The MacMedic

Now that the students are gone Friday nights are quiet. Tonight was no exception. Only one call, an woman in her sixties with chest pain that resolved after one spray of nitroglycerin. Not very exciting and I was not very upset. I picked up the paid day shift today and it was really helpful to get some good solid sleep before going in to work.

I woudl say it was an uneventful day but it would not exactly be true. It was a day that required more preparation than any other day during the course of the year and because of that preparation it was uneventful. The University held commencement today, almost 3000 students graduated today and between the graduates and their friends and families we had several thousand extra people in town today. We staffed all three ambulances at the paramedic level, had four foot teams patrolling the stadium ready to respond to emergencies on the grounds and a joint command post with the fire department.

We were prepared and it showed. The grand total for the eight hours we were in “all hands on deck” mode was 1 transport. Everything went pretty smoothly with the exception of the police not sending a representative to the command post so we could have a bona fide unified command structure. Even so, the FD rep told the EMS rep that things had gone too smoothly and they had worked to well together and that they had “better leave with scowls on their faces before the fire chief thinks they actually liked working together”. By and large we really do like working with the fire department and it is only select individuals that try to muck that up.

Even after the commencement crews were told to stand down I was still on duty, a full 24 hour shift for me. I actually only did one call and that was only to fill out the crew to transport a chemotherapy patient who had a sudden onset of nausea that spontaneously resolved itself prior to EMS arrival.

It seems like it should have been done a long time ago but tonight the volunteer ambulance finally made operational changes to improve our efficiency and ability to better respond to calls for service.

For as long as anyone can remember our operation personnel have been stratified into three  levels and our qualified crew required one of the top level and one of any other level to respond.  The problem is, when you take away all of the top tier personnel who live out of town, or are paramedics filling duty paramedic slots, you are left with 8 people covering that position. Clearly that is not enough.

A few years ago the operational guidelines were amended so that two of the second tier members could together be a crew. This helped a little but left a quirky problem. If the ambulance signed on with one of the bottom tier personnel waiting for another crew member this second tier may as well roll over and go back to sleep, they could not qualify the crew at all. Likewise, if the ambulance was on waiting with a second tier member all the third tier members rolled over again. Two classes of people who were feeling like their contributions were minimal.

The proposal fielded tonight was in part to collapse this structure and only have two classes of members, crew chief and attendant. One of each would be needed to qualify a crew.

Initially there was a lot of resistance from some of the membership. They viewed this as decreasing our standards and harming the quality of care provided. Eventually, however, as the plan was fleshed out and the new training requirements that go along with each position were made public much of the resistance subsided.

The plan was pretty comprehensive and committed to some other things as well. The purchase of an actual paramedic intercept vehicle was committed to with in 6 months. This should help us considerably as it would mean that the duty paramedic would be responding in a vehicle with equipment, radios, markings, and lights. A definite step up from responding in our own vehicles to meet the ambulance.

The last thing that was in the plan was potentially the most controversial. The addition of officers to the operational structure. The idea being that an officer would respond to calls that needed additional management skills that the average member might not have. Multiple casualty incidents, haz mat, structure fires, violent crimes, and the like would all get an officer responding to provide additional support to the crew, watch their back, liaison with other organizations, and in general be able to run interference to allow the to do their job. The corps of officers would be small, just 8 or 10 members with proven leadership and scene management skills and they would have free reign to respond whenever they thought they might be needed.

For all of the resistance that was verbalized the debate was short, the objections few and the vote unanimous except for one abstention. Progress.

I wasn’t supposed to be in today. I had planned on taking my dog to puppy school graduation and then spending the afternoon mowing the lawn and cleaning the basement but fate (and the fact that I can’t let a shift go uncovered) conspired against me and when the day guy called in with a family emergency I volunteered to fill the shift after I got back from puppy school.

Only one call during my shift and that one only required me to transport to qualify the crew to our organizations standards. The call was for a fall in the alzheimers unit of a local facility. The patient was, as far as anyone could determine, uninjured but the staff felt he should be transported “just to be sure”.

That was the only call during my shift and I actually crashed a little early. It didn’t last however. I had forgotten to turn my pager to “off duty” mode and heard the ambulance and duty paramedic get sent to a possible carbon monoxide poisoning. Before I could get across the room to change the setting and silence it the dispatcher updated the responding units to the fact that there were three patients “in and out of consciousness”. The duty paramedic requested a second ambulance, another paramedic and an engine company.

Since I was up already I changed quickly and headed for quarters to get the second ambulance. When we signed on the fire chief was just signing off on scene. Two minutes later we arrived on scene and I called command asking where they wanted us. The response I got back, “One step at a time 315″ was totally confusing and made no sense at all. Ah, OK. We parked just outside the perimeter of the scene and waited for some directions. The