Thanks for posting.

Daniel Pearl was captured in Pakistan and beheaded by al Qaeda terrorists:
http://en.wikipedia.org/wiki/Daniel_Pearl

Retired NY Times journalist David E. Rosenbaum died of an unrecognized head injury after a robbery where 9-1-1 services were part of an awful chain of events:
http://oca.dc.gov/oca/cwp/view,a,3,q,605216,fem...

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Whether it is police protection, garbage pickup, snow removal, issuing permits or ambulance service, the citizens who vote determine what is acceptable or intolerable. ALL municipal services are a political and economic activity.

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What is the difference between a medic from a “6 month medic mill” and a special forces warrior who also complete an intense and accelerated caregiver training program?

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ALS engine companies and high performance ems systems with a 8:59 paramedic ambulance response time 90% of the time may BOTH be gigantic wastes of resources when we look at the latest information in patient outcomes.

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I did not “admit” that fire-based EMS is motivated by money. I pointed out that fire departments will consider assuming ambulance service to retain jobs.

What a joke.

Are you admitting that patient care is not a priority of fire-based systems?

“Philadelphia tolerates grossly overworked ambulances, 20 to 40 minute waits and occasional fatal outcomes. “

There's a difference between “tolerate” and “able to do anything about it.” Poor people will sometimes have trouble filing a lawsuit. If Daniel Pearl was a black man from the slums of DC instead of a white newspaper reporter who made a decent living, do you think his death would have been as big a deal as it was via his family's legal action? (Not that DC has fixed the problem as promised anyway.

“The voters are not focused on the details of delivery of the service, until it becomes perceived as a problem. “

So whatever happens in the meantime is ok? If the citizens don't PERCEIVE 6-month medic mill graduates who'd rather be on the Big Red Truck instead of caring for their loves ones on an ambulance as a problem, then let's just not mention it or do anything abou tit?

“As a result, the consensus group proposed that EMS systems not focus response time measurement on ALS ambulances, but rather pay greater attention to first response/BLS response time to measure what it called the “most important predictive elements for optimal outcome: time elapsed until initiation of basic chest compressions and time elapsed until defibrillation attempts.””

Hmm…. it's almost like those thousands of ALS fire companies were just exposed for what they are- a gigantic waste of resources.

“If aggressive takeover of private and third service 9-1-1 ambulance service preserves jobs, then expect to see fire departments reaching out.”

That doesn't make it a good idea. It just makes the take over quicker, less planned, and with less thought to the consequences for everyone- firefighter and citizen alike. But thank you for admitting that fire-based EMS is motivated by money, not patient care.

With very few exceptions (like Houston), fire-based ems services are not delivering clinically excellent services or using the most effective practices in delivering ems.

Richmond Ambulance Authority, EMSA (Tulsa & Oklahoma City OK), Sunstar (Pinellas County FL), Toronto, Boston, King County/Medic One and Wake County NC provide amazing high performance ems delivery. So did MAST.

One key is significant medical director involvement.

Mike

Houston: http://firegeezer.com/2009/03/29/bright-lights-...

That being said, I am still a proponent of fire-based EMS. In my area even the third services (i.e., not privates) cannot match their counterpart fire departments for professionalism, professional development, and dedication. EMS just does not have the tradition and institutional memory that the fire service does; those are big parts of what make us so effective.