Double medic crews on ALS rig?

[nsmedic393]

As my fellow Ontarians have said, ACP/ACP (advanced care paramedic) crews in this province are rare. In my service you will find that configuration only in instances where a PCP (primary care paramedic) books off and an ACP is called into work overtime with another ACP.

As far as ACP's attending ALL calls, it doesn't happen. If the patient requires a level of care above the education/training/skill set of a PCP then the ACP will attend. If the care required falls within the PCP's scope of practice then we will go call for call. If there is a change in patient condition then the ACP can always switch from driver to attendant if necessary. As an example, I, as a PCP, will often attend on an ischemic chest pain call. My ACP partner must start the line and give the fentenyl (if indicated) but I can monitor the patient, administer the Nitro and ASA, aquire/interpret the 12 lead, etc.

Same here in Nova Scotia

[SSG G-man]

Well, if Dust had his way almost no one would get an ambulance where I live. We have a few paid Medics in the county, but most is Volunteers weather basics or medics. I don't know why you think a EMT-B should not be on an ambulance. Should we do away with EMT B and make everyone become Medics?

[Ridryder 911]

We operate about the same. Out of the 24 full time 2 are below Paramedic level on the trucks so most of the time it is a Paramedic-Paramedic unit. However; I find it ironic that the billing be ALS if no ALS procedure was performed or justified. A company should and technically can not bill for ALS runs because of staffing and licensure level.

We rotate calls and the basic or Intermediate attend patients that so not need ALS intervention. This allows them to get patient experience and allow the medic a break.

If you are really concerned about the issue, you might want to contact medicare fraud for investigation. They have an anonymous clause and "whistle blower" protection. Patients should be treated according to illness not for billing purposes. Again, medicare is quite aware of some of the unethical practice and this type of performance needs to be stopped.

For staffing, have the medics met formally with management and discussed this situation?.. If this is a private company I am sure there is a chain of command to follow, up to board of directors etc...

I wish you the best of luck.

R/R 911

[Wannabe]

A company should and technically can not bill for ALS runs because of staffing and licensure level.

I'm speaking out of turn because I don't know how medicare works in the US, but doesn't it just make sense that services are allowed to bill more because it costs more to provide an ALS unit than a BLS unit, regardless of the level of care provided? I can kind of see the logic the other way, but if services were only allowed to bill based on the type of call, they could wind up in a pretty serious deficit at the end of the year if they don't get the budgeted number of ALS calls, but have been paying for Paramedics all along.

It wouldn't be a big deal if Basics and Medics earned the same, but with the disparity you can bet if the billing dept. has to change their ways, they'll be looking to change the pay structure so that Paramedics only get paid the higher rate if they use the skills or some such BS like getting rid of Paramedics altogether because (as has been so often pointed out on this very board) 90/92/95/98/whatever % of calls are BLS calls anyway?

Another way to try to pin down my thinking - if you go to the ER and are seen by a Doctor who doesn't do anything more for you than a nurse would have done (take your vitals (which, face it - the nurse does anyway), tell you do go home and get rest and fluids) does your plan not get billed for an MD contact? He/she didn't do anything doctorly so is that right?

You are paying for the knowledge embodied in the people who arrive on the truck, not necessarily the procedures those people provide to you.

Perhaps the rules are set up the way Rid suggests, but to me it doesn't make any sense at all...

(FWIW - In Canada (Alberta anyway), you pay more for an ALS truck than a BLS truck, even if you just get a bandaid and a ride to the ER.)

[Ridryder 911]

The way they see it is, why should the insurance and government pay for an ALS unit when it only provided a taxi ride. The same is true in hospital billing, you have base rates and different level of care. A cardiac arrest is not the same price as a splinter removal etc.. you are not paying for the knowledge but the services rendered.

Most services has 2 means of billing individual ( base rate with individual line billing -procedure and equipment used) or a capitulated rate ( inclusive) one set fee that you have agreed that you will charge for certain calls... i.e basic =$; ALS =$ all the time no matter if you use a little bit of equipment or empty the drug box is the same rate. It usually equals out the same .. mangers and the government know this as well.

One must remember that the most EMS services can receives is about 80% of rate from medicare. Then collection rate from the provider contracted out to the medicare rep is all dependent on how well things are documented and coded. I believe EMT's should be aware of billing procedures and regulations. It would make EMT's more appreciate of managerial staff and have an understanding the need of proper documentation.

Be safe,

R/R 911

[Nate]

At Bay Star we run BLS trucks and the paramedic responds on a squad for transfers and 911 calls. Now our day crew paramedics work on a truck with either an EMT-B or an EMT-I. One of my 24 crews (they don't rotate, but we as paramedics do) has two paramedic students who are just waiting to test, and one of them is an EMT-I; so it is nice to have the extra set of hands on that crew. (They are all awesome crews though, just nice to have an EMT-I so he can grab the line while I get the tube.)

At the City of South Houston (SoHo), we are down to three paramedics, and soon will only have two because one of them is having a child. So it is rare that we even get to work with another paramedic (although I'll be one for a few hours tomorrow). Quality paramedics are hard to come by in the Houston area. Most that are decent don't find themselves with out a job that often, and those that are usually not employeed are that way for a reason.

I think that soon we will see more services start to go towards dual paramedic trucks as the pay increases. A few of the cities around here run dual paramedic trucks.

[medic5587]

I work in a system that is Paramedic/EMT-A. It sucks, in comparison to Medic/Medic. The medic has to take 90% of all patient calls, so he or she does not end up in Q & A. You are responsible for the documentation as well. On transfers, if the EMT drives, you are responsible for driving back, normal transfer 2 to 3 hours. I have worked medic/medic and I can tell you the calls go much smother and the shifts are not as strenuous. I am not cutting down the EMT's, we have some awesome EMT's. The call has to be straight forward BLS before they can take the call. If the patient has any s/s of any sort that can be scrutinized into any form of ALS intervention, and it is brought in BLS we are in the Q & A office.

[Guest]

We run Medic/Medic crew here 24/7/365 unless on is sick, vacation or an opening that is not filled then we have EMT-B or I part-time members that fill in.

I have to admit i do prefer running double medic crews. The biggest problem we run in to is our part timers don't either know enough or don't care enough to write good complete PCR's, so then we make them drive instead of patient care then they bitch to managment that they are not getting "oppertunities" to treat patients. Our B's and I's are taught wel and beyond what is needed to do the job they just don't.

To all the Part-time B's and I's. Please don't take offence to my comment. Just remember when you are filling in for a Medic on a truck, Please remember this is Our full time job. Don't bitch about the way we do things. Prove us wrong and do the job with out bitching you don't get to do enoughand you will gain more respect in the end.

[Dustdevil]

I don't know why you think a EMT-B should not be on an ambulance.

Really? Interesting. I thought I made it perfectly clear. They lack the educational and technical sophistication necessary to safely practice alone. And -- as stated by many people here -- practicing with a medic partner, they become little more than a driver because they can handle only a very few patients. What part are you having trouble understanding?

Should we do away with EMT B and make everyone become Medics?

In 911 ambulance EMS, yes. However, B's are qualified for first response.

[Thunderchild145]

A good basic partner can actually do quite a bit for a paramedic. I know I help my partner out on calls all the time. I do participate in patient care and I'm not just a driver. Your assumption that all basics, everwhere, are useless is invalid. Since education varies between states you really can't generalize. There is a national minimum, but some states exceed that quite a bit. Lastly, I know that without EMT-Basics, that reduces the amount of staffed ambulances. So it comes down to would you rather have a ALS/BLS truck in 5-15 minutes, or a 30 minute, 45 minute, 1 hour wait for an ALS/ALS truck? I have to say with the way my partner and I operate, ALS/BLS is pretty good.