Something Doesn't Seem Right

[lightsandsirens5]

Hey,

I am in a fire/first response district that has unmanned stations and whoever showes up whe the tones drop is who you have. We have got several non-EMT firefighters on my department who respond on most of the medical aid calls. As the only EMT out of my station, there have been many calls where I am not available and a rig rolls with no EMT (me) on board. Yesterday night, it came to my knowledge that these non-EMT firefighters have been providing "pt care" before the amb arrives. Ie. putting pts on O2, putting on the monitor and printing rythm strips, c-spining pts, etc, with NO EMT ON SCENE. These folks have had no medical training and if they have, their certs expired 15 years ago.

There have been several instances that I know of where they have put COPD pts on 15 L via NRB. I have no problem with doing this myself because I know how to use a BVM. (Not that they don't, they just have no training and no crets.) I also heard of someone putting the monitor on, but somehow leads ended up on the pts neck instrad of chest. Figure that out......

Anyhow, it is only a matter of time before someone is paralysed by improper c-spining or killed when they put hi-flow O2 on a COPD and shut them down.

I can't talk to the chief since he don't listen to me anyhow and doesn't really care what is going on in the district with regards to medical and the people involved. Our EMS officer doesn't seem to know what is going on half the time nor do they really know what the state regs and codes are. And my station captian is one of the "self imposed" EMTs. Basically my whole chain of command is out of the picture for my purposes.

I don't really know what to do short of writing to the state DOH, and that would go over really well when my officers found out.

Any sugestions?

 

[CAOX3]

No one should be providing patient care without a certification.

I really dont have any suggestions besides speaking with your OEMS board.

I have no experience with volunteer stations and there politics.

 

[Seaglass]

If the chain of command up to the medical director is in on this, and you'd be the only person who would likely write to the DOH, you're pretty screwed. I'd still recommend sounding all of them out individually, though, even if you have to do it indirectly. There's not much you can do short of complaining on your own. And while complaining may well be the best option, whistleblower protections often won't hold up so well in small departments and towns, and you could easily find yourself out of a job and a friendly place to live.

Do you think any of the people who've been providing care would be open to the idea of EMT or even FR training? Perhaps you could take one or two of them aside and say something along the lines of "Hey, you seem enthusiastic about this, why don't you take EMT? I think you'd be good at it!"

Could you talk any EMTs/FRs in nearby districts into joining yours for mutual aid? My county has a system with medics where we can borrow one from other stations for an intercept, or even have them come hang out with us for a whole shift. I imagine that could be implemented on a BLS level, if other people were willing.

Regardless, I'd seriously consider complaining to your EMS council or DOH. That's really bad, and headed for trouble.

 

[CAOX3]

From what I gather your station is more interested in fighting fires and EMS is just something they have to do, which isnt really a good combination at least for the patients.

Get another job if possible before you go down with the ship.

 

[MrBrown]

There have been several instances that I know of where they have put COPD pts on 15 L via NRB. I have no problem with doing this myself because I know how to use a BVM.

So it's acceptable to deliver what may infact be a harmful treatment and make the patient so hypocapenic they stop breathing because you know how to use a BVM?

Yes, I have a suggestion, stop practicing on live patients.

 

[CAOX3]

Oxygen shutting down a COPD s patients hypoxic drive is a myth. Hypoxia will most likely kill them first.

The majority of COPD patients will tolerate oxygen without a problem even at a high flow. I usually start at high flow and work down to where their comfortable.

Sure they may stop breathing from fatigue but its your job to intervene with vent. support before that happens.

 

[VentMedic]

This was discussed extensively on another forum and FRs have very tight protocols they must follow especially for O2 delivery and that most often includes a NRB mask just like EMTs in some areas. But as CAOX3 stated, hypoxia kills faster and if a patient goes somnolent within 15 minutes, they probably would have with or without the O2.

Due to V/Q mismatching and pulmonary vasoconstriction (not necessarily the hypoxic drive theory as some claim), there is a chance for the PaCO2 to rise with the administration of O2 but in cases that severe, they are probably looking at a tube in their near future or at the very least BiPAP for awhile. The patient also does not have to be a "known CO2 retainer" for this to occur. Any disease process that causes severe V/Q mismatching and pulmonary vasoconstriction may have a rise in PaCO2 if they are too weak to maintain adequate respirations. CO2 retainers also only make up about 5% of all COPD patients as that is a very broad term.

 

[VentMedic]

I guess I should add that if these FFs do not have even a FR cert, then there is an issue that should be addressed.

 

[CAOX3]

You should really look at your options, seems like a big mess on the horizon. Those things seem to gobble up everyone in its path, even the innocent people.

Side note:

Im not a big fan of the COPD patient.

They just seem unpredictible to me and you cant catch up once they start decompensating at least in a basics role.

Im not afraid to admit when Im overmatched by something.

 

[EMSLaw]

So it's acceptable to deliver what may infact be a harmful treatment and make the patient so hypocapenic they stop breathing because you know how to use a BVM?

Yes, I have a suggestion, stop practicing on live patients.

That may be a concern where you are, with much longer transport times, but in most places in the US the theory is that 15 LPM will not cause harm to a COPDer in the short time it takes to get them to the hospital.

As Vent correctly pointed out, if things go pear shaped in fifteen minutes, they likely were going to get there no matter whether you put on O2 or not.

Anyway, I think you're being a little harsh.

 

[Tincanfireman]

I can't talk to the chief since he don't listen to me anyhow and doesn't really care what is going on in the district with regards to medical and the people involved. Our EMS officer doesn't seem to know what is going on half the time nor do they really know what the state regs and codes are. And my station captian is one of the "self imposed" EMTs. Basically my whole chain of command is out of the picture for my purposes.

I don't really know what to do short of writing to the state DOH, and that would go over really well when my officers found out.

Any sugestions?

It's commendable that you see the situation as a disaster waiting to happen and want to fix it. That said, it's not your job to fix it. The members of your organization in leadership positions are responsible to the community, not you. Your participation as a volunteer is to work within the scope of your cert to provide care and treatment, not to worry about the actions of non/never current members. That said, you sound like a caring and interested member who'd be an asset to any organization. I'd pack my bags and get out of Dodge, fast...

 

[rescue99]

It's commendable that you see the situation as a disaster waiting to happen and want to fix it. That said, it's not your job to fix it. The members of your organization in leadership positions are responsible to the community, not you. Your participation as a volunteer is to work within the scope of your cert to provide care and treatment, not to worry about the actions of non/never current members. That said, you sound like a caring and interested member who'd be an asset to any organization. I'd pack my bags and get out of Dodge, fast...

Getting out before something terrible happens and the wrong person is held responsible sounds like a wise idea.

 

[EMSLaw]

Getting out before something terrible happens and the wrong person is held responsible sounds like a wise idea.

Seriously, a FR course is, like, 40 hours - they can't find the time. At least make sure they have Professional-level CPR with Oxygen Administration. The liability issues are huge. If they don't have training, they shouldn't be rolling a rig to emergency calls.

 

[usalsfyre]

So it's acceptable to deliver what may infact be a harmful treatment and make the patient so hypocapenic they stop breathing because you know how to use a BVM?

Yes, I have a suggestion, stop practicing on live patients.

I have never made a patient hypocapenic with a NRB. Pushed their PaO2 into the 400 range perhaps, but never hypocapenic. What Ventmedic describes is the hypercapenic "narcosis" that may come from hypoxic pulmonary vasoconstriction.

Before telling others to stop practicing, I suggest you check your own understanding of physiology.

 

[rescue99]

Seriously, a FR course is, like, 40 hours - they can't find the time. At least make sure they have Professional-level CPR with Oxygen Administration. The liability issues are huge. If they don't have training, they shouldn't be rolling a rig to emergency calls.

Yeah the liability on the shoulders of the responders and the community in this scenario is a bit scary.The community may not be aware but I wonder if the responders are? It's worse if they know and still act without a license. And yer right. AA/ CPR/AED with the ability to apply a preset amount of 02 is an option. It's at least a partial solution for budget restricted departments.

 

[EMSLaw]

Yeah the liability lying on the shoulders of the responders and the community in this scenario is a bit scary.The community may not be aware but I wonder if the responders are. It's worse if they know and still act without a license. And yer right. AA/ CPR/AED with the ability to apply a preset amount of 02 is an option. It's at least a partial solution for budget restricted departments.

It's also, in the colloquial rather than legal sense, fraudulent. Or, if you prefer, it's a false economy. People will think they are getting better 9-1-1 service because the FD shows up to help as first responders. But without any training, they are giving the false impression to the public that they are capable of providing emergency aid. It's papering over the cracks in the emergency response system when you really need to replaster.

The false economy will come in when this failure to either hire more EMTs/Medics or train the FF's to the FR/EMT-B level causes a patient death that will result in liability far in excess of the pittance it would cost to give the training.

 

[reaper]

First, Find a new area to Volunteer at. Get out now, before you go down with them.

Second, Start reporting it to the state! You have a responsibility to the people of your area. You have ethical standards to follow. You can lose your certification, if the state finds out you knew and did not report it.It can be seen as unethical actions by the State. You know that they are practicing with out a license and impersonating EMT's, but did nothing about it. Sorry, but the State does not condone "See No Evil, Say No Evil" mentality.

If the command will do nothing, then leave and report it!

 

[rescue99]

It's also, in the colloquial rather than legal sense, fraudulent. Or, if you prefer, it's a false economy. People will think they are getting better 9-1-1 service because the FD shows up to help as first responders. But without any training, they are giving the false impression to the public that they are capable of providing emergency aid. It's papering over the cracks in the emergency response system when you really need to replaster.

The false economy will come in when this failure to either hire more EMTs/Medics or train the FF's to the FR/EMT-B level causes a patient death that will result in liability far in excess of the pittance it would cost to give the training.

This very scenario happened here in 2003. Can't say whether or not it caused a legal issue with the family however, it sure caused a Med Control stink. I questioned the horrible "MFR" care prior to ALS arrival; something I really never do. Only then did me and my partner discover that FD wasn't licensed to practice and shouldn't have been there in the first place!!

Now, wouldn't that be a nice detail for OPS to let its Medics know? We had no idea and nowhere in the protocol book did it list any of the area levels of response. The whole thing was one big deception to keep a stupid contract happy. Talk about peeved!

 

[wolfwyndd]

There's already been some really great ideas thrown around and we had a similar incident where we had a paramedic do something that he probably shouldn't have done and the two basics on the run complained about it to our QC officer. Our QC officer knew it was wrong, but was unsure WHO to report it too so he brought it to the attention of our Medical Director and the EMS coordinator of the hospital where the transport went too. As of this moment, our Medical Director has pulled the license of the paramedic in question and he is on 'administrative duties' only. It just so happens that the paramedic in question is also our Chief. I wouldn't be surprised if there are things going on at the State level too but I can neither verify, nor deny that.

So, yeah, try your Medical Director and any EMS Coordinators that you might work with. If THAT doesn't work then I guess contact the State. In the meantime, get the H E double hockey stick outta dodge because you could get drug down with the ship when it implodes.

 

[DoubleOSpoon]

Seriously, a FR course is, like, 40 hours - they can't find the time. At least make sure they have Professional-level CPR with Oxygen Administration. The liability issues are huge. If they don't have training, they shouldn't be rolling a rig to emergency calls.

Exactly! - My biggest concern is liability, liability, liability. I can't believe that this is even going on somewhere, I'm a volunteer myself and we can't roll our rig without at least an EMT and MRT(MFR) on the crew. If the state found out we were breaking this rule we'd lose our license to operate. If I were in your shoes, if you couldn't find an officer or a way to start correcting the problem I would start looking at another department. You don't want to be involved when someone catches onto this!