WestMetroMedic

I see Nec Fasc all of the time since my hospital has a Burn Center and Hyperbarics. Our Hyperbarics didnt get moved over when they moved the hospital 30 some years ago, so we have always had to drive patients 2 blocks to our HBO chamber, but come tomorrow, New HBO chamber on campus! Woot Woot! I have seen some very interesting manifestations of it in 5 years of working there, from simple feet, to significantly revised facial structures due to its incursion. I wear Gloves and apply copious amounts of bath blankets so I don't have to see or smell it.

Anti-Theft has always been in our trucks, and we have that cute little remote on the keyring until it gets completely destroyed but there is an obscured unlock button in a totally top secret location. Valid point on the standard key, but it is something that Police Departments have been doing for years. With most Police Departments, if you have one key, you have them all and in this age of AVL, one would have to know how to disable our locked transponder in order to disable it, so that isnt a huge concern. Our camera system is a 25ish day loop system that is always recording. 2 cameras sit above the rear view mirror to give a panoramic view, one sits above the passengers head and looks at the driver and the other is the rear view camera. The microphone for the system is located in an exterior cabinet, simply to verify that the siren was or wasn't running in the event of a collision. Our union forbade microphones on the interior. It is a much better system than DriveCam. The solid state warmers were the answer to problems that we had with our previous generation of warming pads. Previously, the ones with thermostats failed and caused the heat to become excessive. These new warmers have fixed that problem (so far). Ours are either on or off and they hit a set temperature and maintain. 45 Degree front seats make dynamic deployment much more tolerable. We got rid of our last street corner post 2 years ago, we have about 16 posting locations and even though you can go inside, you can escape an annoying partner with a comfortable cab. Although my record is 5 patients, I can only care for 1 high acuity patient and maybe 2 triagable patients. If you have 5 Patients, smart money says they are all going to triage. Often times it is from car accidents when there is an acute onset of the Neck Pain Plague. The dual bench seats also allow you to bring 3 supine patients. We looked at Type 1's, but with as much destruction as we unleash on our trucks and the quality of our roads, they weren't cost effective. We also had overhead clearance concerns with many of our hospitals canopies and garages.

I didnt really touch on many of the things we have always had in our trucks, but we do not buy a cookie cutter truck as they are built completely custom, nothing against standard designs as they work well for many people. Even a POS Wheeled Coach filled with Laminated wood is gonna run you $150 these days. Our county RFP'd it, and Road Rescue was the best price that met the RFP of the 7 bidders. I don't push paper, so my numbers are probably wrong, but our County and Hospital supports us correctly and gave us what we need to do our jobs in our specific environment. I don't properly capture how wonderful these trucks are, but they are more amazing than any Braun, Osage, AEV, Wheeled Coach, Crestliner or Horton that I have ever worked out of. We have always had great luck with Road Rescue, perhaps it is still some mutual hometown loyalty since they used to be made up here. The simplified switch panel was a huge improvement over that POS that Road Rescue used to put in their trucks, and many of their new trucks for other buyers are following in suit and using the same controls. 6' headroom was a new addition over our past 5'10", which really threw me for a loop when i tried to use my head to brace against movement the first time. They also offset the grab bar on the roof, which took some adaptation. We can't do the sliding harness seats as we often transport multiple (3/+) patients. Here are a couple things I forgot - The dual bench seats increase the price as you have to get a little more creative with cabinetry, btu they are a neccessity here as 4-7 patients is not unheard of to transport in one truck. Cab seats that recline to about 45 deg Dual Inverters, one for outlets, one for 4 Camera system, APX Radio, Toughbook MDC, DRS ePCR Tablet. We dont need outlets in each cabinet, they are only in 3 of them and 4 others in the module as we only really need that charge our Zoll, Bed Battery Charger, DRS Tablet battery charger, and SonoSite. We dont carry IV pumps or portable electric suction. Solid State heating pads in Cabinets Liquid Oxygen system with redundancy adapters for compressed tanks if needed Better "Rub Bars" on the exterior perimeter All cabinetry is Solid sheet metal, sprayed with a Rhino-Liner like coating, so no more cracks in Laminated steel, easy repair, easy clean, antimicrobial 2 inch reduced loading height, helpful with our topography Reinforced floors for anticipated addition of Stryker PowerLoad system All Vinyl flooring in Cab instead of Carpet "Short Bus" mirror on Passenger side fender panel Obscured keyless unlock button All fleet keyed the same Simplified enviromental controls Timer/Clock in rear (Suprisingly nice) There was a bunch on non-standard cabling done in our trucks to support our unique technology situation All Grab Bars are now yellow, compared to previous stainless. Makes it easier to direct drunks around. Are the new trucks perfect? Nope, bu tthey are the best we have ever had, and the best that any service in Minnesota has ever had.

We got a crap load of new trucks this year and i figure i am going to do a bit of bragging. Hennepin EMS is the 911 provider for most of Minneapolis and 14 other municipalities in Hennepin and Ramsey counties. Look us up on the internets at http://www.hennepinems.org or Hennepin EMS on Facebook. After deferring new ambulance purchases because of the economy, we nearly flipped our fleet this year with 23 new trucks delivered during Q1 and early Q2 of this year, and three more in october and the last truck getting replaced in Q3 of 2013. We continued to use Road Rescue Ultramedics as we have for many years which we bought through our local dealer, Everest in St. Paul. I think they clocked in at around $185,000 USD each. The biggest change was switching to Ford E450 gas engines from Ford E450 diesel engines. Much like many of you have experiences, with the amount of dynamic deployment that we do, we had a lot of heat related damage from idling as much as we do since our temps can range from -35 to 105 degrees farenheit. They use more gas, but the trucks are about half a ton lighter and you can replace the gas motors 3-4 times for the cost of one diesel motor. They added many new safety features to the exterior, most noticable being the flourescent yellow and blue chevrons across the entire rear of the truck. Many of our cops have noted they have to flip their sun visor down while following us because of the ridiculous conspicuity of the 3M reflective decaling. Also added was a directional stick on the rear, so we can reduce our emergency lighting on arrival at highway scenes, as the research is suggesting this may reduce accidents. We also got the wicked bright LED lighting. Many employees love the addition of the howler, which is a subwoofer attached to your siren that you can use to really get peoples attention. I am torn on this, because it can come off as much more rude than a regular siren and has a serious potention for abuse. At the end of the day, its cool. The guardian safety seat was added to our new trucks, which can adapt in to a child seat and then can also break down to a fully crash tested infant seat also. These are really cool, and they also add a four point seatbelt system for adults using the chair, which is much appreciated when compared the the safety factor of the standard lap belt. We initally had some ssues with them, but i guess when you buy $100,000 worth of safety seats, the manufacturer is very willing to work out issues with you. The interior of the module has a couple changes, but our modules have always been exceptionally functional. We have always had dual bench seats and that didnt change, but we did switch to LED interior lighting, which is soft, but crisp, adjustable and doesnt kick off much heat. We also moved the plenum off center so it didnt blow directly onto the patient anymore, but still kept of vent holes the size that allows us to run the bair hugger off of the domestic heat. In addition to adjusting the plenum off center, perhaps the most incredible addition, and one that can only be appreciated in cold climates, is the plenum was extended to the backboard cabinet, which means HEATED BACKBOARDS in the winter. I was shocked no one had come up with this before. The rest of the changes are creature comforts. There was a fluid dam added beween the module and the cab so snow melt can run into the cab and soak all of our stuff. We also got 110volt outlets added to the cab of the truck for laptops and umm... Hair dryers i guess. The passenger side of the module was extended four inches towards the ground allowing easier access to the truck for ambulatory patients. The backup camera is now viewable in the rear view mirror and can also be left on so you can see behind you. Velvac mirrors were also added and are a wonderful addition. We have always had a great fleet, but these are trucks that all of our neighboring services are envious of. There are plenty of pictures on our facebook page, but if anyone wants specific pictures, or has any opinions, let it begin.

Our structure is rather simplistic... White shirts and brown shirts. The sups wear white, because they are not covered in crap. But more seriously, we run strictly paramedics. When you start, you are on probation for the first six months and during that time, you responsibility level steadily increases. Our probies also wear a probationary badge and are not allowed to be union members which allows us to easily clean house if remedial training has not succeeded. After six months, you become a run of the mill medic with a couple exceptions. The majority of the new employees we hire come to us with a couple years of experience, but even with that, they still cannot work with someone who has less than one year of employment due to the little things they may have missed in their first six months. You also are not assigned a permanent shift until one year of employment. After you have gotten your full year in, you are the king of your domain, about half of our 135 shifts have two regular partners and the rest have 5ish regular partners. In the event of an incident that we start ICS, the senior medic is EMS command. There are a couple other things that come into play during the course of your day that revolve around senority, but for the most part everyone is an equal. Next up on the food chain is supervisors, which we have 13, which is where you begin wearing a white shirt. There is always a duty sup who answers supervisorish phone calls, responds to a very select group of calls and is available for whatever else. Each sup also has a specific responsibility that they manage such as QA, STEMI, stroke, MCI, supply chain, facilities, ePCR, fleet management, PR and scheduled events and more. Either way, they work about 40-60 hours a week. Our sups are required to have an associates degree, but most have their bachelors and a couple are working on their MBAs. Next is our operations manager, who obviously, manages our operations. After that is our department director who oversees operations, communications and education. Followed by a bunch of people in our hospital management.

Fire fighters are excellent force multipliers that perform the tasks you ask them to with adherence and ease. Perhaps that is my experience, where here in Minnesota, fire fighters and police officers are required to be first responders and many departments push for EMT Basic. do I think that fire is the correct celery method for ALS EMS? Absolutely not, but that is another conversation in and of itself and in no way means that I don't implicitly appreciate the fire service for the help we get from them. There are about 40 fire stations in my service area, 25 of which are full time stations and our max truck load is 18. There are many more of them and more well spread out than us making them ideal first responders only second to police. If one is so concerned about the patency of their airway, perhaps one should do a rock solid job of securing the tube and monitor continuous capnography. Professional first responders know what they are doing generally speaking. Sent from my DROID RAZR using Tapatalk 2

I waited 7 years to take ccemtp and I found it to be a remarkably difficult course, but the kick in the but the I really needed professionally. I don't do any critical care except further occasional hyperbaric trip across the street but still found much of the information valuable for my everyday practice, however I mainly took it tohelp push me into the research world. I also am ending my 6 year college hiatus this next fall and going back to finish the 3 semesters I have left on my bachelors. Sent from my DROID RAZR using Tapatalk 2

Maybe I am doing EMS the wrong way, but the patients privacy is my responsibility. Dicks exist. So do sheets and tarpaulins. My goal on a critical patient is 6 minutes of scene time. I have better things to worry about than some nosy nellies. If I don't, then perhaps I should make the patients privacy my obligation. Adapt, overcome, improvise. Sent from my DROID RAZR using Tapatalk 2

The gentlemans code clearly states that unless you served in the armed forces or have been to prison - no tattoos. Sent from my DROID RAZR using Tapatalk 2

my view is that out isn't the amount of resources you have available to you, but more of a safety issue. How many of us actually wear our seatbelt in the back of the truck? Its hard to do your job while wearing a seatbelt. I wear mine about 75% of the time and suspect I am one of about 5% of people who do and only because I saw a video of a friend of mine almost die when he was in an ambulance rollover. How many of your first responders step into the back of the truck and at first instinct reach for their belts? None. I love my first responders, but get them out of the truck a they are dangerous. Putting a vent is a truck that is already carrying an automatic CPR device virtually eliminates the need to leave your seat during a transport. There isn't any more complexity than that. The other advantage of a vent is that if it can do SIMV, then you can add BiPAP to your truck. I'm working on a research study proposal right now on that premise. CPAP is great but BiPAP is better. Duh. Sent from my DROID RAZR using Tapatalk 2

Generally speaking 35 miles or minutes is a good threshold for consideration of aeromedical. Helicopter flight time is 1/3 the drive time, which assuming you have a 35 min transport and the helicopter is activated immediately (and coming from the receiving area, as often, but not always, is the case), gives the helicopter 5 minutes to get airborne, 12 min to respond, 5 minutes of scene time and 12 minutes of flight time making it about a wash for time, but if you incorporate the factor of having two critcal care practicioners caring for a patient, the data supports an outcome (and more importantly, financial) benefit to aeromedical transport. Obviously situation drives the transport modality, but 35 is often the magic number. In my PSA, we are not allowed to use aeromedical unless it is outside of our urban interstate loop and it is a prolonged extrication situation and our supervisor approves it. I have never considered it in almost 5 years at my service even in 2 feet of snowy hell, but in my rural days, it was an excellent tool to have.

BLS, ALS1 and ALS2 are not the crew certification, but rather the medicare billing code. We run strictly dual medic als units but we bill based on the actual level of service we provide. ALS2 is an invasive airway treatment, 3 iv med doses or electrical intervention. BLS is an ambulance ride.

EMS - you call, we haul. In all reality, this year is kinda lame. Is it my calling? Who knows (i always kinda wanted to be an astronaut). Have i found something that consistently satiates my ADD? Yup. Am i proud of what i do and do i want to make it better? You bet your biffy.

The upper penninsula of michigan is the UP, and it is filled with 'yoopers. They are an odd bunch.

I think generally speaking, people are insured and they dont have a great functional understanding of how billing works. We as providers generally also know little more about billing than the patient. Its important to recognize why the bill we create is a rather arbitrary number based on actual remuneration from payors or the specific source of remuneration. Patients with private insurance have varying coverage among many other variables. If field providers collect the proper information and obtain their signatures, often times the patient shouldnt even receive a bill, perhaps only an explaination of benefits. We charge a flat fee at my service plus mileage. We have an easily accessable list of our billing rates and will discuss those charges with patients upon request. I also must be ready to explain why those numbers are crazy high and must account for the costs associated with running an EMS, but must also include the caveat that EMS treatment and transport generally reduces the overall cost of hospital courses enough to justify the expense as evidenced by OPALS. IIRC, our billing charges are apprimately $1100 for BLS, $1250 for ALS1, $1350 for both ALS2 and CPA treat/no trans, and $450 for diabetic treat/no trans plus $23/mile. Our charges are the lowest in our area but not far off. At the end of the day, we are operating a business and our job depends on revenue. This sucks, but thems the bricks.

I work currently as a single role 911 only paramedic for a county owned level I trauma center EMS that runs dual paramedic in 27 transport vehicles used by 135 paramedics serving about 800,000 residents and 1.2 mil people during the weekdays. Our last UHU i saw was 0.43 but we are working that down. I also am a Paid on-call firefighter in the 'burb i live in and am one of two medic we have of the 40ish firefighters we have. Other previous roles were Paramedic/emergency communications specialist EMT basic Not too bad for 9 years of doing this...

These are what we carry our narcs in. The taped thingy on the front is an RF ID tag that allows or storage cabinet to sense when it has been restowed. They work fine for us and the 3 vitals of morphine, 2 vials of versed and Ketamine vial we carry and are rather indestructible. Sent from my DROID RAZR using Tapatalk 2 Other pic that didn't come through on first post Sent from my DROID RAZR using Tapatalk 2

Well, I ran out of stupid phone games to play at work so I now migrate to lurker status here. I am a full time paramedic with Hennepin EMS in Minneapolis since 2008 and have never worked somewhere that I more implicitly love and and proud to work at. I spent 3 years working for Mayo Clinic's ambulance service and although I don't regret my time there, I am very glad to not be there anymore for my own mental health. I'm also a pretty apathetic volunteer firefighter in the suburb I live in. I spent most of February of this year in the DFW area taking my CCEMTP at Careflite and have nothing but wonderful things to say about that program and the educators they employ. my general goal is to take a reserved approach to EMS and make sure that we all know that we aren't the most important people in the world but still have a vital role and really try to have as much fun as possible while at work but when my 40 hours is up, work is over. Blah, blah, blah. Sent from my DROID RAZR using Tapatalk 2

The OPs cited study was completed at the hospital I work at and one of my medical directors is a principle on it. We have adjusted our protocol slightly since this study was published but contrary to what you might think from the results of the study, we are still using the KingLTS in our practice. About two years ago, we were given the mandate that the KingLTS was to be the only airway we use in cardiac arrest for the simple fact that, agree with it or not, paramedics are generally not the best at intubation based simply on the fact that we don't have the muscle memory to be great at it (we employ 135 medics and each medic sees 1300 patients yearly), we should really take the results of OPALS and numerous other studies to heart and make the airway as simple and mindless as possible and based on the emerging literature, the KingLTS was that device. as with any new product, testing of the product is paramount and based on this study and other findings at our service, the KingLTS is a decent airway, BUT it isn't prefect. Or new policy is to continue having our first responders place the KingLTS so that an airway is in place and the patient receives ventilation. A cardiac arrest patient will receive KingLTS therapy for 10 ish minutes while the majority of our cardiac arrest tasks are accomplished such as application of the LUCAS2, vascular access and initial airway management. After the brunt of tasks have been performed and med admin is the task at hand, we are then supposed to intubate our patient using a bougie seldinger method with the LUCAS2 running (which is actually very easy). I generally like this method as it allows paramedics to continue being paramedics and still allows for decent outcomes based on the evidence we currently have but I suspect you can expect followup studies based on or experiences. Sent from my DROID RAZR using Tapatalk 2