KCM1 Video

[chaz90]

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.

That's the PMD system though. I don't agree with all of it either, but it doesn't leave room for dispatcher interpretation to downgrade calls. Thus, you have "not alert" calls with 102 year old demented patients dispatched as Deltas from nursing homes and a 50 year male who faints dispatched as an Alpha sick person. On the other hand, I've heard Omega calls dispatched with ALS because it's dispatch discretion to add them on.

There has to be some form of priority dispatching to allow tiered response, but I do wish it could be implemented more effectively. Honestly, I don't think the average caller understands the definition of "alert" or "normal breathing" as it's presented by the call takers. Heck, we had a call the other day dispatched as a fever that was actually an unresponsive male with agonal respirations. There's no accounting for what people report on the phone.

 

[EMDispatch]

That's the PMD system though. I don't agree with all of it either, but it doesn't leave room for dispatcher interpretation to downgrade calls. Thus, you have "not alert" calls with 102 year old demented patients dispatched as Deltas from nursing homes and a 50 year male who faints dispatched as an Alpha sick person. On the other hand, I've heard Omega calls dispatched with ALS because it's dispatch discretion to add them on.

There has to be some form of priority dispatching to allow tiered response, but I do wish it could be implemented more effectively. Honestly, I don't think the average caller understands the definition of "alert" or "normal breathing" as it's presented by the call takers. Heck, we had a call the other day dispatched as a fever that was actually an unresponsive male with agonal respirations. There's no accounting for what people report on the phone.

EMD is a system that only works great in ideal conditions. Unfortunately no caller, not even a skilled medical provider will provide an ideal set of circumstances. We just have to role with the punches, and stick to our limited guidelines. We're flying blind every time we take the call, so everything we have is setup to assume the worse case scenario until proven otherwise.

 

[NomadicMedic]

Okay, we got a little far off topic here. Let's try to get back to the King County recruitment video.

 

[Common Sense]

Cool video thanks for sharing. Question what's with all the bullet proof vests?

The paramedics are required to wear their vests on all shooting and stabbings. They just happened to be filming during 2 shootings.

KCM1, Im sorry, but that does not look like anything other than Kool-Aid. Aside from ensuring that most of your patients who could benefit from ALS never see a paramedic, your own video showcases 1989's finest patient care, touts the ability to perform highly controversial techniques with little proven clinical value and emphasizes rote learning over education.

I do think the Harborview educational model is superior, but the KCM1 system looks like a horrible one to have anything other than a cardiac arrest in.

I missed where in the video it shows that "most of your patients who could benefit from ALS never see a paramedic". Could you please point it out. I would like to review it. I looked at the video a couple of times and still could not find it.

I also think that making a blanket statment that "the KCM1 system looks like a horrible one to have anything other than a cardiac arrest in" is a bit strong. Even if you disagree with everything in this video reguarding patient care, it only show a couple of contacts. I am not sure how this video justifies your statement. Unless you spent time in the system then I would submit my humble appology.

Agreed. I'd rather work in a system that wants people who understand the science behind what they're doing and speak up when the "orders" don't make sense or aren't in the patient's best interests.

On a side note, I'm guessing that this thread isn't moving in the direction that KingCountyMedic expected..... :unsure:

In the King County system you are driven by science. There is no set of protocals to follow. Every patient is different and therefore the ability to think on your own is paramount. They do "question orders" that do not make sense or are not in the patient's best interest. The statement that Dr Copass made is in reguards to training. When you begin training, you are there to learn. Just because you spent "x" number of years as an EMT, you really don't know how to treat sick people. You may have been treating patients a certain way as an EMT, but during paramedic training, you are learning a whole different way.

Let's be honest, King County medic one has a fantastic promotional machine that continually churns out material. That's not to say that they're not a good system. But when you start believing your own press releases, there's a problem.

The last time I look at the King County Medic One Org. chart, I did not see a "promotions machine" person listed. There is a lot of published studies that come out of that county, and I think that many people view that as a "promotional machine". I look at it as a way to improve care for the sick and injured. This video and maybe two others are the only ones that I have seen that have any hint of a "promotional machine". Just my opinion.

Lets see...I saw plenty of ineffective manual compressions, gastric distension, questionable invasive venous access, old equipment lacking power cots and autopulses, a tiered system discussing how low-priority calls are turfed with no further discussion of them and an educational system that seems to be first-rate until you realize that it boils down to thirty-five years of tradition unimpeded by progress.

Why would I move there?

I would like to know how you can tell the difference between effective and ineffective CPR by watching a video that shows only a few compressions. I am sure that you did not have the capability to feel for a femoral pulse, or have a chance to look at end tidal CO2 (which is now the standard for quality CPR via the AHA) while watching this video. But you can still make this statement. WOW. What do you mean by "turfed". I can understand a system that utilizes BLS crews for non-emergent transports. I don't think that is turfing a patient, I think that it is a good use of additional resources. Again, my opion. I would also like to add "it is thirty-five years of tradition unimpeded by unscientific fads".

 

[NomadicMedic]

As you'll notice, I've combined your posts into one for the sake of clarity. In the future, a single post, multi quoting the relevant items to which you're responding, would be appreciated.

Also, do you have any experience with the Medic One system? Are you perhaps an EMT in King County?

 

[Common Sense]

As you'll notice, I've combined your posts into one for the sake of clarity. In the future, a single post, multi quoting the relevant items to which you're responding, would be appreciated.

Also, do you have any experience with the Medic One system? Are you perhaps an EMT in King County?

My appologies for all of the single posts, I am new to the forum and not quite up on multiple posts/replies. Thanks for the note.

 

[VFlutter]

In the King County system you are driven by science. There is no set of protocals to follow. Every patient is different and therefore the ability to think on your own is paramount.

So King County has no protocols? That sounds like practicing medicine without a medical license.

If King County is "driven by science" then why do they place central lines in the field without sterile precautions when IO access is faster, just as effective, and has substantially less risks. Or RSI but not use NIPPV. Etc, etc

Like others have said King County seems to do a lot of stuff well but their Medics are not omnipotent like some try to make them out to be.

I would like to know how you can tell the difference between effective and ineffective CPR by watching a video that shows only a few compressions. I am sure that you did not have the capability to feel for a femoral pulse, or have a chance to look at end tidal CO2 (which is now the standard for quality CPR via the AHA) while watching this video. But you can still make this statement. WOW.

Seriously? If I walk into a code I can immediately tell if the compressions a person is doing are effective or not without ever feeling a pulse or looking at ETCO2. I am also usually lucky enough to have an arterial waveform to confirm my suspicions.

Here is a decent video showing the difference in compressions on a morbidly obese patient.
https://www.youtube.com/watch?v=r8AcE__B3c0

 

[NomadicMedic]

This look like a protocol to me. It even says it at the top of the page!

 

[RocketMedic]

The paramedics are required to wear their vests on all shooting and stabbings. They just happened to be filming during 2 shootings.

Fair enough, does KCM1 have any other crew safeties?

I missed where in the video it shows that "most of your patients who could benefit from ALS never see a paramedic". Could you please point it out. I would like to review it. I looked at the video a couple of times and still could not find it.

Do you routinely provide pain management to elderly falls? Diabetic wakeups? "Unknown sick people"? Abnormal lab values? In practice, is there a mechanism for a BLS crew to request backup and actually get it, or is load-and-go better? There have been some reports to the contrary on this forum.

I also think that making a blanket statment that "the KCM1 system looks like a horrible one to have anything other than a cardiac arrest in" is a bit strong. Even if you disagree with everything in this video reguarding patient care, it only show a couple of contacts. I am not sure how this video justifies your statement. Unless you spent time in the system then I would submit my humble appology.

What I saw in that video was a lot of questionable and possibly substandard care. One-handed compressions, a nonsterile central line...yeah. If thats par for the course, Im sorry for your patients. The fact that you dont have interventions like CPAP that are proven to reduce patient morbidity and mortality shoots your entire argument in the leg. There is no reason to apologize for voicing legitimate concerns.



In the King County system you are driven by science. There is no set of protocals to follow. Every patient is different and therefore the ability to think on your own is paramount. They do "question orders" that do not make sense or are not in the patient's best interest. The statement that Dr Copass made is in reguards to training. When you begin training, you are there to learn. Just because you spent "x" number of years as an EMT, you really don't know how to treat sick people. You may have been treating patients a certain way as an EMT, but during paramedic training, you are learning a whole different way.

So there is no valid experience outside of King County? Do you have a special kind of sick people? For an agency that has less of a scope of practice than many and a training program that is essentially a ten-month paramedic school, it is a bold assertion to make that you are 'the best'. Back it up with outcomes.


The last time I look at the King County Medic One Org. chart, I did not see a "promotions machine" person listed. There is a lot of published studies that come out of that county, and I think that many people view that as a "promotional machine". I look at it as a way to improve care for the sick and injured. This video and maybe two others are the only ones that I have seen that have any hint of a "promotional machine". Just my opinion.



I would like to know how you can tell the difference between effective and ineffective CPR by watching a video that shows only a few compressions. I am sure that you did not have the capability to feel for a femoral pulse, or have a chance to look at end tidal CO2 (which is now the standard for quality CPR via the AHA) while watching this video. But you can still make this statement. WOW. What do you mean by "turfed". I can understand a system that utilizes BLS crews for non-emergent transports. I don't think that is turfing a patient, I think that it is a good use of additional resources. Again, my opion. I would also like to add "it is thirty-five years of tradition unimpeded by unscientific fads".

Turfed = placing patients who only need pain meds or palliation of nausea, or who are noncritical, to BLS. Once again, we have reports that KCM1 sometimes pulls lines and sends in BLS patients post-ALS. Many on this board think that that practice is retarded.

Your video is long on hype and short on substance. What are your pay scales, internal options, etc like? Where are cpap, power cots and automatic compression devices?

 

[KingCountyMedic]

It seems many of you will never be satisfied with anything, you love to argue and trash talk for the sake of doing it. I am baffled at the off topic BS and general behavior of many people on here when it comes to anything having to do with Seattle/King County. We have never claimed to be perfect. We do a few things much better than anyone else in the world and we have proven that beyond a doubt. We as Paramedics are a small piece of the pie when it comes to what we do in our system. Without the support of the medical community, the public, our citizens and our BLS providers, both public and private we would have nothing as special as our current system as it stands. You don't like the fact we do central lines in the field? I don't give a :censored::censored::censored::censored:! I have hundreds of Physicians all over King County that support what we do in the field 100% If your program had a bunch of involved, dedicated physicians tell you tomorrow, "we want you guys to triple your time in training and we want you trained in placing central lines in the field, we want you running less calls and we want you seeing the truly sick patients and we will give you the ability to really make a difference and save lives" are you going to say no??? I don't see any other threads on this forum that go sideways like this. The "mods" shut down stuff every day but I see many of these "mods" like to jump in on King County bashing so that would explain why they let it go on. How professional! I have tried to give information when I can, I have tried to be civil. I realize that even this post will draw nothing but more attacks from the internet medics and I'll sleep just fine tonight. You have the general means to apply for our program if you care to do so. Like I have said before, ANYONE is welcome to come ride with us anytime. I didn't create this system in King County, I just applied, tested, and worked my *** off to get a job here. Best thing I ever did. PEACE!

 

[Aidey]

All those threads that go sideways are the ones "the mods" close. As I have now closed this one. This is a recruitment video, and people are going to be curious and ask questions about the system. The conversation here was quite constructive, with a lot of good questions and discussion by our members. If you chose to see that as "bashing" so be it. If you have an issue with a specific person or post, please report it.