January 2005 Letters

We Want to Hear From You!

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Mail: EMS, 7626 Densmore Ave.
Van Nuys, CA 91406-2042
E-mail: emseditor@aol.com
Letters may be edited for clarity and to conform to space requirements.

Glad They Asked

In Mike Smith’s recent article, If You Don’t Ask, You’ll Never Know (August 2004), he examined how agencies assess and measure quality. He talked about “running the numbers” for responses, etc., and then talked about customer feedback via surveys. Surveys are definitely a direct way to check the pulse of your company by hearing what the customers have to say. It is widely known that a customer will be quick to phone in a complaint, but seldom do supervisors receive a phone call praising the experience.

At Action Ambulance Service, Inc., we decided to step up the survey process and tie it in to our philosophy of S*T*A*R C*A*R*E, which stands for Safe, Team-based, Attentive to human needs, Respectful, Customer-accountable, Appro-priate, Reasonable and Ethical. We process the surveys that are returned and run a report utilizing the associated run numbers to show us who was on each particular call. Then we tally the compliments for each crew member and send them copies of the positive surveys along with letters of appreciation. We also track any negative feedback received from customers.

The S*T*A*R C*A*R*E Award was developed as a way to reward team members for their dedication and hard work. We have created five different levels of award: Copper (five compliments), Bronze (25 compliments), Silver (50 compliments), Gold (75 compliments) and Platinum (100 compliments). With each level, the team member receives a printed certificate and a recognition pin; and with the higher levels, a gift certificate in varying denominations.

Year to date, we have sent out 6,755 surveys and have had 853 returned (even though we include no self-addressed stamped envelope with the surveys); that’s a 13% return rate. These have been overwhelmingly positive, with 98% positive feedback. Although the dollar-figure Mike used as an example is substantially smaller than what we spend—because of the volume of surveys we send out, the associated reports, tallying and sending of feedback and awards to crew members—it has been an enlightening and rewarding experience. I would wholeheartedly recommend the use of surveys to everyone.

John C. Laffy, NREMT-P
Wilmington, MA

Mothers Go Feet First

Great article on transport of pregnant patients (Extra Riders: Surprises in Pregnancy Transport, October 2004, by Gerard M. DiLeo, MD). Most curricula teach childbirth once, and then it’s up to you to remember all the material someday down the road. Childbirth and its related problems are unlike trauma or cardiac emergencies; childbirth tends to catch you off guard and make you wish you hadn’t hidden that OB kit.

I have had both the pleasure and the scare of my life delivering a baby in the back of an ambulance. One was a normal delivery and the other was a Murphy’s Law delivery: Snow and ice on the road, hospital 20 minutes away under normal road conditions, first child, five weeks premature and a limb presentation. Everything worked out great for both mom and baby, as well as for myself.

The one additional thing I wanted you to emphasize in this article was the position of the gurney. I’ve seen plenty of EMS teams place the mother in headfirst, just because everything seemed normal. Just imagine if I had placed the mom of the limb presentation delivery in headfirst. It’s a simple thing to forget since 99% of all the other patients you load in your ambulance go headfirst.

Armando A. Armijo
San Bernardino Co. Sheriff’s SAR

Competition on the Field

I truly enjoyed and learned from your article Joint Collaboration Enhances Response to Athletic Emergencies (by Thomas J. McCarthy, et al) in the October 2004 issue.

Two items: (1) Athletic trainer and EMS interaction and (2) EMS at children’s sporting events.

When invited by my son’s Babe Ruth League (16–18-year-olds) baseball coach to sit in his dugout to provide first aid to the team at an away game, I had a cloudy understanding of “who was on first.” Unbeknownst to me, the home team provided an athletic trainer for the game. When a collision occurred between two of our outfielders, knocking both of them down, I responded to the field as soon as it was apparent that the boys were not getting up. I was met on the field by two other adults who took charge and curtly introduced themselves as the athletic trainers who were “responsible for the teams.” I introduced myself as an EMT who was there at the request of my son’s team coach, and was just as curtly dismissed.

This can be analyzed to death, but what is operative here is that now I know to introduce myself before the fact to any other first aid types on the field.

My second point comes in reaction to the photo chosen for the article. It appears to be Pop Warner football players, which I find ironic. I was the medic for four games in a Pop Warner League tournament, where I called local EMS four times—all for possible c-spine injuries. One of the players had a momentary loss of consciousness (described as “having his bell rung”). I learned later that this child was helo’d out of our county (which had neither a neurosurgeon on call at the local ED or a trauma facility) to a trauma center in an adjacent county for a possible neuro problem. The other three complained of neck and back pain and, even though I could detect no neuro deficits, I wanted them checked out by those with greater medical skills than I possess. I can only presume they were cleared at the local ED, though they didn’t return to play. I have had absolutely no regrets erring way over on the side of caution for these kids and would do the same again without hesitation.

I hope to stimulate some discussion on injuries and their frequency in children’s sports. Though football appears to have a high potential for injury, baseball may have more, with soccer a close second. How dangerous have others found Pop Warner football, notwithstanding basic football protective equipment and kids’ limited body mass? From what I’ve seen, the children playing these sports are still exposed to c-spine injuries at the worst, and limb fractures at the least.

I think it noteworthy to mention that the first responders I called had to be reminded not to remove helmets and shoulder pads because of the extra care required to prevent misaligning the injured players’ c-spines.

Jim Piper, NREMT-B
Aptos, CA