These Bumblers Popped Up Last Year

THE CITY OF ALLEN PARK, MICHIGAN, is back in the news again.  One of the nation's most inept city councils voted last night (Tuesday) to balance their budget by completely eliminating both the police and fire departments.

Firegeezer readers were acquainted with these financial wizards in February of last year when they threatened their firefighters with elimination unless they renegotiated their salary structure way down.  (See the Firegeezer video report HERE.)  An agreement was made that included a tax increase on the citizens if they approved of it in a vote.  But that measure failed at the ballot twice, back in November and again this month on May 8.

You may recall that the primary act that bankrupted the city was the city council’s falling for the song-and-dance of a film maker who told them that if they would provide a suitable location for his big-time movie studios and film production school, then he would give the city $2 million to balance the city budget. The council then sold $24 million in bonds to purchase a property and industrial building that was only assessed at $14 million. The studio maven, Jimmy Lifton then took his act to Detroit without “donating” the $2 million and reneging on the deal to make Allen Park a motion picture home.  This all took place in 2009.

Allen Park's $24 million baby

The stunt led to a Securities and Exchange Commission investigation into the validity of the city's bond sale with the threat of fraud indictments.  Ever since then the city has been drowning under the debt load of having to pay off the bonds for near-worthless property and unable to provide basic city services.

Now the council has a $4 million deficit and has decided to balance their budget by eliminating the public safety services, police and fire, and contract with a neighboring municipality to provide the services.  They voted last night to pass that budget which includes the public safety layoffs.

There is only one tiny little problem… none of the other towns are interested in taking on Allen Park's emergencies.  All of them are struggling as it is just to cover their own calls.  WJBK-TV was at the city council meeting last night and prepared this video report:

The Detroit Free Press adds:

Adding to the appearance of disarray in City Hall, the council voted 6-1 to accept the resignation of the city's top staffer, Administrator John Zech.

And still to be resolved is how the city will pay its bills this year. Appointment of a state emergency manager remains possible, city officials have said.

The city's annual budget had been projected to be $19 million in the next fiscal year, 2012-13, but must drop to $15.8 million because of skidding property-tax revenues combined with $2.6 million in annual bond payments for the city's failed movie studio, according to budget documents. The studio sits largely empty next to City Hall. "Nobody knows what's really going to happen," Mayor William Matakas said before the meeting. None of the cities that Allen Park has approached about contracting for police and fire services has responded, he said.

News Herald photo

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Time to build our paramedic profession infrastructure

It appears that our physician colleagues accomplished more than paramedics since 1968, establishing Emergency Medicine as a specialty in 1979 and Emergency Medical Services as a subspecialty in 2010. (How EMS physicians became recognized and rewarded)

The development of the National EMS Educational Standards in 2009 is a more significant development. (EMS Future is HERE)

Emergency Medicine built upon an existing graduate medical education structure

The significant physician accomplishments were built upon a well-established graduate medical education infrastructure.

A September 2006 article in the New England Journal of Medicine describes the foundation of medical education:

Almost a century ago, Abraham Flexner, a research scholar at the Carnegie Foundation for the Advancement of Teaching, undertook an assessment of medical education in North America, visiting all 155 medical schools then in operation in the United States and Canada. His 1910 report, addressed primarily to the public, helped change the face of American medical education.

American Medical Education 100 Years after the Flexner Report

Two physician members of the National Emergency Medical Services Advisory Committee referenced the Flexner report when discussing update options to the 2009 National EMS Educational Standards in an all-day roundable on March 28, 2012 (agenda).

All professions with significant academic preparation go through this type of review process.

I used the results from evaluation of the Masters in Business Administration program to discuss the state of EMS Education in 2009.

The Ford Foundation and Carnegie Corporation criticized business graduate education in 1959 as filled with:

• Weak Students
• Inappropriately trained faculty members
• Unintellectual curriculum
• Poor research

What Direction for EMS Education?

From "sticky side down" first aid mechanic to health care professional

The 2009 Educational Standards vaults paramedicine out of the vocational training arena. It will have the same impact as the Flexner report had on physician education and the Ford/Carnegie reports had on Masters in Business Administration programs.

But we have signficant gaps to fill to satisfy the medical professional model.

Need appropriately trained faculty members

I will never forget talking to a community college assistant dean about the Educational Standards. An experienced paramedic with years as a state-credentialed paramedic instructor, she shared that she recently got her associate degree. The associate degree was from the same paramedic program she was running. Not sure she could complete a bachelor degree.

Most community college leaders are required to have master's degree, often they have a Ph.D. or Ed.D. terminal degree.

I have no doubt she is a dedicated, passionate and effective paramedic instructor … but she needs better academic credentials.

The biggest push back to CoAEMSP accreditation of paramedic programs was the requirement that the program director have a bachelor degree. (2008 fact sheet)

In the academic world, those with terminal doctorial degrees "create knowledge" and impact professional/graduate educational programs.

Will you step up?

Mike "FossilMedic" Ward

How our physician colleagues got respect

To follow up on last night's discussion on compensation, a board-certified emergency medicine physician with five to ten years experience earns an average of $258,000 per year, or $124/hour. (2009 data)

It was not always so. Forty years ago emergency medicine was a low-pay, low-prestige side job. The mom-and-pop community hospital with a dozen beds maintained a poorly equipped "Emergency Room" staffed by part-time or fill-in physicians.

Defining a Profession:

Medicine considers five factors in defining a specialty:

• Unique body of knowledge
• Professional association
• Peer-reviewed vetting of knowledge acquisition
• Testing of competence
• Institutional training: internship, fellow, clerkship

Three organizations have pushed emergency medicine and EMS physicians into the light.

1968: American College of Emergency Physicians (ACEP)

The first professional organization, established Annals of Emergency Medicine in 1972 as their peer-reviewed scientific journal.

Establishing a scientific journal is a major component in establishing a specialty, from the Annal's website:

Annals is the emergency medicine journal most frequently cited by authors and has the highest impact factor over the years of all 19 journals in the emergency medicine category of the SCI (Science Citation Index). The impact factor (the average number of citations per published article) is the commonest measure of journal influence; the 2010 impact factor for Annals was 4.14, placing it in the top 12% of all 8,005 science and medical journals tracked by the SCI.

Not only is Annals most frequently cited, but it is cited more promptly and longer than any other emergency medicine journal (9.5 years, 83% longer than its nearest competitor). In the past 5 years, more than1,200 different journals in the ISI science journal database cited an article in Annals, and in a typical year, Annals articles are cited by more than 400 different scientific journals, most of them from a broad range of specialties outside of emergency medicine.

In 1979 Emergency Medicine becomes the 23rd specialty recognized by the American Board of Medical Specialties.

1984: National Association of Emergency Medical Service Physicians (NAEMSP)

One hundred emergency physicians established NAEMSP to define the needs and specialties unique to an EMS Physician. The first effort was a task force started in 1992 to establish EMS as an emergency medicine subspecialty. Their efforts moved the ball forward, but not enough to achieve recognition. The task force disbanded in 1996.

In 1997 Prehospital Emergency Care (PEC) was created as the scientific journal for emergency medical service physicians.

From the 2011 NAEMSP annual report:

In July, PEC received its third Impact Factor, which increased to an impressive 1.889. This Impact Factor placed PEC as the 8th most oft-cited Emergency Medicine journal out of the 23 that are currently rated by the ISI Web of Knowledge.

PEC had an even more impressive Immediacy Index, which indicates how rapidly articles that are published in PEC are cited in the same year. PEC had an Immediacy Index of 0.533.

This ranks PEC 4th out of the 23 EM journals that are ranked in terms of being rapidly cited. PEC continued to be placed ahead of such well-established journals as Journal of Emergency Medicine, Pediatric Emergency Medicine, Journal of Emergency Nursing, Emergency Medicine Clinics of North America, and European Journal of Emergency Medicine.

PEC is also the official journal of the National Association of State EMS Officials (NASEMO), the National Association of EMS Educators (NAEMSE) and the National Association of EMTs (NAEMT).

1998: United States Metropolitan Municipalities Medical Directors Consortium

Known as the "Eagles," this group is comprised of most of the jurisdictional EMS medical directors for the nation's largest cities 9-1-1 services. Read more about them HERE (510 minutes that shape EMS: The Eagles speak in Dallas)

Establishing a unique body of knowledge

By 2005 the professional, peer-reviewed literature was sufficient to make a second effort at establishing EMS physicians as an emergency medicine subspecialty.

NAEMSP members wrote a four volume Emergency Medical Services Clinical Practice and Oversight publication that covered four areas:

1. Clinical aspects of prehospital medicine
2. Medical oversight of EMS
3. Evaluating and improving quality in EMS
4. Special operations medical support

The books were published in 2009.

The content and organization of EMS Clinical Practice and Oversight matched the proposed curriculum for the EMS subspecialty fellowship.

EMS was recognized as an emergency medicine subspecialty in 2010. You can go HERE (How medicine approaches EMS credentialling) for details of the ems physician fellowship. The first board exam is anticipated in late 2013.

You get what you invest in.

I appreciate Skip Kirkwood's response to yesterday's article. It provides an appropriate conclusion to today's example:

My frustration comes from the failure of, or the unwillingness of, so many EMSers to "engage," to spend even a few minutes or a few dollars to advance their profession.  MANY are willing to speak, but a willingness to speak without the willingness to WORK on what you are speaking about is just whining.  And as a kid I learned (whap!) that there are few things worse than a whiner.

My second source of frustration comes from the "What's in it, or what's easy, for me" focus. Improving the stature of EMS in our communities, and improving the lot of EMTs and paramedics, is not rocket science. It involves improving educational standards, becoming active in political regulator affairs, and stepping up to take control of our profession and our work environment. Unfortunately, the response seems to be "If they're not going to pay me more, up front, I'm not going to make any additional effort in this arena."

Folks, you make the investment first, then you get the dividend. It works that way in the stock market, and it works that way in the economic, political, and academic environments.

Mike "FossilMedic" Ward

Offer Expires Midnight Tuesday

OUR BLOGGING COLLEAGUE GREG FRIESE has found us a great deal on a new EMS eBook.  A free download until midnight Tuesday night.  Here in Greg's words he tells us about the book and the author of 2 Weeks a Year:  Finding Humor While Deployed in Iraq, Chat Trent Cherin.

In this episode of the Medical Author Chat Trent Cherin tells us about his book 2 Weeks a Year: Finding Humor while Deployed in Iraq which is about his deployment to Iraq as an Army National Guard Medic. Unlike most authors being a medic wasn’t something Trent did full-time. Rather it was something he did away from his normal work because he enjoyed helping others and being part of the National Guard. He describes being a medic as "a nice break."

2 Weeks a Year is a chronicle of Trent’s 548 total days of deployment. Much of which he spent on a base in Iraq just north of Baghdad. The book was put together from photos and emails he sent to family and friends during his deployment. He also wrote the book as a way to remember his experience.

EMS Week Special: Trent is graciously offering a free download of 2 Weeks a Year from Amazon for the Kindle e-reader or Kindle app during EMS Week 2012. This download is only available from midnight Sunday to midnight Tuesday. Make sure to take advantage of this opportunity to download the book.

The list price for the eBook is $4.99, but you can download it for FREE to your Kindle or your Kindle app on your smartphone or computer.

Just CLICK HERE to get the order page and download NOW (remember, offer expires at midnight Tuesday).  Thanks, Chat!

Firegeezer sez:  I just downloaded one for me.

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Party Doll's Weekend Comes to Quick Conclusion

ANOTHER RURAL/METRO AMBULANCE was stolen Sunday morning in the Buffalo suburb of Amherst, New York.  It all began around 6:30 am when a policeman brought Heather Sullivan, 37 and drunk, into the emergency room of the ECMC hospital.  Once she was left unattended, she dashed out the ER entrance where she found the ambulance, also unattended and with  the keys in the ignition.  WGRZ-TV continues the tale:

She started heading east down Kensington Ave. with police in pursuit. Once she reached the first traffic circle, she lost control of the ambulance and went straight through the circle and continued towards the Walgreens. She slammed into a brick wall surrounding the parking lot, slowing her down before the ambulance came to a rest.

WIVB-TV

"Thank God she missed the building though. The brick wall stopped her, otherwise, she would have been definitely into the building," said Amherst Police Senior Investigator Scott Lawida.

The ambulance was heavily damaged due to the impact of the brick wall.

The woman has been arrested and charged with reckless endangerment, grand larceny, criminal possession of a stolen vehicle and other charges.

A Rural/Metro spokesman says that the ambulance will probably be a total loss with damages estimated at $80,000 to $100,000.  The police said that she was driving at an extremely high rate of speed.

WGRZ-TV filed this video report:

The Buffalo News has the STORY.
WIVB-TV has MORE.

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Another excellent music video from Farooq Muhammad (KingFarooq Productions)

from FireEMSRescue:

A music video showing the potential hazards EMS professionals face on a day to day basis. It emphasizes the importance of safety while working under these dangerous conditions.

Blauer provided the funding for this project and is a huge supporter of EMS, Fire and PD all around the country. Please visit www.blauer.com for more information on their wonderful products and services

Mike "FossilMedic" Ward

How do WE get engaged?

This video shows how a population was motivated to participate in their first free elections.

Click here to view the embedded video.

The Return of Ben Ali. On January 14th 2011, we chased former Dictator President Ben Ali out of Tunisia. Since then many had lost interest in politics.

After many uneffective attempts to push Tunisian people to go out and vote for the upcoming elections, a new campaign was set up in La Goulette, to the shock of residents.

Their reaction was filmed. Results: On October 23rd, there was 88% turnout when 55% were expected.

EMS: More than a job (??)

This year's theme selected by the American College of Emergency Physicians is: EMS: More than a Job, a Calling

If you have been following the posts by National EMS Management Association President Skip Kirkwood, you may have a different observation. He is not a snarky pundit, but someone who has been doing heavy lifting for EMS. I would say he is a little frustrated.

Working conditions for many paramedics are grim, near minimum wage.

The US Department of Labor identified 2010 median pay for 226,500 "paramedics and emts" at $30,360 per year ($14.60 per hour).

As a contrast, the 310,600 firefighters 2010 median pay is $45,250 per year ($21.76 per hour). Police and detectives make more than firefighters.  Registered nurses even more than police and detective, at $64,690 per year ($31.10/hour).

I appreciate that this year's theme is:

… reflecting the idea that EMS practicioners don't choose this field for big salaries, comfortable working conditions, or 9-to-5 hours; they have a true calling to help and care for others in their hour of need.

Over the same 38 years, physicians dedicated to the practice of emergency medicine have significantly improved their compensation and professional status within the universe of medicine.  Nurses have transformed their profession.

Why are medics still near minimum wage? Why are some single-role ems providers engaged in 9-1-1 service without the same worker compensation presumptions that fire and police have?

Celebrating working for free does not pay the rent

My three passions; teaching, writing and emergency service, are not known as wealth builders.

When I went to work full-time as a community college fire science program director, I was making less money than the rookie firefighters I was teaching … with a master's degree and a dozen years experience as a part-time college instructor.

At the beginning of every academic year, one of the college leaders would celebrate that a retired federal worker was teaching for free. After four years I left the college because of poor pay and threadbare resources.

This week we are going to look at issues affecting the profession of out-of-hospital care that will probably make you annoyed or uncomfortable.

Mike "FossilMedic" Ward

At Least 18 More Injured

A RALLY CAR PARTICIPATING IN A ROAD RACE in Southern France near Toulon left the course and struck several spectators killing two of them on Saturday.

AFP

The race was the annual Pays des Maures rally at the Plan-de-la-Tour road course, and the accident happened at 4:30 pm local time.  The car was coming to an intersection and was supposed to turn right, but instead the driver made an error and drove straight ahead into a row of spectators.  One of the dead is reportedly one of the track marshals.  At least 18 people were injured, four of them critically, including a 21-yr.-old woman who suffered a serious spine injury.

Several of the spectators who were all behind the security tape barrier, were pitched several meters into a vineyard. The driver of the car, Yann Buron, is "shocked" but unharmed. His co-driver Jean-Luc Ferrero, injured his chest.

When the dispatch for the mass casualty was sent, the emergency services in the area were initially overwhelmed.  More than 60 firefighters were dispatched along with 20 ambulances and several helicopters.

BBC News

Varmatin has the STORY.
BBC News has an English language report HERE.

AFP has filed this video report from the scene:

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Anybody Besides the Fire Chief and Mayor Surprised at This?

THE LOS ANGELES, CALIFORNIA, CONTROLLER Wendy Greul released the report yesterday of an audit her department conducted into the Fire Department's response times.  Using a 2-year baseline from June 2007 to July 2009, the auditors found that after the fire station closings and rotating brownouts took place in July of last year, the response times for ambulance calls increased an average 12 seconds citywide and as much as 20 seconds in certain areas including the San Fernando Valley.  The Daily News reports:

The report found response times for emergency medical calls increased an average of 12 seconds to four minutes, 57 seconds. However, the response time to fires and non-medical emergencies dropped about 21 seconds — also to four minutes, 57 seconds.

Pat McOsker, president of the United Firefighters of Los Angeles City, said the audit confirms his warnings over the past several years.

"You cannot cut the department by the 15 percent it has been cut and not have an impact," McOsker said. "In emergencies, seconds count and we have a system that delays the response."

Not to be overlooked in the report is this observation by the Controller:

She also expressed concern about the quality of the department's response time data, noting that about one-third of the incidents reviewed were not coded properly and it was unclear whether they were emergency or non-emergency calls.

"It's unacceptable that the LAFD has not been able to accurately track its emergency response times," Greuel said, adding she hoped the audit would lay the groundwork for city officials to make improvements.

In her report Greuel also pointed out that 650,000 of the 1.9 million incident reports they reviewed were coded "unclearly" rendering their study unable to be compared with the NFPA response standards.

KNBC-TV Ch. 4 tells more in this video report:

View more videos at: http://nbclosangeles.com.

Los Angeles Mayor Antonio Villaraigosa, left, and Fire Chief Brian Cummings
discuss response times and deployment at a March 13 news conference.
(Barbara Davidson, Los Angeles Times / March 13, 2012)

It has been pointed out that part of the problem is created at the dispatch center where calls are taking longer to be processed before the alarm is dispatched. Again from the Daily News:

(Local President) McOsker said part of the problem is dispatchers are required to go through a list of more than 20 questions before an emergency call is placed with paramedics. The protocol was developed to try to reduce the number of calls made for nonemergencies.

"There was a time that once they determined the nature of the emergency, they could send a unit out," McOsker said. "Now, they have to go through the entire list of questions before they send anyone to the call."

Using their own resources to analyze the raw data, the Los Angeles Times has concluded:

(Times staff writer Ben) Welsh crunched data from more than 1 million dispatches from the department's database and found that the Fire Department falls far short of the standard that rescue units be alerted within one minute on 90% of 911 calls. And average call-processing time has increased, most notably for medical calls, which account for the overwhelming majority of responses.

Five years ago firefighters were dispatched to medical calls within a minute 38% of time, the analysis found. By 2011, that number dropped to 15%.

The Times also found that in the more than 250,000 medical dispatches last year, the department took 75% longer, on average, than the national standard.

You can read the entire 46-page Controller's report (.pdf file) HERE.

On March 18 Firegeezer reported on the surprising announcement that LAFD had been using phony numbers to calculate their response times.  Read that posting HERE where we also addressed the vehicle maintenance problems that are affecting the response times as well.

It was also last March when McOsker opined:  "This department is being held together with bubble gum, baling wire and duct tape."

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Class of 2012

Prior to our reorganization, I would use my faculty web page to recognize and celebrate the achievement of students enrolled in the Emergency Health Services program.

Lacking that resource, let me tell you know how happy and proud I am of the following folks:

Master of Science in Health Science: Emergency Services Management

Kashif Cheema

Andrew Mader

Bachelor of Science in Health Science: Emergency Health Services  (also called EMS Management )

Michael Beller

Aaron Botteron

Paul Cissel

Andrew Ecker

Bobbie Rogers

Heather Shymansky

Ronald Taylor

Because these are distance education programs, I will be meeting many of these students for the first time this weekend.

Except for locals Paul and Ronald

Mike "FossilMedic" Ward