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

[Guest guest]

Does anybody know anybody in TAEMT? I thought it had died and been buried.

Gene Gandy

Mike (MCS) wrote:

> 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]

I would also be interested in forming an association of this nature and for

this cause. Anything to better the #1 job in the country that we all so

dearly love.

Eddie on, EMT-P

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

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]

The only reason I mentioned mandatory membership is that so far voluntary

membership has not worked with anything we've tried.

Gene

RaaEMS605@... wrote:

> 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]

Why would this be key to just "Public EMS"? We did many of these

things when I was the GM of a private provider that not only had the 911

contract, but did intrafacility transports. Teaching CPR and First Aid

classes, Safety awareness, Public Service spots on the radio and in news

media were just some of the ways of staying in the public eye.

Lee Sulecki

Rosehill Fire Department

" We do not provide this service to make money, but

we must have money to provide the service"

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]

I'm afraid I have to disagree, I have a DEFINITE PROBLEM with the government

telling me what organizations I HAVE to belong to. The same with a company

that tells me I HAVE to be union to work. Agreed, we need to have a voice,

but it should be our voice because we care enough to be heard, not because

we are forced to.

[Guest guest]

Lee,

I've read and enjoyed many of your posts, and I certainly hope you don't

take offense to what I am about to say. My intention is not to slander.

Please take what I have to say in the spirit it is intended.

Your post perhaps epitomizes why EMS does not already have a coherent

professional organization. How long have we been around? The cowboy attitude

of " nobody is going to tell me what to do " is rampant within our ranks. I

understand that you speak specifically of the government here, but what Gene

was suggesting,I think, is legislation that we, the people, would ask for,

and not something just shoved down our throats by politicians. Legislation

that we feel would improve our lot. I'm not saying I necessarily agree that

this is the way, but that I understand what Gene intended by his remarks.

Perhaps the cowboy attitude is a character flaw in us EMS types, or perhaps

it is a necessary part of the type of person required to perform well in

this job. Perhaps it will also be the reason we may fail to progress beyond

where we are right now. The funny thing here is that we often roundly

condemn our patients when a similar attitude brings them into some

misfortune and we are summoned to their aid.

The Texas Assn.. of EMTs, The Texas Society of EMTs, The Texas Paramedic

Society, and now this new one is trying to form (EMSEAT I believe is the

acronym) have all experienced low participation due to the independence and

divisiveness that seems to be inherent in our ranks. Even the NAEMT has been

suffering from the infighting and distractions caused by the ever-present

cowboy attitude.

What is it going to take before we recognize the necessity of unity and the

benefit of a professional organization? I do not speak of a union. A union

is an organization to which you send you dues and hope they do something for

you in exchange. The strongest, perhaps the only real tool of the union is

the strike, and I couldn't do that. A professional organization would

require that we as individuals participate in the process. That you not sit

back and snipe at the other members because they don't necessarily do things

just the way you would. That we find some common ground.

We have some strong, intelligent folks in our number who could take the

reins of a professional organization and drive it into the future, if we

would just join in and help instead of balk and carp. The TAEMT is still

alive, perhaps it would be the way to go. I don't know. Maybe EMSEAT. Once

again, I don't know. What I do know is that we had better get off our duffs

and do something before we rust.

I'm still a cowboy, I guess, but maybe not as much of one as when I was

younger. Cowboys get bucked off every now and then, and that old ground

seems to get harder with every fall.

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!)]

>I'm afraid I have to disagree, I have a DEFINITE PROBLEM with the

>government telling me what organizations I HAVE to belong to. The same

>with a company that tells me I HAVE to be union to work. Agreed, we need

>to have a voice, but it should be our voice because we care enough to be

>heard, not because we are forced to.

[Guest guest]

The strike is not the only tool of the union. There are other tools if you

know how to use them. Again misinformation and speculation instead of actual

knowledge.

Danny

EMT-P I/E

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

[Guest guest]

Lee Sulecki wrote:

I'm afraid I have to disagree, I have a DEFINITE

PROBLEM with the government telling me what organizations I HAVE to belong

to. The same with a company that tells me I HAVE to be union to work. Agreed,

we need to have a voice, but it should be our voice because we care enough

to be heard, not because we are forced to.

[Guest guest]

Gene,

That explanation helps clarify things. Would it be correct to say that a similar EMS association would govern EMS including certification, liscensure, discipline, grievances, and CE?

-----Original Message-----From: E. Gandy Sent: Saturday, November 14, 1998 5:57 PMTo: egroupsSubject: [] Re: [Fwd: Private services & 911 (long!)]Lee Sulecki wrote: I'm afraid I have to disagree, I have a DEFINITE PROBLEM with the government telling me what organizations I HAVE to belong to. The same with a company that tells me I HAVE to be union to work. Agreed, we need to have a voice, but it should be our voice because we care enough to be heard, not because we are forced to.

[Guest guest]

That was the idea I was throwing out to see who would pounce on it.

Whaddaya think?

Gene

wrote:

Gene, That

explanation helps clarify things. Would it be correct to say that

a similar EMS association would govern EMS including certification, liscensure,

discipline, grievances, and CE?

-----Original

Message-----

From: E.

Gandy

Sent: Saturday, November

14, 1998 5:57 PM

To: egroups

Subject: []

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

Lee Sulecki wrote:

I'm afraid I have to disagree, I have a DEFINITE

PROBLEM with the government telling me what organizations I HAVE to belong

to. The same with a company that tells me I HAVE to be union to work. Agreed,

we need to have a voice, but it should be our voice because we care enough

to be heard, not because we are forced to.

[Guest guest]

No offense taken, I do agree we need a voice, but I don't think having the

government mandate it is the answer. Maybe I fell off my horse one too many

times..

Lee

D.E. (Donn) , REMT-P wrote:

> Lee,

>

> I've read and enjoyed many of your posts, and I certainly hope you don't

> take offense to what I am about to say. My intention is not to slander.

> Please take what I have to say in the spirit it is intended.

>

> Your post perhaps epitomizes why EMS does not already have a coherent

> professional organization. How long have we been around? The cowboy attitude

> of " nobody is going to tell me what to do " is rampant within our ranks. I

> understand that you speak specifically of the government here, but what Gene

> was suggesting,I think, is legislation that we, the people, would ask for,

> and not something just shoved down our throats by politicians. Legislation

> that we feel would improve our lot. I'm not saying I necessarily agree that

> this is the way, but that I understand what Gene intended by his remarks.

>

> Perhaps the cowboy attitude is a character flaw in us EMS types, or perhaps

> it is a necessary part of the type of person required to perform well in

> this job. Perhaps it will also be the reason we may fail to progress beyond

> where we are right now. The funny thing here is that we often roundly

> condemn our patients when a similar attitude brings them into some

> misfortune and we are summoned to their aid.

>

> The Texas Assn.. of EMTs, The Texas Society of EMTs, The Texas Paramedic

> Society, and now this new one is trying to form (EMSEAT I believe is the

> acronym) have all experienced low participation due to the independence and

> divisiveness that seems to be inherent in our ranks. Even the NAEMT has been

> suffering from the infighting and distractions caused by the ever-present

> cowboy attitude.

>

> What is it going to take before we recognize the necessity of unity and the

> benefit of a professional organization? I do not speak of a union. A union

> is an organization to which you send you dues and hope they do something for

> you in exchange. The strongest, perhaps the only real tool of the union is

> the strike, and I couldn't do that. A professional organization would

> require that we as individuals participate in the process. That you not sit

> back and snipe at the other members because they don't necessarily do things

> just the way you would. That we find some common ground.

>

> We have some strong, intelligent folks in our number who could take the

> reins of a professional organization and drive it into the future, if we

> would just join in and help instead of balk and carp. The TAEMT is still

> alive, perhaps it would be the way to go. I don't know. Maybe EMSEAT. Once

> again, I don't know. What I do know is that we had better get off our duffs

> and do something before we rust.

>

> I'm still a cowboy, I guess, but maybe not as much of one as when I was

> younger. Cowboys get bucked off every now and then, and that old ground

> seems to get harder with every fall.

>

> 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!)]

>

> >I'm afraid I have to disagree, I have a DEFINITE PROBLEM with the

> >government telling me what organizations I HAVE to belong to. The same

> >with a company that tells me I HAVE to be union to work. Agreed, we need

> >to have a voice, but it should be our voice because we care enough to be

> >heard, not because we are forced to.

[Guest guest]

An association would be much better than a union. I work in a union job. As Gene has stated, the union gets more in dues than what you will get from them. As medical providers, we would not be able to strike (this would really show the public why we were doing the job). I would definitely be in favor of an association.

Alan W Wells, EMT-P

awwells@...

[] 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]

Out of lurk mode for a couple of quick comments, then back off of the soapbox.

1. A professor in undergrad school once made

the comment "If you have a union, you probably deserve it." This

comment was directed at labor and management. (The professor had been an

arbitrator of contract disputes for 20+ years.) If management treats

workers poorly, it can expect organization of the workforce. The

problem is that a contract makes the work experience very rigid.

And a few bad apples can make life miserable for everyone with a couple

of dumb contract provisions.

2. I grew up with my father belonging to a union.

He earned a good living, in part because of the union representation, but

when a few loose cannons organized a wildcat strike, his union "brothers'

tried to run him off the road because he would not honor the illegal picket

line.

3. My union experience (in building trades) was horrific.

I was the object of a grievance because I picked up a broom, to move it

out of a walkway. (that was a laborer's job). So, as is obvious,

union has a very negative connotation to me.

Mike Carr, JD, EMT-P

P.S. There was once a very active professional association

which lobbied hard and heavy during the 1983 legislative session for the

EMS Act. T.A.E.M.T. never had more than approximately 1500 of the

25,000 persons certified at the time. Why not?

M.

Alan Wells wrote:

An association

would be much better than a union. I work in a union job. As

Gene has stated, the union gets more in dues than what you will get from

them. As medical providers, we would not be able to strike (this

would really show the public why we were doing the job). I would

definitely be in favor of an association. Alan

W Wells, EMT-Pawwells@...

-----Original

Message-----

To: egroups

<egroups>

Date: Thursday, November 12,

1998 12:35 PM

Subject: [] Re: [Fwd:

Private services & 911 (long!)]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

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