Medics as EMT's

[LCFD994 8]

I have read in alot of different threads how many members of this Network feel about Medics being dispatched on every EMS call, no matter what the call is for.

It seems to me that since the State has mandated that an EMT be on every ambulance, many agencies are utilizing the " medic" to fill the EMT spot due to lack of personnel, or a delay in response times so they can roll the ambulance.

I agree with many of you that it is absolutley ridiculus to send a medic for a " low priority call", and yes I know some people will argue that sometimes the caller gives bad information or the dispatcher wasnt sure so then send the medic anyways. Its such a waste of resources to commit a medic to a finger laceration that occured 4 days ago(just an example) and the person now wants to go to the hospital, and then the AMI comes in right next to your station but your unavailable. Yes some people will say that oh the higher priority came in so you have to redirect, meanwhile the ambulance that is going to the finger cut has no EMT except the Medic that is still on there way. But people who make these decisions dont see the problem here. I guess, god forbid, when something happens to someone close to them then they will open up there eyes. Unfourtanetly this is how things get changed.

Things will not change until the Chiefs, and Captains of most agencies light a fire under there personnel and the politicians, and these politicians wake up and realize whats going on. Well maybe not the politicians but maybe the Commissioners or Directors, or whatever you want to call them.

Dont get me wrong here I am not against any EMT, or Department, or Dispatcher... I am against the way certain systems are run and the lack of committment that the powers to be have with the way that some systems are run.

[Oswegowind 17]

I liked it when the dispatcher could choose to send a medic or a bls bus at Empress...had to determine via "EMD"as to whether the need was there...and of course save the medics some writing if poss...If it is a fall or something why can't the VAC/EMS service handle it alone...not all calls need paramedics...maybe the one time they are the only one in a particular district and an ALS job comes in they wouldn't be waiting on scene for the ambulance to get to a BLS job that they can't leave until they hand care down or face abandonment...

[WAS967 97]

At my main job, it is our policy to NOT ride as the EMT if the call is BLS. If it's ALS of course we go, but we don't "fill in" if an EMT doesn't show up. We have way to large an area to cover to take one of our medics out of service for a BLS call. If you can't cover it, call mutual aide. At my part time job it happens rarely where a local VAC can't get an EMT, especially after 6am. There it's not as big a deal since the hospital is only about 5 minutes away and we can get back in service quickly. We also less area to cover. In the end, i do whats best for the patient. IF that means riding in a BLS call because there is no EMT, then so be it. I wouldn't call it right, but thats the way of the world.

[Guest]

There are so many other solutions to the problem that are and aren't being considered. One should be - if they are going to stick with this sending the medic on all calls - for a BLS run - as soon as an ambulance gets a full crew - CANCEL THE MEDIC!!! But that's not up to us right now (dispatchers).

It hasn't happened yet, we're lucky - as far as not sending Medics to BLS calls if two medics are out - great - there's always one available for the AMI - however - the difference is that they are coming from the TSP/301 to Putnam Lake - by the time they get there it's over a 20 minute response - that's when something will change.

The other thing - for the amount of benefits you get out of a volunteer fire dpartment or VAC - which may be as small as a place to wash your car or someplace to go watch TV - why can't you department say - everyone sign up for a day shift - YES - VOLUNTEER!!!

The other solutiion some of us came up with while discussing it was to have one ambulance from each side of the county get assigned a day of the week - I'm sure there's ways to work that out - if the district ambulance can't get out with a full crew - send the one that's manned! Of course on a busy day this idea goes down the drain - but it's another option...

As for your "lacerated finger" - the medic isn't the only resource being tied up...but you know that

[PVFD113 6]

In all honesty- some area's really do over use the medic as an EMT. Daytime calls for alot of volunteers can be difficult BUT can you justify going 4 tones or mutual aid after hours or on weekends when most of us are home? If it is common to not have EMT's during the day--maybe some funds should be set aside to hire a paid EMT (as other agencies do) to fill that void? It can work. At times there also seems to be a misunderstanding on the public's part also. Lets get a free ride to the hospital--and we won't have to wait in the ER. That happens--in my opinion too much. What about the nursing homes that are too impatient to wait for a transport ambulance like Emire or Empress. This does unfortunately happen. Please don't take me the wrong way--I am all for the Volunteer's 150%--but something needs to change before someone gets hurt.

[Guest chief865]

We've definitely gone down a road that I think we can't return from. The days of a full volunteer ambulance service are never going to come back. Speaking of Putnam County, one of the limited options that I believe we're going to see in the future is paid ambulances. By that, I mean, paid BLS ambulances. Its a avenue most of our "decision-makers" want to go. I personally fully support the ambulance service in my department and wish we could handle our own, 100% of the time. Not realistic these days, but I feel we provide a valuable service to the community and should strive to make ourselves better. Other people may disagree in that they feel that the volunteer ambulance service was "hurting" patient care and that's the reason ALS assist was brought into the county. The fact of the matter is, yes, volunteer ambulance service needed a change in Putnam. Ambulances were taking longer and longer to get out. It only supports the fact that people in the community have less time to volunteer and less time to take the EMT class.

As for the problem at hand, existing EMT's are getting (or are already there) too complacent about utilizing the medics. They don't feel that they have to stop what they're doing after a few sets of tones and cover the ambulance. They know that the medic will cover. Sad, but true! Will giving the dispatcher discretion to reroute or cancel medics be the answer? Why would a dispatcher be willing to call a number of different ambulance corps to get one ambulance out when it can be covered with a medic and a driver from the local corps?

How do you turn around a system after it gets this far? Restrict the medic service to ALS only and have mutual aid called from five departments to cover one BLS call time and time again? It sounds cruel and doesn't happen all the time, but it does happen.

With all the questions I've throw out, you can tell I don't have the answer. As with most people, I can point out the issues involved, but the answers are definitely tougher.

[roeems87 0]

I guess our service is a little bit different. We are a VAC, but we have two vehicles that respond (that's the protocol) to every EMS call, the BLS ambulance and the Medic fly-car. The medic is paid 24/7, so there is always a fly-car to respond (if not already elsewhere), the BLS bus is covered by a paid EMT (and one volunteer) from 7am to 7pm, and then is strictly volunteer at all other times. We VERY rarely have any issues getting an ambulance out, or a second bus, or a third bus for that matter, within very short periods of each other. We have a good corps with people willing to come. The issue with sending the medic is protocol since to my understanding, not everyone at 60 is EMD just yet, though, so I am told, they are finishing that up soon. That's not the issue though, the service provided by our town (and two villages) is that of an on-duty paramedic, he triages or evaluates every patient. If he or she sees fit, we transport ALS to the hospital in the ambulance with one of the EMTs following in the fly-car. If it goes, BLS, the medic can go back in service and bus can transport. In some cases, the ambulance will be on scene first and can tell the medic it's a BLS job and he can stay in service. In others, the medic may be tied up, but we have another BLS bus to cover. So all in all, I think it's the best kind of system with the fly car. If we needed a second medic to a scene, we could get it from any of the surrounding communities mutual aid within about 10-15 minutes. Just to note though, you can be at about 5 hospitals from every corner of our response area in that amount of time.

It works well. I like it. Opinions?

[LCFD994 8]

A lot of the responses to this thread interested me. Like I said in the begining I wasnt picking on a particular agency or area. I do work in two very different systems, and have been part of the fire and ems system for over 20 years. I have seen some good ideas and some bad ideas come and go. Some have stayed and some were worthless from the start.

The problem in Putnam isnt that there isnt enough personnel ,most of the time, its the question of how to motivate or re-motivate the personnel that is there now. There are alot of great EMTS and EMS people in this county, and yes sending the Medic on every call does hurt them. I understand why the County does it, dosent mean I agree with it. But the bottom line is whats best for the patient.

There has been alot of talk out there about paid EMTS and paid Ambulances being used in Putnam, I dont think that is the solution. But it does need to be addressed and addressed before something bad happens.

Every Ambulance service in the County has a set crew for night duty, and like PC422 said maybe setting something up with set daytime crews is the answer. They used to have a shared EMT program in the County, and it worked very well, where did that go? Someone from one of the departments made a great point one day, he said if everyone would just pick up one or two extra calls a week then this problem would solve itself. Until then I guess we will keep our fingers crossed and hope for the best.

[Remember585 815]

The issue with sending the medic is protocol since to my understanding, not everyone at 60 is EMD just yet, though, so I am told, they are finishing that up soon.

Not true. All of the 60 Control staff are EMD certified, and we utilize the ProQA software for all EMS calls per our protocols. The only reason your agency gets ALS and BLS response for everything is YOUR PROTOCOL, hence no FD response on certain types of calls. I think, and again this is MY OWN OPINION, your agency is one of the best in Westchester, and I don't recall any times where I had to send Mutual Aid into your jurisdiction. Keep up the good work!

On a side note, I think that ALS abuse is a major issue. But what makes matters worse is when patient transport is drastically delayed awaiting Mutual Aid, and the Medic is ALREADY ON SCENE. Correct me if I'm wrong, but if you,re already there, that patient is in fact under your care, right? Delaying the transport because of personal feelings on covering BLS calls is inappropriate. If you're there, and in some instances for 10-20 minutes awaiting Mutual Aid, and the local VAC has only a driver, why not take in the transport? More importantly, the local agencies have to resolve the staffing issue and stop relying on ALS Fly-Cars!!! Suck it up and pay someone if you have to - and think about your public, not your pride! How proud can you really be if you couldn't cover a call in sufficient time and the outcome is DEATH? THINK ABOUT IT!

[Guest NYTruckie]

Remember585 wrote

"The only reason your agency gets ALS and BLS response for everything is YOUR PROTOCOL, hence no FD response on certain types of calls. I think, and again this is MY OWN OPINION, your agency is one of the best in Westchester, and I don't recall any times where I had to send Mutual Aid into your jurisdiction. Keep up the good work!"

Well why doesn't South Salem FD respond to EMS calls anymore? I was told by two officers the following:

They wanted to respond to serious calls, and not to others. For example, an ankle injuried at the high school football game (where a BLS ambulance was standing by). They were told (by 60) they can be dispatched to ALL EMS call or NONE.

I think that EMD is a good thing and can change the outcome of a call. One problem is all the different agency's answering the 1st 911 call. Do they transfer the call or hang up and then call for the ambulance after dispatching police. Which just becomes a game of telephone.

[Medic137 6]

There are good reasons for dispatching medics on BLS calls such as getting patient care in progress while the volunteers are assembling a crew.

The problem with this is that by the time the ambulance gets on scene the medic has done the assessment, splinted the fractures, and bandaged the lacerations. The EMTs get frustrated because they rarely get to put their training to use and are pretty much limited to lifting, carrying, and driving.

Most of the EMTs certified in the last 5 years have never been on a call without a medic and many lack the confidence to take charge on anything but the most basic calls.

It has become a vicious circle: We need to use medics for BLS calls due to the lack of EMTs, and we are driving the EMTs away by having medics do their jobs.

[LCFD994 8]

EXCELLENT POINTS !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!1

[WAS967 97]

I had a call recently where a patient required a splint to the forearm/wrist. I asked the EMT if she wanted to do it and she defered to me. I thought about it afterward and next time I will make the EMT do it for the experience and be there for them to call back on if needed. When I was a medic student (back in the bronze age) I had an ER rotation at WPH. I was working with a patient getting ready to start an IV and a cocky medic from Abbey walked in and saw that I was a student and took it on himself to show me how to do the start. He did everything and I just stood back and watched. What did I learn? Nothing I didn't already know from watching. Experience is best earned from doing. Medics: Put your EMTs to work. If they are standing around with a clipboard and there is something that needs to be done, have them do it. We can get name/demographics later. The worst thing a new EMT can do is hide behind a clipboard.

[Remember585 815]

Good point WAS. I think I said this in another post a while back...but new EMTs are pretty much taught from the start "that if it is anything major, you'll have a medic anyway."

BLS before ALS people! Use those skills learned in EMT class or you'll lose them. I know this for fact, because I recently expired after nearly 9 years as an EMT, and I have forgotten so much that I am nervous about my recert.

Anyone want to take it for me? I got it - any MEDICS wanna take it for me????? #-o

[LCFD994 8]

HA HA 585... how much you willing to pay??? just kidding. I am sure youll do fine its like riding a bike.. and I know you were kidding but would you really want "some Medics" actually doing your test for you...

One other point, I know it dosent happen that often, but it does happen, but the EMTs shouldnt count on a Medic always being there. Especially in Putnam where there are only four Medics, there is a chance that they are coming from a distance or not available for what ever reason.

I for one take pride in utilizing all of the crew that shows up on the ambulance. It dosent matter what there certification level is, I make sure that everyone has something to do and everyone gets involved.

[Guest ksneubec]

Remember585 wrote

Well why doesn't * * FD respond to EMS calls anymore?  I was told by two officers the following:

     They wanted to respond to serious calls, and not to others. For example, an ankle injuried at the high school football game (where a BLS ambulance was standing by).  They were told (by 60) they can be dispatched to ALL EMS call or NONE.

As a former member who was in the above-mentioned department when the transition occured, I can say completely objectively, without prejudice, that the reasoning behind no longer responding to EMS calls is that SSFD did not want to get woken up in the middle of the night to respond to EMS calls when the VAC had a lot of members responding to the scene much of the time who were able to do most of what the FD First Response could do. This is the reasoning that was presented to the Fire Comisioners at a public meeting. At the time, we were told by 60 Control that they could not prioritize EMS calls b/c they were not EMD at the time, although it was well known that it was only a matter of time before that came into place.

It was a move decided by a few non-medically trained members, and not by the actual EMTs in the department, the ones who actually got out of bed and didn't just roll over and reset the pager the ONE time a week it went off in the middle of the night.

As for my personal opinion, this was a very bad move. For starters, as one of those EMTs, I would say we were actually VERY useful on at least 50% of the calls we responded to. And on the others when the VAC had enough manpower or just didn't need us, we were happy to go home. A lot of EMTs lost their training and real-world chances to learn, and SSFD lost a great way to be seen helping people in the public eye, especially b/c like most departments these days, 50% of calls were EMS related. MOST fire departments are moving towards responding to EMS calls, not the other way.

[Guest NYTruckie]

I'm sorry Karl I was told incorrect information. How is CT, treating you?

[Guest ksneubec]

Good! No complaints from up here in CT. New Fire Department, same old stories Miss you guys in Westchester-

[chazEMT 5]

I think I said this in another post a while back...but new EMTs are pretty much taught from the start "that if it is anything major, you'll have a medic anyway." #-o

I know that is NOT taught in my class....quite the opposite!! We teach the students to recognize when ALS is needed on a call, and to call for ALS as early as possible...

But EMT students in my classs (and hopefully every EMT class) are NOT taught to rely on medics for "anything major!" EMTs are taught to assess and treat/stabilize life-threats using BLS skills-and none of those skills include "hiding behind a clipboard" or depending on a medic!

[Medic137 6]

I think I said this in another post a while back...but new EMTs are pretty much taught from the start "that if it is anything major, you'll have a medic anyway." #-o

I know that is NOT taught in my class....quite the opposite!! We teach the students to recognize when ALS is needed on a call, and to call for ALS as early as possible...

But EMT students in my classs (and hopefully every EMT class) are NOT taught to rely on medics for "anything major!" EMTs are taught to assess and treat/stabilize life-threats using BLS skills-and none of those skills include "hiding behind a clipboard" or depending on a medic!

Unfortunately, what you can't teach them in class is how to get to a call before the medic and put anything else they've learned to use.

[LCFD994 8]

Speaking of clipboards, I cannot tell you how much that Pi**** me off when people bring the clipboard inside the house or up to the car during extrication. GRRRRRRRRRRRRRRRRRRRR ](*,)

[Guest]

It's not that they are relying on Medics - What is happening is that the Medics are getting to the scene long before the ambulance and the EMTs who would have been great EMTs are not using the skills they did learn in their EMT class because the Medic has already done everything by the time the ambulance gets there. WHEN the medic stops getting dispatched to BLS calls most of the EMTs are going to need to refresh their basic skills because they never have the opportunity to use them...

[PVFD113 6]

You are 100% correct--the only thing--maybe if the crew responded on the 1st or 2nd tone out they could gt there in time also. I am not slamming anyone--as I am sure you hear when you are working--there are a lot of times all you hear is tones and tones----and tones.

By the way--the new crew up there seems to be coming along very well--keep up the good work!!

[Guest NYTruckie]

Speaking of clipboards, I cannot tell you how much that Pi**** me off when people bring the clipboard inside the house or up to the car during extrication. GRRRRRRRRRRRRRRRRRRRR ](*,)

Well how about this one, I responded to a rollover that near the county line, when I arrived it was in another county, that county's medic was standing over the patient that was packaged and stat flight was already on the way. I look at the medic and said this is your county and your here first the patient is yours do you need help. He ssid no he is not then I noticed he didn't have any gear, it was all still in his fly car. I loaded the patient in the ambulance the FD said there are pateints that want to RMA I told them to have the other medic do it. I went to the landing zone came back to my fly car. A person walked up to me said hello to me by name. He told me he was a police officer in a town I covered, he then told me he was involed in the MVA and nobody RMAed him. So I took his patient, then had to RMA 3 patient, while he just left.