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Trust… It’s everything

Dooooo Doooooo! Beep Beep Beep Beep Beep Beep Beep - Attention AMBULANCE ONE, Ambulance One. Respond Code 3. 1234 Anystreet lane, 1234 Anystreet lane for the (Insert Age and Gender Here) patient found unresponsive, unknown if breathing.

Imagine you heard that dispatch go out just now. Imagine you’re at home, off duty, and just happen to be listening to your dispatch channel. Perhaps you’re a volunteer, perhaps you have a scanner, but picture yourself hearing that and realizing… “Oh My God… That’s So-and-So’s house! A (blank) aged Male/Female? That’s gotta be So-And-So!!”

As an EMS person who lives in your district you know the people who work on the service. Now you’re sure you know the patient too. It’s someone you care deeply about and it sounds like they may be in mortal danger. As someone “in the know” you know what you’re going to do next, right? You’re going to listen intently to whatever traffic happens to come out next on the radio, aren’t you?

“Come on, Come on, Come on!” you think to yourself as you wait the agonizing seconds for the crew to acknowledge the page and go enroute to the scene. “What’s taking them so long!?” you ask yourself. “Ambulance 1 is enroute to 1234 Anystreet Lane” says the crew of Ambulance One over the radio. You don’t think that they sound excited enough. They must not know that this is So-and-So! To them, this is just a routine response for an unresponsive patient. They’re going to do a routine, every day job and perform their routine, every day care. They don’t have any idea that this patient is special to you and they’re going to give this patient the same care they’d give anyone else.

Now, since you’re sitting at home and unable to respond, you’re going to be glued to that radio, right? You’re going to know from the voice on the radio exactly who it is that will be taking care of “So-and-So”. You’re going to either be relieved or horrified by your knowledge of who’s on that responding ambulance. If you have trust in the medic on the truck, you’ll feel slightly better about So-and-So’s chances of survival. If you don’t have trust in the medics, you’ll probably feel a lot worse… right?

It’s always been a sticky ethical situation for a healthcare provider at any level to work on someone they know well and care deeply about. Try it just once, or more realistically for an EMS provider, have the situation thrust upon you, and you’ll see that “Stuff gets real” really quick. We have a vested interest in the care that our loved ones receive and while some of us may know that it isn’t always best that we personally be the one caring for them, we all understandably want them to receive the best care possible.

Trusting a provider to care for your special “So-and-So” is a big deal. I’m sure we all have secret mental lists of our colleagues whom we’d want caring for our loved ones and also our lists of who we wouldn’t. It is a supreme responsibility to be a healthcare provider in charge of the care of any patient and I believe that EMTs and Paramedics hold that responsibility every bit as much as or more so than any other healthcare provider. It is a responsibility that I don’t take lightly and one that I hope my colleagues do not either. We are the first people that our patients and their families want to see walk through their door when the unthinkable happens. When the situation is critical, and skilled, complex, time-sensitive care makes the difference between life and death, we are the ones out there doing just that. A good paramedic must be knowledgeable, highly skilled, and experienced to provide that level of care. Not just that, they must do it every time they get in their truck; because every patient is somebody’s “So-and-So”.

Speaking of “stuff getting real” I have to ask you: What kind of provider are you?

Are you out there every day earning the trust of your peers?

Do you work hard enough, study hard enough, and train hard enough?

Do you do your absolute best for every patient, every time?

When it does happen (and it will) that you are sent to care for a colleague’s “So-and-So”, are you the kind of provider they will trust?

If you think about these questions, you know the answers already. If you can honestly say that you’re good enough, I salute you. If not, well then we have some work to do, don’t we?

Earn it. Study hard. Know your stuff. Do your best. Every patient. Every time.

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on March 15, 2010 • Filed under: Administration & Leadership, EMS, EMS Motivation, EMS Topics, EMS ethics, EMS training, Emergency Medical Services, Ethics, Fire Rescue Topics, Paramedic, Patient Management, Training & Development, edemse, ems education, everyday ems ethics, medical ethics, paramedic education, patient care, pride, profession, professionalism, scenario

Any Random Person

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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.

Care to Share My Stuff?? C'mon, Go ahead.

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

3am with Ckemtp – (See Gus? I can do that too)

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(The title? My friend Gus writes the blog http://3amwithgus.blogspot.com – Occasionally I throw him a shoutout)

I don’t generally do this much anymore, but this is kind of a personal blog post.

It’s 19 degrees outside and the clock is nearing Midnight here in Illinois. About 20 minutes ago I was snuggled up with my beautiful wife in bed trying to get some sleep before I have to get up at 3am to drive to Milwaukee to catch a flight at 6am. Tomorrow brings something that I’ve been looking forward to for what seems like forever, but really has only been a month or two. Tomorrow I’m heading to Baltimore, MD to attend the JEMS conference, EMS Today 2010.

This is going to be my first big, national conference. Really, I’ve never had the incentive to go before. I’ve always wanted to, but they have always seemed to be too much of an expense and have always seemed far away from what I’ve been doing in the field. Tomorrow I get to see for myself just what the hubbub is about.

But that all seems pretty far away right now as I sit here in my fire station covering the ambulance. 25min ago (now) I was snuggled up all comfy like just in the twilight stage of my sleepy-time cycle when Mama Juggs, the night dispatcher tonight set off the vile tones a few times and sent all of the on-duty paramedics out to the various hospitals, leaving the district uncovered. She toned out for any available paramedic to come in to cover and…

Yes, the above was a horrible way to end a paragraph, (and Greg Friese recently told me I use the elipse (the “…”) too much) but I have to make this statement. Both my wife and I are firefighters and EMS people on the same volunteer/POP/POC/Takes-up-all-of-your-free-time department. We’re both dedicated as the next guy too, and she’s in paramedic school right now. So when the tones went out, I got “the elbow”. No, I didn’t go on the other calls but we had an ambulance crew at all 3 stations with an engine crew on-duty backing them up. There wasn’t a need for me to head in for the EMS calls, until they took all the medics off of the street handling them. They needed a medic to come in for the next call, and I have a Gina at home elbowing me in the ribs to head out into the 19 degree weather to go cover the district. Yes it’s now Midnight, and yes I have to be up at 3am to catch my flight.

I’ve spoken before about the responsibility I feel when I’m the only paramedic available to cover the emergency medical needs of a jurisdiction. Right now, there’s 30k people (roughly) whom for if they have an emergency medical need, I’m now the first person they want to see. If that happens (and now, one of the trucks is returning so the chances are lessening) I better be on my game when I get there.

Anyways, I’m sitting next to Mama Juggs (The Dispatcher, remember?) blogging away, and I should probably be a good conversationalist and talk to her because I haven’t gotten much of a chance to chat with her lately. So, in parting, if you are at EMS Today, come up and say Howdy! to me. If you’re not, be sure to follow me on Twitter and Facebook (the links are over there on the Right. I accept all friend requests that seem like fans.) and I’ll be sure to try and give you a first-hand look at what it’s like at a Big National Conference.

Oh, and the Biggest meetup of EMS and Fire Bloggers is happening Friday night at a pizzeria. BE THERE. If you need info, tweet me and I’ll getcha there. (Connections? I has them)

G’night all.

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on March 5, 2010 • Filed under: EMS Conference, EMS Topics, EMS ethics, EMS training, ems education, ems garage

Guest Post – From JDmedic on Two Cases, One Letter

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This is a guest post coming to you from a Mr. John Fekety (JdMedic) who took the time to leave a thoughtful comment on the recent post I wrote “Two Cases, One Letter… From One Paramedic’s Struggles, Change Can Come”. He doesn’t have a website for me to link to, but his resume is pretty impressive. I gave him the opportunity to flesh out the thoughts he wrote in the original comment, and I’m turning the post over to him. Good Stuff.

As promised, I’ll put a plug in for his friend’s Safety Training Business: Http://www.Source4Safety.com – Safety & Health Solutions, LLC

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Many good comments were made regarding the anonymous letter published here last week. Here are my two cents on the things raised in the letter by Ckemtp and others. First, I confess that I also routinely rant about other healthcare providers not understanding our profession, what we are capable of and what we required to do at times. However, the point of the matter is it is not in their job descriptions to educate themselves about us. We must become much more proactive in educating professionals and the public about whom and what we are. Granted, in a situation like described with the cancer patient with heated emotions, educating someone is not easy – if indeed possible. However, we need to begin to relate one-on-one during down times and talk about what we do and the things we come up against. Will it solve all of the problems? Obviously not, but it may crack open a door for dialogue in the future that can help defuse a tense situation.

Secondly, as both the letter writer and I have learned you have to pick your battles. Would it have done any good to bring up the MRSA issue with the sending hospital? Probably not. They could have simply said, “We told them.” Or more abrasively, “Are you questioning our professional ability to give a simple transfer report?” I think the suggestion of Dave Konig represents the best of both worlds. You let it slide with the sending facility and keep your relations there happy. However, you protect the patients in the other facility and maintain your professionalism by giving the receiving facility a heads up. Before the patient reaches the room you may say something like, “While I was checking the patient’s history during the transport I discovered a history of MRSA and I wanted to make sure you knew.” Everyone wins. Another part of this lesson is the patient does not leave your litter until you are comfortable with releasing the patient (more on this below), or you have no other choice.

Thirdly, we have to educate ourselves about the programs and people we deal with. In that regard, Dave makes a good point about hospice programs as well. Many hospice contracts require a patient to agree not to go to the ED in exchange for the hospice services, including in-patient care when appropriate. Under those circumstances, a patient who goes to the ED is dropped from the program and becomes responsible for all medical bills. Given the cost of just medications, conditions like this alone could drive a patient and family members over the edge. Whether that was the case with the patient in this instance is unknown. One service that I worked for had the director of a hospice service come out to a meeting and give us a presentation (did someone say education?). She explained the various services of hospice, why they may need a patient transported, and what we could do – within our scope of practice – to make things go as easy for the patient and family. It’s about communication folks.

Fourth, like others here I have been in the situation where I needed to be a patient advocate. I was doing an interfacility transport of a trauma patient who still rated pain at 9 out of 10 after meds. I asked the nurse about additional meds and she said the patient had already received everything he/she could recieve. I could have taken a chance, loaded the patient and called for pain management en route but I chose a more direct approach. I tracked down one of the ED docs and asked him to check on the patient with me since I did not feel comfortable accepting the patient in her current condition. (I learned that once the patient is on your litter nobody is willing to help since the person is now your “problem”.) When he saw the girl, he readily agreed she required more meds and not only ordered more immediately but gave me orders for addtional meds en route if needed. No arguments with the nurse, no bad feelings and the patient got what she needed. However, there are those times when feelings be damned and you have to take a stand for your patient.

An example of that situation was when I did an interfacility transport of a patient going for a cardiac cath and other procedures. The patient, in addition to having flunked his recent stress test, had a hisory of a previous MI. When we arrived at the receiving facility nobody knew where he was supposed to go because there was a question about which of two procedures were to be done first. We were finally sent to one location only to find it empty. We were redirected to another location to put the patient in a room until things were sorted out. We got to a hospital room with no monitor and an aid told us to put the patient in the bed. I asked about the monitor, she said there was none, and since he was not going to be there, long he did not need it. I explained that he came from a monitored bed, he required a monitor in the ambulance and he was not leaving my litter until he could be placed on a monitor. She huffed out of the room and came back with a nurse who restated that a monitor was not available and not needed. When I once again explained that the patient was not leaving my litter until a monitor was found. She left in a huff saying she was going to get a nursing supervisor to “… straighten you out.” I thanked her since getting a supervisor was better than us waging war. She came back without a supervisor, but with a monitor and told me the supervisor said I was to leave. With the patient in the bed and on the monitor, I thanked her for getting it and asked her to sign that she received the patient. Not unexpectedly, she refused. However, the patient’s wife who witnessed me ensuring that her husband received the proper care was more than willing to witness my note that the nurse refused to sign.

If we and the rest of the medical community (and/or the public safety community) want to use polite words, EMS is the redheaded stepchild.(Ckemtp here: “ouch”) In not so nice terms, we are the bastards. Either way, we are the new kids on the block and we still have to prove ourselves everyday. It has not been easy nor will it likely get any easier for quite a while, but there are ways we can stop shooting oursevles in the feet. When we hit the street if we keep the following in mind, maybe we can begin to level the playing field.

1. Look professional: If you wear a hat – one that is appropriate – wear it correctly, not to the side or backwards. How you chose to dress/look on your own time is your business. If your dress impacts me and my profession it becomes my business. Although I slack at polishing my boots, my uniforms are always clean and neat (at least at the start of the shift – stuff happens). Take a couple of seconds to tuck shirts in.

2. Act professional: Everyone likes a joke. And, God knows many times with what we see we need humor to get through. However, remember what your parents said about a time and a place for everything. The parking area outside the ED is not the place to have a water fight with syringes. Nor is it appropriate to run up and bang on in-coming units.

3. Talk professionally: You do not need to be a walking dictionary or memorize Grey’s Anatomy. For the most part just dropping the slang and cursing would go a long way. “Thank you.” You’re welcome” Have a nice day.” would not hurt either. And out of respect for Thom Dick, let’s get rid of “No problem.” as a response to a thank you.

4. Respect your patients: If you call your patient, any one of the degrading words used in EMS to refer to, especially nursing home, patients (such as cheese or GOMER), go get a job for FedEx or UPS and deliver packages. You will make more money, not have to put up with mouthy nurses or winey patients. These are people we are supposed to be caring for. Many times, there may be nothing we can do except listen or hold a hand – and many times that is enough.

A final thought comes from a quote supposedly said by Mark Twain. “It is better to keep your mouth closed and let people think you are a fool than to open it and remove all doubt.” Whenever it may be possible for you to be an example of an EMS professonal, act like one rather than acting as our detractors characterize us and provding their proof.

There are many things all of us can point to and complain about EMS and the systems, institutions and people we work with. I have worked in other professions and with all of the problems EMS has, I would not want to work anywhere else, as it sounds like so many other people feel.

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Great Post, JDmedic. (Yes, this guy has more education than I ever want to sit through). He’s a lawyer-turned-paramedic and that just brings a smile to my face, I have to tell ya’.

Comments are, as always, very much welcome.

(Would YOU care to guest post? Shoot me an e-mail at ProEMS1@yahoo.com – Or Tweet me @ckemtp)

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on March 2, 2010 • Filed under: EMS, EMS Motivation, EMS Topics, EMS ethics, EMS training, Paramedic, profession, professionalism

Two Cases, One letter – From one Paramedic’s struggles, change can come

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A letter I received from a reader recently has gotten me just as mad as he is, even more so maybe. This letter came in from someone who identifies himself as a paramedic but asks that I protect his identity and location completely. I will do so, only identifying that the letter comes from someone who works out west, somewhere between the Mississippi and Montana but not east as Maine or as far south as Amarillo.

So He comes from somewhere in the US, not the east coast, and not Hawaii. He’s a paramedic and he’s male. That’s all I’ll say. I’m going to work the things he wrote me in his letter with my thoughts and feelings on what he wrote and the situation he wrote about. I’ll rewrite the letter keeping the point of it intact. I’m fairly sure that you’ll be just as angered as I. (Note – This is LONG but it’s good. It will probably tick you off too, enjoy)

(more…)

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Posted by Ckemtp on February 25, 2010 • Filed under: Administration & Leadership, DNR, Do Not Resuscitate Order, EMS, EMS Health & Safety, EMS Management, EMS Topics, EMS ethics, EMS paramedics, EMS system, Emergency Medical Services, Ethics, Line of Duty, PR, Paramedic, Patient Handovers, Patient Management, Public relations, change, ckemtp rants, edemse, ems 2.0, ems education, everyday ems ethics, medical ethics, paramedic education, patient care, politics, potential, pride, profession, professionalism, rant, stories

The Perfect Emergency? Well, almost

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So a while ago, I went to an emergency medical call that was about as perfect as an EMS call could be.

Picture this if you will. Our ambulance was in service. The system was at normal operating levels which are well funded and are adequate for our response loads 90% of the time. I had thoroughly checked and cleaned my ambulance and the equipment inside of it at the beginning of my shift and I had even gotten a chance to have a cup of coffee or two before the call came in. When the call did come out over the radio, it was merely a short walk to the ambulance for my paramedic partner and I. We climbed into our dual paramedic staffed, well maintained, state-of-the-art ambulance, and rolled out to the scene of the emergency which was about 8 blocks away through light traffic. We arrived within 4 minutes of the 911 call and were informed by our dispatcher that the residence was equipped with a “Knox Box” entry system so we could quickly gain entry. We retrieved the key from our ambulance, were able to open the Knox Box, and easily entered the residence using the key inside of it. While entering, we noticed that the resident had a “Vial of Life” sticker on the front door, which signified that the patient was most probably participating in our “Vial of Life” program, meaning that the patient had all of their medical information written down properly on one of our stock forms. In fact, we found the “Vial of Life” right in the refrigerator door, where it was supposed to be. The patient, an elderly person, had used a (Non brand-name specific) home emergency call button to summon assistance, which we also had recommended to him/her during the public outreach that convinced her to have everything else in place for our arrival.

In short, this patient had done almost everything right. He/She had paid taxes throughout his/her long time living in the district and had supported us in order to allow us to have quality, state-of-the-art equipment. He/She had supported us so that we could get good training as well. He/She had listened to us when we suggested that He/She wear an emergency call button as he/she got up there in years, had written down his/her medical information in the “Vial of Life”, had put the Vial of Life in the correct place, and had even installed a Knox Box on the home so we could gain access quickly.

So what wasn’t right with this call? The patient had been experiencing symptoms consistent with a stroke. In fact, it was an easy diagnosis from across the room type of stroke. The patient had noticed that he/she was possibly having stroke-like symptoms and had decided that it would be best to get cleaned up, get dressed, clean up the house a little, and call a neighbor over to see if he would take him/her to the doctor’s office before the neighbor convinced the patient to press the button and call us out to help. By that time… well let’s hope the doctors can work some magic.

With all of the bloggers, paramedics, EMTs, and everyone else out there harping about “BS” 911 ambulance calls, one would find it easy to overlook cases like the one above. I for one will come right out and say that I will gladly run 100 nonsense EMS calls rather than miss just one of the above… I don’t want someone to die or suffer further morbidity simply because they were too scared, or polite, or timid to call an ambulance.

I don’t know how to fix the problem, I’d just like to remind you all out there that our job is indeed to take care of people when they’re scared, when they’re sick, and when they’re just plain-ol’ stupid. We’re healthcare providers and it’s our duty. No exceptions.

Remember that.

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on February 22, 2010 • Filed under: 911 fail, EMS, EMS Management, EMS Topics, EMS ethics, EMS system, Emergency Medical Services, Ethics, Fire Prevention & Education, Fire Rescue Topics, Paramedic, Patient Management, everyday ems ethics, patient care, scenario, scenario based training

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.

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

Care to Share My Stuff?? C'mon, Go ahead.

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

Equipment Review: Scary Post Ahead

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This was one of my first posts. Since I’m attending an EMS conference, I figured it deserved a bump-up too. Good Luck!

Some of you have been telling me: “Chris, you’re a good paramedic. You should be providing tips and tricks for EMS people so that they can use your hard-won wisdom to improve their patient care. Don’t spend your time ranting about things that bother you in the back of the truck and keep making feeble attempts to make people laugh. Write a serious article, darn it!!”

Actually, I’m really the only one that’s been telling me that, since this blog is only read by like, six people including my mother, fiancé, and my cat… but nonetheless I am going to attempt a serious piece regarding actual patient care issues. As such, I have identified piece of equipment that is carried on my ambulance and is most probably carried on every ambulance in the country. This particular piece of patient care equipment is rarely used, yet critical for patient care when needed. When this piece of equipment is called for, the patient needs it and needs it NOW. Yet, I’m sure that even the most experienced EMTs and Paramedics are struck with horror at the mere thought of its use.

I’m talking here about: The bedpan.

Yes, in my storied career I have been called upon to use a bedpan more often than I would have liked to. The situation is almost always the same, the patient is otherwise stable but the pressures of the bumpy ride on the human bowels are just too much for him or her during the prolonged transport time. Usually in complicated cases like these I prefer to bring along a nurse, since they are eminently more qualified to perform in these critical patient care scenarios. However, as is often the case in EMS, we are called upon to take care of any patient presentation in any patient population and must perform professionally in all situations. I have researched the use of this piece of patient equipment in numerous trade publications and critical care guides and have been struck with the lack of educational materials available for this critical patient care skill.

So, as any EMS writer would do when setting out to write a patient care article, I hit the streets to query other paramedics and EMTs on their secrets for the proper use of the bedpan. I began with the coworkers I have at my two ambulance jobs, one a private, not-for-profit city 911/Specialty Care Transport service and the other a Fire Department based service. Both of them work around 3000 calls per year and run at the ALS level. Here is a sampling of the responses I received:

Question: By a show of hands, how many of you have used a bedpan in the back of an ambulance??

Answer: I raised my hand.

Some of the people there wanted me to clarify the question, they wanted to know if I meant had THEY themselves personally used a bedpan in the back of an ambulance? One guy admitted to using a urinal in the back while transporting a patient. When badgered by the other providers, he clarified by saying that it “was a pretty long trip”. I offered that there have been some situations in my career where I have put the bedpan under a patient who absolutely HAD to go poopie during a trip to the hospital. However, and I just realized that this is the most blessed thing to ever happen to me ever, not one of them has ever been able to “go” with me hovering over them.

Of course, in EMS, I have been covered with every imaginable bodily fluid, including the unholy trinity of urine, vomit, and feces ALL AT THE SAME TIME. And I have plans to erect a statue to the person who came up with the idea of prehospital people administering Zofran (an anti-throw up medication). The other day I spent a few minutes starting a saline lock IV on a lady in her bed inside her apartment just so that I could give her that blessed medication. My fairly new EMT partner wanted to know why I did that, when I usually wait until we’re back in the truck. I let him know that I had been on the foot end of the stair chair going down the stairs before the golden-age of zofran had arrived.

Yes, us “experienced” EMS providers (read: old people who never got real jobs) will tell you that when you can’t let go of the end of the stair chair without letting your patient plummet down a full flight of stairs and the patient chooses THAT EXACT MOMENT to decide that they just *have* to throw up. You well, you just have to close your eyes, close your mouth, lower your face to cover your nostrils, and take it like a true professional. Been there, done that, cleaned the chicken and rice out of my ears with a q-tip. It’s moments like that when you reevaluate your commitment to the profession, and realize that it must be something other than the *interesting* amount of money that they pay you that keeps you coming to work every day. For me, it’s the amount of time that I get to spend typing up articles about bedpans and vomit in my ears… at least it is right now. Has anyone else ever thought that they had been ruined by EMS? I mean, I don’t think that I could ever do an office job. Years of EMS work has left me with the remarkable ability to begin to focus on something like a laser beam for 90minutes tops, then… Hey look!! A Bunny!!

Oh yea, bedpans. So you slide them under the patient and um… Pray that they’re positioned correctly. Wear correct BSI including a pair of gloves, a mask, goggles, and Vick’s Vapo-Rub under your nostrils. Of course, for us old timers, this is required even when you’re making your partner use the bedpan in the back while you drive (heh) Ever So Carefully to your destination. Tell your partner that they need the experience, tell them how professional they are being and tell them that they’re showing true compassion to the patient. Then go out and buy them an ice cream cone filled with Rocky Road. With any luck, you’ll get to eat that too when they suddenly become less than hungry.

In all seriousness, everyone poops. Never let your patient suffer when you can alleviate their suffering with a simple slide of the bedpan under their derriere. Of course, make sure that they REALLY have to go to lessen your risk of contaminating yourself with some really funky pathogens, and also to avoid ticking off the nurses’ lobby by taking their jobs.

Until next time…

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Posted by Ckemtp on January 23, 2010 • Filed under: Ambulance, Bed pan, Bed pans, EMS, EMS Health & Safety, EMS Humor, EMS Topics, EMS ethics, EMT, Ethics, Fire Rescue Topics, Fire department, Firefighter, Paramedic, bedpan, everyday ems ethics, odansetron, puke, zofran

Cat Puke Chicken

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Note: This is a repost. I’ve been a busy blogger and this post deserved a bump-up. Also, the “Fiance” in this post is now my lovely wife. Enjoy.

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The other day I got off shift at 8am and had to be to work at my other full-time job at 10am. Since both of the jobs that I work at are about a half hour from my house in opposite directions it worked out that I had about a half hour to go home, perform the personal hygiene ritual, change uniforms, and get on my way to work again. So I did that, got home, fed the cat, and got all prettied up as quickly as I could. Then, without warning, on my way out of the house I noticed it: A pile of cat puke on my rug.

Yes, I like cats. I have one. She’s a keeper, regardless of her regurgitation issues. I think that I’m more of a man because I love my fluffy-wuffy lil’ Kitty-Witty. So cat puke on my rug isn’t the horror of horrors to me that it might be to some people. In EMS, we tend to get puked on by humans more often than does the regular population and that fact may have further desensitized me to the violent act of emesis perpetrated on my rug by my mostly cute little kitty. However, I do like a clean house and the cat puke on my rug is an issue that normally warrants immediate action.

But of course, that’s not what happened. And for those of you in a spousal relationship with another human being you know exactly what I did. You guessed it, I left the cat puke on my carpet and went to work. For those of you who are not in a spousal relationship with another human you may not understand the thought process here. Yes, as I looked down at the cat puke on my otherwise (mostly) spotless rug the thought that it must be immediately cleaned up did in fact occur to me; but the other thought that occurred to me was: “I can leave and go to work and when I get home, my lovely fiancé will have cleaned this up for me. She’ll think that the cat puked on the rug *after* I went to work and I’ll get off scot free!”

And so that’s what I did. Yes, I *could* have taken the five or so minutes it would have taken to clean up the cat puke… but in my defense I’m a model employee and I need those extra five minutes of early arrival time at work to drink coffee and to tell everyone what a model employee I am. So if I would have cleaned it up I would have taken the risk of not being such a model employee. So you see, leaving the cat puke for my lovely, beautiful, and remarkably intelligent fiancé (who will probably read this, btw) to clean up was not something that I did because I’m lazy. It was something I did so I could continue to bring home the bacon for my family in the most productive manor possible.

That’s what I thought anyway, until I came home late that night after a hard day’s 10 hour shift off of a hard fought 24 hour shift spent saving lives and alleviating the suffering of the sick and injured and stepped in the same pile of cat puke on my carpet that I had courageously not cleaned up the morning before. True, she had put in a paltry 12 hour shift at the fire department practicing for the recliner racing 500 and had fed, bathed, and put our son to bed; but that didn’t stop my obviously well-earned righteous indignation to the pile of cat puke permeating my pile covered floor. She had decided (although she swears that she did not in fact see the pile of puke) that I should be the one to clean up the cat puke using some amount of flimsy logic that I have yet to understand.

So, to tie the above 646 words back into the title of the piece, “Cat Puke Chicken” is not the new special at your local Chinese Restaurant. It is the battle of wills that solidified between my fiancé and I as soon as my sock made contact with partially digested Kitty Kibble. We both subconsciously agreed to ignore the cat puke for as long as we could stand it in order to have the other person clean it up first. (See also: “Laundry Chicken”, “Last Sip of Milk in the Carton Chicken”, and “Couples’ Counseling”). This occurs a lot, unfortunately, in most relationships between other perfectly rational human beings. We know that we don’t like having cat puke on our carpeting; we obviously know that the cat puke should be cleaned up at the first available opportunity; and we also have continued doing the other things that we normally do to keep our houses from turning into slovenly hovels. In fact, while this has been going on I have cleaned numerous dishes, laundered, dried, and folded at least four loads of laundry, and have started (but not finished) three household improvement projects. I’m at least as good as a housekeeper as the next guy (Read: Not a good housekeeper) and I do indeed do my best to keep my family and myself from living in squalor.

So why, as two perfectly rational adults who um, chose to work in EMS, are we locked into this powerful battle of powerful wills? In a word: “politics”. Not the kind of politics that provide the revenue stream for the myriad of cable news networks, but the politics of household supremacy that truly affect our day to day lives. This isn’t Senator So-and-So bloviating about the fact that pork in the stimulus bill is in fact, not pork… it’s me and the woman that I love and want to spend the rest of my life with deciding who shall be the designated Cat-Puke-Cleaner-Upper!! Pulse pounding stuff here.

And as with everything else, this got me thinking about politics in EMS.

Say you’re in a service way far away from anywhere where I work and you have a small volunteer squad that covers the areas that your service is not jurisdictionally bound to cover. Sure, your service would be glad to come if they called you, but somewhere back in history when the powers that be drew the political boundaries they decided that your service was not responsible to respond to the pleas for help that come from that particular geographic area. Suppose that your service just happens to be a small ALS service with two paramedic ambulances and a BLS ambulance on duty 24/7 and the other service was a BLS squad with volunteers coming from home and/or work. These volunteers are dedicated, caring individuals that want to do the best that they can for their friends and neighbors but work in a system where when a call for service comes out it takes about 20 to 25 minutes for the system to get an ambulance to the patient’s side. Say also that the service that you work for has your three ambulances and paramedics about 6 miles from their patients staffed and on duty but you can’t respond because the political system is such that you would be in trouble if you did so.

You may also relate to having that coworker in your EMS or Fire service that just isn’t up to par. They may be a basically qualified EMS provider through the state licensing body, but you still would cringe at the thought of that person responding to take care of anyone in your group of family or friends. They’re a provider that just doesn’t get it. Their care is substandard, their attitude is poor, and you can’t help but feel that the patients being “cared” for by this individual or crew aren’t getting the best medical care possible from your service. You’d want to say something, and normally would, but you’d become an outcast in your agency and would be looked down upon for blowing the whistle. Besides, even if you did the service is short handed and your management wouldn’t fix the problem anyhow because they need to staff the trucks.

Or maybe you can see that EMS in general is underfunded, underappreciated, and undereducated and you can’t shake the feeling that something has to be done to improve patient care industry-wide. You feel powerless to do so, but you’re angered every time you see a representation of bumbling ambulance drivers on TV, or see the local news completely mishandle a news story involving EMS, or especially when you look at your paltry pay check.

In all of the above cases, you’ve got cat puke on your rug and you’re hoping that somebody else is going to clean it up.

As EMS professionals, we know that there are myriad little political games that play out in each and every little jurisdiction a
cross the map. This service may not call this service for mutual aid because someone’s brother once stole a pumpkin from one of the other service member’s brother’s pumpkin patch. “Jim” may not provide good care, but you let it slide because he’s popular with the other crews. Sure, the local fire department gets a kajillion dollars more in funding than your EMS service does and runs like a tenth of the calls that you do, but that’s just the way it’s always been, right?

We need to step up as a profession and clean the cat puke from our carpet. Ignore the politics. Ignore the personal hurt feelings and the power plays. EMS is about the patient. It isn’t about you, or me, or that person down there. We exist solely to save lives and alleviate suffering in the people that we serve in the best possible way that we can. Nothing else matters more than that. So if you can see that cat puke on your rug, and I’m absolutely positive that you know exactly what I’m talking about no matter where you are, you probably have better things to do than be playing chicken. We all need to stand up and say that we are the Cat-Puke-Cleaner-Uppers and that quality EMS is our responsibility, no matter what little political games of chicken are going on. Our patients deserve nothing less.

(Fiance’s note: As of press time, the pile of cat puke on Chris’s floor is still intact solidifying into the fibers of the carpet)

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Posted by Ckemtp on January 22, 2010 • Filed under: Administration & Leadership, Ambulance, Command & Leadership, EMS, EMS Humor, EMS Management, EMS Topics, EMS ethics, EMT, Emergency Medical Services, Ethics, Fire Rescue Topics, Fire department, Firefighter, Paramedic, ambulance humor, cat puke, edemse, everyday ems ethics, politics, relationships

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

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Did I do good?

The Chronicles of EMS, if you’re living under a rock and you haven’t heard, is a cooperative effort between the Great Filmmaker Thaddeus Setla (EMSmedia.tv), the Remarkably Strong Paramedic Mark Glencourse (Medic999), and the “Ruggedly Handsome” firefighter/paramedic Justin Schorr (The Happy Medic). Their cooperative venture has taught me things that I’ve put to use in my own EMS practice that I believe have improved my care. Mark showed me the UK’s “Front Loaded” model and Justin has been talking about EMS providers being a gatekeeper to the emergency healthcare system. It’s a powerful collaboration. (Be sure to follow #CoEMS on twitter and become a fan of Chronicles of EMS on Facebook as well)

So here’s an example of what I mean. I can talk about this now because it’s been long enough that I can sufficiently muddle any possible trace back to the patient and fulfill any patient confidentiality concerns. I work in two very diverse service areas and cover approximately 35 different skilled nursing facilities at any one time. So in the time since the Chronicles of EMS has come out I’ve transported umpteen-hundred patients from those facilities and the patient I’m writing about could be any of those umpteen hundred. So there’s no way to violate confidentiality, Mmmm ‘Kay?

Anyway, some time ago I was dispatched as the ALS response to backup a BLS ambulance for the “unresponsive” patient at a skilled nursing facility. I arrived a few seconds after the ambulance did and carried my drug bag and EKG/Defib into the facility with the ambulance crew following close behind with their jump kit, the cot, and a backboard. After a few seconds in the facility, a staff member directed me to the Physical Therapy area of the facility which was a bit of a walk. When I got there, I saw three other staff members huddled around an elderly female patient who was seated in a reclining chair.

The staff members were fairly excited about the situation, as was the patient, who was very much conscious and alert. The story everyone told me at once was that the patient had finished her physical therapy session on her upper body to strengthen her shoulders and had been sat in the chair by the PT Assistant to rest. After a few minutes, the PT asst. came to check on the patient and found her unresponsive to verbal stimuli, by which I mean that the patient would not awake when spoken to. The PT asst. called the facility’s emergency response team and another staff member activated 911. When one of the nurses arrived, the patient awoke to a sternal rub and was quite surprised to be the subject of so much attention. She had been fully alert and cognitive since that time and when I asked her she denied any chief complaint other than being understandably emotional about the situation.

As I do with every patient after I rule out any immediate life threats I moved into a more detailed assessment. My lady here had skin that was Pink, Warm, and dry. Her pupils were PERRL and her Cincinatti Pre-hospital stroke scale was negative. Her Lungs were clear, her abdomen was soft and non-tender with normoactive bowel sounds, and her extremities were warm and had good pulses, motor, and sensation. Her blood glucose was well within limits, and so were all of her vital signs. All of my other assessment findings were not indicative of any acute abnormalities other than a complaint of slight shoulder pain and weakness which could have been indicative of either an acute MI or of a rigorous PT session. So, to be even more thorough, I hooked her up to my 5-lead EKG which showed normal sinus rhythm with some peaked T-waves. I then ran a 12-lead EKG which was admittedly probably better than mine is.

I asked the nurse “Has she had a potassium level drawn recently?” She looked through the patient’s chart and found out that the patient in fact had been tested for that two days prior and had been found to have a slightly elevated serum potassium level. Since they had been active witnesses to my assessment we agreed that other than for perhaps a bit too much potassium there was little chance of anything being wrong with the patient.

Since we were here in the US and not in the UK like Mark, where he can treat and release (or “Respond, not Convey”) I asked the patient if she wanted us to take her to the hospital. She didn’t want to go and said that she just wanted to go back to bed. When the staff members weren’t completely convinced that we shouldn’t transport her, I suggested that they call the patient’s primary care physician to ask him what his wishes were. The nurse did so, and called from her cell phone in front of us. She did a good job of explaining in detail the events of the call and our collective assessment findings, I provided my interpretation of the 12-lead EKG and chimed in with my assessment findings that I use in my acute care practice.

For his part, the doctor was amenable to treating the patient at the facility and stated that he was comfortable with us not transporting the patient. He ordered a few stat labs and requested that we leave a copy of the 12-lead for the patient’s chart, which I was happy to do. Bottom line: The patient signed a refusal and was happy not to have to go to the hospital; The skilled-nursing-facility staff members were happy that the patient was in no immediate danger; and I was happy that we had made the best possible decision for the patient and that I wasn’t exposing her to unnecessary risk.

What happened here is exactly one of the things that I and others have been talking about with the EMS 2.0 movement: EMS people having the ability to make an educated and sound decision about the best possible healthcare options for our patients and not simply having to activate the full emergency healthcare system for every complaint. This case had every element of that and I believe that the patient being redirected through her normal primary healthcare pathway was a much better choice than taking her to the emergency room.

Heck, since there turned out to be no adverse results to this, and since the patient was probably on Medicare, I would surmise that I’ve ended up saving the taxpayers thousands of dollars in unneccesary costs… Huh? Can educating and empowering paramedics “save” the healthcare system in the US by creating a huge savings in the most expensive form of providing healthcare?

What do you think? Did I do good?

QGE5GE5AAH4W

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Posted by Ckemtp on January 21, 2010 • Filed under: EKG, EMS, EMS Topics, EMS ethics, Emergency Medical Services, Ethics, Patient Management, Skilled Nursing Facility, US economy, change, edemse, ems 2.0, ems education, everyday ems ethics, medical ethics, new perspective, patient care, physician, politics, potential

“CPR Theatre” – Pediatric Deaths, resuscitations, and futility

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This post is a cooperative joint topic with two widely respected EMS bloggers, Steve Whitehead from Http://www.TheEMTspot.com and Greg Friese, from Http://www.EveryDayEMStips.com – Our topic is supposed to be on why it is that EMTs, Paramedics, and other healthcare providers will sometimes “go through the motions” and continue on with futile resuscitations with pediatric cardiac arrest victims. I’m sure that they will have very insightful posts on the topic, as they always do. Here’s my take.

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Can someone say “emotionally charged”?

One of the truths about where I’m sitting right now is that I’m chained to a lot of potential responsibility. Today, like a lot of days I’m one of two paramedics on-duty in my service area and the next call is mine. No matter what the next call is, it is my responsibility to get up and answer that call… without regard the horror that fate may be sending me to bear witness to and intervene in. All medics have to accept this inherent part of the job. One of the worst of those possibilities is that it may be a call that involves the significant injury or illness to, or even the death of a child.

Mention the possibility of a child’s death to even the most cynical and seasoned of healthcare providers and you will send a very cold chill down their spine. It’s just horrible. For me, the blessedly rare times that I’ve lost a child have been sentinel events in my life, things that are often thought of but rarely spoken of… almost always spoken of only to comfort the pain of a colleague experiencing the same thing. The loss or suffering of a child just burns into our souls and leaves an indelible scar that only someone who has experienced it can have true empathy for.

And I for one, wish that I didn’t have the empathy that I have for it.

Heaven forbid that I ever have to be one of the parents with pleading eyes at one of those tragic and traumatic scenes. I just can’t imagine what they go through when I’ve said “I’m Sorry”. I can’t imagine their pain, and frankly I don’t want to. As a parent myself the thought is blocked from my conscious mind and relegated only to the deepest recesses of my subconscious fears. Losing an adult patient is one thing, as we humans come to know that our lives are fragile and that our price of admission is to be removed from this existence. It’s a knowledge that we get as we progress through life and gain the experiences, both good and bad, that make us who we are and will become. However, the terrible thought that one could be ripped from us in their age of innocence is an affront to everything that almost everyone holds dear… and it’s more than a lot of us can bear to make the last decision of a child’s life. Instead, we try. We try hard and we keep trying. We hold out hope against thought and fight on, sometimes against futility.

But in my mind, I think I know why it is… because no healthcare person wants to be the person who looks into those pleading eyes and says “I’m sorry”. That decision takes an enormous emotional toll upon the parents and family, of course… but also upon the EMT or Paramedic. It’s ultimately easier on us as EMS people, we reason, to fight on. To race headlong into futility and hold out hope that someone else won’t have to say “I’m sorry”. At least we won’t have to.

There are probably psychological studies out there that I haven’t read that deal with the issue of whether “CPR Theatre” is harmful or helpful to the long-term well being of the surviving family. These studies are probably well-researched. I took a class once that told me that it was better for family members to be in the resuscitation room inside of a hospital to witness the events as healthcare people try to save their loved ones… and I can understand that I guess. Perhaps it is better to witness that “everything possible was done” for your departed loved one. I don’t know.

As healthcare providers, it is our sworn duty to alleviate suffering as best we can using the tools at our disposal. I, like most of my colleagues, realize that the secondary and tertiary patients that we treat are the family members and their grief reactions to the tragic circumstances that resulted in their calling us. I am reasonably comfortable handling their grief reactions and sadness when an adult passes on scene but I am humbly inadequate to be of much comfort to a parent that has just lost their child no matter how I might try.

My guess that futile CPR theatre can be explained as being more for the parents and families of departed children than it is for the slight chance that we might have missed something. We make the effort in the name of showing to the family members that “everything possible” was indeed done, up to and including running their child lights and sirens to a hospital. I’ll even admit that in the back of the ambulance while I’ve done this, I’ve prayed right along with the family that just perhaps this once we would have a miracle. Never once has it happened.

Here’s a mea culpa for you, even though every time I’ve gone through the motions I’ve said it was for the family… It may really have been for my own benefit as I’ve stated it could be above. I am a paramedic and I’ve seen my share of pain, but I don’t think that I can look a parent in the eyes and say “I’m sorry” ever again. I just don’t want to and as I write this, I can’t imagine that I could do that and then come back and look the guy in the mirror in the eyes without wondering if maybe this time would’ve been the miracle. I am probably selfish for this practice… but is that wrong?

From a completely actuarial perspective, no futile resuscitation should be performed due to safety concerns and the unnecessary costs involved. I agree that with adults, transporting cardiac arrest victims is probably deadly. I also understand that no ambulance should risk a lights-and-sirens trip to transport a body to the emergency room. However, I am not an actuary. In those cases I’m a witness to horrible emotional pain and I want someone else to be the one who says “I’m sorry”. It’s human nature, perhaps.

In my career, I have told parents “I’m sorry, there’s nothing I can do” in cases where it was blatantly obvious that the child was long beyond hope of any intervention. I’ve done it more than once and I can see the places where I’ve done it in my mind to this day. Sometimes it’s completely obvious that there is indeed nothing that anyone can do. However, occasionally I have indeed known this and just done it anyway. Perhaps it’s completely subjective. Perhaps it was my level of experience and intuition that guided me at the times I’ve made the decision. I’ll tell you this, it certainly wasn’t a decision made from the pages of a textbook.

I don’t have the answers to this. But I do want to go home and hug my kid. My only advice to the EMS people out there is to realize that we’re all human, and that all you have to do is your best. Be compassionate, and use your best judgment. For that’s all we can ever do.

For more on this powerful topic for EMS, head over to Greg Friese’s page and also to Steve Whitehead’s page. You also may want to read “Splashed Sadness – A look at Negative Emotions in EMS” where I further explore the sad side of EMS and our reactions to it.

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Posted by Ckemtp on January 5, 2010 • Filed under: Ambulance, EMS, EMS Blog, EMS Health & Safety, EMS Topics, EMS ethics, EMT, Emergency Medical Services, Ethics, Fire Rescue Topics, Paramedic, Patient Management, The EMT Spot, Training & Development, bad calls, cpr, emotions, everyday ems ethics, inside the mind of a paramedic, medical ethics, patient care, psychology, sadness

Thanking Those who REALLY Deserve it – Merry Christmas

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I originally meant to post this during Thanksgiving, but this season seems appropriate enough. I love Christmas. It’s my most favorite time of year. I love family, friends, cooking, and giving gifts. I love Christmas parties, I love the fellowship, and I love being kind to everyone and having them not look at me strangely… ok *as* strangely as they do other times of the year.

And also, I tell people “Merry Christmas”. I don’t say “Happy Holidays”, “Happy Winder Holiday”, or “My lawyer sez to tell you ‘good luck”. If someone responds with “Happy Chanukah”, or “Happy Kwanza”, or “Happy MishMash Shaloob” I’m not offended by it and I’m happy that they wished me the sentiment so there ya go.

Oh, and to my UK friends, Merry Frumpydumples to ye’

So what’s my Christmas post going to be? Well, it’s about thanking who’s really important to thank. As you all know, I’m a volunteer paramedic and firefighter as well as being a career paramedic and firefighter. This time of year in the small towns, it’s pretty common to have people stop by and offer up sweet treats and tell us “Thank you” for what we do for them. Let me make the blanket statement that I really appreciate it folks, even if my waist line and my pending diabetes doesn’t. However, I don’t think that I deserve your thanks.

I have always gotten more from my service to others than I could ever hope to give back to it. I love EMS and I love the Fire Department and I love helping people. I identify with it and I couldn’t imagine my life without it. Even after a solid decade of running my “Life Under the Lights” I can’t imagine doing anything else. I am rewarded a thousand times over by every smile I get, every person I comfort, and every person that I am privileged enough to come into contact with as a caregiver.

So who should the people that wish to thank us actually be thanking?

Well , first thank my wife for every time that I’ve had to get up and leave for a volunteer call in the middle of a family dinner. Thank my kid for every time that I’ve missed out on play time, or story time, or nap time because the pager called me away. Thank my family for all of the times that they’ve had to do without me because I was working mandatory overtime. Thank my wife too for all the nights she sleeps alone because I’m on a 24 and am sleeping at the station. Thank my friends for all the times that I’ve stood them up on plans because I’ve gotten stuck running calls. Thank everyone who cares that I spend time with them, because a lot of the time I could be doing that I’m off caring for everybody else.

Thank the same people for every volunteer or public safety person you know… because without the caring and understanding of the people that truly matter in life for us, we couldn’t be out there doing it for you. They’re the heroes here.

That, and one more thing. I was never in the Military and I probably should have been. This may not be much, but Thank You to all of our Military Men and Women out there serving for me and my family. I can’t write enough to say how much I deeply, and truly appreciate your sacrifice… but from the most humble part of my heart, Thank You for everything you do. The same thanks goes to your families and loved ones as well.

Merry Christmas, Every one.

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Posted by Ckemtp on December 24, 2009 • Filed under: 2009, Ambulance, EMS, EMS Health & Safety, EMS Motivation, EMS Topics, EMS ethics, EMS pep talk, Emergency Medical Services, Fire Rescue Topics, Firefighter, Firefighter Safety & Health, In the Line of Duty, Line of Duty, News, Paramedic, appreciation, fire, pride, profession, professionalism

Guest Post – An Open Letter to Wisconsin Physicians Concerning Do-Not-Resucitate Orders

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This is a guest post written by a local paramedic that has an important message to get out about Physician involvement with Do-Not-Resuscitate (DNR) Orders. I’ve included it in its entirety. It’s an important issue. It takes such an emotional toll on the EMS providers and the families of our patients. Please share this with your colleagues and loved ones.

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An open letter to the Physicians of Wisconsin:

“Medic 1, Engine 7 respond to 123 Anystreet for a male unresponsive. Time out 21:19.”

This simple statement spoken by a dispatcher starts a series of events that will place an EMS crew in a moral dilemma, a family in a confused and angry state, and a personal physician sitting at home, unaffected. As the responding EMTs and Paramedics enter the home in response to this call, they see an elderly female cradling an elderly male in her arms. She is sobbing and distraught. The elderly female holds in her hands the lifeless body of her life long partner and soul mate who seems to have finally given up his long suffering in this world. The lead EMT quickly approaches the patient and finds that the patient is in cardiac arrest. The female states that she always knew that he would die in her arms. She states how long and difficult these last months have been with his terminal illness creeping into their lives and stealing her husband away. The Lead EMT asks if the patient has a DNR (Do Not Resuscitate) order. The wife states that he does. A quick check of wrists and ankles does not produce the state approved DNR bracelet. The EMT’s crew stares at Lead EMT looking for direction. They know that unless there is a valid DNR bracelet on his wrist they must start CPR and perform life saving measures. The Lead EMT knows that the clock is quickly winding down, they must act soon. She asks the spouse again about the DNR and where it might be in the house. The spouse states that there is a copy of the DNR at the hospital. She states that she filled it out at the months ago at the doctor’s office. The spouse says, “I never got a bracelet. The doctor knows that he didn’t want anything does, can’t you call him?”

Meanwhile, a county away, a physician sits at his desk, dictating the notes of the day. He is completely unaware of the drama that is unfolding in the darkness of night and the darkness that is enveloping one spouse’s life. This physician has practiced medicine for years, graduating medical school in the early 1960’s. He has been kind, caring, and concerned for every patient he has seen and is highly regarded within the medical community. When he first started in medicine, ambulances were simply Cadillac station wagons that whisked through the night. They moved the sick and injured from point to point without offering much more than a fast ride. Over the decades the rules changed, medical advances occurred, and now an ambulance is a rolling emergency department with full advanced life support abilities. Unfortunately, unless a physician takes an interest in EMS this change has occurred without notice.

The lead EMT removes the patient from his spouse’s arms. They move him to the floor and start CPR. The crew has no choice, they have no valid DNR order and they have been summoned by a 911 call from the spouse. The spouse screams at and pleads with the crew to stop, she doesn’t understand why this is happening. Her husband has filled out papers; they have them on file at the hospital. She thought this wouldn’t happen. The spouse watches as I.V.’s are started, defibrillator pads applied, and an endotracheal tube is placed into the airway of her spouse. The spouse is now frantic. This was never supposed to happen. Why aren’t the EMT listening to her? She knows what her husband wanted, they were together for over 50 years. Medications are now being given and the EMS crew is trying to coax a pulse out of a tired heart. The crew shoots looks at each other questioning what is right and wrong.

The lack of a DNR order puts EMS crews in a terrible moral and ethical dilemma. They must proceed as the law states; but their hearts are heavy and they are unsure if they are truly doing the best for the patient or the family. They sat in on the trainings years ago about the DNR bracelet. The instructors said it would eliminate these situations, patients would speak to their personal physicians, sign all the necessary forms, and then the patient would be issued a DNR bracelet that would clearly state the patient’s wishes. Yet time and time again, this scenario repeats itself and each time the frustration grows.

After 45 minutes of CPR and three rounds of ACLS medication, medical control is contacted. The ED physician is advised of the situation and advises the crew to terminate all efforts. The crew cleans up and a mournful wife sits by her husband’s side again, holding his hand. This is where she wanted to be all along, just holding his hand and looking for support in this darkest time in her life. Instead, she had to witness the brutality of a full ACLS code. The ribs breaking, the I.V.’s being placed, the monitor screaming out orders in its electronic voice. The peaceful, honorable death she had hoped for has been taken from her, she will now have the visions of CPR and strangers doing procedures to her husband that neither of them ever wanted. These are events that we can never go back in time and change.

Our physician is now walking to his car. Rattling through his pocket looking for keys that he can’t seem to find. He will receive a call later tonight from the county coroner explaining what has happened. He will be honestly horrified to hear of the efforts by the EMS unit and will wonder why this has happened. Ironically, he doesn’t know that he set these events in motion years ago by not securing a DNR order for his patient that EMS crews are able to honor.

“Medic 1 and Engine 7 are clear, no transport, coroner on scene.” This will be another long ride back to the fire house. Emotions are running high, the crew is upset. They can’t figure what is making them angrier, the fact that this happened or the fact they know it will happen again. The cycle continues.

I would ask that each primary care physician look into the laws as they apply to DNR orders and EMS providers in the State of Wisconsin. We do not have the luxury of time. We must make decisions within seconds. We NEED the DNR bracelet. All we need to know is “yes or no” to CPR. We have NO time to read through long winded orders or other legal documents. This is a problem that we must fix and fix fast. You have the power to fix this. Please do so.

Respectfully,

Todd A. Bluhm, Paramedic

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Posted by Ckemtp on December 3, 2009 • Filed under: 911 fail, DNR, Do Not Resuscitate Order, EMS, EMS Topics, EMS ethics, EMS rant, EMT, EMT-Intermediate, EMT-Paramedic Specialist, Emergency Medical Services, Fire Rescue Topics, Paramedic, Patient Management, cpr, cpr fail, crisis, emotions, ems 2.0, medical ethics, patient care, physician, professionalism, rant, southern wisconsin

Everyday EMS Ethics – Thoughts on Ethical Behavior in EMS

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Everyday EMS Ethics? Where do I get my authority to talk about anything ethical? I’m definitely not a perfect person. I’ve made some decisions that I’m not proud of in this life, I’m human, and I’m certainly not immune to the mud that life can sling on a person. How then can I talk about ethics with a straight face, knowing that I’ve made some of the very mistakes that I seem to be condemning?

It’s because that just like everyone else, I have the ability to feel good or bad about anything that happens to me and anyone else, I have the ability to introspect and wonder why my gut feels the way it does about something, I also have the ability to want to be a better, more ethical person. As silly as it seems in this world sometimes, striving to be a better person on this journey we call life is what we all must do as we edge closer to “Point B” in our path.

The omnipresent “they” have always told me that “Being a good person means doing the right thing even when nobody’s looking” and I like that phrase. If a lot more people took that view, I think that the world could improve overnight. Imagine if everyone did the “right” thing all the time? We’d have no crime, no “half-assed” jobs, and everyone would get along, right?

Well no, probably not. Of course things would improve and crime would cut down, but since two perfectly ethical people can have logical disagreements on the same issue, we’d still have discord and differences of opinion. We’re all still human and human beings have different thoughts, feelings, emotions, and standards of right and wrong. Therefore, when one throws out the term “Ethics” it seems to draw a lot of shrugs from people who aren’t looking for the conflict it can generate, or who simply aren’t looking to put forth the effort to debate their positions effectively.

Grey areas abound in any discussion involving ethics, but I think that it can be simplified. Even in an area where lives are literally on the line such as in EMS or other healthcare disciplines, the realm of ethics can be summed up in the above phrase about doing the right thing when nobody’s looking and with the application of the Golden Rule, the one about doing unto others as you would have others do unto you.

Of course, that’s not always easy as it sounds, is it? People are motivated by different things and behaving ethically in one situation may justify behavior that may be considered unethical in another. For example, take the case where a family’s breadwinner has to make more income to feed his/her family at home and that need justifies taking more overtime at work than would normally be considered his/her “share” of the OT and the extra income that it brings. The breadwinner’s coworkers may consider the person to be an “overtime hog” and may think that he/she is behaving unethically whereas the breadwinner may feel that the need to feed his family with the extra OT income justifies his taking more OT than is his/her share. Who would be “right” here? If everyone had a family at home that they were supporting with the extra income from the OT, it wouldn’t be ethical for that one person to take more than their proper percentage of the OT… but would it be right if everyone else was a single person with no families to support? Who would decide that?

We have to be unafraid to discuss the grey areas and tailor solutions to fit the unique situations we face. Discussion among rational adults can help guide the actions of the group towards a more ethical and equitable organization, which makes everyone happier in the end. Some organizations discourage this, and instead make overarching rules that discourage the rational adults within those organizations from free thought that would benefit the overall operations, and some are too lax and instead encourage unethical behavior by never sanctioning those who engage in it.

On political topics, I’ve always liked the words of a country song that state “You’ve got to stand for something or you’ll fall for anything” meaning that a person has got to have a set of values and beliefs based upon their own moral compass and introspection in order to guide their decision making when faced with an overwhelming amount of information. And we’re all overwhelmed. I firmly believe that human beings can only process so much information and that there is no possible way for any human being to be well-enough informed on every issue to form a truly solid and rational opinion. Therefore, when we hear something, if we judge it based upon our foundation of core beliefs, we have a way to gauge how we feel about it. For example, I’ll bet that if any, only a small percentage of the people who read this post have ever studied the effects of globalization on the food supply in Micronesia. Sure, we could research the issue, but our core beliefs most probably would tell us that anything that decreases affordable food for the majority of the population is bad. My guess is that this opinion on the issue is perfectly fine and I don’t have the time to put in the requisite study to find out otherwise. This can be applied to EMS almost daily. I believe that a thorough assessment and judicious application of treatment modalities benefits the highest number of patients. I believe that any amount of study time that I put in learning about pathophysiology enables me to better assess my patients and judiciously apply treatment to them. Therefore, I can ethically and logically assume that putting in one hour of study time per day on pathophysiology is a good thing.

Of course, if there were to be a study that came out unequivocally showing that 45 minutes per day is the optimal number and that one hour actually causes degradation in knowledge through um, brain fatigue or something, then my opinion would be wrong… but nobody has studied this topic with enough depth to be sure of that.

Here’s what it comes down to for little ole imperfect me: “Shower Guilt”. I usually say that when I make decisions it’s because I have to look myself in the mirror and shave every morning but that’s honestly not where it gets me. My conscience rears its head during my morning shower. If I’ve done something that I don’t feel deep-down is ethical, my “Shower Guilt” kicks in and I beat myself up for it. I usually can tell how I’m doing by how rough my showers are. It’s been that way for years for me and I’m thankful for it. The introspective time has made me a better, more rounded person.

I guess what I’m saying with this post, and with my whole Everyday EMS Ethics series is that ethical issues must be discussed in a positive, adult manner for progress to be made. When people look at problems or violations in ethical standards in a rational and objective manner, solutions come out that go beyond heavy-handed rule spewing and approach the realm of positive resolution and healthy growth. By maintaining an open dialogue, others participating and observing the dialogue can glean lessons that will allow them to make more ethical decisions in their own lives and professional situations. Ethical behavior encourages others to behave ethically. Discussing the ethical standards of a group in a positive and uplifting manner makes people within the group feel good about doing the “right” thing.

Paramedics and EMTs face heavy ethical questions in our day to day work. It’s in our job description.

What does your organization do to encourage ethical behavior?

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Posted by Ckemtp on December 2, 2009 • Filed under: Administration & Leadership, Command & Leadership, EMS, EMS Topics, EMS ethics, Emergency Medical Services, Ethics, Fire Rescue Topics, Paramedic, Training & Development, edemse, everyday ems ethics, medical ethics, professionalism

Everyday EMS Ethics – Social Media and “Smart” phones?

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Today I finally joined The Future™ and got up to speed with the latest technology 2006 has to offer by purchasing myself a shiny new BlackBerry Curve™ “Smart” phone. This thing is SO COOL! I can access my tweets, my facey page, and all of my other online stuff right through it AT ALL TIMES. It’s not an overload, really… I like carrying on 14 conversations at once… at all times. Really I do.

This new addition to my arsenal of cool tech gadgets got me thinking about a story I heard somewhere about a young firefighter/EMT that ran into a bit of trouble with one of these things. Incidentally, this story could have come from any public safety agency anywhere these days, so you probably don’t know whom I’m speaking of here, but if you think you do then go kick that person in the butt for me.

Anyway, this young firefighter/EMT was a full-fledged, “smart” phone carryin’ member of The Future™. Like any good young member, he was fully invested in Social Media. This firefighter/EMT responded to an incident scene and thought that a picture of the incident would make excellent fodder to post on one of the social media sites that he participated in. So, he snapped the picture with his “smart” phone and immediately posted it on the social media site. Appended to the photo he put what undoubtedly was an especially witty and thoughtful comment related to the person(s) who caused the incident.

Thus ensued “all hell” being brought down upon this young firefighter/EMT by the upper echelons of his fire department. Turns out that the Chief, the Assistant Chief, and a number of his coworkers were “friends” of this young firefighter/EMT and were immediately notified of what he’d posted on the social media site. They were not amused in the least and did not find the humor in the especially witty comment that he’d posted with the picture.

I agree with the Chief on this one. Let me be the first one to expound upon the virtues of social media in EMS and Fire. The fact that you’re here reading this is a testament to its potential to positively influence our profession and our interactions with the public and each other. However, its potential to tarnish our image if used irresponsibly is there as well. This case was an example of that.

I never did get a chance to see the picture, but from what I heard of the case the picture did not involve any personally identifiable information. Locals could have seen the picture and identified it, so could those involved of course, but it didn’t violate any laws that I know of.

What it did violate, are the ethical standards in which we operate under. Public safety people respond to incident scenes where we see things not meant for public viewing every day. We’re all familiar, I hope, with HIPAA and the various other privacy laws that we operate under, but we also need to be aware of the ethical standards that guide our interactions with private information.

When I got into this business, the metaphor that we used was “The Coffee Shop”. We were told to keep our shop talk behind closed doors within the service, and not go down to the local coffee shop where people could hear us talk. In the small town I lived in, everybody knew everybody and everybody had a scanner. Even if one of our guys was talking about “This Person” who had had some type of medical condition or had injured themselves in a spectacular way, everyone would know whom he was speaking of. Thusly, we didn’t go talking about what we saw out in the public. It wasn’t a legally mandated standard, it was an ethical standard of behavior that allowed the public to trust us and feel comfortable calling us in their hour of need. People won’t call us when they need us if they fear public embarrassment. Most people, that is.

Nowadays, it’s gotten complicated. With social media sites more popular than ever and showing no signs of slowing down, the impulse for some of our ranks to post information of an ethically non-public nature up there on the interwebz can be irresistible. With my “smart” phone in my pocket at all times, I have an express lane to career ruin right there at my fingertips. All I have to do is act irresponsibly one time with a photo, comment, or post and my career is finished.
And I remember and respect that.

Professionally Ethical behavior requires that we separate our professional lives from our personal ones. While it would have been no big deal for Joe-Public-Came-Across-An-Accident-Scene to snap a quick pic and send it off, it is a huge deal for a Professional Rescuer to do the same. We were called to the scene to help the people involved. Professional Ethics mandate we leave our personal feelings and personal lives at the station. If the public gets the perception that their personal business is going to be splashed across the interwebz by one of the people who came to help them, then I’ll bet that the public is going to be mad at that.

Just remember, folks. Friends and families of public safety people have always been interested in what we do out there. They always will be. With today’s ultra access into our personal lives that social media can bring, it’s easy for youngins to get carried away and violate the ethical standards on spreading private information. There’s a rule for this and technology hasn’t changed that rule. You don’t use your position of public trust to gain access to and spread private information.

Just don’t do it. Resist the urge and keep your career, and honor, intact.

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Posted by Ckemtp on December 1, 2009 • Filed under: Administration & Leadership, EMS, EMS Topics, EMS ethics, Emergency Medical Services, Ethics, Fire Rescue Topics, Fire department, Firefighter, PR, Technology & Communications, edemse, everyday ems ethics, medical ethics, professionalism, technology-communications-ems-topics, whattaya do

Dear State of Illinois EMS…

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State of Illinois EMS… It’s time that you and I had a little talk. You see, I’m an EMT-Paramedic holding licensure in your fair state. I’m also a mostly life long resident except for a short, torrid affair with residency in the State of Iowa. I moved back, you welcomed me back with your open arms and I’ve been here ever since.

Except for now, State of Illinois EMS, while your EMT-Paramedic licensure will always be the first card I carry… I’ve been flirting with other states. Yes… it’s true. I have my licensure in Iowa as a Paramedic Specialist, and my Paramedic card from Wisconsin too. I don’t want to hurt your feelings, State of Illinois EMS but frankly their paramedicine is more exciting than yours is. Yes, State of Illinois EMS… the magic just seems to have gone out of our relationship. I can do so much more in the other states. They UNDERSTAND me and my need to take care of my patients to the best of my ability. They’ve given me exciting advanced techniques, medications, protocols, training and technology that enables me to breathe new life into my practice. They let me LIVE, State of Illinois EMS! They help my patients to live longer, fuller lives.

And now, State of Illinois EMS, this conversation comes on to the prospect of what we should do about our relationship.

Yes it’s been a torrid love affair, State of Illinois EMS. Really it has. Unfortunately, I’ve changed. It’s not you… it’s me.

Literally. It’s like you haven’t changed in ten years. What’s up with that? Medicine’s changed. Techniques and research have changed. Evidence based EMS practice has changed… but, State of Illinois EMS… you haven’t hardly changed a bit. You’re not a national state, your CE requirements are strange, your license hasn’t gotten easy reciprocity anywhere I’ve tried, and your policies are dictated by the ‘Little Kingdoms’ that you call EMS systems and EMS regions, and well… it’s just not working for me anymore.

I’m not leaving you, State of Illinois EMS. I wouldn’t, you mean too much to me and a good chunk of my income is dependent on that little green card I carry with your picture on it. Remember when you gave me that card, State of Illinois EMS? It seems like just yesterday… but it was a while ago I guess. We’ve been together a long time, haven’t we? I think that our relationship is worth salvaging, don’t you?

Here’s what I think we should do, State of Illinois EMS: Let’s work together on a plan that I’ve come up with. It’s a plan that I think will help fix everything that is wrong with our relationship. I think that the way you’re all set up, the way you’ve parceled yourself into EMS regions and the Little Kingdoms that you call “EMS Systems” has given too much control to local politics and individual egos without enough accountability. I think that the EMTs and Paramedics that work within these EMS systems, you know the ones working for actual EMS agencies, are actually “customers” of these EMS systems. Only these EMS systems seem to treat the EMTs and Paramedics like “Bothersome Bastard Stepchildren” instead of the customers they are and don’t give them any support or service.

Yes, I know that not all of these Little Kingdoms that you call EMS systems function like this, State of Illinois EMS… some actually treat their EMTs and Paramedics like (gasp) People. However, in my decade or so of toiling in these Little Kingdoms, State of Illinois EMS, I’ve seen that to be the exception and not the rule.

So here’s what I propose to you, State of Illinois EMS. I propose that we inject these three things into the whole system: Information, Competition, and Accountability.

Yep, I think that we will both benefit by adding healthy dashes of those three items into our relationship. I’ll explain:

Information: I want to put every little policy, procedure, and standing medical order from every EMS system in Illinois on the interwebs. I want every form, personnel roster, and individual quirk of every Little Kingdom in the land to be posted up for scrutiny by every individual EMS provider and provider agency in the state and elsewhere. If they do something, I want everyone to know how and why they do it.
Competition: When EMS systems compete, we win. Really, if your hardware store sells your widgets for cheaper than the store across the street, you’ll get more business. If they lower their prices to match yours but your service is better, you still get the business. If their service is just as good but your widgets are of better quality, you still get the business. They have to improve their service, quality, and price just as consistently as you do. It’s called competition and it’s healthy in any food chain or market. Right now as things stand, there’s barely any competition in the EMS systems in the state. EMS provider agencies stay within their systems usually no matter what the conditions are and only rarely change. It’s difficult for new and better ideas to flourish in the current system. It’s also hard for the EMTs and paramedics working under the systems to get any kind of service. Remember, I think that the EMTs, paramedics, and EMS provider agencies are customers of the EMS systems. Now they kneel… with competition and information, they can vote with their feet. EMS systems will be forced to improve or wither and die. The cream will rise to the top, the others… well they may be floaters or sinkers if you know what I mean.
Accountability: Are EMS systems accountable to anyone? I mean, if there are complaints against them, to whom are the complaints addressed? If the paramedics and EMTs working under the system are treated like diseased cattle and they are unhappy mooing and coughing like that, whom do they complain to… their EMS provider agencies that don’t want to switch systems due to the immense amount of effort for no real perceived benefit? We need to make them accountable not only to competition, but accountable to a public airing of grievances and peer evaluation.

So there you have it, State of Illinois EMS. Three little words that I’ve come up with that I think will fix our long-term relationship. Sure, I’ll probably keep dabbling in the other states… but I feel entitled to because I know that I’m not your only one either. We can tell people that we have an “arrangement”.

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Look, Illinois EMS could use some repairs. Not every EMS system behaves badly or treats their members poorly, and that’s just it. Those systems should be encouraged to flourish and expand. I don’t think that one blog, one blogger, or one paramedic can disband the Illinois practice of creating EMS systems… but I do think that there should be competition and accountability injected into the system.

So, could we do that?

If there’s any fellow Illinois EMS people out there reading this, feel free to interject. I’d love to get a conversation going on this. Grassroots activism to change EMS from the professional level up? Wow, that’s way EMS 2.0

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on October 28, 2009 • Filed under: 911 fail, Administration & Leadership, Command & Leadership, EMS, EMS Management, EMS Topics, EMS ethics, EMS protocols, EMS system, Emergency Medical Services, Iowa, Iowa EMS, Protocol development, change, ckemtp rants, crisis, edemse, ems 2.0, idph, illinois, new perspective, northern illinois, southern wisconsin, wisconsin

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?

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on October 24, 2009 • Filed under: Ambulance Driver, EMS, EMS Blog, EMS Topics, EMS ethics, Emergency Medical Services, Paramedic, blogosphere, ems 2.0, ems education, new perspective, paramedic education

The Drunk Responder

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Greg Friese, over at Everday EMS Tips, has written a post in observance of Drug Free Work Week – Oct 19-25th, 2009 entitled “When a Coworker is Intoxicated” In it, he asks what we would do as EMS professionals and Firefighters in cases where we suspect that a coworker is under the influence. This originally started as a comment to his post, but it went long enough that I thought I could get a post out of it. Here it is:

Ewww, I hate these situations. I’ve worked full-time EMS for a long time, but I’ve volunteered for longer than that. One would think that this is a problem that I’ve encountered more often in the volunteer services, however I’d have to say that the few times I’ve actually noticed it are about equally distributed.

Thankfully, these situations have been few and far between. However, EMS and Fire people like to drink sometimes (ahem) and the potential exists for this to happen more often than you’d think.

In a volunteer service, the classic example is someone showing up for an emergency call after consuming alcohol. Often, these people sincerely did not want to “show up drunk” but thought that the need was great enough for them to show up after having “Just one or two”.

For the paid services, aside from the absolute taboo of consuming alcohol while on duty, the classic example would be spending a late night out at the bar and then showing up for work in too short of a time for the alcohol to be removed from the person’s system. If you’ve ever had a coworker show up complaining of a hangover, this may indeed be the case.

Both are unacceptable. Personally, I know that my career depends on never doing this. I also know that my patients deserve a caregiver who is on top of his (or her) game. I subscribe to the FAA’s rule governing pilots, or the “8 hour from Bottle to Throttle” rule. I take myself out of the response roster for at least 8 hours if I have had one sip of ETOH and I stop drinking a minimum of 8 hours before having to go on duty.

There’s no excuse for a provider having any amount of alcohol on board while performing any aspect of EMS. If the patient smells even a whiff of ETOH on their provider, that provider is drunk until proven otherwise. Even if the provider is under the legal limit the patient loses confidence. Our patients deserve better. If you had EMS come for a family member and smelled alcohol on the responding ambulance crew, you’d think the same thing and would probably become very angry or fearful for the actions of the responding crew.

Remember, each “drink” defined as one ounce of alcohol, raises your BAC (Blood Alcohol Content) by roughly 0.02%. That amount of alcohol takes approximately one hour to be removed from your system by your liver. Each person is different, and other factors come into play… however if you’ve been drinking you need to leave hours between your personal fun and your professional care.

The problem here, of course, is the percieved effect on the person who reports a coworker for possibly being under the influence. In some agencies there may be fear on the part of the coworker who notices the smell of ETOH or other intoxicant that they will be ostracized by the group for blowing the whistle and turning the offender in. In reality, it is your duty to your future patients and the reputation of your agency to turn someone in no matter the percieved ill effects. However, to make this easier I have some tips:

Act immediately – If this person gets activated for a call or otherwise interacts with a patient, they could cause that patient harm. This is unacceptable.
Enlist the aid of a coworker if you’re uncomfortable immediately going to a supervisor – Get someone else to nonchalantly speak to the person or linger in their vicinity to see if they notice what you do. Go together to report the suspicions even if the other person doesn’t notice what you do. It’s that important.
Remember that someone’s life may very well depend on your actions – Friendship among coworkers is one thing, but a drunk firefighter or EMS provider may very well kill someone. You or another coworker may be injured or killed by their actions on the fireground or emergency scene. Your patients may suffer at their hands because their decision making ability and reaction times are impaired. Can you stand that on your hands for not reporting it?
You may be helping the person through a real problem – Is the coworker an alcoholic? Could they be? Being at work drunk, especially in such an important job as EMS and firefighting is indicative of a real problem with alcohol. Turning them in may be the first, and biggest influence in getting that person help or in allowing them to help themselves.

This is a tough situation, but is an easy call. Keep alcohol and other drugs out of the emergency services. Keep yourself sober and sharp while on-duty or responding. It’s just not worth losing everything over a couple of beers. Have your fun and enjoy yourself while off duty but remember, alcohol can be a wonderful servant but is a terrible master. Do yourself, your career, and your patients a favor and leave ETOH in your personal life, far away from your station.

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on October 22, 2009 • Filed under: Administration & Leadership, Command & Leadership, EMS, EMS Health & Safety, EMS Topics, EMS ethics, EMS safety, Emergency Medical Services, Ethics, Fire Rescue Topics, Firefighter Safety & Health, edemse, everyday ems ethics, medical ethics, professionalism, safety

EMS 2.0 & EMS Ethics – How far would you go?

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Throughout my EMS career I’ve heard a lot of the same complaints from paramedics that seem to be endemic within the system. One of these is the quality of physician medical direction and whether or not theirs is considered “Progressive” or “Permissive” by the EMTs and Paramedics that work within the protocol system. Some systems seem almost regressive. They don’t seem to show any trust in the providers that work within the protocols and end up being putting forth “Mother-May-I” protocols that disallow aggressive field treatment and require hand holding over the radio or cell phone to a base station. Others, are fairly progressive and allow quite a bit of treatment to be provided in the field.

However, even in the more progressive of the systems out there the medics always tend to have their own personal “wish list” of things that they’d like to be permitted to do. I currently work in the most progressive protocol system I’ve ever worked in and yet there are a few things that I would like to be allowed to do further than I can do now. Toradol for pain control, and the inclusion of a paralytic to our Medication Assisted Intubation protocols would be examples.

However, there begs a question here that I haven’t seen explored before: What if this was reversed?

Say tomorrow you head on into work and get there to hear the news that your medical director up and left for Tahiti with a new love interest with whom he or she will be very happy. Incidentally, you’ve now got a new medical director that just graduated medical school after spending 10 years as a field paramedic. There’s a “Get to Know Me” meeting scheduled in a half hour,

In the meeting the new medical director, who emphatically insists that you call him “Dr. Pat”, and then changes it to “Just Pat” outlines the new protocols that you will be functioning under starting as soon as you all can get through the trainings and meetings that are scheduled. These protocols are amazing. For example, your protocols for treatment of severe asthma used to include just oxygen, nebulized albuterol, and subcutaneous epinephrine. Now you’ll be giving Albuterol mixed with atrovent for your nebulizers, Epi 1:1000 sub-q or brethine (terbutaline) sub-q, epi 1:10000 IV for severe cases, Solu-Medrol (an injectable steroid), and Magnesium Sulfate infusions for refractory cases. For pain control, you used to have to call for orders to give Morphine. Now you give Morphine in 2mg increments titrated to effect up to 20mg if the blood pressure is over 100mmhg systolic, Fentanyl 50mcg – 200mcg, Toradol 60mg IM, and/or Nitronox (Inhaled Nitrous Oxide). The protocols are really advanced and have at least twenty new medications, some of which you’ve never even heard of.

Soon after you start reading the new protocols you start noticing things that frankly, scare you a bit. Never mind the fact that you don’t know how you’re going to calculate amiodarone drips and use propofol for conscious sedation, you’re frankly scared that the protocol system directs you to perform emergent C-Sections to save a viable fetus in cases of limb presentations in pregnancy. Really?

Mannitol and induced hypothermia for head injuries? Wow. You also now have needle crics, surgical crics, Needle decompression of the chest, pericardiocentesis, retrograde intubation, and what are those words? Thoracostomy (Chest Tubes)?? Thoracotomy? Holy crap! There’s almost nothing you can’t do!

After the meeting you head out on the streets with your partner. You’re honestly feeling a little nostalgic for the days when your Tahiti-bound regressive medical director wouldn’t let you be responsible for hardly anything. It’s completely opposite now. You’ve gone from one extreme to the other. There’s nothing that you’ve ever thought of doing in the field that you can’t do anymore.

On one hand this would be very exciting for me (and yes, I went a little overboard with plausible treatment modalities to make a point here) but on the other hand, I’d have to ask the question:

Where would be the line where progressive treatment protocols cross the line? When would be the point where paramedics are given too much responsibility for complex invasive treatments?

I’ve never seen the case I’m describing. I love working under a progressive and liberal protocol system. However, in a meeting the other day when the possibility of administering thrombolytics for refractory ventricular fibrillation in cardiac arrest came up I had a thought that I’d never had before:

“I don’t get paid enough to have that much responsibility. I take on a lot of liability and have to put in a lot of uncompensated education time for the meager wage that I get paid now… how much is that going to have to increase for no more money?”

I don’t want to think that way, and I’d have to question the dedication of any paramedic in any of the protocol systems that I’ve examined that would say no to being able to provide potentially lifesaving treatments to their patients. I can’t imagine refusing to do something because I didn’t think that I was compensated enough to take on the responsibility of doing it. I’d be happy to sit through the required education, but I doubt that they would increase the compensation of the medics in the above example.

Could it happen? Has it happened? Will it happen as treatments progress and professional responsibility increases? I’ll firmly say that I’m nowhere near adequately compensated for the responsibility I have today. Where would I be if the above scenario happened to me tomorrow?

EMS 2.0 needs to seek out and find answers to the questions that we haven’t asked yet just as much as we need to find answers to the questions we’ve been struggling with for years.

What do you think?

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Posted by Ckemtp on October 18, 2009 • Filed under: Als, EMS, EMS Topics, EMS ethics, EMS protocols, EMS training, Emergency Medical Services, Ethics, Paramedic, Patient Management, SMG, SMO, change, edemse, ems 2.0, ems salary, everyday ems ethics, medical ethics, paramedic education, patient care, physician, politics

The Medics are Revolting

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Howdy everyone! This pre-script note is my apology for starting off my first post on my new blog site with a rant. Yes… I am indeed ranting here.

“Do you hear the people sing? Singing the songs of Angry Men. It is the music of a people who will not be slaves again! When the beating of your heart echoes the beating of the drums, there is a life about to start when the morrow comes.

Will you join in my crusade? Who will be strong and stand with me? Beyond the barricade there is a world you long to see? Then join in the fight that will give you the right to be free!”

- Jean Valjean, Les Miserables

< rant>

“You’re just a dumb EMT/Paramedic. Know your place. Shut up and take it. Don’t make waves. Don’t question the system. You’re a cog in the wheel. The system is in place for reasons you don’t understand. Stay in your lane. You don’t have to understand, just obey. Don’t overstep your boundaries. Shut up and do your job. Don’t be a “problem child”.”

All of my professional life I have heard the above. All of my professional life there has been the chorus of the negative. The naysayers have been winning and the apathetic have been in control. The dreamers are troublemakers and the innovators are punished for breaking the rules. They must control us, they must hold us within our role and not allow their status quo and their version of where we are, who we are, and the direction that we should be heading to be challenged. They set the rules and we are to follow them without all but the most superficial of questions.

All of my professional life I have seen patients suffer for it. All of my professional life I have felt my peers and myself suffer for it. Patients suffer from poor, outdated care borne from outdated thinking and EMS people suffer from it through pitiful wages, laughable working conditions, and no professional respect. The ones that conform to the status quo are rewarded for their compliance through slightly better wages and working conditions, but their patients still suffer the same. Every service delivery model has it’s problems. There is no unified voice. Every system has it’s limitations and those who seek to limit it.

And I’m mad as hell and I’m not going to take it anymore.

EMS is suffering from apathy. We’re suffering from a distinct lack of the pioneering spirit held by those that came before us. They saw that the lack of a system was causing suffering in their communities and built a system to care for those persons emergently sick and injured. Through their trials, tribulations, work, and sacrifice a system was put into place that we currently function within. Amazingly, our system is functioning well in it’s adolescence and I am proud to carry on under the banner of the Emergency Medical Services. Our blessing and our curse is that we are the ones whom our society has burdened with the responsibility of responding to our fellow humans in their time of need. It is an awesome responsibility and one that we are honored to hold a place within.

But are we honoring the work of those pioneers who came before us? Are we truly accepting the burden of our responsibility to those we’re sworn to care for?

Sadly, no. We’re not.

Here’s the deal. As a profession, we have some decisions to make and some lines to draw in the sand. First off: We all have to care about the right things. Yes, in some cases, it’s debatable what the “right things” are… but here are some that I think everyone can agree on.

Every patient deserves our best
Every patient deserves our advocacy
Every patient deserves the best medical care we can give them
No patient risk harm due to petty political games or power struggles
No patient should risk harm due to ego
Every EMS provider is responsible to ensure the best care possible for patients in their charge

That all sounds simple, right? Unfortunately, you all know that it doesn’t work like that every time. Systems fall through the cracks, mediocre providers coast along providing mediocre care, ego trips by the various health professions engage in endless power struggles using patients, jurisdictions, and policy as pawns in the game. “Uppity” paramedics who question their role are shamed into submission. Patient advocates who stand up for the rights of their patient against apathy and whatever requires the least effort are chastised. We’re called troublemakers. We’re vilified for our pursuit of improvement in the system or our pursuit of the best possible care for every patient, every time.

EMS 2.0 is the maturing of EMS out of the adolescent trade phase into a grown-up profession. EMS people need to take a stand together, casting off our petty differences and realize that we are here for the same reasons. Our awesome responsibility is to the patients who depend on us. It’s something that we can no longer take lightly. We can no longer allow the various outside forces to dictate our educational standards, our standard of care, and our “place” in the medical hierarchy.

I know “my place”, and it’s not where the ER nurses want me to be. I’m not “unlicensed assistive personnel”. It’s not where the fire unions want me to be, I’m not “a firefighter who works on the ambulance”. It’s not where the private companies want me to be, I’m not a “Pulse and an EMT card”. As a professional paramedic, “my place” is dictated by the professional competence and responsibilities earned by the members of my profession as supported by science and as allowed by law.

That’s just it. A true “profession” meets the following criteria, as can be found on our friend Wikipedia:

The main milestones which mark an occupation being identified as a profession are:

It became a full-time occupation;

The first training school was established;

The first university school was established;

The first local association was established;

The first national association was established;

The codes of professional ethics were introduced;

State licensing laws were established.^[2]

So does EMS meet the above criteria? Yes, and no. I think that we are indeed a full-time occupation. Even volunteers must put in full-time hours to maintain proficiency. We have multiple training schools that are loosely based on the National Standard Curriculum, but even with that standard there’s a ton of variation throughout states and regions. For example, somewhere on this site you’re going to see a Google ad for a “Guaranteed Pass” online EMT class. My wife, Gkemtp(it), is going for almost 15 months. Is there a University school? Yes, go ask Firegeezer about George Washington University’s EMS degree program. While there really aren’t any degrees above the bachelor level that I know of, at least it’s something. There’s local and national EMS associations, like the Wisconsin State EMS Association and the NAEMT. There’s the EMS Professional Code of Ethics and every state has licensing laws.

So why aren’t we a respected profession? We meet the 7 standards, don’t we? Mostly anyway.

I’ll answer for you, it’s because we’re not united… yet.

Welcome to Life Under the Lights. Welcome to my little piece on the web. I believe that we can unite under free exchange of impassioned ideas about the profession we believe in. I invite you to dig in, saddle up, and help our profession achieve the greatness we know that it can.

< /rant>

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Posted by Ckemtp on October 15, 2009 • Filed under: Ambulance Driver, EMS, EMS Blog, EMS Topics, EMS ethics, Emergency Medical Services, Paramedic, change, edemse, ems 2.0, everyday ems ethics • Tagged: ckemtp, EMS ethics, EMS profession

Soapy Demons – Ckemtp is a geek

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Washing Machine Sta 1 Ok, so this post really proves just how much of a geek I really am. Just bear with me for a bit.

This subject causes me a lot of personal grief. I know that it probably shouldn’t and that I am indeed a geek for worrying about this issue because seemingly no one else does, however this issue has plagued me for years and I need to get it off of my chest.

This is about the washing machine at the main fire station where I work. I’m at this station a lot, whether I’m working one of my three weekly scheduled paid shifts, hanging around with my wife who works there three scheduled paid shifts as well, or volunteering my time for call response, training, or work projects. So I have the opportunity to use this particular large, commercial, washing machine quite a bit.

It’s a nice machine. It handles the huge loads that we generate on a daily and nightly basis. It cleans the stuff pretty well and runs pretty quickly and quietly.

The problem is, the soap. It does not rinse the soap out of the clothes, bed sheets, blankets, turnout gear, or anything else that we put in there. The “rinse” water is always white with suds and everything comes out soapier than when we put it in there.

I am well aware that this is not a sexy problem. It’s not a big issue and castles will not fall because of it. It just drives me nuts.

When it comes to be my time to use the machine, I run two full cycles at a minimum to rinse out the machine. The third cycle usually has at least some soap in the water but I use it anyway because all of the residual soap that is left in the stuff that we constantly wash in there. The stuff is full of soap! Our sheets, our towels, our turnout gear… everything. After you run a load in there, even after a second full cycle, the water is white with suds on the final rinse phase.

For a few years, I begged, pleaded, cajoled, and bargained to get people to use less soap in the machine. I tried to get the purchasing division to get us a different type of soap that might rinse cleaner. I even went so far as to post up a few memos in the washing room and write a couple of written requests to the purchasing division and the officer above them.

Predictably, nobody cared those times and still nobody cares about the issue now. Everybody still dumps the same big glob of soap into the machine when they start it and then promptly forgets about it. Whomever comes in and removes the stuff from the washer just puts the stuff right in the dryer, still soapy as all get out, and throws another load in the washer. Then, they dump a big glob of soap in the machine and the cycle perpetuates. Honestly, it’s a losing battle for me and I know that I’m the only geek who cares out of the 100 other people on the department. Nowadays I’ve resorted to trying not to care about it so much and also by surreptitiously watering down the soap that we use. I’ve been doing that for years and nobody seems to ever have noticed (until they read this). It helps a bit, but still our stuff is soapy as heck.

Am I crazy? Probably, but consider this: This small issue is hurting my department and the way we function. Really. We spend hours per week cleaning and polishing our apparatus. To do that, we need towels. Lots of them. Now that they’re all full of soap, they don’t soak up water anymore and we have to constantly replace them with new towels that promptly get full of soap and don’t absorb water and leave our trucks streaked with laundry soap and water spots. Then, we replace the towels again and the cycle perpetuates. How much money do we spend on new towels?

Consider this also: Our guys sleep on linens that get washed every day after they’re used. These linens are full of soap and are against our guys’ skin every night. What happens when one of them develops an allergy? Occasionally, some of this linen goes for use on an ambulance… when will we get a patient with an allergy to our soap?

Consider this as well: How much does it degrade our turnout gear to be full of regular laundry soap? Sure, we bought the expensive specialized turnout gear cleaner, but it doesn’t matter because the water we’re using to wash the gear is full of the soap from everything else? Does that degrade our protection? How much are we harming our very expensive protective clothing by filling it with soap? When will the gear fail and someone get burned because of this? Will it happen? When someone gets burned will it be my fault because I didn’t try hard enough to fix an issue that I saw?

Yes, I’m a geek for caring about this issue so much. I feel like an OCD Chicken Little. However, this small, nothing issue is costing the department money overall and could get someone hurt out there on the fireground. After that, I’m sure people will wonder how this could have been prevented. I’m sure also that they’re looking for ways to cut costs now that the economy tanked and tax revenues are down.

And there sits the washing machine, quietly driving me crazy.

How many issues out there do people know about like this? Issues that are small enough so that nobody else cares but that snowball into big problems for the organizations. How many of these issues affect EMS and the fire service industry-wide. How many of them affect everything?

One day I’ll conquer my soapy demon. For now, I have to keep watering down the soap in secret… but as crazy as it seems, I feel that I’m making some small difference. You can too. Be it the way your equipment is checked in the morning, the way you package your lifesaving gear, the way you make sure that the gas tank is full, or the way you do whatever it is you do to make your service the best it can be.

Now get out there and water down your soap. You might just save a life.

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on October 10, 2009 • Filed under: EMS, EMS ethics, EMS safety, EMT, Emergency Medical Services, Ethics, Fire department, Firefighter, Paramedic, edemse, ems 2.0, everyday ems ethics, fire, new perspective, pride, professionalism, soap

Someone Failed… Is it the System? Everyday EMS Ethics

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A tempestuous night is blowing outside the station walls. The cold night air is stirred wildly, blowing splatterings of rain against the glass window of my bedroom. The wind howls through the trees conjuring up fantastic images of the disturbed environs of the world outside my bunk room. Having gone to bed early, I cannot remember the dreams I must have been having but judging from the fact that my sheets were in such disarray when I awoke, they must have not been pleasant.

I awoke to a familiar but unwelcome voice, the night shift dispatcher coming from my radio. He spoke of a seizure in the next town over. The local ambulance service from that jurisdiction was calling for a paramedic to intercept and assist them with their call. I was due, it was my turn to be ripped from the warmth of my bed and respond to their aid.

I pulled on my clothes and zipped up my shoes. Since whomever controls the seasons in my area has decided to outright skip Fall and move straight to Winter I pulled on a jacket as well. Stepping out into the night air I halfway expected there to be a late September frost on the ground. As I started my truck and keyed the address into my GPS I cranked up the heat to stop my shivering. Hopefully this wouldn’t be too challenging for me in my sleep deprived, freshly woken up state. Hopefully I can wake up enough to safely drive. I shook my head violently to clear the sleep from my bleary eyes and keyed up the mic:

“Dispatch, Medic 84 is enroute to intercept Anytown”

The night shift dispatcher answered me and I switched to Anytown’s frequency:

“Anytown, Medic 84 is enroute to your scene”

With the red lights flashing over my SUV I pointed out into the deserted city streets. Anytown was about ten miles away from my station over country roads. The address was a few miles into their city limits. Curiously, the address they called me to was just a few short minutes from Anytown Hospital and it was strange that the EMT-Intermediate volunteer service had called me to an address where they would usually just scoop and run ILS to the ER. I figured that this must be one of those “Seizures” where the patient seized because of the fact that their heart stopped. People will oftentimes have a seizure when their heart does something funky, like stop, and blood flow is slowed or stopped to their brain. An old paramedic instructor I had once put it this way “Brains need blood flow to be happy, stop the blood even for a second, and the brain gets pissed off”. Everything seemed to get pissed off to that guy. An MI causing arrythmia was a “Pissed off heart”. Diabetes was a pissed off pancreas. A drunk at the bar was pissed off at his liver and so forth.

I wondered what this patient had that was pissed off for her.

The roads were open but the night was pitch black. The wind was blowing my small SUV in all directions but straight. Thinking that this was probably a bad call, I pushed the gas as hard as I felt was prudent with the driving conditions. I didn’t meet any traffic to get in my way. Just as I was coming into their town, a familiar voice crackled over Anytown EMS’s frequency:

“Medic 84. We still need you to respond but you can slow it down to non-emergent. We’re short an “I” and it’s going to be you”.

Ohhhh, so they couldn’t staff the truck fully and responded using me to make their full crew. Now I understood. Anytown EMS is a good service with dedicated people, but sometimes even the best volunteer service needs a hand. That’s what mutual aid is for. We have an arrangement with them in such circumstances so that our intercepting paramedic can make up a full crew for them by partnering with one of their EMTs.

I turned off the lights and just cruised silently through their deserted town. Yes, I popped the lights on momentarily to get through a couple of stop lights, but who’s counting, right? Arriving on their scene the EMT came out to me and said:

“You don’t need to bring anything. This is her third ambulance ride in 24 hours. She spilled a glass of water and (a family member) called because she thought she was “having a seizure” and needed to go back to the hospital”

Oh, now I remember this address. I don’t even work for this town and I’ve been here like umpteen times this year. The patient is one of their frequent fliers. Every community has them. I swear, without our frequent fliers we’d be short like a thousand annual calls. Think of the sleep time I could get.

Climbing up into the ambulance, I met the patient for the umpteenth time this year. She was in no distress and this is where her part in the story ends. My question isn’t about her. Honestly, the question here could be about any frequent flier in any community that has an ambulance response.

Why do we have them? Why do they depend on us so much?

The patient in this example had been to the ER twice already in the previous twenty four hour period, both times being transported by EMS and both times being taken home in a private car by family. Both previous times she had called her General Practitioner physician and had been referred to the ER because she said the word “seizure”. I can hardly blame the GP for recommending she call 911 rather than phone triaging her and suggesting she come into the office. But remember, it’s not about her. I can think of probably ten patients right now that I would consider to be among my personal roster of repetitive patients (I only have ten fingers) and their use of the emergency healthcare system for management of their chronic complaints is staggering in comparison to the use of it by the general population. Last year, every shift for two months we would respond to the same gentleman’s house to wake him up by popping in an IV line and giving him some D-50. We got pretty tired of it, as you can imagine. Most people with diabetes manage their illness pretty well and only occasionally need the assistance of an ambulance crew. This guy chose to manage it by drinking hard alcohol. I swear that I wanted to just leave the IV in place so that I wouldn’t have to start one the next day.
We fixed it by refusing to treat him on scene and release him anymore. It is common practice in my area to “sweeten up” a comatose diabetic with low blood sugar by popping in an IV and giving IV sugar (D-50), or in milder cases, by giving them high-sugar foods and making them eat until they regain full mental faculties. Once they regain their senses, all but a few of these patients sign a refusal of treatment form and do not wish transport to the ER. However, for this patient, we would find him unresponsive, so we would pack him up, move him into the ambulance, start the line and sugar him up while enroute to the ER. Once we were transporting, he couldn’t refuse to go and would end up at the ER for hours. Finally, he started managing his diabetes better because it was more convenient than waiting at the busy, urban ER we would take him to (yes, it was the closest. I work in many different jurisdictions).

However, the above solution just passed our problem we were having with the ambulance response onto the already overburdened Emergency Room. Yes, it “solved” the problem by increasing the patient’s level of personal inconvenience (although we still go to this guy about once or twice a month), but at what cost?
Who or what is causing the failure for these people? Who or what is causing the failure for this whole patient population? Is it the system that fails to adequately educate them on how to properly care for themselves or cure their ailment? Or is it the patient who is unwilling, or incapable of caring for themselves?

For both of the above named patients, socialized medicine already exists for them. They’re wards of the state as far as healthcare is concerned. One of them owns a house, one of them is in a free, government subsidized apartment, one
is in one state, the other is in another. You and I pay for their healthcare and almost their every need.

Is this the system’s fault? Is it their fault? Who should pay for the failure?

I’m writing this after coming back into my bunkroom and finding my sheets and blankets twisted into a ball. Everyone else in the house is snoring because of the abrupt weather change. (and DDex, if you read this YOU FREAKING SNORE WORSE THAN NACHO!) Whatever dreams I was having before this call came out must have been strange.

Until the next…

—————————————-
Update:

My blogger buddies Happy Medic and Medic999 took off from this post and wrote their point of view on their respective blogs. Here they are. Join the discussion.

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on September 29, 2009 • Filed under: 911 fail, ALS Intercept, Ambulance, EMS, EMS ethics, Paramedic, edemse, emotions, medical ethics, politics, socialized medicine, universal healthcare

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.

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on September 28, 2009 • Filed under: EMS Blog, EMS Blog Carnival, EMS blogosphere, EMS ethics, bernoulli, blog, blogosphere, change, ems 2.0

Still more Everyday EMS Ethics – Gkemtp(it) is born

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I’ve been on this kick lately for medical ethics in EMS. So, I’ve decided that “Everyday EMS Ethics” is going to be a featured area on my blog. I think that It’s annoying my wife Gkemtb who, by the way, is starting Paramedic school today and is now becoming Gkemtp(it). The (it) means, “in training”.

The unfortunate thing is that she’s now reading her paramedic textbook and she’s asking me ethical questions as she’s studying medical legal aspects of paramedicine. Tonight, she asked me this question:

Imagine you’re in the back of an ambulance with a patient on a long-distance transfer. During the transfer, the patient states to you: “I think that I’m ready for my life to end. I’ve had a good run and I’m just comfortable with the idea of the end of my life. If I die, don’t do anything to bring me back. I’m ready to go”.

I said, “Well… it depends. Is the patient in his right mind?”, “How old is the patient?”, “is this a suicidal ideation? Or is this someone who might be getting ready to sign a DNR but hasn’t yet?”. She indicated that in her mind, it was an elderly person with a long medical history. If it was someone that was possibly mentally ill… the likelihood of which increases with decreasing age and better long-term prognosis, then I wouldn’t honor it just the same as you wouldn’t kill someone who asked you to kill them because they wanted to commit suicide. However, if it was, say, a long term brain cancer patient that had metastasized and was causing great pain… then it’s a different question. Ultimately, if I was the only person that the patient said it to, I would try to get them to say it in front of other witnesses. If that couldn’t happen, and the patient did in fact go into cardiac arrest… well then I would probably resuscitate them because I would never be able to prove that I acted in accordance with the patient’s wishes. But I wouldn’t like it. Please tell me what you would do, because heck, I don’t know…

The other thing she brought up was if I knew about the “Oath of Geneva” and um… I didn’t know about it.
A quick Google search brought it right up for me, so here it is:

Physician’s Oath

At the time of being admitted as a member of the medical profession:

I solemnly pledge myself to consecrate my life to the service of humanity;
I will give to my teachers the respect and gratitude which is their due;
I will practice my profession with conscience and dignity; the health of my patient will be my first consideration;
I will maintain by all the means in my power, the honor and the noble traditions of the medical profession; my colleagues will be my brothers;
I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient;
I will maintain the utmost respect for human life from the time of conception, even under threat, I will not use my medical knowledge contrary to the laws of humanity;
I make these promises solemnly, freely and upon my honor.

According to the article I read on it, which surprisingly wasn’t from Wikipedia this time, and is located at (http://www.cirp.org/library/ethics/geneva/) this oath was adopted by the World Medical Association (A group made up of National Medical Associations… well, read it yourself:

The World Medical Association is an association of national medical associations. This oath seems to be a response to the atrocities committed by doctors in Nazi Germany. Notably, this oath requires the physician to “not use [his] medical knowledge contrary to the laws of humanity.” This document was adopted by the World Medical Association only three months before the United Nations General Assembly adopted the Universal Declaration of Human Rights (1948) which provides for the security of the person.

Paramedics come from physicians. Therefore, I believe that we are to honor much of the same ethical standards as they are. Healthcare is an honorable profession. We have the obligation to carry it on that way.

Sorry about the serious posts lately guys J I’ll go back to posting about driving fast and kneeling in poo soon.

Care to Share My Stuff?? C'mon, Go ahead.

Posted by Ckemtp on August 27, 2009 • Filed under: Ambulance, EMS ethics, EMS paramedics, edemse, medical ethics, scenario, whattaya do

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