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A Slap in the Face for Medics? How about a Wake-up call

20 comments

Thank you everyone! Yesterday when I posted “A Slap in the Face to Paramedics Everywhere?” I recorded my biggest traffic day ever by at least one thousand visitors. I’m honored. Thank you for coming and reading this and thank you for caring about EMS. Especially, thank you those who left such intelligent comments and added to the debate. We who care about our profession need people who are passionate, intelligent, and who are ready to work alongside of us to improve who we are and what we do. By participating here and in the wider EMS blogosphere, you’re helping spread the ideas that we need to spread. Read, Talk, Learn, and Think. Make this the profession you want it to be.

I’m going to repeat that above statement: “Make this the profession you want it to be”

And there lies the true meaning of what I wrote yesterday. Sure, I was mad about the perceived encroachment by nurses onto our professional “turf”, and sure I played my anger up into what I thought would be something to fire you up as well, but there was a message there that not everyone may have gotten.

I know that there are good nurses out there that know a lot about a lot of stuff. A lot of them do a great job in the field within their scope and their experience in such things as neonatology, pediatrics, and critical care has proven invaluable to me on a lot of occasions. Yes, like each and every medic out there I can speak volumes about the times I’ve seen and worked with nurses who seem to be lacking vital chromosomes, but I’ve seen members of every profession that seem to have written their final exams in crayon. It’s no different when I am staffed alongside an idiot partner of the EMT persuasion… give me a smart nurse in their place any day.

However, my beef is this: Why is it necessary that a nurse need ever step into the field? The times I’ve had to carry one in the back of my rig have been mainly because of protocol deficiencies, where the EMS system I was working in at the time didn’t allow me to transport a specialized piece of equipment that was attached to a patient or to administer medications that were beyond the normal scope of the field. Now days, my EMS system allows me to transport pretty much anything and I’ve personally taken the steps to educate myself on the less-common things that I see. However, I’ve grabbed a nurse on occasion when called to transport multiple uncommon medications along with unfamiliar equipment. I’ve never been too proud to ask for help when I wasn’t fully confident in my abilities to fully handle possible eventualities with the patient. It’s not about my ego, it’s about patient care. I live by that motto. However there is no reason, in my opinion, that a paramedic cannot take the education necessary to become experts in any and every aspect of out-of-hospital care. It’s our bread and butter and the thought that our skills are lacking causes me concern. Whatever you call it: inter-hospital, pre-hospital, field, or other care… Paramedics are supposed to be the experts at that in my opinion and I want us to take the steps to ensure that we are so.

If you were angered by the actions of this ambulance service plastering their truck with the phrase “Staffed by Nurses”, that’s good. You should have been. Be angry at the management of that service for existing in a system that they haven’t changed for the better so that they don’t have to use nurses for things that paramedics should be doing. Be angry at their EMS system and their state for limiting their paramedics’ scope of practice and education so that they cannot be used to adequately staff the truck. Then, be angry at each and every one of us for not taking the ownership of our profession so that we can step up and dictate what is best for the patient’s we serve.

Is that petty “turf preservation”? Maybe. However we need some of that. For us to have pride in our profession we need to take the steps necessary to own what we are supposed to own. If we can see our profession lacking the necessary educational background, skills, or just plain old gumption to fix a problem, then we have to band together to do the work needed to fix it. The fact that this service and this system are thinking that having and advertising a “special” truck, “Staffed by Nurses” is a good idea is representative of a bigger problem, and that bigger problem must be handled by our people stepping up and handling our deficiencies so that we can solve the problem. We must improve the education, improve our skills, and improve our public perception so that people trust us beyond just the feel-good perception we have as “life saving” “ambulance drivers”.

You’ve heard me, Justin “the Happy Medic” Schorr, Mark “Medic999” Glencorse, and many, many others talking about EMS 2.0 over the last year. Well, this is part of it. My version of EMS 2.0 involves us paramedics taking ownership of problems like these and taking the necessary collaborative steps to fix them. We have to do just that if we want to advance. Now is the time for us to analyze the problems, dissolve the political boundaries, do the necessary work, and collectively grow up as a profession.

And fixing management philosophies that view us as contemptible morons is first.

One last comment, I got a link in a fascinating article by the Nursing Show ran by my buddy Jamie Davis. You should read it, it’s a good way to see how the nurses take this.

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Also, for more of my thoughts on the state of EMS in the State of Illinois, check out “Dear Illinois EMS”

Posted by on April 26, 2010 • Filed under: Administration & Leadership, ckemtp, ckemtp rants, Command & Leadership, Emergency Medical Services, Emergency Nurse, EMS, ems 2.0, ems education, EMS Management, EMS pep talk, EMS rant, EMS system, EMS Topics, Paramedic, paramedic education, politics, potential, pride, profession, professionalism, Training & Development

A Slap in the Face to Paramedics Everywhere?

90 comments

As some of you probably know, last weekend I went to the Fire Department Instructors’ Conference (FDIC) in Indianapolis, IN and I spent a great deal of time wandering the convention floor, looking at cool things and talking to cool people. There were plenty of great things to see and great new things to learn about and I immersed myself in doing just that. One of the things I’m always interested in is looking at the new trends in ambulance design and the manufacturers always have their coolest new vehicles on display to feed my interest. However, while walking the conference floor, I came across an ambulance that did more to tick me off than it did to promote their new vehicle design. Seriously, it was like someone slapped me in the face. Here’s the picture I took from my phone:

 Ambulance Staffed by RNs

Does anybody see anything wrong with that picture? I was immediately ticked off…  I’m talking a level 7 hissy fit. I was livid for quite a while and if you follow my twitter feed, you probably saw the three or four times I TwitPic’d it.

I mean really? They had to put “Staffed By Nurses” in six inch high script on three sides of this thing?

I blocked out the name of the service that runs the ambulance and in all fairness to the manufacturer, this truck is awesome. I would be quite happy to work in this truck although being that it has no bench seat, its usefulness as a 911 truck is hampered by its inability to carry more than one patient at a time. However, I would flatly refuse to work in this truck or for the ambulance service that puts it on the street. I happen to know the service that bought it and I’m trying to avoid naming them directly, but they serve a midsize city in Illinois.

Before you go all West Side Story, whip out your switch blade and zip gun, and prepare to have a dance fight with the nurses out there, realize that I’m not mad at them. Sure, mostly they’re well-paid and have climate controlled jobs inside of well-lit buildings, but they didn’t do this to us. My beef is with the management of this particular ambulance service.

So, let’s say that you’re the manager of this particular ambulance service. Obviously, sitting there in your office you must think that your paramedics and EMTs are contemptible morons who live simply to cause you problems. Furthering your view of the world, you probably think that the rest of the medical profession and the members of the general public in your area view them the same way and simply don’t trust them to provide medical care when it’s like *really* complicated and stuff. You probably feel that everyone would feel safer knowing that their patient or loved one is traveling via the companionship of “nurses” whom you must view as actually being like actually *Competent* and stuff.  

And that’s what this rolling billboard to your contempt of your employees and their profession says about you. It’s a slap in the face to the good men and women you have working for you and there is flatly no excuse for it.

Here’s a tip, anonymous ambulance manager person (AAMP). There isn’t a need to have your precious ambulance be “staffed by nurses” when you have sufficiently equipped and prepared paramedics working in it. Paramedics are acute care specialists. We’re also experts in mobile medicine. Our education, training, and experience prepare us for the unique environment that we create when we move patients from one place to another. Critical Care Paramedics have the intensive Care experience, training, and background needed to operate in a critical care ambulance environment, nurses do not. Sure, ICU and ER nurses are great at Critical Care. However you shouldn’t regularly staff a critical care nurse in the transport environment for the same reasons that you wouldn’t put a critical care paramedic inside of the ICU. The professions are like in a lot of ways, but they’re separate for a good reason.

And you, AAMP, don’t respect that. Perhaps it’s because you’re burnt out. Perhaps it’s because you’ve beaten the system you’ve created into such a pulp that nobody wanted to staff your new Critical Care Truck. Perhaps it’s because of a lot of reasons, but it’s certainly not because you wanted the best in patient care or to show that your employees are capable of operating your shiny new “special” ambulance. No, you wanted “nurses” to “staff” that truck… and not only did you want the medical people you’re contracting with to know this, you wanted everyone who saw the truck to know it as the 6 inch high letters stating that fact clearly show. Do you think that the public views your crews as incompetent? If so, do you think that furthering the notion by advertising that your “special” truck is “staffed by nurses” will help that situation?

If your protocols are so draconian that even critical care certified paramedics cannot be allowed to staff that truck, then your protocol system is in the Stone Age. If your educational system isn’t up to the challenge of preparing your most experienced medics to staff it, then fix that problem. I know that there are great medic/nurse combos out there and I know that flight nurses have garnered quite a bit of respect out there in the world… and heck, I’m not knocking them for doing it. However, this is the time for Paramedics to step up and claim our turf. This ambulance clinched it for me. AAMP, your shortsightedness has caused me to lead a revolution of sorts here. You’re contempt for your staff has indicated to me that now is the time for paramedics and EMTs, such as the ones that work for you, to stand up and start claiming what is rightfully ours. Frankly, AAMP, your ambulance and your attitude is ridiculous and thinking like that must be stamped out right now by the good medics among us.

And I should also say this to the nurses in the audience before you start skewering me for knocking you: Have you looked at the debates in your circles concerning the use of paramedics in the ER and in other hospital units? Have you ever seen the term “Unlicensed Assistive Personnel”? Well I have, and it’s what the upper nursing echelon calls me and my professional colleagues.  It’s offensive, but hey… our jobs are different. You have the hospitals and the fixed facilities. That’s what you do. We have the field. It’s what we do. There’s a line, respect it. If you want to do EMS, go through a real paramedic program. If we want to do nursing, we should go to nursing school. Really, it’s that simple. The transport environment is difficult and requires the use of specialized personnel… which we have, they’re called paramedics. The medical care we provide is close to the care that you provide, except we have autonomy that you do not and we are use to working independently in the environment in which we operate. Your focus is different than mine.  You may be the best transport nurse out there, but even though you personally may be awesome, my profession needs to have people as awesome as you working on our side. That’s what this is about, not to knock your transport nursing skills, but to kick us paramedics in the shorts and get us to step up and maintain ownership of what we should own.

The responses I got back on Twitter show me that there are a lot of like minded individuals out there. Perhaps some of them might work for you, AAMP. You better take that into consideration because if I have my way the paramedics are going to get the notion that we’re not just a bunch of contemptible morons and we’re soon going to take control of our own profession. On that day, managers like you will be obsolete. Perhaps you can get a job managing nurses.

Here is my personal ‘thumbs down’ for the graffiti against my profession that you had someone slather on your shiny new truck, AAMP. My advice? Take it off and reconsider your staffing patterns. What you’re doing is bad for my profession. It affects me negatively, it affects my profession negatively, and it shall not go unanswered.

What do you think?

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Be sure to check out the follow-up to this post “A Slap in the Face? How about a Wake-Up Call?”

Also, for more of my thoughts on the state of EMS in the State of Illinois, check out “Dear Illinois EMS”

Posted by on April 26, 2010 • Filed under: 911 fail, Administration & Leadership, Ambulance, Ambulance Driver, ckemtp rants, Command & Leadership, Emergency Medical Services, Emergency Nurse, EMS, ems 2.0, EMS Management, EMS Motivation, EMS rant, EMS Topics, EMS training, Paramedic, paramedic education, politics, potential, pride, profession, professionalism, Scope of Practice, Vehicle Operation & Ambulances

Ckemtp goes to FDIC – 2010

3 comments

So last weekend I went to the Fire Department Instructor’s Conference (FDIC) in Indianapolis, IN and just had me a bona fide blast. What a good time. I met so many new people, spoke with some amazing personalities, kissed a Canadian (Hey! So did Happy! It was not intentional! We were ambushed!) (and also got kissed by a well known male fire blogger who shall remain anonymous… creepy but anonymous), and learned so much about what it is we all are trying to do here. It was amazing.

First off, I didn’t get to take any classes. Our handlers here at the www.FireEMSblogs.com network were extremely nice to provide me with a free pass to the convention center floor and expo. I would have loved to have learned from the excellent fire service leaders that were teaching there, but my finances didn’t allow me to. Nonetheless, I learned a great deal by just walking around and talking to new people. I met hundreds of new faces, saw some of my blogger buddies, and had a great time. I consider the time I spent talking to the passionate people I met and hung out with to be some of the most valuable time I could have spent. If one wants to be passionate and positive, it is always a good policy to spend time with people who are passionate and positive. I needed a boost and I got it by going to this conference. Big thanks to Dave Iaonne (@coolDaveJ), Chris Hebert (@CHebert13), and Bill Carey http://www.twitter.com/ffbehavior from the www.FireEMSblogs.com network for getting me the pass and setting up an awesome event. It just plain rocked.

Speaking of the event, we held the FireEMSBlogs.com Meetup at the Rock Bottom Brewery in beautiful Down Town Indianapolis, IN. I had me a few of their famous Rescue Captain Ales and hung out with a great group of cool people. I’m sure that I’ll miss some, so please leave me a comment if I missed you and I’ll add ya, but here’s a list of some of the people I hung out with:

Justin “The Happy Medic” Schorr

Rhett “Fire Critic” Fleitz

John “Fire Daily” Mitchell

Tiger “Yes, that’s the name he really uses” Schmittendorf

Art “Chief Reason” (last name redacted because I can’t remember it… Sorry Chief)

April “Epi Junky” Saling

John “Not Trained but We Try Hard” Smith (@firecap5 – Anonymous Blogger)

Christopher “Command Safety” Naum

Mike “Fossilmedic” Ward

Shelly “@Shell1972” Wilcoxen

@KentOKC

@Fire_Captain

I’d also like to thank the people I met from EMS Magazine and from Fire Rescue Magazine as well as from www.EMS1.com. I look forward to working with you all and I’m excited about what we discussed. 

Look for lots of posts coming up about what was discussed and what I saw at the conference.  I’m refreshed, motivated, and ready to kick some EMS 2.0 butt in the coming weeks. There’s a LOT of heavy lifting ahead, and I’m rolling up my sleeves. If you ever have a chance to go to a Big National Conference, you need to do so. I’m going to EMS Expo in Dallas next, and I hope to see you all there. I am sure there’ll be a meetup there and you should 100% go, that’s an order.

Oh, and while at that conference, if The Happy Medic asks you to sit shotgun in your car to navigate you anywhere, make sure your tank is full of gas and that you have a pillow handy for him to drool into. Good thing the guy’s not an Engineer. :)

Posted by on April 25, 2010 • Filed under: EMS Topics, Fire Rescue Topics

Foot-in-Mouth-Itis. Stupid Things We Say in EMS

21 comments

A letter I received from a reader who states that she is a paramedic student has gotten me thinking. I’m going to include her letter in this post with her permission, but before I do I would like to speak a little bit about things that we say to patients. EMS and all of emergency medicine tends to be full of emotionally charged situations being handled by emotionally drained people. Sometimes our experience in dealing with situations that lay people find to be traumatic can lend itself to our making comments that we find perfectly acceptable to make at the time we make them, and yet upon reflection seem like the wrong thing to have said. I can’t tell you just how many times I’ve been in trouble for my mouth. I will say something that I intend to relieve the tension of a situation and to provide comic relief that I think is cute and funny, completely thinking that it is above-board and not-offensive to anyone, and then find out that some wet-blanket took offense.

Honestly, I make it my policy never to make a dirty joke. All of my “patient friendly jokes” are clean enough to tell to my five-year-old with nary an off-color word or adult reference in sight and sometimes still people look at me like I’ve dropped a live weasel in the ball-pit at the McDonald’s Play Land. Like some random time ago where a patient who had overdosed, scratched her wrists with a dull knife, and was found trying to hang herself apologized to me during my assessment of her because she hadn’t shaved her legs. I said “Oh that’s quite alright, Ma’am.. You weren’t planning on needing them anymore and besides, you shaved your wrists real nice”. I believe the question I got from my partner after the call was “Does your Brain-Mouth filter even work anymore?!” He was laughing as he said it, so obviously it was funny. The patient laughed too.

I have stock comments to the common questions and situations that come up on calls that I trot out when needed to liven up the situation. Some are movie quotes, some are lines that I’ve stolen from other providers, and some are straight up from my strange brain. Like when I find someone lying in bed that needs to be lifted over from the bed to the cot with a sheet and a couple of people. Some beds are way too wide for me to work from my feet and it’s often useful to crawl right in bed alongside the patient to lift them over. I ask them “So when was the last time you had a strange man in your bed?” The unconscious ones almost always laugh. I have yet to have an older lady blush and be embarrassed and the comments I get back are always entertaining. Also, when I’m palpating an area of a patient’s body to see where they’re hurting such as for an injured extremity or the like, if the patient yelps out in pain when I touch something I excitedly declare “Found it!!” It’s much to their relief to know that I know where it is that they hurt. I also have what I call the “Poor Man’s X-Ray”. If someone thinks that something’s broken on their body, I grab it, give it a good squeeze and a shake, and ask them if it hurts. If they say “Yea that hurts” it’s probably not fractured. If they say “YEeeeeEEaaargh!!!” it probably is.  

So, exactly how serious do you think I’m being with all of that above there? Here’s the test. If you took me serious enough that you want to call my medical director to tell him to pull my license… I was joking!! Ha Ha!

I remember probably the worst thing that I’ve ever said to a patient ever, and in all seriousness I still feel bad about this comment to this day. Early on in my career I worked as a Security Guard *slash* EMT at a big regional 400 bed hospital/trauma center/psyche center/everything center. Usually I worked alone on weekend nights and it was an absolute zoo. While this was one of the most enjoyable jobs I’ve ever held, I was in way over my head for an eighteen year-old country boy working in the big city. One day we had a patient come in who had been witnessed swallowing baggies full of what was presumed to be crack cocaine during a traffic stop. He was belligerent as all heck, swearing at us and trying to swing at the police officers who brought him in, the nurses, and myself. He looked at me and said “So what the (colorful word) is going to happen to me now you (something my mother would be unhappy with me if I typed on my blog, or even thought about for that matter)” I asked him “So, are you a religious man?” To which he replied “Blankety-Blank No!! You Blankety Blankin Blank blank!” I said back to him “Well you probably should be, because you’ll need to be saying some prayers”. Then he seized and went into V-Fib. I have no idea if he survived. I honestly feel really, really bad about that. I wish I hadn’t have said it.

So when you read this letter, go easy on the paramedic student who sent it in. She seems to feel pretty bad about saying what she said and since I’m going easy on her, you probably should too.

Here it is:

I did something colossally stupid today.   Something so… irresponsible and cocky that I truly can’t believe I allowed it to happen.

I allowed myself… to assume.

To assume that as a paramedic student I knew enough about a patient’s condition that I could safely make a statement to a family member, when in reality, I should have just kept my mouth shut.

It was careless. It was reckless, and it resulted in a family being given false hope.

He was brought into the ER by two of his daughters for a syncopal episode. He hadn’t been feeling well for a few days, and his daughters had been forcing him to eat. When they found him on the floor next to his bed writhing in pain, they loaded him up and drove him over to the local ER.

His VS upon arrival were… less than ideal. Hypoglycemic, hypothermic, hypotensive.   He had the hypo’s covered. His coloring was even less impressive than his vitals. A few amps of D50 and some warm blankets later and we had 2/3′s of the hypo’s resolved. He was no longer altered, he was flirting with the nurses, and the color had improved.

Still, his BP was crap. His tank was dry. He needed fluids, and after his third liter bag, his BP in the 60′s started to creep it’s way towards 70 and 75. I did a happy dance in my head.

Then it happened.

I was removing some of his blankets and replacing them with some that were straight from the warmer when daughter number 3 asked me a question. “His blood pressure is still so low, should we be worried?” Me. The only one in the room with them that had any medical experience.

Five sets of eyes were on me in an instant.

I finished tucking a piping hot blanket in and casually said something to the effect of, “His BP is coming up, he’s just a bit dehydrated. One more bag and I’d be willing to bet that his pressure is better than mine.”

Ugh. How could I let myself say something like that?

I didn’t know that he had a fractured hip.
I didn’t know he was in kidney failure.
I didn’t know he had a leaking AAA.

I didn’t know the complete picture, and I should have just kept my mouth shut.

I guess it goes without saying, but his blood pressure never came up. It dropped, and it dropped again, and it dropped again.

The family was informed of the complete picture. A DNR was signed. Hospice was called. He died before he could even make it to the inpatient hospice facility.

A family was given hope, because I gave it to them. And I had no right to do that. Watching them emerge from a family consultation room, one by one with blood shot eyes, holding each other when just two hours earlier they had been laughing and joking with their father…

That was probably the hardest lesson that I’ve learned in school. It’s one I’ll never forget, or forgive myself for.

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So the student who wrote this letter expects to be flamed for it… I’m willing to bet that the response will be just the opposite. We’ve all been there. We’ll all be there again.

What about you?

Posted by on April 20, 2010 • Filed under: 911 fail, ambulance humor, Emergency Medical Services, EMS, EMS Humor, EMS Topics, Fire Rescue Topics, funny, humor, Paramedic, patient care, Patient Management, stories

Hey, Wanna Hang Out?

8 comments

So, what are you doing this next Friday night? You know, Friday the 23rd of April… Are you going to be in Indianapolis? I’m going to be hanging out with some of my blogger buddies down at FDIC this year and I wanted to know if you wmeetupatIndylogoere interested in coming to hang out with us.

The Happy Medic‘s going to be there, @GinaKaiser’s going to be there too. I’ll be hanging out with them and some other really cool guys and gals at the Rock Bottom Restaurant and Brewery around 8pm (ish), which is just a block or two away from the Convention Center in downtown Indianapolis. The address of the place is 10 West Washington St. I’ve been there before with a buddy of mine the last time I was in Indy on business and it’s a good time (Ask about the Snake. It’s a cute story, actually).

So, you can just show up if you wanna. Or you could “@” me on Twitter (It’s @ckemtp if you didn’t know) and get directions. We’ll be kicking back, shooting the breeze, and talking about the stuff we’re talking about online and elsewhere. That, and fishing, and whatnot. It’s a guaranteed good time. If you’re there (and you really should get yourself there, because it’s going to be a hoot) definitely come up and say “Howdy!” I’d love to meet you.

Be there or be abberantly conducted.

Posted by on April 9, 2010 • Filed under: EMS Topics, Uncategorized

Grumblemedics

9 comments

Grumblemedics, you know them. You’ve seen them. Heck, you may even be one. Whether they’re a Grumble Pee or a Grumble Bee, there’s an apparent glut of them in the profession and I’d like to know why. See, to me, EMS is the greatest job in the world. Sure, there’s the great pay and benefits, but there’s also the great hours, plentiful time off, and comfortable ergonomic working environment. I can’t tell you how many times I’ve been just left with a warm-fuzzy feeling after a shift…

Ok, so that could have been an exaggeration, I know that there are things in this profession that just plain ol’ stink. But I gotta tell you, EMS really is my favorite job. I really can’t imagine doing anything else. While there are times in my career that I’ve wondered if it was an abusive, co-dependent type of relationship, I realize that I would not want to be anything other than a paramedic.

So why does it seem like there are so many Grumblemedics? Could it be the long hours with little chance of getting a day off? Could it be the fact that we must get up at all hours of the night to take care of someone in better shape than we are? Tangent: The other day another crew transported a person with a chief complaint of “Dry Feet”. When they asked him if he really wanted transported, he said “Yeah! I got dry feet!” Or, the one last night where a woman had an NSAID pain patch fall off at 4am and called us because she thought that she was going into withdrawal. End Tangent.

OK, heck with the ending the tangents. There are a whole heck of a lot of calls that can be filed under “They called us for THAT!?” Why do people do this? Why? I mean, I’ve been called for things that I wouldn’t even take an aspirin for more times in my career that I can count (And I know that’s more than ten because I have ten fingers and if you think that I’m going to take off my boots after working in them for all of these 24 hour shifts you’re nuts). Why do people call us when they have a muscle cramp? Why did the guy call me when he got a fish hook in his finger? Why do people who happen to be type 1 diabetics drink themselves into a stupor and then call me first thing in the morning to wake them up? Seriously, I once spent a few months going to some guy’s house every shift bright and early in the morning to squirt him with a little D50 and he’d sign the refusal that would send him on his way. It ended when we began putting him on the cot and starting to drive to the ER before we sugared him up. He’d wake up in the rig just as we were backing into the bay doors and be mad at US for transporting him. Sorry guy, but you obviously need more help than we can give you.

So, there may be times in my career that I’ve been a Grumble Pee, but that might be expected. Heck, if I worked in a factory I’d probably be complaining about the lack of adequate ventilation and the fact that I couldn’t sit in the crew lounge and watch TV for a few hours of my shift. We all complain about things we can’t change or our own perceptions of injustice. I would guess that any profession has those things that the people in the profession just hate. Heck, would any of us want to work retail during the holidays? They don’t even get to jab strangers with sharp objects or have their own keys to the leather restraints.. Now THAT would suck.

You know what my absolute, all-time, worst pet-peeve is in EMS? No? I’ll bet you don’t care either but this is my rant and you can’t seem to stop me. My biggest, all-time, worst pet-peeve in EMS is: People who don’t call us when they need us. Yep, I would gladly take a hundred 3am “lost condom” calls rather than have one potential patient have that occult MI and lose any percentage more of heart muscle than they have to because they didn’t want to call EMS and bother us. You see, I work in rural EMS these days where people are nice, and they don’t want to bother their local EMS service with getting up out of their chairs, and they don’t want to bother their neighbors with having to look out their windows at the pretty flashing lights, and they really don’t think that the fact that the left side of their body is numb is any reason to be alarmed. These non-calls that should have been calls bother me more than any of them, and we all grumblemedics are somewhat on the hook here.

If you’ve read any of what I’ve written, you’ve probably seen my statement that “PR Saves Lives”. It means that the more positive Public Relations an ambulance agency has, the more people trust them, and the more people are apt to call them when they truly need them. I haven’t seen studies on what an effective PR program does in reducing so-called “nuisance calls”, but I have seen recent studies that say like 60% of patients having heart attacks make their first call to a friend or family member upon the onset of their crushing chest pain. I’m here to tell ya, I’m jealous. I want to get that call.

So maybe grumblemedics like I probably will be about an hour from now when someone calls me at 3am for something that I would take pepto-bismol for need to remember that we are blessed to do this job, and that EMS professionals need to approach this business with the heart of a servant. Because that’s what we are. We aren’t here for our health, we’re here for everyone’s health. Sometimes people get scared and call us because they’re scared and it is our job to make them feel better by telling them they don’t have to be scared anymore. Sometimes we need to haul them in so someone with a whole-heckovalotta medical education can tell them that same thing. I decided a long time ago that if I ever got to a point in my life where I had to call the ambulance just so I could get some human contact because my real chief complaint was loneliness that I didn’t need some punk kid with a pulse and a medic card judging me.

Us grumblemedics need to realize that the nuisance calls are never going to go away. We’ve got to realize that there are, however, ways to combat them:

  • Check your Ego at the Door: You serve the public. Not the other way around. You are blessed and dang lucky to be the person that this person asked to take care of them in their or their loved one’s hour of perceived need and you best not forget it, because your mental health is at stake, and their life could be too. The best EMS people approach this job with a servant’s heart.
  • Evangelize EMS: You want the general public to know how to properly use EMS, right? Then what have you personally done to help teach them. Get out there and get the word out. Don’t hide in your station, or in the parking lot you’re posting in. Get the message out about what you’re there for, what you’re capable of, and how friendly you are while you are doing it.
  • Everything is PR: Every single, solitary thing an EMS person does affects the publics’ perception of them, their service, and the profession in general. Really. When you meet up with another crew for breakfast in the morning and talk about how wasted you got last night at the bar don’t think that the people around you aren’t listening. When you swear in public don’t think that the kids who are looking up to you in your shiny uniforms with your neat big truck aren’t filing that away. Take your public image seriously. Exude professionalism at all times because it saves lives. The more comfortable everyone is with your professionalism affects how apt they are to call you first, call you fast, or call you at all in a life or death situation. That can make all the difference for a lot of potential patients.

There’s a lot more that every one of us can do, but I’m tired here and I still have the last 8 of my 24 to do be
fore I have to get up in the morning and do 8 hours with my other full-time job and then do a 4 hour training with my volunteer department. Hey! I have an idea!! Maybe if there weren’t so many grumblemedics and the public took a more positive view of our value to society we could maybe squeeze some more pennies out of them at budget time and get paid better so we wouldn’t have to have so many freakin jobs and work so many hours to feed our families! Yea, wouldn’t that be great!!

As always folks, comments and flames are welcome. Public commentary is most appreciated, but I may always be reached privately at: proems1@yahoo.com

Posted by on April 8, 2010 • Filed under: Ambulance, EMS, EMS ethics, EMS Health & Safety, EMS rant, EMS Topics, EMT, Fire department, Firefighter, first responder, friendly, grumblemedics, Paramedic, PR, Public relations

Red Lights to the Left of them, Blue to the right! – Coloring Emergency Lighting

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So you’re driving down the road in an unfamiliar state, let’s say that it’s Iowa or Wisconsin, when in your rear-view mirror you see flashing red lights on a big utility truck coming your way. You can’t really make out what kind of truck it is, but you see red lights flashing so you pull over to let it go by. When it does, you realize that you’ve just pulled over for a tow-truck.

Or how’s this? The same thing happens, but it’s a flashing blue light in Colorado. When you pull over, you realize that you just got pulled over by a snow-plow.

I live in Illinois and work between IL and Wisconsin and there’s quite a bit of a difference between the different lighting colors and upon who can use what color light for what purpose. As a volunteer paramedic/Firefighter in Illinois I run a blue light with no siren in my personal vehicle. Even though I rarely turn it on, I have it in case I get stuck behind a 20mph Grandma on my way to the Big One. Interestingly, the blue light gives me no legal authority or any legal leeway on traffic laws and I must obey all traffic laws even while running the light. I Wisconsin, however, volunteer firefighters and EMS people may use red lights and sirens in their personal vehicles. They have the same legal status as governmental emergency vehicles when they’re driving with their lights activated.

In Iowa, volunteer firefighters may run blue lights in their personal vehicles with no legal authority granted them, and EMS volunteers may run clear (white) lights in their personal vehicles. Volunteers for fire and EMS combination agencies may run a mixture of both, however if a person volunteers for both a separate Fire department and a separate EMS agency, they must be careful to run the clear light for EMS responses and the Blue light for fire responses.

Of course, that’s just for personal vehicles right? Allowing emergency lights in the personal vehicles of emergency volunteers is a debatable issue in some circles. I argue for responsible control of their use and think that they are needed in some communities and not needed in others. Out of the 400-500 volunteer runs I respond to annually, I probably turn on my blue light for less than ten percent of the runs. I use it judiciously, but I know others that I can say did not.

However, this isn’t a post about volunteer emergency lighting and the pros and cons of it. It’s about the messed up spectrum of colors that we use on emergency vehicles in this country. Sure, we have the same stock colors pretty much everywhere. Red, blue, amber (yellow), green, clear (white), and in some states purple (Yes! Purple!). In the southern states, blue lights are for law-enforcement only and red is for fire only. In Wisconsin, law enforcement runs red and blue lights and fire and EMS is red only. In Iowa, up until a few years ago everyone ran red lights except for volunteer firefighters. They changed the law and now allow blue on the Passenger side only. In the City of Chicago, the Chicago Police Department runs blue only and the Fire department runs Red and Green. Downstate Illinois (Read: Outside of the City of Chicago City Limts) runs red and blue for all “Authorized Emergency Vehicles” and blue lights for the volunteers. Green lights are only permitted on stationary vehicles for command lights but can also be used for private security officers. As I mentioned before, in Iowa and Wisconsin, tow trucks run red lights. In Colorado, snow plows run blue. In some states, funeral processions run purple.

Confused?  I sure as heck am.

Consider this: Different lighting colors exist because different members of the driving public see different wavelengths of light in the spectrum (i.e. “Colors”) better or worse in differing ambient light conditions. Also, different colors penetrate different atmospheric and/or ambient light conditions better than others. You can see blue forever at night or in the fog, but not so much in the bright light. Red washes out to amber in the day light but is still fairly visible. Clear lights penetrate for a very long way but can be confused with light reflecting off of a surface almost the same as amber lights. We need a diverse spectrum of colors emanating from our response vehicles in order to ensure that the highest amount of drivers out there are able to see the lights. If someone’s color blind to the particular light color that we choose, they’re not going to see us all that well, are they?

The arguments that I hear for the use of lighting colors don’t hold much weight with me. Who cares if the public is able to see that an approaching emergency vehicle is Fire, EMS, Law Enforcement, ASPCA, Haz-Mat, Tech-Rescue, Volunteer, or miscellaneous. They just need to pull over and get out of the way. One color lighting schemes may give the agency a sense of personality or whatnot, but they’re certainly not the safest way to be seen. An emergency vehicle needs to throw out a lot of light across the spectrum of visible colors in order to help ensure the safest response possible.

So why are we having this hodgepodge of warning light colors? Why do people think they’re a good idea? I can think of a few advantages of having “law enforcement only” colors, as in reducing false traffic stops from people impersonating police officers, but having one color and one color only simply makes it easier for a criminal to get a hold of that one color of light. Why fire would only need red lights is a question that I can’t come up with a good reason for.

So good luck driving out there! If you see me, I’ll be on the side of the road letting a tow-truck go by. Then I’ll run my blue light in Wisconsin because we got a house fire in my district that touches the WI state line and I’ll get arrested for impersonating a police officer. Then I’ll be at work getting into a crash because someone driving out there was color blind to the color red.

Anyone want to add to the confusion? What colors do your state or country use? Is anybody else in favor of a national standard?

Posted by on April 7, 2010 • Filed under: 911 fail, accident, Administration & Leadership, Ambulance, Ambulance Driver, Ambulance maintenance, ckemtp rants, code-3, Command & Leadership, drive fast, Emergency Medical Services, EMS, EMS Health & Safety, EMS Management, EMS rant, EMS safety, EMS Topics, Fire Rescue Topics, In the Line of Duty, Iowa, Iowa EMS, lights and sirens, Line of Duty, Management, politics, Technology & Communications, technology-communications-ems-topics, Vehicle Operation & Ambulances, Vehicle Operations & Apparatus, volunteer fire department, volunteer firefighter

Reflections on an Easter Morning – EMS

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Easter is a family time in the Kaiser household. Everybody gathers together, does the church thing, and as is the tradition here in the Midwest, we eat a lot as well. This Easter was no different. My wife Gina’s mother was there, my parents were in town, and a lot of other miscellaneous relatives came over to the LUTL compound for family time. The weather was beautiful and the coffee was hot.

In the morning, even though I had my own stuff to cook, I became the go-fer for my wife and her mother for groceries. They gave me their list and sent me off to the store for their last minute sundry items. The traffic was light but the after-church crowds were starting to clog the roadways on their way to wherever they were going for their own Easter family time. I was happy to be out though. It simply was a beautiful Spring day in the Midwest. The Sun was shining, the breeze was warm, and it was one of the first days nice enough so that I could finally open up the windows and let the fresh breeze sweep out the air in the car a bit. It was idyllic… all until I saw this:

Roadside Memorial

A grieving family had placed that beautiful memorial in the very corner where a year or so ago I had responded to and worked one of the worst motor vehicle accidents of my career. A car, driven by an elderly couple had pulled out in front of a van, which T-boned them into the spot where the memorial now stands. It ended up killing both of the elderly occupants, the Husband on scene and the wife a few days later at the trauma center. I worked the husband… and I mean I really worked him hard. Altogether, we had two ambulances and two helicopters on scene. Even though I arrived on the Engine Company, I took charge of the Husband, performed an emergency extrication, and worked him as a trauma code. An EMT-Basic who I trust very much was first on scene and stated that the patient was responsive just after the incident. He told me that the patient began breathing after the EMT repositioned his airway. I worked him in the second ambulance to arrive on scene. We had the helicopter on the ground and the flight crew ready to take him when we decided to cease our efforts. Intubation, bilateral IVs, and all of our tricks couldn’t reverse the massive thoracic and anterior neck trauma this poor guy had received. We decided it was futile and called it.

032508-hono-37

I’m inside the ambulance in the foreground. I’m working hard in there.

So today, on this beautiful Easter morning, I’m reminded of that dark day from which I really wonder if there was something that I could have done differently to change the outcome. Yes, I know that there were three other paramedics there with good experience. Yes, I know that we all did our best and no, we didn’t make any mistakes. I am sure, in all rationality, that there was nothing I could have done differently that would have made any difference in the patient’s outcome… but that’s what I thought when I saw the family’s new memorial.

And it’s a beautiful memorial, really.

It’s times like these when I reflect on the gifts and the burdens that all EMS people receive in their jobs that they carry on to their daily lives. I have always said that I can give nothing back to EMS that would ever compare to what it has given me. I cherish the successes and know that the failures make me stronger. It’s made me the person that I am today and I thought that I’d share some of that with you on this Easter. I’m sure you have your own stories and I would love to have you share them as well.

Happy Easter, y’all.

Posted by on April 6, 2010 • Filed under: EMS Health & Safety, EMS Motivation, EMS Topics, Uncategorized

Advances in Prehospital Analgesia and Conscious Sedation

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Pain is endemic within Emergency Medical Services, whether it’s the pain from a grotesque traumatic injury, the chest pain from a heart attack, or the emotional pain suffered by the local teenage drama queen in response to a minor texting-while-driving incident. EMTs and Paramedics must become better at overall pain management and in conscious sedation. Luckily, there are researchers and pioneers working on new and innovative strategies for just that end.

Researchers at the Plover, WI Polytechnic Institute of Cosmetology and Cheese Making  (PPICCM) have been bringing some cutting edge research to the forefront of Prehospital Pain Management and Prehospital Conscious Sedation and have released some new technologies for use in the field. They have field tested these devices in the dive bars in and around Plover on Friday and Saturday nights and even once or twice on the infamous “TwoFer Tuesdays” down at MoeLarry’s Curly Fries and Cheese Bar. They have come up with compelling data that your agency should consider for your own use.

Tradtionally, EMS providers have had a few choices for use in prehospital analgesia and conscious sedation. Advanced providers and paramedics have injectable medications for use, and basic level providers and EMTs have basic splinting and positioning for use in controlling severe pain and the secret weapon for use in putting people to sleep. These medications, including Morphine, Fentanyl, Toradol, Aspirin, and sometimes Nitronox have proven to be very effective, but all of them carry with them side effects and the risk of allergic reactions that can prove fatal in some patients. So can the medications used in Drug Assisted or Rapid Sequence Intubation Techniques: Etomidate, Succynocholine, and the like. To reduce the risk of poor outcomes from these medications, the researchers at PPICCM have developed the following tools:

  • The Open Handed Slap – This is effective as a calming technique for persons who have become hysterical due to superficial trauma to their fingers as well as for family members overcome with emotion due to their loved-one’s bout of indigestion. An example is included below:

 

  • The Mallet Method of Anesthesia Induction – Pioneered by the indomitable Drs Moe, Larry, and Curly (and previously by Dr. Shemp), the use of mallets in induction of conscious sedation is well documented. Simple, yet elegant in it’s use, cranial contact by the fast-moving business end of a mallet is highly effective in reducing any complaints of pain from a patient. In fact, just the visual feedback recieved from opening the case the mallet is stored in and showing the patient that you are preparing to use said mallet is effective in reducing complaints from most alert patients. However, if needed for use, one or two blows in rapid succession is shown to be quite effective in the literature. An example is included below:

 

  • Transcutaneous Oxygen Therapy (TOT-WTYTR) - This method involves pressing the external wall of a “D” sized oxygen cylinder against a bony prominence of a patient in the throws of a violent reaction towards EMS providers. Use of TOT can be handled by both Basic and Advanced providers and it’s effects are determined by the speed and location of the bony prominence that the side wall of the oxygen cylinder is applied to. Lower extremities can be calming while the head and cranium can induce anesthesia and facilitate Rapid Sequence Intubation in most patients. Unfortunately, there is no accompanying video literature for this particular therapy, however it is a simple technique to learn.

Thanks to the brilliant scientists at the PPICCM, prehospital anesthesia and analgesia is in good hands. These simple yet powerful techniques are scheduled to be released for use by my agencies on April Fools Day and should NEVER EVER be used by yours. Ta’ Y’all. Happy Spring.

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Posted by on April 1, 2010 • Filed under: 911 fail, Als, Ambulance, crisis, Emergency Medical Services, EMS, EMS Health & Safety, EMS Humor, EMS Topics, Fire Rescue Topics, funny, humor, Paramedic, paramedic education, Uncategorized
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