Dallas Fire Department EMS Care - Quality

[foreverbound]

I just wanted to open this thread to generate some conversation on something I haven't been able to get off my mind. Just a quick intro...I'm a FF/EMT-LP for a small department here in Texas. We run what most would consider an advanced EMS system (aggressive anaglesia, RSI, field hypothermia, etc). The culture at our department is very pro-EMS and puts quality care as a primary goal and focus.

I recently had the misfo...err...opportunity to ride with a friend who works at Dallas Fire Department for 12 hours on one of their Rescue Ambulances.

Wow.

I know this is going to sound like a rant for a while, and especially considering this is my first post, I'm sure it'll go well.

---I seriously left my ride along pissed. Pissed at what I saw. While one ride out and one crew isn't representative of the whole department...the level and quality of care I saw was horrible, unprofessional, and honestly embarrassing.

When was it okay to show up with an unprofessional uniform with laces untied, shirt hanging out, and "sporty" mostly black tennis shoes?

When was it okay to try to convince people that need to go to the hospital that they were "fine"?

When did it become okay to not provide analgesia to a pt with an obvious fracture who has no contraindications to pain management?

...and if that wasn't enough...

WHEN in the WORLD did it become acceptable to have MVC patients climb into an ambulance and lay on a LSB? SERIOUSLY!?:angry::angry::angry::angry:

Seriously, I was shocked and embarrassed at what I saw. I saw care that was just simply horrible and minimal. I looked at some previous threads about DFD and couldn't agree more about some of the things I read. They shouldn't even be considered an "ALS" department by any means...heck, they shouldn't even be considered "BLS" for that matter.


Can somebody enlighten me? Did I just have a bad experience or did I really witness what I've heard from many...that EMS in Dallas is really that bad? Maybe for those who enter the DFD EMS system with no prior EMS experience, they see nothing wrong...but...it's my hope that as EMS professionals, we have better standards.

Thoughts, comments, and opinions are welcome. I just couldn't get this experience out of my head.

 

[Aidey]

I have zero first hand knowledge of DFD, so I can't comment on their overall quality.

When was it okay to show up with an unprofessional uniform with laces untied, shirt hanging out, and "sporty" mostly black tennis shoes?

Show up? Perfectly fine. You just have to tuck in your shirt before you go out on the amb. We also allow all black athletic shoes as long as they do not have colored logos. So no big Nike swish.

When was it okay to try to convince people that need to go to the hospital that they were "fine"?

It depends on what the pt is complaining of and how they are presenting. People are going to disagree on who needs to go to the hospital by amb.

When did it become okay to not provide analgesia to a pt with an obvious fracture who has no contraindications to pain management?

This is the only thing you've mentioned that is an obvious issue.

...and if that wasn't enough...

WHEN in the WORLD did it become acceptable to have MVC patients climb into an ambulance and lay on a LSB? SERIOUSLY!?:angry::angry::angry::angry:

Since around the time we discovered that LSBs are utterly useless. However, we still have to use them because the protocols haven't gotten around to acknowledging just how useless they are yet. I agree it is a bit unorthodox, but I personally wouldn't get worked up about it.

 

[foreverbound]

Aidey, the uniform issues were during patient contact. I agree with solid black shoes are no problem and arguably more comfortable than some boots. These were shoes with logos and colors on them.

There were some pts that clearly needed to be evaluated at the hospital...but..the vibe I got was they wanted to clear up and go available as soon as possible and did not like transporting. This one, I agree with you, could be discussed for a while.

As for analgesia, people have told me DFD rarely rarely ever uses pain meds (believe fentanyl is the only thing they carry). Maybe somebody with more insight about DFD could comment on this part.

Yes, LSBs for the most part are completely useless. Unfortunately, DFD doesn't have selective backboarding protocols. I agree with the fact that we can (arguably) do more harm by using LSBs. However, there are still some patients that need the whole package. Having pts who are weak/dizzy and/or short of breath climb into ambulances is just wrong.

Thanks for your fast reply, Aidey.

 

[RichLew]

I haven't heard anything positive about them actually. It's actually my understanding that they'll hire you with zero certification, send you through a 3 month EMS program and then you're out there running calls.

 

[STXmedic]

I haven't heard anything positive about them actually. It's actually my understanding that they'll hire you with zero certification, send you through a 3 month EMS program and then you're out there running calls.

That's pretty standard for many larger cities. They hire off a civil service exam with zero experience required. They then put you through a 6ish month fire academy that includes a 5ish week EMT school. After that, you're put into your probationary period in the field. Some cities will have an accelerated academy for people who already have their certifications (usually 2-3 months). Very common and not surprising at all.

 

[NYMedic828]

That's pretty standard for many larger cities. They hire off a civil service exam with zero experience required. They then put you through a 6ish month fire academy that includes a 5ish week EMT school. After that, you're put into your probationary period in the field. Some cities will have an accelerated academy for people who already have their certifications (usually 2-3 months). Very common and not surprising at all.

Exactly how FDNY does it.

Must be EMT or medic to get hired.

3 month academy.

 

[terrible one]

If you want to witness stellar EMS than feel free to visit any one of the fire departments in SoCal. The energy and enthusiasm to provide quality EMS care is palpable.
Enter sarcasm wherever you'd like.

 

[RichLew]

I personally don't feel that's long enough to confidently provide quality medical care, especially in the prehospital setting when it can hit the fan rapidly

 

[NYMedic828]

I personally don't feel that's long enough to confidently provide quality medical care, especially in the prehospital setting when it can hit the fan rapidly

Nor is a 150 hour EMT program. Or 1400 hour medic program.

None of the standards in EMS are acceptable.

 

[STXmedic]

I personally don't feel that's long enough to confidently provide quality medical care, especially in the prehospital setting when it can hit the fan rapidly

Long enough? It's the same class everybody else takes; they just go Monday through Friday 8-5. They have the exact same curriculum. They take the exact same national registry. What is it you feel you learn in a 1-2 day per week class that they don't? The selectivity of the entrance exam tends to naturally bring on people who are fairly intelligent, and we have a near 100% first time pass rate for EMT (100% total pass rate). I tend to be quite tough on my judgement of EMS providers; I find our basics to be excellent, even fresh out of the academy. Now our paramedics are a different story... :glare:

 

[usalsfyre]

I personally don't feel that's long enough to confidently provide quality medical care, especially in the prehospital setting when it can hit the fan rapidly

It is short, but the school (through UTSW) isn't the biggest issue. DFRs biggest issue is a culture of mediocrity.

 

[NYMedic828]

The issue that seems to be widespread with municipalities is not getting acquiring good employees, it's getting rid of the bad ones.

FDNY for example has many great providers but at the same time we have a good few awful ones. The problem is it takes an act of god to lose your job. The only real way to get fired is payroll fraud, drug use, DUI, losing your cert or drivers license.

There's people who have basically killed patients but didnt lose their cert so they still have a job...

 

[Christopher]

WHEN in the WORLD did it become acceptable to have MVC patients climb into an ambulance and lay on a LSB? SERIOUSLY!?:angry::angry::angry::angry:

That's actually more in tune with the literature than boarding and collaring the patient in the vehicle or a standing takedown.

True story.

If they left off the LSB and just put a collar on and walked them to the truck and lay them down on the stretcher they'd be among the most progressive forward thinking departments in the country. No sarcasm here either.

 

[rescue1]

That's actually more in tune with the literature than boarding and collaring the patient in the vehicle or a standing takedown.

True story.

If they left off the LSB and just put a collar on and walked them to the truck and lay them down on the stretcher they'd be among the most progressive forward thinking departments in the country. No sarcasm here either.

To be fair to the OP though, accidentally being a progressive service due to laziness is not quite the same as being a progressive service. Though I share your skepticism towards the effectiveness of spinal immobilization.


As to the issue, I have no experience with Texas EMS at all, but it is my experience that in any profession, if management does not expect excellence, then the service provided will not be excellent.

 

[Christopher]

To be fair to the OP though, accidentally being a progressive service due to laziness is not quite the same as being a progressive service. Though I share your skepticism towards the effectiveness of spinal immobilization.

We have procainamide available at my service, not because we're in tune with the literature, but because a broken clock is right twice a day...

 

[Fish]

If you want to witness stellar EMS than feel free to visit any one of the fire departments in SoCal. The energy and enthusiasm to provide quality EMS care is palpable.
Enter sarcasm wherever you'd like.

Ha exactly,

I used to get wide eyed while watching the news in San Diego and behind the News reporter you'd see SDFD and Rural Metro pointing patients to Back Boards lying on the ground and having patient's walking around with c-collars on to the board and having them lay down on them.

 

[Fish]

Since around the time we discovered that LSBs are utterly useless. However, we still have to use them because the protocols haven't gotten around to acknowledging just how useless they are yet. I agree it is a bit unorthodox, but I personally wouldn't get worked up about it.

While no one disagrees that SMR is over done and serves no purpose in a lot of cases. I think everyone agrees that if your going to do a skill, do it right and not half-assed.

 

[Tigger]

While no one disagrees that SMR is over done and serves no purpose in a lot of cases. I think everyone agrees that if your going to do a skill, do it right and not half-assed.

This is how I feel. It does not seem likely that such a large department would have instituted such a policy (letting a patient walk into the ambulance to the board) and then none of us would have ever heard of it. That would be considered a pretty big deal in the EMS world.

While I agree that the board is horribly overused, I'm not going to give them any credit for being lazy and accidentally ending up with something that's acceptable.

For those of us that think that SMR is really overrated and have the protocols in place to limit it's use, would you ever walk a patient into the truck and onto a board? That just seems pointless.

 

[Fish]

This is how I feel. It does not seem likely that such a large department would have instituted such a policy (letting a patient walk into the ambulance to the board) and then none of us would have ever heard of it. That would be considered a pretty big deal in the EMS world.

While I agree that the board is horribly overused, I'm not going to give them any credit for being lazy and accidentally ending up with something that's acceptable.

For those of us that think that SMR is really overrated and have the protocols in place to limit it's use, would you ever walk a patient into the truck and onto a board? That just seems pointless.

We rule out cspine a lot, if we are cspine-ing, it is for a reason or a "potential" and for that reason I will always do it correctly. Including standing take downs on ambulatory patients

 

[NYMedic828]

If a patient has been walking around an MVA seen for 10 minutes, and claim spinal injury they can't attribute that damage to you not performing a standing takedown.

I've had patients walk to the stretcher and lay down as well as walking into the ambulance.

My agency can knock me for doing it improperly, but in a court of law you can't prove negligence on that basis.