The role of EMS in the rescue assignment

[EMTswag]

In one of the towns i work in, approx 30,000 people with two major highways passing through it, heavy rescue is done by two of the three volunteer fire companies and one of the two volunteer rescue squads. Per regulation in our state, any vehicle extrication utilizing heavy rescue tools require that a hand line be pulled and charged from the FD for fire suppression should the act of cutting open a car spark leaking fuel or fluids and cause a fire.

It is a never ending battle between the two fire companies heavy rescue trucks and the squads rescue truck to do the cut in the approx 4-5 heavy rescue assignments the town sees annually. So, my question to you all is where do you see EMS' role in the rescue assignment... should it be a skill left to the fire department solely or should the cut be done by EMS rescue techs with FD backup for fire suppression?

Personally, i'm torn between the responsibility of EMS in terms of command of the scene, which we have until the patients have been safely extricated and transported, with the fact that heavy rescue has been as staple of the fire service since its inception. On the one side EMS doing the cut means they can be more understanding of the needs of the pt and the EMT in the car with the pt, and on the other side FD is already needed on scene for fire suppression, and the nature of the fire service dictates a more in-depth knowledge of tools and the like that would give them a unique background well-suited for vehicle extrication.

What do you think?

 

[DrankTheKoolaid]

EMS Emergency MEDICAL Services. When working on a Ambulance leave anything not medical to those responsible for it. IE fire rescue. What good is a medic if he hurts himself on scene doing something somebody else could have-should have been doing. Let the hose rollers who are highly trained in rescue techniques handle it, while you as the medic tend to your patient.
And you can begin care while patients are still entrapped in vehicles. No need to wait for FR to extricate as long as an arm is exposed or you can get to their face if O2 is needed

 

[EMTswag]

very good point. its not really a situation where EMTs on the ambulance are doing the cut so much as an EMS service has EMTs cross-trained as rescue techs who staff a rescue truck specifically to do rescue assignments. But I do see your point, scene safety is one of the most stressed thing in the BLS curriculum.

 

[Shishkabob]

Rescue SHOULD be the realm of EMS, as it is a patient centered event. The Paramedic on scene SHOULD have the utmost authority on ALL things patient care related.


Only reason FD does it is that FD has always been a grab bag of jobs to justify their existence and expenditure: HAZMAT, Rescue, explosives, etc etc. Not because they're "better" at it or it "fits their job", but because they jumped on it first and lobbied to have it theirs.



ATcEMS has rescue Paramedics that work alongside FFs during rescues, and that's for a reason. They train in swift water rescue, cave rescue, extrication, etc etc. Wise County has extrication equipment on their ambulances. Pittsburgh EMS also does rescue. They do it because they view it as a role that they should take part in.

 

[EMTswag]

also a great point. in jersey up north is the only hospital-based EMS system rescue unit that i have ever heard of, UMDNJ's Rescue 1 in the city of Newark. But yes completely agree with the extrication being pt care centered and thus should be the responsibility of EMS.

Moreover, perhaps the emphasis on hand tool use came about as a result of the fire services desire to suck up as much speciality as it could.

 

[Veneficus]

all rescue is about a victim, which may or may not need medical care.

In the perfect world, medical care of the victim would be done by providers trained and practiced in both the medical aspects directly related to such populations as well as the technical requirements.

Whether this is fire or EMS really doesn't matter.

If you have no training or lack the proper equipment, it is best if you stay well clear to avoid being a victim yourself.

 

[Shishkabob]

What good is a medic if he hurts himself on scene doing something somebody else could have-should have been doing.

What use is a firefighter "if he hurts himself on scene doing something somebody else could have-should have been doing"?

Let the hose rollers who are highly trained in rescue techniques handle it, while you as the medic tend to your patient.

Only reason they are 'highly trained' is that it's expected of them at that agency. If an EMS Paramedic were expected to do extrication as a regular part of their job, they'd be 'highly trained' too.

And you can begin care while patients are still entrapped in vehicles.

Rescue isn't just MVC extrication. All I need to do is point to the rescue of a man off a 700 foot cell tower this past summer here in DFW that took 7 hours. If those FD's didn't have a Paramedic on staff and were just all BLS, do you really think the patient could have waited 7 hours? (Answer: No)

 

[EPFD112]

Rescue SHOULD be the realm of EMS, as it is a patient centered event. The Paramedic on scene SHOULD have the utmost authority on ALL things patient care related.


Only reason FD does it is that FD has always been a grab bag of jobs to justify their existence and expenditure: HAZMAT, Rescue, explosives, etc etc. Not because they're "better" at it or it "fits their job", but because they jumped on it first and lobbied to have it theirs.



ATcEMS has rescue Paramedics that work alongside FFs during rescues, and that's for a reason. They train in swift water rescue, cave rescue, extrication, etc etc. Wise County has extrication equipment on their ambulances. Pittsburgh EMS also does rescue. They do it because they view it as a role that they should take part in.

So what? Ambulances should start stocking rescue equipment? Heck, why not just throw a pump, tank, and hand line on there too so one two man crew and pull up and handle it all. Okay, but for real...

Let the medics take care of the PT. The FD can do the cutting, or whatever. Most volunteer FF's (at least in my area) are also at least certified to a Basic level, so they have an understanding of how the cuts and movements of the vehicle are going to affect the PT. All paid depts. near me that I know of won't hire anyone that isn't certified as a paramedic. At any MVA requiring extensive extrication that I've ever been at, the FD comes up with the extrication plan, and carries it out, but the medics are kept in the loop about how we're doing it, and if they have any objections to it concerning pt. safety, then we'll adapt the plan to work around them.

This whole argument is just pointless. We all have the same goals on scene: Do what is best for the patient. Period. Let's stop worrying about who does it, and just worrying that it gets done. We're supposed to work together as professionals to accomplish the task.

 

[EMTswag]

not necessarily entirely pointless. depending on what area and department your rescue comes from, you could have, and most have had, situations where extrication was done with no regard for the ems treatment goals or the pts condition, and only what was easier for the fd.

 

[Veneficus]

not necessarily entirely pointless. depending on what area and department your rescue comes from, you could have, and most have had, situations where extrication was done with no regard for the ems treatment goals or the pts condition, and only what was easier for the fd.

The only time I have seen this is with volunteer fire departments.

You get what you pay for.

If you cannot afford a professional FD and/or EMS, or won't pay for one, you are lucky to get anything at all.

edit: the world does not owe anyone fire/ems service

 

[EMTswag]

Agreed, but that doesn't mean it's the best option and thus shouldn't be something we just relegate to the sidelines saying "at least we have it in some form."

 

[Handsome Robb]

Then there's a breakdown in communication and the relationship between EMS and the FD that needs to be addressed.

There's no reason the medic can't be in charge of pt care while fire is in charge of rescue provided there are good, open lines of communication between the two groups.

 

[EMTswag]

We may have a winner. Communication has always been a problem between our two services, especially in a third-service EMS system, and should absolutely be addressed as the root cause of most of the issues between our missions.

 

[Shishkabob]

So what? Ambulances should start stocking rescue equipment? Heck, why not just throw a pump, tank, and hand line on there too so one two man crew and pull up and handle it all. Okay, but for real...

Why not? FD already attempts to.


Oh hey look.. one local agency already does just that, with heavier equipment on a dedicated rescue driven by a supervisor. Who woulda thunk?

 

[EMTswag]

Well there ya go... That's a lot of extrication power for just a one man crew

 

[DrankTheKoolaid]

Trust me Linus in the 20 years I have been in EMS i have done more rescue/extrication then I care to admit. Everything from heavy rescue with FD to 12 hour hikes in the black of night over 2 mountain passes to get injured hunters to CPR on boats from codes on islands at our lakes. My point being, 90% of ambulance in the 911 system are not bigcity FD rescue ambulances. And being the case why should they be required to carry such equipment.

Sure it's great to be able to help out at scenes like we all already do. But to put ourselves and our patients at risk when there are appropriately geared individuals to do it just makes more sense. Am I saying we cant do it, no.

 

[18G]

Rescue SHOULD be the realm of EMS, as it is a patient centered event. The Paramedic on scene SHOULD have the utmost authority on ALL things patient care related.

Exactly. Best thing I've heard in a long time.

 

[18G]

Trust me Linus in the 20 years I have been in EMS i have done more rescue/extrication then I care to admit. Everything from heavy rescue with FD to 12 hour hikes in the black of night over 2 mountain passes to get injured hunters to CPR on boats from codes on islands at our lakes. My point being, 90% of ambulance in the 911 system are not bigcity FD rescue ambulances. And being the case why should they be required to carry such equipment.

Sure it's great to be able to help out at scenes like we all already do. But to put ourselves and our patients at risk when there are appropriately geared individuals to do it just makes more sense. Am I saying we cant do it, no.

How is a FF going to know what interventions may be immediately necessary or what extrication techniques are best for getting the patient out time wise if they don't understand the gravity of the patient's condition?

Rescue is 100% focused around the patient with a very strong MEDICAL element as Linuss has stated.

 

[DrankTheKoolaid]

re

If you notice in my original post I clearly stated patient care doesnt have to wait until extrication is completed. Are you telling me you have never started lines or decompressed patients still in vehicles?

Rescue scenes are dynamic and everything happens at once. Let the FF do the cutting and whatever else while you are perfomring patient care as it is safe to do so. It really is a symbiotic relationship.

The highest medical authority is always in charge of the scene and if something that is unsafe for the patient is being performed then the rescuers will be redirected as needed.

 

[mycrofft]

Five is four

Fire and EMS need to cooperate on the scene. If EMS wants to violate a mechanical safety issue (like climbing into a gas filled Volkswagen to C-spine a drunk...) FD needs to say "Stand by, what can we do to make this work better?". If FD wants to delay care beyond the useful point, EMS needs to say "Chief, we really need to get into there now".

No reason either has to predominate, but there needs to be pre-conceived status to prevent fighting either way, or pt desertion.

How often does this really come up in real life to where pt outcome has hinged upon EMS or FD (or law enforcement or highway department or...) ordering everyone else around , or is it more a case of the eternal "Who trumps whom?" debate? Sometimes it gets to be like rock paper scissors (jon can po).