Anyone read the L.A. Times??  This article was in there the other day, never in the Crapofornian...  A study was done out of UCLA.  It stated the sooner ALS intervention was provided to cardiac arrest patients, even before getting to an ER, the stronger the chance the patient had for survival.  Duh...   The reason...  When somone is taken to an emergency room, whether by ambulance or by family, patients are triaged....  Hmm...  Triage?   It's a French word meaning to sort, do the greatest good for the greatest number...  So in a crowded ER, they are going to try and save the most viable patients.  Now back to Kern and the report.  The report stated that on-scene paramedics can give one on one patient care, stabilize and than transport.  Doesn't it make sense to have fire-medics working with private medics?   The more paramedics the better.

Grassrootsmedic, thanks for the input, but this is Ca.  In FDNY, I have been told by FDNY guys that a fair amount of them are so busy running "Fire" calls, they need a third service EMS unit to handle EMS.  I also think you should check with the local stations around here and you'll find most of the FF's like being at the busy stations to run calls and put thier skills to use.  And yes, 80% of those calls are medical aid.  Firefighters here have AED's, and compitube skills.  Visit any of the hospitals in Bakersfield (Serious patients are transfered to Bako ASAP.  Tying up yet another ambulance.) and you'll see ambulances stacked up waiting for beds.  More paramedics unavailable.  I agree with you, most are BLS or less, but with a profit driven ambulance company and 911 abusers, thats what you get.

 You can throw worst case scenarios into any response plan like having engines responding back and forth across their response areas. Pretty rare events. And if engines are crossing response areas to run multiple medical calls, then the local ambulances are already long gone transporting those calls. The engines you mentioned belong to who Bakersfield City? Some other department? We're talking about the KCFD in rural areas. Look at ambulance response times in and around Bakersfield when call volumes are up. Look how bad response times go up to outlying areas when call volumes are up in Bakersfield.

Wow, the assumptions are flying! Guess the ambulance personnel should never promote to supervisor for better pay because they will instantly turn into EMS hating money grubbers. The firefighter at my station wants to go to medic school because he loves EMS! Why do you private guys assume that because a person tries to improve their income and make a better life for their family and circumstances (by going to the fire service) they must hate EMS? You say go to any fire station and ask how they feel aout EMS. I've never seen any of you at any of my stations asking.

If we look at the PMC issue itself it pretty easy to see that a fire medic is what they want, they are willing to pay for and for 1/3 the cost per parcel vs. private ambulance (see EMS report on the BOS agenda)  http://www.co.kern.ca.us/cl..., and improves the situation. PMC is bearing the cost, not the rest of the county. Throwing that issue out is just a smoke screen to distract from the real issue: lack of timely ALS in PMC. Future quality of care issues are just far flung assumptions. 

In remote areas, I have found the people to be hearty, independent people who generally take care of themselves except in the most urgent care cases where they can't. That's when they need timely care, not just want it. Since we're also discussing the transport issues, in the critical care cases in PMC an air ambulance is the choice for transport. A ground ambulance from Frazier Park should arrive within a few minutes of helicopter arrival to transport the patient to the helicopter when ground transport is needed. If there is no ambulance in Frazier Park it's obvious the helicopter is going to be sitting a long time waiting for ground transport (Unless someone like the fire department had a transport unit to hand off with the private air or ground ambulance...hmmm). Since the air ambulance can’t launch for cardiac arrest (per county EMS protocol) unless they respond to ALS intervention, the sooner ALS is started and a response is seen, the sooner rapid transport by air can begin.

This assumes the air ambulance is available. We could have another one available for use in the system, but again, the anti-fire medic, anti-fire transport rhetoric prevents the KCFD helicopter from transporting even as a last resort. Yes, 408 could be on a fire and unavailable, but that too is "worst casing" people out of a service that is usually available. As often as the flight or pilot conditions cause the Bakersfield based air ambulance to refuse missions KCFD's helicopter should not be held back for the reasons it is: KCFD is not permitted to have flight qualified paramedics, and resistance by private companies.

How about the multi-patient/multi-ambulance call? Anyone ever have a car crash in remote areas? The first in ambulance paramedic has to remain on scene until another paramedic arrives or the last patient is transported to avoid patient abandonment laws. Here we go again waiting for the Arvin or worse unit to arrive again. A non-transporting PMC fire based medic who arrives first and stabilizes can remain on scene so the ambulances, ground and air, can transport.

 Hello,  Have you seen Ross Elliot's updated Emergency Medical Report?  According to Ross's stats, my husband was dead 11 to 19 minutes before the fire fighters arrived at our home?  Why than did they bother to send the ambulance and the helicopter?  And why were the fire fighters so concered by the hour delay in the arrival of the ambulance?  I have to assume that my husband is the "Sudden Cardiac Death" mentioned in Ross's report for Pine Mountain in 2005.  At least mentioned this time around, in the last report his death was totally excluded.  Karen Bailey 

 Hi, If I am reading Ross Elliot's updated Emergency Medical Services Report correctly - he is saying that my husband was dead 11 to 17 minutes before the the fire fighters even arrived at our home.  Where in the HELL does that come from and why did they bother to send the ambulance and the helicopter?  Since my husband died in Pine Mountain in 2005, I assume that he is the "Sudden Cardiac Death" in ross's stats for Pine Mountain in 2005.     Karen Bailey  

 I have been reading the posts regarding ALS service to the more remote areas of Kern county. I am new to this location, however, i have been activley involved in the exact sitauations you folks have been worrying about. I have been in EMS for many years in both urban and rural areas, and having lived and worked as a paramedic in both i feel that i can provide some further insight. though i could go on for hours about the problems and deficits of rural ambulance service, but i will stick to two that seem to be a reaccuring theme on this issue here. First and foremost the main isse/problem is in EMS as a whole and our failure to provide the public with a definition of what EMS, advanced life support services and basic life support services can provide. The general population lacks an understand of what a medical emergency truy is, i do understand that this is because EMS has failed to provide this, and of course television and moveis regarding EMS/public service are grossly inaccurate. so the definition of a medical emergency according the American Hear association( AHA), which provides treatment protocols for prehospital and emergency room care alike are identical. the MD and paramedic must have the same AHA certifications in order to practice, in fact the paramedic is required to have more certifications than the emergency room MD. the AHA definition of a medical emergency is

"A medical emergency is an injury or illness that is acute and poses an immediate threat to a person's life or long term health. These emergencies may require assistance from another person, who should ideally be suitably qualified to do so, although some of these emergencies can be dealt with by the victim themselves. Dependant on the severity of the emergency, and the quality of any treatment given, it may require the involvement of multiple levels of care, from a first aider to an emergency physician through to specialist surgeons.

Any response to an emergency medical situation will depend strongly on the situation, the patient involved and availability of resources to help them. It will also vary depending on whether the emergency occurs whilst in hospital under medical care, or outside of medical care (for instance, in the street or alone at home).

I'll simplify this with a few examples. calling 911 for a sprained ankle is not a medical emergency, as are most calls that 911 recieves.  This seems obvious, however, there are consequences to this. the ambulance dispatched to this call is capable of providing advanced life support services(ALS), so while this required no more treatment than one could do at home, and leter if needed be driven to that persons primary care physician or to the ER, that ALS unit is no longer available for a true medical emergency. Another important side note to this is that the public assume that when when transported by an ambulance they will be taking directly to ED and have a bed and immediate care, as opposed to sitting in the waiting room at the hospital. this is not the case. patients are still 'triaged' at the hospital. meaning that if the condition is not a medical emergency that patient will still be sent to the waiting room. In this example, with transport from this area, that ALS unit will no be available again for 3-4 hours in your service area.

Secondly, in regards to the fire department providing ALS level care. the issue that has been discussed is transport to definitive care. This is an absolute truth. transport to defiitive care is part of the 4 step chain of survival by the AHA. and yes in some cases ALS can provied definitove care. those cases are few. in other cases interventions by paramedics can substanitally impact the survival of a patient. thise cases are aslo few. one example given in this blog was giving lasix to a patient in congestive heart failure, what was failed to mention is that lasix takes 30-60 mins to have any effect on the patient. It something we do prehospitaly to get the process "started". Point being that transport to definitive care is the most important link in the chain of survival. So the question of haveing firefighters be able to be paramedics come to mind. There are many many statistics to be found online, through the AHA, various Fire dapartments, etc. There are some fire fighters who are good paramedics, who are interested in paramedicine, however, go to any firehouse and ask the personell where their interests lie. the answer is in firefighting. Firefighter are given incentives to become trained in further areas, i.e. hazmat, confined space rescue, interior firefighting. the incentive being money and of course, prestige. The Fire department of New York ( my origins) and LA city are prime examples. In New York, though fire and EMS both belong to the same FDNY system they are seperate entities, which was accomplished in the mid 90's for a number of reasons. Primarily patient care and skill maintance. in order to preform either job, there are numerous continuing skill sessions, lectures, drills, etc  in order to maintain proficiency in the selected field. as the saying goes "jack of all trades, master of known". Firefighters have significantly more practice in firefighting then in medical care, just as paramedics have significantly more competance in paramedicine, simply because we use it more. the number of calls that are true medical emergencys are few, especially in rural areas. And all the classes and lab sessions don't make up for actual experience. In LA county where firefighters run on both fire and rescue, the rescue statistics are abysmal. The statistics are available by contacting the LA county department of EMS, as such the firemedics in LA county, which is far busier that Kern county in rescue calls, are consistently having medications and procedures removed from their protocols because of their failue to preform them properly.  Having worked in many types systems, each solution has its issues. One that i have found that would seem to answer the questions posed on this site, is a basic life support fire department that provides transport and meets an ALS  provider en route to the hospital. All firefighters are trained at the basic life support level, therefore being able to provied some care in the event of medical emergencys, and most importantly being able to provide timely transport to definitve care while still being able to have ALS access much sooner then would be the norm, allowing the patient rapid transport, early access to advanced life support services. The fire department is already subsidized through tax payer funds.

this is but one of many solutions available. Please feel free to respond with your thoughts on the subject

 Sorry ventura422, but Im sick and tired of all this non-sense and excuse me for rambling in advance.....

Im sure that the medic rig "Ventura422" that was just recently stationed in Gorman 24/7 as of March 1st will see their fair share of SVT's, CHF patients etc.... NOT!  Get off your high horse!  No one is saying we don't need private ambulance!  All that is being requested is an assessment engine paramedic in remote areas to begin treatment while the ambulance is responding to provide transportation.  The same applies to all of the private companies in Kern County.  I've been a firefighter/medic for 20 years and I agree with some of your comments but I wish private paramedics would quit thinking they are Para-Gods!  When was the last time you repelled down the side of a hill or hoisted down by helicopter to begin ALS treatment?  Or climbed into a wrecked vehicle to start an IV while your partner is providing an advanced airway with fuel on the ground with the possiblility of a fire starting?  Yes we fight fires, but we are well versed in EMS, USAR, hazmat, swiftwater rescue, extrication, etc....  Hours and hours of training that is on going throughout the year, every year!  How many hours of training do you get in these areas?  Hummmm, lets see 48 hours of continuing education to keep up your pm certs every 2 years. 

I can't remember the last time I saw an ambulance with a Jaws unit on board or 2 sets of turnout gear.  So, if you think we should get out of the EMS business then you better speak to your company about getting a larger budget in order to purchase turnout gear, extrication equipment, hazmat, USAR, swiftwater equipment etc....  Further more I don't think I'll be seeing a private ambulance medic doing a confined space rescue anytime soon either!   As for too many PM's on scene it actually helps to have extra medics.  In the case of a full arrest, one medic is doing an advanced airway, one is starting an IV and pushing meds, while the other is preparing to shock the patient or else make base station contact.  CPR is being done by the Fire fighter while the Engineer is assisting the medics with setting up an IV etc.... The Captain is comforting the family member who's loved one is lying on the floor or else contacting dispatch asking the ETA for the AMBULANCE arrival on scene to transport!!!!!  

For the paramedic ambulance, they forget to inform the public that if you have a full arrest, 1 medic is in the back, while the other is driving to the hospital.... (and that ambulance consists of 1 pm or an EMT, with the exception of Ventura422 which has 2 paramedics). For the general publics information,  Who is doing CPR, Ventilations, pushing drugs, insuring the ET tube remains secured, shocking the patient while driving?  I just hope that indivduals as yourself do not get in a situation where you have to wait 30 plus minutes for the PM ambulance to arrive while your family member is dying and all you have on scene is the "fire deparment" administering oxygen. C'mon, oxygen an AED and an EPI pen!  "LOL"!  Bottom line, everyone needs to work together!!!!!  That means private ambulance and the fire department.  This continued slamming of the fire deparment and how private ambulance pm's are superior has to stop!  There are just as many crappy ambulance medics as there are fire department PMs.  ie: the ambulance pm in frazier park that told the parents of a rattle snake victim to go private auto to the hospital, mean while the child starts experiencing shortness of breath, etc enroute to the hospital....  Yup, you medics are cream of the crop!  But like I said, there are bad firemedics as well too!  So, lets find a solution to the problem instead of this continued ongoing war of words....  ok!   Thank you

Question is? When the "Rural" firefighter performs an advanced procedure on a patient - Is that FF/Medic going to ride in to the ER to monitor that procedure? I have seen several instances where that happens and the only FF/Medic is gone from the station for an hour or two. And no other medics available to cover. And don't someone tell me they will move someone from another station. That doesn't always happen.

Yes, the LA County Intubation rate is low. California EMSA administrators are considering pulling intubation statewide because of it! I believe that quite a few people here made a lot of good valid points. Ventura422 - you made some excellence points and so did Countygirl. Whether KCFD gets there program or not, one thing will remain. The need for more EMS in rural areas of the county is there. The resources are not.  I know that their are areas of Kern that are not covered. And this is not a Hall/KCFD issue. Its County Wide!!!!! Tehachapi is not the only area that the County EMS is dealing with. It just happens to be a main area due to the high population of rural citizens in Stallion/BVS.

I will say that a fire medic is not the Holy Grail for answering your problems!! Nine times out of ten a patient with Chest pain has had that pain for more than a day and just cant take it no more. Or the stroke patient has had tingling and numbness for a week but chose to ignore it. And wait, what about the patient with Congestive Heart failure that is on home O2, is morbidly obese, smokes, and has obvious other undiagnosed medical problems that decides to call at 0200 hours and ties up the Fire Department Paramedic to change her O2 tank because she cant get out of her bed to change it and their is a true Seizure on the other side of the valley that turns into a cardiac arrest. What do you do there? Pre-existing conditions have so much weight on outcome. IE. Health history, medications, do they smoke? Do they drink alcohol?  

I have lived in other areas of the country in the Midwest and have seen TRUE rural areas with limited or no Full time EMS. When you do call you get the podunk redneck Paramedic volunteer that runs 1 call every 2 months, that drives in to the ambulance "building" and drives to your house in about an hour even though you were only 4 miles from the ambulance building, and the hospital is 2 hours away. 

That's just my 2 cents. Tear it apart how you wish! You always do! Happy Sunday!

Hey, now that your finished banging your drum Hall drummer.  Your own company represenitives said thier wasn't enough $$/profit to maintain the PMC contract.  CDF, it will never happen.  They are fighting to keep the contracts they still have.  Why should the taxpayers subsidize a private company that could go bankrupt, have employee strike etc..  AND, you are missing the big picture.  The fire dept does not want to take away anything from the privates including your job!!.   If I was a  private paramedic, I dont think I would want to work for minimum wage, post at 7-11 at 3 am., or hold up an ER wall for 4 hours.   The fire dept. just wants to help IMPROVE the EMS system that your boss, the mayor, owns.  Get medics onscene sooner, to stabilize and treat a person.  Working together for the benefit of a patient.

"If the people of Stallion and Bear Valley want a paramedic firefighter, fine. I just don't think the rest of the county should be expected to pay for it. Do you?"    I dont think the taxpayers should subsidize a private company.  The fire dept is putting stations, yes slowy, into rural areas to keep up with the population growth.  Ie; Stallion, 3rd person in Bear Valley, future station in Golden Hills.

I have witnessed some horrific accidents where, properly trained and equipped firefighters spent long periods in vehicles, aircraft etc extricating people.  Unable to start an IV, push pain meds etc. because they are not allowed to.  Meanwhile the Medics, although willing, are untrained, nor equiped to be in an unsafe area. 

Obviously you are biased against fire medics.  Couldn't passe the test?  Had a bad scene?  Just go on believing what they tell you at the company meetings.  Get paid for those??

"Lol, "amish to current". In most other counties you would be lucky to get a volunteer fire department with a population the size of bear valley and stallion. Take a look at San Luis Obsipo, Tulare, San Bernadino, Madera, Fresno, the list goes on. I think we have it pretty good here. True L.A. County is an exception, not having any more volunteer departments (at least that i know of) but their financial situation and tax base is much much greater than Kern. "

Get your facts straight Brainwashed drum.... All of those locations have fulltime fire depts.  Take a closer look and I'll better you'll see some, if not most of them have fire-medics also....  CDF even has medics..... 

And to add to my statement....

If the people of Stallion and Bear Valley want a paramedic firefighter, fine. I just don't think the rest of the county should be expected to pay for it. Do you?

Lol, "amish to current". In most other counties you would be lucky to get a volunteer fire department with a population the size of bear valley and stallion. Take a look at San Luis Obsipo, Tulare, San Bernadino, Madera, Fresno, the list goes on. I think we have it pretty good here. True L.A. County is an exception, not having any more volunteer departments (at least that i know of) but their financial situation and tax base is much much greater than Kern.

So if I'm bias against fire than answer this. For the same price, would it be better to have a full time ambulance or a fire paramedic stationed in rural areas?

People living in PMC accused the board of supervisors as well as Hall Ambulance for "putting money in front of lives". They had an offer on the table to staff a full time paramedic ambulance for an increase of $10.00 a month from the home owners association fees. Their response was to turn it down and run Hall out of town. Explain that for me. If $10.00 a month isn't worth a human life....what is?

Drummin4fun missed the point of this blog.  Bear Valley and Stallion Springs and several other rural areas ARE NOT asking for an ambulance to be stationed there.  What the rural areas are requesting that the KERN COUNTY FIRE STATIONS THAT ARE MANNED WITH FIREFIGHTERS IS  ALLOW THEM TO BECOME PARAMEDICS SO THEY CAN START TREATING THE PATIENT IMMEDIATELY AND NOT HAVE TO WAIT UP TO AN HOUR.   The call volume for ALS would also increase as residents now know there could be an hour wait for so many times they drive themselves to the ER (with CP) or  have a family member drive them.  But it is hard to do CPR and drive at the same time. What may have been appropriate 15 years ago for EMS is not now.  The population has doubled and it is now time to move the EMS from Amish level to the current standard of care.

Lets start with Pine Mountain Club. Hall left because of A) Lack of call volume and B) poor treatment from the community. How bad did they really want that ambulance there when a store owner refuses to serve a Hall EMT saying "your not welcome here"? People would flip the "bird" to hall employees as they are driving by. I think anyone could image how difficult staffing a station like that would be.

As far as technical rescue goes, last time I checked it doesn't take a paramedic to put oxygen on a patient in a car.

Countygirl - I was making a point about the fire department complaining that people of rural areas dont have paramedic service. But how can they blame private ambulance when they have plenty of areas without ANY coverage (Sand Canyon, North Edwards, Caliente). Just as many calls go out in those areas, if not more than areas like PMC, Glennville, Woody, etc. I understand why they don't have engines there. It's the same reason private ambulances don't post there. As well as the reason private ambulances don't post in areas like PMC. If they are so set on getting paramedic service to rural areas, then why aren't they rushing to place stations in those remote areas?

As far Rosamond goes. Yes generally private companies will adjust coverage when units go on calls (or Long Distance Transfers). But some coverage is better than none. Moving one of the 2 ambulance from Mojave to cover Rosamond seems acceptable to me. Like I said, I don't see engine 14 moving half way in case a second call goes out.

Thats nice that the NFPA "recommends" that you respond in a certain time frame. But I'm guessing KCFD's contract isn't at stake if they don't make those times. I guess a close eye would be good for performance. Either meet the times or get bid out by CDF.

If the county, thats right, THE COUNTY felt that the private ambulance was not making it to bear valley or stallion in a timely manor, then they would up the response zone to a 15 minute or 8 minute forcing the private ambulance to place a station or risk losing the area.

Once again, yes fire might run 75, 80, 90% medical calls. But whats 90% of 3 calls? You can't stay sharp on 2-3 calls a month. And for the record I don't dislike firefighters. I think they do a great job in this county fighting fires and helping on medical-aids. I however, do not feel the need to add paramedics to the rural systems. So yes they are nice to have in a "full arrest" scenario to help with CPR and a BVM. They are great for rescues, being that private ambulances don't carry the equipment to extricate patients that are "pinned in". Thats why we have a teired system in place.

And also for the record. I never took the fire test. I don't want to fight fires. It just doesn't interest me.

Countygirl--Ventura has tripped himself up so many times he going to fall!  Hope he doesn't hurt himself, esp. out in a rural area.  Then he would know how it feels to wait an hour for pain medicine from an ambulance paramedic!

Funny thing though. I'm sure lots of Hall employees are reading this and NOT ONE has backed ventura up on his point of view.  Any Hall employees want to jump in here and back up what ventura says?