My Sweet Spot

Through my career I have worked in a couple of different style of EMS systems.  I started out in a volunteer system that commonly saw anywhere between 2 and 4 people riding on an ambulance, cramming themselves in back with a medic and a patient for transport to the hospital.  Despite how big our ambulances were (and granted, they were smaller than many of the ones on the street today) things still felt cramped.  I must admit that from my BLS stand point things seemed to run smoothly.  It was all that I knew.  Everyone had their role.  Things seemed to go well, however, now, twenty years later I can certainly see where things could have been frustrating for an ALS provider.

Fast forward a few years to my tenure in Springfield.  There was no predicting who I would be in an ambulance with, and more importantly, how much help I would get if I asked for it and it was actually granted to me.  Sometimes I worked with another medic, sometimes an intermediate, and sometimes an EMT.  I did not mind the work load that was generated by not working double medic because such a high volume of our runs were BLS runs anyway.  Admittedly though, there were certainly some frustrating times in the early years of my career as I felt like I could never get enough done.  I was and am my own worst critic.  When things don’t go how intend them to, I beat myself up.  That seemed even easier when I was the only medic there.

On most cardiac arrests, we had a fire engine or ladder company with us ready to do compressions, but they were not always the easiest to give feedback to if compressions weren’t being done well enough, or there was something that needed to change.  Don’t get me wrong, many of them were fantastic but it was certainly a barrier we encountered.  Finally, the question of “how many EMTs do you need to run a code?” was a common question that was asked.  A lack of recognition for the evolution of medicine was something that constantly held us back.  My opinion was always that if a provider on scene felt that they needed more help they should get it.  Not everyone agreed with that.

There were also those occasions where I could find myself in a patient’s residence with my partner, a BLS ambulance that happened to be a few blocks closer, four people on a fire engine, and two police officers.  It was overkill.  There were just too many people there.

Before I go any further with this post, I feel the need to state something though.  Far too often we lump all of the calls that we do into one pot.  Personally, on the medical I feel like there are cardiac/respiratory arrest responses and then everything else.  On the “trauma” side there are motor vehicle accidents and everything else, and even that is a vague line.  My point is, there are certainly calls that benefit from having a more significant response.  What I am about to say does not reflect my thoughts on those calls.

That said, I must say that in my current system, I have found my sweet spot.  What I mean by that is I have found the number of people on the scene of a call that I have found has made the most difference for my patients.  Granted, I have only been here for a year, but frankly, I am impressed.

More times than not, a routine chest pain response for example receives a BLS ambulance, and ALS intercept vehicle (QRV, chase car, interceptor, fly car).  That person who has chest pain has four people walk into their house: two BLS providers and two ALS providers.  Because of this setup, a patient gets the best possible ALS assessment that they could receive that I have encountered in my career.  The BLS providers obtain demographics, perform any BLS skills needed, and figure out how we are going to get the patient out to the ambulance.  It really is a smooth system.  I don’t feel crowded, I don’t have so many people on scene that I feel crowded or feel like there are too many hands doing too many things, and I’m not spread so thin that I’m left alone to care for a patient while my partner figures everything else out.  Once that patient is out to the truck, it is up to the ALS team to decide if the patient at that point would benefit more by having two paramedics by their side of if just one will suffice.  Either way, there is rarely, if ever, just one provider with a patient in the back of an ambulance.

It is quite the impressive system and seems to work really well.  Congestion at a scene is low, tasks get accomplished in a timely manner, and the patients get the care that they need.  Realistically, I cannot see more benefit from having more people huddled around a patient than what we have here.  To me, if that number is more than two things just seem to get too crowded.

Comparatively speaking, this system works, and it works extremely well.  It benefits the patients, our providers get to do a large number of skills and see a high population of critical patients.  Judging from the feedback that we get, this setup seems to certainly be benefiting the patients as well.

So, if anyone ever asked me, “Hey Scott, how many people do you need to best care for a patient?”  Four.  My answer is four.