Looks like EMT shortage is hitting hard in the state of CT. Many Vol EMS depts are resorting to paid providers or hospital based providers.
NJ has been doing this for decades. It's not new, nor is it necessarily a bad thing.Looks like EMT shortage is hitting hard in the state of CT. Many Vol EMS depts are resorting to paid providers or hospital based providers.
Why do you say that? shouldn't local services be funded at the local level? If I want an ambulance on every street corner, and am willing to pay for it, why shouldn't it get it? if the next town over doesn't want it, or are not willing to pay for it, they don't get it. you get what you pay for. And the further away you get from the local level, the worse many situations get. Don't get me wrong, I'm not against deionization, but I've seen the county and state screw things up royally, and the federal government is even worse.I think this highlights one of the problems of leaving these sorts of things up the local municipality which can usually only raise money through property taxes or user fees suchlike. They are obviously under pressure to keep these taxes or fees down. That. to me, seems incompatible with the idea of ensuring local services run effectively.
You might not want to advocate too much about the UK's NHS system... unless you think a 1 hour wait for an ambulance with a pediatric head injury is acceptable...In New Zealand, Australia, the United Kingdom and some parts of Canada, the ambulance service s run at the state or province or regional level as part of the health system. That way, the local governments are not on the hook. The same here with the fire brigade, which is funded mainly by insurance levies and some central government funding but that is entirely non-contentious.
That's not entirely true... but do you really want some government official in another state determining that you shouldn't have an ambulance that can provide a quick response during an emergency?I accept in the US there is no real public health provision so it makes it quite difficult to replicate such a model because there is no overarching public body responsible for providing healthcare. I am sure it could be done if it was really seen as a viable option.
I do agree, but as you so clearly stated "our fearless pols finally agreed to pump serious money to the ambulance service to largely replace the need for volunteers to double crew." In the US, too much of the country has received the service for free for decades, so now that agencies are looking to improve their services, better response times, and raise standards, the pols are saying "why should I have to pay for something that has always been done for free?"Now in saying that, there will always be a need to some extent for volunteers. How far that should extend is debatable. I do not think "just get some people to do it for free" is the answer to solve the ills of insufficient money. I can happily say after decades of doing little, our fearless pols finally agreed to pump serious money to the ambulance service to largely replace the need for volunteers to double crew. Huzzah! There are also programmes where docs or other medicos and lawyers do some free work to help solve access block. Encouraging or forcing people to work for free is not the answer.
It's likely cultural. the US is, historically, a partnership between the federal government and the states, with the 10th amendment to the US constitution explicitly saying any rights not explicitly assigned to the feds are the responsibility of the states.@DrParasite I won't quote your entire post at length, but needless to say, and this is not a criticism, it shows a very American mindset that I find hard to understand, even after having spent significant amounts of time in the US. There is this entrenched fear or loathing or just downright hatred of the government that is not something I have seen elsewhere.
Because the larger you get, the more inefficient things tend to get, and the less voice smaller areas have in how things get done.For example, lets say one particular state wants to establish a statewide ambulance service run by the state Department of Health using a standard vehicle and equipment, all bought in bulk, and establish a network of stations and suchlike to ensure local response and fund it from the state health budget so the local towns or cities do not have to try to raise the money themselves. Great idea. But something like that in America is scoffed at and booed.
So you are ok with a 2 hour wait for a pediatric head injury? because that was the example provided in that link (feel free to read it yourself, it's that person's story, not mine). What if it was your kid?And to answer your specific question, yes, I see nothing wrong about waits of one to two hours or more for non-urgent ambulance dispatch. When my flatmate worked in Control (five or more years ago), I believe then non-urgent work could be held for up to two hours. That is not including the portion of work that was told you are not getting an ambulance. I remember just before I stopped having anything to do with the ambos (2014), they introduced nurse triage of low acuity work into the control room and demand dropped something like 15% overnight. The immediately comparable example I can think of is triage at the emergency department, so I looked up the lowest category for the Australiasan Triage Scale and category 5 patients (lowest acuity) are deemed safe to wait up two hours to see a doctor. As a different but somewhat related example, the Police Detention Legal Assistance scheme now no longer defaults to in-person attendance.
Do you consider a heart attack to be non-emergent? or a shooting? a 2 hour wait might affect patient outcomesand IDK much about Australia, but IIRC, the majority of the population is located on the east/south east coast right? so if I'm in northern Australia, and have a heart attack/get attacked by an animal/ get shot/etc. what's the response time going to be like? I'm assuming the majority of the calls are in the high population centers, so I pay national taxes, but the services are going to those big cities. As I mentioned beforehand, I know nothing about Australia, so that does include a lot of assumptions about the EMS system there.
I totally agreeI have said for my entire EMS career that all EMT's should spend at least 1 summer working at a Scout or Youth camp where the closest EMS is 30-45 minutes away. You will learn more about working EMS in a case like that than you do working in a city for your entire career. It has been over 20 years for me, and I can still decide if a patient needs sutures or not; saves patients a lot of money when they don't need to go to the hospital for a small laceration.
Every Medic need to spend time in a rural area. Where the closest hospital is 2 hours away, and the closest helicopter is 45 minutes away (when you can get one). Medics in Major Metro areas do not do well coming to areas like that...... we have areas that we can't even call Medical Control for help, because there is no radio or cell coverage for 30 miles or more. Where you might have a 6 hour ground transport with an Acute MI, due to a blizzard, and you can't get a helicopter, and when you call the ED for orders for more pain meds and more NTG the ED doctor almost cries when you tell him you are still probably 4 hours away.