What's wrong with this picture?

[BEorP]

Hint: Ontario doesn't have any fire medics.

I sometimes truly wonder whether the IAFF teaches FFs how to be sure they are looking at their best in media shots.

In all seriousness though, I wonder about the patient care here. (Yes, there are countless factors that we don't know because we weren't there.) In general though, why would a paramedic have a first responder managing a patient's airway? If you were the paramedic responsible for this patient, wouldn't you prefer to be up there yourself to make sure everything is as it should be?

[akflightmedic]

That dangling strap is going to get caught under the wheel causing the stretcher to jerk to a halt thus allowing the FF to accidentally dislodge the tube in which all blame will later be placed on the paramedic for improperly placing a tube.

[Bieber]

Around here, all of our firefighters are trained to the EMT level and as such as allowed to ventilate patients using a BVM. Perhaps the paramedic was keeping an eye on the monitor or managing some other aspect of patient care. Would I prefer to be bagging the patient? It depends on what other priorities are present and my own assessment of where I will be able to provide the most effective care. I get where you're coming from, and I share your sentiments about the IAFF, but unfortunately we can't know when we're going to be behind the camera lens and we've got to make decisions based on what our patients need, not necessarily what makes us look better than fire. Stressing the importance (IMHO) of EMS-based EMS comes later.

[Arctickat]

As Bieber states, firefighters may not be ACP trained, (although I do know a few who are) but they are all PCP trained and well within their scope to use a BVM on an intubated patient. Additionally, this picture appears to be taken at Eaton Centre, and judging from the presence of uniforms there, likely from June 2 when 6 people were shot in the food court including a 13 year old in the head and a pregnant woman who went into labour. More were injured during the stampede and the gunman was still on the loose.

In this situation, getting in and getting out quickly were likely at the top of everyone's list.

[Kiwiology]

how do we know the patient is intubated and that the firefighters left hand is not holding the mask of the BVM?

... and are those head blocks?

[Happiness]

Yep the strap will get caught it always does. No those are not head blocks they are rolled up towels, and third Im pretty sure the medic is suppose to be in charge of the airway, at least it is that way here, it dosn't matter what level the FF would be.

I always find it so rude for people taking pictures of what can be someone last moments on earth. Just my opinion.

[Arctickat]

how do we know the patient is intubated and that the firefighters left hand is not holding the mask of the BVM?

... and are those head blocks?

Good point Kiwi, it looks like there is a colourmetric CO2 device attached and the towel rolls in the absence of a spineboard would be used to prevent movement of the head and ensure the tube isn't dislodged. I don't see a spineboard, so I figured there was a tube in place, but you're right, we can't actually see it.

The strap is the over the shoulder harness strap, too short to get caught in the wheels until they load the cot into the ambulance. There is no requirement for the medic to maintain constant contact with the airway, but he does have to be responsible for it. That's why I check it regularly if one of my PCPs is using the BVM. EMS and Fire work closely together, and I don't doubt that the medic and the FF are well known to one another. I'll hand off airway control to any person I believe is competent enough to care for it and recognise if a problem presents so I can move on to additional ALS treatments.

Edited June 12, 2012 by Arctickat

[emtdennis]

I never really had a problem with onlookers, as long as they don't interfere. I really have a problem with the "cameras".

[DFIB]

I am an EMT and ventilate patients all the time while the medic is attending things that only he can do. It is all about resource economy and management. There are other things in the picture that seem more concerning.

EDIT: The faces are interesting. Notice how the FF have a look of urgency, the guy in blue is striking a modeling pose (he is probably oblivious) and the guy in the back (who I assume is the medic) almost looks bored. This makes me think the patient may not be as critical as the first impression may seem.

Edited June 12, 2012 by DFIB

[Arctickat]

Yup, white shirt is a medic supervisor, black shirts are LEOs, and the FFs are pretty obvious.

Here's something more disturbing and illustrates the technology available today compared to 10 years ago.

Edited June 12, 2012 by Arctickat