How to operate EMS

(Graphic by Michael Dorame)

Michael Dorame

Heated discussion has taken place countless times throughout this county regarding how Emergency Medical Services should be run, and it seems almost all first responders have an opinion on the matter.

Some of the biggest debates have been between private verses fire department-run models.

One argument against private services is they’re all about money. Of course misuse of money is also a problem with many fire departments, just check out that chunky ‘medium duty’ ambulance compressing the cement in firehouses throughout the country.

Unless your patient is King Kong or Free Willy, what the heck?

But don’t unleash your rage on the rescue-Annie manikin just yet. I’m not saying all fire departments blow their money on shiny Mac-truck mammoth mods.

Going back to private services, I can say first hand that money does come into play. When I was working for one company, the owner constantly ran units with low oxygen and changed the tags on rigs to avoid payments while managing to keep them all looking ghetto-fabulous and committing enough Medicare fraud to buy an island.

When it comes down to it, good and bad management can be found in both fire departments and private services.

One danger that lurks within the fire department is viewing paramedic certification as simply a means to an end. Many aspiring firefighters look at medic school as their highway to the firehouse, as opposed to their life’s work, these people are dangerous.

The system Mission Viejo and Irvine use is one in which the Orange County Fire Authority contracts with private ambulance services to transport, while medics with the fire dept. run patient care.

They don’t have their own ambulances, and the crews on the private ambulances are capable of basic life support only, this results in rolling fire trucks needlessly.

It’s useless to roll a fire truck on a medical call, when all you need is an advanced life support ambulance. There are some medical calls that require more than two people, but certainly not all.

If some dude just jacked up his back because his kid thinks it’s cute to steal daddy’s chair, he doesn’t need the whole battalion giggling in his foyer.

But seriously, rolling engines when you don’t need to, sucks valuable resources away from places that really need it, and that’s not cool.

Quality of workers is another piece of the puzzle. Having Paramedics who are burnt-out, calloused and jaded can be a very serious concern in pre-hospital emergency care.

The public doesn’t want EMS workers that treat them like they’re on an episode of cops.

They also don’t want medics who drop the f-bomb every other word while strapping them down to the backboard. When I was with the private service I mentioned earlier, I knew an employee who had no problem cussing around the patients.

In general it seemed to me that more of the jaded variety worked with private companies. I think competition weeds these folks out somewhat, and the competition is found in the fire departments.

You want a medic who’s aware of the fact that atrioventricular nodal re-entrant tachycardia is indeed a form of paroxysmal supra-ventricular tachycardia. And I happen to think that better compensating jobs attract those kinds of medics, and the cash is with the fire departments.

As a side note, I think paying entry-level Emergency Medical Technicians poorly is also a problem. When fast-food workers receive the same McPaycheck that EMTs do, something is wrong.

Another factor that comes up with using a third service or private contracted service is that when communities get slapped with a Multi Casualty Incident, it’s easier to deal with less agencies rather than more.

Adding to the issues that come with using contracted services, paramedics don’t have their own units to get familiar with and stock appropriately since they use various ambulances that don’t belong to them.

What if Ricky Rescue, working for brand x ambulance service, just labeled everything in the rig with his neat-o organizing system, that only makes sense for traumas?

Yet another problem posed by using private providers along side the fire dept is camaraderie and R.E.S.P.E.C.T.

In my experience, sometimes fire medics just didn’t see private ambulance workers as part of their circle. While some treated EMT-1s as lowly peasants, kind of like physicians treat them, others treated them as brothers and sisters in duty, the later is necessary for the best possible pre-hospital care.

In conclusion, because of the fact that fire departments offer better benefits and pay, not to mention the higher competition than private services, and the fact that managing large emergencies is easier with less agencies and the belief that medics should know their own units, I believe the most effective way to operate EMS is by a fire department, using its own ambulances, manned by two EMT-P level personnel, with a system of dispatching additional ALS units and fire engines only when needed.

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