Continuing from Part I. Later in his article, Kelly Grayson of A Day in the Life of an Ambulance Driver, writes –
At least one large, metropolitan EMS agency, once featured on the cover of JEMS and often lauded for its clinical excellence, no longer allows paramedic students to perform ETI when doing clinical rotations with their agency. Their reasoning? Because we don’t get enough ETI attempts to remain proficient ourselves.
And thus, they sacrifice the seed corn in favor of the current crop. There is but one predictable end result of that policy, and that is within the next five years, their intubation proficiency will nosedive, or they’ll have to abandon the procedure altogether.[1]
This is a problem with far more than just intubation, airway management, or even paramedic education. There are systems where the written policy is that the most experienced person must be in the back and provide all of the treatment on every call. This usually means the highest certified person, but there has not been a lot of thought put into this kind of rule writing (or there has been a great quantity of thought, just no quality).
The problem is that the less experienced person (in a 2 medic system, the less experienced medic) never has the opportunity to develop experience. Let’s assume that New Medic is a new graduate and is assigned to a regular partner named Old Medic. Regardless of how much experience he has, Old Medic has more experience than New Medic. Therefore, on every single call, Old Medic will perform all treatments (at least that will be what the documentation will show to satisfy company policy). Fortunately, most medics are probably not going to comply with such a myopic company policy, even if it comes from the medical director (and sometimes it does).
What if New Medic does not work extra shifts and always is the least senior medic on the ambulance?
5 years later Old Medic transfers to somewhere else. Now New Medic is assigned a brand new medic partner named Brand New Medic.
Old Medic now has 10 years experience and has been doing all patient care that might have been done by New Medic for the past 5 years.
New Medic has been a ride-along for 5 years. New Medic has 5 years of experience on paper, but he has not started any IVs; he has not defibrillated anyone; he has not paced anyone; he has not cardioverted anyone; he has not been required to make any independent decisions, except about where to go for food.
New Medic is as inexperienced as the brand new medic – Brand New Medic.
Now the rule will require that New Medic provide all treatments and ride in the back with all patients, because on paper New Medic has five years of paramedic experience.
The reality is that for 5 years New Medic has been working as the basic EMT partner to Old Medic.
Is New Medic the equivalent of Old Medic, who had 5 years of experience, when New Medic was assigned as his partner?
Absolutely not.
As Kelly writes – And thus, they sacrifice the seed corn in favor of the current crop.
This is what happens when EMS agencies apply this policy across all skills. Maybe this is not the way things are done where you are, but there are places doing this. This is a form of medical command permission requirement on steroids.
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To be continued in
Part III,
and Part IV.
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Footnotes:
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[1] Is it time we give up endotracheal intubation?
by Kelly Grayson
EMS1.com
Article
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There is a rumor of this happening in the area I work in. I can’t believe that patient care is compromised because of lack of training. This is just a training issue. If we don’t do enough tubing then we need more training and/or more time in O.R. or E.R.. While I know that no one wants to hear that, any Medic worth their salt is not above more training if it means better care.