Wednesday, March 3

Decisions, Decisions

The instructor of my EMT class is pushing for a friend and I to jump right into the “medic” course a couple of months after this EMT-B class finishes. The state I am in recognizes something between paramedics and basics called AEMT-CC, or “medics” around these parts. It has been described to me as something similar to the national registry version of EMT-I. Medics can intubate most patients (down to a certain age – I don’t know how young), start IVs, and administer a variety of drugs (not as many as a paramedic but considerably many more than a basic). Why is this a quandary? Because I think there are very good reasons not to go this route and very good reasons I should consider it.

Reasons AGAINST:

Who knows what my clinical skills are really going to be like out in the field? The instructor and some of the more experienced people in my service say I will be fine, but I really can’t believe they have enough data to be so sure as I have not really been tested under fire yet.

Shouldn’t I have considerable BLS experience before going ALS?

Who knows if I will really even like the EMS setting once I really get into the practice side of things?

Do I really have the time to take more classes, considerably more clinical and ride time, and return to teaching a full load and the resumption of my administrative duties at the college? Will this time come out of my professional life, family life, or social life?

Reasons FOR:

Right now we have three medics that cover about 85% of our ALS calls, and one is retiring this summer. These medics are tired and stressed as they have day jobs (one in EMS at a paid service, one as a nurse and one as a teacher’s aid in my son’s kindergarten class). These medics spend most of their “free” time listening in for ALS calls. Not only do they cover our service, but our service is often asked to do ALS link-ups with nearby services that are only able to get out BLS. There is clearly a need in the community for more ALS providers, and it looks like the choice isn’t between me (and my friend “B”) and someone better qualified, but instead it is between us and no one.

I HATE listening to the scanner and hearing a call that should be handled ALS but isn’t due to lack of coverage. A few weeks ago a call came in during the middle of the day (when it is hardest for all-volunteer services to get out) for a 50-something year old man with chest pains and difficulty breathing. When the second page came through the dispatcher added that the man had a history of three prior heart attacks. The first responders on the scene were from the local fire department (my ambulance corps overlaps with something like three fire districts), and they found a responsive patient complaining of severe chest pains radiating down his left arm. They had oxygen with them on their rescue truck but could not administer it because no one who made the call was a certified first responder or EMT (they were certified in CPR so they could bang away on the guy once his heart stopped). Our service went out BLS with a desperate plea for ALS support. On route to the scene ALS was requested again along with a mutual aid request for ALS. Again ALS was requested from the scene, and again while on the way to the hospital. ALS never materialized. These types of calls make may stomach churn and really wish I could help. Yes, I KNOW that even if I was a medic there would be times when this still would happen, but if I can make a difference in just ONE instance, what is that worth to me? My community? The patient and his/her family?

I mentioned it before - This is not an ideal EMS system. It is, however, what my community has. I KNOW that a younger, fulltime medic with a lot of BLS experience would be better than me. That is not, however, what I am being compared against. The question is, then, would I be a good enough medic to do no harm and make a positive impact on pre-hospital care? How can I make this judgment?

I have a couple of months to decide. I honestly don’t know what I am going to do.