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EMERGENCY MEDICAL SERVICES. (EMS).
Term Paper ID:28474
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Essay Subject:
Discusses from managerial perspective the effectiveness of combining EMS with the operations of a municipality's fire department emergency medican technicians (EMTs). Strategies, medical services, costs.... More...
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9 Pages / 2025 Words
15 sources, 29 Citations,
APA Format
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Paper Abstract:
Discusses from managerial perspective the effectiveness of combining EMS with the operations of a municipality's fire department emergency medican technicians (EMTs). Strategies, medical services, costs.
Paper Introduction:
People's lives often depend upon the quick reaction and competent care of emergency medical technicians (EMTs) and paramedics, who represent for many the "front line" of caregivers in the American public health system (Occupational Outlook Handbook, 2000. EMTs provide prehospital services, including emergency care and transportation for the injured and the ill (Occupational Outlook Handbook, 2000). The purpose of this brief report is to examine, from a managerial perspective, the efficacy and efficiency of combining emergency medical services (EMS) with the operations of a city's or township's fire department. A general overview of the roles of EMTs and of EMS will be provided as a framework for this discussion.
EMS generally consist of an assortment of trauma, accident, rescue and medical care and services that are provided by EMTs who
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The program was recognized in 1998 withan Outstanding Achievement Award in the Public-Private Partnerships Awardsprogram of the U.S. Swersey,Goldring and Geyer (1993) conducted a study of EMS and fire departmentactivities, using 911 emergency call data, and found that this was aninherently cost-effective method of nursing that residents would haveaccess to high quality EMS services and that the natural synergies betweenfire department and EMS operations would be exploited. Georgia Association of Emergency Medical Technicians. Fire trucks andother rigs carry a variety of basic first aid equipment and front lineengines and trucks are also equipped with cardiac defibrillators under aprogram that is administered by the Mayo Clinic (Rochester FireDepartment..., 2 ). Other normativeand ethical issues impacting upon the EMT include the refusal toparticipate in unethical procedures. At the heart of the EMS system is the EMT. Available at www.bostonems.com. A general overview ofthe roles of EMTs and of EMS will be provided as a framework for thisdiscussion. The needs of eachjurisdiction must be recognized as unique, consequently requiring uniqueprogram design. Support for this position has beenreceived from the U.S. (1999).ALS Provider Manual. Given these protectivecaveats, the EMT must "under no circumstances withhold care from a patientknown to have a communicable disease or suspected to be a carrier ofcommunicable disease (Eastern Pennsylvania Emergency Services Council,1999, p. Needlestick injuries should be reported immediately and allinfectious disease incidents or cases should be thoroughly documented andprocessed through the provider's medical director. Fikes (1992) and Robinet(1996) noted that some problems have existed, specifically with respect tounion demands for benefit increases and regarding working conditions; onbalance, however, both Fikes (1992) and Robinet (1996) agree thatpositioning EMS within the context of fired department activities isbeneficial. Smaller cities or jurisdictions often find thatprivatization is more beneficial in terms of both cost and quality of care. However, the Boston EMS isan autonomous agency which operates under the aegis of the public healthcommission as opposed to the fire and police departments. Congress, which is now considering legislation thatwill allocate additional funding to equip and train firefighters and EMSpersonnel (Rigsby, 2 ). References Anonymous. LosAngeles Business Journal, 21(45), 15. Operating a single call centerfor fire, safety, and rescue services is one way in which costs arereduced. (2 ). (1996). Population density is invariably associated with higher demands forEMS operations. Occupational Outlook Handbook. Interfaces, 23(1), 1 9-13 .----------------------- 11 (2 ). Available athttp://stats.bls.gov/oco/ocos1 1.htm. Robinet (1996) haspointed out that cities across the country are facing both increaseddemands for services of this type and decreasing revenues. (2 ). For this reason, manyjurisdictions have reached the conclusion that EMS should be under thedirect supervision of some branch of city government; the fire department,because of its own rescue and trauma/accident prevention and controlfunctions, is viewed as an almost ideal locus for such activities (Austin,2 ; Fine, 1999; Rigsby, 2 ). A private firm, Gold Cross Ambulance Service, providesadvance life support in the community and service area. People's lives often depend upon the quick reaction and competentcare of emergency medical technicians (EMTs) and paramedics, who representfor many the "front line" of caregivers in the American public healthsystem (Occupational Outlook Handbook, 2 . Anonymous. In LosAngeles and Orange County, public funds bare the major burden for suchservices, which are integrated with the Los Angels City Fire Departmentand/or offered by the county to unincorporated areas and dozens of contractcities (Fine, 1999). Available at http://pfd.vfo.com. Gloves should be worn when dealing withknown or suspected communicable diseases, particularly when drawing blood,before respiratory procedures such as intubation, when caring for openwounds or sores, and working with patients who are vomiting, havingdiarrhea, melena, or drainage from surgical sites. Conference of Mayors (Contract lets ambulance...,1999). 911 emergencies: Who pays the tab? A fundamental responsibility of the EMT is toconserve life, alleviate suffering, promote health, do no harm, andencourage the quality and equal availability of emergency medical care(www.gaemt.org/ga 1 .htm, 1998). In San Diego, California, as well as Pittsburgh, Pennsylvania, thelinkages between EMS and fire departments have also been well documented ashaving much the same results (Fikes, 1992; Robinet, 1996). DenverBusiness Journal, 51(34), 1A. Eachof these strategies has been found to be successful. Lynn is also home to several minority groups, includingCambodian-Americans and individuals of Hispanic descent. Beyondthese general duties, the specific duties of EMTs depend on their level ofqualification and training. This system represents what can be described as ahybrid program in that ambulance services are provided by a private sectororganization which is responsible for its own billing, while crisis EMS ispositioned within the context of the fire department. In New Haven, Connecticut, budgetary constraints have ledthe city officials to combine EMS and the fire department to achievegreater economies of scale (Swersey, Goldring, & Geyer, 1993). (1998). The Eastern PennsylvaniaEmergency Medical Services Council (1999) stated that EMTs should becognizant of the fact that all patients must be considered potentialcarriers of communicable disease and precautions should be taken to avoidexposure to blood or body fluids. This image notwithstanding,not all EMS are financed by and operated by city or country government;some EMS services, such as ambulance transportation and even emergencymedical care, are privatized (Fine, 1999). Rochesterfirefighters are themselves trained to the EMT-B level and are required tobe members of the National Registry of Emergency Medical Technicians(Rochester Fire Department..., 2 ). Knight-Ridder Tribune Business News, Oct. (2 ). The alternatives available range from using the public purse to payfor all medical emergency services offered in the community to privatizingselected services to incorporating EMS into fire department systems. EMTs are also ethically required to determine the competency of thepatient with respect to treatment decisions, and respond accordingly.Health care workers should not jeopardize their own safety but shouldprovide all clients with state-of-the-art care. According to information supplied by ChiefHugh Osborne (From the Chief, 2 ), the city elected to group theseservices together in recognition of both their natural synergies and thecost savings benefits to be realized by this strategy. Available at www.easternmscouncil.org/index 1.htm. Anonymous. In Lynn, Massachusetts, other concerns also impact upon the questionof where an EMS service should be positioned. Pittsburgh Business Times,16(19), 15-17. Rochester Fire Department emergency medicalservices. When this is the case, government canposition EMS and EMTs under civil service education, experience andbehavioral standards and guidelines. Swersey, A.J., Goldring, L., and Geyer, E.D. Masks and eye protection should always be usedwhen there is a possibility that body fluids or blood may be sprayed oraerosolized. Austin, M. Currently, quality standards for EMS units and EMTs vary widelyacross the country (Austin, 2 ). Currently, this agency has 285 EMTsand paramedics who work 24 hours-a-day, 365 days a year on the streets ofBoston. Lawmakers debate fix to EMS care. EMTs provide prehospitalservices, including emergency care and transportation for the injured andthe ill (Occupational Outlook Handbook, 2 ). Fikes (1992)reported that the city-run 911 emergency service links fire, police, andparamedic services; this system also integrates in-hospital emergency ortrauma services to create a seamless operation. Withthe advent of both managed care and increased costs for all kinds ofmedical services, some municipalities began to bill patients, most of whompaid for services via Medicare, Medicaid, or private insurance. The larger concern, says, Fikes (1992), is whether the EMSoperations should be privatized - or run by a private sector contractor,while physically positioned within the 911 umbrella and located (i.e.,housed) within the city's own fire department facilities. Eastern Pennsylvania Emergency Medical Services Council. City's emergency medical services becomes ahot potato between hospitals and unions. Bill gives federal dollars to fire, rescueservices. Larger jurisdictions and urban areas which are home to substantialpopulations of the poor may need to dig deep to find the revenues toprovide no-cost or low-cost EMS to their citizens. Nation's Cities Weekly, 23(16), 12. It is one of thenation's oldest providers of pre-hospital care and can trace its beginningsback more than 1 years when the Department was known as the City HospitalAmbulance Service (Boston EMS, 1998). Rigsby, D. In Portsmouth, Virginia, the city has elected to integrate fire,rescue, and emergency services. Inthis plan, the city provides and staffs the EMS operations, while a privatesector firm, Lockheed Martin IMS, takes care of the billing and collectioneffort. The advent ofmanaged care has further complicated this situation by increasing thedifficulty of obtaining reimbursement for services provided by cities. Anonymous. It islinked to the Boston Fire Department via a call center and some overlap offacility use also is a feature of this agency. In Rochester, Minnesota, the Rochester Fire Department responds tomedical emergencies in conjunction with the Rochester Police Department.These two agencies are the First Responders for this city and provide basiclife support. This agency has an educational as well as service function. Further, the EMT is required underprofessional codes of ethics to respect and hold in confidence, allinformation of a confidential nature obtained in the course of professionalwork unless required by law to divulge such information. When private firms are employed on afee-for-service or contractual basis, control over performance and qualitystandards is more difficult to maintain. Anonymous. Because many HMOs andother providers are now beginning to deny EMS reimbursement claims based onthe notion that a "prudent layperson" would not have viewed the situationas a true emergency, city EMS providers are facing new budgetary shortfalls(911..., 1999). From the Chief. Massachusetts regulators to require communityrole in merged hospital firm. Lack of resources may result in a crisis. 29,1 29B1 97. City to consider revising its 911 emergencyservice. Improving firedepartment productivity: Merging fire and emergency medical units in NewHaven. HMOs andother health plans, responding to the increased costs of such services andthe corresponding increase in 911 EMS calls, are beginning to use the"prudent layperson" approach for reimbursement; this is the same standardmany HMOs and other providers use for emergency room (ER) use, and it asksthe insured party to assess whether or not a reasonably prudent laypersonwould consider using an ER or calling a physician. In this case, the county does not provide freeemergency transport (i.e., ambulance) services, which are handled byprivate-sector carriers that charge fees to patients. (1993). In Philadelphia, a public-private partnership for the delivery of EMSunder the aegis of the fire department has been in place since 1988. In the case of Rochester, cross-training of firefighters and EMTs toprovide basic trauma and medical care services was the strategy identifiedby government officials as most likely to be successful in meetingcommunity needs and providing a high quality of care. As this discussion has demonstrated, there are any number ofstrategies available to a city government faced with the necessity ofproviding for street level emergency medical services. (1999). As a result, saysFine (1999), the county budgets substantially less for such services thandoes the city of Los Angeles, which has experienced a 17 percent increasein calls for paramedic services over the last five years with correspondingbudget increases. Fine, H. Available at www.ci.rochester.mn.us/rfd/Ems.htm. San Diego Business Journal, 13(32), 1-2. (1997). Traditionally, all "911 emergency" call and service costs were paidby the municipality providing the services (911 emergencies..., 1999). EMTs may use specialequipment, monitor vital signs and give additional care as needed. Available at http://www.gaemt.org/ga 1 .htm. Fikes, B.J. Proper disposal ofneedles and sharp instruments and other contaminated equipment orinstruments is essential. (1998). This spreads thecost burden more equitably, while simultaneously ensuring that potentialrecipients of EMS will be well and efficiently served. Blanton (1997) reported onthe situation confronted by Lynn, noting that community services area high-profile issue in Lynn because the population is poorer on average than muchof the state. Boston EMS. Nation's Cities Weekly, 22(23), 7. This reduces the administrative burden placed on the city, whilealso increasing its reimbursement. Contract lets ambulance crews focus on savinglives, not bill collection. The popular television program, Third Watch, depictsEMS services in New York City, where the EMS and fire departments work hand-in-hand with each other (and with police), sharing facilities andresponding separately and jointly to emergency or crises situations rangingfrom fires to auto and transportation accidents to drug overdoses,shootings, and in-home injuries and accidents. Anonymous. Blanton, K. Many fires requirethe services of EMTs, and while fire department staff are often trained inbasic emergency medical practices, they tend to lack the extensiveeducation of the certified or licensed EMT. KiplinersPersonal Finance Magazine, 53(12), 3 . 4)." Efforts to reduce the costs of providing EMS and funding EMTactivities have ranged from privatization to combining EMS operations withthose of other public agencies, particularly fire departments. Standards tend to be higher when theseservices are fully integrated into existing government-managed and fundedpublic health and safety programs. EMTEthics Code. Making decisions asto which strategy will be selected requires a thoroughgoing analysis oflocal emergency medical service needs and an assessment of existinginfrastructure. The purpose of this briefreport is to examine, from a managerial perspective, the efficacy andefficiency of combining emergency medical services (EMS) with theoperations of a city's or township's fire department. The Lynn HealthTask Force, and the city's Public Health Council, have been confronted withthe necessity of determining answers to several critical questions.Included are issues related to proposed hospital mergers (which somebelieve will leave many of the city's poor, minority residents withoutadequate accessible health care), escalating EMS costs, and privatizationof some services. Osborne believes that this approach also enhances local emergencypreparedness and fosters cooperation between emergency agencies whileproviding the high levels of service and care that residents have come torely upon. (1999). EMS generally consist of an assortment of trauma, accident, rescueand medical care and services that are provided by EMTs who may or may notwork under the aegis of a city, county or other form of government (911emergencies..., 1999). In Boston, Boston Emergency Medical Services is operated as adepartment of the Boston Public Health Commission. Robinet, J.E. (2 ). (1999). (1992). From a managementperspective, these represent difficult choices which must be undertaken inlight of political, social, and economic considerations.
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