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Wednesday, May 30, 2007

EMT "Ambulance Drivers" - Who is at fault

For a long time now I have been a big proponent of EMT’s fulfilling their role and riding with patients in the back of the ambulance on BLS calls. All the while, most of the dissention has been among those who do not care for EMS and say that the EMT-I’s and Paramedics get paid to ride in the back. I have had long discussions with numerous EMT’s, Medics, and Officers to try and pinpoint what exactly the extra pay that ALS providers receive is for. Some say it is for the certification, others say it is to ride the ambulance. I do not think it benefits anyone to have a Firefighter/Medic ride the ambulance all of the time, and most end up riding the Engine at least 1 day a cycle. Of course if we had an abundance of ALS providers it wouldn’t be a big deal.

In talking with the EMT’s, most will state that they are ambulance drivers. Like I have said before, I have never seen it this way. If you ask many ALS providers they will tell you that the EMT’s should take BLS calls. Other ALS providers seem to be content with taking all the patients.

It seems as though the hospitals demands of nearly all patients having I.V.’s obtained pre-hospital and sometimes even the blood samples drawn makes almost every call an ALS call. The exception being most nonsense “BS” calls we run.

Therefore the system we use has created mostly ALS calls across the board, leaving only the nonsense calls for the EMT’s to ride in with. That is if the EMT knows what they are doing.

I will admit it, I had more experience as an EMT than a Firefighter when I came to Roanoke. I had volunteered as a firefighter for about 5 years, yet worked as a paid EMT in Richmond. Even though I only worked in Richmond a year, which was plenty, I have yet to experience many calls which I ran there on a weekly basis. Yet in Richmond I was an ambulance driver. Yes, I helped with pt. care, and there was a lot more on scene pre-hospital care given than Roanoke. We usually sat on scene for a while taking care of the basics on ALS calls before leaving the scene, whereas in Roanoke the medics usually take care of things en route to the hospital.

So I got experience with being an EMT. When I came to Roanoke, I was stationed at #9. I rode the medic truck a day and a half a cycle, basically every other day unless the other EMT was off and then I rode every day. I took patients in the back whenever possible and I knew what I was doing. If I didn’t I asked the medic, and if I didn’t feel comfortable with the illness/injury, the medic took the call.

The point I am getting to is that it seems as though we are not training EMT’s in Roanoke. It seems as though we are certifying EMT’s and teaching them to drive an ambulance. Then we are expecting them to become ALS providers. It just doesn’t work.

Ask any ALS provider and they will tell you if all else fails when attempting ALS skills to revert to BLS skills. For example if you can’t get the pt. intubated then bag them.

Over time, I have heard nearly every argument on both sides of the fence. I enjoy learning what others opinions are on the subject. I have come to the realization that the Roanoke Fire-EMS Department puts a lot of stock in its ALS providers. That is understandable. However, the emphasis that should be placed on learning the basics as an EMT is nonexistent.

It seems as though the $4000 carrot being waived in the face of these new guys isn’t working either. This blows my mind. I can tell you that if I had it to do over again, I would have gotten my ALS certification. Just think of the money I would be making right now. I have thought for a while that these guys are stupid for not getting it. In my mind there should be a line at the door. Sure there is a downside, having to ride the ambulance more. Unfortunately there is a cap on how many ALS providers we can have. However, I have come to realize that most of these new guys are in over their heads as EMT’s. Many see these ALS providers’ skills, knowledge, and experience and find it overwhelming. They cannot comprehend how they know all the stuff they are required to know. It is because the EMT’s are rushed through EMT class and taught to drive the ambulance. Sure they go to Continuing Education and might further their knowledge, but they aren’t really EMT’s. They are more like first responders, which I believe was a very short and basic class.

I know as I write this that many of you might not agree. Some things going through your head might be that you are a strong EMT, or that you know a Medic that is dumb as hell. I am sure that what I write about true about everyone. We have plenty of competent EMT’s. But how many would be comfortable on a BLS ambulance. That is what I thought. Oops, did I say that. Hang on; I am not advocating BLS ambulances. I think that every ambulance should be ALS. However, that is a good judge of comfort – that EMT’s should be comfortable taking patients in the back of the ambulance on a BLS truck.

Before all of the guys who were blue patches start hollering, you guys should know what I think about that by now.

There are so many other tangents to explore on this situation, some that I have hit on in the past and others I might get to in the future.

I guess my main point is that over the years I have thought that the EMT’s were somewhat at fault for not embracing EMS. That is the case with some who remain somewhat anti-EMS. However, it seems as though the system we have in place has set a precedence which has created EMT drivers.

My last thought is that maybe this is exactly what is wanted "EMT Ambulance Drivers". If so, then why in the world would we want to take an ambulance driver and turn them into an EMT-I? The phrase that comes to mind is having the cart before the horse. You cannot become a skilled EMT-I if you are not a skilled EMT.

18 comments:

Anonymous said...

All I got to say about this is;

Big Jim, himself, said on TV that all the EMT's have to do is drive the medic unit. Our union had a copy of this video. Of course, now times have changed with all these do-gooders, not from this area, trying to push their agenda on us. If you love EMS so much, become a medic and leave us EMT's alone. Some of use are still firefighters.

FireFleitz said...

I think you missed my point. I started with how I used to feel and added some thoughts on it, then came to the understanding of basically what you have stated.

Anonymous said...

you see that is the problem. "some of use are still firefighters". you know what it is not just a fire department anymore if you just want to be a fireman than go somewhere where there are only firefighters. REMEMBER this is a FIRE/EMS dept. Rhett you make some good points and maybe the ALS people should so the EMTs what they are doing and tell them why they do it.

Anonymous said...

Nice discussion on an ever-present issue facing This Department! Facts are that we have not hired any fire-fighters in over 10 years. The job title is firefighter EMT. The problem is with the job "expectations". Why do the officers tolerate or encourage personnel to have the "I'm a fire-fighter only" attitude? I have heard it pointed out that this logic would not be accepted if it was applied to station duties or other task.
"I fight fires I'm not a janitor!"

Truth is that a big portion of the blame lies with the officers of the dept for tolerating this behavior, and it starts at the top!

We have a very subjective, ambigous evaluation tool and no clearcut expectations of the personnel in the firefighter EMT role. Grigsby was coward and would not express his expectaions for fear he would have to defend them in court. Maybe the new Chief will address the situation?

Anonymous said...

very well put i think you hit the nail on the head. If you ask me the new guys should all go to medic truck stations and then bid out for non medic truck stations. that way guys that have some years get something out of it. And they don't get that tude about I'm just a firefighter not an EMT.

Anonymous said...

the officers have the attitude that they were made to do EMS and they don't want to, so the newer guys pick up on that and behave the same way. It is a cycle that needs to be broken. We talk about bad morale and how it needs to be fixed. 1st take a look at yourself and say "what can I do to make this a better department to work in."

Anonymous said...

each day you get better or worse, the choice is yours

Anonymous said...

Thanks for the GREAT advice their Ralf in your last comment. Your choice was to plant your seeds with the crowed that tells you what you need to do today. The choice is theirs. The pied piper on C shift runs the dept.
The ol Grumpy guy

Anonymous said...

Hire more medic's so you can staff your ambulances with two ALS providers...that will solve the problem!!!

Anonymous said...

How about two to three years on the ambulance for medics and firefighters, after that, let seniority have its privliges and let guys move up to riding engines and ladders all the time?? It worked in Lynchburg for years!!

Anonymous said...

How come they aren't still doing it then?

Anonymous said...

Lynchburg has changed, they do it like we do in roanoke now,Its cause of the flsa, to be a paramedic and work 24 hours,you have to be a constituent part of the fire service in order to work 24 hours and a 56 hour work week,SO thats why we do it this way and why lynchburg changed. Either you are a firefighter paramedic, or you can work a 40 hour work week and be a paramedic and be a division of the fire service.Not a firefighter!

Anonymous said...

Did someone "throw a rock."

Anonymous said...

Hey! As being what some people call a "Blue Patcher", I will admit that I became an EMT for the stipend. But, that was then and this is now. It is now required of me as I did sign the agreement as a condition of promotion to maintain EMT cerification. Maybe I am missing something here, but, with all the griping about riding the Medic Unit, I think that we have overlooked something very real. Who are the ones that often times are the first to arrive on some of the more serious incidents? Usually a bunch of (3) poor ole' EMT's reponding on an Engine. I have witnessed alot of really great emergency medical care given to the victims of an accident or sudden illness by a couple of plain old EMT's following the plain old ABC's. Who establishes a good airway? The EMT! Who contols the bleeding? The EMT! Who applies the AED? The EMT! Who stabilizes the fracture or mintains c-spine control? The EMT! Who oftentimes does the "packaging"? The EMT! So, from what I have seen, us plain ole' EMT's really do more in the field than we have been given credit for in this discussion. Let it be known that we are fortunate to have ALOT of really good ALS providers, and many times I have been really glad to see them arrive on scene.

Craig Sellers

Anonymous said...

Craig you are right about that, but on the other hand some do little. I was new and two guys that have been here a long time were on the engine with me. I was glad to see the ALS providers walk in because as i did the plain old ABC's they did nothing. I think that the ALS providers will be the 1st to tell you a good BLS provider is worth his weight in gold.

Anonymous said...

Drink the Cool Aid and drift away.

Anonymous said...

Watch it Craig. with all that medical terms on your post they may send you to emt-i class, you are starting to sound like a medic! this post is just in fun!! But you are right Craig WE are all in this together.

Anonymous said...

Yeah, You might would think that by now I would learn to keep my opinions to myself. Maybe all those medical terms may come in handy working at a station with Medic Unit #4 assigned to it. HAH!
Craig Sellers