Sep 10, 2014

For today’s post I was going to share my thoughts about the ongoing fight between American Medical Response and the Las Vegas Fire Department.  Some might say that with the Las Vegas City Council’s approval of the 5 year contract between the two, the “fight” was resolved.  Then, I read the editorial by Glenn Cook that I am going to share below.  There are certainly some alarming constraints that any ambulance provider opting into this deal will have to deal with, including what some may consider a gag order when it comes to speaking with the media. What could Las Vegas Fire and their chief William McDonald be so afraid of that would make them add this stipulation to the contract?  Ultimately, AMR did what they had to in order to keep their doors open for their 450 employees and their company.  I still feel that this move is more about generating income for the city and the fire department.  I have plenty more that I could say about this but I will defer today’s post to Glenn Cook and his editorial titled “City to AMR: Shut up and drive.” This is what defeat looks like.   This is what happens when a business, trampled by government yet still dependent on government approval to operate, dares to defend itself and alert the taxpaying public to obvious wrongs. This is what happens when city functionaries decide to expand their empire, regardless of cost, regardless of harm.   Wednesday’s Las Vegas City Council meeting was all about a proposed downtown soccer stadium. But amid the sports circus, the council presided over another significant action, one that officially killed the city’s dual-response medical transport system.   Private ambulance business American Medical Response fought the Fire Department, and the Fire Department won.   Earlier this year, Fire Chief Willie McDonald put his boot on the neck of AMR, which had been paying Las Vegas nearly $400,000 per year to handle most patient transports within city limits. He ordered his paramedic units to drive more patients to hospitals, so that the city could boost its bleeding general fund with transport fees. McDonald also cut off AMR from emergency communications and put...

Aug 22, 2014

Every day, I try to put aside some time for combing the internet and reading a variety of industry related articles.  This week an older article from FireRescue1.com from July of 2012 that former Washington DC fire chief Dennis Rubin reposted called “5 reasons not to merge fire and police” caught my eye.  The article presents arguments against combining police and fire departments.  I read through the article and was able to draw a parallel between this topic and the argument against merging fire and EMS.  Keep in mind that this is in no way a reflection of every single fire-based system on the map.  Some do it very well but for each of those effective, progressive fire based EMS systems, I feel like I have found two who do it very poorly or worse, do not understand or care what they are getting into when they take over ambulance response.   I invite you to read the full article by clicking here  but here are some of the chief’s observations and my thoughts on them. “There are a multitude of examples where communities have fused the police and fire departments into one public safety agency.  The motivating logic seems to be that neither department is busy enough to command the tax share needed t operate separate agency. The initial belief is that merging two costly departments into one will create a more efficient department, thereby saving big public bucks.” EMS and fire are often combined for the exact same reason.  The fire departments are not busy enough so in theory, combining fire and EMS gives them the ability to handle an additional piece of the public safety workload.  The workload that EMS brings in, however, is often ignored or it is not realized to be as involved and time consuming as it is. However, the transition of police duties into the fire and rescue department comes at a steep price that you will not find on a budget line-item spreadsheet.  Intangibles such as organizational stress, personnel, resistance, and demoralization of the rank-and-file members of both departments are the major factors that will ensure this type of plan’s failure.” Take a close look at any fire and...

Aug 6, 2014

Recording Monday’s podcast was a lot of fun.  The topic of arming paramedics and EMTs usually results in a heated discussion and I got to sit back and listen to two people with a lot more knowledge on a topic debate the finer point of it for close to an hour.  The arguments shared by both Chris Montera and Sean Eddy were both constructive and well thought out.  I found myself agreeing with both of them on many points, and could each of their sides of the arguments and walked away better understanding why they stand where they do. The one thing that I did not do on the podcast though is share my personal opinion on the topic.  So, where do I stand, you ask? Let me start out by saying that this topic is nothing new to the internet.  People have been debating arming EMTs and paramedics for years.  With each and every story posted on Facebook that has anything to do with an EMT getting assaulted comes a barrage of comments both for and against arming EMTs and paramedics.  There have been times where I have added my two cents to the conversation, consistently on the “con” side of the issue.  The replies I have gotten have been amusing. I have been told that I am “infringing on (my) Second Amendment rights.”  I have been called a liberal who wants to empty out everyone’s gun cabinets.  Well, if you have met me, or read my political views, you would realize that I am far from what most would consider a liberal.  If you have any doubt about that, just ask Justin Schorr.  We have had some spirited political debates over the years. Also, if you follow me on Twitter, it is easy to see that I am also a fan of the Opie and Anthony Show on Sirius/XM radio.  I feel silly calling it that now after the firing of Anthony Cumia, which personally I feel was unjust.  Without getting into the particulars of my feelings on that topic, I bring it up to point out one particular argument brought up by some of Anthony’s fans.  Some think that Anthony should not...

How many paramedics should be on an amulance?  Truth is, we really do not know.  With operational concerns, skill dilution, and burnout as chief concerns, Sean Eddy, Russell Stine, and host Scott Kier share their opinions on the topic. Check out Sean’s blog post that started the conversation over at MedicMadness.com To download this week’s podcast, click this link!  Otherwise, use the player...

For this week’s podcast it is just me.  That’s right, 15 minutes of me rambling (and ranting) a bit about the situation in Belchertown Massachusetts and the direction that I feel that EMS needs to go in the future.  I make some bold statements in regards to departments who are trying to get into EMS. To read more about the four Belchertown paramedics who were laid off, click here. For the Holyoke Fire story, click here. To check out Inside EMS where Rom Duckworth, Chris Cebollero and Kelly Grayson talk about fire-based vs private EMS, follow this link. As always, I welcome your comments on any of these matters. To download this week’s podcast, click this link!  Otherwise, use the player...

I have had more than a few part time jobs in my career in EMS one of which was with Belchertown EMS when I lived in that town for a couple of years.  After I moved out of town, the volunteer fire department that ran less than 300 calls a year absorbed an EMS service that ran over 1,000 calls annually.  One thing to realize is that Belchertown is pretty remote.  If a second ALS ambulance responded from another community, the length of that response could be significant. I remember when the departments combined.  The reaction of many in the community was “Other towns have fire based EMS systems so I am sure that it will work here too.”  The community support for Belchertown EMS was minimal, and their director did not put up much of a fight I would speculate because he was about to transition over into a leadership position within the fire department.  People saw this as a money saving opportunity for the taxpayers.  Consolidate the departments because that was the pattern in most of the Pioneer Valley but what they did not realize is that many of these already established fire based EMS systems were set up by the right people who had an idea of what they were doing.  They recognized the value of experienced providers and stocked their system with not only “home grown” paramedics that their department put through school but people from existing paramedic level services who already had experience. Belchertown, like most EMS services in the country, was different from anything around it.  Due to the isolated nature of the town and the moderately low call volume (1,000 – 1,500) experience was vital.  Transport times to local hospitals were considerably longer than other systems experienced and it was a frequent occurrence that a tech’ing paramedic might find themselves diving deeper into their protocols than they were used to.  The department itself was set up with a lot of input from a small core of full-time employees that kept the place going which made it easier for Chief Bock from Belchertown Fire to just take over.  Turnouts from the call department were low for most fires, especially...

DC Fire and EMS Chief Kenneth Ellerbe has finally seen the light and stepped down from his current position.  Interestingly enough, he had what could be the quote of the year, “I think we’ve left the department in a much better position than when I got here.”  I am not sure what changes Chief Ellerbe made to the “fire side” of the operation, but judging from what has been going on with the EMS side, the most positive thing that has happened to the department is his departure from it. So where does DCFEMS go from here?  Inevitably, they will hire on a chief with a fire department background who might even end up being former Prince George’s County Fire Chief Eugene Jones.  While there are probably some pretty qualified candidates out there with fire based EMS experience, is that really the right direction for DCFEMS to go or should they make a bolder move? One of the best things about moving down to the mid-Atlantic region of the country is the fact that there is now a WaWa superstore on almost every corner.  It meets all my needs, and more importantly keeps my coffee cup full.  I wonder how much business their coffee provides for them in relation to the groceries, gas pumps, and delis do.  I can tell you, however, that the coffee probably takes up less than a quarter of the actual space in the store.  I am sure though that the general managers that the stores hire are well versed in all sections of their store.  I would find it unusual if they hired someone who said, “Well, I know A LOT about coffee, but the other 80% stuff, I guess I’ll find someone who knows a bit about that too.” On this week’s podcast, David Konig, Sean Eddy, and RJ Stine and I discuss this exact issue.  As a host, I try to “steer the ship” if you will, but sometimes it is hard for me to keep my thoughts contained and not soapbox.  Luckily, in this episode, David Konig said a lot of what I wanted to say.  It is time for DCFEMS to do something different. In a...

This week, Scott Kier is joined by David Konig, Sean Eddy, and later in the show Russell Stine.  The group tackle the resignation of Chief Kenneth Ellerbe of the Washington, DC Fire and EMS Department (DCFEMS) and share their viewpoints about what should be next for the department.  Is this a leadership issue?  A cultural one?  Find out what the group thinks this week on EMS in the New Decade! Read more from David Konig at his blog The Social Medic. Check out Sean Eddy’s blog, Medic Madness. Finally, to see more from RJ Stine, check out his website, Hybrid Medic. To download this week’s podcast, click this link!  Or just use the player below....

May 26, 2014

On this week’s episode of EMS in the New Decade, Scott Kier and Ben Neal talk about an inspirational conversation they were part of while sharing a few Happy Hour drinks at a bar called Huck Finn’s in New Orleans at the tail end of EMS Expo 2012.  What started out as a group of medics swapping war stories turned quickly into a conversation about pit crew CPR led by Tom Bouthillet from EMS 12 Lead and Code STEMI that was the jumping off point for some major changes in Ben’s EMS system. So crack open a beer, sit back, and enjoy a night at Huck Finn’s with Scott and Ben. To download this week’s podcast, click this link!  Otherwise, use the player...

For the first twelve years of my career the answer to most questions was “just take them to the hospital.”  Don’t know what’s wrong with them?  Take them to the hospital. Paramedics and EMTs seemingly start to “over think” calls?  Stop thinking and take them to the hospital. A certain facility doesn’t want our medics to do anything for the patients?  Just get them in the truck and take them to the hospital. More times than not “take them to the hospital” is at least a functional answer.  Whether they need to be there or not a trip to the ER either delivers the patient to definitive care or makes them someone else’s problem.  Oh, and did I mention that taking them to the hospital allows a department to bill for the call as well?  It does.  Or at least it did in my former service, but that is another discussion all together. The big question though is what do we do when taking them to the hospital does not benefit our patients?  Who am I talking about?  Our cardiac arrest patients of course. By now many of the readers have seen Tom Bouthillet’s picture of the “Resuscitation Fairy” who magically revives our patients when we deliver them to the ER.   While Tom and I don’t always see eye to eye on issues in our industry, I feel like we are not only on the same page, but the same paragraph when it comes to running cardiac arrests.  I have been lucky enough to spend enough time with Tom that I have learned a great deal from him.  Changing how we do things can be scary.  It takes a commitment to do it.  We all have our comfort zones and stepping outside of that can be difficult, but we need to for our patient’s sake. Moving patients kills them, or rather prevents us from saving them.  Wake County has studied it and proven it.  The simplest thought processes confirm it.  A heart needs to beat in order to sustain life.  In order to get that heart beating again, we must work for it, whether that be manually or with a CPR assistance device...