How Writing May Have Saved My Career

There’s a new post up at Uniform Stories featuring yours truly. I’m really excited to announce that I’ll be writing for them on a bi-weekly basis. This is really a huge blessing for me as I try to take my writing to the next level. None of this would even be remotely possible if it wasn’t for everyone that continues to come back and support this blog every day. Ya’ll (I can say that now that I’m in Texas) are freaking awesome!

In this article I talk about an incident I had a number of years back when I tried to pronounce a patient dead on scene after failed resucitation attempts and was overruled by the ER physician. The ER doc’s decision saved the patient’s life. Go check out the article to see what kind of emotional toll that had on me and how blogging may have been the one thing that kept me in EMS.

Check it out: How Writing May Have Saved My Career

If Al Sharpton Was a Paramedic

Our Celebrity Medic this week is no stranger to tragedy. With all the violent crime in the streets, he has no problem keeping his travel schedule full. Chances are, he will never find himself in a position to need a new line of work. But what if he got tired of his life in the spotlight? What if he decided to seek a more hands-on approach to responding to tragic events? Sure, he might need some training, but a transition to EMS would be right up his alley. So without any further delay, let’s ask ourselves the big question of the week:

What kind of Paramedic would Al Sharpton be?

Training for Al Sharpton would be tricky as most people wouldn’t be sure exactly what his qualifications were. While most paramedics train to thoroughly examine every patient before developing a clinical impression, Rev Sharpton would instead train to find only specific clinical signs to support a pre-determined diagnosis. It should also be noted that his patients would be screened before hand for these specific clinical signs before he would agree to respond.

Traditionally, paramedics responds to all calls for assistance. These might include – but are certainly not limited to – heart attacks, strokes, asthma attacks, pregnancy emergencies, trauma and even minor viral illnesses. Rev Sharpton would be unique as he would most likely specialize in trauma, more specifically, acts of violence. He would also stray from the long-standing belief in EMS that everyone is to be treated regardless of race, sex, religious beliefs or sexual orientation. Instead, his patient qualification criteria would exclude the Hispanic population, Caucasians, and people of Asian descent. African Americans would be his primary focus, however they could be disqualified for service if harmed by a member of the same race. Given the scarcity of patients that meet his criteria, he would have to expand his response area to include the entire United States.

Rev Sharpton would not have a need for the traditional lights and sirens that traditional emergency vehicles have. Members of the communities that he was responding to would be notified ahead of time via press-releases and therefore would have plenty of time to yield the right-of-way for his arrival.

Radio reports and patient-care documentation would be a thing of the past. Rev Sharpton would instead utilize press-conferences, FM radio monologue and speech rallies to deliver patient information to the receiving hospital. The ER staff would certainly know of his arrival as he would tend to make a large entrance. However, they would be surprised to find that he would quickly and quietly leave the facility without saying a word to anyone.

Joining Rev Sharpton at his new ambulance service would be none-other than the famous Jesse Jackson and possibly Michael Bloomberg. Dispatch would be handled by Barack Obama and Eric Holder. Together they would start the first official Racial Tension Task Force (RTTF). While many would speculate that this group would work well together, people might be surprised to find that Rev Sharpton typically works better alone.

In conclusion, we can clearly see that Al Sharpton’s experience dealing with tragedies, background in communication, and ability to quickly assess situations without clear facts or evidence would make him a perfect fit for a job in EMS.

Have an idea for the next Celebrity Medic? Comment below or e-mail me at: sean@medicmadness.com

Why Paramedics are Going to Lose Intubation

I’m sure the headline of this article will have many people lighting up their torches and sharpening their pitchforks, but hear me out before you burn my village down. Most of us have heard and most likely participated in the heated debate about whether or not paramedics should be intubating in the field. If you’ve been reading my blog for any amount of time, you know that I’m no exception. Do I think our industry falls short when it comes to airway management training? You bet. Do I think the solution is to eliminate intubation from the standard scope of practice? No, I don’t. However, we are going to be left with little choice unless we get over ourselves and make the necessary changes to improve our competency in airway management.

I recently read an article by Dr. Minh Le Cong on the Prehospital and Retrieval Medicine blog asking what the “gold standard” of airway management is for paramedics 1. Had I read this article 10 years ago, I would have been painting my face, soaking my torch in kerosene and rallying the villagers to start the witch-hunt.  Now after a decade of involvement in management, Q.A. and EMS education, I simply nod my head in agreement. Let’s face it guys, we have some serious work to do. Our educational systems, clinical sites, monitoring procedures, and most importantly, attitudes are all killing us when it comes to airway management.

Allow me to elaborate….

Initial advanced airway management training for paramedic students is highly inadequate. Studies have shown that it takes ER physicians anywhere from 18-35 successful monitored intubations to be considered “competent” and somewhere around 47 to be “good” 2. Anesthesia residents obviously require much more. Paramedic students? Well, the National Standard Paramedic Curriculum recommends 5. Mind you, paramedics traditionally perform the skill with much less frequency and in much less desirable environments, yet we are expected to be “competent” in the skill. Do you see a problem with that? This is unacceptable and we have to find a way to change this. Having said that, I have to point out some serious obstacles that we face in gaining more monitored experience. 

Hospitals and anesthesiologists aren’t exactly making this easy for us. We already have to compete against medical students for intubations during O.R. rotations and fewer and fewer anesthesiologists are allowing paramedics to perform the skill under their supervision. That’s a huge problem and I could write several blog posts on that topic alone. We are also missing out on opportunities as alternative airway devices are taking the place of ET tubes in many procedures. Clearly, getting over this hurdle isn’t going to be easy but something will have to change if we are going to increase our educational standards.

Another issue we have is continuing education and monitoring. Once our paramedics clear their initial training, many of our systems just cut them loose and hope for the best. A few years back, I worked for an EMS service that has a very unique coverage area. Depending on your assignment, you could find yourself working in a busy metropolitan area, or an extremely rural area with a very small call-volume. I knew a few paramedics in the rural stations that went nearly 2 years without attempting intubation. Nothing personal against those paramedics, but do you honestly think they possess the competence and / or confidence to handle a difficult intubation? More importantly, do you think anyone was watching over them to make sure they were practicing the skill enough to maintain competency? The system I mentioned only deploys one paramedic to every call. Imagine a fire-based system that deploys several paramedics to every call. We’ve already established that our paramedics aren’t intubating enough when they are the only advanced provider on scene, imagine having to split that skill between 4 paramedics.

We need to be monitoring our paramedics to make sure they are performing the skill enough to maintain competency. If they aren’t, we need to bring them in for monitored practice and refreshing. We also need to be doing quarterly airway training. The Law Enforcement community figured out a long time ago that most of their officers will go their entire career without firing a shot. They also recognized that if that time came, they had better be able to react appropriately and hit their target. That’s why they have to qualify with their firearms quarterly. We need to be doing the same.

One of the biggest things we need to change is our attitudes towards airway management. Back in 2010, there was a panel discussion on JEMS.com about the issue. I think William Gandy hit the nail on the head when he said: “Paramedics should be thoroughly schooled in airway evaluation and should have a variety of airway adjuncts, such as bougies, video laryngoscopy and supraglottic airways, available and be willing to use them3. The 4 words to take away from that sentence are “WILLING TO USE THEM”. I’m going to come right out and plead guilty to previously possessing the mindset that airway management revolved around direct laryngoscopy and that the use of any additional tools somehow made me less of a paramedic. Many of us in EMS still possess that mindset and it is killing patients.

If police officers approached every aggressive subject thinking “should I shoot him?” as opposed to “how can I stop the threat?” we would have a lot more officer-involved shootings. The same goes for airway management. We think we are doing our patients good by intubating everyone that presents with anything above a moderate level of distress. The truth is, we aren’t. In the cases where intubation is actually indicated, we have a huge potential to save a life. However, using the tool prematurely or inappropriately can be extremely detrimental and often fatal. For example; the bad CHF or COPD cases. These people often can’t come off the ventilators and therefore wind up dying in the ICU. In those specific cases, we need to be trying everything from medications to CPAP before even considering intubation. Just like the law enforcement analogy, we can’t approach every patient thinking: “Should I tube them?” Or even worse: “Can I tube them?” We need to be thinking about how we can improve ventilation and oxygenation. 

When it comes to intubating, we have this terrible habit of making it as difficult as we possibly can. Every time I hear the “we intubate in ditches while it’s raining” BS, I wan’t to choke someone. Why on Earth would anyone elect to intubate anyone in anything but the most convenient and practical location possible? I’ll tell you why: Because we don’t take it seriously. While there are those select few times that we will find ourselves forced to intubate in difficult environments, they are extremely rare and should be avoided at all costs. With every time that we place a blade we are causing damage, pain and potentially negative neurological effects such as increased ICP. We need to be approaching every case with the intention to intubate on the first try. That means having suction ready, having different size blades nearby, properly positioning the patient and using apneic oxygenation. It also means getting off our high-horse and using every available tool to make the intubation as easy and safe as possible. Got a bougie? Use it! Got a video laryngoscope? Then why in God’s name are you using a regular laryngoscope? The “I don’t need it” attitude is dangerous and it kills patients.

If you’re a paramedic working in the field, don’t wait for your employer to hold your hand and force you to practice. You can be the change we need. Stay up to date on your skills. Take 30 minutes each month and go practice on the airway manikins. Talk to your medical director and ER docs and see what you can learn. Whatever you do, don’t just sit around and complain that “The Man” is trying to take away your ability save lives and stamp out disease. If you read the previously mentioned JEMS panel, you will see that nobody is out to abolish prehospital intubation…..yet. That can and will change if we continue down this path.

Notes:

  1. Prehospital Airway Management – What is the Gold Standard? | Prehospital and Retrieval Medicine
    -http://prehospitalmed.com/2014/07/18/prehospital-airway-management-what-is-the-gold-standard/
  2. Laryngoscopic Intubation: Learning and Performance | PubMed
    -http://www.ncbi.nlm.nih.gov/pubmed/12502974
  3. Experts Debate Paramedic Intubation | JEMS
    -http://www.jems.com/article/patient-care/experts-debate-paramedic-intub

If Willie Nelson Was A Paramedic

This week’s Celebrity Medic has certainly seen his share of rough times, but will most likely never have to seek employment again. That is, unless he gives the finger to the IRS forgets to pay his taxes again. With Willie’s extensive knowledge in herbal remedies, experience working on a bus and ability to work with old, broken equipment, a job in EMS should be right up his alley. So without further delay, it’s time that we ask ourselves the almighty question of the week:

What kind of Paramedic would Willie Nelson be?

Even though his heroes have always been cowboys, his mamma certainly didn’t want him to grow up to be one. The truth is, a career of helping people has always been on his mind. All this highwayman really needs is an old bus and a good hearted woman to work with.

While most paramedics often seek an easy day shift, this midnight rider would most likely prefer the night life. Many people would call him crazy for working those kinds of hours, he’ll gladly pound the pavement until the the party’s over and the blue skies bring him sunshine. At that point he’ll be clocking out and headed home for a Bloody Mary morning in the city of New Orleans.

Willie’s coverage area certainly wouldn’t be limited to a single city or county. From the Mendocino County Line, to Luckenbach, Texas and even the seashores of old Mexico, this desperado would be on the road again at the first sign of trouble. Of course, with Georgia on his mind, expansion into new territories would always be a possibility. There would be no need to build stations when he could just stay at the Heartbreak Hotel.

Medical billing is no easy task, and Willie’s ambulance service is no exception. However, with Medicaid and insurance reimbursement at an all time low it would be safe to say that his bucket’s got a hole in it. To address this cash-flow problem, Willie would stop accepting forms of insurance and government aid. Instead, he would operate on a simple cash-pay system where if they had the money, he’d have the time.

At the end of the day, he’d clock out, travel down the lost highway and roll right into his sweet baby’s arms to help him make it through the night once again.

Have an idea for next week’s Celebrity Medic? Comment below or e-mail me!

Could you do me a small favor?

Over the last few months, I have really tried to evaluate what I’m doing on this blog and where I want to take it. I have some exciting goals and plans including a possible podcast, e-book, and a new article series.

I would really like to gather input from everyone who follows my blog as I move forward with growing and improving. I have put together a quick 7-question survey and I would REALLY appreciate any feedback that you have to offer. You can complete it here on this page or by click the following link:

http://seaneddy.polldaddy.com/s/reader-survey

Thanks a bunch, guys!

Take Our Survey

Ebola and What It Means For EMS

Yes, I have an opinion on whether or not we should bring American citizens with Ebola home for treatment, and trust me, I’ll get to that. However, I’m going to discuss a few things about the virus and what it means for us in EMS.

As most of you know, there is tons of hysteria over the decision to bring our citizens home for treatment and plenty of fear that doing so is going to open us up to risk for an outbreak on U.S. soil. Well, that threat has existed ever since the discovery of the virus and it continues today. As it currently stands, we aren’t at a very high risk for infection. However, these outbreaks show us that these diseases are out there and that we need to educate ourselves on them and take the necessary precautions.

Ebola Hemorrhagic Fever (Ebola HF) is a viral hemorrhagic fever that is severe and often fatal to humans and animals. The exact natural reservoir host isn’t known but it is believed to be bats. What the CDC does know, is that it originates from animals. 1

The virus is NOT airborne. It is transmitted through direct contact with blood or other bodily fluids. Typically, those at risk of infection are people that are close to the infected patients, like close family members and healthcare providers. 2 It has an incubation period of approximately 21 days with symptoms showing up anywhere from 2-8 days after the infection. So far, the virus has been found to be non-contagious prior to the onset of symptoms. 3

Some of the symptoms include:

Early Symptoms:

  • Arthritis
  • Backache
  • Chills
  • Diarrhea
  • Fatigue
  • Fever
  • Headache
  • Malaise
  • Nausea
  • Sore Throat
  • Vomiting

Late Symptoms:

  • Bleeding from eyes, ears and nose
  • Bleeding from mouth and rectum
  • Eye swelling
  • Genital swelling
  • Increased feeling of pain in the skin
  • Rash over the entire body that often contains blood
  • Roof of mouth looks red

Source: Medline Plus 4

So what does this mean for EMS? Well, not much. As it currently stands, our risk of exposure is pretty low. However, when we run into patients with unexplained symptoms as described above, it would be good practice to ascertain whether they have left the country recently or been exposed to anyone that has. Of course, proper isolation precautions should be utilized. For situations where the Ebola Virus or other similar infectious diseases are suspected, gloves, gowns, masks and eye protection should always be worn.

Now that I’ve given you the facts, let’s talk about my opinion a little bit…..

I have to admit, I can’t help but shake my head when I read all the fear and massive hysteria over the decision to bring infected patients back to U.S. soil. I can understand the concern, being that we have never had an infected person in our country, but the disrespectful meme comics and doomsday predictions are nothing more than ignorant and absurd. Like I mentioned earlier, the risk hasn’t changed. If we are going to worry about infected patients entering our country, we need to focus on the ones entering through our borders, not the ones flying in on state-of-the-art medical aircraft wearing air-tight space suits.

There is always the possibility of an infected person arriving on an airline, however given the several layovers, long periods of travel, short symptom-onset, and heightened screening measures, it’s unlikely that someone will reach our country before diagnosis. Even if they do, let’s remember that this disease isn’t airborne, so they aren’t going to be infecting everyone that passes by.

The second theory, and scariest in my opinion, is the possibility of a terrorist attack. When our enemies are willing to strap bombs to their chest, we certainly can’t overlook the possibility of intentional infection with the intent to spread. Having said that, conventional air travel isn’t typically possible for this group of people, therefore greatly extending their travel time to the United States. Once again, with the short symptom onset and no treatment rendered, it would be highly unlikely that they could reach the western hemisphere before becoming incapacitated. Is it a threat? Sure. Is it likely? No.

Now, back to the Americans with the Ebola Virus……seriously guys, let’s kill the panic. The disease isn’t airborne and these patients aren’t walking the streets. In fact, they are in the ONE place where spreading the disease is virtually impossible. They aren’t freaking zombies, they’re U.S. Citizens. It’s going to be in our best interest to get real hands-on experience treating infected humans. We can only go so far treating monkeys in a lab. If everyone is so worried about a future outbreak in the United States, then wouldn’t be in our best interest to learn as much as we can about this disease?

The bottom line is, we will be fine. Just like every other time these outbreaks have occurred, we will see it die down. Only this time, we’ll have physician and another medical professional survive because of the treatment we made available to them. It’s a win for everybody.

Notes:

  1. About Ebola Hemorrhagic Fever | Center for Disease Control and Prevention
    -http://www.cdc.gov/vhf/ebola/about.html
  2. Ebola Hemorrhagic Fever – Transmission | Center for Disease Control and Prevention
    -http://www.cdc.gov/vhf/ebola/transmission/index.html
  3. Incubation Period of Ebola Hemorrhagic Virus Subtype Zaire | NCBI
    -http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3766904/
  4. Ebola Hemorrhagic Fever | Medline Plus
    -http://www.nlm.nih.gov/medlineplus/ency/article/001339.htm

Arming Medics: The Podcast Debate

Image Credit: EMSWorld.com

Last week I had the opportunity to once again join Scott Kier on the EMS In The New Decade Podcast. Our topic was EMS personnel carrying firearms. Yep, THAT topic again. Nothing gets my blood pressure up like a good gun debate and this podcast episode was no exception. Joining us was Chris Montera, host of the EMS Garage podcast. As most of you know, I hold the opinion that we should be allowed to carry. Chris, feels very strongly to the contrary. Mix us together on a podcast and you get 55 minutes of intense debate.

My opinion on this subject has changed a few times over the years. For the most part, I have been in favor of EMS personnel carrying firearms, however I had held this opinion with a healthy dose of skepticism. Like many people, I feared that the less-than-mature of us might abuse the responsibility and end up killing someone unnecessarily. As more states and services started allowing their providers to carry, I realized that the scare might have been over nothing. After all, we hear the same thing from opponents of open / concealed carry every time a state lifts a carry ban. Everyone predicts massive bloodshed, and it keeps not happening.

Another thing I realized is that we keep making decisions based on the abilities and expectations of “that guy”. You know who I’m talking about. We all work with “that guy”. The one that pushes every rule, questions every policy and always finds himself in the hot seat for something that “wasn’t his fault”. Don’t get me wrong, this is a legitimate concern. However, it should open our eyes to a larger problem: Us. Lets face it, we have low standards and we need to do something about it. When we are left with no choice but to default to the lowest common denominator every time we write protocols or policies, we have a big problem on our hands. I worked in the State of California for over 8 years and the EMS industry was essentially frozen out of fear that “that guy” wouldn’t be able to handle new or advanced procedures. Only, instead of “that guy”, it was more like “that department” or “that county”. Instead of shaping up or shipping out, we all got dumbed down to lowest level in a ridiculous effort to play it safe.

So where exactly do I stand on this? I believe that my right to defend myself shouldn’t stop at the time clock. HOWEVER, being that my employer is ultimately responsible for my actions while on duty, I do believe that they should have the ultimate say on whether or not we are allowed to carry. Until we find a way to relieve the legal liability from the employer, I simply don’t believe that it would be fair to tie their hands and force them to roll the dice and hope that we don’t screw up. I’m not opposed to additional training and I’m certainly not opposed to monthly or quarterly qualifications. Hell, I think we should be doing that with half of the skill sets that we utilize as EMS professionals. Open carry creates a problem for us as our attention would have to shift towards weapon retention. In my opinion, concealed carry would be a better and safer option. I’m not asking to issue guns to every EMT and paramedic, I’m just asking that my employer be given the option to allow me to carry a concealed weapon that I’m already licensed and legally able to carry.

When I bring this topic up, I am often advised that if I want to carry a gun, I need to go be a cop. I’ve heard it a thousand times and this podcast was no different. Here’s the thing: If anyone becomes a cop for the sole purpose of being able to carry a gun, then they are dangerous and have no business anywhere near law enforcement. The games for the crowd that becomes EMT’s so they can drive fast. I’m not looking to expand my role as a paramedic. I’m not looking to track down bad guys and turn my profession into a modern day group of vigilantes. I just want the means to protect myself. For the most part, I don’t think EMS is THAT dangerous of a job. Having said that, neither is going to the bank or the grocery store. Am I walking around every day in fear that I’m going to need to protect myself? No, but I do know that bad things do happen to good people. Just like the fire extinguisher in my ambulance, the seat belt and airbag in my car, and the accidental death policy taken from my paycheck every month, I hope to never use it. But if a situation should arise, I would like to have the option to be prepared.

The interesting thing about this debate, is that party lines don’t exist. Chris Montera is an avid supporter of the 2nd Ammendment and concealed carry. He makes that clear at the beginning of the podcast. Like many of us, he feels that allowing concealed carry would have a negative effect on our image and of course, he worries about “that guy” killing someone and bringing a negative public opinion of our professional. Those are very legitimate concerns and I certainly respect his experience and opinion. Overall, it was a great debate. I walked out with a black eye and delivered a few good blows as well. If this is a subject that you are passionate about, then you won’t be disappointed by this podcast.

Check out the podcast by clicking the link below:

Episode 14: Should We Arm Them? [EMS In The New Decade]

Product Review: CPR RsQ Assist

CPRRsQAssist[Video review at the bottom of the post]

A few weeks ago, I received this handy device in the mail to test out. The CPR RsQ Assist is essentially what the name says: A CPR assist device. The idea behind it is to guide lay-rescuers through CPR and to reduce fatigue. From what I found, it does both very well. More on that in a minute….

Opening the Package

The CPR RsQ Assist comes ready to use. No need to assemble or install batteries. It comes packaged in a round, plastic carrying case that’s easy to open. The case is handy for storing the device and keeping it free from dust or other objects that might damage it. So far, I have kept mine stored in the back of my SUV and it has held up against me tossing in work gear, music equipment and even firewood.

Using the Device

For EMS providers and rescuers trained in CPR, using this device should be a no brainer………just put the device on the chest and start pumping.

For the lay-rescuer or bystander with no CPR training, it has a button in the center of the device that activates voice prompts to guide the rescuer through chest compressions. The device even gives voice prompts to help rescuers keep compressions going at a rate of 100 per minute. Pretty cool if you ask me.

Being that the manufacture promises a significant reduction in fatigue, I decided to put it to the test. I pulled out the CPR manikin at work and did a couple rounds of 200 compressions using the CPR RsQ Assist and then did the same using the traditional method with my hands (after plenty of rest between sessions). I can honestly say that it felt like I exerted myself far less when I used the CPR RsQ Assist. Of course, I don’t have any scientific data to back this up, just my personal experience.

Field Application

The CPR RsQ Assist is certainly a good investment for lay rescuers and businesses that see a large amount of people passing through their property on a regular business. While the device isn’t specifically marketed to first-responders, I think it could actually be of great benefit to rural providers who might be waiting a long time for an ambulance or extra help to arrive. The reduction in fatigue should equate to longer periods of quality CPR, which ultimately leads to increased chances of survival. At less than $100 per device, it should fit most budgets.

Information and Purchasing

For more information on the CPR RsQ Assist and for purchasing, you can visit their website: www.cprrsqassist.com

The CPR RsQ Assist can also be purchased from Amazon.com for $79.50: CPR RsQ Assist Hands-Only CPR Device

 

Do you even save lives, bro?

Overheard at the tire shop while attempting to get a flat repaired on our ambulance:

Store Clerk (interrupting the mechanic that’s helping us): “How many lives have you guys saved today?”

Sean: “Everyone’s healthy so far today.”

Clerk: “Do you guys see some crazy stuff, or what?”

Sean: “We have our good days and bad days, fortunately today has been peaceful.”

Clerk: “So you haven’t seen any crazy, mangled, bloody people today? That’s no fun! What’s the worst thing you’ve ever seen, bro?”

I don’t know why this scenario continues to get under my skin. I got over being called an “ambulance driver” years ago and I have accepted the fact that everyone assumes that I’m either a firefighter or that I want to be. However, I simply can’t seem to shake the irritated feeling I get when I hear that ignorant statement.

I can’t help but wonder if we are to blame for this. Most people wouldn’t dream of asking that question to a Child Protective Services agent or a counselor that works with battered women. Is it the “adrenaline junkie” label that many of us so proudly wear? Perhaps we are over-glorifying our profession. I have yet to see a C.P.S. agent or counselor hype their jobs up or refer to themselves as “emotional junkies”. I can’t figure this one out.

When this conversation comes up, it takes every ounce of self control not to honestly answer their question. I have to remember that they are expecting some answer that involves someone getting decapitated or shot. Maybe even a funny story. They aren’t wanting to hear about the child we had to leave lifeless on the icy bridge because there were too many other critical patients that had a chance of survival. They probably also aren’t interested in hearing about the 6-month-old sitting in a car seat in the back of the ambulance while we do CPR on his mom.

So what is the worst thing I’ve ever seen? I don’t have an answer for that because I choose not to make comparisons on the things I’ve witnessed during my career. That would require me to dig up some of those memories, and I really have no desire to do that.

Does anyone else feel this way?

The Dual Medic Dilemma

I have spent the overwhelming majority of my career as a paramedic working in single-medic systems. I had EMT-Basic partners and for the most part, all of the Fire Department first-responders functioned at the EMT-Basic level. That meant that I was ultimately in charge of every call. Assessments, documentation, and advanced-level procedures were all my responsibility. It was a great experience and it made me the medic I am today.

Now I work for a service that only employs paramedics, and I absolutely love it. I have a very experienced and well educated partner and we work seamlessly together. I only have to attend every other call and I have a second set of hands to perform ALS-level procedures during critical calls. For me, it’s a dream come true.

Here’s my dilemma……

While I love working in a dual-medic system, I can see that one of the reasons it works so well is because the majority of us came from a single-medic environment. Most of us spent our careers having to be responsible for all aspects of patient care. Yes, we made mistakes and we all had to learn hard lessons along the way, but we aren’t afraid to act. None of us have seen it all, but I can say with confidence that most of us wouldn’t hesitate to take on any scenario that comes our way. Would I be able to say the same if had we all come up working in a dual-medic system? I really don’t know.

I have always been of the opinion that having too many paramedics on scene (on a regular basis) can actually be detrimental to the quality of care provided. While many argue that 2 heads are better than one, I see it another way. Yes, it is nice to be able to bounce ideas off one another, but at what point does a resource become a crutch? Throughout my career, I have worked with plenty of paramedics that started out in systems that made it a practice to deploy multiple paramedics to every call. Some of them turned out fine, but in my experience, the majority of them struggled when it came time to make decisions and act independently. When everyone functions at the same level, it’s easy to hide weaknesses. For example, if I’m not very competent in a certain skill or area of care, it would be easy to “delegate” those tasks to another provider while I do something I’m more comfortable with. While I don’t encourage people to perform procedures that they are confident in, avoiding it all together doesn’t fix the problem.

Let me bring you back to a couple experiences I had as a brand new paramedic:

I had been working on my own for 1 week. We were dispatched to a call for a cardiac arrest. When we arrived on scene, I was absolutely shocked to see a sheriff’s deputy holding a 6-week-old baby in his arms, doing CPR. I was told this patient was an adult prior to our arrival. This was my first time not only intubating a child, but also running a critical pediatric call all together. I was scared out of my mind, but I had to act. I knew what to do. I had trained long and hard for that call, I was just scared. I had no choice but to overcome my fear and treat that child, and I did just that. Would I handle that call better today than I did 10 year ago? Absolutely, but at that time, I did the best I could and I’m confident that the outcome would have been same had I responded today.

Another scenario was 3 weeks after being released to work on my own. We responded to a lady in active labor. Being that this was her 10th pregnancy, with one time being twins, I made the decision that we were going to load her up and drive that ambulance like we stole it. The problem was, the baby started coming out as soon as I loaded her into the back. I gowned up, elevated her hips, put on my gloves and mask and probably repeated the words “Okay, Ma’am, Okay….” about 100 times. I was sweating profusely and could hardly get a word out. I don’t know why, but the thought of delivering a baby on my own scared the hell out of me. At one point, the lady actually placed her had on my shoulder and said “relax kid, It’s going to be fine. I’ve done this plenty of times. I’ll get you through it.” And that she did.

Both of those scenarios scared the living crap out of me, but only once. When I ran the 6 month old in cardiac arrest with a complete airway obstruction 7 months later, I was ready. Sure, it was scary, but I didn’t lock up. I was confident in my ability to treat that child and I can honestly say that I wouldn’t have changed a thing about that call had I ran it today. Likewise, when I responded to the woman delivering triplets over an hour away from the nearest hospital, I was ready. Could I say the same had I been able to take the path of least resistance and allow a more experienced paramedic to take control of those 2 calls? My guess would be no.

I’m simply torn. I absolutely love the system I work in, and when done right, I believe it’s one of the best ways to deliver quality patient care. I’m just not sure how to overcome the issues that a dual-medic system brings.

I would love to hear your thoughts and experiences. Do you, or have you worked in a dual-medic system? If so, how do you ensure that new paramedics are ready to function independently and with confidence?