stcommodore

Ya'll are missing the point. Dynamic deployment means that units are out at specific posts and not tied down at a station during the shift. Having those units out on the road, ideally closer to expected call demand cuts down response time. It also cuts down on "out of chute" time that can be two or more min's coming out of a station.

Lets go back to the heart of the issue, are we willing to cut costs and save fuel at the risk of delaying response times?

It all breaks down to...in a busy something it can happen. Was it right? Probably not but we all know that there are times that you listen to the radio and hear unit after unit go out and know that if the rush doesn't stop we could all see something like this happen. In the area I work once you go "transport complete" a in county hospital that hospital is considered a location on the box cards that you can be dispatched from. Often times the dispatchers check to see if your ready to take the next call, but its not impossible that a southern unit transporting to a central hospital gets dispatched north, and before you know it miles and miles from its local. I know FDNY doesn't have set locations for stations but we all know that when volume gets as bad as that sounded then logic should dictate units relocate to cover areas from central locations.

Better control of the quality of care and providers. Take for example the county I work in. X County has aprox 25 separate ALS services that are independent squads separate from the hospital, fire dept, township, etc. There are 25 chief's, 25 medical directors, and a numerous amount of Paramedics that work in the county. While the county is also a Region that has overall control and reports to the state its still basically every kingdom for its own. You have Paramedics that work for 2,3,4, etc services and easily work up to 72 hours or more strait going from one department to another. Some do it for the love of the job, most though to make enough to get by. None of which is at all healthy! Now if this was a County Based service, be it hospital based, county controlled or whatever you would solve a lot of problems. -Central Purchasing for Supplies and Units -Units Staged/Staffing Levels based on demand and not a static system based on 20yrs of "this is how we have always done it" -Increased pay for EMT's/Medics because a central service could have better funding and many other reasons -Better control over work loads of the staff: A medic couldn't get away working 72 hours when it was one service, overtime may not decrease but you could control things better. NJ may not be perfect but don't blame the hospitals.

Thats probably the must uneducated thing you could say! Dynamic deployment is probably one of the most progressive means to respond to call volume and call location. Planning where you know the demand will be, covering large areas that are stripped of units with a unit in a central location and more are the best way to get care to a patient as quick as possible.

I typically spend about 30min checking the truck before a shift. That depends a lot on who was in the unit before me, did I work the shift before them, etc. Sometimes you put a little work into a unit and assuming your working with other good staff the truck should stay in shape for some time after that. If I'm working a 24, 36, etc on the same unit I'll only restock as the calls dictate. Typically after the truck check we'll wash it and get fuel if necessary. Today I'm working a station I'm not typically at and is staff 4 nights a week but some volly staff when they decide to show up. So the career staff know to take a little extra time to make sure everything is where it should be. I have a thing for a neat and minimally stocked IV tray so I have been known to spend a half hour on that alone on a bad day. I see no need for 5 22g's, 6 20g's, etc. We are not a very busy service and there is nothing worse then trying to pull an INT out of the tray and getting four other things all over the floor with it! Like everything in EMS this is situation dependent but we should all be in the habit of checking the unit at the start of a tour, and teaching this habit to new providers.

I'm glad I don't leave anywhere near the departments like this! Plenty of the squads in southeast pa have slow days where you might get 1-3 calls, heck thats probaby the average for some departments but they are staffed. Long gone are the days of responding from home like some silly volly fire house.

For every person that says something about a fear of "hypoxic drive" in EMS there are then that says it shouldn't change your treatment. I got the "you have this copd'er on a nrb" face from the nurse but like I said he was in obvious distress and I had him for maybe 15min and not 2 hours.

Breath Sounds:I heard maybe a crackle in the right middle lobe, but nothing drastic or dramatic enough to want to dictate treatment over. Needless to say the next sick respiratory call I had that shift got CPAP, etc. Maybe saying we learn from our mistakes is to harsh but we take away something from every call and patient and build on it for the next.

PT: 79 year old caucasian male Hx:MI, COPD, HTN, CHF Arrived to find the male perpherial cyanosis, resp distress, pt stated abdominal pain and diarrhea. FD on scene had the patient on NRB 15 LPM. Put him on the liter and to the ambulance. EKG-couldn't get a good tracing, looked sinus. 12 Lead-no luck with that either SP02 99% B/G 134. 20g IV Right Hand. Only other substantial physical findings:some crackles (nothing dramatic) in right lower lobe Total transport time 10min, on scene 7min. Doc said he suspected Pneumonia, was going with Bipap when I left. Thinking through treatments after the only thing I could have done different was throw in a neb. thoughts? comments? suggestions?

My ideal staffing if we are sticking to single tier response P/P Units in high acuity/high volume areas P/B Units in Lower Acuity/Lower volume areas Also, guys we all go to school longer and learn more so we make the big calls to me it sounds like your all afraid to do it!

doesn't sound like this board is very pro-union. I don't know what they are striking over but if we can't stand together in this profession we are all screwed.

the paramedic shortage is a myth

we all know where you stand on this issue and staffing so get off your soap box and come up with something new

My preceptors were one of the two best mentors I'ver ever had.

In a county with over 25 parmamedic providers its not uncommon to see a medic work at 2-3 squads. Is that simply because they love to work and want something to do? Or is it that they need the 2-3 jobs to make a good wage? If this county had a unified system and paid its staff the 50-70,000 much of the rest of the working population made then you would get more medics, and alot more improvements.

I don't believe in such a thing as a paramedic shortage. I believe systems aren't set up to use the providers properly and services haven't moved into the future in the paramedics comming out of school.

I was given two in school, eventually had a third after one didn't work out and moved to another. When I initally started preceptor A was nights and B was days so there platoon rotation worked well. By the end Preceptor A was back on rotating days/nights and Preceptor C switched platoons and ended up working oppsite of Preceptor A which made the end very intersting.

As I'm sure is normal our diverson policy says that during "Code Yellow" or "Code Red" status in the county that no diverson will be accepted. "Code Yellow" is used due to weather conditions or any abnormal increase in volume and is a recommendation to squads to prepare to bring in more crews, as well as arrangments to staff the 4 county MCI units. "Code Red" is used when the above or other large scale incident happens. The code status can be specific to North, Central, South or county wide. Additonal units should be staffed and squads should expect units to be relocated to cover the effected areas. I've been working on the EMS responce to terrorism program on LMS and it makes you think what our local hospitals surge capiblities are. Also, do we have secondary areas that can be used to treat, relocate, manage a massive amount of patient influx. On top of that do we have a system in place for mass population and or mass patient relocation? The hell with diverson, say due to weather related damage one of your hospitals must be evacuated have you thought at all the amount of resources it would take, where you would take people and how long it would take to do such a thing?

Good topic... I've been trying to teach EMT students that your inital notification should be short as in within 30 seconds the RN taking the call should know what they need because anything longer they really don't listen to. EX. Who you are, what you found, what you did, when you'll be there Calls to Medical Command you should introduce who you are/cert level and be clear as to what you want, and also find out who they are.

Tell us about yourself Where do you see yourself in 5 years What are your short term/long term goals What do you know about us Why did you apply to our department What would you do if you got in an argument with your partner What would you do if your partner did X wrong and wouldn't report it What are your strengths and weaknessess Tell us about your best/worst call Any questions for us... This has pretty much been the norm in what I've seen in recent interviews

It's called EMTALA, they can't close the front door so they try and block the back. Until society and abuse of Emergency services changes or EMTALA changes then this is our reality.

County is divided into "North", "Central" and "South" clusters. " Each has three hospitals, execpt "South" who has four including two trauma centers. No more then 50% of hospitals in each cluster can be on divert, one trauma center is in "south" and "central". Divert is for I believe 2 hours with 2 hours off before you can divert again, if more then the 50% try and divert then everybody is "forced open." We also have 'trauma only' which is what the busier trauma center(s) end up doing around the end of day shift when we hit them with 2-3 traumas to add to there day long back up.

I think this thread goes back to my "what do you bring into a call" thread. I did my paramedic field time in the area that the orignal poster is working in. They had an "A Box" and a "B Box" and for the clearly BS calls you would carry in your oxygen and the small box but for everything ALS you would bring the larger. Then for long and deep runs you take everything, the same applies for medics that ride calls in on BLS units. I don't run 20 calls a day, heck I'd love to run half that so I can't put myself in that place. But regardless of the system I hope we do the right thing for the patient.

Then tell me how you define or provide a text source that defines SSM.