The best service in the country

[txemsdoc]

Actually, I don't think we differ much at all in our definitions. ... A rideout with most large metropolitan fire based systems isn't likely to impress the international visitor who is accustomed to a greater clinical sophistication....

And most of all, I would hate to see an international visitor come here only to go back home with his lasting impression of American EMS being how a major urban FD breaks down paramedic education and practise into the lowest common denominator, and then staffs it with people who, for the most part, don't even want to be doing the job.

While I certainly agree that all of the factors you mention are extremely important for a service to be "good," the two most important elements of any system will always be the two you didn't mention: Education and people.

What do you mean be clinical sophistication? Is it an individual paramedic/emt thing, or is it based on the meds/procedures at the disposal of the pm/emt? If the latter, I would argue that the systems(I'd exclude air systems) with things like RSI are not 'sophisticated' and/or don't have a large amount of input from their medical directors because the evidence does not conclusively support pm's can do rsi and recognize all esophageal intubations.

Your comments about urban FD's and pm education seem somewhat personally slanted. I would think it unaccurate to say that a rural EMS providor is in any way better than an urban one (individual characteristics aside).. I would actually argue the opposite. Nevertheless, education in many cities is farmed out to a college or university setting which teaches off of standard curriculum. A better representation would be national registry pass rates, though colleges can 'adjust' who takes the test to get them higher percentages.

You are right about people in FD's and 'not wanting to be doing the job'. I think the connection was a matter of convienence for the powers that were to align ems and fire. A good firefighter doesnt' equal a good paramedic.

I agree with needing 'good' people to have a 'good' system. You don't need them to be terribly smart, just motivated. You can get through medical school with just determination. The education aspect I question, only because that is so entailed in the QA/QI process that should be happening.. more of an ongoing education.

Just my thoughts,

txemsdoc

[Dustdevil]

What do you mean be clinical sophistication? Is it an individual paramedic/emt thing, or is it based on the meds/procedures at the disposal of the pm/emt? If the latter, I would argue that the systems(I'd exclude air systems) with things like RSI are not 'sophisticated' and/or don't have a large amount of input from their medical directors because the evidence does not conclusively support pm's can do rsi and recognize all esophageal intubations.

We're definitely on the same page. I agree with you on all points. My core point is that the best system to showcase American EMS would be a system (and community) that emphasises both quality and quantity in their education without regards for how fast they can get their firemen out of school and on the streets, as well as being staffed by people who actually chose EMS as a profession, and not just those who "ride the box" to pay their dues as a rookie fireman.

The most extensive protocols, drug list and skill set on earth isn't going to impress our international EMS friends if those in the field have a condensed 800 hour "education," can't talk intelligently about pharmacology or physiology, and don't even want to be on the ambulance in the first place.

[Just Plain Ruff]

One of the best services I've ever worked for was Johnson County Med Act. High call volume really depended on the station but our crew in the north east part of the county (low call numbers) ran 11 - 15 calls in 24 hours. The busier trucks would run about a call an hour or so

Very very progresive protocols, top quality equipment and very in to allowing riders.

If you want contact info let me know.

MAST in KC MO is pretty good too

If you want a day or two at a rural service where you and your medic partner are the only ones on a critical call - no fire no pd most of the times then I've got a pretty progressive couple of services to put you in touch with. These are all in the Kansas City area.

Near a major airport.

PM Me for more info.

[txemsdoc]

The most extensive protocols, drug list and skill set on earth isn't going to impress our international EMS friends if those in the field have a condensed 800 hour "education," can't talk intelligently about pharmacology or physiology, and don't even want to be on the ambulance in the first place.

OK, so here I agree.... so then, because someone doesn't want to be at the job, that system as a whole 'sucks'? Maybe from the point of view of the individual EMT/PM I spose... But if I were in a trauma or cardiac arrest, I'd rather be in Houston proper than any of the surrounding entities...as long as they aren't in 'resource management' when unit availability is running low. The numbers simply show that Houston's resuscitation rates are in the top 2 or 3 of the US and exceed those of unincorporated harris county, neighboring counties, etc...(or those services don't track their numbers appropriately). What I wish is that you could merge the motivation of those in outlying systems (although believe it or not, there are some people in Houston Fire who don't want to run into a burning building) with the 'system' of Houston Fire and that would exceed Fire's already decent patient outcomes.

txemsdoc

[Aaron]

I know Israel isn't in the US but it is definitely worth the trip, if you would like to see a one of a kind system.

1. We have very advanced ALS protocols.

2. A very unique first response system, like no other in the world.

3. An outlook on MCI's that has been put to the test many times.

4. Payed workers working hand in hand with volunteers.

5. Emt's on ambulances from age 15.

6. doctors on specific MICU (ALS) units.

7. A high tech command system including GPS tracking, computers in ALS units, And state of the art dispatch centers.

8. much much more.

And we like having visitors.

regards,

Aaron

[flight-lp]

OK, so here I agree.... so then, because someone doesn't want to be at the job, that system as a whole 'sucks'? Maybe from the point of view of the individual EMT/PM I spose... But if I were in a trauma or cardiac arrest, I'd rather be in Houston proper than any of the surrounding entities...as long as they aren't in 'resource management' when unit availability is running low. The numbers simply show that Houston's resuscitation rates are in the top 2 or 3 of the US and exceed those of unincorporated harris county, neighboring counties, etc...(or those services don't track their numbers appropriately). What I wish is that you could merge the motivation of those in outlying systems (although believe it or not, there are some people in Houston Fire who don't want to run into a burning building) with the 'system' of Houston Fire and that would exceed Fire's already decent patient outcomes.

txemsdoc

So am I to understand that you are saying Houston F.D. has higher resuscitation rates than agencies such as Cypress Creek EMS, HCESD-1, Cy-Fair VFD, Northwest EMS, and Montgomery County Hospital District? If that is what you are saying, then show me the numbers as I have a real hard time believing that. Medically, Cypress Creek EMS has a greater than 80% ROSC on in field worked arrests with a discharge neurologically intact rate running in the low 40's% (As of earlier this year). Trauma wise, no EMS agencies have decent resuscitation percentages. EMS doesn't save the trauma patient, the trauma center does..........

Now if your referring to Houston hospitals having a higher resuscitation rate than the outlying hospitals, then yes you are correct. It may have something to do with the fact that the only level I trauma centers are downtown :wink: . My personal opinion, Houston does suck when it comes to trauma care. It's not Hermann's fault nor is it Ben Taub's fault. It's the fact that the 4th largest city in this nation needs more, but will probably never receive.....................

Sorry, got a little off topic (hope admin didn't see it!!! )................

[Ridryder 911]

When evaluating resuscitation outcomes, one needs to really look at the statistics of the studies. I find them very questionable, and somewhat skewed. Not addressing one specific EMS, but in general.

Like to see more comparative analysis to occur.

R/r 911

[Nate]

So am I to understand that you are saying Houston F.D. has higher resuscitation rates than agencies such as Cypress Creek EMS, HCESD-1, Cy-Fair VFD, Northwest EMS, and Montgomery County Hospital District?

With the exception of a few of those services, I could believe HFD has a better save rate.

[Dustdevil]

What I wish is that you could merge the motivation of those in outlying systems (although believe it or not, there are some people in Houston Fire who don't want to run into a burning building) with the 'system' of Houston Fire and that would exceed Fire's already decent patient outcomes.

Wouldn't we all! And that is really the only key advantage to an FD administrated system. If anybody knows how to run a bureaucracy, it's the fire service. Just about every big FD looks wonderful on paper, with assistant chiefs paid to sit around and write policies and procedures, and publish statistics and mission statements, and all the other fluffy paperwork that impresses the academics. But you're right. If we could combine the best of both worlds, it would be great for the profession. However, I maintain that, aside from geography and taxes, there is nothing inherently superior about HFD that does not or could not be applied to any other service.

And, as Rid says, the numbers would have to be vetted to determine a true cause and effect relationship before I could climb on board with HFD being excellent on any level. And even then, I don't think it would be impressive to international visitors that HFD's ambulances happen to all be within 10 minutes of a trauma centre. That's hardly clinical sophistication.

[1EMT-P]

I suggest that you check out the Richmond Ambulance Authority, they are one of the leading EMS systems in the country. Good Luck!