Really? Did you just?? Oh come on now… you don’t really think?? Seriously… Did you really just call me an “Ambulance Driver”? An Ambulance Driver? Oh come on… Four years of college level classes, hundreds upon hundreds of hours of continuing educations, a veritable alphabet soup of certification acronyms behind my name, and this nifty Star of Life disco ball patch on my arm and you STILL just called me an Ambulance Driver? Really? Oh come now, do you know that calling me an ambulance driver is like calling a High School Teacher a “Nanny”, or calling a Police Officer a “Police Car Driver” or calling a Nurse a “Bedpan Jockey”, or calling a Firefighter a “Fire Truck Driver”, or calling a scientist a “Microscope Looker-Inner” or calling a Congressman a “Pork spewing bloviator” (I could go on, but I won’t… although that last one might be right) EMS is an acronym for “Emergency Medical Services”. EMT stands for “Emergency Medical Technician”. Nationally, there are three levels of EMS professionals. Each level signifies to the public that the person holding the Title and the requisite license or certification has met stringent educational and training standards that allow them to take care of people. These levels are EMT-Basic, EMT-Intermediate, and EMT-Paramedic. Some of the states have expanded on this by offering additional levels of certifications between the levels, such as the EMT-IV Tech in Wisconsin (an EMT-Basic that can start IVs and give some limited IV meds), or the EMT-Paramedic Specialist in Iowa that is above the NREMT-P a bit but still below their Critical Care paramedic. A paramedic these days has a college level education, takes over 1000 hours of didactic (classroom) time and can spend anywhere from 6 months to a year in clinical rotations. We can poke, prod, cut, inject, bandage, stabilize, evacuate, and care for you sixteen ways from Sunday. In my ambulance I carry 48 different emergency medications that I have to know how to use REALLY well or I can kill you. (I do know how to use them really well, trust me, so do my peers). I can intubate your trachea so you can breathe, reinflate your collapsed lung with a needle, surgically open your airway if I need to in order to save your life, and do a whole host of other things that you wish that you never ever need. My ambulance is a critical care unit on wheels that can be at your curbside in under 8minutes flat twenty four hours a day seven days a week. Today’s ambulances bring the emergency room right to you and begin advanced medical care right away. This care saves lives and improves your medical outcome greatly for a whole host of medical complaints. And you, Joe public, still call me an “Ambulance Driver”. Which, if you hadn’t noticed, somehow irks me a bit. Unfortunately for me, and for the members of my profession, it’s not your fault that you call me that, dear Joe Public. It’s my fault. It’s the fault of each and every EMS professional out there that you know so little about our profession and our industry that you resort to calling us that detestable term. It is our responsibility to get the word out. It is our responsibility to educate you about our life saving services, and our responsibility to let you know just how and when to use us properly. If we don’t do it, and therefore let the responsibility fall to others, we EMS people aren’t going to be happy with the job they do. We’re not going to be happy with the popular representations of paramedics in the popular media. We’re not going to be happy with the results of our public health education campaigns. The American Heart Association has recently released a campaign entitled “Mission: Lifeline”. It’s a marketing campaign aimed at increasing public awareness of heart attack symptoms so that Joe Public calls us first when they start having the big one. If you’ve been reading this, you know that my all time biggest pet-peeve is when the people having conditions where they need us and need us now but aren’t dramatic like a car accident or cardiac arrest don’t call us. I can’t make a direct quote, but I read a study once where like 60% of people call a friend or family member first when they think they’re having symptoms of a heart attack. Calling EMS for these 60% or so of potential patients whose lives may very well depend on the early interventions we can provide them seems to be an afterthought. I can’t tell you how many people I’ve transported from small hospitals to big hospitals that were having the big one and DROVE THEMSELVES INTO THE ER without calling us. Please, Joe Public, know that the VERY FIRST CALL you should make when you have pains in your chest is 911. Do NOT hesitate. Do NOT worry about the cost. JUST CALL US!! Do you know that approximately 1% of cardiac muscle tissue DIES AND CANNOT BE SAVED per MINUTE in a bad heart attack (myocardial infarction)? The difference is simple. You call 911 and usually (depending on where you are located) an ambulance arrives within 10minutes and starts lifesaving interventions and gives you medications to help slow or stop the damage in progress and salvage heart tissue that is being damaged. Please remember that “Time is Muscle” and that the extra expense of an ambulance is more than covered by the quality of life that we’re keeping for you. Really. Please call. Don’t wait. You can call your family AFTER you call 911. Please, I’m begging. I’m also telling you EMS people out there to get the word out. Go market yourselves! If you want people to know what we do, it is YOUR PERSONAL RESPONSIBILITY to tell them. Go, do it now. If you want my help to write something, e-mail me and I’ll help. For free even. It’s that important. Ambulance driver….. Seriously.
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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
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The other day I determined the most important piece of equipment in my ambulance for the day. It varies from shift to shift, you see. Sometimes it’s one of the sexier tools we carry, like the IO (intraosseous – Into bone marrow) drill or the $25k cardiac monitor. That day, it was definitely NOT sexy but nonetheless it attained the status of the most important piece of equipment of the day. It was (drum roll please): The emesis basin.
For my non-EMS audience (Yes!! I’m getting one!! Keep telling your friends!!) “Emesis” is a medical term for “Raalllpfffegh” or, more technically, “barf”. It’s puke, vomit, throw-up, and the like. It’s something that, (apologetically) has been mentioned a few times in my writings. For EMS people, as I keep saying, it tends to be an integral part of our careers. The “Emesis basin” is a polite, professional term for a puke bucket; A portable version of the Porcelain Goddess that people pray to on hungover mornings if you will. Having one on the ambulance is necessary for a lot of reasons, none the least of which is to keep the puke out of your shoes. If you ever want to see a medical person scramble, and I mean any medical person, yell that you’re going to need an emesis basin quick like.
Quick sidebar story: The other day I was working the clinic when a patient asked for someone to come into his room. He said “I think I’m gonna throw up!” and he definitely looked like he wasn’t kidding. The problem was, when calculating his probable trajectory; I saw that he was aiming for the exact ground level cabinet where the emesis basin was stored. I had to act fast. I sprung into action, diving commando style towards the cabinet. Seconds ticked like hours. Quickly I opened the door and grabbed for the basin, cursing myself in my head for the lack of dexterity I had in getting the basin out the door. If only I had more time! I could…
Yes, he puked on me… Only a little bit though… He just peppered my scrubs a bit with splatter off the floor.
So anyways, the emesis basin was the most important piece of equipment on the ambulance the other day. The patient needed it and needed it right then and there and I got it for her. Luckily for me we had one. Yep, we had ONE; Just ONE bucket that I used ten minutes into my hour long transfer. It was my fault too, because it was my ambulance for the day and therefore the responsibility to check the stock levels and functionality of the equipment was mine and mine alone. The fact is, though, that the emesis basin just isn’t on my mental list of things that I absolutely have to check. I check the biggies really well every shift. I make sure that there’s plenty of EKG electrodes because I really like 12-lead EKGs and I’ll do the fancy right sided ones when I think that they’re necessary. I check to see that we have a good supply of all sizes of IV caths just in case I need to turn multiple people into pin cushions. I check the airway stuff religiously, and even do a monthly op check on my monitor every shift just to make sure it works. That, and I follow our check list to the letter every time.
But I took the emesis basin count for granted, and it almost cost me another vomit bath.
Now, I’m not shying away from my responsibility to check out every piece of equipment on my truck before I head out the door every morning, but really if I was down to my last basin, so probably was the crew before. Since I don’t think that they had to use one, so probably was the crew before them. Then it goes right back to me, when I probably didn’t check it that shift either. More of my fault there then.
Luckily I had the one that I did.
I would wager that one of the most annoying things that can happen to an ambulance person is to find out that you’ve run out of something you need at the worst possible time. Everyone hates that. If it happens a lot it can really tear down The Shine Factor of your organization a lot. It makes the EMT that it happens to blame themselves a bit, but also blame their coworkers a lot more. Nobody likes to bear the blame entirely on themselves so they rationalize that while they may have not exactly checked that exact piece of equipment, the previous crew obviously didn’t either. Then anger starts, and eventually apathy blooms.
Here’s what a grunt like me can do to put an end to this: (Yes, very very simple, I know) Check your freaking truck!
I don’t mean check it like you are told to do per the rule book, I mean check it out thoroughly every single shift. Pull everything out. Make sure that it works. Make sure you know how to use it (couldn’t we all use a refresher on the traction splint?) Make a production of it to whomever happens to be around to see you do it. While you’re doing it, take the extra minute or two to spray something on the surfaces and wipe them off with a towel. It may not be a full decon, but it at least make things cleaner and more sanitary.
A strange thing will happen here, I guarantee it.
First, you will KNOW for sure that your truck is in tip-top response readiness. You can’t fix the fact that it may have 200k+ miles on it, but you sure can make sure that you’ve done your part. It’s a good feeling. Trust me.
Second, you’ve now just picked up a big part of the responsibility for increasing the shine factor in your organization by taking away a big potential aggravation spot for your other crews. They may not deserve it all the time… but at least you’re doing your part to keep everyone happier and to make sure that every patient in that ambulance doesn’t have to suffer additionally from the lack of needed equipment.
Third, by making this a production, and even by turning this into a game, you’ve single-handedly improved the overall care that your organization provides and therefore the pride that your coworkers have in the service. If you do your best truck check, and then challenge another crew to find something that you may have missed, you’re pulling their pride into it too. Make it a bet. Put breakfast or something like it on the challenge. Their pride is on the line too, and that will get them invested.
At a service I worked for in times past, we always stayed with the same truck day in and day out. Since I’m pretty much OCD on truck cleanliness, I got into a competition with another medic from a different station that was riddled with the same OCD that I was. We polished, shined, cleaned, vacuumed, and tried to generally outdo the other with how brightly our truck shone in the sunlight. If I would have had the ability, I’m sure that we would have taken surface cultures to see how sanitary our trucks were (and THAT would be a great topic for an upcoming piece!). That competition put our personal pride into making our trucks the cleanest and shiniest they could be. Once we were invested personally, our pride inspired us to clean the trucks better than any management policy ever could. In fact, management’s best option to further motivate us would probably have been to offer prizes and recognition for the competition. Positive reinforcement other than negative sanctions that there would have been. It works.
Here are some things that I resolve to check each shift:
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The batteries in my ear thermometer
- And I’ll make sure that we have the little cover things too
- I want at least two of every size ET tube in case the first one gets all mucked up
- Every blade too.
- I’m actually going to get out the test solutions and calibrate my glucometer. (Yea, when was the last time you did THAT)
- The child car seat.
- The portable suction unit, both manual and mechanical.
- The cot. I’ll bet that the one you’ve got needs at least ONE thing tightened and has at least ONE speck of blood on it.
- The number of towels in the cabinet. Does anyone else put one on their knee when they
kneel down at the side of the cot and put the patient’s arm on their knee to cushion the bumps? How many times have you had blood run down on your pants? Now, be honest, how many times have you just felt it easier to walk around that way for the rest of your shift? (Guilty. Ewww) - Every other little thing, too.
As always, “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
Tonight I would like to take a few moments to hit on what is one of my top-ten all-time use-a-lot-of-dashes-in-between pet-peeves in EMS and probably in health care in general. It’s the “DNT” or “Do not Treat” order. It might just as well be called the “DNC” or “Do Not Care” order, or “Do Not Comfort”, or “Do Not Be Humane”, “DNBH” Order. Yes, I’m talking about DNRs here. They’re “Do Not Resuscitate” orders and if you’ve been in EMS for longer than a minute or two you’ve heard about them. DNRs serve a good, humane purpose in a lot of cases. We all know that even though we’re improving (GO CCR!!) CPR and ACLS are largely rituals that we perform for the dead in our society. They rarely bring people back if they happened to be sick enough to die in the first place. They’re also very traumatic things to do to a body. DNR Orders are a humane way for patients and families to say “Enough. When God or whom/whatever I may or may not believe in says it is my time, it is indeed my time”. I can respect that. I happen to be a Christian and I believe that we go to a better place once God decides that it’s time to punch our clocks. If I had a hopelessly terminal disease I would probably be pretty ticked off if some young kid with a shiny new EMT card brought me back to face more of the disease progression with a couple of broken ribs for the trouble. I get it. What I don’t get, and what just drives me crazy is people who treat DNR orders like they’re “DO NOT TREAT THIS PATIENT BECAUSE THEY’RE JUST A DNR” Orders. I know that I will hear this again, and probably tomorrow because I heard it three times today and I’m on a 48hr shift here, but I think that I might say something unkind to the next person that says, “well.. They’re a DNR” when I ask them why they’ve let their patient suffer in agony for hours before they decided to send them to the ER. Yes, I um… occasionally go to “Skilled Nursing Facilities”, can you tell? Here’s what a DNR order does NOT mean:
Don’t think that I’m just picking on the nursing homes here.
I once had a transport where I took a young infant with a horrible medical condition from a small ER to a tertiary Childrens’ Hospital. (A different one from the one in a previous post). This poor little baby was now living with a set of very nice foster parents but just didn’t seem to have much chance in the world due to his/her terrible start in life. The child was on oxygen, needed regular suctioning, and was being sent to this tertiary facility to replace his/her feeding tube, which had become dislodged. Because of that, the patient was having some increased breathing difficulty and was actually pretty challenging to take care of for the hour long transport. The foster mother had brought the baby into the pediatrician’s office for this condition, and the pediatrician had set up the direct admit to the tertiary facility after sending the kid to the ER close to his office.
The foster mother was a very nice lady who seemed genuinely concerned and caring about the kid. I asked her why if the kid was in that bad of shape did she not call 911. Her answer? “I thought I couldn’t call 911 because he has a DNR order”. Someone, and I don’t know whom… but someone had told this wonderful foster mother that this child was NOT WORTH EMERGENCY CARE because he had a DNR order! Yea, not in so many words I don’t think… but that’s the general idea she had. I corrected it. Told her to call 911 whenever she felt she needed to and let her know that the ambulance crew where she lived would love to come visit her to learn about and help take care of the child. I cannot believe that someone would lead a person to believe that… I just can’t.
Oh, and yes, today I had a SNF patient that fit my whole DNR/DNT pet peeve thing… and yes, an ER staff person may or may not have given the “Just a DNR” comment. In fact the whole healthcare system may have failed someone today that chose to have a DNR order and neither he/she nor his/her family knew about it. But I did, and I fixed it.
And I just ranted about it.
Someday soon I may turn this blog post into a coherent article, got any rants you’d like to post? I like comments. As always: ProEMS1@yahoo.com
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