What is the right model?

So here’s the ever present question.  What is the right model for EMS?  Is it private for profit? non profit? hospital based? municipality? fire? third service?  PUM?  I think, unfortunately, that the stereotype of private EMS has a lot of credence to it.  Like the saying goes, stereotypes exist for a reason.

I think unfortunately, a lot of the stereotypes of private EMS are true.  But, not due to the fault of the medics/EMTs.  I think it rests more on the shoulders of those in charge of these groups.  They are the ones driving how these groups respond react to changes.

Maybe if they’d remember how to take care of the patients.  This emphasis in private EMS on customer service is ridiculous.  Perhaps we go back to the old adage of do the right thing for the patient and it will all work out.

I regularly interact with fire based, private, hospital based, even municipal based EMS providers. That being said it seems like the only ones that actively try and avoid work are the private providers.  You look at their rigs and how sadly equipped/supplied they are.  Look at the lack of attention to detailing of their vehicles exteriors.  Look at their ragtag looking uniforms. More so I watch these fire guys hustle in and out of the ER.  Same with the other municipal types and even the hospital based.

The private guys?  Not a chance.  Hanging out.  For excessive amounts of time.  And when is the only time they leave?  When one of two things happen.  Either they are finally ready to leave, or they’re being forced back out for something they feel is beneath them.

Now private guys out there, don’t get me wrong.  I’m sure you went into this with the best of intentions and wanted to help sick and hurting people.  Alleviate morbidity and mortality, all that good stuff.

What was that broke you?  Is it the soulless crushing monotonyhigh performance EMS system? Is it the endless parade of frequent flyers that even the fire systems don’t want to transport?  What is it?

Now for the fire guys, to be fair and all.  What is it with only giving the unwashed masses to the private guys for calls?  Why can’t we just send the closest car in multi service systems?

Better yet, why can’t we just actually issue contracts with actual teeth and consequences.  One provider is easier to control.  And if you write a good contract that’s fair those in “leadership” can make their precious profits and provide high quality, not “high performance” EMS.

Maybe someday we can get it right.  And stop burning out good medics.  Then maybe we can stop losing good medics to becoming RNs, MDs, MBAs, lawyers, etc.  And then we can finally move forward as an industry and become a true profession instead of just a skilled trade.

 

Rant done.

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Why are we doing this more and more?

So, the inimitable CCC over at Captain Chair Confessions got me thinking with his recent post These people got lights and siren responses  

Why is it, roughly 40 years into this grand experiment called EMS, that we seem to be responding more and more frequently to all manner of nonsense in a code 3 response?

This seems to fly in the face of reason, logic, and science.  I am just wondering why it is that we have many studies that seem to at the minimum, imply that increased use of emergency response proves to rarely provide a benefit and yet it goes on.

We are supposed to use science and reason and all manner of things, but we seem to flaunt it just as often.  I find it pretty damning that many times over the years we’ve even seen Jeff Clawson, of MPDS fame/infamy depending on your mindset, decry the overuse of code 3 responses.  If we have all this evidence pointing to less use of code 3 response, why do we feel the need to adhere to such silly things as 8 minute response time “standards”?  Especially when that “standard” isn’t the same from municipality to the next?

Maybe if we’re going to have all this science and evidence we could use it.  Just maybe.

Clawson, Jeff. “Unnecessary Lights and Siren Use: A Public Health Hazard.” International Academies of Emergenct Dispatch. N.p., Oct. 2002. Web. 11 Mar. 2014. <https://www.emergencydispatch.org/articles/uneslightnsiren.pdf&gt;.