Re: MANDATORY READING ----- How can I fix EMSAT??

[Guest guest]

In a message dated 10/10/2005 1:42:45 P.M. Central Daylight Time,

rsdrn@... writes:

Nope. When they show me they are serious about priorities, I'll support

them. Until then, I seriously doubt they want me to come and tell them how I

think they ought to do things. Do you?

Actually I do, I'm on the BoD of EMSAT and I've been reading this thread

very closely lately.

I want every EMS Provider to tell EMSAT what they want. When the plates were

on the front burner it was due to the Membership of EMSAT at the time

telling the then members of the BoD that they wanted those plates.

I was not really overly impressed at that time with the whole concept but

the vast majority of the MEMBERS of EMSAT at that time wanted the plates. They

got the plates, if you and others come through and tell us YOUR priorities as

MEMEBRES well EMSAT is a MEMBER driven organization it really is so if

someone wants their opinion heard all they need to do is 1) join and 2) make

their

opinions known. You do that long enough you might just change things at EMSAT

as well as in EMS overall?

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

LNMolino@...

(Office)

(Cell Phone)

(Office Fax)

" A Texan with a Jersey Attitude "

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

[Guest guest]

Exactly Alan. We need to teach the nursing homes and health care facilities

the difference between 911 response and a transfer. I've seen the mistakes go

both ways. Private services being called for an emergency and the city/county

service being called for a transfer.

We've muddied the waters between emergency care and transport as opposed to

facility transfers ourselves because of the nature of EMS funding. Even most

public services rely some on fees for their services. In comparison, how much of

the police or fire budget comes from fees for service? Or for that matter, the

public health department?

-Wes

Re: MANDATORY READING ----- How can I fix

EMSAT??

Danny <petsardlj@s...> wrote:

>

> Transportation is EMS. That is where we are and that is where we

came from.

By that logic, funeral services are also EMS. That's where I came

from.

There is nothing " emergency " nor " medical " about funeral services.

And there is nothing " emergency " nor " medical " about invalid

transportation. So are we now reducing EMS to nothing but a fancy

semantic with no actual meaning?

Rob

[Guest guest]

Exactly Alan. We need to teach the nursing homes and health care facilities

the difference between 911 response and a transfer. I've seen the mistakes go

both ways. Private services being called for an emergency and the city/county

service being called for a transfer.

We've muddied the waters between emergency care and transport as opposed to

facility transfers ourselves because of the nature of EMS funding. Even most

public services rely some on fees for their services. In comparison, how much of

the police or fire budget comes from fees for service? Or for that matter, the

public health department?

-Wes

Re: MANDATORY READING ----- How can I fix

EMSAT??

Danny <petsardlj@s...> wrote:

>

> Transportation is EMS. That is where we are and that is where we

came from.

By that logic, funeral services are also EMS. That's where I came

from.

There is nothing " emergency " nor " medical " about funeral services.

And there is nothing " emergency " nor " medical " about invalid

transportation. So are we now reducing EMS to nothing but a fancy

semantic with no actual meaning?

Rob

[Guest guest]

And I ask why should it...as long as we keep looking at your example as

2 separate issues instead of one (transportation) then we are doomed to

do both poorly. It isn't until someone grasps ALL aspects of

transportation under one hat that you can find the optimal plan to do

it all.

BTW, on my example, get out of the County Utopia and you will

see the issue I raise in all its glory.

Dudley

Re: MANDATORY READING ----- How can I fix EMSAT??

Danny <petsardlj@s...> wrote:

>

> Transportation is EMS. That is where we are and that is where we

came from.

By that logic, funeral services are also EMS. That's where I came

from.

There is nothing " emergency " nor " medical " about funeral services.

And there is nothing " emergency " nor " medical " about invalid

transportation. So are we now reducing EMS to nothing but a fancy

semantic with no actual meaning?

Rob

[Guest guest]

And I ask why should it...as long as we keep looking at your example as

2 separate issues instead of one (transportation) then we are doomed to

do both poorly. It isn't until someone grasps ALL aspects of

transportation under one hat that you can find the optimal plan to do

it all.

BTW, on my example, get out of the County Utopia and you will

see the issue I raise in all its glory.

Dudley

Re: MANDATORY READING ----- How can I fix EMSAT??

Danny <petsardlj@s...> wrote:

>

> Transportation is EMS. That is where we are and that is where we

came from.

By that logic, funeral services are also EMS. That's where I came

from.

There is nothing " emergency " nor " medical " about funeral services.

And there is nothing " emergency " nor " medical " about invalid

transportation. So are we now reducing EMS to nothing but a fancy

semantic with no actual meaning?

Rob

[Guest guest]

And I ask why should it...as long as we keep looking at your example as

2 separate issues instead of one (transportation) then we are doomed to

do both poorly. It isn't until someone grasps ALL aspects of

transportation under one hat that you can find the optimal plan to do

it all.

BTW, on my example, get out of the County Utopia and you will

see the issue I raise in all its glory.

Dudley

Re: MANDATORY READING ----- How can I fix EMSAT??

Danny <petsardlj@s...> wrote:

>

> Transportation is EMS. That is where we are and that is where we

came from.

By that logic, funeral services are also EMS. That's where I came

from.

There is nothing " emergency " nor " medical " about funeral services.

And there is nothing " emergency " nor " medical " about invalid

transportation. So are we now reducing EMS to nothing but a fancy

semantic with no actual meaning?

Rob

[Guest guest]

I think my point is, the nurse is the nurse is the nurse, just as the medic

is the medic is the medic. Initial training, and minimum training are the

starting point, where you go from there is a gamble. But the Certification,

or Registry, or licensure is just that. Nurses are regulated by the BNE,

the places they work for are regulated by DSHS, JCAHO standards, etc. If

you don't like the specific business you've gotten into, change to something

else.

<does it require EMS skills and knowledge merely to provide transport to

someone who is unable to walk?>

those people have no medical necessity for ambulance transport, and

therefore don't qualify for reimbursement. So their ride is paid for by

them, and if they want to pay for a physician to ride along it's their

prerogative.

Re: MANDATORY READING ----- How can I fix EMSAT??

Danny <petsardlj@s...> wrote:

>

> Transportation is EMS. That is where we are and that is where we

came from.

By that logic, funeral services are also EMS. That's where I came

from.

There is nothing " emergency " nor " medical " about funeral services.

And there is nothing " emergency " nor " medical " about invalid

transportation. So are we now reducing EMS to nothing but a fancy

semantic with no actual meaning?

Rob

[Guest guest]

Depends upon why they can't walk and why they need transport. And

there is always the desire to see someone who " might " need medical

attention taken by non-medical transport for either efficiency, money,

or some combination of both. And not always on the transport

side...since DRG transports from SNF's are paid by the SNF, they often

desire the cheapest form of transport regardless of the possible need

for medical intervention.

Dudley

Re: MANDATORY READING ----- How can I fix

EMSAT??

Danny <petsardlj@s...> wrote:

>

> Transportation is EMS. That is where we are and that is where we

came from.

By that logic, funeral services are also EMS. That's where I came

from.

There is nothing " emergency " nor " medical " about funeral services.

And there is nothing " emergency " nor " medical " about invalid

transportation. So are we now reducing EMS to nothing but a fancy

semantic with no actual meaning?

Rob

[Guest guest]

Depends upon why they can't walk and why they need transport. And

there is always the desire to see someone who " might " need medical

attention taken by non-medical transport for either efficiency, money,

or some combination of both. And not always on the transport

side...since DRG transports from SNF's are paid by the SNF, they often

desire the cheapest form of transport regardless of the possible need

for medical intervention.

Dudley

Re: MANDATORY READING ----- How can I fix

EMSAT??

Danny <petsardlj@s...> wrote:

>

> Transportation is EMS. That is where we are and that is where we

came from.

By that logic, funeral services are also EMS. That's where I came

from.

There is nothing " emergency " nor " medical " about funeral services.

And there is nothing " emergency " nor " medical " about invalid

transportation. So are we now reducing EMS to nothing but a fancy

semantic with no actual meaning?

Rob

[Guest guest]

Depends upon why they can't walk and why they need transport. And

there is always the desire to see someone who " might " need medical

attention taken by non-medical transport for either efficiency, money,

or some combination of both. And not always on the transport

side...since DRG transports from SNF's are paid by the SNF, they often

desire the cheapest form of transport regardless of the possible need

for medical intervention.

Dudley

Re: MANDATORY READING ----- How can I fix

EMSAT??

Danny <petsardlj@s...> wrote:

>

> Transportation is EMS. That is where we are and that is where we

came from.

By that logic, funeral services are also EMS. That's where I came

from.

There is nothing " emergency " nor " medical " about funeral services.

And there is nothing " emergency " nor " medical " about invalid

transportation. So are we now reducing EMS to nothing but a fancy

semantic with no actual meaning?

Rob

[Guest guest]

I think you're comparing appkes to oranges. When you look at health funding

in ANY aspect it can come from public or private sources.

Hospital is government funded, as well as user fees.

Methodist (a mile away) is ALL private funded. Should we ask

to close its doors because it generates a profit?

Re: MANDATORY READING ----- How can I fix

EMSAT??

Danny <petsardlj@s...> wrote:

>

> Transportation is EMS. That is where we are and that is where we

came from.

By that logic, funeral services are also EMS. That's where I came

from.

There is nothing " emergency " nor " medical " about funeral services.

And there is nothing " emergency " nor " medical " about invalid

transportation. So are we now reducing EMS to nothing but a fancy

semantic with no actual meaning?

Rob

[Guest guest]

I think you're comparing appkes to oranges. When you look at health funding

in ANY aspect it can come from public or private sources.

Hospital is government funded, as well as user fees.

Methodist (a mile away) is ALL private funded. Should we ask

to close its doors because it generates a profit?

Re: MANDATORY READING ----- How can I fix

EMSAT??

Danny <petsardlj@s...> wrote:

>

> Transportation is EMS. That is where we are and that is where we

came from.

By that logic, funeral services are also EMS. That's where I came

from.

There is nothing " emergency " nor " medical " about funeral services.

And there is nothing " emergency " nor " medical " about invalid

transportation. So are we now reducing EMS to nothing but a fancy

semantic with no actual meaning?

Rob

[Guest guest]

Nope, never said profit was a bad thing. Just reminding folks there's a

difference in how EMS is funded as opposed to *MOST* other government

operations. In that respect, EMS funding is closer to hospital funding than it

is any other government operation. I'm hard-pressed offhand to think of any

other area where there are a variety of services (private, government, etc) all

" competing " and being paid from a variety of sources (taxes, insurance,

self-pay, etc).

-Wes

Re: MANDATORY READING ----- How can I fix

EMSAT??

Danny <petsardlj@s...> wrote:

>

> Transportation is EMS. That is where we are and that is where we

came from.

By that logic, funeral services are also EMS. That's where I came

from.

There is nothing " emergency " nor " medical " about funeral services.

And there is nothing " emergency " nor " medical " about invalid

transportation. So are we now reducing EMS to nothing but a fancy

semantic with no actual meaning?

Rob

[Guest guest]

Nope, never said profit was a bad thing. Just reminding folks there's a

difference in how EMS is funded as opposed to *MOST* other government

operations. In that respect, EMS funding is closer to hospital funding than it

is any other government operation. I'm hard-pressed offhand to think of any

other area where there are a variety of services (private, government, etc) all

" competing " and being paid from a variety of sources (taxes, insurance,

self-pay, etc).

-Wes

Re: MANDATORY READING ----- How can I fix

EMSAT??

Danny <petsardlj@s...> wrote:

>

> Transportation is EMS. That is where we are and that is where we

came from.

By that logic, funeral services are also EMS. That's where I came

from.

There is nothing " emergency " nor " medical " about funeral services.

And there is nothing " emergency " nor " medical " about invalid

transportation. So are we now reducing EMS to nothing but a fancy

semantic with no actual meaning?

Rob

[Guest guest]

Nope, never said profit was a bad thing. Just reminding folks there's a

difference in how EMS is funded as opposed to *MOST* other government

operations. In that respect, EMS funding is closer to hospital funding than it

is any other government operation. I'm hard-pressed offhand to think of any

other area where there are a variety of services (private, government, etc) all

" competing " and being paid from a variety of sources (taxes, insurance,

self-pay, etc).

-Wes

Re: MANDATORY READING ----- How can I fix

EMSAT??

Danny <petsardlj@s...> wrote:

>

> Transportation is EMS. That is where we are and that is where we

came from.

By that logic, funeral services are also EMS. That's where I came

from.

There is nothing " emergency " nor " medical " about funeral services.

And there is nothing " emergency " nor " medical " about invalid

transportation. So are we now reducing EMS to nothing but a fancy

semantic with no actual meaning?

Rob

[Guest guest]

Dudley -- I have some, albeit limited, experience outside of County. And

trust me, Austin is far from utopia for EMS. However, the standard in other

places is sometimes so low, that simply approaching competence looks like

utopia.

There is a big difference between solely providing transportation (e.g.

wheelchair van) and providing advanced care with transportation (far end example

-- neonatal intensive care transport). Can one service do it all? Probably so.

However, I personally believe there needs to be a dividing line between

emergency care, critical care transfer, and non-urgent, stable interfacility

transfers. Will the dividing line end up being arbitrary? Yes. Will mistakes

happen? Probably. But then, I'd challenge you to find any institution created

by humans where there isn't an arbitrary nature to it and where mistakes don't

happen.

-Wes

Re: MANDATORY READING ----- How can I fix EMSAT??

Danny <petsardlj@s...> wrote:

>

> Transportation is EMS. That is where we are and that is where we

came from.

By that logic, funeral services are also EMS. That's where I came

from.

There is nothing " emergency " nor " medical " about funeral services.

And there is nothing " emergency " nor " medical " about invalid

transportation. So are we now reducing EMS to nothing but a fancy

semantic with no actual meaning?

Rob

[Guest guest]

Dudley -- I have some, albeit limited, experience outside of County. And

trust me, Austin is far from utopia for EMS. However, the standard in other

places is sometimes so low, that simply approaching competence looks like

utopia.

There is a big difference between solely providing transportation (e.g.

wheelchair van) and providing advanced care with transportation (far end example

-- neonatal intensive care transport). Can one service do it all? Probably so.

However, I personally believe there needs to be a dividing line between

emergency care, critical care transfer, and non-urgent, stable interfacility

transfers. Will the dividing line end up being arbitrary? Yes. Will mistakes

happen? Probably. But then, I'd challenge you to find any institution created

by humans where there isn't an arbitrary nature to it and where mistakes don't

happen.

-Wes

Re: MANDATORY READING ----- How can I fix EMSAT??

Danny <petsardlj@s...> wrote:

>

> Transportation is EMS. That is where we are and that is where we

came from.

By that logic, funeral services are also EMS. That's where I came

from.

There is nothing " emergency " nor " medical " about funeral services.

And there is nothing " emergency " nor " medical " about invalid

transportation. So are we now reducing EMS to nothing but a fancy

semantic with no actual meaning?

Rob

[Guest guest]

Dudley -- I have some, albeit limited, experience outside of County. And

trust me, Austin is far from utopia for EMS. However, the standard in other

places is sometimes so low, that simply approaching competence looks like

utopia.

There is a big difference between solely providing transportation (e.g.

wheelchair van) and providing advanced care with transportation (far end example

-- neonatal intensive care transport). Can one service do it all? Probably so.

However, I personally believe there needs to be a dividing line between

emergency care, critical care transfer, and non-urgent, stable interfacility

transfers. Will the dividing line end up being arbitrary? Yes. Will mistakes

happen? Probably. But then, I'd challenge you to find any institution created

by humans where there isn't an arbitrary nature to it and where mistakes don't

happen.

-Wes

Re: MANDATORY READING ----- How can I fix EMSAT??

Danny <petsardlj@s...> wrote:

>

> Transportation is EMS. That is where we are and that is where we

came from.

By that logic, funeral services are also EMS. That's where I came

from.

There is nothing " emergency " nor " medical " about funeral services.

And there is nothing " emergency " nor " medical " about invalid

transportation. So are we now reducing EMS to nothing but a fancy

semantic with no actual meaning?

Rob

[Guest guest]

THEDUDMAN@a... wrote:

>

> Question for you...why does Aunt Mabel who falls in her living

> room and fx her hip deserve a better or different response than

> Aunt Betty who falls in the NH and breaks her hip?

Good point. And it is a question I have asked of the powers that be

in the past. In most places that I have worked, both public and

private, there was no difference in the response they received. Both

got an emergency ambulance. The only difference was whether or not

they were sent first responders.

On the other hand, far be it from the Dallas Fire Department to

respond to a nursing home if it's not on fire. So yes, that problem

does exist in some places. If you are suggesting that it is wrong,

then I am right there with you.

Rob

[Guest guest]

THEDUDMAN@a... wrote:

>

> Question for you...why does Aunt Mabel who falls in her living

> room and fx her hip deserve a better or different response than

> Aunt Betty who falls in the NH and breaks her hip?

Good point. And it is a question I have asked of the powers that be

in the past. In most places that I have worked, both public and

private, there was no difference in the response they received. Both

got an emergency ambulance. The only difference was whether or not

they were sent first responders.

On the other hand, far be it from the Dallas Fire Department to

respond to a nursing home if it's not on fire. So yes, that problem

does exist in some places. If you are suggesting that it is wrong,

then I am right there with you.

Rob

[Guest guest]

THEDUDMAN@a... wrote:

>

> Question for you...why does Aunt Mabel who falls in her living

> room and fx her hip deserve a better or different response than

> Aunt Betty who falls in the NH and breaks her hip?

Good point. And it is a question I have asked of the powers that be

in the past. In most places that I have worked, both public and

private, there was no difference in the response they received. Both

got an emergency ambulance. The only difference was whether or not

they were sent first responders.

On the other hand, far be it from the Dallas Fire Department to

respond to a nursing home if it's not on fire. So yes, that problem

does exist in some places. If you are suggesting that it is wrong,

then I am right there with you.

Rob

[Guest guest]

That's just it though Wes, time for a paradigm shift, and a rude awakening

for most folks. Not all EMS is GOV operated. Period. End of story. No

matter how much we complain about it within this industry, WE don't get to

say who runs EMS. That's up to the State, County, City, RFD, ESD, ETC. And

no matter what we say about THEY will always do what they think is best.

So, guess what? We either learn to love the fact that EMS is diverse, and

make the best of what exists, OR, try Barber College.

I love a good spirited debate as much as the next guy, and as much as I have

to admit it, Gene, et all, is right. Education is the key. Pay sucks,

reimbursement sucks, conditions suck. They will only get better, when WE

get better. We have to learn how to police ourselves, stand up for

ourselves, improve ourselves.

Educatio est omnium efficacissima forma rebellionis

(Education is the most effective form of rebellion)

Re: MANDATORY READING ----- How can I fix

EMSAT??

Danny <petsardlj@s...> wrote:

>

> Transportation is EMS. That is where we are and that is where we

came from.

By that logic, funeral services are also EMS. That's where I came

from.

There is nothing " emergency " nor " medical " about funeral services.

And there is nothing " emergency " nor " medical " about invalid

transportation. So are we now reducing EMS to nothing but a fancy

semantic with no actual meaning?

Rob

[Guest guest]

That's just it though Wes, time for a paradigm shift, and a rude awakening

for most folks. Not all EMS is GOV operated. Period. End of story. No

matter how much we complain about it within this industry, WE don't get to

say who runs EMS. That's up to the State, County, City, RFD, ESD, ETC. And

no matter what we say about THEY will always do what they think is best.

So, guess what? We either learn to love the fact that EMS is diverse, and

make the best of what exists, OR, try Barber College.

I love a good spirited debate as much as the next guy, and as much as I have

to admit it, Gene, et all, is right. Education is the key. Pay sucks,

reimbursement sucks, conditions suck. They will only get better, when WE

get better. We have to learn how to police ourselves, stand up for

ourselves, improve ourselves.

Educatio est omnium efficacissima forma rebellionis

(Education is the most effective form of rebellion)

Re: MANDATORY READING ----- How can I fix

EMSAT??

Danny <petsardlj@s...> wrote:

>

> Transportation is EMS. That is where we are and that is where we

came from.

By that logic, funeral services are also EMS. That's where I came

from.

There is nothing " emergency " nor " medical " about funeral services.

And there is nothing " emergency " nor " medical " about invalid

transportation. So are we now reducing EMS to nothing but a fancy

semantic with no actual meaning?

Rob

[Guest guest]

That's just it though Wes, time for a paradigm shift, and a rude awakening

for most folks. Not all EMS is GOV operated. Period. End of story. No

matter how much we complain about it within this industry, WE don't get to

say who runs EMS. That's up to the State, County, City, RFD, ESD, ETC. And

no matter what we say about THEY will always do what they think is best.

So, guess what? We either learn to love the fact that EMS is diverse, and

make the best of what exists, OR, try Barber College.

I love a good spirited debate as much as the next guy, and as much as I have

to admit it, Gene, et all, is right. Education is the key. Pay sucks,

reimbursement sucks, conditions suck. They will only get better, when WE

get better. We have to learn how to police ourselves, stand up for

ourselves, improve ourselves.

Educatio est omnium efficacissima forma rebellionis

(Education is the most effective form of rebellion)

Re: MANDATORY READING ----- How can I fix

EMSAT??

Danny <petsardlj@s...> wrote:

>

> Transportation is EMS. That is where we are and that is where we

came from.

By that logic, funeral services are also EMS. That's where I came

from.

There is nothing " emergency " nor " medical " about funeral services.

And there is nothing " emergency " nor " medical " about invalid

transportation. So are we now reducing EMS to nothing but a fancy

semantic with no actual meaning?

Rob

[Guest guest]

" , " <manemtp@y...> wrote:

>

> Is there a difference in education for the Nurse who cares for Joe

at the ER

> when he falls and Joe at Dialysis? Is there two seperate registry

services

> for those nurses? Are they Regulated by different people?

Actually, in the context of this analogy, yes. The nurse is licensed

to CARE for that patient by the Board of Nurse Examiners. But the

nurse is licensed to DRIVE by the Department of Public Safety.

Apples and oranges.

Rob