Re: Corpus Christi FF's don't want Paramedic Promotion

[Guest guest]

Like Ron says, this is going to get interestinger and interestinger. When

the NREMT-P exam hits it's going to further reduce the supply of available

Paramedics while those who opted for the short courses try to figure out how

to pass it. In the meantime more and more services will face staffing

crises, and more and more marginal services will shut down. City and county

officials will squeal and run off in all directions trying to get something

for nothing, and finally, MAYBE, the public will begin to realize what EMS

means to them and that there ain't no such thing as a free lunch. Perhaps

they will even get their pitchforks and torches and get after the sorry

politicians and MegaService people who have created this situation through

greed.

Remember when Laidlaw and R/M were buying up everybody in sight, paying

ridiculous prices for services that couldn't ever grow just to gain

territory? Territory was everything; some people had the delusion that

there would only be 3 or 4 national services by this time. As I recall, that

great prophet and seer Jack Stout was one of them. Now that things haven't

turned out like he planned, the MegaServices are in the toilet financially,

and the EMS industry is going to be stuck with the funding problems that

those people helped bring about.

Nobody can fully realize the folly and the kind of problems the

SystemStatusManagement/UnitHourUtilization gurus have caused the EMS

community without studying a place like, for instance, Tarrant County, Texas

(Fort Worth) which was one of his early efforts and which now is in deep

doodoo financially, being an R/M company.

SSM thrives upon the model of promoting rapid burnout. And when Paramedics

were a dime a dozen that was, from a pure economics point of view (and Stout

is an economist, not a medical person) gjreat strategy. Hire people at low

wages, work the shit out of them, don't give them any significant benefits

or raises, and encourage them to pass on to other careers after about 5

years. Payroll being the biggest cost in EMS, schemes such as this were

designed to keep payroll down.

Improved education was not encouraged and in fact was subtly discouraged

through maintenance of a system with no career ladder to speak of. Why get a

degree when it won't improve your income?

Add to the stew the " evidence-based " crew who have worked to make sure that

Paramedics don't expand their scope of practice in any way that would siphon

off patients from the ERs, and you have quite a few parts to the puzzle.

There are others, but I'll direct my attention to them later.

Bottom line. All EMS issues ultimately depend upon funding. Funding is

outside the realm of understanding and knowledge of 99% of the field

personnel working in EMS. Funding is POLITICAL, and 99% of the field

personnel working in EMS are NOT politically astute.

Gene

E. Gandy, JD, LP

EMS Professions Program

Tyler Junior College

Tyler, TX

[Guest guest]

I agree, that is why they should either hire personel that are paramedic

certified (or licensed) only and want to work on the ambulance, or make it a

third city service. That way at least the patients will not run into the

FF/EMTP that was 'stuck on the box' and forced to be there.

Donnie Stone

Re: Corpus Christi FF's don't want Paramedic Promotion

In a message dated 12/30/2001 12:17:57 PM Central Standard Time,

bwiseman@... writes:

>

> this is the biggest problem with Fire based EMS. Paramedic positions are

> promotions, meaning you only have medics there for a short time and only to

> promote. You have nobody on the box that likes being a Paramedic, pt care

> has GOT to suffer!!!

>

>

AMEN!!!!!

Andy Foote, EMTP

City of Beaumont EMS

A Division of Public Health

[Guest guest]

I'll go on a limb with my little crystal ball and bet you see most FD services

as a third service, and still housed in the Fire Station. We had this battle

when I was in the FD in the Air Force and they introduced us to doing both. We

told them then we can do either one better than anyone, but if we did both we

would only be able to do a half a** job of each. So they order us to do the

training, and do both. Well we did, and we knew what we were doing medically,

but didn't know why.

Ron

Re: Corpus Christi FF's don't want Paramedic Promotion

In a message dated 12/30/2001 12:17:57 PM Central Standard Time,

bwiseman@... writes:

>

> this is the biggest problem with Fire based EMS. Paramedic positions are

> promotions, meaning you only have medics there for a short time and only

to

> promote. You have nobody on the box that likes being a Paramedic, pt care

> has GOT to suffer!!!

>

>

AMEN!!!!!

Andy Foote, EMTP

City of Beaumont EMS

A Division of Public Health

[Guest guest]

Gene,

I agree that things are going to become more and more " interestinger " but I

also must argue on a few points you tried to make that missed the mark.

First of all, on the consolidator's, although it did not work out as planned,

it did do some things for some cities and counties in our great country. It

provided some areas with better, higher quality EMS and non-emergency

services than they had prior to AMR, MedTrans, R/M, CareLine, etc etc etc.

Additionally, it created competition and forced other agencies to improve or

get pushed aside which also improved care. So, although through some poor

decisions in corporate boardrooms hastened the quick decrease in size

(national branding vs. franchise's, etc) the advent of consolidation was not

the darkest day......

On funding problems...I would also caution that, although private services

and consolidator's didn't necessarily do the best job working on the M'Care

fee structure, they were behind the first nationally unified voice

representing varied interests and probably did more to make sure that we were

not even further out in the cold on this fee structure than we are. I know

one of the guys who basically lived in D.C. for months during this process

and I know that there was no other group, agency, city, or county that would

or could have spent the amount of money lobbying Congress and HCFA all for

the interests of ambulance providers that this consolidator did.

Allow me to get a little politically incorrect here for a moment and address

who actually did hurt the funding problems....namely municipal EMS agencies,

for the most part fire-based. How many times have you read about private EMS

requesting a modest increase in subsidy and then getting lambasted by a

municipal agency claiming they can do it for the same money, with no

increase, and actually make money for their city/county? Then, like

clockwork, they are back at the table the next year looking for a substantial

increase because they had " unanticipated " cost increases. It is happening

across our nation every day.

Then on top of that, go look at the latest testimony before Congress on the

fee schedule and providing proper initial funding for that schedule prior to

its implementation. Who is in favor of more money and presenting a unified

voice and who is the lone voice dissenting against more money to EMS

providers? I will tell you that Paramedics, EMS managers, and even fire

chief's are in favor and it is the lone voice of the IAFF who stated they

felt EMS should be funded locally, and that no more money was needed from the

Federal Gov't not because they truly believe that but because they understand

that it would drive another nail in the coffin of private and third service

EMS.

To suggest that the consolidator's hurt our funding is quite laughable. They

knew there was no way to stop the " fee-schedule " train as EMS was the last

group to be without one. So, they went to work on making it as palatable and

easy to use as possible, working with a unified voice to make sure EMS

interests were addressed and even today are working to get more and more

funding placed into pot.

The other issue you brought up that I must contest is that SSM and UHU gurus

have also caused great grief to the EMS community. I would caution you

against throwing the baby out with the bath water when examining EMS systems.

SSM is the most efficient and flexible way to staff and manage EMS

resources. Yes, it is different from everybody working 24 hour shifts, but I

can tell you that with the need to be more and more flexible to attract the

better employees as our staffing becomes even tighter, the ability to

flexibly schedule folks (like SSM allows) will be a true benefit that cannot

be beat.

Is SSM always the best? No it isn't. Is it always managed the best? No it

isn't. SSM is probably one of the most difficult concepts in EMS today. It

takes years of experience and data plus constant monitoring, tweaking, and

adjusting to make it successful, but it does work. SSM does not force

agencies to hire people at low wages, work the s$@@ out of them, not give

adequate benefits or encourage people to leave the career field....EMS

managers do that. That happens as readily in the shrine of EMS schedules

(24/48) as much as it does in SSM. It isn't caused by the work schedule as

much as it is caused by the work environment/mangement. I can name over 5

EMS agencies off the top of my head that employ SSM fully and are some of the

best places to work in EMS across this country. The reason is because the

management works to make it a great place to work....not because of some

scheduling pattern.

Secondly, the Tarrant County MEDSTAR system is a unique animal in Texas and

the US. It is a Public Utility Model EMS system. Although they use system

status management to allocate their resources, it is hardly this that is

causing the issues with the MedStar system. Public Utility Models (about 15

of them in the country) are without a doubt some of the most efficient,

well-run EMS organizations that traditionally provide the highest level of

care, the most consistent patient care, at the lowest cost to taxpayers. The

PUM concept, developed by Mr. Stout, is not without flaws, however it has

proven successful wherever it has been properly implemented. If the MedStar

system is in deep doodoo financially, I would doubt, again, it is because of

SSM......

I DO agree with you however that EMS is all about funding (as is everything

life). Show me the $$$. I also agree that it is not understood by a

majority of field personnel, but not because it is outside their realm of

understanding but because no one has ever taught them about it. Look at the

EMS curriculum in paramedic schools...how much time is taught on how the

system operates and the criticalness of the paramedic in making it

successful? Look at the EMS conference: How many lectures were there

(approximately 90???) and ONE had discussion about funding?

We see patients everyday and when we tell them they need to go to the

hospital and be checked out and they state they cannot afford it, what do we

do? " Don't worry about the money, we just need to get you checked out and

make sure you are okay...we can worry about the money later. " We feel so

good about it, they consent to go, we take them, start the IV, give the

medications, interpret the EKG, hold their hand, and pat their head. After

dropping them off at the ER we high-five each other and head back to our

station.....when do we worry about the money later? We don't. The patient

gets treated, goes home, and finds a bill for ambulance services.....a bill

that IF we had worried about it half as much as the patient, we could have

properly documented the medical necessity of the treatment and ambulance

transport, properly educated the patient as to why money was not an issue,

and the bill would have been paid by the insurance, thereby truly making

money something they didn't need to worry about.....That is compassion in EMS

care.

BUT we don't do that. We all try to believe that getting paid for our

services is a great evil. That it is somebody else's problem, not ours.

That excellent healthcare is a right....not a service that must be paid for.

As such, then EMS funding becomes political.

I must object and state that I feel EMS funding is NOT political. It is a

local management problem. We, as EMS managers, directors, chiefs, do not

insist and demand that we complete reports dictating medical necessity with

as much emphasis as we do that every box is checked and every little

minuscule thing about the patient, their odor, color, taste, etc is all

documented in a narrative that could compete for Pulitzer prizes. If we all

corrected the issues we have with medical necessity and documentation, we

would be surprised at how much extra revenue that would bring in. We might

even smile more......

Anyway, I wanted to voice my opinion on these issues Gene. As always, this

is my opinion...and mine alone.

Dudley Wait