RE: Re: Public Utility Model - LONG RESPONSE TO GENE

May 3, 2004

Points to Kenny and Gene:

1. There is no evidence that System Status Manamgement is effective. It is

statitisically impossible with 20 weeks (or even a years) worth of data to

predict where and when a call will occur. One statitsican I spoke with at

A & M estimated that it would take 30 years worth of data before predictions

in a town the size of Fort Worth would be anywhere near accurate. One at

Harvard said it would take nearly 100 years. SSM is nothing more than a

" smoke and mirrors " mechanism to keep from purchasing and maintaining fixed

stations. Ambulances and crews are less expensive than fixed stations

(especially of you view an ambulance crew as an expendable commodity). SSM,

if working as Stout says it does, should constantly be diverting ambulances

from low call areas to high call areas. Studies have shown that lower

socioeconimc area use ambulances more than higher economic areas. Thus. If

working as it should, SSM should discriminate against higher-income economic

areas (i.e., affluent areas) despite the fact that they higher affluency

areas pay the majority of the taxes. Look at the weather. We have over 100

years of temperature history and forecasters simply predict high and low

temperatures. You know how accurate they are. Now, take 20 weeks of data and

try and predict WHEN and HERE an ambulance call will occur in Fort Worth

with a geographic area of 272 square miles and a population of 534,000. If

you believe SSM works, I have some pyramids and magnets and CISM to sell

you. SSM is 100% economics. Screw the field personnel by using them as much

as possible and keeping them in a damned ambulance for hours ata time

driving around waiting for the call that never comes.

2. How come MedStar still pays paramedics between $9.00 and $13.00 an hour

without benefits and Rural/Metro can barely make ends meet? The SSM model

was an economic model that was not designed to promote the evolution of EMS,

just to draw as much out of personnel and equipment as is possible. That is

why MAST is soon to be taken over by the city and Mecklenberg County was

waken over by the county. If PUMs are so great, how come fire departments

don't follow that model (or use SSM for that matter). Also, if PUMs are so

great, how come there have been no PUMs established over the last 10-15

years and many cities are trying to back off from them. Do you really think

Stout came from the work of economics at the University of Oklahaom

enlightened with knowledge of how to run EMS. It was amd is simply use the

system as much as possible, low-ball every possible parameter, don't worry

about staffing becaue there is an endless line of recent EMT and paramedic

graduates willing to work for minimum wage " to get the experience " until

they get a real job. What is the turnover at MedStar? Those statistics are

closely held and frightening.

Bledsoe, DO, FACEP

Midlothian, TX

" Faith is believing what you know ain't so. "

Mark Twain

Following the Equator

Don't miss EMStock 2004!http://www.emstock.com

Re: Public Utility Model - LONG RESPONSE TO GENE

Gene, I think you have some good points, although many of them are opinion.

My comments are embedded in your text...

<< The PUM is founded upon the idea of system status management, a flawed

doctrine that was never based upon anything other than economics. Patient

care and public service were only incidental.

The idea was to convince city councils, county commissioners, and city

managers that a system constructed of smoke and mirrors would provide

excellent patient care while expending the least amount of money possible.

>>

I agree that system status management (SSM) is based (to a certain

degree) on economics, but so is any decision that determines how many

ambulances will be placed into service. SSM attempts to answer the

question, " With X amount of resources, where can they be placed in order to

provide the greatest amount of coverage? " SSM does not attempt to predict

where the next emergency call will occur, it simply looks at data that

shows, historically, where the greatest number of calls occur within a

geographic location in any given time period. In very large systems, it is

fairly accurate.

We all know there are going to be a greater number of calls in a low-

income inner-city area at 10 pm on a Friday night than there will be in the

sleepy suburbs at 1 am on a Tuesday morning. Every large system I know

about (PUM, FD, Private) practices some type of SSM, even if it isn't the

term they use to describe it. This is how they determine how many

ambulances they need to put into service. And to that extent, I think there

is some public service motivation behind that decision. If the system (PUM,

FD, Private) cannot meet the response needs of their public, they will have

to answer to someone.

Clinically, you are correct; patient care is incidental from a SSM

standpoint. But then again, that isn't the job of a System Status Manager.

That manager's job is to get ambulances to the patients in a certain amount

of time. It is the job of the Clinical Department to make sure that

appropriate patient care is delivered. A PUM consisting of an accurate

system status plan coupled with an aggressive clinical department CAN

provide excellent patient care at a reasonable cost to the taxpayers. It

isn't smoke and mirrors(my

opinion.)

<< Clever enticements such as " all our medics will be NREMT " and other

meaningless promises were used to mesmerize dumb city councilmen, county

commissioners, and city managers into believing that contracts with private

providers were the way to go. >>

Of course clever enticements were used on the weak-of-mind. It's called

marketing. Would you expect Jack Stout to approach the city council and say

he was offering a load of crap? Would you expect a fire chief to report a

decrease in fire responses within the city and a request that the council

decrease his budget because he can make do with less? Isn't one of the

purposes of a Citizens Fire Academy(very popular in my neck of the woods) to

gain support for the department from the population it serves? Would you

expect a plaintiff's attorney to stand up in court and say, " Your honor, our

case is completely without merit, and in fact, you should sanction me for

even being here. "

" All of our medics are ACLS-certified, " " ...BTLS-certified, " " ...PALS-

certified, " " two-medics per truck, " " oxygen-equipped, " " radio dispatched, "

.... aren't all these phrases really cleaver attempts to convince those who

don't know any better that you have the answer to their problems?

<< Artificial but high-sounding concepts such as responses within

8:59 90% of the time for urban responses and 12:59 90% of the time in rural

responses came into being. They were based upon nothing other than Jack

Stout's musings. Stop and think about it! What good will an 8:59 response

do for a patient in cardiac arrest? Not much, even if good CPR has been

done. But this figure was sold over and over to politicians who hadn't a

clue and who fell for a great presentation, which Jack is perfectly capable

of rendering. >>

If I remember correctly, the 8-minute benchmark was loosely based on the

early American Heart Association position that ACLS providers should be

on-scene " as soon as possible, ideally between 4 and 8 minutes. " As for the

fractile reporting of response times, I think (my opinion again) this gives

a much clearer picture of public service than straight averages.

Prior to the PUM model in Fort Worth, the previous provider was able to

serve the city of Fort Worth with 8 emergency ambulances and could honestly

report an average response time of less than six minutes.

They were able to do it because about 50% of all the calls came in two

response districts in the inner-city. Those two ambulances had response

times very low (within just a couple of minutes), but because they ran so

many calls, they were able to keep the averages down for the entire city.

Do 8 minutes and 59 seconds 90% of the time have any clinical relevance?

Probably not, but what is the magic number? Can Fort Worth, or Dallas, or

Houston, or San , or the citizens of County, or Shackelford

County or the Big Bend have an ambulance on a scene within seven minutes, or

six minutes, or three minutes of collapse? Of course they can, if they are

willing to pay for it. Jack did sell an arbitrary number, which replaced an

existing arbitrary number. R/M, the Houston Fire Chief, the Arlington Fire

Chief, AMR, and the San Fire Chief routinely " sell " their wares to

their respective politicians. I'm attempting to sell my position now (as you

also have.)

<< Thus emerged the concept of unit hour utilization which strives to force

the maximum amount of work from each unit in the shortest amount of time,

providing a stated amount of coverage for a very little expenditure, but not

taking into consideration the level of care provided. Nobody who controls

the finances actually gives a rats patoot about patient care. Care to

challenge me on that? Git it on! Prove it to me. You can't. >>

As an attorney, surely you understand the difficulty in attempting to prove

that something didn't happen. Also, unit hour utilization

(UHU) is not actually based on the shortest amount of time possible.

UHU is a measure of the amount of work one ambulance accomplishes in a

shift. A 12-hour shift might spend 40% of their actual time on calls, so

the UHU would be .40 (a very high UHU, by the way.) This would mean that

60% of the shift, the ambulance was not on a call.

What UHU doesn't take into account is that time a crew spends driving after

or between responses, which could sometimes double the utilization time of

that ambulance. (That is one of the drawbacks I

agree.)

A well constructed SSM plan will have a UHU cutoff, so as ambulances reach

that level, the plan is adjusted and additional units are placed into

service. I actually worked at a 24-hour station in the stop-six area of

Fort Worth whose UHU got so high, the management replaced our one 24-hour

ambulance with four 12-hour ambulances (2 in the day and 2 at night.) I had

to take a 24-hour shift at a station with a much slower UHU (and it just

about drove me crazy.)

<< There are no considerations given by system status management to the

personal comfort or needs of the employee; in fact, as Jack Stout once said

to me over a lunch, the idea is to employ young people as medics, work the

living shit out of them, burn them out in about 3 years, and replace them

with new employees. That way you never have to give pay raises based on

seniority and experience. Mr. Stout and his disciples fervently believe and

adhere to this concept. Most of the people now running the big national EMS

companies are Stoutians.

>>

Well, I have no idea what you and Jack Stout talked about over lunch; I

personally didn't care much for the man. I don't believe that, as a general

rule, SS managers are oblivious to the comfort of the crews (my example

above seems to support that.) There is always going to be that animosity

between the people who parcel out the work and the people who have to

accomplish it.

As far as a business plan, it doesn't make sense to systematically engage in

a plot to replace senior medics with younger, less experienced medics in

order to save $5,000 each. When I was at MedStar all those years ago, to

replace the five-year medics would have probably saved about $80,000 a year

in salary (out of a 10 million-dollar payroll budget.) This could easily

have been offset if one of the young medics made a mistake that one of my

senior people would not have made. The idea of replacing senior medics may

be a popular story (I heard it back then too), but it doesn't make good

business sense. I can't speak to the religious affiliations of the big

national EMS companies.

<< The private contractors who bid on these contracts, big players like

AMR, R/M, and others, typically " low ball " the bid in order to get the

contract and then engage in a scheme to demand increased subsidies from the

PUM in order to continue service. >>

I have heard that one for years and years. I know of an area fire

department that underbid one of the big private providers and won the

service for their city. Before the year was up, the fire department was

more than 1 million dollars over what they proposed. Did the fire

department " low ball " in order to get the service? I don't know because I

wasn't a party to the inner-circle at the fire department.

Does AMR and R/M " low ball " in order to get contracts and then force the PUM

to increase the subsidy in order to continue service? I don't know, but if

it was happening, don't you think the PUM or the city of county officials

would see that pattern after a while?

<< Top level managers in these services are paid corporate salaries in the

multiple 6 figure ranges, and their allegiances are to their owners rather

than the public. They are no different from the CEO of Halliburtin, or

General Electric. Their output and accomplishments are never designed to

provide excellent care to those they serve; rather their entire set of goals

are intended to make money for the company and perpetuate their jobs. >>

As far as salaries are concerned, I agree entirely with you. I feel certain

the CEO of General Electric could care less if my lights are on. The CEO of

PepsiCo doesn't care if my soda is flat. The CEO of R/M only wants to make

sure that the cities are happy with the service so they can continue to get

contracts. The city is happy with the service if the ambulance gets to the

patients in a timely manner and there are no complaints from the public.

And the public is happy as long as they don't have to wait for a long time

and are treated with respect. The public and city officials are generally

not in a position to judge the quality of the medical care being provided.

That is why some PUMs(like MedStar) have an independent medical board (EPAB)

to make that judgement. MedStar also has a Clinical and QI Department

funded by the private provider (not the

PUM) to collect medical data and report to the EPAB.

<< Since street medics are traditionally anti-union and cannot be enticed

to band together for the common good, they are a corporate manager's dream.

The managers exploit the workers to the max, and they play the game to

remain in power by providing service as the very lowest cost to the PUM but

still making a profit for the corporation. Into this mix goes

Medicare/Medicaid abuse and fraud, abuse of employees by enacting schemes to

deprive them of overtime, and so forth. >>

I agree about street medics not banding together, but I don't think there is

maximum exploitation at work here. I know there are less than honorable

managers in the private sector, but I've seen that behavior within the

public sector as well. I honestly believe, however, the private hierarchy

sees value in treating its employees with respect. They do it if for no

other reason than to keep them in compliance with their contract

requirements to help ensure future contracts.

<< At one time paramedics were a glut on the employment market.

However, now, there are fewer and there is a shortage. But corporate

providers will never respond to the market by paying better wages; rather,

they will find ways to use lower level certified medics such as EMT-I and

EMT basic to do the bulk of the work in their systems. >>

Are you arguing that using an EMT-I or EMT-Basic will impact patient

outcomes? I hope not, because I don't think there is any evidence to

support that position. I have worked in systems that were Paramedic- Basic,

Paramedic-Intermediate, Paramedic-Paramedic and I'm not sure I could say for

certain there were any differences in outcomes between the systems. The

private providers are always going to provide whatever service the city or

county wants to pay for. If a city is willing to pay for a double-medic

truck, that is usually what they get. If R/M or AMR wants to come in and

offer a Paramedic-EMT option that is cheaper, the city could say no. You

are not suggesting that cities are contracting and paying for double medic

trucks and getting paramedic-EMT services?

Maybe the shortage of paramedics has something to do with the fact that

Texas schools have such a low pass rate on the National registry exam.

<< So what does the PUM do for EMS? Little except huge salaries for its

managers. Wouldn't it be interesting to know who the surviving PUMs are and

who their managers are and where they came from. You'll find out that they

all came from services that Jack Stout was hired to build and structure.

Would somebody please come forward and attempt to justify the PUM. You've

got the stage. Can you do it?

Let's see. >>

I'm not trying to be the poster boy for PUMs or MedStar. If the PUMs

created 20 years ago are still around, then something must be right about

them. EMS is not the same animal it was 20 years ago and if the time has

come for them to go, they will. I suspect there are still cities that want

them, for whatever reason (financial probably.)

Finally, I don't think there is any one right way to provide EMS service.

If your city creates a PUM, it will not enjoy the advantages offered by a

municipal service, but the city will save a lot of money. If your city

wants to fund a municipal service, it will not enjoy some of the benefits of

a private provider or PUM (and there are benefits, albeit mostly financial.)

Municipal services don't guarantee clinical excellence nor does private EMS

equate with malpractice.

Gene, you and I are closer on this issue than this essay reflects, I think.

Thanks for listening.

Kenny Navarro

May 3, 2004

Kenny,

I posted and the manager previous to me posted on the SSM method. I did the

research on my city and promptly stopped it.

We did it for 5 years and I stuck pins in maps, did the numbers, poured over

certain times of the day calls came in, and came up with the only findings I

could. That during certain times of the day, more calls came in than at other

times. As follows:

1. There is an abundance of calls during the hours of 5a-7a for sick calls and

DOS's. This is when people wake up, feel bad, go the bathroom and vagal out.

This is when people wake up and find out that the person next to them or in the

room next door didn't wake up. There were never any general locations and I

found out that people die everywhere in the city.

2. Between 8a-9a, most morning MVC's happen. This is when people go to work

and have wrecks. They happen everywhere in the city and not on one specific

street.

3. Between 12-1pm there are more wrecks. This is when everyone goes to lunch

and tries to get 2 hours worth of personal business done in one hour. Again, no

specific location.

4. Between 5-6p we have more wrecks. Everyone tries to make the 30 minute trip

home in 10 minutes. Again, no specific street or location.

5. Between 10p-2a we have most of our shootings and stabbings and domestic

disturbances. I have yet to figure out where they are going to happen by 5

years of record keeping.

I do know that moving units constantly during the 24 day, it stresses out my

medics. They would love to sit at their station and eat, instead of sitting at

a mall parking lot or in a service station waiting to be moved again in 20

minutes.

It has nothing to do with how I fund. I lose approximately 500,000 dollars a

year. But my medics stay with me, they get promoted, they make good money and

have the greatest benefits that can be had, working for the city. This is

because my City knows that you get what you pay for. They see the PUM's that

have tried to come into our City for 200,000 dollars and then ask for $2 million

and state they underbid the following year. We also have every major physician

in this city on our side. We do medicine. We cure people. We get back 35.7%

of our full arrests. Last 26% of those were discharged home. We have a 375

page protocol book and over 45 meds in our ambulance that we are allowed to use,

not expire.

PUM's have no business paying slave labor wages to good college graduate LP's.

It is destroying our occupation.

Andy Foote

City of Beaumont.

May 3, 2004

Andy Foote.....another voice of reason in the wilderness!!!!!!!!!!!

Bledsoe, DO, FACEP

Midlothian, TX

" Faith is believing what you know ain't so. "

Mark Twain

Following the Equator

Don't miss EMStock 2004!http://www.emstock.com

Re: Re: Public Utility Model - LONG RESPONSE TO GENE

Kenny,

I posted and the manager previous to me posted on the SSM method. I did the

research on my city and promptly stopped it.

We did it for 5 years and I stuck pins in maps, did the numbers, poured over

certain times of the day calls came in, and came up with the only findings I

could. That during certain times of the day, more calls came in than at

other times. As follows:

1. There is an abundance of calls during the hours of 5a-7a for sick calls

and DOS's. This is when people wake up, feel bad, go the bathroom and vagal

out. This is when people wake up and find out that the person next to them

or in the room next door didn't wake up. There were never any general

locations and I found out that people die everywhere in the city.

2. Between 8a-9a, most morning MVC's happen. This is when people go to

work and have wrecks. They happen everywhere in the city and not on one

specific street.

3. Between 12-1pm there are more wrecks. This is when everyone goes to

lunch and tries to get 2 hours worth of personal business done in one hour.

Again, no specific location.

4. Between 5-6p we have more wrecks. Everyone tries to make the 30 minute

trip home in 10 minutes. Again, no specific street or location.

5. Between 10p-2a we have most of our shootings and stabbings and domestic

disturbances. I have yet to figure out where they are going to happen by 5

years of record keeping.

I do know that moving units constantly during the 24 day, it stresses out my

medics. They would love to sit at their station and eat, instead of sitting

at a mall parking lot or in a service station waiting to be moved again in

20 minutes.

It has nothing to do with how I fund. I lose approximately 500,000 dollars

a year. But my medics stay with me, they get promoted, they make good money

and have the greatest benefits that can be had, working for the city. This

is because my City knows that you get what you pay for. They see the PUM's

that have tried to come into our City for 200,000 dollars and then ask for

$2 million and state they underbid the following year. We also have every

major physician in this city on our side. We do medicine. We cure people.

We get back 35.7% of our full arrests. Last 26% of those were discharged

home. We have a 375 page protocol book and over 45 meds in our ambulance

that we are allowed to use, not expire.

PUM's have no business paying slave labor wages to good college graduate

LP's. It is destroying our occupation.

Andy Foote

City of Beaumont.

May 3, 2004

In a message dated 5/3/2004 12:58:08 AM Central Standard Time,

kenneth.navarro@... writes:

Does AMR and R/M " low ball " in order to get contracts and then force

the PUM to increase the subsidy in order to continue service? I

don't know, but if it was happening, don't you think the PUM or the

city of county officials would see that pattern after a while?

The answer to that one is that it is too late now. Area City EMS closes to

allow " Low Ball " to take over. Sell all of the ambulances, let all of the

medics go and now what do you do?

You go to another PUM and they low ball the present and then it is a vicious

circle. The City cannot afford to buy all new ambulances, monitors, meds,

supplies, and rehire new people. When it gets SOOOOOOOOOOOOO bad they usually

go

and get it in the Fire Department and cover their heads (council members) in

the sand or they have already been voted out by now.\

Andy

May 3, 2004

I can tell you, ditching the posting made a world of difference to the

street folks. I don't think I got more down time, but just knowing that you

weren't going to be moved at 2am on the off chance you were going to be

slow, helped attitudes immensely. It did mine. Our street medics also took

some initiative to ensure that response times stayed down by being vigilant

about taking calls if they were closer.

If you have an area of town that you think more calls happen in....staff

another ambulance there.

magnetass sends

Re: Re: Public Utility Model - LONG RESPONSE TO GENE

>

> Kenny,

>

> I posted and the manager previous to me posted on the SSM method. I did

the

> research on my city and promptly stopped it.

>

> We did it for 5 years and I stuck pins in maps, did the numbers, poured

over

> certain times of the day calls came in, and came up with the only findings

I

> could. That during certain times of the day, more calls came in than at

> other times. As follows:

> 1. There is an abundance of calls during the hours of 5a-7a for sick

calls

> and DOS's. This is when people wake up, feel bad, go the bathroom and

vagal

> out. This is when people wake up and find out that the person next to

them

> or in the room next door didn't wake up. There were never any general

> locations and I found out that people die everywhere in the city.

> 2. Between 8a-9a, most morning MVC's happen. This is when people go to

> work and have wrecks. They happen everywhere in the city and not on one

> specific street.

> 3. Between 12-1pm there are more wrecks. This is when everyone goes to

> lunch and tries to get 2 hours worth of personal business done in one

hour.

> Again, no specific location.

> 4. Between 5-6p we have more wrecks. Everyone tries to make the 30

minute

> trip home in 10 minutes. Again, no specific street or location.

> 5. Between 10p-2a we have most of our shootings and stabbings and

domestic

> disturbances. I have yet to figure out where they are going to happen by

5

> years of record keeping.

>

> I do know that moving units constantly during the 24 day, it stresses out

my

> medics. They would love to sit at their station and eat, instead of

sitting

> at a mall parking lot or in a service station waiting to be moved again in

> 20 minutes.

>

> It has nothing to do with how I fund. I lose approximately 500,000

dollars

> a year. But my medics stay with me, they get promoted, they make good

money

> and have the greatest benefits that can be had, working for the city.

This

> is because my City knows that you get what you pay for. They see the

PUM's

> that have tried to come into our City for 200,000 dollars and then ask for

> $2 million and state they underbid the following year. We also have every

> major physician in this city on our side. We do medicine. We cure

people.

> We get back 35.7% of our full arrests. Last 26% of those were discharged

> home. We have a 375 page protocol book and over 45 meds in our ambulance

> that we are allowed to use, not expire.

>

> PUM's have no business paying slave labor wages to good college graduate

> LP's. It is destroying our occupation.

>

> Andy Foote

> City of Beaumont.

>

May 3, 2004

I would normally not wade into this debate but I feel obligated as a

representative of AMR. Let me just go on the record as saying that no matter

what the past behavior of AMR was or percieved to be, AMR does not now nor will

they in the future intentionally " low-ball " a bid just to get a contract. To

the contrary, we try to bid the proposal as accurately as the RFP will allow and

we try to ensure that the costs we charge the entities we contract with are

clearly defined for them in advance. Why you may ask, because we want to be

here for the long haul so we do not want to burn bridges or damage our

reputation. This is also why we try very hard to ensure our crews are paid

competetively for the markets we are in and that we provide good benefits for

our employees. Additionally, we do not try or even want to " burn out " our

employees and in fact try to work with them to find ways to make working for AMR

better.

Keep in mind that when you make generalities like that with information that is

old (AMR hasn't had a PUM in Texas since R/M took over Medstar in 1999 or

therabouts and we lost that because we didn't low ball it) that AMR is a dynamic

company and an evolving company.

Dralle

South Texas CES Manager

American Medical Response

Re: Re: Public Utility Model - LONG RESPONSE TO GENE

In a message dated 5/3/2004 12:58:08 AM Central Standard Time,

kenneth.navarro@... writes:

Does AMR and R/M " low ball " in order to get contracts and then force

the PUM to increase the subsidy in order to continue service? I

don't know, but if it was happening, don't you think the PUM or the

city of county officials would see that pattern after a while?

The answer to that one is that it is too late now. Area City EMS closes to

allow " Low Ball " to take over. Sell all of the ambulances, let all of the

medics go and now what do you do?

You go to another PUM and they low ball the present and then it is a vicious

circle. The City cannot afford to buy all new ambulances, monitors, meds,

supplies, and rehire new people. When it gets SOOOOOOOOOOOOO bad they usually

go

and get it in the Fire Department and cover their heads (council members) in

the sand or they have already been voted out by now.\

Andy

May 4, 2004

Okay, here's my two cents....

At this point (in San ) most paramedics still do not hold degrees. I

know that UTHSCSA has recently developed a Bachelors Degree for paramedics, but

other than that, I think to say it's safe to say that the majority of

paramedics are certified only. There are a lot of LP's running around, but are

their

degrees in EMS? More than likely, not. Nurses are degreed. I've always argued

about how we can do more (intubate, etc.) than they can and we deserve fair

compensation. But the fact remains that they did sit through all their core

courses, to get what they have.

$25.00 dollars an hour would be great, and definitely fair. I've known nurses

with bachelor's degrees that could not perform patient care for s**t!! But

let's pick a starting point. How about just a LIVING WAGE for EMS personnel? DO

you know the federal government states that you can support a family of 4 on

$8.20 per hour? Is this where big companies get their pay scale determinations?

I've worked for $10.00 per hour and not been able to " support " myself and my

2 kids without a second job. Not if you want to live where you feel safe. I

digress though.

Yes, AMR has good benefits, and they come in handy when you're ill, but does

it pay your light bill every month? NO!!

How much do their managers make? Is that maybe why they don't get concerned

with whether or not their employees can survive?

Mr. Dralle, I have known you for a long time. Can you honestly tell me that

if you had to start all over again at Metro or AMR, with their current going

rates for paramedics (as just a regular street medic), would you alone be able

to provide for your family without extra assistance or a second (or third) job?

If you say you could, then please post a realistic monthly budget.

I am not trying to attack you, but you have witnessed first hand the

struggles I have had. Do you realize that a lot of your employees literally live

in

poverty? Or as Dr. Bledsoe said, is there anyone who really care about the

individual employee?

Do you have to pay degreed nurse rates? Not yet, but one you could live off

of would be nice.

May 4, 2004

Okay, here's my two cents....

At this point (in San ) most paramedics still do not hold degrees. I

know that UTHSCSA has recently developed a Bachelors Degree for paramedics, but

other than that, I think to say it's safe to say that the majority of

paramedics are certified only. There are a lot of LP's running around, but are

their

degrees in EMS? More than likely, not. Nurses are degreed. I've always argued

about how we can do more (intubate, etc.) than they can and we deserve fair

compensation. But the fact remains that they did sit through all their core

courses, to get what they have.

$25.00 dollars an hour would be great, and definitely fair. I've known nurses

with bachelor's degrees that could not perform patient care for s**t!! But

let's pick a starting point. How about just a LIVING WAGE for EMS personnel? DO

you know the federal government states that you can support a family of 4 on

$8.20 per hour? Is this where big companies get their pay scale determinations?

I've worked for $10.00 per hour and not been able to " support " myself and my

2 kids without a second job. Not if you want to live where you feel safe. I

digress though.

Yes, AMR has good benefits, and they come in handy when you're ill, but does

it pay your light bill every month? NO!!

How much do their managers make? Is that maybe why they don't get concerned

with whether or not their employees can survive?

Mr. Dralle, I have known you for a long time. Can you honestly tell me that

if you had to start all over again at Metro or AMR, with their current going

rates for paramedics (as just a regular street medic), would you alone be able

to provide for your family without extra assistance or a second (or third) job?

If you say you could, then please post a realistic monthly budget.

I am not trying to attack you, but you have witnessed first hand the

struggles I have had. Do you realize that a lot of your employees literally live

in

poverty? Or as Dr. Bledsoe said, is there anyone who really care about the

individual employee?

Do you have to pay degreed nurse rates? Not yet, but one you could live off

of would be nice.

May 4, 2004

Well, then by god, you are working for a whole, totally NEW AMR. I have no

choice but to believe you, as I don't know you, but my experience with AMR

would have to be characterized as totally opposite. It's where I first heard

the term " meat in the seat " and the quote I posted the other day about the

difference between 2 year medics and 10 year medics only being salary....was

said by an AMR manager to a group of employees. I realize that AMR, or any

other private ambulance company in the state are not evil incarnate. They

are however profit driven, and that brings an entirely new dynamic into the

equation. The second you start keeping track of how much time an ambulance

is being utilized, or making money, in a 911 system, you are headed down the

wrong road, and bad things happen.

AMR has set ablaze plenty of bridges in the past, and might have developed a

new set of corporate values recently. I guess it's possible, but I believe

it's still a " for profit " company.

Why don't you start the ball rolling, and increase the hourly rate for your

medics to $25? They earn it, don't you think? Don't you think AMR could

afford it.....or would that cut into the profits too much? I certainly think

that a paramedic out there saving lives deserves at least as much hourly

compensation as an RN, don't you Steve? I hear that all the time from

people. I think 25 bucks is not a lot to ask for the kind of work we do.

Surely there are places in AMRs corporate budget to find the money to do

this, huh? AMR being a dynamic company and all, and it being interested in

finding ways to make working there better. I guarantee you, THAT would prove

how much you value your employees.

magnetass sends

Re: Re: Public Utility Model - LONG RESPONSE TO GENE

>

> In a message dated 5/3/2004 12:58:08 AM Central Standard Time,

>

> kenneth.navarro@... writes:

>

> Does AMR and R/M " low ball " in order to get contracts and then force

>

> the PUM to increase the subsidy in order to continue service? I

>

> don't know, but if it was happening, don't you think the PUM or the

>

> city of county officials would see that pattern after a while?

>

> The answer to that one is that it is too late now. Area City EMS closes

to

>

> allow " Low Ball " to take over. Sell all of the ambulances, let all of the

>

> medics go and now what do you do?

>

> You go to another PUM and they low ball the present and then it is a

vicious

>

> circle. The City cannot afford to buy all new ambulances, monitors, meds,

>

> supplies, and rehire new people. When it gets SOOOOOOOOOOOOO bad they

usually go

>

> and get it in the Fire Department and cover their heads (council members)

in

>

> the sand or they have already been voted out by now.\

>

> Andy

>

May 4, 2004