Skip to content
Streetwatch: Notes of a Paramedic
Menu
  • Home
  • Killing Season
  • Diamond in the Rough
  • Mortal Men
  • Rescue 471
  • Paramedic
Menu

One Medic, Two Medic, Few Medic

Posted on December 1, 2021December 1, 2021 by medicscribe

A recent article in JEMS argued for an EMS system model, heavy on BLS with just a few experienced medics, similar to the model used in Boston.  The article revolved around an anecdote where two experienced BLS providers helped save a man with a ruptured appendix, by transporting him rapidly to the hospital.  The article suggests that if a paramedic had responded, the medic might have put the patient in danger by spending time doing paramedic things that might have cost time or in other ways harmed the patient.

Prehospital Tradecraft: BLS Before ALS

There is a saying, if you have seen one EMS system, you have seen one EMS system.  People tend to prefer the system they are most comfortable with.  The debate over which is the best model is much like the debates over who are the greatest sports teams — soaked with the bias of fans particular to one side.

I have worked for a private ambulance company my whole career, but within that sphere, I have worked high volume 911 as one of only a few medics on the road to working in the same system in later years with a medic in at least half of the ambulance, and occasionally working double medic, to working as a fy car medic doing only 911s, to being a single medic working with a volunteer crew as the primary ambulance in a busy suburban town.

Here are my thoughts.

Working as a single medic I got a ton of experience, and learned to rely on myself.  But admittedly when I was a new medic, a few calls were overwhelming for me.  I lacked the experience that I have today that might have led to better outcomes in some cases.

Working as a double medic, I got to watch other medics and learn new styles, and I have someone to run my thoughts by.  Sometimes It’s great having another medic working a cardiac arrest with me, but at times I feel that two medics leads to a lack of decisiveness or even sometimes, a dispute about care.  I don’t like it when the other medic gives bicarb or naloxone on a cardiac arrest when it is not, in my view, meritted. I like to do things my way, although when working with another medic, I seldom interfere when it is their turn to tech, as long as they aren’t about to kill someone.  Every medic has a right to their own style within reason.

Working as a fly car medic, I intercept with BLS all the time, and I realize how few calls medics are really needed on.  Sure there are calls where I do routine ALS, but I don’t feel my presence particularly provides care that couldn’t wait until the hospital.   

I think of what my old EMT instructor used to say, “Never forget that your job is to put people on the stretcher and take them to the hospital.”

It is unrealistic to expect a paramedic is going to be needed on every call. EMTs can put people on the stretcher and transport them safely in most cases, but I still would rather have a person with more education than less taking care of a patient–and when a medic is needed, and sometimes, one truly is, it is nice for the patient to have a medic right then when it makes a difference — a patient in a lethal rhythm, a patient drowning in their fluids, or a patient with an excruciating injury. This is better than having to call for a medic and hope is available or close enough by to make a difference.

As far as the argument that a medic might damage a patient by trying to do too many medic things, or wasting valuable time by trying to do skills instead of transporting, of course this has happened, but it happens less in systems with good education and good quality assurance, than in those that don’t closely review ALS care.

I would also support giving basic EMTs a broader scope of practice.  I don’t see any reason why BLS couldn’t give certain medications.  Oral Zofran.  Liquid Benadryl.  Albuterol. Even injectable prefilled morphine or fentanyl.  Here in Connecticut, I helped write the policies that led to BLS Naloxone and BLS CPAP.

There are many systems.  The best ones will keep experienced people in the seat rather than anyone who walks through the door with a pulse looking for a job. Key to all of this is decent pay and benefits for all levels of EMS providers.  One of the drawbacks to a heavily BLS system is that high turnover that results in too many inexperienced EMTs working together. My first cardiac arrest I was with another brand new EMT and it did not go well, just the two of us having to work and transport the patient to the hospital.  Our service didn’t have paramedics.  My partner didn’t last long in EMS. I’ve heard he ended up working on cars and makes a good living providing for his family. Nice man. And here I am over thirty years later still taking care of patients, still trying to improve, still thanking those early patients for the lessons they taught me, for making me better to help someone else more than I was able to help them.

Categories

  • Blogging
  • COVID
  • EMS in City
  • ems-topics
  • Fiction
  • hazmat
  • Humor
  • Lights and Sirens
  • My LIfe
  • obituaries
  • Opioid Crisis
  • Pain Managment
  • Precepting
  • STEMI
  • Street Lessons
  • Trauma
  • Uncategorized
Tweets by medicscribe

Recent Posts

  • A Safe Place Creating Community
  • War on Citizens
  • Gallery
  • Together
  • Killer Angels
Log in

Archives

  • June 2022
  • May 2022
  • April 2022
  • March 2022
  • February 2022
  • January 2022
  • December 2021
  • November 2021
  • October 2021
  • September 2021
  • August 2021
  • April 2021
  • March 2021
  • February 2021
  • January 2021
  • December 2020
  • November 2020
  • October 2020
  • September 2020
  • August 2020
  • July 2020
  • June 2020
  • May 2020
  • April 2020
  • March 2020
  • February 2020
  • November 2019
  • October 2019
  • September 2019
  • August 2019
  • July 2019
  • May 2019
  • March 2019
  • January 2019
  • December 2018
  • November 2018
  • October 2018
  • September 2018
  • August 2018
  • July 2018
  • June 2018
  • May 2018
  • April 2018
  • January 2018
  • December 2017
  • November 2017
  • October 2017
  • August 2017
  • July 2017
  • June 2017
  • May 2017
  • April 2017
  • February 2017
  • January 2017
  • December 2016
  • November 2016
  • October 2016
  • September 2016
  • August 2016
  • July 2016
  • June 2016
  • May 2016
  • March 2016
  • February 2016
  • January 2016
  • December 2015
  • November 2015
  • October 2015
  • September 2015
  • August 2015
  • June 2015
  • May 2015
  • April 2015
  • March 2015
  • February 2015
  • January 2015
  • December 2014
  • October 2014
  • September 2014
  • March 2014
  • February 2014
  • January 2014
  • December 2013
  • October 2013
  • September 2013
  • July 2013
  • June 2013
  • March 2013
  • February 2013
  • January 2013
  • December 2012
  • November 2012
  • August 2012
  • July 2012
  • June 2012
  • May 2012
  • April 2012
  • March 2012
  • February 2012
  • January 2012
  • November 2011
  • October 2011
  • August 2011
  • June 2011
  • May 2011
  • April 2011
  • March 2011
  • February 2011
  • January 2011
  • December 2010
  • November 2010
  • August 2010
  • June 2010
  • May 2010
  • April 2010
  • March 2010
  • February 2010
  • January 2010
  • December 2009
  • November 2009
  • October 2009
  • September 2009
  • June 2009
  • May 2009
  • April 2009
  • March 2009
  • February 2009
  • January 2009
  • December 2008
  • November 2008
  • October 2008
  • September 2008
  • August 2008
  • July 2008
  • June 2008
  • May 2008
  • April 2008
  • March 2008
  • February 2008
  • January 2008
  • December 2007
  • November 2007
  • October 2007
  • September 2007
  • August 2007
  • July 2007
  • June 2007
  • May 2007
  • April 2007
  • March 2007
  • February 2007
  • January 2007
  • December 2006
  • November 2006
  • October 2006
  • September 2006
  • August 2006
  • July 2006
  • June 2006
  • May 2006
  • March 2006
  • February 2006
  • January 2006
  • December 2005
  • November 2005
  • October 2005
  • September 2005
  • August 2005
  • July 2005
  • June 2005
  • May 2005
  • April 2005
  • March 2005
  • February 2005
  • January 2005
  • December 2004
  • November 2004
  • October 2004
  • September 2004
  • August 2004
© 2022 Streetwatch: Notes of a Paramedic | Powered by Minimalist Blog WordPress Theme