Re: Inconvenient EMS Truths (Was: Call an Ambulance, Get a Taxi)

[Guest guest]

,

Which one. Superman, batman, or, my all-time favorite, aquaman?...

:-D

Sent from my BlackBerry® smartphone with SprintSpeed

Inconvenient EMS Truths (Was: Call an Ambulance, Get a

Taxi)

That's a possibility, but it will have to be a far, far different

critter than what we have today. It may well require a redesign of EMS

from top to bottom. But if we're going to do that, first we'll have to

actually admit, to ourselves and the public, what EMS *is* and *is not*

capable of doing. In other words, foster some realistic expectations of

EMS and health care in general. So I'll start by speaking a little heresy:

1. Very little of what we do is actually all that time sensitive, and

response time standards are essentially meaningless. The only meaningful

response time is less than 4 minutes for cardiac arrest, but it is

rather foolish to design an entire system around the 1% of calls that

are cardiac arrests.

2. ALS care is expensive, and generally wasteful. The default level of

EMS provider for most communities should be an EMT-B (albeit a better

educated one than the current model).

3. Every call does not deserve a paramedic. In fact, most calls don't.

4. There is no such thing as a paramedic shortage. In fact, we have too

damned many paramedics as it is.

5. Volunteer EMS, while honorable in its intentions, is actually holding

back the profession. No other health care profession routinely gives

away its services. And every time we do, we devalue what we can provide

to a community. Why buy the cow when you can get the milk for free?

I'm sure there are other inconvenient truths, and other people I've yet

to offend, so everyone else feel free to chime in with their own.

spenair wrote:

>

>

> Wonder if I count as both? If you deny both I will understand.

>

> Don't worry I do understand that the Paramedic education is enough to

> kill a patient and not nearly enough to properly assess them and treat

> them. But I still hold out hope that we can design a much better system.

>

> Renny

>

>

> >

> > My friends and former students (you know who you are! ) who have

> been advocating medic-initiated refusals will come around eventually,

> trust me.

> > GG

> >

>

>

--

Grayson

www.kellygrayson.com

[Guest guest]

,

Which one. Superman, batman, or, my all-time favorite, aquaman?...

:-D

Sent from my BlackBerry® smartphone with SprintSpeed

Inconvenient EMS Truths (Was: Call an Ambulance, Get a

Taxi)

That's a possibility, but it will have to be a far, far different

critter than what we have today. It may well require a redesign of EMS

from top to bottom. But if we're going to do that, first we'll have to

actually admit, to ourselves and the public, what EMS *is* and *is not*

capable of doing. In other words, foster some realistic expectations of

EMS and health care in general. So I'll start by speaking a little heresy:

1. Very little of what we do is actually all that time sensitive, and

response time standards are essentially meaningless. The only meaningful

response time is less than 4 minutes for cardiac arrest, but it is

rather foolish to design an entire system around the 1% of calls that

are cardiac arrests.

2. ALS care is expensive, and generally wasteful. The default level of

EMS provider for most communities should be an EMT-B (albeit a better

educated one than the current model).

3. Every call does not deserve a paramedic. In fact, most calls don't.

4. There is no such thing as a paramedic shortage. In fact, we have too

damned many paramedics as it is.

5. Volunteer EMS, while honorable in its intentions, is actually holding

back the profession. No other health care profession routinely gives

away its services. And every time we do, we devalue what we can provide

to a community. Why buy the cow when you can get the milk for free?

I'm sure there are other inconvenient truths, and other people I've yet

to offend, so everyone else feel free to chime in with their own.

spenair wrote:

>

>

> Wonder if I count as both? If you deny both I will understand.

>

> Don't worry I do understand that the Paramedic education is enough to

> kill a patient and not nearly enough to properly assess them and treat

> them. But I still hold out hope that we can design a much better system.

>

> Renny

>

>

> >

> > My friends and former students (you know who you are! ) who have

> been advocating medic-initiated refusals will come around eventually,

> trust me.

> > GG

> >

>

>

--

Grayson

www.kellygrayson.com

[Guest guest]

Spiderman. And I wear them outside my pants, as a fashion statement.

paramedic300@... wrote:

> ,

>

> Which one. Superman, batman, or, my all-time favorite, aquaman?...

>

> :-D

>

> Sent from my BlackBerry® smartphone with SprintSpeed

>

>

>

> Inconvenient EMS Truths (Was: Call an Ambulance, Get a

Taxi)

>

>

>

> That's a possibility, but it will have to be a far, far different

>

> critter than what we have today. It may well require a redesign of EMS

>

> from top to bottom. But if we're going to do that, first we'll have to

>

> actually admit, to ourselves and the public, what EMS *is* and *is not*

>

> capable of doing. In other words, foster some realistic expectations of

>

> EMS and health care in general. So I'll start by speaking a little heresy:

>

>

>

> 1. Very little of what we do is actually all that time sensitive, and

>

> response time standards are essentially meaningless. The only meaningful

>

> response time is less than 4 minutes for cardiac arrest, but it is

>

> rather foolish to design an entire system around the 1% of calls that

>

> are cardiac arrests.

>

> 2. ALS care is expensive, and generally wasteful. The default level of

>

> EMS provider for most communities should be an EMT-B (albeit a better

>

> educated one than the current model).

>

> 3. Every call does not deserve a paramedic. In fact, most calls don't.

>

> 4. There is no such thing as a paramedic shortage. In fact, we have too

>

> damned many paramedics as it is.

>

> 5. Volunteer EMS, while honorable in its intentions, is actually holding

>

> back the profession. No other health care profession routinely gives

>

> away its services. And every time we do, we devalue what we can provide

>

> to a community. Why buy the cow when you can get the milk for free?

>

>

>

> I'm sure there are other inconvenient truths, and other people I've yet

>

> to offend, so everyone else feel free to chime in with their own.

>

>

>

>

>

>

>

> spenair wrote:

>

>

>>

>>

>

>

>

>

>> Wonder if I count as both? If you deny both I will understand.

>>

>

>

>

>

>> Don't worry I do understand that the Paramedic education is enough to

>>

>

>

>> kill a patient and not nearly enough to properly assess them and treat

>>

>

>

>> them. But I still hold out hope that we can design a much better system.

>>

>

>

>

>

>> Renny

>>

>

>

>

>

>>

>>

>

>

>

>

>>> My friends and former students (you know who you are! ) who have

>>>

>

>

>> been advocating medic-initiated refusals will come around eventually,

>>

>

>

>> trust me.

>>

>

>

>>> GG

>>>

>

>

>

>

>

>

>

>

>

>

>

>

--

Grayson

www.kellygrayson.com

[Guest guest]

You forgot fire in your list.

> > >

> > > My friends and former students (you know who you are! ) who have

> > been advocating medic-initiated refusals will come around eventually,

> > trust me.

> > > GG

> > >

> >

> >

>

>

> --

> Grayson

> www.kellygrayson.com

>

[Guest guest]

, good points but I'm going to make a couple of opposing/inquiring

thoughts about your comments on volunteers.

Volunteers may be still needed in those areas where there is

insufficient call volume or tax base to economically maintain a system

with paid staff. If the dollars aren't there, then they aren't there.

(I'm not talking areas where they choose to spend money on other things.

I'm talking about the truly frontier/rural areas where time is marked

with a calendar not a watch and is so dirt poor they borrow from the

proverbial church mouse. Places where two calls a month is a busy month

and volunteers take turns buying gas and bandages.)

Also, (and this is a dumb question but I'm not privy to fire list

serves), do the fire folks have the same thoughts that VFDs are holding

back the profession?

I look forward to your thoughts.

Barry

Barry Sharp, MSHP, CHES

Tobacco Prevention & Control Program Coordinator

Substance Abuse Services Unit

Mental Health and Substance Abuse Division

________________________________

From: texasems-l [mailto:texasems-l ] On

Behalf Of Grayson

Sent: Tuesday, November 03, 2009 8:32 PM

To: texasems-l

Subject: Inconvenient EMS Truths (Was: Call an Ambulance,

Get a Taxi)

That's a possibility, but it will have to be a far, far different

critter than what we have today. It may well require a redesign of EMS

from top to bottom. But if we're going to do that, first we'll have to

actually admit, to ourselves and the public, what EMS *is* and *is not*

capable of doing. In other words, foster some realistic expectations of

EMS and health care in general. So I'll start by speaking a little

heresy:

1. Very little of what we do is actually all that time sensitive, and

response time standards are essentially meaningless. The only meaningful

response time is less than 4 minutes for cardiac arrest, but it is

rather foolish to design an entire system around the 1% of calls that

are cardiac arrests.

2. ALS care is expensive, and generally wasteful. The default level of

EMS provider for most communities should be an EMT-B (albeit a better

educated one than the current model).

3. Every call does not deserve a paramedic. In fact, most calls don't.

4. There is no such thing as a paramedic shortage. In fact, we have too

damned many paramedics as it is.

5. Volunteer EMS, while honorable in its intentions, is actually holding

back the profession. No other health care profession routinely gives

away its services. And every time we do, we devalue what we can provide

to a community. Why buy the cow when you can get the milk for free?

I'm sure there are other inconvenient truths, and other people I've yet

to offend, so everyone else feel free to chime in with their own.

spenair wrote:

>

>

> Wonder if I count as both? If you deny both I will understand.

>

> Don't worry I do understand that the Paramedic education is enough to

> kill a patient and not nearly enough to properly assess them and treat

> them. But I still hold out hope that we can design a much better

system.

>

> Renny

>

>

> >

> > My friends and former students (you know who you are! ) who have

> been advocating medic-initiated refusals will come around eventually,

> trust me.

> > GG

> >

>

>

--

Grayson

www.kellygrayson.com

[Guest guest]

I believe that the IAFF thinks that volunteers hold back paid fire departments.

Having said that, I will now ask Grayson if knows where I can find some

asbestos underoos....

-Wes Ogilvie

Inconvenient EMS Truths (Was: Call an Ambulance,

Get a Taxi)

That's a possibility, but it will have to be a far, far different

critter than what we have today. It may well require a redesign of EMS

from top to bottom. But if we're going to do that, first we'll have to

actually admit, to ourselves and the public, what EMS *is* and *is not*

capable of doing. In other words, foster some realistic expectations of

EMS and health care in general. So I'll start by speaking a little

heresy:

1. Very little of what we do is actually all that time sensitive, and

response time standards are essentially meaningless. The only meaningful

response time is less than 4 minutes for cardiac arrest, but it is

rather foolish to design an entire system around the 1% of calls that

are cardiac arrests.

2. ALS care is expensive, and generally wasteful. The default level of

EMS provider for most communities should be an EMT-B (albeit a better

educated one than the current model).

3. Every call does not deserve a paramedic. In fact, most calls don't.

4. There is no such thing as a paramedic shortage. In fact, we have too

damned many paramedics as it is.

5. Volunteer EMS, while honorable in its intentions, is actually holding

back the profession. No other health care profession routinely gives

away its services. And every time we do, we devalue what we can provide

to a community. Why buy the cow when you can get the milk for free?

I'm sure there are other inconvenient truths, and other people I've yet

to offend, so everyone else feel free to chime in with their own.

spenair wrote:

>

>

> Wonder if I count as both? If you deny both I will understand.

>

> Don't worry I do understand that the Paramedic education is enough to

> kill a patient and not nearly enough to properly assess them and treat

> them. But I still hold out hope that we can design a much better

system.

>

> Renny

>

>

> >

> > My friends and former students (you know who you are! ) who have

> been advocating medic-initiated refusals will come around eventually,

> trust me.

> > GG

> >

>

>

--

Grayson

www.kellygrayson.com

[Guest guest]

Wes, et al,

The IAFF in general likely feels that way at a national level but if

you spend any time at the grass roots level you will quickly find that

many Members don't really feel that way. Very few IAFF Members that I

know (100's) truely have any disdain or negitive feelings toward

volunteer FD's. Of course there are a few. Many of the Memners of the

IAFF that I know are long time and current volunteers even in light of

national IAFF policy against such Memberships. Politics is a strange

world.

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typos

(Cell)

LNMolino@...

>

> I believe that the IAFF thinks that volunteers hold back paid fire

> departments.

>

> Having said that, I will now ask Grayson if knows where I can

> find some asbestos underoos....

>

> -Wes Ogilvie

>

> Inconvenient EMS Truths (Was: Call an Ambulance,

> Get a Taxi)

>

> That's a possibility, but it will have to be a far, far different

> critter than what we have today. It may well require a redesign of EMS

> from top to bottom. But if we're going to do that, first we'll have to

> actually admit, to ourselves and the public, what EMS *is* and *is

> not*

> capable of doing. In other words, foster some realistic expectations

> of

> EMS and health care in general. So I'll start by speaking a little

> heresy:

>

> 1. Very little of what we do is actually all that time sensitive, and

> response time standards are essentially meaningless. The only

> meaningful

>

> response time is less than 4 minutes for cardiac arrest, but it is

> rather foolish to design an entire system around the 1% of calls that

> are cardiac arrests.

> 2. ALS care is expensive, and generally wasteful. The default level of

> EMS provider for most communities should be an EMT-B (albeit a better

> educated one than the current model).

> 3. Every call does not deserve a paramedic. In fact, most calls don't.

> 4. There is no such thing as a paramedic shortage. In fact, we have

> too

> damned many paramedics as it is.

> 5. Volunteer EMS, while honorable in its intentions, is actually

> holding

>

> back the profession. No other health care profession routinely gives

> away its services. And every time we do, we devalue what we can

> provide

> to a community. Why buy the cow when you can get the milk for free?

>

> I'm sure there are other inconvenient truths, and other people I've

> yet

> to offend, so everyone else feel free to chime in with their own.

>

>

>

> spenair wrote:

> >

> >

> > Wonder if I count as both? If you deny both I will understand.

> >

> > Don't worry I do understand that the Paramedic education is enough

> to

> > kill a patient and not nearly enough to properly assess them and

> treat

>

> > them. But I still hold out hope that we can design a much better

> system.

> >

> > Renny

> >

> >

> > >

> > > My friends and former students (you know who you are! ) who

> have

> > been advocating medic-initiated refusals will come around

> eventually,

> > trust me.

> > > GG

> > >

> >

> >

>

> --

> Grayson

> www.kellygrayson.com

>

>

[Guest guest]

Just trying to get the discussion going.

To quote the former President, " Mission accomplished! "

-Wes

Inconvenient EMS Truths (Was: Call an Ambulance,

> Get a Taxi)

>

> That's a possibility, but it will have to be a far, far different

> critter than what we have today. It may well require a redesign of EMS

> from top to bottom. But if we're going to do that, first we'll have to

> actually admit, to ourselves and the public, what EMS *is* and *is

> not*

> capable of doing. In other words, foster some realistic expectations

> of

> EMS and health care in general. So I'll start by speaking a little

> heresy:

>

> 1. Very little of what we do is actually all that time sensitive, and

> response time standards are essentially meaningless. The only

> meaningful

>

> response time is less than 4 minutes for cardiac arrest, but it is

> rather foolish to design an entire system around the 1% of calls that

> are cardiac arrests.

> 2. ALS care is expensive, and generally wasteful. The default level of

> EMS provider for most communities should be an EMT-B (albeit a better

> educated one than the current model).

> 3. Every call does not deserve a paramedic. In fact, most calls don't.

> 4. There is no such thing as a paramedic shortage. In fact, we have

> too

> damned many paramedics as it is.

> 5. Volunteer EMS, while honorable in its intentions, is actually

> holding

>

> back the profession. No other health care profession routinely gives

> away its services. And every time we do, we devalue what we can

> provide

> to a community. Why buy the cow when you can get the milk for free?

>

> I'm sure there are other inconvenient truths, and other people I've

> yet

> to offend, so everyone else feel free to chime in with their own.

>

>

>

> spenair wrote:

> >

> >

> > Wonder if I count as both? If you deny both I will understand.

> >

> > Don't worry I do understand that the Paramedic education is enough

> to

> > kill a patient and not nearly enough to properly assess them and

> treat

>

> > them. But I still hold out hope that we can design a much better

> system.

> >

> > Renny

> >

> >

> > >

> > > My friends and former students (you know who you are! ) who

> have

> > been advocating medic-initiated refusals will come around

> eventually,

> > trust me.

> > > GG

> > >

> >

> >

>

> --

> Grayson

> www.kellygrayson.com

>

>

[Guest guest]

As much as I hate to admit it Barry, I am going to have to agree with on

this point.  While I concede that there are rural/frontier areas that cannot, or

will not currently pay for EMS professionals, I have to wonder.  Do these areas

also have volunteer police officers?  What about volunteer Post Masters or

postal workers?  Surely they must have volunteer school teachers if they cannot

afford to pay EMS workers,right?  I think we all know the answers to that.

 

If these other, much needed services, demand payment of qualified personnel to

operate, why not EMS?  This is the question we have to find an answer to.

 

 

McGee, EMT-P

[Guest guest]

Going points . I look forward to when we find and can implement

the answer. Barry

Barry Sharp, MSHP, CHES

Tobacco Prevention & Control Program Coordinator

Substance Abuse Services Unit

Mental Health and Substance Abuse Division

________________________________

From: texasems-l [mailto:texasems-l ] On

Behalf Of McGee

Sent: Wednesday, November 04, 2009 1:33 PM

To: texasems-l

Subject: RE: Inconvenient EMS Truths (Was: Call an

Ambulance, Get a Taxi)

As much as I hate to admit it Barry, I am going to have to agree with

on this point. While I concede that there are rural/frontier

areas that cannot, or will not currently pay for EMS professionals, I

have to wonder. Do these areas also have volunteer police officers?

What about volunteer Post Masters or postal workers? Surely they must

have volunteer school teachers if they cannot afford to pay EMS

workers,right? I think we all know the answers to that.

If these other, much needed services, demand payment of qualified

personnel to operate, why not EMS? This is the question we have to find

an answer to.

McGee, EMT-P

[Guest guest]

Good points Barry, but volunteerism should be the exception - like in

the cases you mentioned - and not the rule. It certainly should not be

well over half the EMS care in this country.

I too wonder about whether the fire folks think that volunteer FDs are

holding them back. It has been my observation, however, that the IAFC

and IAFF only represent the interests of paid professional firefighters,

and not the volunteers.

Except, that is, when they are implying that the vast majority of EMS in

this country is provided by fire departments, which as we have stated

before, are mostly volunteers. It would seem that the view volunteer

firefighters in the same way they view EMS - as a convenient way to pad

their statistics, and little more.

Sharp, Barry wrote:

>

> , good points but I'm going to make a couple of opposing/inquiring

> thoughts about your comments on volunteers.

>

> Volunteers may be still needed in those areas where there is

> insufficient call volume or tax base to economically maintain a system

> with paid staff. If the dollars aren't there, then they aren't there.

> (I'm not talking areas where they choose to spend money on other things.

> I'm talking about the truly frontier/rural areas where time is marked

> with a calendar not a watch and is so dirt poor they borrow from the

> proverbial church mouse. Places where two calls a month is a busy month

> and volunteers take turns buying gas and bandages.)

>

> Also, (and this is a dumb question but I'm not privy to fire list

> serves), do the fire folks have the same thoughts that VFDs are holding

> back the profession?

>

> I look forward to your thoughts.

>

> Barry

>

> Barry Sharp, MSHP, CHES

>

> Tobacco Prevention & Control Program Coordinator

>

> Substance Abuse Services Unit

>

> Mental Health and Substance Abuse Division

>

>

>

> ________________________________

>

> From: texasems-l

> [mailto:texasems-l

> ] On

> Behalf Of Grayson

> Sent: Tuesday, November 03, 2009 8:32 PM

> To: texasems-l

> Subject: Inconvenient EMS Truths (Was: Call an Ambulance,

> Get a Taxi)

>

> That's a possibility, but it will have to be a far, far different

> critter than what we have today. It may well require a redesign of EMS

> from top to bottom. But if we're going to do that, first we'll have to

> actually admit, to ourselves and the public, what EMS *is* and *is not*

> capable of doing. In other words, foster some realistic expectations of

> EMS and health care in general. So I'll start by speaking a little

> heresy:

>

> 1. Very little of what we do is actually all that time sensitive, and

> response time standards are essentially meaningless. The only meaningful

>

> response time is less than 4 minutes for cardiac arrest, but it is

> rather foolish to design an entire system around the 1% of calls that

> are cardiac arrests.

> 2. ALS care is expensive, and generally wasteful. The default level of

> EMS provider for most communities should be an EMT-B (albeit a better

> educated one than the current model).

> 3. Every call does not deserve a paramedic. In fact, most calls don't.

> 4. There is no such thing as a paramedic shortage. In fact, we have too

> damned many paramedics as it is.

> 5. Volunteer EMS, while honorable in its intentions, is actually holding

>

> back the profession. No other health care profession routinely gives

> away its services. And every time we do, we devalue what we can provide

> to a community. Why buy the cow when you can get the milk for free?

>

> I'm sure there are other inconvenient truths, and other people I've yet

> to offend, so everyone else feel free to chime in with their own.

>

>

>

> spenair wrote:

> >

> >

> > Wonder if I count as both? If you deny both I will understand.

> >

> > Don't worry I do understand that the Paramedic education is enough to

> > kill a patient and not nearly enough to properly assess them and treat

>

> > them. But I still hold out hope that we can design a much better

> system.

> >

> > Renny

> >

> >

> > >

> > > My friends and former students (you know who you are! ) who have

> > been advocating medic-initiated refusals will come around eventually,

> > trust me.

> > > GG

> > >

> >

> >

>

> --

> Grayson

> www.kellygrayson.com

>

>

[Guest guest]

Granted, I've never lived on the frontier, but I have lived and worked

in rural environments. I spent 10 years in a system that covered 923

square miles with two ambulances, with a total population of around 25k.

From that, several observations come to mind:

1. Everything is a trade off. If you want no property taxes, don't

expect the things that property taxes provide.

2. If you want to live far enough away from nosy neighbors that you can

mow the lawn nude, if you so choose, then don't expect a fast response

from police, fire or EMS.

Note that I didn't say they weren't entitled to a *response,* just that

they weren't entitled to a *fast* one.

McGee wrote:

>

>

> As much as I hate to admit it Barry, I am going to have to agree with

> on this point. While I concede that there are rural/frontier

> areas that cannot, or will not currently pay for EMS professionals, I

> have to wonder. Do these areas also have volunteer police officers?

> What about volunteer Post Masters or postal workers? Surely they must

> have volunteer school teachers if they cannot afford to pay EMS

> workers,right? I think we all know the answers to that.

>

> If these other, much needed services, demand payment of qualified

> personnel to operate, why not EMS? This is the question we have to

> find an answer to.

>

>

>

> McGee, EMT-P

>

>

[Guest guest]

I agree in part. I would add that the frontier EMS actually would need meds and

even perhaps skills that a city EMS would not because they will have patients

for so much more time. I do think both need the education to handle the extra.

> > > > > > >

> > > > > > > My friends and former students (you know who you are! )

> > > who have

> > > > > > been advocating medic-initiated refusals will come around

> > > eventually,

> > > > > > trust me.

> > > > > > > GG

> > > > > > >

> > > > > >

> > > > > >

> > > > >

> > > > >

> > > > > --

> > > > > Grayson

> > > > > www.kellygrayson.com

> > > > >

> > > >

> > > >

> > >

> > > --

> > > Grayson

> > > www.kellygrayson.com

> > >

> > >

> >

> >

[Guest guest]

et al,

I must corect my Cajun Brother on one very important point.

The IAFF represents paid Firefighters in thier union. Not all paid and

not even all union Firefighters are IAFF Members. In some States the

IAFF isn't even the largest Firefighter Union.

The IAFC does indeed represent volunteer Fire Departments and they

even have a dedicated Section for Volunteer and Combonation Officers

which is very much involved in representing the Volunteer segemt of

the American Fire Service.

Again there are likely some at the IAFC that have negitive feelings

regarding the volunteer community but the are the exception not the

rule.

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typos

(Cell)

LNMolino@...

> Good points Barry, but volunteerism should be the exception - like in

> the cases you mentioned - and not the rule. It certainly should not be

> well over half the EMS care in this country.

>

> I too wonder about whether the fire folks think that volunteer FDs are

> holding them back. It has been my observation, however, that the IAFC

> and IAFF only represent the interests of paid professional

> firefighters,

> and not the volunteers.

>

> Except, that is, when they are implying that the vast majority of

> EMS in

> this country is provided by fire departments, which as we have stated

> before, are mostly volunteers. It would seem that the view volunteer

> firefighters in the same way they view EMS - as a convenient way to

> pad

> their statistics, and little more.

>

> Sharp, Barry wrote:

> >

> > , good points but I'm going to make a couple of opposing/

> inquiring

> > thoughts about your comments on volunteers.

> >

> > Volunteers may be still needed in those areas where there is

> > insufficient call volume or tax base to economically maintain a

> system

> > with paid staff. If the dollars aren't there, then they aren't

> there.

> > (I'm not talking areas where they choose to spend money on other

> things.

> > I'm talking about the truly frontier/rural areas where time is

> marked

> > with a calendar not a watch and is so dirt poor they borrow from the

> > proverbial church mouse. Places where two calls a month is a busy

> month

> > and volunteers take turns buying gas and bandages.)

> >

> > Also, (and this is a dumb question but I'm not privy to fire list

> > serves), do the fire folks have the same thoughts that VFDs are

> holding

> > back the profession?

> >

> > I look forward to your thoughts.

> >

> > Barry

> >

> > Barry Sharp, MSHP, CHES

> >

> > Tobacco Prevention & Control Program Coordinator

> >

> > Substance Abuse Services Unit

> >

> > Mental Health and Substance Abuse Division

> >

> >

> >

> > ________________________________

> >

> > From: texasems-l

%40yahoogroups.com>

> > [mailto:texasems-l

> > ] On

> > Behalf Of Grayson

> > Sent: Tuesday, November 03, 2009 8:32 PM

> > To: texasems-l

> > Subject: Inconvenient EMS Truths (Was: Call an

> Ambulance,

> > Get a Taxi)

> >

> > That's a possibility, but it will have to be a far, far different

> > critter than what we have today. It may well require a redesign of

> EMS

> > from top to bottom. But if we're going to do that, first we'll

> have to

> > actually admit, to ourselves and the public, what EMS *is* and *is

> not*

> > capable of doing. In other words, foster some realistic

> expectations of

> > EMS and health care in general. So I'll start by speaking a little

> > heresy:

> >

> > 1. Very little of what we do is actually all that time sensitive,

> and

> > response time standards are essentially meaningless. The only

> meaningful

> >

> > response time is less than 4 minutes for cardiac arrest, but it is

> > rather foolish to design an entire system around the 1% of calls

> that

> > are cardiac arrests.

> > 2. ALS care is expensive, and generally wasteful. The default

> level of

> > EMS provider for most communities should be an EMT-B (albeit a

> better

> > educated one than the current model).

> > 3. Every call does not deserve a paramedic. In fact, most calls

> don't.

> > 4. There is no such thing as a paramedic shortage. In fact, we

> have too

> > damned many paramedics as it is.

> > 5. Volunteer EMS, while honorable in its intentions, is actually

> holding

> >

> > back the profession. No other health care profession routinely gives

> > away its services. And every time we do, we devalue what we can

> provide

> > to a community. Why buy the cow when you can get the milk for free?

> >

> > I'm sure there are other inconvenient truths, and other people

> I've yet

> > to offend, so everyone else feel free to chime in with their own.

> >

> >

> >

> > spenair wrote:

> > >

> > >

> > > Wonder if I count as both? If you deny both I will understand.

> > >

> > > Don't worry I do understand that the Paramedic education is

> enough to

> > > kill a patient and not nearly enough to properly assess them and

> treat

> >

> > > them. But I still hold out hope that we can design a much better

> > system.

> > >

> > > Renny

> > >

> > >

> > > >

> > > > My friends and former students (you know who you are! ) who

> have

> > > been advocating medic-initiated refusals will come around

> eventually,

> > > trust me.

> > > > GG

> > > >

> > >

> > >

> >

> > --

> > Grayson

> > www.kellygrayson.com

> >

> >

[Guest guest]

et al,

I must corect my Cajun Brother on one very important point.

The IAFF represents paid Firefighters in thier union. Not all paid and

not even all union Firefighters are IAFF Members. In some States the

IAFF isn't even the largest Firefighter Union.

The IAFC does indeed represent volunteer Fire Departments and they

even have a dedicated Section for Volunteer and Combonation Officers

which is very much involved in representing the Volunteer segemt of

the American Fire Service.

Again there are likely some at the IAFC that have negitive feelings

regarding the volunteer community but the are the exception not the

rule.

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typos

(Cell)

LNMolino@...

> Good points Barry, but volunteerism should be the exception - like in

> the cases you mentioned - and not the rule. It certainly should not be

> well over half the EMS care in this country.

>

> I too wonder about whether the fire folks think that volunteer FDs are

> holding them back. It has been my observation, however, that the IAFC

> and IAFF only represent the interests of paid professional

> firefighters,

> and not the volunteers.

>

> Except, that is, when they are implying that the vast majority of

> EMS in

> this country is provided by fire departments, which as we have stated

> before, are mostly volunteers. It would seem that the view volunteer

> firefighters in the same way they view EMS - as a convenient way to

> pad

> their statistics, and little more.

>

> Sharp, Barry wrote:

> >

> > , good points but I'm going to make a couple of opposing/

> inquiring

> > thoughts about your comments on volunteers.

> >

> > Volunteers may be still needed in those areas where there is

> > insufficient call volume or tax base to economically maintain a

> system

> > with paid staff. If the dollars aren't there, then they aren't

> there.

> > (I'm not talking areas where they choose to spend money on other

> things.

> > I'm talking about the truly frontier/rural areas where time is

> marked

> > with a calendar not a watch and is so dirt poor they borrow from the

> > proverbial church mouse. Places where two calls a month is a busy

> month

> > and volunteers take turns buying gas and bandages.)

> >

> > Also, (and this is a dumb question but I'm not privy to fire list

> > serves), do the fire folks have the same thoughts that VFDs are

> holding

> > back the profession?

> >

> > I look forward to your thoughts.

> >

> > Barry

> >

> > Barry Sharp, MSHP, CHES

> >

> > Tobacco Prevention & Control Program Coordinator

> >

> > Substance Abuse Services Unit

> >

> > Mental Health and Substance Abuse Division

> >

> >

> >

> > ________________________________

> >

> > From: texasems-l

%40yahoogroups.com>

> > [mailto:texasems-l

> > ] On

> > Behalf Of Grayson

> > Sent: Tuesday, November 03, 2009 8:32 PM

> > To: texasems-l

> > Subject: Inconvenient EMS Truths (Was: Call an

> Ambulance,

> > Get a Taxi)

> >

> > That's a possibility, but it will have to be a far, far different

> > critter than what we have today. It may well require a redesign of

> EMS

> > from top to bottom. But if we're going to do that, first we'll

> have to

> > actually admit, to ourselves and the public, what EMS *is* and *is

> not*

> > capable of doing. In other words, foster some realistic

> expectations of

> > EMS and health care in general. So I'll start by speaking a little

> > heresy:

> >

> > 1. Very little of what we do is actually all that time sensitive,

> and

> > response time standards are essentially meaningless. The only

> meaningful

> >

> > response time is less than 4 minutes for cardiac arrest, but it is

> > rather foolish to design an entire system around the 1% of calls

> that

> > are cardiac arrests.

> > 2. ALS care is expensive, and generally wasteful. The default

> level of

> > EMS provider for most communities should be an EMT-B (albeit a

> better

> > educated one than the current model).

> > 3. Every call does not deserve a paramedic. In fact, most calls

> don't.

> > 4. There is no such thing as a paramedic shortage. In fact, we

> have too

> > damned many paramedics as it is.

> > 5. Volunteer EMS, while honorable in its intentions, is actually

> holding

> >

> > back the profession. No other health care profession routinely gives

> > away its services. And every time we do, we devalue what we can

> provide

> > to a community. Why buy the cow when you can get the milk for free?

> >

> > I'm sure there are other inconvenient truths, and other people

> I've yet

> > to offend, so everyone else feel free to chime in with their own.

> >

> >

> >

> > spenair wrote:

> > >

> > >

> > > Wonder if I count as both? If you deny both I will understand.

> > >

> > > Don't worry I do understand that the Paramedic education is

> enough to

> > > kill a patient and not nearly enough to properly assess them and

> treat

> >

> > > them. But I still hold out hope that we can design a much better

> > system.

> > >

> > > Renny

> > >

> > >

> > > >

> > > > My friends and former students (you know who you are! ) who

> have

> > > been advocating medic-initiated refusals will come around

> eventually,

> > > trust me.

> > > > GG

> > > >

> > >

> > >

> >

> > --

> > Grayson

> > www.kellygrayson.com

> >

> >

[Guest guest]

Is IAFF membership open to volunteers? I've been told by some volunteers

that it isn't.

Louis N. Molino, Sr. wrote:

>

>

> et al,

>

> I must corect my Cajun Brother on one very important point.

>

> The IAFF represents paid Firefighters in thier union. Not all paid and

> not even all union Firefighters are IAFF Members. In some States the

> IAFF isn't even the largest Firefighter Union.

>

> The IAFC does indeed represent volunteer Fire Departments and they

> even have a dedicated Section for Volunteer and Combonation Officers

> which is very much involved in representing the Volunteer segemt of

> the American Fire Service.

>

> Again there are likely some at the IAFC that have negitive feelings

> regarding the volunteer community but the are the exception not the

> rule.

>

> Louis N. Molino, Sr. CET

> FF/NREMT/FSI/EMSI

> Typed by my fingers on my iPhone.

> Please excuse any typos

> (Cell)

> LNMolino@...

>

> On Nov 4, 2009, at 16:30, Grayson Grayson902@...

> > wrote:

>

> > Good points Barry, but volunteerism should be the exception - like in

> > the cases you mentioned - and not the rule. It certainly should not be

> > well over half the EMS care in this country.

> >

> > I too wonder about whether the fire folks think that volunteer FDs are

> > holding them back. It has been my observation, however, that the IAFC

> > and IAFF only represent the interests of paid professional

> > firefighters,

> > and not the volunteers.

> >

> > Except, that is, when they are implying that the vast majority of

> > EMS in

> > this country is provided by fire departments, which as we have stated

> > before, are mostly volunteers. It would seem that the view volunteer

> > firefighters in the same way they view EMS - as a convenient way to

> > pad

> > their statistics, and little more.

> >

> > Sharp, Barry wrote:

> > >

> > > , good points but I'm going to make a couple of opposing/

> > inquiring

> > > thoughts about your comments on volunteers.

> > >

> > > Volunteers may be still needed in those areas where there is

> > > insufficient call volume or tax base to economically maintain a

> > system

> > > with paid staff. If the dollars aren't there, then they aren't

> > there.

> > > (I'm not talking areas where they choose to spend money on other

> > things.

> > > I'm talking about the truly frontier/rural areas where time is

> > marked

> > > with a calendar not a watch and is so dirt poor they borrow from the

> > > proverbial church mouse. Places where two calls a month is a busy

> > month

> > > and volunteers take turns buying gas and bandages.)

> > >

> > > Also, (and this is a dumb question but I'm not privy to fire list

> > > serves), do the fire folks have the same thoughts that VFDs are

> > holding

> > > back the profession?

> > >

> > > I look forward to your thoughts.

> > >

> > > Barry

> > >

> > > Barry Sharp, MSHP, CHES

> > >

> > > Tobacco Prevention & Control Program Coordinator

> > >

> > > Substance Abuse Services Unit

> > >

> > > Mental Health and Substance Abuse Division

> > >

> > >

> > >

> > > ________________________________

> > >

> > > From: texasems-l

>

> %40yahoogroups.com>

> > > [mailto:texasems-l

>

> > > ] On

> > > Behalf Of Grayson

> > > Sent: Tuesday, November 03, 2009 8:32 PM

> > > To: texasems-l

>

>

> > > Subject: Inconvenient EMS Truths (Was: Call an

> > Ambulance,

> > > Get a Taxi)

> > >

> > > That's a possibility, but it will have to be a far, far different

> > > critter than what we have today. It may well require a redesign of

> > EMS

> > > from top to bottom. But if we're going to do that, first we'll

> > have to

> > > actually admit, to ourselves and the public, what EMS *is* and *is

> > not*

> > > capable of doing. In other words, foster some realistic

> > expectations of

> > > EMS and health care in general. So I'll start by speaking a little

> > > heresy:

> > >

> > > 1. Very little of what we do is actually all that time sensitive,

> > and

> > > response time standards are essentially meaningless. The only

> > meaningful

> > >

> > > response time is less than 4 minutes for cardiac arrest, but it is

> > > rather foolish to design an entire system around the 1% of calls

> > that

> > > are cardiac arrests.

> > > 2. ALS care is expensive, and generally wasteful. The default

> > level of

> > > EMS provider for most communities should be an EMT-B (albeit a

> > better

> > > educated one than the current model).

> > > 3. Every call does not deserve a paramedic. In fact, most calls

> > don't.

> > > 4. There is no such thing as a paramedic shortage. In fact, we

> > have too

> > > damned many paramedics as it is.

> > > 5. Volunteer EMS, while honorable in its intentions, is actually

> > holding

> > >

> > > back the profession. No other health care profession routinely gives

> > > away its services. And every time we do, we devalue what we can

> > provide

> > > to a community. Why buy the cow when you can get the milk for free?

> > >

> > > I'm sure there are other inconvenient truths, and other people

> > I've yet

> > > to offend, so everyone else feel free to chime in with their own.

> > >

> > >

> > >

> > > spenair wrote:

> > > >

> > > >

> > > > Wonder if I count as both? If you deny both I will understand.

> > > >

> > > > Don't worry I do understand that the Paramedic education is

> > enough to

> > > > kill a patient and not nearly enough to properly assess them and

> > treat

> > >

> > > > them. But I still hold out hope that we can design a much better

> > > system.

> > > >

> > > > Renny

> > > >

> > > >

> > > > >

> > > > > My friends and former students (you know who you are! ) who

> > have

> > > > been advocating medic-initiated refusals will come around

> > eventually,

> > > > trust me.

> > > > > GG

> > > > >

> > > >

> > > >

> > >

> > > --

> > > Grayson

> > > www.kellygrayson.com

> > >

> > >

[Guest guest]

The IAFF is a union. A Member of the AFL-CIO. I have only limited

knowledge of the IAFF policy and practice as while I have been a Paid

Firefighter I've never been a Union Firefighter. I will see what I can

learne from my IAFF contacts.

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typos

(Cell)

LNMolino@...

> Is IAFF membership open to volunteers? I've been told by some

> volunteers

> that it isn't.

>

> Louis N. Molino, Sr. wrote:

> >

> >

> > et al,

> >

> > I must corect my Cajun Brother on one very important point.

> >

> > The IAFF represents paid Firefighters in thier union. Not all paid

> and

> > not even all union Firefighters are IAFF Members. In some States the

> > IAFF isn't even the largest Firefighter Union.

> >

> > The IAFC does indeed represent volunteer Fire Departments and they

> > even have a dedicated Section for Volunteer and Combonation Officers

> > which is very much involved in representing the Volunteer segemt of

> > the American Fire Service.

> >

> > Again there are likely some at the IAFC that have negitive feelings

> > regarding the volunteer community but the are the exception not the

> > rule.

> >

> > Louis N. Molino, Sr. CET

> > FF/NREMT/FSI/EMSI

> > Typed by my fingers on my iPhone.

> > Please excuse any typos

> > (Cell)

> > LNMolino@...

> >

> > On Nov 4, 2009, at 16:30, Grayson Grayson902@...

> > > wrote:

> >

> > > Good points Barry, but volunteerism should be the exception -

> like in

> > > the cases you mentioned - and not the rule. It certainly should

> not be

> > > well over half the EMS care in this country.

> > >

> > > I too wonder about whether the fire folks think that volunteer

> FDs are

> > > holding them back. It has been my observation, however, that the

> IAFC

> > > and IAFF only represent the interests of paid professional

> > > firefighters,

> > > and not the volunteers.

> > >

> > > Except, that is, when they are implying that the vast majority of

> > > EMS in

> > > this country is provided by fire departments, which as we have

> stated

> > > before, are mostly volunteers. It would seem that the view

> volunteer

> > > firefighters in the same way they view EMS - as a convenient way

> to

> > > pad

> > > their statistics, and little more.

> > >

> > > Sharp, Barry wrote:

> > > >

> > > > , good points but I'm going to make a couple of opposing/

> > > inquiring

> > > > thoughts about your comments on volunteers.

> > > >

> > > > Volunteers may be still needed in those areas where there is

> > > > insufficient call volume or tax base to economically maintain a

> > > system

> > > > with paid staff. If the dollars aren't there, then they aren't

> > > there.

> > > > (I'm not talking areas where they choose to spend money on other

> > > things.

> > > > I'm talking about the truly frontier/rural areas where time is

> > > marked

> > > > with a calendar not a watch and is so dirt poor they borrow

> from the

> > > > proverbial church mouse. Places where two calls a month is a

> busy

> > > month

> > > > and volunteers take turns buying gas and bandages.)

> > > >

> > > > Also, (and this is a dumb question but I'm not privy to fire

> list

> > > > serves), do the fire folks have the same thoughts that VFDs are

> > > holding

> > > > back the profession?

> > > >

> > > > I look forward to your thoughts.

> > > >

> > > > Barry

> > > >

> > > > Barry Sharp, MSHP, CHES

> > > >

> > > > Tobacco Prevention & Control Program Coordinator

> > > >

> > > > Substance Abuse Services Unit

> > > >

> > > > Mental Health and Substance Abuse Division

> > > >

> > > >

> > > >

> > > > ________________________________

> > > >

> > > > From: texasems-l

> >

> > %40yahoogroups.com>

> > > > [mailto:texasems-l

> >

> > > > ] On

> > > > Behalf Of Grayson

> > > > Sent: Tuesday, November 03, 2009 8:32 PM

> > > > To: texasems-l

> >

> >

> > > > Subject: Inconvenient EMS Truths (Was: Call an

> > > Ambulance,

> > > > Get a Taxi)

> > > >

> > > > That's a possibility, but it will have to be a far, far

> different

> > > > critter than what we have today. It may well require a

> redesign of

> > > EMS

> > > > from top to bottom. But if we're going to do that, first we'll

> > > have to

> > > > actually admit, to ourselves and the public, what EMS *is* and

> *is

> > > not*

> > > > capable of doing. In other words, foster some realistic

> > > expectations of

> > > > EMS and health care in general. So I'll start by speaking a

> little

> > > > heresy:

> > > >

> > > > 1. Very little of what we do is actually all that time

> sensitive,

> > > and

> > > > response time standards are essentially meaningless. The only

> > > meaningful

> > > >

> > > > response time is less than 4 minutes for cardiac arrest, but

> it is

> > > > rather foolish to design an entire system around the 1% of calls

> > > that

> > > > are cardiac arrests.

> > > > 2. ALS care is expensive, and generally wasteful. The default

> > > level of

> > > > EMS provider for most communities should be an EMT-B (albeit a

> > > better

> > > > educated one than the current model).

> > > > 3. Every call does not deserve a paramedic. In fact, most calls

> > > don't.

> > > > 4. There is no such thing as a paramedic shortage. In fact, we

> > > have too

> > > > damned many paramedics as it is.

> > > > 5. Volunteer EMS, while honorable in its intentions, is actually

> > > holding

> > > >

> > > > back the profession. No other health care profession routinely

> gives

> > > > away its services. And every time we do, we devalue what we can

> > > provide

> > > > to a community. Why buy the cow when you can get the milk for

> free?

> > > >

> > > > I'm sure there are other inconvenient truths, and other people

> > > I've yet

> > > > to offend, so everyone else feel free to chime in with their

> own.

> > > >

> > > >

> > > >

> > > > spenair wrote:

> > > > >

> > > > >

> > > > > Wonder if I count as both? If you deny both I will

> understand.

> > > > >

> > > > > Don't worry I do understand that the Paramedic education is

> > > enough to

> > > > > kill a patient and not nearly enough to properly assess them

> and

> > > treat

> > > >

> > > > > them. But I still hold out hope that we can design a much

> better

> > > > system.

> > > > >

> > > > > Renny

> > > > >

> > > > >

> > > > > >

> > > > > > My friends and former students (you know who you are! )

> who

> > > have

> > > > > been advocating medic-initiated refusals will come around

> > > eventually,

> > > > > trust me.

> > > > > > GG

> > > > > >

> > > > >

> > > > >

> > > >

> > > > --

> > > > Grayson

> > > > www.kellygrayson.com

> > > >

> > > >

[Guest guest]

In many parts of the country there are volunteer law enforcement

officers, just for reference. They probably do have full-time

professional staff (or at least a resident deputy or like) but there

are plenty of volunteer LEOs in the country.

> As much as I hate to admit it Barry, I am going to have to agree

> with on this point. While I concede that there are rural/

> frontier areas that cannot, or will not currently pay for EMS

> professionals, I have to wonder. Do these areas also have volunteer

> police officers? What about volunteer Post Masters or postal

> workers? Surely they must have volunteer school teachers if they

> cannot afford to pay EMS workers,right? I think we all know the

> answers to that.

>

> If these other, much needed services, demand payment of qualified

> personnel to operate, why not EMS? This is the question we have to

> find an answer to.

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

> McGee, EMT-P

>

>

>

>

>