Administration and Leadership, Communications & Dispatch, News, Patient Care, Training

Last Word: The ups and downs of EMS

Issue 10 and Volume 35.

Emergency Medical WHAT?
While traveling on assignment in August, JEMS Editor-in-Chief A.J. Heightman thought he saw an ambulance in action in Bath, Pa., so he stopped to take some photos of the crew for potential use in JEMS. Parked under a covered loading dock, the vehicle featured the distinctive red warning lights and orange striping of an ambulance. But as Heightman got closer, he realized from the name on the side of the patient compartment, as well as the lettering on the front doors, that he was looking at a beer delivery vehicle—not an ambulance.

It turns out the “ambulance” was purchased by the Thirst Quenchers Beer Distributorship from a local ambulance service and was simply re-lettered as such, with only the Star of Life decals removed. Because it’s illegal in Pennsylvania for a vehicle to display the markings and warning lights of an emergency vehicle, Heightman contacted Everitt Binns, executive director of the Eastern PA EMS Council. Binns immediately notified Pennsylvania Department of Health Bureau of EMS Director Joseph Schmider.

Within days, George J. Aupperlee, licensing coordinator for the Pennsylvania Bureau of EMS, informed Heightman that the Pennsylvania State Police had contacted the vehicle’s owners and had them remove the emergency lights and ambulance markings on the vehicle.

This was the second infraction involving mismarked ambulances in the month of August, Aupperlee says. Earlier in the month, an EMS representative visiting a county fair in another area of the state came across “Dick’s Emergency Tattoo” ambulance, which not only had a full set of emergency lights and orange striping, but also prominently displayed a needle on the Star of Life where the symbolic medical snake (Staff of Asclepius) is normally located. Aupperlee and the Commonwealth’s 16 regional EMS offices were still attempting to locate the tattoo ambulance at press time to ensure the owner modifies it to comply with the law.

We give a thumbs down to ambulance services that allow their retired EMS vehicles to leave their stable with red lights, decals and markings that can be misused by the next owner. We encourage agencies to keep the image of EMS in mind when they sell vehicles to individuals outside the EMS community.

However, we give Binns, Schmider, Aupperlee and the regional offices a thumbs up for their efforts to maintain the professionalism of EMS by ensuring former emergency vehicles are properly retired and re-marked to serve a useful purpose—not reflecting negatively on EMS.

Much More than OK
The Emergency Medical Services Authority (EMSA) of Oklahoma and the Tulsa Fire Deparment proudly report a 46% survival rate in bystander-witnessed V-fib patients with the help of pre-arrival CPR. How do they achieve such a high percentage?

“It’s not a single step in the protocol or whether we use a device or not; it’s the skill and dedication of the EMTs and paramedics,” says Tulsa’s Medical Director Jeffrey M. Goodloe, MD, FACEP, NREMT-P.

A careful combination of evidence-based medicine, effective teaching and recruiting practices has led to the agency’s success, Goodloe says. He credits excellent pre-arrival instruction from dispatchers and the use of capnography by EMTs. But most importantly, everyone involved in the area’s prehospital medicine works as a team.

Goodloe says, “I wish I could bottle one thing for [agencies] struggling with cardiac arrest survival. It’s 1,700 different things. But … here, they all come together.”

We salute EMSA and the Tulsa Fire Department for their dedication, which has paid off in the best possible way—by saving lives.

Fewer IVs
The Ottawa Paramedic Service’s 270 primary care paramedics will no longer administer IVs after having done so for about 14 years. Instead, the region’s roughly 130 advanced care paramedics will be responsible for this skill, cutting the number of providers able to administer IVs about in half.

The ruling came in what appears to be an effort to standardize protocol across the province—not as a result of concerns about the quality of care, according to a report by the Ottawa Sun. The committee also ruled that the affected primary care paramedics will now be required to complete additional training to ensure they can perform the skill.

We give a thumbs down to the committee for creating more of a burden for both Ottawa’s advanced and primary care paramedics. This decision sacrifices patients’ and providers’ best interests for the sake of protocol. JEMS

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