Re: [Fwd: Private services & 911 (long!)]

[Guest guest]

This post by is required

reading.

Those of us at the "grunt level" of EMS

have a vested interest in this post. We are the ones who allow the

corporate managers of EMS companies to inflict their destructive policies

upon the patients they serve and upon us.

This happens because: We have no organization.

We have no input into the decisions to award contracts. Yet, we're

the people who have to fulfill those contracts, according to the rules

we're required to live by, rules that are made by SUITS.

It's our own fault. We have no gripe

againse anybody but ourselves. We've relinquished control to others.

We didn't and don't have to do that, but we do it because we absolutely

refuse to organize.

Gene

E. Gandy, JD, EMT-P

EMS Professions Program Director

Tyler Junior College

Tyler, TX

ggan@...

Check out our website at: http://www.tyler.cc.tx.us/emmt/

My vision for our profession precludes the

involvement by entities such as these we speak of here. Healthcare

should be

patient oriented, and standard of care should be patient driven.

Decisions

regarding patient care should be made in the field, not in the

boardroom.

Patient outcome must be our primary focus. Of course the cost

must be

considered, but it should be secondary. >>

Well, you certainly are a brave soul. Well said. After what

will certainly

turn out to be less-than-adequate consideration, I have decided to

wade in

here with you and make some statements that will probably *not* get

me elected

to the Board of Directors of the American Ambulance Association.

After spending many years of my career attempting to coax for-profit

entities

to embrace even simple patient care oriented advancements, mostly

unsuccessfully, I find myself resolved and committed to a similar opinion.

I do believe that for-profit ambulance services have a place....in the

non-

emergent transport business. I believe that there is *no* place

for such

agencies in the emergency realm. I propose that non-emergency

("transfer")

work and emergency ("911") response are **two different jobs**, requiring

different resources, system designs, personnel, and -- here's the kicker

to

the whole thing -- DIFFERENT FUNDING SYSTEMS.

I do not come to that opinion lightly or easily. My last job was

as the

Medical Control Director for Metrocrest Medical Services in Dallas.

In that

position, I was responsible for clinical practice and clinical quality

assurance/improvement for about 45 different EMS agencies, including

both an

AMR operation and an R/M operation, along with several public (paid

and

volunteer) agencies. I fought long and hard to convince our customer

cities

and the public EMS agencies that R/M and AMR could and would do as

good a job

as a public EMS service. At the same time, I fought the management

of the

private services to get them to do the job they told me they wanted

to do, and

that I was assuring the "outside world" they would do. The cities

and public

EMS agencies were very skeptical of the abilities of the private services,

despite my strenuous efforts.

Alas, as you might imagine, after 5 long years, I found something out:

the

public agencies were right. Neither AMR nor R/M had any intention

of truly

committing the resources necessary for quality EMS operations.

Unfortunately,

it was not a question of desire on their part, but rather of ability.

You

see, EMS is fundamentally not reimbursed appropriately for the level

of

staffing and equipment that is required to do the job right.

Also, the

problem is *not* with the EMS personnel who work for the private services,

who

are no different from public EMS workers, it is with the very structure

of

trying to fit a private entity (square peg) into a public service function

(round hole).

I use the following analogy to explain the problem to the public here;

to be

effective in EMS, we must be "armed for bear" every minute of every

day,

knowing (and hoping) that most of the time we will only be required

to hunt

for squirrels. However, every so often (more often than we like),

usually in

a situation that will result in high visibility and publicity, you

know what

we are faced with? A really big, hairy, bear. And if you're

carrying a

squirrel gun then, you're in deep doo-doo.

What do I mean by "armed for bear"? Here in Beaumont, we staff

our trucks

with 2 paramedics, both of which are required to have 2 years experience

BEFORE they work here, and both of which are paid fairly well.

We give them

good equipment, let them have the amenities they like (stations, 24/48

schedules, cool protocols) so they'll stay. We keep a free-floating

supervisor in a well-equipped vehicle in the system at all times.

We train

like the dickens, and pay dearly for an intense orientation program.

That

stuff is *very* expensive......arming for bear. Today I went

to a few calls

with my crews; a really difficult CPR and a MVC that required 3 ambulances.

Both of them were very challenging - honestly, many medics would not

have done

too well - and both went perfectly. Good thing we were armed

for bear, even

though the other 30 calls the system ran were squirrel hunts.

By the way,

these other calls were still *very* important and we needed to be there...but

they didn't necessarily require the level of resources we had available.

If you get the opportunity, I recommend that those of you who are seriously

interested in the future and pathway of our profession to read a paper

published by NHTSA called "EMS: Agenda for the Future." There

is a good

discussion of this paper in this month's "ls of Emergency Medicine."

These guys really hit it on the head. They note that we (EMS)

must be the

"medical safety net," closely tied to public health, public safety,

and

traditional health care. They also note that EMS, separate and

apart from

medical transport service, must be "funded for service to the community,"

NOT

financed for service to individuals.

So, if you're still with me, I appreciate you taking the time (better

part of

the week, it probably seems) to read my little dissertation.

I have my Nomex

underwear on, so flame away if it so pleases you. But this is

my story, and

I'm sticking to it.

By the way, the opinions stated here are DEFINITELY my own, and do not

reflect

the opinions or policies of my employer.

Thanks

EMS Manager

City of Beaumont Public Health

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

[Guest guest]

One of the keys to a successful Public EMS service, is to remain in the

public eye as much as possible. Go every school, Rotary Club meeting, Mended

Hearts, neighborhood watch meetings, etc. and present the facts concerning

your department. The equipment on your ambulance, the experience level of

your paramedics, the response time statistics, resuscitation stats, the

difference your tax dollar makes in cost of Public vs. cost of Private. Show

up at every Soccor tournament, BMX race, softball tournament and convince them

that you care about their health and well being. Go to their houses,

rearrange their medicines in a plastic pharmacology box that you brought at no

cost to them. When you are called to their house, glance around, is there

food in the pantry or refrigerator, are there health problems created by an

abnormal amount of unfed pets. When you leave, contact the agencies in your

public health department that can assist and talk to meals on wheels. Become

your Cities health partner. You will never have to remind them again what it

was like when you had Private Ambulances in the City and why they demanded

more. It also helps to have a Manager, a Medical Director with a vision and a

City Council that would have it no other way.

post was required reading Gene Gandy and it is a blessing to be

required to work for him each and every day.

Andy Foote, EMTP

Beaumont EMS

A Division of the Public Health Department

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

[Guest guest]

and what do you suppose we do?

Eddie (aka.texsmedic)

-----Original Message-----From: E. Gandy Sent: Tuesday, November 10, 1998 4:13 AMTo: TAEMSE-L@...; EMS List; TRAUMA-L@...Subject: [] Re: [Fwd: Private services & 911 (long!)]This post by is required reading. Those of us at the " grunt level " of EMS have a vested interest in this post. We are the ones who allow the corporate managers of EMS companies to inflict their destructive policies upon the patients they serve and upon us. This happens because: We have no organization. We have no input into the decisions to award contracts. Yet, we're the people who have to fulfill those contracts, according to the rules we're required to live by, rules that are made by SUITS. It's our own fault. We have no gripe againse anybody but ourselves. We've relinquished control to others. We didn't and don't have to do that, but we do it because we absolutely refuse to organize. Gene E. Gandy, JD, EMT-P EMS Professions Program Director Tyler Junior College Tyler, TX ggan@... Check out our website at: http://www.tyler.cc.tx.us/emmt/ My vision for our profession precludes the involvement by entities such as these we speak of here. Healthcare should be patient oriented, and standard of care should be patient driven. Decisions regarding patient care should be made in the field, not in the boardroom. Patient outcome must be our primary focus. Of course the cost must be considered, but it should be secondary. >> Well, you certainly are a brave soul. Well said. After what will certainly turn out to be less-than-adequate consideration, I have decided to wade in here with you and make some statements that will probably *not* get me elected to the Board of Directors of the American Ambulance Association. After spending many years of my career attempting to coax for-profit entities to embrace even simple patient care oriented advancements, mostly unsuccessfully, I find myself resolved and committed to a similar opinion. I do believe that for-profit ambulance services have a place....in the non- emergent transport business. I believe that there is *no* place for such agencies in the emergency realm. I propose that non-emergency ( " transfer " ) work and emergency ( " 911 " ) response are **two different jobs**, requiring different resources, system designs, personnel, and -- here's the kicker to the whole thing -- DIFFERENT FUNDING SYSTEMS. I do not come to that opinion lightly or easily. My last job was as the Medical Control Director for Metrocrest Medical Services in Dallas. In that position, I was responsible for clinical practice and clinical quality assurance/improvement for about 45 different EMS agencies, including both an AMR operation and an R/M operation, along with several public (paid and volunteer) agencies. I fought long and hard to convince our customer cities and the public EMS agencies that R/M and AMR could and would do as good a job as a public EMS service. At the same time, I fought the management of the private services to get them to do the job they told me they wanted to do, and that I was assuring the " outside world " they would do. The cities and public EMS agencies were very skeptical of the abilities of the private services, despite my strenuous efforts. Alas, as you might imagine, after 5 long years, I found something out: the public agencies were right. Neither AMR nor R/M had any intention of truly committing the resources necessary for quality EMS operations. Unfortunately, it was not a question of desire on their part, but rather of ability. You see, EMS is fundamentally not reimbursed appropriately for the level of staffing and equipment that is required to do the job right. Also, the problem is *not* with the EMS personnel who work for the private services, who are no different from public EMS workers, it is with the very structure of trying to fit a private entity (square peg) into a public service function (round hole). I use the following analogy to explain the problem to the public here; to be effective in EMS, we must be " armed for bear " every minute of every day, knowing (and hoping) that most of the time we will only be required to hunt for squirrels. However, every so often (more often than we like), usually in a situation that will result in high visibility and publicity, you know what we are faced with? A really big, hairy, bear. And if you're carrying a squirrel gun then, you're in deep doo-doo. What do I mean by " armed for bear " ? Here in Beaumont, we staff our trucks with 2 paramedics, both of which are required to have 2 years experience BEFORE they work here, and both of which are paid fairly well. We give them good equipment, let them have the amenities they like (stations, 24/48 schedules, cool protocols) so they'll stay. We keep a free-floating supervisor in a well-equipped vehicle in the system at all times. We train like the dickens, and pay dearly for an intense orientation program. That stuff is *very* expensive......arming for bear. Today I went to a few calls with my crews; a really difficult CPR and a MVC that required 3 ambulances. Both of them were very challenging - honestly, many medics would not have done too well - and both went perfectly. Good thing we were armed for bear, even though the other 30 calls the system ran were squirrel hunts. By the way, these other calls were still *very* important and we needed to be there...but they didn't necessarily require the level of resources we had available. If you get the opportunity, I recommend that those of you who are seriously interested in the future and pathway of our profession to read a paper published by NHTSA called " EMS: Agenda for the Future. " There is a good discussion of this paper in this month's " ls of Emergency Medicine. " These guys really hit it on the head. They note that we (EMS) must be the " medical safety net, " closely tied to public health, public safety, and traditional health care. They also note that EMS, separate and apart from medical transport service, must be " funded for service to the community, " NOT financed for service to individuals. So, if you're still with me, I appreciate you taking the time (better part of the week, it probably seems) to read my little dissertation. I have my Nomex underwear on, so flame away if it so pleases you. But this is my story, and I'm sticking to it. By the way, the opinions stated here are DEFINITELY my own, and do not reflect the opinions or policies of my employer. Thanks EMS Manager City of Beaumont Public Health ------------------------------------------------------------------------

[Guest guest]

So, Mr. Gandy...........(regarding your most recent post about

organization)........how do you suggest we organize to solve the problem. I

don't understand how it could ever happen. I know we need to start with

support for each other, rather than criticizing other people.....but what

comes next??????? Macara

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

[Guest guest]

Hidy, Eddie,

I suppose we form an organization of medics, pay a little bit of annual

dues (there are now 42,000 certified EMS people in Texas. At $25

apiece, that would amount to $1,050,000 to be spent on PI & E, lobbying

in the Legislature, and so on.

We ain't got no voice in the Lege an we need one.

Gene

Eddie on wrote:

and

what do you suppose we do? Eddie

(aka.texsmedic)

-----Original

Message-----

From: E.

Gandy

Sent: Tuesday, November

10, 1998 4:13 AM

To: TAEMSE-L@...;

EMS List; TRAUMA-L@...

Subject: []

Re: [Fwd: Private services & 911 (long!)]

This post by is required

reading.

Those of us at the "grunt level" of EMS

have a vested interest in this post. We are the ones who allow the

corporate managers of EMS companies to inflict their destructive policies

upon the patients they serve and upon us.

This happens because: We have no organization.

We have no input into the decisions to award contracts. Yet, we're

the people who have to fulfill those contracts, according to the rules

we're required to live by, rules that are made by SUITS.

It's our own fault. We have no gripe

againse anybody but ourselves. We've relinquished control to others.

We didn't and don't have to do that, but we do it because we absolutely

refuse to organize.

Gene

E. Gandy, JD, EMT-P

EMS Professions Program Director

Tyler Junior College

Tyler, TX

ggan@...

Check out our website at: http://www.tyler.cc.tx.us/emmt/

My vision for our profession precludes the

involvement by entities such as these we speak of here. Healthcare

should be

patient oriented, and standard of care should be patient driven.

Decisions

regarding patient care should be made in the field, not in the

boardroom.

Patient outcome must be our primary focus. Of course the cost

must be

considered, but it should be secondary. >>

Well, you certainly are a brave soul. Well said. After what

will certainly

turn out to be less-than-adequate consideration, I have decided to

wade in

here with you and make some statements that will probably *not* get

me elected

to the Board of Directors of the American Ambulance Association.

After spending many years of my career attempting to coax for-profit

entities

to embrace even simple patient care oriented advancements, mostly

unsuccessfully, I find myself resolved and committed to a similar opinion.

I do believe that for-profit ambulance services have a place....in the

non-

emergent transport business. I believe that there is *no* place

for such

agencies in the emergency realm. I propose that non-emergency

("transfer")

work and emergency ("911") response are **two different jobs**, requiring

different resources, system designs, personnel, and -- here's the kicker

to

the whole thing -- DIFFERENT FUNDING SYSTEMS.

I do not come to that opinion lightly or easily. My last job was

as the

Medical Control Director for Metrocrest Medical Services in Dallas.

In that

position, I was responsible for clinical practice and clinical quality

assurance/improvement for about 45 different EMS agencies, including

both an

AMR operation and an R/M operation, along with several public (paid

and

volunteer) agencies. I fought long and hard to convince our customer

cities

and the public EMS agencies that R/M and AMR could and would do as

good a job

as a public EMS service. At the same time, I fought the management

of the

private services to get them to do the job they told me they wanted

to do, and

that I was assuring the "outside world" they would do. The cities

and public

EMS agencies were very skeptical of the abilities of the private services,

despite my strenuous efforts.

Alas, as you might imagine, after 5 long years, I found something out:

the

public agencies were right. Neither AMR nor R/M had any intention

of truly

committing the resources necessary for quality EMS operations.

Unfortunately,

it was not a question of desire on their part, but rather of ability.

You

see, EMS is fundamentally not reimbursed appropriately for the level

of

staffing and equipment that is required to do the job right.

Also, the

problem is *not* with the EMS personnel who work for the private services,

who

are no different from public EMS workers, it is with the very structure

of

trying to fit a private entity (square peg) into a public service function

(round hole).

I use the following analogy to explain the problem to the public here;

to be

effective in EMS, we must be "armed for bear" every minute of every

day,

knowing (and hoping) that most of the time we will only be required

to hunt

for squirrels. However, every so often (more often than we like),

usually in

a situation that will result in high visibility and publicity, you

know what

we are faced with? A really big, hairy, bear. And if you're

carrying a

squirrel gun then, you're in deep doo-doo.

What do I mean by "armed for bear"? Here in Beaumont, we staff

our trucks

with 2 paramedics, both of which are required to have 2 years experience

BEFORE they work here, and both of which are paid fairly well.

We give them

good equipment, let them have the amenities they like (stations, 24/48

schedules, cool protocols) so they'll stay. We keep a free-floating

supervisor in a well-equipped vehicle in the system at all times.

We train

like the dickens, and pay dearly for an intense orientation program.

That

stuff is *very* expensive......arming for bear. Today I went

to a few calls

with my crews; a really difficult CPR and a MVC that required 3 ambulances.

Both of them were very challenging - honestly, many medics would not

have done

too well - and both went perfectly. Good thing we were armed

for bear, even

though the other 30 calls the system ran were squirrel hunts.

By the way,

these other calls were still *very* important and we needed to be there...but

they didn't necessarily require the level of resources we had available.

If you get the opportunity, I recommend that those of you who are seriously

interested in the future and pathway of our profession to read a paper

published by NHTSA called "EMS: Agenda for the Future." There

is a good

discussion of this paper in this month's "ls of Emergency Medicine."

These guys really hit it on the head. They note that we (EMS)

must be the

"medical safety net," closely tied to public health, public safety,

and

traditional health care. They also note that EMS, separate and

apart from

medical transport service, must be "funded for service to the community,"

NOT

financed for service to individuals.

So, if you're still with me, I appreciate you taking the time (better

part of

the week, it probably seems) to read my little dissertation.

I have my Nomex

underwear on, so flame away if it so pleases you. But this is

my story, and

I'm sticking to it.

By the way, the opinions stated here are DEFINITELY my own, and do not

reflect

the opinions or policies of my employer.

Thanks

EMS Manager

City of Beaumont Public Health

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

[Guest guest]

Thanks for you and what you do!

gg

Rachfoote@... wrote:

> One of the keys to a successful Public EMS service, is to remain in the

> public eye as much as possible. Go every school, Rotary Club meeting, Mended

> Hearts, neighborhood watch meetings, etc. and present the facts concerning

> your department. The equipment on your ambulance, the experience level of

> your paramedics, the response time statistics, resuscitation stats, the

> difference your tax dollar makes in cost of Public vs. cost of Private. Show

> up at every Soccor tournament, BMX race, softball tournament and convince them

> that you care about their health and well being. Go to their houses,

> rearrange their medicines in a plastic pharmacology box that you brought at no

> cost to them. When you are called to their house, glance around, is there

> food in the pantry or refrigerator, are there health problems created by an

> abnormal amount of unfed pets. When you leave, contact the agencies in your

> public health department that can assist and talk to meals on wheels. Become

> your Cities health partner. You will never have to remind them again what it

> was like when you had Private Ambulances in the City and why they demanded

> more. It also helps to have a Manager, a Medical Director with a vision and a

> City Council that would have it no other way.

>

> post was required reading Gene Gandy and it is a blessing to be

> required to work for him each and every day.

>

> Andy Foote, EMTP

> Beaumont EMS

> A Division of the Public Health Department

> ------------------------------------------------------------------------

>

>

[Guest guest]

sounds like a union!!!! How many EMS personnell do you think would go for that? If it would raise salaries and not decrease patient care, I'm all for it!!

Eddie (aka.texsmedic)

[] Re: [Fwd: Private services & 911 (long!)] This post by is required reading. Those of us at the " grunt level " of EMS have a vested interest in this post. We are the ones who allow the corporate managers of EMS companies to inflict their destructive policies upon the patients they serve and upon us. This happens because: We have no organization. We have no input into the decisions to award contracts. Yet, we're the people who have to fulfill those contracts, according to the rules we're required to live by, rules that are made by SUITS. It's our own fault. We have no gripe againse anybody but ourselves. We've relinquished control to others. We didn't and don't have to do that, but we do it because we absolutely refuse to organize. Gene E. Gandy, JD, EMT-P EMS Professions Program Director Tyler Junior College Tyler, TX ggan@... Check out our website at: http://www.tyler.cc.tx.us/emmt/ My vision for our profession precludes the involvement by entities such as these we speak of here. Healthcare should be patient oriented, and standard of care should be patient driven. Decisions regarding patient care should be made in the field, not in the boardroom. Patient outcome must be our primary focus. Of course the cost must be considered, but it should be secondary. >> Well, you certainly are a brave soul. Well said. After what will certainly turn out to be less-than-adequate consideration, I have decided to wade in here with you and make some statements that will probably *not* get me elected to the Board of Directors of the American Ambulance Association. After spending many years of my career attempting to coax for-profit entities to embrace even simple patient care oriented advancements, mostly unsuccessfully, I find myself resolved and committed to a similar opinion. I do believe that for-profit ambulance services have a place....in the non- emergent transport business. I believe that there is *no* place for such agencies in the emergency realm. I propose that non-emergency ( " transfer " ) work and emergency ( " 911 " ) response are **two different jobs**, requiring different resources, system designs, personnel, and -- here's the kicker to the whole thing -- DIFFERENT FUNDING SYSTEMS. I do not come to that opinion lightly or easily. My last job was as the Medical Control Director for Metrocrest Medical Services in Dallas. In that position, I was responsible for clinical practice and clinical quality assurance/improvement for about 45 different EMS agencies, including both an AMR operation and an R/M operation, along with several public (paid and volunteer) agencies. I fought long and hard to convince our customer cities and the public EMS agencies that R/M and AMR could and would do as good a job as a public EMS service. At the same time, I fought the management of the private services to get them to do the job they told me they wanted to do, and that I was assuring the " outside world " they would do. The cities and public EMS agencies were very skeptical of the abilities of the private services, despite my strenuous efforts. Alas, as you might imagine, after 5 long years, I found something out: the public agencies were right. Neither AMR nor R/M had any intention of truly committing the resources necessary for quality EMS operations. Unfortunately, it was not a question of desire on their part, but rather of ability. You see, EMS is fundamentally not reimbursed appropriately for the level of staffing and equipment that is required to do the job right. Also, the problem is *not* with the EMS personnel who work for the private services, who are no different from public EMS workers, it is with the very structure of trying to fit a private entity (square peg) into a public service function (round hole). I use the following analogy to explain the problem to the public here; to be effective in EMS, we must be " armed for bear " every minute of every day, knowing (and hoping) that most of the time we will only be required to hunt for squirrels. However, every so often (more often than we like), usually in a situation that will result in high visibility and publicity, you know what we are faced with? A really big, hairy, bear. And if you're carrying a squirrel gun then, you're in deep doo-doo. What do I mean by " armed for bear " ? Here in Beaumont, we staff our trucks with 2 paramedics, both of which are required to have 2 years experience BEFORE they work here, and both of which are paid fairly well. We give them good equipment, let them have the amenities they like (stations, 24/48 schedules, cool protocols) so they'll stay. We keep a free-floating supervisor in a well-equipped vehicle in the system at all times. We train like the dickens, and pay dearly for an intense orientation program. That stuff is *very* expensive......arming for bear. Today I went to a few calls with my crews; a really difficult CPR and a MVC that required 3 ambulances. Both of them were very challenging - honestly, many medics would not have done too well - and both went perfectly. Good thing we were armed for bear, even though the other 30 calls the system ran were squirrel hunts. By the way, these other calls were still *very* important and we needed to be there...but they didn't necessarily require the level of resources we had available. If you get the opportunity, I recommend that those of you who are seriously interested in the future and pathway of our profession to read a paper published by NHTSA called " EMS: Agenda for the Future. " There is a good discussion of this paper in this month's " ls of Emergency Medicine. " These guys really hit it on the head. They note that we (EMS) must be the " medical safety net, " closely tied to public health, public safety, and traditional health care. They also note that EMS, separate and apart from medical transport service, must be " funded for service to the community, " NOT financed for service to individuals. So, if you're still with me, I appreciate you taking the time (better part of the week, it probably seems) to read my little dissertation. I have my Nomex underwear on, so flame away if it so pleases you. But this is my story, and I'm sticking to it. By the way, the opinions stated here are DEFINITELY my own, and do not reflect the opinions or policies of my employer. Thanks EMS Manager City of Beaumont Public Health ------------------------------------------------------------------------

[Guest guest]

Well, Since we are all now using colors here I go. The Paramedics in Arlington and Grand Prairie, Texas voted in the union for some form of representation. To this date I can assure you that the union has not done much. Since the union has been voted in the atmosphere is just not the same. Some individuals have tried to use the union as a personal vandeta and not for the good of the entire department. I have no doubt that no matter what type of organization that you work for, if the management team and the field employees are willing to work together, much could be accomplished and the union would not be needed. Unfortunately, this does not always seem to happen and turmoil begins. As many of us know it seems to start at the bottom and slowly,if at all, work its way to the top.

Throughout my career, 10 years, I have worked for some small mom & pop companies to the large corporate ones. I am currently employed by R/M in Texas and have come to learn that talking with the upper management in a voice to be heard is always better at the smaller companies. One of the reasons that I believe this is due to the smaller companies are usually owned/operated by an individual that started from the bottom and worked his/her way up. They remember what it was like to try and have your voice heard and most do not want another individual to experience their turmoil. I can name a small company that I worked for here in the Metroplex for several years that desperately wanted to obtain an EMS contract. After a few attempts at obtaining one he finally did and the employees that he obtained were gratified. They had been working for a hospital base EMS service and never had a voice. With the new smaller operator coming in the employees were able to have a voice. Today it is a difficult system to get into due to very low turnover rate, employee satisfaction and being able to have a voice.

If there is a way to get upper management to hear our voices and take heart with what the employees are saying, MAYBE JUST MAYBE, EMS can go forward in a positive manner.

These expressions are solely my OWN personal beliefs!!!!

Sincerely,

Joby Berkley EMT-P

[] Re: [Fwd: Private services & 911 (long!)] This post by is required reading. Those of us at the " grunt level " of EMS have a vested interest in this post. We are the ones who allow the corporate managers of EMS companies to inflict their destructive policies upon the patients they serve and upon us. This happens because: We have no organization. We have no input into the decisions to award contracts. Yet, we're the people who have to fulfill those contracts, according to the rules we're required to live by, rules that are made by SUITS. It's our own fault. We have no gripe againse anybody but ourselves. We've relinquished control to others. We didn't and don't have to do that, but we do it because we absolutely refuse to organize. Gene E. Gandy, JD, EMT-P EMS Professions Program Director Tyler Junior College Tyler, TX ggan@... Check out our website at: http://www.tyler.cc.tx.us/emmt/ My vision for our profession precludes the involvement by entities such as these we speak of here. Healthcare should be patient oriented, and standard of care should be patient driven. Decisions regarding patient care should be made in the field, not in the boardroom. Patient outcome must be our primary focus. Of course the cost must be considered, but it should be secondary. >> Well, you certainly are a brave soul. Well said. After what will certainly turn out to be less-than-adequate consideration, I have decided to wade in here with you and make some statements that will probably *not* get me elected to the Board of Directors of the American Ambulance Association. After spending many years of my career attempting to coax for-profit entities to embrace even simple patient care oriented advancements, mostly unsuccessfully, I find myself resolved and committed to a similar opinion. I do believe that for-profit ambulance services have a place....in the non- emergent transport business. I believe that there is *no* place for such agencies in the emergency realm. I propose that non-emergency ( " transfer " ) work and emergency ( " 911 " ) response are **two different jobs**, requiring different resources, system designs, personnel, and -- here's the kicker to the whole thing -- DIFFERENT FUNDING SYSTEMS. I do not come to that opinion lightly or easily. My last job was as the Medical Control Director for Metrocrest Medical Services in Dallas. In that position, I was responsible for clinical practice and clinical quality assurance/improvement for about 45 different EMS agencies, including both an AMR operation and an R/M operation, along with several public (paid and volunteer) agencies. I fought long and hard to convince our customer cities and the public EMS agencies that R/M and AMR could and would do as good a job as a public EMS service. At the same time, I fought the management of the private services to get them to do the job they told me they wanted to do, and that I was assuring the " outside world " they would do. The cities and public EMS agencies were very skeptical of the abilities of the private services, despite my strenuous efforts. Alas, as you might imagine, after 5 long years, I found something out: the public agencies were right. Neither AMR nor R/M had any intention of truly committing the resources necessary for quality EMS operations. Unfortunately, it was not a question of desire on their part, but rather of ability. You see, EMS is fundamentally not reimbursed appropriately for the level of staffing and equipment that is required to do the job right. Also, the problem is *not* with the EMS personnel who work for the private services, who are no different from public EMS workers, it is with the very structure of trying to fit a private entity (square peg) into a public service function (round hole). I use the following analogy to explain the problem to the public here; to be effective in EMS, we must be " armed for bear " every minute of every day, knowing (and hoping) that most of the time we will only be required to hunt for squirrels. However, every so often (more often than we like), usually in a situation that will result in high visibility and publicity, you know what we are faced with? A really big, hairy, bear. And if you're carrying a squirrel gun then, you're in deep doo-doo. What do I mean by " armed for bear " ? Here in Beaumont, we staff our trucks with 2 paramedics, both of which are required to have 2 years experience BEFORE they work here, and both of which are paid fairly well. We give them good equipment, let them have the amenities they like (stations, 24/48 schedules, cool protocols) so they'll stay. We keep a free-floating supervisor in a well-equipped vehicle in the system at all times. We train like the dickens, and pay dearly for an intense orientation program. That stuff is *very* expensive......arming for bear. Today I went to a few calls with my crews; a really difficult CPR and a MVC that required 3 ambulances. Both of them were very challenging - honestly, many medics would not have done too well - and both went perfectly. Good thing we were armed for bear, even though the other 30 calls the system ran were squirrel hunts. By the way, these other calls were still *very* important and we needed to be there...but they didn't necessarily require the level of resources we had available. If you get the opportunity, I recommend that those of you who are seriously interested in the future and pathway of our profession to read a paper published by NHTSA called " EMS: Agenda for the Future. " There is a good discussion of this paper in this month's " ls of Emergency Medicine. " These guys really hit it on the head. They note that we (EMS) must be the " medical safety net, " closely tied to public health, public safety, and traditional health care. They also note that EMS, separate and apart from medical transport service, must be " funded for service to the community, " NOT financed for service to individuals. So, if you're still with me, I appreciate you taking the time (better part of the week, it probably seems) to read my little dissertation. I have my Nomex underwear on, so flame away if it so pleases you. But this is my story, and I'm sticking to it. By the way, the opinions stated here are DEFINITELY my own, and do not reflect the opinions or policies of my employer. Thanks EMS Manager City of Beaumont Public Health ------------------------------------------------------------------------

[Guest guest]

I don't think union is the answer to the EMS question. That is the quickest

way to turn off the public support we want and need. If you think I have

an answer, think again. A well run EMS organization with a extremely large

membership would have a voice in Texas EMS. How do we accomplish this?

Hell I don't know. TAEMT went bust the EMS educator society went bust.

The current educator group is off to a slow start. Ron's new group is moving

slowly. We as a breed (ECA's, EMT's, EMT-I's and Paramedics and soon Licensed

Paramedics fail to get involved. To many individual agendas.

We can not blame the private or public providers for not supporting

us, we don't support ourselves. We remain fragmented because we are continually

struggling in our individual environments.

It is my understanding that TAEMT still has some funds available. Why

not attempt to revive a the organization with some new blood. Folks that

have nothing to gain other than improving the status of EMS professionals

across the state. Focus on having a voice in government. We don't need

to have another symposium, the one we have is excellent.

Well I guess I will stop here and see what kind of response I get from

this post and see where it takes us.

Lets whip this up a little folks.

Henry

Eddie on wrote:

sounds

like a union!!!! How many EMS personnell do you think would go for

that? If it would raise salaries and not decrease patient care, I'm

all for it!! Eddie

(aka.texsmedic)

-----Original

Message-----

From: E.

Gandy

Sent: Wednesday,

November 11, 1998 3:30 AM

To: egroups

Subject: []

Re: [Fwd: Private services & 911 (long!)]

Hidy, Eddie,

I suppose we form an organization of medics, pay a little bit of annual

dues (there are now 42,000 certified EMS people in Texas. At $25

apiece, that would amount to $1,050,000 to be spent on PI & E, lobbying

in the Legislature, and so on.

We ain't got no voice in the Lege an we need one.

Gene

Eddie on wrote:

and

what do you suppose we do? Eddie

(aka.texsmedic)

-----Original

Message-----

From: E.

Gandy

Sent: Tuesday, November

10, 1998 4:13 AM

To: TAEMSE-L@...;

EMS List; TRAUMA-L@...

Subject: []

Re: [Fwd: Private services & 911 (long!)]

This post by is required

reading.

Those of us at the "grunt level" of EMS

have a vested interest in this post. We are the ones who allow the

corporate managers of EMS companies to inflict their destructive policies

upon the patients they serve and upon us.

This happens because: We have no organization.

We have no input into the decisions to award contracts. Yet, we're

the people who have to fulfill those contracts, according to the rules

we're required to live by, rules that are made by SUITS.

It's our own fault. We have no gripe

againse anybody but ourselves. We've relinquished control to others.

We didn't and don't have to do that, but we do it because we absolutely

refuse to organize.

Gene

E. Gandy, JD, EMT-P

EMS Professions Program Director

Tyler Junior College

Tyler, TX

ggan@...

Check out our website at: http://www.tyler.cc.tx.us/emmt/

My vision for our profession precludes the

involvement by entities such as these we speak of here. Healthcare

should be

patient oriented, and standard of care should be patient driven.

Decisions

regarding patient care should be made in the field, not in the

boardroom.

Patient outcome must be our primary focus. Of course the cost

must be

considered, but it should be secondary. >>

Well, you certainly are a brave soul. Well said. After what

will certainly

turn out to be less-than-adequate consideration, I have decided to

wade in

here with you and make some statements that will probably *not* get

me elected

to the Board of Directors of the American Ambulance Association.

After spending many years of my career attempting to coax for-profit

entities

to embrace even simple patient care oriented advancements, mostly

unsuccessfully, I find myself resolved and committed to a similar opinion.

I do believe that for-profit ambulance services have a place....in the

non-

emergent transport business. I believe that there is *no* place

for such

agencies in the emergency realm. I propose that non-emergency

("transfer")

work and emergency ("911") response are **two different jobs**, requiring

different resources, system designs, personnel, and -- here's the kicker

to

the whole thing -- DIFFERENT FUNDING SYSTEMS.

I do not come to that opinion lightly or easily. My last job was

as the

Medical Control Director for Metrocrest Medical Services in Dallas.

In that

position, I was responsible for clinical practice and clinical quality

assurance/improvement for about 45 different EMS agencies, including

both an

AMR operation and an R/M operation, along with several public (paid

and

volunteer) agencies. I fought long and hard to convince our customer

cities

and the public EMS agencies that R/M and AMR could and would do as

good a job

as a public EMS service. At the same time, I fought the management

of the

private services to get them to do the job they told me they wanted

to do, and

that I was assuring the "outside world" they would do. The cities

and public

EMS agencies were very skeptical of the abilities of the private services,

despite my strenuous efforts.

Alas, as you might imagine, after 5 long years, I found something out:

the

public agencies were right. Neither AMR nor R/M had any intention

of truly

committing the resources necessary for quality EMS operations.

Unfortunately,

it was not a question of desire on their part, but rather of ability.

You

see, EMS is fundamentally not reimbursed appropriately for the level

of

staffing and equipment that is required to do the job right.

Also, the

problem is *not* with the EMS personnel who work for the private services,

who

are no different from public EMS workers, it is with the very structure

of

trying to fit a private entity (square peg) into a public service function

(round hole).

I use the following analogy to explain the problem to the public here;

to be

effective in EMS, we must be "armed for bear" every minute of every

day,

knowing (and hoping) that most of the time we will only be required

to hunt

for squirrels. However, every so often (more often than we like),

usually in

a situation that will result in high visibility and publicity, you

know what

we are faced with? A really big, hairy, bear. And if you're

carrying a

squirrel gun then, you're in deep doo-doo.

What do I mean by "armed for bear"? Here in Beaumont, we staff

our trucks

with 2 paramedics, both of which are required to have 2 years experience

BEFORE they work here, and both of which are paid fairly well.

We give them

good equipment, let them have the amenities they like (stations, 24/48

schedules, cool protocols) so they'll stay. We keep a free-floating

supervisor in a well-equipped vehicle in the system at all times.

We train

like the dickens, and pay dearly for an intense orientation program.

That

stuff is *very* expensive......arming for bear. Today I went

to a few calls

with my crews; a really difficult CPR and a MVC that required 3 ambulances.

Both of them were very challenging - honestly, many medics would not

have done

too well - and both went perfectly. Good thing we were armed

for bear, even

though the other 30 calls the system ran were squirrel hunts.

By the way,

these other calls were still *very* important and we needed to be there...but

they didn't necessarily require the level of resources we had available.

If you get the opportunity, I recommend that those of you who are seriously

interested in the future and pathway of our profession to read a paper

published by NHTSA called "EMS: Agenda for the Future." There

is a good

discussion of this paper in this month's "ls of Emergency Medicine."

These guys really hit it on the head. They note that we (EMS)

must be the

"medical safety net," closely tied to public health, public safety,

and

traditional health care. They also note that EMS, separate and

apart from

medical transport service, must be "funded for service to the community,"

NOT

financed for service to individuals.

So, if you're still with me, I appreciate you taking the time (better

part of

the week, it probably seems) to read my little dissertation.

I have my Nomex

underwear on, so flame away if it so pleases you. But this is

my story, and

I'm sticking to it.

By the way, the opinions stated here are DEFINITELY my own, and do not

reflect

the opinions or policies of my employer.

Thanks

EMS Manager

City of Beaumont Public Health

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

[Guest guest]

Here it is again.

[] Re: [Fwd: Private services & 911 (long!)] This post by is required reading. Those of us at the " grunt level " of EMS have a vested interest in this post. We are the ones who allow the corporate managers of EMS companies to inflict their destructive policies upon the patients they serve and upon us. This happens because: We have no organization. We have no input into the decisions to award contracts. Yet, we're the people who have to fulfill those contracts, according to the rules we're required to live by, rules that are made by SUITS. It's our own fault. We have no gripe againse anybody but ourselves. We've relinquished control to others. We didn't and don't have to do that, but we do it because we absolutely refuse to organize. Gene E. Gandy, JD, EMT-P EMS Professions Program Director Tyler Junior College Tyler, TX ggan@... Check out our website at: http://www.tyler.cc.tx.us/emmt/ My vision for our profession precludes the involvement by entities such as these we speak of here. Healthcare should be patient oriented, and standard of care should be patient driven. Decisions regarding patient care should be made in the field, not in the boardroom. Patient outcome must be our primary focus. Of course the cost must be considered, but it should be secondary. >> Well, you certainly are a brave soul. Well said. After what will certainly turn out to be less-than-adequate consideration, I have decided to wade in here with you and make some statements that will probably *not* get me elected to the Board of Directors of the American Ambulance Association. After spending many years of my career attempting to coax for-profit entities to embrace even simple patient care oriented advancements, mostly unsuccessfully, I find myself resolved and committed to a similar opinion. I do believe that for-profit ambulance services have a place....in the non- emergent transport business. I believe that there is *no* place for such agencies in the emergency realm. I propose that non-emergency ( " transfer " ) work and emergency ( " 911 " ) response are **two different jobs**, requiring different resources, system designs, personnel, and -- here's the kicker to the whole thing -- DIFFERENT FUNDING SYSTEMS. I do not come to that opinion lightly or easily. My last job was as the Medical Control Director for Metrocrest Medical Services in Dallas. In that position, I was responsible for clinical practice and clinical quality assurance/improvement for about 45 different EMS agencies, including both an AMR operation and an R/M operation, along with several public (paid and volunteer) agencies. I fought long and hard to convince our customer cities and the public EMS agencies that R/M and AMR could and would do as good a job as a public EMS service. At the same time, I fought the management of the private services to get them to do the job they told me they wanted to do, and that I was assuring the " outside world " they would do. The cities and public EMS agencies were very skeptical of the abilities of the private services, despite my strenuous efforts. Alas, as you might imagine, after 5 long years, I found something out: the public agencies were right. Neither AMR nor R/M had any intention of truly committing the resources necessary for quality EMS operations. Unfortunately, it was not a question of desire on their part, but rather of ability. You see, EMS is fundamentally not reimbursed appropriately for the level of staffing and equipment that is required to do the job right. Also, the problem is *not* with the EMS personnel who work for the private services, who are no different from public EMS workers, it is with the very structure of trying to fit a private entity (square peg) into a public service function (round hole). I use the following analogy to explain the problem to the public here; to be effective in EMS, we must be " armed for bear " every minute of every day, knowing (and hoping) that most of the time we will only be required to hunt for squirrels. However, every so often (more often than we like), usually in a situation that will result in high visibility and publicity, you know what we are faced with? A really big, hairy, bear. And if you're carrying a squirrel gun then, you're in deep doo-doo. What do I mean by " armed for bear " ? Here in Beaumont, we staff our trucks with 2 paramedics, both of which are required to have 2 years experience BEFORE they work here, and both of which are paid fairly well. We give them good equipment, let them have the amenities they like (stations, 24/48 schedules, cool protocols) so they'll stay. We keep a free-floating supervisor in a well-equipped vehicle in the system at all times. We train like the dickens, and pay dearly for an intense orientation program. That stuff is *very* expensive......arming for bear. Today I went to a few calls with my crews; a really difficult CPR and a MVC that required 3 ambulances. Both of them were very challenging - honestly, many medics would not have done too well - and both went perfectly. Good thing we were armed for bear, even though the other 30 calls the system ran were squirrel hunts. By the way, these other calls were still *very* important and we needed to be there...but they didn't necessarily require the level of resources we had available. If you get the opportunity, I recommend that those of you who are seriously interested in the future and pathway of our profession to read a paper published by NHTSA called " EMS: Agenda for the Future. " There is a good discussion of this paper in this month's " ls of Emergency Medicine. " These guys really hit it on the head. They note that we (EMS) must be the " medical safety net, " closely tied to public health, public safety, and traditional health care. They also note that EMS, separate and apart from medical transport service, must be " funded for service to the community, " NOT financed for service to individuals. So, if you're still with me, I appreciate you taking the time (better part of the week, it probably seems) to read my little dissertation. I have my Nomex underwear on, so flame away if it so pleases you. But this is my story, and I'm sticking to it. By the way, the opinions stated here are DEFINITELY my own, and do not reflect the opinions or policies of my employer. Thanks EMS Manager City of Beaumont Public Health ------------------------------------------------------------------------

[Guest guest]

Well, since everyone (or a lot of us) is wanting an organization, maybe

everyone wanting an organization should get together somewhere in Austin

during the EMS Convention in a couple of weeks.

Until everyone gets their acts together, & get on the same page, with the

same agenda, everything will remain status-quoa.

Jay Hoskins

EMT

[] Re: [Fwd: Private services & 911 (long!)]

This post by is required reading.

Those of us at the " grunt level " of EMS have a vested interest

in this post. We are the ones who allow the corporate managers of EMS

companies to inflict their destructive policies upon the patients they serve

and upon us.

This happens because: We have no organization. We have no

input into the decisions to award contracts. Yet, we're the people who have

to fulfill those contracts, according to the rules we're required to live

by, rules that are made by SUITS.

It's our own fault. We have no gripe againse anybody but

ourselves. We've relinquished control to others. We didn't and don't have

to do that, but we do it because we absolutely refuse to organize.

Gene

E. Gandy, JD, EMT-P

EMS Professions Program Director

Tyler Junior College

Tyler, TX

ggan@...

Check out our website at: http://www.tyler.cc.tx.us/emmt/

My vision for our profession precludes the

involvement by entities such as these we speak of here.

Healthcare should be

patient oriented, and standard of care should be patient

driven. Decisions

regarding patient care should be made in the field, not in

the boardroom.

Patient outcome must be our primary focus. Of course the

cost must be

considered, but it should be secondary. >>

Well, you certainly are a brave soul. Well said. After

what will certainly

turn out to be less-than-adequate consideration, I have

decided to wade in

here with you and make some statements that will probably

*not* get me elected

to the Board of Directors of the American Ambulance

Association.

After spending many years of my career attempting to coax

for-profit entities

to embrace even simple patient care oriented advancements,

mostly

unsuccessfully, I find myself resolved and committed to a

similar opinion.

I do believe that for-profit ambulance services have a

place....in the non-

emergent transport business. I believe that there is *no*

place for such

agencies in the emergency realm. I propose that

non-emergency ( " transfer " )

work and emergency ( " 911 " ) response are **two different

jobs**, requiring

different resources, system designs, personnel, and --

here's the kicker to

the whole thing -- DIFFERENT FUNDING SYSTEMS.

I do not come to that opinion lightly or easily. My last

job was as the

Medical Control Director for Metrocrest Medical Services in

Dallas. In that

position, I was responsible for clinical practice and

clinical quality

assurance/improvement for about 45 different EMS agencies,

including both an

AMR operation and an R/M operation, along with several

public (paid and

volunteer) agencies. I fought long and hard to convince our

customer cities

and the public EMS agencies that R/M and AMR could and would

do as good a job

as a public EMS service. At the same time, I fought the

management of the

private services to get them to do the job they told me they

wanted to do, and

that I was assuring the " outside world " they would do. The

cities and public

EMS agencies were very skeptical of the abilities of the

private services,

despite my strenuous efforts.

Alas, as you might imagine, after 5 long years, I found

something out: the

public agencies were right. Neither AMR nor R/M had any

intention of truly

committing the resources necessary for quality EMS

operations. Unfortunately,

it was not a question of desire on their part, but rather of

ability. You

see, EMS is fundamentally not reimbursed appropriately for

the level of

staffing and equipment that is required to do the job right.

Also, the

problem is *not* with the EMS personnel who work for the

private services, who

are no different from public EMS workers, it is with the

very structure of

trying to fit a private entity (square peg) into a public

service function

(round hole).

I use the following analogy to explain the problem to the

public here; to be

effective in EMS, we must be " armed for bear " every minute

of every day,

knowing (and hoping) that most of the time we will only be

required to hunt

for squirrels. However, every so often (more often than we

like), usually in

a situation that will result in high visibility and

publicity, you know what

we are faced with? A really big, hairy, bear. And if

you're carrying a

squirrel gun then, you're in deep doo-doo.

What do I mean by " armed for bear " ? Here in Beaumont, we

staff our trucks

with 2 paramedics, both of which are required to have 2

years experience

BEFORE they work here, and both of which are paid fairly

well. We give them

good equipment, let them have the amenities they like

(stations, 24/48

schedules, cool protocols) so they'll stay. We keep a

free-floating

supervisor in a well-equipped vehicle in the system at all

times. We train

like the dickens, and pay dearly for an intense orientation

program. That

stuff is *very* expensive......arming for bear. Today I

went to a few calls

with my crews; a really difficult CPR and a MVC that

required 3 ambulances.

Both of them were very challenging - honestly, many medics

would not have done

too well - and both went perfectly. Good thing we were

armed for bear, even

though the other 30 calls the system ran were squirrel

hunts. By the way,

these other calls were still *very* important and we needed

to be there...but

they didn't necessarily require the level of resources we

had available.

If you get the opportunity, I recommend that those of you

who are seriously

interested in the future and pathway of our profession to

read a paper

published by NHTSA called " EMS: Agenda for the Future. "

There is a good

discussion of this paper in this month's " ls of

Emergency Medicine. "

These guys really hit it on the head. They note that we

(EMS) must be the

" medical safety net, " closely tied to public health, public

safety, and

traditional health care. They also note that EMS, separate

and apart from

medical transport service, must be " funded for service to

the community, " NOT

financed for service to individuals.

So, if you're still with me, I appreciate you taking the

time (better part of

the week, it probably seems) to read my little dissertation.

I have my Nomex

underwear on, so flame away if it so pleases you. But this

is my story, and

I'm sticking to it.

By the way, the opinions stated here are DEFINITELY my own,

and do not reflect

the opinions or policies of my employer.

Thanks

EMS Manager

City of Beaumont Public Health

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

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

[Guest guest]

Here's some good reading on the subject... Check out the August 1998 issue of Fire House Magazine article on AMR and Rural Metro.

Shiplet, AAS, EMT-P

EMS Coordinator

City of Whitewright

[] Re: [Fwd: Private services & 911 (long!)]This post by is required reading. Those of us at the " grunt level " of EMS have a vested interest in this post. We are the ones who allow the corporate managers of EMS companies to inflict their destructive policies upon the patients they serve and upon us. This happens because: We have no organization. We have no input into the decisions to award contracts. Yet, we're the people who have to fulfill those contracts, according to the rules we're required to live by, rules that are made by SUITS. It's our own fault. We have no gripe againse anybody but ourselves. We've relinquished control to others. We didn't and don't have to do that, but we do it because we absolutely refuse to organize. Gene E. Gandy, JD, EMT-P EMS Professions Program Director Tyler Junior College Tyler, TX ggan@... Check out our website at: http://www.tyler.cc.tx.us/emmt/ My vision for our profession precludes the involvement by entities such as these we speak of here. Healthcare should be patient oriented, and standard of care should be patient driven. Decisions regarding patient care should be made in the field, not in the boardroom. Patient outcome must be our primary focus. Of course the cost must be considered, but it should be secondary. >> Well, you certainly are a brave soul. Well said. After what will certainly turn out to be less-than-adequate consideration, I have decided to wade in here with you and make some statements that will probably *not* get me elected to the Board of Directors of the American Ambulance Association. After spending many years of my career attempting to coax for-profit entities to embrace even simple patient care oriented advancements, mostly unsuccessfully, I find myself resolved and committed to a similar opinion. I do believe that for-profit ambulance services have a place....in the non- emergent transport business. I believe that there is *no* place for such agencies in the emergency realm. I propose that non-emergency ( " transfer " ) work and emergency ( " 911 " ) response are **two different jobs**, requiring different resources, system designs, personnel, and -- here's the kicker to the whole thing -- DIFFERENT FUNDING SYSTEMS. I do not come to that opinion lightly or easily. My last job was as the Medical Control Director for Metrocrest Medical Services in Dallas. In that position, I was responsible for clinical practice and clinical quality assurance/improvement for about 45 different EMS agencies, including both an AMR operation and an R/M operation, along with several public (paid and volunteer) agencies. I fought long and hard to convince our customer cities and the public EMS agencies that R/M and AMR could and would do as good a job as a public EMS service. At the same time, I fought the management of the private services to get them to do the job they told me they wanted to do, and that I was assuring the " outside world " they would do. The cities and public EMS agencies were very skeptical of the abilities of the private services, despite my strenuous efforts. Alas, as you might imagine, after 5 long years, I found something out: the public agencies were right. Neither AMR nor R/M had any intention of truly committing the resources necessary for quality EMS operations. Unfortunately, it was not a question of desire on their part, but rather of ability. You see, EMS is fundamentally not reimbursed appropriately for the level of staffing and equipment that is required to do the job right. Also, the problem is *not* with the EMS personnel who work for the private services, who are no different from public EMS workers, it is with the very structure of trying to fit a private entity (square peg) into a public service function (round hole). I use the following analogy to explain the problem to the public here; to be effective in EMS, we must be " armed for bear " every minute of every day, knowing (and hoping) that most of the time we will only be required to hunt for squirrels. However, every so often (more often than we like), usually in a situation that will result in high visibility and publicity, you know what we are faced with? A really big, hairy, bear. And if you're carrying a squirrel gun then, you're in deep doo-doo. What do I mean by " armed for bear " ? Here in Beaumont, we staff our trucks with 2 paramedics, both of which are required to have 2 years experience BEFORE they work here, and both of which are paid fairly well. We give them good equipment, let them have the amenities they like (stations, 24/48 schedules, cool protocols) so they'll stay. We keep a free-floating supervisor in a well-equipped vehicle in the system at all times. We train like the dickens, and pay dearly for an intense orientation program. That stuff is *very* expensive......arming for bear. Today I went to a few calls with my crews; a really difficult CPR and a MVC that required 3 ambulances. Both of them were very challenging - honestly, many medics would not have done too well - and both went perfectly. Good thing we were armed for bear, even though the other 30 calls the system ran were squirrel hunts. By the way, these other calls were still *very* important and we needed to be there...but they didn't necessarily require the level of resources we had available. If you get the opportunity, I recommend that those of you who are seriously interested in the future and pathway of our profession to read a paper published by NHTSA called " EMS: Agenda for the Future. " There is a good discussion of this paper in this month's " ls of Emergency Medicine. " These guys really hit it on the head. They note that we (EMS) must be the " medical safety net, " closely tied to public health, public safety, and traditional health care. They also note that EMS, separate and apart from medical transport service, must be " funded for service to the community, " NOT financed for service to individuals. So, if you're still with me, I appreciate you taking the time (better part of the week, it probably seems) to read my little dissertation. I have my Nomex underwear on, so flame away if it so pleases you. But this is my story, and I'm sticking to it. By the way, the opinions stated here are DEFINITELY my own, and do not reflect the opinions or policies of my employer. Thanks EMS Manager City of Beaumont Public Health ------------------------------------------------------------------------

[Guest guest]

Gene,

Why not ask the employees of RM-Grand Prairie about the Union-busting

tactics that are being wrought there by RM? That's why so many fear

joining an association.

E. Gandy wrote:

>

> Hidy, Eddie,

>

> I suppose we form an organization of medics, pay a little bit of

> annual dues (there are now 42,000 certified EMS people in Texas. At

> $25 apiece, that would amount to $1,050,000 to be spent on PI & E,

> lobbying in the Legislature, and so on.

>

> We ain't got no voice in the Lege an we need one.

>

> Gene

--

, FF/NREMTP

“Live your life. Respect its brevity”

medic720@...

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

[Guest guest]

Go ahead. Ask me. I work for R/M Grand Prairie.

Joby Berkley

[] Re: [Fwd: Private services & 911 (long!)]

>Gene,

>Why not ask the employees of RM-Grand Prairie about the Union-busting

>tactics that are being wrought there by RM? That's why so many fear

>joining an association.

>

> E. Gandy wrote:

>>

>> Hidy, Eddie,

>>

>> I suppose we form an organization of medics, pay a little bit of

>> annual dues (there are now 42,000 certified EMS people in Texas. At

>> $25 apiece, that would amount to $1,050,000 to be spent on PI & E,

>> lobbying in the Legislature, and so on.

>>

>> We ain't got no voice in the Lege an we need one.

>>

>> Gene

>--

> , FF/NREMTP

>“Live your life. Respect its brevity”

>medic720@...

>------------------------------------------------------------------------

>

>

>

[Guest guest]

,

The web site for Fire House Magazine will not be online until December. Can you briefly explain what the context of the article is about?

Joby Berkley EMT-P

[] Re: [Fwd: Private services & 911 (long!)]This post by is required reading. Those of us at the " grunt level " of EMS have a vested interest in this post. We are the ones who allow the corporate managers of EMS companies to inflict their destructive policies upon the patients they serve and upon us. This happens because: We have no organization. We have no input into the decisions to award contracts. Yet, we're the people who have to fulfill those contracts, according to the rules we're required to live by, rules that are made by SUITS. It's our own fault. We have no gripe againse anybody but ourselves. We've relinquished control to others. We didn't and don't have to do that, but we do it because we absolutely refuse to organize. Gene E. Gandy, JD, EMT-P EMS Professions Program Director Tyler Junior College Tyler, TX ggan@... Check out our website at: http://www.tyler.cc.tx.us/emmt/ My vision for our profession precludes the involvement by entities such as these we speak of here. Healthcare should be patient oriented, and standard of care should be patient driven. Decisions regarding patient care should be made in the field, not in the boardroom. Patient outcome must be our primary focus. Of course the cost must be considered, but it should be secondary. >> Well, you certainly are a brave soul. Well said. After what will certainly turn out to be less-than-adequate consideration, I have decided to wade in here with you and make some statements that will probably *not* get me elected to the Board of Directors of the American Ambulance Association. After spending many years of my career attempting to coax for-profit entities to embrace even simple patient care oriented advancements, mostly unsuccessfully, I find myself resolved and committed to a similar opinion. I do believe that for-profit ambulance services have a place....in the non- emergent transport business. I believe that there is *no* place for such agencies in the emergency realm. I propose that non-emergency ( " transfer " ) work and emergency ( " 911 " ) response are **two different jobs**, requiring different resources, system designs, personnel, and -- here's the kicker to the whole thing -- DIFFERENT FUNDING SYSTEMS. I do not come to that opinion lightly or easily. My last job was as the Medical Control Director for Metrocrest Medical Services in Dallas. In that position, I was responsible for clinical practice and clinical quality assurance/improvement for about 45 different EMS agencies, including both an AMR operation and an R/M operation, along with several public (paid and volunteer) agencies. I fought long and hard to convince our customer cities and the public EMS agencies that R/M and AMR could and would do as good a job as a public EMS service. At the same time, I fought the management of the private services to get them to do the job they told me they wanted to do, and that I was assuring the " outside world " they would do. The cities and public EMS agencies were very skeptical of the abilities of the private services, despite my strenuous efforts. Alas, as you might imagine, after 5 long years, I found something out: the public agencies were right. Neither AMR nor R/M had any intention of truly committing the resources necessary for quality EMS operations. Unfortunately, it was not a question of desire on their part, but rather of ability. You see, EMS is fundamentally not reimbursed appropriately for the level of staffing and equipment that is required to do the job right. Also, the problem is *not* with the EMS personnel who work for the private services, who are no different from public EMS workers, it is with the very structure of trying to fit a private entity (square peg) into a public service function (round hole). I use the following analogy to explain the problem to the public here; to be effective in EMS, we must be " armed for bear " every minute of every day, knowing (and hoping) that most of the time we will only be required to hunt for squirrels. However, every so often (more often than we like), usually in a situation that will result in high visibility and publicity, you know what we are faced with? A really big, hairy, bear. And if you're carrying a squirrel gun then, you're in deep doo-doo. What do I mean by " armed for bear " ? Here in Beaumont, we staff our trucks with 2 paramedics, both of which are required to have 2 years experience BEFORE they work here, and both of which are paid fairly well. We give them good equipment, let them have the amenities they like (stations, 24/48 schedules, cool protocols) so they'll stay. We keep a free-floating supervisor in a well-equipped vehicle in the system at all times. We train like the dickens, and pay dearly for an intense orientation program. That stuff is *very* expensive......arming for bear. Today I went to a few calls with my crews; a really difficult CPR and a MVC that required 3 ambulances. Both of them were very challenging - honestly, many medics would not have done too well - and both went perfectly. Good thing we were armed for bear, even though the other 30 calls the system ran were squirrel hunts. By the way, these other calls were still *very* important and we needed to be there...but they didn't necessarily require the level of resources we had available. If you get the opportunity, I recommend that those of you who are seriously interested in the future and pathway of our profession to read a paper published by NHTSA called " EMS: Agenda for the Future. " There is a good discussion of this paper in this month's " ls of Emergency Medicine. " These guys really hit it on the head. They note that we (EMS) must be the " medical safety net, " closely tied to public health, public safety, and traditional health care. They also note that EMS, separate and apart from medical transport service, must be " funded for service to the community, " NOT financed for service to individuals. So, if you're still with me, I appreciate you taking the time (better part of the week, it probably seems) to read my little dissertation. I have my Nomex underwear on, so flame away if it so pleases you. But this is my story, and I'm sticking to it. By the way, the opinions stated here are DEFINITELY my own, and do not reflect the opinions or policies of my employer. Thanks EMS Manager City of Beaumont Public Health ------------------------------------------------------------------------

[Guest guest]

I'm really not pro-union. Perhaps because I used to do labor law

on the side of management, but I always felt the unions took a lot more

in dues than they gave back in advantages. Plus, the big weapon in

the union's arsenal is the strike, which absolutely could never be done

in EMS (although in England the "ambulance drivers" seem to do it quite

often).

I'm thinking more along the lines of a professional association similar

to the Texas Bar Association or the Texas Medical Association. We

need lobbying activities in the Lege in the worst way. The AAA and

TAA have them; the hospitals have them; the doctors, lawyers and nurses

have them, so why shouldn't we?

The trick is in the formation of the association. It should begin

with a broad base of support from all around the state and should not cater

to any certain faction. Perhaps legislation is needed to make membership

mandatory for licensed and certified medics, as the Bar Association is

for lawyers. In the Bar Association, elections are held by secret

mail ballot, and this works very well. There is a non-political staff

to carry out everyday functions.

What do you think about that sort of plan?

Gene G.

Eddie on wrote:

sounds

like a union!!!! How many EMS personnell do you think would go for

that? If it would raise salaries and not decrease patient care, I'm

all for it!! Eddie

(aka.texsmedic)

-----Original

Message-----

From: E.

Gandy

Sent: Wednesday,

November 11, 1998 3:30 AM

To: egroups

Subject: []

Re: [Fwd: Private services & 911 (long!)]

Hidy, Eddie,

I suppose we form an organization of medics, pay a little bit of annual

dues (there are now 42,000 certified EMS people in Texas. At $25

apiece, that would amount to $1,050,000 to be spent on PI & E, lobbying

in the Legislature, and so on.

We ain't got no voice in the Lege an we need one.

Gene

Eddie on wrote:

and

what do you suppose we do? Eddie

(aka.texsmedic)

-----Original

Message-----

From: E.

Gandy

Sent: Tuesday, November

10, 1998 4:13 AM

To: TAEMSE-L@...;

EMS List; TRAUMA-L@...

Subject: []

Re: [Fwd: Private services & 911 (long!)]

This post by is required

reading.

Those of us at the "grunt level" of EMS

have a vested interest in this post. We are the ones who allow the

corporate managers of EMS companies to inflict their destructive policies

upon the patients they serve and upon us.

This happens because: We have no organization.

We have no input into the decisions to award contracts. Yet, we're

the people who have to fulfill those contracts, according to the rules

we're required to live by, rules that are made by SUITS.

It's our own fault. We have no gripe

againse anybody but ourselves. We've relinquished control to others.

We didn't and don't have to do that, but we do it because we absolutely

refuse to organize.

Gene

E. Gandy, JD, EMT-P

EMS Professions Program Director

Tyler Junior College

Tyler, TX

ggan@...

Check out our website at: http://www.tyler.cc.tx.us/emmt/

My vision for our profession precludes the

involvement by entities such as these we speak of here. Healthcare

should be

patient oriented, and standard of care should be patient driven.

Decisions

regarding patient care should be made in the field, not in the

boardroom.

Patient outcome must be our primary focus. Of course the cost

must be

considered, but it should be secondary. >>

Well, you certainly are a brave soul. Well said. After what

will certainly

turn out to be less-than-adequate consideration, I have decided to

wade in

here with you and make some statements that will probably *not* get

me elected

to the Board of Directors of the American Ambulance Association.

After spending many years of my career attempting to coax for-profit

entities

to embrace even simple patient care oriented advancements, mostly

unsuccessfully, I find myself resolved and committed to a similar opinion.

I do believe that for-profit ambulance services have a place....in the

non-

emergent transport business. I believe that there is *no* place

for such

agencies in the emergency realm. I propose that non-emergency

("transfer")

work and emergency ("911") response are **two different jobs**, requiring

different resources, system designs, personnel, and -- here's the kicker

to

the whole thing -- DIFFERENT FUNDING SYSTEMS.

I do not come to that opinion lightly or easily. My last job was

as the

Medical Control Director for Metrocrest Medical Services in Dallas.

In that

position, I was responsible for clinical practice and clinical quality

assurance/improvement for about 45 different EMS agencies, including

both an

AMR operation and an R/M operation, along with several public (paid

and

volunteer) agencies. I fought long and hard to convince our customer

cities

and the public EMS agencies that R/M and AMR could and would do as

good a job

as a public EMS service. At the same time, I fought the management

of the

private services to get them to do the job they told me they wanted

to do, and

that I was assuring the "outside world" they would do. The cities

and public

EMS agencies were very skeptical of the abilities of the private services,

despite my strenuous efforts.

Alas, as you might imagine, after 5 long years, I found something out:

the

public agencies were right. Neither AMR nor R/M had any intention

of truly

committing the resources necessary for quality EMS operations.

Unfortunately,

it was not a question of desire on their part, but rather of ability.

You

see, EMS is fundamentally not reimbursed appropriately for the level

of

staffing and equipment that is required to do the job right.

Also, the

problem is *not* with the EMS personnel who work for the private services,

who

are no different from public EMS workers, it is with the very structure

of

trying to fit a private entity (square peg) into a public service function

(round hole).

I use the following analogy to explain the problem to the public here;

to be

effective in EMS, we must be "armed for bear" every minute of every

day,

knowing (and hoping) that most of the time we will only be required

to hunt

for squirrels. However, every so often (more often than we like),

usually in

a situation that will result in high visibility and publicity, you

know what

we are faced with? A really big, hairy, bear. And if you're

carrying a

squirrel gun then, you're in deep doo-doo.

What do I mean by "armed for bear"? Here in Beaumont, we staff

our trucks

with 2 paramedics, both of which are required to have 2 years experience

BEFORE they work here, and both of which are paid fairly well.

We give them

good equipment, let them have the amenities they like (stations, 24/48

schedules, cool protocols) so they'll stay. We keep a free-floating

supervisor in a well-equipped vehicle in the system at all times.

We train

like the dickens, and pay dearly for an intense orientation program.

That

stuff is *very* expensive......arming for bear. Today I went

to a few calls

with my crews; a really difficult CPR and a MVC that required 3 ambulances.

Both of them were very challenging - honestly, many medics would not

have done

too well - and both went perfectly. Good thing we were armed

for bear, even

though the other 30 calls the system ran were squirrel hunts.

By the way,

these other calls were still *very* important and we needed to be there...but

they didn't necessarily require the level of resources we had available.

If you get the opportunity, I recommend that those of you who are seriously

interested in the future and pathway of our profession to read a paper

published by NHTSA called "EMS: Agenda for the Future." There

is a good

discussion of this paper in this month's "ls of Emergency Medicine."

These guys really hit it on the head. They note that we (EMS)

must be the

"medical safety net," closely tied to public health, public safety,

and

traditional health care. They also note that EMS, separate and

apart from

medical transport service, must be "funded for service to the community,"

NOT

financed for service to individuals.

So, if you're still with me, I appreciate you taking the time (better

part of

the week, it probably seems) to read my little dissertation.

I have my Nomex

underwear on, so flame away if it so pleases you. But this is

my story, and

I'm sticking to it.

By the way, the opinions stated here are DEFINITELY my own, and do not

reflect

the opinions or policies of my employer.

Thanks

EMS Manager

City of Beaumont Public Health

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

[Guest guest]

Gene is free to correct me if I'm wrong, but at no point in any of his

statement did I see him mention a union.

>> I suppose we form an organization of medics<< snip

Regards,

Donn

-- --

D.E. ( Donn ) , NREMT-P

Safety & Training Coordinator, R & B Falcon, Corp.

phud@...

phud@...

http://www.phudpucker.com

http://www.rbfalcon.com

[] Re: [Fwd: Private services & 911 (long!)]

>Gene,

>Why not ask the employees of RM-Grand Prairie about the Union-busting

>tactics that are being wrought there by RM? That's why so many fear

>joining an association.

>

> E. Gandy wrote:

>>

>> Hidy, Eddie,

>>

>> I suppose we form an organization of medics, pay a little bit of

>> annual dues (there are now 42,000 certified EMS people in Texas. At

>> $25 apiece, that would amount to $1,050,000 to be spent on PI & E,

>> lobbying in the Legislature, and so on.

>>

>> We ain't got no voice in the Lege an we need one.

>>

>> Gene

>--

> , FF/NREMTP

>“Live your life. Respect its brevity”

>medic720@...

>------------------------------------------------------------------------

>

>

>

[Guest guest]

You speak the truth.

Gene G.

Henry J. Barber wrote:

I don't think union is the answer to the EMS

question. That is the quickest way to turn off the public support we want

and need. If you think I have an answer, think again. A well run EMS organization

with a extremely large membership would have a voice in Texas EMS. How

do we accomplish this? Hell I don't know. TAEMT went bust the EMS educator

society went bust. The current educator group is off to a slow start. Ron's

new group is moving slowly. We as a breed (ECA's, EMT's, EMT-I's and Paramedics

and soon Licensed Paramedics fail to get involved. To many individual agendas.

We can not blame the private or public providers for not supporting

us, we don't support ourselves. We remain fragmented because we are continually

struggling in our individual environments.

It is my understanding that TAEMT still has some funds available. Why

not attempt to revive a the organization with some new blood. Folks that

have nothing to gain other than improving the status of EMS professionals

across the state. Focus on having a voice in government. We don't need

to have another symposium, the one we have is excellent.

Well I guess I will stop here and see what kind of response I get from

this post and see where it takes us.

Lets whip this up a little folks.

Henry

Eddie on wrote:

sounds

like a union!!!! How many EMS personnell do you think would go for

that? If it would raise salaries and not decrease patient care, I'm

all for it!! Eddie

(aka.texsmedic)

-----Original

Message-----

From: E.

Gandy

Sent: Wednesday,

November 11, 1998 3:30 AM

To: egroups

Subject: []

Re: [Fwd: Private services & 911 (long!)]

Hidy, Eddie,

I suppose we form an organization of medics, pay a little bit of annual

dues (there are now 42,000 certified EMS people in Texas. At $25

apiece, that would amount to $1,050,000 to be spent on PI & E, lobbying

in the Legislature, and so on.

We ain't got no voice in the Lege an we need one.

Gene

Eddie on wrote:

and

what do you suppose we do? Eddie

(aka.texsmedic)

-----Original

Message-----

From: E.

Gandy

Sent: Tuesday, November

10, 1998 4:13 AM

To: TAEMSE-L@...;

EMS List; TRAUMA-L@...

Subject: []

Re: [Fwd: Private services & 911 (long!)]

This post by is required

reading.

Those of us at the "grunt level" of EMS

have a vested interest in this post. We are the ones who allow the

corporate managers of EMS companies to inflict their destructive policies

upon the patients they serve and upon us.

This happens because: We have no organization.

We have no input into the decisions to award contracts. Yet, we're

the people who have to fulfill those contracts, according to the rules

we're required to live by, rules that are made by SUITS.

It's our own fault. We have no gripe

againse anybody but ourselves. We've relinquished control to others.

We didn't and don't have to do that, but we do it because we absolutely

refuse to organize.

Gene

E. Gandy, JD, EMT-P

EMS Professions Program Director

Tyler Junior College

Tyler, TX

ggan@...

Check out our website at: http://www.tyler.cc.tx.us/emmt/

My vision for our profession precludes the

involvement by entities such as these we speak of here. Healthcare

should be

patient oriented, and standard of care should be patient driven.

Decisions

regarding patient care should be made in the field, not in the

boardroom.

Patient outcome must be our primary focus. Of course the cost

must be

considered, but it should be secondary. >>

Well, you certainly are a brave soul. Well said. After what

will certainly

turn out to be less-than-adequate consideration, I have decided to

wade in

here with you and make some statements that will probably *not* get

me elected

to the Board of Directors of the American Ambulance Association.

After spending many years of my career attempting to coax for-profit

entities

to embrace even simple patient care oriented advancements, mostly

unsuccessfully, I find myself resolved and committed to a similar opinion.

I do believe that for-profit ambulance services have a place....in the

non-

emergent transport business. I believe that there is *no* place

for such

agencies in the emergency realm. I propose that non-emergency

("transfer")

work and emergency ("911") response are **two different jobs**, requiring

different resources, system designs, personnel, and -- here's the kicker

to

the whole thing -- DIFFERENT FUNDING SYSTEMS.

I do not come to that opinion lightly or easily. My last job was

as the

Medical Control Director for Metrocrest Medical Services in Dallas.

In that

position, I was responsible for clinical practice and clinical quality

assurance/improvement for about 45 different EMS agencies, including

both an

AMR operation and an R/M operation, along with several public (paid

and

volunteer) agencies. I fought long and hard to convince our customer

cities

and the public EMS agencies that R/M and AMR could and would do as

good a job

as a public EMS service. At the same time, I fought the management

of the

private services to get them to do the job they told me they wanted

to do, and

that I was assuring the "outside world" they would do. The cities

and public

EMS agencies were very skeptical of the abilities of the private services,

despite my strenuous efforts.

Alas, as you might imagine, after 5 long years, I found something out:

the

public agencies were right. Neither AMR nor R/M had any intention

of truly

committing the resources necessary for quality EMS operations.

Unfortunately,

it was not a question of desire on their part, but rather of ability.

You

see, EMS is fundamentally not reimbursed appropriately for the level

of

staffing and equipment that is required to do the job right.

Also, the

problem is *not* with the EMS personnel who work for the private services,

who

are no different from public EMS workers, it is with the very structure

of

trying to fit a private entity (square peg) into a public service function

(round hole).

I use the following analogy to explain the problem to the public here;

to be

effective in EMS, we must be "armed for bear" every minute of every

day,

knowing (and hoping) that most of the time we will only be required

to hunt

for squirrels. However, every so often (more often than we like),

usually in

a situation that will result in high visibility and publicity, you

know what

we are faced with? A really big, hairy, bear. And if you're

carrying a

squirrel gun then, you're in deep doo-doo.

What do I mean by "armed for bear"? Here in Beaumont, we staff

our trucks

with 2 paramedics, both of which are required to have 2 years experience

BEFORE they work here, and both of which are paid fairly well.

We give them

good equipment, let them have the amenities they like (stations, 24/48

schedules, cool protocols) so they'll stay. We keep a free-floating

supervisor in a well-equipped vehicle in the system at all times.

We train

like the dickens, and pay dearly for an intense orientation program.

That

stuff is *very* expensive......arming for bear. Today I went

to a few calls

with my crews; a really difficult CPR and a MVC that required 3 ambulances.

Both of them were very challenging - honestly, many medics would not

have done

too well - and both went perfectly. Good thing we were armed

for bear, even

though the other 30 calls the system ran were squirrel hunts.

By the way,

these other calls were still *very* important and we needed to be there...but

they didn't necessarily require the level of resources we had available.

If you get the opportunity, I recommend that those of you who are seriously

interested in the future and pathway of our profession to read a paper

published by NHTSA called "EMS: Agenda for the Future." There

is a good

discussion of this paper in this month's "ls of Emergency Medicine."

These guys really hit it on the head. They note that we (EMS)

must be the

"medical safety net," closely tied to public health, public safety,

and

traditional health care. They also note that EMS, separate and

apart from

medical transport service, must be "funded for service to the community,"

NOT

financed for service to individuals.

So, if you're still with me, I appreciate you taking the time (better

part of

the week, it probably seems) to read my little dissertation.

I have my Nomex

underwear on, so flame away if it so pleases you. But this is

my story, and

I'm sticking to it.

By the way, the opinions stated here are DEFINITELY my own, and do not

reflect

the opinions or policies of my employer.

Thanks

EMS Manager

City of Beaumont Public Health

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

[Guest guest]

In a message dated 11/12/98 12:35:27 PM Central Standard Time, ggan@...

writes:

<<

The trick is in the formation of the association. It should begin with

a broad base of support from all around the state and should not cater

to any certain faction. Perhaps legislation is needed to make

membership mandatory for licensed and certified medics, as the Bar

Association is for lawyers. In the Bar Association, elections are held

by secret mail ballot, and this works very well. There is a

non-political staff to carry out everyday functions.

What do you think about that sort of plan? Gene G. >>

Gene,

Although I do think that forming an actively working association is the

correct way to improve the EMS profession, I do not feel that " mandatory "

membership through legislation is the way it should be. If we do form an

association, we want members who want to be members. Members who will be

active and take part in projects and endeavors of the association. We don't

want " dead weight " that is just a member because they " have to be. "

I agree with you in the forming an association of professional EMS

providers. I will more than willing to help you, or anyone else, in the

formation of the association or whatever might need to be done. Having

previously been a member of an active association, Texas Association of

Polygraph Examiners, I have seen what an active lobbyist can do for the

profession as well as the association.

Someone mentioned possibly having a meeting of those interested in this

endeavor at the EMS conference in Austin. I think this is a very good idea.

I will be in Austin and will assist you, if you desire to do this.

Thank you for your interest in EMS and in improving our service to the public.

, BS, EMT/P

DFW Airport DPS

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

[Guest guest]

What about TAEMT?

[] Re: [Fwd: Private services & 911 (long!)]

 

This post by is required reading.

 Those of us at the " grunt level " of EMS  have a vested interest in this

post.  We are the ones who allow the corporate managers of EMS companies to

inflict their destructive policies upon the patients they serve and upon us.

This happens because:  We have no organization.   We have no input into the

decisions to award contracts.  Yet, we're the people who have to fulfill

those contracts, according to the rules  we're required to live by, rules

that are made by SUITS.

It's our own fault.  We have no gripe againse anybody but ourselves.  We've

relinquished control to others.   We didn't and don't have to do that, but

we do it because we absolutely refuse to organize.

Gene

E. Gandy, JD, EMT-P

EMS Professions Program Director

Tyler Junior College

Tyler, TX

ggan@...

Check out our website at:  http://www.tyler.cc.tx.us/emmt/

<http://www.tyler.cc.tx.us/emmt/>

My vision for our profession precludes the

 involvement by entities such as these we speak of here. Healthcare should

be

 patient oriented, and standard of care should be patient driven. Decisions

 regarding patient care should be made in the field, not in the boardroom.

 Patient outcome must be our primary focus. Of course the cost must be

 considered, but it should be secondary. >>

Well, you certainly are a brave soul.  Well said.  After what will certainly

turn out to be less-than-adequate consideration, I have decided to wade in

here with you and make some statements that will probably *not* get me

elected

to the Board of Directors of the American Ambulance Association.

After spending many years of my career attempting to coax for-profit

entities

to embrace even simple patient care oriented advancements, mostly

unsuccessfully, I find myself resolved and committed to a similar opinion.

I do believe that for-profit ambulance services have a place....in the non-

emergent transport business.  I believe that there is *no* place for such

agencies in the emergency realm.  I propose that non-emergency ( " transfer " )

work and emergency ( " 911 " ) response are **two different jobs**, requiring

different resources, system designs, personnel, and -- here's the kicker to

the whole thing -- DIFFERENT FUNDING SYSTEMS.

I do not come to that opinion lightly or easily.  My last job was as the

Medical Control Director for Metrocrest Medical Services in Dallas.  In that

position, I was responsible for clinical practice and clinical quality

assurance/improvement for about 45 different EMS agencies, including both an

AMR operation and an R/M operation, along with several public (paid and

volunteer) agencies.  I fought long and hard to convince our customer cities

and the public EMS agencies that R/M and AMR could and would do as good a

job

as a public EMS service.  At the same time, I fought the management of the

private services to get them to do the job they told me they wanted to do,

and

that I was assuring the " outside world " they would do.  The cities and

public

EMS agencies were very skeptical of the abilities of the private services,

despite my strenuous efforts.

Alas, as you might imagine, after 5 long years, I found something out: the

public agencies were right.  Neither AMR nor R/M had any intention of truly

committing the resources necessary for quality EMS operations. 

Unfortunately,

it was not a question of desire on their part, but rather of ability.  You

see, EMS is fundamentally not reimbursed appropriately for the level of

staffing and equipment that is required to do the job right.  Also, the

problem is *not* with the EMS personnel who work for the private services,

who

are no different from public EMS workers, it is with the very structure of

trying to fit a private entity (square peg) into a public service function

(round hole).

I use the following analogy to explain the problem to the public here; to be

effective in EMS, we must be " armed for bear " every minute of every day,

knowing (and hoping) that most of the time we will only be required to hunt

for squirrels.  However, every so often (more often than we like), usually

in

a situation that will result in high visibility and publicity, you know what

we are faced with?  A really big, hairy, bear.  And if you're carrying a

squirrel gun then, you're in deep doo-doo.

What do I mean by " armed for bear " ?  Here in Beaumont, we staff our trucks

with 2 paramedics, both of which are required to have 2 years experience

BEFORE they work here, and both of which are paid fairly well.  We give them

good equipment, let them have the amenities they like (stations, 24/48

schedules, cool protocols) so they'll stay.  We keep a free-floating

supervisor in a well-equipped vehicle in the system at all times.  We train

like the dickens, and pay dearly for an intense orientation program.  That

stuff is *very* expensive......arming for bear.  Today I went to a few calls

with my crews; a really difficult CPR and a MVC that required 3 ambulances.

Both of them were very challenging - honestly, many medics would not have

done

too well - and both went perfectly.  Good thing we were armed for bear, even

though the other 30 calls the system ran were squirrel hunts.  By the way,

these other calls were still *very* important and we needed to be

there...but

they didn't necessarily require the level of resources we had available.

If you get the opportunity, I recommend that those of you who are seriously

interested in the future and pathway of our profession to read a paper

published by NHTSA called " EMS: Agenda for the Future. "   There is a good

discussion of this paper in this month's " ls of Emergency Medicine. "

These guys really hit it on the head.  They note that we (EMS) must be the

" medical safety net, " closely tied to public health, public safety, and

traditional health care.  They also note that EMS, separate and apart from

medical transport service, must be " funded for service to the community, "

NOT

financed for service to individuals.

So, if you're still with me, I appreciate you taking the time (better part

of

the week, it probably seems) to read my little dissertation.  I have my

Nomex

underwear on, so flame away if it so pleases you.  But this is my story, and

I'm sticking to it.

By the way, the opinions stated here are DEFINITELY my own, and do not

reflect

the opinions or policies of my employer.

Thanks

EMS Manager

City of Beaumont Public Health

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

[Guest guest]

Gene, I think this is an absolutely wonderful idea. We should of done this years ago. If we can get the information needed, I do have a friend that is a State Senator and I will be more than willing to forward the information to him.

Joby Berkley EMT-P

[] Re: [Fwd: Private services & 911 (long!)]This post by is required reading. Those of us at the " grunt level " of EMS have a vested interest in this post. We are the ones who allow the corporate managers of EMS companies to inflict their destructive policies upon the patients they serve and upon us. This happens because: We have no organization. We have no input into the decisions to award contracts. Yet, we're the people who have to fulfill those contracts, according to the rules we're required to live by, rules that are made by SUITS. It's our own fault. We have no gripe againse anybody but ourselves. We've relinquished control to others. We didn't and don't have to do that, but we do it because we absolutely refuse to organize. Gene E. Gandy, JD, EMT-P EMS Professions Program Director Tyler Junior College Tyler, TX ggan@... Check out our website at: http://www.tyler.cc.tx.us/emmt/ My vision for our profession precludes the involvement by entities such as these we speak of here. Healthcare should be patient oriented, and standard of care should be patient driven. Decisions regarding patient care should be made in the field, not in the boardroom. Patient outcome must be our primary focus. Of course the cost must be considered, but it should be secondary. >> Well, you certainly are a brave soul. Well said. After what will certainly turn out to be less-than-adequate consideration, I have decided to wade in here with you and make some statements that will probably *not* get me elected to the Board of Directors of the American Ambulance Association. After spending many years of my career attempting to coax for-profit entities to embrace even simple patient care oriented advancements, mostly unsuccessfully, I find myself resolved and committed to a similar opinion. I do believe that for-profit ambulance services have a place....in the non- emergent transport business. I believe that there is *no* place for such agencies in the emergency realm. I propose that non-emergency ( " transfer " ) work and emergency ( " 911 " ) response are **two different jobs**, requiring different resources, system designs, personnel, and -- here's the kicker to the whole thing -- DIFFERENT FUNDING SYSTEMS. I do not come to that opinion lightly or easily. My last job was as the Medical Control Director for Metrocrest Medical Services in Dallas. In that position, I was responsible for clinical practice and clinical quality assurance/improvement for about 45 different EMS agencies, including both an AMR operation and an R/M operation, along with several public (paid and volunteer) agencies. I fought long and hard to convince our customer cities and the public EMS agencies that R/M and AMR could and would do as good a job as a public EMS service. At the same time, I fought the management of the private services to get them to do the job they told me they wanted to do, and that I was assuring the " outside world " they would do. The cities and public EMS agencies were very skeptical of the abilities of the private services, despite my strenuous efforts. Alas, as you might imagine, after 5 long years, I found something out: the public agencies were right. Neither AMR nor R/M had any intention of truly committing the resources necessary for quality EMS operations. Unfortunately, it was not a question of desire on their part, but rather of ability. You see, EMS is fundamentally not reimbursed appropriately for the level of staffing and equipment that is required to do the job right. Also, the problem is *not* with the EMS personnel who work for the private services, who are no different from public EMS workers, it is with the very structure of trying to fit a private entity (square peg) into a public service function (round hole). I use the following analogy to explain the problem to the public here; to be effective in EMS, we must be " armed for bear " every minute of every day, knowing (and hoping) that most of the time we will only be required to hunt for squirrels. However, every so often (more often than we like), usually in a situation that will result in high visibility and publicity, you know what we are faced with? A really big, hairy, bear. And if you're carrying a squirrel gun then, you're in deep doo-doo. What do I mean by " armed for bear " ? Here in Beaumont, we staff our trucks with 2 paramedics, both of which are required to have 2 years experience BEFORE they work here, and both of which are paid fairly well. We give them good equipment, let them have the amenities they like (stations, 24/48 schedules, cool protocols) so they'll stay. We keep a free-floating supervisor in a well-equipped vehicle in the system at all times. We train like the dickens, and pay dearly for an intense orientation program. That stuff is *very* expensive......arming for bear. Today I went to a few calls with my crews; a really difficult CPR and a MVC that required 3 ambulances. Both of them were very challenging - honestly, many medics would not have done too well - and both went perfectly. Good thing we were armed for bear, even though the other 30 calls the system ran were squirrel hunts. By the way, these other calls were still *very* important and we needed to be there...but they didn't necessarily require the level of resources we had available. If you get the opportunity, I recommend that those of you who are seriously interested in the future and pathway of our profession to read a paper published by NHTSA called " EMS: Agenda for the Future. " There is a good discussion of this paper in this month's " ls of Emergency Medicine. " These guys really hit it on the head. They note that we (EMS) must be the " medical safety net, " closely tied to public health, public safety, and traditional health care. They also note that EMS, separate and apart from medical transport service, must be " funded for service to the community, " NOT financed for service to individuals. So, if you're still with me, I appreciate you taking the time (better part of the week, it probably seems) to read my little dissertation. I have my Nomex underwear on, so flame away if it so pleases you. But this is my story, and I'm sticking to it. By the way, the opinions stated here are DEFINITELY my own, and do not reflect the opinions or policies of my employer. Thanks EMS Manager City of Beaumont Public Health ------------------------------------------------------------------------

[Guest guest]

Mike, Does TAEMT have a web site? Unable to locate one if they do.

[] Re: [Fwd: Private services & 911 (long!)]

>

>This post by is required reading.

>

> Those of us at the " grunt level " of EMS have a vested interest in this

>post. We are the ones who allow the corporate managers of EMS companies to

>inflict their destructive policies upon the patients they serve and upon

us.

>

>

>

>This happens because: We have no organization. We have no input into the

>decisions to award contracts. Yet, we're the people who have to fulfill

>those contracts, according to the rules we're required to live by, rules

>that are made by SUITS.

>

>

>It's our own fault. We have no gripe againse anybody but ourselves. We've

>relinquished control to others. We didn't and don't have to do that, but

>we do it because we absolutely refuse to organize.

>

>

>Gene

>

>

> E. Gandy, JD, EMT-P

>EMS Professions Program Director

>Tyler Junior College

>Tyler, TX

>ggan@...

>

>

>Check out our website at: http://www.tyler.cc.tx.us/emmt/

><http://www.tyler.cc.tx.us/emmt/>

>

>

>My vision for our profession precludes the

> involvement by entities such as these we speak of here. Healthcare should

>be

> patient oriented, and standard of care should be patient driven. Decisions

> regarding patient care should be made in the field, not in the boardroom.

> Patient outcome must be our primary focus. Of course the cost must be

> considered, but it should be secondary. >>

>

>Well, you certainly are a brave soul. Well said. After what will certainly

>

>turn out to be less-than-adequate consideration, I have decided to wade in

>here with you and make some statements that will probably *not* get me

>elected

>to the Board of Directors of the American Ambulance Association.

>

>

>After spending many years of my career attempting to coax for-profit

>entities

>to embrace even simple patient care oriented advancements, mostly

>unsuccessfully, I find myself resolved and committed to a similar opinion.

>

>

>I do believe that for-profit ambulance services have a place....in the non-

>emergent transport business. I believe that there is *no* place for such

>agencies in the emergency realm. I propose that non-emergency ( " transfer " )

>work and emergency ( " 911 " ) response are **two different jobs**, requiring

>different resources, system designs, personnel, and -- here's the kicker to

>the whole thing -- DIFFERENT FUNDING SYSTEMS.

>

>

>I do not come to that opinion lightly or easily. My last job was as the

>Medical Control Director for Metrocrest Medical Services in Dallas. In that

>

>position, I was responsible for clinical practice and clinical quality

>assurance/improvement for about 45 different EMS agencies, including both

an

>

>AMR operation and an R/M operation, along with several public (paid and

>volunteer) agencies. I fought long and hard to convince our customer cities

>

>and the public EMS agencies that R/M and AMR could and would do as good a

>job

>as a public EMS service. At the same time, I fought the management of the

>private services to get them to do the job they told me they wanted to do,

>and

>that I was assuring the " outside world " they would do. The cities and

>public

>EMS agencies were very skeptical of the abilities of the private services,

>despite my strenuous efforts.

>

>

>Alas, as you might imagine, after 5 long years, I found something out: the

>public agencies were right. Neither AMR nor R/M had any intention of truly

>committing the resources necessary for quality EMS operations.

>Unfortunately,

>it was not a question of desire on their part, but rather of ability. You

>see, EMS is fundamentally not reimbursed appropriately for the level of

>staffing and equipment that is required to do the job right. Also, the

>problem is *not* with the EMS personnel who work for the private services,

>who

>are no different from public EMS workers, it is with the very structure of

>trying to fit a private entity (square peg) into a public service function

>(round hole).

>

>

>I use the following analogy to explain the problem to the public here; to

be

>

>effective in EMS, we must be " armed for bear " every minute of every day,

>knowing (and hoping) that most of the time we will only be required to hunt

>for squirrels. However, every so often (more often than we like), usually

>in

>a situation that will result in high visibility and publicity, you know

what

>

>we are faced with? A really big, hairy, bear. And if you're carrying a

>squirrel gun then, you're in deep doo-doo.

>

>

>What do I mean by " armed for bear " ? Here in Beaumont, we staff our trucks

>with 2 paramedics, both of which are required to have 2 years experience

>BEFORE they work here, and both of which are paid fairly well. We give them

>

>good equipment, let them have the amenities they like (stations, 24/48

>schedules, cool protocols) so they'll stay. We keep a free-floating

>supervisor in a well-equipped vehicle in the system at all times. We train

>like the dickens, and pay dearly for an intense orientation program. That

>stuff is *very* expensive......arming for bear. Today I went to a few calls

>

>with my crews; a really difficult CPR and a MVC that required 3 ambulances.

>Both of them were very challenging - honestly, many medics would not have

>done

>too well - and both went perfectly. Good thing we were armed for bear, even

>

>though the other 30 calls the system ran were squirrel hunts. By the way,

>these other calls were still *very* important and we needed to be

>there...but

>they didn't necessarily require the level of resources we had available.

>

>

>If you get the opportunity, I recommend that those of you who are seriously

>interested in the future and pathway of our profession to read a paper

>published by NHTSA called " EMS: Agenda for the Future. " There is a good

>discussion of this paper in this month's " ls of Emergency Medicine. "

>These guys really hit it on the head. They note that we (EMS) must be the

> " medical safety net, " closely tied to public health, public safety, and

>traditional health care. They also note that EMS, separate and apart from

>medical transport service, must be " funded for service to the community, "

>NOT

>financed for service to individuals.

>

>

>So, if you're still with me, I appreciate you taking the time (better part

>of

>the week, it probably seems) to read my little dissertation. I have my

>Nomex

>underwear on, so flame away if it so pleases you. But this is my story, and

>

>I'm sticking to it.

>

>

>By the way, the opinions stated here are DEFINITELY my own, and do not

>reflect

>the opinions or policies of my employer.

>

>

>Thanks

>

>EMS Manager

>City of Beaumont Public Health

>------------------------------------------------------------------------

>

>

>

[Guest guest]

I never said that I wanted a union. I said it sounded like a union when you pay dues to a group of people that are suposed to represent you. Doesn't it sound like that to you too?

Eddie on, EMT-P

[] Re: [Fwd: Private services & 911 (long!)] This post by is required reading. Those of us at the " grunt level " of EMS have a vested interest in this post. We are the ones who allow the corporate managers of EMS companies to inflict their destructive policies upon the patients they serve and upon us. This happens because: We have no organization. We have no input into the decisions to award contracts. Yet, we're the people who have to fulfill those contracts, according to the rules we're required to live by, rules that are made by SUITS. It's our own fault. We have no gripe againse anybody but ourselves. We've relinquished control to others. We didn't and don't have to do that, but we do it because we absolutely refuse to organize. Gene E. Gandy, JD, EMT-P EMS Professions Program Director Tyler Junior College Tyler, TX ggan@... Check out our website at: http://www.tyler.cc.tx.us/emmt/ My vision for our profession precludes the involvement by entities such as these we speak of here. Healthcare should be patient oriented, and standard of care should be patient driven. Decisions regarding patient care should be made in the field, not in the boardroom. Patient outcome must be our primary focus. Of course the cost must be considered, but it should be secondary. >> Well, you certainly are a brave soul. Well said. After what will certainly turn out to be less-than-adequate consideration, I have decided to wade in here with you and make some statements that will probably *not* get me elected to the Board of Directors of the American Ambulance Association. After spending many years of my career attempting to coax for-profit entities to embrace even simple patient care oriented advancements, mostly unsuccessfully, I find myself resolved and committed to a similar opinion. I do believe that for-profit ambulance services have a place....in the non- emergent transport business. I believe that there is *no* place for such agencies in the emergency realm. I propose that non-emergency ( " transfer " ) work and emergency ( " 911 " ) response are **two different jobs**, requiring different resources, system designs, personnel, and -- here's the kicker to the whole thing -- DIFFERENT FUNDING SYSTEMS. I do not come to that opinion lightly or easily. My last job was as the Medical Control Director for Metrocrest Medical Services in Dallas. In that position, I was responsible for clinical practice and clinical quality assurance/improvement for about 45 different EMS agencies, including both an AMR operation and an R/M operation, along with several public (paid and volunteer) agencies. I fought long and hard to convince our customer cities and the public EMS agencies that R/M and AMR could and would do as good a job as a public EMS service. At the same time, I fought the management of the private services to get them to do the job they told me they wanted to do, and that I was assuring the " outside world " they would do. The cities and public EMS agencies were very skeptical of the abilities of the private services, despite my strenuous efforts. Alas, as you might imagine, after 5 long years, I found something out: the public agencies were right. Neither AMR nor R/M had any intention of truly committing the resources necessary for quality EMS operations. Unfortunately, it was not a question of desire on their part, but rather of ability. You see, EMS is fundamentally not reimbursed appropriately for the level of staffing and equipment that is required to do the job right. Also, the problem is *not* with the EMS personnel who work for the private services, who are no different from public EMS workers, it is with the very structure of trying to fit a private entity (square peg) into a public service function (round hole). I use the following analogy to explain the problem to the public here; to be effective in EMS, we must be " armed for bear " every minute of every day, knowing (and hoping) that most of the time we will only be required to hunt for squirrels. However, every so often (more often than we like), usually in a situation that will result in high visibility and publicity, you know what we are faced with? A really big, hairy, bear. And if you're carrying a squirrel gun then, you're in deep doo-doo. What do I mean by " armed for bear " ? Here in Beaumont, we staff our trucks with 2 paramedics, both of which are required to have 2 years experience BEFORE they work here, and both of which are paid fairly well. We give them good equipment, let them have the amenities they like (stations, 24/48 schedules, cool protocols) so they'll stay. We keep a free-floating supervisor in a well-equipped vehicle in the system at all times. We train like the dickens, and pay dearly for an intense orientation program. That stuff is *very* expensive......arming for bear. Today I went to a few calls with my crews; a really difficult CPR and a MVC that required 3 ambulances. Both of them were very challenging - honestly, many medics would not have done too well - and both went perfectly. Good thing we were armed for bear, even though the other 30 calls the system ran were squirrel hunts. By the way, these other calls were still *very* important and we needed to be there...but they didn't necessarily require the level of resources we had available. If you get the opportunity, I recommend that those of you who are seriously interested in the future and pathway of our profession to read a paper published by NHTSA called " EMS: Agenda for the Future. " There is a good discussion of this paper in this month's " ls of Emergency Medicine. " These guys really hit it on the head. They note that we (EMS) must be the " medical safety net, " closely tied to public health, public safety, and traditional health care. They also note that EMS, separate and apart from medical transport service, must be " funded for service to the community, " NOT financed for service to individuals. So, if you're still with me, I appreciate you taking the time (better part of the week, it probably seems) to read my little dissertation. I have my Nomex underwear on, so flame away if it so pleases you. But this is my story, and I'm sticking to it. By the way, the opinions stated here are DEFINITELY my own, and do not reflect the opinions or policies of my employer. Thanks EMS Manager City of Beaumont Public Health ------------------------------------------------------------------------

[Guest guest]

That sounds great. I would be willing to get into something like that.

Eddie on, EMT-P

[] Re: [Fwd: Private services & 911 (long!)]This post by is required reading. Those of us at the " grunt level " of EMS have a vested interest in this post. We are the ones who allow the corporate managers of EMS companies to inflict their destructive policies upon the patients they serve and upon us. This happens because: We have no organization. We have no input into the decisions to award contracts. Yet, we're the people who have to fulfill those contracts, according to the rules we're required to live by, rules that are made by SUITS. It's our own fault. We have no gripe againse anybody but ourselves. We've relinquished control to others. We didn't and don't have to do that, but we do it because we absolutely refuse to organize. Gene E. Gandy, JD, EMT-P EMS Professions Program Director Tyler Junior College Tyler, TX ggan@... Check out our website at: http://www.tyler.cc.tx.us/emmt/ My vision for our profession precludes the involvement by entities such as these we speak of here. Healthcare should be patient oriented, and standard of care should be patient driven. Decisions regarding patient care should be made in the field, not in the boardroom. Patient outcome must be our primary focus. Of course the cost must be considered, but it should be secondary. >> Well, you certainly are a brave soul. Well said. After what will certainly turn out to be less-than-adequate consideration, I have decided to wade in here with you and make some statements that will probably *not* get me elected to the Board of Directors of the American Ambulance Association. After spending many years of my career attempting to coax for-profit entities to embrace even simple patient care oriented advancements, mostly unsuccessfully, I find myself resolved and committed to a similar opinion. I do believe that for-profit ambulance services have a place....in the non- emergent transport business. I believe that there is *no* place for such agencies in the emergency realm. I propose that non-emergency ( " transfer " ) work and emergency ( " 911 " ) response are **two different jobs**, requiring different resources, system designs, personnel, and -- here's the kicker to the whole thing -- DIFFERENT FUNDING SYSTEMS. I do not come to that opinion lightly or easily. My last job was as the Medical Control Director for Metrocrest Medical Services in Dallas. In that position, I was responsible for clinical practice and clinical quality assurance/improvement for about 45 different EMS agencies, including both an AMR operation and an R/M operation, along with several public (paid and volunteer) agencies. I fought long and hard to convince our customer cities and the public EMS agencies that R/M and AMR could and would do as good a job as a public EMS service. At the same time, I fought the management of the private services to get them to do the job they told me they wanted to do, and that I was assuring the " outside world " they would do. The cities and public EMS agencies were very skeptical of the abilities of the private services, despite my strenuous efforts. Alas, as you might imagine, after 5 long years, I found something out: the public agencies were right. Neither AMR nor R/M had any intention of truly committing the resources necessary for quality EMS operations. Unfortunately, it was not a question of desire on their part, but rather of ability. You see, EMS is fundamentally not reimbursed appropriately for the level of staffing and equipment that is required to do the job right. Also, the problem is *not* with the EMS personnel who work for the private services, who are no different from public EMS workers, it is with the very structure of trying to fit a private entity (square peg) into a public service function (round hole). I use the following analogy to explain the problem to the public here; to be effective in EMS, we must be " armed for bear " every minute of every day, knowing (and hoping) that most of the time we will only be required to hunt for squirrels. However, every so often (more often than we like), usually in a situation that will result in high visibility and publicity, you know what we are faced with? A really big, hairy, bear. And if you're carrying a squirrel gun then, you're in deep doo-doo. What do I mean by " armed for bear " ? Here in Beaumont, we staff our trucks with 2 paramedics, both of which are required to have 2 years experience BEFORE they work here, and both of which are paid fairly well. We give them good equipment, let them have the amenities they like (stations, 24/48 schedules, cool protocols) so they'll stay. We keep a free-floating supervisor in a well-equipped vehicle in the system at all times. We train like the dickens, and pay dearly for an intense orientation program. That stuff is *very* expensive......arming for bear. Today I went to a few calls with my crews; a really difficult CPR and a MVC that required 3 ambulances. Both of them were very challenging - honestly, many medics would not have done too well - and both went perfectly. Good thing we were armed for bear, even though the other 30 calls the system ran were squirrel hunts. By the way, these other calls were still *very* important and we needed to be there...but they didn't necessarily require the level of resources we had available. If you get the opportunity, I recommend that those of you who are seriously interested in the future and pathway of our profession to read a paper published by NHTSA called " EMS: Agenda for the Future. " There is a good discussion of this paper in this month's " ls of Emergency Medicine. " These guys really hit it on the head. They note that we (EMS) must be the " medical safety net, " closely tied to public health, public safety, and traditional health care. They also note that EMS, separate and apart from medical transport service, must be " funded for service to the community, " NOT financed for service to individuals. So, if you're still with me, I appreciate you taking the time (better part of the week, it probably seems) to read my little dissertation. I have my Nomex underwear on, so flame away if it so pleases you. But this is my story, and I'm sticking to it. By the way, the opinions stated here are DEFINITELY my own, and do not reflect the opinions or policies of my employer. Thanks EMS Manager City of Beaumont Public Health ------------------------------------------------------------------------

[Guest guest]

I know about it. That's why, if I was going to join a union, it would be

the Teamsters!

gg

wrote:

> Gene,

> Why not ask the employees of RM-Grand Prairie about the Union-busting

> tactics that are being wrought there by RM? That's why so many fear

> joining an association.

>

> E. Gandy wrote:

> >

> > Hidy, Eddie,

> >

> > I suppose we form an organization of medics, pay a little bit of

> > annual dues (there are now 42,000 certified EMS people in Texas. At

> > $25 apiece, that would amount to $1,050,000 to be spent on PI & E,

> > lobbying in the Legislature, and so on.

> >

> > We ain't got no voice in the Lege an we need one.

> >

> > Gene

> --

> , FF/NREMTP

> “Live your life. Respect its brevity”

> medic720@...

> ------------------------------------------------------------------------

>

>