The Private Ambulance Service Thread

[Dustdevil]

Maybe you just don't recall the early EMS system and that leads you to criticize the comments of someone who has been there and what exists for you is percieved as the "Norm". Who knows, but I am done with this.

We're about the same age, but I've got about a decade of experience on you. That's a long time, but I remember those early days like they were yesterday. I have seen good and bad services of every sort in every sort of environment. Public, private, hospital, PUM, military, rural, urban, suburban, whatever. Been there, done that. You're not going to tell me anything about this business that I do not know.

Your thoughts about what the general public thinks are equally incorrect. The general public has no concept of differences between public and private EMS. All ambulances and all medics look the same to them. That's why they flag down granny tote cars at MVAs. That's why they give transfer jockeys discounts at Dairy Queen. That's why people think transfer jockeys are firemen. That's why they think all firemen are paramedics. And that's why they still call firemen "ambulance drivers." The "general public" simply has no clue. If they did, EMS would be well into the 21st Century by now.

The point remains, a lot of services do indeed suck. You are right about that. But you would have to be naive or -- yes -- ignorant to assert that this is exclusive to private services, or that the majority of private services who provide 911 EMS as their primary business are only interested in tranfers. I don't know where you have spent your 23 years of service, but that sort of perspective usually comes only from the lifelong, small-town, rural provider that has never seen what is going on in the rest of the world. I do know. And if you want to know what is going on in the rest of the world -- which is quite possibly the greatest benefit of participation at EMT City -- then please stick around.

You do, however, touch on a belief of mine that I have taken a lot of criticism for myself over the years. That belief is that private, non-911, transfer services are very definitely NOT part of EMS, should not be representing themselves as EMS, should not even be regulated as EMS. Just like being a firemonkey, transfer work should be a completely separate industry and job from EMS with no cross-pollination. They should not be required to have any EMS training at all and regulated the same way buses and taxis are regulated. It would have a PROFOUNDLY positive effect on EMS as both an industry and a profession if non-emergency transfer ambulances were completely deleted from the realm of EMS and made its own, stand-alone industry with separate standards and regulation. Unfortunately, you are correct that those who run the 911 privates would fight that tooth and nail because they desperately want those milk runs to supplement their cash flow. However, there is no denying that continuing to mix the two industries does indeed hurt the professional growth of EMS, and even hurts the growth of PRIVATE EMS, because they will forever be saddled with the negative image you speak of.

Mr. Dukat, I would be interested in your thoughts on that last paragraph.

[HellsBells]

And, of course, there haven't been paramedics in Alberta for "over 30 years."

I know that this line is meant tongue in cheek, but are you trying to suggest Alberta has weak Paramedics?

Just like being a firemonkey, transfer work should be a completely separate industry and job from EMS with no cross-pollination. They should not be required to have any EMS training at all and regulated the same way buses and taxis are regulated. It would have a PROFOUNDLY positive effect on EMS as both an industry and a profession if non-emergency transfer ambulances were completely deleted from the realm of EMS and made its own, stand-alone industry with separate standards and regulation.

I agree, transfer services are kind of the red headed step child of EMS. Here in Calgary there is a service kind of similar to what you suggest, who take stable patients to and from appointments, doctors office, etc. The employees require first aid training and supply oxygen, providing the patient is on it at home.

Just to clarify your position Dust, I assume when you mean these people should have no formal EMS training, that they receive some other medical training, so that they are able to perform medical interventions during transport for those patients who aren't strictly BLS?

[JakeEMTP]

.

Just to clarify your position Dust, I assume when you mean these people should have no formal EMS training, that they receive some other medical training, so that they are able to perform medical interventions during transport for those patients who aren't strictly BLS?

Aren't pt's that require more than strictly BLS transports and some form of advanced care really ALS transports though?

I do not pretend to know how things work in Canada as I moved to the US prior to my involvement with EMS. In our little corner of the world we have BLS and ALS transports as I'm sure you do also. Any patient that requires more than basic transportation ( no pun intended )ie: hospital discharge, trip to MD's office etc. would be on a ambulance with at minimum 2 Paramedics, more likely than not, a RN and a Medic.

[Dustdevil]

I know that this line is meant tongue in cheek, but are you trying to suggest Alberta has weak Paramedics?

Absolutely not! I would be the last person here at EMT City to suggest that!

Besides, BC holds that dubious distinction.

Just to clarify your position Dust, I assume when you mean these people should have no formal EMS training, that they receive some other medical training, so that they are able to perform medical interventions during transport for those patients who aren't strictly BLS?

Either people need medical transportation (an ambulance), or they need a horizontal taxi. One or the other. Once those horizontal taxis are no longer called "ambulances," people will have no problem making that distinction. In Ontario, transfer jockeys are not required to have any formal medical training. But, then again, there are no private EMS services in Ontario, so there is no need for EMS services to do transfers for the money as is done in Alberta.

Again, separation would eliminate the conflict of interest between the two and allow each to focus on one thing and do it well, as well as forcing both the public, the government, and the insurance industry to recognise the two industries separately for the purpose of regulation and reimbursement.

[Gerry314]

We're about the same age, but I've got about a decade of experience on you. That's a long time, but I remember those early days like they were yesterday. I have seen good and bad services of every sort in every sort of environment. Public, private, hospital, PUM, military, rural, urban, suburban, whatever. Been there, done that. You're not going to tell me anything about this business that I do not know.

Your thoughts about what the general public thinks are equally incorrect. The general public has no concept of differences between public and private EMS. All ambulances and all medics look the same to them. That's why they flag down granny tote cars at MVAs. That's why they give transfer jockeys discounts at Dairy Queen. That's why people think transfer jockeys are firemen. That's why they think all firemen are paramedics. And that's why they still call firemen "ambulance drivers." The "general public" simply has no clue. If they did, EMS would be well into the 21st Century by now.

The point remains, a lot of services do indeed suck. You are right about that. But you would have to be naive or -- yes -- ignorant to assert that this is exclusive to private services, or that the majority of private services who provide 911 EMS as their primary business are only interested in tranfers. I don't know where you have spent your 23 years of service, but that sort of perspective usually comes only from the lifelong, small-town, rural provider that has never seen what is going on in the rest of the world. I do know. And if you want to know what is going on in the rest of the world -- which is quite possibly the greatest benefit of participation at EMT City -- then please stick around.

You do, however, touch on a belief of mine that I have taken a lot of criticism for myself over the years. That belief is that private, non-911, transfer services are very definitely NOT part of EMS, should not be representing themselves as EMS, should not even be regulated as EMS. Just like being a firemonkey, transfer work should be a completely separate industry and job from EMS with no cross-pollination. They should not be required to have any EMS training at all and regulated the same way buses and taxis are regulated. It would have a PROFOUNDLY positive effect on EMS as both an industry and a profession if non-emergency transfer ambulances were completely deleted from the realm of EMS and made its own, stand-alone industry with separate standards and regulation. Unfortunately, you are correct that those who run the 911 privates would fight that tooth and nail because they desperately want those milk runs to supplement their cash flow. However, there is no denying that continuing to mix the two industries does indeed hurt the professional growth of EMS, and even hurts the growth of PRIVATE EMS, because they will forever be saddled with the negative image you speak of.

Mr. Dukat, I would be interested in your thoughts on that last paragraph.

What is suggested in the last paragraph I agree with. At least then when you work for transfer service there are no expectations of being a EMT or Paramedic.

You said it yourself in attempting to prove me incorrect about the view of the public that the public is uneducated about EMS so they view as all the same. You made my case with your contribution. Do you think they would hold a transfer jockey in as high esteem as they do a crisis EMT or Paramedic if they were made aware?

The one flaw in your example is there isn't any distinction drawn between the "granny tote cars" and ambulances that provide EMS. They are all one and the same. The problem I have is in the fact that the EMT's and Paramedics doing this job today don't have a choice in how they are utilized and it has evolved in commercial EMS that more and more of these ambulances are becoming the "granny tote cars". An ambulance that just completed a cardiac arrest, would immediately be dispatched to three or more transfers before seeing their next emergency call, and if the next emergency occurs after receiving a transfer the commercial EMS provider would be mandated to take the transfer over the emergency call under the threat of refusal to do a dispatched call.

I have unwavering respect for the author of this rebuttal for his 30+ years. He is obviously my senior in service longevity so it would be inappropriate for me to discount his expert opinion. You are a credit to the field of EMS and I humbly accept your perspective.

[Dustdevil]

Thanks, Bro. Your points are valid and all too infrequently addressed here. Actually, I think we are really on the same page here. You're just a little more fed up and emotional about it than I, lol. I been there too, though, so I know how it feels.

Again, I'd like to hear Mr. Dukat's thoughts on the subject of completely separating the transfer and EMS industries, leaving a more clear deliniation between ambulances and horizontal taxis. That would give the private EMS industry more respect, as well as giving EMS in general more respect. Yes, I know it would take a little gravy off of their plate, but I firmly believe that success requires us to do only ONE thing and do it well, and leave the rest to somebody else.

[riskynremtp]

Very well put devil. :wink: