Rural EMS can really suck sometimes

“Dispatch will be changing frequency to dispatch ambulance.”

As I hear those words I grab my boots and quickly slip into them and start running, carefully, down the stairs. I know from experience, quite painfully actually, that if I don’t pay attention while going down these stairs, I’ll wind up head first heading towards the floor. I quickly grab my steth and hat off the table where they lay after we got back from our last call.

“EMS, EMS, Ambulance requested in tiny south-county town. Called in as a difficulty breathing. Deputy is responding to scene,” The radio on my belt squawks. I stop and think about where exactly they’re sending us. I can’t recall that little town being on any of our response maps.

“EMS to PD Dispatch, copy call, clear page,” I say into my radio as I pull it from my belt. I head into the bay and hop into our rig. The senior medic I’m riding with is right behind me. We start the rig up and he flips the lights and siren on as well pull out of the parking bay.

“Hey, OldMan, where the hell are they sending us?” I yell over at my partner, while flipping through the map book trying to see where we’re headed to.

“It’s just north of SmallerTown. Usually their vollies will cover that area, guess they can’t raise anyone again, so we’re covering the county,” He tells me as he scans the road ahead and to his left as we blow through town. He gets on the radio to ask dispatch if the volunteers are responding at all.

“Negative on that, EMS. Volunteers are out of service today due to insufficient crew available. SO is sending a deputy out to assess the scene for you. He should be there in ten minutes.”

“Copy that. We have an ETA of 45 minutes to the scene,” my partner tells them, shaking his head in frustration.

The South Town Volunteers might only be BLS capable, but they could still make a difference in this call if it’s anywhere near serious. But since they are unstaffed, a common occurrence lately from what I’ve been told, the patient has to wait for our EMS service to show up. Since we are a paid department, and the only other EMS agency in the county, we are always staffed. Luckily.

We hit the highway once we’re out of town and OldMan gets on the gas for all he’s worth, trying to get there in time. It’s a long trip there, even running flat out with lights and sirens. Luckily it’s pretty much all flat and straight till we get into Tiny South-County Town.

“Dispatch to EMS, SO reports that the patient is not breathing and has no pulse. He is starting CPR.”

“Shit!” My partner curses in the radio’s general direction before picking up the mic. “Copy that dispatch, get EMS2 rolling once they get into station.”

“EMS2 to EMS1, copy direct,” The voice of the OldMans son comes back, since he is the on call lead today. “We’re rolling now.”

Thirty minutes still till we get to scene. No telling of how long the patient has been down. This could wind up not being fun at all. I just hang on and watch the terrain fly by to either side of us, keeping alert for cross streets so I can tell my partner if something looks like it’s gonna come out in front of us. I know what to do if we have to work a code, so I try to relax and just be ready.

As we pull up on scene I notice it’s a single family dwelling, with a slew of vehicles parked in front of it. This gives me a little hope that maybe we got called the minute something started to go wrong. There’s also a deputies truck parked in the driveway with it’s lights still twirling. I quickly glove up and grab the first-in bag from the side compartment behind me. I see my partner grab the cot first thing.

“There’s that working a moving code mentality again.” I think to myself.

We rush inside the residence and take a look. The deputy is in the middle of the floor of the living room with an AED attached to the victim, while performing CPR. I see a face mask there too, so it looks like he’s been doing everything right. Judging his compressions I see that they are good, solid, and deep. Perfect.

The OldMan has him stop and he does his quick assessment. By the way the body moves when we roll it, this person has been down a hell of a lot longer than 45 minutes. As we look at their back we notice lividity present as well. We both look at each other and shake our heads. As he talks to the family to get the story, he motions me to talk to the deputy to get his viewpoint since he got there.

The family is of course not happy with us when we do not continue CPR. They are mad at everyone, especially us, for how long it took their call to go through. It sounds like they tried calling the Small Town Volunteers station to try and get response from them for about a half hour before calling 911. They told the dispatcher that she wasn’t breathing. So why did we get paged out for difficulty breathing? Ya’ll know dispatchers as well as I do. Guess.

Apparently the family thought that calling the vollie station was just as good as calling 911. And they couldn’t figure how the station could be unstaffed in the middle of a weekday. They apparently weren’t happy finding out that the vollies have real jobs and don’t have the staff to maintain a crew 24/7. They were blaming us for taking so long to get there from town, even though it’s impossible to get there faster than we did.

The deputy said he got there and started CPR as soon as he checked for a pulse and got none. He never thought to look for rigor or lividity, but then again that’s not his job. I get some more information from the deputy for our report and watch as he goes to call the JP and make arrangements.

I meet up with my partner again after I finish loading the cot into our rig and put the bag back in the side compartment. As he sees I’m done putting things away he asks, “Still so happy to work in a system like this?”

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This is the first time working here in Rural Town, TX that I wanted to pull my hair out. I wonder if this will be the call that gets the county and my town to decide that our service needs to spread to cover the entire county and needs a station down south in Small Town. In a situation like this it might have made all the difference.

It's gonna be an interesting few years

After doing a lot of talking with my new boss and others members of the service, I’ve come to the conclusion that my first year or two working for this service might be interesting.

First, what I really don’t like. This agency was an all-volunteer agency until about a year ago, and it shows. Now, I’m not trying to put down volunteers, as sometimes they are very professional and great to work with. But we all know some volunteer agencies who are only there because it looks cool and don’t want to do anything more than bare minimum. Or they’re there because it’s a family thing.

This service seems to be a little bit of both. Only 3 medics on the staffing list, mostly EMT-Is and EMT-Bs. A lot of them related in one way or another, and think that it will only help that they are. I’m ok with that, though, since they are willing to hire from out of the area and, hey, they’re giving me a job :D.

What I can’t stand though, is how little they care about education. They are excited to get the newest toys and gadgets, but don’t really like to look at the newest research to see why or why not they should be doing something. Tradition plays a very big role in how they think. The old “We’ve always done it this way”. Luckily they have a medical director who doesn’t like that and wants to keep pushing the protocols to be more progressive.

But things still fall through the cracks and are done just like always. One of them is working a code on scene. I’ve always been taught that you only transport a working code once you get ROSC. They are a big fan of stopping CPR to get the patient into the bus, then running hell-bent towards the nearest hospital with only one provider in the back working the code, in a moving rig, running L/S, and getting thrown around. I’m not a fan of that. Hopefully it’s one thing I can help change their mind on. But we’ll see.

I’ve talked to the chief about going back to school, since I want to finish up and get my medic soon. He’s all for it, but the minute I said I wanted to go for the AAS as a minimum, his eyes kinda glazed over. HE doesn’t understand why anyone would think that a medic isn’t quite educated enough. I love the fact that TX recognizes the extra education and issues a license, not a cert in this case, of Paramedic.

I’ve talked to a couple of the people at teh station about the EMS 2.0 movement and things like #CoEMS (I wore my EMS 2.0 pin on my dress shirt for my ‘interview’, so it was kinda obvious), and one of the on duty crew said she was all in favor of it (she was a part timer who also works as a flight medic). The other just kinda shrugged and said she had her basic, which was more than enough education for her. Not quite what I was hoping to hear. But the chief said he’s ok with me continuing to blog, as well as being active in the EMS social media aspect, which is what I wanted.

Now the service isn’t all bad. Like I said earlier, they have a very progressive medical director. I was told by the chief that if I came up with any research, that the medical director’s door was always open to improvements in the system. Also if there were any new toys that he was more than ok with me learning how to write grants to try and get money for them, pending MD approval. One of those devices is the Zoll Autopulse or the Physio equivalent. I figure if they want to risk everyone by running codes in a moving bus, I’ll see if I can get a device to make it safer and easier for all involved.

Their medical director wants them to get serious about hiring good ALS providers, and according to the chief, the MD would eventually like to see the system move to an all ALS approach. I’m more than ok with that, since it sounds like they want to try to model if after ATcEMS, which seems to be a great system. I have an official interview with the medical director already requested so I can talk to him and get a feel for how he like his ALS providers to function and talk to him about a few questions I have over just how long a leash he gives to EMT-Intermediates in his system, so hopefully I can get a good rapport with him started.

The other good news about the area… I went to the nearest big city on Wednesday morning to talk to their community college’s medic coordinator. He seemed to be a great guy, and seemed interested in me entering their program. They do offer the EMT-P AAS, which I want to take advantage of. He did tell me, though, that I can start their certificate program as early as January if I get paperwork in in time, and then finish the gen-ed courses for the AAS after I get my #discopatch. Not a bad idea. The downside is a 75 mile commute one way for classes. And clinicals. I do, however, get to do half my ride time in my small-town agency. So it is not as bad as it could be. And my new boss said he would be willing to put me on 1 24 and 1 12 a week of first out, and 1 12 every other week as second out (on call), or 2 24s a week and 1 12 of second out every other week, whichever I wanted. He is not a fan of 24s, but he said in my case it might make things easier.

I think I’ll get my medic and try to stay here for another 4 years or so at least once I get it. Then I’m seriously debating trying to transfer to ATcEMS and trying to get on with their system to finish out a career if I decide to stay a medic. but I’m not sure.

Either way, it’s going to be one hell of a ride. Maybe I can make my own little #thunder out there.

Yum tasty fledglings

I recently have gotten called out over on an EMS forum that I frequent about being a little too critical about our fledgling EMTs and medics on the site. I started to think about that and try to figure out why. This is pretty much what I’ve come up with.

1) A lot of them are coming into it for (in my opinion) are the wrong reasons. A lot of them have no desire to do emergency medical care. Some want to do fire, some just want something to do while they ‘find themselves’ (I can’t complain about that too much since it’s almost how I got here), some just want to play with the ‘blinkies and woo-hoos’.

2) There are people who get into this field without a lick of research. They get certified and then complain that they can’t find work where they’re at, or because of how young they are. Or they complain that the only job they [i]can[/i] find is working an IFT ambulance, and they don’t want to do it because it’s not the glamours of 911.

3) People want to embrace the low standards that it takes to get into this field, or drop them even more. I’ve seen some people say that they don’t want to go back and get more education, but want more toys to play with in their toolbox. EMT-Bs complaining that they can’t do any invasive skills, but with their impressive 120 hour course they want to be trusted with needles and tubes and things that could actually end a life if used improperly.

Those are my top three, and combine one or more of them with my cynicism it’s not a good thing when I get going. It also doesn’t help that EMS as a whole in the US is having a major identity crisis. We are the red-headed, soulless, bastard step-child of both the public safety and healthcare worlds. So it’s no wonder that a lot of new people don’t know what the hell we are.

My firm belief is that we are not public safety and should stop acting like it. For those of us who want to improve the profession and make it more than a vocation we need to start acting more like a healthcare entity with all the headaches that might make for those of us who will be in the thick of it for the transition. Yes, this means divorcing ourselves from the FD as the UK, NZ, and Aus (among others) have done. But then again you already knew my feelings about that.

So, until we ourselves get our heads on straight we probably will be a field that eats our young at a freakishly high rate.

New Bling for the bag

Went down to check the mail today and got something new and shiny to add to my work bag. And speaking of it being a work bag it’s gonna get thrown around a lot more coming up real soon, more on that tomorrow.
Here’s the shinyness for ya.
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