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EMS 12-Leads – The Standard of Care

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I’m going to make a statement:

Every ambulance in the United States should have the capability to obtain a 12-lead EKG. Regardless of the service’s level of care, be it Basic, Intermediate, or Advanced Life Support, every ambulance should have the ability to get a 12-lead. There are no exceptions in my opinion. It is the standard of care and every ambulance should be able to do it.

In the last few years, the 12-lead EKG has not only revolutionized EMS care, it has influenced the care given throughout the entire healthcare system. Bringing it to the forefront of urgent and emergency care has helped not only save countless lives but also has improved the ongoing quality of life for countless patients. The 12-lead EKG provides invaluable insight into a patient’s true underlying medical complaint and is useful in diagnosing a whole host of potential medical conditions. If you are an EMT or paramedic, you should be able to obtain a 12-lead.

I’m saying this because right now in communities both urban and rural there are ambulances that still do not have this essentially lifesaving capability. The problem crosses all divisions in the level of care and there is no excuse for this fact. Obtaining a 12-lead is an essential piece of the diagnostic puzzle for many patients. It can make the difference between a proper diagnosis and misdiagnosis that can have a lasting detrimental effect on a person’s entire life. There are many solid positive reasons that support EMS agencies expending their critical resources to obtain this capability and few, if any reasons for them not to.

If your agency does not currently have the ability to acquire a 12-lead EKG, here are some reasons that you can take to the powers that be for your service or use as information to show your community for fundraising activities. In my opinion, these things help show the solid reasons why you should begin offering the service as soon as possible.

  1. Better knowledge drives better medical care – The most common EMS treatments for chest pain can mask essential diagnostic signs and symptoms that help pinpoint cardiac causes of the complaint. Things like Nitroglycerine, Oxygen, narcotic analgesics, and aspirin can normalize the waveform complexes on an EKG tracing after only a few minutes. EMS providers used to begin treating the symptoms of chest pain before acquiring a 12-lead when the technology was not widely available. This caused a broad cross section of patients who were truly experiencing a heart attack that needed to be treated emergently to have 12-lead tracings that were normal upon their acquisition in the ER. The ERs then needed to rely on the laboratory values of the patient’s cardiac enzyme markers to make a diagnosis. This often times added 12 to 24 hours to a patient’s time to proper diagnosis and sometimes resulted in a heart attack that was missed entirely. EMS 12-lead EKG acquisition helps change that. EMS providers can obtain a symptomatic 12-lead EKG at a patient’s first point of entry to the healthcare system when their symptoms are at their worst which will oftentimes show diagnostic information that 12-leads obtained later in their care will not. This exponentially increases the diagnostic sensitivity of the overall assessment of a patient and can change their entire path of care, resulting in more appropriate treatment being given sooner. This can save more of the patient’s heart tissue and increase their quality of life for the rest of their life. In addition, proper care can decrease a patient’s length of hospital stay, saving millions in healthcare costs when viewed as a sum total.

 

  1. 12-lead EKGs increase the safety of EMS care – Certain types of heart attacks such as ones occurring on the front, underside, and the right side of the heart can cause nitroglycerine administration to be dangerous. EMS providers of all levels give nitroglycerine for chest pain. However, when given to a patient experiencing a right-sided, inferior, or anterior heart attack that affects the right ventricle of the heart, nitroglycerine can cause a severe drop in a patient’s blood pressure that can prove detrimental or even fatal for some patients. A 12-lead EKG can pinpoint these types of heart attacks with a fairly high degree of sensitivity and can help prevent the harmful drop in blood pressure. Heart attack victims need nitroglycerine and like all medicines that can be harmful when not properly used, EMS providers need to be able to see the 12-lead and share it with physicians at the receiving hospital to increase patient safety. Increased safety equals better patient care, decreased liability, and better patient outcomes overall.

 

  1. If you can provide oxygen, you can take a 12-lead – All paramedic ambulances should be able to obtain a 12-lead EKG with no exceptions, however so should all ambulances of any level. EMT-Basics and EMT intermediates functioning on an ambulance service of any level should be able to get a 12-lead. The first arriving care providers who will be beginning treatment on a potential heart attack victim need to be able to obtain a symptomatic 12-lead. While BLS and ILS providers cannot and should not interpret the 12-lead EKG and should not change their care based upon it (unless ILS protocols allow), they may transmit the information to the receiving hospital and/or responding ALS intercept and may act upon the orders they receive from their medical control. Obtaining the symptomatic 12-lead is essential for proper diagnosis of heart attacks. The first arriving care provider needs to get one, regardless of their level of care.

 

  1. It can determine the proper hospital to take a patient – Patients having heart attacks need hospitals that can take care of them. The current gold standard of heart attack care is generally agreed upon by physicians to be “Percutaneous Coronary Intervention” (PCI), also known as a “Cardiac Cath.” This is a surgical procedure where an interventional cardiologist threads a tool into the arteries that feed a patient’s heart through the vessels in their leg. The cardiologist can then open a blocked coronary artery and allow the area of the heart being damaged by the heart attack to receive blood flow again. The sooner this is done, the better. A symptomatic 12-lead EKG obtained by EMS can make the difference between a patient being transported to a patient where this surgery can be immediately performed rather than to a hospital that may not have this capability or does not have it immediately available. This makes the difference between immediately appropriate treatment that saves both lives and heart tissue and treatment that may not be the best for the patient. Inappropriate treatment costs a lot more money when it results in a patient needing transport from a facility that cannot properly care for them to one that does.

These are just some of the reasons that all ambulance services of any level should be able to obtain 12-lead EKGs in the field. It is an essentially lifesaving tool and is the standard of care. There are few, if any dangers or drawbacks to using the tool and multiple strongly supported reasons to do so. EMTs and Paramedics that do not currently have the capability should get it as soon as possible, and the communities that they serve should support them with the funding and resources to do so. The medical directors of communities where EMS 12-lead acquisition is not currently possible should write protocols for the practice and should support development of a system of care that properly uses the critical information obtained to make the most positive impact in patient care.

This is an area where EMS truly makes a documented, lasting impact in quality care and where EMS development is driving the healthcare system as a whole. Make sure your service and your practice is a part of it. Do the best by your patients and communities. Save more lives. Help more people get better.

If you have questions, I offer myself for any information you may need. My e-mail is proems1(at)yahoo(dot)com.

Posted by on April 23, 2012 • Filed under: Administration & Leadership, change, Command & Leadership, EKG, Emergency Medical Services, EMS, ems 2.0, EMS system, EMS Topics, new perspective, Paramedic, Patient Assessment, patient care, Patient Management, Scope of Practice, STEMI, Technology & Communications, Uncategorized

Changing Cardiac Care – Being Suspicious

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Want another reason to lug the EKG machine out of the ambulance on your next call? A study recently published in the Journal of the American Medical Association and reported on by many national news outlets has found some information that may change EMS care.

From CBSnews.com:

“The study looked at 1.4 million patients who had experienced a heart attack between 1994 and 2006 to investigate the relationship between age and gender and heart attacks, specifically symptoms and death rates. Data revealed that 14.6 percent of women hospitalized with a heart attack died, compared with 10.3 percent of men.

Women were also much more likely to have a heart attack without any chest pain – 42 percent, compared with 30.7 percent of men.”

http://www.cbsnews.com/8301-504763_162-57382624-10391704/heart-attacks-in-women-greater-death-risk-fewer-feel-chest-pain/

Think about how the media represents heart attack symptoms to the public and about how we educate the public to recognize heart attack symptoms. Think about how even our EMS training has prepared us to recognize the signs and symptoms of a heart attack. We all pretty much look for the same thing, chest pain or pressure with radiation down the left arm. However, this study shows that a staggering 42% of women don’t have that symptom and that 30.7% of men don’t either. It tells us that nearly half of the patients who have this deadly condition don’t present with the symptoms we’re classically trained to recognize.

The study’s other finding that more men than women who had myocardial infarctions died after having the condition help illustrate another point: When looking for heart attacks, we all tend to assess everyone like they’re a 45 year-old white male. It is important to remember that age, gender, ethnicity, and culture play a role in how symptoms present. Comorbid conditions such as diabetes can change the way a heart attack presents as well.

This study helps confirm what we pretty much all know, that no two heart attacks are alike. When the heart doesn’t get blood flow to a part of it, it doesn’t work well, and it sends signals to our bodies that we may misinterpret. The classic “Chest Pain” symptom of a heart attack may well present as Jaw Pain, arm pain, weakness, diaphoresis, back or abdominal pain, or even making the patient feel like they have to burp. Unexplained fatigue with exertion, the inability to lie flat, or even dizziness and/or fainting may point to a heart attack.

EMS plays an extremely important role in cardiac care. It could be one of the biggest areas where the appropriate field assessment, working diagnosis, treatment, and transport decisions made by EMS improve the quality of life for the population as a whole. The proper assessment and working diagnosis by EMS can set the patient on the proper path through the healthcare system and make a huge difference in their quality of life.

What does this mean for your care today? It means that should you suspect that a patient has a possibility of having cardiac ischemia or is otherwise presenting with a cluster of symptoms you can’t pin down you should try to perform a 12-lead EKG with your first set of vital signs. While delaying treatment to perform a 12-lead is not anyone’s goal, emerging evidence is suggesting that significant ST elevation can normalize within as little as 4 minutes of common EMS care, including just the placement of a patient on oxygen. If we capture a symptomatic 12-lead at the point where the patient’s symptoms are most acute we can properly make the diagnosis and save the patient precious minutes, hours, and days of diagnostics to pin down the cause. Serial 12-leads, taking multiple 12-lead EKGs at various time intervals can prove beneficial as well. Remember that one 12-lead is a reference, two are a trend.

Gathering the best information we can on all patients in order to help guide their treatment through the healthcare system is one of the most powerful benefits of EMS care. Let’s help all of our patients get the care they need.

Posted by on February 24, 2012 • Filed under: EKG, Emergency Medical Services, EMS, ems education, EMS system, EMS Topics, EMS training, News, Paramedic, paramedic education, Uncategorized

What is the next “Low Hanging Fruit” of EMS 2.0 and of US Healthcare Reform?

12 comments

I’d like to ask a question to all of you medical-type folks out there, and for this one I’d like other healthcare professionals to weigh in, not just EMS. Of course, Paramedics and EMTs are encouraged to answer this question, but so are Physicians and Nurses (RN and LPNs), as well as CNAs and Techs. 

A conversation I had on Twitter regarding administration of 10% Dextrose IV (D-10) as opposed to 50% Dextrose IV (D-50) for hypoglycemic ambulance patients has me wondering something about how we paramedics can create major savings and improve patient care in a short amount of time. We need to look for more “Low Hanging Fruit”.

It is common practice for known diabetic patients presenting with low blood sugar (hypoglycemia) to receive a treatment with IV D-50, IM Glucagon, oral Glucose, or even with the “Kaiser Cocktail” and then sign off with an AMA refusal. The patients are encouraged to eat something containing protein and complex carbohydrates and are usually left in the care of one of their family members and/or friends who can watch them for a while and make sure they’re ok.

I’d say that calls like this make up a fairly large percentage of all calls for an ambulance. While I have no statistics to back me up, I would guess that it could be something like 5% or better. This complaint and resultant treatment pathway is something I do quite frequently in my own practice. Judging from my own experience, I would say it happens quite frequently in most other paramedics’ practices as well.

The question about administering D-10, as brought up by my twitter peep @un_ojo, is if all patients getting treatment with D-10 as opposed to D-50 should be transported to an Emergency Room. My answer was that I believe a 100% transport policy in this case would result in a lot of people being transported to an ER when they probably didn’t really need to be. This would result in a large population of non-emergent ambulance patients going to the ER who in the past would have been “treated and released” (at least under the guise of an AMA refusal) by EMS crews.

And that got me thinking about this question:

If paramedics did not currently have the means to treat hypoglycemia and every one of those patients were being transported to the ER, how much of a burden on the emergency healthcare system would be removed simply by giving paramedics D-50? Probably quite a bit, right?

What other common medical cases would be as appropriate for field “treat and release” (or “Treat and AMA”) care by EMS? If we save a few hundred trips to the ER by being able to sweeten-up and then release common hypoglycemics, what other conditions might we be doing the same for as safely and effectively?

Would this require some easily attainable training? What about new medications and/or equipment?

I look at this as the “Low Hanging Fruit” if you will, of EMS 2.0, and also of healthcare reform. I am a proponent of EMS crews handling more primary care duties, or failing that, of at least having more options in regards to treatment pathways.

That’s what I’m looking for here, folks. What could we do within six months that would make a big impact?

Please discuss in the comments section, and feel free to shoot me an e-mail at ProEMS1@yahoo.com. You can also weigh in on the LUTL Facebook page if you’d like.

Also, would you do me a favor and invite some of the other healthcare people to the party? I’d love to get some of their opinions on this.

Posted by on July 26, 2010 • Filed under: Administration & Leadership, Als, Emergency Medical Services, Emergency Nurse, Emergency room, EMS, ems 2.0, EMS system, EMS Topics, Paramedic, physician, potential, Protocol development, us

EMS 2.0 as Explained to My Brother

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My brother is an engineer. Yes, he’s a firefighter and occasionally he still drives the Fire Truck, but I’m not talking about being an engineer as it relates to the fire service. I’m talking about a pocket-protector wearing, slide-rule-sliding Engineer who draws lines on paper and calculates weight to strength ratios and the like. It’s math that’s way over my head and I’m glad that he’s the one that has to do that type of work every day and not me. When he explains his job to me my brain starts to overheat and I’m surprised that my hair hasn’t caught on fire yet. It started smoking once, but I was able to catch a glimpse of “The Hills” on the TV and it slowed my mental activity just in time.

My brother, Captain Kaiser, is a volunteer fire captain and he used to be an EMT although he let it lapse due to the fact that it limited time with his family. I guess that I got the EMS genes and he got the “go to college and get a real job that pays well” genes. I say more power to him and he’s one of my best friends. I don’t get to see him as much as I should, but we talk often on the phone. He has always been interested in hearing all of my tales of EMS glory, and I listen to tales of his two daughters. Raising daughters sounds waaaay different than raising my son.

The other day I was talking to him about “this blogging stuff I do” and I breached the subject of EMS 2.0. I haven’t written much about EMS 2.0 by name lately, although the concepts I’ve been bringing forth fit into my model of it, but trust me when I say there has been a lot of behind the scenes activity. It turned into an interesting conversation with my brother. He was an EMT but never got past the volunteering when his community needs him stage. That’s an honorable place to be, no doubt, but he didn’t delve into the level that I take it to. So explaining EMS 2.0 to him was close to explaining it to an educated lay person.

In the conversation, I brought up the scenario that I used to write the post: “Are We the Gatekeepers to the Emergency Healthcare System?” (Unofficially titled, “Did I do good?”) and explained to him how I evaluated a patient in a nursing home, performed a full assessment on her including a 12-lead EKG and a review of her recent lab work, held a telephone conference with her Primary Care Physician and the Nursing staff on scene, and triaged the patient to the Primary Heathcare System as opposed to the Emergency Healthcare System. In the process, I saved the healthcare system (in the form of Medicare) thousands of dollars and provided better care to the patient by deferring her from the emergency room. I explained to him that my ambulance service could not bill the patient for the care I provided her because we did not transport and that the current system needs to recognize the value in having EMS provide such services in terms of cost-savings. If I would have transported, our service would have made the revenue, but Medicare would have paid thousands of dollars in unnecessary care overall. Since I didn’t, I saved Medicare thousands, but the service wasn’t valued and we didn’t receive any compensation for our work.

Basically, the conversation wound up being that he agreed with me that EMS has a powerful position to improve access to primary care and “save” healthcare as it were by increasing access to primary care, properly deferring patients from the emergency healthcare system when their care could be more appropriately managed in the primary care setting, and by saving millions of dollars in the overall healthcare setting. He agreed with me that it would require deregulation of the EMS industry to allow us to attempt programs and offer new services outside of our current mold and would require increased education of street-level EMS providers to get this done. He also agreed with me that money we’re already collectively spending should be allocated from inefficient programs and given to efficient high-performance EMS systems to do this in order to realize greater savings.

Remember, he’s an engineer. He’s good at math. He may not be a healthcare provider currently schlepping patients around in a shiny red and white bus that makes “woo woo” sounds, but he’s as smart as they come…

And when I told him that he’s exactly who we should be getting our message out to, he disagreed. He thinks that we should be out there talking to politicians and Insurance Industry executives. Honestly, he chastised me for not being in my local congresshuman’s office to do just that.

So, here’s a shoutout to the politicos out there: “EMS can ‘save’ healthcare through a free-market, grass-roots, innovative solution using currently available resources. We can save millions and improve the entire healthcare system just by putting in place a few good ideas and allowing EMS professionals the ability to think outside of the box”.

So do me a favor, y’all. Go tell your local politico to e-mail me at Proems1@yahoo.com. I’d love to have a talk with them. You should too.

Posted by on May 26, 2010 • Filed under: Administration & Leadership, Command & Leadership, Economics, Emergency Medical Services, EMS, ems 2.0, EMS Management, EMS system, EMS Topics, Fire Rescue Topics, Management, Paramedic, paramedic education, PR, profession, US economy

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 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

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

17 comments

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

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

(more…)

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

The Perfect Emergency? Well, almost

16 comments

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

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

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

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

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

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

Remember that.

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

Pop! Changes the Industry… Here We Go!

3 comments

Are your coworkers, friends, and colleagues following the Chronicles of EMS?

I ask that, because I’m wondering something. You, the person reading this blog post, are special. You’re probably a Fire or EMS professional that came to my blog site to read up on your profession. That makes you part of an elite and growing group of industry professionals who cares just a little bit more than some of your peers do. I’m guessing that you’re excited about your profession and I’m also guessing that you wonder how excited your colleagues and friends are about this stuff that you’ve been seeing online and in a few other places as well.

Well I’m wondering the same thing.

For all of you Paramedics and EMTs that have been hoping for the industry to spring forward into some of the awesome, groundbreaking things that we’ve been talking about like I have, this could be your moment.

No really, there’s plenty of people out there that are going to tell you “It’s never going to happen”, “It’s all been tried before”, and, “That’s never going to fly here in anytownistan”. I’m not one of those people. I’m one of the people that is going to tell you that those kind of people are wrong… and not only am I about to tell you that, I’m also about to get on a plane so that I can show you.

While the Chronicles of EMS are just sooooo very cool, they’re standing on the pinnacle of a lot of work. If you’ve paid attention on Twitter and Facebook, you might have noticed that there are some big names coming out for this. These names belong to people you might have seen in magazine articles, textbooks, journals, television shows, and in lots of other places. I am going to the Chronicles Premier party and I get to meet some of the people whose names were printed on my original EMT-Basic textbook. These people are as committed as I am to the work that Justin Shorr, Mark Glencourse, and Thaddeus Setla have put in to the Chronicles of EMS and you should be too.

But what if you can’t make it all the way out to San Francisco for the premier party? What do you do then to show your support? Well first off, look online at Chronicles of EMS for the live feed. Watch it. But, before you do, tell your coworkers, friends, and extended colleagues about it. Even if they might think that it’s a little geeky, please do it anyway.

That’s just it. We need you out there plugging in your hometown just as hard as we are out there in San Francisco (swilling martinis, and) plugging this whole EMS 2.0 thing. If you bring in your friends and coworkers to the wider conversation and have your own local conversation to interface with everyone else we’ve all won. The more people we bring in, and the more people YOU PERSONALLY pull in to this, the better off we’re going to be. I pledge that I’m not going to quit trying to improve our profession and I know that my buddies out there aren’t going to quit anytime soon either.

We need you to be just as passionate. As soon as we energize everyone out there, the sooner we all look up and go “Wow! Look at that!” Please, please, please help us spread the exciting message that EMS WILL CHANGE FOR THE BETTER in the very near future. Bug your coworkers. Get the word out.

Heck, if I get an e-mail at ProEMS1@yahoo.com or a tweet at http://www.twitter.com/ckemtp I will personally mention you live on the show, give a link to your service’s website, and might even send a special shoutout. So if you organize your own local premier party, please let me know.

You all Rock, let’s get flying!

P.S: Want behind the scenes access?? Follow my wife Gkemtp(IT), @ginakaiser on twitter too. She’ll be with me and will be tweeting about cool stuff like how awkward I am when I meet my heroes.

Posted by on February 11, 2010 • Filed under: edemse, Emergency Medical Services, Emergency Nurse, EMS, ems 2.0, EMS Blog, EMS system, EMS Topics, medicblog999, Paramedic, Uncategorized

Dear State of Illinois EMS…

16 comments

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

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

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

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

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

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

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

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

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

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

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

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

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

So, could we do that?

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

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