chazmedic

Time to fess up. What are the stupidest things you've said on calls? I'll go first: I walked up to a multiple gunshot victim lying in a pool of blood in the middle of the road and in trying to assess his LOC's actually said: "So, tell me what's going on today?" :?

I had an athletic trainer one time say to me at a football game: "I'd say he's got a second degree concussion with bruising." I responded without thinking: "Wow, I usually have to take them to the ER to learn that." Lots of paperwork.

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Actually, Beagle is right. The EMS, FD, and PD have all done surveys on response times. The city has had 2 studies conducted in regards to response times for the PUM process. The 43 second rule has never really applied in Northwest Arkansas. It is more like 2 minutes in time saved. This is not exceeding the speed limit by 15 mph as conditions warrant. This is accordance to state law. When we went to Priority Dispatch with EMS, the city about had a stroke over the 2 minute time difference between hot (L&S) and cold (no L&S). In fact, as a result, we were told at Fire we had to respond to all calls hot (EMS is a private nonprofit company here, I work for both). We have since got a new chief and dropped this rule. Each area is different. Little Rock, which has a larger population and more traffic, the 43 second number does hold truth. People here do actually pull over for a L&S vehicle. However, the city we are in does not allow any POV's with L&S to respond, except for the detectives (not really POV's, yet unmarked). EMS has strict rules to responding. I can have my driver sent home if he is driving in what I feel to be a dangerous manner. I usually do not let my driver go over the speed limit. We are not supposed to drive 5 miles over in the fire truck. The cops are the most dangerous. They are little land rockets. As to the idea of a trauma doc on scene, our ER docs all say the same thing: "see you in the ER". Trauma requires getting the patient to the ER quickly and safely. Research that is being done with the armed forces in Iraq seems to be supporting the idea of aggressive ALS and PHTLS care with limited scene times and rapid transport with the care continuing while en route. However, limiting your scene time is probably easier when being shot at. If the doc was actually in the ambulance maybe things would be different.

Dustdevil wrote: Nope, none, zip, nada. The hospital's closed. The ALS services have long bugged out for lack of funding. This county is like most in the area with a jail so big, most of it's vacate 'cause they can't afford the jailers.No water department, private company. Street pavers are private bids, teachers are by millage/property taxes collected by the state. Dog catcher is a sheriff deputy (ever seen a handcuffed dog?) Lawn mowers, car detailers, dispatchers, school bus drivers - all prisoners. Seriously folks, I just flew in and boy, are my arms tired. :wink: The people are thinking about a ambulance district tax to support the EMS. Remember, this isn't a urban area, but a rural area of around 15,000 to 30,000 people spread out over a couple of hundred square miles. Getting people to pay for the the service is the problem. But, the most they will be able to afford is a BLS system. Fortunately, there are two helicopter services within 10 minutes flight time for serious and critical calls. Arkansas is strange in that there is a large group of people that are totally against all taxes. They usually go after property taxes. They have tried to close schools, libraries, and public hospitals in the past. They actually filed a lawsuit to require 10 counties to sell off the non profit county hospitals and refund the money. Talking to these people is scary. They are the example of the 80/20 rule. 80 percent wants the remaining 20 percent to pay for it. To the 80 percent, the roads pave themselves. Bridges magically repair themselves.

Exactly, thanks to the new laws, it's all a gray area. Our policy is to turf to the supervisor. Works pretty good for us.

A job offer from the CIA. With an nice expense account.[/font:75983a24b7]

Beagle! Did ya see the crappy weekend I had?

Year and a half ago, my partner and I literally drove up on a guy who got shot and dumped out onto the street. We were actually en route to a different call and had to stop. He was laying out in the middle of the road with a crowd of bystanders around. The victim was talking when we first got there. Within a minute he was unconscious. The PD were very interested in what the victim said. The detective called me later that night and started asking me questions. He wanted to know if the patient had made any dieing statements, specifically if he ID'd the shooter. I put him on hold and called the Operations Captain. She quickly got back to me and said that anything the patient said that bystanders could have overheard is not protected information and could be repeated to the police. Anything he said in the back of the unit, out of public view, had to be subpoenaed.

Trust me, the area I am talking about does not have the money. This has been going on for 10 years. If the people refuse to pay, what can you do? Their hospital shut down 6 months ago and in today's paper their own lawyers are suing for payment.

Some areas simply cannot afford a staffed EMS crew. Low call volume, low tax base, low transfer ability. I know of a small town north of us that has had several ALS services come in, then pack up and leave in 6 months because they were not making money. The town purchased a used ambulance and put it in the vol FD. They try to pay EMT's to staff the unit 24 hours a day. The city FD I work for responds an engine to every EMS call to assist the medics with the patient. We provide BLS until the ALS unit arrives. The interesting thing is if we do not get dispatched, the medics usually request that we are dispatched to assist. We have a good working relationship and try to help each other out. And the majority of us do not want to take over EMS. We like it separate.

A couple of years ago I had a new EMT. We out left on a tone and he left some hot dogs boiling on the stove. I didn't know about it. One of our other employees drove up and saw the smoke rolling out of the station and called. That was a special report or two.

MEMS has been the PUM provider for Little Rock, North Little Rock, and a large chunk of central AR since 1984. They win the contract everytime it comes back up. According to sources, they have been in the "black" for about 5 years. According to employees of MEMS, they have dropped a lot of the street corner SSM for small stations around the city in the past few years. They are also expanding right now. They just got 2 good size cities and another county. But, they have a high turnover rate. Pay isn't that great either. A lot of guys leave for area fire departments like Jacksonville (which has ALS ambulances), North Little Rock, and Benton (which have paramedic rescue units). I wonder if MEMS is the big prize in end. Rural/Metro tried that a few years ago by setting up shop in White County.

[it isn't a public safety service. It is a medical service. It's a transportation service. But it is not a public safety service.] The city bus line is a transportation service. The taxi is a part of the transportation service. A dentist office is a medical service. This is why we are viewed as a taxi ride. The idea that we are not a part of the public safety network is why EMS is always left out. It has to present itself as a vital component of the public safety and trust. If you don't pull yourself up to the big table, you get lumped in at the kiddie table with the cable t.v. franchise, bus line, trash collection. This is what has happened where I work. Our subsidy (for the 911 ALS provider) comes from the same fund as the Meals on Wheels and the Literacy Program. We compete with 14 other non profits for a piece of the pie. Police and Fire funding comes from the General Fund, which is supplied with sales tax and property tax. Police and Fire split $12,000,000. EMS receives $150,000 if we can justify it (the Boys and Girls club gets more than we do). The total non profit funding is whatever is left over at the end of the budget process. We are now getting back to the big table by going PUM. We forced the discussion back to the front burner as presenting this issue as a public safety issue. And yes, a councilman asked "why can't they (the patients) just call a cab?"

Dispatch:"Respond to report of respiratory distress." Dispatch:"Further on your resp distress, this is going to be secondary to her husband currently choking her." Unit: "Do we need to stage for PD?" Dispatch: "Negative, we told her to tell her husband to stop. Continue in." Another one: Dispatch: "Unit --, you're responding to a male subject shot by another subject still on scene." Unit: "10-4, is PD on scene? Dispatch: "Negative, we've talked with the shooter and told him to unload the handgun. He said he would. Continue in."

It really doesn't matter anyway. We are to serve the public and assist those who request it. Ideally, we are all on the same team. We're all here to help. I work on both sides of the barrier because I like both EMS and Fire. We must remember that it's not about our personal satisfaction, it's about the patient. Rise above and serve. EMS is the youngest of the public safety services. So it's still not as recognized as police and fire. Each community makes the decision how we accomplish the goal.

A couple of years ago we had a brand new Freightliner ambulance catch on fire in the bay due to an electrical short. Very scary considering it was the same building with our dispatch inside.

What is some of the things they will do and what will they do with the employees? Pay, retirement, medical, etc.? :?

And since nobody needs the fire department, they simply transported the fire.

Can't spell PROBLEMS without EMS!

Dude, that was my first post on the subject. Second, "sarcasism is one of my many services provided". Third, I work two jobs, in one I drive a fire engine, the second, I ride in the back of the ambo as the paramedic so I hear it and say it.

Nobody likes the fire department until it's time to move the patient to the cot. In my area, the rush to leave EMS to fire service is exactly that: a rush. Right now, 7 out of 10 new EMT's are working in EMS only to get experience to get into the fire service. The medics are leaving to go to the ALS fire departments for 3 reasons: 1) better pay 2) job security 3) better retirement. EMS is a stepping stone. The of the 5 major cities in the area, 4 are FD EMS by choice of the city government to ensure a service that won't go bankrupt, leave in the middle of the night, or have the "emergency" ambulance tied up on a inter facility transfer. The remaining service is a 503c non profit that is having to switch to a public utility model because it can no longer maintain its financial stability. And NOBODY, citizen or politician, wants to raise taxes to save it. So it's either PUM or FD. It's all about money. EMS does not save property owners money on their insurance. FD does. Cities view EMS as a duplication of services. They want to combine it with the FD because they view it a money saving method.

Nobody needs the Fire Department around until it's time to put the patient on the cot and move to the ambulance. Then suddenly everyone "needs" the hose monkeys.

]"AMR is coming! AMR is coming!"[/color] :shock: That was the cry last week at the service I work at part-time. We are a 503c non-profit in the process of switching to a public utility model. We are about 1 year out from the whole thing going out "Request For Proposal" (the county judge doesn't want to bid) and we knew AMR was interested. This week they suddenly parked 4 ambulances and 2 wheelchair vans somewhere here in the county. Until this happened, AMR had NO assets in Arkansas. They lost the Tulsa/OK City PUM (EMSA) a few years ago. Rumor has it they are going to try to drive us out before the RFP so that there is no competition. We heard that they have a hostile takeover plan, a non-hostile plan, and a plan to simply drive you out. Has anyone been taken over, survived a takeover, driven out AMR? What are we in for?