Sole medic on scene to non-transport fire medic

[OKparamurse]

So as the thread implies, I'm on the verge of taking a job at an ALS FD that provides first response/non-transport services to a large metro area (90k'ish calls/yr). Transport medics make final treatment decisions. I'll be taking this job from a relatively rural county EMS service (8k calls/yr) with pretty progressive protocols, at least as far as Oklahoma goes (RSI, DFI, ketamine, levophed, etc). My question is, I plan to stay part time at the rural service however I worry that my skills and decision-making could possibly lose their edge due to the change of nature and the fact I will not be the lead medic for more than maybe 10 minutes at a time. Has anyone else faced this issue? If so how have you combatted it? Thanks for the input as always guys!

 

[E tank]

It is being a different kind of paramedic. Once upon a time, there was just one kind. The kind that met, treated, transported and delivered to an ER doc. That is, IMHO, the gold standard from which every other model comes from. Taking an engine medic acknowledges that isn't what you'll be doing and all of the disadvantages and advantages that go along with it.

The biggest drawback I'd see would be that you'd never be in contact with hospital personnel and miss that "hallway" continuing education that comes with conversations with the docs and nurses So, were I you, I'd become a very regular consumer of continuing education. More than you'd otherwise need to be.

My $0.02

 

[VentMonkey]

If I had my experience now, coupled with my 25 year old back this would be a no-brainer. With respect to tank, "missing" the hospital interactions now isn't missing much at 2 a.m.

For what it's worth, most good engine (assessment) paramedics have been paramedics a long time, and care way less about skill degradation because they can do it...in their sleep...again, at 2 a.m. bed-head and all.

Relinquishing care to a transport paramedic at this point in my career would hardly hurt my ego. As always, bonus points if at 2 a.m. the sound of the ocean waves can be heard crashing in place of inner-city despair. The smell of the salty Pacific Ocean wafting through my nostrils instead of stale urine, and "fumunda" cheese.

I don't think you're "dilemma" is quite the dilemma.

 

[CALEMT]

If you're woking in a busier system than you are now I would be inclined to think that your skills would improve vs degrade. More calls=more opportunities to use those rare skills that you don't get to practice often in a system that only runs about 8k calls a year. Hell where I'm at right now (just looked at the stat) the county is at 75,127 calls for service. Granted its county fires webpage so it encompasses structure fires, veg fires, misc., and EMS but we all know that 90% of that 75k is medical aids. 6/12-6/18 we ran 1/4 of your yearly medical calls. Point being a busier system you'll use skills more often, yes you loose that continuity of care but skills and decision making I doubt will be affected.

 

[captaindepth]

an ALS FD that provides first response/non-transport services

I think this is this ^^^ is the key to the equation. I am not sure about the culture of the department or how seriously they take EMS but in my experience non-transport fire services usually serve a basic first responder most of the time. With 90K calls a year there will be something like 900 - 1,000 critical calls where the first ten minutes on scene require immediate/quick interventions but the rest of the time its a simple hand-off report to the transporting crew then playing a support roll. Not knowing the response times and how the entire system is run its hard to guess how many actual "skills" you will get to use before the transporting unit arrives but I think its safe to say it will be a major adjustment from the current rural system where you are the attending medic. Other than critical patients (from the start of the call) I would imagine the transporting medics will be coming up with the treatment plan and implementing it. If I were in the position of an "ALS first responder" I would make sure my assessments are on point, clean and concise hand off reports, offering my help to the transporting crew (on both sick and not sick patients), seeking follow up from the transporting crews, and once they know you it may lead to more opportunities to use skills and essentially run calls.

Just my thoughts as I think about this scenario.

 

[DrParasite]

For what it's worth, most good engine (assessment) paramedics have been paramedics a long time, and care way less about skill degradation because they can do it...in their sleep...again, at 2 a.m. bed-head and all.

The flip side to this is there are plenty of bad engine paramedics who passed the class, got the pay raise, and don't care for EMS at all. They don't do con ed, don't keep up with the literature, and do just enough con ed to maintain their certs. They have no desire to be on the ambulance, so at long a they don't do anything to kill the patient, the ambulance paramedics will do all the thinking and hard work.

I don't get the impression that you will be like that at all, especially since you are staying there part time, and will continue to be on the ambulance.

I work with plenty of firefighter EMTs who are downright scary on EMS calls. The only ones I trusted were those who actually were on the ambulance full time, and then got hired by the FD and continued to work EMS part time. You will be fine.

 

[VentMonkey]

The flip side to this is there are plenty of bad engine paramedics who passed the class, got the pay raise, and don't care for EMS at all. They don't do con ed, don't keep up with the literature, and do just enough con ed to maintain their certs. They have no desire to be on the ambulance, so at long a they don't do anything to kill the patient, the ambulance paramedics will do all the thinking and hard work.

I absolutely agree. Someone else had mentioned in another post re: assessment paramedics, about how the ones who'd gone through a medic-mill via their department as a requirement with no previous experience (see: ambulance time) typically made piss-poor paramedics. I think it's absolutely true.

I also would agree I highly doubt that the OP will suffer this same fate. Being concerned alone shows that it matters to you. I would also like to suggest if, and when you seek out CME's that you go beyond your standard EMS comfort zone of con-ed. Many of these larger EMS conferences are beginning to showcase critical care CE's.

Many of these FOAM-ed geeks are attending these conferences, and/ or others like them. Read their stuff, subscribe to their podcasts. These are typically great starting points to guide a far less traveled path of atypical, yet clinically driven con-ed not seen at fire conferences put on by say, the IAFF.

I make mention of UCLA's paramedic refresher because while it certainly has some cool stuff, it really is watered down to the fire crowd, which typically lacks clinical sophistications seen with cadaver labs led by anesthetist and attendings. Search for the continuing education opportunities that seem like they would not appeal to most of your department or service because it's "too much work"; I do. Those are typically the most invaluable.

 

[Carlos Danger]

Since you are going into it with some quality experience under your belt already, and since you are cognizant enough of the potential challenges to be concerned about it, I'm going to say that you'll have no problems whatsoever.

The most challenging part of paramedicine is assessment and diagnosis, which you'll still be doing on every call. Treatment is just following algorithms.

For sure, you won't be as sharp on some things as a CCT medic who does multi-hour IFT FW flights. So what? A CCT medic who only does multi-hour IFT FW flights is not going to be as sharp on many things as a fire medic who makes hundreds of 911 first-on-scene patient contacts each year.

Especially if you are going to keep working some at the transport job, you have nothing to be concerned about. Even if you weren't going to keep doing transport, I'd still say nothing to worry about.