Thursday, September 8, 2016

Critical care EMTs on the chopping block in WNY

I’ve written before that Western New York is heading into, if not already in, a public safety crisis. There are too few fire and emergency medical services (EMS) volunteers and those that are good enough to give of themselves are spread too thin. Understaffed fire and ambulance crews find it difficult to address emergencies in a timely and effective fashion – and sometimes even at all.  

The solution, especially in rural areas which do not have paid services, is to encourage volunteerism rather than discourage volunteerism. Unfortunately, the organization that oversees EMS in Western New York is heading down the latter path.

The Western Regional Emergency Medical Advisory Council (WREMAC) is a committee of physicians and first responders from the eight-county region who are empowered by law to develop policies and procedures, and triage, treatment, and transportation protocols to be followed by EMS personnel in the territory.

Since at least 2013, WREMAC has pondered eliminating the position of emergency medical technicians at the critical care level (EMT-CC). It is something that the organization has talked much about in recent meetings and plans to address again this month.

EMT-CC is the highest level of EMT coverage afforded in the state. EMT-CCs are fully classified as advanced life support (ALS) providers and are trained in advanced airway management, intubation, IV fluid administration, cardiac monitoring, cardiac pacing, cardioversion, and medication usage/administration. Their skills are comparable to having a MASH unit on wheels.

But, WREMAC doesn’t think that’s enough. EMT-CCs are one level below paramedics and that’s what WREMAC would like to see utilized as a means to take some of the burden off of emergency room doctors.

What they fail to see, though, is that doing away with EMT-CCs and what EMTs can and cannot do will place an even greater workload on physicians – most folks in the EMS field will choose to become the next lowest level of EMT, which is the advanced EMT (AEMT) rather than taking the path of paramedic. That means ER doctors will see significantly more trauma that was unattended too – and, in such cases, the minutes lost due to the inability to provide critical care will be the difference between health and debilitation or life and death.

Why wouldn’t an EMT-CC want to become a paramedic?

There’s not enough time and money.

It’s a huge investment of time to become an EMT-CC, let alone a paramedic. To become a basic EMT, the volunteer has to take 200 hours of training. To become an AEMT, another 200 hours is required. To achieve EMT-CC rank, there is another 600 hours to be taken. That’s 1,000 total hours.

To become a paramedic, an EMT-CC would have to take another 1,300 hours of classroom, technical, and field training; they would have to spend more time in training to go up just one level as they’ve put into their entire EMS career to date. The paramedic course takes 14 months and there is talk of adding more classes to it which would take it to 18 months.

If EMT-CCs do chose to go up in the ranks, those tiring 1,300 hours would take them away from actually doing what volunteers want to do – that is, being out in the field saving lives -- and it will keep them from family, hobbies, and sometimes work for more than a year.

As if that’s not enough, the typical cost for paramedic training is more than $2,000. That’s a lot of money to ask of someone who’s already giving their time.

If WREMAC moves ahead with their plan rural counties will be hardest hit. In Allegany County there are 24 EMT-CCs and only 10 paramedics. Of those 10, only 5 of them actively practice and/or work in the county. There’s no way that 5 paramedics can handle the needs of 50,000 residents spread across 1,000 square miles.

Eliminating EMT-CCs won’t do a thing to improve emergency medical care in WNY…it will only magnify the problems were are faced with. People will become crippled, or worse yet, dead when the already hard-hit and understaffed fire and EMS crews are not allowed by law to perform medical tasks to the best of their abilities and knowledge.

 From the 12 September 2016 Greater Niagara Newspapers

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