chazEMT

Bottom line - if the agency, whether volunteer or paid, is not fulfilling the one purpose for which they exist - COVERING CALLS - then changes need to be implemented. Whether those changes include "firing" the agency, augmenting the staff, or something else is a case-by-case solution. But the patient has to come first. Hanging on to an ineffective service due to loyalty or out of fear of "ruffling feathers" is ludicrous!

I agree that the spin on the story through the media would be upsetting to a lot of the citizens. Too bad response logs, duty rosters and training attendance logs can't be made public. If the citizens of many communities were made aware of how often their volunteer EMS was unstaffed/understaffed, I'm sure there would be quite an outcry.

I'd like to see the underlying cause of the problem individually in the various agencies throughout the county. With respect to volunteer coverage waning, well, there are two reasons volunteers stop volunteering-they CAN'T, or they WON'T! Take a look at the rosters of many of these agencies, you'll see a long list of names...then take a look at the coverage rosters, and you'll see a significantly different number of names! Why is that?! I believe in the volunteer system, and I believe it could work, if managed properly! Unfortunately, in many cases, it isn't the volunteer system that's flawed...it's the management of it.

My apologies, JJB, I wasn't looking to bash you or your post...although, in reading my response, I see that's how I came across! My response was aimed more at the "recipes" EMTs are being taught...those two recipes (as worded) are incorrect, and those instructors who're imparting that information are relaying both incorrect and incomplete info!

Sorry...was just trying to clarify what is actually taught & in the protocols...chest pain doesn't=aspirin, unresponsive doesn't=oral glucose. My point is that those who are teaching those adages and similar ones aren't teaching correctly, nor are they giving the "whole story." Sorry if I came across as "bashing."

Thank you, you worded it better that I apparently am!

Just attempting to clarify what the cirriculum/protocol indicate...we don't teach that "chest pain=aspirin" or "unresponsive=oral glucose." Those instructors who simplify it to that degree aren't providiing complete information. Sorry if I came across as if I was bashing...my apologies, was only taking issue with what JJB was inidcating is taught.

I probably did not word my response properly ("bad wording!") As a CIC, my "weeding out" process is never simply failing students out of the course! I completely agree when you say our job is to identify students with problems/deficiencies and work with them towards correcting them. The "weeding out" I am referring to is regarding those students who fall short of meeting the course standards and objectives because they put in little or no effort, and do not respond to any efforts on the part of the instructors to help them overcome their deficiencies...in short, I'm 100% with you on your response to my point. By "weeding out," I'm also referring to how I administer the courses I teach. I think it's totally inappropriate to simply "teach to the tests." I strive to teach students how to assess and treat a patient, and try to give them the basis and motivation to develop good clinical judgement. Rarely do my modular exams simply have them regurgitate facts & definitions...I try to put in as many scenario-based questions as possible, and challenge them based on affective as well as cognitive objectives. With regards to the "recipes--" We help the students develop the foundation for "clinical judgement" in class...teach (at least) the cirriculum and the protocols. For example, waaaaaaaay back when you were sitting through your first EMT class you learned the signs, symptoms, causes and physiology behind respiratory failure...now, I'm sure you can spot a patient with "the look" in seconds! But it started with that "recipe." Regarding JJB's first scenario, our recipe doesn't call for aspirin in that situation. Here's the point in class where I would ask the students "...and why not??" And not simply because the recipe says so! For the second scenario, I wanted to make the point that he might have either misinterpreted the recipe, or remembered it incorrectly...unresponsive DOES NOT = oral glucose. I, too, want a comprehensive cirriculum...let's not only teach the "what," but also the "why" and "how!" Again, perhaps I misworded what I wanted to convey. Does the cirriculum need to be "tougher?" Probably not...do we, as instructors, need to consistently evaluate our students and ourselves and ensure we're striving for the best and not just the test? (you can use that slogan if ya want!) Absolutely! I certainly don't feel you're bashing me...while I may not always agree with your opinions on here, I do respect what you have to say, as you speak from experience, and most importantly, you apparently care a great deal both about what you do, and the patients and fellow emergency personnel you deal with... JJB - my apologies if I came across like an "arse" in my response to your post...didn't mean to "bash," but rather make points on your comments (had to borrow your wording there ALS!) Anyway, sorry so long-winded...

OK, a couple of points in response to your post: 1) I'm not sure the quality of EMTs is the fault of the cirriculum...as stated, you get out of it what you put in...and many EMT students enter the EMT course thinking it'll be a cake-walk, and try to coast through. They need only learn enough to pass the tests, and they're an EMT! It's the responsibility of the instructors to challenge the students, and try to weed out those who aren't putting in any effort. 2) As for the cirriculum being too "cookbook," you need to double-check some of your recipes! In your first scenario, aspirin would NOT be indicated, as there is a clear, strong possibility that the chest pain was caused by TRAUMA...and, per protocol, aspirin is indicated for "non-traumatic chest pain not relieved by nitro or lasting longer than 30 minutes." Even if the EMT is following the "cookbook," aspirin is not indicated. In your second scenario, oral gulcose is containdicated, since the patient is unresponsive and cannot either follow commands or swallow...AND oral glucose is only indicated for AMS with a history of diabetes, NOT simply for any unresponsive pt. 3) ALL EMS training centers receive NY State reimbursement for every student (provided they have signed and submitted a "green" agency verification form) who passes the NY State written (at ALL levels, Paramedic, EMT-B, CFR). That does NOT motivate any program (none that I've been associated with) to pass students through the program. The EMT programs need to be tougher and more challenging at the COURSE level...the NY State exams are easy enough for most to pass, once they make it to that point. LAZY EMT students should be weeded out during the EMT course.

So sorry to hear the news! Bob, you'll be missed...my condolences to his family, as well as his extended MFVFD family. Chaz

Having dispatched for a number of years, I can tell you that no matter what protocols that are put in place to "weed out" BS calls for service, it will not solve the problem...as was mentioned in an earlier post, people will learn fairly quickly what they need to say to get an ambulance over to them! AND, there IS that liability thing hanging over the heads of the dispatchers! From the "other side of the phone," I'm not sure I'd be overly comfortable leaving my fate in the hands of a dispatcher reading from a card of "case entry" questions as a determining factor of whether an ambulance should be sent to my emergency! What I believe would make the most sense is to enable EMS to refuse transport to those patients who're using EMS as a taxi...which, I know, opens a whole new can of liability worms! Just watched an old episode of Emergency! where Johnny & Roy not only packed up and left a "patient" who'd called EMS for obvious BS, but they also read him the riot act!! If most of us did that, it'd be a race who'd get to us quicker...our supervisors or the patient's lawyer! As for the gamble people take when calling for EMS...if this refers to the volly system, that is also something that needs to be looked at! I'm so tired of hearing how it's tough for people to volunteer nowadays, yet I see these volly agencies with 50+, sometimes 100+ members on their rolls...and none of 'em show for the "diff breather," but suddenly they can all become available to respond to the MVA rollover with entrapment! In my time dong scheduling for volly EMS, I more often got people dodging my calls & e-mails asking for help than a response, much less a commitment to help out! Can of worms there, I'm sure...

Ummmmmmm, not completely accurate...I worked at GPD up until a couple of years ago. The amount of calls that we received regarding the shopping carts was phenomenal! And no, at that time (and maybe things have changed recently) the cops who brought in the carts (yes, they were impounded!) did not do so on his own time. Remembering the call volume over there, as well as all the "little extras" GPD officers were expected to do (vehicle lockouts, school crossings, and yes, the shopping carts, EMS coverage, as well as delivering the Town Board mail/notifications) hearing that they plan to reduce the # of cops is distressing, to say the least! I'm sure it hasn't gotten less busy!

As an instructor, I can identify several areas where the cirriculum is lacking on things that are already touched on in the EMT-B course: D O C U M E N T A T I O N ! ! !Pharmacology (already mentioned) - touch more on different classes of meds, etcJust to name two, there're other areas... And there needs to be more accountability on the CICs...alot of EMT students get through this course who SHOULDN'T!! There needs to be more oversight, so we're weeding out those who try to glide through the class...no more SHOWING UP = PASSING/BECOMING CERTIFIED!!! No more instructors who say "You don't need to know this, there'll be a paramedic there who'll be responsible for the call." Let's get back to where the EMT-B can assess and treat a patient, and run a call competently, without having to look to a medic for approval first! Add THAT back into the EMT-B course, THEN start thinking about adding in more skills & topics!

I was a member of MFVFD a few years back...Bob joined shortly after I did. One thing I always remember about Bob is his energy and level of dedication. Here's a guy who, in his early 60's, decides to join his local Volunteer Fire Department, volunteer his time, and deal with alot of us "snotnosed" kids. Bob didn't stop with just joining up...I remember seeing Bob on some of those late-night calls, or standing out there in some truly horrible weather as a member of the Fire Police. Every year, when Fire Prevention week came around, there was Bob, volunteering his time for most (if not all) of the daytime visits and presentations. Bob was always one of those guys who you'd see around the firehouse, and he always seemed to be cheerful, always made it a point to say hello. My thoughts and prayers are with Bob, his family, and his "extended family" at the Falls...

You're correct about the protocols STAT...but don't forget that our scope of practice is also defined by WHAT WE'RE TAUGHT...did you check the BLS cirriculum? I beleive that addresses the issue a bit more specifically. I agree that the protocols & practice of spinal immobilization are antiquated...I also agree with previous posts that pointed out that, even though they might not make perfect sense, they are the PROTOCOLS, and disregarding them can open the door to trouble! Always have a REASON for what you do out there...based upon a good assessment and sound clinical judgement!