RE: Texas EMS: Past Medical Hx and Hx of the Present Illness

[Guest guest]

Truly a comprehensive statement and what ails Texas (and national) EMS.

Outstanding!

Texas EMS: Past Medical Hx and Hx of the Present Illness

With the improvement in education and availability of information through the

Internet and otherwise, the distance between licensed professionals and

paraprofessionals has lessened.

Beginning after the second world war nurse education made great strides

forward, the hospital based nursing programs became almost extinct, and the

requirement of college degrees arrived. The recognition that paraprofessionals

can

perform some aspects of medical diagnosis and treatment should come as no

surprise.

Nurses have progressed from being doctor's helpers to semi-independent

practice, and physicians' assistants have come into being.

Paramedics are perhaps where the nurses were in 1945 in terms of formal

education requirements. Some paramedics have educated themselves well, have

used

every opportunity to broaden their knowledge and scope of practice, while

others have been content to learn the minimum curriculum required to pass the

certification exams and no more.

It is truly remarkable that some paramedics have progressed to the levels of

advanced practice that they have achieved in the face of almost no industry

wide support for improved educational and certification requirements. In fact,

the ambulance industry as a whole has doggedly fought against raising

standards for fear that it would cost them money.

When paramedicine first came into being, protocols were written to be

followed strictly and rigidly. This was because the physicians running the

systems

generally had little experience in teaching other than other physicians their

skills and knowledge and had no idea how the experiment in paramedicine would

work out.

They were acutely aware of the very limited education paramedics were to be

given (400 hours above Basic EMT) and were certainly warranted in being

cautious.

However, in time, the best and the brightest paramedics and EMTs found a

thirst for knowledge and pursued self improvement with a vengeance. Through the

efforts and involvement of these people in governmental regulation,

progressive EMS regulatory agencies soon began to realize that more education

and

training could lead to a much higher level of care than was then being provided.

Hence, the evolution of the present National Standard Curriculum

EMS educators were ahead of the national trends in that they developed and

implemented better curriculum and included more basic knowledge than were in the

original curriculum as expounded in Caroline's text. They found a ready

audience for people who wanted to improve their knowledge and skills and

progress

to better positions and pay.

Forward looking EMS physicians and administrators realized that protocols had

ceased to be rigid recipes to be followed blindly and had evolved into

practice guidelines. The very best services have changed their cultures to

reflect

the increased knowledge and abilities of their medics, but not all.

Unfortunately, the ambulance industry under the leadership of large fire

department EMS services and the conglomeration of large private firms which have

now evolved into basically two companies, AMR and Rural/Metro, saw early on

that improved education for paramedics would soon require them to begin paying

wages comparable to those paid to other allied medical professionals such as

radiology techs, respiratory therapists, and nurses. They also recognized that

improved educational standards would soon produce empoyees who would rebel at

the " System Status Management " system and demand decent working conditions.

They quickly mobilized to " dumb down " the curriculum and provide for

continued certification of medics at what was basically the 1988 curriculum.

Under

these pressures mandatory teaching of the full national standard curriculum was

scuttled. The college programs that invested in the new curriculum under the

BEM's assurance that it would be mandated have either dumbed down their

programs or their programs are struggling for life. College administrators

quickly

made the bean counter's decision to chop the legs out from under struggling

programs and return to shorter, simpler courses.

{The only reason that the colleges haven't done that to nursing is that

nursing has a strong national organization and a strong state organization that

controls their curriculum. We have none.}

At the same time, the models used in providing EMS which allows service

contracts to be awarded to the lowest bidder have driven governmental agencies

to

avoid responsibility for providing service. Couple that with the inability of

the EMS profession to decide whether it is a rescue service, public safety

service, or a medical service, and you have a profession that is dead in the

water as ours is now.

Another aspect that cannot be overlooked is the current fascination with

" evidence based medicine. " There may not be much evidence that what we do

works,

but there is also little evidence that much of what physicians do in their

offices and in the ER works other than what they have observed over time. If we

stopped doing every intervention except those that have been proven beyond a

reasonable doubt through valid studies, we could do little more than

defibrillate and drive our patients to the hospital. Once there, they wouldn't

receive

any cardiac medications in the ER because the same rules apply there for acute

cardiac care that we adhere to in the field. The only difference is that

doctors rather than paramedic are doing the interventions. The continued

subterranean buzz about paramedics not really doing anything to change the

mortality

outcomes doesn't help. There are always segments of the medical industry

waiting to shoot us down, argue that we should not be doing advanced procedures

and revert to scooping and hauling.

We certainly do need research that will clear up some of these conceptions,

but in a profession that cannot pay its employees a living wage across the

board, the prospect of doing basic research to confirm that we do some good is

slim to none. There's no money for it. And it's hard to do randomized studies

with people who are trying their best to die within the next 5 minutes and

we're trying to keep them from it.

In my judgment Texas EMS is in crisis. We face many difficult and

threatening situations. The currently ongoing reorganization of Texas Health

and Human

Services and Texas Department of Health will probably result in the breakup of

the Bureau of Emergency Management and its functions being divided among

several other sub-agencies. If that happens, there will be no one agency

focused

on EMS in Texas. Who will look out for our interests? Who will explain our

needs and functions to the bureaucrats? What will happen to GETAC?

What we do in the next two years and in the next legislative session will

mark our course for the next 10 to 15 years. Are we ready for the challenge?

Gene Gandy

[Guest guest]

In a message dated 1/17/2004 11:41:53 PM Central Standard Time,

wegandy1938@... writes:

but in a profession that cannot pay its employees a living wage across the

board, the prospect of doing basic research to confirm that we do some good

is

slim to none. There's no money for it. And it's hard to do randomized

studies

with people who are trying their best to die within the next 5 minutes and

we're trying to keep them from it.

In my judgment Texas EMS is in crisis. We face many difficult and

threatening situations. The currently ongoing reorganization of Texas Health

and Human

Services and Texas Department of Health will probably result in the breakup

of

the Bureau of Emergency Management and its functions being divided among

several other sub-agencies. If that happens, there will be no one agency

focused

on EMS in Texas. Who will look out for our interests? Who will explain our

needs and functions to the bureaucrats? What will happen to GETAC?

What we do in the next two years and in the next legislative session will

mark our course for the next 10 to 15 years. Are we ready for the challenge?

This oh so true. You cannot compete against systems that continuously bid $0

for transport contracts and continue to pay the slave labor prices. FD EMS

systems are basically out for your budget money and more IAFF membership dues

and continue to fumble through the act of paramedicine til they (paramedics)

can get on an engine and get out of the system. My City is very stringent on

qualifications for our department (3rd service Public Health) and have just

about depleted the local area for paramedics that we can find to continue our

high

standards or at least teach the medicine it takes to make people well. This

would be different from making sure they stay alive til we get them to the

hospital.

In a few short weeks we will start hiring Intermediates that can keep the

level of stress down on our paramedics and still manage to get trucks on the

streets and maintain our high level of medicine. It does not make money and

thankfully our City Manager doesn't care right now. He wants us to maintain

that

level of care and he will do whatever it takes to keep the trucks on the

streets. I feel that intermediates can take that ball and help us.

I am proud that our ROSC rate was 37.5% for 2003. I am proud that the CHF'er

get to the hospital with virtually all of their symptoms gone by our giving

the meds we do pre-hospital.

I am not proud that I have to pay them what I do and we will continue to try

and improve that.

I am not proud that certain services feel that this type of treatment is

unnecessary and too expensive to try and implement in on their trucks. You can

bet that the ER doctors at our hospitals know and respect the paramedics on my

trucks. A lot of this goes to and people like him that would

not settle for less. We will keep this practice going and wait for the rest of

the world to catch up or fight like hell as they try to pull us back down to

where they are.

Andy Foote

Manager

City of Beaumont EMS

[Guest guest]

In a message dated 1/18/2004 6:08:44 PM Central Standard Time,

moutlaw@... writes:

Dear Mr. Foote,

I will agree it is very hard to keep paramedics who want to spend their

careers on the ambulance in fire dept systems. However I don't feel all fire

department based EMS " fumble through Paramedicine " . We are part of the

fire department and we have very good parmedics on our ambulances.

Thank you,

Marty Outlaw

Humble Fire Department

Dear Mr. Foote,

I will agree it is very hard to keep paramedics who want to spend their

careers on the ambulance in fire dept systems. However I don't feel all fire

department based EMS " fumble through Paramedicine " . We are part of the

fire department and we have very good parmedics on our ambulances.

Thank you,

Marty Outlaw

Humble Fire Department

I will agree with you on this one. One of my paramedics works for that

department and it is run ENTIRELY different than most Fire Based systems. I

have

done my research and I know from which I speak. This is not common. It is

just like many private systems saying that they took the same test as my

paramedics and the only difference is the color of our ambulances. I have hired

too

many of THEIR paramedics who go through a 9 month training program with us and

tell me that there is NO comparison to the type of medicine we do and where

they left. I have a 376 page protocol book. I have over 60 meds that our

people give, not just carry in the ambulance. I have medicines that cost $500 a

vial that no one in our area carries and I have seen the run sheets of medics

from Fire Based EMS and private EMS systems that prove me correct. They all

have good reasons for not using them (NOT) and always have excuses to why they

do

not use what they had on their truck. It basically comes down to money or

the Medical Director does not care enough to push forward with medical

treatments.

Andy

[Guest guest]

As usual, Andy makes salient points. With the apparent impending break-up of

TDH, it is essential that the EMS community in Texas come together and push

their mayors, county judges, state representatives, and state senators to

establish a Texas Board of EMS that will be run by EMS personnel (as is

present ins several other progressive states). To make this work, EMS

personnel must recruit the support of the Texas Medical Association, Texas

Osteopathic Medical Association, Texas College of Emergency Physicians and

other influential organizations. Otherwise, as occurred in some states that

did not heed the warnings of the enlightened, Texas EMS will soon fall under

the Department of Public Safety (where it will be a step-child to law

enforcement [as in Ohio]) or to the State Fire Commission (where it will be

a step-child to fire [as in New Hampshire]). The fate of Texas EMS is in the

hands of Texas EMS providers--all 50,000+ of you, not just the 1,300 of you

on this list serve.

BEWARE THE IDES OF MARCH!

Bledsoe, DO, FACEP

Midlothian, TX

Don't miss EMStock 2004!

http://www.emstock.com

Re: Texas EMS: Past Medical Hx and Hx of the Present

Illness

In a message dated 1/17/2004 11:41:53 PM Central Standard Time,

wegandy1938@... writes:

but in a profession that cannot pay its employees a living wage across the

board, the prospect of doing basic research to confirm that we do some good

is

slim to none. There's no money for it. And it's hard to do randomized

studies

with people who are trying their best to die within the next 5 minutes and

we're trying to keep them from it.

In my judgment Texas EMS is in crisis. We face many difficult and

threatening situations. The currently ongoing reorganization of Texas

Health

and Human

Services and Texas Department of Health will probably result in the breakup

of

the Bureau of Emergency Management and its functions being divided among

several other sub-agencies. If that happens, there will be no one agency

focused

on EMS in Texas. Who will look out for our interests? Who will explain our

needs and functions to the bureaucrats? What will happen to GETAC?

What we do in the next two years and in the next legislative session will

mark our course for the next 10 to 15 years. Are we ready for the

challenge?

This oh so true. You cannot compete against systems that continuously bid

$0

for transport contracts and continue to pay the slave labor prices. FD EMS

systems are basically out for your budget money and more IAFF membership

dues

and continue to fumble through the act of paramedicine til they (paramedics)

can get on an engine and get out of the system. My City is very stringent

on

qualifications for our department (3rd service Public Health) and have just

about depleted the local area for paramedics that we can find to continue

our high

standards or at least teach the medicine it takes to make people well. This

would be different from making sure they stay alive til we get them to the

hospital.

In a few short weeks we will start hiring Intermediates that can keep the

level of stress down on our paramedics and still manage to get trucks on the

streets and maintain our high level of medicine. It does not make money and

thankfully our City Manager doesn't care right now. He wants us to maintain

that

level of care and he will do whatever it takes to keep the trucks on the

streets. I feel that intermediates can take that ball and help us.

I am proud that our ROSC rate was 37.5% for 2003. I am proud that the

CHF'er

get to the hospital with virtually all of their symptoms gone by our giving

the meds we do pre-hospital.

I am not proud that I have to pay them what I do and we will continue to try

and improve that.

I am not proud that certain services feel that this type of treatment is

unnecessary and too expensive to try and implement in on their trucks. You

can

bet that the ER doctors at our hospitals know and respect the paramedics on

my

trucks. A lot of this goes to and people like him that would

not settle for less. We will keep this practice going and wait for the rest

of

the world to catch up or fight like hell as they try to pull us back down to

where they are.

Andy Foote

Manager

City of Beaumont EMS

[Guest guest]

>>From: Bledsoe

>>The fate of Texas EMS is in the hands of Texas EMS providers--all

50,000+ >>of you, not just the 1,300 of you on this list serve.

>>BEWARE THE IDES OF MARCH!

I could not agree more, but the other thing we need to bring up, is what

the average Joe Paramedic can do, beyond writing letters and making

menacing phone calls to their elected officials.

One voice is not a lot, matter of fact, in politics, one voice is near

worthless, as it is often drowned out in the sea of BS.

Combined however, we can be heard a little better.

I know this has been hashed and re-hashed time and time again, but it

stands true still, we need to organize. The only organization in Texas

that represents EMS personnel on a political basis, is EMSAT.

I have heard a lot of reasons, and I have offered many as well as to why

people would not, or do not join.

We need the unison, we need to go forth and say, " This is the voice of

50,000 dedicated professionals, and you need to listen " , we can only do

that if in fact we have that many voices.

EMSAT has a lobbyist, which can do good and powerful things, but they

need the average Joe support as well.

Not sure what 'your' reasons are for not joining, but shoot an email to

one of the board members, and see if you can't get the issue bridged. I

don't care if you agree with my thoughts on certain issues in EMS, but

the ultimate goal of progressing EMS in Texas and to be recognized as

professionals, we need to set the personal issues aside.

EMSAT elected now board members at the conference in San , it's a

new era, while we appreciate all the work that was accomplished by the

past boards and it's members, many of us are welcoming in new blood with

fresh ideas and a renewed vigor.

Just my thoughts....

Mike

[Guest guest]

Perhaps a member of the EMSAT BOD can update a list as to the very positive

things that happened at the BOD meeting in San .

Bledsoe, DO, FACEP

Midlothian, TX

Don't miss EMStock 2004!

http://www.emstock.com

RE: Texas EMS: Past Medical Hx and Hx of the Present

Illness

>>From: Bledsoe

>>The fate of Texas EMS is in the hands of Texas EMS providers--all

50,000+ >>of you, not just the 1,300 of you on this list serve.

>>BEWARE THE IDES OF MARCH!

I could not agree more, but the other thing we need to bring up, is what

the average Joe Paramedic can do, beyond writing letters and making

menacing phone calls to their elected officials.

One voice is not a lot, matter of fact, in politics, one voice is near

worthless, as it is often drowned out in the sea of BS.

Combined however, we can be heard a little better.

I know this has been hashed and re-hashed time and time again, but it

stands true still, we need to organize. The only organization in Texas

that represents EMS personnel on a political basis, is EMSAT.

I have heard a lot of reasons, and I have offered many as well as to why

people would not, or do not join.

We need the unison, we need to go forth and say, " This is the voice of

50,000 dedicated professionals, and you need to listen " , we can only do

that if in fact we have that many voices.

EMSAT has a lobbyist, which can do good and powerful things, but they

need the average Joe support as well.

Not sure what 'your' reasons are for not joining, but shoot an email to

one of the board members, and see if you can't get the issue bridged. I

don't care if you agree with my thoughts on certain issues in EMS, but

the ultimate goal of progressing EMS in Texas and to be recognized as

professionals, we need to set the personal issues aside.

EMSAT elected now board members at the conference in San , it's a

new era, while we appreciate all the work that was accomplished by the

past boards and it's members, many of us are welcoming in new blood with

fresh ideas and a renewed vigor.

Just my thoughts....

Mike

[Guest guest]

Dear Mr. Foote,

I will agree it is very hard to keep paramedics who want to spend their

careers on the ambulance in fire dept systems. However I don't feel all fire

department based EMS " fumble through Paramedicine " . We are part of the

fire department and we have very good parmedics on our ambulances.

Thank you,

Marty Outlaw

Humble Fire Department

Re: Texas EMS: Past Medical Hx and Hx of the Present

Illness

> In a message dated 1/17/2004 11:41:53 PM Central Standard Time,

> wegandy1938@... writes:

>

> but in a profession that cannot pay its employees a living wage across the

> board, the prospect of doing basic research to confirm that we do some

good

> is

> slim to none. There's no money for it. And it's hard to do randomized

> studies

> with people who are trying their best to die within the next 5 minutes and

> we're trying to keep them from it.

>

> In my judgment Texas EMS is in crisis. We face many difficult and

> threatening situations. The currently ongoing reorganization of Texas

Health

> and Human

> Services and Texas Department of Health will probably result in the

breakup

> of

> the Bureau of Emergency Management and its functions being divided among

> several other sub-agencies. If that happens, there will be no one agency

> focused

> on EMS in Texas. Who will look out for our interests? Who will explain

our

>

> needs and functions to the bureaucrats? What will happen to GETAC?

>

> What we do in the next two years and in the next legislative session will

> mark our course for the next 10 to 15 years. Are we ready for the

challenge?

> This oh so true. You cannot compete against systems that continuously bid

$0

> for transport contracts and continue to pay the slave labor prices. FD

EMS

> systems are basically out for your budget money and more IAFF membership

dues

> and continue to fumble through the act of paramedicine til they

(paramedics)

> can get on an engine and get out of the system. My City is very stringent

on

> qualifications for our department (3rd service Public Health) and have

just

> about depleted the local area for paramedics that we can find to continue

our high

> standards or at least teach the medicine it takes to make people well.

This

> would be different from making sure they stay alive til we get them to the

> hospital.

>

> In a few short weeks we will start hiring Intermediates that can keep the

> level of stress down on our paramedics and still manage to get trucks on

the

> streets and maintain our high level of medicine. It does not make money

and

> thankfully our City Manager doesn't care right now. He wants us to

maintain that

> level of care and he will do whatever it takes to keep the trucks on the

> streets. I feel that intermediates can take that ball and help us.

>

> I am proud that our ROSC rate was 37.5% for 2003. I am proud that the

CHF'er

> get to the hospital with virtually all of their symptoms gone by our

giving

> the meds we do pre-hospital.

> I am not proud that I have to pay them what I do and we will continue to

try

> and improve that.

>

> I am not proud that certain services feel that this type of treatment is

> unnecessary and too expensive to try and implement in on their trucks.

You can

> bet that the ER doctors at our hospitals know and respect the paramedics

on my

> trucks. A lot of this goes to and people like him that

would

> not settle for less. We will keep this practice going and wait for the

rest of

> the world to catch up or fight like hell as they try to pull us back down

to

> where they are.

>

>

> Andy Foote

> Manager

> City of Beaumont EMS

>

>

>

[Guest guest]

HB-2292 passed by the 78th Legislature requires the consolidation of 11

Health and Human Services (HHS) departments into 4 new departments. The

Texas Department of Health and 3 other agencies will become the Department

of State Health Services. If you look at the HHSC proposed organigram for

DSHS you will see that portions of EMS will probably fall under at least

three different sections of the new setup. Can we afford such fragmentation?

<http://www.hhsc.state.tx.us/Consolidation/News/dshs_org/Structure.html>

http://www.hhsc.state.tx.us/Consolidation/News/dshs_org/Structure.html

Folks, we don't have time to debate the small stuff or argue over turf any

more. We had better put our petty differences aside and real quickly learn

how to get along if we don't want to see in Texas that which has already

happened in New Hampshire and Ohio.

Regards,

Donn

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

D.E. (Donn) , LP, NREMT-P

....your educators can be only your liberators...

- Friedrich Nietzsche, " Untimely Meditations "

_____

From: Marty Outlaw

Sent: Sunday, January 18, 2004 6:05 PM

To:

Subject: Re: Texas EMS: Past Medical Hx and Hx of the Present

Illness

Dear Mr. Foote,

I will agree it is very hard to keep paramedics who want to spend their

careers on the ambulance in fire dept systems. However I don't feel all fire

department based EMS " fumble through Paramedicine " . We are part of the

fire department and we have very good parmedics on our ambulances.

Thank you,

Marty Outlaw

Humble Fire Department

Re: Texas EMS: Past Medical Hx and Hx of the Present

Illness

> In a message dated 1/17/2004 11:41:53 PM Central Standard Time,

> wegandy1938@... writes:

>

> but in a profession that cannot pay its employees a living wage across the

> board, the prospect of doing basic research to confirm that we do some

good

> is

> slim to none. There's no money for it. And it's hard to do randomized

> studies

> with people who are trying their best to die within the next 5 minutes and

> we're trying to keep them from it.

>

> In my judgment Texas EMS is in crisis. We face many difficult and

> threatening situations. The currently ongoing reorganization of Texas

Health

> and Human

> Services and Texas Department of Health will probably result in the

breakup

> of

> the Bureau of Emergency Management and its functions being divided among

> several other sub-agencies. If that happens, there will be no one agency

> focused

> on EMS in Texas. Who will look out for our interests? Who will explain

our

>

> needs and functions to the bureaucrats? What will happen to GETAC?

>

> What we do in the next two years and in the next legislative session will

> mark our course for the next 10 to 15 years. Are we ready for the

challenge?

> This oh so true. You cannot compete against systems that continuously bid

$0

> for transport contracts and continue to pay the slave labor prices. FD

EMS

> systems are basically out for your budget money and more IAFF membership

dues

> and continue to fumble through the act of paramedicine til they

(paramedics)

> can get on an engine and get out of the system. My City is very stringent

on

> qualifications for our department (3rd service Public Health) and have

just

> about depleted the local area for paramedics that we can find to continue

our high

> standards or at least teach the medicine it takes to make people well.

This

> would be different from making sure they stay alive til we get them to the

> hospital.

>

> In a few short weeks we will start hiring Intermediates that can keep the

> level of stress down on our paramedics and still manage to get trucks on

the

> streets and maintain our high level of medicine. It does not make money

and

> thankfully our City Manager doesn't care right now. He wants us to

maintain that

> level of care and he will do whatever it takes to keep the trucks on the

> streets. I feel that intermediates can take that ball and help us.

>

> I am proud that our ROSC rate was 37.5% for 2003. I am proud that the

CHF'er

> get to the hospital with virtually all of their symptoms gone by our

giving

> the meds we do pre-hospital.

> I am not proud that I have to pay them what I do and we will continue to

try

> and improve that.

>

> I am not proud that certain services feel that this type of treatment is

> unnecessary and too expensive to try and implement in on their trucks.

You can

> bet that the ER doctors at our hospitals know and respect the paramedics

on my

> trucks. A lot of this goes to and people like him that

would

> not settle for less. We will keep this practice going and wait for the

rest of

> the world to catch up or fight like hell as they try to pull us back down

to

> where they are.

>

>

> Andy Foote

> Manager

> City of Beaumont EMS

>

>

>

[Guest guest]

I have seen several people on the list ask the question what is EMSAT doing

about the present BEM situation. My question to everyone is what are you doing

about EMSAT? A board with-out a large population base to back it's moment is

like a trolling motor moving a 24 foot barge. Things move slow or not at all.

If EMS people on this list and off this list wish to be heard you need to be

willing to make a little sacrifice. We need every EMS certified person in Texas

to be a member of EMSAT. $35.00 is a small price to pay to help try to move EMS

in Texas in the Direction it needs to go, but we can't stop at that. We need

some of your time also. Every member of the EMS community needs to be

contacting their elected officials soon and often. Try to get your local news

media to do a story on our plight. We need public opinion on our side not

tomorrow but right now. I'll get off my soap box now, but will continue to work

toward a resolution to our common problem.

Concerned,

Nacogdoches County EMS.

" D.E. (Donn) " wrote:

> HB-2292 passed by the 78th Legislature requires the consolidation of 11

> Health and Human Services (HHS) departments into 4 new departments. The

> Texas Department of Health and 3 other agencies will become the Department

> of State Health Services. If you look at the HHSC proposed organigram for

> DSHS you will see that portions of EMS will probably fall under at least

> three different sections of the new setup. Can we afford such fragmentation?

>

> <http://www.hhsc.state.tx.us/Consolidation/News/dshs_org/Structure.html>

> http://www.hhsc.state.tx.us/Consolidation/News/dshs_org/Structure.html

>

> Folks, we don't have time to debate the small stuff or argue over turf any

> more. We had better put our petty differences aside and real quickly learn

> how to get along if we don't want to see in Texas that which has already

> happened in New Hampshire and Ohio.

>

> Regards,

> Donn

> ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

> D.E. (Donn) , LP, NREMT-P

>

> ...your educators can be only your liberators...

> - Friedrich Nietzsche, " Untimely Meditations "

>

>

>

> _____

>

> From: Marty Outlaw

> Sent: Sunday, January 18, 2004 6:05 PM

> To:

> Subject: Re: Texas EMS: Past Medical Hx and Hx of the Present

> Illness

>

> Dear Mr. Foote,

> I will agree it is very hard to keep paramedics who want to spend their

> careers on the ambulance in fire dept systems. However I don't feel all fire

> department based EMS " fumble through Paramedicine " . We are part of the

> fire department and we have very good parmedics on our ambulances.

>

> Thank you,

> Marty Outlaw

> Humble Fire Department

> Re: Texas EMS: Past Medical Hx and Hx of the Present

> Illness

>

> > In a message dated 1/17/2004 11:41:53 PM Central Standard Time,

> > wegandy1938@... writes:

> >

> > but in a profession that cannot pay its employees a living wage across the

> > board, the prospect of doing basic research to confirm that we do some

> good

> > is

> > slim to none. There's no money for it. And it's hard to do randomized

> > studies

> > with people who are trying their best to die within the next 5 minutes and

> > we're trying to keep them from it.

> >

> > In my judgment Texas EMS is in crisis. We face many difficult and

> > threatening situations. The currently ongoing reorganization of Texas

> Health

> > and Human

> > Services and Texas Department of Health will probably result in the

> breakup

> > of

> > the Bureau of Emergency Management and its functions being divided among

> > several other sub-agencies. If that happens, there will be no one agency

> > focused

> > on EMS in Texas. Who will look out for our interests? Who will explain

> our

> >

> > needs and functions to the bureaucrats? What will happen to GETAC?

> >

> > What we do in the next two years and in the next legislative session will

> > mark our course for the next 10 to 15 years. Are we ready for the

> challenge?

> > This oh so true. You cannot compete against systems that continuously bid

> $0

> > for transport contracts and continue to pay the slave labor prices. FD

> EMS

> > systems are basically out for your budget money and more IAFF membership

> dues

> > and continue to fumble through the act of paramedicine til they

> (paramedics)

> > can get on an engine and get out of the system. My City is very stringent

> on

> > qualifications for our department (3rd service Public Health) and have

> just

> > about depleted the local area for paramedics that we can find to continue

> our high

> > standards or at least teach the medicine it takes to make people well.

> This

> > would be different from making sure they stay alive til we get them to the

> > hospital.

> >

> > In a few short weeks we will start hiring Intermediates that can keep the

> > level of stress down on our paramedics and still manage to get trucks on

> the

> > streets and maintain our high level of medicine. It does not make money

> and

> > thankfully our City Manager doesn't care right now. He wants us to

> maintain that

> > level of care and he will do whatever it takes to keep the trucks on the

> > streets. I feel that intermediates can take that ball and help us.

> >

> > I am proud that our ROSC rate was 37.5% for 2003. I am proud that the

> CHF'er

> > get to the hospital with virtually all of their symptoms gone by our

> giving

> > the meds we do pre-hospital.

> > I am not proud that I have to pay them what I do and we will continue to

> try

> > and improve that.

> >

> > I am not proud that certain services feel that this type of treatment is

> > unnecessary and too expensive to try and implement in on their trucks.

> You can

> > bet that the ER doctors at our hospitals know and respect the paramedics

> on my

> > trucks. A lot of this goes to and people like him that

> would

> > not settle for less. We will keep this practice going and wait for the

> rest of

> > the world to catch up or fight like hell as they try to pull us back down

> to

> > where they are.

> >

> >

> > Andy Foote

> > Manager

> > City of Beaumont EMS

> >

> >

> >

[Guest guest]

is exactly right. EMSAT can really do very little without the

membership to back it up. When EMSAT speaks, it speaks for the members more

than anything. That is not a derogatory comment because, yes, EMSAT does try

and respresent the EMS community as a whole. However, when EMSAT goes forth

and attempts to fight things for this EMS community, the state reps and

legislators want to know how many people it represents. Truthfully, they can

only really count the folks who are members. That voice is not very strong.

As a professional community, we HAVE to all jump on board SOMETHING common

right now to fight the fight that it appears to be coming our way. EMSAT HAS

fought for us on numerous issues. (EMSAT was responsible for helping to

negotiate the new fees down from unreasonable to tolerable. EMSAT was

responsible for lobbying state reps and encouraging folks to lobby state reps

to block the DUI blood alcohol draws by EMS. EMSAT has been keeping its ear

to the ground and bringing forth many issues because only TAA and EMSAT have

been paying lobbyists to help us be aware of issues that concern EMS at the

legislative level. I am sure there are many more things, but these are the

first that jump to my mind.) Anyway, if we as a community expect ANYTHING to

help us now, we all will HAVE to unite. (And, like someone else on the list

said recently, that is NOT just the 1300 or so we have on this list. There

are, what, approximately 55,000 of us? That sure would carry a lot of weight

and actually could have helped us before now.)

Anyway, there is no excuse not to join now. There is a pretty much new

Board. There is now available a free $10,000 life insurance plan available

through VFIS when you join. AFLAC is available if you are a member and your

company that you work for offers no gap plan - or if you just want it. And

we have a common thing that we MUST fight for - our future in Texas. Talk to

everyone in EMS you know. Let us get together finally and DO something. And

plan to make the EMSAT meeting in Austin at the Red Lion at 1 p.m. on

February 11th. Come on, folks, let's do this - TOGETHER!!!!

Jane Hill