Still Alarm: Froze, should I move on from IFT

Mitchellmvhs

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Quick little background. I work for Doctors Ambulance in OC which is 90% IFT and some 911. I have done a handful of TC’s and other 911 calls, but OC is fire based ems with BLS ambulances and all medics are OCFA with the exception of Placentia I believe. I’ve been an emt for around 7 months now. I haven’t had a 911 call for like 2 months now.

We just cleared a CCT with our Nurse and our on the way back to station today. And it was POURING rain. On the freeway we come across 4 car TC with 1 car completely totaled. My partner’s only a little newer than me. And has only had like 3 911 calls. I have never been first on scene to a call and all my 911’s I’ve been with a really experienced partner who could guide me.

We stop and ask if they need help, 1 pt in the totaled car saying she had back pain, but I think she was just shocked. We’re not even blocking the scene. Just throw our primarys on and hop out, throw on TC gear. My partner is talking to dispatch and my Nurse goes to talk to the lady. I literally just stand there. I feel so stupid. We could literally see fire on the way here and they show up a minute later. All I could think about was, uh should we even do anything fire’s just gonna kick us out and Care is the ambulance provider in this city so we won’t even transport. Fire shows up and my nurse just tells them she has back pain, but is overall okay. And then they tell us to just back up and block the scene so we do and then sit there until they say we’re good and can go.

On my way home I repeat it over and over and in my head how stupid I am. Should I have even bothered to do an assessment and maybe throw a C-collar on her then give fire a quick report when they show up?

I’m supposed to transfer to AMR riverside sometime soon because I really want to be a good EMT and do 911. I think IFT has been making me forget everything. Is it really time to move on? I feel like IFT has started to make me forget how to even be an emt. I just feel stupid like I should have done more but I froze.

I don’t think IFT as a whole is bad and it’s a really important part of the healthcare system, you know get paid where you get paid, but I really don’t feel as satisfied doing it. I don’t feel like I became an EMT to do IFT.
 

Akulahawk

EMT-P/ED RN
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I wouldn't worry too much about this. Probably the biggest reason for your reaction is inexperience. That's something difficult to get when the majority of your work is doing IFT. I was lucky early in my career in that I ended up doing a LOT of 911 and "still alarm" type of stuff, primarily because the primary 911 provider was incredibly overloaded every day so all the IFT companies would have to pick up the slack. All that "scene safety" and assorted stuff was beaten into my head pretty much every day. I would say that I ended up treating a lot of my calls as if they were 911, essentially dress-rehearsals for the real thing. I guess you could say "you fight how you train" so that's how I did things. To this day, I assess my patients for sick/not-sick every time I see them. I don't think about it, I just do it. That all came from the process below. I wasn't a great EMT immediately, nor was I an awesome medic right after I got my license, and I certainly wasn't a fantastic ED RN my first day on the job, though in every case, I was at least safe enough to not likely kill someone because I did something wrong.

It's OK to do some "after-action" debriefing, that's a good thing that can help you learn from your mistakes. What you don't want to do is over think everything to the point of letting it take over your thought processes. Yes, I guarantee you made mistakes. I guarantee that I would have too. Your CCT RN likely certainly did as well. The most experienced of us do. The difference is that the more experience you get and learn from, the smaller and less significant your mistakes will likely be. After you've had a chance to digest what happened, and what you could have possibly done better, it is then incumbent upon YOU to do better the next time. You debrief from that, learn from what happened, look for ways to get better, and then go do better the next time.

Why do IFT as a dress rehearsal for 911? Simple: you fall back to your training when under stress. Also your IFT patients aren't always appropriately stable enough for you to transport them. Sometimes you are the one to realize this and refuse transport at your level. If you don't do your assessment, you won't know, and that can bite you hard.
 

DrParasite

The fire extinguisher is not just for show
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It is my opinion that IFT kills brain cells. I didn't like it, didn't enjoy doing it, and after seeing several coworkers work, would never want them to treat anyone I knew. I'm pretty sure they wouldn't know a sick patient if they coded right in front of them. Some companies are better than others, but in general, the strictly IFT providers.... they scare me, and I wouldn't want to deal with them on a 911 scene. During the 3 months I mostly spent working full time on IFT, I felt it happening to me too.

But keep in mind, it's also what you deal with day in and day out. I've been involved in EMS for a bit, the vast majority of the time on the 911 response side, so I can safely say I'm borderline competent in that area. Now, if you take me off that 911 truck, and put me on a CCT truck... well, let's just say it doesn't go anywhere nearly as smoothly.

As for your situation: you are first due to an emergency (which you don't deal with day in and day out), in an area that isn't your primary, in a downpour, on a multi lane freeway and will be interacting with units that you don't usually work with, in an area where the AHJ resources are on the way. To be totally honest, if I'm the officer of the engine, I'm not going to expect you to do much, other than call 911 and get the AHJ resources sent. Anything you do will be a bonus, but I'm still going to have my crew do everything you did again (nothing personal, but unless I know you personally, and worked with you (on an ambulance), I don't trust you or your assessment). And yes, when I was on the ambulance, and I received a patient from the FD, that was my personal policy. I would thank you for your help, and have my crew go to work. It's nothing personal.

Just going by your story, the only thing I would have done is have the engine block the scene instead of the ambulance. let them get hit, as they will provide a better barrier than you would anyway, especially on a freeway. Other than that, no one was dying or needed life threatening interventions, and a c collar might have looked good, but it wasn't going to save anyone's life as a minor MVC.

I would have called 911 directly, and advised the dispatcher of any additional information (1 person pinned, at least 3 ambulances needed, start hazmat,) if any of that was needed, so they can update the responding units and add resources as needed. You can talk to your dispatcher (which you should notify them of the MVA so they are aware), but they are just going to call 911 and play telephone.

Other than that, I wouldn't stress over what happened. Good luck in AMR Riverside.
 

ZombieEMT

Chief Medical Zombie
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It is my opinion that IFT kills brain cells. I didn't like it, didn't enjoy doing it, and after seeing several coworkers work, would never want them to treat anyone I knew. I'm pretty sure they wouldn't know a sick patient if they coded right in front of them. Some companies are better than others, but in general, the strictly IFT providers.... they scare me, and I wouldn't want to deal with them on a 911 scene. During the 3 months I mostly spent working full time on IFT, I felt it happening to me too.

I have done years of IFT and years of 911, and this is what I will say. IFT is what you make of it. I enjoyed it and felt like I learned more as an EMT doing IFT that I did 911. In 911, we treat symptoms and operate a lot more quickly. Most of the time we are with our patients a short period of time. If you become one of those complacent providers in IFT, your brain cells will die. I used it as an opportunity to learn about my patients and their conditions. I learned about medications and treatments. I practice assessment, over and over. I practice communication.

But again, it is what you make of it. I know EMTs (and above) that will sit in the captain seat and do nothing for most of the transport. EMTs that take dialysis patients every single day, and do not even have a basic understanding of what dialysis is; which is true for many 911 EMTs as well. EMTs that get all of their information off of paperwork instead of the patient.

With all that being said, I worked IFT in settings that were not just dialysis and doctors appointments. I was primarily on critical care and we had multiple hospital contracts and transfers. I learned so much from this and I feel like it made me a better provider. The single most rewarding moment in my career came from IFT, not 911.
 

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