KCM1 Video

[RocketMedic]

+1...if I have to lift it in, we are not taking it inside. I will never work routinely without a power cot again.

Does Medic 1 interact well with other ALS services?

 

[NomadicMedic]

+1...if I have to lift it in, we are not taking it inside. I will never work routinely without a power cot again.

Does Medic 1 interact well with other ALS services?

There are no other ALS services in the county. Some of the private ambulance companies have nurses that run ALS IFT. But in King County, medic one is it.

 

[Ecgg]

We do 24 hour shifts. 1 on, 1 off, 1 on, followed by 5 days off. We have "debit days" which are used to cover vacation. We have 4 platoons, each shift has a MSO (Bat Chief) along with our Chief and 4 other day time MSO's that oversee training/hiring/operations etc. Each shift has an acting MSO that fills in for the shift MSO and then we have FTO's. So there are some promotional opportunities. We do have very good benefits and retirement. We are in the IAFF Union under our own local but we are not firefighters. We do carry bunker gear for car accidents and other operations were full protective gear is needed. We are all custom fitted and issued our own ballistic vests and we are required to wear them on all assault w/weapons calls. Our pension plan is LEOFF 2. Our pay is quite good and overtime is usually always available to those that want it. As far as education requirements yes you can get hired with a high school diploma/GED and an EMT card. Many of our people have multiple degrees, we have a ton of RN's that work here as well. Everything we do is overseen by some of the nations best Doctors, as far as our scope of practice and what we do in the field, everything is overseen by Physicians who are actively involved in running our program. Every patient we see is documented and the case is reviewed by our Docs. Our program was designed by a group of Doctors that wanted to save life. They wanted to see if they could train a firefighter to go out and operate as an extension of the ER Physician. We have a history that we are proud of and we love to go to work. If you are interested we test almost every year. Here's the rest:


http://www.kingcounty.gov/healthservices/health/ems/MedicOne.aspx

I appreciate a serious response to the questions posed. I think people have misconceptions or have own ideas what the program should be instead of what it actually is. What it actually is “train a firefighter to go out and operate” and this is not a knock by any means, just call things for what they are. You take a group of guys who have done this job for at least 3 years or more as primary benchmark and retrain them over 10 month to run sequence of events more proficiently (i.e. the code) with consistent rudimentary drilling. Well what you know? The basics do work and they the results speak for themselves. If you are the sole ALS provider you can control such variables.

 

[KingCountyMedic]

I appreciate a serious response to the questions posed. I think people have misconceptions or have own ideas what the program should be instead of what it actually is. What it actually is “train a firefighter to go out and operate” and this is not a knock by any means, just call things for what they are. You take a group of guys who have done this job for at least 3 years or more as primary benchmark and retrain them over 10 month to run sequence of events more proficiently (i.e. the code) with consistent rudimentary drilling. Well what you know? The basics do work and they the results speak for themselves. If you are the sole ALS provider you can control such variables.

The training never stops really. After completing Paramedic Training you are on probation for 1 year, You are assigned to a shift and assigned to an FTO that will evaluate you on every call. You are not allowed to work with anyone but FTO's for your first six months. Once a month the Shift MSO will come and ride as your partner and evaluate you. Our Medical Director will also ride with you quite a bit while you are on probation. After six months is up you are released into the wild to work with all the folks on your shift. We rotate trucks most every month so you will experience working in very urban areas with tons of trauma and violence and then move out to rural areas and work with mostly volunteer fire departments and spend a lot of time with patients as transport times go much longer out in the sticks. We have a recert test every 2 years. You are required 50 hours of CE per year, 12 intubations per year, 36 IV's per year, 2 central lines per year. These requirements never go down like in other systems that I have worked in. We have multiple opportunities for CE every month and the majority of it involves hands on training with our Doctors present. The first Tuesday of every month we have "Tuesday Series" at Harborview Medical Center and it is 3 hours of Physician lectures. You attend in person and you will get 3 hours CE as well as 3 hours of overtime. You are also able to watch it online for the CE but you only get the OT pay if you attend in person and you are required to attend at least 3 per year in person.

 

[Ecgg]

The training never stops really. After completing Paramedic Training you are on probation for 1 year, You are assigned to a shift and assigned to an FTO that will evaluate you on every call. You are not allowed to work with anyone but FTO's for your first six months. Once a month the Shift MSO will come and ride as your partner and evaluate you. Our Medical Director will also ride with you quite a bit while you are on probation. After six months is up you are released into the wild to work with all the folks on your shift. We rotate trucks most every month so you will experience working in very urban areas with tons of trauma and violence and then move out to rural areas and work with mostly volunteer fire departments and spend a lot of time with patients as transport times go much longer out in the sticks. We have a recert test every 2 years. You are required 50 hours of CE per year, 12 intubations per year, 36 IV's per year, 2 central lines per year. These requirements never go down like in other systems that I have worked in. We have multiple opportunities for CE every month and the majority of it involves hands on training with our Doctors present. The first Tuesday of every month we have "Tuesday Series" at Harborview Medical Center and it is 3 hours of Physician lectures. You attend in person and you will get 3 hours CE as well as 3 hours of overtime. You are also able to watch it online for the CE but you only get the OT pay if you attend in person and you are required to attend at least 3 per year in person.

That is excellent and definitely attributes to the success. However training, drilling and CE ≠ formal college education! It is my opinion and a strong belief that you need strong emphasis on both to be a progressive system and they not interchangeable as some believe. However, Paramedicine is stuck in that archaic model where years on the job and annual performed numbers “X iv sticks per year, X tubes per year, X central lines per year” is king and formal education is trivial.
You may certainly make an argument that what we strive to accomplish is coordinated action that is drilled constantly and you do not need a college education and we have results to prove it. I have no argument with you there. However to put on a façade of being progressive yet listing the same archaic employment criteria. One thing to consider is that someone who has gone through formal schooling (not just CE and on the job training) has a much better understanding at the limitations and consequences of both actions and inactions. Much better at factoring in patient priorities.
Enroll into real college microbiology with lab class and read the leading causes of ICU mortalities. Browse the surviving sepsis site during the class, perhaps read the checklist manifesto book and after come back and tell me about field initiated central line access and how it’s not always possible to have sterile technique in the field yet we need to hit our numbers spiel.

 

[PotatoMedic]

My understanding is that the KCM1 program was working on making the program a BA degree in Paramedicine if you took a few classes post completion of the program. I don't know the status of that but I heard it in the rumor mill a year or two ago.

 

[46Young]

A few people have questioned the need for certain advanced procedures in the field, including central lines. We were told that the first due can be urban, or it can be rural. If the transport times are long, and a medevac is not available, ten certain advanced procedures may be warranted.

I have a deployment question. My department has nearly 1.1 million residents, over 395 square miles. KCM1 serves 750,000 over 500 square miles. We formerly had 14 medic units (all double medic), with one day time medic unit, and 27 BLS units. We also have 37 ALS engines. We now have 15 double medic units, and 26 medic/EMT units. The engine deployment remains the same.

When we had the 14 medic units, I felt that we had adequate coverage over the 395 miles for ALS calls. How does KCM1 manage with 500 miles to cover? If one of the rural units gets a call, how does that area (with a presumably large geographical first due) maintain ALS coverage? Do you have ALS engines or medic chase vehicles?

The reason I'm asking is that these two systems are somewhat close in size and population, with yours being somewhat more sparsely populated. I desperately want to have a tiered system, not the expensive all-ALS nonsense we're currently stuck with. Going on our old deployment model with 14 medic units for 1.1m, your 8 medics for 750k is roughly proportional, where we have one medic per 78k residents, and you have one medic per 93k people. You also cover an area that's more than 125% larger than ours. I'm looking to show how you make it work with less medics and a larger coverage area than we had.

 

[chaz90]

My understanding is that the KCM1 program was working on making the program a BA degree in Paramedicine if you took a few classes post completion of the program. I don't know the status of that but I heard it in the rumor mill a year or two ago.

You'd have to take more than a few extra classes to turn a 10 month program into a Bachelor degree. Also, I think the point being made was the desire to emphasize more in depth learning with full courses in subjects like anatomy, physiology, pharmacology, biology, microbiology, and chemistry. This doesn't mean just tacking a degree on to the same vocational education.

 

[KingCountyMedic]

A few people have questioned the need for certain advanced procedures in the field, including central lines. We were told that the first due can be urban, or it can be rural. If the transport times are long, and a medevac is not available, ten certain advanced procedures may be warranted.

I have a deployment question. My department has nearly 1.1 million residents, over 395 square miles. KCM1 serves 750,000 over 500 square miles. We formerly had 14 medic units (all double medic), with one day time medic unit, and 27 BLS units. We also have 37 ALS engines. We now have 15 double medic units, and 26 medic/EMT units. The engine deployment remains the same.

When we had the 14 medic units, I felt that we had adequate coverage over the 395 miles for ALS calls. How does KCM1 manage with 500 miles to cover? If one of the rural units gets a call, how does that area (with a presumably large geographical first due) maintain ALS coverage? Do you have ALS engines or medic chase vehicles?

The reason I'm asking is that these two systems are somewhat close in size and population, with yours being somewhat more sparsely populated. I desperately want to have a tiered system, not the expensive all-ALS nonsense we're currently stuck with. Going on our old deployment model with 14 medic units for 1.1m, your 8 medics for 750k is roughly proportional, where we have one medic per 78k residents, and you have one medic per 93k people. You also cover an area that's more than 125% larger than ours. I'm looking to show how you make it work with less medics and a larger coverage area than we had.

Our rural areas are typically not high call volume areas, and the way we have our units deployed our transport times to a hospital with cath lab, CT scanner, Level 2-3 are probably 20-30 minutes at the longest end of of the rope. For the big time trauma and super sick needing surgical care we have Airlift Northwest Helicopters and we typically fly the the stuff we get in the most rural areas. We have the option of splitting crews when we need to, one Medic may jump onto an aid car, engine, or private ambulance and go to the next call. We also have our MSO's in SUV's that can cover when the system is busy. During the day we have up to 6 MSO's that are all certified Medics with full kits and they all will run calls if needed. The other thing we will do is if the Medic is coming from a ways out our aid cars or ambulances will load and go meet us. Another option is if the BLS crew feels they can get the patient to the hospital much faster than we can get to them we will discuss it on the radio, they will give us a detailed short report on the patient and we will make the decision. (this happens very rarely) we also have mutual aid agreements with providers both in King County and counties on our borders. And last in many of the more rural areas we have quite a few of our Medics that live in these areas and have volunteered with local departments and have been authorized to have gear with them in the past. I don't know about your system but I imagine you guys probably send Medics to a lot of calls that we don't typically send a Medic response. Not knocking yours or anyone else. I came from a county that had Paramedics on every street corner, every engine company.

 

[KingCountyMedic]

My understanding is that the KCM1 program was working on making the program a BA degree in Paramedicine if you took a few classes post completion of the program. I don't know the status of that but I heard it in the rumor mill a year or two ago.

I think that is still being worked on as an option if the student wants to pursue it. Don't think it's up and running yet. It was more than a few classes I believe, it was quite involved.

 

[KingCountyMedic]

Here's a link to the Resuscitation Academy. This is put on by our Doctors and Medics. It's more info about what we do over here.

http://resuscitationacademy.org/

 

[46Young]

Our rural areas are typically not high call volume areas, and the way we have our units deployed our transport times to a hospital with cath lab, CT scanner, Level 2-3 are probably 20-30 minutes at the longest end of of the rope. For the big time trauma and super sick needing surgical care we have Airlift Northwest Helicopters and we typically fly the the stuff we get in the most rural areas. We have the option of splitting crews when we need to, one Medic may jump onto an aid car, engine, or private ambulance and go to the next call. We also have our MSO's in SUV's that can cover when the system is busy. During the day we have up to 6 MSO's that are all certified Medics with full kits and they all will run calls if needed. The other thing we will do is if the Medic is coming from a ways out our aid cars or ambulances will load and go meet us. Another option is if the BLS crew feels they can get the patient to the hospital much faster than we can get to them we will discuss it on the radio, they will give us a detailed short report on the patient and we will make the decision. (this happens very rarely) we also have mutual aid agreements with providers both in King County and counties on our borders. And last in many of the more rural areas we have quite a few of our Medics that live in these areas and have volunteered with local departments and have been authorized to have gear with them in the past. I don't know about your system but I imagine you guys probably send Medics to a lot of calls that we don't typically send a Medic response. Not knocking yours or anyone else. I came from a county that had Paramedics on every street corner, every engine company.

You're right, we have medics on every call, sometimes 3-4 medics. Most of our call types are ALS (cookbook EMD and CYA up-triage), and every ALS call gets an ALS engine. I don't see how anyone can learn, or get better as a paramedic when most of our calls are non-acute, minor issues, or monitor/IV jobs ate best. I'm lucky if I run one cardiac arrest a month, or do anything past a 12-lead and an IV on 90% of our patients. I used to work in the NYC 911 system. The protocols were very restrictive, probably due to there being numerous hospitals and privates working with the FDNY, but at least it was tiered, and we only responded to ALS calls. No board and collar jobs, injuries, sick jobs, EDP's, drunks, postictal Sz, etc. I learned 90% of what I know from the three years as an EMT, and two as a medic before I left the city. These last five years have been spent basically learning how to slow down to the speed of the other people working on our typical slow paced 6-7 person bum rush into each patient's house. The idea is if we have 2-3 medics on the scene, one of us should know what we're doing.

 

[KingCountyMedic]

You're right, we have medics on every call, sometimes 3-4 medics. Most of our call types are ALS (cookbook EMD and CYA up-triage), and every ALS call gets an ALS engine. I don't see how anyone can learn, or get better as a paramedic when most of our calls are non-acute, minor issues, or monitor/IV jobs ate best. I'm lucky if I run one cardiac arrest a month, or do anything past a 12-lead and an IV on 90% of our patients. I used to work in the NYC 911 system. The protocols were very restrictive, probably due to there being numerous hospitals and privates working with the FDNY, but at least it was tiered, and we only responded to ALS calls. No board and collar jobs, injuries, sick jobs, EDP's, drunks, postictal Sz, etc. I learned 90% of what I know from the three years as an EMT, and two as a medic before I left the city. These last five years have been spent basically learning how to slow down to the speed of the other people working on our typical slow paced 6-7 person bum rush into each patient's house. The idea is if we have 2-3 medics on the scene, one of us should know what we're doing.

Over here in our state we have the same problem in most areas but mine. Most agencies outside of King County bill for transport, including most fire departments. The patient with an IV, blood draw, cardiac monitor, and O2 is worth an extra $500-$700 or more compared to just transporting them BLS. So most places pack on Medics and encourage ALS transport. Where I used to work the phrase was "O2, IV, Monitor every patient you can justify using it on, it protects the patient and your job."

 

[KingCountyMedic]

Here's another one of our sites. We use this for our Airway and Central Line report tracking and we also get all of our CPR cases sent us to follow up on. Our call is recorded from start to finish and then one of our Doctors will critique it and give us feedback. We log in for our portion as it is all HIPPA/Legal but there is quite a bit of content on here for the public to view:

http://www.emsonline.net/

 

[RocketMedic]

Home sick...cut out my last day because Im not spending 12 hours in a rig feeling like this.

24 y/o M, nausea, fever, headache, sore throat. If I were enough of a pansy to call, Id get a PO Zofran, maybe an IV and capno if I got a Kool-Aid drinker. In King County, what would I be triaged as?

 

[KingCountyMedic]

Home sick...cut out my last day because Im not spending 12 hours in a rig feeling like this.

24 y/o M, nausea, fever, headache, sore throat. If I were enough of a pansy to call, Id get a PO Zofran, maybe an IV and capno if I got a Kool-Aid drinker. In King County, what would I be triaged as?

Dispatch would ask you a series of questions to determine if you met any dispatch criteria and if you didn't meet any criteria for urgent dispatch of a BLS unit 911 would probably transfer you to the nurse line. Nurse would talk to you more and figure out if any of our BLS units need to come see you or discuss other options of care. If you seem to be a shut in or have other special needs, or you call 911 a lot one of our fire department CARES units would come out and contact you and see what can be done to assist you. They have access to all sorts of options, get you hooked up with a case worker, medical clinic, etc. With your complaints of headache, nausea, and fever I imagine you would get an engine or aid unit dispatched. The BLS unit would come and further triage you.

 

[46Young]

Home sick...cut out my last day because Im not spending 12 hours in a rig feeling like this.

24 y/o M, nausea, fever, headache, sore throat. If I were enough of a pansy to call, Id get a PO Zofran, maybe an IV and capno if I got a Kool-Aid drinker. In King County, what would I be triaged as?

I've worked at opposite ends of the spectrum. In NYC, that pt would be BLS, and whoever's riding aid would probably just walk him to the bus, tell the driver to start driving, and maybe get a quick set of vitals en-route (or just use "vital vision"). Where I work now, they want everything done, because hey, that nausea could be atypical ACS or something. Like KingCountyMedic said about neighboring jurisdictions, making a BLS pt into ALS by justifying an IV and an ECG can bring in more revenue.

With a patient like this, I'll play dumb and ask if they had already been to urgent care or their doctor, and what did they say?

 

[NomadicMedic]

That would also be triaged as a BLS call here, unless you tripped the "ALS indicator" by answering no to "is the patient breathing totally normally" or "is the patient totally alert" questions. Then it's a Charlie or Delta ALS upgrade. (Usually cancelled by BLS when they arrive on scene and assess the patient.)

 

[RocketMedic]

That would also be triaged as a BLS call here, unless you tripped the "ALS indicator" by answering no to "is the patient breathing totally normally" or "is the patient totally alert" questions. Then it's a Charlie or Delta ALS upgrade. (Usually cancelled by BLS when they arrive on scene and assess the patient.)

Fair enough lol.

 

[46Young]

That would also be triaged as a BLS call here, unless you tripped the "ALS indicator" by answering no to "is the patient breathing totally normally" or "is the patient totally alert" questions. Then it's a Charlie or Delta ALS upgrade. (Usually cancelled by BLS when they arrive on scene and assess the patient.)

I have a problem with places that use dispatchers with no medical experience, and train them to use EMD exclusively. Someone that drops a bowling ball on their foot. The dispatcher asks them if they're short of breath. They may be in a lot of pain, so they answer yes, and then it becomes ALS. Meanwhile, we get a lot of elderly falls, with a concurrent c/o dizziness or weakness, and it's BLS.

I miss the FDNY EMT and medics working as dispatchers for the NYC 911 system. The call types were pretty accurate much of the time.