License differences
April 13th, 2007 by 
Alica
On Monday when the City Council canvasses votes for the election, the ambulance Ordinance #381 will become law and the Council can start taking applications. So I looked at the application approved Jan. 2, 2007, and compared it with the application the city used when Ordinance #286 (the old ambulance ordinance) was in effect. They are different. In general, the new application is more relaxed than the old application and doesn’t require as much documentation. Also, the new application doesn’t require written plans for the type of service to be offered or for staffing.
Here is a detailed list of differences:
1. The old application requires documentation of 15 points. The new one has only 10 points. The five points that are omitted from the new application are A) a detailed statement of the type of service to be offered; B) a written plan for staffing levels; C) verification of direct medical control with documentation of an agreement with at least one Sioux Falls hospital for such control; D) a plan to comply with sanitary and safety standards; and E) proof of safety inspections by a certified mechanic.
2. Both require a listing of vehicles to be used. The old application requires documentation; the new one does not.
3. Both require a listing of employees along with their certifications, training and experience. The old application requires certification before the application is approved and again afterward, before the employee has contact with patients. The new ordinance does not require the double certification.
4. The old application requires documentation of equipment and medications by “the city’s quality assurance entity.” The new one requires documentation of equipment by REMSA standards and medication by state standards. Both applications require proof of inspection.
5. The old application requires verification of availability of a medical director, including a copy of the contract that includes certification that the medical directo has staff privileges with a Sioux Falls hospital. It also requires a copy of the doctor’s license and D.E.A. certificate. The new application requires only th name, address and phone number of the medical director’s state license.
6. Both applications require proof of insurance.
7. The old application requires a fee to “be established by resolution of the city” and requires that payment be included with the application. The new application requires a $25 but doesn’t say that payment must be included with the application.
Posted in Uncategorized, Ambulance | 
April 13th, 2007 at 9:36 am
Alicia, How can any service meet the REMSA Standards for equipment when accorinding to the flyer put out by Med-star and the council that no information could be found after searching the web for hours. This should be a pretty easy standard to meet then.
April 13th, 2007 at 12:50 pm
I would like to thank Alica for the hard work–you are providing a wonderful service for the Brandon citizens. Not many of us would take the time to compare this important issue. I think we all need to be vigilant in the quest for a quality ambulance service. I hope many will attend the upcoming city council meetings.
April 13th, 2007 at 2:54 pm
Regarding the medical director issue, does it say specifically privileges at a TRAUMA hospital?
Another point, and perhaps neither application had this in the past, but shouldn’t we make it mandatory for employee background checks? This is common place these days especially for personnel in the medical field. I can think of a couple of reasons why it is important. These employees will be driving an emergency vehicle and should have an exemplary driving record. They also will have direct patient contact and we should make sure we are safe guarding our citizens.
What protocols does an applicant have in place to handle their staff? Do they regularily monitor driving records? Do they do random drug testing?
With the new application, does the city have the power to approve employees?
What type of check and balance system does the city have in place?
April 13th, 2007 at 9:25 pm
Background checks are presently done through SFREMSA, but it was never stated in the ordinance. This is not present now and is a big concern.
Proof of staffing 24/7?
April 14th, 2007 at 10:07 pm
I work in EMS. The issue of medical control is pretty important. By that I mean that when you need clarification, suggestions on a treatment modality, or are required by protocols to call for orders before proceeding with a particular intervention, you need to make sure that the person answering the call on the other end knows what your protocols are.
So, let’s say you have multiple services who transport to area hospitals. One service uses protocol A, the other uses protocol B. If protocol B says to call for additional orders, or call before going on with the treatment to double check with the doc, then people at the hospital need to know what both protocol A and B are.
OR, the services need to make arrangements to find their own medical control. So, if protocol A is the prevailing one in use, then the service that goes by protocol B needs to make sure that they have their own physician or centralized medical control to contact for orders. As a paramedic, you don’t get to just do what you want. The medical license of a paramedic requires following written protocols to ensure consistency and that treatments are done properly. In many ways, you should get more consistent treatment with a paramedic than you might get from a doctor. Consistent doesn’t always mean better, but it means that every person with condition X should get the same treatment, assuming they generally present in the same fashion.
Even in places with unified protocols, doctors who forget the protocols make things hard. So you have all these different physicians working in an emergency department. But only a handful really know the protocols. So when a paramedic calls the doctor to get a drug order, that order can vary quite a bit.
The issue of medical control, and overseeing of run reports are the two most important issues. There needs to be a review of ambulance runs.It’s not a punitive thing. Every system has its own weaknesses. Independent medical oversight helps identify problems in protocols, or systemic problems that can be fixed. Someone independent of the service needs to pull reports from time to time to verify that policies and protocols are followed, and if the reviewer finds problems, then those problems need to be addressed.
For instance, if the protocol calls for 4 aspirin to be given to each person complaining of chest pain of a cardiac origin, and for whatever reason the paramedics are only giving 2 aspirin, then that should be addressed. If patients should be getting a big IV line, but are instead only getting a small IV line, then that also needs to be addressed. Maybe the paramedics need to have an inservice on the importance of two IV lines or large bore IVs for trauma patients, when time permits on a call.
Or maybe they’re spending too much time monkeying around on scene. Instead of rapidly transporting a patient, they’re not getting moving fast enough. This is another example that can be addressed by medical oversight.
Also, things like success rates of intubations, IV starts, response times, need to be plotted and followed too. This helps identify areas where additional on-going training might be required.
I don’t know if anyone in the area is really doing this. Only a handful of services really plot and track these like they should. But quality improvement is an on-going process for a good EMS system.
It’s absolutely important in systems that have a low call volume, like Brandon. In these systems, paramedics probably aren’t going to see too many cardiac arrests, or critical trauma patients. So they’re not going to get the exposure they need to keep their skills sharp without additional training.
April 15th, 2007 at 12:31 am
Thank you, Anonymous. That’s the best explanation I’ve heard yet of how medical overview works and why it’s important.
April 15th, 2007 at 5:55 pm
How can we insure we are going to get quality care??? It sounds as if the city council is going to grant Med-star the contract regardless. This is such a mess and Brandon deserves better. Sorry if this sounds like sour grapes, but my husband and I both have health problems–this could be life or death for us.
April 15th, 2007 at 6:22 pm
All we can do now is GO TO THE CITY COUNCIL MEETINGS and demand that things are done right the second time around. Meeting tomorrow night 6:00 (Mon)
April 16th, 2007 at 8:18 am
Has anyone considered that Med-Star does not have 911 access in Minnehaha county?
Has anyone asked if Med-Star has mutual aid agreements with any other ambulance service in the county?
Maybe someone should.
April 16th, 2007 at 10:25 am
As I understood our council at the forum presented by them, that the company awarded the ambulance contract will get the 911 access for the city of Brandon and no other. When Med star is given the contract, they will have the 911 access, unless the council decides differently.
April 16th, 2007 at 10:31 am
Hey did anyone catch Brett Karber on the news the other night? It seems that BK thinks that Jay Masur should be able to run in the county.
Two things on that:
1. Jay doesn’t have a county license. He received the papers by mail and DID NOT FILL THEM OUT AND TURN THEM BACK IN.He couldn’t qualify anyway, because he can’t get a Medical Doctor. Congrats citizens of Brandon, you’re paying for his Dr.
2. The county rules are the ones that BK threw out to get this empty, bare bones, not a thing in it ordinance(that Jay wrote it himself!!!!). I’d like to see a show of hands from all of you that get to write their own job description!!
People be very aware of all the smoke that it is being blown and know exactly where it’s coming from.
Lewis T…we are waiting for the conflict of interest “stuff”. Please let someone know!!!
April 16th, 2007 at 12:07 pm
To add a finer point to Anonymous’ comments…any doctor that agrees to become the medical director for an ambulance service is, in reality, allowing that ambulance service to operate as an extension of their medical license.
Quite frankly, if I went to school for 10-12 years and had established myself in the medical community, I would be quite wary of anyone practicing under my license, let alone a group of paramedics hired by a service that was not being required by the City to conform to a rigid set of requirements. This isn’t to say that Med-Star doesn’t have its own internal standards. However, I would want to know for sure.
This slip-shod, fill-in-the-blanks-later ambulance ordinance is just another example of how certain council members think they can run Brandon with pat-on-the-back, wink-wink policies, and that no one will be the wiser. If councilman Ruben has a financial interest in MED-Star, then that needs to be investigated at the State Attorney General level. If councilman Karver is spouting off to the media specifically about Med-Star, even BEFORE the ordinance is in place and a contract awarded, then the people in his district should start a recall petition.
Take back the city. If you are not happy with the performance of your council members, then make some noise and do something about it. I hope City Hall is overrun with Brandon residents at the meeting. I hope they make sure their voices are heard.
April 16th, 2007 at 1:10 pm
Take back the city is great–however I think the only people worrying about this are on this blog and obviously not in the majority–after all the ordinance passed.
April 18th, 2007 at 2:11 pm
I think “grateful” is wrong. The ordinance did not pass because the majority wanted it. It passed because some of those pushing it were not telling the truth. It was misrepresented that the fire department was in favor of the change. One person took it upon himself to “speak” for the whole fire department. He listed some of his “qualifications” as a 40 year resident, an EMT, etc. However, he failed to list some of the reasons why you should not believe him … like his past and present driving record and rap sheet. I know I would not want him driving my ambulance, nor would I want him to be the first responder on the scene. There is a reason a couple of our council people are pushing hard for this, and that reason is not to do what is best for the citizens of Brandon. They have more personal reasons for pushing this through. A good council person would not compromise the safety and lives of our citizens by lowering standards as important as the standards for an ambulance service. Karber is even ready to take on the county. When was he elected to the county commission? People of Brandon, be cautious. We have a couple of loose cannons out there who are not telling the whole truth.
April 19th, 2007 at 11:28 am
Grams, I am interested in knowing where we could find information on this person, and is it that bad that we should not trust him, doesnt the fire dept have rules to be allowed on the fire dept?
April 19th, 2007 at 5:16 pm
Grama,
Can you expand on your comment about Karber taking on the county? I’m interested in knowing about that.
April 20th, 2007 at 9:26 am
EMT-Basics can have offenses in their past, i.e. DUIs. Paramedics are required to have a clean driving and personal record. Therefore, the person you are talking about has not violated any ordinances by being a volunteer firefighter/EMT. If this person does have a ‘rap sheet,’ I am puzzled why the fire department would allow them to be a volunteer.
Even more puzzling is why this person felt they had the right to use their creditials with the volunteer fire department to promote their own person interests. This person has been an employee with Med-star for several years doing patient transfers. They have worked the races at Husets (Husets is owned by councilman Ruben) as a medic with Med-star for several years. They are personal friends with Jay Masur. An honorable person would have mentioned these things, too. Of course, an honorable person wouldn’t have mistrepresented the fire department. As a long standing member of the fire department, they should have kept their opinions to themselves and not publically taken a side on the issue. But then, doing so would mean showing an ethical side.
This entire ambulance ordinance is and was a farce from day one, in my opinion. Laws have been written, ordinances have been established, and guidelines created to protect people from poor pre-hospital care…but apparently this does not apply to Brandon…and I can only speculate it is because of friendships, power, and greed, and perhaps a HUGE dose of ignorance.
If any of our council people have the courage to read these blogs, then let me say that I am so, so ashamed of you. Your backroom deals, under the table antics, misrepresentation, and greed are a classic example of why no one trusts politicians. You are a classic example of why the ’system’ doesn’t work.
Yes, the people have spoken…the ambulance ordinacne passed…you have done an outstanding job of distorting the facts and duping the people…bully for you…you have proven your mastery in the art of deception. Next stop, Pierre, and then, Washington DC.
April 20th, 2007 at 8:30 pm
Doubtful: Now you’re starting to sound like some tinfoil hat freak. You make some good points, but it’s posts like this that make you look like some irrational person who just hates the world.
April 21st, 2007 at 2:58 pm
Anonymous; Do you have something relevant to say? Please keep in mind, you are not the only person in EMS that lives in Brandon. Nor are you the only person allowed to share an opinion.
April 21st, 2007 at 3:03 pm
Now, now. Let’s play nice or I’ll have to turn this blog around and go back home.