http://www.jems.com/video/news/maryland-firefighters-paramedics-hon...

Firefighters were recently given an award for tranporting a five-year-old girl on a fire truck.  She reportedly went into cardiac arrest during an asthma attack, and CPR was preformed during the transport.  The ambulance's ETA was 5 minutes from when they made the decision to transport.  The patient survived with no deficits. 

 

Is this a good idea?  Is this setting a precedent?

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Really, 5 minutes?
I congratulate the crew and the Good Lord for their outcome. But I generally wish first responders would just do their own jobs well. This makes me think of the prospect of a transport medic fiddling with a pump panel, over an engineer's shoulder. There's no ME in TEAM.

In some of the articles it was stated this was an engine with a Paramedic on it who was also able to provide ALS care. Wouldn't that Paramedic have the same level of training and the ability to make decisions as a transport Paramedic with an ambulance especially since they work for the same agency? 

I think there are some situations which are not defined in a protocol.  While an ambulance might be ideal transport, if you can provide the same level of care in a fire truck, why criticize it in this situation. I doubt if this would have  been considered as an optimal choice by this same group of responders if it was a full size adult.  I  think it was a good call since a child who has code due to an asthma attack will need more than the standard ROSC care since the pulmonary problem may still exist. 

Geri Jacobson,

 

Having a paramedic on the engine does not necessarily mean that the same medications are available as would be available on an ambulance.  That is one of the other unknown variables in this story.

Thom,

 

That frankly depends on the system and the individual qualifications.  In my system, a lot of the engineers ARE also the transport medics, due to our cross-staffing model. 



Thom Dick said:

Really, 5 minutes?
I congratulate the crew and the Good Lord for their outcome. But I generally wish first responders would just do their own jobs well. This makes me think of the prospect of a transport medic fiddling with a pump panel, over an engineer's shoulder. There's no ME in TEAM.

I made my statement after reading some of the articles about this county and thought it appeared to be similar to what is available in many of FDs I am familar with where ALS engines are used.  The engine Paramedics have the same abiities as the transport Paramedics except for transport. In situations where private ambulances are used, the engine Paramedics will continue to lead even with Paramedics on board from the private service.  

Ben Waller said:

Geri Jacobson,

 

Having a paramedic on the engine does not necessarily mean that the same medications are available as would be available on an ambulance.  That is one of the other unknown variables in this story.

"Paramedic abilities" does not necessarily equal "Vehicles equipped the same".

Ben Waller said:

"Paramedic abilities" does not necessarily equal "Vehicles equipped the same".


Which is true in this case. Allow me to pull a quote from the supporting press release provided by the JEMS Web Team about 10 posts ago:

[FF/Medic Scott] is a trained and experienced paramedic, yet, performing a firefighters [sic] duty for the day on the engine, he did not have any advanced life support equipment and medication available

On the other hand, if you're paying people to be paramedics, and you don't provide them the equipment to utilize those skills, that is probably a huge false economy.

You do chest compressions on peri-arrest kids with a heart rates < 60 right? If it was my kid who was having an asthma attack and bradying down I'd be happy this crew got the child to the hospital when they did. I certainly wouldn't wait around just to sooth some other paramedic's ego. 5 minutes is a long time when a kid is circling the drain especially when you're only 2.8 miles from the hospital. I'll take a board certified emergency physician over an ALS unit any day of the week for my kid.

In this case, it appears that a firefighter/paramedic was working a firefighter slot on a BLS engine, so there is no "false economy" involved. 

 

Ditto for firefighter/paramedics working any non-transport vehicle without ambulance-level ALS equipment; you still get paramedic-level assessment skills and abilities if the non-transport unit arrives prior to the ALS ambulance, and you also get an extra paramedic when the ALS/no transport unit backs up an ALS ambulance on calls that require an extra ALS provider.

 

There's also the human element and skills retention element in dual role systems - it's good for your paramedics to get some time off of busy ALS transport units and spend that time on a slower non-transport unit to let them work on their fire/rescue skill sets and abilities and to have a break from the higher workload.



Skip Kirkwood said:

On the other hand, if you're paying people to be paramedics, and you don't provide them the equipment to utilize those skills, that is probably a huge false economy.

Paramedics have egos???  Who knew?

Tom Bouthillet said:

You do chest compressions on peri-arrest kids with a heart rates < 60 right? If it was my kid who was having an asthma attack and bradying down I'd be happy this crew got the child to the hospital when they did. I certainly wouldn't wait around just to sooth some other paramedic's ego. 5 minutes is a long time when a kid is circling the drain especially when you're only 2.8 miles from the hospital. I'll take a board certified emergency physician over an ALS unit any day of the week for my kid.



Tom Bouthillet said:

You do chest compressions on peri-arrest kids with a heart rates < 60 right? If it was my kid who was having an asthma attack and bradying down I'd be happy this crew got the child to the hospital when they did. I certainly wouldn't wait around just to sooth some other paramedic's ego. 5 minutes is a long time when a kid is circling the drain especially when you're only 2.8 miles from the hospital. I'll take a board certified emergency physician over an ALS unit any day of the week for my kid.

Given a short transport time vs short ambulance ETA, is there any reason to wait for an ambulance if another vehicle capable of transport is available?

If rapid transport was key, why was ROSC obtained prior to arrival at the hospital?

...and I don't give a darn either about any responder's ego.

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