Tag: EMS

Reading Your Ambulance or EMS Report, Part 2

Picking up from where I left off in my previous post, there are a few more boxes left to read on the Ambulance or EMS Report, and then there is a narrative or Assessment.

In the center of my form are vital sign readings. One thing that surprised me at first was that although the EMS arrived at my home at 16:00 and started oxygen at 16:04, the first set of vitals is for 16:15. That must have been when I got loaded into the ambulance. Prior to that, the EMS had to see where I was and what was happening, and get the oxygen started. Then I had to get carried from the house, secured on a gurney,  and then the gurney was carried to the ambulance. While one team member [#709] ran an EKG strip, another [#332] took the first set of vitals and then a minute or two later started the IV.

The team took my vitals every 5 minutes. These included pulse, respiration rate, blood pressure, and oxygen saturation. My glucose was measured and my pupils were marked as =R, which I think means equally responsive or reactive. Skin color/condition was “pale, diaphoretic, cool.” Diaphoretic means sweating. When these three descriptions appear together, something is wrong.

Next is AVPU. This stands for Alert, Verbal, Pain, and Unresponsive. Alert is normal awareness, Verbal means that the patient responds if spoken to, Pain means that patient responds by flinching or pulling away from a source of pain, and Unresponsive means just what it says. Verbal is tried before Pain. Your possible grades are: A, V, P, U.


In Praise of EMTs and Paramedics

Until recently, my experience with ambulances was limited to thinking: I’m glad it’s not me in there, please let it not be carrying anyone I love, godspeed you to help whoever you are, and, if driving, I hope that ambulance isn’t coming up behind me.

But since my recent medical  emergency, I’ve looked into who these people are who arrive in a flash, save lives, and then are gone. They don’t leave a calling card, you never know their names, and if you are in as bad a shape as I was, you might have heard their voices, but likely never saw their faces. They could be standing next to you in line at the store, sitting beside you in the theater, and you’d never know it.

I’m convinced in my case (and I expect it many others), that the Emergency Medical Services [EMS] team saved my life; the emergency room doctor then fixed the problem. But he wouldn’t have had a patient to work on were it not for the EMS. This is why I was so surprised to find no mention of the EMS’s work in my hospital records. Is this common, that their work is ignored, I wonder.

I’ve learned a little about these professionals since then. It’s more complex than you might think. There are First Responders, Emergency Medical Technicians [EMT] (and several levels of these), and Paramedics, and the requirements for these vary somewhat from state to state. Firefighters are also often cross-trained as EMTs, in case you are wondering why firetrucks accompany ambulances.  I’m sure their physical strength comes in handy, too.

Then there are different categories of emergencies: BLS and ALS. BLS refers to “basic life support” and ALS to “advanced life support.” I learned a lot from browsing the forums at www.emtlife.com and www.emtcity.com. A question about the difference between BLS and ALS brought this answer from Michigan but the responses that follow show there are some state-to-state variations:

Basic Life Support Units that are designed for inter-facility transportation and pre-hospital response to ill or injured patients. Each unit is staffed with 2 licensed emergency medical technicians. …

The ALS units have a minimum of one paramedic and one EMT, can administer certain medications, and have advanced airway equipment, cardiac monitors, advanced cardiac life support equipment and blood glucose testing equipment.

What I found astounding is how poorly EMS workers are paid. All I can think of as an explanation is that in a lot of rural America, first responders are often volunteers, so somehow the idea got embedded that if there are people who will do this for free, why pay anyone well? It’s an absurd and stupid answer, but how else can the salaries of these people who deal with a range of dangerous and to most of us disgusting situations be justified?

Consider these facts from EMS Workforce for the 21st Century: A National Assessment [2008]:

…at $12.54, EMTs/paramedics are among the lowest paid of several comparable allied healthcare professions. Medical assistants, at $12.19, make somewhat less than EMTs/paramedics. L.P.N.s/L.V.N.s, at $16.94, have a median hourly wage of $4.40 more than that of EMTs/paramedics although the program length for L.P.N.s/L.V.N.s is quite similar to those for paramedics. …

EMTs/paramedics are among the bottom three categories in wages, making slightly more than nursing aids/orderlies/attendants, nearly $1 less per hour than medical assistants, and about $4 less than L.P.N.s/L.V.N.s.

…Medical assistants have a broad range of direct patient care responsibilities and work under the supervision of a physician, but have no training, certification, or licensure requirements. Low wage medical assistants (at the 10th percentile) make higher wages than EMTs/paramedics.

How can this be? Does this make sense to anyone? Am I missing something?

According to http://www.salary.com/mysalary.asp, where I live, EMTs make between $24,000 and $31,000 a year, while medical assistants, who “assist in examination and treatment of patients under the direction of a physician” make $26 – 31,000, and medical billing clerks, $27-32,000. These are all lousy salaries, but is it not astounding that people who are out in the field, making life-saving decisions without anyone there to consult, never knowing what they may encounter, make about the same as those who follow routine orders and less than those who send out the bills?

And as if this weren’t bad enough, if my experience is the norm, they don’t get any credit for their work by the ER departments to which they deliver their stabilized patients, and I could provide numerous examples of belittling depictions of their demeanor as insensitive tough guys, but this  New York Times review of the novel Black Flies by Shannon Burke (who worked in the field for five years) about “a rookie, Ollie Cross, who becomes a paramedic after failing to get into medical school” will suffice:

As Cross begins to break free of his borrowed role, Burke offers up one of the book’s most disturbing images, a tragedy of the everyday variety that produces headlines but quickly fades from the news. Five medics, smoking and arguing, stand at the closed door of an elevator that has plummeted down a shaft. As the door squawks open, the men quit bickering and jump up, reacting to “a tangled mess of limbs in contorted, grotesque shapes, tossed grocery bags, blood and eggs and a bag of Cheese Doodles covering the writhing bodies.” They are so desensitized that it takes a scene of sickening destruction to jar them into cooperative action [emphasis added].

Note that it is the reviewer, Liesl Schillinger, safe in her office, who deems the medics as “desensitized,” even as she notes that when it is time to act, they do so immediately. What’s her problem? Are EMTs and paramedics supposed to stand around solemnly and silently all shift long except for when they are saving lives? Would she be as snarky about surgeons in the hospital locker room bickering before going into the OR?

I’ll end with this summary from EMS Workforce for the 21st Century: A National Assessment [2008]:

Research into the EMS workforce in the United States reveals a complicated picture of a workforce that bridges two distinct environments: healthcare and public safety. This is only one of several reasons why the EMS workforce is a unique group of workers.

The EMS workforce comprises both employed and volunteer workers, a feature unique in the healthcare sector although common in fire fighting. Unlike other healthcare providers, EMTs and paramedics are visible and interact with the public primarily outside of healthcare facilities. However, the nature of their work and extent of their skills are often not well understood by public.

Despite their low pay and benefits relative to other healthcare and public safety professions, EMTs and paramedics are in many ways devoted to their field. There is a strong desire among leaders in the field to advance the EMS workforce.

I can attest to the devotion of the team in HEMSI Vehicle 64 to its mission. I wish I could do more.

091114-G-0000X-001 Coast Guard Station Humbolt Bay assist
SAMOA, Calif. – Station Humboldt Bay crewmembers and Eureka City paramedics remove an injured mariner from a 21-foot pleasure craft at the Coast Guard small boat station, Nov. 14, 2009. The man was injured while crossing the Humboldt Bay bar when a large swell threw him against the side of the vessel’s cockpit. U.S. Coast Guard photo by Petty Officer 2nd Class Gregory Brush.
Air Station Los Angeles medevac (FOR RELEASE)
LOS ANGELES – A paramedic from the Los Angeles County Fire Department records a patient’s information inside a Coast Guard rescue helicopter Oct. 3. The patient was medically evacuated from the cruise ship Osterdam 30 miles off Point Conception after it was suspected that he was suffering internal bleeding. (Coast Guard photo/Petty Officer 2nd Class Ken Fuerstinger)
KODIAK, Alaska (Aug. 5, 2004)–Petty Officer 2nd Class Mark Capra, Petty Officer 2nd Class Dave Southwick and Petty Officer 2nd Class Kathy Hayes assist Kodiak paramedics as they remove a litter bearing Wilmer Anderovich from an HH-60 Jayhawk helicopter here. Anderovich was medevaced from Old Harbor suffering from gastrointestinal bleeding. Anderovich was transported by ambulance to Providence Medical Center here. USCG photo by PA1 Paul Roszkowski