KCM1 Video

[KingCountyMedic]

http://vimeo.com/60817271

Our new recruit video, we test every year.

 

[mrg86]

Great video, saw a few familiar faces. I take their physical today and providing I pass it, have an interview later in the week.

 

[Luno]

Good Luck!

 

[Christopher]

http://vimeo.com/60817271

Our new recruit video, we test every year.

Can you elaborate on why your unit's lack captain's/airway chairs?

Also, are the video feeds always active, and if so are they used during QA/QI?

(very impressive video)

 

[terrible one]

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

 

[NomadicMedic]

The production notes show the video was produced with GoPro cams and some standard HD cameras. Those aren't video feeds from in the trucks.

I was impressed with how good it looked until Dr Copass said, "we want people who can shut up and take orders". And bragging about the ability to perform RSI and Central lines?

 

[Ecgg]

The production notes show the video was produced with GoPro cams and some standard HD cameras. Those aren't video feeds from in the trucks.

I was impressed with how good it looked until Dr Copass said, "we want people who can shut up and take orders". And bragging about the ability to perform RSI and Central lines?

Taking orders and RSI, one can build a strong argument and data to support. What I will agree with you is the central line placement in the field. This is how not to "survive sepsis" campaign and that frame at 4:41-4:47 probably goes against everything that Dr Peter Pronovost had in his checklist study
http://www.nejm.org/doi/full/10.1056/NEJMoa061115


What is the education of your Medic One? Associate or Bachelors degree?
The clip made it seem you come in as an EMT and in 10 month you are entry level Medic One. It even stated in the video you do not need a college education just to learn on a college level.

 

[RocketMedic]

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.

 

[Sublime]

Taking orders and RSI, one can build a strong argument and data to support.

What does this sentence mean?

What is the education of your Medic One? Associate or Bachelors degree?
The clip made it seem you come in as an EMT and in 10 month you are entry level Medic One. It even stated in the video you do not need a college education just to learn on a college level.

I was wondering this also. Could you clarify the education requirements? At one point it says no college education is required.

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.

Not going to lie when I first watched it I thought the system looked awesome. I can see where you're coming from though. I think the educational model is what I liked most. 10 months working in the ER with the docs (after completing medic school) seems like a huge step in the right direction. I wish more places would do something like this.

I also liked the idea of a tiered response system... in theory at least. I know the way our calls get dispatched you never know if its really als or bls till you get there. Perhaps they screen better... idk.

Also now that I think about it, I find it odd that they emphasize their ability to perform advanced techniques... but from what i've heard they don't even use CPAP.

 

[Handsome Robb]

I'll echo rocket about the Harborview Medic program.

For whoever asked, you are correct but often they hire medics with years of ALS experience and then put them back through their school.

To work at KCMO you have to attend their medic program. Even if you're already a medic with experience.

I don't understand how they cover such a large area with only 8 medic units. I understand tiered systems but for an area that large with that population 8 units doesn't seem like enough and I've heard plenty of stories of patients that should be attended by an ALS attendant that end up getting turfed to BLS so the medic unit can stay in service.

They're running the same amount of medic units that Sussex County EMS runs and they cover a much smaller area with less population.

Sure there's not a lot of evidence that prehospital ALS changes outcomes as much as we'd like to think but the fact is that there are cases that it does affect outcomes for the better just like sometimes waiting for ALS rather than scooping and running causes a negative outcome.

Maybe I'm just used to having a medic, if not two, on every run. There's been plenty of times in my short career that the ILS FD and my ILS partner didn't pick up on something that I did and ended up having to intervene to keep the patient alive a few minutes down the road. Would the EMTs in the KCMO system picked up on this and requested an intercept? Maybe yes, maybe no... I'm not a paragod by any means, I've got lots of respect for Bs and Is but the education just isn't there and that's not their fault. Some programs go above and beyond but that's not the norm. Some basics and intermediates do a lot of self study and are extremely competent but again, that's not the majority. I think tiered systems can work very well with the proper education. For B/ILS providers, I just personally don't agree with the way KCMO does it.

 

[VFlutter]

I was wondering this also. Could you clarify the education requirements? At one point it says no college education is required.

"King County Medics are trained and expected to treat patient's exactly as an Emergency Physician would"....No college education required

I love the central line placement with non sterile gloves, no masks, and what looks like no prep what so ever. But then again an ambulance is not even close to a clean let alone sterile environment to begin with.

It looks like a great education but I am really not impressed with the system or the "progressive" procedures.

So I am guessing no one gets pain management unless they are an exiting trauma?

 

[Summit]

Who needs pain control? Didn't you see the video? The only things KCMO does is CPR except for the occasional GSW, cric, or central line.

 

[Ecgg]

What does this sentence mean?

One can build a strong supportive argument for having strict medical orders that "medics follow direction" or having the capability to RSI. Where the benefits outweigh the risks. However not with field initiated central lines.

 

[RocketMedic]

Who needs pain control? Didn't you see the video? The only things KCMO does is CPR except for the occasional GSW, cric, or central line.

Pediatric respiratory distress? Meh, get an epi-pen.

 

[chaz90]

I don't understand how they cover such a large area with only 8 medic units. I understand tiered systems but for an area that large with that population 8 units doesn't seem like enough and I've heard plenty of stories of patients that should be attended by an ALS attendant that end up getting turfed to BLS so the medic unit can stay in service.

They're running the same amount of medic units that Sussex County EMS runs and they cover a much smaller area with less population.

We actually run a larger area by square mileage than they do, albeit with a much lower population density. Sussex County is ~1000 square miles, and I think the video mentioned that the portion of King County that this division covers is 600 square miles. That being said, our population density is significantly less. We have a residential population of 200000 vs. 700000 in KCM1s district. I haven't been here for a summer yet, so I'll get back to you on how coverage of the greatly expanded summer population works with 8 medic units.

One thing I have noticed is that we routinely use our ability to split our crew and respond to multiple calls at the same time. I don't think KCM1 can do this as they run a crew of two medics, but respond and transport in their own ambulance. By having two medics with two chase trucks and sets of gear available, we essentially double our surge capacity to respond to calls. Theoretically, our 8 medic units can balloon into 18 single medic ALS units by splitting each crew and adding each supervisor into the mix.

 

[MrJones]

...I was impressed with how good it looked until Dr Copass said, "we want people who can shut up and take orders"....

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:

 

[Christopher]

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:

A bit standoffish if anything. Many of the complaints would be better phrased as a question as most of us are shooting in the dark

For example, instead of, "I love the central line placement with non sterile gloves, no masks, and what looks like no prep what so ever. But then again an ambulance is not even close to a clean let alone sterile environment to begin with."

We could try, "I noticed that the clip of the supposed central line placement showed IJ access without sterile precautions. What sort of setup do you follow when performing central lines? Is there any increase in CLABSI from EMS placed lines?"

 

[chaz90]

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

That's one of the idiosyncrasies of this forum. In much of the EMS community, Medic One is seen as the Mecca for US ALS care. On EMTLife however, we seem to have gone the complete opposite direction and sometimes seem to criticize them overly harshly. No system is perfect, and I think we react to the perception that they are by some providers. In truth, I think they do some things really well and fall short in others, just like all of us. I like their emphasis on education, can understand their desire to have some consistency in background, and think they do the best job of effective PR of any EMS system. At the same time, I agree (from an outside perspective) that they seem to put too much emphasis on a narrow subset of cardiac arrests and may have a system bias towards BLSing less than glamorous calls that should be ALS.

 

[NomadicMedic]

Well, this video was shot as a recruitment video and it should stand on its own, don't you think? Shouldn't the video be a clear depiction of how the process is performed every day? Displaying a video for potential recruits that shows a paramedic performing a skill without the proper PPE or the proper sterile procedure is simply an egregious error.

However, this video seems to rely on the sizzle… And has very little about the steak. If you want a job where you "do cool stuff and lots of skills" this may be the perfect job for you.

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.

 

[VFlutter]

A bit standoffish if anything. Many of the complaints would be better phrased as a question as most of us are shooting in the dark

For example, instead of, "I love the central line placement with non sterile gloves, no masks, and what looks like no prep what so ever. But then again an ambulance is not even close to a clean let alone sterile environment to begin with."

We could try, "I noticed that the clip of the supposed central line placement showed IJ access without sterile precautions. What sort of setup do you follow when performing central lines? Is there any increase in CLABSI from EMS placed lines?"

It was somewhat meant to be snarky. Central line placement is a controversial skill that KCM1 puts on such a high pedestal and in the video used as example of how advanced their paramedics are. I am judging the clip as I see it. I do not think my observations are a shot in the dark.

I have asked the OP about central lines before and here is the response I got...

We place IJ, subclavian, and Fem central lines. We use the Trauma Arrow Kit with sterile drape and sterile procedure and suture them in place. We are required to fill out Central line forms for every line placed in the field, same as we fill out airway form for every tube placed. A central line is to be placed only when we have a patient that has no other peri access available. We have recently started using the EZ IO as well and that has cut down on central line use a bit but we still do quite a few. We place them in cardiac arrest patients, trauma patients, anyone that needs one gets one. We are required to perform at least two a year for recert. Our complication rate is very low, as is our infection rate. We are trained in placing central lines with sterile technique by trauma surgeons at Harborview Medical Center. All lines in King County are yanked if the patient is admitted, especially central lines started in the field unless there is no other line to be had. We are required to document everything we do, every IV, central line and ET tube placed is reviewed that week by our medical director. If you screw up you will hear about it usually in less than 24 hours. I have placed many central lines in awake patients, local lidocaine prep and sterile tech used of course. We do a lot of stuff here that isn't done in a lot of places.

This is not what I saw in the video. I saw a open sterile central line kit and a medic placing an IJ central line wearing unsterile gloves, no mask, and no sterile drapes.

Even in codes we still use sterile gloves and a heavy lathering of betadine before placing a central line.