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Why does that become an EMS problem? PWW make it quite clear that a patient’s percent at the hospital means the hospital has an obligation to follow their EMTALA requirements and cannot use EMS as a crutch. And that epitomizes everything wrong with California, the only state that has such a...

You don’t need to outrun the bear, you just need to outrun the person with you?

Absolutely. Even the best qualified, most experienced people would struggle to manage both. You need a division of labor & a structure that allows for it

Absolutely. She isn’t fellowship trained in EMS, has no EMS-specific focus in her research or practice, and had no management experience or training (https://www.nola.com/news/politics/article_3c3b8b94-27d0-5539-9ca2-4241f61ccdc2.html).

Thanks for sharing this! This was the highlight for me: From CMS, no less! It would be interesting to see if EMS handover to a hospital that then delays care has been litigated.

I should probably have made this story a lead-in for a separate thread. My contention is that there is a necessary & proper division between clinical and operational aspects of a service* - physicians are clearly the clinical* experts, but often lack the (prehospital-specific, particularly)...

I’ve always wanted to do a study of management in EMS and correlates of performance/outcomes. I have a prior coming into this that management coming up from the ranks without any formal management education is a correlate of suboptimal performance. Speaking of fire, why do you think that is? Is...

Before somebody tries to blame this on compensation, that is only part of the picture. This is a major industry-wide cultural problem that can't be patched over by just increasing pay (hedonic treadmill sets in quite quickly & so does entitlement to a new wage level. We even see this in...

That reminded me of this Pew survey. I'd wager that would mean most major cities, almost every sizable suburb, and even well into the exurbs, your exceptions being true rural areas.

https://www.hmpgloballearningnetwork.com/site/emsworld/news/new-orleans-ems-director-steps-down Looking at the story & the admin staff there, coupled with the comp issues they have, I have to wonder - is a physician really the right kind of person to helm your service?

Normal time, rehire everybody at a discount? It’s a neutron bomb not a nuclear bomb.

Perhaps the AAP precis here will be helpful? https://publications.aap.org/aapnews/news/16388?autologincheck=redirected Re: school infections, depends on what you consider an outbreak. MMWR has a number of reports of index cases —> 30+ infected.

In a school setting, I’d be inclined to vaccinate. Schools, prisons, hospitals, nursing homes - all incubators of infectious disease.

Florida?

Where should it be retained? Presume sufficient volume of intubations per medic and sufficient post-licensure education & skills verification are prerequisites for this — probably leaves a small cadre of flight, critical care, and some other specialized folks who could consider ETI in scope?

Skill dilution is the proximate cause, I would think. Fundamental cause is having too many medics in a system.

Lest we forget, CFR can vary hugely by demographic factors (age, gender, etc.)… (CFR may or may not be the best measure since it is based on confirmed cases, thus could exclude the potential asymptomatic unconfirmed cases.)

Ahh, I know this fabled system. It’s one with many, many flaws - and though I love the concept of community volunteerism, I worry about its sustainability. Also, the staffing model seems risky to me, taking PD out of service for a transport + cleanup + getting back to their car. I was thinking...

Personal experience, larger companies seem to be more careful? But definitely agree it seems pervasive. Scary to see in public safety in particular though.

And I suppose not exclusive to EMS. It just boggles the mind how many places think it is ok to just take somebody who is a high performing (or just plain long-tenured) individual contributor and give them people to manage or train without any education in it.