Private EMS vs. Public EMS

[streetsurgeon]

yes i have worked for both.. at one times both at once.. and the differences are huge.. i don't even think i could begin to list.. does anyone have an opinion?

[Christopher.Collins]

I too have worked for both and currently have an interview for another private organization on Friday. I honestly have no preference. I like public because its more 9-1-1, but I like private because it can be a break from all 9-1-1. Also with private you may have access to equipment you dont with a public service; i.e barriatric equipment, which is a great reassurance if you dont have an pt info and arrive to find a morbidly obese patient, you know you can call the barriatric unit (if your not it). I will add that I gained alot of experience with 6 months in the private sector vs. 5 years in a quiet volunteer/public service. All thoes non-emergent transports gave me time to build confidence in talking to the person (which I completley lacked before) rather getting tunnel vision and just treating the patient.

[streetsurgeon]

with your private sector , did you have a lack of resources.. ie. lift assist.. for example..you are on the bari. truck and are dispatched for a 500lb pt.. and your partner is a 120lb soaking wet.. and you have to take multi steps.. are you lucky enough to get the extra hands or are you told to stand by for an hour and a half because all other units are tied up with discharges off the floor.. but it seems at times the private is more into making an extra buck , than to free up other units to save your back from lifting that 500lb pt. by yourself.

[Christopher.Collins]

Fortunatley here in Connecticut most agencies have a good relationship with the fire department... and even the ones that dont still pull it together on calls. Not to mention FD is usually EMS first responders and are automatically sent out. Even the large rural areas they still responded.

This is not to say I havnt been on calls where a couple extra hands would have been appreciated... and yes I have worked bariatrics with said 120lb 5'nothing partners lol.

As far as "treoging" calls goes Ive only had that problem once. I was working in your standard Type II rig with a partner that couldnt lift two stuffed animals on a pole (see Spongebob Squarepants). We had a pickup at a hospital to tx to a rehabilitaion facility for a recent injury he sustained... he wasnt morbidly obese but large enough that our rig and standard sized stryker may have been uncomfortable (because of his injury/surgery and size). The hospital was shocked that they didnt get a bariatric unit sent (weight and other factors are required to be given to dispatch for tx's). I consulted the patient (as politley as possible) and staff asking if they would both mind waiting about 35 minutes to have a more comfort accomodating unit sent out. They both agreed in appreciation. Dispatch flat out denied it. I know for a fact the unit was sitting at base the whole day and there were available crews to man it. So we wound up with the tx... my partner nearly dropped the damn stretcher, the pt was uncomfortable the entire trip (about 25-30 min)... and uppon arrival back at base the unit was still available.

Oh yea and the stretcher dropped down on my knee, fortunatley there has been no long term damage. I filed a complaint and it was thrown out. I could prove to this day that there was available man power in the crew room and the unit was in base the whole time... we didnt need lift assist, just someone to bring us the rig and take ours back ( something weve done many times and thus making both units still available).

[streetsurgeon]

sounds familiar.. the run you described was a typical day in the bari unit.. yes were in the bari truck at the time.. the answer was always the same... dispatch reports all units tied up wait till an hour after your shift and we will get some help there for you.. not to mention my partner was a 60 y.o. woman that would smoke more than a five alarm structre.. so you can see where that ended me up.. so to make a long story short.. the bari business so busy the rig went to a 24hr rotation and got me off of it.. but wait... when ever the crew needed hand for lift they got it asap.. ha ..

but as for fd response .. lol. in the area i worked , the private were the black sheep.. we would be starred at in the er or asked was kind of bs run did we transport .. ect. ect.. and not to mention we all hold the same certs. not to mention some of which were more educated.. so no help from fd.. at all. rather odd from some of the other private sectors that have fd first respond and ems would transport..

[JPINFV]

with your private sector , did you have a lack of resources.. ie. lift assist.. for example..you are on the bari. truck and are dispatched for a 500lb pt.. and your partner is a 120lb soaking wet.. and you have to take multi steps.. are you lucky enough to get the extra hands or are you told to stand by for an hour and a half because all other units are tied up with discharges off the floor.. but it seems at times the private is more into making an extra buck , than to free up other units to save your back from lifting that 500lb pt. by yourself.

Lucky enough? I hate to be a prick, but the company has zero choice in the matter. If I don't think that my crew or my equipment can handle a patient, then that patient doesn't get transported until either enough crew members or the proper equipment for a transport. That does mean that I had one patient which took 4 crews to transport which we almost refused because the patient was at the weight limit for our equipment (below it, but barely. If the hospital gave us a weight above our equipment's rated capacity, I would have refused transport). It didn't help that one crew member was 120 pounds soaking weight and the other had a non-work related shoulder injury. Yes, it took a while before we could assemble the full complement of people (it didn't help that the thrid crew [three were initially dispatched anyways] took their sweet time getting there), but that's why it's called a non-emergent transport.

As far as equipment, I was never missing anything that I needed, but there was things that would have been nice to have just in case.

[letmesleep]

I have definitely had a different experience with the Private sector having better access to equipment (back in the day).

My time with the Private sector was 4 years of getting a truck with your choice of brakes, steering, or air conditioning not a combo of any of these items, but only 1! I always went with the steering so I could aim that bastard truck at a brick wall if I needed too. Most of the trucks had well over 500,000 miles on them and were put together with duct tape and any kind of wire the mechanic could find. It was not uncommon to have very minimal floor boards up front, and you better plan on getting wet if it was raining outside. We did upgrade to LP10 from a LP5 while I was there, and that was only about 10years ago. We still carried those HUGE tackle box type drug boxes in, and the list goes on and on. Barri truck? HA! This was one of the "premiere" private services in this area, and in all fairness they have changed and upgraded their equipment a decade later. This service and the Other "BIG ONE" around here both spent more time trying to make the "All mighty dollar" than worrying about Pt care or their employees. Safety? HA!

I now work and have worked for the same tax based service for over 10 years, and will never look back. I do miss some of the calls and can never trade in my experiences with the private service, but good riddance. Where I work now we are spoiled little "primadonnas" who have just about anything that makes sense to have on an ambulance with a nice mixture of experienced medics to keep it real. The pay is 100x better along with the benefits, we have a great relationship with all 3 FDs that are in our district. FD responds on all "LIFE THREATS", and if a lift assist is needed......we just call or wave our magic wands (radio antennas....lol). Getting PD out there may take some time due to the size of the county, but the come at the drop of a dime. Yeah, I'm spoiled, so what?

[dougd]

Lucky enough? I hate to be a prick, but the company has zero choice in the matter. If I don't think that my crew or my equipment can handle a patient, then that patient doesn't get transported until either enough crew members or the proper equipment for a transport.

I agree with JPINFV. If a pt is too big to carry with the number of people on scene or needs a bari truck, I don't move that patient until we have adequate resources. If that means we sit for 2 hours, we sit for 2 hours. Check your company policy. If it says you need a lift assist for patients over x pounds, get the assist. Failure to do so may lead to worker's compensation denying your claim if you injure yourself in the process. It doesn't matter what the dispatcher said. If the company doesn't like it, tough.

[streetsurgeon]

mr sleep said it. everything be about cutting corners. everything , from fix it and forget it.. as long as it runs. no ac no problem.. just roll the windows down.. it 88 degree weather. with 100 percent humidity. or the fact the we cant get our windsheild to defrost and we dont have heat.. i have heard it all from the company mechanics... ohh just drive it till it catches on fire, cause it will always smell hot.. a damn osha would have had a hayday.. not to mention we would shift equipment just to be omtb compliant. and we still had to fight for some sort of compensation. our wages were horrible.. we had brown nose employees who would dodge runs and would get what ever they wanted cause they were sleeping with the supervisor. yes private ems has a lot of skeletons in the closets. beware.

[dougd]

Well, I can't disagree with the "fix it and forget it... as long as it runs." It's definately a problem. So are the run dodgers, but I'm not about to start sleeping with my supervisor to get around that.