MadMod

We looked at a special unit and equipping all trucks with the new powered Strykers....until we saw the cost involved. However, what will we pay when an employee hurts himself moving such a patient? We regularly now see patients in the 300 to 350 pound range. I fear that average weight will only continue to rise. The best advice I can give is call for help when needed, and get some type of patient mover or "slide board". We have one on every truck. When used correctly, they help getting the patient onto the cot. There's still the issue of lifting the cot up and into the unit. My crews regularly have to do the "four corners" method. Definitely watch your hands and feet. We had an EMT-Basic have a cot with a 450 pound patient roll over and break his foot.

Actually, there are mobile X-ray machines. There are companies that provide this service to nursing homes and what-not. Unfortunately, the equipment takes up the back of a Ford E-350 van. Years from now we will look back and wonder how we ever got by without all the small sized equipment. We still have an old Data-Scope monitor we hang onto as a collectors piece and to show new Paramedics so they'll quit whining about the weight of the LP-12. Dispatch diagnosisng over the phone will always have one major variable: the caller. Either the caller doesn't understand the urgency or lack of during a call, or they "don't want to be a bother." They will get confused or led by the call taker. Those of you who use a priority dispatch type system: think about how many times you get dispatched to a resp distress or chest pain call only to find something completely different. I think it's mainly because the question is asked if the patient is having trouble breathing. "Why come to think of it, I am breathing a bit fast" or "you know, mother does look like she is". "Are you having chest pain?" "Holy crap, I am!" People in a time of "crisis" can be easily led. And even though WE know it's not a crisis, the caller doesn't. No matter how minor the emergency is, to the caller it's the single greatest focused moment of their life to date. Systems based on statistics mean someone will make a mistake one day. If 95% of the time the system correctly identifies the problem, 5% are going to have a day that's just getting worse. Ask yourself this: does your dispatch center "grade" their calls? Now, do they "grade" on if what was dispatched what was really found? I'll go on a limb and say no. I suggested this in a staff meeting one day. You would think I also suggested giving the employees a 100% raise and that they no longer had to wear uniforms. We place all our faith in we're right, we don't want to know the ugly truth. One thing that bothers me about the original idea of this thread, some private company will be competing with the EMS provider for revenue. We generate by transporting, they by assessing and refering. Any guesses who will be cheaper up front? Somebody is still going to get charged. This may hurt the local EMS in the long run. If you start "reserving" the EMS for the "real" calls only and turf everything else to this company and a contracted private transportation company, you just gave the local city or government good excuse to hire a couple of more FD guys and some really cool ambulances. After all, an EMS company would be seen as a waste or a duplication of services since the firefighters are just waiting for a call.

Someplace called Manatee County used too. Also, check out Sunstar EMS.

We have the problem of a shortage here at the service I work for. Various reasons, but almost all go back to money. Due to the demand for paramedics, the EMS community pushed for and successfully got the programs to reduce the hours of the course. We are being picked off by a city FD/EMS 25 miles up the road that offers more pay and benefits than we can offer. They are taking our best and brightest, leaving on my shift the most experience paramedics having a grand total of 2 years as a paramedic. This includes the fact that they went straight from EMT-Basic to Paramedic without any Basic work experience. It's a slow bleed, yet proving to be a serious one. We offer to pay for Basics to go to Paramedic school. They apply, we pick and make them sign a contract promising 4 years of return service. This year, one taker. The 4 others we offered it too refused. Keeping their options open for the boys up the road. Dustdevil wrote: This is an excellent point. Fire departments live and die by the ISO board. These are the people that rate the FD and assigns a number. The lower the number, the more people save on their fire insurance. I have long though that if EMS had a similar independent rating board that evaluated the entire system from dispatch to EMS to ER and gave a number that would affect a persons health insurance premiums, you would see peolpe beating down City Halls' door demanding the best people and equipment. At a city budget meeting, or as I like to call it "the Beating and Fleecing", I had a councilman tell me that. He made the statement of "too bad you guy's don't effect my (health) insurance like fire does my home insurance. I'd back you fully then." We asked (begged) for money to replace 2 ambulances with 300,000 miles. Instead, the city opted for a new 400,000 fire pumper because in 2 years the FD was going to try for a 3 (from a 4). This was the pressing issue in public safety. By the way, they were replacing a pumper that was 5 years old, had 5000 miles and 150 hours on the pump (and before anyone says anything, here we had the option of being considered a part of the public safety. Big step up for us from being beaten in the Budget Wars by Animal Control and Meals on Wheels.) So if we could get more money to offer, the more we could keep. And don't get me started about the retirement differences.[/font:d0288717d0]

Possibly a horrible misuse of the new CPR rules for Bystanders not Health Care Providers? Laymen no longer have to check for a pulse. Maybe the staff got the wrong tape?

In the state and service I work for: The Paramedic is in charge. Deal with it. Why? Because the State's Department of Health Divsion of EMS said so. End of story. If the state discovered a EMT Basic was not operating under the direction of a Paramedic (taking directions or orders) on a licensed ALS rig the service would be fined $7000.00 per incident and we could lose our service license. The medical director would be fined $7000.00 per incident and lose his Dr. license. The Paramedic could be decertified. The state considers the Paramedic as the highest trained person in charge of patient care and the one legally in charge. There has to be a chain of command. I run a shift in an Advanced Life Support Service. We run a service in which each rig is staffed by a Paramedic and an EMT-Basic. We encourage our EMT-Basic's to operate to the fullest extent of what our protocols say they can. However, they still have to let the Paramedic know what they're doing. Why? Good teamwork and more importantly, good patient care. Nurses still have to tell the doctor what they have done even if the doctor trusts them completely. We require it because ALL actions have to be time stamped by the Paramedic in the documentation. Our quality control does random sampling of patient care reports (PCR's) and the initial impression reports of the ER nurses. We check to see if what our Paramedics report matches what the nurses report we bring in. Good quality control. Therefore, the EMT-Basic MUST tell the Paramedic if for nothing else proper documentation. If the Paramedic doesn't want the EMT-Basic to do something, since he/she is legally in charge, he/she can tell the EMT-Basic not to do it. The state will hammer the Paramedic if the EMT-Basic messes up. Mostly from what I see it's a matter of a crew being a team and being able to trust one another. This takes time and work from both parties. Even when we staff two Paramedics on a rig, one is the senior Paramedic in charge. As for stories of Paramedics being abusive to the EMT-Basic, that appears to be an example of a hostile workplace. Also, poor management of the field crews. That behavior cannot be tolerated. This appears to be a situation in which one holds authority over another and abuses it. you will find this in all job field and the military. We do not tolerate it. But it goes both ways. I cannot be abusive to my shift. I cannot brow beat my crews simply because I want too. We have let our share of EMT-Basics, Paramedics and 1 supervisor go because they were not willing to conform to our rules, procedures, and policies. I have often wondered if the pill would have been easier to swallow if the terms were EMT-Basic, Intermediate, and Advanced. That clearly sets apart the resposiblities of each. I had an EMT-Basic on shift that felt he could do whatever he wanted as long as it was within his scope. He constantly complained about the Paramedics he worked with. He constantly refused to work with people; or to have his partner changed in the middle of the shift. He would "write up" paramedics about their treatment of patients (ronically, this was his biggest mistake. Because the Medical Director (a doctor) had to review the calls in question and concluded that the EMT-Basic was wrong. His choice of treatment would have caused potential harm to the patient. Always take time to consider how deep the water is before you plung in) We eventuately terminated his employment for insubordination due to the fact he would not follow our policies and procedures.

Really did this. Wasn't even thinking about it when I did: el box-o of condoms ($4.50) 1 package of zip ties ($2.99) 1 roll of tape ($1.00) A paint brush ($2.00) A can of dog food ($0.95) 1 box of tampons ($4.00) Look on the clerks face - priceless Look on my wife's face when she realized what the clerk was thinking - absestinance

Okay, well then just ignore this thread please. My bad.

The problem will always be with upper management and government leaders. How many times have you heard "do it faster and cheaper with less"? Management tends to always see it as a "bottom-line" issue. Money turns the world, not "ideology". To help people is noble. To help people while charging the maximum allowed amount is good business. They don't want highly educated medics because one day they might join a union or something and demand more pay. Like nursing. They would prefer moderately educated medics, they're cheaper. Plus, it's still a circular logic argument. If they get more medics to man more units, they then argue that the system is "diluted" with medics. Therefore, there are so many available we don't have a shortage, so we don't have to pay 'em so much.

Has anyone using the new CPR updates noticed any changes in survival rates? I'm not talking about studies. I'm talkng about actual hands on experience. Note: Our service rates a "save" as one where the patient goes from prehospital arrest to pulses and perfusion and makes it up to the critical care unit. I personally disagree with this view. I think it should be they make it home long enough to refuse to pay the bill.

Unfortunately, most areas will state that there is a "paramedic shortage". I work in one such area. There are many reasons for this, mainly the low pay versus the high work load. But also, management tends to use circular logic with this problem (mostly to their advantage). Example: we have a high call volume. This results in a high work load per unit because there's not enough units. But we can't fill the trucks because there's not enough medics. There's not enough medics because of the low pay and high work load. And without enough trucks, we lose out on transfers, therefore there's not enough money for pay raises and to hire more medics. But there's a high work load because there's not enough medics for the units... And so on and so on. Upper management will spend hours discussing this, but not working towards solving it. Our administrator came to the decision that the true problem lies in the fact the local paramedic program took 2 years to complete. This was because they were trying to teach excellence. He stated (in many meetings), we don't need excellence. We need a breathing patch-holder that can read the protocol book and show up on time. Goal number one: just try. That's all anyone expects. He successfully lobbied this position to the other surrounding services. They then proceeded to convince the college board to lower the level of teaching or they would find somewhere else. So the college forced the program to go from 2 years to 10 months. And they were very unhappy with the 10 months. They wanted a start to finish time of 6 months. Now we have new medics that are churned out with lower skill levels than every before. Most I wouldn't even characterize as "technical", just as what was wanted: "breathing".

We live in a wonderful country. We have this great and wonderful Constitution that gives ALL of us the RIGHT to free speech. You can say whatever you want without fear of being arrested or placed in "house arrest" until you agree to stop saying what the government or religious leaders want you to. Never forget that. You have the right to disagree with the game. You have the right to agree with the game. You have the right to make the game. You have the right to play the game. You have the right to ignore the game. You have the right to talk about the game in a forum site without fear of punishment. Rock on, my friends. Continue with your opinions whether you agree or disagree. But continue to give your opinions and NEVER let anyone take that wonderful RIGHT away from you!

Having been in the budget process between the service, the municipalities, and the county, I can say in my experience the powers that be and the public do not care about education. All the budgeting powers are concerned with is how much it costs. I have sat threw meetings where the cities say "well, let's just lower the level of service; after all, your job is really just to drive them to the hospital". Why? Because it costs money. And the public doesn't want to pay anymore taxes. Does the rating of the EMS save them money on their insurance like the fire service does? No. Does EMS protect their homes and property like law enforcement? No. If the educational level of all the personnel at the EMS would save them in health insurance premiums and lower their deductibles, people would line up to fund EMS. If, like the fire service, we had a scale where 10 was no service and 1 was the best, and people saw a saving, we'd be in the zone. Why do you think a small town buys a $800,000 ladder truck they only use 5 times a year. Because, the mayor and the fire chief can argue, with this ladder, our ISO goes from a 5 to a 4 and you save $X.XX next year. "How much do I save if we buy and staff 4 ambulances?" None. Plus we bill you. We don't save people money and everyone thinks they'll never need an ambulance. Having dealt with state level interactions with nursing boards and groups, they will prevent any increased acceptance of EMS training. Some of the major nursing groups advocate returning EMS to a specialty field of nursing "where it belongs". EMS is not a widely unionized organization with national lobbying power. That will always hamper the progress and advancement of EMS. We are being sabotaged and we never know it. What everyone needs is a good wake up call.

There is a difference between low pay and substandard pay. The issue will resolve itself because the EMS personnel will leave the field. Dedication does not make the house payment. Dedication does not feed the children. Many will tell you with your education "you should be a nurse".

xcix brings up an excellent point. What are the crews making now versus what the cost of living rate is? What are the other services getting paid around them? What are other AMR divisions getting paid? This turns into a situation where your service workers can't afford to live where they work. And with gas prices the way they are, commuting is a painful process also. If their grossly underpaid, they are more likely to be pushed into corners. And before anyone says "then they should just pick up and move". Try it. It's not that easy to do. Workers have rights. Allowing the company to do what it can to fire the employees is illegal by federal law. If you allow that, what stops the company from deciding they don't want to pay you overtime? The company could then argue you have a responsibility to stay and work another 24. They could call you up on your day off and say we need you to come in and work, it's your responsibility. Responsibility does not feed your children. You have to take a stand somewhere. Unfortunately, years ago many tried to get EMS out of the public safety spectrum and into the private medical/transportation field. Because you're not a part of public safety, then you're not considered vital to the community. Thus, if the employees are dissatisfied and vote to strike (which is their right), then so be it. I have dealt in these issues for years. If they strike, what you will see is management officials and "office personnel" (training officers, supervisors, etc.) start running on the ambulances. They'll bring in people from other divisions to fill in (remember, AMR is the nation's largest EMS company). And then they'll get tired of it. And nothing pushes management back to the table faster than having to work out in the heat. Except having to work in the heat and not want to. The sad fact is the situation is being pushed into the strike. That means both sides are at an impasse. Time for the federal mediation board to come in.