First responders

[rescuemedic7306]

Are they a good thing or a bad thing? What are your thoughts?
Personally, I like 'em, although sometimes I wish they'd be a little less eager

 

[BloodNGlory02]

good- when they have vitals and info waiting for you
bad- when they only apply o2 and 'hang out' with the family
good- makes our dept look good when we get someone there within 2 minutes
bad- enterting an unsafe scene... alone....

 

[rescuecpt]

We have a responder car at the Corps, it is up to the discretion of the crew to use it. Since we have high volume traffic (especially on Saturdays when I ride) the responder car is great because we are more easily able to navigate traffic. We often leave at the same time as the ambulance but arrive on scene 2 - 3 minutes sooner. My crew has 2 drivers, myself, and 2 probies, so I usually ride with the crew chief in the first responder, and the other three take the ambulance.

At the FD, only the Chiefs and Rescue officers go straight to the scene - in my neighborhood it helps, but I am only allowed to carry BLS in my POV. However, it lets me start CPR, start O2, or take vitals so that the situation is assessed the treatment/transport decisions are made by the time the crew steps off the rig.

 

[Chimpie]

Capt... I think he was talking about Medical First Responders vs. EMT's. LOL

Well, speaking as a past-MFR, where I was located it was almost pointless to be a EMT-B. At the time in Indiana (don't know what's changed since I've left) the ONLY thing that an EMT-B could do that a MFR couldn't was Combitube and start a line for an IV. That's it folks. All of the FD's around there were volly-depts and were toned out on most medical runs. Depending on which county you worked in, either AMR or the county ambulance responded. Basically all the MFR's job was to stabilize and prepare for transport. When the ambulance got there it was load and go.

If there were too many MFR's on a scene and people were just standing around, a scene commander should have told them to wait outside for the ambulance or go available.

 

[rescuecpt]

Originally posted by Chimpie@May 2 2005, 10:06 AM
Capt... I think he was talking about Medical First Responders vs. EMT's. LOL

Oh, ok. We don't have those. No one takes the class because for about 1 month extra, they can be EMTs.

 

[coloradoemt]

We have FR's on my dept and it is the same as anything else there are good and bad. I find myself in the situation where I am the only EMT running a call with a first responder quite often. There are those whom I can count on and those that get so excited and unreliable that they are a hinderance more than a help. We pretty much use them on my dept as a support role and not so much for patient care unless it is a non critical pt and I can use them for vitals etc. during transport.

 

[TTLWHKR]

The government calls all of us first responders. We call the advanced first aid people first responders. Our company does not recognize the training of them b/c there is so little they can do in PA. We'll take EMT's or Attendant/Drivers, but not First Responders. Mainly b/c nobody can ever provide protocols for them; I don't even know what is legal and illegal for them to do in the Commonwealth of PA?

I'm still under the impression that it's basic first aid w/ a state certification?

 

[emtchicky156]

We dont have first responders anymore you have to be at least a basic or in basic school.

 

[Chimpie]

I guess it also really depends on what type of service you're in. For private ambulance companies there really is no need for a first responder. For volly fire departments they can be really good.

I've also heard from others across the country that there are different versions of the MFR class. I have a friend in VT who said they didn't learn any transportation techniques. Basically all they were taught was stabilization and vitals. They could splint arms and legs. But no backboards, no c-collars, nothing. To me that is an advanced first aid course.

 

[Jon]

Originally posted by TTLWHKR@May 2 2005, 11:45 AM
The government calls all of us first responders. We call the advanced first aid people first responders. Our company does not recognize the training of them b/c there is so little they can do in PA. We'll take EMT's or Attendant/Drivers, but not First Responders. Mainly b/c nobody can ever provide protocols for them; I don't even know what is legal and illegal for them to do in the Commonwealth of PA?

I'm still under the impression that it's basic first aid w/ a state certification?

TTLWKR - my understading is it is basic first aid, O2, AED, with a state Cert. I think they might be able to assist with an epi-pen, but can't use the one on the squad - not sure on that.

In PA, my understadin is that to drive an ambulance you need at least Advanced first aid (inc. CPR) and EVOC. Some sqauds get by this by sending a 3rd person - say a Jr. who is an EMT, theyby having 2 personell who are recognized as being able to provide care.

 

[Jon]

Originally posted by BloodNGlory02@May 2 2005, 02:37 AM
good- when they have vitals and info waiting for you
bad- when they only apply o2 and 'hang out' with the family
good- makes our dept look good when we get someone there within 2 minutes
bad- enterting an unsafe scene... alone....

Yep.

Bad - when they only do it 'cause it is an excues to drive thrugh town with the blinkies on and then you find them standing out front saying "the patinet is in there...somewhere"

bad - when they drag patients out of cars, no backboard, no straps, no CID, no collar (oh, wait - i'm thinking philly - only need a collar, a board and CID's - screw straps) antd then drag the guy onto a backboard and stand with thumbs up theur butts until the ambulance shows up, ignoring the ALS-level private ambulance that is watching. (oh wait - these are philadelpha firefighters... all are EMTs)

Good - when they take a set of vitals, and you get similar vitals later

Bad - when they invent vitals

Bad - when they look at you like you have 2 heads 'cause you asked them to take a blood pressure

good - when they can speak russian and help you communicate with yur paient.

Bad - when they ONLY EVER speak russian

Bad - when they brung you a reeves when you asked for a backboard (oh wait - he was an EMT)

Jon

 

[Chimpie]

See, all this bad talk about MFRs really fall into SOP and dept training areas. All MFRs should be able to take vitals and admin O2 amongst other things. They have to know how to pass the test. If the department isn't following up on training or giving refreshers it's the their fault. And, if they aren't doing things per protocal kick their butts off the department.

 

[TTLWHKR]

Originally posted by MedicStudentJon+May 2 2005, 12:33 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (MedicStudentJon @ May 2 2005, 12:33 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-TTLWHKR@May 2 2005, 11:45 AM
The government calls all of us first responders. We call the advanced first aid people first responders. Our company does not recognize the training of them b/c there is so little they can do in PA. We'll take EMT's or Attendant/Drivers, but not First Responders. Mainly b/c nobody can ever provide protocols for them; I don't even know what is legal and illegal for them to do in the Commonwealth of PA?

I'm still under the impression that it's basic first aid w/ a state certification?

TTLWKR - my understading is it is basic first aid, O2, AED, with a state Cert. I think they might be able to assist with an epi-pen, but can't use the one on the squad - not sure on that.

In PA, my understadin is that to drive an ambulance you need at least Advanced first aid (inc. CPR) and EVOC. Some sqauds get by this by sending a 3rd person - say a Jr. who is an EMT, theyby having 2 personell who are recognized as being able to provide care. [/b][/quote]
So they are nearly the same as basics? Ya know, this state is so far behind as far as EMS goes... It's sickening! I live live six miles from the NY State Line, I'm thinking about going up there and getting my Critical Care EMT while I work on getting my final tests for NREMT-P again. Pennsylvania just doesn't seem to move ahead. I think all I need is to take the written for state cert, b/c I did everything else w/ in the past year.

 

[BloodNGlory02]

In the licensure sense- state of WI doesnt have a first responder level anymore. you're either basic, IV Tech, I-99 or Paramedic.

 

[rescuecpt]

Originally posted by TTLWHKR@May 2 2005, 02:05 PM
I live live six miles from the NY State Line, I'm thinking about going up there and getting my Critical Care EMT while I work on getting my final tests for NREMT-P again. Pennsylvania just doesn't seem to move ahead. I think all I need is to take the written for state cert, b/c I did everything else w/ in the past year.

Well, NY's CC would only help if you plan on working or joining in NY, obviously, and as far as your medic class goes, none of my CC training counts towards medic whatsoever, so I'm not sure if it's worth 9 months of your time.

 

[jafo]

Ok this one made me register just so I can post a comment.
You folks are all talking about First responders like they are a Sub-Class life form. Here in New York, they are called CFR (Certified First Responder) and they can do pretty much everything a basic can do EXCEPT fill out the PCR and transport.
Personally, I don't care what your patch says, it is how well you practice your skills that count. We have CFR's on our squad that can run circles around most Basics, and in fact one did just that last month when he arrived on scene where an experienced basic was at a loss as to how to clear an airway. The CFR executed an ABD thrust with 'extreme predjudice' and cleared the obsruction that the EMT failed to on 3 attempts. He then bagged him unitl ALS arrived. (It was an OD.)
Many LEOS are CFR's but they don't take it as seriously and don't study/practice as much. Of course, some do, and save lives because of it.
The CFR class is about 46 hours compared to about 120 or so for Basic. CFR's are not required to do ride time or clinical time. From a educational point of view, there is a fair difference between the two, but when you look at the statistical chances of having a complex call, the CFR is in good shape to make a big difference most of the time, provided he has some experience. I can see why there is little use for CFR's in large communities or cities, but out here in the sticks, you need all the people you can get.
The reason I'm a little defensive on this subject is because I have thought long and hard about which course to take. At the age of 50 I have a lot of life experience and have patched up a lot of ugly injuries. I also spend a lot of volunteer time in my community on other areas outside Fire/Rescue, so I have minimal time available to take a course. I have no intention of making EMS a career. I also doubt my abilities to be the main decision maker on difficult calls. Therefore I have opted to take the CFR and be the best I can be at that level. Some of you may think it is advanced First Aid, but it is not. I have Advanced First Aid, Wilderness First AId, and CPR. This is another notch up. I am however, studying from the Basic manual not the CFR manual, because I want that extra knowledge that allows me to understand things better.
It's not the patch that matters. What really matters is how you apply the knowledge and skills you have been given. Lets face it, we've all seen people at all levels, from First Aider, right up to Physician, that are not very good at what they do, so why pick on people based on the patch they wear?

I feel better now.

 

[rescuecpt]

Good for you, it sounds like you will be a great CFR. I am in NY too, and in my part of NY (Western Suffolk County) CFRs are not utilized nearly as much as they seem to be in your area.

 

[TTLWHKR]

I didn't think anyone was talking poorly about them (FR's). No matter what you call any of our certifications, the simple fact is that the "Scope of Practice" is different for every level of cert, in every state. What you can do in NY, may not be legal in PA. And knowing how to do more is great, but it's a big no-no to go out of your scope of practice. Good way to get the service your running with in hot water. I don't care if your willing to lose your certification to save someones life; we all think about that every now and then. But my career depends on my certifications.
My "beef" with FR's stems from a couple we had on a substation QRS team. They were provided with basic first aid equipment, that came from looking in the only "First Responder" guide we could find, from 1980, and that was American Red Cross FR's. We operated fine for about six years, had a Class 1 Medical Call, arrived; the squad was doing everything that we would have done. But not with our equipment. They went out and bought their own, a lot of equipment; outside of their scope.. Out side of MY scope. They wiped that QR service out with one call, that was all it took. The first person on the scene was an off duty Paramedic, also the regional director. :angry: They removed the "First Responder" patches from their uniforms and put on simple "EMS" patches. The person was boarded for a medevac (ER is 60 miles away), Nasal Airway, Bagging him and someone had cut the lock off the EPI box on the rescue and given it to him w/ out calling medical command. The law then was EMS could carry EPI but only give it w/ Med Command Orders.
It is a fact that their actions saved the patients life. But it is also a fact that FR's (at the time) were not permitted to carry backboard, EPI, Oxygen, Nasal Airways or Bag Valve Resuscitators. All of them were stripped of their certs, and we lost the license for operating a QRS. Now, they were so proud that they lost their certs and the license; but saved someones life. What happens when someone drops in Cardiac Arrest, and there is a chance that CPR or AED can save their life now that FR's can use AED's? We can't go for a QRS license because it was permanently revoked. They weren't seeing the big picture, they have to be there for everyone, not just to satisfy themselves. Their little ego trip cost us 5,500.00 in Fines; and near loss of all EMS vehicle certifications.

ANYHOO. After this happened, I contacted the PA EMS Director and asked for "Protocols" for First Responders. They said "use the BLS protocols". They were using the BLS protocols-except EPI-when they broke all the FR Protocols. How can they accuse them of breaking protocol, when they do not have a written protocol for just first responders?

I still have never gotten an answer, somewhere there is a list of what people can do under scope of practice. But it lists certifications they have not existed since the early 80's. Which shows again how far behind PA is.

Following that incident, we no longer all personnel to be active as First Responders; because we are still glad the guy didn't die b/c the lawsuits would have been horrible when they found out what happened.

I can't wait till they come up w/ a national scope of practice and hopefully take over so PA can't keep holding us back.

 

[TTLWHKR]

Originally posted by TTLWHKR@May 3 2005, 09:14 AM
I didn't think anyone was talking poorly about them (FR's). No matter what you call any of our certifications, the simple fact is that the "Scope of Practice" is different for every level of cert, in every state. What you can do in NY, may not be legal in PA. And knowing how to do more is great, but it's a big no-no to go out of your scope of practice. Good way to get the service your running with in hot water. I don't care if your willing to lose your certification to save someones life; we all think about that every now and then. But my career depends on my certifications.
My "beef" with FR's stems from a couple we had on a substation QRS team. They were provided with basic first aid equipment, that came from looking in the only "First Responder" guide we could find, from 1980, and that was American Red Cross FR's. We operated fine for about six years, had a Class 1 Medical Call, arrived; the squad was doing everything that we would have done. But not with our equipment. They went out and bought their own, a lot of equipment; outside of their scope.. Out side of MY scope. They wiped that QR service out with one call, that was all it took. The first person on the scene was an off duty Paramedic, also the regional director. :angry: They removed the "First Responder" patches from their uniforms and put on simple "EMS" patches. The person was boarded for a medevac (ER is 60 miles away), Nasal Airway, Bagging him and someone had cut the lock off the EPI box on the rescue and given it to him w/ out calling medical command. The law then was EMS could carry EPI but only give it w/ Med Command Orders.
It is a fact that their actions saved the patients life. But it is also a fact that FR's (at the time) were not permitted to carry backboard, EPI, Oxygen, Nasal Airways or Bag Valve Resuscitators. All of them were stripped of their certs, and we lost the license for operating a QRS. Now, they were so proud that they lost their certs and the license; but saved someones life. What happens when someone drops in Cardiac Arrest, and there is a chance that CPR or AED can save their life now that FR's can use AED's? We can't go for a QRS license because it was permanently revoked. They weren't seeing the big picture, they have to be there for everyone, not just to satisfy themselves. Their little ego trip cost us 5,500.00 in Fines; and near loss of all EMS vehicle certifications.

ANYHOO. After this happened, I contacted the PA EMS Director and asked for "Protocols" for First Responders. They said "use the BLS protocols". They were using the BLS protocols-except EPI-when they broke all the FR Protocols. How can they accuse them of breaking protocol, when they do not have a written protocol for just first responders?

I still have never gotten an answer, somewhere there is a list of what people can do under scope of practice. But it lists certifications they have not existed since the early 80's. Which shows again how far behind PA is.

Following that incident, we no longer all personnel to be active as First Responders; because we are still glad the guy didn't die b/c the lawsuits would have been horrible when they found out what happened.

I can't wait till they come up w/ a national scope of practice and hopefully take over so PA can't keep holding us back.

I forgot to mention...

The main reason for loss of licensure was that they had an airway bag set up w/ BVM's, assorted airway equipment including some odds & ends of ET Tubes, Laryngscope and Combi-Tubes. The Combi-Tube is not approved for EMT's in the Comm. of PA. The FR's stated in their testimony that EMT's were allowed to because they read about it in JEMS. The articles was from another state.

I think prior to our arrival, they had attemped to intubate the patient, who taught them to do that I have no idea. But it was a very bad situation. When we checked the equipment on our trucks, they had gotten rid of most of the stuff we had on there and replaced it with a slew of stuff they weren't trained to use. Which is how I found out what eBay was. They had sold our equipment on eBay to buy their "Paramedic gear".

Who ever taught them to be Jr. Paramedics did a good job, but sometimes I wish they has stuck to the basic stuff b/c their help is missed on many calls.

 

[Jon]

JAFO - I wasn't bashing all CFR's, just the morons I end up workling with. I wish more were like you.

TTLWHKR, Wow - I've heard things like this happening, but never quite like that, and not in PA. My class instructor has done some work as an expert wittness, and I've heard some of his stories.


And in PA, you don't need ride time or ED shifts to be an EMT - BIG Mistake.


Jon