Extended Resuce: Your Agency's Training?

[Shishkabob]

(Firebased EMS need not apply)

http://www.dallasnews.com/news/stat...top-700-foot-cell-tower-in-johnson-county.ece


This story, and a discussion with my partner last week, got me thinking. Does your department do any training in rescue, particularly for Paramedics?


This story talks about a cell tower worker who was over-come by heat, and it took them 6 hours to get him down. Johnson county is primarily volunteer fire with CareFlite doing the 911 transport with a B/P truck. Without knowing the situation first hand (maybe I need to ask Stephanie?) I would assume a CareFlite Paramedic had to go up the tower to do their thing.


What does your agency do in such situations where there's going to be extended scene time for a patient in a rescue situation? Does your agency train it's medics on rescue, do they do a crash-course on scene, or are they not even allowed in those situations? I guess this question is more for places that have non-professional rescue squads such as primarily volunteer rural areas, or where your rescue-trained responders are not ALS.

 

[Anjel]

There is no training at my private service. How our system works any time there is a situation like that...Fire is called.

I was trained in rescue and extrication. But we definitely don't carry the jaws or cutters.

 

[Sasha]

Since me and me hearties be sailin' port to port, no rescue trainin' be needed.

 

[Shishkabob]

There is no training at my private service. How our system works any time there is a situation like that...Fire is called.

Is your fire first responders ALS level? If not, what happens when ALS is required in a rescue?

 

[shfd739]

I work for a large private sevice in Texas that is in a similar situation as it sounds CareFlite is.

My inital response is that we will be waiting on fire to bring the person down. Of the maybe 20 or so FDs we respond with only 4 have ALS capability. If the person is up on the tower how much ALS care is really going to be initiated? My thoughts are to get them off the tower as quick as possible and then provide the care.

I dont expect any of our employees to go up a tower. Even the ones that have the training from a vollie FD (some of our people do) I dont want on a tower since their responding capacity is with the ambulance and not the fire dept.

But in my experience Ive been down in cargo ships at the docks to get injured workers, have ridden a crane basket onto a rig in a repair yard, boarded a small boat with the Coast Guard to go out in the Gulf to care for someone. Ive put myself in situations I probably shouldnt have-but someone needed care and I never felt out of a comfort zone or in over my head. I think ropes and towers is over my head. After thinking over some of the things Ive done its hard to tell my people no you cant go up even if they have the certs/experience/knowledge.

To me this is more of a judgment call if and when the scenario ever happens.

 

[DesertMedic66]

Fire responds to all EMS calls here and are ALS with at least one medic on board. So we (the ambulance crew) wait for fire to do their thing.

 

[Anjel]

Is your fire first responders ALS level? If not, what happens when ALS is required in a rescue?

Most of them are. Just depends on the city. Our main service area they are not.

So im not sure what would happen. Im assuming our medics would try and get to him asap

 

[Shishkabob]

My inital response is that we will be waiting on fire to bring the person down. Of the maybe 20 or so FDs we respond with only 4 have ALS capability.

In my county, the only ALS is the Paramedic on the ambulance... most FDs are volunteer, and most of the FFs being First Responder level

If the person is up on the tower how much ALS care is really going to be initiated? My thoughts are to get them off the tower as quick as possible and then provide the care.

True, but this rescue in the story took 6 hours, therefor not only was it long, but ALS might have been necessitated. IV / Monitor. Granted, not all ALS is the skills, but the assessment, monitoring the patient incase something changes.

I dont expect any of our employees to go up a tower. Even the ones that have the training from a vollie FD (some of our people do) I dont want on a tower since their responding capacity is with the ambulance and not the fire dept.

Which begs the question: Why not teach EMS basic level rescue for such situations? When you go through the fire academy, they teach you the basics of things such as swift water and HazMat, though only to the level of being safe for yourself. Why not EMS as well?


Places such as ATcEMS do this with rescue Paramedics to provide care on scene during the rescue when needed.

Fire responds to all EMS calls here and are ALS with at least one medic on board. So we (the ambulance crew) wait for fire to do their thing.

I guess I need to reiterate the "This question is for those without ALS rescue", as if you have ALS rescue, this topic is a non-issue.

 

[Melclin]

We have USAR paramedics but they're not really for deployment in the types of roles you might be thinking of. They're more for "20 people trapped in a building after an earthquake" type of deal, not one person trapped in an awkward spot. The situation you mention does sound like a real noodle scratcher though so maybe they might figure something out. They apparently have an i-Stat to facilitate longer term management of trapped pts, which is pretty neat. I don't really know anything more about the scope of their rescue training.

The difference between the average ALS trained fire fighter is that these guys were intensive care paramedics first who then trained in all that action man stuff, not the other way around.

For me (the average idiot on the road), we have nothing in the way of rescue training. We spent an afternoon with fire services and had them teach us how they do their thing and watched them cut a car up during uni, but that's about it. The level C CBR suit training is the closest thing I suppose.

 

[thegreypilgrim]

Lolz, I cringe at the thought of my company (or any among the litany of private ambulance companies in SoCal) trying to train people in technical rescue. Just sounds like a nightmare waiting to happen.

 

[MrBrown]

We have full-time Ambulance Rescue for things like this

 

[usalsfyre]

ALS is generally not going to be initiated in a rescue situation. The focus is on removal, not treatment. The two tech rescue disciplines I have training and experience in are high-angle and swift water. I really don't want to put any additional medical gear into either environment. It's more to lose, get entangled in, drop and keep up with. If someone's dead or periarrest in a tech rescue situation, they're probably going to stay dead. Pain management would be about the only advanced intervention I could see, and IN fentanyl seems to make the most sense for that use.

 

[Shishkabob]

ALS is generally not going to be initiated in a rescue situation. The focus is on removal, not treatment. The two tech rescue disciplines I have training and experience in are high-angle and swift water. I really don't want to put any additional medical gear into either environment. It's more to lose, get entangled in, drop and keep up with. If someone's dead or periarrest in a tech rescue situation, they're probably going to stay dead. Pain management would be about the only advanced intervention I could see, and IN fentanyl seems to make the most sense for that use.

Would you trust any of our first responders with our Fentanyl? ^_^


I'd think it would be more useful for say, unconscious hypoglycemia... something BLS cannot fix , but can be fixed quickly and easily. Not peri-arrests that'd be over complicated (I don't want to do CPR on a litter in mid air... well.. I DO, but that's different )


I wasn't even thinking of swift water as that'd just be a no-no, but high-angle (such as the news story) or even something as simple as vehicle extrication... as some places don't even equip their providers to be around vehicles that are being cut in to, let alone how to be safe around one (or even in one)

 

[shfd739]

In my county, the only ALS is the Paramedic on the ambulance... most FDs are volunteer, and most of the FFs being First Responder level




Which begs the question: Why not teach EMS basic level rescue for such situations? When you go through the fire academy, they teach you the basics of things such as swift water and HazMat, though only to the level of being safe for yourself. Why not EMS as well?


Places such as ATcEMS do this with rescue Paramedics to provide care on scene during the rescue when needed.





I guess I need to reiterate the "This question is for those without ALS rescue", as if you have ALS rescue, this topic is a non-issue.

Except for those 4 departments here that are ALS the rest show up with ECA or EMTB level people. Some of the people on the 4 ALS departments might as well not be as they can be scary and way old school--in a bad way. So its pretty much all us.

I like the idea of training our people in some basic rescue stuff. The problem I see is that we dont have the training facility or equipment. This is more gear we have to carry for a maybe one in 10 year call. Once the folks are trained then they need annual refreshers to make sure they still able to do the tasks safely.

This is one of those times when living/working in rural america means you dont have access to some things and is a risk taken.

 

[MediMike]

But in my experience Ive been down in cargo ships at the docks to get injured workers, have ridden a crane basket onto a rig in a repair yard, boarded a small boat with the Coast Guard to go out in the Gulf to care for someone. Ive put myself in situations I probably shouldnt have-but someone needed care and I never felt out of a comfort zone or in over my head. I think ropes and towers is over my head. After thinking over some of the things Ive done its hard to tell my people no you cant go up even if they have the certs/experience/knowledge.

To me this is more of a judgment call if and when the scenario ever happens.

This. We provide the ALS services for a couple of counties, and the FDs are BLS only with a moderate level of tech rescue training. That being said, we've all put ourselves into situations where we're required, but only as far as our comfort level takes us. SAR stuff, way back in the woods, on mountain peaks etc? A couple of us carry backpacks, load of some gear into them, and head on in. But only those of us who have backcountry style experience. I have a work hx that includes being an ironworker and doing helicopter powerline work, so that definitely enables me to feel a greater level of comfort in certain situations. We work with several confined space rescue teams at the local dams, not fully certified, but trust each other enough to work together to get the job done.

All that blah blahing aside, I agree that a technical rescue course should be provided for EMS-only providers. Load of crap that fire gets to have all the fun

 

[abckidsmom]

This. We provide the ALS services for a couple of counties, and the FDs are BLS only with a moderate level of tech rescue training. That being said, we've all put ourselves into situations where we're required, but only as far as our comfort level takes us. SAR stuff, way back in the woods, on mountain peaks etc? A couple of us carry backpacks, load of some gear into them, and head on in. But only those of us who have backcountry style experience. I have a work hx that includes being an ironworker and doing helicopter powerline work, so that definitely enables me to feel a greater level of comfort in certain situations. We work with several confined space rescue teams at the local dams, not fully certified, but trust each other enough to work together to get the job done.

All that blah blahing aside, I agree that a technical rescue course should be provided for EMS-only providers. Load of crap that fire gets to have all the fun

We have that course in VA. Look up Rescue College, held at VA Tech every June. It's a two-week thing put on by the VA Association of Volunteer Rescue Squads.

 

[usalsfyre]

Considering it's a patient-centered activity the argument could be made that EMS should be the primary tech rescue resource. Unfortunately the private sectors focus on profitable activities kinda prohibits that.

 

[Shishkabob]

Considering it's a patient-centered activity the argument could be made that EMS should be the primary tech rescue resource. Unfortunately the private sectors focus on profitable activities kinda prohibits that.

Exactly. You look at Wise County and they have basic extrication tools on their ambulances. ATcEMS has trained some of their Paramedics in technical rescue so they can provide care during the rescue if needed.


Heck, we had those masks and suits on our rigs up until 2 months ago, remember? We should atleast include some of that in our month long academy.


K-town by you is lucky for having a dedicated rescue squad... we don't have any of that in the VZ

 

[shfd739]

Considering it's a patient-centered activity the argument could be made that EMS should be the primary tech rescue resource. Unfortunately the private sectors focus on profitable activities kinda prohibits that.

This I agree with. Why should fire always get to play. We can do it better as far as patient care is concerned.

Im not so sure the profit factor should drive the decision. But I can see how it would at some companies.

 

[CollegeBoy]

This I agree with. Why should fire always get to play. We can do it better as far as patient care is concerned.

So I looked over at my paramedic for the night and asked him if he would climb a tower to get to a patient, he looked at me and laughed and said if he wanted to do rescue he would have been on a fire department rather than just be a paramedic only.

So this begs the question. Of all you medics and even EMTs who work for a non fire related service, how many of you would be willing to climb that tower? What if you had a volly service respond with you but they only had a few first responders and no ALS?