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Post by 911guy on Oct 18, 2003 8:48:32 GMT -5
I find it ironic that Memorial is complaining about tones, when - as all the dispatchers and many of Memorial's own people know - Memorial is the ONLY service that now has 1st, 2nd AND 3rd due tones (as requsted), but does not use them.
I should probably start this discussion in a different thread, but since I am pretty sure everyone of us wackers read everything just to be nosey anyway, I will put it here:
Not unique to the Memorial tones thing, but I often get requests that essentially say, "Why can't you do [insert unique special procedure here] for us? Why is that so hard?" Here would be an example: What if EVERY ambulance in the county had a unique procedure/protocol for patient care, and you COULD NOT KNOW what that procedure was until you got on the ambulance and read the procedure? Some people would or could remember the myriad of unique procedures for the ambulances that they rode on a lot, but many many mistakes and delays would occur. You may think that is an extreme example but it is NOT! It is VERY apples-to-apples. That is why we have state and regional patient care protocols. Every patient (theoretically) gets the exact same level of assessment, care and treatment and every provider knows what to do in each and every circumstance, because it is always the same. Think about how many times we providers would LIKE to devise and implement a different procedure. How many times has MAST trousers come and gone from protocol? What about cancelling ALS or ALS releasing to BLS? We all know that some medics are better than others at assessment and treatment. The reason some protocols have come and gone in the region is BECAUSE of one or two medics screwing up, so the whole region was made to change. Why don't we just make a "rule" that certain people and services could do certain things, but others could not? How well would that work? Not very well.
I hope that ALL who read this (not just the EMS people) realize why I am particular about ANY service trying to insist on something special just for them. I think ALL of you would admit that, since we HAVE been more standard about things, dispatching has improved 100% in the county.
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Nick
Full Member
OIF Veteran 2006
Posts: 46
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Post by Nick on Oct 20, 2003 15:13:35 GMT -5
The major problem with second-due tones being ineffective is the comm center not being advised when the second due unit is unavailable. We are supposed to assume that second due is always available, but too many times, when only first-due tones were used, we have been told to hit second-due. Therefore, we had to adopt a standard procedure that second-due calls get second-due tones. Unless we are informed when a unit's status changes, we have to have SOP's to go by. We cannot see all that is happening from up here. (actually, since we are in a bomb-shelter we can't see anything!) The problem as I see it is communication, and not in the technical sense.
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Post by canton1 on Dec 2, 2003 3:07:29 GMT -5
SO where does this lead us. I still think there is a better solution than all of these tone and different procedures.
We just had one the other night. "--- Returning available" then a call comes in and it is paged only to have the unit say "Page 2nd due as we are in Elmira"
Seems to me that here is a waste of possible precious time. I have talked about this with many. What is wrong with just saying you are returning if you are not available for YOUR first due coverage area??
I may be the only one that thinks so, but I think the dispatchers for the most part can figure out that we can sent another unit to a call if they are closer.
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Post by canton1 on Dec 2, 2003 3:43:41 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 ). ------------------------------------------------------------------------ Dont we all have "OVER HEAD" . Just a payroll is the difference. We ALL have a business to run. Yes, there is other funds for fire, but remember we do not bill, I bet if we did then there would not be as much for us either and there IS a grant for EMS to apply for. All I am saying is that, If you dont want to go then don't. If it wakes everyone up in the house then turn it Down a BIT. As one of the busiest fire departments in the county (especially after adding QRS) we dont have second due. All we have is tones based on the level of certification. If I had my way there would only be one set of tones like in Tioga County PA. If you want to run with us then you should here everything as you never know when more help will be needed that may not give time for another set of tones. Yes, I have a different opinion of the way it should be and maybe it is because of all the regulations that has to be followed in EMS that even I think is CRAP. But, to me if you have a chance of getting money for it you would be more apt to get out of bed and go. Well, while am asking lots of stupid questions, I have one more. Why is it that if the ambulance association is going away, is there a meeting of just ALS MANAGERS. Why not incluse atleast a couple of BLS appointed by the BLS agencies to be part of it. I ask this with the full understanding that I have no ideawhat goes on in these meetings and maybe BLS should not be there.
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Post by canton1 on May 7, 2004 5:49:13 GMT -5
Think this will Happen? ?? Some how I have my doubts. "If the PSAP or dispatch center provides a response category based upon EMD criteria, EMS services shall respond in a mode (L&S or non-L&S) consistent with the category of the call at dispatch as directed by the dispatch center."
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Post by TheFenceJumper1 on Jun 8, 2004 13:27:00 GMT -5
I can tell you that your probably not going to get all the people to respond in emergency mode, even when they should be. To me you got to way the situation, do you put more lives at risk?
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Post by TheFenceJumper1 on Jun 8, 2004 13:35:37 GMT -5
What about all the fire chiefs (I know what the law states before people get mad, "as long as the vehicle is under control", can you drive 70 + and have your vehicle under control if something happens; I think not.), and blue lighters that just plain drive to fast. It's like a tree that's down on a back road, dose it require us to drive in emergency mode? it aint going any where, what if it's on a corner though and could cause an accident, what's the solution?
Another topic, how long dose it take the state police to get an "incident" that they need to fast, do they hurry, "probably" some do.
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Post by Firemedic on Oct 11, 2004 22:37:49 GMT -5
"If the PSAP or dispatch center provides a response category based upon EMD criteria, EMS services shall respond in a mode (L&S or non-L&S) consistent with the category of the call at dispatch as directed by the dispatch center." To bad this doesn't happen anymore!!
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Post by canton1 on Oct 11, 2004 23:52:48 GMT -5
I agree WE need to get back in the habot of doing it. We were having alot of trouble with the program but I hope it is fixed again.
"to bad that most EMS would not run by the catagory given"
But, then again what is good for the Goose is not good for the Gander ---Meaning the diference from ALS to BLS
Oh well
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Post by Firemedic on Oct 12, 2004 15:16:16 GMT -5
Canton 1-
You speak some truth but to group all EMS providers like that is unfair, and ALS versus BLS is a battle that we should not be stirring around.
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Post by 911wacker on Oct 12, 2004 15:43:27 GMT -5
But, then again what is good for the Goose is not good for the Gander ---Meaning the diference from ALS to BLS The state has pretty much resolved this issue, since September there is a new statewide BLS protocol that also pertains to ALS as well. They have defined criteria for "emergent mode" transport with a patient onboard, this paragraph specifies certian patient conditions that Warrant an "emergency - lights and sirens mode" of transport with the patient. Article 123 of the statewide BLS protocol reads- C. Patient Transport: 1. The crewmember primarily responsable for patient care during transportation will advise the driver of the appropriate mode of transportation based upon the medical condition of the patient. 2. L&S should be used during patient transport unless the patient meets one of the following medical criteria: a. Emergent transport should be used in any situation in which the most highly trained EMS practitioner beleives that the patients condition will be worsened by a delay equavalent to the time that can be gained by emergent transport. Medical command may be used to assist with the decision. The justification for using this criterion should be documented on the patient care report. b. Vital Signs 1) systolic BP < 90 2) Adults w/ respiratory rate >32/min or <10/min c. Airway 1) inability to establish or maintain patent airway 2) upper airway stridor d. Respiratory 1) Severe respiratory distress. (objective criteria may include pulse oximetry <90%, retractions, stridor, or respiratory rate >32/min or <10/min e. Circulatory 1) cardiac arrest with persistant v-fib, hypothermia or poisoning/overdose. Note: most other cardiac arrest patients should not be transported with L&S. f. Trauma 1) Patient with anitomic or physiologic criteria for triage to trauma center. (refer to protocol # 180) g. Neurologic 1) Patient does not follow commands. (motor portion GCS </= 5.) 2) Recurrent or persistant generalized seizure activity. 3) Acute stroke symptoms that began within last 3 hours. (refer to protocol # 706) 3. No emergency warning lights or sirens will be used when ALS care is not indicated (for example ALS cancelled by BLS or ALS released).4. Mode of trasport for interfacility transfers will be based upon the medical protocol and the directions of the referring physician or medical command physician who provides the orders for patient care during transport. Generally, interfacility transport patients have been stabalized to the point where the minimal time saved by L&S transport is not of importance to patient outcome. 5. Exceptions to these policies can be made under extraordinary circumstances (e.g., disaster conditions or a backlog of high priority calls where the demand of EMS ambulances exceeds available resources). These exceptions should be documented.
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Post by canton1 on Oct 12, 2004 23:27:59 GMT -5
STERMER-----HAVE YOU COMPLETELY LOST IT??? I BET MONEY THAT YOU KNOW OF A COUPLE MEDICS THAT DO NOT RUN LIGHTS WHEN THEY ARE "SUPPOSED" TO BE RUNNING THEM. IN THE PROTOCOLS DOES IT SAY TO SAY THAT YOU ARE RESPONDING WHEN YOU ARE NOT? BET YOU KNOW OF A MEDIC OR TWO THAT DOES THAT!! OH WAIT---MEDICS ARE GODS---I KEEP FORGETTING THAT
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Post by canton1 on Oct 12, 2004 23:31:03 GMT -5
WHy cant we stir that up. I thought that this was open forum. Why should BLS/ALS be exempt?
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Post by TheFenceJumper1 on Oct 13, 2004 15:48:09 GMT -5
1. QRS greatly helps BLS (improving patient care) 2. BLS (first responders & EMT's save lives) 3. ALS, God? come on, nobody can compete with that, they, I'll be there soon, just walk on water!!
4. as fare as I'm concerend, it's all about the patient.
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Post by 911wacker on Oct 13, 2004 16:25:17 GMT -5
I BET MONEY THAT YOU KNOW OF A COUPLE MEDICS THAT DO NOT RUN LIGHTS WHEN THEY ARE "SUPPOSED" TO BE RUNNING THEM. IN THE PROTOCOLS DOES IT SAY TO SAY THAT YOU ARE RESPONDING WHEN YOU ARE NOT? You are right, a few people don't follow the recomendations when they should use L&S. These people are far less dangerous than those who use them for stupid things, like fire standbye calls, etc. As far as responding when we are not, we have discussed this issue before. Do we physically have to be behind the steering wheel to be enroute, or can we be headed toward the truck that will take us? Personally I have to take a leak before responding most of the time when I am on duty, and once I acknowledge the call and "respond" I am committed. I don't see where it matters, you look and see overall times and distance travelled, we still make good time to 99% of the places we go. The issue you raise is 30 seconds or 1 minute most of the time, is it worth comlpaining about?
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