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Hangover Heaven? WHY ARE WE NOT DOING THIS!?!?

I came across a new business today while I was casually wandering around the Internet and I just absolutely had to share it with the EMS crowd. The company, called "Hangover Heaven" (www.HangoverHeaven.com) is set to open April 14th, 2011 in Las Vegas, NV. (Where else?)

If you haven't already clicked the link their business model is that they have a bus that drives around the strip, picking up the hungover masses, and providing "a small IV in your arm that provides the necessary treatment to continue the party or just get back to your normal self." They have two packages, the "Redemption" package for $90 that provides IV hydration only, and the "Salvation" Package for $150 that provides relief through their "Proprietary treatment" which they say contains intravenous hydration, an anti-emetic, an anti-inflammatory medication, and a "Vitamin supplement" package.

You should really read their website yourself. Some copywriter did a great job of selling what I can only surmise to be a banana bag, ondansetron, and toradol. Those meds and the IV fluid will most probably cure any hangover quite handily. While I think this is a bit cheesy… I've got nothing but respect for their plan. Heck, if anything I'm jealous that I hadn't thought about it first. While I'm not licensed to practice EMS in Nevada, I could easily cruise around the streets of Milwaukee, Madison, or Chicago in my ambulance providing the same services to the over-imbibed folks in those fair cities. If we could ask for cash up front, like I'm sure they are, we could probably pull in a few thousand a week doing this. For that kind of coin any city could afford to fund the pension plan and give the nice EMS folks a hefty raise.

What I'm saying is, come on cash-strapped municipalities, belly up to the bedside and get your medical directors to authorize this service. Your budget woes are a thing of the past!

Yes, their bus is cooler than your rig.

I do have a few questions though:

Is this legal? The owner is an anesthesiologist, but there is no mention of who is actually providing the service.

I'm a Nationally Registered Paramedic… are you hiring? Please?

Are you selling franchises? Cuz I could use one here in Wisconsin and Illinois real bad. I'd start my own but I'd need a medical director who would be willing… and the ones around here are probably spoil sports

Although… I haven't yet asked them if they are ok with this. They could be. Perhaps it's better that you just sell me a franchise real quick and real cheap-like and we can just keep the brand-name going strong.

In all seriousness. Think of what effect this could have on the already overused emergency healthcare system in the city. I mean, if even 10% of the people who are going to be seen by this bus would have otherwise ended up in the emergency rooms getting largely the same treatment, this company could sincerely ease some of the burden on the healthcare system. It's definitely a cheaper alternative. Even their $150 treatment is way cheaper than a trip to the ER. This bus could immediately benefit the entire system by giving patients an alternative to the traditional, significantly costlier, methods. It will save insurance companies and governmental healthcare payors thousands and free up the ERs from taking care of this patient demographic.

I really do think they're on to something. Wish I'd have thought of it first.The success of this business will go to prove something. If it survives and thrives, then EMS can also find free-market alternatives that will help save our profession and the communities we serve. Obviously it can be done.

In other news, kudos to the State of Maine, who authorized funding for Community Paramedicine. Bravo guys, way to intellegently look for real solutions to your healthcare budget woes. I tip my hat to you. – http://www.jems.com/article/news/new-community-paramedicine-law-maine-loo

Notice anything similar?

Posted by Ckemtp on April 13, 2012 • Filed under: Als, ambulance humor, ckemtp rants, Economics, Emergency Medical Services, EMS, ems 2.0, EMS Humor, EMS Management, EMS rant, EMS Topics, Fire Rescue Topics, Funding & Staffing, humor, IV, odansetron, Paramedic, Patient Management

Hypocritically Speaking – My opinions about EMS models and philosophies

18 comments

I hate when this happens.

I recently had two separate conversations with people that made me think some of my opinions may be in conflict with each other. In fact, the outcome of these conversations made me realize that I may be a tad bit of a hypocrite when it comes to some of my long held beliefs. I hate when that happens. While I freely admit I will happily change any of my opinions in response to new and/or better information, I can’t seem to change my opinion on either one of these beliefs and it’s making me feel… well… like a hypocrite.

Let’s see if you can help me out.

Opinion #1: Modern EMS exists to bring care to the patient.

That’s an important sentence up there if you didn’t realize, because it represents two monumentally different schools of thought. I believe that the primary purpose of modern EMS is to bring care to the patient, not the other way around. That statement may not sound like much, but it is hugely important for the development of our profession. In the very beginning of what evolved to be EMS, back even before the Cadillac ambulances and hearses, EMS existed to bring the patient to care. Everything was based upon that fact. From the “Flying Ambulances” invented by Napoleon’s surgeons to bring injured soldiers to the surgeons away from the battlefield to the ambulances used in the US in the 60s and 70s, most everything that existed before the advent of paramedics and EMTs existed for the purpose of bringing the patient to the care that could only be provided for them in a hospital. That’s why the Cadillac ambulances had those big engines that could drive so fast and the qualifications for being an “Ambulance Attendant” involved mostly being able to burn exceptional amounts of rubber without killing the majority of the motoring public.

Not pictured: An in-depth understanding of the cardiac conduction system

The conversation that brought this up was one I had recently with a Wisconsin EMT-IV Tech (think: NREMT-I 85 level) about a community of 15,000 people nearby that I think should upgrade their EMS to the paramedic level. Their ambulance service is operated by their local fire department and runs an excess 1000 calls for service per year. They have a fairly large state college in their jurisdiction that pumps up their population during the school year and increases the diversity of their response area. I believe that they should upgrade to provide their citizens better care. She believes differently. Her thoughts were that even though there is no hospital in the town, they have three within the area that they transport to. The closest is 10 miles away from their city limits in another town and the other two are both +/- 20miles away. She believes that they don’t need to offer their citizens paramedic service because they’re so close to the hospital. (This is Wisconsin, 20 miles is a run to the corner store ‘round these parts)

I trotted out my old standby, the one I wrote about above that says that EMS is about bringing care to the patient. I explained the two schools of thought and stated that they would be saving more lives and caring for their patients better by offering paramedic care immediately at the patient’s side, rather than withholding advanced care until they had driven a minimum of ten miles. While they provide good service at their current level, I believe that paramedic ambulances in our area bring with them the majority of the care a patient would receive in an emergency room for the first hour or so of their care sans most of the lab work and x-rays. Why wait to stabilize any patient’s condition? Why let someone deteriorate when there are tools out there that can help them?

She seemed to agree with me after I explained it using the “Bring to care Vs. Care brought out” analogy and I, for lack of a better term thought that I had “won” the conversation. (I like winning things) The next week, however, I had a conversation that completely challenged my original argument and made me resort to saying “Because I like it that way” when being asked my opinion about something somewhat similar.

Opinion #2: The US model of EMS is better than the French model.

There are a few competing models of EMS in the world, but two of the starkest contrasts are the French Model of EMS and the US model. In a nutshell, the US model employs paramedics and EMTs who provide limited stabilizing care on site and remove the patient to an emergency room to be attended to by a physician for definitive treatment. The French model relies on physician triage of emergency calls and then sends either a physician to the scene or an “ambulance” with the basic capabilities of a taxi. It’s more complicated than that, and you can read more on the French system on this well-written Wikipedia entry: Emergency Medical Services in France

My thoughts are that the French Model provides too in-depth of care on scene of an incident for severe complaints. For example, while most US paramedics can diagnose and begin treatment on most STEMIs (severe heart attacks) immediately and have the patient undergoing a cardiac cath by a cardiologist in under 30-40 minutes, I challenge the French system to do similarly. I believe that putting physicians on the ambulance limits the availability of EMS care and causes rationing due to the immense costs of having a physician attend to the patient. I also think that the economy lies in having a physician present in the ER where they have the best availability of their necessary tools and the ability to treat many patients at once. However in truth, most my belief comes from little personal experience and more from media reports of incidents like the death of Princess Diana where the doctors sat on scene for two hours trying to treat her injuries rather than bringing her to a hospital with full capabilities.

The conversation I had that made me question this is one I had about a local helicopter ambulance service that provides either a physician/nurse or physician/physician flight crew. I remarked that I didn’t know how an on-scene interface with a physician would be and that I would be worried that they would over-treat a patient that needed to be swiftly removed to a trauma center instead. Of course, I’ve never seen nor heard of an experience like that with this service, I just was airing my biases. That fact was swiftly, and correctly, pointed out to me and I resorted to the shallow argument that I simply thought that EMS was “Our place” and that other professions needed to butt out…

And I was wrong, and admitted that I was. Then we all laughed heartily.

Admittedly, it was less that they were laughing *with* me...

My potential hypocrisy lies in the fact that I want to support the neighboring community to pursue the paramedic level for their service but cannot seem to extend the same argument to support physician/physician crews on the helicopter. Isn’t it the same argument?

In addition… why don’t I support the French model of providing EMS over the US model for the exact same reason? Aren’t I the guy who thinks it’s time for Primary Care Paramedics in the US?

I’d like you to poke holes in all my arguments and call me out in the comments section, but before you do that, in my pre-defense I like parts of the French system and want to adopt them here. I like that they provide physician-level triage for 911 (or 112) calls and send out appropriate resources, provide instructions for self-care, and/or direct people to primary care by alternate transport. I like that they can treat-and-release on scene for appropriate complaints. I think that they have a lot aspects of their service I like, the same things I like about the British EMS model that are provided by paramedics. I also think that Paramedics are the experts in field care. We exist for the purposes of being the masters of the acute, the experts in the expedient, and the… somethings of the… people who need immediate stabilizing care. (Hey, you try thinking up a third thing). I like the US model because I think that it provides appropriately advanced care and proper specialized focus of training while allowing for cost-effective deployment, availability, and access across the broad spectrum.

But nobody’s perfect.

Your thoughts?

Posted by Ckemtp on April 11, 2012 • Filed under: Emergency Medical Services, EMS, ems 2.0, EMS ethics, EMS rant, EMS Topics, Paramedic, politics

A Medic Roast in Tennessee

20 comments

Some time ago I worked for a service that had a governing board made up of community members from various walks of life. Most of them were business leaders around the area and only one or two of them had any EMS experience. One day I overheard one of the board members talking about problems he was having with the quality control at a factory his company ran in another area.

I was fascinated.

It seems that the workers at this factory just didn’t seem to care about the quality of the product they created. Products came out with grievous manufacturing errors that turned a lot of their finished products into unsellable junk. He described these errors as things that any reasonable person would notice had they spent more than one day on the job.

Joining in the conversation, I asked him “So, how much does the average worker at that factory get paid?”

He replied with a wage that was actually above my hourly rate as a paramedic. It was significantly more, actually.

It shocked him when I said “So they make that much more than I do, and when I make a mistake someone dies and my career is over? That doesn’t seem right at all”

And no, it doesn’t seem right. Every human being on this planet is going to screw something up on occasion. We’re not perfect. Medical professionals and especially EMS people are constantly challenged to adapt their knowledge to unfamiliar situations with incomplete information. On top of that, the body of our knowledge is constantly changing and it’s up to us to know exactly how to seek it out so we’re consistently doing the best for our patients. It’s not easy to be a good EMT or Paramedic and it’s a responsibility that we’re largely not well-paid for. Top that with the fact that even one simple mistake can be a career ender and…

You get this article that I saw this morning in JEMS: Tennessee Paramedic Demoted after Drug Mistake

If you’ve been a paramedic in the field for any length of time and this article doesn’t scare you, you’ve not been much of a paramedic for any length of time. This is real folks. This is something we all should sit up and take notice to.

The article concerns a paramedic who made a medication error. While it doesn’t state what error he made, it seems that he had mixed a medication in a bag of normal saline and infused it to a patient while intending to give a different medication. The article doesn’t specify the medications given but from the patient’s condition an educated person may be able to infer what they were. It also specifically does not mention the condition of the patient before or after the medication was given, leading me to believe that the patient suffered only minor ill. Yes, I know that I’m assuming… but you can’t tell me that the newspaper wouldn’t have been more than happy to blast the headline “MAN DIES AFTER MEDIC POISONS HIM WITH WRONG MEDICATION” if he had died. My guess is that if they downplayed his condition, there wasn’t much to sensationalize about it.

The medic, who had been with the service for 9 years and who had only been disciplined once in that time for missing something on a rig check, had received “above average performance reviews” and more than one commendation in his tenure.

From reading the article, it looks like an experienced medic made an honest mistake. He was reprimanded for it, suspended for 28 days, and demoted to an EMT.

Yeah, you read that right. They voided 3 years of education that this man had completed and knocked his license all the way to EMT-Basic.

They did this for one mistake. One mistake that even the medic’s chief stated was “… accidental and an oversight on his (the medic’s) part”. An honest mistake that everyone reading this article has already made or will probably make in their career. A mistake that was apparently easy to make, even by an experienced paramedic that most probably did not result in grievous harm to anyone.

If the facts truly are as reported in the article and there are no other unreported wrinkles to this case, I call shenanigans. The discipline this medic received simply does not fit the crime. It’s too heavy-handed. The discipline seems arbitrary, unnecessary, and patently unfair.

The chief was quoted in the article as saying that their agency, which is reported as responding to around 29,000 emergency calls each year, has a “success ratio” of “100%” and that “this is not the norm.”

Pictured: Every Paramedic

So he’s saying that the all of the EMTs and Paramedics that must handle 29,000 emergency calls per year are expected to be 100% perfect 100% of the time or he will negate their education, harm their lifetime income potential, and defame them in the national press? I know that he probably didn’t *intend* to say that… but he very much did say it. I know of no other single profession that has so much at stake every time they go to work. To my knowledge, no other profession has so much risk of long term harm to their lives, their family, and their professional career riding on a very much unrealistic goal of being 100% perfect 100% of the time. It’s shockingly unfair… and terrifying. No human being can maintain those expectations. We’re just not able to always be perfect all of the time for an entire career.

And when you think that the pay for Paramedics and EMTs in this country is by and large pathetically low, you might wonder why anyone would ever consider doing the job at all.

I’ll say again, if the facts in this case are accurate and complete as reported, this is an outrage. It’s an abomination. It’s enough to generate national attention about the unfair working conditions and haphazard disciplinary standards that EMS must endure.

I’ll say this too: I support this paramedic and formally place a letter in the file of the agency responsible for doing this to him.

(This part is for Google) If you work for WRCB TV in Tennessee, please feel free to consider this my opinion.

(You can find the original article HERE: http://www.wrcbtv.com/story/15463233/ems-used-wrong-iv-in-melvin-davis-transport)

Posted by Ckemtp on September 15, 2011 • Filed under: Administration & Leadership, Command & Leadership, Emergency Medical Services, EMS, EMS ethics, EMS Health & Safety, EMS rant, EMS Topics, Ethics, News, Paramedic, patient care, Patient Management

Perils of Paramedics Pursing imProper Patient Refusals

7 comments

Inspector General Faults DC Paramedic’s Response to ‘Acid Reflux’ Case

This article comes to us from JEMS.com which has a link to the full article over at The Washington Times. It’s not necessary to read both articles, but since JEMS originally called it to my attention it’s only fair to link the boys over there first. Read the full article, please… I want to see if you feel the same way about it that I do.

Ok, ya back? Good.

In this case that is very reminiscent of the case law I wrote about last year in “EMS Case Law – AMA Refusals, Death, and Documentation” – A DCFD EMS paramedic obtained a signed refusal from a patient who called 911 for chest pain. According to the < sarcasm> stellar, just friggin’ stellar < /sarcasm> journalism employed in the story by the reporter (I mean seriously, can any reporter anywhere ever write a story about EMS that doesn’t sound like a 5 year old’s understanding of Mozart?) the Evil paramedic did bad things that caused someone to die.

And, well… Here are some quotes from the piece, although I still think you should read the whole thing:

“The crew found Givens, 39, on the floor of his home after his mother called 911 — “an indication that he may have experienced something more serious than what was later described as simple acid reflux,” the report says.

Although they asked Givens multiple times whether he wanted to be taken to a hospital and he declined, the report suggests responders should have done more to persuade him to go.”

So they find some guy, a 38yo guy, a young guy who lives with his mother (maybe) laying on the floor probably being all dramatic and stuff… I’m sure he was all like “Ow. My chest hurts” and the medics were all like “Dude, we have a low index of suspicion for your condition being cardiac related due to the fact that you’re young and don’t appear to have many risk factors” n’ stuff.

Or something like that. At any rate, I’m sure they were less concerned about this guy than they would have been with say, a middle-aged male with classic STEMI (heart attack) symptoms. Yes, they signed him off AMA while telling him to take Pepto-Bismol, and yes… the article does indeed say this:

“The inspector general’s report also faults emergency workers for not recording fundamental information, such as Givens’ first name, age and medical history and interactions with his family members on a patient care report. The reports are typically passed on to hospital personnel when a patient is taken to a hospital but are considered necessary even in cases in which a patient is not taken to a hospital to provide medical and legal documentation of responder’s actions.”

But that doesn’t mean that they just plain didn’t care about the guy and were encouraging the refusal, right?

“When Givens asked one of the four emergency workers who responded if he needed to go to the hospital, the responder replied, “That’s up to you; if you want to go we will take you,” according to the report.”

Yea… I’m just going to come out and say that the only time I ever use that line is at 0330hrs when I’ve been called out for a stubbed toe in the winter time and I am actively encouraging the AMA.

But this can’t be a systemic problem with the whole administration of the DC Fire Department EMS division, can it? I mean… that’s one of the nation’s busiest fire-based EMS providers and I’m sure they care a great deal about EMS and give it the full attention it deserves.

“A 2009 investigation by The Washington Times into the training and education of the District’s paramedics found many could not pass basic written exams testing their medical knowledge or that they mishandled basic life-saving procedures during videotaped assessments.

The test results of the paramedic who treated Givens were among those criticized by experts in the report by The Times, and the lawsuit filed by the Givens family accuses the fire department of being aware of the paramedic’s “poor performance” but leaving him in the field.”

Um… but that was in 2009! And I’m sure that the DC Fire Department EMS Division has progressed greatly in improving their EMS care and service delivery, right?

DC BLS Ambulances out of service as Hot Weather Arrives

<sigh>

I will admit, there isn't enough information or proof here to make a decision on due to the *amazing* clarity of the reporting here. I'll admit that I read between the lines when I made my judgement and then pulled back from my original thoughts. Then again, it does seem like my worries about this case are correct… I don't know exactly what the truth is, but I'm guessing it's not favorable for DC Fire EMS.

Excuse me, I mean "FEMS."

<sigh>

—————————————————————————–

Have you ever read my post on the ultimate, most off-limits “no go” topic in EMS blogging? It might tick you off as well.

My Thoughts on Fire-Based EMS

Posted by Ckemtp on June 17, 2011 • Filed under: Administration & Leadership, Case law, Command & Leadership, Emergency Medical Services, EMS, EMS Management, EMS rant, ems report, EMS Topics, everyday ems ethics, Fire Rescue Topics, Paramedic, training-fire-rescue-topics

A Late-Night Rant about Petty Politics in EMS

16 comments

I had to think about a Facebook comment that I just posted on my personal Facebook page. Admittedly, I’m pretty angry right now and I probably shouldn’t be writing. It’s been a long night, you see… and I’ve had it up to my eyeballs with what I’m angry at.

However, this blog is my therapy and I can use it to get some stuff off of my chest whenever I see fit, right? Good, then here goes.

Tonight I’m going to forget that my computer has been acting up on me and has lost two 1000word-plus articles that I was lining up for the end of the week. I’m not even going to mention that I’m behind on a lot of projects because I’ve been overwhelmed with work. I’m not even going to talk about how the workload that I’ve let pile up has been making the blog suffer… Nope. I’m going to jump to the front of the line and bring that Facebook comment right here, to the front of this blog page where a few thousand EMTs and Medics might read it this month.

“Revenue Preservation, Area Preservation, Ego Preservation, and Political Capital Preservation” – These things are the top priorities of some EMS agencies I’ve dealt with over the years. Patient care is on the list, but its way down on the bottom of these agencies’ priorities. Some agencies have their priorities straight, but more it’s more common than I’d like to admit that EMS agencies have those four things at the beginning of this paragraph firmly implanted into their unwritten mission statements.

I’ve written at length about EMS politics and how I hate them. For example:

- Is What You Do “The Best You Can Do”

- Volunteer Fire/EMS – Taking the High Road and Letting Go

- Two Cases, One Letter: From One Paramedic’s Struggles, Change Can Come

- Cat Puke Chicken

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

- And Much, Much more…

And tonight, again, I’ve seen yet another example of the worst kind of EMS politics. I’ve seen these situations countless times before and I’ll see them countless times again, I’m afraid. People who don’t put the patient first have missed the whole point to this EMS thing. We’re here for the patient. We’re here for the citizens. There is a selfless aspect to EMS that must be respected in the preservation of the greater good. To miss that for almost any reason is to disrespect not only the foundation that EMS was built upon, but also the foundation of the entire healthcare system.

“First, Do No Harm”

Yea, that’s the first pledge of the Hippocratic Oath, the same one that Physicians take when they become doctors. EMS people are an off-shoot of physicians and we should follow those four words up there as much as they have to. Using the citizens of your jurisdiction as pawns in a political game is to violate those most sacred of oaths. EMS people tend to feud for the flimsiest of forgettable reasons. These feuds escalate unchecked for years until every action taking by the opposing party seems only to reinforce the perceived validity of the petty feud, even when the original actions or inactions that caused the feud were lost to history or died with the people who started the feud to begin with. Often, neighboring squads hate each other for no reason that they can remember. Factions within a single EMS agency may feud internally for no good reason whatsoever. These things escalate and escalate until patients are harmed by them… for no reason at all.

And if there ever has been a reason to harm a patient for a petty feud between services, between cliques, or between individuals, I’ve yet to hear it. In my opinion, using a patient as a pawn in a political game is the worst kind of offense.

These petty EMS politics, these laughable feuds, and the little kingdoms must have the light shown upon them. As I said in my probably politically incorrect Facebook post:

“I don’t like it when Petty People play petty politics with peoples’ lives. Really, people die from the kind of stuff I’m angry at without ever knowing that they were pawns in a political game. EMS politics must be exposed to the light so that the people that play them can be scattered like the cockroaches they are.”

Do you see anything that I’m going to be in trouble for tomorrow when people read that post? Remember, that’s on my personal account… not the blog account. Yes, I do take personal responsibility for everything I say on this blog page or in any of my public speaking or writing for that matter, but there’s a chance that people I know and may or may not have been talking about will read that tomorrow. My guess is that I will be the bad guy for saying it.

And frankly, I don’t care.

As I said in the post that I linked to above, Volunteer Fire/EMS – Taking the High Road and Letting Go – I am willing to bury each and every hatchet I do now hold or have ever held and solemnly pledge to conduct myself in friendship, mutual understanding, and for the good of the ideals in which we all should share. My guess is that there are people out there tonight who should do exactly the same. Don’t let petty politics harm those whom we’re pledged to serve. It’s not about us. It’s about them. It’s about our ideals.
It’s bigger than us. We are more than the sum of our parts. Don’t forget that.

I know that this hasn’t been the most polished piece I’ve ever posted up here, but everything I’ve said I believe. That’s why I’m a blogger. It’s why I’m a paramedic as well. Thanks for letting me rant.

EMTs have an Oath as well...

Posted by Ckemtp on October 27, 2010 • Filed under: Administration & Leadership, change, ckemtp rants, Command & Leadership, edemse, Emergency Medical Services, emotions, EMS, EMS ethics, EMS Management, EMS rant, EMS Topics, Ethics, everyday ems ethics, Fire Rescue Topics, medical ethics, Paramedic, politics, professionalism, rant, Uncategorized

Too Much Information For a Paramedic?

20 comments

This is a coordinated post by our friends Greg Friese and Steve Whitehead.

- Greg’s post on this topic can be found at: http://www.everydayemstips.com/?p=3628

- Steve’s post on this topic can be found at: http://theemtspot.com/2010/08/25/too-much-information/

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“They Don’t Know What They Don’t Know”

It’s an established fact that 60% of fatalities within confined spaces are would-be rescuers. They see someone down in a confined space, enter the space, and are overcome by the conditions that took down the initial victim. The process sometimes repeats itself, with multiple would-be rescuers entering the space and falling victim themselves. It’s tragic really, but the cold, hard fact is that these people are victims of their own ignorance. They don’t know what they don’t know. They don’t know that there is a fatal set of conditions within the space, and they don’t know that whatever it is that killed the first victim, or subsequent victims, will kill them as well. It’s a well documented phenomenon that plays on the compassion of the would-be rescuers and ends up getting them killed.

They simply don’t know what they don’t know.

Hey Guys?? Guys?

So when I was approached by our friend Greg Friese from www.EveryDayEMStips.com the other day regarding a comment he received on one of his training articles, I was interested in doing a co-post with him. He also has contacted our friend Steve Whitehead from www.TheEMTspot.com and together we’re tri-posting on this issue. Their links will follow below and are just great as always.

The comment that followed this online training article was written presumably by a paramedic. It was a critique of the article that simply stated “too much information for a paramedic”. I read that, and immediately thought of confined space incidents, where ignorance can get a person killed. Lots of situations fit that scenario and it’s not always the rescuers who get killed. EMS providers who “don’t know what they don’t know” can and do kill patients. More often, they don’t provide the best possible care.

There’s this thing that we have made it our business to know how to repair. It’s called the “Human Body” and if you’re reading this article, the chances are good that you possess one. The human body is VASTLY complex. It’s the most complex machine we humans know about and we are still learning about it to this day. There are some amazingly smart people out there who have dedicated their lives to studying these meat machines that our brains pilot around and they still haven’t figured everything out yet. We can help set it back on course to heal itself in a lot of cases but we can’t construct a new one. We don’t know about all the minutia, the microscopic works inside of it that make it do all of the amazing things that it does. The levels of systems within systems that function seamlessly within still other systems are numerous and fascinating. I learn something new about it all the time, and still there are people who know vast amounts more about the inner workings of it and about the huge number of things that can affect it’s operating effectiveness than I do. The human body is remarkably complex yet elegant and perfect in its design.

C'mon... Don't be a wuss.

And we who call ourselves “medical professionals” are well advised to study every possible aspect of it. Consider it your “life’s work”. If your job is to fix and support the end users of the human body, you darn well better know everything you can about it.

“But”, you say, “There are people out there who are supposed to know much more about the human body than we are. They’re called Physicians, and they get paid a whole lot more than we do. We’re just paramedics. (or EMTs).” And you’d be right for saying that, of course. Physicians have the ultimate responsibility for knowing the human body. It’s their life’s work as well. Their patients live and die based upon their knowledge, skills, and talents they have for examining the human body and being able to figure out what’s going on. Their whole practice is based upon their knowledge, skill, and talent. The more they know when they’re working there, the better provider they are.

It’s that simple, and it’s exactly the same for us EMS people. The more we know, the better we are. Nobody is better served by dumbing us down. Nothing is gained by denying yourself knowledge. Not a single patient is better served by you not knowing everything you can know about what is going wrong with them and it’s your duty to learn as much as you can about what you’re supposed to know about.

What is the line for how much paramedics “need to know?” Is everything that we need to know covered by our initial training course? Is that everything we need to get out there in the world and start slinging IVs and Meds all willy nilly?

I look at the paramedic license as a “learner’s permit”. It’s the baseline knowledge level needed to function at that level under supervision. It’s a jumping off point from which the provider should immerse themselves in knowledge. I can certainly say that I’ve learned volumes past my initial certification and that the “extra” knowledge has saved lives. Did you know that Fentanyl can cause chest muscle tetany when administered too rapidly? Or how about that lasix, when pushed too rapidly can cause hearing loss? Do you know that ST depression in the high V leads can signify a posterior MI? What about differentiating an acetabulum fracture from a “pulled groin”? Can you reliably predict the patients whose blood pressure is going to crash after Nitroglycerine administration by reading a 12-lead EKG? What about the clinical presentation of a non-ST elevation MI? Do you know the MEND stroke screen? What about the different neurological exams to find an intracranial bleed?

Etcetera, etcetera… The point is, there isn’t a cut off. The final exam we take for our licensures prepares us with the baseline knowledge to get out there and learn what it takes to make us truly great EMS providers. The true professional will learn this, and constantly seek the knowledge he or she needs. The average to sub-average provider will comment that they “don’t need to know” something.

Get out there, get fascinated, and learn as much as you can. It will never be enough knowledge… but your mind is a sponge for a reason.

Study Hard. Know Your Stuff. No Excuses.

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This is a coordinated post by our friends Greg Friese and Steve Whitehead. Be sure to read their posts on this

Greg’s post on this topic can be found at: http://www.everydayemstips.com/?p=3628

Steve’s post on this topic can be found at: http://theemtspot.com/2010/08/25/too-much-information/

Posted by Ckemtp on August 24, 2010 • Filed under: change, Emergency Medical Services, EMS, ems education, EMS ethics, EMS Motivation, EMS practice, EMS rant, EMS Topics, EMS training, Paramedic, paramedic education, Patient Management, Training & Development, training-fire-rescue-topics, Uncategorized

Four Words: EMS, Apathy, Disgrace, Massachusetts.

12 comments

By now you’ve all heard of the flap that is happening in Mass. regarding the 200 or so EMTs and Paramedics that had their licenses suspended or revoked for running a non-existent training program or for falsely representing that they attended non-existent training classes. If you haven’t heard about it by now, you’re probably not following EMS news as much as you should.

Here is one of the articles on the subject from JEMS.com

The issue has been discussed quite a bit around the EMS blogosphere. Some big name bloggers have written on it, and I even discussed it a little bit on the EMS Educast the other day.

Here’s TOTWTYTR’s take on this: I’m Not Very Sympathetic

And here’s Rogue Medic’s take on it: (this is a part-2 that reiterates the first)

Here’s the episode of the EMS Educast where we discussed the issue briefly

Other than for speaking about the issue briefly, I’ve been avoiding writing on it. My job is usually to report positive things that are happening in the EMS world and this is definitely not a positive thing. In fact, it’s a disgrace to us all. Rogue Medic has it right when he asks the question “Why do we Encourage such apathy in EMS?”

And that’s what this is. It’s not just that it’s apathy for the boring destruction of brain cells that we call “Continuing Education” in most areas of EMS, it’s the apathy for the whole process. The apathy where we as a profession have let the standards get to this point.

I mean, really. How many of you feel that the continuing education you receive is anything more than something you have to do in order to keep your license up? How many of you feel that your regularly scheduled, mandatory, continuing education classes are of any quality? How many of you feel like they’re actually doing anything good for you?

And that’s the system in which we function. TOTWTYTR made the statement that he sits through boring traning classes all the time because those are the hoops he has to jump through in order to maintain his licensure. I do too, of course. I sit through probably as many or even more classes than anyone reading this article because I am a practicing paramedic with National Registry and licensure in three states. Sometimes the training from one state carries over into the next, and sometimes it doesn’t. At any rate, I get to listen to unmotivated speakers read flat material whilst sitting in an uncomfortable chair on a very regular basis. We all do.

However, I feel that I keep up my continuing education quite well on my own through other means such as extensive self study and non-credit medical education. Keeping my professional skills sharp is very important for me because not only am I proud of my professional skills, but I am well aware of the fact that the quality of my skills translates into the quality of life for my patients. If I keep myself sharp, I’m a better paramedic. If I let them get dull, well then I’m an apathetic paramedic who isn’t doing my duty. Duty is important to me. So are things like Pride, Professionalism, and Honor. In fact, those three words are more than just the slogan for my blog, they are how I think that I and other EMS professionals should live their lives and careers.

Others have been quick to demonize the 200 suspended EMTs. Others have been quick to defend them. The ones defending them have said that these people are apt to lose their incomes, their livelihoods, and that the punishment is unfair. Well, for that part I disagree. The punishment is indeed fair. You could have killed someone by being untrained oafs with lackluster skills. You never proved you were otherwise. However, if you were to ask me if I thought that a state EMS agency – ANY state EMS agency – was competent to manage such a program, I would laugh at you. Every state has made an attempt to regulate continuing education and I agree that there is a good reason for them to do so. I would also agree that the prospect of regulating a group of EMS people in their continuing education efforts is a daunting task. I would say that the perfect system has yet to be developed and that a good number of the 200 were simply “playing the game” and thought that since their states EMS continuing educational system was a joke that they could make a joke out of it as well.

Here’s the most biting apathy of all to me. If you believe that a system that you work under is a joke. If you believe that there is a better way to do something. If you believe that what you’re made to do is pointless and obsolete… then why the heck haven’t you done anything about it?

I’d like you to look at this issue from this perspective, folks. Sure, not everyone in that group of 200 were caring, competent professionals. I’m sure some of them were jackasses. (And yes, I said “Jackasses). However, I’m also sure that there is a percentage of them in that group that sincerely care about being the best they can be in EMS and they simply got caught up in the mob mentality. I’m sure that some of them had just given up. I’m sure some of them were good people who just became apathetic.

I hate apathy.

If what, say 50% of that group were of the caring kind, that leaves 100 people who thought that the system was broken. Did it not occur to any of those 100 people to try and change it? Did they not try and band together to improve the system? Could one person do it? Could 100 people do it?

If we are to be regulated and controlled by obsolete and ineffective bureaucratic systems, then it is our duty to rise up and change things. Sure, that sounds melodramatic… but how many times have you thought that your state regulations were stupid. One of the defining aspects of a Profession is Self-Regulation. Look at your states “Bar Association” for Lawyers, or the states “Medical Association” for physicians.

Is there any state out there that has a “Paramedic’s Association” that has any teeth to it?

No continuing education system or relicensure processes is even close to perfect. That’s because of a few reasons, not the least of which is because the government is the one running it. The other reason could be because it isn’t being policed by the paramedics who care about it the most.

I’ve said it before, I’ll say it again. It’s time for us to take ownership of our profession. Stand up and make this the profession it deserves to be. Stamp out apathy and band together to let your voices be heard. If you don’t start the process of meaningful change, who do you expect to do so?

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For more positive discussion on EMS, check out the comments section in “Negativity? You Won’t Find That Here” or for a description of two real-world moral and ethical dilemmas in EMS, check out “Two Cases, one letter. From one paramedic’s struggles, change can come”

Posted by Ckemtp on July 9, 2010 • Filed under: Administration & Leadership, ckemtp rants, Command & Leadership, edemse, Emergency Medical Services, EMS, ems education, EMS ethics, EMS rant, EMS Topics, Ethics, everyday ems ethics, Paramedic, paramedic education, politics, Training & Development, Uncategorized

To Kneel or not to Kneel

23 comments

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

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

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

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

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

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

Right now, I’m on the 2^nd 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:

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!)
Take and put a towel or washcloth (a smaller wash cloth works better) in between your knees and your pants.
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)
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.
Re spray with disinfectant and let it air dry.
Remove the towels from your pants.
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, ambulance humor, Emergency Medical Services, EMS, EMS Health & Safety, EMS Humor, ems pants, EMS rant, EMS Topics, ems uniforms, EMT, Fire department, Fire Rescue Topics, Firefighter Safety & Health, In the Line of Duty, infection control, inside the mind of a paramedic, kneeling, Paramedic, paramedic education, paramedic pants, Patient Management, puke

A Slap in the Face for Medics? How about a Wake-up call

20 comments

Thank you everyone! Yesterday when I posted “A Slap in the Face to Paramedics Everywhere?” I recorded my biggest traffic day ever by at least one thousand visitors. I’m honored. Thank you for coming and reading this and thank you for caring about EMS. Especially, thank you those who left such intelligent comments and added to the debate. We who care about our profession need people who are passionate, intelligent, and who are ready to work alongside of us to improve who we are and what we do. By participating here and in the wider EMS blogosphere, you’re helping spread the ideas that we need to spread. Read, Talk, Learn, and Think. Make this the profession you want it to be.

I’m going to repeat that above statement: “Make this the profession you want it to be”

And there lies the true meaning of what I wrote yesterday. Sure, I was mad about the perceived encroachment by nurses onto our professional “turf”, and sure I played my anger up into what I thought would be something to fire you up as well, but there was a message there that not everyone may have gotten.

I know that there are good nurses out there that know a lot about a lot of stuff. A lot of them do a great job in the field within their scope and their experience in such things as neonatology, pediatrics, and critical care has proven invaluable to me on a lot of occasions. Yes, like each and every medic out there I can speak volumes about the times I’ve seen and worked with nurses who seem to be lacking vital chromosomes, but I’ve seen members of every profession that seem to have written their final exams in crayon. It’s no different when I am staffed alongside an idiot partner of the EMT persuasion… give me a smart nurse in their place any day.

However, my beef is this: Why is it necessary that a nurse need ever step into the field? The times I’ve had to carry one in the back of my rig have been mainly because of protocol deficiencies, where the EMS system I was working in at the time didn’t allow me to transport a specialized piece of equipment that was attached to a patient or to administer medications that were beyond the normal scope of the field. Now days, my EMS system allows me to transport pretty much anything and I’ve personally taken the steps to educate myself on the less-common things that I see. However, I’ve grabbed a nurse on occasion when called to transport multiple uncommon medications along with unfamiliar equipment. I’ve never been too proud to ask for help when I wasn’t fully confident in my abilities to fully handle possible eventualities with the patient. It’s not about my ego, it’s about patient care. I live by that motto. However there is no reason, in my opinion, that a paramedic cannot take the education necessary to become experts in any and every aspect of out-of-hospital care. It’s our bread and butter and the thought that our skills are lacking causes me concern. Whatever you call it: inter-hospital, pre-hospital, field, or other care… Paramedics are supposed to be the experts at that in my opinion and I want us to take the steps to ensure that we are so.

If you were angered by the actions of this ambulance service plastering their truck with the phrase “Staffed by Nurses”, that’s good. You should have been. Be angry at the management of that service for existing in a system that they haven’t changed for the better so that they don’t have to use nurses for things that paramedics should be doing. Be angry at their EMS system and their state for limiting their paramedics’ scope of practice and education so that they cannot be used to adequately staff the truck. Then, be angry at each and every one of us for not taking the ownership of our profession so that we can step up and dictate what is best for the patient’s we serve.

Is that petty “turf preservation”? Maybe. However we need some of that. For us to have pride in our profession we need to take the steps necessary to own what we are supposed to own. If we can see our profession lacking the necessary educational background, skills, or just plain old gumption to fix a problem, then we have to band together to do the work needed to fix it. The fact that this service and this system are thinking that having and advertising a “special” truck, “Staffed by Nurses” is a good idea is representative of a bigger problem, and that bigger problem must be handled by our people stepping up and handling our deficiencies so that we can solve the problem. We must improve the education, improve our skills, and improve our public perception so that people trust us beyond just the feel-good perception we have as “life saving” “ambulance drivers”.

You’ve heard me, Justin “the Happy Medic” Schorr, Mark “Medic999” Glencorse, and many, many others talking about EMS 2.0 over the last year. Well, this is part of it. My version of EMS 2.0 involves us paramedics taking ownership of problems like these and taking the necessary collaborative steps to fix them. We have to do just that if we want to advance. Now is the time for us to analyze the problems, dissolve the political boundaries, do the necessary work, and collectively grow up as a profession.

And fixing management philosophies that view us as contemptible morons is first.

One last comment, I got a link in a fascinating article by the Nursing Show ran by my buddy Jamie Davis. You should read it, it’s a good way to see how the nurses take this.

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Also, for more of my thoughts on the state of EMS in the State of Illinois, check out “Dear Illinois EMS”

Posted by Ckemtp on April 26, 2010 • Filed under: Administration & Leadership, ckemtp, ckemtp rants, Command & Leadership, Emergency Medical Services, Emergency Nurse, EMS, ems 2.0, ems education, EMS Management, EMS pep talk, EMS rant, EMS system, EMS Topics, Paramedic, paramedic education, politics, potential, pride, profession, professionalism, Training & Development

A Slap in the Face to Paramedics Everywhere?

90 comments

As some of you probably know, last weekend I went to the Fire Department Instructors’ Conference (FDIC) in Indianapolis, IN and I spent a great deal of time wandering the convention floor, looking at cool things and talking to cool people. There were plenty of great things to see and great new things to learn about and I immersed myself in doing just that. One of the things I’m always interested in is looking at the new trends in ambulance design and the manufacturers always have their coolest new vehicles on display to feed my interest. However, while walking the conference floor, I came across an ambulance that did more to tick me off than it did to promote their new vehicle design. Seriously, it was like someone slapped me in the face. Here’s the picture I took from my phone:

Does anybody see anything wrong with that picture? I was immediately ticked off… I’m talking a level 7 hissy fit. I was livid for quite a while and if you follow my twitter feed, you probably saw the three or four times I TwitPic’d it.

I mean really? They had to put “Staffed By Nurses” in six inch high script on three sides of this thing?

I blocked out the name of the service that runs the ambulance and in all fairness to the manufacturer, this truck is awesome. I would be quite happy to work in this truck although being that it has no bench seat, its usefulness as a 911 truck is hampered by its inability to carry more than one patient at a time. However, I would flatly refuse to work in this truck or for the ambulance service that puts it on the street. I happen to know the service that bought it and I’m trying to avoid naming them directly, but they serve a midsize city in Illinois.

Before you go all West Side Story, whip out your switch blade and zip gun, and prepare to have a dance fight with the nurses out there, realize that I’m not mad at them. Sure, mostly they’re well-paid and have climate controlled jobs inside of well-lit buildings, but they didn’t do this to us. My beef is with the management of this particular ambulance service.

So, let’s say that you’re the manager of this particular ambulance service. Obviously, sitting there in your office you must think that your paramedics and EMTs are contemptible morons who live simply to cause you problems. Furthering your view of the world, you probably think that the rest of the medical profession and the members of the general public in your area view them the same way and simply don’t trust them to provide medical care when it’s like *really* complicated and stuff. You probably feel that everyone would feel safer knowing that their patient or loved one is traveling via the companionship of “nurses” whom you must view as actually being like actually *Competent* and stuff.

And that’s what this rolling billboard to your contempt of your employees and their profession says about you. It’s a slap in the face to the good men and women you have working for you and there is flatly no excuse for it.

Here’s a tip, anonymous ambulance manager person (AAMP). There isn’t a need to have your precious ambulance be “staffed by nurses” when you have sufficiently equipped and prepared paramedics working in it. Paramedics are acute care specialists. We’re also experts in mobile medicine. Our education, training, and experience prepare us for the unique environment that we create when we move patients from one place to another. Critical Care Paramedics have the intensive Care experience, training, and background needed to operate in a critical care ambulance environment, nurses do not. Sure, ICU and ER nurses are great at Critical Care. However you shouldn’t regularly staff a critical care nurse in the transport environment for the same reasons that you wouldn’t put a critical care paramedic inside of the ICU. The professions are like in a lot of ways, but they’re separate for a good reason.

And you, AAMP, don’t respect that. Perhaps it’s because you’re burnt out. Perhaps it’s because you’ve beaten the system you’ve created into such a pulp that nobody wanted to staff your new Critical Care Truck. Perhaps it’s because of a lot of reasons, but it’s certainly not because you wanted the best in patient care or to show that your employees are capable of operating your shiny new “special” ambulance. No, you wanted “nurses” to “staff” that truck… and not only did you want the medical people you’re contracting with to know this, you wanted everyone who saw the truck to know it as the 6 inch high letters stating that fact clearly show. Do you think that the public views your crews as incompetent? If so, do you think that furthering the notion by advertising that your “special” truck is “staffed by nurses” will help that situation?

If your protocols are so draconian that even critical care certified paramedics cannot be allowed to staff that truck, then your protocol system is in the Stone Age. If your educational system isn’t up to the challenge of preparing your most experienced medics to staff it, then fix that problem. I know that there are great medic/nurse combos out there and I know that flight nurses have garnered quite a bit of respect out there in the world… and heck, I’m not knocking them for doing it. However, this is the time for Paramedics to step up and claim our turf. This ambulance clinched it for me. AAMP, your shortsightedness has caused me to lead a revolution of sorts here. You’re contempt for your staff has indicated to me that now is the time for paramedics and EMTs, such as the ones that work for you, to stand up and start claiming what is rightfully ours. Frankly, AAMP, your ambulance and your attitude is ridiculous and thinking like that must be stamped out right now by the good medics among us.

And I should also say this to the nurses in the audience before you start skewering me for knocking you: Have you looked at the debates in your circles concerning the use of paramedics in the ER and in other hospital units? Have you ever seen the term “Unlicensed Assistive Personnel”? Well I have, and it’s what the upper nursing echelon calls me and my professional colleagues. It’s offensive, but hey… our jobs are different. You have the hospitals and the fixed facilities. That’s what you do. We have the field. It’s what we do. There’s a line, respect it. If you want to do EMS, go through a real paramedic program. If we want to do nursing, we should go to nursing school. Really, it’s that simple. The transport environment is difficult and requires the use of specialized personnel… which we have, they’re called paramedics. The medical care we provide is close to the care that you provide, except we have autonomy that you do not and we are use to working independently in the environment in which we operate. Your focus is different than mine. You may be the best transport nurse out there, but even though you personally may be awesome, my profession needs to have people as awesome as you working on our side. That’s what this is about, not to knock your transport nursing skills, but to kick us paramedics in the shorts and get us to step up and maintain ownership of what we should own.

The responses I got back on Twitter show me that there are a lot of like minded individuals out there. Perhaps some of them might work for you, AAMP. You better take that into consideration because if I have my way the paramedics are going to get the notion that we’re not just a bunch of contemptible morons and we’re soon going to take control of our own profession. On that day, managers like you will be obsolete. Perhaps you can get a job managing nurses.

Here is my personal ‘thumbs down’ for the graffiti against my profession that you had someone slather on your shiny new truck, AAMP. My advice? Take it off and reconsider your staffing patterns. What you’re doing is bad for my profession. It affects me negatively, it affects my profession negatively, and it shall not go unanswered.

What do you think?

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Be sure to check out the follow-up to this post “A Slap in the Face? How about a Wake-Up Call?”

Also, for more of my thoughts on the state of EMS in the State of Illinois, check out “Dear Illinois EMS”

Posted by Ckemtp on April 26, 2010 • Filed under: 911 fail, Administration & Leadership, Ambulance, Ambulance Driver, ckemtp rants, Command & Leadership, Emergency Medical Services, Emergency Nurse, EMS, ems 2.0, EMS Management, EMS Motivation, EMS rant, EMS Topics, EMS training, Paramedic, paramedic education, politics, potential, pride, profession, professionalism, Scope of Practice, Vehicle Operation & Ambulances

Grumblemedics

9 comments

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

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

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

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

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

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

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

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

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

Check your Ego at the Door: You serve the public. Not the other way around. You are blessed and dang lucky to be the person that this person asked to take care of them in their or their loved one’s hour of perceived need and you best not forget it, because your mental health is at stake, and their life could be too. The best EMS people approach this job with a servant’s heart.

Evangelize EMS: You want the general public to know how to properly use EMS, right? Then what have you personally done to help teach them. Get out there and get the word out. Don’t hide in your station, or in the parking lot you’re posting in. Get the message out about what you’re there for, what you’re capable of, and how friendly you are while you are doing it.
Everything is PR: Every single, solitary thing an EMS person does affects the publics’ perception of them, their service, and the profession in general. Really. When you meet up with another crew for breakfast in the morning and talk about how wasted you got last night at the bar don’t think that the people around you aren’t listening. When you swear in public don’t think that the kids who are looking up to you in your shiny uniforms with your neat big truck aren’t filing that away. Take your public image seriously. Exude professionalism at all times because it saves lives. The more comfortable everyone is with your professionalism affects how apt they are to call you first, call you fast, or call you at all in a life or death situation. That can make all the difference for a lot of potential patients.

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

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

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

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

52 comments

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

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

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

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

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

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

Confused? I sure as heck am.

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

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

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

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

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

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

Saved by the Bell? High School Student EMS

62 comments

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 (9^th – 12^th 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, ckemtp, ckemtp rants, Command & Leadership, edemse, Emergency Medical Services, EMS, ems education, EMS ethics, EMS Health & Safety, EMS Management, EMS rant, EMS Topics, EMS training, EMT, Ethics, everyday ems ethics, Fire Rescue Topics, Firefighter Safety & Health, medical ethics, politics, rant, Training & Development, volunteer fire department, volunteer firefighter

Any Random Person

560 comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“Like Being on a Carousel” – The NREMT Cert? From TOTWTYTR

2 comments

One of my absolute favorite EMS bloggers calls himself “Too Old to Work, Too Young to Retire”. His blog and his writing is witty, insightful… and as the name may suggest, sometimes pretty cantankerous. I missed this post when it came out, but today when I came home from shift and was looking for a good read, I popped over to his blog to have me a look.

I was not disappointed, my friends. Looks like TOTWTYTR is in good form lately and he’s loaded up his torpedoes and aimed them straight at the NREMT, the state licensing agencies, and EMS education in general.

My favorite line from the post? “The entire process of recertification is a fracking farce” Preceeded immediately by a Ron White quote. Classic.

I’ll shut up so you can go read. http://tooldtowork.blogspot.com/2010/01/like-being-on-carousel.html

Posted by Ckemtp on January 11, 2010 • Filed under: Emergency Medical Services, EMS, ems education, EMS rant, EMS Topics, paramedic education

EMS Pay Sucks!! (Part 4) – We Control the Market

7 comments

I read a short article in Entrepreneur Magazine (to which I subscribe) that had a story about a sign hanging in a shop somewhere that said this:

“Low Price. High Quality. Good Service. – Pick two”

The saying goes that consumers can pick two of the above things that they feel are most important to them in their buying decisions. It also implies that businesses can focus and compete on two of the three, but they can’t do them all.

I agree with the sign. It shows in the fact that there are multiple outlets in the marketplace to purchase similar goods and services. If you’re price sensitive and don’t want the highest quality of furniture you buy from Ikea and assemble your purchase yourself. If you’re always after the best quality you go to a custom furniture builder who would be more than happy to deliver and install for the price you’re paying him. As always, if you as a consumer do not like what the merchant has for sale you “vote with your feet” and go somewhere else to spend your hard-earned money.

And that is how “the market” works. Businesses compete with one another for your patronage and this competition keeps their prices as low as the consumers are willing to pay for the level of quality they are willing to accept. People are willing to accept lesser quality products for lower cost as much as they are willing to pay more for better quality. Service and support plays a role in there too as nobody wants to get burned on a deal, product, or service. If your widget store has exactly the same quality of widgets for sale with the same service as the widget store across the street, people are going to buy the widgets at the lowest cost. Change any of the price/quality/service variables and the sales will follow where the consumer sees the best value. Of course I’ve oversimplified this a bit as the system we call “the free market” is infinitely nuanced in its simplicity, but this is indeed an EMS article. So don’t even get me started on that Adam Smith guy and his sleight of hand.

So why am I bringing forth this short little explanation of the free market? It’s because the ambulance industry is a service provider. Unfortunately (or fortunately if you prefer) we’re not entirely bent upon the whims of the marketplace due to the governmental regulations that set our price, control our service types, and dictate how we run our businesses. You probably know that Ambulance Services are “service providers” as they provide a service to our patients in exchange for fees paid for that service (ha!) and their tax revenues, but did you know that the Paramedics and EMTs are collectively a “service provider” for the ambulance industry itself?

Follow me here for a bit. If you separate out the collective “ambulance industry” from the collective EMTs and Paramedics making up the Profession of Paramedicine, you can see that there are two separate groups functioning in tandem. While we’ve always been inseparable and have been defined as one collective group, I suggest that we are really two entities. The Profession (Defined here as the Paramedics and EMTs together) and the ambulance industry (defined as the places we most usually work).The ambulance industry needs a service from the Profession in the form of us providing them with bodies to run their trucks, and we need them to employ us. If you were to take this thought further, we as members of the Profession compete with one another to provide our services to the various ambulance companies in the form of applying to and accepting positions with them under whatever conditions they set for us. They set the pay rates, benefits, shift schedules, etc and we paramedics compete with each other for the positions… usually accepting less compensation than we wished to receive as a condition of being employed.

Historically, our profession has competed on price as evidenced by the fact that our pay rates are much lower than we want to accept for our services. According to the above analogy, as we push our price lower either the quality of our education and skills or our level of service is going to suffer for it. One needs to look no further than their own paycheck to see that the pay is terrible. One also needs to look no further than their local “Medic Mill” school that exists solely to pump out EMTs and Paramedics with “a pulse and an EMT card” at the lowest possible cost with the absolute minimum level of education. We’ve become the Wal-Mart of ambulance staff, always rolling back our prices and lowering quality to encourage more and more demand.

If I have any liberty to speak to our profession I ask that today we all make the collective decision to compete on “High Quality” and “Good Service”, leaving “Low Price” behind. Frankly it hasn’t worked for our profession to provide our services for the low bid price. The subsequent drop in the quality of our education and services isn’t the best for our patients. We’ll always compete amongst each other to provide our services to the ambulance industry (I.E. apply for jobs) but if we all accept that we’re no longer competing on “Low Price”, we’ll all reap the benefits. Our patients will as well.

I suggest that we begin to “vote with our feet” more often in our quest for employment. If there are multiple ambulance services in your town, pick the one that offers the best pay and benefits and apply there for your employment. If and when you get hired, work like heck to make them the dominant ambulance company in the marketplace. Once the other competitors realize that the ambulance service with the best pay and benefits is gaining a competitive advantage, they’ll change… or be forced out of business. What you’ll begin to see is that the ambulance service that pays the best will begin to be able to “get what they pay for” from the profession in the fact that they will only hire the best qualified among us. Therefore we’ll begin to have to compete on quality and service to get hired for the best pay. We’ll no longer be competing on price alone. You’ll have to put more effort into the profession, but you’ll reap the rewards in terms of higher pay and benefits.

In addition, we need more Medicpreneurs. I’ve said before that the only way to make a lot of money in this game is to be the owner of a service. What’s to say that you can’t start your own ambulance company to put your boss out of business? Hire the best of your coworkers and pay them what they deserve. Do your best and work very hard every day. Soon enough, you’ll win if you can beat the market. You’ll be helping your profession and yourself as well.

When we begin to see the collective power that we wield as a profession in the marketplace we can begin to change the marketplace to fit our wishes. If we want EMS 2.0 to go ahead and get here already we’ve got to collectively become aware of our power and our duty to control the playing field. We haven’t won yet, let’s change the rules so we do. We owe it to our families, our patients, and everyone who depends on us. Wake Up EMS. We control the game here folks… We just have to realize the power we have together.

Low Price. High Quality. Good Service – Which two do you pick?

Posted by Ckemtp on January 7, 2010 • Filed under: Administration & Leadership, change, Economics, Emergency Medical Services, EMS, ems 2.0, EMS Management, EMS pay sucks, EMS rant, ems salary, EMS Topics, Funding & Staffing, paramedic salary, politics, potential, salary, US economy

Fiddling While Rome Burns – The “Ambulance Industry”

14 comments

Allow me if you will to allude to some Roman history here. I know that it’s a little heavy for an EMS blog but if you would please search the dusty recesses of your memories to think of the Roman Emperor Nero, it would help this post. You know, the one who “fiddled while Rome burned”

I am way oversimplifying this, but the way that I remember the story was that Rome was being swept by the “Great Fire of Rome” that burned for days and decimated the city. Popular legend has it that Nero, unconcerned with the plight of his citizenry, played the fiddle while the city was burning.

(Although, the MOST TRUSTWORTHY SITE ON THE INTERNET *Other than Mine* has this on the subject: http://en.wikipedia.org/wiki/Great_Fire_of_Rome)

Recent events and some things that I’ve been reading lately have brought some EMS issues to light in my mind, and thoughts about good ol’ Nero have popped into my head.

Are we Fiddling while Rome Burns?

There’s a few competing EMS system design models out there that have various people in their camps. Mention the virtues of one over another and you will get passionate and snarky responses from the various members of these camps. Trash Fire Based EMS and you’ll get a ton of people that will take a break from lifting weights and will bombard you with reasons while Fire Based EMS is awesome while wearing their T-Shirts emblazoned with “FIRE RULES!!”. Mention that 3^rd service and not-for-profit EMS may have their downfalls and the EMS Chess Club will bring forth obscure research that shows how much better they are for the patients than everyone else is. Trash Private-for-profit EMS and um, the employees thereof will trash it right along with you and their management will be too busy putting out fires to care.

Try as you might to convince me that one is better than the other and I’ll agree with you on some points and disagree with you on others. I will only endorse what I call “EMS based EMS”, which is EMS provided by truly dedicated caregivers who base their decisions and actions simply upon what is best for their patients and their communities. I have my beef with fire based services that place protecting firefighter jobs and the “fun” stuff involving spraying water on things that happen to be on fire over solid patient care. I have my beef with private-for-profit services that always default to the bottom line, and admittedly, I have a bias towards third service and not-for-profit EMS agencies. However, no one system has ever proven to be a good fit for every community, none are inherently evil, and other professions find their fit within lots of configurations.

If the system design models out there are really locked into a competition for the soul of EMS then they’ve all got a lot of work to do. In this piece, I’m going to ignore patient outcomes, efficient use of tax money, and all of the stuff that I usually talk about… and focus on one thing and one thing only.

The way EMS people are treated by the competing systems will probably decide this debate we’ve got going on here. The model that treats the paramedics the best will win and will take over the industry. Why wouldn’t it? What paramedic with half of a brain would continue to work in a service model that didn’t pay and treat them the best?

Here in Northern Illinois, there are very few options for a paramedic that doesn’t want to do Fire Based EMS for one reason or another. The few options that there are don’t pay nearly as well as the fire-based groups and this creates an endless revolving door of young paramedics entering the system, working the “privates” for a while, while trying to get a “real job” with a fire department. The private services suffer for it, and the fire based services reap the benefits while fostering a system that (gulp, here it comes) focuses less on the healthcare and more on the fun stuff.

So I challenge the private, third-service, and not-for-profit services out there with my next statement.

You’re fiddling while Rome burns.

If you aren’t out there doing your absolute damndest to treat your employees well and pay them what they deserve, you’re failing. You push your employees away. You push the best and brightest into other professions and into fire-based EMS which hands down has the best pay and benefit structure. Your lack of interest in caring for your caregivers is killing our profession. You fiddle whilst complaining about decreased reimbursements and failing to do anything about it. You fiddle whilst focusing on minutia like stupid rules and regulations that degrade the dignity of the adults who work for you. You fiddle while worrying about protecting your jurisdictional boundaries and contracts while they’re eroded away by the constant stream of departing employees.

Nero could have been an ambulance manager in some of the services I’ve been to, worked for, and observed from the outside. Could he be you?

You have got to find a way to pay your people better. I don’t know exactly how it’s going to happen either, but it has to be priority #1 for every ambulance manager out there. Trust me, if you don’t do it you will find that your capital city has burned to the ground. You will lose your empire and it will not come back. If you aren’t out there doing every possible thing you can to keep your employees as happy as you can get them, you’re fiddling, and you’re failing our profession.

This blog has a lot of content on it that explores new revenue sources for ambulance organizations already. Coming soon: Ways for each individual EMS professional to take control of our own income potential, own our profession, and improve our care to our patients. I’ve said it before and I’ll say it again folks, hang on cuz it’s going to get fun.

Posted by Ckemtp on January 6, 2010 • Filed under: 911 fail, Administration & Leadership, change, ckemtp rants, Command & Leadership, Economics, Emergency Medical Services, EMS, ems 2.0, EMS Health & Safety, EMS Management, EMS paramedics, EMS pay sucks, EMS rant, ems salary, EMS Topics, Funding & Staffing, Management, Paramedic, paramedic salary, politics, profession

EMS Pay Sucks!! Part 2 – Identifying the problem

33 comments

Welcome back to the “Life Under the Lights Bar and Grille”, your local dive bar filled with lousy food, tepid beer, bad ambiance, and great friends. Like any local Midwestern dive bar, it’s a come-as-you-are-and-sit-on-down-and-hang-with-your-buds kinda place. A conversation has broken out on the topic of “EMS Pay Sucks!! Let’s DO something about it!!” and me, your local blogger has decided to write a series of posts explaining the issues as I see them.

So, if you haven’t been here to read the last two, I suggest you go back and read them before you read this. If you don’t, well then that’s your choice. It’s a pretty informal place we have here.

Part 1: “EMS Pay Sucks!! Let’s DO something about it!!”

Part 2: “EMS Pay Sucks!! (Part 2) – Identifying the Problem (you’re here)

Part 3: “EMS Pay Sucks!! (Part 3) – Who or what is at fault here?

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The way our country compensates its EMS personnel is an abomination. It’s almost criminal, it’s inhumane, and it’s just plain wrong. Paramedics and EMTs do not deserve to live at, near, or below the poverty line simply because they chose to make a career out of helping others. We do not deserve the shame of being struggling from paycheck to paycheck. We do not deserve the hardships of trying to raise a family and continuously have to explain to them just why it is we have to work so many hours and have such little in our paychecks to show for it.

I know that EMS compensation is frankly despicable… but you don’t have to take my word for it. There is a lot written on the subject that comes from some very credible sources. Some examples:

“Five Surprising Salaries” – From Http://www.CNN.com

Favorite Quote (but the read the link to get even angrier):

“Paramedics

What they do: Paramedics respond to emergency situations and attempt to provide the necessary medical care, whether it involves transporting participants to a hospital or treating them on the scene.

Surprising salary: $27,070. Seeing as paramedics have high stress jobs that require them to be on call and ready to save lives at a moment’s notice, you might expect their mean annual salary to be higher.”

“We Don’t Pay Them Like Heroes” – By one of MY heroes, Dr. Bryan Bledsoe – This article is about 5 years old now, but it’s sadly very much still relevant. It’s from Http://www.EMSresponder.com
The US Bureau of Labor Statistics page on Paramedics – This one’s a long read, but if you’re only skimming it you should skip to the statistics on the salaries. Here’s my favorite quote from the article, under the heading of “Related Occupations”

”Other workers in occupations that require quick and level-headed reactions to life-or-death situations are:

Air traffic controllers

Fire fighters

Physician assistants

Police and detectives

Registered nurses

All those links work, by the way. Here’s a little pre-test question for you: Of those “occupations” listed above, which one is markedly the lowest paid??

I’ve been in full-time EMS for over ten years and currently work two-full time paramedic jobs. Not only do I feel the low wages, awful benefits, and long hours personally, but I also see what my coworkers go through with their lives and their families. What does one do when their calling is something so vital to the community, yet is so unappreciated financially that it hurts their families and their future?

In my travels throughout the nation I have had the chance to seek out and speak with EMS people in a lot of localities. I tend to visit odd places and I make it a point to seek out and get into conversations with interesting strangers. Luckily, all of the EMS people I know seem to fit the description of being “interesting”. I’ve heard them speak of the same problems that I’ve experienced. I’ve seen the pain and embarrassment in their eyes as they describe their love for the job and try to downplay the fact that they’re struggling financially. I’ve heard the same stories almost every time I’ve spoken with them. When they were young and new to the profession the long hours and low wages didn’t matter all that much to them… However, once they spend about five to ten years working the box they tend to experience the same struggles that I have. Spouses and Children don’t like it when the EMS person continues to work 100 hours a week to earn a paycheck that only comes close to covering the bills. They don’t like not having any disposable income. They don’t like the 24/7 demands of the job too much either. These facts rear their ugly heads when the EMS provider reaches a certain point in their life, and a career in EMS gets harder and harder to justify. Ever wonder why you don’t see many EMS professionals that have been continuously working full-time EMS for more than ten or so years? It’s for this reason. Sure there are a lot of exceptions, but I would think that the statistical clustering would bear this out. Eighteen-to-twenty year olds enter the profession, become family people around five-to-ten years later, and realize that the hours and the money they get for those hours are killing their family life… then they get other jobs, or stay in EMS and become very bitter about it.

So if I were to be asked to identify the problem using words that everyone could understand, I’d say this:

“The public is counting on the people in Emergency Medical Services to protect the lives of themselves and their loved ones. They then turn around and compensate them for this task at about the level they compensate fry cooks. They demand that there is a paramedic or EMT immediately available to them at all times to help them when the unthinkable happens, but they aren’t willing to pay them more than they do their bartender or waitress. People need advanced care immediately available to them in order to maintain the quality and presence of their lives after an emergency, and they need highly trained, experienced, and dedicated people to provide that care, but all that care seems to be worth to them is poverty-level income. What is wrong with our priorities?”

What is wrong with our priorities indeed.

I think that the above information is enough to identify that I think there is indeed a problem here. It’s an almost overwhelmingly complex problem as well. However, if it were an easy problem to fix, it would have been fixed by now. Fixing this has become mandatory for me, as it is mandatory for all of you. I’m writing this to contribute to the solutions that we’ll have to put into place, and by participating in this, you’ll be too. Over the next few days, I’ll be posting parts in this series, because I don’t think that one post will provide as many angles as I feel I need to.

One thing I do know, we’re going to act on what I put out here and on what you add to the discussion in the comments section and in your daily lives. We can no longer hope someone else will act. I ask every person who reads this to participate for our own well-being and the improvement of our profession. We’re not going to agree on everything, but “perfection is the enemy of the Good Enough”. Complete consensus is not necessary, action for our collective professional well-being is.

Coming tomorrow: EMS Pay Sucks!! Part 3 – Who or what is at fault here?

Posted by Ckemtp on December 29, 2009 • Filed under: 911 fail, Administration & Leadership, change, ckemtp rants, Economics, Emergency Medical Services, EMS, ems 2.0, EMS Health & Safety, EMS Management, EMS pay sucks, EMS rant, ems salary, EMS Topics, Funding & Staffing, Paramedic, paramedic salary, politics, salary

Swinging a Sledgehammer and Thinking about the UK… Strange times

10 comments

So here’s the good news. The ambulance service I work for up North, “Ambo’s R’ us” has finally taken the leap and is getting us a new station. Yep, that’s right folks. I will no longer be living in squalor whilst working up here in the vast frozen wastelands.

Except for one little hitch in the gittyup.

In big ambulance services, when one gets a new station, usually the service employs people to work on the station, build and/or remodel the station, and move the stuff from the old location to the new one. Not so in a small, rural ambulance service. Nooooo…. Here, a paramedic is expected not only to work on the ambulance during their shift, they’re also expected to put on their tradesman hat and get their hands dirty.

So, yep… today Ckemtp was not *just* a paramedic. Today yours truly was a demolition man, a moving man, a wall-paper remover, and a carpenter’s apprentice. All of my crew mates were today too, as were the crews yesterday, and so will be the crews who are unlucky enough to come work ambulance shift any time in the next couple of weeks.

But here’s my mea culpa confession folks: I’m not handy.

There, I said it. I am so not handy that hardware stores actually have my picture up on their walls stating that I must ask for staff permission to enter their premises. Apparently they want someone to follow me around with a fire extinguisher because there’s a concern that I might come into contact with a carriage bolt or something and the resulting sparks will start a fire. I, like most of my colleagues, became paramedics because we’re generally not handy enough to get a good paying job in the construction and/or “real job” industry.

What’s that you say? You’re a full-time paramedic/EMT and you own/work/watch a construction business on the side? Well good for you. I don’t. I write stuff about stuff and ride ambos.

The dreaded “other duties as assigned” clause in my job description is being stretched so thin here that you can hear it singin’ in the wind. I didn’t sign up for this. It’s actually very hazardous to my health and well being for me to be doing anything remotely construction or “handyman” related.

There’s a lot of reasons why, the risk of fire, explosion, and/or structural collapse being amongst them… but they’re not the real reasons that I’m so worried about this. You see, I have a lovely wife named Gkemtp(it) who is the absolute light of my life. However, together we own a home which happens to be the scourge of my existence. Like EVERY guy who owns a home, my home is full of things that are disintegrating at an alarming rate. There’s ALWAYS something that needs fixing and they rarely respond to an IV, o2, and monitor. Heck, even my clock radio didn’t do well with defibrillation. I can’t give my clothes dryer Epinephrine to get it started again, my clogged drain didn’t respond to a heparin bolus, and my leaky faucet leaked right through an occlusive dressing. I just don’t understand my home and its malfunctions the way I understand humans and their maladies. It’s awful.

So my wife knows that I am the opposite of the handyman… and she’s pretty ok with it, lest she nag and have me end up breaking something much, much worse than it was before I tried to fix it. I *like* that she’s ok with it… And I don’t need her to think that I came to work, built us a shiny new ambo station, and learned how to be Bob Vila with an NREMT-P patch. It’s bad enough that I clean toilets, vacuum, and do dishes here at work. If she found that out, she might make me do more of that at home.

So I’m stuck here. I’m destined to make anything I fix much worse than it was before, I’m destined to demolish something I’m not supposed to demolish, and I’m destined to make an egregious wiring error that’s going to burn the place down while I’m sleeping inside of it and I won’t even get to go to the fire because I’m on ambulance detail!

Maybe I should move to the UK and work with my good buddy Mark Glencourse, of Medic999 fame. One of the biggest things I took from the Chronicles of EMS, his and Justin Schorr’s (The Happy Medic) foray into cross-national EMS exchange (Soon to be an AWESOME TV show!!) is that UK firefighters DON’T CLEAN THEIR OWN STATION! Yes. They FREAKING HAVE CLEANING CREWS THAT COME IN AND CLEAN UP ALL BUT THE MOST SUPERFICIAL MESSES! Hell, they even have a bona-fide chef to cook for them.

And here I am, scrubbing toilets and swingin’ a sledge hammer here in the ‘States.

So, I’ll keep toiling until I break something so bad that they make me go post somewhere where I can’t hurt myself, and Mark will keep living in the lap of luxury.

Maybe being a Limey isn’t so bad.

Posted by Ckemtp on December 20, 2009 • Filed under: 911 fail, appreciation, ckemtp, ckemtp rants, EMS Health & Safety, EMS Humor, EMS pep talk, EMS rant, EMS Topics, Fire Rescue Topics, grumblemedics, humor, Line of Duty, medicblog999, UK paramedics, united kingdom, Your Happy Medic

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

32 comments

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

———————————————————–

An open letter to the Physicians of Wisconsin:

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

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

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

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

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

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

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

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

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

Respectfully,

Todd A. Bluhm, Paramedic

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

Request for ideas on a problem – Can we be paid enough already?

5 comments

Howdy! This post is random, disjointed neural firings. It comes from me trying to reconcile the fact that I really, truly do love working EMS but also hate the fact that I get paid worse than a fry-cook. It’s not the easiest read, and I’m sorry about that, but I can’t think of any good ideas.

So really, I’m just complaining about being paid so poorly. Sorry.

Can you help? At the end I’ve put some ideas. Care to expand upon them in the comments section?

A comment I received on my last post got me thinking on this beautiful Sunday. Here it is:

“Loved the quiz. It would not only appear that I have another decade left to supplement the two already under my belt, but will most likely be found pulseless and apneic while seated in the rig one day…. I can’t think of anything I would rather do for a living!”

(Thanks to JimHaden for the comment)

On that post “Will Your Career Survive a Decade or More in Full-Time EMS? Take this 3 question quiz!” I got a lot of cool comments from long-time EMSers stating how they “beat the odds” and have survived upwards of a decade or two in this business. Then, the above comment kinda tied it together for me.

And on a warm, Indian Summer day here on duty, I gotta admit that I’m getting the warm fuzzies from my career choice. I’ve always said that I have an abusive, co-dependent relationship with paramedicine and EMS. I may need it more than it needs me, but…

Dang I wish I got paid more.

I love this job. I like the quirky personalities of the people I’ve met that do this. I like the camaraderie I’ve got with them. I like the pressure to perform in challenging conditions. I like having to think on my feet. I like meeting new people. I like making people feel better. Heck, I even like driving fast and breaking things.

I could go on.

Sure, there’s a ton of things about this job that I could do without. I’d like to be able to schedule calls to handle them when I’m ready. I’d like to be able to have the 911 dispatchers instruct certain patients to “Take a shower and then call 911 back when you’re done.” I’d also like magnetically levitating stretchers that can pick patients up with cranes.

I can go on there, too.

How are we going to make this into a profession that pays, heck… If not a “good” wage, at least a “fair” wage?

It’s not fair what we make. It just isn’t. Sure, I’m a rural paramedic but I feel strongly about rural paramedicine and the fact that the lives of people who don’t live in urban areas are just as important as the lives of those who do. The fact is though, that rural paramedics make much less than their urban counterparts. Yes, I know that it’s because of call volumes, but also because the competition with the overall amount of jobs available in urban areas as opposed to rural ones. It’s also due to tax base and service delivery model issues as well as overall economic conditions and demographics of the areas we cover.

I could go on, but you get that it’s a complex issue.

Today I had someone complain to me about their recent ambulance bill that they received for a long-distance transport. They felt that it was unfair to be billed so much for something they felt they could do with a taxi cab. I was very professional like I always am, but honestly I’ve got mixed emotions on this one. I don’t know how many people share this opinion, but I’m one to think that ambulance bills are a tad on the too expensive side. I don’t think that cost should be a deterrent to people calling for emergency assistance. On the other hand, this person is a resident of one of the jurisdictions I work for and I don’t think that our bills are out of line. I wish I could have told this person that they had the ability to help their own problem with the bill by simply paying more of their share of the ambulance service though their taxes. The money’s gotta come from somewhere, folks. People need 24 hour ambulance coverage and more lives are saved (debatably to some, but not to me) by 24hr paramedic coverage. While I would do this job for free, and do so by volunteering my time in some places, I also have to eat

So I don’t have the answer, even though I would like to say that I did. I think that it’s too complex of an issue in order for there to be a magic fix to the entire situation. If there were, I think that despite the political forces at work, someone would have put it into place by now. I will say that the “Fee For Service” model of ambulance revenue is failing. You know, the one where we only intake revenue if we transport and the volume of transports is supposed to be able to pay for everything. Well, what if you’re in a small town that cannot support a high volume of transports like I am? Or what if you’re in a big city like The Happy Medic (follow @CoEMS on Twitter!) and a high percentage of your patients can not or will not pay you for your services?

The fix, in my opinion, to find new revenue sources for EMS. If you look at professions with the highest salaries, they’re the ones where the people earning those salaries earn large amounts of revenue for the company. Say someone in sales whose salary is commission-based and is dependent on making large sales, or large amounts of small sales, or an athlete who not only fills the stands but also earns tons of money from licensed products. EMS people don’t do that, for the most part our patients cannot afford what we charge them and aren’t using their disposable income to pay our salaries. We’ve got two sources, Secondary payers (Medicare/Medicaid/insurance) whose revenue depend on NOT paying as much as possible, and tax revenue. Yes, there are some that rely solely on one or the other, but most services that I’ve seen rely on both.

So what do we do? As I’ve said, I don’t have the answer and I’m pretty much winging this post from this point on. I don’t know. I’ve thought about adding home care services, having EMTs and Paramedics staff a community health-care clinic, and even working a 2^nd job while on-duty (really, I’ve picked up an application from the local McDonalds to see if I could park the ambulance out back and flip burgers for a while in between calls – I’m only half-way joking about that) to increase the revenue potential for me personally.

Hey, maybe that’s the answer. Could we get the local ERs to let us staff them as techs whilst on duty? The local clinics? Dialysis facilities?

No, probably not…

Help. I can’t finish this because I don’t have a good idea. Maybe I will later, because I’m thinking of this issue pretty hard lately. I need EMS to pay better. You probably do too. Let’s work this out.

Posted by Ckemtp on November 10, 2009 • Filed under: Administration & Leadership, ckemtp rants, Economics, Emergency Medical Services, EMS, EMS Health & Safety, EMS rant, EMS Topics, Funding & Staffing, Paramedic, paramedic salary, salary, Uncategorized

Sunday Randomness – Some EMS Pet Peeves

6 comments

< Rant>

Call me old and cantankerous. Call me obsessive too, probably. After being in EMS for a while now, like over a decade or so, I’ve become somewhat set in my ways.

No, not to the point where I’m not keeping up with cutting edge medic stuff or to the point where I won’t try out new fast food joints… and heck, just today I even tried out a new way to clean the station bathroom using the hose and the truck brush.

You know that the “Wash and Wax” stuff we use to shine up the trucks works AWESOME on the porcelain goddess! I can see my reflection!

But I have definitely developed some Old Guy in EMS Pet-Peeves (or as you UK folks call them, “Frumpydumples” or something weird like that) and I just remembered that I have a blog that people come to read. Because of that, I think that I’m perfectly entitled to rant a bit on what my EMS pet-peeves are. It’s a beautiful thing, for me.

So, without further ado, in no particular order, here are some of Ckemtp’s all time EMS pet peeves.

#14245 Swearing in front of a (member of the public)

Look, there are days where I can spew forth a string of sassy talk that would make Popeye blush. I get it from my mother (She’s a saint). I also grew up in the country around farmers and got my start in a rural firehouse. I know how to swear with the best of em’ (“#$Q#$” See? There ya go). However….

IF YOU ARE AN ON-DUTY PUBLIC SAFETY PERSON DO FREAKING NOT SWEAR IN FRONT OF A PATIENT, THEIR FAMILY, OR ANYONE ELSE FOR THAT MATTER!!!

It’s not cool. It’s not “Just how I talk” and I don’t have to get used to it. People don’t have to adjust to you. You’re a professional, you have to adjust to them. When you do this, it not only makes you look like an ignorant ass (ahem) but it also makes ME look like one by shaping public perception of our profession.

Call me what you want to. I don’t really care. It doesn’t matter matter if we’re with a patient, at a facility in front of staff, or out in public having lunch. You are representing everyone, every EMS and public safety person. Act like it.

Do this in front of me and expect correction, immediately, in front of the patient. (Yes, it’s that important). Swear in front of children and I might just have to hit you.

#3523 Encouraging the Refusal of Medical Assistance (RMA) before assessing and treating the patient

Hey, guess what… I understand that you’re tired. I understand that you’ve got better things to do today. I completely understand that you’re tired of running what you consider to be “BS” calls all day.

But you’re an EMS professional, right? You’re SUPPOSED to be sent to people who call 911. Yea, there… I said it. It’s your FREAKING JOB to assess everyone who calls you to the BEST OF YOUR ABILITY before you give them a professional recommendation about what they should do. If you ask a person “So do you want to go to the hospital or what!?” angrily before you even, like, feel for a radial pulse or get a pertinent history and physical exam you’re NOT DOING YOUR JOB. Most patients WANT you to give them a recommendation on what you think they should do. You’re an EMS professional, do just that.

If we told more people “Well, Ma’am/Sir I believe that what’s going on doesn’t really warrant an ambulance trip to the emergency room. I’ll be happy to take you if that’s what you want me to do, but perhaps you could get better care by taking a trip over to the (Insert Local Urgent Care Clinic Here) or by calling your personal physician and telling the receptionist that a paramedic/EMT told you that you should be seen today, or (Insert locally specific alternative treatment path here)” we could defer a lot of what you consider to be “BS” calls. Not everything is an emergency, but every patient deserves our professionalism, if not our respect. It’s our job and our duty to everyone. Yes, it really is. No, your argument doesn’t hold water with me. You don’t deserve to be so cynical.

Appropriately assess, treat, and make your decisions on behalf of every patient. Don’t put your personal feelings in there. It’s not ethical. No, it’s not. You want to be an EMS professional? Act like one and Earn It.

#7628 Not being EXTREMELY CAREFUL when handling the cot

Ok, this is a patient safety gripe. Have you ever dropped a patient while they’re on your cot? I have. I don’t consider it to be my fault other than the fact that I was responsible by being one of the two people holding the cot at the time. I’ve never forgotten the look of horror on each and every one of their 4 faces. I. Felt. Terrible. It haunted me for weeks. It still does. We’re supposed to protect our patients. To ‘First Do No Harm’ is somewhere in our extended code of ethics. If you’re dropping people on your cot, you’re doing harm.

If I see you absentmindedly wheeling the cot, I will stop the cot, watch you continue walking until you wrench your arm out of it’s socket, and then laugh under my breath. I will compel you to pay friggin’ attention to the cot and the patient before I move again. If you resume being absentminded, I will repeat.

If you don’t know basic physics, which will tell you that the center of gravity for flipping a cot is much smaller when the cot is travelling on from side to side rather than from front to back, then you shouldn’t handle a cot. Yes, the cot wheels rotate 360degrees but that does not mean that you can move the cot sideways. Move it in a straight line. When you need to turn you stop, rotate the cot on its axis, then move in a straight line again.

Yes, I ended that paragraph with a period. There wasn’t any more to say about that. Know what else there isn’t much to say about? The fact that you WILL have BOTH hands on the cot when moving on anything less stable than a level hospital hallway. That’s the only time you can use that little handle on the front of the cot. If you’re on ANY other surface, it’s both hands on the cot.

Yes, that was another period. Trust me. I’m saving you years of torment and some lawsuits.

Alright. Today’s rant has gone on long enough. Thanks for reading! < /rant>

And yes, there will be more coming. I rant a lot. It’s one of the reasons I started blogging. Thank you for reading it.

Posted by Ckemtp on October 25, 2009 • Filed under: Ambulance, ckemtp, ckemtp rants, Emergency Medical Services, EMS, EMS Health & Safety, EMS rant, EMS safety, EMS Topics, pride, profession, professionalism, Public relations, rant, Vehicle Operation & Ambulances

Follow up to The Shine Factor: What makes a great Ambulance Service

2 comments

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

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

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

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

——————————————————–

Perhaps I really am an EMS geek. I do EMS tourism. No, I don’t find new and interesting ways to hurt myself enough to require emergency services but when I’m travelling I usually stop in to EMS and Fire Stations along my way and go look over the service. This has been a lot of fun some times (Thanks MAST in Kansas City and Sedgwick Co. EMS in Wichita! I had a great time) and has been somewhat less fun in other areas. If you’ve ever done this, you’ve probably noticed some things like I have.

First, there are services out there that are average. They run ok equipment, they have an ok group of people working there, and they appear generally competent.

Then there are services that are not so good, the kind that leave you shaking your head at in the car when you leave after politely pretending to be impressed.

And finally, there are services that really, truly do impress you. They’ve got this stuff down to a science. Their rigs are clean, well taken care of, and in great shape. Their equipment is top of the line and well stocked, their uniforms are cool, their people are really friendly and seem more intelligent than your coworkers, and their facilities make yours look like a single-wide trailer. Heck, the place even smells like freshly squeezed awesome. These services are so much of a class act that you find yourself wondering why exactly you work where you do and aren’t working there with them.

I’ve seen these services along my path and I have noticed a few things that seem to characterize all of them. Sure, some do these things better than the others to different extents however you will find a healthy mix of these things at all of these services. I’d like to share some of these things with you.

Things I’ve found out about awesome EMS Services:

Their people are proud of the organization: You’ll find that the people who work at awesome services sincerely have pride in where they work. They’re there for a reason. They enjoy working for a service that has a good reputation in the community and the wider region. They think that their service is cool; they think that working for their service is cool; and they are respected by people from other agencies because of the position with the agency that they have. There’s a general feeling among the people that work for the service that it takes hard work and performance to earn a position within the agency. A service earns self respect the same way a person does, by having high standards and meeting their own challenges. A service that earns the respect of its people earns the respect of the wider community. Their Shine Factor is high.
Their people truly care: “Apathetic” is not an adjective you would use to describe these people. The culture that they’re in allows them to know that they make a difference in everything the service does, not only in the lives of their patients. They know that they are an important part of their service and that they would be missed if they were gone. They care about their coworkers and are as much friends as they are colleagues. There is mutual respect and a feeling that everyone there has to pull their weight in order for the service to meet its goals and thrive. Have you ever seen something wrong in a truck and haven’t spoken up because it was someone else’s fault or someone else’s job to take care of it? These people care enough not to do that.
Their community cares about and supports them: Community support is absolutely essential if an EMS agency is going to thrive. The best services have proven their worth to their communities and constantly work to prove why they need, deserve, and responsibly use the support they receive. The community supports them because they see the benefit in supporting them. You can see the community’s support in the newness and quality of their equipment and facilities as well as in the salaries that the employees are paid. You can see how responsible the service is with the support they get in how well they treat the equipment and the community in return.
The culture of the service just ‘feels good’: The culture of the organization defines the way everything runs. Bad organizational cultures breed discontent and apathy in everyone over time. Good organizational cultures breed people who feel comfortable coming to work and handing the responsibility of being an employee. People that work in a bad culture form cliques and get angry a lot. People that work in good cultures come up with ideas that get judged on their merits. People that work in bad cultures fear mistakes because of the punitive measures that will come down from on high. People that work in good cultures acknowledge their mistakes and are allowed to learn from them so that they grow as a provider and as a person. People that work in bad cultures hate coming in to work. People that work in good cultures have friends at work and feel comfortable, if not happy, with being there. I think that you can get what I’m talking about.
Their people are experts in what they do: Paramedics and EMTs are experts in Pre-Hospital medical care. They have to be, there is nobody else who could or should be. The people in awesome EMS systems have great protocols that are challenging to learn and require advanced skills to perform. Their protocols evolve with emerging science and keep on the progressive edge of medicine. The training, quality review, and quality improvement programs are tough and demanding. People take pride in being the best at what they do and earn their own self respect by doing it well. They respect themselves for their efforts and respect their coworkers for earning their respect every bit as much as they do. Ever been scared that you or a family member or friend would get hurt while so and so’s on? These people don’t have to be.
The organization respects and supports the employees: This relates to the organizational culture but deserves its own point. Employees will not respect the employer unless the employer respects the employees. In awesome EMS services, the employees and management function in an atmosphere of mutual respect. The management provides the employees with adequate, functional equipment and facilities even when asking them to do more with less. They strive to promote fairness in corrective actions and policies, knowing when to cut someone slack when appropriate. The employees are treated like adults and are encouraged to innovate and take ownership of their areas.

I’ve been to these services and I can honestly say that I left their station with the feeling that I wanted to be a part of their organization. Then, I’ve gone back to my service and taken an inventory on what we needed to do to emulate them. It’s all about being able to enjoy coming to work for the right reasons where you work with people who care, respect, and strive for the same things that you do. EMS people who are passionate about EMS who are allowed to shine build great organizations no matter where they happen to land. EMS people who aren’t build organizations that fall into the other two categories. I suggest that you take some of the suggestions below to help get your service to where you want it to be:

Read “The Shine Factor” – One of my previous posts and the predecessor to this one.
Realize that your community won’t care about you u
nless you tell them why they should – EMS organizations need to market themselves just as any other business. No matter what your classification is, you need to market yourself to your community every day. Your constituents are your customers and they won’t think about you unless they either need you or you put your message in front of their faces. Tell them what you do, tell them why you do things the way that you do, and tell them what you need to do what they do. Let them know how you strive for quality. Let them know how well you are stewards of their hard-earned dollars. Let them know who you are and what you stand for. Trust me, PR saves lives and EMS budgets.

Right now, resolve to treat everyone else in your organization like a professional. Try to earn their respect. Someone has to take the first step here, it should be you.

End any secrecy in your organization – Sure, direct personnel actions are one thing, but unwritten policies and issues directly affecting all employees are quite another. Allow people to become involved in the organization in any role they want to. Organizational secrecy builds “Silos” where people tend to stratify themselves based upon their own perception of what is most important to the group and allows individuals to worry that anyone with a new idea is there to steal their position within the silo. Allow people to participate and collaborate on decisions affecting the organization.

Encourage innovation. Encourage participation and new ideas – No idea is a bad idea. Business these days thrives on the economics of ideas. Don’t shoot down any idea without a collaborative review of its merit. Employees come up with new and better ways to do things every day, let them develop those ideas and test their effectiveness. If those ideas are repressed in an organizational culture that resists change, the whole organization will suffer when people begin to feel that their contributions never matter.

Encourage people to take ownership of their roles and responsibilities – I work for my ambulance service because it would miss me if I was gone. Why would anyone ever go to a place where it didn’t matter if they were there or not? When people begin to feel that their time isn’t valued or their efforts aren’t appreciated, they stop putting forth any time or effort above what it takes to avoid being fired. That’s it.

Never let anything stagnate – If you haven’t reviewed a system in over a year, you’re lagging behind. If your protocols haven’t changed in over a year, you’re not keeping pace with medical science. Even if something is working very well, that doesn’t mean it shouldn’t be reviewed and measured regularly. Make systems prove their worth. Don’t let anything get stagnant. Pull ineffective policies or programs and replace them with another idea. Review those ideas and see if they’re better suited to your goals. Set lofty goals and try hard to reach them.

Reevaluate why you do what you do – Why are you in the organization? Are you there because you care about what you do? Are you passionate about it? Once you remember what it was that brought you to EMS and to the organization where you’ve happened to land, evaluate if you still see your organization fires your passion. If it doesn’t, work diligently to make it meet your design. Earn your own respect. Forgive and forget past grievances and collaborate on new solutions. Bust silos and build bridges, not fences.

As always, I welcome comments and e-mails: ProEMS1@yahoo.com

——————————————————

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 April 17, 2009 • Filed under: Administration & Leadership, Ambulance, Command & Leadership, edemse, EMS, ems 2.0, EMS ethics, EMS Health & Safety, EMS Management, EMS rant, EMS Topics, EMT, Ethics, everyday ems ethics, Fire department, Firefighter, new perspective, Paramedic, professionalism, technology-communications-ems-topics, The Shine Factor

Oh no you didn’t…

12 comments

Really? Did you just?? Oh come on now… you don’t really think??

Seriously…

Did you really just call me an “Ambulance Driver”?

An Ambulance Driver? Oh come on… Four years of college level classes, hundreds upon hundreds of hours of continuing educations, a veritable alphabet soup of certification acronyms behind my name, and this nifty Star of Life disco ball patch on my arm and you STILL just called me an Ambulance Driver? Really? Oh come now, do you know that calling me an ambulance driver is like calling a High School Teacher a “Nanny”, or calling a Police Officer a “Police Car Driver” or calling a Nurse a “Bedpan Jockey”, or calling a Firefighter a “Fire Truck Driver”, or calling a scientist a “Microscope Looker-Inner” or calling a Congressman a “Pork spewing bloviator” (I could go on, but I won’t… although that last one might be right)

EMS is an acronym for “Emergency Medical Services”. EMT stands for “Emergency Medical Technician”. Nationally, there are three levels of EMS professionals. Each level signifies to the public that the person holding the Title and the requisite license or certification has met stringent educational and training standards that allow them to take care of people. These levels are EMT-Basic, EMT-Intermediate, and EMT-Paramedic. Some of the states have expanded on this by offering additional levels of certifications between the levels, such as the EMT-IV Tech in Wisconsin (an EMT-Basic that can start IVs and give some limited IV meds), or the EMT-Paramedic Specialist in Iowa that is above the NREMT-P a bit but still below their Critical Care paramedic.

A paramedic these days has a college level education, takes over 1000 hours of didactic (classroom) time and can spend anywhere from 6 months to a year in clinical rotations. We can poke, prod, cut, inject, bandage, stabilize, evacuate, and care for you sixteen ways from Sunday. In my ambulance I carry 48 different emergency medications that I have to know how to use REALLY well or I can kill you. (I do know how to use them really well, trust me, so do my peers). I can intubate your trachea so you can breathe, reinflate your collapsed lung with a needle, surgically open your airway if I need to in order to save your life, and do a whole host of other things that you wish that you never ever need. My ambulance is a critical care unit on wheels that can be at your curbside in under 8minutes flat twenty four hours a day seven days a week. Today’s ambulances bring the emergency room right to you and begin advanced medical care right away. This care saves lives and improves your medical outcome greatly for a whole host of medical complaints.

And you, Joe public, still call me an “Ambulance Driver”. Which, if you hadn’t noticed, somehow irks me a bit.

Unfortunately for me, and for the members of my profession, it’s not your fault that you call me that, dear Joe Public. It’s my fault. It’s the fault of each and every EMS professional out there that you know so little about our profession and our industry that you resort to calling us that detestable term. It is our responsibility to get the word out. It is our responsibility to educate you about our life saving services, and our responsibility to let you know just how and when to use us properly. If we don’t do it, and therefore let the responsibility fall to others, we EMS people aren’t going to be happy with the job they do. We’re not going to be happy with the popular representations of paramedics in the popular media. We’re not going to be happy with the results of our public health education campaigns.

The American Heart Association has recently released a campaign entitled “Mission: Lifeline”. It’s a marketing campaign aimed at increasing public awareness of heart attack symptoms so that Joe Public calls us first when they start having the big one. If you’ve been reading this, you know that my all time biggest pet-peeve is when the people having conditions where they need us and need us now but aren’t dramatic like a car accident or cardiac arrest don’t call us. I can’t make a direct quote, but I read a study once where like 60% of people call a friend or family member first when they think they’re having symptoms of a heart attack. Calling EMS for these 60% or so of potential patients whose lives may very well depend on the early interventions we can provide them seems to be an afterthought. I can’t tell you how many people I’ve transported from small hospitals to big hospitals that were having the big one and DROVE THEMSELVES INTO THE ER without calling us.

Please, Joe Public, know that the VERY FIRST CALL you should make when you have pains in your chest is 911. Do NOT hesitate. Do NOT worry about the cost. JUST CALL US!! Do you know that approximately 1% of cardiac muscle tissue DIES AND CANNOT BE SAVED per MINUTE in a bad heart attack (myocardial infarction)? The difference is simple. You call 911 and usually (depending on where you are located) an ambulance arrives within 10minutes and starts lifesaving interventions and gives you medications to help slow or stop the damage in progress and salvage heart tissue that is being damaged. Please remember that “Time is Muscle” and that the extra expense of an ambulance is more than covered by the quality of life that we’re keeping for you. Really. Please call. Don’t wait. You can call your family AFTER you call 911. Please, I’m begging.

I’m also telling you EMS people out there to get the word out. Go market yourselves! If you want people to know what we do, it is YOUR PERSONAL RESPONSIBILITY to tell them. Go, do it now. If you want my help to write something, e-mail me and I’ll help. For free even. It’s that important.

Ambulance driver….. Seriously.

Posted by Ckemtp on March 31, 2009 • Filed under: AHA, Ambulance, Ambulance Driver, American Heart Association, ckemtp rants, Command & Leadership, edemse, EKG, Emergency Medical Services, EMS, ems 2.0, EMS ethics, EMS Humor, EMS Management, EMS rant, EMS Topics, EMT, Ethics, everyday ems ethics, funny, grumblemedics, inside the mind of a paramedic, Mission Lifeline, new perspective, Paramedic, Public relations, rant, STEMI, technology-communications-ems-topics

The DNT Order??

3 comments

Tonight I would like to take a few moments to hit on what is one of my top-ten all-time use-a-lot-of-dashes-in-between pet-peeves in EMS and probably in health care in general. It’s the “DNT” or “Do not Treat” order. It might just as well be called the “DNC” or “Do Not Care” order, or “Do Not Comfort”, or “Do Not Be Humane”, “DNBH” Order.

Yes, I’m talking about DNRs here. They’re “Do Not Resuscitate” orders and if you’ve been in EMS for longer than a minute or two you’ve heard about them.

DNRs serve a good, humane purpose in a lot of cases. We all know that even though we’re improving (GO CCR!!) CPR and ACLS are largely rituals that we perform for the dead in our society. They rarely bring people back if they happened to be sick enough to die in the first place. They’re also very traumatic things to do to a body. DNR Orders are a humane way for patients and families to say “Enough. When God or whom/whatever I may or may not believe in says it is my time, it is indeed my time”. I can respect that. I happen to be a Christian and I believe that we go to a better place once God decides that it’s time to punch our clocks. If I had a hopelessly terminal disease I would probably be pretty ticked off if some young kid with a shiny new EMT card brought me back to face more of the disease progression with a couple of broken ribs for the trouble. I get it.

What I don’t get, and what just drives me crazy is people who treat DNR orders like they’re “DO NOT TREAT THIS PATIENT BECAUSE THEY’RE JUST A DNR” Orders. I know that I will hear this again, and probably tomorrow because I heard it three times today and I’m on a 48hr shift here, but I think that I might say something unkind to the next person that says, “well.. They’re a DNR” when I ask them why they’ve let their patient suffer in agony for hours before they decided to send them to the ER. Yes, I um… occasionally go to “Skilled Nursing Facilities”, can you tell?

Here’s what a DNR order does NOT mean:

It does NOT mean: Let your patient be Hypoxic – Yep, I can see that they probably don’t want you sticking an ET tube down their throat. BUT PUT THEM ON OXYGEN IF THEY ARE HAVING TROUBLE BREATHING!! HELLO!!?! WOULD YOU WANT TO LAY THERE WITH A PULSE OX OF 80 SOMETHING!?! IT’S CALLED COMFORT CARE!!!! ; Ahem, sorry… but good patient care is one of my highest goals. Please, on behalf of everyone who does not want to go through the agony of suffocating in their own body, please do things to maintain a patent airway and good oxygenation. Please.

It does NOT mean: Wait until a simple medical problem is something critical before you seek a higher level of care – For the EMTs/Medics in the audience (if I ever get one.. Tell your friends!! J) how many times have you walked into a patient’s room at a “Skilled Nursing Facility” and found that only when a patient’s family member came to visit and found grandma gorked out did the staff think to maybe do an assessment on them. Treat every patient the same, give them all the same level of care, just don’t pump on the chests of the ones with the DNRs! Simple, right?? Don’t let them get septic from a UTI. Don’t let them get pneumonia from a simple cough. Don’t… forget that we’re all deserving of human comfort.
It does NOT mean: Let your patient die of dehydration and/or starvation – This goes back to being humane. Really… Yes, I have see this, treated it, and taken care of it but I don’t see the point in saying why or where. (Remember, I’ve been a lot of places in the ten odd years I’ve been in the back of a bus). Every human being needs to eat and drink some way, somehow to keep from dying a horribly painful death. Don’t neglect people because they happen to have made a decision to not have CPR done on them.

Don’t think that I’m just picking on the nursing homes here.

I once had a transport where I took a young infant with a horrible medical condition from a small ER to a tertiary Childrens’ Hospital. (A different one from the one in a previous post). This poor little baby was now living with a set of very nice foster parents but just didn’t seem to have much chance in the world due to his/her terrible start in life. The child was on oxygen, needed regular suctioning, and was being sent to this tertiary facility to replace his/her feeding tube, which had become dislodged. Because of that, the patient was having some increased breathing difficulty and was actually pretty challenging to take care of for the hour long transport. The foster mother had brought the baby into the pediatrician’s office for this condition, and the pediatrician had set up the direct admit to the tertiary facility after sending the kid to the ER close to his office.

The foster mother was a very nice lady who seemed genuinely concerned and caring about the kid. I asked her why if the kid was in that bad of shape did she not call 911. Her answer? “I thought I couldn’t call 911 because he has a DNR order”. Someone, and I don’t know whom… but someone had told this wonderful foster mother that this child was NOT WORTH EMERGENCY CARE because he had a DNR order! Yea, not in so many words I don’t think… but that’s the general idea she had. I corrected it. Told her to call 911 whenever she felt she needed to and let her know that the ambulance crew where she lived would love to come visit her to learn about and help take care of the child. I cannot believe that someone would lead a person to believe that… I just can’t.

Oh, and yes, today I had a SNF patient that fit my whole DNR/DNT pet peeve thing… and yes, an ER staff person may or may not have given the “Just a DNR” comment. In fact the whole healthcare system may have failed someone today that chose to have a DNR order and neither he/she nor his/her family knew about it. But I did, and I fixed it.

And I just ranted about it.

Someday soon I may turn this blog post into a coherent article, got any rants you’d like to post? I like comments. As always: ProEMS1@yahoo.com

Posted by Ckemtp on February 13, 2009 • Filed under: Ambulance, ckemtp rants, cpr fail, DNR, Do Not Resuscitate Order, edemse, EMS, ems education, EMS ethics, EMS rant, EMS Topics, EMT, ER, Ethics, everyday ems ethics, nursing home, Paramedic, Skilled Nursing Facility

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