Train Like you Play

Jeramedic posted a blog called ALS Kills People. It’s a good read, click here, then come back (my rant will make more sense I promise).

I complained recently about how EMS medical directors and services are looking to reduce the ALS interventions that paramedics can perform. I understand the initial intent to reduce the patient mortality and injury and increase survivability. Before anyone pulls interventions from our tool box, we need established scientific studies to prove if the interventions work or do not work. Let’s not just have knee jerk reactions across the industry.

When was the last time you intubated a patient in the field? When was that last time you performed a thoracentesis? I have not worked a full arrest since getting my paramedic license over a year ago. I have only worked two full arrests during my ride time, performing oral intubation once. I have not orally intubated a patient since ride time. Should I remove intubation from my possible treatments? Should I no longer “run” a full arrest?

Jeramedic put forth that we need to view our interventions (both ALS & BLS) like the fire service views special rescue teams, and police view SWAT teams. During my employment as a firefighter I was on all of the special rescue teams, and we trained four hours every quarter at a minimum, Water Rescue, Trench Rescue, Rope Rescue, Confined Space Rescue and Ice Rescue all had their place on our training calendar.  Hazmat was one area my fire chief thought we needed to be more proficient than the average fire department. We trained on hazmat once a month. Firefighting skills were drilled once a month, sometimes once a week. I was a big advocate of training every shift, given the long list of specialties that we needed to maintain (including BLS care).

Why on earth do we in EMS think that 48 hours every two years is adequate to maintain our skills? The interventions we use infrequently but could be considered life saving need to be second nature to us when we need to perform them. I stole the risk matrix from Gordon Gram when I taught my fire fighters. There were four categories in the matrix, High Risk/Low Frequency, High Risk/High Frequency, Low Risk/Low Frequency, Low Risk/High Frequency. We can use this matrix in a similar manor applied to medical interventions. Risk will be applied as risk to the patient, and frequency will be the number of times over a given date range.

Low Risk/High Frequency Interventions:

  • Nasal Cannula
  • EKG
  • Blood Glucose

Low Risk/Low Frequency

  • Oral Glucose
  • Splinting & swathing

High Risk/High Frequency

  • Intravenous Catheter
  • Nebulizer Medication Administration

High Risk/Low Frequency

  • Oral endotracheal Intubation
  • External Cardiac Pacing
  • Nasal endotracheal Intubation
  • Thoracentesis
  • Intraosseous placement
  • Needle Cric
  • Therapeutic Hypothermia
  • IV/IO medication administration

The lists above are not all inclusive and are based on interventions that I perform in the field. Your list might look different, and I encourage you to identify the high risk/low frequency interventions.

Many of our ALS interventions can be classified at high risk/low frequency. This is the area we need to concentrate on perfecting if we want to maintain the interventions. As a prehospital provider, we need to be training on the interventions that we do not perform often to reduce the risk to the patient. Minimum guidelines are just that, we should exceed the minimum standards in our attempt to become better providers of prehospital care.

I do not want to minimize the importance of didactic education, only take a small look at emphasizing the need for improvement in psychomotor skills. We should focus the skills sessions on the high risk/low frequency interventions, and we should train a few minutes every shift on these skills.  Pick one skill in the HR/LF category and spend a few minutes every shift on proper procedure, technique and protocols. You want to advance our profession from a trade to a medical profession, then we need to be able to demonstrate excellence in what we do everytime.

Advertisements

About Joel

I am a paramedic, firefighter and I work for an organ procurement organization. All stories related to work have been altered to HIPPA standards and for the protection of those involved. The personal stories are different. Photography, flying, aviation, hiking, camping, travel, geocaching, amateur radio are a few of my hobbies.
This entry was posted in EMS, EMS 2.0, paramedic and tagged , , , , , , , , . Bookmark the permalink.

2 Responses to Train Like you Play

  1. jeramedic says:

    Great points Monk. I really like the risk matrix approach, and it is something I will adopt when it comes to teaching, and studying. You said that “we need established scientific studies to prove if the interventions work or do not work.” This is true for medical practice in general. It is important to remember that our field treatments reflect the standards of in hospital care, limited only by (at this point) what can be accomplished remotely. Example: Asthma is treated with the same medications, weather by EMS or an ER Doc. The difference being the chest X-Ray and possible labs. The same goes for Chest Pain, minus the labs and X-Ray, the initial treatments and some diagnostic tests (12 lead) are the same. Now, the proper use and manner spinal immobilization, and other procedures is a whole other science fair. But you know…
    Being expertly proficient in our skills, all skills is paramount for the progression of the profession. And it starts with frequent study and practice.

    Now for proving if the interventions work or do not work, we need to stop measuring the effectiveness of prehospital interventions solely on cardiac arrest saves. I know it is very difficult data to collect, but I believe (as I’m sure many others do) that giving a breathing treatment 10-15 min sooner, makes a difference. That stopping a seizure on scene make a difference. That splinting an extremity fracture, and providing pain management, and at nothing else making the patient more comfortable makes a difference.

  2. Pingback: ALS Kills People « JERAMEDIC

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s