Posted by: medicblog999 | October 25, 2009

Preconceived ideas of U.S EMS

stars_and_stripes

 Its now less than 2 weeks until I fly out to San Francisco to work alongside Happy Medic for a week.

I am both very excited and a little nervous at the same time.

What I do know, is that it is going to be a once in a life time experience for a geeky, passionate UK paramedic to experience first hand, the difficulties, frustrations and successes of the US emergency medical services.

This has got me to thinking though; I keep trying to imagine what it is going to be like when I get there.

I am afraid that all I have to judge things on is my knowledge gained from reading so many of the wonderful EMS blogs out there penned by US Paramedics and EMTs, and what I see on TV (although I haven’t managed to see NBC`s Trauma yet – Just as well really as that would spoil the surprise as I would know exactly how the system works in San Francisco if I watch a couple of episodes of that right?)

So, what do I think?

What are my pre conceived ideas about the US Emergency Services model and the paramedics who provide the care to the patients?

Please take this with a pinch of salt. It’s done with good intentions and a bit of humour. I hope I don’t offend anyone here. If I do, please understand that some of these are just funny thoughts and some are true beliefs that I have about how things run over there. I may be completely wrong about some, all or none of them, but that’s what I am going to find out. Please remember that I am just a UK medic who has no real clue about what to expect over there!

I will re-visit this post once I am back and see if I was right or wrong.

  1. If someone doesn’t have insurance, they may not get transported to hospital, or receive treatment once they get there.
  2. Some Fire-fighter/Paramedics don’t want to be duel qualified. There appears to be some disharmony within those that hold duel qualifications.
  3. Private Ambulance company’s race against each other to get to patients first (may not be the case in SF).
  4. American Paramedics are very well dressed with pristine uniforms, and proud of the role they perform in their communities.
  5. There are American flags flying outside/on all the stations and all the staff are incredibly patriotic.
  6. When Paramedics arrive at a scene they take ALL the kit in strapped onto the top of a stretcher.
  7. Paramedics like to ‘ride’ the stretcher into the ER whilst doing CPR.
  8. If some little old granny falls in her house, there will end up being 8 Fire-fighters turn up to tend to her before the Ambulance arrives.
  9. You can often find an ambulance or ‘Rig’ outside of a coffee shop or donut shop (or is that just the police).
  10. American Paramedics like to say ‘Stat’, ‘Don’t you die on me’, ‘Not on my shift’ and ‘Lets roll’ alot!
  11. You all like to wear your stethoscopes around your neck.
  12. You have a camaraderie between your ‘brothers and sisters’ that is unmatched in any other field (other than maybe the military)
  13. You are more advanced than UK paramedics in the treatments and interventions that you can give your patients.
  14. Before I started blogging, I would have said that you always have to radio for a Drs permission to give any meds, but now I know differently (I think)
  15. Your citizens love the Fire-fighters, but not so much the Paramedics, or rather being a Paramedic doesn’t hold the same Wow factor as being a Fire-fighter  (That’s certainly true over here)
  16. You use helicopters more than most other countries for moving your patients to hospital (even in SF if ‘Trauma’ is true)
  17. ALL patients go to hospital, no matter how minor their injury or illness.

So, am I right?

I guess I will soon find out.

I can’t wait!!

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Responses

  1. Ooooooh! I don't particularly know why I got so excited when I read this and now get to be the first to interject… but I did nonetheless. Ha!Here are my answers to some of your assumptions:#1: Not true in the least. In fact, the opposite is true. The US has a very powerful law that governs this called EMTALA or the “Emergency Medical Treatment and Active Labor (pregnancy) Act” which states that any hospital that recieves federal funds (Mainly through the Medicare or Medicaid programs) must provide the following:”Any patient who “comes to the emergency department” requesting “examination or treatment for a medical condition” must be provided with “an appropriate medical screening examination” to determine if he is suffering from an “emergency medical condition”. If he is, then the hospital is obligated to either provide him with treatment until he is stable or to transfer him to another hospital in conformance with the statute's directives.”A female patient in active labor must be provided with delivery services to include delivery of the placenta. The newborn then falls into the category of being in an emergent medical state. This is part of COBRA or the “Patient Anti-Dumping Law”You can find more at http://www.EMTALA.com#2 Some Firefighters don't like EMS and hate riding the “box”. It indeed is a post of dishonor in some fire departments. Really. A lot of firefighters don't feel this way, but some do. Which is the majority? I don't know.#3 Really? Yea, in Mother, Jugs, and Speed they did but with 10 years of working private EMS I've never seen this. Call jumping does rarely exist, but I've never seen it in the 911 system. BIG TROUBLE would result.#4 I would LOVE to say this is true. It is in my service… well kinda. I do. Not everyone does. It depends on the pride in the department and “The Shine Factor” as I call it#5 I love my country. I wear a flag on all formal uniforms. Most departments do. There's a flag flying outside of every station I work out of and in front of my home. Can't say as to if I've ever seen a fire station without a flag flying. Maybe I don't remember.#6 Ha! Yea. Rural medics take stuff in. I take the jump bag and o2 in. (at one service they're together in the same bag) With some city medics? You're lucky to get a band-aid#7 I admit it. I love to go “Code Surfing”. I do. Really. It's fun. Nowadays though, I don't transport unless I get a rhythm back. If they code again whilst enroute to the ER I get to surf. It's still fun.#8 In some cities, yep. Gotta justify those Big Shiny Engines! (poke)#9 Eh, maybe. Coffee's cheaper at the station… but EVERY good ambulance shift starts with a hearty, unhealthy breakfast. #10 Ummm… I don't think I've ever said one of those things. Maybe the “Don't you die on me”. I have said “If you die again I will smack you!” but the patient was unresponsive and it worked. I think.#11 Steve Berry just posted an article in JEMS (http://www.jems.com – Thanks for the website guys!) about this very topic. I showed it to a coworker. Priceless.#12 Hell yea we do. We're one big dysfunctional family. #13 In some areas of the country, yes we are. In Wisconsin, we probably meet the definition you're using as “advanced”. In Illinois, no… flatly, we wouldn't. In terms of medicine as a whole though… is *any* EMS provider “Advanced”?#14 I don't call for anything. Unless I am unsure or too busy to think of a drug calculation. Or for Peds. If I'm unsure about something, the patient is more important than my ego and I ask the ER doctor. I'm not a doctor and I don't know everything. While there are no mandatory call-in's in my system… it is nice to have a doc just a cell phone or radio call away.#15 Dead on. My Wisconsin service is not part of the fire department. While doing critical care transfers, I am annoyed by people asking me “Are you part of the Fire Department?” and then being disappointed when I say “Nope, we're an ambulance service”. Hey, I'm managing 5 drips, conscious sedation, and a vent here… Firefighters don't do that. Yes, I'm a firefighter as well, but a paramedicine is a profession unto itself.#16 I use helicopters probably more often than most medics over here, but that's because I'm rural and my greater metro area is blessed with more helicopters than we can shake whatever you shake at a helicopter at. Really. In a metro area of 300k we've got 2 choppers in the city and 3 within 30min away. At my Illinois job, that is. #17 All patients CAN go to the hospital, no matter how minor their sprained anus is from their latest bout of horizontal flatulence. We can counsel them on better use of the healthcare system, but we cannot refuse to take them in most jurisdictions. Not that everyone follows that rule… but they do so at great personal and professional risk. Can't wait to come visit you and Happy in California!

  2. Marc, this is some of your best work! :)Tom

  3. I have a question for you Mark (prompted by the 8 firefighters tending to granny, who fell, before the ambo. arrives comment). Since the fire Brigade in the UK isn't normally sent on an EMS run what happens when you get on scene and find a 400 lb (180 kg) patient at the bottom of some narrow, steep basement stairs. Would you and the ambo. crew package the pt. by yourselves, doing the best you can or request the FB for manpower ?Dave O

  4. 17. Last week we transported a female with a stuck tampon who insisted we take her, that lived less than a mile from the hospital, on a sunny 70 degree day. As they say at a nearby city ” EMS is faster than a bus, cheaper than a cab”.We did refuse to transport a child to the big city children's hospital an hour away. The mother had just returned home from the local hospital and didn't believe the ER doctor who told that her child had a cold. She insisted we take them to childrens, rather than the other local hospital, because her mom lived closer to childrens and could give her a ride home.

  5. Hey Mark, I am an ex-pat living up in the Pacific Northwest. I used to live in San Fran area and can maybe help clue you in on some of your questions.1. As Ckemtp mentioned there are strict laws about just leaving people behind simply because they have no insurance. In fact the company I work for has an average collection rate of ~40%. Which means that of 100 patients we transport, usually only 40 of them pay their bill. But if they call us once a week from their little sleeping hole under the bridge…we have to transport them if that is what they require.2. There are a few firefighters who became paramedics simply because it helped them land a job as a firefighter. There are also some that are great medics who really like doing the medical stuff as well as the rescue stuff. My field training officer would be one of the latter. I am dual certified as a firefighter and an EMT-I and love the medical stuff and plan to become a medic in the very near future. Approx 70% of our call volume is medical, so I would be pretty miserable if I didn't like it.3. Typically one company will have the “9-1-1 contract” in any given area. There is another company who runs in the county next to ours and and as strange as it sounds, our company could respond to calls on one side of the street, while the other company gets the other side, because that is where the county line ends. 4. Unless they have been doing it for too many years and have become burnt out. Every day I am surprised by the ability of some of them to fit behind the wheel of an ambulance, let alone lift a gurney without their gut getting in the way.5. Every fire station I have ever seen has a flag flying outside. The whole country is very patriotic. I find it very refreshing. Of course I still have the Union Jack sticker on the back window of my car :)6. In our area it depends on who arrives first. If fire gets there first they take their kits in and we simply roll in with a stretcher. If we get there first we take an airway kit, a med kit and the monitor. Depending on the call we may take portable suction in with us too. Nothing worse than arriving on a simple “ground level fall” to find the patient on the 3rd floor with symptomatic bradycardia and a head laceration that is squirting all over the place because he hit his head on the nightstand as he fell. 7. Only did that one time. Not as easy as it looks on the tele. Even more frustrating when the doc pronounces the patient even before you have gotten all your gear out of the emergency room. 8. Typically there is a fire station closer to most calls unless we happen to be sitting on the right street corner. We respond with different fire departments. Although in the last few weeks I've been the one that had to climb in through the window to get the door open so we can get to the little old lady who fell down. “Get the limey to do it!” 🙂 9. We usually prefer the coffee shops so we can get free WiFi :)10. All the time. They also yell “whyyyyyyyyyyyyy!!!” while staring in the sky when a code doesn't go well. 11. I have to admit that I do this sometimes. Only because I like to listen to lung sounds myself and I don't like using the crap stethoscopes the company pays for so I use my own.12. I would say this is true in my fire dept, but not so much in the ambulance company. I am lucky to have a good paramedic partner, but I have worked some shifts with a few medics that I could barely be bothered holding a conversation with. 13. The paramedic scope is pretty good up here, but then again so is my “Intermediate” scope. You are allowed to give thrombolitics over there I believe. That is not the case in our region. 14. Certain meds require a call to Onlin Medical Control (OLMC) or Medical Regional Hospital (MRH), but the scope of practice and your county protocols are what we work by. I could even send you a copy of ours if you like. 15. I agree. For the most part, but the kids still love seeing the ambulance rolling by with the lights and sirens going. I always have stickers in my pockets and pass them out when I see kids riding bicycles with their helmets on etc. But I admit that was a habit I picked up from my fire dept. 16. My fire dept uses a “bird” once in a while and it is usually for a stroke patient or a trauma where time is of the essence. A 35 minute ground transport vs a 10 minute helicopter ride is a no brainer for some of the wrecks we get. Traffic is unbearable sometimes so I have seen them land a helicopter on the freeway for a bad wreck and transport only a few miles because of the mechanism or the severity of the injuries.17. If they ask to go, we have to take them. If we respond and they say that they don't want to go, we have to have them sign a refusal. Usually the fire dept will arrive first and will cancel us in route if it turns out there is no need for a transport to the ER or if the patient is able to go with a friend or family member. Nobody wants a $1000 bill unless they really have no other means….except maybe the bloke living under the bridge that we mentioned before.

  6. Hi Dave,We can call on the Fire Service for a “special services assistance”, if we have a very heavy patient or need more than one other ambulance crew to help us.It doesn't happen very often, but they are always keen to help when we ask

  7. This comes from an email Reply that was sent to me about this post. Reprinted with Permission:MarkI understand that much of this is tongue-in-check and humorous but I thought that I would give you my insight coming from a different area from where you will be and from my experience working in different systems and areas.If someone doesn’t have insurance, they may not get transported to hospital, or receive treatment once they get there.FALSE. There are federal laws that prohibit this in general. A hospital is required to stabilize the patient to the best of their ability and transfer to a facility that can provide that treatment if it is like life-threatening. If it is non-life-threatening, they might be referred to their PCP (Primary Care Physician). The requirement to treat regardless of ability to pay is one of the things that drives the cost of providing care upSome Fire-fighter/Paramedics don’t want to be duel qualified. There appears to be some disharmony within those that hold duel qualifications.TRUE. If I wanted to be a medic, I would have gone to medic school. This is more typical of the older generations in the fire house. Most of the newer guys it is more of this is the job and it has always been this way. Some fire departments have started running first response as a way to help justify their budgets and in many areas, 75% of alarms made by fire departments are medical in nature not fire. The other reason behind having fire run first response is that there are typically more fire stations than ambulances which can translate to a medically trained person being at a patients side quicker.Private Ambulance company’s race against each other to get to patients first (may not be the case in SF).DEPENDS. This is true in some areas and not in others. More communities are covered by private services than by public services. That being said, the more runs that you make, the more money that you can make. This is going on the assumption that the more runs that you make the higher chance of getting paying runs and therefore an increase of revenue.American Paramedics are very well dressed with pristine uniforms, and proud of the role they perform in their communities.DEPENDS. Some places have standards are try to maintain a professional appearance but others are more lax. The current trend here is to utilize some of the things learned from Europe in the use of reflective clothing and markings of units (barricade pattern and Battenberg) You will probably see that the typical American idea is that we must invent the wheel ourselves; we don’t care what others have proven unless it was our idea.There are American flags flying outside/on all the stations and all the staff are incredibly patriotic.TRUE. For the most part. Our armed services are the defenders of our freedom whilst the emergency services are the defenders of the homeland. It is very common for members of the services to have had prior military service or to be currently serving in the national guard or reserve components of the military. It is also common for members of one branch to also work for another branch. A full-time paramedic is a volunteer firefighter or a full-time firefighter works part-time on the ambulance. The later is seen most often when a person starts off in emergency services with the ambulance and then goes to the fire department for the increase in pay and benefits.When Paramedics arrive at a scene they take ALL the kit in strapped onto the top of a stretcher.DEPENDS. This is dependent on the area and the individual. My thoughts are to typically take the jump kit in and depending on the call and how far away I have to go from my unit dictates what I take to the patients sideParamedics like to ‘ride’ the stretcher into the ER whilst doing CPR.TRUE. Cot surfing is rather common whilst doing CPR. It prevents the person who is doing compressions from getting tangled up and to move at the same pace as those providing the forward momentum. You have to remember though that this makes the stretcher wider than normal so watch their bum and the door facings.If some little old granny falls in her house, there will end up being 8 Fire-fighters turn up to tend to her before the Ambulance arrives.DEPENDS. In a metro area, granny ( memaw around here) might get an engine company response which will put anywhere from 2 to 6 firefighters on scene before the ambulance arrives. In other areas, this doesn’t happen and then again, in still other others that are covered by volunteer fire departments that do first response, the number could be much higher.You can often find an ambulance or ‘Rig’ outside of a coffee shop or donut shop (or is that just the police).DEPENDS. I many systems, the ambulances are not in houses so they go to those places where they can get out of the unit for a bit and maybe get something to drink and/or eat. Often times, they are at those types of establishments because they are open 24 hours or such.American Paramedics like to say ‘Stat’, ‘Don’t you die on me’, ‘Not on my shift’ and ‘Lets roll’ alot!FALSE. Using those will label you as a wanker or someone who is so new they are dumb.You all like to wear your stethoscopes around your neck.DEPENDS. This is up to the individual. Personally, I do sometimes and sometimes I don’t just depend on what I am doing and where I am doing it. It is really more there for convenience then how cool or uncool it looks. When working a cardiac arrest, it typically makes its way there because I like to check breath sounds after I hand-off to the ER staff.You have a camaraderie between your ‘brothers and sisters’ that is unmatched in any other field (other than maybe the military)TRUE. But then again, this kind of depends on the area. But more often than not, yes. The police secures the scenes and covers our butts. The Fire department provides resources that we generally don’t have. It also helps, as I said earlier, that many members of one service also work for another service so you can understand the mentality of both.You are more advanced than UK paramedics in the treatments and interventions that you can give your patients.UNKNOWN. I think that you will discover that this is a toss-up. We are more advanced in some areas and behind in others. This will also change from service to service.Before I started blogging, I would have said that you always have to radio for a Drs permission to give any meds, but now I know differently (I think)DEPENDS. Some areas have more liberal protocol (or treatment guidelines) than others. A system that requires a medic to call for a lot of things is generally referred to as a mother-may-I system Your citizens love the Fire-fighters, but not so much the Paramedics, or rather being a Paramedic doesn’t hold the same Wow factor as being a Fire-fighter (That’s certainly true over here)TRUE. For the most part. Firefighters are the heroes that run into a burning building and pull people out or put out the fire. We are there to pick up the pieces. Medics are respected but generally misunderstood as to what it is that we do. Most of the respect comes from a misconception more than the reality of the profession.You use helicopters more than most other countries for moving your patients to hospital (even in SF if ‘Trauma’ is true)TRUE. To what extent depends on the area. Typically the further from a hospital, the more often air transport is used. It also depends quite a bit on the medics, who are the ones who summons air support.ALL patients go to hospital, no matter how minor their injury or illness.TRUE. If the patient wants to be transported, they get transported and then to a hospital. It is rather difficult to get reimbursement for transport to facilities other than a hospitalI hope that helps give you another look at what we do. As I have told you before, I hope to one day make it to the UK and see, like yourself, firsthand how it is done in the UK.

  8. You have told happy medic its rained here for the best part of the last week and is set to continue for the next two months yeah!!!!!!

  9. Mark, everyone seems to be going number by number and I got lost. in all, many of your preconceptions are right on while others are nowhere close. I won't tell you which ones. heheheI think everyone has covered the insurance and mandatory transport when requested.Helicopters in SF? Abut as likely as in NYC. Each place they've showed the helicopter landing in the City, we spit out our 2% milk and laugh. Can't get an engine in those spots most days.Flag, yup. Brotherhood (sisterhood, family etc), yup. Stethoscope, nope. I keep mine in the kit. When transferring from one role EMS, to a fire call, it needs to be out of the way. amny of the single roll folks you'll meet do wear them.Rolling the gear in strapped to the cot, no. We have special cots that fold into chairs so they can fit into the small elevators here. we also have a unique gravity defying way of balancing those items on the cot so they won't fall.On an engine you better bet I'm bringing everything inside – ALS kit and monitor, the EMT will bring his BLS and O2 bag. The ambulance will do the same. CK's comments about City medics made bringing a band aid is his observation. I know plenty of rural medics that forget their gear all the time. We all have folks we work with we're not so proud about.Riding the cot for CPR here won't work on account of the lightweight cots. I can do just as well walking beside.I've never said “stat” or “don't you die on me” but I have said, “are you not entertained” “Can you skip to the part where it's an emergency” and “I am not Jesus, Ma'am, I'm with the Fire Department. Thank me, not him.”As you will see, we take pride in our appearance, something that has held over from the para-military structure. We wear navy pants and navy shirts.As part of your research, you should watch the following films:Mother, jugs and SpeedThe Towering InfernoBringing out the DeadI'll watch some reruns of Benny Hill and post my own pre-conceptions later in the week.See you next Sunday,HM

  10. Here is the link you referenced in #11. Very good read 🙂http://www.jems.com/news_and_articles/articles/

  11. My Private ambulance–rather borg like–can't afford flags to fly outside of our stations. They are too busy spending that money on trips for execs to “healthcare summits” in the Bahamas.

  12. 17–On my nights, about 25% go by ambulance. Part of that could be that about 50% ride in a cop car….I rarely call for orders. I also can call a code without medical direction or coroner control, and rarely transfer dead bodies–except to funeral homes(just got my keychain from the most popular one in town…)10, can't say I've ever said any of them. Sadly. Might just try that out tonight. I take the O2 bag in. I only take a stretcher in when i know walking or a stair chair is out of the question. Stretchers are heavy. My back needs to last a few more years.

  13. 1) Wrong. You'd think so from the hype in the media and from some politicians, but that's wrong. 2) Pretty much. 3) Not for years and years. Non emergency work is pretty much on contract and emergency work is decided by other means. Those days are long gone. 4) Varies widely. 5) Varies very widely. 6) Varies widely, depending on the call, the service, and other variables. 7) We don't see that very much any more. I think it used to be sort of common. 8) It varies. 9) It's neither. Well, around here. Systems that use System Status Management might use coffee shops as posting locations. 10) Hardly. Usually it's “Who triaged this sausage?”, “Where is the day crew?”, or “That nurse is pretty cute”. 11) Sometimes. 12) That varies widely too. 13) That varies widely too. 14) Most systems don't, but I think a few still do. New Jersey comes to mind for some reason. 15) Paramedics rate as highly trusted. Of late the firefighters as heroes meme has worn thin in many areas. 16) Varies widely. Germany seems to have a lot of helicopter services. Of course the US is much larger than most of Europe, it's possible to be over a hundred miles from any sort of hospital. That being said, there is a growing consensus that helicopters are over used. 17) Most not all. All patients have the right to refuse treatment, any part of any treatment, and transport to the hospital. That's providing they are capable of making a rational (even if we think “wrong”) decision. The bottom line is that EMS varies incredibly in the US. Since each state is sovereign regarding internal decisions, such as the delivery and funding of EMS, there are a bewildering number of different delivery models. Even within CA, there are several different ways that EMS is delivered.

  14. You have to remember, that a major difference between the US and the UK is that:In America, we think 200 years is a long time.In Britain, you think 200 miles is a long distance.–Jim RNY EMT/FF

  15. You have to remember, that a major difference between the US and the UK is that:In America, we think 200 years is a long time.In Britain, you think 200 miles is a long distance.–Jim RNY EMT/FF

  16. 1. Hardly. Actually, it's more like #17, and if they want something trivial – like a pregnancy test – they can get an ambulance ride to the ER, and have no expecttation to pay a dime for any of it.2. True. It's hard to serve two masters equally well, and a great many firefighter/medics only become medics so they can be firefighters. Doesn't exactly make for good medics.3. Can be true, especially in those rare cases where there is no exclusive 911 provider. They actually race for the NON-emergency patients, because they're more lucrative. Case in point, Harris County, TX, where Houston is located, has over THREE HUNDRED non-emergency ambulance SERVICES. That's not ambulances, but ambulance COMPANIES.4. Proud? Yes, for the most part. But obviously you've never seen my uniform at 3:00 am on a rainy night.5. Yes, for the most part, especially when the ambulance is based at a fire station.6. Depends on company policy. My company requires the monitor, ALS kit, portable suction, and oxygen on every emergency call. Now ask me if I actually follow company policy every time, and you may get a different answer…7. Only when they're young and foolish, not to mention limber. We called it “codesurfing.”8. Sometimes. Depends on where you are.9. That's just the police. Firefighters have nice stations and kitchens in which to cook, and medics usually are running so much that they wolf down their food in the rig between calls.10. I thought you said that you hadn't seen Trauma yet?11. Some of us. I quit, once I realized that it made quite a handy garrote when attacked.12. That depends. Others might also tell you that we eat our own young.13. Doubtful. Systems vary widely in capability, but I'd say, education-wise, we're well behind Canada and Australia, and probably a bit behind the UK as well. But some systems are very capable, and hold up well to their better-educated counterparts in other countries.14. Depends on the system. Some prefer a “Mother may I?” approach, whereas others will let you do anything short of opening the cranial cavity before calling a doctor.15. Equally true over here. We need to learn to do PR like the firefighters.16. Much of the U.S is overly enamored of medical helicopters. But no, there aren't that many medical helicopters in San Francisco. Happy Medic may correct me here, but as far as I know, there are no medical helicopters in San Francisco. There's not much place to land them.Once you get there, you'll realize that one doesn't walk the streets in San Francisco so much as one climbs them.17. Yeah, pretty much. And the places that actually do paramedic-initiated refusals usually wish they hadn't, once our tort system gets through with them.

  17. A very interesting peek into what we look like. I've often said that perception trumps reality, and you hit on a bit of both! I know you'll be following up at various points, and I look forward to your insights and how your perception may have changed. Godspeed. I have to leave now to iron my uniform for the flying of the flag ceremony at the donut shop. We already got permission to go from our Dr., so lets roll!…

  18. I'll bite too, Mark. Good post! Keep in mind these will be limited to my service experience. 1. FALSE. Insurance doesn't matter. 2. MAYBE. The FF/Medics I know take both roles very seriously. I imagine this is a very specific to the person. I will be interested in seeing your thoughts on this after your visit. 3. DUNNO. Here private EMS only does scheduled transport, not 911 response. 4. MAYBE. Depends on the service. We just switched to polos from t-shirts. I think we look more professional, but the polo under the bunker gear causes discomfort for some. I don't notice it. 5. TRUE. Here in SC we also fly our State flag with pride. 6. TRUE. I do, and most medics I work with do as well. I find it easier to cart out bags I didn't need than get someone to go grab what I should have brought in the first place. 7. TRUE. But depends on the height of the medic. Some can stand and compress, others ride the rail. 8. MAYBE. Depends on your service and staffing. On average I would say between 2-5 personnel. (2 person medic and 3 person Engine crew). 9. FALSE. You will find most either in the ER parking lot or in quarters. 10. FALSE. I have never heard these uttered. You are more likely to hear some dark humor to break the tension. 11. TRUE. It is a ready reminder that breath sounds should be checked on all patients. 12. TRUE. The only topics off limits in a firehouse is someone's wife, sister and deceased mother. Everything else is fair game. 13. DUNNO. Dependent upon State and service protocols. Not everything is equal over here. Some medics in another State can do things I can't do in mine. 14. MAYBE. Again depends on the State and service protocols. 15. TRUE. I am both a Firefighter and a Paramedic, but people love the Big Red Truck more than the box. 16. MAYBE. Our nearest Level 1 trauma center is about 40 minutes away by ground, so we use HEMS when indicated, mainly for trauma, burns, etc. 17. TRUE. You call, we haul. I hope you have a safe trip and enjoy your time here. I will be looking forward to how you view 'us'!

  19. Just wanted to say thank you all for taking the time to comment and reply. Im more excited than ever to get over there now and see what its like in reality. It should be a good post to write when I can address my own preconceived ideas!!Not long now……

  20. I'll bite too, Mark. Good post! Keep in mind these will be limited to my service experience. 1. FALSE. Insurance doesn't matter. 2. MAYBE. The FF/Medics I know take both roles very seriously. I imagine this is a very specific to the person. I will be interested in seeing your thoughts on this after your visit. 3. DUNNO. Here private EMS only does scheduled transport, not 911 response. 4. MAYBE. Depends on the service. We just switched to polos from t-shirts. I think we look more professional, but the polo under the bunker gear causes discomfort for some. I don't notice it. 5. TRUE. Here in SC we also fly our State flag with pride. 6. TRUE. I do, and most medics I work with do as well. I find it easier to cart out bags I didn't need than get someone to go grab what I should have brought in the first place. 7. TRUE. But depends on the height of the medic. Some can stand and compress, others ride the rail. 8. MAYBE. Depends on your service and staffing. On average I would say between 2-5 personnel. (2 person medic and 3 person Engine crew). 9. FALSE. You will find most either in the ER parking lot or in quarters. 10. FALSE. I have never heard these uttered. You are more likely to hear some dark humor to break the tension. 11. TRUE. It is a ready reminder that breath sounds should be checked on all patients. 12. TRUE. The only topics off limits in a firehouse is someone's wife, sister and deceased mother. Everything else is fair game. 13. DUNNO. Dependent upon State and service protocols. Not everything is equal over here. Some medics in another State can do things I can't do in mine. 14. MAYBE. Again depends on the State and service protocols. 15. TRUE. I am both a Firefighter and a Paramedic, but people love the Big Red Truck more than the box. 16. MAYBE. Our nearest Level 1 trauma center is about 40 minutes away by ground, so we use HEMS when indicated, mainly for trauma, burns, etc. 17. TRUE. You call, we haul. I hope you have a safe trip and enjoy your time here. I will be looking forward to how you view 'us'!

  21. Just wanted to say thank you all for taking the time to comment and reply. Im more excited than ever to get over there now and see what its like in reality. It should be a good post to write when I can address my own preconceived ideas!!Not long now……

  22. […] the next big paramedic shortage. Mark at Medic 999 gives an amusing and and telling look at how US EMS is precived in the UK. Epijunky at pink warm and dry broke our hearts with the story of the little white houseand Renolds […]

  23. I'm enjoying reading about and hearing about your adventure so far.One thing you should know, though, is that there isn't really such a thing as “US Emergency Services.” Things are very different in different places.In the state where I live, what is allowed changes according to region, which means that people ten miles down the road from us, who happen to be in a different region, have different protocols and different standing orders.Also, keep in mind that things in a city, and things in very rural areas, are also different.For one thing, where I am, we almost have to fly any serious trauma patient because the nearest trauma center is over an hour away by road. Also, we don't have public transportation or taxis in our response area, so that isn't really an option for most people.Enjoy your learning experience- and it would be fun to see YOUR answers to the above questions once you're back home.

  24. Our system will not allow us to refuse transport. The patient can willingly sign an AMA (against medical advice) and decline treatment and/or transport. I really hate that people have the preconcieved idea that EMS is a cheap alternative to a cab or bus. I have had patients to call and fake chest pain just for a ride closer into town, so they could go to a store that was close to the hospital. Ambulance service is an expensive operation to run, and when patients are looking for a free ride it really puts a damper on our operating budget. As CKEMTP stated though, according to EMTALA and COBRA have strict laws that mandate how we decide to transport patients, and it is a general rule of “You call, we'll haul!”

  25. We can refuse to transport a priority 3 out of county. If they had gone to childrens, the ambulance would have been gone for 2 hours. We offered to take her to any one of 3 closer hospitals. She signed AMA because she didn't want to go to any of them.

  26. Yeah, that is a luxury that we don't have. If they want to go to a local hospital, we take them. If they request transport to Johns Hopkins, we take them.

  27. We can refuse to transport a priority 3 out of county. If they had gone to childrens, the ambulance would have been gone for 2 hours. We offered to take her to any one of 3 closer hospitals. She signed AMA because she didn't want to go to any of them.

  28. Yeah, that is a luxury that we don't have. If they want to go to a local hospital, we take them. If they request transport to Johns Hopkins, we take them.

  29. We can refuse to transport a priority 3 out of county. If they had gone to childrens, the ambulance would have been gone for 2 hours. We offered to take her to any one of 3 closer hospitals. She signed AMA because she didn't want to go to any of them.

  30. Yeah, that is a luxury that we don't have. If they want to go to a local hospital, we take them. If they request transport to Johns Hopkins, we take them.


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