A Weighted Issue? A Burning Issue… Wow.

I’ve always said that I love EMS and that I’ve taken from it far more than I could ever give back to it. The same is true with this blog. From my readers and people who comment, I learn more than I can teach and enjoy more than I can entertain.

This weekend proved all of those facts quite well.

If you didn’t read the blog over the weekend, you missed an amazing discussion on my last post. The post, “A Weighted Issue, The Fire Service Helping Private EMS” discussed the case of a private ambulance requesting a fire department for assistance in carrying a bariatric patient back into her home on a long-distance hospital discharge. The private ambulance was 5 or 6 hours out of their area of operations and the Fire Department was a full-time municipal department.

I linked to the stories that had popped up on www.JEMS.com and also on www.EMS1.com. I wrote my feelings on the issue, explored the case a bit, and then opened up the floor to the readers for their comments.

And what happened floored me, just knocked me over.

Predictably, I started getting comments on the post… Then some more… then more.. then a LOT more.. then a TON more. The post spread like wildfire and attracted some of the most intelligent discussion I’ve ever had here. It’s by far my most commented post with 86 at the time I write this.

And I read them all. I love comments, they come to my BlackBerry. Really. I read the discussion, the back and forth, and the wide spectrum of opinions as they came in, sometimes two and three at a time.

And my opinion has been swayed… my original perception that the Fire Department was Evil has been tempered. My original perception that the Private Ambulance could have dropped a dime and handled the issue with a phone call before the incident has not changed. However, I now focus my ire on the system that caused this issue.

The reimbursement structure holds the ambulance service hostage. No private ambulance would be reimbursed for hauling the patient with extra people. The service wouldn’t have been reimbursed for a 2nd rig and the patient had to be taken home. My guess, as was stated by a handful of commenters, is that the service was taking the patient as a favor to garner more business from the rehab hospital. I have no way of knowing that for sure, but it makes sense to me.

Not only did I get a TON, just a ton of great discussion… but the post spawned a few others as well.

This event has taught me something that should be the takeaway for us all. That is this: Issues like this are not going away. In fact, they’re only going to get more common. Private EMS isn’t evil and the “Private Transport Industry” is necessary for the functioning of our healthcare system. Fire-Based EMS will have to help and could never handle the strain of not having private EMS.

Sorry to both parties here, we’re all needed in the current system. Healthcare needs us all.

So play nice and help each other out. Remember the Golden Rule.

And remember the five P’s: “Proper Planning Prevents Poor Performance”

I shall leave you with two things:

http://lifeunderthelights.com/2010/09/a-weighted-issue-the-fire-service-helping-private-ems/ – A link to the post for you to wade into the comments if you haven’t (you should. Bring a snack)

And this, a  video that this experience has brought to my mind. “The Hats of Incident Management” It’s about highway incidents… but you’ll get the point. It’s a classic.

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  • Steve

    True story. And maybe both entities would be more willing to help each other if they could adopt the mindset of being each others advocates. (Radical as it seems.)


    • Ckemtp

      I read that when you put it out there. It struck a chord with me as a guy who works both Private EMS (quasi-Gov supported non-profit) and Fire-based.

      Do private hospitals hate county hospitals and vice versa?

  • Anonymous

    Since you said please, you can call me NABO.

    Great discussion on the topic. I was surprised at the complexity of the many competing issues and interests related to this incident. I hope we can all learn something from it.

    Thanks for generating the discussion.

  • Fire-Based EMS will have to help and could never handle the strain of not having private EMS. No fire service would ever admit to this truth.

    While I agree advocating for each other, the fire service has for the past 20+ years been eliminating services and adding many “jobs we don’t do” to the list; which as a private EMS provider I see this all the time.

    Much of the time I’d rather the fire dept not even show up. The crews just mill about doing nothing (making passers-by misconstrue that “fire has come to help”) and often complaining about being woken up in the middle of the night. And ironically enough, it’s the professional paid fire crews, not the per diem or vollie departments I get the most flack from when I do need the manpower.

    I don;t like coming to this point, but recently I’ve started to conclude that the most applicable response from the FS is only when specific tools are needed (i.e. extrication) or actual fires occur; everything else is just wasted effort.

  • Christine Springfield

    Just had to say… that video was SO funny! I have been on both sides of the issue, private and public. First off, yes, the private provider should have called and set up the lift assist with the FD as soon as they knew it would be required. Creativity in rewarding the help could have been applied – buy the FD pizzas, etc. Surely the FD does not receive lift assist requests from far away private services that often. If they are getting them often from local companies, that’s a matter to be handled with those providers. I would think professional courtesy from the FD and a generous round of “thank you’s” from the privates would have at least resolved the situation. Good grief that it’s all turned into such a huge issue!