Are More Ambulances the Right Answer?

Posted by Patrick Lickiss on Apr 5, 2012 in Current Events, General | 10 comments

In an unsurprising move, the Los Angeles mayor, Antonio Villaraigosa, announced that he was ordering six more ambulances as one of several steps meant to improve the level of service provided by the Los Angeles Fire Department.  As you may remember, LAFD ran into a few hiccups recently regarding exaggerating response time performance.  This is certainly a good move to make politically but will it ultimately matter?

The response time issue resulted from statisticians using a six minute response time requirement rather than the five minute response time actually required for first response units.  This had nothing to do with transport response or performance.

There is little, if any, evidence supporting the notion that response time affects patient outcomes.  There is also little evidence supporting the idea that more paramedics equate to better patient care.  Finally, the issue at hand has nothing to do with transport unit availability.  Sounds like three strikes against Villaraigosa.  What do you think?  Let me know in the comments.

Why Response Boundaries Shouldn’t Matter

Posted by Patrick Lickiss on Mar 28, 2012 in Current Events, EMS 2.0, General | 0 comments

Disclaimer: As some of you may know I work for one of the companies in this story in the county in question.  That said, I’m proud that the three providers here were able to make this step, even if it makes me biased!

WOOD TV in Grand Rapids, MI recently ran a story about the three provider agencies in Kent County instituting a polling policy for all cardiac arrest cases to ensure that the closest available ambulance responds regardless of jurisdiction.  Over at EMS1, Art Hsieh weighs in on the bigger picture of responding out of your zone.  Hsieh makes a compelling argument for utilizing available technology and establishing reimbursement schemes to ensure that patients get care as quickly as possible.  While response times have not really been shown to affect patient outcome it’s just good customer service to get resources on scene sooner rather than later.  Also, if there were a time-sensitive patient condition it would certainly be cardiac arrest.

What do you think? Should we be crossing lines to respond to patients? Does your system have a similar program in place? Any significant result? Let me know in the comments!

Reflections on a New System

Posted by Patrick Lickiss on Jan 25, 2012 in Current Events, EMS 2.0, General | 1 comment

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

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!