As I sit here in my Expedition typing away on my Netbook, I am reminded by the night’s weather of how much I love the City during the summer.13 years ago when I leftNew Jerseyas a naive 19 year old EMT, I figured I was on a “four and out” plan.I would get my EMS Management Degree, get my Paramedic Certification, and bail on out of here and back to my comfort zone: theJerseyShore. Once I graduated College in 2001, I had about 8 months experience as a Paramedic here in the city, and it had gotten its claws into me.At that point in my career, I saw no other option for me than to be an Urban Paramedic, running all of the 911’s I could.In a week at work here, I was personally doing as many 911 responses as my Volunteer Service that I got my start with back in 1993 would do in a month, and I was loving every minute of it. UrbanEMSis definitely unique.Your transport times are commonly shorter, and while per capita, your high acuity patients might be a fewer in number than suburban and rural systems, you still see your share of critically sick and injured people.I’m not just talking about the shootings and stabbings, trust me they’re there, but I’m also talking about the STEMIs, strokes, and generalized respiratory and cardiac patients. Commonly in this busy system, except for a few patient complaints that would also trigger the request for fire to respond, you were on your own with just your partner.On my shift though, we all looked out for each other. We were definitely one big family.If you were going into a bad neighborhood, chances are, someone else would “float” your way for no other reason than to just watch your back.They’d set up your gear, help you stairchair a patient, or just simply make sure that people respect your personal space. This October will mark my 10th anniversary as a Paramedic.Its funny, but I can still remember heading in for my first shift after getting cleared and sitting in the parking lot of my college dorm dry heaving because I was so nervous.(I swear it...

As some of you may or may not know, I got my start in EMS in the state of New Jersey, and more specifically at the Jersey Shore.For the first 8 years or so I was an active member with two different Squads servicing Ocean County.I still have family and friends in the area who are very active in the EMS Community. New Jersey possesses some unique issues when it comes to Pre-Hospital Care.A large amount of the system State wide is still Volunteer based at the BLS Level.ALS Services are limited, and must be hospital based or hospital affiliated, and largely participate in prehospital care as non-transporting units. While there is a State EMS office, it is often rivaled by the New Jersey State First Aid Council which advocates for what it feels should be beneficial changes to the EMS system in the state to keep Volunteer EMS alive.Membership in the NJSFAC is not mandatory, but they expect departments affiliated with them to maintain the minimum standards they set. As time goes on, more Volunteer departments are having a tough time getting rigs on the road to care for the sick and injured.As a result, many municipalities are starting to turn to paid ambulance services or Municipal Third Service or Police Department affiliated EMS systems.The NJSFAC’s solution in response to this problem though is to lower the required level of care on most ambulances within the state from a mandatory 2 EMT staffing to one EMT and one First Responder/Driver. Paid ambulance services, municipal or not however, are required to have a minimum of 2 EMTs on each truck. While speaking with family today, I was told that they had a conversation with one of our New Jersey State First Aid Council representatives who voiced his displeasure for pending state bill S-818, seeing it as something that could potentially destroy the Volunteer EMS system in the State of New Jersey.Intrigued, I decided to take a look at it for myself. NJ State Bill S-818 was developed in response to a state-wide EMS study that was conducted in 2006 and released in 2007.It is a 150 page document that outlines the accomplishments and short...

ER Over crowding.System abuse.Lack of resources.Lack of treatment pathways.Its all there! Last night, I was in Philadelphia for the Chronicles of EMS 3 City Meetup for the premier of Firestorm, a documentary about the Los Angeles Fire Department and their struggles to provide efficient appropriate care to the citizens of Los Angeles in a setting where resources are often scarce, hospitals are closing, and abuse of the system is out of control.The atmosphere is described by one LAFD Captain as “The Perfect Storm” with no relief is sight, and from what I saw last night, that statement couldn’t be more accurate. Firestorm focuses mainly on the men and women ofLos Angeles’ Station 65, which houses two Paramedic Level Ambulances.It is one of the busiest stations in the city.They deal with everything that one would expect to deal with in an urban setting.The spectrum ranges from violent crime, like shootings and stabbings, MI’s and major cardiac events, to stubbed toes, fevers, and abdominal pain patients.Their options for patient pathways are limited, just as they are in almost every otherEMSsetting that you’ll find, and their task times are increasing due to ER closures and generalized overcrowding.On numerous occasions, ERs inLos Angeleshave wait times in excess of 24 hours. One scene that was particularly telling of the struggles that the LAFD faces featured a woman and her young son.She wanted the 2 year old evaluated because he had a fever and had appeared to have been shaking.The child, from the assessment that one could make by watching the movie, was clinging to the woman, appeared to be acting in the shy and bashful manner that you would expect from a kid under the age of 3.The LAFD Medic painted a picture of his assessment, that in short and without straight out saying the words said “He seems to be okay now, and would be more appropriately evaluated by a pediatrician.He doesn’t need an ambulance.”The woman’s reaction?”I’d still like to get him checked.We all have our opinions.”The Medics then did the right thing, and loaded the kid up and transported him. Now, this woman will probably sit in the Emergency Room for 12+ hours, with her already sick...

I sat down last night and watched Chronicles of EMS again and realized that there is an EMS system operating right under my nose that just might be the perfect EMS system. Let me tell you about it: It is a fully functional ALS transport system which staffs both ALS and BLS and usually has 6-8 people on duty on any given day. The population served fluctuates from around 10,000 people to as many as 25,000 people and covers an area that is about 5 square miles in size. It serves both the young and the old, the rich and the poor and has a decent sized migrant worker population. In 2009 the service had nearly 4,000 patient contacts and, are you ready for this? It only transported 100 patients. Average response times to all calls is under 7 minutes and it drops to under 5 minutes for higher priority assignments. Severity of the calls ranges from bee stings and knee scrapes go trauma activations, cardiac arrests and STEMIs. There are a number of different patient pathways available to the paramedic who has a large influence of the final disposition of the patient. They include: -Ambulance transport to an ER -Private vehicle transport to an urgent care facility -Monitoring of a patient and then releasing them back into the public -Treat and release of minor injuries -And reevaluation and continued care of prior injuries. When a patient IS transported they have access to ALS care and there is no charge for the ambulance service provided. ER services still need to be addressed but the ambulance services are completely free of charge. When the staff isn’t taking care of patients they turn towards preventative measures to help the community they serve. This includes auditing the safety and durability of buildings roads and attractions, and conducting free CPR classes to insure that as many people as possible are certified at the laypersons level. I’m sure by now you’re saying to yourself “come on, Scott spill the beans! Where is this EMS Utopia?” okay I will tell you but you’ll never believe it. It’s actually at my part time job at the New England branch of a...

While discussing EMS Issues over my first crepe breakfast, the focus of the conversation between Jeramedic, MsParamedic, and myself briefly turned to howEMSis viewed and measured in the prehospital setting.How are we evaluated by the people who monitor our performance? Jeramedic remarked that, “For a lot of departments, and for a lot of decision makers, if an ambulance gets to somebody’s house in a reasonable amount of time, and they end up at the hospital, that’s a successful, efficientEMSsystem.”All three of us agreed that this was a very poor measure of how good we are at our job.Its like saying that when there is a fire, all that matters is how quickly we get a fire truck there.Once they’re there, they can stand there and watch the place burn to the ground, but it doesn’t matter because they got there! Police Departments can hang their hats on arrest numbers and crime rates.Fire Departments can measure the number of actual fires they have, and other factors such as inspection results, smoke and CO detector compliance, and loss of life from fire.InEMS, The focus simply on that first ten minutes of a call.Are you making your response time compliance?If so, how far under the bar are you?Whatever happens between the arrival at the scene and arrival at the hospital is mostly overlooked.The reason for this is its very difficult (unless we are talking about ROSC) to measure the performance of anEMSsystem within that time frame.Clinical measurement is based on success rates of skills such as IV attempts and ET attempts, and subjective QA/QI. A Paramedic friend of mine brought her 4 year old son with her to some of her skill practice session prior to testing for her State certification.She was able to teach her son how to intubate a mannequin, and if she let him play with sharp things, I’m sure he could have learned how to establish an IV as well.Those skills can be taught to anyone, and are a poor measure of the ability of a paramedic.That doesn’t make them unimportant.Those skills are a vital piece of the treatment we provide, and we have to be good at the to be successful.The point...