Does your call have too many cooks?
In the kitchen that is. Over at JEMS, Guy Haskell has an article about a patient with suicidal ideation who evidently requires no less than 10 fire, police and EMS employees to treat her. The article brings up an interesting question: How many providers do you REALLY need on scene?
Having gone from a system that had up to 6 medics on every medical call (and more on traumas) to a system that only has two from the ambulance (and many calls get no first responders), I’m not sure that there is an easy answer. Predictably, the comments section of article devolves into an argument for or against ALS fire/ALS first response/public vs. private EMS/whatever else we want to argue about. That’s unfortunate because I think Haskell raises a legitimate concern. Driving emergency vehicles is dangerous. Driving them with lights and sirens is more dangerous. And not just to us but to the public as a whole. Putting everyone at risk under the guise of “first doing no harm” is ridiculous. We owe it to ourselves and our public to find a better way.
Medical priority dispatching does go a long way towards reducing the number of vehicles running code around the city, but I don’t think it goes far enough. Why not have units (first response or transport, I don’t think it matters) treat and release more patients? Why not only call a transport unit if the patient actually NEEDS transport? What about alternate destinations by alternate means? Say, for instance, your patient has suicidal ideations but has not made an attempt and is cooperative? Couldn’t you use a single responder to take that patient directly to the psychiatric facility? The vehicle would, of course, have to have a screen and door handles removed and what not, but I don’t see a reason why that couldn’t work. Suddenly, Haskell’s patient has one, maybe two, personnel on scene rather than 10. Cost savings and improved safety, all in one package.
Obviously this is the ideal. Some areas are moving towards such a model, but there is a long way to go. What about you? What do your ideal system look like? Totally ignore tradition for a moment and forget the way things have always been done. Design the perfect medical response and share it with the rest of us.