A Couple More Thoughts on KCFD and EMS

What is done is indeed done. The Kansas City Fire Department has taken over emergency medical services in Kansas City. The imperfect meshing of systems and cultures is still in process after two years--anyone who says this thing is working perfectly is fooling themselves at this point.

Somewhere is a line where non-support turns into hostility, and sticking it out becomes tolerating abuse. The only ones who know where that line is are the people experiencing it. Because we are all individuals, with different experiences and needs, that threshold will be reached in different places. It is also up to each person to make up their mind what they will tolerate, and what is enough.

Once the squishy stuff of morale is out of the way, it is time to ask tough questions about operations. That brings us to the qualifications and abilities of those running the system. There are 24 crews running ridiculous numbers of calls in the city. There are 24 hour shifts in fire houses not staffed. The irony of a lot of dynamic (i.e. not stationed in a fire house) crews is not lost on me--the reduction of use of the dynamic model was one of the points used to sell the merger/take over.

Whatever you think of response time as a measure of performance, there is no doubt that it is not up to standard in many respects. Changing the numbers by changing the status of calls from emergency to non-emergency only puts lipstick on the ugly pig. Better to be honest and ask the hard questions about the system, or to admit that with the resources given, this may be the best that can be done--if that is true.

And when you bottom line this thing at this point, that is the question you have to ask: Are we doing the best job we can or do we need to change some things to truly do as well as we can do? That question can be applied both to EMS performance and to those morale issues.

An Era Passed

As has been previously noted here, Kansas City, Missouri emergency first responders are moving their radio communications to a new digital 700 MHz radio system. The police moved their communications in early November to the new system. Just yesterday, fire, both EMS and suppression, moved over to the new system. I hear tell that there have been a few glitches, as not only did they move to new radio hardware, they also changed software and dispatch method0logies.

That aside, there are just a few stragglers on my scanner, the way it is set up. Animal Control. The Veteran's Administration Hospital. Some of the airport. Until I can pony up the funds, or the price of 700 MHz scanners comes down some, my fun of scanner listening is over.

I am going to miss it.

Ambulance Tour

Station 28 was able to bring their ambulance to the recent Red Bridge Shopping Center party, and I took advantage to shoot some photos of the equipment. There have been some good changes in the 30 years since The Observer was doing prehospital EMS. A few things we wished for back in the day have been developed and incorporated into ambulances today.

Now most people will not need an ambulance ride, but if you do, or a relative of yours does, take this small tour around and see what it's like in there. A little bumpy, but not too scary.

So this is your basic Advanced Life Support ambulance. This usually is about all most people see of ambulances. That is a good thing--most folks manage to make it through most of their lives without needing a ride in an ambulance.

Here, a quick glace in the back--what you might see if you were passing by an accident scene or if the neighbors had to call for some reason.

Let's go inside shall we? If we were riding along, we might have a seat here. Back in the 1980s we called this the squad bench and it had no seat belts. Now you get a seat, and five point restraints.
If you are the patient, likely you will ride here, on the cot, facing the rear of the ambulance. Usually you will get to sit up some. Back in the day, it was common for the cot to sit flush against the wall but now it is mounted closer to the middle. There is actually room enough to stand over there now. The heart monitor is right there easy to attach to the patient and easy for the medic to see. The walls are lined with cabinets storing all kinds of supplies, More supplies are kept in compartments outside.

This area, at the patient's head, is the paramedic's care headquarters. Radio equipment is readily at hand to talk to dispatch, medical control and the destination hospital. Neither seat here is far from the patient, and medics can move quickly to take care of changes in patient condition.

Peering through the passage way into the driver's compartment, we see the Computer Aided Dispatch computer. You probably can't see it, but a map was up on the screen. Many CADs can send along quite a bit of information about a call, and Kansas City ambulances have had satellite tracking and GPS for several years.

As well as the computer, the front features buttons for the lights and siren and more radio equipment. It also has all the usual items you would find in any truck.

So, that what the inside of that noisy white box looks like. I hope you enjoyed your tour, and maybe even saw something new. It is my wish that none of my readers ever need to take a closer or longer look--unless you make EMS a career of course.

Well, Extra Safe Right Then...

At the McDonald's at Red Bridge and Hickman Mills June 24( a week ago yesterday), a convergence of ambulance crews. Response times have improved, as we noted before, but one wonders what folding and spindling is occurring to get it done? Some of my sources have been telling me about some odd positioning of ambulance units...

KCFD EMS: Best It Can Be?

I am becoming convinced that a vital part of life is dealing with failure and defeat. Failure is something that will happen to us as we live our lives. Some things we do will not work. We will exhibit bad judgement. We will commit, we will omit. It is going to happen. I wanted to follow up with part two of KCTV 5's report on the death of Frank Nigro. Mr. Nigro died while being transported between hospitals in inclement weather in January of this year

Dana Wright interviewed Dr. Joseph Salamone, Kansas City's EMS medical director. I found this interview troubling in many ways. However, this exchange really bothered me. First of all, Ms. Wright had to really chase Dr. Salamone around for an answer--he kept hiding behind not being able to discuss "this case."
"Give me a general example of how someone dies and a paramedic sitting a few inches away doesn’t notice he's dead," Wright said.

"I think that there are a variety of things that can happen, just as in a health care setting and depending on the degree of illness, the patient who has been medicated and appears to be comfortably sleeping," Salamone said. "You know we're not watching every, every heartbeat and respiration ...."

"Don't you think people will be surprised, though, that if you're in an ambulance someone's not necessarily paying attention to you?" Wright asked.

"Continuously paying attention to you? I don't think that's any different unfortunately than any health care setting in the country today, if not the world," Salamone said. "Nurses may sit at your bedside and document. They may not be watching you absolutely every second. And that's just part of medicine because unfortunately medicine is actually practiced by humans, too."

Wright: "I wanna know this won't happen again."

I can't guarantee that (it won't happen again)," Salamone said. "I couldn't guarantee that in my hospital, unfortunately."

When Wright pressed the issue of protocols that might prevent such failures in the future, an off camera voice interceded.

Wright: "There's no protocol that would prevent this from happening."

Then a voice comes from off camera--the camera backs out so you can see the person talking. No doubt, he's a lawyer.

Off camera lawyer: "You're saying that can happen and that leads to this specific case."

Wright's response: "I can't change the fact that a man died in the back of an ambulance and no one noticed," Wright said. "There's no protocol that would prevent that from happening."

Salamone: "I cannot discuss that case."..."...or how protocols may apply or be changed..." [snippets from Salamone's last statements.]

Watch for yourself--here's the link to the KCTV5 report. I wanted to quote that exchange exactly, not just taking the written report off the web, because I think it says something important about dealing with failure, first this failure and then failure as a whole. Because, as I said, it's gonna happen. The problem is when health care has fails, usually somebody gets hurt. It's disturbing to me that instead of going into a problem solving mode--Dr. Salamone goes into CYA mode after opening the door to the reality of human failure. Here we have a tragic case of an individual human failure and the medical director is too bound to the doctrine of CYA (with the help of Mr. OffCamera) to say well, yes, we might have an issue with protocols here--to say either the protocols need changing or we need training to make sure they are followed. If this is the best he can do, perhaps he should not have given this interview or at least not have given it right now (and no, throwing the individual paramedic under the bus, while tempting and rational sounding, will not address any systemic problem that is present.)

This is the EMS system we have right now--as political and ill advised as its conception was. Perhaps it is time to make it the best it can be--or evaluate different models for its administration if need be. If this sad case, a case which due to privacy laws (our old friend HIPAA) and possible lawsuits about which we may never learn the full truth, should demonstrate anything to us, it should show us that we have a lot of room for improvement and that there is no substitute for a corporate and individual commitment to excellence, both in planning and protocol and in delivery. That commitment includes taking full responsibility as an organization--even an organization that is government run--for failures and times that the work falls short of expectations.

One Year Out: After MAST Hangover Persists for KCFD

Well it's been about one year since the take over of ambulance service in Kansas City, MO and things are at best, unsettled. For many the feeling is that the service is not as good as it was. Recently, the editorial page at the Kansas City Star took notice--and wrote an excellent piece that asks all the right questions.Here's the link to the editorial, which is bylined "Kansas City Star editorial."

The issue of the response times has been talked about here and in other places. I have heard Chief Dyer's song and dance about how response times are not as important as they are made out to be and how it is important to deliver quality care. The times I have heard him he has been careful to not be overly dismissive. It sounds like he failed this time. In addition, I have heard the chief talk about how he feels that such concerns grow out of, not a public safety concern, but a political concern. However, all that posturing does not solve the problem--it tries to make itSomeone Else's Problem or even worse, says, "What problem? There's not a problem." All I'm hearing is that it is too expensive to solve the problem, or too hard to solve the problem. It's funny, we all know that MAST wasn't perfect, but did we hear about response time problems when MAST was running the ambulances?

The two other important concerns, raised by the editorial writer, are the use/non use of 24 shifts for EMS workers and the pension issue. The problems reflected in the 24 shift issues are those of badly blended work cultures and career goals, with a good dollop of legal labor issue thrown in. It is not an issue for fire departments where the EMS personnel are fully qualified firefighters and were hired with the understanding that they were firefighters as well as EMS providers--see Grandview and Lee's Summit for the easiest examples. Until the day comes that all EMS providers employed by KCMO are fully qualified firefighters also, this is going to be an issue, and a dividing point. Toss in the national discussion on the effects of 24 hour shifts, and this issue is not going away any time soon. As to the pension issue, it again is a function of the different nature of the personnel that the KCFD took in. MAST employees were under an entirely different type of retirement plan, one that cannot legally be rolled into or converted to the type of pension that firefighters are under. If the city had taken MAST in and made it its own department with its own management and command structure, something that would not cost the city as much (if any cost at all) could have been done without breaking promises that were made to the rank and file MAST employee. Now, it looks inevitable that the city will not provide a pension that matches completely the years of service of the former MAST worker. In the current political environment, I do not see that happening.

So there you go. The results of a politically motivated and understudied decision. Every single issue explored by this editorial should have been throughly studied BEFORE any action was taken, not a year AFTER the deed was done. To borrow a phrase, these were "known unknowns"--things we knew that could very well be issues with this merger idea. NONE of them were "unknown unknowns"--things that we didn't know were going to be issues.

It's a mess and now we have to, somehow, clean it up. Cleaning it up is going to cost, and there will be collateral damage of all kinds. Tough assignment for the new mayor and new city council--are they up to doing the best for the people of the city, above city hall and union politics?

KMBZ Breaks News of Potential Local 42 Lawsuit

980 KMBZ has obtained a copy of the lawsuit that IAFF Local 42 is thinking of filing against the city with regard to the MAST/KCFD pensions. There have been rumors of this coming down the pike due to the hesitation on the part of the City Council over the $30 million cost to the city of fully vesting former MAST employees. Details are still sketchy but basically local 42 is suing the city for failure to follow the contract that was negotiated in collective bargaining.

The Observer has laid eyes on and read the very contract between local 42 and the now KCFD emergency medical service workers. The contract is quite clear as to what was to occur with the pensions. This subject was desperately under examined and evaluated by those pushing for the city/KCFD take over of the ambulance service and that lack of close study is now coming home to roost.

I would be watching very closely how those who are interested in being the next mayor of this city handle themselves around this very political topic that will have consequences for years to come. It is hard to see how the City Council can avoid litigation if they choose to not finance the pensions as specified in the contract.

Big kudos to KMBZ City Hall reporter Bill Grady. Here's the link to the story, and the above picture is snipped from KMBZ's website.

Author's Note: A commenter has already noted that Yael Abouhalkah wrote up the story of the letter from Local 42's lawyer to the City Council and the mayor two days ago warning of the impending law suit. To be honest, I did think I had seen something about this previously but I wasn't sure. It's a pretty big deal for one of the city's most powerful unions to sue the city for breach of contract. It looks to me that Local 42 is looking to gradually ramp up the publicity and pressure, pressing the City Council to pass the needed ordinance to fund the pension for the former MAST employees.

Here's the link to Mr. Abouhalkah's write up: Local 42 threatens lawsuit over MAST pensions

The Observer has vigilant commenters. Added at 1730 10/8

Pensions for Former MAST Folks

Terry Riley asks for more time and information with regard to action on the MAST/KCFD pension funding.

Yes, this took place last week. However, if you think the issue of pensions for former MAST people--in fact, the issues of pensions in general--is going to go away, you are sadly mistaken. Remember: Information is Power.

It looks innocent enough on the docket: Ordinance 100607. A previous ordinance to do with pensions--100606--had been advanced without difficulty. 100607 reads: Amending Article IX, Division 2, entitled "Retirement System" of Chapter 2, Code of Ordinances, by repealing Sections 2-1171, 2-1172, 2-1176, 2-1186, 2-1189, and 2-1193, and enacting in lieu thereof, new sections of like number and subject matter; enacting a new Section 2-1201, "Same-City funding"; and reaffirmation of supplemental pension benefit and enhanced contributions therefor. The City Council meeting had been going along rather smoothly, with several items advanced, omitting the second reading. When it was proposed by a council member (I think John Sharp--I really need to learn to take clearer notes!) that this item be passed now, omitting a reading, the debate was on.

The gobbledygook refers to the city pensions and the actions would cause the city to finance $40 million over 10 years for former MAST employees to have their now Fire Department pensions funded. When MAST was MAST, it had 401 (k) plans and other retirement options of that nature--not a classic pension. Part of the deal with the merger was that MAST employees would be in the pension plan, with their pension status reflective of all their years of service at MAST, not starting at April 2010, the merge date. Now, this is complicated financial stuff. However, the entire Kansas City pension system for its employees has been described as "upside down" and MAST only brings about $4 million to fund the pensions.

As the debate raged, here were some of the debate points:

1. It was feared that there would be "a wholesale attack on" the retirement pension funds by retiring former MAST employees who could retire with full pension starting in late 2011, and there would be no money.

2. There were fears that the plan was illegal under the laws of the state of Missouri. Terry Riley in particular felt that more information was needed about this point.

3. Former MAST employees, including paramedics, emergency medical technicians, dispatchers, and vehicle technicians (these folks prepare, clean and stock the ambulances) serve the city well and deserve a pension.

4. Questions as to whether or not the KCFD can maintain the same revenue level as MAST (patient charges, medicare/medicaid, collections, membership, nonemergent transports, etc.) came up.

5. Some felt that MAST board spent $6 million ineffectively and in fact the phrase "golden parachute" was used in reference to people leaving the EMS service as the merger/take over process started and continued in 2009. Actually, I could use the term accused, as in "MAST board was accused of spending $6 million on golden parachutes."

6. Funkhouser several times felt that approving the financing of the $40 million over 10 years had to be done as soon as possible, terming it "a good deal for the city."

7. City Manager Troy Shulte felt that money would come over the 10 year term from reducing EMS administration costs, "Overtime issues" that would reduce costs, and the changes in Federal health care financing ("Obamacare" effects, if you will). Ed Ford thought the money would end up being pulled from general city revenue funds and the health levy.

So after all this complicated and frequently contentious debate, a vote was taken to push ahead and omit the second reading of this ordinance. If you were watching on Ch. 2, this vote got fouled up rather badly, but when all was clear as mud, the item fell short of the 9 required to pass. So we will hear from this issue again, not this week as the Council is not meeting, but sometime in the future. In fact, the entire pension issue, of funding these usually very nice pensions for many of these government jobs, is going to have to be dealt with.

Again, one of the critical points that those of us who stood opposed to the folding of MAST was this pension issue. It is only illuminated even more by the general state of pension funding in Kansas City--and in the nation.

Understatement of the year: "This takeover has had some challenges."--John Sharp

Ambulance Response Times

Well, the Special Committee on Emergency Services turned out to be quite the little show on Thursday. It was going along pretty quietly--councilpersons Sharp, Curls, Ford and Riley in attendance along with Fire Chief Smokey Dyer and others--until Ed Ford had some things to add.

Ford represents the area of KC north of the Missouri River, where there have been some concerns about response times for ambulances. It seems that only 72% of the time is an ambulance making it onto the scene of an emergency call within 9 minutes. Mr. Ford had some issues for Chief Dyer.

The two of them went at it pretty strongly for a good period of time. Mr. Ford pressing the issue, and Chief Dyer denying that it was a real problem.

It was pretty plain by the end of the morning that the chief does not see this as a problem to solve. The chief goes back to three points: 1. He wants to concentrate on "patient outcomes" and not just response time as a measure of EMS effectiveness. 2. He does not see the problem being solved by using more personnel or going back to posting at non-FD sites. 3. He does see it as strictly a political issue, and feels "caught in the middle." 4. He thinks it is not worth spending more money except maybe to move a northland firehouse.

I understand where the chief is coming from in some ways, but appearing to shrug off the concerns of the Northland councilman was a very bad move for public relations. In addition, the only reason he is not hearing it about Southland response times is that John Sharp of District 6 is a champion of this dumb idea of merging MAST into the FD. And finally, response times have to be part of evaluation of performance, because in the true emergency (yes, there aren't that many of them, but each one counts for the patient!), time really does count.

Now, with regard to the numbers, I managed to obtain the figures from an assistant chief, who said, oh they are available on the website. I says, I looked and couldn't find. He took my email address and said he'd send the url. Any bets on whether or not I'll actually get an email with the web url?

Here, after the jump are photos of the actual documents. You should be able to read them after clicking on them to make them bigger.

photos of (top) Chief Smokey Dyer and (bottom) Councilman Ed Ford by The Observer

Very Interesting Day at City Hall

I'll be posting more my take on the situation with the ambulance response times and the pension for former MAST/now KCFD employees tomorrow. I'll leave you all tonight with this photo taken during the city council meeting when Ed Ford and others objected to pushing forward with the ordinance that would have had the city financing $40 million of pension obligation over 10 years. Note the mayor's charming body language!

Oh, this is amazing and juicy stuff...

MAST/KCFD: Observations From Outside

Well, it's been about a week since the merger of operations of the free standing EMS provider MAST into the Kansas City Fire Department. Has anything much changed? The most visible change is that ambulances are no longer posting in public. There are still dynamic ambulances, ambulances that move around the city, but they "post" at fire stations now. I would love to see how response times are doing with the new system. They may not be terribly changed closer to the heart of the city, but I bet Southland and Northland times have been affected. I wonder where you can get this data?

Biggest visible change: One no longer finds ambulances hanging out here (QuikTrip at 102nd and Wornell--formerly post 44)...

More likely to find them hanging out in places like here (Fire Station 42 at Red Bridge and Hillcrest-ish--this ambulance still bears MAST logo and livery)...

Listening to the scanner reveals that numbering for the ambulances has changed--rather a lot actually. I would have to ask someone to be sure, but it appears that dynamic ambulances are being given 500 series numbers and assigned ambulances take the numbers from the fire stations or apparatus to which they are assigned. Ambulances are still being dispatched by a separate dispatcher, and are still being assigned lunch times. The shifts are still partial days--no 24 hour shifting as the KCFD does. And awkward! At times, everyone sounds like it's their first day at work! It's almost funny to hear the "er, ah, um, po--er station 36." type stuff that comes over the radio.

Questions, questions, questions--I have stupid practical questions I would love to have answered! If a dynamic ambulance is assigned to a certain fire house and they get there and the boys and girls are out, how do they get in? Is there a skeleton key that will open every fire house in the city? (Readers of Report from Engine Co. 82 will recall that that was the way they rolled in NYC in the '70s) Those assigned to dynamic ambulances still have to bring all the personals they might need, don't they. Unless a nice fire house would let them put their lunches in the fridge (and not eat them!) and they lunch there?

I see mondo big changes--I see central dispatch real soon. This is just too confusing to last. Hopefully, MAST dispatchers will still be retained. That's a lot of expertise to show the door to. KCFD dispatchers will need to learn about all the neat tracking and map tools that MAST has installed on the ambulances to help medics find their way around our big (in terms of square miles) city. MAST dispatchers will have to learn something about fire terms and fire suppression and how to support the companies at a working fire. There will need to be systems to help instruct the phoning public in first aid measures while they wait for help--this is done by MAST dispatch now.

Eventually, I see assigned ambulances to fire houses and regular crews manning those ambulances. Same people every day coming in, eventually developing a group of regular people who man that ambulance in that fire house. I don't know if they are doing this now. I think that might be a tough thing for the personal dynamics, just dropping in four or six new people suddenly into a group that has gotten to know each other over years. Just speculating here, but maybe this period is to see if any natural dynamics develop over time between certain medics and certain fire crews. Or perhaps these crews will develop from new recruits and be used in static applications over the old guard?

Because EMS calls vary in volume during the course of a 24 day and and 7 day week, it would be better for the Fire Department to maintain the use of shifts short of a full day, and extra ambulances for certain times of the day and certain days. I have felt all along that the flexibility of MAST's staffing was one of their strong advantages as a stand alone department. I can see losing this flexible approach, and this would definitely hurt the quality of the service given to the people. So I hope they retain the reservoir of ambulances and resources that are represented by the facility on Eastwood Trafficway.

There's a lot of work to be done, and a lot of evaluation. Now that this deed is done, we have to do it right.

And are we really saving money? I want to know about that, too.

Spotted It Again!

Spotted it again--and this time have photographic evidence! Generic Kansas City Missouri EMS box...not even a crummy Star of Life on the side. (Photo taken January 20th--yes, that is all that is left of our snow--lumps here and there. The pic was taken holding my cell phone up next to my ear as I turn the car to the right.)

In a related note, today Fire Chief Smokey Dyer was officially made head of MAST by the ambulance board. I can't make light of or have any fun with this news.

History Of Emergency Medical Services

I debated posting this video for a little while as it is kind of long and "teachy", but it sent me right down memory lane, as well as addressing some here and now issues near the end. It gave me some historical perspective on something I ended up doing and loving, almost by a happenstance. So I want to share it with you.



Yes, we've visited the history of EMS before. I gave you a link to the report on accidental death and disability, and I introduced you to Freedom House. We'll link up to those posts here so you can go to them easily.

In this video there is a reference to the Hyatt Regency sky walk disaster here in Kansas City, MO. That event, in 1981, taxed the then rather haphazard EMS system of this city to the max. It was that memory that stood behind the eventual formation of the Metropolitan Ambulance Services Trust, MAST. MAST, along with Johnson County Med-Act on the Kansas side, eventually provided some of the best, most cutting edge EMS in the country, with cardiac arrest save rates and response times in the top 10 of the nation. Now we are coming full circle, barring further political maneuvers, MAST will cease to exist and the EMS service will be merged into the Kansas City Fire Department.

I became involved in EMS in 1976 in Vermont. Back then, we made our own backboards, out of sturdy wood, stain/paint and finish. I was trained in CPR with some of the newest standards. We had a proper federally funded Type I ambulance. That service, which was established in 1968, still exists today, with dedicated volunteers, and provides ambulance service for at least four towns. Vermont now has state wide 911 service, and considerable effort was made to give every occupied dwelling a street or house number. Many of the towns have established FAST squads, or organized their fire department to go to scenes quickly, and provide care before the ambulance gets there. This service has provided care to two of my relatives, and I am proud to have been a part of this organization. We were part of the vanguard. While in college in PA, I worked BLS level transport ambulance, and later became a part of a volunteer unit trying to revolutionize the EMS care in our Main Line suburban township. I also was a CPR instructor. While I was there, our unit transitioned to a ALS or advanced life support unit. When I left, the service was still trying to convince the police department that we were a far better choice then the back of a paddy wagon.

Now, I am an RN, who finds the ER to be my favorite type of nursing. One of the gaps in the video, besides its lack of recognition for Freedom House, is its neglect to mention the Emergency Nurses Association. ER nurses are a special breed!

Looking at this video, and looking back, I am both amazed and gratified to have played a small part in encouraging and being involved in the development of prehospital care and treatment of the sick and injured in this country.

Ambulance Livery: A Brief Update

I saw, last night, at a common MAST post (44 for those in the know) an ambulance in the most generic paint job known. A red stripe around the rig with MAST in tiny letters in it and that was all! Not even a crummy Star of Life--and no nifty diagonal stripes on the back--it was just white back there! Nothing reflective either. No pictures of the rig unfortunately, because it was dark and I did not have a camera camera. New rig and they didn't want to paint it? Rig in process of being fixed/remounted on new chassis? Hmmm?

While we are on the subject of MAST, I found this pearl in the comments section over at Tony's place:

Anonymous said...

twas the week before christmas and all through the town,
the murders were up, instead of going down.
The guys were going down the chimneys with ease,
The soot inside, boy, made them sneeze!

The weapons were nestled all snug in their waists,
while cars ran away in a quick police chase.
My man in his doo rag and I in my cap,
had just settled down, when we heard him get capped!

When out on the lawn there arose such a clatter,
the screams and the tears, they just didn't matter.
The cops did we call , but alas there were few,
For city council made deals, as they always do.

The moon on the breast of the man on the lawn,
showed glimmers of red, where he had fall'n
When what do my wondering eyes do appear?
A big white box with medical gear.

With an efficient driver, so learned and fast,
I knew in a minute, IT MUST BE MAST!
To the man on the lawn, they arrived so swift,
I knew in a minute they just started their shift.

Medic called on the radio, just need to know,
Man shot in the gut in the fresh fallen snow,
BP is not good, respers are weak,
Loading him now, will be there shortly, with whom do I speak?

The doctor said his name, which never is clear,
It did not matter for this life is dear.

Though things will be changing, come around May,
let's hope there'll still be money, for the city to pay.
The people who drive and ride in the box,
still will be swift and smart as a fox.

They may not have badges and training and such,
but some say they don't need them, they just need the touch.
Time will not matter, advance does not pay,
Load them up quickly and get on your way.

He is chubby and plump, a jolly old chief, I cringed when I saw him, in utter disbelief.
A wink of his eye to Louie he made, the deal was all done, boy what a trade!

He spoke many words, no sense did they make, the council all nodded,said he was great.
Laying pen on the paper they wrote it is done, MAST is all gone now we are one.

When taxes go up and time limits go away, remember the man, in the snow as he lay.
Will there be money to pay for the gal, the guy,the box,the equipment, will you be asking why?

We will hear them exclaim as they drive into to sight, lets load him and go, it is football tonight!

12/21/2009 01:32:00 AM

Oh, if it goes through to completion, this merger between MAST and the fire department is going to be interesting every single step of the way.

Red Or Something Else?

The Kansas City, MO Fire Department is poised to merge with MAST and essentially take over ambulance services in May 2010. There are many important issues that will come up during the merger/takeover, but here is a really important one...

Red ambulances or something else? You make the call...

A sampling of local liveries for your consideration...pictures snatched from various websites, except the last two which are mine.

More EMS History...

Ambulance--1971

Ambulance--2009

Some More on the History of Emergency Medical Services

While we are on the subject of the history of EMS, I want to give you an opportunity to read the landmark report from 1965. This report, Accidental Death and Disability: The Neglected Disease of Modern Society, provoked the deliberate planning and helped put in place the structure that has given rise to our modern emergency medicine, both outside and in the hospital. Everything that has happened since goes back to this report. It's hard to conceive of it, emergency transport being done by funeral homes in hearses and police departments in paddy wagons--because these were the only vehicles that could accommodate a recumbent patient. Care along the way was nonexistent. No board certified ER doctors, no surgeons specializing in trauma, no research into ways to improve survival of cardiac arrest or severe trauma. While EMS is not perfect, and is struggling with issues of professionalism and leadership, it's a far cry from these bad old days.

Lost History--Freedom House on EMS Cutting Edge

I was doing some window shopping--looking around TJ Maxx yesterday. They had a display of 2010 calenders and appointment books; you know, the ones with themes and pictures. One was 365 days of African-American History. It attracted my attention with its Library of Congress pictures--on the cover was a group photo of the Pullman Porter's Union. I opened it up and it fell to a page with a picture of an open ambulance rear door and two Black men wheeling a cart with a patient. I stopped and read about Freedom House in Pittsburgh, PA. And it is a truly amazing story; starting in 1967 this organization trained men who had little formal education how to be paramedics. This was just two years after the landmark report "Accidental Death and Disability: The Neglected Disease of Modern Society" had been issued. They were doing just about everything out in the field that our paramedics do today. Among the pioneers of this organization were Dr. Peter Safar, who basically invented CPR, and Dr. Nancy Caroline, who wrote one of the best paramedic text books ever. There is now a documentary film available about Freedom House, and a website. Here is an article from the Pittsburgh Tribune-Review that was also carried on the EMS museum website. Here is a clip of the trailer for the film.

Every paramedic in this city stands on the shoulders of these pioneers, men who were throwaways, from the worst neighborhood in Pittsburgh. They have been forgotten. We would do well to take time to remember them.

Oh, and One Last Thing...

Just one more bit on the MAST meeting: the actual running of the most vital services in a city must be above politics. The union guys kept saying, well, you all say fire is a good service, you like the FD and firefighters, why not merge MAST into the fire department? Well why merge MAST if it's working and you can't/won't demonstrate really good reasons for the changing of the command structure? Other than politics and power. Fire, Police and EMS must be above the political fray, to the very best of their ability. That's how come the people of the city have a higher regard for the PD, FD and MAST than most city departments and services. If politics is driving this move to merge, then it is wrong and should not be done. For example, will the new structure continue mobile posting (posting ambulances at various places in the city)? If not, what will they do? How will that affect response time? How many ambulances will be out on the street? How many at 7 a.m? 2 p.m? 10 p.m? 3 a.m? Right now, MAST can vary the number and be very flexible.

A lot to chew on tonight. Let the people know what's going on. Let's have an informed and open vote of the people. Readers, sign the petition when it's presented to you. There will be more meetings and opportunities to sign. Don't miss out.

Save MAST!

I have to admit, I was wondering where we were at with the possible city take over of the ambulance service MAST. And there is TKC fearlessly supplying the answer! (Yes, that is a shameless plug.) This is more than a passing issue to me. As an RN in the ER, what happens out in the field is very important to me; it might make the difference between receiving a live patient in the ER verses receiving a dead one. I think very highly of the service MAST gives, and have been very impressed at the high level of care that is given, often under very difficult conditions.

The most important thing I want to get across to everyone is this:

Local physicians, MAST employees, community leaders, local politicians and petition organizers will be on hand gathering 4300 signatures of registered Kansas City voters required to put the issue on the ballot in February and providing more information about the MAST takeover at the Southeast Community Center located in the Multi-purpose Conference Room at 4201 E. 63rd St. Kansas City, MO 64130 from 6:30pm to 8:30pm on Friday, August 21, 2009. Light Refreshments will be served. Space is very limited.

Go and sign the petition, Kansas City voters!