This post can also be found at The EMS Leader I remember the first time that I watched Mother, Juggs, and Speed and saw Larry Hagman walk into F&B Ambulance for the first time, and put his resume on the table.  After barely even looking at his resume, Mr. Fishbine hired him, with barely an interview.  No selection process, no nothing.  A guy with a card, getting a job.  Many might see that as a Hollywood shortcut, but sadly in my experience in many places, especially the private industry, the vetting of prospective employees is far too brief.  You then are introduced to the rest of the “team” at F&B ambulance which includes the veteran, Mother.  The guy who is really in charge, seemingly because he is the guy who has been there the longest. I point out this great 70’s movie because it was actually the first exposure to EMS that many people who are my age had.  Sure, I’m 35, and this movie came out the same year that i was born, but even nineteen years later when I was a freshman in college we watched it as part of one of our EMS management classes.  Although my two full time jobs have been with pretty large, put together organizations I have plenty of friends who have and do work in the smaller mom and pop sized section of the industry.  I have heard plenty of stories about people being sent out on the street as fast as they come in the door.  It is time for EMS to take a good look at their career ladder and hiring processes.   First though, we need, as an industry, to decide who we want and decide what a career ladder really entails.  Should the evolution of BLS to ALS really be considered part of that ladder, or is it possible to move “up” the chain in EMS without having a paramedic patch on your sleeve? Can a BLS provider be qualified to be a section leader on a major incident?  Can they receive and utilize the training necessary to deal with day to day personnel and scheduling issues that always seem to pop up?  Far too...

In the wake of the controversy with the Mayor of Toronto, Canada allegedly using crack-cocaine, I revisited a post from a few months back regarding the struggles of Toronto EMS, and the attempted takeover by the Toronto Fire Department, and it got me thinking about priorities.  When it comes to delivering high quality pre-hospital care, we really need to take a closer look at what drives us to choose the systems and models for our community. EMS is a diverse field, much more so than our brothers and sisters in the other branches of public safety.  Largely, it is an a la carte industry.  Choices about response structure, desired time, equipment, and protocols based on what decision makers feel is best for their community.  Fire based.  Third service.  Private.  With first response.  Without.  Two trucks.  Twenty trucks.  One paramedic and one EMT versus two paramedics.  There are countless choices and configurations one could come up with, and countless community models to serve.  All in all though, it all comes down to Frank Stroud’s old saying of “ambulance services can be fast, cheap, or efficient.  Choose two out of the three.” Once a decision is made about a system’s design, the community has to stick with it, at least for a little while, to see what is good and what is bad about it, and then decide what changes need to be made.  Far too often changes are made based on snap judgments driven by one or two particular calls that usually require a high amount of attention.  Instead, when making a change to their system design, especially when looking at who provides the care, the first question that should be asked should be “how will this improve patient care?” I used to work a part time job in a small town outside of Springfield, Massachusetts for what was then the only third service municipal agency in the area.  It was really a terrific system with experienced providers who did a great job.  It had its share of short comings, but no system is the perfect system.  When time came for the reevaluation of the town’s delivery method, there was a strong push to shift...