Re: MANDATORY READING ----- How can I fix EMSAT??

[Guest guest]

THEDUDMAN@a... wrote:

>

> And I ask why should it...as long as we keep looking at your example

as

> 2 separate issues instead of one (transportation) then we are doomed

to

> do both poorly. It isn't until someone grasps ALL aspects of

> transportation under one hat that you can find the optimal plan to

do

> it all.

So perhaps we should send all bus and taxi drivers to paramedic

school? Same thing.

Rob

[Guest guest]

THEDUDMAN@a... wrote:

>

> And I ask why should it...as long as we keep looking at your example

as

> 2 separate issues instead of one (transportation) then we are doomed

to

> do both poorly. It isn't until someone grasps ALL aspects of

> transportation under one hat that you can find the optimal plan to

do

> it all.

So perhaps we should send all bus and taxi drivers to paramedic

school? Same thing.

Rob

[Guest guest]

THEDUDMAN@a... wrote:

>

> And I ask why should it...as long as we keep looking at your example

as

> 2 separate issues instead of one (transportation) then we are doomed

to

> do both poorly. It isn't until someone grasps ALL aspects of

> transportation under one hat that you can find the optimal plan to

do

> it all.

So perhaps we should send all bus and taxi drivers to paramedic

school? Same thing.

Rob

[Guest guest]

You missed the point, no one is driving

Re: MANDATORY READING ----- How can I fix EMSAT??

" , " <manemtp@y...> wrote:

>

> Is there a difference in education for the Nurse who cares for Joe

at the ER

> when he falls and Joe at Dialysis? Is there two seperate registry

services

> for those nurses? Are they Regulated by different people?

Actually, in the context of this analogy, yes. The nurse is licensed

to CARE for that patient by the Board of Nurse Examiners. But the

nurse is licensed to DRIVE by the Department of Public Safety.

Apples and oranges.

Rob

[Guest guest]

Wes wrote:

Dudley -- I have some, albeit limited, experience outside of County. And

trust me, Austin is far from utopia for EMS. However, the standard in other

places is sometimes so low, that simply approaching competence looks like

utopia.

--------------------------------------------

I can attest to Wes' experience outside of Austin... rode with him years *cough*

ago when I was a bright-eyed student on EMS units with some damned good medics

to learn from... before his move to Austin.

--------------------------------------------

Wes wrote:

There is a big difference between solely providing transportation (e.g.

wheelchair van) and providing advanced care with transportation (far end example

-- neonatal intensive care transport). Can one service do it all? Probably so.

However, I personally believe there needs to be a dividing line between

emergency care, critical care transfer, and non-urgent, stable interfacility

transfers. Will the dividing line end up being arbitrary? Yes. Will mistakes

happen? Probably. But then, I'd challenge you to find any institution created

by humans where there isn't an arbitrary nature to it and where mistakes don't

happen.

-Wes

-------------------------------------------

Mistakes will and do happen everyday. In my experience, I have to say... " train

for the worst and hope for the best " . That lil' ol' man you've taken to

dialysis for months as a " non-medical transport " twenty miles away in BFE can

also be the 'lil ol' man who codes on you enroute. You have to expect this poop

to happen, because it will... whether you're hauling in a stretcher van or an

MICU ambulance.

The thing that gets my goat with some services is the lack of training. I dug

into every word of the recent Australian posts; wow... three weeks of CE???

That doesn't scare me one bit... That's better than sliced bread IMHO! There

are services here that has no concept of contining education or skills

refreshers... er, except for that one hour a year of " okay, tube that manikin so

medical direction knows you refreshed your skill this year " . I've been there...

I hate that. But there's no High Standard a lot of services demand from their

own people or training, unless something bad happens to the patient and the crew

screws up. Then you get a 15 minute inservice. ***Slams head on wall***.

" Train for the worst and hope for the best " . If such a policy was followed by

_all_ services, I'd guess even the " Public vs Privates " debates would be toned

down to a mild grumble in the pt care arena.

And that's getting closer to utopia.

K. Pelletier

[Guest guest]

Wes wrote:

Dudley -- I have some, albeit limited, experience outside of County. And

trust me, Austin is far from utopia for EMS. However, the standard in other

places is sometimes so low, that simply approaching competence looks like

utopia.

--------------------------------------------

I can attest to Wes' experience outside of Austin... rode with him years *cough*

ago when I was a bright-eyed student on EMS units with some damned good medics

to learn from... before his move to Austin.

--------------------------------------------

Wes wrote:

There is a big difference between solely providing transportation (e.g.

wheelchair van) and providing advanced care with transportation (far end example

-- neonatal intensive care transport). Can one service do it all? Probably so.

However, I personally believe there needs to be a dividing line between

emergency care, critical care transfer, and non-urgent, stable interfacility

transfers. Will the dividing line end up being arbitrary? Yes. Will mistakes

happen? Probably. But then, I'd challenge you to find any institution created

by humans where there isn't an arbitrary nature to it and where mistakes don't

happen.

-Wes

-------------------------------------------

Mistakes will and do happen everyday. In my experience, I have to say... " train

for the worst and hope for the best " . That lil' ol' man you've taken to

dialysis for months as a " non-medical transport " twenty miles away in BFE can

also be the 'lil ol' man who codes on you enroute. You have to expect this poop

to happen, because it will... whether you're hauling in a stretcher van or an

MICU ambulance.

The thing that gets my goat with some services is the lack of training. I dug

into every word of the recent Australian posts; wow... three weeks of CE???

That doesn't scare me one bit... That's better than sliced bread IMHO! There

are services here that has no concept of contining education or skills

refreshers... er, except for that one hour a year of " okay, tube that manikin so

medical direction knows you refreshed your skill this year " . I've been there...

I hate that. But there's no High Standard a lot of services demand from their

own people or training, unless something bad happens to the patient and the crew

screws up. Then you get a 15 minute inservice. ***Slams head on wall***.

" Train for the worst and hope for the best " . If such a policy was followed by

_all_ services, I'd guess even the " Public vs Privates " debates would be toned

down to a mild grumble in the pt care arena.

And that's getting closer to utopia.

K. Pelletier

[Guest guest]

Isn't part of the problem that the EMS model is oriented towards EMERGENCY

medical care? Would it be more effective to have trained transport technicians

with some basic healthcare knowledge to provide non-emergency interfacility

transfers? Of course, the issue there would be twofold. First, ensuring

reimbursements from Medicare, Medicaid, and private insurance. Second, ensuring

that health care facilities knew when EMS was needed as opposed to medical

transport.

-Wes

Re: MANDATORY READING ----- How can I fix EMSAT??

THEDUDMAN@a... wrote:

>

> And I ask why should it...as long as we keep looking at your example

as

> 2 separate issues instead of one (transportation) then we are doomed

to

> do both poorly. It isn't until someone grasps ALL aspects of

> transportation under one hat that you can find the optimal plan to

do

> it all.

So perhaps we should send all bus and taxi drivers to paramedic

school? Same thing.

Rob

[Guest guest]

Isn't part of the problem that the EMS model is oriented towards EMERGENCY

medical care? Would it be more effective to have trained transport technicians

with some basic healthcare knowledge to provide non-emergency interfacility

transfers? Of course, the issue there would be twofold. First, ensuring

reimbursements from Medicare, Medicaid, and private insurance. Second, ensuring

that health care facilities knew when EMS was needed as opposed to medical

transport.

-Wes

Re: MANDATORY READING ----- How can I fix EMSAT??

THEDUDMAN@a... wrote:

>

> And I ask why should it...as long as we keep looking at your example

as

> 2 separate issues instead of one (transportation) then we are doomed

to

> do both poorly. It isn't until someone grasps ALL aspects of

> transportation under one hat that you can find the optimal plan to

do

> it all.

So perhaps we should send all bus and taxi drivers to paramedic

school? Same thing.

Rob

[Guest guest]

" , " <manemtp@y...> wrote:

>

> No matter how much we complain about it within this industry, WE

don't get to

> say who runs EMS. That's up to the State, County, City, RFD, ESD,

ETC. And

> no matter what we say about THEY will always do what they think is

best.

Best? Ha! Now we ARE talking about Utpoia! Most governments -- at

best -- do only what they think is adequate, which is far from what

is " best. "

Rob

[Guest guest]

" , " <manemtp@y...> wrote:

>

> You missed the point, no one is driving

Actually, that WAS the point. It is the reason that your analogy is

invalid.

Rob

[Guest guest]

" , " <manemtp@y...> wrote:

>

> You missed the point, no one is driving

Actually, that WAS the point. It is the reason that your analogy is

invalid.

Rob

[Guest guest]

" , " <manemtp@y...> wrote:

>

> You missed the point, no one is driving

Actually, that WAS the point. It is the reason that your analogy is

invalid.

Rob

[Guest guest]

So what happens when the non-emergency becomes one, as it does quite often?

And for the record, not all interfacility transfers are non emergent,

there's a wide variety of transports requiring ALS care (Cancer Patients on

PCA pumps, IV infusions, Stat Cath lab transfers, etc.)

Re: MANDATORY READING ----- How can I fix EMSAT??

THEDUDMAN@a... wrote:

>

> And I ask why should it...as long as we keep looking at your example

as

> 2 separate issues instead of one (transportation) then we are doomed

to

> do both poorly. It isn't until someone grasps ALL aspects of

> transportation under one hat that you can find the optimal plan to

do

> it all.

So perhaps we should send all bus and taxi drivers to paramedic

school? Same thing.

Rob

[Guest guest]

So what happens when the non-emergency becomes one, as it does quite often?

And for the record, not all interfacility transfers are non emergent,

there's a wide variety of transports requiring ALS care (Cancer Patients on

PCA pumps, IV infusions, Stat Cath lab transfers, etc.)

Re: MANDATORY READING ----- How can I fix EMSAT??

THEDUDMAN@a... wrote:

>

> And I ask why should it...as long as we keep looking at your example

as

> 2 separate issues instead of one (transportation) then we are doomed

to

> do both poorly. It isn't until someone grasps ALL aspects of

> transportation under one hat that you can find the optimal plan to

do

> it all.

So perhaps we should send all bus and taxi drivers to paramedic

school? Same thing.

Rob

[Guest guest]

So what happens when the non-emergency becomes one, as it does quite often?

And for the record, not all interfacility transfers are non emergent,

there's a wide variety of transports requiring ALS care (Cancer Patients on

PCA pumps, IV infusions, Stat Cath lab transfers, etc.)

Re: MANDATORY READING ----- How can I fix EMSAT??

THEDUDMAN@a... wrote:

>

> And I ask why should it...as long as we keep looking at your example

as

> 2 separate issues instead of one (transportation) then we are doomed

to

> do both poorly. It isn't until someone grasps ALL aspects of

> transportation under one hat that you can find the optimal plan to

do

> it all.

So perhaps we should send all bus and taxi drivers to paramedic

school? Same thing.

Rob

[Guest guest]

excercise your voter registration card, or.....Barber College

Re: MANDATORY READING ----- How can I fix EMSAT??

" , " <manemtp@y...> wrote:

>

> No matter how much we complain about it within this industry, WE

don't get to

> say who runs EMS. That's up to the State, County, City, RFD, ESD,

ETC. And

> no matter what we say about THEY will always do what they think is

best.

Best? Ha! Now we ARE talking about Utpoia! Most governments -- at

best -- do only what they think is adequate, which is far from what

is " best. "

Rob

[Guest guest]

excercise your voter registration card, or.....Barber College

Re: MANDATORY READING ----- How can I fix EMSAT??

" , " <manemtp@y...> wrote:

>

> No matter how much we complain about it within this industry, WE

don't get to

> say who runs EMS. That's up to the State, County, City, RFD, ESD,

ETC. And

> no matter what we say about THEY will always do what they think is

best.

Best? Ha! Now we ARE talking about Utpoia! Most governments -- at

best -- do only what they think is adequate, which is far from what

is " best. "

Rob

[Guest guest]

excercise your voter registration card, or.....Barber College

Re: MANDATORY READING ----- How can I fix EMSAT??

" , " <manemtp@y...> wrote:

>

> No matter how much we complain about it within this industry, WE

don't get to

> say who runs EMS. That's up to the State, County, City, RFD, ESD,

ETC. And

> no matter what we say about THEY will always do what they think is

best.

Best? Ha! Now we ARE talking about Utpoia! Most governments -- at

best -- do only what they think is adequate, which is far from what

is " best. "

Rob

[Guest guest]

-- many interfacility transfers do require EMS-level care. No doubt. But

in a purely economic sense, when dealing with the concept of scarcity, doesn't

it make sense to conserve resources (in this case, properly trained personnel)

for those transfers rather than to " waste " these resources?

For what it's worth, I'm using very specific definitions of scarcity and waster

from the economic and legal realms. I *NEVER* believe that providing the

appropriate level of patient care and advocacy is a waste.

-Wes

Re: MANDATORY READING ----- How can I fix EMSAT??

THEDUDMAN@a... wrote:

>

> And I ask why should it...as long as we keep looking at your example

as

> 2 separate issues instead of one (transportation) then we are doomed

to

> do both poorly. It isn't until someone grasps ALL aspects of

> transportation under one hat that you can find the optimal plan to

do

> it all.

So perhaps we should send all bus and taxi drivers to paramedic

school? Same thing.

Rob

[Guest guest]

-- many interfacility transfers do require EMS-level care. No doubt. But

in a purely economic sense, when dealing with the concept of scarcity, doesn't

it make sense to conserve resources (in this case, properly trained personnel)

for those transfers rather than to " waste " these resources?

For what it's worth, I'm using very specific definitions of scarcity and waster

from the economic and legal realms. I *NEVER* believe that providing the

appropriate level of patient care and advocacy is a waste.

-Wes

Re: MANDATORY READING ----- How can I fix EMSAT??

THEDUDMAN@a... wrote:

>

> And I ask why should it...as long as we keep looking at your example

as

> 2 separate issues instead of one (transportation) then we are doomed

to

> do both poorly. It isn't until someone grasps ALL aspects of

> transportation under one hat that you can find the optimal plan to

do

> it all.

So perhaps we should send all bus and taxi drivers to paramedic

school? Same thing.

Rob

[Guest guest]

I think in a broad, general sense you have a valid point. But, what's

scarce? In Dallas County alone there has to be 15 competing for-profit

providers. Let them compete, it's no different, in my mind, than Medical

City Childrens and Childrens_Dallas, competing for patients. What I do

agree with you on, is regulation. Get tough, as my grand pa used to say

DTNS ( Don't take no stuff). Give DSHS a mission to regulate the providrs,

and let NREMT, or the Board of EMS examiners, or 7-11, the task of

regulating PEOPLE. DSHS is spread too thin to the kind of butt kicking they

need to when it comes to providers. Make it too damn hard for just ANYONE

to become an EMS provider. Make the fee $20,000 instead of $200. Plenty of

options.

Re: MANDATORY READING ----- How can I fix EMSAT??

THEDUDMAN@a... wrote:

>

> And I ask why should it...as long as we keep looking at your example

as

> 2 separate issues instead of one (transportation) then we are doomed

to

> do both poorly. It isn't until someone grasps ALL aspects of

> transportation under one hat that you can find the optimal plan to

do

> it all.

So perhaps we should send all bus and taxi drivers to paramedic

school? Same thing.

Rob

[Guest guest]

ExLngHrn@a... wrote:

>

> Isn't part of the problem that the EMS model is oriented towards

> EMERGENCY medical care? Would it be more effective to have trained

> transport technicians with some basic healthcare knowledge to

> provide non-emergency interfacility transfers?

Ah! We're on the same wavelength again. I am not diminishing the

importance or necessity of the transfer industry. I am merely

saying that it is time that they are a separate industry. Separate

industries with separate concerns necessitate separate personnel and

separate regulation.

Of course the people who run private EMS (and even many public

systems) will never go for it. Even that idiot Jack Stout

recognized that " the cream " is what funds ambulance services. I

don't know of any private company that would be willing to still

provide EMS if they had to give up transfer money. Well, not

without huge taxpayer compensation at least.

Rob

[Guest guest]

There definitely needs to be regulation. My first proposal for regulation would

be to crack down on absentee medical directors who sign off on protocols, then

disappear without any other involvement. Ideally, there should be concrete,

minimum expectations for medical directors, enforced by the Texas Medical Board

(the new name for the Texas State Board of Medical Examiners).

In some areas where entities are licensed, the government issues a certificate

of need, or something similar. Do we need to go to this model for non-911

providers? It might cut down on some issues in the larger cities and in the

Valley.

-Wes

Re: MANDATORY READING ----- How can I fix EMSAT??

THEDUDMAN@a... wrote:

>

> And I ask why should it...as long as we keep looking at your example

as

> 2 separate issues instead of one (transportation) then we are doomed

to

> do both poorly. It isn't until someone grasps ALL aspects of

> transportation under one hat that you can find the optimal plan to

do

> it all.

So perhaps we should send all bus and taxi drivers to paramedic

school? Same thing.

Rob

[Guest guest]

>

> And for the record, not all interfacility transfers are non

emergent...

And for the record, that is why we have been careful to note the

difference. Wes very specifically said non-emergency interfacility

transfers.

Rob

[Guest guest]

But how many fire departments compete in the same jurisdiction? How

many law enforcement agencies compete in the same jurisdiction?

If DSHS is spread to thin to do its mission maybe EMS is spread to thin

to do its mission (both non emergent transportation and emergency

response)?

AJL

________________________________

From: [mailto: ] On

Behalf Of ,

Sent: Monday, October 10, 2005 10:56 AM

To:

Subject: RE: Re: MANDATORY READING ----- How can I fix

EMSAT??

I think in a broad, general sense you have a valid point. But, what's

scarce? In Dallas County alone there has to be 15 competing for-profit

providers. Let them compete, it's no different, in my mind, than

Medical

City Childrens and Childrens_Dallas, competing for patients. What I do

agree with you on, is regulation. Get tough, as my grand pa used to say

DTNS ( Don't take no stuff). Give DSHS a mission to regulate the

providrs,

and let NREMT, or the Board of EMS examiners, or 7-11, the task of

regulating PEOPLE. DSHS is spread too thin to the kind of butt kicking

they

need to when it comes to providers. Make it too damn hard for just

ANYONE

to become an EMS provider. Make the fee $20,000 instead of $200. Plenty

of

options.

Re: MANDATORY READING ----- How can I fix

EMSAT??

THEDUDMAN@a... wrote:

>

> And I ask why should it...as long as we keep looking at your

example

as

> 2 separate issues instead of one (transportation) then we are

doomed

to

> do both poorly. It isn't until someone grasps ALL aspects of

> transportation under one hat that you can find the optimal plan to

do

> it all.

So perhaps we should send all bus and taxi drivers to paramedic

school? Same thing.

Rob