Symbolism of the EMS Star of Life
EMS is a relatively young branch within the healthcare system. I cringe every time anyone, especially a nurse, refers to ambulance personnel as “ambulance drivers.” Just don’t do it. At one time, in the early days of EMS, that was true. However, times have changed and, generally, ambulances are staffed with an EMT- Basic and a Paramedic. It’s okay if you don’t really understand the difference between the two- this article will explore the symbolism behind the Star of Life, which applies to any field first responder. Lets begin!
Early Detection: Good Samaritans may be the first ones to witness an emergency. Family, or even the patient themselves, may also understand they need emergency services. Either way, someone needs to recognize that an emergency is happening.
Early Reporting: Someone needs to call 911 with the information they have about the emergency. When times are hectic it is best to point at someone and ask them specifically to be the one to call- otherwise everyone will assume someone else will or has called.
Early Response: Whoever is on scene provides assistance the best they can, while EMS response is activated and on their way.
On Scene Care: Medical staff have criteria they consider when they are providing patient care. “Stay and play” or “load and go” are phrases often used. They may sound fun or lighthearted, but stay and play means the crew has a patient they can spend time with on scene. It could be someone who is stable, or it could be someone that needs critical interventions before anything else happens.
Consider, for example, a patient with a vague chief complaint of “weakness.” The crew may consider different causes such as diabetes, heart problems, or sepsis. Any of these could contribute to a patient feeling weak, but the crew would need to assess them first. By starting their assessment, the crew can take advantage of any family or caregivers that may be home, or look at the environment for clues. They can also see if the patient is properly being cared for. Sometimes adult or child protective services must be called. Maybe the patient has medication bottles the crew can check, or make a list for the receiving hospital. Many patients are poor historians when it comes to knowing their medical problems and medications. This could be treated as a stay and play call.
Although critical, CPR in progress is also a bit of stay and play, depending on the crew. A crew that has a paramedic may take the time to place an IV, start fluids, push drugs, or intubate before transport. The paramedic can do these tasks while the EMT does chest compressions. If the crew only has two EMTs and no paramedic, they should normally load and go after starting compressions, and applying the AED pads.
Load and go means timing is urgent. Consider load and go for trauma, such as car accidents or gun shot wounds. Medical calls such as stroke or heart attack are also urgent and would be treated as load and go.
Patient assessment is not limited to load and go or stay and play. Mnemonics are used as actual terminology and as assessment aids. One example would be SAMPLE. A crew considering a SAMPLE history thinks about signs and symptoms, allergies, medications, past pertinent medical history, last oral intake, and events leading up to the emergency. I’ve made refresher notes on various mnemonics.
Care in Transit: Sometimes people may wonder, why is their family member in the ambulance and they aren’t moving? They need to go! Well, that is not necessarily true. The crew needs to use their best judgement. It may be easier for them to interview the patient away from their family. Sometimes well intentioned family members are overbearing. They may need to ask the patient personal questions. Maybe starting an IV and giving drugs are best done in the unit for this particular call. In the long run, it hurts the patient more if the crew just throws them in and drives off. Interventions done by EMS not only help the hospital, but may be critical for the patient. For example, if someone is having an allergic reaction, they cannot wait to get to the hospital to receive epinephrine. EMS needs to administer that.
Transfer to Definitive Care: It matters where a patient goes. Not all hospitals have the same capabilities. For example, a gunshot wound may need to go to a Level I Trauma Center. If the patient is having a stroke, they need to go to a hospital equipped to handle a stroke. Although ideal for a patient to go to a hospital that has all of their medical records, their choice is not always appropriate. Maybe their medical condition requires a hospital with advanced capabilities in a certain area. Maybe they have a true emergency, but the hospital of their choice is across town during rush hour traffic.
Any hospital will accept an emergency, but depending on their capabilities, the patient may get stabilized and transferred to a more appropriate hospital. This not only causes the patient to have a bill from two different hospitals, but also an EMS bill from the hospital to hospital transfer.
An EMS crew will also call report to the receiving hospital. This allows the hospital to have an ETA and prepare staff and equipment for the incoming patient. For example, some hospitals may require certain traumas to meet with social work, or if someone is bleeding they may need to prepare for blood transfusions.
EMS plays a vital role assessing, treating, and appropriately transporting sick and injured patients. Please do not call them ambulance drivers- they are so much more!
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