Re: Houston

December 31, 2008

Rob,

Your definition of " EMS " appears to differ from that of the State of Texas. All

organizations operating ambulances in Texas are classified as EMS Providers -

those that do not get dispatched via 911 are not segregated or separately

regulated. ALL of them are considered " EMS Providers " and have the same

requirements for licensure.

It is NOT the same as the distinction between police and private security. In

those cases, the training, responsibilities, authority, etc., are drastically

different. In the EMS field, the only significant differences are the way they

are dispatched and the type (medical, trauma, etc.) of call that they usually

respond to. Even the most " private " of services that normally do only routine

transports may roll up on an MVA - in which case they are constrained to stop

and act.

Your attitude appears to be another case of considering some people in the EMS

(state definition) field to be " just ambulance drivers " - and that is something

we definitely don't need.

SB

Subject: RE: Re: Houston

To: texasems-l

Date: Wednesday, December 31, 2008, 8:49 AM

On Wednesday, December 31, 2008 08:08, " mood " <mlindamood (AT) aemstar (DOT)

com> said:

> Rob,

>

> I would like to take note of what you said about the service “not being E

> MS, it was just an ambulance service”! I work for AEMSTAR EMS, a PRIVATE

> AMBULANCE SERVICE. We run our share of emergency calls and transfer calls.

>

> We DESERVE the same respect as that of any other EMS service. By the way, The

> service that was involved in the accident runs the 911 service for Pasadena,

> Texas, and runs 911 calls up in the Tyler area.

I stand corrected on the service involved in this incident. Generally speaking,

a private ambulance in the City of Houston equals non-EMS, so it was a logical

assumption. The error was on the part of whoever reported this to be a private

service in the first place.

I don't know anything about your agency. However, I maintain that, if a service

is not 911 dispatched, it is not EMS, no matter how many of their transfers

happen to turn emergent. Recognising that reality does not in any way disrespect

you or the job you do. It simply makes a technical distinction. It is the very

same distinction I would make between a police department and a private security

agency.

Rob

December 31, 2008

Well said.

RE: Re: Houston

To: texasems-l

Date: Wednesday, December 31, 2008, 8:49 AM

On Wednesday, December 31, 2008 08:08, " mood " <mlindamood (AT) aemstar (DOT)

com> said:

> Rob,

>

> I would like to take note of what you said about the service " not being E

> MS, it was just an ambulance service " ! I work for AEMSTAR EMS, a PRIVATE

> AMBULANCE SERVICE. We run our share of emergency calls and transfer calls.

>

> We DESERVE the same respect as that of any other EMS service. By the way, The

> service that was involved in the accident runs the 911 service for Pasadena,

> Texas, and runs 911 calls up in the Tyler area.

I stand corrected on the service involved in this incident. Generally speaking,

a private ambulance in the City of Houston equals non-EMS, so it was a logical

assumption. The error was on the part of whoever reported this to be a private

service in the first place.

I don't know anything about your agency. However, I maintain that, if a service

is not 911 dispatched, it is not EMS, no matter how many of their transfers

happen to turn emergent. Recognising that reality does not in any way disrespect

you or the job you do. It simply makes a technical distinction. It is the very

same distinction I would make between a police department and a private security

agency.

Rob

December 31, 2008

Rob,

Then you are definitely wrong on your analogy. My license from the state is the

same as the one hanging on any municipalities wall-issued after careful scrutiny

of our protocols, policies, procedures, insurance, etc. A security company does

not meet the same requirement as a pd, not in the companies licensing nor in the

individual professionals licensing. I was called during the 2 year licensing by

a state specialist several years ago, and he said that I had not filled a

document out correctly- that I did not list a 911 area(or include a map). I

advised him that technically, I did not get paid to cover, nor was I contracted

to provide that service to anyone. We have mutual aid agreements, back the

municipality in the area, covering when they are at a structure fire or all

ambulances are busy, and we receive a lot of emergency calls directly because of

the care and compassion that we offer, as well as the skill set that we offer.

The ems specialist started to say " but these aren't the protocols of a " and

stopped himself. -I replied " of a transfer service? " He said " You know I can't

say that. These protocols are very advanced. " I posed the following question to

him, " Does a patient in a skilled nursing facility, or a patient with an active

mi going from a rural hospital to an urban cath lab, deserve less care? " I spend

a lot of money to advance the level of care in my service. I pay a lot of money

to the professional which I hire. I am not oblivios to the fact that a lot of

private services have minimal protocols, hire young and inexperienced emts or

medical professionals(we won't hire you unless you are 23 to satisfy what I feel

is a brilliant requirement on the part of my insurance company), and provide

mainly dialysis transports. Most of the professionals which work for me came out

of 911; I have worked 911; there are very few true emegencies compared to the

level of abuse. Just listen to the number of non-emergent transports from scene

to hospital in your area, if you are able. I have been watching closely the

assumptions made in the ambulance accident. There are too many factors unknown

at this time to pass judgement.

Have a good holiday, and try not to lump people into a category-it's no

different than someone from navy saying " Oh, your army, your #### doesn't float. "

There's fun and games, and then there is business. We provide a valuable,

needed, service.

Akin

Akin Ambulance

Sent from my BlackBerryÂ® smartphone with SprintSpeed

RE: Re: Houston

On Wednesday, December 31, 2008 08:08, " mood "

said:

> Rob,

>

> I would like to take note of what you said about the service â€œnot being E

> MS, it was just an ambulance serviceâ€! I work for AEMSTAR EMS, a PRIVATE

> AMBULANCE SERVICE. We run our share of emergency calls and transfer calls.

>

> We DESERVE the same respect as that of any other EMS service. By the way, The

> service that was involved in the accident runs the 911 service for Pasadena,

> Texas, and runs 911 calls up in the Tyler area.

I stand corrected on the service involved in this incident. Generally speaking,

a private ambulance in the City of Houston equals non-EMS, so it was a logical

assumption. The error was on the part of whoever reported this to be a private

service in the first place.

I don't know anything about your agency. However, I maintain that, if a service

is not 911 dispatched, it is not EMS, no matter how many of their transfers

happen to turn emergent. Recognising that reality does not in any way

disrespect you or the job you do. It simply makes a technical distinction. It

is the very same distinction I would make between a police department and a

private security agency.

Rob

December 31, 2008

ok, since security officers are ot REAL cops, then are you saying that that

transfer medics are not real paramedics? I know a lot of transfer guys that I

trust a whole lot more some some of your so called REAL medics. You need to

retink your statement ..........

---

December 31, 2008

Wow!! Sounds like they know each other.

Andy Foote

RE: Re: Houston

ok, since security officers areÂ ot REAL cops, then are you saying that

that transfer medics are not real paramedics?Â I know a lot of transfer

guys that I trust a whole lot more some some of your so called REAL

medics.Â You need to retink your statement ..........

---

Â

December 31, 2008

Joe,

Look at it this way...Does a security guard go through the same training

that a LEO goes through? I don't think so. Does a Paramedic or EMT that

works for a transfer service go through the same training that a Paramedic

or EMT that works at a 911 provider does? Of course they do. There is your

analogy.

Thom Seeber, CCEMT-P

RE: Re: Houston

ok, since security officers are ot REAL cops, then are you saying that that

transfer medics are not real paramedics? I know a lot of transfer guys that

I trust a whole lot more some some of your so called REAL medics. You need

to retink your statement ..........

---

December 31, 2008

I have had friends comment on both sides of this issue here on this list.

For EMS to progress, we have to stop the internal bickering. The

firefighters will still talk under their breath about volunteers versus

" professionals. " (In my writing and speaking, I use the term " career versus

volunteer " because I feel both are " professionals " ). But, as an industry

and profession they have a unified voice (IAFC has a volunteer chief's

division). EMS, after all, is a transportation business primarily. While

medical care is important, the heart of the issue is TRANSPORTATION.

Fundamentally, 911 and non-911 providers transport patients (just as career

and volunteer firefighters fill burning buildings with water). Thus, let's

look for our common interests and not pick each other apart. Every person

in EMS is a colleague and a professional-regardless of whether they are

running dialysis centre transfers in Houston or flying for Life Flight.

That is how I see it.

BEB

E. Bledsoe, DO, FACEP

Clinical Professor of Emergency Medicine

University of Nevada School of Medicine

Department of Emergency Medicine

University Medical Center of Southern Nevada

December 31, 2008

Joe Berry,

E-mail me off line. I want to talk to you.

Mike L.

B. mood

Marketing and Business Development Manager

AEMSTAR EMS

13003 Road Suite F-1

Stafford, Texas 77477

Office:

Cell:

Fax:

E-mail: mlindamood@...

From: texasems-l [mailto:texasems-l ] On

Behalf Of Joe B

Sent: Wednesday, December 31, 2008 11:00 AM

To: texasems-l

Subject: RE: Re: Houston

ok, since security officers are ot REAL cops, then are you saying that that

transfer medics are not real paramedics? I know a lot of transfer guys that

I trust a whole lot more some some of your so called REAL medics. You need

to retink your statement ..........

---

December 31, 2008

On Wednesday, December 31, 2008 09:55, " STEVE BOWMAN "

said:

> Your definition of " EMS " appears to differ from that of the State of Texas.

Agreed. However, I certainly was not attempting to put forth a legal definition

of the term. I was merely stating the reality of the semantics involved. I

also was not fishing for a debate on the issue. It's like debating whether or

not gay marriage is really " marriage " . It is pointless, as neither side is

likely to convert, so there will be no consensus.

> It is NOT the same as the distinction between police and private security.

> In those cases, the training, responsibilities, authority, etc., are

drastically

> different.

Not really. If all the employees of a private security company paid their way

through some police academy, but were not employed as police officers, would

that make them police officers? Of course not. EMS is a job description. If

you aren't performing that job, then it isn't you, even if you are certified and

qualified to do it. The Cosmetology Commission regulates nail technicians.

That doesnâ€™t make nail technicians cosmetologists.

> Your attitude appears to be another case of considering some people in the EMS

> (state definition) field to be " just ambulance drivers " - and that is

something we

> definitely don't need.

Do you know me that well, Steve, or have you recently been licensed to practise

psychology? Regardless, your characterisation of my motivation is a recklessly

incorrect assumption. I mean no disrespect to those non-EMS ambulance service

providers. And I did NOT call them â€œambulance driversâ€, so I resent your

dishonest attempt to put words into my mouth. Their training is as valid as

yours and mine. They do an important job for very little reward. And, at my

age, I am not far off from requiring their services, so they certainly have my

respect. Iâ€™m just calling a spade a spade. Just because you occasionally run

across an emergency does not make you EMS. Otherwise, every bystander in the US

would be EMS too. And I believe that honesty is indeed what â€œwe needâ€.

This â€œBig Tentâ€ theory of EMS is killing us just like it killed the

Republican Party. A little dose of reality is exactly what â€œwe needâ€.

Regards,

Rob

January 1, 2009

On Thursday, January 1, 2009 09:51, " , Rick "

said:

> In your perfect world a person who trains to work for an

> ambulance company would have to be certified/licensed as a TMT (transfer

> medical technician) or perhaps a NEMT (non-emergency medical technician)

> rather than EMT (which stands for emergency medical technician).

I believe your plan has merit. It's a good start.

> regardless of your meaning, you sir, are stereotyping a group of colleagues

> that you claim to respect.

You seem to be confused about what this discussion is about. It isn't about

people. It isn't about training, licensure, competency, or professionalism. It

is about jobs and job descriptions. I don't care if you have a Master's degree,

twenty years in EMS, and are the smartest, hardest working, most professional

medical provider in the state, providing critical care transports. The reality

remains that, if your employerâ€™s PRIMARY mission is not EMERGENCY RESPONSE,

then you are not in EMS. And really, any medic whose self worth is dimished by

that reality has issues. Whether I respect them or not is irrelevant if they

donâ€™t respect themselves.

Rob

January 1, 2009

Now we're getting to the meat of the matter. Dudley for President. Oops,

we already have one. Well then, Dudley for Philosopher King.

He nails it. The crap about EMS vs. non-EMS is just that. Crap. The

truth is that we are all prehospital medical care givers, and we should be

concentrating on the best ways to serve our patients, not whose system patch is

the

most macho. We seem to be hung up on the word " emergency. " We have never

defined that word adequately in the history of our craft. Notice I do not use

the word " profession. " We are a long way from being a profession, as this

discussion amply demonstrates.

The dictionary definition is an unforeseen condition that requires urgent or

immediate action. That can be viewed narrowly or broadly. Perhaps we are

wrong in using it at all to describe what we do and who we are. We do much

more than " emergency care. " In fact, in those services that are strictly 911,

very little of the care given is actually emergency care. So what's the

problem?

There may be functional differences in our roles at any one time, but overall

we're in the same boat. We learn a set of skills and knowledge that enable

us to care for people in a variety of different settings, just as some

physicians do family practice and some do ER work. They are all physicians,

and

they all stick together like super glue. Lawyers are the same way. It

doesn't

matter whether you're a plaintiff's lawyer or a defense lawyer, a contract

specialist, or a divorce lawyer, write wills for a living or do copyrights. In

the end you're a doctor or a lawyer, and you stick together where it counts,

that is, in matters that define you as professionals and determine how you

are treated by the rest of the world.

I have about given up on the idea that we in prehospital medicine, which is

really what we do, will ever learn to stick together and promote our common

interests. It's easier to herd tomcats on horseback than it is to get EMTs to

stick together. But it is senseless to argue about whose practice is more

important and what it ought to be called when our average rate of compensation

is

less than $15.00 an hour and we are forced to work under conditions that Joe

the Plumber would not stand for.

Let's join together as prehospital medical caregivers and forget about the

semantics in the names we give ourselves. Whether you're transporting a lady

who is post-CVA and now has a urinary tract infection from her Foley and is in

septic shock, or a guy who just took a .45 round in the chest, you're

important, and there's no difference in degree.

How about we resolve to act like medical professionals this year?

Gene Gandy, Prehospital Medical Caregiver

>

> I believe what this particular discussion is about... " emergency " vs

> " non-emergency " is much deeper and darker than any of us are willing to truly

admit.Â

> What we are talking about is that once a person reaches a certain age,

> certain disability status, or certain chronic illness capacity and especially

if

> they can no longer live on their own...THEY NO LONGER MERIT THE SERVICES OF US

> HIGHLY TRAINED, RANDY RESCUE, CRASH-BURN-DIE, LIFE-SAVING, DEATH-CHEATING

> PARAMEDICS AND EMT'S.

>

> This is all about the bias we all have that those patients in nursing homes

> and other assisted living facilities are not worthy of our services.Â How

> else would you explain the everyday accepted practice in almost every medium

and

> large city in the state (as long as they are served by a " non-emergency "

> provider)Â where a 70 yo female with pulmonary edema in a " NURSING HOME " is

> perfectly fine sitting in a wheelchair on 4 lpm by nasal cannula for 25 or 30

> minutes waiting on the " PRIVATE " crew to come pick her up...yet that same

patient

> sitting in her own living room would warrantÂ 1 (if not 2) ambulances, an

> engine company and one or maybe two patrol officers.Â Or the elderly patient

who

> falls on her way to the dining room at the nursing center can lay on the

> floor for 75 minutes without any type of protest by the medics in the station

3

> blocks away...yet we will run emergency through multiple intersections to

> shave 30 seconds off our response to the 68Â yoÂ patient who is sitting on

their

> couch after twist

> ing their ankle in the backyard.Â Or my personal favorite.... ing their

> ankle in the backyard.Â Or my personal favorite....<wbr>those " non-emergency "

> guys are lo ing their ankle in the backyard.Â Or my personal

favorite....<wbr>

> those " non-emergency "

>

> Face it....this isn't about the use of lights and sirens (or if it is, we

> are much farther behind the " professional " curve than I thought) but it is

more

> about who is " deserving " of us 911'ers and who isn't....and very often, it

> has nothing to do with the medical condition of the patient and everything to

> do with where that patient lives, how they smell, or look or what type of

> medical history they have.Â

>

> This is a deep, dark secret that we don't like to talk about....but it is

> very real and exists in I would bet almost every agency in the state (and

> nation).Â If we are a transport profession.. This is a deep, dark secret that

we

> don't like to talk about....but it i

>

> Dudley

>

> PS: I am constantly reminded of the talent that exists in the lowly

> " non-emergency " providers... PS: I am constantly reminded of the talent that

exists

> in the lowly " non-emergency " providers...<wbr>as they usually deal with many

> more complex

>

> RE: Re: Houston

>

> On Thursday, January 1, 2009 09:51, " , Rick " <

> rick.moore@...> said:

>

> > In your perfect world a person who tra

> ins to work for an

> > ambulance company would have to be certified/licensed as a TMT (transfer

> > medical technician) or perhaps a NEMT (non-emergency medical technician)

> > rather than EMT (which stands for emergency medical technician).

>

> I believe your plan has merit. It's a good start.

>

> > regardless of your meaning, you sir, are stereotyping a group of

> colleagues

> > that you claim to respect.

>

> You seem to be confused about what this discussion is about. It isn't about

> people. It isn't about training, licensure, competency, or professionalism.

> It is about jobs and job descriptions. I don't care if you have a Master's

> degree, twenty years in EMS, and are the smartest, hardest working, most

> professional medical provider in the state, providing critical care

transports. The

> reality remains that, if your employerâ€™s PRIMARY mission is not EMERGENCY

> RESPONSE, then you are not in EMS. And really, any medic whose self worth is

> dimished by that reality has issues. Whether I respect them or not is

irrelevant

> if they donâ€™t respect themselves.

>

> Rob

>

January 1, 2009

You know, the irony is that I routinely transport patients in my 'Transfer'

service that would curl the hair of a 911 paramedic... The bottom line is,

there is a rift that doesn't belong, and a common belief among many in

hospitals and all over the medical field, even among our own colleagues that

transport providers are worth less than the 911 paramedic... Your statement

that you " believe Rick's plan has merit. It's a good start. " is indicative

of that mindset. The fields are vastly different but both take the same

clinical skills and training, and to think that we need a separate

certification is folly. Let's stop disparaging the folks who work for an

ambulance service and not county government. EMS is EMS is EMS. We all learn

out of the same textbook in the same classrooms in the same hospitals.

Joe Percer, LP

On Thu, Jan 1, 2009 at 11:54 AM, rob.davis@... <

rob.davis@...> wrote:

> On Thursday, January 1, 2009 09:51, " , Rick " <

> rick.moore@... <rick.moore%40triadhospitals.com>> said:

>

> > In your perfect world a person who trains to work for an

> > ambulance company would have to be certified/licensed as a TMT (transfer

> > medical technician) or perhaps a NEMT (non-emergency medical technician)

> > rather than EMT (which stands for emergency medical technician).

>

> I believe your plan has merit. It's a good start.

>

> > regardless of your meaning, you sir, are stereotyping a group of

> colleagues

> > that you claim to respect.

>

> You seem to be confused about what this discussion is about. It isn't about

> people. It isn't about training, licensure, competency, or professionalism.

> It is about jobs and job descriptions. I don't care if you have a Master's

> degree, twenty years in EMS, and are the smartest, hardest working, most

> professional medical provider in the state, providing critical care

> transports. The reality remains that, if your employer's PRIMARY mission is

> not EMERGENCY RESPONSE, then you are not in EMS. And really, any medic whose

> self worth is dimished by that reality has issues. Whether I respect them or

> not is irrelevant if they don't respect themselves.

>

> Rob

>

January 1, 2009

I believe what this particular discussion is about... " emergency " vs

" non-emergency " is much deeper and darker than any of us are willing to truly

admit.Â What we are talking about is that once a person reaches a certain age,

certain disability status, or certain chronic illness capacity and especially if

they can no longer live on their own...THEY NO LONGER MERIT THE SERVICES OF US

HIGHLY TRAINED, RANDY RESCUE, CRASH-BURN-DIE, LIFE-SAVING, DEATH-CHEATING

PARAMEDICS AND EMT'S.

This is all about the bias we all have that those patients in nursing homes and

other assisted living facilities are not worthy of our services.Â How else

would you explain the everyday accepted practice in almost every medium and

large city in the state (as long as they are served by a " non-emergency "

provider)Â where a 70 yo female with pulmonary edema in a " NURSING HOME " is

perfectly fine sitting in a wheelchair on 4 lpm by nasal cannula for 25 or 30

minutes waiting on the " PRIVATE " crew to come pick her up...yet that same

patient sitting in her own living room would warrantÂ 1 (if not 2) ambulances,

an engine company and one or maybe two patrol officers.Â Or the elderly patient

who falls on her way to the dining room at the nursing center can lay on the

floor for 75 minutes without any type of protest by the medics in the station 3

blocks away...yet we will run emergency through multiple intersections to shave

30 seconds off our response to the 68Â yoÂ patient who is sitting on their couch

after twist

ing their ankle in the backyard.Â Or my personal favorite....those

" non-emergency " guys are losers, they can't do the job we do...oops we are out

of ambulances...call those " non-emergency " guys and have them cover those 911

calls we can't get to....

Face it....this isn't about the use of lights and sirens (or if it is, we are

much farther behind the " professional " curve than I thought) but it is more

about who is " deserving " of us 911'ers and who isn't....and very often, it has

nothing to do with the medical condition of the patient and everything to do

with where that patient lives, how they smell, or look or what type of medical

history they have.Â

This is a deep, dark secret that we don't like to talk about....but it is very

real and exists in I would bet almost every agency in the state (and nation).Â

If we are a transport profession...why is it we try to segregate ourselves based

upon the transports we do?

Dudley

PS: I am constantly reminded of the talent that exists in the lowly

" non-emergency " providers...as they usually deal with many more complex and sick

patients every day instead of the low % of the time that us " emergency " superior

folks do.Â

RE: Re: Houston

On Thursday, January 1, 2009 09:51, " , Rick "

said:

> In your perfect world a person who tra

ins to work for an