Lack of Training for EMS?

[Bnechis 3,961]

Sounds very easy, but now you are basically putting an EMS provider on the spot to operate in an environment they may not be familiar with, with equipment they're not familiar with, even if the only skill they need is walking.

We train everyday and often invite the EMS crews to participate. Even if there is not a specific invite, they have always been welcome. Much of the classroom work takes place 20' from 30A1's quarters and the crews walk back and forth thru the classes.

It is a rare event when they even sit in. When I have invited them in, 90% of the time the crews are not interested...too busy doing "EMS" - Earning Money Sleeping. Back longer ago than I care to admit my 2 partners on NR AMB 1 and I sat in for almost the entire "probie" school.

Being exposed to this environment through training, in my opinion, will only benefit a provider if they do ever have to operate in such a scenario. Providers should have some level of comfort in a particular environment through training and exposure to that environment before they are expected to perform in a real life situation.

Agreed

Speaking from a TEMS perspective, if there were a school shooting and I was an untrained provider, I wouldn't be comfortable if a SWAT officer said, hey this victim-rescue stuff is easy, just throw on this vest and helmet. The only skill you need is running.

Almost all non LEO responders fall into this boat this, this is an issue for everyone. This is one of the reasons we have done some cross training (but need a whole lot more) with NRPD's CIU.....my fav was firing the MP5 at camp smith (can we get them for the rig?).

Of greater importance, Over the years I've noticed that many in EMS are not in good enough physical condition to run for their lives or anyone elses, much less get lowered into a confined space.

[ONEEYEDMIC 68]

We train everyday and often invite the EMS crews to participate. Even if there is not a specific invite, they have always been welcome. Much of the classroom work takes place 20' from 30A1's quarters and the crews walk back and forth thru the classes.

It is a rare event when they even sit in. When I have invited them in, 90% of the time the crews are not interested...too busy doing "EMS" - Earning Money Sleeping. Back longer ago than I care to admit my 2 partners on NR AMB 1 and I sat in for almost the entire "probie" school.

Agreed

Almost all non LEO responders fall into this boat this, this is an issue for everyone. This is one of the reasons we have done some cross training (but need a whole lot more) with NRPD's CIU.....my fav was firing the MP5 at camp smith (can we get them for the rig?).

Of greater importance, Over the years I've noticed that many in EMS are not in good enough physical condition to run for their lives or anyone elses, much less get lowered into a confined space.

I worked AMB 1 and NEVER ONCE did anyone from the FD ever ask me or my partner if we wanted to sit in on a class. I would also feel it is not in my place unless I was asked. So if one was sitting in on a class and did get called out on and EMS run when you get back you are in the dark about what happened the past say hour. So I just wasted my time when I could have been sleeping. LOL.

I would definitely agree that some EMSers are not in good enough physical condition to even consider this. Heck, you might need to set up a rigging exercise just to get them out of bed.

[Guest]

It may not be, but in my experience most spaces would not allow for ALS often due to extreme contamination, limited space and other hazards. rescue vs. recovery...If an EMT (even a ff EMT) can not tell if the victim is breathing or not, maybe the training needs should be on basic EMT skills. And in most cases Rescue vs. recovery determinations are based on space conditions not patient conditions...i.e. the person went in to the xylen tank and has not moved in 20 min. if the IDLH level is deadly in 3 minutes, the IC would determine it to be a recovery.

I have been in spaces that were over 500' in diameter that still were confined spaces and you would not be able to do patient care because of conditions. Size of the space is only one issue.

You dont want knit picking but then you keep giving examples. I understand your intent, I spent many years trying to convince EMS and fire agencies to train for this without sucsess. Took almost 15 years to convince NYS that rescue training was even needed. While EMS is critical to the patient during the rescue, EMS still does not take main aspects of EMS training serious. MCI & Triage training, rescue scene safety, decon training, etc.

Very easy, if we need them. Put them in a harness and lower them down. The only skill they need is walking. To teach low angle (lowering, MA & packaging) skills takes about 12-16 hours.

Another great skill is how to lower a patient from upper floors down an interior stairs. 24 story tower, elevators out, 300# MI patient day crew is a 65y/o "driver" and two 19 y/o EMT's who combined weigh about 200 Ibs. This crew was able to lower the pt. 24 floors in 12 min. (including set up time)....no carry down. The hardest part was trying to keep up with them with my VHS Recorder.

I GUESS IT ALL DEPENDS ON THE DEPT. MY DEPT IS A COMBO PAID/VOLUNTEER AND WE HAVE OUR OWN AMBULANCES AND PARAMEDICS. SO AS A FF/EMT I CAN ASSESS PTS. BUT IT WOULD BE BETTER TO HAVE EVERYONE TRAINED PROPERLY. WHY NOT HAVE THE FF'S THAT ARE TRAINED IN RESCUE BE TRAINED IN EMS, IE: BE A PARAMEDIC FIREFIGHTER. AND ARENT MOST FIREFIGHTERS NOW AT LEAST CFR'S. A FIRST RESPONDER SHOULD BE ABLE TO AT LEAST DETERMINE IF SOMEONE IS A RECOVERY OR RESCUE??

[JJB531 652]

I worked AMB 1 and NEVER ONCE did anyone from the FD ever ask me or my partner if we wanted to sit in on a class. I would also feel it is not in my place unless I was asked. So if one was sitting in on a class and did get called out on and EMS run when you get back you are in the dark about what happened the past say hour. So I just wasted my time when I could have been sleeping. LOL.

Same thing here Oneeyed, not once was I ever asked if I wanted to sit in on a class or participate in any way. We were always the red headed step children that were banished to the basement of the Firehouse. Maybe things have changed, but I didn't feel that we were as welcome as it's been made to sound.

[ONEEYEDMIC 68]

Do you really think things have changed?

[JJB531 652]

Do you really think things have changed?

No, but I figured I'd give the benefit of the doubt....

[helicopper 1,050]

Chris, it takes 12-16 hrs to teach the rigging, lowering and hauling systems. the "walking" was how much (or little) we could get away with.

My point is that there is training for low angle rescue, it may take a couple of days to learn the fundamentals, and EMS is in the dark on it.

Sorry but I don't care who you are, you're not putting me in a harness and tying me to the end of the rope and saying "walk" down that embankment/hill/whatever. What happens if something goes wrong and I have absolutely no idea what to do? Recipe for problems, I'd say!

EMS should be trained if they're going to perform in that environment and EVERY district in EVERY county has embankments that cars launch themselves off of so low angle rescue is a great place to start!

[Guest alsfirefighter]

While I am not against anyone making money, we really need to sit down some day and decide to stop screwing each other with high priced training that forces departments to limit how many can attend, if they let any at all.

OK. I have to say that I have seen some trainers out there who do seemed to charge a lot more then what they are actually giving. But who is "we" in the "we really need to sit down." In some cases fees are what they are because you are getting what you pay for. Instructor costs, materials fees, travel, etc. I do think there is a common sense to it, and again I agree with you that some are outright greedy or just can't manage/budget what they are doing. This is all over to be honest, look at the cost of training videos particularly on the fire side. Outragous! And some of the eariler ones look like they were filmed on a regular store bought VHS based on the quality.The bottom line is this, if there were more opportunities that were covered by funding, such as OFPC courses taught by SFI's, perhaps there would be more technically trained providers out there. I also doubt that there are agencies out there that couldn't afford a couple of hundred bucks a few times a year for someone to come in and do a good, in depth lecture with a touch of hands on. Even if they didn't do a percentage coverage for members or open it up to outside people for a small fee to make up the difference. Most training CME's in EMS are flat rate based. Meaning if 2 people show up or 20, your going to get what you agreed to pay for and the more that show up the more economical for you it will be. I usually have very good numbers at agencies when they bring me in to do a specific training for them or to spice up a typical lecture a little to get more in depth or interesting instead of the same old chest trauma CME, or rehab, or hemmorrhage, etc. The good ones don't kill the agencies budgets..they work with them to give good education materials, be able to come back and still cover the expenses of what they are doing. Oddly enough as much as I am on here...I have never gotten one inquest about any of the things that I do...except for fire training through members of this site.

JJB, I think you still have excellent points and I feel you on the confined space as just some examples. There are a plethra of examples that you could have used you just chose that one. The answer isn't always as simple as train all firefighters in EMS. I've been in this business a long time and not all either want to, would be able to pass or even be able or want to do the job properly. Having EMS providers trained at a more advanced level makes sense as it gets into having a comprehensive, well rounded response system.

Anyone who knows about Columbine High School, knows the USFA recommends better and more skilled training for EMS agencies to have members trained for tactical responses. Yet how many agencies in this area can do that? Or are you still a sit and wait agency, which cost the life of at least 1 teacher inside Columbine as he bled to death. Or are we still stuck in the sandbox quagmire of its PD's issue, its the FD's issue....guess what sooner or later it becomes your issue!! Whether its a severly decompensated patient...the patient's family...or you end up as a entire section in a after action, investigation report of what you "could" have done better. Or even worse in every trade magazine out there. How many of you would be comfortable enough to do treatment through a barracade scenario, or take that to another level and do assessment treatment through a radio? How many have ever been trained to do that?

As far as the confined space incident, yes Barry I agree there is often no space to do much more then get air on them. But there are other cases where you could have space to work and some other techniques could be more beneficial for life threats where it still could be rescue. Assessment as always and we could 'what if' the confined space issue to death but I want to let it go.

[ckroll 101]

What is rapid removal is not possible? What if you have access to an arm to initiate IV fluids? What if you want a paramedic to make a determination if this a rescue or a recovery? It's almost impossible to do any real patient care, but not totally impossible, especially depending on the size of the confined space.

I can see we are still knit-picking here and not taking what I'm saying for face value, so I will once again use yet another example for you to try to rip apart...

Car goes over a guardrail down an steep embankment. Person is pinned in the vehicle, and part of the extrication process involves the use of ropes, rappelling down to the victim's vehicle, and a mechanical advantage system to raise the victim up the slope. The way things are now, your ALS unit will have to stand up there by the guardrail and wait for the patient to come to them. How about properly training EMS providers so they can safely and appropriately access the patient along with FD so they can begin patient care while FD performs the extrication?

First, and I hate to nit pick, but it's NIT PICK, derived from removing the eggs of lice from a hair follicle; grandma's sweaters have nothing to do with it.

Second, vertical rescue is inherently dangerous. One cannot simply take a course and go out there. If you are serious about it, join a team and practice with a team. Your life, and that of your patients' may depend on it. Local agencies ought to know where their rescue challenges are and ought to have a plan in place. Keeping current with high angle is hugely time consuming and not many providers have the time to stay current on EMS and vertical rescue. Question. How many vertically capable paramedics are there? Does anyone keep a list?

Third, useful training ideas. How about strategies for extricating and packaging patients. Getting patients out of houses is no small skill, certainly as patients get larger. 90% of the time a crew does not even put spider straps on correctly. On scene times might be reduced if crews practiced together and had plans for getting patients out of tight situations. I'm sure there's a few great stories out there of less than conventional approaches to getting patients to an ambulance. And how often should you just walk the patient out?

[JJB531 652]

First, and I hate to nit pick, but it's NIT PICK, derived from removing the eggs of lice from a hair follicle; grandma's sweaters have nothing to do with it.

Thanks for correcting my grammar and the definition of nit pick... I guess I haven't gotten to that snapple bottle cap yet that's full of useless information.

Edited January 27, 2008 by JJB531

[Bnechis 3,961]

Same thing here Oneeyed, not once was I ever asked if I wanted to sit in on a class or participate in any way. We were always the red headed step children that were banished to the basement of the Firehouse. Maybe things have changed, but I didn't feel that we were as welcome as it's been made to sound.

I personnal use to invite crews and almost never did anyone sit in. Even when I told them I had CME sheets for the class. Maybe when some of the "red headed step children" say not interested and go into the room sut the lights off and drop on the sofa enough times, we group everyone together and stop asking.

They were never banished other than by themselves. I worked AMB1 for 4 years before going to NYC and al I ever had to do was say "can I participate" and was never turned down.

Last year I ran a series of drills on how to remove a patient from the operators booth of one of the tower cranes (trump & avalon) the classes were on the apparatus floor and I invited at least 3 different crews, none were interested.

[Bnechis 3,961]

..... I would also feel it is not in my place unless I was asked. So if one was sitting in on a class and did get called out on and EMS run when you get back you are in the dark about what happened the past say hour. So I just wasted my time when I could have been sleeping. LOL.

Sorry you feel you can ask here for training, but not in a place that is doing it.

Our crews often get called out as well, sometimes we stop, sometimes we will review what we covered, but we never go back to bed.

I would definitely agree that some EMSers are not in good enough physical condition to even consider this. Heck, you might need to set up a rigging exercise just to get them out of bed.

Those providers are generally not worth setting up a haul system, we will just get a sked and drag them to the rig.

[JJB531 652]

I'm definetly agree that a majority of EMS providers are in fact lazy and have absolutely no desire whatsoever to take part in any kind of training. While there are also police officers and firefighters who are lazy themselves, and have no desire to do any kind of training, the training is still readily available to them. I enjoy training and try to take as many classes as I can when they are available, but that's just the problem. For those of us (EMS providers) who do appreciate good training, it's not only very hard to come by, but very expensive when we are constantly shelling money out of our own pockets for it.

[ONEEYEDMIC 68]

BNECHIS what you did when you worked AMB 1 and what goes on now I am sure is WAYYYY different. Maybe because you were involved with EMS before you became a FF made it different. I know that all your FF's are EMT's or higher but that doesn't mean that they want EMSers to train with them. I am sure in their minds they are thinking, lose some weight, take the test and become a FF. I personally thought that most of the FF's thought who they were. Couple of cool people, but for the most part, they didn't really care about the EMS part of the FD. Unfortunately that is where FF is going. Better built building = less fires.

I can ask my job for training but will I get sent? If I walked in and asked to go to a ROPE RESCUE class they would probably ask for what. They have a point. Am I going to train with myself? NO, but it is good to know that there is 1 more person int the Town that has what I would call RARE SKILL.

Being Paid you also have the advantage of training. YOU GET PAID TO DO IT. What else are you going to do when you are waiting for a run. I know you can eat and lift weights but you can also train. Lots of PEOPLE in VFD's and VAC's don't have that opportunity. Maybe once a month and usually a different TOPIC. I think you get where I am going.

[Guest alsfirefighter]

Thanks for correcting my grammar and the definition of nit pick... I guess I haven't gotten to that snapple bottle cap yet that's full of useless information.

LOL. Thanks for making me laugh my bootie off, JJB. That was a good one.

Hey...wait a minute. We're good friends and you know I'm full of useless information. That's why I keep trying to get on jeopardy. LOL.

[helicopper 1,050]

Is the County's "Technical Rescue Team" qualified for low and high angle rescue? Is it possible for them to train with EMS providers since odds are they'll be working along side them someday?

What other departments are qualified (that is to say trained, equipped, and recently exercised) in low/high angle rescue?

[50-65 205]

I didn't read all the replys to this topic, but I just wanted to say that my department tries, at least once a year, to include our local VAC in an extrication drill.

We don't have rope rescue, low/high angle, confined space, collapse, or trench rescue teams. We did at one time have an underwater recovery team. We do, however, run a lot of MVA's and our heavy rescue gets a lot of use.

We usually have a good turnout from them. Sometimes we will do the drill in their back lot and rope off an area for local residents to watch. We have to work together on these calls so it only makes sense to train together.

We usually try to make the drill as realistic as possible by putting a live person in the drivers seat. After vehicle stabilization, we allow EMS to gain access to the patient and let them do their thing while we extricate.

If anyone is interested, I'll let you know when the next time we do this.