1. #1
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    Default Is this "wrong" of me?

    Just a quick intro...I am an explorer for a large career department that runs their own EMS system. As an explorer, when we get an EMS call, I am expected to grab the EMS equipment and bring it to the scene where it's needed. However, recently I've been stuck in a "sticky situation".

    The station I ride out at consists of an engine and ambulance.The "sticky situation" I've encountered is whether to bring all the EMS equipment on every call. Our department does not categorize calls into severity/priority and there is no patient information on the MDC terminals inside the units.

    Our EMS gear is set up this way on the engine and ambulance with the ambulance having a Lifepak 15 instead of an AED:

    Red bag: BLS and ALS equipment (everything except O2 and an AED)
    Blue bag: portable O2, NRB, NC, etc
    Black bag: AED

    Our department uses Locution and the sad part is...we do not get any patient information on the MDCs as the call-takers are not EMD certified. In fact...all the MDC usually says is just "Difficulty Breathing"...and that's all you get.

    Given the following calls (and nothing else)...what would you bring (from the list above)?

    Difficulty Breathing
    Chest Pain
    Abdominal Pain
    Unconscious Person (we do not have a cardiac arrest call type...any cardiac arrest is dispatched as an unconscious person)
    Stroke
    Medical Emergency (yes...it's a broad call type)
    Back pain
    Injured person
    Burn victim
    Head injury
    Headache
    Assault
    Gynecological problem
    Emergency Childbirth
    Seizure
    Heat/Cold Emergency


    I know that's a lot of call types...but I'd be interested in hearing what you'd bring.

    Thanks!

  2. #2
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    Until you know what you have, bring everything. Our county dispatch now does pre-arrival, but that wasn't always the case.

    I've been sent out on "general illness" calls that turned out to be full arrests.

    If you're going in with an engine and the bus, you've got plenty of people to carry back the stuff you didn't need.

    The first medical person to contact the patient can usually make a fairly quick assessment and determine if you need to bring the rest of the gear in with you.
    Opinions my own. Standard disclaimers apply.

    Everyone goes home. Safety begins with you.

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    For any non-life threatening call just bring your first-in bag.
    Anything that could be a life threat throw everything you might need on the cot and take it in with you.

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    BW21,

    From the call types that I listed...what would you consider a life-threatening call?

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    You can leave the AED behind for calls that aren't cardiac arrests, chest pain, or unconscious. Other than that, bring them both.
    Even the burger-flippers at McDonald's probably have some McWackers.

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    Quote Originally Posted by Box9104 View Post
    Difficulty Breathing Full ALS
    Chest Pain Full ALS
    Abdominal Pain Full ALS
    Unconscious Person (we do not have a cardiac arrest call type...any cardiac arrest is dispatched as an unconscious person) Full ALS
    StrokeFull ALS
    Medical Emergency (yes...it's a broad call type) Full ALS
    Back pain Full ALS - Possible cardiac
    Injured person Full ALS
    Burn victim Full ALS
    Head injury Full ALS
    Headache Full ALS - Possible stroke
    Assault Full ALS
    Gynecological problem Full ALS
    Emergency Childbirth Full ALS
    Seizure Full ALS
    Heat/Cold Emergency Full ALS
    Because we have the luxury of pre-arrival screening by dispatch, some of those might get downgraded before arrival, once the true nature of the injury or illness is known. F'rinstance, a burn may turn out to be a low percentage first/second degree burn or the head injury may turn out to be a non-impact laceration.

    But if you don't have enough information to make that determination before you walk in the door, bring it all.
    Opinions my own. Standard disclaimers apply.

    Everyone goes home. Safety begins with you.

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    Quote Originally Posted by Box9104 View Post
    Just a quick intro...I am an explorer for a large career department that runs their own EMS system. As an explorer, when we get an EMS call, I am expected to grab the EMS equipment and bring it to the scene where it's needed. However, recently I've been stuck in a "sticky situation".

    !

    Two ways to look at this.

    1. You are an explorer. You have been told to bring everything. Bring everything.

    2. Its all ALS until you know better. When someone is on the scene, they can advise.

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    agree with lvfd - listen to your officer - not the internet.

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    Why are you asking strangers? You should ask your crew what they want. Also, out here in the city we have terrible dispatchers. I usually don't even pay attention to what the call is for anymore. It's almost pointless since we always get something different when we are there.

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    Our personnel are advised that much of the info that we receive from 911 is incorrect. This is not a failing of the dispatchers or call-takers, but due to the fact that callers are usually upset, emotional, intoxicated, or confused.

    We can visualize the type of situation and our response is based on the report, but we also know that we have to be prepared for something other than what has been reported.

    Smoke calls can be everything from a trash container to a structure fire. So we don't have much choice but to respond with 2 Engine Companies and Command Vehicle, and pushing additional resources immediately. To not do this delays additional resources if it turns out to be more than what we are sending can handle. As first arriving units size the situation up, we adjust, demobilizing or moblilzing as needed.

    Medical Responses must be handled much the same way. Without enough info, you must carry everything in. I have seen many situations where the caller is the patient, and they advise they don't feel right. Then when we arrive we find an unresponsive person that must be quickly assessed to determine the issue. A B C (Airway, Breathing and Circulation) in that order very much determine the course of the action.

    So because we cannot or do not know with 100% certainty, you must prepare for anything.

    I must add this. If you are an explorer, you are lucky to have the opportunity to respond with the truck. I advise that you not try to second guess anything and do not ask "why" to often.

    Listen, learn, observe. You are working with people that have been in the trench a long time, and they already know how to survive.

    You may feel like you are nothing but a pack mule. That is part of your right of passage. Just do as instructed and as you gain the knowledge and insight, you will eventually understand that we can never go with too much. If we don't use it, then it is just placed back onto the truck or sent back to the barn.

    Yes it seems senseless after the fact. But if you arrive without it, what are you going to do?

    Stay safe and keep your head squarely on your shoulders. Good luck.
    HAVE PLAN.............WILL TRAVEL

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    Quote Originally Posted by PaladinKnight View Post
    So because we cannot or do not know with 100% certainty, you must prepare for anything.
    Ran this call tonight. From the CAD:
    You are responding to a patient with chest pain. The patient is a 84-year-old male, who is conscious and breathing. Abnormal breathing.
    Initial signs and symptoms on scene indicated possible gastrointestinal issues, but EKG wasn't looking quite right and heart rate was bradycardic.

    Just before we pulled in at the hospital, the patient said he felt tired.

    As we rolled the stretcher into the ER door, he coded.

    Normally the ambulance crew (paramedic, EMT/driver) would have handled the transport alone, but the medic just had this sense that something larger was amiss, so I rode to the hospital as well, having rolled in as a first responder with our light rescue. We were fortunate (in a way) that we could just roll him into a room where hospital staff could do their thing, but had the arrest occurred any earlier, the extra equipment (me) would have been put to use.

    You just never know.
    Opinions my own. Standard disclaimers apply.

    Everyone goes home. Safety begins with you.

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    Some very good advice here.

    Do what your officer or lead paramedic tell you. If there is a possibility of something becoming "life threatening" then bring everything.
    Jason Knecht
    Assistant Chief
    Altoona Fire Dept.
    Altoona, WI

    IACOJ - Director of Cheese and Whine
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    EAT CHEESE OR DIE!!

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    Agreed that you do what your officer wants. We use EMD and even with all the pre-arrival questions that are asked, it's still hit or miss. If you can carry everything at once, I would do so. If not, unless it's a cardiac call, I'd take the Red & Blue bags first and then come back for the AED as needed. If you can't carry it all and it is a cardiac call, have someone else carry one of the bags with you (or put them all on the cot).

    And EMD, although helpful, is not the solution to all problems. For consistency, our dispatchers must ask the question EXACTLY as written, nothing more, nothing less. If they vary more than a word or two and they are audited, they can be written up. The computer uses the answers provided to classify the call. I've seen something that ended up being nothing more than back pain classified as Chest Pains/Diff Breathing because the caller said something like "It hurts when I breathe" in reference to their back, not being difficult to breathe.

    It's better to have and not need, than need and not have. On an unresponsive/unknown medical call, our cot may look like a band of gypsies: long back board, BLS bag, ALS box, monitor, suction, c-collar bag, etc.

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    Quote Originally Posted by nmfire View Post
    You can leave the AED behind for calls that aren't cardiac arrests, chest pain, or unconscious. Other than that, bring them both.
    The AED goes in on every run for us. Twice we've been dispatched for a "fall" where it turns out the person "fell" because they coded. Currently, we use backpack style jump kits with a pouch on the exterior for the AED. It's one less thing to carry and it makes sure it always goes in with the crew.

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    Quote Originally Posted by LVFD301 View Post
    Two ways to look at this.

    1. You are an explorer. You have been told to bring everything. Bring everything.

    2. Its all ALS until you know better. When someone is on the scene, they can advise.
    Look at it both ways. I am a 14 year firefighter, if my boss says bring something- I bring it. And he do not have to say it, because the Med bag and AED come in on EVERY medical call; stubbed toe- Medical bag and AED. Because you never know.

    Quote Originally Posted by pipeman1822 View Post
    Why are you asking strangers? You should ask your crew what they want.
    Root of the problem.
    ~Drew
    Firefighter/EMT/Technical Rescue
    USAR TF Rescue Specialist

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    I don't get your "sticky situation". You are not in charge of the call so why do you think the decision is up to you to make? If the guys you ride with are looking at you to choose the equipment necessary for the call then they are morons and should be fired unless they are proctoring you for medic school and are evaluating you decision making process. If what you are saying is correct and you are not in medic training then let me know where you are and what shift you ride on so I NEVER come through your town.

    Now on to the part about your limited information. If your dispatch protocol doesn't have dispatchers ask basic questions like: age, sex or how about WTF is going on besides the initial SOB, C/P etc then they must be chipping the info on to stone tablets. Locution has nothing to do with supplement information whether it is over the air or on the MDT.
    If your going to cry about doing the job you signed up for do us all a favor and quit, there are plenty of dedicated people standing in line for the best job in the world.

    Firefighter/Paramedic

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    I agree with all the above posters. In your position you shouldn't be making any decisions in the scenario you provided. You should strictly be following the orders of your superiors. If you want guidance on what is to be expected of you, you should first consult the SOPs to see if they don't already cover what you should be doing. If that can't help you need to be asking the person who will be treating the patient what they want for what type of call. Don't ask them unless they are able devote their attention to responding to you.

    I'm kinda concerned that your crew is leaving the sole responsibility to you to fetch equipment. In my area explorers are very rare, but where they do exist they aren't allowed out of sight an experienced firefighter and allowing them to go on medical calls is unheard of.

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    If I was in any position to offer you any advice, I would say that while responding to the call, politely ask the Company Officer or Senior Medic what equipment he/she would like you to get off of the rig with.

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    I have been and heard alot of calls been paged wrong. My advice as the Cheif of my ambulance, try what we do that we find works for us who will most of the time only have 3 responders.

    We go in with ONE bag that can handle just about everything, now the only things we dont have in that bag is the DeFib, splints, and back board. Now your stetcher goes in empty right? Your Defib, first in bag and splints can all go on it and yes it only takes one person to remove it from the truck. If you need a back board you can go back and get it for you need to stabilize your patient first anyway and there is a least two of you.

    Any patient can go south at any time. Just remember you need to treat your Patient and nothing else, what they tell you or what you see on them not what your told by third parties.

    Otherwise worst case, if you think its bad most police carry a simple defib and oxgen in their cars and most are fisrt responder if not emts. Just remember use your resourses thats why they are there.

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