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Shining through Suffering – Learning How to Cope with Sadness in EMS

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Medic Trommashear, who writes great stuff has offered to co-post with me on this. You can check it out at her blog: http://lookingthroughapairofpinkhandledtraumashears.com/

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This morning the wife came home from her night shift on the ambulance and told me a sad story. During the wee hours of the morning she handled a rather nasty fatality accident. The victim, a 20-something male was walking home from a party on a dark country road and tragically, a passing motorist didn’t see him in time and the accident ensured that he’d never make it. Pedestrian vs. car accidents at high speeds have a way of doing that.

Sad stories like this are getting more common for her as she’s immersed herself fully into paramedic school and professional EMS in general. She’s been seeing sad stuff multiple times per week it seems. I can see that it’s wearing on her and I feel her pain. I have experienced it quite a bit myself in my own career and I continue to do so on a regular basis. Jumping into full-time EMS exposes a person to sadness on a level that can’t easily be prepared for. A person just has to jump in with both feet and not be afraid to feel the range of emotions that they’re going to be exposed to. It’s hard, it’s tough, and it’s one of those things a person just has to learn how to overcome if they want to make EMS a part of their life.

That’s the part that most people don’t get, I think. The part where you have to “Learn How” to overcome the sadness and negative emotions we’re faced with as EMS people. A common statement that lay people make when they hear that I am a paramedic is “Oh, I could never do that job and see what you see. I just couldn’t handle it”. Perhaps they’re right, but I would guess that anyone can train themselves to handle almost anything. My pseudoscientific opinion is that we develop our tolerance and our healthy ways of dealing with being exposed to such negative emotions on a regular basis through experiencing it and learning ways to function and feel happy afterwards. It’s harder for some than others and I can’t imagine that there is a single roadmap for learning it. It’s individual. Friends help and so does an understanding family. Good coworkers are great to observe and learn from as long as they realize their own humanity and aren’t simply trying to fool themselves out of bravado. We’re all human and I can testify that we’re all affected, no matter how thick our skin may appear.

Back when I was a new medic I was working a ton of hours. I mean, I worked a lot. I worked TOO much. I worked for days on end without sleep for multiple jobs. At the time, I felt I had good reason. I was attempting college for the first time, taking care of my recently deceased father’s businesses, and trying to sock away money to help my mother. I worked a full-time EMS job, a full-time hospital job, ran the businesses, and volunteered for a separate fire department and EMS agency. It was nuts. I would literally go for days without sleep. During that time it seemed like I was getting slammed by horribly sad calls. I felt I was surrounded by suffering and death. I was working at least two codes a week on average. Mayhem and madness seemed to rule the day. I was getting deeper and deeper and…

I was going nuts.

I was horribly, deeply depressed.

I almost went insane.

I was at my darkest hour when I found myself angry at anything that was cute or fun. Literally things like jokes, teddy bears, and Hallmark cards made me angry. I just couldn’t see how people could stand to look at that kind of stuff when there was so much suffering in the world. How frivolous! What a waste of time! It made me angry to think of anything that didn’t acknowledge the pain I was bearing witness to on such a regular basis. I was depressed and angry. I just couldn’t understand anything other than feeling the pain that the people I was taking care of were feeling. It affected my life, my work, and my human interaction. It was horrible.

Then I had an epiphany that changed my personality and who I am to this day.

Those who meet me know that I like to joke around. A lot. There are things that I take seriously however I do not personally happen to be one of them. My epiphany was that the stuff that was cute, fun, loving, friendly, and/or happy was all that actually did matter in life. We combat the bad with the good, the yang with the yin. I chose to pay attention to the comedy of life and downplay the tragedy. After that revelation, my whole outlook on life and my personality changed for the better. I had found that comedy, friendship, and love were the ways to live my life. Come what may, I can make a joke about it and that makes it ok. I laugh at inappropriate times and seek out the good in life. My life and career ensure that I’ll still have an onslaught of human tragedy thrown at me whether I’m ready for it or not but If I can actively seek out the positive, I may just end up ahead of the game.

To my wife, I love you. Hopefully you don’t end up where I have been… but I’ll be here for you, come what may. I understand what you’re going through and I love you for this any many, many other reasons. Always.

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You may want to read one of my most popular posts. It’s an older post of mine where I explore what I call “Splashed Sadness”. It’s along these lines. We EMS people have to deal with a lot. Never be afraid to share it. Don’t hold it in. Get it out and learn how you can cope with it because there’s not a one of us ain’t human.

“Splashed Sadness – A look at Negative Emotions in EMS”

Or “Reflections on an Easter Morning” – another post about a bad call.

Also, don’t forget to check out Medic Trommashear’s co-post on this. You can check it out at her blog: http://lookingthroughapairofpinkhandledtraumashears.com/

(Note: I’ll link to the post directly when it’s up)

Posted by Ckemtp on August 30, 2010 • Filed under: EMS, EMS Health & Safety, EMS Topics, Emergency Medical Services, Fire Rescue Topics, Firefighter Safety & Health, Line of Duty, Paramedic, Training & Development, Uncategorized, bad calls, emotions, inside the mind of a paramedic, psychology, sadness

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

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

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

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

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

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

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

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

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

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

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

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

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

I’d write more but Zzzzzzzzzzzzzzzzzz

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

You Know You Work Rural EMS When… (#12234)

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Today I overheard an ambulance service somewhere out in the sticks get dispatched to a “Car Vs. Pedestrian” on a rural backroad. This particular backroad is known to be a real rural speedway, where cars just fly down the road far from any prying eyes of the local traffic cops. Any vehicle/pedestrian interface on this road would be sure to be a real messy call and the rural ambulance service that got dispatched to the call made a pretty good turn-out time.

About ten minutes after dispatch, the county dispatcher came back over the radio and cancelled the response. Apparently the “Car Vs. Pedestrian” wasn’t Vs. a human pedestrian… it was a Car Vs. Deer. Sure, the deer was probably walking at the time it was hit, but even with as rural as this ambulance service is, they don’t handle veterenary emergencies.

To her credit, the dispatcher made sure to inform the ambulance crew that the “Patient has left the scene”.

Now, you may think that the rural dispatcher was just being cheeky and funny when she informed them that the deer scampered away. However, then you wouldn’t be in rural EMS. The dispatcher, who probably has known every crew member since Sunday School did the crew a favor by letting them know that the deer wasn’t there. Us rural folk know that fresh deer meat out of season is a rare delicacy and that the first person to get there gets the carcas.

I’m not incinuating anything… just sayin.

Posted by Ckemtp on June 25, 2010 • Filed under: EMS Health & Safety, EMS Topics

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

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

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

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

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

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

And that’s the important part.

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

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

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

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

For more information:

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

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

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

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

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

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

To Kneel or not to Kneel

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

 

 

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

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

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

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

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

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

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

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

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

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

EMS Week 2010 – Thank You Letter from Management to EMS Crews

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This letter is free to copy and customize for your organization. It is a thank you letter from Management to Medics. I do not wish for any credits and you may use it as you see fit.

Oh, and if anyone who comes here wants a custom EMS Week 2010 letter written to fit their needs I will do it for free. Shoot me an e-mail at: Proems1@yahoo.com

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Dear fellow EMS professionals,

EMS Week again is upon us and we’d like to take this chance to say thank you for all that you do. We know that everyone who works here puts in long hours and sleepless nights taking care of the needs of our community and meeting our (company)’s mission. We know that you’re dedicated, we know that you care, and we also know that you don’t get the amount of thanks that you deserve most of the time.

So today, we’d like to take this opportunity to say “Thank you” to everyone who works here. Thank you for your time. Thank you for your dedication. Thank you for your caring, your compassion, and your devotion to patient care. Thank you for working long shifts and for holding over to cover late calls. Thank you for taking time away from your families to keep our trucks on the streets for our communities 24/7. Thank you for thinking on your feet to solve new problems for our patients. Thank you for comforting families. Thank you for comforting the community. Thank you for risking your safety. Thank you for your bravery. Thank you for your commitment. Thank you for more than we have space to thank you for. Thank you for more than we know how to thank you for.

EMS Week is an opportunity for the public to recognize what we do out there every day. It’s an opportunity for us to showcase our talents, to let the public know how to use us, when to use us, and why to use us. It’s an opportunity for us to connect with our communities and for them to connect with us. What we do is important. EMS is a necessary service that is vital for our community and the nation. EMTs and Paramedics are the healthcare safety net for all of us. We’re there for everyone when they need them, on their terms, doing what’s best for them. We come to them, meet them as they are, and give them the best that we have to offer. We should use this week to reinforce that, and to improve our relationship with them.

In closing, EMS Week isn’t quite up to the task of thanking heroes. In reality, nothing is. Please know that no matter what happens, we know that you work hard and that you care. We know what you are accomplishing out there and we give you our respect. We give you our sincere thanks. We pledge to support you as best as we are able and we know that you’ll continue to give us your best.

Respectfully,

Management of Some Ambulance Company Somewhere

http://www.LifeUnderTheLights.com

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Just change it to suit your needs. Rework it as you see fit. It’s free to use and to modify. Do me a favor and leave a comment, anonymous if you’d like, about your using it.

Posted by Ckemtp on May 4, 2010 • Filed under: Administration & Leadership, Command & Leadership, EMS, EMS Health & Safety, EMS Management, EMS Topics, EMS pep talk, EMS week, Emergency Medical Services, Fire Rescue Topics, Management, Paramedic, ems week 2010

Grumblemedics

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Grumblemedics, you know them. You’ve seen them. Heck, you may even be one. Whether they’re a Grumble Pee or a Grumble Bee, there’s an apparent glut of them in the profession and I’d like to know why. See, to me, EMS is the greatest job in the world. Sure, there’s the great pay and benefits, but there’s also the great hours, plentiful time off, and comfortable ergonomic working environment. I can’t tell you how many times I’ve been just left with a warm-fuzzy feeling after a shift…

Ok, so that could have been an exaggeration, I know that there are things in this profession that just plain ol’ stink. But I gotta tell you, EMS really is my favorite job. I really can’t imagine doing anything else. While there are times in my career that I’ve wondered if it was an abusive, co-dependent type of relationship, I realize that I would not want to be anything other than a paramedic.

So why does it seem like there are so many Grumblemedics? Could it be the long hours with little chance of getting a day off? Could it be the fact that we must get up at all hours of the night to take care of someone in better shape than we are? Tangent: The other day another crew transported a person with a chief complaint of “Dry Feet”. When they asked him if he really wanted transported, he said “Yeah! I got dry feet!” Or, the one last night where a woman had an NSAID pain patch fall off at 4am and called us because she thought that she was going into withdrawal. End Tangent.

OK, heck with the ending the tangents. There are a whole heck of a lot of calls that can be filed under “They called us for THAT!?” Why do people do this? Why? I mean, I’ve been called for things that I wouldn’t even take an aspirin for more times in my career that I can count (And I know that’s more than ten because I have ten fingers and if you think that I’m going to take off my boots after working in them for all of these 24 hour shifts you’re nuts). Why do people call us when they have a muscle cramp? Why did the guy call me when he got a fish hook in his finger? Why do people who happen to be type 1 diabetics drink themselves into a stupor and then call me first thing in the morning to wake them up? Seriously, I once spent a few months going to some guy’s house every shift bright and early in the morning to squirt him with a little D50 and he’d sign the refusal that would send him on his way. It ended when we began putting him on the cot and starting to drive to the ER before we sugared him up. He’d wake up in the rig just as we were backing into the bay doors and be mad at US for transporting him. Sorry guy, but you obviously need more help than we can give you.

So, there may be times in my career that I’ve been a Grumble Pee, but that might be expected. Heck, if I worked in a factory I’d probably be complaining about the lack of adequate ventilation and the fact that I couldn’t sit in the crew lounge and watch TV for a few hours of my shift. We all complain about things we can’t change or our own perceptions of injustice. I would guess that any profession has those things that the people in the profession just hate. Heck, would any of us want to work retail during the holidays? They don’t even get to jab strangers with sharp objects or have their own keys to the leather restraints.. Now THAT would suck.

You know what my absolute, all-time, worst pet-peeve is in EMS? No? I’ll bet you don’t care either but this is my rant and you can’t seem to stop me. My biggest, all-time, worst pet-peeve in EMS is: People who don’t call us when they need us. Yep, I would gladly take a hundred 3am “lost condom” calls rather than have one potential patient have that occult MI and lose any percentage more of heart muscle than they have to because they didn’t want to call EMS and bother us. You see, I work in rural EMS these days where people are nice, and they don’t want to bother their local EMS service with getting up out of their chairs, and they don’t want to bother their neighbors with having to look out their windows at the pretty flashing lights, and they really don’t think that the fact that the left side of their body is numb is any reason to be alarmed. These non-calls that should have been calls bother me more than any of them, and we all grumblemedics are somewhat on the hook here.

If you’ve read any of what I’ve written, you’ve probably seen my statement that “PR Saves Lives”. It means that the more positive Public Relations an ambulance agency has, the more people trust them, and the more people are apt to call them when they truly need them. I haven’t seen studies on what an effective PR program does in reducing so-called “nuisance calls”, but I have seen recent studies that say like 60% of patients having heart attacks make their first call to a friend or family member upon the onset of their crushing chest pain. I’m here to tell ya, I’m jealous. I want to get that call.

So maybe grumblemedics like I probably will be about an hour from now when someone calls me at 3am for something that I would take pepto-bismol for need to remember that we are blessed to do this job, and that EMS professionals need to approach this business with the heart of a servant. Because that’s what we are. We aren’t here for our health, we’re here for everyone’s health. Sometimes people get scared and call us because they’re scared and it is our job to make them feel better by telling them they don’t have to be scared anymore. Sometimes we need to haul them in so someone with a whole-heckovalotta medical education can tell them that same thing. I decided a long time ago that if I ever got to a point in my life where I had to call the ambulance just so I could get some human contact because my real chief complaint was loneliness that I didn’t need some punk kid with a pulse and a medic card judging me.

Us grumblemedics need to realize that the nuisance calls are never going to go away. We’ve got to realize that there are, however, ways to combat them:

  • Check your Ego at the Door: You serve the public. Not the other way around. You are blessed and dang lucky to be the person that this person asked to take care of them in their or their loved one’s hour of perceived need and you best not forget it, because your mental health is at stake, and their life could be too. The best EMS people approach this job with a servant’s heart.
  • Evangelize EMS: You want the general public to know how to properly use EMS, right? Then what have you personally done to help teach them. Get out there and get the word out. Don’t hide in your station, or in the parking lot you’re posting in. Get the message out about what you’re there for, what you’re capable of, and how friendly you are while you are doing it.
  • Everything is PR: Every single, solitary thing an EMS person does affects the publics’ perception of them, their service, and the profession in general. Really. When you meet up with another crew for breakfast in the morning and talk about how wasted you got last night at the bar don’t think that the people around you aren’t listening. When you swear in public don’t think that the kids who are looking up to you in your shiny uniforms with your neat big truck aren’t filing that away. Take your public image seriously. Exude professionalism at all times because it saves lives. The more comfortable everyone is with your professionalism affects how apt they are to call you first, call you fast, or call you at all in a life or death situation. That can make all the difference for a lot of potential patients.

There’s a lot more that every one of us can do, but I’m tired here and I still have the last 8 of my 24 to do be
fore I have to get up in the morning and do 8 hours with my other full-time job and then do a 4 hour training with my volunteer department. Hey! I have an idea!! Maybe if there weren’t so many grumblemedics and the public took a more positive view of our value to society we could maybe squeeze some more pennies out of them at budget time and get paid better so we wouldn’t have to have so many freakin jobs and work so many hours to feed our families! Yea, wouldn’t that be great!!

As always folks, comments and flames are welcome. Public commentary is most appreciated, but I may always be reached privately at: proems1@yahoo.com

Posted by Ckemtp on April 8, 2010 • Filed under: Ambulance, EMS, EMS Health & Safety, EMS Topics, EMS ethics, EMS rant, EMT, Fire department, Firefighter, PR, Paramedic, Public relations, first responder, friendly, grumblemedics

Red Lights to the Left of them, Blue to the right! – Coloring Emergency Lighting

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So you’re driving down the road in an unfamiliar state, let’s say that it’s Iowa or Wisconsin, when in your rear-view mirror you see flashing red lights on a big utility truck coming your way. You can’t really make out what kind of truck it is, but you see red lights flashing so you pull over to let it go by. When it does, you realize that you’ve just pulled over for a tow-truck.

Or how’s this? The same thing happens, but it’s a flashing blue light in Colorado. When you pull over, you realize that you just got pulled over by a snow-plow.

I live in Illinois and work between IL and Wisconsin and there’s quite a bit of a difference between the different lighting colors and upon who can use what color light for what purpose. As a volunteer paramedic/Firefighter in Illinois I run a blue light with no siren in my personal vehicle. Even though I rarely turn it on, I have it in case I get stuck behind a 20mph Grandma on my way to the Big One. Interestingly, the blue light gives me no legal authority or any legal leeway on traffic laws and I must obey all traffic laws even while running the light. I Wisconsin, however, volunteer firefighters and EMS people may use red lights and sirens in their personal vehicles. They have the same legal status as governmental emergency vehicles when they’re driving with their lights activated.

In Iowa, volunteer firefighters may run blue lights in their personal vehicles with no legal authority granted them, and EMS volunteers may run clear (white) lights in their personal vehicles. Volunteers for fire and EMS combination agencies may run a mixture of both, however if a person volunteers for both a separate Fire department and a separate EMS agency, they must be careful to run the clear light for EMS responses and the Blue light for fire responses.

Of course, that’s just for personal vehicles right? Allowing emergency lights in the personal vehicles of emergency volunteers is a debatable issue in some circles. I argue for responsible control of their use and think that they are needed in some communities and not needed in others. Out of the 400-500 volunteer runs I respond to annually, I probably turn on my blue light for less than ten percent of the runs. I use it judiciously, but I know others that I can say did not.

However, this isn’t a post about volunteer emergency lighting and the pros and cons of it. It’s about the messed up spectrum of colors that we use on emergency vehicles in this country. Sure, we have the same stock colors pretty much everywhere. Red, blue, amber (yellow), green, clear (white), and in some states purple (Yes! Purple!). In the southern states, blue lights are for law-enforcement only and red is for fire only. In Wisconsin, law enforcement runs red and blue lights and fire and EMS is red only. In Iowa, up until a few years ago everyone ran red lights except for volunteer firefighters. They changed the law and now allow blue on the Passenger side only. In the City of Chicago, the Chicago Police Department runs blue only and the Fire department runs Red and Green. Downstate Illinois (Read: Outside of the City of Chicago City Limts) runs red and blue for all “Authorized Emergency Vehicles” and blue lights for the volunteers. Green lights are only permitted on stationary vehicles for command lights but can also be used for private security officers. As I mentioned before, in Iowa and Wisconsin, tow trucks run red lights. In Colorado, snow plows run blue. In some states, funeral processions run purple.

Confused?  I sure as heck am.

Consider this: Different lighting colors exist because different members of the driving public see different wavelengths of light in the spectrum (i.e. “Colors”) better or worse in differing ambient light conditions. Also, different colors penetrate different atmospheric and/or ambient light conditions better than others. You can see blue forever at night or in the fog, but not so much in the bright light. Red washes out to amber in the day light but is still fairly visible. Clear lights penetrate for a very long way but can be confused with light reflecting off of a surface almost the same as amber lights. We need a diverse spectrum of colors emanating from our response vehicles in order to ensure that the highest amount of drivers out there are able to see the lights. If someone’s color blind to the particular light color that we choose, they’re not going to see us all that well, are they?

The arguments that I hear for the use of lighting colors don’t hold much weight with me. Who cares if the public is able to see that an approaching emergency vehicle is Fire, EMS, Law Enforcement, ASPCA, Haz-Mat, Tech-Rescue, Volunteer, or miscellaneous. They just need to pull over and get out of the way. One color lighting schemes may give the agency a sense of personality or whatnot, but they’re certainly not the safest way to be seen. An emergency vehicle needs to throw out a lot of light across the spectrum of visible colors in order to help ensure the safest response possible.

So why are we having this hodgepodge of warning light colors? Why do people think they’re a good idea? I can think of a few advantages of having “law enforcement only” colors, as in reducing false traffic stops from people impersonating police officers, but having one color and one color only simply makes it easier for a criminal to get a hold of that one color of light. Why fire would only need red lights is a question that I can’t come up with a good reason for.

So good luck driving out there! If you see me, I’ll be on the side of the road letting a tow-truck go by. Then I’ll run my blue light in Wisconsin because we got a house fire in my district that touches the WI state line and I’ll get arrested for impersonating a police officer. Then I’ll be at work getting into a crash because someone driving out there was color blind to the color red.

Anyone want to add to the confusion? What colors do your state or country use? Is anybody else in favor of a national standard?

Posted by Ckemtp on April 7, 2010 • Filed under: 911 fail, Administration & Leadership, Ambulance, Ambulance Driver, Ambulance maintenance, Command & Leadership, EMS, EMS Health & Safety, EMS Management, EMS Topics, EMS rant, EMS safety, Emergency Medical Services, Fire Rescue Topics, In the Line of Duty, Iowa, Iowa EMS, Line of Duty, Management, Technology & Communications, Vehicle Operation & Ambulances, Vehicle Operations & Apparatus, accident, ckemtp rants, code-3, drive fast, lights and sirens, politics, technology-communications-ems-topics, volunteer fire department, volunteer firefighter

Reflections on an Easter Morning – EMS

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Easter is a family time in the Kaiser household. Everybody gathers together, does the church thing, and as is the tradition here in the Midwest, we eat a lot as well. This Easter was no different. My wife Gina’s mother was there, my parents were in town, and a lot of other miscellaneous relatives came over to the LUTL compound for family time. The weather was beautiful and the coffee was hot.

In the morning, even though I had my own stuff to cook, I became the go-fer for my wife and her mother for groceries. They gave me their list and sent me off to the store for their last minute sundry items. The traffic was light but the after-church crowds were starting to clog the roadways on their way to wherever they were going for their own Easter family time. I was happy to be out though. It simply was a beautiful Spring day in the Midwest. The Sun was shining, the breeze was warm, and it was one of the first days nice enough so that I could finally open up the windows and let the fresh breeze sweep out the air in the car a bit. It was idyllic… all until I saw this:

Roadside Memorial

A grieving family had placed that beautiful memorial in the very corner where a year or so ago I had responded to and worked one of the worst motor vehicle accidents of my career. A car, driven by an elderly couple had pulled out in front of a van, which T-boned them into the spot where the memorial now stands. It ended up killing both of the elderly occupants, the Husband on scene and the wife a few days later at the trauma center. I worked the husband… and I mean I really worked him hard. Altogether, we had two ambulances and two helicopters on scene. Even though I arrived on the Engine Company, I took charge of the Husband, performed an emergency extrication, and worked him as a trauma code. An EMT-Basic who I trust very much was first on scene and stated that the patient was responsive just after the incident. He told me that the patient began breathing after the EMT repositioned his airway. I worked him in the second ambulance to arrive on scene. We had the helicopter on the ground and the flight crew ready to take him when we decided to cease our efforts. Intubation, bilateral IVs, and all of our tricks couldn’t reverse the massive thoracic and anterior neck trauma this poor guy had received. We decided it was futile and called it.

032508-hono-37

I’m inside the ambulance in the foreground. I’m working hard in there.

So today, on this beautiful Easter morning, I’m reminded of that dark day from which I really wonder if there was something that I could have done differently to change the outcome. Yes, I know that there were three other paramedics there with good experience. Yes, I know that we all did our best and no, we didn’t make any mistakes. I am sure, in all rationality, that there was nothing I could have done differently that would have made any difference in the patient’s outcome… but that’s what I thought when I saw the family’s new memorial.

And it’s a beautiful memorial, really.

It’s times like these when I reflect on the gifts and the burdens that all EMS people receive in their jobs that they carry on to their daily lives. I have always said that I can give nothing back to EMS that would ever compare to what it has given me. I cherish the successes and know that the failures make me stronger. It’s made me the person that I am today and I thought that I’d share some of that with you on this Easter. I’m sure you have your own stories and I would love to have you share them as well.

Happy Easter, y’all.

Posted by Ckemtp on April 6, 2010 • Filed under: EMS Health & Safety, EMS Motivation, EMS Topics, Uncategorized

Advances in Prehospital Analgesia and Conscious Sedation

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Pain is endemic within Emergency Medical Services, whether it’s the pain from a grotesque traumatic injury, the chest pain from a heart attack, or the emotional pain suffered by the local teenage drama queen in response to a minor texting-while-driving incident. EMTs and Paramedics must become better at overall pain management and in conscious sedation. Luckily, there are researchers and pioneers working on new and innovative strategies for just that end.

Researchers at the Plover, WI Polytechnic Institute of Cosmetology and Cheese Making  (PPICCM) have been bringing some cutting edge research to the forefront of Prehospital Pain Management and Prehospital Conscious Sedation and have released some new technologies for use in the field. They have field tested these devices in the dive bars in and around Plover on Friday and Saturday nights and even once or twice on the infamous “TwoFer Tuesdays” down at MoeLarry’s Curly Fries and Cheese Bar. They have come up with compelling data that your agency should consider for your own use.

Tradtionally, EMS providers have had a few choices for use in prehospital analgesia and conscious sedation. Advanced providers and paramedics have injectable medications for use, and basic level providers and EMTs have basic splinting and positioning for use in controlling severe pain and the secret weapon for use in putting people to sleep. These medications, including Morphine, Fentanyl, Toradol, Aspirin, and sometimes Nitronox have proven to be very effective, but all of them carry with them side effects and the risk of allergic reactions that can prove fatal in some patients. So can the medications used in Drug Assisted or Rapid Sequence Intubation Techniques: Etomidate, Succynocholine, and the like. To reduce the risk of poor outcomes from these medications, the researchers at PPICCM have developed the following tools:

  • The Open Handed Slap – This is effective as a calming technique for persons who have become hysterical due to superficial trauma to their fingers as well as for family members overcome with emotion due to their loved-one’s bout of indigestion. An example is included below:

 

  • The Mallet Method of Anesthesia Induction – Pioneered by the indomitable Drs Moe, Larry, and Curly (and previously by Dr. Shemp), the use of mallets in induction of conscious sedation is well documented. Simple, yet elegant in it’s use, cranial contact by the fast-moving business end of a mallet is highly effective in reducing any complaints of pain from a patient. In fact, just the visual feedback recieved from opening the case the mallet is stored in and showing the patient that you are preparing to use said mallet is effective in reducing complaints from most alert patients. However, if needed for use, one or two blows in rapid succession is shown to be quite effective in the literature. An example is included below:

 

  • Transcutaneous Oxygen Therapy (TOT-WTYTR) - This method involves pressing the external wall of a “D” sized oxygen cylinder against a bony prominence of a patient in the throws of a violent reaction towards EMS providers. Use of TOT can be handled by both Basic and Advanced providers and it’s effects are determined by the speed and location of the bony prominence that the side wall of the oxygen cylinder is applied to. Lower extremities can be calming while the head and cranium can induce anesthesia and facilitate Rapid Sequence Intubation in most patients. Unfortunately, there is no accompanying video literature for this particular therapy, however it is a simple technique to learn.

Thanks to the brilliant scientists at the PPICCM, prehospital anesthesia and analgesia is in good hands. These simple yet powerful techniques are scheduled to be released for use by my agencies on April Fools Day and should NEVER EVER be used by yours. Ta’ Y’all. Happy Spring.

Posted by Ckemtp on April 1, 2010 • Filed under: 911 fail, Als, Ambulance, EMS, EMS Health & Safety, EMS Humor, EMS Topics, Emergency Medical Services, Fire Rescue Topics, Paramedic, Uncategorized, crisis, funny, humor, paramedic education

Saved by the Bell? High School Student EMS

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Ahhh, High School. The classes, the lockers, the bells, the peer pressure, the parties, the immaturity, the congestive heart failure, the overdoses, the emergent response, the…

Wait, what?

I’ve been hearing a lot recently about Emergency Medical Technician training being held in High Schools (9th – 12th grades) with teenage high school students being trained to be EMTs. At first blush, it actually seems like an innovative way for communities to meet the EMS staffing shortage problem head-on. In addition, it would seem to be a great way to get young people interested in EMS. In fact, THIS ARTICLE posted recently by Zoll EMS&Fire on their Facebook page seemed like a good idea to me at first. A county partnered with a technical high school in order to train new EMTs to swell the rosters of their county’s services. It’s gotta be a good idea? Right?

Then how about this service in Darien, CT. that is ENTIRELY STAFFED BY TEENAGERS AND HIGH SCHOOL STUDENTS? (Dept. Web Site)

Or this service, in Hoboken, NJ that has a student emergency response team that “respond(s) with the school nurse to non-emergency calls”? (additional article)

I have been hearing about such things for a while now and even spoke about it with Tiger Schmittendorf on the March edition of the Firefighter Netcast, however I didn’t give it very much thought until I read the “Last Word” section of JEMS Magazine in what I believe was the March 2010 issue (although I can’t find it anywhere on their web site www.jems.com). It talked about our friends in Darien Connecticut that run Post 53 EMS, a service that is staffed and ran almost entirely by high school students. I was a bit peeved after I read that. Then yesterday when I read the article about the service in Sussex County, I got just plain mad. I don’t agree with this at all. In fact, even though I might have been for it without thinking it through, now I am coming out completely against it.

There, I’ve said it. I am against beginning Emergency Medical Technician training in high school and I am most certainly against persons under the age of 18 staffing ambulances. I also must strongly condemn persons under the age of eighteen responding to emergencies, operating emergency vehicles, or taking responsibility for professional level patient care.

Look at the words there and understand just how much I condemn the actions of the politicians and officials that permit this. You are endangering the public, harming the profession of EMS, and creating a systemic negative impact on patient care throughout the system. You run the chance of increasing patient morbidity and mortality, run the risk of getting teenagers injured and/or killed on an emergency scene, and are exposing youth to situations that they cannot possibly be experienced enough to understand.

I am fully aware that the above paragraph is inflammatory and I am aware that the proponents of these situations are not going to like what I have said, but that doesn’t make it less true. Look for a minute beyond the arguments that you are going to make about the kids themselves, who I am sure are all upstanding young citizens who are surely beyond reproach. Look for a minute even beyond the fact that evaluation of the kids themselves must be taken on “a case by case basis” as I’ve heard before when this issue is argued. T o be certain, there are kids that are capable of functioning to the EMT-Basic level with proper, adult, professional supervision… However, I want to know why there is a perceived need?

The communities that support and offer these plans where students are trained to the EMT level and especially those communities where persons under the age of 18 are active emergency responders generally purport to be offering these plans in order to combat a “shortage” of trained emergency responders. This is where my biggest grievance lies. This “shortage” of which they speak is manufactured. It’s false, and it’s created by the very attitude that causes the local political powers to think that a program that provides a consistent stream of young, inexperienced, naive EMTs who are willing to work just for the “excitement”, “honor”, and “cool factor” that these programs seem to offer is a good idea. Here’s the thing, these communities don’t have a shortage of adult, professional EMTs who are willing to do the job. They have a shortage of adult, professional EMTs who are willing to work for peanuts in a system that has no respect for what they do.

Get it? If you have such little respect for EMS and the EMTs that provide it that you are comfortable letting teenage kids work your trucks, you obviously have such little respect for EMS that you provide horrible pay and working conditions to the point where no self-respecting adult can make a living on the wages and conditions you offer them. There’s no shortage of EMTs willing to provide excellent EMS. There’s a shortage of pay and professional respect that causes them not to be able to survive working the available jobs. Trust me, if these communities paid better and provided better jobs there would be no shortage of EMTs. It’s manufactured by their willingness to just have someone with a pulse and an EMT card on their trucks. It’s manufactured by their thought process that EMS is simply childs’ play and that since “any idiot can do it” they might as well put kids on the trucks. The EMT shortage has always been created by lack of pay, poor working conditions, and an unwillingness of local politicians to provide adequate amounts of these things. Creating high-school EMT programs reinforce this by always providing a stream of fresh meat willing to work for nothing. Young people don’t worry about such things as pay high enough to support a family, nor do they care so much about things like insurance, benefits, or retirement plans. They just want to get out there and go to work. 

I make the argument that putting inexperienced high-schoolers on ambulances increases morbidity and mortality using my experience as an experienced long time paramedic. I offer the full body of research that proves that experienced healthcare providers provide better healthcare than do inexperienced ones. The fact that there’s such little research out there does not diminish the fact that you have no such research that shows safety in what you do. I say that your communities would be better served by adult, professional, well compensated providers. I say that they would save more lives and reduce more suffering than do your high-school kids. It is well known that patients have better outcomes when they trust their healthcare provider and you ask your patients to put their trust in high school students. There are many possible scenarios out there where the patient’s very life and/or death rest upon the skilled interventions provided by an EMT. In these situations, even experienced providers make mistakes. You’re telling me that the incidence of these mistakes will not be unacceptably higher using teenagers?

When your Wife, Son, Husband, Daughter, or friend is lying there, dying on the floor, the roadway, or on the cot, will you feel comfortable with your decision to put a high school student at their side to be in charge of their continued comfortable survival? I make the charge that you will not. Your community members do not need a child coming to them in their hour of highest need. They need a professional, adult provider and your system denies them this.

I support EMS education in high schools. I support explorer programs that give firsthand experience and education to teenagers and younger students. I support CPR and First Aid Training at any age. I will support students coming to the EMS station, cleaning the trucks, taking classes with the crews, learning about EMS, and even staffing first-aid stations and special events under the watchful eye of an experienced adult provider. I do not support students responding in ambulances for the reasons I’ve stated above… but in closing I also offer this:

In one of the articles above, someone stated that these programs prepare students for a career in the emergency medical services. They might. However, by their very existence they prepare students for a career in a low-wage, low respect industry that might as well be provided by teenagers. These programs are a slap in the face to our profession. We will never advance when mindsets like these are allowed to propagate and flourish

Your thoughts?

Posted by Ckemtp on March 29, 2010 • Filed under: 911 fail, Administration & Leadership, Command & Leadership, EMS, EMS Health & Safety, EMS Management, EMS Topics, EMS ethics, EMS rant, EMS training, EMT, Emergency Medical Services, Ethics, Fire Rescue Topics, Firefighter Safety & Health, Training & Development, ckemtp, ckemtp rants, edemse, ems education, everyday ems ethics, medical ethics, politics, rant, volunteer fire department, volunteer firefighter

Huddled Masses. Healthcare. Honor. EMS.

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A conversation that I had with another healthcare provider has me pondering a lot of things. Until now, I’d been pondering these things in a solitary way but I think that I’m going to put these ponderable thoughts up on the blog.

This post gets a little more political than my usual stuff. I don’t post politics up here unless the politics specifically relate to EMS (unless they’d get me in a lot of trouble, for example the best EMS delivery model).

But today, I’m making an exception. I think that some of the things that I’m pondering have to be put out there and I think that if I don’t throw this out to the blogosphere I’m gonna go nuts.

I work in a community that has a large Hispanic population. A good portion of them are probably undocumented immigrants from Mexico. Yes, I said “undocumented” and that can mean Illegal immigrants if you so choose to say that. It’s a fact that small towns in the Midwest have been growing by leaps and bounds with undocumented immigrants looking to find work wherever they can. Some of them have legal members of their family that they live with, some don’t.

There’s a huge debate going on in this country over illegal immigration. It’s bigger than me, it’s bigger than this blog, and it’s bigger than EMS. I’m not going to get into my personal opinion on the topic as much as I would if we were discussing this in a bar over a couple of beers, or a country cafe over coffee if you’re a morning person. I can say this: I’m all for border security. I’m all for people following the law and I believe that illegal immigration is a drain on our resources. Those points are barely arguable. Another thing I believe in are the words to a song that I used to sing when I was with a rather patriotic small-town childrens’ choir. The song went something like this: “Give me your tired, your poor, your huddled masses yearning to breathe fee. The wretched refuse of your teeming shore. Send these, the homeless, tempest-tost to me. I lift my lamp beside the golden door!” There’s a lady that stands in the harbor that has these words inscribed upon her, and they mean something.

I look upon this debate and I see both sides fervently trying to destroy any point-of-view other than their own. The lefties want them here because their hearts bleed for them. The righties think that the lefties want them because they can mold them into a new communist workers’ party. Both of them may be right. I am more of the opinion that America is an experiment. We’re a melting pot of people that have come together over the last two-hundred and some odd years to be stronger in our diversity. I believe that any cultural group entering our melting pot should come here and embrace the American ideals. “Melt” into the pot if you will. This has made us strong over the centuries and has built the country that I love, the one I will stand up for. Europe didn’t do that, they isolated their ethnicities into countries and fought amonst each other for a thousand years. We melted and homogenized into a strong nation full of rugged individuals championing their best ideals. I say that the most successful immigrant groups in the storied history of this nation celebrated their old cultures while melting in to our diverse one.

As far as today’s debate goes, I wonder if that would be the whole rub. Are the new illegal immigrants celebrating their own culture while melting into ours? Or our they placing their old culture on top of the American culture and creating discord within a proud nation? I think that we have always accepted the “Tired and poor huddled massess yearning to breathe free” because of our American Dream. People here have equal opportunity, a guarantee of the equal chance for humans to strive to reach their potential. Everyone has the chance to try and succeed to their own definition of success. “Life, Liberty, and the Pursuit of Happiness” is a guarantee of the chance to pursue. It is not, however, a guarantee of results. Our experiment is that everyone who has the chance will strive to give it their best shot, and that the people who succeed will pull others up alongside them.

I can’t say what’s right here. I don’t know. I don’t want to offend, but here I am, a paramedic. My job is to help everyone and anyone who needs me. I will do so. I have always done so. I took an oath and I honor my convictions. The hypocratic oath means something to me. Healthcare providers are honor-bound to help everyone as much as they can. I always will.

The conversation that we had was short, but he got his point across. I had brought up that while we have a large hispanic population in our coverage area, we rarely have calls involving those hispanic members of our population. I think that this is a bad thing because obviously these people fall ill and get injured at a rate comparable or even moreso than the other demographic groups in our area. I don’t know why they’re not calling but I can figure that it might be alleviated for the good of our community as a whole if we reach out to this population and let them know how, and when, to access the emergency healthcare system. I don’t believe in race and to me “hispanic” is a cultural label and is not even close to whatever “racial” means, but this is a cultural group that should be calling us and doesn’t. It’s deliniated over cultural lines and therefore is handy to address that way.

The other guy thought that it was stupid, pointless, and maybe even wrong to do this. It was because of the “illegal” thing. As strongly as I feel on that issue, and I do have strong feelings, as a healthcare provider my job is to help everyone. Every human deserves the best care that we can give them, every time. I don’t judge people. He shouldn’t either.

Neither should you.

Thoughts?

Posted by Ckemtp on March 25, 2010 • Filed under: Administration & Leadership, Command & Leadership, EMS, EMS Health & Safety, EMS Topics, EMS ethics, Economics, Emergency Medical Services, Ethics, Fire Rescue Topics, In the Line of Duty, Uncategorized, edemse, everyday ems ethics, inside the mind of a paramedic, medical ethics, politics, professionalism, socialized medicine

The Shine Factor

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Now get out there and polish some chrome.

——————————————————————-

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

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

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

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

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

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

A Shoutout to Emergiblog – Every EMS person should read this

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Go here – http://www.emergiblog.com/2010/02/why-dont-you-just-become-a-doctor.html

Read that post from Emergiblog. Then read it again. Then read it a third time.

Did you read what she’s saying? Try substituting “Paramedic” for every time the word “nurse” comes up in the text.

Couldn’t you imagine any EMS blogger saying that? What about any paramedic or EMT you’ve ever known?

Expect more on this post tomorrow. Right now I want you to look at what she has to say. It’s an important message.

Posted by Ckemtp on February 21, 2010 • Filed under: Administration & Leadership, EMS, EMS Blog, EMS Health & Safety, EMS Topics, EMS blogosphere, Paramedic, link

A writing Exercise – Working a weekend 48hr shift equal randomness

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I like Scott Adams a lot. The guy who writes and draws the Dilbert comic strip, not any other particular Scott Adams you may know. I’m not saying that I wouldn’t necessarily like any other Scott Adams, it’s just that I’m a huge Dilbert fan and also of its creator’s writing.

Why am I saying this? Well as has become en vogue to say with bloggers these days, “I told you that so I could tell you this”

Scott Adams, creator of Dilbert, was once asked his about his opinion on what to do about writer’s block. He gave this answer: (Courtesy of The Internet Writers Journal)

“One of the most common questions I get is “Do you ever get writer’s block?”

The thing I love about that question is that it reveals a wonderful optimism in the person who is asking. I suspect that the people who ask this question believe they possess deep wells of creativity and talent that are inexplicably blocked. All they need is the secret unblocking spell from a cartoonist and then a geyser of bestselling books will spray forth.

I wish I had that kind of attitude. I imagine myself asking an NBA player how he deals with Jumper’s Block, under the theory that if I can learn how to unblock my jumping skills, I will no longer need a car. I’ll just jump wherever I want to go, like the Hulk, but less angry.”

A smart man, Scott.

(like I know him well enough to call him “Scott” and not Mr. Adams… but like all great writers, a reader gets the feel that they know him through his writings so please forgive me. One day I hope to be that good of a writer… so if and when we ever get the chance to meet, please call me “Chris” or “Conan” or “CK” or something, it’ll make me feel better)

Maybe to stretch his analogies further for a paramedic blogger, if I were to unblock my “deep wells” of something, I imagine that I would miss in my unblocking attempt and might unblock my sarcasm well, or my “getting back to back calls starting at 2am” well, or something even less pleasant than those. However, judging from the 14 or so unfinished articles on my desktop right now, my geyser of creativity is not spewing forth. I’ve had like 6 good post ideas today, but not enough has come up from my deep wells in order to make them into a good post on their own.

So what I’m planning on doing here, is to just write the intros to each of these posts and post them here. I’m hoping that this exercise will pop the cork on my deep wells and allow the spewing of creativity to ensue.

Post #1: (dramatic intro to something… ahem)

It’s a foggy and overcast winter’s evening here on shift tonight. The sky is crowded with thick, dark clouds that are taking the colors from the multicolored illuminants below them on the shining streets. The fog is nearly impenetrable. In fact I’m almost surprised that my response vehicle is slicing through it as smoothly as it seems to be. The reflections of my red emergency lights bounce back inside the truck, turning the drive into a shining, bright experience as the fog pushes back against my truck’s insistence that it’s progress is indeed urgent. Somewhere, out there in the fog, someone needs me.

Post #2 (Feel good story with a twist)

Hey! While writing this second post intro, I actually finished it! I’m scheduling it for Monday Morning. So, instead of Post #2, I’m giving you a video…


 

Post #3 – Interrupted due to my being sleepy

Hey! This little exercise worked! I think I’ll try it again sometime. Today and tomorrow I’m working a 48hr shift, so you’ll probably be seeing some random posts come up in that time.

Happy Interwebbing!

Posted by Ckemtp on February 20, 2010 • Filed under: EMS, EMS Health & Safety, EMS Topics

Splashed Sadness – A look at negative emotions in EMS

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

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

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

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

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

     

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

     

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

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

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

     

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

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

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

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

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

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

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

Or you go nuts.

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

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

 

Posted by 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

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

Thank you EMS – Some reasons I love what I do

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Judging by how I felt this morning when I got up at 06:43 for a seizure victim after getting to bed at 03:30ish beforehand, I would say that I’ve been doing this for a while. I’m not as young as I used to be and I certainly am not the same person I was when I first got behind the wheel of an ambulance and flipped on the flashing lights.

I’ll never forget that first time I ever drove an ambulance lights and sirens. I was so excited. When I was younger I had always wanted to be an EMT and I viewed my first emergency driving experience as the time when I’d really “made it”. I was working as a security guard in a hospital where our security department ran an ambulance service that existed solely to transport patients from a free-standing ER attached to an outpatient facility to our larger flagship hospital with inpatient beds. Mostly we did tech work in the ER and transported every admission to the larger facility. Occasionally we got to “knock the cobwebs outta the siren” and run the ten minute trip “hot”. That was my first time driving in an emergency fashion… it may have not been a clean win since it wasn’t a 911 call… but it was still my first.

However, I digress. This post isn’t about my youth and exuberance that I didn’t know I was in the midst of when I first pinned on an EMS badge. This post is about the person I am today. I’m a paramedic now and I will say that I am proud of my son, my wife, my family, and my skills as a paramedic. I try not to brag on much, but I have put so much effort into all of the above that I am proud of the way they’re turning out. As a paramedic I have put in years of continuous effort to become the provider that I am today and even if nobody else ever cares about how good I was when I retire one sad day in the future, I will, and that’s enough for me to drive on.

I will never have the ability to give back to EMS all of the positive gifts that it has given me. Growing as a paramedic and as a healthcare provider is directly related to my growth as a person. I entitled this blog “Life Under the Lights” because I feel that I’ve lived a significant portion of my own life “Under the lights” of an ambulance. We all share a lot of the same experiences on our journey as EMS providers and we’re only starting to realize our true potential as a profession.

So here are a few things that I am thankful for that I’ve gotten back from my career as a paramedic so far:

-          Thank you EMS for allowing me to see the power and passion in people going through the worst times in their lives… and in some cases the best ones.

-          Thank you EMS for allowing me to have conversations with fascinating individuals I’ve met as I’ve taken care of them. I love hearing the stories my patients tell me… it’s got to be one of the best parts of the job. I’ve learned so much from my patients.

-          Thank you EMS for taking me on a journey through my own emotions and allowing me to feel the highest peaks and lowest valleys of my own psyche as I’ve lived out the world through facing emergencies. I may have never known such things about my own capacity for feeling.

-          Thank you EMS for teaching me that I always have it in me to go on fighting when the stakes are high… Without having to fight through the pain, exhaustion, and other discomforts that you’ve thrown at me I wouldn’t know nearly how much I could take.

-          Thank you EMS for allowing me to meet my wife. I love her more than I love you.

-          Thank you EMS for allowing me to meet my coworkers, some of them have become my closest friends. Maybe I’ve had better parties while on the clock than I have had off-duty. Being at work is just such a blast sometimes.

-          Thank you EMS for showing me that no matter what struggles I’ve been facing in my personal life, that there is always someone out there struggling harder than I am.

-          Thank you EMS for shaping my personality. I used to be a shy introverted person. Now I can almost always come up with something close to the right thing to say by thinking on my feet.

-          Thank you EMS for giving me the opportunity to Drive Fast and Break Things occasionally, it’s the manliest thing I do most weeks.

-          Thank you EMS for making my life exciting. I love the feeling I get when the stakes are extremely high and the adrenaline is pumping… it has to be better than any drug.

-          And finally, Thank you EMS for more than I can thank you for. I (quite geekishly, actually) can relate most things to something I have done or might do in the field. That’s very cool in my book.

Without my starting point in EMS more than a decade ago, you wouldn’t be here reading this right now. I would be some guy doing something somewhere else. My life is shaped because of what I do and who I’ve become from pounding the streets every day. Thanks for making me “somebody”. Thanks for giving me something to write about. Thanks for being as cool as you are.

Posted by Ckemtp on February 9, 2010 • Filed under: EMS, EMS Blog, EMS Health & Safety, EMS Motivation, EMS Topics, EMS paramedics, EMS pep talk, EMT, EMT-Intermediate, EMT-Paramedic Specialist, Emergency Medical Services, Fire Rescue Topics, Firefighter Safety & Health, Paramedic, appreciation, emotions, potential, pride, profession, professionalism, thank you

Why I am Passionate about the Chronicles of EMS

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If you’re an EMS professional, you should be paying attention to the Chronicles of EMS.

I think every person involved in EMS on any level needs to pay attention to the work of three of the profession’s upcoming giants, Mark Glencourse, Justin Schorr, and Thaddeus Setla. Their collective project is a warp-leap forward for how our profession is presented to, judged by, and thought about by our internal and external observers, customers, and colleagues. With their efforts come Hope… Hope that one day soon EMS will take its rightful place as a true profession; Hope that our profession will get the paid the attention that it deserves; Hope that our educational standards, resource needs, and compensation will finally be improved; and Hope that we will be able to improve our total service to our patients and our community through shedding a new light on our profession.

If this works… everything could change. Everything could change quickly, incredibly, and wonderfully. Imagine if EMS became “cool” and the public finally thought about who we are, what we are, and what it is that we do for them. Imagine if people demanded that their community leaders pay as much attention to EMS as we need them too… Just Imagine.

EMS needs a strong, unified message. The Chronicles of EMS can be that message. It is a professional, smart, and uber-cool message aimed straight at where we want to be going. It is not lip service, it is not Hollywood glamour, and it is certainly not dramatized for profit. It is being prepared by industry-experts who are still working the same streets that we are everyday. Everyone involved is one of us. Everyone involved is passionate. Everyone involved wants this, and they want it as bad as you do.

The reason I write about EMS is because I want to improve our profession and our service to others. I want to make this better so bad that I can taste it and I’m willing to work as hard as I have to. Our patients and our communities deserve the best we can give them and I believe that key to fixing EMS is communication and the spreading of our message. This blog exists for that reason and so do the other blogs in this genre. The other bloggers, authors, speakers, and writers I’ve met have all spoken to me of the same goals. Our profession exists to save lives and alleviate suffering and improving our profession help us save more lives and alleviate more suffering in our communities. EMS does indeed make a difference out there in the world and we’re the ones doing it. The Chronicles of EMS is a great beacon of hope in our collective quest.

EMS Deserves More. Our Patients deserve more; Our Families deserve more; and yes… We deserve more. Mark, Justin, Ted, and everyone involved in the Chronicles of EMS are working hard to give us just that. They deserve our support and our attention.

I’ll be in San Francisco on March 11th for the premier of their pilot episode. I wouldn’t miss it for anything. Look out world, EMS is moving forward.

Posted by Ckemtp on February 8, 2010 • Filed under: Administration & Leadership, Command & Leadership, EMS, EMS Blog, EMS Health & Safety, EMS Management, EMS Topics, EMS blogosphere, EMS training, EMT, Emergency Medical Services, Fire Rescue Topics, Firefighter Safety & Health, Happy Medic, Line of Duty, News, Paramedic, Patient Management, Public relations, change, ems 2.0, ems education, humor, medicblog999, paramedic education, pride, profession, professionalism

Ten (or so) things that you should try to do with every patient

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I am not a perfect medical provider. In fact I’m really only practicing prehospital medicine (Ha ha!) but there are a few things that I try to do with every patient to improve my care for them and improve their comfort level as I care for them. I can’t claim that I always remember to do these things, but I really try to. I think that you should too.

Here they are (in no particular order other than ZIP code):

  1. Always introduce yourself and your partner to the patients and their loved ones using your first name. I wouldn’t want some upstart guy in some uniform type thing just randomly poking at me. I think that it reduces patient anxiety when you properly introduce yourself to your patient. I say “Hi, I’m Chris and I’m a paramedic with F&B Ambulance Service and Taxi Squad. This is my partner Fuzzy McGee. What is your name Sir/Madame?”

     

  2. When you’re in the back transporting the patient after you’ve given them most of the care you were planning to give them, go over your assessment again. Ask the patient questions that get them to expand on their original answers. Challenge yourself to find anything that you may have missed. 
  3. Play a game with yourself. Try to have the patient diagnosed by the time that you get them to the ER. If you can’t figure it out, fire up the internet when you get back to quarters and look it up. You’ll learn a lot of good medical information by doing this. I have.

     

  4. Once you get the patient in the back of the ambulance if they’re not facing an immediate “Life-or-Death” crisis ask them “Is there anything I can do to make you more comfortable?” Maybe another pillow or moving the head of the cot up or down would help them. Do it if they ask.

     

  5. Try not to have the pillow stuffed under the patient’s shoulder blades. It makes it uncomfortable when they’re lying on the cot. Moving the pillow up from under their back and placing it under their heads makes them a lot happier. They won’t know to ask for it. Just do it.

     

  6. If you find a patient down with an isolated fracture or dislocation get pain meds in their system before you start splinting or packaging them. It does take a bit more time, but you’re not being very humane if you don’t.

     

  7. You are the patient’s advocate when you walk in to the imposing world of ER care. Your job is to present them to a medical system that is overworked and overtired. Stick up for them and make sure that the medical care providers that are following you learn about what is wrong with the patient before you throw him or her to the wolves… er, um, nurses. I mean nurses.

     

  8. Before you hand off your patient to the ER, ask them: “Is there anything that I haven’t addressed? Is there anything that you would like me to be sure and tell the ER about?”

     

  9. Explain to the the patient WHAT you are going to do and WHY you are going to do it.

     

  10. Approach EMS with a servant’s heart. No matter what some EMTs may think, we are here for the patients. It’s not the other way around.

     

By trying to do these things you’ll provide better patient care. I think that I’ve grown as an EMS professional by doing these things. I’ve also grown as a person by doing these things. Let me know how this works out for ya.

Posted by Ckemtp on February 7, 2010 • Filed under: Ambulance, EMS, EMS Health & Safety, EMS Humor, EMS Topics, EMS training, EMT, Paramedic, Patient Management, comfort, courtesy, patient care

Mental Quickness – Do Smart Alecks Make Better EMTs?

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Alright, I admit it. Driving to work this morning was a bit of a challenge. We had two inches of fresh snow and the tires in my car are in desperate need of replacement. Yes, I drive a Subaru and usually it’s all-wheel drive does awesome in the snow… but I cheaped out on the tires, and they’re honestly a bit mismatched size-wise. Therefore driving it in conditions even remotely slick is hard as heck. I would have driven the SUV and had no problems at all but the wife had to drive the kid to school and then had to drive into the city afterwards and I wanted her to have the safe vehicle. Who cares if I go into the ditch? Work can do without me if they have to, but I need my family to be safe.

Since I think of things to write about when I drive, this morning brought my thoughts to how hard I had to concentrate on the road and the minute adjustments of the steering wheel and the accelerator needed in order to keep the car safely on track. Like everyone who knows about driving in slick conditions, I kept my eyes on the road ahead of me in order to “read” the changes in the road surface before I got to them in order to be ready to quickly make the adjustments needed to keep the car heading in the right direction. See a dark shiny patch? Foot off the gas, be ready to steer slightly away from it when the car slides in that direction. See a pile of snow with a frozen rut running through it? Minutely avoid it if possible and steer into the slide with just enough change in the gas to power through the slide. I made it to work, but I had to call in a favor to have a guy stay over for me for ten minutes. I let him know the night before that he might have to, and I did leave early… but I’m not wrecking the car just so I can save a few moments.

I consider myself a pretty good driver in the snow. In a vehicle with good tires I wouldn’t even worry about anything less than 6 inches this far into the winter season, but today was hard. I’m not patting myself on the back here, because if I would have put good tires on the car in the first place I wouldn’t have been in this position, but isn’t that most of what we do in EMS? We end up using our mental prowess to clean up other people’s messes caused by their lack of planning all the time. Today wasn’t much different. The amount of mental power and concentration needed to keep a car moving forward safely in snow-covered conditions is actually quite staggering when you think of it. You have to make quick observations of rapidly evolving conditions, surmise what you think the presentation of the road surface means to vehicle’s path of travel using your limited observations paired with your past experience and knowledge, and come up with a near simultaneous decision on how to handle the situation ahead of you. If you find yourself to be wrong, based upon the car not reacting the way you want it to, you have to instantaneously correct the situation while adjusting for the conditions ahead… or crash.

Now picture yourself managing a challenging patient presentation, one requiring a handful of pharmacological and physical interventions. You’re pretty much doing the same thing as driving in snow. Just like playing a game of chess, you have to be “thinking a few moves ahead” in order to keep up with what the patient’s physiology is going to throw at you. Do you have a fall victim with a broken hip in need of pain control? Did you think that they’re possibly going to drop their blood pressure with a dose of morphine? Well then you better be ready to give fluid to bump it back up to acceptable levels. However, what if you’re treating a CHF patient that would suffer further from the added fluid? What if they were a patient with Chronic Renal Failure? Would that affect your initial dose of morphine based upon the unknown factor of untoward hypotension? In my Northern system, I’d choose to use Fentanyl over Morphine in that case because of the lessened risk of hypotension, but in my Southern system I’d just have to start with a lower dose of Morphine and slowly titrate to an acceptable level of pain control once I gauged the patient’s response to the med.

How about a patient with a large anteriolateral MI? Their Left Ventricular function is soon to be compromised if not treated in a cath-lab. You need to increase blood flow to the Left Ventricle and decrease overall cardiac work by decreasing afterload with use of nitrates, but that’s going to decrease their cardiac output and blood pressure by decreasing their preload as well. You need to stabilize the infarct as best as possible while maintaining the patient’s hemodynamic state, and you may need to consider supporting their left ventricular function with the use of a vasopressor such as dopamine to treat possible cardiogenic shock. In this case, careful observation of the patient’s presentation and all information available to you is of paramount importance in order to make the minute treatment decisions necessary for your patient’s best possible outcome.

It all comes down to “Mental Quickness” or having the mental prowess and state needed to rapidly intake complex information, process it against your knowledge base, and then make reasonable decisions on a course of action in a very short period of time. We call people who are good at this “Quick Witted” and it applies to myriad situations in daily life. People who are good at this are usually funny, are quick to react to new situations, handle change fairly well, and make darn good EMS providers. I practice by trying to have a joke ready for any situation… so you could also call a person who’s mentally quick a “smart ass”.

You can practice your skills at being mentally quick the same way I do. Use humor and try to make good comebacks to the hooks and barbs that your coworkers and friends throw at you. When we’re sitting around busting each other’s chops… we’re actually practicing our EMS skills, right?

Think about it. Exercise your mind through reading, learning new things, and trying to come up with new ways to think of existing information. You’ll be funnier, more popular, will be able to knock your buddies down a peg better, and will improve your patient care.

Posted by Ckemtp on February 2, 2010 • Filed under: Administration & Leadership, EMS, EMS Health & Safety, EMS Humor, EMS Topics, EMS paramedics, EMS practice, EMS training, Emergency Medical Services, Fire Rescue Topics, Paramedic, Patient Management, Training & Development, change, ems education, ems scenario based education, inside the mind of a paramedic, mental imagery, paramedic education, patient care, scenario based training, training-fire-rescue-topics

EMS practice

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Did anyone else play a sport (or sports) in high school? I did, actually I played football for a few years. I was on the line, which in my small high school meant that I played every position on the line, both offense and defense, because there just weren’t that many kids out there to play. My graduating class was 83 in my small, small town.

I didn’t touch the ball though. Coach told me just to go out there and hit people. I haven’t touched a football since.

Every day after school we went out there no matter rain, shine, snow, heat, or better things to do and practiced for three hours every night. We did this all season and I hated it. It sucked and sucked bad. However, it did make me a much better football player. It kept my mind focused and kept me in shape. I was a much better “Go out there and hit people” guy than I would have been had I just taken a football class and then played parts of the game every day.

Does anybody do this with EMS? Sure, we all do Continuing Education, but do we really practice as hard as we should as much as we should?

We play parts of the game every day but just as sure as I didn’t intercept a pass and run in a touchdown every game, I don’t perform a pericardiocentesis every shift. I can plink in an IV in my sleep (and do… a lot…) and I probably can treat a STEMI as good as the next guy. Playing the parts of the game that we do more often than the others gets us good practice on what we do most often, and if we don’t allow ourselves to get complacent, that’s just fine. However, how many times have you calculated a dopamine drip lately? Even if you live in the busiest, most dopamine swillingest jurisdiction on the planet you’ve still interpreted Normal Sinus Rhythm a lot more than you’ve shown off your math chops.

The other day I missed a tube. I was caring for a patient who crashed in front of me while heading to the ER. The Pt went from CAOx3 to very obtunded in a matter of a minute or two. The first time I went to tube, (the Pt) was clenched and by the time I got the etomidate ready we were close enough to the hospital that bagging was my best option. When the Pt got sux and sedate juice in the ER I tried again…. and missed.

I freakin hate that! Man, I never miss a tube! At least almost never. I hate it when I do and beat myself up about it. Probably more hard than I should, but that’s just me. I take this stuff seriously if you can tell. The next shift I spent an hour playing with our two intubation dummies and our “Fred the head”. I tubed over and over again every way I could think of. For an hour. Yes, I know that it’s not exactly like the real thing, but it was all that I had access to for practice.

Something cool happened right after I got done with my hour long tubing pennance. I sat down for lunch and immediately got toned out to intercept a code with CPR in progress. I pointed my SUV towards the rural address and hit the gas. When I got on scene, the BLS crew told me over the radio that they were having difficulty with the airway. I walked in, and got the most beautiful tube that I think that I’ve ever gotten. Right in, right through, and right hole.

I think that my football coach would have been proud.

Posted by Ckemtp on February 1, 2010 • Filed under: ALS Intercept, EMS, EMS Health & Safety, EMS Topics, EMS practice, EMS training, EMT, ET Intubation, Emergency Medical Services, Fire department, Paramedic, Patient Management, ems education, ems scenario based education, intubation, paramedic education

Zombies!!!

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I hate horror movies…

A while ago I walked into our crew lounge where the other members of my crew had just popped in some low-budget zombie flick. It was your classic “B-Movie” and had all the hallmarks of every good zombie show that I’ve ever seen. Gratuitous bloodshed by hapless victims? Check. The walking dead feasting on human flesh? Check. A few good looking zombified women? Check and Check. I watched it against my better judgment. I hate horror flicks for all of the above reasons, except for the good looking women of course. I have an annoying habit of taking on the characteristics of every movie that I watch for varying lengths of time. After watching Top Gun, for instance, I drove my car like a fighter pilot for a few days. After watching Star Wars I tried to use the force to get the TV remote from across the room when I lay down on the couch. After watching the South Park Movie I swore every other word. Really. So I don’t like horror flicks because I get scared like a little girl afterwards and I don’t like it.

Unfortunately though, I watched the whole thing like a doofus, knowing full well that I’d be having nightmares later.

Cue the call for the unresponsive seizure victim…

We went to an apartment complex where our patient had fallen into a seizure right by the inward swinging door to his apartment. He had fallen in a way that made it so his body was blocking the door and I could only swing it open a few inches, just enough for me to squeeze inside. He was pretty out of it, and wasn’t responding with anything but unintelligible grunts and groans.

Then, of course, he moved and shut the door, blocking it with his body and trapping me alone in his apartment with him while he was groaning on the floor.

Does it make me a scaredy cat because I thought I was going to be eaten by a zombie?

I hate horror flicks…

 

Posted by Ckemtp on January 29, 2010 • Filed under: EMS, EMS Health & Safety, EMS Humor, EMS Topics, EMT, Fire Rescue Topics, Fire department, Paramedic, funny, humor, professionalism

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…

 

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