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Air Ambulance – Vital and Overused

December 11, 2009 By 2 Comments

Good evening readers. Today I want to discuss a topic that has been in EMS journals and the news frequently. Lately it seems that EMS helicopters are being used way more than they should. This applies to both emergency and inter-facility transfer calls. I do feel that helicopters are a vital resource to EMS, however it is a tool that should be used wisely.

As part of my job as a field supervisor I investigate calls where a helicopter was used on a daily basis. This includes the patient outcome, reason for deployment, time savings, care rendered prior to airship arrival and risk factors. People often use mechanism of injury as a decision on whether or not air transport should be utilized. I completely disagree with this practice.

Determining the mechanism of injury is great for assessing injuries, but not so great for transport decisions. A physical assessment should be the number one tool used to determine the severity of injuries and whether or not a patient could benefit from air transport. The old “better safe then sorry” routine has got to stop. As paramedics and EMT’s, we are trained to detect life threatening injuries. Launching a helicopter because “they might have internal bleeding” is not an example of a good assessment. Sure if the patient presents with poor skin signs, a distended abdomen, bruising, tachycardia and severe pain after rolling his car 3 times, then launch the helicopter if it will save time. But don’t do it just because his car looks “really bad”.

Being a patient advocate is not purely a medical role. Some other emotional and financial factors play into the positive outcome for the patient. Your patient will likely have a negative opinion on you and the service that you provide when they receive a $15,000 bill that the insurance company just rejected for his air-ambulance ride when he only had a broken arm. Something like this can greatly impact a persons life in a very negative way. All of this can be avoided by performing a good thorough assessment before making the decision to transport by air.

Your decision to use an air-ambulance may not just affect your patient, but other patients as well. When you take a helicopter out of the system, you may be denying that resource to a critically injured person that can actually benefit from the time savings.

Helicopters are a great tool and can really make a difference when time matters. As EMS providers we have an obligation to make sure that our resources are used responsibly.

As always, questions and comments are always welcomed. Please feel free to e-mail me.


Filed Under: Opinion, Politics Tagged With: , , , , ,

Two paramedics are not always better than one.

December 11, 2009 By Leave a Comment

Good morning readers,

Today I am going to discuss the theory that “more is better”. In many cases this true, but no necessarily for EMS systems. In many systems ambulances are staffed with one paramedic and one EMT, while assisted by EMT first-responders. In some systems several paramedics are deployed as transport units as well as first responders. Both systems have their benefits and disadvantages.

In a system where multiple paramedics are deployed on a single call can certainly have its advantages. On critical patients, multiple ALS interventions can be done at the same time. For example; while paramedic-a is starting and IV, paramedic-b can be intubating. Unfortunately there are more downfalls to this system than advantages. Intubation, starting an IV and various other ALS interventions require frequent practice to be proficient. In a system like this, you can expect the amount of ALS interventions performed by a single paramedic to significantly decrease. Lets say that normally paramedic-a intubates 4 times a month. If you put a second paramedic on every call, it is very likely that the number of intubations performed would be cut in half, and so forth as you add more paramedics.

Systems where single paramedics are utilized for emergencies are not exactly perfect either. Being the only ALS provider can lead to increased stress and burnout. It also provides almost no checks and balances. However, this system has many advantages. Being the only paramedic means that you are responsible for patient care, documentation, radio reports, and transport decisions. This produces paramedics that are capable of independent thinking and taking control of situations. There is no deterioration of skills and scene times are typically kept to a minimum. There is also more accountability when one person is responsible for all aspects of patient care. This makes quality assurance much easier. This system also provides a more cost-efficient way to do business. Not having to send multiple paramedics on every call means that more ALS ambulances can be placed in the system for better coverage.

It is to my opinion that a single-paramedic response system shows more benefits than disadvantages, however this does not mean that multiple paramedic response systems can’t be run effeciently. I do believe that certain guidelines can be followed to limit “head butting” and delayed scene times. Assigning a designated leader to take responsibility and assign tasks to other paramedics can help to ensure that calls are run in a timely and effecient manner. This can be as easy as designating the transporting paramedic or the first paramedic on scene to be the patient care leader for the call.

After all is said and done it all comes down to doing whats best for the patient. What works in some systems, may not work well in others. Head-butting and egos do nothing good for the patient or the system. Working together and communicating will be the key to responding to any emergency.

Please feel free to e-mail me if you have any questions or comments.

Thank you,

Sean


Filed Under: Opinion Tagged With: , , , ,

EMS Pay – Is there light at the end of the tunnel?

December 11, 2009 By Leave a Comment

Good morning readers. Today I will bring up the topic that everyone in EMS has been talking about. Pay. Lack of adequate compensation, benefits and retirement have caused many problems in EMS systems across the United States. Paramedic and EMT shortages have taken their toll on response times, work load and the amount of ambulances that are available on the streets. Someone interested in a public safety job, could easily become a police officer, fire fighter or correctional officer within the amount of time it takes to become a paramedic. All three of those jobs offer better pay, benefits and retirement plans. This leaves many EMS professionals looking to their employers and asking “Don’t you see the problem here? Can’t you just pay us more?”

Well if the solution was as easy as increasing compensation, the shortage wouldn’t exist. Many complications factor into the cause of low EMS pay. Poor insurance reimbursement, abuse on the 911 system and constantly increasing costs to do business all play a roll in the current financial situation seen nation-wide for EMS providers.

With Medicare and Medicaid plans only reimbursing pennies on the dollar, it is a wonder that any ambulance service can stay in business. Currently here in California, Medi-Cal reimburses 14 cents on the dollar for ambulance service. On top of that, new legislation has passed decreasing that by another 10 percent. State and federal funded insurance plans make up a very large percentage of payors. Unlike private doctors offices and even hospitals, ambulance providers do have the option of turning away government funded insurance patients. This problem alone is probably the biggest contributer to low EMS salaries.

Most doctors offices do not accept government funded insurance. With only a select few clinics in most areas seeing these patients, many of them are turning to ambulance services and emergency rooms for non-emergency medical needs. If the insurance angency feels that the ambulance ride or ER visit was not justified, then they don’t pay the bill. This also makes up a large portion of the patients transported every day.

Constantly changing government policies and regulations often hit ambulances services in the wallet. In the county where I work, all of the ambulance services have recently been required to switch to paperless documentation systems. This of course has made a huge fiscal impact. This is only one example of constantly increasing costs of doing business. Expiring medications, broken and outdated equipment also contribute to this problem.

So is there light at the end of the tunnel?

Unfortunately it doesn’t appear so anytime soon. With government constantly cutting costs and unemployment rates on the rise, it will take some time before we see any changes for the better. But don’t let this discourage you. There is still money to be made in the EMS field. Promotions to field supervisor and management are one way to increase pay and benefits. There are some on-line EMS Management degrees available that would open doors for jobs at the state and county level as an EMS director, coordinator, or as a operations manager at a private ambulance service.

Despite all the problems in the EMS system today, it still remains a promising career path. Hard work, dedication and the ambition to further your career will ultimately lead to success.


Filed Under: Politics Tagged With: , , , , , , ,

Private EMS – The stepchildren of public safety?

December 11, 2009 By 4 Comments

Anyone who has worked in EMS knows it. It’s all over the news papers, on the TV and in the movies. You always hear “fire fighter this” and “rescue personnel that”. Pictures in the news papers show several people in turnouts and one or two people in blue uniforms hovering around an accident victim. The title reads “fire fighters tend to victim of car accident”. Public service ads run on the TV to support your local law enforcement and fire department. But what about the EMT’s and Paramedics working for the private ambulance? Does anyone ever mention them? Does their hard work ever get recognized?

Obviously public recognition of EMS professionals working in the private sector is nowhere near the calliber of public entities. No one wants to make movies, tv shows and half-naked calendars about “those ambulance guys”. But why is that? Why cant everyone share the spotlight?

You can blame the fire departments, you can blame the police, or you can blame the public, but the real answer lies within the EMS system.

Ambulance services do not operate like fire departments. For example; an ambulance shows up to the scene of an accident, loads the patient and leaves. All of the real work is done en route to hospital in the privacy of the patient care compartment. No cameras and no reporters. Fire departments on the other hand, have more work to do once the ambulance leaves. Their job does not stop with patient care. This leaves time for the news to show up and interview captains and battalion chiefs. If private ambulance providers were sitting on scene talking to the media, they would never get their jobs done.

As an EMT or a Paramedic, what would you do if a reporter showed up at the hospital and asked you what treatment you performed and how the patient turned out? Well if you enjoy having a job you tell them that you can’t answer those questions due to privacy laws. The media knows this, so they don’t bother.

I have worked in private ambulance for quite some time now. I have felt the frustration. I know what it feels like to think that nobody cares. Although something happened to change that. I got recognized for a call I responded to in 2007. I was interviewed several times on TV and in the news papers. They sent me to our state’s capitol to meet legislators and receive the “Star of Life” award. It was a great experience, but at the same time it seemed like a bit much. Here I was getting all the credit, when the only thing I really did was be in the right place at the right time. Any reasonable paramedic would have run that call just like I did had they been there instead of me.

It was at this point that I realized that I don’t do the job for the recognition. I know the value of my work and I know the impact I can have on peoples lives. All of us our here to do the same job. We help people in their time of need and get them to definitive care.

So in conclusion I say this. When you see other people taking credit for the work that you are doing, don’t worry about it. The people you helped know exactly what you did and you know exactly what you did. That is all that truly matters.

Thank you for your time, and please e-mail me with any questions, comments or stories. Thank you!


Filed Under: Opinion, Politics Tagged With: , , , ,

Do snake bite kits really work?

December 11, 2009 By Leave a Comment

You have seen the movies and heard the stories. Someone gets bit by a Rattle Snake in the middle of nowhere. Their life is almost at it’s end. That is, until their buddy pulls out his pocket knife, cuts open the wound and sucks out the venom.

Obviously, this scenario is not likely to happen as the majority of snake bites occur within reasonable distance of civilization. Also, people who frequently work or live in these areas carry commercial snake bite kits. The question is, do they really work?

Most snake bite kits come equipped with suction devices, a scalpel, and a tourniquet of some sort. They typically direct you to cut and suction the site and lightly apply the tourniquet to reduce the spread of the venom. The majority of the bite kits that I reviewed recommend that this only be done if the nearest medical help is greater than 30 minutes away.

Every medical textbook that I posses, including “Essentials of Paramedic Care” actually discourage such treatment. The common theme in textbooks includes splinting the affected limb, keeping the limb at a neutral position(at the level of the heart) and rapid transport. Supportive measures include establishing IV access, high-flow oxygen, ECG and sp02 monitoring. Packing the wound with ice, applying tourniquets or cutting the puncture site can actually cause more damage.

The only treatment that is actually going to make a big difference is anti-venom. If you are in an area where snakes are prevalent, then chances are the nearest ER will be equipped with the necessary antidote for your snake bite.

The idea of a snake bite kit sounds good to most, but not to the “experts”. So in conclusion, if you are bit by a snake, your number one priority will be to seek definitive care. Immobilizing the affected limb, keeping it at even level with the heart and keeping the victim calm will all help to slow the process. Obviously the best thing you can do, is to avoid getting bit in the first place.

If you have any questions or comments, please feel free to e-mail me.


Filed Under: Education, Field Medicine Tagged With: , , ,

Want to Become a Paramedic?

December 1, 2009 By Leave a Comment

13paramedicSo you have been working the field as an EMT-Basic or EMT-Intermediate for some time now and you feel it’s time to take the next step in your career. Making the decision to become a paramedic takes a lot of time and consideration. Working as an EMT is fun, rewarding and exciting, but are you ready to take on the responsibility of being a paramedic?

As a paramedic, you are ultimately responsible for all aspects of patient care on the scene of any medical emergency. You are in charge of proper documentation, radio reports, treatment, transport destinations and mode of transport. You will be held legally responsible for all interventions performed on the patient in your presence. In many cases your closest help will be miles away at the nearest hospital. As you may have heard many times before, great power comes with great responsibility.

Scared yet?

With all the responsibilities and stress associated with becoming a paramedic, the job has still proven itself to be rewarding. After a hard days work, the satisfaction of knowing you made a difference in one or many peoples lives, makes it all worth it. People will look to you in their greatest time of need and place all their trust in your training and expertise to save their life. Parents will hand you – a complete stranger – their child and trust that you will make them better and give them a safe journey to the hospital. Some people will life a long and fulfilling life as a direct result of your life-saving interventions, and some may die regardless of the amount of effort you and your crew had put forth.

Anyone who has been working in the EMS for a while knows that the job isn’t all about saving lives. On many occasions the 911 system is flooded with non-emergent calls and in some cases, strait out abuse. Sometimes you sit in a station for 24 hours and never turn a wheel on your ambulance.

So now you might be thinking “so how do I become a paramedic?”

To obtain certification through the NREMT (Nation Registry of Emergency Medical Technicians), you must pass six to eight months of didactic training, approximately a month of hospital-based clinical training and a minimum of 400 hours of field training. You must then pass a series of skills-based tests and a written or computer based exam. For more information on certification requirements, visit the NREMT website as http://www.nremt.org

Didactic (classroom) training typically lasts about 6 to 8 months. You will extensively cover many subjects such as anatomy, physiology, cardiology, pharmacology, pulmonology, trauma emergencies, medical emergencies, scene control, OB/GYN, geriatric emergencies, pediatric emergencies and ECG interpretation. You will also practice several ALS (advanced life support) procedures such as starting intravenous lines, administering IV medications, needle decompression, surgical airways, oral and nasal intubation, NG tube placement, IO placement, manual defibrillation and external pacing. This is a general list of skills taught. Skills may vary from state to state, depending on the allowed scope of practice.

Once you finish your classroom time, you will move on to hospital-based clinical training. Here you will get the opportunity to practice your newly learned skills on live patients in a controlled environment. Most programs include rotations through the ER, Operating Room, OB/GYN, ICU, NICU and sometimes psychiatric hospitals.

Now that you have practiced your newly learned life-saving skills, you will move on to field training. You will be placed with a paramedic-preceptor as you learn how to apply all your acquired knowledge and skills to a pre-hospital setting. This can the hardest part of paramedic training, especially for those who have little to no experience in a pre-hospital setting. This will last a minimum of 400 hours, but typically lasts 500 to 600 hours depending on your progress.

Once you get signed off from field training, you are now eligible to take the NREMT exam and apply for certification as an EMT-Paramedic. Skills testing will usually consist of stations including verbal scenarios, mega codes, pediatric emergencies, trauma and even some BLS stations as well. The written (or sometimes computer-based) tests are difficult and consist of questions covering everything you learned in your didactic portion of your training.

The whole process can be stressful and can quite possibly be the hardest course you ever take. Taking classes in anatomy, physiology and ECG interpretation prior to starting the program will make the class significantly easier. Some other quick classes offered by the American Heart Association like ACLS and PALS can also make paramedic school easier. For a list of AHA classes, visit http://www.americanheart.org

Good luck in your journey towards becoming a paramedic. I hope this article will serve a good reference or starting point. Please feel free to e-mail with any questions or comments.


Filed Under: Education Tagged With: , , , , , , ,

Want to Become an EMT?

December 1, 2009 By Leave a Comment

Ever considered starting a career in EMS? Being an EMT can be a very rewarding job and open up many opportunities to further your career in the future. Many EMT’s move on to become paramedics, firefighters, and police offers. Now several colleges offer EMS Management degree programs for EMT’s or paramedics that want to promote to management or get jobs at the state or county level.

Before we discuss the steps to becoming an EMT, lets talk about what an EMT is.

EMT’s are a vital link in the health care system, as they are typically the first to arrive at the scene of any medical emergency. EMT’s provide life-saving interventions at the basic, intermediate and advanced (paramedic) level. For the purposes of this article, we will focus on the “basic” or entry-level EMT.

EMT-Basics perform basic airway management, bleeding control, splinting, oxygen administration, spinal immobilization, and suctioning. In some cases EMT’s even administer some medications and are trained in childbirth.

In most settings, EMT-Basics typically work with a paramedic. In some cases ambulances will be staffed with two EMT-Basics in volunteer, rural or inter facility transfer settings.

Now for the big question, “how do I become an EMT?”

To achieve certification through the NREMT (National Registry of Emergency Medical Technicians), you must take a semester long class and pass a written and skills test at a licensed testing facility.

Many community colleges offer EMT-Basic training and testing. Some companies and fire departments also offer in-house EMT-Basic training. For more information on the requirements for certification as an EMT-Basic visit http://www.nremt.org

For someone with no medical or emergency services background, EMT-Basic school can be difficult. The semester-long class is a crash course in anatomy, physiology, pharmacology, airway and breathing emergencies, cardiology, trauma emergencies, pediatric emergencies, patient assessments, OB/GYN and much more.

If you are new to the medical field, I would recommend studying or taking a class in medical terminology. This will relieve a large majority of the challenges associated with EMT-Basic school. Researching basic anatomy and physiology prior to class will also place you ahead of the game.

Unfortunately I can not cover everything that is expected in EMT training as classes may vary from state to state. For information about becoming an EMT-Intermediate or Paramedic, please refer to my article titled “Want to become a paramedic?”.

I hope this will help serve as a starting point in your new exciting career in EMS. Please feel free to e-mail me with any questions or comments.


Filed Under: Education Tagged With: , , , , , , ,

911 – What to expect when you call

December 1, 2009 By Leave a Comment

So your loved one has suffered a heart attack. You fear for their life and feel helpless. You have no medical training and you are in desperate need of help. So what do you do? Like any other person in a time of emergency, you call 911.

Now what?

Activating the 911 system for first time often scares people. The thought of loud sirens, bright lights and several strangers entering your home can make you nervous or even hesitant to call in a time of need. For these reasons, I decided to create this article in hopes that you will know what to expect and what you can do to help in the event that someone you know or love takes a turn for the worst.

Unfortunately you can not plan or schedule emergencies. They often occur when you least expect it. Staying calm and taking control of the situation will be your key to a smooth transition from the panic of the incident to definitive medical care.

If you are at home, work or a place of business, always try to use a land-line telephone. In a state of panic you are likely to forget your address. Using a cell-phone makes tracing your location difficult for 911 dispatchers.

The 911 dispatcher is going to ask you several questions. Some of which may seem time consuming or ridiculous. Just remember, be patient and answer all of the questions clearly and accurately. Your answers will assist the dispatchers in assigning a priority to the call and give the paramedics valuable pre-arrival information. Try not to rush though the conversation. There are several dispatchers on duty at all times. While one is talking to you, another is dispatching the closest ambulance.

Once you know that help is on the way, you can perform several tasks to minimize the amount of time that the emergency workers have to be on scene.

- Make sure your lights are on.

The emergency crews will be looking for signs of activity. This will make locating your house easier.

- Leave your front door open.

This will also aid in spotting your house in the event that your address is not clearly visible.

- Clear a path.

Move cars out of the driveway, unlock any gates and move items that might prevent the paramedics from moving a gurney to the scene.

- Gather medications, identification and insurance information.

Have all of this ready in a bag. By doing this, you will cut several minutes away from the time the paramedics must stay on scene. This translates into a quicker transfer to definitive care.

If there are several people standing around, assign these tasks to others. Keeping people busy and out of the way will benefit your loved-one and make the responding paramedic’s job easier.

The paramedics will likely ask several questions. Some of which you may have answered when you spoke to the 911 dispatcher. Although this may seem like wasting time, be patient. The paramedics must have a clear understanding of what is wrong so they can determine the appropriate treatment and transport destination.


Filed Under: Education Tagged With: , , , , , , , ,
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