Responding Alone

[Jon]

I saw this on another fourm, and decide to pose the question here.


In my area, it is common to have "non-transport" units respond to calls, in addition to transport ambulances. These units include both "QRS" vehicles, recognized by the state, with a minimum of 1 state-certified EMT onboard, with all equipment needed to treat and package a patient prior to EMS arrivial. Also included are state-certified ALS responder units, with a minimum of 1 EMT-P, with all equipment needed to provide ALS care onscene and during transport when combined with a BLS ambulance.

Also included are various "non-certified" response vehicles.... Ambulance and Fire officers responding in personal or squad vehicles, usually with O2 and most BLS equipment, and fire apparatus responding to assist the ambulance as well.

All of these vehicles serve a purpose, and have a place in a modern EMS system. However, many times, (with the exception of a firetruck) these vehicles respond with only 1 provider. These vehicles are used often BECAUSE they can arrive at a scene faster than the ambulance can.


In your opinion, does this present a safety risk??? I'm thinking about scene safety.... in this case, you don't have a partner to back you up.

How do you handle this in your area???

Jon

 

[TTLWHKR]

Carry a radio with a DTMF panic button.

 

[rescuecpt]

I first respond alone. You need to be very aware of your surroundings and a good judge of scene safety. If something doesn't feel right, I putz around with my equipment until backup arrives, but this rarely happens.

 

[Jon]

Originally posted by TTLWHKR@Oct 18 2005, 03:44 PM
Carry a radio with a DTMF panic button.

Nah... I like the top-mounted "big red button."


I've QRS'd with others... never by myself.

Our medics are "single provider" so they will occasionally beat us, and usually beat other Co's to calls (We have crews in station, and they are usually at our station, or their base at the ED across the street). They will often start care as best they can. Other times, they might "time" their arrivial to be the same as the incoming unit, or wait for the BLS crew to get out of the truck until they head in.

Around here, in many of our served municipalities, the PD is dual-dispatched, and beats us in. Most cops have an AED, and several agencies have their Officer/EMT's with full BLS bags. Several departments have all cars equipped with "TraumaDex" or "Quickclot" as well (Non-EMT's can use it, EMT's can't ) it is rare to see the cops use their equipment, but they will if it is really needed.


At work, I'm the only EMT, and, depending on where I'm working, could very easily be the only security officer on a call, and always the only EMT. I'm less concerned here, because we just don't get "violent" calls.

Jon

 

[MMiz]

Our service, in addition to providing ALS ambulances to the cities we serve, also have Paramedic First Responder vehicles. They're staffed by one medic with ALS equipment but no drug box. Mainly we use them to keep our response times fast.

I like having a partner, but our PFRs love what they do. They're senior medics who have earned their spots on the unit, and they like responding to only emergency calls (we're a private company).

We have those little red buttons on our radios too, but unfortunately our radios aren't associated with a unit. We simply grab one off the rack, and dispatch has no clue who is who.

Interesting question.

 

[Jon]

Originally posted by MMiz@Oct 20 2005, 04:53 AM
They're staffed by one medic with ALS equipment but no drug box. Mainly we use them to keep our response times fast.

By this do you mean they have no narcotics, correct.... I would hope they still have Nitro, ASA, D50, and the code drugs.

We have those little red buttons on our radios too, but unfortunately our radios aren't associated with a unit. We simply grab one off the rack, and dispatch has no clue who is who.

Where I did my ride time, the medics Statused themselves at shift change. Each medic advised dispatch which radio they were carring for the shift, and that radio was linked to their unit for their shift.

Jon

 

[joeyjoejoe]

I work in a single paramedic response (city) unit with all the drugs/equip that would normally be carried on a transport unit.

Normally, I only respond to calls that fire would come to as well (tiered response). However, there are often times where I get there before fire or "volunteer" to go to calls that are lower priority that may not require a transport unit and that I assess for that.

I have never felt that my safety was in jeopardy, why? I don't get dispatched to pysch calls/calls where police would be warrented prior to scene safety being established.

Be smart.

 

[Jon]

Welcome, Joe.

Very well written reply.

My only comment..... what if the "head injury" is really from an assault??? Or the one we had locally a year ago.... Dispatch... ALS Injured Subject... Guy was Shot.... somehow, the calltaker neglected to asertain Why the guy was hurt.

Jon

 

[TTLWHKR]

Originally posted by MedicStudentJon+Oct 19 2005, 07:10 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (MedicStudentJon @ Oct 19 2005, 07:10 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-TTLWHKR@Oct 18 2005, 03:44 PM
Carry a radio with a DTMF panic button.

Nah... I like the top-mounted "big red button."


[/b][/quote]
That's the DTMF button, if it's programmed properly. Sends an open air signal and your radio ID to an advanced CAD system.

If it isn't programmed to do that, then it just makes a loud noise. A "man down" siren.

 

[joeyjoejoe]

Originally posted by MedicStudentJon@Oct 21 2005, 03:15 PM
My only comment..... what if the "head injury" is really from an assault??? Or the one we had locally a year ago.... Dispatch... ALS Injured Subject... Guy was Shot.... somehow, the calltaker neglected to asertain Why the guy was hurt.

Jon

Meh, these things happen all the time. The pseudo injury that ended up being an assault, or (certainly less often) the person shot that wasn't evident in the dispatch details. The anecdotal stories of the Alpha abdo pain turning into the "crazy psych guy".

For dispatching, we use I assume a "good" dispatching algorithm, ProQA? It's the Alpha, Brava...Echo one. I can't recall in recent memory any call that really required police on scene, where I wasn't given details to indicate that prior.

Thankfully I have full discretion (as I hope you all do) to attend calls where I believe the scene is safe and secure. If there is anything evident from the details or upon pulling up to the scene itself, I would hope (especially if you were by yourself in a response unit) you would use extreme discretion prior to entering. You don't think it's safe? Stage, and wait for police.

Unfortunately the fire department does not always use such discretion.

 

[emtff99]

We do alot of "direct scene response" here in my area, with the fact that @least 1 Emt & Driver is responding to the Station for the Ambulance. However, Pysch & "unknown" calls Everyone will either head directly to the Station or stage away from the scene until otherwise told by Dispatch. 100% of our coverage area is rural, with the exception of the Resort lake that is also in our coverage area.

If I dont feel safe coming upon the scene, I will stage & wait until either Ambulance shows up or @least 2 other crew members show.

 

[squid]

I'm in what you folks would probably call a rural volly dept, and we respond POV all the time. The difference in response times can be very long, depending on where you live or are at the moment -- I could get to a scene 20 minutes before the ambulance, if conditions were right. The official policy is *no one* goes in alone, but it's tacitly acknowledged that we break protocol frequently, because we often know the people involved or because it appears safe and it might make a difference. I'm not saying that's the best way, not at all. Just that's how we seem to do it. Oh, and all of our EMTs have a radio, but there's a large portion of our district that doesn't get radio coverage.

 

[TTLWHKR]

Protocols were made to be broken..

HEY! That's a lyric... I could write a song!

 

[squid]

Well, I just wanted to look cool by using a big word like "protocol." I'm not sure we actually have those in my department...I think we just do whatever we don't think someone will yell at us for...

 

[emtff99]

Originally posted by squid@Oct 26 2005, 04:48 PM
I'm in what you folks would probably call a rural volly dept, and we respond POV all the time. The difference in response times can be very long, depending on where you live or are at the moment -- I could get to a scene 20 minutes before the ambulance, if conditions were right. The official policy is *no one* goes in alone, but it's tacitly acknowledged that we break protocol frequently, because we often know the people involved or because it appears safe and it might make a difference. I'm not saying that's the best way, not at all. Just that's how we seem to do it. Oh, and all of our EMTs have a radio, but there's a large portion of our district that doesn't get radio coverage.

Good now I kind of feel @ home,,"Another Country Bumkin Volly" J/K 98% of our area is good for radio coverage,,but its the 2% that sometimes bothers me.

 

[Rangat]

In South Africa (Your probably getting used to this intro...), the provincial and private Response Vehicles have different motivations:

The provincial has a PRV (paramedic resp veh.) that only goes out on request or on serious calls. h34r:

The Private co's have response vehicles so that if they get on the scene first, they take the pt. And besides that they try to get around to all the calls, because if they say to the pt. "Hey, how do you feel?", they charge ALS rates. B)

You have noooo idea how good pt care can get when competition is involved! :lol:

 

[hfdff422]

Our hick volly dept. has SOP's that dictate no POV's (going direct) unless you are an officer (PIO or training officer does not count, Lt. or higher), or are requested by an officer or the incident commander. In other words, you take the ambulance or the engine- period. The fact that we dont have radios for all of our personnel is the reason for this. We will always have at least one person manning the radio and at least one person working the patient until scene assesment is done and patient priority is established. Since we are a BLS provider we will usually have a medic enroute as well. This is feasible in our area because most of our active personnel are within 2 miles of the station and if the ambulance is not out the door in 5 minutes, it probably is not going to go.

While it isn't feasible in all situations, POV's are something of a relic and should be avoided whenever possible. It doesn't instill confidence in the people you serve when an ill equipped, undermanned POV shows up for a full code in addition to the personal safety issues that are involved. But the flip side is that if your dept. can not afford additional stations or apparatus for area coverage, having an EMT or FR properly equip their POV with a full array of BLS equipment, (including and especially an AED) radios and signal lights is the next best thing to apparatus coverage. One of our neighboring dept.'s have battalion chief and chief vehicles that carry BLS bags, full radio (mobile and portable), full emergency lighting, etc.

Personal safety is paramount, an injured FF or EMT takes the focus off of the original patient and is something that could cause serious repercussions for all involved. Two in /two out is a good rule for EMS as well, although two in/ one "out" would be a reasonable modification. When granny is having the FDGB's or PCL's then the rules are not as critical, but when you are approaching a scene where you aren't pretty sure what is going on, develop and stick by SOP's with safety in mind. You will apear more professional and render better and more complete patient care.

While there are variations to this, the only situations that are regularly priorities to the point that personal safety would be secondary would be getting defib or airway to the patient. All other circumstances should have two people on scene with a radio before patient/family member contact is made. That diabetic emergency could turn violent just as fast as that OD situation. Or a frantic mother could interfere with EMS on a child having an asthma attack. be aware of the dangers that come from the places you least expect. Make sure that the person with the radio is using the radio- if Jim Bob turns violent, radio man should use the radio as his first weapon, then assist his partner instead of jumping in right away. Two dead EMT's with no radio contact would not be my idea of a well managed situation, of course, one dead EMT is not much better but at least if law enforcement is enroute and you get control of the scene you can save your partner.

 

[ResTech]

I have responded to many calls POV and QRS by myself before. One good thing is that my volly station operates itz own repeater system and volunteers are issued radios on our own private UHF frequency. Our system has about a 30-40 mile range so it covers no matter where were at. I dont think it poses a safety risk. I prefer to have a partner but it doesnt bother me if I dont. And alot of times PD is notified of EMS calls and if they are in the area they will swing by to assist anyways.

I like POV's going to the scene... especially on MVC's, CODEs, structures, etc. Not everyone lives within a block from the station and is nice to have help show up onscene.

 

[squid]

I agree that it's desirable to have as few vehicles on the road as possible, and no POVs is a good rule for small areas, but -- for instance -- my department covers an area about an hour's drive in decent weather (and we're lucky if we have that for 6 months out of the year). The difference in response times for a person getting to the station to pick up a piece of apparatus and going direct from the residence can be considerable.

Since because of where I live I almost always respond in my POV, I try to put on my jumpsuit for medical calls or my bunkers before I get to the person's house -- make it a little more obvious who I am by the uniform. And even if I have absolutely no supplies on me other than what fits in a pocket, I an give a good assessment to the other responders, and even that helps save time when they know exactly what to grab from the rig and they know vitals and such before they get there.

 

[hfdff422]

Originally posted by squid@Nov 9 2005, 11:35 AM
I agree that it's desirable to have as few vehicles on the road as possible, and no POVs is a good rule for small areas, but -- for instance -- my department covers an area about an hour's drive in decent weather (and we're lucky if we have that for 6 months out of the year). The difference in response times for a person getting to the station to pick up a piece of apparatus and going direct from the residence can be considerable.

Since because of where I live I almost always respond in my POV, I try to put on my jumpsuit for medical calls or my bunkers before I get to the person's house -- make it a little more obvious who I am by the uniform. And even if I have absolutely no supplies on me other than what fits in a pocket, I an give a good assessment to the other responders, and even that helps save time when they know exactly what to grab from the rig and they know vitals and such before they get there.

I agree with that approach in your situation. I was not thinking about an hour drive for an entire district! That is big. The long dimension of our district is 7.75 miles, which is about average in our area. Some municipal distrcts have a 3-4 square mile coverage area. So thinking in those terms, the apparatus response is reasonable, thinking in your terms, the POV response would be critical.

What works is what works for that department (yes I know that is oversimplified).

My biggest concern is for the safety of my crew and the people we are treating. I feel that having a full crew is the safest way to go. To me a full crew is three on the bus or two on the bus and an engine crew, which with the volly's you arent always afforded that luxury. But when that is not feasible, then you do what you have to do.

People always associate a firefighters bravery with going into a burning building. Fire is not scary to me, the unpredictability of people is the scariest thing we have to deal with. Working that MVC on the interstate, or that "sick person" run at 01:00 with several "family members" is much scarier to me than a structure fire. Fire is dangerous, but it is what it is. People are more dangerous since they aren't what they appear all too often.

I do wonder, squid, do any of your POV's have an AED, with that kind of territory to cover it would seem wise to equip some EMT's with them depending on their location.