Thursday, September 17, 2009

MAST to Fire Department part 3--the devil in the details

The devil is in the are some:

Residency requirement for MAST employees. If waivers are granted, how do other city workers feel about that?

Pension issues--not just local 42 and vesting, but what about the city workers of local 500?

Medical supervision and protocols--making sure we are doing the best evidence based efficient emergency care.

The women of MAST in the mostly male firehouses. (A woman firefighter came to me and said women were fine in the firehouses--but history tells us otherwise...)

Static/fixed posting (ambulances in firehouses) VS dynamic posting (ambulances moving).

Response times for advanced life support personnel. If you only have EMT-B, EMT-AED and EMT-I on fire trucks and ambulances are further away, you might have basic care arrive in 8 minutes, but have advanced care and the transporting vehicle 15 minutes away. This matters to the patient's outcome! Viva the Golden Hour (especially for trauma cases).

Same number of personnel on duty all the time VS variable numbers of personnel on duty at different times. (A model used in hospital ERs--you need more nurses and doctors at 3 p.m. than at 3 a.m.)

24 hour shifts VS shorter shifts (12, 10 and 8) Busy ambulance units will have tired people if staffed on a 24 hour shift. Study data is relentless on how bad 24 hour shifts are for performance. Driving, intellectual performance and the medic's home life all suffer.

Oh, there's probably more, but that's all I can think of now.

I think that's enough.

No comments: