By Mick Messoline
Today’s fire service has created new and evolving positions that did not exist 30 years ago. The integration of emergency medical service (EMS) into daily operations of nearly every fire department has placed advanced life support providers on most apparatus. This change has taken place with little guidance to the specific role of the engine medic, who has a multitude of role responsibilities that include both suppression and medical duties. The focus must be placed on daily preparation! This requires additional diligence. A solid daily routine will set you up for the very best results.
Every shift starts on the drive in. Firefighters often overlook this part of preparation, but it’s a vital piece of everything you do. Coming on shift without the proper mindset can easily set you up for a disastrous shift. Be sure to arrive rested, hydrated, and mentally prepared for what your day may bring. Though it is impossible to prepare for every situation, ensuring you show up rested and ready will help you deal with what could come.
The beginning of every shift is essentially the same. Gear is placed in a ready position and the equipment is checked to ensure its readiness. What things need to be checked every day? A simple answer is everything! Medical equipment is just as fragile as any other equipment. It is crucial that each and every device be checked to ensure its proper operation–the monitor, suction unit, laryngoscope (handle and each blade), glucometer, and any other multiple-use device. A weak or dead battery could easily be the difference between a quality outcome and a very long incident report.
Expiration dates also need to be checked on a regular basis. Most medics know that drugs have an expiration date printed on them. The “5 Rs” of medication administration have been drilled into us from the first day of paramedic school. Angiocaths can degrade over time and lose the bond between the catheter and the stylet. This may cause the catheter to compress over the stylet rather than advance as expected. These devices should be replaced at their expiration date. What about the rest of the supplies? It would seem odd that 4×4 sterile gauze would have an expiration date. The dates we see on a large number of our other supplies are actually based on the packaging. They are the dates up to which the manufacturer will guarantee the packaging. As a general rule, if the packaging is intact, the contents are still usable. If there is a breach of any kind in the package, replace the contents. Be sure to check with your local medical director; follow his guidance on any issues involving expiration.
The final component of preparation falls firmly in the world of education. Like anything else in life, medicine is constantly evolving. Keeping up with the current trends and changes is paramount. Closely monitor expiration dates of certifications; look for additional courses. As a single-resource medic, there is always opportunity for skill degradation. Address it by establishing a standard related to patient contacts. You can manage to do this by placing a medic on a department ambulance for a minimum number of hours a year or by sending personnel to a local hospital to practice those less frequent skills in a controlled setting. Just as any other skills developed over a career, if not practiced, medical skills will begin to deteriorate. Another part of education involves keeping up on local protocols. Most protocols cover all of the treatment guidelines and local hospital specialties. Knowing this information can help the provider in making critical on-scene decisions. Modes of transport and on-scene interventions are just a few of the things that can be driven by knowing your local resources.
As an engine medic, your actions and decisions directly affect patient outcomes. By being properly prepared, you can be sure that each patient will receive the interventions and disposition that most benefit them.
Mick Messoline has been in the fire service since 1985. A paramedic and an educator, he has worked for the Denver (CO) Paramedics, Sacramento (CA) Fire Department, and Sacramento State University. He is a firefighter in Thornton, Colorado.
