Words are not sufficient to describe this FAIL!

[Kiwiology]

There is absolutely no place in an emergency ambulance service for a driver only role. The education framework is designed to transition the prehospital model away from the concept of driver and attendant, and it is worrying that this could be a means to correct the single crewing issue.

1. Incidents involving more than one patient require a second clinician

2. Certain procedures require two trained clinicians

3. Most equipment requires two trained clinicians

4. Cardiac arrests generally require three to four clinicians to offer the best chance at survival

5. Motor vehicle accidents frequently have multiple patients that require assessment

6. Uniform similarities further confuse the public and promote credibility issues

7. Funders and service providers would be culpable for the fraudulent misrepresentation of service provision i.e. claiming a crew of driver and attendant is a safe crew and equitable in comparison with a crew of professional Paramedics

8. The concept is a crude method to crew rural emergency ambulances (driver and clinician)

9. Only having one clinician limits overall capacity for multi casualty situations

10. A driver only concept attracts inappropriate people who are more interested in the red lights and sirens aspect. This creates privacy and confidence issues

11. A driver only concept is internationally inconsistent and would be a backwards step

Stakeholders that promote such a concept show a lack institutional knowledge, limited international experience and understanding, and show poor leadership by even considering this.

[Dustdevil]

Stakeholders that promote such a concept show a lack institutional knowledge, limited international experience and understanding, and show poor leadership by even considering this.

The problem here is that the people promoting this are not stakeholders. They are people attempting to circumvent the system and get by without employing actual stakeholders.

[Kiwiology]

The problem here is that the people promoting this are not stakeholders. They are people attempting to circumvent the system and get by without employing actual stakeholders.

OK maybe the wrong word but I would say they are a stakeholder, they provider the service, they have a stake in how that service is provided.

[Just Plain Ruff]

They are quite capable individuals in many ways. These people are not hobbyist. They are simply citizens helping their community, a term apparently vacant from the vocabulary of many on this network site.

It's good that they are giving back but I don't see many other professions giving away their time on a consistent basis.

Do your homework before you go bashing on other EMS agencies ways of working. This particular service can not afford to staff that many paid providers, not to mention they have 2 medics, 2 WHOLE MEDICS!!! The rest of their service is comprised mostly of ECAs and EMTs. These are not stupid or lazy people. Just because they have some other full time job does not make them less of an EMT, ECA, or Paramedic for that matter. If anything it broadens their ability to help others for engagin them in the empthetic aspects of the job.

Broadens their ability to help others by having another job? Hmmmm so if I have a 2nd job as a paramedic it broadens my ability to help people for engaging me in the empthetic (what the heck is empthetic) part of my job? How does that work?

By the way, the State of Texas is perfectly aware of systems that work in this fashion. They MADE IT THAT WAY!!!!! Because they have sense enough to realize that not every area will be needy of fully staffed and paid services. Nor could they afford it if they wanted to. There is far too much terrain to cover.

So the state of Texas MADE IT THAT WAY???? Can you cite the source of that empthetic statement.

Take note. I work for a private company, we do 14,000 calls a year in a city of 110,000 roughly. We also serve over 90% of the county we operate in, not to mention some thousands of miles of area in 3 other surrounding counties. We also provide mutual aide for some 6 or 7 additional cities on a regular basis. But we have investors and billing companies and non county acquired funding.

If your county is underpopluated, you simply can not afford paid services to the extent of what some people on here are suggesting.

Yet, I have continued to cite a service that works close to mine that has two full time crews, One ALS and one bls crew and they run around 400 or so calls a year. If they can pay 2 full time crews on 400 calls a year, then this service you are emphatically supporting can certainly support at least one full time crew. Maybe two.

As you have seen Princess, I have not slammed this service. I simply have expressed distrust in this style of management. You seem to have a great deal of personal experience with this service, why don't instead of you blowing off the handle and calling us out, why don't you come to us and tell us why that service CANNOT survive without letting someone who is CPR trained only drive the ambulance. Before you say they get to run calls with a veteran driver what happens when they are in the front of the ambulance and a patient crashes. The medic needs help and all that CPR certified driver can do is go back and look pretty.

Plus, I don't believe that the state of texas would allow this but without you citing sources and just telling us that "Texas made it that way" you need to cite a source because this is just a BAD IDEA.

I await your reply. IF you wish to reply privately I'm game for that.

Just don't come back here with your opinions or unsubstantiated claims.

ok, I was just on the department of EMS in Texas website. Did some quick research on their statutes/rules.

Here is what I found

An ECA is defined as the following:

(24) Emergency care attendant (ECA) - An individual who is certified by the department as minimally proficient to provide emergency prehospital care by providing initial aid that promotes comfort and avoids aggravation of an injury or illness.

Sounds like a EMT or First responder.

AS for minimum staffing of an ambulance is listed here

(g) Minimum Staffing Required.

(1) BLS--When response-ready or in-service, authorized EMS vehicles operating at the BLS level shall be staffed at a minimum with two emergency care attendants (ECAs).

(2) BLS with ALS capability--When response-ready or in-service below ALS two ECAs. Full ALS status becomes active when staffed by at least an emergency medical technician (EMT)-Intermediate and at least an EMT.

(3) BLS with MICU capability--When response-ready or in-service below MICU two ECAs. Full MICU status becomes active when staffed by at least a certified or licensed paramedic and at least an EMT.

(4) ALS--When response-ready or in-service, authorized EMS vehicles operating at the ALS level shall be staffed at a minimum with one EMT Basic and one EMT-Intermediate

So is an ECA someone who is CPR certified only? IF that's all that it takes then WOW. Plus the drivers that this volunteer service is going to allow to drive, won't they need to be certified by the state of Texas

Gotta love those rules.

[spenac]

ECA is actually a condensed emt class. Believe it or not they condense that 110 hours even further. They are trained really all skills that a basic is but with even less education if you can believe it.

Texas fails in that it allows 2 ECA's to staff an ambulance with no higher level. Worse yet it allows 1 ECA with an non trained driver to staff ambulances with a waiver and no additional help. I speak from experience as I started in EMS as a volunteer ECA then actually became a full time paid ECA. I made nearly $30000 a year as an ECA that was often the highest trained on the ambulance. Scary isn't it. The public really has no clue how little actual medical care they are going to get when an ambulance comes gets them.

As to not being able to pay because to much area and to few people. Bull crap. I used to work in a service with over 2500 square miles of primary and more than 6000 square miles of response responsibility. That total 6000 square miles has no hospital and fewer than 10000 people, with one of the highest poverty levels percentage wise in the nation yet it staffs paid ambulances 24/7. So any place says they can not pay for ambulance is a liar.

[croaker260]

E So any place says they can not pay for ambulance is a liar.

WAY to general of a statement.

Example, I am proud to say I believe I work in one of the top 10% of EMS agencies in the nation here in Idaho. We serve an indigenous population of about 350K with a transient workforce of about 75-100K from out of county, and are a pleasant mix of suburban, rural, and even a little bit of urban thrown in, with median income from near zero to over 1 mil and everwhere in between. Sounds great, right?

HOWEVER, you go north of here into the mountains, where most of the land is federal or state forests, The populated areas are small barely sustained communities of less than 1000 people....and these are the the "LARGE" communities,and are separated by mountainous terrain and snowed out roads in the winter for WEEKS at a time. This is not the natural disasters you see on CNN. This is the NORM.

These communities are unincorporated, and have no tax base to speak of, and the EMS lives of the generosity of donations. The Counties they live in are little better. These community first responder/transport units often get less than 20-50 EMS calls a YEAR.

Some examples:

1. Valley County Idaho- Population 8000 total over 3678 square miles. An average population of 2 people per square mile. Yet most of this population lives in three communities along HWY 55, and are SEASONAL populations. the REAL population once you get off the HWY into the 6 or 7 uncooperative communities is closer to 0.25-0.5 people per square mile.
   

• Custer County Idaho: 4,166 (and decreasing BTW)in 4,937 square Miles. Less than 1 person per square Mile, and most of this population is in CHALLIS (pop 909), McKay (pop 500), STANLEY (pop 100) and other communities with a population of about 25-50. , Population is very seasonal, and mostly around red fish lake. The remainder of this population is spread out among 4-6 "smaller" communities. Many of these communities are vacated (except for 1-5 families as caretakers) during the winter.
  

• Adams County, Population 3400 over 1,365 square miles, most are seasonal with a ski resort or between two small communities each with less than 900 and 500 respectively. The remaining are scattered through out the mountains and along the river, many are "off the grid", and real population density is about 1/square mile or less.
  

These are typical Idaho counties in MID/Central Idaho (where the Mountains and Valleys are). Hopefully you can see the budgetary issues, not to mention the personnel shortage this causes. Making a system out of a seasonal workforce and without a decent tax base is neigh impossible. In Texas, I only found one or two counties resembling this demographics on simple square miles (brewster for example) , They were agricultural in nature, not necessarily seasonal as we understand it here, and arent ISOLATED like we are for weeks or months at a time. Most had counties less than HALF this size, and population densities far exceeding what we have here in rural Idaho.

THATS the REALITY here. And there are similar areas in OR and WA too, and in other parts of the country (SD, WY, and MT for example)

You seem to imply that these comminities simply are to lazy to do anything other than volunteer EMS with an EMT and A "driver"/ECA. You seem to imply that if they wont do it "right", they should not do it at all. Yet without their own volunteer EMS, they would be HOURS in winter from anyone getting in by snowmobile or snow cat, or 4x4. If you have a population of say, 1000 (wich is the upper end of the LARGER communities, amy have populations less than 100). and you have an unheard of rate of 2.5% voluntarism, than thats still only 25 volunteers. In this state fully half of those will go to a first responder course and be a "driver", as long as there is an EMT in back. Then , if they stick with it, the service will find a way to send them to a EMT course, many will have to travel an hour or more to get that course in the summer.

Now the state requires an EMT in the back, and at least a driver in the front. Most will run with 2-3 man crews on call from home. Usually the same people will be on call for weeks at a time.

In the summer, they ONLY have to manage the patient for 20 minutes until air medical can get there, if they can get there (mountains are tricky to fly in).......In Winter, due to weather, white out, and other concerns, it may be hours to ALS or a facility thats more than a clinic and a PA/NP on call.

In these areas, called FRONTIER, or SUPER-RURAL by medicare, ECA/First Responder/Drivers are the brutal reality, and the step to EMT in areas with no budget and no support.

I am all for "doing it right", but in the rural parts of this state, every certificate that is issued is a victory, and everyone that re-certs, is a triumph. You have to see these beautiful, scene, and terrifyingly majestic areas to appreciate the isolation you can find here. I have volunteered my time to teach in some of these communites from time to time. It is way more rewarding than doing it in the "Big City" of Boise... (I have to laugh when I say that). And these guys are wanting the training. They just dont have the resources. In some places, "Doing it right" is simply doing it.

Respectfully submitted.

P.S. There is a push by the state to legislate counties into taking a more active role in supporting and funding these communities EMS and forming SYSTEMS....., and in forming taxing districts to support those "systems"......but guess who opposed it. The various FF lobbies. They dont want to be told how to run EMS by anyone.....)

Edited May 15, 2010 by croaker260

[Dustdevil]

Steve, we were discussing the United States, not Idaho.

But anyhow, you don't make the point that they cannot afford it. You only make the point that they don't think they use it enough to justify it. And hey, when you move to BF Egypt, that's the choice you make. But it has nothing to do with not being able to afford it.

Edited May 15, 2010 by Dustdevil

[croaker260]

Steve, we were discussing the United States, not Idaho.

But anyhow, you don't make the point that they cannot afford it. You only make the point that they don't think they use it enough to justify it. And hey, when you move to BF Egypt, that's the choice you make. But it has nothing to do with not being able to afford it.

Dust, respectfully , I think I am making that point.

We can look at median income, but the math is mind numbing. Basically it is pretty low for needs of the area.

Also remember, unless you go 100% tax funded, fee for service is directly Dependant on the volume of runs you make, so run volume does play into the equation. Though due to the size of most of these agencies they contract out their billing (at BLS reimbursement rates), and get only about half of what is collected. Wich, because of the volume of runs, still aint much.

Finially, if you tax property, if you only have 7000 homes to tax, no matter how much you tax, you still aint getting much.

7000 x 100K value of home typical Tax ($25) = 175,000 per annum, ANd remember that many of hese homes are trailers, small cabins, though you do have homes that are woth more, its a wash. And this number is for a whole county!

Adams county, for example, only has 3k or so population. Not even homes, total population. But lets say HOMES to "round up" so to speak. Assuming all are homes worth at least 100 K after home owners exemption, wich is saying a lot.

3000 x 25 = 75,000 Per ANNUM. And if we say $ average collection for about 100 calls per year total.....thats 25000.....100,000 for ALL EMS expenses. Maintenance, Payroll, Fuel, training, cost of equipment and a warm shed to keep an ambulance, everything! For the whole COUNTY.

EVEN IF YOU DOUBLE the PER ANNUM, how can you afford a full crew? And this is assuming you have a taxing district for the whole county, last I heard 14 counties in Idaho do not.

So assuming you decide to take EVERY funding rescource for EMS fro the tax base, and fund a crw, You can afford 1 paid crew 24/7.

In Adams county of 1,365 miles of MOUNTANOUS Terrain and DIRT FORREST Roads.... where do you put it? In wich of the 7 or so small communities? And what about the rest? Do you say, since you cant afford a "proper" PAID EMS crew, you cant have any at all. Oh yes, you get no funding because we took all you funding....to support a single "proper" EMS crew? You just half to wait for 2 hours or so?

There is a point of funding collection that you just cant support paid personnel. You just cant. Even if you pay them minimum wage and no benefits. And you cant tax FEDERAL LAND, wich most of these counties are made up of. Many people live and ranch on 100 year leases on federal land, so technically they dont even "own" their home, grazing rights, or land, though the banks think they do

My point is this, in my state no one believes that ECA/Drivers are the best solution, but with limited money to send people for training, If I can send one person (who may or may not be here next season) 1 hour or more for EMT training, or 2-3 for ECA/first responder training and then send the one who stays to EMT later, which is smarter?

And in my state you still have to have an EMT in the back with the patient. SO...If I can train 1 EMT and 2-3 ECA's/First Responders or train 2 total EMT's, which is smarter use of limited $$$???

Edited May 15, 2010 by croaker260

[Dustdevil]

How do they afford to fund the public schools there? Since they have no money, are they allowed to simply let their kids work the fields through their childhood instead of attending school?

Of course, I'm being facetious because we all know they have schools. And paid teachers. And paid school bus drivers. And paid athletic coaches. And paid janitors.

If the people there thought EMS was important, they'd fund it. They don't, so they won't. It's that simple.

[Fox800]

As you have seen Princess, I have not slammed this service. I simply have expressed distrust in this style of management. You seem to have a great deal of personal experience with this service, why don't instead of you blowing off the handle and calling us out, why don't you come to us and tell us why that service CANNOT survive without letting someone who is CPR trained only drive the ambulance. Before you say they get to run calls with a veteran driver what happens when they are in the front of the ambulance and a patient crashes. The medic needs help and all that CPR certified driver can do is go back and look pretty.

Plus, I don't believe that the state of texas would allow this but without you citing sources and just telling us that "Texas made it that way" you need to cite a source because this is just a BAD IDEA.

I await your reply. IF you wish to reply privately I'm game for that.

Just don't come back here with your opinions or unsubstantiated claims.

ok, I was just on the department of EMS in Texas website. Did some quick research on their statutes/rules.

Here is what I found

An ECA is defined as the following:

(24) Emergency care attendant (ECA) - An individual who is certified by the department as minimally proficient to provide emergency prehospital care by providing initial aid that promotes comfort and avoids aggravation of an injury or illness.

Sounds like a EMT or First responder.

AS for minimum staffing of an ambulance is listed here

(g) Minimum Staffing Required.

(1) BLS--When response-ready or in-service, authorized EMS vehicles operating at the BLS level shall be staffed at a minimum with two emergency care attendants (ECAs).

(2) BLS with ALS capability--When response-ready or in-service below ALS two ECAs. Full ALS status becomes active when staffed by at least an emergency medical technician (EMT)-Intermediate and at least an EMT.

(3) BLS with MICU capability--When response-ready or in-service below MICU two ECAs. Full MICU status becomes active when staffed by at least a certified or licensed paramedic and at least an EMT.

(4) ALS--When response-ready or in-service, authorized EMS vehicles operating at the ALS level shall be staffed at a minimum with one EMT Basic and one EMT-Intermediate

So is an ECA someone who is CPR certified only? IF that's all that it takes then WOW. Plus the drivers that this volunteer service is going to allow to drive, won't they need to be certified by the state of Texas

Gotta love those rules.

Interesting. I was under the impression that the minimum required staffing for a Texas BLS ambulance was two EMT's.

ECA is actually a condensed emt class. Believe it or not they condense that 110 hours even further. They are trained really all skills that a basic is but with even less education if you can believe it.

Texas fails in that it allows 2 ECA's to staff an ambulance with no higher level. Worse yet it allows 1 ECA with an non trained driver to staff ambulances with a waiver and no additional help. I speak from experience as I started in EMS as a volunteer ECA then actually became a full time paid ECA. I made nearly $30000 a year as an ECA that was often the highest trained on the ambulance. Scary isn't it. The public really has no clue how little actual medical care they are going to get when an ambulance comes gets them.

As to not being able to pay because to much area and to few people. Bull crap. I used to work in a service with over 2500 square miles of primary and more than 6000 square miles of response responsibility. That total 6000 square miles has no hospital and fewer than 10000 people, with one of the highest poverty levels percentage wise in the nation yet it staffs paid ambulances 24/7. So any place says they can not pay for ambulance is a liar.

It's not even close to an EMT class. It's based off the NREMT First Responder curriculum.