For The Dinosaurs!

[firetender]

I'm really interested to hear you share with this community your take on what have been the most significant changes in EMS over the last 20 years.

You don't have to have been in the field that long, but if you were in it during a significant "turn", I'd love to hear about it. And it doesn't have to be limited to technique type stuff, it can include the politics, expanding or contracting services, the "culture" of the paramedic, response of the public, safety...you catch my drift. Thanks for your perspective!

 

[Tincanfireman]

Here's an easy one to kick things off. When I first started, we still used the ancient FW's. To load a pt, you got them onto the cot, then did the deep-knee bend to raise the cot. Roll it to the unit, do a reverse DKB to lower it to the ground while staring into your partner's eyes to make sure you both lowered simultaneously. Then, grab that bar and hoist pt and stretcher as a unit into the back of the ambulance. No collapsing undercarriage like the Strykers of today, no hook to catch the head end. It was all back, knees, and shoulders. I have no idea why I still have any usable motion in my back, but I'm sure glad I was in my 20's then!

(For the dinosaurs? Ouch... )

 

[Canoeman]

Significant changes?

I see the changes related to EMS as some of the changes related to the medical field entirely over the last 3 decades. There has been small increments of change but nothing that is "significant" or that hit me as a tidal wave.

I also see many things that we use in the EMS field today that we used 20 years ago that have no scientific basis or studies to prove they actually can reduce mortality or morbidiity but we still use them, so that is also significant.
Have things changed?

Off the top of my head this is what just came to my mind. (Based on my area)

- Changing from the Caddies to real Type II's then III's in late 70's
- First Defibs LP 3 -5's late 70's - 80's
- first ACLS late 70's early 80's - Epi - Bicarb-Epi-Bicarb (not Paramedics yet)
- Johnny and Roy
- MAST pants in -------now out
- Aeromedical - Trauma Centers late 80's
- Mid 80's Paramedic Program
- SSM - 8 Mins to Patient
- 12 Leads; Capanography
- AAS Paramedic 90's
- CC Paramedic
- Nothing to do with EMS - but AED in the hands of the public 90's(should have done this in the beginning)
- CPAP - 2005-6

I'll ponder this some more

Canoeman

 

[firecoins]

19 is no longer apart of the year.

 

[VentMedic]

Medical Flight transport did not have nice helicopters with nice gadgets and equipment. Nor did it have the "pretty" uniforms. If you needed to evacuate by air, you relied on what the local police department sent you. Then, you flipped a coin with your partner to see who was going to be stuffed into it with the patient, O2 tank and med box.

CPR was a lot slower. There were more steps to remember but easier overall to do.

Smaller community based fire departments and ambulance services instead of The County or AMR. Schaefer and Goodhew in California and Randle-Eastern in Miami were the "big guys" of the private ambulance industry.

 

[BossyCow]

The equipment weighs less now.

 

[firetender]

How about this!

Florida, New Smyrna Beach, back in the 20th Century, what they called "the 70's, the Rescue Crew was two good ole' local boys and their tow truck!

I wish I could remember their names to honor them because I swear to all that's Holy I never found a more efficient pair in the field!

With nothing more than a come-along and an ax they could extricate the unextricatable, first time, every time...and in minutes, AND I had no worries at being killed by what they were doing. (Wish I could say that for other allied protective personnel at the time, including my partners!)

Pot-bellied poetry in motion, no kiddin'!

 

[beckoncall62]

How It Was....

How about this!

Florida, New Smyrna Beach, back in the 20th Century, what they called "the 70's, the Rescue Crew was two good ole' local boys and their tow truck!

I wish I could remember their names to honor them because I swear to all that's Holy I never found a more efficient pair in the field!

With nothing more than a come-along and an ax they could extricate the unextricatable, first time, every time...and in minutes, AND I had no worries at being killed by what they were doing. (Wish I could say that for other allied protective personnel at the time, including my partners!)

Pot-bellied poetry in motion, no kiddin'!

My grandfather and my dad were firefighters and ran ambulance back in the '60s and '70s. No EMTS or paramedics back then. My grandfather was the chief and kept the ambulance at his house. It was a relatively small dept-he and my dad usually responded to calls from home.

 

[eggshen]

I think the most significant change is that the technical imparative now seems to be the norm. Instead of people using their heads it seems alot rely on gadgetry, pulse ox, glucometer, capnography and the like. When someone thinks they need to go back to the garage because their pulse-ox does not work I want to scream.

Egg

 

[RescueShirts.com]

I think the most significant change is that the technical imparative now seems to be the norm. Instead of people using their heads it seems alot rely on gadgetry, pulse ox, glucometer, capnography and the like. When someone thinks they need to go back to the garage because their pulse-ox does not work I want to scream.

Egg

AMEN to that...

Tools are great... but the days of running calls with a LP5, Stethescope, and BP cuff meant that you had to really look at and assess the patient.

Is this diabetic hypoglycemic or hyperglycemic? No CBG to check... so Hx and exam was your guide.

Does the patient actually look sick, or is the rapid breathing just psychological? No SAO2 to double check...

Don't get me wrong... I wouldn't want to go back to that... just feel that those of us who started back then got a good "Street Education" in assessment... simply because we had to.


This also spills over into the "higher education" paramedic debate. There are new medics out now that run circles around me as far as anatomy and physiology knowledge... but with my experience, I tend to be better at assessments and knowing when a patient is really "sick".

 

[firetender]

A possible trap that all medics face is, just by the cool factor of all the bells and whistles we get to use, our focus shifts more on the therapies than the patient.

In my career arc, when things in P-level EMS were first getting started, I had to pull teeth to get an order for a TKO IV and then, by the time I started working with some very forward looking Docs, I was in the field doing intra-cardiac sticks and doing UN-sychronized cardioversions (200 Joules) for life-threatening atrial-tach. At about year nine of my experience and for my last three years in the field I started to let go of my "drive" to use everything I could get away with and scaled-back to become extremely judicious in my use of ALS.

 

[eggshen]

In my experience I have found that when it comes to actually running the call I can run circles around these kids that seem to compensate for lack of common sense with reams of BS knowledge. Does one need a strong didactic base to do the job well? Absolutley! However, as soon as it gets in the way of doing your job you need to stow it. I have forgotton a lot of impressive information over the years, what I have retained however is what matters and what is needed to run any call you give me.

As far as the higher education debate goes my feeling is this; we are not doctors, we are paramedics, EMT's and so forth. It seems the more people get wrapped up in thinking they are "street doctors" or whatever, the more we muddy the waters surrounding what we do. Keep in mind at all times that what we do is take people to the hospital and sovle various other problems for them if we do not take them to the hospital. It really is that simple. Very little we do truly benefits the pt. a grand majority of the time. The most frequent one being (for those that need an ambulance) is getting them to a physician. Keep in mind that my entire career has been urban EMS with short transport times and I have no authority to discuss rural EMS with protracted transport times. I am sure that this will ruffle more than a few feathers but this I can handle.

"Yea that's real fine expensive gear ya brought out here mister Hooper. I don't what that ******* shark's gonna do with it. Eat it I suppose. Seen one eat a rockin' chair one time."

Egg

 

[eggshen]

Cricket................... cricket

 

[Asclepius]

I'm going to have to respectfully disagree somewhat here with you fellas. As our ever changing duties continue to evolve, EMS is being required to do things that at one time would never have been considered field procedures. The pressure to take the burden off of our EDs is being distributed down the rank and file. Some systems are considering allowing their medics to perform sutures in the field or things like allowing a medic to decide whether or not a condition requires a trip to the ED or if it can wait for the doctor in the morning.

Having a thorough understanding of the systems of the body and all the nuts and bolts isn't something that can be taken or left any longer. Soon we, the field personnel, will be doing things never before considered appropriate for us. This is good and bad, but regardless of your opinion on it, it is coming and we need to be prepared for it. Its no longer going to be just about the life-saving procedures and/or transport to the hospital. No, its going to be about diagnosing, evaluating, and deciding.

 

[Airwaygoddess]

The run reports, used to be black ball point pen and paper system, chart-chart-chart.
Now is a computeriezd system, with some of the systems set up like a laptop.
What will I ever do with all of those cheap black ball point pens!