"First Responders" on Ambulances

[AnatomyChick]

Personally.. I was talking about the "paid service" setting... As far as Vollies go... I don't know where we would be without our First Responders... 9 times out of 10 they are on the scene before us with a patient assessment done and the patient "packaged".

[cfaulknor]

On on ALS Rig? No. I think it should be Paramedics, EMT-I's and EMT-B's.

Now on a BLS rig, I think it is fine. They only have Basics and below, so having FR's, while not ideal, is acceptable.

[Nate]

I'm not even touching this one!

I agree, nothing but a can of worms that I DO NOT want to open.

[temsp40]

First Responders on an ambulance???? There is not a clear answer that is going to keep any of us from sounding either overconfidant or bashers of all that are not at least EMT's.

I think that in some instances a FR and an EMT-Basic would be a fine combination -- as long as there was NO possibility of the patient requiring intense medical care (i.e. they have no reason to be in an ambulance in the first place) or if there is an MCI or some other over taxing incident to the EMS service involved.

As a routine staffing combination, I don't feel this is safe or reasonable. How many times have you gone into a scene with your partner and missed something OBVIOUS that your partner saw? How many times have you ever wanted to be sure that you partner was looking at the same patient you are (assuming that you are working with an equally experienced and certified partner), or how many times has it been just as easy to flip the coin with your partner to figure out who is taking the alcohol enhanced individual to the the hospital?

FR's may inhibit our ability to do this, to have the option of not having to tech every single call that comes our way and to be able to get another trained opinion on the current patient. I for one think that if the FR wants to ride in, observe, help in anyway they can and learn from what is going on, then great. But to make them my primary partner, I think not.

Now, in many communities, FR's are the PD, the FD or another organization dedicated to getting to the patient before the ambulance. These FR's perform a vital roll in patient care, many that I know have been FR's for eons and have learned some of what is going to go on when the ambulance arrives. There are other communities that actually have EMS providers as FR's because for whatever reason, they do not have their own ambulance and have to wait for the private company to send one out from the city located below them. The "Fire Rescue" unit rolls and they can do pretty much everything for the patient except for transport.

Of course I think I just got a little carried away -- we aren't talking about EFR services, we are talking about certification levels as a First Responder.

Again, no, I don't feel that a First Responder belong as part of a primary ambulance crew, an assistant to the crew - yes.

P-40

[Nate]

Truth is, most of the first responders from the fire departments that we work along with are at least EMT-Basics. I really haven't come across to many ECA (Texas' version of the certified FR) except at the ER working on a transfer truck (yes they are allowed to work on an ambulance, but it can't bill higher then BLS rate).

[jafo]

This is a great question, and the opinions this far have been enlightening to say the least.

The First Responder has been the ugly step child of the EMS community. Indeed, as many of you have hinted, he or she is not even part of that community. Every state treats the First Responder certification differently, and consequently the First Responder is treated differently.

For instance, in PA there is no classroom time required for the certification. Pass the test and you’re in. As a result, there is little respect or use for those individuals in PA. In New York State, where I live, there is a required 50 hour course, followed by a practical and written exam. It is handled exactly as the EMT B, but to a different set of protocols. We call them Certified First Responders (CFR). The protocols in this state are very similar to the Basic, and it is easier to state what a First Responder cannot do, as apposed to stating what he can do. In this state Certified First Responders may not : administer oral glucose or activated charcoal, perform splinting, backboarding, or apply an extrication collar without a Basic assisting, and they cannot supervise a transport. They can do PCR’s, Vitals, Manual stabilization, OPA’s NPA’s, BVM, AED, etc..

The stated purpose of a First Responder is to get on scene fast, assess the pt, handle life threats quickly, update incoming EMS units, call for ALS if needed, and generally get things rolling quickly.

We are a rural Fire/EMS department of volunteers. Although we don’t rely heavily on our CFR’s, they do have a purpose and a place. We encourage everyone to work to at least the Basic level. However, we do have young folks that are just trying this out, and the CFR allows them to work with patients and see if they are cut out for this sort of work. It also allows some of our more experienced but very busy volunteers to get in a course that teaches them the basics and allows them to initiate care until the duty crew arrives.

I don’t know about where you live, but around here our CFR’s are treated with respect by the EMT’s, Medics, Nurses, Doctors, and Dispatchers. Of course we have LEO’s that were required to become Certified as part of their job and have no intention of touching a patient. They don’t practice, so they really can’t do the job. We understand that. (We had a LEO CFR call in a “Pediatric cardiac arrest, 15 y/o female†Our first EMT-B arrived on scene in under a minute to find the LEO standing with her hands in her pockets 25 feet away from the pt.. Turned out to be an elevated heart rate and nothing more. So yeah, we do have our bozo’s.

The last “Dramatic Save†in our department was done by a CFR who was assisting an EMT-B. The EMT had grown frustrated in not being able to clear the airway on an overdose pt. who by this point was very hypoxic. The EMT asked the CFR if he had any ideas, and the CFR asked for a try at it. The EMT yielded and in one thrust the CFR popped out the obstruction. Both the EMT and the CFR had about 10 years experience. Did anyone care what patch they had on their jackets? Not on our squad. Its’ not what you have, it’s how you use it.

When and EMT or a medic shows up on a scene, they EXPECT to hear something like the following from a CFR who arrived first: “This is Joe Bloe, he has had a really hard time breathing since he woke up this morning. Joe’s pulse is 95 and his resps were 22 when I arrived, and very labored. His BP is 140/90. We’re giving Joe O2 at 15 LPM for about 5 minutes now and his respirations have become a little easier and dropped to 18. Joe is on no medications and has no allergies but does smoke about 2 packs a day. He says he has never had a problem like this before and is a little frightened by it. His last oral intake was dinner last night. â€

SO having said all that, here is MY opinion: CFR’s have a definite place in the system. If we expect CFR’s to perform well, we must include them in all parts of the job. This includes being part of the crew on an ambulance. If nothing else, it’s an extra pair of trained hands. At best, that CFR will gain experience and confidence allowing him or her to move up the ladder when training time permits. I am a firm believer that if you hold people to a high standard, they will perform to that standard.

As for all you folks who discard the CFR’s out of hand, I suggest you take a good look in the mirror, your narrow mindedness is showing. You who are so quick to complain about being called “Ambulance Driversâ€, are equally quick to toss out the efforts of some very dedicated and committed individuals. Not every system is like yours, and in places where the CFR fits, they should be treated as equals.

I think I’m done here,

JAFO

[BEorP]

Should certified first responders be permitted to function as a primary member of a non-emergency transfer ambulance crew?

Why or why not?

In Ontario I'd have to say yes.

Our lowest level after First Responder is PCP and there's no reason to put someone with at least two years of education on a truck that just does stable transfers.

[PRPGfirerescuetech]

Should certified first responders be permitted to function as a primary member of a 911 ambulance crew?

Should certified first responders be permitted to function as a primary member of a non-emergency transfer ambulance crew?

Why or why not?

no

[strippel]

I would say no, but...

We still have many suburban and rural (some very rural) volunteer services near us. They would not be able to respond without them, and there would be a long delay until staffed compensated services could arrive.

Here in PA, even though the DOH states ambulances are to be staffed with a minimum of 2 EMTs, there are many that provide an ARC "Emergency Responder", or DOH certified "First Responder" as the second member of the crew, and driver.

The service I work for has 1 First Responder on the payroll. He was hired as a wheel chair attendant, but does ride on a BLS truck from time to time, usually last minute fill in for call offs. I have ridden with him, and had no problems. He is also a full time 911 dispatcher, and a volunteer fire chief. He is well experienced, and trust him. Could I say that about others....NO!

We are a (3rd service, hospital based, community, non-profit..yes, all the above) service, and we do have volunteers who are First Responders. They are a third on the crew, and help with care during transport.

[Thunderchild145]

No. Not only is it not a good idea, it's illegal here in Arkansas. There are certain levels of certification that services can have, ALS (rig must carry at LEAST 1 Paramedic and 1 EMT-Ambulance), ILS: again, at LEAST an Intermediate and an -Ambulance, BLS: Must carry 2 EMT-Ambulance. There's no rooms for CFRs in here, except as maybe a third rider, and I don't think they should actually be a part of the ambulance crew. If, for instance, there is a CFR on scene and we could use an extra set of hands in the back, sure. Hop on in. But no, CFRs arent and shouldn't be part of a 911 ambulance or even a non-emergency transport crew. Notice I said transport. I think that CFRs can start up thier own squads and get thier own apparatus and uniforms and such and be dispatched alongside an ambulance. (That's what we do here, since we cover a large area.) CFRs get on scene, do what they can, and wait for an ambulance in the previous 3 catgories to arrive.