EMS-Still for emergencies? (private sector EMS only)

[AnthonyM83]

Good topic, one I've been thinking about lately.

Other than the concern about them being able to pay, insurances, using up ER resources, I have a big concern about EMS personnel burnout. 24 hour shifts with 10-20 calls take a lot out of you, pulling yourself out of 10 minutes sleep (which is a lot worse than getting no sleep at all) is one of the hardest physical acts I've had to do...several times a night. BS calls lead to cynicsm, burnout, and hating patients.

Now, I'm all for a wider role of EMS, such as prevenative health and discussing health concerns with patient and such, but I'm not a proponent of non-emergency ambulance house-calls. This is contributing to even less personal responsibility in society today. Though, I suppose if you have a different number to call for non-emergencies and there wouldn't be liability issues with dispatch classifying calls as emergency/non-emergency, then I guess It could be a good business...

[JPINFV]

^

Of course the following equation should apply.

Increasing scope/role requires increasing education level.

Increasing the education level would require an increase in wages.

Increased education requirement and wages means increasing attractiveness of the career.

Increased attractiveness means more people apply.

Increased workforce means that emergency response isn't weakened by non-emergency programs.

[Dustdevil]

Other than the concern about them being able to pay, insurances, using up ER resources, I have a big concern about EMS personnel burnout. 24 hour shifts with 10-20 calls take a lot out of you, pulling yourself out of 10 minutes sleep (which is a lot worse than getting no sleep at all) is one of the hardest physical acts I've had to do...several times a night. BS calls lead to cynicsm, burnout, and hating patients.

Excellent point, although this almost starts a new thread entirely. The burnout factor is not so much the result of running BS calls as it is the result of poor management and poor education.

Poor management is at fault because any employer who knows this is how his medics shifts are running is just plain neglegent to even schedule them on 24 hour shifts to begin with! But, you know why he does it? First, because there are enough wankers who are so desperate to play with the siren that they will work any shift and take any abuse just to get to wear that uniform and make that $7 dollars an hour. Second, because these employers WANT you to burn out! People who stay with the company more than a couple of years demand too much money in raises and benefits. Heaven forbid that they stay long enough for the company to have to pay retirement benefits. How many people have you ever heard of retiring from AMR or Rural Metro, even though they have been around for around thirty years? *crickets chirping*

Education is at fault because EMT schools feed into this big lie about how you are going to be a highly educated and valued professional lifesaver, when they know that you're actually going to be just a glorified taxi driver, who makes less money than the un-glorified ones. They set you up for burn-out. They get your engine all revved up with excitement, only to watch you crash into a wall of disappointment, the moment you let out the clutch. And they don't care anymore than the employers do, because high burn out equals high turnover. And high turnover ensures that classes stay full of suckers ready to plop down $250 to $2500 dollars for a three week first aid course that offers them the pipe dream of being a "medical professional" in less time than it takes to learn to drive a truck.

If both of those entities would get their houses in order, burnout would not be a significant side effect of the increased workload of non-emergent transports.

[emtgal40222]

Seeing as how I work for a private service, I can give you some insight. We do "emergency" runs for local nursing homes and medical centers (immediate care centers, doctors' office, etc). We also provide transportation for people who require oxygen, suction, or other interventions that can't be done in a taxi. As for the money aspect, most insurance companies require a medical necessity form from a doctor. Medicare still only pays something like 80-85% of the total cost. So I guess you could say we are a "kinda for profit" ambulance service!

[medicare-emr]

I run an emergency response service in a rural village in South Africa, as it takes a minimum of 40min and above for a private service to arrive and anything from 3 hours for the local service to arrive, we do this as a response and stabilization service only and is membership based, in SA 70% of critically injured or ill people die on the scene, so in my mind i feel that through proper communication and awareness and education of the people can curb the idea that ambulances are taxi's, we are there for emergencies, life threatening ones and non threatening, we do a lot of community work as well for free and use this opportunity to inform people on the use of ems and not to abuse ems.

[AnthonyM83]

I run an emergency response service in a rural village in South Africa, as it takes a minimum of 40min and above for a private service to arrive and anything from 3 hours for the local service to arrive, we do this as a response and stabilization service only and is membership based, in SA 70% of critically injured or ill people die on the scene

Yikes...I think in such a region I might actually not mind people waiting to see if their illness gets worse... :-/

[medicare-emr]

the funny thing is that a lot of the local well off people live in this bubble of disillusion that because they have a medical aid insurance and that it pays for a private service, they think that they are safe....hahahah ah a aaa hahaahahhahaaha aahahaha aaha right!!! dream on buddy, when we start bursting these bubbles with stats and figures of quickly you will die without o2 then they will begin to understand ther importance of such a service that we emt's provide in this world, viva emts!!!!!

[Coop]

I hate missing real calls because someone is abusing the EMS system. We don't have a fleet of vehicles --only two-- and 95% of the time, we only have staffing for one. If a non-patient is commanding our resources, then a real patient can't get them. Sure, another company will cover, but to make a patient wait for extended response time because some dolt doesn't know the difference between taxi and ambulance is criminal. And if it ain't, it oughta be.

Later!

--Coop

[Richard B the EMT]

Medicare-emr is referring to his situation in South Africa. It sounds like, due to population densities and distance, he might not be operating on the "Golden Hour" concept most of us in "big city" operate under, and even our "open countryside" counterparts. If he is not operating under the Golden Hour concepts, it is probably either not his fault, under his control, or both.

As most of you know, I operate in New York City, with an Emergency Department at a hospital, usually no more than a quarter hour travel time from loading the patient. I probably am spoiled rotten by that.

I guess I fall back on my usual "thang" of following your local protocols, to the best of abilities, and availabilities.

[katbemeEMT-B]

Dear State Ambulance Association Contact --

It would be greatly appreciated if you would forward to all of your members the below Call To Action on extending Medicare ambulance relief. Please do not hesitate to contact me if you have any questions. Thank you.

-- Tristan North

Senior VP of Government Affairs

American Ambulance Association

--------------------------------------------------------------------------------

8201 Greensboro Drive

Suite 300

McLean, VA 22102

703-610-9018

1-800-523-4447

703-610-9005 fax

May 18, 2007

CALL TO ACTION – Extend Medicare Ambulance Relief

TO: All Ambulance Service Professionals

FROM: Jim McPartlon, AAA President

RE: Extending Medicare Ambulance Relief

Please send letters to your members of Congress asking them to cosponsor the Medicare Ambulance Payment Extension Act (S. 1310, H.R. 2164). This legislation would implement a 5% Medicare rate increase for 2008 and 2009 for all ground ambulance services. Please act today!

Sending Letters is Easy

To access the letters, go t http://capwiz.com/the-aaa/issues/alert/?alertid=9768116.

Draft letters have already be written for you so sending letters to your members of Congress has been made easy and will take you only a few minutes using the AAA online letter writing tool. The AAA online letter writing tool not only has letters already drafted for you to send but it will also automatically determine your members of Congress and will send the letters to them for you! You can also access the letter writing tool through the AAA homepage at www.the-aaa.org by clicking on "Write to Congress" in the "On Capitol Hill" box.

Please forward this e-mail to all members of your state ambulance association as well as your entire staff. The more letters that are sent the better.

About the Medicare Ambulance Payment Extension Act

The Medicare Ambulance Payment Extension Act (S. 1310, H.R. 2164) was introduced on May 3 in the Senate by Senators Charles Schumer (D-NY), Trent Lott (R-MS) and Kent Conrad (D-ND) and in the House by Representatives Mike McNulty (D-NY), Tom Reynolds (R-NY), Chip Pickering (R-MS) and Tom Allen (D-ME). The legislation would implement an across the board Medicare increase of 5% to all ambulance service providers regardless of the state or area in which the transport originated. The two-year relief would apply to just the base rate and not mileage and would commence on January 1, 2008 and expire on December 31, 2009. The legislation is being viewed as an extension of the relief lost from the expiring provisions of the Medicare Modernization Act (MMA) and would not impact the relief currently in place including the 50 plus mileage bump, the regional fee schedule adjustment or the super rural bonus payment. If enacted, S. 1310 and H.R. 2164 would result in an estimated $341 million in additional Medicare relief to ambulance service providers.

Please Write Your Members of Congress Today!

I thought I would add this for anyone else who is concerned about what Medicare is paying our services. I noticed that it was brought up several times here. It was sent to our crew by our EMS manager. I have already sent my letter. My thought is the more revenue my service makes the higher the possibility some of that may trickle down to me whether it's through a pay raise or help with my education.

Thanks for the time!