I say lowly, because I work in a private fire based system performing EMS duties for a third party private ambulance.

They provide the rig and the Medic, my company provides the EMT-B for the rig.

I volunteer in one of the premier ALS systems in my state. 5 time winners of ALS Provider of the Year. All the local VFD's and Career FD's have EMT-B and First Responders on staff and respond to calls in their jurisdiction, establishing BLS care quickly and then assisting the ALS Ambulance crew upon their arrival.

Education is key.

Educate yourself AND those you serve. I don't mean wait until you want something or are facing budget cuts. I mean every dang day of the week. Participate in local events, talk to people while you are there, don't just sit in the rig. Be your own advocate!

Educate yourself so that when your views are challenged you are ready to rebutt with facts and knowledge, not emotion. It is WAY easier to get emotional than stay rational. If you go over to emotion, the argument is lost.

Where is EMS's Billy G, Branigan, Dunn, Brunacini?? Where are the nationallly recognized voices? It is all Doctors at hospitals and an isolated Medic here or there speaking out and up.

Volunteers do hurt the overall goal. They are held up everytime more pay is asked for. They are not to blame though. Stop bashing them. Without their services, countless numbers of Americans would lie bleeding to death on our rural highways and in their homes. There is NO WAY that those rural areas they serve are going to pony up the money for a paid service, and if they did it would only serve to drag wages lower on the average.

Stand Alone EMS services can and do work. The one I volly with works very well, they bill Medicare and Medicade as well as insurance companies. They field 6 ALS ambulances 24-7, with 22 fire departments supporting the mission by decreasing response times.

Fire Based works too! In many areas, the FD has the facilities in place to forward deploy ALS units to population centers, and even to rural clusters. The old mentality of firefighters that I hate EMS is slowly dying out as these guys retire or quit. THere is no shartage of replacements for them either. The quality and professionalism of fire based EMS is every bit as good as anywhere.

There is no one answer that fits all for what type of provider system is best, anymore than there is one way to establish an airway in a patient! STOP THE BICKERING AND WORK TOGETHER!!

This is the same problem the Fire Service as a whole has.

We will never bring wages up until we speak with one voice and get the people to understand what we do and why.

Get 'em on our side!

That said, I believe the ideal model for EMS is a third-service, taxpayer subsidized system, separate from police and fire. They should also bill private insurance, Medicare and Medicaid for their services, when applicable.

This doesn't necessarily mean they should be profitable, but they should do whatever it takes to lessen their dependence on taxpayer subsidies, while still providing quality care and good wages for their medics.

But part of the problem IS the volunteers, and not just in the abstract, “Why buy the cow when you can get the milk for free?” argument.

I'm not bashing volunteers. I teach a lot of them, and I've been one myself. But whenever CMS calculates a new Medicare fee schedule (and usually Medicaid reimbursement is tied proportionally to Medicare), they do so by averaging the cost of providing EMS services around the country.

When well over half of EMS care in this country is provided by volunteers, that really drags down the average, resulting in a far smaller revenue pool for paying personnel.

Heck, it took several years of Medicare reimbursing at only 70% of actual cost before relief legislation could be passed to make the fee schedule a little less of a colossal money-loser for providers.

And you can bet that, when the next revision comes around, they will use the same formula.

I appreciate the dedication and altruism of volunteers, but the cynical realist in me says that if a community wants EMS, they'd better be willing to pay for it. As long as we continue to provide our services for free, those services are not going to be valued.

I say lowly, because I work in a private fire based system performing EMS duties for a third party private ambulance.

They provide the rig and the Medic, my company provides the EMT-B for the rig.

I volunteer in one of the premier ALS systems in my state. 5 time winners of ALS Provider of the Year. All the local VFD's and Career FD's have EMT-B and First Responders on staff and respond to calls in their jurisdiction, establishing BLS care quickly and then assisting the ALS Ambulance crew upon their arrival.

Education is key.

Educate yourself AND those you serve. I don't mean wait until you want something or are facing budget cuts. I mean every dang day of the week. Participate in local events, talk to people while you are there, don't just sit in the rig. Be your own advocate!

Educate yourself so that when your views are challenged you are ready to rebutt with facts and knowledge, not emotion. It is WAY easier to get emotional than stay rational. If you go over to emotion, the argument is lost.

Where is EMS's Billy G, Branigan, Dunn, Brunacini?? Where are the nationallly recognized voices? It is all Doctors at hospitals and an isolated Medic here or there speaking out and up.

Volunteers do hurt the overall goal. They are held up everytime more pay is asked for. They are not to blame though. Stop bashing them. Without their services, countless numbers of Americans would lie bleeding to death on our rural highways and in their homes. There is NO WAY that those rural areas they serve are going to pony up the money for a paid service, and if they did it would only serve to drag wages lower on the average.

Stand Alone EMS services can and do work. The one I volly with works very well, they bill Medicare and Medicade as well as insurance companies. They field 6 ALS ambulances 24-7, with 22 fire departments supporting the mission by decreasing response times.

Fire Based works too! In many areas, the FD has the facilities in place to forward deploy ALS units to population centers, and even to rural clusters. The old mentality of firefighters that I hate EMS is slowly dying out as these guys retire or quit. THere is no shartage of replacements for them either. The quality and professionalism of fire based EMS is every bit as good as anywhere.

There is no one answer that fits all for what type of provider system is best, anymore than there is one way to establish an airway in a patient! STOP THE BICKERING AND WORK TOGETHER!!

This is the same problem the Fire Service as a whole has.

We will never bring wages up until we speak with one voice and get the people to understand what we do and why.

Get 'em on our side!

I say lowly, because I work in a private fire based system performing EMS duties for a third party private ambulance.

They provide the rig and the Medic, my company provides the EMT-B for the rig.

I volunteer in one of the premier ALS systems in my state. 5 time winners of ALS Provider of the Year. All the local VFD's and Career FD's have EMT-B and First Responders on staff and respond to calls in their jurisdiction, establishing BLS care quickly and then assisting the ALS Ambulance crew upon their arrival.

Education is key.

Educate yourself AND those you serve. I don't mean wait until you want something or are facing budget cuts. I mean every dang day of the week. Participate in local events, talk to people while you are there, don't just sit in the rig. Be your own advocate!

Educate yourself so that when your views are challenged you are ready to rebutt with facts and knowledge, not emotion. It is WAY easier to get emotional than stay rational. If you go over to emotion, the argument is lost.

Where is EMS's Billy G, Branigan, Dunn, Brunacini?? Where are the nationallly recognized voices? It is all Doctors at hospitals and an isolated Medic here or there speaking out and up.

Volunteers do hurt the overall goal. They are held up everytime more pay is asked for. They are not to blame though. Stop bashing them. Without their services, countless numbers of Americans would lie bleeding to death on our rural highways and in their homes. There is NO WAY that those rural areas they serve are going to pony up the money for a paid service, and if they did it would only serve to drag wages lower on the average.

Stand Alone EMS services can and do work. The one I volly with works very well, they bill Medicare and Medicade as well as insurance companies. They field 6 ALS ambulances 24-7, with 22 fire departments supporting the mission by decreasing response times.

Fire Based works too! In many areas, the FD has the facilities in place to forward deploy ALS units to population centers, and even to rural clusters. The old mentality of firefighters that I hate EMS is slowly dying out as these guys retire or quit. THere is no shartage of replacements for them either. The quality and professionalism of fire based EMS is every bit as good as anywhere.

There is no one answer that fits all for what type of provider system is best, anymore than there is one way to establish an airway in a patient! STOP THE BICKERING AND WORK TOGETHER!!

This is the same problem the Fire Service as a whole has.

We will never bring wages up until we speak with one voice and get the people to understand what we do and why.

Get 'em on our side!

I say lowly, because I work in a private fire based system performing EMS duties for a third party private ambulance.

They provide the rig and the Medic, my company provides the EMT-B for the rig.

I volunteer in one of the premier ALS systems in my state. 5 time winners of ALS Provider of the Year. All the local VFD's and Career FD's have EMT-B and First Responders on staff and respond to calls in their jurisdiction, establishing BLS care quickly and then assisting the ALS Ambulance crew upon their arrival.

Education is key.

Educate yourself AND those you serve. I don't mean wait until you want something or are facing budget cuts. I mean every dang day of the week. Participate in local events, talk to people while you are there, don't just sit in the rig. Be your own advocate!

Educate yourself so that when your views are challenged you are ready to rebutt with facts and knowledge, not emotion. It is WAY easier to get emotional than stay rational. If you go over to emotion, the argument is lost.

Where is EMS's Billy G, Branigan, Dunn, Brunacini?? Where are the nationallly recognized voices? It is all Doctors at hospitals and an isolated Medic here or there speaking out and up.

Volunteers do hurt the overall goal. They are held up everytime more pay is asked for. They are not to blame though. Stop bashing them. Without their services, countless numbers of Americans would lie bleeding to death on our rural highways and in their homes. There is NO WAY that those rural areas they serve are going to pony up the money for a paid service, and if they did it would only serve to drag wages lower on the average.

Stand Alone EMS services can and do work. The one I volly with works very well, they bill Medicare and Medicade as well as insurance companies. They field 6 ALS ambulances 24-7, with 22 fire departments supporting the mission by decreasing response times.

Fire Based works too! In many areas, the FD has the facilities in place to forward deploy ALS units to population centers, and even to rural clusters. The old mentality of firefighters that I hate EMS is slowly dying out as these guys retire or quit. THere is no shartage of replacements for them either. The quality and professionalism of fire based EMS is every bit as good as anywhere.

There is no one answer that fits all for what type of provider system is best, anymore than there is one way to establish an airway in a patient! STOP THE BICKERING AND WORK TOGETHER!!

This is the same problem the Fire Service as a whole has.

We will never bring wages up until we speak with one voice and get the people to understand what we do and why.

Get 'em on our side!

That said, I believe the ideal model for EMS is a third-service, taxpayer subsidized system, separate from police and fire. They should also bill private insurance, Medicare and Medicaid for their services, when applicable.

This doesn't necessarily mean they should be profitable, but they should do whatever it takes to lessen their dependence on taxpayer subsidies, while still providing quality care and good wages for their medics.

But part of the problem IS the volunteers, and not just in the abstract, “Why buy the cow when you can get the milk for free?” argument.

I'm not bashing volunteers. I teach a lot of them, and I've been one myself. But whenever CMS calculates a new Medicare fee schedule (and usually Medicaid reimbursement is tied proportionally to Medicare), they do so by averaging the cost of providing EMS services around the country.

When well over half of EMS care in this country is provided by volunteers, that really drags down the average, resulting in a far smaller revenue pool for paying personnel.

Heck, it took several years of Medicare reimbursing at only 70% of actual cost before relief legislation could be passed to make the fee schedule a little less of a colossal money-loser for providers.

And you can bet that, when the next revision comes around, they will use the same formula.

I appreciate the dedication and altruism of volunteers, but the cynical realist in me says that if a community wants EMS, they'd better be willing to pay for it. As long as we continue to provide our services for free, those services are not going to be valued.

The movement to Scope of Practice may provide opportunities … opportunities that Physician Assistants and Nurse Practicioners may also be looking at.

Happy New Year!

The movement to Scope of Practice may provide opportunities … opportunities that Physician Assistants and Nurse Practicioners may also be looking at.

Happy New Year!

I came to Fire/EMS (per diem and volunteer) in my mid-20’s and saw how much was being done in my service that could be improved, how mentalities and cultures (civilians and firefighters) worked so much against the department I joined. The department culture (and that of many others) was “US” (firemen) against “Them” (taxpayers). Meanwhile, the private ambulance I worked for part-time (in my state all “privates” are little more than glorified taxi’s) exemplified how anyone with a license and a pulse could be technically in EMS (be they EMT-B, EMT-C or EMT-P) but do nothing but dialysis runs and transfers. Meanwhile since only the fire departments do real 911.around here there was no way to improve the lot of the crews on an ambulance. Why pay someone as a professional when the obviously don’t look, act or conduct themselves as one? By the way “ambulance” around is here is a semi-dirty word (volunteer is even worse in many quarters) because it refers to a private service. REAL EMS happens in a Rescue.

I agree that barriers to entry need to be raised, I came in with a decent amount of life and career experience but many of the 18 year olds fresh from EMT did little more than drive code 3 as fast as possible to ANYTHING. We need to change cultures to be seen as valuable as fire and police and as educated and professional as a nurse, PA or (dare I say) MD. I disagree that we have to be a municipal service like public works. Why? Those services are cost centers, not revenue centers and as soon as the tax dollars dry up so does everything else. I would prefer to see EMS run as a professional service under a “quasi-public” entity/joint municipal-private venture (we have a few here that actually work well). Put some checks and balances on the corporate aspect (too much profit driven is bad) as well as the public side (too much cronyism and political sway is also bad). I see nothing wrong with trying to maximize revenue provided that patient care isn’t compromised. “Business, revenue and profit” are not bad words and if we’re successful, professionals we’ll get paid as such.

Another issue that I see around here is the “image” problem. Too many services here do a terrible job of managing public perception. The fire departments get paid damn well (when you include OT) for the most part, yet many carry a sense of entitlement that irks the taxpayers, the “privates” look like a 3 ring circus and many of the volunteer companies are their own worst enemies. I recently moved and ended up changing departments. Recently I was promoted to Rescue Lt and have at once begun working on building my departments “brand” with the public we serve. Little things like have a better appearance, a better job of communicating with patient (or clients), using our service name/crew member names, doing more outreach, etc. have done a lot to bolster our image in the public eye. On more than on occasion we’ve been told by the patient/patient family “Thank God it’s Rescue 1 not those other clowns in the town”, heck the cops even have an unofficial policy: if they get shot they will drive or drag themselves to our district to ensure WE are the ones working them up. Applying good business principles makes perfectly good sense in EMS and would go a long way to getting us where we need to be.