When dud EMS lose its "E"? [Archive] - Glock Talk

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aspartz
02-09-2008, 06:30
I've been running EMS for about 10 years. IIRC, the current EMS system was devised by the DOT to deal with TRAUMA. Now it seems tha t it has become a geriatric taxi service. When I started, trauma was about 20% of the call volume, critical medicals were about the same and the remaining 60% were horizontal taxi rides for MC/MA.

In the last year, trauma was at most 5% of the calls, still the same for critical care medicals. In this same period, geriatric taxi rides were better then 80%. I'm not saying that I expect only the "cool" runs, but it seems that the vast majority of calls have become transport of people who should be in a POV. There are patients who have been ill for a number of days and finally just got "tired" of being sick and called 911. Teir condition is no worse than it had been, and in many cases they are alert, oriented and able to ambulate. There is almost always an offspring there who could have driven the parent into the Clinic anytime over the past few days, but insist that they now get EMS, even though the parent refuses any care, sometimes including oxygen.

What put me over the top was our training this month. BART -- Basic Animal Rescue Training. It may be a good cause, but really, isn't there some sort of training that would save humans we could have had?

ARS

Skintop911
02-09-2008, 08:40
Hit the web and do some reading on geriatric services in EMS and the predictions for service demands with our aging baby boomers.

What you're seeing now is only the beginning.

huskerbuttons
02-09-2008, 11:37
I've been in EMS for 19 yrs and I see the same thing. I have found that EMTP now stands for Expensive Medicaid Taxi Provider. It's only going to get worse.

Sucka
02-09-2008, 11:54
Part of the decline in true trauma responses is the emphasis on safety now. Cars are safer, roadways are safer, people are more safety conscious in general. Lets face it, unless you live in a gang warland the majority of trauma calls are going to be MV related. I've pulled up on scenes where i was sure there was going to be a fatality and an extended extrication, when i walk to the car i find a self extricated driver without so much as a scratch on them. Outside of that, traumas are hit and miss. Sometimes you get some good falls, industrial accidents and so on, but they are so unpredictable as to when you'll run them.

As far as medical aids, they have always been hit or miss. I've been in the field for 7+ years, and i can go entire go arounds without what i consider a true ALS call, and i can run 5 in a day, it just goes in waves. When i worked on a private ambulance in a city of 150+K we would run 10-15 calls a day, most of which were complete BS, just a product of the area i worked in (lower class, less education).

Talking to partners, seems things have changed a lot since some of them started. I started in 2000, and i can't say i've seen a trend of any kind. Been pretty status quo since i started with the exception of the areas i worked in. I gotta say though, 99% of the time i do feel like a glorified taxi service.

Also keep in mind geriatric transport is HUGE business. I was the product of a system that used it way to much, my first year in the field as an EMT i don't think i did anything but IFT's. Our BLS division paid for our ALS contracts.

Lynn D
02-09-2008, 17:23
I've only been doing EMS for a year, but I'm also a nurse in a large teaching hospital. And honestly, what the OP is seeing, as far as I know, is a continuing of the trend of "the graying of America".

My agency is in a suburban metropolitan area, and has a very large number of assisted living facilities, senior complexes, and nursing homes. Almost all of the calls I take involve patients older than 65. And most of them are, in fact, sick.

Unfortunately, it has been my experience that some of the younger patients are the ones that want the "taxi ride".

gruntmedik
02-09-2008, 17:56
As the geriatric poulation is increasing, we are going to see more and more of these runs. The ground service I worked for did about 48000 runs a year. Depending on the area we rode, the majority were retirement age or better. With that age group, it is only natural to see more medical runs vs trauma, but when trauma is involved it is usually significant.

I, as well as most in EMS, thrive on trauma. But trauma care is pretty easy in the pre-hospital setting. The runs that make you have to think are the sick cardiac and head bleeds. Trying to keep them alive can be quite challenging at times.

Unfortunately, there will always be those with their suitcase packed, waiting for you to give them a ride. In todays society, with everyone ready to sue someone else at the drop of the hat, we just have to suck it up. Public education is the key, but unless we have someone to say you don't need an ambulance for this, it's not gonna change.

RyanNREMTP
02-09-2008, 18:12
Well, no one is getting any younger.

First off, congrats on making it in EMS for as long as you have. It's a trend, it will change in time.

Sucka
02-09-2008, 18:16
But trauma care is pretty easy in the pre-hospital setting. The runs that make you have to think are the sick cardiac and head bleeds. Trying to keep them alive can be quite challenging at times.

+1

I like the "good" medical aids more than a trauma. Traumas make great stories, but C-Spine, IV, bandaging/stabilization is a no brainer. Problem is, legit medical aids are even hard to come by anymore. Pushing meds is what it's all about :tongueout:

RyanNREMTP
02-09-2008, 21:00
Sorry, didn't get to finish. Had a call come in.

If you think about it, it all boils down to one thing. We pretty much did this to ourselves. We spent the last several years educating the public to call 911 for an emergency. And remember to them anything is an emergency. When you have people call 911 for having their electricity cut off or a stubbed toe, this is what we asked them, the public, to do. Also, we've had to find justification in having the equipment, the personnel, the protocols and the salary (if volunteer, a budget) to the public. We can't argue that we need a raise if an ambulance sits in the station 90% of the time.

In the end, we need to just enjoy the time we have. EMS is a field that I don't believe will always be around forever.

4095fanatic
02-09-2008, 22:46
*shrug* to them, it's an emergency. With very few exceptions, very few cities are allowed to "triage" over the phone; the liability of telling someone "drive yourself to the hospital" and them having an MI on the way is too great. Thus why we send out the booboo box on stubbed toes... i saw a dispatched hangnail turn into a working code. *shrug*. Like I tell myself, better to respond to 99 BS calls than miss the 1 true emergency.

Short Bus
02-12-2008, 23:20
I am just waiting for them to put a meter and a little taxi light instead of red lights on the top :)

KyInvestigator
02-12-2008, 23:56
In the end, we need to just enjoy the time we have. EMS is a field that I don't believe will always be around forever.

I would disagree here....with the aging of the general populous, and the continuing trend of certain demographics to attempt to defy the odds with poor lifestyle choices, personal management, and genetics, you will continue to be needed. This being said, though, many moons ago it became obvious that ALS was NOT a money making sport for either public or private providers. Skill retention means that you must work the calls which require a specific skill set and knowlege base. Departments have to balance staffing issues with call volumes to keep skills and knowlege on par with the community expectations.

In order to justify staffing, and to find a way to offset the cost of staffing ALS units, public and private agencies found that the BLS transfer service was a gold mine. Ready payment by medicaid and medicare made for for a situation too good to pass up. Add to that the physicians who own dialysis centers who readily document that a patient was non-ambulatory just so they would have an ambulance pick them up for their session (hey, got to find a way to get them there when appointment times don't mean a lot or they don't have transportation). In short, the system grew into what it is today because of greed...IMNTBHO.

I retired after 17 (or was it 18) years of working as a "P" in some of the biggest cities in the country. Loved every minute of it....but having "been there" when all we did was run ALS calls (we had BLS units, too), the introduction of transfers was an insult to the patch.....after all, we were also known as ParaGods!

Transfers are a part of EMS life. If you can accept that fact you will do fine. If you want the lights and sirens all the time....well, the best I can tell you is to join the fire department. Best time I had driving code was operating an old style pumper without baffles! Old time airhorns, windup sirens, and sheer mass make for a fun ride!

BTW, what's up with the sirens on a non-emergency transport to a facility of any nature. Where I came from that opened liability like crazy. And as a courtesy we NEVER ran siren in a subdivision early in the morning. No traffic=nobody to warn. Violating policy? Technically, but we had brains and we used them for thinking in addition to hanging our hats.

Back to your regularly scheduled thread...

Dean
02-13-2008, 06:59
A friend wrote:
I've been running EMS for about 10 years. IIRC, the current EMS system was devised by the DOT to deal with TRAUMA. Now it seems that it has become a geriatric taxi service. When I started, trauma was about 20% of the call volume, critical medicals were about the same and the remaining 60% were horizontal taxi rides for MC/MA.

When I started in the 1980's, in the busiest areas of NYC, Times Sq, Hells Kitchen, Harlem - it was the same thing. An important mission of EMS is assisting with the health care needs of the poor and the elderly. Often that means a ride to the hospital.
Enjoy your job. Don't get into arguing with your patients that an ambulance wasn't needd. Your bosses won't back you on that. Keep your skills at a high level and go with the flow. Get your BCLS, ACLS, and PALS instructor certs. Get your medic, if you don't have that yet. You've got a good job. Hang in there.

D25
02-14-2008, 12:04
A friend wrote:
I've been running EMS for about 10 years. IIRC, the current EMS system was devised by the DOT to deal with TRAUMA. Now it seems that it has become a geriatric taxi service. When I started, trauma was about 20% of the call volume, critical medicals were about the same and the remaining 60% were horizontal taxi rides for MC/MA.

When I started in the 1980's, in the busiest areas of NYC, Times Sq, Hells Kitchen, Harlem - it was the same thing. An important mission of EMS is assisting with the health care needs of the poor and the elderly. Often that means a ride to the hospital.
Enjoy your job. Don't get into arguing with your patients that an ambulance wasn't needd. Your bosses won't back you on that. Keep your skills at a high level and go with the flow. Get your BCLS, ACLS, and PALS instructor certs. Get your medic, if you don't have that yet. You've got a good job. Hang in there.

Amen, brother! I recently started teaching and acquiring all of the instructor certs and it is quite enjoyable in and of itself, plus it is a good way to keep sharp. Another thing to consider striving toward is air transport. No BS runs there.

Tvov
02-15-2008, 06:44
When my late mother was in an assisted living complex, almost ANY call to the doctor led to a call for an ambulance if a person didn't have someone to drive them, either to the doctor's office or to the hospital. Even if they did have someone to drive them, the doctor might insist on an ambulance.

Even when I would take my mother to a doctor's appointment, and the doctor decided she needed to go to the hospital for more work, an ambulance would be called. Now, my mom would be fine as far as I could tell, and I would be standing there ready to take her to wherever. But I was told, once the doctors decided she needed more work, ambulance transport ONLY due to liability issues.

I am not sure what, if anything, can be (or should be) done about it.