List Archives

Sun Jun 10 03:50:45 BST 2007

Phil,

If I understand your question:  why would EMS go to the length of mobilizing you and your associates, then divert the chopper to them and transport "around" you to the university (I assume, knowing your geography).  I think you have a strong argument to present to your EMS crews/director.  Again, I have the advantage of knowing you and your capabilities...so should they...more so than me.

For whatever reason, we have allowed EMS to become completely autonomous in certain situations where, clearly, a more experienced person, such as yourself would/could/should be more involved.  I am speaking of your specific situation because I am well aware that there are many EMS providers who get little more than an occasional pat on the back from their FP trained, EMS "Medical Director"...but, I digress.

First, for all you EMS providers out there, hold back on your strike.  I was a field medic in a busy system for 10 years, I write for your #1 journal (JEMS), have book chapters in your books and I have been medical advisor for a nationally accredited paramedic program for more than 8 years...I speak from experience.

That said, Phil, your EMS people need to be reigned in.  If they are going to communicate like they did with you at the outset, the lines need to stay open.  Not only did you assemble an experienced crew to handle the patient (no matter how sick she was), you also took time away from other duties to do so...this is taxing to any system, especially a smaller one such as yours...not only in the terms of manpower, but fiscally as well.

We now know a couple of things about air transport:  1) it is very, very expensive 2) they are probably not as safe as ground transport and 3) they may or may not contribute a survival benefit (http://publicsafety.com/article/article.jsp?id=2029&siteSection=1).. I think they do not...personal opinion only.

So, if EMS crews are going to take the initiative to make the patient a trauma alert in your system, they damn well should take the initiative to call you with VS every 10 min or so, an update on pt condition and mostly, they should ask for YOUR input as to the next step.  

As an aside, my monthly rant at our local EMS run review is the lack of adequate analgesia/sedation in the field.  2 weeks ago a 34 y.o. woman with bilat displaced radius fx, s/p fall from ladder was transported by a paramedic crew of 2 with a paramedic student...no IV, no pain meds...their excuse: "we couldn't start an IV in her arms because of the fractures".  This is 7 kinds of B.S....she had foot veins the size of the AK pipeline and would've gladly taken a poke there to receive much needed analgesia.

Anyway...that's the way I see it.

Hope this finds you well, Phil.

Roy Danks
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