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.