Personal Responsibility

Last night was a big night for me. It started out with the opportunity to participate in a great Podcast hosted by one Kyle David Bates called The First Few Moments. If you haven’t checked it out yet, please do so. It’s got some great information about dealing with issues such as triage, treatment, and management of the critical first minutes of a scene.

That was followed by the 100th episode of EMS Garage. Not only was I able to listen to the show, but I was actually on it too. Like I told Chris Montera, the show’s host, “Being on the Garage for me was like being a fan that is plucked out of the crowd and put on the court.” It was a great experience, and I am extremely grateful.

I finished the night catching up with Ms. Paramedic and Jeramedic over Skype. If you haven’t heard of them, check them out on their many projects: The Gen Med Show, Mutual Aid, and their personal blogs to name a few. I had a great discussion with Jeramedic about some of the recent events here in Massachusetts.

As many of you know, my wonderful Commonwealth has been in the news quite a bit over the last few months, first for the more than 200 EMTs who have had their certifications suspended, and more recently, the law that was signed in by Governor Deval Patrick making the minimum staffing for an ALS Ambulance one Paramedic and one EMT. Previously, it was two Paramedics, and if a service wanted to run with anything less, they would have to obtain a waiver from their Region.

The President of the Professional Fire Fighters of Massachusetts has expressed his concerns for this proposed minimal staffing change by saying that “People are going to die because of this law.” In my opinion, that assessment of the new law is a touch dramatic. There are many, many systems across the country of a variety of sizes that staff with a “one and one” standard.

So the question was raised: “Is more less?” Does the presence of more Paramedics mean the deterioration of one single Paramedic’s skills? I was excited to hear Jeramedic’s views on this. As part of his participation in the pair’s Mutual Aid project, he was temporarily relocated from Los Angeles County, California to a more rural Parish in Louisiana. The two locations couldn’t be any different. The best way I can describe it is imagine if Green Acres was actually about a couple of EMTs. . . I kid, of course.

We went round and round on the topic for a while, with both of us playing both ends of it. Having extra help is great, yes, but information can be lost in the handover of a patient from one Paramedic to the other. Also, having a number of paramedics at one’s disposal allows a lead paramedic to step back and direct those around him. Finally, lets face it. . . Sometimes its nice to just have someone else there who we can bounce an idea off of, or ask for a second opinion on a 12-Lead.

On the other hand, ACLS has actually moved to emphasizing more effective BLS care and moved away from advanced airway techniques in the initial states of a code. These calls, however, make up a small percentage of the calls that we do. Finally, what about the dilution of skills? Sure, Paramedics might not get as many tubes in a calendar year, but why can’t we push to have the difference made up in a hospital setting? Many paramedics would benefit from spending a little time with an anesthesiologist.

For the last ten years, I’ve been working in a system that based on our city contract, it stresses the need for double paramedic trucks. For most of my career before I was promoted, my regular, full time partner was also a Paramedic. Personally, in my experience, there was no shortage of skills for either of us. In fact, one of my old partners and I used to track our IV and intubation success rates as well as the volume of ALS contacts that each of us had. Our skill rates were successful, and the work was split evenly. Neither of us was ever at a loss on a call, and we both participated in the treatment of our patients. We were a great team, and we worked well together and played off of each other’s strengths and weaknesses.

Maintaining one’s proficiency in any skill should be the responsibility of the individual Paramedic. If you feel like you are getting rusty on tubes, look for help. If you’re having trouble with EKGs, there are plenty of resources out there to help your skills improve. The resources are out there. The success of a Paramedic rests solely on his or her shoulders. We all want to see better Paramedics on the streets, but I dont think that necessarily means less Paramedics.

Finally, I’d like to apologize for my absence from the EMS Blogging world. Work and life have been very busy for me as of late. Have no fear though, I’m back!

As always, your comments and opinions are welcomed and encouraged. What do you think? Do we need nationalized standards for the service we provide? If so, what should they include?

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