Fly car (rapid response) medics in the U.S.

[NomadicMedic]

Amen. We try to put an "experienced" medic with a new guy, but that's mostly to help navigate the operational stuff. Medically, once they're cleared from FTO time, they can function as full paramedics.

 

[Handsome Robb]

It is an opportunity to progress from hand holding to complete independence. I know that I do not want Molly Medic with 6 months of experience going to a call unassisted while a senior medic with 18 years of experience sits in the office. This system was designed by our senior staff and it works for us.

It is clear we will not agree on this.

:deadhorse:

That's ridiculous.

I have 6 months of experience as a medic. Does that mean I need my hand held? They're never going to learn if you don't let them get out on their own, make their own decisions, make mistakes and have to recover from them. You can say they do that with the senior medic watching until you're blue in the face but the fact of the matter is that the junior medic is going to defer decisions to the senior guy the second they get uncomfortable. That's not conducive to learning and progressing in your career.

I find your lack of confidence in young medics somewhat offensive. Experience doesn't mean someone is good at their job. I know plenty of experienced medics I wouldn't let touch me, my family or friends with a 10 foot pole.

I'm a medic just like that 18 year vet. Despite popular belief I'm sure I could teach him or her a thing or two.

I'm glad it works for you but you just stated you routinely leave your district without coverage because you had to send both ALS units to a call a single unit can handle so the junior medic can have his hand held. Doesn't sound like it works to me...

I'll agree to disagree but I still think the way your system is setup is assbackwards.

 

[Simusid]

That's ridiculous.

I have 6 months of experience as a medic. Does that mean I need my hand held? They're never going to learn if you don't let them get out on their own, make their own decisions, make mistakes and have to recover from them. You can say they do that with the senior medic watching until you're blue in the face but the fact of the matter is that the junior medic is going to defer decisions to the senior guy the second they get uncomfortable. That's not conducive to learning and progressing in your career.

I find your lack of confidence in young medics somewhat offensive. Experience doesn't mean someone is good at their job. I know plenty of experienced medics I wouldn't let touch me, my family or friends with a 10 foot pole.

I'm a medic just like that 18 year vet. Despite popular belief I'm sure I could teach him or her a thing or two.

I'm glad it works for you but you just stated you routinely leave your district without coverage because you had to send both ALS units to a call a single unit can handle so the junior medic can have his hand held. Doesn't sound like it works to me...

I'll agree to disagree but I still think the way your system is setup is assbackwards.

Do you need your hand held? No. I already said this is after the hand holding phase.
Do you need oversight? Yes.

You SERIOUSLY want me to accept a green medic making mistakes at the expense of my patient so he can learn how to recover from it? Particularly when I DO have available resources?

And I'm the one who's assbackwards

 

[Aidey]

Sending 2 ambulances to a scene so one medic can babysit the other is a bit unusual. Arguably, they aren't past the hand holding stage if they have to have someone keeping an eye on them.

 

[Tigger]

There are two hospital based paramedic units left in Massachusetts. Lawrence General Hospital runs two double paramedic intercept units in the city of Lawrence (crappy old mill town of 75k) to intercept with a private company's BLS ambulances.

Saints Medical Center in Lowell (crappy old mill town of 100k) also runs two double paramedic intercept units to intercept with a different private company's BLS ambulances.

In both cities if both medics are tied up, the private ambulance company will send one of their own medic units. Both cities are not real nice any more and I am told the call volume is quite high. Getting a job with either hospital is pretty challenging I am told.

Those are the only "traditional" fly car systems really left in the state. There are a few towns in the metrowest part of the state that are served by a double medic flycar, but it's not always in service and can get pulled out of those towns to backup AMR 911 contracts. Getting on that truck apparently takes serious seniority.

AMR here in Colorado Springs has a two fly cars that are staffed by an extra medic or a supervisor. If the FD and AMR has an extended ETA, they will send them to "stop the clock." <_< The fly car also goes to the rural areas that have BLS first response so that there will be two medics on the call.

 

[EpiEMS]

I find your lack of confidence in young medics somewhat offensive. Experience doesn't mean someone is good at their job. I know plenty of experienced medics I wouldn't let touch me, my family or friends with a 10 foot pole.

I'm a medic just like that 18 year vet. Despite popular belief I'm sure I could teach him or her a thing or two.

This has been studied in physicians, and I'm curious if it applies to medics as well. There's a July effect, where new residents coming in leads to excess mortality and reduced efficiency (for a relevant meta-analysis see: http://www.ncbi.nlm.nih.gov/pubmed/21747093), but on the opposite sort of end, inpatients who had physicians with ≥20 years of practice had higher mortality rates and longer stays than inpatients with physicians from 0-5 years of practice (see: http://www.amjmed.com/article/S0002-9343(11)00319-6/abstract).

So, new versus experienced, not sure which is better, exactly...


Also, regarding having lots of medics, there are diminishing returns...

 

[Handsome Robb]

Does ATCEMS (pretty sure it was them, might be mistaken though) still have their motorcycle medics or did it get cut when they made all the changes to their system? I remember reading a while back they were staffing them at peak hours to help with response times due to heavy traffic, particularly around a certain freeway.

The idea was to put one at each end of that freeway, can't remember which one, to cover it and the metro area immediately surrounding it. No transport capabilities obviously but in the rare cases that it truly matters it gets an ALS provider to the patient's side quicker, well that's the idea at least.

Do you need your hand held? No. I already said this is after the hand holding phase.
Do you need oversight? Yes.

You SERIOUSLY want me to accept a green medic making mistakes at the expense of my patient so he can learn how to recover from it? Particularly when I DO have available resources?

And I'm the one who's assbackwards

It's not your patient. They're the medic, you're the basic. It's their patient, not yours. We are ultimately responsible for everything you do even when we're driving and you're attending.

Nope. I don't I operate just fine on my own. I get my oversight from QA/QI and OLMD if I really need it.

You really want to tell me you've never made a mistake while treating a patient or performing skills? I don't care how long you've worked in EMS, everyone makes mistakes.

EMS providers across the country perform procedures and administer treatments that do more harm than good on a daily basis (read: everyone gets oxygen and an IV or transported code 3 no matter what!). The way the system in the U.S. is designed and with current education requirements there's no way around it.

You're still giving them a crutch by sending a senior medic on every one of their calls. If they aren't capable of operating independently when they clear their FTO period they shouldn't be clearing.

I understand putting a junior and a senior medic on the same truck but what's the point of staffing two ambulances when only one of them can run calls on it's own? There isn't one.

 

[usalsfyre]

You SERIOUSLY want me to accept a green medic making mistakes at the expense of my patient so he can learn how to recover from it? Particularly when I DO have available resources?

Last time I checked this is pretty much how physician residency worked, seems to turn out decent physicians.

What happens when the junior guy is now the senior one but has always been supervised?

 

[matthewspear]

LA County Fire Dept. uses two medics on a truck with no pt. compartment. They contract out to private EMS companies to do pt transfer.

LA City Fire Dept. recently started a program that utilized medics on motorcycles for incidents which made transportation difficult in the traditional sense (ie. brush fires, freeway closures, sports games, etc). LA City Fire also has bike medics.

 

[Handsome Robb]

LA County Fire Dept. uses two medics on a truck with no pt. compartment.

Also known as a Squad.

Never understood why LACoFD contracts out ground transports but do their own HEMS. Well they say they do, how many patients do they actually transport by air down there? I'm just picturing the "Mechanism of Injury" YouTube cartoon :rofl:

 

[jgmedic]

Also known as a Squad.

Never understood why LACoFD contracts out ground transports but do their own HEMS. Well they say they do, how many patients do they actually transport by air down there? I'm just picturing the "Mechanism of Injury" YouTube cartoon :rofl:

Ahh. the good old Air Squad. The FD I work PT for up there uses them a lot up in the Angeles Nat'l Forest when getting the patient from scene to the RA is difficult and the Air Squad can hoist them out. In the 2 years I've been there, at least 4 or 5 transports and I only work twice a month up there.

 

[bahnrokt]

My system has no ALS. We can intercept with medics from a nearby city while in transit. But those medics work for the PD and cannot cross town lines to meet a PT. Because of transport times my patients can be well over 40 minutes from dispatch to seeing a medic with no on scene hang ups.

 

[DrParasite]

We can intercept with medics from a nearby city while in transit. But those medics work for the PD and cannot cross town lines to meet a PT.

Being in New Jersey, I can say we do things that others might think is stupid. But that being said, that has to be the stupidest setup I have ever heard of!!!