Why have a volunteer Squad when the ALS patients keep getting turned over to the Paid ALS service…….

I belong to a Volunteer Rescue Squad which is part of a Volunteer Fire Department. Over the past 2 years we have had a paid ambulance service come in and handle daytime calls, due to our members not being around during the day to get the ambulance out if a rescue call came in.

Okay that is a little information so you understand how this went down. We had an EMS call this morning, so the paid ambulance was out on that call. As I was walking into the post office we were dispatched, along with a backup ALS unit, for a possible stroke at a residence in our town. I went to the firehouse and got the rig. I waited for another crew member and was informed by my Rescue Squad Captain to respond in and she would meet me at the scene. I had another member call in and report on the scene but he wasn’t able to go to the hospital, as he had to go to a college class. When I got on the scene I took the stretcher and crash bag and went into the apartment.

I was given a report by the patient’s home health aide that she had fallen out of bed last night and hit her head; the patient presented with a contusion on her head. The patient is also a diabetic, and her blood sugar (tested by her aide as I arrived) was 368. According to the aide the patient’s blood sugar is always erratic. The patient also has an inoperable brain aneurism, so the fact that she struck her head during the night was making me a little concerned. The patient also was having blurred vision and dizziness, and weakness on the left side. The patient’s blood pressure was within normal limits.

I was about to start getting the patient ready for transport when my Captain came in. I gave her a quick report, asked if she could go to the hospital, and told her that I could also go. She informed me that she could go, and then asked where the medic unit was. I told her I didn’t know, and she went to find out. She came back in and told me the medic unit was advising they were approximately five minutes out. When I said “let’s get the stretcher and get going” I was told “no”; that we could wait for the medic unit and they could transport the patient. I was in shock and disbelief that we were waiting for the other unit and not meeting them en route. I was not happy with the decision but was over ruled by my officer. The medic unit came and we loaded the patient into their rig and off they went ALS with the patient.

As I was getting ready to turn my rig around my captain stopped me and explained that the reason she turned the call over to the other unit was that the patient’s insurance company wouldn’t pay the bill if the medic came in our rig, but would pay if the patient went in their rig.
I questioned her about it in disbelief and told her she needed to get that whole idea out of her head. She insisted that she couldn’t have it where the patient gets sent a bill and has to pay the bill because the insurance company won’t. I gave up trying to get an explanation or getting the point across to her that the billing with the insurance company doesn’t matter.

This upsets me because this same officer has recently discussed us taking back more daytime shifts from the paid service and yet here was a call we handed over to them. Would we have done a meet and assist? Yes for sure. That still doesn’t mean we give the call totally to them. How does this make us as the volunteer squad look to the public? Not good in my eyes. I am at the point of, why are we here as a volunteer squad, if we are going to turn the patients over to the paid service for transport. I just don’t understand and feel that waiting for the other unit is delaying care to the patient. That’s wrong, by any training I’ve had…and if something happens while we’re waiting, then we could be in trouble over the fact that we waited to transport.

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Thanks Caleb and you can be sure then I really would have raised hell and that patient would have been in my rig. The paid service that works out of our station and meets us for ALS assists is also my part time employment. This really sucks when this stuff happens cause I know most of the crews and they look at me with that confused look on their faces and all I can do is give them the report and help them get the patient packaged.
Sounds like your Company needs to sort out a few things...you might want to subtle bring it up at a meeting or throw it by your Chief....something smells wrong here to me....but as an outsider looking in I don't know all the facts....leave it at that....If it were my Family member and you were waiting I would put her in my car and go to the hospital without you...and then raise holy living hell at the county or State level...might remind your "Captain" that we are in this for the people not the proverbial $$$$$$$$$$$$$$$$$$$$
having been on both sides of that issue, a volunteer and a paid full time medic(for a private company), this set up is outdated. one or the other should be done. if your department is going to respond they should be ready to transport. this teird system only delays patient care and uses resources that could be better used elsewhere. i suggest you check into the numbers aspect of it and approach your city administration, and/or your ems chief.
sorry, but it sounds like your pride is overriding your brain. bls units are basically outdated, in the begining ems ambulances were hearses or as we call them now..... bls units. your pt needed a als unit, capable of administering meds. as a chief i would advise you keep the passion for saving lives but remember your units limitations. it seems that your pt hand off report was great and if that pt had gone bad you were there for them. the benefit was 1 pkg&load vs 2, time saved???? talk to your chief, voice your concerns as you all (vol. & paid ) work under the same medical direction. emts save lives...paramedics save emts.
On my department we are volleys as well. We run a BLS ambulance. Our ALS is auto dispatched with all medical calls. Our ALS is just one medic in a echo unit that meets us on sce or if we are ready and in case such as yours we will load the p.t up and start our way to the cloest hospital. We will then meet up with the echo unit enroute. Everyonce in a while our ALS is out on other calls and we have to just run it a BLS that is why we still have our own ambulance so that we can still provide the people of our township EMS.
Essentially if you were 5 minutes from an ER and you had a paramedic enroute with a 5 minute ETA that the BLS bus shouldn't grab the patient and head in? Thats possibally the dumbest thing I have heard. The last I checked paremedics are great but doctors have a lot more useful tools and experience for treating patients.

Waiting with a patient rather than transporting and intercepting the ALS enroute saves what? Not time. Not money.
Mike, My pride is most definitely not overriding my brain first of all and second, when we need a medic we will typically meet them en route to the hospital because we do get the patient loaded into our rig before the medic even reaches our location. We do not take the patient and transfer them from our rig to the medics rig. If we do a meet and assist the medic rides in our rig. I also don't agree with you on saying that BLS units are outdated, that is the most ridiculous statement that I have ever heard. Oh and I know what my limitations are as an EMT and I also know that I am that patients first line of help and I work very well with the paid ALS crews. I will have to run your little saying about Paramedics saving EMTs by my medic partners at my paid EMS job and see what they say and if they agree with you.....
thanks Josh, we are the same as you with ALS being dispatched with us.
In E.M.S. thats the way it is going all paid if they are not all ready thats why anymore I wonder why the Volunteer Firefighters don't get paid the way things are going I sometimes think it would be the way to go atleast your family would be taken care of if anything happened to you and you would have a paycheck coming in while doing something you love to do??? I have thirty years in the service and I am very proud of being a firefighter but why should everyone else get paid and us Volunteers just sit back and say well because we like to do it and we are proud . Thats great but I still think the men and women in the service deserve to be paid afterall they do pretty much the same as the Career guys do in the service. Don't misunderstand me I would always want to see only what is the best for the firefighters!!! Hughie The 57 House
Shouldn't the patient be transported based on a CLINICAL decision only? That's what we're there for aren't we?
Reading down through some of the replies I am astonished by the wide array of responses. Did this paitent need ALS, possibly... she needed advanced care more than ALS. With a blood sugar that high there is nothing other than fluid that an ALS provider is going to provide her. With the possibility of a stroke she needed transport more than a 5 minute delay waiting for ALS. TPA and other clot busters need to be administered in the first 60 minutes of a stroke. Now, with the history indicating an inoperable brain aneurism it might be questionable if they woudl administer TPA. At any rate BLS ems units are not outdated as someone stated in one response. They still are better than no ems and lots af areas still rely on BLS crews to cover their ems. As for waiting to hand off to the other crew based upon billing, who the hell does your billing? Around here if needed a crew will stop and pick up an Intermediate or Paramedic any time and not think twice about it and cause no headache for billing.

I am an Intermediate with a long history of running for volunteer departments (and several years as a Basic). I feel your agency needs to consider this, if you are going to have an ambulance that responds to calls, then use it. If you are simply going to first respond for an outside agency to come in like Johnny & Roy did back in the day, then scale back to a vehicle suited for it. Your department is setting themselves up for one hell of a suit if something happens because you delayed transport because you were waiting for the ALS crew, unless you can without a doubt document a need for immediate ALS interventions before moving the pt. (femur fracture needing premedication for pain control to splint and load, ect.).
You are correct Lutan and that was some of what I was trying to say. Glad to see that some got it here... thanks

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