Every department operates with policies, standard operating procedures, guidelines, etc. However, no matter how strictly you follow these parameters, they do not "always" work from a practical standpoint. Is following them to the "T" always working in the best interest of the client/patients/public?

Sometimes the decision-makers within the top ranks of a department do not have in-depth knowledge about what is taking place at the lower levels — in my case, serving in the emergency response division of the fire department for most of my career.

When on-duty at the station and responding on calls, we have first-hand experience as to what works best in the aid of the public. This is not to say we are breaking any rules. However, as stated above, what is in the best interest of those we serve?

I believe it is beneficial for those at the executive level of any department to spend a tour of duty, on a regular basis, and respond on calls, so they can get the first-hand experience of daily operations. With a more intimate understanding of operating and responding on alarms, they will be able to make better decisions — and therefore, better policies for both the employees and public.

For those of us who work in a large municipality, the local public health system and their hospitals, or any other large hospital with emergency rooms, are always inundated with more than they can handle. There is no doubt you will get the best care at these facilities, since the knowledge and experience gained by handling so many patients are invaluable. However, depending on the severity of a medical condition (triage), you may be spending hours or maybe even a full day before you get seen by medical personnel.

Much of the public still believes that if you are transported by a fire department ALS vehicle, you will get seen immediately by a doctor once you arrive at the hospital/emergency room (ER).

My former department’s policy was to transport anyone, regardless of medical condition. That is because the department collects revenue for transports. A fee for miles, electrocardiogram monitoring, IVs, oxygen, etc., or any other treatment or medication used will be billed. Just to step into the truck to be transported, at that time, was a $300 fee for transport, with no other treatment needed.

Sometimes you have no choice since the person may have no other means of getting to the hospital or does not have access to personal healthcare through a private doctor or insurance, if it is beyond the capability of medical treatment (i.e., wound care) provided by the ALS/EMT/Paramedic unit.

As always when responding to a call, you always observe your surroundings. Let’s say you arrive at home where it is obvious that there are no financial issues present.

After performing patient assessment and vital signs, it has been determined that the patient has a persistent cold that won’t go away, and they wanted an evaluation by the paramedics. You advise them that they can go to their primary care physician to get the treatment that they need.

The patient and their family then state that they want the best treatment for their loved ones and want them transported to the hospital! Even though this is policy, are you really working in the patient’s best interest?

You advise them that you are here to provide a service and that you would be willing to transport them (they are taxpayers and are entitled to your service). However, since their condition is not grave, they may end up waiting in the emergency room for 8/12/16/24 hours before they get seen. Plus, they may end up sitting next to a less privileged person also seeking care whose personal hygiene needs attention.

They would be better off making an appointment with their PCP, since their condition is not grave, having to wait an hour or less, in a nice air-conditioned waiting room, in nice surroundings. This would be the advice, in all honesty, I would give to my own mother, relative, or spouse.

Many of those feel that they are privileged to always take an ALS unit since they have Medicare or Medicaid (and believe they will get seen faster). These health insurance resources will not pay for transport unless “medically” necessary.

A common cold, digestion, fever, minor illnesses, etc. do not qualify. The government is smart, and they are not going to waste tax dollars on unnecessary expenses.

Now, there are times when the explanation becomes lengthy, and you need to ask yourself, "Am I better off staying here 30 minutes explaining when I can have them in the emergency room in 10 minutes?" The only disadvantage to this is that the ER personnel will complain and say you are “dumping” on them.

These days, ERs are closing and diverting patients because they are at full capacity. It gets to the point sometimes that all the beds are occupied, and patients remain on stretchers in the hallways or wherever they can make room. Specific criteria need to be met to override the diversion.

The other issue that needs to be addressed is that when you call an ALS unit to your home because you want your blood pressure taken, you have taken a unit out of service when potentially another alarm can come in for someone experiencing chest pain and possibly a heart attack.

Therefore, that patient will now have to wait a longer time for an ALS unit to arrive at their residence to evaluate them. This basically boils down to public education (administration) and needs to be sent out to a resource so that the public can be educated and not call "911" if it is not a true emergency.

One thing to keep in mind: You will never go wrong if you treat those you serve as if they were your own family!