Hey, Chad Moser!  Remember the message about complaints?
You said to Blake Bowers on 22 Aug 96  01:14:00...
CM> I know that it takes complaints to bring change to an EMS system, but I 
CM> just get tired of the same old complaints.  I also know that these 
CM> complaints are still around is because no one has come up with a 
CM> solution that works for management, i.e. cost effective.
 
I will offer my 2 cents on being "cost effective", and see what you (and 
others) think about it.
It is a problem here in the State of CT, the way EMS gets budgeted (or should 
I say, the LACK of funding).  Volunteers make up over 70% of the services 
hat
deliver Emergency Medical Services, yet they are put under more and more 
unfunded mandates.  While most of them make efforts to comply (such as "a 
Paramedic in every town"), some communities are against "mandates", since 
hey
inevitably lead to increased costs.  For instance, the Council On Small Towns 
(C.O.S.T.) 109 out of 169 being members, are against the "mandatory 
aramedic"
mandate the State wants to impliment.   SOme communities would rather have a 
paramedic for a district of towns, since, in some communities, the need for a 
paramedic in one year was -less- than 2 times in these towns !  
     The Department of Public Health, Office of Emergency Medical Services, 
s
greatly influenced by the rather fickle and austere winds of the medical
insurance companies, which ultimately pay for the majority of costs in EMS.
The DPH and OEMS will respond to the "power players" of the medical
Community, which -are- the Directors of Hospitals and Dept heads of 
ospitals.
At the majority of meetings for issues that involve EMS, there is usually no 
representative from ANY hospital to even hear what is going on!
 The ones of influence (usually MD's) will appeal to what generates the
buck for THEM, and what makes their job easier.  Prehospital EMS is NOT
in the equasion.  Hospitals do NOT want EMT's working "alongside" them at
all, the health care unions will not recognize them as "hospital workers",
so, prehospital caregivers are left to fend for themselves.  Their only means
of support are from ambulance owners, who are also driven, ultimately. by the
"bottom line".  In fact, a past president of the Connecticut Ambulance
Association stated that "EMT's are a dime-a-dozen", and repeated this phrase
at the more recent meeting of the American Ambulance Association.  If you
were an EMT, how do you think YOUR future would look with this kind of
attitude from the regulators and from Ambulance owners?  Did you know that 
he
majority of PAID EMT's make BELOW the national poverty level ?
    A solution is to move EMS from OUT of the direction of Public Health, and
under the control of the Department of Public Safety. (Police and FIRE 
services).  The rationale is that prehospital caregivers are, primarily, a
means of RESCUE and TRANSPORTATION of people in an unsafe personal emergency.
IOW, the EMT exists to RESCUE, RETRIEVE, and stablize a person PRIOR TO
TRANSPORT to a medical facility.   Without the transportation to the scene, 
rescue, retreival, stabilization, and transportation to the medical facility,
the EMT's job really ceases to exist, since the hospitals, most of the time,
view EMT's and EMS as a NON-HOSPITAL profession.  EMS now should be looked at
as a different sort of service.  It is to provide to the PUBLIC a rapid and
SAFE means of TRANSPORTATION -to- MEDICAL CARE.  EMS covers HAZARDOUS
MATERIALS, as well as air- and blood- borne pathogens, EXTRICATION, SEARCH
AND RESCUE, CROWD CONTROL, all in an UNSTABLE WORK ENVIRONMENT.  Hospitals do
NOT engage in HAZMAT, SEARCH and RESCUE, CROWD CONTROL, EXTRICATION, or have
an UNSTABLE WORK ENVIRONMENT.  They work under sterile, flourscently lit
secure work stations, protected by security, with help a STAT page away.  
hey
have computer interface with databases, to look up any problem, to consult
with anyone, anywhere, no expense spared.  They do not transport anyone
anywhere.  They deal ONLY with medical problems, and have vast resources at
their disposal.  How many of you use a computer database on YOUR ambulance?
What medical records were YOU able to access, legally, from the hospital that
provides YOUR medical control?  Hell, how many of you have adequately working 
lights or air conditioning in your ambulances ??!!??
    EMS -is- a PUBLIC SAFETY service, such as police and fire protection.  
Bidding out police work to the lowest bidder is UNHEARD of in any town!  How 
safe would YOU feel if your fire department or police department was provided
by the one who could cut costs the deepest, staffed with the fewest and 
cheapest paid, and equipped with the cheapest?  Yet, this is what those that
regulate and manage EMS are doing all the time!  EMS needs to become a part
of the community of public safety, and viewed as an instrument of public
safety, NOT as an extension of the hospital.
Stick around... you'll see what I'm talking about.
Regards,
Tom Patierno
EMT-I NAEMT #9937
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