commentary FossilMedic on 10 Jun 2008 08:56 am
EMS Follows Rocket Science
FossilMedic explains how:
MAYBE IT IS ROCKET SCIENCE
Last week both the uniformed and civilian head of the Air Force were fired. Secretary of Defense Robert Gates stated:
During the course of the investigation, other issues indicating a decline in the Air Force’s nuclear mission focus and performance became apparent. Rather than an isolated occurrence, the shipment of the four forward-section assemblies to Taiwan was a symptom of a degradation of the authority, standards of excellence and technical competence within the nation’s ICBM force. Similar to the bomber-specific August 2007 Minot-Barksdale nuclear weapons transfer incident, this incident took place within the larger environment of declining Air Force nuclear mission focus and performance…Years ago the career path for Air Force personnel in the nuclear field was well established and prestigious. However, the overall mission focus of the Air Force has shifted away from this nuclear mission, making it difficult to retain sufficient expertise.
Noah Shachtman, writing “Bosses Nuked, Some Air Force Missileers Cheer” for Wired magazine describes the battle over the nuclear mission when the Strategic Air Command was disbanded in 1992. http://blog.wired.com/defense/2008/06/defense-secreta.html
From his article:
ICBM specialists used to spend their entire careers doing nuclear work. But under Space Command, officers had to start branching out — operating satellites, rather than prepping for an atomic strike. They had to take classes on space warfare, instead of nuclear maintenance. “For the past 15 years or so, the Air Force has not been growing nuclear experts… We’ve lost an entire generation of officers.”In 2005, Space Command chief General Lance Lord “punctuated all that nonsense by getting rid of the ICBM badge.” Everyone under his command was supposed to wear Star Trek-esque “Space Wings” instead. [rip badge] That may seem like a minor deal to civilians. For missileers, it was a huge blow to their pride; they took it as a sign that they were now second-class citizens — their heritage gone, their unique training, ignored. “Ever since Space Command took over nukes, they’ve watered down the natural progression of a nuclear officer with Space nonsense.”
If you replace ICBM with firefighting, this conversation is going on in many firehouse kitchens. One of the most contentious items in the Washington DC EMS Task Force items was to eliminate the DCFD title from the fire apparatus, buildings and uniforms in order to show that the fire department is involved in emergency medical services. DCFEMS does not have the same impact.
Many firefighters complain that the impact of EMS, customer service, technical rescue and other non-firefighting tasks erode the ability to develop, prepare and deliver righteous firefighting. Former Fire Engineering editor Bill Manning took a lot of heat for his February 1997 opinion “The More Things Change” when pointing out:
Is there a fire department out there that hasn`t jumped through the EMS hoops for city managers? When they said, “Diversify!” the fire service said, “Thanks for asking–we can`t wait to do something other than fire prevention and protection!” You know there were some old-timers out there chuckling over fire departments falling over themselves in the great rush to be “progressive” and “responsive to the community.” I have nothing against emergency medical services–really, I think every community should have them–but some fire departments may have been better off placing a few more firefighters in the field and on the rigs to prevent and extinguish fires before purchasing ambulances. I hope I`m wrong, but it nags at me that a plunge toward diversification is silent approbation of our yearly fire loss statistics, which, may I remind you, are as yet nothing to brag to the world about.
Eleven years later, as we look at the impact of an economic recession on fire department budgets, it is hard to see how to keep focused on the fire suppression mission. The Air Force Chief of Staff officially approved the reinstatement of the missile badge as one of his last official acts.
on 10 Jun 2008 at 11:06 am 1.FireBoss said …
Every day I go in the station and realize we do not run EMS I get a big smile on my face knowing we still exist quite well as a FIRE Department.
If some fire service management Gurus thought picking up garbage would help our image we would have Garwood Packers sitting in the stations.
on 10 Jun 2008 at 4:45 pm 2.Dennis said …
Very thought provoking commentary. However EMS is not rocket science. That being said, one would expect that in a large urban fire department responsible for the delivery of EMS, a crew from an engine company and a BLS ambulance would recognize the difference between an intoxicated patient and one with a closed head injury. The DCFD was faced with this situation a couple of years ago, failed miserably, and the result was the death of a very high profile patient, lawsuits, and promises of reform in DCFD EMS. Stop whining about what is plastered on the side of your rigs and just do your job.
on 12 Jun 2008 at 12:00 pm 3.fossilmedic said …
Sorry Dennis, I disagree with your assertion that “a crew from an engine company and BLS ambulance would recognize the difference between an intoxicated patient and a closed head injury.” That same patient was left unattended at the emergency department for HOURS.
A survey by three different fire-based ems agencies in the DC area after this incident showed an uncomfortable level of ALS and BLS crews under-reporting closed head injuries. To the order of 20 some patients in a three month period.
Mike
on 14 Jun 2008 at 8:58 pm 4.Dennis said …
Sorry Mike but I guess we will just have to agree to disagree on this one. You are right that Mr. Rosenbaum was in Howard University Hospital for several hours before his condition was discovered, but it all started with the engine company and bls crew. Unfortunately there is much blame here for everyone involved and not much solace for the Rosenbaum family. If he had received proper medical care for the very beginning of the incident the outcome may have been different.
So you are telling me that EMS crews in the DC area under-report closed head injuries. Please tell me that this is a training problem because I know you are an EMS training guru and could fix this problem. If it is not a training problem, then it is that “other” problem which leads me to believe that some EMS providers sterotype a patient because they can smell ETOH on the breath. After that they are’nt taking the time to shine that little penlight in patients eyes, or ascertain LOC, and they are not performing what I was taught so many years ago, what was that called, oh yeah, a thorough “PATIENT ASSESSMENT”.
on 15 Jun 2008 at 6:04 pm 5.Mike "fossilmedic" Ward said …
I agree to disagree with you on point one.
The second point remains troubling, because we are talking about fire-based ALS/BLS performance in many of the DC jurisdictions, from the richest to the poorest. I am not allowed to describe specifics, but the medical directors shared their informal survey results with each other. More similar than disimilar. (eek!)
I agree that the sterotyping is part of the problem, ETOH apparently leads to a consistently incomplete patient assessment.
What “fizes” this is a closer follow-up on the patients that get under-treated. The clinically excellent ems systems have a much higher level of physician oversight and involvement. Before entering academia I thought that this could be handled by ems supervisors, you need the physician clout to effect lasting change.
I appreciate your response.
Mike
on 15 Jun 2008 at 6:12 pm 6.Mike "fossilmedic" Ward said …
Damn, finger slipped. Let me fix my “fizes”.
The ems systems with strong physician involment are:
Seattle,
Boston,
metro Dallas (BioTel)
Chicago
and a half-dozen others. These four are the ones I am most familiar with in relation to large ufban ems systems.
they feature more than one physician,
24/7 physician access,
physician response to major incidents
continuing medical education based on agencies experiences and needs
LA City has one physician to oversee almost 600 paramedics (double eek!)