Looking at EMS Operations From Patient’s Viewpoint

Looking at EMS Operations From Patient’s Viewpoint

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Given two relatively equal emergency medical system jurisdictions, what makes the difference between one providing a high level of service as opposed to the other being only adequate? Maybe it’s the administrative procedures.

As an EMS operations officer, selfevaluation is important. How high is the quality of delivery compared to what you would like to provide for your community?

Maybe the way to reach decisions of this kind is for the EMS officer to project himself as an ordinary citizen who needs help and needs it fast. How would you like to be treated by your own system?

Dispatching system

A knowledgeable EMS person realizes the inherent problem of people waiting too long to call for emergency help when they suspect something is wrong, such as symptoms of a heart attack. It’s the job of the public relations people to deal with this. Nevertheless, the fire department providing emergency medical care is still responsible for dispatching aid as soon as a call determined to be critical in nature is received. Considerations become:

1. Are your dispatchers trained to get the most information possible from the caller to determine the potential severity of the case?
2. Is your dispatching system designed to automatically preselect the closest and most available medic unit through a computerized method or is it all based on dispatcher discretion and judgment?
3. Who are the best people to serve as dispatchers—fire fighters or civilians?
4. Are women more capable than men as EMS dispatchers?
5. What are the most efficient methods of screening emergency from nonemergency calls?

Stress leading to burnout

Paramedic burnout is a serious problem as public demands on the EMS system increase. A number of factors aggravate this already bad situation: Responding to excessive calls for apparent nonemergency situations that should have been screened through communications; the absence of police escorts in trouble areas of major cities to protect the EMTs and paramedics against physical abuse; excessive numbers of emergency calls to handle in short periods of time; strained relations between paramedical and medical professionals that affect the paramedic’s ability to stabilize a patient’s condition as he feels it should be done; and strained relations between paramedics and fire company officers with the traditional view of a “fire fighter first, last, and always.”

If you were the patient, you would expect nothing less than a paramedic who is emotionally strong and stable and is in total control of his actions and decisions as you are diagnosed and treated. Back in your other costume of EMS operations officer now, how do you deal with this problem for your staff?

1. Does the job rotation schedule allow adequate relief for paramedics between heavy response area assignments?
2. Does the department contract the services of a psychologist or family counselor to treat incipient problems before they completely break down the fire fighter paramedic and affect his personal life?
3. Do you have enough periodic contact with your paramedics to spot the telltale signs that signal a problem?
4. What are all the possible alternatives to remedy a troubled paramedic without pulling him out of the ambulance and permanently reassigning him to fire fighting duty only?

Working with private services

Emergency medical care has finally advanced beyond the stoop and scoop days in the back of an old Cadillac hearse. Nevertheless, in parts of the country, the EMS system is handled by a private service. Although some private attendants have a great deal of pride in the work they do and train hard to provide the highest level of care and assistance possible, many will argue that their best intentions cannot match the efficient service provided by fire fighting/EMT/paramedic personnel from a public safety emergency services system.

There still may be need for your personnel to interface with private ambulance services, as the city manager or town councilors may be concerned about the need for fire fighters to accompany patients to the hospital once their condition has been stabilized. This issue has been discussed at great lengths among emergency health care professionals. As the EMS person in charge in your department, as well as the potential patient of your own system, you should be asking yourself:

1. Do I have all my fire fighters trained as EMTs in basic life support so they can begin some degree of patient stabilization prior to the arrival of my paramedics?
2. Is it necessary for my paramedics to transport after patient stabilization or can that responsibility be adequately handled by a private ambulance service under contract with the city or town?
3. How much will the capability of the system be affected, both negatively and positively, if there is coordination between my fire fighter EMTs or paramedics and private attendants?
4. What precautions am I taking to avoid any legal complications that can exist as a patient leaves the care of fire fighter EMS personnel and becomes the responsibility of the private service?

Training standards

The skill level of EMS personnel is a direct result of the quality of their training. Training standards differ from state to state despite efforts by recognized EMS-related organizations to nationally standardize criteria for emergency medical care training. Since the skills used to aid you in your imaginary time of need may make the difference between medical complications and a speedy recovery, ask yourself:

1. Do I know what the current acceptable standards for EMT and paramedic certification are in my state?
2. How do these same standards compare against ones established by the United States Department of Transportation and the Department of Health, Education and Welfare?
3. Am I aware of the International Association of Fire Fighters and International Association of Fire Chiefs EMS apprenticeship program for EMTs, paramedics and fire medics that is available for paid personnel?
4. Do I realize the critical role of training for my personnel by the emergency room doctors and nurses with whom they will be working?
5. Have I incorporated valid measures to evaluate the capability of my EMTs and paramedics before they go out and treat the public?

The EMS operations officer has been examining his records to evaluate his system’s level of efficiency for the past year. Despite having well-trained dispatchers, all fire fighters trained in basic life support, and a modern radio and telemetry system for transmitting vital patient information, he notices a critical deficiency. There has been a significant number of patients found by fire fighters and paramedics in advanced stages of cardiac arrest at the scene. In some cases, the patients have died.

The EMS officer can’t help but ask: Why is this happening? What piece of the puzzle is missing? Knowing it might happen to me as a patient or victim someday, what can be done to stop it?

Public education needed

The key to the mystery may well be the absence of a strong public education program in EMS. If citizens are not aware that the facilities, personnel, and services exist to serve them, they will not make use of them. But the problems go beyond knowing the services are there. In setting up the public education phase of a fire service EMS system, the coordinator must ask himself:

1. Does the public know how to contact the fire department in case of a medical emergency?
2. If a 911 emergency system is in operation, how many people actually know how to dial that number?
3. Has a CPR training program been established to teach citizens the practice of sustaining life until qualified help arrives?
4. Is the public education process under your direct command or is it periodically passed from one line officer to another, thus breaking continuity and stability?
5. Do fire stations conduct blood pressure screening clinics for the public, not only to let them know their state of health, but also so they can learn what the fire department does to help them besides fight fires?
6. Does the EMS public education program go beyond the adult sector and into the schools and youth groups so that young people are taught what to do in a medical emergency?

Most experts would agree that the system design can be state of the art once trained personnel are at the scene of the accident or illness. Without an organized and well-planned EMS public education program, though, the statistics of patients found in advanced heart attack stages may well stay at their present level and, at worst, increase.

There are many other realms of EMS system management that the operations officer plans, coordinates and supervises. As the fire department’s role expands and the level of service advances, EMS management responsibilities also increase in magnitude. The operations officer is the operator.

For the last time, then, take off your uniform and put on your civilian clothes. If you had to be the patient, what kind of EMS manager do you want deciding your chances of survival?

THE AUTHOR: