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snowbank

Paramedic Response Unit/Rapid Response Vehicles/Fly Cars

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Speaking as both a volly and paid EMT in Burlington County NJ:

As a volly it sucks to think that your squad has to go paid ( either during the day or 24) but it is screwed up that a medic unit (my area the medics DO NOT transport) have to sit on scene for 20 min.s waiting for BLS from another town to show up so they can transfer the "unconscious PT" (AKA the drunk that fell asleep) to them.

As a paid EMT why do I have to go into another town in the middle of my dinner to bail out the medics (in my area the medics DO NOT transport) who have been sitting on scene bagging a PT they tubed. Plus if every town would turn the wheels within two mins. of dispatch you would beat the medics to 99.99% of their calls and be able to recall their medics when not needed.

As an EMT what is more important, being a 100% volly squad that does not get out or swallowing you pride or what ever you need to do and start thinking about the people you "serve" And if EMTs would stop being so medic dependent and stop keeping them on B.S..

O.K. Im done now "bad EMT no caffeine!"

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However, once you put your Paramedics in your cheap ambulance, and they are dispatched with BLS for an ALS assigment that ends up being BLS, with no BLS responding, your medics now must dispatched the stubbed toe while the AMI 2 miles away has to wait an extra 20 minutes for the paramedics.

This debate can go around and round. My Utopian society is professional BLS providers in a transport-capable ambulance w/ ALS chase fly cars, this way ALS is kept for more serious emergencies, which is what the original concept was.

Mediccjh, here is where the system in NJ, would work. We, as ALS providers, do not get dispatched to the "BLS" call even if we are in transport capable units. The only calls that we are dispatched on are the typical "ALS" calls. So being in a mini mod or similar would not prevent me from going to the next call. I will say however that doing this would in fact open up a can of worms with the local squads. They would feel threatened by this. Just look at the response that is going on all the time with monoc. Look at the problems that they have created by doing this very thing. The ambulance is nice in some respects but, I'll take my suburban any day.

Now you ask, how do we fix the system. I'll put up my idea for comment and see what you all think in another post, titled similar, because I do not want to hijack this thread.

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It sucks because the volleys can't/won't get out during the day for grandma having the CVA, but if an MVA w/ entrapment come in, they come out of the woodwork.

It's that simple.

Its like this in many places, you can't blame anything but failing systems in these area's. In our region ALS units are almost always dual disptched with all BLS calls so by the time we get there if the volunteers have not crewed up, we take it in the MICU. I personally think that PRU's in the proper system would be a great advantage. I have/do work for services that utilize them in different ways and if administrators and policy makers understand the limitations of these units, they will work well.

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Mediccjh, here is where the system in NJ, would work. We, as ALS providers, do not get dispatched to the "BLS" call even if we are in transport capable units. The only calls that we are dispatched on are the typical "ALS" calls. So being in a mini mod or similar would not prevent me from going to the next call. I will say however that doing this would in fact open up a can of worms with the local squads. They would feel threatened by this.

This has opened up a can of worms in our region, some of the volunteer squads started getting out every time. But other has faded away and are being taken over by paid services. No matter how you look at it, BETTER PATIENT CARE.......doesn't matter if its a volunteer or paid giving it, its getting done sooner.

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We use an ALS first response in the form of sheriff/medics. The time from call to patient contact for these guys is usually faster than some ambulance enroute times. By time Alpha transport arrives, assessment can be done and, if need be, appropriate treatment initiated. It took a while to iron out the turf problems as ambulance companies around here are private and government subsidy was an issue with the PD. After ALS arrives, patient is handed over to transport medic, and the "Echo", as they are called, continues his patrol. Generally any treatment provided by the first response is minimal, but it is available if needed..It is a great system when it works.. :)

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In my region of rural upstate NY, we have volunteer BLS units with ALS fly cars. My department is on the border of 2 counties and the counties have a mutual aid agreement in place, so we usually get an ALS fly car out of the next county. That county provides 2 ALS fly cars and they are always running. We almost never get ALS from our own county (provided by a private service), but our county is huge, about the size of Rhode Island and they only provide 2 ALS fly cars outside of the 2 "cities" in the county that have their own paid services. One of the problems is the regressive regional council for our county. They recently mandated ALS response to more BLS calls. This is increasing ALS usage, but decreasing their availability for true ALS calls.

I would say better than 90% of the time the BLS volunteer squads get on scene either before or with the ALS fly car. Several of the local volunteer departments also have a unique mutual aid system in place, where if one dept has a driver and a neighboring dept has an EMT, they can meet up and staff the driver's rig. It doesn't happen often, but it does help get staffing during the daytime.

My dept also has the advantage of having the 2nd largest employer in the county within our town limits. Their corporate policy allows responders to leave work for Fire or EMS calls. In a rural area, I think it is very important for companies to support the volunteers in this fashion.

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As has been posted before, the idea of a medic fly car is good on paper. In practicality, there are many problems. The main problem, of course, is the response of the BLS. If you are in a rare system where BLS is on the ball, it all works fine and dandy, the medics can free up and go to calls that require them. More often times than not, however, BLS is either part of a hit and miss volunteer system (yes, boring old sick calls need to be transported just as bad as the real cool smash 'em up MVA does), or the BLS is a paid service that, well, utilizes, er, many times less than qualified staff, where your check list before transport ends with "checking the to make sure patient's wallet is intact" to finally "checking to make sure your wallet is intact." Basically, what it boils down to is that an ALS transport unit does not tax resources appreciably more than a BLS transport unit does. So, if a system can reliably get a BLS transport unit to a majority of its calls, 9 times out of 10 it can get an ALS transport unit there too, and as a collolary, if a system has trouble getting ALS transport to the calls that need it and requires PRU's, it probably will have problems getting a BLS unit there too.

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I find the whole New Jersey thing sadly hilarious.

I mean seriously... they do everything completely different from the rest of the country, and they just don't understand why it isn't working. The hilarious part is that they seem oblivious to the obvious, and lack any understanding of what is wrong.

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