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I don’t usually talk about Political things…

4 comments

But when I do, they’re usually of the macro-local type and  have something directly to do with EMS.

This is one of those things.

The village of Schaumburg bucked the national trend of raising taxes and fees to cover rising expenses when its board unanimously approved a 4.4 percent reduction to the 2010 property tax levy

You read that right: reduction.

But that’s not all.  Village officials also did away with vehicle sticker fees and moved to have property taxes cover garbage removal.  

Just for the record, Schaumburg is in Illinois, folks. The same state that sent our senator up to the White House last election cycle. Lowering taxes isn’t exactly the modus operandi for an Illinois municipality. In fact:

Schaumburg is an anomaly among Illinois municipalities. Others like Gurnee and Orland Park raising taxes and fees where ever they can. Northbrook, which has seen an increase in sales tax revenue stood pat.

Schaumburg is one of the larger municipalities in the sprawling conglomeration of suburbs surrounding Chicago. It faces the exact same economic challenges that other municipalities in the area face, but it seems to be doing much better, economy wise.

The measure, if you read the article, isn’t final, but it looks like it will pass. Schaumburg has a full-time Fire/EMS dept and pays their firefighters extremely well, they also seem to have great city services and every time I’ve been in the city I’ve liked what I’ve seen.

In fact, the recent NAEMSE conference was held in a hotel in Schaumburg, and they played a small part in paying the hotel tax.

As I’ve said before, I’m not one to wax too poltical on this blog. This is an EMS and Fire blog and you come here to read about things related to Fire and EMS. I understand that. I don’t want to hijack the discussion to the miasma that is our national political scene and end up alienating a different percentage of my readership every time I post something of an opinionated political nature. However, local politics affect EMS and Fire, and I speak on the politics of EMS quite a bit. This is one of those issues.

I have to ask the question here:

Businesses pay taxes, residents pay taxes, Visitors pay taxes… It goes to say that the more businesses, residents, and visitors a locality gets, the more taxes they’ll pay by sheer volume. People have a choice on where they locate their business, where they visit, and where they choose to live. If you were in the position to do any of these things, knowing that Schaumburg is lowering their taxes, and plans on removing their property tax entirely - just like they said they would – would you choose to do so in Schaumburg, or in the other towns mentioned in this article?

In additon, removing the stupid municipal car stickers, which are really just a massive inconvenience and hassle to the residents of a city, and covering garbage disposal fees through what’s left of the property tax?

Well, Schaumburg… you may just be an island of sanity in an insane state. May word get out and people flock to your borders. It’s called “competition” and usually only successful businesses are the groups that think of lowering their prices to become more attractive to the customer. Bravo.

Source: http://www.nbcchicago.com/news/local-beat/Schaumburg-Officials-May-Lower-Property-Taxes-103947993.html?dr#ixzz10vUpO9PP

Posted by on September 29, 2010 • Filed under: Administration & Leadership, Economics, Emergency Medical Services, EMS, EMS Management, EMS Topics, fire, Fire Rescue Topics, Funding & Staffing, News, newspaper, Paramedic, Uncategorized

EMS case law? AMA Refusals, Death, and Documentation

18 comments

Our friend Valerie DeFrance, who runs the EMS House of Defrance from way up in the Vast Frozen Wasteland facebooked this article this morning and you need to read it.

http://www.leagle.com/unsecure/page.htm?shortname=inmoco20100921246

Yep, check that URL. It’s from a site that specializes in putting out snippets of case law and this one’s simply all-too-common.

You should read the article, or at least skim through the salient points, because this affects you personally. You as an EMS provider should know about this. Pay attention to this case and what it means to you.

In this case, a Paramedic/EMT-B ambulance responded to a person experiencing Chest Pain and Difficulty Breathing. This is a quote from the article: (The emphasis is mine)

The unit arrived at decedent’s home and Respondents performed a primary survey of the decedent ten minutes after the initial call was placed. Respondents followed up on their primary survey with a secondary survey a minute later. They then obtained a set of vital signs. Based on their examination, Respondents diagnosed decedent with acid reflux and recommended a treatment of over-the-counter Maalox/Gaviscon. Believing decedent was in no immediate medical danger, Respondents left the home fifteen minutes after arriving.

The next morning at approximately 10:30 a.m. decedent again called 9-1-1, still complaining of difficulty breathing and chest pains. An ambulance unit from Community Fire Protection District was again dispatched to decedent’s home arriving five minutes later. This unit was manned by a different two-person team than had responded the night before. After finding the decedent was experiencing pain across the chest and into the back, shortness of breath, diaphoresis and nausea, the team began administering emergency treatment with oxygen, aspirin and EKG. At 10:55 a.m. the team initiated emergency transport of decedent to DePaul Health Center where he was admitted ten minutes later. At the Health Center decedent was diagnosed with cardiac arrest and pulmonary embolism and began receiving treatment. The treatment was unsuccessful and decedent died at 4:00 p.m. on 11 July 2008.

So do you see a problem there?

First off, I’m assuming they obtained an AMA refusal form (and if they didn’t, they’re idiots). This case highlights exactly what I’ve always said about refusals being worthless. There’s no mention of the patient having refused transport here. In fact, this isn’t a case on whether or not the EMTs actions were correct or incorrect. This is simply a case to see whether or not they have protection under the doctrine of Sovereign Immunity. It looks to me like they were basing their defense on whether or not they have that legal protection, not basing it on their thought that they provided proper care. It looks like they were assumed not to have provided it. In this case, a signed refusal meant nothing. If they were successfully sued with no mention of the AMA form, what good is it?

Second off, it’s in the official record that their PRIMARY survey took less than a minute… and I can believe that if they were solely attempting to rule out an immediate life threat. That’s what the primary survey is for. As evidenced by the fact that the deceased lasted another ten hours, I can assume that there was no immediate threat to his life. However, they then did a “secondary survey” one minute later and cleared the scene with what I assume to be an AMA refusal in just fifteen minutes. So if we time this out, they made it to the patient’s side in one minute, did two assessments, obtained a refusal, and cleared the scene in 15 minutes? That’s one minute to grab gear and walk to the patient, a minute to rule out immediate life threats, a few minutes to do a secondary assessment and vitals, with no mention of an EKG, and a few minutes to carry whatever gear they took in back to the truck, get back in the truck, and clear? Um… Either these are the fastest medics in the West, or they did a very poor assessment.

And the guy died. And they got sued. And they lost. And they freaking deserved to lose.

The second crew seems to have provided proper care for the patient, and that is evidenced in the case outcome. In fact, the lawyers and the judge seem to have made it a point to show the poor care provided by the first crew in contrast to the proper care provided by the second crew. It’s clearly evident here and I’ll bet that if we were to go to that agency and inspect it, we could probably see the difference in dedication and motivation between the first and second crew. The first paramedic comes off as lazy, callous, and stupid whereas the second paramedic comes off as competent and caring. I’d be willing to bet that this is honestly the case. That the first medic was a “good enough” medic who often encouraged AMA refusals and performed just to the bare minimum and the second medic was somewhat better than the first.

So how, as EMS providers, how do we protect against the precedent set by this case law?

The answer is still now as it always has been, do a thorough assessment every time, kick the decisions up to the physician, and document, document, document. This case was in 2008 and if you were doing EMS back then, you know that a 12-lead EKG was the standard of care. This patient should have had a working diagnosis (Chest pain), attempts at making a differential diagnosis (lung sounds, History and Physical Exam, EKG, SpO2, and trended vital signs and 12-leads) and should have been transported. If the patient wanted to refuse, the physician medical control should have been contacted and this should have been documented. The time limit of 14 minutes of assessment and/or care in this case is evidence that this didn’t happen. The medics blew his call for help off and the patient died.

Here’s what I would have done: I would have performed a thorough patient assessment including lung sounds, ABD assessment, and a history. I would have gotten the OPQRST of the patient’s complaint, and performed serial 12-lead EKGs. Then I would have transported. If the patient refused, I would have transmitted the 12-lead EKG, spoken with a physician about the case, and attempted to have the physician speak with the patient. This all would have been thoroughly documented.

Patients have the right to refuse care if they are conscious, alert, and oriented. They have this right even if they’re being stupid. We have the responsibility to help them make a proper, rational decision and to show that we made every effort to provide them with the best possible information. Proper patient care and excellent documentation are the way we protect against these types of lawsuits… and that really hasn’t changed.

This kind of situation can and does happen. Protect yourself and your agency by never becoming lazy. Document! Document! Document! Do your best every time. Be thorough and don’t succumb to mediocrity just because it’s easy. It will catch up to you just like it did to these two.

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For more tips on EMS documentation:

Posted by on September 27, 2010 • Filed under: Administration & Leadership, Case law, Command & Leadership, Emergency Medical Services, EMS, EMS ethics, EMS Management, ems narrative, EMS narrative report, ems patient care report, ems report, EMS Topics, EMS training, Management, narrative, narrative report, Paramedic, paramedic education, Patient Management, scenario, scenario based training, Training & Development

A Weighted Issue? A Burning Issue… Wow.

5 comments

I’ve always said that I love EMS and that I’ve taken from it far more than I could ever give back to it. The same is true with this blog. From my readers and people who comment, I learn more than I can teach and enjoy more than I can entertain.

This weekend proved all of those facts quite well.

If you didn’t read the blog over the weekend, you missed an amazing discussion on my last post. The post, “A Weighted Issue, The Fire Service Helping Private EMS” discussed the case of a private ambulance requesting a fire department for assistance in carrying a bariatric patient back into her home on a long-distance hospital discharge. The private ambulance was 5 or 6 hours out of their area of operations and the Fire Department was a full-time municipal department.

I linked to the stories that had popped up on www.JEMS.com and also on www.EMS1.com. I wrote my feelings on the issue, explored the case a bit, and then opened up the floor to the readers for their comments.

And what happened floored me, just knocked me over.

Predictably, I started getting comments on the post… Then some more… then more.. then a LOT more.. then a TON more. The post spread like wildfire and attracted some of the most intelligent discussion I’ve ever had here. It’s by far my most commented post with 86 at the time I write this.

And I read them all. I love comments, they come to my BlackBerry. Really. I read the discussion, the back and forth, and the wide spectrum of opinions as they came in, sometimes two and three at a time.

And my opinion has been swayed… my original perception that the Fire Department was Evil has been tempered. My original perception that the Private Ambulance could have dropped a dime and handled the issue with a phone call before the incident has not changed. However, I now focus my ire on the system that caused this issue.

The reimbursement structure holds the ambulance service hostage. No private ambulance would be reimbursed for hauling the patient with extra people. The service wouldn’t have been reimbursed for a 2nd rig and the patient had to be taken home. My guess, as was stated by a handful of commenters, is that the service was taking the patient as a favor to garner more business from the rehab hospital. I have no way of knowing that for sure, but it makes sense to me.

Not only did I get a TON, just a ton of great discussion… but the post spawned a few others as well.

This event has taught me something that should be the takeaway for us all. That is this: Issues like this are not going away. In fact, they’re only going to get more common. Private EMS isn’t evil and the “Private Transport Industry” is necessary for the functioning of our healthcare system. Fire-Based EMS will have to help and could never handle the strain of not having private EMS.

Sorry to both parties here, we’re all needed in the current system. Healthcare needs us all.

So play nice and help each other out. Remember the Golden Rule.

And remember the five P’s: “Proper Planning Prevents Poor Performance”

I shall leave you with two things:

http://lifeunderthelights.com/2010/09/a-weighted-issue-the-fire-service-helping-private-ems/ – A link to the post for you to wade into the comments if you haven’t (you should. Bring a snack)

And this, a  video that this experience has brought to my mind. “The Hats of Incident Management” It’s about highway incidents… but you’ll get the point. It’s a classic.

ParamedicTV is powered by EMS1.com

Posted by on September 21, 2010 • Filed under: 911 fail, Administration & Leadership, Emergency Medical Services, EMS, EMS Topics, Fire department, Fire Rescue Topics, Paramedic, professionalism, Uncategorized

A Weighted Issue – The Fire Service Helping Private EMS

111 comments

There has been quite a bit of buzz lately over a story that happened pretty close to my generic neck of the woods. It’s been featured on www.JEMS.com as well as www.EMS1.com and has blown up the twitter streams. I was made aware of it by the JEMS Facebook fan page posting the link two days ago.

Before I link to the article, I’d like to say that I was immediately on the side of the private ambulance company and I jumped right on the JEMS facebook comments thread to state my case. I figured that there would be some dissention, but that most people would share my view.

But that’s not exactly what happened…

Apparently there is a vast chasm in opinions out there on this issue, and it’s not just the Firefighters vs. the non-firefighters like I thought it would be. The comments section is up to 61 comments as I write this and the discussion is poignant and well reasoned. I still believe in what I said… but I’m willing to revisit the issue

Here’s the article: http://www.jems.com/article/news/illinois-fire-department-refus

So… do you see the discord there?

The private ambulance service, which is a pretty new company that runs only one or two ambulances was started by a paramedic with a dream (yea, really). It took the patient from a rehab hospital to a private residence in Springfield, IL. I don’t know the exact road mileage, but I do know that Springfield, IL is a good 4 to 5 hours away from where the rehabilitation hospital is located. The patient was reported to have been on Medicare and Medicaid and weighed approximately 700lbs.

Yep, this ambulance crew had to take a 700 pound patient on a long distance transfer. I feel their pain.

The crew couldn’t get the patient from their ambulance into the residence when they got there and called the Springfield FD (SFD) for assistance moving the patient. SFD refused to assist them.

Ultimately, the private ambulance crew arranged for another private ambulance from a Springfield area company to come and help them. The job got done and everyone was happy, right?

Well, no… of course that’s not what happened. Someone alerted the media and the story popped up on the wire. Now there’s debate flying all over the interwebs and I for one want to keep it going. Viva debate. Viva discussion.

Here’s my comment from the JEMS Facebook Page:alled “community service” which I guess is something they don’t understand in Springfield.

There is nothing wrong with private ambulances and even the staunchest fire service EMS person would agree that no fire department would accept a long distance transfer (in this case, probably a good 5hrs) discharging a Pt from a rehab hospital to home. Some service has to exist to do this type of work, and Mercy Ambulance stepped up to do it. The patient was a TAXPAYING CITIZEN of Springfield FD’s area and Mercy was returning that taxpaying citizen to his or her home. This person has already paid for Springfield FD’s services and they refused to provide them.

I would guess that SFD regularly responds to other so-called “Nusaince calls” all the time, or have they stopped responding to Activated Fire Alarms, dumpster fires, and CO alarms as well?

Mercy Ambulance wasn’t doing this for the money. The reimbursement from Medicare is laughable and the “reimbursement” from IL medicaid is pretty much non-existant. They did this because the patient needed to get home. The reimbursement system is such that they would have had to eat the cost of additional crew and making the assumption that the SFD would respond for the “Public Assist” of one of it’s tax-paying constituents is reasonable.

SFD gets a letter in the file for this one.

I’m actually familiar with the ambulance service in question. In the area that it mainly operates within, the Fire service is always happy to help out the private ambulances with these types of cases. It has to do with providing something called “community service” which I guess is something they don’t understand in Springfield.

There is nothing wrong with private ambulances and even the staunchest fire service EMS person would agree that no fire department would accept a long distance transfer (in this case, probably a good 5hrs) discharging a Pt from a rehab hospital to home. Some service has to exist to do this type of work, and Mercy Ambulance stepped up to do it. The patient was a TAXPAYING CITIZEN of Springfield FD’s area and Mercy was returning that taxpaying citizen to his or her home. This person has already paid for Springfield FD’s services and they refused to provide them.

I would guess that SFD regularly responds to other so-called “Nusaince calls” all the time, or have they stopped responding to Activated Fire Alarms, dumpster fires, and CO alarms as well?

Mercy Ambulance wasn’t doing this for the money. The reimbursement from Medicare is laughable and the “reimbursement” from IL medicaid is pretty much non-existant. They did this because the patient needed to get home. The reimbursement system is such that they would have had to eat the cost of additional crew and making the assumption that the SFD would respond for the “Public Assist” of one of its tax-paying constituents is reasonable.

SFD gets a letter in the file for this one

That has been “liked” six times since I wrote it.

The rub here for the Defenders of the Fire Service™ is that they say that the “Medical Transportation Industry” is an “Industry” and therefore should have their own plans in place to deal with this type of case. They say that they shouldn’t diminish their ability to respond to emergency requests in order to help out a private business with a client. They say that they would expose themselves to liability, expose themselves to potential injuries of their employees, and that they would be providing this service for free. They say that this isn’t their job and that they shouldn’t be spending taxpayer dollars to help out a private entity.

And… I might concede that to them if I thought it was genuine. I mean, does the fire service help out the towing and recovery industry with cleaning up car wrecks? Do they help out the private fire alarm business by responding to and resetting false alarms? Do they provide private residences with smoke and carbon monoxide alarms?

Yes, of course they do all that. They do other things too. They help out all kinds of community entities, both public and private, for-profit and not-for-profit all the time. The Defenders of the Fire Service™ keep trumpeting their statement that they are an “All-Hazards” emergency response agency that is constantly adapting to meet “the needs that the public are demanding from them”.

All of those community entities the fire service assists have one thing in common, they pay taxes. Some of them pay property taxes, some of them pay rent that goes in-part to pay property taxes, and some of the straight not-for-profits provide services that help the people paying property taxes.

And last time I checked, the SFD does receive property taxes.

Here’s one thing with what I said though… The “All-Hazards response” idea is for responding to “hazards” and I can see where a private ambulance needing a hand isn’t exactly a hazard or an emergent need.

Would any of the Fire Departments I’ve worked on have done it? Yes, absolutely. A citizen needed an assist and we would have marked it as a “Public Assist”. We would have responded non-emergent, helped, and it would have been a non-issue. The person pays tax dollars and we would have looked at it as the same as responding with an engine for a 911 lift assist.

However, I will concede that the Private ambulance service would have been more proactive if they would have called the SFD and asked them if they would help them before they loaded the patient. If the SFD told them “no” at that time, they could have arranged for alternate methods at that time. Instead, they just assumed. They transported the patient to someone else’s sandbox and just hoped that they would play nicely.

And the SFD doesn’t play the way that Mercy Ambulance is used to playing.

If you can’t tell, I’m on the side of Mercy Ambulance here. Although I say that they should have dropped the dime and rang the SFD to ask them before they just assumed they’d help.

One thing’s for sure though, this issue isn’t going away and it will probably become more common. There’s a ton of differing opinions out there as shown by the comments that news story received and it shows that there are EMS professionals on both sides of the fence that have strong and reasoned opinions. This is an issue that would benefit from some discourse and that’s why I’m bringing it up.

What are your thoughts?

Posted by on September 17, 2010 • Filed under: Administration & Leadership, ckemtp, ckemtp rants, edemse, Emergency Medical Services, EMS, EMS ethics, EMS Health & Safety, EMS Topics, Fire department, Fire Rescue Topics, Firefighter Safety & Health, News, Paramedic, Patient Management, politics

A new addition to the blog

3 comments

Howdy Everyone!

This is your friendly neighborhood paramedic-turned-writer Ckemtp here with:

An Important Announcement

As part of my continued struggle through my capitalistic tendencies, I have decided to offer a suite of services to those who may want some sweet services. (see what I did there? The pun? Funny, right? Yea.. it’s funny) You can find those services above the post in the navigational bar.

Yep, right up there in the middle. The “Services I Offer” button.

Want me to write for your organization, speak for your conference, or ginzu up your data?

Here’s your chance.

Posted by on September 14, 2010 • Filed under: Uncategorized

I wanted to put something up about 9-11…

No comments

I wanted to put something up here about 9-11… but I’m having trouble coming up with something new.

Last year, I wrote a piece called “Moved to Tears”.

Even though it’s last year’s post… I’d say that it’s still relevant and I don’t think that anything I write today is going to be any more poignant.

Never Forget. Never Appease.

http://lifeunderthelights.com/2009/09/moved-to-tears/

Posted by on September 10, 2010 • Filed under: Uncategorized • Tagged:

Help!! Riddle me this… Quick like!

15 comments

Ladies and Gentlemen!

I am in a bind… and well, I’m asking for your quick, late night assistance. Consider this the LUTL pager going off and me begging for you to volunteer your time and respond to these questions. Won’t you help me?

I recently signed up for college and I’m facing the end of my first semester at Kaplan University. Http://www.Kaplan.edu. I’m completing a BS in Fire and Emergency Management through their online campus. I must say that I’ve really been enjoying it. I’ve had two excellent instructors thus far, and I can’t speak highly enough of them.

However… as my regular readers know, my schedule has been flipped turned upside down by one of my jobs and I am now facing a deadline of 0000hrs CST to have an “Interview with a fire service professional” completed and done.

And no, I can’t interview myself. Even with my multiple personalities firing on full cylinders… I just can’t do that in good consciousness.

So, I’m asking y’all, my (really nice, handsome/pretty, and intelligent) audience to answer me a few questions before 9/8 0000hrs CST! Hurry!

Three of these are easy questions… one of them is hard as heck and is sure to be controversial, actually. I wouldn’t have it any other way.

Thanks for helping. Please leave your answers in comment form, or you can e-mail them to the blog e-mail at ProEMS1@yahoo.com

Thank you!!!

Questions:

  1. What is your name, rank, and department? (Or general area of the country and type of service if you prefer)
  2. How long have you been a member of this department?
  3. Do you hold multiple jobs in the Fire Service/EMS? Care to share?
  4. Where did you work previously… the abridged version?
  5. What training or education did you undergo in order to get the job you have now?

And here’s the hard one:

First, go read THIS ARTICLE FROM FIREGEEZER.COM WRITTEN BY FOSSILMEDIC about Uniontown, PA scrapping their paid FD for a volunteer/POC department.

Then, go read THIS ARTICLE FROM PETER CANNING (and the subsequent article from the New York Times that he links to) about Fire Departments charging hundreds of dollars for all responses.

Now, answer me this:

With local governments all across the nation facing financial crises and the fire service not being immune to the budgetary axe… do you think that the full-time, paid, professional fire service will continue to be as much as a desirable career goal, in terms of pay and benefits, in five years. How about ten years, or 15 or 20 years?

Consider this as well:

People line up and submit themselves to grueling testing processes for one or two openings in full-time fire departments. Hundreds of people compete for one or two open slots in some cases. This is an example of supply and demand being askew… its simple math. Obviously there’s something that drives these people to submit to that process with little hope of getting the few available jobs. Do you really think that will last?

No offense intended to my brethren in the fire service. This is something I’ve seriously considered and I’ll bet I’m not the only one who has. The question has been asked. Let’s see what answers we get.

(and thanks for helping me with my homework… I’m really going to transpose your answers and turn it in as a paper)

Posted by on September 7, 2010 • Filed under: Administration & Leadership, EMS, EMS Topics, Fire Rescue Topics

What Difference Does EMS Make? Choose Your Own Ending

17 comments

John didn’t need his alarm clock this morning. In fact, he was wide awake just a few minutes before it went off. He turned it off so as to not wake up his wife and got up quietly to start the day. Today was going to be great. It was huge. Months of work at the office were finally going to be recognized today in the biggest project meeting he’d had in a year. Today’s meeting would launch his career faster than almost anything he’d done before. He was excited. He was ready.

John showered, shaved, and got dressed up in his new suit that he’d bought the day before. He wanted to look his best for this meeting. Everything was counting on it. His wife Joanne had coffee and a quick breakfast ready for him when he came down the stairs. He sipped on his coffee for a bit as he ate his breakfast. It was really sweet of her to do that, He thought and he told her so with an extra hug and kiss as he left for his commute. He wanted to be to work early today to make sure that he was there to answer any pre-meeting questions. This was the day.

Traffic was light on the interstate that morning and John was moving at a good clip. It was strange, he thought, for traffic to be this kind to him on a Monday morning but he figured it was a good omen. His phone buzzed with an e-mail and he glanced at it. It wasn’t anything that couldn’t wait until he was in the office, he thought. Then a great song came on the radio. John reached down to turn up the volume so he could get pumped up for the drive…

He never saw the cars stopped just in front of him.

Mary took care of herself pretty well for a type one diabetic. Her doctor had told her that. She stuck to her diet, maintained her sugar levels meticulously, and took her insulin on a sliding scale that seemed to be working perfectly. Her blood sugar readings were always right where her doctor said they should be. Mary was proud of that. She worked out and tried to get out walking or jogging the trail at the park at least 3 or 4 times a week. She felt good, looked good, and thought that she was doing all she could to take charge of her health.

It was a beautiful Saturday morning and Mary thought that she should take her dog Patches out for a walk around the pond. Patches was a 1 year old Golden Retriever and loved jumping in the lake to fetch sticks. Mary had taken her morning dose of insulin, popped a multivitamin tablet from her new bottle that she’d bought the day before, and ate a quick bit of breakfast before she put Patches on his leash and started walking to the park. It was about five blocks away and patches knew the route well. Everything was great, until the nausea hit… Mary tried to fight it but knew that she was going to throw up when she started salivating and breathing heavily. She ended up throwing up in some bushes next to the sidewalk. She thought that she was lucky. Nobody saw her hurl up her breakfast and she immediately felt better. It must have just been the new vitamins that made her stomach upset, she thought as she continued walking to the park. She figured that she just wouldn’t take them again.

Mary never felt sick. She just thought that she should take a nap. The rock over there looked like a good place. Why was she so sleepy? Never mind… Just lay down and nap. Nap good.

Luckily, another jogger happened by to find Mary unresponsive.

Work had been scarce lately and Steve was happy to get his truck back on the road. He drove a live-bottom trailer hauling asphalt for a big local paving company and they hadn’t had many big projects come their way lately. Driveway work was steady, but rarely did the company need Steve to drive a big truck out to a site for a driveway job. Steve made his best money and hours when the company had highway work and today was the first day of a big job they’d just gotten. He’d been in line with the other trucks waiting his turn to dump his load into the paver for hours and even though he was happy to be working, he had to pee. Minutes turned into hours and finally it was his turn to drop his blacktop and head back for a new load. He couldn’t wait to be done. He really had to pee by this time and he knew exactly where his next opportunity would be. He backed his trailer up to the paver and raised the bed. Then through his rear-view mirror he saw the people scramble and jump off of the paver. He felt his truck lurch forward as the paver machine was pushed into it from the impact of a car travelling too fast in the construction zone. When he jumped out of his truck after looking to make sure there was nobody coming at him, he saw his friend Luke laying on the ground. Luke was bleeding, bad. The car and the paver were a tangled mess of metal and there was someone screaming at an unmoving figure in the passenger seat of the car.

Steve no longer had to pee…

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Note to blog readers:     I can’t quite decide on what I should do from this point on. I can take two paths, one is a rallying call to community members asking them to put themselves in the place of the people in the above cases and get out there and support their local EMS. The other, is a rallying call to us EMS people… I’ve written it both ways. You can see what you like best.

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Option #1

Every day, Paramedics and EMTs put on their uniforms, fire up their ambulances, and get ready to face the onslaught of whatever mayhem the streets produce for them during their shift. They do a job that is unpredictable, complicated, and vital to the community. These three stories could happen to you or someone you love tomorrow and each of them will require the response of a highly trained, expert Emergency Medical Services (EMS) provider. There are times when your local ambulance service makes the difference between life and death but there are far more times when they make a big difference in a person’s continuing quality of life. By interceding in the first few moments of a medical emergency with highly trained experts, EMS makes a difference for us all. Communities that support their local Emergency Medical Services have better services and community members that are more educated about what makes quality EMS are better suited to support their local services.

You may not think about the people who respond to your call when you dial 911, but all we do is think about you. Get informed, get involved, and support your local Emergency Medical Services.

We’re there for you. We need you to return the favor.

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Option #2

As you come in to work today, lace up your boots, or turn on your pager, think about the patients in the above cases. They’re people just like anyone you see in your day to day life. They and others like them didn’t intend to be placed in the situations they’re facing and to them; theirs is one of the most intense situations of their life. Their very life and the continuing quality of their lives could rest in your hands today. They are depending on you. Their families are depending on you. Your knowledge, skill, and preparation to perform your best are paramount to these people. Their care rests on you. You owe them your best and there is no excuse they’ll accept for poor performance.

EMS providers transcend their self when they lace up their boots and sign on for duty. Society needs us. Our patients need us. We need us. We will never know the impact we’ll have on the lives of our patients, their families, and their communities… but it’s huge. We as EMS providers play a pivotal role in our communities. They’ll never acknowledge it en masse… but that doesn’t diminish its importance. Recognition for our skills isn’t necessary for our skills to be vital. EMS people do their jobs because they’re important. We do our jobs because our guts tell us that what we’re doing is right… and even when we stumble and find ways to improve ourselves and our care, it doesn’t diminish the importance of what we’ve done. We have acted, and we continue to act in the best interest of humanity.

Today you can make a choice. You can make the choice to seek out and become the best EMS provider you can be or you can choose not to. I suggest that you make the right choice but no one will ever be able to force you. Your care is an art and a science. Your performance is based upon hard science and soft intuition. There can never be a book that will tell you exactly what is right for every situation… you simply have to learn it and learn how to make the right decisions to fit the situations you find yourself in.

My advice to all EMS providers is to take the high road. Err on the side of what you truly feel is best for your patient. Do your best. Study hard and learn from those you consider the best among us. As an EMS provider, you bear the burden of an overloaded system that pays poorly and garners little respect. I feel it too. I say that it doesn’t diminish the importance of what we do and it isn’t the individual patient’s fault. They deserve our best no matter what the system is doing to us. It’s our responsibility and our calling. It has been said that the definition of a “Professional” is one who can perform their duty adequately in conditions that would cause the amateur to turn back. I’d say that we’re living in those conditions today, but we still have to perform. Do your best and know your stuff. Lives depend on your commitment.

It is our job to promote ourselves. It is our job to elevate EMS. It is our job to speak out and optimize the system. The fault for its failings lies within our profession and it is our job to change it. All of us, individually and collectively have the responsibility.

Will you answer?

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So I got a little philosophical in this one. Which ending do you like better?

Posted by on September 7, 2010 • Filed under: 911, edemse, Emergency Medical Services, EMS, ems 2.0, ems education, EMS Motivation, EMS pep talk, ems scenario, ems scenario based education, EMS Topics, EMS training, Ethics, everyday ems ethics, Fire Rescue Topics, In the Line of Duty, inside the mind of a paramedic, letter to the editor, Line of Duty, Paramedic, paramedic education, Patient Management, pride, profession, professionalism, Public relations, scenario, scenario based training, stories, Training & Development, training-fire-rescue-topics

What are you doing reading THIS?

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When you could be reading Happy’s explanation of EMS @.0 over at the Chronicles of EMS website?

Go read it. Print it out please, and share it with the world.

http://chroniclesofems.com/ems-20.htm

Thanks, Happy.

Posted by on September 7, 2010 • Filed under: Administration & Leadership, Command & Leadership, EMS, ems 2.0, EMS Topics, Uncategorized

Speeding to the hospital! or.. Nurses: Above the Law

16 comments

While reading up on EMS blogs today I came across this link over at Burned Out Medic:

http://burnedoutmedic.com/2010/08/there-are-enough-traffic-scofflaws-already/

It links to a story written in a magazine called the “Cath Lab Digest” penned by a “Lead RN” with a bunch of certainly impressive sounding gobbledygook after her name. She writes the story of her outrage and subsequent fight against a traffic ticket she received while responding from home to a cath lab activation at her hospital.

Her story is written in her article, which can be found here: http://www.cathlabdigest.com/articles/My-Day-Court

Here’s the reply that I left her:

I read this and saw the “I’m Special” mentality breaking through all over this piece.

You indicate that by virtue of your job and your training:

- You’re so special your cath lab team cannot handle their job without your leadership, even for up to 12 minutes.

- You’re so special that your objective and destination are more important than the objectives and destination of everyone else on the public roadways.

- You’re so special that the law should not apply to you.

- You’re so special that the other healthcare providers on-duty at the time you are called in cannot possibly be taking care of the patient as well as you can.

- You feel cool being called in and being allowed to drive any way you want.

The officer who stopped and ticketed you disagreed with all of the above. I do as well.

In many states, volunteer fire and emergency medical services personnel are allowed to operate their personal vehicles with emergency lights and sirens when responding to emergency situations. This is because the situations they respond to are extremely time sensitive, requiring professional action within 5 to 10 minutes in some cases in order to mitigate the consequences of the emergency. These calls are usually in the hands of lay persons until the professionals arrive.

Your “emergencies” are time sensitive as well. The AHA recommends a 90 minute window from recognition of STEMI to Cardiac Catheterization. The patient is in the hands of trained people from the time of recognition. There is a huge difference in these standards that does not warrant the risk to the rest of the public for nurses driving in an emergency fashion… especially self-appointed “special” nurses.

I would think that the minutes could be saved in earlier recognition of the STEMI, field activation of the Cath Lab team, earlier notification by the hospital, and perhaps having more qualified people on duty around the clock. This would certainly pay for itself the first time the hospital was liable for you killing someone or being killed yourself while enroute to a page.

I’m sorry if I was perhaps a bit hard on you… but this comment goes out to the rest of the “special” people out there. Obey the law and be safe. Don’t kill me or my family because you believe yourself to be special.

Was I too harsh?

Posted by on September 4, 2010 • Filed under: Emergency Nurse, EMS, EMS Health & Safety, EMS Topics

Link: Tears on her Trauma Shears

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Medic trommashear has written her part of the co-post about sadness in EMS. It’s a story that one just can’t help but get choked up over…

Just read it:

http://lookingthroughapairofpinkhandledtraumashears.com/2010/09/02/teardrops-on-my-trauma-shears/#comment-60

Posted by on September 2, 2010 • Filed under: Uncategorized

A personal note – Wanna “Like” me?

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Howdy everyone!

My schedule got hit with a nuclear bomb lately and every minute of my day has been reordered for probably the next two months. This is a good and natural thing that happens with one of my non-blog-mentionable jobs (although if you know me personally, you know which job it is). I’ll be off of a truck for a while and will instead be sitting in front of a computer in a cubicle working on office-related stuff.

It’s a good job that I just can’t speak of publicly, everyone knows this employers name and I don’t want to have a voice that may affect it or me in any way. It’s just not what I write about.

However, while I’ve yet to see what this will do to my blog posting frequency, I know that it has increased my Facebook posting frequency on the Life Under the Lights Facebook Fan page.

Please to join and interact with me so to as I don’t shut down from brain overload?

Here’s the link: The Life Under the Lights Facebook Fan Page

Or you could just click “like” on the widget over there on the Right.

Thanks y’all!

Posted by on September 1, 2010 • Filed under: EMS Topics
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