Friday, April 1, 2011

Serving Since Tuesday!

A veteran firefighter in a neighboring "big city" recently referred to some of the EMS providers as having nameplates that say, "Serving Since Tuesday." In a metropolitan EMS system, that somtimes isn't a bad thing because the ambulance Paramedics and EMT's have backup from Advance Placement Paramedics (APPs), System Supervisors, Administrative Staff and they have the best, most experienced firefighters around on their worst calls. That approach works great in a large system - but in a smaller suburban EMS system, we cannot afford to have "Serving Since Tuesday" on our front-line ambulances responding to calls alone with a partner who has been "Serving Since Last Tuesday." Consolidation of EMS resources coupled with the demise of many of the traditional "Rescue Squad" EMS providers has led to the rapid growth of County-run EMS systems in our region of the state. Government-run EMS systems are initially very attractive to many EMS recruits. They have decent benefits, retirement, nice equipment and flashy uniforms. Often the County providers tout themselves as "the best" and often times contracted EMS agencies (the former Rescue Squads) are looked down upon because they don't have the funding or resources to have "the bling" and the "flashy" trucks. The government-run systems attract many new EMTs and Paramedics and often have mass-hirings to "put butts in seats" to ensure units stay in service. Thus, "Serving Since Tuesday" may be the front-line response to many EMS emergencies in a large system. I'm "ok" with that because they do have contingincies in place and veteran providers available just a radio call away. I do not agree with smaller, suburban government-run EMS systems hiring with the same philosophy. Often in our area, a single paramedic ambulance is the ONLY responding unit to some really bad calls (no first responders in some areas, no APPs or abundance of system supevisors). Thus, "Serving Since Tuesday" isn't the best that we can do. Our contracted EMS agencies recognize this and hire accordingly. The government-run system MUST adhere to the same standard. When a member of my family becomes ill, a "driver" and a "Serving Since Tuesday" are NOT who I want to come to my family member. You heard it correct - "Driver." It seems there is a trend lately to hire new EMT's who work as firefighters to fill the role of ambulance EMT. I have NO problem with this if they are proficient in ambulance operation. Often times, they are not. They have never filled out a PCR, never driven an ambulance (the operate differently from fire apparatus), and don't know what to say on "the call-in" or even what to do in the back of the truck by themselves. Folks, we need to be hiring CLINICIANS not TECHNICIANS. A technician can fill the seat, but a CLINICIAN can perform patient care adequately, complete the report and operate the unit with little help. Now, as for the government-run agencies touting themselves as "better" than contracted agencies, I agree and disagree. They may be better in that they have more employees, and often better benefits and retirement. I disagree with the notion that patient care is better provided by government-run providers. The contracted agencies in our system have the most experienced providers. If my dear friend Lisa and I work on an ambulance together - our patient receives 40 years of EMS experience caring for them. This is the "norm" for a lot of contracted providers rather than not. There are VERY few times that contracted agencies have less than 5 years of combined experience on a truck. Often it's 10+ years on almost every unit. "Serving Since Tuesday" and "Serving Since Last Tuesday" on a truck together have NO place in a suburban or rural EMS system that does not have the back-up contingency that our big cities have. Many days I see 20+ years of EMS experience on our contracted trucks and then see a 1 month paramedic and a 1 year EMT on a County-run EMS unit. Who would you rather have come to your mother? Contracted agencies may not have the size or the administrative overhead of a government-run system but they do have a lot to offer: 1. Excellent clinical care with years of experience on most units 2. Nice equipment (I work for an agency with 2 nice, new Horton ambulances). 3. Compassionate care - Contracted providers often interact with the same people/geographical area every day. They learn the area, know the people and become attached to the patients. I LOVE riding with new providers. I've been a preceptor in our county since the very first "preceptor class" was ever taught here by guest instructor Steve Gardner from Wake EMS. I enjoy riding with new people because I know my years of "street smarts" and their new "book smarts" even each other out. I can depend on them for quick drug calculations and they can depend on me to "figure out how it works" or how to get a person disentangled from a situation. In conclusion - -"Serving Since Tuesday" should be coupled with a veteran provider, not left alone with a new EMT. It's the right thing for the patient. -Hire Clinicians not TECHNICIANS. I want an EMT who can perform all of the EMT functions assisting the paramedic helping my family member - I don't want a steering wheel holder or clip-board holder coming to our aid. -Don't put down the contracted agencies. Often they have the most experienced clinicians that can be found, nice equipment and SPOTLESS units that you could eat off the floor of. Another thing they have is their customer service which generally far exceeds that of a government run organization that doesn't have to rely on those customers when it comes time for fundraising or making a capital purchase. I have NO problem with any government-run EMS provider in our area. I work for the government myself. I applaud Wake County's initiatives and the dilligence that has been given to their special programs, the APPs and keeping system supervisors responding to calls. Unfortunately, in a rural/suburban system that doesn't have the funding for "extra hands" we must place the most experienced providers available on every unit. We should support our contracted agencies and applaud their efforts serve their communities at a lesser cost.

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