Morning Lineup – July 15

On Saturday we were talking (HERE) about why mandating EMS standards to paramedic level was actually reducing service by causing rescue squads to cut back or stop responding altogether.  In their zeal to improve emergency care, many counties are now requiring all ambulances to have at least one certified paramedic on board.  This creates a burden on the rural areas because the effort involved in getting the certification is beyond the ability of most people regardless of their desire to get it.

Today I want to mention the 2nd roadblock to providing outlying areas with paramedic service, and that’s the lack of call activity.  Paramedic skills are such that require constant use in order to stay proficient.  This is especially true when it comes to making an accurate diagnosis of the patient.  And then beyond that, there are several manual skills that need to be used often enough to stay proficient at them.  Such as the basic procedure of starting an IV line or drawing blood.

This lack of constant use eventually leads to the paramedic either dropping the certification or moving along to another agency with more activity.  In a nutshell, these sparsely populated areas are not going to have consistent paramedic service.  With that in mind, I think it would be more productive to re-establish the local ambulances as basic EMT providers and use them as feeders to a more distant paramedic-level service.  With the growing fleet of air ambulances around the country, it could be blended into the response program (on an as-called basis, of course) and be available when the situation genuinely calls for it.  How many rural VFD’s have ever been trained on when it is appropriate to call for air transport?

There are many different ways to structure an effective rural response plan.  But it’s important to look at it in a different point of view than we’re taking now.  A fresh look, so to speak.  In Oklahoma the state legislature is the one taking the fresh look.  But they are wisely doing it through investigative committees and bringing in knowledgable people with a variety of points of view.  It will be interesting to see if and how they address their EMS problem.

Now it’s time for us to address our equipment check-list and make sure that everything’s ready to go for today.  I’ll go start the coffee.