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Doktor
02 May 16,, 23:37
Guys,

In a neverending talk about which is better and how far should the government reach the safety net, we came to EMS like ambulance and FD. Wont go with which is my take on this, would like to hear your opinions. Even better if you could back it up with first hand experience, as well as ways of funding private entities to do the job.

zraver
03 May 16,, 04:16
Guys,

In a neverending talk about which is better and how far should the government reach the safety net, we came to EMS like ambulance and FD. Wont go with which is my take on this, would like to hear your opinions. Even better if you could back it up with first hand experience, as well as ways of funding private entities to do the job.

Much of America is covered by private EMS. Government EMS won't provide any better services. The only difference is who pays, insurance providers and policy holders via fees, or government and citizens via taxes. Additionally, almost every medical call goes out to both EMS and fire/rescue which makes sure there is plenty of manpower avaible for what ever is needed until its time to transport when normally just 2 people are needed. If a third is needed for say something like CPR in progress, they grab a firefighter/emt from fire rescue and have them picked up from the hospital. Related to a point I make later, with ambulance services, most services are free unless they transport and so most people wont delay in calling an ambulance though it does happen.

Fire/Rescue in the US is almost totally a government service. A private company would find it prohibitively expensive to man engines, pumpers, ladders, rescue rigs, brush trucks and towers and with very little chance to find paying gigs. For example at a wreck, EMS gets the patients, and the tow companies get the cars even though its fire/rescue who has to do all the extrication and who is responsible for any major hazmat spills. Sure a house fire might offer a chance for compensation if the home owner has insurance but then you run into a dangerous situation where people will delay calling for help out of fear of the bill until its too late. Same reason SAR never charges for rescue.

Officer of Engineers
03 May 16,, 07:50
Jason,

Where does your organization fits in? I know you're a volunteer ... and God Bless You ... and you have standards but can you be sued for not doing your job? Has volunteer rescue got sued before?

kato
03 May 16,, 08:11
In Germany general commercial entry to the previously oligopolous market for EMS was forced by the European Union in a couple court cases about a decade ago. Didn't really have any effect though, the previous oligarchs still dominate the market (four entities, including the German Red Cross holding 50% of the market by itself). Commercial EMS have only made significant inroads on transport services, e.g. driving patients from home to hospitals. Government doesn't pay for such services, it's all paid by insurance companies on standard rates; small commercial entities in this market usually are heavily pressured financially and rarely really turn a profit.

Firefighting, as opposed to that, is mostly in the hands of unpaid volunteer groups in Germany. Only cities above (depending on state) 80,000-100,000 people have to field professional firefighters by law. The local municipalities have to provide the financing for the equipment for those volunteer groups, standardization occurs on state level. Companies dealing with hazmat have to field their own firefighting services, usually by forming groups from their employees headed by a few professionals.

Officer of Engineers
03 May 16,, 08:15
Same question, can volunteers be sued for not doing their jobs?

kato
03 May 16,, 11:28
A bit complicated:

If a volunteer causes damage while performing "sovereign tasks" (i.e. on an official firefighting mission) the state is held liable instead of the individual.

If the volunteers cause damage while not performing such a task - i.e. e.g. firefighters that perform a demonstration at some event - then they are held liable individually; however law mandates that the state has to cover volunteer firefighters by buying liability insurance for them. Otherwise volunteer firefighters count as "employees of the state" in this regard with the same accountabilities (e.g. regarding damaging their equipment etc).

The "not doing their job" part of liability has been restricted by courts to gross negligence and e.g. operating differently than they have been trained.

Albany Rifles
03 May 16,, 15:11
Same question, can volunteers be sued for not doing their jobs?

In the US, we have Good Samaritan Laws which can cover in almost all cases when a volunteer steps in to provide help.

So it may bump up by locality, etc. Now if in the case of volunteer EMS & FD (which is what my county has) if one of the volunteers goofs up on duty I believe they are covered. The wronged party/parties could still sue the county.

That is not to say there aren't plenty of ambulance chasers around who try to sue the company that paved the road on which the accident occurred!

Monash
03 May 16,, 15:22
A bit complicated:

If a volunteer causes damage while performing "sovereign tasks" (i.e. on an official firefighting mission) the state is held liable instead of the individual.

If the volunteers cause damage while not performing such a task - i.e. e.g. firefighters that perform a demonstration at some event - then they are held liable individually; however law mandates that the state has to cover volunteer firefighters by buying liability insurance for them. Otherwise volunteer firefighters count as "employees of the state" in this regard with the same accountabilities (e.g. regarding damaging their equipment etc).

The "not doing their job" part of liability has been restricted by courts to gross negligence and e.g. operating differently than they have been trained.

All EMS in Australia is government funded and run (to a large extent by levy's on insurance policies). Some specific support services like radio communications and vehicle maintenance might be outsourced but the rest is public. Volunteers are covered while performing any tasks in uniform. Injuring someone at a public display would be a liability for the organization (and hence the government) but no the individual would be held personally liable - why sue Joe Blogs when the government as a far bigger wallet. Gross negligence or failure to follow procedures resulting in deaths/injuries might in theory lead to criminal prosecutions but such cases are as rear as hens teeth.

Most times the organization concerned is prosecuted and fined. For example there have been instances where controlled burns being conducted by volunteer firefighters designed to reduce the levels of dry undergrowth before summer have got out of hand and caused deaths or damage to property. Again the firefighting organization concerned is prosecuted if negligence is an issue. At the end of the day no-one would volunteer for any public service if they were to be held financially or criminally accountable for every possible misstep.

kato
03 May 16,, 19:02
For example there have been instances where controlled burns being conducted by volunteer firefighters designed to reduce the levels of dry undergrowth before summer have got out of hand and caused deaths or damage to property. Again the firefighting organization concerned is prosecuted if negligence is an issue.
That for example would be a case for checking the training manuals here.

Classic cases here e.g. involve minor fires that are put out, embers are checked for in the immediate area of the fire and the firefighters leave; the fire still reignites later on due to some embers having been carried away by wind. In that case sueing the firefighters for damages (since they did not put up someone watching out for possible reignition) has been rebuffed in courts due to them fulfilling their duty in line with their training and - on top - the fact that in their volunteer situation one cannot expect experience or persistance beyond what's in the training manuals.

Doktor
03 May 16,, 19:21
Ober here the FD is professional, paid by the local government, but employed in the MoI. Smaller towns have volunteers, but the command is proffessional, employeed under Ministry of Interior.

Ambulance is solely under the Ministry of health.

Good luck suing them over negligence.

zraver
04 May 16,, 05:01
Jason,

Where does your organization fits in? I know you're a volunteer ... and God Bless You ... and you have standards but can you be sued for not doing your job? Has volunteer rescue got sued before?

The team I am on now is backed by a county government, and I'm about to be a listed single resource at the state level (k9, wilderness area search) so we have immunity while performing our official duties except in cases of gross negligence. When I do pure volunteer work related to rescue or relief I am covered by good Samaritan laws so long as I do not exceed my scope of training or engage in gross negligence, and have received no compensation.

We train all the time, for us K9 handlers its a little bit every night and hard core every weekend. Then there is bi-weekly team training and quarterly drills/ certification classes. I'm currently a search and rescue tech II, swift water rescue tech A (about to expire), medical first responder, wilderness first responder and am also trained in cpr/aed, damage assessment, rescue boat operations and am about to go certify with Yip as a canine search and rescue tech II (60-80 acres daylight 1 victim). Ivy the dog I started with washed out for being too nervy. Got Yip a bit over a year ago and we are finally ready to go certify. K9 teams certify together. I'll only be certified with Yip and her with I. For her size, she is the most athletic dog I've ever seen. Body of a whippet, head of a terrier, whip smart but stubborn as hell.


Video of her extreme athleticism, 28lbs with a 7' vertical jump
https://docs.google.com/open?id=0B30Y5Edf7jEMR0FMQWg0MUM1eXc

zraver
04 May 16,, 05:07
That for example would be a case for checking the training manuals here.

Classic cases here e.g. involve minor fires that are put out, embers are checked for in the immediate area of the fire and the firefighters leave; the fire still reignites later on due to some embers having been carried away by wind. In that case sueing the firefighters for damages (since they did not put up someone watching out for possible reignition) has been rebuffed in courts due to them fulfilling their duty in line with their training and - on top - the fact that in their volunteer situation one cannot expect experience or persistance beyond what's in the training manuals.

Fire is really hard to kill, especially deep in timber or structures where the fuel itself protects embers from the water and traps heat which dries out what was wet. Drywall/ insulation is famous for this. Re-kindles are common with house fires and after a certain point, or if you are sure there is no risk to life all you can do is surround and drown in a defensive fight and then sift through the ashes looking for the hot spots.

In the US we have 2 types of volunteers, trained, which are considered unpaid professionals and we must meet professional standards. The other is spontaneous or emergent, and they are only expect to perform in a reasonable manner.

DonBelt
04 May 16,, 06:26
Many FD's are taking up the EMS role as the number of fires are down. There is some debate in areas whether to have a private ambulance company provide EMS, many will contract for very short money as they make it from insurance payments but fire-based EMS usually makes enough money to pay for itself with a surplus. Many places in Mass will require you to be an EMT or better to be a firefighter.

kato
04 May 16,, 17:27
In the US we have 2 types of volunteers, trained, which are considered unpaid professionals and we must meet professional standards.
Germany requires between 150 hours basic training for the "volunteer" sort plus up to 70 hours specialist training (for breathing apparatus, radios, machinery etc) and annual 40 hours advanced training, which seems to be straight up in the middle between the two types in the US from a cursory glance via Google.

Gun Grape
08 May 16,, 02:34
Much of America is covered by private EMS. Government EMS won't provide any better services. The only difference is who pays, insurance providers and policy holders via fees, or government and citizens via taxes. Additionally, almost every medical call goes out to both EMS and fire/rescue which makes sure there is plenty of manpower avaible for what ever is needed until its time to transport when normally just 2 people are needed. If a third is needed for say something like CPR in progress, they grab a firefighter/emt from fire rescue and have them picked up from the hospital. Related to a point I make later, with ambulance services, most services are free unless they transport and so most people wont delay in calling an ambulance though it does happen.

I'm gonna disagree with that. That may be the norm in your part of the US but not all. Private EMS (ambulance) services were the norm before the 80s. Now the norm is government connected, either a stand alone government (city/County) entity or one ran from the government funded public hospital.

Private ambulance companies do provide routine transport services between hospitals, transport to medical appointments for some hospital patients but they are not the ones than respond when a ambulance is dispatched to a wreck or home emergency.

Like these guys

http://www.americanambulancesvc.com/services.asp

In Florida, the ambulance sends you a bill if they transport or not. You are paying for emergency medical care/evaluation not the ride to the hospital.

There are lots of reasons that private companies are rarely in the EMS business. Form the requirement of having a sponsoring physician. Unless that Fire rescue person is covered by the sponsoring physician for the ambulance service he/she cannot do CPR in the back of the ambulance without the physician being held liable if something goes wrong.. Our county EMS director was suspended recently because he had a new hire paramedic working before the sponsoring physician had signed off on him. The Doc threatened to pull his sponsorship over the service.

Not being able to contract with a specific hospital to bring all the patients they pick up to a certain facility. Patients have the right to choose which hospital they are being transported to to receive care.

Lastly there are laws that say that if emergency services are started in an area they cannot be stopped. If the private company or even volunteer group that has set up operation goes bust, the local government is required to step in and maintain services. So its hard to get a business license under those circumstances.

Gun Grape
08 May 16,, 02:51
Can a volunteer be sued/held liable? Yes, with an explanation.

Most states have Good Samaritan laws like AR stated. As long as the vol or for hire EMS person is working within their training they cannot be sued. If they overstep that boundary and attempt something that they are not certified/trained to do then they are liable.

easy example A first responder can perform the heimlich maneuver on a choking victim. He can put his fingers in the mouth and try to remove any seen obstructions. Those actions he cannot be sued for because he was trained to perform them. But when he pulls out the xacto knife and attempts to perform a tracheostomy he has overstepped his boundary and will be held liable for any injury he causes.

Many Good Samaritan laws have a flip side that most people are not aware of. If a trained person fails to respond he can be held liable/negligent. One of the reasons all EMTs around here have jump bags in their POV.

If a trained EMS responder, not on duty fails to stop and render aid they can be held liable, be charged. If EMT Jones and his wife are going home after dinner and a movie with the wife and the guy in from of him runs off the road and has an accident, EMT Jones is required by law to render aid until relieved by other EMS personnel.

kato
08 May 16,, 03:18
Patients have the right to choose which hospital they are being transported to to receive care.
For free?

Over here, emergency services always bring you to the next hospital able to admit you. If you want a different one (for treatment beyond first aid), you can then arrange transport from there - usually with one of the private companies - to the hospital of your choice. Insurance only pays for transport to the two closest ones, and only if you require medical care during transport, if the transport is required for medical purposes or if you got permission from them beforehand. Typical fee for a 10-mile drive would be around $130, some private companies will underbid that by 10-20 bucks. If you're transported in an emergency services vehicle without insurance paying the fee for the same distance would be around $450-500. Payable on the spot.

Gun Grape
08 May 16,, 04:03
For free?

I can only say for my local area. The county EMS service transports to any of the 3 hospitals with an emergency room in the area for a flat fee. All within a 40 mile radius. This is for a emergency response only. I have the choice between 2 public hospitals and a private hospital.

That said, the private hospital does not accept patients without insurance. If you go there and do not have insurance or the money to pay up front, they will stabilize your injury to the point you are safe to travel then call an ambulance/have a family member to transport you to one of the public hospitals. You pay for both ambulance calls.

I've been to that ER, as a patient. The first question from them is "Is this a life threatening emergency?" Then Its "We don't accept medicare/medicaid, what insurance do you have?" "I need to see your insurance card and a major credit card" Only after they are satisfied you have the means to pay do you start receiving medical care.

The private ambulance companies that transport from home care/nursing home or inter-hospital transports have their own fee schedule.

anotar
31 Oct 16,, 05:19
Guys,

In a neverending talk about which is better and how far should the government reach the safety net, we came to EMS like ambulance and FD. Wont go with which is my take on this, would like to hear your opinions. Even better if you could back it up with first hand experience, as well as ways of funding private entities to do the job.

Greetings all,

Let me preface this by saying that I am trying to find the "Introductions" forum which I cannot seem to find so instead of jabbering about stuff like the F35's catching on fire I'll talk about something that I have a tiny bit of first hand knowledge about.

Anyway, I live in a pretty rural area and we have a volunteer EMS and fire system here. The entities are separate and the fire departments actually get some money, the EMS system is all pretty much self funded and if we can find a grant for something we can do that as well sometimes. Even though we are volunteers we can still get sued for things like "not providing care to the level we have been trained at" and some such. May not seem like a big thing until you go on an accident run and one of the drivers in the accident is up and walking around while you are working on the less fortunate one, second ambulance gets there a little while later then trauma packages the person and transports them to the hospital. Later you find out the walker had already sued a different person when they were in a different accident a few years earlier, as if there was any sort of spine injury yes you could be sued even though you were working on a different patient you should have instructed this person to not be walking around. Whether or not a lawsuit would be successful is a different matter but make no mistake, you can get sued.

In regards to costs, things are so screwed up there is really no one single place to pick as a starting point. Personally I think the beginning should be there needs to be a price list made available to the public itemizing what the costs are, from what aspirin and band aids cost to how much a heart valve or hip replacement costs. In the US it is not allowed to hide costs at gas stations, why should it be allowed for hospitals?

I will also say that the closest hospital averages about 25 miles away, and even so it takes more time to do the paperwork after the run than it typically does to do the actual run itself.

Anyway, greetings to all from a long time lurker!

A