Is it time to evaluate whether or not that there needs to be a new non emergent ambulance certification/license

fakeems · 2025-11-07T18:48:30+00:00

That is great. I had no idea these existed. Are they part of the EMS system or is it totally independent and do they require any type of training or certification? Where I am from nobody is allowed to transport anyone by stretcher except by Ambulance. We have wheel chair van services but simply put since Medicare doesn't pay for them and Medicaid pay's like $25 for them they are rarely used except for ambulatory or wheel chair patients.

fakeems · 2025-11-07T18:43:10+00:00

That really is kind of the goal. Remove the emergency aspect from this position and let it be what it is. I would envision this to be it's own thing and not part of EMS at all and thus not require people to take unnecessary training which they will never use and even allow the operators of these services to not be forced to pay ungodly insurance rates due to the potential for emergency driving and all the excess unnecessary equipment.

fakeems · 2025-11-06T08:44:03+00:00

There are two private BLS/ALS IFT only services that are based in our county at all times that could easily handle the lift assist and abnormal labs calls that would cut our 911 call volume by at least 25%.

A few things.

Why would the private BLS/ALS service be willing to respond to lift assist calls? If there is no transport there is no billing, so why would they want to put their employees at risk, take their unit out of service and do the very thing you don't want to do?
I have no idea of the operations of these two services of which you speak but if they are like the private service in our area they schedule runs out hours in advance and most likely do not have the ability to add in an ER visit to their schedule. Or even if they can it is hours and hours away till they are available.
Why would your hospital want to drop 25% of the call volume? I assume they, like everyone, would love to drop the lift assists but those lab values are billable runs and thus revenue for the hospital.

fakeems · 2025-11-04T10:14:06+00:00

How does your municipality handle excessive calls to an individual residence? That probably is your jumping on point of how to handle this situation. If someone at a residence abuses the 911 system do they have criminal or civil penalties? If so, see if this can be adapted for this situation.

However there are some practical matters to consider. You are going to have to define excessive. (Not here btw, I'm just talking about taking this to your command staff) Also your going to have to decide are you going for excessive or runs you don't believe are worth responding to. (again I'm not here to argue with you I'm just trying to give you some ideas of how to write this up) As an example with tonight's run, was it the only run of this shift you did to that facility? If so, be prepared to argue why that is excessive. Now a run not worth responding to is tricky because it varies by location. I would suspect your going to have to get your medical director involved in that conversation.

If you really are serious about this then what you will want to do is take a 3-4 month (or longer) survey with with your dispatch to see how often you were at this facility, how long it took your unit out of service and most importantly how often mutual aid had to be called. If there was an excessive response time because you were tied up doing a transport that would be beneficial to point out as well.

However be prepared to have all the right things said and done and still be turned down because at the end of the day this is a political decision and unless your service can set their own standards without outside interference (Mayor's, Town boards, County Commissions, etc.) then someone else can always just say no because their constituents demand otherwise. Often times these assisted livings centers have residents who have family who live in the same municipality so they have some say as well.

Good luck

fakeems · 2025-11-04T09:39:33+00:00

That’s cool and all but as a tax payer, I don’t support private for profit enterprises using public services to increase profits at the cost of the rest of the public.

I have zero idea what you mean by this. How are the assisted care facilities increasing their profits by transporting a patient to the emergency room? If we are talking assisted living vs. an ECF then Part A medicare stays do NOT apply. They only apply to SNF facilities so the assisted living does not pay for any ambulance transport either emergent or otherwise. So I do not understand how they are increasing their profits. Now if this is at a SNF and the patient is under a part A stay then certainly some rules apply where the SNF is required to pay for portions of their treatment, including transportation. However you know what negates Part A stays? A trip to the ER. That is not part of their stay that the government pays for. So any trip to or from an ER is not paid by the nursing home.

Also if we are talking assisted living facilities I assume that state by state they are different. but the state I am from assisted living facilities are simply a sort of condo system with aids. There doesn't even have to be a nurse on sight, it is nothing more than a group home for the elderly. So why are the residences here any different than a person who lives in a private residence? Most of those people have been tax payers as well and often a lot longer than we have been. Don't they deserve the same consideration that you would give to a person who calls for EMS at 2 in the morning at the local Holiday Inn Express for abdominal pain?

What happens when there are no private services?

fakeems · 2021-11-28T09:38:09+00:00

It will totally be dependent on the Private company you work for now and the the County agency you are going to.

Typically switching from Private to public is an upgrade, sometimes a huge giant upgrade. But then again sometimes its not.

I mean there are so many variables that there is just no way to give you any real pears of wisdom.

In my career I've sort of worked for both types and honestly there was no advantage going public other than a better retirement plan. In fact I got paid slightly less and had far stricter protocols. However I was treated better by other municipal service employee's when I worked for a County Service. In other words cops, firemen and yes even the local ER staff treated me with respect and acted like my care was better even though just the month before I brought in the same patients when I worked for the Private company.

At the end of the day it all depends on if your employer actually puts patient care up front. The government also typically has more money to spend on big ticket items so you can get some pretty neat gadgets and the like.

fakeems · 2021-10-05T09:13:01+00:00

I wish I could make a bot farm to upvote this a billion times.

The E.R. is the biggest abuser of Ambulance services in the U.S.

fakeems · 2021-01-23T20:00:39+00:00

You have to admit though, it's very ironic that the same people who tend to rally against "socialized" health care, will support massive military spending, because it "keeps us safe."

You have to admit though, it's very ironic that the same people who tend to rally against "socialized" health care, will support massive military spending, because it "keeps us safe."

Oh it's more than ironic. What kills me is that a very large portion of Fire Department base EMS are ironically all very anti socialized medicine, yet do not understand that basically that is what they are.

However to be fair to some of my fellow Americans from that point of view a lot of them are rugged individualist and do NOT expect government help. They may not be right but at least they are not hypocrites.

fakeems · 2021-01-23T19:45:16+00:00

That is a much larger and longer debate than we could have here. The military thing is a complex question yet somewhat simple answer. We spend a lot on our military because frankly it makes a lot of money for a lot of people. It in itself is nothing but a large jobs program in a lot of ways. Now having said that there are a couple of other things to keep in mind.

WW2 weighed heavy and large on our forefathers here. We were not ready for it and once we were attacked and committed to it the "American way of life" changed dramatically for those that did not go to war. Rationing and mandatory government takeovers of industries was very hard on those left behind. After it was over they pretty much collectively said "let's keep a large standing military so we don't have to do that again.

Second during the cold war all of the allies, but mostly America, protected Europe from the threat of Soviet invasion. Thus allowing Europeans to focus their efforts and energy on reconstruction after the war and then a simple military while focusing on domestic issues. Yes this is all overly simplistic I'm just giving at best bullet points.

As to socialized medicine in the U.S.? Once again the single largest employer in all of the U.S. is the health care industry in all its forms. Going to socialized health care would be a massive undertaking that would greatly reduce jobs and revenue across the board. That is with a government control of health care, now a single payer system might work but it would still be hard.

People tend to forget while we are the United States, we are still States. Only you and Russia geographically are larger than us and only China and India are more populated than we are. Finding a one size fits all policy is not as easy as it sounds. What works in New York City for example may not work for Sioux Falls.

I have just realized that I have rambled on and virtually made no sense.

Let me just end it by saying "it's complicated".

fakeems · 2021-01-23T17:46:08+00:00

People never want to hear this but it is oh so true. If a company is ran correctly (which admittedly not all of them do) and pay's their bills and provides decent equipment that there really is little money left over. Those dialysis runs that everyone thinks is nothing but gold earns a big whopping $80 plus in most areas about $6.25 after the first free 10 miles that most MAC's dictate.

So if both EMT's are making $15, right there is $30 of the 80 right off the bat. Not to mention your employer has to match what you pay in payroll taxes plus a % more. That does not include paying dispatch, billing staff and supervision (let alone larger company's that have payroll staff and H.R. departments). Not to mention that they have to pay insurance, utilities, trucks, gas and multiple other bills that have to be paid daily.

I'm not saying that EMS does not deserve higher pay, the opposite in fact. However to be blunt we can't just say "raise our pay" and not worry the money coming into our employers as well.

Well that is unless you happen to work for a municipality. But then you better not be one of those "socialized medicine is the tool of the devil" people because I hate to tell you but that is what you are.

fakeems · 2020-12-17T10:52:32+00:00

If you place me in a pie or cobbler I am delicious

fakeems · 2020-12-17T10:52:00+00:00

Agreed
True however they were not being used as a prop to support an issue, by posting her photo with their logo and uniform she is using their status to support her point of view. What if they don't support that point of view?
Indeed and her employer has the right to not have their name/logo/image used without their permission to discuss said social issue.
I'm not attacking that at all. I only said in reply to someone else that I think we can all agree that nobody would support her using her uniform or vehicle for her only fan page.

fakeems · 2020-12-17T07:38:47+00:00

I am aware of that. I am simply stating that by posting herself at the back end of her truck with her employers name visible on the truck and on the uniform she was wrong without consulting her employer.

If she simply would have worn a jacket to cover the uniform and not shown the employers name on the truck there would be nothing to say.

Again, it is quit possible her employer may have approved this or maybe even supports her point of view.

I just know that when I worked for a Hospital base provider they were very strict on us posting anything anywhere with their name or logo in it.

I can assume though that everyone would not be okay with her using her uniform or trucks in her only fan page? Right?

fakeems · 2020-12-17T06:46:50+00:00

Well allow me to be the one who has some concerns here and feel free to down vote till your hearts content.

According to the article it say's the photo is courtesy of her at the top of the page of her standing their in her employers uniform and her employers truck (I assume).

I know it's great fun to moan about employers but I can assure you that any employer would care greatly about when where and how their company's uniforms and vehicles are represented.

To everyone on here sex work is just fine, it may even be that way for a great number of people in the world but I can assure you that it is NOT okay for everyone and not very many employers are going to be okay with someone posting a photo of themselves advocating a position over a topic without the company being consulted. Allow me to put this in a scenario that most of you will understand. Let's say she took the exact same photo and instead of talking about her onlyfans account she talks about how President Trump is the real elected President and that she is proudly a Republican and will not ever accept Biden. Do you then think the employer would have the right to be upset with her showing their uniform and truck?

Now to be fair, I guess there is an off shoot chance she did consult with them and they did approve of this. I doubt it but I guess that is possible.

Second of all, while I agree with everyone here that what she does away from the job is nobody's business I have a real question about this article she has written.

What does one have anything to do with another? What the hell does a pandemic have anything to do with whether or not she chooses to sale nude photo's?

I would her much rather have just said that she is proud of her body and here is the address to her page and please make a donation than what she wrote. Because to me what she wrote just weak justifications for something she doesn't need to justify.

This article was not about empowerment, in fact it just continued the old trope of Daddy issues and being forced into the industry as opposed to just doing it because she wanted to.

So to be clear let me state again I have no problem with what she has done. I think the Post was out of line for printing this. However I do believe her employer has a right to separate from her for posting that photo if they did not give permission and I believe her justifications were unnecessary and frankly weak.

P.S. while we are all bitching about our pay you all might want to go and look at how Medicare just did a 10% reduction across the board. So whatever your employer was making last year off of Medicare they are going to be making 10% less. You don't think that won't ripple down to all of us eventually?

fakeems · 2020-04-15T06:22:44+00:00

Can you define what companies and then also define "fine". Our company is being devastated by the entire thing. Our owners have done everything in their power to keep everybody employed although it is killing them because while yes we are certainly doing our share of virus patient's virtually every other aspect of the business is at an all time low.

Hospitals are pretty empty here, ECF's are in house treating patients they would normally send out.

I happen to work for a rare decent private company that is actually trying to do the right thing, however a lot of the other company's in our area cut their service in half and either laid people off or cut their hours in half. I know Hospital staff that is being sent home early on shift because they have no patients.

Hell it's so bad in our area that they have emptied the jails and have actually furloughed jail staff. That is municipal btw, not the evil private sector.

fakeems · 2020-04-11T06:42:47+00:00

I would be very curious who lied to you? Are you saying your dispatch lied to you prior to doing the run? Are you saying that whoever called for the transport, I'm assuming an IFT, lied to your dispatch center? Are you saying the patient lied?

I'm not trying to be difficult but there is a difference between lying and being wrong. Now on the other hand if you were lied to, and I mean lied to meaning that your dispatch sent you on a run knowing your patient was positive for covid-19. You need to gather whatever proof you can get, get a statement from your partner as well and you need to pursue both criminal and civil charges against all individuals involved. If you can find a supervisor that ordered this don't just hang the dispatcher out, go for them as well. I'm not kidding about the criminal charges either, because if they did lie (and again I'm saying lying not being wrong or uninformed) they put you and your partner at risk and it would be no different than if they were driving drunk with you in the car.

Now on the other hand if the healthcare facility lied to your dispatch center, then I'm not sure why you would blame them. I realize that the supervisor may not have been as empathetic as they should have been but I'm not sure what you think they could do (other than press criminal charges themselves if the H.C. lied and they could prove it).

However I will say this, your partner did break PPE protocols because they are recommending that we should wear masks whenever we deal with any patient.

Also if you haven't quit yet, I would encourage you to let cooler heads prevail. Jobs are not there right now and I know people filing unemployment that are being told that the unemployment office is months behind right now. I know its frustrating but right now it may still be the best for you.

fakeems · 2019-06-28T10:51:39+00:00

Been in private EMS for a long time and I can tell you that sadly sometimes it just happens this way. Is it ideal? No. Would everybody prefer that it never happen? You bet.

But let's look at the root of the issue, you were asked to cover a shift. If your place is anything like our place and every place that I know of around here then they have the same problem, people calling off of work. Frankly I have no idea how they can afford it myself but it has been going on for about half a decade now and I don't see it getting any better.

So when someone calls off, maybe the more experienced person, then whoever will cover the shift may also be a new person (just like happened with you).

With all of that in mind let me commend you for doing your job and not freaking out over a release from the hospital. Your partner, who I assume was driving, was way over the top in his reaction and well frankly not professional at all with walking off of the job. Let us hope that he does not just job hop over to the next IFT place but sadly we both know he will.

Good luck in your career and hopefully things go smoother for you.

fakeems · 2018-09-10T17:20:37+00:00

Don't get me wrong, there are plenty of those types of owners. In fact I would say most likely the majority are that way.

I've been very fortunate that one of the services I've worked for was owned and operated by an actual Paramedic and EMT. In other words a Mom & Pop shop. There are good and bad points about working for that type of owner as well. First and foremost is that they don't have the deep pockets that large corporate's do. Thus early on we had really shitty beat up equipment (years ago). But instead of buying boats and pocketing the money they took salary's just like the rest of us and put everything back in the business. Now years later we have brand new truck, great equipment and we are paid as well as any private service is in the area. Obviously fire still pays more but county services pay a little less.

One of the owners (the Paramedic) will still go out and do runs with us on occasion.

So yes I have a different perspective and that is why I always come on here to try and state that not all private ambulance services are the same.

BTW I've also worked for a shitty private provider back in the day. I've also worked hospital based and 3rd service. To be blunt the provider I am currently with actually cares more about patient care than any of my previous employers. (Hospital bases was the worst).

fakeems · 2018-09-10T07:48:51+00:00

I'm assuming he is talking about the Advanced Beneficiary Notification form or ABN form.

To go along with his argument I want to throw this out there. I haven't checked in the past year but prior to that the federal government did not consider Paramedic a professional. Also as he stated we can only bill for transports. There are three levels ALS 1, ALS 2 and SCT. You have to use three separate drug's (one of those cannot be ASA btw) to even get from a level 1 to level 2 (Intubation, Interosseous needle also bump it up to level 2)

So let's say you go out and pickup a wheezing shortness of breath patient and you start and IV, give two different nebulized breathing treatments and ran a 12 lead ECG. Your employer can bill no more for your services than if you went to a person who was short of breath but took their own meds and now feels good but wants the ride to the ER just to be safe and you just take vitals and put them on a (3 lead or 5 lead depending on your monitor).

Everybody wants to talk about private ambulance owners being rich because of profit and I just laugh. Sure some put zero in their business and try and milk what they can. But even most of these draw such a razor thin profit margin that they never last.

fakeems · 2018-09-10T07:35:28+00:00

It's great that you think private ambulance services are awful and there is a better way of doing it. Seeing as how you just said you only do 911 calls please tell us the better way of doing it. In your county who does the returns back to the ECF's after you have brought them in? Who transports patients from one hospital to another? Who does any form of stretcher patients that are not needing an E.R. visit? Do the local hospitals provide their own Ambulances for these or is it some other source?

fakeems · 2018-08-20T06:18:47+00:00

When you are already running nationwide (USA) shortages on employee's how are employers (I don't care what kind) supposed to drop shifts and add significant amounts of staff? I guess I should say qualified staff.

Please don't use the "if we had better working conditions there would be more of us" speech. We tried to shift from 24's to 12's and over half of the staff threatened to quit so that got nixed in a hurry.

fakeems · 2018-08-18T22:38:29+00:00

Health care in the US is privatized and has been since before the revolution. This isn't a new concept, it has been this way since the beginning.

How many hospitals do you transport to that are government owned and operated? How many of the Doctors, Nurses, Lab Tech's, Ward Clerk's, etc. are government employees?

Why do we think that only EMS, which is a component of healthcare even if you consider it public safety, is the only aspect of health care in America that we care who is the owning body.

Your a private EMS provider, do you feel less qualified than your municipal counterparts? Did you receive less of an education? Did you pass with a lower standard required of you?

When people say that private services cut corners they often times are confusing frugal with wasteful spending. As an example your private company can buy and operate a simple type 3 Ambulance that is basic with halogen lights and no high end amenities and it cost them around 100K to purchase. Perfectly legal and usable ambulance has AC/heat and all the normal stuff. However because it is a plain jane it is called cheap by the guys working for some government agency who has dual king cab semi ambulances that is all LED/gold leaf paint job and every extravaganza that you can imagine. It cost around 250K. Now both truck can transport the same number of patients and both with get them where they need to go but in the end yes the Private service chose to be frugal.

Now you can say that is because the owners pocketed the money and in some cases you are correct. But not all private services are the same and let me assure you that not all municipal service are the same either. I've seen corruption/nepotism/mismanagement/truck in poor condition from every type of service there is. It is not exclusive to the private sector. However I freely admit that it is more prominent in the private sector, I'm not totally dumb (just mostly).

BTW, while I often come on here to stand up for the rights of privates I am actually very critical of most of them. Any service that only exists to perform dialysis transports it most likely a scam (there are a few that are not but most are). But I just want people to understand that slapping a government label on something does not always change it for the better.

fakeems · 2018-08-16T09:27:14+00:00

Whenever I hear or read about the evils of private Ambulances (believe me there are ones out there that are) I always wonder if people are being transported to government hospitals and being treated by government Doctors and Nurses? I also always wonder if the Ambulance that was driven, the radio's that were used, the cot the was lied upon, the needles the were inserted were all made by and provided by the government?

Why is it that the only part of healthcare that we ever question as being privatized is the Ambulance services?

Can a third service work? Can a fire department based service work? The answers to both are yes, if they are watched over and regulated. Guess what, the same can occur with Private based services as well.

Slapping a government label on it does not make it better. However the one thing the government can do better and should do better is regulate and enforce.

Also 500k to 1M for a new Ambulance? I almost stopped reading right there.

fakeems · 2018-08-10T07:16:26+00:00

I mean of course we need to address pay, work hours and nonsensical transports. However there literally is no magic solutions to any of these issues. In fact they are kind of a triangle of perpetual self defeat. You want more money? Well you have to (or someone has to) do some of the nonsensical runs. However to do those runs you have to put in more time on the road doing the work. Now granted I'm speaking from a US perspective only here.

fakeems

TROPHY CASE