Musings from the chalkboard
Vol. 27 No. 3
Several times throughout the years that I have written for Industrial Fire World, I have had a column entitled “Musings from the Chalkboard.” While some of these are just that, musings from an old medic about the state of things and of things to come, this one is more about what is currently happening in EMS. Funny, some of this always seems to become cyclical and comes back into clarity after years of neglect.
When browsing the literature, several things kept rising to the surface. The issue of “scene safety” is back in focus. The education of our EMS providers and the use of simulation trainings are also being hammered into the minds of those held responsible for quality training and education. It is stated that this is the “future” of EMS training. Makes me wonder what we have been doing with most of the “simulations” we have been using. Lastly, we took a real look at the fatigue experienced by EMS providers (and maybe our extinguishment brothers and sisters) with long shifts or combined shifts.
Industrial EMS providers are aware of the issue of scene safety. When responding to a tank fire at any refinery, senses are heightened in awareness of possible boilover. Anyone who has witnessed a storage tank boilover will tell you it is a more than frightening occurrence and many a crew has been lost due to poor planning or not knowing when to fold the cards and retreat. At a IFW Conference in Beaumont, TX, I witnessed a 42-inch demo tank boilover. It took about 30 minutes for this small demo tank to reach critical, but when it blew it shot flames 40 feet into the air and had overflow out to about 10 feet. This demo gave me new respect for these types of incidents and the guys who fight them. Chief officers learn to retreat early. No reason to risk life when you are losing the battle. This situational awareness is something we all need to train and develop. From the beginning we are taught to verbalize, “is the scene safe?” We need to develop this in all levels of command. I tell my students about developing a “spidy sense” and how I cannot have people standing behind me (there is much more to this “sense”) as it will immediately raise the hackles on the back of my neck. This sense of situational awareness should continually be reevaluated and a certain gauge of risk/reward be calculated for all impending action. Remember, if the scene is not safe, make it so or do not enter. If the action is not overly weighted to reward than risk, we may want to reconsider the action.
Simulation training is something we have always utilized in the fire service and in EMS. It is now being brought to the forefront again to reiterate the value and to implement technological improvements. We at the College of Southern Nevada have had a Sim-Man for years, but our latest version is computer driven and will do lung sounds, pupil reaction, real palpable pulses, and blood pressures, etc — everything but kiss you. The simulation advances do not stop with mannequins. As I write this the Chicago Fire Department is constructing an EMS simulation “station.” They are creating a simulated living room, child’s room, a bathroom and an alley — seven areas in all. Similar to what the fire service has built for years with burn towers and smoke rooms, this places EMS trainees in real situations they will encounter. The “station” also is apparently wired with video and audio with the ability to transmit live training to outlying units. The bulk of the money used to plan and construct this state-of-the-art facility came from grants. So you departments looking for training monies, check the federal grants as there are beaucoup monies available. Kudos to the CFD!
Lastly, the Federal Aviation Administration has had strict guidelines for pilots and the amount of hours they can fly before they must break and rest, recently set at 10 hours between flights. While there are no guidelines for EMS or extinguishment front line personnel, talk is that some standards should be adopted. Recent research out of Pennsylvania has shown the increased fatigue among EMS providers leads to errors in patient care, medication calculations, and injury rates for the providers themselves (probably related to bad decision making when fatigued). Much of this may be related to “double shifts” and other such anomalies that may occur, but a real look at the amount of fatigue induced by long shifts alone is occurring. The days of the 24 hour shifts for EMS providers may soon see an end. Expect much crying by city administrators facing increases in staffing to meet the needs of the departments and the public.
As always, I welcome your comments and concerns of any issue related to EMS, topics, products and general concerns about our profession.