Reflections on a New System

Posted by Patrick Lickiss on Jan 25, 2012 in Current Events, EMS 2.0, General | 0 comments

So I’ve been working in my new EMS system for a little while now and a few readers have asked if I have noticed any differences between Western Michigan and Alameda County. I’ll spare you the weather-related differences and focus on the actual EMS aspect.

DISPATCH
The three counties we serve have fully embraced the Medical Priority Dispatch System (MPDS). While cards are used to determine if a call is Alpha (stubbed toe) through Echo (cardiac arrest) in severity, each county medical director has assigned a response priority to the phone triage results. A Priority One call involves both the transport and first responder units traveling with lights and sirens. A Priority Two call involves just the first responders using lights and sirens and a Priority Three call involves just the transporting unit responding with no first responders.

The end result of this system is fewer units running code around the city. The risk, of course, is undertriage. I can say that, so far, I have only been upgraded en route a handful of times and have not yet gone to a Priority Three that needed more medical resources (just the occasional manpower call out for lifting). There is a QA/QI process at the dispatch level and though I was skeptical at first, the system seems to work. I’m even considering cross training in dispatch after I get my bearings (I know, I know!).

FIRST RESPONDERS
All of the fire departments we routinely run with are BLS, at the most. Many of the volunteer agencies require only Medical First Responder. Now this is not to say that there aren’t some paramedics who volunteer with these agencies, but they are generally limited to providing BLS care. There is a caveat, however. If I, as the transporting medic, know that a volunteer firefighter is an approved paramedic in the county, I can ask him/her to operate at the ALS level. Medical direction basically offers us a way to have additional ALS hands on scene and during transport as needed. Pretty cool if you ask me.

The Sheriff’s Department in our neighboring county also staffs first response paramedic units. Back when the Federal government was first handing out money to develop EMS systems, this county chose to funnel those funds to law enforcement rather than fire. Today, the ALS first responder program is limited to a few townships under a contract basis with the Sheriff’s office, but the idea is sound and generally works well. When thinking about redesigning a system from the ground up, looking to this type of first response may be helpful.

PROTOCOLS
Now down to the nitty gritty: the medicine.

The protocols here are largely the same though we have a few medications like fentanyl and magnesium sulfate that I didn’t carry in Alameda. Most treatments are performed based on standing orders, though there are a few which I take issue with. For instance, I have to call medical control to treat abdominal pain. I can give pain meds for traumatic injuries, but any non-traumatic pain requires a physician consult. Now, that being said, I haven’t been turned down yet, but it feels a bit old-school to have to ask. That being said, the new Michigan State protocols allow aggressive treatment of anaphylaxis with IM/IV epinephrine and encourage liberal use of CPAP. I feel as though I’ve been able to treat critical patients as I see fit without needing to interact with medical control too often. That seems like a good fit to me.

Perhaps the best part about our protocols is that they are interpreted as guidelines, not as a cookbook. Decisions made in the best interest of the patient are honored as such.  That is a similarity to Alameda County that I am thankful to see.

CALL VOLUME
In a word: busy. I would say that, on a given shift, I run the same number of 911 calls that I did in Alameda. We also run transfers on top of that. The upside is that our days go by quickly. The downside is that I’m exhausted at the end of a shift. I will say, I actually enjoy running transfers from time to time. It’s usually a slower pace, but we also run CCT calls (including written orders from the sending physician with whatever medications they need us to carry) so some of the transfers are pretty critical.

SO WHAT’S IT ALL MEAN
Professionally, I miss Alameda County like crazy. That being said, the system here feels very similar. The protocols are largely the same and the Medical Director seems to support the idea of paramedics as true medical providers. The receiving facilities here are great and welcome us as team members. Though I miss where I started, I’m excited about where I am and where I’m going. Thanks for indulging me in a self-centered post!

Have you moved to a vastly different EMS system than where you started?  Any reflections on that process?  What do you like better about your system now?  What about your old system?  Let me know in the comments!

Image via Flickr

Pediatric Assessment Tips

Posted by Patrick Lickiss on Jan 18, 2012 in Assessment, General | 2 comments

Having a one year old at home has done more for my pediatric assessment skills than any class I could have ever taken. Pediatric patients have some very subtle changes and behaviors that can be easily over-looked. Given that kids can maintain for quite some time before deteriorating very quickly, it is important to learn to read the cues they give off. Over at Everyday EMS Tips, Greg has a great guide for comparing pediatric findings to what is “normal’ for the patient. Go take a look!

Whatever it takes…

Posted by Patrick Lickiss on Jan 11, 2012 in General | 0 comments

I have a friend who works for a large urban EMS system (hint, it’s not me!) and he was told by a member of his leadership team that it’s important for EMS to do “whatever it takes to save a life”. While listening to this story, I couldn’t help but shake my head. What does that even mean?

Aren’t we supposed to be working in the best interest of the patient? Sure sometimes that means making a difficult decision in order to improve a patient’s outcome, but the bravado in that statement scares me.
Take a cardiac arrest patient, for instance. If that patient presents in asystole, should we be going out of our way to transport? Wouldn’t that fall under the category of doing “whatever it takes to save a life”? Sure, but it wouldn’t be in the patient’s best interest. In fact, the American Heart Association has gone so far as to say that transporting a patient in persistent asystole is unethical. Notice that they didn’t say “not recommended” they said UNETHICAL. That’s about as strong statement as I’ve ever heard the AHA make.

We have to be careful that we’re not doing more “stuff” to patients because we can or because we’re trying to “save a life”. We should be acting in the best interest of our patients and doing what we can to improve outcomes. Bravado and grand standing simply doesn’t have a place in modern EMS.

It should be pretty obvious that I’m a fan of evidence-based medicine.  If a treatment has evidence to back it up, great. But a role of “hero” or “savior” in order to inflate your ego is plain silly and belies an attitude seen more frequently on television than in the real world.  Beating a dead horse isn’t brave and it just doesn’t accomplish anything. Just my two cents, what do you think?

Image via Wikimedia Commons

Wishes for a New Year

Posted by Patrick Lickiss on Jan 1, 2012 in EMS 2.0, General | 0 comments

So here we are, another year is upon us.  For those of you following me on Facebook and Twitter, there have been a lot of recent changes in my life.  A cross-country move, a whole new EMS system, a son growing faster than I can imagine; the list goes on and on.  As you may have guessed, I’m sitting down and writing this post well before the new year begins.  I’ve been reflecting recently on what I’m hoping to accomplish in the new year.  Part of that process is to look back on what I’ve done in the past 12 months.  So far, in the EMS 2.0 world, one item stands out beyond all the others.

This year I was able to connect with a group of like-minded providers at the First Responders Network to develop an online magazine that I think has a great deal of potential.  I certainly harp on the need for evidence-based practice in EMS often enough but Interventions goes a step beyond that.  Our goal with the magazine is to engage the EMS community and get them talking to their own managers, medical directors, peers and public about the next steps in EMS.  It’s not enough to sit here and demand evidence-based standards, I want to mobilize an entire community.

So there it is, my EMS 2.0 resolution for 2012:  I pledge to do whatever I can to involve those in the EMS community not already engaging on Twitter and Facebook, those who don’t yet read blogs but are interested in shaping the future of EMS.  I encourage you to think of ways to do the same.  We over at FRN can’t do it alone.  What are your ideas for engaging the rest of the EMS community?  Let me know in the comments.

Image via Flickr

510 Medic Returns!

Posted by Patrick Lickiss on Nov 28, 2011 in Current Events, General | 3 comments

Hello everyone from the 510 Medic Eastern Operating Base in Grand Rapids, Michigan!  Things are slowly settling down here after the move.  The good news is we all survived the cross-country drive (including the two cats) and are enjoying our new home.  My list of house-related projects is slowly dwindling and I can turn my attention back to the blog.  I’ve been moving through my FTO process at my new gig and have greatly enjoyed learning a new EMS system.

I’m working on new articles and hope to launch a few new features on the site after the first of the year.  Work is still progressing with the FRN Magazine:  Interventions, so look for a new issues soon.  I’m also hoping to become more active with podcasts and on social media now that I have some free time.

Thanks again for all your patience!

The End of an Era

Posted by Patrick Lickiss on Oct 31, 2011 in Current Events, General | 3 comments

As many of you know, change has been brewing for some time in Alameda County.  At midnight tonight, the emergency ambulance provider contract will change hands.  This time will mark the end of an era and the beginning of a new one.   Many of the practitioners in the county are taking positions with the new company and some, myself included, are moving elsewhere.  I’ve been in Alameda County for a little over six years and though I am excited to move on to the next stage in my career, it is with some sadness that I do so.

I have had the opportunity to work with an incredible array of providers from EMTs and paramedics to nurses and physicians. I’m extremely proud of what we’ve been able to accomplish here and I know that the innovation and excellence in patient care which exists in Alameda County is due in part to an aggressive EMS agency but is also due to high-quality, driven field crews who prioritize patient care above all else.

As for me, I’ll be transferring to Grand Rapids, Michigan.  I’ll be moving back into the field and will welcome the opportunity to provide direct patient care again.  My new system will be a new adventure and I can’t wait to detail my experiences there.

To my friends and soon-to-be former coworkers, I’m proud to have worked with each of you.  Keep up the great work and don’t forget why we are so proud of the system we’ve built together.  You are among the best EMS practitioners in the world and don’t let anyone tell you otherwise.  I wish you all the best going forward and please stay in touch.

Image via Flickr

A Brief Hiatus

Posted by Patrick Lickiss on Oct 26, 2011 in Current Events, General | 2 comments

Things have been a little sparse around the blog recently and I wanted to give some insight into the reasons why.  As those of you in my County know, there is a huge professional transition coming up.  As some of you may not know, I have a huge personal transition pending as well.  Next week, I will pack up my family and move across the county (well, most of the way) to start the next stage of my career in Grand Rapids, MI.  This move will be bittersweet for a multitude of reasons.

With all of these changes, my blog has taken a bit of a back seat.  While the content has become less frequent lately, please don’t think I’ve forgotten about you.  Life has been a bit hectic recently, but rest assured that I have plenty of great content, as well as a few possible side projects, planned for the coming months.

Thank you so much for your patience, support and understanding.  I’ll be back in no time!