SSM

[Guest guest]

SSM with shorter shifts like 8 or 10 hours might be easier on the troops.

Does anybody know of any systems that employ 8 or 10 hour shifts in their SSM

trucks?

Gene

[Guest guest]

SSM is a system that CAN work. I am not saying that it is my favorite system

to manage calls, but it worked out VERY well for the over 1.5 million folks

that we serviced.

From some of the earlier posts... you are correct about cost, but those cost

are only there if you don't have a TOP QUALITY fleet maintenance program in

place. I recall having 24-hour in-house AMBULANCE FLEET mechanics [2 at night

and 4 during day]. There was not a vehicle there I didn't feel safe in, and I

don't recall any FD paramedics getting upset with us for the condition of our

rigs.

With SSM, you get what you pay for... if your company gives a crappy

investment, you will have a crappy product. But I was lucky to work for folks

that went the extra mile to produce a QUALITY service.

The same goes for agencies that use stations - I am lucky to work for

employers that put forth the investment to have a quality return of service.

[Guest guest]

BTW - we never had a shift that ran any more than 12-hours... most were 8 and

10-hour shifts.

I am NOT defending that SSM, but I will state that SecoAmerica LifeFleet -

Anaheim Division did it GREAT. We always had quality dispatching [computer

911 linked to NorthNet FD Comm Center], we always had GREAT rigs to workout

of [no truck was older than 5-yrs with a true PM program in place], and we

were one of the top paid companies in Southern California [$26K for a 42/week

Basic EMTs in 1993-4 with benefits, retirement, YADA-YADA]. I cannot complain

about my experience with SSM.

[Guest guest]

BEB,

What is right for one area/service may not be right for another... therefore,

the published numbers are nothing but wasted paper.

[Guest guest]

BEB,

I noticed that you have a thing for numbers and research...

My question is ---

#1 - Since San Diego ended its study of RSI, should we consider that RSI is

something NOT needed in pre-hospital care?

#2 - Since Houston concluded their study on MAST, should we remove them from

ALL units nationally?

#3 - Since LA/Orange Counties concluded their joint study, should we no

longer intubate pediatrics?

OR should we just consider that those agencies decided that it was NOT for

them?

What was so bad about your SSM experience because I had no problem with mine.

I loved the fact that I had a chance to work with some of the best guys in

Southern California [Anaheim FD, Orange County Fire Authority, Orange FD,

Buena Park FD - back then, and LA County FD] and would not trade that

experience for anything. I am sorry that I had a chance to work for a company

that cared for employees and could make a dollar doing it.

Yes, I will agree with you that there are some companies with less than

acceptable operational practices, using both SSM and station placement. In

Southern California, SSM is a GREAT concept due to the lack of real estate,

and uncertainty of getting the right location for a station. But you also

have to take care of your employees and they did that with us.

[Guest guest]

Los Angeles does not use SSM, but I will admit to being 25 minutes into a

county FD response going from one batallion to another, and being cancelled

because the private BLS-provider could have the patient at the hospital

before our ALS-squad could get there.

What you read on paper may NOT always be the ACTUAL method of operation. In

LA County, nowhere in protocol does it state you have to call or wait for

ALS-back up. This is because in some situations, on a NON-DISASTER day, you

could wait 20+ minutes for ALS-squad.

[Guest guest]

I worked the system... I didn't write it.

All that I wanted to illustrate is that NUMBERS can be worked, and I think we

all can agree on that.

Being a Basic-EMT in LA can be FUN!

[Guest guest]

Damn, I am young... I have no idea who that is. Is that anything like Farmer

Ted from Water Boy?

[Guest guest]

Ahhhh-hhhhh, your key word is SHOULD and life threatening. Pu-lease, GSW

victim in Compton... MLK 5 minutes Code 3... LACO Squad 31 15 minutes out...

GUESS what I did?

[Guest guest]

The overall problem is that no one ever considers the welfare of the EMS

workforce when bidding out these service areas. The players involved

(RFP writers, municipalities and bidders) couldn't care less about the

human costs of their system designs.

It all starts with the RFP (request for proposal) writers who are

contracted by the municipalities to organize the bid process, establish

the essential elements of the contract, conduct pre bid conferences,

assimilate proposals and manage the bid evaluation process. These people

are consultants who regularly perform contract work for the very

companies who bid these contracts. Thus, they are financially incented

(if not completely biased) to establish system criteria that favors the

operational style, manner and philosophy of the prospective bidders

(companies).

The municipalities that hire the RFP writers don't have a clue about

what to include in an RFP. Moreover, the RFP writers (for personal

economic reasons) steer clear of issues and content that measures and

compares workforce satisfaction (i.e., how well the EMS workforce is

treated). Most RFP's do include an element that requires the bidder to

address " workforce accommodation " , wherein many companies lie about

their plans to incorporate the existing personnel.

I've been working on a workforce protection index (for inclusion in

RFP's) that requires bidders to disclose certain facts about their

company's treatment of their workforce. The intent is to force the

municipalities to acknowledge that a fairly treated workforce yields

better results than ones that are brutalized by demented and torturous

designs, schemes and management styles. Some of the questions that I

would ask (and compare between bidders) include:

1. The ratio of exempt (salaried) to non-exempt (hourly) employees.

2. The ratio of exempt to non-exempt annual income.

3. Annual percentage of unscheduled overtime.

4. Annual employee attrition from all causes.

5. The relationship of non-exempt income to the prevailing cost of

living indices.

6. A comparison of exempt and non-exempt employee benefits.

7. The rate of non-exempt sick leave utilization.

8. The frequency of employee initiated lawsuits and regulatory

complaints.

9. The frequency of on-the-job injuries.

10. The percentage of absenteeism.

11. Post move frequency ratio.

12. The frequency of non-exempt internal promotions.

13. The ratio of non-exempt annual income by gender.

14. Non-exempt hiring ratio by gender.

In addition, I would include in the RFP an index that lists all of the

benefits that the bidding company provides its employees. [Email me

privately to obtain a copy of this document] Forcing bidders to reveal

their draconian beliefs and operational methods will eventually result

in the abandonment of these arcane practices. But, the contracting

entities must appreciate and subscribe to the merits of a satisfied EMS

workforce.

Because today's RFP's generally " spec-in " technology costs and

administrative systems, the only area of competition left is that of

Unit Hours, wherein bidders (like in a warped game of " Name That Tune " )

sit around speculating on how few UH's it will take (and cost) to

operate the system. The effects of a high UHU on the workforce are never

considered. As a result, many bidders intentionally underbid the total

unit hour costs in order to win the contract. Monetary penalties for

response time violations are considered to be a cost of doing business -

regardless of the effects on the workforce.

Change will only come when the contracting entities and RFP writers

subscribe to the belief that employee satisfaction and fair treatment is

the key to a competent and effective EMS system.

Bob Kellow

[Guest guest]

>Jim,

>

>What do you mean? Extraordinary survival rates? Less morbidity or mortality?

>What? Where's the evidence? Where was it published? Who were the peer

>(referee) reviewers? It's not proper to disgorge statements without generally

>accepted means to verify same! Where, and by what means did you derive your

>conclusions?

>

>Bob Kellow

Bob as I would love to debate further its game 7 in the World Series..

Chow Jim<

[Guest guest]

Other than Denver, eveything you listed is a PUM and many of the PUMs are in

some sort of distress right now (especially Kansas City). How come not a single

major fire department utilizes SSM for EMS or fire suppression?

BEB

E. Bledsoe, DO, FACEP

Midlothian, Texas

All outgoing email scanned by Norton Antivirus and guaranteed " virus free " or

your money back.

Re: SSM

>Jim.

>

>Please establish the link between SSM and " great patient care " !

>

>Bob Kellow

Bob, I am aware of many SSM systems (maybe not in Texas) that provide

excellent patient care and actually the entire system is setup around

the patient. Oklahoma City, Richmond, Charlotte, Denver, Kansas City

and the list goes on.

Jim<

[Guest guest]

>Other than Denver, eveything you listed is a PUM and many of the

>PUMs are in some sort of distress right now (especially Kansas

>City). How come not a single major fire department utilizes SSM for

>EMS or fire suppression?

>

Don't get me started on most fire depts EMS systems are in the

backwater of EMS and they are a distant second to suppression. Like a

fire dept medic would really want to sit post like a good SSM

requires. They like there warm and fuzzy fire stations.

Where would you like to start? Dallas, Houston, LA, Seattle, New

York, Chicago, Calgary, Washington DC, Baltimore and the list goes

on.

Jim<

[Guest guest]

Calgary is a third city service.

BEB

E. Bledsoe, DO, FACEP

Midlothian, Texas

All outgoing email scanned by Norton Antivirus and guaranteed " virus free " or

your money back.

Re: SSM

>Other than Denver, eveything you listed is a PUM and many of the

>PUMs are in some sort of distress right now (especially Kansas

>City). How come not a single major fire department utilizes SSM for

>EMS or fire suppression?

>

Don't get me started on most fire depts EMS systems are in the

backwater of EMS and they are a distant second to suppression. Like a

fire dept medic would really want to sit post like a good SSM

requires. They like there warm and fuzzy fire stations.

Where would you like to start? Dallas, Houston, LA, Seattle, New

York, Chicago, Calgary, Washington DC, Baltimore and the list goes

on.

Jim<

[Guest guest]

>SSM with shorter shifts like 8 or 10 hours might be easier on the troops.

>Does anybody know of any systems that employ 8 or 10 hour shifts in their SSM

>trucks?

>

>Gene

Yes Gene, Denver is mostly 8hrs and some 10's. I agree if your going

to work the crews that hard they can't work 24's. Many of the SSM

systems are going to 10's and 12's.

Jim<

[Guest guest]

A local service not mine does 24's on ssm and repost all the time.

Silsbee EMS

114 hwy 96 south

Silsbee, Tx 77656

Re: SSM

> SSM with shorter shifts like 8 or 10 hours might be easier on the troops.

> Does anybody know of any systems that employ 8 or 10 hour shifts in their

SSM

> trucks?

>

> Gene

>

>

>

[Guest guest]

>A local service not mine does 24's on ssm and repost all the time.

>

>

>Silsbee EMS

>114 hwy 96 south

>Silsbee, Tx 77656

>

Thats crazy you can't have an effective SSM system that works 24's

and reposts frequently. Optimal SSM deployment as been written to be

10 or 12hr shifts and moving only once every 2-3hrs.

Jim<

[Guest guest]

Um, the published numbers would seem to constitute the beginnings of

research. I fail to see how that would be wasted paper. Ever notice

how every solution advertises itself as " the " solution but never really

is? It's partly because nobody really knows how this EMS thing is

supposed to work and partly because there is no " the " solution - it's

all one giant contiuum. It would seem that any published numbers would

be of help in figuring it all out and locating a good starting point for

any service based on its needs, etc.. Either they (the numbers) stand

up as valid and a valid way of doing things or they don't. Either way,

we learn something about what we're doing. Hardly wasted paper...

Mike

Re: SSM

BEB,

What is right for one area/service may not be right for another...

therefore,

the published numbers are nothing but wasted paper.

[Guest guest]

You never change practices based on one study. But, brows should be raised.

Name one city in LA County using SSM. LA City and LA County do not. Name one

fire department nationwide, other than Lincoln, using SSM. What agency did you

work for in LA county? With the excellent pay there, why would one come to

Texas>

BEB

E. Bledsoe, DO, FACEP

Midlothian, Texas

All outgoing email scanned by Norton Antivirus and guaranteed " virus free " or

your money back.

Re: SSM

BEB,

I noticed that you have a thing for numbers and research...

My question is ---

#1 - Since San Diego ended its study of RSI, should we consider that RSI is

something NOT needed in pre-hospital care?

#2 - Since Houston concluded their study on MAST, should we remove them from

ALL units nationally?

#3 - Since LA/Orange Counties concluded their joint study, should we no

longer intubate pediatrics?

OR should we just consider that those agencies decided that it was NOT for

them?

What was so bad about your SSM experience because I had no problem with mine.

I loved the fact that I had a chance to work with some of the best guys in

Southern California [Anaheim FD, Orange County Fire Authority, Orange FD,

Buena Park FD - back then, and LA County FD] and would not trade that

experience for anything. I am sorry that I had a chance to work for a company

that cared for employees and could make a dollar doing it.

Yes, I will agree with you that there are some companies with less than

acceptable operational practices, using both SSM and station placement. In

Southern California, SSM is a GREAT concept due to the lack of real estate,

and uncertainty of getting the right location for a station. But you also

have to take care of your employees and they did that with us.

[Guest guest]

Comments inline...

-----Original Message-----

From: CenTexMedic1970@...

What you read on paper may NOT always be the ACTUAL method of operation.

In

LA County, nowhere in protocol does it state you have to call or wait

for

ALS-back up. This is because in some situations, on a NON-DISASTER day,

you

could wait 20+ minutes for ALS-squad.

Mreed> Then why have ALS squads? Why not reallocate that money for

more BLS squads and make the coverage even better, further reducing

arrival and transport times? What benefits can ALS provide in a 20

minute wait that an ER couldn't? Why extend the time until ALS care, be

it paramedic or physician?

[Guest guest]

Wll stated--spoken like Mongo from Blazing Saddles.

E. Bledsoe, DO, FACEP

Midlothian, Texas

All outgoing email scanned by Norton Antivirus and guaranteed " virus free " or

your money back.

Re: SSM

BEB,

What is right for one area/service may not be right for another... therefore,

the published numbers are nothing but wasted paper.

[Guest guest]

Comments inline...

Re: SSM

BEB,

I noticed that you have a thing for numbers and research...

My question is ---

#1 - Since San Diego ended its study of RSI, should we consider that RSI

is

something NOT needed in pre-hospital care?

Mreed> Yes, we should consider it. Consider it by designing and

implementing further studies until a general scientific consensus is

reached.

#2 - Since Houston concluded their study on MAST, should we remove them

from

ALL units nationally?

Mreed> No, we should inspect further studies and see if MAST/PASG holds

other benefits than those recognized. If they turn out to provide

little or no benefit, providers should spend their money on more

efficacious things.

#3 - Since LA/Orange Counties concluded their joint study, should we no

longer intubate pediatrics?

Mreed> No, but you should consider and inspect why you do, and attempt

to study the dynamics of pediatric intubation in your own system, then

assist in a study to get a more widespread look at the issue.

OR should we just consider that those agencies decided that it was NOT

for

them?

Mreed> Actually, different systems will have different needs. And

multiple studies from multiple angles will drive out these differences

and needs. Does a system with a 5-10 minute " to hospital " time need the

same things a 1.5 hour " to hospital " system needs? How many urban

departments carry Foley catheters? How many rural ones would be

swimming in urine if they DIDN'T? Of course one thing isn't right for

everyone, but some things are right for no one... And that's what good

research helps figure out.

Mike

[Guest guest]

I was in Anaheim a few weeks ago. Anaheim FD is the ALS provider. CARE

ambulance service is the transport provider. Neither agency was running true

SSM as of a month ago.

BEB

E. Bledsoe, DO, FACEP

Midlothian, Texas

All outgoing email scanned by Norton Antivirus and guaranteed " virus free " or

your money back.

Re: SSM

Los Angeles does not use SSM, but I will admit to being 25 minutes into a

county FD response going from one batallion to another, and being cancelled

because the private BLS-provider could have the patient at the hospital

before our ALS-squad could get there.

What you read on paper may NOT always be the ACTUAL method of operation. In

LA County, nowhere in protocol does it state you have to call or wait for

ALS-back up. This is because in some situations, on a NON-DISASTER day, you

could wait 20+ minutes for ALS-squad.

[Guest guest]

You might want to re-read your LA County protocols (I have a copy here if you

need them). Dr. Stratton says that you should wait for ALS unless you are

caring for a life threatening situation and BLS transport time will be shorter

than waiting for ALS intercept. I think Sam included this in his protocols to

prevent the sort of free-lancing you described.

Los Angeles County EMS Agency

Ref. No. 808 -- BASE HOSPITAL CONTACT AND TRANSPORT CRITERIA

Field Reference

PRINCIPLES:

1

Contact assigned base whenever possible.

2

Clinical judgment should be exercised in situations not described in this

policy.

3

Thorough documentation is essential, especially if contact/transport is not

performed in accordance with this policy.

4

Circumstances may dictate immediate transport with base contact enroute.

5

EMT-Is shall not cancel EMT-P response if a patient meets any criteria in

Section I; an ALS Unit shall be requested if one has not been dispatched.

6

In life threatening situations, consider BLS transport if ALS arrival is

longer than transport time.

7

Contact shall be made with the area's trauma hospital, when it is also a

base hospital, on all injured patients meeting Trauma Criteria and/or

Guidelines.

[Guest guest]

I thought you were in Anaheim--now Compton. I hope you respect Steve's

protocols in town more than you did Sam's in LA county.

BEB

E. Bledsoe, DO, FACEP

Midlothian, Texas

All outgoing email scanned by Norton Antivirus and guaranteed " virus free " or

your money back.

Re: SSM

Ahhhh-hhhhh, your key word is SHOULD and life threatening. Pu-lease, GSW

victim in Compton... MLK 5 minutes Code 3... LACO Squad 31 15 minutes out...

GUESS what I did?