Wake up call

Wake up call

By Alan Perry

October 11, 2015

The Fire department acknowledges that it’s EMS SOP’s largely have not been updated since the consolidation of its Fire & EMS Divisions nearly 20 years ago. The rapid changes to the practice of EMS, including high performance EMS, crew resource management and position assignments brought a group together to re-evaluate and create operating guidelines for EMS, as well as develop training, deployment and feedback mechanisms. Our current guidance comes from the old SOP’s, a handful of Medical Directives and the regional EMS Protocols. Most other departments rely on these same mechanisms locally, nationally, there seems to be a tendency to develop agency/system specific protocols and SOG/SOP’s by agencies that find this lacking. This Department is pushing into new territory with its EMS activities, rapidly adopting practices and methods that have proven success with the goal of saving as many lives as possible with the latest science and technology. The regional protocols have not kept up, and the complexity of EMS operations has increased as well. The field forces are expected to keep up with these changes and be prepared to apply these new skills without any additional training resources being made available. The Department hopes that developing their own resources (protocols/ SOP’s/etc.) will give those in the field the resources they require to reference and be prepared to use these new tools.

A quick internet search reveals that there are many good models of EMS and agency specific protocols/ SOP’s & SOG’s. What I find lacking is training plans for communication to, instruction of, and feedback for providers. In fact it seems many departments, while communicating the requirements of maintaining certification and/or licensure to their providers are quite forthcoming, there is no reciprocal statement defining the agencies commitment or responsibility for training to its providers. While I am happy to embark on that task, I feel it will be futile since any attempt to compel even a willing organization to commit funding & staffing at any defined level will likely not be supported.

So, before I attempt anything like that, I ask that anyone with a similar circumstance take a moment and reply with their experience (especially if successful) so I can at least move forward with reasonable expectations.

Thanks,

Alan

Fire based EMS Position Assignments

PROPOSAL

Model Position assignments for fire units on EMS calls

By Alan Perry

October 7, 2015

Purpose

Position assignments are a tool that can assist your team in accomplishing complex tasks. In a work environment that frequently includes overtime and swing assignments with apparatus and crews we may not be familiar with, standardized position assignments can help personnel and the organization achieve a higher level of performance in spite of staffing issues and more complex treatment goals. One goal is to minimize the shift/station/apparatus variability that occurs as a normal process when crews find what works for them. This is fine if you know you will always be working with the same people on the same piece of equipment, but that seems to be the exception now rather than the norm. Another goal is developing a system for deploying and delivering more advanced tools and skills consistently and effectively. Consider that the practice of high performance EMS is already promoting teamwork and assigned roles in dealing with critical medical events like cardiac arrest. Because of the advantages, it seems reasonable that we could start practicing that way on every call to improve our performance and patient outcomes. We already apply these pre-assigned roles for firefighting activities, it should not be much of a stretch to apply it to EMS as well. Below is an outline model of how it might look, again it does not replace good decision making and must remain adaptable. Feedback welcome and encouraged, especially if you are already practicing some form of this.

The Model Assignments

Alpha             (Officer)

·       Scene safety/Command/Communications with EDC

·       Patient/Family advocate

·       Assist with collecting patient information and history

·       Assist with staging equipment and manpower

·       Assume #2 CPR position during resuscitation

Bravo              (Jumpseat)

·       Lead EMS provider- first to patient – marks patient contact

·       Deploys with Tablet and monitor

·       Applies defibrillator and directs resuscitation efforts during resuscitation

·       Primary patient assessment/interview/determine nature of call

·       Directs care of patient by crew

·       Documentation

·       Develops and communicates treatment plan to team

·       ALS performs procedures outside others scope of practice

·       Communicates with patient’s family and med control PRN

Charlie                        (Jumpseat)

·       Forcible entry if needed

·       Deploys with  blue & red bags

·       Assumes #1 CPR position during resuscitation

·       Obtains patient vitals & physical exam

·       Procedures as directed by lead within scope of practice

Delta               (Driver)          

·       Deploys with drug & IV boxes

·       Assumes control of airway during resuscitation

·       Secure scene for incoming resources

·       Stage patient moving equipment

·       Procedures as directed by lead within scope of practice

ALS                 (any position)

·       If an ALS provider is assigned to a position other that Bravo/lead EMS provider, they will assume the role of the Bravo/lead EMS provider if the patient is presumed, or found to be in need of, ALS care and/or evaluation.

Summary                       

Emergency medical services are increasingly driven by outcomes and the application of tools and skills with proven benefits. Delivery of these devices and skills requires greater organization and communication to produce favorable outcomes. The adoption of formal crew assignments can produce more efficient and effective care and thereby improved outcomes. It is a new way of thinking for most but not one we are unfamiliar with, team sports, card games and hunting all require strategy and tactics to produce a successful outcome. We can apply these tools to the delivery of our service, save more lives and improve quality of life for survivors.