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I hate horror movies…
A while ago I walked into our crew lounge where the other members of my crew had just popped in some low-budget zombie flick. It was your classic “B-Movie” and had all the hallmarks of every good zombie show that I’ve ever seen. Gratuitous bloodshed by hapless victims? Check. The walking dead feasting on human flesh? Check. A few good looking zombified women? Check and Check. I watched it against my better judgment. I hate horror flicks for all of the above reasons, except for the good looking women of course. I have an annoying habit of taking on the characteristics of every movie that I watch for varying lengths of time. After watching Top Gun, for instance, I drove my car like a fighter pilot for a few days. After watching Star Wars I tried to use the force to get the TV remote from across the room when I lay down on the couch. After watching the South Park Movie I swore every other word. Really. So I don’t like horror flicks because I get scared like a little girl afterwards and I don’t like it.
Unfortunately though, I watched the whole thing like a doofus, knowing full well that I’d be having nightmares later.
Cue the call for the unresponsive seizure victim…
We went to an apartment complex where our patient had fallen into a seizure right by the inward swinging door to his apartment. He had fallen in a way that made it so his body was blocking the door and I could only swing it open a few inches, just enough for me to squeeze inside. He was pretty out of it, and wasn’t responding with anything but unintelligible grunts and groans.
Then, of course, he moved and shut the door, blocking it with his body and trapping me alone in his apartment with him while he was groaning on the floor.
Does it make me a scaredy cat because I thought I was going to be eaten by a zombie?
I hate horror flicks…
It is a very sleepy morning for me today. Yesterday was a hard-fought day on the ambulance by our standards. For the first part of the day I couldn’t run a call without somebody getting angry at me. It really didn’t bother me all that much, but you know how it goes. I actually got about 6 hours of sleep during the night though, so I got that going for me. Perhaps it’s the morning fog mixed with the lack of coffee available in the station this morning that’s causing my AM neural firings to generate random questions… perhaps I’m just nuts. However, if y’all would like to think about some things (and perhaps answer in the comments section, please) I invite you to join in on my personal morning groggies.
- If Medicare would assign a payment that you could access for treating and releasing patients, thereby diverting them from the Emergent healthcare system and redirecting them to the more cost effective healthcare system, how would that change the industry?
- If your service could choose to accept a lower payment from Medicare and Medicaid for every transport without regard to the nuances of medical necessity and never have to be denied reimbursement in exchange for a lower payment for every call, would your service take it? How would that change the industry?
- How would you improve your service if all of a sudden a big, national competitor moved into your service area and started taking your share of the market… you’re losing calls to them and it’s affecting your bottom line… What do you do to improve your service to keep yourself in business?
- How would you change your care if your medical director was watching over your shoulder on every call? What would change if it were your mother watching you?
I think that these questions aren’t the biggest questions facing the industry today, but I’ll bet ya’ that if they were considered by peons like us and also by the powers that our landscape would change quite a bit, wouldn’t it?
See you in the comment’s section.
Good morning all!
I’ve been running quicker than I’ve been able to keep up with lately and I thought that I’d dig down into the archives and give you an older post to read. I think that it’s entertaining.
I take that back, I think that it’s frankly, shocking. (Ha!)
This was one of my first posts. Since I’m attending an EMS conference, I figured it deserved a bump-up too. Good Luck!
Some of you have been telling me: “Chris, you’re a good paramedic. You should be providing tips and tricks for EMS people so that they can use your hard-won wisdom to improve their patient care. Don’t spend your time ranting about things that bother you in the back of the truck and keep making feeble attempts to make people laugh. Write a serious article, darn it!!”
Actually, I’m really the only one that’s been telling me that, since this blog is only read by like, six people including my mother, fiancé, and my cat… but nonetheless I am going to attempt a serious piece regarding actual patient care issues. As such, I have identified piece of equipment that is carried on my ambulance and is most probably carried on every ambulance in the country. This particular piece of patient care equipment is rarely used, yet critical for patient care when needed. When this piece of equipment is called for, the patient needs it and needs it NOW. Yet, I’m sure that even the most experienced EMTs and Paramedics are struck with horror at the mere thought of its use.
I’m talking here about: The bedpan.
Yes, in my storied career I have been called upon to use a bedpan more often than I would have liked to. The situation is almost always the same, the patient is otherwise stable but the pressures of the bumpy ride on the human bowels are just too much for him or her during the prolonged transport time. Usually in complicated cases like these I prefer to bring along a nurse, since they are eminently more qualified to perform in these critical patient care scenarios. However, as is often the case in EMS, we are called upon to take care of any patient presentation in any patient population and must perform professionally in all situations. I have researched the use of this piece of patient equipment in numerous trade publications and critical care guides and have been struck with the lack of educational materials available for this critical patient care skill.
So, as any EMS writer would do when setting out to write a patient care article, I hit the streets to query other paramedics and EMTs on their secrets for the proper use of the bedpan. I began with the coworkers I have at my two ambulance jobs, one a private, not-for-profit city 911/Specialty Care Transport service and the other a Fire Department based service. Both of them work around 3000 calls per year and run at the ALS level. Here is a sampling of the responses I received:
Question: By a show of hands, how many of you have used a bedpan in the back of an ambulance??
Answer: I raised my hand.
Some of the people there wanted me to clarify the question, they wanted to know if I meant had THEY themselves personally used a bedpan in the back of an ambulance? One guy admitted to using a urinal in the back while transporting a patient. When badgered by the other providers, he clarified by saying that it “was a pretty long trip”. I offered that there have been some situations in my career where I have put the bedpan under a patient who absolutely HAD to go poopie during a trip to the hospital. However, and I just realized that this is the most blessed thing to ever happen to me ever, not one of them has ever been able to “go” with me hovering over them.
Of course, in EMS, I have been covered with every imaginable bodily fluid, including the unholy trinity of urine, vomit, and feces ALL AT THE SAME TIME. And I have plans to erect a statue to the person who came up with the idea of prehospital people administering Zofran (an anti-throw up medication). The other day I spent a few minutes starting a saline lock IV on a lady in her bed inside her apartment just so that I could give her that blessed medication. My fairly new EMT partner wanted to know why I did that, when I usually wait until we’re back in the truck. I let him know that I had been on the foot end of the stair chair going down the stairs before the golden-age of zofran had arrived.
Yes, us “experienced” EMS providers (read: old people who never got real jobs) will tell you that when you can’t let go of the end of the stair chair without letting your patient plummet down a full flight of stairs and the patient chooses THAT EXACT MOMENT to decide that they just *have* to throw up. You well, you just have to close your eyes, close your mouth, lower your face to cover your nostrils, and take it like a true professional. Been there, done that, cleaned the chicken and rice out of my ears with a q-tip. It’s moments like that when you reevaluate your commitment to the profession, and realize that it must be something other than the *interesting* amount of money that they pay you that keeps you coming to work every day. For me, it’s the amount of time that I get to spend typing up articles about bedpans and vomit in my ears… at least it is right now. Has anyone else ever thought that they had been ruined by EMS? I mean, I don’t think that I could ever do an office job. Years of EMS work has left me with the remarkable ability to begin to focus on something like a laser beam for 90minutes tops, then… Hey look!! A Bunny!!
Oh yea, bedpans. So you slide them under the patient and um… Pray that they’re positioned correctly. Wear correct BSI including a pair of gloves, a mask, goggles, and Vick’s Vapo-Rub under your nostrils. Of course, for us old timers, this is required even when you’re making your partner use the bedpan in the back while you drive (heh) Ever So Carefully to your destination. Tell your partner that they need the experience, tell them how professional they are being and tell them that they’re showing true compassion to the patient. Then go out and buy them an ice cream cone filled with Rocky Road. With any luck, you’ll get to eat that too when they suddenly become less than hungry.
In all seriousness, everyone poops. Never let your patient suffer when you can alleviate their suffering with a simple slide of the bedpan under their derriere. Of course, make sure that they REALLY have to go to lessen your risk of contaminating yourself with some really funky pathogens, and also to avoid ticking off the nurses’ lobby by taking their jobs.
Until next time…
Note: This is a repost. I’ve been a busy blogger and this post deserved a bump-up. Also, the “Fiance” in this post is now my lovely wife. Enjoy.
The other day I got off shift at 8am and had to be to work at my other full-time job at 10am. Since both of the jobs that I work at are about a half hour from my house in opposite directions it worked out that I had about a half hour to go home, perform the personal hygiene ritual, change uniforms, and get on my way to work again. So I did that, got home, fed the cat, and got all prettied up as quickly as I could. Then, without warning, on my way out of the house I noticed it: A pile of cat puke on my rug.
Yes, I like cats. I have one. She’s a keeper, regardless of her regurgitation issues. I think that I’m more of a man because I love my fluffy-wuffy lil’ Kitty-Witty. So cat puke on my rug isn’t the horror of horrors to me that it might be to some people. In EMS, we tend to get puked on by humans more often than does the regular population and that fact may have further desensitized me to the violent act of emesis perpetrated on my rug by my mostly cute little kitty. However, I do like a clean house and the cat puke on my rug is an issue that normally warrants immediate action.
But of course, that’s not what happened. And for those of you in a spousal relationship with another human being you know exactly what I did. You guessed it, I left the cat puke on my carpet and went to work. For those of you who are not in a spousal relationship with another human you may not understand the thought process here. Yes, as I looked down at the cat puke on my otherwise (mostly) spotless rug the thought that it must be immediately cleaned up did in fact occur to me; but the other thought that occurred to me was: “I can leave and go to work and when I get home, my lovely fiancé will have cleaned this up for me. She’ll think that the cat puked on the rug *after* I went to work and I’ll get off scot free!”
And so that’s what I did. Yes, I *could* have taken the five or so minutes it would have taken to clean up the cat puke… but in my defense I’m a model employee and I need those extra five minutes of early arrival time at work to drink coffee and to tell everyone what a model employee I am. So if I would have cleaned it up I would have taken the risk of not being such a model employee. So you see, leaving the cat puke for my lovely, beautiful, and remarkably intelligent fiancé (who will probably read this, btw) to clean up was not something that I did because I’m lazy. It was something I did so I could continue to bring home the bacon for my family in the most productive manor possible.
That’s what I thought anyway, until I came home late that night after a hard day’s 10 hour shift off of a hard fought 24 hour shift spent saving lives and alleviating the suffering of the sick and injured and stepped in the same pile of cat puke on my carpet that I had courageously not cleaned up the morning before. True, she had put in a paltry 12 hour shift at the fire department practicing for the recliner racing 500 and had fed, bathed, and put our son to bed; but that didn’t stop my obviously well-earned righteous indignation to the pile of cat puke permeating my pile covered floor. She had decided (although she swears that she did not in fact see the pile of puke) that I should be the one to clean up the cat puke using some amount of flimsy logic that I have yet to understand.
So, to tie the above 646 words back into the title of the piece, “Cat Puke Chicken” is not the new special at your local Chinese Restaurant. It is the battle of wills that solidified between my fiancé and I as soon as my sock made contact with partially digested Kitty Kibble. We both subconsciously agreed to ignore the cat puke for as long as we could stand it in order to have the other person clean it up first. (See also: “Laundry Chicken”, “Last Sip of Milk in the Carton Chicken”, and “Couples’ Counseling”). This occurs a lot, unfortunately, in most relationships between other perfectly rational human beings. We know that we don’t like having cat puke on our carpeting; we obviously know that the cat puke should be cleaned up at the first available opportunity; and we also have continued doing the other things that we normally do to keep our houses from turning into slovenly hovels. In fact, while this has been going on I have cleaned numerous dishes, laundered, dried, and folded at least four loads of laundry, and have started (but not finished) three household improvement projects. I’m at least as good as a housekeeper as the next guy (Read: Not a good housekeeper) and I do indeed do my best to keep my family and myself from living in squalor.
So why, as two perfectly rational adults who um, chose to work in EMS, are we locked into this powerful battle of powerful wills? In a word: “politics”. Not the kind of politics that provide the revenue stream for the myriad of cable news networks, but the politics of household supremacy that truly affect our day to day lives. This isn’t Senator So-and-So bloviating about the fact that pork in the stimulus bill is in fact, not pork… it’s me and the woman that I love and want to spend the rest of my life with deciding who shall be the designated Cat-Puke-Cleaner-Upper!! Pulse pounding stuff here.
And as with everything else, this got me thinking about politics in EMS.
Say you’re in a service way far away from anywhere where I work and you have a small volunteer squad that covers the areas that your service is not jurisdictionally bound to cover. Sure, your service would be glad to come if they called you, but somewhere back in history when the powers that be drew the political boundaries they decided that your service was not responsible to respond to the pleas for help that come from that particular geographic area. Suppose that your service just happens to be a small ALS service with two paramedic ambulances and a BLS ambulance on duty 24/7 and the other service was a BLS squad with volunteers coming from home and/or work. These volunteers are dedicated, caring individuals that want to do the best that they can for their friends and neighbors but work in a system where when a call for service comes out it takes about 20 to 25 minutes for the system to get an ambulance to the patient’s side. Say also that the service that you work for has your three ambulances and paramedics about 6 miles from their patients staffed and on duty but you can’t respond because the political system is such that you would be in trouble if you did so.
You may also relate to having that coworker in your EMS or Fire service that just isn’t up to par. They may be a basically qualified EMS provider through the state licensing body, but you still would cringe at the thought of that person responding to take care of anyone in your group of family or friends. They’re a provider that just doesn’t get it. Their care is substandard, their attitude is poor, and you can’t help but feel that the patients being “cared” for by this individual or crew aren’t getting the best medical care possible from your service. You’d want to say something, and normally would, but you’d become an outcast in your agency and would be looked down upon for blowing the whistle. Besides, even if you did the service is short handed and your management wouldn’t fix the problem anyhow because they need to staff the trucks.
Or maybe you can see that EMS in general is underfunded, underappreciated, and undereducated and you can’t shake the feeling that something has to be done to improve patient care industry-wide. You feel powerless to do so, but you’re angered every time you see a representation of bumbling ambulance drivers on TV, or see the local news completely mishandle a news story involving EMS, or especially when you look at your paltry pay check.
In all of the above cases, you’ve got cat puke on your rug and you’re hoping that somebody else is going to clean it up.
As EMS professionals, we know that there are myriad little political games that play out in each and every little jurisdiction a
cross the map. This service may not call this service for mutual aid because someone’s brother once stole a pumpkin from one of the other service member’s brother’s pumpkin patch. “Jim” may not provide good care, but you let it slide because he’s popular with the other crews. Sure, the local fire department gets a kajillion dollars more in funding than your EMS service does and runs like a tenth of the calls that you do, but that’s just the way it’s always been, right?
We need to step up as a profession and clean the cat puke from our carpet. Ignore the politics. Ignore the personal hurt feelings and the power plays. EMS is about the patient. It isn’t about you, or me, or that person down there. We exist solely to save lives and alleviate suffering in the people that we serve in the best possible way that we can. Nothing else matters more than that. So if you can see that cat puke on your rug, and I’m absolutely positive that you know exactly what I’m talking about no matter where you are, you probably have better things to do than be playing chicken. We all need to stand up and say that we are the Cat-Puke-Cleaner-Uppers and that quality EMS is our responsibility, no matter what little political games of chicken are going on. Our patients deserve nothing less.
(Fiance’s note: As of press time, the pile of cat puke on Chris’s floor is still intact solidifying into the fibers of the carpet)
Did I do good?
The Chronicles of EMS, if you’re living under a rock and you haven’t heard, is a cooperative effort between the Great Filmmaker Thaddeus Setla (EMSmedia.tv), the Remarkably Strong Paramedic Mark Glencourse (Medic999), and the “Ruggedly Handsome” firefighter/paramedic Justin Schorr (The Happy Medic). Their cooperative venture has taught me things that I’ve put to use in my own EMS practice that I believe have improved my care. Mark showed me the UK’s “Front Loaded” model and Justin has been talking about EMS providers being a gatekeeper to the emergency healthcare system. It’s a powerful collaboration. (Be sure to follow #CoEMS on twitter and become a fan of Chronicles of EMS on Facebook as well)
So here’s an example of what I mean. I can talk about this now because it’s been long enough that I can sufficiently muddle any possible trace back to the patient and fulfill any patient confidentiality concerns. I work in two very diverse service areas and cover approximately 35 different skilled nursing facilities at any one time. So in the time since the Chronicles of EMS has come out I’ve transported umpteen-hundred patients from those facilities and the patient I’m writing about could be any of those umpteen hundred. So there’s no way to violate confidentiality, Mmmm ‘Kay?
Anyway, some time ago I was dispatched as the ALS response to backup a BLS ambulance for the “unresponsive” patient at a skilled nursing facility. I arrived a few seconds after the ambulance did and carried my drug bag and EKG/Defib into the facility with the ambulance crew following close behind with their jump kit, the cot, and a backboard. After a few seconds in the facility, a staff member directed me to the Physical Therapy area of the facility which was a bit of a walk. When I got there, I saw three other staff members huddled around an elderly female patient who was seated in a reclining chair.
The staff members were fairly excited about the situation, as was the patient, who was very much conscious and alert. The story everyone told me at once was that the patient had finished her physical therapy session on her upper body to strengthen her shoulders and had been sat in the chair by the PT Assistant to rest. After a few minutes, the PT asst. came to check on the patient and found her unresponsive to verbal stimuli, by which I mean that the patient would not awake when spoken to. The PT asst. called the facility’s emergency response team and another staff member activated 911. When one of the nurses arrived, the patient awoke to a sternal rub and was quite surprised to be the subject of so much attention. She had been fully alert and cognitive since that time and when I asked her she denied any chief complaint other than being understandably emotional about the situation.
As I do with every patient after I rule out any immediate life threats I moved into a more detailed assessment. My lady here had skin that was Pink, Warm, and dry. Her pupils were PERRL and her Cincinatti Pre-hospital stroke scale was negative. Her Lungs were clear, her abdomen was soft and non-tender with normoactive bowel sounds, and her extremities were warm and had good pulses, motor, and sensation. Her blood glucose was well within limits, and so were all of her vital signs. All of my other assessment findings were not indicative of any acute abnormalities other than a complaint of slight shoulder pain and weakness which could have been indicative of either an acute MI or of a rigorous PT session. So, to be even more thorough, I hooked her up to my 5-lead EKG which showed normal sinus rhythm with some peaked T-waves. I then ran a 12-lead EKG which was admittedly probably better than mine is.
I asked the nurse “Has she had a potassium level drawn recently?” She looked through the patient’s chart and found out that the patient in fact had been tested for that two days prior and had been found to have a slightly elevated serum potassium level. Since they had been active witnesses to my assessment we agreed that other than for perhaps a bit too much potassium there was little chance of anything being wrong with the patient.
Since we were here in the US and not in the UK like Mark, where he can treat and release (or “Respond, not Convey”) I asked the patient if she wanted us to take her to the hospital. She didn’t want to go and said that she just wanted to go back to bed. When the staff members weren’t completely convinced that we shouldn’t transport her, I suggested that they call the patient’s primary care physician to ask him what his wishes were. The nurse did so, and called from her cell phone in front of us. She did a good job of explaining in detail the events of the call and our collective assessment findings, I provided my interpretation of the 12-lead EKG and chimed in with my assessment findings that I use in my acute care practice.
For his part, the doctor was amenable to treating the patient at the facility and stated that he was comfortable with us not transporting the patient. He ordered a few stat labs and requested that we leave a copy of the 12-lead for the patient’s chart, which I was happy to do. Bottom line: The patient signed a refusal and was happy not to have to go to the hospital; The skilled-nursing-facility staff members were happy that the patient was in no immediate danger; and I was happy that we had made the best possible decision for the patient and that I wasn’t exposing her to unnecessary risk.
What happened here is exactly one of the things that I and others have been talking about with the EMS 2.0 movement: EMS people having the ability to make an educated and sound decision about the best possible healthcare options for our patients and not simply having to activate the full emergency healthcare system for every complaint. This case had every element of that and I believe that the patient being redirected through her normal primary healthcare pathway was a much better choice than taking her to the emergency room.
Heck, since there turned out to be no adverse results to this, and since the patient was probably on Medicare, I would surmise that I’ve ended up saving the taxpayers thousands of dollars in unneccesary costs… Huh? Can educating and empowering paramedics “save” the healthcare system in the US by creating a huge savings in the most expensive form of providing healthcare?
What do you think? Did I do good?
I am not a glow worm.
Full disclosure – This is a repost from 09/2009 – It deserved a bump-up and to fix the video. Make sure to watch the vid!
Hazardous Materials, or “HazMat” as it is commonly known, is scary stuff. At least for me that is. In public safety circles, they’re mainly the concern of firefighters and I’ve never received training on them outside of the realm of the fire department. My EMS only agencies have always told me that we remain in the “cold zone” and wait for patients to be brought to us after decontamination.
And that’s just fine with me. Ckemtp is NOT a glow worm… did I mention that?
But, since I’m also a firefighter I finally broke down one weekend and gave in to the pressure I was under to get my HazMat Operations certification. 40 hours of class, lots of homework, and some very dry PowerPoint slide shows. After the first weekend of the class there’s some things that I’ve learned and figured out.
1. HazMat’s still scary.
2. Ck’s still not a glow worm.
3. EMS agencies really need to train more on HazMat.
“We know hazmat” you say. And I know that you’re saying it because that’s what I would have said before those last 20 boring hours spent learning that I knew nothing about hazmat. HazMat is something that we take for granted in that we think that it won’t happen in our jurisdiction, or that it won’t affect us on our day to day. I happen to hope that it won’t hit during my duty days.
This video is from Seward, IL. A small town in the middle of a lot of corn that found itself one day having a big problem. The video is from a surveillance camera on the side of a grade school in the middle of town. The vid starts slow, but has a definite “HOLY CRAP!” moment about halfway through. You’ll see what I mean, all hell breaks loose.
See? Holy hell on crutches! That’s anhydrous ammonia, a common chemical used in farming (and in methamphetamine production). A tanker truck full of the stuff sprung a leak and flooded the town with a toxic cloud. Thankfully, nobody was killed. There were a few firefighters sent to the hospital, and some very scary moments, but it all turned out to be ok. This one’s from the same school. It’s just as scary.
Remember this, a HazMat incident doesn’t have to be the once in a while overturned tanker truck full of MethylEthylBadJuJu. Any every day response can turn quickly into a hazardous materials incident.
Not too long ago, an EMS only agency that I may or may not work for received a call for an “eye injury” in one of our really rural response areas. This call generated a single ALS ambulance only response out to the farm where the injury happened.
The medic and the EMT responded out to the scene, which was about a 15minute emergent response. Arriving at the farm, they were directed to the dairy barn to find their patient.
Their patient was in a lot of pain.
Apparently, he worked for a dairy services company and was delivering product to the farm when he was injured. If you don’t know much about dairies, milk processing leaves a byproduct called “Milk Stone” which is the dissolved minerals in milk solidifying on dairy equipment. Think of hard-water stains. Dairies use products containing phosphoric acid to clean it out. It’s like Lime Away on steroids. This stuff is pretty nasty. Dairies use it in a diluted form, but the supply companies carry the concentrated stuff. This patient was filling a container with the high-powered stuff to dilute it into the customer’s container when the concentrate fell. He reflexively looked right down at the falling container and got a face full of the stuff when it splashed back up at him.
Do you remember that chemical burn stuff you were trained on? He had them. Do you remember the decontamination training you had? What about proper personal protective equipment, do you have it? Do you know when to put it on? Do you know how? What do you know about the chemical?
While treating the patient, one of the paramedics noticed that his EMS gloves was turning white. It was the acid eating through it. A lot of water was used to irrigate the patient, and the providers, before transporting the patient to the hospital.
This was an everyday incident that actually happened. Think about how you’d handle it, because tomorrow it could happen to you.
And once again, Ck is not a glow worm.
In my decade or so working in EMS, I’ve had the chance to ply my paramedic skills in more places than the back of an ambulance. I’ve been employed as an ER technician, which is of course the usual suspect for a paramedic looking to move their career options from more than just “The back of the truck” and “the front of the truck”, I’ve been employed as a security guard *slash* paramedic for a hospital chain that ran an ambulance service using their security department, and I’ve worked as a paramedic in an urgent care clinic. I think that EMTs and paramedics can and should expand their career options and that to do so, we’ve got to take a few collective steps.
The professional knowledge, skills, and abilities held by a paramedic combined with the unique personal characteristics of successful EMS people makes our profession a valuable resource to a wide variety of potential employers. These employers, beyond the traditional ambulance services, fire departments, and emergency healthcare providers, stand to benefit greatly from opening their hiring processes to paramedics, as does our profession and the general public. Imagine one day that you’ll type in the word “Paramedic” into your favorite job search engine and have more options available to you than you’ve ever thought possible. Imagine that one day when you’ve progressed to a point in your career where the prospect of getting up at all hours of the day and night no longer sounds like a good idea you would be able to get a job that is a better fit to your personality and your unique set of side skills. I say that our ability to improvise, to think quickly on our feet, and to make solid decisions based upon our knowledge base and experiences in the face of limited and evolving information are useful to business in this day and age.
At the urgent care clinic where I worked, there rarely was a call for my advanced life support skills. Rather we had the run-of-the mill cases that would come into the clinic for immediate-access primary care. My skills at patient history-taking, assessment, triage, and bandaging got a work-out. So did my skills in relating to patients on a personal level and interfacing with patients and their families across the demographic spectrum. I also learned how to prepare, acquire, and process various laboratory tests including point-of-care testing for common conditions and how to properly obtain and prepare samples for advanced labs. Surprisingly perhaps, I got a great deal more practice drawing-up, mixing, and administering medications more so than I ever have in the field. Working with the doctors greatly improved my skills as a diagnostician and has helped me immeasurably in my ambulance practice. (Yes, I said “my ambulance practice”) I highly recommend for both Urgent Care Clinics as well as for paramedics to explore this wonderful partnership.
What that experience taught me is that I could “fit” into that job description as a paramedic, it also taught me that there was a learning curve in moving out of the ambulance arena and into a clinical one. In my secret squirrel job that I don’t put out here on the blog, I use my healthcare background as a statistician and data management guru of sorts to help make decisions for a large organization assisting a lot of smaller ones and dealing with a lot of people. There was a learning curve there too, but my experience as a paramedic with knowledge of the real-world of healthcare makes a huge difference and brings a lot to the table. Nurses have expanded into this role for quite a while, and a lot of organizations from Education to Public health employ nurses in a lot of capacities apart from their traditional role as a bedside caregiver. Paramedics and EMTs can and should do this as well.
Previously, I had envisioned a certification as a “Clinical Paramedic” to provide paramedics with the knowledge and skills required to function in a physician’s office setting. I still believe that having additional certifications that build upon our initial licensure and education is the way to go. Imagine that once you attain your initial paramedic education there would be multiple educational options for you to choose from that would lead to a wide variety of career paths. You could be a “Public Health” paramedic working in the inner city to improve health standards and access to care, you could be a “Clinical Paramedic” staffing a clinic, working in primary or specialty healthcare, or you could be some type of “Specialty Paramedic” working perhaps as a liaison with children with special healthcare needs for a community organization. The possibilities are literally endless if we dare to explore our options and trumpet our strengths as a profession to the masses.
In order to do this, we’ll have to fall back on the “We Need More Education” answer as well as exploring how our licensing bodies will have to modify our legal scope of practice to allow us to function in these roles. I’m afraid that we’ll have to fight to “own” our licenses like the nurses do (and AmboDriver, you could weigh in on this) but the fight will be worth it.
I’d love to hear from my readers about how they apply their EMS skills in a manner outside of our traditional role. This is a subject area where I believe our brethren in the volunteer part of our industry can assist us greatly in explaining how their EMS training helps them in their primary occupation. If you are an EMT, Paramedic, jump in and help move us forward. What would do as a medic and what would you like to be doing tomorrow?
Hmmm, it seems that I’ve made an oversight. I was reading Motorcop’s blog today and realized that I hadn’t put him on my blogroll. Why not?? You ask. Because I hadn’t.. and now I’m correcting that error with the addition of Motorcop’s blog “If you got stopped, you deserved it” to my reciprocal blogroll.
As you may know, our friend The Happy Medic and Motorcop are friends. Apparently for a cop, he’s a cool guy. Now, I have nothing against our brothers in Law Enforcement. In fact, I have the utmost of respect for those guys who still wanted to be in public safety but couldn’t hack it as a paramedic or even as a firefighter for that matter. (Ha!). His blog is frankly, hilarious. It’s a regular read for me and it should be for you as well.
Also, I’ve always liked the copblog “Pepper Spray Me” and it was on the blogroll on the old site. It’s being popped up on there as well. It’s *ahem* a little blue sometimes… but it’s wildly entertaining. Just don’t read it in church.
I’m sorry about the lack of streaming posts lately. I’ve been busier than heck lately with a whole rig-full of projects. As I always say, there’s a lot of exciting things coming down the pipe. Stay tuned.
Oh, and if you’d like to be on my (hint) “reciprocal” blogroll, throw me a link, have an awesome blog, and let me know that you’ve linked me on a comment here, at ProEMS1@yahoo.com or on my Facebook or Twitter accounts. We can work something.
This post goes out to my blogger buddy @medicthree - (http://www.medicthree.com) whose been having a few rough shifts lately. If you’ve been having a few rough ones lately, this one’s for you too. It’s kind of a rambling, disjointed post about emotions in EMS. It made me feel better to write it. Here’s hoping that it makes you feel better to read it.
Cruising down the interstate has always been a Zen-like experience for me. I do it a lot due to living here in the rural Midwest. I like it. It’s a quiet time for me to be alone with my thoughts… which can be both good and bad I guess. It’s not uncommon for me to point my car in the direction of some commonly travelled to destination and be exploring the depths of my subconscious mind the whole way. It’s my meditation time, my time to reconcile the goings on in the world with my opinions on them. I’ve had some of my biggest epiphanies with my foot on the gas pedal. Give me the radio, the open road, and a not-so-specific time to be somewhere and I can solve almost any problem I’ve got.
This morning’s cruise home from my Northern job was no different. Today the world was subtly shining with a brilliant white coat of ice. The icy fog that had lingered all night had coated each individual twig, blade of grass, and exposed surface with tiny fernlike diamonds giving the quarter-mile or so of visibility around me an eerie, ghost like quality. It was beautiful. I wonder if anyone else calls this stuff “Ice fog”? I do. At least today I do. My father taught me that pilots call the small ice that builds up on the leading edges of airfoils and antennas “Rime Ice” and it was forming on my antenna as I cruised down the highway. It made me remember my dearly departed dad and smile to myself as I did it. Remembering things he taught me tends to do that. I’ve found that as I progress deeper into my own path of fatherhood I remember the things he taught me more and more. I try to pass that on to my own son but I suppose that I’ll always worry about not being able to live up to the task.
See what I mean? Just thinking about the drive time tends to make my thoughts ramble. Perhaps everyone does this, perhaps not… but I would think that everyone has their time alone with their thoughts. My time is my drive time. Perhaps it is yours as well.
Being a paramedic who thinks while driving affects my rides home from work the most, I believe. If you’re in the business, you know about the peaks and valleys of emotion and the human condition that we witness on our shifts. My drive home is my place to sort them out and reconcile the lowest valleys with the highest peaks so I can be more balanced. There’s been times where I’ve gone through a toll booth with tears streaming down my face, trying to regain my composure to give the toll-booth guy my patented “You ‘ave a good day, my friend” as I hand him my eighty cents. Other days I’m laughing like a fool while blaring European techno, country western, or whatever tripe the pop station’s playing repetitively these days. Sometimes I’m sullen, thinking about some stranger’s death that shouldn’t have happened. Sometimes I’m elated, thinking about something that’s just full of EMS win. Whatever the case, my thoughts tend to run down the calls I had over the previous day’s shift and I dissect my decisions and the circumstances that lead me to make those decisions while I’m sitting there alone in the car. I think that it makes me a better paramedic to do this, I also think that it keeps me only borderline insane. Someone once sent me an e-mail with tips on how to keep oneself with “A Healthy Level of Insanity” and I love that term.
I’m sorry that this post is just a bit of rambling on about emotional stuff, but I hadn’t posted in a while and this Sunday just felt like a good day to let my fingers put something out there. I’ve always believed that EMS people experience the world differently as they live their “Life, under the lights”. Our experiences and the viewpoint they give us make us just a bit different than our neighbors. We laugh at inappropriate times, our thoughts sometimes wander, and we take some things more seriously, and some things less seriously than others. While collectively we EMS people are a diverse lot, we share a common bond that could make me comfortable sitting down to throw back a cold one with almost any of my colleagues. That is, until we get onto a debate about some minor topic and both of us are right beyond the shadow of a doubt. I’ve told students that in the decade or so I’ve been doing this, working in a high-stress environment, surrounded by type-A, ADHD personalities who make their living on making the “right” decisions every time, I’ve ticked some people off along the line. If I hadn’t, I’d have been doing it wrong. I tell the students that they’ll tick some people off too and that they should have fun with it while trying to be as nice as they can and realizing that they can disagree with someone without having to dislike them… and vice versa.
Sometimes, this job sucks. Sometimes our best isn’t good enough… and sometimes we think that we weren’t able to our best for whatever reason. Those times are low times that can consume you in total darkness. Sometimes it’s just the opposite and your shift full of EMS Win leaves you full of inflated confidence. The lows are days when I drive the speed limit, the highs push me over a bit. My advice is to just remember what’s important to you and what your end goal in life is. You’ll get there if you keep travelling in that direction, no matter the speed you’re going at the time. Remember that this profession is like a sine-wave with peaks that can thrill you and valleys that can um, kill you if you let them get to you too much. Just remember, my friends. Someone up there has a purpose for all of this that we’re not meant to understand. Just keep doing your best, honestly putting forth the effort that leaves you honestly convinced that you’ve done your absolute best for everyone you’ve been charged to take care of and you’ll survive this stuff out there.
And keep driving.
One of my absolute favorite EMS bloggers calls himself “Too Old to Work, Too Young to Retire”. His blog and his writing is witty, insightful… and as the name may suggest, sometimes pretty cantankerous. I missed this post when it came out, but today when I came home from shift and was looking for a good read, I popped over to his blog to have me a look.
I was not disappointed, my friends. Looks like TOTWTYTR is in good form lately and he’s loaded up his torpedoes and aimed them straight at the NREMT, the state licensing agencies, and EMS education in general.
My favorite line from the post? “The entire process of recertification is a fracking farce” Preceeded immediately by a Ron White quote. Classic.
I’ll shut up so you can go read. http://tooldtowork.blogspot.com/2010/01/like-being-on-carousel.html
Notice something weird?
I am currently performing some cosmetic surgery on the site based upon the comments I got from my readers when I put up a post soliciting feedback from them about the site. Thanks to everyone who left comments, e-mails, and tweets with your suggestions. I truly appreciate that you all take the time to read my stuff about stuff that I write.
Anytime you come to read me, I’m thrilled. Anytime you comment on a post and join in the discussion, I’m really thrilled. That’s why I’m redesigning the site, to make it a bit easier to get around and such and to enhance the experience here.
In the mean time, check out some of the new bloggers to the Http://www.FireEMSblogs.com family, Also, don’t forget to vote on the blogs in the running for Fire/EMS blog of the year for 2009 over at Http://www.FireCritic.com – You can vote every 6 hours. Hurry up because time is running out!
If you still have time, Check out Mack505′s new site at Http://notesfrommosquitohill.com – He’s put a lot of work into improving the link of his great content.
Later y’all… gotta get back to work.
- @SteveWhitehead Mine’s done. I just have to put the finishing touches on it and clean it up a bit. Mine’s about raw emotion in reply to SteveWhitehead #
- I’m working an odd shift – 9a to 6p. Just got back from call #8 – #wtf? We were dead for the first 2 hours #
- @FireDaily @ukmedic999 Sure, pick on the poor P-med who’s bin bustin his tail all day. I seem to ‘member a DM I sent Mark 2day during a lull #
- @UKMedic999 howdy! See? I’m not ignoring you in reply to UKMedic999 # (more…)
I read a short article in Entrepreneur Magazine (to which I subscribe) that had a story about a sign hanging in a shop somewhere that said this:
“Low Price. High Quality. Good Service. – Pick two”
The saying goes that consumers can pick two of the above things that they feel are most important to them in their buying decisions. It also implies that businesses can focus and compete on two of the three, but they can’t do them all.
I agree with the sign. It shows in the fact that there are multiple outlets in the marketplace to purchase similar goods and services. If you’re price sensitive and don’t want the highest quality of furniture you buy from Ikea and assemble your purchase yourself. If you’re always after the best quality you go to a custom furniture builder who would be more than happy to deliver and install for the price you’re paying him. As always, if you as a consumer do not like what the merchant has for sale you “vote with your feet” and go somewhere else to spend your hard-earned money.
And that is how “the market” works. Businesses compete with one another for your patronage and this competition keeps their prices as low as the consumers are willing to pay for the level of quality they are willing to accept. People are willing to accept lesser quality products for lower cost as much as they are willing to pay more for better quality. Service and support plays a role in there too as nobody wants to get burned on a deal, product, or service. If your widget store has exactly the same quality of widgets for sale with the same service as the widget store across the street, people are going to buy the widgets at the lowest cost. Change any of the price/quality/service variables and the sales will follow where the consumer sees the best value. Of course I’ve oversimplified this a bit as the system we call “the free market” is infinitely nuanced in its simplicity, but this is indeed an EMS article. So don’t even get me started on that Adam Smith guy and his sleight of hand.
So why am I bringing forth this short little explanation of the free market? It’s because the ambulance industry is a service provider. Unfortunately (or fortunately if you prefer) we’re not entirely bent upon the whims of the marketplace due to the governmental regulations that set our price, control our service types, and dictate how we run our businesses. You probably know that Ambulance Services are “service providers” as they provide a service to our patients in exchange for fees paid for that service (ha!) and their tax revenues, but did you know that the Paramedics and EMTs are collectively a “service provider” for the ambulance industry itself?
Follow me here for a bit. If you separate out the collective “ambulance industry” from the collective EMTs and Paramedics making up the Profession of Paramedicine, you can see that there are two separate groups functioning in tandem. While we’ve always been inseparable and have been defined as one collective group, I suggest that we are really two entities. The Profession (Defined here as the Paramedics and EMTs together) and the ambulance industry (defined as the places we most usually work).The ambulance industry needs a service from the Profession in the form of us providing them with bodies to run their trucks, and we need them to employ us. If you were to take this thought further, we as members of the Profession compete with one another to provide our services to the various ambulance companies in the form of applying to and accepting positions with them under whatever conditions they set for us. They set the pay rates, benefits, shift schedules, etc and we paramedics compete with each other for the positions… usually accepting less compensation than we wished to receive as a condition of being employed.
Historically, our profession has competed on price as evidenced by the fact that our pay rates are much lower than we want to accept for our services. According to the above analogy, as we push our price lower either the quality of our education and skills or our level of service is going to suffer for it. One needs to look no further than their own paycheck to see that the pay is terrible. One also needs to look no further than their local “Medic Mill” school that exists solely to pump out EMTs and Paramedics with “a pulse and an EMT card” at the lowest possible cost with the absolute minimum level of education. We’ve become the Wal-Mart of ambulance staff, always rolling back our prices and lowering quality to encourage more and more demand.
If I have any liberty to speak to our profession I ask that today we all make the collective decision to compete on “High Quality” and “Good Service”, leaving “Low Price” behind. Frankly it hasn’t worked for our profession to provide our services for the low bid price. The subsequent drop in the quality of our education and services isn’t the best for our patients. We’ll always compete amongst each other to provide our services to the ambulance industry (I.E. apply for jobs) but if we all accept that we’re no longer competing on “Low Price”, we’ll all reap the benefits. Our patients will as well.
I suggest that we begin to “vote with our feet” more often in our quest for employment. If there are multiple ambulance services in your town, pick the one that offers the best pay and benefits and apply there for your employment. If and when you get hired, work like heck to make them the dominant ambulance company in the marketplace. Once the other competitors realize that the ambulance service with the best pay and benefits is gaining a competitive advantage, they’ll change… or be forced out of business. What you’ll begin to see is that the ambulance service that pays the best will begin to be able to “get what they pay for” from the profession in the fact that they will only hire the best qualified among us. Therefore we’ll begin to have to compete on quality and service to get hired for the best pay. We’ll no longer be competing on price alone. You’ll have to put more effort into the profession, but you’ll reap the rewards in terms of higher pay and benefits.
In addition, we need more Medicpreneurs. I’ve said before that the only way to make a lot of money in this game is to be the owner of a service. What’s to say that you can’t start your own ambulance company to put your boss out of business? Hire the best of your coworkers and pay them what they deserve. Do your best and work very hard every day. Soon enough, you’ll win if you can beat the market. You’ll be helping your profession and yourself as well.
When we begin to see the collective power that we wield as a profession in the marketplace we can begin to change the marketplace to fit our wishes. If we want EMS 2.0 to go ahead and get here already we’ve got to collectively become aware of our power and our duty to control the playing field. We haven’t won yet, let’s change the rules so we do. We owe it to our families, our patients, and everyone who depends on us. Wake Up EMS. We control the game here folks… We just have to realize the power we have together.
Low Price. High Quality. Good Service – Which two do you pick?
Allow me if you will to allude to some Roman history here. I know that it’s a little heavy for an EMS blog but if you would please search the dusty recesses of your memories to think of the Roman Emperor Nero, it would help this post. You know, the one who “fiddled while Rome burned”
I am way oversimplifying this, but the way that I remember the story was that Rome was being swept by the “Great Fire of Rome” that burned for days and decimated the city. Popular legend has it that Nero, unconcerned with the plight of his citizenry, played the fiddle while the city was burning.
(Although, the MOST TRUSTWORTHY SITE ON THE INTERNET *Other than Mine* has this on the subject: http://en.wikipedia.org/wiki/Great_Fire_of_Rome)
Recent events and some things that I’ve been reading lately have brought some EMS issues to light in my mind, and thoughts about good ol’ Nero have popped into my head.
Are we Fiddling while Rome Burns?
There’s a few competing EMS system design models out there that have various people in their camps. Mention the virtues of one over another and you will get passionate and snarky responses from the various members of these camps. Trash Fire Based EMS and you’ll get a ton of people that will take a break from lifting weights and will bombard you with reasons while Fire Based EMS is awesome while wearing their T-Shirts emblazoned with “FIRE RULES!!”. Mention that 3rd service and not-for-profit EMS may have their downfalls and the EMS Chess Club will bring forth obscure research that shows how much better they are for the patients than everyone else is. Trash Private-for-profit EMS and um, the employees thereof will trash it right along with you and their management will be too busy putting out fires to care.
Try as you might to convince me that one is better than the other and I’ll agree with you on some points and disagree with you on others. I will only endorse what I call “EMS based EMS”, which is EMS provided by truly dedicated caregivers who base their decisions and actions simply upon what is best for their patients and their communities. I have my beef with fire based services that place protecting firefighter jobs and the “fun” stuff involving spraying water on things that happen to be on fire over solid patient care. I have my beef with private-for-profit services that always default to the bottom line, and admittedly, I have a bias towards third service and not-for-profit EMS agencies. However, no one system has ever proven to be a good fit for every community, none are inherently evil, and other professions find their fit within lots of configurations.
If the system design models out there are really locked into a competition for the soul of EMS then they’ve all got a lot of work to do. In this piece, I’m going to ignore patient outcomes, efficient use of tax money, and all of the stuff that I usually talk about… and focus on one thing and one thing only.
The way EMS people are treated by the competing systems will probably decide this debate we’ve got going on here. The model that treats the paramedics the best will win and will take over the industry. Why wouldn’t it? What paramedic with half of a brain would continue to work in a service model that didn’t pay and treat them the best?
Here in Northern Illinois, there are very few options for a paramedic that doesn’t want to do Fire Based EMS for one reason or another. The few options that there are don’t pay nearly as well as the fire-based groups and this creates an endless revolving door of young paramedics entering the system, working the “privates” for a while, while trying to get a “real job” with a fire department. The private services suffer for it, and the fire based services reap the benefits while fostering a system that (gulp, here it comes) focuses less on the healthcare and more on the fun stuff.
So I challenge the private, third-service, and not-for-profit services out there with my next statement.
You’re fiddling while Rome burns.
If you aren’t out there doing your absolute damndest to treat your employees well and pay them what they deserve, you’re failing. You push your employees away. You push the best and brightest into other professions and into fire-based EMS which hands down has the best pay and benefit structure. Your lack of interest in caring for your caregivers is killing our profession. You fiddle whilst complaining about decreased reimbursements and failing to do anything about it. You fiddle whilst focusing on minutia like stupid rules and regulations that degrade the dignity of the adults who work for you. You fiddle while worrying about protecting your jurisdictional boundaries and contracts while they’re eroded away by the constant stream of departing employees.
Nero could have been an ambulance manager in some of the services I’ve been to, worked for, and observed from the outside. Could he be you?
You have got to find a way to pay your people better. I don’t know exactly how it’s going to happen either, but it has to be priority #1 for every ambulance manager out there. Trust me, if you don’t do it you will find that your capital city has burned to the ground. You will lose your empire and it will not come back. If you aren’t out there doing every possible thing you can to keep your employees as happy as you can get them, you’re fiddling, and you’re failing our profession.
This blog has a lot of content on it that explores new revenue sources for ambulance organizations already. Coming soon: Ways for each individual EMS professional to take control of our own income potential, own our profession, and improve our care to our patients. I’ve said it before and I’ll say it again folks, hang on cuz it’s going to get fun.
This post is a cooperative joint topic with two widely respected EMS bloggers, Steve Whitehead from Http://www.TheEMTspot.com and Greg Friese, from Http://www.EveryDayEMStips.com – Our topic is supposed to be on why it is that EMTs, Paramedics, and other healthcare providers will sometimes “go through the motions” and continue on with futile resuscitations with pediatric cardiac arrest victims. I’m sure that they will have very insightful posts on the topic, as they always do. Here’s my take.
Can someone say “emotionally charged”?
One of the truths about where I’m sitting right now is that I’m chained to a lot of potential responsibility. Today, like a lot of days I’m one of two paramedics on-duty in my service area and the next call is mine. No matter what the next call is, it is my responsibility to get up and answer that call… without regard the horror that fate may be sending me to bear witness to and intervene in. All medics have to accept this inherent part of the job. One of the worst of those possibilities is that it may be a call that involves the significant injury or illness to, or even the death of a child.
Mention the possibility of a child’s death to even the most cynical and seasoned of healthcare providers and you will send a very cold chill down their spine. It’s just horrible. For me, the blessedly rare times that I’ve lost a child have been sentinel events in my life, things that are often thought of but rarely spoken of… almost always spoken of only to comfort the pain of a colleague experiencing the same thing. The loss or suffering of a child just burns into our souls and leaves an indelible scar that only someone who has experienced it can have true empathy for.
And I for one, wish that I didn’t have the empathy that I have for it.
Heaven forbid that I ever have to be one of the parents with pleading eyes at one of those tragic and traumatic scenes. I just can’t imagine what they go through when I’ve said “I’m Sorry”. I can’t imagine their pain, and frankly I don’t want to. As a parent myself the thought is blocked from my conscious mind and relegated only to the deepest recesses of my subconscious fears. Losing an adult patient is one thing, as we humans come to know that our lives are fragile and that our price of admission is to be removed from this existence. It’s a knowledge that we get as we progress through life and gain the experiences, both good and bad, that make us who we are and will become. However, the terrible thought that one could be ripped from us in their age of innocence is an affront to everything that almost everyone holds dear… and it’s more than a lot of us can bear to make the last decision of a child’s life. Instead, we try. We try hard and we keep trying. We hold out hope against thought and fight on, sometimes against futility.
But in my mind, I think I know why it is… because no healthcare person wants to be the person who looks into those pleading eyes and says “I’m sorry”. That decision takes an enormous emotional toll upon the parents and family, of course… but also upon the EMT or Paramedic. It’s ultimately easier on us as EMS people, we reason, to fight on. To race headlong into futility and hold out hope that someone else won’t have to say “I’m sorry”. At least we won’t have to.
There are probably psychological studies out there that I haven’t read that deal with the issue of whether “CPR Theatre” is harmful or helpful to the long-term well being of the surviving family. These studies are probably well-researched. I took a class once that told me that it was better for family members to be in the resuscitation room inside of a hospital to witness the events as healthcare people try to save their loved ones… and I can understand that I guess. Perhaps it is better to witness that “everything possible was done” for your departed loved one. I don’t know.
As healthcare providers, it is our sworn duty to alleviate suffering as best we can using the tools at our disposal. I, like most of my colleagues, realize that the secondary and tertiary patients that we treat are the family members and their grief reactions to the tragic circumstances that resulted in their calling us. I am reasonably comfortable handling their grief reactions and sadness when an adult passes on scene but I am humbly inadequate to be of much comfort to a parent that has just lost their child no matter how I might try.
My guess that futile CPR theatre can be explained as being more for the parents and families of departed children than it is for the slight chance that we might have missed something. We make the effort in the name of showing to the family members that “everything possible” was indeed done, up to and including running their child lights and sirens to a hospital. I’ll even admit that in the back of the ambulance while I’ve done this, I’ve prayed right along with the family that just perhaps this once we would have a miracle. Never once has it happened.
Here’s a mea culpa for you, even though every time I’ve gone through the motions I’ve said it was for the family… It may really have been for my own benefit as I’ve stated it could be above. I am a paramedic and I’ve seen my share of pain, but I don’t think that I can look a parent in the eyes and say “I’m sorry” ever again. I just don’t want to and as I write this, I can’t imagine that I could do that and then come back and look the guy in the mirror in the eyes without wondering if maybe this time would’ve been the miracle. I am probably selfish for this practice… but is that wrong?
From a completely actuarial perspective, no futile resuscitation should be performed due to safety concerns and the unnecessary costs involved. I agree that with adults, transporting cardiac arrest victims is probably deadly. I also understand that no ambulance should risk a lights-and-sirens trip to transport a body to the emergency room. However, I am not an actuary. In those cases I’m a witness to horrible emotional pain and I want someone else to be the one who says “I’m sorry”. It’s human nature, perhaps.
In my career, I have told parents “I’m sorry, there’s nothing I can do” in cases where it was blatantly obvious that the child was long beyond hope of any intervention. I’ve done it more than once and I can see the places where I’ve done it in my mind to this day. Sometimes it’s completely obvious that there is indeed nothing that anyone can do. However, occasionally I have indeed known this and just done it anyway. Perhaps it’s completely subjective. Perhaps it was my level of experience and intuition that guided me at the times I’ve made the decision. I’ll tell you this, it certainly wasn’t a decision made from the pages of a textbook.
I don’t have the answers to this. But I do want to go home and hug my kid. My only advice to the EMS people out there is to realize that we’re all human, and that all you have to do is your best. Be compassionate, and use your best judgment. For that’s all we can ever do.
For more on this powerful topic for EMS, head over to Greg Friese’s page and also to Steve Whitehead’s page. You also may want to read “Splashed Sadness – A look at Negative Emotions in EMS” where I further explore the sad side of EMS and our reactions to it.
- @TheRoadDoctor @Another_Version Hey, on a 24, ran a big part of the day. B2B calls from 0000hrs till 0415hrs. I earned my nap! #
- RT @Fireground: RT @ENeitzel: RT @Social_Media118: Texas county to name drunk drivers on Twitter http://twa.lk/KNcU6 #
- RT @gfriese: Never seen #packers score so many pts ^ weird, isn't it? The packers? Scoring points? Huh.. #
- @scoolgirl101 Nope. Love is being up with her anyways, in spit of having a rough nite in reply to scoolgirl101 #
- @rescue_monkey @gfriese 20? Pssh.. Not cold at all. That's how cold Hell's gotta be before the #packers will make it to the superbowl in reply to rescue_monkey #
- I've been a bad twitterer today. But I did get a lotta quality time with the Wife (@GinaKaiser) and the boy. Love ya, Inky McTicketwasher #
- Oh, and tomorrow on the blog? I'm kicking EMS pay squarely in the arse. To hell with living in poverty for saving lives!! #
- RT @tweetmeme Why does being a Paramedic seem so worthless sometimes? – Life Under the Lights http://bit.ly/1ZzUii #
- RT @ckemtp EMS 2.0 & EMS Ethics – How far would you go? – Life Under the Lights http://retwt.me/18XWA #
- RT @ckemtp The Current US Economy and EMS: An In-depth look at how this mess will affect 911 in your community http://retwt.me/1A6yl #
- @EMS_Princess I was doing that a while ago whilst hanging dopamine on a resuscitated code. 30yo SCA vic discharged neurologically intact in reply to EMS_Princess #
- @slichten01 I know about us EMS vollies. I've been one for 12 years. in reply to slichten01 #
- @in_the_city Gypsy like medics aren't neccesarily a bad thing.. It actually is capitalism in action… If we'd only do it right in reply to in_the_city #
- @UKMedic999 @emtdani I KNEW "frumpydumples" would catch on! in reply to UKMedic999 #
- RT @UKMedic999: EMS system abuse – caused by lack of education, common sense, or responsibility for self or others -Discuss! #whatacrapday #
- @UKMedic999 EMS system abuse: first two calls toned out on Xmas day: 0002 Elderly male w/a bladder infection. 0008 Stabbing victim in reply to UKMedic999 #
- Wow, I'm furiously writing on this #EMSpaySucks topic. I'm creating a hashtag for it. Great comments on the stuff, btw. Expect more #
- #EMS people: Do you drop down your pay to a reduced rate for "sleep pay" or "on call" time while on a 24? #
- @theHappyMedic @ukmedic999 I am SOOOO there. When? in reply to theHappyMedic #
- @p_e_naylor Damn right you should. Damn right #
- RT @FireDaily: FireDaily blog post Fire YesterDaily- “The Head Rule” http://bit.ly/6te90J #
- RT @EMTDani: What on earth is FTW? Flip the wheelie? Feeling the wind? Finding the wizard? ^I don't know either. Right there witcha #
- RT Is this something i should be getting excited about? RT @theHappyMedic: If @ukmedic999 is flown out for #CoEMS world premier in SF ^yes! #
- @EMTDani Ohhh, THAT's what it is… "Find the wizard" in reply to EMTDani #
- RT @UKMedic999: Wanna know how to make me turn as red as a strawberry? Read my latest post from the SF trip: http://bit.ly/6ylxsC #CoEMS #
- @UKMedic999 That was an awesome post oh, and um.. I may have letcha win. LOL in reply to UKMedic999 #
- @ukmedic999 your last post brought such a big smile to my face that the guys@the station were laughing at me @ginakaiser readin it now #
- @gfriese @thehappymedic @ukmedic999 – I'm 100% committed to a #CoEMS event in WI.. I'm already prepping the cows #
- @scoolgirl101 an #ems tweetup in Chicago?? Maybe. @gfriese @in_the_city @firecap5 @firedaily @chiefreason @annainchicago @ginakaiser in reply to scoolgirl101 #
- @TheRoadDoctor and @ you too @emschick in reply to TheRoadDoctor #
- @Anna_n_Chicago oops, I got her @ wrong for the upcoming Chicago #ems tweetup in reply to Anna_n_Chicago #
- @ssgjbroyles you should come too to the upcoming Chicago EMS tweetup in reply to ssgjbroyles #
- @ssgjbroyles #CoEMS ?? It's "The Project" with @ukmedic999 – http://www.ChroniclesOfEMS.com in reply to ssgjbroyles #
- @EMTDani I use 1and1.com in reply to EMTDani #
- RT @TheRoadDoctor: @Ckemtp @ me? What? Who? Where? I'm lost… ^ for an upcoming Chicago EMS tweetup #
- @EMTDani I'm on the border of IL and WI in reply to EMTDani #
- @ssgjbroyles there aren't details yet, just an idea that @schoolgirl101 et al had. I can't do it next week, but soon in reply to ssgjbroyles #
- @MsParamedic @gfriese Actually, I've been meaning to ask you about that. Absolutely yes. I'd love to #
- @shell1972 @ssgjbroyles Will do. Once we get the details hammered out, I'll put it up on the blog. This was @schoolgirl101 's idea, btw in reply to shell1972 #
- @FireDaily Did you hear about the upcoming EMS tweetup in Chicago? Even though you're a fire guy, you're invited in reply to FireDaily #
- @MsParamedic I've made New Orleans from Chicago in one 13hr drive more than a few times. I usually get there a few times a year. You could 2 in reply to MsParamedic #
- @p_e_naylor Can't stomach the #bears ? Man… this year they suck… but we're true believers, right? in reply to p_e_naylor #
- RT @everydayemstips: New EMT Tips MedicCast: Conversation about EMS Education from EMS Expo 2009 http://ow.ly/16eiUP #
- @MsParamedic no date set yet, but I'm thinking Jan in reply to MsParamedic #
- Attention everyone: @myrtlife is finally following me. Finally. Twas a long time coming… But y'know #
- Ran down to the station and sent a heavy rescue unit for a Mutual aid "public assist"… A "dog stuck under a deck" wtf!? #
- Quote the captain: "It's like getting called to get a tree outta a cat" – nope, not a typo #
- @Pheenyxfyre Nope That's how we roll. Can someone say "Chainsaw"? in reply to Pheenyxfyre #
- OK, I like @mattdamon again. Just say him juggle three tennis balls whilst reciting the preamble to the Constitution on Leno #
- @mack505 Nope I'm that fast. You should see me with a six-shooter in reply to mack505 #
- #CoEMS My Wife and I really really really want to go back to San Francisco for the #CoEMS release party! @thehappymedic @ukmedic999 @setla #
- @shell1972 Hey, thanks for all the RT's! in reply to shell1972 #
- RT @FireCritic: Blog Tip – Monetizing your Fire/EMS Blog Part II Will be posted at 11am tomorrow!!! Look for it @ http://bit.ly/17hPPj #
- My kittehs are cuter than your kittehs http://tweetphoto.com/7487637 #
- @EMTDani where ya goin? in reply to EMTDani #
- RT @tbernemtp How hard is it 2 flush a toilet? Most peeps don't enjoy finding what u left behind, flush the damn thing!!! ^edited to add !'s #
- @KevinReiter Hey, thanks for the RT bud in reply to KevinReiter #
- @thehappymedic Um… it's ten degrees outside here. TEN whole degrees. Isn't that nice? #
- @NJGhostDiva911 Naw, it builds character. Think of all the character I'm building in reply to NJGhostDiva911 #
- @NJGhostDiva911 @NJGhostDiva911 But you'd die WITH CHARACTER in reply to NJGhostDiva911 #
- @NJGhostDiva911 Hmmm, they both sound so good… except for the "boy" part, y'know in reply to NJGhostDiva911 #
- Night tweeps – Read my new post #
- @KevinReiter why thank you. Feel free to post away in reply to KevinReiter #
- @theHappyMedic I'm at work now. It's 12. Usually this time of year we have our week or two long run of subzero-by-a-lot days in reply to theHappyMedic #
- @theHappyMedic Oh and you can rant in my comments section anytime in reply to theHappyMedic #
- @theHappyMedic I'm trying this as a 6 or 7 post run. The response has been exciting and almost overwhelming. Look 4 another post today in reply to theHappyMedic #
- @TravelMedico Thanks for the kind words buddy, something has to be done and hopefully we can bring ideas to the table in reply to TravelMedico #
- Would like to get some more writing done on my series entitled "EMS Pay Sucks!! Let's do something about it!" http://bit.ly/5uXwDA #
- RT @JustMyBlog: new blog post up at http://justmejustmyblog.blogspot.com/ ^ y'all should read it, too #
- RT @UKMedic999: New blog post: My 1st Blogoversary! http://999medic.com/2009/12/29/my-1st-blogoversary/ #
- @UKMedic999 I'd love to get "EMS Pay Sucks!! Let's do something about it!!" Part 3 up soon.. But I've been running B2B calls all day! in reply to UKMedic999 #
- RT @UKMedic999: A heart breaking blog post from @NeeNaw : http://www.neenaw.co.uk/index.php/ambulances/448/unknown-male/ #
- @in_the_city I am SO beating you! Dang it! in reply to in_the_city #
- RT @EastCoastEMT: RT @UKMedic999 New blog post: My 1st Blogoversary! http://999medic.com/2009/12/29/my-1st-blogoversary/ #
- RT @hazmatmedic: If security would let us, we could touch the stage @ the Zac Brown concert! http://twitpic.com/vst87 ^ so freaking jealous #
- RT @everydayemstips: #elearning 10 Essential Skills for Elearning Designers Using Social Media http://ow.ly/16eEis #
- RT @in_the_city: @ckemtp beating me runwise or paywise? ^ oh so not paywise. I should come work for y'all #
- RT @Epi_Junky: Finally back at the station. Now leave us alone for a lil bit, mmkay? ^I'll 2nd that. Just had a stretch of 9 b2b calls #
- RT @gfriese: 7 EMS iPhone Apps is a post from: Everyday EMS Tips 7 EMS iPhone Apps is a post fr… http://ow.ly/16eGm8 #
- RT @ChiefReason: Checking out http://www.firefighternation.com/profiles/blogs/becoming-a-trustee-was-my #
- RT @NathanFillion Sittin on the beach watchin the whales frolic in the warm sea. This place is bananas. http://yfrog.com/4e2vsj ^it's 8 here #
- @FireMom @firedad Yes absolutely. Support your team through the good AND the bad. And answer them when they eff up in reply to FireMom #
- Well tweeps.. I Tried valliantly to get my new post up in the series. Too tired from running all day.. First thing tommorow tho! Night y'all #
- RT @davehitt: WI Firefighter Killed, One Critical, Eight Injured in WI Explosion http://ow.ly/R4t7 ^ Our prayers are with them #
- RT @FireDaily: FireDaily blog post Brotherhood this, Brotherhood that, bla bla bla… http://bit.ly/6GlzRp #
- RT @geekymedic: I am really tired of hospitals this year. I really hope 2010 is better. Son in surgery now. ^ Have y'all in my prayers bud #
- RT @FireCritic: @FireDaily should we go with 9pm est? ^ ooh ooh!! For what?! #
- @FireDaily @FireCritic Why hasn't this talk of the cat gotten dirty yet? ^ I *was* behaving, wasn't I?! Hmmm, that's not like me #
- @FireCritic Grilled PB&J's made by @ginakaiser How's that?? in reply to FireCritic #
- RT @twnstar2: RT @LAcrimes: Patrick Stewart call him Sir not Capt. Queen to knight star trek captain http://bit.ly/5QjXE6 ^Yay! #IamAgeek #
- RT @BigWhiteFireDog "I just realized how bad the economy rlly is. I recently bought a new toaster oven & as a free gift, I was given a bank" #
- RT @davidkonig: RT @FireCritic: Fire/EMS Blog of the Year 2009 #FCBLOG09 http://bit.ly/73oD8C #
- The 3rd post in my series entitled "EMS Pay Sucks! Let's do something about it!" Is up @ http://bit.ly/5uXwDA. I ♥ comments #
- @gfriese @stevewhitehead yes, although I don't have a draft yet. in reply to gfriese #
- Just found out a guy I work with blogs: http://3amwithgus.blogspot.com/ – How many hits can I get him in a day? #
- RT @FireCritic: Several nominations already for Fire/EMS Blog of the Year 09…read more http://bit.ly/73oD8C #
- RT @UKMedic999: My final day with Engine 13, and getting to realise some childhood dreams. My penultimate #CoEMS post: http://bit.ly/8Az1MH #
- @ukmedic999 hehe, you said "penultimate" whilst you were twittering. British. #
- Nominating #FCBLOG09 blogs I read daily: @thehappymedic @ukmedic999 @gfriese @stevewhitehead @ambodriver @firedaily @firecritic #
- Nom #FCBLOG09 blogs I read daily: http://tooldtowork.blogspot.com – Http://roguemedic.blogspot.com – Http://insomniacmedic.blogspot.com #
- RT @firehat If any of u care about #EMS then get over to @Ckemtp and his series on y EMS peeps aren't respected http://bit.ly/5uXwDA ^Thx! #
- RT @firehat: And just to be clear, EMS is best handled by a FD but the FD must also care about EMS. ^ Eh, we'll see.. But still thx! #
- RT @firehat It's an all-hazards + institutional memory thing to me. ^ Napolionic wars vs Ben Franklin? How about Hypocrates and the MDs #
- @scottthemedic Now THAT'S geekery! #makeItSo in reply to scottthemedic #
- @firehat btw, I may disagree with you, but that doesn't mean I don't respect your opinion. I just can't do the FD-based EMS debate right now in reply to firehat #
- @firehat oops, didn't catch that. The FD based debate tends to derail any progress. I agree, later with it in reply to firehat #
- @EMTDani don't forget Guam, the Mariana Islands, and the Federated States of Micronesia. All US territories in reply to EMTDani #
- RT @FireBlogger Astonished @ the hate on Twitter for Rush Limbaugh. The ugly side of American society on full display. Sad and telling #Rush #
- RT @davidkonig: New Post: Daily Digest for December 31st http://bit.ly/8van4J #
- RT @FireDaily 3 FF Deaths in Four Years: Steven Koeser of the St. Anna Volunteer Fire Department is the third fi.. http://bit.ly/5OszXx #
- @EMTDani I know where yer at in reply to EMTDani #
- @TravelMedico http://tweetphoto.com/7648261 ^ Ummmm… Need another paramedic there in Vietnam?? in reply to TravelMedico #
- @EMTDani @myrtlife Don't hafta: You're @ a computer! in reply to EMTDani #
- @EMTDani I also know where you got them shoes you're wearing in reply to EMTDani #
- RT @vanand98: With true friends…even water drunk together is sweet enough. -Chinese Proverb #quote #
- RT @theHappyMedic: New blog post: Do my job? http://happymedic.com/2009/12/30/do-my-job/ #
- @EMTDani Nope, you got them on yer feet! in reply to EMTDani #
- @theHappyMedic whatchoo doin up so late?? Dontcha know you should be in bed? in reply to theHappyMedic #
- @theHappyMedic cool give the wife a snuggle fer me. And @ginakaiser says hello in reply to theHappyMedic #
- RT @vanand98: U.S. faces fiscal crisis with $12 trillion debt http://bte.tc/ab6N #RTW ^ Hey, people who's income depends on Loc. Gov. Tax $ #
- @FireCritic Workin tomorrow in reply to FireCritic #
- @mrs999 It's right nice to see you!! Welcome to twitter! #
- @Mrs999 I'm honored to be your first tweet Happy new year in reply to Mrs999 #
- @FireCritic Do I want to admit to doing that in the past? Naw tonight's a very family oriented new years. The 2nd however, will not be in reply to FireCritic #
- @PGSilva oh I have my pager on my hip tonight too, as always in reply to PGSilva #
- Hmmm, not many people on the blogs today? The stats seem to be way down today. Hmmm, and I had a good post too. http://bit.ly/8RPlzs #
- @NeilMcD Oh, http://bit.ly/4of9tT Is that better? in reply to NeilMcD #
- @UKMedic999 yea! How rude on a holiday? Nobody's workin today, anyways in reply to UKMedic999 #
- http://bit.ly/4sMtlw – JEMS Article on POC testing. I've been wanting this in my ambulance for years now #
- I want to comment on this, but I don't know exactly how to word what it is I want to say. If you look at the discussio… http://disq.us/7sne3 #
- RT @Firegeezer @fossil_medic http://bit.ly/4Rmu0R FF's AIG Problem. Is this the opposite of what I'm talking about? @thehappymedic #
- RE: @thehappymedic Yep. EMS was indeed mentioned in the healthcare debate. I believe that one of the congressional aid… http://disq.us/7spiv #
- One full year of bloggery? Wow. Congratulations Mr. Mark! For this day, I'll give you a present:
- @mrs999 "Frumpydumples" that is all #
- #FCBLOG09 @ukmedic999 and @thehappymedic for being hugely entertaining and always revlevant to the cause #
- Love the pictures Mate
- #FCblog09 Http://roguemedic.blogspot.com – For being very research oriented, insightful, and way smarter than I @firecritic #
- #fcblog09 Http://tooldtowork.blogspot.com – 4 having a good political eye on EMS & not being afraid to point out a naked emperor @firecritic #
- @MsParamedic Awww thanks in reply to MsParamedic #
- Thanks @jemsconnect ! Your facebooking me has brought 3-5 hits per minute on my 3rd EMS Pay Sucks!! Piece. #
- @MsParamedic Why thank you again in reply to MsParamedic #
- #FBblogs09 @firedaily for the daily news and commentary that I get from him, and his high use of soc media, and his making fun @ my grammar #
- #FCblogs09 @firedaily for the daily news and commentary that I get from him, and his high use of soc media, and "whilst" @firecritic #
- #fcblogs09 @gfriese and http://www.everydayemstips.com – For great posts and useful EMS tips for the young professionals market @firecritic #
- #FCblogs09 @ambodriver – For being one funny-ass mofo. Gosh, that guy cracks me up most times. @firecritic #
- @DocMacaSTAT one day I'm gonna get there. in reply to DocMacaSTAT #
- @FireDaily Heh I always salt my words, just in case I have to eat them later (I think somone else said that, but I forget who) in reply to FireDaily #
- The boy got A LOT of nerf dart guns for xmas. Hehe do y'all have any idea just how much fun it is to terrorize my kittens w/em? #
- I'm a grown man (read: not mature) I should not be having THIS much fun with this thing.. Right?? http://tweetphoto.com/7703201 #
- RT @firedaily With Friends Like These….. – http://firedaily.com/2009/12/with-friends-like-these/ ^ Had to RT this one #
- @mrs999 @ukmedic999 Awwww… ask him if he wants to arm wrestle. #
- @Anna_n_Chicago @schoolgirl101 has been thinking of a Chicago EMS tweetup. I think that it's a great idea. Jan maybe? in reply to Anna_n_Chicago #
- @MsParamedic My wife could probably kick yer butt lol. She's got guns too. Heck, I'd say that she'd bead @ukmedic999 too… but that'd be in reply to MsParamedic #
- @Anna_n_Chicago Perhaps. Or we could do the Chicago #EMS tweetup in New Orleans @msparamedic @ambodriver in reply to Anna_n_Chicago #
- Was I complaining about traffic earlier? Just hit over 500 pg views 4 today, which for me @ this time of day on a holiday is pert good #
- @TheRoadDoctor We've got like 4 or em, ranging from highly acc powerful revolvers, to COD type semi-autos, to a batt-powered chain-fed auto in reply to TheRoadDoctor #
- @MsParamedic You should see @ginakaiser with a maul and a chainsaw in turnout gear. She's wonderful. in reply to MsParamedic #
- @UKMedic999 It's the opposite here, poor @ginakaiser 's um, got um… idiot pains?? hehehehe. You should ask her about it in reply to UKMedic999 #
- RT @UKMedic999: Battling through man flu at work to put up a final post for 2009 : http://bit.ly/4nasdp Happy New Year one and all! #
- There's a SpongeBob Marathon on today. OMG they just had the REAL LIFE Davy Jones on there. Y'know? From the Monkees? "Cheer up Sleepy Jean" #
- Writing "EMS Pay Sucks!! Let's DO something about it!" Part 4 – "A Call to Action" – I'm declaring the 2010's the "Best Decade Ever for EMS" #
- Huge response today. I don't think I can break 1000 page views… but with my Tweeps helping… could I? #
- RT @FireCritic: RT @FireFleitz: Top Ten Most Popular Posts This Year on Fire Critic http://bit.ly/7Ej27y ^RT'ing both of ya #
- Hey tweeps, think you can help me get 465 more page views in 7 hours today at Http://www.lifeunderthelights.com? I'd be your friend #
- @emtdani Thanks girl! If I can end 2009 up around 1000pg views for the day, I'll be pretty happy And you're right, you are my friend #
- RT @patrickjscott @ckemtp There. Quit your bitching ^Thanks bud! My best friend, everyone! What did @FireDaily say? "WIth Friends like these #
- @theHappyMedic DId you read the comment I put on @ukmedic999 's "blogoversary" post yet? I was not making that up. Sorry Bud #CoEMS in reply to theHappyMedic #
- #smile09 I nominate my wife @ginakaiser for the prettiest smile of 2009 #
- RT @firehat: RT: help me get 465 more page views in 7 hours today at http://bit.ly/8RPlzs? I'd be your friend (via @Ckemtp) ^thanks bud! #
- DId I put forth a bad link in my quest for 1000 pg views today to wrap up 2009? Sorry http://bit.ly/4of9tT – Thx 4 the help Tweeps! #
- @TheRoadDoctor I'm only @569 page views at http://bit.ly/4of9tT right now.. but it's climbing in reply to TheRoadDoctor #
- @theHappyMedic @mrsHM @mrs999 @ginakaiser @ukmedic999 I so wholeheartedly second that. Not the biased part. They won fair and square in reply to theHappyMedic #
- RT @EMTDani: My personal Anthem (2009) This years last post: http://medicdani.blogspot.com #
- @ukmedic999 @mrs999 HAPPY NEW YEAR!!! #
- It is SO ON!! http://tweetphoto.com/7716011 #
- I'm at 599 page view in my quest for 1000 at http://www.lifeunderthelights.com – anyone care to join the raging comments section? #
- #fcblog09 I nominate http://www.rescuingprovidence.com/blog and Lt Mike cuz of the good content and his great book @firecritic #
- RT @TherealJillK: My cousiin tweets alot. I don't. I guess I'm antisocial media. Happy New Year, though. ^ yes I do tweet a lot, thx #
- @FossilMedic Thank you my friend. Your name's getting mentioned in the next post along with 1 of my personal #newyearsresolutions in reply to FossilMedic #
- @UKMedic999 What? No! Wait! You can't say that about your wife!! Even if it *is* true. You just can't! Get them things back from her purse in reply to UKMedic999 #
- Big Thank you to everyone! Today has been (drum roll please) MY BIGGEST DAY EVER ON THE NEW URL. (the old site beat this) I'm @612pg views #
- @Boshbrand I'm doin this. Happy new years! http://tweetphoto.com/7732912 in reply to Boshbrand #
- RT @setla @UKMedic999 @theHappyMedic funny how things worked out this year. Very thankful to have met you guys! #CoEMS ^I can 2nd that w/U 2 #
- @Hemspara I'm just sitting here doing the happy dance! I'm so OFF tonight!! (working tomorrow though…) in reply to Hemspara #
- Dsn't look lke I'm gonna make 1000 page views today, but I'm at 649. Can I still make 1000? C'mon Tweeps! Http://www.lifeunderthelights.com #
- @Hemspara I'm on a beer run during a poker night waiting for the car to warm up Um… #ftw in reply to Hemspara #
- @Hemspara But trust me buddy, I feel your pain. I've worked EVERY holiday for the last umpteen years. This year's a fluke in reply to Hemspara #
- RT @tweetmeme FireGroundVideo.com Version 2.0 http://bit.ly/61tk0U #
- And any suggestions you can give on the blog would be awesome. I just guess and read things. Advice is always appreciated #
- RT @EastCoastEMT: Off we go! http://eastcoast-emt.blogspot.com/2009/12/off-we-go.html #
- RT @shell1972 2 all #ff's #ems #police #responders on shift 2night herez prayin that it's a quiet one and u all come home safe #egh *hugs* #
- @Boshbrand #ftw just beat it http://tweetphoto.com/7742842 in reply to Boshbrand #
- @EastCoastEMT anytime dear in reply to EastCoastEMT #
- RT @theHappyMedic: Let's make 2010 the year #EMS made the turn towards being accepted as a Profession. ^ coming up on a post tomorrow #
- @medic_bella Here's to sharin it witcha http://tweetphoto.com/7750921 in reply to medic_bella #
- Happy New Year to All! I am so glad I started a blog this year so I could be kinda with y'all @ginakaiser I lo http://tweetphoto.com/7753213 #
- RT @UKMedic999 @theHappyMedic Let's make 2010 the year #EMS made the turn twrds being accepted as a Profession ^w/you 2 guys, we can't fail #
- @Anna_n_Chicago same here!! Lol in reply to Anna_n_Chicago #
- I'm not on duty, but one agency's 1st call of 2010 was a polypharm and ETOH OD. Welcome Baby New Year!! #
- @patrickjscott ?? Yea chuck, do what PJ said! in reply to patrickjscott #
- If you follow ONE PERSON for 2010 follow @patrickjscott and @P_e_naylor – my best friends in the world along with my wife @ginakaiser #
- #Twinking to start out 2010 – stopped drinking an hour ago to be a good boy #
- Well, I did 700 page views on my quest for 1000. The quest for 1000 begins again today thanks tweeps! Happy new year! #
- RT @gfriese: @Ckemtp thanks for the #FCBLOG09 nomination ^ no problem bud, you deserve it #
- RT @insomniacmedic Writer's block finally unblocked! Happy New Year to 1 and all http://insomniacmedic.blogspot.com/2010/01/resolutions.html #
- RT @medicTHREE: When you get so drunk you shit yourself, you've crossed the line. Just saying. ^Happy 2010. We needed to add that. I helped #
- Apparently 2010 is running low on degrees. We started negative one, and now we've only got 3. #frozen #
- RT @gfriese: Took a few minutes to review #EMS 2009 LODD list. Let's make this list shorter in 2010. ^ I 2nd that #
- RT @LaughItUp: Happy 2001 to all dyslexics! ^ love it #
- @mack505 Thanks buddy. I think I topped 700 though. Not a bad way to end 2009 in reply to mack505 #
- RT @theHappyMedic: New blog post: You Make the Call…Chili Cookoff http://happymedic.com/2010/01/01/you-make-the-call-chili-cookoff/ #
- #fcblog09 have y'all nominated your fav fire/ems blogs for @firecritic and his top #fire #ems blog for 09 contest yet?? #
- And so it begins http://tweetphoto.com/7782605 #
- @insomniacmedic I did it once on the old page when I hosted #TheHandover, actually I beat 1000 views with over 700 visits. That day in reply to insomniacmedic #
- @mack505: @insomniacmedic I hafta drive my wife crazy to get it that way tho #
- RT @GetEMSJobs: EMS Coordinator – Oakland, CA (http://tinyurl.com/yawoj7t) Get EMS Jobs #EMS #94601 #jobs ^@thehappymedic should I apply? #
- RT @STATter911 View the 20 most popular stories for 2009. Happy New Year to all. http://tinyurl.com/ydog4fh #fire #firefighter #firefighting #
- RT @patrickjscott I told my wife we should see if 2010 sex was like 2009 sex. She laughed & walked away. Guess it's similar. Happy new year! #
- RT @patrickjscott: RT @velosportiowa: Only 22 days until our race! Is everybody ready? Check the site @ http://www.velosportiowa.com #
- @geekymedic Depending where you are in CO, you may feel my pain in reply to geekymedic #
- RE: @AmboDriver Ambo, you've got the distinct honor of having written the funniest thing I've read all year. #HTFU I l… http://disq.us/7um31 #
- RT @FireDaily: Firefighter dies during training: by Charles S. Williams A 24-year-old Millers Creek man, who was.. http://bit.ly/8vSUkl #
- @TheRoadDoctor Love it Love it Love it. Ha! it's bonechillingly cold here, with like -13 on tap for tonight… but not much snow coming in reply to TheRoadDoctor #
- @TheRoadDoctor Lucky!! I love snow days like that. That, and they're usually much warmer than today is too in reply to TheRoadDoctor #
- @FireDaily I did 700pg views. Ok 698… But that's fair rounding in reply to FireDaily #
- @FireCritic I have 4 coworkers on shift with me right now.. Same feeling in reply to FireCritic #
- @FireDaily @firecritic I want to help do my part to promote http://bit.ly/8jIcYK @ffnetcast #
- @FireCritic Oh, they know how I feel They feel the same way about me. We're cooking steaks & trying 2 avoid any 1 who's sick &/or injured in reply to FireCritic #
- RT @FireDaily: RT @FireCritic
Test live podcast now… http://bit.ly/8mCiqk join us!!! ^ I'm listening right now #
- @FireDaily I'm listening right now, sitting in the crew quarters near people. So I'm just listening right now in reply to FireDaily #
- RT @FireDaily: @ckemtp Test live podcast now… http://bit.ly/8mCiqk join us!!! @ginakaiser should listen, and y'all should too #
- RT @ssgjbroyles: @Ckemtp @FireDaily same here…except competing with TV and kids ^honestly that's what I'm doing, just at work #
- @ffnetcast (888)887-8718?? @firecritic @firedaily #
- @FireDaily I'm working on the signing in thing for the blogtalkradio.com site in reply to FireDaily #
- @FireDaily Can I get on by clicking the "click to talk" button on the site?? What's that site again? It's http://bit.ly/8mCiqk in reply to FireDaily #
- @FireDaily I'm trying the "click to talk button" It's giving me issues that I'm working on in reply to FireDaily #
- @ellenrossano Nice to "meet" you as well. in reply to ellenrossano #
- @firedaily @firecritic Good job guys, y'all sounded great. I'm adding a link to http://www.FireFighterNetCast.com on my site now #
- @captmac184 Howdy buddy, thanks for the follow #
- @CaptMAC184 On your time line you sent me an @ that I didn't get. I'm Ckemtp – ya had a typo. It happens in reply to CaptMAC184 #
- RT @FireCritic: @ssgjbroyles @shell1972 @TheRoadDoctor @ellenrossano @eng56ine @EngineMedic Thanks for having us @FFNetcast Twas great! #
- @eng56ine Thanks for the follow #
- Hey Bloggers out there: Is my blogroll link to you correct? Is your link to mine correct? I'm turning an eye to it right now #
- RT @EMTDani: @Ckemtp I'm at http://medicdani.blogspot.com ! ^that should get an RT #
- RT @FireRecruiter: REVIEW: 10 Step Guide to Volunteering: http://wp.me/pIG05-3b ^ Oh I am SO #FF this guy #
- @911Brent Sure, I'll be your friend. Can I borrow 5 bux? in reply to 911Brent #
- RT @NJGhostDiva911: It's officially my birthday! Time to jump off the wagon and into a river of Vodka Sours!! ♡ ^ #happybirthday !! #
- @911Brent But I'm one of your tweeps, that's different in reply to 911Brent #
- @NJGhostDiva911 in reply to NJGhostDiva911 #
- RT @myrtlife #FF EMTweeps tht inspre @MsParamedic @EMTDani @setla @UKMedic999 @NJGhostDiva911 @Ckemtp @thehappymedic @scottthemedic @medic61 #
- @jedifire11 Yes. It does not. Don't fall into the trap of discounting it. it's not as fun, but a patient is a patient is a person needing us in reply to jedifire11 #
- @jedifire11 I know how you feel. Trust me, I've been there buddy. Remember, we're here to take care of people who need us, not our egos in reply to jedifire11 #
- http://bit.ly/6qvgqY – Please folks, just click on this Google search I found on my statcounter… I *uber* LOL'd… hard #
- RT @ckemtp Paying My Pennance – Life Under the Lights http://retwt.me/18XXs #
- @jedifire11 I push a ton of drugs and have a lot of scary situations w/the interfacility stuff I do. Most are tame, some are pretty critical in reply to jedifire11 #
- @gfriese @stevewhitehead Just got my draft up for the post we're doing on the 5th. Wow, that was emotional to write. #
- @EngineMedic That last one I tweeted?? lol that was about a month old..but is the 4th google search result to "weirdbondage.com" I found out in reply to EngineMedic #
- @EngineMedic And just for the record, I found that through my blog statcounter site's google results page I didn't search for it myself in reply to EngineMedic #
- @EngineMedic Yep. I need a better way to reference old posts. That only got a few hundred reads. in reply to EngineMedic #
- @jedifire11 There is no such thing as "just an EMT" or "just a basic". The patient would have died without you doing what you do. Honestly in reply to jedifire11 #
- @EngineMedic Well, we do have posey restraints and spider straps in reply to EngineMedic #
- @EngineMedic I'm headed to the rack for the night. Check out the latest post and let me know if you get any new followers please in reply to EngineMedic #
- night tweeps. It's -something degrees outside. Here is my sincere hope that nobody has to be out in it. #
- RT @STATter911: Boy Scout Fire Explorer's hospitalization brings probe of role on fireground. http://tinyurl.com/ydu9tdr #fire #firefighting #
- Good morning! It's -2deg. I don't wanna get up! #
- @Chrismedic You know it's -14 with windchill in reply to Chrismedic #
- Hey, any southern and/or tropical medics looking to do a medic exchange for a few weeks? You could come here and learn to treat hypothermia #
- @ChadFord OMG! Just remembered Ima medic in Costa Rica. Wonder if #CoEMS would send me there to do a show @setla @thehappymedic @ukmedic999 in reply to ChadFord #
- @rescue_monkey It's *ahem* "ass cold" here – Sorry for the profanity, but there's no other way to describe it in reply to rescue_monkey #
- @rescue_monkey it warmed a bit with the sun, thankfully. 0 I can deal with.. Under that sux http://tweetphoto.com/7858727 #
- RT @gemlala: RT @Marie_Ang: Not failure, but low aim, is the crime. In great attempts it is glorious even to fail – Bruce Lee #quote #
- @gfriese The combo of low friction and high gravity makes for interesting shifts in reply to gfriese #
- @TheRoadDoctor I am sending karma in your general direction in reply to TheRoadDoctor #
- @TravelMedico THAT's what I should do!! Move someplace warm! in reply to TravelMedico #
- RT @theHappyMedic: My day by day account of the 2nd leg of #CoEMS begins http://happymedic.com/2010/01/01/my-first-day-in-newcastle/ #
- RT @Anna_n_Chicago: Awesome article written by Carol Marin about present day politics on the SW Side of Chicago: http://tinyurl.com/yf9lezc #
- Oh man… I think I'm gonna have to get angry and cause blog trouble today. The question is… Should I stir up the pot or not? #
- @TheRoadDoctor @thehappymedic Therez a fight brewing over the EMS in Peru, IL 1hr 'ish S of me. Not mad @the fight, just @the arguments used in reply to TheRoadDoctor #
- @theHappyMedic Um… Angry stirring Sir…. in reply to theHappyMedic #
- @theHappyMedic I'm havin lunch with the fam. I'm afraid ya gotta fire up google in reply to theHappyMedic #
- RT @NorthwestFire: In San Francisco, it’s illegal to wipe a vehicle with used underwear http://bit.ly/5XcCIx ^@thehappymedic see? Told ya #
- RT @CalFireNews Bad tooth @apollosfyre ? Well that's @Swellyn badly…Maybe the @theHappyMedic could get you into the @EMSWeek.. ^ um, what? #
- @TheRoadDoctor NOW you understand. Ask me one time privately what happened once when I did this. @thehappymedic knows in reply to TheRoadDoctor #
- RT @TonyOlivero: It's quite bloody windy again today. ^ oh yea?? Well, is your temp over the single digits?? Huh!? Is it!? #
- @DocMacaSTAT was she a blonde or a brunette? in reply to DocMacaSTAT #
- @theHappyMedic @theroaddoctor I am for #EMS based #EMS. None of the other systems garner my favor in reply to theHappyMedic #
- @TravelMedico I love weird laws, although that's probably a very well thought out one.. Maybe in reply to TravelMedico #
- @Firedog627 well, here in northern I'll it's colder than that.. So in reply to Firedog627 #
- @ssgjbroyles Yea, I went down and rode with AMT a few years back. It was…. interesting? Their front office is really well ran…. in reply to ssgjbroyles #
- Attention EMS Tweeps: I am "NOT" condoning that you go to http://bit.ly/6FP6Hm and "help" the "discussion" or the "angry yelling" on there #
- @Pheenyxfyre @thehappymedic CA FBased EMS is effed up?? Man do I gotta get offa this topic today in reply to Pheenyxfyre #
- @TheRoadDoctor I cannot condone stirring up a small town's EMS woes… It *might* be wildly entertaining… but I cannot condone it in reply to TheRoadDoctor #
- I've no connection w/the agency being spoken of @ this link http://bit.ly/8lRaWc – I don't know ne1 there. It *is* an int. look tho #
- @ssgjbroyles I have my thoughts on Peoria area EMS… but I can't boil down that local. I'm already going too far with Peru in reply to ssgjbroyles #
- @Firedog627 Here I sit warm on my couch playing checkers and tweetin' with the boy No ladders for me today. Unless the pager goes off in reply to Firedog627 #
- @thehappymedic Are you online right now? #
- @theHappyMedic I was just passing along a tweet. Nothing more. I'm sure you have Very Good EMS and some less than stellar, just like here in reply to theHappyMedic #
- @thehappymedic Just sentcha an e-mail so you can help keep me from doing something stupid.. Fun, but stupid #
- @TheRoadDoctor @thehappymedic Reasoned and thorough research into and debate of the issues with an eye towards moving past the petty #
- I'll be a bad tweeter for the resta the day. Headin out for kidless fun with @ginakaiser . Thanks Nana #
- @TheRoadDoctor you can do it buddy, just remember to keep an open mind in this debate. Lord knows there's already a lotta closed ones in reply to TheRoadDoctor #
- RT @RescueResponse: New Blog Post: An Important New Tool for Professional Rope Rescuers.http://bit.ly/4FCr02 #
- RT @FireDaily Vote early and Vote often-Who is the best Fire EMS Blogger of 2009? http://bit.ly/7yyv2u ^yer around Chicago, right? #FCBLOG09 #
- RT @Epi_Junky: http://twitpic.com/wegch – RIP Big Red. Gone before we had a chance to mock you completely. @cupdike #
- Sitting at a fancy suburban Chicago bar. A real upscale place. What'll I have? http://tweetphoto.com/7884958 #
- RT @lola_snow: OK, next glass. I wish they made pills which got you drunk, would be so much less effort! ^but nowhere near as fun! #
- RT @FireDaily: @ckempttp Not interesting in entering the fray Got my own issues Like who left the toilet seat down again? ^it's @ckemtp #
- Ok folks, please disregard me if I am to start twinking tonight #
- Anybody know if there's a condition where a person's blood sugar would not rise with 2 amps o' D50 and a dose of glcucagon other than a code #
- Dunno, got this question via text and was lookin for a smarter answer to give other that "um, equipment malfunction?" #
- @gfriese uhhhhhhhhhhh… No? Of course not?? in reply to gfriese #
- @tbernemtp hmmm, well hmmm. Ok, that makes sense @docmacastat help? in reply to tbernemtp #
- @tbernemtp @docmacastat hmmm, sound plausible in reply to tbernemtp #
- This came as a question via text. I dunno all the circumstances. Great answers tho #
- @DocMacaSTAT us medics are askin about hypoglycemia refractory to 2 amps o' D50 and 1mg of glucagon in reply to DocMacaSTAT #
- Did everybody hear @docmacastat 's explanation of the refractory hypoglycemia? If not, follow the guy #
- RT @ssgjbroyles: In San Fran, it’s illegal to wipe a vehicle with used undies & 2 pile horse manure more than 6' high on any street corner. #
- RT @EastCoastEMT: In Remembrance… http://eastcoast-emt.blogspot.com/2010/01/in-rememberance.html We'll miss you, Greg. #
- RT @STATter911: If you missed Dave's top 20 for 2009 click here. http://tinyurl.com/ydog4fh #fire #firefighter #firefighting #
- @DocMacaSTAT anytime bud, always happy to help hook a cheesehead up. Thanks for not minding the request for your expertise in reply to DocMacaSTAT #
- RT @theHappyMedic: http://the-public-servant.blogspot.com/2010/01/real-ems-job.html I've had this conversation, like, a billiondy times. #
- RT @FireDaily: Vote early and Vote often- Who is the best Fire EMS Blogger of 2009? http://bit.ly/7yyv2u #fire #firefighter #FCBLOG09 #
- @EMSWeek so what are the plans for EMS week 2010? in reply to EMSWeek #
- @helmetdude Hehe. Been there buddy the life of a dedicated volunteer FF. I wouldn't trade it for anything, ever in reply to helmetdude #
- @grindermedic Uman what does FML mean? in reply to grindermedic #
- Tomorrow I've got an audience participation exercise in #EMS2 check the blog after 10a CST and then help us out. #
- G'morning! Twas a good boy last night & got to watch lots of people have fun whilst keeping caffinated and well-hydrated. Bar coffee? Ewww #
- Does anybody know if it is possible to send cheap international SMS texts? #
- RT @vanand98: People are more violently opposed to fur than leather because it's safer to harass rich women than motorcycle gangs. -? #quote #
- @pgsilva @jodfie @enginemedic No, I'm a crackberry guy. My network's got no Iphonez. NE way 4a Cberry? I want 2 be able 2 bother @ukmedic999 #
- RT @mifireservice @inspector911 http://twitpic.com/wiuqv -This's where yer tree shd be right now! ^Ok done. But the plastic will get brittle #
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When I was looking through my statcounter results tonight I LOL’d… hard.
Apparently THIS POST comes up when one chances to type in “wierdbondage.com” into our friend Google.
Since I haven’t quite finished my latest post on the fact that EMS pay sucks, I figured I’d give the post a rerun. Enjoy. It’s a funny one according to my Tweep @enginemedic