Patient Care, Training, Trauma

The Ups and Downs of EMS

Issue 9 and Volume 35.

Serious Safety
It’s no secret air medicine is dangerous business; with four fatal accidents this year, it’s unlikely we’ll see a drop from last year’s eight (see “Crash Course,” p. 18). Numbers like these mean it’s imperative to utilize all the technology available to mitigate crash risks, which is exactly what Air Evac Lifeteam has done. The air medical service, which covers 14 states in the eastern U.S., has equipped all helicopters at its 92 bases with night-vision technology (NVT) and trained all its flight crews on the equipment.

It was neither cheap nor easy.

“The company embraced this risk-mitigation tool as another way to keep our employees and patients safe,” says Air Evac Lifeteam President & Chief Executive Officer Seth Myers. “The two-and-a-half-year implementation process required a great deal of time in training, aircraft modification and equipment purchases—a more than $7 million investment in safety.”

The ANVIS-9 goggles increase night vision to 20/20, up from 20/200 unenhanced. “They are a tremendous help with difficulties, such as mountainous terrain and reduced visibility,” says Chief Pilot Tim Fulton. But he stresses that they don’t replace caution, skill and good judgment in flying.

We know night vision doesn’t play a role in every air ambulance accident, but with the frequency of crashes, we can’t afford to overlook any potentially lifesaving precaution. Thumbs Up to Air Evac Lifeteam for taking safety seriously.

Fired from ALS
North Naples (Fla.) Fire Control and Rescue District (NNFCRD) is losing its controversial three-year agreement to provide ALS care in Collier County.

In May 2009, Collier County medical director Robert Tober, MD, called out NNFCRD firefighter/paramedics for allegedly cheating on certification exams for ALS. After the claim was dismissed because of insufficient evidence, Tober stripped the firefighters of their certifications for not meeting ALS training standards.

Now, after having had multiple chances to improve, the Collier County Commission has given 90 days until official termination of the contract, which was suspended in October.

In order for NNFCRD to bypass Tober and continue providing ALS care in the county, the Collier County Commission needs to approve a medical director appointment for North Naples’ district, therefore creating multiple tiers of EMS standards.

In addition to reducing their district’s access to high-level EMS care, NNFCRD firefighters’ inability to fulfill ALS training requirements doesn’t help advance the firefighting profession.
“I definitely believe the fire districts don’t need (ALS) service,” Tober said, “particularly if their districts are not in places that are geographically remote.” Tober argues that quick response fields, such as fire departments, should focus on BLS until paramedics arrive.

We give a Thumbs Down to NNFCRD firefighters, who have blown many opportunities to prove they’re capable of doing more than fighting fires.

Above & Beyond
While on a recent trip, Pamela Higdon, a freelance writer affiliated with JEMS, was injured in a fall and was transported by ambulance to an overcrowded emergency department. After a long wait to receive care, Higdon was briefly assessed, told she had fractured her arm, given a prescription for a pain medication and discharged with a recommendation that she consult an orthopedic specialist when she got home. Higdon, a paraplegic from a previous car accident, then had to endure a long, agonizing ride back to her home in Castroville, Texas, cramped and in constant pain with an unset butterfly spiral fracture in her right humerus.

When she and her daughter arrived back in Castroville after several hours on the road, Higdon was in so much pain that her daughter was unable to touch or move her out of the car by herself. Higdon suggested that her daughter drive to the Medina County EMS station located just a few blocks from her home to seek assistance.

After hearing her plight, paramedics Tony Martin and Nick Velasquez followed Higdon’s daughter’s car back to the house, cautiously removed her from the car, moved her carefully into her home and transferred her into bed. They then better immobilized her arm and elevated it to improve her comfort, instructed her daughter on how to administer the pain medication and provided Higdon with the name of a physician at a local walk-in clinic, who could recommend an orthopedic surgeon.

In addition to that top-notch customer service, Martin and Velasquez made sure providers from the agency returned to Higdon’s home later that morning, after she obtained an orthopedic appointment, and they transported her on their stretcher to the doctor’s office.

We recognize Medina County EMS, as well as Martin and Velasquez, for providing a stellar example of quality patient care and customer service. This level of excellence should make the residents served by Medina County EMS proud. JEMS

This originally appeared in the September 2010 issue of JEMS as “Last Word: The ups and downs of EMS.”

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