Friday, March 11, 2011

Repeal AR 2-260

Why do bureaucrats need to be watched?
Here's a great example:
What's that, you ask?
Well, besides being some state bureaucrat's desperate attempt to justify their job (a job which otherwise could go away tomorrow without the slightest effect on prehospital care whatsoever), it is also the latest burden on EMS providers and taxpayers foisted upon us in last fall's sneak attack on EMS.
What AR 2-260 does, besides evoke the Orwellian nature of our state OEMS, is to require that all EMTs and Paramedics -- most of whom are already working 50 to 80 hours a week at multiple jobs in order to put food on the table -- take 4 hours out of their lives to attend a lecture to learn things they A) already learned in school, B) already do on a daily basis, and C) also re-learn in the respective ALS and BLS refreshers that they are forced to take every 2 years in order to keep their certifications.
The regulation requires ALL EMTs and Paramedics take an initial 4-hour course on how to work together, THEN repeat a 2-hour version of said course every other year.
If you're an EMS provider in Massachusetts, it's another 4-hours the state wants you to waste jumping through pointless hoops.
If you're a Massachusetts taxpayer, it's just a few more hundred thousand dollars that will be wasted every year, since, believe me, any EMT or Paramedic working for a municipality or the state isn't going to attend this course for free.
I know I'm not.
AR 2-260 is a response to the debacle that was quietly adopted last November (when everyone was thinking about Thanksgiving dinner and Christmas shopping) in which ALS ambulance services are no longer required to seek permission to staff their ALS ambulances with a single ALS provider.
Prior to the change, ALS ambulances in Massachusetts were required to have two Paramedics in order to work at the ALS level, although with a state-approved waiver they could staff ALS ambulances with a single Paramedic and an EMT partner.
In reactionary, knee-jerk fashion possible only in Massachusetts or some similarly dysfunctional banana republic, someone in Boston decided that this new regulation -- which goes into effect literally decades since Paramedics and EMTs began working together -- will result in a knowledge gap.
Apparently, these same people don't realize (or forgot) that there ALREADY exists a 4-hour Paramedic Assistant class for EMTs to cover the things with which they can legally assist a Paramedic.
Now, thanks to AR 2-260, Paramedics ALSO have to take a 4-hour class to learn how to work with EMTs, which I COMPLETELY don't understand because you can't work as a Paramedic without ever having been an EMT, so what exactly am I expected to learn?
Other than 6 hours of pay for drooling my way through a 4 hour class, what am I supposed to get from this?
Of course, I'm asking the wrong question, because this has nothing to do with how Paramedics or EMTs or the patients and taxpayers we serve will benefit from this, it's all about a bunch of hacks sitting in a room hunt-and-pecking their way through another Microsoft Word document of meaningless bureaucratspeak in a transparent attempt to justify their employment.
Ok, still doubtful? Think I'm just ranting again?
Here is the course outline.
If you're an EMT or a Paramedic and need help with any of the below, please raise your hand and I'll send someone around to hit you in the head with a tack hammer.
Students (because that's how OEMS refers to participants in this class, not "professionals") will:
- demonstrate use of a BVM, OPA/NPA, nasal cannula, non-rebreather (NB: does anyone really, seriously need any help with this?)
- identify intubation equipment
- appy cricoid pressure
- ventilate with a BVM
- identify an Easy-Cap ETCO2 detecting device
- identify a Combi-tube, King LT, LMA, CPAP device, Bougie ETT introducer
- identify signs/symptoms of hypoxia (NB: well, I worry about whoever came up with AR 2-260; they seem a little oxygen-deprived)
- state causes of false readings on SpO2 and CO monitoring devices
- turn on cardiac monitor, place leads properly (NB: my God, they've discovered my personal shame; all these years and I don't know how to push a button or where those sticky things go)
- access the monitor's archives function
- spike an IV bag
- prepare tape for securing an IV (NB: seriously, I'm not making this up. You're going to be evaluated on this. Ok, let's cover this whole section now -- folks, the sticky side goes against the patient)
- identify an IO device
- state meds allowed to assist/administer, include indications/contraindications
- demonstrate ability to properly administer BLS medications
- identify indications/contraindications for albuterol use
- put a neb together
- properly use a glucometer (NB: Yup, YOU need to take a class to learn how to use a device that my Nana uses, and which is currently on-sale for $9.99 at CVS)

Folks, if you need a 4-hour class to learn this stuff, and have failed to demonstrate said knowledge during your initial training, your state-mandated testing, your biannual state-mandated refresher training, or to the satisfaction of your daily employers, then you don't need to be working in EMS.
There is NO RATIONALE whatsoever that justifies forcing yet another redundant class down the throats of this state's already overworked, under-paid and under-appreciated EMS workers, and there's NO JUSTIFICATION for extracting another few hundred thousand dollars from the pockets of taxpayers (who will have to pay overtime for municipal employees forced to undergo this training) already straining under the burden of the worst economic conditions since the Great Depression.
I'm calling for no less than the complete repeal of AR 2-260.
Of course, OEMS isn't going to listen to us, so we need to take this to their bosses.
I urge everyone who is against wasting time and money on nonsense to write their state Representatives and Senators and complain about AR 2-260.
I would start with the Joint Committee on Public Health at the state legislature.
Email state Sen. Susan Fargo at, and state Rep. Jeffrey Sanchez at and register your complaint.
Sen. Fargo and Rep. Sanchez are the co-chairs of the committee.
In addition, I would contact your local state Representatives and Senators, as well as your local city managers or Boards of Selectmen, and let them know about this new financial burden on their communities.