The Engine Company Medic: To Keep or Transfer Care?

By Mick Messoline

Previously, this column has reviewed steps for getting prepared, initial assessment, and interventions. In this segment, we will cover various patient conditions and when to transfer or continue care. It is always important to remember that regional and state protocols may dictate which patients will not be appropriate for transfer of care. Be sure to know local guidelines and information specific to the system in which you function.

As an engine company medic, it is not uncommon to see many different patients in a single shift. Some will require only minimal intervention whereas others will require extensive and complex care. These interventions alone may dictate the need to continue care. Treatments like airway management, cardioversion, or medication administration may require that the paramedic initiating the treatment continue control of the patient until proper transfer of care has been completed at the emergency department (ED). Other interventions like establishing an intravenous line or obtaining an EKG may not necessitate that the paramedic from the engine continue care.

The engine medic should avoid transferring care for the patient population that could easily be defined as “any critical patient.” This, however, would be far too vague and create a generalization that is not quantifiable. Some of the following presentations should have care continued by the primary paramedic, and the transporting paramedic should assume a supportive role throughout the duration of the incident:

  • Compromised or advanced airways
  • Cardiovascular compromise
  • Anaphylaxis
  • Segment elevation myocardial infarction (STEMI)
  • Fractures with vascular compromise
  • Penetrating proximal trauma
  • Multisystem trauma
  • Respiratory compromise with RR <10 or >30

Although many patients will benefit from the continuation of care from the initial provider, the following patient populations do not require the expertise of two paramedics for transport:

  • Isolated long bone fractures
  • Cardiac chest pain
  • Moderate dyspnea
  • Stable patients requiring analgesics
  • BLS patients

For patients not requiring a continuation of care from the initial provider, it should be common practice for the paramedic making initial contact to deliver a complete and comprehensive transfer of care to the transporting paramedic. Any information gathered during the patient’s initial interview is important to the continued care of the patient. When possible, and without delaying transport, a written account of the information gathered should also be passed along. In many cases, there is so much information gathered and transferred verbally that small items can be forgotten, and important information may not ultimately find its way to the receiving ED.

In the perfect world, every patient would be accompanied to the receiving hospital by the provider making initial contact. It is, however, not possible to guarantee this, especially in light of the budget cuts and limited staffing found in today’s fire service. To ensure that every call is answered with an appropriate response, the modern-day engine company medic is required to hand off many patients to a transporting medic. Making sure that each assessment is conducted in a timely and complete manner facilitates shorter scene times. Short scene times in conjunction with proper transfer of care will ultimately benefit the patients by getting them to the hospital for definitive treatment earlier.

The evolution and growth of the fire service have resulted in greater expectations. Emergency medical services may have the most dynamic and rapidly changing expectations. Medicine is evolving faster than ever, and along with this evolution is an ever expanding list of medical conditions now seen commonly in the prehospital setting. The expectations placed on the engine company paramedic may be the greatest of any member of the team. Although every firefighter must be prepared for firefighting and rescue situations, the medic has a large cadre of skills added to the list.

The modern-day engine medic is truly a fire service handyman, capable of performing every task in the company and leading the team on the medical runs. This position should be seen as a company leader’s position, and those in the position should embrace it as such. Engine medics should take extra time to help expand the knowledge and abilities of those around them. Much like the fire scene, medical calls run more smoothly if all team members are on the same page. There is nothing more efficient than a well-trained and organized team. Every patient benefits from training and preparation.

Mick Messoline has been in the fire service since 1985. A paramedic and educator, he has worked for the Denver (CO) Paramedics, Sacramento (CA) Fire Department, and Sacramento State University. He is a firefighter in Thornton, Colorado.

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