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     EMS Reruns addresses dilemmas in EMS. If you think of an example like the one that follows, send it to us. If we choose to publish your dilemma, we'll pay you $50. E-mail ideas to

     Your agency has a rule: Three dings and you're outta there. It doesn't matter if you bend a bumper, scratch a door or total an ambulance. It doesn't matter if you've worked 20 hours without a wink or 20 years without a scratch. And it doesn't matter if you work in Olathe, Kansas, or Long Beach, California. You're out, you're not needed, adios, good luck. Actually, forget the luck; just leave. Whoever made that rule could count. But they sure didn't understand what matters.

     You've been working for the past two years in a Type II transfer car. So far, so good. Now you get moved to a 9-1-1 unit, which is a Type III (a box mounted on a van chassis). The Type III is wider, and you're still checking your equipment when your first call comes in. It's chest pain, and on your way in you receive an update from the first responders: The patient just became unconscious.

     Sure enough, the patient's a code. You're a little nervous backing out of the parking lot at his apartment complex. In the process of negotiating a tight turn, a psychotic light pole jumps right out of the dark and nails your right-side mirror. Oops! There went a third of your job security in less than a second.

     Q. This is a pretty risky place to work, all right. I've applied elsewhere, but breaking that mirror was a big hit on my sense of confidence. I'm worried about making another mistake and the effect even this one may have on my references. Got any suggestions?

     A. Your confidence is an important tool, but there's a quick way to get your head straight. Think about your past driving record (including the off-duty part). If you've made lots of mistakes, we're not just talking about luck. But if you haven't, there's no reason to beat yourself up. Even two years in a transfer car without a scratch says you're a decent operator. And chances are, even if it does get mentioned, most folks you'd want to work for would understand a broken mirror.

     Q. I thought there was a major shortage of EMTs and paramedics. There doesn't seem to be much of a balance here between the risks and the benefits. Most of us get paid little enough, if anything at all. The people we serve have impossible needs, and some of them are actually dangerous. On top of that, most of us are just one back injury away from the ends of our careers. This driving rule seems unreasonable.

     A. I can't argue with you, and I'm thinking if we could unlock a few secrets, there might be an insurance company at the bottom of it. A friend of mine who works for one of the bigger services says that's true for them. But insurance companies live and die by numbers. In their world, nothing else matters. If your current outfit is subject to that kind of rule, there's a reason for it somewhere in their past. It could be their selection process, or maybe a lack of proper training.

     Q. I had a brief training module when I first got hired and no driver training at all in EMT school. Since then, I haven't had anything, and there's nothing available in my area. I accept the responsibility for my mistakes, but shouldn't there be more physical, behind-the-wheel training, especially in the bigger vehicles?

     A. Our industry has never done a good job of spending its money where its needs are. Medicine's important, but what EMS agencies get punished for most often is their lack of commitment to safety (theirs and the public's.) Do yourself a favor. Make sure your own written response to the documentation that goes in your file over this incident reflects your desire for training. That may come in handy if you have another mishap.

     Q. I've already approached my ops director about the need for more training, and she says they're doing all they can afford to do.

     . I don't envy her; these are hard times, and most of today's operations are probably strapped for cash. But this is a high-priority need, and education is much easier to budget for than collisions. We can forecast the cost of training, but collisions are always surprises. When they do occur, they demand 100% of our unscheduled attention. We never know what they're going to cost or whom they're going to hurt.

     I do have a suggestion. Don't wait for that next mistake. Talk to some of those other EMTs who share your predicament. Get them to join you next time you meet with your boss about that training program (and the policy). Let your boss know you're not the only one who's worried.

     Do that soon.

     Thom Dick has been involved in EMS for 38 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of EMS Magazine's editorial advisory board.

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