When I was fifteen years old, the first ambulance that I set foot on was a 1984 slant sided Braun.  That truck, 219, was a beast.  Gas powered with two tanks that it would guzzle on a Summer day, and to better make sure it was plugged in when you left the station because if you didn’t, it would be dead as a doornail for the next call and you’d be forced to take the van one bay over.  Nobody wanted to take the van. The back of the truck was typical for your smaller box truck.  The s tretcher was side mounted to the left hand wall with a bench seat running down the side and the airway seat where you would expect it to be.  There was really nothing unusual or breathtaking about the back of the truck.  About a year into my time, the dreaded van was replaced with a 1994 Horton ambulance with a center mounted stretcher, but otherwise nothing remarkable to it.  219 was remounted sometime after the turn of the century, and that 1994 Horton, 218, was replaced in 2007 with a brand new Horton ambulance, ready to keep the populace of Island Heights safe. Now, in 2011, 218 and 219 still sit in their respective bays.  219 is still that remounted 1984 box on a new chassis, and 218 is that pristine 2007 Horton, 23 years younger than its big brother just a few feet away.  Here is the problem: if you open up the back doors of each of the trucks, you will find that they are alarmingly similar.  That’s right: 23 years of history, zero progress.  218 still has that same center mounted stretcher, much like its 1994 predecessor did.  The bench seat is still running down the right side, airway seat still in the same spot that it was not only in the old truck, but also in 219.  No bucket seats.  No advanced restraint systems.  No harnesses.  No steps taken to make the providers safer in the back of the ambulance.  Just the same old lap belts.     Now, compare it to the back of an ambulance from “across the...

I recently read a story in EMS World about a paramedic who has been placed on administrative leave for failing to treat a patient.  According to the article, he arrived on scene, assessed the patient, and despite the requests of the BLS ambulance on scene, he decided to go back in service and triage the call to the BLS unit.  The patient was transported to the hospital where they subsequently died. I am not writing this to debate whether any ALS interventions would or would not have made any difference in the patient’s outcome.  There has not been enough information released to even dip one’s toe into that debate.  I am also not going to debate the “liability” issue of a lower level of care taking care of a patient when the higher level of care is present because I feel that quite often, if a patient can be triaged, and the BLS unit willingly accepts to take over care of that patient, then there is no issue with doing that.  I am writing this to discuss comfort levels. Throughout my career, I have viewed ALS as serving many different roles in prehospital care.  They are there to provide ACLS care, pain management, and trauma care just to name a few, but they are also there to be a safety net for BLS providers who may or may not be comfortable with a patient that is in front of them.  With three times the training that a BLS provider receives, sometimes a more knowledgeable presence when caring for a patient rather than a brief pat on the back and a polite “you’ll be fine” is what that lower level provider needs. In the system that I work in, I often work by myself in a fly car (or interceptor, or QRV depending on where you are from).  The majority of the patient contacts that I have are while intercepting with an ambulance staffed by EMTs.  Throughout the course of my day, I will see a variety of complaints from stubbed toes to cardiac arrests, depending on what I am sent to.  After my assessment is done on my patient, and I am comfortable with...

This past Monday, issue number 2 of EMS INterventions went “live” on the internet.  Comprised of articles and videos put together by the team at the First Responders Network, the magazine offers a look at what we want from our Medical Directors and what they can do to help us achieve that reboot of EMS, that EMS 2.0 that we so desperately need. I would like to invite you to check out the edition and please share any comments that you might have either on our respective blogs or at [email protected].  Additionally, I welcome you to download and print out the PDF version of the magazine and share it with your colleagues and medical directors.  This is where you, the reader comes in.  Help us spread the word, and help us put EMS 2.0 on the tip of everyone’s tongue. I am very proud of what we have put together, and would like to thank everyone involved in creating the publication for their hard work, dedication, and spectacular content that was contributed.  We look forward to putting together Issue 3, due for release sometime around EMS Today in Baltimore.  Stay tuned for updates in the weeks and months to...

How important are response times in EMS?  To most communities, they mean everything.  There is no greater measure of how effective an EMS system is than how quickly an EMT or paramedic gets to the scene of the call. We are, however, barking up the wrong tree.  Lets compare two calls and I will explain where I am going with this: An ambulance company has a required response time of 9 minutes 59 seconds or less ninety five percent of the time.  Medic 1 is dispatched to a single family home on New Jersey Avenue on the other side of the city from where they are posted.  They try the best that they can, but despite their best efforts, they arrive on scene in 12 minutes, almost two minutes after their longest allowed response time.  The crew gets out of the truck, gathers their equipment, and a minute later, 13 minutes into the call, they are greeting their patient and starting their assessment. After transporting that patient to the hospital, Medic 1 is dispatched to an apartment building on New York Avenue.  This time, they arrive on scene in 9 minutes, narrowly making their response time.  They again gather their equipment and start pressing buzzers.  After confirming the apartment number with their dispatcher and having them make a call back, one of the patient’s family members walks down from the fourth floor to let them in.  They start their trek up four flights of steps, and fourteen minutes into the call, they are at their patient’s side.  Given these two situations, which patient got the better service? In situation number one, the crew missed their response time but due to “geography” they were able to reach their patient more quickly than they did on their second call.  On the second call, they provided the service that is expected of them with their 9 minute response time, but their patient waited longer.  Should a question be raised about the second patient waiting as long as they did, the service provider could answer “we made our required response time.” Taking this into consideration, are response times really what matter in EMS or are they this mythical...

Some posts are more difficult to write than others.  This is one of them. Coming from a volunteer background, I have seen a variety of levels of abilities in EMTs.  Some can’t hear a blood pressure.  Others just seem to say the wrong thing at the wrong time.  Some are just plain unreliable, and still others are downright negligent.  Sometimes, people tried to make excuses for these people by shrugging and saying “they’re doing this out of the kindness of their heart.”  That argument never seemed to hold much water to me. I came to the conclusion early in my career that not all EMTs are paramedics are created equally.  This should not be anything anyone considers earth shattering, some people is better at things than others.  As an industry though we seem to have taken this “all for one and one for all” mentality and it is hurting us. “A paramedic is a paramedic, and an EMT is an EMT.”  Have you ever heard anyone say that?  Unfortunately, if they don’t say it, many people think it.  There is no differentiation between a good provider and bad one, and there needs to be.  It is time to work with those who might not be cutting it.  It is time for them to get on the bus or move on. How much of the problem comes down to our reluctance to be educated?  Our view that continuing education is the two or three year grind that we have to do.  I think many providers might get a decent education under their belts right out of the gate, but once the reeducation or discovery of new educational opportunities is put in the hands of the “responsible” provider, we fail.  Miserably. But I digress. . . The first step to dealing with someone who is not cutting it is to correct them.  Be blunt about it.  Let them know that they are not getting the job done and show them the right way to do it at the right time: away from the patient.  Let them know what they are doing wrong, and tell them, no, show them how to do it the right way. When...