I mentioned in my previous post that laypersons are often left out of the loop when it comes to how EMS operates. A lot of this mystique, I think, stems from the “for what to tell a layperson” phenomenon. Sometimes, it’s easier to keep EMS to yourself and those involved because how do you explain tragedies to someone who sells insurance or babysits for a living? It almost seems unfair to put laypersons in that position, especially if they just want to help. However, not every shift contains a tragedy. But regardless, before things become too complicated, I would like to build a foundation.
Dispatch: This is the coalition of people working the radio traffic. When someone calls 911, it is dispatch who answers, takes notes, and then alerts us of the emergency. These alerts are done over the radio, so if you ever ride shotgun in one of my company’s ambulances, you’ll see about three or four different radios in the front cab. Depending on the hospital we’re transporting the patient to, we have to use a different radio.
There is one “main” radio, where we communicate with dispatch from. We have to tell dispatch the following: when we are clear to respond to the call, en route, arrival on scene, leaving the scene, arrival to the hospital, leaving the hospital, and back in the service area. It seems like a long list, but really, we just have to tell dispatch when we leave and arrive places. They then give us a timestamp for each corresponding update, and we write these timestamps in our own paperwork.
I love using the radios, and it has nothing to do with my “control freak” tendencies. Maybe I just watch too many spy movies.
Service Areas: I’ve tried explaining this to friends and family, but even then, they don’t quite understand. Basically, these are the geographical locations that our company will drive to. For example, if you order Pizza Hut for delivery, they can only deliver so far– they have a radius, and so do we. Our service area only covers so much territory. If you call 911 in the Upper Peninsula, our truck from southern Michigan is not going to pick you up. My service area consists of roads in Allegan and Barry County. So if you live in Kalamazoo County, my EMS company will not be the ones showing up to take care of you.
Another aspect of service areas involves coverage. This refers to when neighboring ambulance services leave their area and require a truck from another company to “watch over” their territory while they are gone. Wayland covers Plainwell frequently, meaning: when Plainwell’s last available truck goes out on a call, they have dispatch call Wayland (via the radio), and Wayland sends a truck down (or near) to Plainwell. This ensures that Plainwell’s service area is being watched over while their company is occupied with a patient.
The Hierarchy: Just like in hospitals (and many other professions), there is a hierarchy of skills and training. In EMS, there are four levels of certification: Medical First Responder (MFR), Emergency Medical Technician (EMT), Advanced EMT (AEMT), and paramedic. The differences include instruction time, skill sets, and legality.
MFRs are typically firefighters or other volunteers with their First Responder certification. MFRs do not work on the ambulance, but they can first respond to accidents. If CPR is necessary for a patient, MFRs are typically called via dispatch to respond to the scene. The intent of First Responders is that they will arrive before the ambulance and keep the patient alive until we show up with more advanced equipment and personnel.
EMTs are the lowest level you can be to work on an ambulance. An EMT is not a paramedic. You wouldn’t call a nurse a doctor. There’s a difference. We can administer some drugs, but we cannot start IVs or poke the patient with any sort of needle (except lancets for testing blood sugar). We are Basic Life Support, while paramedics are Advanced Life Support.
Advanced EMTs are not very common, in my experience. I am not sure what specifically makes them different from basic EMTs, except that they have a longer schooling period. Being the level between EMT and paramedic, I imagine AEMTs have more training in cardiac-related issues.
Paramedics typically go to school for an entire year to earn their certification. As mentioned above, they can start IVs and give drugs intravenously. They can also intubate patients, read EKGs (the squiggly lines on a heart monitor), and possess more training on cardiac-related issues. So if you have an irregular heartbeat, a paramedic would be able to read your EKG and know this, and what type of irregularity you have. As a Basic, this is like magic to me.
On a crew, the paramedic is the boss. EMTs and First Responders usually do not administer care to a patient, without first answering to their paramedic. This is critical, especially on a cardiac arrest. The paramedic facilitates a lot of the actions taken to preserve the patient. Oftentimes, your paramedic already has a patient plan in his/her head. This is why communication is important.
On Scene: When we’re running a call, a lot of the decisions being made are based on judgment (sometimes yours, sometimes your medic’s). We have to follow county Protocols (a book of written instructions for general scenarios), depending on which county we are responding in. Besides that, EMS is the application of training and problem-solving. A textbook can only depict real life so accurately. In short, don’t get caught up in “functional fixedness” because pillows are great for splinting broken bones.
This is why I enjoy EMS so much: you never know what kind of calls you’ll get for the day. It’s like rolling a die with infinite sides. Yes, some of those sides are horrific– you won’t be able to sleep for a week. But some of those sides are exhilarating too– you remember the look in the patient’s eyes when you shocked her back to life. “Adrenalizing” was made a word, simply for this reason.
EMS chaos and taking what you can get. It’s asking a little girl what her favorite book is, so she won’t cry. It’s conversing with a little old lady at 2AM while your medic tries to fix her home oxygen machine. It’s the small things.