Did you get a chance to see my posts on the CCR stuff that we do here in Rural Wisconsin? I had a talk with my medical director about how our save rates are higher than King County’s. They are. *We* send a paramedic to every call.

You hit a point on there that I’m reluctant to harp on… However, I will. Firefighters are not EMS providers by definition. ALS/BLS determination systems only function properly when driven by proper and thorough assessment, not by cynicism. I’m not sayin, I’m just sayin’

However, I do respect the King County system. Don’t get me wrong. However… has it been too taken over by the interests of the FD?

I like the idea of “EMS 2.0″ raising the standard of care. I like the idea that, at minimum, every truck that responds to a 911 call should have at least one paramedic on board. I also agree that a prioritized or tired response is inadequate, simply due to the fact that dispatchers and call takers get limited information from that 911 call.

Seems like we’re on the same page, doesn’t it?

But, when I say “it’ll never happen here,” I mean it.

See, I live in King County Washington. Do I need to say anything else?

The Paramedics in Seattle are members of the Seattle Fire Department. All of the other King County paramedics, with the exception of one agency, are also fire medics. All of the medics in King County are trained at Harborview Medical Center, in one of the most rigorous Paramedic education programs in the world. (I’m sure you know about the Medic One System.)

Well trained. Highly educated. Able to respond quickly.

So far, so good. Where’s the problem?

Well, in King County Dr. Copass runs the show. And here, the EMS model doesn’t include a medic on every rig. Sure there are Paramedics available, but they’re not on scene first, to make the determination if the patient is an ALS or BLS patient. It’s a fire fighter that makes that call. Not knocking the fireguys, because most of the time they’re on point with getting medics en route when they need them. It’s the situation like the call above.

I won’t back down on this: Every patient deserves an ALS evaluation. Even if it’s NOT an ALS transport, a paramedic should make that decision, and not have to be “summoned to the scene.”

When I suggest more paramedics, or (gasp!) Private Ambulance paramedics to respond with fire, I’m met with stony silence. People look at me like I have two heads when I suggest medics should be on EVERY call.

Sorry y’all. It’s the way I feel.

And that’s one of the big reasons I’m moving as soon as I finish medic school.

“Don’t screw up ALS, improve BLS” – Timothy Clemans

“Let’s be honest, does every 911 call need a medic? No. Does every patient deserve a medic? Absolutely” – Medic 22

“Again, it will never happen here” – Medic 22

And you’re right about every patient DESERVING a medic, Medic22. They do.

Years ago, I lobbied pretty hard on some EMS message boards for all ALS ambulance services. I believed then that every ambulances should be staffed by Paramedic/Basic crews. The reasons for this were that “prioritizing” emergency calls at the dispatch center never works. It does on some levels, but invariably it will have severe consequences for outliers on both the very severe and less severe of the mistakenly “Phone diagnosed” conditions.

Some of that has to do with cynicism on the part of the EMS proividers. Most of it has to do with the limitations of the system design.

Here I am on one blog commenting that we should have more than one option to send to an emergency response, and on this one I’m lobbying for the opposite. Here’s why. In the current incarnation of EMS, a “prioritized” response is woefully inadequate and has the potential to hurt people based simply upon their understanding and ability to describe a medical condition over the phone to a minimally medically trained and overworked dispatcher. In the future of EMS 2.0 this will change, it hasn’t yet.

While BLS should very well improve, and I support the use of BLS units having the ability to obtain 12-lead EKGs and use other diagnostic tools (With minimal impact upon their treatment pathways), I also think that BLS only (and this is not a crack at their personal dedication) should not be sent to 911 calls without at least an ALS QRV responding to back them up. Every patient DESERVES a paramedic. We should not let the individual calling suffer because of our lack of ability to design a system.

“Again, it will never happen here” – That’s where you’re wrong my friend. Things are constantly changing and steadily improving. We will change the world

There is absolutely no such thing as a ‘typical patient’. I have been caught with MIs before who really didnt present as such. I have wrote more than a couple of posts sharing these ‘learning opportunities’, just like you have.

I always go with my gut instinct. If I am thinking about leaving someone at home as I feel they dont need to go to A&E, then they get the works, just in case something crops up that I didnt expect. If all of that is fine too, but I am still not 100% happy then they are going to hospital.

I am sure I will be caught out again in the future, as we all will at some point, but I will do everything I can to make sure it happens as infrequently as possible!!

This has nothing to do with “crappy” BLS or “diluting” ALS. It’s all about raising the standard of care for every patient.

Let’s be honest, does every 911 call need a medic? No. Does every patient deserve a medic? Absolutely.

Again, it’ll never happen here. Not worth arguing about.

This call makes a perfect argument for a medic on every call.

But, that’ll never happen here. Maybe at my next job.

“Silent MI’s” affect people, like diabetics, who have varying degrees of neuropathy that effect their ability to feel the ischemic chest pain. Diabetics are notorious for having these silent MI’s due to their roller coaster blood sugar levels playing havok with their nerves.

In these cases, MIs present as nonspecific weird general malaise cases. The kind of cases where people “Just weren’t feeling well” and then drop dead. A good and thorough physical assessment is always your best friend to guard against being pinched by these.

Oh, and always a 12 lead. If you don’t know what you’re looking at and nothing else fits… get a 12 lead

Great post!