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Post by 2Truck on Oct 5, 2003 10:49:52 GMT -5
Cudos for implementing a level of responses for EMS. The only problem that I see is that there are so many levels that are present in the current system it would make it uncertain for individuals to remember exactly what is supposed to happen for a given one. I know where I'm living (Cumberland County) they have a similiar system that is a little bit easier to understand. Class 1- Medic or Micu and a BLS ambulance (emergency) Class 2- BLS ambulance only (emergency) Class 3- BLS ambulance only (non-emergency)
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Post by 911guy on Oct 5, 2003 16:53:36 GMT -5
It appears that I need to explain the response codes for the non-Bradford County units here.
First and foremost, the codes were NOT set up or established BY Bradford OR Susquehanna County (our region), they have been established for many years by the National Academy of Emergency Medical Dispatch. For those NOT familiar with it, the lowest priority is Alpha, with a non-linear escalation to Echo. Echo is reserved for someone who is at or near imminent death. Training was provided to all Bradford County EMS agencies at the time we implemented the announcement of the response levels. They are being tied to the Act 45 required lights and siren policy.
We also use the Class I, II and III patients for classification once patient contact and assessment have been made.
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Post by Firegirl on Oct 5, 2003 21:02:51 GMT -5
Jeff, maybe you guys need to do a quick EMD overview to those interested - similar to the "radio roadshow". Then maybe they would understand better. I know that since I've had the class I don't ask many questions about response levels.
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Post by 911wacker on Oct 7, 2003 0:26:06 GMT -5
AHHHHHH- Canton 1 is taking driving lessons from Western 16 agian ;D On a more serious note, with time we will all look back and wonder how we ever got along without it. EMD dispatch codes that is!!
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Larry
Junior Member
Posts: 24
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Post by Larry on Oct 7, 2003 11:39:56 GMT -5
Nothing like stiring the pot but I got to put this one out to hang, Jeff's comment about ALS rarely makes a difference in life or death. Why do we need ALS? It's my understanding that ALS is billing the BLS units for all their calls! BLS isn't getting paid from the insurance co. the amount that ALS is charging so therefore the volunteers are making up the difference of the cost of the call! It looks like to me that who ever came up with this type of billing is for doing away with the volunteers?? So which unit is more important or needed ALS or BLS? I know I got off the subject but that comment that Jeff made has me wondering?? Are they really needed? I'm not in favor of lossing BLS and the EMS sevice is gonna have QRS go on all calls til ALS arrives! Not gonna happen in Smithfield as long as I'm Chief!
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Post by 911guy on Oct 7, 2003 12:12:21 GMT -5
Regarding ALS making a difference, I should qualify my views with 2 comments:
1) ALS CAN and DOES make a life-or-death difference....SOMETIMES. Unfortunately, there is no way to know which one of the chest pains, difficulty breathings, weakness, etc patients are going to go right down the tubes and ALS WILL make that difference.
2) Even if an ALS intervention does not ultimately change the patient's final outcome, if YOU or I were having some type of discomfort, whether musculo-skeletal or difficulty breathing or whatever - having relief even a few minutes sooner would really be important to YOU and I as the patient. Nebulizer treatments, analgesics, etc can make the patient that much more comfortable that much sooner.
So if anyone thinks that by my original post that I am negative towards ALS, FAR FROM IT. I was simply making a very statistical analysis of ALS, not implying that they are nearly useless.
Now that I've schmoozed on that one, I DO want to ALSO say that good BLS is STILL the best EMS there is.
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Flynn
Full Member
Often imitated; Never Duplicated
Posts: 45
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Post by Flynn on Oct 7, 2003 16:46:22 GMT -5
Blueeighty8;
I take exception to your reference of the FD on MVA's performing any form of patient treatment without the proper training or skill level. As I can only speak for my department, we respond as a support unit for the rescue company and scene safety support for EMS. My personnel are trained to work at the commands of their company officer or command level officer. When you need assistance from the FD with patient stabilization, do you request this from the ranking officer or the command officer? He would most likely assign the personnel most capable of giving you the best service or support. I will not assign any of my people to "jobs" they are either uncomfortable doing or untrained in doing the required task. As you know there are many jobs on the scene, and most of the time with very limited resources.
Because we are not trained or equipped for medical assistance, I have also questioned the need for fire apparatus on MVA's in "my" jursdiction that don't require rescue services. I believe this should be both a Duty officer call, so you have representation from the municipal level as well as the Traffic Unit for scene/traffic control.
This would be akin to asking an untrained EMS person "standing-by" at a bldg fire to ladder a bldg, hand-jack supply lines. All necessary, but needing little to no formal training (NFT).
I don't normally respond with commentary on EMS issues, as I am ems-illiterate, and rely heavily on all your knowledge and training. Sorry to butt in here.
10-4 Kaye
Tim
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911Mom
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Welcome to the real world!
Posts: 60
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Post by 911Mom on Oct 7, 2003 18:59:49 GMT -5
I also have a tragic flaw and those of you who know me are well aware of it. Plus, I also want to say that these are my opinions and not those of my employers. I guess I don't understand how if your pages are going over the wrong frequency most of the time, how you are hearing them. Also, the pages are done twice and if you don't hear it the first time, it is said in the second page also. Your corp has an excellent response record so someone is hearing the pages! As far as fire departments onscene of an MVA, I must live in the luckiest area of the county. Alot of our members are crosstrained and members of both. If I need a hand, no offense Tim, all I have to do is say "Hey, give me a hand here" and I have help in an instant. I believe in the IC system, but there are times I can't thingy around going to IC for what I need. And by the same token, I (EMS captain) have assisted with whatever I can do at a fire. I think if there was more cross training (for those interested of course) there would be more resources available at scenes. And Tim, it's always good to hear from a "bucket boy"
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Flynn
Full Member
Often imitated; Never Duplicated
Posts: 45
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Post by Flynn on Oct 7, 2003 20:19:50 GMT -5
Mother Dearest, no offense taken! Hell, I can't even offend myself I am not stating the non-qualified FD shouldn't offer service, immediately, upon the asking. I just think the "Deer in Headlights" look you will receive should not be mis-construed. My personnel follow guidelines of what is expected on arrival, and in our case, patient care is not our priority. This may sound grim, but I have a limited few that have any medical training, or desire. They go about with what orders they are given, and when asked (outside the Command realm) will alter, but worry about there assignment not being completed. Not to smart off here, but in my jurisdictional area for example, I know the capacities of my personnel better than an outsider. It is for this reason that I would rather assign someone to assist EMS and give them someone that I feel will benefit both the patient and the care-giver. Maybe if we had our "own" EMS, things would be different, however being part of a career EMS serviced area, we see different people on just about every call, as schedules change. Is cross training a key, possibly. Do I personally feel we could do more as an ENGINE CO. assisting at an MVA, ABSOLUTELY! But until we field more trained and capable personnel in pre-hospital care, I have a hard time just giving you, my providers, just anybody. Now you see why I am a "Bucket Boy!" At least I wave to y'all when I am goin' vertical! ;D ;D ;D ;D 10-4, Kaye Tim
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Post by Firegirl on Oct 7, 2003 22:36:19 GMT -5
I think we've gotten a little away from the original topic but........... Sue is right our ems and fire departments work very well together and help each other out quite a bit (pat pat pat . I also feel cross training is a must to some extent. I hear what you are saying Tim but....what if you are waiting for that paid 3rd due (or god forbid 4th due) ems crew to even get a crew together.....someone is gonna have/need to give some sort of help to a patient. Even though you don't run rescue you still have to wait for ems and a rescue to come to an mva. To that person having a heart attack - your guys "could" make that difference on whether they live or die. The same with an mva and at the very least holding c-spine until ems gets there so that the pt doesn't do further damage to him/herself. I am not saying that all of us fire guys need to be first responders (some really don't have it in them to do it) but to at least know cpr and basic first aid - some day it could really make a difference in someone's life. Just my opinion and thoughts..............
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Post by Firegirl on Oct 7, 2003 22:41:36 GMT -5
...oh yeah (let me see if I can wake up Dupont 1)
we don't have a problem with everyone going to the scene up here but at the plant......everyone goes to the scene..... is it as serious there as it is out here - no, but some day............
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Post by Matt Russell on Oct 8, 2003 12:19:58 GMT -5
Nothing like stiring the pot but I got to put this one out to hang, Jeff's comment about ALS rarely makes a difference in life or death. Why do we need ALS? It's my understanding that ALS is billing the BLS units for all their calls! BLS isn't getting paid from the insurance co. the amount that ALS is charging so therefore the volunteers are making up the difference of the cost of the call! It looks like to me that who ever came up with this type of billing is for doing away with the volunteers?? So which unit is more important or needed ALS or BLS? I know I got off the subject but that comment that Jeff made has me wondering?? Are they really needed? I'm not in favor of lossing BLS and the EMS sevice is gonna have QRS go on all calls til ALS arrives! Not gonna happen in Smithfield as long as I'm Chief!
Larry - I'm not sure where you got your information about billing but, whoever it is was miss informed.
The current billing agreement (Per my boss) is $175.00 for ALS services. This means that if ALS TRANSPORTS with BLS then BLS ows the ALS service $175.00.
NOW if BLS isn't getting the $175.00 for a call then there is a problem with the Billing Company!
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911Mom
Full Member
Welcome to the real world!
Posts: 60
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Post by 911Mom on Oct 8, 2003 17:21:05 GMT -5
These are my opinions and not those of any organization I belong to. We need both BLS and ALS, not that one group is any better than the other. The only difference is that ALS can do more to help a patient who is seriously ill or dying. There has long been the fear that BLS (volunteers) are going to be "taken over" by various paid entities. In my opinion that is a load of booha because they would have to hire alot more people to even begin to cover 1/4 of the county and I would think that they would worry about having enough personnel to cover their own areas when it is third or fourth due first. Here is a radical thought that I haven't noticed in any of our posts- lets focus on the patient instead of the money. If we go broke (which I highly doubt it will happen tomorrow) at least we did it for an honorable reason. I got into this to help people, not worry about how much it will cost to have ALS help me save her life! If I feel a patient needs ALS, I am not going to sit back for a second and think "Hmmm, is this worth X amount of dollars or can I save a few bucks?" But by the same token I don't want ALS to hold my hand on an Ehh call. The last time I checked we are all part of the life saving TEAM- QRS, BLS, and ALS-and the goal is to help the patient, not fill our coffers! I'll get off my soapbox now.
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Post by canton1 on Oct 17, 2003 5:35:51 GMT -5
Boy, I bet that gets some peoples goats, "not in it for the money" The paid services are all running and hiding from that statement. If they werent in it for the money then why do they have to have so many different tones as not to wake anyone up. Gotta have their sleep.
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Post by redlight on Oct 17, 2003 8:47:33 GMT -5
I think this may clear the air some on “getting paid”. ALS and BLS volunteer and paid services both bill ( in most cases together at the higher ALS rate, depends on the agreement that the 2 services have together ) the patients insurance for services provided. The monies collected for the services are then split between the 2 services. There is also a fee for service agreement that some had opted to take this means they pay ALS a flat fee for the service and then bill the patients insurance at the higher ALS rate and keep all monies collected. This is the norm for the nation not something made up in Bradford County.
Yes, paid services too have things called overhead which means they have paid staff that do this as their career ( which in turn is a guarantee to our communities that we have at the least one fully staffed ambulance ready to respond ), billing services, all utilities, multiple ambulances to keep in good running order with high maintenance costs, ems supplies, and the list goes on.
There are no multi-thousand dollar grants out there for paid services and very few and very hard to get grants for the volunteer EMS services. Legislators have given generously to the fire service over the years and have left out EMS when it comes to funding. EMS services do not have a relief fund sent to them every year. I must stress that I am not faulting the fire services for this they are taking what is given to them by the government. Lets see …….What have legislators done for EMS decrease medicare reimbursement, denied any increase in Medicaid ( access ) reimbursement for years, HIPAA ( the wonderful privacy law pushed in by Clinton so he left a lasting impact ), oh and just when you think your service is finally doing what they want you to they change the ruling to mean something different than what was originally interpreted. Such as now you cannot even bill a patient unless you get this and that form signed by the patient, POA or a doctor, and the list goes on………….
I am not going to get into an us and them thing on this forum. I think that there is only an US that needs to stick together. This county needs ALS and BLS services and yes we both do bill in order to keep in service. We all are by NO means RICH services sitting on a throne smoking Cuban cigars and drinking champagne. It takes money to keep a business going and I do not care if you are ALS, BLS, FIRE paid or volunteer we all are a business of some form and we all have to generate income to keep in operation.
As far as the “tone thing” goes, I personally have asked to have separate tones set off so when we have available a second due truck not all the pagers are going off at everyone’s home continuously waking up the whole house and then the individual gets out of bed and starts getting ready to go only to have the truck that was available respond. This is only going to happen so many times until people start saying they don’t need me so why keep waking up the whole house and then eventually the pager gets turned off. This is especially true for paid services that run 2500 to 3000 calls a year ( that is a lot of pagers going off ).
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