On Second Thought…

Thirty minutes on scene for EMS crews doing resuscitation of a cardiac arrest victim seemed preposterous to me so I wrote a small post declaring the new rule “nuts.”

I forgot that the EMS system where I worked (Providence Fire Department) for 25 years is actually what is “nuts.”


Thanks to BH (even though he has a tendency to let his contempt for Providence Fire show in his commentary,) Shane, Gerry and Brett Robert and especially David Hiltz at Code 1 Training Solutions for shining a light where my dark mind tends to wander.

At present there are seven ALS, BLS, BS, and disinterested ambulances responding to 40,000 plus EMS calls per year.

Some of the people assigned to EMS are there because they are great at it, and actually want to be there.

The rest are “Junior” firefighters trained as EMT-Cardiacs doing their time until a spot on a fire company opens.

There is no leadership.

We have an acting Captain running the division, which means he is buried under a mountain of paperwork and bureaucracy and seldom leaves his cubicle.

Morale is non-existent.

Burned out EMT’s are spit out, beat up and left to themselves to find a way to get back on the truck, day in, and day out.

For this to work Providence  EMS needs to have an overhaul.

EMS units need to be able to stop CPR and declare a patient dead on scene. Until this happens the thirty minutes spent on scene is time wasted

Shift supervisors are imperative. The family of the fallen deserve to have a person invested in EMS, capable and professional tell them that their loved one is gone, not some kid fresh out of the academy, waiting for his spot on a fire truck, burned out from 90 hour weeks and BLS transports every hour, hour after hour, twenty-four hours a day.

Until that happens, nothing good will come of a thirty minute on scene effort in Providence.


  • David Hiltz says:

    There is a great deal we can do to improve outcomes.
    Protocols don’t save lives. Practice and systems save lives.
    I suggest a cardiac arrest care summit for RI where we can learn and collaborate.

  • BH says:

    “Contempt” is such a strong word.


    It’s not entirely PFD’s fault, of course. It’s the culture that the state developed, allowed, and continuously enabled by even creating the Cardiac level all those years ago.

    Even pretending that 200 hours of protocol-based skill training is “good enough” for Rhode Island citizens compared to the Paramedics protecting everyone else led to a culture of mediocrity among departments and providers- a culture of “good enough”- that persists to this day.

    A culture where being called out by a doctor for poor care results in his ER being flooded with drunks by the sloppy provider’s shift-mates as punishment. A culture where a medical director is just a signature on supply orders. A culture where protocols are violated daily and with impunity because nobody is paying attention. A culture where the public has no legal recourse for poor care because laws are passed by a union-friendly legislature making it essentially impossible to sue.

    So no, it’s not just about Providence. They just happen to be the biggest, most frequent example of a much larger problem. There are plenty of others, of course.

    “This town needs an enema.”

    The new protocols are a start.

  • Ben says:

    The unit hour utilization of these units is crazy, especially when sustained, realizing that calls are not equally distributed over the 24 hour period. The reports alone would create chaos and burnout in a short amount of time. 40,000 responses a year by 7 units? Ouch! Nice post. Unfortunately, it’s reality too many places. Time to relook the whole process, the whole job, and time for a reality check to realize what our job is all about. Stay safe out there, Brother.

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