Who’s the Most Important Person at a Scene?

As we began our medical training, we were taught that scene safety was paramount. Protecting ourselves and our partners from harm superseded the importance of care for our patient. The premise is valid; if we become injured, we cannot properly care for our patient.

Do we really heed this lesson? Not really. Yes, we try to check as we enter a scene, we try to prevent from being cornered into a bad situation but protecting ourselves goes much further than what we do when we are on the scene.

Many of us have a “Hero” mentality and want to do whatever it takes to help our patients. We try to do superhuman feats of lifting; drive faster than is prudently safe in inclement weather and deprive ourselves of needed recuperation time.
Studies have shown that there is no way to properly and safely lift another person. We must move into untenable positions to be able to move our patients. Additional help would be very beneficial, but in an effort to cut overhead services generally send our too few medics for the task at hand. Even lifting a light patient of 100 pounds (45 Kg) can twist us into positions that cause undue strain on our back or joints. Learning to rely on bystanders and ask for needed help will definitely help increase your longevity in the career.

We all like to drive like our hair’s on fire; that’s one of the things that new medics list as a draw to the field. . . Driving Fast. But speed is not needed in most cases and we are putting ourselves at undue risk. We face a double-edged sword; we are told that we may exceed the speed limits, travel on the wrong side of the road and proceed through traffic controlled intersections, but if anything goes wrong are held criminally responsible. There has been a number of Paramedics and responders that have served jail terms because they were rushing to help someone else.

Add to this the weather. We cannot control when someone becomes ill or injured, but need to take a higher regard as we head out into conditions not fit for man or beast. We take undue risks to transfer patients from one hospital to another during some of the worst weather. Yes, the patient needs the higher level of care, but is this outweighed by the much higher risk placed on the patient and the caregivers to transport during severe weather. . . I would suggest no!

We put ourselves into danger every shift, but there’s an even uglier monster that is often ignored. All of the recent studies have shown a huge negative effect on sleep deprivation. Why they needed to spend money to tell you something that everyone knows is another topic, but we all know that we are not thinking clearly or acting properly when we do not sleep. I guess the studies are trying to quantify the dangers.

Going without sleep for more than 24 hours is more impairing than 0.10 blood-alcohol on our reacting times, our higher reasoning, and physical abilities. Would anyone find it acceptable for their staff to be drunk on duty? Absolutely not. But 24 hours of work is considered the norm among many departments and residency programs.

While it is stated that we can relax between calls, how realistic is this expectation? Medics will not normally sleep between calls during the day, and some companies expect this time to do station maintenance and training. Calls may be continuous, preventing downtime and paperwork has a higher priority than the well-being of the crew. Even when the time is available, do we really achieve a relaxing sleep as we are always on alert for the next call?

There is no standard as exists for pilots or transportation careers that require a prescribed amount of downtime between working hours. Many leave their EMS jobs to work someplace else to make ends meet, missing the requisite relaxation and sleep. Sometimes people will trade work shifts to accommodate family functions and can work 48 or 72 hours. How do you think their mental facilities handle these hours.

At what point does it make sense to switch to an 8 hour or 12 hour day? A department that averages 10 calls per day per staffed unit? 20 calls? Where do we draw that line?

Some compensation packages require working 48-72 hours per week to be able to make a livable wage. This model may need to be adjusted.

On our very first night of class we were taught our safety was paramount, but after that, we’ve only ever paid lip service.

 

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