Guest guest Posted October 27, 2002 Report Share Posted October 27, 2002 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2002 Report Share Posted October 27, 2002 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2002 Report Share Posted October 27, 2002 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2002 Report Share Posted October 27, 2002 BEB, What is right for one area/service may not be right for another... therefore, the published numbers are nothing but wasted paper. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2002 Report Share Posted October 27, 2002 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2002 Report Share Posted October 27, 2002 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2002 Report Share Posted October 27, 2002 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! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2002 Report Share Posted October 27, 2002 Damn, I am young... I have no idea who that is. Is that anything like Farmer Ted from Water Boy? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2002 Report Share Posted October 27, 2002 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? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2002 Report Share Posted October 27, 2002 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2002 Report Share Posted October 27, 2002 >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< Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2002 Report Share Posted October 27, 2002 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< Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2002 Report Share Posted October 27, 2002 >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< Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2002 Report Share Posted October 27, 2002 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< Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2002 Report Share Posted October 27, 2002 >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< Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2002 Report Share Posted October 27, 2002 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 > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2002 Report Share Posted October 27, 2002 >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< Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2002 Report Share Posted October 27, 2002 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2002 Report Share Posted October 27, 2002 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2002 Report Share Posted October 27, 2002 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? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2002 Report Share Posted October 27, 2002 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2002 Report Share Posted October 27, 2002 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 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2002 Report Share Posted October 27, 2002 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2002 Report Share Posted October 27, 2002 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. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 27, 2002 Report Share Posted October 27, 2002 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? Quote Link to comment Share on other sites More sharing options...
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