Thanks to all of you

With over 40+ years in emergency services, I’ve witnessed a lot of changes.  It used to be VHF all the way.  My pager, Plectron, and mobile were all VHF.  Then we got portables – VHF.  Then the with the advent of the 911 system, we got another radio and we had to talk to two separate dispatch centers for every radio transmission.  One was on 800, the other VHF.

Then we went from the HEAR system to UHF for medical control/hospital reporting communications – now I had 3 radios.  Then they added the MDC/MDT – one could argue that is another radio (and it is).  I also have the cell phone which has become invaluable, and the pager.  Currently, in my rig, I have 6 radios (MDC, VHF mobile, VHF portable, 800 portable/mobile convertible, cell, and pager).

The 800 works great and allows great flexibility to communicate with various agencies – police, fire, private ambulance, and others.  However, I don’t believe it is the technology that limits us, I believe it is the bureaucracy.  I should have only one dispatch control center that I communicate with.  That would eliminate a lot of redundant radio traffic.

BTW, I like your show, but I would listen to it more if it were streamlined.  The chit-chat and inner jokes don’t connect with me very well.  I don’t find I have the time to listen and would like to get to the heart of the matter more quickly.

Thanks though for your leadership in EMS!

Thanks

When I went into EMS air medical transport, as a part time flight medic, we worked 12 hr shifts.

Currently, I’m working a private service in a major metro area, working 12 hr shifts – 4 on/4 off. We are running about 10 calls a shift and it is killing paramedics. For me, by the time I commute home and back for my next 12, I’m only getting about 6 hrs of sleep (after spending time with my family, taking care of chores, personal stuff, etc). By day three, I’m dead.

The people who work overtime, have “newborns at home,” etc – I don’t know how they do it.

This is a serious issue – not just for the short term, ambulance accidents, etc – but for the long term of medic health, employee morale, and employee retention. Not only are we losing some good medics, but we will drive up the cost of health insurance premiums as our workforce ages.

As to this specific case, is there validity in including GERD in a list of differential diagnoses (DDx)? Absolutely, but STEMI and NSTEMI, among others causes, absolutely has to be considered in the list of DDxs as well. STEMIs can be ruled out with a 12 lead, but even if a crew has point of care cardiac troponin (cTNT or cTNI) testing (those tests are out there), NSTEMI requires serial troponin tests followed by a stress test. So even if you’re fairly sure that a patient might be suffering from GERD, if you can’t rule out NSTEMI (which EMS can’t, regardless of the level), you need to push for transport.

In short, if you (generic “you”) aren’t considering a list of differential diagnoses when treating your patient, you better not be doing anything short of following the protocol list like a cook book, which of course makes you a technician, not a professional. If you’re thinking that the patient might not be fitting your protocol perfectly, then you’re making a DDx and saying, “Well, gee, it could be A, or B,” which is the definition of a differential diagnosis.

The biggest thing I think we should take from this topic is this: We need to take a good hard look at how we measure what we do. We are REALLY bad at that. Many EMS systems, especially on the commercial side of the page is UHU Driven. For those who don’t know what a UHU is, simply put its the measure of how busy a system is based simply on how many transports (or calls) a crew does on a per hour basis.

Chris does a good job of explaining it, but if a crew in one system has a task time of 30 minutes, meaning that from start to finish it takes them 30 minutes to do a call, and another system has a task time of 45 minutes, and they both do one call every 2 hours, they will both have the same UHU, which says to me that is a broken measurement.

TASK TIME and call volume is what should drive us. If a system does a call in an average of 3 hours, and they do that twice a day on average, I think 24 hour shifts can work in that system, but at the same time, in a system where an average ambulance does 15-20 calls in a 24 hour period, maybe 24 hour shifts arent appropriate.

There’s A LOT that needs to be looked at. We have an idea of what that is: fatigue, call volume, task times, the decline of the quality of patient care later in a shift, or even after a crew is woken from a sound sleep.. Now, we just need to figure out a way to put that all into a readable and measurable form..

So what is that statistic supposed to be??

winsorhelpdesk@gmail.com

In regards to the living wills, in most places, living wills dictate to designated person what are the patient’s wishes but are not generally honored in the field. Whereas, DNRs are physicians orders made with the input of the patient and/or the patient’s family or designee. We just recently switched to allow not only the state EMS DNR form but to allow DNR documentation in a patient’s chart to be honored. Originally, EMS could only honor DNRs that were on the EMS DNR form.

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John-Luke R. Ord, EMT-P

I would love to see an episode of EMS Garage or EMS Leadership about selecting EMS Officers. Training these leaders has been talked about for awhile but the first question we need to answer is how do we chose them?

Thanks for putting out such a great show.

Jeff Anderson
Bossier City, LA