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My Biggest Blogging Fears and Heart Attacks

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Want to know what my biggest fear as a blogger is? It’s that one day you may find out that I’m an idiot. You’ll find out that there are things that I don’t know, and those things that I don’t know will be something that “any idiot should know” and if I don’t know them you’ll think that I’m not as smart as “any idiot”.

Take this issue for an example. Say you have a 48yo M Pt with substernal chest pain. He indicates with his hand that it’s radiating towards the lower left part of his chest from the manubrium. He stresses that he doesn’t perceive it as “pain” per se, but that he feels it more as a “pressure” and he rates it at a 4 out of 10. He denies that it exacerbates to movement or palpation, and it doesn’t change with respiration. His skin is slightly flushed and moist and he complains of some shortness of breath. He states that he’s been experiencing it for an hour or so, and that it’s getting worse despite antacid tablets and an aspirin he took. The patient has no medical history and takes no meds. He does have a family history of heart disease but has never experienced any problems.

What would we do here? Easy: a 12-lead, IV, o2, and EKG Monitoring is in order. You do that and get…

A normal 12-lead EKG. Nothing is wrong with it. Not a darn thing.

Doesn’t that suck? I mean, no, not for the patient of course… but for you. Now what are you going to do? Are you sure that this patient’s chest pain isn’t caused by cardiac ischemia? You’ve seen the 12-lead… but you also see the patient’s presentation. They seem to contradict each other, don’t they? If this patient had three boxes of ST segment elevation in three leads, you’d know right what to do and the treatment would be pretty straight-forward, right? Now it’s not so clear.

I’ve vacillated in my career between giving nitroglycerine to these types of patients to make sure that there isn’t something I’m missing with them. My usual decision is to prophylacticly give one NTG tablet (0.4mg SL) after the IV is in place under the doctrine of treating the patient and not the monitor; but I don’t call the cavalry, activate cath lab, or give them the bigger drugs we have to give them (Our STEMI protocol includes: o2, Asprin, Nitroglycerine tablets and paste, Morphine, Metoprolol, and Heparin while bypassing the closest ER by a minimum of 45min to go direct to a hospital with interventional cardiology capabilities)

You tell me that I should contact medical control for these cases and I do if I have something vital to ask that I’m unsure of. I do know that I can’t possibly know everything about everything there is to know about. I also, like probably a good number of providers out there am sometimes afraid to be found out as an idiot by asking a question that “any idiot should know”.

So there you have it. Like most people, I’m afraid to be found out as an idiot and it’s keeping me from asking questions that may give me the appearance of being stupid and ignorant.

Unfortunately for my urge to go hide underneath a rock, I have a blog about EMS that I feel compelled to write something on every day. This means that eventually, I’m going to write something that is so stupid and ignorant about something that you are going to find me out for being an idiot. I may even ask a question about something that I should know by now and you may laugh at me for not knowing the answer to the question I ask.

So I’ve made up my mind. From now on, with you as my witness, I am going to be unafraid to ask dumb questions about things I should already know about. If I don’t know something, I’m going to assume that there’s someone out there that doesn’t know it either… and I’m going to write those answers down here on this blog just for that person… and for you.

I hope that maybe you might start being unafraid to ask those types of questions too. You never know what you might learn. The only cure for this affliction is to buck up and ask the questions, knowing full well that every single person out there feels the same way that you do… and is scared of being found out themselves.

Or you can come here and find out the answers that I’ve found out for you. I’m already a known idiot… no sense in you risking your own neck.

See you tomorrow, Folks.

EMS 2.0 – What are our Core Beliefs?

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Building a foundation.

A comment I got on my last post – EMS 2.0 – Momentum Building – from Timothy Clemans has inspired me to write this post. He stated that EMS should develop our set of core beliefs. Click over to go read it, and then please come back because this is a participatory event.

Second Edit: I didn’t finish writing this as soon as I wanted to, and Ambulance Driver got out a post I want to answer, but yesterday and most of today have been blogging days off. So expect my answers to the issues raised by our respected friend AD

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What should we state are the core beliefs of the “EMS 2.0 Movement” as it’s being called now on Twitter, Google Groups, and as I’m sure by the time I get this finished, all over the interwebs? What are our core beliefs, the truths we hold to be self evident? What are our virtues and our rallying cry to fend off the slings and arrows that are sure to be launched at our group as we sally forth to set right what we see wrong in EMS today?

Here’s the deal, I’m from the country. I love country music (Yea? So?) and one of the songs I like is from INSERT NAME OF ARTIST HERE. In it, the HE sings “You’ve got to stand for something or you’ll fall for anything”. I believe in that. It actually shapes my political beliefs quite a bit. Here’s why, there is so much happening out there that one single human being cannot possibly keep up with it and form a coherent opinion on everything. Even if you tried, you’d still be basing some opinions on some shoddy reasoning and incomplete information. This is why I pay more attention to what I believe as a person. I have tried to develop my sense of right and wrong, and use that as a filter to determine whether a belief is good or bad.

That’s what we should do with EMS 2.0, in my opinion as someone who writes about it as a concept and yearns for change in my profession. We should develop our core beliefs and possibly a statement of our mission and use them as a filter to determine our stance and actions to take as we move forward. They must be general, universally acceptable, and applicable to a broad range of circumstance.

They should be the ethical standards that guide our progress.

And no, they cannot come directly from me and they will not be easy to implement. They must be collaborative and engaging to as many people as possible in order to have broad appeal and effectiveness.

So here’s what I’m going to do:

I’m going to write my thoughts on them, and my recommendations on what I think they should be. I ask you to comment on what I’ve written and add your own thoughts. If you have a blog, please link to any posts you’ve posted. Please join the Google Groups and follow EMS2Movement, (and ME too!) on Twitter. Participate and grow this. If we can harness the thoughts, feelings, and ideas of the multitude of EMS people out there from across the nation and the world, we’ve really got something here.

EMS is truly on the brink of something very exciting. Yes, I know you’ve heard that before and you have your doubts about whether anyone can actually do anything to fix what you see as being wrong with the profession. I say that EMS has never had what it has now, we have never had the EMS blogosphere and online communities bringing forth cooperative and collaborative voices in such a powerful way as now. Through our efforts we can bring positive change. We can set the tone and the direction for our profession to follow and set forth to improve emergency care for everyone.

It will be a long road, but through cooperation and collaboration, we can start the journey together.

And that’s powerful stuff.

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Proposed Mission Statement for EMS 2.0 – By: Chris Kaiser (Ckemtp)

“EMS 2.0 is the common name for a group of interested professionals within the Emergency Medical Services that strive for excellent and ever improving patient care within our communities. We will work to establish guidelines for EMS professional education, common licensure and certification standards, evidenced based medical care protocols, and professional ownership of EMS by paramedics and Emergency Medical Technicians. We will establish strategies for improving compensation and working conditions for our fellow professionals as well as strategies for increasing our service level to individual communities in the face of dwindling resources and revenue by developing new services and revenue streams for our industry. Our focus will be intentionally broad and collaborative and will serve to encompass the spectrum of well thought and tested ideas through research, communication, and self-regulation of our profession.”

Proposed “Core Beliefs” for EMS 2.0 – By Chris Kaiser (Ckemtp)

  • Emergency Medical Care is a right, not a privilege for those members of our society truly experiencing a life threatening emergency. Communities must fund EMS as they would fund any other essential public service.  
  • EMTs and Paramedics are members of a profession serving the most basic of human needs and the most diverse of all patient populations. We must attain the tools necessary to serve our mission through education and flexibility.
  • EMS providers must seek out new educational opportunities and work within regulatory systems to allow new knowledge to be translated to our care.

I’ll add more later. What are your ideas?

EMS 2.0, Bernoulli, Fluid Dynamics, and Changing the World

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Today the Boy was playing with one of the junk mail “newspapers” that we get involuntarily delivered to our home when I thought of a way to actually make it useful. I tore off a long, narrow piece of it and made him a Bernoulli strip to play with. For those of you who don’t know, a “Bernoulli Strip” is a long, narrow piece of paper that you hold just below your bottom lip and use your mouth to blow straight out. The strip then floats up and lays perpendicular from your mouth in response to the faster moving stream of air above the strip.

It works because of the “Bernoulli Principle” which was devised by the 18th century physician and physicist Daniel Bernoulli and published in his text, “Hydrodynamica”. It states that with velocity of an inviscid flow, as velocity increases, pressure decreases. So, the Bernoulli strip shows that as you blow outward and increase the velocity of the air above the strip, the static air below the strip of paper is of higher pressure and pushes the strip upward towards the faster, lower pressure airflow.

Bernoulli’s principle of fluid dynamics also made possible a method for physicians to measure the blood pressure of patients by sticking a glass tube directly into an artery and measuring how high the blood rose inside the tube. This method was the preferred method of measuring blood pressure for 170 years!

In this simple experiment, where he found out, basically that higher velocity fluid was of lower pressure than lower velocity or static fluid, he ended up changing the freaking world. Why? Because airplanes fly because of the Bernoulli principle. Wings, or “Airfoils” are shaped according to Bernoulli’s principle, with a longer humped surface area on the top and a straight edge on the bottom.

(Yes, there is the Radial Velocity theorem and the whole battle between Newtonian flight that is raging in the physics community. I’m not smart enough to get into it. They both seem plausible to me.)

So why, you ask, am I putting the above on THIS BLOG, where I usually write about kneeling in poo?

Think about this: Bernoulli published “Hydrodynamica” in 1738. Powered flight became possible by the Wright Brothers in 1903. Yes, a lot of others contributed… but the basic principle that made it all possible had been around for 165 years.

What if Daniel Bernoulli had had a blog?

I imagine that the post would have detailed the experiment that he conducted. His twitter feed would have said “Whoa! Check out the experiment I just did. I made a piece of paper float… It’s on my blog”. His readers and peers would have read it, commented on it, linked to it, and participated in the discussion. The wider community would have devoted a lot of brain power to it. My guess is that flight would have been made possible inside of 6 months.

Ok, maybe that’s a stretch… but you see what I mean. The community participation, shared brain power, the collective engagement of an interested wider audience: That’s the power of this medium. With each post by every blogger, we invite you to participate. We all think of comments as gold. I do. I love when I spark a conversation on my blog and I like participating in the ideas brought forth by my fellow bloggers and commenters. Each idea, like Bernoulli’s simple strip of paper, has the power to change the world.

EMS is an industry sorely neglected by the people actively practicing it. Our profession has been controlled by outside influences and groups for too long. There’s a lot of players trying to dictate the profession, and most of them have an interest in keeping our educational standards low and our pay dismal.

But that time is coming to an end. You have the power, right here in your keyboard, to change everything. I don’t want to sound pretentious or even naive, and maybe I am… but I look at the EMS blogosphere as the end of the status quo in EMS. The times they are a changing, and I have an important role to play in it just because I say that I do. You have just as much of a role as I do because you’re here reading this. Reading articles in a magazine transmits information to you, and that’s important. However, reading blogs transmits information to you and invites you to transmit information back to them. The next reader intakes both opinions, and calculates their own response. Bad ideas are found out, good ideas round out and float to the top of the collective consciousness. Everything can be analyzed, absorbed, participated in, and reworked rapidly. Ideas are shared immediately.

Change happens. A single EMS professional, or even a group of them, often feels powerless to make changes they feel are positive. EMS politics keep a great many good ideas and new ways of improving care down for various reasons. Most of those politics are swept under the rug and kept from the light of day. Just like in Chicago, corruption only exists in the dark. While I’m not calling day-to-day EMS politics “corruption” per se, shining the light of scrutiny on both of them tend to bring positive change.

Welcome to the EMS blogosphere. It is the single most powerful force for positive change in the profession I’ve ever seen. We are the future. The bloggers, the readers, and anyone whose ever punched “EMS” into a search engine are poised to usher in the change in the industry we’ve all been yearning for.

Here’s the call to action: Bring a friend. The more eyeballs we have reading the ideas put forth in the EMS blogosphere, the more participants we’ll have in the marketplace of ideas. Together, we’re strong and are growing stronger with every post, comment, and thought put forth about our profession. We’ll change everything… but we need you to do it.

“Bring a friend to the Blogoshere” I like the sound of that.