Richland County EMS South Carolina

[HCFRFF 0]

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I about threw up in my mouth when i read this. This is just crazy!!!!! I would be looking for a new JOB if i worked there! Can you say law suit!

I can see this happening in Westchester....yeah right!

[INIT915 1,119]

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I can see this happening in Westchester....yeah right!

I hope to never see this in Westchester, but with some turf wars that do develop locally, I cannot say for sure it wouldn't ever happen.

[x129K 1,393]

I had a Yonkers FF or Cop drive or ride in the back of my bus MANY times.....

Poughkeepsies does the same.

[helicopper 1,050]

I'm not aware of a written policy in our area prohibiting fire or PD acting as first responders to assist EMS by either accompanying the medic/EMT or driving. There may be preferences and there may be turf/ego issues but they usually get set aside long enough to finish the call before the bashing begins. In twenty plus years I've never seen a crew refuse the help if it was needed nor have I ever seen someone not at least offer to drive or help out when necessary.

It is absurd that a paramedic can't perform his/her skills in an ambulance being driven by PD or FD. If they're going too fast, tell 'em to slow down. Are all the crews matched for life? What if I take a day off and you get a different driver?

There are major issues down there and I applaud the few brave souls that made it a public issue! For the political powers to say that it is not an issue is unbelievable.

[Guest]

In twenty plus years I've never seen a crew refuse the help if it was needed nor have I ever seen someone not at least offer to drive or help out when necessary.

i've only been doing this vollie stuff since 2001, and i HAVE seen crews refuse to help, thankfully not often, but it has happened.

was the pt. dying on the floor? not at all, but help was requested (communication was face to face) and denied.

[Guest feraldan]

Maybe I'm dense but I don't understand what the situation in the article even has to do with FD driving the bus?

From my reading:

- Guy is SOB.

- EMS crew shows up and starts work.

- Ambulance is outside waiting.

- Guy stops breathing.

- Crew calls for back up?

- Back up arrives and crew leaves.

What are they calling backup for, if not ALS intercept assuming this is a BLS crew? Are there not already 2 of them on scene?

Load the patient and have one guy work him. It says he stopped breathing, so how many people does it take to administer rescue breaths with a BVM?

I guess I just don't get why one person couldn't drive and one couldn't tech. Maybe I'm misreading the article but FD not driving doesn't seem to even enter into this. The crew just sounds incompetent.

[HCFRFF 0]

All crews are ALS as far as i know.

[INIT915 1,119]

Maybe I'm dense but I don't understand what the situation in the article even has to do with FD driving the bus?

From my reading:

- Guy is SOB.

- EMS crew shows up and starts work.

- Ambulance is outside waiting.

- Guy stops breathing.

- Crew calls for back up?

- Back up arrives and crew leaves.

What are they calling backup for, if not ALS intercept assuming this is a BLS crew? Are there not already 2 of them on scene?

Load the patient and have one guy work him. It says he stopped breathing, so how many people does it take to administer rescue breaths with a BVM?

I guess I just don't get why one person couldn't drive and one couldn't tech. Maybe I'm misreading the article but FD not driving doesn't seem to even enter into this. The crew just sounds incompetent.

Having only one guy in the back with a BVM doesn't allow for much else (read: anything) to get done.

[Guest alsfirefighter]

Happen in Westchester...no not at all there aren't any rifts or tensions at anytime. Well hopefully never this bad but I'm sure I could discuss with a few of my colleagues on here some pretty close paralells.

As with anything else...this is a total mismanagement issue. From the very top, down to department heads, down to field supervisors. Utterly ridiculous. There has to be more this story as to why they used it and the reporter just didn't paraphrase it right.

[WAS967 97]

$5 says it all boils down to liability and insurance issues. I just spoke to an EMT that used to work for us and he said he tried to come back to work after graduating college. Said he was turned away because of a single no-seatbelt ticket he received upstate and was told that the insurance company wouldn't cover him. I'm willing to bet the insurance company for the EMS agency in question is at the heart of the issue, probably disallowing anyone but EMS employees to drive the rigs or work in them. Sounds like it's time to find a new insurance carrier.

[DaRock98 76]

I have never had a problem with asking for assistance from anyone just the other week I was driving the ambulance on an MVA and our crew asked if anyone could help with CPR and the officer gladly volunteered himself and rode the call in to the hospital with our crew and assisted with CPR so the emt could take a break and work on other things.

[ems-buff 81]

I think this is all an ego trip for this EMS agency, There has to be something else going on with this Agency's management. How could you allow a wait well over 20mins for someone to drive, when you have perfectly good people willing and able to drive. Something just doesn't seem right.

[Guest feraldan]

Having only one guy in the back with a BVM doesn't allow for much else (read: anything) to get done.

Come again? So you'd delay transport on respiratory arrest to wait for backup?

[INIT915 1,119]

Come again? So you'd delay transport on respiratory arrest to wait for backup?

No, you'd step up and ask one of those firefighters that were present on the scene to ride in with you. If you choose to cowboy it by yourself, you just better hope nothing else goes wrong on that transport, because you're committed yourself entirely.

[Oswegowind 17]

I would fore go that policy in an instant and if they fired me, they would have to explain to the court system why they were preventing me from saving the lives that I am supposed to because they have some ridiculous, inefficient, unthought-out, ludicrous, and bull droppings policy! I know, I know, firemen aren't qualified to drive ambulances, only ambulance drivers can do that! I think that both the EMS personnel and the fire personnel in this specific area are, for lack of a better/obscene word, wussies!

[Guest feraldan]

No, you'd step up and ask one of those firefighters that were present on the scene to ride in with you. If you choose to cowboy it by yourself, you just better hope nothing else goes wrong on that transport, because you're committed yourself entirely.

My agency (one of them) has a policy that says firefighters and police officers are not allowed to drive the ambulance under any circumstances.

They can ride in the back as an extra set of hands, but that's it.

Given the choice between delaying for backup or transporting, I'm transporting. If that's being a cowboy then I know a lot of cowboys. For a patient in cardiac or respiratory arrest, I'm not sitting on my hands for 10 minutes. I've done 1-person CPR so 1-person Rescue Breathing is a relief by itself. I had no other personnel available but if the company doesn't have a policy against it, why not grab one of the firefighters and have him help in the back? Assuming they all are at least CPR training (I sure as hell hope so), you could either direct them verbally or give them a task like bagging to free up your hands.

Have the second crew intercept you if you must, but after your initial stabilization efforts, its time to go.

[Oswegowind 17]

3 words!

NEVER DELAY TRANSPORT

[INIT915 1,119]

My agency (one of them) has a policy that says firefighters and police officers are not allowed to drive the ambulance under any circumstances.

They can ride in the back as an extra set of hands, but that's it.

Given the choice between delaying for backup or transporting, I'm transporting. If that's being a cowboy then I know a lot of cowboys. For a patient in cardiac or respiratory arrest, I'm not sitting on my hands for 10 minutes. I've done 1-person CPR so 1-person Rescue Breathing is a relief by itself. I had no other personnel available but if the company doesn't have a policy against it, why not grab one of the firefighters and have him help in the back? Assuming they all are at least CPR training (I sure as hell hope so), you could either direct them verbally or give them a task like bagging to free up your hands.

Have the second crew intercept you if you must, but after your initial stabilization efforts, its time to go.

If a cardiac arrest (no trauma involved), it would be more beneficial to work the patient at the scene with the second set of hands (my EMT partner.) You want to initiate transport just to get a patient to a facility that has all the same ACLS capabilities we do in the field?

[Guest MVFD334]

I would fore go that policy in an instant and if they fired me, they would have to explain to the court system why they were preventing me from saving the lives that I am supposed to because they have some ridiculous, inefficient, unthought-out, ludicrous, and bull droppings policy! I know, I know, firemen aren't qualified to drive ambulances, only ambulance drivers can do that! I think that both the EMS personnel and the fire personnel in this specific area are, for lack of a better/obscene word, wussies!

I'm with most people on this is wondering why one of the ff's just didnt jump in and help, or why they werent ask too. Watever the case, I have to believe the courts are gonna side with the policy because if you jump in that bus to drive and get into an accident there is going hell to pay. What I didnt see in the article, is how long they where on scene waiting after the person became unresponsive after their BLS or ALS interventions.

[Guest feraldan]

If a cardiac arrest (no trauma involved), it would be more beneficial to work the patient at the scene with the second set of hands (my EMT partner.) You want to initiate transport just to get a patient to a facility that has all the same ACLS capabilities we do in the field?

There's only so much ALS or BLS can do on scene. There's more a hospital can do than any EMS crew. There is more equipment, diagnostic tools, advanced procedures and of course actual doctors/surgeons. Do you really believe that the patient is better off on scene with you than at a hospital?

I don't presume to tell you your job as a medic, but as someone who routinely works ALS buses, I can say from experience that we have *never* delayed transport after making our initial efforts, especially if we are unsuccessful. That's even more of a reason to get to more advanced care (as ALS is not the end all in the emergency medical chain.)

I'll repeat what I said before, after your initial stabilization efforts, its time to go. They obviously weren't able to stabilize him as he's now deceased. No reason to wait, even if it means one guy in the back when no one else is available.

Unfortunately, someone was available in this case and they were not utilized in any form.

[INIT915 1,119]

There's only so much ALS or BLS can do on scene. There's more a hospital can do than any EMS crew. There is more equipment, diagnostic tools, advanced procedures and of course actual doctors/surgeons. Do you really believe that the patient is better off on scene with you than at a hospital?

I don't presume to tell you your job as a medic, but as someone who routinely works ALS buses, I can say from experience that we have *never* delayed transport after making our initial efforts, especially if we are unsuccessful. That's even more of a reason to get to more advanced care (as ALS is not the end all in the emergency medical chain.)

I'll repeat what I said before, after your initial stabilization efforts, its time to go. They obviously weren't able to stabilize him as he's now deceased. No reason to wait, even if it means one guy in the back when no one else is available.

I guess on this one, we'll just have to agree to disagree.

[STAT213 332]

Well, as unpopular as it is, I think I will side with the EMS agency on this one. Here's why: I don't anyone not from my agency driving my bus. Period. I don't know them, I haven't worked with them or trained them. I have no control over them. I have worked in a similar situation as is described in the article, and I agree with it. Remember, there are two sides to every story. Right now we are hearing pretty much one side.

In addition, what exactly is gonna happen with a respiratory arrest or cardiac arrest in the ED that we aren't going to do in the field? Twenty minutes of work passes very quickly. There really isn't a lot that is going to happen quickly in the ED (beyond airway management and initial medications.) Now, there is the PERCEPTION that the hospital has more to offer than the ambulance, and perception is everything. I can see that a lot of the providers on here have that perception. That the person expired has little or no bearing on this, in my mind. There are those you will save, and those you won't. To come to the right conclusion from this case, I need a lot more information. A LOT. Were the medics trying unsuccessfully to RSI the person? Or, were they simply working a respiratory arrest that led to a cardiac arrest? I hope you all realize that you can have an MI on the cath lab table and still die. You can get shot in front of a cardio thoracic surgeon and not live. There are a lot of missing pieces here.

As for the firefighters "helping out", what exactly are they going to do? Do they know how to assist the medics on critical patients? Do the two agencies work together? And, in saying this, I don't mean do they go on the same calls. Do they work TOGETHER? If not, then this could be an area that needs work. Do they know how to spike lines, start lines, set up the monitor? If this is a system where the firefighters respond as a first response agency only? I have worked in a system that had firefighters doing things like 02, vitals and CPR. That is what you got from the FD. Period. Yes they were EMTs. That doesn't mean that they were used during transports. Is that right or wrong? Neither, it just was what it was. We needed help, we called another bus or the supervisor. I think that training them to a point where they could have been functioning team members would have been awesome, but that wasn't a reality in that system. It was just too big. Were there some FF's that would jump in because they used to work with the transporting ambulance and knew what needed to be done on a critical patient. Sure. But, quite frankly the critical patient is not the time to teach. As a medic, I have work to do, and its a lot easier to just do it myself than showing someone how to do it in the heat of the moment.

I can also see the seedy side of this whole thing, where the fire department is saying to the press - "hey we offered to help, but they said no!" when in reality they had little to no intention of helping, and their help would've made things worse for the patient. Does this fire department want to take over the ambulance? Are there darker motives here?

Anyway, just wanted to offer the other side of this argument, because I have lived it.

[INIT915 1,119]

In addition, what exactly is gonna happen with a respiratory arrest or cardiac arrest in the ED that we aren't going to do in the field? Twenty minutes of work passes very quickly. There really isn't a lot that is going to happen quickly in the ED (beyond airway management and initial medications.) Now, there is the PERCEPTION that the hospital has more to offer than the ambulance, and perception is everything. I can see that a lot of the providers on here have that perception.

This was the position I was lying out, whether or not I clearly conveyed it.

Edited May 4, 2008 by INIT915

[ny10570 745]

Care on scene is a completely different story. If they were that interested in treating this patient on scene they would have stayed in the house and begun treatment. Once you start moving to the ambulance the next stop is the hospital, not the curb in front of the house.

STAT, coming from a large service where even working within my regular area there are many times that I have people I am completely unfamiliar with driving my vehicle. Thanks to the voluntary units I have people driving where I know nothing about their training outside the state requirements. You have to assume that they found their way to the job, so they must be able to get me to the hospital (all thought there have been a few times I've had to give directions from the back or let PD lead the way). Either way it was a much better option than sitting on scene for 20 or even 10 minutes.

[STAT213 332]

Care on scene is a completely different story. If they were that interested in treating this patient on scene they would have stayed in the house and begun treatment. Once you start moving to the ambulance the next stop is the hospital, not the curb in front of the house.

STAT, coming from a large service where even working within my regular area there are many times that I have people I am completely unfamiliar with driving my vehicle. Thanks to the voluntary units I have people driving where I know nothing about their training outside the state requirements. You have to assume that they found their way to the job, so they must be able to get me to the hospital (all thought there have been a few times I've had to give directions from the back or let PD lead the way). Either way it was a much better option than sitting on scene for 20 or even 10 minutes.

I disagree here for a couple of reasons...paramedics bring care to the patient. While it has yet to be proven that we make a bit of difference (but, that's an argument for another day, isn't it...LOL) when I have someone sick...I will generally move to the ambulance and play there. That's my office, my space. I have more of my toys there. So, sitting on scene for 10, 20 minutes after getting to the truck is not unreasonable. To me, this is about style and preference of practice more than anything else. I hear your side, all I am asking is for you to hear mine.

I hear you about the whole large service thing. The example I gave was from a large service, one of the biggest in the nation. It was their policy that no NON employees drive the rigs. In my 8 or 9 year tenure there, I had a cop drive me to the hospital once. And, I got spoken to by a supervisor about it, reminding me that cops driving was a no-no. Again...style and practice. Maybe this agency has had really bad experiences with this FD driving their trucks, and finally forbade them from doing it. Maybe the FD is retaliating in the press. I am just trying to present an argument for the other side.

I still disagree that sitting on scene for 10 or 20 minutes is a bad thing. Was the patient's issue a time sensitive one? I don't know. What exactly is the ED gonna do in 10 minutes to save someone's life? The list is pretty short and we have most of those tools on the trucks now. This goes back to the argument about what is best for our patients. Is it treatment and care in the field, or is it rapid transport. I believe there is a balance, and that this call is one end of the extreme that I occasionally have lived on. Now, this is NOT me saying that paramedics are the end all and be all of medicine and I stick around on scene all the time playing doctor, so please don't think that. Just another view of the call.

[Goose 188]

Why not just have a FF hop off the engine and into the back if the extra hands are needed? If these guys are running a FR engine then they must have some form of BLS training, no?

[STAT213 332]

Why not just have a FF hop off the engine and into the back if the extra hands are needed? If these guys are running a FR engine then they must have some form of BLS training, no?

Goose, some form of BLS training is a completely different animal from a paramedic using all their skills to take care of a critically ill patient. They are different skill sets. I am not knocking the abilities of firefighters as EMS First Responders, but if I asked one of them to set up my CPAP machine, or do a 12 lead or place an IO line, do you think they could?

[Goose 188]

Goose, some form of BLS training is a completely different animal from a paramedic using all their skills to take care of a critically ill patient. They are different skill sets. I am not knocking the abilities of firefighters as EMS First Responders, but if I asked one of them to set up my CPAP machine, or do a 12 lead or place an IO line, do you think they could?

Not saying they could or am i advocating having them do that. But, in all honesty, how often do you need 2 paramedics in the back working up a patient? I've only been doing this a few years and have only seen it a handful of times. I understand it's nice to have a second set of ALS or competent BLS hands in the back. But, why couldn't the FF/EMT bag that CHF patient while you setup the CPAP? Or take vitals while you get the 12 lead ready and maybe even set up a lock or run a line while you get ready to do an IO? Just a thought.

[Guest]

I think this is all an ego trip for this EMS agency, There has to be something else going on with this Agency's management. How could you allow a wait well over 20mins for someone to drive, when you have perfectly good people willing and able to drive. Something just doesn't seem right.

I agree a 100 percent. This is an ego issue. Just look at the article when they "interviewd" the EMS agency. I cant believe they even tried to say its because its hard to stick a pt with a needle if an EMS personisnt driving. That is total BS. I have had some better rides from a Firefighter driving than my own partner. And Firefighters take EVOc and CEVO just like EMS does. They gave no other reason than the driving issue, which in my mind proves its an EGO trip.

[Skooter92 7]

In Stamford CT, if we need an extra set of hands, FD hops on board. They are all EMT's, and some are even medics (some are ex-SEMS or other area agency ones). Cardiac arrest? I tube, my partner sticks, the FFs then compress and bag, we do meds or whatever, and another FF drives. Time saved, no one crosses any lines, and patient care gets done ASAP. Traumas? Me and my partner hop in the back with an FF as another set of hands PRN, and an FF drives. Most codes, we go routine into the ED. Rarely do we go a$$ pounding into Stamford ER because it generally isn't needed, even on traumas. We are starting to train with SFRD on basic skills/knowledge, and IMHO (21 years on the job), it works very well. Plus they make good meals.