December 29, 2018
Will you survive a life threatening medical emergency in the US?
Depends on where you live.
Collapse in Seattle from cardiac arrest – you’re guaranteed defibrillation within minutes. Collapse in Washington? Call a cab.
In the fifty largest US cities, about 9,000 people collapse from cardiac arrest caused by a short circuit in the heart. This is a very treatable issue – all it needs is a shock from an AED machine. Yet only about 10% are saved.
Something is clearly wrong. True; in a large percentage of EMS calls, a longer response time will not cause harm to the patient. But what about all the other times, when every second counts?
Let’s take a deeper look at the problem.
1) Insufficient Ambulances
Before we get into all the complicated issues, let’s get down to the most obvious problem – lack of ambulance units. As populations in different areas grow and change, the need for ambulances changes as well – but EMS systems are not evolving enough.
Recently, Mayor Martin J. Walsh of Boston announced that Boston Emergency Medical Service had begun training a new class that would increase their EMS count by 24 employees.
It’s time for other cities and towns to follow their lead and ramp up the number of ambulances.
2) Dispatch Errors
Last year, two young siblings, Ayina and Jai’Launi Tinglin, were killed in a Far Rockaway fire. EMS did not reach the scene until 20 minutes after the call was received.
The cause? Personnel errors preceding the dispatch.
Why the errors? Not enough training, says Jack Tanski, a telecommunicator for the Colony Police Department in Latham, NY, and a former paramedic.
Much more funds and effort needs to be invested in training and overseeing EMD. At the moment, in many agencies the management uses the communications center as a “dumping ground” for women who are on maternity leave or employees on light duty.
A dispatch center full of improperly trained employees who don’t even want to be there. Like every other part of the EMS system, EMD needs a clear protocol and oversight. “EMD is like the kid in the family who gets the hand-me-downs,” said Jeff Clawson, MD, owner of Medical Priority Consultants, Inc., in Salt Lake City, UT, “EMS buys all the fire engines, helicopters and equipment, but balks at buying a protocol that may cost $300-about the same as a battery for a defibrillator and half as much as the chair a dispatcher traditionally sits in.”
In addition, personality needs to be assessed when hiring dispatchers. A good dispatcher must have good interpersonal skills and a calm, reassuring manner.
3) Lack of Teamwork Between the EMS System and the Fire Department
The fact is that firefighters today are more likely to respond to medical emergency calls than to actual fires. Yet the culture doesn’t yet reflect that. Firefighters went into their careers expecting to fight fires, and not to plug in AEDs – so it is unsurprising that it is often difficult for them to respond properly.
In one city, firefighters median response time to a dumpster fire – which requires donning protective boots, pants, coats and breathing apparatus – was faster than their response to a cardiac arrest call. And this is understandable. Medical treatment was not what they signed up for. It is not what they were trained for.
In addition, infighting and turf wars between fire departments and ambulance services cause deadly delays.
Maybe it is time for firefighter recruiting and training to be changed to reflect the new reality. Let’s develop a new culture of partnership between EMS and fire departments.
4) Inability to Find Location of Emergency
Paper maps are basically extinct, right?
Many city’s ambulances have high priced GPS systems – but their paramedics still use time consumer paper maps. Why?
Because those GPS systems are only there to let the dispatchers keep track of the ambulances, not to provide direction to the drivers. Although this does cut 30-plus seconds off response time, there’s no reason the EMS responders themselves shouldn’t have GPS to help them navigate the streets.
The FDNY says that it isn’t so necessary since most EMTs work in the same areas each day. But even in an area that’s basically familiar, a GPS can go a long way in helping to locate a specific address and the best route to get there.
5) Calls Coming During a Shift Change
From his apartment window, Jonathan Agronsky saw Julia Rusinek on the ground. He rushed to the firehouse less than a block from where she fell – the firefighters there said a fire engine from another station farther away was on the way. Why couldn’t they come? Their ambulance crew was going off duty.
Last December, a paramedic was dispatched to a report of a cardiac arrest at 6:01 – but his shift had ended at 6. What did he do? He drove back to his firehouse to go off duty, and firefighters performed CPR on the victim for 25 minutes until the new paramedic crew drove to the scene.
It is not certain if such scenarios take place often, but it is definitely an issue that should be address, perhaps by offering a significant financial incentive for post-shift calls.
EMTs continue to be devoted to their jobs and saving lives. Putting some of the above changes into practice can go a long way towards increasing efficiency and making things easier for EMTs everywhere.