Tag Archives: ems safety

Are You an Ambulance Driver Too?

One of the fastest ways to piss off almost anyone in the emergency medical services community is to call them an “ambulance driver.” It has become a triggered response as reliable as setting off the tones for a call. We bristle at the fact that driving an ambulance is such a small part of what we are trained to do – even though “high-flow diesel” can be an effective, legitimate treatment for certain patients. Retired FD captain and bestselling author of Rescuing Providence, Michael Morse, wrote an article last year on accepting the title of “ambulance driver.” His reasoning was due in large part to the variety of nuanced titles that we stubbornly cling to including Paramedic (which is reserved only for “those who can intubate”), EMT, Basic, EMT-I, or AEMT as well as several permutations of NREMT. Quite frankly, we simply do not accept any generalized term for “EMS workers” that is as easy to understand and say as doctor, nurse, firefighter, or cop. And for those who are offended at being lumped into the cadre of “first responders,” at least the term “ambulance driver” does distinguish one of our unique capabilities.

“Ambulance Driver”

While I agree that Morse has a legitimate argument in his assertion that we have made this predicament ourselves, there is another salient point that comes to my mind from the news multiple times each month when an ambulance is involved in a serious wreck. A local Minnesota news channel investigation discovered that the requirements for operating an ambulance in emergency traffic while carrying a sick patient and an often unrestrained paramedic in a moving emergency room is far less than is mandated for a “truck driver hauling a semitrailer load of beer.”

With a shortage of paramedics, more EMTs are being hired to fill out crews. With low starting wages, it is often people who are still too young to legally rent a car by themselves that are put behind the wheel of a 14,000 pound vehicle costing nearly a quarter of a million dollars and loaded with the most vulnerable of human cargo after just a day or two of experience driving a cone course!  

Recently, NHTSA analyzed 20 years of data and found that the nation averages 29 fatal crashes involving an ambulance each year. Furthermore, these accidents result in an average of 33 fatalities annually. For a group of individuals dedicated to saving lives, this should be an unacceptable statistic. Rather than being indignant that the name describes so little of our training, we need to adequately train for the job of driving an ambulance for proficiency just as we train for our skills as a medical clinician. The lives of our patients (and our partners) depend on that skill every bit as much, if not more, than our medical skills.

In addition to my personal credentials as a professional (both in EMS and GIS), I am a fire vollie, a backpacker, an instructor, and an amateur historian. While none of these monikers describe the entirety of my personality, none of them offend me by limiting the description. Why should I be insulted for being recognized for a critical function in safely operating an emergency vehicle? I do not hear doctors being offended by not being identified by their specialty or even by being lumped in with a PhD outside of the medical community. The sad fact is that we just don’t have an agreed generic term for the collection of people with which we share our profession. Although the term “ambulance driver” does not fully define me as a person, or even as an emergency medical professional, I will proudly accept the title as my personal commitment to safely operate my ambulance for the benefit of the public, my patient, my partner, and myself. To any other “ambulance driver” out there, let me thank you for all you do for the public beyond the safe operation of your rig.  

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Filed under Administration & Leadership, Dispatch & Communications, EMS Dispatch, EMS Health & Safety, EMS Topics, Funding & Staffing, Line of Duty, News, Opinion, Patient Management, Technology & Communications, Training & Development, Vehicle Operation & Ambulances

Is Our Success Killing Us?

Should we really be upset when people in the community listen to us? After all, EMS protocols and people are notorious for creating our own problems. We write the public a “blank checkâ€? saying that if they believe it is an emergency to call 9-1-1 immediately and as a result we have created an increase in calls for non-emergent complaints. We continue to treat every call we can by transporting to the hospital and create a class of consumers called “frequent flyers”. When we need funding, we tell the public that “seconds matterâ€? and we define a parameter that the public uses against us to measure our success. Perhaps they listen much closer than we typically give them credit.

So what happens once we figure out they have heard us – we change our story! And we feel that we must do it dramatically in order to make the point that “we don’t do it like that anymore.� At some point we began to use MAST or PASG as a primary treatment against shock but eventually removed them from every ambulance as they fell from favor by delaying definitive care for a short-term gain. At first it was critical to get cardiac arrest patients to the ED, but now we set policies to work them on scene for better survivability. We drill into each responder that every single fall must be suspected to have a spinal injury and now some have begun to campaign to remove long spine boards from vehicles. Evidence showed us that tourniquets should be used only as last resort measures before learning evidence now shows that proper application early can have the best effect. And then we learn that there is nothing magical that actually requires a doctor to remove them as well! It seems that the “evidence-based� trend in EMS requires that being “progressive� means we lay in wait for some “proof� in order to jump on a previously long held belief so we can debunk it as some old “wive’s tale.� But why must we always go to an extreme new position? Our industry is designed to resist “fashions� by accepting change of practice slowly for safety reasons. While personal beliefs can be more fluid, it takes a while for the protocols to catch up. Perhaps we need to moderate both ends.

Change within a system is not expedited by extreme positioning, but reasoned and thoughtful conversation. The article on Things Your System Should Deliver is well written and certainly worth the read and consideration. You don’t have to become a zealot for change, a thoughtful advocate is powerful enough. Learn from the process we work within and work with it instead of against it if you want it to update more quickly. Engage in dialog with medical direction AND politicians AND the communities you serve. It is through these channels that change is truly affected and we will find the success we can live with.

 

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Filed under Administration & Leadership, EMS Health & Safety, EMS Topics, Firefighting Operations, Funding & Staffing, Training, Training & Development

Second Thoughts on 'Scene Safety'

In addition to my regular job, I continue to proudly serve as a medical first responder in my home community. But, now, in the wake of a Christmas ambush of firefighters last year and yesterday’s hostage situation during a fake medical call, I am thinking back on the doors I have rushed through attempting to offer my help to someone in need. When I respond to that late night page, I review in my head the details given to me by the dispatcher and construct my index of suspicion regarding the medical condition I will likely encounter and never suspect I am entering any sort of trap. Just like you, I was taught to say “scene safe” during my drills and exams, but that was in a classroom setting which is far different than I have ever experienced in the field. Now matter how good your imagination, that fluorescent lit room full of desks and chairs never becomes the cramped, dimly lighted bedroom down a narrow hallway. So, how do we relate the real-world idea of safety concerns into practice in the field? Back in school, we have simulators for patients that can respond to treatments providing feedback on my care and mock-ups of ambulances that even make noise to disrupt the use of my stethoscope, but where is the effort to really teach recruits caution before entering a home? Or even how to deal with the dangerously irate family member once we reach our patient? Maybe we need to go down the hall of the community college and ask the theater students to join our tidy little scenarios as grieving relatives.

And it doesn’t always have to be the setup of a deranged psychopath to present a danger, there are times I have simply gone to the wrong address. And in my state, a homeowner is justified in using “deadly force” on anyone who “was in the process of unlawfully and forcefully entering a home.” Hopefully by announcing myself and asking who called 9-1-1, I can argue the “unlawfulâ€? part if logical debates were possible in those late night situations. Fortunately, I have never found myself in a situation where my life was truly in danger. But I suspect other responders have felt that same casual assurance before things went sideways for them. Arming medics is also not the answer. My “concealed carry” training was very good, but it doesn’t begin to help me understand how to react in a hostage taking situation even assuming my hands weren’t already full of equipment when entering the room.

I read of states like Iowa and New Jersey that are having trouble recruiting volunteers and in some cases offering incentives for service. I have always felt that EMS is a calling however. We don’t just need more bodies in uniform, we need the right people to care enough about helping patients. We also need to do a better job of protecting the professionals (including volunteers) who give of themselves already. We must use the CLIR E.V.E.N.T. database to share experiences of how to make EMS safer and better for responders as well as patients. Take the recent events that have happened and let them make you more aware, not more afraid. Work with others to help them understand the real-world of “scene safety” and practice it in every call. Let your “index of suspicion” always include your own safety, because we need you back doing this job again tomorrow!

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Filed under Command & Leadership, EMS Dispatch, EMS Health & Safety, EMS Topics, Firefighter Safety & Health, Funding & Staffing, In the Line of Duty, News, Training, Training & Development