medics, don't do this...

[True Anomaly]

Look guys, real sorry about your poor experiences with fire medics. But I have to honestly say I am shocked at the bashing going on. Surely you don't believe that because you experienced something, it can be extrapolated out to an entire group of professionals.

Some of the best and most experienced medics in the country are fire based. These same medics are on the cutting edge of EMS based on their research participation.

Yes, I am obviously biased, being a former fire medic. Feel free to blow me off if you wish. But I would hope you would think clearly and objectively before making assumptions based solely on personal experience alone.

 

The key word is SOME....not ALL.  

 

The most progressive EMS system I've personally come across was not associated with any fire department- as such, their medics willingly participate in research activities.  Ten years ago they were looking at pushing heparin for obvious STEMIs in the field en route to the cath lab.

 

I get wanting to defend fire medics especially if you've been there, and I have said on this thread that great paramedics exist in these large fire systems.  But all of us on this thread are not mere observers- everyone has been (or even continues to be) an EMT or paramedic before becoming a PA, and had been for several years and working for several different EMS/fire systems of all stripes.  Some of us have even done some form of medical direction as PA's.  From working in very tiny EMS systems to first aid organizations to hybrid fire/EMS suburban systems to the largest fire departments in the country- and thus talking with administrators and medical directors of all stripes- I am not the least bit surprised by the comments I've read here, and it does sum up my not-so-uninformed opinion that linking fire and EMS systems together and making EMS a stepping stone to promotion within the fire department is poisoning the well, and ideally I'd love to see all EMS systems separated from fire departments.  Financially, I know this won't happen.

 

As to the corollary discussion, NAEMSP has come out against the use of backboards, and like rc I'd love to see them become EMS relics as well.  So while it may be medical directors who still keep them on protocol, the parent organization is doing what it can to eliminate them from the field

[FfIghter23]

The key word is SOME....not ALL.  

 

The most progressive EMS system I've personally come across was not associated with any fire department- as such, their medics willingly participate in research activities.  Ten years ago they were looking at pushing heparin for obvious STEMIs in the field en route to the cath lab.

 

I get wanting to defend fire medics especially if you've been there, and I have said on this thread that great paramedics exist in these large fire systems.  But all of us on this thread are not mere observers- everyone has been (or even continues to be) an EMT or paramedic before becoming a PA, and had been for several years and working for several different EMS/fire systems of all stripes.  Some of us have even done some form of medical direction as PA's.  From working in very tiny EMS systems to first aid organizations to hybrid fire/EMS suburban systems to the largest fire departments in the country- and thus talking with administrators and medical directors of all stripes- I am not the least bit surprised by the comments I've read here, and it does sum up my not-so-uninformed opinion that linking fire and EMS systems together and making EMS a stepping stone to promotion within the fire department is poisoning the well, and ideally I'd love to see all EMS systems separated from fire departments.  Financially, I know this won't happen.

 

As to the corollary discussion, NAEMSP has come out against the use of backboards, and like rc I'd love to see them become EMS relics as well.  So while it may be medical directors who still keep them on protocol, the parent organization is doing what it can to eliminate them from the field

Coming from a dual Fire/EMS system, I completely agree with you TA. EMS will always be the step-child of first responders and I was one of the few in my large, suburban FD that wanted competent and dedicated paramedics. The medic certification was only something that was need to promote and once promoted, never rode the ambulance. 

 

Medical Director (Dr. Gamber) was outstanding and just pulled "backboards" as standard of care. In five years-- I doubt you will see them on the street.

 

http://starlocalmedia.com/planocourier/news/plano-fire-rescue-among-first-ems-providers-to-do-away/article_128a6336-0dd1-11e4-a174-001a4bcf887a.html

[SHU-CH]

Wow - good thread. Back when I got involved in EMS, we were boarding everyone that got hit in the head with a nerf ball. They were just starting to talk about allow people to "field clear" a neck.

 

In 20 years of vollie EMS, I know of exactly one patient that I collared with what turned out to be a significant injury. We rolled at a fairly minor rear ender to find the two drivers ambulatory and screaming at each other. One young lady had fairly minor neck pain so we did the standing take down routine.

 

A couple days later her mom (who happened to work in the ER, unknown to me) stopped us after another call and thanked us for the great job, said her daughter was doing well after neurosurgery, etc. I forget the exact nature of the injury, but she did have some minor long term sequelae.

 

Backboards I used to not mind too much. Now the KED, I would have happily burned...

[GetMeOuttaThisMess]

Coming from a dual Fire/EMS system, I completely agree with you TA. EMS will always be the step-child of first responders and I was one of the few in my large, suburban FD that wanted competent and dedicated paramedics. The medic certification was only something that was need to promote and once promoted, never rode the ambulance. 

 

Medical Director (Dr. Gamber) was outstanding and just pulled "backboards" as standard of care. In five years-- I doubt you will see them on the street.

 

http://starlocalmedia.com/planocourier/news/plano-fire-rescue-among-first-ems-providers-to-do-away/article_128a6336-0dd1-11e4-a174-001a4bcf887a.html

I wish your EMS chief would've read the email that I had sent him a couple of months back when they went to the Suburban first response and allowed me to ride out with them just to keep my EMS experience active (no treatment, just obs).  I'm down the street from the west side unit at Sta. 6 (assuming that there are still only two in service).  He didn't address the inquiry but got off on another topic.  We need a modified cervical immobilization device since Houston FD med director showed several years back that C-collars distract internal decaps as opposed to providing a form of immobilization.  We need some form of air device like are available for extremity immobilizations that harden and immobilize the neck posteriorly, laterally, and under the chin.

[True Anomaly]

Coming from a dual Fire/EMS system, I completely agree with you TA. EMS will always be the step-child of first responders and I was one of the few in my large, suburban FD that wanted competent and dedicated paramedics. The medic certification was only something that was need to promote and once promoted, never rode the ambulance. 

Medical Director (Dr. Gamber) was outstanding and just pulled "backboards" as standard of care. In five years-- I doubt you will see them on the street.http://starlocalmedia.com/planocourier/news/plano-fire-rescue-among-first-ems-providers-to-do-away/article_128a6336-0dd1-11e4-a174-001a4bcf887a.html

I did my EMT rotations eons ago with your department- they've always employed excellent medics. Too bad your medical director is one of very few who actually heeds evidence

[Accelerator]

same medic, same facility as prior case....guy in his 30s with L elbow posterior dislocation. site not visualized or splinted. no IV and no analgesics. no mention of neurovascular status in oral or written report. I cut off the guy's sweatshirt on arrival to see the obvious deformity. Reduced easily with propofol after a bit of fentanyl for pain control and ativan for anxiety.

report made to ems medical director. hopefully the guy will lose his job or go back to some sort of remedial training...in theory this guy is a senior medic and field training officer...

 

Elbow should have definitely been splinted in the position found, analgesia is usually reserved for long bone fractures per most protocols at least where I live (tri state area of Kentucky, Ohio, and West Virginia), although you could call for orders from MCP if necessary it will usually be deferred unless extremely severe. If he failed to check PMS or visualize that is a serious failure.

 

Our county has a dedicated ems agency and they are the only agency permitted to run 911 calls. The neighboring county runs all of their ems calls from the volunteer fire departments although ems is paid. I work for the county agency and the nearest fire dept in the neighboring county (because every medic needs two jobs). My experience is that you have good and bad medics everywhere. I think we lose perspective because there are people who are bad at their jobs at all levels.

 

Not every agency has the ability to clear c spine in their protocols. I am able to clear c spine and I do so whenever I can at the county, but cannot at the fire dept no matter how superflous the board may be.

[True Anomaly]

As an addendum to the spineboard/c-collar discussion, for those of you in EMS still banging your heads against the wall with unnecessary spinal "precautions", here is the resource paper/position statement from both NAEMSP and the American College of Surgeons as to c-collar and backboard recommendations that you can present to your medical director:

 

http://www.naemsp.org/Documents/Position%20Papers/POSITION%20EMS%20Spinal%20Precautions%20and%20the%20Use%20of%20the%20Long%20Backboard.pdf

 

If your medical director still won't implement changes after this, they better have a sound medical and/or systems reasons for continuing their course of action

[csmmedic]

medic report " I brought you a drunk with a scalp lac"

" did he pass out? "

"yup"

you have him in c-spine with a line? what's his cbg?"

" nope, just a taxi ride"

"ok"

 

Actual pt

gcs 10, almost intubated on arrival. took nasal airway without moving or complaint. moans to pain.

cbg=60

large scalp lac repaired

head/neck ct neg

chest/pelvis plain films neg

banana bag given

tox and metabolic workup other than very high etoh neg

 

so, yes. a drunk with a scalp lac skillfully disguised as a trauma.....still....that report and tx of this pt would have gotten me fired as a medic 20 years ago..

Eh, more concerned they didn't check the sugar on a patient with ALOC than the lack of cervical precautions, which basically only hurt people. But I would have definitely been in trouble too. 

[csmmedic]

We did away with backboards last year for most of our EMS patients, and ultimately aim to use it only as an extrication device.  There is no literature supporting their use, and plenty of literature showing the downsides (respiratory compromise, pressure sores, patient discomfort).

 

Our medics have also been doing selective spinal immobilization for several years, using NEXUS criteria to limit unnecessary use of cervical collars (although clearly this patient wouldn't have qualified and should have been immobilized).

Our system had a clearance protocol for years, and now just effectively did away with spinal motion restriction all together. We kept the boards for extrication as well.