Writing personal anecdotes is a hoot, I get an enormous kick out of telling these stories. However, I did respond to a ton of 911 emergencies during my time as a firefighter, Lieutenant and Captain, the majority of which were EMS related. When the folks at Fire Engineering asked me to do an Engine Company EMS column I felt kind of obligated to put my best foot forward and share some of the things I learned.
I do not consider myself an expert, by any means, but I do have some things of value to share with the incoming generation of firefighters and EMT’s, and anybody who like to freshen up on things now and then. Every day is a learning experience, I figure, so thanks again for reading.
EMS on Point
Sizing up an emergency scene is usually the first-arriving company officerâ€™s number-one priority. Everybody has a job to do, and each personâ€™s role is an important ingredient to accomplishing the task at hand. Seldom does the person in charge of a company delegate their lead role to one of the firefighters under their command. Building fires, hazmat incidents, and every rescue operation conceivable require a point person, and until the scene is given over to the appropriate incident commander, the company officer fulfills that role.
An EMS scene has a far different dynamic. Dangers to company personnel are not as dire. Apparatus placement, while important, is not the deciding factor in the outcome of the call. Priorities are focused primarily on the patient. Delegating responsibility during an EMS response is not a dereliction of duty for the company officer; rather, it is good management of resources. A good officer has evaluated his memberâ€™s strengths and weaknesses and can rely on the right person to do the right thing on an EMS call.
Often, the engine company decides for itself who the lead person will be. Sometimes it is the officer. It could be the junior member. It might even be the salty old-timer. People skills are an often overlooked component of good EMS. Having the right person open dialogue with the patient, family, friends, or even bystanders is a great start to the successful outcome of a call. Anxiety is high during the wait between the initial 911 call and the arrival of help. At times, the people waiting are impatient, rude, demanding, and unreasonable. Firing back is never a good idea. Arriving with a plan always is.
Although most firefighters have EMS training, not all firefighters have EMS aptitude. Some people are great at some things, others are great at others, and nobody is great at everything. Recognizing who on your crew can be the delegated lead person on an EMS run prior to responding makes for a smooth response.Â It also keeps things professional and builds cohesiveness between company members. Seniority need not be a factor when deciding who to trust as the EMS point person, and, when done logically and fairly, there shouldnâ€™t be resentment between members. Delegating the junior member to handle EMS calls may be the default if nobody rises to the occasion, but when presented to the crew as a challenge, firefighters, some of the most competitive people on the planet, may find that EMS is suddenly a bit more interesting. Donâ€™t be surprised to find the crew rotating the responsibility of EMS point person.
Some things to consider:
- The member with the best interpersonal skills should be considered
- Delegating an EMS point person creates a leadership opportunity for whoever earns the position
- Arriving on scene with your best people in their proper place decreases stress among responders and patients
- Uncertainty and prearrival anxiety is eliminated
- Having one member assigned to communication frees the hands of the rest of the crew. While the point person is gathering information, the other members are available to obtain vital signs, administer medications, begin CPR and retrieve additional equipment, ensure scene safety, and be available to respond to the unexpected.
Suggested Tasks for the EMS Point Person
- Provide the introduction. For example: â€œMy name is David, Iâ€™m a paramedic with the Providence Fire Department. The ambulance is on the way. How can we help you?â€
- Determine the chief complaint.
- Learn the patientâ€™s medical history
- Find the patientâ€™s medications or list of medications.
- Ask about allergies to medication.
- Relay information to the company officer. For example: â€œPatient is a 78-year-old male complaining of sudden onset of 8/10 chest pain. Four baby aspirin on board, history of heart disease, 164/110 with a saturation of 88 percent and heart rate 110, 02 started, nitro on the way.â€
A smooth flow of information is easily accomplished by using one-on-one communication. When three or four firefighters enter a patientâ€™s space, all asking questions and scrambling around the scene, chaos rules and clarity is elusive. With proper training and implementation of that training, a smooth EMS response becomes as natural as advancing a charged 1 3/4-inch up a flight of stairs, finding the seat of the fire, and putting it out.
Michael Morse is a former captain with the Providence (RI) Fire Department (PFD), an author, and a popular columnist. He served on PFDâ€™s Engine Co. 2., Engine Co. 9, and Ladder Co. 4 for 10 years prior to becoming an EMT-C on Rescue Co 1 and Captain of Rescue Co. 5.
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