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December 2004 Letters

We Want to Hear From You!

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Mail: EMS, 7626 Densmore Ave.
Van Nuys, CA 91406-2042
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Letters may be edited for clarity and to conform to space requirements.

We received an overwhelming response to Mike Smith’s Beyond the Books column, What’s Up At the Airport?, in the July 2004 issue of EMS. We appreciate your input on the issues Mike raised, as well as the effort he has taken to respond to everyone’s comments (see Mike’s comments in italics).

—Ed

I wanted to reply to Mr. Smith’s ill-informed article regarding airport paramedics. Upon my initial reading, I figured I needed to simply put down the magazine and walk away, as mindless venting of spleen does nothing to advance the argument. Several days on, I’m still a bit miffed, but hopefully able at this point to present a cogent debunking of his assertions.

Let me begin by stating that I’m not here to defend the indefensible, and the tale he told regarding the paramedic who supposedly just had to try that tube, despite all the clinical evidence, pretty much falls into the indefensible category. By the same token, however, it is indefensible to extrapolate three anecdotal incidents into a series of blanket generalizations regarding paramedics who work at airports.

I am an EMS professional at Washington Dulles International Airport, and the opinions in this letter are my personal observations. This airport and Ronald Reagan Washington National Airport are both governed by the Metropolitan Washington Airports Authority, which operates a public safety program that, for all intents and purposes, functions just about the same as any municipalities. At Dulles, we serve approximately 20 million passengers per year, which breaks down to about 55,000 per day. Add 10–15K for the airport/airline employees and another 15–20K or so for the folks who work in the areas around the airport proper—and to whom we also respond on a regular basis—and you come up with about 90,000 potential patients per day. I haven’t even tried to factor in the numbers who pass by daily on the highways adjacent to the airport or the people in the surrounding hotels.

We are a full-service department, and we do everything every other mid-sized city department does, with the added responsibility of dealing with aircraft firefighting. We also have our own hazmat and technical rescue teams, and we staff our own communications center. I’m not going to try to pretend that we’re FDNY—we’re not. But neither are we a department that in a busy year runs only 400 calls. The call volume averages 10–12 on any given day at Dulles, and it is not uncommon to run 15 or more, most of which are EMS calls.

OK—enough general information. The first statement I’d like to address is the one made by Mr. Smith’s attorney/paramedic friend, who stated that “Once is an event, twice might be a coincidence and three times is a pattern.” Well, not so fast. Now, I will admit to not knowing how many airport-based paramedics there are in the U.S., nor do I know what sorts of systems they function in, whether or not their systems are progressive, etc. I’ll be conservative in my estimate. Let’s say there are 800 airport-based paramedics in all of the U.S. Mr. Smith had three bad experiences. That works out to a whopping total of less than one-half of one percent. This example is precisely why anecdotal evidence isn’t used by anyone to make a serious point. It just doesn’t bear up under scrutiny, unless one has had a very large number of these incidents. To use another example: It would be easy—although intellectually lazy—to say that all U.S. military prison guards in Iraq engage in prisoner maltreatment, based upon the Abu Ghraib affair. It would also be wrong and would border on the slanderous.

Mr. Smith says that airport paramedics may be substandard—couldn’t cut it on the street and were therefore hustled off to the airport and out of the way. This line of reasoning is, in my opinion, counterintuitive. If you wanted to hide an incompetent paramedic, the last place to do that would be at a busy airport. Where are you more likely to see a news crew on a regular basis: a large airport or randomly driving through a neighborhood? Where are you more likely to have to treat a VIP: a large airport or a housing development? As for Mr. Smith’s option two, regarding medics with seniority who jumped at the chance to work at the airport in order to ride out their careers, see above. We work next to, and with, one of the busiest jurisdictions in the region, but even that jurisdiction has many stations that would be far more alluring (read “less hectic”) to that sort of paramedic—stations that are out of the public eye and thus less likely to involve much in the way of demanding EMS cases.

Again, I do not pretend to know the circumstances regarding all airport paramedics. But I have 16 years’ experience at Dulles, and here’s what I do know about our medics: They face as many, if not more, critical-thinking situations on a daily basis than many nonairport paramedics. Aside from proper patient care, they have to deal with all the ancillary issues that arise when people are in transit and speak foreign languages that present a huge barrier to assessment. Security issues also must be dealt with. How about trying to coordinate the transfer of information from sick passengers whose relatives are meeting them “somewhere in the main terminal” and who don’t want to be transported unless we can assure them we will send someone to find that other person; or how to tactfully explain to the flight crew that they simply do not have a right to this person’s private medical history? A corollary to that is learning how to pacify a planeload of people who must wait to deplane until after I’ve finished my assessment and removed the patient. In addition, nearly all of our paramedics either volunteer or work part-time as medics in their own communities and/or teach EMS classes, some of them at the college level.

I’m sorry Mr. Smith has had some bad experiences, but I’m just as sorry that he has used them to denigrate the many paramedics who have devoted their careers to serving airports. I didn’t end up at an airport because I couldn’t cut it elsewhere, Mr. Smith. I chose an airport because, upon finishing my military enlistment, it was the first jurisdiction to offer me a job. We do everything any other department does. We’re busier than some, not as busy as others, but we’re not substandard in any way; we have the many thank-you letters to prove it.

Doug Walker, AA, BA, NREMT-P
EMS Captain

First off, I was not making generalizations about all airport paramedics. I was disturbed enough by what I personally witnessed at three different times, at three different airports, with three different agencies to raise the question as to what our readers’ experiences were with airport EMS. That is why I clearly solicited that input.

Being that I have been flying about 100,000 miles a year for about 20 years to teach at EMS conferences, I have had the opportunity to care for dozens of folks on planes, in jetways, in terminals, etc. The overwhelming majority were minor issues like sprained ankles, fingers slammed in suitcases and the like. Hardly ever was airport EMS even called.

Please consider the mathematical probability of the likelihood of the three critical/serious patients I’ve encountered all getting substandard care from three different agencies at three different airports. I’ll bet it is very, very small. Hence the reason I chose to write what I did and to ask for our readers’ feedback. I consider this a professional dialog between myself and other EMS professionals in a professional venue: EMS Magazine.

I do appreciate your observations about the issue of “hiding” a provider at an airport. You make some interesting, and I suspect valid, observations about that aspect of the column.

Moving along, let’s look at the fact that most people probably wouldn’t choose to fly if they were really ill. In addition, wouldn’t you agree that airport medics don’t see a lot of gunshots, knifings or serious car crashes? That, to me, would raise the likelihood that the vast majority of what is seen at an airport is in the noncritical category. I have never worked at an airport and therefore cannot speak to that issue. You contend that airport paramedics face as many or more critical-thinking challenges than your basic street medic. I will defer to your judgment on that, since that is where you work.

Lastly, please understand I had no intention of denigrating any paramedic. If you have read my columns over the years, you would know that I spend much of my time recognizing excellence and innovation in EMS and patient care. I am 100% committed to excellence in prehospital care, and the “three- event” situation prompted me to write what I did. Believe me, when the dust settles, I would like no more than to find out I witnessed a mathematical anomaly, and there is good medicine at the airports. However, if I had done what was “easy,” which was to ignore what I saw and walk away, I would not consider myself much of an EMS professional. Instead, I did what I felt was right and simply asked the question.

I appreciate you taking time to write and share your insider’s view of airport EMS.

I am shocked and extremely disappointed in the commentary you published on page 30 of your July issue. As the medical director of the agency you attack, I cannot understand how or why I would not learn of concerns about “negligent medicine” and “outright malpractice” until they are published. If your intent is to determine the truth or initiate an investigation, as opposed to throwing out irresponsible accusations for effect, why on earth would you handle it this way? I was already aware of the case Mr. Smith discussed, as I review all cardiac arrests that occur at the airport in question. I have reviewed the information again since you published his commentary. There are some facts in this case that do not match Mr. Smith’s version of events at all.

I would like to use some of what are, in my opinion, the slanderous comments Mr. Smith made to describe his commentary, but don’t believe anything is accomplished by attacking with such a clear intent to provoke, not investigate.

I can think of no situation more prone to second-guessing and the opinion of the armchair quarterback than a paramedic running a cardiac arrest in a public place, and I am surprised a magazine dedicated to EMS would publish something like this.

Christopher B. Colwell, MD
Medical Director,

Denver Paramedic Division and Denver Fire Department

Associate Director, Emergency Department, Denver Health Medical Center

I read with interest your letter regarding my recent column. My intent in writing this piece was to simply share what I observed firsthand on three separate occasions and to ask our readers for their feedback to see if what I had experienced was a mathematical fluke or something much more problematic.

In addition, given other events that have transpired over the last few months within your service, I can understand the anger and frustration pulsing from your letter.

That being said, I would suggest that you review the facts that you say “do not match [my] version of events at all.” I am standing behind what I personally witnessed and reported. If you truly wish to get another opinion, I suggest you contact United Airlines to get the name of the cardiologist who witnessed the majority of what I saw. I cannot say exactly when he arrived on the scene, but I know for sure it was well before the airport paramedic arrived. As such, he clearly saw the intubation fiasco. In fact, I asked him twice if he thought this patient needed intubating, and he said NO! both times. This was after I had told the paramedic twice that I felt this patient would not take a tube. Again, I can fully understand why the on-scene paramedic chose to ignore my comments. I was functioning as a first responder/good Samaritan, and he had the right to listen to or ignore whatever he chose.

I do feel a need to address your analogy of armchair quarterbacking. I have been doing expert witness work in EMS for over 15 years. When I am reading reports and depositions, I am armchair quarterbacking. Unlike legal review work, I was the quarterback on this call until your paramedic arrived, and I gave him the hand-off report.

In regard to your being “shocked and extremely disappointed,” it should be targeted toward the care that was rendered and the lack of clinical judgment and decision-making.

Immobilize This

I read with great interest your three articles on spinal injuries and immobilization in the May 2004 issue. For years, my focus has been on spinal instability due to injury, proper packaging and back-splinting methods. I have been disheartened the last few years as agencies have been working overtime to find ways to not properly splint and immobilize a patient’s spine. The normal excuses for not splinting range from, “We have more important things to do” to “We didn’t have time.” The saddest excuse presented in Selective Immobilization: Current Research and Practice was because “the provider felt it would be more traumatic for the patient.” I will grant you, some patients will be compromised by being laid out on a long board, but a rescuer can still splint an unstable back, even though the patient is sitting upright or semi-upright. The bottom line of almost every excuse I’ve ever heard came down to the rescuer either being lazy or just missing the injury altogether.

There are several methods that would make patient packaging a much better experience for both the patient and the EMT. One is working on a better team approach and practicing together. Way too often I see in pictures, on the news and in the field a lead medic being the only one working on a patient, one task at a time, while several other rescuers stand by and watch. Several tasks can be performed at once and in concert, thus reducing scene time and getting the job done properly. My point is made if you look at just three scene pictures in the same issue.

The comfort issue is multifaceted. Placing a folded blanket on the board and/or using a pillow under the knees (if not contraindicated) goes a long way toward reducing the discomfort. Using a short spine vest-type splint will reduce pressure-point pain. You should also build rapport with the ED staff, so when you bring in a patient on a board, they listen to you. A quick evaluation by the doc can determine if the patient can be safely removed from the board. The time that a patient is on a board in the prehospital setting is minimal. The hours lying in the ED on the board promote discomfort and/or pain. We use the board for many reasons, and to have board use thrown out because the patient may spend hours on it at the hospital is sadly wrong.

The technical concept of clearing the spine by way of a flowchart is darn near impossible, as was pointed out. By the time a rescuer has covered all the bases, the patient could have been packaged and transported. When you show me a medic with x-ray vision, I’ll agree that he is more than welcome to clear the spine in the field.

Page 91 of the May issue also says, “no negative outcomes have been reported and some believe it is extremely rare, if not implausible.” One or more of those authors needs to sit down with me over an Irish coffee, and I will give them a few “negative outcomes.” I can give them several firsthand examples from pre- and in-hospital experiences, as well as several secondhand examples from stories told to me in confidence. Of course, none of these stories ever make it to the run sheet—do you think we’re all crazy? I can see the line now: “Patient found in ‘fubar’ condition. We should have put the patient on a back board, but hey, it was late and we had other things to do. Heard later, on follow-up, patient is now confined to bed, a quad.” Yup, I can see all that on a run report shown in court.

All in all, your articles are most informative. I believe all the agencies desiring to rush to a protocol for “clearing” the spine in the field should read your fine writers first. After all, if I found myself in a severe trauma situation, I’m not an algorithm, and I wouldn’t want to be treated as one.

P.S. I truly dislike the term “anecdotal evidence.” It is really a legal term used to throw out or bypass the real world. If an authority doesn’t like what you have to say, he/she calls it anecdotal to destroy your credibility. The words “circumstantial evidence” seem to work well in a court of law. Overwhelming circumstantial evidence has been used to convict criminals in cases where absolute evidence didn’t exist. The old adage proves true: “If it looks like a duck, walks like a duck, quacks like a duck,” I don’t need a DNA test to prove to me that it’s a duck. If a patient has anything short of total neurological deficit on scene and then goes total, I would say something was done wrong somewhere along the line. If a patient has a deficit that doesn’t get worse with proper care, I would say, “Job well done!” Please, let’s take care of the people we’ve dedicated ourselves to protect.

Rick Kendrick
Former firefighter/EMT

Editor’s note: Rick Kendrick is the inventor of the Kendrick Extrication Device (KED).

Shocked, Shocked

I find it disconcerting that David W. Powers chooses to blame dispatch for the run described in the June Prehospital Rounds column, A Bad Way to End a Vacation. As stated, dispatch can only give the information available to us. Our primary objective is to direct you safely to the scene with as much available patient information as we can.

My impression of this run is that the call came in to dispatch as “a person who has been stung by a jellyfish and is experiencing shortness of breath.” The key word when dispatching this call was “possible” anaphylaxis. The dispatcher didn’t “tunnel vision” the crew. Dispatch simply relayed the given information. Both the ALS and BLS units are trained to keep their minds open for any and all possibilities. Had the call come in as a GSW to the left arm, and, given all the available info at the time, dispatch toned out for a GSW to left arm, but arriving on scene, EMS finds multiple wounds, or even that the GSW is on the right, you wouldn’t say, “Well, dispatch said it was to the left arm.” Our job is to relay the information needed to get you to the scene safely, not to diagnose the patient prior to your arrival. Maybe the ones responsible for “tunnel vision” are those who believe they can blame it on dispatch.

Amy Scarborough
San Diego, CA

David W. Powers replies: I hope I haven’t offended you by blaming dispatch for any tunnel vision. As you mentioned, many times the tunnel vision can only be blamed on ourselves. The point I wanted to get across was that many factors and many people can contribute to a narrow focus, and providers need to be aware of and resistant to this.

Unfortunately, on this call, the dispatcher could have done a better job. Please don’t take that to mean all dispatchers or even the majority are poor at their jobs. I gather from your response and the fact that you’re reading a professional journal that you take your job seriously and don’t want field personnel like me dogging dispatchers for no good reason.

Please keep up the good work and do what you can to keep the ambulance-bound medics and EMTs on their toes and respectful of the work you do. I know we could sure use more dispatchers like you in my area.

System Status Management Lacks Scientific Proof

I read with interest Stephen Dean’s article entitled The Origins of System Status Management (EMS, June 2004). Mr. Dean, like many others in EMS management, evidently has been worshiping at the Church of Jack Stout a little too long. Regardless of the hyperbole, Stout and other advocates of PUMs and SSM have never provided a single scientific reference attesting to the efficacy of either in EMS. Thus, since they can’t prove that PUMs or SSM work, they ask you to accept their statements based on faith alone. And, quoting Mark Twain in his book Following the Equator, “Faith is believing what you know ain’t so.”

In his summary, Dean states that the article was a review of the scientific, administrative and popular literature on SSM. But we must ask, where is the scientific literature? Of the 16 references he listed, only one is from a peer-reviewed journal listed in the Index Medicus and, in that article, there is no mention of SSM. Most of the articles were non-peer review opinion pieces written by Jack Stout in a popular EMS trade magazine.

Let’s look at Dean’s conclusions:

1. Dean states that historical demand patterns can predict future patterns of ambulance needs. But statisticians say that this is impossible. Given the number of variables in a town the size of Kansas City or Fort Worth, statisticians estimate that it would take between 30 and 100 years of data before such predictions would approach statistical significance.

2. If the number of calls exceeds the number of ambulances available, then calls must wait for an available ambulance. Boy, I hope Mr. Dean picked up on this before grad school. This is why we have mutual aid agreements.

3. Response times can be reduced by placing the ambulances near calls. True, if you can predict with accuracy where calls occur—but that is not possible without years’ worth of data.

4. Ambulance demand patterns fluctuate by the hour of the day and day of the week. Now, this is a divine revelation. Everything in the world fluctuates by hour and day. That is why we react by ongoing analysis, not by feeble attempts at prediction.

5. All ambulance services have policies and procedures for responding to a call (system status management). Again, a divine revelation. Intuitively, if an EMS system did not prepare for responding to a call, they would not respond to the call and would go out of business. This is not SSM. SSM is a pseudoscientific staffing scheme that avoids the need for fixed stations, thus decreasing system operating costs. It is nothing more and nothing less.

6. Peak-load staffing and dynamic staffing can decrease response times. True, but we did this in the 1970s and did not call it system status management. When there was a football game or a rodeo in town, there were more people in town, so we placed more ambulances in service. Likewise, when the streets were covered with ice, we put more ambulances on the streets. This is called common sense, not SSM.

Dean never addressed the issues raised in the Myths of EMS series (EMS Magazine, 2003). SSM negatively impacts employee morale, increases vehicle maintenance costs, never gives employees a slow day to work on other aspects of EMS, minimizes the chances of learning the roads, and discriminates against the more affluent parts of town by constantly directing ambulances to the less affluent areas where ambulance calls are more common.

It was curious that the only people who wrote to complain about the PUM and SSM articles in the Myths of EMS series were those who had a proprietary interest or employment relationship with a PUM. In a recent informal survey conducted in Texas asking EMS providers if SSM had a role in modern EMS, 66% said it did not. The same population was asked which EMS system model they preferred to work in. Only 2.3% said a PUM. The largest response said a third city service (34%).

Thus, I ask Mr. Dean and the other proponents of SSM and PUMs to put up or shut up. Show us your peer-review science that says SSM and PUMs are efficacious and quit recycling the old Stout writings as if they were divinely inspired. Don’t continue to ask EMS providers to accept your postulates based on faith alone—EMS has evolved beyond that stage.

Bryan E. Bledsoe, DO, FACEP, EMT-P
Midlothian, TX

Stephen Dean responds: It might be helpful to start my response by identifying those issues where the writer and I apparently agree:

1. Ambulance demand fluctuates by hour of day and day of week.

The scientific literature confirms this and is acknowledged by the writer.

2. There are geographic patterns of ambulance demand.

The scientific literature confirms this, and the writer also acknowledges the existence of geographic patterns when he criticizes deployment plans that place ambulances in certain neighborhoods where ambulance calls are more common.

3. Dynamic deployment and peak-load staffing can decrease response times.

The scientific evidence supports this conclusion, and several scientific studies were cited in the article as proof. This is the purpose of effective System Status Management (SSM) as described by Stout: to organize a system’s resources so that it can best respond to the next request for ambulance service. While there are a number of other techniques, these two—dynamic deployment and peak-load staffing—are the most obvious and the most controversial, because they are the most easily abused.

So, we agree on the major points about SSM, even though the writer is unwilling to recognize that these points are also supported by substantial scientific evidence.

It appears we disagree on the following:

1. The writer states that patterns of demand cannot be predicted because unidentified “statisticians” have stated it would take 30–100 years of data to accurately predict future ambulance need. Scientific studies published in refereed journals state it is possible to predict temporal and geographic patterns of demand to reduce response times. The studies by Savas and Holloway cited in the article both describe how NYC made significant improvements in ambulance response times by placing ambulances near locations where call volume was historically high, and by shifting ambulances from times when historical call volume was low to times when call volume was historically high.

2. The writer believes the only “scientific” journals are medical journals. While medical science is very important, there are other disciplines that may help EMS managers determine when and where to deploy their ambulances. The disciplines of statistics, economics, urban planning and public administration all have peer-reviewed publications, and much of the literature on vehicle deployment resides in the scientific literature outside of medicine. In my article, I cited studies published in the following refereed journals: Socio-Economic Planning Sciences, Operations Research, Health Services Reports (now Public Health Reports) and Management Science.

3. The writer implies that the only persons supporting SSM are those with proprietary interests in the subject. There are a number of studies by independent researchers showing that system status management techniques improve response time performance.

4. The writer believes that good SSM is just good common sense. Just as good medicine might also be described as good common sense, good SSM and good medicine both require practitioners to constantly analyze their data and then develop rational plans that promote good patient care.

The evidence of 35 years, which includes studies published in the scientific literature, articles published in the EMS literature and observations from numerous EMS systems, confirms that system status management techniques, used appropriately, improve response time performance. There is also evidence that poor system status management contributes to a number of problems, including poor employee morale, higher costs and lower quality.

The use of data analysis, peak-load staffing and dynamic deployment are practices promoted by Jack Stout in his conception of effective system status management. Others call it using common sense. For the sake of our patients, I wish good SSM and common sense were both much more common.

Stephen Dean’s article on the enticing yet largely failed concept of Public Utility Models was appallingly out of sync with the EMS that Medicare dominates in 2004.

The ideas of the architects of such a scheme for EMS longevity have endured in just a handful of places since the 1980s. During that decade, a JEMS conference about the trials and tribulations of introducing it to affluent sections of Southern California proved to be a virtual post- mortem. What was once a dream is hardly that now. The inventors saw many of their systems collapse recently. This elegant but hard to implement plan in which EMS is like a 1970s phone company or a power company now runs well in Pinellas County, FL. Exporting the concept from less than three dozen locales to the entire country is not feasible when EMS providers are dotting i’s and crossing t’s to please Medicare. Too bad.

Carl Post

APUS

The author replies: I thank the reader for sharing his comments, although I disagree with the assertions presented. As Medicare reduces its payments to ambulance providers, the need for efficiency, doing more with less, becomes even more critical. The fact that PUMs are designed to operate efficiently, and do so with an average unit-hour utilization ratio of .33 (transports divided by unit hours), should encourage communities to study this type of system design and its efficiencies.

PUMs are designed to maximize third-party reimbursement. The average tax subsidy of a PUM is only $3 per capita—very small compared to the typical subsidy of public systems, which are three to 10 times this amount. PUMs, like all other systems that depend on third-party reimbursement, will most likely require increased subsidies from local government to offset Medicare cutbacks. It is true that systems that are already receiving massive local tax subsidies will not be affected as much.

Only one PUM has recently been in the news— Kansas City’s MAST—and it cannot be considered a failure by the standards used to judge EMS in this country. It is still producing rapid response times with 90% reliability, using an all-ALS fleet, and achieving a cardiac survival rate, as measured by those discharged alive from the hospital, of 8% using the Utstein template.

It is true the city of Kansas City, MO, has been required to increase its local tax subsidy to MAST. However, the system still receives less subsidy than that of many neighboring systems, and the cause of this “financial crisis,” as documented by both the city auditor and Jay Fitch and Associates, was a failure of MAST’s management and board to perform their duties properly, not a failure of the model. The executive director of MAST has been removed, and the mayor has requested the resignations of MAST board members, so that a new board and a new director may be appointed.

The PUMs, as a group, produce nine-minute response times to life-threatening emergencies, as measured from receipt of call to unit on scene, with 90% reliability. They do this at an average system cost per capita of $27, which includes an average local tax subsidy of $3 per capita. This pays for all of the emergency, nonemergency and routine ambulance service in these communities, and it is all provided by ALS ambulances. The average ROSC rate for patients in cardiac arrest with a cardiac etiology in these systems is 24%, with a hospital discharge-alive rate of 10% of those reporting. This hospital discharge rate for cardiac arrest patients exceeds many systems’ ROSC rates, including systems that have much larger subsidies. The financial data on PUMs are produced by independent auditors, and the medical data by independent medical directors, who are not employed by the contractors they regulate.

If there are other systems in the United States, or the world, producing this type of performance at equal or lower cost, it has not been reported. If anyone knows of systems that can match or exceed this level of clinical, financial and response time performance, identify them, so they can be studied.

Column As Training Tool

I am writing to say that the Prehospital Rounds section of EMS Magazine is a valuable training tool for rural fire departments that offer a first responder service. It makes a good round-table discussion for our EMTs and MRTs and lets them give their thoughts and views on what they are thinking, as well as what kind of patient care they would offer. It is a great addition to your magazine.

I am a faithful reader of EMS Magazine and look forward to receiving my issue each month.

John Kuzminski
Waterford Fire Department
Oswegatchie Co. 4

Kudos

I wanted to take this opportunity to thank you for a great magazine. The information provides invaluable insight into current trends and hot topics, and keeps my skills sharpened. Even though there are times that some techniques/practices may be questionable, it stimulates me to search out definitive answers to either refute or support the example. This is a valuable educational experience for me, and I hope, for others.

Jerry Durant, NREMT
Orlando, FL

Just wanted to take a minute to tell you how much I enjoyed Thom Dick’s EMS Reruns column (The Probie) in the August issue of EMS Magazine. I consistently enjoy the column and felt this month’s touched on an exceptionally important topic. Unfortu-nately, it seems our field has become one that “eats its young.” His perspective was refreshing and necessary.

Raphael M. Barishansky
Hudson Valley (NY) Regional EMS Council

EMS Wages Revisited

I just recently received your August ’04 issue with feedback on the pay situation for EMTs of all levels. I have only been in this business for six years and have worked for a private ambulance service, volunteered for our local rescue squad and now work full-time for a hospital ED. I have seen the worst of EMS life after leaving a $14/hour job to work as an EMT-I for $10/hour. While there, I put in 72 hours a week to help make ends meet at home and went to class for paramedicine. I worked there as a medic for a year before taking up the offer to work at the hospital, which is 32 miles closer to home, and the starting pay gave me a 42% increase with benefits!

It is a shame that garbagemen (my former job) make, on average, 50% more than EMTs, but remember, in this profession, we often work 12- or 24-hour shifts and lie around the station most of that time. I heard of a study done some years ago that stated the average downtime for an EMT was 75%. So, when they complain about only making $8 per hour, is that for each of the 24, or for the six hours they are actually working? As for the low wage, if you can make a decent life and/or have a desired lifestyle at your present pay scale, that’s great! But if you feel your wages are deficient and this is causing discontent with your job and toward your coworkers and patients, you really need to move on to another profession or job market.

Last, if you think that being a medical professional entitles you to huge pay and all the toys you desire, think about this: Most of our paychecks are directly related to either municipal taxes or insurance payments. If only we could convince the slackers in our world who don’t have insurance to pay up, our wages might increase by 30%. But do you really want to ask your neighbors to freely give up 30% more of their hard-earned money in property taxes so you are happier? I don’t think so!

Kevin Kaminski
via e-mail

Is Your Vehicle Secure?

It is amazing to me how many agencies have not initiated, or do not enforce, vehicle security policies, especially in this post-9/11 era. EMS providers read articles in industry journals month after month regarding terrorism preparedness. Unfortunately, many providers do not see the problem with leaving an EMS vehicle completely unlocked on scene, with the keys in the ignition. In Fresno, CA, mechanical security systems have been in place on EMS vehicles for years. In other areas, such as Rochester, MN, the fire department personnel remain with the emergency response vehicles. We should all follow the example of such proactive services, as well as the law enforcement community, that secure their vehicles each and every time they are unattended. It is time for every EMS agency to re-evaluate their specific security policies and procedures. Perhaps nothing will ever happen in your local response area, but we can no longer afford to take that chance.

Ed McConville, NREMT-P
Rochester, MN

Correction

The first learning point in Marathon Maladies & Dehydration Debunked in the June issue requires a correction: Tylenol is not an anti-inflammatory, but rather an analgesic only. This is not to take away from the point being made, which is that NSAIDS cause many problems. Take it from me, I had a GI bleed from a subtherapeutic dose of one of them.

Joseph Dillmann, RPH, ACCP,
FASCP, MAC
Libertyville, IL

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