If, in moving through your life, you find yourself lost...go back to the last place where you knew who you were, and what you were doing, and start from there. Bernice Johnson Reagon.

30 January 2012

How things change...

Of late I am back in my 'old stomping grounds', sort of. At the end of November the powers-that-be assigned me to EMS4, which is located in the western part of the Capital CIty, near the NC State Fairgrounds, Carter-Finley Stadium, and the RBC Center.

I call it my old stomping grounds because it is the unit I have spent the second-most amount of time on since I have been employed by the county. Back a few years ago, I spent 13 consecutive months on that unit, at the time working 24 hour shifts. Back then, we seemed to average about five calls in a 24 hour shift, and seldom ran calls after midnight. Actually, I could count on one hand the number of times we did not get at least five consecutive hours of sleep in a night.

Fast forward to now. EMS4 is now a "2x12" unit, meaning we are staffed with two 12-hour crews. My shift is 07:00 - 19:00. My shift is M-Tu-F-Sa-Su-W-Th in a two week cycle, with me being off the days not shown. It works out to every other weekend, Friday, Saturday, and Sunday off. Not bad.

I do miss the camaraderie from working 24s, because I worked with the same folks at the area fire stations. I get to work with all of the different shifts now, but it was nice building the close relationships with the folks at Raleigh FD stations 8, 14, 16, and 17, along with Cary FD stations 1 and 2, and Western Wake FD.

But things change. People get moved around. And the call volumes go up. Remember that average of five in a 24-hour shift? Now it is an average of six or more in a 12-hour shift. And the night shifts run steady all night.

Not sure what has changed. There are no new elder care facilities, no new housing developments... But it does seem like we are responding more and more to doctors' offices and urgent care offices (we have a lot of them in my first due). I'll have to study on that...

Ya'll be safe out there...

01 January 2012

Do We Really Need A Federal EMS Agency?

There is a lot of talk these days about creating a federal agency for EMS guidance and oversight. There are a lot of good arguments on both sides. A lot of the pro arguments center around standardization of educational issues, treatment protocols, and various standards. I also believe that the main push is to due grant funding availability.

It is no secret that the fire service and law enforcement communities receive money in the form of grants. A lot of money. Here in North Carolina there is even state funding grant available. Law enforcement agencies have benefited for years from the Governor’s Highway Safety Program. I would think that a program named "highway safety", and intended to "reduce the number of traffic crashes and fatalities" (emphasis added by me) would also include initiatives to help EMS agencies provide trauma care, but I would be wrong. It is a law enforcement program.

Yes, the Assistance to Firefighters Grants can provide grants for EMS related equipment, but honestly, how many independent EMS agencies receive grant funding? I really don’t know. But from the information I have been able to read, there are a lot EMS agencies (private or hospital based) that are not even eligible for grant assistance, and these agencies provide primary 9-1-1 services to a significant portion of our country's population.

Here in North Carolina there is a grant fund, administered by the state, for Volunteer Rescue/EMS fund, which was created by the North Carolina General Assembly to financially assist North Carolina’s volunteer emergency personnel. It is administered by the Department of Insurance. From a news report on the WTSB radio station web site- “the fund program helps rescue/EMS organizations purchase equipment and make capital expenditures.” According to the report, agencies can apply for matching dollar for dollar grants up to $25,000.00 each fiscal year. Agencies with cash assets of less than $1,000.00 can apply for grants of up to $3,000.00.

This information was included in a news item that highlights the award of $147,319.00 to thirteen different fire departments. There are twenty-four fire departments operating in that county, as well as seven different EMS organizations. I am assuming that none of the EMS agencies neither received nor applied for the grants, which to me causes concern, not because the fire departments received the grants but EMS agencies did not receive grants from a program to assist “rescue/EMS organizations”. But then, it would be really hard for those EMS organizations to apply. Read the requirements-

     Eligibility Criteria:

     -Rescue provider is all volunteer, with the exception of ten paid positions. (Most EMS agencies around here have more than 10 paid employees, including full and part time personnel, to keep the ambulances on the road.)
     -Rescue provider is recognized by the Department of Insurance as a rescue or a rescue EMS provider. (There are not many primary EMS agencies that perform 'rescue' duties any more. Just staying current on EMS is a full time job.) 
     -Rescue provider must meet the eligibility criteria of the NC Association of Rescue & EMS.
     -County recognizes organization as providing rescue or rescue/EMS or EMS
     -Rescue provider must be certified by the Office of Emergency Medical Service to request ALS equipment.

That would tell me that the vast majority of EMS organizations in my state are not eligible to apply.

So why do I mention this particular funding program? First, to point out that this program benefits only a small number of the EMS agencies in my state. To that end let me ask the question- How many ambulances, power stretchers, 'half-track' stair chairs, bariatric stretchers, induced hypothermia coolers, ALS training materials and equipment, manual monitor defibrillators with ETCO2 monitoring capabilities, turn-out gear for EMS personnel, etc., were bought? You know, EMS stuff. Second, to help point out the absolute lack of EMS grant funding available. True EMS grant funding just isn't there.

Many EMS agencies are supported solely by billing revenue. Many more only receive limited supplemental funding over billing revenue. And there is a tremendous need for funding initiatives for EMS that are not tied to billing-for-transport revenue.

Me personally, I am wary of any creation of another funding bureuacracy or agency. To that end think Transportation Security Adminstration. Or Department of Homeland Security. Or Department of Education. Or Department of Energy. I don't want to see another federal agency that gets bloated and over reaching and intrusive.

But, on the other hand, for no other reason, there is a need for some sort of equitable grant funding for EMS. All EMS, to include those small Mom and Pop companies that are the only ambulance provider for communities all over the nation. To include those hosptial based agencies that serve their communities because the fire department or local government do not want to get involved in EMS.

Fire departments that respond to a few actual fire calls are receiving funding for custom fire trucks, often duplicating what is available in the next fire department over by just a few miles. They receive up to date PPE and SCBA, and other high tech and modern gear.

Law enforcement agencies receive grant funding for automatic weapons and other tactical gear, SUVs, up to date radar and radio equipment, and more. Even those agencies that see little activity that equires such gear.

And there is money available for fire departments and law enforcement agencies to hire people.

But there is no grant funding that I can find to help EMS agencies to hire EMTs and paramedics, whether for response capability or community prevention initiatives.

And that has to change.

So, with that in mind, even though federal (and state) funding for local initiatives is just somehow wrong to me, I would have to say that in this day and time, with the way the rules are set, then we do need a federal EMS agency. And it needs to have proven EMS leaders, mostly those that realize that EMS has to change the way we do business, to head it up.