LA county EMS/Fire?

[billydunwood]

I'm not criticizing Culver City Fire in particular, nor am I trying to be funny. Honestly, I'm not even questioning the fire fighters who did what they had to do to become career FFs in your area. What I've seen in systems just like what you describe is having fire-medics (Fire first, medic a distant second) serve as apathetic providers who attended paramedic school only because their department mandated it. Age or time of experience wasn't really the point of my initial post. When people want to do one job and are forced to do another as they wait for what they've really wanted all along their "temporary" job performance suffers.

Having a paramedic on every call "just in case" only ensures this medic goes on too many "IV Monitor" BLS transfers and sees too few acute calls. You also take away the ability of the EMT to recognize the need for ALS and provide basic transport services on their own.

Well, most of them were paramedics prior to applying. Others have the opportunity to have the city pay for their paramedic school, and most of them are excited about that. Second, the ambulances are ALS so the medic is on it regardless of the call. However, if it is a BLS call and an ALS call comes in, the ambulance will most of the time divert to the ALS call while an engine stands by with the BLS patient awaiting a private BLS ambulance. Again, most of them were paramedics prior to joining.

 

[medicsb]

Plus, I would rather have a paramedic on the engine than an EMT-B just in case anything happens. I would rather have ALS and not need it than not have ALS and have it be tied up or 10 minutes away. By the way, this system has been working fine for years and CCFD has an excellent reputation for both firefighting and medical service

The only problem with that system design is that there is NO EVIDENCE anywhere to show that it does what you and others claim it does. The existence of your type of system was almost exclusively founded on cardiac arrest survival and old data (early 80s) that showed improved survival w/ defib/ACLS in under 8 minutes back when only ALS was able to defibrillate.

Your system and others like it are paying millions of dollars to buy ALS equipment, maintain ALS equipment, pay for fuel, pay for con-ed, pay for liability insurance, pay for salary etc., etc. based on data that is no longer relevant. Despite this approach being around for decades now, there is no data to support it. (The cynic in me would not at all be surprised if it has been studied, but results not published due to negative results.)

 

[CFal]

There are studies that show that in most cases ALS has little benefit. In my area I think the best way to go would be keeping Fire based ambulances ran at the local level and regional 3rd service ALS intercept.

 

[billydunwood]

The only problem with that system design is that there is NO EVIDENCE anywhere to show that it does what you and others claim it does. The existence of your type of system was almost exclusively founded on cardiac arrest survival and old data (early 80s) that showed improved survival w/ defib/ACLS in under 8 minutes back when only ALS was able to defibrillate.

Your system and others like it are paying millions of dollars to buy ALS equipment, maintain ALS equipment, pay for fuel, pay for con-ed, pay for liability insurance, pay for salary etc., etc. based on data that is no longer relevant. Despite this approach being around for decades now, there is no data to support it. (The cynic in me would not at all be surprised if it has been studied, but results not published due to negative results.)

And only 43% of statistics are true. Studies can be rigged and faked. But CCFD's system has been working fine for years and I have never heard residents/patients complain. Plus, why change something that works perfectly fine?

 

[chaz90]

And only 43% of statistics are true. Studies can be rigged and faked. But CCFD's system has been working fine for years and I have never heard residents/patients complain. Plus, why change something that works perfectly fine?

Gah, because there is a better way! Lack of complaints when your patient population doesn't know any better isn't confirmation of a quality system. You're assuming validation based on hearing nothing at all, when in reality the burden should be on the system to prove its own utility.

Giving someone from the year 1840 an early Ford Model T would blow their mind. They would think they had stumbled on the pinnacle of transportation technology, and you wouldn't hear a single complaint from them. After all, they can now travel up to 30 MPH in utter freedom without switching horses and with only a dull roar, soot stains, and slightly sore backs as payment. Let them have a taste of a high end 2014 Mercedes though and they may start to realize how much things could improve.

I'm not saying any system is perfect, but to have blind faith in what you have just because it's what is currently available is utterly myopic.

Also, please tell me you're not actually trying to use a trite phrase to ignore mountains of evidence. Statistics can be manipulated, but they are the very foundation of data. Data leads to scientific conclusions, which beget human progress. Ignorance of statistics is ignorance of the future.

 

[DesertMedic66]

Gah, because there is a better way! Lack of complaints when your patient population doesn't know any better isn't confirmation of a quality system. You're assuming validation based on hearing nothing at all, when in reality the burden should be on the system to prove its own utility.

Giving someone from the year 1840 an early Ford Model T would blow their mind. They would think they had stumbled on the pinnacle of transportation technology, and you wouldn't hear a single complaint from them. After all, they can now travel up to 30 MPH in utter freedom without switching horses and with only a dull roar, soot stains, and slightly sore backs as payment. Let them have a taste of a high end 2014 Mercedes though and they may start to realize how much things could improve.

I'm not saying any system is perfect, but to have blind faith in what you have just because it's what is currently available is utterly myopic.

Ok, I could not have made a better reference.

 

[medicsb]

And only 43% of statistics are true. Studies can be rigged and faked. But CCFD's system has been working fine for years and I have never heard residents/patients complain. Plus, why change something that works perfectly fine?

Yeah, and EMS systems can be far worse than the stake-holders would ever admit to, particularly when they rely on hubris instead of objective evidence.