Hi,
I'm a MassArt Industrial Design student. I am working on a project right now that focuses on analyzing the work requirements of EMS providers and attempts to design a product or system that would improve the work environment of EMT's/Paramedics, or the services they provide. I have a few questions listed below that would help me to better understand where improvements can be made.
Thanks
Are you an EMT or Paramedic? (Please specify) For how long?
Paramedic, a little more than a year and a half plus worked as an EMT-I for a little over a year before that, same agency.
What is your most commonly used tool/piece of equipment?
Most commonly used tools for me would be a BP cuff and stethoscope. every call they get used. Also any call that I attend the patient the cardiac monitor is used as well both 4, 5 and 12 lead continuous monitoring.
What is the protocol when you receive a call?
This is a tough question to answer. What exactly are you looking for? When someone calls 911 in the county I work in they go to the main dispatch center where they ask Fire, PD or Paramedics, ask address and phone number in case the call gets disconnected or the RP hangs up. Then our Call Takers follow a dispatch protocol known as Emergency Medical Dispatching or Medical Priority Dispatching System to determine the acuity of the call, which resources to send and whether we need to respond with or without lights and sirens. The call is then dispatched via radio to the ambulance crew and we have 60 seconds to go en route from the time we're dispatched. Depending on the priority of the call (1-4) we have county set time limits on required response time varying from 8.5-30 minutes and the county tracks our compliance with these times.
What is the protocol when you arrive on the scene?
Again, difficult question. Determine the scene doesn't have any threats to myself, my partner or other co-responders. Make patient contact, do an assessment, determine whether my partner or I will attend the patient based on their complaint, treat things that need to be treated on scene, load the patient, make them comfortable and transport them to the hospital.
What is the protocol transporting a patient?
I don't know what you're looking for here, sorry.
What is the most time-consuming part of a call?
Transport is generally the most time consuming depending on distance. Getting people out of their home can be a task too. I've mopped floors, done dishes, fed animals, made beds, changed laundry from the washer to the dryer, al sorts of stuff to help the patient get what they need taken care of before we go to the hospital. Documentation can also be time consuming.
What is the most useful tool/piece of equipment? What is the most useful part of the ambulance?
The most useful tool to me is my brain. Also, seat belts. I'd say my monitor is pretty useful as I can do continuous 4,5 or 12 lead cardiac monitoring, continuous sidestream and mainstream waveform capnography, continuous SpO2 monitoring with pleth form, continuous esophageal or rectal temperature monitoring, cardioversion, defibrillation, continuous and demand transcutaneous pacing, AED mode, real-time CPR feedback, event monitoring for interventions and drug administration in the presence of a cardiac arrest. It does more but that's off the top of my head.
What is the most frustrating tool/piece of equipment? What is the most frustrating part of the ambulance?
Our inline nebulizers can be a pain in the *** if our VST department doesn't assemble them correctly or they miss a piece when they're putting the kits together. Also, backboards frustrate the :censored::censored::censored::censored: out of me.
How much medical care is administered inside the ambulance as opposed to at the hospital or at the scene?
This depends on the call. I do mostly everything on scene then re-assess and treat as needed during transport. Sometimes we'll move to the unit then sit on scene while we work on getting them ready for transport if we're in a public place for the patient's privacy. Also, it's easier to work out of the cabinets than my bag. Bag means I have to go into the cabinets anyways to re-stock my bag. The hospital generally provides definitive care so a lot more care goes on there than in the field if the patient truly is sick.
Once on the scene, what are the responsibilities of the EMT/paramedic vs the responsibility of the driver?
We don't have drivers. We run Paramedic and EMT-I OR AEMT and the person who isn't taking care of the patient drives the truck. As the Paramedic I am ultimately responsible for everything that goes on in my ambulance and on my scenes including the care provided by my partner. Some describe a Paramedic's job as a conductor of an orchestra. We run the show while we delegate skills and tasks to other people. It's not unusual for my partner to do most of the assessment while I sit back and listen, talk to family, take in the whole scene for something that may be missed if I'm one on one with the patient assessing them then will step in and take over as we move to the rig and start transporting if it's my patient. If it's my partners I assist them with whatever they ask for, might toss in my two cents if they ask or seem like they're getting lost.
What would make your job easier?
Loading devices for the cot into the ambulance. They already exist we just don't have them. Also a way to be seated and belted in a forward or rear facing seat and still be able to talk to the patient and provide care would be the number one thing but that's more safety rather than easier. It's pretty easy for me to walk around the back of the unit while it's moving and provide care but if we get in a wreck I'm a dead man.
How often does the interior of the ambulance change?
Ours rarely change. we make small changes when we remount a box but they generally have been the same in the ~3 years I've been here. We have 43 ambulances so they can't just replace all of them at the same time.
What is your uniform? Do you regularly carry any tools/equipment on your person?
Company issued navy button down shirt with our logo and my name and certification level on the front. Pants are 5.11 EMS cargo pants. I carry my stethoscope, a pair of shears, my narcotics, pens and sharpies on my person otherwise the rest is in my bags.
How do the seasons affect your work?
Summer tends to be busier and hotter, winter is slower and colder and we get a lot of environmental emergencies depending on the time of year. I like the winter because I have to wear long sleeves because of tattoos.
What kind of call is the most challenging?
In EMS the majority of what we do isn't emergent. The most difficult calls are those where someone truly does need help but it's not the type of help we know how or have the capability of providing such as social services, long term care, end of life care, things of that nature.
Do you feel equipped to serve every patient you are called to see? If not, please elaborate.
For the most part yes. There's always going to be people we can't provide the necessary care for but the majority we are equipped to care for.
Is there any system of color coding involved with tools/equipment?
Check out the Broselow tape. Its a tool to determine the weight of a pediatric patient and also has information for resuscitation for each weight category including drug doses, sizes of things like endotracheal tubes and things like that. Our pediatric bag has a roll out section that's color coded to the appropriate section of the broselow tape.
What are specific physical stressors you experience in your job?
Lifting is the biggest physical stressor. Being stuck sitting gin the cab of an ambulance on street corners for long shifts can take it's toll on your body. The long hours and lack of scheduled breaks as well.
How many calls can you/do you answer in a day?
We average ~8 calls in a 12 hour shift. 16 hour shifts generally will sit in the 10-12 range. Most I've done was 16-17 in a 12 and 18-19 in a 16. Then I've had days on both lengths of shifts that we don't run a single call.
After a call, how long does it take to prep the ambulance to answer the next call?
We have 25 minutes to turn the unit around from the time we mark out at the hospital to being "status 5" which means we're available for calls and can be pulled by dispatch if they need us. It's rare we need more time than that and that includes passing off the patient and giving a report but if needed we can call "out bio" if it's really destroyed and then they'll give us as much time as we need, within reason of course.
How long is an average shift?
We work either 4 12 hour shifts week with 3 days off or 3 16 hour shifts a week with 4 days off. 12s all start at the same time (i.e. 0400-1600 or 1700-0500 so on and so forth) 16s have a staggered start by two hours. My shift if I wasn't out hurt this shift bid would have been Sunday Monday Tuesday (S)0400-2000, (M)0600-2200 and (T)0800-0000.
I know it's kind of long (sorry.) If you think I can cut anything out pleas tell me and I will. Thanks again.
