative.

Why would you need 2400 sq ft to sleep?

You can make over 100k a year as a firefighter/medic