Up In Smoke, and why is EMS treated different then other employees?

Nicotine Tests Could Cost Fla. Medics Their Jobs

http://www.emsworld.com/article/article.jsp?id=17983&siteSection=1

The above article is the top news story on www.EMSWorld.com right now. Long story short, it appears that the county is now in the EMS buisness, so the EMS employees are now County Employees. The policy change doesn't go into effect until October of this year.

I've never been able to understand why so many people in EMS, the fire service, and LEO's smoke. We've all seen people dying of tobacco-related cancers. My favorite irony is seeing a firefighter come outside from a fire, and take off his mask on his way to rehab... and light up a smoke. If you really want to inhale smoke and carcinogens, why bother wearing a pack?

To be honest, I'm of mixed opinions. While I personally, don't smoke, and can't understand why people do (it's disgusting and harmful to your health). I don't see that my employer (especially a government employer) has any right to tell me what I can and can't do when I'm NOT at work/in uniform.

My biggest concern of the whole article, though, is this line:

“The nicotine test only applies to uniformed workers, like law enforcement. Paramedics and ambulance crew members will be required to take a nicotine test starting on Oct. 1.”

Why does it only apply to uniformed workers? Is there a different policy that applies to the rest of the county employees? The ones that sit behind desks all day, and get real lunch breaks? The article isn't clear, and I can't find anything else quickly online – If someone can enlighten me, I'd appreciate it. If there is no policy for the “office dwellers” - than this policy is out of line.

EMS 2.0 Primer

Ok... blogging again. First post is an EMS 2.0 primer I wrote to a collegiate EMS educator I met at the NCEMSF Conference this year, after attending a very good presentation discussing that EMS will only grow as much as we, as providers, want it to. She'd never heard of EMS 2.0, though. Great minds think alike.

~~~~~~~~~~~~~~

Professor ___,

It was great to see the enthusiasm you have for moving EMS forward... as I said in the session, you are not the only person with similar thoughts. I've been involved in EMS for 10 years, and active in various online forms for much of that time. There are several great web fourms dedicated to EMS, and one of the recurring discussions is the difference in training, professional recognition, and compensation between EMS in the USA, and other countries.

There are MANY EMTs and Paramedics that are active with online blogs, as well as being on web forums and other new social media (Twitter, Facebook, etc). It's amazing that there are many voices in unison saying the same thing – we, as providers, are responsible for helping shape our profession.

A few things I truly think are worth your time online:

EMS 2.0 – Written by a Paramedic from Wisconsin named Chris Kaiser, who writes a blog titled Life Under The Lights (http://lifeunderthelights.com/).

EMS 2.0 seeks to address the issues blocking EMTs and Paramedics from moving forward as a Profession. Built upon the concepts of Technology, Training and Trust, the movement seeks to improve all aspects of emergency services, including community care, disease and injury prevention and opening new avenues for patient care rather than simple transport to an ER.

Chronicles of EMS / Beyond the Lights and Sirens – a ~20 minute short film looking at a fire based urban EMS system from the point of view of both a medic within the system looking for the same change you want, and a English NHS paramedic. The project was instigated by social media, and exchanges between Justin Schorr, who blogs as The Happy Medic (http://happymedic.com/) and Mark Glencorse, who just retired from blogging after several years as 999Medic (http://999medic.com/).

The show is here: http://chroniclesofems.com/reality-series.htm (If you only look at one link, look at this one!).

Lastly, the Chronicles of EMS website has more to say on EMS 2.0:

http://chroniclesofems.com/ems-20.htm

Professor – I actually was able to meet all of the above at EMS Today last year. All are truly great people. There are many providers with a similar vision, united under the concept of EMS 2.0. We are self motivated, and while each of us is a small voice within our respective agencies, we constantly talk online and are able to be self-motivated and help each other. I follow a number of blogs on a daily basis (I am able to read/skim new posts through an application on my phone that syncs from the blog feeds). These blogs help entertain me on my downtime, and engage me in discussion when needed. There is also a great motivation in the knowledge that I am not alone.

If you have ANY questions or there is anything I can do, please feel free to ask.

Jonathan Blatman

Paramedic, West Chester, Pensylvania.

Fraud vs. Government Waste

The other day, I was talking with @WmRandomWard (www.twitter.com/wmrandomward), in regards to his latest blog post (http://randomparamedicine.firstrespondersnetwork.tv/?p=123). Our discussion was about Medicare/Medicaid billing, waste, and fraud.

Further, over on www.EMTLife.com there have been a few discussions lately that allude to EMS "buffing" charts so Medicare will pay.

Take a call from the other night for example. I was held over 5 hours late to deal with transfering a ventilator patient discharge from a Pennsylvania long-term acute care facility to a long term vent unit in New Jersey.

Pennsylvania and New Jersey have very different EMS rules. With Pennsylvania, I can manage a list of IV drugs on pumps, Monitor Cardiac rhythms, and manage advanced airways and ventilator settings. All by protocol and/or written orders. I need a nurse to manage drugs not on my list, TPN, continuous tube feedings, and transport blood.

In New Jersey, there is no provision for a private service to operate ALS interfacility, so all interfacility transports are SCT nurse runs, with a crew that contains at least 2 people who are EMT's as well as an RN (the nurse can also count as an EMT).

So this guy is going from PA into NJ, so I would be covered under PA protocols and rules for the whole transport. It's a simple ALS call - Vent only, not even on telemetry at the sending facility.

Yet I'm told that this run can't just go ALS, and must go with a RN. So now a nurse is coming to meet me and I'm going to jump in with her and do the run, with an EMT to drive us. Why am I there? Because this nurse isn't qualified as a PA ALS provider. So I have to be there, because this call is technically NOT needing a nurse.

So, why is this a nurse call? Punchline: Because NJ Medicaid is the payor, and they don't seem able to pay for ALS interfacility transports. Because they aren't done in NJ. So instead of running the call with myself and an EMT, there are now 2 advanced providers and an EMT, and a significant increase in cost. And guess who's eating the cost?

http://www.courierpostonline.com/article/20110609/NEWS01/106090338/Coalition-criticizes-Medicaid-cuts-N-J-

Yup. NJ Medicaid. The program that is facing huge budget cuts to help NJ's deficit.

We talk about EMS providers and services that commit fraud by billing for services that aren't indicated, but what of the government mandating services that aren't needed?

Jon

My own letter to Howard Cain

Mr. Cain,

I've been seeing you name in the media recently, and as a conservative, I'm enthusiastic about a conservative living at 1600 Pennsylvania Ave again. As we are in the beginning of the process for 2012, I am nowhere near certain who to support at this point.

I was recently reading a post by David Cordera: http://www.examiner.com/gun-rights-in-national/open-letter-to-herman-cain-on-the-right-to-keep-and-bear-arms
The post discusses your recent quote to Wolf Blitzer regarding your personal beliefs on the subject of "gun control.".

I'd like to see your response to Mr. Cordera's survey, so that as we enter primary season, I can see if I'm comfortable supporting you here in Pennsylvania.

Jon B.
Member: College Republicans, Firearm Owners Against Crime. Life Member, NRA.

EMS on the Hill – My Thoughts:

Two weeks ago, I had the opportunity to travel to Washington DC for the NAEMT's (National Association of Emergency Medical Technicians) EMS on the Hill Day (http://www.naemt.org/advocacy/emsonthehillday/EMSontheHillDay.aspx) I was lucky enough to get a scholarship from NAEMT to cover my costs of attending... as a part time student, this was really the only way I could afford to go.

While I've been involved in political lobbying events at the State level before, I've never done anything at the Federal level. This event was VERY well orchestrated, and went very smoothly.

Arriving the evening before the activism day, we met in a meeting room at the host hotel and went over the 3 main issues we were discussing.

Issue #1 was the expansion of the current PSOB (Public Safety Officer's benefit) death benefit to include EMS providers from third-service non-profit agencies. Currently Firefighters, EMS Providers, and Police Officers employed by a municipal, state, or federal government agency are covered by the PSOB death benefit. House Bill 1668, the Danny McIntosh Emergency Medical Service Providers Protection Act (http://thomas.loc.gov/cgi-bin/bdquery/D?d112:2:./temp/~bdfldE::), sponsored by Rep. Mike Fitzpatrick from Bucks County, PA.

HB 1668 bears the name of Daniel McIntosh, a Paramedic from Bucks County who died in the line of duty last year on a call in Bucks County. Because he was working for a non-profit community EMS agency, he didn't qualify for the PSOB funds. Rep. Fitzpatrick's bill aims to close that loophole and give more emergency medical providers that coverage.

A photo of my group from the event with Rep. Fitzpatrick
(Rep. Fitzpatrick is 2nd from the left, I'm on the right)

We also discussed the Medicare Ambulance Access Preservation Act with our elected representatives, pushing for a mild increase in Medicare reimbursement. In these trying economic times, EMS agencies large and small rely on Medicare reimbursement more and more. For us in Pennsylvania, faced with loosing the Emergency Medical Services Operating Fund from the state... we need to be able to make up that money somehow. The Government Accounting Office (GAO) has acknowledged that EMS is reimbursed below cost by Medicare. This act would increase EMS reimbursement for 5 years, hopefully giving the Government time to actually fix the Medicare reimbursement model to something MORE than just a transport model... we might actually get paid for the care we provide... not just as a transport service.

Finally, we were asking for an expansion of the currently approved 700mhz radio spectrum for Emergency Services to a 20mzh bandwidth with the addition of the D-Block 700mhz airspace. This will allow a national build-out of a broadband data network for Emergency Services across the US. Getting us off of aircards and national cell networks, and letting us have our own network where we can't interfere with other services. The downside to this is that the D-block airspace could go for 2.75 Billion at auction to a cell phone service. That's “real money” as the government attempts to balance the budget.

At the end of the day, we met back at the hotel for a reception where we got to compare notes and discuss our good and bad encounters. Then it was dinner with the EMS 2.0 crowd... that was a fun time.

I spent the next day touring DC – seeing the Capitol Visitor's center, and walking around the city on my own. Then I drove home. I really enjoyed the event... it was great seeing my good EMS 2.0 friends from Twitter: @MsParamedic, @Medic61, @WmRandomWard, @MedicSBK, and @TheHappyMedic. Further, I have applied for the NAEMT's new State Advocacy coordinator position... Looking to see where this goes from here.

The EMS 2.0 Bloggers present:

@MsParamedic: http://msparamedic.com
@Medic61: http://samtheemt.com/
@WmRandomWard: http://randomparamedicine.firstrespondersnetwork.tv/
@MedicSBK: http://medicsbk.com/
@TheHappyMedic: http://thehappymedic.com/

Anyway – It was a blast. Now I need to find an excuse to see them all again at EMS Expo in Vegas.