If, in moving through your life, you find yourself lost...go back to the last place where you knew who you were, and what you were doing, and start from there. Bernice Johnson Reagon.

13 November 2012

The Law of Unintended Consequences

No doubt you have heard about DCFEMS’ latest idea to not staff ALS transport units at night. Haven’t heard? Go here and here to read about it.

Without getting into a long drawn out diatribe- it’s a Band-Aid on a bigger problem.

There have been some reports of late about DCFEMS’ inability to recruit or retain paramedics. They speak of a shortage.

There is no shortage of paramedics. What there is a shortage of is paramedics that are willing to work non-stop in less-than-desirable circumstances.

It seems like a lot of people go to DCFEMS to get some experience and then head for the suburbs. Better staffing, lower call volumes, and in some cases, better schedules. Maybe more money, but money isn’t everything.

I hear a lot of EMS manager types speaking of EMS working conditions. Things like they’re creating career ladders, providing all of the neatest toys, have great protocols…

Things like that really don’t matter when you are running what seems to be non-stop, whether it is actual calls, or posting/move-ups. And regardless of what the stats say, what matters is in the minds of those personnel that feel like they are running non-stop, posting non-stop, etc.

So what about this latest idea?

Well, if ALS is available, even though there is a lot of debate on the value of ALS, then maybe it can work.


What if ALS is not available? You know, if the fire suppression crews that are supposed to be providing ALS are committed elsewhere, you know, suppressing fires?

And how many of those folks that ride on the fire trucks that are holding paramedic certs really want to be on the ambulance? You know, I am willing to bet that a significant number, well, don’t. If they did, they would be working the ambulance. Or, as some folks in that regions refer to them, the ‘shit box’.

And of course, there is the aspect of, no matter how well-meaning the folks involved, how long is it going to take before someone that should have had ALS transport (respiratory distress, seizures, or cardiac issues) gets sent BLS with a less-than-desirable outcome.

And you know it will happen, and when it does, the media will be all over it.

Given the publicity that DCFEMS has generated over the past few years from their prehospital exploits, I am sure that even with the best of intentions, this is going to be a lesson in the law of unintended consequences.

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