ERs may not be designed for treating chronic conditions, but even in Canada people with family doctors often use them in just that way.
Cool, I’m annoyed at living in an oligarchy. It is common knowledge that an ambulance ride can result in economic hardship for Americans.
Ambulance rides yield surprise medical bills: What’s being done? (usatoday.com)
How much does an ambulance ride cost in America? Too much | Opinion - Deseret News
When I got my EMT certification in the early-'90s, EMT jobs were minimum wage.
That is truly ridiculous. I have seen paramedics use their knowledge to save lives many, many times. Attracting good people makes a real difference.
I gather that the “No Surprises Act” requiring fee disclosure was originally meant to apply to both air and ground ambulances in the United States, but then lobbying ensued to better serve democracy and further unite mankind under a banner of solidarity and happiness. As it so often does.
And you would be wrong. You too can become an EMT making minimum wage after some short CPR and first aid training.
The role of the EMT is to keep the body “fresh”, meaning oxygen or CPR to keep the blood moving and keep the brain alive while you tranport the person. Other than those few basics, and of course first aid to stop bleeding and immobilize broken bones, EMTs are not trained in patient care. And in spite of what you see on the TV, CPR doesn’t really work. About 10% of subjects (I wouldn’t call them patients), survive to reach the hospital. That’s it.
EMTs definatley should be paid more, but they are only slightly trained, to keep the body alive while transported. Hopefully keeping the body fresh and a swift transport is enough.
But this speaks to low standards. Canada has different paramedic levels, but much more training than that, including challenging exams. Advanced paramedics intubate, defibrillate and administer some medications, often in consultation with physicians. I know many basic level paramedics who know quite a bit of medicine and are anxious to learn yet more. In a big city, during rush hour, it can take many minutes to arrive at a hospital.
When time is at a premium, such as in many emergencies, using it wisely is better. This does not mean, of course, everything can be or should be definitively dealt with in the prehospital setting. But emergency physicians do rely on the judgement of paramedics, what they saw at the scene, what they might know about familiar patients, and much more. It isn’t just driving, but they also need to do that extremely well.
I recently needed an ambulance. And first came the ambulance with the EMTs, who couldn’t really do anything for me except take my blood pressure. Then came the paramedics, who were able to perform and interpret the EKG , determine what my problem was ( SVT ) , try a couple of techniques to stop it and ultimately give me doses of medication via an IV (which, of course, they placed). The reason the paramedics could do so much more is that they had more training - EMTs in my state have around 150 hours of training and paramedics have more like 1500 hours.
And while starting pay for a fire department EMT in my city is about $40K ( with benefits, including health insurance and a pension) , top pay for paramedics is around $90K - my guess is that the $36K average salary includes only EMTs and not paramedics.
I don’t know if it was mentioned, but in the U.S. paramedics and EMTs are different things. Paramedics get a lot more training than EMTs. I think my EMT training was something like six weeks.
I understand that. In Canada the terms are more interchangeable. The basic level paramedics still have significant medical skills.
It just doesn’t make sense to me. In fairness, so many things do not. Isn’t a patient better off if their low or high blood sugar is quickly identified, their heart rhythm traced, their pain and discomfort assuaged, initiation of common and obvious treatments gets underway sooner (provided these things are appropriate which is usually the case)? Some of this doubtless comes from different systems and philosophies and probably medicolegal concerns. I certainly don’t think Canada always does things really well.
In cities, fire departments often arrive first at the scene of an accident and have basic life support skills (maybe more like EMTs), but they still apply oxygen and can do things beyond taking vitals. Other responders sometimes begrudge this, I don’t. If there is a serious MVC that’s exactly who you want there opening the doors and making the scene safe. Yes, some knowledge is better than none, but being able to identify things both common or dangerous is helpful.
I can’t help thinking these services will look very different in a couple decades. I wonder which country has the most efficient EMS?
To be fair, there are certain situations that do not really need a paramedic, I don’t think I’d say that it’s usually the case that people need blood sugar levels identified or heart rhythm traced. I’ve had occasion to be at a fair number of ambulance calls - most of them involved bleeding, possible broken bones or sprains, overdoses and situations where you might want someone trained in CPR transporting the patients just in case. You don’t need to be a paramedic to administer Narcan or to try to stop a bloody nose and it’s probably more efficient to only send paramedics on the calls where their skills are likely to be needed.
I understand what you are saying. Doubtless you are right, but you could say most situations dealt with by professionals are more often mundane than requiring all their skills. This is much less true of emergency responders than most other professionals, so more training is often better than less. The reason for less training is entirely due to costs.
If I did a full medical exam on someone using every little used thing I know (see Sapira, The Art Of Bedside Diagnosis, etc.), it would literally take hours. In practice, this is never done and you only do what is required for a specific situation. That does not make the esoterica not worth knowing.
Absolutely - but that’s always going to be the case. Otherwise there would be an ER doctor on every ambulance.
There are some things so commonly encountered that it strikes me as a very unproductive way of saving money. Lives also have value. Not every incident requires taking a blood sugar or heart tracing, nor in most individual cases would it make a difference. And yet, on average, taking a blood sugar or tracing would make a difference every single day, probably multiple times, being that frequent.
I took EMT training back in the early 1980s (something sponsored by work, to have people able to respond to emergencies in the office) and it was 3-4 months at most - 2 hours or so, twice a week. Definitely less than paramedic training would have been.
And at one point I actually interviewed to be an EMT on the ambulance squad serving our town. No paid EMTs / paramedics at all, as far as I could tell. I wound up not following through, as I had just started a new job.
Where we live now, there is a county fire department about 2-3 miles in one direction, and a volunteer FD about 2 miles in another. No clue how billing is handled, if any. To the best of my knowledge, my in-laws were never billed for their ambulance rides in Florida, either, though they were on Medicare so it may well have been covered by that.
My city (pop 13k) has a fully-staffed fire/EMT department. Wages are $60k-83k with yearly longevity bonuses ($400-$2000). The difference here is that all EMTs have to be firefighters too. They’re all in the IAFF union, which I was surprised to learn is not universal for fire departments.
I think we practice “soft billing” meaning if you live in the city and use the city service, you don’t have to pay or it’s a very nominal fee. I haven’t asked my mom but I don’t think we got a bill for dad’s final ride.
Our department is nominally funded by property tax, but mostly funded by city income tax (as are most things in our city). Yes, city income tax is a thing in Ohio.
We contract out our services to two neighboring townships. Those townships independently pay for their own equipment and buildings, but our Chief runs the show and staffs them for all of us. I asked the Chief what’s the benefit to us to have this setup, as we’re definitely not making a profit on it. He says it’s because we have to do so much mutual aid with them anyway, it’s easier if we just run as one.
Our city has definitely put a priority on having good fire and EMS services, so people are willing to pay the costs to keep it staffed and to keep the equipment up. Our fire department, including in-house dispatch, is ~10% of our annual budget.
So far it has proven its worth. A good FD gets you a good ISO rating which is good for local insurance rates. Also our community is chock full of elderly people, including 5 nursing homes/rehab centers which often rely on our EMS. My neighborhood itself has probably half of its residents over 70. We get an ambulance down here at least once a week.
So you CAN have good EMS service in America. You just have to be willing to pay for it, via taxes. It can lead to devastating effects when the department is funded by nickels and dimes from payment for calls.
This is what gives me pause about the United States. It is a Canadian stereotype and doubtless often (maybe usually) inaccurate. In Canada government is too large and moneys are often squandered on dubious things, some of which is inevitable and some based on my limited perspective on what the priorities should be. Services are imperfect, of course, but often reasonably timely and professional.
The idea low taxes are the most important thing is silly if it greatly decreases quality of life or things obviously important. I read the first fire service was a “pay as you need it” operation in Ancient Rome run by an enterprising senator who became a sestertii multimillionaire (one might pay a lot for something suddenly needed). Governments are sometimes slow to learn planning saves money (as are we all); masks and Covid equipment is much cheaper and higher quality if available before everyone in the world wants it at the same time; snacks cheaper when sold outside of airports.
Just got a bill for an ambulance ride I didn’t take in a city I wasn’t in.
It’s “legitimate” in that it isn’t an outright scam. The EMS service is real, and it came from their billing company. $1280 for a 1.1 mile trip.
I left a message with the billing company, and we’ll see if they ever get back to me. I assume I’ll get to dispute it with collection companies and the credit bureaus. What fun.
A friend got a $4000 bill for a relatively short ambulance ride - he was severely injured in a bicycle accident and the EMTs did a great job taking care of him. The ride was probably 3-4 miles, not sure which hospital they took him to. His insurance covered some but not all of the cost, and I know his insurance is pretty good.
In Australia, ambulances and paramedic services are considered essential services, and are administered by the various state governments.
When I lived in Victoria, you needed to take out ‘ambulance insurance’ which cost app $50 per year (single) or $100 for family coverage. This was waived for people on government benefits.
In Queensland, the ambulance service is entirely funded by the state government, no levy due.
This means that if I need an ambulance, no matter what the reason or seriousness, no matter whether I am in an urban area or a bazillion kilometres out in the boonies (where either a fixed-wing or chopper will attend) I will never see a bill of any kind. Ever.
In this thread I said the term “essential services” in Canada had to do with rights, before Covid, not necessarily funding. But this is incorrect. The Canadian government has been at odds with some police services run by Indigenous peoples. They have not been labelled essential and so are sporadically funded. Clearly this needs to change, as the Chiefs of Police recognize.