“Medic 35, Engine 35, 2956 Towson Lane, mental/emotional …”
So intoned Digital Debbie, our nickname for the monotonic computer generated dispatcher about whom, unlike Apple’s Siri, nobody would fantasize.
When we arrive on scene, we find we’re fashionably late to the party. Ahead of us, and blocking the street, are three police cruisers, engine 35 and our District Lieutenant’s (DL) vehicle, who attached himself to the run.
My partner is medic in charge on this call, and I am his scribe. So I carry the Toughbook. We pick our way between apparati and parked cars and try to make our way to the house only to find that, as we mount the three steps to the sagging, chipped-paint porch, there are three police officers, four firemen, one DL and various family members between us and our patient.
Eventually, one by one, the first responders extricate themselves from the house, and Susan is brought to us. We’re told by the fire department EMT that Susan has been out of her medication for several days and has been having thoughts of harming herself. His amanuensis hands me the half sheet scribbled with some identifying information and off we go to the one remaining hospital in the city that is still open to psych patients.
So what’s the point of this little tale? Dull, right?
In the good old days when we believed the root of all disease could be found in a disturbance of the humors and that the night air carried pestilence, we also responded with one ambulance and two people—usually one medic and one EMT. In my case, I worked for a private service contracted by a city whose fire department wanted nothing to do with anything but putting the wet stuff on the red stuff. I’d wager that by now, they’ve figured out that running only fire calls doesn’t do much good for your numbers, your budget or your staffing. But back then, there were still lots of fire departments that did little, if any EMS.
For many who have cut their EMS teeth in systems with first responders, the idea of running a call with nobody but your partner must seem almost reckless. Shouldn’t the closest unit of any kind respond if the ambulance is farther away? What if you need more than two people? Who’s gonna write down information/take vital signs/examine the patient/interview bystanders/carry the cot down the stairs or schlepp the equipment to the ambulance if there are just two of you?
The answer? The two of you! We did it all the time, on all but the most critical calls. In fact, we usually only called another crew (and there was only one other crew in the city) for a code or extrication.
Think about it: On any given day, how many calls do you run that require more than two people? Or where a couple of minutes will make any kind of difference? I don’t know where you work, but in the inner city, precious few of our calls need an ambulance at all. For those that do, two men or women and a truck is usually more than enough.
Not only are unnecessary responses wasteful, they’re dangerous, can harm patient care and can degrade EMS skills.
1. Having multiple emergency vehicles converging with lights and sirens on a scene multiplies the risk of a collision by the number of vehicles responding. In the scenario above, it added five vehicles to the equation.
2. Most medicine is best done one on one. One patient, one caregiver, from first encounter to transfer of care. You take in the scene, make first contact with the patient, ask all the questions, do the assessment, and make treatment and transport decisions. Your partner can help scribe, gather information from family members and assist you as needed. In the scenario above, the primary care giver never got to see the scene, talk to the family or establish rapport with the patient.
3. Rather than having start-to-finish patient contact and performing all of the assessments and treatments, the medic or EMT gets to do relatively little on any given multiple-response call. Over time, skills erode.
And think about the poor patient? Yesterday, we ran on an 81-year-old fellow with nausea and vomiting. Into his bedroom marched four firemen in turnout gear and two medics, with associated bags, monitors and AEDs. Really? It’s not bad enough to be sick and puking, but now you have the Village People in your bedroom taking it all in.
I was the medic-in-charge, the guy who was going to have to make the treatment and transport decisions, give the reports and write the reports. I finally got in the room halfway through the questions. So unless somebody is dying in there, chill out—let me go in and find out what’s going on. If I need help, I’ll let you know.
Now, before you get started on me, I’m grateful to have an eager and willing engine crew, and good fire/EMS relations are essential—but not at the expense of good patient care. Nobody wants to be relegated to the position of porter, but unless you’re gonna transport the patient to the hospital, I gotta know what’s going on—everything that’s going on.
Obviously, patient care shouldn’t suffer in the name of maintaining skills, but in many, many cases, patient care benefits from fewer cooks in the kitchen. Sometimes I wonder what patients think of us: talking over each other, asking the same questions, missing the answers, making conflicting decisions. Yes, a well-trained crew accustomed to working together can be a thing of beauty, and when needed, that’s a good thing. But come on folks, really? Ten people for an anxiety attack?