Posted by: medicblog999 | August 22, 2009

I just cant get my head around it!

brainWell, that was interesting!

Ive just finished the podcast with Chris and the EMS Garage lot. I couldn’t get as involved as I usually do as a lot of it was to do with specific issues in Wyoming and with rural service provision of EMS in the states, which is something that I struggle to get my head around.

Come to think of it, I struggle to get my head around service provision across the States full stop.

One of the audience, Ron (I think) was mentioning how his service was funded at the same rate per patient transport as a large urban city. The larger metropolitan service can survive because they have a much larger call volume, hence more income. However, the smaller rural services cant cope with this as they have a much smaller call volume and therefore get much less money coming in to provide the service.

I just don’t see how this model can work to the patients best interest. It doesn’t encourage services to refer onwards to appropriate care providers rather than take people always to the ER. It would be sacrilege to actually leave someone at home because then they wouldn’t get paid for the transport to the hospital.

It even goes against the concept of health promotion. If the State works hard on health promotion and health care in general (not ill health care which is where all the money goes to i.e caring for people who are already ill rather than trying to stop them getting poorly in the first place), then the population will remain healthier longer…then not need ambulance services as much….so less money will come in……can you see where this is going???

As I said, I just cant get my head around it all!

Or maybe I just don’t see things as they are?

Anyway, the podcast will be available to download on Monday from the EMS Garage site.



  1. We need to get you over here, cameras or no, and get you plugged into the system to see how limited we actually are, not just by funding, but by lawyers and politics.

    Look for me on Skype this week.


  2. And for a Spot of Tea, Happy. I think the Brits like tea. I drink coffee myself.

    I have the same problem as the person you described. We get a small reimbursement only if we transport to the ER (in emergencies). In some cases, that’s perfectly fine, such as when the patient is uninjured and not ill and someone called us just to be sure. I can’t see the patient paying for a service they didn’t want and didn’t recieve.

    However, for cases such as acute hypoglycemia (low blood sugar) we may go as far as starting an IV line and administering interveinous sugar to them. Once they regain their faculties they are able to sign off and refuse care… the skills, equipment, and meds are then a gift. We can’t charge if we don’t transport.

    This is an issue for the all-EMS service I work full-time for. We maintain 24hr 911 coverage and lose money on it hand over fist. The fire department is entirely taxpayer supported and does not charge our jurisdiction’s residents for services at all. Out of district residents (people passing through) do get charged because they don’t pay taxes to our district. (and yes, actually, that’s kind of socialized medicine I guess)

    I’ve said it before and I’ll say it again, EMS over here needs to find new sources of revenue. Our business model needs to be revamped if we are to thrive and provide the best patient care.

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