toutdoors

Dust, it is hard to argue some of your points, they are extremely valid. It is easy to see that you also seem to care deeply about EMS, and the standard of care that is out there. I hope you don't interpret my posts to imply that volunteers should be used in place of full time career personnel, I would not support that idea myself, and I was a volunteer. Let's face it, the full time medic is going to see more calls than the volunteer, no doubt, and it is very likely that they will be afforded more and better continuing ed while on the job, during down time. All of these opportunities will result in a medic that has seen more patients and has a broader base of education and experience to draw upon. That is a pretty good package no doubt. But I guess my question would be this: If the budget was so tight for small town USA, and they could not afford to support a paramedic, should we say "Well sucks to live there, you get hurt or sick you die before the medics can make that 20-30 mile trip"? Or would it be a little bit better, to have at least a BLS transport service with 6-12 dedicated EMT's that recognize their limitations, and want to at least try to help their neighbor as best they can with what is available to them? Such as a simple AED and Combitube or King LT airway for the really problematic pt's? I appreciate and admire your zeal in wanting to promote ALS as the next best thing to an ER in home town USA. Because I believe it is just that, not quite an ER, but pretty dang close to it. I think that it is absolutely awesome that we have a prehospital program here in the US that allows a person to become trained and certified to the point that they can do many of the same things performed in an ER to stabilize a pt. ACLS is an excellent example of this. Honestly though, is there no middle ground? As an EMT I understand my limited educational background,(the limits of that education are becoming more evident the further along I go in paramedic class) and my the limited amount of skills I can perform. I can only hope that other EMT's are also aware of their limitations, and that we are NOT a cheaper version of ALS, we are no version of it at all!!! The one thing I can not stand is to sit and listen to a BLS provider sit and brag about how much they can do for you. All you can do is dress an injury, basic splinting, some C-Spine immobilization, assess V/S, and blindly stick a small garden hose down someone's throat, and sometimes zap the crap out of some poor guy. Maybe get an IV, depending on scope of practice in some states. Now, all you EMT's I am not belittling us, (I may be in class for medic, but the card still reads EMT), what I am saying is very simply this: As an EMT, there are a FEW things I can do to help you survive (hopefully), until ALS arrives, or we get you to the ER, whichever occurs first. I am not a miracle worker, nor do I have a fingerprint from the hand of God in my back pocket, I am simply someone who has been trained to mitigate the few things that can take you out of this world real quick, like no airway, and no pulse. The rest of the stuff, well, hang in there bud, there is more help on the way. Sometimes just the presence of someone on scene to say, ok, we are going to do our best for you and we have more help on the way, is enough reassurance to calm a cardiac pt down for those extra few minutes needed for ALS arrival, or for that trauma pt to say, ok, I can make it through this, these guys will take care of me, and hey, more help is on the way, great. Then again there are those times when all the help on scene at the time of the incident will not help some poor sap out of their woes. I don't know Dust, is there room for some middle ground with the understanding of how narrow that room may be? I mean seriously, is something better than nothing? I won't argue the fact that in a perfect world, there would be a medic on every ambulance in this country, but frankly, I do not see that happening. Why? Simply put, money. It has been said time and time again. Another problem is the public's perception of what they are getting, I agree wholeheartedly with you on this too Dust. But what do you think the problem is? Is it that BLS providers brag about how good they are, or is it that people are content to live where they choose, and have to accept the fact that they do not have all the resources avaible to them if they had lived in a larger urban environment? I say that the best we can do is educate people, look at what has happened in regards to heart attacks, and strokes. People are being told that if you think something is wrong, call for help. What is the result, we are getting more and more people calling because they think they are having a serious medical problem, when it may actually be some indigestion or slight naseau. Do I consider that to be a burden to us? Absolutely not, better safe than sorry, besides I am getting paid to be here, so go ahead and use me, that is why I am here. Now Dust there are some old firefighters on my department that still say they did not want to do EMS, they joined to fight fires, so you have allies on the fire side too. But seriously, I hate to see that two organizations that should work so closely together can have such issues as to who should do what. You kinda make it sound as though there are no good fire medics out there at times the way you get rolling. Could just be your intensity, or my misinterpretation too. But I enjoy reading your posts, you put alot of thought into them, and shed some good light on subjects. Take it easy

Dust, and Dahlio you folks make some very good points. If I came across as saying that EMS should just stand back, that was not my intention. Like I said our two agencies work very closely and have some really good relations going on. As to why do we answer EMS on the fire side? Because there are more fire stations than ambulances in the city. This is the way our system is set up, and it seems to work for us most of the time. There are times we could use another ambulance on the street, but there are far more times that 2 of the 4 on the street are not on a run. Do I mean to say we should cut back on the ambulances? Of course not, just that when you spread all the numbers out, the slow times outnumber the crazy, hectic busy times. Our ambulance service is a privately owned company. The city has furnished the company with a place to park the ambulances, along with office space, and storage space for supplies. All in the same building. (I find this sort of efficiency quite crazy on account of the fact that government is involved) The city also purchases the vehicles, such as transport ambulances and elderly clinic transport vans and then leases these vehicles back to the company. The company also is lucky enough to purchase their fuel from the city at a lower cost. So the city does help the company out quite a bit, there is already a good amount of taxpayers money going to benefit a private company. Now I will not argue that this private company provides a much needed emergency service to the community, but as firefighters we look at our cut budget and say "Hey, why did you give them something and take something from us?" I do believe that I will see ambulances in the fire houses in my department, and that the staff on them will be firefighter/paramedics. I know, this opens up a whole other can of worms. There have been talks of this for the past ten years, and I just don't see how much more help the city can give this company without becoming to involved. I do not want to see some of my paramedic friends possibly lose their livelihood that is for sure. I feel very fortunate that the paramedics I work with are for the most part very professional. As for medics snubbing EMT's; I did not mean to imply that I was trying to perform an ALS procedure, just doing your basic EMT stuff. Taking V/S applying some O2, maybe splinting, or minor bleeding control. The issue with a medic treating me like crap is more a personality issue than how I feel about medics in general. Like I have said, we have a pretty good working relationship and I value that. I know medics are looking out for people's best interests, even firefighters. Believe me when I tell you I appreciate what you guys do. I am enrolled in the medic program and have had my eyes opened up a few times these past few months as to why this is happening to my pt. I look forward to continuing my education in EMS and fire. I do believe that one key element to working on the emergency scene with other agencies in a professional and effective manner is to train with these other agencies at times, and the more the merrier. This way we all get to have a little better understanding of what it is that everyone is there for, and what the primary concern is from the other person. Now, I can not leave this post without saying that I am sure you have run into some serious macho firefighters, yeah they are out there, and they kinda give the rest of us a bad image. Sorry about that.

I coundn't agree with you more spenac, but believe that when we say that all services should be paid, we are painting with a very broad brush. I might be misinterpreting what you are saying also. Do you mean that the smalltown USA ambulance, that serves 300 people should be on a full time paid basis, or should they be a paid per call type of service? Even if it were only pay call service, who would pay for the medic school? The service, the community, or the individual? That is alot to ask from some of these small towns and services as well as those dedicated EMT's who volunteer. Maybe the answer lies within the larger hospitals, maybe we (as an organization of EMS personnel) need to lobby the big time hospitals for some money to the outlying areas surrounding them. After all, if they would pay for a few people to take the medic class, the medics may prolong someone's life long enough to make it to the cath lab or OR, or at least to the ER, so the hospital can charge an astronomical fee for services to recoup those few medic classes they paid for? I know, a little sarcasm here, but let us not forget that EMS is still relatively new in the US. Oh sure, we were throwing people in the back of paddy wagons and onto flatbed trucks a long long time ago, but it wasn't until The White Paper in the 60's that EMS was really born here in the US. Does this mean that we should take what we get and be happy with it? Not neccessarily, I think we should look back on what was, and what we have today, and be thankful for the advancements. Then let us take a look ahead and determine what we would like to see short term and long term, and decide how best to procede. To all of you dedicated volunteer EMT's, my hat is off to you, I was only a volunteer firefighter, but heard all the ambulance pages for the EMS and transport to larger hospital calls go out. To all of you full time paramedics, please don't forget where you started, and that BLS is the start of ALS. (Day one stuff I know, I am in the medic class now, trying to better myself and my service) Also, please share with all of the EMT's out there your experiences and any knowledge that you can pass on that will create a learning opportunity for these individuals. Some of these people want to get to where you are, they are just waiting for their chance to get in class, or get the finances. When the call is over, we are all in this together, some of us drive, some of us do basic stuff, some do advanced stuff, and the docs get all the money for working in the nice clean controlled atmosphere, but then again they can have that; all I want is my little piece of the pie, and the satisfaction that comes with it. It is very interesting to sit and read some of the thoughts that are out there. It seems that you can see who works the large service that would be associated with a larger urban environment, and then you can see who is working as hard as they can with what little they have and all on their own for an extended period of time. Makes for some interesting reading, and gives us a chance to see why things are not always the same all over, although it would be simpler if they were. To everyone: Have a great summer filled with laughter, sun and fun family times, and keep up your hard work. I look forward to reading more from you folks.

Dust, it is obvious you have taken this with some great sourness. I can only assume that from your comments, you have been burned by fire service personnel in the past. That is unfortunate. I truly believe that WE all need to work better together, police, fire, and EMS. As I stated, we all have our own little rings in the circus of emergency services to the community we serve. From your comments about fire monkeys, I can see that the professional courtesy and respect is lost as far as you are concerned. This is unfortunate. I can only speak for the department that I work on, none of the firefighters feel that we are all that the community needs. We do not transport, we show up, bandage you up, maybe start an IV, or get the CPR, AED thing going, then in comes the ALS crew. GOOD, cause we don't transport. In our community, the fire based EMS response along with jointly dispatched ALS transport service has worked very very nicely ever since the first ambulance hit the streets here. I did not intend to make it seem in my original post that when we rehab we completely ignore the medics, nope, we will sit and smoke and joke with them. If they feel we need a little extra time out, we will take it. We have a pretty good working relationship with them, of course there are a few of them that I am not that crazy about, but that is a personality issue, not a professional one. With that being said, I can also say that I have been snubbed by medics on EMS runs before, when they get all cocky on me and basically give you the " I am the medic, you are the firefighter" attitude. Well I understand that everyone has a bad day at times, but keep it up, and you can get that 300-400 pound pt lifted up on the cot with just your two person crew if you don't need me. You can also carry all your bags back to the ambulance when the pt is on the cot. Two can play that game, and it usually ends quickly when everyone checks their attitudes and works together for the best outcome of all involved, responders as well as pt's. Like I said in the first post, I believe everyone needs to work together to achieve the best outcome of our calls, regardless of what type of call. Anyway, have a good weekend Dust.

Mateo, I did not mean to imply that ACLS should not be carried out on scene, or that transport should override field delivered ACLS, or that ACLS is not as good on the street as it is in the ER. My view is that if we are going to work a code, we are going to transport, now bear in mind that my service area is urban, and has short transport times. Most transport times being within 10 minutes from scene to ER. I agree that you need to keep the family abreast of the gravity of the situation at hand, and I feel we do a pretty good job of explaining to the family what we are doing and why. As to your response to the life safety issue of the crew; i can not agree with you more. The message I tried to convey was that just because we are going to transport this dead body emergent to the ER, let it be the only dead body that is associated with this crew, drive safely. I understand that there are services out there that may call most of their cardiac arrests if there is no change from an asytole "rhythm" after the second dose of cardiac drugs are on board. Would there be any good reason to transport a cardiac arrest for say 40 minutes while performing CPR and ACLS? I would say that most times the answer would be no, exceptions not being present of course. (such as hypothermia) What I am trying to say is that in our area, we do transport the majority, and by majority i mean over 90 % or our cardiac arrest pt's. Then again, like I said, we have a short transport time compared to alot of folks out there. Of course, this does not in any way mean that we have all the answers to the way things should be done in EMS. Who knows, we may be going the way of no transport on codes in a few years, then again, we may continue to transport these pt's, if for no other reason than "we have always done it this way" Ahhhh...tradition can be so wonderful and mind boggling to us at times. I have found it very interesting that there are a good many services that do call a code after the second dose of drugs with no change. I have a young firemedic on my engine company that came from a service in Wisconsin that had extended transport times, and he said this was the norm for them. I can not argue with someone from another service as to what they believe is best way for them to perform their duties; after all, I have not experienced their challenges. Thanks for the comment though, it makes ya stop and think about what ya said, and explain yourself at times. Another issue for me is that I prefer the ER Doc and chaplian to tell the family, I have done it before, and do not relish that part of the job, so in the good ole american tradition, I am gonna "pass the buck" on that part if I can. Have a good weekend Mateo, hope I cleared up a few things for you, meaning what I was trying to say.

Wow, I feel pretty inadequate here. The bag I have in my vehicle has the following: B/P cuff and stethoscope Adult C collar Adult BVM Combitube a few roller bandages 2 or 3 8x10, a trauma dressing, half dozen or so 4x4 a roll or two of 1" tape, normally about a 1/4 of the amount of tape on them trauma shears, one or two cheap space blankets a few of the large heat pads for hands a cold pack a bottle of baby ASA 3 or 4 pairs of gloves penlite window punch seatbeltcutter OPA various size bandaids a couple of occlusive dressings one or two pressure dressings 2 or 3 triangle bandages When I worked construction, I also used to have a bottle of iodine as well. I feel that is is a pretty adequate bag for what I am going to come across. I have used it numerous times on calls both around my home area, and when visiting as far away as the west coast. It has always been pretty well rounded, and it fits into one of those nice smaller "first responder" bags that catalogs sell. Now when I am deer hunting with the guys, I carry a kit that fits into a one gallon ziplock bag. It has pretty much just trauma gear. Shears, a couple of pressure dressings, a few occlusive dressings, a whistle, two space blankets, and 4 or 6 large heat pads a couple of 8x10's and a few 4x4's with a small roll of tape, for those nuisance cuts. The idea here being that god forbid something happens, we can stabilize you with basic skills as we get help on the way, and get one of our vehicles out into the field to bring you to the road. I am not saying that those of you that carry alot of stuff are nuts. I am just glad I am not your back. Seriously, I can understand that some of you folks can be stuck out there on your own for awhile, and I applaud you for what you do.

I agree with you. When I was in intermediate, every pt we had in class was an IV candidate. Now every pt in medic class a candidate for intubation, the monitor, RSI, a needle decompression, some type of medication, pacing, cardioversion, god the list goes on. I too have been trying to "find" a reason to do more than vitals and maybe a little O2 on a good number of pt's during my ride time. It seems frustrating that when I am working I see truly sick or injured pt's, and when I ride, they simple need a white taxi to the ER. I have been involved in this field of work for almost 15 years and do know this, as your experience base broadens, your intuition becomes much more keen. Good luck in your ride time, and know that you are not alone in the corral.

If any EMS weenie EVER tried to take my helmet, , you'd be in for a fight. LOL Former, I agree with you. Touching my helmet is akin to touching my weapon when I was in the Corps; you just don't do it. I say this part jokingly, but also to serve as a wake up call to some EMS personnel who may not appreciate how this action can damage a relationship between two agencies that need to work together. One of the most important things we all need to remember is that we are not the cure all for every call we go on. Yes I did spend 5 years in the military, and have recieved some very good personal defense training, yet when we go on violent calls, who goes in first? The police, cause they have the guns, as a fire officer, my crew is staged down the street until the scene is cleared. If I am working the ambulance part time gig on that run, I will stage with fire. If we are on a cardiac arrest, as firefighters, we assist the medics with pt treatment. On the fire or hazmat scene, the police and EMS support the firefighters. Everyone has a specialty, and we all need to work together to keep the lines of communication open, and the respect for one another high, so that we all truly carry out our duties as professionals, and not with the attitude that THIS IS MY CALL, it is our call. I know I kinda got off of your original post, sorry. In our area, the crew stays together, we use passport tags. This makes it easier for the IC to account for us. Our private contracted ambulance service responds to all working fires and they will do our rehab if things get really escalated. Normally, we will rehab and rehydrate ourselves, I think we are pretty good about it, but then again may be able to do it better. If I am working the medic gig on a fire standby, and if it is a really good worker, with a potential for injury, we will get things set up in the rig. backboard and collar on the cot, spike a bag and hang it in the rig, get the intubation kit rolled out, and electrodes on the monitor leads and hooked up, NRB hooked up to O2, and a BVM on the counter but still in the bag. Sounds like a lot of prep, I know, but these guys are my brothers and friends. The biggest expense is a wasted IV bag, and tubing along with the NRB taken out of it's wrapping, if this puts the company under, we were in pretty bad shape to begin with. While we do have a fair share of fires in our area, luckily we don't get a lot of the really big ones, mostly the room and contents type of fires. I have also found that with anything else in these fields, if your agencies train together frequently, then you play together much better.

I believe that the biggest issue is summed up very simply; money. I spent 5 years in a volunteer fire department that worked very closely with a volunteer ambulance, it wasn't until my last two years there, that one of the EMT's from the ambulance took the paramedic. Let us not forget that volunteers put in a great many hours dedicating themselves to their community. Now ask them to leave work early for the better part of a year two or three days a week to take night classes, and more than likely they will have to drive at least a half an hour or more to get to the class. Then take away that family vacation this summer because you are doing your ride and clinic time. Now that you finally made it through the studies and tests, and still have a job, and your family, your ambulance crew finds itself being requested by smaller ambulance services that are transporting to your small community hospital because you have a paramedic on your crew and they have a critical patient. This can be alot to ask of one or two people on an ambulance team that may be made up of only 6-10 people taking turns being on call. I agree wholeheartedly that the rural areas would be of great benefit if there were more medics available. I guess the next key word is EDUCATION of the public, and those who hold the purse strings, see if we can't dole out a few bucks to those dedicated volunteers who put everything on hold at a moments notice to try to help someone they may or may not know. I miss the volunteers I used to work with, but love the 24 up 48 down schedule, now at least I can plan around someonelse's emergencies.

I posted pretty much the same reply in another forum, but will state what I feel. First and foremost, we must remember that the best thing we can do when transporting a cardiac arrest is to DRIVE PRUDENTLY!!! Just because we are going to the ER code 3, does not mean that we should be taking corners so fast that the rig is tilting, nor should we be swerving through traffic like a drunk monkey. Personally, unless the pt has obvious signs of death, and they are still warm, I prefer to work the code, and transport. Let the Dr and Chaplian do the talking. I have told family members there is nothing we can do, both in the traumatic case of a child having obvious signs of death, and in the case of the spouse of umpteen years is lying in bed, pale, cool, and stiff. I have learned one thing, I hate that part of the job, and prefer that it is left up to the folks in the ER. I guess it also comes from the fact that this is how we have always done it, and I am ok with it,( wow, that sounds like a typical fire service response ) not sure I would be really comfortable doing 20 minutes of ACLS and then packing up our gear. Of course, in our area, the city I work in has a 10 minute response time from the far end of the district, of course out in the counties, the transport time is much greater, and then you need to consider that when we do ALS tiers, the pt has been down for a much longer time frame by the time ACLS is initiated. Of course let's not forget the beancounters, some of these issues may revolve around billing issues.

I work for a career fire department, and part-time for the ALS transport service that we contract with in our city. The FD will provide the manpower that the transport service requests. A lot of the time the transport service is running two medics, sometimes a medic and an intermediate. The FD has over half of it's manpower at the intermediate level or above. We transport all codes, if there are no obvious signs of mortality. The key to transporting a dead body with people beating up on it, and pushing all kinds of expensive liquids ( meds) into it is simple: DRIVE PRUDENTLY!!!!! Remember that there are coworkers in the back of the rig, as well as a pt, (this term being used loosely in this circumstance) There is also the possiblity of family being on board. I understand that the highly educated DR's want to make the call of death, and that is fine, what we need to remember is that the odds of this pt making it out of the ER are very slim. So calm down, take it easy, and consider that 5 mph over the posted speed limit may be all you need to do, even if you are "Code 3" or "running hot".

Doing a research paper for medic class. Here is the question: Are there any services, other than US&R task forces, that have protocols in place for a pt who is experiencing a crushing injury, and is entrapped? The medical specialists on the task force I am assigned to have protocols they can follow, but the fire department and ALS service I work for do not have standing protocols in the event we are faced with prolonged extrication such as trench collapse. Paper is due end of June, feedback would be great. If any one does have protocols specifically geared toward the treatment of this injury pattern, could you please, include a short bio, such as how big the service is you work for and what type of demographics or geography you cover? ie; full time paid x number of employees, and cover a district of urban or rural area? Thanks and have a great summer guys, and gals.