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Issues: I’m Scared of something, Have a Rhythm, and A New Column Up, Too.

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First off, my newest column is up over at JEMS.com – You might like it. I’m challenging the status quo. Like I do:

“EMS Provider Questions 3-Dose Nitro Rule – JEMS.com”

Did you read that and then come back? Good! But if not, I’ll link it again for you at the bottom. I’ve got a few other things that are on my mind today. Like this:

If you haven’t noticed yet, my posts are back in a rhythm.

I’m really enjoying all of the feedback and participation I’m getting on the blog since I’ve been hitting it regularly lately. I’m trying to do good, solid posts on Mondays and Wednesdays, with something on Friday to carry me through the weekend. On Tuesdays and Thursdays I plan on the occasional link love and mention of some of the other great bloggers out there. I hope y’all like the schedule and what I’ve been putting out lately.

But this week? The schedule is a tad off…

I wrote a detailed, strongly worded, journalistic, researched, and somewhat opinionated piece on a topic I care deeply about. It went long, so I broke it into two parts and planned to run it this week on Monday and Wednesday.

However, you’re probably noticing that you aren’t reading that post right now. That’s because the post scares me.

I am playing with fire with this post. Literally. It involves a burning issue that’s impacting a fire department that I am very familiar with. They, in turn, are very familiar with me. Their city council just voted to end their ambulance service in a move that they deemed purely financial. In the piece, I gave them strong advice and tough love after thoroughly exploring the issue as best as I was able.

But I’m scared to put it up here, honestly.

Any Fire-Based EMS vs. The World issue is a hot issue, fraught with peril for anyone who should so dare offer an opinion that isn’t “FIRE RULES!!! WHAT ARE THOSE IDIOTS WHO DON’T LIKE FIRE DOING!?!?!?!” I didn’t offer that opinion. While I support those firefighters and my good, long-time friends among them, I simply can’t blindly repeat that dogma. This issue is much, much more complex than that and unfortunately for my friends, that dogma isn’t going to work here. It has already failed and it will continue to fail if they continue to use it. The landscape has changed. Down is now up. Dogs and Cats are living together… Mass Hysteria! is happening and they need some new strategies.

Our friend Chief Reason wrote on the topic on his blog over at Fire Engineering and you can read his opinion on the issue I’m talking about here: “City Fires; Chief ‘retires’.  (Oh, and Art? We miss you over here at FEblogs)

Chief Reason does a good job of explaining the issue. I respect that man’s opinion a great deal and always have… and I’m not saying he’s wrong at all. I’m just saying that the argument he’s using to defend the position he’s defending is well… dated. The reality has changed as I have said and that kind of argument just isn’t going to work anymore.

Read Art’s post on the subject for more. I’ve written on it but am holding the post for a while. If anyone from Moline cares to talk about my opinion, I’d be happy to speak on it. However, I didn’t just write it for Moline. There is a much, MUCH wider issue at hand.

Here’s the deal: This thing that happened in Moline? It’s coming to your town. It’s coming to where you live and if you defend yourselves the same way I see them defending themselves, you’re probably going to lose your fight. (Not that I want them to. I support quality EMS in the City of Moline. I have a lot of friends and family that live and work there and I want the EMS there to be the absolute best it can be)

I’m going to think about posting the piece. Till then, if you care to read it before I decide, e-mail me at ProEMS1@yahoo.com or hit me up on Facebook and I’ll send it to you.

Also as I mentioned up at the top, my newest monthly column is up over at JEMS.com – Pop by and have a read. I’m challenging beliefs there, too.

“EMS Provider Questions 3-Dose Nitro Rule – JEMS.com”

Posted by on November 2, 2011 • Filed under: Ambulance, ckemtp, ckemtp rants, Emergency Medical Services, EMS, EMS Humor, EMS Topics, EMT, Fire department, Fire Rescue Topics, Funding & Staffing, News, Paramedic

Tripping at the Hospital – A Teachable Moment for EMS

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Quick: Name the safest place you can think of to have a medical emergency.

Would it be inside of a hospital? Maybe an ambulance base? Perhaps a concert venue with medical staff on site?

Back when I worked in a hospital, we used to have a procedure called a “Code Green.” We’d call one on the occasion of “A medical emergency occurring in a non-patient care area of the property resulting in a need for emergency medical care.” It was implemented in the early 2000’s in response to the disorganized response we had been seeing to on-property medical emergencies in areas such as the parking lot or the hospital lobby. Usually Code Greens would result from someone falling however they occasionally resulted from some other type of medical problem. I even think they even worked a cardiac arrest in the parking lot on a day I wasn’t on-duty. My position at the hospital was a cross between a Security Guard and an EMT as I progressed through Paramedic school. At that chain of hospitals with three campuses and around 500 beds, the Security department operated an ambulance service to do interfacility transports between the ERs and inpatient units. It was an interesting system. As Security/EMTs we naturally became the primary responders to “Code Green” calls, which seemed to happen once or twice a month in my recollection.

I was reminded of our Code Greens when I read this article coming out of Niagra Falls, Ontario (Canada) concerning an elderly woman who fell while walking out of a hospital.

According to the article from The Toronto Star, the 87 year old woman was leaving the facility after visiting her terminally ill husband when she suffered a fall and fractured her hip in the hospital parking lot. The article has a fairly critical tone towards the hospital and its staff; blasting them for having to call an ambulance and for the time it took to get the woman off of the ground. The woman, who in the article is stated to have a previously fractured arm, is reported to have laid on the ground for “Nearly 30 minutes” while waiting for the ambulance to transport her to the ER, which is stated by her son to be “only 50 yards away” from where the fall occurred.

I linked this article today because I believe the opinions expressed show a great deal of information towards the public’s perception of the roles of healthcare workers. The article seems to think that it’s quite ironic that an ambulance was called by hospital staff… to a hospital. When, according to the article there were two nurses on the scene. The article places the orthopedic surgeon who happened by “eventually” and “moved the woman into a wheelchair” as the hero of the story.

My thoughts here are that the nurses who were called to the scene of the fall most probably identified the woman as being at a high risk for further injury from additional movement as evidenced by the fact that she had a previous arm fracture and what I would guess to be an obviously fractured hip. Their concern was probably that further movement of the patient in an incorrect fashion would have aggravated her injuries and could have resulted in further damage. As far as I know, Canadian nurses (like their US counterparts) aren’t trained to move patients with potential spinal injuries and obvious hip fractures who aren’t prepackaged by EMS crews or otherwise immobilized. They also most probably did not have access to the proper equipment needed to do so. In fact, the physician who picked up the patient “with the assistance of an aide” and placed the woman in a wheelchair would have been lambasted if he were a paramedic. While I’m going to assume that an orthopedic surgeon would have extensive knowledge of the human skeleton, it’s not exactly optimal care to bend a hip fracture the 90 degrees to move a patient from a supine (or prone) position to an upright seated one. In this case, packaging the patient on a long spine board with full cervical spinal precautions would have been the best medicine. Everyone has their areas of expertise and as we’ve all observed, or at least became aware of by watching the trial of Dr. Conrad Murray in the MJ death fiasco, doctors aren’t always the best experts in emergency care. That’s what Paramedics and EMTs are for. EMS people are the “Masters of the Acute”. Our specialty is those things that are happening in the here and now. It would have been irresponsible for the nurses to move the patient in this article without having the requisite training and equipment and even the physician that did move her risked causing further injury. While the article lauds him as the hero of the situation, the headline just as easily could have been about how he paralyzed her or lacerated her femoral artery when he moved her obvious fracture 90 degrees.

In my opinion, the statement of the hospital administrator is laughable. It’s doublespeak and must have been given for purely political reasons… I hope.

From the article:

“The supervisor of the Niagara Health System said the incident stemmed from a communication problem among staff.

“We shouldn’t have called the emergency room,” said Dr. Kevin Smith, who was hired on to aid the beleaguered region at the end of August. He said when a person is hurt in hospital, staff should call a “code,” meaning a team — not necessarily in the ER — is paged to help immediately.

When asked why staff felt the need to call for an ambulance, Smith said that may have been an old rule at the hospital. He said staff has now been briefed on the correct policy and a review is underway.

He could have mentioned any of the above things that I mentioned and it would have been just fine. It might have even been a non-issue if Canada’s less-litigious society is taken into account. Instead of stating that nurses aren’t paramedics and aren’t trained to do the same things, he backpedaled and blamed “communication problems” and “old rules”. I can’t say… but maybe this hospital administrator just doesn’t get the difference in emergency healthcare professionals either.

The writer of the article sure doesn’t.

We need to get the word out that EMTs and Paramedics are highly specialized emergency healthcare professionals with expertise in handling acute emergency situations. We are not interchangeable with other healthcare disciplines. Saying that a nurse or even a physician is a good substitute for a paramedic is missing the point that emergency healthcare is different than other specialties. EMS is truly a specialty requiring expertise, practice, and study. A person cannot just be thrown into the position and be expected to perform… no matter what the setting of the emergency happens to be.

This article provides our profession with a teachable moment. I just wish we all had the ability to seize upon it and spread the right message.

The safest place to have a medical emergency? It’s right next to a paramedic. No questions here.

Posted by on October 31, 2011 • Filed under: Ambulance, Emergency Medical Services, Emergency Nurse, Emergency room, Emergency Room Nurse, EMS, ems education, EMS Management, EMS Topics, hospital, News, Paramedic, Patient Management, politics, RN

Blood Pressure – Vital Knowledge for EMS

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The blood pressure is one of the most ubiquitous diagnostic tools used in medicine and has a sacred role in EMS. Every EMT and Paramedic needs to be able to get an accurate blood pressure from every patient, every time. It is so widely regarded throughout medicine as a useful diagnostic tool that it’s considered to be one of the “Vital Signs” and pretty much everyone reading this has either taken someone’s blood pressure, and/or has had theirs taken many times.

Of course we know that the blood pressure is the measure of the heart’s ability to pump blood throughout the body. It’s simple, right: Cardiac Output – Vascular resistance = BP. The blood pressure is represented as a number *slash* number, or “Something *over* something” measured in “mmHg” (millimeters of mercury). These numbers represent the “Systolic” and the “Diastolic” pressures, with the Systolic blood pressure meaning the peak fluid pressure of blood flowing through the arteries at “systole”, or the heart’s peak contractile force; and the Diastolic blood pressure measuring the pressure of blood in the arteries when the heart is at “diastole”, or at rest. EMS people use the blood pressure to see how well the patient is “Perfusing” or circulating blood and the oxygen and nutrients it carries to the end tissues it supplies. “Hypotension” is too low of a blood pressure and can result in tissue damage, tissue death, and/or Shock; and “Hypertension” is too high of a blood pressure and can result in all kinds of short and long-term damage to the body, including heart disease, kidney disease, stroke, and many other chronic conditions. In EMS, we use the blood pressure as an important diagnostic tool in such things as trauma to measure blood loss, and also in medical care to determine shock or cardiac compromise.

But we all know the basics, right? Good, if you’re an EMT, you probably should know all that. However, you may not have heard these terms:

  • Pulse Pressure: The difference between the Systolic Blood Pressure and the Diastolic blood pressure. For example, a patient with a BP of 120/80 has a Pulse Pressure of 40mmhg.
  • Stroke Volume: A measure of the volume of blood ejected with each beat. (Stroke volume + Pulse rate = Cardiac Output)
  • Preload: A measurement of the pressure left in the vascular system during Diastole (Or “Left Ventricular End Diastolic Pressure” I’m just going to call it preload)
  • Afterload: The pressure that chambers of the heart must generate in order to pump blood. In the case of the Left Ventricle, it’s the pressure it must create through contraction in order to pump blood into the aorta.

(For everything else you’ve ever wanted to know about blood pressure, read this: “Overview of Blood Pressure” by John Ross)

What if there were more things that taking a patient’s blood pressure could tell you about them?

There are, of course. The blood pressure is way more useful as a diagnostic tool than most EMTs and Paramedics realize. Here are some of the things that the simple blood pressure can help you learn about your patients and the care they need:

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It can diagnose Orthostatic Hypotension

Have you ever seen a medical provider take “Orthostatic Blood Pressures?” These are taken as three consecutive blood pressure measurements taken with the patient in the Supine (laying down), Sitting upright, and Standing position. To properly perform this, have the patient lay supine for five minutes and take a baseline blood pressure measurement. Then have the patient sit upright, wait two minutes then take their blood pressure. Repeat with the patient in a standing position. If the patient gets dizzy for more than a minute with positional changes, that’s a positive sign for orthostatic hypotension, as is a drop in systolic blood pressure by 20mmhg between readings.

What does this mean?

Well, it can mean that the patient is dehydrated, is experiencing hypovolemic shock, has some type of cardiac compromise or an arrythmia, is anemic, has a problem regulating their blood pressure, has an electrolyte imbalance, and a few other conditions. It can also be caused by medications such as Beta Blockers or even Viagra. Orthostatic Hypotension is also a common cause of Syncope, or fainting. It’s an important assessment finding to record in your patient care report and to pass on to the receiving facility.

(Read More? http://www.medicinenet.com/orthostatic_hypotension/page2.htm)

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It can help diagnose a Thoracic Aneurism

The arms are the most common places where the blood pressure is measured. The blood pressure cuff aka a “Sphygmomanometer” is wrapped around the arm at the bicep and applies pressure to occlude the brachial artery. The brachial artery is supplied by the subclavian artery, of which there are the Right and the Left subclavian arteries respectively. It has been shown that there may be a normal 10 to 20mmHg difference in blood pressure between the arms in a small minority of patients. Therefore it is important to take blood pressure readings from both arms when diagnosing hypertension. It is also useful to note when there is a difference in readings above 20mmHg from one arm to another. This can be a sign of Increased intra-thoracic pressure, a Thoracic Aneurism, or something called “Subclavian Steal Syndrome”.

In a thoracic aneurism, a condition with a mortality rate reaching up to 80%, the aortic arch in the chest is compromised. This results in severe pain (usually described as “ripping” or “tearing”), hypotension, and usually death if it ruptures. As the aneurism tears, it compromises the entrance to the right subclavian artery before the left, causing the blood pressure in the right arm to drop. This is an important diagnostic tool to use in diagnosing chest pain and should be documented.

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 It can help detect increased intrathoacic pressure and other conditions

The thoracic cavity is the area commonly called the chest and is the area above the diaphragm protected by and enclosed in the rib cage. As we know, there are a lot of important things in there that humans need functioning properly in order to, you know, live. Pulsus Paradoxus is a condition where the heart’s pumping capacity is compromised by the thoracic pressure and the blood pressure rises and falls with inspiration and exhalation. The blood pressure drops (and sometimes even the radial pulse disappears) with inspiration and rises again with exhalation based upon the volume/pressure of air in the chest. The “paradox” results from the fact that you can hear cardiac beats on auscultation of (listening to) the chest, but cannot detect them with the blood pressure and/or pulse.

What does this mean?

Lots of conditions can cause Pulsus Paradoxus and roughly they can be broken down into three groups: Cardiac causes, Pulmonary Causes, and Other causes.

First, let’s give a nod to the other causes, the non-cardiac and non-pulmonary causes, which are Anaphylaptic Shock and an obstruction of the superior vena cava.

The cardiac causes can be:   (and THANK YOU Wikipedia for being smarter than me and very accessible)

  • cardiac tamponade – A “bruise” of the heart resulting in the pericardial sac filling with blood that cannot escape and compromises cardiac function. (Treated with a pericardiocentesis, which some EMS providers can do in the field. I can).
  • constrictive pericarditis – Inflammation or purulent (puss-filled) infection of the heart which compromises pumping ability.
  • pericardial effusion – Fluid around the heart
  • pulmonary embolism – A blockage in the pulmonary artery or vein
  • cardiogenic shock – Impaired pumping ability of the heart due to cardiac damage or other compromise. Commonly seen in severe myocardial infarctions. (Heart attacks)

It can also be caused by pulmonary (lung) conditions, such as a tension pnuemothorax, COPD, and sometimes in severe and acute asthma, where the patient traps so much inhaled air in the lungs that they cannot exhale the excess pressure due to the inflammation of the air passages.

When you see these signs, make sure to take multiple blood pressure measurements to trend the patient’s progression. Calculate their Pulse Pressures, as cardiac tamponade, tension pneumothorax,  and other conditions are characterized by narrowing of pulse pressure and compromised cardiac output also resulting in hypotension.

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 It can help detect a closed head injury, stroke, or Intracranial Hemorrhage (<– that’s an excellent link)

Cushing’s Triad, aka Cushing’s reflex, is a group of symptoms that has been shown to reveal increased intracranial pressure (ICP), the pressure within the cranial vault around the brain. This reflex shows three distinct signs which are predictive of Stroke (both ischemic and hemorrhagic), intracranial bleeding, head trauma, and some other conditions that raise ICP. These signs are:

  • Slowed pulse rate
  • Markedly increased systolic pressure (high BP) with widened pulse pressure, as the diastolic pressure usually stays normal, and:
  • Irregular breathing (Cheyne-Stokes pattern respirations)

Any time you suspect an injury or condition that may raise ICP, check the blood pressure and look for Cushing’s Reflex. It can help you zero in on the patient’s condition.

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Here are some tips for making sure your blood pressures count:

  • Automatic BP cuffs do an ok job of measuring the blood pressure in a routine setting, but they have weaknesses. They cannot detect pulsus paradoxus, they give wildly inaccurate readings in bradycardia (slow heart rate), and they’re very much affected by the bumps in the road felt in the back of an ambulance. TAKE AT LEAST ONE OR TWO MANUAL BLOOD PRESSURES.

 

  • Can’t hear the systolic pressure? Take a palpated blood pressure by feeling the radial pulse while you deflate the cuff. The first pulse you feel = a reasonably accurate systolic pressure.

 

  • As with a lot of diagnostic tools, the first blood pressure measurement is a spot-check. The second reading creates a trend and reveals a lot more information. Take them every 5-10 minutes on critical patients, and every 10-15 on stable ones, keep mindful of the pattern.

This is by no means an exhaustive list, but it should give you some more respect for the humble blood pressure. As always, follow your local protocols and medical orders and this article isn’t meant as medical advice. Keep learning out there.

Also, feel free to add things in the comments section. I’d love to see what I missed.

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Want to learn more stuff about stuff? Check out:

 

 

Posted by on June 20, 2011 • Filed under: Ambulance, Emergency Medical Services, ems education, ems narrative, ems patient care report, EMS Topics, EMS training, Fire Rescue Topics, Paramedic, paramedic education, Patient Assessment, patient care, Patient Management, Training & Development, training-fire-rescue-topics

Eight Ways you can Ace your Patient Assessment – EMS

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The patient assessment is probably the most important skill every EMS person should master in order to be a truly exceptional EMT. No matter the call, no matter the patient, the EMS provider needs to be able to rapidly zero in on a complaint, make a working diagnosis, and provide adequate treatment for the patient’s condition. This skill is more important than any other simply because if you don’t know what is going on with the patient, you can’t know how to treat them.

Patient assessment has been taught many ways over the years by different versions of the EMT curriculum. I was taught that each patient gets three different types of assessment during the course of an encounter with EMS. These are: The Primary Assessment, the Secondary Assessment, and the Ongoing Assessment. Each of these three types of assessments is valuable to the EMT or Paramedic in determining what is really wrong with the patient. They’re designed to function in concert, each giving more information to the EMS provider that they can use in formulating an effective treatment plan. The more detailed they are, the better treatment decisions they allow and the better the patient’s overall progression through the healthcare system will be. Every patient should get all three of these assessments. EVERY PATIENT, EVERY CALL, EVERY TIME. Whether the call is a 911 emergency fall off of a cliff or a simple discharge back to a nursing home, every patient you come into contact with in your entire career should get your best assessment. It’s something you just can’t skip.

Take a look at the three general types of assessments:

  • The PRIMARY ASSESSMENT: The quickest assessment in the EMS toolkit, it is the first impression you make of your patient. It is intended to rapidly identify life-threatening conditions and facilitate immediate stabilizing treatment. In this assessment you should check for Airway Patency (openness), Breathing (Rate, quality, presence), and Circulation (Pulse, blood pressure, and Skin perfusion – Color, temperature, and moisture). You should also check for gross deformity, major trauma and/or blood loss, or anything else that may cause the patient to crash. If found, you should act immediately to provide stabilizing treatment. This is also where you should determine the chief complaint, the need for spinal immobilization, and form your general impression of the overall patient condition.

 

 

  • The Ongoing Assessment: The previous two assessments are useful in determining your patient’s baseline presentation and making your working field diagnosis. However, your assessment doesn’t stop there. The Ongoing Assessment is used to monitor changes in the patient’s condition and to get a trend of their progression, good or bad. You can measure the effectiveness of your treatments and see how their condition is progressing. This could be as simple as asking a patient “Do you feel any better or worse?” and rechecking their vital signs, or as in-depth as redoing your entire secondary assessment. Monitor every patient closely for changes. Recheck vitals every 5-10 minutes for compromised patients, and every 10-15 for stable ones.

Here are some tricks you can use to nail your assessment:

  1. Just Do It! – Remember, you can’t over-assess your patient. The more information you get the better. Every patient gets a full assessment, every time. Even if you can’t act on the information you gather, the information could prove invaluable to healthcare providers further down the road. They need good information on the acute phase of the patient’s illness. Remember, the EMT is “the eyes and ears of the physician in the field.” You’d never see a physician diagnose a patient without a thorough exam, don’t skip it either.

 

  1. Standardize! – Develop a standard assessment that covers at least all of the stuff I talked about above, and do it every time. Start at the head and work your way down. Think up a set of questions you want to know the answers to about your patient, and answer them every time. Not only will practicing the assessment get it down to a science, you’ll also get very quick at it. This also can help you with your narrative report writing. You can put the answers to all of your questions in your patient care report, and that’s a great way to write a narrative.

                                                    

  1. Start your assessment the second you arrive on scene – Start gathering information about the patient immediately. Note the ambient temperature. Note the condition of the patient’s living space and where you found them. If the patient is at home, look for adequate food and water. Check for disease vectors such as filth. You may want to ask the patient about their living conditions later, such as asking them if they’ve been sleeping upright in a chair when checking for CHF. Any information you gather is useful.

 

  1. Check THESE THREE THINGS when you first encounter the patient – Always introduce yourself to the patient using your name and while you’re doing this, feel their radial pulse with your fingers. This tells you three immediately important things that will drive the rest of your care: The status of their Airway, Breathing, and Circulation. You’ll feel the rate and quality of their pulse; feel their skin temperature, moisture, and condition; and be able to assess their work of breathing when they answer you back from your introduction. If any of these things are compromised… the patient is probably sick and in need of intervention.

 

  1. Try to determine the patient’s ultimate diagnosis – What, you’re scared of making a diagnosis because you’ve heard that medics don’t diagnose? That’s BS. We diagnose all the time, we just don’t make the final diagnosis. Call it a “Field Diagnosis” if you want, but I say you should try to piece together the symptoms your patient is having and try to diagnose the cause. If you don’t know the answer, fire up the Google and do some research. You’ll be surprised at what you can learn that way. Also, talk to the receiving physicians and nurses at the ER. You’ll learn a vast amount of information that will make you a better provider overall.

 

  1. Be as thorough as time will allow – Certainly, there are times where an EMT will be focused on immediately stabilizing treatment, such as airway management or hemorrhage control and won’t be able to hit all of the possible nooks and crannies of a patient assessment. However, most patients aren’t that severe and you’ll have time to gather all of the information you can. The more you assess the better information you can collect and pass on. Check for such things as: Pulsus paradoxus; a difference in blood pressure between the arms; the Babinski Sign; hidden trauma; Cushing’s Triad; and many other interesting things. You’ll learn a lot, and might just catch a few zebras.

 

  1. Don’t afraid to touch the patient – You’re a medical person. Medical people touch other people. Sometimes they see them naked. Sometimes it’s uncomfortable and sometimes you have to touch them in a way that wouldn’t otherwise be socially acceptable. Of course, don’t do anything wrong, illegal, or immoral… but when you’re checking for a broken leg you have to touch the leg. Actually Look at, Listen to, and Feel your patients. Be a professional.

 

  1. Know what “normal” is, and look for things that aren’t – Eventually, once you master the art of determining what a normal presentation is, the things that are abnormal will jump out at you. Once you’ve practiced and honed your assessment skills, you’ll be able to see any abnormalities with relative ease. It takes practice, but developing the skill is well worth the effort.

Employ these tricks and you’ll be well on your way to mastering the art of the assessment. Always learn and strive to improve your craft. Keep your eyes open and absorb new information. Pretty soon you’ll be amazing your colleagues with what you know and what you can tell them about your patients.

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Want more information on the patient assessment?

Read – Assessing Greatness: Catching the stuff you’re supposed to

Or – Ten (or so) Things You Should Try to do with Every Patient

Also, Check out TheEMTspot.com’s “Mastering the Head to Toe Assessment”

Posted by on June 13, 2011 • Filed under: Ambulance, Emergency Medical Services, EMS, EMS practice, EMS Topics, EMS training, paramedic education, Patient Assessment, patient care, Patient Management, Training & Development, training-fire-rescue-topics

Keeping an Eye on the Sky

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If some of you out there don’t know it yet, I’m away from my home area working one of my jobs in another state. I’ve been gone for just over a month at the time I write this and I haven’t gotten my end date quite yet. I may be here a while longer.

Last night I came back into my hotel room and turned on the TV to find none other than Jim Cantore on the screen talking about my home area. Apparently, the wrath of Mother Nature isn’t limited just to other areas of the country. My area took it pretty hard last night and thank goodness there weren’t any injuries.

My girlfriend (Oh yea, I have one of those now by the way, which you would know if you followed me on Facebook or Twitter) was driving my car during the storm and just happened to drive right into the heart of the gust line, the leading edge of this monster storm. She ended up taking the brunt of it and had to leave the car and take cover in a ditch (Which by the way, is the smart thing to do) she got scraped up a little bit by flying debris and all; but thank goodness… the car is fine. (Love ya honey!)

This storm blew up quickly and just exploded out there. To my knowledge, there wasn’t a tornado formed, but the wind gusts were reported at upwards of 80mph and were forecast to hit over 100mph. The rain was torrential and the storm lasted a long time, lashing the area with high winds for quite a while. It was a bad one, but thankfully not as bad as other areas of the country have been getting. There was some damage, and my local Facebook buddies have been posting pictures of it on their accounts all morning. It could have been much worse, but it was pretty bad by itself. It certainly was a wake-up call.

Talking to my girlfriend on the phone last night after her scary ordeal she told me how she figures she was able to be caught off-guard by the storm. While she drives, she listens to MP3s rather than listening to the radio and therefore did not hear any severe weather warnings. She said that as soon as she saw how bad the storm was getting that she turned on the local radio, but by then it was too late… she had driven right into the path of the oncoming fury. A few days prior to this, I had discussed with her the possibility of employing underground storm shelters in our area and she said how she thought it was overkill. She didn’t think that we had bad enough weather in our area. I assured her we do get bad enough storms often enough, but the conversation didn’t go much further. Storm preparedness, like fire safety, is not a flashy topic. It doesn’t seem to be taken seriously until after something happens. However, as Mother Nature has proven to us this season, we need to be prepared.

The girlfriend is a smart lady, very smart actually. She’s not one to be taken off-guard by anything and can handle most anything that comes. This, however, was a surprise to her and I’m sure it surprised a lot of other people as well. It’s not that we don’t get storms like that in my area, in fact they come quite frequently, but people are still complacent about them. They just don’t think that it could ever get that bad, no matter what they see on the news happening in other areas. There are a lot of things in our society that are affected by our natural tendency to become complacent in our contemporary lifestyles. There are lots of things we just seem to forget can happen to us when we’re caught unaware by the realities of our world. Everything from storm preparedness, to fire safety, to cardiovascular health, to crime prevention, to drinking and driving, to most of the behaviors that keep EMS in business can be attributed to this fact. It’s just how we’re wired, I think.

If I can offer you all out there any advice, it would be to consistently remind yourself of the need to be aware of your surroundings. Maybe it’s the fact that as a paramedic my life is spent cleaning up the messes of the more unwary of those among us, but I tend to believe that most “accidents” can be attributed in most part to a lack of planning and situational awareness. I don’t want anyone to be afraid of living their lives, but keeping an eye on the horizon seems prudent these days. Don’t be caught off guard. I need all of my readers out there and want you to be safe.

Also, if you’re driving and you see or suspect severe weather, turn on the radio and turn off the CD or the MP3 so you can hear emergency broadcasts. It might just save your life.

Have you been to these websites yet?

As always folks, stay safe out there.

Posted by on June 9, 2011 • Filed under: Ambulance, ckemtp, Emergency Medical Services, EMS, EMS Health & Safety, EMS safety, EMS Topics, FEMA, Fire Rescue Topics, first responder, Paramedic, severe storm pictures, Training & Development, Uncategorized

We Oughta Look In to This – EMS 2.0

3 comments

It looks like something has been right under our noses all this time, and I think that it just might be looking into.

Mobile Doctors: Http://www.MobileDoctors.com

Yep, you read that website address correctly, and yes, it really is a group of Primary Care and other physicians that make house calls their business. In fact, according to their website, they make around 5000 house calls PER MONTH in the Chicago, Detroit, Indianapolis, and Phoenix areas. The website also says they’ve been around since 1996.

I came across this ad today as I was surfing around and I was curious enough to click on it. I read their website with some interest, and their claims started sounding awful familiar to me. If you’ve been following the EMS 2.0 and Community Paramedicine movements, you’re probably familiar with what they say as well. It’s pretty much what we’ve been talking about. Read this:

“Our team of healthcare professionals specializes in chronic disease management and care plan development. This results in a significant reduction of emergency room, hospital and nursing home admissions for our patients.”

Also, this:

“Our practice focuses on primary care/internal medicine, podiatry, and diagnostic testing. Our goal is to provide high quality, responsive in-home health care to stabilize patients, improve their health, manage their medications, and reduce hospitalizations and ER visits. We also coordinate patient care with home health agencies, durable medical equipment providers, hospitals, and other medical professionals.”

Huh.

Those two short paragraphs in their static, online brochure of a website are quite obviously advertisements for the services they provide… but aren’t those the things we’ve been saying with the whole EMS 2.0 thing? Isn’t that what we want to do? To expand our service offerings and reduce inappropriate use of emergency healthcare while increasing overall wellness through primary care, that’s the point of it all, right?

Well here’s a company, albeit very much a physician driven company, that’s been making their living off of doing just that since 1996. In addition, they take Medicare.

I think that there’s something we can learn from this company and their business model. It’s worth a look at their website: Http://www.MobileDoctors.com. Sometime in the near future I plan on contacting them and asking them about how their company can interface with EMS.

Till then, take a look at these two posts and see what you think:

Primary Care Paramedics? I think it’s time

Are We the Gatekeepers to the Emergency Healthcare System? EMS 2.0

Posted by on June 8, 2011 • Filed under: Ambulance, Emergency Medical Services, EMS, ems 2.0, EMS Management, EMS Topics, Paramedic, physician, politics, Uncategorized

Heart Attack? Call 911 – Don’t just burp

7 comments

“I’m just sore… I must have pulled a muscle in my chest or something.”

“I keep taking these antacids, but they’re defective or something. They aren’t working like they should.”

“I have drank like 5 sodas… if I could only belch I would feel so much better!”

If you’ve been in the EMS business long enough I’ll bet you have heard those exact words before from different people in disparate situations. They’re describing the uncomfortable feeling their having, and not the one they’re sure they’re not actually feeling in their chests. They’re describing to you the uncomfortable feeling they’re having within their psyche. They’re describing fear. They’re describing doubt. They’re describing the hope they want to have that they’re not actually feeling pain in their chests. They don’t want to be having something wrong with their hearts. They don’t want to be having a HEART ATTACK. This couldn’t be happening to them… this can’t be. They’re sorry they bothered you with a silly 911 call. They didn’t want to have all this fuss made for them by the ambulance and the fire truck and the police officers and the ER staff and the Doctors. This is all just so silly! Can’t we all just understand that if they could only belch that they’d feel better?

But, unfortunately that’s just not the case. That won’t be their path. That won’t be happening for them today. Today, they’re having a myocardial infarction and they’ve got a blocked artery in their heart that is causing it to tell them something… they just don’t want to listen. Honestly, the artery in their heart has been narrowing for a while now, they’ve just been ignoring the warning signs and not taking care of the problem for so long that their heart is becoming annoyed with them. Today, it is getting downright angry at them. Soon, their heart might just become “Pissed Off” and go on strike if they ignore what it’s telling them. Today it’s screaming at them and they’re still trying to do just that… They want to ignore the feeling they’re having, but now they’re scared and they’re starting to bargain. They don’t want to be someone who’s having a heart attack. This can’t happen to them. They don’t have heart attacks. That is something they’re worried about happening to other people, you know… people who aren’t them.

And yet the pain is there. It’s constant. They can’t seem to shake it or rationalize it away. Belching won’t help, and neither will taking antacids, drinking water, stretching, breathing deeply, or calling their friends to ask them about it. The pain, the weird feeling, the sickness, the dread… it’s not stopping and now it has been going on for hours.

And now? Now it is getting worse.

Fear creeps into these patients quickly but still they deny that anything is really wrong. When finally they present for treatment, whether by driving themselves to an urgent care center, by calling their doctor, or by even going to the local emergency room, they’re always shocked and in denial when they’re told “This could be a heart attack”. They defensively react and think that the medical care that is being “forced upon” them is “stupid” or unnecessary, or is “Just too much fuss”. They will still try to not believe it… well, part of them will try. They usually maintain a front. They don’t want to know that they could be indeed having a HEART ATTACK and that now is the time they need to trust the medical profession more so than they ever have trusted it in their life. They can’t fix this on their own, they can’t wish the pain away, and they can’t self heal the problem. By this time… no rationalization or self-healing thing will work. They need hard, conventional medical care… and they need it now.

As a paramedic, I have seen the type of patient I’ve described above many, many times. I have diagnosed acute myocardial infarctions in multitudes of patients who were angry at me for bestowing even the possibility of the diagnosis of “Heart Attack” upon them. Some have sworn at me, some have been relieved when I believed them, and all were scared. As a paramedic, I can diagnose and begin treatment on many types of cardiac conditions that fall into the “Heart Attack” category people fear so much. Paramedic and Ambulance care in the first stages of a heart attack can make a huge difference in how bad it gets and how much damage is prevented. Ambulance care during a heart attack saves not only lives, but it saves muscle. Consider the fact that during a heart attack, 1% of heart muscle is lost EVERY MINUTE it is left untreated. EMS can intervene, make a working diagnosis, and provide treatment and medications that will help slow or stop the damage.

And people really just need to forget about doing anything else other than calling 911 when they may be having one.

Really, if you’re even the least bit concerned that you could be having a heart attack, you should drop everything and just call 911. Don’t call your mom, your son, your friend, your spouse, or even your doctor. Call 911. Don’t do anything else… call 911 and just sit there. Someone in an ambulance will show up that knows what they’re doing. They’ll help you and you need their help. Now is the time to trust them and to let them do their job. Don’t ignore the pain, don’t worry about bothering them, and don’t feel bad for asking for help. You need an ambulance. They’re the best thing for you.

As a paramedic or EMT who is presented with a patient like this, you have a hard job. Not only must you provide appropriate diagnosis and treatment, but you also have to convince the patient to believe you and allow appropriate care. Reading a 12-lead EKG is easy compared to telling the patient and their family that you must bypass the closest hospital that they want to go to in favor of taking them to a bigger hospital, farther away, that has the cardiac surgery capabilities and cardiology services that they really need. This is the time to become a politician. This is the time to earn trust. This is the time that your skills as a caring and compassionate healthcare provider are going to be put to the test.

And if everyone stopped ignoring the problem and trusted their feelings, a lot of lives would be saved.

In the community that I serve, it is actually better medicine for a person having a heart attack to call 911 than it is for them to present to the emergency room. Even if that person immediately presents to the ER at the first warning sign of a heart attack, the ambulance still would have provided better care for them. Today’s ambulances bring appropriate care and highly trained medical professionals right to the patient’s side. Paramedics and EMTs can recognize the signs, help rule out mimics of a heart attack, perform diagnostic tests and an EKG, and can begin treatment with medications that stop, slow down, or even reverse the damage to the heart tissue in progress. The paramedics or EMTs in the ambulance can communicate with cardiologists and ER physicians at the local facilities and have a system in place to bring patients having a heart attack right into the facilities best prepared to take care of them, bypassing facilities that cannot provide the surgical intervention they may need… right away. Being immediately and appropriately treated by a paramedic and the emergency cardiology team early enough in a heart attack can make it almost seem like no big deal.

And that’s what we all want our heart attacks to be if and when we have one: No big deal.

So I’m telling you all out there. Don’t guess, don’t rationalize, and don’t hope it will go away. At the very first realization that the feeling you’re having, the pain, the ache, the soreness, the unusual heartburn, or however you describe it may be a heart attack; Call 911. Then sit and wait for us. We promise we won’t be mad if it’s something less serious.

But you’ll feel better, much better, no matter what it is.

Please, just call 911.

Posted by on February 9, 2011 • Filed under: Ambulance, attack, Emergency Medical Services, Emergency room, EMS, EMS Topics, letter to the editor, Paramedic, Public relations, STEMI

You Can Nap if You Want To! Or You can Leave Your Calls Behind!

17 comments

What a week! You’ve been pulling at least a double shift a week at your full-time ambulance job and have been hitting it pretty hard at your part-time job as well. Both services can’t seem to keep their schedules filled and everyone’s been working lots of hours in order to keep the doors going up and the trucks going out. To top it all off, the citizens just can’t seem to be good lately and both services’ call volumes have been high.

You were tired when you got up this morning and were seriously considering a nap after your morning shower, but after a gallon or two of coffee you were bright and shiny in your uniform at your station, ready for another day of EMS greatness.

That was five hours ago though, and the early barrage of calls fired at you this morning has turned into an afternoon lull. Now you’re sitting at your main station, close to the brass, with the words in the educational article you’re reading fading in and out of your bleary, cross-eyed vision. Since the activity level has decreased, you’ve gotten yourself a case of the sleepies that you just can’t shake. Since you’ve been consuming the steaming bean juice religiously lately, your stomach just won’t let you think of having another cup of the acrid station coffee and there’s no shift chores left to do, since you did them an hour ago fighting the same lethargy.

Unfortunately, in three hours you can see a long distance transfer scheduled that you’re probably going to have to do. Four hours of monotonous highway driving and the radio in the truck doesn’t have that great of reception. You don’t have any idea how you’re going to stay awake enough to drive the truck and that’s not even considering the fact that if the tones went off right now for an emergency you probably wouldn’t remember how to put on a band-aid, let alone remember a drug calculation.

You’re tired, you’re fatigued, and your body’s telling you that you’ve been pushing it too hard. It wants to shut down for a while. Your brain won’t think. You’re mouth won’t talk. You can’t keep your eyes open and wake up with a startle when you’ve realized you’ve dozed off for a bit. This is torture.

Sleep deprivation is no stranger to EMS people. We’ve all fought the lethargy caused by long 24, 48, and more-hour shifts. A great number of us work more than one job to make ends meet and pack as much family time and recreation into our off time as we can. A lot of us are going for more education and all of us get woken up from our sleep a lot more often than is healthy to run on calls. I regularly miss full nights of sleep and rarely have a night when I can say I got a full night’s sleep. We get use to it some of the way, but our bodies just aren’t meant for chronic sleep deprivation. We need to reset and reorder our brains and let our bodies recharge once in a while.

Unfortunately, our communities need us and we have to be there for them. EMS is important and it’s easy to get sucked in.

That’s why in this situation, I have very little dispute with taking a “Safety Nap”.

"SSSS-AAAA-FFFF-EEEE...."

The “Safety Nap” is a quick power nap. A shut-down and reset period where a person who never knows when they may be called to be up all night without sleep can rest and relax for a while and ensure that they’ll be wide awake and alert for whatever they may be called to do. I took an hour last shift around 3pm as a matter of fact. I didn’t get to sleep until 1am afterwards and I was up at 5am for a call. EMS is like that, shift work is like that. We have to ensure that we’re well-rested enough to make quality decisions of the type we have to when they need to be made… and we can’t do them well when we’re drooling on ourselves from exhaustion. One of Murphy’s laws for EMS states that “You know you’re in EMS when your favorite hallucinogen is sheer exhaustion” and I have to tell you, I’ve done that while on duty before. It’s just not safe.

There are problems with this, I know. Some will say that we shouldn’t allow ourselves to be scheduled this many hours and that it’s irresponsible to do so. Well, then they can come talk to my bosses and pay my mortgage. Some people will sleep all day if they let them, and won’t put any effort into their shifts unless they have to. That has to be monitored. With that said, a balance has to be sought. I see nothing wrong with the occasional safety nap and I believe that EMS managers should allow it. They also should be unafraid to throw a cup of cold water on the Rip Van Winkles among us to ensure that they pull their weight with the non-call-response aspects of an EMS job.

What do you think? Does your employer allow “Safety Naps”? Do you take them?

I’d write more but Zzzzzzzzzzzzzzzzzz

Posted by on August 4, 2010 • Filed under: Administration & Leadership, Ambulance, ambulance humor, Command & Leadership, Emergency Medical Services, EMS, EMS Health & Safety, EMS Humor, EMS Management, EMS safety, EMS Topics, EMT, Ethics, Fire Rescue Topics, Firefighter Safety & Health, Management, Paramedic, patient care, Patient Management, salary, shift length, Uncategorized

As AmboDriver Always says… For all you EMS types

2 comments

The good folks over at EMS Magazine and Http://www.EMSresponder.com have seen fit to publish some of my EMS type ramblings in print format. It’s an article on Partnering With your Community as an EMS agency and if-I-do-say-so-myself it’s got some useful information in it.

So take a trip on over to have a read at http://emsresponder.com/print/EMS-Magazine/Community-Partnerships/1$13742 

Or, you could go ahead and wait till your magazine arrives in the mail of course… you do subscribe, don’t you?

Posted by on July 1, 2010 • Filed under: Administration & Leadership, Ambulance, Command & Leadership, Emergency Medical Services, EMS, EMS Management, EMS Topics, Fire Prevention & Education, Fire Rescue Topics, Management, Paramedic, volunteer fire department

Should EMS Improvise? And the Recipe for the “Kaiser Cocktail”

29 comments

Here’s the recipe for what I call the “Kaiser Cocktail”:

  1. Look in the patient’s kitchen cupboards until you find a box (or a bag) of some type of granulated sugar, powdered sugar, or brown sugar. (in a pinch, you can use honey or syrup)
  2. Find one of the patient’s own cups or glasses, wash it if you have to.
  3. Dump a bunch of the sugar in the glass.
  4. Look in the patient’s refrigerator until you find some soda pop or some type of sweet juice like orange, apple, or grape juice.
  5. Pour that in the glass with the sugar.
  6. Mix it up really well with some type of stirring device. Don’t use your pen or your finger. (Your partner’s pen or finger is ok though.) (Not really.)
  7. Serve warm, chilled, or tepid. Garnish with a peanut butter and jelly sandwich.

Have you guessed what the “Kaiser Cocktail is used for? If you’re in EMS I’m pretty sure you may have figured it out. It’s for sweetening up your local mild hypoglycemic… and no, it’s definitely not for serving to my son right before I drop him off with the in-laws for revenge purposes. The Kaiser Cocktail is for those patients who have blood glucose levels in the mid double digits but that still have the mental faculties necessary for drinking fluids and for protecting their airway while they do it. It’s a home remedy of sorts and it isn’t exactly the kind of thing that they teach you in EMT school. It works like a charm every time and I’ve never seen it not be well tolerated by the patients I’ve used it on or by the families that watch me do it. In fact, the families always seem more than willing to help whip one right up when I ask them to do so.

Picture this scenario: Your ambulance is dispatched to the “Known Diabetic with Altered Mental Status” at an address a short 8 minutes away. You respond to a well kept address in a nice neighborhood and are directed into the residence by a twenty-something female who tells you that her grandfather “Just isn’t acting right and won’t get out of bed”. Seeing no obvious hazards, you enter the residence with the granddaughter and follow her to the back bedroom of the residence to find a 60-something male patient sitting on the bed. He acknowledges you when you introduce yourself and you can see that he’s trying to talk but that he cannot seem to form the words. You say to him “Howdy! How are you feeling??” He answers: “Um… hello…” with a normal voice quality. His airway is patent, his skin is pink, warm, and sweaty, and he doesn’t appear to have any hemispheric neurological deficit. His pulse is bounding and regular at the radial and his respirations are normal. The granddaughter tells you that the patient is diabetic and that he takes insulin.

Got the case diagnosed yet? I’d bet you do. The next thing I would do with this patient is to take a quick finger stick glucose check. For the above fictional scenario, the reading would be 40mg/dl (which is um… “something’ MMOL for you British folk). It’s mild hypoglycemia. I ruled out a possible stroke (CVA/TIA) with the Cincinnati Pre-Hospital Stroke Scale and he patient’s cardiac function seems very normal with his bounding, regular pulse rate. The diaphoresis (sweating) and skin color are differential signs of hypoglycemia, and the patient’s past medical history helps clinch the field diagnosis. This patient’s blood glucose level dropped too low for his brain to function normally and he needs more sugar coursing through his veins in order to feed his brain.

You may be wondering why I brought forth such a common, run-of-the-mill patient presentation on the blog today. As pre-hospital providers, we have a few options available for us that could be considered proper care for this patient. Most EMTs have oral glucose paste at their disposal and a growing number of EMT-Basics carry Glucagon for IM injection. EMT-Intermediates and Paramedics usually have both of the previous medications available and almost all of them carry D-50, or 50% Dextrose solution in water, for IV administration. All of these treatments could be considered for this patient; however I would pull out my namesake concoction in this case. Call it experience, but starting an IV and giving D-50 seems like it would be risky overkill for this patient and an IM injection of glucagon saps the patient’s natural reserves of glycogen for quite a while after administration. Patients seem to hate the taste of oral glucose paste (Lemon?? Really??) and one tube never sees to do the trick. We only care two of them anyway.

That’s why I use a Kaiser Cocktail with these patients. As long as the patient can maintain their own airway and there’s not an aspiration risk, I can’t think of any contraindications once you rule out a possible stroke. It’s cheap, easy, and it has worked like a charm for me every time I’ve tried it. I like using it too, as it feels like a “Mr. Wizard” type home remedy that always fascinates the patient’s family members who watch me make it up.

Here’s the rub though, nowhere in my protocols does it give me authority to give a patient any nourishment or fluids by mouth. In fact, I can’t give a patient anything to eat or drink that isn’t specifically allowed by my standing orders. In EMS, even something as innocuous as sugared-up orange juice can be a legal difficulty. Common sense isn’t allowed by lawyers, unless of course they’re saying you should have used some. The reality is that every time I whip up a Kaiser Cocktail, I’m putting my license at risk.

I used a Kaiser Cocktail as recently as of the day I’m writing this post and I’m asking for a debate here. I’d like it if you would please answer some questions for me below the post in the comments section:

  1. Do you think that the Kaiser Cocktail is an appropriate treatment for mild-to-moderate hypoglycemia in a known-diabetic patient with a patent airway?
  2. Do you see any contraindications or risks that I have missed?
  3. Would a tube of oral glucose paste (or tablets, if you use them) be more appropriate than the Kaiser Cocktail?
  4. Should EMS providers be allowed to improvise treatments such as the Kaiser Cocktail for these and other like situations? Why or Why not?

I can’t wait to see your answers.

Posted by on June 21, 2010 • Filed under: Administration & Leadership, Ambulance, Emergency Medical Services, EMS, ems 2.0, EMS ethics, EMS protocols, ems scenario, ems scenario based education, EMS Topics, EMS training, medical ethics, Paramedic, paramedic education, Patient Management, Protocol development, scenario, scenario based training, SMG, SMO

Police Car Drivers, Ambulance Drivers, and their responsibilities

12 comments

Look at the pictures below and see if you can identify the three occupations represented by the people in the pictures.

What are their jobs?

What are their areas of expertise?

What would you expect them to be responsible for?

                                     

 

Yep, pretty much everyone reading this and almost every lay person you can think of should probably be able to answer the above questions. The Police Car Driver chases bad guys; The Fire Truck Driver squirts water at things; and the Paramedic takes care of people who are sick and hurt, right? Sure, their jobs sometimes overlap and so does some of their training, but the jobs and the requisite education and responsibilities are different and separate for a reason. The different roles up there are different, specialized, and require expertise in order to be effectively performed… right?

And before you think that I’m opening the Fire Based EMS can of worms, I want to direct you to this news story I just read on EMS1.com – Kentucky EMTs not called for 5 hours until coroner ruled woman was alive. Go read this and then come back please. It got me all riled up and I’m sure it will you as well.

The moral of the story, is that police officers were called for a dead body found in some bushes some where. They started doing their cop stuff and didn’t call EMS to evaluate the body because their cop training told them that the woman was obviously dead. Unfortunately for all involved, when the coroner arrived he told them that their police-issued medical training wasn’t adequate and that the woman was indeed alive.

And yes, I am 100% sure that nobody intended for that to be the tragic result.. people make mistakes, I know… but:

How many times have you been called out in your ambulance to a potential medical emergency and then cancelled while en route? Have you ever wondered who is cancelling you and for what reason? When we arrive on scene, we evaluate the patient and determine their need for transport. We have extensive training to help us do this and we function within a complex set of laws and regulations to help ensure that bad outcomes like this happen as infrequently as possible. Unfortunately, however, things like this do happen, even to experienced paramedics. How many times have you heard news stories about paramedics calling someone dead only to have them be found alive later on? How many times have you heard about occult neck fractures and other severe injuries being found later even after a patient was evaluated by a physician? It happens, folks… and it happens to us medical people too. Even with the training, knowledge, skills, and experience we have that is specifically geared to emergency medical care that is again enhanced by the fancy tools that we carry with us, we sometimes still make mistakes…

So why in the heck would a police officer, who as stated above chases bad guys and does other kinds of “cop stuff”, want to make the decision that someone was dead or not? It simply doesn’t make any sense to me. I have always been leery of having police officers call us off of medical scenes. Even when I know the officer and trust his or her judgment, I know that my medical training and tools are superior to theirs. That’s the way the system is designed, we do medical stuff and they do cop stuff.

I think that there’s a pervasive trend out there that causes dispatchers to send police units first to things like auto accidents and possible crimes in progress and then potentially forget to send EMS. Most of the time, it’s perfectly ok and turns out just fine. Other times, incidents like the above happen. How many times, also, has a police officer determined an auto accident to not require medical response and an occult injury been found later? I don’t know and haven’t seen any statistics… but I’ll bet it happens a lot more than is ever reported.

My advice? I promise to let the cops to their cop stuff. They just need to always remember to call me out to do my stuff. I don’t mind doing the report if I’m not needed or I get a refusal, I just don’t want anyone to suffer needlessly.

Be careful out there.

—————————————————

Want more of my thoughts on Fire Based EMS? See: “Fiddling While Rome Burns… The ambulance “industry”

Posted by on June 15, 2010 • Filed under: 911 fail, Administration & Leadership, Ambulance, Command & Leadership, Emergency Medical Services, EMS, EMS Topics, EMS training, Firefighter Safety & Health, Paramedic, paramedic education, patient care, Uncategorized

When all you have is a hammer… Every problem looks like, lasix?

9 comments

A few years ago I responded to a structure fire on the main engine out of my station. The fire was at a house that had been converted to a dog kennel and grooming shop just a few blocks away from the firehouse and was a short response time. It was a light-staffing day and we responded as a three person engine company. As the senior firefighter I was the acting company officer and my new girlfriend at the time, who just happens to be my wife now, was the backseat firefighter. Get ready for the “Awwww” moment… it was our first fire “as a couple”. There was a number of cool things that came out of the fire, but one of them was the fact that Gina grabbed *my* maul.

My wife and I fighting our first fire "as a couple" - We're the ones in turnout gear

On our main engine, there’s an 8-pound maul (big hammer) that I grab as my tool of choice every time I jump off the truck for a fire. It just tucks so neatly in my SCBA’s belt and is so compact yet handy that I make a beeline for it every time. This time, Gina had taken it, so I grabbed a pick-head axe.

It’s amazing that when I have my maul that every access problem looks like something that I can solve by whacking it with a hammer of some sort. On this fire, I learned that when one has an axe, every problem looks like it can be solved by some sort of chopping.

Moral of the story, Gina and I entered the structure, saved the pooches, and stopped the fire in its trucks with minimal damage. There’s actually a hilarious video that I believe is still on our department’s web site that I’d let you see if I didn’t hide the name of the department(s) I work for due to “I want to remain employed reasons”.

And, like a lot of things on here, I told you that so I could tell you this about an EMS call I responded to an indeterminate amount of time ago. I have the honor and privilege to be the senior medic on most shifts I work and I precept a lot of students on the ambulance. This shift was no different and this 0-dark-30 call illustrates a point that I’d like to explain to you.

The doggies were SHOCKED that Gina took MY maul

For this call, the primary ambulance out of our station responded because they were on the way back from another call and my partner and I responded in our ambulance because we were up on the alternating call rotation. They arrived at the poorly-accessible apartment complex a few minutes before we did and made first patient contact. As it turns out, the middle age patient had ran out of his/her prescription Lasix (a potent diuretic, or water pill) a week or so prior to the call and had been retaining a great deal of excess bodily fluid. The patient’s legs were markedly and grossly swollen and weeping fluid out of fluid filled blisters. The Patient called us because he/she could no longer stand the pain of the cellulitis (infection) that had developed. The patient had no respiratory compromise, his/her lungs were clear, and he/she really had no other complaints. The patient had an extensive medical history of organ failure and disease. He/she was fully alert and oriented, and was able to assist us as we simply picked him/her up and carried him/her to the cot.

As we were loading the patient up in the ambulance and I was about to get into the back to continue my assessment and treatment of the patient, the EMT from the other ambulance who happens to be an almost-done Paramedic student told me, “So those legs are the worst I’ve ever seen fluid wise, you’re going to push some lasix on this one”. I mumbled something and got into the truck. I was tired and wasn’t really able to form complete sentences at the time due to sleep deprivation. I got in the truck and continued my assessment where I found that the frail patient had a blood pressure in the 70 systolic range (Low!) and that in addition to retaining fluid in his/her legs, he/she was also retaining fluid in his/her abdomen and was probably in need of a paracentesis. I managed the patient with a (beautifully executed) IV stick into an impossibly small crooked vein, and gave just enough fluid to bring his/her BP up a bit without adding to his/her fluid overload all that much. I put the Pt on oxygen and a cardiac monitor, which revealed a normal sinus rhythm without ectopy. I obtained a 12-lead EKG as well, which was not indicative of any acute problems. The patient stated that his/her pain was managed by padding and positioning of his/her swollen legs and even though he/she complained of no breathing problems, I put him/her on a bit of oxygen via nasal cannula.

The transport was uneventful, although his/her blood pressure never did come up. The ER later diagnosed the Pt with complete liver failure and toxicity.

But the interesting part of the story is this, when I got back the medic student asked me about giving IV lasix to the patient, as we carry that in our medication stock and have it available as an emergency diuretic for patients in congestive heart failure and/or fluid overload with pulmonary edema and respiratory compromise. He was almost taken aback when I said that I didn’t give any.

I asked him if he did a full assessment. He said that he had tried… but that he didn’t have enough time before I arrived and we took the patient out to the ambulance. I gave him my assessment findings and the news of the very low blood pressure. He said that he agreed with me on not giving the lasix with the markedly low blood pressure but was curious when I explained that it wasn’t the reason I didn’t give the medication.

We in EMS, and especially new providers carry our own hammers… our treatments and medications that we’re able to give in the field. Medics that use these treatments more often are called “aggressive” and it is a badge of honor. In fact, in some cases, aggressive field treatment is indeed warranted and improves patient outcomes. However, in a lot of cases it is not indicated and patients benefit from what we don’t do more so than from what we could have done.

This patient didn’t have any respiratory compromise and while he/she obviously could have benefited from the dieresis or removal of the excess fluid, she didn’t meet the criteria for emergent field administration of lasix, which is respiratory compromise from pulmonary edema. I made the decision to let the physician evaluate the patient and determine the best treatment path that would fit in with the patient’s ultimate plan of care. I didn’t believe that the patient would ultimately benefit from my administration of lasix twenty minutes earlier than the ER could have done it if the physician so chose.

Every treatment we administer must be given with a full assessment of the risks and benefits to the patient for doing so. Every EMS person should familiarize themselves with the long-term care paths of the conditions we treat and try to maximize the long-term benefit to the patient with the acute and short-term care we give. Not every problem is “a nail” and sometimes the hammers we carry aren’t the best ultimate solution for excellent patient care. Remembering how we as EMS people fit into the grand scheme of the overall healthcare system and in the ultimate care paths of our patients will help us all to do what we’re supposed to do, which is to provide excellent and appropriate patient care.

It is also of note, I guess, that Gina rarely steals my maul anymore. Now that we’re married… I “give it freely” to her.. What’s mine is her’s, as they say.

Posted by on June 14, 2010 • Filed under: Ambulance, Emergency Medical Services, EMS, ems education, ems scenario, ems scenario based education, EMS Topics, Fires, funny, In the Line of Duty, Paramedic, paramedic education, patient care, Patient Management, professionalism, scenario based training, stories, Training & Development

Rural EMS – A Fictional Letter to the Small Town Community

17 comments

Rural EMS has it’s challenges, not the least of which are the low pay and long hours. I believe that the lives of those in the sticks are just as important as the lives of those in the city and that rural folk need paramedics too. This is a fictional letter with a very real message. It could be written by a lot of paramedics and EMTs to a lot of people who live out in the sticks and I could have written this letter once when I left my small town EMS service to seek my EMS fame and fortune out there in the Big City. Now that I’ve come full circle and I’m once again working rural EMS I’m starting to wonder when I might have to write this letter again.

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Mr. and Mrs. Penry

1212 Gravel Road

SmallTown, USA.

Dear Mr. and Mrs. Penry,

                My name is Chris and I am a paramedic working for your local EMS service. I live here on Mulberry St. in SmallTown and my parents and grandparents live out here as well. I’ve seen you on the street, at the local café, and pretty much anywhere in town for most of my life. I went to high school with your son, Johnny and thought about dating your daughter once but could never work up the courage to ask her out. I wanted to take her to the prom but I ended up taking Mary Buckrop instead. We sure got us in some trouble with the Sheriff when he caught us out by the lake, but he ended up letting us go. Thank goodness that he turned out to be so nice. He was one of the people that helped me through Paramedic school. He kept telling me that we needed good people for the ambulance out here in SmallTown and I’ve found out that he was right. We do.

                That’s why I’m having trouble writing this letter to you, Mr. and Mrs. Penry. I’ve taken it upon myself to write a personalized letter to everyone in the SmallTown EMS district because I’m facing a hard decision that I’d like you all to know about. I’ve been a paramedic now for the last ten years. I became an EMT and started volunteering with the SmallTown EMS District right out of high school and did that while I worked down at the Grain Elevator and put myself through college over in MidSizeTown. It was there that I decided that I wanted to be a paramedic and I completed my paramedic training at St. MidSize Hospital. I immediately fell in love with the work and I knew that it was something that I always wanted to be a part of. I continued volunteering with SmallTown EMS while I worked a full-time job for MidSizeTown Ambulance Service. I worked there for seven years and got a good bit of experience. I also worked part-time at St. MidSize’s Emergency Room. I still do.

                Three years ago when the voters approved SmallTown EMS District’s referendum to hire full-time paramedics, I jumped at the chance to come on board. This is my home. As cheesy as it may sound, I feel a connection with the people here in SmallTown and I feel that it’s my duty and my calling to protect them with my Paramedic skills. I’ve always studied and trained hard throughout my career to be the best paramedic I could be because I’ve felt it was my duty to be my best. I felt very good about coming on board with SmallTown EMS to protect my Neighbors, family, and Friends here in my hometown.

                Rural EMS is different than is EMS in the city. Sure, we may not be as busy out here in SmallTown as we could be if we were a bigger city, but that doesn’t make it easier on us. People out here don’t have access to primary care since Doc. Walters closed up his shop. While they can drive out to see the clinic in MidSizeTown, that’s thirty miles away. Most people don’t make the drive as often as they should and since people aren’t getting regular checkups and primary medical care they tend to let their minor and chronic conditions get so bad that when they finally call us, it’s because they don’t have anything else they can do. A lot of the time, their minor condition has become life threatening because it got out of hand. We can take them to St. MidSize ER, but they don’t have the capability to do things like perform cardiac catheterization surgeries to fix heart attacks, or to take care of trauma patients that need surgery right away, or to handle complicated patients in their inpatient wards. Their “ICU” is staffed by some dedicated people, but it only has two beds. This means that we have to bypass St. MidSize ER for the bigger hospitals in BigTown and that’s an hour away for us running Lights and Sirens. Because we have such long transport times and because our patients tend to be pretty sick when they call for us, we have to provide critical care level interventions. We carry more medications with us than do the big city ambulances and we can do more things than they can. That’s because ambulances in the city don’t have to be with their patients for as long as we do. They have a hospital within ten to fifteen minutes transport time of anywhere they may be. We have one within thirty minutes to an hour away. The fact that we’re so far away from hospital care forces us to be on our game all the time. We also have to be on call a lot to cover the duty ambulance when it’s away transporting a patient to the Big City. A normal call can take two hours. A critical call can take three or four. If we didn’t listen up, the calls that happen while the duty ambulance is away wouldn’t get a paramedic. I try not to let that happen.

                Here’s the deal, Mr. and Mrs. Penry, I’m not complaining about my job. I love it. I love the work and I really don’t mind all of the hours that I have to put in. While it’s hard on my family to have me gone so often, they have always understood. My wife Mary supports me in my desire to cover the town we grew up in. She has since Prom night. She’s been great. However, we’ve got our new little boy that just turned three this last month and he doesn’t understand why Daddy has to be gone so often. He also is starting to get very expensive, as kids do, and the meager salary I get working in town isn’t covering all of my bills. I took a pretty hard pay cut to come here. I wanted to and thought that I could keep my part-time job at St. MidSize to make ends meet. Unfortunately, since I’m always on call for SmallTown, I can’t hardly work any hours at St. Midsize. We don’t get paid to be on call, only for when we’re on duty and I’d say no to covering… but then someone in town might die because I’m not here to take the second call. I answer the second call all the time, like I did the night of Johnny’s car accident. I’ve heard he’s doing better but I can tell you that he probably wouldn’t be had I not decided to stay home and cover that night. Mary had plans to go to dinner in MidSizeTown but I just wanted to stick around for an hour to make sure the duty truck was back in town. I’m sure glad I did.

                I’m going to come right out and say it. There’s a job opening in BigCity EMS that would pay me twenty-thousand dollars a year more than I make here in SmallTown. I’d be able to work one job and wouldn’t have to put in so many hours away from my family. We wouldn’t have to skimp and save to pay the bills nearly as hard as we do now. I’d love to stay here and take care of my home town but the pay is just too low to survive on. A lot of good people have left since we went full time when they realized they couldn’t survive on the pay. I’ve been doing my best to train the kids that they hired to replace them, but they only seem to be coming here to use it as a stepping stone to a better job in the big city. I think that our town deserves better but I can see why the people would leave. I didn’t become a paramedic to get rich but I don’t think that I deserve to live in poverty because I choose to help my home town. People out here need experienced paramedics just as much as the people do in the big city. The lives of the people in the city aren’t any more important than the lives of the people out here. I feel strongly about rural EMS and I feel strongly about my home town… I just can’t make it anymore. The bank might come take the house and my family doesn’t deserve to suffer because I choose to help those that can’t pay me back.

                So, Mr. and Mrs. Penry, I’m asking you what you think I should do. One day the unthinkable is going to happen to someone and I want to make sure that there are good people to take care of them when it does, but I can’t have my family suffer financially anymore. My kid needs his daddy and my wife needs her husband. The bank needs the mortgage and my student loans need paying off. It’s a tough decision I’m facing and I’m asking the community what they think I should do.

                If you need me, just call 911. I’ll come like I always do. If I’m not on the duty truck you can just stop by the house. You know how to get ahold of me. Say Hi to Johnny for me.

Sincerely,

Chris NREMT-P

Posted by on June 10, 2010 • Filed under: Ambulance, crisis, Emergency Medical Services, EMS, EMS ethics, EMS Topics, Funding & Staffing, inside the mind of a paramedic, Paramedic, paramedic salary, politics, rural ems, Uncategorized

Comfort from a Nurse during EMS week

1 comment

My new blogger friend @SeeJaneNurse, has written a really nice tribute to EMS people on her blog Http://SeeJaneNurse.wordpress.com – Y’all should go read it.

http://seejanenurse.wordpress.com/2010/05/17/896/#comment-1118

Oh, and can someone get her a ride-along?

Posted by on May 17, 2010 • Filed under: Ambulance, appreciation, Emergency Medical Services, Emergency Nurse, Emergency Room Nurse, EMS, EMS Blog, EMS Motivation, EMS pep talk, EMS Topics, EMS week, ems week 2010

EMS Week – Introducing EMS to the Public. Spread the word

4 comments

This is another in my series of posts that you may send as a letter to the editor of your local newspaper and/or put in for publication on your site to use my words to help spread the message of EMS week. You may use this freely, but please keep it intact.

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Barely given a passing thought until the unthinkable happens, the emergency medical services (EMS) are always there, toiling in relative obscurity until the flashing lights and wailing sirens of an ambulance remind you that there are indeed paramedics out there waiting for your call. People don’t tend to think of the ambulance service that cares for them and their loved ones as an essential service. They also rarely think much about them when they aren’t in need of their care. Usually then it’s only to wonder “What is taking them so long!?” instead of wondering if they’re currently bogged down with a lack of resources due to funding constraints and/or abuse of the emergency healthcare system.

Ambulances are a part of every community in one form or another and the US certainly has one of the best EMS systems the world has ever seen. Highly trained paramedics and Emergency Medical Technicians (EMTs) have progressed far past what the public perception of them tends to be and instead of being there only to provide a quick lights-and-sirens rush to the hospital, today’s ambulance is a ‘Mobile Intensive Care Unit’ that can roughly provide care equivalent to the first hour or so of care in the Emergency Room. The focus has long shifted from bringing the patient to care and now focuses on bringing care to the patient. While there are a few conditions that warrant immediate evaluation and treatment by a physician there are many more that benefit from immediate stabilization in the field provided by a paramedic or EMT. In fact, the care provided in the first few minutes of symptom onset by a paramedic can make the difference between a ‘bump-in-the-road’ for your health and long-term morbidity and lasting ill effects.

Think of a paramedic as Emergency Healthcare Specialists focused on the Acute, or care of the “Here and Now”. If it’s happening to you and it’s going to harm or even kill you, chances are that a paramedic can step in and make a big difference in the progression of the disease process. They may not be able to cure you, but they can make a good deal of difference in terms of stabilization and in limiting the long-term harm that you suffer.

Even in the United States, and perhaps especially here in the US, there is variability in the level of care and service provided by ambulance services. Each state has their own individual licensing requirements and the level of authority on those licenses varies greatly due to local control within those states. All paramedics and EMTs function under the ultimate authority of a Licensed Physician to provide “Medical Control” and a system of standing medical orders or “protocols” that the paramedics and EMTs use their medical judgment to pick and choose from based upon their working field diagnosis of a patient’s condition. In my home state of Illinois, the medical direction has provided what some EMS personnel would consider to be conservative protocols while just across the state line in Wisconsin the protocols allow much more breadth in the abilities of the paramedic and EMT to care for the patient. These differences can be caused by myriad factors ranging from the personal prerogative of the medical control physician, to local political pressures, and even to distance to a hospital emergency room. The way that a service is configured also plays a roll, with some private ambulance services having experience in “Critical Care” paramedicine, and some Fire Department based providers focusing on short transport times. Within the industry, there is much debate on the topic of what organizational configuration, Fire-Based, Hospital-Based, Private-for-profit, Private-Not-For-Profit, Governmental Third Service, or otherwise provides for the best operational effectiveness and therefore the best patient care. While the opinions have run very high, it is clear that no one solution will work for every community. The public does need to be aware that EMS is not simply a function of “The Fire Department” or “the hospital” or of anything other than EMS itself existing to provide optimal patient care. The terms “Firefighter” and “Paramedic” are no more synonymous than are “Garbageman” and “Librarian”. The importance is that Paramedics and EMTs focus on healthcare and providing the best quality EMS. However some communities have chosen to combine the functions for a perceived cost savings. You should explore the issue in your own community to see what best works.

And that’s the important part.

EMS is in desperate need of public involvement. We are in desperate need of the public giving us more than a passing thought and actively taking an interest in how EMS is able to care for them and in their own healthcare. For too long, EMS and the Profession of Paramedicine have gone unnoticed. We’ve been suffering from public apathy as acutely as our patients suffer from heart attacks and strokes. Now perhaps more than ever, we need you to help us. We have to raise public awareness and work with our communities to provide the best possible service and the best possible patient outcomes.

Within the industry, there have emerged a few powerful ideas that could have far reaching impact not only upon EMS, but upon the entire healthcare system. Loosely entitled “EMS 2.0”, the ideas have come forth from street-level paramedics and EMTs and represent a “reboot” of the entire spectrum of how we do our work. Imagine if a few regulatory and educational changes could save billions in overall healthcare costs. Imagine if paramedics could improve access to primary healthcare for millions of underserved citizens catching and screening out serious disease before they even result in an acute emergency. It would be game changing, and it has a very real possibility of happening if the public would pay attention to us. It’s your future we’re trying to improve. It’s your health that motivates us to get out of bed at all hours to care for you. By your taking an interest in what we have to say, you could improve the health of your community many times over.

Here’s what you can do. First off, speak with your local EMS provider to see what their immediate needs are. In many communities, EMS is understaffed and underfunded. When was the last time you saw your community’s public works or police departments holding a bake sale to raise operational funds or to buy a new bulldozer or ammunition? Fire departments and EMS agencies do it all the time. Learn about how EMS is provided in surrounding communities and in communities of like size in your state and region. Talk with your healthcare providers and community leaders to ensure that their commitments to EMS reflect the lifesaving importance of EMS care. Local politics kill quality in EMS, communities need to tell their politicians to stop petty squabbles and focus on what is truly important. Learn the issues and listen to the people out on the street providing care.

Another good resource for the public to learn about EMS is to look at industry-specific information provided in the trade journals, online sites, and the EMS blogosphere. Whatever the local flavor of EMS that has developed in your community may be, there may be a better option out there. In fact, there probably is a better way and community members need to demand these better ways from their local EMS service or find, expose, and change local political factors that keep new and more efficient operations away from their local service. Medicine changes, so do best practices, and the public needs to demand the best from their EMS providers. Learn what the best truly is. In discussions with local politicos, scare tactics tend to run the argument. Educate yourself on the issues so that you can make the best possible decisions for your EMS providers and for your community.

For more information:

Http://www.JEMS.com – The Journal of Emergency Medical Services

Http://www.EMSresponder.com – EMS Magazine

Http://www.LifeUnderTheLights.com – The Author of this articles industry-specific EMS blog

Http://www.ChroniclesOfEMS.com – A new television show and videocast being produced by street Paramedics trying to explore EMS in an entertaining and informative way. This could be considered the “Face of EMS 2.0”

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The author, Chris Kaiser, is a nationally registered Emergency Medical Technician-Paramedic licensed in multiple states. He has been providing EMS for over a decade and is a writer and speaker on EMS issues. More from Chris can be found at Http://www.LifeUnderTheLights.com

Posted by on May 15, 2010 • Filed under: Ambulance, ckemtp, Emergency Medical Services, EMS, ems 2.0, EMS Health & Safety, EMS Management, EMS Topics, EMS week, ems week 2010, Paramedic

EMS Week 2010 – Sent to the Newspaper

19 comments

I wrote this post for publishing in my community’s local newspaper. You may wish to send it to yours as well. It’s a generic “EMS Needs Your Support” piece. It might work for any time of the year, but it’s customized for EMS week 2010.

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“Anytime. Anywhere. We’ll Be There” National EMS Week 2010

National Emergency Medical Services Week or “EMS Week” 2010 is coming up this year on May 16th through May 22nd. It is a time to think about the people whom our communities rely on to help us when the unthinkable happens. Every day in our community and in communities like ours throughout the nation, emergencies happen to people just like you and I. These local emergencies may not get the press coverage that the big disasters happening thousands of miles away receive, but to our friends and neighbors these day-to-day emergencies can be just as dangerous and deadly. We rely upon Emergency Medical Technicians (EMTs) and Paramedics to respond and make a difference in our lives. No matter the need, no matter the call, EMS stands ready to serve you.

Logo for EMS Week 2010 - from ACEP

Logo for EMS Week 2010 - from ACEP

EMS is at once the most iconic and visible part of the emergency healthcare system. It is also probably the most misunderstood. Almost everyone can recognize an ambulance and most people have an idea of its purpose. However people rarely give thought to the capabilities and education of the people working inside of it. EMTs and Paramedics have long since evolved from their humble beginnings as simply a fast ride to the hospital. Today’s ambulances are highly specialized mobile intensive care units and today’s EMT attends hundreds of hours of classroom education for their initial certification. Paramedics, the highest level of field medical providers, attend thousands of hours of initial education and internship time and must be masters of acute care. Not only that, but EMTs and Paramedics alike must recertify their license every few years and must attend hundreds more hours of continuing education to achieve their recertification. This training covers all aspects of acute emergency care and is quite intense and rigorous.

Today’s EMS system, with Paramedics and EMTs working in tandem, brings the first hour of Emergency Room care to the patient’s side no matter where the patient may be. EMS focuses upon providing immediate stabilizing care that stops or slows the progression of the acute disease process or damage from any injury, protects the patient from further aggravation of the condition, and impacts their long-term continuity of care. This care reduces Mortality, or loss of life, as well as Morbidity, or future quality of life. Calling 911 during a medical emergency produces better outcomes than does simply driving a seriously ill or injured person to a hospital. Early intervention in cases such as a heart attack or stroke can mean the difference between those conditions leading to long-term disability or a full recovery.

Every community in our region has emergency ambulance services available at a moment’s notice that are simply a 911 call away. Some communities provide Basic Life Support ambulances, with EMT level personnel. These ambulances are supported by Advanced Life Support ambulances and units staffed by Paramedics that can respond with the Basic ambulances to provide advanced level Paramedic care. It is important for people within our community to ask questions and get to know the people responding to their calls for help. Learn about their capabilities and their needs. Pitch in and help where you can. EMS people have always been the absolute masters of doing anything with nothing but we are desperately in need of the support and attention of the communities we serve. It is common for community members to not think about their local ambulance services until the time that they need their services however, EMS needs your support. Americans have always been massively charitable towards disasters happening thousands of miles away when images from them flood our television screens and newspapers, but rarely does that same charity flow to their local emergency responders who are taking care of our friends and neighbors. Your local EMS service needs your support to maintain high-levels of lifesaving service in your own communities. You can directly impact the service that your local EMS can give to your friends, your neighbors, your loved-ones, and even yourself. 

Get informed, get involved, pitch in, and help us help you.

The official theme for EMS week 2010 is “Anytime. Anywhere. We’ll Be There.” EMS has made the commitment to be there for you. This week, please think about how you can be there for EMS. The impact of your support for EMS translates directly back into improving the lives of the people in our communities. As the saying goes, the life you save may be your own.

Respectfully,

Chris Kaiser NREMT-P

www.LifeUnderTheLights.com

Posted by on May 14, 2010 • Filed under: 911, Administration & Leadership, Ambulance, ckemtp, Emergency Medical Services, EMS, EMS Management, EMS Topics, EMS week, ems week 2010, Paramedic, politics, profession, professionalism, Uncategorized

To Kneel or not to Kneel

23 comments
“Muungh… What the heck was that!?” I thought to myself as I looked around the darkened room. “Where am I? Why am I awake? What IS that awful noise?” I thought. Something had awoken me from a not-so-good sleep on a not-so-comfy sofa. Slowly, I realized where I was. “I must have fallen asleep in the day room at the station” I thought. “Why am I awake?”. I heard commotion outside and realized that it must have been the radio that woke me up. Somewhere in the dark subconscious recesses of my brain it came to me that the pager said “Person not breathing, CPR in progress”. I pulled on my shoes and thought the most important thought that any EMS provider can have when being jolted from a deep sleep at 0′ dark 30 to try and wake the dead: “I have to pee!”

 

 

Once the bathroom duty was completed I slid into the passenger seat of the ambulance and pulled up the address on the map program. My partner pointed the ambulance South while I clicked on the siren. Wailing into the night we went, lights flashing, adrenaline pumping, morning breath so bad I could slay a walrus. “Where did I put that mouthwash?” was my thought. So focused on the job were we.

Arriving at the address just behind the engine company from the first due station we hurried to gather up our gear for the battle ahead. Monitor? Check. Airway and drug bags? Check and Check. Backboard? Check that too. We hurry up to the front door and are met by a middle aged female saying “I couldn’t wake him up! He was fine when we went to bed!” We enter the bedroom and I see the middle aged male on the bed. His lifeless eyes were fixed and unseeing as we approached him. His mottled skin was cool to the touch. Long gone was any fighting chance at life. I knelt on the bed next to his torso to check a pulse and apply pads to get a strip and immediately know what is going to happen next.

“I’m freakin going to have freakin dead guy pee on my freakin knees for the rest of the freakin shift! Dang it! Dang it! Dang it!”

EMS people kneel a lot, and not just when we want a raise or need to get state-to-state reciprocity from an EMS office. At one of the departments I work at we did a big action photo spread of all of the EMTs and Medics in action. EVERY SHOT was me kneeling. Kneeling at a patient’s head working on the airway, kneeling at the patient’s chest starting an IV, kneeling next to a patient to assess them after an injury, I kneel so much that you’d think I have a promotion by now. We all do.

But you’d think that by now I’d know enough not to kneel in poo, pee, blood, vomit, or whatever vile substance is on the bed, floor, or surface that I have to kneel on. I mean come on. I’ve been doing this over a decade now. I have thousands of calls under my belt. I live, sleep, eat, breathe, blog, and study EMS as much as I can stand to (and that’s a lot) and I *still* am stupid enough to put my knees in poo on a somewhat regular basis?

Right now, I’m on the 2nd day of a 48hr shift a half hour away from my home. Last night, around late evening I knelt in a poo/pee mixture. I was really trying not to here, but the patient began to vomit after we got (the Pt) on the backboard in the cramped, carpeted bathroom (the Pt) was in. I couldn’t log roll (the Pt) without kneeling and the carpet was just saturated with a vile mixture of hours old poo/pee. My knees got soaked in it. And no, if you are asking, I ran out of the house late and didn’t think to bring an extra pair of pants and the pants that I had kept at the station had been taken home for laundering after another like incident.

For times like these, I recommend the “Ckemtp” method of knee disinfection. It applies for those times where call volumes don’t allow you to actually take your pants off to clean them:

  1. Put on gloves. No sense in contaminating your hands. Chances are your knees won’t have broken skin on them unless you’ve been trying to get that promotion (Enough with the “on your knees” jokes! – This is serious!)
  2. Take and put a towel or washcloth (a smaller wash cloth works better) in between your knees and your pants.
  3. Spray the ever-loving bejeebus out of your pants, saturating your knees with disinfectant spray. DO NOT use bleach-based spray. The milder the better. (see “Clean EMS” for advice on contact times)
  4. Press another towel on the outside of your pants, soaking up as much poo/pee laced disinfectant into the towels as you can. Rub them together a bit.
  5. Re spray with disinfectant and let it air dry.
  6. Remove the towels from your pants.
  7. Call your wife and beg her to drive you up a new pair. Beg. Hard.

Just for the record, my lovely wife was unable to drive me up some new pants. Awesome…..

Posted by on May 5, 2010 • Filed under: Ambulance, ambulance humor, Emergency Medical Services, EMS, EMS Health & Safety, EMS Humor, ems pants, EMS rant, EMS Topics, ems uniforms, EMT, Fire department, Fire Rescue Topics, Firefighter Safety & Health, In the Line of Duty, infection control, inside the mind of a paramedic, kneeling, Paramedic, paramedic education, paramedic pants, Patient Management, puke

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

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

52 comments

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

Advances in Prehospital Analgesia and Conscious Sedation

10 comments

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.

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

Any Random Person

560 comments

I love Dave Barry, he has been called the most influential humor writer since Mark Twain. If you haven’t read any of his stuff, you really should. In fact, I’ll even provide a link to his web site here: www.davebarry.com. Yes, I’m providing that before what I’m sure will be my well-written, extremely interesting content below. He’s that good.

I put that up there because I am going to use a quote of his that he put into one of his columns; he asks his readers if they are saying to themselves “Hey, I can do this! *Any* random person can do this!” And he counters that they are wrong, because “It takes a very special kind of random person to do this”.

And that’s how I’m tying this into EMS.

I work with a few EMT-Intermediates (I-99 curriculum) and some EMT-IV Techs (WI has a version of a basic that can start IVs with NS and give a few IV meds) that are very sour on the fact that they aren’t paramedics yet. They’re not sour on the fact that they do not yet wish to sit through the required education to become paramedics, but they’re sour that there are skills that they can’t do that they see their ALS counterparts doing. They see us “paragods” performing ALS skills and say, “Hey, I can do that”.

And it may indeed be true. I see these days that they keep pushing skills that were once only the domain of paramedics down to the BLS providers. Heck, that’s what EMS is entirely built upon. In the far beginnings of our profession (and we’re still really in the beginning phases) the skills that Paramedics and EMTs perform were once only the domain of physicians. If you would have asked a physician in the 70′s whether a non-physician could interpret an EKG and give relevant medications and treatment as well as he could, you probably would have gotten a very incredulous answer. EMS is all about proving to the medical profession that treatments once firmly entrenched as only for use in the hospital have a demonstrated benefit to the patient when used quickly at the patient’s side close to the onset of symptoms. EMS personnel were trained for that most probably because it just isn’t cost effective to have doctors sitting around manning ambulances.

However, the question that has come up in my mind is where the bottom of that lowering of educational requirements for advanced skill performance ends. I have seen in my career a paradoxical movement in educational standards for paramedics and EMTs. There are a smattering of disparate and yet somehow complimentary certifications in some states, but while some educational standards have improved, most of them have decreased. While a good argument can be made for EMS levels between the Paramedic and the EMT-Basic, such as the I-99 and the IV tech in WI or the Iowa Intermediate in Iowa in the sense that they allow rural communities to be able to perform some advanced skills without having to shoulder the full breadth of costs and responsibilities associated with full paramedics, they also don’t take into account that a lot of those skills require a whole heck of education to be safely performed in the outlying patient that can be harmed by inexperienced providers.

The debate that I got into with an EMT-IV Tech over breakfast the other morning went something like this. He brought up the fact that EMT-IVTs could administer Narcan to reverse heroin OD’s or other narcotic overdoses. His statement to that was that they ought to be then able to give Morphine for pain control “since we already carry the reversing agent” (in case they give the patient too much or the patient has a reaction). My thoughts are that they should not be able to, because the administration of a narcotic for anything requires a requisite knowledge of the pharmacologic, physiological, and social actions of the drug. And while yes, that could be covered in a module I could assume, why should it be? I brought up that it takes physicians years of experience to be able to tell how to identify drug seekers who want to get a high from the legal, medically prescribed narcotic. Contemporary medical journals in family practice and emergency medicine have written volumes on the topic, and still physicians can be fooled. The extrapyramidal reactions possible with morphine, including respiratory and other Central-Nervous-System (CNS) depressing features of the drug have other treatments and symptoms that can be hard to recognize for an inexperienced provider. An EMT-IVT just doesn’t have the breadth of background knowledge needed in order to judiciously use the drug safely in all cases. The fact that most of the time it would work out fine does not withstand the certain percentage of patients that could and would be harmed. I ended the argument with him by bringing up something that I’ve always remembered from paramedic school. Our lead instructor told us that our drug bag was nothing but “A big bag full of poison” if you didn’t know how to use it.

Remember, every single time any medical care provider performs any treatment of any kind on a patient they’re making the statement that “Right now, I know better than your body does. I know better than your brain, your nervous system, and better than all of your body’s self healing systems do what you need to keep living and get better”. Any time you put on a bandage, you’re telling that patient that you know better than their body does that they need to stop bleeding. Every time a paramedic or other provider uses an airway management technique they’re saying that they know how to breathe better for the patient than the patient’s own body does. Every time you give a medication to a patient you’re telling them that you know how best to control their body’s systems. Think about it. Every treatment, every time. It is a HUGE deal to be able to do this stuff, and you dang well better know your stuff.

Physicians are rooted in the quest for knowledge. Their reputation as learned individuals goes back to prehistory in one form or another. They’ve earned their vaulted place in society due to their quest for knowledge and reason and their caring for others above all else. EMS people came from physicians. I can think of no other medical profession that has a downward pressure on their educational standards. I’m saying that, because I think that EMS does. We have elements in our own ranks, and external forces that are continuously working to make us into skills monkeys that can be paid very little and know very little.

This is a big statement: Not everyone can be a good paramedic or EMT. It takes a certain intellect, sound ethical reasoning skills, and a level of professionalism that not everyone can attain.

This is another big statement: There are groups in our society that want to make it so that any random idiot can become a basically qualified one. This keeps us all down and lowers the quality of patient care… a lot.

Yet another: Us good EMS people should be really ticked off that educational standards are so dang low these days. Fight for excellence. Respect ourselves.

If you and or your service want to be able to perform advanced skills, earn the requisite knowledge through your studies and earn the level that it takes to do them. Enough is enough. I don’t believe that we should lower any more educational standards. No other group would do this, not the nurses, not the PA’s, and certainly not the physicians. Why should we? Yes, I understand that with the advent of Urban Fire Based EMS the IAFF and IAFC want to put more paramedics on the streets to increase their influence and their revenues, and that in order to do this they need to match the intellectual skills of medics with the intellectual skills needed to be a good grunt firefighter, but EMS is a MEDICAL profession built from the quest for knowledge. It should not be relegated to the technical performance of skills if X equals Y.

Heck, I think that the current level of Paramedic should be the basic level, and that Paramedics should be as independent as Physician Assistants. In fact, I’d like to see that in the future.

Posted by on March 11, 2010 • Filed under: Ambulance, ckemtp rants, dave barry, edemse, Emergency Medical Services, ems 2.0, ems education, EMS ethics, EMS rant, EMS Topics, EMT, EMT-Intermediate, Ethics, everyday ems ethics, IV, Paramedic, paramedic education, physician

The Shine Factor

4 comments

 This is part 2 of a 3 part series on “The Shine Factor”

Part 1 of this series can be found here – The Shine Factor

Part 2 of this series can be found here – What Makes a Great Ambulance Service

Part 3 of this series can be found here – The Shine Factor – Grunts

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You know what I’m talking about here. The distinctly subtle, but powerful mix of sights, smells, and sensory input you find when walking into the apparatus bay of your station. The faint smell of diesel exhaust mixing with rubber tires, the musty smell of damp hose drying on the rack, the smells of not-so-clean turnout gear (best right after a good fire), and all of the various cleaning products used to keep the trucks looking their best. My favorite is when I’m just walking in the station for start-of-shift. It’s about 6am and the guys before haven’t gotten up yet to turn on the lights in the bay or make noise. One of my favorite things to do is to walk around the bay with the lights off, with the sun just starting to glint in from the windows onto the dark floors. It’s quiet. I love the first sunlight making deep reflections off of the shiny paint and gleaming chrome. The trucks just seem to be anticipating the day, yearning for the next call to come in. The atmosphere is electric, and quite palpable. You could blindfold me and take me into any fire station in the country and I could identify it just by smell alone. It’s intoxicating. I think that I like it more than my fiance’s perfume. It’s ok, she’s a firefighter too. She gets it.

So, what I’m about to suggest here plays off of that knowledge that we’ve all got… It’s basically an EKG hooked right up to the morale of your organization. I call it the “Shine Factor”.

Fancy name, huh? Yea, I liked it too. I’d recommend that every person who works in any fire station or ambulance base walks into the apparatus bay every time they start their shift. Don’t go in through any other door. Walk right into the apparatus bay with the memory of the favorite time you’ve ever been there. Take a big whiff of the natural aroma and look to see how much your trucks shine. Check the corners for cobwebs too. Then, simply file the information away in your brain and know exactly how the morale of the troops is doing.

Why is this so simple, yet so powerful, and a lot of the time, so unnoticeable? It’s because every organization has grunts, and the grunts carry out the day-to-day operations of your organization. No matter how many policies are written, budgets are adhered to, or strategic plans are championed by administration, the grunts are out there actually performing the duties that make your organization do what it does. If your department is like every department in the country, the grunts have more tasks than just providing service to the public; they’re responsible for cleaning, maintenance, and upkeep of your equipment. The lower and more “gruntish” they are within the organization, the more responsible for the upkeep they are. This is where the Shine Factor comes into play. Every group has assigned or assumed maintenance and cleaning tasks. Administration can formalize it with all of the written plans, paperwork, and task sheets that they want to, but all those pieces of paper ever do is ensure that the tasks are done to the minimally acceptable level. They cannot and will not make the grunts put in the elbow grease required to get that extra shine out of the equipment. My theory is that only happiness and pride in the organization entice the grunts to go above and beyond, to put the extra few swipes with the rag onto the chrome to really bring the shine out. Think about it, when you complete a task and get it looking good enough to pass muster, you could stop… but if you really have the pride and desire to make the equipment look it’s best, you’re going to go get the magic cleaner in the storeroom and clean out the crust around the lug nuts to make it look perfect, to reflect the personal pride you have in the organization and your fellow grunts.

Do you think that the grunts will spend those extra few seconds, minutes (or in my case, hours.. but I’m obsessive) to make that floor it’s cleanest, or that chrome it’s shiniest if they’re ticked off about management’s latest asinine policy or off the cuff directive? I don’t. It’s human nature. It works on a subconscious level across all of the grunts you have who polish your stuff. If the morale of your department is in the tank, your stuff may be cleaned regularly because the grunts will be sanctioned if they don’t clean off the first layer of crud… but that’s usually where it stops. When morale goes down, the shine factor goes down. When morale goes up and people are uplifted, pride goes up and the grunts put forth the extra effort. It affects more than their performance at the station too, it affects how polite they are to the public, how clean and pressed their uniforms and presentation are reflecting your public image, it affects how much personal effort they put into training, and it may very well affect patient and emergency scene outcomes too. You can regulate all that you want, but the beatings never improve morale. The only things that can do that is respecting your grunts and treating them like adults.

I haven’t formally named it, but I think that new officers and/or managers in the EMS and Fire industry who were promoted from the troops arrive to their new posts with a predetermined agenda. I don’t think that they can help it. Usually, it’s from the mistakes they’ve seen their coworkers make on the streets around them and builds especially upon their own pet peeves. They arrive to their managerial desk wanting to “fix” things and usually the result is a lot of new policy objectives and memos. They know who, at least subconsciously, they want to get back at for the aggravation that they’ve caused them over the years and think that the rest of the organization will share their personal pet peeve. Unfortunately, these attempts to “fix” things usually do just the opposite. The new managers with their personal objectives take things to the extreme. They fail to respect that the people who committed the offenses against the manager’s pet peeves are concerned adults that may have very different pet peeves, and they fail to recognize that every single employee’s pet peeve is micromanagement.

To some managers, paper seems to solve everything. If your ambulance turn-around times are too long in your opinion, you create a paper system to fix it complete with a memo and/or a new policy. The crews fill it out, and it’s supposed to make the management and crews aware of the time it takes them and it’s supposed to fix the problem. Got dirty floors in the trucks? Make a “clean floor” policy with a tracking sheet. Got a crew who uses too much gauze? Make a “Gauze Utilization” flowchart with a tracking sheet. Does your station go through too much toilet paper? You see what I mean. While all management wants to create measurable objectives, all employees hate being micromanaged.

Shortly after I got my first management position my boss, the COO, related to me a story about what he did one day when he found a truck that had been left absolutely filthy by a crew after their shift. Apparently this crew hadn’t been running more than usual that day, and had just left the ambulance filthy. Now, what he could have done, being the COO and all, is write an edict to be handed down through the chain-of-command to have the crew reprimanded from on high about the clean truck policy and the proper utilization of cleaning materials. He could have written a memorandum, or even a shiny new “Clean Truck” policy to enforce the rules. There could have been reams of paper and managerial-type fire power brought down on these guys. But that’s not what he did.

When the crew who had left the truck that dirty came back in for their day shift the next morning the COO met them at the door and lead them to their ambulance. At their ambulance they found a whole host of cleaning supplies… and two chairs. The COO then proceeded to have the medics sit in the chairs while he cleaned their entire ambulance, inside and out, from top to bottom.

Unorthodox? Sure.. Effective? Yes. The problem had been attended to, the desire for a clean
truck was reinforced, and the crews saw just how badly the COO wanted the trucks to be cleaned. Now maybe that’s not something that would work at your department, but it sure seemed to at this ambulance service. Maybe your shine factor would be increased if the grunts got the chance to work with the brass on solving problems like this. Maybe myriad policies aren’t the answer, and teamwork and mutual respect are the answer. Maybe communication increases it. Maybe the full realization by everyone within the organization that everyone has their roles and everyone has to be given the tools to take responsibility for what they own increases it.

Until now, this piece has focused on management, but us grunts can benefit from increased shine factor as well. Right now, you need to decide that you’re going to put in the effort to increase the shine factor in your department. Remember, it’s a subconscious thing. Everyone just feels better when it looks like people are taking pride in the department. Everyone from your partner, the guys, the brass, the public… even you. If the grunts make the effort, it can benefit the shine factor too and maybe the other stuff will come along with it. Positive attitudes breed positive results. It sounds corny, but someone’s gotta make the decision to be the positive change in the organization. Even in a perfect situation, if there even is one, someone’s gotta keep making the decision to keep it that way. Let that be you and others will follow suit.

Now get out there and polish some chrome.

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 This is part 2 of a 3 part series on “The Shine Factor”

Part 1 of this series can be found here – The Shine Factor

Part 2 of this series can be found here – What Makes a Great Ambulance Service

Part 3 of this series can be found here – The Shine Factor – Grunts

Posted by on February 28, 2010 • Filed under: Administration & Leadership, Ambulance, Ambulance maintenance, Command & Leadership, Emergency Medical Services, EMS, ems 2.0, EMS Health & Safety, EMS Management, EMS Motivation, EMS pep talk, EMS Topics, EMT, Fire department, Fire Rescue Topics, Firefighter, Firefighter Safety & Health, Management, Paramedic, PR, pride, profession, professionalism, Public relations

Splashed Sadness – A look at negative emotions in EMS

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WARNING TO NON-EMS PEOPLE: This post is pretty emotional. If you’re not emotionally equipped to handle really sad descriptions of EMS calls, don’t read it.

Here’s a revelation: EMS People are better suited to handling sadness than are laypeople. Of course we are. Not because we are necessarily any emotionally stronger than anyone else but because we have experience in dealing with it. As anyone could see, a good number of the situations we respond to and either assist with or observe are really sad. In my decade or so of riding the ambulances I have come across more situations than I could possibly remember that I wouldn’t want to casually discuss outside of the industry for fear of really making laypeople very uncomfortable. A story that might turn into a running joke among your colleagues might just depress a layperson for weeks.

Like all medics, I have my coping mechanisms and some of them are healthier than the others, they include sarcasm, dark humor, clean humor, Tanqueray martinis dirty and dry up with three olives, blogging, fishing, picking on my soon-to-be wife (9 days till the nuptials as of today!), playing with my boy, fishing, MGD, cigars, and sarcasm. There are a few other things in there too, I’m a rich tapestry.

This blog gets read by mostly EMS people, but there are public people out there that read me too. For both of your benefit, I’m going to relate some stories here of calls that I’ve personally attended to over the years:

  • A 16yo male takes his 24yo soon-to-be brother in law out into the city for the 24yo’s bachelor party. On the way home, they’re both just obliterated after drinking all night. The 16yo boy is driving home and is going way too fast to notice the semi hauling gravel that pulls into the right hand lane of the 4-lane road they’re driving on. The kid notices it at the last second, swerving just in time to impact the passenger side of the car against the back of the semi trailer. The impact shears off the left side of the 24yo’s skull, popping out the left side of his brain and leaving it, mostly intact, in between the front seats of the car (I almost put my knee into it). The 24yo dies a not-so-immediate death (I don’t want to get into it. Hopefully it was mostly painless). I pronounced the 24yo dead and took care of this very intoxicated 16yo. He was barely able to comprehend the terror of the situation and was covered in blood and brains that formerly belonged to the man his sister was going to marry. He was unhurt but I ran him into the hospital anyway. How could I leave him there immersed in the terror of that scene, in the terror of what he was more or less responsible for?

     

  • A 19yo male comes home from the military and his friends throw him a house party. During the party the 19yo takes his 18yo male friend down to the basement of the house to show the friend a new pistol that the 19yo brought home with him. The friend takes the gun to look at it and playfully twirls it around his finger ‘Old West’ style in an attempt to be cool. When he does, the gun fires, shooting the friend from the chin through the top of the skull. When I got to him, he was still breathing and had a strong pulse however it was mostly his brain stem that was controlling the reflex. Most of his brain was splattered on the basement floor. We worked him, transported him to the trauma center, and I believe that they were able to harvest his organs.

     

  • A man and his wife of upwards of twenty years are just bumming around the house on a nondescript weekday. It’s about lunch time and they’re going to eat at home before they go to the wife’s doctor appointment. The wife gets up to make sandwiches, gets to the counter, and slumps to the floor. She never woke up. We worked her very hard, but her heart had just decided that it had reached its allotted number of lifetime beats.

The above short summaries of calls that I’ve been to are sad. There’s no joke that can make them not sad. If you read this, there are two reactions I expect from you here:

  • For non-medical people: You’ve related these stories to yourself. You may be crying. You’ll think about them and your heart will go out to the unfortunate people involved. You’re sad.

     

  • For EMS People: Don’t these sound like good calls? They were. Yep, they were sad and I felt very bad for the people that were involved. Good calls though. What’s for lunch?

I think I remember what I did after the above three calls. I think that it was profound although my memory is pretty foggy after all these years. After the first one, I cleaned up the truck and actually got to sleep the rest of the night. After the second I cleared and went to a few more calls and then had lunch. After the third I um, had lunch because it was lunch time.

EMS people can probably know what I’m talking about here. I call it “The Howl”. It’s the sound that a family member makes after you’ve transported their close loved one to the hospital where the patient is pronounced dead by the ER Doc before the family gets there. So there you are, cleaning your equipment while the ER staff makes the sad announcement to the family. Here comes The Howl of anguish that the family member makes when they hear the news. I’ve heard it time after time in hospital after hospital. It’s loud. It’s haunting. It haunts my dreams some nights. I say that The Howl is an example of direct sadness. Direct Sadness is the pain/sorrow/anguish/horror that a person feels when they are a primary person in the situation. In my position of hearing The Howl after working the patient and unsuccessfully trying to save their life I experience Indirect Sadness. For the coworkers that I tell the story to and the readers of this blog, “Splashed Sadness” is the term I use. I think that “Splashes Sadness” is what a person experiences when hearing a terribly sad story like that.

In this business, Splashed Sadness is everywhere. It is one of the hallmarks of professional EMS. Think about it like this, I will always remember a conversation that happened between a group of coworkers and me one nondescript morning some time ago. They told the story of a college age male that overdosed on illegal drugs, stopped breathing, and was resuscitated from asystole (flat-line) by the paramedic that was telling the story. He mentioned that the fiancé of the patient was in the ER with the most-probably brain-dead patient and was holding the patient’s hand and telling anyone that happened by that they were supposed to get married that weekend. He said that she just kept repeating “We’re getting married this weekend” over and over again.

The sadness contained in that story splashed on to me and I’ve remembered it to this day. It will probably be there tomorrow too…

I responded by asking if they recommended that she cancel the caterer. Then there were fart jokes and wrestling (It was an all male crew that day). That’s how I dealt with the splashed sadness. I try not to get any of it on me and I try to psychologically squeegee any of it that I do get on me off as quickly as possible by interjecting humor and sarcasm into the situation. Extreme humor to deal with extreme sadness.

EMS people gain experience in dealing with negative emotions and sadness through all of these routes, direct, indirect, and splashed. While I have dealt with Direct sadness in cases of the deaths of close loved ones including my father, I don’t want to deal with any more. I get indirect sadness a lot of the days that I show up for work, and splashed sadness happens every dang time I talk to a coworker or discuss a bad call with a peer. I’m splashing sadness on you all right now as you read the above stories. If you’re an EMS person, you can deal with the splashing. If you’re a layperson, I’m very sorry for doing that to you but I did warn you before you started reading. My theory is that the more experience you
get with sadness, the better equipped you are to deal with it.

Or you go nuts.

Or you go nuts and start blogging and drinking martinis like I did.

Maybe I’ll get credit in a psychology journal for coining “Splashed Sadness” in EMS.

 

Posted by on February 16, 2010 • Filed under: Ambulance, bad calls, CISD, Emergency Medical Services, emotions, EMS, EMS ethics, EMS Health & Safety, EMS pep talk, EMS Topics, EMT, Fire department, Fire Rescue Topics, Firefighter, Firefighter Safety & Health, In the Line of Duty, inside the mind of a paramedic, Paramedic, paramedic education, psychology, sadness, safety

The Chronicles of EMS – Day 3?? Who knows, I’m flying

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My goodness I’ve got to get into this room! That was a long set we’ve just had. Oh yea, Mark’s in the building so I had better check the lock on the door. It’s locked… good. I shouldn’t have had so much coffee in preparation for the talk I just had. Was I nervous? A bit maybe… I feel silly about it though. After all, I was really just shooting the “breeze” with some people who have become good friends of mine over the last year or so and I honestly feel pretty comfortable being in front of the community that’s popped up around the Chronicles of EMS.  

Yes I was talking about what the Frumpydumple crowd calls the “water closet” and I had just gotten done filming Episode #1 of “Chronicles of EMS – A Seat at the Table” with an amazing panel of guests. I can’t tell you how much I’ve enjoyed being here in San Francisco to watch this all take place, I can’t really put into words how much I have enjoyed meeting the people I’ve gotten to meet, and I just wouldn’t do the feeling of inspiration I’ve gotten any justice if I were to put it into static black and white words on this page. For you to know how I feel about this I’ll just have to use an analogy.

Picture that you’ve been laboring in a tunnel for years, digging as fast as you could every day you were down there. You’re passionate about your digging but you don’t really know if you’re ever going to get anywhere before you run out of steam. You dig and dig and dig… Then one day you feel like you can’t dig any more… not even one more shovel full of dirt… You’re tired, cold, hungry, and cranky and it feels like eons since you’ve seen the sun… Finding Herculean strength you tell yourself that this shovel full of dirt may be the one that finally counts, so you dig the shovel into the dirt and…

Break through into an underground lake that fills the tunnel with water and sweeps you away.

And just when you find you’re about to drown you start a blog and find out that there’s people out there that will throw you a lifeline. You reach out to them and find yourself at a television premier in San Francisco having the time of your life.

So um, yea. That’s how it is. See why I said that I couldn’t do it any justice?

I was here to watch the show and I’m still here writing this from my hotel room. I have to say this: We all knew that Mark and Justin were caring, competent paramedics who are fantastic at what they do. It wasn’t really a shock to me to see them portrayed in the video as just that. No camera could hide how much they care about this stuff and it wouldn’t be possible to hide how committed to the cause of furthering emergency medical care around the world as they are. I know them, they’re really, truly good people and I’ll vouch for them. What impressed me, nay, amazed me the most was the quality of the camera work and the production of the film. I was quite literally blown away by the superb quality of the production. Hats off to Chris Eldridge and Ted Setla… You guys honestly blew right past my preconceptions and delivered a product that was way beyond my expectations. I mean, I knew that it was going to be good… I just did not expect the quality to be so high. I had high expectations and you blew past them. That’s solid work guys. I know that there were many behind the scenes that I don’t know all of the names of to thank properly, but rest assured that I am thoroughly impressed by the class act that you have developed here.

So what I am saying is: Thank you. Thank you for the work you have done to further our profession and emergency medical care around the world. I am happy and downright honored to have played a small part in it and I cannot wait to see the heights that you all reach with this endeavor.

You guys rock.

So tonight, I am frankly having way too much fun here with my wife over Valentine’s day hanging out with the Chronicles Crowd to spend any more time on this computer. I’ve met a ton of great people, all of which I will dish about (Mwa Ha Ha ha!) in a later post. But tonight is about fun, and off I go.

Here’s some suggested reading:

Http://www.setlafilms.com – Ted Setla’s Production Company

Http://www.LevelZeroMovie.com – The Level Zero Movie (I have a signed copy!!)

Http://www.ChroniclesOfEMS.com – The page for #CoEMS

MsParamedic’s article on #CoEMS – Great Meeting you!

EMS1.com ‘s article on #CoEMS

David Konig’s article on #CoEMS

FireGeezer’s Article on #CoEMS – Really? Johnny and Roy?? Well, maybe…

Fire Daily’s article on #CoEMS – Bromance indeed

 

And Just to Enhance the Social Media Experience – I put out a tweet looking for posts that referenced the meetup this weekend. Here are the ones I’ve gotten so far:

- From @FirstDueMedic - http://gatesofintegrity.blogspot.com/2010/02/are-we-ready.html

- From @ssgjbroyles - http://1union801.blogspot.com/2010/02/chronicles-of-ems.html

Posted by on February 13, 2010 • Filed under: Ambulance, EMS, ems 2.0, EMS Blog, EMS blogosphere, EMS Conference, ems education, EMS ethics, EMS Health & Safety, EMS Motivation, EMS pep talk, EMS Topics, Paramedic
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