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  1. #101
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    Okay, so I'm posting in an Illinois thread as an Iowan...right across the old Mississipp!

    What I have to say might offend some of you, so if you're thin-skinned...stop reading now. However, I do mean what I am saying with the utmost respect for the EMS providers in the fine state of Illinois, but from an outsider's prospective.....

    There seems to be numerous problems with your state's EMS system, and it seems that alot of it lies in training issues. I practice in the Southeast corner of Iowa and have had first hand experience with many Illinois based providers along the border in west central IL. This experience represents a small population of the state's EMS system and I realize it may not be the same all over.

    Quite honestly...I am amazed at the amount of money that many of the counties I am familiar with waste annually on subsidizing multiple ambulances in sparcely populated counties. Where I work part-time in Lee County Iowa (which is a full-time paid ALS service), Hancock County Illinois is situated directly across the river. I think there are something like seven communities with ambulances that serve a county that has maybe 10,000 people, and with the exception of the small hospital-based system in the center of the county...all run BLS. I have read newspaper articles about how many of them are out of service due to staffing issues at any given time. We used to tier with them as they routinely brought patients to hospitals in Iowa, but quit after a bad incident almost landed our system in a lawsuit because of care provided by the BLS unit. I know this is not the only county that does that...Henderson County just north of there is in the same boat and relies on ALS units from Galesburg and the Burlington, IA Fire Department to tier with them. To me it would make more sense to pool all of the county subsidy together, start a career ALS service that covers the whole county, and convince the volunteer fire departments to provide first-response in a non-transport capacity. But that would be in a perfect world...I am sure that is easier said then done.

    Now, to get back on the topic, it appears that reason many of your providers have issues with the NR exam is because they have not been trained to NR standards. The training standards have been dictated by the state and are sub-par to NR. It is no doubt that the NR exam is tough...it is designed to be, but I think a system is needed to "weed-out" the weak so to speak, to provide a pool of higher competency EMT/Paramedics....especially at the ALS level.

    Iowa became a NR state several years ago and it was met with alot of resistance, but has worked out well since implementing it. I think that you will see the same thing in IL. While I do agree that NR testing fees are pretty rediculous, I am proud to be Nationally Registered and live with the comfort that I can go to almost any state and get a job....including IL....without having to jump through as many hoops.

    So with that being said, I really think you all should just give it a shot....but that's just an outsider's perception. It would be one positive change in what seems like a disorganized mess of a system with many problems to be contemplated.

    Just my $0.02 anyways....

  2. #102
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    Jacob;

    I want to reply to a couple of your thoughts....

    First, thank you for an intelligent post, with well thought-out points. So many people will spew crud from their mouths based on their "perceptions." I do take issue with a couple of points, though.

    For the most part, EMS evolved differently in Illinois than in Iowa, and incidentally in Wisconsin. I mention this, because Wisconsin seems to run their EMS systems similar to what you have described. Most Illinios providers, especially north of I-80, evolved from the fire departments, or an off-shoot thereof. If not, then somebody started a volunteer "rescue squad" as an independant group. Generally, this happened because nobody (i.e. county) stepped up to provide this service. Also, Illinois State Laws says that if no other provider exists, then the fire department/district MUST provide EMS. Consequently, EMS has becaome a strictly-local problem, just like schools. As you move further south, you'll find more county-based EMS systems. My own theory is that these systems evolved later than the ones up north, and maybe had some planning. A county-based EMS system certainly appears to function better, especially when it comes to tiered response. There has been an effort by some providers in my county to do this. It won't happen for a couple of reasons:

    1. The one making the biggest push doesn't have their own ambulance. They contract with a neighboring town to provide ALS transport. The contract is not cheap. So they would stand to benefit quite hugely from a county-run ambualnce. They are the only non-transporting department in the county.

    2. The real struggle now becomes, where do you put your full-time ALS rigs? Population centers? Okay, that's fine, but that means that 6 providers would stop transporting, one of whom is an ALS provider now. How do I present that to my community: that, for the better of the county, we are going to give up our ALS transport ambulance to another town 15 miles away. They'll still come if you need help, but it'll be a little while.

    3. You can bet they'll be a tax increase for this. Example: our fire district does not tax separately for EMS. So, even if we give up our ambulance, our tax rate won't change. But you can bet the county will levy a tax to pay for this. For those districts that do tax for EMS, do they now turn this money over to the county? What about those districts that don't tax the same rate? Does somebody get a cut or an increase? Does this district tax go away in favor of a county tax? Those fire districts aren't going to like that.

    4. You are right on the money as far as some departments not wanting to give up their little serf-doms.

    Some of the problem with the IDPH EMS system is that the state's EMS law is written rather loosely. I was told this was done purposefully, in order to give maximum flexibility to local providers to meet their local needs. Unfortunately, it seems that somewhere along the way, bureaucrats with a bunch of initials at the end of their names have gone on power trips and gummed up the works.

    The biggest issue I have with what you have posted comes to the NR stuff. The curricula for EMT-B, I and P are written by the federal DOT. All courses must be based on this curricula. How can their be so much variation between the NR and what IDPH puts out? I'm not saying it's not possible, but somebody's not go their shyte straight. It may be IDPH; it may not. If the state wants to go to NR, then pressure must be applied to provide adequate training, testing sites, etc. Who gets that pressure, and who applies it? I dunno..... However, I take umbrage with a private organization deciding if my state will issue me a license. Somehow, that just don't seem right.
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  3. #103
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    [QUOTE=parafire81]
    I know this is not the only county that does that...Henderson County just north of there is in the same boat and relies on ALS units from Galesburg and the Burlington, IA Fire Department to tier with them. To me it would make more sense to pool all of the county subsidy together, start a career ALS service that covers the whole county, and convince the volunteer fire departments to provide first-response in a non-transport capacity. But that would be in a perfect world...I am sure that is easier said then done.

    Its probably just a matter of semantics here, but the Henderson County, and to some degree, Hancock County uses the ALS unit out of Monmouth. I used to do a lot of ALS intercepts within that area. Take this with a grain of salt, because its been some time since I have been down there. I think that area has a hard enough time supporting the basic level services, let alone a career ALS service. Towns like Abingdon and Avon were having trouble supporting a part time ILS service (although that may have been the fault of the company providing the service, just like the Mercer county thing) I think the key is getting the FD's to run as first responders, and then maybe start an ALS ambulace on Auto Aid from Monmouth, or from the other provider. This isn't really a feasible option, but they could utilize the helicopter more. An answer is out there, but finding it and getting everyone to play nice is another issue.

    As far as the classes being trained to the NR level, I'm not going near that one. As Jay had said, it should all be the same. That may be a problem with those instructing.

    And furthermore, I don't know of any official at IDPH that has gone on a power trip, ever. Please note that is dripping with sarcasm.
    IACOJ, Flatlander Division

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    Jay and F18Wub: Thanks for your replies....

    In retropsect I should've worded my opinions about training in IL not being to NR standards differently. What I meant was that the classes were probably not taught with the NR testing expectations in mind.

    For example....I took my classes (both EMT-B and P) here in Iowa...at the University of Iowa EMSLRC...which accepts students from all over the US and even international students. While we followed the NSC like everyone else does, much of our training was taught in a manner to prepare you for the NR exam. Test questions were written similar to the NR's, Practical Skill Sets were practiced using NR exam criteria, so when we were done and tested, we were prepared for what the preceptors would expect at a NR testing site.

    I'm not sure if you have ever taken an NREMT exam, but it is tough. In my personal opinion, the test is not a good measure of how good of a paramedic you will be, but it does force you to study, and it does give your critical thinking skills a workout. Supposedly, it is impossible to cheat on this test...which as I understand it is why IL is switching to NR. I see this as being a good thing because it will do three things: 1. it will produce better EMS personell who have good clinical judgement and will have studied their arses off to pass 2. It will ensure that no cheaters will be granted the ability to practice paramedicine and then go out and kill someone and 3. it will allow your state EMS office to get more done, not having to deal with writing and checking tests.

    Another consideration in differences in training is that the NR shows that you meet the training expectations on a national scope, as skills vary from state to state. They are not determining that you are qualified to practice in your state per se...but that you have met the requirements that show that you could go to any state and with a minimum amount of requirement (or no requirement) get a certification.

    For example, a Paramedic in IL cannot come to Iowa and practice without first passing the NR exam.....why? Not just because Iowa is NR, but because the scope is more advanced for a paramedic in Iowa than in IL. Same as First Responder....FR's in Iowa can place combitubes....you can't in IL. EMT-Basics in Iowa cannot do albuterol, but in IL they can. These differences are yet another reason why I am in support of a National Scope of Practice. To me....it is not fair for people who live in IL along the border with Iowa to be stuck with the limits placed on Paramedics in IL, but if they crossed the river it wouldn't be. Read: However, this is certainly not a dig on the ALS providers in IL.

    As for the higher costs stated earlier.....NREMT does not see most of those profits. Much of that goes to the site administering the tests to pay for station preceptors for the practicals, and other miscellaneous costs...which is why their is a varience in rates from site to site.


    Now on this issue:

    2. The real struggle now becomes, where do you put your full-time ALS rigs? Population centers? Okay, that's fine, but that means that 6 providers would stop transporting, one of whom is an ALS provider now. How do I present that to my community: that, for the better of the county, we are going to give up our ALS transport ambulance to another town 15 miles away. They'll still come if you need help, but it'll be a little while.

    I wouldn't give up an ALS service, but the counties I spoke of are not in this boat...they have BLS ambulances they can barely staff and are sometimes waiting long periods of time for another ambulance to come from another town with no ALS capability.

    But to use your community as an example....keep in mind I know nothing of your demographics, geography etc.

    But, let's say you live in a square county or nearly square county and cities are distributed across the landscape with a county seat/high pop. area (6-10000) (likely in the center) with several medium sized towns (500-2500) around the edges, with an overall county population of 10-20000. An ALS service runs out of the county hospital in the county seat. Average response time to the corners of the county is 18 minutes. Now lets say there are 6 communities in this county besides the county seat. 5 of them run BLS ambulances and your community runs an ALS ambulance. So if each service has atleast two trucks, that's 12 ambulances covering 20000 people. While this is great...its a waste of money. Especially when only 4 of those have ALS equipment.

    As a tax payer...I would much rather pay a subsidized tax of about $7 per capita a year to help fund a county ALS service that runs out of the county seat and incoporate EMS First Response into the FD's. Sure my ambulance might be 18 minutes away at the most, but I know that my first responders will be there in less than that, and that when my ambulance gets there, it will have a paramedic on board.

    Now your community will lose its ambulance, but obviously you already have trained paramedics, and ALS equipment, so buy a rescue truck and run ALS first response. You can get there first and start ALS care and by the time the transport unit arrives, their job is done, except trasnporting and monitoring the patient. Your community still has rapid access to ALS, but a much better EMS system response. Not to mention...you can't argue the safety factors of having a 2-3 person ambulance crew on scene along with 5-7 first responders. I have been glad the first responders were there many times in my career (help lifting...assistance with codes...etc).

    I live in a community of 1000, my vollie department runs ALS first response and response time for the ambulance (on the other side of the county is 15-19 minutes. But there is no delay in care because we complete assessment and treatment....usually the ambulance is on scene less than 5 minutes and they are on their way to the hospital.

    I realize this may not work everywhere, but I just cannot see the justification of having $1.2 million worth of ambulances scattered around a county of 10-20000 people and not be able to provide ALS care.

    Its probably just a matter of semantics here, but the Henderson County, and to some degree, Hancock County uses the ALS unit out of Monmouth. I used to do a lot of ALS intercepts within that area. Take this with a grain of salt, because its been some time since I have been down there.

    I believe the Monmouth Ambulance is only EMT-I now....the tiers on the east side of Henderson County are handled by Galesburg Hospital now and the west side is handled by Burlington Fire Department. Hancock County operates an ALS service out of Carthage, but they are very understaffed and cannot always tier....which is why Lee County IA used to do it.

    I think the key is getting the FD's to run as first responders, and then maybe start an ALS ambulace on Auto Aid from Monmouth, or from the other provider.

    I couldn't agree more! But I am sure that is going to be difficult for the FD's to accept EMS.

    This isn't really a feasible option, but they could utilize the helicopter more.

    They could, and with the advent of the Med-Force Helicopter in Burlington, they have one much closer and do use it alot. But this leads to over triage and waste of healthcare resources. Not to mention Med-Force does alot of missions to the smaller hospitals to do what is pretty much routine cardiac transfers because no ambulance service with ALS capability exists to handle them.

    An answer is out there, but finding it and getting everyone to play nice is another issue.

    Unfortunately this is the truth. I certainly do not claim to have the answer, but when I look at some of the situations locally....it seems to come down to small towns who really cannot afford to operate ambulances and are providing a disservice to their citizens by not being able to staff them simply do not want to swallow their pride and give it up. This is what I do not understand.


    To everyone: Again I am not bashing anyone. I mean this simply as a spirited discussion from someone who only hopes to see EMS advanced everywhere....not just where I live.

    Keep the comments coming!

  5. #105
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    Parafire-

    Great comments. You obviously have thought a lot about the tiered ambulance response, and it clearly works well were youse guys have it set up. Your demogrpahics are a little off for my county, but the concepts are very good. The trouble we run into is two-fold: the biggest city is 40,000 population, with a college that swells the populaiton to around 65,000 when school is in session. And I don't that they'd go along. But they might. Also, the next closest town, in size and location, is around 25,000 or so. There are two towns to the north a little further that have a combined ambulance service, and I think they cover about 6,500. My district is around 2,500. The town west of us is around 1,800, but they have a couple of subdivisions going in that will nearly triple the size of their town in five years. We are on the cusp of similar growth. There is probably a way to place ambulances strategically to handle the volume, but it'll take somebody smarter than me to fingure it out. That part shouldn't be too hard. Secondly, is the pay situation. The cost of living in this county is quickly becoming comparable to the collar suburbs of Chicago. For example, my brother owns an 1,800 square foot ranch house, nothing special. Cedar siding, about 10 years old. He pays nearly $5,000 a year in taxes now, and doesn't get a helluva lot for his money. A similar house in a bigger city would probably pay about the same, but have a full-time career FD and EMS, better schools, park district, blah, blah, blah. Most people here realize that they are paying more because there is less populaiton, and that's what they want, but we have to pay the same for an ambulance as anybody else. So I'm not sure that a $7 surcharge per capita would make it happen. Not saying it wouldn't, it'd just have to be calculated.

    As for the NR issue, I'll agree with you whole-heartedly about the classes not teaching properly to pass that exam. Obviously, something is seriously wrong when your community colleges go from a pass rate in the high 80%s to the low 50%s.
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    I agree whole heartedly with everyone that says that the EMT-B class is not taught properly in order to pass the NR in the state of Illinois. Because of all the issues with the state exam, I of course took the NR in December 2004. And there were questions about procedures and scope of practice that were never discussed by the book or the instructor. As a result, something like 9 out of 21 in the class failed? You do the math. But the point is, the umbrella of the NR has to consist of procedures used in every state's system, but my local EMS system only taught the procedures allowed in their EMT-B scope. I really have no idea what the solution is here, but it is unfortunate that some people failed an exam because they didn't know the answers to things they were never trained on, and as a result will drop out of the EMS practice. One good example: A gentleman in one of our recent EMT-B classes was licensed as a B in I think 1998, let his card go, and decided to take the class again last semester. He passed the class, including the final, with a 97%, but squeeked by the NR with a 71%. So this guy took the class once, practiced as a B for 4 years, and then almost failed the NR because of the training. I am extremely confident in the instructors in our system. They're wonderful, and I'm excited to go to class every week, but all the confusion makes me somewhat nervous about my EMT-P exam in 2006.

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    Rumor on the street is the State "pilot" paramedic exam has been suspended till next year. Has anyone heard this?

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    the instructors are great,the test is flawed!They won'tshare info with the teachers,they say continue your way of teaching and we'll keep failing em'

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    Quote Originally Posted by Unscarred021
    I am extremely confident in the instructors in our system. They're wonderful, and I'm excited to go to class every week, but all the confusion makes me somewhat nervous about my EMT-P exam in 2006.
    Maybe they're great instructors in the old IL curriculum, but many, if not most, never taught a class that took the NR before. Give them a couple more classes to teach and the pass rate on the NR exam will go up.

    We do a county ALS service with First Responders on all the fire departments. It does take a rig 20-25 minutes to get to part of our district, but we're there in less than 10. Our fire district is about 100 sq. miles with only 2500 population. We run about 70 calls a year with the ambulance. I doubt that even a BLS service could survive in our district on that. This is working for us and it'll probably stay the same for the forseeable future.
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    Default its nonsense!

    N R won''t share any info. with the trainers,screw them!

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    Quote Originally Posted by jboczek
    Maybe they're great instructors in the old IL curriculum, but many, if not most, never taught a class that took the NR before. Give them a couple more classes to teach and the pass rate on the NR exam will go up.
    Very true. Its mostly new to all of them too. But it they have the right information, then they can teach just about anybody. There are people who won't pass B class no matter how easy it is made for them though. So I guess an even better solution would be to teach the instructors more of the NR so they can teach the students? Makes sense. Good point too, because my B instructor didn't even know what site the exam was going to be given at untill 3 days before the exam!

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    Quote Originally Posted by k3twpfire
    Rumor on the street is the State "pilot" paramedic exam has been suspended till next year. Has anyone heard this?
    I just took it on Tuesday the 16th, so if it is suspended, it just happened.

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    Well, its almost 2 years later and IDPH has made no movement on the Paramedic test. What a shock.

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    Quote Originally Posted by k3twpfire
    Well, its almost 2 years later and IDPH has made no movement on the Paramedic test. What a shock.
    Wow, how time flies! Didn't realize it had been that long already. But I'm a little confused. I know a group of guys that just went to the Chicagoland area in the begining of March and took an IDPH Paramedic test. I have heard that they are out and that they are evaluating them now. I also heard that the Intermediate test will be out soon enough. Still no word on EMT-B, Lead Instructor, Pre-hospital RN, or ECRN though.

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    I still haven't heard anything on the B test for the state. I will be taking the National on May 10th.

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    Hey;
    You can't solve all of the turf wars in two years.
    These things take time.
    They didn't call it the "Hundred Years War" for nothin'.
    And does anyone remember the members initiative grants that were frozen 3-1/2 years ago so the "new" governor could review each one?
    Now; I'm a slow reader, but Blago is no Evelyn Wood graduate either.
    If he's involved in this EMS fiasco, there could be your reason, also.
    I have another theory, but docrum won't permit me to post it.
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    I've heard that there is finally some movement towards a new state test.
    Apparently, the Illinois Fire Chiefs Association has been pressuring IDPH to get it done.
    I'm looking for the news article. I know Don Moffitt has been working hard on it as well.
    Stay tuned.
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    It appears as though the EMT testing fiasco is over.
    I see state test dates starting on January 20th.
    It appears all of the sites will be college campuses.
    The winter Fire Call was dedicated to EMS and there were several articles discussing the state testing debacle.
    Took alot of push, but it looks like the wait is finally over.
    CR
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    Quote Originally Posted by ChiefReason View Post
    It appears as though the EMT testing fiasco is over.
    I see state test dates starting on January 20th.
    It appears all of the sites will be college campuses.
    The winter Fire Call was dedicated to EMS and there were several articles discussing the state testing debacle.
    Took alot of push, but it looks like the wait is finally over.
    CR
    When I was in class and scheduled to take the NREMT test in December we were told if we failed the NR then we could take the IL state starting in Jan but I am not sure if that was a concrete fact then. Looks like everything is good now though.

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    Quote Originally Posted by ChiefReason View Post
    It appears as though the EMT testing fiasco is over.
    CR
    I wouldn't bet on that quite yet. Lets see the results of the tests.

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