Saturday, June 13, 2009

You're an EMT What?

But first- The Pedro "I wouldn't want to hurt anyone's feelings" Disclaimer

I like and respect EMS providers of all levels- I started my career as an EMT-B, worked my way through Medic class and now work as an EMT- P. I like it, I like you... ok?

There's been alot of talk around the ol' neighborhood about fixing the Paramedic shortage by training EMT-Basics (B) to the EMT- Intermediate (I) level. I believe that there has already been one state that promoted all of their EMT-I's to Paramedic- because that was the only way they could get any Medics on the trucks. Well there's a flaw in that approach- I'll get to it, but first...

My partner and I walked into the EMS room of a major inner city hospital following a call. The ER was busy and the ambulance bay had been filled- as was the EMS room. The conversation seemed to be revolving around, what else, the EMT- B scope of practice.

One EMT-B, who was apparently from out of state, said "Back home I can start IVs", another EMT answered that "Back home I can intubate, well, Combi-tube anyways"

My partner that day was a hard core, long term city medic. He's also a really big guy with a pretty low tolerence for BS. He took a slow look around the room and then said " You idiots are all sittin' around here braggin' about monkey skills. Can any of you jackasses do a f****** Paramedic, ALS patient assessment?"

Ah- and there is the problem. You can teach a monkey to do an IV or to intubate- they could probably do it while riding in circles on a little bicycle. But you can't teach a monkey how to do a patient assessment- and it's the assessment that saves lives. It's the assessment.

So, here we are. On one hand we have a dwindling number of experienced Paramedics, who have done the training, the clinical time, the days and nights on the trucks to learn the ART of pre-hospital Advanced Life Support. And on the other hand we have the Dinosaurs who run EMS- the same folks who have made the field inhospitable enough to cause our current shortage.

The answer? Hell I don't know, but if you want a circus send in the monkeys- we've already got the clowns.

Monday, June 8, 2009

EMS Resource Allocation...

... or how to get the right stuff to the right people right away...

A recent post on The Happy Medics Blog got me thinking about how we do things here in EMS world. Please take a moment to follow the link and read Happy Medics well written, thoughtful post- no sense in me re-hashing it.

We all know that EMS calls run the gamut from "You didn't really call 911 for this" to "Wow, you're really sick dude!" with most in the former category.

So here is how we USED to handle 911 calls around here:

  • The Paramedics could of course, treat and transport the patient irregardless of their complaint. No jokes please about how many Medics does it take to transport a sore thumb- around here the answer is two...
  • The Medics could call for a BLS Ambulance- so the sore thumbs and other appendages still found their way to the ER but the City got to keep its ALS crew in service. Sounds good- except our BLS crews were all let go for budgetary reasons... so scratch this option
  • We could call for "alternative transport"- the Wheel Chair Van. This was great for folks going to clinics or doctors appointments who had somehow been misdirected to 911. But again, the ol' WCV was a victim of the mighty cost cutting sword- gone...
So what to do with all these "patients" with bumps, bruises and other minor complaints and chronic non acute illnesses? Of course- after an assessment, they climb in the back of a full ALS crewed ambulance for a cab ride to the ER.

Anyone who has been in the EMS field for very long knows the frustration that comes from hearing potential life threatening calls being dispatched while transporting Grandpa with a tender nut. Remember how you felt the first time you sliced and diced rush hour traffic to get cross town to that CHF patient- when the ambulance in her distrct was transporting a kid with "itchy legs"? Oh yeah- you remember...

Will things ever change? Sure, but probably not for the better. Because EMS is, without a doubt, the fish that stinks from the head.