Engine Company EMS: Frequent Flyers

By Michael Morse

Above illustration courtesy of Paul Combs

When responding to an EMS call at an address that you have repeatedly responded to, it is difficult to avoid the “been there, done that” mindset. All firefighters are familiar with the letdown that follows our initial response to the tones once we hear that familiar dispatch. It is human nature to react to similar circumstances in more mechanical ways every time we do a repetitive task. Practice makes perfect, or pretty darn close. That’s why firefighters train; we want our response to emergencies to be as free from emotion as possible. When we take our thoughts, fears, and doubt out of our psyche and resort to automatic response gained from repetitive training, jobs go smoothly, fires go out, and people get rescued.

If only EMS were that simple. It’s difficult to respond for the same intoxicated person every day, day after day, year after year. The incident loses its luster and the automatic response kicks in. Where once there was a full patient assessment, a mere set of vitals becomes the norm. This may further erode to a pulse or breathing check, and eventually become simply standing by waiting for EMS to arrive. The fact that WE are EMS is easy to overlook when we have done the same thing for the same patient hundreds of times. We know that the medics are on their way and will be taking the frequent flyer off our hands.

Similar complacency sets in with an elderly patient complaining of chest pain, weakness, dizziness, or fatigue day after day. Before arriving on scene, you have already prepared the radio report to the incoming unit: “Engine Company to incoming ALS, 80-year-old female complains of chest pressure times 30 years, vitals stable, conscious and alert, awaiting transport.”

The good news? These patients, more often than not, will survive our interventions–or lack thereof.

The bad news? One of these days, and we never know which one, they will die. Their demise may just happen during one of your calls to assist them. It might happen shortly after you obtained a signed refusal, or a day after you transferred care to the ambulance staff without a proper evaluation or protocol-based treatment.

It matters not to a patient’s friends and family, your medical director, chief, or even your colleagues that you had responded and treated the deceased 10, 50, 100, or even 1,000 times. What matters to them will be that you failed to perform. You might, and probably will, feel not so great about yourself or your crew as a result of a missed opportunity to save that person.

We pride ourselves on doing the right thing every time we are called upon. Doing the right thing is easy when it is staring us in the face and the outcomes of our actions are obvious. Either we win or we lose. It is the calls that seem to matter the least where our true mettle is tested. The mark of a good firefighter is the ability to perform in any atmosphere and do the job under any circumstances. Sometimes doing the job without the tiniest bit of adrenaline is difficult and the temptation to take shortcuts can be overwhelming. In the end, though, it is never worth not doing what we know to be the right thing, every time.

An effective way to make sure you or your crew stays focused on even the most mundane, repetitive calls is to insist that vital signs are obtained on every patient you encounter. If the patient is calling for cardiac problems, or is unconscious, an EKG needs to be done. Every time these procedures are done, the person doing it gets that much better at it. Lead placement is vital to getting it right, and practice makes perfect. Use the EKG strip as a learning tool after the call; see who can identify abnormalities. Listen to lung sounds, start an IV if the patient’s complaints suggest necessity, even if you think otherwise. Every patient encounter is a learning experience, and who better to learn from than a living, breathing person who expects emergency medical treatment?

Making the most of a seemingly unnecessary call is just another way to be as good an EMS engine company as you can be.

Michael Morse is a former captain with the Providence (RI) Fire Department (PFD), an author, and a popular columnist. He served on PFD’s Engine Co. 2., Engine Co. 9, and Ladder Co. 4 for 10 years prior to becoming an EMT-C on Rescue Co 1 and Captain of Rescue Co. 5.