Re: (no subject)

[Guest guest]

> Since then, there has been a steady decline in the

> nuturing and

> emergence of national EMS leadership.

I agree wholeheartedly. I think part of the problem

is that when we are rookies, we are taught to

concentrate on our scene right now; don't worry about

the last call or the next call. EMS is a " commando "

job; we arrive, assess, treat, transport, deliver,

brief, finish paperwork, and get back in service

generally within an hour in cities where the transport

time is not too long.

People who are good at this become Senior Medics,

Field Training Officers, Trainers, or whatever your

system calls them. People who are good at training

other people to be medics become Commanders, Officers,

Lieutenants, etc. People who are good at this become

administrators. Unfortunately, good medics do not

**necessarily** make good system administrators

> I was recently at Phoenix FD. They utilize 43 ALS

> engines and 34 BLS

> transport vehicles. Why don't they do SSM?

They do. All fire departments practics System Status

Management. The difference is that fire departments

call them a " move up/standby assignment " , and fire

trucks go to other fire stations. The reason that you

don't see 60-ton engines at 7-11s is that there are

two- or three times as many fire stations to hide the

fire trucks in. Did you ever notice that a

third-alarm assignment arrives in only slightly more

time than it took the first alarm assignment to

arrive? This is because of move-ups. I did one just

last night (7/26 0330 hrs).

What you are ***actually*** asking is this: " Why

don't we see ***as many*** move-ups in the fire

service as standbys in the EMS system? Here's your

answer. There's more fire trucks. More fire trucks

in a city means that a smaller percentage of the total

fire trucks (translation: smaller hole in the overall

coverage) is necessary to complete a task.

How do we fix this? We raise our EMS standards to

match our fire standards, at least in the response

time area. Instead of 8-minute response standards,

make them 4- or 5-minute standards, like the fire

department. This will yield an EMS system with (ready

for this?) **MORE** ambulances than fire trucks. Why

" more " ambulances? because an *average* EMS call

results in an EMS unit being out of service for a

longer period of time than an *average* fire incident

(remember that the *average* city fire company also

runs EMS first response, which run about 20-30 minutes

or so per incident). Therefore, in order to keep

ambulances responding as quickly as fire trucks, we

need more ambulances, since ambulances spend a greater

percentage of their time out of service on calls.

There is no outcome evidence to support this

> activity.

Well, let's look at that, too. Is there any evidence

that arriving in, say, 8 minutes saves lives? In a

small percentage of patients, yes. In the vast

majority, consisting of Basic Life Support patients

(many of whom could have taken a taxi with no worse

outcome), no. No *medical* difference in an 8-minute

response or a 15-minute response in your average " toe

pain for three weeks " patient.

The difference is that administrators (refer to my

first paragraph about their competence) can *measure*,

with absolutely 100% accuracy, their response times.

Therefore, if they staff enough ambulances to hit a

6-minute standard, then shuffle a couple of trucks

when another is transporting, those two trucks who are

posted (stand-by in my area) can still meet the

8-minute 59-second standard. Also, remember that your

comfort and fatigue is of no concern to the

administrator until your fatigue causes you to wreck

one of his ambulances. The fact that he can stand in

front of the city council and *document* response

times and call volumes is of great concern, however.

EMS System Directors, just like any other department

head, live and die NOT by the amount of money they

spend, but by the amount of money they save.

Don't get me wrong. As I said in my first sentence, I

agree wholeheartedly with you. I agree with you so

much that I am now a firefighter, where I get paid

more and work less, and my Battalion Chief is

genuinely concerned that my TV remote's batteries

failed catastrophically during a critical channel

flip. A dispatcher actually (swear to God) apologized

for calling us in the middle of the night one time.

However, as long as we continue to allow the check

writers (and I'm talking about the city councils, not

the system administrators) to believe that they

actually CAN get more blood from this turnip, the

situation will not change. Remember that city council

members don't know squat about EMS; that's why they

pay the EMS administrator so much money. They believe

what he tells them, unless YOU tell them otherwise.

Make an appointment with one of your city council

members. Reschedule the appointment because you got

snatched for overtime. Explain this, in detail, to

the secretary, and again to the council member when

you finally meet him or her.

Then explain what that overtime did to the patient

care that would have been rendered to the council

member's husband/wife/mother/father/child, had they

called you.

Now get up, delete this letter from your email, and go

talk to your city council members.

stay safe - pr